Manual of operative surgery

Front matter

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HEALTH

Preface

The frequent request on the part of those whom it has been my pleasure to instruct in operative surgery during the past few years, to make a book based somewhat on the plan I have employed in teaching this subject, is the principal incentive to my action. The field of operative surgery is too well cultivated already for one to do more in this brief space than aid the student of surgery to acquire established facts. The works of Ashhurst, Agnew, Gross, Erichsen, Holmes, Smith, Esmarch, Packard, Stimson, and many others, together with the current medical literature, have been consulted. The illustrations, which are numerous, have been selected in most instances from standard works, although a considerable number of original and modified illustrations have been introduced. Mr. W. F. Ford, of the reputable firm of Caswell, Hazard & Co., of this city, kindly provided the instrumental cuts, as is to be seen by the " Index of Illustrations." The author desires to acknowledge the aid derived from the above-mentioned sources, and trusts the reader will find something to commend in the pages that are to follow. The author regrets that sufficient data are not at hand to permit the " results " to be given in all instances as modified by the antiseptic method of treatment. The operations peculiar to the female sex, and the eye and ear, have not been considered, since they are entitled, in the opinion of the author, to a more extended consideration than the intentional scope of this work will admit. The author desires to acknowledge the valuable services of Drs. Glover, C. Arnold, and Herman M. Biggs, in connection with the proofreading, and of Dr. Arnold also for the complete indices of the book. The assistance of Dr. A. II. Doty in preparing many of the original illustrations is likewise gratefully acknowledged.

Joseph D. Bryant, M. D.

66 W. TuiKTY-fifTH .Street, New Yor.K, October 28, 1886.

Chapter I. General Considerations

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Definition of operative surgery — Facts to be ascertained before operating — Season of the year for operating — Time of day — Surroundings of the patient — Temperature of the room — Place for an operation — Nursing — Preparatory treatment — Diet — Essential and preparatory requirements — Anaesthetics — Inflammability of ether — Chloroform more dangerous than ether — Varieties of inhalers — Amount of ether required — Purity of the anaesthetic — Dangers of — How to prepare a patient for anaesthesia — Method of administering ether — Treatment for an overdose of ether — Intestinal etherization — Local anaesthesia — Instruments necessary for operating — Methods of holding the scalpel — Forms of incisions — Instruments should be plain — Receptacle for instruments — Operating table — Empty vessels — Clean towels and old linen — Antiseptic solutions — Sponges . 1

Chapter II. Agents Fok Controlling Hemorrhage

Styptics — Position — Elastic bandage — Compresses — Digital pressure — Davy's lever — Petit's tourniquet — Trendelenburg's rod — Acupressure — Torsion — Forceps — Tenacula — Cautery — Ligatures — Assistants — Patient prepared . . - .23

Chapter III. Treatment Of Operation Wounds

Sutures — Needles — Needle-holders — Various forms of sutures — Drainage-tubes — Canalization — Antiseptic spray — Antiseptic douche — Antiseptic dressings — Antiseptic solutions — Quietude of patient — Common preparations for an antiseptic operation — Open dressings — Precautionary requirements of operations — Special emergencies of operations 41

CHAPTER IV. LIOATUBE ok ARTERIES

Guides to ligaturing — Making primary incision — Opening the sheath of a vessel — I' - img ili'' ligature — Instruments required for ligaturing — Ligature of abdominal aorta — Of common iliac arteries — Of internal iliac artery— Of gluteal artery — Of sciatic artery — Of internal pudic artery — Of dorsalis pedis artery — Of external iliac artery — Ot epigastric artery — Of deep circumflex artery — Of femoral artery — Of innominate artery — Of subclavian artery — Of vertebral artery — Of yjii CONTENTS.

