{"1": {"fulltext": "ssmSsms\\nIms m\\nWfflm", "height": "3591", "width": "2317", "jp2-path": "essentialsofsur00mart_0001.jp2"}, "2": {"fulltext": "Glass.\\nBook.\\nCOPYRIGHT DEPOSIT", "height": "3504", "width": "2326", "jp2-path": "essentialsofsur00mart_0002.jp2"}, "3": {"fulltext": "", "height": "3504", "width": "2326", "jp2-path": "essentialsofsur00mart_0003.jp2"}, "4": {"fulltext": "", "height": "3504", "width": "2326", "jp2-path": "essentialsofsur00mart_0004.jp2"}, "5": {"fulltext": "Saunders New Series of Manuals.\\nPHYSIOLOGY. By Joseph Howard Raymond, A. M., M. D., Professor\\nof Physiology and Hygiene and Lecturer on Gynecology in the Long\\nIsland College Hospital, etc. Price, $1.25 net.\\nSURGERY, General and Operative. By J. Chalmers DaCosta, M. D.,\\nClinical Professor of Surgery, Jefferson Medical College, Philadelphia;\\nSurgeon to the Philadelphia Hospital. New edition, thoroughly revised\\nand greatly enlarged. Handsome octavo volume of 900 pages, with 386\\nillustrations. Cloth, $4.00 net Sheep or Half Morocco, $5.00 net.\\nDOSE-BOOK AND MANUAL OF PRESCRIPTION-WRITING.\\nBy E. Q. Thornton, M. D., Demonstrator of Therapeutics, Jefferson\\nMedical College, Philadelphia. Price, #1.25 net.\\nMEDICAL JURISPRUDENCE. By Henry C. Chapman, M. D., Pro-\\nfessor of Institutes of Medicine and Medical Jurisprudence in the Jefferson\\nMedical College of Philadelphia, etc. Price, $1.50 net.\\nSURGICAL ASEPSIS. By Carl Beck, M. D., Surgeon to St. Mark s\\nHospital and to the German Poliklinik Instructor in Surgery, New York\\nPost-Graduate Medical School, etc. Price, $1.25 net.\\nMANUAL OF ANATOMY. By Irving S. Haynes, M.D., Adjunct\\nProfessor of Anatomy and Demonstrator of Anatomy, Medical Department\\nof the New York University, etc. (Double numbev.) Price, $2.50 net.\\nSYPHILIS AND THE VENEREAL DISEASES. By James\\nNevins Hyde, M. D., Professor of Skin and Venereal Diseases, and\\nFrank H. Montgomery, M. D., Lecturer on Dermatology and Genito-\\nurinary Diseases, in Rush Medical College, Chicago. (Double number.)\\nPrice, $2.50 net.\\nPRACTICE OF MEDICINE. By George Roe Lockwood, M. D.,\\nProfessor of Practice in the Woman s Medical College of the New York\\nInfirmary, etc. (Double number.) Price, $2.50 net.\\n)BSTETRICv,. By W. A. Newman Dorland, M.D., Assistant Obstet-\\nrician to the Hospital of the University of Pennsylvania, etc. (Double\\nnumber.) Price, #2.50 net.\\nISEASES OF WOMEN. By J. Bland Sutton, F. R. C. S., Assistant\\nSurgeon to the Middlesex Hospital, and Surgeon to the Chelsea Hospital\\nfor Women, London and Arthur E. Giles, M. D., B. Sc. Lond.,\\nF. R. C. S. Edin., Assistant Surgeon to the Chelsea Hospital for Women,\\nLondon. (Double number.) Price, $2.50 net.\\nVOLUMES IN PREPARATION.\\nNERVOUS DISEASES. By Charles W. Burr, M. D., Clinical Pro-\\nfessor of Nervous Diseases, Medico-Chirurgical College, Philadelphia, etc.\\nThere will be published in the same series, at short intervals, carefully-prepared\\nwfyrk e on various subjects, by prominent specialists.", "height": "3504", "width": "2326", "jp2-path": "essentialsofsur00mart_0005.jp2"}, "6": {"fulltext": "", "height": "3504", "width": "2326", "jp2-path": "essentialsofsur00mart_0006.jp2"}, "7": {"fulltext": "ESSENTIALS\\nOF\\nSURGERY.", "height": "3504", "width": "2326", "jp2-path": "essentialsofsur00mart_0007.jp2"}, "8": {"fulltext": "Since the issue of the first volume of the\\nSaunders Question=Compends,\\nOVER 175,000 COPIES\\nof these unrivalled publications have been sold.\\nThis enormous sale is indisputable evidence\\nof the value of these self-helps to students\\nand physicians.", "height": "3504", "width": "2326", "jp2-path": "essentialsofsur00mart_0008.jp2"}, "9": {"fulltext": "SAUNDERS QUESTION-COMPENDS. No. 2.\\nESSENTIALS OF SURGERY,\\nTOGETHER WITH A\\nFULL DESCRIPTION OF THE HANDKERCHIEF\\nAND ROLLER BANDAGE.\\nARRANGED IN THE FORM OF\\nQUESTIONS AND ANSWERS\\nPREPARED ESPECIALLY FOR\\nSTUDENTS OF MEDICINE.\\nBY\\nEDWARD MARTIN, A.M., M.D.,\\nCLINICAL PROFESSOR OF GENITO-URINARY DISEASES IN THE UNIVERSITY\\nOF PENNSYLVANIA.\\nILLUSTRATED.\\nSeventh Edition, Revised and Enlarged\\nWITH AN APPENDIX\\nCONTAINING\\nFULL DIRECTIONS AND PRESCRIPTIONS FOR THE PREPARATION OF\\nTHE VARIOUS MATERIALS USED IN ANTISEPTIC SURGERY.\\nALSO SEVERAL HUNDRED RECEIPTS COVERING THE MEDICAL\\nTREATMENT OF SURGICAL AFFECTIONS.\\nPHILADELPHIA\\nW. B. SAUNDERS,\\n925 Walnut Street.\\n1900.", "height": "3504", "width": "2326", "jp2-path": "essentialsofsur00mart_0009.jp2"}, "10": {"fulltext": "TWO COPIES RECEIVED,\\nlibrary of Con^ret%\\nOffice of tho\\nMA 1 2 9 1900\\nKegttUr if Copyright*\\n570.35\\nCopyright, 1900, by\\nW, B. SAUNDERS,\\nS\u00c2\u00a3OOND GQPt,\\nPress of\\nW. B. Saunders, Philadelphia.", "height": "3504", "width": "2326", "jp2-path": "essentialsofsur00mart_0010.jp2"}, "11": {"fulltext": "PREFACE TO THE SEVENTH EDITION.\\nThe fact that new editions of this little book continue to\\nbe called for from time to time justifies the author in feeling\\nthat his efforts to provide the student with a satisfactory\\ngroundwork for the study of surgery have not been altogether\\nin vain.\\nHe has taken pleasure, therefore, in subjecting the volume\\nto a careful and thorough revision, in order that it might\\nrepresent, as fully as is possible in a work of the kind, the\\npresent status of surgical theory and practice.\\nNumerous changes and additions have been made through-\\nout the text and it seemed advisable to add a section on the\\nmodern treatment of appendicitis.\\nIX", "height": "3504", "width": "2326", "jp2-path": "essentialsofsur00mart_0011.jp2"}, "12": {"fulltext": "", "height": "3504", "width": "2326", "jp2-path": "essentialsofsur00mart_0012.jp2"}, "13": {"fulltext": "PREFACE TO FIRST EDITION.\\nAs one thrown yearly in contact with large numbers of\\nmedical students, and familiar with the furious rate at which\\nthey are driven, the writer feels assured that, under our\\npresent system of rapid education, outline works are of dis-\\ntinct value. Third year men who attend six lectures and\\ntwo clinics daily have no time for reading, no time for sys-\\ntematizing their knowledge on any one subject. This work\\nmust either be done for them, or left undone. The author\\nhas carefully gone over the subject of Surgery, and has en-\\ndeavored to emphasize the essential points as a framework\\nupon which more detailed knowledge may be hung. Agnew,\\nAshhurst, Gross, Walsham, Tillmann, Kbnig, Treves, Weir,\\nSmith, Gerster, and many others have been freely consulted.\\nThe table of Urinary Calculi is taken direct from Moullin s\\narticle in Treves s manual. The classification of Venereal\\nDiseases follows that of White (University of Pennsylvania).\\nTo Mr. W. M. Alrich and Mr. Daniel Webster thanks are\\ndue for their valuable assistance.\\nThe author has made an earnest effort to be accurate,\\nconcise, and modern.\\nE. M.", "height": "3504", "width": "2326", "jp2-path": "essentialsofsur00mart_0013.jp2"}, "14": {"fulltext": "", "height": "3504", "width": "2326", "jp2-path": "essentialsofsur00mart_0014.jp2"}, "15": {"fulltext": "CONTENTS.\\nPAOB\\nInflammation 17\\nAbscess 27\\nUlceration 31\\nMortification u 38\\nWounds 44\\nThe germ theory of 44\\nShock r -45\\nWound fever l 47\\nErysipelas 50\\nTetanus 52\\nHydrophobia 54\\nGlanders .55\\nMalignant pustule 55\\nThe healing of wounds 56\\nThe treatment of wounds 57\\nWounds of arteries 73\\nWounds of nerves 75\\nHead injuries 76\\nInjuries of the meninges and brain 81\\nConcussion and contusion 83\\nCompression 84\\nIntracranial inflammation 85\\nCerebral localization 87\\nWounds of the face 90\\nWounds of the neck 91\\nWounds of the chest 92\\nWounds of the abdomen 0-*i\\nBurns and scalds ll)2\\nxiii", "height": "3504", "width": "2326", "jp2-path": "essentialsofsur00mart_0015.jp2"}, "16": {"fulltext": "xiv CONTENTS.\\nPAGE\\nFractures 105\\nSpecial fractures 112\\nLuxations or dislocations 137\\nSpecial luxations 140\\nSprains 158\\nWounds of joints 159\\nSynovitis 160\\nArthritis 161\\nCoxalgia 163\\nSacro-iliac disease 166\\nWhite swelling of the knee-joint 166\\nRheumatoid arthritis 167\\nLoose bodies in joints 167\\nAnchylosis 168\\nDiseases of bones 169\\nPeriostitis 169\\nOsteitis 170\\nOsteomyelitis 170\\nAbscess of bone 171\\nCaries 172\\nNecrosis 172\\nTubercle 173\\nSyphilitic bone disease 173\\nOsteomalacia 174\\nPott s disease 174\\nRickets 176\\nHaemophilia 177\\nStruma 177\\nCurvature of the spine 177\\nHernia 179\\nSpecial hernias 188\\nAppendicitis 195\\nIntestinal obstruction 198\\nDiseases of the anus and rectum 200\\nSyphilis 208\\nChancroid .212\\nGonorrhoea 213\\nUrethral deformities 219", "height": "3504", "width": "2326", "jp2-path": "essentialsofsur00mart_0016.jp2"}, "17": {"fulltext": "CONTENTS\\nxv\\nPAGE\\nStricture of the urethra 219\\nDiseases of the prostate 226\\nAffections of the bladder 229\\nRupture of the bladder 229\\nExstrophy of the bladder .229\\nCystitis 230\\nAtony and paralysis of the bladder 231\\nHematuria 231\\nRetention of urine 232\\nStone in the bladder 235\\nHydrocele 240\\nHematocele 241\\nVaricocele 242\\nSarcocele 242\\nDiseases of veins 244\\nAngeioma 246\\nAneurism 247\\nDiseases of the lymphatics 250\\nEffects of cold 251\\nForeign body in the air-passages 252\\nAffections of the oesophagus 253\\nSurgical affections of the breast 255\\nClub-foot 256\\nHare-lip and cleft palate 257\\nDiseases of bursa? and tendons 258\\nBursitis 258\\nOnychia 259\\nAnaesthetics 260\\nLigation of arteries 263\\nExcision of joints 280\\nAmputations 284\\nTumors 292\\nBandaging 296\\nThe roller bandage 296\\nHead bandage 305\\nHandkerchiefs .307\\nThe Rontgen ravs 315", "height": "3504", "width": "2326", "jp2-path": "essentialsofsur00mart_0017.jp2"}, "18": {"fulltext": "", "height": "3504", "width": "2326", "jp2-path": "essentialsofsur00mart_0018.jp2"}, "19": {"fulltext": "ESSENTIALS OF SURGERY.\\nsi\\nINFLAMMATION.\\nWhat is inflammation\\nInflammation is the succession of changes which occurs in\\nan injured living tissue, provided the injury is not to the degree\\nof at once destroying tissue or vitality.\\nName the varieties of inflammation.\\nAcute and chronic, simple and infective.\\nWhat is simple inflammation\\nAn inflammation limited in extent, and tending to recovery.\\nWhat is infective inflammation\\nAn inflammation caused by micro-organisms, and having a\\ntendency to spread.\\nWhat is coagulation necrosis\\nDeath of tissue from arrested nutrition or from the action\\nof chemical or thermal agents, the changes seen being due\\npartly to coagulation of lymph, and partly to cell changes.\\nName the causes of inflammation.\\n1. Predisposing. Anything lowering the powers of resistance,\\nsueh as heredity, age, sex, occupation, habits, food, previous in-\\nflammation, temperature, climate, temperament, mental con-\\ndition.\\n2. Exciting. Traumatism, heat, cold, acids, alkalies, micro-\\norganisms and their products.\\nHow does inflammation extend?\\nBy the means of bloodvessels or lymphatics. Extension by\\ncontinuity, contiguity, metastasis, and sympathy is really due to\\neither the blood or lymph vessels.\\nHow may inflammation terminate\\n1. Kesolution, or return of tissues to their normal condition.\\n2. Organization, or tissue-production.\\n3. Death of tissue, by suppuration or mortification.\\nWhat are the phenomena of inflammation\\n1. Disturbed innervation, causing, first, a contraction of the\\n2", "height": "3504", "width": "2326", "jp2-path": "essentialsofsur00mart_0019.jp2"}, "20": {"fulltext": "18 ESSENTIALS OF SURGERY.\\ncapillaries, followed shortly by a paralytic dilatation producing\\nactive hyperemia.\\n2. Alteration in the bloodvessels and contents. The vascular walls\\nare widely dilated, plastic, and their endothelial cells greatly\\nswollen. The white blood corpuscles are numerous, cling to the\\nsides, and the current is slowed or stopped. The red corpuscles\\nstick together the liquor sanguinis contains more fibrin forming\\nelements.\\n3. Exudation or passage through the walls of white corpuscles\\n(diapedesis) and liquor sanguinis.\\n4. Alteration in the perivascular tissue. Intercellular matrix\\nundergoes mucoid softening, connective-tissue corpuscle white\\nblood-cells proliferate, the exudate coagulates.\\nWhat zones are found about an inflamed area\\nMost peripherally, a bright red ring where the bloodvessels\\nare widened, called the zone of determination. Within this an\\narea in which from overcrowding the blood current is slow, the\\ncolor here is somewhat dusky, this area is called the zone of\\ncongestion. Centrally, an area where the blood current is prac-\\ntically at a stand-still, this is the focus of inflammation, and is\\ntermed the zone of stasis.\\nWhat are the stages of inflammation?\\nFirst stage. Acute hypercemia with slight exudation.\\nSecond stage. Lymphatization or free exudation and the for-\\nmation of plastic lymph.\\nThird stage. Suppuration or formation of pus due to the death\\nof white blood corpuscles and their fibrinous trabecule.\\nWhat is plastic lymph?\\nThe exudate of acute inflammation. It is made up of white\\nblood corpuscles and proliferated connective-tissue cells, im-\\nbedded in a frame-work of coagulated fibrin. It is also called\\nembryonic tissue.\\nName the different kinds of exudate.\\n1. Serous. Thin, non-organizable. Examples hydrocele,\\nascites, hydrothorax.\\n2. Fibrinous. Contains much fibrin, coagulates, and readily\\nundergoes organization,", "height": "3504", "width": "2326", "jp2-path": "essentialsofsur00mart_0020.jp2"}, "21": {"fulltext": "INFLAMMATION. 19\\nHow may the various stages of inflammation terminate?\\nActive hyperemia may terminate in resolution or in exudation.\\nExudation may terminate in resolution, organization, or sup-\\npuration.\\nSuppuration may terminate in ulceration or death of the\\npart.\\nDescribe resolution.\\nThe dilated vessels again contract, the white blood corpuscles\\nbegin to move away from the inflamed area as circulation is\\nrestored. The migrated corpuscles either return to the blood-\\nvessels, degenerate, and are carried off by the lymphatics, or\\nremain as fixed connective-tissue corpuscles. The fibrin becomes\\ngranular and is absorbed.\\nDescribe organization.\\nNew bloodvessels are formed in the exudate by looping of\\nthe old ones these loops anastomose with each other, forming\\na network. In addition new vessels are separately developed\\nin the inflammatory tissue which, in turn, anastomose with the\\npreviously existing vessels. If the irritation ceases many of the\\nexudation cells disintegrate and are removed, others are con-\\nverted into connective-tissue corpuscles, which, by their contrac-\\ntion, obliterate the new bloodvessels and form cicatrices.\\nDescribe suppuration.\\nPyogenic cocci are introduced, and they liquefy the exudate\\nby the action of their ptomaines, and so form pus.\\nWhat is phagocytosis\\nThe process in which white blood-cells attack, devour, and\\ndestroy invading organisms.\\nWhat is pus\\nPus is the product of suppuration. It is a creamy-looking,\\nhighly albuminous liquid, sp. gr. 1030, and contains fat, blood\\nsalts, tyrosin, leucin, and other nitrogenous derivatives, pyogenic\\norganisms and their ptomaines. On standing it separates into\\nliquor pur is, a clear liquid, practically the same as liquor san-\\nguinis, and pus corpuscles, made up of living or dead leucocytes,", "height": "3504", "width": "2326", "jp2-path": "essentialsofsur00mart_0021.jp2"}, "22": {"fulltext": "20 ESSENTIALS OF SURGERY.\\nName the varieties of pus.\\nLaudable. Thick and cream-like this variety comes from\\nordinary acute inflammation in healthy subjects.\\nSanious. Thin, reddish, mixed with blood. From malignant\\ndisease, chronic ulcers, etc.\\nIchorous. Thin, watery, irritating. From chronic ulcers,\\nbone disease, etc.\\nCurdy or cheesy. Contains flakes of degenerated fibrin. From\\nchronic abscesses connected with bone disease.\\nGummy. Thick and ropy. From syphilitic abscesses.\\nContagious pus. Muco pus, etc.\\nWhat becomes of pus\\nIt may be disintegrated and absorbed it may be discharged\\nits more liquid portions may be absorbed, while the solid portions,\\ntogether with the affected tissues, undergo fatty disintegration\\nand remain as a putty-like mass, this constitutes caseation.\\nName the varieties of suppuration.\\nCircumscribed. Diffuse. The diffuse may be superficial as in\\nthe cases of coryza and dysentery or deep as in cellulitis.\\nWhat are the symptoms of acute inflammation?\\nFever, together with redness, heat, swelling, pain, alteration of\\nfunction and nutrition.\\nWhat are the characteristics of inflammatory redness\\nIt is persistent if the capillaries are emptied by pressure with\\nthe finger the redness instantly returns on removal of the pressure.\\nThe shade of color depends upon the rapidity and freedom of\\nthe circulation if dark or bluish it denotes obstruction or stasis.\\nCopper-red often denotes syphilitic inflammation. Rose-red\\nstreaks along the course of the lymph vessels denote lymphan-\\ngitis. A dusky-red tract in the course of a vein indicates phlebitis.\\nAt what portion of an inflammatory area is heat most marked?\\nAt the focus or centre.\\nDescribe inflammatory swelling.\\nIt is due to the increased amount of blood in the part, to pro-\\nliferation, and to exudation. It is soft in acute, hard in chronic", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0022.jp2"}, "23": {"fulltext": "INFLAMMATION. 21\\ninflammations; is especially well marked in loose connective\\ntissues. Its limitations by fascia may indicate the seat of\\ninflammation.\\nDescribe inflammatory pain.\\nIt is persistent, increased by pressure, by motion, and by a depend-\\nent position of the part, and accompanied by the signs of inflam-\\nmation. Is mainly due to mechanical injury to the nerves from\\nthe swelling. Most intense in dense structures. May be felt in\\nregions remote from the inflamed area instance, the knee pain\\nof coxalgia or the shoulder pain of hepatitis.\\nDescribe inflammatory alteration of function.\\nSecretions are perverted or abolished. Reflexes become\\ngreatly exaggerated instance, the tenesmus (straining) of\\ndysentery, the strangury of cystitis, the convulsions of teething,\\nNon-sensitive parts become hyper-sensitive instance, the pain\\nof peritonitis or of teething.\\nDescribe the constitutional symptoms of inflammation.\\nFever. May be sthenic or asthenic in type.\\n1. Sthenic inflammatory fever.\\na. Circulatory symptoms. Full, strong, rapid pulse, flushed\\nface, injected conjunctivae.\\nb. Nervous system. Increased temperature, 100\u00c2\u00b0 to 103\u00c2\u00b0, head-\\nache, lumbar pains, troubled sleep, special senses often hyper-\\nsesthetic.\\nc. Glandular system and alimentary tract. Secretions dimin-\\nished and scanty dark colored irritating urine of high specific\\ngravity. Anorexia heavy white or yellowish coating on the\\ntongue. Constipation.\\n2. Asthenic inflammatory fever. The general symptoms are\\nthe same as those of the sthenic type, except there is profound\\ndepression in place of over action, and the patient shortly falls\\ninto the typhoid, condition. Pidse feeble, rapid, and compres-\\nsible. Temperature fluctuating from 99\u00c2\u00b0 or 100\u00c2\u00b0 to 103\u00c2\u00b0 or even\\n105.\u00c2\u00b0 Mental condition dull and torpid, or delirious and busy.\\nTongue dry, with brown or black coat.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0023.jp2"}, "24": {"fulltext": "22 ESSENTIALS OF SURGERY.\\nHow do you treat inflammation\\nLocally and constitutionally.\\nGive the local treatment of inflammation.\\nBemove the cause. Best, either general by putting the patient\\nto bed, or local by the employment of splints and bandages.\\nPosition. Elevation with relaxation of all structures by posi-\\ntion.\\nCold, may be employed with or without moisture ice-bag,\\nirrigation, rubber tubes, cold compresses, and evaporating\\nlotions. Use in the beginning of acute inflammation.\\nHeat, may be combined with moisture hot cans or bottles,\\npoultices, spongio piline, irrigation, baths, douches.\\nLocal depletion. Cups, leeches, and scarification.\\nCounter-irritation. Tr. iodin., mustard plaster, turpentine,\\nchloroform liniment, actual cautery, seton, issue.\\nVesication. Fly blister, cantharidal collodion.\\nPressure. Either direct or on the main bloodvessel of the part.\\nWhat are the contraindications to the use of cold in inflam-\\nmation?\\nIt should not be employed where there is great impairment\\nof vitality, either local or general, where it is disagreeable to\\nthe patient, after inflammation is fully established, or in the\\nextremes of life.\\nHow does heat control inflammation\\nIt restores tonicity to the bloodvessels, increases the rapidity\\nof the circulation, hastens resolution, and is a powerful vitalizer.\\nUnder what circumstances are heat and moisture indicated\\nWhere there is great tension where sloughs or dead parts are\\nto be separated where suppuration is taking place.\\nWhat conditions indicate the employment of local depletion\\nA condition of vascular engorgement so great that the vitality\\nof the part is threatened instance, scarification in prolapsed\\nhemorrhoids or acute conjunctivitis\\nDescribe cupping.\\nIf the blood is to be merely drawn to the surface, dry cupping", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0024.jp2"}, "25": {"fulltext": "INFLAMMATION. 23\\nis employed. This may be accomplished by a regular apparatus,\\nor by lighting a few drops of alcohol poured into a small cup or\\nglass, and suddenly clapping it to the surface to be treated. A\\npowerful vacuum is created, and the skin is drawn far into the\\nhollow of the cup. If blood is actually to be abstracted, wet cups\\nare used. Incisions are made through the skin, and free bleed-\\ning is encouraged by applying cups over these parts.\\nDescribe leeching.\\nThe Swedish leech is generally used it draws about f^ss\\nof blood. Wash the surface of the skin carefully, apply a little\\nmilk or blood to it, put the leech in a wide-necked bottle, and\\npress the mouth of the bottle against the surface to be bled. Let\\nthe leech drop off, and check the bleeding either by a pledget of\\nstyptic cotton, by compress and bandage, or by passing a hare-\\nlip pin through the depth of the leech bite and tying around it.\\nWhat parts should be avoided in applying leeches\\nLeeches should not be placed over loose cellular tissue. In-\\nstance, the eyelids and the scrotum. A leech should not be\\napplied directly over a nerve or a blood-vessel, nor on the face.\\nAreas of infection must not be leeched.\\nWhen do you use counter-irritation\\nAs counter-irritation acts by drawing the blood from the in-\\nflamed part, it may be used in the very beginning of inflamma-\\ntion. It may be employed for the relief of pain, or, as inflam-\\nmation is subsiding, its use may materially hasten resolution.\\nDescribe the application of counter-irritants.\\nA mustard plaster must never be allowed to blister. Mix one\\npart mustard, two parts flour, and cover with a thin film of egg\\nalbumen or molasses. The more severe forms of counter-irri-\\ntation, the actual cautery, the seton, and the issue, are especially\\napplicable to chronic inflammation. In using the actual cautery\\nthe part may be previously anaesthetized by freezing. The seton\\nis made by passing some strands of silk or other material through\\na pinched up fold of the skin, and leaving them in place, slightly\\nmoving them from day to day to keep up irritation. The issue\\nis an ulcer made by cautery Or chemicals, and kept open by a\\nforeign body, such as a pea or a pebble.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0025.jp2"}, "26": {"fulltext": "24 ESSENTIALS OF SURGERY.\\nDescribe vesication.\\nThis is really a powerful form of counter-irritation combined\\nwith depletion. Cantharides in some of its forms is generally\\nused, either the cerate or cantharidal collodion. After six hours\\napply a poultice small blisters frequently repeated are termed\\nfugitive blisters.\\nWhat dangers attend the use of cantharides\\nIt may be absorbed and produce strangury, i. e., inflamma-\\ntion of the genito-urinary tract, attended with great pain, and\\nconstant straining to pass water, with the evacuation of a few\\ndrops at a time. Treat by opium and belladonna suppositories,\\ndemulcent drinks, warm sitz baths, and leeches. Avoid by re-\\nmoving the blister after six hours and applying a poultice, or by\\nincorporating camphor with the cantharidal cerate.\\nIn old and debilitated persons extensive sloughing may follow\\nthe use of blisters.\\nWhen is pressure used\\nEither in the very beginning, or after the inflammatory swell-\\ning has reached its height. It supports the bloodvessels, pre-\\nvents exudation, and hastens resolution. The ordinary or the\\nrubber bandage may be employed. Often the sand bag or shot\\nbag is of service.\\nGive the constitutional treatment of inflammation.\\n1. Bleeding or general depletion. To be employed only in the\\nstrong and plethoric at the beginning of an attack, and where\\nlife or the vitality of an important organ is threatened by the\\nviolence of the congestive symptoms. Instance, incipient menin-\\ngitis or pulmonitis. Place the patient in a semi-recumbent pos-\\nture, tie a cord or bandage about the middle of the arm, making\\nenough tension to completely stop the venous circulation, tho-\\nroughly disinfect the skin in the region of incision. Under all\\nantiseptic precautions divide the median cephalic vein, and\\nwhen sufficient blood has been drawn close the wound with\\na compress of iodoform gauze remove the fillet from the arm,\\napply a small antiseptic dressing, and put on a tight spiral re-\\nversed of the upper extremity, carrying the hand in a sling. In", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0026.jp2"}, "27": {"fulltext": "INFLAMMATION 25\\ncase of brain congestion bleed from the external jugular. Bleed\\ntill the pulse becomes soft and slow.\\n2. Cardiac sedatives. Used where the pulse is full and bound-\\ning in acute inflammation. Tr. aconit. rad. gtt. ij, or tr. verat.\\nvir. gtt. v, hourly. Ex. gelsem. fl. Tltv every two hours. Care-\\nfully watch the effect of cardiac sedatives, especially aconite.\\n3. Diaphoretics and diuretics. Applicable to nearly all forms\\nof inflammatory fever. Liq. amnion, acetat. or mist. pot. cit.\\nfgss, spirit, seth. nit. f^ss well diluted, or pot. nit. gr. v, every two\\nhours. Citrate of caffein or infusion of digitalis may also be given.\\n4. Cathartics. In the beginning of an acute attack of inflam-\\nmation the bowels should be thoroughly cleared. This may be\\neffected by blue mass gr. x, followed in six hours by a seidlitz\\npowder, or calomel gr. sod. bicarb, gr. iij, repeat every hour\\ntill evacuation, or liquorice powder 3j. Keep the bowels regu-\\nlated by Janos or Carlsbad water.\\n5. Antipyretics. Quinine gr. xx, antipyrine gr. xv, antifebrine\\ngr. v, phenacetine gr. x, or guaiacol locally. Not to be used\\nunless the fever exceeds 105\u00c2\u00b0.\\n6. Anodynes. Morphia for acute pain, gr. hypodermically.\\nBromide and caffein for headache. Chloral and bromide for\\nrestlessness.\\n7. Stimulants. Always in the asthenic or typhoid form of sur-\\ngical fever. Where there are symptoms of depression, brandy,\\nwhiskey, or wine, given at regular intervals with the food.\\n8. Tonics. After the acute stage has passed, tr. cinch, comp.\\nelix. calisay., or quinine with iron and strychnia.\\n9. Diet. Water and cracked ice for two or three days if the\\nsymptoms are very acute, and the affection not liable to termi-\\nnate in the typhoid condition. Follow by milk taken in small\\nquantities and at regular intervals. As the fever subsides the\\ndiet can be rapidly increased. For adynamic fever fullest diet\\nthe patient can digest from the first. Milk three pints daily\\nwith malt, oyster juice, raw oysters, peptonized raw-meat juice,\\nliquid peptonoids, beef tea, etc.\\nWhat symptoms call for the use of stimulants\\nA weak pulse and dry tongue, particularly if associated with", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0027.jp2"}, "28": {"fulltext": "26 ESSENTIALS OF SURGERY.\\ndelirium. The guide as to the quantity to be employed is the\\npulse if it becomes slower and fuller the stimulants are doing good.\\nWhat are the symptoms of chronic inflammation\\nThe same as in acute but less marked any or all of the\\ncardinal symptoms may be so slight as to escape notice.\\nWhat are the causes of chronic inflammation\\nPreceding acute inflammation. Long continued local irrita-\\ntion or functional activity. Constitutional weakness or diathesis.\\nWhat is the pathology of chronic inflammation\\nA large amount of plastic lymph is effused and undergoes\\npartial organization, causing considerable induration. This in-\\nduration greatly slows the circulation by compressing the blood-\\nvessels. The infiltrated tissues undergo fatty degeneration and\\nmay break down forming cold abscesses.\\nHow do you treat chronic inflammation\\n1. Local. Bemove cause. May be sequestrum or foreign body.\\nBest, general, in bed local, by splints and bandages. Local de-\\npletion. By leeches and scarification. Vesication. Small and\\nfrequently repeated blisters. Counter-irritation. Actual cautery,\\nsetons, issues. Alteratives. Tr. iodin., unguent, iodin. comp.,\\nunguent, hydrarg. cum belladon. Irrigation and pressure.\\nApply a tight roller bandage and keep wet by cold or hot irri-\\ngation. This is the most efficient local treatment of chronic\\ninflammation. Massage Electricity.\\n2. Constitutional.\u00e2\u0080\u0094 Fresh air, generous diet, stimulants, and\\ntonics. Mercury, iodine, cod-liver oil, and iodide of iron.\\nWhen must mercury be avoided\\nIn tubercular and broken down constitutions.\\nHow is mercury given?\\nHydrarg. chlor. mit. gr. Dover s powder gr. ij., give every\\ntwo hours. Mainly used in head injuries or inflammations, also\\nadvised in inflammation of all serous membranes.\\nWhat is meant by salivation?\\nThe constitutional effect of a persistent overdosing with mer-", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0028.jp2"}, "29": {"fulltext": "INFLAMMATION. 27\\ncury. Early symptoms, a foetid breath followed by tenderness of\\nthe gums, noticed on chewing. Metallic taste in the mouth.\\nCopious flow of saliva. Often colic and bloody stools.\\nHow do you treat salivation\\nStop the mercury, open the bowels, use a mouth wash contain-\\ning tr. myrrh, and pot. chlor. Administer belladonna or atropia\\nin fairly full doses, and give hot-baths.\\nAbscess.\\nWhat is an abscess\\nA collection of pus surrounded by a wall of lymph. An ab-\\nscess is a hollow ulcer. An abnormal cavity containing pus.\\nDescribe the formation of abscess.\\nFrom excessive or continued irritation there is an exuda-\\ntion so copious that not only are the lymph channels blocked,\\nbut there is absolute blood stasis and coagulation the central\\nportion of the exudation and the involved tissues perish form-\\ning pus because of the action of pus cocci; the peripheral por-\\ntions, however, are not absolutely cut off from nutrient blood\\nthey undergo organization, and form around the central part a\\nbank of organized lymph or granulation tissue this serves a\\ndouble purpose to prevent the extension of the suppurative\\nprocess, and to provide for the healing of the abscess when the\\npus is evacuated. The direct cause of the pus formation is the\\npresence of micro-organisms in the exudate.\\nWhat symptoms denote the formation of an abscess\\nThrobbing pain. Increase in swelling. Color darker, surface\\nat times glazed. (Edema of skin. Tendency to point. Fluc-\\ntuation, elicited by palpation, percussion, and pressure. Rigors\\nand fever.\\nIn what direction does an abscess point\\nIn the direction of least resistance. This is usually, but not\\nalways, towards the surface.\\nWhat local symptoms point to deep suppuration\\nPain, oedema, and dark discoloration.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0029.jp2"}, "30": {"fulltext": "28 ESSENTIALS OF SURGERY.\\nHow do you treat an acute abscess?\\nJSndeavor to abort by the use of heat (110\u00c2\u00b0), cold, local de-\\npletion or blisters. It is a waste of time to poultice, and we\\nshould open early. Open under antiseptic precautions, wash\\nout the cavity with bichloride solution 1 2000, drain, and apply\\nan antiseptic dressing.\\nHow do you open an abscess\\nIf superficial, with one quick cut. If deep, make an incision\\nwith the scalpel to the deep fascia, through this a director is\\npassed and forced on till it enters the abscess cavity. A pair\\nof dressing forceps, closed, is carried along the director by open-\\ning these and drawing out forcibly a free opening is made without\\nendangering bloodvessels (Hilton s method). In evacuating\\npus, bear in mind that any violence, which breaks down the\\norganized walls of lymph or granulation, retards healing; hence\\nif pus is squeezed out it must be by means of gentle pressure\\nmade with pledgets of cotton.\\nIn what regions must abscesses be opened before fluctuation is\\ndetected?\\n1. Ischiorectal, to prevent pointing into the rectum (path of\\nleast resistance). 2. Perineal. 3. Palmar. 4. Tonsillar. 5.\\nPostpharyngeal. 6. Any abscess near important bloodvessels\\nor beneath deep fasciae.\\nWhat circumstances may retard the healing of abscess after\\nincision\\n1. Want of free drainage. To remedy, enlarge the opening,\\nor make another in a more dependent position, or insert drain-\\nage tube.\\n2. Imperfect apposition of the granulation walls, hemorrhage, or\\nbreak in the limiting walls allowing an infiltration of pus into the\\nsurrounding tissue. Treat by compress and bandage.\\n3. Indolent granulations or constitutional weakness. Treat\\nlocally by stimulating applications. Cu. sulph. or argent, nit.\\ngr. iv to aq. f ^j, iodoform the constitutional condition must be\\nremedied by tonics and stimulants.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0030.jp2"}, "31": {"fulltext": "INFLAMMATION. 29\\nHow does a chronic abscess differ from an acute one?\\nThe course is slow, the signs and symptoms are slight or want-\\ning. The tendency to point is not marked, pus accumulating at\\ntimes to an extraordinary extent before the skin shows signs of\\nyielding. The pus corpuscles are broken up and there are few or\\nno micro-organisms to be found on microscopic examination. The\\ngranulation wall is very thick, partially organized into connec-\\ntive tissue, and showing little tendency toward the production\\nof healthy granulation. The condition is one of passive conges-\\ntion rather than active hyperemia, hence the name congestive\\nabscess called also cold abscess from the slight development of\\ninflammatory heat.\\nWhat are the constitutional symptoms of chronic abscess?\\nMay be slight or wanting till the abscess bursts or is opened,\\nwhen hectic quickly develops by this is meant a daily rise in\\ntemperature, often preceded by rigors, and followed, after some\\nhours, by profuse sweating with subsidence of fever. Emaciation\\nis continuous and rapid.\\nHow do you treat a chronic abscess\\nGenerous diet, stimulants, tonics, iodide of iron, and cod-liver\\noil. Unless the abscess is stationary, and giving no trouble\\neither directly or indirectly, open at once under strictest anti-\\nseptic precautions. Aspiration followed by pressure may succeed\\nwhen there is no bone involvement. Usually incision will be\\nnecessary the cut must be as far removed from sources of con-\\ntagion as possible (hence open psoas abscess above Poupart s liga-\\nment), and planned to thoroughly drain the cavity. Irrigate\\ndaily with iodoform suspended in olive oil, 1 per cent, carbolic,\\nor 1 6000 bichloride. Apply each time a complete antiseptic\\ndressing, providing cushions of jute, oakum, sea moss, or cotton\\nto receive and absorb the discharge.\\nWhat are the chief characteristics of tubercular abscess?\\nThey are chronic, have a tendency to caseation and long-con-\\ntinued discharge, and affect mainly bones, lymph glands, and lungs.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0031.jp2"}, "32": {"fulltext": "30 ESSENTIALS OF SURGERY.\\nHow do you treat tubercular abscess\\nThoroughly remove the affected area by means of the knife or\\ncurette. Inject 10 per cent, iodoform-olive oil into the infiltrated\\ntissues.\\nWhat is a residual abscess\\nAn abscess which appears at or about the seat of a former\\nsuppuration commonly due to caseous masses.\\nWhat is a sinus\\nA suppurating canal, left by an imperfectly healed wound or\\nabscess.\\nWhat is a fistula?\\nA communication between two mucous cavities, or between a\\nmucous cavity and the external air, by means of a suppurating\\ncanal.\\nHow do you treat sinus and fistula?\\nKemove all irritating causes and bring the walls together by\\npressure, employing stimulating injections (silver, copper, zinc)\\nor freely lay open, and by gentle packing with iodoform gauze,\\ncause healing from the bottom.\\nHow do you diagnose abscess from aneurism\\nShould abscess occur in the immediate neighborhood of a\\nlarge vessel the history will be one of previous inflammation\\nthe pulsation of abscess is a simple lifting impulse, not an expansive\\nthrob the abscess may be absolutely isolated from the artery by\\nmanipulation pressure on the distal side does not increase the\\ntension of abscess, nor does pressure on the proximal side di-\\nminish it. Abscess gives no thrill, no bruit finally, if there be\\nthe chance of a doubt, the exploring needle gives pus from the\\nabscess.\\nHow do you distinguish encephaloid disease from abscess?\\nIn soft cancer the course is chronic, and at first painless it\\npresents multiple eminences, has large purple veins coursing\\nover it, and is elastic rather than fluctuating.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0032.jp2"}, "33": {"fulltext": "INFLAMMATION. 31\\nUlceration.\\nWhat is ulceration?\\nThe molecular death of tissues, leaving a solution of continuity,\\nand accompanied by a discharge.\\nWhat are the causes of ulceration\\n1. Predisposing, quantity and quality of the blood, together with\\nthe freedom and rapidity of the circulation.\\n2. Excitiug, irritation, physical or chemical.\\nWhat is the pathology of ulceration?\\nAs for abscess from over-crowding, the tissues and effused\\nmatter about the focus of inflammation perish, the peripheral\\nareas become vascularized, and are converted to granulations.\\nWhat is a granulation\\nA capillary loop about which are clustered leucocytes, held\\ntogether by a slight amount of intercellular material.\\nDescribe healthy granulations.\\nCherry-red, non-sensitive, elastic, and discharging laudable\\npus.\\nBy what processes is ulceration healed?\\nBy granulation and cicatrization. While the dead central\\nparts of the ulcer come away as a thin discharge called ichor,\\nthe exudation beneath and around is becoming vascularized,\\ncapillary loops shoot out toward the surface (the direction\\nof least resistance) about each loop clings a cluster of living\\nleucocytes, and a surface of healthy granulation is established,\\ndischarging laudable pus. Cicatrization now begins, the sur-\\nrounding skin sinks to the level of the granulations, and its epi-\\nthelial cells undergo segmentation and grow as a ring about the\\nperiphery toward the centre of the ulcer this skinning over is\\ndenoted by a blue film, and while it is extending the ulcer is\\ncontracting, from conversion of leucocyte to fibrous tissue this\\ncontraction goes on long after the ulcer is entirely healed, and\\nmay cause great deformity. The process of skinning and con-\\ntraction is called cicatrization, the result is a cicatrix or scar.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0033.jp2"}, "34": {"fulltext": "32 ESSENTIALS OF SURGERY.\\nDescribe a cicatrix.\\nAt first blue, it finally becomes white, the progressive contrac-\\ntion of the connective tissue squeezing all the blood from the\\npart. A cicatrix has neither nerves, glands, lymphatics, nor\\nhair it readily ulcerates, and is slow in healing.\\nWhat is an ulcer\\nA surface of granulations.\\nName the varieties of ulcers.\\n1. Local.\\na. Simple healthy or healing.\\nb. Complicated or spreading.\\n2. Constitutional, strumous, syphilitic.\\nOf the complicated or spreading we have the fungous, the\\noedematous, the inflamed, the sloughing, the phagedenic, the\\nindolent ulcers.\\nDescribe a simple or healthy ulcer.\\nGranulations, healthy, cherry-red, small, uniform, not painful.\\nDischarge, laudable pus in small quantity if the ulcer has been\\ntreated antiseptically the discharge is serum. Shape, oval,\\nregular. Edges, gently sloping, moderately indurated, showing\\nthe blue line of beginning skinning. Surrounding skin soft and\\nflexible.\\nGive the treatment of simple ulcer.\\nIn the forming stage, abort or limit by rest, elevation, local de-\\npletion, and cold at the same time treating the rather high\\nconstitutional symptoms by withholding food, giving abundance\\nof water, iced drinks, or cracked ice, opening the bowels, and,\\nif necessary, administering morphia hypodermically to control\\nthe pain.\\nWhen disintegration is evident hasten the separation of the\\ndead from the living tissues by warm antiseptic poultices\\n(sponges, lint, or gauze soaked in weak bichloride solution 1:6000,\\nand covered in by waxed paper and a bandage). Milk diet.\\nWhen the dead part is separated leaving a surface of healthy\\ngranulations, cleanse with sterilized salt solution 5 per cent., or", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0034.jp2"}, "35": {"fulltext": "INFLAMMATION. 33\\nvery weak antiseptic lotions, bichloride 1 10,000. Cover with\\nprotective or gutta-percha tissue, and apply a light antiseptic\\ndressing, finishing with moderately firm pressure by a roller\\nbandage. Full diet. A healthy ulcer heals kindly under nearly\\nany dressing.\\nDescribe the inflamed ulcer.\\nA simple ulcer may become converted to an inflamed ulcer by\\nany of the local or constitutional causes which give rise to in-\\nflammation. Instance, debauch, injury, etc. Granulations, at\\nfirst bright red, become dusky, finally break down forming a\\ngray, ragged, sloughing surface. Discharge, very profuse, con-\\nsists of pus and the debris of broken down tissue. Edges, irregu-\\nlar, deep, sharply cut, indurated. Surrounding skin, red and\\ncedematous. Pain and tenderness acute. Constitutional symp-\\ntoms well marked.\\nGive the treatment of inflamed ulcer.\\nA saline cathartic in the beginning of the attack. Rochelle\\nsalts 3j. Rest in bed with elevation of the part. Local deple-\\ntion by leeches, or incisions into the edge of the ulcer. Hot\\nantiseptic poultices. Low diet, opium to relieve pain.\\nDescribe the sloughing ulcer.\\nYery commonly associated with venereal disease. This is\\nbut an aggravated inflamed ulcer, and is characterized by the\\nsame peculiarities, with the addition that there is a rapid spread\\ning attended by destruction of visible portions of the tissues which\\nare thrown off as offensive gray sloughs. All symptoms, both\\nlocal and general, are aggravated.\\nHow do you treat sloughing ulcers\\nTonic and stimulant. Constitutional condition must receive\\nparticular attention, as all sloughing processes tend rapidly to-\\nwards exhaustion. Charcoal or antiseptic poultices till sloughs\\ncome away. Spray of hydrogen peroxide.\\nDescribe the phagedenic ulcer.\\nThis form is an aggravated sloughing ulcer. Found only in\\nvenereal disease or in patients with profoundly depressed con-\\n3", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0035.jp2"}, "36": {"fulltext": "84 ESSENTIALS OF SURGERY.\\nstitution. The granulations are absent, being replaced by gray\\nsloughs the discharge is ichorous, containing shreds of dead\\ntissue the edges are ragged, dusky red, and extensively under-\\nmined the surrounding skin cedematous, red. The extension is\\nvery rapid, may destroy an entire organ (the penis), and is at-\\ntended by severe constitutional symptoms of the adynamic type.\\nGive the treatment of phagedenic ulcer.\\nClear the bowels. Rich nourishing diet, stimulants, tonics,\\nopium. Continuous warm baths during the day, with iodoform\\ndressing at night. Or the ulcer may be treated by charcoal\\npoultices and antiseptic washings till sloughs are separated.\\nDescribe the serpiginous ulcer.\\nThis is really a phagedenic ulcer. Its course is slow but per-\\nsistent it may produce most extensive destruction of tissue.\\nTreatment. Constitutionally, supporting locally, actual cau-\\ntery, or as for phagedenic ulcer.\\nWhat is an irritable ulcer\\nAn ulcer which presents the features of an inflamed ulcer, to-\\ngether with great pain, out of all proportion to its apparent\\ncause. This pain is probably due to the stretching of small nerve\\nbranches.\\nTreatment. Subcutaneous section of the nerve branch sup-\\nplying the ulcerating area, or applications of chloral gr. xx., or\\nargent, nit. gr. xx. to the ounce of water.\\nWhat are fungous and cedematous ulcers\\nIn the fungous ulcer the granulations grow above the level of\\nthe surrounding skin, and may spread out as a cauliflower or\\nmushroom-like growth they bleed readily. Cause, obstruction\\nto venous return from undue contraction of surrounding tissues.\\nThe cedematous ulcer is characterized by large, pale, flabby,\\nwatery granulations which have a tendency to become fungous.\\nCause, venous obstruction combined with struma or systemic\\ndepression.\\nHow do you treat fungous and cedematous ulcers?\\nAstringent applications. Powdered alum, glycerole of tannin,", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0036.jp2"}, "37": {"fulltext": "INFLAMMATION. 35\\nfollowed by compression applied by means of imbricated adhesive\\nstraps and a tight roller bandage.\\nExcision. If these means fail, or if the granulations have\\nassumed a mushroom-like growth, shave off level with the sur-\\nface, dust with iodoform, and apply an antiseptic dressing, with\\na tight roller bandage over the whole.\\nDescribe the indolent, callous, or chronic ulcer.\\nGranulations. Never healthy, usually small, scanty, and\\nbrickdust-red frequently fungous or oedematous.\\nDischarge. Ichorous or sanious pus.\\nEdges. Everted or inverted, irregular, never gently sloping.\\nBlue line of skinning absent.\\nSurrounding skin. Discolored, often eczematous and densely\\nindurated.\\nOccurs. After middle age, and in those whose occupation\\nrequires long standing.\\nFavorite seat. The outer surface of the lower third of the leg,\\nbecause 1 It is an exposed portion. 2. There is little cellular\\ntissue separating skin from bone. 3. Its dependent position\\nfavors passive congestion and thrombosis.\\nCourse. Exceedingly slow, may last many years.\\nConstitutional symptoms. None.\\nThe eczematous and varicose ulcers are simply chronic ulcers\\nwith marked development of the affections from which they\\ntake their names.\\nWhat prevents chronic ulcers from healing\\nFrom long congestion the bank of lymph becomes redundant,\\nand is, in part, converted to imperfect fibrous tissue, which, by\\npressure upon the vessels, blocks the circulation. They may\\nfail to heal because of adhesions to the deeper structures, be-\\ncause of absence of granulations, or because the epithelium\\ndoes not grow over it.\\nHow do you treat chronic ulcers\\nCause the absorption of the obstructing bank of lymph. Healing\\ngranulations will then appear. This is accomplished by heat,\\nmoisture, and pressure.\\nTreatment.\u00e2\u0080\u0094 Soak the ulcer for two hours at night in warm", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0037.jp2"}, "38": {"fulltext": "36 ESSENTIALS OF SURGERY.\\n2 per cent, boric acid solution, followed by a thick poultice\\n(boric acid solution and ground flaxseed, the surface being\\ncoated with boric ointment), well protected by oiled silk, or\\nwaxed paper, so that it may not cake before being removed. In\\nthe morning, substitute for the poultice strips of lint wet in\\nboric lotion, and imbricated over the affected region cover\\nthese strips with waxed paper, and apply very carefully over\\nthe whole a roller bandage, taking in the foot and going as high\\nas the knee at night remove the dressing and soak again. Con-\\ntinue this treatment for three or four days, or until the bank of\\ninduration is softened, then strap. Use adhesive plasters cut in\\nstrips one inch wide, and long enough to extend nearly around the\\nlimb. After elevating the leg and allowing the blood to drain\\nout, begin the dressing by applying the first strap two inches\\nbelow the lower border of the ulcer, making firm pressure as it\\nis carried around the leg or foot the next strap is applied nearer\\nthe ulcer, overlapping the first for two-thirds of its width so\\ncontinue till the ulcer is reached, when the straps must overlap\\nas before, but in applying them, first fasten one end, then press\\nthe edges of the ulcer together, diminishing its size as much as\\npossible, and secure it in this position by continuing the strap\\nfirmly across it and around the limb. The straps must entirely\\ncover in the ulcer and an area two inches above and below.\\nOver the straps apply a layer of lint, and cover in the whole by\\na closely fitting roller bandage. The dressing is removed and\\nreapplied as required by the amount of discharge. If this\\nmethod cannot be carried out, apply a Martin s rubber bandage\\ndirectly to the skin, removing it at night wash the leg night\\nand morning in boric lotion.\\nA blister applied to the entire ulcer and surrounding skin may\\ncause the induration to disappear. Incisions, or shaving off of the\\ninduration may be required.\\nWhat are the characteristics of tubercular ulcers\\nFavorite seats neck and groin. Chronic, painless, discharge a\\nthick oily pus, granulations cedematous, skin extensively un-\\ndermined, and overhanging the ulcer in the form of loose blue\\nflaps.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0038.jp2"}, "39": {"fulltext": "INFLAMMATION. 87\\nWhat ulcers are mostly found on the leg\\nVaricose, traumatic, and syphilitic. A non-traumatic ulcer\\nof the upper third of the leg is mostly syphilitic.\\nWhat ulcers chiefly affect the face\\nRodent ulcers, and those due to lupus, syphilis, or epithelioma.\\nThe rodent idcer is distinguished from the epitheliomatous from the\\nfact that it does not involve lymphatic glands, nor induce secon-\\ndary deposits its course is very slow its base is smooth and\\nglossy, with little or no discharge its edges moderately indu-\\nrated, smooth, round, and rolled over.\\nDescribe skin grafting.\\nBy skin grafting is meant the placing on granulating sur-\\nfaces of healthy epidermis for the purpose of hastening cicatri-\\nzation and preventing subsequent contractions. It is chiefly\\napplicable where the granulating surface is large, or conspicu-\\nously placed, or slow in healing. The granulations must be\\nhealthy, discharging very slightly, and preferably aseptic. This\\nmay be accomplished by washing with weak bichloride solutions\\nand dressing antiseptically for several days before the operation.\\nThe area from which the grafts are taken should be thoroughly\\nwashed with soap, water, and bichloride, 1 1000, followed by 5\\nper cent, sterilized salt solution (sodium chloride 5 parts, water\\n95 parts, boil for one hour). By means of a scalpel, scissors, or\\na razor, small or large pieces of cuticle, including the rete rau-\\ncosum, but not the corium, are removed, and placed, fresh sur-\\nface down, on the granulations, from which all antiseptics have\\npreviously been washed by liberal salt solution irrigations.\\nApply protective wet in salt solution, and either a sterile, or\\nan antiseptic dressing, covering in the whole with a tight roller\\nbandage. By this method strips of skin, in. by 2 in., may be\\ntransplanted and retain their vitality. The grafts should be\\ntaken from young healthy persons.\\nThe grafting of a piece of considerable size is the operation\\nof Thiersch, while the planting of a number of small pieces is\\nthe procedure of Reverdin. Krause transplants the entire thick-\\nness of the skin.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0039.jp2"}, "40": {"fulltext": "38 ESSENTIALS OF SURGERY,\\nMortification.\\nWhat is mortification or gangrene\\nDeath in mass.\\nWhat is a slough or sphacelus?\\nThat portion of tissue affected by mortification.\\nWhat are the causes of gangrene\\n1. Direct violence from physical or chemical agencies.\\n2. Deficient blood supply from inflammatory engorgement, weak\\ncirculation, diseased vessels, embolus, or thrombus.\\n3. Bacterial infection.\\nName the two commonest forms of gangrene.\\n1. Acute or moist. 2. Chronic or dry.\\nWhat structures resist gangrene\\nArteries (hence thrombi form before their walls are disinte-\\ngrated, and bleeding is prevented), nerves, tendons, and bones.\\nHow is gangrene limited\\nBy a reactive inflammation. A wall of granulation is thrown\\nout, at the expense of the healthy tissues, by which the slough is\\nseparated from the living parts.\\nWhat first indicates the limit of gangrenous processes\\nThe line of demarcation. A red line due to capillary conges-\\ntion, indicating the beginning of inflammatory reaction.\\nWhat follows the line of demarcation\\nThe line of separation. A line of ulceration or granulation.\\nWhat are the general indications in the treatment of all gan-\\ngrenous processes\\nKeep the dead or dying part thoroughly aseptic. Cleanse, dis-\\ninfect, and wrap in thick layers of antiseptic wool, cotton, or\\ngauze. Carefully guard against the invariable tendency to ady-\\nnamia.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0040.jp2"}, "41": {"fulltext": "INFLAMMATION. 39\\nWhat are the symptoms of acute mortification\\nSynonym Local traumatic gangrene.\\nUsually acute inflammatory symptoms with evidence of great\\nlocal congestion, and intense burning pain. The pain ceases,\\nthere is loss of sensation, of power to move the part. The temper-\\nature falls, and pulsation of the arteries cannot be detected. The\\ncolor, at first dusky-red, turns to blue, to purple, to dirty brown,\\nor black. Blebs form, the course of the superficial vessel is\\nmarked by lines of dark discoloration. Even yet vitality may be\\nrestored. If, however, the cuticle separates from the derm and\\ncan be rubbed off by light pressure, if there is crackling, emphy-\\nsema, and foul odor, death is absolute.\\nThe constitutional symptoms are those of inflammatory fever,\\nbut of an adynamic or typhoid type. Rapid, feeble pulse, low\\ndelirium, etc.\\nHow do you treat acute mortification\\nPreventive. Believe tension. Remove tight bandages. Evac-\\nuate retained discharges. Freely incise inflammatory congestions.\\nMassage. Render the part aseptic wrap in antiseptic wool.\\nIf the slough is thoroughly established, and is putrid, char-\\ncoal poultices or wet bichloride dressings may be used other\\nwise, dry antiseptic dressings are indicated.\\nAmputate when the line of demarcation is formed. (In the hand\\nand foot spontaneous amputation generally gives a better stump\\nthan the surgeon s knife.)\\nConstitutional treatment Yery free stimulation, full nourishing\\ndiet, quinine, and opium.\\nWhat is spreading traumatic gangrene\\nAn acute, rapidly spreading, moist gangrene, dependent on a\\nspecific micro-organism. It appears shortly after severe trau-\\nmatism, and before the line of separation can form, extensively\\ninvades the tissues, and causes death from exhaustion or septic\\npoisoning. All local inflammatory symptoms may be absent\\nswelling, discoloration, and loss of temperature circulation and\\nsensation, denoting the extension of the process. In other cases,\\nan inflammatory redness and induration precede the gangrene.\\nThe constitutional symptoms are profoundly adynamic.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0041.jp2"}, "42": {"fulltext": "40 ESSENTIALS OP SURGERY.\\nHow do you treat spreading traumatic gangrene?\\nImmediate amputation through healthy tissue, high up.\\nWhat is hospital gangrene\\nAn epidemic, contagious, gangrenous process, dependent upon\\nthe presence of micro-organisms, which destroys granulations,\\nattacks the tissues lying about and beneath them, and rapidly\\nproduces extensive sloughs.\\nGive the symptoms of hospital gangrene.\\nAs for acute mortification. The surface of a wound, or its\\nmargins, are rapidly converted into an extensive slough, there is\\nsurrounding oedema and congestion, the discharge is foul, the\\nprocess rapidly extends.\\nThe constitutional symptoms are adynamic high temperature\\nat first, with weak, quick irregular pulse, wet surface, and, fre-\\nquently, muttering delirium.\\nWhat circumstances predispose to attacks of hospital gan-\\ngrene\\nOver-crowding, deficient ventilation, want of proper nourish-\\nment, or any depressing cause.\\nHow do you treat hospital gangrene?\\nIsolate the patient. Break up the sloughs by thrusting closed\\ndressing forceps through them, and withdrawing the forceps\\nopened. In these openings make a thorough application of pure\\nbromine, nitric acid, or other escharotic. Dress with anti-\\nseptic charcoal poultice, and subsequently observe the most rigid\\nasepsis in regard to wound treatment.\\nConstitutionally give stimulants, free diet, quinine, iron, and\\nopium.\\nWhat is cancrum oris\\nSynonym. Gangrenous stomatitis.\\nIt is a gangrenous ulcer of the cheek or gums, occurring in\\npoorly nourished children. It is frequently developed after an\\nattack of measles, scarlet fever, or typhoid fever. It usually\\nappears opposite a rough or decayed tooth, which has caused\\nan abrasion. It is seen in the mouth as an offensive, sloughing,", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0042.jp2"}, "43": {"fulltext": "INFLAMMATION. 41\\npunched out ulcer on the external surface of the cheek as a\\nglazed, dusky red, indurated spot, which is shortly converted into\\na black slough, causing perforation, and extensive destruction\\nof tissue. The constitutional symptoms are those characteristic\\nof all gangrenous processes.\\nHow do you treat cancrum oris\\nThoroughly cauterize with, nitric acid. Wash at intervals with\\nboracic acid lotion, or tr. myrrh. Give internally stimulants,\\nrich milk in abundance, malt, iron, and quinine. Repair de-\\nformity by subsequent plastic operation.\\nWhat is noma pudendi?\\nA gangrenous process similar to cancrum oris, attacking the\\ngenitals of female children. Treatment. As for cancrum oris.\\nWhat is a bed sore\\nA sloughiug ulcer, due to pressure, appearing on the bony\\nprominences of the weak and badly nourished.\\nHow do you treat bed sores\\nClear away the slough by charcoal poultices, wash and dress\\nantiseptically, relieve the part from pressure by pads, pillows,\\nor air cushions.\\nDescribe a furuncle.\\nDefinition, A circumscribed inflammation of the skin and\\nsubcutaneous tissue, terminating in suppuration, and the forma-\\ntion of a central slough or core. Synonym. Boil,\\nOccurs. In crops, on the neck, nates, and back of the young.\\nCauses. Systemic depression, and the rubbing into the ducts\\nor hair follicles of the skin of a micro-organism.\\nBegins as a red pimple, usually with a hair in the centre, in-\\ncreases rapidly in size, causing a purple-red, very painful\\nswelling which may undergo resolution (blind boil), or open, dis-\\ncharging the central core.\\nTreatment. 1. Pull out the central hair, wash thoroughly\\nwith bichloride, apply 50 per cent, ichthyol ointment. 2. Inject\\nwith Tfl.v. of a 10 per cent, solution of carbolic acid. 3. If in-\\nflammatory symptoms increase in severity, apply spongio piline", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0043.jp2"}, "44": {"fulltext": "42 ESSENTIALS OF SURGERY.\\n(lipped in hot boracic or carbolic acid lotion. 4. When fluctua-\\ntion is evident, incise, syringe the cavity with antiseptic solution,\\nand apply an antiseptic dressing, making firm pressure.\\nWhat is a carbuncle\\nAn inflammation of the skin and subcutaneous tissues, in-\\nvolving a much larger surface than furuncle, and attended by\\nthe formation of sloughs of considerable size.\\nIt differs from boil in being much larger, flattened instead of\\nconical, and accompanied by great surrounding oedema. The\\nskin gives way in several places, sloughs of some size are dis-\\ncharged. Constitutional symptoms are severe.\\nOccurs in the aged and debilitated.\\nCause. The rubbing in, by friction, of a micro-organism.\\nSeats. Neck, back, nates. When occurring on the face or\\nhead it is exceedingly fatal.\\nGive the symptoms of carbuncle.\\nA hard, brawny, flattened, dusky-red area of induration, cir-\\ncular in shape, and riddled with apertures, through which a\\ngray slough can be seen. The constitutional symptoms are\\nsevere and of an adynamic type.\\nGive the treatment of carbuncle.\\nThe constitutional treatment should be conducted on the plan\\nindicated for all gangrenous processes. Stimulants, full diet,\\niron, quinine, and opium may be given. Locally, the affection\\nmay be treated by\\n1. Tight concentric strapping, leaving a central aperture for\\nthe escape of sloughs.\\n2. Hot fomentations or poultices, the moisture being supplied\\nby boracic or carbolic acid solution. Heat and moisture may\\nbe combined with strapping.\\n3. Injections through the inflamed area, and about its periph-\\nery, of carbolic acid (5 or 10 per cent, in glycerine) as much\\nas a half drachm may be used.\\n4. Crucial incision, and removal by curetting of all the involved\\ncellular tissue. The operation must be done antiseptically.\\nPack the wound with iodoform gauze, and apply a thick antisep-\\ntic dressing.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0044.jp2"}, "45": {"fulltext": "INFLAMMATION. 48\\nWhat is the usual cause of dry gangrene?\\nSynonym Senile or chronic gangrene.\\nCause. Arterial obstruction from atheroma and thrombosis.\\nWhat are the premonitory symptoms of senile gangrene\\nThe limb feels cold and numb; tingles and is subject to shooting\\nand violent pains steady deterioration in health.\\nWhat symptoms denote the onset of the disease\\nThe appearance of a black spot, usually to the inner side of\\nthe great toe, surrounded by a dusky-red areola, and causing an\\nintense burning pain. There is a slow extension till the entire\\nfoot becomes hard, dry, black, and mummified.\\nHow do you treat dry gangrene\\nDisinfect the part and wrap in antiseptic wool or cotton. Al-\\nlow a generous diet. Give tonics and stimulants opium two or\\nthree grains daily.\\nUnder what circumstances is amputation required in gan-\\ngrene\\nWhen the line of separation is formed.\\nImmediately, in spreading or traumatic gangrene.\\nIn gangrene from arterial occlusion, when the seat of the\\nocclusion can be certainly determined. Instance, wound or liga-\\ntion of an artery.\\nIn senile gangrene, if the process is slow, if there is no ex-\\nhaustion and no evidence of sepsis, wait a line of demarcation,\\nand amputate through an area which exploratory incisions\\nshow is free from arterial disease. If the process is rapid, if\\nthere be no tendency to form a line of separation, if the patient\\nis exhausted, or if there be evidences of sepsis, amputate high\\nup without waiting for a line of demarcation.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0045.jp2"}, "46": {"fulltext": "44 ESSENTIALS OF SURGERY.\\nWOUNDS.\\nThe Germ Theory.\\nOutline the germ theory.\\nPutrefaction is the result of the growth of micro-organisms in\\nthe substance which putrefies. These micro-organisms are di-\\nvided into\\n1. Non-pathogenic, or those which do not directly create dis-\\nease.\\n2. Pathogenic, or disease creating.\\nAmong the non-pathogenic, are included those which can live\\nor grow only in dead or dying matter, termed saphrophytic.\\nThese saphrophytic micro-organisms, entering a wound in which\\nthere is much pent-up discharge and dying tissue, rapidly in-\\ncrease, and produce certain irritating substances, called ptomaines.\\nThe absorption of ptomaines into the system gives rise to the\\nsymptoms which are characterized as septic intoxication, ptomaine\\nfever, or saprxmia.\\nPathogenic micro-organisms thrive not only on dead matter, but\\ninvade and destroy the living tissues. They may be carried\\nthrough the circulation to all parts of the body, increasing with\\nincredible rapidity wherever deposited, destroying tissue, and\\nforming fresh centres for the production of poisonous products.\\nThey enter the system, by a process of direct inoculation, through\\nwounds. Nearly all pathogenic microbes are either micrococci\\n(spherical) or bacilli (rod-shaped).\\nWhat are the general principles of antiseptic treatment?\\nPrevent wound-changes due to the presence or introduction\\nof micro-organisms or, if such changes have begun, endeavor\\nto arrest them. Since microbic changes depend upon the pres-\\nence of organisms and a soil in which they can grow, the indi-\\ncations for the prevention of these changes are\\n1. Exclude all organisms from the wound. This may be ac-\\ncomplished by most minute attention to the details of surgical\\ncleanliness.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0046.jp2"}, "47": {"fulltext": "WOUNDS. 45\\n2. Bemove organisms from the wound, before they can work\\nharm, by irrigation.\\n3. Destroy organisms, by bichloride or other germicides.\\n4. Bemove the soil in which organisms can nourish, by free\\ndrainage.\\n5. Prevent the formation of favorable soil, by avoiding tension\\nor unnecessary manipulation, and by careful dry dressing.\\nWhat is the distinction between antiseptic and aseptic\\nAseptic means germ free; antiseptic means germ destroying.\\nThe surgeon who does not practise antisepsis cannot procure\\nasepsis. An aseptic wound is the result of antiseptic treatment.\\nDressings sterilized by heat have undergone as thorough anti-\\nseptic treatment as those saturated with bichloride. By an\\naseptic dressing is meant the application of substances previously\\nsterilized, but containing, at the time of application, no germ-\\ndestroying agents. Antiseptic dressings contain germ destroying\\nagents. By the term aseptic operation we mean an opera-\\ntion conducted with cleanliness, but without the introduction\\nof a chemical germicide into the wound.\\nShock.\\nWhat is shock?\\nA lowering of the vital powers consequent on profound mental\\nor physical impression. Shock is a vaso-motor paralysis, affect-\\ning also the heart, and chiefly the abdominal vessels.\\nWhat are the causes of shock\\n1. Powerful mental impressions, joy, grief, and fear.\\n2. Mechanical injury; traumatism, especially of the abdomen;\\nburns, scalds, cold gunshot, lacerated, and contused wounds.\\nAs predisposing causes can be classed all conditions which\\ncause enfeeblement of the resisting powers. Instance, Bright s\\ndisease, sedentary occupation, and hemorrhage.\\nWhat are the symptoms of shock?\\nPulse first slow, then rapid, feeble, compressible, and scarcely\\nperceptible. Temperature sub-normal.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0047.jp2"}, "48": {"fulltext": "46 ESSENTIALS OF SURGERY.\\nSurface cold, pale, and wet.\\nMuscular system relaxed, contractility of sphincters lost.\\nPatient lies in any position in which he may be placed. Decu-\\nbitus usually dorsal. Nausea and vomiting frequently present.\\nConsciousness and special senses blunted.\\nWhat is your prfignosisjn shock?\\nBad if the temperature falls below 96\u00c2\u00b0, or if reaction is delayed\\ntwenty-four hours.\\nWhat becomes of a patient suffering from shock\\nHe either collapses and dies from syncope or asthenia, or reacts.\\nDescribe reaction.\\nHealthy reaction is characterized by an increase in the force,\\nand a diminution in the rapidity of the heart s beat, a rise of\\ntemperature, a restoration of color to the blanched surface, and\\ndisappearance of all the characteristics of shock. In other cases\\nreaction may take the form of an acute fever, with flushed face,\\ninjected conjunctivae, high temperature, restlessness, jactitation,\\nactive or muttering delirium, and a full, throbbing pulse. The\\npulse, however, is soft and compressible the tongue is dry and\\ntremulous the symptoms are asthenic, and are liable to lapse again\\ninto profound and fatal shock. This condition is termed trau-\\nmatic delirium, and is a condition of under reaction from shock.\\nHow do you treat shock\\nExternal warmth most important of all treatment. Hot bath,\\nhot bricks or bottles applied along the spine, to the epigastrium,\\nand about the patient s body and limbs.\\nPosition. Dorsal decubitus with head low.\\nMedication. Atropia gr. y^ and brandy 3js, every thirty\\nminutes hypodermically morphia gr. if there is great pain.\\nAvoid medication by the stomach till reaction begins, as there is no\\nabsorption. Use stimulating enemata. Hot coffee, or hot, highly\\nseasoned beef tea, may be given in small doses by the mouth.\\nHypodermoclysis or enteroclysis or venous transfusion of hotnor-\\nmal salt solution. When reaction has fairly set in, stop stimidating.\\nDescribe the forms of traumatic delirium.\\nIn addition to the form described as an imperfect reaction", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0048.jp2"}, "49": {"fulltext": "WOUNDS. 47\\nfrom shock, there is an inflammatory, a nervous, and an alcoholic\\ntraumatic delirium.\\nThe inflammatory form is characterized by fever and sthenic\\nsymptoms with either sthenic or asthenic condition. It develops\\nin from three to five days after the injury, and is really a symp-\\ntom of septic inflammatory fever. Treat as for the fever, apply-\\ning an ice cap to the head.\\nThe nervous and alcoholic forms of traumatic delirium have the\\nsame busy asthenic delirium, the soft, full, quick pulse, the\\ntremulousness, and absence of fever, the difference being that\\nthe nervous is not caused by alcohol.\\nTreatment. Stimulants, bromide, chloral, morphia. Clear\\nthe bowels, give plenty of nourishing liquid food highly-\\nseasoned.\\nWhat is secondary shock\\nSymptoms coming on at varying times from the primary\\nshock, and causing death from heart clot, are characterized as\\nsecondary shock.\\nShould you operate during shock?\\nNot unless it is for the relief of a condition causing, or keep-\\ning up the shock. Instance, a strangulated hernia, a bleeding\\nartery, a depressed fracture of the skull. The rule is to wait\\nfor reaction.\\nWound Fever.\\nWhat is primary wound fever\\nA fever accompanying healing without suppuration.\\nWhat are its forms\\nAseptic fever and traumatic or surgical fever.\\nWhat is aseptic fever\\nThe slight febrile condition which accompanies the healing\\nof aseptic wounds. The temperature may reach 102\u00c2\u00b0, but it\\nbecomes normal in a day or two, and the rise is due to the ab-\\nsorption of fibrin ferment.\\nWhat is traumatic or surgical fever?\\nThe febrile state developed during the healing of wounds", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0049.jp2"}, "50": {"fulltext": "48 ESSENTIALS OF SURGERY.\\nwhich are inflamed but not suppurating, and caused by the\\nabsorption of the pyrogenous products of inflammation and\\nthe ptomaines of bacteria. A day or two after the operation\\nthe temperature rises to 102\u00c2\u00b0 or more, and there are positive\\nevidences of the febrile condition. On the third or fourth day\\nsuppuration occurs. The fever lasts about one week.\\nWhat is scondary wound fever\\nA fever arising after the establishment of suppuration, and\\nespecially marked when pus is pent up.\\nHow would you treat aseptic fever?\\nThe patient is very comfortable, and no especial treatment is\\nrequired.\\nHow would you treat surgical fever\\nCut the stitches and evacuate retained fluids; either lay\\nopen or insert tubes after irrigation, and apply antiseptic\\ndressings.\\nHow would you treat secondary wound fever\\nMake counter-openings for drainage and irrigate use stimu-\\nlants, good food, and opiates.\\nWhat is septicaemia\\nA poisoning by the absorption of pus cocci or their ptomaines.\\nHence, it is most liable to occur in wounds not treated antisep-\\ntically, or in those which, from their depth, extent, or location,\\ncannot be thoroughly disinfected and protected. Instance,\\ncompound fractures, wounds involving the peritoneum.\\nWhat are its forms\\nTrue septicaemia or septic infection, due to the absorption of\\nthe organisms and their multiplication in the blood. Sapraemia\\nor septic intoxication, due to the absorption of a large dose of\\npoisonous ptomaines.\\nGive the symptoms of septicaemia.\\nInflammatory fever may run into septicaemia, or this affection\\nmay develop very shortly after the infliction of a wound.\\nTemperature. Rises suddenly, and is at first very high (104\u00c2\u00b0-\\n106\u00c2\u00b0), may shortly sink to normal or below.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0050.jp2"}, "51": {"fulltext": "WOUNDS. 49\\nPulse. Soft, rapid, and compressible, becoming weak and\\nthready. Respirations, rapid and shallow.\\nNervous condition, heavy, apathetic, somnolent. Rarely, active\\ndelirium.\\nTongue, dry, hard, and discolored. Teeth covered with sordes.\\nAt times profuse diarrhoea. Urine and fseces passed involunta-\\nrily. Death in collapse.\\nThe wound is always unhealthy, frequently sloughing.\\nThe septic poisoning may be so slight in amount as to cause\\nscarcely recognizable symptoms, or may, within twenty-four\\nhours of the infliction of an injury, overwhelm the system.\\nHow do you treat septicaemia\\nRemove the septic matter, and make the wound sterile by\\nirrigation, or continuous baths with bichloride solution. Elimi-\\nnate the ptomaines by a saline purge. Support the strength by\\nstimulants, quinine in tonic doses, nutritious food given fre-\\nquently in small quantities milk and malt, peptonoids, raw beef\\njuice. Reduce high temperature by antipyrine, gr. x.-xv., or\\nquinine, gr. xx. Intravenous use of normal salt solution may\\ndo good. Secure plenty of fresh air and sunlight.\\nWhat is pyaemia?\\nA septic fever, characterized by the formation of metastatic\\nabscesses. Pathogenic organisms (staphylococci and strepto-\\ncocci) invade the blood, and are carried from the infected area\\nto all parts of the body, where they are lodged as emboli, and\\nform new foci of suppuration and infection.\\nWhat is the difference between traumatic inflammatory fever,\\nsepticaemia, and pyaemia\\nSimply a difference of degree. They all depend upon the same\\ncause, and are of the same nature. They occur only in infected\\nwounds, and are due to the septic action of micro-organisms and\\ntheir products.\\nWhat are the symptoms of pyaemia\\nIrregularly recurring attacks, characterized by a marked and\\nprolonged chill, associated with high temperature (104\u00c2\u00b0-106\u00c2\u00b0) fol-\\nlowed by a brief hot stage, the patient manifesting the symptoms\\n4", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0051.jp2"}, "52": {"fulltext": "50 ESSENTIALS OF SURGERY.\\nand signs of fever terminating in a drenching sweat, the tempera-\\nture quickly falling to normal or below. Several such attacks\\nmay occur in a day. The strength rapidly fails the pulse be-\\ncomes weak and rapid the tongue dry and brown coated\\nbreath mawkish metastatic abscesses are detected in the lungs; the\\nwound is unhealthy, the discharges ichorous.\\nHow do you treat pyaemia?\\nThoroughly cleanse the original source of infection by irriga-\\ntion, curetting, and antiseptic dressing if this be impracticable,\\nas in osteomyelitis, amputate. Open and drain all accessible\\nabscesses. Push stimulants to their fullest extent, give quinine\\nin heroic doses (gr. lx. daily), milk and pressed beef-juice in small\\nquantities frequently repeated. Provide for sun-light, and open\\nair.\\nWhat is hectic fever\\nA continued remittent fever, due to septic absorption char-\\nacterized by rigors and fever during the afternoon and evening,\\nfollowed by profuse sweats and defervescence during the night.\\nThe pulse is constantly rapid, the eye bright, the cheek flushed,\\nthe tongue red and dry at the edges, the emaciation progressive.\\nInstance, the fever of consumption.\\nHow do you treat hectic?\\nKemove the source of septic absorption, by resection, if it is an\\ninfected bone area by incision and curetting, if it is an abscess.\\nGive tonics, stimulants, and a full nourishing diet. Change of air\\nis beneficial.\\nErysipelas.\\nWhat is erysipelas?\\nAn acute infective capillary lymphangitis due to the strepto-\\ncoccus of erysipelas.\\nWhat is its cause\\nA special streptococcus.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0052.jp2"}, "53": {"fulltext": "WOUNDS. 51\\nName the varieties of erysipelas.\\n1. Cutaneous or simple. 2. Cellulo-cutaneous ox phlegmonous.\\n3. Cellular or diffuse cellulitis.\\nDescribe simple erysipelas.\\nConstitutional symptoms. Kigors, headache, and fever, the\\ntemperature suddenly rising to 103\u00c2\u00b0 or 104\u00c2\u00b0 with nausea and\\nvomiting. The fever shortly assumes a typhoid type.\\nLocal symptoms. A rash, rapidly spreading from a scratch,\\nabrasion, or wound, and characterized by well defined margins,\\nrosy-red hue, smooth, glazed, cedematous, slightly raised surface,\\nstiffness and burning pain, frequently blebs or vesicles, involve-\\nment of nearest lymphatic glands. The eruption may suddenly\\ndisappear from one part to reappear in another, erysipelas\\nambulans.\\nThe pathogenic organism of simple erysipelas has been isolated.\\nIt is found blocking the lymph vessels and spaces in the spreading\\nborders of the inflammation, shows up well in dry cover glass\\npreparations, appearing as micrococci grouped in chains, and is\\ndiagnostic of erysipelas. The eruption lasts about four days in\\none part, and as it subsides is followed by desquamation.\\nGive the treatment of simple erysipelas.\\nIf there is a distinct wound, thoroughly cleanse and drain it.\\nFreely open the bowels by a saline cathartic. Milk diet for the\\nfirst few days. Tr. fer. chlor. TTL xx. every two hours from the\\nfirst shortly begin quinine, in tonic doses (gr. v. to x. daily),\\nstimulants, and as free a diet as the stomach will bear.\\nTo the eruption apply starch and zinc oxide, equal parts of\\neach, and cover in with cotton-wool or apply a 50 per cent,\\nichthyol ointment, over which is placed salicylated cotton.\\nDescribe phlegmonous erysipelas.\\nThe skin and subcutaneous tissues are both affected the\\nsymptoms are, in general, the same as for simple erysipelas, but\\nmore marked. The swelling is greater, the edges not so\\nsharply circumscribed, the color darker, blebs and vesicles are\\nmore common.\\nThe surface, at first densely indurated, becomes boggy in spots", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0053.jp2"}, "54": {"fulltext": "52 ESSENTIALS OF SURGERY.\\nand may break down, exposing extensive sloughs. The consti-\\ntutional symptoms are well marked, running shortly into the\\ntyphoid type. The patient may perish from pneumonia, blood\\npoisoning, or exhaustion.\\nHow do you treat phlegmonous erysipelas\\nConstitutionally as in the case of simple erysipelas. A purge,\\nlight milk diet followed in a day or two by full nourishment,\\ntonics, and stimulants. Iron as before.\\nLocally. Applications of heat and moisture (hot antiseptic\\nfomentations). Multiple incisions as soon as the part becomes\\nbrawny, going down to, but not through the deep fascia. Check\\nhemorrhage by packing with iodoform gauze. Strict antiseptic\\ndressing.\\nDescribe cellular erysipelas, or diffuse cellulitis.\\nThis is a spreading infective inflammation, which may involve\\nthe cellular tissues of any part of the body. Instance, the inter-\\nmuscular planes, the pelvic cellular tissues.\\nThe constitutional symptoms are the same as those character-\\nizing phlegmonous erysipelas the typhoid condition appears\\nmore quickly, and septic poisoning is more commonly developed.\\nThe local symptoms are at first less marked than in any of the\\nvarieties of erysipelas. There is dense induration succeeded by\\nbogginess and ending in extensive sloughing.\\nTreatment as for cellulo-cutaueous. Incisions early. Stimu-\\nlating and supporting treatment from the first.\\nTetanus.\\nWhat is tetanus?\\nA disease characterized by tonic spasm of the voluntary mus-\\ncles with clonic exacerbations, due to the introduction into the\\nsystem from a wound of the ptomaines of the bacillus tetani.\\nWhat are the causes of tetanus?\\n1. Predisposing. Hot climate, exposure to cold and damp, or\\nsudden change of temperature, negro race, lacerated and punc-\\ntured wounds, burns, frost-bites, all septic wounds.\\n2. Exciting. A micro-organism.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0054.jp2"}, "55": {"fulltext": "WOUNDS. 53\\nWhat are the symptoms of tetanus?\\nA slight stiffness of the muscles of the neck and jaws, with\\nincrease of pain, and the appearance of a sanious or ichorous dis-\\ncharge in the wounded part, denote the onset of the disease.\\nAll the voluntary muscles, including those of respiration, may\\nbecome involved. There is intense precordial pain from tonic\\nspasm of the diaphragm, the countenance exhibits a peculiar\\ngrinning expression (risus sardonicus), and at the slightest irri-\\ntation, such as a breath of air, a loud noise, or an attempt to\\nswallow, violent spasms occur which may variously contort the\\nbody. If the spinal muscles are chiefly affected, we have opis-\\nthotonos, or arching backward, the body being supported on the\\nhead and heels. Emprosthotonos may be developed, the body\\nbeing bent forward and rolled up like a ball. More rarely pleu-\\nrothotonos, or drawing of the body to one side, is seen. The\\nskin is wet, the bowels confined, the temperature about normal\\nit may rise to 108\u00c2\u00b0 or 110\u00c2\u00b0 shortly before death. Intellect\\nclear.\\nWhat is the prognosis of tetanus\\nBad in acute cases becomes more favorable if life be pro-\\nlonged till the twelfth day. Death occurs from spasm of the\\nglottis or respiratory muscles, from syncope, from exhaustion.\\nWhat are the diagnostic points of tetanus\\nThe absence of fever from the first, the tonic character of the\\nspasm, the early involvement of the neck and jaw, the marked\\nconvulsive attacks, and the clear mind.\\nGive the treatment of tetanus.\\nLocal. Make the wound aseptic.\\nConstitutional. Bromide of potassium up to its constitutional\\neffect (40 to 80 grains every two hours), chloral at night to produce\\nsleep. Morphia may be given it must be pushed to the extreme\\nlimit of safety. An antitoxine has been advised, consisting of the\\nblood serum of animals rendered immune by inoculations. This\\nis given hypodermatically. Recently, in some cases antitoxine\\nhas been injected directly into the frontal lobe of the brain. To\\nprevent death from asphyxia, give chloroform during the spasm.\\nStimulants and nourishing diet are indicated from the first.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0055.jp2"}, "56": {"fulltext": "54 ESSENTIALS OF SURGERY\\nHydrophobia.\\nWhat is hydrophobia\\nA disease due to a specific poison introduced into the system\\nby the bite of a rabid animal.\\nWhat bites are especially liable to be followed by hydrophobia?\\nThose on the face, or involving parts of the body unprotected\\nby clothing.\\nWhat is the period of incubation\\nIt varies from six weeks to three months it may be a very\\nfew days, or many years.\\nWhat are the symptoms of hydrophobia\\nFirst stage, or stage of melancholia, itching, burning, or inflam-\\nmation of the cicatrized wound anxiety, melancholia, or change\\nof disposition slight difficulty in swallowing, or a catch in the\\nrespiration. After a few days the disease is fully developed.\\nThe stage of excitement is characterized by clonic convulsions,\\ninvolving especially the muscles of respiration and deglutition\\nby mental disorder similar to that of delirium tremens, with\\nperiods of maniacal excitement, and intervals of lucidity. It is\\nfollowed after some days by the stage of exhaustion and paralysis.\\nThe muscular system is entirely unresponsive, and the dying pa-\\ntient lies motionless the mind is often clear at this stage.\\nHow do you treat hydrophobia\\nAt the time the wound is inflicted, cauterize, at once and thor\\noughly, by hot iron, nitric acid, or caustic potash. Suck the wound.\\nIf the wound has cicatrized when seen, excise the cicatrix. Send\\nthe patient where he can be inoculated after Pasteur s method\\nwith attenuated virus.\\nWhen the symptoms are pronounced, morphia, chloral, chloro-\\nform to relieve suffering. Pilocarpine gr. hypodermically,\\nrepeated frequently. Hot vapor bath.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0056.jp2"}, "57": {"fulltext": "WOUNDS. 55\\nGlanders.\\nWhat is glanders?\\nAn infective disease of horses, dependent on a specific micro-\\norganism communicable to man through wounds, or the mu-\\ncous membrane. In horses it is called glanders when it attacks\\nthe nasal mucous membrane, farcy when it attacks the lymphatic\\nvessels and glands.\\nWhat are the symptoms of glanders\\nA discharge from the nose, thin, sanious, offensive, purulent,\\nwith involvement of the submaxillary glands. A pustular erup-\\ntion resembling smallpox, involving the skin and the mucous\\nmembrane of the respiratory and alimentary tracts. Sub-cutane-\\nous nodules, shortly breaking down and forming foul ulcers.\\nThere is fever, which quickly becomes adynamic, and death\\ntakes place within a week from septicaemia or pysemia. There is\\na chronic form of glanders with less marked symptoms, and from\\nwhich recovery is possible.\\nHow do yon treat glanders\\nUse antiseptic nose washes (boracic acid or weak bichloride\\nsolution). Open abscesses. Pursue from the first a tonic, stimu-\\nlating, and supporting treatment.\\nMalignant Pustule.\\nWhat is anthrax\\nA specific infective disease due to the entrance of a bacillus\\nor its spores into the system. Its starting-point is in a scratch\\nor abrasion. It is found, in this country, mainly among those\\nwho handle imported hides or wool.\\nWhat are the symptoms of anthrax\\nA red, itching pimple, followed shortly by a vesicle attended\\nwith well-marked, brawny induration. Sloughing begins at once,\\nand the anthrax pustule is formed, characterized by a dry, central\\nslough, surrounded by a ring of vesicles, peripheral to which there", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0057.jp2"}, "58": {"fulltext": "56 ESSENTIALS OF SURGERY.\\nis an area of redness, induration, and great oedema. The neigh-\\nboring lymphatic glands are involved. Fever of an adynamic\\ntype develops, and the patient commonly perishes of exhaustion\\nor syncope. Diagnosis by examining the contents of the vesicle\\nbacilli from ^g to y^s of an inch in length can be detected by\\nlow powers of the microscope.\\nHow do you treat malignant pustule\\nFreely excise the pustule, and either cauterize the wound with\\ncaustic potash or carbolic acid, or wash thoroughly and repeatedly\\nwith 5 per cent, potassium permanganate solution. A stimu-\\nlant, tonic, and supporting treatment is indicated constitution-\\nally.\\nThe Healing of Wounds.\\nDescribe the process of repair in incised wounds.\\nRepair takes place in all wounds by the organization of plastic\\nlymph.\\nIf the wound is an incised one, if its surfaces are accurately\\napproximated, if it is not subject to irritation, either mechanical\\nor chemical, the exudation takes place in minimum quantity,\\nthe red blood corpuscles of the blood clot are absorbed in\\ntwenty-four hours the surfaces adhere, and in two or three\\ndays the thin layer of plastic lymph which binds them together\\nis supplied with vessels this is called union by adhesion or by\\nfirst intention. Inflammation scarcely passes the first stage\\nthere is simply a little hyperemia, pufliness, and tenderness\\nabout the lips of the wound.\\nIf the wound surfaces are not accurately apposed, if they\\nare subject to irritation, either mechanical, from improper\\ndressing, or chemical, from irritating applications or the pro-\\nducts of germ life, the exudation becomes excessive there is\\ndeath of tissue, there is suppuration if tension and other\\nsources of irritation be removed by free discharge, the gap is\\npromptly filled in with organized plastic lymph or granulations,\\nand the wound heals by granulation or second intention.\\nIf healthy granulating surfaces can be brought together and", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0058.jp2"}, "59": {"fulltext": "WOUNDS. 57\\nretained in position, permanent adhesion between them takes\\nplace at once. This constitutes union by secondary adhesion or\\nthird intention.\\nPrimary adhesion or first intention. The prompt union of\\ndivided surfaces without obvious signs of inflammation.\\nAdhesion by granulation or second intention. The union of\\ndivided surfaces by granulation tissue (organized lymph), at-\\ntended with evident inflammatory symptoms.\\nSecondary adhesion or third intention. The union of granula-\\nting surfaces. Amputation flaps which fail to unite by primary\\nintention heal in this way.\\nWhat circumstances prevent wounds from healing by primary\\nintention?\\n1. Want of accurate apposition from gaping, from extensive\\nloss of substance, from retained blood or wound secretions, or\\nfrom foreign body.\\n2. Want of proper protection. There may be undue motion of\\nthe part, it may be subject to direct mechanical or chemical\\nviolence, it may be exposed to infection from poisonous agents.\\n3. Defective nutrition, either local, from bad position or from\\ntension, or general from constitutional weakness.\\nThe Treatment of Wounds.\\nWhat are the general indications in the treatment of wounds?\\n1. Arrest hemorrhage.\\n2. Cleanse, and remove foreign bodies.\\n3. Provide for drainage.\\n4. Bring the wounded surfaces in contact, and keep them\\napposed.\\n5. Provide for absolute local rest.\\n6. Prevent putrefaction.\\nName the varieties of hemorrhage.\\nArterial^ Venous, Capillary. Internal or concealed hemorrhage\\nindicates bleeding into one of the cavities of the body. Ex-\\ntravasation indicates bleeding into the areolar tissue. Further,\\nhemorrhage may be primary, intermediate or consecutive, secondary.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0059.jp2"}, "60": {"fulltext": "58 ESSENTIALS OF SURGERY.\\nWhat are the characteristics of the different kinds of hemor-\\nrhage\\nArterial. Bright red blood jets from the wound. Pressure\\non the arterial trunk above checks the bleeding.\\nVenous. Dark blood wells from the wound. Pressure on the\\nvenous trunk below checks the bleeding.\\nCapillary. The blood oozes from the surface of the wound,\\nand collects as a pool in its deeper parts.\\nWhat are the constitutional effects of hemorrhage?\\nA feeble, fluttering, rapid pulse, finally perceptible in the\\nlarge arteries only. A cold, blanched, wet surface, with colorless\\nlips, and sighing respiration. ^Nausea. Frequently, uncontrol-\\nlable restlessness, a roaring in the ears, darkness before the eyes,\\nand horrible sinking sensations. The patient may suddenly\\nfaint. In syncope the heart s action is so feeble that clotting\\nmay take place and bleeding be permanently arrested, or, on re-\\naction, the clot may be washed away by the returning blood\\ncurrent and bleeding continue, to end in a return of syncope,\\nin convulsions and death. Or the patient may recover, passing\\ninto the condition known as hemorrhagic fever, an irritative fever\\ncharacterized by rise of temperature, extreme restlessness, great\\nthirst, and a quick jerky pulse.\\nA sudden violent hemorrhage is much more liable to produce\\nfatal syncope than a slow continuous one. Infants bear the loss\\nof blood very badly.\\nDescribe nature s method of arresting hemorrhage.\\n1. Contraction and retraction of the vessels.\\n2. Coagulations of the blood aided, after severe bleeding, by\\nenfeebled heart action and alteration in the composition of the blood.\\nOn cutting an artery the muscular fibres of its midddle coat\\ncontract, narrowing or closing the lumen and drawing the end\\nof the vessel from its sheath the cut ends also retract from each\\nother, owing to the natural elasticity of the artery. Neither con-\\ntraction nor retraction can take place unless the artery is entirely\\ncut across; hence, complete section of a bleeding artery often\\nstops the hemorrhage.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0060.jp2"}, "61": {"fulltext": "wounds. 59\\nCoagulation is excited by the divided vessel wall, the sheath\\nof the artery, and the air it presently occludes the opening in\\nthe artery, and also fills with clot the space left vacant in the\\nsheath by retraction this constitutes external clot. Coagulation\\nalso extends from the mouth of the vessel backward, forming a\\nclot, conical in shape, with its base to the wound, and extend-\\ning as far as the nearest branch this constitutes the internal\\nclot.\\nBy continued hemorrhage the blood is made more coagulable\\na clot forms too rapidly to be washed away by the feeble arterial\\nwave. Arrest of hemorrhage from veins is due to coagulation.\\nThe permanent arrest of hemorrhage is effected by the exudation\\nof plastic lymph, which takes the place of the clot, the subsequent\\norganization of this lymph, and the conversion of the occluded\\npart of the artery into a fibrous cord.\\nWhat is the constitutional treatment of hemorrhage\\nThe patient should be laid flat on his back if the symptoms\\nare very severe, elevate the foot of his bed and apply an Esmarch s\\nbandage to the legs and arms, thus keeping the blood to the\\nnerve centres. Hot bottles may be applied about the body. In\\nextreme cases resort to transfusion. Ether Tftxxx., morphia\\ngr. should be given subcutaneously. Place a mustard plaster\\nover the heart. Give injections of hot water and brandy. Hot\\ncoffee or beef tea in frequently repeated small doses by the mouth,\\nif the stomach is retentive. As the patient recovers stop stimu-\\nlants. Give milk diet at first, increasing as rapidly as possible.\\nGive iron as soon as the stomach will allow of its use. In all\\ncases avoid stimulants unless life is directly threatened by cardiac\\nfailure. The use of stimulants is frequently attended by a re-\\nturn of bleeding.\\nDescribe the methods of transfusion.\\nBlood or saline solutions may be used. It must be introduced\\nwarm (98\u00c2\u00b0-100\u00c2\u00b0), in sufficient quantity to add strength and\\nvolume to the pulse, and must not contain bubbles of air. Trans-\\nfusion may be immediate, the blood being passed directly from\\nthe vein of the donor to the patient s circulation or mediate, the\\nblood being first whipped and strained of its fibrin, then injected.\\nS", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0061.jp2"}, "62": {"fulltext": "60 ESSENTIALS OF SURGERY.\\nHow do you check hemorrhage?\\nBy 1. Position. 2. Cold. 3. Heat. 4. Pressure. 5. Styp-\\ntics. 6. Cautery. 7. Ligation. 8. Torsion. 9. Acupressure.\\n10. Forcipressure. 11. Constitutional treatment.\\nWhat position favors the checking of hemorrhage\\nElevation of the part and forcible flexion. Flexion bends the\\nartery sharply on itself, and is applicable to wounds of the ex-\\ntremities.