These 5 Books of an Outline to a
Course of Lectures on Surgical and Relative
Anatomy, were written in the Evenings and
Nights of the Summer of 1852 at Bloomingdale.
The important parts omitted, such
as Hernia, the Perineum &c are contained
in my former Books on Anatomical
Surgery.
This Synopsis I found valuable in
the Lectures which I delivered in the [Session]
of 1852-53- immediately following my return
to this University in March of 1852 -
V. Mott.
"

Introductory Lecture
to
A Course of Lectures on Surgical Anatomy
and the
Operations of Surgery.
It is expected in an Introductory
Discourse that we should look back to the
origin of the Science we aim to teach.
To carry our inquiries back into time
and not the great epock: but also mark its
progress and affects upon the practice of sound
Operative Surgery.
The cultivation of the Anatomy of [Relation]
will continue in all coming time to plan 
the Science of Surgery of pure Classic Surgery upon
the most elevated pinnacle of the Lasting art.
It is its true and legitimate Landmaid-
the true Polar Stone of the Operation.
Maps and slants will do, but the true

was made to Surgical practice. Since
which it has spread its happy influence over
the whole Surgical world.
Soon, very soon the wave of improvement
reached our own shores, brought by the far
America Pupils who then visited Europe.
About one hundred and two years ago,
(1750), the first Dissection and Injection of the Body
of a Criminal was made by Drs. Baid and Middleton
in Kings College, now Columbia, in
this City, for the benefit of Students.
It is not from arrogance, but a feeling of
gratification; that I can state, that forty two
years ago, I publickly announced a Course of
Lectures on Surgical Anatomy in Columbia
College in this City. They were the first I well
know that we were given in this country.
It was considered as an absurdity, and
spoken of rather, in derision, that Surgery could be so
associated with Anatomy as to justify the title of
Surgical Anatomy.
This is no necessity said an eminent Professor
of Anatomy of learning any thing more
than what Descriptive Anatomy will teach.

and unerring source is natures model, the
dead body.
The first impulse to this beautiful
and enduring Pillar in the Temple of Surgery,
was given by that Master spirit in Operative
and Pathological Surgery, Sir Astley Cooper.
His admirable and Classical
Dissections of the Relative Anatomy of
Inguinal and Female Hernia, prepared
the way, and fully settled the [illegible] study
of the Relative structures, and the safety
of the staffs of Surgical Operations for its
relief, upon the sound and exact [principles]
of a true Science.
The association of the Anatomy of
[cross out] Relation with Operations and Diseases we
owe to him.
It truly forms one of the noblest
Epochs in our Science.
To confine this assertion, we will give
some illustrations and proofs from the Touters
and Surgeons who immediately preceded his
time.
Description of what that knowledge was.

I bore it as becomes my eyes, in the commendable composure,
confident that time would bring about
all that was right, determined to wait my
time.
This fortunately soon arrived, and it was
indeed a great triumph for me.
A case of Traumatic Neuralgia was
sent to me from the Country in the bottom of the
foot of a young Lady, from a punctured wound.
It was of nearly two years standing, and
she was from the violence of pains in the bottom
of the foot, together in the violent spasms in the
calf of the leg, totally unable to use it.
The bottom of the foot had been cut and
scarified in various directions, & escharotics had
destroyed extensively the surrounding parts, but
all to no purpose, as the disease still existed.
Narcotics and Tonics had all been tried
in vain.
I proposed to her to cut out an inch or
more of the Posterior Tibial Nerve, to which she
readily consented. I now asked myself the ques.

Compare the knowledge of Potts, for example
into the magnificent illustrations of Astley Cooper -
It stamps with [the] simplicity and bounty of
truths, the justness of his would [illegible] fame
and lasting reputation -
These truths and laid marks in Operative
Surgery, some spread over Great Britain -
from London to Edinburgh - to Dublin
to Continental Europe.
By his attention and admiring Pupils,
the [waves] of improvement soon reached
our happy shores. And we hope to believe,
its is rapidly extending its blessed influence
into the far distant West.
Onward - Westward is the word - not
the cry of Conquest to bloodshed, but the soft
and persuasive voice of Peace and Science.
Our march is then onward, verifying
the Prophetic line of Bishop Beckley -
"Westward the [illegible] of Empire takes its way" -
How delightful it is for me to retrospect
upon the Air of this important application
of Anatomy to Surgery, and that I lived [at that time] and
learned at that the quat fœccutain of know. quat foccitaiar

-tion as to its relation to the Internal Malleolus
and the Tendo Achillis, and the Posterior Tibial
Artery. This I could not answer, never having
studied its Relation with a vein to an Operation
upon it.
The Surgical Anatomy of this Nerve, I
soon informed myself of by an appeal to this
dead body, as has always been my practice
in all Operations, where not thoroughly informed.
Wishing to have the Operation sanctioned
by the best authority, I requested that my
old friend & Colleague Dr. Post might be called in to
Consult upon the case - I now proposed that
the operation should be performed, in which
he fully concurred.
I now asked him how this Nerve
lie Relatively to such and such parts, to which
he answered that he knew it run behind the
Internal Malleolus, and that was what Special
Anatomy taught.
I now told him that it run nearer the
Tendo Achillis than the Malleolus - that it was between
the Artery and the Tendo Achillis - and that

knowledge, the [B??sing] [??] School of St. Thomas
and Guy's Hospital in London, where the
Masters (Cline Said) and the Pupil (Sir Astley Cooper)
show so conspicuously brilliant.
The first impulse to this beautiful Science
was given here, by that Master spirit in Operative
and Pathological Surgery - Astley cooper.
And you cannot be surprised that in looking
back into time, it affords men unspeakable delight
to know that it I was then a Pupil at that School,
and there learnt my first lesson. and made my
first dissection of these important parts -
His admirable and splendid Dissections
of the Relative Anatomy of Surgical & Femoral
Hernia, prepared the way, and fully established the
true knowledge of the Surgical Anatomy of this important
subject - This settled upon the principles
of an exact Science, the step's to be pursued in
the several Hernia which occur at the Groin.
The associations of the Anatomy of Relation
with Surgical Operations, the world owes to
him. And it forms in the Diadem that will

this was what was called Relative or Surgical
Anatomy - and that it was a Science by itself
and could never be learnt in any other way
than by studying it as a distinct branch of
knowledge -
I performed the Operation, took out
about an inch of the nerve & cured my Patient.
"Les faits sout les mulleus raisonnements,
says the celebrated Monsterquien, "cau un fait
est le raisonnement, plus la preuve".

