| LECTURE I. |
|
A wound made by a musket-ball is essentially a contused wound;
sometimes bleeds; attended by shock and alarm, particularly
when from cannon-shot, or when vital parts are injured; secondary
hemorrhage rare. Entrance and exit of balls. Course of
balls. Position. Treatment: cold or iced water; no bandage to
be applied; wax candles. Progress of inflammation. Extraction
of balls in flesh wounds; manner of doing it. Dilatation; when
proper. Bayonet wounds; delusion respecting them. | pp. 25‑39 |
| LECTURE II. |
|
Peculiar phlegmonous inflammation. Erysipelatous inflammation;
internal treatment. Erysipelas phlegmonodes, or diffused inflammation
of the areolar tissue; treatment by incision; first case
treated in England by incision; caution with respect to the
scrotum. Mortification—distinction into idiopathic or constitutional
and that which is local; humid and dry; traumatic.
Local mortification from intense heat or cold; wind of a ball;
electricity; search for these cases after the battle of Waterloo;
case of recovery after amputation; appearances on dissection.
Mortification from injury of the great vessels; appearance of the
skin. Patient dies when the mortification passes the knee.
Points of practice; amputation to be performed below the knee.
Wound being on the thigh, amputation not to be done above the
knee when the line of separation has formed below it. Wounds
of the axillary not so dangerous as wounds of the femoral. Wounds
of nerves; complete division of, followed by the loss of sensation,
motion, and the power of resisting cold and heat. Cases of Sir
James Kempt, of Sir Philip Broke, and Brigade-Major Bissett.
Treatment; external and internal remedies. | pp. 39‑51 |
| LECTURE III. |
|
Necessity for immediate amputation when an extremity is so
wounded as to preclude all hope of saving it; degree of danger
attending amputations of the upper and lower extremities; the
question us to immediate amputation—of the arm, or leg below
the knee; in the upper half of the thigh. Constitutional alarm
of shock from the injury. Illustrative cases by Dr. Beith, Dr.
Dane, etc. Advantages of primary over secondary amputations;
consequences of secondary amputations. Purulent deposits;
cases by Dr. Irwin, Mr. Rose, and Mr. Boutflower; case of purulent
deposit in the thyroid gland; Daniel Lynch’s case. Inflammation
of the veins; cases; two varieties of phlebitis—the
adhesive and irritative, or unhealthy; symptoms and treatment of
the unhealthy inflammation. The case of Private A. Clarke; of
Jane Strangemore; cases of endemic fever after secondary amputation
ending in sub acute inflammation of the lungs and effusion
into the chest. Employment of the sulphuric acid lotion in sloughing
stumps. Writers on purulent deposits: the author’s claims;
opinions of Mr. Henry Lee and Dr. Hughes Bennett. Hemorrhage
in sloughing stumps, and its treatment; ligature of the
principal artery of the limb in such cases, and its failure; hemorrhage
after amputation at the shoulder-joint; sloughing of the
stump caused by the bad air of the hospital; hemorrhages from
irritable stumps not unfrequent in crowded hospitals; symptoms
and treatment. | pp. 51‑73 |
| LECTURE IV. |
|
Aphorisms for amputations; necessity for the operation; compression
of the femoral artery as it passes over the edge of the pubes;
no necessity for the tourniquet in great amputations; the hemorrhage
greater when a tourniquet is applied; use of the instrument
after amputation; old mode of performing circular amputations;
nicking the periosteum injurious; ligature of wounded vessels;
bringing together the integuments; dressing the stump; subsequent
treatment. Amputation at the hip-joint; injuries justifying
the operation; case of Captain Flack; wound of the
principal artery, with fracture of the femur, necessitates the operation;
in malignant diseases of the femur, the operation affords
the only chance of success; amputation at the hip-joint not to be
done when the bone can be sawn through immediately below the
trochanter major, and there be sufficient flaps; mode of operating;
prior ligature of the femoral artery, by Baron Larrey; not practiced
in the British army; directions for operating; Professor
Langenbeck’s mode; Mr. Brownrigg’s; illustrative engravings;
amputation by the circular incision; secondary amputation;
number of vessels to be tied in primary and secondary operations;
Mr. Luke’s amputation of the thigh by the flap operation;
protrusion
of bone after the operation; exfoliation from badly sawing
or splitting the bone, or unduly separating the periosteum. Bulbous
enlargement of the divided nerve. | pp. 73‑89 |
| LECTURE V. |
|
Removal of the head of the femur, dislocated in consequence of strumous
disease, or for fracture of the head or neck of the bone,
caused by an external wound; cases most favorable for the operation;
