Dr. Solis Cohen has recently (in a paper read before the Philadelphia College of Physicians, April 4, 1883) collected the notes of sixty-five cases of excision of the entire larynx. Fifty-six of these were done for cancer, and the remainder for sarcomata, papillomata, etc. Of the fifty-six done for cancer, forty are reported as having died, either shortly after the operation from shock or pneumonia, or a few months later from recurrence of the disease. In two instances the disease had recurred, but death had not been reported when the paper was read. Fourteen remain in which neither death nor recurrence had been reported. Dr. Cohen's conclusion is that laryngectomy does not tend to the prolongation of life, and thinks that the greatest good to the greater number appears better secured by dependence on the palliative operation of tracheotomy.

1

This line is placed too low down; it should be in the middle third of the thigh.

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2

Erichsen, Surgery. Sixth edition, vol. ii. p. 121.

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3

The line 3 in Plate I. shows the direction required. It will not be necessary to carry the incision so far up for the external as for the common iliac.

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4

On the Arteries and Veins, p. 421.

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5

Cyclopædia of Practical Surgery, vol. i. p. 277.

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6

John Bell's Prin. of Surg., vol. i. 421; Dublin Jour., vol. iv. 321.

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7

Observations in Clinical Surgery, Syme, pp. 171-3.

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8

Brit. Med. Jour. 1867, Oct. 5.

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9

International Encyclopædia of Surgery, vol. iii. p. 466.

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10

Poland, Guy's Hosp. Report, ser. iii. vol. vi.

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11

Mr. W. Thomson's most interesting paper on this subject is full of information down to the latest date.

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12

Lancet, Jan. 5, 1867.

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13

Lancet, May 1879.

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14

Dublin Quarterly Journal, Nov. 1867.

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15

W. Zehender—Monatsbl. für Augenheilkunde. 1868.

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16

Butcher, Op. and Cons. Surgery, p. 861.

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17

Leçons Orales, iv. 530.

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18

Ed. Med. and Surg. Journ. vol. xlv.

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19

Observations in Clinical Surgery, pp. 148, 149.

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20

Edin. Med. Journal, March 1879.

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21

See case of recurrence, Fergusson's Practical Surgery 1st ed. p. 222.

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22

Operative Surgery, p. 279.

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23

Surgical Operations, p. 50.

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24

For details see article "Amputation" in Cooper's Surgical Dictionary, and the short sketch of the history in Mr. Lister's paper in the third volume of Holmes's System of Surgery.

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25

See a most interesting foot-note to Professor Lister's paper on "Amputation," in Holmes's System of Surgery, vol. iii. pp. 52, 53.

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26

This line is placed too low down; it should be in the middle third of the thigh.

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27

This line is placed too low down; it should be in the middle third of the thigh.

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28

Manuel d'Opérations chirurgicales.

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29

As the surgeon will find it most convenient to stand on his own right side of the limb to be removed, the knife will be entered on the palmar side of the radius of the right arm, of the ulna of the left.

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30

Teale, On Amputation by Rectangular Flaps, pp. 46-48.

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31

Johnson's folio ed., p. 342.

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32

Gross's Surgery, 6th ed. vol. ii. p. 1103.

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33

International Encyclopædia of Surgery, vol. i. p. 641.

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34

Spence's Surgery, pp. 800, 801.

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35

Gross's Surgery, 8vo., 6th ed., vol. ii., p. 1106.

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36

Excision of Scapula, p. 33.

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37

Hey's Observations, 3d ed. pp. 552, 556.

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38

Roux's Parallel between English and French Surgery. Translation abridged from Cooper's Surgical Dictionary, p. 106.

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39

Syme's Principles, 4th edit. p. 145.

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40

International Encyclopædia, vol. 1. p. 655.

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41

Observations in Clin. Surgery, p. 48.

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42

Monthly Journal of Medical Science for 1849, vol. ix. p. 951.

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43

Med. Times and Gazette, June 3, 1865.

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44

Operative Surgery, p. 170.

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45

Annali Universali de Medicina, Milano, 1857.

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46

Med. Chir. Transactions of London, vol. liii., p. 175.

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47

Carden's (of Worcester) Pamphlet, pp. 5, 6; and British Medical Journal, 1864.

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48

B. Bell's Surgery, 6th ed. vol. vii. pp. 336-339.

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49

In diagram the amputation is drawn as if for middle third of thigh.

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50

Teale, op. cit., pp. 34, 39.

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51

Edin. Med. Journal, for April 1863.

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52

Edin. Medical Journal, March 1879.

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53

On Diseases and Injuries of Joints, p. 121.

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54

For a very large amount of most interesting and valuable information on the whole subject of excisions of joints, I would refer to Dr. Hodge's most excellent work on this subject—On Excisions of Joints. By Richard M. Hodge, M.D., Boston, Massachusetts.

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55

See Syme's Observations on Clinical Surgery, pp. 55, 57; Hodge on Excision of Joints, p. 63.

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56

Maunder's Operative Surgery, 2d ed. p. 123.

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57

Edin. Med. Journal, May 1873.

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