The principles and practice of modern surgery

by Roswell Park

	PAGE
INTRODUCTION	[17]
PART I.
SURGICAL PATHOLOGY.
CHAPTER I.
HYPEREMIA: ITS CONSEQUENCES AND TREATMENT	[19]
CHAPTER II.
SURGICAL PATHOLOGY OF THE BLOOD	[28]
CHAPTER III.
INFLAMMATION	[43]
CHAPTER IV.
ULCER AND ULCERATION	[65]
CHAPTER V.
GANGRENE	[73]
PART II.
SURGICAL DISEASES.
CHAPTER VI.
AUTO-INFECTION, ESPECIALLY IN SURGICAL PATIENTS	[79]
CHAPTER VII.
THE SURGICAL FEVERS AND SEPTIC INFECTIONS	[85]
CHAPTER VIII.
SURGICAL DISEASES COMMON TO MAN AND DOMESTIC ANIMALS	[97]
CHAPTER IX.
SURGICAL DISEASES COMMON TO MAN AND DOMESTIC ANIMALS(Continued)	[111]
CHAPTER X.
SYPHILIS.	[122]
CHAPTER XI.
CHANCROID OR VENEREAL ULCER	[144]
CHAPTER XII.
GONORRHEA	[146]
CHAPTER XIII.
SCURVY AND RICKETS	[160]
CHAPTER XIV.
THE STATUS LYMPHATICUS	[163]
CHAPTER XV.
SURGICAL ASPECTS AND SEQUELS OF OTHER INFECTIONS AND DISEASES	[166]
CHAPTER XVI.
POISONING BY ANIMALS AND PLANTS	[171]
CHAPTER XVII.
ACUTE INTOXICATIONS, INCLUDING DELIRIUM TREMENS	[174]
PART III.
SURGICAL PRINCIPLES, METHODS AND MINOR PROCEDURES.
CHAPTER XVIII.
DISTURBANCES OF BLOOD-PRESSURE; SHOCK AND COLLAPSE	[177]
CHAPTER XIX.
ABSTRACTION OF BLOOD; COUNTERIRRITATION; PARACENTESIS; TRANSFUSION; CATHETERIZATION;SKIN GRAFTING; BANDAGING	[182]
CHAPTER XX.
ANESTHESIA AND ANESTHETICS, GENERAL AND LOCAL	[192]
PART IV.
INJURY AND REPAIR.
CHAPTER XXI.
WOUNDS AND THEIR REPAIR	[211]
CHAPTER XXII.
GUNSHOT WOUNDS	[220]
CHAPTER XXIII.
PREVENTION AND CONTROL OF HEMORRHAGES; SUTURES; KNOTS	[234]
CHAPTER XXIV.
ASEPSIS AND ANTISEPSIS; TREATMENT OF WOUNDS	[243]
CHAPTER XXV.
PREPARATION OF PATIENTS FOR OPERATION AND THEIR AFTER-TREATMENT	[250]
PART V.
SURGICAL AFFECTIONS OF THE TISSUES AND TISSUE SYSTEMS.
CHAPTER XXVI.
CYSTS AND TUMORS	[255]
CHAPTER XXVII.
THE SKIN	[299]
CHAPTER XXVIII.
SURGICAL DISEASES OF THE FASCIÆ; APONEUROSES;TENDONS AND TENDON SHEATHS; MUSCLES AND BURSÆ	[319]
CHAPTER XXIX.
SURGICAL DISEASES OF THE HEART AND VASCULAR SYSTEM	[334]
CHAPTER XXX.
INJURIES AND DISEASES OF THE LYMPH VESSELS AND NODES	[368]
CHAPTER XXXI.
SURGICAL DISEASES OF THE JOINTS AND JOINT STRUCTURES	[379]
CHAPTER XXXII.
SURGICAL DISEASES OF THE OSSEOUS SYSTEM	[416]
CHAPTER XXXIII.
DEFORMITIES DUE TO CONGENITAL DEFECTS OR ACQUIREDDISEASES OF THE LOCOMOTOR APPARATUS; ORTHOPEDICS	[444]
CHAPTER XXXIV.
FRACTURES	[479]
CHAPTER XXXV.
DISLOCATIONS	[524]
PART VI.
SPECIAL OR REGIONAL SURGERY.
CHAPTER XXXVI.
INJURIES AND SURGICAL DISEASES OF THE HEAD	[545]
CHAPTER XXXVII.
THE ORBIT AND ITS ADNEXA; THE EXTERNAL AUDITORY APPARATUS; THE ACCESSORY SINUSES;THE CRANIAL AND CERVICAL NERVES; THE ORBITAL CONTENTS AND ADNEXA	[592]
CHAPTER XXXVIII.
THE SPINE, THE SPINAL CORD AND THE PERIPHERAL NERVES	[621]
CHAPTER XXXIX.
THE FACE AND EXTERIOR OF THE NOSE AND MOUTH	[638]
CHAPTER XL.
THE MOUTH, THE TONGUE, THE TEETH AND THE JAWS	[652]
CHAPTER XLI.
THE RESPIRATORY PASSAGES PROPER	[671]
CHAPTER XLII.
THE NECK	[698]
CHAPTER XLIII.
THE THORAX AND ITS CONTENTS	[718]
CHAPTER XLIV.
THE BREAST	[755]
CHAPTER XLV.
THE ABDOMEN AND ABDOMINAL VISCERA	[767]
CHAPTER XLVI.
THE PERITONEUM AND ITS DISEASES	[785]
CHAPTER XLVII.
INJURIES AND SURGICAL DISEASES OF THE STOMACH	[793]
CHAPTER XLVIII.
THE SMALL INTESTINES	[822]
CHAPTER XLIX.
THE APPENDIX AND ITS DISEASES	[851]
CHAPTER L.
THE LARGE INTESTINES AND THE RECTUM	[869]
CHAPTER LI.
HERNIA	[890]
CHAPTER LII.
THE LIVER	[910]
CHAPTER LIII.
THE OMENTUM, THE MESENTERY, THE SPLEEN AND THE PANCREAS	[934]
CHAPTER LIV.
THE KIDNEYS	[955]
CHAPTER LV.
THE BLADDER AND PROSTATE	[977]
CHAPTER LVI.
THE MALE GENITAL ORGANS	[1004]
CHAPTER LVII.
AMPUTATIONS	[1023]