\\nDescribe the use of cold as a haemostatic.\\nUsed only to check bleeding from smaller vessels. Causes con-\\ntraction and coagulation. Ice, ice- water as a fine forcible stream\\ndirected against the bleeding point, or a spray of ethyl chloride.\\nDescribe the use of heat as a haemostatic.\\nUsed to check general oozing from large surfaces. It causes\\ncontraction and coagulation. Apply in the form of large com-\\npresses wrung out in hot (120\u00c2\u00b0-140\u00c2\u00b0) water.\\nDescribe the use of pressure as a haemostatic.\\nA graduated compress and a bandage may be used for the\\npermanent arrest of hemorrhage when other means are not avail-\\nable, or when several vessels are bleeding and there is a firm\\nbone against which to make pressure. Instance, wounds of the\\npalm or of the scalp.\\nAs a temporary means of checking bleeding the finger in the\\nwound is most efficient, the hemorrhage from any accessible\\nartery can be checked in this way. The tourniquet and Es-\\nmarch s rubber tube are also of temporary service.\\nDescribe the use of styptics as haemostatics.\\nAct by coagulating the blood, they also contract the arteries.\\nThey must be brought into immediate contact with the bleeding\\nvessel. They all interfere with primary union. Use powdered\\nalum, antipyrine, tannin, gallic acid, or persulphate of iron so-\\nlutions of the same drugs, especially hot saturated solutions of\\nalum, maybe employed; alcohol, turpentine, chloroform are\\nalso recommended. Chiefly useful in checking bleeding from\\nmalignant ulcers or in inaccessible regions. Styptics should be\\nemployed in conjunction with pressure.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0062.jp2"}, "63": {"fulltext": "WOUNDS. 61\\nDescribe the use of the actual cautery as a haemostatic.\\nIt coagulates the blood, causes contraction of the muscular coat\\nof the artery, and forms an eschar. It should not be heated be-\\nyond a dull red. Secondary hemorrhage may occur when the\\neschar separates. Applicable where there is difficulty in placing\\nligatures. Instance, in operation about the bones of the face.\\nPaquelin s cautery or the galvano cautery should be used.\\nDescribe ligation as a means of arresting hemorrhage.\\nThis is the most important of all haemostatic agents. By the\\npressure of the thread, the middle and internal coats are divided,\\nand curl up within the vessel, causing clotting this clotting\\nextends to the first lateral branch.\\nIf the artery is ligated in its continuity, a conical clot is formed\\non both the distal and proximal sides of the ligature, with the\\napex in each case pointing away from the thread.\\nAbout the ligature there is deposited a layer of plastic lymph\\nthe internal clot becomes infiltrated with leucocytes and or-\\nganizes the ligature, if aseptic, is either absorbed or encysted,\\nand the artery is converted into a fibrous cord. If the ligature\\nis septic, or subject to irritation, it separates by ulceration; this\\nseparation may be accompanied by secondary hemorrhage.\\nWhat precautions are observed in applying a ligature?\\nIt must be aseptic. It should include only the vessel. If ap-\\nplied to an artery in its continuity, a healthy part of the vessel\\nmust be selected a square knot should be tied.\\nOf what should ligatures be made?\\nCatgut, rendered aseptic by carbolic acid, corrosive sublimate,\\nboiling in alcohol or cumol, or some other method, and possibly\\nhardened by chromicizing sterile silk.\\nDescribe the method of applying torsion as a haemostatic.\\nTorsion consists in seizing the artery in torsion forceps, draw-\\ning it from its sheath, and twisting till the inner and middle\\ncoats give way.\\nDescribe acupressure.\\nThis consists in checking hemorrhage by compressing the", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0063.jp2"}, "64": {"fulltext": "62\\nESSENTIALS OF SURGERY.\\nwounded vessel between an acupressure needle and the tissues.\\nThe methods of accomplishing this are by\\n1. Circumclusion. A pin or needle is thrust through the tissues,\\nbeneath the artery, and brought out to the surface on the opposite\\nside. If necessary a thread can be carried around the two ex-\\ntremities of the pin in the form of a figure-of-8. The hare-lip\\nsuture is really an application of circumclusion.\\n2. Torsoclusion. The pin transfixes the tissues parallel to the\\nartery, is twisted till it lies at right angles to its former direc-\\ntion, is pushed directly across the artery, and plunges into the\\ntissues on the opposite side.\\n3. Retroclusion. The needle is carried in and out, transfixing\\nthe tissues on one side of the artery and at right angles to its\\ncourse. The point of the needle is then carried over the artery\\nto the opposite side, is plunged directly downwards, is carried\\nunder the artery and its point makes its\\nFi S- 1 appearance on the side from which it\\noriginally started.\\nDescribe forcipressure.\\nForcipressure consists in seizing the\\nend of the bleeding vessel in haemostatic\\nforceps, which are allowed to remain in\\nplace till either the end of the opera-\\ntion, or till the forceps are required in\\nanother place, when they should be\\ngently removed. The artery is crushed\\nthe middle and inner coats break as in\\nligation.\\nWhat drugs may be administered by\\nthe mouth for the arrest of hem-\\norrhage\\nOpium, ergot, ol. erigeron., acid.\\nsulph. aromat, acetate of lead.\\nWhat is primary hemorrhage\\nBleeding which occurs immediately,\\nHemostatic forceps. on the infliction of a wound.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0064.jp2"}, "65": {"fulltext": "WOUNDS. 63\\nWhat is recurrent hemorrhage?\\nSynonyms Keactionary, consecutive, intermediate.\\nBleeding, which comes on with reaction. It occurs within the\\nfirst twenty-four hours after a wound.\\nWhat are the causes of recurrent hemorrhage\\nThe slipping of a ligature. The displacement of a clot. This\\nmay occur from the wounded part not being kept at rest, or from\\nthe increased force of reaction circulation.\\nHow do you treat recurrent hemorrhage\\nFirst elevaze, and apply firm pressure by means of additional\\nbandages, covering in the soiled dressings with antiseptic gauze.\\nIf bleeding still continues, remove the dressing, open the wound,\\nclear out the clots, and ligate or secure the bleeding vessel.\\nWhat is secondary hemorrhage?\\nBleeding which comes on between the end of the first day and\\nthe complete cicatrization of the wound. It is most frequent\\nabout the time of the separation of ligatures or sloughs.\\nWhat are the causes of secondary hemorrhage\\n1. Constitutional conditions which interfere with organization,\\nor are associated with an overacting heart. Instance, Bright s\\ndisease, diabetes, haemophilia, traumatic delirium, septicaemia,\\npysemia, and plethora.\\n2. Disease of the arterial walls, as found in atheroma, calcare-\\nous degeneration, syphilis, or tuberculosis.\\n3. Septic condition of the wound. The ulceration and sloughing\\nmay involve the arterial walls.\\n4. Defect in the ligature or its application. The ligature may\\nsoften prematurely. It may be septic and cause suppuration.\\nIt may be badly applied, being too loose, or irregularly knotted,\\nor tied too near a collateral branch.\\nHow do you treat secondary hemorrhage\\nIf from a severed artery, as in a stump, and only a few days\\nhave elapsed since the infliction of the wound, treat as consecu-\\ntive hemorrhage that is, try elevation and pressure first, if the\\nbleeding be moderate, that failing, or at once, in case of violent", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0065.jp2"}, "66": {"fulltext": "64 ESSENTIALS OF SURGERY.\\nhemorrhage, reopen the wound and secure the vessel. If there\\nis much sloughing use the actual cautery.\\nLater, when the healing is well advanced, try pressure first,\\nthen either reopen the wound, or ligate the main artery just\\nabove. If the bleeding recurs amputate higher up.\\nIf from an artery tied in its continuity. Pressure by graduated\\ncompresses and compression of the artery above. If this fails\\nopen the wound and tie above and below. Should the bleeding still\\npersist amputate, if the femoral artery is the one involved, or\\ntie above, in the case of other arteries.\\nHow do you cleanse wounds\\nGross foreign particles can be picked out with forceps. Blood\\nclots and dust should be washed away by means of a fine stream\\nof sterile or antiseptic liquid avoid all rough handling or\\nrubbing.\\nHow do you provide for drainage\\nBy means of drainage tubes, which may be made of red rub-\\nber, glass, or decalcified bone or by strands of catgut or horse-\\nhair. Drainage does not allow the serous exudate to make\\ntension in the wound, or to remain as a rich culture fluid for the\\nreception of germs. It should be employed in all wounds ex-\\ncept those which are superficial, or are placed in very vascular\\nregions, as in the face. Drainage tubes are to be removed in\\nfrom 24 to 48 hours. If the wound is very deep and extensive\\ntake the tubes out gradually. The tube should be carried\\nthrough the protective, should be cut off flush with the surface,\\nand should be prevented from slipping into the wound by silver\\nwire or a safety pin.\\nHow do you close wounds\\nBoth edges and surfaces must be approximated. In superficial\\nwounds adhesive plaster, isinglass plaster, or gauze collodion\\nand iodoform may be used. In deep wounds sutures must be\\nemployed together with compresses and bandages.\\nOf what materials are the ordinary sutures made\\nSilk, silver wire, catgut, horsehair.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0066.jp2"}, "67": {"fulltext": "WOUNDS\\n65\\nDescribe the various kinds of suturing.\\n1.. The continuous (glover s). The stitches are made with one\\nunbroken thread, carried across the wound in one direction.\\n2. The interrupted. Each stitch is carried across the wound\\nand tied as inserted.\\nFig. 2.\\nInterrupted sutures.\\n3. Pin suture (twisted or hare-lip). The apposed margins of\\na wound are transfixed with pins, around the two ends of which\\nand across the wound is carried a thread in the form of a fig-\\nure-of-eight. This keeps the surfaces in accurate apposition,\\nand checks bleeding (circumclusion).\\n4. The quill suture. Threads are passed deeply across the\\nwound and looped around quills or sections of catheter, placed\\nparallel to the wound and at some little distance from its edges.\\nThe button or plate suture. Wire is passed across the very bot-\\ntom of the wound, brought out to the surface at some distance from\\nits edges, and secured by fastening to leaden plates or buttons.\\nThe subcuticular suture of Hoisted. In this the suture material\\nis passed through the true skin, but not through the epidermis.\\nThe Lembert and Czerny sutures will be described under\\nintestinal wounds.\\nWhen there is much gaping, or loss of substance, the plate or\\nquill sutures are used, they prevent tension in the skin sutures,\\nand are termed sutures of relaxation. If the wound is moder-\\nately deep, a number of interrupted sutures are passed across\\n5", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0067.jp2"}, "68": {"fulltext": "66 ESSENTIALS OF SURGERY.\\nFi g\u00c2\u00ab 3 it to its bottom and brought\\nout at some little distance\\nfrom its edges, these are\\ntermed sutures of approxima-\\ntion. The skin is accurately\\njoined by closely applied super-\\nficial sutures, either interrupt-\\ned or continuous, called sutures\\nSutures of approximation and coaptation. Oj coaptation.\\nUnless there is great ten-\\nsion, and reason to fear gaping, remove sutures about the fourth\\nday.\\nHow do you prevent putrefactive or infective processes in the\\nwound\\nBy antiseptic treatment and dressing.\\nDescribe the antiseptic treatment.\\nThere must be provided basins for the sponges. Shallow trays\\nfor the instruments. A fountain syringe for irrigation.\\nSolutions. Carbolic acid 1 20. Bichloride of mercury 1 500.\\nThese solutions can be weakened by the addition of water as\\nrequired.\\nSponges and drainage tubes which have been kept in carbolic\\nacid 1 30.\\nLigatures and sutures which have been rendered aseptic and\\nare kept in absolute alcohol.\\nThe surgeon prepares himself by scrubbing his arms, hands,\\nand nails with a brush, soap, and hot water, puts on his anti-\\nseptic coat and again washes his hands first in alcohol, then in\\nsublimate solution 1 1000. Some surgeons wear rubber gloves.\\nThe patient is prepared by a general hot soap bath, if possible.\\nThe entire region of the wound of operation is scrubbed with hot\\nwater and sublimate soap, shaved, washed with alcohol, and\\nirrigated with 1 500 sublimate solution.\\nAll portions of the patient s body and the operating table\\nnear the seat of injury are covered with towels wet in 1 :500\\nsublimate solution. Instruments and drainage tubes are placed", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0068.jp2"}, "69": {"fulltext": "WOUNDS.\\n67\\nin 1 30 carbolic solution. The sponges\\nare put in a basin and covered with, bi-\\nchloride, of the strength used for irriga-\\nting. The fountain syringe is filled\\nwith bichloride 1:2000. The dress-\\nings are cut to the proper size, and\\nwrapped in bichloride towels.\\nDuring the operation or manipulation,\\nirrigate occasionally with the bichloride\\nsolution, finally flushing out, if the\\nwound be large, with a weak solution,\\nsterile water or salt solution. Carefully\\nguard against instruments, sponges, or\\nhands coming in contact with non-\\nsterilized surfaces.\\nAt the termination of the operation,\\nsee that the hemorrhage is absolutely\\nstopped, and that drainage is amply pro-\\nvided for. Apply the dressing.\\nFig. 4.\\nSutures.\\nDescribe the antiseptic dressing.\\nListens dressing. Dust with iodoform. Apply a piece of pro-\\ntective (varnished silk), wet in 1 40 carbolic, just large enough\\nto cover the closed wound. Over the protective, and overlap-\\nping it, place several layers of carbolized gauze, wrung out in\\nthe 1 :40 solution. Over this deep dressing and overlapping it,\\napply six layers of dry carbolized gauze, a seventh of Mackin-\\ntosh (rubber cloth), an eighth of gauze. Over the whole and\\nabout the edges place antiseptic cotton, and cover in with a car-\\nbolized gauze bandage. The protective guards the wound sur-\\nfaces from the irritation of the strongly carbolized gauze. The\\ndeep wet dressing disinfects the immediate neighborhood of the\\nwound it is wet because dry cold gauze may contain septic\\nparticles of dust. The Mackintosh prevents the discharge from\\npassing through the gauze immediately to the surface.\\nThe dressing in ordinary use is 1. Dry iodoform gauze to\\nthe wound. 2. Covered and overlapped by bichloride gauze,", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0069.jp2"}, "70": {"fulltext": "68 ESSENTIALS OF SURGERY.\\n3. Bichloride cotton overlapping the whole and covered in by a\\ngauze bandage.\\nWhen do you change an antiseptic dressing\\n1. When drainage tubes or non-absorbable sutures are to be\\nremoved.\\n2. When fever, other than that due to reaction, appears.\\n3. When there is hemorrhage.\\n4. When the wound is healed.\\nWounds.\\nWhat is a wound?\\nA solution in the continuity of the tissues, produced by sudden\\nforce.\\nUnder what two headings may wounds be classed?\\n1. Subcutaneous wounds. There is either no break in the skin\\nor an exceedingly small one compared to the extent of the lesion\\nbeneath. Instance, the wound of tenotomy is said to be subcu-\\ntaneous.\\n2. Open wounds. The break in the surface is, to a certain ex-\\ntent, commensurate to the deeper injury.\\nWhat is a contusion\\nA subcutaneous injury (distinguish from contused wound in\\nwhich there is a break in the surface) occasioned by squeezing\\nor crushing the tissues. There is hemorrhage and discoloration,\\nat times vesicles and blebs form, and the part may appear gan-\\ngrenous. The effused blood may form a fluctuating swelling,\\nknown as hcematoma, or may coagulate, forming a hard swelling,\\ntermed thrombus.\\nHow do you treat contusion\\nBy rest, pressure, and the application of evaporating and\\nstimulating lotions.\\nName the different kinds of open wounds.\\n1. Incised, or clean cut. 2. Lacerated, or torn. 3. Contused,", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0070.jp2"}, "71": {"fulltext": "WOUKDS. 69\\nor bruised. 4. Punctured, or pierced. 5. Gunshot, or lacerated\\nand contused. 6. Poisoned.\\nDescribe incised wounds.\\nCause. Sharp cutting instruments. They bleed freely, gape\\nwidely, and cause burning pain.\\nTreatment. Use all antiseptic precautions. Check hemorrhage\\nby cold, forcipressure, and ligation. Bring the surface and edges\\nof the wound in most accurate apposition. If tendons, nerves,\\nmuscles, or bones are severed, their corresponding ends must be\\ncarefully united by catgut sutures. If the wound is extensive,\\ncatgut drains may be employed. Absolute rest must be enforced.\\nUnion, in seven to ten days, by first intention\\nDespribe lacerated and contused wounds.\\nCaused by machinery, dog-bites, blows with blunt instrument,\\netc.\\nCharacterized by slight hemorrhage, moderate gaping, dull\\npain, ecchymosis (hemorrhage into the surrounding tissue), and\\nshock.\\nTreatment. Antiseptic. Thoroughly cleanse, remove dead tis-\\nsue, provide for free drainage, making counter openings in depend-\\nent positions, and using full-sized rubber drainage-tubes. Care-\\nfully coapt, if it can be done without tension. Apply iodoform\\ngauze liberally, bichloride gauze, bichloride cotton, and band-\\nages. Keep the part absolutely at rest.\\nDangerous complications. Shock, extensive inflammation and\\nsloughing, secondary hemorrhage, cellulitis, gangrene, tetanus.\\nDescribe punctured wounds.\\nCaused by pointed instruments depth is their greatest meas-\\nurement. Usually associated with contusion.\\nDangers. Wounds of deep structures, hemorrhage, the car-\\nrying in of septic substances, retention of discharge.\\nTreatment. Remove the vulnerating body, check bleeding,\\nthoroughly disinfect the accessible portion of the wound, put in\\na drainage-tube, apply an antiseptic dressing, and put the part\\nat rest. On the first sign of inflammation (pain and fever) re-", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0071.jp2"}, "72": {"fulltext": "70 ESSENTIALS OF SURGERY.\\nmove the dressings, and lay the wound open to its very bottom\\ndisinfect, drain, and reapply the antiseptic dressing.\\nDescribe gunshot wounds.\\nCaused by missiles, either round (buck-shot, bird-shot) or coni-\\ncal (pistol and rifle balls). The wound of entrance is smaller\\nthan the wound of exit, and is slower in healing. One bullet\\nmay cause multiple wounds, depending upon the position of\\nthe wounded man and the direction from which the missile\\ncomes. Two bullets may form but one wound of entrance. One\\nbullet may form several wounds of exit by being split; the\\nwound of entrance may also be the wound of exit, as when a\\nball passes completely around the head, beneath the skin.\\nBalls may be deflected by tendons, bones, or even bloodves-\\nsels. Devitalization of tissue is proportionate to the velocity of\\nthe ball hence is greatest at the wound of entrance. The mod-\\nern rifle propels a ball with great velocity, and the bullet is\\ncoated with a hard metal.\\nThe immediate effect of gunshot wounds is hemorrhage, pain,\\nand shock. There may be no pain excessive hemorrhage oc-\\ncurs only when large vessels have been wounded shock may\\nbe delayed. The secondary effect of gunshot wounds is inflamma-\\ntion, sloughing, hemorrhage, with the complications incident to\\ncontused and lacerated wounds (tetanus, gangrene, cellulitis,\\nand blood poison).\\nHow do you treat gunshot wounds\\nOn the field. Check hemorrhage by position, pressure, or the\\ntourniquet. Apply an antiseptic pad to the surface wounds. Im-\\nmobilize. If no septic matter has been carried in by the missile,\\nor the surgeon s probe or finger, the wound is practically rendered\\nsubcutaneous by this treatment, and can be allowed to heal as\\nsuch, no effort being made to find the ball.\\nIn the hospital. Under all antiseptic precautions, remove the\\nantiseptic pad, thoroughly clean the opening of the wound and\\nthe skin surface about it. Keapply an antiseptic dressing and\\nimmobilize. Do not probe. If inflammatory fever appears, or\\nif the original wound was so extensive as to preclude the idea", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0072.jp2"}, "73": {"fulltext": "WOUNDS. 71\\nof primary occlusion, do a formal antiseptic operation. Freely lay\\nopen the wound tract, remove foreign bodies, devitalized tissues,\\nor loose fragments of bone, explore and irrigate every recess of\\nthe wound, pack with iodoform gauze, insert sutures for the\\npurpose of approximating the parts, but do not tie them, dress\\nantiseptically. In one or two days remove the dressing and\\niodoform packing. If the wound is aseptic, close by knotting the\\nsutures. If the wound is not aseptic, irrigate and renew the\\npacking, or supply free drainage, dressing daily till the granula-\\ntions become healthy. An aseptic bullet is readily encysted.\\nShould it subsequently give trouble, its removal is much safer\\nafter the wound has healed.\\nNelaton s probe, tipped with unglazed porcelain, which is\\nmarked by contact with lead, and long-bladed bullet forceps,\\nmay be useful in locating and extracting a bullet. The Nela-\\nton probe will not detect a modern bullet with a hard metal\\njacket. A bullet may be located by a telephonic probe, an in-\\nduction balance, or an #-ray apparatus.\\nWhat gunshot wounds require amputation\\n1. Wounds which comminute the bone and injure or destroy\\nthe main vessels of a limb. 2. Wounds which destroy a large\\nportion of the limb or carry away a part of it. 3. Wounds\\ncomplicated by osteomyelitis, intractable secondary hemor-\\nrhage, or spreading gangrene.\\nWhat injuries are classed as poisoned wounds\\n1. Dissecting wounds. 2. Stings of insects. 3. Wounds in\u00c2\u00ab\\nflicted by arachnids and reptiles. 4. Wounds infected from\\ndiseased animals.\\nDescribe the dissecting wound.\\nIt appears more frequently where fresh bodies or arsenical\\ninjections are dissected. It is due to inoculation with infective\\nmicro-organisms these are destroyed by advanced putrefaction,\\nhence the most offensive bodies may be the least dangerous. Its\\nvirulence depends upon the strength of the original virus and\\nthe constitutional vigor of the patient infected.\\nSymptoms. Within twenty-four hours of the infliction of a\\nscratch or cut, there is an itching, then a burning pain a vesicle is", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0073.jp2"}, "74": {"fulltext": "72 ESSENTIALS OF SURGERY.\\nformed which breaks, disclosing an indurated ulcer. There may\\nbe a stop at this stage, or the inflammation may extend the\\nlymphatic vessel and axillary glands become involved, and may\\nsuppurate freely. The constitutional symptoms are well marked.\\nThe patient may reach this stage and rapidly recover, or the\\ndisease may make steady progress, suppuration attacking the\\nneck and thorax, cellulitis involving the arm, the symptoms be-\\ncoming markedly adynamic, and the patient perishing of septi-\\ncaemia or pyaemia.\\nHow do you treat dissecting wounds\\nImmediately, at the time of infliction, encourage bleeding by\\ntying a ligature about the part. Suck the wound and press the\\nblood from it apply carbolic acid or sulphate of zinc, dust with\\niodoform, and cover with a light antiseptic dressing.\\nIf an infective inflammation appears, freely incise, curette the\\nindurated tissue, pack with iodoform gauze and dress antisepti-\\ncally, applying a splint. Open abscesses promptly. Make mul-\\ntiple incisions for cellulitis.\\nClear the bowels, give stimulants, tonics, and nutritious diet.\\nFor pain, apply locally, chloral gr. xx. to the ounce of water.\\nA circular blister about the arm may limit the extension of\\nlymphangitis.\\nThere is always marked constitutional involvement in these\\nwounds. There is fever and exhaustion, loss of sleep from pain,\\nand the rapid development of an adynamic condition. Treat\\nby anodynes, stimulants, full diet, tonics.\\n(For Anthrax, Glanders, Hydrophobia, see pp. 54, 55.)\\nHow do you treat stings of insects and spider bites\\nLocally. Ammonia.\\nSystemically. Stimulants if necessary, ammonia or brandy.\\nWhat are the symptoms of rattlesnake poisoning\\nKapid and extensive swelling, discoloration, and disintegra-\\ntion. Profound systemic depression.\\nHow do you treat rattlesnake bites?\\n1. Put a tight ligature about the part above the wound.\\n2. Excise, and subsequently cauterize the wound area.\\n3. Encourage bleeding by suction.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0074.jp2"}, "75": {"fulltext": "WOUNDS. 73\\n4. Administer alcohol to the point of intoxication, and give\\nstrychnine hypodermatically.\\n5. Release the ligature for a few seconds at a time, tightening\\nagain till each small dose of poison thus admitted to the system\\nis eliminated. This is termed the intermittent ligature.\\nInjections of permanganate of potassium in and about the\\nwound (10 per cent.) are said to be efficient. If collapse threat-\\nens, ammonia must be given hypodermatically. An antivenene\\nserum has been advised.\\nWounds of Arteries.\\nDescribe wounds of the arteries.\\n1. Non-penetrating. The outer coat or coats only are in-\\nvolved. The artery may subsequently ulcerate and give way,\\ncausing extravasation, or may cicatrize and gradually yield,\\nforming true circumscribed traumatic aneurism.\\n2. Penetrating. The artery is laid open. It may be partially\\ncut across, when there will be free and continuous bleeding, or\\ncompletely cut across, when contraction and retraction favor co-\\nagulation.\\nHow do you treat wounded arteries?\\nLigation in the case of large and accessible arteries forcipres-\\nsure, acupressure, or the actual cautery under other circum-\\nstances. When the artery is partially divided, complete the\\ndivision. In some cases of partial division it is possible to\\nsuture the vessel with fine silk.\\nWhat rules must be observed in applying the ligature to a\\nwounded artery\\nTie in the wound. Tie both ends of the wounded vessel. Do not\\nsearch for the arterial wound unless there is actual bleeding at the\\ntime of search. While operating, check further bleeding by\\npressure, or by the finger in the wound.\\nHow do you, treat gangrene appearing after ligation of a\\nwounded artery\\nIf rapidly progressive, amputate at once. If slow in progress,\\nwait for the line of demarcation.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0075.jp2"}, "76": {"fulltext": "74 ESSENTIALS OF SURGERY.\\nDescribe traumatic aneurisms.\\n1. Diffuse traumatic aneurism. This is simply a collection of\\narterial blood, in the tissues of a part, which communicates with\\nthe blood stream in the interior of the artery, and is limited by\\nperipheral coagulation.\\n2. Circumscribed traumatic aneurism. This is blood in the tis-\\nsues, communicating with the arterial current, and provided\\nwith a sac formed by the condensation of the surrounding cellu-\\nlar tissues. The circumscribed traumatic aneurism may be\\nformed by a protrusion of the inner coat through a laceration\\nof the outer, in which case it is called hernial; or by the yield-\\ning of a cicatrix of the arterial coat, when it is called true circum-\\nscribed traumatic aneurism.\\nSymptoms as for aneurism, except in the case of diffuse trau-\\nmatic aneurism, when a spreading tumor, in which thrill and\\nbruit can be detected, and feeble or absent circulation of the\\npart below, will indicate the nature of the affection.\\nHow do you treat traumatic aneurism\\nLigate just above, or, if the aneurism threatens to burst, open\\nthe sac and tie above and below.\\nDescribe an arterio-venous aneurism.\\nDefinition. An abnormal communication between an artery\\nand a vein.\\nCause. A wound involving both vessels.\\nVarieties 1. Aneurismal varix. The artery and vein commu-\\nnicate directly. The vein is dilated by the arterial beat, form-\\ning a fusiform swelling.\\n2. Varicose aneurism. The artery and vein communicate by\\nmeans of an intermediate sac.\\nSymptoms. A tumor, characterized by a jarring pulse, and a\\nrough buzzing bruit. The artery is large above and small be-\\nlow. The vein is large above and pulsates.\\nTreatment. Pressure on the tumor by means of an elastic\\nbandage. Ligation of the artery above and below. When pres-\\nsure fails to control the bleeding from the vein, it must be liga-\\ntured also.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0076.jp2"}, "77": {"fulltext": "WOUNDS. 75\\nWhat are the dangers in wounds of veins\\n1. Hemorrhage. Control by pressure or ligation.\\n2. Blood poisoning from septic thrombosis. Prevent by keep-\\ning the wound aseptic.\\n3. Entrance of air. Characterized by a hissing sound during\\ninspiration, by the escape of frothy blood during expiration, by\\na churning sound heard on ausculting the heart, and by prompt\\ncollapse of the patient. Stop the vein wound immediately with\\nthe finger, or fill the entire wound with water. Ether, brandy,\\nor ammonia subcutaneously.\\nHow are vein- wounds treated?\\nIn a slight wound of a vein, apply a lateral ligature. In a\\nlongitudinal wound and in some transverse wounds, suture with\\nfine silk. In extensive wounds, ligate with two ligatures and\\ndivide the vessel between them.\\nWounds of Nerves.\\nWhat are the consequences of wounded nerves\\nThe nerve may be partially or completely divided. If com-\\npletely divided, the entire peripheral part undergoes atrophy\\nand degeneration (Wallerian degeneration), the proximate end\\nbecomes bulbous from proliferation of the fibrous tissue. Should\\nunion occur the degenerated fibres are regenerated.\\nAs a result of destroyed innervation there follows\\n1. Motor and sensory paralysis.\\n2. Muscular atrophy and degeneration.\\n3. Trophic changes, characterized by the skin becoming glazed,\\nsmooth, bluish-red, and prone to ulcerate the nails becoming\\ncracked and deformed the hair falling out and rheumatoid\\njoint affection.\\nHow do you treat wounded nerves\\nIf recent, suture together with fine chromicized catgut passed\\nthrough the sheath of the nerve. If old, free from all cicatricial\\nadhesions, resect the bulbous proximal extremity, freshen the\\ndistal extremity, and suture as before.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0077.jp2"}, "78": {"fulltext": "76\\nESSENTIALS OF SURGERY.\\nHead Injuries.\\nGive the surgical anatomy of the scalp.\\nLayers. Skin, superficial fascia, aponeurosis of the occipito-\\nfrontal, subaponeurotic fascia, pericranium.\\nSuperficial fascia binds the skin firmly to the aponeurosis. It\\nis made up of intersecting, non-elastic bands of connective\\ntissue, containing in its meshes globules of fat it is very vas^\\ncular, and freely supplied with nerves.\\nFig. 5.\\nLayers of the scalp.\\nAponeurosis. Covers the vault of the skull, is attached to\\nthe superior curved line and the mastoid process is blended in\\nfront with the pyramidalis nasi, corrugator supercilii, and\\norbicularis palpebrarum, and is continued laterally to the\\nzygoma by laminated layers of areolar tissue.\\nSubaponeurotic fascia. Is made of delicate, elastic, con-\\nnective-tissue fibres containing no fat loose in texture, and\\nallowing free motion on the part of the aponeurosis. Blood\\nsupply limited.\\nArteries of the scalp are from the temporal, occipital, auricular,\\nsupraorbital, and frontal. Certain branches strike deep and\\nsupply the periosteum.\\nVeins of the scalp intercommunicate with those of the peri-\\ncranium, the diploe,the meninges, the sinuses.\\nWhat is the surgical bearing of these facts\\n1. From the vascularity of the superficial fascia extensive in-\\njury can be quickly repaired.\\n2. From its lack of elasticity no tension can be made in\\nuniting wounds. There is little gaping unless the aponeurosis\\nis cut.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0078.jp2"}, "79": {"fulltext": "WOUNDS. 77\\n3. From its denseness of structure, effusion, or suppuration\\nwill probably be circumscribed, and movable only to the extent\\nthat the aponeurosis can be moved.\\n4. In the subaponeurotic fascia effusion or suppuration will\\nprobably not be circumscribed, from the looseness of structure,\\nand will appear as a fluctuating swelling about the ears or the\\nroot of the nose, from which position it can be moved to the\\nvarious dependent parts of the aponeurotic attachment.\\n5. The arrangement of the vessels allows the scalp to be\\nentirely detached from the pericranium without loss of vitality.\\n6. It also allows of the direct extension of septic processes\\ninto the diploe and the interior of the skull.\\n7. Swellings beneath the pericranium are bounded by the\\nsutures and are immovable.\\nDescribe contusion of the scalp.\\nSwelling very rapid. On palpation a soft yielding centre (fluid\\nblood), and hard, distinctly outlined edges (fat and coagulum).\\nHow do you diagnose contusion from depressed fracture\\nThe hard margins about the apparently depressed central\\narea are raised from the bone. By firm pressure with the nail\\nthe clot may be pushed aside, and the bone felt through it.\\nIn case of fracture, the finger passes directly from the surf ace\\nof the skull into a depression, without first surmounting a ridge.\\nWhere may the effusion due to contusion take place\\nThe blood may be effused in the superficial fascia, beneath the\\naponeurosis and beneath the pericranium. When in the latter\\nposition it may ossify.\\nHow do you treat contusions of the scalp?\\nIce-bag till swelling ceases to increase. Evaporating and\\nstimulating lotions, moderate pressure. Aspirate a persistent\\nhematoma. If suppuration occurs, incise freely.\\nHow do you treat wounds of the scalp\\nCarefully shave, wash, and disinfect the region of the wound.\\nRemove all foreign matter, and check hemorrhage. If the wound\\nis very extensive, drain by strands of horsehair or catgut. Su-", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0079.jp2"}, "80": {"fulltext": "78 ESSENTIALS OF SURGERY.\\nture, making accurate apposition, apply iodoform, protective,\\nwet bichloride gauze, dry bichloride gauze, bichloride cotton, and\\na firm bandage.\\nDescribe contusions of the cranial bones.\\nContusions may cause\\n1. An inflammation of the pericranium, or periostitis, which\\nmay terminate in resolution, chronic periostitis, or suppuration,\\ninvolving the neighboring bone, and terminating in caries or ne-\\ncrosis.\\n2. The inflammation may extend to the diploe causing septic\\nosteophlebitis, with septicaemia or pyaemia.\\n3. The inflammation may extend to the intracranial struc-\\ntures, causing supra- or subdural suppuration.\\n4. The inflammation may terminate in chronic osteitis and\\npachymeningitis, causing thickening.\\nWhat symptoms aid the surgeon in determining the character\\nand seat of inflammatory action\\n1. Pus beneath the pericranium, or simple necrosis. Chill and\\nfever, moderate in severity, local oedema, tenderness, and deep\\nfluctuation. Detection of the diseased bone when the abscess is\\nopened.\\n2. Pus in the diploe. Chill, high fever, local signs of suppura-\\ntion, general symptoms of pyaemia or septicaemia.\\nIntracranial extension. High fever, headache, vomiting, mono-\\nplegia or hemiplegia, delirium or stupor.\\nPotVs puffy tumor, a circumscribed superficial swelling over\\nthe affected area, sometimes accompanies supradural suppura-\\ntion.\\nHow do you treat contusions of the cranial bones\\nOpen the bowels freely, keep the patient in bed and absolutely\\nquiet, give liquid diet, and apply cold to the head. If there is a\\nwound, rigid antisepsis must be observed. Should symptoms\\npoint to subpericranial suppuration, open freely. Deeper suppu-\\nration should at once be exposed by the trephine.\\nClassify fractures of the skull.\\nA. Fractures of the vault. B. Fractures of the base.\\n1. Partial, involving the inner or the outer table.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0080.jp2"}, "81": {"fulltext": "WOUNDS. 79\\n2. Complete, involving the entire thickness of the skull. The\\ninner table is usually damaged more extensively than the outer.\\nOf the complete fractures we have\u00e2\u0080\u0094\\n1. Fissured, taking the form of a simple crack.\\n2. Stellate or radiate, appearing as several fissures radiating in\\ndifferent directions.\\n3. Comminuted. The bone is broken into several pieces.\\n4. Depressed. The bone is pressed in upon the brain.\\n5. Punctured or pierced. This is usually accompanied by con-\\nsiderable comminution of the inner table.\\nAny of these fractures may be simple (no external wound) or\\ncompound (external wound communicating with the break).\\nWhat causes fractures of the vault of the skull\\nSudden concentrated force, as the blow of a hammer.\\nHow do you diagnose fractures of the vault of the skull\\nSimple fractures without displacement (fissured, stellate) can\\nonly be inferred from accompanying symptoms.\\nSimple fractures with displacemevit can frequently, but not al-\\nways, be detected by careful examination of the surface. There\\nis usually depression, and the abrupt bone edges may be felt.\\nSymptoms of compression are commonly present.\\nCompound fractures can be diagnosed by inspection and palpa-\\ntion through the wound. There is frequently free bleeding, and\\nthere may be escape of cerebrospinal fluid.\\nHow do you treat fractures of the vault?\\nSimple fracture without depression.\\nPlace the patient in a quiet, darkened room, clear the bowels\\nwith calomel, cut the hair closely, and apply an ice-bag; give a\\nlight milk diet (Oij daily).\\nSimple fractures with slight depression, but without signs of com-\\npression are treated as above unless symptoms arise.\\nIn simple fracture with marked depression, trephine, even if\\nthere are no symptoms. This is done to prevent trouble in the\\nfuture (preventive trephining).\\nCompound fractures and punctured fractures. Always trephine.\\nTrephine to asepticize, and to elevate if there is depression.\\nThorough asepsis makes the operation practically safe, Pun(", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0081.jp2"}, "82": {"fulltext": "80 ESSENTIALS OF SURGERY.\\ntures through the supraorbital plate or the nose do not in them-\\nselves call for trephining, though the operation should be done\\nif unfavorable symptoms subsequently appear.\\nWhat is the cause of fractures at the base of the skull?\\nDirect force. Punctures. Driving of a condyle through the\\nglenoid fossa by a blow upon the chin, or shattering the cribri-\\nform plate of the ethmoid by a blow on the nose.\\nIndirect force. 1. Falls upon the buttocks or feet drive the spine\\nagainst the occipital condyles.\\n2. Falls upon the cranial vault drive the occipital condyles\\nagainst the spine. If the head is flexed the force is carried back-\\nward, and is exerted on the posterior cerebral fossa. If the head\\nis extended, the force is carried forward, and is exerted on the\\nanterior or middle cerebral fossa.\\n3. Conduction and amplification of vibrations. The force is\\npowerful and diffused. If applied to the frontal region, there is\\nusually fracture of the anterior cerebral fossa. The middle\\ncerebral fossa is fractured by such force applied to the temporo-\\nparietal region. The posterior cerebral fossa by force applied to\\nthe occipital region.\\nWhat are the symptoms of fracture of the anterior cerebral\\nfossa\\nFree and continuous bleeding from the nose. Subconjunctival\\neffusion with palpebral ecchymosis, involving the lower eyelid\\nparticularly. Escape of watery fluid (cerebro-spinal fluid) from\\nthe nose. Paralysis of the olfactory, optic, or oculo-motor\\nnerves. Concussion or compression.\\nThe blood and cerebro-spinal fluid may pass back into the\\npharynx, which should always be examined in these injuries.\\nWhat symptoms denote fracture of the middle cerebral fossa\\nFree continued bleeding from the ear, followed by escape of\\ncerebro-spinal fluid, increased in quantity by firm pressure on\\nthe jugular veins.\\nParalysis of the auditory and facial nerves, usually coming on\\nsome days after the injury. If the membrana tympani is not\\nruptured, the blood and cerebro-spinal fluid will escape into the\\npharynx by way of the Eustachian tube.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0082.jp2"}, "83": {"fulltext": "WOUNDS. 81\\nWhat symptoms characterize fractures of the posterior cerebral\\nfossa\\nExamination through the pharynx may show depression or\\ncomminution. Severe pharyngeal hemorrhage. Ecchymosis in\\nthe line of the posterior auricular artery (Battle s sign).\\nWhen the neck is not involved in the injury late discoloration\\nis a valuable sign of fracture at the base (middle or posterior\\nfossa).\\nHow do you treat fractures of the base\\nSince these fractures are usually fissured, they, in themselves,\\nrarely require treatment. The gravity of fractures of the base\\ndepends almost entirely upon the concomitant injury to the\\nbrain or its bloodvessels, and the treatment must be directed to\\nthe prevention of encephalitis which is liable to develop after\\nthese injuries.\\nKeep the patient absolutely quiet. Elevate the head and ap-\\nply an ice-bag to it. Control restlessness by bromide of potas-\\nsium or morphia. Give water only, for 48 hours, then a light\\nliquid diet. Mercurials may be used.\\nWhen the cerebro-spinal fluid escapes externally, the fracture\\nis, of course, compound, and the channel of escape must, if pos-\\nsible, be antiseptically cleansed and occluded.\\nInjuries of the Meninges and Brain.\\nIn what regions may intracranial blood extravasations take\\nplace\\n1. Between the dura mater and the skull.\\n2. In the cavity of the arachnoid.\\n3. In the meshes of the pia mater (on the brain surface).\\n4. In the cerebral substance.\\n5. In the ventricles.\\nWhat are the sources of extravasation between the dura mater\\nand the skull\\n1. The small vessels passing from the dura to the bone. The\\nhemorrhage is slight in amount.\\n2. The middle meningeal artery. The usual source of exten-\\nsive bleeding.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0083.jp2"}, "84": {"fulltext": "82 ESSENTIALS OF SURGERY.\\n3. The venous sinuses. Rarely a source of bleeding.\\nWhat symptoms denote extravasation of blood between the dura\\nmater and the skull\\nSymptoms of compression coming on after an interval of im-\\nmunity.\\nImmediately after an injury the patient suffers from concussion\\nand shock he reacts and recovers from this condition shortly to\\nexhibit symptoms of compression, characterized by 1. Spasm\\nfollowed by paralysis, affecting the face, arm, or one side of the\\nbody, and accompanied by a local fall of temperature. 2.\\nComa. 3. Widely dilated pupil of the affected side.\\nHow do you treat hemorrhage between the dura and the skull?\\nTrephine over the middle meningeal artery (anterior branch).\\nThe pin of the trephine is placed 1^ inches behind the external\\nangular process of the frontal bone, and the same distance above\\nthe most prominent part of the zygoma. Clear away the clot,\\nclose the artery by means of ligatures, a plug of wax or catgut,\\nor the touch of a hot needle. If the trephine opening does not\\nexpose the bleeding point, remove the bone along the course of\\nthe artery till the source of hemorrhage is found. If no hem-\\norrhage is found, but the symptoms are positive, trephine over\\nthe posterior branch of the middle meningeal (just below the\\nparietal eminence).\\nIf no supradural hemorrhage is found, but the dura is bluish,\\nprojecting, and does not pulsate, there is effusion beneath, which\\nmust be evacuated by incision.\\nIf the symptoms do not definitely indicate the probable seat\\nand nature of the injury, treat as for all head injuries, i. e. elevate\\nthe head, and apply cold to it, clear the bowels, give a very\\nrestricted fluid diet, use bromides, chloral, morphia, mercury,\\nor bleeding as indicated by symptoms.\\nWhat are the symptoms of hemorrhage beneath the dura\\nBlood in the arachnoid is generally diffused over the whole\\ncerebral hemisphere. There may be symptoms of compression,\\nor, some time after the injury, irritability of temper, headache,\\nor convulsions may develop. There is nothing diagnostic. The", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0084.jp2"}, "85": {"fulltext": "WOUNDS\\n83\\neffused blood may become encysted or may organize as a tough\\nmembrane.\\nBlood in the pia mater usually accompanied by cerebral lacera-\\ntion. The blood is widely diffused. The symptoms are those\\nof the brain injury, or of apoplexy.\\nHow do you treat subdural extravasations\\nExpectantly, as for head injuries in general. If the symptoms\\nshould point to localization of the hemorrhage, trephine.\\nConcussion and Contusion.\\nDescribe concussion of the brain.\\nBy concussion is meant a simple jarring of the brain without\\nattendant lesions. There is, however, always congestion, and,\\ncommonly, serous or sanguinolent effusion. If concussion is at-\\ntended with marked and persistent symptoms, it is probably\\nassociated with contusion.\\nContusion may be circumscribed or diffused. It may produce\\nhemorrhage in mass, or diffuse miliary extravasations. Its effects\\nmay be found at the point of injury, or on the opposite portion\\nof the brain. Laceration frequently accompanies contusion.\\nThe anterior part of the frontal and temporo-sphenoidal lobes\\nare commonly involved.\\nWhat are the symptoms of concussion\\nOf the slighter form, momentary loss of consciousness, or giddi-\\nness, with pale face and feeble pulse, some mental confusion,\\nsweating of the face, nausea, vomiting, and reaction.\\nOf the more severe forms (contusion, with congestion, bleeding\\nor laceration), prolonged unconsciousness, with feeble, scarcely\\nperceptible pulse, shallow breathing, pale, cold surface, subnor-\\nmal temperature, muscular relaxation, variable pupils (depend-\\nent on the seat and character of the injury). Restlessness,\\nscreaming, and local spasm or paralysis may suggest lacera-\\ntion. The beginning of reaction is characterized by vomiting.\\nAfter a variable time the patient may pass into the second stage\\nof concussion, termed cerebral irritation.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0085.jp2"}, "86": {"fulltext": "84 ESSENTIALS OF SURGERY.\\nHe can be roused with difficulty, but responds angrily, and im-\\nmediately lapses into a somnolent condition.\\nHe lies curled up on his side, with limbs flexed and eyes tightly\\nclosed. He resents any effort at changing his posture. He may\\nbe exceedingly restless.\\nThe pulse is small and feeble, the respirations are quiet, or at\\nleast are not stertorous. The pupils are contracted.\\nAs the condition of cerebro-irritation subsides, the third stage\\nof concussion, characterized by inflammation, abscess, softening,\\nor fatuity, may develop. Later, hereditary or acquired tendency\\nto brain disease may appear.\\nConcussion and contusion are always attended by shock.\\nHow do you treat cerebral concussion and contusion\\nFirst stage (insensibility and shock). Absolute quiet in a dark-\\nened room. If reaction is slow, encourage by external heat.\\nVery rarely should stimulants be given if absolutely indicated,\\nadminister brandy or ammonia hypodermically. On the deve-\\nlopment of the second stage (cerebral irritation) apply an ice-bag\\nto the raised head, clear the bowels, give water and cracked ice\\nfor two days, followed by milk and lime-water, in small quanti-\\nties. For restlessness and pain give bromide, chloral, or opium.\\nPrevent sequelae by long-continued rest in bed, by very slow re-\\nsumption of ordinary duties and responsibilities.\\nCompression.\\nWhat are the causes of cerebral compression\\n1. Depressed bone. 2. Extravasated blood. 3. Pus, or in-\\nflammatory products. 4. Foreign bodies. 5. Tumors.\\nWhat are the symptoms of cerebral compression\\nUnconsciousness, absolute (coma). Bespirations, slow, sterto-\\nrous, blowing. Pulse full and slow. Paralysis involving one\\nside of the body. Pupils may be unequal. Urine retained, faeces\\npassed involuntarily. Decubitus dorsal.\\nHow do yon determine as to the cause of compression\\nSymptoms appear immediately when due to depressed fracture", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0086.jp2"}, "87": {"fulltext": "WOUNDS. 85\\nor foreign body after some hours, if due to hemorrhage after\\nsome days, if due to inflammation.\\nHow do you treat compression of the brain?\\nTrephine and remove the cause, if it can be located. Under\\nother circumstances expectantly, as for head injuries in general.\\nHow do you distinguish concussion from compression?\\nIn many cases this cannot be done the symptoms of one con-\\ndition merging into those of the other. The distinctive symp-\\ntoms of the two affections are as follows (Agnew)\\nConcussion. Compression.\\nPatient semi-conscious special Absolutely unconscious, para-\\nsenses blunted, not abolished. lyzed, and with abolition of special\\nPower of movement not lost. senses.\\nRespiration quiet and feeble. Respiration full and noisy.\\nPulse feeble, frequent, and inter- Pulse full, slow, laboring,\\nmittent.\\nNausea and vomiting. Neither nausea nor vomiting.\\nPupils generally contracted. Pupils generally dilated, often un-\\nequal.\\nSubnormal temperature. Temperature about normal.\\nOf what significance is the size of the pupil in brain injuries?\\nA contracted pupil denotes cerebral irritation (slight injuries\\nor effusion). A pupil fixed in wide dilatation denotes abolition of\\ncerebral function (large effusions or extensive injury).\\nIntracranial Inflammation.\\nWhat are the causes of traumatic intracranial inflammation\\nWounds of the scalp, bone, or brain. Fractures or contusions of\\nthe cranial bones. Concussion, compression, contusion, or lacera-\\ntion of the brain.\\nDescribe traumatic intracranial inflammation.\\nThere may be either meningitis or encephalitis. More com-\\nmonly, both meninges and brain are involved (meningo-encepha-\\nlitis). Should suppuration occur, the pus may be diffused, or may\\nform an abscess. The inflammation may be acute or chronic.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0087.jp2"}, "88": {"fulltext": "86 ESSENTIALS OF SURGERY.\\nGive the symptoms of traumatic intracranial inflammation.\\nPain referred to the seat of injury, fever, intolerance of light\\nand sound, vomiting with a clear tongue, contracted pupils, quick,\\nfull pulse, restlessness, insomnia, and delirium. Later, com-\\npression symptoms develop, and the patient perishes comatose.\\nFormation of pus is attended by rigors.\\nHow can you localize the inflammation\\nIf, in from one to four weeks from the infliction of injury,\\nsymptoms of encephalitis suddenly develop preceded by head-\\nache, if Pott s puffy tumor of the scalp forms, if there is local\\nspasm or paralysis, and the history of a chill, there is probably\\nan abscess between the dura and the skull.\\nInflammatory symptoms, appearing about the fourth day after\\na head injury, point to contusion or laceration of the brain sub-\\nstance.\\nIf, after several weeks, there is found optic neuritis, with hebe-\\ntude, headache, and involvement of motor areas if there has\\nbeen a chill, and symptoms of compression develop suddenly,\\nthere is probably a cerebral abscess.\\nHow do you treat traumatic meningoencephalitis\\nPrevent by quiet, cold to the head, purgation, low diet, and\\nabsolute asepticity of all head wound.\\nTreat, on the earliest symptom, by calomel, bleeding from ex-\\nternal jugular, ice-bag to head, light diet opium and bromide\\nas required, calomel gr. 3. Dover s powder gr. ij every two\\nhours.\\nIf an abscess can be localized, trephine and evacuate.\\nDescribe hernia cerebri.\\nDefinition. A protrusion of brain matter disintegrated by in-\\nflammatory action, through an opening in the skull.\\nCause. Wound of the bone and dura mater, attended with\\nlaceration and bruising of the brain substance.\\nAppearance. A blood-stained, fungous mass, projecting from\\nthe skull opening.\\nPrognosis. Usually bad.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0088.jp2"}, "89": {"fulltext": "WOUNDS. 87\\nTreatment. Remove all irritating causes, such as spiculse of\\nbone. Treat in general as for encephalitis.\\nLocally, apply antiseptic dressings, with very moderate com-\\npression. Nature sometimes effects a cure by strangulating the\\ngrowth.\\nWhat are the prognosis and treatment of foreign bodies in the\\nbrain?\\nThe ultimate prognosis is bad in all cases where the foreign\\nbody is not removed. The usual foreign body is a bullet. Its\\nwound may be perforating or penetrating.\\nThe perforating wound allows of free drainage, and the foreign\\nbody has passed out hence, if not intrinsically fatal, the prog-\\nnosis is comparatively favorable. Trephine, if necessary.\\nThe penetrating wound should be trephined to remove bone\\nspiculee. Explore with a soft rubber catheter. The ball, being\\nfound, should be removed, either through the wound of entrance,\\nor by making a counter trephine opening. Provide abundantly\\nfor drainage. Absolute asepsis. Treat as for head injuries.\\nCerebral Localization.\\nGive the position of the motor areas grouped about the fissure\\nof Rolando.\\n1. The face. Motor and sensory nerves from lower third of\\nthe ascending frontal and parietal convolutions, and posterior\\nend of the second frontal convolutions.\\n2. The arm. Motor and sensory supply from middle third of\\nascending frontal and parietal convolutions.\\n3. The leg. Motor and sensory supply from the upper portion\\nof the ascending frontal and parietal convolutions, and the\\nparacentral lobule.\\n4. The tongue. Receives its nerve supply from the posterior\\nportion of the third (inferior frontal) convolution of the left side\\nin right-handed persons.\\nLocal spasm and hyperesthesia indicate an irritative lesion\\nof a motor area.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0089.jp2"}, "90": {"fulltext": "88 ESSENTIALS OF SURGERY.\\nLocal paralysis and anaesthesia indicate complete suppression\\nof function from more extensive injury.\\nWhat symptoms founded on cerebral localization indicate tre-\\nphining?\\nHemiplegia, complete or incomplete, with or without hemi-\\nspasm, following a blow on the temporo-parietal region, would\\nindicate an exploratory operation on the side opposite to that\\nof peripheral symptoms.\\nMonoplegia or monospasm following an injury to the head in-\\ndicates operation.\\nMono-hypercesthesia anaesthesia or analgesia following an in-\\njury indicates an operation.\\nIf the peripheral sensory or motor disturbance be on the side\\nopposite to that of the lesion, operate at the site of the lesion\\nif, however, these symptoms are on the same side, exploratory\\noperation would be indicated on the opposite side of the head.\\nWhat symptoms contraindicate operation\\nLesions of the base of the brain as indicated by paralysis of\\ncranial nerves, neuro-retinitis, Cheyne-Stokes respiration.\\nHemiplegia accompanied by anaesthesia.\\nHow can the position of the Rolandic fissure be indicated upon\\nthe head\\nShave the scalp, draw a vertical line from one external\\nauditory meatus to the other (at right angles to the alveolo-con-\\ndyloid plane), from the centre of this vertical line (bregma)\\nmeasure directly backward for 5.5 centimetres (5 in women).\\nFrom the external angular process of the frontal bone measure\\n7 centimetres horizontally backward and 3 centimetres vertically\\nupward a line drawn from this point to the point 5.5 centi-\\nmetres posterior to the bregma will indicate the fissure of\\nKolando. For general hemiplegia trephine over the centre of\\nthe line. In other cases over the portion chiefly involved.\\nSensory disturbances of the arm or leg would indicate that\\nthe lesion lies somewhat posterior to the fissure of Rolando.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0090.jp2"}, "91": {"fulltext": "WOUNDS. 89\\nWhat are the indications for trephining\\n1. Simple depressed fractures, attended with persistent grave\\nsymptoms.\\n2. Compound depressed fractures. Except in children, when\\nthe depression is of less serious consequence and often spon-\\ntaneously corrected.\\n3. Punctured fractures.\\n4. The presence of a foreign body.\\n5. Traumatic osteomyelitis and necrosis.\\n6. Localized blood clot between the dura mater and the bone.\\n7. Localized intracranial suppuration, with symptoms of com-\\npression or irritation.\\n8. Traumatic epilepsy or localized obstinate headache follow-\\ning an injury.\\n9. Accessible cerebral tumors.\\nMany surgeons advise trephining in all depressed fractures,\\nwith or without serious symptoms.\\nDescribe the operation of trephining.\\nPrepare the patient the day before the operation, if possible,\\nby shaving the scalp and washing with sublimate soap and warm\\nwater, followed by a cleansing with ether, after which washings\\nwith the sublimate soap and water must again be repeated.\\nApply, for twenty-four hours, to the entire scalp, gauze saturated\\nin 1 2000 bichloride solution, covered in with an antiseptic\\ndressing. Renew the sublimate and ether washings just before\\nthe operation, and further cleanse the surface with 1 500 bi-\\nchloride solution.\\nThe instruments required are scalpel, haemostatic forceps,\\nperiosteal elevators, a conical trephine, a fine probe, a small stiff\\nbrush, a Hey s saw, bone forceps, curved needles, and catgut.\\nThe incision. Must be/ree and to the bone, including perios-\\nteum. A semicircular flap is raised, the pin of the trephine is\\npressed to the bone, and, by a twisting motion, made to penetrate\\ntill the teeth grip, when the pin is withdrawn, and the instru-\\nment steadily worked through. Free bleeding indicates when the\\ndiploe is reached. (Note that in infancy and old age there is\\npractically no diploe. The instrument must now be advanced", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0091.jp2"}, "92": {"fulltext": "90\\nESSENTIALS OF SURGERY.\\nwith the greatest care. It is removed from time to time, and the\\ngroove probed to see whether the inner tablet is penetrated at\\nany part. When the bone is loosened, it is removed by means\\nof sequestrum forceps or an elevator, and wrapped in a warm\\nantiseptic towel. The surgeon now endeavors to accomplish\\nthe specific object for which the skull was opened. Spiculse of\\nbone are removed, depressed fractures are elevated, bleeding\\nmeningeal arteries are secured by passing a thread beneath them,\\nclots are cleared away. If further exposure is necessary, it can\\nbe accomplished by dividing the bone by a chisel, bone forceps,\\nor, best of all, a circular saw run by a surgical engine. On the\\ncompletion of the operation free drainage is provided for by\\nmeans of catgut strands, the disk of bone is replaced, either entire\\nor cut into pieces, the flap is held in place by one or two sutures.\\nIodoform is dusted over the line of incision, a deep dressing of\\niodoform gauze is applied over and about the wound, and the\\ndressing completed by bichloride gauze, bichloride cotton, and\\nan elastic bichloride bandage.\\nWounds of the Face,\\nWhat rules should be observed in treating wounds of the face\\nSecure most accurate coaptation. Avoid sutures in superficial\\nwounds, closing by means of iodoform, ether, and collodion. In\\nwounds involving the cartilages of the nose or ear, pass sutures\\nonly through the skin. In operations, so place the incision that\\nit may correspond with the natural lines of the face. If stitches\\nare inserted, remove them in twenty-four hours.\\nHow do you treat salivary fistula\\nThis is usually caused by a wound of Steno s duct. Treat by\\npassing a thread around the duct from the inside of the cheek\\nposterior to the external opening. When this thread has ulce-\\nrated an opening into the mouth, the external wound will usually\\nheal. If not, freshen its edges and suture.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0092.jp2"}, "93": {"fulltext": "wounds. 91\\nWounds of the Neck,\\n(For the anatomy of the Cervical Triangles, see Ligations.\\nDescribe wounds of the neck.\\nThese wounds are commonly incised suicidal wounds. They\\nextend obliquely from left to right, and from above downward,\\nand are deepest at their starting-point. They are most fre-\\nquently found in the laryngeal region, particularly over or\\nthrough the thyrohyoid membrane. The carotid arteries are\\nrarely injured, the wound being usually placed too high, and the\\nlarynx and trachea bearing the brunt of the incision. These\\nwounds may be penetrating or non-penetrating.\\nWounds above the hyoid bone may divide the tongue, the lingual\\nand facial arteries, and the hypoglossal nerve. There is great\\ngaping frequently escape of food and saliva.\\nWounds through the thyro-hyoid membrane open the pharynx,\\nand may involve the epiglottis, the superior thyroid and lingual\\narteries, and the superior laryngeal nerves.\\nWounds through the cartilages may involve the vocal cords and\\nthe recurrent laryngeal nerve. There is usually but moderate\\nbleeding.\\nWounds below the cartilages may involve the superior or inferior\\nthyroid arteries, the thyroid and anterior jugular veins, the\\ntrachea, and even the oesophagus.\\nWhat are the immediate dangers of penetrating neck wounds\\n1. Hemorrhage, arterial or venous.\\n2. Suffocation from the plugging of the air-passages, with either\\nblood-clot, the tongue, the epiglottis, or the divided cartilages.\\n3. Entrance of air into the veins.\\nWhat are the secondary dangers of penetrating neck wounds\\n(Edema of larynx, emphysema, bronchitis or broncho-pneu-\\nmonia, cellulitis, cicatricial contraction and stricture.\\nHow do you treat penetrating neck wounds\\nCheck bleeding, ligate both ends of every bleeding vessel. The\\ncommon carotid should only be tied for bleeding from its", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0093.jp2"}, "94": {"fulltext": "92 ESSENTIALS OF SURGERY.\\nbranches, when it is found impossible to tie the branches. If the\\nexternal carotid is wounded at its origin, tie the common carotid,\\nthe external carotid, and, to avoid bleeding from collateral circu-\\nlation, the internal carotid.\\nIf the larynx is obstructed by blood-clot, clear by the fingers,\\nby suction, or by forcing the air suddenly from the chest. Re-\\nmove a partially severed portion of the epiglottis. Hold the\\ndivided tongue forward by a ligature passed through its tip.\\nWounds of the oesophagus should be closed by catgut sutures.\\nIf the trachea is completely divided across, the two ends may be\\nheld in apposition by fine catgut sutures passed through the invest-\\ning cellular tissue. The external wound should not be sutured\\nits surfaces are apposed by raising the head, and supporting it in\\none position by pillows and sand-bags, or by a gutta-percha splint.\\nProvision is made for free drainage, and light antiseptic dress-\\ning is applied. If dyspnoea appears, perform tracheotomy lower\\ndown, or insert a tracheal canula through the wound. Feed by\\nthe rectum for four days, then by an oesophageal tube, passed\\njust beyond the wound. Non-penetrating wounds are treated\\nas wounds in any other part of the body.\\nWounds of the Chest.\\nDescribe non-penetrating wounds of the chest.\\nA non-penetrating chest wound is one which does not involve\\nthe costal pleura. In chest wounds the finger must be used as a\\nprobe, and great care taken lest a non-penetrating be converted\\ninto a penetrating wound. Hemorrhage must be absolutely\\nchecked before closing, and the wound approximated by deep\\nsutures passed to its very bottom. Firm pressure is applied over\\nthe antiseptic dressing, by a bandage carried around the chest.\\nThese wounds may involve the brachial plexus, the intercostal,\\ninternal mammary, acromio-thoracic, long thoracic, or axillary\\narteries. Check bleeding by ligature or haemostatic forceps.\\nDescribe penetrating wounds of the chest.\\nThe pleura and lung, the pericardium and heart, or the great\\nvessels may be wounded.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0094.jp2"}, "95": {"fulltext": "WOUNDS. 93\\nInjuries of the pleura and lung are characterized by shock,\\ndyspnoea, pain, cough, abdominal breathing, expectoration of\\nfrothy blood-stained mucus, escape through the wound of a bloody\\nfroth accompanied by a hissing sound (tromatopnoea), emphysema,\\npneumothorax, external bleeding, hemothorax. In case the\\npleura alone is injured there will be no haemoptysis and no\\nbloody froth from the wound.\\nPrognosis, grave in wounds involving the root of the lung,\\nand in gunshot wounds which penetrate but do not perforate.\\nInjuries to the pericardium and heart are characterized by great\\nshock, hemorrhage, and the subsequent development, if the pa-\\ntient lives long enough, of pericarditis. Death in wounds of the\\npericardium occurs from shock, the pressure effect of haemoperi-\\ncardium, or from pericarditis.\\nWhat are the complications of penetrating wounds of the chest?\\nExternal bleeding, hemothorax, emphysema, pneumothorax,\\npleurisy, pneumonia, prolapse of lung.\\nHow do you treat the external bleeding of penetrating chest\\nwounds\\nIf from an intercostal artery ligate, or apply haemostatic forceps\\nthis being impossible, dissect off the periosteum from the lower\\npart of the rib (carrying the artery with it of course) and tie or\\nresect a portion of the rib. A ligature may be carried around\\nthe entire rib.\\nIf from the internal mammary, ligate in the wound, resecting\\nthe chondral cartilages if necessary.\\nIf from the lung, close the external wound, place the patient\\non the injured side, and apply an ice-bag. Internally give\\nopium, ergot, gallic acid. If the bleeding continues, producing\\nconstitutional signs of hemorrhage, and local signs of extensive\\nhsemothorax, open again and allow the blood to escape. In\\nsome cases ribs have been resected, and the bleeding artery in\\nthe lung ligated or controlled by packing.\\nDescribe hsemothorax.\\nDefinition. Bleeding into the pleural sac.\\nUsual cause. Wound of the lung, or of an intercostal artery\\nby a broken rib,", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0095.jp2"}, "96": {"fulltext": "94 ESSENTIALS OF SURGERY.\\nSymptom?. Those of internal hemorrhage, together with bulg-\\ning of the intercostal spaces, increasing dyspnoea, flatness on\\npercussion, and absence of breathing sounds. The symptoms\\nappear almost immediately after the injury. Inflammatory\\neffusions do not take place till some days later.\\nTreatment. As for external bleeding from lungs. Aspirate\\nor open if there is threatening dyspnoea. If suppuration takes\\nplace, open freely and drain.\\nDescribe pneumothorax.\\nCause. Injury to lung and pleura, usually by a broken rib.\\nSymptoms. The lung collapses. Increasing dyspnoea, great\\npercussion resonance, amphoric breathing, metallic tinkling,\\nbulging of intercostal spaces.\\nTreatment. Should dyspnoea become urgent, aspirate.\\nDescribe emphysema.\\nCause. Wound of the lung and pleura. It may arise after\\nwound of the lung alone, in this case extending by way of the\\nroot to the posterior mediastinum, and from there into the con-\\nnective tissue of the neck and arms.\\nSymptoms. A diffused, colorless, elastic, puffy swelling,\\ncrackling on pressure.\\nTreatment. A compress and bandage over the wound. Should\\ndistension become great, puncture.\\nHow do you treat prolapse of the lung\\nReturn if not adherent. If adhesions have taken place, ligate\\nor excise, taking precautions against opening the pleural cavity.\\nDescribe hernia of the lung.\\nCauses. The yielding of a cicatrix. The result of subcutaneous\\nwound. Great muscular effort.\\nSymptoms. A soft circumscribed tumor, resonant on percus-\\nsion, giving a loud respiratory murmur, and crepitating on\\nmanipulation.\\nTreatment. Protective.\\nWhat is concussion of the lung\\nA condition following traumatism. Characterized by dyspnoea,\\nfeeble respiratory murmur, and slight dullness on percussion.\\nThe symptoms pass off after a few hours.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0096.jp2"}, "97": {"fulltext": "WOUNDS. 95\\nWhat operations may be done for the evacuation of blood or in-\\nflammatory effusion within the chest walls\\n1. Tapping the pleura. For serous effusion. Thrust an as-\\npirating needle through the sixth intercostal space, in the mid\\naxillary line. This operation must be done under antiseptic\\nprecautions. The skin is drawn down before the puncture is\\nmade, forming a valvular wound. Dress with iodoform and\\ncollodion.\\n2. Incision and drainage of pleura. For empyema and the re-\\nmoval of decomposing clots. Operate in the sixth intercostal\\nspace, in the axillary line, or as low as the eleventh space, in a\\nline with the angle of the scapula. Make a careful dissection.\\nExcise a portion of the rib if necessary, and insert a drainage\\ntube.\\n3. Tapping the pericardium. Fourth intercostal space two\\ninches to the left of the sternum.\\n4. Incision and drainage of pericardium. Beginning one inch\\nfrom sternum, make an incision two inches in length along the\\nupper border of the fifth or sixth ribs. Dissect down carefully,\\ninsert drainage tube after opening.\\n5. Pneumotomy. Lung incision for abscess, gangrene, or\\ncysts. Open down to the pleura, thrust a trocar and canula into\\nthe affected area. Enlarge this puncture by dressing forceps.\\nWounds of the Abdomen.\\nDescribe contusion of the abdomen.\\nContusion may take place with, or without, rupture of the contained\\nviscera.\\nContusion without rupture of the contained viscera is character-\\nized by pain, discoloration, swelling, and shock. The rectus\\nmuscle may be ruptured, or there may be a hematoma formed,\\nfollowed by abscess.\\nTreatment. Put the patient to bed, apply heat to the body,\\nhot fomentations to the abdomen. Give water and cracked ice\\nfor twenty-four hours. Treat rupture of the rectus by position.\\nApply cold in case of hematoma. Evacuate abscesses early.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0097.jp2"}, "98": {"fulltext": "96 ESSENTIALS OF SURGERY.\\nWhat symptoms denote contusion with laceration of the viscera?\\nGreat shock, pain, persistence of collapse with signs and symp-\\ntoms of internal bleeding, in case the solid viscera or a highly-\\nvascular portion of the peritoneum is ruptured, symptoms of\\nrapidly developing peritonitis in case the hollow viscera are\\nruptured.\\nThe following signs, if present, are indicative of rupture of\\nthe individual viscera.\\nLiver. Pain in right hypochondrium, increased hepatic dull-\\nness, signs of internal bleeding later, bilious vomiting, clay-\\ncolored stools, sugar in the urine.\\nSpleen. Pain in left side, increased splenic dullness.\\nStomach. Intense pain in stomach, hsematemesis, rapid de-\\nvelopment of general meteorism, tympany over the liver.\\nIntestines. Intense radiating pains. Vomiting of stomach\\ncontents, then bile, finally blood. Bloody stools. Tympanites\\nwith dullness in the flanks. Percussion resonance over liver.\\nPeritonitis.\\nKidneys. Frequent passage of bloody urine, with extravasa-\\ntion in the loin.\\nIn all cases, the portion of the body which received the brunt\\nof violence must be considered, in determining what interna)\\norgans are probably injured.\\nHow do you treat abdominal contusion with rupture of con-\\ntained viscera\\nIn doubtful cases, after reaction from shock, insist on abso-\\nlute rest and give opium.\\nIf symptoms characteristic of internal hemorrhage, or rupture\\nof a hollow viscus, appear, do an exploratory laparotomy. Bleeding\\nfrom the liver or spleen can be checked by iodoform tamponade,\\nor by the actual cautery. Torn vessels in the peritoneum can\\nbe ligated. Rents in the stomach or intestines can be united by\\nsutures or brought to the surface. By irrigation, the peritoneal\\ncavity can be freed of blood and extra vasated matter. Ruptured\\nkidney with lumbar extravasation should be treated by free\\nlumbar incision and drainage.\\nWhat are the causes of traumatic peritonitis?\\nThe bursting of an abscess, or the extravasation of urine,", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0098.jp2"}, "99": {"fulltext": "WOUNDS. 97\\nblood, bile, or the contents of the alimentary canal into the\\nperitoneal cavity.\\nTermination usually fatal, from collapse or blood poison.\\nWhat are the symptoms of traumatic peritonitis\\nSevere pain, at first local, then general.\\nExtreme tenderness. Dorsal decubitus with legs and thighs\\ndrawn up. Breathing thoracic. Abdomen distended and tym-\\npanitic; later, dull in the flanks from effusion. Obstinate\\nvomiting. Complete constipation Small, quick, wiry pulse. Dry\\nbrown tongue. Temperature 103\u00c2\u00b0 to 104\u00c2\u00b0.\\nIn the septicemic form there may be little pain or tenderness,\\nand a normal or even subnormal temperature throughout\\nHow do you treat traumatic peritonitis?\\nPrevent by absolute rest, cracked ice diet, hot fomentations,\\nlaparotomy.\\nTreat, on the development of the first symptom, by a full saline\\npurge and turpentine enema. Open and wash out the peritoneal\\ncavity with gallons of hot normal salt solution. Insert a glass\\ndrainage-tube or gauze drainage. Stimulants and nourishment\\nin teaspoonful doses. If there is great exhaustion, employ\\nsaline transfusion into the median basilic vein.\\nHow do you treat non-penetrating wounds of the abdomen\\nCheck all bleeding. Extensive extravasation may take place\\nbetween the muscular planes if this precaution is not observed.\\nPass sutures to the bottom of the wound, approximating accurately.\\nPrevent tension by position. Apply an antiseptic dressing, and a\\nbinder about the body.\\nIf signs of inflammation appear, open freely (abdominal ab-\\nscesses do not point). Guard against subsequent hernia.\\nDescribe penetrating wounds of the abdomen.\\nThese wounds involve the peritoneal cavity. There may be\\n1. Simple penetration without visceral injury or protrusion.\\n2. Penetration with visceral injury, but no protrusion.\\n3. Penetration with visceral protrusion, but no injury.\\n4. Penetration with both protrusion and injury.\\n7", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0099.jp2"}, "100": {"fulltext": "98 ESSENTIALS OF SURGERY.\\nHow do you treat simple penetrating abdominal wounds\\nThoroughly cleanse. Irrigate the abdomen with salt solution.\\nClose the wound by sutures passed from within outward, includ-\\ning the peritoneum and the entire thickness of the abdominal\\nwall. Apply an antiseptic dressing and a binder about the\\nbody, and place the patient in that position which will most\\neffectually relax the wounded muscles. Give internally cracked\\nice for two days, then milk in small quantities. Saline purges\\nfrom time to time. If there has been hemorrhage into the\\nperitoneal cavity, remove all blood by irrigation and insert a\\nglass drainage-tube.\\nHow do you treat penetrating wounds with visceral injury?\\nEnlarge, if necessary, and treat the visceral injury. Check\\nbleeding from the liver and spleen by cautery, or iodoform tam-\\npons. Drain small wounds of the kidney. If the organ be ex-\\ntensively lacerated, do a nephrectomy. Wounds of the ureter\\nrequire either a nephrectomy, a uretero-ureterostomy, or the\\nformation of a urinary fistula by bringing the ureter to the\\nsurface. Wounds of the stomach or intestine should be\\nsutured; if large, the sutured portion may be secured in\\nthe wound, the latter not being closed immediately (iodoform\\ntamponade). Extravasation will then take place externally\\nif the sutures yield. Slight punctures are closed by prolapse\\nof the mucous membrane, and do not require suturing.\\nHow do you determine as to the existence of a visceral injury in\\npenetrating abdominal wounds\\nIf the wound is large, inspection and palpation may be suffi-\\ncient.\\nIn small wounds intense pain and severe collapse, with or with-\\nout escape of faeces, gas, bile, serum, or food, indicate the nature\\nof the injury.\\nWounds of the stomach and intestines usually give a clear\\ntympanitic percussion note over the liver.\\nIn case of doubt inject hydrogen gas into the rectum if the\\nstomach or intestines are wounded, the gas will escape through\\nthe wound* Where there is no evidence of visceral wound treat", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0100.jp2"}, "101": {"fulltext": "WOUNDS.\\n99\\nas penetrating wound, performing an exploratory laparotomy on\\nthe first sign of internal hemorrhage or traumatic peritonitis.\\nHow do you suture the intestine\\nBy the Lembert interrupted suture. The threads include only\\nthe serous and muscular coats of the bowel, are made of sterilized\\nLembert suture.\\nChina silk, and are placed a twelfth of an inch apart. The\\nsuture is designed to approximate serous surfaces. It passes in\\nand out on one side of the wound, across, and in and out on the\\nother side, and is then tied. Cushing s right-angled suture is a\\ncontinued inversion suture, and is often preferred to the inter-\\nrupted inversion suture. If the intestine is entirely torn across\\nor extensively injured, a portion may be resected, a V-shaped\\npiece of mesentery removed, and the gut ends united by first\\nbringing the peritoneal coat together by a circle of interrupted\\nO* sutures, then invaginating the incision and approximating se-\\n6 rous surfaces by Lembert s suture. This constitutes Czerny s\\nJ suture. In some cases an artificial anus should be made.\\nHow do you treat penetrating abdominal wounds with protru-\\nsion of viscera\\nCarefully cleanse and return. If intestine is gangrenous, in-\\ncise and leave in the wound if congested and adherent, free\\nfrom adhesions and return. The abdominal wound may be\\nenlarged if necessary. Congested omentum should be ligated,\\nremoved, and the stump returned. to the .abdominal cavity. ..If", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0101.jp2"}, "102": {"fulltext": "100 ESSENTIALS OF SURGERY.\\nthe intestines protrude and are wounded, apply a Lembert suture\\nand return, or make an artificial anus.\\nIn all extensive injuries do not close the abdominal wound ab-\\nsolutely. Insert sutures, knot them loosely, and pack the wound\\nwith iodoform gauze. When danger from intra-peritoneal com-\\nplications has passed away, approximate the granulating surfaces\\nby removing the packing and drawing the sutures tight. The\\nwound heals by secondary adhesion (third intention).\\nDescribe laparotomy.\\nPreparation most thoroughly antiseptic. Incision in median\\nline. Check all hemorrhage by haemostatic forceps before open-\\ning peritoneum. The latter is nicked, held up by two fingers,\\nand divided by scissors. Insert a large flat sponge to catch all\\noozing from wound. Irrigate the abdominal cavity, if necessary,\\nwith warm distilled water. If there is much shock, use hot water\\n(not over 106\u00c2\u00b0). After the completion of the operation dry with\\nsponges, inserting glass drainage-tube if there has beea much\\nmanipulation or hemorrhage close. First bring the peritoneum\\ntogether with a line of interrupted catgut sutures then insert\\nsome plate sutures of relaxation, using silk-worm gut. Suture\\ntogether the fibrous investments of the two rectus muscles finally\\nunite the skin and subcutaneous tissues with interrupted sutures\\nof approximation and continuous sutures of coaptation.\\nDust with iodoform, apply a strip of protective, several layers\\nof iodoform gauze, a thick investment of bichloride cotton, Mack-\\nintosh, and a moderately tight binder.\\nGive cracked ice for two days. Stimulants as required. See\\nthat the bladder is regularly emptied, drawing the water if\\nnecessary.\\nDescribe tapping of the abdomen.\\nThis operation is done for ascites.\\nSee that the bladder is empty, pass a many-tailed bandage\\nabout the body, to make pressure, let the patient sit up, leaning\\nsomewhat forward, make a skin incision in the linea alba, mid-\\nway between the umbilicus and pubis, and thrust the trocar and\\ncanula into the abdomen. To avoid syncope draw off slowly,", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0102.jp2"}, "103": {"fulltext": "WOUNDS.\\n101\\ngradually tighten the bandage as the liquid flows away, and let\\nthe patient lie down.\\nDescribe rupture of the bladder.\\nCause. A blow or kick when the bladder is full. Fracture\\nof the pelvis. Very rarely from simple over-distension. In re-\\ntention from stricture the urethra more commonly gives way.\\nThe rupture is usually vertical. Occurs more commonly in\\nthe posterior part, when the urine escapes into the peritoneal\\ncavity, causing peritonitis. May occur in the anterior part, with\\nextravasation into the loose cellular tissue of the pelvis, causing\\ncellulitis with secondary peritonitis or septic poisoning.\\nWhat are the symptoms of ruptured bladder\\nCollapse following an injury to the abdomen or pelvis, with\\nabsence of urine and presence of blood in the bladder, as demon-\\nstrated by passing a catheter. If the patient has passed his\\nurine immediately before the injury, inject two ounces of warm\\nboracic acid solution (4 per cent.) into the bladder if there is\\nan extensive rent in its walls, the solution will escape and can-\\nnot again be drawn off by a catheter. A catheter may some-\\ntimes be felt to pass through the rent. Take a Davidson s\\nsyringe, plug up one end with cotton, and attach the other to a\\ncatheter which is inserted in the bladder. Pump in filtered\\nair. If the bladder distends, it is not ruptured. We can make\\nat the course of the air by percussion.\\nHow do you treat rupture of the bladder\\nDo a supra-pubic cystotomy. If the rent is extra-peritoneal,\\ninsert a drainage tube. If the rent is intra-peritoneal, open the\\nperitoneal cavity (through the same parietal incision), irrigate\\nthoroughly to wash away all urine. Close the rent by the\\nCzerny suture, taking particular care to see that no thread\\npierces the mucous membrane. Insert a drainage tube, tampon\\nthe external wound with iodoform gauze, and let the patient\\ninsure free drainage by the lateral decubitus.\\nThese ruptures may be treated by the introduction and reten-\\ntion of a soft catheter passed through the urethra.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0103.jp2"}, "104": {"fulltext": "102 ESSENTIALS OF SURGERY.\\nBurns and Scalds.\\nHow are burns classified?\\nBurns are of six degrees.\\n1st Degree. Simple erythema followed by slight desquamation.\\nThere is no tissue destruction.\\n2c?. Degree. Vesication. The superfical layers of the epiderm\\nare destroyed.\\n3cZ Degree. Destruction of the epiderm and the greater part of\\nthe true skin. A portion of the papillary layer, and the epithe-\\nlium about the hair follicles and sebaceous glands escapes.\\nThis is of great importance in the subsequent healing, as skin-\\nning starts from these points as islands, and the elements of true\\nskin are preserved to an extent. There is scarring, but not\\nmarked contractions. This is the most painful form of burn,\\nfrom involvement of the nerve-endings.\\n4:th Degree. Destruction of the skin and subcutaneous tissue.\\nScarring and contractions.\\n5th Degree. The deep fascia Is penetrated and the muscles are\\ninvolved.\\n6th Degree. Destruction of the entire part.\\nDescribe the constitutional effects of severe burns.\\nDependent on the extent of surface involved, and the depth.\\nThree stages.\\n1. Shock and internal congestion. Most marked in extensive\\nburns of the trunk and head. The patient shivers and complains\\nof cold.\\n2. Beaction and inflammation. Coming on in from one to two\\ndays. The patient complains of thirst and inflammatory fever.\\nInternal congestion may run on to inflammation, causing menin-\\ngitis, pleurisy, or peritonitis, according to the seat of the burn\\n(head, chest, abdomen). Duodenal ulcer and nephritis are fre-\\nquent complications.\\n3. Suppuration and exhaustion, setting in on the separation of\\nsloughs. The patient often complains of cough and diarrhoea,", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0104.jp2"}, "105": {"fulltext": "WOUNDS.\\n103\\nand may now perish from amyloid degeneration, exhaustion, or\\nblood poison.\\nGreat deformity ensues on cicatrization of deep burns.\\nWhat is your prognosis in severe burns\\nBad in burns involving one-third the surface, and in extensive\\nburns upon the trunk. Fatal cases mostly perish within forty-\\neight hours from shock.\\nHow do you treat burns\\nConstitutionally. Treat the shock by external heat, hot bath,\\nhypodermics of brandy, ammonia, atropia, and morphia. See\\nthat there is no retention of urine. When reaction and inflam-\\nmation appear give a saline cathartic, neutral mixture. If\\nthe kidneys are congested apply dry cups, hot fomentations.\\nGive liquid nourishment in small doses frequently repeated.\\nKeep up the use of stimulants. Allay thirst by cracked ice.\\nDuring the third stage give tonics and stimulants, push the\\nnourishment, and treat diarrhoea by opium and astringents.\\nLocally. All burns beyond those of the first degree should be\\nwashed and dressed under all antiseptic precautions.\\nBurns of the second degree. Wash with 1 2000 sublimate solu-\\ntion, shave the surrounding skin, remove all loosened epithelium,\\nwash again with 1 2000, using a soft brush or sponge for the in-\\njured surface, complete the cleansing with 1 5000 sublimate\\nsolution, cover with strips of protective wet in 1 5000, sprinkle\\niodoform over the protective, apply a thick layer of iodoform\\ngauze overlapping the protective, a still larger and thicker layer\\nof bichloride gauze, finally bichloride cotton and a bichloride\\nbandage. Cure in ten days on removal of the dressing.\\nBurns of the third and fourth degrees, if limited in extent, are\\ntreated as burns of the second degree. Remove dressings when\\nthey become rank (ten days), thoroughly bathe in 1 5000, trim\\naway sloughs, re-dress. When sloughs are all removed, and the\\nburn converted to a granulating surface, skin graft.\\nWhen the burn is very extensive cleanse, wash, and remove\\nloose cuticle as before, liberally sprinkle each region so treated\\nwith subnitrate of bismuth, cover with a single layer of lint or soft", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0105.jp2"}, "106": {"fulltext": "104 ESSENTIALS OF SURGERY.\\nlinen, held in place by one or two adhesive strips. Twice a day\\ngently raise the edges of the lint, and sprinkle more bismuth\\nwherever the coating has become loosened by discharge.\\nOr, puncture vesicles, but do not remove the cuticle, apply lint\\nsaturated in carron oil (lime-water and linseed oil in equal parts),\\nand cover in with waxed paper and a light bandage. Change the\\ndressing daily, uncovering a small amount of surface at a time, and\\nredressing one part before another is exposed.\\nIn extensive deep burns the continued warm bath may be em-\\nployed till the sloughs separate.\\nRelieve the pain of burns of the first degree by white-lead\\npaint.\\nOpium is indicated in all stages of severe burns.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0106.jp2"}, "107": {"fulltext": "FRACTURES,\\n105\\nFRACTURES.\\nWhat is a fracture?\\nThe sudden solution in the continuity of a bone.\\nWhat are the causes of fracture\\n1. Predisposing.\\na. Local. Function, form, position, disease of the bone.\\nb. Constitutional. Includes conditions under which the\\nbone becomes fragile, or subject to disease or injury\\nsuch as age, sex, rickets, locomotor ataxia, and ne-\\ncrosis.\\n2. Exciting.\\na. External violence.\\nb. Muscular action.\\nWhat are the varieties of fracture?\\nIncomplete, partial, or greenstick. The bone is bent, but not\\nentirely broken through.\\nStellate, grooved, and\\nfissured fractures are\\nalso classed as incom-\\nplete.\\nComplete. The break\\ninvolves the entire thick-\\nness of the bone.\\nSimple. Not accompanied by an open wound leading down\\nto the break. A single uncomplicated fracture.\\nCompound. Accompanied by a wound leading down to the\\nbreak.\\nSingle. Having but one line of fracture, making in the long\\nbones two fragments.\\nMultiple. Two or more fractures, the lines of breakage not\\ncommunicating if these fractures are of the same bone.\\nComminuted. The bone is broken into more than two pieces,\\nthe lines of fracture communicating.\\nGreenstick fracture of clavicle.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0107.jp2"}, "108": {"fulltext": "106 ESSENTIALS OF SURGERY.\\nImpacted. One fragment is driven into the other, and fixed\\nin that position.\\nComplicated. Accompanied by an injury to some other im-\\nportant parts in the same region, as joints, bloodvessels, nerves,\\nor muscles.\\nFurther, fractures about joints are classed as\\nIntracapsular within the capsular ligament.\\nExtracapsular without the capsular ligament.\\nIn young persons epiphyseal separation occurs, especially in\\nthe humerus, and constitutes epiphyseal fracture.\\nIn what direction does the line of fracture extend?\\nIt is generally oblique, but may be trans verse, from direct vio-\\nFig. 8.\\nOblique and transverse fracture of the tibia.\\nlence, longitudinal, when force is applied in the direction of the\\nlong axis of the bone, spiral or stellate.\\nWhat are the symptoms of fracture\\n1. Deformity or displacement due to 1, the fracturing force\\n2, the muscular contractility 3, the weight of the part.\\n2. Abnormal mobility.\\n3. Crepitus, or harsh grating, both felt and heard on manipu-\\nlation.\\n4. Loss of function.\\n5. Pain and tenderness, sharp and severe.\\n6. Swelling and ecchymosis, the latter appearing in certain\\nlines.\\nWhat are the different kinds of displacement\\nAngular or bending, rotary or twisting, transverse, longitudinal\\nor overlapping.\\nm.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0108.jp2"}, "109": {"fulltext": "FRACTURES. 107\\nWhen have you difficulty in recognizing displacement?\\nWhen but one of two parallel bones is broken, or when the\\nshort, flat bones are involved.\\nUnder what circumstances is crepitus absent\\nIn greenstick and impacted fractures when the fragments\\noverlap considerably or are widely separated when soft tissue\\nis interposed between the ends of bone.\\nIn epiphyseal fracture we have moist crepitus only.\\nWhat fractures do not present abnormal mobility\\nGreenstick and impacted fractures.\\nHow do you diagnose a fracture\\nDeformity, unnatural mobility, and crepitus, if elicited, are\\nabsolutely diagnostic. If great swelling prevents a positive\\ndiagnosis, treat as a fracture till swelling subsides. The Ront-\\ngen rays may clear, up a doubtful diagnosis.\\nWhat is the general treatment of all fractures\\n.1. Eeduce the fracture. 2. Retain it in position. 3. Treat in-\\nflammation and other complications, either constitutional or\\nlocal.\\nHow do you reduce a fracture\\n1. By extension or traction, made by the surgeon steadily\\npulling upon the lower fragment.\\n2. Counter-extension or fixation of the upper fragment.\\n3. Coaptation or adjusting the broken ends of the bone to\\ntheir proper position.\\nHow do you overcome muscular spasm?\\nIf muscular spasm interferes with reduction, it must be over-\\ncome by position, etherization, or tenotomy.\\nHow do you retain the bones in proper position\\nBy means of splints and bandages. Splints may be made of\\nwood, tin, gutta-percha, binders board, leather, etc.\\nBandages may be made of muslin, linen, or gauze, or may\\nhave incorporated with them various materials which, harden-\\ning, make a solid and firm dressing, as plaster, silicate of potas-\\nsium, gum, etc.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0109.jp2"}, "110": {"fulltext": "108 ESSENTIALS OF SURGERY.\\nUnder what circumstances are the fixed dressings applied?\\nPrimarily, when there is little swelling, displacement, or dam-\\nage to the soft parts. Secondarily, in fractures of the lower ex-\\ntremity, after the subsidence of swelling and inflammation.\\nWhat is ambulatory treatment\\nA method of applying plaster which permits the patient to\\nwalk about. The dressing extends below the sole of the foot,\\nand the weight of the body is caught above the seat of fracture.\\nWhat rules guide you in the application of splints\\n1. Splints should be well padded.\\n2. They should fix the joints above and below the break.\\n3. The extremities of the limbs should be left exposed to view\\n(fingers and toes).\\nCircular compression must be avoided, primary rollers being\\nabsolutely discarded in fractures of the leg or forearm. Applied\\nwith great caution in fractures of the thigh or upper arm.\\nHow often do you re-dress a fracture\\nThe fracture dressing must be inspected daily for one week.\\nIf too loose or too tight, or if there is evidence of displacement,\\nthe dressing must be renewed. Otherwise, twice weekly will\\nbe sufficient.\\nWhat complications may arise, and how should they be treated?\\n1. (Edema and swelling often accompanied by blebs. Treat by\\nloose bandaging at first, and evaporating lotions follow by pres-\\nsure.\\n2. Ulceration and sloughing of soft tissues. Free ulcerating\\nspot from pressure by careful padding of splint.\\n3. Muscular spasm. Treat by moderate pressure, morphia\\ninjections, or tenotomy.\\n4. Gangrene. Usually the result of too tight dressing, or lace-\\nration of main artery. Relieve pressure.\\nRarely. Venous thrombosis, embolism, fat embolus causing\\ndeath by asphyxia. Treatment cardiac stimulants.\\nHow do you treat compound fractures?\\nIf the external wound is small and the fracture not otherwise", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0110.jp2"}, "111": {"fulltext": "FRACTURES. 109\\ncomplicated, thoroughly cleanse with bichloride 1 1000, and\\nclose with absorbent cotton saturated in a solution of ether,\\niodoform, and collodion, equal parts of each. Splint as usual.\\nIf inflammatory symptoms arise, or if there be much original\\ncomminution or laceration of soft parts, pick out loose frag-\\nments, thoroughly cleanse, irrigate with bichloride solution\\n1 1000, drain, and apply antiseptic dressing, splinting as usual.\\nIf wound be older than twenty-four hours, wash with 1 5 car-\\nbolic solution (acid carbol. 1, alcohol 5).\\nWhat complications arise in the treatment of compound\\nfractures\\nNecrosis, osteomyelitis, periostitis, extensive sloughing of soft\\ntissues.\\nWhat is the pathology of fracture\\nThere is first free bleeding from the vessels of the injured bone,\\nmedulla, and surrounding soft parts. This is followed by in-\\nflammation with exudation, absorption of blood clot, and deposit\\nof plastic lymph about the seat of injury. Organization completes\\nthe process the plastic lymph is converted first into cartilage,\\nthen into bone.\\nWhat is callus\\nThe plastic lymph which is organized into bone tissue for the\\nrepair of fractures.\\nHow is the callus disposed about a fracture?