PAGB internal mammary artery — Of axillary artery — Of brachial artery — Of radial artery — Of ulnar artery — Of superficial palmar arch — Of common carotid artery — Of the common carotids — Of the external carotid artery — Of the internal carotid artery — Of the superior thyroid artery — Of the lingual artery — Of the facial artery — Of the temporal artery — Of the occipital artery . . . .56

Chapter V. Operations On Veins, Capili.akies, Etc

Ligature of veins — Operations for varicose veins — Injection — Acupressure — Subcutaneous ligaturing — Hemorrhoids — Operation for internal hemorrhoids — Excision— Crushing — Ligaturing — Ligature with incision — Injection — Varicocele, treatment of — By excision of the scrotum — By compression with wires or pins — By subcutaneous ligaturing — Venesection — Transfusion — With blood — With saline solutions — With milk — Mother's mark — Treatment of — Nsevi — Treatment of — Cirsoid growths — Treatment of 117

Chapter VI. Operations On The Nervous System

Operations for hydrocephalus — For meningocele — For hydrorachis — Trephining the cranium — Instruments for — Precautions in — Location of special functions of brain — Operations on supra-orbital nerves — On infra-orbital nerves — On superior maxillary nerves — On inferior dental nerve — On lingual nerve — On facial nerve — On great occipital nerve — On auricularis magnus nerve — On spinal accessory nerve — On musculocutaneous nerve — On musculo-spiral nerve — On median nerve — On radial and ulnar nerves — On great sciatic nerve— On internal popliteal nerves — On external popliteal nerves — On small sciatic nerves — On anterior and posterior tibial nerves — On plantar nerves — On perineal nerves — On anterior crural nerve — On long saphenous nerve — On short saphenous nerve — Nerve suturing — Nerve transplantation . . . . . . . .134

Chapter VII. Operations On Tendons, Fasciae, And Muscles

Instruments for tenotomy — Rules for tenotomy — Tenotomy of flexor sublimis and profundus digitorum muscles — Of extensor communis digitorum — Of extensor primi internodii, secundi internodii, and ossis mctacarpi pollicis — Of flexor carpi radialis — Of flexor carpi ulnaris — Of biceps of forearm — Of tibialis posticus — Of flexor longus digitorum of leg — Of flexor longus pollicis of leg — Of tendo Achillis — Of peroneus longus and brevis — Of tibialis anticus — Of extensor proprius pollicis — Of extensor longus digitorum — Of peroneus tertius — Of biceps of leg — Of inner hamstring tendons of leg — Of the quadriceps extensor tendon — Of pectineus — Of adductor longus — Of tensor vaginae femoris — Of sartorius — Of multifidus spinsc — Of latissimus dorsi — Of erector spinse — Of sterno-cleidomastoid — Of the plantar fascia — Of the palmar fascia — Dupuytren's contraction — Tendon suturing 151

Chapter VIII. Operations On Bones

Gouging — Instruments necessary for — Sequcstrotomy — Instruments necessary for — Direct method of — Indirect method of— Excision — Time of operating — Instru-

CONTEXTS.

ments necessary for — Treatment of excision wounds — Excision of the upper jaw— Special instruments for— Complete removal of — Operation by median incision— Excision below floor of orbit— Subperiosteal excision of — The superior maxilla? may be removed simultaneously— Excision of the inferior maxilla- Excision of central portion of — Of lateral portion of— Of half of— Of entire bone — Of the alveolar process of — Operations for anchylosis of — Excision of the sternum — Excision of a portion of a rib — Excision of the clavicle — Excisions of the scapula — Excisions of the humerus — Excision of glenoid angle of scapula — Excisions of the elbow-joint — Excision of the ulna— Excision of the radius — Excisions of the wrist-joint — Excision of the lower extremities— Of the bones of the forearm — Of the metacarpophalangeal joints— Of the phalangeal joints— Of the metatarso-phalangcal joints— Of the metatarso-tarsal joints Of the tarsal joints — Excision of the calcaneum — Of the astragalus — Excisions of the ankle-joint — Excision of the bones of the leg— Excisions of the knee-joint — Excision of the patella — Of the great trochanter — Excisions of the hip - joint— Excision of the coccyx — Osteotomy — Instruments employed for — Neck of femur, sections of— Supra-condyloid osteotomy — Osteoarthrotomy— Osteotomy for genu varum— For "bow-legs" — For hallux valgus— Osteoplasty 1G1

