Manual of Surgery

OXFORD MEDICAL PUBLICATIONS MANUAL OF SURGERY

 * First Edition                                            1904
 * Second Edition                                           1907
 * Third Edition                                            1909
 * Fourth Edition                                           1911
 * "      "    Second Impression                          1913
 * Fifth Edition                                            1915
 * "      "    Second Impression                          1919
 * Sixth Edition                                            1921

PRINTED IN GREAT BRITAIN BY                 MORRISON AND GIBB LTD., EDINBURGH

PREFACE TO SIXTH EDITION
Much has happened since this Manual was last revised, and many surgical lessons have been learned in the hard school of war. Some may yet have to be unlearned, and others have but little bearing on the problems presented to the civilian surgeon. Save in its broadest principles, the surgery of warfare is a thing apart from the general surgery of civil life, and the exhaustive literature now available on every aspect of it makes it unnecessary that it should receive detailed consideration in a manual for students. In preparing this new edition, therefore, we have endeavoured to incorporate only such additions to our knowledge and resources as our experience leads us to believe will prove of permanent value in civil practice.

For the rest, the text has been revised, condensed, and in places rearranged; a number of old illustrations have been discarded, and a greater number of new ones added. Descriptions of operative procedures have been omitted from the _Manual_, as they are to be found in the companion volume on _Operative Surgery_, the third edition of which appeared some months ago.

We have retained the Basle anatomical nomenclature, as extended experience has confirmed our preference for it. For the convenience of readers who still employ the old terms, these are given in brackets after the new.

This edition of the _Manual_ appears in three volumes; the first being devoted to General Surgery, the other two to Regional Surgery. This arrangement has enabled us to deal in a more consecutive manner than hitherto with the surgery of the Extremities, including Fractures and Dislocations.

We have once more to express our thanks to colleagues in the Edinburgh School and to other friends for aiding us in providing new illustrations, and for other valuable help, as well as to our publishers for their generosity in the matter of illustrations.

EDINBURGH,
 * March 1921.

CONTENTS
PAGE
 * Chapter I - REPAIR                                                           1
 * Chapter II - CONDITIONS WHICH INTERFERE WITH REPAIR                          17
 * Chapter III - INFLAMMATION                                                    31
 * Chapter IV - SUPPURATION                                                     45
 * Chapter V - ULCERATION AND ULCERS                                           68
 * Chapter VI - GANGRENE                                                        86
 * Chapter VII - BACTERIAL AND OTHER WOUND INFECTIONS                           107
 * Chapter VIII - TUBERCULOSIS                                                   133
 * Chapter IX - SYPHILIS                                                       146
 * Chapter X - TUMOURS                                                        181
 * Chapter XI - INJURIES                                                       218
 * Chapter XII - METHODS OF WOUND TREATMENT                                     241
 * Chapter XIII - CONSTITUTIONAL EFFECTS OF INJURIES                             249
 * Chapter XIV - THE BLOOD VESSELS                                              258
 * Chapter XV - THE LYMPH VESSELS AND GLANDS                                   321
 * Chapter XVI - THE NERVES                                                     342
 * Chapter XVII - SKIN AND SUBCUTANEOUS TISSUES                                  376
 * Chapter XVIII - THE MUSCLES, TENDONS, AND TENDON SHEATHS                       405
 * Chapter XIX - THE BURSAE                                                     426
 * Chapter XX - DISEASES OF BONE                                               434
 * Chapter XXI - DISEASES OF JOINTS                                             501
 * INDEX                                                          547

