Elements of Surgery

Fracture of the bones composing the _pelvis_ occasionally takes place, but can be produced only by the application of great force, as by a loaded vehicle passing over the body,...

_Ulcers of Lips._—The prolabium is liable to ulceration from various causes; from long-continued irritations, as sharp corners of teeth, rugged tartar on the external surfaces o...

In the slighter cases, it is sufficient to restrain the motions of the chest by a broad bandage applied firmly round it; and a split cloth, or a scapulary, may be passed over th...

Retention from stricture is, as already observed, the most difficult to manage. No time can be put off in bleeding or warm bathing, in giving internal remedies, or exhibiting en...

Operation for the removal of necrosed, or softened and ulcerated portions of the carpal and tarsal bones, is sometimes successful. But operative interference, either with these,...

When cataract is spontaneous, and vision not altogether lost, the patient being able to distinguish bright objects, though unable to direct his steps or follow his avocation—whe...

If there be extensive disease in the medullary canal of a bone, several perforations may require to be made, and these may be connected by the use of a small saw, or the cutting...

The patient was placed upon a narrow table of moderate height, the head and chest being elevated with pillows, and the face turned slightly towards the opposite side, while an a...

Occasionally the contraction of the vagina is to a great extent; the uterine discharges are not permitted to escape at all, and great uneasiness is thereby occasioned. In one ca...

In some articulations, on account of the formation of the opposed surfaces, attempts at reduction prove ineffectual after the lapse of two or three weeks; in others, of more sim...

The patient is placed recumbent. An incision is commenced a little above the inguinal aperture, and carried downwards; on reaching the tumour it is inclined to one side, so that...

Various applications to the ulcerated cavities are employed. Injections of spirituous and aromatic lotions are used to wash away the discharge and correct the fetor, as diluted...

The shoulder is to be depressed as much as possible, and the head thrown to the opposite side. An incision is made along the upper margin of the clavicle, and a second perpendic...

In luxation of both bones, reduction is much facilitated by position of the arm. The arm and forearm are extended, and the limb is brought well behind the trunk, so as to relax...

_Ranula_ is a swelling produced by accumulation in, and distention of, the extremity of the combined ducts of the sublingual and submaxillary glands. The extremity of the duct c...

To expose the tumour and admit of the bone being readily divided, incision of the soft parts requires to be extensive. And previously to determining on the plan of operation, th...

The gland itself is most frequently affected by carcinoma. Sometimes it is attacked by, or involved in, medullary sarcoma; and bloody tumours are also met with. In some cases, t...

Hitherto, these general observations on amputation have regarded the operation by flaps only; the circular method has not been mentioned. The reason is, that the circular amputa...

[9] [Dr. Physick (_American Journal of the Medical Sciences_, Vol. VII., p. 304) was always in the habit of commencing the treatment of hip-joint disease by the administration o...

From this view it is evident, that, besides a certain excitement of the bloodvessels, it is necessary that the raw margins be in close apposition, and carefully retained so, for...

Suppuration in the organ of hearing often follows eruptive diseases; and both ears, or one, may continue to discharge for a long time. There is always more or less derangement o...

The interval between the divided extremities of the tendon is filled up with coagulating lymph, which is often poured out in considerable quantities. As in other situations, it...

Scarification of the tonsils and surrounding membrane is seldom required. A lancet concealed in a canula, with a spiral spring to withdraw its point, is used for this purpose, a...

_Of Hemorrhoids or Piles._—Piles are blind, furnishing no discharge, except a mucous or puriform fluid; or open, pouring out a greater or less quantity of blood from time to tim...

In the lower extremity, as in the upper, the _bursæ_ become enlarged, in consequence either of pressure or of external injury. The affection may be acute, following a blow or sq...

By a dexterous use of the sound the size of the foreign body can be tolerably well judged of, as well as the state of its surface, and it may also be known whether there are mor...

In the operation for femoral hernia, the position and preliminaries are the same as for inguinal. A longitudinal incision is made from above the margin of Poupart’s ligament to...

The term _Onychia_ is sometimes, and not without good reason, designated _maligna_: it is applied to ulceration about the nail. Some of such sores are small, and not indisposed...

Amputation at the _shoulder-joint_ is more frequently required for accident than for disease. It has always been the custom to trust for suppression of bleeding, during this ope...

The _recto-vesical_ method should never be resorted to in preference to the lateral; in other words, it is unwarrantable, in my opinion, in those cases to which lateral operatio...

