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A MANUAL OF THE OPERATIONS OF SURGERY
For the Use of Senior Students, House Surgeons, and Junior Practitioners.
Illustrated.
by
JOSEPH BELL, F.R.C.S. EDIN.
Lecturer on Clinical Surgery, Surgeon to the Royal Infirmary and to the Eye Infirmary, and Late Demonstrator of Anatomy in the University of Edinburgh.
FIFTH EDITION, REVISED AND ENLARGED.
Edinburgh: Maclachlan & Stewart, Booksellers to the University. London: Simpkin, Marshall, & Co. 1883.
TO THE MEMORY OF JAMES SYME, ESQ., F.R.C.S. AND F.R.S.E. SURGEON TO THE QUEEN IN SCOTLAND
PROFESSOR OF CLINICAL SURGERY IN THE UNIVERSITY OF EDINBURGH ETC. ETC.
THIS BOOK IS DEDICATED BY HIS OLD HOUSE-SURGEON AND ASSISTANT
THE AUTHOR.
PREFACE TO FIFTH EDITION.
To retain the small size of the work and to keep it up to date have been the Author's aim in the Fifth Edition.
20 MELVILLE STREET, EDINBURGH, _August 1883._
PREFACE TO THE FIRST EDITION.
Having been asked, year after year, by the members of my Class for Operative Surgery, to recommend to them some Manual of Surgical Operations which might at once guide them in their choice of operations, and give minute details as to the mode of performance, I have been gradually led to undertake the production of this little work.
My aim has been to describe as simply as possible those operations which are most likely to prove useful, and especially those which, from their nature, admit of being practised on the dead body.
In accordance with this plan, neither historical completeness of detail, nor much variety in the methods of performing any given operation, is to be expected. Hence, also, many omissions which would be unpardonable in the briefest system of Surgery are unavoidable. For example, excision of tumours and operations for necrosis are hardly mentioned, because for these no special instructions can well be given; for, while general principles may guide us to _what_ should be done, the special circumstances of each case must dictate _how_ it is to be done.
In such a work as this, to attempt originality would be undesirable and intrusive; a judicious selection, a faithful compilation, are all that can be expected.
That the selection of operations may sometimes show "Northern Proclivities" is possible; and this is perhaps not unnatural to a scholar and teacher in the Edinburgh School.
An earnest endeavour has been used to make the references correct and copious: for any mistakes or omissions the author would crave indulgence.
The four plates which precede the letterpress were drawn on wood (from original photographs) by Mr. D.W. Williamson, Melbourne Place, and the lines of incision for the various operations were added by the author.
Table of contents (by pages)
- 1: A Manual of the Operations of Surgery by Bell
- 2: Bowman's Operation Pterygium Strabismus
- 3: PAGE Excision of Mamma Paracentesis Thoracis
- 4: Diagram of Partial Fissure Harelip
- 5: Ligature of Femoral below Sartorius
- 6: Amputation at Wrist joint palmar incision
- 7: Without wounding the peritoneum
- 8: The close proximity of the peritoneum
- 9: The peritoneum covers it anteriorly
- 10: Hidden amid the fibres of psoas and iliacus
- 11: Till the transversalis fascia is reached
- 12: When the aneurism is spontaneous
- 13: Between it and the pyriformis muscles
- 14: Before the profunda is given off
- 15: As the artery dives below the sartorius
- 16: Which would result in gangrene
- 17: Both branches of which may unite and form the popliteal
- 18: Clearing out the contents of the aneurismal sac
- 19: By the flexor longus digitorum
- 20: Profunda branches with anastomotica and articular branches
- 21: One eighth of an inch from the innominate
- 22: Ligature of carotid below the omohyoid
- 23: The common carotid must be tied
- 24: Either before it dips under the hyo glossus muscle
- 25: Running in front of the scalenus anticus
- 26: Along the upper edge of the clavicle
- 27: But hidden by the costo coracoid membrane
- 28: Syme's Operation for Axillary Aneurism
- 29: The flexor carpi ulnaris is relaxed
- 30: Suprascapular with dorsal branches of subscapular
- 31: 7 Observations in Clinical Surgery
- 32: And apt to leave a central adherent cicatrix
- 33: Amputation of a distal phalanx
- 34: To aid by its leverage in separating the metacarpal head
- 35: Amputation of first and fifth metacarpals
- 36: About an inch below the styloid processes
- 37: So important in its function of pronating the radius
- 38: 30 was much approved by Dupuytren
- 39: Leaving the olecranon attached
- 40: In some they are not divided till after disarticulation
- 41: The posterior border of the axilla
- 42: From the root of the acromion to near the coracoid process
- 43: Commencing with the most distal
- 44: Transfixes just at the tarso metatarsal joint
- 45: Thus completing the disarticulation
- 46: At the joints between the astragalus and scaphoid
- 47: Instead of proceeding to disarticulate
- 48: And the tendo Achillis nearly reached
- 49: 9705 cases of amputation resulted in death
- 50: And passing half an inch below the external malleolus
- 51: Found advantage in leaving the periosteum in the heel flap
- 52: Amputation just above the ankle
- 53: In order to prevent splintering of the fibula
- 54: It is important to retain the patella
- 55: Carden's amputation at the condyles of the femur
- 56: And the skin over the patella unavailable
- 57: 47 AMPUTATION OF THIGH BY RECTANGULAR FLAP Teale's
- 58: The lower margin of the patella
