The rapid sale of the fifth, and the demand for a sixth edition of this work, enable me to say that the precepts inculcated in it have been fully borne out and confirmed by the practice of the Surgeons of the Army now in the Crimea in almost every particular. To several of these gentlemen I desire to offer my warmest thanks for the assistance they have afforded. Their names are given with the cases and observations they have been so good as to send me, and a fuller “Addenda” shall be made from time to time, as I receive further information from them, and others who will, I hope, follow the example they have thus set. More, however, has been done; they have performed operations of the gravest importance at my suggestion, that had not been done before, with a judgment and ability beyond all praise; and they have modified others to the great advantage of those who may hereafter suffer from similar injuries. They have thus proved that if the Administrative duties of the Medical Department of the Army have not been free from public animadversion, that its practical and scientific duties have merited public approbation; which I am satisfied, from what they have already done, they will continue to deserve.
The precepts laid down are the result of the experience acquired in the war in the Peninsula, from the first battle of Roliça in 1808, to the last in Belgium, of Waterloo in 1815, which altered, nay overturned, nearly all those which existed previously to that period, on all points to which they relate. Points as essential in the Surgery of domestic as in military life. They have been the means of saving the lives, and of relieving, if not even of preventing, the miseries of thousands of our fellow-creatures throughout the civilized world.
I would willingly imitate the example lately indulged in, by many of the best Parisian surgeons, of detailing circumstantially the improvements they have made in practical and scientific surgery; the manner in which they were at first contested, and the universal adoption of them which has succeeded, were it not that I might run the risk of being accused of gratifying some personal vanity, while only desirous of drawing the attention of the public to the merits of the men who so ably served them in the last war, nearly all of whom are no more; and who have passed away, as I trust their successors will not, with scarcely a single acknowledgment of their services, except the humble tribute now offered by their companion and friend.
4 Berkeley Street, Berkeley Square,
October 7, 1855.
CONTENTS.
| LECTURE I. |
| [A wound made by a musket-ball is essentially a contused wound;sometimes bleeds; attended by shock and alarm, particularlywhen from cannon-shot, or when vital parts are injured; secondaryhemorrhage rare. Entrance and exit of balls. Course ofballs. Position. Treatment: cold or iced water; no bandage tobe applied; wax candles. Progress of inflammation. Extractionof balls in flesh wounds; manner of doing it. Dilatation; whenproper. Bayonet wounds; delusion respecting them.] | pp. 25‑39 |
| LECTURE II. |
| [Peculiar phlegmonous inflammation. Erysipelatous inflammation;internal treatment. Erysipelas phlegmonodes, or diffused inflammationof the areolar tissue; treatment by incision; first casetreated in England by incision; caution with respect to thescrotum. Mortification—distinction into idiopathic or constitutionaland that which is local; humid and dry; traumatic.Local mortification from intense heat or cold; wind of a ball;electricity; search for these cases after the battle of Waterloo;case of recovery after amputation; appearances on dissection.Mortification from injury of the great vessels; appearance of theskin. Patient dies when the mortification passes the knee.Points of practice; amputation to be performed below the knee.Wound being on the thigh, amputation not to be done above theknee when the line of separation has formed below it. Woundsof the axillary not so dangerous as wounds of the femoral. Woundsof nerves; complete division of, followed by the loss of sensation,motion, and the power of resisting cold and heat. Cases of SirJames Kempt, of Sir Philip Broke, and Brigade-Major Bissett.Treatment; external and internal remedies.] | pp. 39‑51 |
| LECTURE III. |
