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About Google Book Search Google’s mission is to organize the world’s information and to make it universally accessible and useful. Google Book Search helps readers discover the world’s books while helping authors and publishers reach new audiences. You can search through the full text of this book on the web at{http: //books.google.com/] Lane MEDICA Lupeay 00 (ORIN i 5 00b1 L4bb MEDICAL BOOKS PUBLISHED BY J. B. LIPPINCOTT & CO. Q. Neh, Iv Bartholow on Enlisting and Discharging Soldiers. A Manual of Instructions for Enlisting and Dischat oldiers, with special e to the Medical Examination of , and the Detection of Disqualifying and Feigned Diseases. By Ronenrs BaxtnoLow, uperuuve surgery. Arrangea lor te use or ptuuents, by HENRY j H. Suir, M.D., Professor of the Principles and Practice of Surgery “ in the University of Pennsylvania. Illustrated with numerous steel | and wood engravings. Two vols. 8y0. ee | Wood's Practice of Medicine, A Treatise on the Theory and Prac- tice of Medicine. By Geo. B. Woop, M.D., Professor of Theory and Practice of Medicine in the University of Pennsylvania, &c. &. Me MEDICAL BOOKS. } Wood's Therapeutics and Pharmacology, A Treatise on Thera- peuties and Pharmacology or Materia Medica. By Geo. B. Woop, M.D. Second edition. Two vols. 8vo. Wood & Bache's Dispensatory, Dispensatory of the United States. || By Drs. Woop and Bacus. Twelfth edition, much enlarged and ili carefully revised. Jn press. Nélaton’s Surgery. Clinical Lectures on Surgery. By M. Néitaroy, From Notes taken by Walter F. Atlee, M.D. 8vo. | Stromeyer and Esmarch on Gunshot Fractures. On the Fractures of Bones occurring in Gunshot Injuries, by Dr. Lovis SrRoMEYER; and Resection in Gunshot Injuries, by Dr. Friepnicu Esmancn. One vel. 12mo. Students. By Josrra Ley, M.D., Professor of Anatomy in the # University of Pennsylvania. One vol. 8vo. Elegantly illustrated | from original designs. By T. Loscmore, Deputy Instructor of Hospitals, Professor of Mili- tary Surgery at Fort Pitt, Chatham. In two parts, Part I., Gun- shot Wounds in General. Part IL, Gunshot Wounds in Special Regions of the Body. One vol. 12mo. i! i Malgaigne’s Fractures, A Treatise on Fractures. By Prof. MaLoarone, { ll of Paris, Translated from the French by Jou H. Packanp, M.D. ao 8yo, with numerous illustrations. | Gerhard on the Ohest, The Diagnosis, Pathology, and Treatment of the Diseases of the Chest. By W. W. Geruann, M.D., Fellow of | the College of Physicians of Philadelphia, Member of the American ji Philosophical Society, and one of the Physicians to the Pennsylvania Hospital, &. Fourth edition, revised and enlarged. One vol. 8v0. at J. B. LIPPINCOTT & CO., Publishers, i PHILADELPHIA, A MANUAL or MINOR SURGERY. ‘JOHN H. PACKARD, M.D., ‘DEMONSTRATOR OF ANATOMY IN THE UNIVERSITY OF PENNSYLVANIA, ONE OP THE ‘VISITING SURGEONS 70 THE WEST PHILADELPHIA MILITARY HOSPITAL, ETO. RTO. AUTHORIZED AND ADOPTED BY THE SURGEON-QENERAL OF THE UNITED STATES ARMY FOR THE USE OF SURGEONS IN THE FIELD AND GENERAL HOSPITALS. PHILADELPHIA : J.B. LIPPINCOTT & 00. 1863. Kee Entered, according to Act of Congress, in the year 1868, by J. B, LIPPINCOTT & CO, In the Clerk’s Office of the District Court of the United States for the ‘Eastern District of Pennsylvania, N\ul : Pil \Bos ° 70 GEORGE W. NORRIS, M.D., sm moron oF IB DISTINGUISHED PROFESSIONAL STANDING, axp IN TOKEN OF GRATITUDE FOR MANY KINDNESSES, This little Volume is respectfully Inscribed Br THE AUTHOR. PUBLISHERS’ NOTICE. ‘Tue Publishers of Packarn’s Maxcau or Minor Surcry are authorized to issue, for the information of the profession, the following Report of a Board, convened by order of the Surgeon- General, to examine the work with the view of ita adoption for use in the Medical Department of the Army. Suscson-Gxwxnr’s Ornics, Wasumeron Orrr, D.0., Manou Bist, 1868. Brie.