Part 2

S. D. GROSS.

Louisville Medical Institute, May, 1842.

PREFACE.

The rapid advancement made in the pathology and treatment of surgical diseases demands a perpetual revision and correction of the systematic works devoted to this department of the healing art.

Accordingly, text books, various in merit and extent, have emanated from the different schools. Several of these have, by successive editions, kept pace with the science; whilst others have fallen into disuse.

In this part of Britain, the systems of Latta, B. Bell, and Allan, occupied the field; but it being now vacant, I venture to supply the deficiency, by reducing the heads of my lectures into a compendium, or guide, for those students who resort to this city.

It must appear superfluous to preface such a work by anatomical descriptions, anatomy being now studied more generally, and with greater zeal, than heretofore. Pathology also is more attended to, and better understood. To which circumstances are to be ascribed the improvements in surgical science, as well as in the art of operating.

The functions and structure of parts are more frequently preserved uninjured—mutilation is more rarely required—and operations are dispensed with. The wider the extension of pathology, the fewer the operations will be—thus affording the best criterion of professional attainment. Who will question, that there is more merit in saving one limb by superior skill, than in lopping off a thousand with the utmost dexterity?

To treat surgical diseases as they ought to be treated, the practitioner must be thoroughly acquainted with the healthy and morbid structure; he must also have a mind vigorous and firm from nature, well instructed in the best precedents, and matured by observation.

Years are not the measure of experience. It does not follow, that the older the surgeon is, the more experienced and trustworthy he must be. The greatest number of well-assorted facts on a particular subject constitutes experience, whether these facts have been culled in five years or in fifty.

It is only from experience, directed and aided by previous study, that accuracy of diagnosis and celerity of decision can be acquired. Besides knowing in what manner to proceed, the surgeon must know well wherefore he acts, and also the precise time at which he should interfere. With knowledge and confidence derived from experience, he will perform such operations as are indispensable for the removal of pain and deformity, or for the preservation of life, with calmness and facility—with safety to his patient, and satisfaction to those who assist in, or witness, his proceedings.

Attention to the apparatus is necessary. It should be in good order, simple, and ample. The young surgeon should note down, previously to an operation, whatever, on reflection, can possibly be required. "For in most capital operations, unforeseen circumstances will sometimes occur, and must be attended to; and he who, without giving unnecessary pain from delay, finishes what he has to do in the most perfect manner, and that most likely to conduce to his patient’s safety, is the best operator."

It is seldom necessary to employ much preliminary treatment. From the usual preparative course of bleeding, purging, cooling diet, etc., patients about to undergo capital operations, as lithotomy, suffer more than they can gain.

It is of the utmost importance to attend to the state of the patient’s mind and feelings. He ought not to be kept in suspense, but encouraged and assured; and his apprehensions must be allayed. If this cannot be effected—if he is dejected and despondent—talks of the great risk, and of the certainty of his dying, it is better that the operation be abandoned, or at least delayed. If, on the contrary, he is confident in the resources of his constitution, and in the ability of his attendant, and looks forward to the advantage to be derived from his own fortitude, then should there be no delay.

A mild laxative may be given, when an empty state of the bowels is desirable, or when they, by acting too soon afterwards, might put the patient to inconvenience or pain, or interrupt the curative process.

Attention to after-treatment is of much greater importance. The practitioner is not to rely on success, however well the manual part has proceeded. He must consider his labour only begun, when the operation has finished; the patient is yet to be conducted, by kindness and judgment, through the process of cure.

It is thus only that difficult and unpromising cases can be brought to a happy conclusion, and favour and lasting reputation gained.

In the present work an endeavour has been made, in the first place, to lay down, correctly and concisely, the general principles which ought to guide the practitioner in the management of constitutional disturbance, however occasioned.

The observations introduced to illustrate the doctrines inculcated are given as briefly as is consistent with an accurate detail of symptoms and results. The descriptions of particular diseases have been sketched and finished from nature; and, it is hoped, with such fidelity, that their resemblance will be readily recognised.

To describe all the methods recommended and followed, in the different surgical operations, would occupy more space than can be allotted in an elementary work—would, without answering any good purpose, lead into the wide range of the history and progress of surgery.

Such modes of operating are described as have been repeatedly and successfully performed by the Author.

If by clear and simple description of the phenomena attendant on morbid action, and of the changes which it produces,—if by plain rules for the treatment of the diseases, and performing the operations for their alleviation or cure,—he contribute to the progress of surgery, and the consequent diminution of human misery, he will consider himself fully rewarded for the time and the labour spent on this production.

CONTENTS.

PART FIRST. Page

INFLAMMATION 13 Signs 14 Irritation 20 Termination of Inflammation 25 Adhesion 25 Suppuration 29 Mortification 43 Erysipelas 55 Furunculus and Anthrax 62 Inflammation of Mucous Membranes 65 Serous Membranes 66 Joints 67 Hypertrophy and Atrophy of the Articular Cartilages, with Eburnation 75 Scrofulous Disease of Joints 77 Neuralgic Affections of Joints 78 Growths from the Synovial Membrane and Loose Substances in Joints 79 Affections of Bursæ 80 Coxalgia 81 Alterations of Form in the Head of the Femur 86 Inflammation and Diseases of Bone 94 Suppuration in Bone 96 Caries 96 Necrosis 103 Fragilitas Ossium 110 Mollities Ossium, Rachitis, &c. 110 Arterial System, Affections 116 Aneurism 118 by Anastomosis 127 Inflammation of Veins 130 Tumours 134 Adipose 137 Fibrous 138 Encephaloid 139 Melanoid 142 Carcinomatous 142 Fungus Hæmatodes 147 Painful Tubercle 149 Polypus 150 Encysted Tumours 151 Tumours of Bones 153 Osteosarcoma 154 Spina Ventosa 157 Aneurismal 158 Osseous 158 Hydatic 161 Wounds 164 Tetanus 183 Ulcers 186 Hospital Gangrene 191 Sloughing Phagædena 191 Malignant Pustule 193 Ulcers on the Genital Organs, with their Consequences 195 Scalds and Burns 211

PART SECOND.

