As soon as the floor of the mouth is opened and the tongue loosened
from the lower jaw the left hand is introduced beneath the skin,
through the incision, into the mouth, and the tongue seized by
thumb and middle finger, and drawn forcibly downward, while the
other fingers are used to lift up the skin from the knife. The long
section-knife, with cutting edge turned toward the left, is then
introduced in the median line, along the left hand, until its point
reaches the hard palate, taking care to work the point back slowly
until it reaches the border between soft and hard palate. This must
be done by feeling rather than by sight. The block under the neck
is then pushed up under the head and the chin thrown forward so
that the point of the knife is directed at right angles against the
cervical vertebræ. The soft palate is then cut to the left, while
the tongue is pulled firmly downward and toward the right, putting
the uvular arch on a stretch so that the knife passes around the
left tonsil. The knife is then turned and the same cut made on the
right, severing the right faucial pillar and tonsil, while the
tongue is pulled downward and to the left. The point of the knife
is then pushed back to the pharyngeal wall and the latter is cut
from right to left by a strong, firm stroke directed at right angles
to the surface of the upper cervical vertebræ. The cut through the
pharyngeal mucosa should be at the level of the boundary between the
laryngeal and nasal portions, at about the height of the axis. While
this cut is being made firm traction should be kept up on the tongue,
pulling it downward, and alternately to the left and right. The loose
retropharyngeal and retroœsophageal fascia tears easily and the
mouth organs can now be pulled so far downward that first transverse
and then oblique cuts through this fascia can now be made upon the
vertebræ, severing the vagi, carotids and jugulars, and working
from above downward, until the mouth and neck organs can be lifted
up through the skin-incision and the entire mass of the neck-organs
separated from the spinal column as far as the clavicles. Pulling the
mass toward the right, the left subclavian vessels and fascia are
severed by a cut directed downward and outward beneath the clavicle.
Traction is then made toward the left and the right subclavians cut
beneath the clavicle. If the thoracic organs have been removed the
œsophagus and aorta may now be stripped down to the diaphragm and
there cut off, or the neck-organs may be cut off at the level of the
bifurcation of the bronchi.
Public-domain text, read in full here on John Shaqi.
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