SURGERY, 
the case. If the surgeon were to endeavour to take out the 
whole sac, he could hardly avoid wounding the raninal ar¬ 
tery, the haemorrhage from which might prove excessively 
troublesome, and even fatal. 
Practitioners, therefore, are content with laying open the 
tumour from one end to the other; squeezing out its con¬ 
tents ; and removing every particle of calcareous matter that 
can be felt within the wound. 
Cutting away a portion of the sac is sometimes necessary; 
for when a mere incision is too small, or closes prematurely, 
the disease generally recurs. After making a free opening 
into the swelling with a knife, the surgeon can easily cut off 
a part of the edges of the incision, either with the same 
instrument and a pair of forceps, or with a pair of scissars. 
The tonsils are exceedingly liable to inflame, and some¬ 
times the swelling thus produced is so great as to obstruct 
deglutition and respiration in a very dangerous degree. 
Prompt succour is now most urgently required, and relief 
may commonly be obtained by scarifying the enlarged ton¬ 
sils, and promoting the bleeding with warm gargles. 
The tonsils sometimes become enlarged, without being 
inflamed. Discutient and astringent applications here prove 
ineffectual. The tumour admits of being removed, but it is 
unnecessary and improper to take away the whole tonsil, as 
a dangerous and even fatal hsemorrhage might be the conse¬ 
quence. Only so much of the swelling should be removed 
as is sufficient to afford relief. The remaining portion in 
general heals without difficulty. 
Cancerous diseases of the lip are met with in various 
forms; sometimes having the appearance of an ulcerated, 
wart-like excrescence, which occasionally becomes as large 
as an apple; sometimes the form of a very destructive ulcer, 
which consumes the surrounding substance of the lip; and, 
in other examples, the disease resembles a hard lump, 
which at length ulcerates. The disease in its infancy is 
often no more than a pimple, which gradually becomes 
malignant. 
Cancers of the lip are said to be more frequent in men 
than women, and generally to occur in the lower spheres of 
life. The under lip is commonly the seat of the disease; the 
irpper one being but seldom affected. 
Every obstinate hardness and ill-conditioned ulcer on the 
lips, is not to be regarded as cancerous; many may be 
cured by keeping the constitution under the influence of 
either mercury, cicuta, opium, or the arsenical preparation. 
Whenever there is reason to believe that the disease is of 
an unyielding, cancerous nature, the sooner it is extirpated 
the better. 
The operation should be done as for the hare-lip, making 
the wound of such a shape as will allow its edges to be 
evenly united by adhesion, and taking care to extirpate 
every portion of the morbid part. When the affection is 
extensive, the surgeon, however, is frequently necessitated 
to remove the whole of the lip, a most unpleasant occurrence, 
as the patient’s saliva can then only be prevented from con¬ 
tinually running over his chin by some artificial mechanical 
contrivance. The deformity is very great; and swallowing, 
and the pronunciation of words, can only be imperfectly 
performed. 
When the membrane lining the antrum inflames and ul¬ 
cerates, a darting pain is felt in the side of the face, extend¬ 
ing from the teeth to the orbit, and unattended with any 
external swelling. The pain and tenderness do not affect 
the integuments, which may be handled without inconve¬ 
nience to the patient. This state of the disorder is not at¬ 
tended with much fever, and is usually regarded as a tooth- 
ach. 
In some instances, matter flows into the nose; and, its 
being discharged from one of the nostrils, excites a suspicion 
of the nature of the case. But many patients do not dis¬ 
tinguish the pus from the usual mucous evacuation; and fre¬ 
quently, in consequence of the communication between the 
nose and antrum being closed, there is no purulent discharge 
whatever. 
739 
The disease, when further advanced, becomes more ob¬ 
vious. The whole antrum now expands, and its parieties 
are rendered thinner by absorption. The expansion of the 
bone towards the nose may produce a complete obstruction 
of the nostril, or its swelling above may raise the floor of 
the orbit, and push the eye out of its situation. But the 
greatest degree of expansion commonly takes place towards 
the surface of the body; for, all collections of matter have a 
natural tendency to burst externally. 
At length, the abscess makes its way through the bony 
parieties of the antrum, and continues to be discharged 
through ulcerated openings. In some instances, the matter 
finds a passage into the mouth, through one of the sockets 
for the teeth. 
The indications in the cure are chiefly two, viz., to pro¬ 
cure a vent for the matter confined in the antrum as speedily 
as possible, which is done by drawing a tooth; and to check 
the suppuration, and promote the separation of any exfolia¬ 
tions which are taking place. 
The ossa nasi are occasionally broken: as there are no 
muscles that tend to displace these bones, they merely re¬ 
quire to be reduced. 
The lower jaw may be fractured either in its body, or 
rami, on one side or both ; at the neck of one of the con¬ 
dyles, or near the symphysis. According to Delpech, the 
fracture is never situated exactly at the symphysis itself; but 
this remark is incorrect, at least with respect to children, in 
whom the bone sometimes splits in that very situation. 
When the fracture has happened towards the chin, whe¬ 
ther the bone be broken on one side, or both, the fragment 
comprehending the symphysis is drawn downwards. If the 
fracture be oblique, this sort of displacement is much more 
considerable, especially when the solution of continuity runs 
downwards and backwards, as it frequently does; for, in 
this case, the direction of the muscles, which depress the 
jaw, and are chiefly inserted into the portion of bone most 
liable to be drawn out of its right place, is parallel to that 
of the fracture, and consequently they have a greater effect 
in producing the displacement. 
A fracture of the lower jaw may be detected by intro¬ 
ducing a finger into the mouth, and pressing on the front 
teeth of the side on which the fracture is supposed to be, 
while, at the same time, the fingers of the other hand are 
applied to the basis of the bone, near the angle. On mak¬ 
ing alternate pressure in each of the above situations, the 
bone may be felt to move, and a crepitus distinguished. 
This painfnl mode of examination, however, is not invari¬ 
ably requisite; for, when the fracture is displaced, the nature 
of (he accident is obvious enough without any such pro¬ 
ceeding. In this case, the body of the bone is drawn down¬ 
wards from the rami; the mouth is more or less open, and 
so distorted that the commissure of the lips is much lower 
on the injured side than the other; while the front teeth are 
below the level of the molares; the regularity of the arch 
formed by the teeth and alveolary process being more or less 
destroyed. 
The generality of fractures of the jaw are easily reduced; 
but the reduction cannot be maintained without diffi¬ 
culty. 
When the fracture is not displaced, the surgeon need only 
adapt some pasteboard, wet and softened with vinegar, to 
the outside of the jaw, both along its side, and under its 
basis. Over this wet pasteboard, a bandage with four tails 
is to be applied, the centre being placed on the patient’s 
chin, the two posterior tails pinned to the front part of his 
night-cap, and the two anterior attached to a part of the 
same cap, more backward. When the pasteboard becomes 
dry, it forms a convenient apparatus for supporting the frac¬ 
ture. The soap plaister frequently applied to the skin is 
rather to be considered as a thing done for the amusement of 
the patient and bystanders than as a measure of any real 
utility. 
When the symphys isappears to be drawn below the level 
of the base of the jaw behind the fracture, the coronoid 
process 
