Of the Extirpation of the TONSILS.
THESE Glands sometimes grow so large and scirrhous as to become incurable, and even to threaten Suffocation if not extirpated: The manner of doing this Operation formerly, was by cutting them off; but the almost constant Consequence of this Wound, was a violent Bleeding, and sometimes too a mortal one; on which account it is rejected in favour of the Ligature, which is not only void of Danger, but also seldom fails of cure.
If the Basis of the Tonsil is smaller than the upper part, you may pass the Ligature by tying it to the end of a Probe, bent into the form of an Arch and set into a handle, which being carried beyond the Gland, and round it, is to be brought back again; this done, you may easily tie it by the means or an Instrument of Mr. Cheselden's Contrivance, which holds one end of the String on the side of the Tonsil next the Throat, while you make the Knot by pulling the other with the right Hand quite out of the Mouth, as will be easily understood by the Draught in the Copper-plate. Should it happen that the Tonsils are Conical, so that the Ligature will necessarily slip over its Extremity when we attempt to tie, in this case, he has recommended an Instrument like a crooked Needle, set in a Handle, with an Eye near the Point, threaded with a Ligature, which is to be thrust through the bottom of the Gland, and being laid hold of with a Hook, the lnstrument is to be withdrawn; then pulling the double Ligature forwards, it must be divided, and one part be tied above, and the other below the Tumour: The Knots are to be always double, and the Ligature to be cut off pretty near them: However, to confess the Truth, I have never in one Instance been obliged to use this Method; for where the Tonsils have been Conical, I have employed a very thin Thread, which has cut into the Substance of the Gland a little, and making a small Grove, prevented its sliding over. If after four or five Days they slip, or seem to have mortified the Tonsil only in part, you must repeat the whole Operation; and if it fail a second time, you must even repeat it again, as I have sometimes done, though it frequently happens, that the Cure is effected by the first Operation.
This kind of Extirpation is more practised in large Piles, that are esteemed incurable; and if the Success of it were better known, the Operation would be much more frequent. I have by this Method cured several People that have discharged Blood every Stool for many Years, and some that have been almost quite destroyed by the repeated Losses of it. When the Piles are withinside of the Intestine, you must place your Patient over a Fomentation in a Closestool, and have a crooked Needle with a double Ligature ready to pass thro' them, when by straining, they are pushed out of the Anus (for sometimes the Intestine will return suddenly) and tie above and below as in the Instance of the Tonsil. Sometimes the Piles are of that shape as to admit a single Ligature to be tied round them without the help of a Needle, which is less painful: If there are several, you must only tie one or two at a time; for the Pain of the Ligature is excessive, and would be intolerable if many were tied at once. However, every five or six Days, the Operation may be repeated 'till all are extirpated, and the Parts must be kept supple by some emollient Ointments.
When the Piles are small, they may safely and with much less Pain be cut off; but when this Method has been taken with very large ones, I have seen the Patient in the utmost Danger, from a violent Effusion of Blood.
The Uvula is subject to so great a degree of Relaxation sometimes, that it almost choaks the Patient; the readiest Cure is cutting off all but half an Inch of it, which may be done at one snip with a pair of Scissars (particularly curved for that purpose,) laying hold of it with a Forceps, lest it should slip away. I once cut off a Uvula that lay rolled upon the Tongue about two Inches; the Patient recovered immediately, and never felt any Inconvenience afterwards.
A. The bent Probe fixed in a Handle, with the Ligature made of the same Thread as the Ligatures for tying the Blood-Vessels.
B. The Iron Instrument for tying the Tonsils.
I have here made a Knot upon a Pin, which is to be supposed in the Situation of one of the Tonsils, and may easily be imagined to have been tied by pushing the String beyond it, when held firm by one Hand against the Instrument, and pulled by the other, on the outside of the Mouth.
This Instrument is also of great Service in extirpating by Ligature, a Species of Scirrhus that sometimes grows from the Neck or Cavity of the Uterus.
C. The Needle With the Eye towards the Point, for passing the Ligature through the Tonsil, when the Basis is larger than the Extremity.
D. A Canula made of Silver to be used in the Empyema.
E. A Canula to be used in Bronchotomy.
To keep the Canulas in their place, small Ribbands may be passed through the Rings of them, and carried round the Body and Neck; or they may be held by a Ligature run through, and fastened to a Hole cut in a piece of sticking Plaister, which is to be laid on each side of them.