EXCISION OF UPPER JAW OF RIGHT SIDE FOR A BONY TUMOR: CASE OF A NEGRO GIRL, AGED TWELVE YEARS, IN SOUTH CAROLINA; CURED. N. Y. MED. JOURNAL, NO. XV, VOL. III, 1866.

Fig 2.

A

Fig. 16.

A. A. showing where the nasal process of the upper jaw was cut with chain saw; B. B. where the alveolar arch and the bony roof of the mouth were cut with the chain saw. C, Showing where the cheek bone was cut with a very small straight narrow saw made for the occasion by a gunsmith.

SECOND CASE OF EXCISION OF THE UPPER JAW. CASE OF MISS F. P. OF VIRGINIA.

Explanatory sketch of this Second Case of Excision of the upper-maxillary bone for tumor:

Case of Miss F. P., of Virginia. Tumor also on right side; dotted line shows the outside cut through the lip, up around the nostril on the side of the nose. a. Heavy cutting pliers of Liston, with which the maxillary bone was cut; cheek bone cut with small narrow saw. b. Lion forceps used for wrenching out the tumor. There was much improvement in her appearance

after operation, notwithstanding the floor of the orbit, being diseased, was removed. See Medical Record, June 1, 1867. No illustrations accompany report of this case in Record.

Miss F. P. was living in Suffolk, Va., and came to New York to consult the writer, who excised the tumor.

About four years before this, Dr. Charles Bell Gibson of Richmond, Va., advised the removal of the tumor. It grew slowly at first, then rapidly increased in size.

The accompanying accurate sketch is designed to give a correct idea of the appearance of the patient and also to show by dotted lines the incision that was made through the middle of the lip, up around the nostril on the side of the nose, and which occasioned a less conspicuous scar than in the preceding case. Dr. Nathan Bozeman of New York City was present and assisted at this operation.

The result was very successful, and she afterwards wore a dental plate. She subsequently removed from Virginia to Colorado, married, and some years ago lived at Boulder, Colo.

EXHIBIT FOUR.

SUCCESSFUL CASE OF TREPHINING FOR FRACTURE OF SKULL; ILLUSTRATIVE OF THE VALUE OF DRAINAGE TUBES IN THIS OPERATION. FROM MY ARTICLE ON "SURGICAL DRAINAGE" IN TRANS. COLO. STATE MED. SOCIETY OF JUNE, 1888; ALSO IN "MEDICAL NEWS" OF PHILADELPHIA OF AUGUST 25, 1888.

Excerpts: CASE.-Horace C., aged 5 and a half years, on the evening of April 22, 1888, while crawling near a horse, received a kick, which fractured the frontal bone on the left side, the fracture extending to the coronal suture. The depressed piece of bone was nearest to this suture, and the depression corresponded to a line extending obliquely downward, forward and outward from the coronal suture to the temporal ridge and slightly posterior to the external angular process of the frontal bone. The depression did not

give rise to any cerebral disturbances affecting consciousness, or causing motor paralysis.*

The accompanying picture of the boy shows the scars, indicating the location of the injury; and shows, in part only, the extent of the fracture downward and outward. The dark spot in the line of the scar corresponds to the site of the trephining, and the scar to the right of this spot, to the cut made for room to apply the trephine.

Result of a case of trephining for fracture of the skull and depression of bone from the kick of a horse; illustrating the value of drainage in such

cases.

*The line of fracture crossed the horizontal convolutions of the frontal lobe anterior to the ascending frontal and parietal convolutions or motor areas of the cortex. I thought best to trephine, because under careful

Trephine used in my cases of this kind; to the left is a Hay's saw, sometimes handy in removing corners of fractured bone about the skull.

asepsis and skilful management of the case, the dangers of trephining are greatly less than the subsequent dangers of cerebral disturbance from a neglect to elevate the depressed bone. The button of bone was not returned, because it was small, and the small opening permitted the use of a drain tube, a consideration infinitely more important than the complete occlusion of the line of fracture, because the blood which escaped in the dressing through the drain tube would otherwise have given rise to compression.

His head having been shaved he was chloroformed by Dr. J. E. Lowery of Denver. An incision was made at right angles to the lacerated cut, and under aseptic precautions the head was trephined, and the depressed piece of bone elevated with the point of a Sayre's periosteotome; the depressed piece of bone returning to its place with a sudden and quite audible snap. The wound was sutured with catgut, and a small rubber drain-tube placed in the center of the wound, opposite the button of bone removed (see A in the illustration), and a still smaller tube was placed in the posterior angle of the wound. Both drain-tubes were secured in place, each with a stitch of catgut; a slightly moist iodoform gauze dressing was applied immediately over the wound; over this dressing was placed a small piece of folded sublimate