Clinical report [on cases in the Edinburgh Surgical Hospital] for the winter session 1834-35.

  • Syme, James, 1799-1870.
Date:
1835]
Catalogue details

Licence: Public Domain Mark

Credit: Clinical report [on cases in the Edinburgh Surgical Hospital] for the winter session 1834-35. Source: Wellcome Collection.

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    of the interrupted suture, except at the two points where the lip was divided, each of which was secured by the twisted suture, a sewing needle being used for the purpose. Cloths moistened with cold water were diligently applied. The wounds healed by the first intention, and the patient was dismissed on the 20th of December with wonderfully little deformity. She continues perfectly well. Though there are unfortunately many malignant tumours of the face which do not admit of being eradicated, it is satisfac¬ tory to find that even those of the most threatening character, which are limited in their osseous connections to the superior maxillary bone, may be removed with complete and permanent relieF. In one of my former Reports (1830) there is related the case of a woman from Galashiels, who was afflicted with a soft, red, and most malignant-looking tumour of the upper jaw, which encroached upon the mouth, and distended the cheek. This tumour was removed by excision of the superior maxillary bone, and nearly five years having now elapsed since the time of the operation, the patient may be considered safe from any return of the disease. She has been provided by Mr Na¬ smyth, with an artificial palate and set of teeth, which render her appearance, mastication, and articulation, hardly at all de¬ fective. To prevent this operation from being misapplied, and losing the confidence which may justly and advantageously be placed in it, the cases admitting of its effectual performance must be carefully distinguished from those in which, from the disease implicating the bones of the nose or the base of the skull, it cannot be of any use. As the external appearance in both these kinds of cases is not unfrequently very similar, the history of the disease should always be attentively considered along with its existing features. Headach, stuffing of the nose, pro¬ trusion of the eye, and expansion of the upper part of the face, must always be regarded as unfavourable signs, especially if ob¬ served primarily or early in the case. On the other hand, cau¬ tion is required lest the operation be employed in cases where it is not really necessary, as when the tumour depends on a cyst containing fluid developed in the substance of the bone. The external appearance and consistence of such swellings closely simulate those of fibro-cartilaginous solid tumours, which, of all the morbid growths in this situation, are the most favourable for removal. But the diagnosis between them may in general be easily effected by pressing with the fingers over the surface of the enlargement, in one or more parts of which the bony shell is usually found so thin as to yield and crackle like a piece of parchment. Gensoul^ relates a case in which the thick- * Lettre Chirurgicale, 1833.