Introduction and Background

GIT eal e S32. 1 To } F: ef CQOPER, BART. F.R.S, » ay SIR ASTLEY COOPER, BART. F.R.S. SERORANT-SURGEON TO THE XING, CONSULTING SURGEON TO GUY’s MOSFITAL; arp JOSEPH HENRY GREEN, ESQ. F.R.S. FRoPRtOR OF ANATOMY TO THE ROYAL ACADEMY, sunazoX To, AnD LECTURER ON sURGERY, #7. THOMANs MosFITAL —_— THE THIRD EDITION, CONSIDERABLY RNLAROND, CONTAINING MANY ADDITIONAL NOTES FROM ‘THE WRITINGS OF OTHER DIsTINGUISHED SURGEONS. — EDITED BY THOMAS CASTLE, F.LS. OF quEEn’s coLLzax, oxvoRD 5 PROPEAHON OF MATERIA MEDICA TO THR RCLECTIC SOCIETY RE-PUBLISHED BY MUNROE AND FRANCIS, AND CHARLES ‘. FRANCIS, NEW-YORK. are, 270. i { 4 Sonvon : in | PRINTED FOR E. COX, ST. THOMAS'S STREET. ‘Boston : mpccexxxi1, SIR ASTLEY COOPER, BART. F.R.S. ROR ANT-AURGEON To THE KING, CONBULTING SURGEON 10 GUY's HOSPITAL ; and JOSEPH HENRY GREEN, ESQ. F.R.S. FROFESOOR OF ANATOMY TO THE ROYAL ACADEMY j SURGEON To, AND LEO- ‘TURE ON SURGERY, 51. THOMAs HODPITAL} THE PRESENT VOLUME OF SURGICAL NOTES, CHIEFLY SULECTED PROM THEIR LECTURES, FOR THE USE OF STUDENTS, Xs, by permission, MOST RESPECTFULLY INSCRIBED, IN PARTIAL TESTIMONY OF THE VALUE OF ‘THEIR INSTRUCTIONS ; AND WITH THE EARNEST HOPE IT WILL PROVE A CONVENIENT AND USEFUL COMPANION TO THE WARDS 3 AND ALS0 ASSIST IN THE FURTHER DISSEMINATION OF PRACTICAL INFORMATION. EDITOR'S PREFACE, A very prominent object, in the publication of all works, should be, to convey as much useful matter in as concise and convenient a volume as the peculiar nature of the subject will allow. Almost every department of the study of medicine has _ been presented to the student, both in the elaborate and more restricted form,—the first with a view of furnishing every known circumstance connected with the science, and the second to be the more immediate guide and companion to his studies. In acquiring a knowledge of the theory and practice of surgery, extensive reading is not only beneficial, but abeo- Tutely necessary, before we can practise with success, or “understand the true intention and application of our reme- dies ; yet, for the mere beginner to commence his studies by plodding through volume after volume, forgetting, as he must, in the multiplicity of description, the very facts he is anxious to acquire, ia not only overloading the under- standing ere it can form a judgment for itself, but it is a Pe vi PREFACB. sad loss of time, and a great source of perplexity and con- fasion. While the mind is young in knowledge, let us re- member its powers of comprehension are but weak; and, since the study of the medical profession generally includes such a variety of subjects, alike extensive and alike wrapt in the mysteries of doubt, rather should we first be taught the ruling principles, and then, when we have derived a perfect knowledge of the outlines, we may safely venture to drink deeper of the science, and be better -prepared to meet the baflling sentiments so universally presented in all medical and surgical works. Although we have advanced thus much upon the part of reading, it is well known, that neither the principles nor practice of surgery can be sufficiently impressed upon the mind by that alone. There must be something far more illustrative, to make a scientific and skilfol surgeon; he must not only read, but he must compare, at the bed-side of the patient, that which he reads, with the peculiar char- acter of attending circumstances. This, and this alone, will make him an accurate observer of nature: he will then be able to judge the value of existing opinions, and not until then can he enter on the stage of his professional life, prepared to perform the various duties of his station: ‘Most students in the country have not the opportunity of pursuing such a course with much advantage; bit, when they arrive at the metropolitan schools, every faciti- ty is offered, and it only rests with themselves to make a necessary proficiency. The grand source and support of surgical knowledge must ever devolve on the noble institutions which human- PREFACE. vii ity has erected in this and other cities of distinction ; for, without these, the collateral rays, which emanate from private practice, would never have raised the dignity of surgery to the rank it now holds in the opinion of the world. Here we have, at one and the same time, an assem- blage of the diseases and accidents to which mortality is heir, and, attached to every institution, a school of instruc- tion for the young and inexperienced, where they may learn to avoid the superstition and empiricism of our an- cestors, and be taught to exercise their profession with honor to themselves, and with benefit to the public. Although the usual means of cultivating sound surgical knowledge are generally given in these institutions, yet there remains, in my humble opinion, one point in which their utility might be more constantly secured to the pupil. The mere walking from one ward to another, and taking ‘a cursory view of every patient, is