forever encircles his brow, the purest gems-
What was the knowledge of this subject
possessed before his time.
Give some explanation of it.
Not half a century has got rolled away since
the first wave of Surgical impulses was seen in
London, and wave has followed waves, until this
whole Surgical world feels its mighty and healing
influence.
It must not be forgotten, that the distinguished
Spanish Surgeon Antonio de Quinbamont
bears a distinguished part in the honor of this great
impulse. - For while Astley Cooper was labouring
for the knowledge of the Surgical Anatomy of the
Inguinal Rings and the abdominal Canal, the
fame of Quinbamont had spread abroad, and
he was rendering the same service to Operative
Surgery in his accurate and beautiful
delineations of the Crural Ring.
So far therefore they laboured together in
the great subject of the Surgical Anatomy of the
[Groin], and their names will be hailed in all

[illustration] [illustration] [illustration]
[illustration]

coming time as the greatest Benefactors to this
department of Operative Medicine -
The delicate and important Operation
which must even be connected with Hernia,. the
sudden and imminent peril to which life is subjected
on many occasions, by night and by day,
will constantly urge us on, to become Masters of
the subject - There is no lagging behind - no
half way house - no Book nor Cadaver to
consult or appeal to - the patient is before you
and you must act or he will die, and if you
are ignorant of the parts you ought to cut, most
probably you will kill him if you do cut.
Can you imagine a more awful & responsible
situation for a Surgeon to be in - ignorance may
Kill - Knowledge may save the life of a human
being -
A Husband or a Wife, a Father or a Mother
may be the object of our case, and amidst all the
intreaties, questions and sympathizing solicitudes,
you are looked up to as their only hope. their only 
comfort.
Other callings and Professions may be ever
so important but they fall far short of the responsibilities

 

responsibilities of ours. The Lawyers and the Divine may
delay an opinion, and Consult their Authorities, but
the Surgeon must act with promptness and dicisions.
Our knowledge must be exact and available or
all occasions; it must not only be in our heads
but must circulate to the ends of our fingers.
The important of this knowledge to
Surgery was soon wafted to Scotland, and awakened
the attention of that excellent Anatomist,
and distinguished Surgeon of Glasgow,
Allan Burns - With his keen eye and Masters
hand, the same light was shed upon
the Neck and Head, and gave birth to his
invaluable Work on the Surgical Anatomy
of the Head and Neck.
His Work is a Master-piece of study [and]
the application of the same principles of Relative
Anatomy to the various Surgical Operations
which are called upon then important regions,
that Cooper and Quimberat had so
happily and successfully carried out for Inguinal
and Crural Hernia -
This Volume is an enduring Monument
to his fame, and ought to be studied and re-studied
by every Student and Practitioner of Surgery -

[illustration]
[photograph] [photograph]

It sheds a light, and imparts a knowledge of the
Surgical Relations of the one of the most important
Regions of the body. A light that should
ever shine and illumine the path of the Operator
in every step of his knife -
But for a premature death this eminent
and excellent Anatomist and Surgeon, intended
to have extended his labours and researches,
into all the important regions of the body -
Which is accomplished in the same Masterly
manner, would have been indeed a rich
Legacy to Surgery, and a [blessing] to the human
race.
But Alas, his work was finished - his
labour was ended -
Next in the train of the Benefactors to Surgery,
comes Telpeau - the wonderful Telpeau -
for so truly may he be styled. the Blacksmiths
Boy - Determined to Study Surgery, he
travelled on foot from a remote part of France
to Paris - On his way obliged to stop and work
in a Shop to earn a few Sous, to enable him
to reach the end of his journey ~ There in the
midst of a might Capital, surrounded by a tumultuous

tumultuous rivalry, he studied, dissected and struggled in
the greatest penny and waist. But his end was
accomplished, - he was studying Anatomy - he was
in Paris -
The rough edge of poverty did not daunt his
ambitions, perseverance was his motto, and onward was
his course - He encountered every obstacle, and mastered
every difficulty -
Like his Predecessors and Contemporary, who
also struggled with poverty, [Duypretrens], the Giant
in Surgery, he rose by degrees to consideration,
and some distinction - Such examples as Duypretren
and Velpeans are profitable to us all,
they ought to encite our admiration and stimulate
our ambitions.
Look now at the position of Velpeans -
at the head of his Profession in one of the greatest
Capitals of Europe - The noblest Profession that can
engage the attention of Man. All by his own [??tizing]
efforts - What a proud triumph - What an
example to imitate -
Among the various efforts of his vast intillect,
he has given us an extensive book on

what he calls the Anatomy of Regions, in these
large Volumes, called "Anatomic Chirurgicale" -
It embodies a vast amount of matter on this
subject, and an extent of research which surpasses
all the labours of his Predessessor - It is
more extended and ample than can be attained
by any Pupil - It must, and even will
be a most valuable book of reference to the
Student and Surgical Practitioner -
Its only defect is, in its extraordinary
minuteness, and in the creation of too many
regions, loading and embarassing the subject
too much, whereby he complicates, instead of
elucidative he obscures - Therefore instead
of cheering the student is overloads and oppresses
him - It is therefore more a book for a
Practitioner than a Student.
It is however a Masterly performance
and ought to be in the Hands of every Student
and Practitioner as a Book of constant reference -
Next Blamdius appears, another Contemporary
of Velpian, in a large Volume, entitled,
"Anatomic Topographicale" - His Book displays

much less learning and labour than [Velpeanns],
but his is thoroughly acquainted with the subject,
and from the concise and luminous arrangement,
will be found much more usefull & practical -
It is a work which you study with pleasure and
infinite advantage -
The name of Blandair's is familiar too all
who have visited the Surgical School of Paris,
and his fame alone is sufficient to stamp his
Plume with an enduring reputation.
He was the favourite Pupil of Marjolam,
and the Successor of [Concours], at an early age
to the celebrated [Richaud], as Professor of Surgery
in the School of Medicine of Paris - This
was a distinguished honor - He died at an early
age
From these General Works on Surgical
Anatomy, we will for a moment turn our atten.
to the laboures of other Men who have enriched this
branch of Science by their Specialities -
In this list of worthier stands another distinguished
French Surgeon, Amupat -
Taking a particular Region of the body, [he]
he has thrown great light on the Surgical Anatomy
of the Male Urethra - Our knowledge on this subject

were poor and insufficient when he commenced his
investigations, and he has not yet enhanced the
subject -
To Morton and Mactise of England we are
greatly indebted for a thorough investigation, and
beautiful delineation of the Surgical Anatomy
of the Genito-Urinary organs - Their admirable
work will always be consulted with profit and
advantage by the Student and Practitioner of
Surgery in every Country, who take an interest in
a correct knowledge of this important subject -
Another contribution to the Science of Relative
Anatomy, we have in the book of Professor
Lanister [of Dublin] on the Arteries -
Though the Experiments of Majendie may have
led to a speculative Science in many respects purely
so, still they have opened a new way for the advancement
of useful knowledge -
Surgeons have been led by his labours to
make experiments for the benefit of sound Surgical
Science, and to him we owe the investigations of
Lours and Amupat on the Arteries - those of Travers
and even those of Reyband and Fobert on Wounds
of the Intestines and of Hernia, we have [all] felt the

