Anatomical dissection

“ The point or lobule of the nose is usually tilted upward and the subseptum curved upward at its middle third.
The cause of this deformity is usually due to direct violence at some time in life, with improper replacement at the time of injury. Syphilis and intranasal catarrh, lupus and ulcerative diseases, are also causes.
The skin overlying the defect may or may not be closely adherent, but is in most cases rather thickened and inelastic. It is therefore necessary, in most cases, to loosen the skin by subcutaneous dissection, done as already described before the injection is made. ”

“ To assure the operator of a thorough dissection he may inject the site with sterile water through the opening made with the knife, squeezing it out before injecting the nose.
If the skin has had to be freed by surgical means the mass injected should be sufficient to overcome the defect almost entirely, to prevent the reformation of the bands of connective tissue which have been severed. ”

“ The dissection is rendered easier and is attended with less risk of injury to the nerves, if the patient is placed in the sitting posture so as to empty the veins, and, instead of a knife, the conical scissors of Mayo are employed. When the glands are extensively affected on both sides of the neck, it is advisable to allow an interval to elapse rather than to operate on both sides at one sitting. ”

“ Assuming this to be the case, therefore, it follows that when the dissector removes the cremaster from the space L h, he himself causes this vacancy in the muscular parietes of the groin to occur, and at the same time gives unnatural definition to the lower border of the transverse and oblique muscles. In a dissection so conducted, the cord is made to assume the variable positions which anatomists report it to have in respect to the neighbouring muscles. But when we view nature as she is, and not as fashioned by the scalpel, we never fail to find an easy explanation of her form. ”

“ If an aneurism has rendered amputation through it and through the joint a last resource, the flap must be gained chiefly at least from the outside; a malignant tumour of the humerus will almost certainly prevent any transfixion, and require flaps to be made by dissection, wherever the skin is least likely to be involved. ”

“ For finer dissections the smaller scalpels are to be employed, and in such cases the dissection-technique of fixed arm and free finger movement must be used. In many places within the body the cutting-edge of the knife should be directed outward rather than inward so that underlying structures may not be injured. ”

“ Under this method may be included certain operations for small epitheliomas low down in the rectum done through the anus. The patient having been properly prepared, the sphincter is thoroughly dilated; a circular incision through the entire wall of the gut is made, and the segment is caught with traction forceps and dragged by an assistant while the operator frees, by scissors and blunt dissection, to a point at least one-half inch above the cancer. ”

“ Since the skin is rather firmly adherent at the sides of the nose, except in the major part of the superior third, it will be found best to raise the skin of such defect into normal contour by a series of very small injections instead of following the method heretofore advised in connection with tense or adherent areas of skin, for the reason that such dissection would render the skin too mobile over an area usually beyond the defect itself and inviting the surgeon to an annoying hyperinjection which renders the part more unsightly than prior to the operation. ”

“ Disarticulation is facilitated by the surgeon forcibly bending the wrist when he makes the transverse cut, and it will be found easier to shape the palmar flap from the outside by dissection, than to do it by transfixion after disarticulation, on account of the prominence of the pisiform on the inner side of the palm. ”

“ Of the Eyeball only.—A circular incision should be made with curved scissors through the conjunctiva, a little beyond the corneal margin, then, beginning with the external rectus, muscle after muscle should be raised with the forceps, and divided, after which the optic nerve is cut through with the scissors. A slight preliminary extension outwards of the optic commissure will facilitate the dissection, and must be secured with metallic sutures; any vessels should be tied, and the orbit filled up with a light compress of charpie secured with a bandage. ”

“ When permission is withheld for the removal of the neck-organs they may be examined in situ, by freeing the skin of the neck by a subcutaneous dissection, cutting the lobes and isthmus of the thyroid in place and then opening the trachea and larynx by an anterior median incision. The salivary glands, parathyroids, cervical lymphnodes, vessels and nerves can all be examined by this method without removing the organs as a whole. ”

“ We operate upon them as upon scrofulous tumours, by incision, dissection, sutures, and the rest of the treatment, only avoiding to wound the membrane, lest its fluid contents be poured out and obstruct the operation, and lest a part of it should be left behind, which often occasions a renewal of the complaint at the wrists, ankles, and the moveable parts about joints, as a scrofulous tumour does in like manner, if the whole or a part of it be left behind. If any such thing be left it will be better not to sew up the wound, but to consume the remainder with septic applications. ”

“ The skin and the dartos being divided, the edges of the wound separate, and the testicle, still pressed downwards and outwards with the left hand, protrudes more or less, still included, as it is, within its fibrous covering. A careful dissection, with a few light strokes of the bistoury, or laceration with the thumb nail of the hand, now suffices for the separation of the fibrous envelope from its external covering, an entire separation of both of which can thus be easily obtained by pressing the most external layer upwards through the laceration of the cellular coat which unites them. ”

“ Special mention should be made of the _myeloma_ which is met with at the wrist or ankle as an elongated swelling of slow development, or over the phalanx of a finger as a small rounded swelling. The tumour tissue, when exposed by dissection, is of a chocolate or chamois-yellow colour, and consists almost entirely of giant cells. The treatment consists in dissecting the tumour tissue off the tendons, and this is usually successful in bringing about a permanent cure. ”

“ On dissection, it was found to exhibit no material difference from the general structure of the ray, excepting with respect to the electric or galvanic organs, [Pg 201] which have been minutely examined and detailed by the celebrated anatomist, John Hunter: he states them “to be placed on each side of the cranium and gills, reaching thence to each great fin, and extending longitudinally from the anterior extremity of the animal, to the transverse cartilage which divides the thorax from the abdomen.” ”

