A manual of diseases of the ear, for the use of students and practitioners of medicine / by Albert H. Buck.

  • Buck, Albert H. (Albert Henry), 1842-1922.
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: A manual of diseases of the ear, for the use of students and practitioners of medicine / by Albert H. Buck. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

    354/444 (page 336)
    A Comparison of the two Methods of Perforating the Mastoid Process.—The next step in the operation is the perforation of the bone laid bare in the manner just stated. Before describing how this perforation is to be made, it will be well for us to rehearse briefly once more what such an opening is expected to accom- plish and to enumerate the different ways in which it may be made. The main object to be secured by an operation upon the mastoid bone is the establishment of free drainage from the antrum, i.e., from the middle ear. Free drainage puts a stop to the dangers of a too long- continued intra-tympa- nic pressure, and affords an easy egress to any de- composing substances (cheesy pus, cast- off epithelium, and necrosed fragments of bone) that may be lodged in some part of the tympanic system of cavities. This object may be attained in two ways: (1) a direct cylindrical channel of ade- quate size may be made in the bone, down to the antrum, by means of a suit- ably constructed drill; or (2) the outer portion of the process may be chiselled away in such a manner that the wound in the bone shall represent roughly a shallow cone, the base of which corres- ponds with the outer surface of the mas- toid process, while the apex reaches into the antrum. Both of these methods have been thoroughly tried, and it has been shown that just as good results may b'e secured by the former as by the latter plan of procedure. Hitherto, I have been a strong advocate of the em- ployment of the drill (the pattern shown in Fig. 89), for the reasons that it had al ways proved to be a thoroughly safe instrument in my hands and in those of my colleagues; that the duration of the subsequent heal- ing process was, on the average, much shorter than in the cases in which the chisel had been used; and, finally, that the resulting scar behind the ear Avas far less conspicuous than that following the chiselling operation. Furthermore, the arguments brought by the advocates of the latter operation against the employment of the drill were so conspicuously unfair, that it was difficult for me not to espouse the cause of the drill more warmly than I might other- wise have done. My attention, however, has recently been called Fig. 89.—Bone Drills. (The two larger sizes.)