not a proper plan to be pursued: ‘they should take with them a pocket companion, and, when, they meet with any particular case, they should first make their own observations, and then immediately refer, to know what they have overlooked, or what is unu- sual to its general character. In this way, they would readily acquiré accuracy of observation, and soon become tolerable masters of each subject. Notwithstanding the surgical press teems with works of every description, I do not know that there is one which will answer the double indication of furnishing the pupil with a general outline of the science, and, at the same time, is sufficiently portable to admit of no material per- sonal incumbrance as a companion to the wards. It is viii PREFACE. under such an impression, that I am endeavouring, in the publication of this volume, to supply that deficiency ; and, as the opinions herein contained were for many ‘years de- livered at a public hospital,* and have been occasionally publishedf to the world, the reader must not expect any thing novel, save the manner of re-communication. The lectures from which I have made my extracts, I was led to select, because they’ are the result of extensive practice, and the instructions of observing surgeons,—the one highly courted for his skill and universal reputation, the other equally admired for his general knowledge and profession- al acquirements. , The lectures of Sir Astley Cooper, I would farther add, are the result of forty years’ experience in St. Thomas's and Guy’s Hospitals, and in a large scene of private prac- tice. The only ground, on which I was induced to become editor of this Manual of Surgery, was the full assurance .of the utility and necessity of such a work; and, as the learned’ lecturers have individually and connectedly given me an honorable permission to re-publish their surgical sentiments, I cannot be considered trespassing on literary property. If a free grant had not been conferred on the part of the respected gentlemen in question, I would not, on any account, have undertaken the work ; but as they have in this, as in every other professional capacity, proved themselves disinterested well-wishers of surgery, I have a- vailed myself of their generosity, and seek no other remu- * Bt Thomas's Hospital, Boroughs Lancet, Be. PREFACE. ix neration than their approbation, and the satiafaction of ben- efitting the student. ‘Throughout the whole treatise, I have aimed at brevity and clearness of communication, and, wherever it was pos- sible, I have inserted the usual expressions of each lecturer ; but thinking that short sentences are best adapted for con- venient reference, I have treated each subject in the form of paragraphs with appropriate or occasional notes, and so arranged the peculiarity of type in printing, as to give the whole a marked and impressive appearance ; not however but that one part is as much entitled to minute attention as another. In the present edition, I have endeavoured to remove such points as were objectionable, and to make more per- fect other passages, which may have been considered want- ing in progressive developement. I have also introduced considerable additional matter, selected from the most pop- ular surgical writings, and more particularly from the truly practical “Dictionary of Surgery,” by Samuel Cooper, esq. a work abounding in interest and utility, and one which every student should use, not only as a book for general re- ference, but'as a valuable compendium of all surgical sub- jects. My cole object, in the execution of my task, has been di- rected towards the convenience and advantage of the stu- dent, but if he unhappily considers his inquiries have gone sufficiently far, when he understands the contents of the volume in hand, he labours under a very serious and dan- gerous error ; the work is only presented to him to refresh . oF direct his memory, and not to complete the grand struc- x PREFACE. ture of his surgical understanding : surgery is a science too extensive to be condensed in so small a compass ; it is". only possible to give leading points, and he must naturally look to other sources, before he can conscientiously enter in- to practice. Although I am desirous, in the present undertaking, of alleviating the steps to a general knowledge of surgery, let it not be imagined, for one moment, that I am wishing to save the necessary toil and perseverance of greater devo- tion to the subject, and thereby encouraging idleness in the rising profession ; for, on the contrary, I have pointed out the value of extensive reading, and would have this effort of assistance considered only as intended for their conven- jence, and as an additional means of ensuring them prac- tical information. It is their duty to recollect that they are - hereafter to hold responsible situations in life, and if they neglect to embrace every opportunity of instruction, they will probably be called upon to equalize the consequences, by