Tumor of the hard palate, acute appendicitis, perinephritic abscess : clinical lecture delivered at the Jefferson Medical College Hospital / by W.W. Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
[1893?]
Catalogue details

Licence: Public Domain Mark

Credit: Tumor of the hard palate, acute appendicitis, perinephritic abscess : clinical lecture delivered at the Jefferson Medical College Hospital / by W.W. Keen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    TUMOR OF THE KA^DT^t^ATE; ACUTE APPEN- DICITIS; PERINEPHRITIC ABSCESS. CLINMCAL LECTURK DELIVKRED AT THE JEFFERSON MEDICAL COLLEGE HOSPITAL. BY W. W. KEEN, M.D., LL.D., Professor of the Principles of Surgery in Jefferson Medical College, Philadelphia. Gentlemen—I have three cases to bring before you to-day, one of appendicitis, another a perinephritic abscess, and the third a tumor which arises from the hard palate. I shall operate on the mouth case first, since it is never wise to operate on infectious cases and after- wards on those which are not, lest the later ones become infected and suppurate. TUMOR OP THE HARD PALATE; REMOVAL; RECOVERY. Case I.—This man is twenty-six years of age; his father died of phthisis; his mother is healthy, and he himself has always been healthy until ten years ago, when he noticed a small tumor on the back part of the roof of his mouth. This has gradually increased since, and now he has difficulty in swallowing and talking. When I examine the mouth I find that there is a tumor attached to the roof of the mouth at the junction of the hard and soft palates. It is not connected with the base of the skull, as I have determined by the finger and the laryngoscopic mirror. It is about the size of an egg. There is some bleeding and some discharge. The trouble in these cases is chiefly the hemorrhage. Wliat I pro- pose to do here will be, first, to split the cheek backward and slightly downward so as not to injure Steno's duct, and, as far as possible, to avoid the branches of the seventh nerve. Tiien I can lay his head on one side with a pillow under his shoulder, and the blood can escape sideways and tracheotomy will not be necessary. I will then sever the attachments to the soft {)alate on each side and below, next chisel it loose from the hard palate, seize the mass with a pair of forceps and quickly wrench it loose. I will perform the operation as quickly as pos- 196