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

LIST OF ILLUSTRATIONS

FIG. PAGE

1. Secondary Cancer of the Ovary 15

2. Secondary Cancer of the Ovary in Section 16

3. An Infected Fallopian Tube 22

4. A Tuberculous Fallopian Tube and Ovary: Entire and in Section 23

5. Primary Cancer of the Fallopian Tube 27

6. A Section of Primary Cancer of the Fallopian Tube 27

7. A Gravid Fallopian Tube 30

8. A Gravid Fallopian Tube, containing Twins 31

9. A Diagram to show the Arterial Supply of the Uterus 37

10. A Fibroid growing near the Right Uterine Cornu 38

11. The Mattress Suture 39

12. The Stump after Subtotal Hysterectomy 39

13. A Bicornate Uterus 42

14. A Bicornate Uterus shortly after Delivery 43

15. Villous Disease of the Uterus 45

16. An Adenomyomatous Uterus 54

17. An Adenomyomatous and Tuberculous Uterus 55

18. Uterus with the Decidua _in situ_ 58

19. Cancer of the Uterus 64

20. The Fundus of a Uterus 68

21. Portion of Ovary and Fallopian Tube 71

22. A Uterus distorted by Fibroids 76

23. A Gravid Uterus in Sagittal Section 79

24. Diagram representing a Gunshot Injury of the Uterus 90

25. The Pulmonary Artery and Adjacent Part of the Lung and Trachea 103

26. A Pair of Pressure Forceps 106

27. The Relation of Parts after Ricard’s Operation of Uretero-cysto-neostomy 114

28. A Uterus in Sagittal Section 119

29. Patient prepared for Operation 126

30. Complete Laceration of the Perineum 128

31. Long-handled Sharp-pointed Scissors curved on the flat 129

32. Complete Laceration of the Perineum 129

33. Complete Laceration of the Perineum 130

34. Laceration of the Pelvic Floor 131

35. Repair of a Lacerated Perineum, with Non-union of the Sphincter Ani, before a Plastic Operation 132

36. Repair of a Laceration of the Perineum after a Plastic Operation 133

37. Auvard’s Self-retaining Speculum 135

38. Knives for freshening the Edges of a Vesico-vaginal Fistula 135

39. Toothed Forceps for use in Vesico-vaginal Fistula 135

40. Emmett’s Hook 136

41. Sims’s Operation for the Repair of a Vesico-vaginal Fistula 136

42. Simon’s Operation for the Repair of a Vesico-vaginal Fistula 137

43. Repair of a Vesico-vaginal Fistula by _Dédoublement_ 138

44. Repair of a Vesico-vaginal Fistula. Sims’s Operation 139

45. Stoltz’s Operation for Cystocele 141

46. Sims’s Vaginal Rest 144

47. Pozzi’s Retractors 145

48. Anterior Colpotomy 146

49. Martin’s Trochar for Pelvic Abscess 147

50. The Passage of the Uterine Sound. _Introduction of the point into the external os uteri_ 149

51. The Passage of the Uterine Sound. _Commencement of the tour de maître_ 149

52. The Passage of the Uterine Sound. _Completion of the tour de maître_ 150

53. The Passage of the Uterine Sound. _Entry of the sound into the uterine cavity_ 150

54. Chronic Uterine Inversion 151

55. Volsella for fixing the Cervix 153

56. Hegar’s Dilators (three sizes) for dilatation of the Cervix Uteri 153

57. Metal Bougies for dilatation of the Cervix 154

58. Bozemann’s Double-channelled Tube 155

59. Budin’s Celluloid Catheter 155

60. Murray’s Flushing Curette; Blunt Curette 155

61. Dilatation of the Cervix 157

62. Marckwald’s Operation for Congenital Hypertrophy of the Cervix 161

63. Hegar’s Operation for Supravaginal Elongation of Cervix 161

64. Emmett’s Scissors (left) for Trachelorrhaphy 162

65. Trachelorrhaphy 163

66. Pedunculated Fibroid Polypi in various Stages of Extrusion 165

67. Wire Écraseur 166

68. Submucous Fibro-myomata, capable of Treatment by _Morcellement_ 167