| [Necessity for immediate amputation when an extremity is sowounded as to preclude all hope of saving it; degree of dangerattending amputations of the upper and lower extremities; thequestion us to immediate amputation—of the arm, or leg belowthe knee; in the upper half of the thigh. Constitutional alarmof shock from the injury. Illustrative cases by Dr. Beith, Dr.Dane, etc. Advantages of primary over secondary amputations;consequences of secondary amputations. Purulent deposits;cases by Dr. Irwin, Mr. Rose, and Mr. Boutflower; case of purulentdeposit in the thyroid gland; Daniel Lynch’s case. Inflammationof the veins; cases; two varieties of phlebitis—theadhesive and irritative, or unhealthy; symptoms and treatment ofthe unhealthy inflammation. The case of Private A. Clarke; ofJane Strangemore; cases of endemic fever after secondary amputationending in sub acute inflammation of the lungs and effusioninto the chest. Employment of the sulphuric acid lotion in sloughingstumps. Writers on purulent deposits: the author’s claims;opinions of Mr. Henry Lee and Dr. Hughes Bennett. Hemorrhagein sloughing stumps, and its treatment; ligature of theprincipal artery of the limb in such cases, and its failure; hemorrhageafter amputation at the shoulder-joint; sloughing of thestump caused by the bad air of the hospital; hemorrhages fromirritable stumps not unfrequent in crowded hospitals; symptomsand treatment.] | pp. 51‑73 |
| LECTURE IV. |
| [Aphorisms for amputations; necessity for the operation; compressionof the femoral artery as it passes over the edge of the pubes;no necessity for the tourniquet in great amputations; the hemorrhagegreater when a tourniquet is applied; use of the instrumentafter amputation; old mode of performing circular amputations;nicking the periosteum injurious; ligature of wounded vessels;bringing together the integuments; dressing the stump; subsequenttreatment. Amputation at the hip-joint; injuries justifyingthe operation; case of Captain Flack; wound of theprincipal artery, with fracture of the femur, necessitates the operation;in malignant diseases of the femur, the operation affordsthe only chance of success; amputation at the hip-joint not to bedone when the bone can be sawn through immediately below thetrochanter major, and there be sufficient flaps; mode of operating;prior ligature of the femoral artery, by Baron Larrey; not practicedin the British army; directions for operating; ProfessorLangenbeck’s mode; Mr. Brownrigg’s; illustrative engravings;amputation by the circular incision; secondary amputation;number of vessels to be tied in primary and secondary operations;Mr. Luke’s amputation of the thigh by the flap operation;pro][trusionof bone after the operation; exfoliation from badly sawingor splitting the bone, or unduly separating the periosteum. Bulbousenlargement of the divided nerve.] | pp. 73‑89 |
| LECTURE V. |
| [Removal of the head of the femur, dislocated in consequence of strumousdisease, or for fracture of the head or neck of the bone,caused by an external wound; cases most favorable for the operation;anatomical description of the operation; the operation onthe dead body; commencing for the removal of the head of thebone: completing, by amputation of the thigh at the hip-joint,the injuries being such as to require that operation; ligature of agreat artery, close to a large branch, successful; completing theoperation for the removal of the head of the femur; case of removalof the head of the femur; wounds of the knee-joint frommusket-balls, with fracture of the bones, require immediate amputation;secondary amputation does not offer such a chance ofsuccess; compound fractures of the patella without injury to otherbones; the joint involved; lodgment of the ball in the joint; theball penetrating the condyles of the femur; wound of the poplitealartery; cases for amputation; clean incised wounds of theknee-joint; case of Colonel Donnellan; excision of the knee-joint;formerly rarely successful; Mr. Jones, of Jersey, mode of operating;Dr. Gurdon Buck’s case of excision of the knee-joint, foranchylosis, following a gunshot wound; Mr. Jones’s improvementof the operation; amputation of the leg; by the circular incision;the flap operation, as performed by Mr. Luke; amputation atthe tuberosity of the tibia: removal of the head of the fibula;excision of the ankle-joint; removal of the os calcis; Mr. Syme’samputation at the ankle-joint; sloughing of the under flap, andits causes; gunshot wounds of the foot; wounds of the fore partof the foot by cannon-shot, grape-shot, or musket-balls; amputationat the tarsus of the foot, leaving the astragalus and oscalcis; operation for the removal of the astragalus and os calcisby Mr. Wakley, jun.; necessary not to wound the anterior tibialartery; amputation of a single metatarsal bone; M. de Beaufort’sartificial foot.] | pp. 90‑120 |
| LECTURE VI. |
