A Manual of the Operations of Surgery, Joseph Bell [suggested reading .txt] 📗

August 1883.

Having been asked, year after year, by the members of my Class for Operative Surgery, to recommend to them some Manual of Surgical Operations which might at once guide them in their choice of operations, and give minute details as to the mode of performance, I have been gradually led to undertake the production of this little work.

My aim has been to describe as simply as possible those operations which are most likely to prove useful, and especially those which, from their nature, admit of being practised on the dead body.

In accordance with this plan, neither historical completeness of detail, nor much variety in the methods of performing any given operation, is to be expected. Hence, also, many omissions which would be unpardonable in the briefest system of Surgery are unavoidable. For example, excision of tumours and operations for necrosis are hardly mentioned, because for these no special instructions can well be given; for, while general principles may guide us to what should be done, the special circumstances of each case must dictate how it is to be done.

In such a work as this, to attempt originality would be undesirable and intrusive; a judicious selection, a faithful compilation, are all that can be expected.

That the selection of operations may sometimes show "Northern Proclivities" is possible; and this is perhaps not unnatural to a scholar and teacher in the Edinburgh School.

An earnest endeavour has been used to make the references correct and copious: for any mistakes or omissions the author would crave indulgence.

The four plates which precede the letterpress were drawn on wood (from original photographs) by Mr. D.W. Williamson, Melbourne Place, and the lines of incision for the various operations were added by the author.

The rough woodcuts scattered through the work were drawn on wood by the author, and for their roughness he, not his engraver, is responsible. He also hopes that the references in the letterpress will be accepted as sufficient acknowledgment of the true ownership, in those few instances in which the idea of the diagram has been borrowed.

It has been thought unnecessary to introduce woodcuts of surgical instruments, as the illustrated catalogues lately published by Weiss, Maw, and others, are sufficiently accurate.

In excuse of the frequent baldness and brevity of the style, the author must point to the size and price of the work. Its composition would have been easier had its dimensions been greater.

Though intended chiefly to guide the studies, on the dead subject, of students and junior practitioners, the author ventures to hope that the Manual may be useful to those who, in the public services, in the colonies, or in lonely country districts, find themselves constrained to attempt the performance of operations which, in the towns, usually fall to the lot of a few Hospital Surgeons.

JOSEPH BELL.

5 Castle Terrace, Edinburgh,

July 1866.

CONTENTS.

CHAPTER I.

LIGATURE OF ARTERIES.   PAGE Ligature of Arteries—General Maxims—Ligature of Aorta—Iliacs—Gluteal—Femoral—Popliteal—Innominate—Carotids— Lingual—Subclavian—Brachial, etc., 1-45

CHAPTER II.

AMPUTATIONS. Eras of Amputation—Flap and Circular compared—Special Amputation of Arm and Leg, 46-107

CHAPTER III.

EXCISION OF JOINTS. Brief Historical Sketch—Comparison of Excisions with Amputations—Special Excisions of the six larger Joints—Excisions of smaller Joints and Bones, 108-146

CHAPTER IV.

OPERATIONS ON CRANIUM AND SCALP. Trephining—Excision of Wens, 147-150

CHAPTER V.

OPERATIONS ON THE EYE AND ITS APPENDAGES. Entropium and Ectropium—Trichiasis—Tarsal Tumours—On Lachrymal Organs—Mr. Bowman's Operation—Pterygium—Strabismus, convergent and divergent—Paracentesis of the Anterior Chamber—Operations for Cataract by Displacement, Solution, and Extraction—Various methods of Extraction—Operations for Artificial Pupil—Iridesis—Corelysis—Iridectomy—Excision of Staphyloma—Excision of Eyeball, 151-174

CHAPTER VI.

OPERATIONS ON THE NOSE AND LIPS. Rhinoplastic Operations from Cheek, Forehead, and elsewhere—Removal of Nasal Polypi—Excision of Cancers of Lips—Cheiloplastic Operations—Operations for Harelip, 175-187

CHAPTER VII.

OPERATIONS ON THE JAWS. Excision of Upper Jaw—Of Lower Jaw, 188-195

CHAPTER VIII.

OPERATIONS ON MOUTH AND THROAT. For Salivary Fistula—Excision of Tongue, complete and partial—Fissures of the Palate, soft and hard—Excision of Tonsils, 196-205

CHAPTER IX.

OPERATIONS ON AIR PASSAGES. Larynx and Trachea—Tracheotomy—Tubes—Laryngotomy—Œsophagotomy—[see Addendum, p. 302], 206-217

CHAPTER X.

OPERATIONS ON THORAX. Excision of Mamma—Paracentesis Thoracis, 218-221

CHAPTER XI.

OPERATIONS ON ABDOMEN. Paracentesis Abdominis—Gastrotomy—Ovariotomy—Operation for Strangulated Hernia—Inguinal—Femoral—Umbilical—Operations for the Radical Cure of Hernia, 222-255

CHAPTER XII.

OPERATIONS ON PELVIS. Lithotomy—Varieties—Lithotrity—Operations for Stricture—Puncture of the Bladder—Phymosis—Amputation of Penis—Hydrocele—Hæmatocele—Castration—Operation for Fistula—Fissure—Polypi of Rectum—Piles, 256-295

CHAPTER XIII.

TENOTOMY. On Tenotomy for Wry Neck and Club Foot, 296-298

CHAPTER XIV.

