Manual of Surgery
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OXFORD MEDICAL PUBLICATIONS MANUAL OF SURGERY edit
BY
ALEXIS THOMSON, F.R.C.S.Ed.
_PROFESSOR OF SURGERY, UNIVERSITY OF EDINBURGH_
SURGEON EDINBURGH ROYAL INFIRMARY
_PROFESSOR OF SURGERY, UNIVERSITY OF EDINBURGH_
SURGEON EDINBURGH ROYAL INFIRMARY
AND
ALEXANDER MILES, F.R.C.S.Ed.
SURGEON EDINBURGH ROYAL INFIRMARY
SURGEON EDINBURGH ROYAL INFIRMARY
VOLUME FIRST
GENERAL SURGERY
GENERAL SURGERY
_SIXTH EDITION REVISED_
_WITH 169 ILLUSTRATIONS_
_WITH 169 ILLUSTRATIONS_
LONDON
HENRY FROWDE and HODDER & STOUGHTON
THE _LANCET_ BUILDING
1 & 2 BEDFORD STREET, STRAND, W.C.2
HENRY FROWDE and HODDER & STOUGHTON
THE _LANCET_ BUILDING
1 & 2 BEDFORD STREET, STRAND, W.C.2
- 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 edit
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 edit
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 edit
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
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