| [Primary amputation of the upper extremity rarely to be practiced formusket-shot wounds, or for injuries of the soft parts; treatmentof slight gunshot wounds of the head of the humerus; a dependingopening for the exit of matter to be made, if not previouslyexisting; the principal points to attend to in such cases; simpleincised wounds of the joint; splintering of the head of the bone,or the passage of a ball through it, requires its being sawn off;cases for amputation of the arm; site of the operation, the headof the bone being uninjured; complete shattering of the arm;][complicated with more or less severe injury of the chest or abdomen;if the latter not likely to cause a speedy dissolution, thenamputation of the arm is to be performed; moderate hemorrhageor expectoration of blood, under such circumstances, not absolutelyfatal; destructive injuries from rebounding or nearly spentround shot, or flat pieces of shell, without external signs of awound; necessity for an immediate operation in such cases;amputation at the shoulder-joint; the fear of hemorrhage passedaway; compression of the subclavian; amputation at the shoulder-jointfor malignant disease of the bone and periosteum; theacromion and coracoid processes should not be exposed, nor is itnecessary to deprive the glenoid cavity of its cartilage; the nervesto be cut short, after the operation has been completed, else theymay cause distressing pain for life; primary amputation at theshoulder-joint a very simple operation; secondary amputationmuch less so; general directions prior to the operation; the operationby two flaps, external and internal; by one, or nearly one,upper flap; Lisfranc’s operation; modification of it by M. Baudens;difficulties of the secondary amputation; amputation ofthe arm immediately below the tuberosities of the humerus; excisionof the head of the humerus; Langenbeck’s operation; thisexcision not easy of execution when the head and neck of thebone are broken from the shaft, nor in secondary operations: notto be practiced in every instance of compound fracture of thepart; cases; injury of the head of the humerus, with much loss ofthe soft parts; giving way of the axillary artery during the treatmentnot a cause for amputation; the vessel to be tied above andbelow the opening, and the subclavian not to be ligatured till allother means have failed; amputation of the arm by the circularincision; cases requiring this operation; Mr. Luke’s operation bytwo flaps; excision of the elbow-joint; injuries of the joint notrequiring this operation; cases in which it is admissible; mode ofoperating; amputation at the elbow-joint recommended, but notoften performed; mode of operating; supposed advantage attendingthe retention of the olecranon; amputation of the forearm;seldom requisite; the flap operation preferable, particularly nearthe wrist; mode of operating; the circular operation in the middleof the forearm; amputation at the wrist; in all injuries of thehand, requiring an operation, the thumb and one or more fingersto be preserved, if possible; treatment of metacarpal bones fracturedby a musket-ball; of injured metacarpal bones, the fingersbeing destroyed; removal of the heads of the metacarpal boneswhen necessary; amputation of the phalanges; Langenbeck’s operationfor excision of the phalangeal joints; excision of the metacarpalbone of the thumb by Langenbeck, the periosteum beingseparated from the bone, and left behind in the wound.] | pp. 120‑141. |
| LECTURE VII. |
| [Secondary amputations not so successful after injuries as afterincurable disease; circumstances under which the operation is][performed in military surgery, and the consequences; secondaryhemorrhage; non-union of the stump; phlebitis and sloughing ofthe stump; depositions of matter in the viscera; in secondaryamputations larger flaps required, or the bone to be cut shorter;directions for sawing the bone; larger number of arteries to betied; torsion of arteries; bleeding from a small branch, cut short,above the ligature; mode of avoiding this; use of the tourniquet;and its inconveniences; in oozing of blood, the wound not to befinally closed for some hours; treatment in cases of non-union;cat-gut or other animal ligatures; hemorrhage from large veinsto be controlled by pressure, not by ligatures; if the bone be toolong, a piece to be sawn off; consequences of not doing so. CompoundFractures: definition of; comminuted; compound fractureof the arm or leg does not necessitate amputation; of thethigh, amputation is requisite; difficulty of treating a gunshotfracture, with extensive splintering of the bone; consequences ofthe splintering; necrosis of the bone, and formation of sequestra;case of Lieut. Timbrell, fracture of both femurs; recovery withoutamputation: lodgment of a ball in, or its passage through, a bone,without splintering; consequences; its removal requisite whenlodged in a bone; mere grazing a bone by a ball; simple transversefracture of a bone by a ball; flattening of a ball; its lodgmentbetween the broken portions of a bone; extensive shatteringof the femur, a case for immediate amputation; gunshot fracturesof head and neck of the femur; excision of the injured portionsof bone-if the upper third, or middle of the bone, amputationnecessary; in fractures of the lower third, not communicatingwith the knee-joint, an attempt is to be made to save the limb;when the femur is splintered, if the limb is to be saved, the principalsplinters to be removed; the necessary incisions often neglected;if the splinters cannot be got at, amputation is requisite;secondary