Chapter LVII: Amputations (2)

=Amputations Of the Leg.=--Modern prosthetic methods have materially changed the indications in amputating the leg. The pressure in artificial limbs is not borne upon the end of the stump, but is rather circumferential and borne by a conical socket. It is now, therefore, an object to preserve as much of the limb as practicable, in order to have better leverage or control of the artificial member. Consequently the point of election is now the middle of the leg, unless the amputation may be made even below this point. The objection to a short leg stump is the inevitable flexion which the hamstring flexors will produce; in such cases the pressure will be borne upon the knee, while the appearance of the stump is by no means ideal. If, therefore, one is forced to make a high amputation of the leg it would be far preferable to make a good knee disarticulation, or, better still, a supracondyloid amputation, with preservation of the patella, thus furnishing a stump which affords perhaps the only exception to the general rule, _i. e._, that weight cannot be borne upon the stump end.

Skeleton of stump after Pirogoff’s osteoplastic amputation. The sawed surface of the calcaneum in apposition with divided surface of tibia. (Farabeuf.)]

Stump after Pirogoff’s operation. The weight of the body must rest upon the thick plantar skin of the heel and never on the thin skin of the retrocalcaneal surface. (Farabeuf.)]

Sections of bone in Pirogoff’s amputation and its modifications: 1, oblique section of calcaneum to correspond with (1) oblique section of tibia. (Gunther.) 2, curvilinear or concave section of calcaneum to correspond with (2) convex section of tibia. (v. Bruns.) 3″, horizontal section of calcaneum to correspond with (3) similar section of tibia. (Pasquier Le Fort.) 3‴, vertical section of calcaneum to correspond with (3) horizontal section of tibia. (Typical Pirogoff.) (Modified by Matas from Mignon.)]

Osteoplastic excision of foot. (Mikulicz.)]

Let us, then, consider but one or two amputations of the leg--that low down or near the middle and that at the knee. Whatever the method it is most desirable that the scar be kept off to the side, and especially _away from the front of the shin_. This can be best accomplished by a modified circular (Fig. 708) or a bilateral flap method (Fig. 711), or by the oblique method with lateral incisions, which practically convert it into an anteroposterior operation, while for certain instances the method of Teale may be preferred, _i. e._, that with a long anterior and short posterior flap, or its modification by which the flaps are made more lateral, or the even long flap method of Bell.

Modified circular amputation of upper third of leg. (Erichsen.)]

Whichever of these be selected, after division of the muscles and exposure of the bone, it is usually helpful to retract the flaps, whatever their shape, by a cloth retractor made of a piece of sterile bandage torn into three strips, the middle of which should be inserted between the bones of the leg, the interosseous membrane being divided for this purpose; by this they are held more perfectly out of the way during the act of dividing the bones. The anterior border of the tibia, which is practically a sharp ridge, should be divided obliquely (bevelled), either by a small oblique section before the transverse division is made, or by effecting this later, in order that there shall not remain a sharp point to project through the skin or be subject to constant irritation. The tibia is usually divided transversely, with the above exception. The fibula may be divided slightly obliquely. It is customary, however, to make the division simultaneously, and to so conduct the sawing process as to divide the fibula completely before the last strokes of the saw cut through the tibia.

There is greater difficulty in the recognition and securing of vessels in leg amputations than in any other, especially if they have been divided obliquely. The principal vessels may be found from their known anatomical location. They nevertheless sometimes tend to retract and they must be followed up in order to properly secure them. The accompanying nerve trunks should also be seized firmly, drawn down, and divided two or three inches above the line of division of the other tissues, in order that they may retract out of harm’s way. Every nerve which can be recognized, even in the skin, should be thus treated. Before closing the wound it is well, unless one is absolutely sure of his work, to release the tourniquet and ascertain if any vessel which would otherwise bleed be not yet secured. Oozing may be checked with hot water, while muscle surfaces which leak too much blood may be lightly enclosed within catgut sutures inserted with a curved needle.

Providing that these stumps have well-nourished flaps, and that no sharp or angular bone ends interfere with subsequent comfort, and that the scars be kept away from their lower surfaces, they serve their purpose admirably.

Supposing, then, that amputation is to be about the middle, the first incision, made with a stout scalpel, is begun at the anterior border of the tibia and carried downward along it until it is turned abruptly backward to the posterior aspect, and then upward until a point is reached opposite that of commencement. The skin is dissected up for perhaps an inch. Then the flap on the other side is cut after the same fashion, after which, with a short or long knife, the muscles are divided transversely or circularly down to the bone. Much will depend now upon whether the desire is to resort to the more modern osteoplastic methods or adhere to the old. In the latter case it is well to separate the flaps for the necessary distance from the bone, with or without the periosteum, dividing the bones after suitable retraction, as above suggested. If preference be for an _osteoplastic flap_ it is planned and made at this time, the bone being divided at the same level as the muscles, and the amputation being thus practically completed, after which the osteoplastic flap is arranged, it being now necessary to carefully preserve the periosteal bridge and to again divide the bone at the base of this periosteal flap, this being the true end of the bone stump. In this case the fibula is divided at a higher level.

It is perhaps less desirable to preserve periosteum in young children than in adults, for if bone be permitted to grow too rapidly conical stumps result, sometimes even with protrusion of bone ends. Ollier and his pupil Mondan have shown that this so-called _atrophic elongation_ of bone is a consequence of abnormally rapid growth from the upper epiphyseal direction, permitted by lack of pressure from below, and that conical stumps will often happen in children in spite of every precaution. Nevertheless it should not be encouraged, and for this reason periosteum should not be preserved.

The _method of Teale_ was to cut a long anterior flap, raising the coverings from the bone with the least possible disturbance, to divide the bone at the high level, then to double the flap upon itself in such a way as to bring the scar at a level one inch or more above the stump end. Heine modified this slightly by raising the periosteum with the rest of the anterior flap. In cases which permit such a long flap to be formed from one aspect of the leg the method gives excellent results (Fig. 709).

Teale’s method of amputation.]

Bruns devised a method which is begun almost as an exsection, by an oblique circular incision, with liberating lateral incisions, and division of all the tissues over the inner border of the tibia and the outer side of the fibula; after which, without disturbing skin attachments in front, the periosteum is separated from the bones as high as the liberating lateral incisions permit, and then the fibula first and later the tibia divided. It is practically a subperiosteal excision of the leg bones and affords a well-protected stump. In effect it is an anteroposterior flap method.

Stump after Stephen Smith’s amputation at knee.]

=The Knee.=--It was Brinton who, in 1872, suggested the preservation of the semilunar cartilages in all knee disarticulations, as in this way all the normal relations are preserved and retraction is prevented. But the makers of prosthetic apparatus have urged to abandon all true disarticulations, and to substitute for them the supracondyloid method, which affords ideal stumps. Disarticulations are supposed to produce less shock, less loss of blood, and less danger of sepsis from opening up the bone-marrow, while muscle insertions are less disturbed and the stump covering usually is mobile and not very sensitive. No disarticulation should be thought of unless the joint involved be free from disease and unless about it there be met sufficient healthy integument to furnish a satisfactory flap.

