On the operative surgery of malignant disease / by Henry T. Butlin ; with the co-operation of James Berry (The thyroid) W. Bruce Clarke (The kidney) Alban Doran (The ovary and uterus) Percy Furnivall (The stomach, intestine, and rectum) Walter Jessop (The eye) H.J. Waring (The liver and gall-bladder).

  • Butlin, Henry T. (Henry Trentham), 1845-1912.
Date:
1900
Catalogue details

Licence: Public Domain Mark

Credit: On the operative surgery of malignant disease / by Henry T. Butlin ; with the co-operation of James Berry (The thyroid) W. Bruce Clarke (The kidney) Alban Doran (The ovary and uterus) Percy Furnivall (The stomach, intestine, and rectum) Walter Jessop (The eye) H.J. Waring (The liver and gall-bladder). Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    are raised. A tooth is extracted in front of the tumour, and, through the socket, the bone is divided with a saw or large pair of bone-forceps. The affected half is drawn outwards with the lion-forceps, and the tissues are divided close to it on the inner side. In order to free the coronoid process, the jaw is drawn forcibly downwards. The internal maxillary artery and the facial nerve are avoided by keeping close to the inner and outer surfaces of the ramus of the jaw. After the coronoid process has been freed, the joint comes into view, is opened in front, the condyle dislocated, the knife carried cautiously behind it, and the bone finally removed by wrench- ing through the remaining fibres of the external pterygoid muscle. For the safer conduct of the later steps of the opera- tion, a flat bone-elevator may be employed instead of the knife ; there is then less danger of wounding the maxillary artery. When the tumour is very large, a vertical incision through the lip is very desirable, in order to allow of a thorough exposure of the disease; and, as the large size of the growth may hinder the dislocation of the condyle and the freeing of the coronoid process, Mr. Heath recommends the division of the process with bone-forceps, and to remove as much of the disease as possible below the joint, clearing out the remainder and the condyle when the main mass of the tumour has been removed. Again, when the tumour has extended so far round the front of the bone as to necessitate the removal of the symphysis, there is a danger that the tongue may fall back during and afcer the operation, and suffocate the patient. To avoid this accident, a thread should be passed through the tip of the tongue with which to draw it forward. During the whole of the operation it is the duty of the assistants to keep the mouth clear of blood and to prevent the blood finding its way into the trachea and lungs. Vessels should be tied or clamped as soon as they are divided ; and, when the disease has been removed, the wound must be as quickly as possible cleansed, and bleeding points secured. The surface may then be covered with iodoform powder, or plugged with gauze. After the operation, it is not usually necessary to feed the patient through a tube. But, if the parts removed are very extensive, and the patient's condition is seriously affected by