A text-book of minor surgery

Front matter

V e vV ^ o N

A*

C0 N

Preface To The Second Edition

The medical fraternity has taken so kindly to this Minor Surgery that a second edition is necessary. While I feel very proud of the reception which has been given to my first born, I realize that most of the success has been due to the need for a book of this character, rather than to the particular way in which the author has handled the subject. Much of the credit is also due to the publishers, and to their excellent methods of bringing their books to the attention of physicians. I welcome the opportunity which they now offer me to make some textual corrections, and to add a number of new paragraphs.

I wish also to take this method of thanking the many friends who have expressed their approval of the work. I hardly dared hope that the recent hospital graduate would have an interest in the study of so humble a topic as Minor Surgery ; and the statement that many of them have made to me, that they have repeatedly turned to it for guidance, is the most satisfactory criticism that the book could have.

Edward Milton Foote. 186 West Forty -eighth Street, New York.

Preface

In preparing this " Minor Surgery," it has been my purpose to apply to the less serious, every-day problems of surgical practise the new knowledge which the discoveries of the last twenty-five years have revealed. During this period the advances in diagnosis and treatment have rendered necessary a new surgical literature, and many excellent text-books have appeared, in one, two, and four volumes. In these the more serious surgical conditions are exhaustively discussed, while the treatment of the lesser ailments — the minor surgery which forms the bulk of surgical practise — is condensed into a chapter or two, in which methods of treatment long since outgrown still find their place. Nor is the importance of minor surgery recognized in the curriculum of our medical schools.

And yet this neglected field of minor surgery is the only one into which the average practitioner will ever enter, and is also the one in which most surgeons will find the majority of their patients. What wonder then that the physician, untaught and unread in minor surgery, fails to achieve good results, and that more bad surgery is performed upon the hand than upon the organs of the abdomen ?

Impressed by the need of a text-book which describes in detail the manifold lesser accidents and surgical diseases which the general practitioner is called upon to treat, I commenced eight years ago the preparation of such a book. It has been rewritten several times. until hardly a page of the original manuscript remains; and it appears now in its development, somewhat larger, but the same in purpose as when it was first conceived.

If this " Minor Surgery " fails to meet the expectations of the reader, this fault does not lie in the author's lack oi' experience: for \ had the richest opportunity for the preparation oi' just such a book in a ten years' almost daily service in the Surgical Department of the

vii

Vlll PREFACE

Vanderbilt Clinic, with an average annual attendance of about four thousand new patients. Besides this I have enjoyed the advantages which come from teaching both minor surgery and general surgery in the College of Physicians and Surgeons, and from surgical attendance in the Kandall's Island Hospitals, the New York City Hospital, and the New York Polyclinic Hospital.

I have striven to present in compact form the results of this experience and the best that has been written in books, magazines, and journals, taking with free hand from every available source. A mere list of the articles consulted would fill several pages. Very few authors' names are mentioned because such simple procedures as are herein described must often suggest themselves to many minds. We all owe so much to our predecessors.

The aim has been to illustrate by photographs as far as possible. Too often medical illustrations show what might be, rather than what is ; for the difficulties of making clinical photographs sufficiently clear for good reproduction are tremendous. Mr. H. C. Lehmann has aided me very much in this part of the work, and has also furnished all of the drawings. My thanks are also due to Dr. E. J. McKenzie for many good photographs made while he was a student in my clinic; and to Mr. B. F. Puffer, who took for me the photographs to illustrate the chapter on bandaging.

Edward Milton Foote.

136 West Forty-eighth Street, New York.

Chapter I. — Injuries of the Head General considerations 1

Contusions: Subconjunctival ecchymosis — Hematoma of the new-born; of the ear.

Hemorrhage: From the nose ......... 2

Abrasions: Removal of powder grains 7

Foreign body in the eye; ear and nose; mouth and throat.

Wounds of the eye; mouth; Steno's duct; periosteum.

Fracture of skull; into frontal sinus; of malar; of nasal; of superior maxilla; of inferior maxilla; complications.

Dislocation of the jaw: Subluxation 24

Chapter II. — Inflammations of the Head

Burns — Sunburn; of lip — X-ray burn — Frost-bite — Dermatitis. Acute inflammations 31

Urticaria — Herpes — Impetigo — Acne — Cellulitis — Erysipelas

— Boil — Stye — Boils of the nose and ear — Abscess — Alveolar

Abscess.

Inflammations of the eye 47

Acute conjunctivitis — Purulent conjunctivitis — Granular lids —

Trachoma — Ingrowing lashes.

Inflammation of the ear: Otitis media 51

Inflammations of the nose 53

Acute rhinitis — Chronic rhinitis — Suppuration in frontal sinus;

in antrum of Highmore.

