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.

CHAPTER I

PAGES

CŒLIOTOMY
Preparation of Patient, [3]. Basins, Dishes, and Instruments, [4]. Sutureand 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]. AnomalousOvariotomy, [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 Oöphorectomyand Ovariotomy, [25]. Mortality, [25]. Operation for Primary Cancerof the Fallopian Tube, [26][21][28]

CHAPTER IV

OPERATIONS FOR EXTRA-UTERINE GESTATION
Indications, [29]. Operation, [29]. Concurrent Intra- and Extra-uterinePregnancy, [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]. AbdominalMyomectomy, [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]. Cancerof the Uterus after Bilateral Ovariotomy, [55]. Adenomyoma of theUterus, [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 forProlapse 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 andTubal Pregnancy, [82]. Pregnancy with Tumours growing from thePelvic 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 theGravid Uterus in the course of an Abdominal Operation, [89]. BulletWounds of the Pregnant Uterus, [90]. Stab-wounds of the PregnantUterus, [91][86][92]

CHAPTER XI

THE AFTER-TREATMENT, RISKS, AND SEQUELÆ OF ABDOMINAL
GYNÆCOLOGICAL OPERATIONS
After-treatment of Abdominal Operations, [93]. Complications of AbdominalGynæcological 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 leftin the Abdomen, [105]; Tetanus, [107]; Injury to the Intestines, [109]; IntestinalObstruction, [110]; Perforating Ulcer of the Stomach and SmallIntestine, [111]; Injuries to the Bladder, [111]; to the Ureter, [112]. The fateof 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 CompleteLaceration of the Perineum, [127]. Operation for Laceration of thePelvic Floor, [132][125][133]

CHAPTER XIII

OPERATIONS UPON THE URETHRA AND BLADDER
Extirpation of a Urethral Caruncle, [134]. Operations for Incontinencefollowing Labour, [134]; for Vesico-vaginal Fistula, [135]; for Recto-vaginalFistula, [139]; for Cystocele, [140][134][141]

CHAPTER XIV

OPERATIONS UPON THE VULVA AND VAGINA
Operations upon Bartholin’s Glands, [142]. Operations for Atresia of theHymen 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 UterineInversion, [151]. Curetting the Uterus, [152]. Dilatation of theCervix, [156]Rapid Dilatation, [157]; Gradual Dilatation, [159]. Operationsfor 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]; forSessile Tumours, [166]; for Interstitial Tumours, [167]. VaginalHysterectomy, [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 thePatient, [80]. Making and Healing of Wounds in the Globe, [182]Purificationof 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]. Evulsionof the Capsule, [195]. Extraction of the Lens, [195]. Modifications,[201]; Delivery of the Lens by Irrigation, [203]; Extraction of the Lensin 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]. PosteriorSclerotomy, [232]. Paracentesis of the Anterior Chamber, [233]. ForPenetrating Wounds of the Globe, [234]. Electro-magnet Operations—withSmall 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 theCornea, [240]. Operations for Conical Cornea, [241]. Removal ofTumours involving the Cornea, [243]. Tattooing the Cornea, [243].Scraping Calcareous Films, [243]. Operations upon the Conjunctiva—Removalof 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’sOperation, [259]. Operations upon the Socket after Removal of theEye—Paraffin Injection, [260]. Operations for Restoration of a ContractedSocket—Skin-grafting, [261]; Inclusion of Flaps (Maxwell’sOperation), [261][255][262]