value, and experienced the benefit of these enquiries and
investigations, [crossed out] in [in] enlarging our views of correct practice,
and improving the Science of Surgical Anatomy.
Other names may yet be mentioned among
the most illustrious and distinguished, who have sanctionend
experiments, such as Duypetrens. Scarpas, Beckand
and Sir A Coopers, all of whom have extended the
bounderies of our knowledge on this subject.
Another, and the last Author on our favourite
subject which we shall name is Malgaine
of Paris, a distinguished Surgeon of that Capital -
He has furnished us with the best work on [the] Surgical
Anatomy of the [whole] body - It is a clear and [accurate]
exposition of every part and Organ of the body, its
relations & Diseases - And besides [the] lucid style of
the Author, it is not so Voluminous as Velpears.
It is in two large Volumes, entitled "Anatomic
Chїrurgicale".
You see therefore, that this is a Science
of yesterday, [and] I feel a gratification in knowing, [and] that
I lived at the Area, when the first application of
this important Science of Anatomical Relations

Relative Anatomy of the Integuments.
Of what they are composed.
Cuticle.
Late Muccosum
Cutis.
Demonstrate rack -
Very in different parts of the body.
Demonstrate this difference.
Scalp.
Axilla
Groin.
Hands
Feet.
A Surgeon should be aware of this difference
It influences our Operations.
The Scalp is composed of several parts.
Peculiarity of Scalp -
Composed of Scalp - so called.
Then - Adipose tissue.
Filimentous -
Tendinous expansion of the Occipita -

a) Erysipelas we believe more frequently follows a puncture
into this tissue also a lacerated wound.

portalis muscles -
Lastly we have the periosteum of the
Skull - called pericranium, - because it
is the investive membrane of the Cranium.
These make together the Scalp.
A very compound covering -
Interesting to Surgeons -
not only as a piece of Relative Anatomy.
But to enable us to understand
the injuries to which it is subject -
And to Operate safely upon it.
In wounds which penetrate into the adipose
tissue, we have one set of symptoms. [?]
In the filimentous another.
In the tendinous Aponeurosis
quite no different.
And another acquires where [in] this pericranium -
To illustrate, or give an example.
It takes a Surgical Anatomist to explain
and understand why an extravassation of blood

 

to form tumors must always take place
in this filimentous tissue.
All the trunks of the Arteries of the
Scalp are found in this tissue.
If for one moment it were to be under
the Aponeurosis, it would unyielding and
very painful.
This is firm & inelastic -
The tumor from this circumstance would be
firm and unyielding.
They would be long also in forming -
Now we see in slight blow, and even pulling
the hair to occasion them -
They are thus sudden [crossed out] found, and quickly to
disappear.
These seldom require to be punctured -
Absorption is generally rapid -
Discutient may be employed.
As Ice water - Camporated Spirits.
Muriate of Ammonia & Vinegars.
Circumstance under which they may be punctured.

[illustration]

Inflamatory tumor, very tender & painful -
cluster inflammations & effusions under
the Aponeurosis.
From the tendinous [illegible] if this
structure it is unyielding & [excessively]
painful -
Requires a free incision and an
emollient poultice.
This soon relieves all the local
and general symptoms.
It is only a knowledge of the relative
Anatomy that leads to a covert
practice -
The puffy tumor of the Scalp is
of quite a different character -
Denotes effusion under the pericranium,
so that there is an inflammation of the
Dura Mater, & separations of it from the
Cranium within -
If coma and Stupor attend, it justifies
a free incision to the bone.

 

The Cranium under these circumstances
will be of an [opake] white colour, and indeed
be dead.
Generally trepining in these cases
is required.
Under what circumstances it may
be required.
All Incisions from the removal of
tumors or nævis ought to be made obliquely,
so as to leave the filimentous tissue
the longest, to enable the vessels readily to be
tied -
Inattention to this has occasioned serious
and even fatal hemorrhages -
Young Operators ought be aware of this,
as they may thereby escape danger -
[Cases] in [which] the bleeding was fatal, the
child on the table -
As knowledge of Relative Anatomy
of the Scalp, will lead to the propriety of this kind
of incision -

 

In the Exsection of nasi, the importance of
this kind of incision is particularly shown -
It is an interesting fact to mention
that a & Lowe never knows a single instance
of sloughing of the scalp, however
much torn or lacerated.
Not even in [Erysipelatous] affections
when the filimentous tissue is destroyed
did [I even] see the integuments slough.
The power of vitality must therefore
be very great in the Scalp.
Its vascularity is great indeed, and
well known to those who have dissected [a]
[well] injected Scalp. or Surgeons who are in
the Latest of performing Operations upon it.
It possesses great powers of reproduction
consequently.
This is seen not only in the adhesive
process, but the granulations.
L. Lowe removed a large portion of the
hairy scalp in one instance for a Melanosis

 

and the wound granulated & healed kindly,
& the patient recovered. See Specimens
in the Museum -
No Plastic Operations from my observation
is ever required upon the Scalp,
not even the glissemat.
But if called for it would be &
have no doubt eminently successfull.
Under all circumstances it is the Surgeons
duty to save every portion of Scalp
let its attachments be even so trifling.
I have been often astonished at results
even under the most discouraging circumstances.
Always try to save it.
Anaplasty has been practiced upon
every other integumental covering of the body,
with the exception of the palms of the hand
and the Soles of the feet.
As a Generic term, Anaplasty has a
most extensive family of Species.

 

the term Anaplasty is comparatively of
modern origin -
But a few years since and you
will find no such word in the Books.
Soon after the Introduction of this
great improvement in Surgery by the
immortal Mr Hunter, we soon find
the term Rhinoplasty used by Surgeons.
No Man did as much to settle
the principles and establish the practices
of union by the first intestine, or by the
adhesive process, as this eminent English
Surgeon.
His Work on the fundamental
principles of Inflammation is original and ingenious
and true. And is a lasting monument
to his fame, more enduring than
Marble or Brass.
It is delightful to contemplate the
importance of the practice of adhesive in the
walks of a Surgical Practitioner.