LIST OF ILLUSTRATIONS
FIG.                                                            PAGE

1. Ulcer of Back of Hand grafted from Abdominal Wall            15

2. Staphylococcus aureus in Pus from case of Osteomyelitis      25

3. Streptococci in Pus from case of Diffuse Cellulitis          26

4. Bacillus coli communis in Pus from Abdominal Abscess         27

5. Fraenkel's Pneumococci in Pus from Empyema following         28 Pneumonia

6. Passive Hyperaemia of Hand and Forearm induced by Bier's     37 Bandage

7. Passive Hyperaemia of Finger induced by Klapp's Suction      38 Bell

8. Passive Hyperaemia induced by Klapp's Suction Bell for       39 Inflammation of Inguinal Gland

9. Diagram of various forms of Whitlow                          56

10. Charts of Acute Sapraemia                                    61

11. Chart of Hectic Fever                                        62

12. Chart of Septicaemia followed by Pyaemia                     63

13. Chart of Pyaemia following on Acute Osteomyelitis            65

14. Leg Ulcers associated with Varicose Veins                    71

15. Perforating Ulcers of Sole of Foot                           74

16. Bazin's Disease in a girl aet. 16                            75

17. Syphilitic Ulcers in region of Knee                          76

18. Callous Ulcer showing thickened edges                        78

19. Tibia and Fibula, showing changes due to Chronic Ulcer of    80 Leg

20. Senile Gangrene of the Foot                                  89

21. Embolic Gangrene of Hand and Arm                             92

22. Gangrene of Terminal Phalanx of Index-Finger                100

23. Cancrum Oris                                                103

24. Acute Bed Sores over right Buttock                          104

25. Chart of Erysipelas occurring in a wound                    108

26. Bacillus of Tetanus                                         113

27. Bacillus of Anthrax                                         120

28. Malignant Pustule third day after infection                 122

29. Malignant Pustule fourteen days after infection             122

30. Colony of Actinomyces                                       126

31. Actinomycosis of Maxilla                                    128

32. Mycetoma, or Madura Foot                                    130

33. Tubercle bacilli                                            134

34. Tuberculous Abscess in Lumbar Region                        141

35. Tuberculous Sinus injected through its opening in the       144 Forearm with Bismuth Paste

36. Spirochaete pallida                                         147

37. Spirochaeta refrigerans from scraping of Vagina             148

38. Primary Lesion on Thumb, with Secondary Eruption on         154 Forearm

39. Syphilitic Rupia                                            159

40. Ulcerating Gumma of Lips                                    169

41. Ulceration in inherited Syphilis                            170

42. Tertiary Syphilitic Ulceration in region of Knee and on     171 both Thumbs

43. Facies of Inherited Syphilis                                174

44. Facies of Inherited Syphilis                                175

45. Subcutaneous Lipoma                                         185

46. Pedunculated Lipoma of Buttock                              186

47. Diffuse Lipomatosis of Neck                                 187

48. Zanthoma of Hands                                           188

49. Zanthoma of Buttock                                         189

50. Chondroma growing from Infra-Spinous Fossa of Scapula       190

51. Chondroma of Metacarpal Bone of Thumb                       190

52. Cancellous Osteoma of Lower End of Femur                    192

53. Myeloma of Shaft of Humerus                                 195

54. Fibro-myoma of Uterus                                       196

55. Recurrent Sarcoma of Sciatic Nerve                          198

56. Sarcoma of Arm fungating                                    199

57. Carcinoma of Breast                                         206

58. Epithelioma of Lip                                          209

59. Dermoid Cyst of Ovary                                       213

60. Carpal Ganglion in a woman aet. 25                          215

61. Ganglion on lateral aspect of Knee                          216

62. Radiogram showing pellets embedded in Arm                   228

63. Cicatricial Contraction following Severe Burn               236

64. Genealogical Tree of Haemophilic Family                     278

65. Radiogram showing calcareous degeneration of Arteries       284

66. Varicose Vein with Thrombosis                               289

67. Extensive Varix of Internal Saphena System on Left Leg      291

68. Mixed Naevus of Nose                                        296

69. Cirsoid Aneurysm of Forehead                                299

70. Cirsoid Aneurysm of Orbit and Face                          300

71. Radiogram of Aneurysm of Aorta                              303

72. Sacculated Aneurysm of Abdominal Aorta                      304

73. Radiogram of Innominate Aneurysm after Treatment by         309 Moore-Corradi method

74. Thoracic Aneurysm threatening to rupture                    313

75. Innominate Aneurysm in a woman                              315

76. Congenital Cystic Tumour or Hygroma of Axilla               328

77. Tuberculous Cervical Gland with Abscess formation           331

78. Mass of Tuberculous Glands removed from Axilla              333

79. Tuberculous Axillary Glands                                 335

80. Chronic Hodgkin's Disease in boy aet. 11                    337

81. Lymphadenoma in a woman aet. 44                             338

82. Lympho Sarcoma removed from Groin                           339

83. Cancerous Glands in Neck, secondary to Epithelioma of Lip   341

84. Stump Neuromas of Sciatic Nerve                             345

85. Stump Neuromas, showing changes at ends of divided Nerves   354