\\nA portion is deposited as a fusiform swelling ensheathing the\\ntwo broken bone ends, called ensheathing callus a portion fills the\\nmedullary canal above and below the break acting as a support-\\ning pin, called pin or central callus. A portion is directly be-\\ntween the broken surfaces restoring their continuity, called\\nintermediate or definitive callus.\\nWhat is meant by temporary and permanent callus\\nThe ensheathing and pin callus is temporary, being absorbed\\nwhen the bone is firmly united by the intermediate or permaneut\\ncallus.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0111.jp2"}, "112": {"fulltext": "110 ESSENTIALS OF SURGERY.\\nWhat period of time is occupied by the various processes neces-\\nsary for the repair of fracture\\nAbsorption of clot first week, formation of plastic lymph and\\nbeginning organization second week, ossification of the callus 4\\nto 8 weeks, absorption of temporary callus one year.\\nWhat complications are common to all fractures\\nShock.\\nRetention of urine, treat by catheter.\\nTraumatic delirium, especially in drunkards sedatives,\\nstimulants.\\nHypostatic congestion of lungs.\\nWhat compound fractures require amputation?\\nCompound fractures associated with\\n1. Very extensive laceration of soft parts.\\n2. Great destruction of bone substance.\\n3. Injury to the main artery of leg or thigh (femoral or post-\\ntibial).\\n4. Injury to knee or ankle, if extensive.\\nDefine delayed union and non-union.\\nUnion is delayed when fractures are not firmly joined by callus\\nin 4 to 6 weeks.\\nWe have non-union or ununited fracture when the continuity\\nof the bone is not restored after twelve weeks.\\nWhat are the causes of delayed union and non-union?\\n1. Constitutional include all conditions depressing to health\\nand nutrition, as acute fevers, syphilis, phthisis, scurvy, ne-\\nphritis, etc.\\n2. Local, a. Undue mobility of fragments often from improper\\nsplinting or meddlesome interference.\\nI. Separation of fragments, by muscular action, or by interpo-\\nsition of soft parts or necrosed bone,\\nc. Interference with blood supply, as in intracapsular fracture.\\nHow do you treat non-union\\nTreat constitutional conditions.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0112.jp2"}, "113": {"fulltext": "FRACTURES. Ill\\nLocally the means adopted would be in the order given below,\\none failing the next should be tried. The object of all these\\nmethods is to set up an acute aseptic inflammation, which shall\\nprovide sufficient exudation for the formation of healthy callus.\\n1. Absolute fixation 7 careful dressing, plaster bandage.\\n2. Friction. Rub ends of bone together either manually or by\\ngetting patient up and allowing some use, the fragments being\\nheld in apposition by fixed plaster bandage or apparatus.\\n3. Brill fragments subcutaneously to excite inflammation and\\ndeposition of plastic lymph treat subsequently by absolute fix-\\nation.\\n4. Drill and pin fragments together leaving the pin in place.\\n5. Besection of the ends of the bones, joining the fresh surfaces\\nby silver wire or bone-clamps. Drain thoroughly and close the\\nwound. Secure fixation by careful splinting.\\nName the forms of non-union.\\n1. No union whatever between the fragments.\\n2. Ligamentous union.\\n3. False joint.\\nWhat is vicious union\\nUnion accompanied either by great deformity, or by the bind-\\ning together of bones which should move on each other, as the\\nradius and ulna.\\nHow do you treat vicious union\\nIf recent, restore immediately by force, or by splints and pres-\\nsure. If firm union has taken place, or phe fracture is not\\namenable to other treatment, the bone should be broken again,\\nproperly set, and fixed in position. Deformity from exuberant\\ncallus gradually disappears. Should it persist, and should\\npressure symptoms arise, callus must be cut away.\\nHow do you treat an injury which you suspect may be a frac-\\nture?\\nTreat as a fracture, subsidence of swelling will clear the diag-\\nnosis,", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0113.jp2"}, "114": {"fulltext": "112 ESSENTIALS OF SURGERY.\\nUnder what circumstances do you use anaesthetics in the diag-\\nnosis and treatment of fracture?\\n1. In case of difficulty or doubt.\\n2. In complications requiring prolonged Or painful manipu-\\nlations.\\n3. Where reduction is not readily effected.\\nHow do you treat the swelling and ecchymosis common to all\\nfractures\\nEvaporating lotions for two or three days, followed by care-\\nfully guarded pressure. Four ounces of alcohol and four drachms\\nof ammonium muriate, two ounces of the solution of acetate of\\nlead, or eight ounces of laudanum, to the pint of water. Apply\\non lint which must not be covered with oiled silk, but kept con-\\nstantly wet by the solution.\\nWhat is the cause of the late discoloration in fractures?\\nThe effused blood gradually works its way to the surface, be-\\ntween layers of fascia, in the path of least resistance the disin-\\ntegration of the red corpuscles causes the ecchymosis or discolo-\\nration.\\nWhat do you mean by an ambulatory dressing?\\nA dressing of splints, or preferably of plaster, so applied to a\\nfractured lower extremity as to permit the patient to move\\nabout during treatment.\\nSpecial Fractures.\\nDescribe fractures of the nasal bone.\\nCause. Direct violence.\\nSigns. Displacement, backward or lateral. Crepitus. Un-\\nnatural mobility. Deformity. Very rapid swelling. Free\\nbleeding.\\nHow may this fracture be complicated?\\n1. Profuse hemorrhage.\\n2. Emphysema of surrounding soft parts.\\n3. Deflection or fracture of septum nasi.\\n4. Injury to base of brain through the perpendicular plate of\\nethmoid.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0114.jp2"}, "115": {"fulltext": "FRACTURES. 113\\nGive the treatment of fracture of the nasal bone.\\nBeduce at once by pressure exerted by a director or closed\\nhaemostatic forceps passed into the nostril. Retain in place, if\\nnecessary, by packing the nostrils with iodoform gauze or an\\ninflatable rubber bag, the respiratory tract being kept open by\\na rubber tube. If there is much comminution and these means\\nfail, fasten thefragments together withpivis, passed from the outside,\\ntaking in the periosteum (Mason s pins). Inspect the nostrils\\nfor deflection of septum, which must always be replaced.\\nCheck hemorrhage by heat, cold, astringents, or packing.\\nTreat swelling by evaporating lotions.\\nAlicays reduce thoroughly.\\nDescribe fractures of the superior maxillary bones.\\nOrdinary fracture symptoms, generally accompanied by great\\nswelling.\\nCommon seat of fracture, alveolar process at times nasal pro-\\ncess, malar process, or body of maxilla. The anterior wall of\\nthe antrum may be driven in.\\nHow do you treat fractures of the superior maxilla?\\nReduce, if deformity. If the bone is driven in, raise by pres-\\nsure applied from the mouth, or by means of an elevator passed\\nthrough a small skin wound. Retain alveolar process by making\\nthe lower jaw the splint, applying a Barton s bandage treat\\nswelling and inflammation by evaporating lotion, applied on lint\\n(alcohol and water equal parts).\\nDescribe fractures of the inferior maxilla.\\nUsual seat. Near or through the anterior mental foramen.\\nFractures also occur at the symphysis through any part of\\nthe body through the ramus through the condyloid process\\nthrough the coronoid process.\\nThese fractures are often compound, from rupture of the mu-\\ncous membrane.\\nGive the symptoms of fracture of the inferior maxilla.\\nBody. The cardinal signs of fracture, together with pain,\\nswelling, dribbling of saliva, disability. The central portion of", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0115.jp2"}, "116": {"fulltext": "114 ESSENTIALS OF SURGERY.\\nthe bone is pulled downward and backward by the digastric,\\ngeniohyoid, and geniohyoglossus muscles.\\nFractures of the ramus give little deformity, the bone being held\\nin place by the masseter without, the internal pterygoid within.\\nManipulation elicits mobility and crepitus.\\nIn fractures of the neck, the condyle is pulled forward and in-\\nward by the external pterygoid, causing great pain and crepitus\\non opening or closing the mouth.\\nGive the treatment for fracture of the inferior maxilla.\\nCareful reduction and the application of a moulded pasteboard\\nsplint, well padded with cotton, and held in place by a Barton s\\nor Gibson s bandage. Frequently wash the mouth with satu-\\nrated solution of boracic acid.\\nIf the dressing fails to keep the fragments in proper position,\\nthey should be drilled and wired in place. The dressing can be\\nremoved in five weeks.\\nGive the symptoms of fracture of the hyoid bone.\\nSeat of injury. Greater horn. Pain on eating or speaking,\\ntogether with the cardinal signs of fracture, elicited by exami-\\nning with the fingers of one hand in the pharynx, while the other\\nhand outlines the bone from without. The displacing factor is\\nthe middle constrictor.\\nGive the treatment for fractures of the hyoid bone.\\nReduce by pressure, keep the head between flexion and exten-\\nsion, support by a pasteboard collar, give nutrient enemata for\\nfour days, then, if dysphagia be still great, feed by the oesopha-\\ngeal tube.\\nGive the symptoms of fracture of the laryngeal cartilages.\\nUsual seat. Thyroid cartilage. Symptoms Aphonia, dys-\\npnoea, and bloody expectoration, together with emphysema, deform-\\nity, and possibly moist crepitus.\\nTreatment. On the appearance of dyspnoea, intubation, or,\\nthat failing, tracheotomy. Feed by rectum for some days, and\\nsecure absolute rest to the parts.\\nDescribe fractures of the clavicle.\\nCause. Usually indirect violence, as falls on the palm of the\\nhand.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0116.jp2"}, "117": {"fulltext": "FRACTURES. 115\\nSeat. May be any portion of the bone, generally outer portion\\nof middle third.\\nDirection. Oblique.\\nDisplacement. Shoulder falls downward, forward, and inward,\\nshortening detected by measurement from middle of upper\\nborder of sternum to coracoid process.\\nWhat causes the displacement in fractured clavicle?\\nThe outer fragment drops downward, inward, and forward\\nfrom the weight of the shoulder, and the action of the two pecto-\\nrals, the latissimus dorsi and the serratus magnus the inner\\nextremity of the outer fragment is thrown somewhat backward\\nby the rhomboidei and levator anguli scapuli, so that it lies\\nbehind and below the outer extremity of the inner fragment,\\nwhich is slightly tilted up by the sterno-cleido mastoid.\\nGive the symptoms of fractured clavicle.\\nCrepitus and preternatural mobility readily elicited by pushing\\nup and rotating the humerus.\\nDeformity detected by passing the finger along the subcutane-\\nous surface of the bone, by inspection, by measurement shoulder\\nflattened, arm disabled.\\nFractures of acromial and sternal end necessarily allow of but\\nlittle displacement. If external to conoid and trapezoid liga-\\nments, there is marked displacement of the outer fragment.\\nGive the treatment for fractured clavicle.\\nThe object of the treatment is to restore the fragments to their\\nproper position by forcing the shoulder upward, outward, and\\nbackward. This is accomplished by\\n1. Sayre s dressing. Strips of adhesive plaster three and one-\\nhalf inches wide. The first is long enough to surround the body\\nincluding the arm. This strip encircles the arm over the inser-\\ntion of the deltoid in the form of a loosely fitting loop, which must\\nbe made secure by sewing. Draw the arm somewhat down-\\nward and backward, to make tense the clavicular origin of the\\npectoralis major, and fasten it in this position by carrying the\\nstrip entirely around the body securing it to itself in the back.\\nThe second strip begins at the sound shoulder, is carried ob-\\nliquely over the back to the elbow of the injured side, which is", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0117.jp2"}, "118": {"fulltext": "116\\nESSENTIALS OF SURGERY.\\nreceived in a slit provided for the purpose, it is then carried\\nupward across the front of the chest to its point of origin. This\\nforces the shoulder upward, backward, and, by pulling the elbow\\nin, also outward.\\nFig. 9.\\n2. The recumbent posture, supine, with the arm carried across\\nthe chest, is the best theoretical treatment for this injury.\\n3. VelpeaiCs dressing. A pad fastened in the axilla of the in-\\njured side. The forearm flexed on the arm and carried across the\\nchest till the hand rests on or near the sound shoulder. Careful\\nmanipulation of the fragments into proper position, and the ap-\\nplication of Yelpeau s bandage.\\n4. DisaulVs dressing. A pad fixed in the axilla by the first\\nroller. The arm bound to the side by the second roller. The\\nshoulder pressed upward and backward by the third roller.\\nUnion in about four weeks carry the arm in a sling for one\\nor two weeks longer.\\nDescribe fractures of the scapula.\\nCause of fracture. Direct violence.\\nSeats of fracture through 1. Body or inferior angle. 2. Surgical\\nneck (supra-scapular notch). 3. Glenoid cavity. 4. Acromion\\nor coracoid processes.\\nWhat are the symptoms of fractured scapula\\nIn all situations there are found disability, pain, swelling, crepi-\\ntus, and preternatural mobility.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0118.jp2"}, "119": {"fulltext": "FRACTURES.\\n117\\nFig. 12.\\nNeck (through suprascapular notch). Disability complete.\\nIf conoid and trapezoid ligaments are torn there will be a space\\nbetween the acromion and humerus disappearing on pressing\\nthe arm upward, but recurring again when the support is\\nremoved. Coracoid process moves with humerus, the acromion\\nremains fixed.\\nAcromion process. If behind the acromioclavicular articula-\\ntion the shoulder is flattened, and drops downward, forward,\\nand inward. Crepitus and undue mobility.\\nCoracoid process. Complete disability. Unnatural motion\\nmay be felt by pressing a finger deeply in the region of this pro-\\ncess and pushing up the elbow.\\nGive the treatment for fractures of the scapula.\\nBody. Compress to both borders of the scapula, adhesive\\nplaster extending circularly from the spine to the sternum,\\nVelpeau or Desault bandage, with the arm vertically to the side.\\nNeck, glenoid cavity, acromion or cora-\\ncoid process. Towel in axilla, and Vel-\\npeau or Desault bandage.\\nDescribe fractures of the humerus.\\nMuscular attachments.\\nTo greater tuberosity. Supraspina-\\ntus, infraspinatus, and teres minor.\\nTo lesser tuberosity. Subscapularis.\\nAnterior bicipital ridge. Pectoralis\\nmajor. Posterior bicipital ridge. La-\\ntissimus dorsi, teres major. Shaft.\\nCoraco-brachialis, deltoid, triceps. In-\\nternal condyle. Pronator radii teres and\\ncommon flexor tendon. External con-\\ndyle and condyloid ridge. The two supi-\\nnators, anconeus, extensor carpi radialis longior, and the com-\\nmon extensor tendon.\\nThere may be fractures of the head, anatomical neck, tuber-\\nosities, surgical neck, including epiphysis, shaft there may be\\nsupra-condyloid, inter-condyloid, T or comminuted, condyloid,\\nepicondyloid (internal only) fractures.\\nComminuted or T fracture.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0119.jp2"}, "120": {"fulltext": "118 ESSENTIALS OF SURGERY.\\nGive the symptoms of fractured humerus.\\nIn all, except the impacted fractures of the anatomical neck,\\nthere are pain, crepitus, preternatural mobility, deformity, dis-\\nability, and swelling.\\nHead and anatomical neck. Symptoms obscure, slight short-\\nening, crepitus on upward pressure and rotation, broken ex-\\ntremity may be felt in axilla.\\nGreater tuberosity. Depression under acromion process, widen-\\ning of shoulder, smooth bony prominence (head of bone) under\\ncoracoid, crepitus on rotation and pressing tubercles together,\\nexternal rotation cannot be performed by the patient.\\nSurgical neck. (That portion of the shaft of the humerus lying\\nbetween the tuberosities and the insertion of the latissimus\\ndorsi and teres major muscles.) Commonest seat of fracture.\\nDirection transverse. Shortening (measured between acromion\\nprocess and external condyle). Lower fragment drawn inward\\nand forward by latissimus dorsi, pectoralis major, and teres\\nmajor, pulled upward by deltoid, biceps, triceps, and coraco-\\nbrachial. Rough end of lower fragment felt near coracoid\\nprocess. Unnatural mobility and crepitus on extension and\\nrotation.\\nEpiphyseal. As in surgical neck, except that it occurs in\\nyoung people, and that the crepitus is moist and the fragments\\nsmooth.\\nShaft of humerus. Mostly below middle third. Direction\\noblique. Deformity, overlapping, from biceps and triceps if\\nabove insertion of the deltoid the lower fragment is pulled out-\\nward by that muscle if below, the upper fragment is tilted for-\\nward. Cardinal signs of fracture readily detected.\\nSupra-condyloid. Projection in front and behind. That in\\nfront is due to the rough end of the upper fragment that\\nbehind is due to the condyles and olecranon occupying their\\nnormal relation in regard to each other. Shortening between\\nacromion process and external condyle. Reduction easy, but\\ndeformity promptly recurs.\\nIntercondyloid. Increased breadth between the condyles, and\\ncrepitus elicited by pressing and rubbing them together.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0120.jp2"}, "121": {"fulltext": "FRACTURES.\\n119\\nCondyloid. Crepitus and mobility on manipulating the bony\\nprominences, displacement slight.\\nAll fractures about the elbow-joint are accompanied by great\\nand rapid swelling.\\nFig. 13.\\nFig. 14.\\nFracture of the lower extremity\\nof the humerus.\\nDressing for fracture of the upper\\nthird of the humerus.\\nGive the treatment for fractures of the humerus.\\nTJ pper extremity. Including intra- and extra-capsular, trochan-\\nteric, and fractures of the surgical neck.\\nFasten a folded towel in the axilla by a bandage and adhesive\\nstrap.\\nFlex the arm, and carry the elbow slightly forward, apply a\\nspiral reversed from the hand to the seat of fracture. Place a\\nmoulded pasteboard cap, or three straight, narrow, external\\nsplints, reaching from the acromion process to the external\\ncondyle, upon the outer aspect of the arm and shoulder, bind\\nin place by a few circular turns of a roller, and complete the\\ndressing by fastening the arm to the side, and slinging the fore-\\narm at the wrist.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0121.jp2"}, "122": {"fulltext": "120\\nESSENTIALS OF SURGERY.\\nShaft of humerus. Primary roller up to the seat of fracture,\\nwell padded internal angular splint, avoiding pressure upon\\ninternal condyle, shoulder cap extending to external condyle\\nor below on forearm, arm bound to the side by circular turns\\nof the roller, and slung at the wrist.\\nIf obstinate deformity from outward tilting by the deltoid,\\nrelax by dressing in the abducted position for a few days.\\nFig. 15.\\nAnterior angular splints.\\nSupra-condyloid. Internal angular and external moulded\\nsplint, or anterior angular splint and posterior moulded trough.\\nCondyloid. Very obtuse angled, anterior, or internal splint.\\nWhat complications may arise in the treatment of these frac-\\ntures\\n1. Non-union, always in intracapsular fractures, frequently\\nin fractures of the shaft.\\n2. Paralysis, from injury to the musculo-spiral or ulnar nerves.\\n3. Anchylosis, from inflammation within or about the joints,\\nparticularly the elbow.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0122.jp2"}, "123": {"fulltext": "FRACTURES. 121\\nHow do you avoid anchylosis in fractures about the joints\\nBy practising passive motion. Begin in four weeks for the\\nshoulder-joint one week for the elbow. Promptly treat inflam-\\nmation by cold, local depletion, aspiration at times, and pressure.\\nHow long do you continue treatment\\nFive to eight weeks, replacing the splints with a sling in that\\ntime.\\nWhat fractures occur in the ulna?\\nSeats of fractures: shaft, olecranon, styloid or coronoid pro-\\ncesses.\\nCause, direct or indirect violence. Usual seat lower third.\\nGive the symptoms of fractured ulna.\\nCardinal symptoms as in all fractures.\\nShaft, being subcutaneous, deformity, crepitus and undue\\nmobility readily recognized.\\nOlecranon. Loss of power to extend, undue mobility crepitus\\non extending forearm and pressing olecranon in position. Dis-\\nplacement often very slight. If aponeurosis is torn through,\\nthe process is drawn well up the arm from between the condyles,\\nleaving a perceptible gap.\\nCoronoid process. Very rare. Tendency to backward luxation\\nof ulna, movable bony prominence in front.\\nStyloid process. Mobility. Crepitus detected by carrying\\nhand towards radial border.\\nGive the treatment for fractures of the ulna.\\nOlecranon. Figure-of-eight about the joint, the upper segment\\nlooping behind the displaced fragment, pulling it downward.\\nApplication of a very obtuse anterior or internal angular splint.\\nShaft. Two well padded splints, each wider than the forearm,\\none reaching from the internal condyle to the tips of the fingers,\\nthe other from the external condyle to the metacarpo-phalangeal\\narticulation. Reduce the fracture, apply splints, with the hand\\nmidway between pronation and supination. Support the fore-\\narm through its whole extent by a handkerchief.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0123.jp2"}, "124": {"fulltext": "122\\nESSENTIALS OF SURGERY.\\nCoronoid process. Anterior angular splint and compress,\\nPassive motion in three weeks.\\nFig. 16.\\nDressing for fractures of one or both bones of the forearm.\\nStyloid process. Keduce, apply a compress. Bandage to a\\nBond splint, or apply anterior and posterior straight splints.\\nDescribe fractures of the radius.\\nSeats of fracture. Head, neck, shaft, lower extremity. Ordi-\\nnary seat, lower extremity.\\nMuscular attachments. Biceps, supinator brevis, pronator\\nradii teres, pronator quadratus. supinator longus.\\nWhat fractures occur at the lower extremity of the radius\\nBarton s (rare). A chipping off of the posterior lip of the\\narticular surface.\\nColles s. Common. A transverse break inch to 1^ inches\\nabove the joint.\\nSmith s. A transverse fracture 1\u00c2\u00a3 inches to 2| inches above\\nthe joint.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0124.jp2"}, "125": {"fulltext": "FRACTURES.\\nFig. 17.\\n123\\nGive the symptoms of fractured radius.\\nCause. Fall on the palm of the hand. Direct violence.\\nLower extremity. Silver fork deformity. Lower fragment lies\\nposterior to the upper fragment. Hand carried towards radial\\nside by supinator longus, extensor carpi radialis, and extensors\\nof the thumb. Crepitus and mobility on rotation. All symp-\\ntoms marked.\\nShaft. Upper fragment slightly tilted forward by biceps,\\nand, if above insertion of pronator radii teres (middle third),\\nsupinated by biceps and supinator brevis. Lower fragment pro-\\nnated by two pronator muscles, tilted towards ulna by pronator\\nquadratus and supinator longus. If below the insertion of the\\npronator radii teres, deformity as before, except that both frag-\\nments are midway between pronation and supination. Crepitus\\nand mobility elicited by rotation.\\nNeck of radius. Upper fragment supinated by short supinator,\\nlower fragment pulled forward by biceps. Crepitus, mobility,\\nand deformity detected by pressing the thumb into the bend of\\nthe elbow and rotating the forearm.\\nBoth bones. Usual seat lower third. Shortening and angular-\\nity often marked. Crepitus, unnatural mobility by grasping the\\nbones on either side of the fracture and manipulating, or by\\nplacing the thumb upon the head of the radius, making exten-\\nsion, and rotating.\\nUpper fragments pulled forward by biceps, brachialis anticus,\\nand pronator radii teres. Lower fragments approximated by\\npronator quadratus overlapping from the action of the flexors\\nand extensors.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0125.jp2"}, "126": {"fulltext": "124\\nESSENTIALS OF SURGERY\\nHow do you treat fractures of the radius?\\nNeck. Anterior angular splint, and compress over upper end\\nof displaced shaft. Dress in supination.\\nShaft. As for shaft of ulna. Reduce by extension, counter-\\nextension, manipulation.\\nLoiver extremity. Reduction most important. Fragments\\nonce placed in proper position usually remain so.\\nFig. 18.\\nBond s splint.\\nReduce thoroughly by extension, pressure, and manipulation.\\nApply a Levis or a Bond splint, a dorsal splint, or simple circu-\\nlar strips of adhesive plaster. In all cases leave the fingers free,\\nand encouraging their use. The Bond splint requires two\\npyramidal pads, the base of the posterior one to go over the\\nupper extremity of the lower fragment, the apex pointing\\ntoward the fingers. The base of the anterior one to go under\\nthe lower extremity of the upper fragment, the apex pointing\\ntoward the elbow. Firm union in four to five weeks.\\nFractures of both bones, or shaft of either, including Colles-S frac-\\nture, complicated by a fracture of the styloid process of the ulna.\\nTwo straight splints wider than the forearm, as in fractures\\nof the shaft of the ulna.\\nSling all fractures of the forearm by means of a handkerchief\\nsupporting it throughout its entire extent.\\nWhat forearm fractures are dressed in supination\\nDress fractures above the insertion of the pronator radii\\nteres with the palm up in all other fractures, dress with the\\nthumb up (midway between pronation and supination).", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0126.jp2"}, "127": {"fulltext": "FRACTURES. 125\\nDescribe fractures of the metacarpus.\\nUsually second or fifth. Posterior angular projection, from\\ndistal end of bone being pulled forward by the flexors. Crepitus\\nand mobility elicited by seizing and manipulating the two ex-\\ntremities of the bone.\\nGive the treatment for fractures of the metacarpus.\\nTreat by an anterior splint to the hand and forearm, padding\\nwell to preserve the concavity of the palm. Compress poste-\\nriorly if any tendency to deformity. Ketain the dressing for five\\nweeks. Passive motion in three days.\\nDescribe fractures of the phalanges.\\nBare. Due to direct force readily diagnosed by manipulating\\nthe finger bones. Treat by anterior moulded, posterior straight\\nsplint, extending to the wrist. A long palmar splint may be\\nused.\\nDescribe fractures of the pelvis.\\nCause. Great and direct violence.\\nSeats. Crest of ilium, basin of pelvis, acetabulum, sacrum,\\nor coccyx.\\nSymptoms. In all these fractures there is a sense of falling\\napart.\\nCrest. Patient leans toward the affected side crepitus and\\nmobility on grasping and manipulating the bone. External\\nevidence of injury, discoloration, swelling, etc.\\nPelvic basin. Crepitus and mobility may be elicited by grasp-\\ning the iliac spines and attempting to move them in opposite\\ndirections great pain, and inability to sit or stand often a\\nline of ecchymosis along Poupart s ligament and the crest of\\nthe ilium. Examination per rectum or vagina may reveal dis-\\nplacement or crepitus.\\nAcetabulum. Either the floor or the rim may be fractured\\ncaused by blows on the trochanter.\\nFloor. Great pain on attempting to stand, or in any way\\nmoving the femur crepitus best detected by thrusting the femur\\ndirectly upward very slight shortening.\\nRim. Usually the upper and posterior part is broken off.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0127.jp2"}, "128": {"fulltext": "126 ESSENTIALS OF SURGERY.\\nSubluxation of femur backward. On circumduction, the head\\nof the bone can be felt to slip out at a certain point, returning to\\nits proper position as the motion is continued there is crepitus.\\nSacrum and coccyx. Direction transverse. Cause, direct vio-\\nlence. There may be some anterior projection from the action\\nof the coccygeus and levator ani muscles. Crepitus and mobility,\\ndetected by a finger in the rectum. Pain on defecation.\\nHow are these fractures treated\\nPlace the patient on a fracture bed, i. e., a firm, hard, evenly\\npadded bed, with a central perforation through which the con-\\ntents of the bowel may be passed without moving the patient.\\nApply a broad bandage or binder tightly about the pelvis tie\\nthe knees together. The most comfortable position is usually\\non the back, with the thighs and knees flexed, and supported by\\npillows allow the patient to assume the position of his choice.\\nIf there is displacement of the coccyx, pack the rectum with\\niodoform gauze or an inflated rubber bag.\\nFractures of the acetabulum are treated by extension, and\\nsand bags or splints, as fractures of the femur.\\nDescribe fractures of the femur.\\nMuscular attachment\\nTo greater trochanter Two gluteals (medius and minimus), two\\nobturators, two gemelli, pyriformis, quadratus femoris. All ex-\\nternal rotators except the glutei.\\nLesser trochanter Psoas, iliacus (below), both flexors and ex-\\nternal rotators.\\nCondyles Gastrocnemius, plantaris, and popliteus.\\nSeats of fracture. Neck Intracapsular, extracapsular, mixed.\\nShaft. Lower extremity Supracondyloid, intercondyloid, T\\nor comminuted, and condyloid.\\nGive the symptoms of intracapsular fracture of femur.\\nOccurs in aged people, frequently females, from slight violence.\\nHip flattened, trochanter less prominent, and lying nearer to\\nthe anterior superior spinous process of the ilium, with its upper\\nborder above Nela ton s line (a line from the anterior superior\\niliac spine to the tuberosity of the ischium).", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0128.jp2"}, "129": {"fulltext": "FRACTURES. 127\\nCrepitus elicited by pressure upon the trochanter, and making\\ntraction and internal rotation. Pain on motion. Preternatural\\nmobility, foot can be everted till the heel looks directly upward.\\nSwelling not accompanied by marked ecchymosis. Shortening\\nfrom to H inches may be slight at first and progressively\\nincrease. Loss of power.\\nFig. 19. Fig. 2\\nLines of fracture of the upper extremity Intracapsular fracture of\\nof the femur. the neck of the femur.\\nGive the symptoms of extracapsular fracture of the femur.\\nCause. Considerable direct violence. It occurs in middle-\\naged males, with well-marked external evidence of injury, i. e. T\\nswelling and discoloration.\\nCrepitus distinct, harsh, readity elicited.\\nShortening marked, 1 to 2\u00c2\u00a3 inches.\\nGive the symptoms of impacted fracture of the hip joint.\\nThe impacted fracture may be either intra- or extracapsular.\\nThere will be 1. No crepitus. 2. Slight shortening, not dis-\\nappearing on traction. 3. Loss of function in the iimb, but not\\nabsolute. 4. Evidence of much injury to the soft parts.\\nThe foot may be inverted or everted.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0129.jp2"}, "130": {"fulltext": "128 ESSENTIALS OF SURGERY.\\nGive the symptoms of fracture of the great trochanter.\\nThis injury often accompanies extracapsular fracture, but may\\nexist alone. Cause. Direct violence. It is characterized by\\npain, swelling, discoloration, and crepitus. Unnatural mobility\\nelicited by pressing into place the broken fragment, whicn may\\nbe felt as a hard lump upon the dorsum of the ilium.\\nGive the symptoms of fracture of the shaft of the femur.\\nCause. Direct violence.\\nCommon seat. Middle third. Direction Oblique.\\nE version of foot, very marked shortening, increased mobility,\\ncrepitus, loss of power. Upper fragment, especially in the upper\\nthird, drawn forward and everted by psoas, iliacus, and external\\nrotators lower fragment pulled up and in by adductors, flexors,\\nand extensors.\\nGive the symptoms of fracture of the lower extremity of the\\nfemur.\\nSupracondyloid. Lower fragment pulled back by gastrocne-\\nmius, shortening, and eversion.\\nIntercondyloid, condyloid, or T {transverse and inter condyloid).\\nIncreased measurement between the condyles, associated with\\ngreat and rapid swelling of the knee. Undue mobility and\\nFig. 21.\\nExtension applied for fracture of the femur.\\ncrepitus, elicited by bending the knee, or by grasping the con-\\ndyles and pushing them in opposite directions. Very great\\npain.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0130.jp2"}, "131": {"fulltext": "FRACTURES,\\n129\\nHow do you treat fractures of the femur?\\nUpper extremity and shaft. Extension by adhesive plaster 2\u00c2\u00a3\\ninches wide and long enough to extend from the upper end of\\nthe lower fragment, on both sides of the limb, and leave a 4 to 6\\ninch loop hanging free below the sole of the foot in this loop is\\nlaid a piece of thin splint board 2| inches wide, and so long, that\\nwhen traction is made, the plaster will stand free from the\\nmalleoli. This board is fastened in place, and through a hole\\nin its centre a cord or bandage is passed. The adhesive plaster\\nis placed along the inner and outer aspect of the limb up to the\\nseat of fracture, and secured in place by a few strips carried\\naround the limb, and a neatly applied spiral reversed bandage\\nof the lower extremity. After an hour or two the plaster is\\nFig. 22.\\nDressing for fractured femur.\\ntightly adherent, when the extending cord is carried over a\\npulley, a weight is attached, and a pad of oakum is put beneath\\nthe tendo Achillis. A sand-bag, or a bran-bag and straight\\nsplint is placed on each side of the leg, the inner extending from\\nthe sole to the perineum, the outer from the sole to the axilla,\\nand the foot of the bed is raised two to four inches to provide for\\ncounter-extension. The position of the foot is slight eversion,\\nand flexion. The inner borders of the inner malleolus, internal\\ncondyle, and ball of the great toe should lie nearly in the same\\nvertical plane, the great toe pointing directly upward.\\nFractures of the upper extremity or shaft of the femur may\\nalso be treated by well-padded straight internal and external\\n9", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0131.jp2"}, "132": {"fulltext": "130 ESSENTIALS OF SURGERY.\\nsplints. The shaft may be treated by plaster or other fixed\\nbandage, or by straight short splints buckled about the seat of\\nfracture. In all cases, except in impacted fracture, extension\\nshould be used.\\nWhat dressing should be applied when the upper fragment pro-\\njects anteriorly\\nKelax the psoas and iliacus by flexing the thigh and support-\\ning it and the leg upon a double inclined plane, raise to such an\\nangle that the deformity is corrected. Apply the extension\\nplaster from the knee to the upper end of the lower fragment,\\nmake a stirrup as before, then carry the extending cord over\\na pulley, so elevated that traction is made in the long axis of the\\nfemur.\\nGive the treatment for fractures of the great trochanter.\\nA bandage about the hips with a moulded cap to keep the\\ntrochanter in position, and a long straight external splint ex-\\ntending from the axilla to sole.\\nHow do you treat fracture of the lower extremity of the femur\\nIf there is obstinate angular deformity, section of tendo\\nAchillis. If marked shortening, extension as before, carried\\nnot quite up to the seat of fracture. A splint, or long fracture-\\nbox, well padded with pillows, should be used. Evaporating\\nlotions, or aspiration, for accompanying synovitis.\\nHow long should treatment be continued in fractures of the\\nfemur\\nTreatment, five to eight weeks. Passive motion of the knee\\njoint after fourteen days. Massage before allowing the patient\\nto put the leg down. Application of plaster, or other fixed\\ndressing about the fracture, before walking is allowed.\\nHow do you treat fracture of the femur in infants\\nReduce by extension, counter-extension, manipulation. Place\\nin position a carefully padded external splint extending from\\nthe axilla to the sole of the foot, and fasten it in place by a,\\nSilica or planter pressing. Treatment for four weeks,.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0132.jp2"}, "133": {"fulltext": "FRACTURES. 131\\nHow do you distinguish between intracapsular and extracap-\\nsular fractures of the femur\\nIn extracapsular\\n1. Crepitus is rougher, more readily elicited, and feels as\\nthough immediately beneath the fingers of the surgeon.\\n2. Swelling and discoloration are greater and more immediate.\\n3. Deformity or shortening is more marked, but eversion can-\\nnot be carried so far as in intracapsular fracture.\\n4. On rotation the trochanter is found to pass through an arc\\nof less radius in extracapsular fractures.\\nDescribe fractures of the patella.\\nCauses. Direct violence, and muscular action.\\nDirection. Transverse or longitudinal. Generally, but not\\nalways, marked separation of fragments.\\nGive the symptoms of fractured patella.\\nPower of extension lost. Gap between fragments, increased\\non flexion. Great swelling. In longitudinal fractures, crepitus\\nand mobility on grasping the two sides of the bone and pressing\\nin opposite directions.\\nHow do you treat fractures of the patella\\nIf there is not much separation, elevate and apply a straight\\nposterior splint to the thigh and leg. If great swelling, cold and\\nevaporating lotions for one or two days, aspirating the joint if\\nnecessary. The posterior straight splint is provided with lateral\\npegs and ratchets, to which are attached strips of adhesive\\nplaster which are looped over the upper and lower fragments\\nby turning these pegs, the lower fragment is steadied, and the\\nupper fragment is drawn down in position. Fix the lower\\nfragment first, then the upper. Imbricate the plaster strips\\nfrom above downward. If the edges of the fragments tilt for-\\nward, carry a piece of strapping transversely around the limb.\\nComplete: the. dressing with a figure-of-eight bandage. Begin\\npassive motion in two or three weeks. Continue the splint for\\nsix or eight weeks. Follow with a stiff bandage, plaster or\\nglass, and keep the patient on crutches for several months.\\nThese fractures may also be treated by Malgaigne s hooks,\\nby Barker s method of subcutaneous wiring, or by making a", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0133.jp2"}, "134": {"fulltext": "132\\nESSENTIALS OF SURGERY.\\ntransverse incision, clearing the breach between the fragments\\nand the knee joint of all clots or blood, drilling the fragments\\nobliquely (sparing the cartilage), and wiring them in close con-\\ntact.\\nFig. 23. Give the symptoms of fracture of the tibia\\nUsual seat, lower third. Cause, direct or\\nindirect violence. Deformity, slight, detected\\nby passing the finger along the subcutaneous\\nedge of the bone. Mobility and crepitus can\\nusually be elicited by extension and counter-\\nextension.\\nWhat are the symptoms of fracture of the\\nfibula?\\nCause, direct or indirect violence. Seat of\\nfracture, lower third. Fracture of lower fifth\\nis termed PoWs fracture. Symptoms obscure,\\ndisability and deformity being slight. Crepi-\\ntus and mobility detected by placing the fin-\\ngers over the seat of fracture and rotating,\\nor by pressure on both sides of the suspected\\nPott s fracture. point.\\nWhat is Pott s fracture?\\nA fracture of the fibula, two to four inches above its lower ex-\\ntremity the foot is displaced outward at the ankle-joint. The\\ninternal lateral ligament is frequently torn. There may be a\\nfracture of the internal malleolus also.\\nWhat are the symptoms of Pott s fracture?\\nA well-marked depression at the seat of fracture. Crepitus\\nand mobility on local pressure. The foot is twisted outwards and\\nthe sole everted by the peronei muscles the internal malleolus\\nprojects prominently as if broken, and the fragments can be dis-\\ntinctly felt.\\nDescribe fracture of both tibia and fibula.\\nUsual cause, indirect force. Seat of fracture, lower third.\\nDirection of fracture, oblique. Deformity, dependent on direc-\\ntion of fracture, there is usually overlapping, and anterior pro-", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0134.jp2"}, "135": {"fulltext": "FRACTURES.\\n133\\njection of the upper or lower fragment,\\nsigns and symptoms.\\nDiagnosis, all cardinal\\nFig. 24.\\nFracture-box.\\nHow do you treat fractures of the leg?\\nAll these fractures may be treated by the fracture-box, apply-\\ning lateral compresses to correct deformity, and using extension\\nif there is marked shortening. The fracture-box should fix\\nthe knee-joint, should be strong, and\\nshould hold the leg in such a position\\nthat the inner borders of the inter-\\nnal condyle, the internal malleolus,\\nand the ball of the great toe lie\\nnearly in the same vertical plane,\\nand the foot is kept at right angles\\nto the leg, pressure being taken off\\nthe heel by a pad of oakum beneath\\nthe tendo Achillis. For very marked displacement, and diffi-\\nculty in retention, flex the hip and knee, lay the limb on its\\nouter side, and bind it to a double-angled external splint for a\\nfew days, then place it in the fracture-box.\\nThe fracture-box consists of a posterior splint, with a foot-\\npiece and hinged sides a pillow is placed in the box, the leg\\nplaced on the pillow, and the sides brought up and tied.\\nExternal, posterior, anterior, and straight moulded splints\\nmay also be used for these fractures.\\nPoWs fracture may be treated with Dupuytren s splint. This\\nconsists of a straight internal splint, notched at the lower end,\\nand extending from the head of\\nthe tibia to a point four inches be-\\nlow the side of the foot. The up-\\nper part of the splint is fastened\\nto the leg, a thick pad is applied\\nto the lower portion, not extend-\\ning below the internal malleolus,\\nthe foot is drawn close to the splint, in the space beneath the\\npad, by a figure-of-eight, so applied that there are no turns\\nwhich make pressure above the external malleolus. The knee\\nis then bent, and the leg suspended, or laid on its outer side.\\nFig. 25.\\nDupuytren s splint applied.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0135.jp2"}, "136": {"fulltext": "134\\nESSENTIALS OF SURGERY.\\nDescribe fractures of the tarsal bones.\\nCause, great violence.\\nCalcaneum or astragalus. Little displacement, unless the\\ntuberosity is separated, when it will be drawn up by the gas-\\ntrocnemius and soleus. Diagnosis depends on crepitus, pain,\\nmobility, and great swelling.\\nTreatment. Fracture-box, or fixed dressing after subsidence of\\nswelling. For separation and displacement of the tuberosity, ex-\\ntend the foot on an anterior or lateral splint, and flex the knee.\\nDescribe fractures of the sternum.\\nSeat, about the junction of the manubrium and gladiolus.\\nCause. Direct violence. Indirect violence (over flexion or\\nextension of the body).\\nDeformity, readily felt. Irregularity and projection.\\nCrepitus and, mobility by extending the body, or causing the\\npatient to take a deep inspiration. Embarrassment of respira-\\ntion, discoloration.\\nThis injury is usually a diastasis, or separation of the bone at\\nits cartilaginous junction. In this case the lower fragment pro-\\njects anteriorly, the crepitus is smooth, and the true nature of\\nthe injury is suggested by its location.\\nTreatment. Eaise the chest by placing a pillow beneath the\\nback, force the patient to take a long breath, giving ether if\\nnecessary, and press the fragments into place.\\nDressing. Broad compress, held in place by adhesive straps or\\nbandages.\\nComplications. Mediastinal abscess and necrosis. Treat the\\nformer by opening at the side of the sternum.\\nIf the ensiform cartilage is drawn in upon the stomach, caus-\\ning distressing symptoms from pressure, it should be hooked up\\nor resected.\\nDescribe fractures of the ribs.\\nCause. Direct or indirect violence, muscular action. Kibs\\ncommonly broken, fifth to tenth.\\nOrdinary seat of fracture, just anterior to the angle.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0136.jp2"}, "137": {"fulltext": "FRACTURES. 135\\nGive the symptoms of fractures of the ribs.\\nCrepitus and mobility, elicited by the pressure of the thumbs,\\npassing from the sternum to the spine. Restriction of respira-\\ntory movements by a sharp pain or stitch. Displacement, if\\npresent, is internal from direct force, external from indirect.\\nGive the treatment for fractures of the ribs.\\nAdhesive strips two and one-half inches wide, running par-\\nallel to the ribs, from the spine to the sternum, and each tightly\\napplied during expiration. The whole side of the chest is in-\\ncluded.\\nIf displacement exists it must be reduced, by pressure, by\\nforcing the patient to inspire deeply under ether, or by hooking\\nup with a tenaculum.\\nWhat complications accompany fractured ribs\\nLaceration of the lung, pleura, or an intercostal artery.\\nHow do you treat the complications\\nOpen and tie, if there are signs and symptoms of internal\\nbleeding. Subsequent pleurisy and pneumonia are usually local-\\nized and conservative. Emphysema may require openings in\\nthe skin (strict asepsis).\\nIn what fractures is the union ligamentous\\nNeck of the femur, olecranon, acromion coracoid and coronoid\\nprocesses, patella, tuberosity of the os calcis, spinous processes\\nof the vertebrae. This is due, in part, to the difficulty in securing\\nor maintaining apposition.\\nDescribe fractures of the vertebrae.\\nCause. Direct or indirect violence.\\nSeats. Spinous processes. Laminae. Body.\\nGive the symptoms of fractured vertebrae.\\nCrepitus, mobility, and deformity may be detected by grasping\\nand manipulating the spinous process, or pressing upon them, or\\nby examination through the pharynx, in fractures of the upper\\ncervical vertebrae. There is immediate paralysis of the parts\\nbelow the injury, with loss of control over the bladder and\\nrectum. Temperature of the paralyzed part is increased.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0137.jp2"}, "138": {"fulltext": "136 ESSENTIALS OF SURGERY.\\nDor so-lumbar region. Paraplegia, retention and overflow of\\nurine, incontinence of faeces.\\nDorsal region. Second to eleventh dorsal. Paralysis of ab-\\ndominal muscles, and muscular coat of intestines. Expiration\\nmarkedly embarrassed from involvement of serratus posticus in-\\nferior, quadratus lumborum, sacro-lumbalis, longissimus dorsi.\\nCervico-dorsal, cervical. If above the fifth and sixth cervical\\nvertebra?, paralysis of the arms, and more marked embarrass-\\nment of respiration from involvement of the long thoracic\\nnerves (fifth and sixth). If above the third and fourth verte-\\nbrae, instant death, from involvement of the phrenic. Fractures\\nof the atlas and axis need not be immediately fatal, since the\\ncanal is so roomy that the cord may not be encroached upon.\\nOdontoid process will cause a prominence in pharynx from sub-\\nluxation of the axis. Rigid maintenance of head in one position.\\nHow do you treat fractures of the vertebrae\\nIf there is displacement, reduce by extension and manipulation.\\nPlace the patient on an air or water bed, guarding against bed-\\nsores by frequent washings with whiskey and alum, and careful\\npadding with soft pillows. Move the bowels by enemata. Draw\\nthe water regularly with a soft, thoroughly aseptic catheter. In\\nfractures about the neck, support by means of short sand-bags.\\nHow do you treat fractures of the extremities complicated by\\ndelirium tremens\\nCarefully pad with raw cotton, and put on a fixed dressing, as\\nplaster or silica when dry, bind the limb in a soft pillow.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0138.jp2"}, "139": {"fulltext": "LUXATIONS. 137\\nLUXATIONS OR DISLOCATIONS.\\nDefine luxation.\\nA luxation is the displacement of the articular surfaces of a\\njoint from their normal relation to each other.\\nName and define the various kinds of luxation.\\nIn regard to cause\\n1. Traumatic, due to sudden force.\\n2. Pathological or spontaneous, due either to alterations of\\nthe joint from disease (coxalgia), or to paralysis of the surround-\\ning muscles.\\n3. Congenital, due to congenital malformation of the joint\\n(luxation produced by Violence in delivery is not congenital).\\nFurther, we have luxation classed as\\nComplete. An entire separation of the articular surfaces from\\neach other.\\nPartial (subluxation). The articular surfaces remain in con-\\ntact through a portion of their surface.\\nRecent. When sufficient time has not elapsed for inflam-\\nmatory changes seriously to impede reduction.\\nOld. When such changes have taken place.\\nSimple, compound, and complicated are applied to luxations\\nprecisely as in case of fracture.\\nWhat are the causes of luxation\\n(1.) Predisposing.\u00e2\u0080\u0094 1. The nature of the joint (ball-and-\\nsocket joint). 2. The position of the joint. 3. The condition of\\nthe surrounding soft parts. (Paralysis, relaxation, and previous\\ninflammation.) 4. Age and sex of the patient. (Adult male.)\\n(2.) Exciting. Direct or indirect violence. Muscular force.\\nWhat are the cardinal symptoms of luxation\\n1. Change in the shape of the joint.\\n2. Alteration of the normal anatomical relations of the bony\\nprominences about the joint, the displaced bone being often felt\\nin its abnormal position.\\n3. Alteration in the length of the limb.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0139.jp2"}, "140": {"fulltext": "138\\nESSENTIALS OF SURGERY.\\n4. Eigidity, or restricted motion of the affected joint.\\n5. Alteration in the direction of the axis of the bone.\\nIn addition we have the symptoms attendant on all trauma-\\ntisms.\\nPain of a dull sickening character. Swelling often very great.\\nDiscoloration diffused about the joint.\\nHow do you distinguish luxations from fractures\\n1. In luxation there is no harsh crepitus.\\n2. There is rigidity in place of undue mobility.\\n3. The deformity, when reduced, has not the same tendency\\nimmediately to recur.\\nThe pain is not so intense, the swelling and discoloration not\\nso rapid, and at times the smooth displaced articular surface\\nmay be felt, while in fracture, except epiphyseal, the surfaces\\nwould necessarily be rough. The Rontgen rays may clear up\\ndoubt.\\nWhat articular changes take place in luxation\\nRupture of capsular ligament, with stretching or tearing of\\nsurrounding vessels, tendons, muscles, and nerves.\\nPrompt reduction of the bone favors the repair of the injury.\\nIf the bone is not reduced the articular cavity becomes filled\\nup, the prominences rounded off a new socket is formed about\\nthe displaced head of the bone. The surrounding soft parts\\nbecome shortened and atrophied, and adhesions between the\\nbone and the vessels or nerves often take place.\\nWhat is the prognosis in luxation\\nUsually a weakened joint. If the dislocation is not reduced,\\npermanent disability, which, however, is rarely absolute.\\nHow do you treat luxation\\nReduce by either manipulation or extension.\\nDescribe the methods of reduction.\\n1. Manipulation consists in so placing and moving the parts\\nthat muscles and ligaments are relaxed, articular prominences are\\ndisentangled from each other, and the head of the bone is either", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0140.jp2"}, "141": {"fulltext": "LUXATIONS. 139\\ndrawn by the muscles, or pushed by moderate force into its proper\\nposition.\\n2. Extension consists in overcoming resistance by force this\\nforce may be applied by the hands, by wet sheets or bandages\\nfastened about the parts, or by multiplying pulleys. When the\\ntension is sufficient to overcome all resistance the bone is pushed\\ninto its proper position. Retain in position by splints and ban-\\ndages.\\nHow do you treat the inflammatory symptoms\\nTreat by evaporating lotions or counter-irritants. The diet\\nshould be restricted and the bowels kept opened.\\nHow do you prevent anchylosis\\nBy passive motion, beginning in seven to ten days, or as soon\\nas inflammatory symptoms subside.\\nWhat complications attend luxations\\n1. Fracture. Treat by setting and splinting the fracture, then\\nreducing the luxation.\\n2. Rupture of a large artery, indicated by a rapidly increasing,\\nfluctuating, pulsating swelling. Treat by rest and pressure, or\\nligate both ends at the point of injury, if it can be found. If\\nthis is impossible, make a formal ligation of the artery above.\\n3. Injury to nerve-trunks. Treat by friction, electricity, mas-\\nsage, incision and suture.\\n4. External wound, or compound luxation. If no extensive\\ninjury to the joint, thoroughly disinfect, replace, close the\\nwound, and fix. If the bone is comminuted, resect.\\nHow do you treat an old luxation\\nLoosen adhesions and relax contracted muscles and ligaments\\nby passive motion. Endeavor to replace the bone by manipula-\\ntion that failing, use force.\\nWhat accidents may occur in the reduction of old luxations\\nFractures. Set at once, and give up further attempt.\\nRupture of important muscles. Put at rest.\\nRupture of principal artery. Ligation of artery above, or liga-\\ntion of both ends at point of rupture, or amputation.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0141.jp2"}, "142": {"fulltext": "140\\nESSENTIALS OF SURGERY.\\nBuptured vein. Pressure.\\nIf an old luxation gives little pain on movement let it alone,\\nas the prognosis is good. If great pain, try to reduce, since\\nthe pain will prevent the patient from endeavoring to restore\\nfuuction.\\nSpecial Luxations.\\nDescribe luxations of the lower jaw.\\nDirection is forward. May be unilateral more commonly bi-\\nlateral. May be partial, the condyles resting on the articular emi-\\nnence, or complete the\\nFig. 26.\\nComplete luxation of the lower jaw.\\ncondyles slipping into\\nthe zygomatic fossa.\\nCause. Violence or\\nmuscular force, applied\\nwhen the mouth is\\nwidely opened. In this\\nposition the condyles\\nride well up on the ar-\\nticular eminence, and\\nmay be easily pulled\\nforward by the action\\nof the external ptery-\\ngoid, and masseter, or\\nby direct force. This\\ndisplacement may occur\\nin yawning, laughing,\\netc.\\nGive the symptoms of dislocation of the jaw.\\nBilateral. Mouth widely opened and rigid, lower jaw thrust\\nforwards, lips cannot be approximated, hence dribbling of saliva.\\nA depression is felt in the normal position of the condyle, the\\nlatter forming a prominence in front. Difficult deglutition, pain,\\nand swelling.\\nSub-luxation. Condyles and lower jaw slightly anterior to\\nnormal position, jaw rigidly closed, and great pain.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0142.jp2"}, "143": {"fulltext": "LUXATIONS. 141\\nUnilateral luxation. Mouth less widely opened, lower jaw\\nprojected anteriorly, and thrust towards sound side displaced\\ncondyle detected on the affected side other symptoms as in\\nbilateral luxation.\\nGive the treatment for dislocations of the inferior maxilla.\\nDisengage the head of the bone from the zygomatic fossa,\\nwhen the internal pterygoids and the masseter and temporal\\nmuscles will pull it in place. This can be effected by pressing\\ndownward upon the molar teeth of the lower jaw, at the\\nsame time pulling up the chin. The protected thumbs of the\\nsurgeon s hand are placed upon the molar teeth, exerting force\\ndownward and backward, while, with the fingers, the chin is\\npressed up or wedges may be inserted between the molar\\nteeth of the lower and upper jaws on each side, and the chin\\nforced directly upwards.\\nUnilateral luxation. Force exerted as before, on the affected\\nside of the jaw.\\nSub-luxation. Slip a case-knife between the teeth of the upper\\nand lower jaws, and pry them open, when the muscles promptly\\nreduce the displacement.\\nDescribe luxation of the ribs.\\nOccurs at costo-chondral or vertebral articulations. If at verte-\\nbral extremity, usually associated with fracture.\\nSymptoms as in fracture, except no crepitus.\\nTreatment as for fracture.\\nDescribe luxation of the vertebrae.\\nNearly always complicated by fracture.\\nUsual seat. Cervical region.\\nSymptoms. Sudden paralysis, rotary or angular deformity, and\\nrigidity.\\nTreatment. Eeduce by extension and counter-extension in\\nthe line of the body. Treat subsequently on a water-bed as for\\nfracture.\\nDescribe luxations of the clavicle.\\nMore frequent at acromial than at sternal extremity.\\nSternal extremity. Forward, by force applied to front of", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0143.jp2"}, "144": {"fulltext": "142 ESSENTIALS OF SURGERY.\\nshoulder. Most common. Backward, by force applied to back\\nof shoulder or applied directly on sternal extremity of bone.\\nUpward, very rare, by force applied to shoulder from above.\\nGive the symptoms of luxations of the sternal end of the\\nclavicle.\\nShoulder falls towards median line, pain on motion. Smooth\\narticulating surface of bone felt in its abnormal position leaving\\na depression in the seat of its articulation. If luxation back-\\nwards or upwards there may be dyspnoea, dysphagia, or venous\\ncongestion of head, from pressure.\\nGive the treatment for luxation of the sternal end of the\\nclavicle.\\nForward and backward luxations. Reduce by knee between\\nscapulae, pulling shoulders back, and pressing the bone in place.\\nUpward luxation. Reduce as above, or by placing a large pad\\nin the axilla, pressing the humerus to the side, and pushing the\\nbone in place.\\nDressing. Forward luxation. ;Flex arm and apply a Velpeau\\nor Desault, keeping the displaced bone in place by compress\\nand adhesive strips.\\nBackward. Posterior figure-of-eight and Velpeau or Desault.\\nUpward. Velpeau bandage, with compress and adhesive\\nstrips if persistent deformity.\\nDescribe luxations of the acromial extremity of the clavicle.\\nReally luxations of the scapula.\\nDirection upward, rarely downward below acromion, or still\\nmore rarely, below coracoid process.\\nCause. Direct blow on scapula.\\nGive the symptoms of luxation of the acromial end of the\\nclavicle.\\nUpward luxation. Shoulder falls down and in. Arm cannot\\nbe raised over head. Outer extremity of clavicle very prominent,\\noverriding acromion process. J\\nDownward luxation. Same _symptoms, except the; acromion\\nis prominent the clavicle leads down to the axilla and can be", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0144.jp2"}, "145": {"fulltext": "LUXATIONS. 143\\nfelt in its abnormal position beneath the acromion or coracoid\\nprocess.\\nGive the treatment for luxations of the acromial end of the\\nclavicle.\\nBeduce, by pulling the shoulder backwards and pressing the\\nbone in place. Place a compress over the acromial extremity\\nof the clavicle and fasten it in place by broad straps passing\\nover it and around the point of the elbow. Apply a Velpeau\\nbandage. In all luxations of the clavicle reduction easy, reten-\\ntion difficult.\\nKeep up the dressing for five to six weeks, then carry the arm\\nin a sling for some time.\\nDescribe dislocation of the scapula.\\nBy this is meant the slipping out of the inferior angle, of the\\nbone from beneath the latissimus dorsi.\\nCause. Paralysis of the serratus magnus, or violence.\\nSymptoms. Wing-like projection, pain, and weakness of\\nshoulder.\\nTreatment. Broad belt which will keep the inferior angle of\\nthe scapula close to the chest.\\nDescribe the shoulder-joint.\\nCharacterized by a large ball and small socket, allowing great\\nfreedom of motion.\\nLigaments. 1. Capsular. Very lax, weakest at lower part,\\nattached to margins of glenoid cavity and to anatomical neck\\nof humerus.\\n2. Coraco-humeral. Passing from root of coracoid process\\ndownward and outward to the front of the great tuberosity.\\n3. Glenoid. A triangular ring of fibro-cartilage, deepening the\\nglenoid cavity. The joint is further strengthened by the tendon\\nof the biceps passing directly over it, and invested in a prolonga-\\ntion of its synovial membrane.\\nName the luxations of the shoulder-joint.\\nFour in number, Subglenoid, subcoraQOid, subclavicular* and\\n$ubspinou", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0145.jp2"}, "146": {"fulltext": "144 ESSENTIALS OF SURGERY.\\nFig. 27. Fig. 28.\\nSubclavicular.\\nSubspinous.\\nWhat symptoms are common to all shoulder luxations\\n1. Flattening and squareness of the shoulder, with apparent\\nprojection of acromion process.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0146.jp2"}, "147": {"fulltext": "LUXATIONS. 145\\n2. A depression beneath the acromion process, where the head\\nshould lie.\\n3. The head of the bone can be felt in its abnormal position.\\n4. The vertical measurement of the shoulders, from the axilla\\naround the acromion process, is one or two inches greater on the\\naffected side than on the sound |ide.\\n5. With the elbow brought clJse to the body, the patient can-\\nnot place the hand of the injured side upon the opposite shoulder\\n(except in subspinous).\\n6. Alteration in the axis of the humerus.\\n7. Bigidity, pain, swelling, discoloration, etc.\\nWhat symptoms characterize subcoracoid luxation\\nThis is the most common luxation. 1. Head of bone can be\\nfelt in the upper and anterior part of the axilla, beneath the\\ncoracoid process.\\n2. The humerus stands from the side (deltoid), and is some-\\nwhat oblique in direction, the elbow being carried back (latissi-\\nmus dorsi and teres major).\\n3. Pressure on axillary plexus especially marked, and conse-\\nquent numbness and tingling in the arm and forearm.\\nWhat symptoms characterize subglenoid luxation\\nNext in frequency. Head of bone rests on axillary border of\\nscapula, and can be felt in the axilla. Elbow carried far from\\nthe side (deltoid). Lengthening of the arm, measured from the\\nacromion process to the external condyle of humerus.\\nWhat symptoms characterize subspinous luxation?\\nElbow carried somewhat forward (pect. major), and bone\\nrotated inward (subscapularis), the forearm being thrown across\\nthe chest. Head of bone felt on dorsum of the scapula. Cora-\\ncoid process prominent.\\nWhat symptoms characterize sub-clavicular luxations\\nHead of bone seen or felt internal to coracoid process, and be-\\nlow clavicle, much laceration of muscles attached to tuberosities.\\nElbow out and back. All the characteristic symptoms.\\n10", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0147.jp2"}, "148": {"fulltext": "146\\nESSENTIALS OF SURGERY.\\nHow do you treat luxations of the humerus?\\n1. Beduce by manipulation.\\nSubglenoid, subcoracoid, and subclavicular. Flex forearm on\\narm (relax long head of biceps) raise the arm from the body\\n(relax deltoid and supra-spinatus) rotate the humerus outward\\n(relax infra-spinatus and teres minor); make forcible traction\\nupon the humerus with one hand, sweeping it to the side of the\\nbody and rotating it inward, carrying the forearm across the\\nchest, while with the other hand in the axilla the head of the\\nbone is pressed into place.\\nSubspinous. Flex the forearm, grasping the elbow, carry the\\nhumerus from the side, rotate inward (subspinous), and with the\\nthumb press the head of the bone in place.\\n2. Beduce by extension.\\nHeel in the axilla. Patient supine, surgeon sits down beside\\nhim, places his heel (unbooted) in the axilla, and makes traction\\nFig. 31.\\nReduction by extension.\\non the wrist, at first directly downwards. If the luxation is not\\nreduced, the humerus is carried across the chest by pulleys.\\nEarely employed except in old dislocations.\\nAfter treatment, arm to side and axillary pad for a week,\\npassive motion for two weeks, then allow patient to use arm.\\nOld luxations. If more than three months have elapsed and\\nthere is a fair amount of motion, do not attempt to reduce.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0148.jp2"}, "149": {"fulltext": "LUXATIONS. 147\\nLuxations of Elbow.\\nWhat dislocations may occur at the elbow-joint?\\nEadius. Forwards, backwards, outwards.\\nUlna. Backwards.\\nBoth bones. Forwards, backwards, inwards, outwards.\\nOrdinary luxation. Both bones backwards.\\nDescribe backward luxation of both bones.\\nCause. Fall on palm of hand.\\nMay be complete, when coronoid process of ulna is lodged in\\nolecranon fossa of humerus, or incomplete, when coronoid process\\nrests upon the articulating surface of the humerus (trochlear).\\nGive the symptoms of backward luxations of the radius and\\nulna.\\n1. Olecranon projects posteriorly, is out of line with condyles,\\nand the distance between it and the condyles is greatly in-\\ncreased. Head of radius felt behind external condyle.\\n2. A smooth, broad, rounded projection, the articular ex-\\ntremity of the humerus, can be felt in front of the elbow, below\\nthe joint crease.\\n3. The forearm is flexed, supinated, and rigid.\\n4. Shortening, from external condyle to styloid process of\\nradius.\\nGive the symptoms of forward and lateral luxations of radius\\nand ulna at the elbow.\\nBoth bones forward, very rare, forearm lengthened, condyles\\nof humerus prominent, sigmoid notch can be felt in front of arm.\\nLateral luxation of both bones. Great deformity. The articu-\\nlating extremity of the radius or ulna can be felt in their\\nabnormal positions, with marked projection of the condyle from\\nwhich the bones are displaced joint widened, forearm flexed\\nand pronated.\\nGive the symptoms of luxation of the ulna at the elbow.\\nDirection, always backward. The symptoms are the same as\\nfor both bones backward, except that the head of the radius", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0149.jp2"}, "150": {"fulltext": "148 ESSENTIALS OF SURGERY.\\ncan be felt in its normal position, and the forearm is shortened\\nonly on its ulnar aspect.\\nGive the symptoms of luxations of the radius at the elbow.\\nDirections, forward, backward, outward.\\nForward, due to force applied in supination.\\nBackward, due to forcible pronation. In both, the head of\\nthe bone can be felt in its abnormal position, leaving a hollow\\nbelow the capitellum of the humerus. Motion restricted.\\nGive the treatment for luxations at the elbow.\\nDislocation of idna or of both bones.\\nForcible flexion of forearm over the knee placed in the bend\\nof the elbow or forcible extension of the forearm, followed by\\nflexion.\\nBadius. Anterior luxation. Flexion of forearm, direct pres-\\nsure upon head of radius, and forced pronations.\\nPosterior luxation. Flexion of forearm, forced supination,\\ndirect pressure.\\nDressing. Anterior angular splint one week, with compress, in\\ncase of radius passive motion daily. These luxations become\\nold in one or two weeks. If attempt to reduce an old luxation\\nis made, first break up adhesions.\\nDescribe luxations of the carpal extremity of the ulna.\\nCause. Forward, violent supinations. Backward, violent\\npronations.\\nSymptoms. Projection, with ordinary symptoms. Triangular\\ncartilage always broken.\\nTreatment. Press bone in place, apply compress and bandage,\\nor adhesive plaster, keep up support for several months.\\nDescribe luxations of the carpus.\\nThe wrist-joint is formed by the radius and triangular carti-\\nlage articulating with scaphoid, semilunar, and cuneiform bones.\\nCause of luxation. Force applied to hand in front or behind.\\nDirection. Backward or forward.\\nSymptoms. Thickness of wrist greatly increased. Distance\\nbetween styloid process of radius and base of metacarpal bone", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0150.jp2"}, "151": {"fulltext": "LUXATIONS. 149\\nof thumb lessened. The smooth round projection of the carpal\\nbones felt on one surface of the wrist, the more irregular projec-\\ntion of the lower extremity of the radius felt on the opposite\\nsurface. Kigidity, pain, etc. Hand somewhat flexed in poste-\\nrior luxation, somewhat extended in anterior luxation.\\nTreatment. Posterior displacement. Flex, press carpus for-\\nward, on first sign of slipping into place suddenly extend.\\nAnterior displacement. Extend, press carpus backward, and\\non first sign of slipping into place suddenly flex. Keduction\\nmay be effected by extension and counter-extension.\\nSplint and begin passive motion as soon as inflammation sub-\\nsides.\\nDescribe luxation of the individual carpal bones.\\nDirection. Backwards.\\nCause. Direct force.\\nCommon seat. Os magnum.\\nSymptoms. Projection at base of third metacarpal bone,\\nwith ordinary symptoms of luxation.\\nTreatment. Extend, press into place, and apply palmar splint\\nwith compress.\\nWhat luxations may occur in the hand?\\nMetacarpus. Rare.\\nDirection. Backwards.\\nSymptoms. Prominence and shortening.\\nTreatment. Extension, pressure, and palmar splint.\\nPhalanges. Seat. Usually first phalanx of index or little\\nfinger. Direction. Anterior or posterior.\\nSymptoms. Shortening and undue prominence.\\nTreatment. Traction, or extreme extension and forcing bone\\ninto place by direct pressure.\\nWhat is the most difficult luxation to reduce?\\nBackward displacement of first phalanx from the metacarpal\\nbone of the thumb.\\nWhat is the cause of difficulty?\\nThe head of the metacarpal bone slips in between the two\\nheads of the short flexor of the thumb, and is embraced the more", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0151.jp2"}, "152": {"fulltext": "150\\nESSENTIALS OF SURGERY.\\ntightly, in proportion to the amount of traction exerted on the\\ndisplaced phalanx.\\nWhat are the symptoms of backward luxation of the first\\nphalanx of the thumb\\nHead of metacarpal bone felt in palmar aspect of hand.\\nProximal phalanx extended, terminal flexed. Immobility, etc.\\nGive the treatment.\\nForcibly adduct the metacarpal bone into the palm, extend\\nthe phalanx far backward till the thumb-nail nearly touches the\\nwrist, then suddenly flex on the metacarpal bone, at the same\\ntime pressing the displaced phalanx into position. If this\\nmethod fails, tenotomy of the flexor brevis pollicis.\\nName the ligaments of the hip-joint.\\n1. Cotyloid, a rim of fibro-cartilage deepening the acetabulum.\\n2. Transverse, bridges over the notch, and is continuous at\\neach end with\\nFig. 32.\\nFig. 33.\\nY-ligament.\\nObturator luxation.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0152.jp2"}, "153": {"fulltext": "LUXATIONS. 151\\n3. Ligamentum teres, which passes to a depression in the head\\nof the femur.\\n4. Capsular, encircling the acetabulum above and attached to\\nanterior intertrochanteric line, to inner and upper border of the\\ngreat trochanter, and posteriorly and below to the junctions of\\nthe middle and outer thirds of the neck of the femur.\\n5. Y -ligament, a thickened part of the capsular ligament\\nrising from the anterior inferior iliac spine and splitting as it\\npasses down to be inserted into the intertrochanteric line.\\nLower and inner part of joint is weakest.\\nName the dislocations of the hip-joint.\\n1. Up and back on dorsum ilii. Iliac.\\n2. Back in sciatic notch. Ischiatic.\\n3. Forward and down in obturator foramen. Obturator.\\n4. Forward and up on pubis. Suprapubic.\\nCauses. Force applied when the limb is abducted.\\nWhat symptoms characterize the backward luxations\\n1. Dorsum ilii. Upwards and backwards. Bulging of hip from\\ndisplaced trochanter major, which lies above Nelaton^s line and\\nnearer the anterior superior spinous process of the ilium than\\non the sound side.\\nShortening, one and one-half inches. Pressing the fingers into\\nthe groin over the femoral vessels, their firm base or support is\\ngone, a hollow is felt instead. Head of the bone may be felt\\nbeneath glutei muscles.\\nPosition of leg. Adduction and inversion due to Y -ligament.\\nKnee rests against lower third of opposite thigh. Great toe rests\\non instep of opposite foot.\\nHigidity, pain, swelling, etc.\\n2. Ischiatic or sciatic luxation (below the tendon of the obtu-\\nrator).\\nSymptoms the same, but less marked. Less shortening, adduc-\\ntion, and inversion.\\nKnee touches, but does not cross opposite knee. Ball of great\\ntoe rests on metatarsal bone of opposite side.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0153.jp2"}, "154": {"fulltext": "152 ESSENTIALS OF SURGERY.\\nFig. 34. Fig. 35.\\nDorsum ilii.\\nIschiatic.\\nFig. 36.\\nGive the treatment of backward luxations,\\nManipulation. Flex leg on thigh (relax hamstring mus-\\ncles), thigh on abdomen, and still\\nfurther adduct to relax anterior\\npart of capsule then maintain-\\ning flexion, circumduct (abduct\\nand rotate) outward as far as pos-\\nble, bringing the leg suddenly\\ndown to an extended position by\\nthe side of its fellow. By this\\nmeans the head of the bone is\\nmade to retrace the steps by which\\nit escaped, and is wound in place\\nby the Y -ligament.\\nManipulation failing, try\\nExtension. Secure counter-exten-\\nsion by strapping the pelvis to the\\nfloor or bed. Make extension by\\nflexing the thigh on the pelvis and\\npulling directly upward.\\nManipulation for reduction of\\nbackward luxation.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0154.jp2"}, "155": {"fulltext": "LUXATIONS.\\n153\\nGive the symptoms characterizing forward luxations.\\nObturator luxation forward and downward.\\n1. Psoas, iliacus, external rotators, and Y -ligament put upoi*\\nthe stretch, hence\\nEversion and abduction with slight flexion, thigh being carried\\nsomewhat forward.\\n2. Flattening of hip and, possibly, detection of bone in abnor-\\nmal position.\\n3. Slight lengthening (one-half inch).\\n4. Fixation, swelling, and other signs.\\nFig. 37.\\nFig. 38.\\n-^^0*^\\nSuprapubic.\\nSuprapubic luxation. 1. Head of bone readily felt on pubis, to\\nouter side of femoral artery.\\n2. Shortening (1\u00c2\u00a3 inch), with very marked eversion of foot and\\nknee, heel inclining towards opposite one.\\n3. Trochanter may be internal to anterior superior spinous pro-\\n4. Depression over acetabulum.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0155.jp2"}, "156": {"fulltext": "154\\nESSENTIALS OF SURGERY\\nGive the treatment of forward luxations.\\nReduction. Obturator Flex leg on thigh, thigh on abdomen,\\nabduct somewhat, then circumduct\\ninward, carrying thigh over body and\\nmaking internal rotation, and bring\\nthe leg down to the side of its fellow.\\nSuprapubic as for obturator, but\\ndo not carry the thigh so far across\\nthe body.\\nGive the after-treatment of all luxa\u00c2\u00ab\\ntions at the hip-joint.\\nThe knees bandaged together (a\\ntowel between them) for ten days,\\npassive motion in bed for two weeks,\\nManipulation for reduction of Wearin moulded su PP ort for three\\nforward luxations. months.\\nName the internal ligaments of the knee-joint.\\n1. Anterior and posterior crucial.\\n2. The transverse ligament, binding together the two semilunar\\ncartilages.\\n3. The coronary ligament, connecting the outer borders of the\\nsemilunar cartilages to the head of the tibia.\\n4. Ligamentum mucosum, a process of synovial membrane, and\\nligamenta alaria, its fringed borders.\\nDescribe luxations of the knee-joint.\\nCause great violence. Directions Forward, backward, in-\\nward, and outward.\\nLateral dislocations mostly incomplete more common than an-\\nteroposterior.\\nGive the symptoms of backward and forward luxations of the\\nknee-joint.\\n1. Shortening. 2. Great deformity. The articulating extremi*\\nties of the femur and tibia being readily felt in their abnormal\\npositions.\\nGive the symptoms of lateral luxations of the knee-joint.\\nNo shortening, but marked lateral projection of the tibia, with", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0156.jp2"}, "157": {"fulltext": "LUXATIONS. 155\\na depression above condyle of femur prominent on opposite side,\\nwith a corresponding depression below.\\nGive the treatment of luxations of the knee-joint.\\nTreatment. Flex the thigh, make extension, and push bone\\nin place. Reduction easy.\\nApply a posterior straight splint. Treat the synovitis (cold,\\ncounter-irritation, etc.), and begin passive motion as soon as\\nacute inflammatory symptoms subside. A knee-cap must be\\nworn when the patient is allowed to walk.\\nIn what directions may the patella be dislocated\\n1. Outwards. (Most common, from oblique attachment of\\nquadriceps tendon.)\\n2. Inicards.\\n3. Quarter rotation.\\n4. Half rotation.\\nGive the symptoms of luxation of the patella.\\nOutward and inward luxations.\\n1. Knee flattened and broadened.\\n2. Sulcus in normal position of patella.\\n3. Patella readily found in abnormal position.\\nGive the treatment for lateral luxations of the patella.\\nAnaesthetize, flex thigh or abdomen, extend leg on thigh,\\nforcibly depress the margin of the patella furthest from the\\ncentre of the joint, when its inner edge being raised and freed,\\nwill be snapped into place by the quadriceps.\\nGive the symptoms of rotatory luxation of the patella.\\nQuarter rotation. 1. Sharp edge of patella felt prominently\\nunder skin. 2. Leg fixed in extension.\\nHalf rotation. 1. Tendo patella stands rigidly out and is\\ntwisted. 2. Smooth articular facets of under portion of patella\\nfelt. 2. Limb rigidly extended.\\nTreatment. Anaesthetize. Rapid flexion and extension of\\nleg on thigh. If this fails, employ direct pressure.\\nDescribe luxation of the semilunar fibro-cartilage.\\nCauses. Twists of foot or leg while the knee is flexed.\\nDirections. Inward towards spine of tibia, outward.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0157.jp2"}, "158": {"fulltext": "156 ESSENTIALS OF SURGERY.\\nGive the symptoms of luxation of the semilunar cartilage.\\n1. If outward, a projection may be felt between tibia and con\u00c2\u00ab\\ndyle of femur. If inward, a depression may be noted in the same\\nposition.\\n2. Sudden, violent, sickening pain.\\n3. Leg fixed in senii-flexiom\\n4. Rapid effusion into joint.\\nGive the treatment for luxations of the semilunar cartilage.\\nForcible flexion, straight posterior splint. Treat accompanying\\nsynovitis. A knee cap must subsequently be worn.\\nDescribe luxations at the ankle-joint.\\nDirections. Outwards, inwards, forwards, backwards, up-\\nwards (between tibia and fibula).\\nMay be complete or incomplete. Complications. Frequently\\nfractures.\\nOutward. Always accompanied by fracture of fibula, fre-\\nquently of internal malleolus also, or rupture of internal lateral\\nligament.\\nSymptoms. As in Pott s fracture (p. 32). Foot everted. In-\\nternal malleolus prominent.\\nInward. Rare. Accompanied by fracture of tibia.\\nSymptoms. 1. Foot inverted. 2. External malleolus promi-\\nnent and nearly touching ground. 3. Depression over seat of\\nfracture.\\nBackward. 1. Marked shortening of foot with toes pointed\\ndownward. 2. Lengthening of heel.\\nForward. 1. Lengthening of foot. 2. Heel less prominent.\\n3. Tibia lies close to tendo Achillis, which is relaxed.\\nUpward. Caused by heavy fall on feet.\\nSymptoms. Joint very wide, malleoli may be prominent and\\nnearly on a level with the sole.\\nGive the treatment for luxations of the ankle-joint.\\nBeduce. Flex leg on thigh, extend ankle-joint to relax muscles\\nof calf. Extension must be made at the foot. Counter-extension\\nat the thigh, while by manipulation and pressure the bones are\\nreplaced in their proper position.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0158.jp2"}, "159": {"fulltext": "LUXATIONS. 157\\nAfter treatment. Control inflammatory symptoms by evapo-\\nrating lotions. Fracture-box, or moulded splints for two weeks,\\nthen passive motion.\\nDescribe luxations of the astragalus.\\nDirections. Forward, backward, outward, inward.\\nForward, most common.\\nCause. Violent twists.\\nSymptoms. In all these luxations the malleoli are nearer the\\nsole than they should be.\\nForward. A round smooth swelling upon the instep, with\\nordinary signs of luxation.\\nBackward. 1. Hard prominence between tendo Achillis and\\nmalleoli. 2. End of tibia and fibula prominent anteriorly. 3.\\nFoot apparently shortened.\\nLateral luxations. If astragalus is thrust outward the foot is\\ndisplaced inward. Internal malleolus very prominent.\\nInward luxation. Foot displaced outward. External malleo-\\nlus prominent.\\nReduce. By traction and direct pressure, under ether. Failing,\\nperform tenotomy, dividing all resisting structures. If skin\\nsloughs over projecting astragalus, remove the bone.\\nFailing to reduce, put in fracture-box and treat as ankle luxa-\\ntion.\\nGive the differential diagnosis between fracture of the surgical\\nneck of the humerus, and luxation about the shoulder-\\njoint.\\nIn fracture, crepitus, unnatural mobility. Head of the tone in\\nits normal position, but not moving with shaft. Deformity readily\\novercome, but at once recurring on removal of reducing force\\nacromion not especially prominent, and no undue space beneath\\nit jagged bone ends may be felt very acute pain. Arm hangs\\nto the side.\\nLuxation. No crepitus. Rigidity. A hollow in the normal\\nposition of the head of the bone. Detection of head of bone in\\nabnormal position, moving with the shaft. Deformity reduced\\nwith difficulty, after reduction the bone remains in its normal\\nposition acromion prominent, with a space beneath. Shoulder\\nflattened and squared. Arm stands from the side.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0159.jp2"}, "160": {"fulltext": "158 ESSENTIALS OF SURGERY.\\nGive the differential diagnosis between supracondyloid fracture\\nof the humerus, and backward luxation of the radius and\\nulna.\\nFracture. Crepitus, mobility, and all cardinal signs olecra-\\nnon and internal and external condyle in their normal relation to\\neach other no shortening from external condyle to styloid pro-\\ncess of radius, shortening from acromion to external condyle.\\nLuxation. Immobility, and all the signs of luxation; olecranon\\ndisplaced backward from its normal position in relation to internal\\nand external condyles; shortening from external condyle to\\nstyloid process of radius, no shortening from acromion to ex-\\nternal condyle.\\nThe differential diagnosis between any fracture, and a luxation\\nin the same region, may readily be given by bearing in mind the\\ncardinal symptoms of each affection.\\nSprains.\\nWhat is a sprain\\nThe twisting of a joint, by which the soft parts about it are\\nstretched or torn. Muscles, tendons, ligaments, nerves, and\\nbloodvessels may be involved.\\nWhat is a sprain fracture\\nThe tearing away of scales of bone to which ligaments are at-\\ntached.\\nWhat are the symptoms of sprain\\nPain and swelling due to both extravasation of blood, and in-\\nflammatory effusion within and without the joint. Discoloration\\nand loss of function.\\nGive the treatment of sprain.\\nHot fomentations, or hot bath, lasting for several hours, fol-\\nlowed by pressure bandage for two to four days. Passive motion\\nand massage as soon as the inflammatory symptoms begin to sub-\\nside. Or, cold applications and evaporating lotions, followed by\\npressure and massage.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0160.jp2"}, "161": {"fulltext": "DISEASES OF JOINTS. 159\\nDescribe sprains of the back.\\nSymptoms. Pain, stiffness, and disability, appearing some time\\nafter the injury. There may be apparent paresis, together with\\nretention of urine and faeces, due to the pain caused by motion.\\nThere is sometimes hematuria.\\nTreatment. Best in the most comfortable position for a few\\ndays, with local depletion (leeches), hot moist applications\\n(antiseptic poultices), and counter-irritants. Then massage and\\nuse. If there is great pain on motion, a plaster bandage may be\\napplied, to be removed as soon as possible.\\nWounds of Joints.\\nWhat symptoms characterize joint wounds\\nSymptoms of acute inflammation, with distension, due to ef-\\nfused blood and synovial fluid, and escape of the latter through\\nthe external wound.\\nIf the contents of the joint cavity become infected, the char-\\nacteristic symptoms of an acute suppurative synovitis and ar-\\nthritis will appear, together with the high fever (103\u00c2\u00b0-105\u00c2\u00b0), and\\nmarked constitutional symptoms of the affection.\\nHow do you treat a wounded joint?\\nIf uncertain as to whether the joint is wounded, do not probe,\\nbut treat as a wounded joint.\\n1. Small incised wounds. Thoroughly disinfect the wound area,\\nclose promptly, using sutures if necessary. Cover with a scale\\nof iodoform and collodion. Carefully splint in the easiest posi-\\ntion, and apply cold by means of ice-bags. If marked local and\\ngeneral inflammatory symptoms appear, open the joint, and\\ntreat as\u00e2\u0080\u0094\\n2. Large or lacerated wounds. Thoroughly disinfect the entire\\nwound area. Wash out the synovial cavity with 1 1000 bichlo-\\nride solution, finishing with 1 5000. Make a counter opening,\\nand insert drainage-tubes. Suture the external wound, apply\\nan antiseptic dressing, splint most carefully, and elevate the\\nlimb.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0161.jp2"}, "162": {"fulltext": "160 ESSENTIALS OF SURGERY.\\nSynovitis.\\nWhat is synovitis\\nAn inflammation of the synovial membrane of a joint. It may\\nbe acute or chronic. There may be an effusion consisting of\\nsynovia and serum, constituting serous synovitis. This effusion\\nmay become infected, causing purulent synovitis.\\nWhat are the causes of synovitis\\nExposure to heat or cold, traumatism, rheumatism, gout,\\nsyphilis, tuberculosis, gonorrhoea, and pyaemia.\\nGive the symptoms of acute synovitis.\\nPain, intense, bursting. Worse at night.\\nTenderness. Slightest touch or motion unbearable.\\nSwelling. Fluctuates, takes the shape of the synovial sac, and\\nappears at certain portions of the joint. (At the sides of the\\nquadriceps tendon and beneath the patella, in the knee-joint\\nat the sides of the olecranon and triceps in the elbow-joint.)\\nMuscular atrophy. Inflammatory fever, with local heat and\\nIf suppuration ensues, these symptoms, both local and con-\\nstitutional, are aggravated the patient has chills, the fever\\nshortly becomes typhoid in type, and the joint becomes red and\\noedematous.\\nHow do you treat acute synovitis?\\nCarefully splint in the position which will leave the most use-\\nful limb should anchylosis occur. (Elbow at right angles, knee\\nstraight.) Leeches and an ice-bag in the early stages. Aspi-\\nrate if the synovial sac becomes greatly distended. Light diet,\\nopium to relieve pain, regulate the bowels.\\nIf suppuration ensues, incise, irrigate, drain, and dress anti-\\nseptically. Stimulants, tonics, and generous diet.\\nDescribe chronic synovitis.\\nMay result from acute. Synovial membrane may become\\nthickened and indurated from venous congestion, or pass into a", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0162.jp2"}, "163": {"fulltext": "DISEASES OF JOINTS. 161\\nstate of fatty or pulpy degeneration. Fluid in the synovial sac\\nusually considerable in amount clear, or slightly opalescent.\\nMuscular atrophy commonly present. Symptoms of inflamma-\\ntion slight or wanting. Disability not absolute, joint weak,\\nbut can be used.\\nGive treatment of chronic synovitis.\\nCounter-irritation by blisters, or tr. iodin. Pressure by elastic\\nbandage. Unguent, hydrarg. cum belladon. locally. Steaming the\\njoint. Fixation by means of plaster bandages. Injections of tr.\\niodin. and distilled water, equal parts of each, into the joint.\\nTreatment of associated systemic conditions, as rheumatism or\\nsyphilis.\\nDescribe hydrarthrosis.\\nHydrarthrosis or hydrops articuli is a serous effusion into a\\njoint. It may arise from acute or chronic synovitis, or\\nspontaneously.\\nSymptoms and treatment as for chronic synovitis. Open and.\\ndrain if everything else fails.\\nArthritis.\\nWhat is arthritis\\nArthritis is an inflammation beginning in either the synovial\\nmembrane or the bone, and affecting all the structures of a joint.\\nWhat are the varieties of arthritis\\nAcute. Chronic. Traumatic and infective (pyaemia, gonor-\\nrhoea, etc.), usually acute. Diathetic (struma, gout, rheuma-\\ntism), frequently chronic.\\nWhat are the symptoms of acute arthritis\\nPain. Throbbing, tensile, worse at night. The limb is subject\\nto spasmodic startings during sleep, which, from the pain they\\nprovoke, will cause the patient to wake suddenly with a cry\\nosteocopic cry\\nTenderness. Developed to its most extreme extent.\\nSwelling. Involves the entire joint area.\\nCrepitus. May be felt when the cartilages are eroded.\\n11", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0163.jp2"}, "164": {"fulltext": "162 ESSENTIALS OF SURGERY.\\nPreternatural mobility. Although the joint is rigidly fixed by\\nthe muscles, examination under either will show softening and\\nrelaxation of ligaments, and the possibility of producing motions\\nnot normal to the joint.\\nAtrophy. Muscles of the affected limb rapidly waste.\\nHeat, redness, and oedema. Especially when pus is formed.\\nFever. Ranges high, accompanied by rigors when there is\\nsuppuration, and quickly passes to the typhoid or the hectic\\ntype.\\nWhat symptoms distinguish arthritis from synovitis\\nIn arthritis. Starting pains at night. Swelling more diffused\\nabout the joint and doughy rather than fluctuating. Crepitus.\\nUnnatural mobility and atrophy more marked. Constitutional\\nsymptoms more serious.\\nGive the treatment for acute arthritis.\\nAbsolute rest in a favorable position (splint), with elevation,\\nand the application of cold or heat.\\nIf suppuration ensues, open freely, drain thoroughly, and treat\\nantiseptically.\\nIn some cases of traumatic arthritis, or arthritis secondary to\\nacute epiphysitis, amputation may be necessary, if the patient\\nsteadily fails after opening and draining.\\nConstitutional treatment. Stimulants, tonics, and generous\\ndiet.\\nWhat is the usual cause of acute arthritis in infants\\nAn acute epiphysitis which suppurates, and quickly involves\\nthe joint. Treatment. Evacuate pus immediately, and splint to\\nprevent deformity.\\nWhat is white swelling\\nWhite swelling, or gelatinous arthritis, is a strumous inflam-\\nmation of a joint, beginning usually as a (tubercular) synovitis,\\nand characterized by slow course, with ultimate tendency to\\ntotal disorganization of the part.\\nSwelling. Diffuse and somewhat elastic;\\nPain. Gnawing in character, not very acute.\\nColor, Usually blanched.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0164.jp2"}, "165": {"fulltext": "DISEASES OF JOINTS. 163\\nAtrophy. Well marked.\\nPreternatural mobility. Keadily detected.\\nImpairment, but not loss of function.\\nGive the treatment for white swelling.\\n1. Absolute rest, by means of fixed dressings kept on for\\nmonths.\\n2. Tonics, stimulants, alteratives, cod-liver oil, quinine, iodide\\nof iron.\\n3. Fresh air and good food in abundance.\\nGoxalgia.\\nWhat is coxalgia\\nCoxalgia is a strumous arthritis of the hip-joint, occurring\\nusually in persons under fifteen years of age. It is more\\ncommon in boys than in girls, and is frequently tubercular.\\nName the varieties of coxalgia.\\n1. Femoral. The disease begins in the upper epiphysis of\\nthe femur.\\n2. Acetabular. The floor of the acetabulum is first involved.\\n3. Arthritic. The disease begins as a synovitis.\\nInto what stages may coxalgia be divided\\n1. Inflammation. Flexion and fixation of joint.\\n2. Effusion. Flexion, abduction, and fixation, with apparent\\nlengthening from compensatory curvature of the spine.\\n3. Frequently suppuration. Flexion, fixation, adduction, and\\ninversion. Apparent shortening, due to a compensatory curvature\\nof the spine in the opposite direction. Backward luxation of\\nfemur may take place in this stage.\\nWhat are the early symptoms of hip-joint disease\\nPain, frequently referred to knee.\\nTenderness, elicited by jarring the femur upward, or pressing\\nsuddenly inward upon the trochanter.\\nLimping, which may wear off in the evening.\\nFixation, detected by attempting to flex, extend and rotate", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0165.jp2"}, "166": {"fulltext": "164 ESSENTIALS OF SURGERY.\\nthe femur, when the muscles resist and the pelvis is felt to move\\nwith the thigh. Place the patient on his back, upon a bed or\\ntable, and press the knee of the affected side downward till the\\npopliteal space touches the supporting surface, the lumbar ver-\\ntebrae can be felt arching upwards. Raise the thigh to a right\\nangle with the pelvis, the vertebral arch disappears, and on\\nfurther flexion, the pelvis on the affected side is raised from the\\ntable.\\nFlexion. The limb of the affected side is slightly flexed and\\ncarried in advance of its fellow, the latter bearing the weight of\\nthe body.\\nWhat symptoms denote the further extension of the disease?\\nSecond stage. Pain is more intense, with starts at night\\n(showing exposure of bone by erosion of cartilages). Tenderness,\\nlimping, and fixation are more marked. Swelling may be per-\\nceptible. Atrophy is apparent nates flattened gluteo-femoral fold\\nless distinct than on the sound side, circumference of thigh and\\nleg lessened. Position. Limb flexed, abducted, and everted,\\nwith pelvis lowered on affected side. Failure in general health.\\nThird stage. Position. Flexion, adduction, and inversion,\\nthe affected thigh crossing the other. Pelvis elevated on the\\ndiseased side. Shortening, real from wasting, and apparent from\\nspinal curvature. Suppuration and abscesses common. Hectic\\nwith rapid emaciation.\\nHow may you distinguish between the various forms of cox-\\nalgia\\nThe arthritic form approaches nearer to the type of an acute\\ninflammation, with sharp pain in the hip-joint, swelling, etc.\\nThe femoral variety is characterized by starting pain most\\nmarked at the knee (obturator and anterior crural nerves), by\\nshortening and luxation as the disease progresses, by abscesses\\npointing to outer part of thigh, below the trochanter.\\nAcetabular. Tendency to abscess most marked, may point from\\nwithin the pelvis, over the nates, or above Poupart s ligament.\\nWhat is the prognosis in hip-joint disease?\\nArthritic form is, in children, favorable. Femoral and age-", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0166.jp2"}, "167": {"fulltext": "DISEASES OP JOINTS. 165\\ntabular forms more grave, especially the latter. In adults the\\nprognosis is unfavorable.\\nWhat are the complications of hip-joint disease\\n1. Suppuration. 2. Amyloid degeneration. 3. Tubercular\\nmeningitis.\\nHow do you treat hip-joint disease\\nIn light and beginning cases, ^a fixation splint to the affected\\nside (Agnew s, Thomas s, or a plaster bandage), a high-soled\\nshoe (three inches) on the sound side, and a pair of crutches.\\nFor more serious cases, rest in bed, with extension apparatus, as in\\nfractures, applied to the affected side, and counter-irritation, by\\nmeans of blisters, over the inflamed joint. On disappearance of\\nall symptoms get the patient up with high shoe, crutches, and\\nsplint, which must be continued for one year.\\nConstitutional treatment on general principles. Plenty of nour-\\nishing food and fresh air. Stimulants and tonics as required.\\nCod-liver oil and syrup ferri iodidi. Abscesses should be evacuated\\npromptly by aspiration, or incision and drainage, under anti-\\nseptic precautions.\\nHow do you treat anchylosis in a faulty position, following hip-\\njoint disease\\nBy subcutaneous division of the neck of the femur by means\\nof a strong narrow saw (Adams s), bringing the thigh into\\ngood position (extension), and treating as a fractured femur.\\nContinuous extension may succeed without an operation, in some\\ncases.