A dictionary of practical surgery: comprehending all the most interesting improvements, from the earliest times down to the present period : an account of the instruments, remedies and applications employed in surgery : the etymology and signification of the principal terms : ... forming together a "catalogue raisonné" of surgical literature (Volume 2).

  • Cooper, Samuel, 1780-1848.
Date:
1823
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical surgery: comprehending all the most interesting improvements, from the earliest times down to the present period : an account of the instruments, remedies and applications employed in surgery : the etymology and signification of the principal terms : ... forming together a "catalogue raisonné" of surgical literature (Volume 2). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    TONSIL* kinds of carved scissors, or knives. Instead of the simple tenaculum used by the ancients, a sort of double one came into fashion. Bichat describes the following, as once the common plan: the surgeon is to open the mouth very wide, and depress the tongue with any flat instrument, which is to be held by an assistant. The operator is then to take hold of the diseased tonsil with a tenaculum, and with a common scalpel, having the back half of its blade covered with rag, he now removes as much of the tonsil as ought to be taken away. In com- mon cases, it is deemed sufficient to cut on a level with the pillars of the velum pendu- lum palati. Any other portion, needing re- moval, should next be taken away. The operation being finished, the patient is fre- quently to wash his mouth with proper gar- gles. The preceding method was long adopted by Desault. However, one objection is urged against it, viz. that when the end of the knife is conveyed far into the mouth, it may do mischief, not (as has been alleged) to the internal carotid artery, the backward situation of which completely keeps it out of all danger of !>eing wounded, but to the membranous covering of the palate, in a place not corresponding to the tonsils. De- sault thought this objection was the more forcible, as when the hook is introduced in- to the tonsil, the danger of the above mis- chief is considerably increased by a general spasm, which seems to affect every part of the mouth. Hence this eminent surgeon used to employ, for the removal of diseased tonsils, an instrument, which was first in- vented for dividing cysts of the bladder. It consisted of a sharp-edged blade, which was included in a silver sheath. The latter had at its extremity a kind of notch, in which the gland, which was to be extirpated, was re- ceived. The rest of the instruments were similar to those commonly used. Desault proceeded as follows: 1. The patient being seated on a high chair, with his head supported on an assist- ant's breast, he is to open his mouth very wide, and the lower jaw is to be kept thus depressed, by some solid body placed be- tween the teeth, and held there by an assist- ant. 2. The tongue is to be kept down with a broad spatula. 3. The surgeon is next to take hold of the tonsil with a double hook, with which lie is to raise and draw it a little towards him. He is then to take the above cystitome, and put the tonsil in the notch, on a level with the place where the incision is intended to be made. 4. When the portion which is to be ct?t off, is engaged in the notch, the operator is to draw the part towards him, so aa to stretch it, and press the instrument against it from below upward. The blade being next pushed across the tsoti h, the necessary section is accomplished. When the division articutarly to happen, when the diseased gland considerable magnitude the blade is drawn back, and the section completed by applying the instrument to the wound, which it has already made. Soint even a third application may possibly be- come requisite. 5. The patient is to be directed to wash his mouth. Bichat states, that this plan of operating, adopted by Desault, is as simple and easy as the method above related, with the advantage of beinji saler. Such is the construction of the blade of the instrument, that when it slides across the notch, it presses against, and steadily fixes the parts which are to be d.vided ; an advan which neither the knife nor scissors have, under the action of which the part quite moveable. Hence there is diflkulty in cutting them. When the introduction of the instrument from above downward ia difficult, it is better to withdraw it; and, after turning the notch iu the opposite di- rection, pass it from below upward. In general, however, the first of these methods is preferable, because the gland, when half cut through, cannot now fall back and ob- struct the ritna glottidis, so as to bring on danger of a sudden, suffocation ; a circum- stance which Wiseman and Moscati saw happen. With a view of preventing tlii; occurrence, Louis recommended the com- mon scalpel to be used, with its edge direct- ed upward, as has been advised for above instrument; which latter contrivance, however, being, according to Bichal's ac- count, more easy and safe, merits the pre- ference. Besides the advantage of fixing the soft parts, which are to be cut, it has that of not contusing them, like most other instruments ot this nature, as, for instance, scissors. The oblique disposition of its blade enables it to divide parts, in the man- ner of a saw. This invention, as Bichat allows, is cer- tainly increasing the number of surgical in- struments ; a thing, which all the best mo- dern surgeons endeavour to avo.d But it is to be recollected, that this instrument is not exclusively applicable to any particular operation. It may be employed for cutting away the tonsils and uvula ; dividing mem- branous fra;:ia in the rectum, vagina, and bladder; amputating luugous excrescen- ces, polypi of the nose, (if this mode of extirpating them were preferred) and va- rious tumours in general, which are deeply situated in different cavities of the body, where instruments introduced unguardedly might injure parts which should be avoided, or where the base of the tumour should be steadily fixed, when its division is to be ac- complished. The latter object cannot safely he effe.-ted by scissors When the base ot the 'u«i;our is too large to be received inth<! notch, one part is first to be divided, and then another, till its whole thickness i through. In England, when a diseased tonsil be cut away, surgenns srenerall .