On resection of the Gasserian ganglion, with a pathological report on seven ganglia removed by W.W. Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: On resection of the Gasserian ganglion, with a pathological report on seven ganglia removed by W.W. Keen. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    iodoform gauze, will overcome the difficulty if the vessel cannot be ligated. On no account, in my opinion, should the external carotid be ligated as a preliminary measure. In one case in this city (Philadelphia) in which it was done, ne- crosis of the temporal flap took place, and the patient’s death from sepsis followed as a result. c) The removal of the ganglion itself is best done by Krause’s method; namely, — uncovering the ganglion and then seizing it, and slowly twisting it out, after dividing the second and third divisions at their foramina. This method of removal should be employed instead of the un- certain method of « breaking up » the ganglion when we act blindly and unscientifically. d) The preservation of the eye. The method which experience has taught me now definitely to adopt is as follows: — either immediately before, or at the close of the operation, I disinfect the eye, and sew the two lids together by two or three stitches, drawing together only the middle of the lids. This leaves the two ends open sufficiently, first, for washing the space between the lids and the eye- ball with a warm boric acid solution to wash away any mucus, and also leaves enough space for us to observe the cornea when the patient looks strongly to one side. This occlusion of the lids should last for not less than four or five days. The stitches may then be cut, and the eye im- mediately covered with a Buller shield, i. e. a watch glass held in place by means of, either a circular fenestrated disk of rubber plaster, or by four separate pieces of plaster. I prefer the circular plaster. The reason for the corneal ulceration and loss of vision, or loss of the eye, is undoubtedly, first, the drying of the cornea due to the want of appreciation of its drying, by reason of its being anaesthetic, and, therefore, to want of winking, by which the cornea is hept moist; and, secondly, as another result of the want of sensitiveness of the cornea,