A Manual of the Operations of Surgery by Joseph Bell (best e reader for epub txt) π
Operation.--The ligature may be applied in one of two ways, the choice being influenced by the nature of the disease for which it is done.
1. A straight incision (Plate I. fig. 1) in the linea alba, just avoiding the umbilicus by a curve, and dividing the peritoneum, allows the intestines to be pushed aside, and the aorta exposed still covered by the peritoneum, as it lies in front of the lumbar vertebræ. The peritoneum must again be divided very cautiously at the point selected, and the aortic plexus of nerves carefully dissected off, in order that they may not be interfered with by the ligature. The ligature should then be passed round, tied, cut short, and the wound accurately sewed up.
2. Without wounding the peritoneum.
A curved incision (Plate I. fig. 2), with its convexity backwards, from the projecting end o
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[106] Diagram of double harelip, with projecting bone:βa, central piece of lip, dotted lines showing incision; b, projecting bone bearing teeth, which are generally small and stunted.
[107] Diagram of operations on the jaws:βa, incision for removal of the whole upper jaw; b, incision for removal of alveolar portion and antrum; c, incision for removing the larger half of lower jaw; the opposite side is the one supposed to be operated on, and the incision is crossing the symphysis and turning up at a right angle.
[108] Operative Surgery, p. 265.
[109] Lancet, July 1, 1865.
[110] Temporary compression of the facial can be easily managed, in cases where it is of much importance to avoid loss of blood, by passing a needle from the outside through the skin above the vessel, then under the vessel, and out again through the skin below. A figure-of-eight suture can then be thrown round both ends of the needle, and the artery thus thoroughly compressed.
[111] Syme, Contributions to the Path. and Practice of Surgery, p. 21; Carnochan of New York, Cases in Surgery.
[112] Contributions to the Path. and Prac. of Surgery, pp. 23, 24.
[113] Lancet, July 1, 1865.
[114] Rough diagram of operation for salivary fistula:βa, section of cheek close to buccal orifice; b, section of zygoma, muscles, etc.; c, the duct of the parotid; d, the fistulous opening of the cheek; E E, the thread knotted inside the mouth; f, the palate.
[115] Lancet, Feb. 4, 1865.
[116] Med. Times and Gazette for Feb. 10, 1866.
[117] Lancet, April 20, 1872.
[118] Transactions International Medical Congress, 1881, vol. ii. p. 460.
[119] Gross's Surgery, vol. ii. p. 472.
[120] Langenbeck, Archiv, ii. p. 657.
[121] Med. Chir. Trans. for 1867-8.
[122] Diagram of staphyloraphy, chiefly to illustrate the passing of the threads:βa, the first thread; b, the second. The dotted line at edge of fissure shows amount to be removed; the other dotted lines showing size and position of the incision through the mucous membrane above.
[123] Holmes's Surgery, vol. ii. pp. 504-513.
[124] Edinburgh Medical Journal for Jan. 1865, Mr. Annandale's instructive paper on "Cleft Palate."
[125] Diagram of fissure of hard palate:βa, anterior palatine foramina; b, posterior palatine foramina with groove for artery; c, incisions requisite to free the soft structures.
[126] Holmes's Diseases of Children, p. 555.
[127] Leçons sur la Trachéotomie, p. 10.
[128] Rough diagram of larynx and trachea:βA, crico-thyroid space, laryngotomy; B B, dotted outline of thyroid isthmus and lobes, defines the upper and lower positions for tracheotomy; C, thyroidβD, cricoid cartilages; E, dotted outline of thymus gland in child of two years; F F, outline of clavicles and jugular fossa.
[129] Surgical Observations, p. 335. See also Harrison On the Arteries, vol. i. p. 16.
[130] Leçons sur la Trachéotomie, p. 9.
[131] Lectures on Surgery, 3d ed., vol. ii. p. 900.
[132] Clinical Surgery in India (1866), p. 143.
[133] Mr. John Wood, Path. Soc. Trans., vol. xi. p. 20.
[134] South's Chelius, vol. ii. p. 400; and case recorded by Spence, in Ed. Med. Journal, for August 1862.
[135] Med. Chir. Transactions of London, 1872.
[136] British Med. Journal (Nos. 643, 644), 1873.
[137] Gross's Surgery, 6th ed., vol. ii. p. 342.
[138] Guy's Hospital Reports for 1858.
[139] Both in Guy's Hospital Reports, second series, vol. ii.
