Chapter II: Preface: To Volume IV

Every effort has been made to keep this volume strictly within the definition of a work upon Operative Surgery--a somewhat difficult task in the case of certain of the special subjects with which it deals. In some cases methods of examination or manipulation have been described that are not strictly operative in nature, but their inclusion has been justified upon the ground that many of them are essential in operations upon the regions concerned, and all require special manipulative skill and dexterity.

The Index to this volume has been arranged in five parts, one part for each Section comprised in it. In this way it has been possible to economize space and, it is hoped, to render the task of reference easier.

In the Section on Vaginal Gynæcological Operations, instrument blocks have been kindly supplied by Messrs. Montague, Down Bros., and Griffin. The remaining illustrations are from original sketches by the author.

In the Section on Ophthalmic Operations, Messrs. Weiss have kindly supplied the instrument blocks. The remainder of the illustrations are original. Mr. Mayou desires to thank Mr. W. H. McMullen for valuable help in reading the proof sheets.

In the Section on Operations upon the Ear, all the illustrations, with the exception of the instrument blocks kindly supplied by Messrs. Mayer and Meltzer and a few illustrations from Tod’s _Manual of Diseases of the Ear_, are original.

In the Section on Operations upon the Nose, the instrument blocks have been supplied by Messrs. Mayer and Meltzer, who have also furnished them in the Section on Operations upon the Throat. Mr. F. A. Rose has kindly read the proof sheets of the latter Section, for which Mr. Harmer desires to thank him.

CONTRIBUTORS TO THIS VOLUME

JOHN BLAND-SUTTON, F.R.C.S. (Eng.)

_Surgeon to the Middlesex Hospital, and Senior Surgeon to the Chelsea Hospital for Women, London_

Abdominal Gynæcological Operations

JOHN PHILLIPS, M.A., M.D. (Cantab.), F.R.C.P.

_Professor of Obstetric Medicine, King’s College, London; Obstetric Physician and Gynæcologist to King’s College Hospital_

Vaginal Gynæcological Operations

M. S. MAYOU, F.R.C.S. (Eng.)

_Assistant Surgeon to the Central London Ophthalmic Hospital; Ophthalmic Surgeon to the Children’s Hospital, Paddington Green_

Ophthalmic Operations

HUNTER F. TOD, M.A., M.D. (Cantab.), F.R.C.S. (Eng.)

_Aural Surgeon to the London Hospital_

Operations upon the Ear

W. DOUGLAS HARMER, M.C. (Cantab.), F.R.C.S. (Eng.)

_Surgeon to the Throat and Nose Department, St. Bartholomew’s Hospital_

Operations upon the Larynx and Trachea

StCLAIR THOMSON, M.D., F.R.C.P. (Lond.), F.R.C.S. (Eng.)

_Professor of Laryngology and Physician for Diseases of the Throat, King’s College Hospital, London_

Operations upon the Nose and its Accessory Cavities

CONTENTS

SECTION I

OPERATIONS UPON THE FEMALE GENITAL ORGANS

PART I

ABDOMINAL GYNÆCOLOGICAL OPERATIONS

By JOHN BLAND-SUTTON, F.R.C.S. (Eng.)

Surgeon to the Middlesex Hospital and Senior Surgeon to the Chelsea Hospital for Women, London.

PAGES

CHAPTER I

CŒLIOTOMY

Preparation of Patient, 3. Basins, Dishes, and Instruments, 4.
Suture and Ligature Material, 5. Dabs, 5. Gloves, Operating
Table, Anæsthesia, 6. The Incision, 7. Misplaced Viscera, 8.
Closure of Wound, 8 3-9

CHAPTER II

OVARIOTOMY

The Operation, 10. Cysts of the Broad Ligaments, 14. Spurious
Capsules, 15. For Carcinoma of Ovary, 15. Incomplete
Ovariotomy, 16. Anomalous Ovariotomy, 16. Ovariotomy followed
by Hysterectomy, 17. Repeated Ovariotomy, 17. Pregnancy after
Bilateral Ovariotomy, 17. Ovariotomy at Extremes of Life, 18.
Ovariotomy in Old Age, 19. Mortality, 19 10-20