 

It commemorates the greatest [illegible] not only
in Operation, but in Practical Surgery -
The magnificent discovery of the
ligature by Ambrose Pané, does not even
eclipse the Hunterian eras.
Hunters was an application of sound
principles to the solution of a fact.
Theory and practice with him went
hand and hand.
He arrived at great conclusions by
the most laborious experiments.
His results have benefitted all races
of Men where Surgery is inclinated, and will
continue to do so in all coming time.
Hunters views & opinions enable us
to understand in what way a ligature obliterates
an Artery.
That it is by adhesive process - and
that serous tissues or membranes, are indispensable
surfaces for the plastic motion.
He has taught us to know that upon

[illustration] [illustration] [illustration]
[illustration] [illustration] [illustration]

such tissues only are we to expect the adhesive
inflamation to take place.
The Mucous Surface being prone to a
totally different result when inflamed.
Stupid indeed must those [Surgeons] be who now
should attempt to unite by the plastic process
two mucous surfaces.
Serous tissues or membranes are the
parts upon which we are to look for the
beautiful process of adhesive inflamation.
Upon Mucous Surfaces for the Suppurative -
Parré established the fact, that a ligature
upon an Artery [crossed out] would arrest hemmorhages,
a most important step in Operative
Surgery - a monstrous improvement upon the
actual Country of his predecessors and even his
Contemporaries -
Decidedly one of the greatest Epocks, (if not
the greatest) in the whole range of the History
of Surgery -

 

Parzaus creavit
Hunter's disposuct -
a Surgeon may say this of these two great
Benefactors to Surgery - as Naturalists
have to the distinguished Linnæus.
Various experiments were made
by Hunter to extend the adhesive process -
He tried to convert the Hen into
the Cock, by accomplishing an adhesive of
the Testes of the latter to the Peritoneum 
of the Hen -
But in this amusing experiment
he failed -
He did make the human tooth take
firm hold & grow in the Gonad of the Cock.
That a part of the human body, as a
finger or toe, when completely detached or
severed, can even become united again to the
parent stock is what I never saw, but there are 
abundant evidence to establish the fact -
Medical Men of character have stated

What is a Gentleman?
What is a gentleman? Is it a thing
Decked with a scarf-pin, a chain, and a ring;
Dressed in a suit of immaculate style,
Sporting an eyeglass, a lisp, and a smile,
Talking of races, concerts, and balls,
Evening assemblies, and afternoon calls,
Sunning himself at "at homes" and bazaars?
Whistling mazurkas, and smoking cigars?
What is a gentleman? Say, is it one
Boasting of conquests and deeds he has done?
One who unblushingly glories to speak
Things which should call up a flush to his cheek?
One who, whilst railing at actions unjust,
Robs some young heart of its pureness and trust,
Scorns to steal money, or jewels, or wealth,
Thinks it no crime to take honour by stealth?
What is a gentleman? Is it not one
Knowing instinctively what he should shun,
Speaking no word that could injure or pain,
Spreading no scandal and deepening no stain?
One who knows how to put each at his ease,
Striving instinctively always to please;
One who can tell by a glance at your cheek
When to be silent, and when he should speak?
"What is a gentleman? Is it not one
Honestly eating the bread he has won,
Living in uprightness, fearing his God,
Leaving no stain on the path he has trod?
Caring not whether his coat may be old,
Prizing sincerity far above gold
Recking not whether his hand may be hard,
Stretching it boldly to grasp its reward?
"What is a gentleman? Say, is it birth
Makes a man noble, or adds to his worth?
Is there a family tree to be had
Shady enough to conceal what is bad?
Seek out the man who has God as his Guide,
Nothing to tremble at, and nothing to hide;
Be he a noble or the poorest in trade,
He is the gentleman nature has made.
- Selected.

to use such instances, as fingers & toes; and
our Journal often contains cases of as like
natures.
The [illegible] story of Gaurgat
can scarcely be believed as the nose of
his patient was bitten off, & was afterwards
put on & it grew fast.
The nearest I have ever known any
member of the body to be severed, and yet
grow on was the Penis -
My Cases in Chatham Street.
Entire transplantation as applied to the
human body I have no confidence in -
In all the Anaplastic [cross out] Operations we
have ever seen, performed by others and done
by ourselves, the portion or patch of integuments
must be left attached to the
Parent stock by an Isthmus, or it will
have no chance of being preserved -
The most beautiful noses made by
the Rhinoplastic Operations were by Baron

[illustration] [illustration] [illustration]
[illustration] [illustration]
[illustration]

Graaffe and Profr. Deiffenbach of Berlin.
The former made them from the Arm,
and the latter from the forehead -
Those by Deiffenbach were by law
the best, and his indeed may be considered to
have been the Princes of Nose Makers.
The Surgeons of our Country have been
very enterprising in all these important Operations,
and been equally successfull with
our European Brotheres -
We have applied this principle of Anaplasty
extensively ourselves -
To the Noses.
Eyelids -
Cheeks
Lips -
Perineum, and various other
parts of the body -
From observations we have had an opportunity
of making for ourselves in different
countries, it is our full belief, that in no part

 

of Europe is the priciple of adhesive inflammations
better understood, and certainly more
successfully practised than in our own.
We found when in Egypt that
union by the first intention was truly remarkable -
Even that [the] lateral incision for Stone
in the Bladder would often heal by the
first intention, a result we have never
met with in this Country.
In other Operations it was equally
remarkable -
This simple manner of living, and the
pair unvitiated constitutions of the common
people of the remarkable Country and perhaps
too the very dry & warm atmosphere of that region
of the world, may have some agency in
favouring it -
The fact however is so -

 

Relative Anatomy of the
Cranium -
As far as we may be permitted
to speak of the wonderful mechanism
of the Skull, it seems to be a wise provision,
that this bony arch is not constituted
of one entire bone.
The sutures perhaps are wisely
provided then we may say to prevent the
extension of fracture - That they have
this effect I have no doubt. It is true
that we often see fractures pass through
the sutures, & it is also true that they
are often arrested by them.
The two tables also which enter into
its constitution are calculated to ward off
the effect of injuries - And I have no doubt
also that this is a wise provision -
A solid bony arch would be much
less fitted to protect the important encephalous 
within -
It is important that a Surgeon,

 

should be aware of the two tables composing
the greater part of the bones of Cranium,
but also that there is an intermediate cancellated
structure, on account of Operations
that are performed upon the bones -
Also that the two tables vary in
density, & that there is very little of the cancellated
structure or diploe on the outer
sides of the Parietal bones, to the squarous
portions of the temporal -
The greater thickness of the Cranium
at one part, [and] that another, is important to
be bourne in mind by all who perform Operation,
as giving confidence to the Operator,
and safety to the patient.
From the great thickness of the Os
Occipitis, we are seldom called upon to Trephains
this bone.
In two or three instances we have
had occasion to Trephine the os occipitis -
There is perhaps a general character