For a true _disarticulation_ Stephen Smith’s bilateral method is now almost universally adopted. Here the incision is begun one inch below the tubercle of the tibia and is carried directly down to the bone, downward and forward around the side of the leg, and then inward and upward toward the middle of the popliteal space, the lateral flaps thus made being nearly duplicates. The flaps thus cut out are completely separated from the bone up to the joint level, where the ligaments are divided, the joint being manipulated as may be necessary to best expose them and facilitate division. In this operation the patella is usually removed, the joint being opened by separating its ligament at its insertion into this bone. One should remember that the internal condyle is lower and longer than the external, and that the internal flap should be perhaps made on this account a little the longer of the two. Fig. 710 illustrates the stump resulting from this operation and shows the cicatrix drawn up out of harm’s way and resting in the fossa between the condyles. Fig. 711 illustrates the simple method by lateral flaps.

Amputation at knee by lateral flap. (Erichsen.)]

=Amputation of the Thigh.=--Under this head, rather than that of amputation at the knee, should be described the _supracondyloid amputations_ which give decidedly the best results of all, and which are preferable to any others for the middle of the lower extremity. Of these the best is that suggested by Gritti, which consists in not only removing the condyles but sawing off the articular surface of the patella, which is then drawn upward and applied to the end of the femur, the division of the latter being made at a point above the condyles, where the diameter of both bones will nearly correspond, this latter perhaps being a suggestion of Stokes rather than of Gritti, who did not divide the bone quite so high. (See Fig. 712.)

Gritti’s osteoplastic supracondyloid knee amputation, patella utilized: _a_, shaded parts are those brought in apposition; _b_, appearance of Gritti stump after suture; _c_, correct apposition of patella to femur; _d_, defective apposition. (Farabeuf.)]

Fig. 712 will best illustrate the intent of the method as well as its performance. The incisions are planned much as in the Stephen Smith disarticulation method, only they are placed higher, and the patellar tendon is divided as low down as possible, or even separated from the tibia, in order that it may be made of use in attaching the divided patellar surface to the femoral end. The rest of the operation is performed as by other methods, the attachment of the patella being effected by tendon sutures, or, if necessary, by an ivory peg, or even a metal tack or nail which may be left in place.

The beauty of this method is that the anterior surface of the patella is preserved with its natural weight-bearing facilities and the bursa between it and the skin, while the latter is undisturbed. On the end of this stump as much weight can be steadily borne as when one ordinarily kneels, and to it a most serviceable kind of artificial limb can be attached, with which one may walk as though nothing had ever happened.

Another osteoplastic method, namely, that of Sabanejeff, is illustrated in Figs. 713 and 714. In this instance the bone covering over the end of the femur is taken from the upper end of the tibia, the patella not being disturbed. It permits a lower division of the femur and the formation of a stump which is of practically the same length as the original thigh.

Sabanejeff’s knee amputation. (Chalot.)]

Stump made as in Fig. 713. (Chalot.)]

=Amputation of the Thigh above the Knee.=--For _removal of the thigh_ it is well to preserve as much of its length as possible, and yet not at the expense of all other considerations. A thigh stump too short is likely to be pulled awkwardly upward by the psoas muscle, and upon such a stump it is difficult to secure an artificial limb tolerable of control against such action of this muscle. On this account, then, thigh stumps should be long. So far as the method is concerned the circular, or some modification thereof, gives the best results in the majority of instances. It may easily be modified into one of the oblique methods, or liberating incisions may be used whenever they will be of service. If it be absolutely necessary to make the amputation high hemostasis can be secured by the same methods that are used in hip-joint amputations. The dense and strong fascia lata, which lies beneath the superficial fascia, should be divided at the same level with the skin, since it serves admirably, when secured by a separate set of sutures, to make a good covering for the ends of the muscles, after these have been themselves carefully united by buried sutures. The sciatic nerve should be especially sought, thoroughly stretched, and divided high up. The vessels often evince a tendency to retract within Hunter’s canal; it is not, however, difficult to separate the vastus internus from the adductor longus, between which they lie, and in this way gain access to them. Even for high work on the thigh one may, if necessary, do as some have done at the hip, make a preliminary ligation of the femoral artery. This may be especially serviceable as an emergency measure, or in special cases of tumors which have attained large size, are placed high up and call for somewhat atypical methods.

=The Hip-joint.=--Amputation here is essentially a _disarticulation_ and constitutes one of the usually formidable and serious operations of major surgery. Although the joint itself is generally easily reached there are many things to be considered in the performance of this operation, of which the mere arthrotomy is by no means the most important.

Preparations being all made, the first consideration is the _control of hemorrhage_, for which several methods have been suggested, but of which but two or three are in general use. Such procedures as compression of the abdominal aorta, either with the hand or by tourniquet, or of the common aorta through the rectum, with a lever, as suggested by Davey, or with the hand, as suggested by Woodbury, or the exposure of the common iliac, either within the peritoneum as practised by McBurney, or externally, or exposing the common femoral above Poupart’s ligament, are now adopted by very few surgeons. Langenbeck used to be fond of preliminary ligation of the femoral where it is most accessible in the groin, and this is probably the best of all of these methods. But they have been all practically discarded since Wyeth introduced the simple method of transfixing the limb with his pins (_i. e._, long mattress needles or skewers made for the purpose), these serving to hold in place an elastic cord or tourniquet (Fig. 715). This has been found to be a great improvement on the suggestion of Senn, who excised the femoral head and then compressed each half of the limb with a separate elastic band.

Wyeth’s bloodless method: pins inserted and tube applied.]

The directions for the use of Wyeth’s pins are simple. Here, as in other cases, it may not be practicable to use the elastic bandage from the lower end of the limb, but one may at least elevate the limb and thus coax the blood out of it by gravity or by gentle manipulation. While it is still in this position one of the long pins is introduced just below the anterosuperior spine and a trifle to its inner side, and made to emerge on a level with and about three inches from the point of its entrance. The other needle is inserted just to the inner side of the saphenous opening, and below the level of the crotch, and brought out about one inch below the tuberosity of the ischium. Corks should then be placed upon them so as to protect the needle points. Next a piece of elastic tubing or band is placed around the limb above these pins and tightened, each turn being made a little tighter, so as to absolutely control the circulation. The effect of this is felt upon practically every vessel in that part of the body, and if the method be properly practised it affords absolute security.

The surgeon now has his choice of various methods of disarticulation, either that by anteroposterior flaps or lateral flaps, or by the circular, with the free liberating lateral incision; or he may devise any method of his own which will best meet the indication in a given case. Fig. 715 illustrates the employment of Wyeth’s pins and the first circular incision made as for the circular method. Of these all the latter seems preferable when circumstances permit. It should be combined with a sufficient lateral incision, which should be made to pass well over the great trochanter. The cuff raised through this incision should extend down to the deep fascia and up to the level of the lesser trochanter, at which level the deeper tissues are divided transversely or by a circular cut.

It is well next to lay down the knife and secure the large vessels, after which the deep muscles are separated from the upper end of the shaft and the proximity of the joint, while the entire limb may be still used as a lever in so stretching the joint capsule as to better expose and divide it. So soon as the capsule has been opened, and the entrance of air thus permitted, it will be easy to expose and divide the teres ligament, after which the balance of the disarticulation is easily effected. The large nerve trunks are now sought, retracted, and divided high up, all visible vessels are secured firmly, after which the elastic constriction may be gradually released and any vessels that spurt may still be secured. There will nearly always be troublesome oozing from the cut ends of the large muscles, and here, if hot water prove insufficient to check it, with large curved needles and catgut sutures the muscle ends may be secured by ligature _en masse_, before they are brought together for the purpose of closing the stump.