69. Galabin’s Broad-ligament Needle (right) 169

70. Jessett’s Broad-ligament Needle 169

71. Vaginal Hysterectomy 170

72. Vaginal Hysterectomy. _Final stage_ 171

73. Schauta’s Needle-holder 172

74. Window of the Operating Theatre, King’s College Hospital 178

75. Bull’s-eye Electric Hand-lamp 179

76. Lang’s Eye Speculum 181

77. Undine for washing out the Conjunctival Sac 182

78. Cataract Extraction 183

79. Sympathetic Ophthalmia 184

80. Cystoid Scar after Glaucoma Iridectomy 184

81. An Eye Bandage 185

82. A Pressure Bandage 185

83. A Lens Three Weeks after Needling 187

84. Anatomy of the Anterior Segment of the Eye 188

85. Eye Speculum 190

86. Fixation Forceps 190

87. Secondary Cataract 192

88. Capsulotomy. _The method of incising the capsule_ 193

89. Capsulotomy. _The method of dividing a dense band_ 193

90. Iris Forceps 196

91. Iris Scissors 196

92. A Vectis 196

93. Pagenstecher’s Spoon 196

94. Lens Extraction 197

95. The Knife entering the Anterior Chamber in Cataract Extraction 198

96. Making the Counter-puncture in Cataract Extraction 198

97. Incision and Iridectomy in Cataract Extraction 199

98. Opening the Capsule with Forceps in Cataract Extraction 200

99. Cataract Extraction 201

100. McKeown’s Irrigation Apparatus for washing out the Anterior Chamber 202

101. Subconjunctival Extraction 205

102. Iridotomy 212

103. Iridotomy 212

104. Iridotomy by Ziegler’s Method 213

105. Iridotomy by Ziegler’s Method 214

106. Iridotomy by Ziegler’s Method 214

107. Optical Iridectomy 215

108. Optical Iridectomy 216

109. Optical Iridectomy 217

110. The Normal Angle of the Anterior Chamber 218

111. The Angle of the Anterior Chamber from a Case of Recent Glaucoma 219

112. The Angle of the Chamber in a Case of Chronic Glaucoma 220

113. Iridectomy for Glaucoma 221

114. Iridectomy for Glaucoma 222

115. Iridectomy for Glaucoma 222

116. Iridectomy for Glaucoma 223

117. Glaucoma Iridectomy 224

118. Prolapse of the Iris through a Punctured Wound of the Cornea 226

119. Cyclo-dialysis Operation 229

120. Cyclo-dialysis Operation 230

121. Lagrange Operation for the Production of a Cystoid Scar in Chronic Glaucoma 232

122. Lagrange Operation for Chronic Glaucoma 232

123. Hollow Needle used for Paracentesis of the Anterior Chamber 234

124. Author’s Chair for the Localization of Foreign Bodies in the Eye by the X-rays 236

125. Small Electro-magnet for extracting Pieces of Steel from the Eye 238

126. Large Electro-magnet 239

127. Electro-cautery 241

128. Tattooing Needles 243

129. Graddy’s Forceps 245

130. Tenotomy 249

131. Tenotomy by the Open Method 250

132. Prince’s Forceps for Advancement 252

133. Advancement by the Three-stitch Method 253

134. Enucleation 256

135. Mules’s Operation. _First step_ 258

136. Mules’s Operation. 258

137. Maxwell’s Operation for Contracted Socket. _First step_ 262

138. Maxwell’s Operation. _Final step_ 262

139. Canthorrhaphy 266

140. Harman’s Operation for Ptosis 270

141. Ptosis Operation. Panas’ 271

142. Ptosis Operation. Advancement of the Levator Palpebræ 272

143. Ptosis Operation. Advancement of the Levator Palpebræ 273

144. Treacher Collins’s Entropion Forceps 276

145. Lid Clamp 277

146. Streatfield’s Entropion Operation 277

147. Arlt’s Operation for Trichiasis 278

148. Snellen’s Sutures 280

149. Fergus’s Operation for Slight Ectropion of the Lower Lid 281

150. Modified Kuhnt’s Operation for Severe Ectropion. _Second step_ 282