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 Hernia Cerebri 233 Perforation of the Cranium 234 Inflammation of the Scalp 238 Thickening of the Scalp 239 Tumours of the Scalp 243 Diseases of the Eye and its Appendages 245 Inflammation and Abscess of the Lachrymal Passages 245 Inflammation of the Lachrymal Sac 246 Fistula Lachrymalis 248 Encanthis 252 Encysted Tumours of the Eyelids 253 Closure of the Eyelids 253 Ectropion 254 Entropion 255 Trichiasis 255 Pterygium 256 Diseases of the Eyeball 257 Ophthalmia 257 Purulent Ophthalmia 260 Staphyloma 261 Inflammation of the Cornea 261 Pustular Ophthalmia 263 Ulcers of the Cornea 263 Leucoma 264 Hernia of the Iris 264 Albugo 264 Nebula 264 Ophthalmia Tarsi 265 Staphyloma 266 Hydrophthalmia 266 Exophthalmia 266 Internal Ophthalmia 272 Iritis 272 Hypopium 273 Choroiditis 274 Amaurosis 275 Glaucoma 277 Cataract 277 Artificial Pupil 287 Wounds of the Eyeball 288 Orbital Inflammation 290 Tumours in the Orbit 290 Strabismus 292 Nasal Polypi 301 Malignant Polypi 303 Nose, and Nasal Cavities, Inflammation, &c. 308 Noli me tangere 310 Ozœna 310 Rhinoplastic Operations 312 Inflammation of the Antrum Maxillare 317 Lips, Ulcers 319 Congenital Deficiencies 322 Palate, Congenital Deficiencies 322 Soft Palate, Tonsils, &c., Inflammation, &c. 326 Tongue, Ulcers 331 Inflammation 332 Division of Frænum 334 Salivary Ducts, Diseases 335 Ranula 335 Gums, Diseases 337 Teeth, Diseases 338 Extraction of 340 Lower Jaw, Diseases 341 Disarticulation 345 Wounds of the Face and Neck 347 Larynx and Trachea, Diseases 354 Foreign bodies 363 Tracheotomy 364 Pharynx, Diseases 368 Foreign bodies 371 Œsophagotomy 372 Ear, Diseases of 373 Foreign bodies 375 Polypus 375 Deafness 375 Bronchocele 377 Glandular Tumours in the Neck 379 Hydrocele of the Neck 381 Distortion of the Neck 382 Venesection in the Jugular Vein 384 Ligature of the Carotid Artery 385 Arteria Innominata 387 Subclavian Artery 387 Axillary Artery 392 Brachial Artery 392 Humeral Artery 394 Wounds of the Palmar Arches 395 Paronychia or Whitlow 396 Onychia 399 Collections in Thecæ 401 Ganglia 401 Venesection, bend of the arm 403 Mamma, Diseases 405 Encysted Tumours 406 Affections of the Chest 409 Hydrothorax 410 Empyema 410 Wounds 411 Affections of the Abdomen 412 Hernia 412 Congenital Scrotal Hernia 413 Hernia Infantilis 414 Inguinal 415 Crural or Femoral 416 Ascites 435 Ovarian Dropsy 436 Bruises of the Abdomen 438 Lumbar Abscess 441 Spina Bifida 444 Affections of the Rectum and Neighbouring Parts 445 Hemorrhoids or Piles 445 Distinct Varieties 445 Inflammation of the Rectum 447 Fistula 449 Stricture 450 Schirro-contracted Rectum 452 Prolapsus Ani 453 Pruritus of the Rectum 460 Neuralgia of the Rectum 460 Affections of the Mucous Membranes of the Urinary and Genital Organs 461 Gonorrhœa 462 Hernia Humoralis 467 Inflammation of the Bladder 469 Irritable Bladder 470 Stricture of the Urethra 470 Fistula in Perineo 472 Retention of Urine 478 Incontinence of Urine 489 Gonorrhœa Præputialis 490 Phymosis 491 Paraphymosis 491 Hypospadias and Epispadias 495 Chimney-sweeper’s Cancer 495 Hydrocele 496 Cirsocele 501 Hæmatocele 503 Sarcocele 505 Castration 507 Calculus Vesicæ 508 Lithotrity 517 Lithotomy 519 Calculus in the Female 530 Gonorrhœa in Females 531 Gonorrhœal Lichen 532 Retention of Urine in Females 533 Vesico-vaginal Fistula 534 Imperforate Vagina 535 Contracted Vagina 535 Inflammation of Vagina 536 Polypus Vaginæ 537 Diseases of the Uterus 538 Ligature of the Common Iliac Artery 539 Internal Iliac 539 External Iliac 540 Femoral 541 Aneurismal Varix in the Thigh 542 House-Maid’s Knee 543 Cartilaginous Bodies in the Knee-joint 544 Distortion of the Feet 545 Varus 547 Valgus 548 Pes Equinus 548 Calcaneal 549 Exostosis of Distal Phalanx 551 Fractures 552 of the Cranium and Face 558 Spinal Column 560 Thorax and Upper Extremity 564 Pelvis and Lower Extremity 574 Disunited Fracture 586 Dislocations 588 Lower Jaw 591 Upper Extremity 592 Lower Extremity 600 Sprain 607 Bruise 610 Amputation 612 Excision of Portions of Diseased Bones 632 Excision of Joints 634

ELEMENTS OF SURGERY.