SURGERY,

4B»

67 H

commonly employed for this purpose, sometimes gives relief formany months, or even years ; but at other times are of little ad-vantage, and in some instances cause great pain. Gum-mastichor bees’-wax are often employed, and can he made to fill thecavity of the tooth still better than metalline substances. Whenstuffing is to be employed, it ought to be done in the intervals ofthe fits of toothach, otherwise it will give great uneasiness.When it is to be used, the whole cavity of the tooth should befilled ; and this is to be done with the instruments, (fig. 58, No. 1,2, 3.) One of the best instruments for extracting the teeth, is.that, (fig. 59,) in form of a key, with a claw and fulcrum. Pre-vious to the operation, this should be covered with a linen-rag, toprevent the gum from suffering. After dividing the gum, or se-parating it from the tooth, the claw is to be fixed as deep betweenthe teeth and gum as possible. Then the fulcrum is to rest onthe opposite side. The surgeon may now, with one turn of thehandle of the instrument, pull the tooth out at once. But theturn should not be effected by a sudden jerk, but in the mostcautious and slow manner. When it happens to be one of thegreat molares, whose roots diverge vc-ry much, and when theyare firmly fixed, after only loosing it with the first pull, the clawof the instrument is to be applied to the other side of the tooth,and the turn given in a contrary direction to the first. In caseswhere it lias been sufficiently loosened but not extracted, it is to belaid hold of by a common teeth-forceps, (fig. 60,) and extractedOi the easiest manner. Upon extraction of the tooth, any detach-ed splinters occurring are to be immediately removed. Shouldany considerable hemorrhagy take place, the patient may takes oine cold water, vinegar, or spirit of wine, into his mouth, anddossils of lint may be introduced into the socket. After all thesefail, recourse must be had to the actual cautery; When stumps°ccur from caries, or when the teeth have broken in time of theextracting, the common key will sometimes remove them ; if thatfidl, the punch, (fig. 61,) is to be used. The operator, having this'■'strument in one hand, is to place the fore-finger of the°lher, with a piece of cloth wrapped round it, upon the inside°f the jaw opposite to the stump, to protect the neighbouringParts,

Diseases of the Ear.

Sometimes a thin membrane is spread over the mouth of theeternal passage, while at other times a considerable part of thePassage is filled up with a fleshy looking substance, occasioningdeafness. When the first circumstance occurs, the skin is easilydivided by a simple incision, and the accretion of its sides may bePrevented by a dossil of lint, or a bit of bougie, inserted betweenthe edges of the wound, and daily cleaned and returned till theP?rt be rendered callous. When the other cause is present, the in-f'Sion must be continued, considerably deeper, till the resistanceI? 6 removed, or till the instrument reach near to the membrane .ofP' e tympanum, when the operator should desist, lest the mem-brane should be wounded ; then the same kind of treatment mayformed as in the former case. The proper time for performing! e operation is when children usually begin to speak; for pre-*ous to this the patient may be too weakly to bear it, and after*Us speech would be impelled. Children sometimes push hard““files into their ear, or different kinds of insects occasionallyj ^? e P into it, so as to cause considerable uneasiness. Substances-'Og near the outer end of the passage may generally be extract-p i’y the same forceps, (fig. 65,) but round hard bodies situatede Uper in the passage arc more readily removed, by a crookedto ) e ' ^’hen insects are deep seated in the ear, they, ought firstWl ■ billed, by filling the passage with oil, or any other fluid'p, llc ii proves noxious to them, without hurting the tympanum,v le y may then be washed out by injecting warm water frequentlypf a syringe.