The bleeding is to be arrested as speedily as possible by ligature, and the patient placed in bed with the head and shoulders raised. The edges of the wound are brought together...

Affections of the membranes, ligaments, and bones, often occur in persons of weak constitutions, and proceed very gradually. They have been all classed under the general term of...

The secondary eruption which follows the phagedenic form is pustular, though differing from that which has been already noticed. The pustules soon give way, and ulcers remain, c...

The distortion in question can be remedied only by a surgical operation, it having no tendency to a spontaneous cure. On the contrary, it generally manifests a disposition to in...

_Of Gonorrhœa_, or Inflammation of the Urethra.—The morbid action is usually limited to the extremity of the canal, seldom extending more than two or three inches from the orifi...

It has been said that we must be regulated in our proceedings very much by the existence or not of external wound; that we must be cautious in cutting down upon fractures of the...

As already hinted, the operation of tapping the abdomen is to be undertaken only when the distention is very great, when the functions of the thoracic and abdominal viscera are...

_Treatment of External Ophthalmia, and its Consequences._—The exciting cause, if such exist and can be discovered, ought in the first place to be removed. The surface of the org...

The period at which the symptoms of gangrene appear after an accident varies, in general, according to the severity of the injury. As was already observed, the part may be immed...

In other instances, the difficult breathing recurs soon after withdrawal of the tube, the morbid state of the laryngeal mucous membrane having not been wholly removed. In such c...

The ligament of the patella does not often give way from muscular action; it is much stronger than the bone, and the latter consequently snaps. It may be, and has been, divided,...

Depletion, local and general, especially the former, if employed on the first appearance of the inflammatory symptoms, will often arrest their progress; but if practised at a mo...

Though inflammation does not always accompany the sensation of pain, yet the latter, in a greater or less degree, attends inflammatory action; and, perhaps, it is fortunate that...

_Wounds of the Eyeball and its Neighbourhood._—Wounds near the eye, though unimportant in themselves, require considerable attention, on account of the eye, or its appendages, b...

From such changes in the osseous parts of the articulation the limb is shortened, sometimes to a great degree, though no dislocation has occurred. Indeed, dislocation is by no m...

_Treatment of Affections of the Rectum._—In the treatment of hemorrhoids, the cause should be removed if possible; and this may suffice for the cure. When the tumours are recent...

This disease is generally seated in the external cellular tissue. It has been supposed to attack occasionally the internal organs; and a case is related in which it was situated...

_Inflammation of the Scalp_ occurs either spontaneously, or in consequence of external injury, though slight; and is generally met with in those who have lived freely and irregu...

The _post-mortem_ appearances vary. In general the cotyloid cavity is partially obliterated, or entirely deficient, being replaced by a small, irregular, osseous prominence, dev...

When the instrument has been fairly lodged in the bladder, it is to be retained. A tape is attached to each of the rings at the neck of the catheter, is brought under the thigh,...

In the treatment of bruise, the parts should be placed in a state of absolute rest, and methodically fomented. Local bleeding is seldom required, and is of little use; at first...

Rickets and mollities ossium seem to differ also in this. In the latter there is seldom, if ever, any reparative action. The diseased process of deposit continues in the bone, t...

[54] [When the pain is considerable the camphorated liniment with morphia, laudanum, or belladonna, will be of great service. It should be rubbed upon the scrotum every four or...

Many patients have perished within the first day or two from bleeding, owing to the using of the knife too freely, and in an improper direction. By very slight application of th...

In acute inflammation of the synovial membrane, and in cases where the cartilage is ulcerated, the pain is very intense, and the spasms of the limb most distressing. This happen...

Though of small size, and not possessed of malignant action or disposition, is a tumour of very great interest, on account of the excruciating pain with which it is accompanied....

The bladder becomes thickened, and lymph is effused between its coats, from repeated attacks of inflammation, or from long continued irritation in consequence of resistance to t...

As to treatment, after the infliction of an injury, the scalp ought to be shaved, and the wound cleansed of coagula and foreign substances. If a large flap of integument is deta...

In gangrene occurring after exposure to cold, amputation should not be had recourse to till after the line of separation has formed; and in this case the constitutional symptoms...

In compound fracture the detached spiculæ are to be picked out, and the wound cleansed of blood and extraneous bodies; its edges are to be brought neatly together, and retained...

