ught. Too well I knew the meaning of the
lapping, hissing, sucking noise that instantly smote our ears. I had
made a deep cut across the jugular vein, the wound gaping widely in
consequence of the tension given to the vein by the position of the
patient's head. A large quantity of air rushed in instantly.

"An exclamation of alarm from Doctor Kline, as he changed the position
of the patient's neck in order to force the lips of the wound together
and stop the fatal influx of air, roused me from a momentary stupor,
and I came back into complete self-possession. The fearful exigency of
the moment gave to nerve and brain all the stimulus they required.
Already there was a struggle for breath, and the face of Mrs. Carlton,
which had been slightly suffused with color, became pale and
distressed. Sufficient air had entered to change the condition of the
blood in the right cavities of the heart, and prevent its free
transmission to the lungs. We could hear a churning sound occasioned by
the blood and air being whipped together in the heart, and on applying
the hand to the chest could feel a strange thrilling or rasping
sensation.

"The most eminent surgeons differ in regard to the best treatment in
cases like this, which are of very rare occurrence; to save life the
promptest action is required. So large an opening as I had unhappily
made in this vein could not be quickly closed, and with each
inspiration of the patient more, air was sucked in, so that the blood
in the right cavities of the heart soon became beaten into a spumous
froth that could not be forced except in small quantities through the
pulmonary vessels into the lungs.

"The effect of a diminished supply of blood to the brain and nervous
centres quickly became apparent in threatened syncope. Our only hope
lay in closing the wound so completely that no more air could enter,
and then removing from the heart and capillaries of the lungs the air
already received, and now hindering the flow of blood to the brain. One
mode of treatment recommended by French surgeons consists in
introducing the pipe of a catheter through the wound, if in the right
jugular vein--or if not, through an opening made for the purpose in
that vein--and the withdrawal of the air from the right auricle of the
heart by suction.

"Doctor Kline favored this treatment, but I knew that it would be
fatal. Any reopening of the wound now partially closed in order to
introduce a tube, even if my instr