anatomical description of the operation; the operation on
the dead body; commencing for the removal of the head of the
bone: completing, by amputation of the thigh at the hip-joint,
the injuries being such as to require that operation; ligature of a
great artery, close to a large branch, successful; completing the
operation for the removal of the head of the femur; case of removal
of the head of the femur; wounds of the knee-joint from
musket-balls, with fracture of the bones, require immediate amputation;
secondary amputation does not offer such a chance of
success; compound fractures of the patella without injury to other
bones; the joint involved; lodgment of the ball in the joint; the
ball penetrating the condyles of the femur; wound of the popliteal
artery; cases for amputation; clean incised wounds of the
knee-joint; case of Colonel Donnellan; excision of the knee-joint;
formerly rarely successful; Mr. Jones, of Jersey, mode of operating;
Dr. Gurdon Buck’s case of excision of the knee-joint, for
anchylosis, following a gunshot wound; Mr. Jones’s improvement
of the operation; amputation of the leg; by the circular incision;
the flap operation, as performed by Mr. Luke; amputation at
the tuberosity of the tibia: removal of the head of the fibula;
excision of the ankle-joint; removal of the os calcis; Mr. Syme’s
amputation at the ankle-joint; sloughing of the under flap, and
its causes; gunshot wounds of the foot; wounds of the fore part
of the foot by cannon-shot, grape-shot, or musket-balls; amputation
at the tarsus of the foot, leaving the astragalus and os
calcis; operation for the removal of the astragalus and os calcis
by Mr. Wakley, jun.; necessary not to wound the anterior tibial
artery; amputation of a single metatarsal bone; M. de Beaufort’s
artificial foot. | pp. 90‑120 |
| LECTURE VI. |
|
Primary amputation of the upper extremity rarely to be practiced for
musket-shot wounds, or for injuries of the soft parts; treatment
of slight gunshot wounds of the head of the humerus; a depending
opening for the exit of matter to be made, if not previously
existing; the principal points to attend to in such cases; simple
incised wounds of the joint; splintering of the head of the bone,
or the passage of a ball through it, requires its being sawn off;
cases for amputation of the arm; site of the operation, the head
of the bone being uninjured; complete shattering of the arm;
complicated with more or less severe injury of the chest or abdomen;
if the latter not likely to cause a speedy dissolution, then
amputation of the arm is to be performed; moderate hemorrhage
or expectoration of blood, under such circumstances, not absolutely
fatal; destructive injuries from rebounding or nearly spent
round shot, or flat pieces of shell, without external signs of a
wound; necessity for an immediate operation in such cases;
amputation at the shoulder-joint; the fear of hemorrhage passed
away; compression of the subclavian; amputation at the shoulder-joint
for malignant disease of the bone and periosteum; the
acromion and coracoid processes should not be exposed, nor is it
necessary to deprive the glenoid cavity of its cartilage; the nerves
to be cut short, after the operation has been completed, else they
may cause distressing pain for life; primary amputation at the
shoulder-joint a very simple operation; secondary amputation
much less so; general directions prior to the operation; the operation
by two flaps, external and internal; by one, or nearly one,
upper flap; Lisfranc’s operation; modification of it by M. Baudens;
difficulties of the secondary amputation; amputation of
the arm immediately below the tuberosities of the humerus; excision
of the head of the humerus; Langenbeck’s operation; this
excision not easy of execution when the head and neck of the
bone are broken from the shaft, nor in secondary operations: not
to be practiced in every instance of compound fracture of the
part; cases; injury of the head of the humerus, with much loss of
the soft parts; giving way of the axillary artery during the treatment
not a cause for amputation; the vessel to be tied above and
below the opening, and the subclavian not to be ligatured till all
other means have failed; amputation of the arm by the circular
incision; cases requiring this operation; Mr. Luke’s operation by
two flaps; excision of the elbow-joint; injuries of the joint not
requiring this operation; cases in which it is admissible; mode of
operating; amputation at the elbow-joint recommended, but not
often performed; mode of operating; supposed advantage attending
the retention of the olecranon; amputation of the forearm;
seldom requisite; the flap operation preferable, particularly near
the wrist; mode of operating; the circular operation in the middle
of the forearm; amputation at the wrist; in all injuries of the
hand, requiring an operation, the thumb and one or more fingers