\\nUnder what circumstances should the head of the femur be ex-\\ncised?\\n1. When it is necrosed and detached.\\n2. When other treatment has failed to check very free suppu-\\nration and rapid exhaustion of patient.\\n3. In some cases of displacement.\\nUnder what circumstances is amputation justifiable in the\\ntreatment of hip-joint disease?\\n1. When there is extensive disease of the femur and free sup-\\npuration.\\n2. After excision which has not modified symptoms.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0167.jp2"}, "168": {"fulltext": "166 ESSENTIALS OF SURGERY.\\nHow do you distinguish between psoas abscess and coxalgia\\nPsoas abscess can be felt as a fluctuating swelling, appearing\\nto the outer side of the bloodvessels below Poupart s ligament,\\nand traceable, through the abdominal wall, along the course of\\nthe psoas muscle. On marked flexion the pelvis does not move\\nwith the femur. Extension gives pain, referred to the loins.\\nSacro-Iliac Disease.\\nDescribe sacro-iliac disease.\\nSacro-iliac disease is a strumous arthritis of the sacro-iliac\\njoint, occurring in early life, and characterized by\\nPain over the affected joint, aggravated by coughing, strain-\\ning at stool, or by lateral pressure.\\nTenderness and swelling in the region affected.\\nLameness appearing early.\\nLengthening real, from downward displacement of os innomi-\\nnatum. Suppuration.\\nThe prognosis is bad. Treatment as in case of hip-joint dis-\\nease. If an abscess threatens to break, incise, remove dead\\nbone, asepticize, and drain.\\nWhite Swelling of the Knee-Joint,\\nDescribe white swelling of the knee-joint.\\nWhite swelling of the knee is usually a strumous (tubercular)\\naffection, occurring in children, and characterized by\\nPain, slight at first, becomes starting.\\nSwelling, moderate at first, gradually increasing.\\nTenderness, particularly marked on inner aspect.\\nLameness, not producing entire disabilit) r for some time.\\nDisplacemeyit. Knee at first flexed, but as ligaments are soft-\\nened and yield, there is a backward displacement and outward\\nrotation of the tibia on the femur.\\nCrepitus, marked. Undue mobility, in a lateral direction.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0168.jp2"}, "169": {"fulltext": "DISEASES OF JOINTS. 167\\nAbscesses may form, opening externally, or the joint may be-\\ncome anchylosed.\\nTreatment. Fixation in good position, as for chronic synovitis\\nand arthritis. In some cases aspiration and injection with a 10\\nper cent, emulsion of iodoform in sterile olive oil. In some\\ncases erasion, in some resection, in some amputation.\\nRheumatoid Arthritis.\\nDescribe rheumatoid arthritis (osteo-arthritis).\\nSeats. 1. Hip. 2. Shoulder. 3. Jaw.\\nLesions. Absorption of cartilage, ulceration of bone surfaces\\nwith rarefaction, shortening of ligaments, and bony deposits in\\nand around the joint. Occurs after middle life, usually in men.\\nSymptoms. Frequently bilateral disability, some deformity,\\ncrackling, and atrophy.\\nTreatment. Local support, quinia, and general hygiene.\\nLoose Bodies in Joints.\\nWhat are the causes of loose bodies in a joint\\n1. From altered blood-clot (fibrinous).\\n2. From hemorrhage into a synovial fringe, which subse-\\nquently organizes and is loosened.\\n3. From the gradual detachment of a synovial fringe.\\n4. In rheumatoid arthritis synovial fringes may be converted\\ninto cartilage, and become pediculated or loosened, or the nodular\\nmasses about the joint may project into the articular cavity.\\n5. As the result of injury, a portion of cartilage may be either\\nchipped off or may, by a process of necrosis, be shed into the\\njoint.\\nKnee-joint usually affected.\\nGive the symptoms of loose bodies in a joint.\\nBecurrence of attacks characterized by\\nSadden, agonizing pain, and fixation of the joint in slight flexion,\\nfollowed by synovitis.\\nDetection of the body by manipulation commonly found in the\\npouch over the external condyle of the femur.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0169.jp2"}, "170": {"fulltext": "168 ESSENTIALS OF SURGERY.\\nHow do you treat loose bodies in joints\\nRadical. Secure the body in place by transfixing it with a\\nstrong needle dissect it out, checking bleeding before opening\\nthe joint. If it has a pedicle, ligate. Close the wound, dress,\\nand immobilize.\\nPalliative. Knee-cap.\\nAnchylosis.\\nWhat are the varieties of anchylosis or stiff joint\\nTrue anchylosis is dependent on articular and intra-articular\\nthickening and adhesions. True anchylosis may be complete, in\\nwhich case the articular surfaces are united in part or through-\\nout by bone. Rarely found except after traumatic arthritis.\\nOr it may he incomplete, motion being restricted by fibrous\\nunion between the joint surfaces, and thickening of the capsule.\\nFalse anchylosis is dependent on contractions and adhesions of\\nthe soft parts around the joints.\\nThe Rontgen rays are useful in diagnosis of the exact condi-\\ntion.\\nGive the treatment of anchylosis.\\nIncomplete or fibrous anchylosis. Passive motion, employment\\nof hot-air apparatus, and use of the part. Application of\\nsplints, the angle of which can be changed. Continuous exten-\\nsion by means of weights. Forcible flexion and extension\\nunder anaesthetics.\\nComplete or bony anchylosis. If the position is good, let alone,\\nexcept in the case of the elbow, which should be excised. If\\nthe position is bad, osteotomy or resection.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0170.jp2"}, "171": {"fulltext": "DISEASES OF BONES. 169\\nDISEASES OF BONES.\\nName the inflammatory diseases of the bones.\\nPeriostitis, osteitis, osteomyelitis, epiphysitis.\\nPeriostitis.\\nDescribe periostitis.\\n1. Simple local periostitis, which may become suppurative peri-\\nostitis, forming periosteal abscess.\\n2. Diffuse infective periostitis.\\n(1) Local periostitis. Cause. Local injury or extension of in-\\nflammation from other parts.\\nPathology. Thickening of external fibrous layer, prolifera-\\ntion of inner osteogenetic layer, and inflammatory exudate\\nloosening the periosteum from the bone. It may terminate in\\n1. Resolution. 2. Periosteal abscess. 3. Periosteal nodes (par-\\nticularly in chronic periostitis).\\nSymptoms. Pain. Intense, bursting, and worse at night.\\nSwelling of soft parts overlying.\\nTenderness. Well marked on pressure. Fever.\\nIn suppuration, symptoms are increased in severity there are\\noedema, and discoloration of skin.\\nTreatment. Rest in bed, elevation, cold, opium for pain,\\nleeches. Should pain and fever be unabated, or increase in\\ntwenty-four hours, free incision. If pus, open. For osteoplastic\\nperiostitis (periosteal nodes), oleate of mercury, subcutaneous\\nsection, or ablation by gouging.\\n(2) Diffuse infective periostitis.\\nCause. Injury to a strumous subject.\\nSeat. Long bones femur, tibia, humerus.\\nPathology. Rapid septic suppuration, completely separating\\nperiosteum from bone.\\nSymptoms. High fever and profound constitutional disturbance\\nrapidly running to a condition of septicaemia.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0171.jp2"}, "172": {"fulltext": "170 ESSENTIALS OE SURGERY.\\nDeep-seated pain. Bedness, puffiness, and oedema of the skin\\nappear early.\\nTreatment. Early and free incisions. Antiseptic irrigation.\\nThorough drainage. Stimulants, tonics, and rich diet.\\nOsteitis.\\nDescribe osteitis.\\nCause. Injury, diathesis (scrofula, syphilis, rheumatism).\\nPathology. Inflammatory exudation and cellular hyperplasia in\\nthe Haversian canals, with solution and removal of the bone sub-\\nstance. Haversian canals, lacunae, canaliculi become widened,\\nand may disappear by coalescence. This constitutes rarefying\\nosteitis or osteoporosis. The bones may yield to pressure and be-\\ncome greatly deformed, constituting osteitis deformans. If the\\ninflammation is very acute, rapid proliferation causes strangu-\\nlation of vessels and the bone dies in mass (necrosis), or by\\nmolecular death and discharge (caries). If inflammation is\\nsomewhat chronic, the absorbed bone is replaced by a new de-\\nposit, excessive in amount, and very dense (osteosclerosis or\\nosteoplastic osteitis), or the inflammation may result in a local-\\nized collection of pus (abscess of bone).\\nSymptoms. As in periostitis. Osteocopic (starting) pains\\nmore marked. Tenderness on tapping. (Tenderness on pres-\\nsure greatest in periostitis.) Limb heavier and more useless.\\nTreatment. As for periostitis. Hot fomentations of lead\\nwater and laudanum. Subcutaneous drilling. Trephine. Treat\\ndiathesis.\\nOsteomyelitis,\\nDescribe osteomyelitis.\\nDefinition. Inflammation of the marrow of the bone.\\nCause. Traumatism. May occur primarily, or may be sec-\\nondary to other affections of the bone.\\nVarieties. 1. Simple. 2. Suppurative. 3. Gangrenous.\\n1. Simple osteomyelitis. There is proliferation affecting the\\nembryonic cells in the medulla and in the surrounding Haversian", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0172.jp2"}, "173": {"fulltext": "DISEASES OF BONES. 171\\ncanals and cancellous tissue, the fat disappears, the bone is\\nabsorbed. Granulation tissue is formed which may undergo\\nresolution, may organize into bone filling the medullary canal (as\\nin case of fractures), or may suppurate.\\n2. Suppurative osteomyelitis. May be circumscribed forming\\nbone abscess, or diffuse, leading to extensive necrosis or pyaemia.\\n3. Gangrenous osteomyelitis. Due to a very high grade of in-\\nflammatory action, causing death by obstruction to circulation.\\nComplications of osteomyelitis. Caries, or bone ulceration. Ne-\\ncrosis, death of bone this may be central, involving the inner\\nlaminse only peripheral, involving the outer laminae, or total,\\ninvolving the whole thickness of the shaft. Separation of epiphy-\\nsis. Inflammation of epiphysis. Pyarthrosis. Pycemia.\\nOsteomyelitis exhibits a tendency to spread towards the trunk.\\nTreatment. Simple osteomyelitis, as for osteitis.\\nSuppurative osteomyelitis. Open with trephine, chisel, or gouge.\\nIf suppuration is extensive and associated with pyarthrosis (pus\\nin joint), amputate.\\nGangrenous osteomyelitis. Amputate.\\nAbscess of Bone.\\nDescribe abscess of bone.\\nNature. Usually strumous.\\nCause. Due to rarefying osteitis, or the breaking-up of case-\\nated tubercular masses.\\nSeat. Head of tibia usually (Brodie s abscess).\\nSymptoms. Boring persistent pain, worse at night. Tender-\\nness especially marked on striking or tapping.\\nTreatment. Apply a rubber bandage and tourniquet and\\nsearch for pus with a drill. Trephine scrape, and chisel out\\nall rough or carious bone. Pack with iodoform gauze, apply an\\nantiseptic dressing and a splint.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0173.jp2"}, "174": {"fulltext": "172 ESSENTIALS OF SURGERY.\\nCaries.\\nDescribe caries.\\nDefinition. Ulceration or molecular death of osseous tissue.\\nPathology. As for rarefying osteitis. The surrounding bone\\nis indurated, except in struma, when it is converted into a\\nmass of fungous granulations.\\nSeats. Cancellated extremities of long bones. Often affects\\nthe joints secondarily.\\nSymptoms. Those of osteitis with abscess.\\nOn probing, the softened, roughened, readily bleeding diseased\\narea is detected. The discharge contains an excess of phosphate\\nof lime.\\nTreatment. Kemove the diseased bone by the curette, gouge,\\nor osteotrite. When the detritus preserves its color in spite of\\nwashing, sound tissue is reached. Excision or amputation may\\nbe necessary.\\nNecrosis.\\nDescribe necrosis.\\nDefinition. Death of bone in mass.\\nDirect cause. Osteitis in any of its varieties.\\nBemote cause. Scrofula, syphilis, phosphorus, exposure to\\nheat and cold, etc.\\nNecrosis may be dry (the ordinary variety), due to inflam-\\nmatory strangulation, or moist, due to sudden death from injury.\\nNecrosed bone is dry, dirty yellow or brown, hard, and does\\nnot bleed when struck with a probe. When loosened it is\\nthrown off as an exfoliation. The periosteum frequently retains\\nits vitality, and throws out a sheath of new bone surrounding\\nthe dead portion, which, when it is entirely separated from the\\nliving bone and thus surrounded, forms a sequestrum, and is\\nsaid to be invaginated. The sheath of bone investing the seques-\\ntrum is called the involucrum. The openings in the involucrum,\\nthrough which the discharge makes its way to the surface, are\\ncalled cloacae. Dead bone is separated from the living by a\\nprocess of granulation.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0174.jp2"}, "175": {"fulltext": "DISEASES OF BONES. 173\\nSequestrum. Dead bone surrounded by living bone.\\nInvolucrum. A shell of living bone surrounding a sequestrum.\\nCloacae. Openings in an involucrum.\\nSymptoms. Those of bone inflammation, followed by free sup-\\npuration, with discharge of laudable pus this continues for a\\nlong time, the abscess openings contracting down to sinuses.\\nDiagnosis. Made by feeling the hard, rough surface of dead\\nbone with a probe.\\nTreatment. Nourishing food, tonics, fresh air, iodide of iron,\\nand cod-liver oil. Sequestrotomy when the sequestrum is loose.\\nIn some cases close the bone cavity by a moist blood clot or\\nSenn s bone chips.\\nTubercle.\\nDescribe tubercle of bone.\\nThree forms. Miliary tubercle, caseating tubercle, and scrofulous\\nosteitis (chronic rarefying osteitis). May be local (encysted) or\\ndiffuse (infiltrated) more commonly the latter.\\nSeal. Cancellated ends of long bones.\\nCommon form. Scrofulous osteitis (tubercular nature cannot\\nalways be proven) occurs chiefly on hands, feet (strumous dac-\\ntylitis), ends of long bones (abscess, or scrofulous arthritis), and\\nbodies of vertebrae, (Pott s disease).\\nSymptoms. Those of osteitis, together with the signs of scrofu-\\nlous diathesis.\\nTreatment. Air, good food, general hygiene, etc.\\nCounter-irritation, pressure,, and splinting. When suppura-\\ntion takes place, open, and remove entire disease area.\\nSyphilitic Bone Disease.\\nDescribe the osseous lesions of syphilis.\\nAcquired. Gummata between periosteum and bone, forming\\nperiosteal nodes. These nodes chiefly affect the tibia, ulna,\\nclavicle, and hard palate. Rarely, a diffused chronic form of in-\\nflammation causes syphilitic osteitis or sclerosis.\\nCongenital, In very young children cranio tabes, or wasting", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0175.jp2"}, "176": {"fulltext": "174 ESSENTIALS OF SURGERY.\\nof bone at the sites of decubitus, i. e., behind the eminences of\\nthe parietal bones. Alterations in the epiphyseal cartilage making\\nthe bone brittle and soft, Hutchinson s teeth, and Parrot s nodes or\\nosteophytes, appearing in the form of bony projections about the\\nanterior fontanelle, and on the tibia and humerus.\\nOsteomalacia.\\nDescribe mollities ossium or osteomalacia.\\nA disease characterized by general softening of the bones, ren-\\ndering them liable to be bent or broken.\\nOccurs during and after adult life, mostly in females.\\nPathology. Rarefaction and absorption of bone, advancing\\nfrom the centre outward. Replacement of medullary tissue by a\\ndark-red, semi-fluid material.\\nSymptoms. Obscure pain in the bones and malaise. Phos-\\nphates in the urine. Fractures, deformity.\\nWhat is fragilitas ossium\\nA brittleness of bone dependent on fatty degeneration.\\nPott s Disease.\\nWhat is Pott s disease?\\nPott s disease is an angular deformity of the spine caused by\\ncaries of the vertebrae or the intervertebral cartilages.\\nGive the pathology of Pott s disease.\\nUsually due to a tubercular osteitis which affects the bodies\\nof several vertebrae simultaneously these becoming softened,\\nyield to the superimposed weight, thus causing deformity. There\\nmay be no pus formation, the inflamed area being removed\\nby interstitial absorption, the pus may become encysted and\\ncaseated, or, more commonly, may appear as a cofa? abscess. The\\ncord is rarely injured, the deformity being so gradual that it ac-\\ncommodates itself to its new course.\\nAnchylosis, which is a reparative effort, goes hand in hand\\nwith the disease, new bony arches being thrown out between the", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0176.jp2"}, "177": {"fulltext": "DISEASES OF BONES. 175\\nvertebrae. Pott s disease occurs most frequently in childhood,\\nand is commonly found in the dorsal and cervical regions.\\nGive the symptoms of Pott s disease.\\n1. General failure in health.\\n2. Rigidity of spine. Detected by getting the patient to pick\\nan object from the floor, to rise from a dorsal recumbent posture,\\nor. to turn from the back to the belly. In consequence of rigidity\\nand tenderness, the gait is tottering, shuffling, and uncertain.\\n3. Pain and tenderness, elicited at times by jarring the head\\nor by inducing the patient to jump from a chair or step. May be\\nfound by direct pressure. There is a constant tendency to sup-\\nport the back the patient will frequently lie down, or, if sitting,\\nwill support the weight of the shoulders on the thighs.\\n4. Reflex irritation. Lumbar disease is frequently attended\\nwith colicky pain, irritation of the bladder, and incontinence of\\nurine. Dorsal disease is characterized at times by a grunting\\nrespiration. Cervical disease may cause torticollis, choreic move-\\nments of the neck muscles, or difficulty in deglutition.\\n5. Deformity. Undue prominence of spinous process causing\\na backward projection.\\n6. Abscesses.\\n7. Paresis or paralysis.\\nIn what directions do the abscesses of Pott s disease point?\\nCervical region. Post-pharyngeal abscess may be formed, or\\nthe pus may pass outward between the longus colli and scaleni\\nmuscles, appearing behind the sterno-cleido-mastoid, or it may\\npass downward.\\nDorsal region. Pus may pass directly backward, or form\\npsoas, iliac, or lumbar abscess.\\nLumbar region. Lumbar abscess, appearing to outer side of\\nquadratus lumborum. Psoas or iliac abscess.\\nGive the treatment of Pott s disease.\\nConstitutional, as for strumous affections.\\nLocal. Best. In the early stages rest in bed. Plaster jacket\\nwith either entire or partial confinement to bed.\\nAbscesses must be opened asepticatly as soon as detected. Open\\npsoas abscesses above Poupart s ligament before they are per-", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0177.jp2"}, "178": {"fulltext": "176 ESSENTIALS OF SURGERY.\\nceptible in the groin. Some surgeons also make an incision in\\nthe back and remove the dead bone.\\nHow is the plaster jacket applied\\nBandages two and one-half or three inches wide, seven yards\\nlong, made of gauze, mull, or crinoline. Rub dry plaster of Paris\\nthoroughly in the meshes of each bandage as it is rolled. Place\\non the patient a clean thin summer undershirt, pad all bony\\nprojections with cotton, put over the abdomen next to the skin\\na dinner pad (a folded towel), suspend the patient by the\\nhead and shoulders, wet the bandages, and apply them so that\\nthe expanded basin of the pelvis is caught below and the sup-\\nport comes well up beneath the axilla of each side. Remove\\nthe dinner pad when the bandage hardens.\\nThe treatment of forcible correction of the deformity and\\napplication of plaster-of- Paris finds a number of advocates.\\nRickets.\\nDefine rickets.\\nRickets is a constitutional disease of childhood, characterized\\nby lesions of the osseous system, and a tendency to amyloid de-\\ngeneration of the viscera.\\nEtiology, defective or unsuitable food.\\nGive the pathology of rickets.\\nIncreased cell-growth, with deficiency of earthy matter. En-\\nlargement of epiphyseal cartilages. Thickening of periosteum.\\nSoftening and distortion of the shafts of the bones.\\nGive the symptoms of rickets.\\nPremonitory. Delayed dentition, restlessness at night, sweating\\nabout the head, abundant urine loaded with phosphates.\\nOf the developed disease. Deformities. Such as\\n1. Pigeon-breast, with beaded ribs from enlargement of costo-\\nchondral junction.\\n2. Lateral or antero-posterior curvatures of the spine.\\n3. Bent legs or arms with rounded enlargements at the ends of\\nthe long bones.\\nAs a frequent complication we have bronchitis, serious on ac-\\ncount of the yielding nature of the chest walls.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0178.jp2"}, "179": {"fulltext": "CURVATURE OF THE SPINE. 177\\nTreatment. General hygiene, nourishing diet, cod-liver oil,\\nlactophosphate of lime, iron, sj^rup. hypophos. comp.\\nHaemophilia.\\nDescribe haemophilia.\\nHaemophilia is a congenital and habitual hemorrhagic dia-\\nthesis, in virtue of which persistent bleeding may occur, of it-\\nself, or from the slightest wound.\\nTreatment. Compresses saturated in Monsel s solution local\\napplication of a 10 per cent, solution of gelatin in normal salt\\nsolution elevation of part strong pressure, ergot, acetate of\\nlead, or chloride of calcium internally.\\nStruma.\\nWhat is struma?\\nStruma or scrofulais a defective bodily condition characterized\\nby a tendency to the development of chronic (tubercular) inflam-\\nmations of the bones, joints, and lymphatic glands.\\nWhat are the characteristics of scrofulous inflammations\\n1. They develop at an early period in life.\\n2. They are chronic in type.\\n3. They occur chiefly in phthisical families.\\n4. They exhibit a marked tendency to pass on to suppuration\\nand caseation.\\n5. They are prone to appear in certain regions. Example,\\ncervical adenitis.\\nGive the treatment of scrofulous inflammation.\\nConstitutional. Generous diet, fresh air and sunshine, cod-\\nliver oil, iodide of iron.\\nLocal. Active counter-irritation, pressure, operative pro-\\ncedures.\\nCurvature of the Spine.\\nDescribe spinal curvature.\\nThe curvature may have its convexity directed forward, back-\\nward, or to the side.\\n12", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0179.jp2"}, "180": {"fulltext": "178 ESSENTIALS OF SURGERY.\\nThe cause of curvature is long-continued, unequal compression\\nof the intervertebral cartilages.\\nForward curvature, or lordosis, is usually found in the lumbar\\nregion, and is simply an exaggeration of the normal curve, com-\\npensatory to some deformity or diseased condition, such as\\nricket, congenital femoral luxation, coxalgia, etc.\\nBackward curvature, or kyphosis, usually appears as an exagge^\\nration of the normal dorsal curve. It is the result of debility,\\nrickets, or occupation requiring constant stooping.\\nTreatment. In the young, friction, massage, deep breathing,\\nexercises for back muscles, braces which are comfortable only\\nwhen the shoulders are held back.\\nLateral curvature, or scoliosis, develops most frequently in\\ngirls, between the ages of 14 and 18. There are usually two\\ncurves with their convexities turned in opposite directions. The\\nvertebrae are rotated on their vertical axes, their spinous pro-\\ncesses pointing towards the concavity of the curves.\\nCauses. Inequality in the length or strength of the legs; one-\\nsided position or use of the body contractions following em-\\npyema or paralysis of spinal muscles of one side. These causes\\nare rendered more operative by debility, or a strumous or rachitic\\ndiathesis.\\nSymptoms. Sense of fatigue and pain in back and shoulder\\nwhen sitting, or on first lying down. Wing-like projection of\\nscapula (dorsal curvature is usually toward right), and undue\\nprominence of the iliac crest of the affected side, with projection\\nof the breast on the opposite side. Curvature may be detected\\nby marking the spinous processes, though it must be remembered\\nthat the amount of deformity is much greater than is indicated\\nby this test.\\nTreatment. Change in habits or occupations which can act as\\nexciting causes. Massage, friction, and electricity to the mus-\\ncles of the back, systematic gymnastic exercises, suspension fol-\\nlowed by rest in the recumbent position. If deformity increases,\\nit may be necessary to apply a plaster-jacket.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0180.jp2"}, "181": {"fulltext": "HERNIA. 179\\nHERNIA.\\nWhat is a hernia?\\nThe protrusion of a viscus through an abnormal opening in the\\nwalls of the cavity in which it is contained.\\nAs applied, hernia is synonymous with rupture, and indicates\\nprotrusion of the abdominal viscera through abnormal openings\\nin the parietes.\\nWhat are the essential parts of a hernia\\n1. The sac. 2. The contents.\\nDescribe the sac.\\nThe sac may be (1) congenital. Found only in umbilical and\\ninguinal regions consisting of a pouch of peritoneum ready to\\nreceive the hernia. (2) Acquired. Developed by gradual stretch-\\ning of the parietal peritoneum. This is the form of sac ordinarily\\nfound.\\nThe formation of the sac. Pressure of abdominal contents upon\\nthe parietal peritoneum may cause a bulging of the membrane\\nwhere it is poorly supported, as at the internal inguinal ring the\\nperitoneum yields, and the bulging is developed into a pouch\\nwhich fills the inguinal canal escaping from the external ring\\nits base is less supported, and it forms a pyriform swelling, con-\\nsisting of\u00e2\u0080\u0094 (1) The neck, at the internal ring. (2) The body, the\\nmain part of the sac. (3) The fundus, or wide extremity. As\\nthe peritoneum is dragged downward it becomes puckered at the\\nneck.\\nDuring the stage of (1) Formation, this puckered neck exerts\\nno constriction upon the hernial contents.\\nStage 2. Organization. These puckerings become adherent,\\nand the surrounding subserous fat is indurated.\\nStage 3. Contraction. The neck of the sac contracts and may\\nbecome obliterated, or may cause strangulation if the gut be\\nprotruding.\\nThe sac, at first smooth, becomes thickened, contracts, adheres,\\nand is irreducible at times it sends off diverticula or secondary\\nsacs.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0181.jp2"}, "182": {"fulltext": "180 ESSENTIALS OF SURGERY.\\nHow are hernias classified in regard to the contents of the sac?\\n1. Epiplocele. Containing omentum only, most common on\\nleft side.\\n2. Enterocele. Containing intestine only, usually ileum.\\n3. Entero-epiplocele. Containing both omentum and gut.\\nFurther we may have cystocele (bladder), ccccocele (caecum), gas-\\ntrocele, etc.\\nWhat are the causes of hernia\\n1. Predisposing, Stec, males. Heredity. Age, young. Length-\\nened mesentery. Structural defects (congenital). Occupation.\\nAbnormal conditions, such as a protracted cough, operations on\\nthe abdomen, and muscular relaxation.\\n2. Exciting. Muscular contraction.\\nWhat are the common seats of hernia\\nIn the inguinal, femoral, and umbilical regions.\\nWhat are the varieties of hernia in regard to their condition\\n(Clinical varieties.)\\n1. Beducible. Most common form, the contents can readily\\nbe returned into the abdomen.\\n2. Irreducible. Contents cannot be reduced into abdomen.\\n3. Obstructed or incarcerated. The contained bowel becomes\\nobstructed by its contents.\\n4. Inflamed. There is inflammation or localized peritonitis\\nof sac and contents.\\n5. Strangulated. Subject to a constriction not only obstruct-\\ning the bowel, but seriously interfering with its circulation.\\nReducible Hernia.\\nWhat are the symptoms of reducible hernia?\\n1. Enterocele. A smooth, regular, round tumor in a hernial\\nregion, often to be traced through the hernial canal, larger on\\nstanding than on lying down. Tympanitic on percussion, gurgles\\nwhen manipulated. Disappears with a flap when pressed inwards.\\nPresents succession (an expansile push) on coughing. Local\\nweakness, dragging pains, and irregular dyspepsia.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0182.jp2"}, "183": {"fulltext": "HERNIA. 181\\n2. Epiplocele. No tympanites, no flop, no gurgle the symp-\\ntoms the same but less marked. Doughy and uneven on palpa-\\ntion.\\nGive the treatment for reducible hernia.\\n1. Palliative. 2. Radical.\\nPalliative. Truss, consisting of pad and spring. Pad must\\nbe slightly convex, and large enough to cover the external open-\\ning and the canal through which the hernia descends. The\\nspring must so act on the pad that the pressure is just sufficient\\nto keep the hernia up.\\nTo test a truss, let the patient stoop, cross the legs, and cough,\\nsitting on the edge of a chair with the body leaning forward\\nand legs widely separated.\\nTo measure for a truss. (Inguinal or femoral.) From lower\\nborder of hernial opening to the anterior superior spine of\\nilium of same side, from this point around the body one inch\\nbelow crest of ilium to other iliac spine, thence to upper part of\\nhernial opening.\\nDirections for use. Immediately remove truss if hernia should\\ncome down. Bathe the skin beneath the pad with whiskey and\\nalum on taking off the truss, and before replacing it. Take off\\nafter lying down and replace before rising.\\nRadical cures. The various operations devised for this pur-\\npose have in view 1. Obliteration of the neck of the sac either by\\nligature, or stitches, or by plugging it with the invaginated\\nfundus. 2. The obliteration of the canal and 3. The closure of\\nthe external and internal rings. Bassini s operation for inguinal\\nhernia makes a new canal by transplanting the cord to just\\nbelow the external oblique muscle. In Halsted s operation the\\ncord is placed between the skin and the external oblique muscle.\\nIrreducible Hernia.\\nWhat are the causes of irreducible hernia?\\nTemporarily irreducible, from slight distension with faeces or\\ngas.\\nPermanently irreducible, from the bulk of the tumor, constric-", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0183.jp2"}, "184": {"fulltext": "182 ESSENTIALS OE SURGERY.\\ntion of the neck of the sac, adhesions within the sac, fatty\\nenlargement of prolapsed omentum.\\nHow do you treat irreducible hernia\\nTemporarily irreducible, as for incarcerated.\\nPermanently irreducible. If very large, apply a bag truss, if\\nmoderate in size, fit a truss with a concave pad advising, in all\\ncases where there is pain or discomfort, an operation for the\\nradical cure of the hernia.\\nIncarcerated Hernia.\\nWhat are the symptoms of obstructed or incarcerated hernia\\nOccurs mostly in irreducible hernia, particularly in such as con-\\ntain colon. Constipation is a strong predisposing factor.\\n1. Tumor is enlarged and slightly tender. Liquid and gaseous\\ncontents may be pressed out, and doughy faeces detected.\\n2. There is some pain, -with distension of the stomach, constipa-\\ntion, nausea, and vomiting.\\n3. The constitutional symptoms are of moderate severity.\\n4. There is impulse on coughing.\\nHow do you treat incarcerated hernia?\\nTreatment. Eest in bed, cracked ice by the mouth, complete\\nrelaxation oy position. Apply an ice-bag to the hernia, and\\ngive opium if there is pain. Open the bowels by purgative ene-\\nmata, followed by castor oil as soon as the tumor is diminished in\\nsize. If symptoms of obstruction persist, perform herniotomy.\\nInflamed Hernia.\\nDescribe inflamed hernia.\\nCause. Injury to a small irreducible hernia, usually inflicted\\nby a badly fitting truss.\\nSymptoms. Chiefly those of acute local inflammation. Bed-\\nness, heat, pain, swelling (nodulated if epiplocele, sac contains\\nfluid if enterocele), impulse on coughing. Fever, vomiting, and\\nconstipation of moderate severity. Wind passed by bowels.\\nTreatment. Opium if great pain. Rest in bed with local", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0184.jp2"}, "185": {"fulltext": "HERNIA. 183\\nrelaxation by position. Ice-bag to the inflamed part. Opening\\nenema (soap and water Ojss). Gentle purgation when inflam-\\nmation subsides.\\nStrangulated Hernia.\\nWhat are the causes of strangulated hernia?\\n1. Sudden descent into the sac of an irreducible hernia of an\\nadditional mass of omentum or intestine.\\n2. Sudden descent of a hernia long retained by a truss.\\n3. Parietal constriction about the opening of a hernia suddenly\\nproduced by violent effort.\\nWhere is the seat of constriction\\n1. At the neck of the sac. At times in the body of the sac,\\nfrom hour-glass constriction.\\n2. Entirely within the sac. Due to bands of lymph, or a rent\\nin the omentum.\\n3. Entirely without the sac. In small hernia suddenly pro-\\nduced by violent effort.\\nWhat changes take place in strangulated hernia?\\nBowel is grooved by constriction, becomes oedematous, ecchy-\\nmosed, red deepening into purple, loses its lustre, becomes harsh,\\nsticky, non-elastic, and dirty black.\\nSign of local death loss of lustre and elasticity.\\nMay rupture into the sac, or at the line of constriction. In-\\nflammatory adhesions mostly prevent faecal extravasation into\\nthe peritoneal cavity.\\nSac, attacked by inflammation, effuses serum.\\nWhat are the symptoms of strangulated hernia\\n1. Tumor becomes more tense, somewhat duller on percussion,\\ntender at the neck of the sac, and gives no succussion on coughing.\\n2. Abdominal pain, with sense of constriction about umbilicus.\\n3. Vomiting, frequent and persistent; first, contents of stomach,\\nthen bile, finally faeces.\\n4. Obstinate constipation.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0185.jp2"}, "186": {"fulltext": "184 ESSENTIALS OF SURGERY.\\n5. Rapid loss of strength; small, rapid, compressible pulse; dry,\\nbrown tongue. Very little urine passed, it may contain albumen\\nand indican, and be deficient in chlorides.\\nGangrene is denoted by cessation of pain and vomiting, and rapid\\ndevelopment of symptoms of collapse.\\nWhat is Littre s hernia?\\nA hernia involving only a portion of the circumference of the\\nbowel. Though the pouch is strangulated,\\nthere is not absolute internal obstruction.\\nWhat are the symptoms of Littre s hernia\\nAs for strangulated hernia, but less marked;\\nvomiting not stercoraceous, constipation not\\nabsolute. Tumor is small, and gangrene rap-\\nidly develops hence the treatment is early\\nLittre s hernia. herniotomy.\\nWhat are the principal points in the diagnosis of strangulated\\nhernia?\\n1. Stercoraceous and persistent vomiting.\\n2. Absolute constipation.\\n3. Great constitutional depression.\\n4. Absence of succussion, or impulse on coughing.\\nHow do you treat strangulated hernia\\nRest. Relaxation of parts by position. Taxis. Herniotomy.\\nHow do you employ taxis?\\nAnaesthetize, and fully relax by position (flexion and adduction\\nof thigh for femoral or inguinal hernia). The head and shoulders\\nshould be low, the pelvis elevated. Define the neck of the sac\\nwith the thumb and forefinger of the left hand, then with the\\nfingers of the right hand draw the sac down a little, and by a\\nkneading, rolling, compressing movement press the gut in a di-\\nrection corresponding to its line of the descent.\\nIn oblique inguinal hernia the pressure must be outwards, up-\\nwards, backwards.\\nIn femoral hernia first slightly downwards till falciform pro-\\ncess is cleared, then directly backwards towards pubic spine.\\nTaxis failing in five to eight minutes, perform herniotomy.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0186.jp2"}, "187": {"fulltext": "HERNIA.\\n185\\nUnder what circumstances must taxis be avoided\\n1. Very acute cases, as in hernia of sudden development, from\\nviolent muscular action.\\n2. Where symptoms of strangulation have existed for several\\ndays.\\n3. Where the strangulated gut was previously irreducible.\\n4. Where the gut is gangrenous.\\nWhat accidents may occur in the employment of taxis?\\n1. Reduction en masse or en bloc. The hernia, together with its\\nsac, is pushed directly inward, the strangulation being in no way\\nrelieved. Denoted by slow, clif-\\nFig. 41.\\nFig. 42.\\nReduction en\\nbloc.\\nReduction en\\nficult, forcible reduction not ac-\\ncompanied by gurgle or flop,\\nand by persistence of symptoms.\\n2. Reduction en bissac. The\\nbowel is pressed into a congeni-\\ntal diverticulum or pouch, run-\\nning from the body of the sac\\nbelow or beneath the abdominal\\nmuscles. Symptoms the same\\nas reduction en bloc.\\n3. Reduction through a rup-\\nture in the neck of the sac, the\\nhernia escaping into the subserous cellular tissue.\\nThese three forms are usually classed as reduction en bloc.\\nTreatment. Cut down, secure the sac, open it, and divide the\\nconstriction at the neck.\\n4. Bupture of intestine. Rapid collapse, no gurgle.\\nUnder what circumstances may symptoms persist after complete\\nreduction?\\n1. Paralysis of bowel.\\n2. Internal strangulation (causes within sac).\\n3. Acute peritonitis.\\nWhat treatment should follow reduction by taxis\\nCompress and bandage locally. Absolute rest, milk diet opium", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0187.jp2"}, "188": {"fulltext": "186 ESSENTIALS OF SURGERY.\\nto quiet pain. If no inflammatory symptoms, open bowels by\\ncastor oil or purgative enemata the fifth day.\\nWhat treatment should follow continuance of symptoms after\\nreduction?\\nExploratory laparotomy, and careful search for causes of ob-\\nstruction.\\nDescribe herniotomy.\\nEmpty bladder and rectum. The antiseptic method must be\\ncarried out to its minutest details. Shave the seat of operation,\\npinch up a fold of skin and transfix, cutting outward and making\\nan incision about three inches long. Divide the successive layers\\nof tissue on a grooved director till the sac is reached. The sac is\\ntense, rounded, bluish, with arborescent vessels. Pinch up a small\\nportion with forceps, and notch a straw-colored or blood-stained\\nserum escapes. Open freely with scissors, pass the finger up to\\nthe seat of constriction, slip the nail under the resisting band,\\npass a probe-pointed hernia knife along the finger, turn the edge\\nforward, and divide the stricture. If the gut is in good condi-\\ntion, return then restore the mesentery, and sew across the neck\\nof the sac, removing its body, or do a formal radical operation.\\nInsert a drainage-tube, close the external wound, and apply\\nantiseptic dressing, compress, and bandage.\\nNo fo6d for twenty-four hours, then milk diet. Enema in\\ntwo days.\\nHow should the intestine be managed?\\nReturn if it be smooth, glistening, and elastic, even though there\\nbe great discoloration and ecchymosis. Draw down a little more\\nof the gut and inspect the line of constriction before returning.\\nThis is a common seat of perforation.\\nAll manipulations must be practised with great gentleness.\\nA dull black, sodden, sticky bowel is beyond hope of recovery\\nand must not be returned.\\nHow do you treat gangrenous bowel?\\nIf the condition of the patient justifies it, resect the gangren-\\nous portion of the intestine, do an anastomosis, and return the", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0188.jp2"}, "189": {"fulltext": "HERNIA. 187\\nbowel. If the patient s condition is critical, it is best to make an\\nartificial anus, which can be closed by a subsequent operation.\\nIf only a limited portion of the bowel is gangrenous, excise,\\nand unite the healthy tissue with Czeryiy\\\\s suture, the first row\\nincluding only the edge of the serous membrane, the second\\n(Lembert s) starting one-half inch from the edge of the wound,\\nand including a quarter of an inch of all the coats of the bowels\\nexcept the mucous membrane.\\nHow do you treat a faecal fistula or an artificial anus\\nThe faecal fistula frequently closes spontaneously if not, a\\nplastic operation may be performed, or it may be treated as an\\nartificial anus.\\nIn artificial anus the spur or partition formed by the anterior\\nprojection of the posterior wall of the bowel may be ulcerated\\nthrough by means of Dupuytren s enterotome, after which the\\nexternal opening may be closed by a plastic operation; or the\\nintestine may be detached from the abdominal w T all, drawn out,\\nfreshened, and united by Czerny s suture. Prepare by twenty-\\nfour hours light diet, and thorough washing out of the bowels.\\nHow should the omentum be managed?\\nIf acutely strangulated, clamp, excise, secure the bleeding\\npoints, and return the stump to the abdominal cavity. If ad-\\nherent, excise. Omentum must not be left in the sac.\\nHow do you treat adhesions?\\nBreak down recent adhesions. Apply two ligatures, and cut\\nbetween old vascular adhesions.\\nHow do you treat the sac\\nDissect it out, suture across the neck, and excise below the\\nsuture line.\\nWhat is the after treatment\\nNo food for thirty-six hours. Morphia hypodermically for\\npain. Stimulants, if necessary, by the rectum. Open bowels by\\nan enema the seventh day. Eemove the drainage-tube in forty-\\neight hours, the sutures on the fourth day. Keep up firm pres-\\nsure by means of bandages. In one month apply a truss and\\nget the patient out of bed.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0189.jp2"}, "190": {"fulltext": "188\\nESSENTIALS OF SURGERY,\\nSpecial Hernias.\\nWhat are the varieties of hernia in regard to position\\nDiaphragmatic, Inguinal, Femoral,\\nEpigastric, Obturator, Lumbar, Perineal,\\nYentral, Umbilical, Ischiatic, Pudendal.\\nFig. 43.\\nInguinal Hernia.\\nWhat is the most common variety of hernia?\\nInguinal hernia.\\nName the varieties of inguinal hernia?\\n1. Acquired.\\nComplete. When the hernia has passed through the external\\nring.\\nIncomplete. When the hernia is still in the inguinal canal,\\ncalled also Bubonocele.\\nOblique. Commonest variety.\\nThe hernia passes to the outer side\\nof the epigastric artery, and if com-\\nplete, through the two rings and the\\ncanal.\\nDirect. The hernia passes to the\\ninner side of the epigastric artery\\nand through the external abdominal\\nring only.\\nFurther, a complete inguinal\\nhernia reaching the scrotum is\\ncalled scrotal, or the labium, in\\nwoman, is termed labial.\\nRarer forms, depending upon congenital defects, are\\n1. Congenital hernia. In this the peritoneal process (vaginal\\nprocess), accompanying the testis in its descent, remains an\\nopen pouch and receives the gut.\\nInguinal hernia.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0190.jp2"}, "191": {"fulltext": "HERNIA.\\n189\\nFig. 45.\\nFig. 46.\\nFig. 47.\\n2. Hernia into the funicular Fig. 44.\\nportion of the vaginal process (in-\\nfantile hernia). This implies the\\nsame condition as before, ex-\\ncept that the proper tunic of\\nthe testis has become closed,\\nthe funicular (cord) portion of\\nthe process alone remaining\\npatulous.\\n3. Encysted hernia. The ven-\\ntricular orifice of the peritoneal\\npouch is closed, the funicular\\nand testicular parts remaining\\nopen. This hernia is of gradual\\nformation. It invaginates the\\nexisting pouch and carries an\\nadditional layer of peritoneum Encysted hernia,\\nwith it, making three layers of\\nserous membrane to be cut through.\\nDescribe the inguinal canal.\\nThe inguinal canal is an oblique passage through the anterior\\nabdominal wall, lying parallel to Poupart s ligament and above\\nit. It begins at the internal ring, ends at the external ring, and\\nis one and one-half inches long. It transmits the spermatic\\ncord in man, the rounded ligament in woman. It is bounded\\nIn front, by the external oblique, internal oblique (outer\\nthird), cremaster muscles.\\nBehind, by the conjoined tendon (inner third), transversalis\\nfascia, triangular ligament, sub-peritoneal tissue, deep epigastric\\nartery, and peritoneum.\\nAbove, by the arch made by the internal oblique and trans-\\nversalis.\\nBelow, by Poupart s ligament and the transversalis fascia.\\nDescribe the internal abdominal ring.\\nThe internal abdominal ring is an oval opening situated in\\nthe transversalis fascia, one-half inch above the middle of Pou-", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0191.jp2"}, "192": {"fulltext": "190 ESSENTIALS OF SURGERY.\\npart s ligament. Above and external to it lie the arched fibres\\nof the transversalis, below internally the deep epigastric artery.\\nFrom its circumference a thin funnel-shaped membrane, the in-\\nfundibuliform fascia, is continued around the cord\\nDescribe the external abdominal ring.\\nThe external abdominal ring is a triangular aperture in the\\nfascia of the external oblique muscle, bounded below by the\\ncrest of the pubis, above by the intercolumnar fibres. Internally\\nand above by the internal column inserted upon the front of the\\npubic symphysis. Externally and below by the external column,\\ninserted upon the pubic spine.\\nDescribe Poupart s ligament.\\nPoupart s ligament is that portion of the fascia of the external\\noblique muscle extending from the anterior superior spinous pro-\\ncess of the ilium to the pubic spine. In the lower portion it\\nforms the external column of the external ring a backward re-\\nflection from the pubic spine to the pectineal line forms Gimber-\\nnaVs ligament. A band of tendinous fibres continued from its\\nattachment to the pectineal line up and in towards the linea alba\\nforms the triangular ligament.\\nWhat is the cremasteric fascia\\nIt consists of the muscular fibres carried down from the in-\\nternal oblique by the testicle in its descent they form a series\\nof loops covering the cord.\\nWhat are the coverings of an oblique inguinal hernia?\\nSkin, two layers of superficial fascia, intercolumnar fascia\\n(from columns of external ring), cremasteric fascia (from canal),\\ninfundibuliform fascia (from internal ring), peritoneum (true\\nsac).\\nName the coverings of a direct inguinal hernia.\\nSkin, superficial fascia, intercolumnar fascia, conjoined ten-\\ndon, transversalis fascia, and peritoneum.\\nIf the hernia passes to the outer side of the conjoined tendon,\\nthis structure is replaced as a covering by the cremasteric fascia.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0192.jp2"}, "193": {"fulltext": "HERNIA. 191\\nWhat effect has a long-standing inguinal hernia upon the\\nlength of the canal\\nThe internal ring is dragged down till it lies almost directly\\nbehind the external ring.\\nWhat is the relation of the cord to inguinal hernia\\nBelow and behind.\\nIn what direction should the incision be made in relieving the\\nstricture of an inguinal hernia\\nUpward and outward, parallel to Poupart s ligament.\\nDescribe congenital hernia.\\nThe testis, in its descent into the scrotum, is accompanied by a\\nperitoneal pouch. The pouch becomes occluded at two points,\\nthe internal ring, and the top of the epididymis. The portion\\nbetween these two points occupies the whole of the inguinal\\ncanal it shortly shrinks, and is transformed to a fibrous cord.\\nIf the peritoneal process remains patent throughout, we have\\nthe condition which gives rise to congenital hernia.\\nIf it is occluded at the lower end, hernia of the funicular pro-\\ncess {infantile hernia).\\nIf it is occluded at the upper end only, and the occluding sep-\\ntum yields, we have infantile hernia.\\nHow do you diagnose these forms of hernia?\\nCongenital and funicular hernia (infantile) usually occur in early\\nlife, are of sudden development, become complete at once, do not\\ndrag down the internal ring. They are very prone to become\\nstrangulated, and are difficult to reduce.\\nThe congenital hernia intimately surrounds the testicle all\\nother forms of hernia lie above it.\\nThe encysted hernia cannot be diagnosed before cutting then\\nit will be found to have a double sac.\\nCongenital hernia may be associated with undescended tes-\\nticle. In this case it will protrude outward along the fold of\\nthe groin.\\nPrognosis of congenital hernia is good.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0193.jp2"}, "194": {"fulltext": "192 ESSENTIALS OF SURGERY.\\nWith what affections may inguinal hernia be confounded?\\nVaricocele, hydrocele of the cord, congenital hydrocele, and en-\\nlarged inguinal glands.\\nHow do you diagnose hernia from varicocele\\nVaricocele feels soft, doughy, and like a bunch of worms to the\\nfingers. Disappears on lying down, to appear again on stand-\\nbut first enlarges at the bottom of the scrotum. If it is made\\nto disappear, and the finger is placed over the external ring, it\\nwill appear more quickly than before. No gurgling, no tympa-\\nnites, slight succussion. An omental hernia may feel doughy,\\nbut not like a bunch of earth-worms, the enlargement comes\\nfrom above, and if reduced, the finger placed over the external\\nring will prevent it from reappearing.\\nHow do you diagnose inguinal hernia from other affections of\\nthe same region\\nHydrocele of the cord is translucent, enlarges like varicocele\\nfrom the bottom, and fluctuates. It has neither gurgling nor\\ntympanites.\\nUndescended testicle. Absence of gland on affected side, hard\\ntumor in inguinal canal, sickening pain on pressure.\\nEnlarged inguinal glands. Direction of tumor oblique to long\\naxis of canal. It is hard, very painful, and the skin is reddened.\\nTumor freely movable at first. Hernia lies in the long axis of\\nthe inguinal canal, is soft, is not painful, the skin is normal, the\\ntumor lies very deep, and is immovable.\\nFemoral Hernia.\\nDescribe the femoral canal.\\nThe femoral or crural canal is a narrow interval below Pou-\\npart s ligament, between the femoral vein and the crural sheath\\n(sheath of the vessels).\\nIt is one-quarter to one-half inch long, extending from the\\nfemoral ring to the upper border of the saphenous opening. The\\nseptum crurale closes the canal at the femoral ring, the cribri-\\nform fascia at the saphenous opening.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0194.jp2"}, "195": {"fulltext": "HERNIA\\n193\\nDescribe the femoral ring.\\nThe femoral ring lies between Poupart s ligament above,\\nthe pubis and pectineus muscle be-\\nlow, with Gimbernat s ligament to\\nFig. 48.\\nFemoral hernia.\\nthe inner side, the femoral vein to\\nthe outer side. It is oval in shape,\\nabout one-half inch in diameter, and\\nis closed by the septum crurale and\\na lymphatic gland.\\nDescribe the saphenous opening.\\nThe saphenous opening, formed\\nby a reflection of the fascia lata\\nbeneath the femoral vein, is an oval-\\nshaped aperture, one and one-half\\ninches in length, one inch in breadth,\\nsituated beneath the inner portion of Poupart s ligament.\\nIts upper and outer margin, sharply defined and semilunar in\\nshape, passes in front of the vessels and is inserted into the\\npubic spine and pectineal line. It is called the superior comu\\nof the falciform process. Its lower and inner margin forms the\\ninferior comu of the falciform process.\\nThe inner margin is formed by the fascia passing to the pec-\\ntineal line, curving upwards and behind the femoral vein, cover-\\ning in the pectineus muscle. This portion of the ring is not\\nsharply defined.\\nWhat are the boundaries of the femoral canal\\nAnterior. Poupart s ligament, transversal is fascia, falciform\\nprocess of fascia lata.\\nPosterior. Iliac fascia, pubic portion of fascia lata.\\nInternal. The junction of the transversalis and iliac fascia,\\nforming the inner wall of the crural sheath, Gimbernat s liga-\\nment.\\nExternal. The septum covering the femoral vein.\\nWhat are the coverings of femoral hernia\\nSkin, superficial fascia, cribriform fascia, crural sheath, septum\\ncrurale, peritoneum.\\n13", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0195.jp2"}, "196": {"fulltext": "194 ESSENTIALS OF SURGERY.\\nWhere is the gut commonly strangulated in a femoral hernia?\\nGimbernat s ligament. Superior cornu of falciform process,\\nor Hay s ligament. (Agnew.)\\nWhat important structures lie near the femoral ring\\n1. Spermatic cord, just above the superior margin.\\n2. Epigastric artery, passes above to the outer side.\\n3. Obturator artery, may curve across the upper and inner\\nborder.\\n4. Femoral vein to the outer side.\\nHow do you distinguish femoral from inguinal hernia\\nFemoral hernia, traced upward towards its neck, is found to\\npass to the outer side of the pubic spine. Inguinal hernia\\npasses to the inner side.\\nIn what direction should you cut in relieving the constriction\\nof a strangulated femoral hernia\\nUpward and inward, using a blunt-pointed knife with a dull\\nedge.\\nHow do you distinguish femoral hernia from a psoas abscess\\nThey both give succussion, and disappear on pressure or recum-\\nbency. Psoas abscess comes down to the outer side of the vessels,\\ngives the signs of the diseased condition by which it is caused,\\nand fluctuates. It can be traced above PouparVs ligament.\\nHernia appears to the inner side of the femoral vessels and has\\nthe characteristic signs. It cannot be traced above Poupart s\\nligament.\\nUmbilical Hernia.\\nWhat are the varieties of umbilical hernia?\\n1. Congenital, depends upon imperfect closure of the ventral\\nplates, the sac extends into the cord and has been tied by the\\naccoucheur.\\n2. Acquired, depends upon yielding of the abdominal cicatrix.\\nThis is the commonest variety of umbilical hernia, both in infants\\nand adults.\\nWhat are the coverings of an umbilical hernia?\\nSkin, superficial fascia, linea alba, sac.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0196.jp2"}, "197": {"fulltext": "APPENDICITIS. 195\\nHow do you treat umbilical hernia\\nIn infants, draw the recti muscles together, strap tightly, and\\napply a binder or bandage. In adults apply a protecting con-\\ncave truss.\\nWhere should the incision for relief of strangulated umbilical\\nhernia be made\\nIn the linea alba, beginning a couple of inches above the upper\\nmargin of the hernia. The parietal tissues are often very thin.\\nAPPENDICITIS.\\nWhat is appendicitis?\\nAn inflammation of the vermiform appendix of the caecum.\\nWhat are the causes of appendicitis\\nThe disease is rare in infants, rare in the aged, and most com-\\nmon in the young and the middle aged. The actual cause of\\nthe disease is bacterial infection. The usual microbic cause is\\nthe bacterium coli commune but pus cocci alone or in con-\\njunction with colon bacilli may be the causative agents. These\\norganisms do no harm to a healthy appendix, but attack with\\nviolence a damaged one, because when the appendix is dam-\\naged by disease or injury it becomes a point of least resistance.\\nThe appendix may be damaged by being bruised, by being\\nkinked or twisted, by the action of catarrhal inflammation of\\nits* mucous lining, or by the presence of a foreign body or a\\nstercoral concretion. In most cases the appendicular outlet is\\nsealed and the appendix is converted into a closed cavity.\\nGenuine foreign bodies are rarely found. Stercoral concretions,\\nfrequently resembling grape-seeds, are often found.\\nName some of the possible results of appendicitis.\\nPeritonitis, perforation, gangrene of the appendix, and ab-\\nscess-formation.\\nName the chief forms of appendicitis.\\nCatarrhal, suppurative, perforative, gangrenous, obliterative,\\nand chronic relapsing appendicitis.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0197.jp2"}, "198": {"fulltext": "196 ESSENTIALS OP SURGERY.\\nGive the symptoms of acute appendicitis.\\nThe patient usually feels unwell for a day or so. There may,\\nhowever, be no premonitory symptoms, the condition arising\\nwith great suddenness. There develop loss of appetite, dys-\\npepsia, flatulence, colicky pain about the umbilicus, nausea,\\noccasionally vomiting, and generally constipation, but possibly\\ndiarrhoea. Pain develops in the right iliac fossa, and examina-\\ntion discloses acute tenderness, fulness, and marked muscular\\nrigidity. The point of most acute tenderness is known as\\nMcBurney s point. In many cases this is found two inches\\ninternal to the anterior superior iliac spine, on a line from the\\niliac spine to the umbilicus. The pulse is about 100 or over.\\nIs there fever?\\nAs a rule, there is moderate fever, but in some of the worst\\ngangrenous cases the temperature may be normal or even sub-\\nnormal. When pus. is forming the temperature is usually irreg-\\nular, and the periods of fall are accompanied by sweating.\\nWhat course may the symptoms take?\\nThe symptoms may disappear and the patient recover they\\nmay suddenly become aggravated, because of gangrene or per-\\nforative peritonitis or they may gradually become worse. In\\nthis case the pain becomes violent and the tenderness acute.\\nThe patient lies on his back with the right leg drawn up.\\nRectal or vaginal examination may disclose tenderness or the\\nexistence of an inflammatory mass.\\nWhat prognostic significance has the pulse?\\nA very rapid pulse gives a bad prognosis. A pulse much\\nabove 100 is a bad sign.\\nWhat is the result of a sudden perforation\\nCollapse, followed by rapidly fatal general peritonitis.\\nWhat is the result of a gradual perforation?\\nPus forms outside of the appendix, and is often limited by\\nadhesions (appendicular abscess).\\nCan the inflamed appendix be palpated?\\nIn many cases an enlarged appendix can be palpated if the\\nabdomen is thin and not rigid. It may be palpated in an inter-", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0198.jp2"}, "199": {"fulltext": "APPENDICITIS. 197\\nval between attacks. It is not wise to palpate forcibly in acute\\nappendicitis, as the diseased structure may be ruptured.\\nWhat are the terminations of appendicitis?\\nRecovery. Death. A condition of impaired health, further\\nattacks being sure to occur.\\nWhat is the treatment of appendicitis\\nAppendicitis is a surgical disease. Some surgeons operate on\\nevery case as soon as the diagnosis is made. Many surgeons\\noperate when the symptoms are severe, but in a case with ordi-\\nnarily mild symptoms they put the patient to bed, apply an\\nice-bag over the right iliac fossa, and administer a saline purge.\\nMcBurney s rule is as follows If the patient is no worse six\\nhours after the attack begins, wait longer. If the symptoms are\\nno worse in six hours more, they will probably soon improve.\\nIf in twenty-four hours after the beginning of an attack the\\nsymptoms have improved, the surgeon can usually postpone\\noperation until an interval. If during the second twenty-four\\nhours the symptoms have grown worse or have not continued\\nto improve, operate at once.\\nAfter a single attack has passed away should the appendix\\nbe removed?\\nIf there is tenderness or pain, yes. If the patient has no dis-\\ncomfort or tenderness, operation is not demanded, as there may\\nnever be a second attack.\\nAfter two or more attacks should the appendix be removed?\\nYes; because after two attacks others will almost certainly\\narise.\\nWhen should the interval operation be performed?\\nAbout three weeks or more after the attack.\\nShould the appendix be removed in every operation for acute\\nappendicitis\\nNo. It should be removed in most cases. It should be re-\\nmoved in some abscess cases. When it constitutes part of an\\nabscess-wall, it should not be removed, because, if removal is\\neffected, the abscess-wall will be broken down and pus will\\nobtain access to the general peritoneal cavity.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0199.jp2"}, "200": {"fulltext": "198 ESSENTIALS OF SURGERY\\nINTESTINAL OBSTRUCTION.\\nGive the causes of acute intestinal obstruction.\\n1. Congenital malformation, imperforate anus, etc.\\n2. Impaction of foreign bodies and gall-stones.\\n3. Invagination or intussusception.\\n4. Volvulus or twisting, commonly dependent on mesenteric\\nelongated.\\n5. Internal strangulation, or constriction of the bowel by\\nbands or diverticula having no structural connection with the\\ncircumference of the constricted gut.\\nSymptoms of acute intestinal obstruction may also appear in\\nenteritis, peritonitis, and perityphlitis; or in chronic obstruction.\\nGive the symptoms of acute intestinal obstruction.\\nPain, often intense and localized. Vomiting, gastric, bilious,\\nintestinal, and finally fsecal. Constipation, absolute. Abdomen\\nswollen, tender, tympanitic. Peristalsis increased, causing borbo-\\nrygmus and gurgling. Great vital depression. Small, rapid pulse.\\nTemperature may be normal or subnormal till just before death,\\nwhich commonly occurs in from seven to ten days.\\nHow may the seat of acute intestinal obstruction be inferred\\nThe probability of the stnall intestine being involved is in\\ndirect proportion to the acuteness of the pain and the rapidity\\nof the course. Early and severe vomiting, scanty urine, and\\nearly distension all point to small intestine.\\nWhat are the causes of chronic obstruction\\nFsecal accumulation, stricture of the bowel, glueing of the in-\\ntestines together from chronic peritonitis or cancer, abdominal\\ntumors.\\nGive the symptoms of chronic obstruction.\\nConstipation abnormal distension very slowly developed vom-\\niting comes on slowly or may be absent pain rarely acute con-\\nstitutional depression not marked.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0200.jp2"}, "201": {"fulltext": "INTESTINAL OBSTRUCTION. 199\\nWhat are the special characteristics of intussusception\\nThis is the common form of acute obstruction in infancy and\\nchildhood. Usual seat, ilio-colie valve. It is characterized by\\ntenesmus and passage of mucus and blood.\\nSausage-shaped tumor usually to the left side of the abdomen.\\nOn examination per rectum the invaginated gut may be\\nfound.\\nGive the treatment for intussusception.\\nInflation per rectum with air or water inversion gentle\\nkneading of the bowels.\\nLaparotomy, and reduction by kneading and drawing down the\\nsheath or outer tube. If reduction is not possible, make an arti-\\nficial anus, or cut off the intussuscepted part, and suture together\\nthe two ends of the bowel.\\nWhat are the special characteristics of internal strangulation?\\nOccurs during adolescence or early adult life.\\nPatient has been previously healthy, symptoms following a\\nblow or a straining effort.\\nSymptoms very acute. Severe pain referred to umbilicus with\\nintense prostration or syncope. There is no peristalsis, no tumor.\\nWhat are the special characteristics of volvulus\\nOccurs in advanced life.\\nSeats. Sigmoid flexure of colon, and in the neighborhood of\\nthe ilio-csecal valve.\\nSymptoms are characterized by extreme rapidity and severity.\\nGive the treatment of acute intestinal obstruction.\\nMake most carefid search in all hernial regions for strangidation.\\nKeep the patient in the recumbent position. Give liquid nour-\\nishment and in minimum quantity. Morphia gr. every three\\nto six hours, as required to relieve pain. Hot fomentations to\\nthe belly. Cocaine, hydrocyanic acid, etc., for vomiting. If,\\nafter a reasonable time (one to three days, according to the se-\\nverity of the symptoms), there is no change for the better,\\nlaparotomy, with further measures adapted to the relief of the\\nobstruction.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0201.jp2"}, "202": {"fulltext": "200 ESSENTIALS OF SURGERY.\\nGive the treatment of chronic intestinal obstruction.\\nEnemata. If from impaction of feces, break up mechanically\\nand remove. If from malignant trouble, or stricture, excision,\\nwith circular enterorraphy or artificial anus.\\nWhat is laparotomy?\\nOpening the abdominal cavity.\\nIncision. Linea alba, midway between pubes and umbilicus,\\nlarge enough to admit the fingers. Stop all bleeding before open-\\ning peritoneum. Explore first all the hernial rings, then the\\nccecam. If it be distended, obstruction must be in large intestine,\\nand can be found by searching along the colon. If caecum empty,\\nsearch for an empty loop of small intestine, which can be fol-\\nlowed up till the seat of trouble is reached.\\nIf intestine sloughing, enterectomy (excision), and artificial anus\\nor circular enterorraphy (suture).\\nDiseases of the Anus and Rectum.\\nDescribe the varieties of congenital malformation of the anus\\nand rectum.\\n1. Partial or complete occlusion of the anus. There is a mem-\\nbrane of varying thickness, bulging when the child cries or\\nstrains, and thin enough for the meconium to be detected.\\n2. Imperforate anus. The rectum terminates in a blind pouch,\\nfrom half an inch to an inch from the surface the normal posi-\\ntion of the anus is occupied by dense tissue.\\n3. Occlusion of the rectum. A membranous septum is found\\nfrom half an inch to an inch above the anal orifice.\\n4. Imperforate rectum. Rectum wanting. The colon termi-\\nnates in a blind pouch in the iliac fossa.\\n5. Malformation with abnormal opening in other parts.\\nHow do you treat congenital malformation of the anus and\\nrectum\\nPlace the child in lithotomy position.\\nIncision in the middle line, over the natural position for the\\nanus. Work backward toward the coccyx. The bowel being", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0202.jp2"}, "203": {"fulltext": "DISEASES OF THE ANUS AND RECTUM. 201\\nfound, open, and, if possible, suture to the external wound. Pass\\na bougie daily to prevent contraction. If, after dissecting to the\\ndepth of H inches, no sign of bowel is perceived, do Littre s\\noperation (left inguinal colostomy), making an artificial anus.\\nRecently, osteoplastic resection of the sacrum has been advised\\nas a plan which will disclose the rectum.\\nWhat are hemorrhoids\\nSwellings about the margins of the anus due to a varicose\\ncondition of the bloodvessels. Hemorrhoids may be external,\\naffecting the muco-cutaneous folds external to the sphincter, or\\ninternal, affecting the mucous membrane within the sphincter.\\nWhat are the causes of hemorrhoids\\nAnything tending to increase the. supply of blood to the rectum,\\nor to impede its venous return. Instance, liver troubles, constipa-\\ntion, straining, occupations requiring much standing, sedentary\\nlife. They begin as dilations of the hemorrhoidal veins, and are\\nfollowed by infiltration of surrounding tissues.\\nDescribe external piles.\\nMay be made up of dilated and thrombosed veins, thrombotic;\\nmay be due to swollen muco-cutaneous folds, oedematous or may\\nconsist of permanently hypertrophied flaps or tags of skin,\\ncutaneous. These occasion little trouble till, from cold, consti-\\npation, imprudent diet, or some other cause, they become in-\\nflamed, when they give rise to intolerable pain and itching, and\\nexhibit all the local signs of an acute inflammation this con-\\nstitutes an attack of piles.\\nGive the treatment of external piles.\\nKeep the bowels open by equal parts confection of senna and\\nconfection of black pepper, or a glass of Friedricb shall on rising\\nin the morning scrupulous cleanliness of the parts. Cocaine\\nsuppository (gr. for acute attacks.\\nThrombotic. Apply a ten grain to the ounce calomel ointment\\nat night and in the morning, after washing. If the parts become\\nvery painful, incise and turn out the clot.\\nDescribe internal piles.\\nMay be open or bleeding, blind or not bleeding.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0203.jp2"}, "204": {"fulltext": "202 ESSENTIALS OP SURGERY.\\n1. Capillary hemorrhoids. Small, granular, bright red tumors,\\nsituated high in the bowel really arterial nsevi.\\n2. Arterial hemorrhoids. Hard, vascular, glistening, slippery\\nmay attain considerable dimensions. On scratching, bright red\\nblood in jets. Large artery can be felt entering the upper part\\nof each pile.\\n3. Venous hemorrhoids. Large, livid, prone to prolapse.\\nWhat are the symptoms of internal hemorrhoids\\nBleeding at stools. The blood is bright red and coats the fceces.\\nProtrusion. An irregularly nodulated congested mass protrudes\\nafter defecation. It may become strangulated by the sphincter.\\nConstipati07i. Discomfort and heaviness about the rectum. Pain\\nand fever, if the piles are inflamed or strangulated.\\nGive the treatment for internal piles.\\n1. Palliative. Equal parts of senna and black pepper confec-\\ntion, a teaspoonful on rising. Coat the diseased area with ferri\\nsubsulph. 3ss, cosmoline \u00c2\u00a7j. Inflamed piles. Laudanum and\\nstarch-water injections. Hot fomentations. Cocaine supposi-\\ntories (gr. i). For strangulated piles, anaesthetize, and return\\nwithin the sphincter.\\n2. Operative. Clear the lower bowel by laxatives and injection.\\nLithotomy, or the lateral position. (1) Injection of carbolic acid.\\nClamp the pile and inject TTLv of a 20 per cent, glycerine and\\nwater carbolic solution into the centre of the pile. (2) Ligature.\\nParalyze the sphincter, draw down each pile, divide the skin\\nabout it, and encircle its base by a ligature or transfix with a\\nneedle carrying a double thread, and tie each half separately.\\nInsert an opium suppository and apply a T bandage with a\\ncompress of iodoform gauze. Open the bowel on the fifth day.\\n3. Clamp and cautery. 4. Crushing.\\n5. Excision of pile-bearing area by Whitehead s method.\\nGive the treatment for secondary hemorrhage after pile opera-\\ntions.\\nCold injections. Pass in a full-sized drainage-tube and pack\\nthe rectum about it with styptic cotton or gauze (containing\\nsubsulphate of iron). Separate sphincter, find bleeding point,\\nand ligate.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0204.jp2"}, "205": {"fulltext": "DISEASES OF THE ANUS AND RECTUM. 203\\nName the forms of prolapse of the rectum.\\nPartial, involving only mucous membrane.\\nComplete, involving all the tissues of the gut (really an invagi-\\nnation).\\nName some of the causes of prolapse.\\nRelaxation. Undue straining. Irritation, such as that caused\\nby ascarides, polypus, stone in bladder, phimosis.\\nUsually occurs in children or aged people.\\nGive the symptoms of prolapse.\\nA protrusion of a soft, non-nodulated, non-pediculated, smooth\\nmass about the entire circumference of the anus, continuous\\nwith the mucous coating of the sphincter in the partial form.\\nGive the treatment of prolapse.\\nEeduce. Patient in knee-breast posture bowel covered with\\noiled lint and pushed up. If strangulated, divide the sphincter.\\nAfter reduction strap the nates together (plaster), keep bowels\\nsoluble, and let them be moved while the patient is in the\\nrecumbent or standing posture. The cold douche, or astringent\\ninjections are often serviceable.\\nOperative. 1. Take up longitudinal folds of mucous membrane\\nin Smith s clamp, cut off with scissors, and cauterize pedicle\\n(clamp and cautery). 2. Ligate portions of the mucous mem-\\nbrane. 3. Apply nitric acid to entire prolapsed surface, cover\\nwith carbolized oiled lint, and restore.\\nWhat is a fistula in ano\\nAn abnormal communication between the rectum and the\\nsurface.\\nUsual cause. Abscess.\\nName the varieties of fistula in ano.\\nComplete, having a gut and a surface opening. The gut open-\\ning is usually just above the internal sphincter.\\nIncomplete or blind, having but one opening.\\na. External, opens on surface only.\\nb. Internal, opens in bowel only,", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0205.jp2"}, "206": {"fulltext": "204 ESSENTIALS OF SURGERY.\\nWhat are the symptoms of fistula in ano\\n1. Discharge. Thin pus, causing excoriations, and coating the\\nfasces in the internal or blind variety.\\n2. Local signs of inflammation, which are subject to frequent\\nexacerbations.\\n3. Opening, sometimes very small. On using a probe its end\\nwill be felt by the finger in the rectum, either passing into the\\nbowel, or, if there be no internal opening, lying beneath the mu-\\ncous membrane.\\nGive the treatment for fistula.\\nOperation. Pass a grooved director along the fistulous tract\\ntill its point is felt on the finger introduced into the bowel, hook\\nit forward bringing it out through the anus, divide the structures\\nthus raised upon the director and all sinuses or pockets communi-\\ncating with the fistula. Do not divide the sphincter in more\\nthan one place. In women do not divide the sphincter, as it\\ndecussates with the vaginal fibres. Wipe out the wound with\\ncaustic potash, pack with lint saturated in carbolized oil, and\\nallow the wound to heal from the bottom. In some cases it is\\nwell to dissect out the fistula, sew up with buried sutures, and\\ntry to obtain primary union.\\nWhat is anal fissure?\\nAnal fissure is a lineal ulcer or crack, usually just within the\\nanus. Caused by constipation, and large hard passages.\\nGive the symptoms of anal fissure.\\n1. Smarting pain coming on after defecation, often intense and\\nradiating from rectum. Smarting changed to an aching sensation\\nwhich may last for several hours.\\n2. Faeces streaked with blood.\\nHow do you diagnose anal fissure\\nExamination is painful; the sphincter and levator ani are\\nspasmodically contracted. Two cedematous folds of mucous\\nmembrane are found, which being separated reveal the ulcer.\\nGive the treatment of anal fissure.\\n1. Keep the bowels loose (cascara sagrada gr. iij. at night, or", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0206.jp2"}, "207": {"fulltext": "DISEASES OF THE ANUS AND RECTUM. 205\\nHunyadi Janos on rising), wash with soap and warm water after\\neach passage, and apply ferri subsulph. (gr. x to ^j cosmoline).\\n2. Anaesthetize the patient. Insert the thumbs into the anus,\\nseparate them till the ischial tuberosities are felt.\\n3. Local anaesthesia by cocaine (gr. xx to gj). Draw a bis-\\ntoury longitudinally through the base of the ulcer from above\\ndownwards.\\nWhat other forms of ulceration occur about the anus and\\nrectum\\nSyphilitic, tubercular, senile (varicose).\\nGive the symptoms of ulcer of the rectum.\\nTendency to morning diarrhoea. There is an urgent desire to\\nopen the bowels immediately on rising.\\nPain, moderate. Tenesmus, relieved by evacuation.\\nDischarge. Mucus or muco-pus, at times containing also\\ndisintegrated blood.\\nUlcerated surface is seen a,ndfelt on examination.\\nGive the treatment of ulceration of the anus and rectum.\\nTreat constitutional condition. Highly nutritious diet, bowels\\nsoluble. Night and morning, cleansing injections of warm bor-\\nacic acid solution (ad lib.), or boroglyceride at night starch\\nwater and laudanum gttxx by injection. In severer cases\\nnitric acid directly to ulcer, applied through speculum.\\nName the varieties of stricture of the rectum.\\n1. Fibrous. 2. Malignant.\\nWhat is the cause of simple (fibrous stricture)\\nInflammation or ulceration.\\nWhat are the symptoms of fibrous stricture\\n1. Constipation, slowly increasing.\\n2. Motions like pipe-stems, or broken up into scybala.\\n3. A sense of fullness after passages, as though there were more\\nto come.\\n4. Diarrhoea, alternating with constipation, or predominating.\\nConstant desire to go to the closet, passage of very little solid,\\nwith yeasty liquid.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0207.jp2"}, "208": {"fulltext": "206 ESSENTIALS OF SURGERY.\\n5. Wind which cannot be passed except in the closet, as it is\\naccompanied by a liquid discharge.\\n6. Excoriation and inflammation of anus from discharge.\\nFrequently fistula.\\nBy examination the stricture can usually be felt.\\nGive the treatment for fibrous stricture of the rectum.\\nGradual dilatation by means of bougies. Partial or complete\\ndivision of the stricture. Inguinal colotomy. Excision of stric-\\nture.\\nGive symptoms and treatment of malignant stricture of the\\nrectum.\\nUsually epithelioma about half inch above anus. In addi-\\ntion to the signs of stricture, there is intense pain radiating from\\nthe seat of trouble, there is frequently free bleeding, and the\\ndischarge is profuse, offensive, watery, or often bloody, and\\nbecomes finally like coffee-grounds. Cancerous cachexia always\\ndevelops. On examination, the abnormal growth is detected\\nindurated, nodulated, and, if the disease is advanced, with\\nfungoid out-croppings over its surface, which break down under\\nthe examining finger, coating it with a blood-stained offensive\\nmuco-pus.\\nTreatment. Excision if the disease is strictly local, inguinal co-\\nlostomy if it is irremovable or if there is systemic involvement.\\nGive the symptoms of impacted faeces.\\nConstipation, distension, pain, and very frequently a spurious\\ndiarrhoea, i. e., a mucous semi-fseculent discharge, due to the\\nirritation of the impacted mass.\\nDiagnosis by rectal examination.\\nTreatment. Break up the lower part of the mass with the\\nfinger or the handle of a wooden spoon, and wash away by\\nmeans of copious injections.\\nDescribe polyp of the rectum.\\nTwo varieties. 1. Fibrous. Smooth surface, may reach large\\nsize. 2. Adenoid. Identical in structure with the mucous mem-\\nbrane looks very much like a raspberry. Both usually pedun-\\nculated occur in children.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0208.jp2"}, "209": {"fulltext": "DISEASES OF THE ANUS AND RECTUM. 207\\nSymptoms. Bleeding after stools, and prolapse.\\nTreatment. Ligate and remove.\\nDescribe villous tumors of the rectum.\\nPractically a mass of non-pediculated adenoid polyps.\\nSymptoms. Hemorrhages, feeling of fulness in rectum, and\\nthin, mucoid, glutinous discharge.\\nOn examination a lobulated, soft, velvety, movable mass is found.\\nTreatment. Complete removal.\\nDescribe pruritus ani.\\nObstinate itching about the anus frequently depending on\\nlocal irritation (as pediculi, threadworms, piles), or on gouty\\ndiathesis it may be without obvious cause.\\nGive treatment of pruritus ani.\\nKemoval of cause, strict cleanliness, regularity in the motions\\nfrom the bowels, exercise, Turkish baths. Suppositories of\\ncocaine (gr. i) or iodoform (gr. v), morphine, carbolic acid,\\nmercurial ointment. Alum and zinc sulphate, equal parts of\\neach, fuse, powder, dissolve in 3j aq. use as injection. A rec-\\ntal plug may be worn at night.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0209.jp2"}, "210": {"fulltext": "208 ESSENTIALS OF SURGERY.\\nVENEREAL DISEASES.\\nWhat is syphilis?\\nSyphilis is a contagious constitutional disease due to inocu-\\nlation with specific virus.\\nWhat is the primary lesion of syphilis?\\nThe chancre.\\nWhat is the period of primary incubation?\\nThe time which intervenes between inoculation and the ap-\\npearance of chancre. Rarely earlier than two weeks or later\\nthan five average, three weeks.\\nWhat is the period of secondary incubation\\nThe time between the appearance of chancre and the develop-\\nment of secondary symptoms. Rarely before the first or after the\\nthird month succeeding the chancre.\\nWhen do the tertiary symptoms appear\\nAt a period varying from a few months to many years after\\nthe secondaries.\\nDescribe chancre or primary sore.\\nFound commonly about the corona glandis, may appear any-\\nwhere. Contracted directly, by contact with chancre or second-\\naries (mucous patches), indirectly from articles used by syphilitics.\\nAppears as an indurated papule, which develops into an\\nabrasion, tubercle, or ulcer.\\nWhat are the characteristics of the primary sore?\\n1. Indurated base and thin, scanty secretions.\\n2. Inflammation slight around the sore.\\n3. Usually single, not autoinoculable.\\n4. Buboes are poly ganglionic and painless rarely suppurate.\\n5. Appears after an incubation period and is followed by sec-\\nondaries.\\nThe Hunterian chancre is characterized by greater depth, freer\\ndischarge, and more marked induration.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0210.jp2"}, "211": {"fulltext": "VENEREAL DISEASES. 209\\nThe mixed chancre exhibits the peculiarities of both syphilitic\\nand chancroidal inflammation.\\nGive the treatment of chancre.\\nWash several times daily with black wash, and dust with\\ncalomel, subiodide of bismuth, iodol, or iodoform. Do not begin\\nmercury till the secondaries appear.\\nDescribe the secondary lesions of syphilis.\\n1. General enlargement of the lymphatic glands.\\n2. Eruptions of the skin and mucous membranes at times, in-\\nflammation of the iris or periosteum, and falling of the hair.\\nPathology. Congestion, infiltration, ulceration.\\nThe development of secondaries is preceded by general malaise,\\nfever, and anaemia, lasting a few days and disappearing on the\\nappearance of roseola and sore throat, ^r\\nThe skin eruption may simulate the various forms of skin dis-\\nease. It may be erythematous (s. roseola), papular (s. lichen),\\nvesicular (s. herpes, eczema, and varicella), bullous (s. pemphigus),\\nor pustular (s. ecthyma, acne, or variola).\\nMucous membrane lesions.\\nPathology, as in the skin, first congestion (syphilitic sore\\nthroat), then infiltration with maceration of the epithelium\\n(mucous patches), finally ulcers.\\nWhat are the characteristics of syphilitic skin eruptions\\n1. Absence of itching.\\n2. Symmetrical arrangement (on the two sides of the body).\\n3. Reddish-brown or coppery in color (raw ham).\\n4. Polymorphous (many kinds of eruption at the same time).\\n5. Therapeutic test (use of mercury).\\nDescribe the mucous patch.\\nSynonyms. Condyloma. Mucous tubercle.\\nPathology. A congested, infiltrated macule, the surface of\\nwhich is, from its peculiar position (about the anus, on the\\nscrotum, in the gluteal folds), continually moist, in consequence\\nof which the epithelium becomes sodden.\\nAppearance. A somewhat elevated, flat macule, covered with\\na dirty whitish, offensive exudation.\\n14", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0211.jp2"}, "212": {"fulltext": "210 ESSENTIALS OF SURGERY.\\nGive the treatment of secondary syphilis.\\nMercury liydrarg. prot. iodid. gr. three times daily, guard-\\ning the bowels by opium. Increase the dose gradually till the\\npatient exhibits the offensive breath or the beginning mouth\\ntenderness of ptyalism. Then cut the daily quantity down one-\\nhalf, and continue for eighteen months, unless new symptoms\\nappear, when the dose may be temporarily increased. After\\neighteen months, add iodide of potassium, and continue for six\\nmonths or a year.\\nMercury may be given 1. By the stomach. 2. By inunction.\\n3. By vaporization. 4. By hypodermatic injection.\\nBy inunction. Unguent, hydrarg. jss to \u00c2\u00a3j at night rubbed\\ninto the feet after they have been soaked in hot water. The\\nsame stockings must be worn night and day.\\nMucous patches should be washed with black wash, and dusted\\nwith a powder made up of calomel one part, zinc-oxide two\\nparts.\\nSore throat is treated by astringent gargles.\\nDescribe the tertiary lesions of syphilis.\\nBetween the secondaries and tertiaries proper there are certain\\nsymptoms, called reminders, which sometimes appear. Among\\nthem are skin eruptions, enlargement of the testicle, choroiditis,\\nulceration of the tongue, disease of the arteries, and psoriasis of\\nthe palms.\\nTertiary lesion of syphilis is the gumma. This has no tendency\\nto spontaneous cure, and is characterized by the formation of\\nmasses of granulation cells, which commonly infiltrate the sur-\\nrounding tissues, and break down in the centre.\\nA gumma may break down, leaving an ulcer, or may be ab-\\nsorbed, leaving fibroid thickening and scarring (syphilitic stricture\\nof rectum and oesophagus, etc.). The gumma may attack the\\nperiosteum, causing nodes, caries, or necrosis the cutaneous\\nand mucous surface, causing ulcers on any part of the body.\\nThese ulcers of tertiary syphilis are asymmetrical, and are not\\ncontagious.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0212.jp2"}, "213": {"fulltext": "VENEREAL DISEASES. 211\\nGive the treatment of tertiary syphilis.\\nMercury and potassium iodide, or iodide of potassium alone or\\ncombined with tonics. Commence with ten grains of potassium\\niodide three times a day, gradually increasing the dose till the\\ndesired effect is accomplished.\\nWhat are the characteristics of a tertiary ulcer?\\nBegins as a gumma or lump, which, when it breaks, exposes a\\ngray slough, surrounded by granular tissues. The edges are\\nrounded and sharply cut. Other signs of syphilis can be found.\\nThe affection yields to specific treatment.\\nSyphilitic leg ulcers usually involve the upper third.\\nWhat is congenital syphilis?\\nSyphilis transmitted to the foetus through the spermatozoa of\\nthe father, or the ovum of the mother.\\nWhat are the characteristics of congenital syphilis\\nManifestations are rare before four to six weeks after birth\\nthen there may be secondaries, as snuffles or coryza, macular or\\npapular eruptions, mucous patches, ulcerations about the mouth\\nand lips (rhagades), stomatitis, which, by its effect upon the\\ndental sacs of the permanent teeth, causes the subsequent de-\\nvelopment of Hutchinson s teeth. After some years, tertiaries\\ndevelop. These commonly take the form of interstitial keratitis,\\nand gummatous developments.\\nDescribe Hutchinson s teeth.\\nThe upper permanent median incisors chiefly show this lesion,\\nwhich consists in a dwarfing of the entire tooth, an extreme\\ndiminution in its free end, and a narrowing of the cutting edge,\\nwith a central notch or crescent.\\nGive the treatment of hereditary syphilis.\\nUpon the same lines as the acquired secondaries. Mercury best\\ngiven by inunction, gr. x. unguent, hydrarg. being rubbed over\\nthe abdomen and covered by the belly-band every night. Stop\\nmercury shortly after disappearance of symptoms. Prevent a\\nnon-infected woman from suckling the child.\\nTertiaries, Mercury and iodide with tonics.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0213.jp2"}, "214": {"fulltext": "212\\nESSENTIALS OF SURGERY.\\nWhat is Colles s law?\\nA syphilitic child suckled by its mother will not infect her,\\nthough she be (apparently) free from venereal disease.\\nChancroid.\\nWhat is a chancroid\\nChancroid is a local contagious ulceration caused by contact\\nwith the secretions of a similar ulcer.\\nWhat are the characteristics of chancroids\\n1. No period of incubation. Appears in from three to five\\ndays first as a papule, then a vesicle or pustule, very shortly\\nan ulcer.\\n2. Usually multiple.\\n3. Inflammatory in type, with punched-out edges, irregular\\nsloughing surface, and abundant discharge.\\n4. Monoganglionic and unilateral lymphatic involvement.\\nMay be simple inflammatory enlargement, or virulent bubo from\\ndirect absorption and suppuration.\\n5. Autoinoculable.\\n6. Not indurated.\\n7. Not followed by secondaries.\\nHow may a chancroid be complicated\\nPhagedenic ulceration. Characterized by very rapid and exten-\\nsive sloughing.\\nSerpiginous ulceration. Characterized by slow but persistent\\nextension.\\nPhimosis. Paraphimosis.\\nGive the treatment for chancroids.\\n1. Cauterize with hot iron, sulphuric or nitric acid. Dress\\nwith black wash or iodoform.\\n2. Cleanse thoroughly with acid, nitric, \u00c2\u00a3ss, aq. foviij. Dust\\nwith iodoform, or zinc oxide one part, bismuth two parts.\\nBubo. Try to abort by blisters, iodine around the inflamed\\narea, or pressure by means of a salt or shot-bag. If it sup-\\npurates, open. If it is a simple inflammatory bubo, it quickly", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0214.jp2"}, "215": {"fulltext": "VENEREAL DISEASES. 213\\nheals if it is chancroidal, it has no tendency to heal, but must\\nbe thoroughly cauterized. After operation pack with iodoform\\ngauze and dress antiseptically.\\nPhagadenic ulceration. Remove slough and thoroughly cauterize.\\nContinuous warm bath is frequently curative. Internally, tonics,\\nopium and iron, rich food, and alcoholic stimulants.\\nSerpiginous ulceration. Repeated applications of the actual\\ncautery to the entire diseased surface, together with nourishing\\nand stimulating internal treatment.\\nWhat is primary bubo or bubon d emblee\\nA simple adenitis resulting from mechanical irritation. It is\\nseen at times, after coitus, when there is no taint of chancroid,\\ngonorrhoea, or syphilis.\\nGonorrhoea.\\nDescribe the urethra.\\nLength, 8 to 9 inches.\\nThree portions. Spongy, membranous, and prostatic.\\nSpongy portion. 6 inches long from meatus to anterior layer\\nof triangular ligament. Meatus narrowest portion of urethra.\\nLacuna magna, a large mucous follicle 1^ inches from meatus on\\nthe upper surface of urethra its opening is directed forward\\nand may catch instruments. Glandular and bulbous parts of the\\nspongy urethra somewhat dilated.\\nMembranous portion, inch long. From apex of prostate to\\nbeginning of spongy portion, between the two layers of the tri-\\nangular ligament, 1 inch below pubic arch. Except meatus, the\\nnarrowest part. Embraced by compressor urethrse muscle.\\nProstatic portion. inches long. Widest and most dilatable\\npart; passes through prostate near its upper surface.\\nWhat is gonorrhoea\\nGonorrhoea or clapis a contagious (probably specific) inflamma-\\ntion attacking mucous membranes, particularly those of the\\ngenito-urinary tract.\\nCause. Direct contagion (gonococcus). Urethritis, identical\\nwith gonorrhoea, is developed by contact with retained and foul", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0215.jp2"}, "216": {"fulltext": "214 ESSENTIALS OF SURGERY.\\ndischarges (leucorrhoea), or other irritants. It begins in the\\nmale usually in the fossa navicularis, and passes backward. In\\nthe female it begins in the vulva and vagina.\\nName the clinical varieties of gonorrhoea.\\n1. Acute inflammatory (typical). 2. Subacute or catarrhal.\\n3. Irritative or abortive.\\nWhat are the stages of an acute attack\\nFirst, or increasing stage. Second, or stationary stage. Third,\\nor subsiding stage.\\nWhat are the first symptoms of gonorrhoea\\nUsually, in three to five days, there is a tickling sensation at\\nthe meatus, which is changed to a burning at the next urina-\\ntion. On examination, the lips of the meatus are somewhat\\nreddened and everted, and there is a slight muco-purulent dis-\\ncharge. In a very short time (twelve to twenty-four hours) the\\npatient reaches the well-developed first stage.\\nGive the symptoms of the increasing stage,\\n1. Ardor urinse. 2. Profuse purulent discharge. 3. Chordee\\n(painful erections). 4. Frequent urination.\\nWhat are the complications of the first stage\\n1. Balanitis, or inflammation extending over the glans penis.\\n2. Balano-posthitis. Inflammation of the mucous layer of the\\nforeskin.\\n3. Phimosis, or inability to retract the foreskin, from oedema-\\ntous swelling.\\n4. Paraphimosis. The retracted and swollen foreskin cannot\\nbe brought forward.\\nThe first stage lasts about one week.\\nGive the symptoms and complications of the second stage.\\nThe inflammation gradually extends backward. There is a\\ncontinuance of the symptoms of the first stage, with possibility\\nof the following complications\\nFollicular abscesses, appearing as small, round, tender tumors\\nalong the floor of the urethra. They may open either internally\\nor externally.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0216.jp2"}, "217": {"fulltext": "VENEREAL DISEASES. 215\\nPeriurethral abscess. Favorite seat about the fossa navicularis\\nand the anterior membranous portion of the urethra, where the\\ndisease is most persistent.\\nLymphangitis. Dependent usually on retention of discharge\\nbeneath prepuce. Thick, tender, reddened cord-like line along\\ndorsum of penis.\\nBubo. One gland affected may undergo resolution, or may\\nsuppurate.\\nCowperitis. Characterized by very intense throbbing pain.\\nPainful urination, especially at the end of the act (compressor\\nurethra? m.), and the detection of the hard, inflamed glands by\\nexamination of the perineum.\\nSecond stage lasts one or two weeks.\\nGive the symptoms and complications of the stage of subsidence.\\nSymptoms as of the other stages. They may be complicated\\nby epididymitis, characterized by pain of an intense and sicken-\\ning character passing along the cord to the loins, swellings, out-\\nlined at the back of the scrotum and considerable in extent, and\\ntenderness there is nearly always fever.\\nDescribe subacute or catarrhal gonorrhoea.\\nOccurs usually in persons who have had previous attacks. Is\\ncharacterized by very free discharge, with absence of other symp-\\ntoms or complications. Yields rapidly to treatment, but does\\nnot entirely disappear, a drop or two of muco-pus being dis-\\ncharged daily.\\nWhat are the complications of subacute gonorrhoea?\\nQonorrhceal rheumatism or urethral synovitis. Characterized by\\nslight constitutional symptoms and a rapid development of syno-\\nvitis in knee, ankle, wrist, or elbow.\\nGonorrhoeal ophthalmia (sclerotitis, iritis), or conjunctivitis.\\nDescribe irritative or abortive gonorrhoea.\\nThe symptoms are those of beginning acute gonorrhoea, i. e.,\\nredness, pouting, and tingling or itching at the meatus, with a\\nvery slight mucous discharge. The disease does not advance be-\\nyond this point. These symptoms may persist for several days,\\nthen disappear. No complications, no sequelae.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0217.jp2"}, "218": {"fulltext": "216 ESSENTIALS OF SURGERY.\\nGive the treatment of gonorrhoea.\\nRest in bed, if possible, on a diet of skimmed milk, giving plenty\\nof bland liquids, such as Apollinaris water, soda water, etc. Keep\\nthe bowels open. To make the urine alkaline, and to act as a\\nsedative, give\\nI\u00c2\u00a3. Tr. aconit. rad. gtt. xvj.\\nPot. brom. 5iij.\\nInfus. pareir. brav. fSviij.\\nS. fgss in aq. every two hours.\\nFor ardor urince give the above prescription. Immerse the\\npenis in hot water during urination. Wrap the organ in cloths\\nsaturated with\\nTr. aconit. rad.,\\nTr. opii,\\nAlcohol, aa gj.\\nLiq. plumb, subacetat. dil. fSiij.\\nCliordee. Bromide of potassium till drowsiness is produced\\na double dose on retiring, repeated during the night.\\nIf the patient wakes with chordee, camphor gr. iij, opium\\ngr. j, as a suppository or hypodermics of morphia (gr. injected\\ninto the perineum.\\nWhen the disease has reached its height and is declining give\\ncapsules of cubebs and copaiba, TTLxx of each, every two hours.\\nInjections may now be used\\nBismuth, subnit. 5j.\\nG-lycerin, f3ij.\\nAq. ros. q. s. fgiv.\\nFollowed in a few days by\\nZinc, sulph. gr. viij.\\nMorph. sulph. gr. j.\\nAq. ros. fgiv.\\nGradually stop injections and internal medication.\\nWhat are the causes of chronic urethral discharge\\n1. Urethral catarrh.\\n2. Chronic gonorrhoea, a localization of the disease, producing\\na granular and somewhat ulcerated surface.\\n3. Stricture of urethra. The usual cause of gleet.\\n\u00e2\u0096\u00a0M", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0218.jp2"}, "219": {"fulltext": "VENEREAL DISEASES. 217\\nHow can the nature of chronic urethral discharge be deter-\\nmined\\nUrethral catarrh immediately follows gonorrhoea, and presents\\nno symptoms beyond a thin, watery discharge.\\nCJironic gonorrhoea discharges creamy pus, is greatly aggravated\\nby any excess. There is some burning at urination, and at times,\\nchordee. It is generally found about the navicular fossa and the\\nbulbo-membranous portion of the urethra. Examination by\\na bulbous bougie detects a rough, tender spot, and pus and blood\\nmay be brought away upon the shoulder of the instrument.\\nGleet from stricture appears some time after subsidence of\\ngonorrhoea. It is characterized by muco-purulent discharge,\\nand frequent urination, with imperfect cut off. On passing a bul-\\nbous bougie narrowing is detected.\\nGive the treatment of chronic urethral discharge.\\nUrethral catarrh. Constitutional treatment, open air, nourish-\\ning diet, exercise, regular living, iodide of iron.\\nChronic gonorrhoea. Locate the spot by means of the bulbous\\nbougie. Apply, by means of the prostatic syringe, a one-quarter\\nper cent, solution of nitrate of silver, increasing the strength if\\nthere is no pain follow by astringents, zinc or copper. Irriga-\\ntion with hot solution of permanganate of potash (1 2000).