CHAPTER III

OÖPHORECTOMY

Operation, 22. Abdominal Hysterectomy after Bilateral
Oöphorectomy and Ovariotomy, 25. Mortality, 25. Operation for
Primary Cancer of the Fallopian Tube, 26 21-28

CHAPTER IV

OPERATIONS FOR EXTRA-UTERINE GESTATION

Indications, 29. Operation, 29. Concurrent Intra- and
Extra-uterine Pregnancy, 33. Results of Operative Treatment,
34 29-35

CHAPTER V

HYSTERECTOMY AND MYOMECTOMY

Indications, 36. Subtotal Hysterectomy, 36. Total Hysterectomy,
40. Mortality, 44. Risks of Abdominal Hysterectomy, 45.
Abdominal Myomectomy, 46 36-49

CHAPTER VI

ON THE RELATIVE VALUE OF TOTAL AND SUBTOTAL HYSTERECTOMY

Cancer of the Body of the Uterus and Fibroids, 52. Sarcoma, 53.
Cancer of the Uterus after Bilateral Ovariotomy, 55.
Adenomyoma of the Uterus, 56. Fate and Value of Belated
Ovaries, 56 50-60

CHAPTER VII

HYSTERECTOMY FOR PRIMARY CARCINOMA OF THE UTERUS

For Cancer of the Cervix, 61. For Cancer of the Body of the
Uterus, 63 61-65

CHAPTER VIII

OPERATIONS FOR DISPLACEMENT OF THE UTERUS

Ventro-suspension for Retroflexion of the Uterus, 66.
Ventro-fixation for Prolapse of the Uterus, 67 66-68

CHAPTER IX

OPERATIONS UPON THE UTERUS DURING PREGNANCY, PARTURIENCY, AND PUERPERY

Cæsarean Section, 69; _Immediately after the Death of the
Mother_, 72. Ovariotomy and Hysterectomy during Pregnancy and
in Labour, 73. Ovariotomy during the Puerperium, 76. Fibroids
and Pregnancy, 77. Pregnancy with Cancer of the Cervix, 82.
Concurrent Uterine and Tubal Pregnancy, 82. Pregnancy with
Tumours growing from the Pelvic Walls, 83. Operations for
Puerperal Sepsis, 83 69-85

CHAPTER X

OPERATIONS FOR INJURIES OF THE UTERUS

Gynæcological, 86. Obstetric, 87; to the Pregnant Uterus, 89; to
the Gravid Uterus in the course of an Abdominal Operation, 89.
Bullet Wounds of the Pregnant Uterus, 90. Stab-wounds of the
Pregnant Uterus, 91 86-92

CHAPTER XI

THE AFTER-TREATMENT, RISKS, AND SEQUELÆ OF ABDOMINAL GYNÆCOLOGICAL OPERATIONS

After-treatment of Abdominal Operations, 93. Complications of
Abdominal Gynæcological Operations--_Metrostaxis_, 95;
_Bed-sores_, 95; _Post-anæsthetic Paralysis_, 95; _Giving way
of the Wound_, 96; _Hæmorrhage_, 97; _Intrapelvic Hæmorrhage_,
98; _Pneumonia_, 99; _Parotitis_, 99; _Thrombosis_, 101;
_Pulmonary Embolism_, 101; _Foreign Bodies left in the
Abdomen_, 105; _Tetanus_, 107; _Injury to the Intestines_,
109; _Intestinal Obstruction_, 110; _Perforating Ulcer of the
Stomach and Small Intestine_, 111; _Injuries to the Bladder_,
111; _to the Ureter_, 112. The fate of Ligatures, 117.
Post-operative Kraurosis, 120. The Cicatrix, 120 93-122

PART II

VAGINAL GYNÆCOLOGICAL OPERATIONS

By JOHN PHILLIPS, M.A., M.D. (Cantab.), F.R.C.P.

Professor of Obstetric Medicine, King’s College, London; Obstetric Physician and Gynæcologist to King’s College Hospital.