 

as to thickness of the Skull in the White
Holes in the sound state, but very great
variations are to be observed -
From the massive thickness of the
Crania of some individuals, and the excessive
thinness of others, it beckons a Surgeon
to be very guarded in the use of the
Trephine, and Saw in every case, as he
cannot [know] the state of the bone in this respect,
unless a fracture with depression
and wound exists.
I have seen in the adult where
there was only a single table, & that much
thinner than natural.
Dr Ball's case at Brooklyn in
which there was fractures & depressions in
which he Trephined an adult, and the Skull
was not thicker than the thumb nail -
My Case (Mr Oliphant) from [illegible]
I task a considerable portion of a parietal
bone for Epilepsy, in which the bone was

 

not as thick as a single table, such was
its atrophied state. It was to all appearances
perfectly natural in all other respects.
The pin on the Trephine completely
pieced it before the saw was set.
See the specimen in my possession.
All Surgeons ought to be aware of these
varieties in the thickness of the Skull.
It ought never to be taught, and
much less practiced, that until a change in
the sound of the Trephine takes place, we may
go in sawing with safety -
It is well if we can to avoid the
sutures in Trephining as the Dura Mater
is more adherent about there than at other
places. But we may if necessary, or by observing
more care.
We are to avoid if possible the whole
course of the Sagittal Sutures, as beneath it is
situated the longitudinal Sinus.
Alas about the lower and anterior

 

angle of the parietal bones, as at these points
the trunk of the Spinous artery of the Dura
Mater is to [mate] be mate with -
At all these places however I have
frequently applied the Trephine with perfect
safety. The Spinous artery at its trunk we
have [frequently] torn through with the trephine - It
will bleed freely, and sometimes I have arrested
it with a fine dossile of lint.
In two cases I met with pieces of
bone driven into the Longitudinal sinus, which
when removed has given rise to a profuse
hemorrhage. These also have been readily
arrested by small pledgists of lint, with
the flap of Scalp over it and the usual
dressings -
The transverse Occipital ridge may
also be avoided on account of the transverse
or lateral sinus beneath -
Cases must seldom serve to require
the Trephine in this situation -
I have only met with one;  that required
two applications of the Instrument -

 

During one of the perforations from the great
restlessness of the patient, I injured the dura
mater, but no bad consequences followed -
It ought to be bourne in mind by a
Surgeon, that the Dura Mater is an internal
periosteum of the Skull, & that from the
free communications between it and the pericranium,
there is a close connection between
them in their diseased relations.
The situation of the Spinous Artery
of the Dura Mater at the anterior and inferior
angle of the parietal bone, and that
it is upon the surface of this membrane,
in its whole course, enables us to explain,
why the largest extravassations of blood should
be not with or the sides of the head. And
that here we are to apply the Trephine when
we are in [search] of blood, as a cause of
compressions of the brain -
It is stated by some great Practical
Surgeons, that if blood or matter be deposited
upon the Dura Mater, the bone without will
not bleed when the pericranium is detached

 

from it. This I believe is an important
practical lesson. which I have verified in
my own experiences -
For a Simple Fracture you are not to Trephine -
but use means to prevent Inflamation -
If symptoms of effusion come on then you
must perforate the Skull -
For a Simple Fracture and Depression of Bone you
have the best authority for [not] Trephine particularly
if there be no symptoms of Compression -
I would & have always Trephined, in Simple Fracture
with Depression with Symptoms of Compression
If no symptoms of Compression exist, treat the
case Antiphlogistically and wait.
In Compound fracture [illustration] with Depressions of Bone
& Trephine at once, with or without symptoms of Compression -
For Pus on the Dura Mater & symptoms of compression,
& trephine -
If no Matter is found on the Dura Mater we puncture
it to let it out from beneath.
The same for blood - Both cases we have had recourse -
[here] to select the proper place to Trephine for Matter -
a) In Compound fracture without Depression you are not to
Trephine unless symptoms of Compression exist, but least
antiphlogistically.

Appearance of the wound if there be one - colour of the
Bone - tumor of the Scalp - separations of the pericranium
- bone does not bleed -
Fungus [illegible] - what it is, and how to be treated -
Extrusive fractures less dangerous than those of small
[extent] -
Laceration of membranes and loss of the substance of
the Brain not necessarily fatal.
Less compression when the substance of the brain is
discharged.
Never think a case without hope, so long as
consciousness remains -
Dressing the wound & after treatment -
Cranium never is reproduced -
Necessity of some covering to the opening of
the Cranium - Always a soft place remains -

Relative Anatomy of the Eye.
The Eye is composed of Gouts & humors -
It also has muscles to move it [in] different
directions -
The relative situation of these is necessary
for the Surgeons to be acquainted with
to direct to the proper performance of the
various operations which are called for
at his lands.
In the Operation for Cataract he
should be well acquainted with the exact
position of a Cataract, that he may avoid
injuring any important part which it is
associated with -
The success of this Operation frequently
depends upon not injuring the Iris -
The Lens [or its vascular being] the seat of Cataract is
so closely associated with the Iris, that great
care is required not to wound it -
In most cases, if it receives the least

 

injury inflamation will be induced in it
and the Pupil will be either closed or be
made as irregular, that vision will be
more or less injured -
If the Operation by the Anterior [or]
posteriors, great care is to be taken that the
Iris is not injured by the needle -
In the Anterior Operation the Pupil
must always be dilated with Belladonna or
Stramonium to make room to act with
the needle without endangering the Iris.
Not as much care is required where
the Posterior or Couching Operation is undertaken.
But this even requires care, as
the needle is made to come in front of the
Cataract, so that it [is] visible in the Pupil.
The relations of these parts at once
shows the necessity of great caution in the use
of a Needle even in the Posterior Operations -
When the Needle is seen in the Pupil,
the Capsule of the Lens is [to be] lacerated by the movement

 

movement of the needle before any attempt is made
to depress or dislocate it.
So for any of the various Operations for
Artificial Pupil, an exact knowledge of the
relations of parts is required.
The position of the Muscles should
be well studied, & the points that they become
attached to the Sclerotic coat, bourne well
as mind.
To accomplish [this] they must be studied
in relation to a division of them for the
distortions of the Eye called Squinting.
The modern Operation [for] Strabismus,
calls for a division of either the Internal
or external Rectus, to redress the deformity -
The Superior & inferior Oblique muscles
are now and then imbued in the distortions of
this organ & requires to be well understood.
Indeed all parts that have a solution
of Operation must be dissected, demonstrated
and studied with that particular object.

