Incus

“ The body is weakly pointed ventrally and rounded dorsally. A beaklike manubrium malleus composed of anterior projecting external and internal spines extends from the body to the tympanum. The incus has a dorsally rounded body with an anterior downward snoutlike projection with which the malleus articulates. The short limb of the incus is broad basally and narrows somewhat distally. The long limb is narrow and its articulating lenticular process is a flat circular structure. The limbs of the stapes are wide-spread and heavy. ”

“ The middle part of the bar just outside the skull forms the stylohyal (styloid process in Man) which is attached by ligament to the anterior cornu of the hyoid (ceratohyal) .
While the account of the formation of the malleus, incus, and stapes just given is that usually accepted in this country, a somewhat different view of the development of these parts has as a rule been adopted in Germany. Reichert (No. 461) held that both the malleus and the incus were derived from the mandibular bar ”

“ And by the help of a Muscle drawing the Incus, these three bones, which otherwise could lye more streight, are brought to a Curved or Arched posture; and the Stapes being fixt unmovable, the Malleus yields, to bring the terms of that line nearer, in proportion as it is curved, and draws the Center of the Tympanum, stretching the surface of it from a Plain to a Conoid figure, within the same Circumference. And l conceive, the action of this Muscle does ordinarily and constantly draw the Tympanum to a moderate Tension ”

“ A semilunar incision is made through the integuments in the direction of the fibres of the aponeurosis of the external oblique muscle. One extremity of the incision will be situated near the spine of the ilium; the other will terminate a little above the inner margin of the abdominal ring. The aponeurosis of the external oblique muscles will be exposed, and is to be divided throughout the extent, and in the direction of the external wound. The flap which is thus formed being raised, the spermatic cord will be seen passing under the margin of the internal oblique and transverse muscles. ”

“ Straight incisions are to be made in the legs, as in the muscles and tendons; and nerves, arteries, and vital parts are to be avoided, taking care of their safety by sometimes making a straight incision and sometimes a transverse one into the abscess, according to the circumstances of each case. When the abscesses are small we make one incision, but when they are larger we make more, always dividing the thinner parts, and those which are most convenient for the escape of the matter. ”

“ When, therefore, the sinus extends upwards, the ichor readily flows out from the sore, and adhesion easily takes place; but when it extends downwards the ichor by remaining within corrodes the continuous parts, and unless you first make an incision for its discharge, you will be able to effect nothing; for the sores can neither be incarnated nor the parts made to unite. But if the sinus is in any of the limbs, as the arms or legs, one may produce adhesion without a counter-division by putting the limb in a declining position. ”

“ If no sinus exists, but a diagnosis has been clearly made, or even if symptoms of sufficient severity exist to justify a strong suspicion and decisive treatment, an incision may be made along the edge of the erector spinæ or the great mass of muscle attached to the spinal column and passing through the quadratus lumborum. An incision outside of the quadratus lumborum will come upon the kidney, but too far outside to make a direct access to the pelvis practicable. ”

“ The little wound being then stretched open between the finger and thumb of the operator, the incision is moistened with the matter, by gently touching it with the flat side of the infested lancet. This operation is generally performed in both arms, and sometimes in two places in one arm, a little distance from each other. For as I have not observed any inconvenience from two or three incisions, I seldom trust to one; that neither I nor my patient may be under any doubt about the success of the operation from its being performed in one place only. ”

“ On the afternoon of the day of execution, we saw the body of Bishop at the Royal College, where it was publicly exhibited, and to which hundreds of persons thronged, as if they were hastening to a [Pg 200] theatrical exhibition. A longitudinal incision had been made from the thorax downwards, and transversely on the pectoral muscles. A more healthy or muscular subject has not been seen in any of the schools of anatomy for a long period. The ligaments of the atlas indentatus were not broken, and he died of apoplexy, and not from the fracture of the vertebræ of the neck. ”

“ After the incision we apply the instrument called hypospathister, and extend the division from the left temple to the middle incision, dividing all the intermediate substance along with the pericranium; then we push a spatula from the middle one to the rest, and applying the point of a sharp-pointed knife to the first division, so that its sharp side may be turned to the flesh within the skin, and the blunt one to the bone, we push it as far as the middle division, cutting through all the vessels which descend from the head to the eyes, but not comprehending the external skin. ”

“ The iliacus muscle was exposed by a short incision like that for ligature of the external iliac artery. Half the threads were passed through a portion of the iliacus muscle, and were knotted in pairs to the other four threads, thus fixing them securely to the tissues of the iliac fossa. ”

“ Unilateral cerebellar exposure. The patient being placed in the semi-prone or face-down position, the incision starts at the posterior border of the apex of the mastoid process, curves inwards along the superior curved line of the occipital bone to the occipital protuberance, and then passes straight down the middle line of the neck for 2 to 3 inches. If the incision is deepened at once to the bone, hæmorrhage is severe. The incision should first involve the skin and then the muscles attached to the occipital bone. ”

“ In most cases it is possible, and in nearly all advisable, to excise the joint by means of a less complicated incision. Thus one long vertical incision at the posterior surface, with its centre about midway between the ulna and the external condyle, with a transverse{122} incision at right angles to it, and reaching almost to the internal condyle, has been often practised with a very good result. ”

“ An unguiculated operculum is one in which the layers are disposed laterally, and the nucleus constitutes part of the outer edge.
UNGULINA. Daud. (Ungula, a nail or claw.) Fam. Mactracea, Lam. Conchacea, Bl.—Descr. Equivalve, sub-orbicular, sub-equilateral, with margins entire, simple, closed all round; hinge with one short, sub-divided cardinal tooth in each valve, and a very minute additional tooth in one valve, an oblong ligamentary pit divided into two portions, one of which receives the cartilage, the external ligament is immediately below the umbones ”