CHAPTER XII

PREPARATION OF THE PATIENT FOR PERINEAL AND VAGINAL OPERATIONS: OPERATIONS FOR INJURIES TO THE PERINEUM AND PELVIC FLOOR

Preparation of the Patient, 125. Operations for Repair of a
Complete Laceration of the Perineum, 127. Operation for
Laceration of the Pelvic Floor, 132 125-133

CHAPTER XIII

OPERATIONS UPON THE URETHRA AND BLADDER

Extirpation of a Urethral Caruncle, 134. Operations for
Incontinence following Labour, 134; for Vesico-vaginal
Fistula, 135; for Recto-vaginal Fistula, 139; for Cystocele,
140 134-141

CHAPTER XIV

OPERATIONS UPON THE VULVA AND VAGINA

Operations upon Bartholin’s Glands, 142. Operations for Atresia
of the Hymen and the Vagina, 143. Dilatation of the Vulval
Orifice, 143. Colpotomy, 144; _Anterior_, 145; _Posterior_,
147; _Lateral_, 148 142-148

CHAPTER XV

OPERATIONS UPON THE UTERUS

Passage of the Uterine Sound, 149. Reposition of a Chronic
Uterine Inversion, 151. Curetting the Uterus, 152. Dilatation
of the Cervix, 156--_Rapid Dilatation_, 157; _Gradual
Dilatation_, 159. Operations for Hypertrophy of the Cervix,
160. Trachelorrhaphy, 161. Vaginal Fixation, 164 149-164

CHAPTER XVI

OPERATIONS FOR NEW GROWTHS OF THE UTERUS

For Uterine Fibro-myomata, 165--_for Pedunculated Tumours_, 165;
_for Sessile Tumours_, 166; _for Interstitial Tumours_, 167.
Vaginal Hysterectomy, 167--_for Carcinoma_, 168; _for
Fibroids_, 173 165-173

SECTION II

OPHTHALMIC OPERATIONS By M. S. MAYOU, F.R.C.S. (Eng.)

Assistant Surgeon to the Central London Ophthalmic Hospital; Ophthalmic Surgeon to the Children’s Hospital, Paddington Green.

CHAPTER I

GENERAL CONSIDERATIONS APPLICABLE TO OPERATIONS UPON THE EYE

General Preliminaries to an Operation, 177. Local Preparation of
the Patient, 80. Making and Healing of Wounds in the Globe,
182--_Purification of Hands_, 182; _of Instruments_, 183;
_Direction of Incision_, 183; _Position of Incision_, 184;
_Dressings_, 186; _Bandaging_, 186 177-186

CHAPTER II

OPERATIONS UPON THE LENS

Surgical Anatomy, 187. Discission or Needling, 189--_for
Cataract_, 189; _for High Myopia_, 190. Capsulotomy, 192.
Evacuation, 194. Evulsion of the Capsule, 195. Extraction of
the Lens, 195. Modifications, 201; _Delivery of the Lens by
Irrigation_, 203; _Extraction of the Lens in its Capsule_,
204; _Subconjunctival Extraction_, 204. Couching, 209 187-210

CHAPTER III

OPERATIONS UPON THE IRIS

Iridotomy, 211. Alternative Methods--_Kuhnt’s Operation_, 212;
_Ziegler’s_, 213. Iridectomy--Optical Iridectomy, 214;
Glaucoma Iridectomy, 217--for small Growths of the Iris, 225;
for Prolapse of the Iris, 225. Transfixion of the Iris, 226.
Division of Anterior Synechiæ, 227 211-227

CHAPTER IV

OPERATIONS UPON THE SCLEROTIC

Anterior Sclerotomy, 228. Cyclo-dialysis, 229. Sclerectomy, 231.
Posterior Sclerotomy, 232. Paracentesis of the Anterior
Chamber, 233. For Penetrating Wounds of the Globe, 234.
Electro-magnet Operations--_with Small Magnet_, 237; _with
Giant Magnet_, 238 228-239

CHAPTER V

OPERATIONS UPON THE CORNEA AND CONJUNCTIVA

Removal of a Foreign Body from the Cornea, 240. Cauterization of
the Cornea, 240. Operations for Conical Cornea, 241. Removal
of Tumours involving the Cornea, 243. Tattooing the Cornea,
243. Scraping Calcareous Films, 243. Operations upon the
Conjunctiva--_Removal of Foreign Bodies_, 244; _for
Pterygium_, 244; _Expression_, 245; _Conjunctivoplasty_, 245;
_Removal of Tarsal Cysts_, 246 240-246

