OPERATIONS 



910 



OPERATIONS 



part of the scrotum, and the skin is divided between 

 the two by transfixion ; the veins are then secured in a 

 loop of platinum wire attached to a battery. Gouley's : 

 (_/. IV. S.) I. For external Urethrotomy ; a small conduc- 

 tor is passed through the stricture, and, guided by this, 

 the stricture is divided and a catheter conducted into the 

 bladder. 2. For extirpation of the penis ; a curvilinear 

 incision is made on either side of the root of the 

 penis ; the cavernous bodies and the urethra are 

 transfixed with needles, and the organ is amputated 

 y% inch in front of these ; a grooved staff is passed 

 into the bladder ; a sharp-pointed scalpel is carried 

 through the perineum and lodged in the groove of the 

 staff, and all the tissues are divided from behind for- 

 ward ; the urethra is stitched to the skin ; the crura are 

 removed. 3. For hypospadias ; a flap is removed from 

 either side of the normal site of the urethra, and the 

 skin brought forward so that the denuded surfaces 

 are doubled on themselves ; they are then secured 

 by stitches. 4. For internal urethrotomy ; it is 

 done with a special tunneled urethrotome after 

 Maisonneuve and Voillemier ; or, with a special 

 dilating instrument. Goyrand's (A 7 !) : I. P 'or divi- 

 sion of the contracted palmar fascia ; a longitudinal 

 incision is made in the skin in the long axis of the 

 contracted band, which, when exposed, is divided 

 transversely. 2. For ligation of the internal mammary 

 artery ; an oblique incision two inches long is made at 

 the end of the intercostal space near the edge of the ster- 

 num. Von Graefe's : 1. For cataract ; extraction of 

 the cataract through a scleral incision, with iridectomy 

 and laceration of the capsule. 2. Y ox conical cornea ; 



(a) A small portion of the cornea is removed in the 

 immediate vicinity of the apex of the cone, without 

 perforation, in order to induce cicatricial contraction. 



(b) The production of an ulcer at the apex of the cornea 

 to give rise to cicatricial contraction. 3. For dacryops ; 

 the introduction of a fine thread through the lacrymal 

 duct and anterior wall of the cyst; the ends are tied 

 and the ligature is allowed to slough through, or the 

 tissue may be divided after a few days. 4. For 

 ectropion ; the denudation of a wedge-shaped portion 

 of the lid, and the edges brought together byahare-lip 

 suture, after an incision in the cheek, parallel with 

 the margin of the orbit. 5. For entropion; {a) two 

 vertical incisions are made through the skin of the 

 upper lid, which lid is split into an anterior and a poster- 

 ior leaf, and the cutaneous margins are entered higher 

 up along the vertical incisions. (b) A horizontal 

 incision is made through the skin of the upper lid, and 

 a triangular piece of skin, with its base downward, 

 is removed ; also a triangular portion of the tarsus, 

 base upward, is removed ; the wound is then sutured, 

 6. For evisceration ; removal of the cornea and ad- 

 jacent zone of the sclera ; the contents of the eye- 

 ball are entirely scooped out with a spoon, and the 

 opening is closed with sutures. 7. For fistula of the 

 lacrymal gland ; extirpation of the gland. 8. For 

 prolapse of the lower lids; excision of a triangular 

 portion of skin, and closure of the wound vertically. 

 9. For ptosis ; excision of the fibers of the orbicu- 

 laris muscle. 10. For retinal detachment ; incision 

 of the retina by a needle made to penetrate the 

 vitreous chamber through the sclerotic, near the cornea. 

 11. For rhinoplasty; the same as the Tagliaco- 

 tian method, q. v. 12. For single hare-lip ; the edges 

 are prepared by an arch-like incision and brought 

 together with the muco-cutaneous margins even. 13. 

 For staphyloma ; the production of suppurative choroid- 

 itis, followed by natural atrophy of the globe of the 

 eye. 14. For strabotom r ; a small incision is made mid- 

 way between the center and the lower edge of 1 lie mus- 



cle's insertion (internal rectus) near the edge of the 

 cornea ; a hook is introduced from below upward 

 and the tendon is divided close to its insertion. 15. 

