OPERATIONS 



906 



OPERATIONS 



after the evisceration they are brought together and tied. 

 3. For iridodesis ; drawing of the iris through a corneal 

 incision and its ligation with silk. The ligatured loop 

 sloughs oft. 4. Eor keratoconus ; excision of an ellip- 

 tic portion by a two-edged knife. 5. For staphy- 

 loma ; a method of carrying several curved needles 

 through the ciliary region before abscinding the sta- 

 phyloma. 6. For stilliciciium lacrimaritm ; excision of 

 a portion of the posterior wall of the canaliculus, thus 

 forming a reservoir for the tears. 7. For subconjunc- 

 tival sirabotomy ; a small incision is made at the lower 

 edge of the insertion of the internal rectus, close 

 to which the tendon is divided. A small counter- 

 puncture may be made at the upper edge of the 

 tendon for the escape of the effused blood. Croft's : 

 I. For exposing the antrum ; an incision is made from 

 the ala nasi to the nasal process of the superior maxil- 

 lary bone, then along the margin of the orbit ; the 

 nasal process is cut through with forceps, the peri- 

 osteum stripped off and a portion of bone removed. 2. 

 Plastic ; a bridge of sound skin is raised and separ- 

 ated from the subjacent tissues, except at the extremities, 

 by means of oiled silk. After granulation has been es- 

 tablished the adjoining contracted (cicatricial) struc- 

 tures are divided and the bridge of skin severed at one 

 end, and made to occupy the gap. Crosby's, for back- 

 ward dislocation of the first phalanx of the thumb ; 

 the phalangeal portion of the thumb is first raised to a 

 right angle with the metacarpal bone ; the proximal 

 phalanx is then pressed from behind forward. (An 

 old method, having been practised by Sir C. Bell 

 and by Gerdy.) Curling's, for varicocele ; a straight 

 pin is passed between the vas deferens and the veins 

 about two inches above the testicle, and another three- 

 quarters of an inch below this point. A figure-of-eight 

 ligature is then applied and the veins are divided 

 subcutaneously between the pins. Cusack's, for hemor- 

 rhoids ; removal by the clamp and cautery. Cushing's 

 (If. IV.), for suture of the intestine ; a right-angled con- 

 tinuous suture is introduced, the needle passing through 

 the serous and muscular coats of the bowel only. 

 Czerny's (V.) '• I. For the radical cure of inguinal 

 hernia ; the sac is exposed and isolated ; the neck is 

 tied with a strong catgut ligature, and amputated below 

 this point ; the stump is pushed into the abdominal 

 cavity ; the borders of the opening are freshened and 

 united by continuous catgut sutures. 2. For the re- 

 moval of tonsillar tumors ; tracheotomy is performed 

 and the larynx or fauces plugged. The growth is then 

 exposed by cutting downward and outward from the 

 angle of the mouth to the anterior border of the mas- 

 seter, and sawing through the lower jaw, between the 

 second and third molar teeth. 3. For suture of the 

 intestine ; a modification of Lembert' 's suture, in 

 which there is inserted an inner row of interrupted 

 sutures which unite the mucous membrane only. 4. 

