Chapter 6

THE LARYNX, TRACHEA, AND BRONCHI 634

INDEX 645

LIST OF ILLUSTRATIONS

FIG. PAGE

1. Multiple Fracture of both Bones of Leg 4

2. Radiogram showing Comminuted Fracture of both Bones of 5 Forearm

3. Oblique Fracture of Tibia; with partial Separation of 6 Epiphysis of Upper End of Fibula; and Incomplete Fracture of Fibula in Upper Third

4. Excess of Callus after Compound Fracture of Bones of 9 Forearm

5. Multiple Fractures of both Bones of Forearm showing 11 Mal-union

6. Radiogram of Un-united Fracture of Shaft of Ulna 13

7. Excessive Callus Formation after Infected Compound 27 Fracture of both Bones of Forearm

8. Partial Separation of Epiphysis, with Fracture running 29 into Diaphysis

9. Complete Separation of Epiphysis 29

10. Partial Separation with Fracture of Epiphysis 29

11. Complete Separation with Fracture of Epiphysis 29

12. Os Innominatum showing new Socket formed after 41 Old-standing Dislocation

13. Oblique Fracture of Right Clavicle in Middle Third, 45 united

14. Fracture of Acromial End of Clavicle 46

15. Adhesive Plaster applied for Fracture of Clavicle 49

16. Forward Dislocation of Sternal End of Right Clavicle 51

17. Diagram of most common varieties of Dislocation of the 53 Shoulder

18. Sub-coracoid Dislocation of Right Shoulder 55

19. Sub-coracoid Dislocation of Humerus 56

20. Kocher's Method of reducing Sub-coracoid 57 Dislocation--First Movement

21. Kocher's Method--Second Movement 58

22. Kocher's Method--Third Movement 59

23. Miller's Method of reducing Sub-coracoid 60 Dislocation--First Movement

24. Miller's Method--Second Movement 61

25. Dislocation of Shoulder with Fracture of Neck of Humerus 64

26. Transverse Fracture of Scapula 68

27. Fracture of Surgical Neck of Humerus, united with 70 Angular Displacement

28. Impacted Fracture of Neck of Humerus 71

29. Ambulatory Abduction Splint for Fracture of Humerus 72

30. Radiogram of Separation of Upper Epiphysis of Humerus 73

31. "Cock-up" Splint 77

32. Gooch Splints for Fracture of Shaft of Humerus; and Rectangular Splint to secure Elbow 77

33. Radiogram of Supra-condylar Fracture of Humerus in a 81 Child

34. Radiogram of T-shaped Fracture of Lower End of Humerus 83

35. Radiogram of Fracture of Olecranon Process 86

36. Backward Dislocation of Elbow in a Boy 89

37. Bony Outgrowth in relation to insertion of Brachialis 90 Muscle

38. Radiogram of Incomplete Backward Dislocation of Elbow 91

39. Forward Dislocation of Elbow, with Fracture of Olecranon 93

40. Radiogram of Forward Dislocation of Head of Radius, with 95 Fracture of Shaft of Ulna

41. Greenstick Fracture of both Bones of the Forearm 98

42. Gooch Splints for Fracture of both Bones of Forearm 99

43. Colles' Fracture showing Radial Deviation of Hand 103

44. Colles' Fracture showing undue prominence of Ulnar 103 Styloid

45. Radiogram showing the Line of Fracture and Upward 104 Displacement of the Radial Styloid in Colles' Fracture

46. Radiogram of Chauffeur's Fracture 107

47. Radiogram of Smith's Fracture 108

48. Manus Valga following Separation of Lower Radial 109 Epiphysis in Childhood

49. Radiogram showing Fracture of Navicular (Scaphoid) Bone 111

50. Dorsal Dislocation of Wrist at Radio-carpal Articulation 113

51. Radiogram showing Forward Dislocation of Navicular Bone 114

52. Extension Apparatus for Oblique Fracture of Metacarpals 117

53. Radiogram of Bennett's Fracture of Base of Metacarpal 118 of Right Thumb

54. Splints for Bennett's Fracture 119

55. Multiple Fracture of Pelvis through Horizontal and 123 Descending Rami of both Pubes, and Longitudinal Fracture of left side of Sacrum

