bone and joint, and held back by an affiftant. Every artery which appears is now to be fecured. Then the capfular ligament, and next the round one, are to be feparated from the acetabulum; by which means the limb will be removed from the body. The acetabulum and neighbouring bone are next to be examined; and if they appear found, the cafe will be more favourable; but at any rate, a cure is to be attempted by the first intention. For which purpose, after removing all the clotted blood from the furface of the wound, and bringing the ligatures over the edges of the fkin, the mufcies are to be placed as nearly as poflible in their natural fituation; and drawing the flaps together, fo as to cover the wound in the most accurate manner, they are to be kept in this fituation by adhesive plafter, and by the twifted future and other dreffings, as in amputat.ng at the under part of the thigh. The dreffings are to be retained by a broad flannel roiler paffed 3, or 4 times round the body, and spiraly over the flump, and fecured. The patient is then to be laid in bed on the found fide, and treated as for amputation in other parts of the body; only that greater attention is neceffary, as there is no affiftance from a tourniquet. Uncommon attention will also be neceflary to prevent inflammation, and every symptom of fever which may fucceed to the operation. 824. When the foot is much diseased as to require amputation, the operation might be performed at the point of the ankle; but for the reafons giver, when treating of amputation of the leg, it is found better to do it above the ankle. When a considerable part remains found, it ought to be faved. It any of the tarfal bones are affected, these are to be removed. When the middle or whole body of any of the metatarsal bones are difcafed, they are to be removed in the fame man, ner as directed for fimilar operations in bones of the hand; and if even two of them remain found, provided they be fo placed as to support the toes, they ought to be preserved, as it is known that, by proper treatment, an offeous matter may afterwards fill a confiderable part, if not the whole, of the void; or if any cavity remain, it may be fo ftuffed that the ufe of the foot may ftill be enjoyed. 825. In performing an operation of this kind, the patient thould be upon a table, and the tourniquet applied in the ham to prevent hemorrhagy. An incifion is then to be made along the affected part; and if the feat of the difeafe admit it, the incifion fhould be made upon the upper fide of the foot fo as to fave the fole. The integuments are to be feparated and turned to each fide, to allow the affected parts to be completely removed.. 826. The principal veffels and nerves are to be faved as much as poffible; but if any particular artery be cut, it is to be fecured, and the part treated as after the removal of fimilar parts of the hand. when they protruded in fuch a manner that they could not otherwise be returned, have frequently been fawed through; and their place has frequently been supplied by a renewal of bone, so as to preferve the ordinary ute of the limb. Many cafes have likewife happened, where a large part of the body of the bore has been thrown out by fuppuration, and its place fupplied; and a few are upon record, where either the whole of a bone, or that end next the joint, has been thrown out, and its place filed up with callus, fo that no inconvenience has been felt. From these circumftances, Mr White of Manchester was led to preferve an arm by fawing off the head of a diseased humerus; and Mr Park of Liverpool, to fave a limb, by sawing off the ends of the boues, in a cafe of white fwelling of the knee. When there. fore it happens that the end of a bone is diseased, while the other parts are found, the diseased part may be removed, and the found one faved, fo as in a great mealure to preferve the free use of the limb. 829. In performing the operation, the first step fou'd be, to ufe fuch meaus as may enable the operator to have a full management of the circulation of the part affe&ted. Then a longitudinal incifion of fufficient length, and perhaps another across it, may be neceflary to be made through the foft parts of the joint; and this opening ought to be at a distance from the large blood-veffels, that they may be in no danger of being injured. After the end of the diseased bone is fufficiently laid bare, it is either to be brought out of the joint, or a spatula or fome other proper substance is to be introduced between the bone and foft parts, fo as to defend the latter in time of fawing the bone, After the diseased part of the bone is removed, the arterial branches are to be secured, and the wound treated like any other wound of equal fize. 830. During the cure the limb ought to be kept in the posture most favourable for the removal of the bone, and afterwards for the prefervation of the natural motion of the joint. In this way a limb may fometimes be faved which would otherwife have been removed. But though the removal of the diseased end of one bone may be readily effected, the removal of all that part of the bones which enters into the compofition of a joint must be attended with fo much inconvenience, that it can feldom be useful, unless it be where the ends of bones are defroyed by external violence; for then it appears that this operation may be performed with confiderable fuccefs. CHAP. XXXIV. OF DIMINISHING PAIN IN SURGICAL OPERATIONS. 