112 
REVIEW. 
unsuccessful^ and the gland itself has become scirrhous, and 
of a cancerous character. The operation is very difficult and 
dangerous to perform, on account of the many large blood- 
vessels and nerves b} r which the gland is intersected. After 
the patient has been cast and properly secured, the head is to 
be slightly elevated by a small bundle of straw being put 
under it; and the neck being somewhat extended, an incision 
is made from the base of the ear to the inferior end of the 
gland, through the skin and the subcutaneous muscles. This 
incision divides it into two unequal parts, the anterior being 
the smallest. To reach the posterior, or largest portion of 
it, a cross incision in this stage, in the direction of the first 
vertebra, may be necessary. The skin is now to be detached 
close to the substance of the gland, and the flaps reflected 
back, and held in that position by proper aids. The operator 
now begins carefully to dissect away the gland from over the 
facial nerves, at the edge of the posterior maxillary bone, by 
which means the inferior part of the gland is reached, and 
from thence the posterior part ; the upper portion being the 
last dissected out, so as to reach the centre. Whenever it 
can be detached with the handle of the scalpel or the fingers, 
the danger will be lessened, but where that cannot be done, 
the sharp edge of the scalpel must be used ; in which case 
particular care must be taken not to injure the facial nerves, 
or the large blood-vessels ; the first of which would produce 
paralysis of the lips, difficult mastication, &c„ The blood- 
vessels, if cut, must be taken up and secured forthwith, so as 
to prevent dangerous and troublesome haemorrhage. Isolated 
remaining lobules of the gland need not give any trouble, as 
they will be detached by the subsequent suppuration that will 
take place ; and even that part which is situated under the 
inner maxillary vein, and which is very difficult to dissect out, 
may be left without causing the least inconvenience. The 
wound is to be closed by the interrupted sutures, and treated 
in the ordinary way. The cure requires from four to five 
weeks.” 
We strongly recommend this work to the notice of our pro- 
fessional brethren, as one replete with valuable instructions; 
only regretting that to the majority we fear the language in 
which it is written is one they are unacquainted with. 
