OPERATIONS 



Madelung's, for lumbar colotomy ; a modification of 

 Bryant's operation in which the lower end of the 

 colon, after being completely detached, is closed by 

 invagination and two rows of sutures, and dropped 

 back into the abdomen. Maisonneuve's : I. 

 A method of performing amputations; it is also 

 called the diaclastic method, and was devised for the 

 purpose of avoiding hemorrhage, infection, and other 

 accidents ; the bone is first broken with an osteoclast 

 and the soft parts are divided by means of an ecraseur. 

 2. For excision of the elbow ; it is done through a pos- 

 terior median incision. 3. For excision of the rectum; 

 a circular incision is made around the anus, and several 

 needles, armed with ligatures twelve inches long, are 

 passed into the incision and through the bowel above 

 the growth, and brought out of the anus and made to 

 retrace their course — one free extremity of the thread 

 presenting at the anus, and the other in the wound. 

 A whip-cord is passed through the loops of thread in 

 the anus, when traction on the ends in the wound 

 draws the cord through the bowel after the ligatures. 

 The bowel is divided by allotting each loop of cord to 

 an ecraseur. 4. For excision of the tongue; a modifi- 

 cation of Jaeger's operation, q. v. 5- for excision of 

 part of the upper jaw; Guerin's operation, slightly 

 modified. 6. For excision of the 7orist; it is done by 

 a single median dorsal incision. 7. For internal 

 urethrotomy ; a special urethrotome is used to divide 

 the stricture from without inward. 8. For oophorectomy; 

 the entire pedicle is twisted. 9. For the removal of a 

 naso-pharyngeal polyp; a slight modification of 

 Guerin's operation ; an incision is made in the me- 

 dian line, from the junction of the hard palate down 

 into the body of the uvula as far as is necessary, its free 

 border being preserved. Malgaigne's (f. F): 1. A 

 method of performing amputations ; it is a variety of 

 oval amputation in which the spiral incisions are con- 

 tinuous above with a single longitudinal one, so that 

 the gaping wound has the form of a racket. 2. For 

 utation of the arm ; a single rounded flap is cut, 

 usually from the flexor surface of the arm. 3. For 

 amputation through the foot ; subastragaloid disarticu- 

 lation by a single, large, internal flap, the astragalus 

 only being left. 4. For amputation at the hip-joint ; 

 a modification of Ravatori s amputation, in which the 

 vertical incision is shorter and the circular incision 

 more oblique. 5. For chiloplasty ; two lateral in- 

 cisions are made on either side of the lower Up to re- 

 store this portion by the sliding method. 6. For ex- 

 cision of the shoulder ; it is done by a single anterior 

 vertical or oblique incision. 7. For hare-lip; the 

 same as Clemofs operation. Manec's, for amputa- 

 tion at t/ie hip-joint ; a single long anterior flap is 

 1 made by transfixion ; the joint is then disarticulated, 

 \ and a circular incision made posteriorly. Manne's, 

 i for the removal of a polyp from the nasopharynx ; an 

 : incision is made through the soft palate with a bis- 

 toury, in the median line, from the tip of the uvula 

 : to its junction with the hard palate ; after removal of 

 yp, the parts are restored by one or more 

 sutures. Margary's, for congenital dislocation of the 

 the formation of an acetabulum in the normal 

 '. position, reduction of the femur, and the formation of a 

 i capsule from the periosteum. Marian's, for Iithot- 

 | omy ; the old median perineal operation for stone 

 • in the bladder. See Lithotomy. Markoe's, for 

 le ; a modification of Vidafs method, in 

 which the pin is dispensed with, and a loop of silver 

 wire is clamped to a lead plate ; the wire is gradually 

 tightened. Martin's (A.) : I. Yen lacerated perineum ; 

 . a modification of Freund 's operation, in which the 

 ; vaginal tongues are denuded more deeply into the 



917 OPERATIONS 



vagina, and the vulval denudations are carried higher 

 up. 2. For the radical cure of hydrocele ; the in- 

 jection of tincture of iodin after aspiration. 3. 