[140] Edinburgh Medical Journal for June 1866.
[141] Description of Sir Spencer Wells's Trocar.β"It consists of a hollow cylinder six inches long, and half an inch in diameter, within which another cylinder fitting it tightly plays. The inner one is cut off at its extremity, somewhat in the form of a pen, and is sharp. The sharp end is kept retracted within the outer cylinder by a spiral spring in the handle at the other end, but can be protruded by pressing on this handle when required for use. When thus protruded it is plunged into the cyst up to its middle; the pressure on the handle is taken off, and the cutting edge is retracted within its sheath. The fluid rushes into the tube, and escapes by an aperture in the side, to which an india-rubber tube is attached, the end of which drops into a bucket under the table. The instrument is furnished at its middle with two semicircular bars, carrying each four or five long curved teeth like a vulsellum. These teeth lie in contact with the outer surface of the cylinder, but can be raised from it by pressing two handles. When the cyst begins to be flaccid by the escape of the fluid, these side vulsellums are raised, and the adjoining part of the cyst is drawn up under the teeth, where it is firmly caught and compressed against the side of the tube."
[142] For further details on the operations described above, reference may be made to Sir Spencer Wells's work on ovarian disease, and to the very valuable papers contributed by Dr. Thomas Keith to the Edinburgh Medical Journal. To the latter especially the author is indebted for much oral instruction, and for the opportunity of seeing his careful and dexterous mode of operating.
[143] Lect. on Surgery, 3d ed., vol. ii. p. 998.
[144] Operative Surgery, p. 462.
[145] Rough diagram of abnormal course of obturator and its relation to the neck of a hernia. Parts seen from the inside: h, femoral hernia; a, femoral artery; v, femoral vein; e, epigastric artery; o, obturator from epigastric (dangerous); s o, obturator from epigastric (safe); n o, normal course of obturator; i r, internal inguinal ring; Sp c, spermatic chord and its vessels; g, Gimbernat's ligament; +, in triangle of Hesselbach.
[146] Holmes's Surgery, 3d ed., 1883, vol. ii. p. 837.
[147] Clinical and Pathological Observations in India, pp. 44, 325.
[148] Wood On Rupture, 1863.
[149] Diagram of an artificial anus, showing small sutures which unite the edges of the gut and the skin, and the large ones stitching up the wound beyond.
[150] Diagram of section of prostate seen from the inside:βpf, pelvic fascia or prostatic sheath; rr, ring which must be cut; l, position of incision in the lateral operation; dd, position of incisions in the bilateral operation.
[151] Diagram of muscles of membranous portion of urethra seen from the inside:βss, section of os pubis; u, urethra; g, Guthrie's muscle, compressor urethrΓ¦; w, Wilson's muscle, levator urethrΓ¦.
[152] Boston Medical and Surgical Journal, May 29, 1879.
[153] Gross, Surgery, 6th ed. vol. ii. p. 736.
[154] Holmes's Surgery, vol. iv. p. 392.
[155] See Miller's Practice of Surgery, p. 212.
[156] Solly's Surgical Experiences, pp. 537, 538, etc.
[157] The Immediate Treatment of Stricture. By Bernard Holt, F.R.C.S. London. Third Edition, 1868.
[158] Holmes's System of Surgery, 1st ed. vol. iv. p. 403.
[159] Diagram of puncture of the bladder:βb, bladder; sp, symphysis pubis; sc, scrotum; b, bulb; pr, peritoneum; p, prostate; r, rectum; s, sacrum and coccyx.
[160] Med. Chir. Trans., vol. xxxv.
[161] Diagram of operation for phymosis:βa, glans penis; b b, mucous membrane exposed by retraction of the skin, and slit up; c d, sutures introduced and ready to be tied, uniting the skin and mucous membrane.
[162] To illustrate Teale's operation:βc, section of penis b, thread inserted uniting mucous membrane and skin; a, thread tied.
[163] Med. Times and Gazette, vol. xix. p. 354.
[164] Miller's System of Surgery, p. 1255.
[165] Miller's System of Surgery, p. 1256.
[166] Syme's Pathology and Practice of Surgery, p. 220.
[167] Holmes's Surgery, vol. iii. p. 573.
[168] Cross's Surgery, vol. ii. p. 273, 3d ed.
[169] Miller's System of Surgery, p. 1339; Holmes's Surgery, vol. iii. p. 571.
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