OPERATIONS 



920 



OPERATIONS 



ward along the border of the nose ; the triangular flap 

 is then drawn downward to supply the loss of the 

 lower part of the nose. Olshausen's, for vaginal 

 hysterectomy ; a modification of Czerny's operation; 

 the uterus is not turned backward, but the connections 

 are gradually separated, as traction is made on the 

 organ ; the broad ligaments are tied with rubber liga- 

 tures. Orred's, for excision of the shoulder ; it is 

 done by a longitudinal incision from the socket of the 

 shoulder to the insertion of the deltoid. Otis' (F.N.), 

 for internal urethrotomy, it is done with a special 

 dilating urethrotome. Pagenstecher's : I. For 

 cataract-extraction; extraction of the lens in the 

 closed capsule ; a scoop is inserted under the lens 

 and gentle pressure is made on the cornea. 2. For 

 entropion; division of the external canthus; stretch- 

 ing of the horizontal wound to a vertical one, and 

 suture of the opposed surfaces. 3. For iridodesis ; a 

 modification of Critchetfs operation, the incision being 

 made with a broad needle or narrow knife. 4. For 

 obliteration of the lacrymal sac ; slitting of the canalic- 

 uli, and the introduction of zinc chlorid paste into 

 the sac. 5 • For pterygium ; separation from the 

 cornea and sclerotic and turning back ; the edges of 

 the conjunctival wound are brought together with 

 sutures. 6. For ptosis ; the fibers of the occipito- 

 frontalis are made to act on the lid. J. For stricture 

 of the lacrymal duct ; the introduction of Bowman's 

 probe No. 3; slitting of the canaliculus and sac, and 

 the daily passage of sounds. Paget's, for excision 

 of the tongue ; a modification of JVunneley's operation, 

 the tongue being made free by incision of its attach- 

 ments to the floor. Palasciano's, for tumor of the 

 naso-pharynx ; an incision is made through the skin 

 over the lacrymal sac ; this is partially dissected out 

 and a puncture is made through the lacrymal bone, 

 thus exposing the superior meatus. Panas' : 1. For 

 proctotomy ; linear proctotomy. 2. For ptosis ; the 

 tarsal portion of the lid is raised by sutures and the 

 occipito-frontalis muscle is caused to assume, to a great 

 extent, the function of the levator palpebrae. Pan- 

 coast's [Joseph) : I. For amputation at the knee- 

 joint ; three flaps are made : a short, oval, anterior 

 flap including the patella, and two latero-posterior flaps 

 which join in the middle of the popliteal region. 2. 

 For ectopia vesica ; closure by means of two lateral flaps 

 dissected upon either side of the defect, and reversed, 

 but not superimposed. 3. For hernia ; a method of 

 operating by injections. 4. For neurectomy ; the re- 

 moval of the second division of the fifth nerve at its 

 point of exit from the skull ; a square-shaped flap is 

 raised over the ramus of the jaw, and the masseter 

 muscle is elevated ; the coronoid process is then re- 

 sected and the internal maxillary artery is ligated, after 

 which the spheno-maxillary fissure is - exposed by sep- 

 arating the two heads of the external pterygoid muscle. 

 5. For rhinoplasty ; the subcutaneous division of the 

 depressed tissues, so that they may be separated from 

 their bony connections. 6. F or varicocele ; a modifi- 

 cation of Levis' s operation ; a button is introduced 

 between the skin and the rubber. Pare's {A.), for 

 hare-lip ; the edges are united by means of pins and 

 figure-of-eight sutures. Park's: 1. For excision of the 

 elboiv : it is done through a posterior median incision. 

 2. For excision of the knee: it is done by an anterior 

 crucial incision, with its convexity downward. Par- 

 ker's : I. For the relief of chronic cystitis in the male ; 

 perineal cystotomy. 2. For perityphlitie abscess ; in- 

 cision. 3. Syndesmotomy for talipes varus in children ; 

 division of the " astragalo-seaphoid capsule" and the 

 anterior and posterior tibial tendons. Parker's (A*. 