-Gen. Wu. A. Hannonp, Surcron-Genzran U. 8. A. General :— The Board appointed to examine and report upon the merits of a work on Minor Surgery, subtnitted by Dr. John H. Packard, respectfully report that they have carefally examined - this work, both in manuscript and in proof-sheets, and are satis- fied that it is a better text-book upon the subject than any of the treatises with which the American market has hitherto been supplied. J. H, BRINTON, J.J. WOODWARD; Surgeon U. S. Volunteers, Aasistant-Surgeon, U.S A., President of the Board. Recorder. PREFACE. Tue aim kept in view in the preparation of the following pages has been to produce a practical manual; to put the reader in possession of clear directions for the ordinary duties (minor but not unimportant) of the practice of surgery. Some points belonging to the principles of the science have been necessarily touched upon; and a rigid critic might perhaps take exception to some of the matters introduced, as belonging to general and not to minor sur- gery. But here, as elsewhere in dealing with medical subjects, it is hard to draw a precise boundary-line, and better to overstep it than to fall shert of it. The author has endeavored in every case to present the best method of attaining the object sought, with such others as may afford desirable substitutes for it. Objec- tionable plans, or such as have deservedly fallen into disuse, have been either passed over in silence, or men- tioned in the way of condemnation. Especial reference has always been had to such emergencies as constantly arise in civil as well as military practice. () vi _ PREFACE. Most of the cuts of instruments have been furnished by Mr. Kolbé, well known in this city as an able and ingenious manufacturer of surgical apparatus. Many of the other illustrations are original. - In the earnest hope that it may be found usofal, this little work is placed before the profession, Paiapetpuia, 1868, TABLE OF CONTENTS. CHAPTER I. PAGE Pocket-Case—Materials used in Dressings, etc... CHAPTER II. Application of Dressings..... CHAPTER III. Arrest of Hemorrhage—Sutures 45 - : CHAPTER Iv. 69 85 OL CHAPTER VII. CHAPTER VIII. ~ 195 Dislocations. . (vii) CONTENTS. viii CHAPTER IX. PAGE Catheterisation—Injections ...... CHAPTER X. v 282 Foreign Bodies. CHAPTER XL. Post-mortem Examinations....... CHAPTER XII. Disinfectants. . CHAPTER XIII. Minor Surgical Operations........ssssses A MANUAL or MINOR SURGERY. CHAPTER I. THE POCKET-CASE, MATERIALS USED IN DRESSINGS, ETC. Barore proceeding to the performance of even the slightest operation in surgery, everything that can pos- sibly be required should be placed in readiness. Whe- ther a wound is to be dressed, or a limb amputated, the surgeon should run over in his mind all the appliances he will need, all the exigencies that may arise; sponges, towels, dressings, ligatures, needles, instruments, all should be so arranged as to be at hand when called for. This is absolutely essential to the proper perform- ance of every capital operation, and adds greatly to the comfort of all parties concerned in lesser surgical procedures. @ 1—THE POCKET-CASE. Some articles the surgeon should always carry with him, ready for use. They are put up in what is called 3 (9) 10 THE POCKET-CASE. the pocket-case; and are generally as follows: Scis- sors, a scalpel, bistouries, forceps, tenaculum, lancet, gum-lancet, needles, ligatures, porte-caustic, director, probes, and male and female catheter. Other instru- ments may be added, to any extent that the surgeon’s fancy, or the peculiar demands of his practice, may dic- tate; but these are the commonly recognised essen- tials. A good pair of scissors is indispensable; some sur- geons carry several, of different shapes, straight, curved on the flat, or bent at an angle at the joint. The best form is that last named, since it is never inconvenient, and sometimes answers when a plain straight pair would not. But they must be in good order; nothing looks so awkward as for