56. Fracture of Left Iliac Bone; and of both Pubic Arches 124

57. Many-tailed Bandage and Binder for Fracture of Pelvic 125 Girdle

58. Nelaton's Line 128

59. Bryant's Line 129

60. Section through Hip-Joint to show Epiphyses at Upper 130 End of Femur, and their relation to the Joint

61. Fracture through Narrow Part of Neck of Femur on Section 131

62. Impacted Fracture through Narrow Part of Neck of Femur 132

63. Fracture of Neck of Right Femur, showing Shortening, 133 Abduction, and Eversion of Limb

64. Fracture of Narrow Part of Neck of Femur 134

65. Coxa Vara following Fracture of Neck of Femur in a Child 136

66. Non-impacted Fracture through Base of Neck 137

67. Fracture through Base of Neck of Femur with Impaction 137 into the Trochanters

68. Non-impacted Fracture through Base of Neck 138

69. Fracture of the Femur just below the small Trochanter, 140 united, showing Flexion and Lateral Rotation of Upper Fragment

70. Adjustable Double-inclined Plane 141

71. Diagram of the most Common Dislocations of the Hip 142

72. Dislocation of Right Femur on to Dorsum Ilii 143

73. Dislocation on to Dorsum Ilii 144

74. Dislocation into the Vicinity of the Ischiatic Notch 145

75. Longitudinal Section of Femur showing Fracture of Shaft 148 with Overriding of Fragments

76. Radiogram of Steinmann's Apparatus applied for Direct 150 Extension to the Femur

77. Hodgen's Splint 151

78. Long Splint with Perineal Band 152

79. Fracture of Thigh treated by Vertical Extension 153

80. Section of Knee-joint showing Extent of Synovial Cavity 156

81. Extension applied by means of Ice-tong Callipers for Fracture of Femur 158

82. Radiogram of Separation of Lower Epiphysis of Femur, 160 with Backward Displacement of the Diaphysis

83. Separation of Lower Epiphysis of Femur, with Fracture 161 of Lower End of Diaphysis

84. Radiogram of Fracture of Head of Tibia and upper Third 163 of Fibula

85. Radiogram illustrating Schlatter's Disease 164

86. Diagram of Longitudinal Tear of Posterior End of Right 171 Medial Semilunar Meniscus

87. Radiogram of Fracture of Patella 173

88. Fracture of Patella, showing wide Separation of Fragments 175

89. Radiogram of Transverse Fracture of both Bones of Leg 178 by Direct Violence

90. Radiogram of Oblique Fracture of both Bones of Leg by 178 Indirect Violence

91. Box Splint for Fractures of Leg 180

92. Box Splint applied 181

93. Section through Ankle-joint showing relation of 186 Epiphyses to Synovial Cavity

94. Radiogram of Pott's Fracture, with Lateral Displacement 187 of Foot

95. Ambulant Splint of Plaster of Paris 189

96. Dupuytren's Splint applied to Correct Eversion of Foot 190

97. Syme's Horse-shoe Splint applied to Correct Backward 191 Displacement of Foot

98. Radiogram of Fracture of Lower End of Fibula, with 192 Separation of Lower Epiphysis of Tibia

99. Radiogram of Backward Dislocation of Ankle 195

100. Compound Dislocation of Talus 197

101. Radiogram of Fracture-Dislocation of Talus 198

102. Radiogram of Dislocation of Toes 199

103. Arthropathy of Shoulder in Syringomyelia 203

104. Radiogram of Specimen of Arthropathy of Shoulder in 204 Syringomyelia

105. Radiogram showing Multiple partially Ossified 205 Cartilaginous Loose Bodies in Shoulder-joint

106. Diffuse Tuberculous Thickening of Synovial Membrane of 206 Elbow

107. Contracture of Elbow and Wrist following a Burn in 207 Childhood