to be preserved, if possible; treatment of metacarpal bones fractured
by a musket-ball; of injured metacarpal bones, the fingers
being destroyed; removal of the heads of the metacarpal bones
when necessary; amputation of the phalanges; Langenbeck’s operation
for excision of the phalangeal joints; excision of the metacarpal
bone of the thumb by Langenbeck, the periosteum being
separated from the bone, and left behind in the wound. |
pp. 120‑141. |
| LECTURE VII. |
|
Secondary amputations not so successful after injuries as after
incurable disease; circumstances under which the operation is
performed in military surgery, and the consequences; secondary
hemorrhage; non-union of the stump; phlebitis and sloughing of
the stump; depositions of matter in the viscera; in secondary
amputations larger flaps required, or the bone to be cut shorter;
directions for sawing the bone; larger number of arteries to be
tied; torsion of arteries; bleeding from a small branch, cut short,
above the ligature; mode of avoiding this; use of the tourniquet;
and its inconveniences; in oozing of blood, the wound not to be
finally closed for some hours; treatment in cases of non-union;
cat-gut or other animal ligatures; hemorrhage from large veins
to be controlled by pressure, not by ligatures; if the bone be too
long, a piece to be sawn off; consequences of not doing so. Compound
Fractures: definition of; comminuted; compound fracture
of the arm or leg does not necessitate amputation; of the
thigh, amputation is requisite; difficulty of treating a gunshot
fracture, with extensive splintering of the bone; consequences of
the splintering; necrosis of the bone, and formation of sequestra;
case of Lieut. Timbrell, fracture of both femurs; recovery without
amputation: lodgment of a ball in, or its passage through, a bone,
without splintering; consequences; its removal requisite when
lodged in a bone; mere grazing a bone by a ball; simple transverse
fracture of a bone by a ball; flattening of a ball; its lodgment
between the broken portions of a bone; extensive shattering
of the femur, a case for immediate amputation; gunshot fractures
of head and neck of the femur; excision of the injured portions
of bone-if the upper third, or middle of the bone, amputation
necessary; in fractures of the lower third, not communicating
with the knee-joint, an attempt is to be made to save the limb;
when the femur is splintered, if the limb is to be saved, the principal
splinters to be removed; the necessary incisions often neglected;
if the splinters cannot be got at, amputation is requisite;
secondary danger from the smaller splinters; a careful examination
to be made for them when suppuration is established, and incisions
made if requisite for their removal; consequences of their
retention; proper bedsteads for the wounded should form a part
of military stores; position of the patient in gunshot fractures of
the leg or thigh; splints, and their application; gunshot wounds
of the leg; limb rarely to be amputated; removal of splinters;
position of the limb; Mr. Luke’s the best apparatus for a compound
fracture of the leg; illustrated by wood-engraving; bearers
for wounded men; gunshot wounds of the arm; more probability
of saving the limb; if an artery ulcerate, it should be tied at each
end; primary amputation in such cases rare; secondary, only for
mortification, or when the strength gives way; in incisions at a
late period, the nerves and arteries to be avoided; splints for the
arm. Hospital returns. |
pp. 141‑162 |
| LECTURE VIII. |
|
Hospital Gangrene: its synonyms; may be caused by the use of
charpie, instruments, bandages, etc., which have been previously
employed on infected parts; is a highly contagious and infectious
disease; its prevalence at Leyden in 1798; if the disease be mild
or chronic, wounds on the arm may continue healthy for some
days after those on the leg are infected, but not so if the gangrene
be acute; Mr. Blackadder’s description of the disease, as it occurred
in his own person, from inoculation; M. Delpech attributed
its spread in the French army to the misfortunes and sufferings of
the soldiery; Dr. Tice on the attendant depression, apathy, and
despair; description of the disease in its most virulent and less
destructive forms; characteristic signs of the disease; the question
as to its constitutional or local origin; character of the fever;
opinion of the French surgeons that the disease was of local origin;
local and constitutional treatment; use of mineral acids at
Santander in 1813; Dr. Boggie on large bleedings in the disease
at Bilbao; cases of hospital gangrene, with tetanus-bleeding
curing the one, and failing in the other; Dr. Boggie on the treatment
of phagedœna, and of inflammatory gangrene, after disorganisation;
the introduction of Fowler’s solution of arsenic, as an
escharotic, by Mr. Blackadder; dangers of that practice; Dr.