Whatever the method selected as perfect a closure of the wound as possible should be made, with ample provision for drainage. By careful deep suturing, with tiers of buried sutures, it is possible to avoid leaving dead spaces at any point except perhaps the acetabulum. Through retaining sutures may also be used to advantage. It is most desirable to so plan the incisions and the closure of the wound as to keep them, so far as possible, away from the region of the perineum. Therefore the longer the inner flap or inside of the stump the better. As conditions which necessitate removal of the limb at the hip-joint are always serious, and have each their own peculiarities, any method which will best serve the purpose should be used.

Plates LIX and LX, designed by Prof. Matas, afford the best and briefest epitome of the choicest amputation methods which can be furnished.

THE STUMP.

An amputation having been effected, and the stump closed, there is still occasion to consider how it may best be treated to fit it for its future purposes. When entire chapters, or even small monographs, can be written on the subject of “diseases of stumps” it would appear that the consideration is not one of merely trifling import.

A _good stump_ has a regular outline, with a protected scar, and should be firm, yet mobile, and without tender or sensitive surfaces. It should constitute the lower end of a truncated cone, and needs to be of sufficient length to permit leverage within the socket of the artificial limb which will be fitted about it.

A stump failing in these characteristics is a _bad_ stump, the features which especially tend to make it bad being undue conicity (Fig. 716) or sensitiveness of surfaces, ulceration from friction, or, worse yet, occurring without it, and neuralgia from inclusion of nerve ends, or from bone ends which present osteophytic outgrowths and thus distort and displace tissues (Fig. 717). Acute osteomyelitis occurs in stumps, as do slower carious processes which may call for re-amputation, perhaps even at a distance. The stump is for a long time more or less tender and troublesome, and its owner may be a sufferer from hyperesthesia or perverted sensations.

The possibility of the production of a conical stump in children as the result of _atrophic elongation_ was mentioned early in this chapter. While this cannot always be prevented it may sometimes be foreseen, and one should be prepared at any time in such cases to circumcise the bone, forcibly retract the tissues, and then divide the bone ends on a higher level.

_1, 2. Circular for middle and upper thirds of thigh._

_3. Circular for lower third of thigh, showing tendency of circle
to incline downward on adductor side to compensate for greater
retraction._

_4. Incision for Gritti’s or Carden’s amputations at knee (single
anterior flap)._

_5, 6. Stephen Smith’s bilateral flaps (posterior racquet)._

_7. Antero-posterior flaps, cut solid to the bone, the soft parts
being elevated from the periosteum (Marc See, von Brun’s method).
This is the author’s preferred method for leg only, simplified by
making a simple circular with two lateral liberating incisions on
fibular and tibial sides._

_8, 9, 10. Circular with posterior racquet extension to form
bilateral flaps (Stephen Smith)._

_11. Guyon’s supra-malleolar amputation._

_12. Lines of Syme’s amputation._

_13. Inner aspect of Roux’s tibio-tarsal amputation; also
subastragaloid._

_14. Medio-tarsal amputation (inner aspect)._

_15. Tarso-metatarsal disarticulation (inner aspect)._

_16. Disarticulation of toe with its metatarsal._

_17. Disarticulation of big toe; in front of this lines for
amputating first or terminal phalanx by long plantar flap._

The Right Lower Limb, Internal Lateral View (Surface Incisions).]

_1. Low circular with external incision (Furneaux Jordan) or at a
higher level (gluteo-femoral furrow) applicable to Wyeth’s method of
disarticulating hip._

_2. Circular incision with tendency to racquet posteriorly in middle
third amputations._

_3. Circular with posterior vertical incision in amputation of lower
third of thigh._

_4. Long anterior flap for supra-condyloid amputation of thigh._

_5. Racquet incision with long anterior flap for extreme upper third
of leg. Note long posterior tail, which facilitates upward retraction
of a solid musculo-cutaneous flap cut down to the periosteum,
resembling a bilateral flap operation (Stephen Smith). The same
incision cut a little higher is most serviceable in disarticulating
at the knee._

_6. Long-hooded anterior flap, with posterior racquet (Stephen Smith
and Bier’s osteoplastic)._

_7. Amputation by equal antero-posterior flap (Marc See, von Bruns)._

_8. Amputation by long anterior and short posterior flaps (Teale’s
principle)._

_9. Amputation of leg at extreme lower third, practically a circular
amputation converted into a solid antero-posterior flap by liberating
incisions on fibular and tibial sides._

_10. Guyon’s supra-malleolar amputation of leg._

_11. Medio-tarsal and intra-tarsal amputations (Chopart and its
derivatives)._

_12. Tarso-metatarsal amputation (Lisfranc and derivatives)._

Surface Outlines of Amputations Practised in the Lower Extremity.]

An exquisitely neuralgic stump is usually made so by the entanglement of nerve ends and their subsequent enlargement into so-called _amputation stump neuromas_ (which are histologically fibromas), from pressure upon nerve terminals. Under these circumstances their excision through incisions planned for the purpose, or the exsection of a portion of the nerve trunk at a higher level, may be necessitated (Fig. 717).

Extreme case of conical stump.]

Neuromatous endings of nerves in a stump.]

Ideal stump.]

Bad stump, because posterior flap was cut too short, and there has been great retraction of all soft tissues. (Farabeuf.)]

While patients may prefer disuse of a stump for as long a time as possible the judicious surgeon will prepare it as rapidly as he may for early application of the expected artificial limb. Inasmuch as leg stumps allowed to hang downward become cyanotic and edematous it is well to keep them bandaged, and the makers of artificial limbs prefer to have the bandages kept wet. When the stump is healed, passive motion of the remainder of the limb should be begun, in order that there may be a minimum of stiffening of joints. If, then, such a stump be bathed, massaged, moved, and then bandaged with comfortable snugness with cold, wet bandages, over which oiled silk may be fastened, and if this be done at least once each day, the stump will be prepared for the artificial limb, on the average, in two to three months. One should not wait for this expiration of time if it be thoroughly healed; or, on the other hand, he may have to wait much longer under unfortunate circumstances; but the above general principles of treatment and general statements will be found to prevail. Figs. 718 and 719 illustrate the difference between good and bad stumps, while Plates LIX and LX (reproduced from Matas) furnish the surface outlines for selection of the various amputations of the lower limb.

CINEPLASTIC OR CINEMATIC AMPUTATIONS OF THE UPPER EXTREMITY.

The most pronounced and illustrative of recent methods is perhaps the “cinematic” or “cineplastic” procedure of Vanghetti. This Italian surgeon proposed a prosthetic method, in 1898, which is illustrated in Figs. 720, 721 and 722. He has shown that tendon terminations may be left exposed in stumps, under favorable conditions, and so utilized as to serve remarkably useful purposes--though under exceptional conditions. For a description of these methods the reader is referred to his monograph. (G. Vanghetti, _Plastica e Protesi Cinematiche_, Empoli, 1906.)

FIG. 721

FIG. 722

Results of Vanghetti’s “cinematic” method, with preservation and utilization of tendons.]

INDEX.