“ If the Probe cannot enter, the Intestine must be taken out a little, laying a Finger upon it near the Ring, and making a small Scarification in the Ring, with a streight Incision-Knife guided with the {237}Finger, to let in the Probe, into which may be put a crooked Knife, to cut the Ring; that is to say, to dilate the Wound on the inside; but care must be had to avoid penetrating too far, for fear of dividing a Branch of Arteries; and then the Parts may be put up into the Belly. ”

“ The Brachiæus Externus is a fleshy Muscle which proceeds from the hinder part of the Humerus, and adheres to the Olecranum with the Brevis and the Longus.
The Anconeus or Cubitalis being situated behind the Fold of the Cubitus, is the least Muscle of all; it springs from the Extremity of the Arm-Bone, at the end of the Brevis and the Longus, and in descending is inserted between the Radius and the Cubitus or Ulna, three or four Fingers breadth below the Olecranum.
How many Muscles hath the Radius, and which are its Motions? ”

“ Modus Operandi.—In the first step of the operation, the ordinary manipulations of the division of the envelopes, the opening of the sac and exposure of the testicle being accomplished, and the envelopes being carefully pushed upwards, the torsion and excision of the cord are effected in the following manner: The entire cord is embraced by the fixing forceps (see Fig. 6) , or only its anterior fasciculus if the posterior septum has been cut, as in the process by free torsion above the epididymis. ”

“ Ligature of Left Subclavian.—First Part.—This operation, which has been described by some as impossible, has, I believe, been only once performed on the living body. Operation.—Incisions as for the preceding operation, except being on the opposite side. After the skin, platysma, and muscles have been divided, as already described, the deep cervical fascia requires division close to the inner edge of the scalenus anticus. The artery lies excessively deep, and great difficulty is experienced in avoiding injury to the pleura and the thoracic duct. ”

“ Accordingly we find, that most of the brute, as well as the human Species, chuse some easy posture of this kind to sleep in.
When the human Body lies horizontally, the Blood must flow in greater abundance to the Head; and with a greater momentum, cæteris paribus, through the Carotid and Vertebral Arteries, than when the Body stands erect; because the Blood, moving through these tubes in an horizontal direction, will not so much resist the force of the Heart, as when it ascends perpendicularly contrary to its own gravity. ”

“ 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. ”

“ When the fluid is in the adnata, we make the incision where the apex of the tunica adnata makes its appearance, and separating the lips of the incision with a hook, and having dissected the darti with a knife for hydrocele and a scalpel, and laid bare the tunica vaginalis, we divide it through the middle with a lancet for bleeding, more especially in that part where it is separated from the testicle ”

“ The cure of the varices by incision appears, from the works of Celsus and Paulus Eginetus, to have been a familiar practice among the ancients. The ancients describe the mode of curing the polypus of the ear, a malady little understood by the moderns. They were likewise well acquainted with all kind of fractures and luxations, and the means of remedying them; as well as with all the sorts of sutures in use among us, besides many we have lost. ”

“ Then, sharply: “Swabs . . . Ingleby, what the hell do you think you’re doing?” And Edwin would press a swab of gauze to the incision to absorb the blood that escaped from the subcutaneous veins.
“Right.”
Layer by layer the various planes of fascia, muscle, and peritoneum would be opened and neatly laid aside, every one of them slipped in its own pair of artery forceps. Then, from the gaping wound, that L.M. probed with his thin finger, a sickening odour would rise . . . one that Edwin never remembered apart from the other sickening smell of ether.
“Pus. . . I thought so,” L.M. would say. ”

“ The form of incision is somewhat sickle shaped, the upper curvature of the incision following the inferior border of the helix and extending well into the fossa of the helix, as shown in Fig. 136. Where the antihelix is particularly large a triangular section may be removed, as shown at A, with a corresponding shortening of the helix flap at B. The latter gives more contour to the ear as well. ”

“ Ligature of Right Subclavian.—First Part.—Operation.—An incision just at upper edge of sternum and right clavicle, extending from inner edge of left sterno-mastoid transversely to outer border of right sterno-mastoid through skin, platysma, and exposing sterno-mastoid, to be joined at an angle by a second incision, which, two, three, or even four inches long, must extend along inner border of right sterno-mastoid. Flap to be raised upwards and outwards. ”

“ For a hunter, two incisions are usually made, the second being about two inches below the first, and likewise as nearly as possible in the centre of one of the bones; the reason of which is, that the incision, in order perfectly to divide the muscles that bring down the tail, must not be so deep, as, in the neighbourhood of a joint, to endanger the wounding of the ligament which ties the bones together, or the substance which is interposed between the joints, and thus by destroying the joint to render the tail deformed. ”

“ When a sinus exists from the inflamed and perforated pelvis, or an abscess connected with the kidney has been recently opened, it may be dilated or enlarged by incision sufficiently to allow the passage of an exploring finger and forceps. ”

“ Albucasis describes the nature of the case and the operation in nearly the same terms as Celsus and our author. If the obstruction is occasioned by a superficial membrane he directs us to perforate it with a slender instrument. If a fleshy excrescence obstruct the passage he approves of seizing it with a hook, and dissecting it out. If the obstruction be more deeply seated he directs the membrane to be opened by means of a heated iron, taking care not to hurt the nerves. It is to be kept open with a tent. ”