\\nGleet. Gradual dilatation with steel sounds, passed twice\\nweekly, till the urethra is of normal size (28 to 32, depending on\\nthe size of the penis).\\nGive the treatment for complications of gonorrhoea.\\nBalanitis. Wash carefully four times daily, and dust with\\niodol, iodoform, or a powder of bismuth and opium.\\nBalano-posthitis. Careful washing. If great swelling, envelop\\nin lead water and laudanum.\\nPhimosis. Injections beneath the prepuce of soap and water,\\nthen water, finally lead water and laudanum wrap the penis\\nin cloths wet in lead water and laudanum. Incision or circum-\\ncision may be necessary.\\nParaphimosis. Reduce by manipulating, or, covering the\\nglans with lint, envelop it from before backward in an elastic", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0219.jp2"}, "220": {"fulltext": "218\\nESSENTIALS OF SURGERY.\\nband, slip a director under the constriction, remove the elastic\\nwrapping, and reduction may be effected. Incision if other means\\nfail.\\nProstatitis, cystitis (see under these headings).\\nEpididymitis. Best in bed, elevation of scrotum, application\\nof evaporating lotions, abstraction of six or eight ounces of blood\\nFig. 49.\\nFig. 50.\\nR. R. The constricting ring in\\nparaphimosis.\\nR. R. The constricting ring in\\nphimosis.\\nby leeches placed over the cord. Open the bowels, give morphia\\nhypodermically, bromide of potassium and aconite internally.\\nIf swelling increases and pain is intense, puncture the tunica\\nalbuginea with a tenotome. When acute inflammatory symp-\\ntoms begin to subside, strap the testicle.\\nGonorrhoeal rheumatism. Iodine and splint to the joint, to-\\ngether with firm pressure very full doses of quinine (grains xl.\\ndaily), small doses of mercury, generous diet.\\nGive the treatment of gonorrhoea in the female.\\nUsual form, vulvo-vaginitis, may extend to the urethra, the\\nwomb, the Fallopian tubes (gonorrhoeal salpingitis), and the\\novaries.\\nRest in bed, milk diet, free motion from the bowels, repeated\\ndaily washings with strong sod. bicarb, solutions, followed by\\nthorough application of liq. argent, nit. grains lx to tbe ounce.\\nGeneral hot baths, or, in case of vaginitis, every two hours inject", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0220.jp2"}, "221": {"fulltext": "STRICTURE OF THE URETHRA. 219\\nbicarbonate of soda solution, Oj, follow with aq., Oj, finally\\nacetate of lead ^iij (teaspoonful) in the pint of water. Keep the\\nmucous surfaces apart by packing with absorbent cotton con-\\ntaining lead acetate.\\nUrethral Deformities.\\nDescribe epispadia.\\nEpispadia, or deficiency of the urethral roof, may be complete\\nor partial. Complete epispadia is usually associated with ex-\\nstrophy of the bladder.\\nTreatment. Freshen the edges on either side of the urethral\\nfloor, and bring them together over a catheter by means of quill\\nsutures flaps may be transplanted.\\nDescribe hypospadia.\\nHypospadia, or deficiency of the urethral floor, may occur at\\nthe base of the frenum, or at the junction of the penis and\\nscrotum.\\nTreatment. Restore the natural passage freshen the edges of\\nthe abnormal opening, and close or cover by transplanted flaps.\\nStricture of the Urethra.\\nWhat is stricture of the urethra?\\nTrue or organic stricture is permanent narrowing of the urethral\\ncanal at one or more places, due to disease, injury, or congenital\\ndefect. There are also spasmodic and congestive strictures.\\nWhat are the causes of stricture\\nGonorrhoea, traumatism, ulceration, and masturbation.\\nGive some varieties of organic urethral stricture.\\nIn regard to cause: 1. Idiopathic. 2. Traumatic. 3. In-\\nflammatory.\\nIn regard to anatomical appearances\\n1. Bridle stricture. A band of lymph, attached only by its ends,\\nstretching across the urethra.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0221.jp2"}, "222": {"fulltext": "220 ESSEKTIALS OF SURGERY.\\n2. Annular. A circular constriction as though a string were\\ntied about the urethra.\\n3. Indurated annular.\\n4. Cartilaginous.\\nIn regard to the possibility of passing instruments strictures\\nare classed as permeable and impermeable.\\nIn regard to their behavior on manipulation, they may be sim-\\nple, irritable, contractile or recurring.\\nWhat are the favorite seats of stricture\\n1. Anterior part of the urethra. 2. Just in front of the mem-\\nbranous portion of the urethra. Strictures are never found in\\nthe prostatic portion of the urethra.\\nWhat are the consequences of an untreated stricture?\\nHyperemia and inflammation about the stricture. Dilation\\nand thinning of the urethral walls behind. Hypersecretion and\\ngleet. Ulceration majr take place, followed by extravasation,\\nabscesses, and fistula?. From constant straining, bladder be-\\ncomes thickened, hypertrophied, and sacculated. Urine is\\nretained and ferments cystitis may reach a high grade. The\\ninflammation passes along the ureters, involves the pelves of\\nthe kidneys, and may cause death by suppurative pyelitis, or\\nnephritis.\\nWhat are the symptoms of organic strictures of the urethra?\\nGleety discharge, especially in the morning increased frequency\\nof urination, with some pain, twisting, forking, or diminution in\\nthe size of the stream. Retention may be the first and only sign.\\nLater symptoms are due to involvement of other organs hemor-\\nrhoids frequently result from constant straining.\\nHow do you diagnose strictures\\nBy examination of the urethra with bulbous bougies. Com-\\nmence with medium-sized bulbous bougie and increase the size\\ntill decided resistance is experienced or if the first tried will\\nnot pass, diminish the size till one finally enters the bladder,\\nmarking on its stem the point where resistance begins slowly\\nwithdraw from the bladder, marking again the point where\\nresistance begins this will give both the calibre and the width", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0222.jp2"}, "223": {"fulltext": "STRICTURE OF THE URETHRA.\\n221\\nof the stricture. If the obstruction is more than six Fig. 51.\\ninches from the meatus, it is probably an enlarged\\nprostate. The possibility of spasm or the catching\\nof the bulb of the bougie in a lacuna or at the tri-\\nangular ligament must be borne in mind.\\nWhat special points must be observed in passing a\\nbougie or catheter\\n1. See that the instrument is clean, smooth, and,\\nif it is a catheter, pervious.\\n2. Warm and oil.\\n3. Place the patient on his back with thighs flexed.\\n4. Bear in mind the course of the urethra, keep\\nthe catheter in the middle line, stretch the penis\\nforward and upward, and use no force.\\nWhat difficulties may occur in passing the catheter?\\n1. It may catch in a fold of mucous membrane or\\nin a lacuna. Avoid by keeping the point on the\\nfloor of the urethra at first, then along its roof.\\n2. It may catch where the urethra enters the tri-\\nangular ligament. Withdraw a little and keep the\\npoint of the instrument along the roof of the urethra.\\n3. It may make a new false passage, or enter one\\nalready made. Denoted by a sudden slipping of the\\ninstrument, pain, and detection of the point of the\\ncatheter outside of the urethra by rectal examina-\\ntion. The handle of the bougie is deflected from the\\nmiddle line, no urine escapes, the point is not freely\\nmovable, and, if the false passage is recent, there will\\nbe free bleeding.\\nHow do you treat false passage\\nWithdraw the instrument at once, and make no further effort\\nto pass it for one or two weeks. Infiltration of urine rarely takes\\nplace, the passage healing promptly.\\nWhat constitutional effects may follow the passage of an in-\\nstrument\\nHematuria, due to reflex congestion, syncope, rigors, urethral\\nfever, suppression of urine, pyaemia.\\nBulbous\\nbougie.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0223.jp2"}, "224": {"fulltext": "222\\nESSENTIALS OF SURGERY.\\nHow may the danger from these sequelae be lessened?\\nPass instrument with the patient in the recumbent position\\ngive 12 grains of quinine an hour before treating; inject U[x\\nto xx of a 1 per cent, solution of cocaine into the bulbous por-\\ntion of the urethra by means of\\nFig. 52. Fig. 53. ne prostatic syringe a few min-\\nutes before passing an instru-\\nment. Keep the patient in bed\\nsix to twenty-four hours after\\nthe instrument is used.\\nHow do yon treat strictures?\\nStrictures may be treated by\\n1. Dilatation. This may be\\nintermittent, continuous, or forci-\\nble (splitting). 2. Urethrotomy,\\nor cutting either internal or ex-\\nternal. 3. Excision. 4. Electro-\\nlysis.\\nHow do you get through a tight\\nstricture\\nTry a small, soft, olive-point-\\ned catheter or a small steel\\nsound. That failing, electro-\\nlysis may succeed. Finally sev-\\neral filiforms should be passed\\ninto the urethra, and each ma-\\nnipulated in turn till one passes\\ninto the bladder this may be\\nthreaded upon a railroad cathe-\\nter and the latter forced through the stricture with-\\nout fear of making a false passage.\\nDescribe intermittent dilatation.\\nThe calibre of the stricture having been determined,\\nthe largest flexible bougie which will pass through it\\nis introduced, and allowed to remain in the urethra\\nfor four or five minutes before withdrawing. At the\\nFiliform threaded\\nupon a railroad cath-\\neter.\\nOlive-\\npointed\\nsoft\\ncatheter.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0224.jp2"}, "225": {"fulltext": "STRICTURE OF THE URETHRA\\n223\\nnext attempt a larger instrument is used, till 28 to 30 French\\nwill readily pass in three days should elapse between each\\ndilation. This is the best and safest of all methods of treat-\\nment for the simple forms of stricture.\\nDescribe continuous dilatation.\\nThe patient is put to bed a flexible ca-\\ntheter is passed through the stricture into\\nthe bladder, and allowed to remain for one\\nor two days, when it is replaced by a larger\\none; continue in this way till the stric-\\nture is fully dilated.\\nUnder what circumstances may continu-\\nous dilatation be employed?\\nWhere there is great difficulty in pass-\\ning an instrument, or where the stricture\\nis irritable or contractile.\\n(The majority of surgeons condemn\\nrapid dilatation or splitting.)\\nDescribe internal urethrotomy.\\nBy means of a guarded knife the stric-\\nture is cut entirely through. In tight stric-\\ntures a guide or small instrument is passed,\\nwhich can be threaded on the urethrotome,\\nand the latter can then be made to cut its\\nway inward without fear of its going\\nastray. Pass a bulbous bougie to see that\\nthe stricture has been completely divided,\\nin which case there is no fear of urinary\\nextravasation. In four days pass a full-\\nsized soft catheter.\\nWhat strictures are properly subject to\\ninternal urethrotomy?\\nStrictures in front of the scrotum, and\\ncontractile, irritable, and cartilaginous\\nstrictures.\\nFig. 54.\\nRailroad urethrotome.\\n(White.)", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0225.jp2"}, "226": {"fulltext": "224\\nESSENTIALS OF SURGERY\\nFig. 55.\\nDescribe external perineal urethrotomy with a guide (Syme s\\nmethod).\\nLithotomy position. The groove of a Syme s staff is passed\\nthrough the stricture till its shoulder is caught in the beginning\\nof the narrowing. A 1^ inch incision is made\\nin the median line of the perineum, the groove\\nof the staff is found, the knife slipped into it\\nbehind the stricture, and the latter divided by\\npressing the cutting edge forward. A director\\nis passed into the bladder, and a 14 (English)\\nsoft-rubber catheter passed per urethram.\\nThis catheter is not left in, but is passed every\\nthree or four days till the wound is healed.\\nWhat strictures call for external perineal ure-\\nthrotomy with a guide?\\nDense cartilaginous strictures, or irritable\\nand contractile strictures when complicated by\\nperineal fistulse.\\nHow do you treat impermeable strictures\\nBy Wheelhouses s modification of perineal\\nsection.\\nBy Cock s operation of perineal section, or\\ntapping the urethra at the apex of the prostate.\\nWhat is Wheelhouses s modification of perineal\\nsection?\\nThe urethra is opened half an inch in front\\nof the stricture, when the latter can be exposed\\nto view, entered by a probe, and divided. A\\nbroad director introduced into the bladder\\nSyme s staff. guides a flexible catheter passed through the\\nmeatus. The catheter is left in for three or\\nfour days. In this operation the Wheelhouses staff is used this\\nis practically a director, grooved to within half an inch of its\\nend, and terminating in a blunt-hooked projection.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0226.jp2"}, "227": {"fulltext": "STRICTURE OF THE URETHRA. 225\\nWhat are the indications for Wheelhouses s modification of\\nperineal section\\nDense cartilaginous, or irritable and contractile strictures,\\nwhich are impermeable.\\nDescribe Cock s perineal section.\\nLithotomy position. Left forefinger in rectum, the point ap-\\nplied to apex of prostate. Pass a long, straight knife, with its\\nback towards the rectum, in the middle line beneath the bulb,\\nso that it may enter the membranous portion of the urethra a\\ndirector is then introduced, and guided by it a soft catheter is\\npassed into the bladder. The urethra is opened behind the\\nstricture, the latter not being touched.\\nIndicated in case of impermeable stricture complicated by\\nurinary retention, or in case of urethral rupture.\\nDescribe rnptnre of the urethra.\\nCause. Violence. May be torn partly or completely across.\\nSeats. Just in front of, or just behind the triangular liga-\\nment.\\nGive the symptoms of ruptured urethra.\\nBehind triangular ligament as in rupture of bladder. Inability\\nto pass water. Blood and urine on catheterization. Infiltration\\nbehind symphysis.\\nIn front of triangular ligament. Tumor in perineum blood\\nper urethram inability to pass water.\\nHow do you treat ruptured urethra\\nPass in a catheter. If there is any difficulty in introducing,\\ndo an external perineal urethrotomy, passing a catheter after\\ntwo or three days, and at regular intervals afterwards. If ure-\\nthra completely torn across, unite by catgut suture.\\nDescribe urinary extravasation.\\nIf extravasation takes place from the prostatic portion of the\\nurethra, the symptoms and treatment are the same as for rup-\\ntured bladder. If from the membranous portion, there will be\\nat first a hard lump in the perineum, as the anterior layer of the\\ntriangular ligament gives way, the extravasation will take the\\n15", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0227.jp2"}, "228": {"fulltext": "226 ESSENTIALS OF SURGERY.\\ncourse common in all anterior extravasations, that is, into the\\nscrotum and up upon the abdominal parietes, not descending\\nupon the thighs (attachments of deep layer of superficial fascia).\\nThe symptoms are characteristic if the patient has been suffer-\\ning from retention, he may suddenly experience a sense of\\nrelief, followed shortly by burning pain in the perineum and in-\\nflammatory fever, which quickly becomes typhoid in type. There\\nare redness, swelling, oedema, and early sloughing of the infil-\\ntrated area.\\nThe treatment is perineal section, tapping the source of extrava-\\nsation. Long incision should follow up the subcutaneous infil-\\ntration.\\nDiseases of the Prostate.\\nName the surgical affections of the prostate gland.\\nInflammation; may be acute, chronic, or complicated by\\nabscess. Hypertrophy. Atrophy. Tubercle. Malignant disease,\\nsarcoma in the young, carcinoma in the old.\\nGive the symptoms of acute inflammation of the prostate.\\nUsual cause gonorrhoea or stricture.\\nThere is pain at the neck of the bladder, increased by defecation\\nand by micturition, especially towards the end of the act.\\nThe water is passed frequently On examination per rectum the\\nprostate is felt as a hot, tender enlargement. There is fever.\\nTermination. Eesolution, abscess, or chronic inflammation.\\nGive the treatment of acute prostatitis.\\nOpen bowels freely. Render the urine bland by full doses of\\nalkaline carbonates. Apply leeches to the perineum, followed\\nby hot fomentations, poultices, and hot hip-baths. If there is re-\\ntention, a catheter should be passed. If an abscess forms, open\\nthe perineum in the middle line.\\nDescribe chronic prostatitis.\\nCauses. An acute attack, stricture, masturbation, gout.\\nIt is characterized by constant aching pain in the perineum,\\naggravated by defecation and urination. There is a discharge.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0228.jp2"}, "229": {"fulltext": "DISEASES OF THE PROSTATE. 227\\nlike the white of an egg, appearing during defecation and at the\\nbeginning of urination. There is frequent urination with imper-\\nfect cut off, and cystitis.\\nTreatment. Avoidance of stimulants, sexual indulgence, or\\nviolent exercise. Bowels must be kept open. Tonics. Sea\\nbathing. Fugitive blisters to perineum. By means of the pros-\\ntatic syringe nitrate of silver, TTLv of a two per cent, solution,\\napplied to the diseased area.\\nGive the symptoms of enlarged prostate.\\nThis is a disease of advanced life. It is characterized by\\ngreatly increased frequency of micturition, especially at night,\\nby loss of force in the stream, with difficulty and slotcness in start-\\ning it, by a sense of fulness about the rectum. Yery frequently\\nthere are hemorrhoids from straining. Fermentation of retained\\nurine with cystitis may follow. Finally, retention with overflow,\\nor even absolute retention may result.\\nHow do you diagnose an enlargement of the prostate\\nThe finger in the rectum will recognize most enlargements.\\nIn case there is projection of the middle lobe into the urethra\\na silver catheter will meet with an obstruction, more than seven\\ninches from the meatus, which is only overcome by greatly de-\\npressing the handle of the instrument. An ordinary catheter\\nmay not be long enough to reach the bladder.\\nHow do you treat chronic enlargement of the prostate\\nImmediately after urination pass a soft catheter. If addi-\\ntional water can be drawn, it is proof that the obstruction pre-\\nvents thorough emptying of the bladder. Give the patient a\\nsoft catheter, elbowed if the middle lobe is enlarged, and let\\nhim pass it every night on retiring. Commence this treat-\\nment before cystitis appears. For more aggravated cases do\\nWhite s operation of orchidectomy or vasectomy. In some\\ncases, when the bladder is irritable and sacculated, the pain\\nunbearable, the patient absolutely unable to pass water with-\\nout a catheter, but suffering intensely each time the instru-\\nment is passed, it may be necessary to drain the bladder by\\n1. Perineal section. 2. Suprapubic tapping and retention of", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0229.jp2"}, "230": {"fulltext": "228 ESSENTIALS OF SURGERY.\\ncarmla. 3. Suprapubic incision with excision of a portion of\\nthe prostate.\\nWhat symptoms denote malignant disease of the prostate?\\nPain, frequent urination, hemorrhage per urethram, shreds\\nof growth in urine, rapid swelling of unequal consistency, gland-\\nular enlargements, cachexia.\\nTreatment. Palliative.\\nWhat is meant by bar at the neck of the bladder?\\nA ridge due to hypertrophy of the lateral lobes.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0230.jp2"}, "231": {"fulltext": "AFFECTIONS OF THE BLADDER. 229\\nt\\nAFFECTIONS OF THE BLADDER.\\nRupture of the Bladder.\\nDescribe rupture of the bladder. {See also p. 101\\nCauses. Violence. Over-distension. May be intra- or extra-peri-\\ntoneal.\\nSymptoms. Pain and collapse, sense of something giving way,\\nurgent desire to urinate without the power to do so, rapid devel-\\nopment of inflammation or peritonitis. Catheter passed just in-\\nside the bladder draws blood only, or a small amount of bloody\\nurine. If the patient has passed his urine immediately before\\nthe accident, a weak antiseptic solution (boracic acid) may be\\ninjected into the bladder. If there is a rupture, it cannot be\\nagain drawn off.\\nTreatment. Insertion of full-sized catheter and expectant, or\\nSuprapubic Cystotomy; opening and washing out the peritoneal\\ncavity if urine has been extravasated into it, closing the peri-\\ntoneal rent, and inserting a drainage tube. After treatment,\\npatient in lateral decubitus.\\nWhat tumors are found in the bladder\\nPapilloma most common benign tumor. Mucous and fibrous\\npolyps, rare. Sarcoma. Carcinoma, epithelial or encephaloid.\\nTumors are usually situated on the trigone.\\nGive the symptoms of bladder tumor.\\nHematuria, cystitis, pain, the passage per urethram of frag-\\nments of the growth.\\nTreatment. Benign growths may be removed by perineal or\\nsuprapubic operations.\\nExstrophy of the Bladder.\\nWhat is exstrophy of the bladder\\nSynonyms. Ectopion, extroversion.\\nDefinition. Congenital absence of the anterior wall of the", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0231.jp2"}, "232": {"fulltext": "230 ESSENTIALS OF SURGERY.\\nbladder, together with the corresponding portion of the abdomi-\\nnal wall. The posterior wall of the bladder projects as a round,\\nvascular, red, ulcerated tumor, covered with mucous membrane,\\nand exposing the orifices of the ureters.\\nTreatment consists in covering in the defect by deep and super-\\nficial flaps, which have their raw surfaces apposed, and offer\\nboth to the bladder wall and externally, skin surfaces.\\nThis deformity is usually accompanied by epispadia.\\nCystitis,\\nWhat are the causes of cystitis?\\nCystitis, or inflammation of the bladder, may be acute or\\nchronic.\\nCauses. Mechanical or chemical injury, or direct extension\\n(gonorrhoea).\\nGive the symptoms of acute cystitis.\\nPain, burning, may be very severe, located in the bladder and\\nperineum. Strangury, a continual desire to void urine, which\\nis spasmodically passed, a few drops at a time. Tenderness, well\\nmarked over the pubes, in the bladder region. Urine, scanty,\\nhighly colored, containing mucus, blood, and pus. Fever, directly\\nproportionate to the grade of inflammation.\\nGive the treatment of acute cystitis.\\nRest in bed. Diet of skimmed milk, with carbonated drinks.\\nBowels soluble. Leeches to perineum, or over pubes. Hot hip-\\nbaths and hot poultices. Alkaline carbonates, hyoscyamus, morphia\\nand belladonna suppository. If urine is ammoniacal, the bladder\\nmust be washed out with antiseptic lotions (boracic acid gr. iv\\nto gj); this failing, an external perineal urethrotomy with\\ndrainage of the bladder is indicated.\\nDescribe chronic cystitis.\\nSymptoms as in acute, but milder. Urine often ammoniacal,\\nvery offensive, contains large quantities of ropy mucus and pus.\\nMucous membrane thickened, congested, ulcerated. Muscular\\ncoat thickened, fasciculated, giving the interior of the bladder a", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0232.jp2"}, "233": {"fulltext": "AFFECTIONS OF THE BLADDER. 231\\nridged appearance. Between the muscular ridges the mucous\\nmembrane may he forced outward by constant straining, form-\\ning sacculations, in which stones may form.\\nTreatment. Kemoval of cause, where possible. General\\nhygiene. Milk diet, with free use of non-stimulating drinks.\\nTriticum repens, uva ursi, copaiba, cubebs. When urine alka-\\nline, benzoic acid. Load washinys. Twice daily with boracic\\nacid, or water hot as it can be borne. In severe cases, perineal\\ncystotomy and drainage.\\nAtony and Paralysis of the Bladder.\\nWhat is atony of the bladder\\nBy atony is implied a loss of tone in the muscular fibres of\\nthe bladder, making it unable to expel its contents. The blad-\\nder is only partially emptied at each micturition it gradually\\nbecomes more and more full till the condition known as reten-\\ntion with overflow is developed, simulating incontinence. The\\ncause of atony is over-distension it may arise in the course of\\nlow fever, from voluntary neglect, or from urethral obstruction.\\nTreatment. Catheter cold douche to bladder and to lumbar\\nspine.\\nDescribe paralysis of the bladder.\\nCause. Injury, or organic disease of nervous system, nervous\\nexhaustion. If the neck of the bladder is affected, it causes\\nincontinence. If the body of the bladder alone is involved, there\\nwill be retention.\\nTreatment. Catheter, tonics, strychnia, electricity.\\nHaematuria.\\nHow can you determine the source of blood in the urine?\\nFrom the kidney. Blood is uniformly distributed through the\\nurine. From the bladder. Comparatively clear urine is passed\\nat first, followed by blood. From the urethra. Blood passes first^\\nthen urine.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0233.jp2"}, "234": {"fulltext": "232 ESSENTIALS OF SURGERY.\\nWhat surgical affections may cause renal hemorrhage\\nContusion or jarring, congestion, inflammation, calculus, the\\nuric acid diathesis, catheterism, malignant disease.\\nGive the causes of bladder hemorrhages.\\nTraumatism, calculus, inflammation, new growths.\\nGive the causes of urethral hemorrhages.\\nInjury, ulceration, calculus, erectile growths.\\nHow are clots removed from the bladder?\\nBy large suction catheter. By digesting the clots in the blad-\\nder. By urethrotomy or cystotomy.\\nRetention of Urine.\\nWhat are the causes of retention of urine\\nRetention means simply inability to pass the urine from th\\nbladder. Suppression means absence of the secretion.\\nThe causes of retention are\\n1. Impacted calculus or foreign body.\\n2. Alterations in the urethral walls, either permanent, as stric-\\nture and enlarged prostate, ov temporary, as congestion and spasm.\\n3. Pressure from without the urethra, as in case of certain\\ntumors.\\n4. Atony or paralysis of the bladder.\\nIn retention due to stricture, the acute condition is generally\\nbrought about by an added spasm or congestion due to excesses\\nor exposure.\\nAfter operations or injury, spasmodic retention is especially\\nliable to occur.\\nGive the symptoms and signs of retention.\\nIf the condition comes on slowly, the bladder may become\\nenormously distended, with few local or constitutional signs other\\nthan those connected with urethral obstruction. Finally the\\nurine dribbles away as fast as secreted, the bladder still remain-\\ning full. This constitutes the condition known as retention with\\noverflow, and is diagnosed by outlining the full bladder by means\\nof abdominal percussion, and bypassing a catheter.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0234.jp2"}, "235": {"fulltext": "AFFECTIONS OF THE BLADDER.\\n233\\nProstatic catheter.\\nBetention due to organic stricture. Attempt to pass\\na soft catheter or filiform, failing, give opium per\\nrectum, and hot bath. If the urine is still not\\npassed, anaesthetize and again attempt to pass an\\n5G.\\nIn sudden and complete retention there is intense local pain, with\\nrapid development of constitutional symptoms of a typhoid type.\\nThe bladder, unless greatly stiffened and altered b} previous\\ninflammation, rises out of the pelvis, and can be readily detected\\nIry abdominal examination.\\nWhat are the consequences of retention f:\\nAtony, cystitis, nephritis, rupture of either the\\nbladder, or of the urethra behind a point of obstruc-\\ntion, or retention with overflow.\\nGive the treatment of retention of urine.\\nIf the symptoms are urgent, immediate catheteri-\\nzation.\\nBetention due to spasmodic and congestive strictures.\\nSpasm and congestion are rarely sufficient in\\nthemselves to cause retention they are usually as-\\nsociated with slight stricture or enlargement of\\nprostate, and are brought on by exposure, debauch,\\nor operation.\\nTreatment. Hot bath, and full dose of tr. opii\\n(TTLxxx) by the rectum. If there is no spontaneous\\nrelief, pass a catheter. Open the bowels, and keep\\nthe urine unirritating.\\nFig. 57.\\nI\\nMercier s\\nelbowed ca-\\ntheter.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0235.jp2"}, "236": {"fulltext": "234 ESSENTIALS OF SURGERY.\\ninstrument if unsuccessful, either incise, or make a suprapubic\\naspiration or puncture.\\nRetention due to hypertrophy of prostate. Usually due to con-\\ngestion (congestive stricture), it is induced by debauch, etc.\\nTry the elbowed catheter, the flexible catheter with stylet, which\\nis somewhat withdrawn when the beak impinges on the prostate,\\nthe silver prostatic catheter. If passed with much difficulty,\\nleave in. If bladder very full, draw off only a part of the urine\\n(to avoid syncope and hemorrhage). Catheterization failing,\\ndo not try to relax, but immediately puncture, or aspirate above\\nthe pubes.\\nRetention due to atony and paralysis of the bladder (usually re-\\ntention with overflow). Regular use of soft catheter.\\nDescribe suprapubic tapping of the bladder.\\nTrocar and canula, full-sized, and with a marked curve, thrust\\nthrough the abdominal w r all just above the pubes and into the\\nbladder beneath the peritoneal reflection. The trocar is with-\\ndrawn, and a rubber tube is passed through the canula and left\\nin. In three or four days the tube is withdrawn, leaving a short\\nsinus into the bladder, which may be kept open indefinitely.\\nWhen temporary relief is sought from retention, aspirate in the\\nsame region. Tapping may also be done through the pubes,\\nthrough the perineum, through the rectum.\\nWhat are the varieties of incontinence of urine?\\nTrue incontinence. The urine dribbles away as fast as secreted.\\nDue to either enlargement of the middle lobe of the prostate, or\\ndisease or injury involving the lumbar cord.\\nHocturnal incontinence. Due to an abnormal reflex sensibility.\\nSlight irritation, such as might be caused by worms or phimosis,\\ncauses micturition.\\nTreatment. For nocturnal incontinence, lateral decubitus, and\\nregular emptying of the bladder once or twice during the night.\\nSponge baths night and morning, belladonna pushed to its physi-\\nological limit.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0236.jp2"}, "237": {"fulltext": "AFFECTIONS OF THE BLADDER. 235\\nStone in the Bladder.\\nWhat are the common varieties of calculus\\nUric acid. Oxalate of lime. Phosphatic salts. Among the less\\ncommon varieties are the stones made up of urates, cystin,\\nxanthin. Calculi are formed of concentric -laminae, frequently\\nmade up of different materials (alternating calculi). They may\\nbe single or multiple, free or encysted, only one surface, in the\\nlatter case, being subject to deposit.\\nHow may you infer the nature of a stone\\nBy an examination of the urinary sediment.\\nHow may stone terminate\\nIn cystitis, pyelitis, nephritis.\\nGive the symptoms of stone in the bladder.\\nFain. Chronic, aggravated hj motion and jarring, felt across\\nthe loins and down the thighs also anaczrfe pain, referred to the\\nend of the penis, and most intense towards the termination of\\nmicturition (the stone falls on the sensitive trigone and the\\nbladder walls contract upon it).\\nIncreased frequency of micturition during the day, or while the\\npatient is moving about.\\nHcematuria. Slight, following micturition.\\nSudden stoppage of the stream while micturating. Cystitis.\\nPiles in adults. Elongated prepuce in boys (from pulling).\\nProlapse of rectum in children.\\nHow do you diagnose cystic calculus\\nPass into the bladder a solid or hollow sound with a sharply\\ncurved bulbous beak. Insert a finger into the rectum. By\\nmanipulating the instrument, and turning it towards all portions\\nof the bladder, the stone may be struck. The click of the sound\\nagainst the calculus should be both heard and felt.\\nUnder what circumstances may careful sounding fail to detect\\nstone?\\nWhen the stone is encysted, or when it is coated with blood\\nand mucus. If symptoms point to stone, sound repeatedly.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0237.jp2"}, "238": {"fulltext": "236\\nESSENTIALS OF SURGERY\\n-I\\no\\nO H=\\no\\no\\nb^\\no\\np\\nPc-h\\nft\\nd\\nc c8 3 \u00c2\u00a3p\\n-P\\n2 S3\\nd\\n1*\\nrtf 03\\nB\\n03 ,2 d\\n_d d rn -rH\\nn\\nd\\nM v\\nB e8\\nfc P\\no\\no\\na x\\nOS\\n2\\ncp d\\n!l\\nw .d d\\nP ;2 o\\nP^\\nif 02\\no e\\nS2 b\\nS a\u00c2\u00a3\\nnd d\\nB B\\nCD\\na\\nR\\n,P\\nPh\\n13 c8\\nCB rj\\nCO tf", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0238.jp2"}, "239": {"fulltext": "AFFECTIONS OF THE BLADDER. 237\\nHow may vesical calculi be treated\\nBy Litholysis or solvent treatment, practically useless in treat-\\ning bladder stones. Lithotrity, or crushing the stone in the\\nbladder. Litholapaxy, or crushing and washing out at one\\nsitting. Lithotomy, or cutting into the bladder and removing\\nthe stone.\\nWhat circumstances guide you in the choice of operation?\\nLitholapaxy, in adults as a rule.\\nLithotomy is indicated.\\n1.. In children, because the urethra is small, the bladder lies\\nhigh, and lithotomy has given the best statistics.\\n2. For large hard stones, an oxalate stone with maximum\\ndiameter greater than one inch would indicate the cutting\\noperation.\\n3. In case of marked urethral stricture.\\n4. In aggravated cystitis or sacadation of bladder. The incision,\\nby providing drainage, would greatly ameliorate the bladder\\ndisease.\\n5. In irritable urethra, with tendency to urethral fever.\\nMention some sequelae of litholapaxy.\\nRigors and fever, retention of urine, cystitis or prostatitis,\\nhemorrhage, suppression of urine, phlebitis, and pyaemia. If\\ndeath occurs, it is mostly due to the chronic kidney trouble.\\nDescribe lithotomy.\\nMay be Perineal. (1. Lateral. 2. Median. 3. Bilateral.)\\nBecio-vesical. Suprapubic.\\nUsual operation. Lateral perineal. Prepare the patient by\\nrest in bed, a laxative the night before, an injection the morn-\\ning of operation. Anaesthetize, draw the urine, and inject six\\nounces of warm water. Pass into the bladder a full-sized\\ngrooved staff and strike the stone. If it is not found, withdraw\\nthe staff and pass a sound. Failing to strike it with this, the\\noperation should be postponed. If the stone is found, place the\\npatient in lithotomy position, the soles of the feet being grasped\\nin the palms of the hands, and secured by shackles or band-\\nages in this position bring the nates down over the end of the", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0239.jp2"}, "240": {"fulltext": "238 ESSENTIALS OF SURGERY.\\ntable, let an assistant hold the staff directly in the middle\\nline hooked under the pubes, while the operator, seated facing\\nthe buttocks, passes the finger of his left hand into the rectum,\\nand, with the knife in his right hand, makes an incision midway\\nbetween the scrotum and anus, and just to the left of the mid-\\ndle line, downward and outward to below the anus and some-\\nwhat nearer the tuberosity of the ischium than to this opening.\\nThe incision divides skin, superficial fascia, external hemor-\\nrhoidal and superficial perineal vessels, and the correspond-\\ning nerves. Deepen the wound, cutting transversus peronei\\nmuscle and artery, the lower border of the triangular liga-\\nment, and, possibly, some fibres of the accelerator urinse.\\nSearch with the disinfected finger of the left hand for the staff,\\nplace the point of the knife in the groove, dividing the compres-\\nsor urethral and membranous portion of the urethra. Turn\\nthe blade somewhat toward the patient s left (the longest dia-\\nmeter of the prostate), and push it through the levator pros-\\ntata3, and the gland itself, till it enters the bladder. Withdraw\\nthe knife, and twist the finger along the concave surface of the\\nstaff into the bladder. When the stone is touched and the staff\\ntaken out, pass the forceps along the finger on withdrawing\\nthe latter, there will be a rush of water, which commonly car-\\nries the stone into the grasp of the instrument. See that the\\nstone is grasped with its smallest diameter presenting, and\\nexert traction in the axis of the pelvis. Encysted calculi must\\nbe removed by the finger and a scoop.\\nApply no dressing simply dust with iodoform. Urine comes\\nthrough the lithotomy wound for two days, then from the\\nurethra, owing to swelling as inflammation subsides it again\\nflows from the wound. Put the patient in bed, on his back, and\\nwith a rubber bed-pan to receive the urine.\\nWhat accidents may occur in lateral lithotomy?\\nHemorrhage, from a wounded artery, or from the prostatic\\nplexus.\\nTreatment. Tie the bleeding point. If that cannot be accom-\\nplished, haemostatic forceps, or acupressure. Venous hemor-\\nrhage may take place some hours after the operation, the blood", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0240.jp2"}, "241": {"fulltext": "AFFECTIONS OF THE BLADDER. 239\\nflowing into the bladder in which case wash out all coagula, and\\ncheck the hemorrhage by a petticoated tube packed with lint.\\nOther less common accidents are, wound of rectum, wound of\\nbladder, and tearing the urethra across, the latter complication\\nespecially liable to occur in children. If the urethra is pushed\\noff the staff, the operation must be abandoned.\\nMention some causes of death after lithotomy.\\nInfiltration of urine, from opening of recto-vesical fascia dif-\\nfuse inflammation, from bruising hemorrhage, pyaemia, peritoni-\\ntis, shock, cystitis, suppression of urine.\\nDescribe median lithotomy.\\nPass a grooved staff as before. Feel the apex of the prostate\\nwith the finger in the rectum. Make an incision in the median\\nline of the perineum, beginning inch from the anus, and pass\\nthe point of the knife into the groove of the staff, nicking the\\napex of the prostate and dividing the membranous portion of\\nthe urethra.\\nWhat are the indications for median lithotomy\\nSmall stones, foreign bodies, exploratory incisions.\\nDescribe suprapubic lithotomy.\\nThis operation consists in opening the anterior wall of the\\nbladder, below the peritoneal reflection.\\nPosition. On the back, with the buttocks elevated. Inflate\\nthe rectum moderately, by means of a rubber bag distended with\\nair or water. Draw the urine, and inject four to six ounces of\\nboracic acid solution into the bladder. Incision through the\\nlinea alba, immediately above the symphysis. Tear through the\\nfibrous and fatty tissues till the wall of the bladder is exposed.\\nDraw the peritoneal reflection upward. Incise below its attach-\\nment. Enlarge, if necessary, by tearing, and extract the stone.\\nThe patient maintains the lateral decubitus, changing from one\\nside to the other. This drains the bladder. A rubber air-cushion\\nis arranged to receive the urine.\\nWhat are the indications for suprapubic lithotomy\\nLarge, hard stones, of a greater diameter than one-and-a-half\\ninches.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0241.jp2"}, "242": {"fulltext": "240 ESSENTIALS OF SURGERY.\\nThis method of cystotomy is also advised in cases of tumor of\\nthe bladder. Many surgeons consider this operation as prefera-\\nble in nearly all cases where the bladder has to be opened.\\nWhat are the symptoms of calculus impacted in the urethra\\nSudden stoppage of the stream, great pain, a drop or two of\\nblood, and retention of urine.\\nTreatment. If possible, work it forward along the urethra,\\ngrasp and extract with urethral forceps. Stretch the skin over\\nit and extract by a small incision, letting the wound granulate.\\nIf at the neck of the bladder, do a median lithotomy.\\nHydrocele.\\nName the varieties of hydrocele.\\n1. Vaginal hydrocele. This is the common variety the\\nserous effusion is in the tunica vaginalis testis. Hydrocele im-\\nplies this form.\\n2. Congenital hydrocele. Arises from an imperfect closure of\\nthe communication between the peritoneal cavity and the tunica\\nvaginalis.\\n3. Encysted hydrocele of the testis or epididymis. Keally cystic\\ngrowths from these structures. The fluid is often opalescent\\nand contains spermatozoa.\\n4. Encysted hydrocele of the cord. A serous effusion into an\\nunobliterated portion of the funicular part of the tunica vagi-\\nnalis.\\nWhat are the symptoms of hydrocele?\\nA smooth, tense, elastic, fluctuating swelling in the scrotum;\\nof pyriform shape, and translucent. The testicle lies behind it and\\nnear its lower part.\\nIn congenital hydrocele the effusion can be slowly pressed\\nback into the peritoneal cavity, to reappear when pressure is\\nremoved.\\nGive the treatment of hydrocele.\\nPalliative. Discutient remedies (especially in the congenital\\nform), such as muriate of ammonia 3ss to aq. ^j, or weak solu-", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0242.jp2"}, "243": {"fulltext": "HYDROCELE. 241\\ntions of iodine. Tapping and draining off the fluid by trocar\\nand canula.\\nRadical. Tapping and injection of iodine. Incision, drain-\\nage, and antiseptic dressing. Excision of sac. Tapping with\\ninjection is dangerous.\\nDescribe tapping a hydrocele.\\nSee that the trocar and canula are clean, and movable on each\\nother. Determine the position of the testicle. Grasp the\\nenlargement with the left hand, making its anterior portion\\ntense. Thrust the trocar directly backward, turning it upward\\nas soon as it has entered the sac. Evacuate the fluid, withdraw\\nthe canula, and close the wound with iodoform collodion.\\nIf the hydrocele is to be radically cured, inject, after draining\\nthe fluid, tr. iodin. \u00c2\u00a3ij, and manipulate the scrotum so that the\\ninjection may come in contact with every portion of the sac\\nwalls. Withdraw the canula, and close the wound as before.\\nAcute inflammation shortly follows, and the swelling may even\\nexceed its original extent. It shortly subsides, obliterating the\\ncavity by inflammatory adhesions.\\nThe safest operation is that of Hearn. Make a small incision,\\ncatch the edges of the sac with forceps, dry its interior with\\ngauze, swab out with pure carbolic acid, pack for 24 hours with\\niodoform gauze, and allow it to heal.\\nHematocele.\\nWhat is hematocele\\nAn effusion of blood into the tunica vaginalis testis. Strictly,\\nthe term includes effusion in connection with either testis or\\ncord, as in case of hydrocele.\\nWhat are the causes of hematocele\\nTraumatism, or spontaneous rupture of diseased bloodvessels.\\nHow do you diagnose hematocele?\\nA smooth, tense, semifluctuating, pyriform swelling appears\\nrather suddenly. It is opaque by transmitted light, gives to the\\nexploring needle disorganized blood, and is often accompanied\\nby considerable ecchymosis of the scrotum.\\n16", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0243.jp2"}, "244": {"fulltext": "242 ESSENTIALS OF SURGERY.\\nGive the treatment of hematocele.\\nIf recent, rest in bed, elevation, and application of cold. If\\nthis fails, incise and evacuate.\\nVaricocele.\\nWhat is varicocele\\nA varicose condition of the pampiniform plexus.\\nWhy is varicocele commonly found on the left side\\n1. The left spermatic vein is longer. 2. It opens into the\\nrenal vein at right angles to the blood-current. 3. It is crossed\\nby the sigmoid flexure, and hence subject to pressure from feecal\\naccumulations.\\nWhat are the symptoms of varicocele?\\nDragging pain and discomfort, relieved by recumbency.\\nConsiderable mental depression. On examination there is found\\na soft, knotted, irregular, opaque, pyriform tumor, feeling like a\\nbunch of earth-worms; it gives an impulse on coughing, and\\ngradually disappears on lying down.\\nGive the treatment of varicocele.\\nGeneral hygiene, regular exercise, cold sponging, and local\\ndouches. The bowels should be regulated, and a suspensory\\nbandage worn, with a ring through which a portion of the scro-\\ntum can be drawn.\\nRadical. Subcutaneous ligation or acupressure. Excision\\nby the open method is the best operation.\\nSarcocele.\\nName the surgical affections of the testicle.\\nEpididymitis and orchitis, acute or chronic. Syphilitic, tuber-\\ncidar, cystic, or malignant disease. All these enlargements may\\nbe accompanied by hydrocele.\\nWhat is sarcocele?\\nA term applied to all solid enlargements of the testes, hence\\nwe have simple, tubercular, malignant sarcocele, etc.\\n(For acute epididymitis see pages 213, 216. Acute orchitis has\\nthe same symptomatology and treatment.)", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0244.jp2"}, "245": {"fulltext": "SARCOCELE. 243\\nDescribe simple sarcocele.\\nDue to simple chronic orchitis. It is simply an overgrowth\\nof the connective tissue, following an acute attack of inflamma-\\ntion forming a smooth, hard, non-sensitive enlargement. Tes-\\nticular sensation may ultimately disappear. This indicates\\natrophy of the secreting tissues.\\nTreatment. Strap.\\nDescribe syphilitic sarcocele.\\nPathology. Either a diffused or localized induration (gumma).\\nThe testicle, at first smooth and globular, becomes nodular, of\\nstony hardness, and non-sensitive. The tumor preserves its gene-\\nral ovoid outline.\\nTreatment. Strapping and constitutional medication.\\nDescribe tubercular disease of the testicle.\\nThe diagnostic points of tubercular sarcocele are It occurs in\\nthe young adult, whose family history is frequently strumous,\\nit is indolent and slow in development, the epididymis is first\\nattacked, there is rarely hydrocele, the vas deferens is thick-\\nened, and the induration is prone to break down.\\nTreatment. Constitutional. Total ablation of diseased area.\\nCastratijon if necessary.\\nDescribe fibro-cystic disease of the testes.\\nOccurs in old men, and is a gradual, painless, unilateral en-\\nlargement, attended with absence of testicular sensation, and\\npresenting no history of previous injury or inflammation.\\nTreatment. Castration.\\nDescribe malignant disease of the testicle.\\nSarcoma, most common, small round-celled. Carcinoma, usu-\\nally encephaloid. The diagnosis from fibro-cystic disease is\\nmade by the exceeding rapidity of the growth, which involves\\nthe skin and ulcerates. All the signs of malignant disease are\\npresent.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0245.jp2"}, "246": {"fulltext": "244 ESSENTIALS OF SURGERY.\\nDISEASES OF VEINS.\\nWhat is thrombosis?\\nA clot formed in a vessel during life.\\nWhat are the causes of venous thrombosis?\\n1. Inflammation, injury, or degeneration of the walls of a\\nvein.\\n2. Alteration in the blood, blood stasis, or exhaustion.\\nWhat becomes of a thrombus\\nIt may organize, it may calcify, forming phleboliths, or it\\nmay undergo red or yellow (septic) softening.\\nWhat are the symptoms of thrombosis\\n(Edema, and the detection of a tender, knotted, cord-like\\nswelling in the course of a vein. There is pain on motion.\\nHow do you treat thrombosis?\\nRest and elevation. Mercury and belladonna ointment thickly\\napplied, hot fomentations. Clear the bowels by a saline cathartic,\\ngive a simple but nourishing diet, and administer iron and\\nquinine. Subsequently apply a pressure bandage, and use fric-\\ntion and massage.\\nWhat are the causes of phlebitis?\\nTraumatism, thrombosis, gout, micro-organisms.\\nWhat are the symptoms of phlebitis?\\nA dusky red line in the course of the vein, and the symptoms\\nof thrombosis. Treatment as for thrombosis.\\nDescribe suppurative phlebitis.\\nCause. Septic micro-organisms.\\nSymptoms. As for phlebitis and thrombosis. Local inflam-\\nmatory signs are more marked there are frequently softening\\nand suppuration in the course of the vein, and constitutional\\nsymptoms and metastatic abscesses indicate the development of\\npyaemia.\\nPrognosis. Unfavorable,", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0246.jp2"}, "247": {"fulltext": "DISEASES OP VEINS. 245\\nTreatment. If possible, ligation above and below the clot.\\nLocal disinfection and opening of abscesses. Amputation in\\nsome cases.\\nWhat is a varix\\nA permanent dilatation of a vein. The vein is said to be\\nvaricose.\\nWhat are the causes of varicose veins\\nIncreased intravenous pressure from mechanical compression,\\nfrom violent muscular contractions emptying the deep veins into\\nthe superficial, from long standing. Alteration in the vein\\nwalls.\\nWhat are the symptoms of varix?\\nAching pains, and a sense of fulness after standing, together\\nwith the enlargement evident to the sight and touch. Muscular\\ncramps are said to characterize deep varix.\\nHow do you treat varicose veins\\nPalliative. As much rest and elevation of the part as possible,\\nthe application of a rubber bandage or an elastic stocking, tonics,\\nand laxatives.\\nRadical. Ligature and excision of the varices or ligature and\\ndivision of the internal saphenous vein at the junction of the\\nupper and middle thirds of the thigh. Schede s plan of a cir-\\ncular incision through the skin of the leg, entirely around the\\nlimb, a hand s breadth below the knee.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0247.jp2"}, "248": {"fulltext": "246 ESSENTIALS OF SURGERY\\nANGIOMA.\\nDescribe the different varieties of angiomata.\\n1. Arterial varix. A dilatation and lengthening of a single\\nartery.\\n2. Cirsoid aneurism. A tumor composed of a number of di-\\nlated and tortuous arteries.\\n3. Aneurism by anastomosis. A dilatation and lengthening,\\ninvolving the arteries, capillaries, and lesser veins.\\n4. Capillary ncevus. A dilatation and tortuosity involving the\\ncapillaries.\\n5. Venous ncevus. A tumor composed of a number of inter-\\ncommunicating spaces lined with endothelium, into which the\\narteries empty, and from which the veins take their origin.\\nHow do you treat angiomata\\nArterial varix, circoid aneurism, aneurism by anastomosis. Pro-\\ntect. If rapidly extending, excise, cutting free of the involved\\narea, and tying each artery as it is cut. Ligation of the main\\nartery of the part, or injection of perchloride of iron may also\\nbe tried.\\nNaivus. Very large superficial nsevi (port-wine marks), and\\nthose which are neither increasing in size nor produce visible\\ndeformity, should not be treated. Under other circumstances\\ncapillary ncevi may be removed by superficial cauterization, or\\nincision, or escharotics lightly applied venous ncevi may be\\ncured by incision, carried free of the diseased area by ligation,\\nthe thread being placed subcutaneously, or in an incision made\\nthrough the skin by electrolysis, by coagulating injections.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0248.jp2"}, "249": {"fulltext": "ANEURISM. 247\\nANEURISM.\\nWhat is an aneurism\\nA blood tumor communicating with the interior of an artery.\\nGive the classification of aneurisms.\\n1. Traumatic (see p. 74). 2. Spontaneous.\\na. Diffused. a. Tubular or fusiform.\\nb. Circumscribed. b. Sacculated.\\nc. Arterio-venous. c. Dissecting.\\nThe cirsoid aneurism and aneurism by anastomosis are, pro-\\nperly, varieties of spontaneous aneurism.\\nDescribe spontaneous aneurism.\\nTubular or fusiform. A circumscribed dilatation of the whole\\ncircumference of the artery. The sac consists of all three coats.\\nSacculated. The dilatation involves a portion of the circum-\\nference only. The sac consists of the outer coat and of con-\\ndensed areolar tissue. May be circumscribed or diffused.\\nDissecting. The internal and a portion of the middle coat\\nhave yielded, the blood forcing its way between the layers of the\\nmiddle coat.\\nWhat are the causes of spontaneous aneurism?\\nPredisposing. Atheroma, an embolus, leading to inflamma-\\ntory softening.\\nExciting. Blows, strains, or sudden violent exertion.\\nHow may an aneurism terminate\\n1. In spontaneous cure. 2. In death.\\nSpontaneous cure may be effected by, 1, gradual consolidation\\nby deposit of laminated clot 2, arterial occlusion above or below\\nthe sac by a fibrinous plug, or by the aneurism itself 3, inflam-\\nmation of the sac and consequent clotting of the contained\\nblood 4, suppuration and gangrene. Aneurism may cause\\ndeath by pressure, by rupture and bleeding, by gangrene.\\nWhat are the diagnostic signs of aneurism\\nA tumor iK the course of an artery, diminished in size by", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0249.jp2"}, "250": {"fulltext": "248 ESSENTIALS OF SURGERY.\\npressure of the main artery above, increased in size by pressure\\nupon the artery below. Characterized by thrill, bruit, and ex-\\npansile pulsation. The pulse in the artery below the aneurism\\nis delayed in time, and more feeble than that of the opposite\\nside of the body. There are various pressure effects, such as\\noedema, bony erosions, pain, muscular spasm, etc.\\nHow do you treat aneurism\\n1. Medical treatment. Absolute rest. Very restricted diet.\\nIodide of potassium.\\n2. Surgical treatment. (1. Pressure. May be direct, upon the\\naneurismal sac, or indirect, upon the artery above or below. It\\nmay be digital, instrumental, or applied by an Esmarch s band-\\nage. It may be so applied as to merely slow the blood-current\\nproducing laminated clots, or may completely stop the circulation\\n(rapid pressure). (2.) Flexion. Usually combined with pres-\\nsure. (3.) Ligation. The thread may be applied to the ar-\\ntery, 1, above the aneurism, and at some distance from it\\n(Hunter s operation), 2, just above the aneurism (Anel s opera*\\ntion), 3, both above and below the aneurism (operation of\\nAntyllus, or old operation), 4, just below the aneurism (Brasdor s\\noperation), 5, to one or more of the main branches below the\\naneurism (Wardrop s operation). (4.) Manipulation. (5.) Gal-\\nvano-puncture. (6. Injections. (7. Introduction of foreign bodies.\\nDescribe the application of digital pressure to the cure of aneu-\\nrism.\\nThis, if it can be applied on the proximal side of the artery at\\nsome distance from the sac, is superior to other methods of pres-\\nsure, since it is less painful, it is less liable to injure the soft\\nparts, it does not obstruct venous circulation. This method can\\nbe combined with flexion and instrumental compression. Kelays\\nof assistants are necessary for its proper application. The pres-\\nsure is made with the thumbs, the artery being controlled by the\\nnext assistant before the one pressing is relieved. A hand should\\nbe kept constantly on the sac to see that pulsation is prevented.\\nThis method is not applicable to very large aneurisms accom-\\npanied by much oedema from venous obstruction, or aneurisms", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0250.jp2"}, "251": {"fulltext": "ANEURISM. 249\\noccurring in habitual drunkards or those of irritable disposi-\\ntion.\\nDescribe Hunter s method of ligation.\\nThe ligature is applied so high above the artery that a double\\ncollateral circulation is established, one around the thread, the\\nother around the aneurism. The cure is effected by diminish-\\ning the circulation, and favoring the deposition of laminated clots\\nin the aneurisraal sac these organize much more readily than\\nthe currant-jelly clots.\\nWhen the ligature is applied, pulsation can no longer be felt\\nin the aneurism after awhile a slight pulse is again perceptible\\nas the sac becomes occluded, this pulsation becomes more feeble,\\ntill it finally ceases permanently. After operation, the limb\\nshould be swathed in cotton, elevated, and kept warm.\\nWhat are the dangers of ligation\\nGangrene, secondary hemorrhage, suppuration and sloughing,\\nrecurrent pulsations.\\nWhat are the objections to ligation close to the aneurismal sac\\nThe artery is probably not healthy. The circulation is abso-\\nlutely stopped, hence there is clotting in mass. The anatomi-\\ncal relations of the vessel are frequently altered by the tumor,\\nmaking the operation difficult. The aneurismal sac is liable to\\ninjur} during the operation.\\nHow do you treat traumatic aneurisms\\nTurn out the clots, and ligate above and below.\\nWhat knot would you use to ligate for aneurism\\nThe stay knot of Ballance and Edmunds, a double ligature\\nof floss silk being used.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0251.jp2"}, "252": {"fulltext": "250 ESSENTIALS OF SURGERY\\nDISEASES OF THE LYMPHATICS.\\nDescribe lymphangitis.\\nDefinition. Inflammation of lymphatic vessels.\\nCauses. Septic absorption from a wound, or simple trauma-\\ntism.\\nSymptoms. Irregularly placed erythematous patches, and red\\nlines running to the nearest lymphatic glands, which are en-\\nlarged and tender. Chill followed by fever.\\nTreatment. Cleanse wounds and render aseptic. Promptly\\nevacuate pus. Elevate and apply hot antiseptic fomentations.\\nOn subsidence of acute symptoms, apply belladonna and mer-\\ncury ointment, together with pressure. Clear the bowels, give\\ndiaphoretics and diuretics.\\nDifferential diagnosis. From phlebitis, by absence of knotted,\\ncorded feeling, and dusky redness in the course of veins; by the\\npresence of glandular involvement.\\nDescribe lymphadenitis.\\nDefinition. Inflammation of lymphatic glands. May be acute\\nor chronic.\\nAcute lymphadenitis is usually secondary to inflammation of\\nsoft parts. The symptoms are those of inflammation or abscess.\\nThe treatment consists in cleansing the source of trouble, the\\nuse of hot applications, prompt incision for pus, pressure, and\\napplications of mercury and belladonna.\\nChronic lymphadenitis. Common in strumous children, arises\\nfrom slight irritation or without obvious cause. Glands of the\\nneck frequently affected. Characterized by slow, painless, en-\\nlargements, which discharge curdy pus on breaking down, and\\nleave indolent, undermined ulcers.\\nTreatment. Counter-irritation by iodine till signs of softening,\\nthen incise, curette, and dress antiseptically. Nourishing diet,\\nfresh air, cod-liver oil, iodide of iron.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0252.jp2"}, "253": {"fulltext": "EFFECTS OF COLD\\n251\\nEFFECTS OF COLD.\\nHow may death occur from cold\\nFrom cerebral anazmia, caused by sudden and progressive\\nchilling. From cerebral congestion, due to slow and continuous\\nchilling. From embolism, due to sudden reheating.\\nDescribe the local effects of cold.\\nPernio or chilblain. Caused by sudden alterations in tempera-\\nture. Characterized by swelling, congestion, vesication, and\\nintense itching and burning. Frequent recurrence from slight\\ncauses.\\nTreatment. Kestore circulation gradually by friction with\\nsnow, by the use of cold water. Apply a one per cent, solution\\nof nitrate of silver, and wrap in raw cotton.\\nFrost-bite. Characterized by actual congelation of the part,\\nwhich is brittle and of a tallowy whiteness subsequently in-\\nflammation of a high grade appears, and may be followed by\\ngangrene.\\nTreatment. Moderate the severity of reaction by rubbing with\\nsnow, continued cold irrigation, massage. If mortification ap-\\npears, continue the use of cold as long as this process is inclined\\nto spread. Amputate when the line of separation is formed.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0253.jp2"}, "254": {"fulltext": "252 ESSENTIALS QF SURGERY\\nFOREIGN BODY IN THE AIR-PASSAGES.\\nAt what portions of the air-passages do foreign bodies become\\nimpacted\\nCommonly in the larynx, or the right bronchus.\\nWhat are the symptoms of foreign body in the air-passages?\\nIf impacted in the larynx. Asphyxia from spasm and obstruc-\\ntion this may cause immediate death, or, the first spasm passing\\naway, may be succeeded by an exhausting cough, a blood-stained\\nmucous expectoration, and recurring spasmodic attacks.\\nIf loose in the trachea. Recurring and violent attacks of spas-\\nmodic asphyxia from impact of the body against the rima\\nglottidis, free secretion of a frothy mucus from the air-passages.\\nIf impacted in a bronchus. Pain and whistling rales at the\\nseat of lodgment, absence of respiratory sounds in the lung,\\nabscess.\\nTreatment. If dyspnoea urgent, instant tracheotomy. If the\\nforeign body is lodged in the larynx, an effort should be made to\\nremove it by laryngeal forceps failing in this perform laryn-\\ngotomy and thyrotomy if necessary let the patient wear a\\ntracheal tube for twenty-four hours. If the foreign body is loose\\nin the trachea, immediately tracheotomize, draw the wound open,\\ninvert the patient, and instruct him to cough. If the foreign\\nbody is lodged in a bronchus, endeavor to extract by means of\\nwire or an instrument, passed through a tracheal opening.\\nWhat is bronchotomy\\nLaryngotomy and tracheotomy, with their modifications. 1.\\nThyrotomy, opening through the thyroid cartilages. 2. Laryn-\\ngotomy, opening through the crico-thyroid membrane. 3.\\nLaryngo-tracheotomy, opening through crico-thyroid mem-\\nbrane, cricoid cartilage, and upper rings of the trachea. 4.\\nTracheotomy, opening through the rings of the trachea.\\nUnder what circumstances is bronchotomy required?\\nAcute laryngitis, or oedema glottidis. Spasm. Emphysema.\\nForeign bodies in the air-passages, or gullet. Croup. Diph-\\ntheria. Polypi.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0254.jp2"}, "255": {"fulltext": "FOREIGN BODY IN THE AIR- PASS AG ES 253\\nWhat structures lie in the middle line of the neck\\nThyrohyoid membrane, thyroid cartilage, crico-thyroid mem-\\nbrane and arteries, cricoid cartilage, two or three tracheal rings,\\nisthmus of the thyroid, trachea.\\nDescribe laryngotomy.\\nLongitudinal skin incision, an inch-and-a-half long, is made\\nover the thyroid cartilage, thyro-cricoid membrane, and cricoid\\ncartilage the crico-thyroid membrane is opened by a transverse\\ncut.\\nDescribe tracheotomy.\\nIn the high operation the opening is made above the isthmus\\nof the thyroid in the low operation it is made below.\\nIncision for high operation, two and a half inches long, begin-\\nning at the upper border of the cricoid cartilage. Divide skin,\\nsuperficial fascia, sterno-hyoid and sterno-thyroid inter-muscu-\\nlar fascia, and loose cellular tissue. Avoid anterior jugular veins\\nand their communicating branch, inferior thyroid vein, and mid-\\ndle thyroid artery, if present. Draw the trachea forward with\\na tenaculum, incise, cutting from below upward, and pass in the\\ntracheal tube. Check all bleeding before opening the larynx,\\nexcept when death from asphyxia is imminent, or when the\\nbleeding is due to intense venous engorgement.\\nAfter-treatment should be conducted in a warm, moist atmo-\\nsphere the opening of the tracheal tube should be protected by\\nmoist gauze, and a physician or nurse should be constantly\\npresent to clean the inner tube when it becomes filled. When\\nthe breathing becomes hissing, and the epigastrium and intercos-\\ntal spaces are sucked in during inspiration, the tube is danger-\\nously clogged. Bronchitis, pneumonia, or the disease which\\nnecessitates the operation, are the common causes of death after\\nthis operation.\\nAffections of the (Esophagus.\\nWhere are the narrowest portions of the oesophagus\\nAt its commencement (the lower border of the cricoid carti-\\nlage), and as it passes through the diaphragm.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0255.jp2"}, "256": {"fulltext": "254 ESSENTIALS OF SURGERY.\\nWhat are the symptoms of foreign body in the oesophagus\\nPain, difficulty in swallowing, and frequently, asphyxia from\\nspasm or direct pressure.\\nHow do you treat foreign body in the (esophagus?\\nIf suffocation threatens, tracheotomize at once. Under other\\ncircumstances, endeavor to extract by forceps, or by the swivel\\nor horsehair probang. If the body is of such a nature that\\nit can be digested, or passed by the bowel, push it into the\\nstomach. If the body is irregular and tightly lodged, perforin\\ncesophagotomy.\\nDescribe stricture of the oesophagus.\\n1. Spasmodic. Occurs in young hysterical women. Gives\\ntrouble only at times. Under ether, a bougie is passed without\\ndifficulty.\\n2. Fibrous. Due to contractions following traumatism or\\nsyphilis.\\n3. Malignant. Generally epitheliomatous. Occurs opposite\\ncricoid cartilage, tracheal bifurcation, or at cardiac end of stom-\\nach.\\nSymptoms of fibrous or malignant stricture are, increasing dif-\\nficulty in swallowing, first solids then liquids giving trouble. A\\nfeeling of obstruction referred to the top of the sternum, regurgi-\\ntation of swallowed food, progressive wasting. Finally the di-\\nagnosis is made by passage of bougies (after excluding aneurism,\\nwhich has been burst by this procedure).\\nTreatment. Dilatation or internal cesophagotomy for fibrous\\nstrictures. GEsophagotomy (establishment of a fistulous open-\\ning into the oesophagus), or gastrostomy for malignant strictures.\\nAbbe s operation for cicatricial stenosis consists in doing a\\ngastrotomy and an cesophagotomy, passing a string in through\\nthe stomach and out through the wound in the oesophagus, and\\nusing the string as a saw to cut the constriction.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0256.jp2"}, "257": {"fulltext": "SURGICAL AFFECTIONS OF THE BREAST. 255\\nSURGICAL AFFECTIONS OF THE BREAST.\\nIn what situation may abscesses of the breast occur\\nSupra-mammary, superficial to the gland. Tntra-mammary,\\nwithin the gland. Post-mammary, behind the gland.\\nGive the treatment of mammary abscess.\\nEarly and free incision in a direction radiating from the nip-\\nple, drainage, and pressure by means of bandages or concentric\\nstrapping.\\nWhat is Paget s disease of the nipple?\\nAn inflammatory condition of the nipple and areola which\\nfrequently precedes the development of cancer.\\nWhat tumors are most frequently found in the breast?\\nScirrhus, fibroma, sarcoma.\\nGive the differential diagnosis between scirrhus and non-malig-\\nnant breast tumors.\\nScirrhus. Non-malignant tumors.\\nOccurs after the fortieth year. Occurs before the fortieth year.\\nVery hard, nodulated, shortly be- Nodulated, moderately hard, elas-\\ncomes fixed. tic, movable.\\nSkin infiltrated and adherent. Skin free and movable.\\nNipple retracted, superficial veins None of these signs present,\\ndilated, lancinating pain.\\nLymphatic involvement, rapid\\ngrcvrth, quick recurrence, cachexia.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0257.jp2"}, "258": {"fulltext": "256 ESSENTIALS OF SURGERY\\nCLUB-FOOT.\\nDescribe the common forms of club-foot.\\n1. Talipes varus. The sole of the foot looks inward. This is\\nthe commonest congenital form (usually equino-varus) when\\nit affects both feet it is frequently associated with spina bifida.\\nCause. Contraction of tibialis anticus and posticus, muscles of\\nthe calf, and the plantar fascia. Treatment. Division of all re-\\nsisting tissues.\\n2. Talipes equinus. The heel is raised. Cause. Contraction\\nof gastrocnemius and soleus, or paralysis of the opposing mus-\\ncles. Treatment. Division of tendo Achillis.\\n3. Talipes valgus. The foot is everted. Caused by long-con-\\ntinued standing, or anything tending to obliterate the plantar\\narch the peronei muscles subsequently contract. Treatment.\\nFriction, support to the arch of the foot, and section of peronei\\ntendons, if necessary.\\n4. Talipes calcaneus. The toes are raised by the extensors.\\nCauses. Contraction of the anterior muscles, or paralysis of those\\nof the calf. Treatment. Section of the tibialis anticus, extensor\\nlongus pollicis, extensor longus digitorum, peroneus tertius.\\nThere may be a combination of distortions, constituting equino-\\nvarus, calcaneo-v^rus, etc.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0258.jp2"}, "259": {"fulltext": "HARE-LIP AND CLEFT PALATE.\\n257\\nHARE-LIP AND CLEFT PALATE.\\nFig. 58.\\nWhat is hare-lip\\nA congenital deformity, characterized by a fissure or fissures on\\nthe upper lip, due to arrested development. Hare-lip is single\\nwhen one side is involved, double\\nwhen it appears on both sides. It\\nis frequently associated with cleft\\npalate.\\nThe treatment consists in closing\\nthe fissure, by freshening the edges\\nand bringing them together with\\nhare-lip pins, or by performing a\\nplastic operation, sacrificing none of\\nthe tissues.\\nWhat is cleft palate\\nA congenital cleft in the median\\nline of the palate it may be con-\\nfined to the uvula, the soft palate,\\nor involve the entire roof of the\\nmouth.\\nStaphylorrhaphy indicates the operation for the closure by\\nsuture of the soft palate. The method of closing the fissure by\\na transparent flap from the pharynx is termed staphyloplasty.\\nThe flap operation for the closure of clefts in the hard palate is\\ntermed uranoplasty.\\nOperation for hare-lip.\\n17", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0259.jp2"}, "260": {"fulltext": "258 ESSENTIALS OF SURGERY.\\nDISEASES OF BURSJE AND TENDONS.\\nBursitis.\\nDescribe bursitis.\\nBursitis is characterized by pain, fever, and the rapid develop-\\nment of a fluctuating swelling. The bursa patellae is commonly\\ninvolved, constituting, in the chronic form, housemaid s knee.\\nThis swelling is diagnosed from intra-articular effusions by the\\nfact that it is above the bone. Inflammation of the bursa over\\nthe olecranon constitutes u miner s elbow. Weaver s bottom\\nis an inflammation of the bursa over the tuber ischii.\\nTreatment. Leeches, evaporating lotions, counter-irritation,\\nand splinting. If suppuration, free incision.\\nHow do you treat dropsy of a bursa?\\nThis condition is usually due to subacute inflammation, or\\nlong-continued pressure. It may, at times, be resolved by\\ncounter-irritants, more commonly it will require incision and\\nscraping.\\nWhat is a bunion\\nA bursal enlargement occurring in the foot. It is usually\\nplaced at the side of the metatarsal joint of the great toe.\\nWhat is tenosynovitis\\nInflammation of tendons and their sheaths due to traumatism,\\ngout, or rheumatism. CJiaracterized by a puffy swelling along the\\ntendon, and fine crackling crepitation. Treated by iodine or\\nblisters.\\nWhat is a ganglion\\nA cyst formed in connection with the sheath of a tendon. The\\nsimple ganglion is developed on the synovial sheath. The com-\\npound ganglion consists of a dilatation which commonly involves\\nthe sheaths of several tendons. Ganglion occurs upon the ex-\\ntensor tendons at the back of the wrist, and in front of the ankle.\\nIt can be felt as a round, tense, fluctuating, freely movable", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0260.jp2"}, "261": {"fulltext": "DISEASES OF BURSil AND TENDONS. 259\\ntumor, sometimes giving considerable pain on motion, and\\nalways causing some loss of power.\\nTreatment. Subcutaneous rupture, either by force or by the\\ntenotome. Incision and curetting.\\nWhat is paronychia\\nSynonyms. Whitlow. Felon. Panaris.\\nDefinition. An acute septic inflammation, involving the\\nsheath of the tendon, the tissues superficial to it, or the peri-\\nosteum, or all these structures. Always due to a septic wound.\\nCharacterized by intense pain, rapid disorganization, and ten-\\ndency to spread along the course of the tendon. Treated by\\nearly, free incision, scraping, and thorough disinfection.\\nOnychia.\\nWhat is onychia\\nInflammation of the matrix of the nails.\\nMay be simple onychia or run around, due to injury, and\\nattended by suppuration and loosening of the nail. Treated by\\nwet boric acid dressing.\\nMalignant onychia, due to injury and profound constitutional\\ndepression characterized by fungous ulcerations, showing no\\ntendency to heal. Treated by trimming the nail, and applying\\npowdered nitrate of lead to the granulations.\\nWhat is ingrowing toe nail\\nAn ulceration, caused by tight shoes pressing the soft part of\\nthe toe against the edge of the toe nail. Kemedied by wearing\\nloose shoes, packing absorbent cotton and iodoform between the\\nsoft parts and the nail, or by avulsing the nail.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0261.jp2"}, "262": {"fulltext": "260 ESSENTIALS OF SURGERY.\\nANAESTHETICS.\\nWhat substances are used to produce anaesthesia?\\nGeneral anaesthesia is induced by nitrous oxide, chloroform,\\nor ether. Local anaesthesia is induced by cocaine or freezing.\\nWhich is the safest general anaesthetic\\nNitrous oxide for brief operations (one minute), ether for ma-\\nnipulations requiring more time.\\nWhat is the danger in chloroform inhalation\\nCardiac syncope. It may attack the robust and apparently\\nhealthy. Particularly liable to occur when operations about the\\nanus are begun before complete anaesthesia.\\nHow do you prepare patients for the administration of anaes-\\nthetics\\nGive no food for six hours before the time of administration.\\nExamine the urine, and carefully auscult the lungs and heart.\\nHalf an hour before the administration of the anaesthetic give to\\nanaemic and nervous patients a full dose of whiskey or wine. See\\nthat there are no artificial teeth or foreign bodies in the mouth.\\nLoosen the clothing about the neck and chest. In drunkards the\\nanaesthetic should be preceded by a quarter of a grain of morphia.\\nHow do you administer ether\\nUse a folded towel, or one of the many inhalers. The recum-\\nbent position should be enforced. Protect the eyes by a folded\\ntowel. Let the vapor be very dilute for the first few inhalations,\\nincreasing the strength as the patient loses consciousness. Per-\\nsistent cough is most quickly overcome by pushing the ether.\\nWatch the respiration and pulse. When the pulse is slow and\\nfull, the respirations deep and snoring, the reflex irritability\\nabolished, and the patient totally relaxed, the anaesthesia is car-\\nried to the limit of safety.\\nWhat accidents may occur during the administration of ether?\\nIn the first stage there may be respiratory forgetfulness, or a\\nCessation of breathing efforts, tbQugh consciousness is still pre-", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0262.jp2"}, "263": {"fulltext": "ANESTHETICS. 261\\nserved. Corrected by sudden pressure or a dash of ether over\\nthe epigastrium.\\nIn the third stage mucus may collect in the throat to such an\\nextent as to embarrass respiration it should be mopped out by\\nsponges tied to sticks. If there is vomiting, the head should be\\nturned to the side. If the air does not enter the lungs freely, the\\nlower jaw should be pushed forward by the fingers placed be-\\nneath the ramus.\\nThere may be threatened asphyxia, from excess of ether, drop-\\nping back of the tongue, or closure of the glottis. Denoted by\\nirregular pulse, laryngeal stertor, blue surface, absence of respi-\\nratory movements. Immediately push the angles of the jaw\\nforward and extend the head, practise artificial respiration,\\nclash ether over the epigastrium, raise the foot of the bed or table,\\nand intermittently apply the electric brush to the epigastrium,\\nthe other pole of the battery being placed over the sternum.\\nTracheotomy may be performed and the lungs inflated directly.\\nWhat precautions are taken during the administration of ether\\nLights, if near, should always be held above the level of the\\nether. The ansesthetizer should devote his entire attention to\\nthe patient. The respiration, the pulse, the color of the skin,\\nand the pupil should be carefully noted. A third person should\\nalways be present when women are etherized.\\nWhat are the indications for allowing the patient more air\\nA feeble frequent pulse. Lividity of the surface. Laryn-\\ngeal stertor. Pallor and tonic spasm. A pupil fixed in dilata-\\ntion (always a sign of great danger). Paralysis of the diaphragm,\\ndenoted by purely thoracic breathing, with sucking in of the\\nbelly walls with each inspiration.\\nUnder what circumstances is chloroform preferred to ether\\nWhen there is emphysema of the lungs, bronchitis, kidney dis-\\nease, or vascular degeneration. In infants. In operations about\\nthe mouth, when the cautery may be required.\\nHow do you administer chloroform\\nThe vapor must not be stronger than four parts to the hundred\\nof air. Pour a few drops upon a piece of lint or a towel and", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0263.jp2"}, "264": {"fulltext": "262 ESSENTIALS OF SURGERY.\\nhold it a short distance from the mouth and nose. Watch the\\npulse most carefully.\\nHow do you treat syncope in chloroform narcosis\\nPush the lower jaw far forward, and extend the head. Baise\\nthe foot of the table high up. Dash cold water over the face\\nand chest. Begin artificial respiration immediately.\\nShould you give ether in shock\\nAs ether directly lowers the temperature, it should not be\\ngiven when shock is marked. After restoration of temperature\\nand the free administration of whiskey and opium, a minimum\\nquantity will be required, and may be cautiously administered.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0264.jp2"}, "265": {"fulltext": "LIGATION OF ARTERIES. 263\\ny LIGATION OF ARTERIES.\\nUnder what circumstances is an artery ligated in its conti-\\nnuity\\n1. In the treatment of aneurism.\\n2. In the checking of bleeding, under certain circumstances.\\n3. In the treatment of inflammation.\\nWhat instruments are required for the operation\\nScalpel, dissecting and artery forceps, blunt hooks, retractors,\\ngrooved director, aneurism needle, ligature, needles, and dres-\\nsings. All should be arranged in trays and covered with car-\\nbolic solution 1:20 which is diluted up to 1:40, when the ope-\\nration is begun.\\nDescribe the ligatures and dressings.\\nLigature of antiseptic, prepared cat-gut. After operation, the\\nwound, if small, is closed without drainage if large, it is drained\\nby means of rubber tubes, horsehair, or strands of cat-gut. Its\\nedges are closely approximated, and the whole covered in by a\\ncareful antiseptic dressing.\\nWhat precautions are taken in performing the operation?\\n1. Begin and end the superficial cut with the knife-blade ver-\\ntical to the surface, thus avoiding heeling.\\n2. Divide the deep fascia to the full extent of the superficial\\ncut. Open the sheath by cutting toward the dissecting forceps, in\\nwhich a portion of its periphery is pinched up. The incision is\\nsubsequently enlarged by the director. Avoid forcible tearing\\nor wide separation of the artery from its sheath. Pass the an-\\neurism needle from the side where the most important and vul-\\nnerable structures are placed. Before tying, compress the artery\\nand feel for pulsation below, to be sure that the circulation is\\ncontrolled.\\nIn securing the ligature, make more tension upon the first\\nthan upon the second knot.\\nWhat complications may arise in the after-treatment of liga-\\ntion?\\nGangrene, hemorrhage, return of pulsation in aneurism.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0265.jp2"}, "266": {"fulltext": "264 ESSENTIALS OF SURGERY.\\nDescribe the after-treatment of ligation.\\nElevate the limb and surround it with a thick layer of wool.\\nKeep at absolute rest. Light, nutritious diet. Strict quiet,\\nboth mental and physical.\\nDescribe the triangles of the neck.\\nAnterior triangle. In front, the middle line. Behind, the\\nsterno-cleido-mastoid. Above, the base of the lower jaw, and\\na line from its angle to the mastoid process. Apex, at the\\nsternum. Subdivided into three smaller triangles by the digas-\\ntric above, and the anterior belly of the omo-hyoid below, named\\nfrom below up, the inferior carotid, the superior carotid, and\\nthe submaxillary.\\nInferior carotid triangle. In front, middle line. Behind,\\nsterno-raastoid. Above, anterior belly of omo-hyoid.\\nSuperior carotid triangle. Behind, sterno-mastoid. Below, an-\\nterior belly of omo-hyoid. Above, posterior belly of digastric.\\nSubmaxillary triangle. Above, body of jaw, parotid gland,\\nand mastoid process. Below, posterior belly of digastric, and\\nstylo-hyoid. In front, median line.\\nPosterior triangle. In front, sterno-mastoid. Behind, trape-\\nzius. Below, clavicle. Apex, at occiput. Divided by the poste-\\nrior belly of the omo-hyoid into an upper or occipital, and a\\nlower or subclavian triangle.\\nOccipital triangle. In front, sterno-mastoid. Behind, trape-\\nzius. Below, omo-hyoid.\\nSubclavian triangle. Above, posterior belly of omo-hyoid. Be-\\nlow clavicle. In front, sterno-mastoid.\\nCommon carotid. Origin\u00e2\u0080\u0094 right, from the innominate, behind\\nthe sterno-clavicular articulation left, from the arch of the\\naorta, more deeply placed. Extent from behind the sterno-\\nclavicular articulation to the upper margin of the thyroid carti-\\nlage. The carotid artery lies in the same sheath with the\\ninternal jugular vein and the pneumogastric nerve, each of these\\nstructures being separated from the other by fibrous septa, and\\nhaving a distinct compartment. The sheath rests upon the lon-\\ngus colli, and, in the upper part of its course, the rectus capitis\\nanticus muscles, and is crossed at the level of the cricoid carti-\\nlage by the omo-hyoid muscle.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0266.jp2"}, "267": {"fulltext": "LIGATION OF ARTERIES.\\n265\\nLine. From the sternoclavicular articulation to a point mid-\\nway between the angle of the jaw and the mastoid process.\\nSuperficial guide anterior border of sterno-cleido-mastoid.\\nBelations. Anterior. Skin, superficial fascia, platysma, deep\\nfascia, sterno-hyoid, sterno-thyroid, sterno-mastoid muscles su-\\nFig. 59.\\nLines of incision for carotid, facial, lingual, subclavian, and axillary arteries.\\nperior and middle thyroid, and anterior jugular veins descen-\\ndens noni and communicans noni nerves. Posterior. Longus\\ncolli and rectus capitis anticus muscles sympathetic, recurrent\\nlaryngeal nerves inferior thyroid artery. Internal. Trachea,\\noesophagus, larynx, pharynx, recurrent laryngeal nerve, and\\ninferior thyroid artery. External. Internal jugular vein, infe-\\nrior thyroid artery. On the left side the internal jugular vein\\nis somewhat anterior to the artery.\\nCollateral circulation. Inferior with superior thyroids, ascend-\\ning branch of transversalis colli with princeps cervicis, terminal\\nbranches of internal and external carotids on the two sides.\\nOperation, above the omo-hyoid. Patient supine with a pillow\\nunder the shoulders and neck, head extended, face turned", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0267.jp2"}, "268": {"fulltext": "266 ESSENTIALS OF StTRGERY.\\ntowards sound side. Incision, three inches, along the anterior\\nborder of the sterno-cleido-nmstoid muscle, and with its centre\\non a level with the cricoid cartilage. Divide skin, superficial\\nfascia, platysma, deep fascia. With retractors draw aside the\\nsterno-mastoid. Expose the omo-hyoid by cutting through a\\ndense fascia covering it and the sheath of the vessels, carefully\\navoiding the venous plexus formed by the superior thyroid with\\nits communications from the lingual, facial, anterior and ex-\\nternal jugular. The sheath of the artery is found bisecting the\\nangle made by the anterior belly of the omo-hyoid and the\\nanterior border of the sterno-mastoid. Open the inner compart-\\nment of the sheath, avoiding descendens and communicans noni\\nnerves, and pass the ligature from without inward.\\nExternal carotid. A branch of the common carotid, given\\noff at upper border of thyroid cartilage. It extends from the\\nsuperior border of thyroid cartilage, to neck of condyle of lower\\njaw.\\nChief relations. Anterior. Hypoglossal nerve, lingual and\\nfacial veins, digastric muscle. Posterior. Superior laryngeal\\nand glossopharyngeal nerves. Internal. Hyoid bone and\\npharynx. External. Internal carotid artery and internal jugu-\\nlar vein.\\nCollateral circulation. Lingual, superior thyroid, occipital,\\nand the same of the opposite side.\\nOperation. Incision midway between angle of jaw and ante-\\nrior border of sterno-cleido-mastoid muscle, carried down three-\\neighths of an inch in front of the latter to one-half inch below\\nupper border of thyroid cartilage. Divide skin, superficial fascia,\\nand platysma at once. Slit up the deep fascia spreading from\\nthe anterior border of the sterno-cleido-mastoid, avoiding the\\nexternal jugular, temporal, and facial veins. By blunt dissection\\nthe parotid gland and the posterior belly of the digastric are ex-\\nposed the latter is drawn upward with blunt hooks, when the\\nexternal carotid is found, crossed by the hypoglossal nerve, with\\nthe superior laryngeal nerve lying beneath.\\nPass the needle from without inward.\\nLingual. Is given off from the external caiotid between the\\nsuperior thyroid and facial.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0268.jp2"}, "269": {"fulltext": "LIGATION OF ARTERIES. 267\\nIu the first part of its course, from its origin to the posterior\\nborder of the hyoglossus, it passes obliquely up and in to the\\ngreat cornu of the hyoid bone, and is covered simply by skin,\\nfasciae, platysma, and veins, resting on the middle constrictor.\\nIn the second part of its course, beneath the hyoglossus muscle,\\nit runs parallel with the great horn of the hyoid, then ascends to\\nthe tongue. It is crossed here by the posterior belly of the\\ndigastric and the stylo-hyoid muscles, and is covered by the\\nhyoglossus muscle.\\nCfiief relations. Anterior. Hyoglossus muscle. Posterior.\\nMiddle constriction of pharynx, and genio-hyoglossus muscle.\\nAbove. Hypoglossal nerve. Below. Tendon of digastric, and\\ngreat horn of hyoid bone.\\nPoint of election. Second part of artery, lying beneath hyo-\\nglossus.\\nOperation. Incision three inches begin a little below and\\ninternal to the symphysis menti, convex downward to the great\\nhorn of the hyoid, and outward to the inner border of the sterno-\\nmastoid. The three outer layers being divided the submaxillary\\ngland is reached, lying in the deep fascia the latter is divided\\nand the gland turned up exposing the tendon of the digastric,\\nand the hypoglossal nerve above the nerve is dissected up and\\nretracted exposing the hyoglossus muscle, which, when divided\\nupon a director, enables the operator to pass the ligature about\\nthe artery from above downwards. Superficial guide, great horn\\nof hyoid. Deep guide, nerve and tendon.\\nFacial arises from external carotid, a little above the lingual,\\npasses beneath the posterior belly of the digastric and stylo-\\nhyoid muscles and hypoglossal nerve, winds through a groove in\\nthe posterior and upper border of the submaxillary gland, and\\ncrosses the lower jaw in a slight depression just in front of the\\ninsertion of the masseter muscle. Here is the point of election\\nthe artery is covered at this point by skin fascia and platysma.\\nOperation. Incision one inch, just on the jaw, along the\\nanterior border of the masseter muscle vein lies posteriorly.\\nPass the thread from behind forward. Guides. Anterior edge of\\nmasseter muscle, and groove in the submaxillary bone.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0269.jp2"}, "270": {"fulltext": "268 ESSENTIALS OF SURGERY.\\nOccipital arises from the external carotid opposite the facial,\\nand passes backwards under the posterior belly of the digastric,\\nthe stylo-hyoid, and the lower part of the parotid gland, across\\nthe internal carotid artery, internal jugular vein, and the pneu-\\nmogastric and spinal accessory nerves. The hypoglossal nerve\\nhooks around it beneath the gland. The artery ascends the\\nneck to the level of the transverse process of the atlas, passes\\nthrough a groove on the mastoid process of the temporal bone,\\nbeneath the sterno-mastoid, splenius, digastric, and trachleo-\\nmastoid, pierces the insertion of the splenius, and becomes super-\\nficial.\\nOperation. Point of election. Occipital portion. Incision from\\nthe apex of the mastoid process backward and very little upward\\nfor two inches. Divide skin, superficial fascia, deep fascia, and\\nouter border of the sterno-mastoid, the splenius, the complexus.\\nGuides. Transverse process of the atlas, and the mastoid process\\nthe artery is found between the two, and can be traced outward\\nto a more superficial position. Isolate from the occipital vein,\\nand ligate.\\nTemporal. A terminal of the external carotid. It lies in the\\nspace between the condyle of jaw and external auditory meatus.\\nLine. Directly upward, between the condyle of jaw and the\\ncartilage of the ear.\\nChief relations. Anterior. Branches of facial and auriculotem-\\nporal nerves. Posterior. Vein, and facial and auriculo-temporal\\nnerves. As it crosses the root of the zygoma, the artery is cov-\\nered by a dense fascia derived from the parotid gland, this\\nshould not be opened.\\nOperation. Incision vertical, one inch long, between the car-\\ntilage of the ear and the condyle of the jaw. Skin, superficial\\nfascia, and some fibres of the attrahens aurem are divided,\\nartery freed, and thread passed from behind forward.\\nSubclavian. On the right side from the innominate. On the\\nleft side from the arch of the aorta. Three portions\\n1. From its origin to inner border of scalenus anticus. This\\nportion gives off the thyroid axis, the vertebral, and the internal\\nmammary arteries.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0270.jp2"}, "271": {"fulltext": "LIGATION OF ARTERIES. 269\\n2. Behind the scalenus anticus. Gives off superior intercostal\\nartery on the right side.\\n3. Outer edge of scalenus anticus to lower border of first rib.\\nPoint of election is the outer third.\\nRelations of the outer third. Posterior. Scalenus medius. Above\\nand external. Brachial plexus. Anterior and below. Subclavian\\nvein. Internal. Edge of scalenus anticus. Structures lying in\\nfront. Skin, superficial fascia, platysma, deep fascia, a plexus\\nof veins formed by the external jugular, suprascapular, and\\ntransversalis colli clavicle and subclavius muscle suprascapu-\\nlar artery.\\nOperation. Position of patient, recumbent, shoulder supported\\non pillows, head back, face toward sound side, arm of the affected\\nside depressed as much as possible. Superficial guide, most promi-\\nnent part of clavicle. Deep guides, brachial plexus above and\\nbehind, outer edge of scalenus anticus muscle, and tubercle of\\nfirst rib internal. Incision. The skin is drawn down from the\\nneck over the clavicle, and a three-inch incision made upon the\\nbone, from the external border of the sterno-mastoid muscle out-\\nwards. On releasing the skin this wound lies somewhat above\\nthe clavicle. Secure or push aside the external jugular vein,\\nopen the deep fascia, feel for the tubercle of the first rib and\\nthe outer border of the anterior scalene muscle free the artery\\nby blunt dissection, and pass the thread from below.\\nCollateral circulation. Suprascapular artery and posterior\\nscapular, branch of the transversalis colli with the subscapular\\nand circumflex. Internal mammary, superior intercostal, and\\naortic intercostals, with the long and short thoracics.\\nFirst part of subclavian artery. Right side. In front. Skin,\\nsuperficial fascia, platysma, and deep fascia. Three muscles,\\nsterno-mastoid, sterno-hyoid, sterno-thyroid. Three veins,\\ninternal jugular, vertebral, anterior jugular. Three nerves,\\nvagus, cardiac filaments of sympathetic, phrenic. Behind.\\nLongus colli, and three nerves, sympathetic cardiac branches\\nof vagus and recurrent laryngeal. Below. Pleura and recur-\\nrent laryngeal.\\nLeft side. Longer, more deeply placed, ascends almost verti-\\ncally to neck. In front. Pleura, lung, internal jugular and", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0271.jp2"}, "272": {"fulltext": "270 ESSENTIALS OF SURGERY.\\ninnominate veins, the same muscles and nerves as on the right\\nside. Behind. (Esophagus, thoracic duct, and as on right side\\nexcept the recurrent laryngeal. Inner side. (Esophagus, trachea,\\nthoracic duct. Outer side. Pleura and lung.\\nSecond, part of the subclavian. Rests between the anterior and\\nmiddle scalene muscles, with brachial plexus above; phrenic\\nnerve, transversalis colli and suprascapular arteries in front;\\nand pleura below.\\nInternal mammary. Arises from the first portion of the sub-\\nclavian and passes down behind costal cartilages to sixth inter-\\nspace. Line of incision is vertical, two and one-quarter inches\\nlong, beginning at lower border of clavicle one-quarter of an inch\\nexternal to margin of sternum or the incision may be trans-\\nverse. The point of election is in the first three intercostal\\nspaces.\\nChief relations. Anterior. Costal cartilages and internal\\nintercostal muscles. Posterior. Pleura. As it is about to enter\\nthe chest it is crossed by the phrenic nerve.\\nAxillary. Continuation of the subclavian. Extends from the\\nlower border of the first rib to the lower border of the insertion\\nof the teres major.\\nCourse. With abducted arm, from the middle of the clavicle to\\nthe inner border of the coraco-brachialis muscle. Three portions\\n1. Lower border of first rib to upper border of pectoralis\\nminor. Branches. Superior thoracic, acromio-thoracic the latter\\nruns along the upper border of the pectoralis minor.\\n2. Behind pectoralis minor. Branches. Long thoracic, at the\\nlower border of the pectoralis minor, alar thoracic.\\n3. From lower border of pectoralis minor to insertion of latis-\\nsimus dorsi and teres major. Branches, subscapular running in\\nthe posterior axillary fold, posterior circumflex, anterior circum-\\nflex.\\nPoints of election. First and third portions, particularly the\\nlast.\\nOperation. First part. Patient supine, arm carried from the\\nside. Incision three inches, commencing one-half inch from the\\nsterno-clavicular articulation, extending outward along the line", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0272.jp2"}, "273": {"fulltext": "LIGATION OF ARTERIES. 271\\nbetween the sternal and clavicular portions of pectoralis major.\\nWork upward and backward between the two portions of\\nthe pectoral muscle till a dense fascia, the costo-coracoid, is\\nreached depress the shoulder and tear the fascia with the\\ndirector, when the axillary vein is found behind it is the artery,\\nand still deeper the brachial plexus. Pass the ligature from below.\\nGuides. The brachial plexus behind and above. Subclavian vein,\\nbelow and in front. Inner border of pectoralis minor, externally.\\nThird portion. Arm abducted and supinated. Incision three\\ninches long, in the hollow of the armpit, along aline passing from\\nthe junction of the anterior and middle third of the axilla to the\\nmiddle of the bend of the elbow. Divide skin, superficial and\\ndeep fascias relax by bending the elbow, displace the median\\nnerve to the outer side, the axillary vein with the ulnar and\\ninternal cutaneous nerves to the inner side. Open the sheath,\\nand pass the thread from the inner side.\\nRelations. In front. Skin and fascia only at lower part of its\\ncourse. At the upper part, pectoralis major, internal cutane-\\nous nerve, inner head of median. Behind. Subscapulars,\\ntendon of latissimus dorsi and teres major, musculo-spiral and\\ncircumflex nerves. Outer side. Coraco-brachialis, median nerves,\\nmusculo-cutaneous nerve. Inner side. Ulnar nerve, nerve of\\nVYrisburg, axillary vein. Guides. Superficial, the coraco-\\nbrachialis. Deep, the branches of the brachial plexus.\\nCollateral circulation. Ligation of first part. Acromio- thoracic\\nand superior thoracic with subscapular and circumflex. Long\\nthoracic with intercostals and internal mammary.\\nLigation of third part. Posterior circumflex and subscapular\\nwith superior profunda anastomoses through muscular branches\\nand through the bone.\\nBrachial. Continuation of the axillary, from the lower bor-\\nder of the teres major, along the inner and anterior aspect of arm\\nto one-half inch below the bend of the elbow. Passes along the\\ninner border of biceps and coraco-brachialis, which are its mus-\\ncles of reference, or guides.