The first lines of the practice of surgery: designed as an introduction for students, and a concise book of reference for practitioners (Volume 1).

  • Cooper, Samuel, 1780-1848.
Date:
1822
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Licence: Public Domain Mark

Credit: The first lines of the practice of surgery: designed as an introduction for students, and a concise book of reference for practitioners (Volume 1). 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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    When ranulae have become as large as a walnut, they some times burst spontaneously, and a cure may be the consequence .• though in general the opening is not large enough ; or calca- reous matter exists in the sac, and the cure is incomplete. TREATMENT. From what has been stated, it might be inferred, that the cysts of these swellings ought to be dissected out, in the same manner as those of ordinary encysted tumours. Owing to the particularity of the situation of rauulae, this is not exactly the case. If the surgeon were to endeavour to take out the whole sac, he could hardly avoid wounding the raninal artery, the hemorrhage from which might prove excessively trouble- some, and even fatal. Practitioners in this country are, in general, content with laying open the tumour from one end to the other ; squeezing out its contents; and removing every particle of calcareous matter, that can be felt within the wound. Foreign surgeons, after opening the tumour in this manner, very frequently cut away the whole anterior portion of the sac with scissors, and even attempt the destruction of the rest by applying caustics to it. Cutting away a portion of the sac is, perhaps, the surest mode of cure ; for when a mere incision is too small, or closes prematurely, the disease generally recurs.* After making a free opening into the swelling with a knife, the surgeon can easily cut off a part of the edges of the incision, either with the same instrument, and a pair of forceps, or with a pair of scis- sors, as he may prefer. It was in this manner, that my friend Mr. Lawrence lately treated, with perfect success, an enormous ranula, which formed a large prominent swelling, extending from the sym- physis to the angle of the jaw. When the substance of a tumour beneath the tongue is fat, as soon as the surgeon has ascertained.the nature of the case by an incision, his best plan is to take hold of the swelling with a hook, draw it forward, and carefully take it out, by de- taching it from the surrounding parts in front with a bistoury ; and breaking the connexion, on the side towards the raninal artery, with his fingers. This may be safely and easily done. * J'en ai ouvert plusieiirs; et il est presque toujours arrive, Lorsque 1 incision n'avoit pas ete assez etendue que les levres de ia plaie se reunis- soient; et la tumeur se reproduisoit queique tems apres. Louis, in Mem de l'Acad. de Chirurgie, torn. ix. p. 96. edit. 12mo.