GENERAL SURGERY.

INTRODUCTION.

An ultimate analysis of the primary causes of disease, excluding traumatisms, will permit their reduction to one or the other of the following categories: nutritional (functional) and parasitic. These may co-exist, in which case each tends to modify the other more or less, usually unpleasantly, or either may precede and perhaps pave the way for the other. In general, it may be said that parasitism perverts nutrition, locally or generally, and, per contra, that perverted nutrition often prepares the way for parasitic infection, so that even between these primary causes there may occur all possible combinations.

With traumatisms surgery alone is mainly concerned, but its conceded scope is now widened to include an ever-increasing number of morbid conditions, which, in time past, were treated medicinally—or not at all. Thus it has come to pass that it is no longer possible to make an abrupt distinction between medicine and surgery, nor even briefly to define the words “surgery” and “surgeon,” nor yet to ascribe to either the physician or the surgeon his exact functions as such. In centuries past physicians were exceedingly jealous of their vested rights, and with propriety, when the only surgeons were uneducated barbers. But about one hundred years ago conditions were materially altered for the better, and surgery, liberated from its medieval environment, and from the restrictions imposed by the clergy, rapidly developed into both a science and an art, while the surgeon came to take that position in society to which his increasing attainments entitled him. During the past thirty years surgery, thanks to earnest workers in the surgical laboratories of the world, has made progress scarcely equalled by the science of electricity, and the impossibilities of yesterday have become the routine of today.

Thus has come about the earlier separation, and now, in some respects at least, the closer appreciation of the respective scope and functions of the physician and the surgeon. Between them lies yet what has been felicitously called the “borderland,” where they meet on common ground, too often as rivals and not often enough as co-workers. Nowhere do comprehensive knowledge, wide experience, and trained judgment appear to better advantage, nor lead to better results, than when exhibited where co-operation in these respects is most hearty. Someone has most happily said that “the surgeon is a physician who knows how to use his hands,” yet to regard a course in surgery as one in manual training would be a most lamentable conception of its purposes. Rather is it to be regarded as a superstructure, to be built upon a thorough familiarity with anatomy, physiology, pathology, and therapeutics. In fact, the better general practitioner a man is, the better surgeon may he thereby become, providing he possess the other necessary attributes. John Hunter took this view, but too many since his day have forgotten or never realized it.

In the pages which follow it has been impossible to do more than epitomize our present-day knowledge of surgery, an early disavowal which is intended to save too frequent repetition of the advice to consult, as needed, other larger and more specialized works. The attempt here has been rather to build up a framework upon which the student and the investigator may build with such other material as they may later select from the quarries which are accessible to them. Hence it has been impossible to describe or even mention all the operations which have been devised to meet various indications. Preference has therefore been given to those which have best served the author in his personal experience.

Because of the numerous interrelations between surgery and internal medicine, so called, I have not hesitated to insert paragraphs and even whole chapters on subjects hitherto omitted from the later works on surgery. To teach a student how to recognize nasopharyngeal adenoids, to appreciate the widespread harm they may cause and how to cope with them, and at the same time to leave him quite unfamiliar with their too frequent relation to the status lymphaticus and its dangers, and to omit in such a work all reference to the latter, is to put knowledge and instruments into his possession without teaching him how rightly to employ them. A case of exophthalmic goitre affords another equally apt illustration, as being one in which the physician and the surgeon should heartily co-operate.

The surgeon and the physician have drifted too far apart. It is time that they met again in the presence of the pathologist. Such a group, when properly constituted, forms an almost invincible triumvirate.

It has been said that “the resources of surgery are rarely successful when practised on the dying.” Throughout these pages the attempt has been made to impress the fact that delay, in many of the borderland cases, is dangerous, and, often fatal, and that it is not just to charge to surgery the blame for such a result due to the physician’s dilatoriness.