 IVillard) incision, for excision of the hip; employed 



originally by Dr. Hueter, and later and independently 

 by Parker ; the incision commences on the front of 

 the thigh half an inch below the anterior superior 

 spine of the ilium, and runs downward and a little 

 inward for three inches. As the knife sinks into the 

 limb, it passes between the tensor vaginte femoris and 

 the rectus on the inside, until it reaches the neck of the 

 femur. Pasquier and Le Fort's, for amputation 

 through the foot ; a modification of Pirogoffs operation ; 

 the section of the os calcis is made horizontally, its 

 upper part being removed. Passavant's : 1. For syne- 

 chia ; breaking up of the adhesions with forceps. 2. 

 For staphylo-pharyngorrhaphy ; the halves of the 

 velum are stitched to the posterior pharyngeal wall in 

 order to shut off the nose from the mouth. Patru- 

 ban's, for varicocele; excision of the dilated veins. 

 Paul's, for iliac colotomy ; the bowel is divided and 

 the distal end invaginated as in Senn's method; a 

 glass tube is tied into the proximal end of the bowel, 

 which is fixed into the parietal wound by sutures ; 

 after three days the projecting bowel is cut away. 

 Pean's : I. For amputation at the hip-joint; the 

 vessels are caught as the operation proceeds. 2. 

 For hysterectomy for fibroid tumor ; the extraperitoneal 

 method; after an abdominal incision, the uterus 

 is brought out through the wound, and the stump 

 is transfixed with long heavy needles placed at 

 right angles to each other ; beneath these a wire is 

 passed and made tight by means of a serre-nceud ; the 

 tumor is amputated above the needles, and the ab- 

 dominal wound is closed around the stump. 3. For the 

 removal of a naso-pharyngeal tumor ; an incision is 

 made from the root of the nose down the median line 

 to the lip, through the nostril, and through the median 

 line of the upper lip, which is completely divided ; the 

 flaps are separated ; a portion of the hard palate is re- 

 moved after separating the periosteum ; the second 

 bicuspid tooth is extracted and the antrum is exposed 

 by bone-forceps. 4. For pylorectomy ; a vertical 

 parietal incision is made in the middle line. 5. For 

 vaginal hysterectomy for carcinoma ; removal of the 

 affected uterus per vaginam by morcellement, or bit by 

 bit. Peaslee's, for trachelototny ; an incision of or 

 or both ora uteri for stenosis by Peaslee's metrotome, 

 followed by dilatation. Percy's, for excision of ti 

 hip ; it is done by raising a flap from over the great 

 trochanter. Perier's, for uterine inversion : r 

 moval of the inverted uterus by the elastic ligature. 

 Perrin's (M.), for amputation through the foot; sub- 

 astragaloid disarticulation by the oval operation. 

 Peters', for internal urethrotomy; a special ure- 

 throtome is used to divide the stricture from withii 

 outward. Petersen's, for lithotomy; the h 

 operation. See Lithotomy. Petit's: 1. A metha 

 of performing amputations ; the same as Chcseldn 

 method. 2. For amputation of the fingers ; lateral 

 flaps are cut from within outward. 3. For hernia : 

 the sac is not opened. 4. For stricture of the It 

 mat sac; incision into the sac behind the internal 

 canthal ligament. Petrequin's, for symbl 

 gradual strangulation by means of a thread. Phelps' 

 (A. M.): 1. For club-foot ; a direct open incision is 

 made through the inner and plantar surfaces 1 

 the foot. 2. For hare lip : a loop is passed tliroug 

 the margin of the lip on either side of the cleft ; 1 

 incision is curved on both sides, and a V-shaped 

 flap is allowed to remain in the middle line, be 

 neath the septum of the nose ; the wound 1 

 closed with silk sutures. Physick's, for / 

 removal of a circular piece of the iris by the cutting 

 forceps. Pick's, for amputation at the knee-joint. 

 a modification of Stephen Smith's opera/ion b) con 