108. Advanced Tuberculous Disease of Acetabulum with Caries 210 and Perforation into Pelvis

109. Early Tuberculous Disease of Right Hip-joint in a Boy 212

110. Disease of Left Hip; showing Moderate Flexion and 213 Lordosis

111. Disease of Left Hip; Disappearance of Lordosis on 213 further Flexion of the Hip

112. Disease of Left Hip; Exaggeration of Lordosis 214

113. Thomas' Flexion Test, showing Angle of Flexion at 214 Diseased Hip

114. Tuberculous Disease of Left Hip: Third Stage 215

115. Advanced Tuberculous Disease of Left Hip-joint in a Girl 216

116. Extension by Adhesive Plaster and Weight and Pulley 220

117. Stiles' Double Long Splint to admit of Abduction of 221 Diseased Limb

118. Thomas' Hip-splint applied for Disease of Right Hip 222

119. Arthritis Deformans, showing erosion of Cartilage and 225 lipping of Articular Edge of Head of Femur

120. Upper End of Femur in advanced Arthritis Deformans 226 of Hip

121. Femur in advanced Arthritis Deformans of Hip and Knee 227 Joints

122. Tuberculous Synovial Membrane of Knee 230

123. Lower End of Femur from an Advanced Case of Tuberculous 231 Arthritis of the Knee

124. Advanced Tuberculous Disease of Knee, with Backward 233 Displacement of Tibia

125. Thomas' Knee-splint applied 236

126. Tuberculous Disease of Right Ankle 239

127. Female Child showing the results of Poliomyelitis 243 affecting the Left Lower Extremity

128. Radiogram of Double Congenital Dislocation of Hip in 249 a Girl

129. Innominate Bone and Upper End of Femur from a case of 250 Congenital Dislocation of Hip

130. Congenital Dislocation of Left Hip in a Girl 251

131. Contracture Deformities of Upper and Lower Limbs 255 resulting from Spastic Cerebral Palsy in Infancy

132. Rachitic Coxa Vara 258

133. Coxa Vara, showing Adduction Curvature of Neck of Femur 260 associated with Arthritis of the Hip and Knee

134. Bilateral Coxa Vara, showing Scissors-leg Deformity 260

135. Genu Valgum and Genu Varum 265

136. Female Child with Right-sided Genu Valgum, the result of 266 Rickets

137. Double Genu Valgum; and Rickety Deformities of Arms 267

138. Radiogram of Case of Double Genu Valgum in a Child 268

139. Genu Valgum in a Child. Patient standing 269

140. Genu Valgum. Same Patient as Fig. 139, sitting 270

141. Bow-knee in Rickety Child 271

142. Bilateral Congenital Club-foot in an Infant 274

143. Radiogram of Bilateral Congenital Club-foot in an Infant 275

144. Congenital Talipes Equino-varus in a Man 277

145. Bilateral Pes Equinus in a Boy 280

146. Extreme form of Pes Equinus in a Girl 281

147. Skeleton of Foot from case of Pes Equinus due to 282 Poliomyelitis

148. Pes Calcaneo-valgus with excessive arching of Foot 284

149. Pes Calcaneo-valgus, the result of Poliomyelitis 285

150. Pes Cavus in Association with Pes Equinus, the Result 286 of Poliomyelitis

151. Radiogram of Foot of Adult, showing Changes in the 286 Bones in Pes Cavus

152. Adolescent Flat-Foot 287

153. Flat-Foot, showing Loss of Arch 288

154. Imprint of Normal and of Flat Foot 290

155. Bilateral Pes Valgus and Hallux Valgus in a Girl 293

156. Radiogram of Spur on Under Aspect of Calcaneus 295

157. Radiogram of Hallux Valgus 296

158. Radiogram of Hallux Varus or Pigeon-Toe 298

159. Hallux Rigidus and Flexus in a Boy 299

160. Hammer-Toe 300

161. Section of Hammer-Toe 301