Walker on hospital gangrene at Bilbao: Delpech on phagedœnic
ulcer, and its treatment; attributes the first employment of mineral
acids to the British surgeons in Spain, and especially to Mr.
Guthrie; Deputy Inspector-General Taylor on hospital gangrene
in India; considers it a local disease, to be cured by local treatment;
uses nitric acid to the circumference of the ulcer; the
burning, gnawing sensation removed by the acid; dirty fungous
growths from wounds of the hands and forearm. Conclusions:
Return of the number of cases in the hospital stations in the Peninsula
during the last six months of 1813. |
pp. 163‑175 |
| LECTURE IX. |
|
On wounds of arteries, and the means adopted by nature and art for
the suppression of hemorrhage; their structure; ancient three
coats separated into six-1, the epithelial; 2, fenestrated; 8, muscular;
4, elastic; 5, elastic and areolar combined; 6, areolar.
Nature of epithelium; divided into three kinds—tesselated, cylindrical,
and spheroidal. Structure of epithelial (1) and of fenestrated
coat (2); structure of muscular (3) and elastic coat (4);
structure of elastic and areolar coats (5 and 6). Chemical composition,
protein. Voluntary and involuntary muscular fibers;
difference between them. Muscular fibers in arteries involuntary.
White inelastic and elastic yellow fibers in outer coat. Blood-vessels
of arteries; nerves of. Production of cells, nuclei, and
nucleoli. Cyto-blastema or formative substance. Collateral circulation
of two kinds—by direct, large, communicating arteries,
and by the capillary vessels, both being incapable of supporting
life in the lower extremity after the receipt of a sudden injury to
the main trunk in the thigh. |
pp. 176‑187 |
|
LECTURE X. |
|
Proper treatment of wounded arteries due to the Peninsular war;
Hunterian theory inapplicable; opposing theory of Mr. Guthrie;
means supposed to be adopted by nature for the suppression of
bleeding from large arteries from the time of Celsus to 1811 disputed;
their true nature shown; important distinction drawn
between the processes adopted with the upper and lower ends of
a divided artery; cases illustrative of the facts stated; application
of a small ligature; consequent processes; opinions formerly
entertained, erroneous; internal coagulum not absolutely necessary;
artery does not always contract up to its next collateral
branch, nor is it necessary; important case in proof; ligatures
should be small, round, and strong; undue interference to be
avoided. | pp. 187‑208 |
| LECTURE XI. |
|
Appearance of the femoral artery when torn across high up; illustrative
cases. A small puncture; illustrative cases. An artery of
the size of the brachial cut to a fourth of its circumference; when
completely divided; when wounded at some depth from the surface;
course to be pursued; illustrative case. No operation to be done
on a wounded artery unless it bleed; cases: John Wilson, Don
Bernardino Garcia Alvarez, and Captain Seton. |
pp. 208‑226 |
| LECTURE XII. |
|
Mortification local and dry in the first instance. Case deserving of
great attention. Amputation not always to be had recourse to in
such cases; the case of Cook demonstrative on this point. General
treatment in such cases. Wounds of the arteries of the leg.
Case of H. Vigarelie decisive of the principle and the practice to
be pursued. Remarks on the bleeding from great arteries. The
surgery of the Peninsular war in advance of the surgery of civil
life. Case of suppurating aneurism of the axillary artery; bursting
after ligature of the subclavian; wounds of the radial in the
hand. | pp. 226‑240 |
| LECTURE XIII. |
|
Primitive carotid artery not to be tied for a wound of the external
or internal carotid; danger of doing it. Wounds of the vertebral
artery; illustrative cases. Opinion of Velpean. Parisian in advance
of some London surgeons. Wound of internal carotid;
case by Dr. Twitchell. Operative process described; case by Dr.