Inflammations of the mouth and throat 55

Stomatitis and gingivitis — Peritonsillar abscess — Retropharyngeal abscess.

Inflammations of the skin 57

Eczema — Ringworm — Ulcer — Anthrax — Noma. Chronic inflammations 59

Syphilis: Secondary lesions; tertiary lesions— Tuberculosis of

nose and mouth — Actinomycosis.

ix

X CONTENTS

PAGE

Chapter III. — Tumors and Deformities of the Head Cystic tumors .66

Milium — Comedo — Sebaceous cyst — Mucous cyst — Salivary cysts

— Dental cyst — Dermoid cyst — Congenital sinus. Benign solid tumors 76

Papilloma — Mole — Lipoma — Fibrolipoma — Angioma — Nevus —

Acne hypertrophica — Hypertrophy of tonsil— Adenoids— Epulis

— Otoliths — Osteoma — Spur.

Malignant tumors ....... 92

Epithelioma of scalp; of face; of lip; of tongue — Sarcoma — Angiosarcoma — Parotid tumors — Cancer of tonsil. Acquired deformities 108

Cicatrices — Nasal deformities — Deviation of septum — Elongation

of uvula.

Congenital deformities 112

Harelip — Cleft palate — Cleft lower lip — Thick lips — Tongue tie —

Deformities of ear.

Chapter IV. — Injuries and Inflammations of the Neck Contusions 117

Foreign bodies: of larynx; of trachea; of esophagus.

Wounds of vessels; of trachea; of esophagus — Tracheotomy — Intubation

Sprain of cervical spine 122

Fracture of hyoid; of larynx; of trachea; of vertebra.

Dislocation of vertebra 125

Burn — Cellulitis — Erysipelas — Boil — Carbuncle— Abscess — Angina ludovici — Anthrax — Tuberculosis of vertebra.

Chapter V. — Tumors and Deformities of the Neck

Sebaceous cysts — Thyroid cyst — Thyreoglossal cyst — Branchiogenic cyst — Lipoma: Simple, diffuse, intermuscular — Fibroma — Lymphadenitis: Acute; tuberculous; syphilitic; in leukemia; in pseudoleukemia; in sarcoma; in carcinoma — Goiter.

Cicatrices — Wryneck.

CONTENTS XI

Chapter VI. — Injuries and Inflammations of the Trunk Contusions 153

Contusion of breast; of back and ribs; of abdomen.

Hemorrhage from umbilicus — Gunshot wound of back — Penetrating wound of pleural cavity; of pericardial cavity; of abdomen.

Sprains 158

Sprain of back — Railroad spine.

Fracture of clavicle; of scapula; of sternum; of ribs; of vertebra.

Dislocations 169

Dislocation of clavicle; of costal cartilage; of vertebra.

Burns — Insect bites — Scabies — Herpes zoster— Cellulitis — Dermatitis — -Erysipelas — Abscess of breast; of umbilicus — Bed-sore — Empyema.

Syphilis — -Tuberculosis of sternoclavicular joint; of ribs; of vertebrae; of sacroiliac joint; of mammary gland.

Chapter VII. — -Tumors and Deformities of the Trunk Cystic tumors 181

Sebaceous cyst — Umbilical cyst — Coccygeal cyst — Dermoid cyst —

Cysts of mammary gland.

Solid benign tumors of trunk 183

Granuloma — -Keloid— Papilloma — Fibrolipoma — Lipoma. Solid tumors of breast 187

Hypertrophy — Adenoma — Early diagnosis of malignant tumors —

Tumors of male breast.

Malignant tumors of trunk: Carcinoma and sarcoma of skin . . 191 Acquired deformities 192

Coccygodynia — -Hernia: Umbilical; inguinal; femoral; strangulated

— Ascites — Paracentesis.

Congenital deformity: Spina bifida 201

Chapter VIII. — Injuries and Inflammations of the Male Genitourinary Organs Subcutaneous injuries 203

Contusion of penis and testicle — Hematoma — Hematocele 1 — Fracture of penis — Paraphimosis — Neuralgia of testicle.

xii CONTENTS

PAGE

Foreign bodies of penis; of urethra; of bladder.

Wounds: Rupture of urethra; of bladder 208

Burns — Balanitis — Herpes — Urethritis — Abscess — Gonorrhea — ■ Cystitis — Epididymitis — Posterior urethritis — Stricture — Retention of urine — Incontinence — Catheterization — Eczema — Chancroid — Inguinal adenitis.

Syphilis — Mixed infection — Syphilitic orchitis — Tuberculosis of testicle.