 For vaginal hysterectomy ; an incision is made 

 around the posterior margins of the cervix until the 

 peritoneum is reached; the edges of the vaginal 

 wound are then sewn parallel to the incision to bring 

 the peritoneum and vaginal wall together and so 

 arrest hemorrhage ; the broad ligaments are ligated 

 with silk ligatures in successive portions ; the cen- 

 tral fissure is now incised, the bladder separated, the 

 cervix freed from the broad ligament on either 

 side, the fundus retroflexed, and the remainder of 

 the broad ligaments ligated and severed ; a drainage- 

 tube is inserted into Douglas" s space. Martino's, for 

 the remedy of a large and prominent ear ; a V- 

 shaped piece is removed and the wound closed by 

 sutures. Mason's: I. For osteoplasty ; a modifica- 

 tion of Dieffenbach? s operation in which holes are 

 punched, as a preliminary step, along the line the 

 chisel is subsequently to take. 2. For rhinoplasty ; it 

 consists in bringing across the gap two lateral and one 

 superior flap of integument as a base of support for 

 the frontal flap. 3. For uranoplasty ; perforation of 

 the bone at several points in the line of the lateral in- 

 cision before applying the chisel, to prevent com- 

 minution. Masslorsky's, a method of performing 

 oophorectomy ; double flaps are made of the pedicle, 

 and these are stitched together. Mastin's, for in- 

 ternal urethrotomy ; it is done with a modification 

 of Maisonneuve's urethrotome. Mathews': 1. For 

 fistula in ano ; after dilating the sinus with a laminaria 

 tent, a urethrotome is introduced to the full depth of 

 the sinus, the knife is protruded, and the instrument 

 withdrawn ; the operation is repeated with the knife 

 in the opposite direction. Mathews has devised a 

 special fistulatome for this purpose. 2. For inguinal 

 colotomy; the incision is made two-thirds above and 

 one-third below, and at right angles to a line drawn 

 from the anterior superior spine of the ilium to the 

 umbilicus, one and a half inches from the spine ; when 

 the bowel is brought out of the wound, two large pins 

 are passed parallel and close together through one 

 edge of the incision, through the mesentery near the 

 bowel, and out at the other wound-margin ; the oper- 

 ation is completed by stitching the bowel to the skin; 

 the colon is incised at a later period. Mathewson's, 

 for exostosis of the external meatus ; removal by a drill. 

 Maunoir's, for iridotomy ; incision of the cornea 

 and removal of a triangular flap of the iris, the apex 

 of which is toward the pupil. Maunsell's, for intes- 

 tinal anastomosis ; after dividing the gut, circularly, at 

 the proper points, a longitudinal incision about an inch 

 and a half long is made in the larger segment oppo- 

 site the mesenteric attachment ; a long suture is then 

 passed through all the coats of the two divided ends 

 at the mesenteric attachment and one similarly di- 

 rectly opposite this point ; the sutures are then passed 

 in the lumen of the larger segment and out the longi- 

 tudinal incision, the ends of the gut are invaginated and 

 accurately coaptated by sutures, the invagination is re- 

 duced and the longitudinal incision closed by sutures. 

 Maury's (F. ) : 1. For ectopia vesica ; a modification of 

 Roux's operation, in which one flap is taken from the 

 perineum and the scrotum, the other from the abdomen. 

 2. For gastrostomy ; a curved parietal incision is made 

 with its convexity toward the middle line. Maydl's, 

 for iliac colotomy ; the peritoneal cavity is opened by 

 LittrPs incision ; the loop of intestine is drawn out of 

 the wound and held there by a hard rubber cylinder 

 inserted through a slit made in the mesentry close to the 

 gut ; the latter is stitched in the abdominal incision, 



II 