\\nChief relations. Anterior. Skin and fascia at middle third\\nmedian nerve at lower third, bicipital fascia with median basilic", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0273.jp2"}, "274": {"fulltext": "272\\nESSENTIALS OF SURGERY.\\nFig. 60.\\nvein resting on it. Posterior. Long head of triceps, insertion of\\ncoraco-brachialis, brachialis anticus, musculo-spiral nerve, supe-\\nrior profund artery. Inner side. Internal cutaneous and ulnar\\nnerves, median nerve (below), basilic vein. Outer side. Median\\nnerve (above), coraco-brachialis and biceps. The median nerve\\nfirst to the outer side, passes in front, then to the inner side.\\nBranches, 1 muscular, 2 superior profund, accompanying mus-\\nculo-spinal nerve, 3 inferior profund, accompanying the ulnar\\nnerve, 4 nutrient, 5 anastomotica magna.\\nOperation. Arm extended and everted. Incision three inches,\\nalong the inner border of the biceps, or in the line of the artery\\n(from the junction of the anterior\\nand middle third of the axilla, to\\nthe middle of the bend of the el-\\nbow). Avoid the median basilic\\nvein if it lies in the superficial fas-\\ncia at the seat of operation.\\nAt the bend of the elbow. Incision\\nthree inches. One-half inch inter-\\nnal to the tendon of the biceps, the\\nlower end lying over the neck of\\nthe radius. Divide skin, superfi-\\ncial fascia, bicipital fascia, avoid-\\ning or tying the median basilic\\nvein. The artery is exposed, lying\\nupon the brachialis anticus, with\\nthe biceps tendon to its outer, the\\npronator radii teres muscle to its\\ninner side.\\nCollateral circulation. Circum-\\nflex and subscapular with supe-\\nrior profund profund with radial\\nulnar and interosseous recurrents.\\nRelation of brachial artery to\\nbicipital fascia, internal cutane-\\nous nerve, and median basilic vein\\nit the bend of the elbow.\\nRadial. A terminal of the\\nbrachial, passes from one-half inch\\nbelow bend of elbow, along radial\\nside of forearm to wrist, winds\\nbackwards around outer side of", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0274.jp2"}, "275": {"fulltext": "LIGATION OF ARTERIES. 273\\ncarpus beneath extensors of thumb, and enters palm of hand\\nbeneath the two heads of the first dorsal interosseous muscle.\\nLine. From middle of bend of elbow to a point midway be-\\ntween tendon of flexor carpi radialis, and styloid process of ra-\\ndius. Guide. Inner border of supinator longus.\\nChief relations. Upper third. External, supinator longus mus-\\ncle internal, pronator radii teres. Lower two-thirds. External,\\nsupinator longus internal, flexor carpi radialis. In the middle\\nthird the radial nerve is to the radial side of the artery.\\nOperation. Division of skin and fascial only the artery is\\nsuperficially placed in the muscular interspace.\\nUlnar. A terminal of the brachial. Commences one-half inch\\nbelow middle of bend of elbow, crosses obliquely to ulnar side of\\narm, and continues along its ulnar border to the wrist.\\nLine. From a point at junction of upper and middle thirds\\nof forearm, and three-fourths of an inch external to ulnar border,\\nto the radial border of pisiform bone.\\nChief relations. Below, flexor profundus digitorum external,\\nflexor sublimis digitorum internal, flexor carpi ulnaris and ul-\\nnar nerve. In the upper third of its course it lies beneath the\\nsuperficial set of flexor muscles. In the lower two-thirds, in\\nits muscular interspace beneath the superficial and deep fascia\\nonly.\\nOperation. Pass the needle from within outwards. Guide\\niexor carpi ulnaris.\\nPalmar arches. Superficial. Direct continuation of the ulnar\\nartery, convex downwards, completed by the superficialis volae\\nof the radial, or the radialis indicis. Beneath it lie the digital\\narteries, nerves, and tendons of the flexor sublimis digitorum.\\nBeep. The direct continuation of the radial, completed by the\\nprofunda branch of the ulnar it rests upon the palmar inter-\\nossei, and metacarpal bones near their carpal ends. It lies\\nbeneath the arteries, nerves, and tendons of both superficial and\\ndeep flexors.\\nPosition of the arches. The superficial lies in a line drawn\\ndirectly across the palm of the hand, from the angle of junction\\nof skin covering the inner border of the thumb and the outer\\n18", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0275.jp2"}, "276": {"fulltext": "274 ESSENTIALS OF SURGERY.\\nborder of the metacarpal bone of the index-finger. The deep\\narch lies a finger s breadth nearer the wrist.\\nExternal iliac. A branch of the common iliac. Its course is\\nrepresented by the lower two-thirds of a line drawn from three-\\nfourths of an inch below and to the left side of the umbilicus, to\\na point midway between the anterior superior spinous process\\nof the ilium and the symphysis pubis. Just above Poupart s liga-\\nment it gives off the deep epigastric, and the deep circumflex\\niliac.\\nChief relations. Anterior. Peritoneum, spermatic vessels, vas\\ndeferens, genital branch of genito-crural nerve, circumflex iliac\\nvein. Posterior. Psoas magnus and, on the right side, the ex-\\nternal iliac vein. External. Psoas magnus. Internal. External\\niliac vein and vas deferens.\\nOperation. Patient recumbent, shoulders raised, knees and\\nthighs flexed. Incision. From one inch above anterior superior\\nspinous process ilium, to external abdominal ring, parallel to\\nPoupart s ligament. Pass the needle from within outwards, and\\navoid including the genital branch of the genito-crural nerve.\\nCollateral circulation. Gluteal and obturator with external\\ncircumflex. Sciatic with superior perforating and circumflex\\nbranches of profunda. The deep circumflex iliac with the ilio-\\nlumbar, the lower intercostals, and the lumbar branches of the\\naorta. Internal pudic with the external pudic and internal cir-\\ncumflex. Mammary, inferior intercostals, and obturator with\\ndeep epigastric.\\nFemoral. The direct continuation of the external iliac, and\\nextends from the middle of Poupart s ligament to the opening\\nin the adductor magnus. Its upper part is a little internal to the\\nhead of the femur its lower part lies to the inner side of the\\nshaft of the bone.\\nIn Scarpa s triangle it is superficial. Below it is more deeply\\nseated, and is in Hunter s canal.\\nLine. From middle of Poupart s ligament to inner side of\\ninternal condyle.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0276.jp2"}, "277": {"fulltext": "LIGATION OF ARTERIES\\n275\\nBranches. Superficial\\nepigastric, superficial\\ncircumflex iliac, exter-\\nnal pudic, profunda,\\nfemoris, anastomotica\\nmagna.\\nPoint of election. Apex\\nof Scarpa s triangle.\\nBelations. Behind.\\nPsoas, pectineus, femo-\\nral vein, adductor lon-\\ngus, adductor magnus.\\nInner side. Femoral\\nvein, adductor longus,\\nsartorius. Outer side.\\nPsoas, vastus internus,\\nfemoral vein, internal\\ncutaneous and long sa-\\nphenous nerves. In\\nfront. Skin, superficial\\nand deep fascia, internal\\ncutaneous and long sa-\\nphenous nerves, sarto-\\nrius. The vein lies first\\nto the inner side of the\\nartery, at the apex of\\nScarpa s triangle be-\\nhind, in Hunter s canal\\nto the outer side.\\nOperation. Point of\\nelection. Thigh flexed\\nand rotated outward,\\nknee bent. Incision four\\ninches in the course of\\nthe vessel, its centre at\\nLines of incision for liga-\\ntion of femoral, tibial, and\\ndorsalis pedis arteries.\\nFig. 61.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0277.jp2"}, "278": {"fulltext": "276 ESSENTIALS OF SURGERY.\\nthe apex of Scarpa s triangle. On dividing the deep fascia, draw\\nthe sartorius outwards. The sheath of the vessel is cleared, and\\nthe thread passed from the vein.\\nHunter s canal. Incision four inches exactly in the middle\\nthird of the thigh, and somewhat internal to the line of the\\nartery. Draw the sartorius inwards, open Hunter s canal from\\nabove, avoiding the long saphenous nerve, free the artery, and\\npass the thread from without inwards.\\nScarpa s triangle is a space situated at the upper third of the\\nanterior surface of the thigh. Base, Poupart s ligament. Outer\\nboundary, inner border of sartorius. Inner boundary, adductor\\nlongus. Hoof, skin, superficial, deep and cribriform fascia.\\nFloor, iliacus, psoas, pectineus, adductor longus, and adductor\\nbrevis. Apex, crossing of sartorius and adductor longus. Length,\\nfrom base to apex, four inches.\\nHunter s canal. A triangular, aponeurotic canal, correspond-\\ning to the middle third of the thigh. Anterior, sartorius. Ex-\\nternal, vastus interims. Internal, adductor magnus, This canal\\nincloses the femoral artery, vein, and long saphenous nerve.\\nCollateral circulation. Common femoral. Gluteal, circumflex\\niliac and ilio-lumbar with the external circumflex. Obturator\\nand sciatic with internal circumflex. At apex of Scarpa s triangle.\\nComes nervi ischiadici with arteries of the ham. Perforating\\nbranches of profunda femoris and anastomotica magna with\\narticular arteries of popliteal, and recurrent of the anterior\\ntibial.\\nPopliteal. A continuation of the femoral, from the opening\\nin the adductor magnus. It passes obliquely downwards and\\noutwards behind the knee-joint, and ends at the lower border of\\nthe popliteus muscle. The artery, throughout its extent, lies in\\nthe popliteal space. It lies deep, and is crossed by the internal\\npopliteal nerve and the popliteal vein. The nerve lies super-\\nficial to the vein, which, in turn, is superficial to the artery.\\nLine. Middle of ham the vessel runs along the external\\nborder of the semi-membranous tendon.\\nBelations. Upper third, from outer side, 1. Nerve. 2. Vein.\\n3. Artery. Lower third from outer side, 1. Artery. 2. Vein. 3.\\nNerve. Branches, 4 articulars, 2 muscular, azygos, cutaneous.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0278.jp2"}, "279": {"fulltext": "LIGATION OF ARTERIES\\n277\\nOperation. Rarely undertaken. Patient supine, leg extended.\\nIncision four inches, in the line of the artery. Great care must\\nbe exercised in separating the vein from the artery. In opera-\\nting on the lower third, avoid the external saphenous vein.\\nCollateral circulation. Articulars with anastomotica magna\\nand external circumflex. Superior muscular branches with\\nterminals of profund.\\nThe arrow marks the tendinous arch between the flexor longus pollicis and\\nflexer longus digitorum, beneath which the posterior tibial artery lies.\\nPosterior tibial. From the popliteal, at the lower border of\\nthe popliteus muscle (corresponding to the level of the lower\\npart of the tubercle of the tibia), to a point a finger s breadth\\nbehind the external malleolus. The vessel is covered by skin", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0279.jp2"}, "280": {"fulltext": "278 ESSENTIALS OF SURGERY.\\nand fascia, gastrocnemius, soleus, plantaris, and a tendinous\\narch extending between the flexor longus digitorum and the\\nflexor longus pollicis. The posterior tibial nerve crosses the\\nartery in its upper portion, from the inner to the outer side.\\nThe artery rests upon the tibialis posticus, the flexor longus digi-\\ntorum, and the lower end of the tibia.\\nLine of incision. Upper third, along inner border of tibia.\\nMiddle third, one-half inch from inner border of tibia. Lower\\nthird (ankle), midway between internal malleolus and tendo\\nAchillis. Pass the ligature from the nerve. Incision in upper\\nand middle third four inches. The artery in its upper third lies\\nvery deep, and is secured by separating the soleus from the tibia\\nworking outwards in the muscular interspace between the soleus\\nand the flexor longus digitorum.\\nBehind malleolus. Incision two inches long, a finger s breadth\\nbehind the internal malleolus, convex backward. Artery lies\\nbeneath the deep fascia. Belations. Anterior. Tendon of flexor\\nlongus digitorum. Posterior. Nerve and tendon of flexor\\nlongus pollicis. Branches. Nutrient, peroneal, muscular, com-\\nmunicating calcanean.\\nAnterior tibial. Commences at the lower border of the pop-\\nliteus muscle, passes forwards between the two heads of the\\ntibialis posticus, through an opening above the interosseous mem-\\nbrane to the deep part of the front of the leg, descends on the\\nanterior surface of the interosseous membrane (upper two-thirds),\\nand tibia (lower one-third), to the middle of the bend of the\\nankle joint, where it is more superficial and becomes the dorsalis\\npedis.\\nLine. From a point midway between the tubercle of tibia\\nand head of fibula to the centre of the intermalleolar space.\\nThe ligature is passed from the outer side.\\nBelations. Upper third. Between the tibialis anticus and ex-\\ntensor longus digitorum. Nerve to outer side. Middle third.\\nBetween tibialis anticus and extensor proprius pollicis. Nerve\\nin front or to inner side. Lower third. Between extensor pro-\\nprius pollicis and extensor longus digitorum, or frequently as in\\nmiddle third. Nerve to outer side.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0280.jp2"}, "281": {"fulltext": "LIGATION OF ARTERIES. 279\\nOperation. Upper third. Patient supine. Knee flexed, sole\\nof Foot resting on table. Incision three inches. After opening\\ndeep fascia search with handle of knife for interspace between\\ntibialis anticus aud extensor communis digitorum artery found\\nbetween them resting on interosseous membrane. Nerve to\\nouter side. Pass thread from without. The interspace may be\\ndefined by extending the toes and the foot in turn, thus putting\\neach muscle upon the stretch. Middle and lower third, as for\\nupper third, except for the changed relations. Branches. Ante-\\nrior tibial recurrent, muscular, internal malleolar, external mal-\\nleolar.\\nDorsalis pedis. The continuation of the anterior tibial. Ex-\\ntends from the centre of the instep beneath the annual ligament,\\nto the base of the metatarsal bone of the great toe, where it\\ndivides into the communicating and dorsalis hallucis. Its course\\nis from the centre of the instep, to the space between the first\\ntwo toes.\\nIt is covered simply by skin and fascia, and crossed near its\\npoint of bifurcation by the innermost tendon of the extensor\\nbrevis digitorum, which serves as a guide in its ligation.\\nThe ligature is passed from without inwards. The artery is\\nfound between the tendon of the extensor proprius pollicis and\\nthe inner tendon of the extensor brevis digitorum. Anterior\\ntibial nerve lies to the outer side. Incision one inch long.\\nExternal plantar artery, a terminal branch of the posterior\\ntibial. Passes from the lower part of the internal lateral liga-\\nment posterior to the internal malleolus, forward and outward,\\ntaking a slightly arched course with the convexity outward, to\\nthe base of the fourth metatarsal space. This forms its superfi-\\ncial part, and is covered by the fasciae and first layers of the foot\\nmuscles. From this point it winds round the outer border of\\nthe accessorius, and passes forward and inward to the posterior\\npart of first interosseous space, forming the plantar arch, and\\nlying upon the interossei, and bases of the metatarsal bones.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0281.jp2"}, "282": {"fulltext": "280 ESSENTIALS OF SURGERY\\nEXCISION OF JOINTS.\\nWhat is the distinction between excision and resection\\nExcision means the removal of the joint surfaces of bone. Re-\\nsection means the removal of the shaft of a long bone.\\nWhat is arthrectomy\\nThe removal, by dissection, of the diseased synovial mem-\\nbrane of a joint, without interfering with the bone.\\nWhat conditions may require excision\\nInjury. Instance, compound luxation, compound commi-\\nnuted fracture.\\nDisease. Instance, tubercular synovitis or arthritis.\\nDeformity. Instance, anchylosis in bad position.\\nWhat conditions contraindicate excision\\nMalignant growth. Acute disease. Extensive involvement of\\nbone or soft parts. Extremes of age. Marked amyloid degene-\\nration.\\nWhat precautions are observed in excising a joint\\nThe incision should be free, and in the long axis of the limb.\\nSpare the bone, substituting the gouge or curette for the saw\\nwhenever practicable. Save the periosteum and the capsule of\\nthe joint, if they are healthy. Secure absolute immobility by\\nsplinting.\\nHow do you dress an excision\\nBone drainage-tubes, iodoform, protective, bichloride gauze,\\nbichloride cotton, plaster bandage. Where a movable joint is\\ndesired, do not apply the fixed dressing.\\nShoulder-joint. Position of patient, on his back, the affected\\nshoulder projecting beyond the side of the operating table.\\nIncision four inches in length from a point slightly above and\\nto the outer side of the coracoid process, downward and some-\\nwhat outward, external to the cephalic vein. The long head of\\nthe biceps should be freed by a longitudinal cut. The humerus is\\nrotated outwards, and the periosteum and tendon of the subscapu-", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0282.jp2"}, "283": {"fulltext": "EXCISION OF JOINTS.\\n281\\nFig. 63\\nft\\nlaris separated by the elevator. The humerus is then rotated in-\\nwards, and the periosteum and muscular attachments to the\\ngreater tuberosity are separated. Finally the humerus is forced\\ndirectly upward, the posterior part of the capsule is freed by the\\nperiosteal elevator (avoid the posterior circumflex ar-\\ntery and circumflex nerve), the bone is sawed through\\nthe surgical neck. A posterior opening is made for\\ndrainage, and the wound dressed with a pad in the\\naxilla and the arm to the side. Motion as soon as\\npossible.\\nElbow-joint. Incision three to four inches long,\\nslightly internal to the middle line of the olecranon\\nand humerus, with its central point opposite the top\\nof the olecranon. Clear the olecranon of periosteum\\nand soft parts with the elevator (carefully guarding\\nthe ulnar nerve) and saw off; now forcibly flex the hu-\\nmerus and clear it in the same way, sawing from\\nbefore backward, just above the trochlear surface.\\nFinally clear the ends of the radius and ulnar, and\\nremove their articulating extremities just below the\\nsigmoid notch and capitellum. Strip the bones sub-\\nWrist-joint. Two incisions. The radial incision,\\nplanned to avoid the artery, commences at the level\\nof the styloid process, on the middle of the dorsal\\naspect of the radius, passes downward, parallel to\\nthe tendon of the extensor secundi internodii polli-\\ncis, till it reaches the line of the border of the second\\nmetacarpal bone it is then carried longitudinally\\ndownward for half the length of the bone.\\nThe ulnar incision. From a point two inches above\\nthe lower extremity of the ulna and just anterior\\nto the inner edge of the bone, downward as far as Metacar-\\nthe middle of the fifth metacarpal bone.\\nHip-joint. Anterior incision, three inches long, running down-\\nward and slightly outward, from half an inch below and external\\nto the anterior superior spinous process of the ilium.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0283.jp2"}, "284": {"fulltext": "282\\nESSENTIALS OF SURGERY\\nPosterior incision. Begin midway between anterior superior\\nspine of ilium and top of trochanter sweep backward and\\ndownward behind posterior mar-\\nFl S* 64# gin of the trochanter for about\\nthree inches, keeping about an\\ninch back of the edge of the\\nbone. Do not force the head of\\nthe bone from the wound, but di-\\nvide in situ by a narrow saw;\\nremove subsequently with se-\\nquestrum forceps. Curette and\\ngouge away all diseased portions\\nof the acetabulum, remove dis-\\neased synovia or capsule, wash\\nout with zinc chloride, dry with\\nbichloride sponges, dust with\\niodoform. Dress antiseptically\\nand apply a double Thomas s\\nsplint.\\nKnee-joint. Incision from the\\nouter and posterior border of the\\ninternal condyle, to a corre-\\nsponding point on the external\\ncondyle, curving downward suf-\\nficiently to pass midway between\\nthe patella and the tuberosity\\nof the tibia. Dissect up the an-\\nterior flap containing the patella,\\nflex the joint, divide the lateral\\nand crucial ligaments, clear the\\nend of the femur with the finger,\\nsaw at right angles to its long\\naxis near the upper margin of\\nButcher s saw. the cartilaginous surface. Use\\nButcher s saw, cutting from be-\\nhind forward. Clear the end of the tibia, and remove its articu-\\nlating extremity. Eemove by the gouge or curette all diseased", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0284.jp2"}, "285": {"fulltext": "EXCISION OF JOINTS. 283\\ntissue. Suture the bone together with thick cat-gut or silver\\nwire, provide for drainage, and close. Absolute fixation, plaster\\nbandages if the wound remains aseptic.\\nAnkle-joint. Yery rarely performed. Every effort should\\nbe made to preserve the periosteum. Two incisions are made.\\nThe fibular begins two-and-a-half inches above the tip of the ex-\\nternal malleolus, passes downward along its posterior border,\\naround its tip, and upwards along the anterior border for an inch\\n(hook-shaped). The tibial forms a semicircle around and just\\nbelow the internal malleolus, from the middle of which a third\\ncut runs directly upwards over the malleolus for two inches (an-\\nchor-shaped). The periosteum is first raised from the fibula,\\nwhen the bone is sawed and removed. Next, the articulating\\nend of the tibia is removed finally the astragalus is sawn\\nthrough. If the elevator is carefully used, the tendons and their\\nsheaths will not be damaged.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0285.jp2"}, "286": {"fulltext": "284\\nESSENTIALS OF SURGERY,\\nAMPUTATIONS.\\nUnder what circumstances is amputation required?\\n1. Avulsion of a limb. 2. Mortification. 3. Compound luxa-\\ntions and fractures, if seriously complicated. 4. Extensively\\nlacerated and contused wounds. 5. Diseases of bones and joints.\\n6. Lesions or diseases of arteries. 7. Morbid growths. 8. De-\\nformity.\\nWhat instruments are required in amputation\\nTourniquets, knives, saws, retractors, tenacula, artery forceps,\\nhaemostatic forceps, bone-nippers, scissors, needles, and sutures.\\nDescribe the methods of operating.\\n1. Circular. The skin is drawn upward and divided by a cir-\\ncular sweep of the knife, passing entirely around the limb, and\\nFig. 65.\\nAmputation by the circular method.\\ndividing everything down to the muscles this skin cuff is further\\ndissected up till its length is a little greater than half the dia-\\nmeter of the limb it is then retracted, the muscles are separated\\ndown to the bone by a second circular incision, and the latter is\\nsawed through.\\n2. Flap. There may be one or two flaps these may be ante-\\nrior, posterior, lateral, square or oval they may be cut by trans-\\nfixion, or from without, and may include all the soft parts (mus-", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0286.jp2"}, "287": {"fulltext": "AMPUTATIONS\\n285\\nculo-cutaneous), or simply the skin and superficial fascia (cuta-\\nneous).\\nDescribe the methods of shaping the flap.\\nModified circular. Two short, curved, skin-flaps are cut, and\\nthe notched skin cuff is dissected up as in the circular method.\\nFig. 66.\\nFig. 67.\\nFormation of flaps by transfixion.\\nTeale s amputation.\\nOval and elliptical. The oval method is practically a circular\\nincision, with the cuff slit at one side, and its angles rounded\\noff.\\nIn the elliptical method the incision forms a perfect ellipse the\\nflap is folded upon itself and sutured, making a curved cica-\\ntrix.\\nTeale s method. Eectangular flaps, each equal in breadth one\\nhas a length of half the circumference of the limb, the other (con-\\ntaining the bloodvessels) is only quarter as long.\\nHow are amputations classified in regard to the time of ope-\\nrating\\nPrimary, before the occurrence of inflammatory fever. Inter-\\nmediate, during acute inflammatory fever. Secondary, after sup-\\npuration has been established.\\nWhat period is most favorable for amputation\\nBefore the occurrence of inflammatory fever. If the time for\\nprimary amputation has passed, wait for the secondary period.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0287.jp2"}, "288": {"fulltext": "286\\nESSENTIALS OF SURGERY.\\nWhat sequelae may occur after amputation?\\nHemorrhage, muscular spasm, pain, inflammation, osteomye-\\nlitis, protrusion of bone.\\nAmputations of the Foot.\\nLisfranc s amputation.\\nFig. 68.\\nTarso-metatarsal disarticulation be-\\ntween the metatarsal bones and the\\nthree cuneiforms and cuboid.\\nIncision. From the base of the first\\nto the base of the fifth metatarsal bone\\nacross the dorsum of the foot, with\\na marked convex curve downward.\\nForcibly extend and disarticulate,\\nbearing in mind the backward pro-\\njection of the second metatarsal bone.\\nCut a long plantar flap.\\nArteries. Dorsalis pedis and plan-\\ntar arches.\\nHey s amputation. The same as\\nLisfranc s, except that the projecting\\ninternal cuneiform bone is sawed\\nthrough.\\nChopart s amputation. Intertar-\\nsal disarticulation, between the as-\\ntragalo-scaphoid, and calcaneocu-\\nboid joint.\\nIncision. From a point midway\\nbetween the tuberosity of the fifth\\nmetatarsal bone and the external\\nmalleolus, a curved dorsal incision is made to a point one-half\\ninch behind the tubercle of the scaphoid. Extend the foot, dis-\\narticulate, and cut a long plantar flap.\\nPirogoff s amputation. Through the ankle-joint and os\\ncalcis.\\nIncision, from the tip of the external malleolus, across the\\nunder surface of the heel, to a point half an inch below and\\nL. Lisfranc s operation. H.\\nThe extremity of the internal\\ncuneiform removed by Hey s\\noperation. C. Chopart s ope-\\nration.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0288.jp2"}, "289": {"fulltext": "AMPUTATIONS. 287\\nbehind the internal malleolus. Incline this cut well forward.\\nForcibly extend the foot and unite the ends of the first incision\\nby a deep cut passing directly across the dorsum. Open the\\njoint, draw the foot forward, place a narrow saw behind the\\nastragalus and saw the os calcis through in the line of the first\\nskin incision. Saw off the ends of the tibia and fibula, bring\\nthe heel flap up till the sawn bone surfaces are in contact, unite\\nthem with heavy catgut, and suture the wound.\\nSyme s amputation. Through the ankle-joint.\\nIncision. Inclining backward from tip of external malleolus,\\nbeneath the heel, to a point half an inch below and behind the\\ninternal malleolus. Dissect the flap from the os calcis cutting\\ntowards the bone. Unite the ends of the first incision by a trans-\\nverse cut across the front of the ankle-joint, disarticulate, saw\\noff the articular extremities of the tibia and fibula, and bring\\nthe flaps together.\\nAmputations of the Leg.\\nLower third of the leg. By the circular, modified circular,\\nbilateral tegumentary flap, Teale s method. The fibula should\\nbe divided first. Arteries. Anterior and posterior tibial, pero-\\nneal, and muscular.\\nMiddle and upper third of the leg. By a long anterior tegu-\\nmentary flap half the circumference of the limb in breadth and\\na little more in length. By short antero-posterior flaps. By\\nlateral musculo-tegumentary flaps (Sedillot s). The projecting\\nsharp edge of the tibia should be covered with a flap of perios-\\nteum to prevent perforation of the anterior flap.\\nLateral double flap method (Sedillot s). A long external\\nflap is formed by transfixion, and united to the short internal\\nflap formed by the calf muscles.\\nLateral tegumentary flaps may be formed cutting from with-\\nout inward.\\nPoint of election in leg amputation. Two inches below the\\ntuberosity of the tibia.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0289.jp2"}, "290": {"fulltext": "288 ESSENTIALS OF SURGERY.\\nAmputations at the Knee-Joint.\\nWhere indicated by injury or disease this is one of the most\\nsuccessful of all leg amputations, and leaves a far more service-\\nable stump than amputation in the continuity of the limb.\\nLateral flap operation. Commence the incision in the middle\\nline an inch below the tubercle of the tibia, form a flap convex\\ndownward, carrying the point of the knife to the centre of the\\nposterior surface, when it is continued directly upward to the\\ncentre of the articulation. The second incision begins at the\\nsame point as the first, and pursues the same course on the op-\\nposite side of the leg to the posterior median line. The anterior\\nincisions should incline forward to allow sufficient material for\\ncovering the condyles. The internal flap should have additional\\nfulness. The patella and semilunar cartilages are allowed to\\nremain.\\nLong anterior flap. Incision from the lower extremity of the\\ninner condyle downward for three inches, then directly across\\nthe tibia and upward to the external condyle. Disarticulate and\\ncut a short posterior flap.\\nAmputation through the femoral condyles (Carden s). In-\\ncision, from the upper border of the inner, to the upper border\\nof the external condyle, carried downward and across the front\\nof the leg just below the insertion of the ligamentum patellae.\\nShort posterior flap by transfixion. Condyles sawed across.\\nThe patella is not left in the anterior flap.\\nGritti s modification. Consists in sawing off the articular sur-\\nface of the patella, turning it backward, and suturing it to the\\ndivided femur.\\nAmputations of the Thigh.\\nAntero-posterior musculo-tegumentary flaps. Anterior cut\\nfrom without inwards, about four inches long, and somewhat", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0290.jp2"}, "291": {"fulltext": "AMPUTATIONS. 289\\nsquare. Posterior flap about the same length to allow for re-\\ntraction, cut by transfixion. The posterior muscles of the thigh\\nalways retract more than the anterior group.\\nLateral flap. Teale s method or modified circular operation\\nmay also be done on the thigh.\\nHip-Joint Amputation.\\nHemorrhage controlled by abdominal tourniquet, digital pres-\\nsure on the femoral, Esmarch s tube applied in the form of a\\nspica of the groin, or by Esmarch s tube thrown above Wyeth s\\npins.\\nLong anterior and short posterior flaps. Enter the knife at\\na point midway between the anterior superior spinous process\\nof the ilium and the tip of the trochanter, push it directly across\\nthe capsule of the joint, grazing the head of the bone, till it ap-\\npears on the inner side of the thigh just in front of the tuber\\nischii cut directly downwards for six inches, let the femoral\\nartery be seized by the fingers of an assistant, then complete the\\nanterior flap by cutting outward. Turn the flap up, clear the cap-\\nsule, forcibly extend the femur, and, placing the knife behind\\nthe trochanter, form a somewhat shorter posterior flap. First\\nsecure the gluteal and sciatic vessels, then the femoral artery\\nand vein. The flaps may be cut from without inwards, securing\\nthe vessels as cut.\\nVertical and circular method. A vertical incision is made,\\nfrom a little above the tip of the trochanter for five inches in the\\nlong axis of the femur. Through the incision disarticulation is\\neffected, and by means of the elevator and knife the soft parts\\nare separated from the bone. At the lower extremity of the\\nvertical incision, skin, fascia, and muscles are divided by a\\ncircular sweep of the knife around the thigh, and the entire\\nfemur, together with the soft parts below the circular cut, is\\nremoved. This operation is tedious, but far more safe than the\\nRouble flap method.\\n19", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0291.jp2"}, "292": {"fulltext": "290 ESSENTIALS OF SURGERY\\nAmputation of the Hand.\\nPhalanges. The palmar flexure is the guide to the joint sur-\\nface. Flex the joint, open it by a slightly convex dorsal in-\\ncision a little below its most prominent part, and cut a long\\npalmar flap. The digital arteries can usually be secured by the\\nskin suture. The proximal phalanx of the middle and ring\\nfingers should not be saved.\\nMetacarpophalangeal. Oval method (en raquette). The point\\nof the knife is entered in the mid dorsal line, a little above the\\nknuckle, carried first downward, then around the side of the fin-\\nger, across its web and palmar surface, and back to the point of\\nstarting.\\nAny of the bones of the hand may be amputated through their\\ncontinuity by either the double flap, or the oval method.\\nWrist-joint. Incision, convex downward, from styloid process\\nof radius to corresponding process of ulna. Dissect up the flap,\\ndivide tendons, disarticulate, and cut a palmar flap from within,\\nguarding against the knife catching on the pisiform bone.\\nAmputations of the Arm and Forearm.\\nForearm. Modified circular, or antero-posterior flaps. Teale s\\nmethod.\\nArteries. Anterior and posterior interosseous, radial and\\nulnar.\\nElbow-joint. The line of articulation is oblique, from with-\\nout inward and downward, hence there will not be enough flap\\nto cover the internal condyle if the knife is carried directly\\nacross the arm.\\nLong anterior and short posterior flap. Flex and supinate\\nthe forearm, raise the soft parts from the bone, enter the knife\\nan inch below the internal condyle, and push it across the limb\\nclose to the ulna, till it appears an inch and a half below the", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0292.jp2"}, "293": {"fulltext": "AMPUTATIONS. 291\\nexternal condyle. Make a three-inch flap, bringing the knife\\nout sharply at the finish. Draw the skin well up and unite the\\ntwo extremities of the incision by a semilunar dorsal cut. Dis-\\narticulate, either dividing the triceps, or sawing off the ole-\\ncranon.\\nCircular method. The incision is made three to four inches\\nbelow the joint.\\nArm. Circular. Flap. Any of the methods.\\nShoulder-Joint.\\nOval method. (Larrey s.) Forming lateral musculo-tegument-\\nary flaps. Enter the point of the knife to the bone just below\\nthe acromion process, and make an incision downward in the\\nlong axis of the arm for about two inches. From the end of the\\nincision two curved incisions are carried to the anterior and\\nposterior axillary folds, respectively. These flaps are dissected\\nup, and disarticulation is effected by rotating the humerus out-\\nward, and dividing first the subscapularis, then the long head of\\nthe biceps and capsular ligament, then rotating the humerus\\ninward and dividing the insertions of the supra- and infra-spi-\\nnator and teres minor muscles. The knife is now placed behind\\nthe bone, and the two curved incisions are joined by a trans-\\nverse cut, severing the axillary artery, which is controlled by\\nthe thumb of an assistant before it is divided. Hemorrhage is\\nchecked by pressure on the subclavian, Esmarch s tube, and\\nseizure of the artery in the flap before it is cut. Arteries. An-\\nterior and posterior circumflex, supra-scapular, brachial.\\nSingle flap method. (Dupuytren s. A long external flap is cut\\nfrom the deltoid muscle, either by transfixing, or from without", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0293.jp2"}, "294": {"fulltext": "292 ESSENTIALS OF SURGERY.\\nTUMORS.\\nWhat is a tumor\\nA tumor or neoplasm is a new growth which produces local\\nenlargement; which has no tendency to spontaneous cure;\\nwhich is without physiological function and which tends to\\npersist.\\nFrom what do all tumors originate\\nAll tumors not of metastatic origin spring from pre-existing\\ntissues, and are composed of tissue elements resembling those\\nof the originating tissue, in either a mature or embryonic state.\\nWhat is a homologous tumor\\nA tumor composed of fully developed cells, and limited to the\\ntissue from which it originates.\\nWhat is a heterologous tumor\\nA tumor probably embryonic in character, which is not\\nlimited to the tissue from which it originates, but which infil-\\ntrates adjacent parts.\\nMention the causes of tumors.\\nSome tumors (as naevi) are congenital. In some tumors the\\ntendency is inherited. Traumatism seems to bear a relation to\\nthe production of sarcoma. Continued irritation favors the\\ndevelopment of cancer.\\nWhat are some of the theories of tumor origin\\n1. The inclusion theory, or embryonic hypothesis of Cohn-\\nheim. This supposes tumors to arise from embryonic cells,\\nwhich were produced in excess of foetal requirements, and re-\\nmained as embryonic cells until stimulated into growth by irri-\\ntation or the excitation of physiological activity.\\n2. Hereditary influence.\\n3. Irritation and injury.\\n4. Physiological activity and decline.\\n5. The theory of origin from micro-organisms (bacteria or\\ncoccidia), which is gaining in probability every year.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0294.jp2"}, "295": {"fulltext": "TUMORS. 293\\nWhat is a benign tumor\\nAn innocent or a benign tumor is composed of adult tissues\\nresembling the tissues from which it springs it is circumscribed,\\nmobile, and usually encapsuled it grows slowly it is painless\\nit pushes aside, but does not infiltrate, adjacent tissues it does\\nnot recur after thorough removal; it does not affect related\\nlymphatic glands, and does not produce a cachexia.\\nWhat is a malignant tumor\\nIt consists of tissues embryonic in nature, widely different\\nfrom its tissues of origin it is painful it grows rapidly it is\\nnot encapsuled, is not mobile, and infiltrates surrounding parts;\\nit affects the neighboring lymphatic glands, and gives rise to\\nmetastic deposits in organs; it produces a cachexia, and tends\\nto recur after extirpation.\\nOn what does the diagnosis of a tumor depend\\nOn the age, history, sex, situation, rapidity of growth, mobil-\\nity, lymphatic involvement, physical character of growth, and\\nconstitutional condition.\\nWhat rules govern the treatment\\nBenign growths should be removed. Any benign growth\\ncan become malignant. These growths, as a rule, are shelled\\nout of their capsule.\\nA malignant growth, if seen early, is to be removed with the\\nhope of cure, the adjacent lymphatics, much of the surround-\\ning tissue, and often the overlying skin being removed with the\\ngrowth. In advanced cases we may be forced to decline ope-\\nration, but in many cases will operate, not with hope of cure,\\nbut to get rid of pain, ulceration, and foul discharge, allowing\\nlife to be more pleasantly terminated by visceral growths.\\nClassification of Tumors.\\n[According to American Text-Book of Surgery.)\\nI. Mesoblastic or Connective-Tissue Tumors:\\nA. Those conforming to the types of fully-formed conneclive\\ntissue", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0295.jp2"}, "296": {"fulltext": "294 ESSENTIALS OP SURGERY.\\n1. Fibrous tumor or fibroma\\n2. Fatty tumor or lipoma\\n3. Cartilaginous tumor or chondroma\\n4. Osseous tumor or osteoma;\\n5. Mucous tumor or myxoma.\\nB. Those conforming to the types of the higher connective\\ntissues\\n1. Muscular tumor or myoma\\n2. Warty or villous tumor or papilloma\\n3. Vascular or erectile tumor or angeioma;\\n4. Lymphatic vessel tumor or lymphangeioma;\\n5. Nerve tumor or neuroma\\n6. Lymphatic gland tumor or lymphoma\\n7. Glandular tumor or adenoma.\\nC. Those conforming to the type of embryonic connective\\ntissue\\n1. Round-celled sarcoma;\\n3. Spindle-celled sarcoma\\n3. Giant-celled or myeloid sarcoma.\\nD. Tumors intermediate between the sarcomata and the carci-\\nnomata\\nThe endotheliomata.\\nII. Epiblastic and Hypoblastic Tumors i. e. those conforming to\\nthe type of Epithelial Tissues\\nA. The acinous or spheroidal-celled carcinomata\\n1. Hard spheroidal-celled, scirrhous, or chronic carcinoma\\n2. Soft spheroidal-called, encephaloid, or acute carcinoma;\\n3. Colloid carcinoma.\\nB. Epithelial carcinomata:\\n1. Squamous-celled epithelioma;\\n2. Cylindrical- or columnar- celled epithelioma.\\nIII. Tumors composed of Epiblastic, Hypoblastic, and Mesoblastic\\nElements\\nTeratomata, tumors containing bone, hair, teeth, etc., sit-\\nuated in the ovaries or testicles.\\nWhat do you mean by an infective granuloma\\nAn infective granuloma is a new formation composed of\\ngranulation-tissue, transitory in duration, terminating in ulcer-", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0296.jp2"}, "297": {"fulltext": "INFECTIVE GRANULOMA. 295\\nation or resolution, and due to the deposit and multiplication\\nof certain specific micro-organisms.\\nThe patch of lupus, the hard or infecting chancre, the tu-\\nbercle, and the lesions of leprosy and glanders are examples\\nof infective granulomata.\\nThese tumors are locally infective, invading adjacent struc-\\ntures, and are generally infective, involving the constitution,\\nand causing in the various organs and tissues of the body new\\ngrowths identical with or similar to the parent.\\nThese infective granulomata are contagious, and can be\\ninoculated.\\nWhy is an infective granuloma not in reality a tumor\\nBecause it does not tend to persist; its duration is transitory;\\nit does not form a permanent addition to the organism.\\nWhat is a cyst?\\nA sac formed of fibrous membrane, containing matter which\\nis liquid or semi-liquid, or which once has been so.\\nAre cysts new formations\\nAs a rule, no.\\nGive the forms of cysts.\\n1. Dermoid Cysts. These are due to the turning in and catch-\\ning in a foetal cleft of epithelial elements, and they are hence\\nalways congenital. They are lined entirely or partially with\\nskin or mucous membrane, and contain often such structures\\nas bones, teeth, or mammary glands (in ovarian dermoids),\\nsebaceous matter, hair, sweat, etc.\\nThese dermoid cysts are most common about the orbit, the\\nsacrum, the ovary, and the testicle.\\n2. Retention Cysts. These are due to the blocking up of the\\nexcretory duct of a gland and the accumulation of its contents.\\nExamples of this form are ranula, galactiferous cyst, and seba-\\nceous cyst.\\n3. Exudation Cysts. The gathering of fluid in a cavity with-\\nout any excretory duct. Examples of these are housemaid s\\nknee, hydrocele, and goitre.\\n4. Softening Cysts are due to the degeneration of a neoplasm,\\nand are often called cystoid tumors.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0297.jp2"}, "298": {"fulltext": "296\\nESSENTIALS OF SURGERY\\nBANDAGING.\\nThe Roller Bandage.\\nDescribe the roller bandage.\\nA strip of unbleached muslin, from half an inch to three inches\\nin width, and from three to twelve yards in length. It may be\\nmade of calico, linen, or gauze. It is tightly rolled in the form\\nof a cylinder the rolling may be from each end, forming the\\ndouble-headed bandage.\\nName the parts of a roller bandage.\\nThe initial and terminal extremities, the upper and lower bor-\\nders, the internal and external surfaces, and the body of the\\nroller.\\nHow do you apply a roller bandage?\\nFix. The body of the roller being held in the right hand, the\\nexternal surface of the initial extremity is applied to the surface,\\nFig. 69.\\nMethod of applying the spiral reversed bandage.\\nfixed by the thumb of the left hand till it is caught by the band-\\nage carried around the limb, when it is further held in place by\\na repeated circular turn. The following turns can be made to\\noverlap this circular, covering in from a half to three-fourths of\\nits surface. If the part is conical, the overlapping turns may be\\nmade to lie smoothly by the reverse.\\nThe circular turns are those which pass around the part, one\\nj passing directly over the other.\\nThe spiral turns are those which pass up the limb, each one\\noverlapping the other.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0298.jp2"}, "299": {"fulltext": "BANDAGING.\\n297\\nFig. 70.\\nt The oblique turns are those in which the bandage passes up\\nthe limb without overlapping, leaving space be-\\nA tween each turn.\\ns Becurrent turns are those in which the bandage\\nis caught, passed to and fro, across the end of a\\nstump for instance, and the loops held at the\\nsides by circular turns.\\nSpica and figure-of-eight turns are those in which\\nthe bandage forms by oblique turns two loops in\\nthe form of an eight. By overlapping, the crossings\\nof these loops form a series of angles or spicas.\\nDescribe the reverse.\\nConsists in folding the bandage over, so that\\nthe surface in contact with the skin is changed\\nwith each reversed turn. This is accomplished\\nby relaxing all tension on the roller, carrying the\\nright hand, holding the body of the roller, from\\nsupination to pronation, passing the body of the\\nroller to the left hand beneath the limb, and\\nmakinar firm traction.\\nOblique band-\\nage.\\nFor what purposes is the roller applied\\nThe general indications for all roller bandages are to retain\\nsplints and dressings, and to make pressure.\\nSpiral of one finger. Length, one-and-a-half yards width,\\nthree-fourths of an inch. Fix by a circular turn at the wrist\\nonce repeated. Carry the bandage clown over the dorsum of the\\nhand, and by an oblique turn to the extremity of the finger, which\\nis then covered in by spiral or reversed turns as required. Com-\\nplete the bandage by carrying it up to the wrist, over the back\\nof the hand, and making one circular turn.\\nSpiral of four fingers (gauntlet). Length, five yards breadth,\\none inch. Cover in each finger precisely as above, beginning\\nwith the little finger of the left hand, the index-finger of the\\nright. As each finger is finished, the bandage is carried to the\\nwrist, around, and then down to the next finger. The thumb\\nmay be included in this bandage if necessary.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0299.jp2"}, "300": {"fulltext": "298\\nESSENTIALS OF SURGERY.\\nSpica of the thumb. Length, three yards width, three-quar-\\nters of an inch. May be ascending or descending. Ascending.\\nFig. 71.\\nFig. 72.\\nFig. 73.\\nGauntlet, also taking in\\nthe thumb.\\nSpica of thumb.\\nSpiral of one finger.\\nFix at the wrist. Pass to the metacarpo-phalangeal articula-\\ntion, and make a circular. Pass to the wrist again, and alter-\\nnate the wrist and thumb turns so that the line of crossing is\\nover the dorsum of the thumb. Overlap two-thirds from below\\nupward. The descending spica has the same turns, but over-\\nlaps from above downward.\\nDemi-gauntlet. Length, three yards breadth, one inch. Fix\\nat the wrist, pass obliquely across the back of the hand to the\\nindex-finger of the right hand the little finger of the left pass\\naround the finger, and obliquely back to the wrist. Make a cir-\\ncular turn, then take in the next finger in a similar way till each\\none is encircled by a loop.\\nSpiral reversed of upper extremity. Length, twelve yards\\nwidth, one and one-half inches. Apply with hand in pronation.\\nFix at the wrist. Carry across the back of the hand and make\\na circular turn about the fingers at the level of the distal joint\\nof the little finger. Kun up the hand with spiral reversed, or\\nfigure-of-eight turns, covering in the metacarpal bone of the\\nthumb by means of the latter. Continue up the forearm with", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0300.jp2"}, "301": {"fulltext": "BANDAGING.\\n299\\nspiral turns till they cease to fit closely to the surface, when the\\nreverses must be made. The elbow must be covered in by a fig-\\nure-of-eight. Do not make the line of reverses (the line of pres-\\nsure) over the subcutaneous portion of the ulna. Overlap two-\\nthirds.\\nSpica of the shoulder. Length, ten yards width, two-and-\\none-half inches. Ascending or descending. Ascending. Fix by a\\ncircular turn about the arm placed as high as possible. Carry\\nthe bandage, overlapping the circular turn where it passes over\\nit, across the chest (right side) or back (left side), under the oppo-\\nsite axilla and back to the point of starting. It is now carried\\naround the arm, overlapping the circular turn, and making a spica\\ndirectly in the middle line of the shoulder with the beginning of\\nthe body turn. This is repeated, passing upward till the entire\\nshoulder is covered in. The descending spica is applied by the\\nsame turns, but runs from above downward till it reaches the\\nfirst circular turn.\\nVelpeau. Length, fourteen yards width, two and one-half\\ninches. For the proper application of this bandage the arm\\nmust be placed in the Velpeau position, the hand of the in-\\njured side resting on the sound\\nshoulder.\\nCommence over the scapula of\\nthe sound side, carry the roller\\nover the injured shoulder to the\\nmiddle of the outer aspect of the\\nupper arm, across the chest (be-\\nhind the elbow) to the axilla of\\nthe sound side, thence to the\\npoint of starting. Repeat this\\nturn to fix, then make a circular\\nturn about the chest, taking in\\nthe elbow of the injured side. Re-\\npeat these turns, first shoulder,\\nthen body, overlapping so that\\nthe shoulder turns reach the point\\nof the elbow when the body turns Velpeau.\\nFig. 74.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0301.jp2"}, "302": {"fulltext": "300\\nESSENTIALS OF SURGERY\\ntake in the wrist. This requires overlapping of about five-sixths\\nfor the vertical turns, one-third for the horizontal. Used to dress\\nfractured clavicle or scapula.\\nDesault. Requires three rollers.\\nFirst roller. Length, five yards width, two-and-one-half\\ninches. It fixes a wedge-shaped pad, base up, in the axilla.\\nFour spiral turns are made, encircling the thorax and pad, the\\nroller is then carried from the pad obliquely to the sound\\nshoulder, about which and the pad it is made to form a series\\nof spica turns.\\nFig. 76.\\nDesault. First roller.\\nDesault. Second and third roller\\n(the second is here applied last).\\nSecond roller. Length, seven yards width, two-and-one-\\nhalf inches. Presses the elbow to the side, and forces the\\nhead of the humerus outward. It consists of a number of\\ncircular turns embracing the arm and chest, and running from\\nthe head of the humerus to the elbow, overlapping one-half.\\nThe upper turns are applied very lightly, as they descend the\\ntension on each turn is increased.\\nThird roller. Length, seven yards width, two-and-one-half\\ninches. Presses the shoulder upward and backward. Begin at", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0302.jp2"}, "303": {"fulltext": "BANDAGING. 301\\nthe axilla of the sound side, carry the roller obliquely across the\\nchest, over the injured shoulder, down the back of the humerus,\\naround the elbow of the injured side, across the chest again to\\nthe point of starting then under the axilla of the sound side,\\nobliquely across the back, over the injured shoulder, down in\\nfront of the humerus, around the elbow, across the back to the\\npoint of starting. This forms two triangles, one anterior the\\nother posterior. Axilla, shoulder, elbow, first in front, then be-\\nhind, represent the angles of the triangles. These turns may\\noverlap two-thirds, or may exactly overlie.\\nSpiral of chest. Length, seven yards width, three inches.\\nCircular around the waist, ascends to the axilla by spiral turns\\noverlapping one-half. Keep from slipping down by making a\\nrecurrent turn across one shoulder, pinning to the circular turns,\\nbringing the bandage back over the other shoulder, and securing\\nit to the circular turns in front.\\nAnterior figure-of-eight of chest. Length, seven yards width,\\ntwo-and-one-half inches. Fix by a circular about the right arm,\\nthen carry the roller over the shoulder, across the chest, around\\nthe left shoulder, across the chest again, around the right\\nshoulder, across the chest, and so continue till the required\\nnumber of turns have been applied. Over the sternum the\\nspicas may run up, overlapping three-fourths.\\nPosterior figure-of-eight of chest. Length, seven yards\\nwidth, two-and-one-half inches. Fix the roller upon the upper\\npart of the left arm, carry it over the left shoulder, obliquely\\nacross the back to the right axilla, around the right shoulder,\\nobliquely across the back to the left axilla, and so continue till\\nttie necessary number of turns are applied.\\nSpica of breast. May be single or double.\\nSingle. Length, ten yards width, two-and-one-half inches.\\nStarting from the scapula of the affected side, carry the roller\\nover the shoulder of the sound side, just beneath the affected\\nbreast, and around the chest to the point of starting repeat\\nthis turn, then make a circular around the chest, taking in the\\nlower border of the mammary gland and making a spica or cross", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0303.jp2"}, "304": {"fulltext": "302\\nESSENTIALS OF SURGERY\\nFig. 77.\\nwith the oblique turn. Alternate these circular and oblique\\nturns, and continue them, overlapping\\ntwo-thirds, till the gland is covered in.\\nThe spicas or crosses should all be in the\\nsame line.\\nDouble. Length, fourteen yards (two\\nbandages) width, two-and-one-half\\ninches. This is made up of two oblique\\nturns to each circular. Start from the left\\nscapula and make a repeated oblique turn,\\npassing over the right shoulder and under\\nthe left breast as before then carry the\\nroller around the chest as though to make\\nSpica of breast (double).\\na circular turn, till it passes beneath the\\nright breast, when it is carried obliquely upward over the left\\nshoulder (passing above and to the inner side of the left breast)\\nacross the back, and a circular is made, just taking in the lower\\nborders of the glands and making spicas with the two obliques.\\nSpica of the Foot. Length, five yards width, two-and-a-half\\ninches. Begin by a circular turn about the ankle pass over\\nthe dorsum of the foot to the metacarpopha-\\nlangeal articulation make a circular and a\\nspiral turn, overlapping three-fourths, then\\ncarry the roller over the dorsum of the foot\\nto the back of the heel, around the heel, so\\nthat the lower border of the bandage extends\\nas low as the level of the sole, then back\\nto the dorsum of the foot, crossing the begin-\\nning of the heel turn exactly in the middle\\nline as it overlaps the spiral turn this forms\\nthe first spica. Again pass around the sole of\\nthe foot, across the dorsum of the foot overlapping three-quarters,\\naround the heel, and back across the foot, making the second\\nspica. So continue till the foot is covered in. Each turn of the\\nbandage, after the spica is begun, must be parallel to its pre-\\ndecessors throughout its whole extent, and must overlap to the\\nsame degree.\\nSpica of the foot.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0304.jp2"}, "305": {"fulltext": "BANDAGING\\n303\\nSpiral reversed of the foot covering in the heel. Length,\\nfour yards width, two-and-a-half inches. Fix by a circular\\nturn about the ankle, pass over the dorsum of the foot to the\\nmetacarpophalangeal articulation make a circular at that\\npoint, and pass up the foot by two or three reversed turns, over-\\nlapping three-fourths having reached the top of the instep,\\ncarry the bandage around the point of the heel, up over the in-\\nstep, down around the sole of the heel obliquely, backward, and\\nupward, below the malleolus, and around the back of the heel,\\nforward to the instep. Again pass under the sole of the heel,\\nbeneath the malleolus, around the back of the heel, and forward\\nto the instep. The bandage may be pinned at any point, or\\ncarried up the leg.\\nSpiral reversed of the lower extremity. Length, twelve\\nyards width, two-and-a-half inches. Fix at the ankle, pass\\ndown over the dorsum of the foot, and make a circular turn\\nabout the foot at the meta-\\ntarso-phalangeal joint, pass lg\\nup the instep by a spiral, a\\nspiral reversed, and two or\\nthree spica turns then pass\\nup the leg by spiral turns,\\nbeginning to reverse as soon\\nas the shape of the limb re-\\nquires it. Cover the knee\\nwith a figure-of-eight, and\\nascend the thigh by spiral\\nreversed turns. Overlap two-\\nthirds. Do not make the\\nline of the reverse over the crest of the tibia.\\nFig. 80.\\nFigure-of-eight for\\nthe knee.\\nFigure-of-eight of the knee. Length, three\\nyards width, two-and-a-half inches. Fix by\\na circular three or four inches below the joint,\\ncarry the bandage upward obliquely over the\\npopliteal space, and make a circular about the thigh, three or\\nfour inches above the joint, descend obliquely over the popliteal\\nSpiral reversed\\nof the lower ex-\\ntremity.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0305.jp2"}, "306": {"fulltext": "304\\nESSENTIALS OF SURGERY.\\nspace, and make a circular about the leg, overlapping the first\\nturn upward two-thirds, ascend and make a second circular\\nabout the thigh, overlapping downward two-thirds. So continue\\ntill the joint is covered.\\nSpica of the groin. Single or double. Ascending or descend-\\ning. Single ascending. Length, ten yards width, two-and-a-\\nhalf inches. Fix around the upper part of the thigh (if it is the\\nleft side, the bandage must\\nbe applied throughout\\nfrom right to left) carry\\nobliquely across pubes,\\nlower part of abdomen\\nand crest of ilium, around\\nthe back, and down to\\nthe starting-point, passing\\nacross the front of the\\nthigh, and forming the\\nfirst spica turn, which\\nshould be within the mid-\\ndle of the anterior surface\\nof the thigh repeat these\\nturns, overlapping two-\\nthirds in the groin, but\\nconverging as the bandage\\nis carried to the crest of\\nthe ilium, till they overlie\\nin the back.\\nRemember that in all\\nascending spica bandages,\\nthe position of the crossing\\nis determined by the lower\\nborder of the bandage in\\nall descending spicas, the upper border determines the position\\nof the turns. A well-applied spica should have all the angles\\nof crossing exactly in line.\\nDouble ascending spica. Length, fourteen yards width, two-\\nand-a-half inches. Fix by a circular around the waist, carry\\nSpica of groin. Single ascending. Should\\nbe started around the thigh.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0306.jp2"}, "307": {"fulltext": "BANDAGING\\n305\\nobliquely downward across the belly, pubes, and left thigh\\naround the left thigh, and up to the left iliac crest, forming the\\nfirst spica around the back, and obliquely down, across, and\\naround the right thigh, forming the second spica; obliquely\\nacross the belly to the left iliac crest, forming with the first\\noblique abdominal turn the third spica. Repeat these turns,\\ntaking in body, left thigh, body, right thigh, and overlapping\\ntwo- thirds. There are three sets of crossings one in the middle\\nline of the belly, and one within the middle line of each thigh.\\nDescending single and double spicas of groin. The turns are\\nthe same as for the ascending spicas, except that the first turns\\nare placed at the highest point which it is desired to cover by the\\nbandage, and the spicas are made by the upper border of the\\nbandage.\\nHead Bandages.\\nBarton s. Length, five yards width, two inches. Begin be-\\nhind the ear (left if standing behind the patient, right if stand-\\ning in front) carry the roller\\ndown under the occiput, and up Fig. 82.\\nto a corresponding point behind\\nthe other ear; thence directly\\nacross the vertex, down the side\\nof the face, under the chin, up the\\nother side of the face to the ver-\\ntex, making an intersection with\\nthe former turn directly in the\\nmiddle line then to the point of\\nstarting, around under the occi-\\nput, forward along the body of\\nthe jaw, around the symphysis\\nmenti, back along the jaw on the\\nother side, to the point of starting.\\nExactly repeat these turns three\\ntimes. Application. Fracture of Barton s bandage,\\njaw.\\n20", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0307.jp2"}, "308": {"fulltext": "306\\nISSENTIALS OF SURGERY\\nGibson s bandage. Vertical\\nturn should be made first.\\nGibson s. Length, five yards width, two inches. Make\\nthree vertical turns, passing under\\nthe chin, along the sides of the face\\nin front of the ears, and over the top\\nof the head reverse just above the\\near, and make three circular turns\\nabout the forehead and occiput as\\nthe third turn is completed, carry the\\nbandage beneath the occiput, under\\nthe ear, along the body of the jaw,\\naround the symphysis menti, and take\\nin the front of the chin and the sub-\\noccipital region with three turns re-\\nverse beneath the occiput, carry the\\nroller directly forward in the middle\\nline to the forehead, pin all intersec-\\ntions.\\nOblique of the jaw. Length, five yards width, two inches.\\nFace the patient, begin the bandage in the middle of the fore-\\nhead and carry it towards the injured side. Fix by a circular\\nfronto-occipital turn. Carry the roller obliquely down beneath\\nthe occiput, around the front of the neck to the angle of the\\ninjured jaw, then up the side of the face (in front of the ear),\\nacross the vertex, down the side of the head behind the ear of\\nthe sound side, under the chin, and up again on the injured side,\\noverlapping the preceding turn forward three-\\nquarters. The turns behind the ear of the\\nsound side do not overlap.\\nApplication. For fracture of the condyle\\nof the jaw, or fractures with marked lateral\\ndeformity.\\nRecurrent of scalp. Length, seven yards\\nwidth, two inches. Fix by a circular fronto-\\noccipital turn, then reverse, catch the point of\\nreverse with the finger and pass directly from\\nocciput to brow across the top of the scalp.\\nThe bandage is held in front by an assistant\\nFig. 84.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0308.jp2"}, "309": {"fulltext": "BANDAGING. 307\\nand carried back again overlapping the first recurrent turn two-\\nthirds it is carried to and fro in this way till the scalp is entirely\\ncovered, when the loops are fixed at the sides by circular turns.\\nFigure-of-eight of the eye. Single and double.\\nSingle. Length, five yards width, two inches. Fix by a\\ncircular fronto-occipital turn, beginning in the middle of the\\nforehead and carrying the bandage away from the injured eye.\\nAs the bandage passes backwards for the third turn, carry it ob-\\nliquely downward across the occiput, under the ear of the affected\\nside, obliquely upward over the ramus of the jaw and the\\naffected eye, to the most prominent part of the parietal bone\\nthence to the starting-point of the oblique turn, which is to be\\nrepeated two or three times and fixed by a fronto-occipital\\ncircular. This bandage may also be applied by alternating\\ncircular and oblique turns, overlapping upward or downward\\nand making a series of spicas.\\nDouble. Length, seven yards width, two inches. One eye\\nmay be covered as in the single bandage, then the other in a\\nprecisely similar manner or the turns may alternate and over-\\nlap, forming a series of spicas over the bridge of the nose.\\nOccipito-facial. Simply the vertical and circular occipito-\\nfrontal turns of the Gibson bandage. Pin all intersections.\\nFronto-occipito-cervical figure-of-eight. Length, three yards\\nwidth two inches. Fix by a fronto-occipital circular turn, carry\\nobliquely downward across the occiput to the neck, around the\\nneck, obliquely upward across the occiput, around the forehead,\\nobliquely downward and around the neck so continue till\\nthe bandage is completed.\\nFronto-occipito-mental figure-of-eight. Length, three yards\\nwidth, two inches. Apply as the preceding bandage, except that\\nthe turn is carried around the chin instead of around the neck.\\nHandkerchiefs.\\nDescribe the handkerchief bandage.\\nThis consists of a thirty-two inch square piece of muslin,\\ncalico, or any soft strong material, forming the square.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0309.jp2"}, "310": {"fulltext": "308 ESSENTIALS OF SURGERY.\\nThe triangle is formed by bringing the two opposite angles of\\nthe square together. The parts of the triangle are, the base, the\\napex (the angle opposite the base), and the angles or ends.\\nThe cravat is formed by folding the triangle once or twice\\nfrom its apex towards its base.\\nHandkerchief bandages receive a double name, the first being\\nthe part to which the base is applied, the second the part around\\nwhich the ends are carried.\\nThe simple bandage is that made up of a single handkerchief;\\nthe compound bandage is that made up of more than one hand-\\nkerchief.\\nHandkerchief Bandages of the Head.\\nOccipito-frontal triangle. Apply the base to the occiput,\\nletting the apex fall over the forehead. Carry the two ends\\nforward around the head and tie in front, or cross, and pin at\\nthe sides. Turn the apex up and pin to the body of the band-\\nage.\\nFronto-occipital triangle. As the preceding, except that the\\nbase is applied to the forehead, and the apex falls over the\\nocciput.\\nBi-temporal triangle. As the preceding, except that the base\\nis applied over one temple, the. apex falls over the other.\\nIn the choice of these three bandages, the base is applied over\\nthe seat of injury, or where most pressure is desired.\\nVertico-mental triangle. Apply the base to the vertex with\\napex back carry the ends down under the chin, and either tie,\\nor cross and pin. Bring the apex to one side and pin.\\nAuriculo-occipital triangle. This does not conform to the\\nrule in naming. Place the base in front of the ear, apex back,\\ncarry one end under the chin, the other over the top of the\\nhead and tie or pin in front of the ear on the sound side.\\nSquare cap. Fold the handkerchief so that a quadrilateral is\\nformed, with one border overlapping the other three inches.\\nApply this quadrilateral to the scalp with the projecting border", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0310.jp2"}, "311": {"fulltext": "BANDAGING.\\n309\\nnext the surface and hanging over the forehead. Bring the\\nends of the short fold under the chin and tie. Fold back the\\nlong border exposing the forehead, pull the ends forward till\\nthe bandage fits about the head, then carry them back and tie\\nbeneath the occiput.\\nFig. 85.\\nFig. 86.\\nBeginning of square cap of head.\\nSquare cap of head completed.\\nFronto-occipito-labialis cravat. Fold the triangle into a cravat.\\nPlace the body upon the forehead, carry the ends back, cross at\\nthe back of the neck, and bring them forward, tying or pinning\\nover the upper or lower lip, as required by the injury. Used to\\napproximate lip wounds, and to check bleeding from the coronary\\narteries.\\nOccipito-sternal triangle (compound). Apply a sterno-dorsal\\n(straight around) cravat about the chest. Flex the head upon\\nthe chest and apply the base of a triangle, apex forward to the\\nocciput, carry the two ends down to the sterno-dorsal cravat and\\nsecure. The apex of the triangles may be folded back and\\npinned. Used in cut throat wounds of the neck.\\nParieto-axillaris triangle (compound). Apply an axillo-\\nacromial cravat (around the shoulder). Place the base of a tri-\\nangle over the parietal eminence of the opposite side, carry the\\nends around the head and cross them incline the head laterally,\\nand secure the ends of the triangle to the shoulder cravat.\\nUsed to approximate w r ounds at the side of the neck.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0311.jp2"}, "312": {"fulltext": "310\\nESSENTIALS OF SURGERY\\nHandkerchief Bandages of the Trunk.\\nAxillo-cervical cravat. Place the body of the cravat in the\\naxilla, carry the ends over the shoulder, across each other, and\\naround the neck.\\nUsed to retain dressings in the axilla.\\nBis-axillary cravat (simple). Place the body in the axilla,\\ncross the ends over the shoulder and carry one across the chest,\\nthe other across the back, to the axilla of the opposite side,\\nwhere they are tied or pinned.\\nUsed as the preceding bandage.\\nBis-axillary cravat (compound). Place the body of one cravat\\nin the axilla, carry its ends over the shoulder and tie (axillo-\\nacromial cravat). Place the body of another cravat in the\\nopposite axilla, and carry the ends obliquely across the chest\\nand back to the first cravat, tying them together when one end\\nhas passed through the loop of the first cravat.\\nUsed to retain dressings in both axillas.\\nFig. 87.\\nBis-axillo-scapulary cravat (simple). Place the body to the\\nfront of the shoulder, with the\\nlower end one-third longer than\\nthe upper. Carry the upper end\\nover the shoulder, the lower end\\nunder the axilla, obliquely across\\nthe back to the opposite shoulder,\\naround it, and back to the short\\nend, to which it is tied. This\\nforms a posterior figure-of-eight,\\nand is used as a temporary dress-\\ning for fractured clavicle.\\nBis axillo scapulary cravat\\n(compound). Loop one cravat\\nloosely about the shoulder, and\\nBis-axiHoscapulary cravat (com- tie PlaCe the body of the other CTa-\\npound). vat in front of the opposite shoul-", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0312.jp2"}, "313": {"fulltext": "BANDAGING.\\n311\\nder, carry the ends back, one over the shoulder, the other through\\nthe axilla. Tie in a single loose knot, carry one end through the\\nloop of the first cravat, and tie in a double knot.\\nUsed to draw the shoulders forcibly back, as in fracture of the\\nclavicle.\\nDorso-bis-axillary triangle (compound). Breakfast shawl.\\nCarry a cravat around the chest and tie in front (dorso-ster-\\nnal). Place the base of a triangle, apex down, on the back of\\nthe neck, carry each end over the corresponding shoulder, and\\ntie to the dorso-sternal cravat in front. The apex is fastened\\naround the body of the cravat behind.\\nUsed to retain dressings to the shoulder or back.\\nMammary triangle. Place the base of the triangle under the\\nbreast, and its apex over the shoulder of the same side. Carry\\none end across the opposite side\\nof the neck, the other under the Fig. 88.\\naxilla of the affected side. Tie at\\nthe back, and secure the apex be-\\nneath the knot.\\nUsed to support the breast, to\\nmake pressure, to retain dress-\\nings.\\nScroto-lumbar. Tie a cravat\\nabout the waist. Place the base\\nof a triangle beneath the scrotum,\\ncarry the two ends up and secure\\nthem to the cravat. Finally se-\\ncure the apex by carrying it un-\\nder the cravat, folding it in front, and pinning.\\nUsed as a suspensory of the scrotum.\\nAbdomino-inguinal (simple). For this bandage one long cra-\\nvat may be made by tying two together. Place the body of the\\ncravat back of the thigh in such a manner that one end may be\\ntwo-thirds longer than the other. Bring the ends to the front,\\ncross over the groin, and carry them around opposite sides of\\nthe body, knotting or pinning in front.\\nMammary triangle.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0313.jp2"}, "314": {"fulltext": "312\\nESSENTIALS OF SURGERY.\\nFig. 89. Used as the spica of the groin, to retain\\ndressings on bubos, or make pressure upon\\nthem.\\nAbdomino-inguinal (compound). Place\\nthe centre of the cravat (three, knotted or\\nsewed together) over lumbar vertebrse,\\ncarry the two ends forward on each side\\njust below the iliac crests, obliquely down-\\nward and inward over the front of the\\ngroins, backward between the thighs, out-\\nward around each thigh to the front cross\\nover the pubes and pin to the body of the\\nGluteal triangle. Cravat.\\nGluteal triangle (compound). Tie a cravat about the waist.\\nPlace the base of a triangle obliquely at the gluteal fold, and\\ntie the ends around the thigh. Carry the apex up and under\\ncravat, fold it over, and pin.\\nUsed to retain dressings to the gluteal region.\\nHandkerchief Bandages of the Extremities.\\nPalmar triangle. Place the base of the triangle on either the\\npalmar or dorsal surface of the wrist, fold the apex over the hand\\nand back to the wrist, carry the ends around the wrist and apex\\nand tie, fold the apex back, and pin to the body of the bandage.\\nTriangular cap of the shoulder. 1. Place the base on the\\nshoulder, apex hanging down over the arm carry the ends under\\nthe axilla, across each other, around the arm, taking in the apex,\\nand tie. Fold* the apex upward, and pin to the body of the\\nbandage.\\n2. Place the base of the bandage on the upper part of the arm.\\nwith the apex covering the shoulder carry the ends around the\\narm, across each other in the axilla, and up around the shoulder,\\ntaking in the apex. Fold the apex down and pin. Used to re-\\ntain dressings to the upper part of the arm or shoulder.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0314.jp2"}, "315": {"fulltext": "BANDAGING\\n313\\nTriangular cap of a stump. Place the base under the stump,\\ncarry the apex over its end. Secure the apex by carrying the\\nends around the limb, and pinning or knotting. Fold the apex\\nup, and pin to the body of the bandage.\\nCervico-brachial triangle. Sling of the arm. Place the base\\nof a triangle at the wrist of the\\nflexed forearm, carry the ends\\nover the shoulders, around the\\nback of the neck, and tie. Draw\\nthe apex back beyond the elbow,\\nfold it posteriorly, and pin it in\\nthis position. If the triangle is\\nnot long enough, a cravat may be\\ntied loosely around the neck, and\\nthe ends of the triangle knotted\\nin this.\\nMetatarso-inalleolar cravat.\\nPlace the body obliquely across\\nthe back of the foot, carry one\\nend around the foot, the other around the ankle, and tie in front,\\novex* the back of the foot.\\nMalleolo-phalangeal triangle. Place the base in the hollow\\nof the foot. Fold the apex around the toes and in front of the\\nankle-joint. Carry the ends around the foot, cross on the\\ndorsum, and continue around the malleoli then back to the\\ndorsum, securing here, or continuing to the side and pinning.\\nCervico-tibial triangle. Carry a cravat from the top of the\\nshoulder of the sound side to the axilla of the injured side, around\\nthe body to the point of starting, and tie. Flex the leg and place\\nthe base of a triangle on the tibia just above the ankle. Carry\\nthe ends up and tie through the cravat. Bring the apex around\\nthe knee, and pin to the body of the handkerchief. Used to sup-\\nport the leg when it is fractured, and the patient is required to\\nwalk.\\nFigure-of-eight of the knee. Place the body of the cravat just\\nabove the patella, carry the ends back, cross in the popliteal\\nCervico-brachial triangle.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0315.jp2"}, "316": {"fulltext": "314 ESSENTIALS OF SURGERY.\\nspace, bring them forward just below the patella, and tie. Used\\nto approximate the fragments of a fractured patella.\\nTarso-patellar cravat. Place one cravat as a figure-of-eight\\nof the knee, loop another cravat around the foot, just anterior\\nto the ankle catch the body of the third cravat through this\\nloop, and carry its ends under both the lower and upper seg-\\nments of the figure-of-eight, and secure by pinning. Used to\\napproximate the fragments of a broken patella.\\nTibial cravat. Place the body obliquely across the calf, carry\\nthe ends around the leg, one below the patella, the other above\\nthe malleoli. Used to retain dressings.\\nBarton s cravat. Place the body of the cravat around the\\npoint of the heel, with the end corresponding to the outer side\\nof the foot one-third longer than the other. Hold the inner end\\n(short) parallel with the foot, while the long end is carried across\\nthe instep, turned once around the inner end, back under the\\nsole of the foot, and looped around itself as it crosses obliquely\\nover the instep. The two ends are knotted, drawn upon, and\\nthe cravat so arranged that traction exerts equal pressure upon\\ndorsum and heel. Used to make extension for fractured femur.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0316.jp2"}, "317": {"fulltext": "ESSENTIALS OF SURGERY. 315\\nTHE RONTGEN RAYS.\\nIn December, 1895, Professor Rontgen of Wiirzburg made\\npublic his discovery of the capacity of the rays formed in a\\nCrookes tube to penetrate many opaque bodies. Some bodies\\npermit the passage of the rays other bodies do not. A body\\nthat intercepts the rays casts a shadow, and the outlines of the\\nshadow can be photographed upon a sensitized plate. These\\npictures are spoken of as skiagraphs or shadowgraphs.\\nIf the Crookes tube is placed opposite a body, and an individual\\ntries to see through the body by means of the unaided eyes, he\\nis unable to do so but if the person interposes between his\\neyes and the body fluorescent materials, the outlines of certain\\nsubstances become perfectly apparent. An instrument contain-\\ning this fluorescent matter is called a fluoroscope, a skia-\\nscope, or a cryptoscope. The first fluoroscope was a brass\\ntube blackened on the inside, to one end of which was fastened,\\nby means of non-actinic black photographic paper, a disk of\\npaper containing the double cyanide of barium and potassium.\\nThe other end of the tube is applied to the eye, and the tube is\\npointed toward the vacuum tube. The z-rays fall upon the\\nfluorescing screen, causing it to glow, and thus show the\\nshadows of certain objects between the Crookes tube and the\\nfluoroscope. Edison s fluoroscopic paper contains crystals of\\ntungstate of calcium.\\nThe z-rays are very useful to the surgeon. They are valuable\\nin the diagnosis of fractures and dislocations and of diseases\\nand deformities of bones. We can even examine a fracture\\nafter dressings have been applied, and be sure that the ends are\\nin apposition. They are valuable in studying the changes that\\nbones undergo when subjected to mechanical treatment by or-\\nthopedic appliances. They are of great use in locating foreign\\nbodies imbedded in the tissues or lodged in the oesophagus, the\\nair-passages, or the eye. Foreign bodies within the cranium\\nhave been discovered, and foreign bodies lodged in bone can\\nbe detected. Thoracic aneurysm has been skiagraphed. The\\noutlines of the stomach have been observed by making the", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0317.jp2"}, "318": {"fulltext": "316 THE RONTGEN RAYS.\\nperson drink lime-water before using the z-ray apparatus.\\nStones in the ureter, kidney, and gall-bladder have also been\\nobserved.\\nThe normal structures of the body, except the bones, permit\\nthe passage of the rays; hence at present the new discovery\\ndoes not afford much information about them.\\nThis method is still in its infancy, and to what extent its use-\\nfulness will reach no man can at present guess.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0318.jp2"}, "319": {"fulltext": "AN APPENDIX\\nCONTAINING\\nFULL DIRECTIONS AND PRESCRIPTIONS FOR THE PREPARATION\\nOF THE VARIOUS MATERIALS USED IN ANTISEPTIC SUR-\\nGERY. ALSO SEVERAL HUNDRED RECEIPTS COVERING\\nTHE MEDICAL TREATMENT OF SURGICAL AFFECTIONS.\\nABSCESSES.\\nR.. Calcii sulphidi, gr. j\\nSacch. lactis, gr. x.\\nEt ft. chart. No. x. M.\\nS. Take one powder every one or two\\nhours. (Ringer.)\\nR. Sodii hypophosphitis, 9iv\\nCalcii hypophosphitis, 9viij\\nSyrupi siniplicis, fSiss\\nAquae fceniculi q. s. ad. fsiv. M.\\nS. Two teaspoonfuls four times a day.\\n(Churchill.)\\ngr. viij\\nfSj. M.\\nR. Acidi carholici,\\nAquae destil.,\\nS. Inject 5x into swelling and repeat\\nevery three days.\\nR.. Iodoformi, 5j\\nGlycerinae, 3j. M.\\nS. Inject into the abscess cavity after\\nevacuating the pus. (Billroth.)\\nBOILS (See Abscesses).\\nBUBO.\\nR. Tr. iodi, f5j. M.\\nS. Paint well every other day until\\nskin becomes tender. (Van Buren.)\\nR. Acid, carbolic, gr. viij\\nAquae destil., isj. M.\\nS. Inject ten minims into gland after\\nhaving used ether spray. Repeat, if\\nnecessary, in three days.\\nR. Hydrogen peroxide (Mar-\\nchand s solution), fSvj. M.\\nS. Apply with an atomizer after sup-\\npuration has begun. (Ringer.)\\nBUNIONS.\\nR. Tr. iodi,\\nTr. belladonnas, aa 5ij. M.\\nS. Apply twice daily with a brush.\\nR. Argent, nitratis,\\nAquae,\\nS. Paint twice daily.\\n5j\\nfSj. M.\\nBURNS.\\nWash with 1-4000 bichloride lotion;\\ndust lightly with iodoform apply pro-\\ntective and dress antiseptically. Or,\\ninstead of the antiseptic dressing, use\\nR. Acidi borici, 5j\\nUng. petrolati, 5j. M.\\nS. Apply on lint.\\nR. Ung. hydrarg.,\\nAmmon. chlorid.,\\nS. Apply twice daily.\\nR. Cadmii iodid.,\\nAdipis,\\nS. Apply twice daily.\\n5ij\\n5j. M.\\n(Dupuytren.)\\nXXX\\nM.\\nR. Acidi borici, 5j\\nAquae, Siv. M.\\nS. A piece of oiled silk a trifle larger\\nthan the lesion is dipped in the solu-\\ntion and applied then a larger piece\\nof lint, dipped in the same solution,\\nplaced over the silk and held loosely\\nby a bandage. (Lister.)\\n317", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0319.jp2"}, "320": {"fulltext": "318\\nSURGERY.\\nR. 01. lini\\nLiq. calcis, aa fgij\\nAcidi carbolici, gtt. xv. M.\\nS. Wring out dressings of sterile gauze\\nin this mixture and apply.\\n(Charity Hospital, N. Y.)\\nR. Acidi carbolici, gr. viij\\nVaselin., Sij. M.\\nS. Spread on lint and apply where\\nthe skin is broken.\\n(Bellevue Hospital, N. Y.)\\nR. Cerati resinse, Sij\\n01. terebinth., f3ij\\nPhenol sodique, f3j. M.\\nS. Apply on linen or lint. (Read.)\\nR. Sodii bicarb., gij\\nAquae, Oij. M.\\nS. Apply freely, on lint.\\nR. Cerati resinse,\\n01. terebinth.,\\nS. Apply on lint.\\nR. Acidi salicylici\\n01. olivae\\n5j\\nf3j. M.\\n(Agnew.)\\n5j\\nfSiij.\\nM.\\nS. Apply to burn, covering with lint,\\n(Bartholow.)\\nCARBUNCLE.\\nR. Acidi carbolici, gr. viij\\nAquse destil., fsj. M.\\nS. Make several injections into differ-\\nent parts of the induration. Not more\\nthan 5j of this solution should be used\\nat one treatment. The injection may\\nbe repeated, if necessary, in three days.\\nR. Tr. iodi, f3%. M.\\nS. Paint around the carbuncle until\\nvesication is produced.\\n(Furneaux Jordan.)\\nR. Pulv. opii,\\nUnguent, hydrarg.,\\nSaponis durse, aa V/*. M.\\nS. Apply spread on thick leather.\\nApply a flaxseed poultice, over the\\ncentre of which has been spread a little\\ncoarsely-powdered crude soda. Subse-\\nquently dress with compound resin\\nointment, which should be applied very\\nwarm and should be covered with oiled\\nsilk. Change the dressing every six\\nhours. (Agnew.)\\nCARIES.\\nR. Syrup, hypophos. comp.,\\n(N. F.),\\n01. morrhu., aa fjiv. M.\\nS. 3ij four times daily.\\nR. Syrup, calcii lactophos-\\nphat. (U. S. P.), fsvj. M.\\nS. A teaspoonful three or four times a\\nday. (Bartholow.)\\nR. Hydrogen peroxide (Mar-\\nchand), fSvj. M.\\nS. Apply with an atomizer or small\\nsyringe.\\nR. Cupri sulphat.,\\nZinci sulphat., aa gr. xv\\nLiq. plumbi subacetat., i 3ss\\nAceti alb., fsiiiss. M.\\nS. Inject through the sinuses.\\n(Liqueur de Villate.) (Notta.)\\nCHANCRE.\\nR. 01. lavand., Kxx\\nIodoformi,\\nLycopodii, aa Sij. M.\\nS. Dust on part and cover with lint.\\nR. Cupri subacetat.,\\nHydrarg. chlor. mit., aa gr. x. M.\\nS. Dust over sore. (Ellis.)\\ngr. viij\\nfSij. M.\\nR. Hydrarg. chlor. mit., gr. vii\\nLiq. calcis, fgij.\\nS. Shake and use as a wash. (Black\\nwash.)\\nR. Hydrarg. chlor. corros., gr. iv\\nLiq. calcis, f3ij. M.\\nS. Shake and use as a wash. (Yellow\\nwash.)\\nR. Hydrogen peroxide, f3j. M.\\nS. Use as a wash and apply on lint.\\nIf too strong, may be diluted.\\n(Ringer.)\\nCHANCROID.\\nActual cautery and dress antisepti-\\ncally.\\nR. Acidi sulphurici,\\nPulv. carbonis ligni, aa 5ss.\\nq. s. ft. magma. M.\\nS. Dry the sore and apply thoroughly\\nby means of a wooden spatula. Allow\\nartificial eschar thus formed to separate\\nspontaneously, using no dressing.\\n(Ricord.)", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0320.jp2"}, "321": {"fulltext": "SURGERY.\\n319\\nCauterize with nitric acid, protecting\\nthe surrounding parts by oil.\\nR. Iodoform., 5ij\\n01. menth. pip., Ux. M.\\nS. Dust on sore and cover with moist\\nlint.\\nR. Bismuth, subiodid., 3ij. M.\\nS. Dust on sore and cover with dry\\nlint. (Chassaignac.)\\nR. Pulv. acidi salicylici, 5ij. M.\\nS. Dust on sore and cover with dry\\nlint. (Anglada.)\\nCHORDEE.\\nHot sitz bath for one-half to one hour\\nbefore retiring, or steeping penis for the\\nsame length of time in hot water.\\nR\\nExt. opii,\\ngr.\\nvj\\nExt. hyoscyami,\\ngr.\\niij\\n01. theobrom. q. s\\nM.\\nEt ft. suppos. No.\\nvj.\\ns.\\nIntroduce one into the rectum at\\nbedtime, and repeat if\\nnecessary\\nR.\\nExt. opii,\\ngr.\\nvj\\nExt. belladon.,\\ng r\\niss\\n01. theobrom. q. s\\nEt ft. suppos. No.\\nM.\\nvj.\\nS. Introduce one into the rectum at\\nbedtime.\\nR. Ext. opii aquos., gr. ix\\n01. theobrom., q. s. M.\\nFt. suppos. No. vj.\\nS. Introduce one into rectum on re-\\ntiring. (Van Buren and Keyes.)\\nR. Liq. morph. sulph., f3iv\\nAtrop. sulph., gr. j\\nAcidi aceti, q. s.\\nAquae destil., q. s. ad. fsj. M.\\nS. Five to eight minims hypodermi-\\ncally at bedtime. (Sturgis.)\\nR. Ext. opii., gr. iv\\nPulv. camphorae, gr. viij.\\nEt ft. pil. No. iv. M.\\nS. One or two pills on retiring.\\n(Van Buren and Keyes.)\\nR. Sodii bromidi, 5ij to iv\\nCamphor.,\\nLupulin., aa gr. x. to xx\\nFt. chart. No. x. M.\\nPut in waxed papers.\\nS. One powder morning and evening.\\n(Finger.)\\nR. Pulv. opii, gr. vj\\nPulv. camphorae, gr. xij\\nSacch. alb. q. s. M.\\nEt ft. capsul. No. vj.\\n8. One at bedtime, and repeat in two\\nhours if necessary. (Sturgis.)\\nCYSTITIS.\\nHot sitz baths one-half to one hour,\\nt. d.\\nHot flaxseed-meal poultices over lower\\nabdomen.\\nR. Tr. aconit., f3j\\nSpts. aeth. nitros., fsj\\nLiq. potass, cit., q. s. ad. fSvj. M.\\nS. One dessertspoonful every four\\nhours until all fever ceases and the\\npulse is quiet. (Hare.)\\nR. Potass, bicarbonat., 5iv\\nExt. hyoscyami fl., f5ij\\nExt. ergot, fld., f3iy\\nsyrup, simp., fSij\\nAquae, q. s. ad., fSvj. M.\\nS. A dessertspoonful every two to four\\nhours.\\nR. Infus. buchu, fSvij\\nPotass, bicarb., 5j\\nTr. hyoscyami, f3ijss\\nExt. sarsa fl., f5iv. M.\\nS. Two tablespoon fuls three times a\\nday. (In irritable bladder with acid\\nurine.) (Coulston.)\\nR. Potass, citrat., Sss\\nSpts. chloroformi, f3ijss\\nTr. digitalis, 51xxx\\nInfus. buchu, fSviij. M.\\nS. Two tablespoon fuls three or four\\ntimes a day. (Fothergill.)\\nR. Copaibae,\\nSpts. lavan.comp., aa f3ij\\nMucil. acaciae, fSss\\nSyrup, simp., f3iij\\nAquae, fSiv. M.\\nS. A tablespoonful twice daily.\\n(Wood.)\\nR. Atropinae sulph., gr. j\\nAcidi acet., gtt. xx\\nAlcoholis,\\nAquae, aa fSss. M.\\nS. Four drops in a wineglass of water\\nbefore each meal.\\nR. Salol, 5j\\nFt. capsul. No. xij. M.\\nS. One capsule three times a day up to\\ntwo six times daily p. r. n.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0321.jp2"}, "322": {"fulltext": "320\\nSURGERY.\\nR. Acid, boric, 5j\\nAquae, q. s. ad. fgvj. M.\\nS. Two tablespoonfuls three to four\\ntimes a day.\\nR. Phenol sodique, fSij. M.\\nS. Add two tablespoonfuls to a pint\\nof warm water and inject into the\\nbladder once or twice a day.\\nR. Potass, permanganat., 5j\\nAquae, fsj. M.\\nS. Add one teaspoonful to a pint of\\nwarm water and inject into the bladder\\nonce or twice a day.\\nR. Acid, boric, 5iv\\nAquae destil., Oj. M.\\nS. Warm and inject into the bladder\\nonce or twice daily.\\nR. Argent, nitrat., gr. vij\\nAquae destil., fsiijss. M.\\nS. Inject into the bladder every third\\nor fourth day, after washing it out with\\nwarm water.\\nFor profuse suppuration\\nR. Hydrogen peroxide (Mar-\\nchand), fSss\\nAquas destil., q. s. ad. fSiv. M.\\nS. Inject daily, increasing the strength\\nof the solution if it does not give pain.\\nEPISTAXIS.\\nR. 01. erigeron. canad., f5ij. M.\\nI?;\u00e2\u0084\u00a2 a\u00e2\u0084\u00a2\u00e2\u0080\u009e* o fifteen\\nKJl. CllgClUU. UitllitU., l C lJ- J-\\nS. Five drops on sugar every lift\\nminutes as required. (Willard\\nR. Ext. hamamel. fl., fSij. M.\\nS. A teaspoonful every one to three\\nhours. (If pulse is rapid and bounding\\nadd veratrum viride and morphine.)\\n(J. V. Shoemaker.)\\nR. Pulv. acid, tannic, 5ij. M.\\nS. Insufflate after a small quantity of\\ncocaine has been applied. (Ingalls.)\\nR. Pulv. aluminis,\\nPulv. acid, tannic, aa 5j. M.\\nS. Insufflate into the anterior and\\nposterior nares. (Sajous.)\\nERYSIPELAS.\\nR. Tr. ferri chlor.,\\nSyr. simp., aa f5j\\nAquas, fSij. M.\\nS. A teaspoonful every two or three\\nhours, well diluted.\\n(Charity Hospital, N. Y.)\\nR. Potassii permanganat., gr. vj\\nAquae destil., ?3vj. M.\\nS. A tablespoonful three times a day.\\n(Keep in glass-stoppered bottle.)\\n(Bartholow.)\\nIn the early stage, in plethoric cases,\\nDaCosta recommends pilocarpine in\\nsweating doses to gr. hypodermi-\\ncally).\\nR. Campho-phenique, fSij. M.\\nS. Scarify the affected area, particu-\\nlarly at the spreading borders of in-\\nflammation and slightly beyond, and\\napply gauze or lint wrung out in this\\nmedicament or it may be applied\\nwithout scarification.\\nR. Ichthyol.,\\nVaselin., aa Sss. M.\\nS. Wash thoroughly with hot soap-\\nsuds and apply on lint thickly spread.\\n(Nussbaum.)\\nR. Argent, nitrat., gr. lxxx\\nAquae destil., fgiv. M.\\nS. Paint two or three times all over\\nand a little beyond. (Higginbottom.)\\nR. Plumb, acetat., 5j\\nTinct. opii, fsj\\nAquae, q. s. ad. Oj. M.\\nS. Shake the bottle well and wet\\ncloths or lint thoroughly with the lo-\\ntion and apply to the affected parts.\\n(Charity Hospital, N. Y.)\\nFISSURE.\\nR. Ext. hydrastis fl.,\\nS. Apply to fissure.\\nfSj. M.\\n(Bartholow.)\\nR\\nAcidi carbolic, gr. xxiv\\nAquae, f3j. M.\\nS. Apply several times daily.\\n(Parvin.)\\nR. Cocaine hydrochlor., gr. iv\\nAquae destil., fsj. M.\\nS. Apply to nipples and wash off well\\njust before nursing.\\nIf the fissure is deep and slow to heal,\\ntouch with solid stick nitrate of silver.\\nR. Bismuth, subnit., 5j\\n01. ricin.. foij. M.\\nS. Rub in affected parts. (Hirst.)", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0322.jp2"}, "323": {"fulltext": "SURGERY.\\n321\\nR-. Potassii bromid.,\\nGlyceriui,\\nS. Apply locally.\\nSj\\nf5v. M.\\n(Ringer.)\\nR. Iodoform.,\\nAcid, tannic, aa 5j. M.\\nS. Fill fissure with the powder and\\ndust over it. (Bartholow.)\\nR-. Plumb, nitrat., gr. x\\nGlycerini, fSj. M.\\nS. Apply after each nursing, carefully\\nwashing before next nursing.\\nFISTULvE.\\nR. Hydrogen peroxide, fSvj. M.\\nS. Inject once daily dilute if neces-\\nsary.\\nR-. Cupri sulphat,,\\nAquae,\\nS. Inject once daily.\\n^r. ij to iv\\n3iv. M.\\n(Sir A. Cooper.)\\nR-. Argent, nitrat., gr. ij\\nAquae destil., fSviij. M.\\nS. Inject once daily. (Fistula in ano.)\\n(Druitt.)\\nR. Tr. iodi, f5j. M.\\nS. Inject once daily. (Waring.)\\nTouch with solid stick of argent, nit.\\nGLANDS, ENLARGED.\\nIJ.. Syr. ferri iodid., fsj. M.\\nS. Five to thirty drops, well diluted,\\nafter each meal.\\nIfr. Oleat. hydrarg. (U. S. P.), Sj. M.\\nS. Rub over the enlarged glands once\\ndaily.\\nR. Tr. iodi., f3j. M.\\nS. Paint over enlargements thoroughly\\nand repeat as soon as the dark color com-\\nmences to disappear.\\nI\u00c2\u00a3. Cadmii. iodid., gr. xxtoxxx\\nAdipis, 3j. M.\\nS. Apply morning and evening.\\nR-. Ichthyol., 5iij\\nAdipis, 5vij. M.\\nS. Use as inunction morning and even-\\ning. (Agnew.)\\nR% Acidi carbolici, gr. viij\\nAquae destil., isj. M.\\nS. Inject five to ten minims into the\\nenlarged gland.\\n21\\nGONORRHOEA.\\nR-. Hydrarg. chlor. corros., gr. iij\\nSodii chloridi, gr. vj\\nAquae, 13 j. M.\\nS. Add one teaspoonful of the mixture\\nto one pint of hot water and flush urethra\\nthoroughly one or two times a day.\\n(Males.)\\nfy. Hydrarg. chlor. corros., gr. xv\\nSodii chloridi, gr. xxx.\\nAquse, t Sj. M.\\nS. Add two teaspoonfuls of the mix-\\nture to two pints of hot water and flush\\nvagina thoroughly three times a day.\\n(Females.)\\nIJ.. Hydrarg. chlor. corros., gr.^tol%\\nZinci sulpho-carbolat., gr. ij to x\\nAcidi boric, 5j\\nHydrogen peroxide, fsj\\nAquae destil., q. s. ad. fSviij. M.\\nS. Use as an injection from four to six\\ntimes a day, immediately after urina-\\nting. (White.)\\nIJ*. Zinci sulpho-carbolat., gr. vj\\nMorph. sulph., gr. iij\\nAquae destil., fSiij. M.\\nS. Use as an injection from four to six\\ntimes a day, after urinating.\\nR% Zinci sulphatis,\\nAcidi tannici, aa gr. xv\\nAquae rosae, fSvj. M.\\nS. A tablespoonful injected two or\\nthree times a day. (Ricord.)\\nfy. Zinci chloridi, gr. j to ij\\nAquae destil., fgvj. M.\\nS. Inject once or twice daily.\\n(Levis.)\\nR-. Zinci sulphatis, J5j\\nAluminis, giij. M.\\nS. Dissolve a teaspoonful in one pint\\nof water and inject three times a day.\\n(Females.) (Hazard.)\\nR-. Liq. plumbi subacetat.\\ndil., fSj\\nExt. opii aquos., gr. vj. M.\\nS. Use as an injection two to four\\ntimes daily. (Van Buren and Keyes.)\\nR. Zinci sulphat., gr. j to iij\\nLiq. plumbi subacetat.\\ndil., fgj. M.\\nS. Shake and inject three to four times\\ndaily. (Van Buren and Keyes.)", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0323.jp2"}, "324": {"fulltext": "322\\nSURGERY.\\nR-. Potassii permanganatis, gr. j to iij\\nAquas destil., fSj. M.\\nS. Use as an injection. (Gleet.)\\n(Van Buren and Keyes.)\\nR-. Argent, nitratis, 5j\\nAquas destil., fjij. M.\\nS. Apply thoroughly by means of a\\ntubular speculum. (Females.\\n(Grandin.)\\nI*\\nSalol,\\n5j to ij\\nOleoresin. cubeb., aa\\nSj\\nPara balsam copaib.,\\n3ij\\nPepsin,\\ngr. xij\\nEt ft. capsul. No. xxiv.\\nM.\\ns.\\nTake two capsules six times a day\\n(White.)\\nLiquor potasses,\\nBalsam, copaibas,\\nftj\\nfgss\\nTr. cubebas.\\nf3vj\\nMorphinse sulph., gr. ij\\nAquse camphoras, q. s. ad. f3vj. M.\\nS. Take a tablespoonful four times a\\nday. (Agnew.)\\nty. Potass, citratis, Sss to j\\nSpts. limonis, fsss\\nSyr. simplicis, fgij\\nAquse, fsj. M.\\nS. A dessertspoonful, well diluted,\\nthree or four times a day. (In first\\nstage.) (Van Buren and Keyes.)\\nR-. Potass, citratis, 3ij to vj\\nBalsam, copaibas, 3iij to vj\\nExt. hyoscyami li., f5ss to ij\\nSyr. acacias, fsiss\\nAqua? menth.pip.,q.s.ad. fgiij. M.\\nS. Take a teaspoonful in water three\\nor four times a day.\\n(Van Buren and Keyes.)\\nS.\\nday\\nBalsam, copaibas,\\nSpts. aeth. nitrosi,\\nLiq. potassas,\\nExt. glycyrrhizas,\\nM. et ad\\n01. gaultherias,\\nSyr. acacias,\\nOne tablespoonful\\nf5ij\\ngtt. xvj\\nfgyj. M.\\nthree times\\n(Bumstead.)\\nR-. Balsam, copaibas,\\nSpts. astheris nitrosi,\\nSpts.lavand. comp., aa fsss\\nLiq. potassas, fsj\\nMucil. acacias, q. s. ad. f3iv. M.\\nS. Shake and take one tablespoonful.\\n(Lafayette mixture.)\\n(Charity Hospital, N. Y.)\\nH^EMATEMESIS.\\nR. Liq. ferri subsulphatis, fSss. M.\\nS. One to two drops in ice water, fre-\\nquently. (Bartholow.)\\nR-. Destillat. hamamelis, f3ij. M.\\nS. Two to four drops every two or\\nthree hours. (Ringer.)\\nErgo tin., gr. xij\\nAquas destil., f3j. M.\\nS. Five to ten minims hypodermically\\nevery two to four hours. (Wood.)\\nR-. Plumbi acetatis, gr. xij\\nExt. opii, gr. iij.\\nFt. pil. No. vj. M.\\nS. One pill every two or three hours\\nuntil bleeding ceases. (Wood.)\\nR\\\\ Ext. ergot., 3j\\nFt. capsul. No. xij. M.\\nS. One capsule every two hours. May\\ngive morphine or opium to quiet.\\n(Wood.)\\nty. Acidi tannici, 5iij\\nAquas, fsj. M.\\nS. Teaspoonful in water every half-\\nhour until bleeding stops.\\nNote. Do not give Monsel s solution\\nand tannic acid to same patient, since\\nit forms tannate of iron=Ink.\\nHEMATURIA.\\nR-. Aluminis, gr. xxiv\\nAquas, ?Sviij\\nS. Inject into bladder only if hemor-\\nrhage is alarming, since it forms clots\\nwhich may become septic. (Hare.)\\nR\\\\ Acid, gallici, 5j\\nAcid, sulphuric, dil., f5ij\\nAquas, q. s. ad. fgviij. M.\\nS. Teaspoonful in water e^ery four\\nhours. (Hare.)\\nErgot and other internal remedies\\nsame as bleeding from lungs, bowel, etc.