Recapitulation of Surgical Cases-Edmond Souchon, M. D., New Orleans, La.

spasmodic contraction of the parts, and, the next day. allowed the passage of a small instrument.

Ulcers of all kinds were treated in a general way, by rest, iodoform, strapping and bandaging of the limb. When the edges were high and hard, they were incised in several places, and this assisted the case very much.

Of the Various Wounds of the Scalp, one was followed by a phlegmonous erysipelas, which destroyed all the areolar tissue under the pericranial fascia. The pus was fusing towards the eyebrows, and back towards the occiput. The insertion of several drainage tubes arrested the disease, and the patient was finally cured, though after a long time.

The Penetrating Wounds of the Abdomen were all diagnosed at the moment of the accident by the able ambulance surgeons. Two died and one recovered.

APPENDIX-Section on Surgery and Anatomy.

A CASE OF RESECTION OF THE SUPERIOR MAXILLARY BONE, FOR CANCER.

BY EDMOND SOUCHON, M. D., NEW ORLEANS, LA., Professor of Anatomy and of Clinical Surgery, Tulane University of La., in charge of Wards.

On January 8, 1886, Alex. Dykes, a colored man of 41 years, from Providence, La., entered ward 8 in the Charity Hospital. He is a strong, well built Negro, and applies for relief or cure of a tumor of the left side of the face.

There is nothing special in the history previous to the appearance of the tumor, some eighteen months ago, as far as we can ascertain from his dull understanding. except that some four months or so ago the tumor was operated upon, or simply cut into, of which he bears the mark.

On the left side of the face, exists a tumor extending from the upper lip to the lower lid, which is pushed up so high as to close the eye, and from the nose to the malar bone. The surface of the tumor is ulcerated to the extent of a half-dollar silver piece. The tumor is rather hard to the touch, and is painless, both upon

Resection of Superior Maxillary Bone, for Cancer-Edmond Souchon, M. D.

pressure and spontaneously.

By examining through

the mouth, it is found that the tumor does not extend beyond the beginning of the pterygoid process.

The patient was shown to the class on the regular clinic day. All the above features were explained to them, and the case diagnosed one of malignant disease of the superior maxillary bone, having originated, most likely, on the antrum.

The bulging of the tumor on the face, it being on a level with the free border or back of the nose, together with its reaching in the mouth to the pterygoid process, convinced us that it had extended so deep, also, toward the apex of the orbit that to operate on him at that stage would have been a bloody, dangerous and useless. operation. I therefore declined to operate.

During the week that followed, I examined him often. He seemed much disappointed at seeing that nothing was being done for him, since he had come. quite a distance, he thought, to find some one who would attempt something for him. At my request, Prof. Richardson was kind enough to examine him, and we came to the conclusion, since it was the man's only shadow of a chance, especially since the success. depended upon how deep the cancer actually extended, if perchance it did not extend beyond the danger zone of the deep regions, an operation might be successful in saving his life, or in prolonging it, or in affording him an easier death ultimately than would be if the tumor was allowed to go on ulcerating, develop

APPENDIX-Section on Surgery and Anatomy.

ing, spreading and involving the mouth, throat or cranial cavity.

The patient was given a good drink of whisky before getting on the operating table, and he was put under the influence of chloroform. He took it very well, and it was determined that after the removal of the towel, when the operation would begin, the anesthesia would be kept up by the use of a throat atomizer, containing chloroform, which would be atomized, mixed with air and thrown in his throat by means of a long metallic tube, which would not be in the way.

As it was known the operation would be bloody, dangerous and tedious, all precautions were taken to operate quickly, and to have at hand most skillful assistants, who were Dr. R. Matas, my chief of clinic, and my efficient resident students, M. M. Beckham, Bloom and Schmittle, together with some other students of the staff and class. The knives, saws and chisels had all been freshly sharpened.

As soon as the patient was fully under the effects of the chloroform, an incision was made over the malar bone, on a line with the spheno-maxillary fissure, extending down to the bone, and the bone was sawed; immediately, a dry-pressed carbolized sponge was applied over the wound, and kept there firmly, to stop the bleeding.

A second incision was made over the nasal process of the superior maxillary, directed from the lachrymal sac to the anterior nasal orifice, and down to the bone,

Resection of Superior Maxillary Bone, for Cancer-Edmond Souchon, M. D.

which was also sawed through. The upper lip was then cut through, opposite the left middle incisor tooth, which was extracted, and then the palatine process of the superior maxillary bone was sawed through, without previously incising the mucous membrane of the palate.

The next step was the detaching of the upper lip from the tumor, as far back as the ascending ramus of the lower jaw. All this had been done without difficulty, and is usually done quicker than might be supposed, when the instruments are good and the operator has the anatomy of the parts well present to his mind, and is determined not to mind the blood, and to go on quickly. As fast as an incision was completed, it was covered with a sponge, like the first.

Here some little trouble and delay were experienced in opening the mouth fully, so as to be able to reach the articulation of the tuberosity of the superior maxilla with the pterygoid process. As soon as the mouth was well opened, a sharp chisel was placed between the two bones, and, by hard pressure in the right direction, the maxilla was finally loosened from its last hold. Quickly the soft palate was detached from the hard palate, and the lower lid was separated from the tumor. The whole mass of tumor and bone was felt to be loose, and was quickly removed with the knife, severing whatever points resisted. In doing this, no attention was paid to the limits of the tumor, the point in view, at this time, being swiftness, as the bleeding was more considerable than at any previous time. The cavity was at once