Manual of Surgery Volume First: - General Surgery. Sixth Edition.

Alexis Thomson, Alexander Miles

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Project Gutenberg's Manual of Surgery, by Alexis Thomson and Alexander Miles

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Title: Manual of Surgery  Volume First: General Surgery. Sixth Edition.

Author: Alexis Thomson and Alexander Miles

Release Date: March 4, 2006 [EBook #17921]

Language: English

Character set encoding: ISO-8859-1

*** START OF THIS PROJECT GUTENBERG EBOOK MANUAL OF SURGERY ***

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OXFORD MEDICAL PUBLICATIONS

MANUAL OF SURGERY

BY

ALEXIS THOMSON, F.R.C.S.E D .

PROFESSOR OF SURGERY, UNIVERSITY

OF EDINBURGH

SURGEON EDINBURGH ROYAL INFIRMARY

AND

ALEXANDER MILES, F.R.C.S.E D .

SURGEON EDINBURGH ROYAL INFIRMARY

VOLUME FIRST GENERAL SURGERY

SIXTH EDITION REVISED WITH 169 ILLUSTRATIONS

L O HENRY FROWDE AND HODDER & STOUGHTON THELANCETBUILDING 1 & 2 BEDFORD STREET, STRAND, W.C.2

First Edition Second Edition Third Edition Fourth Edition " " Second Impression Fifth Edition " " Second Impression Sixth Edition

1904 1907 1909 1911 1913 1915 1919 1921

P RINTEDIN G REAT B RITAINBY M O RRISO NAND G IBB L TD ., E DINBURG H

PREFACE TO SIXTH EDITION

N

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

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D

O

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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 o nOperative 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 theManualappears 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 colleagu es 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.

E DINBURG H , March1921.

