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Preface To The Second Edition
tions so large and various, the Curators of these Museums have enhanced the value of the work by directing my attention to the more noteworthy cases; and here, perhaps, ^ould thank especially Mr. Charles Stewart, of St. Thomas's Hospital, for thus having given his aid. _ .
My own illustrations, amounting to about one hundred and sixteen relate partly to microscopic specimens, but principally to clinical cases, and the operations of Surgery,-in ^ janous stages and their results. They are mostly indicated by foot-notes, but many other engravings which have no reference whatever have been designed by myself.
To the Wood Engraver and the Draughtsman, Messrs. George Evans and Son, great credit is due for the finished skill each has displayed in the exercise of his art; limited only by my own particular request to make the engravings faithfully effective, rather than elaborate.
Lastly the Index has been altered and enlarged, chiefly with reference to the general transformation which the work has undergone And, for the convenience of use, this edition is published in Two Volumes, both in this country and in America.
Frederick James Gant.
CONNATJGHT SQUARE, LONDON, W.
October, 1878.
CONTENTS OF VOL. I.
Introduction
Modern Surgery as a Science and a Scientific Art. A primary division of Medicine. Pathology, and the intimate relations of Anatomy and Physiology. Biology, Physics, and Chemistry. The relative importance of Diagnosis — its Methods, Physical, Structural, Chemical, and as connected with Pathological Anatomy by Post-mortem Examination ; Etiology and Prognosis. Their relation, severally, to Treatment. Conservative Surgery, and Medicine. Plastic Surgery. Pathology in the plan and performance of Surgical Operations.
Conditions Favourable and Unfavourable for Operation. Pathological Conditions; constitutional and local. Hygienic Conditions: Diet; Ventilation and Sunlight ; Atmospheric Space in Wards of Hospitals, Civil and Military ; Drainage ; Prevention of Contagion or Infection ; Antisepticism. Preparation of Patient for Operation. Arrangements — The Koom, Table, Instruments, Assistants. Anaesthetics — Historical notice. Chloroform— its Physiological Action. Phenomena or Symptoms. Contra-indications to the employment of Chloroform, and exceptional Operations. Administration of Chloroform, and signs of Anesthesia. Inhalers. Death from Chloroform — by Asphyxia, Cardiac Syncope, Coma, persistent Sickness. Treatment of an overdose. Sulphuric Ether. Other Anaesthetics — Nitrous Oxide or Laughing Gas; Bichloride of Methylene; Chloral. Local Ansethesia. Freezing — by frigorific mixtures, ether-spray. Dangers attending, or consequent on, Surgical Operations. Dressing of the Wound, and Constitutional After-treatment. Results of Operation— Temporary, Permanent. Modes of Unsuccessful Results. Statistics in Surgery.
Part I. General Pathology And Surgery
DISEASES OF NUTKITION.
PAGE
Chapter I. — Inflammation. Nutrition . . . . . .37
Textural Changes, and State of the Circulation and Blood- Vessels . 40
Constitutional Symptoms — Inflammatory Fever . . .50
External and Internal . . . . . .70
Exciting and Predisposing .... 71
f
X
Contents
Inflammation — continued.
Course and Terminations Kesolntion
Effusion and Products Suppuration and Abscess Ulceration Mortification Treatment Local
Constitutional Varieties of Inflammation
Chapter II.— Tumours or Morbid Growths General Pathology, and Treatment . Special Tumours
Cysts and Cystic Tumours Fatty Tumour— Lipoma. Steatoma Sarcoma .
Fibro-cellular Tumour .
Painful Subcutaneous Tubercle. Neuroma Glioma. Myxoma. Psammoma Fibrous Tumour
Fibro-Calcareous. Fibro-Cystic Fibro-nucleated and Kecurring Fibroid Tumours Cartilaginous Tumour— Enchondroma Fibro-cartilaginous. Ossific .
