Lectures on surgery

Preface To Second '. Edition

The former edition having been exhausted, this, the Second Edition, has been prepared so as to bring the Lectures up to the present state of Surgery. Whilst I have adhered to the plan of the work and the method of teaching explained in the Preface to the first edition, the whole has been carefully revised, some parts re-written, and much new matter added. In doing this, as well as in the general revision of the work, I have been much indebted to the assistance of my friend and former pupil, Mr. D. J. Cunningham. The Structural Classification of Tumours is entirely written by him. I have in this edition carried out more fully the plan of appending illustrative Clinical Cases, with remarks, to the different sections of the Lectures ; so that, whilst the book serves as a Text-book for my Class, I am not without hope that it may also prove useful as a work of reference for practitioners.

Whilst I have retained the plates and chromolithographs of the former edition, I have added a large number of woodvi PREFACE TO SECOND EDITION.

cuts. Of these a considerable number are from original sketches by my late Resident Surgeon, Mr. J. H. Scott ; others are drawn from photographs by Mr. Ramage, and nearly all the new woodcuts are executed by him. I have also availed myself of other wood-engravings placed at my disposal by the publishers.

In conclusion, my acknowledgments are due to Dr. Braidwood for the valuable abstract which he furnished me of the results of his researches on Pysemia.

JAMES SPENCE.

November 1875.

Preface To First Edition

The publication of these Lectures on Surgery was undertaken with the view of placing in the hands of my Students a Text-book for the Class, and also in consequence of a desire, often expressed by many of my old pupils, that I should enable them to possess in a published form the Principles and Practice which I had orally taught them. Another inducement to undertake the task was the consideration that, when I had placed in the hands of my Students a general view of the Principles and Practice of Surgery, I would be left at greater freedom to vary the method of teaching, and to devote more time to particular departments, more especially to Eegional Surgery, and to teaching the Student the method of applying his knowledge of healthy and morbid anatomy to the investigation and diagnosis of surgical disease, as well as to its treatment — a kind of instruction which my experience as a Surgical Teacher and Hospital Surgeon has shown me to be much required.

The arrangement of the subjects treated of is that which I have hitherto adopted as being best suited for giving a view of Surgery as a whole. The First Division consists in a general view of different forms of Diseased Action, Inflammation and its results, Tumour Growth and the different forms of Tumours, Syphilis, and External Injuries and their consequences. The Second Division treats of Diseases and Injuries of Special Stuctures ; the Diseases and Injuries of the Osseous, Articular, Muscular, and Vascular systems. The Third Division is devoted to the consideration of Eegional and Operative Surgery ; that is, the special diseases and injuries occurring in the different regions of the body, and the operations required for their relief. In connection with the Second and Third Divisions of the course, Clinical Cases are given, illustrative of the doctrine taught and the treatment advised in the Lectures. In regard to Ophthalmic Surgery, the time which can be devoted to it in a Course of Lectures on general Surgery is so limited as to be quite inadequate for doing via

PREFACE TO FIRST EDITION.

justice to such an important subject, and I therefore determined to omit it altogether from my published Lectures.

The number of these Lectures will be enough to show that they were not all delivered during any single course ; the period now allotted for the winter session necessitating the omission of particular subjects, or parts of the course, in different years: The short-hand notes taken by my former pupil Dr. Ballingall Stewart, during the session 1866-7, have been used as the basis ; and these, together with class notes kindly furnished me by former pupils, together with my own heads of Lectures, and published and unpublished papers on special departments of Surgery, have been used in preparing the work as now issued. The publication of the subjects taught in the original Lecture-form may seem of doubtful propriety. The style used in oral instruction is, in a literary point of view, essentially faulty, owing to the colloquial expressions and the tendency to tautology almost inseparable from it, when speaking of matters such as those discussed in a course of Surgery ; but whatever such a practical subject loses in elegance of style, seems to me to be more than counterbalanced by the directness and individuality of the teaching. For my own part, I confess that I have always found more interest in, and more direct instruction from discourses or Lectures on Surgery, than from the systematic treatises, however elegant the composition of the latter.

In teaching, I have adopted what may by many be considered too dogmatic a method ; but the necessity for this has been long impressed on me by experience as a Teacher and as an Examiner at different Medical Boards. The multiplicity of subjects which engage a Student's attention leaves him but little time to weigh and decide controverted points, even supposing him to possess the knowledge requisite for such decision, and hence I think he has a right to look to the Lecturer for distinct definite instruction, founded on a fair and truthful digest of his own experience. Consequently, wherever I have to discuss different methods of treatment, I feel myself bound to tell my pupils precisely how I should act under the circumstances. After thirty-five years' Surgical practice, twenty-two of them spent as a Lecturer on Surgery and an Hospital Surgeon, I feel that I may claim some right to state decidedly the opinions which I hold, and the practice which I have found from experience to be most successful.

It may be thought that I have in some instances entered more fully on anatomical details than necessary, now that so much attention is given to the study of Anatomy. But practically, I

PREFACE TO FIRST EDITION.

be know that it is quite possible for a Student to have a good knowledge of Anatomy, and yet not to be versed in applying that knowledge to the practice of Surgery. Surgical Anatomy, properly understood, implies not merely relation of parts, but such an acquaintance with the position, functions, and relations of the structures entering into the formation of any region, as may assist in the diagnosis and treatment of the injuries and diseases occurring in it ; or in certain cases to judge how far operative interference is warrantable, and guide us if it be, in planning and performing the operation. Hence, I only regret that the nature of the course limited the amount of such teaching to little more than suggestive hints.

The range of subjects treated of in these Lectures is so large as to render it quite impossible to enter fully upon all. I have therefore devoted more space to the important subjects, in which, from various circumstances, I have had an exceptionally large experience, such as Tumours, Diseases of the Vascular System, Excisions of Joints, Amputation, Injuries of the Head, Diseases and Injuries of the Air Passages, Hernia, and Diseases of the Urinary Organs. Even in regard to these the Lectures are necessarily suggestive, not exhaustive, as in the case of monographs ; the other parts of the work, again, though more briefly treated, will be found to contain all that is essential or of practical interest.

In conclusion, I have to acknowledge the assistance afforded me by my friend Dr. Taylor, in prepanng for the press and compiling the Index, and to Dr. Thomas Balfour, for his assistance in the revision of the latter portion of the work. In regard to the artistic department, I am specially indebted to the kind offices of my friend Dr. John Smith. And here I would draw attention to the mode of illustration adopted, as preferable to the ordinary woodcuts, both in respect to the perspicuity afforded by colour, as well as enabling me to give faithful transcripts from photographs, or from original sketches made by various artistic friends, of actual cases or dissections, and used by me as class illustrations in my Lectures at the University.

April 1871.