CHAPTER VI

OPERATIONS UPON THE EXTRA-OCULAR MUSCLES

Squint Operations, 247. Tenotomy, 248. Advancement, 251 247-254

CHAPTER VII

ENUCLEATION OF THE GLOBE AND ALLIED OPERATIONS

Enucleation, 255. Evisceration, 257. Mules’s Operation, 259.
Frost’s Operation, 259. Operations upon the Socket after
Removal of the Eye--_Paraffin Injection_, 260. Operations for
Restoration of a Contracted Socket--_Skin-grafting_, 261;
_Inclusion of Flaps_ (_Maxwell’s Operation_), 261 255-262

CHAPTER VIII

OPERATIONS UPON THE EYELIDS

Surgical Anatomy, 263. Suture of Wounds of the Eyelids, 263.
Operations for Ankyloblepharon, 264; for Symblepharon, 264.
Upon the Palpebral Aperture, 265--_Canthoplasty_, 265;
_Canthotomy_, 265; _Canthorrhaphy_, 265; _Tarsorrhaphy_, 266.
Ptosis Operations, 267; _Shortening the Eyelid by Excision of
a portion of the Tarsal Plate_, 267. _Attachment of the Lid to
the Occipito-frontalis Muscle_, 268. Advancement of the
Levator Palpebræ Muscle, 272. Grafting a portion of the
Superior Rectus into the Lid, 273 263-274

CHAPTER IX

OPERATIONS FOR ENTROPION, REPAIR OF THE EYELIDS, TRICHIASIS, AND ECTROPION

Electrolysis, 275. Skin and Muscle Operation, 275. Rectification
of a Faulty Curvature of the Tarsus--_Burow’s Operation_, 276;
_Streatfield’s Operation_, 277. Transplantation of the
Lash-bearing Area--Arlt’s Operation, 278. Ectropion
Operations, 279--for Passive Ectropion, 280; _Snellen’s Suture
Method_, 280; _Fergus’s Operation_, 281; _Kuhnt’s Operation_,
281; _Argyll Robertson’s Operation_, 282. For the Active or
Cicatricial Form, 284; _VY Operation_, 284; _Denonvillier’s
Operation_, 285; _Fricke’s Operation_, 285; _Thiersch’s
Skin-grafting_, 287. Repair of large Losses of Substance from
the Eyelids, 287; _De Vincentiis’ Operation_, 287;
_Dieffenbach’s Operation_, 288 275-289

CHAPTER X

OPERATIONS UPON THE LACHRYMAL APPARATUS

For the Relief of Lachrymal Obstruction, 290--_Dilatation of the
Canaliculus_, 290; _Slitting the Canaliculus_, 291; _Syringing
the Lachrymal Duct_, 292; _Probing the Lachrymal Duct_, 292;
_the Insertion of Styles_, 293. For Obliteration of the
Canals, 294; _Obliteration of the Canaliculi_, 294; _Excision
of the Lachrymal Sac_, 294. Opening a Lachrymal Abscess, 297.
Operations upon the Lachrymal Gland--_Removal of the Palpebral
Portion_, 298; _Removal of the Orbital Portion_, 299.
Operations upon the Orbit--Exploration of the Orbit
(Krönlein’s Method), 299; Evisceration of the Orbit, 301;
Opening an Orbital Abscess, 301 290-301

SECTION III

OPERATIONS UPON THE EAR

By HUNTER F. TOD, M.A., M.D. (Cantab.), F.R.C.S. (Eng.)

Aural Surgeon to the London Hospital.

CHAPTER I

EXAMINATION OF THE EAR: GENERAL CONSIDERATIONS WITH REGARD TO OPERATIONS

Examination of the Ear, 305--_Sources of Illumination_, 305;
_Technique of Examination_, 306; _Method of cleansing the
Ear_, 307. General Considerations with regard to
Operations--_Preliminary Surgical Toilet_, 309; _Anæsthesia_,
310. Position of Patient and Surgeon, 313 305-313

CHAPTER II

OPERATIONS UPON THE EXTERNAL AUDITORY CANAL

Operations for Furunculosis, 314. Removal of Exostoses from the
External Meatus, 316. Removal of Foreign Bodies--_by
Syringing_, 322; _by Instruments_, 323; _by Post-aural
Incision_, 326; _by Operation upon the Mastoid_, 327.
Operations for Stenosis of the External Meatus, 328.
Operations for Atresia, 330; for Aural Polypus, 331 314-334