86. Diffuse Enlargement of Nerves in generalised                356 Neuro-Fibromatosis

87. Plexiform Neuroma of small Sciatic Nerve                    357

88. Multiple Neuro-Fibromas of Skin (Molluscum fibrosum)        358

89. Elephantiasis Neuromatosa in a woman aet. 28                359

90. Drop-Wrist following Fracture of Shaft of Humerus           365

91. To illustrate the Loss of Sensation produced by Division    367 of the Median Nerve

92. To illustrate Loss of Sensation produced by Complete        368 Division of Ulnar Nerve

93. Callosities and Corns on Sole of Foot                       377

94. Ulcerated Chilblains on Fingers                             378

95. Carbuncle on Back of Neck                                   381

96. Tuberculous Elephantiasis                                   383

97. Elephantiasis in a woman aet. 45                            387

98. Elephantiasis of Penis and Scrotum                          388

99. Multiple Sebaceous Cysts or Wens                            390

100. Sebaceous Horn growing from Auricle                         392

101. Paraffin Epithelioma                                        394

102. Rodent Cancer of Inner Canthus                              395

103. Rodent Cancer with destruction of contents of Orbit         396

104. Diffuse Melanotic Cancer of Lymphatics of Skin              398

105. Melanotic Cancer of Forehead with Metastasis in Lymph       399 Glands

106. Recurrent Keloid                                            401

107. Subungual Exostosis                                         403

108. Avulsion of Tendon                                          410

109. Volkmann's Ischaemic Contracture                            414

110. Ossification in Tendon of Ilio-psoas Muscle                 417

111. Radiogram of Calcification and Ossification in Biceps and   418 Triceps

112. Ossification in Muscles of Trunk in generalised Ossifying   419 Myositis

113. Hydrops of Prepatellar Bursa                                427

114. Section through Gouty Bursa                                 428

115. Tuberculous Disease of Sub-Deltoid Bursa                    429

116. Great Enlargement of the Ischial Bursa                      431

117. Gouty Disease of Bursae                                     432

118. Shaft of the Femur after Acute Osteomyelitis                444

119. Femur and Tibia showing results of Acute Osteomyelitis      445

120. Segment of Tibia resected for Brodie's Abscess              449

121. Radiogram of Brodie's Abscess in Lower End of Tibia         451

122. Sequestrum of Femur after Amputation                        453

123. New Periosteal Bone on Surface of Femur from Amputation     454 Stump

124. Tuberculous Osteomyelitis of Os Magnum                      456

125. Tuberculous Disease of Tibia                                457

126. Diffuse Tuberculous Osteomyelitis of Right Tibia            458

127. Advanced Tuberculous Disease in Region of Ankle             459

128. Tuberculous Dactylitis                                      460

129. Shortening of Middle Finger of Adult, the result of         461 Tuberculous Dactylitis in Childhood

130. Syphilitic Disease of Skull                                 463

131. Syphilitic Hyperostosis and Sclerosis of Tibia              464

132. Sabre-blade Deformity of Tibia                              467

133. Skeleton of Rickety Dwarf                                   470

134. Changes in the Skull resulting from Ostitis Deformans       474

135. Cadaver, illustrating the alterations in the Lower Limbs    475 resulting from Ostitis Deformans

136. Osteomyelitis Fibrosa affecting Femora                      476

137. Radiogram of Upper End of Femur in Osteomyelitis Fibrosa    478

138. Radiogram of Right Knee showing Multiple Exostoses          482

139. Multiple Exostoses of Limbs                                 483

140. Multiple Cartilaginous Exostoses                            484

141. Multiple Cartilaginous Exostoses                            486

142. Multiple Chondromas of Phalanges and Metacarpals            488

143. Skiagram of Multiple Chondromas                             489

144. Multiple Chondromas in Hand                                 490

145. Radiogram of Myeloma of Humerus                             492

146. Periosteal Sarcoma of Femur                                 493

147. Periosteal Sarcoma of Humerus                               493

148. Chondro-Sarcoma of Scapula                                  494

149. Central Sarcoma of Femur invading Knee Joint                495

150. Osseous Shell of Osteo-Sarcoma of Femur                     495

151. Radiogram of Osteo-Sarcoma of Femur                         496

152. Radiogram of Chondro-Sarcoma of Humerus                     497

153. Epitheliomatus Ulcer of Leg invading Tibia                  499

154. Osseous Ankylosis of Femur and Tibia                        503

155. Osseous Ankylosis of Knee                                   504

156. Caseating focus in Upper End of Fibula                      513

157. Arthritis Deformans of Elbow                                525

158. Arthritis Deformans of Knee                                 526

159. Hypertrophied Fringes of Synovial Membrane of Knee          527

160. Arthritis Deformans of Hands                                529

161. Arthritis Deformans of several Joints                       530

162. Bones of Knee in Charcot's Disease                          533

163. Charcot's Disease of Left Knee                              534

164. Charcot's Disease of both Ankles: front view                535

165. Charcot's Disease of both Ankles: back view                 536

166. Radiogram of Multiple Loose Bodies in Knee-joint            540

167. Loose Body from Knee-joint                                  541

168. Multiple partially ossified Chondromas of Synovial          542 Membrane from Shoulder-joint

169. Multiple Cartilaginous Loose Bodies from Knee-joint         543