R EPAIR

CONTENTS

CHAPTER I

CHAPTER II C O NDITIO NSWHICHINTERFEREWITH R EPAIR

I NFLAMMATIO N

S UPPURATIO N

U LCERATIO NAND U LCERS

CHAPTER III

CHAPTER IV

CHAPTER V

PAG E

1

17

31

45

68

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G ANG RENE

CHAPTER VI

CHAPTER VII B ACTERIALANDO THER W O UND I NFECTIO NS

T UBERCULO SIS

S YPHILIS

T UMO URS

I NJURIES

CHAPTER VIII

CHAPTER IX

CHAPTER X

CHAPTER XI

CHAPTER XII M ETHO DSO F W O UND T REATMENT

CHAPTER XIII C O NSTITUTIO NAL E FFECTSO F I NJURIES

T HE B LO O D V ESSELS

CHAPTER XIV

CHAPTER XV T HE L YMPH V ESSELSAND G LANDS

T HE N ERVES

CHAPTER XVI

CHAPTER XVII S KINAND S UBCUTANEO US T ISSUES

CHAPTER XVIII T HE M USCLES , T ENDO NS , AND T ENDO N S HEATHS

T HE B URSÆ

D ISEASESO F B O NE

D ISEASESO F J O INTS INDEX

CHAPTER XIX

CHAPTER XX

CHAPTER XXI

86

107

133

146

181

218

241

249

258

321

342

376

405

426

434

501 547

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LIST OF ILLUSTRATIONS

FIG . PAG E 1.Ulcer of Back of Hand grafted from Abdominal Wall15 2.Staphylococcus aureus in Pus from case of Osteomyelitis25 3.Streptococci in Pus from case of Diffuse Cellulitis26 4.Bacillus coli communis in Pus from Abdominal Abscess27 5.Fraenkel's Pneumococci in Pus from Empyema following Pneumonia28 6.Passive Hyperæmia of Hand and Forearm induced by Bier's Bandage37 7.Passive Hyperæmia of Finger induced by Klapp's Suction Bell38 8.Passive Hyperæmia induced by Klapp's Suction Bell for Inflammation of Inguinal Gland39 9.Diagram of various forms of Whitlow56 10.Charts of Acute Sapræmia61 11.Chart of Hectic Fever62 12.Chart of Septicæmia followed by Pyæmia63 13.Chart of Pyæmia following on Acute Osteomyelitis65 14.Leg Ulcers associated with Varicose Veins71 15.Perforating Ulcers of Sole of Foot74 16.Bazin's Disease in a girl æt. 1675 17.Syphilitic Ulcers in region of Knee76 18.Callous Ulcer showing thickened edges78 19.Tibia and Fibula, showing changes due to Chronic Ulcer of Leg80 20.Senile Gangrene of the Foot89 21.Embolic Gangrene of Hand and Arm92 22.Gangrene of Terminal Phalanx of Index-Finger100 23.Cancrum Oris103 24.Acute Bed Sores over right Buttock104 25.Chart of Erysipelas occurring in a wound108 26.Bacillus of Tetanus113 27.Bacillus of Anthrax120 28.Malignant Pustule third day after infection122 29.Malignant Pustule fourteen days after infection122 30.Colony of Actinomyces126 31.Actinomycosis of Maxilla128

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32.Mycetoma, or Madura Foot 33.Tubercle bacilli 34.Tuberculous Abscess in Lumbar Region 35.Tuberculous Sinus injected through its opening in the Forearm with Bismuth Paste 36.Spirochæte pallida 37.Spirochæta refrigerans from scraping of Vagina 38.Primary Lesion on Thumb, with Secondary Eruption on Forearm 39.Syphilitic Rupia 40.Ulcerating Gumma of Lips 41.Ulceration in inherited Syphilis 42.Tertiary Syphilitic Ulceration in region of Knee and on both Thumbs 43.Facies of Inherited Syphilis 44.Facies of Inherited Syphilis 45.Subcutaneous Lipoma 46.Pedunculated Lipoma of Buttock 47.Diffuse Lipomatosis of Neck 48.Zanthoma of Hands 49.Zanthoma of Buttock 50.Chondroma growing from Infra-Spinous Fossa of Scapula 51.Chondroma of Metacarpal Bone of Thumb 52.Cancellous Osteoma of Lower End of Femur 53.Myeloma of Shaft of Humerus 54.Fibro-myoma of Uterus 55.Recurrent Sarcoma of Sciatic Nerve 56.Sarcoma of Arm fungating 57.Carcinoma of Breast 58.Epithelioma of Lip 59.Dermoid Cyst of Ovary 60.Carpal Ganglion in a woman æt. 25 61.Ganglion on lateral aspect of Knee 62.Radiogram showing pellets embedded in Arm 63.Cicatricial Contraction following Severe Burn 64.Genealogical Tree of Hæmophilic Family 65.Radiogram showing calcareous degeneration of Arteries 66.Varicose Vein with Thrombosis 67.Extensive Varix of Internal Saphena System on Left Leg 68.Mixed Nævus of Nose