“ In the median variety of defect, where a cicatricial band separates the lip into halves, it may be found necessary to do a subcutaneous dissection before a suitable injection can be done, but in cases of long standing the dividing wall is exceedingly thin and the threadlike adhesions below are quite easily broken up by the force of the injection. The later product of new connective tissue will tend to further improve the contour.
Nasolabial Furrows (Unilateral and Bilateral) .—This condition in the bilateral form is exceedingly common in [318] adults beyond middle age. ”

“ Those in which it is feared that malignant action has commenced cannot be trifled with; and the only means which afford a chance of the patient’s being effectually delivered from them is an operation. With a view to their complete extirpation, the external incisions ought always to be free, so as to admit of the after-dissection being easily and rapidly performed: they ought also to be made in the direction of the muscular fibres, whether these lie above or beneath the tumour. In this way the margins of the wound are easily brought into apposition, and there retained ”

“ All these conditions cannot remain after death. Hence, if we desire to form positive opinions concerning much which is unfolded by dissection, we must supply the defect by analogy. Thus, whenever, in any part of the heart or arteries, the cohesion between the internal membrane and the subjacent structure is manifestly lessened, and the membrane is unusually red at that part, we may regard these appearances as the vestiges of inflammation, without thinking that we go too far in so regarding them. ”

“ By injecting sterile water into the area thus loosened with the knife a good idea of the thoroughness of the dissection and the possibility of building up the part to be corrected is obtained, yet in these cases the author has always found more or less difficulty in keeping the injected mass in place for the reason that the divided surfaces tend to unite at their peripheral borders, crowding the mass upward or to one side or diffusing it in such a way that the result has been anything but satisfactory. ”

“ In some instances, dissection has discovered, after death, the cause of the mental affection, and though, in many instances, no physical cause can be detected, yet, when it is considered, how limited are the investigations of the anatomist, and that the art is so imperfect, that diseases occasioning instant death, cannot always be discovered on the most minute dissection, it is not unreasonable to suppose, that the body is in all cases the true seat of the disease. ”

“ For the purpose of fixing the main facts in connection with the development of the higher mammalian hepatic circulation, and in order to obtain a demonstration of the cycle through which the different veins pass, the student is recommended to examine, preferably by personal dissection, a limited series of lower vertebrates which can be readily procured and easily injected. ”

“ Effects similar to those resulting from wounds in dissection often occur in nurses and others who have pricked themselves with pins while washing foul clothes, or from handling poultices or dressings removed from bad, putrid, or sloughing surfaces. ”

“ When we recall the awfully deterrent condition in which bodies must have been that were thus provided for dissecting purposes, it is easy to understand that the enthusiasm of the students for dissection must have been at a very high pitch. Certainly it was far higher than at the present day, when, in spite of the fact that our dissecting-rooms have very few of the old-time dangers and unpleasantnesses, dissection is only practised with assiduity if special care is exercised in requiring attendance and superintending the work of the department. ”

“ If pus is struck below the costal border, the aspirator needle being left in situ as a guide, the abdominal wall is incised down to the peritoneum. A 3-in. incision will give plenty of room. If firm adhesions be discovered, a sinus forceps is at once run along the needle, and pushed through the intervening liver tissue and into the abscess. ”

“ Should an attack of the external variety of piles not result in absorption, but leave an excrescence, painless but inconvenient, and liable at any time to become inflamed, excision would be in order. Divide the integument by an incision radiating from the anus, separate the skin from the tumor down to its base, and after seizing it with toothed forceps cut it off with scissors curved on the flat. Little flaps or tabs of skin remaining after piles may be snipped off with scissors. It is not well to operate upon external piles unless they obstinately resist all milder treatment. ”

“ Where pus has formed in relation to important structures--as, for example, in the deeper planes of the neck--_Hilton's method_ of opening the abscess may be employed. An incision is made through the skin and fascia, a grooved director is gently pushed through the deeper tissues till pus escapes along its groove, and then the track is widened by passing in a pair of dressing forceps and expanding the blades. A tube, or strip of rubber tissue, is introduced, and the subsequent treatment carried out as in other abscesses. ”

“ The eyes being protected by a pad over each, an incision is made along the long axis of the tumor and the skin is freed on all sides so that its base is exposed. If the swelling is very small in a child it may be necessary to make a cross cut through the skin as well, in order to get sufficient room to work in. The bone being exposed, a portion of the swelling can easily be cut away by bone forceps, because it is very soft. ”

“ Once the peritoneal cavity is opened, the incision through the peritoneum must be extended to the full length of the external wound by a probe-pointed bistoury.
The operator's hand must now be passed into the abdomen, and the tumour isolated from its connections as far as possible. When no adhesions exist it is{227} extremely easy to pass the hand quite round the tumour, ascertain its relations to the uterus and Fallopian tubes, and the length and thickness of its pedicle. The presence of adhesions adds very seriously to the danger and duration of the operation. ”

“ Autopsy board and holders designed especially for the purpose can be obtained from makers of laboratory apparatus. A main-incision is made in the anterior or median line from the chin to the genitalia, and the skin stripped back from the thorax on each side to expose the ribs. The thoracic cavity is then opened by cutting the ribs with the bone-shears or bone-forceps, and the sternum and cartilages are removed. ”