2341/697859/
3748964
6078


For several Malignant diseases to which
the Eye Ball is subject, we are obliged to
Extirpate the whole organ, and its attachment
and relations to the surrounding
parts require to be understood.
In other cases where no Malignancy
exists we can Sink the Ball as it is
termed, to fit it for an Artificial Eye.
The mere circumsection of the
Cornea is not generally enough to accomplish
the object. An incision ought to be
made a little beyond [the] Ciliary Ligaments to
be certain of accomplishing the object
we wish -
A Knowledge therefore of the relation
of these parts is necessary -

347/697843796/
698794
6478

Caricucula Lachrymalis
This little body at the inner Canthus of the
Eye is believed to be glandular -
It is subject to morbid conditions,
and its relation to the Ball of the Eye ought
to be understood by a Surgeon.
We are sometimes obliged to extirpate
it entire, or remove tumors of it, and upon
it.
4 1/4 = 6/24
6 1/3 = 8/24
7 1/8 = 3/24
172 17/24 = 1 7/24
18 24 7/24 answer

 

Fistula Lachrymalis.
This name conveys an improper idea of the
affection intended to be described.
Most of the cases are made with
in practice and not fistulous.
It consists in a tumor at the
Canthus of the orbit, just below the inner
commissure of the Eye lids, from a collection
of tears in the Lachrymal sack, from an
obstruction of the directus ad nasum.
The distension of the lachrymal sac
will plainly show its exact situation upon
the os Unguis -
When pressed upon the contents of it
will regurgitate through the puneta, and
the sac will be emptied.
In the third stage of this affection the
sack and integuments will often be ulcerated
& then it is legitimately a fistula.
The sack is wholly within the tendon of
orbicularis muscles, & from the bottom of it the

 

ductus ad nasum begins, which conveys the
tears into the nose.
This duct opens into the noses before
the [crossed out] impression turbinated bone -
Important to be recollected, as we can
frequently pass a probe up from the nose
and remove the obstruction.
When the distension of the Lachrymal
sac exists, it is very simply and easy to open
it, but in the undistended a normal state
few can open it who are not acquainted with
its relative situation - The bony margin of the
orbit must be felt for, and if just within
it we make the incision the sack will
surely be reached -
To pass a probe from the sack also
requires a Knowledge of relation - Many
Practitioners are embarrassed to frequently
fail in the attempt to find it by not
applying the probe firmly against the
supercilliary ridge before [it is] attempted to be
passed into the duct - It will readily succeed
in this way, and as readily fail in the other.

 

In the complete state of Fistula, or stage of
ulcerations, the opening by ulceration always
takes place too low down for the stylus to be
passed through it to effect a cure. If it
is placed in the duct, the motion of the
[moti??] will cause it to be forced out. A
new incision must be made above in
a line with the duct & edge of the supercilliary 
margin.
If the opening through the os unguis is
permanently closed, as is sometimes the case, and
no probe by the most skillful can find it, we
are compelled to perforate this bone in order to establish
a new opening through it, and a passage
for the tears into the nose -
This can only be done by a knowledge of
the relation of the os unguis to the nasal process
of the Superior Maxillary bone -
The probe passed in a perpendicular direction,
as for the natural opening will not enable
us to accomplish it, as it will be resisted in its progress
by the nasal process of the superior maxillary bone
and cannot be forced through it -
To perforate the os unguis use the point of the probe,
and pass it transversely from the outer canthus - When it has

pierced the bone, raise it up perpendicularly and
apply it to the supercilliary ridge, by which the natural 
direction of the duct will be given to it as
it passes into the nose -

Eye Lids
As these are subject to a variety of diseases
and injuries, our Operations to remedy
them and repair the damage they may have
sustained, should have a constant reference
to the normal structure of these parts.
The Puncture in each lid must be
bourne in mind as an essential element
in its functions, not to be disturbed, or
encroached upon. If from any cause, either
puncture is obstructed or obliterated, the
tears must flow more or less over the
under eye-lid, & give the eye the appearance
of more or less weeping.
The Operation to supply defects, or
destruction of the Lids from Burns, does great 
honor to Modern Sugery. It is called Blepheroplasty.
Care, judgment and skill are
necessary to plan and execute the Operation's
Deformities of the lids from Burns and

 

and Cicatrices from wounds, are the most frequent
causes of frightful and distressing deviations
of the upper and lower lids -
To such an extent are these conditions
of the lids at times, as to prevent
the Corneas from being covered even with
the greatest effort of the patient. The surface
of the Cornea becomes dry, inflamed
and thickened, and no exposure whatever
to the light can be endured.
It is an important step indeed
to address a plastic Operation that shall
restore the use of this valuable & beautiful
organ.
We have frequently performed these
delicate and important Operations, and had 
the most signal benefit from them -
The flaps may be taken from the
Cheek and Temple - Great care must be taken
to have the connecting isthmus of sufficient
depth and width to secure the circulation.

a) And the circulation will be more likely to preserve
the vitality of the flap - Without a certain
amount of circulation we cannot expect the
adhesive process, and when still less the flap
will perish -

The flap also should be rather redundant
in size, as all tension is infavourable to
union by adhesion. [illustration]
All pressure must be carefully guarded
against, as it may interrupt the circulation.
A natural anxiety to have every
part unite has led some non-practical Surgeons
to put in too many pins on stitches - A certain
number is indispensible - But if too
large a number be introduced the inflammare
will be augmented to such a degree, as to
have the suppurative inflamation instead 
of the adhesive -
I have verified this important
fact in a multitude of instances in my own
experiences, and the observations I have
and opportunity of making in the practices
of others -

 

Anaplasty as applied to the Nose
Lips and Cheeks ~
The first step taken in these important Operations
was in the substitution of a new Integumental
noses for the original & beautiful
fabric of nature -
The important feature of the face is
frequently cut off by swords and other warlike
weapons in times of peace & war - We have
known it also several times to be bitten off
in brutal conflict between man to man.
In early times we read that the nose
has been bitten off, and after some half an hour
washed, applied, and that it has grown fast.
In all the cases we have seen, no restorations
of the bitten off part has taken place, on the contrary
a permanent disfigurement has been the
result -
These are the best cases for the success
of Anaplasty - We have addressed it very beneficially
to these cases in various proportions.

 

Destruction of the Nose from Lues Venerea
and Lapus, are now and these [remedial]
by Anaplasty as applied to the whole
member, called Rhinoplasty.
The integuments originally taken by
Taliacotias was from the Arm or fore
arm - In latter times the skins or portions
of integument is turned down from the
forehead - These ones by far the best noses
that are made upon the patching plan.
We believe Canpare of London introduced
this improvement into Surgery, and it was
extensively & successfully carried out by the
celebrated Liston.
We remember to have seen two
noses made by the celebrated Baron Graffe
when in Berlin, from this and - They were much
less symetrical and beautiful than several we
saw made by Deiffenbach from the forehead.
We also saw Profr. Dabonviskic of
St Petersburg, make one from the forehead which
looked & succeeded very well -

a) See several drawings in my Portfolio.