Keith. | pp. 241‑250 |
|
LECTURE XIV. |
|
Ligature of the common iliac artery; abdominal hernia; ligature of
the aorta; of the internal iliac artery; of the external iliac artery—two
methods; in cases of aneurism of the gluteal or sciatic artery,
the internal iliac artery should be the vessel secured—in all
cases of wounds, the wounded artery itself; Dr. Tripler’s (U. S.
army) case of wound of the gluteal artery; unsuccessful ligature
of that artery, followed by ligature of the internal iliac, and
death; errors in the treatment of this case; ligature of the femoral
artery in the groin; compression not to be made upon it
when the operation is done for aneurism; operation for popliteal
aneurism; suppression of urine; constitutional irritation after
these operations; popliteal artery only to be tied, when wounded
and bleeding; case of wound of the popliteal by a heavy mortising
chisel; secondary hemorrhage; unsuccessful ligature of the
femoral; subsequent ligature of the popliteal, followed by cure;
ligature of the posterior tibial and peroneal arteries; of the anterior
tibial artery; of the plantar arteries. |
pp. 250‑269 |
| LECTURE XV. |
|
Ligature of the common carotid artery: the external; the internal;
the arteria innominata; the subclavian, the axillary, the brachial,
the ulnar, the radial, and their terminations in the palm of the
hand. | pp. 270‑283 |
| LECTURE XVI. |
|
General remarks. Balls lodged in the brain. Respiration consists
of four movements. Excito-motor system of Dr. Marshall Hall.
Concussion of the brain; symptoms of first stage; of second
stage. Treatment: blood-letting in large and small quantities;
mercury; blisters on the head, between the shoulders, and on the
nape of the neck; refrigerating lotions; ice. Supervention of
mania. Effects of concussion at a later period. Relapses from
irregularities. |
pp. 283‑302 |
| LECTURE XVII. |
|
Compression, meaning of. Brain compressible; motions of the
brain. Symptoms of compression. Paralysis of the opposite
side to the injury; of the same side, and of both. Convulsions.
Illustrative cases of paralysis. Fissure or fracture of the skull;
treatment. Symptoms in more serious cases. Injury to the middle
meningeal artery; trephine necessary. Fractures on one side
of the skull from blows on the other. Fractures of the base from
a fall on the vertex; not always fatal. |
pp. 302‑321 |
|
LECTURE XVIII. |
|
Fracture of inner table without injury to the outer, of rare occurrence.
Illustrative cases. Subsequent mischief relieved by operation
at the end of two years. Peculiar division and fracture
of inner table. Principle in surgery on this point. Illustrative
cases. Trephine less dangerous at the first than at a later period.
Fragments of bone injuring the brain to be removed; propriety
of division of scalp in an adult, to examine the state of the
bone beneath. Operation dangerous; illustrative cases. Brain
bears pressure best in young persons. Symptoms of concussion
are frequently accompanied by those of compression. Contre-coup. |
pp. 321‑340 |
| LECTURE XIX. |
|
Immediate and secondary tumors of the scalp. Suppuration on the
dura mater; on the brain; elevation or rising up of the dura
mater, indicating fluid beneath. Balls penetrating the brain.
Sutures separated by musket-balls. Injury of the frontal sinuses;
of the orbit and brain. Fungus, or hernia cerebri. Presumed
cause of permanent defects. Application of trephine; abuse of.
Erysipelas of the scalp. |
pp. 340‑364 |
| LECTURE XX. |
|
Wounds of the chest most dangerous. Incised wounds require a
treatment essentially distinct from those made by gunshot. Contused
wounds. Auscultation of primary importance; distinctive
sounds learned from it. Symptoms of inflammation. Serous effusion
the most important evil in wounds of the chest. Respiratory
murmur; pleuritic effusion. Symptoms of pneumonia. Pulse.
Difficulty of breathing; cough; sputum. Differences of delirium.
Rhoncus crepitans. Effects of inflammation of the pleura; thickness
of pleura in or after chronic inflammation. Changes in the
lung, subsequent on pneumonia, are principally three. |
pp. 364‑381 |
| LECTURE XXI. |
|
General blood-letting in pleuritis and pneumonia; local bleeding.