CHAPTER III

OPERATIONS UPON THE TYMPANIC MEMBRANE AND WITHIN THE TYMPANIC CAVITY

Surgical Anatomy of the Tympanum, 335. Paracentesis, 336.
Artificial Perforation of the Tympanic Membrane, 340. Division
of the Anterior Ligament, 341. Division of the Posterior Fold,
341. Intratympanic Operations, 342; _Division of Adhesions_,
342; _Tenotomy of the Tensor Tympani_, 346; _Tenotomy of the
Stapedius_, 347. Removal of Granulations from the Tympanic
Cavity, 348. Operations upon the Ossicles--_Direct
Mobilization_, 349; _Removal of the Ossicles_, 351 335-363

CHAPTER IV

OPERATIONS UPON THE EUSTACHIAN TUBE

Catheterization, 364. Passing of the Eustachian Bougie, 369.
Washing out the Tympanic Cavity through the Eustachian Tube,
372 364-372

CHAPTER V

OPERATIONS UPON THE MASTOID PROCESS: WILDE’S INCISION AND SCHWARTZE’S OPERATION

Surgical Anatomy, 373. History of the Mastoid Operation, 375.
Wilde’s Incision, 377. Schwartze’s Operation, 378. Treatment
of Special Conditions--_in an Infant_, 389; _Subperiosteal
Abscess_, 389; _Bezold’s Mastoid Abscess_, 389; _Necrosis_,
390; _Osteomyelitis_, 390 373-390

CHAPTER VI

THE COMPLETE MASTOID OPERATION

Methods of Operation, 392; _Küster-Bergmann (Schwartze-Stacke)
Operation_, 393; _Wolf’s Operation_, 396; _Stacke’s
Operation_, 397; _Preservation of the Ossicles and Tympanic
Membrane_, 399. The Formation of Post-meatal Skin Flaps, 401.
Closure of the Wound, 404. Skin-grafting after the Mastoid
Operation, 405. After-treatment of the Case, 410. Difficulties
and Dangers of the Operation, 412. Results, 415 391-416

CHAPTER VII

OPERATIONS UPON THE LABYRINTH

General Considerations, 417. Indications, 417. Surgical Anatomy,
420. Methods of Operating, 421; _Curetting a Localized Lesion
of Wall_, 421; _Opening the Vestibule_, 422; _Removal of the
Cochlea_, 424; _Extirpation of the Labyrinth_, 425 417-428

CHAPTER VIII

OPERATIONS FOR EXTRA-DURAL ABSCESS AND MENINGITIS OF OTITIC ORIGIN

On Intracranial Complications in General, 429. Operations for
Extra-dural Abscess, 430. Operations for Meningitis of Otitic
Origin, 433 429-438

CHAPTER IX

OPERATIONS FOR LATERAL SINUS THROMBOSIS OF OTITIC ORIGIN

General Considerations, 439. Exposure of the Lateral Sinus, 440.
Opening of the Lateral Sinus, 442. Ligature of the Jugular
Vein, 446. Exposure of the Jugular Bulb, 454 439-458

CHAPTER X

OPERATIONS FOR INTRACRANIAL ABSCESS OF OTITIC ORIGIN

Indications, 459. Operation, 460. After-treatment, 469.
Complications, 469. Prognosis and subsequent Progress, 470.
Recurrence of Symptoms, 471 459-471

SECTION IV

OPERATIONS UPON THE LARYNX AND TRACHEA

By W. DOUGLAS HARMER, M.C. (Cantab.), F.R.C.S. (Eng.)

Surgeon to the Throat and Nose Department, St. Bartholomew’s Hospital.

CHAPTER I

ENDOLARYNGEAL OPERATIONS

Indications, 475. Operation by Indirect Laryngoscopy, 477.
Operation by Direct Laryngoscopy, 479 475-486

CHAPTER II

EXTRA-LARYNGEAL OPERATIONS

Thyrotomy, 487. Hemi-laryngectomy, 495. Anatomy of the Laryngeal
Lymphatics, 496. Total Laryngectomy, 498. Comparative Results
of Extra-laryngeal Operations, 502. Infrathyreoid Laryngotomy,
510 487-516

