Operations for mastoid disease / by Seth S. Bishop.

  • Bishop, Seth Scott, 1852-1923.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Operations for mastoid disease / by Seth S. Bishop. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    whole lower portion of the process has given way under a dull chisel, carrying with it some healthy bone, and exposing the dura mater. The chisel was not properly tempered and beveled, and the cutting surface chipped during the operation. After all the superficial dead bone has been removed and the edges of the sinus rimmed out and made smooth by the conical drill, we may find the cellular tissue of the process diseased and filled with dark red, ugly looking granulations. The curette, adapted in size to the circumference and contour of the opening in the bone, should then be employed with the utmost caution to avoid injury to the dura mater, the lateral sinus, or the middle ear. Frequent stops should be made to examine the tissues we encroach upon and to determine when we reach sound parts. Small sponges used frequently will free the wound of blood so that we can make satisfactory e^camina- tions of our progress, and if the bleeding is consid- erable it is advisable to have an assistant syringe the cavity at every step with a warm solution of mercuric bichloride, i-io,ooo, so that we shall make it impos- sible to remove tissues that should be left intact. In this way I have removed diseased bone until por- tions of the inner table were taken out, the dura mater exposed and the pulsations of the brain were visible, and yet have avoided harming the dura mater, as the subsequent progress of the case demonstrated. In using the trephine or drill the instrument should be directed upward, forward and inward, as a rule; but the location of the sinus, if one be present, or the place selected for opening the bone, must help to determine the direction of the instrument. The pressiire exerted on the drill or trephine should be very light, for fear that the outer layer may be un- usually thin, and that the instrument may suddenly settle into the soft tissues beneath. The thickness of the outer layer will average from an eighth to a quarter of an inch. In children it is very thin; while in adults I have found it nearly a half-inch thick.