Internal remedies; tartar emetic; mercury; opium; blisters.
Typhoid pneumonia; treatment. Empyema or effusion of fluids
into the cavity of the chest; symptoms of. State of lung. Auscultation;
operation for empyema; place of election. Admission
of air into the chest when in a healthy state harmless; illustrative
cases. Pneumothorax, nature of, as ascertained by auscultation.
Metallic tinkling; illustrative cases; treatment. Emphysema;
nature of; treatment. |
pp. 382‑414 |
|
LECTURE XXII. |
|
Simple injuries to the chest from sword or knife; involving the
lung; wound not to be probed; to be closed by a continuous suture;
patient to lie on the wounded side. Treatment of incised
wounds of greater extent; not to be examined by the probe or
finger; absolute quietude necessary; to relieve the oppression in
breathing; to suppress hemorrhage; closure of the wound; secretion
of fluid into the cavity; necessity for a depending opening.
Illustrative cases. Ecchymosis, pathognomonic of blood effused
into the chest. Conclusions, six in number. |
pp. 414‑425 |
| LECTURE XXIII. |
|
Penetrating gunshot wounds of the chest; always dangerous; statistics
of cases after Toulouse, the Three Days in Paris in 1830,
and the battles of Waterloo and the Sutlej; appearances of the
orifices of entrance and exit; symptoms; balls passing round the
chest, but not penetrating the cavity; lodging in the sternum;
enlargement of the wound sometimes necessary for the removal of
foreign bodies, or of blood; also when the wound is too small to
admit the finger-end in order to ascertain the state of the ribs, etc.;
not to be greater than absolutely requisite; pieces of shell, of a
sword or lance, broken off, and partly lodged in the thorax, or a
ball sticking firmly between two ribs; to be carefully extracted.
Gunshot fracture of a rib; removal of splinters, and of foreign
bodies; case; comminuted fracture; wound of costal cartilage;
oblique gunshot wound; the ball running round between lung and
pleura for some distance; the lung sometimes only slightly bruised,
at others distinctly grooved by the ball; a ball fairly passing
through the lung; condition of the organ; symptoms; effusion of
blood; if the lung previously adherent, the cavity of the chest not
opened by the ball, its track only communicating externally; illustrative
cases of Generals Sir Lowry Cole, Sir A. Barnard, the Duke
of Richmond, Major-General Broke, Colonel Dumaresq; condition
of the track of the ball; can be detected after death, but not so
during life, as it does not cause any disturbance of the respiration
after recovery has taken place; case of Mrs. M.; wounds of the
upper part of the lung more dangerous than those of the lower;
danger from effusion where the external wound does not communicate
freely with the chest; necessity for its removal by operation;
illustrative cases. |
pp. 426‑442 |
| LECTURE XXIV. |
|
Appearances after death in various instances. Cases of Mr. Drummond,
etc. Splinters of bone to be removed. M. Guerin’s case,
extensive incision for the extraction of a splinter sticking in the
lung. Balls, or other foreign bodies, loose, or rolling about on
the diaphragm. Illustrative cases. Case of General Sir Robert
Crawford. Consequences of traumatic inflammation of the chest;
effusion. Presence of a ball or other foreign body rolling on the
diaphragm, to be ascertained by means of the stethoscope. M.
Baudens on the encysting of balls and splinters of bone; on the
withdrawal of fluids by a syringe. Necessity for an operation for
the removal of balls, etc.; anatomy of the parts concerned; manner
in which the operation should be performed. |
pp. 442‑456 |
| LECTURE XXV. |
|
Hernia of the lung. Wounds of the diaphragm; cases of Captain
Prevost and of others; such wounds never heal; symptoms and
treatment; are often followed by hernia; operation recommended
when the hernia is strangulated. Wounds of the heart; anatomical
position of the heart; theory of the sounds of; endocardial,
exocardial sounds: symptoms when the heart is wounded; treatment;
Larrey’s operation for opening the pericardium, in cases
of hemorrhage from wounds of the heart, or of hydrops pericardii.