A

ABDOMEN, diseases of, diagnosis of, 768
distention of, in appendicitis, 856
drainage of, 776
general considerations and conditions of, 767
inflation of, 769
inspection of, 768
measurement of, 769
operation on, technique of, 773
palpation of, 768
bimanual, 769
wounds of, gunshot, 214, 232

Abdominal aorta, aneurysm of, 346
ligation of, 356
cavity, irrigation of, 775
diseases, diagnosis of, 768
incisions, closure of, 777
operations, after-treatment of, 777
embolism following, 784
hemorrhage after, 780
peritonitis following, 780
technique of, 773
thrombosis following, 784
viscera, general considerations and conditions of, 767
wall, abscess of, 783
actinomycosis of, 783
burns of, 783
carcinoma of, 784
contusions of, 781
cysts of, congenital, 783
endothelioma of, 784
epithelioma of, 784
erysipelas of, 783
fibroma of, 784
foreign bodies in, 783
gangrenous cellulitis of, 783
hematoma of, 781
injuries of, 781
lacerations of, 781
osteomyelitis of, 783
phlegmons of, 783
sarcoma of, 784
suppurative spondylitis of, 783
syphilis of, 783
tuberculosis of, 783
tumors of, 783
vascular, 784
wounds of, gunshot, 783
penetrating, 781

Abscess of abdomen, 783
atheromatous, 73, 339
bone, 419, 425
treatment of, 426
of brain, 567
prognosis of, 569
symptoms of, 568
treatment of, 573
of breast, 757
classification of, 58
acute, 58
cold, 58, 112
gravitation, 58
metastatic, 59
subacute, 58
subfacial, 59
subperiosteal, 59
cold, 112
peri-articular, treatment of, 399
collar-button, 319
definition of, 58
frontal, 569
of heart wall, 733
ischiorectal, 879, 1013
of liver, 911
symptoms of, 912
treatment of, 912
lumbar, 114
of lung, 734
of mesentery, 939
metastatic, 59, 91
occipital, 569
of pancreas, 949
parietal, 569
peri-appendicular, 860
perilaryngeal, 704
perineal, 1013
treatment of, 1013
perinephritic, 961
perirectal, 879
treatment of, 879
peritracheal, 704
perityphlitic, 860
of prostate, 994
psoas, 114
of rectum, 879
treatment of, 879
renal, 957
retropharyngeal, 114, 682
signs of, 60
of spleen, 941
subphrenic, 753
treatment of, 754
symptoms of, 60
temporosphenoidal, 569
of tonsils, 662
treatment of, 60

Abstraction of blood, 182

A. C. E. mixture, 198

Accommodation, defects of, 604

Acetabulum, migration of, 453

Acetonemia, 82

Acetonuria, 82

Acheilia, 638

Achondroplasia, 432

Acid intoxication from anesthetics, 203

Acinous carcinoma, 290

Acoustic nerve, neurofibroma of, 584

Acromegaly, 437

Acromial process, fracture of, 494

Actinomycis, 109
fungi, 55

Actinomycosis, 109
of abdominal wall, 783
of bone, 432
of breast, 759
definition of, 109
diagnosis of, 110
of face, 640
of intestines, 827
of kidneys, 964
of liver, 914
of lung, 732, 734
of mesentery, 939
of mouth, 657
organism of, 109
prognosis of, 110
pus in, 109
of skin, 308
of thorax, 729
of tongue, 659
treatment of, 110

Adenocarcinoma, 285
of bladder, 992
of pancreas, 953

Adenoids of pharynx, 679
treatment of, 680

Adenoma, 284
of bladder, 992
of breast, 760
of kidney, 969
congenital, 969
of liver, 914
of pancreas, 953
of rectum, 885
sebaceous, 285
cysts, 285
of thyroid, 712

Adenosarcoma, embryonal, 268

Adventitious bursæ, 263

Ainhum, 76

Air embolism, 38
of veins, 363

Aleppo boil, 309

Alimentary canal, infection through, 49

Allantoic cysts, 260

Alveolar sarcoma, 274
suppuration, 664

Alypin, 207

Amastia, 755

Amazia, 755

Amputations, 1023
of arm, 1032
atypical, 1023
control of hemorrhage in, 1024
of elbow, 1031
of finger, 1029
of foot, 1037, 1041
Bruns’ method, 1042
partial, 1034
Teale’s method, 1042
of forearm, 1031
of hand, 1031
of hip-joint, 1045
Davey’s method, 1045
McBurney’s method, 1045
Woodbury’s method, 1045
Wyeth’s method, 1045
interscapularthoracic, 1033
of knee, 1043
Gritti’s method, 1044
Sabanejeff’s method, 1044
Stephen Smith’s method, 1043
of leg, 1039
Bier’s osteoplastic, 1028
circular, 1041
Pirogoff’s method, 1040
of lower extremity, 1034
mediotarsal of Chopart, 1037
method of, 1026
circular, 1026
flap, 1027
osteoplastic, 1027
of penis, 1010
of shoulder, 1032
stump after, 1046
bad, 1046
good, 1046
neuromas, 1047
supracondyloid, 1043
of thigh, 1043
above knee, 1044
Gritti’s method, 1043
Stokes’ method, 1043
of thumb, 1029
tibiotarsal, 1037
of toes, 1034
typical, 1023
of upper extremity, 1029
cineplastic, 1048
entire, 1033
of wrist, 1031

Anastomosis of arteries, aneurysm by, 344
gastric, 816
of intestines, 842

Anastomotic varix, 364

Anel’s method of treating aneurysm, 347

Anemia, 30
pernicious, 30
primary, 30
secondary, 30
splenic, 31

Anesthesia and anesthetics, 192
A. C. E. mixture, 198
accidents from, 201
arrested respiration, 202
treatment of, 202
cardiac failure, 201
acid intoxication from, 203
administration of, 193
anesthol, 200
chloroform, 195
accidents from, 196
action of, 196
administration of, 197
death from, 196
choice of, 200
dangers of, 201
discovery of, 192
ether, 193
accidents due to, 194
action of, 194
narcosis by rectum, 195
petroleum, 199
sequels from administration of, 195
ethyl bromide, 198
chloride, 199
local use of, 199
intraspinal, 207
local, 205
alypin, 207
anesthesin, 207
beta-eucaine, 207
cocaine, 205
liquid air, 205
nervanin, 207
orthoform, 207
stovaine, 207
magnesium salts, 209
management of, 192
methylene bichloride, 198
morphine, 205
nitrous oxide gas, 200
scopolamine, 205
somnoform, 199

Anesthesin, 207

Aneurysmal bruit, 341
varix, 363
of abdominal aorta, 346
arteriovenous, 344
of axillary artery, 345
of carotid artery, 345
external, 345
internal, 345
cirsoid, 278, 339, 344
classification of, 342
diagnosis of, 345
diffuse, 339, 342
dissecting, 339, 342
false, 339, 343
of femoral artery, 346
fusiform, 339, 343
of heart, 732
hernial, 339
of iliac artery, 346
of innominate artery, 345
intracranial, 345
of liver, 914
of neck, 701
of orbit, 592
progress of, 341
pulsation of, 341
racemose, 344
rupture of, 341
sacculated, 339, 342
spontaneous, 339
of subclavian artery, 345
traumatic, 339, 343
treatment of, 346
by extirpation, 348
by introduction of wire, 348
by ligation, 347
Anel’s method, 347
Brasdor’s method, 347
Hunter’s method, 347
Wardrop’s method, 347
by open division, 347
by opening and suture, 348
true, 339
varicose, 339, 342, 363