Sloughing of the Cheek from Scarlatinas,
Typhus - the violent action of Mercury on
the Gums, and Cancerous effections of
the Under Lip, spreading from thence to
the Cheeks and invading the corner of the
mouth and upper lip, are the cases in
which we have repeatedly applied Anaplasty
in various proportions, with the greatest
benefit - (a .
These forms of Anaplasty are denominated
by modern authors, when applied
to the Cheeks.
to the Lips.
We have seen and greatly remedied
shocking deformities of all these parts, but sometimes
the destruction of the sides of the face
is so considerable that it does not admit off
any reparations from the surrounding parts. Then
our only resource is in a silver plate fashioned
like the sound side of the face, painted skin
colour and worn over the defects -
We are free to say, that if we were

 

Noseless ourselves, we would not permit
the best Nose-Maker in Europe or America,
to practise upon us, but would infinitely
prefer the Papier Maché imitations -
We have an opportunity sometimes
in these Operations about the lips, cheeks
and Jaws, of availing ourselves very advantageously
of sliding portions of integuments,
(glissament) by merely detaching them from
the bone or parts underneath.
In one instance in the person of
[Judges] from Missouri, we removed an
extensive Cancer which had destroyed the
entire under lip & spread into each angle of
the mouth - The incisions extended beyond
the angles of the mouth into the cheeks, and swept
around near the margin of the chin, to exclude
all the diseased parts. By detaching
the [balances] of integuments from the very margin
of the Chins, and extending the seperation of integument

 

integument to the thyroid Cartilage, I was
readily able to slide the whole up the length
of the chin, so as very satisfactorily to repair
the damages. It succeeded admirably -

 

Relation of the Duct of the Parotid Gland.
Whoever Operates upon the Cheeks should
be fully aware of the courses of the Parotid
duct access this Masseter muscles, to the
point of its termination through the Buccinator
muscles & membranes of the mouth.
A line drawn from the lower part
of the lobe of the Ear, to the lower margins of
an Ala of the noses, will define very accurately
the course if this duct -
Another perpendicular line from this
external Canthus of the orbit, will accurately
indicate the inner margins of the Masseter, &
opening of the duct into the mouth.
All Operations performed in this region
ought always to have reference to the course
and terminations of this duct. Otherwise from
wounds of it troublesome & perhaps incurable
salivary fistula may be the result -
The situation of the Pes Anserinus,
and course of the principal branches of the Portio
dura, or Facial Respiratory Nerve, and a

 

Nerves of the Faces.
Their
Surgical Relations.
Few Nerves in the Body are more
interesting to the Pathologist or Surgeon than
the Tri-facial branches of the 5th- pair.
The Crust and agonizing diseases of
one or more branches of them, denominated [Tic]
Douloureaux or Neuralgia, makes them
important objects of study.
Not only to find out the changes which
which are produced in them by this curious disease,
but to know their relations with other
parts, that we may direct a Surgical Operation
if necessary, for its relief or cure.
The trunk of the Opthalmic branch
of Willis [after passing through the foramen [illegible]] [after] entering [the socket] lies close to the roof
of the orbit, and passes through the supercilliary
foramen, the notch of these, or over the ridge itself
& is distributed to the integuments mostly

 

of the forehead -
The division of this nerve is easily accomplished
either just within the bony margin
first [feeling] for the notch as a direction
for entering the pointed [bestony] - By sweeping
the end of the knife close along the roof
of the orbit, previously pressing down the
ball of the eye, the trunk of the nerve
will easily be caught by it and divided -
It may also be cut just above
the ridge, by the same knife, and to young
Surgeons, this will be the preferable place
as it is entirely out of any danger.
In both places, the numbness upon
the forehead in the track of the nerve will
infallibly denote that it has been cut -
The second branch of the 5th pair or
infla orbital comes out upon the faces
by the infra orbital foramens.
The exact situation of this in relation
to the bony margin of the superior maxillary
bone must be carefully learned - The depression
can generally be felt through the soft

 

parts from without, to convey a correct idea of
the exact situation of the foramen.
As this nerve instantly divides into a
number of branches the instant it emerges
from the foramen, it is important to divide it
at its exit, to secure the full benefit of the
Operation -
The same sensation of numbness will
follow upon the cheek, upper lip and sides of the
nose, if the trunk is cut, that was experienced
on the forehead.
This third branch of the 5th pair or inferior
Maxillary makes its exit from the
foramen mentala. This foramen is situated
about the root of the first bicuspis tooth nearly
half way on the body of the bone - If a
perpendicular line be drawn from the supra
orbital foramen to the bases of the lower jaw,
it will very accurately point out this situation
of the mental [hole] -
This we have often examined, and
never found it to fail. When all the teeth
are gone this is an excellent guide.

 

To divide this nerve the bistoury is passed within
the mouth - The lip being turned down the
cheek is divided to the extend of half an inch
opposite the rest of the first bicuspis tooth -
The knife is then passed flatwise close to the
bone & the cut made from behind forward.
In this way we have been enabled
to readily divide the nerve as it comes out of
the foramen - If it is divided a sensation of
numbness will be felt to some distance
about the cheek, chin & lower lip.
To secure the full division of these nerves, I
am in the habit of making several sections
through the same external incision. The trunk
of the nerve is thereby several times divided,
and perhaps the union of it also may be
somewhat retarded -
These nerves generally unite in from
three to four months, and the disease returns
again with all its former horrors. In a few cases
I have known the Operation affect an entire
cure - It always cures until the function of
sensation returns, then reappears the enemy.

 

In Neuralgia of many parts of the body we
can exsect a portion of the trunk of a nerve,
and thereby prolong the cure, but in the nerves
of the face we cannot attempt this without
in the first place considerably disfiguring
the face, and secondly the shortness of the
trunk forbids it.

 

Portio dura or Facial Respiratory.
The situation of this nerve as it comes out
at the foramen stylo mastoideum is interesting
to us as Surgeons. The trunk here is of some
length before it enters the Parotid Gland. This
is important to be recollected, as [it is] at this point
that it has been advised to divide it [in] cases of
obstinate Neuralgic affections of the side of
the face which follow the branches which go off
in front of the Parotid.
As this nerve emerges from the Parotid,
there is a peculiar conformation of it
which is called the Pes Anserinus, situated
close to the Parotid Duct. Several branches
go off from this across the face in different
directions -
Since Sir Charles Bells views [were] made
public, ascribing to this Nerve only the function
of motion, very little attention has been given
to it as an object of Surgical interest. That
it is more a nerve of motion than sensation

a) You have but to dissect the nerves of the entire side
of the face to be convinced of the intimate and wonderful
connection (anastomosis) of the branches of the portis
dura and the second branch of the fifth pair; To look at
this dried specimen of a masterly dissection you must
inevitably come to the same conclusions -
It is more than I can comprehend, that this
wonderful Anastomosis of these two Nerves, should not
make them have a community of functions, as they interlap
such an intimacy in organization.
One thing is very certain, that Anastomosis in the
nervous system does not serve the same purpose, that the
inosculation of Arteries does to the vascular system.
In severe cases of Neuralgia of the trifacial
nerves, the branches of the Portio dura, and even the trunk
itself is involved in the disease - Of this there cannot be
a question - I have seen it repeatedly -