danger from the smaller splinters; a careful examinationto be made for them when suppuration is established, and incisionsmade if requisite for their removal; consequences of theirretention; proper bedsteads for the wounded should form a partof military stores; position of the patient in gunshot fractures ofthe leg or thigh; splints, and their application; gunshot woundsof the leg; limb rarely to be amputated; removal of splinters;position of the limb; Mr. Luke’s the best apparatus for a compoundfracture of the leg; illustrated by wood-engraving; bearersfor wounded men; gunshot wounds of the arm; more probabilityof saving the limb; if an artery ulcerate, it should be tied at eachend; primary amputation in such cases rare; secondary, only formortification, or when the strength gives way; in incisions at alate period, the nerves and arteries to be avoided; splints for thearm. Hospital returns.] | pp. 141‑162 |
| LECTURE VIII. |
| [Hospital Gangrene: its synonyms; may be caused by the use ofcharpie, instruments, bandages, etc., which have been previously][employed on infected parts; is a highly contagious and infectiousdisease; its prevalence at Leyden in 1798; if the disease be mildor chronic, wounds on the arm may continue healthy for somedays after those on the leg are infected, but not so if the gangrenebe acute; Mr. Blackadder’s description of the disease, as it occurredin his own person, from inoculation; M. Delpech attributedits spread in the French army to the misfortunes and sufferings ofthe soldiery; Dr. Tice on the attendant depression, apathy, anddespair; description of the disease in its most virulent and lessdestructive forms; characteristic signs of the disease; the questionas to its constitutional or local origin; character of the fever;opinion of the French surgeons that the disease was of local origin;local and constitutional treatment; use of mineral acids atSantander in 1813; Dr. Boggie on large bleedings in the diseaseat Bilbao; cases of hospital gangrene, with tetanus-bleedingcuring the one, and failing in the other; Dr. Boggie on the treatmentof phagedœna, and of inflammatory gangrene, after disorganisation;the introduction of Fowler’s solution of arsenic, as anescharotic, by Mr. Blackadder; dangers of that practice; Dr.Walker on hospital gangrene at Bilbao: Delpech on phagedœniculcer, and its treatment; attributes the first employment of mineralacids to the British surgeons in Spain, and especially to Mr.Guthrie; Deputy Inspector-General Taylor on hospital gangrenein India; considers it a local disease, to be cured by local treatment;uses nitric acid to the circumference of the ulcer; theburning, gnawing sensation removed by the acid; dirty fungousgrowths from wounds of the hands and forearm. Conclusions:Return of the number of cases in the hospital stations in the Peninsuladuring the last six months of 1813.] | pp. 163‑175 |
| LECTURE IX. |
| [On wounds of arteries, and the means adopted by nature and art forthe suppression of hemorrhage; their structure; ancient threecoats separated into six-1, the epithelial; 2, fenestrated; 8, muscular;4, elastic; 5, elastic and areolar combined; 6, areolar.Nature of epithelium; divided into three kinds—tesselated, cylindrical,and spheroidal. Structure of epithelial (1) and of fenestratedcoat (2); structure of muscular (3) and elastic coat (4);structure of elastic and areolar coats (5 and 6). Chemical composition,protein. Voluntary and involuntary muscular fibers;difference between them. Muscular fibers in arteries involuntary.White inelastic and elastic yellow fibers in outer coat. Blood-vesselsof arteries; nerves of. Production of cells, nuclei, andnucleoli. Cyto-blastema or formative substance. Collateral circulationof two kinds—by direct, large, communicating arteries,and by the capillary vessels, both being incapable of supportinglife in the lower extremity after the receipt of a sudden injury tothe main trunk in the thigh.] | pp. 176‑187 |
| LECTURE X. |
| [Proper treatment of wounded arteries due to the Peninsular war;Hunterian theory inapplicable; opposing theory of Mr. Guthrie;means supposed to be adopted by nature for the suppression ofbleeding from large arteries from the time of Celsus to 1811 disputed;their true nature shown; important distinction drawnbetween the processes adopted with the upper and lower ends ofa divided artery; cases illustrative of the facts stated; applicationof a small ligature; consequent processes; opinions formerlyentertained, erroneous; internal coagulum not absolutely necessary;artery does not always contract up to its next collateralbranch, nor is it necessary; important case in proof; ligaturesshould be small, round, and strong; undue interference to beavoided.] | pp. 187‑208 |
| LECTURE XI. |