Angina, Ludwig’s, 658, 703
Vincent’s, 703

Angiocholitis, desquamating, 919

Angioma, 277
arterial, 278
capillary, 277
cavernous, 277
of omentum, 935
of orbit, 592
plexiform, 278
of veins, 366
treatment of, 367

Angiosarcoma, 275

Angiotribe, control of hemorrhage by, 236

Ankle, dislocations of, 544
excision of, 414

Ankyloblepharon, 603

Ankyloglossum, 652

Ankylosis, 403
contractures, 403
of hip, 404
of jaw, 667
of knee, 404
treatment of, 405
true, 403

Annular thrombosis, 35

Anthrax, 106
bacillus of, 54
definition of, 106
incubation in, 107
postmortem appearances in, 107
prognosis of, 107
prophylaxis of, 108
symptoms of, 107
treatment of, 107

Antisepsis, 243

Antiseptic applications, 248
solutions, 248

Antiseptics, toxic, 175

Antitoxin treatment of tetanus, 101

Antrum of Highmore, operations on, 611

Anus, absence of, 873
artificial, 839
congenital defects of, 872
fissures of, 876
imperforate, 873
malformations of, 872

Aorta, abdominal, aneurysm of, 346
ligation of, 356

Aplasia cranii, 547

Aponeurotomy, 327

Apoplectic cysts, 952

Apoplexia neonatorum, 564

Apoplexies, compression, 560

Appendicitis, bacteriology of, 852
causes of, 854
chronic, operation for, 866
complications of, 855
diagnosis of, 857
from acute obstruction of bowel, 858
pancreatitis, 858
from cholecystitis, 857
from colitis, 857
from enterocolitis, 857
from floating kidney, 858
from gastric ulcers, 857
from intestinal ulcers, 857
from lead colic, 858
from mesenteric embolism, 858
thrombosis, 858
from peritonitis, 857
from psoas abscess, 859
from pyosalpinx, 858
from ruptured extra-uterine pregnancy, 858
from strangulated hernias, 858
McBurney’s point in, 855
recurrent, 854
operation for, 866
symptoms of, 859
acute, 855
abdominal distention, 856
bowels, 856
jaundice, 856
muscle spasm, 855
pain, 855
pulse, 856
temperature, 856
tenderness, 855
tumor, 856
vomiting, 856
treatment of, 861
non-operative, 862
operative, 862
indications for, 862
in typhoid fever, 859

Appendicostomy, 850

Appendicular colic, 853

Appendix, vermiform. _See_ Vermiform appendix.

Aprosopia, 638

Arlt’s operation for blepharoplasty, 602

Arm, amputation of, 1032

Arrow poisoning, 173

Arterial angioma, 278

Arteries, abdominal aorta, aneurysm of, 346
ligation of, 356
aneurysm of, 339
by anastomosis, 344
arteriovenous, 344
cirsoid, 339, 344
classification of, 342
diagnosis of, 345
diffuse, 339, 342
dissecting, 339, 342
false, 339, 342
fusiform, 339, 343
hernial, 339
progress of, 341
pulsation of, 341
racemose, 344
rupture of, 341
sacculated, 339, 342
spontaneous, 339
traumatic, 339, 343
treatment of, 346
true, 339
varicose, 339, 344
axillary, aneurysm of, 345
ligation of, 355
brachial, ligation of, 355
calcification of, 339
carotid, aneurysm of, 345
common, ligation of, 351
external, aneurysm of, 345
excision of, 352
ligation of, 352
injuries, 563
internal, aneurysm of, 345
ligation of, 352
circumflex, ligation of, 359
epigastric, ligation of, 359
facial, ligation of, 352
fatty degeneration of, 339
femoral, aneurysm of, 346
ligation of, 359
iliac, aneurysm of, 346
common, ligation of, 356
external, ligation of, 357
internal, ligation of, 357
innominate, aneurysm of, 345
ligation of, 350
ligation of, 350
gangrene from, 73
lingual, ligation of, 352
middle meningeal, injuries of, 563
occipital, ligation of, 352
popliteal, ligation of, 360
radial, ligation of, 356
subclavian, aneurysm of, 345
ligation of, 354
surgical diseases of, 337
temporal, ligation of, 35
thyroid, inferior, ligation of, 353
tibial, anterior, ligation of, 360
posterior, ligation of, 360
ulnar, ligation of, 356
vertebral, ligation of, 353

Arteriorrhaphy in treatment of aneurysm, 348

Arteriosclerosis, 339

Arteriotomy, 183

Arteriovenous aneurysm, 344, 564

Arteritis, 338

Arthrectomy, 400

Arthritis, 382
chronic, 386
treatment of, 386
deformans, 387
treatment of, 389
gonorrheal, 392
postgonorrheal, 152, 392
of jaw, 667
rheumatoid, 387
syphilitic, 385
tuberculous, 393
diagnosis of, 398
pathology of, 394
symptoms of, 397
treatment of, 398

Arthropathic joint disease, 394

Arthrotomy, 400

Artificial respiration, 204
Howard’s method, 204
Marshall Hall’s method, 204
in shock, 180
Sylvester’s method, 204

Ascites, chylous, 368

Ascitic tuberculous peritonitis, 791

Asepsis, 243
sterilization, 243
by boiling water, 244
of dressings, 247
by formalin, 244
fractional, 244
of hands, 245
by heat, 243
of instruments, 246
by mustard flour, 245
of sponges, 247
of suture materials, 247

Aseptic wound fever, 85. _See_ Surgical fever.

Aspergillus fungi, 56

Aspiration, paracentesis by, 184

Asthma, thymic, 163

Astomia, 638

Astragalectomy, 467

Astragalus, dislocation of, 544

Atheroma of arteries, 339

Atheromatous abscess, 73, 339
cysts of neck, 707
of skin, 310
ulcer, 339

Atresia of rectum, 872

Atrophic elongation of bones, 436

Atrophy of bone, 422
of brain, 578
definition of, 26
of muscles, 332
treatment of, 332
pathological, 26
physiological, 26
senile, 26
of skull, 547
of testicle, 1015
trophoneurotic, 27
of veins, 361

Auricle, rodent ulcer of, 606

Auricles, supernumerary, 605, 638

Auto-intoxication, 79
cause of, 79
ferments in, 79
intestinal putrefaction in, 81
osmotic pressure of blood in, 80
potassium salts in, 80
treatment of, general, 83
venesection in, 80
urea in, 80, 81

Axilla, syphilis of, 751
tuberculosis of, 751

Axillary artery, aneurysm of, 345
ligation of, 355

B

BACILLUS aërogenes capsulatus, 55
anthracis, 54
bubonic plague, 54
chancroid, 55
coli communis, 53
diphtheriæ, 54
lepræ, 54
mallei, 54
œdematis maligni, 54
pneumoniæ, 54
proteus, 53
pyocyaneus, 53
of Rauschbrand, 55
of rhinoscleroma, 54,
tetani, 54
of tuberculosis, 54
typhi abdominalis, 53

