A Manual of the Operations of Surgery: For the Use of Senior Students, House Surgeons, and Junior PractitionersBell, Joseph
Science
A Manual of the Operations of Surgery: For the Use of Senior Students, House Surgeons, and Junior Practitioners
Bell, Joseph
Surgery, Operative
In making the section of the bones, the saw ought to be applied to the
humerus transversely just at the commencement of its condyloid
projections, and to the radius and ulna, at least at a level with the
base of the coronoid process of the ulna.
But while removing enough, we must not be led into the error of removing
too much. If this is done, as was done by Sir Philip Crampton in his
first case, and as happens occasionally of necessity in cases of
excision for gunshot wounds or other accidents, much of the power of the
arm is lost as a consequence of the shortening and excessive mobility.
A mistaken pathology sometimes deceives in the examination of the state
of the bones, and causes an unnecessary amount to be removed. For in
many cases of disease the bones in the neighbourhood of the joint are
stimulated to an excessive amount of what is in reality Nature's effort
at repair, and while the cartilaginous surfaces are denuded of
cartilage, soft, and porous, the bones close by are roughened with a
stalactitic-looking growth, projecting in knobs and angles. Now, if this
be mistaken for disease and removed, too much will almost certainly be
taken away, and the result will be unsatisfactory.
Much less care need be taken exactly to discriminate and remove the
diseased soft parts; indeed they may be left alone; the synovial
membrane in a state of gelatinous degeneration sometimes presents a
very formidable appearance of disease, but if the bones be properly
removed, all this swelling will soon go down, and a healthy condition of
parts succeed, without any clipping or paring on the surgeon's part.
_Operation._--The back of the joint is of course chosen for the seat of
the incisions, both because the bones are there just under the skin, and
because the great vessels and nerves lie in front of the joint. The form
and number of the incisions vary considerably, and ought to vary
according to the nature of the case and the amount of disease or injury.
Though it is now little used, for historical interest I retain the
description of the H-shaped incision (Plate III. fig. C.), used first by
Moreau, and re-introduced by Mr. Syme, and used by him for most of his
very numerous cases.
Public-domain text, read in full here on John Shaqi.
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