the surgeon to have to chew a ligature or a suture-thread in two with dull scissors. The scalpel is merely a knife with a convex cutting edge, that of a bistoury being always either straight or concave. A probe-pointed scalpel is of use in some operations. The bistouries are usually four in number, two curved and two straight; one of each pair being sharp-pointed, and the other ending in a probe or but- * The instruments contained, according to the Army Regulations, (eupply table last isued,) in the pocket-cases furnished to army medical officers, are as follows:— One scalpel. One tenaculum. Three bistouries. ‘One acissors. One tenotome. One director. One gum-lancet. Three probes. ‘Two thumb-lancets, One caustic-holder. One razor, small. One silver catheter, com- One artery-forceps. pound. One dressing-forceps. Six yards suture-wire, iron. One artery-needle. } ounce ligature-silk.. Six surgeon's needles. $ ounce wax. THE POCKET-CAsE. 11 ton-point. The handles of these knives are usually made of plain tortoise-shell or buffalo-horn; and a small slide, to keep the blades firm when shut or open, is provided. Space is sometimes economized by com- bining two blades in one handle; but this plan is a bad one, unless very great care is taken to clean both blades whenever either one is used. Fig. 1. Fig. 2. Fig. 8. owe The forceps supplied are usually of two kinds; the polypus or dressing-forceps, and the artery-forceps. The former are shaped much like scissors, with ring- handles, and blades filed with transverse ridges, 50 as to afford a good hold of any object grasped between them. The latter are like the ordinary dissecting 12 THE POCKET-CASg. forceps, except that they have a slide, to keep them shut when necessary, and each branch has a longitu- dinal groove at the inner side of its extremity, shaped Fig. 4. Fig. 5. Fig. 6. Common alide-forceps. Another form of side-for- cops. so as to take firm hold of the upper end of a needle or hare-lip pin. About the tenaculum, the only peculiarity is that it is placed in a handle, like one of the knives, and has a slide to keep it immovable when shut up or open. The same may be said of the gum-lancet. The lancet is simply a common thumb-lancet. If the surgeon has himself to do any bleeding that may be required in his practice, he should keep one lancet for THE POCKET-CASE. 18 this purpose, and another for vaccination. The needles, director, and probes vary with the ideas of the surgeon. It is better that the director and probes should be of pure silver, so that no degree of bending will injure them. Among the probes may be placed the porte- méche, for substituting the finger in carrying a ligature or small tampon into any place too deep and narrow to allow convenient entrance to the finger. It is merely a piece of wire about the size of a probe, having at one end a sort of minute fork. (See Fig. 10.) It is often Fig. 7. Fig. 8. Fig. 9. Fig. 10. ‘Tenaculom. Gum-lancet, Probe, porte-méche, ‘and director. of very great use in operations. Various shapes and sizes of needles should be kept to suit different cases; and a supply of silk thread, silver, iron, and lead-wire for sutures should be kept. Ligatures are made of silk thread. The shaft of the catheter is provided with a screw- Qe 14 THE POCKET-CASE. thread towards its lower end, fitting either of two tips, Catheter for pocket-case. Showing the shaft with two tips; one for “aso inthe male and the other in the female subject. one long, and curved so as to suit the male urethra, the other short and bent slightly, for the female. Fig. 12. Fig. 14. Exploring-needle, Porte-caustio. THE DRESSING-BOX. 15 is the grooved exploring-needle, with a handle made to serve as a sheath when the needle is not in use. Cases rarely occur, however, in which the employment of this instrument is necessary or even proper; and much harm may be done with it. The porte-caustic is made of silver, ebony, or hard- rubber. Its tip,