Bacteria of pus formation, 51
facultative pyogenic, 53
bacillus aërogenes capsulatus, 55
anthracis, 54
bubonic plague, 54
chancroid, 55
diphtheriæ, 54
lepræ, 54
mallei, 54
œdematis maligni, 54
proteus, 53
pneumoniæ, 54
of Rauschbrand, 55
of rhinoscleroma, 54
tetani, 54
tuberculosis, 54
typhi abdominalis, 53
obligate pyogenic, 52
bacillus, pyocyaneus, 53
coli communis, 53
colon bacillus, 53
diplococcus pneumoniæ, 53
micrococcus gonorrhϾ, 53
lanceolatus, 53
tetragenus, 53
staphylococcus pyogenes albus, 52
aureus, 52
epidermidis, 52
streptococcus erysipelatus, 52
pyogenes, 52

Bacterial determination of pus as an indication to treatment, 57

Balanitis, 149, 1005

Balanoposthitis, 149, 1005

Bandage, elastic, for control of hemorrhage, 234

Bandaging, 189
kinds of, 189, 190, 191
materials used in, 191

Banti’s disease, 31, 942

Barbadoes leg, 372

Barrel-shaped chest, 719

Barton’s head bandage, 191

Basedow’s disease, 713

Bassini’s operation for hernia, 902

Bastard clap, 148

Bed-sores, a cause of gangrene, 74

Bees, poisoning by, 172

Bell’s palsy, 640

Bellocq’s cannula, 681

Bennett’s fracture, 506

Beta-cocaine, 207

Beta-eucaine, 207

Bichat, fatty ball of, 641

Bier’s osteoplastic amputation of leg, 1028
permanent hyperemia in tuberculosis, 120
treatment of tuberculosis of joints, 399

Biett’s collarette, 131

Bifid penis, 1004
tongue, 652

Biliary calculi, 922
diagnosis of, 925
symptoms of, 924
treatment of, 926
colic, 922
symptoms of, 924
ducts, stricture of, 921
fistulas, 917
intestinal, 917
pathological, 917
postoperative, 917
passages, catarrh of, acute, 918
treatment of, 918
chronic, 918
injuries of, 918
operations on, 927
perforation of, 921
ulceration of, 921
symptoms of, 922
treatment of, 922

Billroth’s chain-stitch suture, 241

Biskra button, 309

Bladder, adenocarcinoma of, 992
adenoma of, 992
calculi of, 986
symptoms of, 986
treatment of, 987
congenital malformations of, 977
dermoid cysts of, 992
ectopia of, 978
treatment of, 978
examination of, 977
exstrophy of, 978
treatment of, 978
fibroma of, 992
foreign bodies in, 982
inflammation of, 984
symptoms of, 984
treatment of, 985
injuries to, 981
treatment of, 981
myxoma of, 992
papilloma of, 992
siphonage of, 1003
tuberculosis of, 118
tumors of, 992
symptoms of, 992
treatment of, 992
wounds of, 233

Blastomycetic dermatitis, 309
lesions of mouth, 658
pus, 56

Blennorrhea, 146. _See_ Gonorrhea.

Blepharitis, 601
marginalis, 601

Blepharoplasty, 602
Arlt’s method for, 602
Dieffenbach’s method for, 603
Fricke’s method for, 603
Richet’s method for, 603

Blood, abstraction of, 182
by arteriotomy, 183
by cupping, 183
by leeching, 183
by venesection, 182
extravasation of, gangrene from, 73
foreign bodies in, 35
formed elements of, 29
glycogen in, 33
infusion of, 185
intravenous, 186
iodine reaction of, 33
osmotic pressure of, in auto-intoxication, 80
microörganisms in, 35
platelets, 30
surgical pathology of, 28
transfusion of, 185

Bloodvessels, injuries of, 216
suture of, 349
end-to-end, 350
lateral, 349
wounds of, 216

Boils, 304
oriental, 309
treatment of, 304

Bones, abscess of, 419, 425
treatment of, 426
achondroplasia, 432
acromegaly, 437
actinomycosis of, 432
atrophic elongation of, 436
atrophy of, 422
caries of, 427
cavalryman’s, 331
cavities, filling of, 431
cranial, acromegaly of, 548
injuries of, 552
leontiasis of, 548
osteomyelitis of, 548
periostitis of, 548
dancer’s, 331
diseases of, parasitic, 432
trophoneurotic, 432
epiphysitis of, acute, 421
exostoses of, 441
fencer’s, 331
fibroma of, 438
fragility of, 435
senile, 436
hydatid disease of, 432
treatment of, 432
hyperostoses of, 441
hypertrophy of, 422
injuries of, 218
leontiasis of, 438
myeloma of, 442
myxoma of, 441
necrosis of, 428
pathological, 428
toxic, 428
treatment of, 428
traumatic, 428
osteoarthropathic hypertrophiante pneumique, 436
osteoma of, 441
osteomalacia of, 434
prognosis of, 434
treatment of, 435
osteomyelitis of, acute, 416
complications of, 419
diagnosis of, 419
etiology of, 419
organisms at fault in, 417
pathology of, 416
prognosis of, 418
symptoms of, 418
treatment of, 419
chronic, 421
tuberculous, 423
latent, 421
osteoporosis of, 422
osteopsathyrosis, 435
osteosclerosis of, 422
ostitis deformans, 436
Paget’s disease of, 436
periostitis, acute infectious, 420
causes of, 421
treatment of, 421
albuminosa, 421
rachitis, 433
rider’s, 331
sarcoma of, 441
treatment of, 441
sequestrum formation of, 429
treatment of, 429
of skull, incomplete formation of, 547
syphilis of, 135, 426
transplantation of, 431
tuberculosis of, 116, 422
acute miliary, 423
pathology of, 423
symptoms of, 423
treatment of, 425
tumors of, 438
cartilaginous, 440

Boric acid, toxic effects of, 175

Bow-leg, 465
treatment of, 465

Brachial artery, ligation of, 355
plexus, operations on, 623

Brain, abscess of, 567
symptoms of, 568
prognosis of, 569
treatment of, 573
atrophy of, 578
compression of, 560
symptoms of, 561
prognosis of, 562
treatment of, 562
concussion of, 559
treatment of, 559
contusion of, 559
symptoms of, 560
treatment of, 560
cysts of, congenital, 578
foreign bodies in, 565
hernia of, 566
treatment of, 566
prolapsus of, 566
treatment of, 566
substance, injuries of, 564
lacerations of, 564
prognosis of, 564
symptoms of, 565
syphilis of, 138
tumors of, 582
symptoms of, 583
treatment of, operative, 585

Brasdor’s method of treating aneurysm, 347

Breast, abscess of, 757
actinomycosis of, 759
adenoma of, 760
anomalies of, 755
cancer of, 761
treatment of, 763
contusions of, 756
cysts of, 760
fibroma of, 760
hemorrhages from, 755
hypertrophy of, 756
inflammation of, 756
injuries of, 756
lipoma of, 760
neuralgia of, 758
treatment of, 758
nipple of, chancres of, 759
eczema of, 316
fissure of, 756
Paget’s disease of, 316, 756
operations on, 764
syphilis of, 759
tuberculosis of, 759
treatment of, 759
tumors of, 760
treatment of, 760

Bronchocele, 712

Brophy’s operation for cleft palate, 654

Bruns’ method of amputation of foot, 1042

Bubo, chancroidal, 144
syphilitic, 128

Bubonic plague, bacillus of, 54

Bubonocele, 893

Bunion, 263, 311
radical cure of, 333 (note)
treatment of, 311

Burba, exostosis, 272

Burns, 300
of abdominal wall, 783
of face, 639
of respiratory passages, 675
treatment of, 301

