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. CHAPTER I PAGES | 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 | CHAPTER VI OPERATIONS INVOLVING THE NASO-PHARYNX: OPERATIONS
FOR RETROPHARYNGEAL ABSCESS: OPERATIONS
FOR NASO-PHARYNGEAL ADENOIDS | | Methods of obtaining Access to the Naso-pharynx through the Nose, 661; through the Mouth, 662. Retropharyngeal Abscess, 664. Removal of Naso-pharyngeal Adenoids, 665 | 661–672 |
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