Myeloid, or Fibro-plastic Tumour Vascular or Erectile Tumours— Angioma Nsevus — Telangeiectasis Aneurism by Anastomosis .
Osseous Tumours
Glandular Tumours— Lymphoma. Adenoma Infiltrating Growths— Cancer
Encephaloid. Scirrhus. Colloid
Varieties— Villous. Melanotic, Fungus Hsematodes
Scirrhus
Varieties — Osteoid
Colloid — Varieties .
Cyst-Formation .
Course
Terminations
Kecurrence, and Secondary Cancer Treatment Operations
Epithelial Cancer— Varieties
Chapter III. — Degenerations. General Pathology and Treatment
Special Degenerations .
Chapter IV.— Ulceration and Ulcers, Gangbenb and Mortification. Ulceration Healthy Ulcer
Inflamed Ulcer Irritable Ulcer
187 188
201 207 209 209
CONTENTS. XI
PAGE
Ulceration and Ulcers, Gangrene and Mortification — continued.
(Edematous Ulcer . . . . . . .210
Indolent and Varicose Ulcer ..... 210
Phagedenic Ulcer . . . . . . .212
Hemorrhagic Ulcer . . . . . . 213
Scorbutic Ulcer . . . . . . . .213
Scrofulous or Strumous Ulcer ..... 214
Cancerous Ulcer ........ 215
Lupoid Ulcer ....... 215
Kodent Ulcer . . . . . . .216
Syphilitic Ulcer . . . . . . .216
Gangrene and Mortification . . . . . . .216
DISEASES OF THE BLOOD.
Chapter V. — Scrofula. General Symptoms . . . . . . . 22S
Special Forms ......... 228
Scurvy and Purpura ........ 236
Chapter VII. — Syphilis. Local Syphilis ........ 249
Chancre, and its Diagnosis ..... 249
Chancroid, or Local Contagious Ulcer ..... 250
Bubo, and its Diagnosis ...... 253
Skin Diseases ....... 259
Tubercular Eruption ...... 260
Vesicular Eruptions ...... 260
Pustular Eruptions ....... 260
Ulceration of the Skin . . . . . .261
Diseases of Mucous Membranes ...... 262
Ulceration of Tonsils ...... 262
Syphilitic Iritis ........ 263
Chronic Enlargement of Testicle ..... 263 xu
CONTENTS.
PAGE
Syphilis — continued.
Diseases of Bones, and Periosteum ..... 264
Tertiary Symptoms ....... 205
Congenital, Hereditary, or Infantile Syphilis .... 205
Vaccino-Syphilitic Inoculation ...... 209
Diagnosis of Constitutional Syphilis ...... 209
Unity or Duality of Syphilitic Virus ..... 270
Local Syphilis .272
Constitutional Syphilis ....... 276
Congenital, Hereditary, or Infantile Syphilis . . . 281
Syphilization ........ 282
SPECIAL PATHOLOGY AND SURGERY.
Division I.
INJUEIES AND DISEASES OP TEXTUKES.
SKIN AND SUBJACENT TEXTURES.
Chapter XVI. — Wounds — Incised Wound. Wounds op Arteries and Veins. Immediate Union ....... 360
Primary Adhesion ...... 360
Suppurative Granulation and Cicatrization . . . 363
Healing under a Scab ...... 363
Modelling Process ....... 364
Antiseptic Dressings ...... 367
Theory of Antisepticism ..... 369
Astringents ........ 376
Cauterization . . . . . . .376
Compression . . . . . . . .376
Acupressure ........ 380
Wounds of Veins ........ 384
Constitutional Treatment of Haemorrhage, Arterial or Venous . 385
Entrance of Air into Veins ....... 386 xiv
Chapter XXV. — Aneurism. Structural Conditions
Circumscribed — True Aneurism
Diffused — False Aneurism
Fusiform or Tubular Aneurism
Dissecting Aneurism Signs .....
Diagnosis ....
Causes .....