- 59: A long anterior flap with a short posterior
- 60: Specially from the posterior flap
- 61: He cut an anterior flap in the usual manner by transfixion
- 62: 32 International Encyclopaedia of Surgery
- 63: Having excised the shoulder in 1786
- 64: Its anchylosis will not be so much felt
- 65: We might very likely obtain anchylosis
- 66: Excisions are performed through degenerate or disorganised
- 67: When the glenoid is also diseased
- 68: This gives a much easier mode of access to the glenoid
- 69: And should extend transversely across to the outer condyle
- 70: And reaching almost to the internal condyle
- 71: Except in cases of excision for anchylosis
- 72: In a line parallel to the extensor secundi internodii
- 73: The articular surface of the pisiform removed
- 74: And great trochanter should be fully exposed
- 75: Erichsen in one case excised the upper end of the femur
- 76: The best seems to be the Semilunar Incision
- 77: And dividing the ligamentum patellae
- 78: Patella and Ligamentum Patellae retained
- 79: About an inch above the malleolus
- 80: Hooked my finger under the coracoid process
- 81: Excision of metacarpals and phalanges
- 82: Somewhat in front of the calcaneo cuboid joint
- 83: Excision of metatarsal bone of great toe
- 84: The diploe is wanting altogether
- 85: As if taking out an ovarian cyst
- 86: For entropium or inversion of the lids
- 87: And chiefly when the canaliculus was slit up
- 88: A little below its transverse diameter to the caruncle
- 89: Which remains attached to the sclerotic
- 90: And in cases of diabetic cataract
- 91: The curette is of the usual size
- 92: Would permit evacuation of the aqueous humour
- 93: Showing that the counterpuncture is effected
- 94: Or between the cornea and iris
- 95: Either by incision or by Corelysis q
- 96: Critchett pierces the sclerotic with a Beer's knife
- 97: Elliptical incision for entropium
- 98: If any septum remains of the old nose
- 99: The columna almost always requires improving
- 100: Till the neck of the polypus is seized
- 101: Involving a large portion of the prolabium
- 102: And a third should unite the prolabium
- 103: Up to the commencement of the first dentition
- 104: 106 Diagram of double harelip
- 105: In cases where the tumour is of moderate size
- 106: But only through the alveolar portion
- 107: Render this disarticulation very difficult
- 108: Together with the attachment of the genio hyoglossi
- 109: In one case the chain was unsatisfactory
- 110: The base being a line between the points of the bifid uvula
- 111: 124 along the alveolar ridge Fig
- 112: And sometimes a troublesome haemorrhage
- 113: Posterior palatine foramina with groove for artery
- 114: As the innominate did in Macilwain's case
- 115: Just below the cricoid cartilage
- 116: Various canulae and tubes have been proposed
- 117: Laryngotomy is occasionally useful
- 118: The omohyoid may be sought and drawn downwards and inwards
- 119: 130 Lecons sur la Tracheotomie
- 120: Bowditch is an improvement on the simple trocar and canula
- 121: The trocar should not be re introduced
- 122: And to the smaller Monograph on Ovarian Pathology
- 123: Such were the ovariotomies prior to 1857
- 124: And the length and thickness of its pedicle
- 125: Preventing the cyst from being recognised
- 126: Sometimes useful in a short narrow pedicle
- 127: Not to open the sac avoids the risk of peritonitis
- 128: Wound of the epigastric artery is the chief danger
- 129: If the bowel is absolutely gangrenous
- 130: Operation for strangulated femoral hernia
- 131: And return the bowel and omentum
- 132: Operation for strangulated umbilical hernia
- 133: As those of Langenbeck and Schmucker
- 134: Consisting of a stout plug in the inguinal canal
- 135: Invaginating the detached fascia before it
- 136: Then through Poupart's ligament again
- 137: Operations for artificial anus
- 138: To which Dupuytren gave the name Enterotome
- 139: These side vulsellums are raised
- 140: But fortunately the sheath of the prostate
- 141: And levator urethrae Guthrie's and Wilson's muscles
- 142: If the perineum has not been previously shaved
- 143: Not against the os pubis or the promontory of the sacrum
- 144: And the lateral lobe of the prostate
- 145: Wound of rectum and recto vesical fistula
- 146: The angle projects in the perineum
- 147: Sanson's Recto vesical Operation
- 148: And the urethra having been previously fairly dilated
- 149: The passing of a succession of bougies
- 150: Raises the penis in his left hand
- 151: Conical bougies of steel or silver
- 152: This being fairly in the stricture
- 153: The catheter should be tied in
- 154: Had a special canula for the purpose
- 155: Numerous vessels in the corpora cavernosa require ligature
- 156: Seizing the now flaccid scrotum in his right hand
- 157: The operations for fistula were most unnecessarily severe
- 158: Cases of prolapsus of the mucous membrane only
- 159: And yet no distinct haemorrhoidal tumour is to be seen
- 160: Subcutaneous section of the sterno mastoid
- 161: Cases of talipes valgus being usually paralytic in character
- 162: Exposing the whole front wall of antrum
- 163: The sterno mastoid edge being once fairly exposed
- 164: Bowditch on paracentesis thoracis
- 165: Dupuytren on ligature of iliac
- 166: Hamilton on rhinoplastic operations
- 167: Case of haemorrhage from iliac
- 168: Malgaigne on Chopart's amputation
- 169: Sanson on recto vesical lithotomy
- 170: Chopart's amputation introduced by