831. THE pain induced by furgical operations may be leffened in two different ways. The firit is by diminishing the natural fenfibility of the fyf tem; and for this purpose narcotics of different kinds, and paaticularly opium, have been used; but thefe are apt to induce disagreeable fymp toms, especially fickness and vomiting, which might be attended with bad confequences after fome operations. They are therefore seldom employed before an operation. When, however, 838. IN compound fractures, the ends of bones, they are given immediately after it, and repeated 817. The amputation of the toes is exactly fimilar to that of the fingers. SECT. VI. Of REMOVING the ENDS of CARIOUS BONES in the JOINTS. as circumftances may require, they often give ly ufed where a bandage is wanted for the bead; great relief. but a nightcap, having a band to go round the head, and another to tie under the chin, appears to be more fuitable for this purpose. For making compreflion on any particulas part of the head, as for stopping of bleeding veffels, the radiated bandage may be employed. 832. The other method of diminishing pain is, by ieffening the fenfibility of a particular part of the body. It has long been known, that the fenfibility of any part may not only be lessened, but entirely fufpended, by compreffing the nerves which fupply it. From a knowledge of this circumftance, an inftrument (PI. CCCXXVIII. fig. 123.) was invented fome years ago by Mr James Moore of London, by which the principal nerves of a member might be fo comprefied as to render the parts below perfectly infenfible. A difficulty, however, arifes here; for as the nerves must be compreffed at leaft an hour previous to the operation, in order to render the parts quite infenfible, and as it is extremely difficut to comprefs the nerves without at the fame time affecting the veins, the latter are therefore in danger of being burt. To prevent this inconvenience, Mr Moore proposes to open a vein; but this might be attended with bad confequences in weakly conftitutions. Befides, it is faid, that by compreffing -the nerves in this manner, although lefs pain may be felt in the time of the operation, it is proportionally greater after the compreffion is removed. In certain parts of the body, however, where fufficient compreffion can be made upon the nerves without acting much upon the veins, it would appear that the method may be practifed with advantage; though it has not yet been done, excepting in a few inftances. CHAP. XXXV. OF BANDAGES. 833. THE proper application of bandages is an object of great importance in furgery: and tho' dexterity is only to be acquired in this branch by practice, yet a few general rules may be useful. Bandages are employed for the retention of dreffings, for ftopping hemorrhagies, for removing deformities, and for effecting the union of divided parts. They ought to be formed of fuch materiais as are fufficiently firm, while, at the fame time, they give no uneafinefs to the parts to which they are applied. They may be compofed either of linen, cotton, or flannel. Of late years the two laft have been preferred by many for their warmth and elafticity, on which account they are certainly the most proper, especially in winter; and likewife in cafes where the parts are liable to swelling and inflammation, as in wounds, luxations, and fractures. Befides, they more readily abforb any moisture which may be discharged from the fores. 834. When firft applied, they should be clean, fufficiently ftrong, and as free of feams as poffible. They fhould be fo tightly applied as to anfwer the purpose for which they are intended, without being in danger of impeding the circulation. They fhould be applied in fuch a manner that they may be eafily loofened, and the parts examined with as much accuracy as poffible; and they should be laid afide as foon as the purpose for which they are intended is accomplished; for when longer continued, they frequently impede the growth of the parts upon which they are applied. 835. The couvre chef of the French, which is a fquare napkin folded cornerwife, is most frequent 836. For keeping the edges of wounds together, as in cafes of longitudinal cuts of the head, or of any other parts, the uniting bandage is uíu. ally employed, and is always to be preferred to futures, where it retains the edges of the wound with fufficient exactnefs. For retaining dreffings upon the eyes, feveral turns of a roller have been ufed, and it is termed monoculus or binoculus ac cording to its being applied to one or both eyes; but the couvre chef, and the nightcap already mentioned, are lefs apt to flip, and therefore found more convenient for this purpose. 837. For fractures of the nofe, or wounds there, or on any other part of the face, the uniting bandage answers beft. And in cafes of fracture of the lower jaw, a four-headed roller is most convenient: the hole in the centre of the roller receives the chin, and affifts in preventing the ban dage from shifting. The two upper heads are to be carried backwards; and being made to país each other at the occiput, they are afterwards brought once or twice round the head. The two other heads of the roller being reflected over the chin, are then to be turned upwards and fixed on the upper part of the head. 838. The bandages neceffary for the neck are, the machine already mentioned after the opera tion of bronchotomy, and one ufed in cafes of wry neck. For every other purpose of bandaging a common roller may anfwer perfectly well. For fractures of the fcapula the application of a long roller may be of fervice. 839. For retaining dreffings upon the thorax, the napkin and fcapulary are commonly, and very properly used; and when the napkin is employed merely for retaining dreffings, it need not be longer than to pafs once round the body; but if it be used for making preffure over a fractured rib, it ought to pafs two or three times round. For both purpofes its breadth ought to be 6 or 7 inches for an adult. 