Bursæ, adventitious, 263
prepatellar, 263
surgical diseases of, 332
synovial, 332
syphilis of, 136
tuberculosis of, 116

Bursal cysts of neck, 707

Bursitis, acute, 333
chronic, 333

C

CALCIFICATION of arteries, 339
of thrombus, 36
of veins, 361

Calculi, biliary, 922
diagnosis of, 925
symptoms of, 924
treatment of, 926
of nose, 672
pancreatic, 954
of tonsils, 663

Calculus, renal, 965
diagnosis of, 965
symptoms of, 965
treatment of, 966
of ureter, 973
vesical, 986
symptoms of, 986
treatment of, 987

Canal of Nuck, hydrocele of, 261

Cancer. _See_ Carcinoma.
en cuirasse, 289, 784

Cancerous ulcers of intestines, 827

Cancers of branchiogenic origin, 698, 709

Cancrum oris, 75, 658

Capillary angioma, 277

Capsulotomy, 956

Caput succedaneum, 549

Carbolic acid, toxic effects of, 175

Carbuncle, 305
of neck, 704
treatment of, 305

Carcinoma, 289
of abdominal wall, 784
acinous, 290
of breast, 761
treatment of, 763
characteristics of, 289
colloid, 289
corset, 289
diagnosis of, from sarcoma, 293
duct, 290
encephaloid, 289
of esophagus, 744
of gall-bladder, 927
general considerations of, 294
of heart, 336
of intestines, large, 870
small, 828
treatment of, 828
jacket, 289
of jaw, 668
of kidney, 969
of liver, 914
of lung, 732
of lymph nodes, 289, 376
mesentery, 939
miliary, 289
pancreas, 953
prostate, 1002
rectum, 886
treatment of, 887
relation of, to other diseases, 295
scirrhus, 289
of skin, 315
of spine, 462
of spleen, 943
of stomach, 801
symptoms of, 802
treatment of, 803
of testicle, 1017
of thorax, 730
treatment of, 295
liquid air in, 296
radium in, 296
toxins of erysipelas in, 296
ultraviolet light in, 296
_x_-rays in, 297

Cardicentesis of pericardium, 336

Cardiolysis, 337

Cardiospasm, 798
operation for, 808
symptoms of, 798
treatment of, 798

Caries of bone, 427
dental, 657, 664
treatment of, 665
of hip, 452
diagnosis of, 454
prognosis of, 454
symptoms of, 453
treatment of, 454
of spine, 444

Carotid arteries, aneurysm of, 345
common, ligation of, 351
external, excision of, 352
ligation of, 352
injuries of, 563
internal, ligation of, 352
body, diseases of, 709

Carpus, dislocations of, 536

Cartilages, semilunar, dislocation of, 543

Castration, 1022

Cataract, 597

Catarrh of biliary passages, acute, 918
treatment of, 918
chronic, 918

Catarrhal cholecystitis, 919
ulcers of rectum, 876

Catgut, sterilization of, 247

Catheterization, 186
catheters used in, 186
complications of, 187
ureteral, 958

Catheters, care of, 186

Cautery, actual, 184

Cavalryman’s bone, 331

Cavernitis, 1009

Cavernous lymphangioma, 278
tumors, 277

Cecum, cancer of, 870

Celiotomy, 773

Cellulitis, gangrenous, of abdominal wall, 783
of orbit, 592
of scalp, 545

Celluloid thread, sterilization of, 248

Cementoma, 281

Cenencephaloceles, 577

Centipedes, poisoning by, 172

Cephalalgia, treatment of, 582

Cephalhematoma, 263
neonatorum, 549

Cephalocele, 576
treatment of, 578

Cerebellar tumors, treatment of, operative, 585

Cerebral conditions in rickets, 162
palsies, 478
treatment of, 478
sclerosis in rickets, 162

Cervical lymph nodes, affections of, 705
plexus, deep posterior, operations on, 618
sympathetic nerve, operations on, 618

Chalazion, 601

Chancre, diagnosis of, from chancroid, 145
of nipple, 759
of rectum, 876
syphilitic, 126

Chancroid, 144
bacillus of, 55
bubo in, 144
diagnosis of, 144
from chancre, 145
from herpes, 145
extragenital, 145
mixed, 145
phagedenic, 144
prognosis of, 145
treatment of, 145

Chancroidal bubo, 144

Charbon, 106. _See_ Anthrax.

Charcot’s artery of hemorrhage, 564
disease of elbow, 390

Cheek, tumors of, dermoid, 641

Cheiloplastic operations, 648

Chemotaxis, 41, 44
negative, 45
positive, 45

Chest, concussion of, 721
treatment of, 722
contusion of, 721
treatment of, 722
wounds of, 722
treatment of, 723

Chilblains, 299

Chimney-sweeper’s cancer, 287, 316

Chin, galoche, 638
malformation of, 638

Chlorosis, 31

Cholangiostomy, 928

Cholangiotomy, 928

Cholangitis, acute, 918, 920
treatment of, 918
chronic, 918
suppurative, 919
diagnosis of, 920
symptoms of, 919
treatment of, 921

Cholecystectomy, 929

Cholecystendysis, 930

Cholecystenterostomy, 928

Cholecystitis, acute, 919
diagnosis of, 920
from appendicitis, 857
phlegmonous, 920
symptoms of, 919
treatment of, 921
chronic catarrhal, 919
gangrenous, 920
obliterans, 919

Cholecystostomy, 929

Cholecystotomy, 929

Choledochenterostomy, 928

Choledochostomy, 928

Choledochotomy, 928

Cholehepatopexy, 933

Cholelithiasis, 922
diagnosis of, 925
symptoms of, 924
treatment of, 926

Cholelithrotrity, 928

Cholera, secondary infection in, 166

Chondritis, 683

Chondroma, 271
of jaw, 668
of testicle, 1017
of thorax, 730
treatment of, 272

Chondrosarcoma, 274

Chopart, mediotarsal amputation of, 1037

Chordee, 149

Chorion epithelioma, malignant, 292

Choroid, tuberculosis of, 595

Chromicized gut, 247

Chromocystoscopy, 958

Chylocele, 372

Chylothorax, 735

Chylous ascites, 368
fistula, 368
hydrocele, 372
hydrothorax, 368

Chyluria, 373

Cicatrices, horns growing from, 283

Cicatricial keloid, 70

Ciliary body, diseases of, 598

Circumcision, 1010

Circumflex artery, ligation of, 359

Cirrhosis of pancreas, 950

Cirsoid aneurysm, 278, 339, 344

Clap, 146. _See_ Gonorrhea.
bastard, 148

Clavi, 311

Clavicle, dislocations of, 529
congenital, 718
treatment of, 529
fractures of, 493
treatment of, 493

Cleft palate, 652
operation for, 654

Clitoris, hypertrophy of, 1007

Clove hitch knot, 241

Club-foot, 465
congenital, 466
treatment of, 466

Coagulation necrosis, 57

Cocaine, 205

Cocainization, intraspinal, 207

Coccidioidal granuloma, 309

Coccodynia, 636

Coccygeal sinus, 635
tumors, 627
congenital, 635

Coccygodynia, 636

Cohnheim’s embryonal hypothesis of cause of tumors, 256

Cold abscess, 112
diagnosis of, 113
lumbar, 114
peri-articular, treatment of, 399
psoas, 114
retropharyngeal, 114
treatment of, 114