Chapter IX. Amputations

General considerations— Care in making flaps— Classification of flaps — Comparative merits of different forms of flaps — Agents required for an amputation — Proper manner of holding amputating knife — Proper manner of carrying it around the limb — Proper manner of using the saw — How to operate — Use of retractors — Amputations at the phalangeal articulations — Amputations at the metacarpophalangeal articulations — Amputations at the carpo-metacarpal articulations — Amputations through the metacarpal bones — Amputations at the wrist-joint — Amputations at the elbow-joint — Amputations of the forearm — Amputations of the arm — Amputations at the shoulder-joint — Amputations above the shoulder-joint ........••••••

Chapter X. Amputations Of Tite Lower Extremities

\mputations of the phalanges in their continuity— Amputations of single toes — Amputations of adjoining toes — Amputation of toes at metatarso-phalangcal joints — Amputation through metatarsal bones — Amputation of great toe, with its metatarsal bone — Amputation of the fifth toe, with its metatarsal bone— Lisfranc's amputation — Chopart's amputation — Forbes' modification of Chopart's amputation — Suh-astragaloid disarticulation — Hancock's amputation — Tripier's method— Mollierc's method— Syme's amputation— Modification of Syme's operation—Roux's operation — Pirogoff's amputation — Modifications of Pirogoffs amputation—I,o Fort's modification of Pirogoff's amputation— Esmarch's lifica-

tion of Le Fort's operal ion— Mikulicz's amputation— Supra-malleolar amputation— Amputations at the lower third of the leg— Amputations at the middle third of the leg— Amputations at the knee-joint — Amputations through the condyle! of (he femur— Garden's method — Grftti's method— Stokos' method— Amputaiions of the thigh — Amputations at the hip- joint 258

X CONTENTS.

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Chapter XI. Deformities

Drisement force — Barton's operation for anchylosis — Curvature of the spine — Plaster-of-Paris jacket for — Webbed fingers, treatment for — Ingrown nail — Ogston's treatment of flat-foot — Stokes' treatment of — Tarsectomy . . . . . 297

Chapter XII. Plastic Suegeby

Preparation of patient for — Formation of flaps — Methods of transfer of flaps — Skin-grafting — Rhinoplasty — Mechanical appliances for deformed nose — Hare-lip — Cheiloplasty — Stomatoplasty — Staphyloplasty — Staphyloraphy — Uranoplasty — Elongated uvula, treatment of 304

Chapter XIII. Opebations On The Mouth, Phaeynx, And Cesophagus

Salivary fistula, treatment of — Excision of tonsils — Treatment for tongue-tie — For ranula — Excision of the tongue — (Esophagotomy — Dilatation of the oesophagus — (Esophagectomy — (Esophagostomy 335

Chapter XIV. Opebations On Hollow Yisceea In Contact With Sebous Suefaces

Indications to be met — Forms of sutures employed for sewing serous surfaces — Gastrostomy — Gastrotomy — Gastroenterostomy — Duodenostomy — Jejunostomy — Resection of the pylorus — Cholecystotomy — Cholecystectomy — Laparotomy — Enterotomy — Enterectomy — Colotomy — Iliac abscess, operation for — Artificial anus, treatment for — Nephrotomy — Nephrectomy — Nephrolithotomy — Nephrorraphy — Splenectomy — Paracentesis abdominis — Hernia — Radical cure of — Kclotomy 348

Chapter XV. Operations On The Anus And Rectum

Examination of anus — Operation for imperforate anus — For absence of anus — For fistula in ano — Surgical anatomy of rectum — Operations for prolapsus ani — For cancer of rectum — For stricture of rectum — For imperforate rectum . . . 401

Chapter XVI. Operations On The Ueinaey Bladdee

Introduction of a catheter or sound into the bladder— Introduction of whalebone guides — Aspiration of bladder — Cystotomy — Digital exploration of bladder — Treatment of extroversion of bladder — Puncturing bladder — Lithotrity — Litholapaxy — Lithotomy 416

Chapter XVII. Operations On The Penis And Scrotum

Operations for hydrocele— Castration— Circumcision— Treatment of paraphymosis — Methods of amputation of penis — Extirpation of penis — Operations for hypo-

CONTEXTS. xj

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spadias — Operations for epispadias — Urethroraphy — Urethroplasty — External perineal urethrotomy — Internal urethrotomy — Tapping the urethra . . . 455