 For trichiasis ; a modification of A r if s operation ; the 

 lid is split into two flaps, and the flap containing the 

 hair-bulbs is transplanted away from the margin of the 

 lid after two vertical incisions have been made on 

 either side. Graefe- Romberg, for blepharospasm ; 

 division of the supraorbital nerve. Green's: 1. Vox en- 

 tropion ; an operation combining the essential features 

 of the Arlt-Jaesche and Anagnostakis' operations, but 

 the chief feature is that the sutures are made to include 

 the upper border of the tarsus and the tendon of the 

 levator. 2. For readjustment of the levator palpe- 

 brce muscle ; dissection through the upper border of 

 the upper lid to reach the eyeball, without opening 

 the conjunctival sac, followed by suture of the tendon 

 of the levator. Gritti's (A'.), fox amputation above the 

 knee-joint ; the patella is preserved in a long anterior 

 flap, and, having had a thin slice removed from its 

 deep surface, is secured in apposition with the femur, 

 the latter having been deprived of its articular surface 

 by being sawn through the condyles. Gross' (S.D.): 



1. For amputation of the foot ; a modification of Syme's 

 operation ; the plantar incision is made further an- 

 teriorly, thus affording greater chances of a good blood- 

 supply. 2. For amputation of the great toe ; the 

 operation is performed through the continuity of the 

 metatarsal bone, not at the articulation ; there is a dor- 

 sal incision. 3. For varicocele ; subcutaneous ligation 

 with a stout cord or silver wire and a cork compress. 

 Gross' (S. IV.), for internal urethrotomy ; a special 

 exploratory urethrotome is used to divide the stricture 

 from within outward. Grossmann's, for retinal de- 

 tachment ; aspiration of the effused sub-retinal fluid 

 and slow injection of a warm saline solution into the vit- 

 reous. Gruening's : 1. For pannus ; curetting of the 

 cornea. 2. For removing steel or iron from the eye ; 

 by means of a magnet the foreign body is drawn out 

 through the original wound, or extracted through an 

 incision made in the sclera, when the panicle can be 

 drawn to a favorable site. Guerin's : 1 . For ampu- 

 tation at the elbow -joint ; by a single external flap. 



2. For carbuncle. See French's opera/ion. 3. I'or 

 excision of part of the upper jaw ; a curved incision, 

 with its convexity outward, is made from the ala of 

 the nose to the angle of the mouth ; the soft parts 

 are dissected up, the nostril opened, and the bone re- 

 moved by dividing the hard palate in the middle line 

 and its facial aspect outward to the maxillary tuberos- 

 ity. 4. For iridotomy ; a crucial incision of the iris 

 through the cornea. 5. For the removal of a naso- 

 pharyngeal polypus ; by removal of part of the upper 

 jaw. See Guirin's excision of part of the upper jaw. 

 6. F or subconjunctival strabotomy ; a Z-shaped tend 

 tome, introduced between the muscle and the sclera, 

 divides the former when the cutting-edge of the instru- 

 ment is turned forward, and a slight sawing motion is 

 applied. Guerin and Brodhurst's, for congenital dis- 

 location of the hip ; subcutaneous division of the stronger 

 muscles connecting the femur and the pelvis, followed 

 by continuous extension. Guerin and Desmarre's, 

 for corectopy ; by means of a punch-like knife a small 

 portion of the cornea is removed, into which opening t8| 

 iris falls, and is retained by adhesions. Giinther's, for 

 amputation at the hip-joint ; disarticulation by a modi- 

 fied oval method, with the summit of the incision on the 

 outer side. Gussenbauer's : I. For suture oj the in- 

 testine ; it combines the Czerny and Lembert suturom 

 one. but does not traverse the mucosa. 2. Vox tapping 

 the pericardium ; resection of part of the fifth lib. 9J 

 lowed by incision of the pericardium. Guthrie's: I- 