162. Congenital Hypertrophy of Left Lower Extremity in a Boy 302

163. Supernumerary Great Toe 303

164. Congenital Elevation of Left Scapula in a Girl: also 304 shows Hairy Mole over Sacrum

165. Winged Scapula 305

166. Arrested Growth and Wasting of Tissues of Right Upper 307 Extremity

167. Lower End of Humerus from case of Cubitus Varus 309

168. Intra-Uterine Amputation of Forearm 310

169. Radiogram of Arm of Patient shown in Fig. 168 310

170. Congenital Absence of Left Radius and Tibia in a Child 311

171. Club-Hand, the Result of Imperfect Development of Radius 312

172. Congenital Contraction of Ring and Little Fingers 314

173. Dupuytren's Contraction 315

174. Splint used after Operation for Dupuytren's Contraction 316

175. Supernumerary Thumb 317

176. Trigger Finger 318

177. Multiple Wens 324

178. Adenoma of Scalp 325

179. Relations of the Motor and Sensory Areas to the 330 Convolutions and to Chiene's Lines

180. Diagram of the Course of Motor and Sensory Nerve Fibres 333

181. Chiene's Method of Cerebral Localisation 336

182. To illustrate the Site of Various Operations on the Skull 337

183. Localisation of Site for Introduction of Needle in Lumbar 338 Puncture

184. Contusion and Laceration of Brain 343

185. Charts of Pyrexia in Head Injuries 348

186. Relations of the Middle Meningeal Artery and Lateral 353 Sinus to the Surface as indicated by Chiene's Lines

187. Extra-Dural Clot resulting from Haemorrhage from the 354 Middle Meningeal Artery

188. Depressed Fracture of Frontal Bones with Fissured 365 Fracture

189. Depressed and Comminuted Fracture of Right Parietal 365 Bone: Pond Fracture

190. Pond Fracture of Left Frontal Bone, produced during 366 Delivery

191. Transverse Fracture through Middle Fossa of Base of Skull 368

192. Diagram of Extra-Dural Abscess 374

193. Pott's Puffy Tumour in case of Extra-Dural Abscess 375 following Compound Fracture of Orbital Margin

194. Diagram of Sub-Dural Abscess 376

195. Diagram illustrating sequence of Paralysis, caused by 380 Abscess in Temporal Lobe

196. Chart of case of Sinus Phlebitis following Middle Ear 384 Disease

197. Occipital Meningocele 388

198. Frontal Hydrencephalocele 389

199. Naevus at Root of Nose, simulating Cephalocele 390

200. Hydrocephalus in a Child 391

201. Patient suffering from Left Facial Paralysis 402

202. Skull of Woman illustrating the appearances of Tertiary 408 Syphilis of Frontal Bone--Corona Veneris--in the Healed Condition

203. Sarcoma of Orbital Plate of Frontal Bone in a Child at 409 Age of 11 months and 18 months

204. Destruction of Bones of Left Orbit, caused by Rodent 410 Cancer

205. Distribution of the Segments of the Spinal Cord 417

206. Attitude of Upper Extremities in Traumatic Lesions of 418 the Sixth Cervical Segment

207. Compression Fracture of Bodies of Third and Fourth 426 Lumbar Vertebrae

208. Fracture-Dislocation of Ninth Thoracic Vertebra 428

209. Fracture of Odontoid Process of Axis Vertebra 429

210. Tuberculous Osteomyelitis affecting several Vertebrae at 432 Thoracico-Lumbar Junction

211. Osseous Ankylosis of Bodies (_a_) of Dorsal Vertebrae, 434 (_b_) of Lumbar Vertebrae following Pott's Disease

212. Radiogram of Museum Specimen of Pott's Disease in a Child 435

213. Radiogram of Child's Thorax showing Spindle-shaped 437 Shadow at Site of Pott's Disease of Fourth, Fifth, and Sixth Thoracic Vertebrae

