216 ANTHROPOLOGY. 



opposite side. The position of the side bands is secured by the six strings 

 attached to the cap. 



Fig. 27 represents the flap of skin dissected from the arm and attached to 

 it only by its base. It is cicatrized along its margin and under surface, and 

 thereby prepared for attachment to the stump of the nose. 



10. Extirpation of poetions of the Tongue. 



For this operation will be needed a piece of cork, and a polypus forceps, 

 or Muzeux' tenaculum forceps {pi. 110, fig. 12). It will sometimes be 

 necessary to pass a string or loop through the sound part of the tongue, for 

 the purpose of drawing it out daring the operation, and for stopping the flow 

 of blood. There will also be required a straight, a sharp, and a blunt bis- 

 toury, a Cooper's scissors, ligature apparatus, cautery irons, cold water, ice, 

 &c. The tongue of the patient is to be protruded as far as possible, and 

 held by forceps or a loop. The operation itself is conducted either by means 

 of an incision or by ligature. 



PI. 139, fig. 30 : at the points g and /<, two needles are passed through 

 from beneath, each provided with a separate and a common thread, the 

 latter of which, g, k, /;, /, is tied on the back of the tongue ; the two former, 

 g, I, on, and A, n, o, are fastened in the edges. For removing the small por- 

 tion of the side of the tongue, a needle with a double thread is passed 

 through at j), and the two ends of those tied together at q and r. 



11. OEsophagotomy. 



This is resorted to sometimes for the removal of foreign bodies, partly for 

 the purpose of introducing food. 



For the first end, three methods have been proposed, that of Eckholdt 

 with the most favor. The operation is to be performed in the triangular 

 space included between the two crura of the sterno-cleido-mastoid and the 

 clavicle. The skin is in an obliquely transverse fold, and an incision made 

 of about two inches in length, running downwards and inwards to the 

 sternal end of the clavicle, and the platysma separated. Should the space 

 between the muscular portion be too much confined to permit a sight of 

 the laryngeal nerve lying along the oesophagus, the angle of the two heads 

 is opened up on a director by introducing this close behind the muscle, and 

 thus avoiding any danger of injuring the inferior thyroid artery and the 

 omo-hyoid muscle. The omo-hyoid may be then pushed up, the carotid 

 artery and jugular vein outwards, the oesophagus laid bare, and then opened 

 either against the foreign body or a small aperture made and enlarged with 

 forceps, or by the introduction of a director. 



PL 139, fig. 32, the lips of the incision are separated by means of two 

 double tenacula : ', sternal, ^ clavicular portion of the sterno-cleido-mastoid 

 muscle ; ', sterno-thyroid muscle ; ', omo-hyroid do. ; ', thyroid gland • 

 922 



