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]

LIST OF ILLUSTRATIONS

FIG.PAGE
1.Secondary Cancer of the Ovary[15]
2.Secondary Cancer of the Ovary in Section[15]
3.An Infected Fallopian Tube[23]
4.A Tuberculous Fallopian Tube and Ovary: Entire and in Section[24]
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[32]
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[40]
12.The Stump after Subtotal Hysterectomy[40]
13.A Bicornate Uterus[42]
14.A Bicornate Uterus shortly after Delivery[43]
15.Villous Disease of the Uterus[45]
16.An Adenomyomatous Uterus[55]
17.An Adenomyomatous and Tuberculous Uterus[56]
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[91]
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[127]
31.Long-handled Sharp-pointed Scissors curved on the flat[128]
32.Complete Laceration of the Perineum[128]
33.Complete Laceration of the Perineum[129]
34.Laceration of the Pelvic Floor[132]
35.Repair of a Lacerated Perineum, with Non-union of the Sphincter Ani, before a Plastic Operation[133]
36.Repair of a Laceration of the Perineum after a Plastic Operation[133]
37.Auvard’s Self-retaining Speculum[136]
38.Knives for freshening the Edges of a Vesico-vaginal Fistula[136]
39.Toothed Forceps for use in Vesico-vaginal Fistula[136]
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[136]
43.Repair of a Vesico-vaginal Fistula by Dédoublement[137]
44.Repair of a Vesico-vaginal Fistula. Sims’s Operation[137]
45.Stoltz’s Operation for Cystocele[140]
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[154]
56.Hegar’s Dilators (three sizes) for dilatation of the Cervix Uteri[154]
57.Metal Bougies for dilatation of the Cervix[154]
58.Bozemann’s Double-channelled Tube[154]
59.Budin’s Celluloid Catheter[154]
60.Murray’s Flushing Curette; Blunt Curette[154]
61.Dilatation of the Cervix[158]
62.Marckwald’s Operation for Congenital Hypertrophy of the Cervix[160]
63.Hegar’s Operation for Supravaginal Elongation of Cervix[160]
64.Emmett’s Scissors (left) for Trachelorrhaphy[162]
65.Trachelorrhaphy[162]
66.Pedunculated Fibroid Polypi in various Stages of Extrusion[165]
67.Wire Écraseur[166]
68.Submucous Fibro-myomata, capable of Treatment by Morcellement[166]
69.Galabin’s Broad-ligament Needle (right)[171]
70.Jessett’s Broad-ligament Needle[171]
71.Vaginal Hysterectomy[171]
72.Vaginal Hysterectomy. Final stage[172]
73.Schauta’s Needle-holder[172]
74.Window of the Operating Theatre, King’s College Hospital[179]
75.Bull’s-eye Electric Hand-lamp[180]
76.Lang’s Eye Speculum[182]
77.Undine for washing out the Conjunctival Sac[182]
78.Cataract Extraction[183]
79.Sympathetic Ophthalmia[184]
80.Cystoid Scar after Glaucoma Iridectomy[185]
81.An Eye Bandage[186]
82.A Pressure Bandage[186]
83.A Lens Three Weeks after Needling[187]
84.Anatomy of the Anterior Segment of the Eye[189]
85.Eye Speculum[191]
86.Fixation Forceps[191]
87.Secondary Cataract[192]
88.Capsulotomy. The method of incising the capsule[193]
89.Capsulotomy. The method of dividing a dense band[194]
90.Iris Forceps[195]
91.Iris Scissors[195]
92.A Vectis[195]
93.Pagenstecher’s Spoon[195]
94.Lens Extraction[196]
95.The Knife entering the Anterior Chamber in Cataract Extraction[197]
96.Making the Counter-puncture in Cataract Extraction[197]
97.Incision and Iridectomy in Cataract Extraction[198]
98.Opening the Capsule with Forceps in Cataract Extraction[199]
99.Cataract Extraction[200]
100.McKeown’s Irrigation Apparatus for washing out the Anterior Chamber[203]
101.Subconjunctival Extraction[204]
102.Iridotomy[211]
103.Iridotomy[211]
104.Iridotomy by Ziegler’s Method[213]
105.Iridotomy by Ziegler’s Method[213]
106.Iridotomy by Ziegler’s Method[213]
107.Optical Iridectomy[216]
108.Optical Iridectomy[216]
109.Optical Iridectomy[217]
110.The Normal Angle of the Anterior Chamber[217]
111.The Angle of the Anterior Chamber from a Case of Recent Glaucoma[218]
112.The Angle of the Chamber in a Case of Chronic Glaucoma[219]
113.Iridectomy for Glaucoma[219]
114.Iridectomy for Glaucoma[221]
115.Iridectomy for Glaucoma[221]
116.Iridectomy for Glaucoma[222]
117.Glaucoma Iridectomy[223]
118.Prolapse of the Iris through a Punctured Wound of the Cornea[226]
119.Cyclo-dialysis Operation[229]
120.Cyclo-dialysis Operation[231]
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[237]
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[257]
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[273]
143.Ptosis Operation. Advancement of the Levator Palpebræ[273]
144.Treacher Collins’s Entropion Forceps[275]
145.Lid Clamp[277]
146.Streatfield’s Entropion Operation[278]
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[288]
162.Modified Dieffenbach’s Operation. Third step[288]
163.Canaliculus Dilator[290]
164.Canaliculus Knife[291]
165.Lachrymal Syringe[292]
166.Muller’s Retractor for Excision of the Lachrymal Sac[294]
167.Axenfeld’s Retractor for Excision of the Lachrymal Sac[294]
168.Excision of the Lachrymal Sac[295]
169.Excision of the Lachrymal Sac[295]
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[314]
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[332]
184.Wilde’s Snare gripping the Neck of Polypus[332]
185.Polypus arising from the Attic Region[332]