| [Appearance of the femoral artery when torn across high up; illustrativecases. A small puncture; illustrative cases. An artery ofthe size of the brachial cut to a fourth of its circumference; whencompletely divided; when wounded at some depth from the surface;course to be pursued; illustrative case. No operation to be doneon a wounded artery unless it bleed; cases: John Wilson, DonBernardino Garcia Alvarez, and Captain Seton.] | pp. 208‑226 |
| LECTURE XII. |
| [Mortification local and dry in the first instance. Case deserving ofgreat attention. Amputation not always to be had recourse to insuch cases; the case of Cook demonstrative on this point. Generaltreatment in such cases. Wounds of the arteries of the leg.Case of H. Vigarelie decisive of the principle and the practice tobe pursued. Remarks on the bleeding from great arteries. Thesurgery of the Peninsular war in advance of the surgery of civillife. Case of suppurating aneurism of the axillary artery; burstingafter ligature of the subclavian; wounds of the radial in thehand.] | pp. 226‑240 |
| LECTURE XIII. |
| [Primitive carotid artery not to be tied for a wound of the externalor internal carotid; danger of doing it. Wounds of the vertebralartery; illustrative cases. Opinion of Velpean. Parisian in advanceof some London surgeons. Wound of internal carotid;case by Dr. Twitchell. Operative process described; case by Dr.Keith.] | pp. 241‑250 |
| LECTURE XIV. |
| [Ligature of the common iliac artery; abdominal hernia; ligature ofthe aorta; of the internal iliac artery; of the external iliac artery—twomethods; in cases of aneurism of the gluteal or sciatic artery,the internal iliac artery should be the vessel secured—in allcases of wounds, the wounded artery itself; Dr. Tripler’s (U. S.army) case of wound of the gluteal artery; unsuccessful ligatureof that artery, followed by ligature of the internal iliac, anddeath; errors in the treatment of this case; ligature of the femoralartery in the groin; compression not to be made upon itwhen the operation is done for aneurism; operation for poplitealaneurism; suppression of urine; constitutional irritation afterthese operations; popliteal artery only to be tied, when woundedand bleeding; case of wound of the popliteal by a heavy mortisingchisel; secondary hemorrhage; unsuccessful ligature of thefemoral; subsequent ligature of the popliteal, followed by cure;ligature of the posterior tibial and peroneal arteries; of the anteriortibial artery; of the plantar arteries.] | pp. 250‑269 |
| LECTURE XV. |
| [Ligature of the common carotid artery: the external; the internal;the arteria innominata; the subclavian, the axillary, the brachial,the ulnar, the radial, and their terminations in the palm of thehand.] | pp. 270‑283 |
| LECTURE XVI. |
| [General remarks. Balls lodged in the brain. Respiration consistsof four movements. Excito-motor system of Dr. Marshall Hall.Concussion of the brain; symptoms of first stage; of secondstage. Treatment: blood-letting in large and small quantities;mercury; blisters on the head, between the shoulders, and on thenape of the neck; refrigerating lotions; ice. Supervention ofmania. Effects of concussion at a later period. Relapses fromirregularities.] | pp. 283‑302 |
| LECTURE XVII. |
| [Compression, meaning of. Brain compressible; motions of thebrain. Symptoms of compression. Paralysis of the oppositeside to the injury; of the same side, and of both. Convulsions.Illustrative cases of paralysis. Fissure or fracture of the skull;treatment. Symptoms in more serious cases. Injury to the middlemeningeal artery; trephine necessary. Fractures on one sideof the skull from blows on the other. Fractures of the base froma fall on the vertex; not always fatal.] | pp. 302‑321 |
| LECTURE XVIII. |
| [Fracture of inner table without injury to the outer, of rare occurrence.Illustrative cases. Subsequent mischief relieved by operationat the end of two years. Peculiar division and fractureof inner table. Principle in surgery on this point. Illustrativecases. Trephine less dangerous at the first than at a later period.Fragments of bone injuring the brain to be removed; proprietyof division of scalp in an adult, to examine the state of thebone beneath. Operation dangerous; illustrative cases. Brainbears pressure best in young persons. Symptoms of concussionare frequently accompanied by those of compression. Contre-coup.] | pp. 321‑340 |
| LECTURE XIX. |
| [Immediate and secondary tumors of the scalp. Suppuration on thedura mater; on the brain; elevation or rising up of the duramater, indicating fluid beneath. Balls penetrating the brain.Sutures separated by musket-balls. Injury of the frontal sinuses;of the orbit and brain. Fungus, or hernia cerebri. Presumedcause of permanent defects. Application of trephine; abuse of.Erysipelas of the scalp.] | pp. 340‑364 |
| LECTURE XX. |