Skielderup’s operation; case of J. Dierking, with a diagram;
the heart insensible to the touch; death from a blow on
that organ; treatment of wounds of; laceration and ruptures of
the heart. |
pp. 456‑472 |
| LECTURE XXVI. |
|
Wounds of the internal mammary artery; operation proposed by
M. Goyraud for ligature of the internal mammary artery, when
wounded; wounds of the intercostal artery; suppression of hemorrhage
from; case of General Sir G. Walker. Wounds of the
neck; two principles of treatment; cases of Captain Hall and
General Sir E. Packenham. Wounds of the face; treatment.
Wounds of the eyelids; treatment. Wounds of the ball of the eye.
Wounds of the nose and ear. Gunshot wounds of the eyeball.
Musket-shot lodged behind the eye; may cause ophthalmitis; loss
of sight by musket-balls passing across the back of both orbits.
Wounds of the first branch of the fifth pair of nerves. Injuries to
the bones of the face; to the bones of the nose. Wounds of the
cheek; of the parotid gland and duct. Salivary fistula. Wounds
of the lachrymal bones and sac; lachrymal fistula; case of General
Sir Colin Halkett. Wounds of the lower jaw; treatment; M.
Baudens’s cases; case of Colonel Carleton; incised and gunshot
wounds of the tongue. Case of Captain Fritz; lodgment of the
iron breech of a gun in the forehead; its descent into the mouth,
and partial protrusion through the palate. Lodgment of balls in
the forehead, etc.; their descent into the throat or soft or hard
palate. Lodgment of a ball in the maxillary sinus for months and
years. |
pp. 473‑482 |
|
LECTURE XXVII. |
|
Structure of an intestine; eight distinct layers. Valvulæ conniventes
peculiar to man. Nature of villi: manner of absorption.
Mucous membrane of the stomach. Glands of Brunner, Grew, and
Peyer. Solitary glands. Muscular coat of the intestine. Wounds
of the abdomen affecting its wall or paries. Illustrative cases.
Entrance and exit of a ball. Lodgment of a ball in the abdominal
paries. Incised wounds of the paries followed by suppuration.
Rupture of viscera from a blow. In incised wounds the muscular
parts are not reunited; formation of an abdominal hernia; treatment.
Admission of atmospheric air a bugbear. Penetrating
wounds. Protrusion of omentum; of intestine. Illustrative cases.
Treatment of wounded intestine. Large effusions of blood into
the cavity of the abdomen. Travers’s experiments on wounded
intestines. Treatment of a divided intestine; by ligature; by
continuous suture. Ramdohr’s treatment of a completely divided
intestine. Manner of making a continuous suture. |
pp. 482‑508 |
| LECTURE XXVIII. |
|
Treatment of incised wounds of the intestine of small extent; when
larger; enlargement of the external wound when necessary. Intestine
or artery injured to be secured by suture; wound to be
reopened. Bleeding from the mesenteric or epigastric artery;
effusion of blood into the cavity; to be evacuated by enlarging
the wound, when in quantity; if the effusion be a small one, the
blood will coagulate, and be absorbed; suppuration in the abdomen
a consequence of the non-absorption or non-evacuation of
blood effused to a large amount; illustrative cases; treatment.
Wounds of the intestines from musket-balls. Illustrative cases
of Captain Smith, Ensign Wright, Mathews, etc. Balls passed
per anum. Remarks. Cases of gunshot wounds of the abdomen
occurring during the Crimean campaign. |
pp. 508‑525 |
| LECTURE XXIX. |
|
Abnormal or artificial anus; mode of formation. Valve or septum
in the orifice of the lower end of the bowel generally present, but
occasionally wanting. Treatment by compression. Desault’s
mode of treatment; Dupuytren’s; Mr. Trant’s. Wounds and
injuries of the liver. Cases of General Sir S. Barns, Corporal
Macdonald, Lieutenant Hooper, etc. Removal of portions of the
liver, the patient surviving. Illustrative cases by Blanchard, Dieffenbach,
and Dr. Macpherson. Wounds of the stomach; treatment.
Fistulous opening in that viscus. Knife swallowing; the operation
of opening the abdomen and stomach for the removal of knives
which have thus passed into that organ. Interesting cases.
Wounds and injuries of the spleen; removal of the organ entire or
in part. Treatment of incised, punctured, and gunshot wounds of
the spleen. Wounds of the kidney and ureter. Illustrative cases.