Course . ...
Terminations ....
Spontaneous Cure Treatment ....
Compression
Ligature . . ' .
Manipulation
Galvano-puncture
Injection ....
Treatment of Traumatic Aneurism Aneurismal Varix and Varicose Aneurism
Signs ....
Causes ....
Treatment ....
Chapter XXVI. — Aneurism op Special Arteries. Arch of Aorta . . . . . . . . 481
Aneurisms at Root of Neck ...... 484
Innominate Aneurism ..... 480
Aneurisms of Right Carotid and Subclavian Arteries . . 492
Carotid Aneurism ...... 492
Subclavian Aneurism ...... 492
Aneurism of Carotid Artery . . . . . 493
Aneurismal Varix ....... 496
Aneurism of Internal Carotid ...... 496
Extra-cranial ....... 496
Intia-cranial ........ 497
. 449 450
. 450 452
CONTENTS.
PAGE
Aneurism of Special Arteries — continued.
Wounds, and Traumatic Aneurism, of Internal or External Carotids 499
Aneurism of Subclavian Artery . . .... . 499
Aneurismal Varix ....... 502
Aneurism of Axillary Artery ...... 503
Aneurisms of Brachial, Radial, and Ulnar Arteries . • 505
Aneurismal Varix, and Varicose Aneurism . . . 506
Aneurism of Abdominal Aorta ...... 506
Aneurisms of Iliac Arteries — Common, Internal, and External . 506
Aneurisms of Gluteal, Sciatic, and Pudic Arteries .... 509
Wounds, and Traumatic Aneurism, of Gluteal Artery . . 509
Aneurism of Common Femoral Artery ..... 509
Aneurismal Varix, and Varicose Aneurism . . . .511
Aneurism of Femoral Artery — Deep and Superficial Femorals . 512
Aneurismal Varix, and Varicose Aneurism . . . 513 Aneurism of Popliteal Artery . . . . . .513
Aneurisms of Tibial Arteries — Anterior and Posterior . . . 517
Aneurismal Varix, and Varicose Aneurism . . . 518
Chapter XXVII. — Ligature op Arteries. Ligature of an Artery in its continuity . . . . .518
Ligature of an Artery at the seat of Wound . . . . 521
Ligature of Innominate Artery . , . . . .521
Ligature of the Internal Mammary Artery .... 523
Ligature of the Common Carotid Artery ..... 523
Ligature of the External and Internal Carotid Arteries . . 525
Ligature of the Lingual Artery ...... 527
Ligature of the Subclavian Artery ..... 527
Ligature of the Axillary Artery ...... 531
Ligature of the Brachial Artery ..... 534
Ligature of the Radial Artery ...... 536
Ligature of the Ulnar Artery ...... 537
CONTENTS.
XVII
FAGK
Ligature op Arteries — continued.
Surgical Anatomy . . • • - • 537 Operation . • 538 Ligature of the Abdominal Aorta, and of Iliac Arteries— Common, External, and Internal 539 Surgical Anatomy .... ... 539
Operation — External Iliac . . . • • • 540
„ Internal Iliac ...... 541
„ Common Iliac 541
„ Abdominal Aorta . . ■ • • 541
Ligature of the Femoral Artery— Common and Superficial . . 541
Operation — Common Femoral Artery ..... 545
„ Superficial Femoral Artery .... 545
Ligature of the Popliteal Artery . - ■ • ■ .546
Ligature of the Anterior Tibial Artery .... 548
Operation . . • • ■ • • 550 Ligature of the Posterior Tibial Artery . . . . .551
Operation . . • • • • i • 552
Peroneal Artery . . • • • .553
Chapter XXXI. — Fracture. Compound Fracture ....... 592
CONTENTS.
FAGE
Fracture — continued.
Amputation ....... 598
Complicated Fracture ....... GOO
Diseased Callus, and Deformed Union ..... 601
Ununited Fracture, and False Joint. Disunited Fracture . . 603
Chapter XXXI [. — Special Fractures.