CHAPTER VIII

OPERATIONS UPON THE EYELIDS
Surgical Anatomy, [263]. Suture of Wounds of the Eyelids, [263]. Operationsfor Ankyloblepharon, [264]; for Symblepharon, [264]. Upon thePalpebral 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]. Advancementof the Levator Palpebræ Muscle, [272]. Grafting a portion ofthe 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 aFaulty Curvature of the Tarsus—Burow’s Operation, [276]; Streatfield’sOperation, [277]. Transplantation of the Lash-bearing Area—Arlt’sOperation, [278]. Ectropion Operations, [279]—for Passive Ectropion,[280]; Snellen’s Suture Method, [280]; Fergus’s Operation, [281]; Kuhnt’sOperation, [281]; Argyll Robertson’s Operation, [282]. For the Active orCicatricial Form, [284]; VY Operation, [284]; Denonvillier’s Operation,[285]; Fricke’s Operation, [285]; Thiersch’s Skin-grafting, [287]. Repairof 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]. ForObliteration 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 PalpebralPortion, [298]; Removal of the Orbital Portion, [299]. Operations uponthe Orbit—Exploration of the Orbit (Krönlein’s Method), [299]; Eviscerationof 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 ofExamination, [306]; Method of cleansing the Ear, [307]. GeneralConsiderations with regard to Operations—Preliminary SurgicalToilet, [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 theExternal Meatus, [316]. Removal of Foreign Bodies—by Syringing,[322]; by Instruments, [323]; by Post-aural Incision, [326]; by Operationupon the Mastoid, [327]. Operations for Stenosis of the ExternalMeatus, [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]. ArtificialPerforation of the Tympanic Membrane, [340]. Division of the AnteriorLigament, [341]. Division of the Posterior Fold, [341]. IntratympanicOperations, [342]; Division of Adhesions, [342]; Tenotomy of the TensorTympani, [346]; Tenotomy of the Stapedius, [347]. Removal of Granulationsfrom the Tympanic Cavity, [348]. Operations upon the Ossicles—DirectMobilization, [349]; Removal of the Ossicles, [351][335][363]

CHAPTER IV

OPERATIONS UPON THE EUSTACHIAN TUBE
Catheterization, [364]. Passing of the Eustachian Bougie, [369]. Washingout 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’sIncision, [377]. Schwartze’s Operation, [378]. Treatment of SpecialConditions—in an Infant, [389]; Subperiosteal Abscess, [389]; Bezold’sMastoid 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]; Preservationof the Ossicles and Tympanic Membrane, [399]. The Formation of Post-meatalSkin Flaps, [401]. Closure of the Wound, [404]. Skin-graftingafter 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]; Extirpationof 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-duralAbscess, [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]. Openingof 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 ofSymptoms, [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]. Operationby Direct Laryngoscopy, [479][475][486]

CHAPTER II

EXTRA-LARYNGEAL OPERATIONS
Thyrotomy, [487]. Hemi-laryngectomy, [495]. Anatomy of the LaryngealLymphatics, [496]. Total Laryngectomy, [498]. Comparative Results ofExtra-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]. LowerBronchoscopy, [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 CONSIDERATIONSIN 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 LowerAir-passages from the Descent of Blood, [576]. Shock, [577]. Sepsisand 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 andSeptum, [581]. For Congenital Occlusion of the Nostrils, [582]. Removalof Foreign Bodies, [584]; of Rhinoliths, [586]. Operations upon theTurbinals, [586]; upon the Inferior Turbinal, [587]; upon the MiddleTurbinal, [592]. For the Results of Syphilis—Sequestrotomy, [594]; Post-syphiliticAdhesions 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’sOperation, [599]; Moure’s Operation, [599]. For Combined Bony andCartilaginous Deformity—Submucous Resection, [601]. ComplementaryOperations, [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]. Extensionof 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 MaxillarySinus, [626]; Puncturing from the Nose, [626]; from the AlveolarMargin, [628]. Operation through the Canine Fossa only, [631]; theCaldwell-Luc Radical Operation, [631]; Drainage through the NasalWall only, [637]. Operations upon the Frontal Sinus—Catheterizingand Washing out the Frontal Sinus, [638]; Opening the Frontal Sinus inAcute Suppuration, [642]; Killian’s Operation, [642]; the Ogston-LucOperation, [651]; Kuhnt’s Operation, [653]. Operations upon theSphenoidal Sinus, [653]; Sounding and Washing out, [653]; Opening theSphenoidal Sinus, [656]. Operation in Multiple Sinus Suppuration, [659][626][660]

CHAPTER VI

OPERATIONS INVOLVING THE NASO-PHARYNX: OPERATIONS
FOR RETROPHARYNGEAL ABSCESS: OPERATIONS
FORNASO-PHARYNGEAL ADENOIDS
Methods of obtaining Access to the Naso-pharynx through the Nose, [661];through the Mouth, [662]. Retropharyngeal Abscess, [664]. Removalof Naso-pharyngeal Adenoids, [665][661][672]