CHAPTER III

OPERATIONS UPON THE TRACHEA

Tracheotomy, 517; _in Diphtheria_, 526; _in Conditions other
than Diphtheria_, 544. Tracheo-fissure and Resection of the
Trachea, 546 517-548

CHAPTER IV

INTUBATION OF THE LARYNX

Intubation v. Tracheotomy in Diphtheria, 549. Indications, 552.
Operation, 553. Difficulties, 555. After-treatment, 556.
Complications, 557 549-558

CHAPTER V

TRACHEOSCOPY AND BRONCHOSCOPY

Indications, 559. Tracheoscopy, 560. Upper Bronchoscopy, 562.
Lower Bronchoscopy, 562. Complications, 563. Results, 566
559-566

SECTION V

OPERATIONS UPON THE NOSE AND ITS ACCESSORY CAVITIES

By StCLAIR THOMSON, M.D., F.R.C.P. (Lond.), F.R.C.S. (Eng.)

Professor of Laryngology and Physician for Diseases of the Throat, King’s College Hospital, London.

CHAPTER I

GENERAL CONSIDERATIONS IN REGARD TO OPERATIONS UPON THE NOSE AND NASO-PHARYNX

Sources of Illumination, 569. Local Anæsthesia, 572. Local
Ischæmia, 573. Bleeding and its Control, 574. The Protection
of the Lower Air-passages from the Descent of Blood, 576.
Shock, 577. Sepsis and other Complications, 577. Asepsis, 578.
After-treatment, 578. Cleansing the Nose, 579. After-results,
580 569-580

CHAPTER II

OPERATIONS FOR INJURIES, DEFORMITIES, FOREIGN BODIES, AND RHINOLITHS: OPERATIONS UPON THE TURBINALS: OPERATIONS IN SYPHILIS AND LUPUS

Operations for Injuries to the Nose--Fractures of the Nasal
Bones and Septum, 581. For Congenital Occlusion of the
Nostrils, 582. Removal of Foreign Bodies, 584; of Rhinoliths,
586. Operations upon the Turbinals, 586; _upon the Inferior
Turbinal_, 587; _upon the Middle Turbinal_, 592. For the
Results of Syphilis--_Sequestrotomy_, 594; _Post-syphilitic
Adhesions of the Velum_, 595. For Tuberculosis, 596 581-596

CHAPTER III

OPERATIONS UPON THE NASAL SEPTUM

For Deformities--_Removal of Spurs_, 597; _Perforating the
Septum_, 598. For Simple Deviation, 598; _Gleason-Watson
Operation_, 599; _Asch’s Operation_, 599; _Moure’s Operation_,
599. For Combined Bony and Cartilaginous Deformity--Submucous
Resection, 601. Complementary Operations, 610. For Perforation
of the Nasal Septum, 611. For Abscess, 612. For Hæmatoma, 612
597-612

CHAPTER IV

OPERATIONS FOR REMOVAL OF NASAL GROWTHS THROUGH THE NOSTRILS: OPERATIONS FOR OBTAINING DIRECT ACCESS TO THE NASAL CAVITIES AND NASO-PHARYNX

Removal by the Snare, 613. Removal by Forceps and Curettes, 615.
Lateral Rhinotomy (Moure’s Operation), 618. Rouge’s Operation,
622. Combination of Moure’s and Rouge’s Operations, 625.
Extension of Rouge’s Operation to allow of Access to the
Maxillary Antrum, 625. Other Methods, 625 613-625

CHAPTER V

OPERATIONS UPON THE ACCESSORY NASAL SINUSES

Operations upon the Maxillary Sinus--_Catheterizing the
Maxillary Sinus_, 626; _Puncturing from the Nose_, 626; _from
the Alveolar Margin_, 628. _Operation through the Canine Fossa
only_, 631; _the Caldwell-Luc Radical Operation_, 631;
_Drainage through the Nasal Wall only_, 637. Operations upon
the Frontal Sinus--_Catheterizing and Washing out the Frontal
Sinus_, 638; _Opening the Frontal Sinus in Acute Suppuration_,
642; _Killian’s Operation_, 642; _the Ogston-Luc Operation_,
651; _Kuhnt’s Operation_, 653. Operations upon the Sphenoidal
Sinus, 653; _Sounding and Washing out_, 653; _Opening the
Sphenoidal Sinus_, 656. Operation in Multiple Sinus
Suppuration, 659 626-660