A report on the operations for fissures of the palatine vault / by Thomas D. Mütter.

  • Thomas Dent Mutter
Date:
1843
Catalogue details

Licence: Public Domain Mark

Credit: A report on the operations for fissures of the palatine vault / by Thomas D. Mütter. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    are made, as the blood prevents to a certain degree, our as- certaining precisely the spot at which the needle enters, but in all the cases which I have seen, the slight hemorrhage which follows the section of the edges, is readily checked by causing the patient to gargle with a little cold water. Mr. Alcock attributes the partial failure in one of his cases, to the denudation of the edges before the passage of the ligatures, in consequence of which some moments elapsed between the denudation and approximation of the margins of the fissure. This short interval could not, however, exert any influence upon the tendency to re-unite, which all denuded tissues pos- sess, when they are closely approximated. Many examples of union by the first intention, even when several minutes have elapsed before the adjustment of the separated tissues could be accomplished, might be cited, were it necessary to prove the assertion just made. When the ligatures are introduced before the edges are denuded, there is always danger of cutting them while this is being done, and should this occur, the operation will of course be rendered more tedious, and necessarily more painful. Again, when the edges are previously denuded, the sutures may be inserted more readily at the proper distances from the margins, and thus the liability to cut out be much dimi- nished. In freshening the edges, we should always commence at the most dependent point. By making the section from be- low upwards, the blood will not obscure the parts, and we are thus enabled to see the tissue through which the knife has to pass, in its natural state. In the introduction of the sutures, we must always, for obvious reasons, commence at the inferior portion of the wound, and be very careful to cause the points of entrance on one side, and exit on the other, to correspond as nearly as possible. Attention to this will prevent a puckering of the wound, and, as a consequence, its irregular union. All the sutures must be passed before we attempt to close the fissure; and in tying them, it is nnnecessary to use any instrument