| [Wounds of the chest most dangerous. Incised wounds require atreatment essentially distinct from those made by gunshot. Contusedwounds. Auscultation of primary importance; distinctivesounds learned from it. Symptoms of inflammation. Serous effusionthe most important evil in wounds of the chest. Respiratorymurmur; pleuritic effusion. Symptoms of pneumonia. Pulse.Difficulty of breathing; cough; sputum. Differences of delirium.Rhoncus crepitans. Effects of inflammation of the pleura; thicknessof pleura in or after chronic inflammation. Changes in thelung, subsequent on pneumonia, are principally three.] | pp. 364‑381 |
| LECTURE XXI. |
| [General blood-letting in pleuritis and pneumonia; local bleeding.Internal remedies; tartar emetic; mercury; opium; blisters.Typhoid pneumonia; treatment. Empyema or effusion of fluidsinto the cavity of the chest; symptoms of. State of lung. Auscultation;operation for empyema; place of election. Admissionof air into the chest when in a healthy state harmless; illustrativecases. Pneumothorax, nature of, as ascertained by auscultation.Metallic tinkling; illustrative cases; treatment. Emphysema;nature of; treatment.] | pp. 382‑414 |
| LECTURE XXII. |
| [Simple injuries to the chest from sword or knife; involving thelung; wound not to be probed; to be closed by a continuous suture;patient to lie on the wounded side. Treatment of incisedwounds of greater extent; not to be examined by the probe orfinger; absolute quietude necessary; to relieve the oppression inbreathing; to suppress hemorrhage; closure of the wound; secretionof fluid into the cavity; necessity for a depending opening.Illustrative cases. Ecchymosis, pathognomonic of blood effusedinto the chest. Conclusions, six in number.] | pp. 414‑425 |
| LECTURE XXIII. |
| [Penetrating gunshot wounds of the chest; always dangerous; statisticsof cases after Toulouse, the Three Days in Paris in 1830,and the battles of Waterloo and the Sutlej; appearances of theorifices of entrance and exit; symptoms; balls passing round thechest, but not penetrating the cavity; lodging in the sternum;enlargement of the wound sometimes necessary for the removal offoreign bodies, or of blood; also when the wound is too small toadmit the finger-end in order to ascertain the state of the ribs, etc.;not to be greater than absolutely requisite; pieces of shell, of asword or lance, broken off, and partly lodged in the thorax, or aball sticking firmly between two ribs; to be carefully extracted.Gunshot fracture of a rib; removal of splinters, and of foreignbodies; case; comminuted fracture; wound of costal cartilage;oblique gunshot wound; the ball running round between lung andpleura for some distance; the lung sometimes only slightly bruised,at others distinctly grooved by the ball; a ball fairly passingthrough the lung; condition of the organ; symptoms; effusion ofblood; if the lung previously adherent, the cavity of the chest notopened by the ball, its track only communicating externally; illustrativecases of Generals Sir Lowry Cole, Sir A. Barnard, the Dukeof Richmond, Major-General Broke, Colonel Dumaresq; conditionof the track of the ball; can be detected after death, but not soduring life, as it does not cause any disturbance of the respirationafter recovery has taken place; case of Mrs. M.; wounds of theupper part of the lung more dangerous than those of the lower;danger from effusion where the external wound does not communicatefreely with the chest; necessity for its removal by operation;illustrative cases.] | pp. 426‑442 |
| LECTURE XXIV. |
| [Appearances after death in various instances. Cases of Mr. Drummond,etc. Splinters of bone to be removed. M. Guerin’s case,extensive incision for the extraction of a splinter sticking in the][lung. Balls, or other foreign bodies, loose, or rolling about onthe diaphragm. Illustrative cases. Case of General Sir RobertCrawford. Consequences of traumatic inflammation of the chest;effusion. Presence of a ball or other foreign body rolling on thediaphragm, to be ascertained by means of the stethoscope. M.Baudens on the encysting of balls and splinters of bone; on thewithdrawal of fluids by a syringe. Necessity for an operation forthe removal of balls, etc.; anatomy of the parts concerned; mannerin which the operation should be performed.] | pp. 442‑456 |
| LECTURE XXV. |
| [Hernia of the lung. Wounds of the diaphragm; cases of CaptainPrevost and of others; such wounds never heal; symptoms andtreatment; are often followed by hernia; operation recommendedwhen the hernia is strangulated. Wounds of the heart; anatomicalposition of the heart; theory of the sounds of; endocardial,exocardial sounds: symptoms when the heart is wounded; treatment;Larrey’s operation for opening the pericardium, in casesof hemorrhage from wounds of the heart, or of hydrops pericardii.Skielderup’s operation; case of J. Dierking, with a diagram;the heart insensible to the touch; death from a blow onthat organ; treatment of wounds of; laceration and ruptures ofthe heart.] | pp. 456‑472 |
| LECTURE XXVI. |