a painful reflection of their incompetency to meet the claims upon their public character. I would therefore re- commend them earnestly to give their sole time and atten tion to the true design of their Hospital Education, to search indefatigably after science, and however difficult and un- bounded the prospect may appear before them, they have only to pursue one even path with patient industry, and they will never fail to secure an honorable passport to the ultimate advantages of their professional studies. T. CASTLE. Janwary, 1832, 98, Bermondsey Square. MANUAL OF SURGERY. PART I. CONTAINING PRACTICAL NOTES: CHIEFLY SELECTED FROM A SERIES OF LECTURES DELIVERED BY SIR ASTLEY COOPER, BART. F.R.S. SEROEANTsURGEON TO THE XING, ComsuitiZ0 suRGEON 70 au¥’s HosriTaL, ke. he. MANUAL OF SURGERY: INTRODUCTION. 1, Surgery is that part of the medical science, which relates to) the performance of operations for the removal of diseased parts ; ‘and which also shows the use of medicin¢ in cases of local disease, produced by constitutional derangement, or vice versa. Te would be a very difficult task to define the exact limits of surgery and physic. With accidents, tamours, and many other affections of the body, there can be no hesitation as to which province they exclusively belong ; but with regard to erysipelas and a few more, itis almost a matter of per- sonal opinion. 2, Surgery is usually divided into the principles and practice. 3. The principles of surgery are learned from observations on’ ‘he living, when diseased 5 by dissection of the dead ; and by exp iments upon living animals. Our deductions from these sources, furoish us with the means of know- ing a malady by its symptoms, the alteration of structare in a part which liad been diseased, and the various ways which nature attempts the repa- ative process, both in external and internal parts. 4. Inthe practice of surgery, many essential qualities are requi- site on the part of the surgeon ; asneatness in applying his remedies, gentleness of manner, and self-possession. The quality of self-possession is of the highest importance in surgical ‘Sperations, for the hend must always direct the band, otherwise the opera- = 4 INTRODUCTION. tor is unfit to discover am effectual remedy for the sudden and unforeseen, accidents which may occur tn his practice, 5. A thorough knowledge of anatomy is absolutely necessary ; it not only firmly impresses on our memory the situation, form, and structure of the different organs of the body ; it also teaches us how to discriminate disease, and to detect the nature of injuries with more, certainty. Morbid anatomy in particular should be attended to. A man who basseea much af morbid preparations, possesses great advan tages; but bis anatomical knowledge cannot be perfect unless he has seen and assisted to the dissection of the healthy body. In surgical sclence, Ibypethests should be entirely discarded, and sound theory, derived from ac- ‘tual observation and experience, alone encouraged, Observation is a polar -ary—bypothests an ignis fatuus. 6. Physialogical knowledge is of the utmost importance to the the profession of surgery. ‘This will give you a clear idea of the healthy fanetions, and thus enable you better to understand the na- ture of diseased action, The study of medicing is important to the surgeon ; he should be able to prescribe with judgment ; should well understand the great influence of local disease on the constitution, ax well as the ‘origin of local disorders from constitutional derangement. ‘Without such knowledge, # surgeon knows but half bis duty, for there fare many cases which require a strict medical treatment, and unless the. medicines are judiciously administered, the disease will be aggravated rather than relieved. 8 Reading and application to your studies will also prove con siderable auxiliaries in rendering you well-informed and skilful surgeons. ‘You should read select works on particular diseases ; but I would not recommend to young students those which lay down systems for their guidance. 9. ‘The expenses of your professional education, and the expecta- tions of the public, call upon you to search for true knowledge, that you may, thereby, fulfill yaur duty toward them, shed honor on the IRRITATION. 15 tnédical profession, and finally, after the necessary toils of life, retire into the bosom of your family honored and respected. IRRITATION. 4. All the actions of the body are excited and sustained by inter nal and external impressions, which are called stimulants, ‘These etimulants may be eltber natural to the human frame, as blood to the blood-vessels, bile to the intestines, and so on; or they may be foreign, ‘as medicines und extraneous bodies. 