Bronchocele, is an indolent enlargement of the thyroid gland, the causes of which are unknown, hut which often attains an immense magnitude, and is endemic in several mountainous countries, aS Swit zerland, Savoy, Derbyshire, &c. Burnt sponge, in the dose of a scruple, two or three times a day, formed with syrup in to troches, which should be placed under the tongue, and allowed to dissolve gra dually, is the most certain remedy for this disease. Previously to commencing this plan, a grain or two of calomel should be given at bedtime for three nights, and a dose of the magnesia vitriolata on the following morning. This should be re peated again in three weeks, the sponge being then omitted, and the same alterna tion should be observed during the cure. Topical means may be combined ; as fric. tion with a dry towel, or camphorated li niments, &e.
Wounds of the Thorax. Much probing should not be employed to ascertain whe ther the cavity is penetrated or no, as symptoms will best indicate this point. Passage of air from the cavity, or protru sion of the lung, are appearpaces which show immediately that the cavity is ex posed.
Emphysema, is an inflation of the cellu lar substance, commencing at the chest, and extending over the whole body, aris ing from a wound of the air-cells of the lungs, and generally produced from bro ken ribs, or narrow punctured wounds : for in either of these cases, the air, which issues from the wounded lung in inspira tion, has no external discharge, as in in stances of large and open wounds. It is surprising to what extent this inflation may proceed : and as the lung at the same time collapses, the greatest distress is experienced in breathing ; yet the swelling of the body is not the danger ous part of the case. Our object is to give a free exit to the air, which may be done by a cut near the injured part, and even, if symptoms require it, into the chest. The air may be discharged from other parts by incisions through the skin, and pressing towards the wound. In about three or four days, the wound in the lung heals, and the air in the chest and cellular substance is absorbed. Bleeding, and other parts of the anti phlogistic regi men, must be used without reetraint. Bandages on the chest gene rally increase the distress.
Wounds of the lungs are indicated by the coughing of blood, by the discharge of that fluid, with air, from the wound, impaired respiration, &c. Though they are often very speedily mortal, yet pa. tients have in many instances recovered. The freest use of the lancet is required, with every other part of the antiphlogis tic treatment ; perfect rest; light dress.
ing of the wound, which must not be probed. Paracentesis thoracic is requir. ed, where it appears that water, air, blood, or pus, are accumulated in the cavity, and give rise to danger by their presence. When there are symptoms indicative of these circumstances, the operation is easy ; and it may be done, unless the cir. cumstances point out any other spot, be tween the sixth and seventh true ribs, about midway between the sternum and spine. The integuments should be drawn aside before the first incision, that the opening may be valvular. After cutting about two inches through the skin, dis sect down cautiously to the pleura, keep ing close on the tipper edge of the rib ; when a small puncture is made in the pleura, it may be enlarged to the requi. site extent with the director and curved knife.
Removal of a diseased breast. In this operation, and in the extirpation of tu mours in other parts, the surgeon must attend carefully to remove all the dis ease ; hence the integuments should be included, when they deviate at all from the healthy condition ; and the pectoral muscle should also be taken away, if the tumour adheres to it, as far as it may have become indurated. In all cancerous complaints, it is most advisable to extend the incision even beyond the seat of ac tual disease : as a morbid disposition may have been formed, and would lead to the reproduction of the disorder. Where the skin does not participate in the dis ease, its removal is unnecessary ; the first incision, therefore, may be a simple cut in such s case; while in others two semi circular cuts should be made, meeting at their extremities in acute angles. The tu mour should then be separated all round from the surrounding parts ; and lastly, the base is to be detached from its con nections from above downwards. The cut surface should then be carefully examin ed, to see if any indurated parts have been divided, for in that case some por tions have been left behind, and ought to be taken away. Arteries may be tied as they are divided, if they bleed profusely. When enlarged glands in the a xilla re quire removal, the incision must be ex tended in that quarter, and the indurat ed parts completely removed, caution being necessary, on account of the proximity of the large vessels and nerves. When the hemorrhage is stopped, the sides of the wound must be brought to gether by sticking plaster.