Chapter IX. — Tumors and Deformities of the Male Genito-Urinary Organs

Cysts of skin; of testicle — Warts — Epithelioma — Carcinoma — Sarcoma — Castration — Tumors of bladder and prostate.

Hydrocele — Hydrocele of the cord — Varicocele.

Phimosis — Circumcision — Short frenum — Narrow meatus — Hypospadias — Epispadias — Exstrophy of bladder — Undescended testicle.

Chapter X.— Affections of the Female Genito-Urinary Organs

Contusions — Rupture of hymen; of vagina — Hematoma — Acute laceration of perineum — Hemorrhage — Rape.

Foreign bodies of vagina; of urethra; of bladder.

Pruritus — Eczema — Simple vulvitis and vaginitis — Acute gonorrhea; of vulva; of urethra; of Bartholin's glands — Simple suppuration.

Chronic gonorrhea — Endocervicitis — Endometritis — Dilatation — Currettage — Chancroid — Syphilis — Chancre — Condyloma.

Cyst of Bartholin's gland — Urethral caruncle — Cervical polyp — Carcinoma; of vulva; of cervix.

Relaxation of sphincter of bladder — Incontinence of childhood — Retention of urine — Catheterization — Prolapse of urethra — Old laceration of perineum — Prolapse of uterus — Fistula of vagina; of urethra.

Adhesions of clitoris — Imperforate hymen — Stenosis of cervix.

CONTENTS Xlii

Chapter XI. — Injuries and Inflammations of the Anus and Rectum Examination of patient — Stretching of sphincter ani — Wounds — ■

Hemorrhage.

Foreign bodies: Impacted feces 286

Intertrigo — Pruritus — Proctitis — Fissure — Abscess — Fistula —

Gonorrhea — Chancroid.

Chronic inflammations 300

Syphilis — Tuberculosis — Ulcer of Rectum — Stricture. Chapter XII. — Tumors and Deformities of the Anus and Rectum

Venereal warts— Polyp — Hemorrhoids: Acute; chronic — Carcinoma

— Sarcoma.

Acquired deformities 318

Prolapse: Acute; chronic — Rectal hernia — Incontinence of sphincter ani.

Congenital deformities 322

Imperforate anus — Stricture.

Chapter XIII. — Injuries to the Soft Parts of the Arm and Hand Subcutaneous injuries 324

Contusion — Blister — Hematoma — Rupture of muscle.

Minute wounds — Ligation of vessels— Suture of tendons; of nerves — Wounds of joints.

Sprains 338

Sprain of shoulder — Neuritis — Acute tenosynovitis: Serous synovitis — Bursitis.

Chapter XIV. — Dislocations and Fractures of the Arm and Hand Dislocations 347

Dislocation of shoulder; of elbow; of radius; of ulna — Subluxation of radius — Dislocation of wrist; of thumb — Overextension of thumb — dislocation of finger — Drop-finger.

Separation of epiphysis — Green-stick fracture — Fracture o\ humerus; of olecranon; of head of radius; of shaft of ulna or radius — Fracture: Colles's; of carpus; of metacarpals; of phalanges — Compound fractures — Crushed fingers — Amputation of fingers.

xiv CONTENTS

PAGE

Chapter XV. — Inflammations of the Arm and Hand

Burns — Mangle injury — Frost-bite — Chilblains — Gangrene: Carbolic, etc.; with cellulitis; diabetic.

Infection in wounds — Anatomical tubercle — Dermatitis — Erysipelas — Erysipeloid — Cellulitis — Boil — Paronychia: Acute; chronic — Thecitis — Suppurating synovitis — Arthritis — Bursitis — Lymphangitis — Lymphadenitis — Eczema — Ulcer from vaccination.

Arthritic and chronic inflammations 433

Rheumatism — Gonorrheal arthritis — Deforming arthritis — Gout — Syphilis — Tuberculosis of tendon sheaths; of joints — Osteomyelitis.

Chapter XVI. — Tumors and Deformities of the Arm and Hand Ganglion — Aneurism— Varix — Inclusion cyst — Lipoma — Fibroma

— Papilloma — Neurofibroma — Osteoma — Granuloma — Wart

— Epithelioma — Sarcoma.

Acquired deformities 463

Cicatricial contractions — Dupuytren's contraction. Congenital deformities 467

Web-finger — Supernumerary finger — Hypertrophy of finger —

Deficiency of finger — Too many accessory tendons.

Chapter XVII.— Injuries of the Leg and Foot

Contusions — -Abrasions — -Blister — Hematoma: Subungual; subperiosteal — Rupture of vein; of tendon.

Wounds of joint; of tendon; of nerve.

Bursitis 476

Bursitis: Prepatellar; subgluteal; back of knee; under tendo Achillis; metatarsophalangeal — Serous synovitis — Floating cartilage.