Wounds of the spermatic cord and testis; case of medullary sarcoma
of the testis and lumbar glands, following a gunshot wound
of the testicle; wounds of the penis. Illustrative case. |
pp. 525‑540 |
| LECTURE XXX. |
|
Wounds of the pelvis from musket-balls; fistulous opening in consequence.
Paralysis of one or of both limbs, complete or incomplete.
Balls lodging in bone should be removed: cases of Colonel
Wade, Sir Hercules Packenham, Sir John Wilson, John Bryan, Sir
E. Packenham, etc. Case by La Motte. Captain Campbell’s case.
Wounds of the bladder; consecutive accidents; employment of
the catheter and its permanent use. Treatment of inflammatory
swelling and sloughing; operations when required; illustrative
cases. Cases of balls lodging and forming the nucleus of calculi,
successfully removed. Wounds of the bladder and rectum; operation
frequently required to save life. Operation in the back for
artificial anus. Conclusions. |
pp. 541‑559 |
ADDENDA.
REPORTS FROM THE CRIMEA. |
|
Use of chloroform in the Crimea; case of Martin Kennedy; amputation
of finger; death following the exhibition of chloroform.
Mr. Hannan’s case of double amputation without chloroform.
Effects of chloroform in cases of amputation at the hip-joint or at
the upper third of the thigh; the operations not successful. Deputy
Inspector-General Taylor on the want of success attending
operations on the lower extremities in the Crimea, and its causes;
his opinion corroborated by Deputy Inspector-General Alexander.
Use of chloroform in the Light Division; Alexander’s statistics of
operations in the Light Division. Five cases of excision of the
head, neck, and trochanter of the femur; four unsuccessful; the
third, Mr. O’Leary’s, doing well at date of report. Staff-Surgeon
Crerar’s case; extensive comminuted fracture of neck, trochanter,
and shaft of the femur, by a fragment of an exploded grenade;
excision of head, neck, trochanter, and part of shaft of the bone;
death on the fifteenth day; P.M.:—the muscles infiltrated with
pus; no attempt to repair the loss; Dr. Hyde’s case; comminuted
fracture of neck of and bone of great trochanter by a grape-shot,
during the attack on the Great Redan, on the 8th of September;
operation the day after; death on the sixth day. Dr. M’Andrew’s
cases of excision of the head of the humerus; attended with success.
Dr. Gordon’s case of fatal wound of the larynx and pharynx,
with fracture of the thyroid cartilage; Deputy Inspector-General
Taylor’s comments on this case; Surgeon De Lisle’s cases of wounds
of the profunda femoris and popliteal arteries; case of loss of the
right leg below the knee by a round shot; Dr. Burgess’s case,
showing the effects of strychnia in injury of the spine and spinal
cord. Dr. Rooke’s case of severe and extensive injury to the right
hand and forearm, and the right side of the abdomen, (the bowels
being exposed by the destruction of skin, muscles, and peritoneum,)
with comminuted fractures of the ilium and neck and trochanter
of the femur; recovery at the end of three months. Mr.
Lyons’s fatal case of gunshot fracture of the left femur. Dr. Milroy’s,
Mr. Atkinson’s, and Dr. Scott’s cases of excision of the elbow-joint;
Mr. Atkinson’s case of round shot fracture of the superior
maxillary and the malar bones; recovery. Mr. De Lisle’s case of
musket-shot wound of the right temple; the supra-orbitar ridge
broken off. Mr. Ward’s, Mr. Wall’s, and Mr. Longmore’s cases
of gunshot fracture of the cranium, with or without injury to the
brain. | pp. 561‑586 |
| REMARKS. |
|
Surgical Commentaries on the preceding Cases: Amputations at
the hip-joint; excision of the head and neck of the femur; the
balls used by the Allies and by the Russians; gunshot fractures
of the lower extremities; the utility of the chain saw; the machines
for moving the wounded soldiers in bed; the apparatus for
slinging a broken leg; excision of the knee-joint; of the head of
the humerus; of the elbow-joint; the head of the humerus to be
retained in the socket, when practicable; wounds penetrating the
chest and abdomen; future reports for the Addenda desired. |
pp. 586‑590 |
|
| Index. |
pp. 591‑608 |
|
| Index of Cases. |
pp. 608‑614 |
|
| Medical Works |
pp. 615‑624 |