151. Modified Kuhnt’s Operation. _Fourth step_ 282

152. Argyll Robertson’s Operation for Ectropion. _Second step_ 283

153. Argyll Robertson’s Operation for Ectropion. _Final step_ 283

154. VY Operation for Ectropion of the Lower Lid due to a Scar. _First step_ 284

155. VY Operation for Ectropion. _Final step_ 284

156. Denonvillier’s Operation for Ectropion of the Lower Lid. _First step_ 285

157. Denonvillier’s Operation for Ectropion 285

158. Fricke’s Operation 286

159. De Vincentiis’ Operation to replace the Loss of the Inner Portion of the Lower Lid 288

160. De Vincentiis’ Operation completed 288

161. Modified Dieffenbach’s Operation to replace the Loss of the whole Lower Lid. _First step_ 289

162. Modified Dieffenbach’s Operation. _Third step_ 289

163. Canaliculus Dilator 291

164. Canaliculus Knife 291

165. Lachrymal Syringe 292

166. Muller’s Retractor for Excision of the Lachrymal Sac 295

167. Axenfeld’s Retractor for Excision of the Lachrymal Sac 295

168. Excision of the Lachrymal Sac 296

169. Excision of the Lachrymal Sac 296

170. Excision of the Palpebral Portion of the Lachrymal Gland 298

171. Clar’s Lamp 305

172. Gruber’s Aural Speculum 306

173. Angular Spring Forceps 306

174. Examination of the Ear 307

175. Aural Forceps holding Cotton-wool 307

176. Milligan’s Intratympanic Syringe 308

177. Neumann’s Syringe for Subcutaneous Injection 311

178. Burkhardt-Merian’s Aural Instrument 315

179. Crocodile Forceps 324

180. Imray’s Scoop for extracting a Foreign Body 325

181. Aural Probe 332

182. Wilde’s Aural Snare 332

183. Wilde’s Snare being passed round an Aural Polypus 333

184. Wilde’s Snare gripping the Neck of Polypus 334

185. Polypus arising from the Attic Region 334

186. Anatomical Preparation of the Middle Ear 336

187. Paracentesis Knife held in position in the Hand 338

188. Tympanic Membrane showing Incision in Acute Suppuration of the Middle Ear 339

189. Line of Incision in Acute Suppuration of the Attic 339

190. Lines of Incisions in Intratympanic Operations 341

191. Cutting through Intratympanic Adhesions 343

192. Free Edge of Tympanic Membrane cut through 344

193. Sexton’s Instrument 345

194. Method of using Siegle’s Speculum 345

195. Division of Intratympanic Adhesion with Excision of Handle of Malleus 346

196. Schwartze’s Tenotomy Knife 347

197. Lucae’s Probe 350

198. To show Sites of Perforation in Attic Suppuration and Caries of the Ossicles 351

199. Removal of the Malleus by Wilde’s Snare. _First position_ 354

200. Removal of the Malleus by Wilde’s Snare. _Second position_ 354

201. Delstanche’s Ring-knife 354

202. Removal of Malleus by Delstanche’s Ring-knife 355

203. Ludwig’s Incus Hook 356

204. Zeroni’s Incus Hook 356

205. Removal of Incus by Zeroni’s Hook 356

206. Pfau’s Attic Punch-forceps 357

207. Removal of the Outer Attic-wall with Forceps 358

208. Diagrammatic Section to show Correct and Wrong Positions of Incus Hook 360

209. Eustachian Catheter 365

210. Passing the Eustachian Catheter 366

211. Passing the Eustachian Catheter 366

212. Passing the Eustachian Catheter 367

213. Passing the Eustachian Catheter 367

214. Author’s Graduated Eustachian Bougie 370

215. Left Temporal Bone, showing Anatomy of the Middle Ear and Mastoid Process 374

216. Diagram showing Position of Sink Incisions in Post-aural Operations 380

217. Schwartze’s Operation 381

218. Schwartze’s Operation 383

219. Schwartz’s Seeker 384

220. Schwartze’s Operation completed 385

221. The ‘Radical’ Mastoid Operation 393