2. Between ali the different parts of the human frame, there exist intimaté relations, which correspond with each other, and carry on reciprocal intercourse of actions. ‘The beautiful harmony produced by these concurrent phenomena, is called sympathy. ‘Thus impressions uot only produce effects on the part to which they are directly applied, but in consequence of the freedom of communication be- tween the nervotis system, parts of the body at adistance from those in ‘which the origival mischief exists, become affected by it. 3. Sympathy may exist viaturally, as the communication which there is between the uterus and breast; or it may be the result bf injury and disease: 4. When sympathetic action is the restit of injury and disease; it becomes the cause of restoration on the one hand, or of dearection ‘on the other. 5. Ishould therefore say, irritation is an altered action excited iii the system by an unnatural impression. ‘Thus syoipathetic pain is experienced in tli¢ knee and foot friiit diseased hip, dnd at the extremity of the penis when there is stone in the bladder 5 the passage of an urinary caleulus through the uretur, occasions retraction of the testicles and pain in the thigh ; disease of the prostate causes pain on the inside of one, or both thighs; disease of the liver occasions pain in the shoulder j a diseased testicle, pain in the loins; and irritation of thé _, itestInes, an Itching of the nose: 16 IRRITATION. 6." ‘The sympathetic effects which we have just mentioned, do not consist in morbid actions of the parts thus affected, but of disordered sensations, Nevertheless, morbid actions are sometimes excited in parts near to, or at a distance from those originally affected. Inflammation of the testicles Is frequently the consequence of irritation In the urethra ; and swelling of the breast, of a morbid action of the uterus ; but there is no organ so much affected hy irritation or sympathetic influ- ‘ence as the stomach, for an obtuse pain in any part of the body will occa- sion sickness. 4. ‘Phe subject of irritation, consequently, is a very important part of your surgical studies ; it is in fact the chief foandation upon which your practice must be established ; for being, as we have be- fore said, the cause of restoration on the one hand, or of destruction on the other, unless you well understand its great local and constit- tional influence, you will be ignorant of the most valuable and uner- ring guide you'can possess. « The art of surgery, it must be remembered, is exercised ona peculiar ‘elas of maladies. The disenses which professedly belong to it, are more or less the result of disordered actions ; accidents are for the most part re- Tieved by attending only to « moderation or restoration of the sympathetle functions, and of tbe secretions ; and ihe success of operations, is also de- pending on the same principle. 8 Irritation, then, is an excited action, necessary, jn a certain Aegree, for the restoration of injuries; but when too violent, or of a morbid nature, occasioning disease and even destruction of the part, ‘The first part of the paragraph shows, that notbing can be more erro- neous in practice, than to bleed or purge immediately after an injurj'or ‘an operation, because the skin is hot, pulse quick, and tongue white; for such a atate Is necessary to restoration : it is only when action is in dan- gerous excess, that such remedies are to be resorted t0- 9. Irritstion is generally communicated through the medium of the nerves, of which, there are two grand divisions in the body. ‘The first composed of the brain, spinal marrow, and their nerves, which naturally convey sensation and volition ; the second, consisting of the grand; sympathetic nerve, the centre of which is behind the slomach, in the semilunar ganglion and solar plexus. inRrraTioN. 4 ‘The inodes of sympathetic communication are various, and with dificulty reducible to any specificlaw. In some instances, the course of irritation Is from the irritated part to the sentient extremity of the uérve, as the pain ‘experienced in the knee and fost from a disease in the bip. In other cases, ‘the course of sympathy Is from the affected part to the origin of thé nerve, ‘as in pain Ia the loins consequent on diseased tésticles. Irritation on the nerves ofthe grand sympathetic, is communicated to the stomach, probably drough the medium of the semilunar ganglion ; nnd to the heart, through the cardiac nerves. 10. Kinds :—Irritatiou may be of two kinds, local and ‘constitu. ional 3 local, when it affects only particular parts, as with an abscess from a decayed tooth ; and constitutional, when irritative fever is produced by local injury or disease. ‘i fs of the greatest importance, to ascertain the caiisé of disordered sym patheic actions, as the removal of the complaint will depend on this circum- tance. If the cause be undiscovered, the effects are likely to continue in te of every tteatment you may pursue. : 11. The constifational or general effetts of irritation, are not ouly produced by severe injury, but they are also sometimes excited by the most trivial circumstances: Aperwo, on having a bougie passed foto the’ uretha, for thefirst time, feels faint, becomes sick, looks pale; and