214. Attitude of Patient suffering from Tuberculous Disease 441 of the Cervical Spine

215. Thomas' Double Splint for Tuberculous Disease of the 442 Spine

216. Hunch-back Deformity following Pott's Disease of Thoracic 443 Vertebrae

217. Attitude in Pott's Disease of Thoracico-Lumbar Region of 444 Spine

218. Arthritis Deformans of Spine 449

219. Meningo-Myelocele of Thoracico-Lumbar Region 454

220. Meningo-Myelocele of Cervical Spine 454

221. Meningo-Myelocele in Thoracic Region 456

222. Tail-like Appendage over Spina Bifida Occulta in a Boy 457

223. Congenital Sacro-Coccygeal Tumour 458

224. Scoliosis following upon Poliomyelitis affecting Right 463 Arm and Leg

225. Rickety Scoliosis in a Child 464

226. Vertebrae from case of Scoliosis showing Alteration in 466 Shape of Bones

227. Adolescent Scoliosis in a Girl 467

228. Scoliosis with Primary Curve in Thoracic Region 468

229. Scoliosis showing Rotation of Bodies of Vertebrae, and 469 widening of Intercostal Spaces on side of Convexity

230. Diagram of Attitudes in Klapp's Four-Footed Exercises for 473 Scoliosis

231. Head of Human Embryo about 29 days old 475

232. Simple Hare-Lip 476

233. Unilateral Hare-Lip with Cleft Alveolus 477

234. Double Hare-Lip in a Girl 478

235. Double Hare-Lip with Projection of the Os Incisivum 479

236. Asymmetrical Cleft Palate extending through Alveolar 480 Process on Left Side

237. Illustrating the Deformities caused by Lupus Vulgaris 483

238. Sarcoma of Orbit causing Exophthalmos and Downward 488 Displacement of the Eye, and Projecting in Temporal Region

239. Sarcoma of Eyelid in Child 489

240. Dermoid Cyst at Outer Angle of Orbital Margin 490

241. Macrocheilia 492

242. Squamous Epithelioma of Lower Lip in a Man 493

243. Advanced Epithelioma of Lower Lip 494

244. Recurrent Epithelioma in Glands of Neck adherent to 495 Mandible

245. Cancrum Oris 497

246. Perforation of Palate, the Result of Syphilis, and Gumma 498 of Right Frontal Bone

247. Cario-necrosis of Mandible 510

248. Diffuse Syphilitic Disease of Mandible 512

249. Epulis of Mandible 513

250. Sarcoma of the Maxilla 515

251. Malignant Disease of Left Maxilla 516

252. Dentigerous Cyst of Mandible containing Rudimentary Tooth 517

253. Osseous Shell of Myeloma of Mandible 518

254. Multiple Fracture of Mandible 520

255. Four-Tailed Bandage applied for Fracture of Mandible 522

256. Defective Development of Mandible from Fixation of Jaw 526 due to Tuberculous Osteomyelitis in Infancy

257. Leucoplakia of the Tongue 531

258. Papillomatous Angioma of Left Side of Tongue in a Woman 538

259. Dermoid Cyst in Middle Line of Neck 539

260. Temporary Unilateral Paralysis of Tongue 541

261. Series of Salivary Calculi 545

262. Acute Suppurative Parotitis 546

263. Mixed Tumour of Parotid 550

264. Mixed Tumour of the Parotid of over twenty years' 551 duration

265. Acute Mastoid Disease showing Oedema and Projection of 565 Auricle

266. Rhinophyma or Lipoma Nasi 569

267. The Outer Wall of Left Nasal Chamber after removal of 571 the Middle Turbinated Body

268. Congenital Branchial Cyst in a Woman 584

269. Bilateral Cervical Ribs 586

270. Transient Wry-Neck 587

271. Congenital Wry-Neck in a Boy 589

272. Congenital Wry-Neck seen from behind to show Scoliosis 590

273. Recovery from Suicidal Cut-Throat after Low Tracheotomy 596 and Gastrostomy

274. Hygroma of Neck 599

275. Lympho-Sarcoma of Neck 600

276. Branchial Carcinoma 601

277. Parenchymatous Goitre in a Girl 606

278. Larynx and Trachea surrounded by Goitre 607

279. Section of Goitre shown in Fig. 278 to illustrate 607 Compression of Trachea

280. Multiple Adenomata of Thyreoid in a Woman 611

281. Cyst of Left Lobe of Thyreoid 612

282. Exophthalmic Goitre 614

283. Radiogram of Safety-Pin impacted in the Gullet and 620 Perforating the Larynx

284. Denture Impacted in Oesophagus 621

285. Radiogram, after swallowing an Opaque Meal, in a Man 626 suffering from Malignant Stricture of Lower End of Gullet

286. Diverticulum of the Oesophagus at its Junction with the 627 Pharynx

287. Larynx from case of Sudden Death due to Oedema of 637 Ary-Epiglottic Folds

288. Papilloma of Larynx 641

MANUAL OF SURGERY