Sprain 486

Sprain of hip; of knee; of ankle — Chronic synovitis — Rupture of ligament.

Dislocation 497

Fracture of femur; of patella; of tibia (non-union); of fibula; of lower end of tibia and fibula; of astragalus; of os calcis; of metatarsals; of phalanges.

Amputation 509

CONTENTS XV

PAGE

Chapter XVIII. — Inflammations of the Leg and Foot Frost-bite — Burns — Gangrene

Acute inflammation 514

Cellulitis — Lymphangitis — Phlebitis — Thrombosis — Lymphadenitis — -Abscess — Pediculosis.

Chronic and arthritic inflammations 519

Eczema — Ulcer — Perforating ulcer — Suppurating synovitis — Rheumatism — Gonorrheal arthritis — Gout — Syphilis — Tuberculosis.

Chapter XIX. — Tumors and Deformities of the Leg and Foot

Callus — Corn — Varicose veins — Aneurism — -Ganglion — Sebaceous cyst — Lipoma — -Fibroma — -Osteoma — Sarcoma — Carcinoma.

Twisted nail — Ingrown nail — Hallux valgus — Hallux rigidus — Hammer-toe — Flatfoot — Transverse flatfoot — Painful heel. Congenital deformities: Hypertrophy — Supernumerary toes . . .561

Chapter XX. — Operative Technique Conditions of operation 563

Asepsis — Operating room — Preparation of patient — Hands of the operator — -Instruments — Solutions — Local anesthesia.

Treatment of the wound 568

Control of hemorrhage — Tying a ligature — -Drainage — Sutures — Dressings: Dry gauze; cotton-collodion; wet.

Some typical operations 575

Opening an abscess — Removal of a tumor — Skin-grafting: Thiersch method; Wolfe method — Plastic operations — Lumbar puncture — Transfusion — Infusion — Venesection — Cupping — Leeching — Vaccination.

Chapter XXI. — The Roller Bandage General principles 5S9

Preparation of a bandage — Application: Anchoring; spiral reverse; overlapping of turns; figure of eight; the spica; amount of pressure; completion.

Bandages of head 595

1. Horizontal circular — 2. Oblique circular — 3. Double oblique circular — 4. Crossed circular — -5. Knotted — 6. Figure of eight — 7. Single roller — 8. Double roller— 9. Partial recurrent — 10. Figure of eight of one eye — 11. Figure of eight of both eyes — 1:2. Four-tailed o\ jaw— 13. Barton's of jaw — 14. Gibson's of jaw — 15. Figure of eight of forehead and chin.

Bandages of the neck and axilla, alone and in combination . . .613 16. Circular — 17. Posterior figure of eight of head and neck -IS. 2 xvi CONTENTS

PAGE

Anterior figure of eight of head and neck — 19. Figure of eight of neck and axilla — 20. Figure of eight of both axillae — 21. Oblique circular of neck and axilla — 22. Complete, of neck — 23. Complete, of axilla — 24. Anterior figure of eight of neck and chest.

Bandages of the trunk 626

25. Anterior figure of eight of chest — 26. Posterior figure of eight of chest — 27. Spiral of the chest — 28. Spica of one breast — 29. Spica of both breasts — 30. Velpeau's figure of eight of chest and shoulder — 31. Desault's of Chest and shoulder — 32. Descending spiral of abdomen — 33. Many-tailed of abdomen.

Bandages of the upper extremity 643

34. Ascending spica of shoulder— 35. Descending spica of shoulder — 36. Spiral of arm — 37. Concentric figure of eight of elbow — 38. Eccentric figure of eight of elbow — 39. Spiral reverse of forearm — 40. Figure of eight of forearm — 41. Figure of eight of hand — 42. Spiral reverse of hand — 43. Spica of thumb — 44. Spiral reverse of finger — 45. Figure of eight of finger — 46. Gauntlet, or figure of eight of fingers and wrist — 47. Recurrent of finger.

Bandages of the lower extremity 657

48. Ascending spica of one groin — 49. Descending spica of one gioin — 50. Ascending spica of both groins — 51. Descending spica of both groins — 52. Ascending spica of buttock — -53. Crossed perineal — 54. Spiral reverse of thigh — 55. Concentric figure of eight of knee — 56. Eccentric figure of eight of knee — 57. Figure of eight of both knees — 58. Figure of eight of the leg — 59. Spiral reverse of leg — 60. Figure of eight of ankle — 61. Figure of eight of foot and leg — 62. Eccentric figure of eight of heel — 63. Modified eccentric figure of eight of heel — 64. Spica of foot — 65. Circular of toe — 66. Spica of great toe — 67. Complex spica of great toe — 68. Recurrent of stump.