\\nR. Olei terebinthinas, f3x\\nMagnesii sulph., 5j\\nPulv. uvas ursi, 5j\\nAquas camphoras, fSviij. M.\\nS. Shake well. Take two tablespoon-\\nfuls every two hours. (Smith.)\\nHEMOPTYSIS.\\nfy. Liq. ferri subsulphatis,\\ngtt. xx to xxx\\nAquas destil., fgiv. M.\\nS. Use in an atomizer every few min-\\nutes. (Hare.)", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0324.jp2"}, "325": {"fulltext": "SURGERY.\\n323\\nR. Acidi tannici, gr. xx\\nGlycerinae, foij\\nAquae destil., q. s. ad. fgviij. M.\\nS. Use in atomizer frequently.\\n(Hare.)\\nAvoid using Monsel s solution and\\ntannic acid on same patient=Ink.\\nR. Aluminis, gr. vj\\nAquae destil., fSiij. M.\\nS. Use in an anatomizer frequently.\\n(Hare.)\\nR. Plumbi acetat., gr. xx\\nPulv. digitalis, gr. x\\nPulv. opii, gr. v\\nFt. pil. No. x. M.\\nS. One pill everv four hours.\\n(Bartholow.)\\nUse opium or morphine to quiet pa-\\ntient.\\nHEMORRHOIDS.\\nR. Acidi gallici, gr. x\\nExt. opii,\\nExt. belladonna?, aa gr. iv\\nUng. simplicis, 5iv. M.\\nS. Apply night and morning.\\n(Hare.)\\nR. Ext. hamamelis fl., fsiv. M.\\nS. Inject some into the rectum and\\napply pledgets of lint soaked in this\\nsolution. (Hare.)\\nR. Cocain. hydrochlor., gr. ij\\nExt. belladonna?, 5j\\nAcidi tannici, 5ij\\nUng. petrolati, 5j. M.\\nS. Apply night and morning.\\n(Alrich.)\\nR. Ext. opii, gr. x\\nPulv. stramonii, 5j\\nPulv. tabaci, 5ss\\nUng. simplicis, Sss. M.\\nS. Use locally. (Shoemaker.)\\nR. Iodoform., Sij to iv\\nAdipis benzoat., gj. M.\\nS. Apply locally after washing.\\nR. Tr. nucis vomicae, f5j\\nExt. ergot, fl., fgj. M.\\nS. One teaspoonful three to four times j\\na day. (For bleeding piles.)\\n(Bartholow.)\\nINCONTINENCE OF URINE.\\nR. Strychninae sulph., gr.j\\nPulv. cantharidis, gr. ij\\nMorph. sulph., gr. iss\\nFerri redacti, gr. xx.\\nFt. pil. No. xl.\\nS. One pill three times a day to\\nchild ten years old. (Gross.)\\nR. Chloral hydratis, 5j\\nSyr. tolutani, fgiiss. M.\\nS. One teaspoonful three times daily.\\n(For infantile incontinence.)\\n(Da Costa.)\\nR. Santonini, gr. xyj\\n01. ricini, fgj. M.\\nS. One to two teaspoon fuls before\\nbreakfast for two or three mornings.\\n(Ringer.)\\nR. Acidi arsenosi, gr. y\\nExt. nucis vomicae, gr. ij\\nFt. pil. No. xx. M.\\nS. One pill three times a day after\\nmeals. (For a child eight to ten years\\nold, when trouble is due to weakness of\\nspinal centres.) (Hare.)\\nR. Potass, citrat., Sss\\nSpts. aeth. nit., f5vi\\nAquae, q. s. ad. fgvj. M.\\nS. A dessertspoonful every four hours\\nin water. (Where urine is concentrated\\nand dark in color.) (Hare.)\\nR. Tr. cantharidis, f3j. M.\\nS. One drop three times a day. (In\\nhysterical females.) (Hare.)\\nINFLAMMATION.\\nFever Mixtures.\\nR. Potass, bromid., 3iv\\nTr. belladonna?, flxxxij\\nTr. aconit. rad., gtt. viij\\nSpts. aeth. nit., foiij\\nMist, potass, cit., q. s. ad. fgviij. M.\\nS. One tablespoonful every two to\\nthree hours. Keep in a cool place.\\n(White.)\\nR. Morph. acetat., gr. j\\nSacchar. alb., Sij\\nSpts. aeth. nit., f5ij\\nLiq. ammonii acet., fgiv\\nAquae camphorae,q.s. ad. fgviij. M.\\nS. One tablespoonful every two to\\nthree hours. (Ashhurst.)\\nR. Morph. acetat., gr.\\nTr. aconit., *2x\\nSpts. aeth. nit., f5iij\\nMist, potass, cit., q. s. ad. fgvj. M.\\n8. Two teaspoonfuls every one to two\\nhours.\\nLaxatives.\\nR. Hydrarg. chlor. mit., gr. iij\\nSodii bicarb., 5j\\nFt. pulv. No. xxiv. M\\nS. One powder every hour.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0325.jp2"}, "326": {"fulltext": "324\\nSURGERY.\\nR. Hydrarg. chlor. mit., gr. iv\\nSodii bicarb., 5j\\nPepsina?, 5ss M.\\nFt. pulv. No. xxiv.\\nS. One powder every hour.\\nAdd 5ij of Rochelle salts to the white\\npaper of a Seidlitz powder, take it and\\nfollow it every two hours by 5ij of Ro-\\nchelle salts until bowels move.\\n(Goodell.)\\nR. Syr. rhei aroniat., fSss\\nAquae, fSij\\nMagnesii sulph., q. s. ad. sat. sol. M.\\nS. A teaspoon ful every hour or two\\nuntil bowels move.\\nR. Hydrarg. chlor. mit., gr. j\\nSacch. lactis, 5j M.\\nFt. pulv. No. xij.\\nS. One powder every one to three\\nhours. (For children.)\\nR. Pulv. glycyrrhiza? comp. gss. M.\\nS. One teaspoon ful in water. Repeat\\nevery two hours if necessary.\\nINGROWING NAIL.\\nR. Liquor potassse, fsij\\nAqua? destil., fgj. M.\\nS. Apply with pledgets of cotton.\\n(Norton.)\\nR. Pulv. plumbi acetat., 5j\\nTr. opii, fsj\\nAqua?, fgviij. M.\\nS. Shake well, and apply constantly\\non cotton until inflammation is re-\\nduced; then separate nail from gran-\\nulating surface by means of a small\\npledget of cotton and use\\nR. Argent, nitratis, gr. xxx\\nAqua? destil., fsj. M.\\nS. Paint two or three times daily.\\n(Davidson.)\\nLARYNGISMUS STRIDULUS.\\nPotassii citratis,\\n5j\\nSyr. ipecac,\\nf3ij\\nTr. opii deod.,\\ngtt. xij\\n?3ij\\nSyr. simplicis,\\nAquse,\\nfSiss. M\\nS. A teaspoon ful every two hours at\\ntwo years of age. (In severe form.)\\n(Meigs and Pepper.)\\nR, Syrupi ipecacuanha?, fsij. M.\\nA teaspoonful every fifteen minutes.\\nR. Amyl. nitrit., f3j. M.\\nS. Three to five drops on a handker-\\nchief by inhalation. (Wood.)\\nR. Tr. belladonna?, f3j. M.\\nS. Five to fifteen drops every hour,\\naccording to age. (Hare.)\\nLEUC0RRHO2A.\\nR. Aluminis, Siv. M.\\nS. Add to one pint of warm water and\\nuse as a wash morning and evening.\\ngr.J\\ngr. vj.\\nM.\\nR. Ext. belladonna?,\\nAcidi tannici.\\nFt. pulv. No. j.\\nS. Place on a pledget of cotton and\\napply to diseased portions daily.\\n(When dependent on disease of cervix.)\\n(Troscall.)\\nR. Acid, arseniosi,\\nFerri redact.,\\nQuin. sulph.,\\nFt. pill. No. xx.\\nS. One pill after each meal, for adult.\\n(Hare.)\\ngr. ij\\ngr. xx M.\\nR. Tr. ferri chloridi, f5.j\\nTr. cinch, comp., fsij\\nTr. gent, comp., q. s. ad. fsiv. M.\\nS. One dessertspoonful after meals.\\n(Hare.)\\nR. Iodi resublimat, 5iv\\nAcid, carboliei crystal.,\\nCblorali, aa gj. M.\\nS. Rub the iodine and chloral in a\\nglass mortar and add the carbolic acid.\\nTo be used by the physician only. Vagi-\\nnal surfaces and cervix to be painted\\nwith it. (Goodell.)\\nR. Sodii bicarb., 5j\\nTr. belladonna?, f3ij\\nAqua?, Oj. M.\\nS. Use as a vaginal wash morning and\\nevening. (Ringer.)\\nR. Potassii permanganat., 5ij\\nFt. pulv. No. iv. M.\\nS. Add to a pint of warm water and\\ninject morning and evening. (When\\ndischarge is fetid.) (Girwood.)\\nR. Zinci sulphat., fSj\\nAlumin. sulph., 3j\\nGlycerina?, fSvj. M.\\nS. Add a teaspoonful to a quart of\\nwater and inject twice a day.\\n(Thomas.)", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0326.jp2"}, "327": {"fulltext": "SURGERY.\\n325\\nty. Acidi tannic! giv\\nGlycerins;, fSxvj. M.\\nS. Add a tablespoon ful to a quart of\\ntepid water and inject into vagina for\\nfive minutes morning and evening by\\nmeans of a fountain syringe.\\n(Thomas.)\\nft. Sodii biboratis, 5ij. M.\\nS. A teaspoonful to a pint of tepid\\nwater as a vaginal wash. (For leucor-\\nrhoea of pregnancy.) (Parvin.)\\nR-. Iodoformi, 5j\\nAcidi tannici, 5j. M.\\nS. Pack a sufficient quantity around\\nthe cervix. (Bartholow.)\\nLUMBAGO.\\n1^. Atropinae sulphatis, gr. j\\nMorphinse sulphatis, gr. xvj\\nAqua? destil., fsj. M.\\nS. Five minims injected deeply into\\nmuscles of the back.\\nR. Antipyrin, 3j\\nSyr. tolutani, fgj\\nAq. menth. pip., q. s. ad. fgiv. M.\\nS. A teaspoonful every one to four\\nhours for three to six doses.\\n(Germain See.)\\nR. Methyl chloride, gss. M.\\nS. Use locally, applying carefully.\\n(Debove.)\\nR. Tr. iodi, fsij\\nTr. aconiti rad., f3iij\\nchloroformi, f3iv\\nLiniment, sapon. comp.,\\nq. s. ad. fgiij. M.\\nS. Apply every few hours locally.\\n(Bellevue Hospital, N. Y.)\\nR. Potass, iodidi, 5ss\\nTr. opii deodorat., f3ij\\nSpts. lavandulse comp., f3j\\nSpts. geth. nit., fgss\\nAquae destil., fgxij. M.\\nS. Take two tablespoon fuls twice daily.\\n(Brodie.)\\nR. Potass, iodidi,\\nPotass, carbonatis, iia. 3j\\nTr. aconiti rad., fgij\\nAquae destil., fSx. M.\\nS. Apply locally every few hours.\\n(Erichsen.)\\nR. Chloroformi, fsij. M.\\nS. Twenty minims injected deeply in\\nregion of pain\\nLUPUS.\\nR. Zinci chloridi, 5j\\nMorph. sulph., gr. ss\\nPulv. acac, 5iij. M.\\nS. Make into a paste by adding a kw\\ndrops of water or alcohol and spread a\\nthin layer over and just beyond the\\nulcer. Use carefully. (Agnew.)\\nR. Ichthyol., 5j\\nAdipis benzoat., 3v. M.\\nS. Apply over affected part. (Hare.)\\nR. Tr. iodi, f3ij. M.\\nS. Paint around the growth apply to\\nretard its spread over the surface also.\\nR. Liquor hydrargyri nit., f5j. M.\\nS. Use with a glass rod until growth\\nis on a level with the skin use care-\\nfully, protecting surrounding parts with\\nlard or oil.\\nR. Acidi pyrogallici, 5j\\nOerati simplicis, 3ix. M.\\nS. Apply locally. (For lupus of eye-\\nlids and skin.) (Kaposi.)\\nApply locally a saturated solution of\\nmuriate of cocaine. (Fowler.)\\nR. Resorcin,\\nVaselini,\\nS. Apply locally.\\n3iiss\\n5iv. M.\\n(Bertarelli.)\\nMAMMARY INFLAMMATION.\\nR. Morph. sulph., gr. x\\nHydrarg. oleat., 5ss\\nAcidi oleici, Sixss. M.\\nS. Anoint three times a day.\\n(Marshall.)\\nIJ.. Ext. belladonna?, 3j\\nLiq. plumbi subacetat.\\ndil., Oj. M.\\nS. Use as a lotion. (Graefe.)\\nS. A tablespoon ful of granular effer-\\nvescent citrate of magnesia in water,\\nfollowed by ten grains of quinine if\\nthere be fever. (In incipient mammi-\\ntis.) (Starr.)\\nR. Cerati resinse co., 3j\\nOlei oliva?, 5j to ij M.\\nFt. ungt.\\nS. Apply, spread generously on a soft\\nrag. (When suppuration is threatened.)\\n(Witherstine.)", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0327.jp2"}, "328": {"fulltext": "326\\nSURGERY.\\nNEURALGIA.\\nR. Ext. aeonit., gr. ij\\nAdipis benzoat., 5j. M.\\nS. Apply over painful parts if limited\\nin area.\\nRhigolene or ether in an atomizer is\\noften effectual if pain is superficial.\\nR. Antipyrin., 5j\\nCaffein. citrat., gs. xx. M.\\nFt. chart. No. x.\\nS. One every thirty minutes until re-\\nlieved. Or,\\nIJ.. Antipyrin., 5j\\nCaffein. citrat., gr. x\\nPotass, bromid., 3iij. M.\\nFt. chart. No. x.\\nS. One every thirty minutes until re-\\nlieved. (Hare.)\\nSometimes acupuncture is useful or\\ndeep hypodermic injections of morph.\\nsulph.\\nR. Tr. cannabis indicas, fgij. M.\\nS. Twenty drops every hour. (Mi-\\ngraine.) (Wood.)\\nR. Methyl, chlorid. pur., fgj. M.\\nS. Apply to painful parts with a brush\\nor atomizer.\\nR. Chloroformi, f5j\\nVaselin. liq., f3iv. M.\\nS. Fifteen to thirty minims hypoder-\\nmically at seat of pain. (Meunier.)\\nR. Menthol., gr. xxiis\\nCocain. muriatis, gr. viiss\\nChloral, hydratis, gr. ivss\\nVaselin., 3iiss. M.\\nS. Apply to painful part and cover\\nwith strip of court plaster. (Supra-\\norbital neuralgia.) (Galezowski.)\\nR. Quin. sulph.,\\nMorph. sulph.,\\n5j\\nAcidi arseniosi, aa\\ngr. iss\\nExt. aconiti,\\ngr. xv\\nStrych. sulph.,\\ngr. j. M.\\nFt. pil. No. xxx.\\nS. One pill three times\\ni day.\\n(Gross.)\\nR. Phenacetin.,\\ngr. xj. M.\\nFt. pulveres No. x.\\nS. One or two powders\\nevery three or\\nfour hours.\\nPlace a small pledget of cotton soaked\\nin chloroform over painful spot and\\nconfine fumes by covering with a small\\nglass or a pill-box.\\nONYCHIA.\\nR. Pulv. plumbi nitrat., gss. M.\\nS. Dust on diseased tissue night and\\nmorning. (Scott and McCormack.)\\nIn the early stages a couple of leeches\\nabove the nail will have a good effect.\\n(Agnew.)\\nUse hot flaxseed poultices for three or\\nfour days, before each renewal of the\\npoultice, thoroughlv washing with\u00e2\u0080\u0094\\nR. Tr. iodi,\\nTr. belladonnas,\\nTr. opii, aa f5ij. M.\\nThen dust with iodoform and dress\\nantiseptically. (Agnew.)\\nR. Acidi arseniosi,\\nGlycerol, amyli,\\nS. Apply on a soft rag.\\nSj. M.\\n(Agnew.)\\nR. Ung. hydrargyri, gss. M.\\nS. Apply for ten minutes every hour,\\napplying poultices at other times.\\n(Ringer.)\\nR. 01. terebinthinas, fgij. M.\\nS. Apply a pledget of lint wet with\\nthe solution. (Ringer.)\\nORCHITIS.\\nKeep the testicles elevated.\\nStrap with adhesive strips.\\nFirst envelop scrotum in thick layer\\nof cotton over this rubber dam then\\nuse an ordinary suspensory that is close\\nfitting. (Horand-Langlebert.)\\nR. Iodi, gr. iv\\nLanolin, gj. M.\\nS. Apply locally (after acute symptoms\\nare past).\\nR. Ung. hydrarg.,\\nUng. belladonnas, aa gss. M.\\nS. Apply locally morning and even-\\ning.\\nR. Potass, iodidi, 5iv to viij\\nSyr. sarsaparillas comp., fgiij\\nAquas, q. s. ad. fgvj. M.\\nS. Two teaspoonfuls three times a day.\\nR. Tr. iodi, fsij. M.\\nS. Paint affected parts after acute\\nrmptoms are over.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0328.jp2"}, "329": {"fulltext": "SURGERY.\\n327\\n1$.. Morphinse sulphatis, gr. viij\\nHydrargyri oleatis (10\\nper cent.), 5j. M.\\nS. Apply twice daily. (For subsequent\\ninduration.) (Marshall.)\\nPROSTATITIS.\\nLeeches to the perineum.\\ngr. viij\\ngr. ij. M.\\nR. Ext. opii aquos.,\\nExt. belladonna;,\\nFt. suppos. No. viij.\\nS. Introduce one into the rectum and\\nrepeat on return of pain.\\nVery hot or very cold water injected\\ninto the rectum, against the prostate\\nthrough a two-way rectal tube, from\\ntwo to four quarts at a time, three or\\nfour times a day.\\nI}.. Ext. opii aquos., gr. viij\\nExt. hyoscyami, gr. iv. M.\\nFt. suppos. No. viij.\\nS. Insert one into the rectum and re-\\npeat when necessary.\\nR. Liq. potassse, foij to iv\\nExt. hyoscyami, 3j to iv\\nSyr. aurant. cort.,\\nAquse cinnamomis, aa fSiij. M.\\nS. A tablespoonful in a wineglass of\\nwater every eight hours.\\n(Van Buren and Keyes.)\\nR. Potass, bicarbonat., 5iv\\nExt. hyoscyami fl., f5ij\\nSyrupi simp., fsij\\nAquse, q. s. ad. fSvj. M.\\nS. A dessertspoonful every two to four\\nhours.\\nPRURITUS.\\n1$.. Acid, carbolici, f5j to f5ij\\nAquse destil., q. s. ad. Oj. M.\\nS. Apply as a lotion several times a\\nday.\\nR. Liq. carbonis deterg., fgij\\nAquse, q. s. ad. Oj. M.\\nS. Apply as a lotion.\\nR. Acidi carbolic,\\nAdipis benzoin.,\\nUng. petrol., aa\\nS. Apply as an ointment.\\nR. Chloroformi,\\nAdipis benzoin.,\\nS. Apply as an ointment.\\ngtt. v to xx\\n3j-\\nM.\\n5x to xx\\nSij. M.\\nR. Argent, nitratis gr. xx\\nAquse destil., fsj. M.\\nS. Paint affected parts (in obstinate\\ncases).\\nfy. Hydrarg. chlor. eorros., gr. j\\nPulv. aluminis, 9j\\nPulv. amyli, 5iss\\nAquse, f5vj. M.\\nS. Apply locally. (Goodell.)\\nR. Aluminii nitratis, gr. vj\\nAquse destil., f3j. M.\\nS. Apply with a soft sponge. (Gill.)\\nR. Acidi acetici,\\nGlycerinse,\\nS. Apply locally.\\nfsj\\nfSiij. M.\\n(Goodell.)\\nRACHITIS\u00e2\u0080\u0094 SCROFULA.\\nR. Olei morrhuae, f3vj\\nSyr. calcii lactophosphat.,\\nLiq. calcis, aa fSiij. M.\\nS. One-half to one teaspoonful three\\nor four times a day. (Smith.)\\nR. Syr. ferri iodidi, gtt. iij to xx\\nAquse destil., q. s. ad. fsiij. M.\\nS. A teaspoonful every four or live\\nhours during the day. (Child six\\nmonths or one year.)\\nR. Syr. calcii lactophos., fsiv. M.\\nS. One teaspoonful three times a day\\nafter meals.\\nR. Phosphor i, gr.\\nOlei amygdalse, i3viiss\\nPulv. acac,\\nSacchar. alb., aa 5iv\\nAquse destil., f3x. M.\\nFt. emuls.\\nS. One teaspoonful three times a day\\nafter meals. (Hare.)\\nR. Phosphor i, gr.\\nOlei morrhuse, isyj. M.\\nS. One teaspoonful three times a day\\nafter meals. (Kassowitz.)\\nR. Calcii phosphatis,\\nFerri phosphatis, aa gr. xxxvj. M-\\nFt. chart. No. xij.\\nS. One powder morning and noon.\\n(Neligan.)\\nR. 01. morrhuse, fsiv\\nAquse calcis, fsiij. M.\\nEt ad.\\nSyr. ferri iodidi, f3iv\\n01. gaultherise, foss\\nSyr. simp., q. s. ad. fSviij. M.\\nS. A tablespoonful three times a day.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0329.jp2"}, "330": {"fulltext": "328\\nSURGERY.\\nSCIATTCA.\\nAcupuncture.\\nDeeply inject hypodermically, just\\nover or about the exit of the nerve\\nfrom the pelvis, ten to twenty minims\\nof chloroform.\\nEther or rhigolene spray.\\nBlisters or actual cautery along the\\ncourse of the nerve.\\nMassage of nerve. Apply lard or ich-\\nthyol ointment along the course of the\\nnerve then take a strong glass rod with\\na round, smooth end, press back and\\nforth over the tender area, using as\\nmuch force as can be borne. (Hare.)\\nR. Morph. sulph., gr. 2 to\\nAtrop. sulph., gr. 1-25. M.\\nFt. pulv. No. j.\\nS. Dissolve in ifyxx aq. destil. and\\ninject near focus of pain. (Brown-\\nSequard.)\\nR. Cannabis indicae, f5yj\\nSyr. acaciae, f5iss\\nAquae destil., q. s. ad. fSyj. M.\\nS. A tablespoonful every four to six\\nhours. (Neligan.)\\nSEPTICEMIA.\\nStimulants should be pressed to their\\nextreme limit.\\nTonics, if the stomach will stand them.\\nQuinine, twenty to thirty grains daily.\\nDigitalis as indicated by the condition\\nof the heart. Strychnia for the respi-\\nration.\\nSHOCK.\\nExternal warmth most important;\\na hot bath, or vessels of hot water all\\naround patient. Keep the head low.\\nAtropine, 1-100 gr. and brandy or\\nwhiskey, minims xxx, hypodermically\\nevery thirty minutes. Digitalis hypo-\\ndermically, in minims-xx doses, may\\nbe indicated. If there is great paiii,\\ngive a hypodermic of morph., to\\ngr. strychnia hypodermically, gr. 1-20,\\nrepeated at twenty-minute interval^\\nWhiskey, hot coffee, or hot beef-tea in\\nvery small quantities by the mouth.\\nSPERMATORRHCE A\\nR-. Potass, brom.,\\nSod. brom., ail 5iv\\nAq. cinnamom., q. s. ad. fSxij. M.\\nS. One tablespoonful at bedtime.\\nI*. Chloral.,\\nSyrupi simplicis\\n5ij\\nfSiss\\nAquae, q. s ad. fSiij. M.\\nS. One tablespoonful at bedtime.\\nR-. Hyoscinehydrobromate,gr. 1-10.\\nFt. pil. No. x. M.\\nS. One pill at bedtime. (Wood.)\\nty. Tr. cantharidis, f5ij\\nTr. ferri chloridi, fgvj. M.\\nS. Twentv drops in water three times\\nday. (Wood.)\\nR-. Acid, arsenios.,\\nStrych. sulph., aa gr.\\nFerri redact., 5ss. M.\\nFt. pil. No. xij.\\nS. One pill three times a day.\\nI\u00c2\u00a3. Argent, nit., gr. xx\\nAquae destil., isiv. M.\\nS. Apply three drops to the prostatic\\nurethra.\\nA full-sized cold-steel sound intro-\\nduced into the bladder is often of ser-\\nvice.\\nSPINA BIFIDA.\\nR-. Iodi, gr. x\\nPotass, iodidi, gr. xxx\\nGlycerinae, fsj. M.\\nS. Inject into the base of the tumor,\\naccording to its size, from 5ij to Siv of\\nthis solution. (Morton.)\\nSPRAINS, CONTUSIONS, ETC.\\nty. Olei monardae,\\nTr. opii,\\nTr. camphorae,\\nFt. liniment.\\nS. Use locally.\\nR\\\\ Olei cajuputi,\\nTr. opii, aa\\n01. terebinthinae,\\nLinimenti ammoniae,\\nFt. linimentum.\\nS. Use locally.\\nfSss\\nf3ij\\nf5ij.\\nM.\\n(Atlee.)\\nf5ij\\nf5iv\\nfSj. M.\\n(Fuller.)", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0330.jp2"}, "331": {"fulltext": "SURGERY.\\n329\\nJ?.. Liquor ammonise, f3j\\nTr. opii, fjij\\nTr. cantharidis, f3iij\\nLii)imeii.sapon.caniph.,f3x. M\\nFt. liniment u in.\\nS. Use locally. (Fuller.)\\nR. Chloroform i,\\nTr. aeon it. rad.,\\nOl. terebinth in*, aa fjss\\nOl. sassafras., ttyv\\nLinimen.sapon.camph.,f3iiss. M.\\nFt. linimentuni.\\nS. Use locally. (Gerhard.)\\nR. Tr. aconiti,\\nChloroformi,\\nAquae ammonia?, aa f5ij\\nLinimen. saponis camph.,\\nq. s. ad. fSviij. M.\\nFt. linimeutum.\\nS. Use locally. (Jefferson Hospital.)\\nR. Tr. aconit. rad.,\\nTr. opii,\\nLin. saponis,\\nFt. linimentuni.\\nS. Use locally.\\nm\\ni Sss\\nfSviss. M.\\n[Richardson.)\\nR. Plumhi acetat., 5j\\nTr. opii, f5ix\\nAqua?, q. s. ad. f3vj.\\nS. Lead water and laudanum.\\nlocally.\\nM.\\nUse\\nAny of the officinal liniments may he\\nused alone.\\nLinimentuni caniphorse.\\nLinimentum chloroformi.\\nLinimentum saponis.\\nLinimentum terebinthinse.\\nSTRANGURY.\\nR. Decoct. uvee ursi, f3viij\\nLiq. potassa?, gtt. exxx\\nTr. belladonna?. gtt. xlviij. M.\\nS. Tablespoon ful every four hours.\\n(Agnew.)\\nR. Balsam, copaibse, 3ss\\nAcidi benzoici, 5j\\nVitelli unius ovi,\\nAqua? camphorse, fSvij. M.\\nS. Take two tablespoon fuls twice a\\nday. (Soden.)\\nR\\\\ Aceti scillse,\\nSpts. a?th. nitrosi, aa foij\\nAquse anisi, q. s. ad. Oj. M.\\nS. A wineglassful every hour or oft-\\nener. (Waring.)\\nR. Ext. opii, gr. iv\\nExt. hyoscyaini, gr. ij. M.\\nFt. suppos. No. iv.\\nS. Introduce one into the rectum.\\nR-. Tr. cannabis indicse, fsij. M.\\nS. Thirty drops every few hours.\\n(Ringer.)\\nR. Ext, belladonna?, gr. ijtoiv. M.\\nFt. suppos. No. ij.\\nS. Introduce one into rectum and re-\\npeat in four hours if necessary.\\n(Hartshorn e.)\\nHot sitz bath for one-half to two\\nhours.\\nSYNOVITIS.\\nCounter-irritation by means of fly\\nblisters.\\nBlood-letting in early stage, followed\\nby ice-bags.\\nR. Acidi carbolici, gr. viij\\nAqua? destil., fsj. M.\\nS. Use ether spray, and inject ten min-\\nims into joint and repeat every three\\ndays. (Chronic synovitis.)\\nR. Morph. sulph., gr. viij\\nHydrarg. oleat. (5 to 10\\nper cent.), 3j. M.\\nS. Apply twice daily with a soft brush.\\n(Acute synovitis.) (Marshall.)\\nPaint joint with tr. iodine and apply\\nR. Ung. hydrarg.,\\nUng. belladonna?, aa 3j. M.\\nS. Apply on lint. (Ashhurst.)\\nR. Iodi, 5iv\\nPotass, iodidi, f3j\\nAquae destil., fSvj. M.\\nS. Apply externally with a brush.\\nSYPHILIS.\\nR. Hydrarg. protiodidi, gr. vj. M.\\nFt. pil. No. xxiv.\\nS. One pill three times a day every\\nsecond day increase by one pill until\\nfirst symptoms of ptyalism appear;\\nthen cut down dose one-half and con-\\ntinue for eighteen months this tonic\\ndose; after that give\\nR. Potass, iodidi, Sisstogiv\\nHydrarg. chlor. corros., gr. i to iss\\nSyr. auranti cort,, fsj\\nAquse, q. s. ad. fSij. M.\\nS. One teaspoonful three times a day\\ncontinued for from six to twelve months", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0331.jp2"}, "332": {"fulltext": "330\\nStfRGERY.\\nR. Mass. hydrarg., gr. xxiv\\nPulv. ferri sesquichlor., gr. xij. M.\\nFt. pil. No. xij.\\nS. One pill three times a day increase\\none pill evei y two days up to physio-\\nlogical limit; then cut down dose one-\\nhalf and continue for eighteen months.\\nR. Ung. hydrarg., gj. M.\\nFt. chart. No. viij.\\nPut in waxed papers.\\nS. Rub, after bathing, for fifteen min-\\nutes the contents of one paper into\\nbody in following order: First night,\\naxilla and side of chest; next night,\\nsame on opposite side; next night,\\ngroin and inner part of thigh next,\\nsame on opposite side; next, chest and\\nabdomen, and repeat. Wear same shirt\\nnext to skin under other clothing.\\nMucous patches in mouth are healed\\nby application of solid stick of silver or\\nsulphate of copper. If elsewhere, wash\\nwith 1-2000 bichloride solution and dust\\nwith\\nR. Hydrarg. chlor. mit.,\\nBismuth, subnit., aa 5ij. M.\\nS. Dusting powder.\\nAfter symptoms disappear, observe\\nhygienic mode of living and take\\nR. 01. morrhuse, fSviij.\\n(Phillips s emulsion.)\\nS. One teaspoonful three times a day.\\nThe mercury may be given by means\\nof vapor bath.\\nR. Hydrarg. chlor. mit., gss.\\nS. Vaporize by means of heat, beneath\\na blanket covering the naked body.\\nR. Hydrarg. chlor. corros., gr. vj\\nSodii chlorid., gr. xxxvj\\nAquae destil., ?3x. M.\\nS. Inject daily five to eight drops\\nhypodermically. (Hebra.)\\nR. Pil. hydrargyri, gr. xx\\nFerri sulph. exsiccat., gr. x\\nExt. opii, gr. v. M.\\nFt. pil. No. xx.\\nS. One pill three times a day.\\n(Otis.)\\nB- Potass, iodidi, 5ij\\nAmmonii carbonatis, gss\\nTr. cinch, comp., f3iv\\nSyr. aurant. cort., f3iss\\nGlycerini., fij. M.\\nS. A teaspoonful, well diluted, after\\neach meal. (Keyes.)\\nB. Tr. myrrh., fsss\\nPotass, chlorat., 5iij\\nAquae, q.s. ad. fgvj. M.\\nS. Wash mouth every two or three\\nhours. (For mucous patches.)\\nR. Hydrarg. chlor. corros., gr. j\\nPotass, iodidi, 5ij\\nTr. gent, comp., fsiij. M.\\nS. A teaspoonful three times a day.\\n(Charitv Hospital, N. V.)\\nB. Hydrarg. chlor. mit.,\\nLycopodii, aa 5ij. M.\\nS. Use as snuff three times daily, in\\nsyphilitic lesions of nose. (Gross.)\\nTETANUS.\\nControl the spasm by inhalations of\\nether, chloroform, or nitrite of amyl.\\nGive 5ij to 5iv of bromide of potash in\\ndivided doses during the day, and\\nchloral, gr. xxx to xl at bedtime.\\nAlso give opium, if necessary. Sup-\\nport with food and stimulants.\\n(Wood.)\\nWARTS AND CORNS\u00e2\u0080\u0094 COMMON.\\nB- Acidi nitrici, fgj.\\nS. Apply to wart with a stick or glass\\nrod three or four times a week.\\nR. Acidi chromici, 5j. M.\\nS. Apply to wart with a glass rod.\\n(Wood.)\\nB- Hydrarg. chlor. corros., gr. x\\nf5v. M.\\nCollodii\\nS. Paint once daily\\n(Kaposi.)\\nR. Acidi salieylici,\\nSpts. vini rectif., aa fsss\\niEtheris sulphuric, 5lxxv\\nCollodii, f3iiss. M.\\nS. Apply every day with camel s-hair\\nbrush. (Vidal.)\\nB- Acidi acetici glacialis, f3j. M.\\nS. Apply a drop to wart once a day.\\nB- Acidi salieylici, gr. xxx\\nExt. cannabis indicse, gr. x. M.\\nCollodii, fsss. M.\\nS. Apply every night and morning\\nfor one week with a camel s-hair brush;\\nthen soak foot well.\\nMoisten and brush every day with\\nsolid stick of nitrate of silver.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0332.jp2"}, "333": {"fulltext": "SURGERY.\\n331\\nWARTS\u00e2\u0080\u0094 VENEREAL.\\nR. Hydrarg. ehlor. in it.\\nS. Use as a dusting powder.\\n(Ricord.)\\nR. Acidi carbolici, f5j. M.\\nS. Apply with glass rod or stick every\\nday or two.\\nR. Hydrarg. chlor. mit., 5vj\\nAcidi borici, 3i ij\\nAcidi salicylici, 5j. M.\\nS. Dust over the vegetation.\\nrregory.)\\nCut off with scissors and apply nitric\\nor carbolic acid to base with a small\\nstick.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0333.jp2"}, "334": {"fulltext": "332\\nSURGERY.\\nDRUGS AND MATERIALS USED IN ANTISEPTIC SURGERY,\\nTOGETHER WITH\\nGENERAL DIRECTIONS CONCERNING PREPARATIONS FOR\\nANTISEPTIC OPERATIONS.\\nANTISEPTIC SOLUTIONS.\\nR. Acid, carbolic, f5vj%\\nAquae, q. s. ad. Oj. M.\\nS. Solution 1-20 carbolic. (Lister.)\\nft. Acidi boric, 5iv\\nAquae destil., Oj. M.\\nS. Saturated solution, gr. x to fsj.\\nft. Potassii permanganat., 5j\\nAquae, fsj. M.\\nS. f3j to Oj=l-1000.\\nft. Zinci cblorid., gr. xl\\nAquae, q. s. ad. fsj. M.\\nS. Apply on a swab to fresh septic\\nrounds.\\nR. Hydrarg. chlor. corros.,\\nSodii chlor., aa 5j\\nAquae, q. s. ad. fsj. M.\\nS. f3j to Oj=l to 1000.\\nft. Hydrarg. chlor. corros., 3j\\nAmnion, chlor., gr. xxxij\\nAquae, q. s. ad. fsj. M.\\nS. f5j to Oj water=l to 1000 solution.\\nft. Hydrarg. chlor. corros., 5j\\nAcid, tartaric, 5v\\nAquae, q. s. ad. fsiv. M.\\nS. fi% to Oj aquae=1000.\\nR. Acidi carbolic,\\n01. olivae,\\nS. Carbolized oil.\\nf5j\\nf5x. M.\\n(Lister.)\\nft. Iodoform., 3j\\nCollodion., f3x. M.\\nS. Iodoform collodion. (Kiister.)\\nft. Iodoform., gr. xxx\\niEther fsss\\nAquae destil., q. s. ad. fsj. M.\\nS. Iodoform ether. (Nussbaum.)\\nR. Iodoform.,\\n^Ether^\\nS. Iodoform ether.\\nft. Creolin,\\nS. f5j to f5vj to Oj.\\nfsj.\\n(v. Esmarch.)\\nR. Hydrogen peroxide, fsj.\\nS. Use in hard-rubber atomizer.\\nSALVES.\\nR. Acidi boric, Siij\\nParaffine, 3x\\nUng. petrol at., 5 v. M.\\nS. Boric acid salve. (Lister.)\\nR. Acidi salicylic, 5j\\nParaffine, 3xij\\nCerat. alb., 5vj\\n01. amyg., 5xij. M.\\nS. Salicylic salve. (Lister.)\\nR. Iodoform i, 3j\\nUng. petrolati, 5vj\\n01. amyg. amar., gtt. ij. M\\nS. Iodoform salve.\\nft. Iodoform., Sj to iv\\nUng. petrolat., Sj. M.\\nS. Iodoform ointment.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0334.jp2"}, "335": {"fulltext": "SURGERY.\\n333\\nI*. 01. olivae, fSj\\nAcidi carbolic, gr. xlj to xxiv. M.\\nS. 1-40 or 1-20 carbolized oil.\\nR-. Ung. petrolati, 5j\\nAcidi carbolic, gr. xxiv to xij. M.\\nS. 1-20 or 1-40 carbolized vaseline.\\nLIGATURES.\\nImmerse the commercial catgut in a\\nfrequently renewed solution made as\\nfollows\\nR. Hydrarg. cblor. corros., 5j\\nAlcohol, fSiiss\\nAquae destil., fSvj. M.\\nPreserve for use in the following:\\nR-. Hydrarg. chlor. corros., gr. vj\\nAlcohol, ftx\\nAquae destil., fjiiss. M.\\nFrom this solution it is taken as\\nneeded.\\nTO CHROMACIZE CATGUT.\\nPlace catgut in ether for forty-eight\\nhours; then immerse in the following\\nfor forty-eight hours and put in anti-\\nseptic, dry, tightly-closed vessels\\nI}.. Acidi chromic, gr.j\\nAcidi carbolic, gr. cc\\nAlcohol, foij\\nAquae destil., f3xxij. M.\\nSoak in carbolic, 1-20 before using.\\nThe catgut is usually prepared by\\nsoaking it in oil of juniper for one\\nweek, then storing it in absolute alco-\\nhol, or a 1-1000 alcoholic sublimate solu-\\ntion.\\nSILK (Czerny).\\nThe silk should be boiled for one hour\\nin a 1 to 20 carbolic solution, then kept\\nin a 1 to 50 carbolic solution.\\nBoil in clean water for one hour, then\\nstore in an alcoholic solution of subli-\\nmate 1-1000.\\nDRAINAGE\\nRubber tubes, wash clean and keep in\\na 1 to 20 carbolic solution.\\nRubber tubing may be hardened by\\nimmersing for five minutes in concen-\\ntrated sulphuric acid. The tubes are\\nthen washed in alcohol and preserved\\nin 1-20 carbolic solution.\\nDecalcified bones, catgut, horse-hair,\\nsilk-worm gut, may all be stored in\\nabsolute alcohol containing sublimate\\n1-1000.\\nOPERATOR S HANDS.\\nPare nails and clean around and under\\nthem with a knife. Clean arms, hands,\\nand nails for one minute with a brush,\\nvery warm water, and potash soap (pear-\\nline) then wash for one minute in\\nstronger alcohol and then for one\\nminute in 1-1000 or 1-500 bichloride- so-\\nlution or 1-30 carbolic solution. The\\nhands are then allowed to remain wet.\\nOPERATIVE REGION.\\nThe patient should have a warm bath\\nbefore the operation, and the operation\\nregion must be shaved and covered with\\ncloths dipped in 1-1000 bichloride or\\n1-30 carbolic, and covered with par-\\naffine paper; this dressing must remain\\nfor several hours previous to the opera-\\ntion. Immediately before the operation\\nthe parts are washed and brushed with\\npotash soap, then rubbed with alco-\\nhol, ether or turpentine, and irrigated\\nwith 1-500 bichloride or 1-30 carbolic\\nsolution. The environs should be cov-\\nered with towels wet with 1-500 bichlo-\\nride or 1-30 carbolic, and changed\\nduring the operation as often as soiled.\\nThe region to be operated upon should\\nalso be covered with similar towels\\nuntil the surgeon commences his in-\\ncision, and during the entire operation\\nscrupulous care must be exercised to\\nkeep every portion of the wound cov-\\nered except that part which the surgeon\\nmust have exposed for the continuance\\nof his work.\\nINSTRUMENTS.\\nBrush with 1-20 carbolic solution;\\nsterilize by roasting, boiling, or by\\nstoring for one hour in 1-20 carbolic\\nsolution. During operation keep in a\\n1-40 carbolic solution. To prevent rust-\\ning boil in one per cent. sod. carb. solu-\\ntion.\\nA very effectual method is to place\\nthem in metal boxes and heat in an or-\\ndinary oven (200\u00c2\u00b0 F.) for one^-half to one\\nhour they may then be used dry.\\nSPONGES.\\nIf new, cleanse in soda solution and\\nimmerse for twenty-four hours in water\\nto which is added\\nIJ.. Potassii permanganat., gr. 15%.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0335.jp2"}, "336": {"fulltext": "334\\nSURGERY.\\nThis turns thein brown then wash in\\na bowl of water, to which add\\nfy. Acid, hydrochlor. f3v\\nSodii hyposulphit., fsiss. M.\\nThis bleaches them. They are then\\nwashed with hot water and potash soap\\nand kept in 1-1000 bichloride or 1-20\\ncarbolic solution. (Keller.)\\nInfected sponges. Keep in lukewarm\\nwater for twenty-four hours, or better\\nstill, in running water for the same\\ntime then wash with potash soap and\\nwarm water and keep in 1-1000 bichlo-\\nride or 1-20 carbolic.\\nTHE WOUND.\\nUnless it is infected, the wound need\\nnot be flushed or irrigated with irri-\\ntating antiseptic solutions. If the me-\\nchanical effect of irrigation is necessary,\\nsterilized water containing three-quar-\\nter per cent, of common salt may be\\nemployed.\\nIf the wound is probably infected,\\nirrigate with 1-500 bichloride solution,\\nsubsequently flushing out with a weaker\\nlotion varying in strength from 1-2000\\nto 1-5000.\\nIn operations about the mouth, blad-\\nder, intestines, etc., boric acid solution\\nor the sterilized salt solution may be\\nused.\\nDRESSINGS.\\nTypical Lister dressing.\\n1. Silkprotectwe, which is made from\\noiled silk, coated with copal varnish,\\nand then with a mixture prepared as\\nfollows\\nR-. Dextrine, 5j\\nStarch, 5ij\\nCarbolic sol. 1-20, fsij.\\n2. Moist compresses. Moist carbolized\\ngauze, six thicknesses, somewhat larger\\nthan the wound, and wrung out of 1-20\\ncarbolic solution.\\n3. The antiseptic gauze, seven layers.\\nThis gauze is preserved in parchment\\npaper, and is made as follows\\nTake cheese-cloth cut in pieces about\\nsix yards long and one yard wide, soak\\nin boiling water for two or three hours,\\nand stretch to dry, after saturating\\nwith the following\\nCarbolic acid, (crystals), 5j\\nResin, 5v\\nParafline (solid), 5vij.\\n4. Makintosh, which is a cloth made\\nimpervious by means of caoutchouc.\\n5. The eighth layer of gauze.\\n6. Bandage, made of muslin or gauze\\nsaturated with 1-50 carbolic acid.\\n7. Cotton and bandage.\\nThe ordinary bichloride dressing is\\napplied as follows\\n1. Protective.\\n2. Several layers of bichloride gauze\\nwrung out in carbolic solution 1-20, and\\nlarge enough to overlap the protective\\neverywhere.\\n3. Many (10-20) layers of bichloride\\ngauze wrung out in 1-1000, and large\\nenough to overlap the preceding dress-\\ning.\\n4. Bichloride cotton overlapping the\\npreceding dressing (No. 3).\\n5. Wet (1-2000) gauze bandage and dry\\ngauze or muslin bandage.\\nBICHLORIDE GAUZE.\\nBoil cheese cloth in water made alka-\\nline by the addition of washing-soda,\\nwring out in hot water, again boil in\\nwater without the addition of the soda,\\nrun it through a bichloride solution of\\n1-200, and pack away moist in jars that\\nhave been previously washed in the same\\nsolution. This gauze should be wrung\\nout in a solution of bichloride 1-1000\\nimmediately before being applied to\\nthe surface of the body.\\n1$. Gauze, 15,500 gr.\\nHydrarg. chlor. corros., 77 gr.\\nSodii chloridi,\\nGlycerine,\\nAquae,\\n7750 gr.\\n1550 gr.\\n68 fs. M.\\n(Maas.)\\nLISTER S DOUBLE CYANIDE GAUZE.\\nWash all utensils used in preparing\\nthis gauze in\\nIJ.. Sol. of bichlor., 1-500,\\nSol. carbol. ae.,1-20, aa equal parts.\\nM.\\nThen add gr. c of double cyanide of mer-\\ncury and zinc (Lister) to four pints of a\\n1 to 4000 solution of bichloride of mer-\\ncury.\\n(Keep this well stirred, since it does\\nnot form a solution the double cyanide\\nis only in suspension in the bichloride\\nsolution.)\\nRun plain gauze through it and pack\\naway moist.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0336.jp2"}, "337": {"fulltext": "SURGERY.\\n335\\nThe double cyanide salt is prepared\\nas follows\\nCyanide of potassium, gr. 130.\\nCyanide of mercury, gr. 252.\\nMix and dissolve in water, f3xss.\\nAdd this solution to\\nZinc sulphate, gr. 287.\\nWater, fsiv.\\nCollect the resulting precipitate and\\nwash with water fSviii divided into two\\nportions. Diffuse the precipitate by\\nmeans of mortar and pestle in distilled\\nwater fSviii containing hematoxylin\\nfr. 1%, and a drop of a solution made\\ny adding stronger ammonia f5j to dis-\\ntilled water fsxv let this mixture\\nstand for several hours. The dyed salt\\nis then drained and dried at a mode-\\nrate heat.\\nSOLUTION FOR CARBOLIZED\\nGAUZE.\\nResin, 3iv\\nAlcohol, f3xx\\nCastor-oil, f$%\\nCarbolic acid, f$ij%- M.\\nRun gauze through this solution and\\nup to dry.\\n(University Hospital.)", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0337.jp2"}, "338": {"fulltext": "", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0338.jp2"}, "339": {"fulltext": "INDEX.\\nABSCESS, acute, 27\\nbone, 171\\nBrodie s, 171\\nchronic, 29\\ndiploe, 78\\nfollicular, 214\\nmammary, 255\\nmediastinal, 134\\nperiosteal, 169\\nperiurethral, 215\\nresidual, 30\\ntubercular, 29\\nAmbulatory dressing, 112\\nAmputation, 284\\nCarden s, 288\\nChopart s, 286\\nDupuytren s, 291\\nGritti s, 288\\nHey s, 286\\ni n coxalgia, 165\\nin fracture, 110\\nin gangrene, 43\\nin gunshot wounds, 71\\nLarrey s 291\\nLisfranc s, 286\\nPirogoff s, 286\\nSedillot s, 287\\nSyme s, 287\\nTeale s, 285\\nAnaesthetics, 260\\nAnkylosis, 168\\nin coxalgia, 165\\nin fracture, 121\\nAneurism, anastomotic, 246\\narterio-venous, 74\\ncirsoid, 246\\nclassification, 247\\ntraumatic, 74\\nvaricose, 74\\nAneurismal varix, 74\\nAngioma, 246\\nAntiseptic treatment, 44, 66\\nAntivenine, 73\\nAnus, artificial, 187\\ndiseases of, 200\\n22\\nAnus, fissure, 204\\nfistula, 204\\nmalformation, 200\\npruritus, 207\\nulceration, 205\\nAppendicitis, 195\\nArthrectomy, 280\\nArthritis, 161\\ngelatinous, 162\\nrheumatoid, 167\\nstrumous, 162\\nof hip-joint, 163\\nof knee-joint, 166\\nBALANITIS, 214\\nBalano-posthitis, 214\\nBandages, handkerchief, 31\\nBarton s 314\\nroller, 296\\nBarton s, 305\\nDesault s, 300\\nGibson s, 306\\nVelpeau s, 299\\nBarton s cravat, 314\\nfracture, 122\\nhead bandage, 305\\nBed-sore, 41\\nBites, 72\\nBladder, atony, 231\\nbar at neck, 228\\nexstrophy, 229\\ninflammation, 230\\nparalysis, 231\\nrupture, 229\\ntumors, 229\\nBone, diseases, 169\\nsyphilis, 173\\ntubercle, 173\\nBrodie s abscess, 171\\nBronchotomy, 252\\nBronchus, foreign body, 252\\nBubo d emblee, 213\\ngonorrheal, 215\\nprimary, 213\\nsyphilitic, 208\\n337", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0339.jp2"}, "340": {"fulltext": "338\\nINDEX.\\nBunions, 258\\nBurns, 102\\nBursa, dropsy, 258\\nBursitis, 258\\nCALCULI, vesical, 235\\nCallus, 109\\nCanal, femoral, 192\\ninguinal, 189\\nCancrum oris, 40\\nCarbuncle, 42\\nCaries, 172\\nCatheter, Mercier, 233\\nolive-pointed, 222\\nprostatic, 233\\nrailroad, 222\\nCellulitis, 52\\nChancre, 208\\nChancroid, 212\\nChilblain, 251\\nChloroform, 261\\nChordee, 216\\nCicatrization, 31\\nCircumclusion, 63\\nClap, 213\\nCleft palate, 257\\nClub-foot, 256\\nCock s perineal section, 224\\nCold, effects of, 251\\nColles s law, 212\\nCompression, cerebral, 84\\nConcussion, cerebral, 83\\nof lung, 94\\nContusion, abdominal, 96\\ncerebral, 83\\nof cranium, 78\\nof scalp, 77\\nCounter-irritation, 23\\nCowperitis, 215\\nCoxalgia, 163\\ndiagnosis, 166\\nCupping, 22\\nCystitis, 230\\nCysts, 295\\nCzerny s suture, 99\\nDELIRIUM tremens, 46\\nDiffused aneurism, 74, 247\\nDilatation of stricture, 222\\nDischarge, urethral, 217\\nDislocation, see Luxation.\\nDissecting aneurism, 247\\nwound, 71\\nDouble inclined plane, 130\\nDressing, ambulatory, 112\\nLister s, 67\\nDupuytren s splint, 133\\nEMBBYONIC tissue, 18\\nEmphysema, 94\\nEncephalitis, 86\\nEnterocele, 180\\nEntero-epiplocele, 180\\nEpididymitis, 215\\nEpiplocele, 180\\nEpispadia, 219\\nErysipelas, 50\\nEther, 260\\nExcision, 280\\nankle-joint, 283\\nelbow -joint, 281\\nhip-joint, 281\\nin coxalgia, 165\\nknee-joint, 282\\nshoulder-joint, 280\\nwrist-joint, 281\\nExtension apparatus, 129\\nExtravasation, intracranial, 81\\nof urine, 225\\nF^CES, impaction of, 206\\nFalse joint, 111\\npassage, 221\\nFever, hectic, 50\\ninflammatory, 48\\npysemic, 49\\nsepticemic, 48\\ntraumatic, 47\\nFissure, anal, 204\\nof Eolando, 88\\nFistula, anal, 204\\nfaecal, 187\\nsalivary, 90\\nForcipressure, 62\\nForeign body in brain, 87\\nin bronchus, 252\\nin larynx, 252\\nin oesophagus, 254\\nFractures, 105\\nanaesthetics in, 112\\nBarton s, 122\\nclavicle, 114\\ncoccvx, 126\\nColles s, 122\\ncompound, 108\\ndelayed union in, 110", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0340.jp2"}, "341": {"fulltext": "INDEX.\\n339\\nFractures, delirium tremens in, 136\\ndiagnosis, 107\\nfemur, 126\\nfibula, 132\\nhumerus, 117\\nhyoid bone, 114\\ninferior maxilla, 113\\nlarynx, 114\\nmetacarpus, 125\\nnasal bone, 112\\nnon-union in, 110\\npatella, 131\\npelvis, 125\\nphalanges, 125\\nPott s, 132\\nradius, 122\\nribs, 134\\nsacrum, 126\\nscapula, 116\\nskull, 78\\nSmith s, 122\\nsternum, 134\\nsuperior maxilla, 113\\nT, 117\\ntarsus, 134\\ntibia, 132\\ntreatment, 107\\nulna, 121\\nununited, 110\\nvertebrae, 135\\nvicious union, 111\\nFracture-box, 133\\nFrost-bite, 251\\nFuruncle, 41\\nGANGLION, 258\\nGangrene, 38\\nGerm theory, 44\\nGlanders, 55\\nGleet, 217\\nGonorrhoea, acute, 213\\nchronic, 217\\nin women, 218\\nGranulations, 31\\nGranulomata, infective, 294\\nGumma, 210\\nHEMATOCELE, 241\\nHematuria, 222\\nHaemophilia, 177\\nHsemothorax, 93\\nHalsted s operation for hernia, 181\\nHare-lip, 257\\nHemorrhage, 57\\nHemorrhage, arrest of, 58\\nbladder, 232\\nkidney, 232\\nurethra, 232\\nHemorrhoids, 201\\nHernia, 179\\ncerebri, 87\\nclassification, 180\\ncongenital, 188, 191\\ncrural, 192\\nencysted, 188, 191\\nfemoral, 192\\nincarcerated, 182\\ninfantile, 188, 191\\ninflamed, 182\\ninguinal, 188\\nirreducible, 181\\nLittre s, 184\\nof lung, 94\\nreducible, 180\\nstrangulated, 183\\numbilical, 194\\nHerniotomy, 186\\nHutchinson s teeth, 211\\nHydrarthrosis, 161\\nHydrocele, 240\\nHydrophobia, 54\\nHypertrophy of prostate, 227\\nHypospadia, 219\\nIMPACTED fasces, 206\\nImperforate anus, 200\\nImpermeable stricture, 224\\nIncarcerated hernia, 182\\nIncontinence, urinary, 234\\nInfective granulomata, 294\\nInflammation, 17\\nintracranial, 86\\nIngrowing toe-nail, 259\\nInternal strangulation, 199\\nIntestinal obstruction, 198\\nIntussusception, 199\\nT7YPH0SIS, 178\\nLAPAEOTOMY, 100, 200\\nLaryngotomy, 253\\nLarynx, foreign body, 252\\nLeeching, 23\\nLembert s suture, 99\\nLigament, coraco-humeral, 14C\\nY-, 150", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0341.jp2"}, "342": {"fulltext": "340\\nINDEX.\\nLigamentous union, 135\\nLigations, 263\\nanterior tibial, 278\\naxillary, 270\\nbrachial, 271\\ncommon carotid, 265\\ndorsalis pedis, 279\\nexternal carotid, 266\\nexternal iliac, 274\\nfacial, 267\\nfemoral, 274\\ninternal mammary, 270\\nlingual, 267\\noccipital, 268\\npalmar arches, 273\\npopliteal, 276\\nposterior tibial, 277\\nradial, 272\\nsubclavian, 269\\ntemporal, 268\\nulnar, 273\\nLitholapaxy, 237\\nLitholysis, 237\\nLithotomy, 237\\nLithotrity, 237\\nLocalization, cerebral, 87\\nLoose bodies in joints, 167\\nLordosis, 178\\nLuxations, 137\\nastragalus, 156\\ncarpus, 148\\nclassification, 137\\nclavicle, 141\\ncomplications, 139\\nfemur, 150\\nhumerus, 143\\njaw, 140\\nmetacarpus, 149\\nold, 139\\npatella, 155\\nphalanges, 149\\nradius, 148\\nribs, 141\\nscapula, 143\\nsemilunar cartilages, 155\\ntarsus, 156\\ntibia, 154\\ntreatment, 139\\nulna, 147\\nMALIGNANT pustule, 55\\nMeningitis, 86\\nMicro-organisms, 44\\nMortification, 38\\nMucous patch, 209\\nN^VUS, capillary, 246\\nvenous, 246\\nNecrosis, 172\\nNodes, periosteal, 169\\nNoma pudendi, 41\\nfT?SOPHAGUS, foreign body, 254\\nVJh stricture, 254\\nOnychia, 259\\nOphthalmia, 215\\nOrchitis, 242\\nOsteitis, 170\\ndeformans, 170\\nrarefying, 170\\nOsteomalacia, 174\\nOsteomyelitis, 170\\nOsteoporosis, 170\\nPAGET S disease, 255\\nParaphimosis, 214\\nParonychia, 259\\nPassage of catheter, 221\\nPerineal section, 224\\nPeriostitis, 169\\nosteoplastic, 169\\nPeritonitis, 97\\nPernio, 251\\nPhimosis, 214\\nPhlebitis, 244\\nPiles, 201\\nPlaster jacket, 176\\nPlastic lymph, 18\\nPneumothorax, 94\\nPneumotomy, 95\\nPott s disease, 174\\npuffy tumor, 78\\nPoupart s ligament, 190\\nProlapsus of lung, 94\\nrecti, 203\\nProstatitis, 226\\nPruritus ani, 207\\nPupil in brain injury, 85\\nPus, 19\\nPysemia, 49\\nRACHITIS, 176\\nKectum, diseases of, 200\\npolyp, 206\\nprolapse, 203", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0342.jp2"}, "343": {"fulltext": "INDEX.\\n341\\nRectum, stricture, 205\\nulceration, 205\\nvillous tumor, 207\\nResection, 280\\nRetention of urine, 232\\nRetroclusion, 62\\nRheumatism, gonorrhoea^ 215\\nRickets, 176\\nRing, abdominal, 189, 190\\nfemoral, 193\\nRontgen rays, 315\\nRupture (see Hernia), 179\\nof viscera, 96\\nSALIVATION, 26\\nSaphenous opening, 193\\nSarcocele, 242\\nSayre s fracture-dressing, 115\\nScalds, 102\\nScalp, layers, 75\\nwounds, 77\\nSchede s method of treating varicose\\nveins, 243\\nScoliosis, 178\\nScrofula, 177\\nSepticaemia, 48\\nShock, 45\\nether in, 262\\nSinus, 30\\nSkin grafts, 37\\nSpine, curvature, 177\\nSplints, Bond s, 124\\ncoxalgia, 165\\nDupuytren s, 133\\nSprain, 158\\nfracture, 158\\nof back, 159\\nStaphyloplasty, 257\\nStaphylorrhaphy, 257\\nStimulants, 25\\nStings, 72\\nStone in bladder, 235\\nStrapping chest, 135\\nStricture, urethra, 219\\nStruma, 177\\nSutures, 65\\nSynovitis, 160\\ngonorrhceal, 215\\nSyphilis, 208\\nTALIPES, 256\\nTapping abdomen, 100\\nbladder, 234\\nTapping pericardium, 95\\npleura, 95\\nTaxis, 184\\nTenosynovitis, 258\\nTetanus, 52\\nThrombosis, 244\\nTorsion, 61\\nTorsoclusion, 62\\nTrachea, foreign body in, 252\\nTracheotomy, 253\\nTransfusion, 59\\nTrephining, 89\\nTriangles of neck, 264\\nTrophic changes, 75\\nTubercle, 173\\nTumors, 292\\nof breast, 255\\nclassification, 293\\ncystic, 295\\ntreatment, 293\\nULCERATION, 31\\nUlcers, 32\\nUranoplasty, 257\\nUrethra, 213\\ndeformities, 219\\nrupture, 225\\nstricture, 219\\nUrethrotome, 223\\nUrethrotomy, 223\\nVARICOCELE, 242\\nVaricose aneurism, 74\\nveins, 245\\nVarix, 245\\naneurismal, 74\\narterial, 246\\nVeins, diseases of, 244\\nvaricose, 245\\nwounds of, 75\\nVenereal disease, 208\\nVesication, 24\\nVolvulus, 199\\nWALLERIAN degeneration, 74\\nWhite swelling, 162\\nhip-joint, 163\\nknee-joint, 166\\nWounds, 44\\nabdomen, 95\\narteries, 73\\nchest, 92\\nclassification, 68", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0343.jp2"}, "344": {"fulltext": "342\\nINDEX.\\nWounds, contused,\\ndissecting, 72\\nface, 90\\ngunshot, 70\\nincised, 69\\njoints, 159\\nlacerated, 69\\nneck, 91\\nWounds, nerves, 75\\noesophagus, 92\\npoisoned, 71\\npunctured, 69\\nscalp, 77\\ntrachea, 92\\nveins, 75\\nY -ligament, 151", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0344.jp2"}, "345": {"fulltext": "", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0345.jp2"}, "346": {"fulltext": "", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0346.jp2"}, "347": {"fulltext": "Medical and Surgical Works\\nPUBLISHED BY\\nW. B. SAUNDERS, 925 Walnut Street, Philadelphia, Pa.\\nPAGE\\nAbbott on Transmissible Diseases 18\\nAmerican Pocket Medical Dictionary 35\\n^American Text-Book of Applied Thera-\\npeutics 8\\n*American Text-Book of Dis. of Children 13\\n*An American Text-Book of Diseases of the\\nEye, Ear, Nose, and Throat 15\\n*An American Text-Book of Genito-Uri-\\nnary and Skin Diseases 14\\n^American Text-Book of Gynecology 12\\n*American Text-Book of Legal Medicine 44\\n*American Text-Book of Obstetrics 9\\n*American Text-Book of Pathology 44\\n*American Text-Book of Physiology 7\\n^American Text-Book of Practice 10\\n*American Text-Book of Surgery 11\\nAnders Theory and Practice of Medicine 21\\nAshton s Obstetrics 43\\nAtlas of Skin Diseases 28\\nBall s Bacteriology 43\\nBastin s Laboratory Exercises in Botany 36\\nBeck s Surgical Asepsis 41\\nBoisliniere s Obstetric Accidents 39\\nBrockway s Physics 43\\nBurr s Nervous Diseases 41\\nButler s Materia Medica and Therapeutics 24\\nCema s Notes on the Newer Remedies 32\\nChapin s Compendium of Insanity 35\\nChapman s Medical Jurisprudence 41\\nChurch and Peterson s Nervous and Men-\\ntal Diseases 17\\nClarkson s Histology 33\\nCohen and Eshner s Diagnosis 43\\nCorwin s Diagnosis of the Thorax 37\\nCragin s Gynaecology 43\\nCrookshank s Text-Book of Bacteriology 27\\nDaCosta s Manual of Surgery 23\\nDe Schweinitz s Diseases of the Eye 29\\nDorland s Pocket Medical Dictionary 35\\nDorland s Obstetrics 41\\nFrothingham s Bacteriological Guide 30\\nGarrigues Diseases of Women 34\\nGleason s Diseases of the Ear 43\\n*Gould and Pyle s Curiosities of Medicine 17\\nGrafstrom s Massage 28\\nGriffith s Care of the Baby 38\\nGriffith s Infant s Weight Chart 39\\nGross s Autobiography 26\\nHampton s Nursing 39\\nHare s Physiology 43\\nHart s Diet in Sickness and in Health 36\\nHaynes Manual of Anatomy 41\\nHeisler s Embryology 19\\nHirst s Obstetrics 20\\nHyde s Syphilis and Venereal Diseases 41\\nInternational Text-Book of Surgery 6\\nJackson s Diseases of the Eye 19\\nJackson and Gleason s Diseases of the Eye,\\nNose, and Throat 43\\nKeating s Pronouncing Dictionary 26\\nKeating s Life Insurance 39\\nKeen s Operation Blanks 36\\nKeen s Surgery of Typhoid Fever 22\\nPAGE\\nKyle s Diseases of Nose and Throat 18\\nLaine s Temperature Charts 32\\nLockwood s Practice of Medicine ai\\nLong s Syllabus of Gynecology 34\\nMacdonald s Surgical Diagnosis and Treat-\\nment 22\\nMcFarland s Pathogenic Bacteria 30\\nMallory and Wright s Pathological Tech-\\nnique 22\\nMartin s Surgery 43\\nMartin s Minor Surgery, Bandaging, and\\nVenereal Diseases 43\\nMeigs Feeding in Early Infancy 30\\nMoore s Orthopedic Surgery 23\\nMorris Materia Medica and Therapeutics 43\\nMorris Practice of Medicine 43\\nMorten s Nurses Dictionary 38\\nNancrede s Anatomy and Dissection 31\\nNancrede s Anatomy 43\\nNancrede s Principles of Surgery 19\\nNorris 1 Syllabus of Obstetrical Lectures 37\\nPenrose s Diseases of Women 24\\nPowell s Diseases of Children 43\\nPryor s Pelvic Inflammations 33\\nPye s Bandaging and Surgical Dressing 23\\nRaymond s Physiology 41\\nSaundby s Renal and Urinary Diseases 25\\n*Saunders American Year-Book of Medi-\\ncine and Surgery 16\\nSaunders Medical Hand-Atlases 3, 4, 5\\nSaunders Pocket Medical Formulary 35\\nSaunders New Series of Manuals .40, 41\\nSaunders Series of Question Compends 42, 43\\nSayre s Practice of Pharmacy 43\\nSemple s Pathology and Morbid Anatomy 43\\nSemple s Legal Medicine, Toxicology, and\\nHygiene 43\\nSerin s Genito-L^rinary Tuberculosis 24\\nSenn s Tumors 25\\nSenn s Syllabus of Lectures on Surgery 37\\nShaw s Nervous Diseases and Insanity 43\\nStarr s Diet-Lists for Children 38\\nStelwagon s Diseases of the Skin 43\\nStengel s Pathology 20\\nStevens Materia Medica and Therapeutics 32\\nStevens Practice of Medicine 31\\nStewart s Manual of Physiology 37\\nStewart and Lawrance s Medical Elec-\\ntricity 43\\nStoney s Materia Medica for Nurses 31\\nStoney s Practical Points in Nursing 27\\nSutton and Giles Diseases of Women 29, 41\\nThomas s Diet-List and Sick-Room Diet-\\nary 38\\nThornton s Dose-Book and Manual of Pre-\\nscription-Writing 41\\nVan Valzah and Nisbet s Diseases of the\\nStomach 21\\nVecki s Sexual Impotence 33\\nVierordt and Stuart s Medical Diagnosis 28\\nWarren s Surgical Pathology 25\\nWolff s Chemistry 43\\nWolff s Examination of Urine 43", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0347.jp2"}, "348": {"fulltext": "GENERAL INFORMATION.\\nOne Price. One price absolutely without deviation. No discounts allowed,\\nregardless of the number of books purchased at one time. Prices\\non all works have been fixed extremely low, with the view to\\nselling them strictly net and for cash.\\nOrders. An order accompanied by remittance will receive prompt\\nattention, books being sent to any address in the United States, by\\nmail or express, all charges prepaid. We prefer to send books by\\nexpress when possible.\\nGash or Credit. To physicians of approved credit who furnish satisfactory\\nreferences our books will be sent free of C. O. D. One volume\\nor two on thirty days time if credit is desired larger purchases\\non monthly payment plan. See offer below.\\nHOW to Send There are four ways by which money can be sent at our risk,\\nMoney by namely a post-office money order, an express money order, a\\nMail. bank-check (draft), and in a registered letter. Money sent in any\\nother way is at the sender s risk. Silver should not be sent through\\nthe mail.\\nShipments. All books, being packed in patent metal-edged boxes, neces-\\nsarily reach our patrons by mail or express in excellent condi-\\ntion.\\nSubscription\\nBooks.\\nMiscellaneous\\nBooks.\\nLatest\\nEditions.\\nBindings.\\nBooks in this catalogue marked with a star are for sale by\\nsubscription only, and may be secured by ordering them through\\nany of our authorized travelling salesmen, or direct from the\\nPhiladelphia office: they are not for sale by booksellers. All\\nother books in our catalogue can be procured of any bookseller\\nat the advertised price, or directly from us.\\nWe carry in stock only our own publications, but can supply\\nthe publications of other houses (except subscription books) on\\nreceipt of publisher s price.\\nIn every instance the latest revised edition is sent.\\nIn ordering, be careful to state the style of binding desired-\\nCloth, Sheep, or Half Morocco.\\nSpecial Offer. To physicians of approved credit who furnish satisfactory\\nMonthly references books will be sent express prepaid terms, $5.00 cash\\nPayment upon delivery of books, and monthly payments of $5 00 thereafter\\nFlan. until full amount is paid. Any of the publications of W. B. Saunders\\n(100 titles to select from) may be had in this way at catalogue price,\\nincluding the American Text-Book Series, the Medical Hand-\\nAtlases, etc. All payments to be made by mail or otherwise, free\\nof all expense to us.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0348.jp2"}, "349": {"fulltext": "SAUNDERS\\nMEDICAL HAND-ATLASES.\\nThe series of books included under this title consists of authorized translations\\ninto English of the world-famous Lehmann Medicinische Handatlanten,\\nwhich for scientific accuracy, pictorial beauty, compactness, and cheap-\\nness surpass any similar volumes ever published. Each volume contains from\\n50 to 100 colored plates, executed by the most skilful German lithographers,\\nbesides numerous illustrations in the text. There is a full and appropriate de-\\nscription, and each book contains a condensed but adequate outline of the\\nsubject to which it is devoted.\\nIn planning this series arrangements were made with representative pub-\\nlishers in the chief medical centers of the world for the publication of transla-\\ntions of the atlases into nine different languages, the lithographic plates for all\\nbeing made in Germany, where work of this kind has been brought to the greatest\\nperfection. The enormous expense of making the plates being shared by the\\nvarious publishers, the cost to each one was reduced to practically one-tenth.\\nThus by reason of their universal translation and reproduction, affording in-\\nternational distribution, the publishers have been enabled to secure for these\\natlases the best artistic and professional talent, to produce them in the most\\nelegant style, and yet to offer them at a price heretofore unapproached\\nin cheapness. The great success of the undertaking is demonstrated by the\\nfact that the volumes have already appeared in thirteen different languages\\n\u00e2\u0080\u0094German, English, French, Italian, Russian, Spanish, Japanese, Dutch, Danish,\\nSwedish, Roumanian, Bohemian, and Hungarian.\\nIn view of the unprecedented success of these works, Mr. Saunders has con-\\ntracted with the publisher of the original German edition for one hundred\\nthousand copies of the atlases. In consideration of this enormous under-\\ntaking, the publisher has been enabled to prepare and furnish special additional\\ncolored plates, making the series even handsomer and more complete than\\nwas originally intended.\\nAs an indication of the great practical value of the atlases and of the im-\\nmense favor with which they have been received, it should be noted that the\\nMedical Department of the U. S. Army has adopted the Atlas of Opera-\\ntive Surgery, as its standard, and has ordered the book in large quantities for\\ndistribution to the various regiments and army posts.\\nThe same careful and competent editorial supervision has been secured in\\nthe English edition as in the originals. The translations have been edited by\\nthe leading American specialists in the different subjects.\\n(For List of Volumes in this Series, see next two pages.\\n3", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0349.jp2"}, "350": {"fulltext": "SAUNDERS MEDICAL HAND-ATLASES.\\nVOLUMES NOW READY.\\nAtlas and Epitome of Internal Medicine and Clinical Diagnosis.\\nBy Dr. Chr. Jakob, of Erlangen. Edited by Augustus A. Eshner, M. D.,\\nProfessor of Clinical Medicine, Philadelphia Polyclinic. With 68 colored\\nplates, 64 text-illustrations, and 259 pages of text. Cloth, $3.00 net.\\nThe charm of the book is its clearness, conciseness, and the accuracy and beauty of its\\nillustrations. It deals with facts. It vividly illustrates those facts. It is a scientific work\\nput together for ready reference. Brooklyn Medical Journal.\\nAtlas of Legal Medicine. By Dr. E. R. von Hofmann, of Vienna. Edited\\nby Frederick Peterson, M. D., Chief of Clinic, Nervous Dept., College\\nof Physicians and Surgeons, New York. With 120 colored figures on 56\\nplates, and 193 beautiful half-tone illustrations. Cloth, $3.50 net.\\nHofmann s Atlas of Legal Medicine is a unique work. This immense field finds in this\\nbook a pictorial presentation that far excels anything with which we are familiar in any other\\nwork. Philadelphia Medical Journal.\\nAtlas and Epitome of Diseases of the Larynx. By Dr. L. Grunwald,\\nof Munich. Edited by Charles P. Grayson, M. D., Physician-in-Charge,\\nThroat and Nose Department, Hospital of the University of Pennsylvania.\\nWith 107 colored figures on 44 plates, 25 text-illustrations, and 103 pages\\nof text. Cloth, $2.50 net.\\nAided as it is by magnificently executed illustrations in color, it cannot fail of being of\\nthe greatest advantage to students, general practitioners, and expert laryngologists. St.\\nLouis Medical and Surgical Journal.\\nAtlas and Epitome of Operative Surgery. By Dr. O. Zuckerkandl,\\nof Vienna. Edited by J. Chalmers DaCosta, M. D., Clinical Professor\\nof Surgery, Jefferson Medical College, Philadelphia. With 24 colored plates,\\n217 text-illustrations, and 395 pages of text. Cloth, $3.00 net.\\nWe know of no other work that combines such a wealth of beautiful illustrations with\\nclearness and conciseness of language, that is so entirely abreast of the latest achievements,\\nand so useful both for the beginner and for one who wishes to increase his knowledge of oper-\\native surgery. Munchener medicinische Wochenschrift.\\nAtlas and Epitome of Syphilis and the Venereal Diseases. By\\nProf. Dr. Franz Mracek, of Vienna. Edited by L. Bolton Bangs,\\nM. D., Professor of Genito- Urinary Surgery, University and Bellevue Hos-\\npital Medical College, New York. With 71 colored plates, 16 black-and-\\nwhite illustrations, and 122 pages of text. Cloth, $3.50 net.\\nA glance through the book is almost like actual attendance upon a famous clinic.\\nJournal of the American Medical Association.\\nAtlas and Epitome of External Diseases of the Eye. By Dr. O\\nHaab, of Zurich. Edited by G. E. de Schweinitz, M. D., Professor of\\nOphthalmology, Jefferson Medical College, Philadelphia. With 76 colored\\nillustrations on 40 plates, and 228 pages of text. Cloth, $3.00 net.\\nIt is always difficult to represent pathological appearances in colored plates, but this\\nwork seems to have overcome these difficulties, and the plates, with one or two exceptions,\\nare absolutely satisfactory. Boston Medical and Surgical Journal.\\nAtlas and Epitome of Skin Diseases. By Prof. Dr. Franz Mracek,\\nof Vienna. Edited by Henry W. Stelwagon, M. D., Clinical Professor\\nof Dermatology, Jefferson Medical College, Philadelphia. With 63 colored\\nplates, 39 half-tone illustrations, and 200 pages of text. Cloth, $3.50 net.\\nThe importance of personal inspection of cases in the study of cutaneous diseases is\\nreadily appreciated, and next to the living subjects are pictures which will show the appear-\\nance of the disease under consideration. Altogether the work will be found of very great\\nvalue to the general practitioner. Journal of the American Medical Association.\\n4", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0350.jp2"}, "351": {"fulltext": "SAUNDERS MEDICAL HAND-ATLASES-\\nVOLUMES IN PRESS FOR EARLY PUBLICATION.\\nAtlas and Epitome of Diseases Caused by Accidents. By Dr. Ed.\\nGolebiewski, of Berlin. Translated and edited with additions by Pearce\\nBailey, M.D., Attending Physician to the Department of Corrections\\nand to the Almshouse and Incurable Hospitals, New York. With 40\\ncolored plates, 143 text-illustrations, and 600 pages of text.\\nAtlas and Epitome of Special Pathological Histology. By Dr. H.\\nDurck, of Munich. Edited by Ludvig Hektoen, M.D., Professor of\\nPathology, Rush Medical College, Chicago. Two volumes, with about\\n120 colored plates, numerous text-illustrations, and copious text.\\nAtlas and Epitome of General Pathological Histology. With an\\n.Appendix on Patho-histological Technic. By Dr. H. DOrCK, of Munich.\\nEdited by Ludvig Hektoen, M.D., Professor of Pathology, Rush Medi-\\ncal College, Chicago. With 80 colored plates, numerous text-illustrations,\\nand copious text.\\nAtlas and Epitome of Gynecology. By Dr. O. Schaffer, of the\\nUniversity of Heidelberg. With 90 colored plates, 65 text- illustrations,\\nand 308 pages of text. Edited by Richard C. Norris, A. M., M. D.,\\nGynecologist to the Philadelphia and the Methodist Episcopal Hospitals.\\nIN PREPARATION.\\nAtlas and Epitome of Orthopedic Surgery. By Dr. Schultess and\\nDr. Luning, of Zurich. About 100 colored illustrations.\\nAtlas and Epitome of Operative Gynecology. By Dr. O. Schaffer,\\nof Heidelberg. With 40 colored plates and numerous illustrations in\\nblack and white from original paintings.\\nAtlas and Epitome of Diseases of the Ear. Edited by Prof. Dr.\\nPolitzer, of Vienna, and Dr. G. Bruhl, of Berlin. With 120 colored\\nillustrations and about 200 pages of text.\\nAtlas and Epitome of General Surgery. Edited by Dr. Marwedel,\\nwith the cooperation of Prof. Dr. Czerny. With about 200 colored\\nillustrations.\\nAtlas and Epitome of Psychiatry. By Dr. Wilh. Weygandt, of Wiirz-\\nburg. With about 120 colored illustrations.\\nAtlas and Epitome of Normal Histology. By Dr. Johannes Sobotta,\\nof Wurzburg. With 80 colored plates and numerous illustrations.\\nAtlas and Epitome of Topographical Anatomy. By Prof. Dr.\\nSchultze, of Wurzburg. About 100 colored illustrations and a very\\ncopious text.\\n5", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0351.jp2"}, "352": {"fulltext": "W. B. SAUNDERS-\\n*THE INTERNATIONAL TEXT-BOOK OF SURGERY. In\\ntwo volumes. By American and British authors. Edited by J. Col-\\nlins Warren, M.D.,LL.D., Professor of Surgery, Harvard Medical School,\\nBoston Surgeon to the Massachusetts General Hospital and A. Pearce\\nGould, M. S., F. R. C. S., Eng., Lecturer on Practical Surgery and Teacher\\nof Operative Surgery, Middlesex Hospital Medical School Surgeon to the\\nMiddlesex Hospital, London, England. Vol. I. General and Operative\\nSurgery. Handsome octavo volume of 947 pages, with 458 beautiful\\nillustrations, and 9 lithographic plates. Vol. II. Special or Regional\\nSurgery. Handsome octavo volume of 1050 pages, with over 500 wood-\\ncuts and half-tones, and 8 lithographic plates. Prices per volume Cloth,\\n$5.00 net; Half-Morocco, $6.00 net.\\nJust Issued.\\nIn presenting a new work on surgery to the medical profession the publisher\\nfeels that he need offer no apology for making an addition to the list of excellent\\nworks already in existence. Modern surgery is still in the transition stage of its\\ndevelopment. The art and science of surgery are advancing rapidly, and the\\nnumber of workers is now so great and so widely spread through the whole of\\nthe civilized world that there is certainly room for another work of reference\\nwhich shall be untrammelled by many of the traditions of the past, and shall at\\nthe same time present with due discrimination the results of modern progress.\\nThere is a real need among practitioners and advanced students for a work on\\nsurgery encyclopedic in scope, yet so condensed in style and arrangement that\\nthe matter usually diffused through four or five volumes shall be given in one-\\nhalf the space and at a correspondingly moderate cost.\\nThe ever-widening-field of surgery has been developed largely by special\\nwork, and this method of progress has made it practically impossible for one\\nman to write authoritatively on the vast range of subjects embraced in a modern\\ntext-book of surgery. In order, therefore, to accomplish their object, the editors\\nhave sought the aid of men of wide experience and established reputation in the\\nvarious departments of surgery.\\nCONTRIBUTORS\\nDr. Robert W. Abbe.\\nC. H.Golding Bird.\\nE. H. Bradford.\\nW. T. Bull.\\nT. G. A. Burns.\\nHerbert L. Burrell.\\nR. C. Cabot.\\nI. H. Cameron.\\nJames Cantlie.\\nW. Watson Cheyne.\\nWilliam B. Clarke.\\nWilliam B. Coley.\\nEdw. Treacher Collins.\\nH. Holbrook Curtis.\\nJ. Chalmers Da Costa.\\nN. P. Dandridge.\\nJohn B. Deaver.\\nJ. W. Elliot.\\nHarold Ernst.\\nDr. Christian Fenger.\\nW. H. Forwood.\\nGeorge R. Fowler.\\nGeorge W. Gay.\\nA. Pearce Gould.\\nJ. Orne Green.\\nJohn B. Hamilton.\\nM. L. Harris:\\nFernand Henrotin.\\nG. H. Makins.\\nRudolph Matas.\\nCharles McBurney.\\nA. J. McCosh.\\nL. S. McMurtry.\\nJ. Ewing Mears.\\nGeorge H. Monks.\\nJohn Murray.\\nRobert W. Parker.\\nDr. Rush ton Parker.\\nGeorge A. Peters.\\nFranz Pfaff.\\nLewis S. Pilcher.\\nJames J. Putnam.\\nM. H. Richardson.\\nA. W. Mayo Robson.\\nW. L. Rodman.\\nC. A. Siegfried.\\nG. B. Smith.\\nW. G. Spencer.\\nJ. Bland Sutton.\\nL. McLane Tiffany.\\nH. Tuholske.\\nWeller Van Hook.\\nJames P. Warbasse.\\nJ. Collins Warren.\\nDe Forest Willard.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0352.jp2"}, "353": {"fulltext": "CATALOGUE OF MEDICAL WORKS.\\n*AN AMERICAN TEXT-BOOK OF PHYSIOLOGY. Edited by\\nWilliam H. Howell, Ph. D., M. D., Professor of Physiology in the\\nJohns Hopkins University, Baltimore, Md. One handsome octavo volume\\nof 1052 pages, fully illustrated. Prices: Cloth, $6.00 net; Sheep or Half-\\nMorocco, $7.00 net.\\nThis work is the most notable attempt yet made in America to combine in\\none volume the entire subject of Human Physiology by well-known teachers\\nwho have given especial study to that part of the subject upon which they write.\\nThe completed work represents the present status of the science of Physiology,\\nparticularly from the standpoint of the student of medicine and of the medical\\npractitioner.\\nThe collaboration of several teachers in the preparation of an elementary text-\\nbook of physiology is unusual, the almost invariable rule heretofore having been\\nfor a single author to write the entire book. One of the advantages to be derived\\nfrom this collaboration method is that the more limited literature necessary for\\nconsultation by each author has enabled him to base his elementary account\\nupon a comprehensive knowledge of the subject assigned to him another, and\\nperhaps the most important, advantage is that the student gains the point of view\\nof a number of teachers. In a measure he reaps the same benefit as would be\\nobtained by following courses of instruction under different teachers. The\\ndifferent standpoints assumed, and the differences in emphasis laid upon the\\nvarious lines of procedure, chemical, physical, and anatomical, should give the\\nstudent a better insight into the methods of the science as it exists to-day. The\\nwork will also be found useful to many medical practitioners who may wish to\\nkeep in touch with the development of modern physiology.\\nCONTRIBUTORS\\nHENRY P. BOWDITCH, M. D.,\\nProfessor of Physiology, Harvard Medi-\\ncal School.\\nJOHN G. CURTIS, M. D.,\\nProfessor of Physiology, Columbia Uni-\\nversity, N. Y. (College of Physicians\\nand Surgeons).\\nHENRY H. DONALDSON, Ph.D.,\\nHead-Professor of Neurology, Univer-\\nsity of Chicago.\\nW. H. HOWELL, Ph. D., M. D.,\\nProfessor of Physiology, Johns Hopkins\\nUniversity.\\nFREDERIC S. LEE, Ph. D.,\\nAdjunct Professor of Physiology, Colum-\\nbia University, N. Y. (College of\\nPhysicians and Surgeons).\\nWARREN P. LOMBARD, M.D.,\\nProfessor of Physiology, University of\\nMichigan.\\nGRAHAM LUSK, Ph.D.,\\nProfessor of Physiology, Yale MedicaF\\nSchool.\\nW. T. PORTER, M.D.,\\nAssistant Professor of Physiology, Har-\\nvard Medical School.\\nEDWARD T. REICHERT, M.D.,\\nProfessor of Physiology, University of\\nPennsylvania.\\nHENRY SEW ALL, Ph.D., M. D.,\\nProfessor of Physiology, Medical Depart-\\nment, University of Denver.\\nWe can commend it most heartily, not only to all students of physiology, but to every\\nphysician and pathologist, as a valuable and comprehensive work of reference, written by\\nmen who are of eminent authority in their own special subjects. London Lancet.\\nTo the practitioner of medicine and to the advanced student this volume constitutes,\\nwe believe, the best exposition of the present status of the science of physiology in the Eng-\\nlish language. American Journal of the Medical Sciences.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0353.jp2"}, "354": {"fulltext": "8 W. B. SAUNDERS\\n*AN AMERICAN TEXT-BOOK OF APPLIED THERAPEU-\\nTICS. For the Use of Practitioners and Students. Edited by\\nJames C. Wilson, M. D., Professor of the Practice of Medicine and of\\nClinical Medicine in the Jefferson Medical College. One handsome octavo\\nvolume of 1326 pages. Illustrated. Prices: Cloth, $7.00 net; Sheep or\\nHalf-Morocco, $8.00 net.\\nThe arrangement of this volume has been based, so far as possible, upon\\nmodern pathologic doctrines, beginning with the intoxications, and following\\nwith infections, diseases due to internal parasites, diseases of undetermined\\norigin, and finally the disorders of the several bodily systems digestive, re-\\nspiratory, circulatory, renal, nervous, and cutaneous. It was thought proper to\\ninclude also a consideration of the disorders of pregnancy.\\nThe articles, with two exceptions, are the contributions of American writers.\\nWritten from the standpoint of the practitioner, the aim of the work is to facili-\\ntate the application of knowledge to the prevention, the cure, and the allevia-\\ntion of disease. The endeavor throughout has been to conform to the title of\\nthe book Applied Therapeutics to indicate the course of treatment to be\\npursued at the bedside, rather than to name a list of drugs that have been used\\nat one time or another.\\nThe list of contributors comprises the names of many who have acquired dis-\\ntinction as practitioners and teachers of practice, of clinical medicine, and of\\nthe specialties.\\nCONTRIBUTORS\\nDr. I. E. Atkinson, Baltimore, Md.\\nSanger Brown, Chicago, III.\\nJohn B. Chapin, Philadelphia, Pa.\\nWilliam C. Dabney, Charlottesville, Va.\\nJohn Chalmers DaCosta, Philada., Pa.\\nI. N. Danforth, Chicago, 111.\\nJohn L. Dawson, Jr., Charleston, S. C.\\nF. X. Dercum, Philadelphia, Pa.\\nGeorge Dock, Ann Arbor, Mich.\\nRobert T. Edes, Jamaica Plain, Mass.\\nAugustus A. Eshner, Philadelphia, Pa.\\nJ. T. Eskridge, Denver, Ccl.\\nF. Forchheimer, Cincinnati, O.\\nCarl Frese, Philadelphia, Pa.\\nEdwin E. Graham, Philadelphia, Pa.\\nJohn Guiteras, Philadelphia, Pa.\\nFrederick P. Henry, Philadelphia, Pa.\\nGuy Hinsdale, Philadelphia, Pa.\\nOrville Horwitz, Philadelphia, Pa.\\nW. W. Johnston, Washington, D. C.\\nErnest Laplace, Philadelphia, Pa.\\nA. Laveran, Pans, France.\\nAs a work either for study or reference it will be of great value to the practitioner, as\\nit is virtually an exposition of such clinical therapeutics as experience has taught to be of\\nthe most value. Taking it all in all, no recent publication on therapeutics can be compared\\nwith this one in practical value to the working physician. Chicago Clinical Reviezv.\\nThe whole field of medicine has been well covered. The work is thoroughly practical,\\nand while it is intended for practitioners and students, it is abetter book for the general\\npractitioner than for the student. The young practitioner especially will find it extremely\\nsuggestive and helpful. The Indian Lancet.\\nDr. James Hendrie Lloyd, Philadelphia, Pa.\\nJohn Noland Mackenzie, Baltimore, Md.\\nJ. W. McLaughlin, Austin, Texas.\\nA. Lawrence Mason, Boston, Mass.\\nCharles K. Mills, Philadelphia, Pa.\\nJohn K. Mitchell, Philadelphia, Pa.\\nW. P. Northrup, New York City.\\nWilliam Osier, Baltimore, Md.\\nFrederick A. Packard, Philadelphia, Pa.\\nTheophilus Parvin, Philadelphia, Pa.\\nBeaven Rake, London, England.\\nE. O. Shakespeare, Philadelphia, Pa.\\nWharton Sinkler, Philadelphia, Pa.\\nLouis Starr, Philadelphia, Pa.\\nHenry W. Stelwagon, Philadelphia, Pa.\\nJames Stewart, Montreal, Canada.\\nCharles G. Stockton, Buffalo, N. Y.\\nJames Tyson, Philadelphia, Pa.\\nVictor C. Vaughan, Ann Arbor, Mich.\\nJames T. Whittaker, Cincinnati, O.\\nJ. C. Wilson, Philadelphia, Pa.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0354.jp2"}, "355": {"fulltext": "CATALOGUE OF MEDICAL WORKS.\\n*AN AMERICAN TEXT-BOOK OF OBSTETRICS. Edited by\\nRichard C. Norris, M. D. Art Editor, Robert L. Dickinson, M. D.\\nOne handsome octavo volume of over iooo pages, with nearly 900 colored\\nand half-tone illustrations. Prices: Cloth, $7.00 net; Sheep or Half\\nMorocco, $8.00 net.\\nThe advent of each successive volume of the series of the American Text-\\nBooks has been signalized by the most flattering comment from both the Press\\nand the Profession. The high consideration received by these text-books, and\\ntheir attainment to an authoritative position in current medical literature, have\\nbeen matters of deep international interest, which finds its fullest expression in\\nthe demand for these publications from all parts of the civilized world.\\nIn the preparation of the American Text-Book of Obstetrics the\\neditor has called to his aid proficient collaborators whose professional prominence\\nentitles them to recognition, and whose disquisitions exemplify Practical\\nObstetrics. While these writers were each assigned special themes for dis-\\ncussion, the correlation of the subject-matter is, nevertheless, such as ensures\\nlogical connection in treatment, the deductions of which thoroughly represent\\nthe latest advances in the science, and which elucidate the best modern methods\\nof procedure.\\nThe more conspicuous feature of the treatise is its wealth of illustrative\\nmatter. The production of the illustrations had been in progress for several\\nyears, under the personal supervision of Robert L. Dickinson, M. D., to whose\\nartistic judgment and professional experience is due the most sumptuously\\nillustrated work of the period. By means of the photographic art, combined\\nwith the skill of the artist and draughtsman, conventional illustration is super-\\nseded by rational methods of delineation.\\nFurthermore, the volume is a revelation as to the possibilities that may be\\nreached in mechanical execution, through the unsparing hand of its publisher.\\nCONTRIBUTORS\\nDr. James C. Cameron.\\nEdward P. Davis.\\nRobert L. Dickinson.\\nCharles Warrington Earle.\\nJames H. Etheridge.\\nHenry J. Garrigues.\\nBarton Cooke Hirst.\\nCharles Jewett.\\nDr. Howard A. Kelly.\\nRichard C. Norris.\\nChauncey D. Palmer.\\nTheophilus Parvin.\\nGeorge A. Piersol.\\nEdward Reynolds.\\nHenry Schwarz.\\nAt first glance we are overwhelmed by the magnitude of this work in several respects,\\nviz. First, by the size of the volume, then by the array of eminent teachers in this depart-\\nment who have taken part in its production, then by the profuseness and character of the\\nillustrations, and last, but not least, the conciseness and clearness with which the text is ren-\\ndered. This is an entirely new composition, embodying the highest knowledge of the art as\\nit stands to-day by authors who occupy the front rank in their specialty, and there are many\\nof them. We cannot turn over these pages without being struck by the superb illustrations\\nwhich adorn so many of them. We are confident that this most practical work will find\\ninstant appreciation by practitioners as well as students. New York Medical Times.\\nPermit me to say that your American Text-Book of Obstetrics is the most magnificent\\nmedical work that 1 have ever seen. I congratulate you and thank you for this superb work\\nwhich alone is sufficient to place you first in the ranks of medical publishers.\\nWith profound respect I am sincerely yours, Alex. J. C. Skene.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0355.jp2"}, "356": {"fulltext": "IO\\nW. B. SAUNDERS\\n*AN AMERICAN TEXT-BOOK OF THE THEORY AND\\nPRACTICE OF MEDICINE. By American Teachers. Edited\\nby William Pepper, M. D., LL.D., Provost and Professor of the Theory\\nand Practice of Medicine and of Clinical Medicine in the University of\\nPennsylvania. Complete in two handsome royal- octavo volumes of about\\nIOOO pages each, with illustrations to elucidate the text wherever necessary.\\nPrice per Volume Cloth, $5.00 net; Sheep or Half-Morocco, $6.00 net.\\nVOLUME I. CONTAINS s\\nHygiene. Fevers (Ephemeral, Simple Con-\\ntinued, Typhus, Typhoid, Epidemic Cerebro-\\nspinal Meningitis, and Relapsing). Scarla-\\ntina, Measles, Rotheln, Variola, Varioloid,\\nVaccinia, Varicella, Mumps,Whooping-cough,\\nAnthrax, Hydrophobia, Trichinosis, Actino-\\nmycosis, Glanders, and Tetanus.\u00e2\u0080\u0094 Tubercu-\\nlosis, Scrofula, Syphilis, Diphtheria, Erysipe-\\nlas, Malaria, Cholera, and Yellow Fever.\\nNervous, Muscular, and Mental Diseases etc.\\nVOLUME II. CONTAINS:\\nUrine (Chemistry and Microscopy).\u00e2\u0080\u0094 Kid-\\nney and Lungs. Air-passages (Larynx and\\nBronchi) and Pleura. Pharynx, (Esophagus,\\nStomach and Intestines (including Intestinal\\nParasites), Heart, Aorta, Arteries and Veins.\\nPeritoneum, Liver, and Pancreas. Diathet-\\nic Diseases (Rheumatism, Rheumatoid Ar-\\nthritis, Gout, Lithaemia, and Diabetes.)\\nBlood and Spleen. Inflammation, Embolism,\\nThrombosis, Fever, and Bacteriology.\\nThe articles are not written as though addressed to students in lectures, but\\nare exhaustive descriptions of diseases, with the newest facts as regards Causa-\\ntion, Symptomatology, Diagnosis, Prognosis, and Treatment, including a large\\nnumber of approved formulae. The recent advances made in the study\\nof the bacterial origin of various diseases are fully described, as well as the\\nbearing of the knowledge so gained upon prevention and cure. The subjects\\nof Bacteriology as a whole and of Immunity are fully considered in a separate\\nsection.\\nMethods of diagnosis are given the most minute and careful attention, thus\\nenabling the reader to learn the very latest methods of investigation without\\nconsulting works specially devoted to the subject.\\nCONTRIBUTORS\\nDr. J. S. Billings, Philadelphia.\\nFrancis Delafield, New York.\\nReginald H. Fitz, Boston.\\nJames W. Holland, Philadelphia.\\nHenry M. Lyman, Chicago.\\nWilliam Osier, Baltimore.\\nWilliam Pepper, Philadelphia.\\nW. Gilman Thompson, New York.\\nW. H. Welch, Baltimore.\\nJames T. Whittaker, Cincinnati.\\nJames C. Wilson, Philadelphia.\\nHoratio C. Wood, Philadelphia.\\nWe reviewed the first volume of this work, and said It is undoubtedly one of the best\\ntext-books on the practice of medicine which we possess. A consideration of the second\\na.nd last volume leads us to modify that verdict and to say that the completed work is, in our\\nopinion, the best of its kind it has ever been our fortune to see. It is complete, thorough,\\naccurate, and clear. It is well written, well arranged, well printed, well illustrated, and well\\nbound. It is a model of what the modern text-book should be. New York Medical Journal.\\nA library upon modern medical art. The work must promote the wider diffusion of\\nsound knowledge. American Lancet.\\nA trusty counsellor for the practitioner or senior student, on which he may implicitly\\n?\u00c2\u00ably. Edinburgh Medical Journal.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0356.jp2"}, "357": {"fulltext": "CATALOGUE OF MEDICAL WORKS. II\\n*AN AMERICAN TEXT-BOOK OF SURGERY. Edited by Wil-\\nliam W. Keen, M. D., LL.D., and J. William White, M. D., Ph. D.\\nForming one handsome royal octavo volume of 1230 pages (iox 7 inches),\\nwith 496 wood-cuts in text, and 37 colored and half-tone plates, many of\\nthem engraved from original photographs and drawings furnished by the\\nauthors. Price Cloth, $7.00 net; Sheep or Half Morocco, $8.00 net.\\nTHIRD EDITION. THOROUGHLY REVISED.\\nIn the present edition, among the new topics introduced are a full considera-\\ntion of serum-therapy leucocytosis post-operative insanity; the use of dry heat\\nat high temperatures Kronlein s method of locating the cerebral fissures\\nHoffa s and Lorenz s operations of congenital dislocations of the hip Allis s re-\\nsearches on dislocations of the hip-joint lumbar puncture the forcible reposi-\\ntion of the spine in Pott s disease the treatment of exophthalmic goiter the\\nsurgery of typhoid fever gastrectomy and other operations on the stomach\\nnew methods of operating upon the intestines the use of Kelly s rectal specula\\nthe surgery of the ureter Schleich s infiltration-method and the use of eucain\\nfor local anesthesia Krause s method of skin-grafting the newer methods of\\ndisinfecting the hands the use of gloves, etc. The sections on Appendicitis,\\non Fractures, and on Gynecological Operations have been revised and enlarged.\\nA considerable number of new illustrations have been added, and enhance the\\nvalue of the work.\\nThe text of the entire book has been submitted to all the authors for their\\nmutual criticism and revision an idea in book-making that is entirely new and\\noriginal. The book as a whole, therefore, expresses on all the important sur-\\ngical topics of the day the consensus of opinion of the eminent surgeons who\\nhave joined in its preparation.\\nOne of the most attractive features of the book is its illustrations. Very\\nmany of them are original and faithful reproductions of photographs taken\\ndirectly from patients or from specimens,\\nCONTRIBUTORS:\\nPhineas S. Conner, Cincinnati.\\nFrederic S. Dennis, New York.\\nWilliam W. Keen, Philadelphia.\\nCharles B. Nancrede, Ann Arbor, Mich.\\nRoswell Park, Buffalo, New York.\\nLewis S. Pilcher. New York.\\nDr. Nicholas Senn, Chicago.\\nFrancis J. Shepherd, Montreal, Canada.\\nLewis A. Stimson, New York.\\nJ. Collins Warren, Boston.\\nJ. William White, Philadelphia.\\nIf this text-book is a fair reflex of the present position of American surgery, we must\\nadmit it is of a very high order of merit, and that English surgeons will have to look very\\ncarefullv to their laurels if they are to preserve a position in the van of surgical practice.\\nLondon Laticet.\\nPersonally, I should not mind it being called THE Text-Book (instead of A Text-Book),\\nfor I know ot no single volume which contains so readable and complete an account of the\\nscience and art of Surgery as this does. Edmund Owen, F. R. C. S., Member of the Board\\ntif Examiners of the Royal College of Surgeons, England;", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0357.jp2"}, "358": {"fulltext": "12 TV. B. SAUNDERS\\n*AN AMERICAN TEXT-BOOK OF GYNECOLOGY, MEDICAL\\nAND SURGICAL, for the use of Students and Practitioners.\\nEdited by J. M. Baldy, M. D. Forming a handsome royal-octavo volume\\nof 718 pages, with 341 illustrations in the text and 38 colored and half-\\ntone plates. Prices Cloth, $6.00 net; Sheep or Half-Morocco, $7.00 net.\\nSECOND EDITION, THOROUGHLY REVISED.\\nIn this volume all anatomical descriptions, excepting those essential to a clear\\nunderstanding of the text, have been omitted, the illustrations being largely de-\\npended upon to elucidate the anatomy of the parts. This work, which is\\nthoroughly practical in its teachings, is intended, as its title implies, to be a\\nworking text-book for physicians and students. A clear line of treatment has\\nbeen laid down in every case, and although no attempt has been made to dis-\\ncuss mooted points, still the most important of these have been noted and ex-\\nplained. The operations recommended are fully illustrated, so that the reader,\\nhaving a picture of the procedure described in the text under his eye, cannot fail\\nto grasp the idea. All extraneous matter and discussions have been carefully\\nexcluded, the attempt being made to allow no unnecessary details to cumber\\nthe text. The subject-matter is brought up to date at every point, and the\\nwork is as nearly as possible the combined opinions of the ten specialists who\\nfigure as the authors.\\nIn the revised edition much new material has been added, and some of the\\nold eliminated or modified. More than forty of the old illustrations have been\\nreplaced by new ones, which add very materially to the elucidation of the\\ntext, as they picture methods, not specimens. The chapters on technique and\\nafter-treatment have been considerably enlarged, and the portions devoted to\\nplastic work have been so greatly improved as to be practically new. Hyste-\\nrectomy has been rewritten, and all the descriptions of operative procedures\\nhave been carefully revised and fully illustrated.\\nCONTRIBUTORS\\nDr. Henry T. Byford.\\nJohn M. Baldy.\\nEdwin Cragin.\\nI. H. Etheridge.\\nWilliam Goodell.\\nDr. Howard A. Kelly.\\nFlorian Krug.\\nE. E. Montgomery.\\nWilliam R. Pryor.\\nGeorge M. Tuttle.\\nThe most notable contribution to gynecological literature since 1887, and the most\\ncomplete exponent of gynecology which we have. No subject seems to have been neglected,\\nand the gynecologist and surgeon, and the general practitioner who has any desire\\nto practise diseases of women, will find it of practical value. In the matter of illustrations\\nand plates the book surpasses anything we have seen. Boston Medical and Surgical\\nJournal.\\nA thoroughly modern text-book, and gives reliable and well-tempered advice and in-\\nstruction. Edinburgh Medical Journal.\\nThe harmony of its conclusions and the homogeneity of its style give it an individuality\\nwhich suggests a single rather than a multiple authorship. Annals of Surgery.\\nIt must command attention and respect as a worthy representation of our advanced\\nclinical teaching. American Journal of Medical Sciences.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0358.jp2"}, "359": {"fulltext": "CATALOGUE OF MEDICAL WORKS.\\n13\\n*AN AMERICAN TEXT-BOOK OF THE DISEASES OF CHIL-\\nDREN. By American Teachers. Edited by Louis Starr, M. D.,\\nassisted by Thompson S. Westcott, M. D. In one handsome reyal-8vr\\nvolume of 1244 pages, profusely illustrated with wood-cuts, half-tone and\\ncolored plates. Net Prices Cloth, $7.00; Sheep or Half-Morocco, $8.00.\\nSECOND EDITION, REVISED AND ENLARGED.\\nThe plan of this work embraces a series of original articles written by some\\nsixty well-known podiatrists, representing collectively the teachings of the most\\nprominent medical schools and colleges of America. The work is intended to\\nbe a practical book, suitable for constant and handy reference by the practi-\\ntioner and the advanced student.\\nEspecial attention has been given to the latest accepted teachings upon the\\netiology, symptoms, pathology, diagnosis, and treatment of the disorders of chil-\\ndren, with the introduction of many special formulae and therapeutic procedures.\\nIn this new edition the whole subject matter has been carefully revised, new\\narticles added, some original papers emended, and a number entirely rewritten.\\nThe new articles include Modified Milk and Percentage Milk-Mixtures,\\nLithemia, and a section on Orthopedics. Those rewritten are Typhoid\\nFever, Rubella, Chicken-pox, Tuberculous Meningitis, Hydroceph-\\nalus, and Scurvy; while extensive revision has been made in Infant\\nFeeding, Measles, Diphtheria, and Cretinism. The volume has thus\\nbeen much increased in size by the introduction of fresh material.\\nCONTRIBUTORS t\\nDr. S. S. Adams, Washington.\\nJohn Ashhurst, Jr., Philadelphia.\\nA. D. Blackader, Montreal, Canada.\\nDavid Bovaird. New York.\\nDillon Brown, New York.\\nEdward M. Buckingham, Boston.\\nCharles W. Burr, Philadelphia.\\nW. E. Casselberry, Chicago.\\nHenry Dwight Chapin, New York.\\nW. S. Christopher, Chicago.\\nArchibald Church, Chicago.\\nFloyd M. Crandall, New York.\\nAndrew F. Currier, New York.\\nRoland G. Curtin, Philadelphia\\nJ. M. DaCosm, Philadelphia.\\nI. N. Danforth, Chicago.\\nEdward P. Davis, Philadelphia.\\nJohn B. Deaver, Philadelphia.\\nG. E. de Schweinitz, Philadelphia.\\nJohn Doming, New York.\\nCharles Warrington Earle, Chicago.\\nWm. A. Edwards, San Diego, Cal.\\nF. Forchheimer, Cincinnati.\\nJ. Henry Fruitnight, New York.\\nJ. P. Crozer Griffith, Philadelphia.\\nW. A. Hardaway. St. Louis.\\nM. P Hatfield, Chicago.\\nBarton Cooke Hirst, Philadelphia.\\nH. Uloway, Cincinnati.\\nHenry Jackson, Boston.\\nCharles G. Jennings, Detroit.\\nHenry Koplik, New York.\\nDr. Thomas S. Latimer, Baltimore.\\nAlbert R. Leeds, Hoboken, N. J.\\nJ. Hendrie Lloyd, Philadelphia.\\nGeorge Roe Lockwood, New York.\\nHenry M. Lyman, Chicago.\\nFrancis T. Miles, Baltimore.\\nCharles K Mills, Philadelphia.\\nJames E Moore, Minneapolis.\\nF. Gordon Morrill, Boston.\\nJohn H. Musser, Philadelphia.\\nThomas R. Neilson, Philadelphia.\\nW. P. Northrup, New York.\\nWilliam Osier, Baltimore.\\nFrederick A. Packard, Philadelphia.\\nWilliam Pepper, Philadelphia.\\nFrederick Peterson, New York.\\nW. T. Plant, Syracuse, New York.\\nWilliam M. Powell, Atlantic City.\\nB. K. Rachford, Cincinnati.\\nB. Alexander Randall, Philadelphia.\\nEdward O. Shakespeare, Philadelphia\\nF. C. Shattuck, Boston.\\nJ. Lewis Smith, New York.\\nLouis Starr, Philadelphia.\\nM. Allen Starr, New York.\\nCharles W. Townsend, Boston.\\nJames Tyson, Philadelphia.\\nW. S. Thayer, Baltimore.\\nVictor C. Vaughan, Ann Arbor, Mich\\nThompson S. Westcott, Philadelphia.\\nHenry R. Wharton, Philadelphia.\\nJ William White, Philadelphia.\\nJ. C. Wilson, Philadelphia.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0359.jp2"}, "360": {"fulltext": "14\\nW. B. SAUNDERS\\nAN AMERICAN TEXT-BOOK OF GENITO-URINARY AND\\nSKIN DISEASES. By 47 Eminent Specialists and Teachers. Edited\\nby L. Bolton Bangs, M. D., Professor of Genito-Urinary Surgery, Uni-\\nversity and Bellevue Hospital Medical College, New York and W. A.\\nHardaway, M. D., Professor of Diseases of the Skin, Missouri Medical\\nCollege. Imperial octavo volume of 1229 pages, with 300 engravings and\\n20 full-page colored plates. Cloth, $7.00 net Sheep or Half Morocco,\\n$8.00 net.\\nThis addition to the series of American Text-Books, it is confidently be-\\nlieved, will meet the requirements of both students and practitioners, giving, as\\nit does, a comprehensive and detailed presentation of the Diseases of the\\nGenito-Urinary Organs, of the Venereal Diseases, and of the Affections of the\\nSkin.\\nHaving secured the collaboration of well-known authorities in the branches\\nrepresented in the undertaking, the editors have not restricted the contributors\\nin regard to the particular views set forth, but have offered every facility for the\\nfree expression of their individual opinions. The work will therefore be found\\nto be original, yet homogeneous and fully representative of the several depart-\\nments of medical science with which it is concerned.\\nCONTRIBUTORS s\\nDr. Chas. W. Allen, New York.\\nI. E. Atkinson, Baltimore.\\nL Bolton Bangs, New York.\\nP. R. Bolton, New York.\\nLewis C. Bosher, Richmond, Va.\\nJohn T. Bowen, Boston.\\nJ. Abbott Cantrell. Philadelphia.\\nWilliam T. Corlett, Cleveland, Ohio.\\nB. Farquhar Curtis, New York.\\nCondict W. Cutler, New York.\\nIsadore Dyer, New Orleans.\\nChristian Fenger, Chicago.\\nJohn A. Fordyce, New York.\\nEugene Fuller, New York.\\nR. H. Greene, New York.\\nJoseph Orindon, St. Louis.\\nGraeme M. Hammond, New York.\\nW. A. Hardaway, St. Louis.\\nM. B. Hartzell, Philadelphia.\\nLouis Heitzmann, New York.\\nJames S. Howe, Boston.\\nGeorge T. Jackson, New York.\\nAbraham Jacobi, New York.\\nJames C. Johnston. New York.\\nDr. Hermann G. Klotz, New York.\\nJ. H. Linsley, Burlington, V t.\\nG. F. Lydston, Chicago.\\nHartwell N. Lyon, St. Louis.\\nEdward Martin, Philadelphia.\\nD. G. Montgomery, San Francisco.\\nJames Pedersen, New York.\\nS. Pollitzer, New York.\\nThomas R. Pooley, New York.\\nA. R. Robinson, New York.\\nA. E. Regensburger, San Francisco,\\nFrancis J. Shepherd, Montreal, Can.\\nS. C. Stanton, Chicago, 111.\\nEmmanuel J. Stout, Philadelphia.\\nAlonzo E. Taylor, Philadelphia.\\nRobert W. Taylor, New York.\\nPaul Thorndike, Boston.\\nH. Tuholske, St. Louis.\\nArthur Van Harlingen, Philadelphia.\\nFrancis S. Watson, Boston.\\nJ. William White, Philadelphia.\\nJ. McF. Winfield, Brooklyn.\\nAlfred C. Wood, Philadeipma.\\nThis voluminous work is thoroughly up to date, and the chapters on gemto-unnary dis-\\neases are especially valuable. The illustrations are fine and are mostly original. The section\\non dermatology is concise and in every way admirable. Journal of the American Medical\\nAssociation.\\nThis volume is one of the best yet issued of the publisher s series of American Text-\\nBooks. The list of contributors represents an extraordinary array of talent and extended\\nexperience. The book will easily take the place in comprehensiveness and value of the\\nhalf dozen or more costly works on these subjects which have hitherto been necessary to a\\nwell-equipped library. New York Polyclinic.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0360.jp2"}, "361": {"fulltext": "CATALOGUE OF MEDICAL WORKS.\\n15\\nAN AMERICAN TEXT-BOOK OF DISEASES OF THE EYE,\\nEAR, NOSE, AND THROAT. Edited by George E. de Schweinitz,\\nA. M., M. D., Professor of Ophthalmology, Jefferson Medical College; and\\nB. Alexander Randall, A. M., M. D., Clinical Professor of Diseases of\\nthe Ear, University of Pennsylvania. One handsome imperial octavo\\nvolume of 1251 pages; 766 illustrations, 59 of them colored. Prices:\\nCloth, $7.00 net; Sheep or Half-Morocco, $8.00 net.\\nJust Issued,\\nThe present work is the only book ever published embracing diseases of the\\nintimately related organs of the eye, ear, nose, and throat. Its special claim\\nto favor is based on encyclopedic, authoritative, and practical treatment of the\\nsubjects.\\nEach section of the book has been entrusted to an author who is specially\\nidentified with the subject on which he writes, and who therefore presents his\\ncase in the manner of an expert. Uniformity is secured and overlapping pre-\\nvented by careful editing and by a system of cross-references which forms a\\nspecial feature of the volume, enabling the reader to come into touch with all\\nthat is said on any subject in different portions of the book.\\nParticular emphasis is laid on the most approved methods of treatment, so\\nthat the book shall be one to which the student and practitioner can refer for\\ninformation in practical work. Anatomical and physiological problems, also,\\nare fully discussed for the benefit of those who desire to investigate the more\\nabstruse problems of the subject.\\nCONTRIBUTORS\\nDr. Henry A. Alderton, Brooklyn.\\nHarrison Allen, Philadelphia.\\nFrank Allport, Chicago.\\nMorris J. Asch, New York.\\nS. C. Ayres, Cincinnati.\\nR. O. Beard, Minneapolis.\\nClarence J. Blake, Boston.\\nArthur A- Bliss, Philadelphia.\\nAlbert P. Brubaker, Philadelphia.\\nJ. H. Bryan, Washington, D. C.\\nAlbert H. Buck, New York.\\nF. Buller, Montreal, Can.\\nSwan M. Burnett, Washington, D. C.\\nFlemming Carrow, Ann Arbor, Mich.\\nW. E. Casselberry, Chicago.\\nColman W. Cutler, New York.\\nEdward B. Dench, New York.\\nWilliam S. Dennett, New York.\\nGeorge E. de Schweinitz, Philadelphia.\\nAlexander Duane, New York.\\nJohn W. Farlow, Boston, Mass.\\nWalter J. Freeman, Philadelphia.\\nH. Gifford, Omaha, Neb.\\nW. C. Glasgow, St. Louis.\\nJ. Orne Green, Boston.\\nWard A. Holden, New York.\\nChristian R. Holmes, Cincinnati.\\nWilliam E. Hopkins, San Francisco.\\nF. C. Hotz, Chicago.\\nLucien Howe, Buffalo, N. Y.\\nDr. Alvin A. Hubbell, Buffalo, N. Y.\\nEdward Jackson, Philadelphia.\\nJ. Ellis Jennings, St. Louis.\\nHerman Knapp, New York.\\nChas. W. Kollock, Charleston, S. C.\\nG. A. Leland, Boston.\\nJ. A. Lippincott, Pittsburg, Pa.\\nG. Hudson Makuen, Philadelphia.\\nJohn H. McCollom, Boston.\\nH. G. Miller, Providence, R. I.\\nB. L. Miliiken, Cleveland, Ohio.\\nRobert C. Myles, New York.