Colic, biliary, 922
diagnosis of, 925
symptoms of, 924
treatment of, 926
renal, 964
treatment of, 964

Colitis, diagnosis of, from appendicitis, 857

Collapse, 177

Collar-button abscess, 319

Colles’ fracture, 503
treatment of, 504
law in syphilis, 139

Colloid goitre, 713

Coloboma, 600

Colon bacillus, 53
syphilis of, 869
tuberculosis of, 869

Colopexy, 850

Colostomy, 874, 888

Coma carcinomatosum, 82

Compression apoplexies, 560
of brain, 560
prognosis of, 562
symptoms of, 561
treatment of, 562

Concussion of brain, 559
treatment of, 559
of chest, 721
treatment of, 722
of spine, 628
treatment of, 629

Condyles, fracture of, 498

Condylomas, 282, 312

Congenital abnormalities of testicle, 1014
adenoma of kidney, 969
affections of thyroid, 710
anomalies and defects of kidneys, 955
of intestines, large, 869
small, 822
of neck, 698
of pancreas, 944
of spleen, 940
of ureters, 955
coccygeal tumors, 635
conditions of skull, 547
cysts of abdominal wall, 783
of brain, 578
defects of anus, 872
of diaphragm, 752
of lips, 638
of mouth, 652
of penis, 1004
of rectum, 872
dislocations, 526
of hip, 471
diagnosis of, 473
treatment of, 474
displacements of liver, 910
hernia, 890
diaphragmatic, 897
inguinal, 897
hypertrophy, definition of, 26
lymphangioma of ear, 606
macroglossia, 652
malformations of bladder, 977
of ear, 604
of esophagus, 737
treatment of, 738
of respiratory passages, 671
of stomach, 793
of thorax, 718
occlusion of lymph vessels, 369
rickets, 161
tumors of scalp, 546
varices, 364
venous nevus, 367

Congestion, 19
neuroparalytic, 20
neurotonic, 20
results of, 22
acute swelling, 22
chronic swelling, 22
gangrene, 22
nutritional changes, 23
resolution, 22
treatment of, 23

Conical stump, definition of, 27

Conjunctival sac, diphtheria of, 599
gonorrhea of, 599

Continuous suture, 241

Contractures of muscles, 332
treatment of, 332

Contusions, 211
of abdominal wall, 781
of bloodvessels, 216
of brain, 559
symptoms of, 560
treatment of, 560
of breast, 756
of chest, 721
treatment of, 722
of face, 639
of muscles, 329
of testicle, 1015
treatment of, 212
of viscera, 219

Copremia, 83

Coracoid process, fracture of, 495

Cord, spermatic. _See_ Spermatic cord.
spinal. _See_ Spinal cord.

Cornea, diseases of, 598
syphilis of, 137

Corns, 311

Corpora cavernosa, syphilis of, 138

Corpus cavernosum, inflammation of, 1009

Corrosive sublimate, toxic effects of, 175

Counterirritation, 183
by actual cautery, 184
by rubefacients, 183
by seton, 184
by vesicants, 184

Cowperitis, 150

Coxa vara, 475
diagnosis of, 476
symptoms of, 476

Coxitis, 452

Cranial bones, acromegaly of, 548
injuries of, 552
leontiasis of, 548
osteomyelitis of, 548
periostitis of, 548
meningoceles, 263
nerves, injuries of, 612
rickets, 547

Craniectomy, 580

Craniofacial sinuses, accessory, operations on, 608

Craniotabes, 547
rachitica, 162

Craniotomy, 580

Cranium, injuries of soft parts of, 551
operations on, 587
septic affections within, 567
abscess of brain, 567
encephalitis, 513
leptomeningitis, 572
meningitis, 571
pachymeningitis externa, 572
interna, 572
sinus phlebitis, 571
thrombosis, 570
trephining of, 587
wounds of, gunshot, 565
treatment of, 565

Crile’s pneumatic suit in shock, 180

Croupous exudates, 23

Crural nerve, anterior, operations on, 623

Cryptogenetic septicemia, 87

Cryptorchidism, 1014
treatment of, 1014

Cupping, 183

Cutaneous horns, 283, 311
growing from cicatrices, 283
nail, 283
sebaceous, 283
treatment of, 311
warty, 283
myxoma, 276

Cylindroma, 275
of skin, 315

Cystic degeneration, 264
of testicle, 260
kidney, 969

Cysticercus, 310

Cystinuria, 82

Cystitis, 984
gonorrheal, 151
postoperative, 985
symptoms of, 984
treatment of, 985
tuberculous, 985

Cystoma, ovarian, 284

Cystoscope, Nitze’s, 993

Cystoscopic examination, 958, 977

Cysts, 259
of abdominal wall, congenital, 783
apoplectic, 952
of bladder, 992
of brain, congenital, 578
of breasts, 760
degeneration, 264
dermoid, 264
glandular, 261
hydatid, 263
hydroceles, 261
of iris, 594
of liver, hydatid, 913
treatment of, 913
of lung, echinococcus, 732
hydatid, 732
lymph, 278
of mesentery, 940
of neck, 707
atheromatous, 707
bursal, 707
dermoid, 707
sanguineous, 701, 707
thyrohyoid, 707
neural, 263
of omentum, 935
of orbit, dermoid, 593
parasitic, 593
of pancreas, 951
diagnosis of, 952
symptoms of, 952
treatment of, 952
pseudo-, 262
retention, 259
sebaceous, 285
of skin, 310
atheromatous, 310
echinococcus, 310
sebaceous, 310
treatment of, 310
of spine, 627
of spleen, 943
of Stenson’s duct, 641
of testicle, 1016
of tongue, retention, 659
tubulo, 260

D

DACRYO-ADENITIS, acute, 599

Dacryocystitis, 600
treatment of, 600

Dacryopic cysts, 262

Dactylitis, 136

Dancer’s bone, 331

Davey’s method of amputation of hip-joint, 1045

Deciduoma malignum, 292

Degeneration, cystic, 264

Delhi boil, 309

Delirium tremens, 174
treatment of, 174

Dental caries, 657, 664
secondary infection in, 169
treatment of, 665

Dentigerous cysts, 666

Dermatitis, blastomycetic, 309
calorica, 299
treatment of, 299
of radio-active origin, 303

Dermatolysis, 313

Dermoid cyst of bladder, 992
of neck, 707
of omentum, 935
of orbit, 593
of scalp, 546
of testicle, 1016
tumors of cheek, 641
of lung, 732

Dermoids, 264
ovarian, 267
sequestration, 265
tubulo, 266

Desault’s bandage, 190

Desmoids, 271
treatment of, 271

Diabetes a cause of gangrene, 74

Diaphragm, congenital defects of, 752
paralysis of, 753
rupture of, 721, 753
treatment of, 722
tumors of, 753
wounds of, 725, 753
treatment of, 726

Diaphragmatic hernia, 897
acquired, 897
congenital, 897

Dieffenbach’s operation for blepharoplasty, 603

Digital compression for control of hemorrhage, 235

Dilatation of stomach, 793, 795
acute, 795
symptoms of, 796
treatment of, 796
chronic, 796
operation for, 811

Diphtheria, bacillus of, 54
of conjunctival sac, 599
of mouth, 657
secondary infection in, 168

Diphtheritic exudates, 23

Diplococcus pneumoniæ, 53

Disarticulations, 1023