186.Anatomical Preparation of the Middle Ear[335]
187.Paracentesis Knife held in position in the Hand[337]
188.Tympanic Membrane showing Incision in Acute Suppuration of the Middle Ear[338]
189.Line of Incision in Acute Suppuration of the Attic[338]
190.Lines of Incisions in Intratympanic Operations[341]
191.Cutting through Intratympanic Adhesions[344]
192.Free Edge of Tympanic Membrane cut through[344]
193.Sexton’s Instrument[344]
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[352]
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[357]
208.Diagrammatic Section to show Correct and Wrong Positions of Incus Hook[360]
209.Eustachian Catheter[365]
210.Passing the Eustachian Catheter[365]
211.Passing the Eustachian Catheter[365]
212.Passing the Eustachian Catheter[366]
213.Passing the Eustachian Catheter[366]
214.Author’s Graduated Eustachian Bougie[370]
215.Left Temporal Bone, showing Anatomy of the Middle Ear and Mastoid Process[373]
216.Diagram showing Position of Sink Incisions in Post-aural Operations[380]
217.Schwartze’s Operation[381]
218.Schwartze’s Operation[382]
219.Schwartz’s Seeker[383]
220.Schwartze’s Operation completed[384]
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[396]
226.Wolf’s Operation[397]
227.Stacke’s Operation[398]
228.Post-meatal Skin Flaps[401]
229.Post-meatal Skin Flaps[401]
230.Closure of Wound after ‘Radical’ Mastoid Operation[401]
231.Körner’s Post-meatal Flap[402]
232.Panse’s Post-meatal Flap[402]
233.Stacke’s Post-meatal Flap[402]
234.Skin-grafting of Mastoid Wound Cavity after Operation[406]
235.Ballance’s ‘Stopper’ for pushing in the Graft[406]
236.Pipette for sucking Air and Fluid from beneath the Graft[406]
237.Skin-grafting of Mastoid Wound Cavity after Operation[407]
238.Skin-grafting of Mastoid Wound Cavity after Operation[407]
239.Posterior Portion of Skin Graft covering Outer Surface of Wound Cavity[408]
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[434]
244.Diagram to show the usual Points at which the Lateral Sinus is primarily infected[442]
245.The Lateral Sinus exposed and opened[444]
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[450]
249.Free Exposure of the Lateral Sinus, which has been incised, with Ligature of the Internal Jugular Vein[451]
250.Method of suturing the Open End of the Internal Jugular Vein in the Neck[452]
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[479]
257.Tube-spatulæ used for Laryngoscopy[481]
258.Removal of Multiple Papillomata by Direct Laryngoscopy[482]
259.Intrinsic Tumour of the Larynx[487]
260.Extrinsic Tumour of the Larynx[487]
261.Thyrotomy[490]
262.Total Laryngectomy[498]
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[525]
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[539]
273.Trachea showing Ulceration into the Innominate Artery after Tracheotomy[542]
274.Aneurism of the Aorta perforating the Trachea[542]
275.Sarcoma of the Trachea[546]
276.Instruments for Intubation of the Larynx[553]
277.Instruments for Bronchoscopy[560]
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[570]
283.Frontal Search-light[571]
284.Meyer’s hollow Vulcanite Nasal Splint[581]
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[592]
293.First Step in the Removal of the Anterior End of the Middle Turbinal[594]
294.Second Step in the Removal of the Anterior End of the Middle Turbinal[594]
295.Cresswell Baber’s Nasal Saw[597]
296.The Gleason-Watson Operation for Deformity of the Septum[599]
297.Asch’s Cutting Scissors[599]
298.Lake’s Rubber Splint[599]
299.Bayonet Knife[604]
300.Incision for Submucous Resection of the Septum[605]
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[606]
306.The Method of employing Ballenger’s Swivel Septum Knife[607]
307.Submucous Resection of the Septum[607]
308.Submucous Resection of the Septum[608]
309.Submucous Resection of the Septum[608]
310.Semi-diagrammatic Transverse Section of the Nose[610]
311.Operation for Perforation of the Septum[612]
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[619]
317.Lateral Rhinotomy[620]
318.Rouge’s Operation. First stage[622]
319.Rouge’s Operation. Second stage[623]
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[629]
324.Solid Rubber Obturators[629]
325.Antrum Nozzle[629]
326.Washing out the Maxillary Sinus from an Alveolar Opening[630]
327.The Incision in the Caldwell-Luc Operation upon the Maxillary Sinus[632]
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[637]
333.Catheterizing the Frontal Sinus[639]
334.Radiograph to show the Value of the Röntgen Rays[639]
335.Radiograph showing Canula in the Frontal Sinus[639]
336.Killian’s Operation upon the Frontal Sinus[644]
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[645]
341.Hajek’s Bone-forceps[645]
342.Killian’s Operation upon the Frontal Sinus[646]
343.Radiograph of the Sphenoidal Sinus[653]
344.Radiograph of the Sphenoidal Sinus[653]
345.Catheterizing the Sphenoidal Sinus[654]
346.Killian’s Long Nasal Speculum[655]
347.Radiograph showing a Probe in the Sphenoidal Sinus[657]
348.Sphenoidal Punch-forceps[657]
349.Adenoid Curette[667]
350.The Removal of Naso-pharyngeal Adenoids[667]
351.Removal of Naso-pharyngeal Adenoids[668]