222. Stacke’s Protector 394

223. The ‘Radical’ Mastoid Operation 395

224. Pfau’s Curette for the Eustachian Tube 396

225. The ‘Radical’ Mastoid Operation completed 397

226. Wolf’s Operation 398

227. Stacke’s Operation 399

228. Post-meatal Skin Flaps 400

229. Post-meatal Skin Flaps 401

230. Closure of Wound after ‘Radical’ Mastoid Operation 402

231. Körner’s Post-meatal Flap 403

232. Panse’s Post-meatal Flap 403

233. Stacke’s Post-meatal Flap 403

234. Skin-grafting of Mastoid Wound Cavity after Operation 407

235. Ballance’s ‘Stopper’ for pushing in the Graft 407

236. Pipette for sucking Air and Fluid from beneath the Graft 408

237. Skin-grafting of Mastoid Wound Cavity after Operation 408

238. Skin-grafting of Mastoid Wound Cavity after Operation 409

239. Posterior Portion of Skin Graft covering Outer Surface of Wound Cavity 409

240. Diagram to show Exposure of the Semicircular Canals 423

241. Operation upon the Labyrinth 424

242. Extirpation of the Labyrinth 425

243. Method of Removal of Bone by the Forceps 435

244. Diagram to show the usual Points at which the Lateral Sinus is primarily infected 443

245. The Lateral Sinus exposed and opened 445

246. Incision for Exposure of the Internal Jugular Vein 448

247. Exposure of the Internal Jugular Vein high up 449

248. Ligature of the Internal Jugular Vein low down in the Neck 451

249. Free Exposure of the Lateral Sinus, which has been incised, with Ligature of the Internal Jugular Vein 452

250. Method of suturing the Open End of the Internal Jugular Vein in the Neck 453

251. Topography of the Auditory Region of the Skull 462

252. Exploration for a Temporo-sphenoidal Abscess 463

253. Exploration for a Cerebellar Abscess 467

254. Skiagram showing a Tumour of the Larynx 476

255. Horsford’s Instrument for transfixing the Epiglottis 478

256. Multiple Papillomata of the Larynx 480

257. Tube-spatulæ used for Laryngoscopy 481

258. Removal of Multiple Papillomata by Direct Laryngoscopy 483

259. Intrinsic Tumour of the Larynx 488

260. Extrinsic Tumour of the Larynx 488

261. Thyrotomy 491

262. Total Laryngectomy 499

263. Total Laryngectomy. Gluck’s Method 501

264. Infrathyreoid Laryngotomy 510

265. Instruments for Laryngotomy 512

266. Laryngotomy Canula fitted with Inner Tube 513

267. Skiagram showing an Angular Tracheotomy Tube in the Trachea 518

268. Anatomy of the Larynx and Trachea and the Position of Incisions for the Operations in this Region 524

269. Tubes for Tracheotomy 527

270. Trachea showing Ulceration caused by a Badly Fitting Tube 537

271. Stenosis following Tracheotomy 539

272. Tubes used in the Treatment of Stenosis of the Larynx 540

273. Trachea showing Ulceration into the Innominate Artery after Tracheotomy 541

274. Aneurism of the Aorta perforating the Trachea 542

275. Sarcoma of the Trachea 547

276. Instruments for Intubation of the Larynx 553

277. Instruments for Bronchoscopy 561

278. Instruments for Bronchoscopy 562

279. Upper Bronchoscopy with the Patient in the Dorsal Position 564

280. Lower Bronchoscopy with the Patient in the Dorsal Position 565

281. Laryngoscope Lamp 570

282. Clar’s Electric Light 571

283. Frontal Search-light 571

284. Meyer’s hollow Vulcanite Nasal Splint 582

285. Krause’s Trochar and Canula 583

286. Nasal Punch-forceps 583

287. Post-nasal Forceps 584

288. Nasal Dressing Forceps 585

289. First Step in removing the Anterior End of the Inferior Turbinal, which is seen to have undergone Polypoid Degeneration 587