| [Wounds of the internal mammary artery; operation proposed byM. Goyraud for ligature of the internal mammary artery, whenwounded; wounds of the intercostal artery; suppression of hemorrhagefrom; case of General Sir G. Walker. Wounds of theneck; two principles of treatment; cases of Captain Hall andGeneral Sir E. Packenham. Wounds of the face; treatment.Wounds of the eyelids; treatment. Wounds of the ball of the eye.Wounds of the nose and ear. Gunshot wounds of the eyeball.Musket-shot lodged behind the eye; may cause ophthalmitis; lossof sight by musket-balls passing across the back of both orbits.Wounds of the first branch of the fifth pair of nerves. Injuries tothe bones of the face; to the bones of the nose. Wounds of thecheek; of the parotid gland and duct. Salivary fistula. Woundsof the lachrymal bones and sac; lachrymal fistula; case of GeneralSir Colin Halkett. Wounds of the lower jaw; treatment; M.Baudens’s cases; case of Colonel Carleton; incised and gunshotwounds of the tongue. Case of Captain Fritz; lodgment of theiron breech of a gun in the forehead; its descent into the mouth,and partial protrusion through the palate. Lodgment of balls inthe forehead, etc.; their descent into the throat or soft or hardpalate. Lodgment of a ball in the maxillary sinus for months andyears.] | pp. 473‑482 |
| LECTURE XXVII. |
| [Structure of an intestine; eight distinct layers. Valvulæ conniventespeculiar to man. Nature of villi: manner of absorption.Mucous membrane of the stomach. Glands of Brunner, Grew, andPeyer. Solitary glands. Muscular coat of the intestine. Woundsof the abdomen affecting its wall or paries. Illustrative cases.Entrance and exit of a ball. Lodgment of a ball in the abdominalparies. Incised wounds of the paries followed by suppuration.Rupture of viscera from a blow. In incised wounds the muscularparts are not reunited; formation of an abdominal hernia; treatment.Admission of atmospheric air a bugbear. Penetratingwounds. Protrusion of omentum; of intestine. Illustrative cases.Treatment of wounded intestine. Large effusions of blood intothe cavity of the abdomen. Travers’s experiments on woundedintestines. Treatment of a divided intestine; by ligature; bycontinuous suture. Ramdohr’s treatment of a completely dividedintestine. Manner of making a continuous suture.] | pp. 482‑508 |
| LECTURE XXVIII. |
| [Treatment of incised wounds of the intestine of small extent; whenlarger; enlargement of the external wound when necessary. Intestineor artery injured to be secured by suture; wound to bereopened. Bleeding from the mesenteric or epigastric artery;effusion of blood into the cavity; to be evacuated by enlargingthe wound, when in quantity; if the effusion be a small one, theblood will coagulate, and be absorbed; suppuration in the abdomena consequence of the non-absorption or non-evacuation ofblood effused to a large amount; illustrative cases; treatment.Wounds of the intestines from musket-balls. Illustrative casesof Captain Smith, Ensign Wright, Mathews, etc. Balls passedper anum. Remarks. Cases of gunshot wounds of the abdomenoccurring during the Crimean campaign.] | pp. 508‑525 |
| LECTURE XXIX. |
| [Abnormal or artificial anus; mode of formation. Valve or septumin the orifice of the lower end of the bowel generally present, butoccasionally wanting. Treatment by compression. Desault’smode of treatment; Dupuytren’s; Mr. Trant’s. Wounds andinjuries of the liver. Cases of General Sir S. Barns, CorporalMacdonald, Lieutenant Hooper, etc. Removal of portions of theliver, the patient surviving. Illustrative cases by Blanchard, Dieffenbach,and Dr. Macpherson. Wounds of the stomach; treatment.Fistulous opening in that viscus. Knife swallowing; the operationof opening the abdomen and stomach for the removal of kniveswhich have thus passed into that organ. Interesting cases.][Wounds and injuries of the spleen; removal of the organ entire orin part. Treatment of incised, punctured, and gunshot wounds ofthe spleen. Wounds of the kidney and ureter. Illustrative cases.Wounds of the spermatic cord and testis; case of medullary sarcomaof the testis and lumbar glands, following a gunshot woundof the testicle; wounds of the penis. Illustrative case.] | pp. 525‑540 |
| LECTURE XXX. |
| [Wounds of the pelvis from musket-balls; fistulous opening in consequence.Paralysis of one or of both limbs, complete or incomplete.Balls lodging in bone should be removed: cases of ColonelWade, Sir Hercules Packenham, Sir John Wilson, John Bryan, SirE. Packenham, etc. Case by La Motte. Captain Campbell’s case.Wounds of the bladder; consecutive accidents; employment ofthe catheter and its permanent use. Treatment of inflammatoryswelling and sloughing; operations when required; illustrativecases. Cases of balls lodging and forming the nucleus of calculi,successfully removed. Wounds of the bladder and rectum; operationfrequently required to save life. Operation in the back forartificial anus. Conclusions.] | pp. 541‑559 |
ADDENDA.