OPERATIONS ON NERVES. Nerve-stretching—Nerve-cutting—Nerve suture, 299-301

Addendum to Chapter IX., 302 Index, 303-311 LIST OF ILLUSTRATIONS.

page 

50Amputations of Fingers, 50Diagram of Finger showing Articulations, 57Dubrueil's Amputation at Wrist (front view), 57    "    "    (dorsal view), 69Amputations of Toes, 126Excision of Wrist-joint—Lister's, 151Operations for Ectropium and Entropium, 151Operation for Trichiasis—Streatfeild's, 155Operation for Epiphora—Bowman's, 156Greenslade's Instrument for above, 157Operations for Squint, 162Linear Extraction of Cataract, 162Flap Extraction of Cataract, 171Operation of Corelysis—Streatfeild's, 172Operation for Staphyloma—Critchett's, 172Result of above, 176Rhinoplastic Operation from Cheek, 177    "    "    Forehead, 181Operation on Lip, V-shaped incision, 181Operation on Lip, by scissors, 182Operation for a new Lip, incisions, 182Operation for New Lip sewed up, 184Diagram of Partial Fissure (Harelip), 184Nelaton's Operation for ditto, 185Operation for Double Harelip, 186Diagram of Double Harelip, 189Excision of Upper and Lower Jaws, 196Operation for Salivary Fistula, 201Operation for Fissure in Soft Palate, 203Operation for Fissure in Hard Palate, 207Diagram illustrating Operations on Air Passages, 241Diagram illustrating Operations for Hernia, 253Diagram of an Artificial Anus, 257Diagram of Section of Prostate, 259Diagram of Membranous portion of Urethra, 284Diagram illustrating Puncture of Bladder, 286Diagram of Operation for Phymosis, 287Diagram of Amputation of Penis,

PLATE I. 1. Ligature of Aorta—Sir A. Cooper's incision. 2. Ligature of Aorta—South and Murray's incision. 3. Ligature of Common Iliac. 4. Ligature of External Iliac—Sir A. Cooper's. 5. Ligature of Femoral in Scarpa's triangle. 6. Ligature of Femoral below Sartorius.[1] 7. Ligature of Innominate. 8. Ligature of third part of Left Subclavian. 9. Ligature of Axillary in its first part. 10. Ligature of Axillary in its third part. 11. Ligature of Brachial. 12. Amputation of Arm by double flaps. 13. Amputation at Shoulder-joint (1st method), showing portion of skin left uncut till the conclusion of the disarticulation. 14. Amputation at Ankle-joint by internal flap—Mackenzie's. 15-16. Amputation of Leg just above the Ankle-joint. 17-18. Amputation below Knee—modified circular. 19. Amputation through Condyles of Femur—Syme, and Pl. III. 5. 20. Amputation at lower third of Thigh—Syme, and Pl. III. 6.
A. Excision of Head of Humerus. B. Excision of Knee-joint; semilunar incision.

PLATE II. 1. Amputation at lower third of Fore-arm—Teale's. 2-2. Amputation at Shoulder-joint by large postero-external flap—2d method. 3-3. Amputation at Shoulder-joint by triangular flap from deltoid—3d method. 4-5. Amputation through Tarsus—Chopart's. 6-7. Amputation at Knee-joint. 8. Amputation by Single Flap—Carden's, and Pl. IV. 16. 9-10. Amputation of Thigh—Teale's.
A. Excision of Hip-joint. B-B. Excision of Ankle-joint—Hancock's incisions.

PLATE III. 1. Ligature of Popliteal. 2. Amputation at Elbow-joint—posterior flap. 3. Amputation at Shoulder-joint—posterior incision of first method, and Pl. I. 13. 4. Amputation at Ankle-joint—Mackenzie's, and Pl. I. 14. 5. Amputation through Condyles of Femur—Syme, and Pl. I. 19. 6. Amputation at lower third of Thigh—Syme, and Pl. I. 20. 7. Amputation at Knee—posterior incision. 8. Amputation of Thigh—Spence's, and at Pl. IV. 18. 9. Amputation at Hip-joint, and Pl. IV. 20.
A. Excision of Shoulder-joint—deltoid flap. B. Excision of Shoulder-joint by posterior incision. C. Excision of Elbow-joint—H-shaped incision. D. Excision of Elbow-joint—linear incision. E. Excision of Hip-joint—Gross's. F. Excision of Os Calcis. G. Excision of Scapula.

PLATE IV. 1. Ligature of Carotid. 2. Ligature of Subclavian (3d stage)—Skey's incision. 3. Amputation at Wrist-joint—dorsal incision. 4. Amputation at Wrist-joint—palmar incision. 5. Amputation at Fore-arm—dorsal incision. 6. Amputation at Fore-arm—palmar incision. 7. Amputation at Elbow-joint—Anterior flap, and Pl. III. 3. 8. Amputation at Arm—Teale's method. 9. Amputation at Shoulder-joint—1st method, and Pl. III. 3. 10-11. Amputation of Metatarsus—Hey's. 12-13. Amputation at Ankle—Syme's. 14-15. Amputation of Leg—posterior flap—Lee's. 16. Amputation at Knee-joint—Carden's, and Pl. II. 8. 17. Amputation of Thigh—B. Bell's. 18. Amputation of Thigh—Spence's, and Pl. III. 8. 19. Amputation of Thigh in middle third. 20-20. Amputation at Hip-joint, and Pl. III. 9.
A. Excision of Wrist—radial incision. B. Excision of Wrist—ulnar incision.

CHAPTER I. LIGATURE OF ARTERIES.

Ligature of Arteries.—In a work of this nature there is no room for any discussion of the principles which should guide us in the selection of cases, or of the pathology of aneurism, or the local effects of the ligature on the vessels. One or two fundamental axioms may