Medical Jurisprudence, Volume 3 (of 3)Paris, John Ayrton
Science
Medical Jurisprudence, Volume 3 (of 3)
Paris, John Ayrton
Medical laws and legislation -- Great Britain
_Dissection of the contents of the thorax._—An incision must be made
through the integuments, in a straight line from the _os hyoides_ to the
navel; we are then to open into the cavity of the abdomen, for the sake
of affording the anatomist free space for his dissections in the chest;
and this is to be effected by incisions from the navel to each spine of
the ilium, so that we shall have thus described by our dissection a
figure resembling the letter Y inverted, thus [Inverted Y]. In
performing this part of our labour, it is essentially necessary to avoid
puncturing or injuring any of the viscera; where such a blunder has been
committed the dissection has lost much of its value. The integuments of
the breast are then to be carefully dissected so as to expose the
cartilaginous articulations of the ribs, which must be cut through on
both sides; the clavicles should also at the same time be separated from
the sternum, by dividing the loose cartilage which unites them. The
latter bone, together with the cartilaginous portions of the ribs, must
be next turned upwards over the face, so that the cavity of the thorax
shall be brought into view. In some cases it will be found expedient to
make a still more extensive exposure of this cavity; for which purpose a
broader flap must be turned up in front, by extending our dissection of
the parietes of the thorax farther towards the back; and, instead of
cutting through the cartilaginous extremities of the ribs, dividing the
bones themselves with a saw. In bending back the sternum, or flap in
front, we must take care and divide the _mediastinum_ with the scalpel
as near the bone as possible, in order to avoid making any opening into
the _pericardium_, which would otherwise be very apt to happen. As soon
as an opening is effected into the thoracic cavity, the lungs collapse,
unless the adhesions formed between them and the pleura should prevent
it. Our first object will be to observe whether any quantity of fluid is
present in the chest, and whether it be limpid, as in dropsy; turbid and
containing flakes of coagulated lymph, as in cases preceded by much
inflammatory action; or purulent, as in empyema. Having removed the
liquid, should any be present, by the application of a large sponge, we
must proceed to examine the lungs, as to their colour and general
appearance; and, by the introduction of a blow-pipe into the trachea, we
should by means of the mouth or bellows inflate these organs, so as to
ascertain the degree of distention of which they are susceptible. We may
at the same time inspect their structure more minutely by raising each
lobe with the hand, introduced into the cavity of the thorax for that
purpose. We are next to cut into their substance in order to observe
whether they are gorged with blood, and inflamed; whether they are
crepitous and light, or dense like liver; and whether they contain any
tubercles; should these latter bodies be discovered, we have to
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