I, * x is one of the most frequent causes of deafness, and it mayy readily detected by looking into the car in a clear sunshine".eaV' n i US met i ,c> fi s ha ve been proposed for removing wax from thej ue ,‘ but one, not inferior to any, is to throw in frequently, by'vli'M? ° l 3 s y™g fi . (fig- 62,) warm milk and water, or water infi e . a little soap lias been dissolved. Assistance may likewiseli ne e ! VCI ' here, by using along with the injection a blunt probe orji ( | 'jltr-pencil, by which the bottom of the passage may be clear.. ut, After the wax is removed, the patient ought to guard

against the effects of cold by introducing a little wool for sometime into the meatus, It sometimes happens, particularly in oldpeople, that, from exposure to a stream of cold air/the tympanumbecomes affected, and a noise is beard by the patient like therushing of water. In other cases the patient is incapable of accu-rately distinguishing the words of some persons speaking in a ioudtone of voice ; or, in mixed companies, he hears only a confu-sion of sounds. Complaints of this kind frequently originate froma relaxation of the soft parts of the tympanum : and though a com-plete cure is not very frequently performed, yet considerable ad-vantage is sometimes derived from the use of hot stimulating oils,and from keeping the part warm at the same time with a littlewool. When deafness arises from affections of this nature, someassistance may be derived from collecting the sound, so as tomake a stronger impression upon Ihe internal ear. A variety ofinstruments have been invented for this purpose. Some use aconvoluted tube, .called an ear-trumpet, (fig. 63,) others a sort ofcup, (fig. 04,) which is concealed under the hair, and fixed to the -head with straps.

Of the Wry Neck.

A wry neck may be owing to different causes; as contractionof the skin in consequence of burns, or other kinds of sores ; re-laxation of the muscles of one side of the neck,, particularly themastoid, while those of the other side continue to act with vigour ;preternatural contraction of the muscles of one side of the neck,the others having their usual power; or, a bend in the vertebraeof the neck. When the disease is owing to a contraction of theskin, this is to be divided through the whole of the contractedpart, guarding against cutting the external jugular vein. Whenthe contraction of the mastoid muscle is the cause of the diseasethe muscle should be divided by gentle strokes, so as to run norisk of wounding the great vessels situated under it. When an in-cision is made either with a. view to divide the muscle or the skin,the head is afterwards, by means of a machine, (fig. 66,) to he keptin a proper posture during the cure, until new granulations formand till up the empty space.

Or Bronchotomy and CEsophagotomy.

The operation of Bronchotomy is an incision made in thetrachea, to make way for air into the lungs, when respiration isobstructed to such a degree that fife is in danger. If the patient’sbreathing be already stopped, the operation ought to be done w iththe greatest expedition ; using any instrument which will mostreadily .make an opening in. the trachea, as the delay of a few mo-ments will often put a period to the person’s existence. In per-forming the operation, where, from the nature of the case,-suffici-ent time is allowed, the patient is to be laid on his back upon atable, and properly secured by assistants. A longitudinal incisionis to be made, about an inch and a half long, through the skinand cellular substance ; beginning at the under edge of the thy -roid cartilage ; the sterno-hyoid and thryoid muscles are then to be-separated ; the thyroid gland is to be avoided as much as possible,on account of its vascularity. As soon as the trachea is laid bare,the bleeding vessels, to prevent coughing, are to be secured ;then, with a common lance, a puncture is to be made as-high asmay be seen practicable hetween two rings of the trachea, of sucha sine as to admit the introduction of a double canula, (fig. 67,)large enough to allow the patient to breathe freely, and of sucha length as neither to be in danger of slipping out, nor of irritatingthe back part, of the trachea. Such a canula has long beenrecommended by Dr. Monro in his course of surgery. Previousto the introduction the canula may be put through several.pile*of linen-compress; or these may be first slit half way' down, aridapplied so that anv of them may be removed and replaced atpleasure. This double canula is to be fixed by a strap round theneck; and when mucus obstructs the passage of the instrument,the inner tube can be withdrawn, cleared, and readily replaced ;while the patient is, during this time, breathing through the outerone; and by means of a screw the tubes can bu regulated accord-ing.to the motions of the trachea, Alter the canula is fixed, itought to he covered with a piece of muslin or crape, to preventthe admission of dust, insects,.&c, As soon as the causes induc-ing suffocation are removed, the canula is to he withdrawn, and