\\nJames E. Newcomb, New York.\\nR. J. Phiilips, Philadelphia.\\nGeorge A. Piersol, Philadelphia.\\nW. P. Porcher, Charleston, S. C.\\nB. Alex. Randall, Philadelphia.\\nRobert L. Randolph, Baltimore.\\nJohn O. Roe, Rochester, N. Y.\\nCharles E. de M. Sajous, Philadelphia.\\nJ. E. Sheppard, Brooklyn, N. Y.\\nE. L. Shurly, Detroit, Mich.\\nWilliam M. Sweet, Philadelphia.\\nSamuel Theobald, Baltimore, Md.\\nA. G. Thomson, Philadelphia.\\nClarence A. Veasey, Philadelphia.\\nJohn E. Weeks, New York.\\nCasey A. Wood, Chicago, 111.\\nJonathan Wright, Brooklyn.\\nH. V. Wiirdemann, Milwaukee, Wis.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0361.jp2"}, "362": {"fulltext": "i6\\nW. B. SAUNDERS\\n*AN AMERICAN YEAR-BOOK OF MEDICINE AND SUR-\\nGERY. A Yearly Digest of Scientific Progress and Authoritative\\nOpinion in all branches of Medicine and Surgery, drawn from journals)\\nmonographs, and text-books of the leading American and Foreign authors\\nand investigators. Collected and arranged, with critical editorial com-\\nments, by eminent American specialists and teachers, under the general\\neditorial charge of George M. Gould, M. D. Volumes for 1896, 97,\\n98, and 99 each a handsome imperial octavo volume of about 1200 pages.\\nPrices Cloth, $6.50 net Half-Morocco, $7.50 net. Year-Book for 1900 in\\ntwo octavo volumes of about 600 pages each. Prices per volume Cloth,\\n$3.00 net; Half-Morocco, $3.75 net.\\nIn Two Volumes. No Increase in Price.\\nIn response to a widespread demand from the medical profession, the pub-\\nlisher of the American Year-Book of Medicine and Surgery has decided to\\nissue that well-known work in two volumes, Vol. I. treating of General Medi-\\ncine, Vol. II. of General Surgery. Each volume is complete in itself, and\\nthe work is sold either separately or in sets.\\nThis division is made in such a way as to appeal to physicians from a class\\nstandpoint, one volume being distinctly medical, and the other distinctly surgi-\\ncal. This arrangement has a two-fold advantage. To the physician who uses\\nthe entire book, it offers an increased amount of matter in the most convenient\\nform for easy consultation, and without any increase in price while the man\\nwho wants either the medical or the surgical section alone secures the complete\\nconsideration of his branch without the necessity of purchasing matter for which\\nhe has no use.\\nCONTRIBUTORS\\nVol. I.\\nSamuel W. Abbott. Boston.\\nArchibald Church, Chicago.\\nLouis A. Duhring, Philadelphia.\\nD. L. Edsall, Philadelphia.\\nAlfred Hand, Jr., Philadelphia.\\nM. B. Hartzell, Philadelphia.\\nReid Hunt, Baltimore.\\nWyatt Johnston, Montreal.\\nWalter Jones, Baltimore.\\nDavid Riesman, Philadelphia.\\nLouis Starr, Philadelphia.\\nAlfred Stengel, Philadelphia.\\nA. A. Stevens, Philadelphia.\\nG. N. Stewart. Cleveland.\\nReynold W. Wilcox, New York City.\\nVol. II.\\nDr. J. Montgomery Baldy, Philadelphia.\\nCharles H. Burnett, Philadelphia.\\nJ. Chalmers DaCosta. Philadelphia.\\nW. A. N. Dorland, Philadelphia.\\nVirgil P. Gibney, New York City.\\nC. H. Hamann, Cleveland.\\nHoward F. Hansell, Philadelphia.\\nBarton Cooke Hirst, Philadelphia.\\nE. Fletcher lngals, Chicago.\\nW. W. Keen, Philadelphia.\\nHenry G. Ohls, Chicago.\\nWendell Reber, Philadelphia.\\nJ. Hilton Waterman, New York City.\\nIt is difficult to know which to admire most\u00e2\u0080\u0094 the research and industry of the distin-\\nguished band of experts whom Dr. Gould has enlisted in the service of the Year-Book, or the\\nwealth and abundance of the contributions to every department of science that have been\\ndeemed worthy of analysis. It is much more than a mere compilation of abstracts, for,\\nas each section is entrusted to experienced and able contributors, the reader has the advan-\\ntage of certain critical commentaries and expositions proceeding from writers fully\\nqualified to perform these tasks. It is emphatically a book which should find a place in\\nevery medical library, and is in several respects more useful than the famous Jahrbucher\\nof Germany. London Lancet.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0362.jp2"}, "363": {"fulltext": "CATALOGUE OF MEDICAL WORKS. \\\\J\\nANOMALIES AND CURIOSITIES OF MEDICINE. By George\\nM. Gould, M.D., and Walter L. Pyle, M.D. An encyclopedic collec-\\ntion of are and extraordinary cases and of the most striking instances of\\nabnormality in all branches of Medicine and Surgery, derived from an ex-\\nhaustive research of medical literature from its origin to the present day,\\nabstracted, classified, annotated, and indexed. Handsome imperial octavo\\nvolume of 968 pages, with 295 engravings in the text, and 12 full-page\\nplates. Cloth, $3.00 net; Half-Morocco, $4.00 net.\\nPOPULAR EDITION REDUCED FROM $6.00 to $3.00.\\nIn view of the great success of this magnificent work, the publisher has decided\\nto issue a Popular Edition at a price so low that it may be procured by every\\nstudent and practitioner of medicine. Notwithstanding the great reduction in\\nprice, there will be no depreciation in the excellence of typography, paper, and\\nbinding that characterized the earlier editions.\\nSeveral years of exhaustive research have been spent by the authors in the\\ngreat medical libraries of the United States and Europe in collecting the mate-\\nrial for this work. Medical literature of all ages and all languages has\\nbeen carefully searched, as a glance at the Bibliographic Index will show. The\\nfacts, which will be of extreme value to the author and lecturer, have been\\narranged and annotated, and full reference footnotes given.\\nOne of the most valuable contributions ever made to medical literature. It is, so far as\\nwe know, absolutely unique, and every page is as fascinating as a novel. Not alone for the\\nmedical profession has this volume value it will serve as a book of reference for all who are\\ninterested in general scientific, sociologic, or medico-legal topics. Brooklyn Medical Jour-\\nnal.\\nNERVOUS AND MENTAL DISEASES. By Archibald Church,\\nM. D., Professor of Clinical Neurology, Mental Diseases, and Medical\\nJurisprudence, Northwestern University Medical School and Frederick\\nPeterson, M. D., Clinical Professor of Mental Diseases, Woman s Medi-\\ncal College, New York. Handsome octavo volume of 843 pages, with\\nover 300 illustrations. Prices: Cloth, $5.00 net; Half- Morocco, $6.00\\nnet.\\nSecond Edition,\\nThis book is intended to furnish students and practitioners with a practical,\\nworking knowledge of nervous and mental diseases. Written by men of wide\\nexperience and authority, it presents the many recent additions to the subject.\\nThe book is not filled with an extended dissertation on anatomy and pathology,\\nbut, treating these points in connection with special conditions, it lays particular\\nstress on methods of examination, diagnosis, and treatment. In this respect the\\nwork is unusually complete and valuable, laying down the definite courses of\\nprocedure which the authors have found to be most generally satisfactory.\\nThe work is an epitome of what is to-day known of nervous diseases prepared for the\\nstudent and practitioner in the light of the author s experience We believe that no work\\npresents the difficult subject of insanity in such a reasonable and readable way. Chicago\\nMedical Recorder.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0363.jp2"}, "364": {"fulltext": "1 8 W. B. SAUNDERS\\nDISEASES OF THE NOSE AND THROAT. By D. Braden Kyle,\\nM. D., Clinical Professor of Laryngology and Rhinology, Jefferson Medi-\\ncal College, Philadelphia; Consulting Laryngologist, Rhinologist, and\\nOtologist, St. Agnes Hospital. Octavo volume of 646 pages, with over\\n150 illustrations and 6 lithographic plates. Cloth, $4.00 net; Half-Mo-\\nrocco, $5.00 net.\\nJust Issued,\\nThis book presents the subject of Diseases of the Nose and Throat in as con-\\ncise a manner as is consistent with clearness, keeping in mind the needs of the\\nstudent and general practitioner as well as those of the specialist. The arrange-\\nment and classification are based on modern pathology, and the pathological\\nviews advanced are supported by drawings of microscopical sections made in the\\nauthor s own laboratory. These and the other illustrations are particularly fine,\\nbeing chiefly original. With the practical purpose of the book in mind, ex-\\ntended consideration has been given to details of treatment, each disease being\\nconsidered in full, and definite courses being laid down to meet special condi-\\ntions and symptoms.\\nIt is a thorough, full, and systematic treatise, so classified and arranged as greatly to facili-\\ntate the teaching of laryngology and rhinology to classes, and must prove most convenient\\nand satisfactory as a reference book, both for students and practitioners. International\\nMedical Magazine.\\nTHE HYGIENE OF TRANSMISSIBLE DISEASES their Causa-\\ntion, Modes of Dissemination, and Methods of Prevention. By\\nA. C. Abbott, M. D., Professor of Hygiene in the University of Pennsyl-\\nvania; Director of the Laboratory of Hygiene. Octavo volume of 31 1\\npages, with charts and maps, and numerous illustrations. Cloth, $2.00 net.\\nJust Issued,\\nIt is not the purpose of this work to present the subject of Hygiene in the\\ncomprehensive sense ordinarily implied by the word, but rather to deal directly\\nwith but a section, certainly not the least important, of the subject\u00e2\u0080\u0094 viz., that\\nembracing a knowledge of the preventable specific diseases. The book aims to\\nfurnish information concerning the detailed management of transmissible dis-\\neases. Incidentally there are discussed those numerous and varied factors that\\nhave not only a direct bearing upon the incidence and suppression of such dis-\\neases, but are of general sanitary importance as well.\\nThe work is admirable in conception and no less so in execution. It is a practical work,\\nsimply and lucidly written, and it should prove a most helpful aid in that department of\\nmedicine which is becoming daily of increasing importance and application namely, prophy-\\nlaxis. Philadelphia Medical Journal.\\nIt is scientific, but not too technical; it is as complete as our present-day knowledge of\\nhygiene and sanitation allows, and it is in harmony with the efforts of the profession, which\\nare tending more and more to methods of prophylaxis. For the student and for the practi-\\ntioner it is well nigh indispensable. Medical News, New York.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0364.jp2"}, "365": {"fulltext": "CATALOGUE OF MEDICAL WORKS. 1 9\\nA TEXT-BOOK OF EMBRYOLOGY. By John C. Heisler, M. D.\\nProfessor of Anatomy in the Medico- Chirurgical College, Philadelphia.\\nOctavo volume of 405 pages, with 190 illustrations, 26 in colors. Cloth,\\n$2.50 net.\\nJust Issued.\\nThe facts of embryology having acquired in recent years such great interesl\\nin connection with the teaching and with the proper comprehension of human\\nanatomy, it is of first importance to the student of medicine that a concise and\\nyet sufficiently full text-book upon the subject be available. It was with the\\naim of presenting such a book that this volume was written, the author, in his\\nexperience as a teacher of anatomy, having been impressed with the fact that\\nstudents were seriously handicapped in their study of the subject of embryology\\nby the lack of a text-book full enough to be intelligible, and yet without that\\nminuteness of detail which characterizes the larger treatises, and which so often\\nserves only to confuse and discourage the beginner.\\nIn short, the book is written to fill a want which has distinctly existed and which it\\ndefinitely meets commendation greater than this it is not possible to give to anything.\\nMedical News, New York.\\nA MANUAL OF DISEASES OF THE EYE. By Edward Jack-\\nson, A. M., M. D., sometime Professor of Diseases of the Eye in the Phila-\\ndelphia Polyclinic and College for Graduates in Medicine. i2mo, 604\\npages, with 178 illustrations from drawings by the author. Cloth, $2.50 net.\\nJust Issued,\\nThis book is intended to meet the needs of the general practitioner of medi-\\ncine and the beginner in ophthalmology. More attention is given to the condi-\\ntions that must be met and dealt with early in ophthalmic practice than to the\\nrarer diseases and more difficult operations that may come later.\\nIt is designed to furnish efficient aid in the actual work of dealing with dis-\\nease, and therefore gives the place of first importance to the recognition and\\nmanagement of the conditions that present themselves in actual clinical work.\\nLECTURES ON THE PRINCIPLES OF SURGERY. By Charles\\nB. Nancrede, M. D., LL.D., Professor of Surgery and of Clinical Surgery,\\nUniversity of Michigan, Ann Arbor. Handsome octavo, 398 pages, illus-\\ntrated. Cloth, $2.50 net.\\nJust Issued.\\nThe present book is based on the lectures delivered by Dr. Nancrede to his\\nundergraduate classes, and is intended as a text-book for students and a practi-\\ncal help for teachers. By the careful elimination of unnecessary details of\\npathology, bacteriology, etc., which are amply provided for in other courses of\\nstudy, space is gained for a more extended consideration of the Principles of\\nSurgery in themselves, and of the application of these principles to methods\\nof practice.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0365.jp2"}, "366": {"fulltext": "20 W. B. SAUNDERS\\nA TEXT-BOOK OF PATHOLOGY. By Alfred Stengel, M. D.,\\nProfessor of Clinical Medicine in the University of Pennsylvania; Physi-\\ncian to the Philadelphia Hospital Physician to the Children s Hospital,\\nPhiladelphia. Handsome octavo volume of 848 pages, with 362 illustra-\\ntions, many of which are in colors. Prices Cloth, $4.00 net Half-\\nMorocco, $5.00 net.\\nSecond Edition.\\nIn this work the practical application of pathological facts to clinical medicine\\nis considered more fully than is customary in works on pathology. While the\\nsubject of pathology is treated in the broadest way consistent with the size of\\nthe book, an effort has been made to present the subject from the point of view\\nof the clinician. The general relations of bacteriology to pathology are dis-\\ncussed at considerable length, as the importance of these branches deserves. It\\nwill be found that the recent knowledge is fully considered, as well as older and\\nmore widely-known facts.\\nI consider the work abreast of modern pathology, and useful to both students and prac-\\ntitioners. It presents in a concise and well-considered form the essential facts of general and\\nspecial pathological anatomy, with more than usual emphasis upon pathological physiology.\\nWilliam H. Welch, Professor 0/ Pathology, Johns Hopkins University, Baltimore, Md.\\nI regard it as the most serviceable text-book for students on this subject yet written by\\nan American author. L. Hektoen, Professor of Pathology, Rush Medical College,\\nChicago, III.\\nA TEXT-BOOK OF OBSTETRICS. By Barton Cooke Hirst, M.D.,\\nProfessor of Obstetrics in the University of Pennsylvania. Handsome oc-\\ntavo volume of 846 pages, with 618 illustrations and seven colored plates.\\nPrices Cloth, $5.00 net Half-Morocco, $6.00 net.\\nSecond Edition,\\nThis work, which has been in course of preparation for several years, is in-\\ntended as an ideal text-book for the student no less than an advanced treatise\\nfor the obstetrician and for general practitioners. It represents the very latest\\nteaching in the- practice of obstetrics by a man of extended experience and\\nrecognized authority. The book emphasizes especially, as a work on obstetrics\\nshould, the practical side of the subject, and to this end presents an unusually\\nlarge collection of illustrations. A great number of these are new and original,\\nand the whole collection will form a complete atlas of obstetrical practice.\\nAn extremely valuable feature of the book is the large number of refer-\\nences to cases, authorities, sources, etc., forming, as it does, a valuable bib-\\nliography of the most recent and authoritative literature on the subject\\nof obstetrics. As already stated, this work records the wide practical ex-\\nperience of the author, which fact, combined with the brilliant presentation\\nof the subject, will doubtless render this one of the most notable books on\\nobstetrics that has yet appeared.\\nThe illustrations are numerous and are works of art, many of them appearing for the\\nfirst time. The arrangement of the subject-matter, the foot-notes, and index are beyond\\ncriticism. The author s style, though condensed, is singularly clear, so that it is never\\nnecessary to re-read a sentence in order to grasp its meaning. As a true model of what a\\nmodern text-book in obstetrics should be, we feel justified in affirming that Dr. Hirst s\\nbook is without a rival. New York Medical Record.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0366.jp2"}, "367": {"fulltext": "CATALOGUE OF MEDICAL WORKS. 21\\nA TEXT-BOOK OF THE PRACTICE OF MEDICINE. By\\nJames M. Anders, M.D., Ph.D., LL.D., Professor of the Practice of\\nMedicine and of Clinical Medicine, Medico-Chirurgical College, Philadel-\\nphia. In one handsome octavo volume of 1292 pages, fully illustrated.\\nCloth, #5.50 net; Sheep or Half-Morocco, $6.50 net.\\nTHIRD EDITION, THOROUGHLY REVISED.\\nThe present edition is the result of a careful and thorough revision. A few\\nnew subjects have been introduced Glandular Fever, Ether-pneumonia, Splenic\\nAnemia, Meralgia Paresthetica, and Periodic Paralysis. The affections that\\nhave been substantially rewritten are: Plague, Malta Fever, Diseases of the\\nThymus Gland, Liver Cirrhoses, and Progressive Spinal Muscular Atrophy.\\nThe following articles have been extensively revised Typhoid Fever, Yellow\\nFever, Lobar Pneumonia, Dengue, Tuberculosis, Diabetes Mellitus, Gout, Ar-\\nthritis Deformans, Autumnal Catarrh, Diseases of the Circulatory System, more\\nparticularly Hypertrophy and Dilatation of the Heart, Arteriosclerosis and\\nThoracic Aneurysm, Pancreatic Hemorrhage, Jaundice, Acute Peritonitis, Acute\\nYellow Atrophy, Hematoma of Dura Mater, and Scleroses of the Brain. The\\npreliminary chapter on Nervous Diseases is new, and deals with the subject of\\nlocalization and the various methods of investigating nervous affections.\\nIt is an excellent book concise,- comprehensive, thorough, and up to date. It is a\\ncredit to you; but, more than that, it is a credit to the profession of Philadelphia\u00e2\u0080\u0094 to us.\\nJames C. Wilson, Professor of the Practice of Medicine and Clinical Medicine, Jeffer-\\nson Medical College, Philadelphia.\\nThe book can be unreservedly recommended to students and practitioners as a safe, full\\ncompendium of the knowledge of internal medicine of the present day It is a work\\nthoroughly modern in every sense. Medical News, New York.\\nDISEASES OF THE STOMACH. By William W. Van Valzah,\\nM. D., Professor of General Medicine and Diseases of the Digestive System\\nand the Blood, New York Polyclinic and J. Douglas Nisbet, M. D.,\\nAdjunct Professor of General Medicine and Diseases of the Digestive Sys-\\ntem and the Blood, New York Polyclinic. Octavo volume of 674 pages,\\nillustrated. Cloth, $3.50 net.\\nAn eminently practical book, intended as a guide to the student, an aid to the\\nphysician, and a contribution to scientific medicine. It aims to give a complete\\ndescription of the modern methods of diagnosis and treatment of diseases of the\\nstomach, and to reconstruct the pathology of the stomach in keeping with the\\nrevelations of scientific research. The book is clear, practical, and complete,\\nand contains the results of the authors investigations and of their extensive ex-\\nperience as specialists. Particular attention is given to the important subject of\\ndietetic treatment. The diet-lists are very complete, and are so arranged that\\nselections can readily be made to suit individual cases.\\nThis is the most satisfactory work on the subject in the English language. Chicago\\nMedical Recorder.\\nThe article on diet and general medication is one of the most valuable in the book, and\\nshould be read by every practising physician. New York Medical Journal.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0367.jp2"}, "368": {"fulltext": "22 W. B. SAUNDERS\\nSURGICAL DIAGNOSIS AND TREATMENT. By J. W. Mao\\ndonald, M. D., Edin., F. R. C.S., Edin., Professor of the Practice of Sur-\\ngery and of Clinical Surgery in Hamline University Visiting Surgeon to St.\\nBarnabas Hospital, Minneapolis, etc. Handsome octavo volume of 800\\npages, profusely illustrated. Cloth, $5.00 net; Half-Morocco, $6.00 net.\\nThis work aims in a comprehensive manner to furnish a guide in matters of\\nsurgical diagnosis. It sets forth in a systematic way the necessities of examina-\\ntions and the proper methods of making them. The various portions of the\\nbody are then taken up in order and the diseases and injuries thereof succinctly\\nconsidered and the treatment briefly indicated. Practically all the modern and\\napproved operations are described with thoroughness and clearness. The work\\nconcludes with a chapter on the use of the Rontgen rays in surgery.\\nThe work is brimful of just the kind of practical information that is useful alike to\\nstudents and practitioners. It is a pleasure to commend the book because of its intrinsic\\nvalue to the medical practitioner. Cincinnati Lancet- Clinic.\\nPATHOLOGICAL TECHNIQUE. A Practical Manual for Laboratory\\nWork in Pathology, Bacteriology, and Morbid Anatomy, with chapters on\\nPost-Mortem Technique and the Performance of Autopsies. By Frank\\nB. Mallory, A. M., M. D., Assistant Professor of Pathology, Harvard\\nUniversity Medical School, Boston; and James H. Wright, A. M., M.D.,\\nInstructor in Pathology, Harvard University Medical School, Boston. Oc-\\ntavo volume of 396 pages, handsomely illustrated. Cloth, $2.50 net.\\nThis book is designed especially for practical use in pathological laboratories,\\nboth as a guide to beginners and as a source of reference for the advanced. The\\nbook will also meet the wants of practitioners who have opportunity to do general\\npathological work. Besides the methods of post-mortem examinations and of\\nbacteriological and histological investigations connected with autopsies, the\\nspecial methods employed in clinical bacteriology and pathology have been\\nfully discussed.\\nOne of the most complete works on the subject, and one which should be in the library\\nof every physician who hopes to keep pace with the great advances made in pathology.\\nJournal of American Medical Association.\\nTHE SURGICAL COMPLICATIONS AND SEQUELS OF TY-\\nPHOID FEVER. By Wm. W. Keen, M. D., LL.D., Professor of the\\nPrinciples of Surgery and of Clinical Surgery, Jefferson Medical College,\\nPhiladelphia. Octavo volume of 386 pages, illustrated. Cloth, $3.00 net.\\nThis monograph is the only one in any language covering the entire subject\\nof the Surgical Complications and Sequels of Typhoid Fever. The work will\\nprove to be of importance and interest not only to the general surgeon and phy-\\nsician, but also to many specialists laryngologists, ophthalmologists, gynecolo-\\ngists, pathologists, and bacteriologists as the subject has an important bearing\\nupon each one of their spheres. The author s conclusions are based on reports\\nof over 1700 cases, including practically all those recorded in the last fifty years.\\nReports of cases have been brought down to date, many having been added\\nwhile the work was in press.\\nThis is probably the first and only work in the English language that gives the reader a\\nclear view of what typhoid fever really is, and what it does and can do to the human organ-\\nism. This book should be in the possession of every medical man in America. American\\nMedico-Surgical Bulletin.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0368.jp2"}, "369": {"fulltext": "CATALOGUE OF MEDICAL WORKS. 23\\nMODERN SURGERY, GENERAL AND OPERATIVE. By John\\nChalmers DaCosta, M.D., Clinical Professor of Surgery, Jefferson Medi-\\ncal College, Philadelphia; Surgeon to the Philadelphia Hospital, etc.\\nHandsome octavo volume of 911 pages, profusely illustrated. Cloth, $4.00\\nnet; Half-Morocco, $5.00 net.\\nSecond Edition, Rewritten and Greatly Enlarged,\\nThe remarkable success attending DaCosta s Manual of Surgery, and the\\ngeneral favor with which it has been received, have led the author in this\\nrevision to produce a complete treatise on modern surgery along the same lines\\nthat made the former edition so successful. The book has been entirely re-\\nwritten and very much enlarged. The old edition has long been a favorite not\\nonly with students and teachers, but also with practising physicians and sur-\\ngeons, and it is believed that the present work will find an even wider field of\\nusefulness.\\nWe know of no small work on surgery in the English language which so well fulfils the\\nrequirements of the modern student. Medico-Chirurgical Journal, Bristol, England.\\nThe author has presented concisely and accurately the principles of modern surgery.\\nThe book is a valuable one which can be recommended to students and is of great value to\\nthe general practitioner. American Journal oj the Medical Sciences.\\nA MANUAL OF ORTHOPEDIC SURGERY. By James E. Moore,\\nM.D., Professor of Orthopedics and Adjunct Professor of Clinical Surgery,\\nUniversity of Minnesota, College of Medicine and Surgery. Octavo volume\\nof 356 pages, with 177 beautiful illustrations from photographs made spec-\\nially for this work. Cloth, $2.50 net.\\nA practical book based upon the author s experience, in which special stress\\nis laid upon early diagnosis and treatment such as can be carried out by the\\ngeneral practitioner. The teachings of the author are in accordance with his\\nbelief that true conservatism is to be found in the middle course between the\\nsurgeon who operates too frequently and the orthopedist who seldom operates.\\nA very demonstrative work, every illustration of which conveys a lesson. The work is\\na most excellent and commendable one, which we can certainly endorse with pleasure.\\nSt. Louis Medical and Stirgical Journal.\\nELEMENTARY BANDAGING AND SURGICAL DRESSING.\\nWith Directions concerning the Immediate Treatment of Cases of Emer-\\ngency. For the use of Dressers and Nurses. By Walter Pye, F.R.C.S.,\\nlate Surgeon to St. Mary s Hospital, London. Small i2mo, with over 80\\nillustrations. Cloth, flexible covers, 75 cents net.\\nThis little book is chiefly a condensation of those portions of Pye s Surgical\\nHandicraft which deal with bandaging, splinting, etc., and of those which\\ntreat of the management in the first instance of cases of emergency. The\\ndirections given are thoroughly practical, and the book will prove extremely use-\\nful to students, surgical nurses, and dressers.\\nThe author writes well, the diagrams are clear, and the book itself is small and portable,\\nalthough the paper and type are good. British Medical Journal.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0369.jp2"}, "370": {"fulltext": "24 W. B. SAUNDERS\\nA TEXT-BOOK OF MATERIA MEDICA, THERAPEUTICS\\nAND PHARMACOLOGY. By George F. Butler, Ph.G., M.D.,\\nProfessor of Materia Medica and of Clinical Medicine in the College of\\nPhysicians and Surgeons, Chicago; Professor of Materia Medica and\\nTherapeutics, Northwestern University, Woman s Medical School, etc.\\nOctavo, 874 pages, illustrated. Cloth, $4.00 net Sheep, $5.00 net.\\nThird Edition, Thoroughly Revised,\\nA clear, concise, and practical text-book, adapted for permanent reference no\\nless than for the requirements of the class-room.\\nThe recent important additions made to our knowledge of the physiological\\naction of drugs are fully discussed in the present edition. The book has been\\nthoroughly revised and many additions have been made.\\nTaken as a whole, the book may fairly be considered as one of the most satisfactory of any\\nsingle-volume works on materia medica in the market. Journal of the American Medical\\nAssociation.\\nTUBERCULOSIS OF THE GENITO-URINARY ORGANS,\\nMALE AND FEMALE. By Nicholas Senn, M.D., Ph.D., LL.D.,\\nProfessor of the Practice of Surgery and of Clinical Surgery, Rush Medical\\nCollege, Chicago. Handsome octavo volume of 320 pages, illustrated.\\nCloth, $3.00 net.\\nTuberculosis of the male and female genito-urinary organs is such a frequent,\\ndistressing, and fatal affection that a special treatise on the subject appears to\\nfill a gap in medical literature. In the present work the bacteriology of the sub-\\nject has received due attention, the modern resources employed in the differen-\\ntial diagnosis between tubercular and other inflammatory affections are fully\\ndescribed, and the medical and surgical therapeutics are discussed in detail.\\nAn important book upon an important subject, and written by a man of mature judg-\\nment and wide experience. The author has given us an instructive book upon one of the\\nmost important subjects of the day. Clinical Reporter.\\nA work which adds another to the many obligations the profession owes the talented\\nauthor. Chicago Medical Recorder.\\nA TEXT-BOOK OF DISEASES OF WOMEN. By Charles B.\\nPenrose, M.D., Ph.D., Professor of Gynecology in the University of\\nPennsylvania; Surgeon to the Gynecean Hospital, Philadelphia. Octavo\\nvolume of 531 pages, with 217 illustrations, nearly all from drawings made\\nfor this work. Cloth, $3.75 net.\\nThird Edition, Revised.\\nIn this work, which has been written for both the student of gynecology and\\nthe general practitioner, the author presents the best teaching of modern gyne-\\ncology untrammelled by antiquated theories or methods of treatment. In most\\ninstances but one plan of- treatment is recommended, to avoid confusing the\\nstudent or the physician who consults the book for practical guidance.\\nI shall value very highly the copy of Penrose s Diseases of Women received. I have\\nalready recommended it to my class as THE BEST book. Howard A. Kelly, Professor\\nof Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Md.\\nThe book is to be commended without reserve, not only to the student but to the general\\npractitioner who wishes to have the latest and best modes of treatment explained with absolute\\nclearness. Therapeutic Gazette.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0370.jp2"}, "371": {"fulltext": "CATALOGUE OF MEDICAL WORKS. 25\\nSURGICAL PATHOLOGY AND THERAPEUTICS. By John\\nCollins Warren, M. D., LL.D., Professor of Surgery, Medical Depart-\\nment Harvard University. Handsome octavo, 832 pages, with 136 relief\\nand lithographic illustrations, 33 of which are printed in colors.\\nSecond Edition,\\nwith an Appendix devoted to the Scientific Aids to Surgical Diagnosis, and\\na series of articles on Regional Bacteriology. Cloth, $5.00 net; Half-\\nMorocco, $6.00 net.\\nWithout Exception, the Illustrations are the Best ever Seen in a\\nWork of this Kind.\\nA most striking and very excellent feature of this book is its illustrations. Without ex-\\nception, from the point of accuracy and artistic merit, they are the best ever seen in a work\\nof this kind. Many of those representing microscopic pictures are so perfect in their\\ncoloring and detail as almost to give the beholder the impression that he is looking down the\\nbarrel of a microscope at a well-mounted section. Annals of Surgery, Philadelphia.\\nIt is the handsomest specimen of book-making that has ever been issued from the\\nAmerican medical press. American Journal of the Medical Sciences, Philadelphia.\\nPATHOLOGY AND SURGICAL TREATMENT OF TUMORS.\\nBy N. Senn, M. D., Ph. D., LL. D., Professor of Practice of Surgery and\\nof Clinical Surgery, Rush Medical College; Professor of Surgery, Chicago\\nPolyclinic Attending Surgeon to Presbyterian Hospital Surgeon-in-Chief,\\nSt. Joseph s Hospital, Chicago. One volume of 710 pages, with 515\\nengravings, including full-page colored plates. New and enlarged Edition\\nin Preparation.\\nBooks specially devoted to this subject are few, and in our text-books and\\nsystems of surgery this part of surgical pathology is usually condensed to a de-\\ngree incompatible with its scientific and clinical importance. The author spent\\nmany years in collecting the material for this work, and has taken great pains\\nto present it in a manner that should prove useful as a text-book for the student,\\na work of reference for the practitioner, and a reliable guide for the surgeon.\\nThe most exhaustive of any recent book in English on this subject. It is well illus-\\ntrated, and will doubtless remain as the principal monograph on the subject in our language\\nfor some years. The book is handsomely illustrated and printed, and the author has\\ngiven a notable and lasting contribution to surgery. Journal of the American Medical\\nAssociation, Chicago.\\nLECTURES ON RENAL AND URINARY DISEASES. By\\nRobert Saundby, M. D., Edin., Fellow of the Royal College of Physicians,\\nLondon, and of the Royal Medico-Chirurgical Society; Physician to the\\nGeneral Hospital. Octavo volume of 434 pages, with numerous illustra-\\ntions and 4 colored plates. Cloth, $2.50 net.\\nThe volume makes a favorable impression at once. The style is clear and succinct.\\nWe cannot find any part of the subject in which the views expressed are not carefully thought\\nout and fortified by evidence drawn from the most recent sources. The book may be cordially\\nrecommended. British Medical Journal.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0371.jp2"}, "372": {"fulltext": "26 W. B. SAUNDERS\\nA NEW PRONOUNCING DICTIONARY OF MEDICINE, with\\nPhonetic Pronunciation, Accentuation, Etymology, etc. By John\\nM. Keating, M. D., LL.D., Fellow of the College of Physicians of Phila-\\ndelphia Vice-President of the American Pediatric Society Ex-President\\nof the Association of Life Insurance Medical Directors Editor Cyclo-\\npaedia of the Diseases of Children, etc. and Henry Hamilton, author\\nof A New Translation of Virgil s ^Eneid into English Rhyme; co-\\nauthor of Saunders Medical Lexicon, etc. with the Collaboration of\\nJ. Chalmers DaCosta, M. D., and Frederick A. Packard, M. D.\\nWith an Appendix containing important Tables of Bacilli, Micrococci,\\nLeucomaines, Ptomaines, Drugs and Materials used in Antiseptic Sur-\\ngery, Poisons and their Antidotes, Weights and Measures, Thermometric\\nScales, New Official and Unofficial Drugs, etc. One very attractive volume\\nof over 800 pages. Second Revised Edition. Prices Cloth, $5.00 net\\nSheep or Half-Morocco, $6.00 net with Denison s Patent Ready-Refer-\\nence Index; without patent index, Cloth, $4.00 net; Sheep or Half-\\nMorocco, $5.00 net.\\nPROFESSIONAL OPINIONS.\\nI am much pleased with Keating s Dictionary, and shall take pleasure in recommending\\nit to my classes.\\nHenry M. Lyman, M. D.,\\nProfessor of Principles and Practice of Medicine, Rush Medical College, Chicago, III.\\nI am convinced that it will be a very valuable adjunct to my study-table, convenient in\\nsize and sufficiently full for ordinary use.\\nC. A. Lindsley, M. D.,\\nProfessor of Theory and Practice of Medicine, Medical De fit. Yale University\\nSecretary Connecticut State Board of Health, New Haven, Conn,\\nAUTOBIOGRAPHY OF SAMUEL D. GROSS, M. D., Emeritus Pro-\\nfessor of Surgery in the Jefferson Medical College of Philadelphia, with\\nReminiscences of His Times and Contemporaries. Edited by his sons,\\nSamuel W. Gross, M. D., LL.D., late Professor of Principles of Surgery\\nand of Clinical Surgery in the Jefferson Medical College, and A. Haller\\nGross, A. M., of the Philadelphia Bar. Preceded by a Memoir of Dr.\\nGross, by the late Austin Flint, M. D., LL.D. In two handsome volumes,\\neach containing over 400 pages, demy 8vo, extra cloth, gilt tops, with fine\\nFrontispiece engraved on steel. Price per Volume, $2.50 net.\\n1 his autobiography, which was continued by the late eminent surgeon until\\nwithin three months of his death, contains a full and accurate history of his\\nearly struggles, trials, and subsequent successes, told in a singularly interesting\\nand charming manner, and embraces short and graphic pen-portraits of many\\nof the most distinguished men surgeons, physicians, divines, lawyers, states-\\nmen, scientists, etc. with whom he was brought in contact in America and in\\nEurope the whole forming a retrospect of more than three-quarters of a century.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0372.jp2"}, "373": {"fulltext": "CATALOGUE OF MEDICAL WORKS. 2 J\\nPRACTICAL POINTS IN NURSING. For Nurses in Private\\nPractice. By Emily A. M. Stoney, Graduate of the Training-School\\ntor Nurses, Lawrence, Mass. Superintendent of the Training-School for\\nNurses, Carney Hospital, South Boston, Mass. 456 pages, handsomely\\nillustrated with 73 engravings in the textj and 9 colored and half-tone\\nDlates. Cloth. Price, $1.75 nex,\\nSECOND EDITION, THOROUGHLY REVISED.\\nIn this volume the author explains, in popular language and in the shortest\\npossible form, the entire range of private, nursing as distinguished from hospital\\nnursing, and the nurse is instructed how best to meet the various emergencies of\\nmedical and surgical cases when distant from medical or surgical aid or when\\nthrown on her own resources.\\nAn especially valuable feature of the work will be found in the directions to\\nthe nurse how to improvise everything ordinarily needed in the sick-room, where\\nthe embarrassment of the nurse, owing to the want of proper appliances, is fre-\\nquently extreme.\\nThe work has been logically divided into the following sections\\nI. The Nurse her responsibilities, qualihcations, equipment, etc.\\nII. The Sick-Room its selection, preparation, and management.\\nT JI. The Patient duties of the nurse in medical, surgical, obstetric, and gyne-\\ncologic cases.\\nIV. Nursing in Accidents and Emergencies.\\nV. Nursing in Special Medical Cases.\\nVI. Nursing of the New-born and Sick Children.\\nVII. Physiology and Descriptive Anatomy.\\nThe Appendix contains much information in compact form that will be found\\nof great value to the nurse, including Rules for Feeding the Sick; Recipes for\\nInvalid Foods and Beverages Tables of Weights and Measures Table for\\nComputing the Date of Labor List of Abbreviations Dose-List and a full\\nand complete Glossary of Medical Terms and Nursing Treatment.\\nThis is a well-written, eminently practical volume, which covers the entire range of\\nprivate nursing as distinguished from hospital nursing, and instructs the nurse how best to\\nmeet the various emergencies which may arise and how to prepare everything ordinarily\\nneeded in the illness of her patient. American Journal of Obstetrics and Diseases of\\nWomen and Children, Aug., 1896.\\nA TEXT-BOOK OF BACTERIOLOGY, including the Etiology and\\nPrevention of Infective Diseases and an account of Yeasts and Moulds,\\nHaematozoa, and Psorosperms. By Edgar M. Crookshank, M. B., Pro-\\nfessor of Comparative Pathology and Bacteriology, King s College, London.\\nA handsome octavo volume of 700 pages, with 273 engravings in the text,\\nana 22 original and colored plates. Price, $6.50 net.\\nThis book, though nominally a Fourth Edition of Professor Crookshank s\\nManual of Bacteriology, is practically a new work, the old one having\\nbeen reconstructed, greatly enlarged, revised throughout, and largely rewritten,\\nforming a text-book for the Bacteriological Laboratory, for Medical Ofiicers of\\nHealth, and for Veterinary Inspectors.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0373.jp2"}, "374": {"fulltext": "28 W. B. SAUNDERS\\nMEDICAL DIAGNOSIS. By Dr. Oswald Vierordt, Professor of\\nMedicine at the University of Heidelberg. Translated, with additions,\\nfrom the Fifth Enlarged German Edition, with the author s permission, by\\nFrancis H. Stuart, A. M., M. D. In one handsome royal-octavo volume\\nof 600 pages. 194 fine wood-cuts in the text, many of them in colors.\\nPrices: Cloth, $4.00 net; Sheep or Half- Morocco, $5.00 net.\\nFOURTH AMERICAN EDITION, FROM THE FIFTH REVISED AND\\nENLARGED GERMAN EDITION.\\nIn this work, as in no other hitherto published, are given full and accurate\\nexplanations of the phenomena observed at the bedside. It is distinctly a clin-\\nical work by a master teacher, characterized by thoroughness, fulness, and accu-\\nracy. It is a mine of information upon the points that are so often passed over\\nwithout explanation. Especial attention has been given to the germ-theory as a\\nfactor in the origin of disease.\\nThe present edition of this highly successful work has been translated from\\nthe fifth German edition. Many alterations have been made throughout the\\nbook, but especially in the sections on Gastric Digestion and the Nervous System.\\nIt will be found that all the qualities which served to make the earlier editions\\nso acceptable have been developed with the evolution of the work to its present\\nform.\\nTHE PICTORIAL ATLAS OF SKIN DISEASES AND SYPHI-\\nLITIC AFFECTIONS. (American Edition.) Translation from\\nthe French. Edited by J. J. Pringle, M. B., F. R. C. P., Assistant Phy-\\nsician to, and Physician to the department for Diseases of the Skin at, the\\nMiddlesex Hospital, London. Photo-lithochromes from the famous models\\nof dermatological and syphilitic cases in the Museum of the Saint-Louis\\nHospital, Paris, with explanatory wood-cuts and letter-press. In 12 Parts,\\nat $3.00 per Part.\\nOf all the atlases of skin diseases which have been published in recent years, the present\\none promises to be of greatest interest and value, especially from the standpoint of the\\ngeneral practitioner. American Medico -Surgical Bulletin, Feb. 22, 1896.\\nThe introduction of explanatory wood-cuts in the text is a novel and most important\\nfeature which greatly furthers the easier understanding of the excellent plates, than which\\nnothing, we venture to say, has been seen better in point of correctness, beauty, and general\\nmerit. New York Medical Journal Feb. 15, 1896.\\nAn interesting feature of the Atlas is the descriptive text, which is written for each picture\\nby the physician who treated the case or at whose instigation the models have been made.\\nWe predict for this truly beautiful work a large circulation in all parts of the medical world\\nwhere the names St. Louis and Baretta have preceded it. Medical Record, N. Y., Feb. 1,\\n1896.\\nA TEXT-BOOK OF MECHANO-THERAPY (MASSAGE AND\\nMEDICAL GYMNASTICS). By Axel V. Grafstrom, B. Sc,\\nM. D., late Lieutenant in the Royal Swedish Army; late House Physi-\\ncian, City Hospital, Blackwell s Island, New York. i2mo, 139 pages,\\nillustrated. Cloth, $1.00 net.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0374.jp2"}, "375": {"fulltext": "CATALOGUE OF MEDICAL WORKS. 29\\nDISEASES OF THE EYE. A Hand-Book of Ophthalmic Prac-\\ntice. By G. E. de Schweinitz, M. D., Professor of Ophthalmology in\\nthe Jefferson Medical College, Philadelphia, etc. A handsome royal-\\noctavo volume of 696 pages, with 255 fine illustrations, many of which are\\noriginal, and 2 chromo-lithographic plates. Prices Cloth, $4.00 net\\nSheep or Half-Morocco, $5.00 net.\\nTHIRD EDITION, THOROUGHLY REVISED.\\nIn the third edition of this text-book, destined, it is hoped, to meet the favor-\\nable reception which has been accorded to its predecessors, the work has been\\nrevised thoroughly, and much new matter has been introduced. Particular\\nattention has been given to the important relations which micro-organisms bear\\nto many ocular diseases. A number of special paragraphs on new subjects have\\nbeen introduced, and certain articles, including a portion of the chapter on\\nOperations, have been largely rewritten, or at least materially changed. A\\nnumber of new illustrations have been added. The Appendix contains a full\\ndescription of the method of determining the corneal astigmatism with the\\nophthalmometer of Javal and Schiotz, and the rotation of the eyes with the\\ntropometer of Stevens.\\nA work that will meet the requirements not only of the specialist, but of the general\\npractitioner in a rare degree. I am satisfied that unusual success awaits it.\\nWilliam Pepper, M. D.\\nProvost and Professor of Theory and Practice of Medicine and Clinical Medicine\\nin the University of Pennsylvania.\\nA clearly written, comprehensive manual. One which we can commend to students\\nas a reliable text-book, written with an evident knowledge of the wants of those entering upon\\nthe study of this special branch of medical science. British Medical Journal.\\nIt is hardly too much to say that for the student and practitioner beginning the study of\\nOphthalmology, it is the best single volume at present published. Medical News.\\nIt is a very useful, satisfactory, and safe guide for the student and the practitioner, artd\\none of the best works of this scope in the English language. Annals of Ophthalmology.\\nDISEASES OF WOMEN. By J. Bland Sutton, F. R. C. S., Assistant\\nSurgeon to Middlesex Hospital, and Surgeon to Chelsea Hospital, London\\nand Arthur E. Giles, M. D., B. Sc, Lond., F. R.C. S., Edin., Assistant\\nSurgeon to Chelsea Hospital, London. 436 pages, handsomely illustrated.\\nCloth, $2.50 net.\\nThe authors have placed in the hands of the physician and student a concise\\nyet comprehensive guide to the study of gynecology in its most modern develop-\\nment. It has been their aim to relate facts and describe methods belonging to\\nthe science and art of gynecology in a way that will prove useful to students for\\nexamination purposes, and which will also enable the general physician to prac-\\ntice this important department of surgery with advantage to his patients and with\\nsatisfaction to himself.\\nThe book is very well prepared, and is certain to be well received by the medical public.\\nBritish Medical Journal.\\nThe text has been carefully prepared. Nothing essential has been omitted, and its\\nteachings are those recommended by the leading authorities of the day. Journal of the\\nAmerican Medical Association.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0375.jp2"}, "376": {"fulltext": "30 m SAIWDEKT\\nTEXT-BOOK UPON THE PATHOGENIC BACTERIA. Spe-\\ncially written for Students of Medicine. By Joseph McFarland,\\nM. D., Professor of Pathology and Bacteriology in the Medico-Chirurgicai\\nCollege of Philadelphia, etc. 497 pages, finely illustrated. Price, Cloth,\\n$2.50 net,\\nSECOND EDITION, REVISED AND GREATLY ENLARGED.\\nThe work is intended to be a text-book for the medical student and for the\\npractitioner who has had no recent laboratory training in this department of medi-\\ncal science. The instructions given as to needed apparatus, cultures, stainings,\\nmicroscopic examinations, etc. are ample for the student s needs, and will afford\\nto the physician much information that will interest and profit him relative to a\\nsubject which modern science shows to go far in explaining the etiology of many\\ndiseased conditions.\\nIn this second edition the work has been brought up to date in all depart-\\nments of the subject, and numerous additions have been made to the technique\\nin the endeavor to make the book fulfil the double purpose of a systematic work\\nupon bacteria and a laboratory guide.\\nIt is excellently adapted for the medical students and practitioners for whom it is avowedly\\nwritten. The descriptions given are accurate and readable, and the book should prove\\nuseful to those for whom it is written. London Lancet, Aug. 29, 1896.\\nThe author has succeded admirably in presenting the essential details of bacteriological\\ntechnics, together with a judiciously chosen summary of our present knowledge of pathogenic\\nbacteria. The work, we think, should have a wide circulation among English-speaking\\nstudents of medicine. N. Y. Medical Journal, April 4, 1896.\\nThe book will be found of considerable use by medical men who have not had a special\\nbacteriological training, and who desire to understand this important branch of medical\\nscience. Edinburgh Medical Journal, July, 1896.\\nLABORATORY GUIDE FOR THE BACTERIOLOGIST. By\\nLangdon Frothingham, M. D. V., Assistant in Bacteriology and Veteri-\\nnary Science, Sheffield Scientific School. Yale University. Illustrated.\\nPrice, Cloth, 75 cents.\\nThe technical methods involved in bacteria-culture, methods of staining, ana\\nmicroscopical study are fully described and arranged as simply and concisely as\\npossible. The book is especially intended for use in laboratory work,\\nIt is a convenient and useful little work, and will more than repay the outlay necessary\\nfor its purchase in the saving of time which would otherwise be consumed in looking up the\\nvarious points of technique so clearly and concisely laid down in its pages. American Med.-\\nSurg. Bulletin,\\nFEEDING IN EARLY INFANCY. By Arthur V. Meigs. M. D.\\nBound in limp cloth, flush edges. Price, 25 cents net.\\nSynopsis Analyses of Milk Importance of the Subject of Feeding in Early\\nInfancy Proportion of Casein and Sugar in Human Milk Time to Begin Arti-\\nficial Feeding of Infants Amount of Food to be Administered at Each Feed-\\ning Intervals between Feedings Increase in Amount of Food at Different\\nPeriods of Infant Development Unsuitableness of Condensed Milk as a Sub-\\nstitute for Mother s Milk Objections to Sterilization or Pasteurization oit\\nMilk Advances made in the Method of Artificial Feeding of Infants.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0376.jp2"}, "377": {"fulltext": "CATALOGUE OF MEDICAL WORKS.\\nMATERIA MEDICA FOR NURSES. By Emily A. M. Stoney,\\nGraduate of the Training-school for Nurses, Lawrence, Mass. late\\nSuperintendent of the Training-school for Nurses, Carney Hospital, South\\nBoston, Mass. Handsome octavo, 300 pages. Cloth, $1.50 net.\\nThe present book differs from other similar works in several features, all of\\nwhich are introduced to render it more practical and generally useful. The\\ngeneral plan of contents follows the lines laid down in training-schools for\\nnurses, but the book contains much useful matter not usually included in works\\nof this character, such as Poison-emergencies, Ready Dose-list, Weights and\\nMeasures, etc., as well as a Glossary, defining all the terms in Materia Medica,\\nand describing all the latest drugs and remedies, which have been generally\\nneglected by other books of the kind.\\nESSENTIALS OF ANATOMY AND MANUAL OF PRACTI-\\nCAL DISSECTION, containing Hints on Dissection. By Charles\\nB. Nancrede, M. D., Professor of Surgery and Clinical Surgery in the\\nUniversity of Michigan, Ann Arbor; Corresponding Member of the Royal\\nAcademy of. Medicine, Rome, Italy late Surgeon Jefferson Medical Col-\\nlege, etc. Fourth and revised edition. Fost 8vo, over 500 pages, with\\nhandsome full-page lithographic plates in colors, and over 200 illustrations.\\nPrice Extra Cloth or Oilcloth for the dissection-room, $2.00 net.\\nNeither pains nor expense has been spared to make this work the most ex-\\nhaustive yet concise Student s Manual of Anatomy and Dissection ever pub\\nlished, either in America or in Europe.\\nThe colored plates are designed to aid the student in dissecting the muscles^\\narteries, veins, and nerves. The wood-cuts have all been specially drawn ancj\\nengraved, and an Appendix added containing 60 illustrations representing the\\nstructure of the entire human skeleton, the wdiole being based on the eleventh\\nedition of Gray s Anatomy.\\nA MANUAL OF PRACTICE OF MEDICINE. By A. A. Stevens,\\nA. M., M. D., Instructor in Physical Diagnosis in the University of Penn-\\nsylvania, and Professor of Pathology in the Woman s Medical College of\\nPennsylvania. Specially intended for students preparing for graduation\\nand hospital examinations. Post 8vo, 519 pages. Numerous illustrations\\nand selected formulae. Price, bound in flexible leather, $2.00 net.\\nFIFTH EDITION, REVISED AND ENLARGED.\\nContributions to the science of medicine have poured in so rapidly during the\\nlast quarter of a century that it is well-nigh impossible for the student, with the\\nlimited time at his disposal, to master elaborate treatises or to cull from them\\nthat knowledge which is absolutely essential. From an extended experience in\\nteaching, the author has been enabled, by classification, to group allied symp-\\ntoms, and by the judicious elimination of theories and redundant explanations\\nto bring within a comparatively small compass a complete outline of the prac-\\ntice of medicine.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0377.jp2"}, "378": {"fulltext": "32 W. B. SAUNDERS\\nMANUAL OF MATERIA MEDICA AND THERAPEUTICS.\\nBy A. A. Stevens, A. M., M. D., Instructor of Physical Diagnosis in the\\nUniversity of Pennsylvania, and Professor of Pathology in the Woman s\\nMedical College of Pennsylvania. 445 pages. Price, bound in flexible\\nleather, $2.25.\\nSECOND EDITION, REVISED.\\nThis wholly new volume, which is based on the last edition of the Pharma-\\ncopoeia, comprehends the following sections Physiological Action of Drugs\\nDrugs; Remedial Measures other than Drugs; Applied Therapeutics; Incom-\\npatibility in Prescriptions; Table of Doses; Index of Drugs; and Index of\\nDiseases; the treatment being elucidated by more than two hundred formulae.\\nThe author is to be congratulated upon having presented the medical student with as\\naccurate a manual of therapeutics as it is possible to prepare. Therapeutic Gazette.\\nFar superior to most of its class in fact, it is very good. Moreover, the book is reliable\\nand accurate. New York Medical Journal.\\nThe author has faithfully presented modern therapeutics in a comprehensive work,\\nand it will be found a reliable guide. University Medical Magazine.\\nNOTES ON THE NEWER REMEDIES: their Therapeutic Ap-\\nplications and Modes of Administration. By David Cerna, M. D.,\\nPh. D., Demonstrator of and Lecturer on Experimental Therapeutics in\\nthe University of Pennsylvania. Post-octavo, 253 pages. Price, #1.25.\\nSECOND EDITION, RE-WRITTEN AND GREATLY ENLARGED.\\nThe work takes up in alphabetical order all the newer remedies, giving their\\nphysical properties, solubility, therapeutic applications, administration, and\\nchemical formula.\\nIt thus forms a very valuable addition to the various works on therapeutics\\nnow in existence.\\nChemists are so multiplying compounds, that, if each compound is to be thor-\\noughly studied, investigations must be carried far enough to determine the prac-\\ntical importance of the new agents.\\nEspecially valuable because of its completeness, its accuracy, its systematic consider-\\nation of the properties and therapy of many remedies of which doctors generally know but\\nlittle, expressed in a brief yet terse manner. Chicago Clinical Review.\\nTEMPERATURE CHART. Prepared by D. T. Laine, M. D. Size\\n8x 13% inches. Price, per pad of 25 charts, 50 cents.\\nA conveniently arranged chart for recording Temperature, with columns for\\ndaily amounts of Urinary and Fecal Excretions, Food, Remarks, etc. On the\\nback of each chart is given in full the method of Brand in the treatment of\\nTyphoid Fever.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0378.jp2"}, "379": {"fulltext": "CATALOGUE OF MEDICAL WORKS. 33\\nA TEXT-BOOK OF HISTOLOGY, DESCRIPTIVE AND PRAC-\\nTICAL. For the Use of Students. By Arthur Clarkson, M. B.,\\nC. M., Edin., formerly Demonstrator of Physiology in the Owen s College,\\nManchester; late Demonstrator of Physiology in the Yorkshire College,\\nLeeds. Large 8vo, 554 pages, with 22 engravings in the text, and 174\\nbeautifully colored original illustrations. Price, strongly bound in Cloth,\\n$4.00 net.\\nThe purpose of the writer in this work has been to furnish the student of His-\\ntology, in one volume, with both the descriptive and the practical part of the\\nscience. The first two chapters are devoted to the consideration of the general\\nmethods of Histology subsequently, in each chapter, the structure of the tissue\\nor organ is first systematically described, the student is then taken tutorially over\\nthe specimens illustrating it, and, finally, an appendix affords a short note of the\\nmethods of preparation.\\nThe work must be considered a valuable addition to the list of available text-books, and\\nis to be highly recommended. New York Medical Journal.\\nOne of the best works for students we have ever noticed. We predict that the book will\\nattain a well-deserved popularity among our students. Chicago Medical Recorder.\\nTHE PATHOLOGY AND TREATMENT OF SEXUAL IM-\\nPOTENCE. By Victor G. Vecki, M. D. From the second Ger-\\nman edition, revised and rewritten. Demi-octavo, about 300 pages.\\nCloth, $2.00 net.\\nThe subject of impotence has but seldom been treated in this country in the\\ntruly scientific spirit that it deserves, and this volume will come to many as a\\nrevelation of the possibilities of therapeusis in this important field. Dr. Vecki s\\nwork has long been favorably known, and the German book has received the\\nhighest consideration. This edition is more than a mere translation, for, although\\nbased on the German edition, it has been entirely rewritten by the author in\\nEnglish.\\nThe work can be recommended as a scholarly treatise on its subject, and it can be read\\nwith advantage by many practitioners. -Journal of the American Medical Association.\\nTHE TREATMENT OF PELVIC INFLAMMATIONS\\nTHROUGH THE VAGINA. By W. R. Pryor, M.D., Pro-\\nfessor of Gynecology in the New York Polyclinic. i2mo, 248 pages,\\nhandsomely illustrated. Cloth, $2.00 net.\\nIn this book the author directs the attention of the general practitioner to a\\nsurgical treatment of the pelvic diseases of women. There exists the utmost\\nconfusion in the profession regarding the most successful methods of treating\\npelvic inflammations and inasmuch as inflammatory lesions constitute the ma-\\njority of all pelvic diseases, the subject is an important one. It has been the\\nendeavor of the author to put down every little detail, no matter how insig-\\nnificant, which might be of service.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0379.jp2"}, "380": {"fulltext": "34 W. B. SAUNDERS\\nDISEASES OF WOMEN. By Henry J. Garrigues, A.M., M. D.,\\nProfessor of Gynecology in the New York School of Clinical Medicine;\\nGynecologist to St. Mark s Hospital and to the German Dispensary, New\\nYork City. In one handsome octavo volume of 728 pages, illustrated by\\n335 engravings and colored plates. Prices: Cloth, $4.00 net; Sheep or\\nHalf-Morocco, #5.00 net.\\nA practical work on gynecology for the use of students and practitioners,\\nwritten in a terse and concise manner. The importance of a thorough know-\\nledge of the anatomy of the female pelvic organs has been fully recognized by\\nthe author, and considerable space has been devoted to the subject. The chap-\\nters on Operations and on Treatment are thoroughly modern, and are based\\nupon the large hospital and private practice of the author. The text is eluci-\\ndated by a large number of illustrations and colored plates, many of them being\\noriginal, and forming a complete atlas for studying embryology and the anatomy\\nof the female genitalia, besides exemplifying, whenever needed, morbid condi-\\ntions, instruments, apparatus, and operations.\\nSecond Edition, Thoroughly Revised,\\nThe first edition of this work met with a most appreciative reception by the\\nmedical press and profession both in this country and abroad, and was adopted\\nas a text-book or recommended as a book of reference by nearly one hundred\\ncolleges in the United States and Canada. The author has availed himself of\\nthe opportunity afforded by this revision to embody the latest approved advances\\nin the treatment employed in this important branch of Medicine. He has also\\nmore extensively expressed his own opinion on the comparative value of the\\ndifferent methods of treatment employed.\\nOne of the best text-books for students and practitioners which has been published in\\nthe English language; it is condensed, clear, and comprehensive. The profound learning\\nand great clinical experience of the distinguished author find expression in this book in a\\nmost attractive and instructive form. Young practitioners, to whom experienced consultants\\nmay not be available, will find in this book invaluable counsel and help.\\nThad. A. Reamy, M. D., LL.D.,\\nProfessor of Clinical Gynecology Medical College of Ohio Gynecologist to the Good\\nSamaritan and Cincinnati Hospitals.\\nA SYLLABUS OF GYNECOLOGY, arranged in conformity with\\nAn American Text-Book of Gynecology. By J. W. Long, M. D.,\\nProfessor of Diseases of Women and Children, Medical College of Vir-\\nginia, etc. Price, Cloth (interleaved), $1.00 net.\\nBased upon the teaching and methods laid down in the larger work, this will\\nnot only be useful as a supplementary volume, but to those who do not already\\npossess the text-book it will also have an independent value as an aid to the\\npractitioner in gynecological work, and to the student as a guide in the lecture-\\nroom, as the subject is presented in a manner at once systematic, clear, succinct,\\n?nd practical.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0380.jp2"}, "381": {"fulltext": "CATALOGUE OF MEDICAL WORKS. 35\\nTHE AMERICAN POCKET MEDICAL DICTIONARY. Edited\\nby W. A. Newman Dor land, M. D., Assistant Obstetrician to the Hospital\\nof the University of Pennsylvania Fellow of the American Academy of\\nMedicine. Containing the pronunciation and definition of all the principal\\nwords used in medicine and the kindred sciences, with 64 extensive tables.\\nHandsomely bound in flexible leather, limp, with gold edges and patent\\nthumb index. Price, $1.00 net with thumb index, #1.25 net.\\nSECOND EDITION, REVISED.\\nThis is the ideal pocket lexicon. It is an absolutely new book, and not a re-\\nvision of any old work. It is complete, defining all the terms of modern medi-\\ncine and forming an unusually complete vocabulary. It gives the pronunciation\\nof all the terms. It makes a special feature of the newer words neglected by\\nother dictionaries. It contains a wealth of anatomical tables of special value to\\nstudents. It forms a handy volume, indispensable to every medical man.\\nSAUNDERS POCKET MEDICAL FORMULARY. By William\\nM. Powell, M. D., Attending Physician to the Mercer House for Invalid\\nWomen at Atlantic City. Containing 1800 Formulae, selected from several\\nhundred of the best-known authorities. Forming a handsome and con-\\nvenient pocket companion of nearly 300 printed pages, with blank leaves\\nfor Additions; with an Appendix containing Posological Table, Formulae\\nand Doses for Hypodermatic Medication, Poisons and their Antidotes,\\nDiameters of the Pemale Pelvis and Fcetal Head, Obstetrical Table, Diet\\nList for Various Diseases, Materials and Drugs used in Antiseptic Surgery,\\nTreatment of Asphyxia from Drowning, Surgical Remembrancer, Tables\\nof Incompatibles, Eruptive Fevers, Weights and Measures, etc. Hand-\\nsomely bound in morocco, with side index, wallet, and flap. Price, $1.75\\nnet.\\nFIFTH EDITION, THOROUGHLY REVISED.\\nThis little book, that can be conveniently carried in the pocket, contains an immense\\namount of material. It is very useful, and as the name of the author of each prescription is\\ngiven,is unusually reliable. New York Medical Record.\\nA COMPENDIUM OF INSANITY. By John B. Chapin, M.D., LL.D.,\\nPhysician-in- Chief, Pennsylvania Hospital for the Insane; late Physician-\\nSuperintendent oPthe Willard State Hospital, New York Honorary Mem-\\nber of the Medico- Psychological Society of Great Britain, of the Society of\\nMental Medicine of Belgium. i2mo, 234 pages, Must. Cloth, #1.25 net.\\nThe author has given, in a condensed and concise form, a compendium of\\nDiseases of the Mind, for the convenient use and aid of physicians and students.\\nIt contains a clear, concise statement of the clinical aspects of the various ab-\\nnormal mental conditions, with directions as to the most approved methods of\\nmanaging and treating the insane.\\nThe practical parts of Dr. Chapin s book are what constitute its distinctive merit. We\\ndesire especially, however, to call attention to the fact that in the subject of the therapeutics\\nof insanity the work is exceedingly valuable. The author has made a distinct addition to the\\nliterature of his specialty. Philadelphia Medical Journal.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0381.jp2"}, "382": {"fulltext": "2 6 W. B. SAUNDERS\\nAN OPERATION BLANK, with Lists of Instruments, etc. re-\\nquired in Various Operations. Prepared by W. W. Keen, M. D.,\\nLL.D., Professor of Principles of Surgery in the Jefferson Medical Col-\\nlege, Philadelphia. Price per Pad, containing Blanks for fifty operations,\\n50 cents net.\\nSECOND EDITION, REVISED FORM.\\nA convenient blank, suitable for all operations, giving complete instructions\\nregarding necessary preparation of patient, etc., with a full list of dressings and\\nmedicines to be employed.\\nOn the back of each blank is a list of instruments used viz. general instru\\nments, etc., required for all operations and special instruments for surgery of\\nthe brain and spine, mouth and throat, abdomen, rectum, male and female\\ngenito-urinary organs, the bones, etc.\\nThe whole forming a neat pad, arranged for hanging on the wall of a sur-\\ngeon s office or in the hospital operating-room.\\nWill serve a useful purpose for the surgeon in reminding him of the details of prepa-\\nration for the patient and the room as well as for the instruments, dressings, and antiseptics\\nneeded. New York Medical Record\\nCovers about all that can be needed in any operation. American Lancet.\\nThe plan is a capital one. Boston Medical and Surgical journal.\\nLABORATORY EXERCISES IN BOTANY. By Edson S. Bastin,\\nM. A., Professor of Materia Medica and Botany in the Philadelphia Col-\\nlege of Pharmacy. Octavo volume of 536 pages, 8j full-page plates. Price,\\nCloth, $2.50.\\nThis work is intended for the beginner and the advanced student, and it fully\\ncovers the structure of flowering plants, roots, ordinary stems, rhizomes, tubers,\\nbulbs, leaves, flowers, fruits, and seeds. Particular attention is given to the gross\\nand microscopical structure of plants, and to those used in medicine. Illustra-\\ntions have freely been used to elucidate the text, and a complete index to facil-\\nitate reference has been added.\\nThere is no work like it in the pharmaceutical or botanical literature of this country, and\\nwe predict for it a wide circulation. American Journal of Pharmacy.\\nDIET IN SICKNESS AND IN HEALTH. By Mrs. Ernest Hart,\\nformerly Student of the Faculty of Medicine of Paris and of the London\\nSchool of Medicine for Women; with an Introduction by Sir Henry\\nThompson, F. R. C. S., M. D., London. 220 pages; illustrated. Price,\\nCloth, 1 1. 50.\\nUseful to those who have to nurse, feed, and prescribe for the sick. In\\neach case the accepted causation of the disease and the reasons for the special\\ndiet prescribed are briefly described. Medical men will find the dietaries and\\nrecipes practically useful, and likely to save them trouble in directing the dietetic\\ntreatment of patients.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0382.jp2"}, "383": {"fulltext": "CATALOGUE OF MEDICAL WORKS. 37\\nA. MANUAL OF PHYSIOLOGY, with Practical Exercises. For\\nStudents and Practitioners. By G. N. Stewart, M. A., M. D., D. Sc.,\\nlately Examiner in Physiology, University of Aberdeen, and of the New\\nMuseums, Cambridge University Professor of Physiology in the Western\\nReserve University, Cleveland, Ohio. Handsome octavo volume of 848\\npages, with 300 illustrations in the text, and 5 colored plates. Price, Cloth,\\n#3.75 net.\\nTHIRD EDITION, REVISED.\\nIt will make its way by sheer force of merit, and amply deserves to do so. It is one of\\nthe very best English text-books on the subject. London Lancet.\\nOf the many text-books of physiology published, we do not know of one that so nearly\\ncomes up to the ideal as does Professor Stewart s volume. British Medical Journal.\\nESSENTIALS OF PHYSICAL DIAGNOSIS OF THE THORAX.\\nBy Arthur M. Corwin, A. M., M. D., Demonstrator of Physical Diagno-\\nsis in the Rush Medical College, Chicago; Attending Physician to the\\nCentral Free Dispensary, Department of Rhinology, Laryngology, and\\nDiseases of the Chest. 219 pages. Illustrated. Cloth, flexible covers.\\nPrice, $1.25 net.\\nTHIRD EDITION, THOROUGHLY REVISED AND ENLARGED.\\nSYLLABUS OF OBSTETRICAL LECTURES in the Medical\\nDepartment, University of Pennsylvania. By Richard C. Norris,\\nA. M., M. D., Lecturer on Clinical and Operative Obstetrics, University\\nof Pennsylvania. Third edition, thoroughly revised and enlarged. Crown\\n8vo. Price, Cloth, interleaved for notes, $2.00 net.\\nThis work is so far superior to others on the same subject that we take pleasure in call-\\ning attention briefly to its excellent features. It covers the subject thoroughly, and will\\nprove invaluable both to the student and the practitioner. The author has introduced a\\nnumber of valuable hints which would only occur to one who was himself an experienced\\nteacher of obstetrics. The subject-matter is clear, forcible, and modern. We are especially\\npleased with the portion devoted to the practical duties of the accoucheur, care of the child,\\netc. The paragraphs on antiseptics are admirable; there is no doubtful tone in the direc-\\ntions given. No details are regarded as unimportant no minor matters omitted. We ven-\\nture to say that even the old practitioner will find useful hints in this direction which he can-\\nnot afford to despise. New York Medical Record.\\nA SYLLABUS OF LECTURES ON THE PRACTICE OF SUR-\\nGERY, arranged in conformity with An American Text-Book\\nof Surgery. By N. Senn, M. D., Ph. D., Professor of Surgery in Rush\\nMedical College, Chicago, and in the Chicago Polyclinic. Price, $2.00.\\nThis work by so eminent an author, himself one of the contributors to\\nAn American Text-Book of Surgery, will prove of exceptional value to\\nthe advanced student who has adopted that work as his text-book. It is not\\nonly the syllabus of an unrivalled course of surgical practice, but it is also an\\nepitome of or supplement to the larger work.\\nThe author has evidently spared no pains in making his Syllabus thoroughly comprehen-\\nsive, and has added new matter and alluded to the most recent authors and operations. Full\\nreferences are also given to all requisite details of surgical anatomy and pathology. British\\nMedical Journal, London.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0383.jp2"}, "384": {"fulltext": "3 8 W. B. SAUNDERS\\nTHE CARE OF THE BABY. By J. P. Crozer Griffith, M. I).,\\nClinical Professor of Diseases of Children, University of Pennsylvania;\\nPhysician to the Children s Hospital Philadelphia, etc. 404 pages, with\\n67 illustrations in the text, and 5 plates. i2mo. Price, #1.50.\\nSECOND EDITION, REVISED.\\nA reliable guide not only for mothers, but also for medical students and\\npractitioners whose opportunities for observing children have been limited.\\nThe whole book is characterized by rare good sense, and is evidently written by a mas.\\nter hand. _ It can be read with benefit not only by mothers, but by medical students and by\\nany practitioners who have not had large opportunities for observing children. American\\nJournal of Obstetrics.\\nTHE NURSE S DICTIONARY of Medical Terms and Nursing\\nTreatment, containing Definitions of the Principal Medical and Nursing\\nTerms, Abbreviations, and Physiological Names, and Descriptions of the\\nInstruments, Drugs, Diseases, Accidents, Treatments, Operations, Foods,\\nAppliances, etc. encountered in the ward or the sick-room. By Honnor\\nMorten, author of How to Become a Nurse, Sketches of Hospital\\nLife, etc. i6mo, 140 pages. Price, Cloth, $1.00.\\nThis little volume is intended for use merely as a small reference-book which\\ncan be consulted at the bedside or in the ward. It gives sufficient explanation\\nto the nurse to enable her to comprehend a case until she has leisure to look up\\nlarger and fuller works on the subject.\\nDIET LISTS AND SICK-ROOM DIETARY. By Jerome B. Thomas,\\nM. D., Visiting Physicia-n to the Home for Friendless Women and Children\\nand to the Newsboys Home Assistant Visiting Physician to the Kings\\nCounty Hospital; Assistant Bacteriologist, Brooklyn Health Department.\\nPrice, Cloth, $1.50 (Send for specimen List.)\\nOne hundred and sixty detachable (perforated) diet lists for Albuminuria,\\nAnaemia and Debility, Constipation, Diabetes, Diarrhoea, Dyspepsia, Fevers,\\nGout or Uric- Acid Diathesis, Obesity, and Tuberculosis. Also forty detachable\\nsheets of Sick-Room Dietary, containing full instructions for preparation of\\neasily-digested foods necessary for invalids. Each list is numbered only, the\\ndisease for which it is to be used in no case being mentioned, an index key\\nbeing reserved for the physician s private use.\\nDIETS FOR INFANTS AND CHILDREN IN HEALTH AND\\nIN DISEASE. By Louis Starr, M. D., Editor of An American\\nText-Book of the Diseases of Children. 230 blanks (pocket-book size),\\nperforated and neatly bound in flexible morocco. Price, $1.25 net.\\nThe first series of blanks are prepared for the first seven months of infant\\nlife each blank indicates the ingredients, but not the quantities, of the food,\\nthe latter directions being left for the physician. After the seventh month,\\nmodifications being less necessary, the diet lists are printed in full. Formula\\nfoi tne preparation of diluents and foods are appended.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0384.jp2"}, "385": {"fulltext": "CATALOGUE OF MEDICAL WORKS. 39\\nHOW TO EXAMINE FOR LIFE INSURANCE. By Joi*N M.\\nKeating, M. D., Fellow of the College of Physicians and Surgeons of\\nPhiladelphia; Vice-President of the American Pediatric Society; Ex-\\nPresident of the Association of Life Insurance Medical Directors. Royal\\n8vo, 211 pages, with two large half-tone illustrations, and a plate prepared\\nby Dr. McClellan from special dissections also, numerous cuts to elucidate\\nthe text. Third edition. Price, Cloth, $2.00 net.\\nThis is by far the most useful book which has yet appeared on insurance examination, a\\nsubject of growing interest and importance. Not the least valuable portion of the volume is\\nPart II., which consists of instructions issued to their examining physicians by twenty-four\\nrepresentative companies of this country. As the proofs of these instructions were corrected\\nby the directors of the companies, they form the latest instructions obtainable, If for these\\nalone, the book should be at the right hand of every physician interested in this special branch\\nof medical science. The Medical News, Philadelphia.\\nNURSING: ITS PRINCIPLES AND PRACTICE. By Isabel\\nAdams Hampton, Graduate of the New York Training School for\\nNurses attached to Bellevue Hospital; Superintendent of Nurses and\\nPrincipal of the Training School for Nurses, Johns Hopkins Hospital,\\nBaltimore, Md. late Superintendent of Nurses, Illinois Training School\\nfor Nurses, Chicago, 111. In one very handsome i2mo volume of 512\\npages, illustrated. Price, Cloth, $2.00 net.\\nSECOND EDITION, REVISED AND ENLARGED.\\nThis original work on the important subject of nursing is at once comprehensive\\nand systematic. It is written in a clear, accurate, and readable style, suitable\\nalike to the student and the lay reader. Such a work has long been a desidera-\\ntum with those entrusted with the management of hospitals and the instruction of\\nnurses in training-schools. It is also of especial value to the graduated nurse\\nwho desires to acquire a practical working knowledge of the care of the sick\\nand the hygiene of the sick-room.\\nOBSTETRIC ACCIDENTS, EMERGENCIES, AND OPERA-\\nTIONS. By L. Ch. Boisliniere, M. D., late Emeritus Professor of\\nObstetrics in the St. Louis Medical College. 381 pages, handsomely illus-\\ntrated. Price, $2.00 net.\\nFor the use of the practitioner who, when away from home, has not the\\nopportunity of consulting a library or of calling a friend in consultation. He\\nthen, being thrown upon his own resources, will find this book of benefit in\\nguiding and assisting him in emergencies.\\nINFANT S WEIGHT CHART. Designed by J. P. Crozer Grjffith,\\nM. D., Clinical Professor of Diseases of Children in the University of Peniv\\nsylvania. 25 charts in each pad. Price per pad, 50 cents net.\\nA convenient blank for keeping a record of the child s weight during the first\\ntwo years of life. Printed on each chart is a curve representing the average weight\\nof a healthy infant, so that any deviation from the normal can readily be detected.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0385.jp2"}, "386": {"fulltext": "V ^K\\nh-\\nSaunders\\nNew Series\\nof Manuals\\nfor Students\\nand\\nPractitioners*\\nTHAT there exists a need for thoroughly reliable hand-books on the leading\\nbranches of Medicine and Surgery is a fact amply demonstrated by the\\nfavor with which the SAUNDERS NEW SERIES OF MANUALS have been\\nreceived by medical students and practitioners and by the Medical Press.\\nThese manuals are not merely condensations from present literature, but\\nare ably written by well-known authors and practitioners, most of them being\\nteachers in representative American colleges. Each volume is concisely and\\nauthoritatively written and exhaustive in detail, without being encumbered\\nwith the introduction of cases, which so largely expand the ordinary text-\\nbook. These manuals will therefore form an admirable collection of advanced\\nlectures, useful alike to the medical student and the practitioner: to the latter,\\ntoo busy to search through page after page of elaborate treatises for what he\\nwants to know, they will prove of inestimable value to the former they will\\nafford safe guides to the essential points of study.\\nThe. SAUNDERS NEW SERIES OF MANUALS are conceded to be\\nsuperior to any similar books now on the market. No other manuals afford so\\nmuch information in such a concise and available form. A liberal expenditure\\nhas enabled the publisher to render the mechanical portion of the work worthy\\nof the high literary standard attained by these books.\\nAny of these Manuals will be mailed on receipt of price (see next page\\nTor List).", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0386.jp2"}, "387": {"fulltext": "SAUNDERS NEW SERIES OF MANUALS.\\nVOLUMES PUBLISHED.\\nPHYSIOLOGY. By Joseph Howard Raymond, A. M., M. D., Professor\\nof Physiology and Hygiene and Lecturer on Gynecology in the Long\\nIsland College Hospital, etc. Price, #1.25 net.\\nSURGERY, General and Operative. By John Chalmers DaCosta,\\nM. D., Professor of Clinical Surgery, Jefferson Medical College, Philadel-\\nphia. Second edition, revised and greatly enlarged. Octavo, 911 pages\\n386 illustrations. Cloth, $4.00 net Half- Morocco, $5.00 net.\\nDOSE-BOOK AND MANUAL OF PRESCRIPTION- WRITING.\\nBy E. Q. Thornton, M. D. s Demonstrator of Therapeutics, Jefferson\\nMedical College, Philadelphia. Price, $1.25 net.\\nMEDICAL JURISPRUDENCE. By Henry C. Chapman, M.D., Pro-\\nfessor of Institutes of Medicine and Medical Jurisprudence in the Jeffer-\\nson Medical College of Philadelphia, etc Price, $1.50 net.-\\nSURGICAL ASEPSIS. By Carl Beck, M.D., Surgeon to St. Mark s\\nHospital and to the German Poliklinik Instructor in Surgery, New York\\nPost-Graduate Medical School, etc. Price, $1.25 net.\\nMANUAL OF ANATOMY. By Irving S. Haynes, M.D., Adjunct\\nProfessor of Anatomy and Demonstrator of Anatomy, Medical Department\\nof the New York University, etc. Price, $2.50 net.\\nSYPHILIS AND THE VENEREAL DISEASES. By James\\nNevins Hyde, M. D Professor of Skin and Venereal Diseases, and\\nFrank H. Montgomery, M. D., Lecturer on Dermatology and Genito-\\nurinary Diseases in Rush Medical College, Chicago. Price, $2.50 net.\\nPRACTICE OF MEDICINE. By George Roe Lockwood, M. D.,\\nProfessor of Practice in the Woman s Medical College of the New York\\nInfirmary, etc. Price, $2.50 net.\\nOBSTETRICS. By W. A. Newman Dorland, M. D., Assistant Demon-\\nstrator of Obstetrics, University of Pennsylvania; Chief of Gynecological\\nDispensary, Pennsylvania Hospital. Price, $2.50 net.\\nDISEASES OF WOMEN. By J. Bland Sutton, F. R. C. S., Assistant\\nSurgeon to the Middlesex Hospital, and Surgeon to the Chelsea Hospital\\nfor Women, London and Arthur E. Giles, M. D., B. Sc. Lond., F. R. C. S.\\nEdin., Assistant Surgeon to the Chelsea Hospital for Women, London. 436\\npages, handsomely illustrated. Price, $2.50 net.\\nIN PREPARATION.\\nNERVOUS DISEASES. By Charles W. Burr, M. D., Clinical Profes-\\nsor of Nervous Diseases, Medico-Chirurgical College, Philadelphia, etc.\\nThere will be published in the same series, at short intervals, carefully prepared works\\non various subjects, by prominent specialists.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0387.jp2"}, "388": {"fulltext": "SAUNDERS QUESTION COMPENDS.\\nArranged in Question and Answer Form,\\nTHE LATEST, MOST COMPLETE, and BEST ILLUSTRATED\\nSERIES OF COMPENDS EVER ISSUED.\\nNow the Standard Authorities in Medical Literature\\nStudents and Practitioners in every City of the United\\nStates and Canada.\\nTHE REASON WHY.\\nThey are the advance guard of Student s Helps that do help; they are\\nthe leaders in their special line, well and authoritatively written by able men,\\nwho, as teachers in the large colleges, know exactly what is wanted by a student\\npreparing for his examinations. The judgment exercised in the selection of\\nauthors is fully demonstrated by their professional elevation. Chosen from the\\nranks of Demonstrators, Quiz-masters, and Assistants, most of them have be-\\ncome Professors and Lecturers in their respective colleges.\\nEach book is of convenient size (5x7 inches), containing on an average 250\\npages, profusely illustrated, and elegantly printed in clear, readable type, on\\nfine paper.\\nThe entire series, numbering twenty-four subjects, has been kept thoroughly\\nrevised and enlarged when necessary, many of them being in their fourth and\\nfifth editions.\\nTO SUM UP.\\nAlthough there are numerous other Quizzes, Manuals, Aids, etc. in the mar-\\nket, none of them approach the Blue Series of Question Compends; and\\nthe claim is made for the following points of excellence\\n1. Professional distinction and reputation of authors.\\n2. Conciseness, clearness, and soundness of treatment.\\n3. Size of type and quality of paper and binding.\\nAny of these Compends will be mailed on receipt of price (see next\\npage for List).", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0388.jp2"}, "389": {"fulltext": "SAUNDERS QUESTION-COMPEND SERIES.\\nPrice, Cloth, $J.OO per copy, except when otherwise noted.\\n1. ESSENTIALS OF PHYSIOLOGY. 4th edition. Illustrated. Revised and enlarged.\\nBy H. A. Hare, M. D. (Price, $1.00 net.)\\n2. ESSENTIALS OF SURGERY. 7th edition, with a chapter on Appendicitis. 90 illus-\\ntrations. By Edward Martin, M. D. (Price, $1.00 net.)\\n3. ESSENTIALS OF ANATOMY. 6th edition, thoroughly revised. 151 illustrations.\\nBy Charles B. Nancrede, M. D. (Price, $1.00 net.)\\n4. ESSENTIALS OF MEDICAL CHEMISTRY, ORGANIC AND INORGANIC.\\n5th edition, revised, with an Appendix. By Lawrence Wolff, M. D. ($1.00 net.)\\n5. ESSENTIALS OF OBSTETRICS. 4th edition, revised and enlarged. 75 illustra-\\ntions. By W. Easterly Ashton, M.D.\\n6. ESSENTIALS OF PATHOLOGY AND MORBID ANATOMY. 7 th thousand.\\n46 illustrations. By C. E. Armand Semple, M. D.\\n7. ESSENTIALS OF MATERIA MEDICA, THERAPEUTICS, AND PRE-\\nSCRIPTION-WRITING. 5th edition. By Henry Morris, M. D.\\n8,9. ESSENTIALS OF PRACTICE OF MEDICINE. By Henry Morris, M.D.\\nAn Appendix on Urine Examin ation. Illustrated. By Lawrence Wolff, M. D.\\n3d edition, enlarged by some 300 Essential Formulae, selected from eminent authori-\\nties, by Wm. M. Powell, M. D. (Double number, price $2.00.)\\n10. ESSENTIALS OF GYN/ECOLOGY. 4th edition, revised. With 62 illustrations.\\nBy Edwin B. Cragin, M. D.\\n11. ESSENTIALS OF DISEASES OF THE SKIN. 4th edition, revised and enlarged.\\n71 letter-press cuts and 15 half-tone illustrations. By Henry W. Stelwagon, M.D.\\n(Price, $1.00 net.)\\n12. ESSENTIALS OF MINOR SURGERY, BANDAGING, AND VENEREAL\\nDISEASES. 2d edition, revised and enlarged. 78 illustrations. By Edward\\nMartin, M. D.\\n13. ESSENTIALS OF LEGAL MEDICINE, TOXICOLOGY, AND HYGIENE.\\n130 illustrations. By C. E. Armand Semple, M. D.\\n14. ESSENTIALS OF DISEASES OF THE EYE, NOSE, AND THROAT. 124\\nillustrations. 2d edition, revised. By Edward Jackson, M. D., and E. Baldwin\\nGleason, M. D.\\n15. ESSENTIALS OF DISEASES OF CHILDREN. 2d edition. By William M.\\nPowell, M. D.\\n16. ESSENTIALS OF EXAMINATION OF URINE. Colored Vogel Scale,\\nand numerous illustrations. By Lawrence Wolff, M. D. (Price, 75 cents.)\\n17. ESSENTIALS OF DIAGNOSIS. 2*d edition, thoroughly revised. 60 illustrations.\\nBy S. Solis-Cohen, M. D., and A. A. Esiiner, M. D. (Price, $1.00 net.)\\n18. ESSENTIALS OF PRACTICE OF PHARMACY. 2d edition, revised. By L.\\nE. Sayre.\\n20. ESSENTIALS OF BACTERIOLOGY. 3d edition. 82 illustrations. By M. V.\\nBall, M.D.\\n21. ESSENTIALS OF NERVOUS DISEASES AND INSANITY. 48 illustrations.\\n3d edition, revised. By John C Shaw, M.D.\\n22. ESSENTIALS OF MEDICAL PHYSICS. 155 illustrations. 2d edition, revised.\\nBy Fred J. Brockway, M. D. (Price, $1.00 net.)\\n23. ESSENTIALS OF MEDICAL ELECTRICITY. 65 illustrations. By David D.\\nStewart, M. D., and Edward S. Lawrance, M. D.\\n24. ESSENTIALS OF DISEASES OF THE EAR. 114 illustrations. 2d edition, re-\\nvised and enlarged. By E. Baldwin Gleason, M. D.\\n43", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0389.jp2"}, "390": {"fulltext": "Some of the Books in Preparation for\\nPublication during 1900.\\nAMERICAN Text=Book of Pa=\\nthology.\\nEdited by Ludvig Hektoen, M.D., Pro-\\nfessor of Pathology, Rush Medical College,\\nChicago; and David Riesman, M.D., De-\\nmonstrator of Pathological Histology, Uni-\\nversity of Pennsylvania.\\nAMERICAN Text=Book of Legal\\nMedicine and Toxicology.\\nEdited by Frederick Peterson, M.D.,\\nChief of Clinic, Nervous Department, College\\nof Physicians and Surgeons, New York City;\\nand Walter S. Haines, M.D., Professor of\\nChemistry, Pharmacy, and Toxicology, Rush\\nMedical College, Chicago.\\nBECK\u00e2\u0080\u0094 Fractures.\\nBy Carl Beck, M.D., Professor of Surgery\\nin the N. Y. School of Clinical Medicine.\\nBOHM, DAVIDOFF, and HU=\\nBER\u00e2\u0080\u0094 A Text=Book of Human\\nHistology.\\nIncluding Microscopic Technic. By\\nDr. A. A. Bohm and Dr. M. von Davidoff,\\nof the Anatomical Institute of Munich, and\\nG. C. Huber, M.D., Junior Professor of Anat-\\nomy and Histology, University of Michigan,\\nAnn Arbor.\\nEICHHORST\u00e2\u0080\u0094 A Text=Book of\\nthe Practice of Medicine.\\nBy Dr. Herman Eichhorst, Professor of\\nSpecial Pathology and Therapeutics and Di-\\nrector of the Medical Clinic, University of\\nZurich. Translated and edited by Augustus\\nA. Eshner, M.D Professor of Clinical\\nMedicine in the Philadelphia Polyclinic.\\nFRIEDRICH Rhinology, La=\\nryngology, and Otology in\\ntheir Relations to General\\nMedicine.\\nBy Dr. E. P. Friedrich, of the Univer-\\nsity of Leipsig.\\nLEVY AND KLEMPERER\\nThe Elements of Clinical Bac=\\nteriology.\\nBy Dr. Ernst Levy, Professor in the\\nUniversity of Strassburg, and Dr. Felix\\nKlemperer, Privat-Docent in the Univer-\\nsity of Strassburg. Translated and edited\\nby Augustus A. Eshner, M.D., Professor\\nof Clinical Medicine in the Philadelphia Poly-\\nMcFARLAND\u00e2\u0080\u0094 A Text=Book of\\nPathology.\\nBy Joseph McFarland, M.D., Professor\\nof Pathology and Bacteriology, Medico-Chi-\\nrurgical College, Philadelphia.\\nOQDEN Clinical Examination\\nof the Urine.\\nBy J. Bergen Ogden, M.D., Assistant in\\nChemistry, Harvard Medical School.\\nPYLE\u00e2\u0080\u0094 A Manual of Personal\\nHygiene.\\nEdited by Walter L. Pyle, M.D., Assis-\\ntantSurgeon to Wills Eye Hospital, Philada.\\nSCUDDER\u00e2\u0080\u0094 The Treatment of\\nFractures.\\nBy Charles L. Scudder, M.D., Assistant\\nin Clinical and Operative Surgery, Harvard\\nUniversity.\\nSENN\u00e2\u0080\u0094 Practical Surgery.\\nBy Nicholas Senn, M.D. Ph.D., LL.D.,\\nProfessor of the Practice of Surgery and of\\nClinical Surgery, Rush Medical College, Chi-\\ncago. Octavo volume of about 800 pages,\\nprofusely illustrated.\\nThe Pathology and* Treatment\\nof Tumors.\\nBy Nicholas Senn, M.D., Ph.D., LL.D.,\\nProfessor of the Practice of Surgery and of\\nClinical Surgery, Rush Medical College, Chi-\\ncago. A New and Thoroughly Revised Edi-\\ntion in preparation.\\nSTENGEL AND WHITE The\\nBlood in its Clinical and Patho-\\nlogical Relations.\\nBy Alfred Stengel, M.D., Professor of\\nClinical Medicine, University of Pennsyl-\\nvania; and C. Y. White, M.D., Instruc-\\ntor in Clinical Medicine, University of Penn-\\nsylvania.\\nSTEVENS\u00e2\u0080\u0094 The Physical Diag=\\nnosis of Diseases of the Chest.\\nBy A. A. Stevens, A.M., M.D., Lecturer\\non Terminology, and Instructor in Physical\\nDiagnosis, University of Pennsylvania.\\nSTONE Y Surgical Technique\\nfor Nurses.\\nBy Emily A. M. Stoney, late Superin-\\ntendent of the Training Schools for Nurses,\\nCarney Hospital, South Boston, Mass.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0390.jp2"}, "391": {"fulltext": "SAUNDERS\\nMEDICAL HAND-ATLASES.\\nThe series of books included under this title are authorized translations\\ninto English of the world-famous\\nLehmann Medicinische Handatlanten,\\nwhich for scientific accuracy, pictorial beauty, compactness, and\\ncheapness surpass any similar volumes ever published.\\nEach volume contains from 50 to 100 colored plates, besides numer-\\nous illustrations in the text. The colored plates have been executed by the\\nmost skilful German lithographers, in some cases more than twenty im-\\npressions being required to obtain the desired result. Each plate is accom-\\npanied by a full and appropriate description, and each book contains a con-\\ndensed but adequate outline of the subject to which it is devoted.\\nOne of the most valuable features of these atlases is that they offer a\\nready and satisfactory substitute for clinical observation. Such ob-\\nservation, of course, is available only to the residents in large medical centers;\\nand even then the requisite variety is seen only after long years of routine\\nhospital work. To those unable to attend important clinics these books\\nwill be absolutely indispensable, as presenting in a complete and con-\\nvenient form the most accurate reproductions of clinical work, interpreted\\nby the most competent of clinical teachers.\\nWhile appreciating the value of such colored plates, the profession has\\nheretofore been practically debarred from purchasing similar works because\\nof their extremely high price, made necessary by a limited sale and an\\nenormous expense of production. Now, however, by reason of their pro-\\njected universal translation and reproduction, affording international dis-\\ntribution, the publishers have been enabled to secure for these atlases the\\nbest artistic and professional talent, to produce them in the most\\nelegant style, and yet to offer them at a price heretofore unapproached\\nin cheapness. The great success of the undertaking is demonstrated\\nby the fact that the volumes have already appeared in thirteen different\\nlanguages German, English, French, Italian, Russian, Spanish, Dutch,\\nJapanese, Danish, Swedish, Roumanian, Bohemian, and Hungarian.\\nThe same careful and competent editorial supervision has been\\nsecured in the English edition as in the originals. The translations have\\nbeen edited by the leading American specialists in the different sub-\\njects. The volumes are of a uniform and convenient size (5 x 7^ inches),\\nand are substantially bound in cloth.\\n(For List of Books, Prices, etc. see next page.)\\nPamphlet containing specimens of the Colored Plates\\nsent free on application.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0391.jp2"}, "392": {"fulltext": "VOLUMES rfaw READY.\\nAtlas and Epitome of Internal Medicine and Clinical Diagnosis.\\nBy Dr. Chr. Jakob, of Erlangen. Edited by Augustus A. Eshner, M.D.,\\nProfessor of Clinical Medicine in the Philadelphia Polyclinic. With 68\\ncolored plates, 64 text-illustrations, and 259 pages of text. Cloth, #3.00\\nnet\\nAtlas of Legal Medicine. By Dr. E. von Hofmann, of Vienna. Ed-\\nited by Frederick Peterson, Ml D., Chief of Clinic, Nervous Depart-\\nment, College of Physicians and Surgeons, New York. With 120 colored\\nfigures on 56 plates and 193 half-tone illustrations. Cloth, $3.50 net.\\nAtlas and Epitome of Diseases of the Larynx. By Dr. L. Grun\\nwald, of Munich. Edited by Charles P. Grayson, M. D., Physician-\\nin-Charge, Throat and Nose Department, Hospital of the University of\\nPennsylvania. With 107 colored figures on 44 plates, 25 text-illustrations,\\nand 103 pages of text. Cloth, $2.50 net.\\nAtlas and Epitome of Operative Surgery. By Dr. O Zuckerkandl,\\nof Vienna. Edited by J. Chalmers DaCosta, M. D., Clinical Professor\\nof Surgery, Jefferson Medical College, Philadelphia. With 24 colored\\nplates, 217 illustrations, and, 395 pages of text. Cloth, $3.00 net.\\nAtlas and Epitome of Syphilis and the Venereal Diseases. By\\nProf. Dr. Franz Mracek, of Vienna. Edited by L. Bolton Bangs,\\nM. D., Professor of Genito-Urinary Surgery, University and Bellevue Hos-\\npital Medical College, New York. With 71 colored plates, 66 text-illus-\\ntrations, and 122 pages of text. Cloth, $3.50 net.\\nAtlas and Epitome of External Diseases of the Eye. By Dr. O.\\nHaab, of Zurich. Edited by G. E. de Schweinitz, M. D., Professor of\\nOphthalmology, Jefferson Medical College, Philadelphia. With 76 colored\\nillustrations on 40 plates and 228 pages of text. Cloth, $3.00 net.\\nAtlas and Epitome of Skin Diseases. By Prof. Dr. Franz Mracek,\\nof Vienna. Edited by Henry W. Stelwagon, M. D., Clinical Professor\\nof Dermatology, Jefferson Medical College, Philadelphia. With 63 colored\\nplates, 39 illustrations, and 200 pages of text. Cloth, $3.50 net.\\nAtlas and Epitome of Special Pathological Histology. By Dr. H.\\nDurck, of Munich. Edited by Ludvig Hektoen, M. D., Professor of\\nPathology, Rush Medical College, Chicago. Two volumes, with about\\n120 colored plates, numerous text-illustrations, and copious text.\\nAtlas and Epitome of Diseases Caused by Accidents. By Dr. Ed.\\nGolebiewski, of Berlin. Translated and edited with additions by PeArce\\nBailey, M. D., Attending Physician to the Department of Corrections and\\nto the Almshouse and Incurable Hospital, New York. With 40 colored\\nplates, 143 text-illustrations, and 600 pages of text.\\nIN PREPARATION.\\nAtlas of General Pathological Histology. Atlas of Operative Gynecology.\\nAtlas of Orthopedic Surgery. Atlas of Psychiatry.\\nAtlas of General Surgery. Atlas of Diseases of the Ear.", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0392.jp2"}, "393": {"fulltext": "", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0393.jp2"}, "394": {"fulltext": "", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0394.jp2"}, "395": {"fulltext": "", "height": "3516", "width": "2181", "jp2-path": "essentialsofsur00mart_0395.jp2"}, "396": {"fulltext": "HHffiP\\n1BHB\\nIHHH\\nHHP\\n|H\\nIll\\n11111\\nwwBBaBM\\nMUMi i i", "height": "3637", "width": "2351", "jp2-path": "essentialsofsur00mart_0396.jp2"}}