REPORTS FROM THE CRIMEA. |
| [Use of chloroform in the Crimea; case of Martin Kennedy; amputationof finger; death following the exhibition of chloroform.Mr. Hannan’s case of double amputation without chloroform.Effects of chloroform in cases of amputation at the hip-joint or atthe upper third of the thigh; the operations not successful. DeputyInspector-General Taylor on the want of success attendingoperations on the lower extremities in the Crimea, and its causes;his opinion corroborated by Deputy Inspector-General Alexander.Use of chloroform in the Light Division; Alexander’s statistics ofoperations in the Light Division. Five cases of excision of thehead, neck, and trochanter of the femur; four unsuccessful; thethird, Mr. O’Leary’s, doing well at date of report. Staff-SurgeonCrerar’s case; extensive comminuted fracture of neck, trochanter,and shaft of the femur, by a fragment of an exploded grenade;excision of head, neck, trochanter, and part of shaft of the bone;death on the fifteenth day; P.M.:—the muscles infiltrated withpus; no attempt to repair the loss; Dr. Hyde’s case; comminutedfracture of neck of and bone of great trochanter by a grape-shot,during the attack on the Great Redan, on the 8th of September;operation the day after; death on the sixth day. Dr. M’Andrew’s][cases of excision of the head of the humerus; attended with success.Dr. Gordon’s case of fatal wound of the larynx and pharynx,with fracture of the thyroid cartilage; Deputy Inspector-GeneralTaylor’s comments on this case; Surgeon De Lisle’s cases of woundsof the profunda femoris and popliteal arteries; case of loss of theright leg below the knee by a round shot; Dr. Burgess’s case,showing the effects of strychnia in injury of the spine and spinalcord. Dr. Rooke’s case of severe and extensive injury to the righthand and forearm, and the right side of the abdomen, (the bowelsbeing exposed by the destruction of skin, muscles, and peritoneum,)with comminuted fractures of the ilium and neck and trochanterof the femur; recovery at the end of three months. Mr.Lyons’s fatal case of gunshot fracture of the left femur. Dr. Milroy’s,Mr. Atkinson’s, and Dr. Scott’s cases of excision of the elbow-joint;Mr. Atkinson’s case of round shot fracture of the superiormaxillary and the malar bones; recovery. Mr. De Lisle’s case ofmusket-shot wound of the right temple; the supra-orbitar ridgebroken off. Mr. Ward’s, Mr. Wall’s, and Mr. Longmore’s casesof gunshot fracture of the cranium, with or without injury to thebrain.] | pp. 561‑586 |
| REMARKS. |
| [Surgical Commentaries on the preceding Cases: Amputations atthe hip-joint; excision of the head and neck of the femur; theballs used by the Allies and by the Russians; gunshot fracturesof the lower extremities; the utility of the chain saw; the machinesfor moving the wounded soldiers in bed; the apparatus forslinging a broken leg; excision of the knee-joint; of the head ofthe humerus; of the elbow-joint; the head of the humerus to beretained in the socket, when practicable; wounds penetrating thechest and abdomen; future reports for the Addenda desired.] | pp. 586‑590 |
|
| [Index.] | pp. 591‑608 |
|
| [Index of Cases.] | pp. 608‑614 |
|
| [Medical Works] | pp. 615‑624 |