Successful removal of a large goitre : with remarks / by Edward Jessop and James Berry.

  • Jessop, Edward.
Date:
[1889]
Catalogue details

Licence: Public Domain Mark

Credit: Successful removal of a large goitre : with remarks / by Edward Jessop and James Berry. 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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    vessels bled l)efore being tied ; none of the others did so. Tbe istlmms proved to be a very narrow one, being only as thick jis the little finger, and no haemorrhage sufficient to require a ligature occurred from ils cut surface. There were some vessels, however, in front ;ind on tlie upper border of the isthmus. The tumour having been removed, a very large cavity was left in the neck; this extended down into the thorax to more than an inch below the upper border of the clavicle. The carotid artery was seen in about four inches of its length. The trachea, larynx, and oesophagus were of course all freely exposed. The first-named of these was flattened, and the tumour was some- what closely attached to it. The wound was not washed out with any lotion, hut two cotton-wool sponges were left in it, until the stitches were inserted, and were withdrawn before tightening the sutures. The wound was sewed ii[) after a method adopted by Dr. Girard of Berne. Half-a- dozen pieces of thin india-rubber drainage-tubing were cut about an inch long; one piece was fastened at the end of a long silk suture, and a deep stitch taken. Another piece of tube was then run along the silk, and laid parallel to the long axis of the wound, and another deep stitch taken, and another piece of tube run along tbe silk, and made to lie on this side of the wound; this was repeated until there were three pieces of drain-tube on each side of the wound, running parallel to its long axis, and acting as a sort of button suture. This brought the deeper parts of the wound thoroughly into contact. A piece of stout di-ainage-tube was now put through a separate opening near the lower angle of the wound, the edges of which were brought together by a continuous suture. Tbe wound was dressed with eucalyptus gauze soaked in carbolic acid, care being taken to keep up pressure after the last sponge had been removed, so that no blood sbould collect, and the dressing was bandaged very tightly round the neck, tbe bandage forming a figure of 8 round the shoulders. The patient was well propped up in bed, and the head fixed with sandbags. Our best thanks are due to Mr. Edgar Willett for the very skilful manner in which he administered chloroform, a matter of no small difficulty; the total amount of chloroform given only amounted to 15 drachms. The operation, from the com- mencement of the chloroform administration, lasted two hours and thirty minutes. For the next twenty-four hours retching and sickness were very troublesome. The patient was allowed to take nothing but teaspoonfuls of iced milk and water; he was very restless during