290. Nasal Scissors 588

291. Amputation of the Posterior End of the Inferior Turbinal 590

292. Nasal Spokeshave 591

293. First Step in the Removal of the Anterior End of the Middle Turbinal 593

294. Second Step in the Removal of the Anterior End of the Middle Turbinal 593

295. Cresswell Baber’s Nasal Saw 597

296. The Gleason-Watson Operation for Deformity of the Septum 599

297. Asch’s Cutting Scissors 600

298. Lake’s Rubber Splint 600

299. Bayonet Knife 604

300. Incision for Submucous Resection of the Septum 604

301. Making the Incision from the Convex Side in Submucous Resection of the Septum 605

302. Dull-edged Detacher 605

303. Denudation of the Septum in Submucous Resection 606

304. Complete Denudation of the Deviated Septum 606

305. Ballenger’s Swivel Septum Knife 607

306. The Method of employing Ballenger’s Swivel Septum Knife 607

307. Submucous Resection of the Septum 608

308. Submucous Resection of the Septum 609

309. Submucous Resection of the Septum 609

310. Semi-diagrammatic Transverse Section of the Nose 610

311. Operation for Perforation of the Septum 611

312. Nasal Snare 613

313. Luc’s Nasal Forceps 616

314. Tongue Clip 617

315. Incisions for Lateral Rhinotomy (Moure’s Operation) 619

316. The Area of Bone removed in Lateral Rhinotomy 620

317. Lateral Rhinotomy 621

318. Rouge’s Operation. _First stage_ 623

319. Rouge’s Operation. _Second stage_ 624

320. Catheterizing the Maxillary Sinus 626

321. Lichtwitz’s and Moritz Schmidt’s Antrum Needles 627

322. Puncturing the Maxillary Sinus 627

323. Antrum Drills 628

324. Solid Rubber Obturators 628

325. Antrum Nozzle 628

326. Washing out the Maxillary Sinus from an Alveolar Opening 629

327. The Incision in the Caldwell-Luc Operation upon the Maxillary Sinus 631

328. The Caldwell-Luc Operation upon the Maxillary Sinus 632

329. Opening the Maxillary Sinus from the Nose 633

330. Carwardine’s Punch-forceps 634

331. The Opening into the Maxillary Sinus from the Inferior Meatus of the Nose 635

332. Denker’s Operation 636

333. Catheterizing the Frontal Sinus 639

334. Radiograph to show the Value of the Röntgen Rays 640

335. Radiograph showing Canula in the Frontal Sinus 641

336. Killian’s Operation upon the Frontal Sinus 643

337. Killian’s Operation upon the Frontal Sinus 644

338. Periosteal Elevators 645

339. Killian’s Triangular Curved Chisel 645

340. Citelli’s Bone-forceps 646

341. Hajek’s Bone-forceps 646

342. Killian’s Operation upon the Frontal Sinus 647

343. Radiograph of the Sphenoidal Sinus 654

344. Radiograph of the Sphenoidal Sinus 655

345. Catheterizing the Sphenoidal Sinus 656

346. Killian’s Long Nasal Speculum 657

347. Radiograph showing a Probe in the Sphenoidal Sinus 658

348. Sphenoidal Punch-forceps 659

349. Adenoid Curette 668

350. The Removal of Naso-pharyngeal Adenoids 668

351. Removal of Naso-pharyngeal Adenoids 669

SECTION I

OPERATIONS UPON THE FEMALE GENITAL ORGANS