130 134 141

144 147 148

154 159 169 170

171 174 175 185 186 187 188 189

190 190 192 195 196 198 199 206 209 213 215 216 228 236 278

284 289

291 296

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69.Cirsoid Aneurysm of Forehead 70.Cirsoid Aneurysm of Orbit and Face 71.Radiogram of Aneurysm of Aorta 72.Sacculated Aneurysm of Abdominal Aorta 73.Radiogram of Innominate Aneurysm after Treatment by Moore-Corradi method 74.Thoracic Aneurysm threatening to rupture 75.Innominate Aneurysm in a woman 76.Congenital Cystic Tumour or Hygroma of Axilla 77.Tuberculous Cervical Gland with Abscess formation 78.Mass of Tuberculous Glands removed from Axilla 79.Tuberculous Axillary Glands 80.Chronic Hodgkin's Disease in boy æt. 11 81.Lymphadenoma in a woman æt. 44 82.Lympho Sarcoma removed from Groin 83.Cancerous Glands in Neck, secondary to Epithelioma of Lip 84.Stump Neuromas of Sciatic Nerve 85.Stump Neuromas, showing changes at ends of divided Nerves 86.Diffuse Enlargement of Nerves in generalised Neuro-Fibromatosis 87.Plexiform Neuroma of small Sciatic Nerve 88.Multiple Neuro-Fibromas of Skin (Molluscum fibrosum) 89.Elephantiasis Neuromatosa in a woman æt. 28 90.Drop-Wrist following Fracture of Shaft of Humerus 91.To illustrate the Loss of Sensation produced by Division of the Median Nerve 92.To illustrate Loss of Sensation produced by Complete Division of Ulnar Nerve 93.Callosities and Corns on Sole of Foot 94.Ulcerated Chilblains on Fingers 95.Carbuncle on Back of Neck 96.Tuberculous Elephantiasis 97.Elephantiasis in a woman æt. 45 98.Elephantiasis of Penis and Scrotum 99.Multiple Sebaceous Cysts or Wens 100.Sebaceous Horn growing from Auricle 101.Paraffin Epithelioma 102.Rodent Cancer of Inner Canthus 103.Rodent Cancer with destruction of contents of Orbit 104.Diffuse Melanotic Cancer of Lymphatics of Skin

299 300 303 304

309 313 315 328 331 333 335 337 338 339

341 345

354

356 357

358 359 365

367

368 377 378 381 383 387 388 390 392 394 395 396 398

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105.Melanotic Cancer of Forehead with Metastasis in Lymph Glands 106.Recurrent Keloid 107.Subungual Exostosis 108.Avulsion of Tendon 109.Volkmann's Ischæmic Contracture 110.Ossification in Tendon of Ilio-psoas Muscle 111.Radiogram of Calcification and Ossification in Biceps and Triceps 112.Ossification in Muscles of Trunk in generalised Ossifying Myositis 113.Hydrops of Prepatellar Bursa 114.Section through Gouty Bursa 115.Tuberculous Disease of Sub-Deltoid Bursa 116.Great Enlargement of the Ischial Bursa 117.Gouty Disease of Bursæ 118.Shaft of the Femur after Acute Osteomyelitis 119.Femur and Tibia showing results of Acute Osteomyelitis 120.Segment of Tibia resected for Brodie's Abscess 121.Radiogram of Brodie's Abscess in Lower End of Tibia 122.Sequestrum of Femur after Amputation 123.New Periosteal Bone on Surface of Femur from Amputation Stump 124.Tuberculous Osteomyelitis of Os Magnum 125.Tuberculous Disease of Tibia 126.Diffuse Tuberculous Osteomyelitis of Right Tibia 127.Advanced Tuberculous Disease in Region of Ankle 128.Tuberculous Dactylitis 129.Shortening of Middle Finger of Adult, the result of Tuberculous Dactylitis in Childhood 130.Syphilitic Disease of Skull 131.Syphilitic Hyperostosis and Sclerosis of Tibia 132.Sabre-blade Deformity of Tibia 133.Skeleton of Rickety Dwarf 134.Changes in the Skull resulting from Ostitis Deformans 135.Cadaver, illustrating the alterations in the Lower Limbs resulting from Ostitis Deformans 136.Osteomyelitis Fibrosa affecting Femora 137.Radiogram of Upper End of Femur in Osteomyelitis Fibrosa 138.Radiogram of Right Knee showing Multiple

399 401 403 410 414 417

418

419 427 428 429 431 432 444

445 449

451 453

454 456 457 458 459 460

461 463 464 467 470

474

475 476

478

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Exostoses 139.Multiple Exostoses of Limbs 140.Multiple Cartilaginous Exostoses 141.Multiple Cartilaginous Exostoses

