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.

    6/16 (page 196)
    sible, ou account of licmorrhagc. Speed but not haste will be my object. Two or three sponges pressed firmly upon the bleeding surface will arrest most of the hemorrhage, and if pressure does not stop the bleeding I will tie any large vessel, or, if necessary, use the Paquelin cautery. In some of these cases it is difficult to get a good light, and I propose to have a mirror witli a small electric light attaclied to my forehead, so that I can throw the light in the back of his throat, if necessary. In these cases you must always operate as quickly as possible, not wasting time over each bleeding vessel (except those in the cheek incision), until the tumor is removed. You must operate quickly, too, for another reason,—namely, that you cannot give ether while operating, and you wish to avoid pain by the speedy termination of the operation. I have now split the cheek and controlled the hemorrhage. Next I get him well etherized again, and now you see the tumor. It is, as I said, about as large as an egg. I think it is a sarcoma of the spindle- cell variety, but it is rather hard, and may be a fibroma, which will have to be determined by an examination with the microscope. The tumor having been quickly removed as above described, I find the hard palate has been left intact except at one small point, and that only the anterior layer of the soft palate has been removed. The bleeding is not very serious. Pressure has stoj^iped most of it very readily, and the Paquelin cautery does the rest. The wound in tlie cheek is then sutured and dressed. [The microscopic examination showed the tumor to be a small spindle-celled sarcoma. The patient easily recovered, and went home in ten days, with a healing ulcer in the roof of the mouth.] APPENDICITIS; OPERATION; EECOYEKY. Case 11.—This case is an admirable lesson upon the need of oper- ation in appendicitis in spite of seeming but delusive betterment. I wish you to understand it thoroughly, as you will often have to deal with its like, and the treatment of late years has improved amazingly, owing chiefly to the labors of American surgeons. Several series of post-mortem examinations have shown us that about one-third of all adults, taken indiscriminately, at some time or other during their lives have suffered from attacks of appendicitis from which they have recov- ered. It is, therefore, a very common disorder, though it is by no means always recognized, for the attacks, unless severe, are often be- lieved to be simply colic or other mere intestinal disorder. Willard Parker, who, in 1867, was the first to impress upon the profession the