84 



Blair Bell 



evident, therefore, that as no assistant is really required for the initial and 

 later stages, these operations can easily be performed without help. But, 

 in order to expedite matters, such as the cutting of ligatures, I was usually 

 assisted by ray then house-surgeon, Mr C. Baxter. 



The brain — that is, the temporal lobe on the left side — was carefully 

 elevated with the special spoon-shaped retractor recommended by Gushing 

 (fig. 7). As soon as the temporal fossa was crossed a thickened ridge of 

 dura mater attached to the inner limit was seen. This marks the outer 

 edge of the sella turcica, or rather the fossa to the edge of which the dura 



Fig. 6. — ■Radiogra])h of dog's head taken during life some weeks after operation, 

 showing the large aperture made in the left side of the skull. 



is attached, and of which the sella turcica is the most dependent part. 

 The long, hooked knife (fig. 8) was then taken, and a slit made in the 

 dura mater above the loAver attachment just mentioned. Care was taken 

 to carry the incision forwards rather than backwards in order to avoid 

 vrounding a large vessel frequently encountered in the dura mater. 

 When the tip of the retractor was passed through the opening thus made 

 a white glistening ridge or strand of reinforced dura was disclosed, and, 

 when the beak was tilted upwards, the third nerve passing from behind 

 forwards and above downwards was brought into view, and in front of 

 this the carotid artery. Between these two structures, but further in, 

 the pituitary body was exposed (fig. 9). This organ was easily recognised 