I fully believe, but that it has also more or
less of the function of sensation, I also am well
satisfied of - The observations I have made
from division of it which [I] have [taken place] [crossed out]
in Extirpating the Parotid Gland, and other
tumors in the vicinity, convinces me of this
fact.
Every Practitioner of experience must
have observed in severe cases of Neuralgia
of the tri-facial nerves, that all the branches
of the Portio dura, even to the trunk, and involved
in this agonizing disease. I am quite
sure of this myself. a)
The close proximity of the branches
of this nerve to the Parotid Duct in front of
the massetic and across it make the division
of these branches objectionable, on account
of this formation of a Salivary fistula. They
have however been cut by Surgeons before the
views of Sir Charles were made public.
We would always prefer in these cases
to search for the trunk as the most effectual
Operations - In all cases trunks are preferable

 

to branches, and the exsections of a portion of the
nerve - At least half an inch of the nerve in
this situation we have removed.
If the relation of this nerve is understood
there is no danger in the Operation, but
there is difficulty -
An incision about two inches long in
front of the mastoid process, & close to it, will
expose the inner edge of the Sterno mastoid muscle -
Then the origin of the Digastric muscles
will be seen - By continuing the dissection in
front of this, we arrive at the root of this process
by seperating the cellular [crossed out] substance with the
handle of the knife & forceps, and just in advance
a little, the nerve will be found. This styloid
process & the rest of the mastoid, cannot fail
to direct us to the exit of the nerve - After
the Digastric is exposed very little use ought to
be made of a cutting instrument -

 

Parotid Gland.
The situation and relations of this Gland
[crossed out] are very important to the Surgeon -
It is not enough to know that it is
the largest of the salivary glands and is situated in
front of the Ear, and that is is an aggregation
of small glands which ultimately terminate in
one general excretory duct.
This is all very well for an Anatomist
but a Surgeon requires more to warrant him in
encountering an Operation upon this important
and dangerous region. He must know the parts
it is related with to enable him to proceed with
satisfaction to himself and safety to his patient -
Above it is connected simply with the
jugum temporale - in part it laps a little over
the masseter muscle. In front & below it lays over
the base of the jaw, and in front it comes forward
to the stylo masillary ligament, which alone separates

 

separates it from the Submasillary gland - below and
in front it lays upon the digastric muscles and
pharynx & external Carotid Artery - upon the
deep jugular and Internal Carotid Artery. - posteriorly
it lays over the mastoid process and the
sterno mastoid muscles, and deeper upon the
portio dura & syloid process -
From these various connections the
Gland has to be seperated when it is removed in
a Surgical Operation.
That it can be removed is now a settled
question in Surgery. At all times it is
difficult and dangerous -
It is always best to tie the External
or Common Carotid, before attempting its removal -
It can be done all must admit,
but safety to the patient and comfort to the
Operator ought to induce every one to do it -
There are several diseases of it which
require the whole Gland to be removed -
Tumors over and upon this Gland have
beyond all doubt been removed for the Parotid

 

itself - And even encysted tumors in the body of
the gland have presented a remarkable resemblance
to it, & from pressure the gland has been
almost entirely absorbed -
Enlargements of the Socii Parotidis,
have been mistaken for the Gland itself. These
bodies are in front of the body of the Parotid, in
the course of the Parotid Duct. They resemble
in structure and appearance the body of the
Gland, but are isolated and are without any
excretory duct.
Since the time of Beclard in 1811, who
was the first among the French to remove by
an Operation this Gland, American Surgeons
have done a large share in establishing the
propriety and safety of the Operation -

 

Submaxillary Gland -
This the second in size of the Salivary
Glands is situated below the base of the
lower jaw and in front of the Parotid - from which
it only is seperated by the stylo-maxillary ligament -
It is covered by the platisma myoides
and superifical cervical fasciar, and a lamina
from the deep cervical closely invests it.
This Gland lies upon the mylo-hyoideus
muscle - It excretory duct passes upward
& forward and opens into the mouth
by the side of the frenum of the tongue -
It is sometimes affected by Scirrhus
hardness which degenerated into Carcinometous
ulcerations -
We have removed it in the latter
state when nearly the size of the fist -
The facial vein & Artery run over the
base of the Jaw about the point where this
gland comes in contact with the Parotid.

 

Lower Jaw
This in the adult is composed of one bone, but
in the Infant it is made up of two portions
united at the Skin -
As a whole it is very important to a
Surgeon, from its relations, and the accidents
and diseases to which it is subject.
It has several muscles which belong to
it and influence its movements -
The Genis hyoideus
Digastricus.
Massetus
Temporalis
Pteregoidei { Eternal -
{ Internal -
Other muscles are attached to this bone, but are
not its moving powers -
Every part of this bone is concerned in some
operation or injury - and ought to be minutely
understood by every Surgeon -
The Skin or anterior angle
Base -
Posterior angle

 

Coronoid process -
Condyloid process -
The peculiarity of the temporo-maxillary articulations -
Interarticular Cartilage -
It is necessary to understand this articulation
with the temporal bone, to enable us
to cut advantageously and safely into the
joint when we wish to disarticulate this
bone when disease requires it removal.
After seperating the temporal muscles
from the Coronoid process we cut into the
joint in front, and by keeping close to the
condyloid process we open into the joint and
thereby avoid wounding the internal maxillary
artery, the [illegible] hemorrhage from which would
complicate the Operation.
This bone in part, and the whole may be
removed successfully for Osteo-Sarcoma, and other
diseases, and at both articulations it has
been taken away for Necrosis.
We have in many instances removed

 

large portions of it for Osteo-Sarcoma - In
one very formidable case three fourths of it,
the tumor being nearly the size of the patients
head. See Princes Cases, and Specimen
in the Museums - See also a series of other
specimens in my Collection of Mastoid Surgical
Pathology -
Dr [Garnochans] has in this same Operation
for Necrosis of the entire bone taken
it away at both temporo-maxillary articulations -
The articulating surface on both
condyloid processes was entirely sound. I saw
the patient when well - there was very little
deformity -
This is the first instance on record
of the entire removal of the lower jaw. It
will be questioned by many Surgeons, whether
there was a necessity for this procedure, it
being only a case of Necrosis.
The bone on each side was sound a
little above the posterior angles, and some
no doubt will say it would have been
better Surgery to [have] left these sound portions as
new starting points for the reproduction of
a new Jaw.