Excerpt from Notes From Clinical Lectures on Surgery, Delivered at the Massachusetts Medical College: During the Session of 1850-51

Case IV. Inverted Toe-nails. Operation. - Many of you know this affection. The great toe-nails are buried as in this case, at their edges, deep in fungous granulations, so tender that they cannot be touched. This begins gradually, With a tight shoe, or an irritable Skin, and a nail nu cut at the corner. The flesh gets tender, the corner cannot be got at, and the affection progresses or remains stationary. It rarely improves even with palliative treatment. I once raised a nail Slowly, with lint beneath it, so that in a week the corner was cut off, and the patient never again suffered. But you are generally obliged to remove the nail or a part of it. The patient is etherized, and if the nail is thin, you thrust one leg of a pair of forceps under it to the root, shut the forceps upon the nail, twist it first to one side and then to the other, and extract it, as was done here. If it is thick, first split it to the root with scissors thrust under it, and peel off one or both halves from tip to root, with forceps. These nails came out whole, but the nail should in general be examined after extraction to see if the corners of the soft root are square, as a bit is often left in at the edge which reproduces the deformity.' A new nail gene rally appears, sometimes deformed. In this case, Dr. Hayward removed three nails.

Case V. Fatty Tumor inside of Cheek. Operation. - This middle aged woman perceived this tumor 4 years ago. Its position, just inside of the labial commissure under the mucous membrane, is a common one for little sacs containing glairy fluid. This looked like one, and fluctuated but proved to be common adipose tissue, as large as a chesnut. Ire moved it with a simple incision. The ether was continued to this pa tient sometime after narcotism, and until She snored her pulse being only reduced a little in frequency. This thorough dose lasted her through the operation. With a common dose, she would soon have partially waked, shut her mouth, groaned and twisted about; and after vain efforts to get along, we should probably have stopped the operation to give her more ether. As it was, She slept tranquilly through it.

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