142.Multiple Chondromas of Phalanges and Metacarpals

143.Skiagram of Multiple Chondromas 144.Multiple Chondromas in Hand 145.Radiogram of Myeloma of Humerus 146.Periosteal Sarcoma of Femur 147.Periosteal Sarcoma of Humerus 148.Chondro-Sarcoma of Scapula 149.Central Sarcoma of Femur invading Knee Joint 150.Osseous Shell of Osteo-Sarcoma of Femur 151.Radiogram of Osteo-Sarcoma of Femur 152.Radiogram of Chondro-Sarcoma of Humerus 153.Epitheliomatus Ulcer of Leg invading Tibia 154.Osseous Ankylosis of Femur and Tibia 155.Osseous Ankylosis of Knee 156.Caseating focus in Upper End of Fibula 157.Arthritis Deformans of Elbow 158.Arthritis Deformans of Knee 159.Hypertrophied Fringes of Synovial Membrane of Knee 160.Arthritis Deformans of Hands 161.Arthritis Deformans of several Joints 162.Bones of Knee in Charcot's Disease 163.Charcot's Disease of Left Knee 164.Charcot's Disease of both Ankles: front view 165.Charcot's Disease of both Ankles: back view 166.Radiogram of Multiple Loose Bodies in Knee-joint 167.Loose Body from Knee-joint 168.Multiple partially ossified Chondromas of Synovial Membrane from Shoulder-joint

169.Multiple Cartilaginous Loose Bodies from Knee-joint

MANUAL OF SURGERY

482 483 484 486 488 489 490 492 493 493 494 495 495 496 497 499 503 504 513 525 526 527 529 530 533 534 535 536 540 541 542 543

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CHAPTER I REPAIR

Introduction—Process of repair—Healing by primary union —Granulation tissue—Cicatricial tissue—Modifications of process of repair—Repair in individual tissues—Transplantation or grafting of tissues—Conditions—Sources of grafts—Grafting of individual tissues —Methods.

I NTRODUCTION

To prolong human life and to alleviate suffering are the ultimate objects of scientific medicine. The two great branches of the healing art—Medicine and Surgery—are so intimately related that it is impossible to draw a hard-and-fast line between them, but for convenience Surgery may be defined as “the art of treating lesions and malformations of the human body by manual operations, mediate and immediate.” To apply his art intelligently and successfully, it is essential that the surgeon should be conversant not only with the normal anatomy and physiology of the body and with the var ious pathological conditions to which it is liable, but also with the nature of the process by which repair of injured or diseased tissues is effected. Without this knowledge he is unable to recognise such deviations from the normal as result from mal- development, injury, or disease, or rationally to direct his efforts towards the correction or removal of these.

P ROCESSOF R EPAIR

The process of repair in living tissue depends upon an inherent power possessed by vital cells of reacting to the irritation caused by injury or disease. The cells of the damaged tissues, under the influence of this irritation, undergo certain proliferative changes, which are designed to restore the normal structure and configuration of the part. The process by which this restoration is effected is essentially the same in all tissues, but the extent to which different tissues can carry the recuperative process varies. Simple structures, such as skin, cartilage, bone, periosteum, and tendon, for example, have a high power of regeneration, and in them the reparative process may result in almost perfect restitution to the normal. More complex structures, on the other hand, such as secreting glands, muscle, and the tissues of the central nervous system, are but imperfectly restored, simple cicatricial connective tissue taking the place of what has been lost or destroyed. Any given tissue can be replaced only by tissue of a similar kind, and in a damaged part each element takes its share in the reparative process by producing new material which approximates more or less closely to the normal according to the recuper ative capacity of the particular tissue. The normal process of repair may be interfered with by various extraneous agencies, the most important of which are infection by disease- producing micro-organisms, the presence of foreign substances, undue movement of the affected part, and improper applications and dressings. The effect of these agencies is to delay repair or to prevent the individual tissues carrying the process to the furthest degree of which they are capable.

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