Fractures of the Facial Bones . . . . . .010
„ „ Septum Narium . . . . . .611
„ ,, Kibs, and Costal Cartilages . . . .616
„ „ Radius and Ulna ...... 637
„ „ Carpal, Metacarpal Bones, and Fingers . . . 642
,, „ Innominate Bones ..... 642
„ „ Tarsal, Metatarsal Bones, and Toes . . . 671
Chapter XXXIII. — Diseases of Bone. Ostitis, or Inflammation of Bone ...... 673
Scrofulous Ostitis ....... 674
Syphilitic Ostitis ........ 675
Osteitis Deformans . . . . . . 676
Osteo-myelitis ....... 678
Diffuse Periostitis . . . . . . .680
Circumscribed Abscess of Bone . . . . .681
Caries 683
Partial Necrosis ........ 690
Necrosis without Suppuration ...... 691
Rachitis or Rickets ........ 697
Mollities Ossium ........ 699
Fiagilitas Ossium ....... 701
CONTENTS.
xix
PAGE
Diseases of Bone — continued.
Enchondroma . . . . . . 70-1
Osteo-Sarcoma — Fibrous Tumour . . . . .704
Cystic Tumours ........ 705
Hydatid Cysts . . . . . . .705
Recurring Tumours . . . . . . .706
Cancer— Interstitial ...... 706
Pulsatile Tumour, and Osteo- Aneurism . . . 709
Diseases of Particular Bones . . . . . .710
JOINTS.
Chapter XXXIV.— Injuries. Sprains. Wounds Sprains or Strains .... Wounds
Dislocations ..... • Signs ....
Diagnosis ....
Causes . . . .
Separation ....
Treatment ....
Compound Dislocation
Treatment . .
Amputation ....
Complicated Dislocation .
Treatment ....
Unreduced Dislocation and False Joint
Treatment ....
Congenital Dislocations .
Chapter XXXV. — Special Dislocations. Dislocations of the Lower Jaw . . . . . .781
„ Clavicle 735
„ „ Shoulder-joint ..... 738
Subglenoid . . . . . .738
Subclavicular ..... 73!)
Subspinous ...... 739
Complicated . . . . . 744
Radius and Ulna .... 747
Ulna 749
„ „ Inferior Radio-Ulnar Articulation . . .755
„ ,, Radio-carpal Articulation .... 756
Injuries allied to Dislocation .... 757 „ „ Carpal Bones ..... 757
„ ,, Metacarpal Bones ..... 758
„ „ Phalangeal Bones ..... 758
t
Dislocations.
. 711
711 . 713
714 . 714
715 . 716
716 . 722
723 . 724
726 . 726 .726 . 728
XX
CONTENTS.
PAflE
Special Dislocations — continued.
Dislocations of the Pelvis . . . . . . .701
On the Dorsum Ilii . . . . .762
Into Great Ischiatic Notch . . . 763 Into Obturator Foramen . . . . .769
Upon the Pubes . . . . . 771
Anomalous Dislocations .... 773
„ „ Patella 777
„ „ other Tarsal Bones ..... 788
„ „ Metatarsal Bones ..... 790
„ „ Phalangeal Bones . . . . . 790
Chapter XXXVI. — Diseases op Joints. Chronic Bheumatic Synovitis or Arthritis .... 796
Scrofulous Synovitis ........ 799
Scrofulous Disease or Caries ...... 801
Ulceration of Articular Cartilages ...... 807
Anchylosis, or Stiff Joint ...... 810
Loose Cartilages ........ 813
Chapter XXXVII. — Diseases op Particular Joints. Diseases of the Hip-joint . . . . . .816
Scrofulous Disease — Morbus Coxarius .... 816
Chronic Rheumatic Arthritis — Morbus Coxse Senilis . . 824
Disease of the Sacro-iliac Joint ...... 825
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