By this term is understood a mere expansion of a bone from a collection of matter in its substance. The disease may be produced by external injury, exciting inflammation, and co...

When bone is extensively affected with inflammation, motion is impaired; the muscles being displaced and retarded in their action by the swelling and irregularity of the bone, b...

[26] [As there are no facts in surgery so valuable as those of a statistical kind, I shall offer no apology for transferring to these pages an abstract of a very able article on...

_Of Inflammation of the Lachrymal Sac._—When the lachrymal sac becomes inflamed, it enlarges considerably; the swelling is small, hard, circumscribed, deeply seated, and extreme...

In the treatment of this scourge, great attention must be paid to cleanliness in all circumstances. Free ventilation must be constantly preserved in the apartments of the sick,...

When the abscess has been deeply seated, and the incision made through a considerable thickness of healthy parts, it is sometimes, though very rarely, necessary to introduce a s...

Certain circumstances give rise to inflammation, and have been called its _Exciting_ or _Immediate Causes_. Among the external applications producing inflammation, stimulants be...

The nostrils can be readily cleared of benign polypi, but seldom completely, as already stated, by one operation: in several cases, wherein only one or two tumours obstructed th...

I. The appearances of the first class were described when the healing of wounds by granulations was considered, p. 173. They heal more readily on the upper extremities, on the f...

For the ulcers of the throat, unless in a sloughing state, the lunar stone appears to be almost a specific, removing the irritability of the sores, and protecting them from furt...

The circumstances which follow division of an artery are these:—The immediate effect is retraction of its ends within the investing sheath, and a simultaneous contraction of the...

_Encysted Tumours of the Eyelids._—These occur beneath the conjunctival lining of either the upper or under lid, but most frequently in the former. They form rapidly, but seldom...

Almost all the viscera of the abdomen and pelvis are liable to protrusion—the stomach—the spleen—the omentum—the great and small intestines, and even some of their most fixed pa...

Hydrocele of the tunica vaginalis is exceedingly common, particularly amongst labouring people, and occurs apparently with equal frequency at all ages. It is a gradual accumulat...

Stimuli, however, should always be used with much caution and prudence, and never unless fully warranted by the train of symptoms under which the patient is labouring at the tim...

The characters by which hydrocele of the neck may be distinguished from other affections are, absence of pain and tenderness on pressure, slight fluctuation, the slow progress o...

We shall next treat briefly of gunshot wounds; under this head are included the contused and the lacerated, caused by splinters, &c. The vitality of the injured surface is gener...

In Hospital Erysipelas, purging cannot be carried to any great extent with safety, and general bleeding is seldom if ever admissible unless the patients previously robust and in...

The most malignant and intractable of tumours is the Carcinomatous. This term is applied to the disease in its occult state, whilst Cancer, a term pretty indiscriminately employ...

_Purulent Ophthalmia_ most frequently occurs in warm climates, and is attended from the first with profuse puriform discharge from the conjunctiva. In the natural state of the o...

The older authors supposed that pus was derived from the solids—or that it was formed by the melting of dead animal matter—or that it was the result of putrefaction; in accordan...

During the progress of the inflammatory action, all the symptoms increase; the pain shoots to the top of the head, and is much aggravated by pressure on the eyeball. Of course v...

An aneurism of the descending aorta, in a great measure one from dilatation, is here represented: the patient also laboured under popliteal aneurism of one limb, and inguinal of...

_Phymosis and Paraphymosis_ are often connected with gonorrhœa of the prepuce, or of the urethra. The edge of the prepuce may be rendered tight by inflammation, swelling from ef...

Returning the contents of the hernia into the abdomen is the only effectual means of counteracting the direful effects of strangulation; and the propriety of an early recourse t...

The simple tumour is mere enlargement of a part, from the infiltration of solid matter deposited by its bloodvessels. There can be little doubt that the action which lays the fo...

Injuries of the Head 215 Wounds of the Scalp 215 Wounds of the Temporal Artery 216 Concussion 218 Compression 226 Fractures of the Cranial Bones 227 Wounds of the Brain 232 Hern...

The character of Mr. Liston’s work is too well established to render it necessary for me to say anything in commendation of it. As an outline of surgical science, which is all t...

Tumours, 134 adipose, 137 of the antrum, 304 of bones, 153 carcinomatous, 142 encephaloid, 142 encysted, 151, 336, 406 fibrous, 138 melanoid, 142 aneurismal, 158 osseous, 158 hy...