 For vaginal hysterectomy ; the uterus is drawn down 

 by Muzeux's forceps and the vaginal vault is completely 

 opened around the cervix. The uterus is separated 

 from the bladder with the finger. A free incision is 

 next made in Douglas's cul-de-sac, when the uterus 

 is turned backward, and brought through the vaginal 

 incision. The peritoneum is now separated anteriorly 

 and the broad ligaments are ligated in from three to six 

 portions on each side. Czerny-Schroder's. hyster- 

 ectomy. See Czerny's hysterectomy. Dallas', for 

 the radical cure of inguinal and femoral hernia ; after 

 a transverse incision through the integument a special 

 instrument is introduced to produce abrasion of the 

 hernial canal ; the instrument is then withdrawn, and 

 the external wound sealed with iodoform-collodion, and 

 a compress applied. The canal is obliterated by the 



resulting inflammatory action. Davat's, for varico- 

 cele : after separating the vas deferens from the veins, 

 an acupressure pin is passed through the scrotum. By 

 means of a perineum needle a thread is carried sub- 

 cutaneously over the veins through the same skin- 

 punctures as the needle has made. The loop is then 

 slipped over the head of the pin and tied tightly over 

 the needle. A cork is now placed on the point of the 

 pin. Daviel's, for cataract; extraction through a 

 large corneal incision downward, without an iridec- 

 tomy. Davies-Colley's : I. Osteotomy for tali- 

 pes ; resection of a wedge of bone from the outer side 

 of the tarsus without regard to the articulation. It 

 always includes portions of the os calcis, cuboid, 

 astragalus and scaphoid bones. 2. For urano- 

 plasty; a triangular muco-periosteal flap is dis- 

 sected from one side of the cleft, while on the other 

 side a raw surface is prepared by reflecting a longitu- 

 dinal flap in such a way that it can be turned, as on a 

 hinge, into the cleft. The first flap is then implanted 

 upon the second. Davy's, for osteotomy ; the same as 

 the Davies-Colley's operation. Dece's, for webbed 

 fingers ; a fold of skin is pinched up near the base of 

 the web, and dissected toward the commissure ; the 

 fingers are then kept apart. Delagarde's, to improve 

 a stump; stitching of the extensor tendons into the 

 tissues of the sole-flap in Chopart's amputation, to 

 prevent tilting upward of the heel and downward 

 of the scar. Delore's. See Redressement force. 

 Delpech's: I. For ligation of the first part of the 

 axillary artery : an oblique incision is made down- 

 ward along the gap that separates the pectoralis major 

 from the deltoid, starting from the clavicle. 2. For 

 tirethroplasty ; a single flap is raised and carried across 

 the fistula to a new surface prepared for it. Del 

 Toro's, for conical cornea; destroying the apex by 

 means of a white-hot knife. Demarquay's.for naso- 

 pharyngeal tumor ; an incision is made from the in- 

 ternal angle of the eye along the nasal furrow to the 

 free margin of the nose ; it is then carried outward 

 horizontally to the margin of the masseter- muscies. 

 Liston's forceps are used to remove sufficient bone 

 to expose the tumor. Denans', for enterorrhaphy ; 

 the joining of the serous surfaces of the cut intesl 

 by means of three metallic tubes. Dennis', for 

 Hon of the internal iliac artery ; it is done by a celiot- 

 omy, the abdomen being opened in the middle line 

 by an incision extending from the symphysis pubis to 

 the umbilicus. Denonvillier's, for rhinoplasty : a 

 triangular flap is raised from the side of the nose above 

 the defective ala, with its pedicle internal, and is then 

 displaced downward into position. Desault's (P. f.) : 

 I . For double hare-lip ; gradual and continuous i 

 ward pressure of the pre-maxillary bone, by means ol • 

 bandage. 2. For a preternatural anus : a plug is 

 placed in the two ends of the intestine so that its mid- 

 dle rests on the spur of mesentery ; when the latter 

 has been sufficiently obliterated, the plug is rem 

 • and an external obturator bandage is applied. 3 

 restoration of Stensen's duct ; a seton is passed thr< 

 the cheek into the mouth in the course of the 

 When the patency of the new duct has been establb 

 the seton is removed and the external aperture I 

 closed. 4. Tear stricture of the lacrymal duct ; tin 

 plication of cauterants by means of threads p; 

 through the duct. Desmarres' : I. Jridectc 

 after incision of the cornea with eye-forceps, 

 iris is drawn out and excised. 2. For pterygium; 

 detachment and transplantation of the pterygium. 

 Desprez', for naso-pharyngeal polypus : removal by 

 an osteoplastic operation through the nose. '1 he car- 

 tilaginous part of the nose is turned over to one side 