840. The fime kind of bandages is also used for making preffure on the abdomen, as in cafes of umbilical or ventral hernia; and to keep the ban dage properly placed, a fcipulary is ufed for preventing it from flipping down, and one or two ftraps connected with it behind, are brought between the thighs, and fixed to it before to prevent it from moving up. A bandage of flannel, and different kinds of beits, are contrived for compreffing the abdomen in the operation of tapping; and truffes of various conftructions are used for the retention of the protruded bowels in cafes of hernia. 841. Bandages of cotton or flannel are used for fupporting the fcrotum in the various diseases which may occur there, as well as after the oper rations performed upon it. One of the best bandages for the penis is a linen or cotton bag, fixe 1 by a roller round the body. For retin ng dres fings about the anus, or between tua. part and the the fcrotum, the T bandage is commonly used; and it is made either with one or two tails, according to the fituation of the part to which it is to be applied. 842. In fimple fractures, and most of the other diseases of the arm, fore-arm, and hand, the roller is the bandage cominonly used; but in compound fractures of these parts, as well as in the different kinds of fractures of the lower extremi ties, the 12 or 18-tailed bandage is neceffary. thence the mufcles with the teguments, the space of two or three inches towards the fpine; then cutting through the cartilages, which will be feen, and easily divided with a knife a little curved near the point; then the incifions are to be continued from the fteruum through the abdominal cavity, in an oblique direction, to each ilium or inguen; after which the clavicles are to be feparated from the fteraum, or this bone divided at its fuperior cartilaginous junétion, with a strong knife, diffecting it from the mediaftinum, and turning it downwards with the mufcles, &c. of the abdomen. This is the most elegible manner of opening thefe cavities, and gives an opportu 843. For longitudinal wounds of the extremities, the uniting bandage is ufed with the fame advantage as has been already mentioned for wounds of a fimilar nature upon the head.. CHAP. XXXVI. OF THE METHOD OF O. nity of fewing them up with a better appearance PENING A DEAD BODY. 844. SURGEONS are often called to inveftigate the caufe and feat of difeafes and death, either by the relations of the difeafed, or the magiftrates to whom a report is to be made; therefore, at the time of performing this operation, minutes fhould be taken of what is obferved. The inftruments, and all things neceffary, should be difpofed in order, as for any other operation; as knives, a razor, a great and fmall faw, fciffars ftraight and curved, elevators, needles threaded, fponges, tow, faw-duft, or bran, bafons with water, towels, and receivers for the vifcera when they are to be taken out of their cavities. The body is to be laid upon a fuitable table, advantageously placed for the light, having a cloth thrown over the parts which decency demands fhould be concealed efpecially in females. 845. When it is intended only to infpect the abdomen and its contents, a longitudinal incifion from the xiphoid cartilage to the os pubis, interfected by a tranfverfe one at the navel, will give a fair opportunity of anfwering thefe purposes, when the angles are reverfed. Should it be required to examine all the three cavities, and the parts contained in them, we are to begin by open ing the head, making an incifion quite crofs to the bone, from ear to ear; which fection is preferable to the crucial commonly made on this occafion then the fcalp may be easily diffected from the skull, and turned down over the face, and towards the neck, giving room for the faw. The head must be held very steadily by an affiftant during the fawing, which should be begun on the middle of the frontal, proceeding to each temporal bone, and fo to finish the circle upon the middle of the occipital bone; which may generally be done conveniently enough, by railing the head and inclining it forward, after having procecded as far as this bone; or the body may then be turned prone, fhould that pofture be found. more convenient to complete the circle. The cap of the skull is then to be railed with the ele vator, occafionally cutting the adhesions of the dura mater; after this the encephalon is to be removed, carefully feparating the other attachments of the membrane. 845. To bring the thorax and abdomen, with the parts contained in thefe cavities, under one view, an incifion is to be made on each fide or the ster um, in the course of the corulaves of the ribs which are annexed to it; diffecting from for any perfon's view, afterwards. That kind of ftitch called by sempftreffes the herring-vone or Aat feam has a very pretty and neat effect upon these occations, 847. If it is propofed to take out the thoracic and abdominal vifcera together, for further examination, the diaphragm is firit to be cut down to the fpine on both fides; then, to avoid being incommoded with blood, &c. two very strong ligatures are to be paffed round the cefophagus and large blood-veffels, in which the trachea may be included; tying them ftrait, and then dividing these parts between the ligatures: the fame meafures are to be taken in respect to the inferior veliels upon the lumbar region, a little above the bifurcation of the acrta, including the vena cava¡ and alfo upon the rectum. After having obierved these precautions, the vifcera, with the diaphragm, are to be removed by a wary diffection, ali the way close to the fpine; and by gently drawing them at the fame, time, the feparation will be greatly facilitated. 848. When the thoracic and abdominal vifceri are to be taken out feparaicly, in the firft cafe ligatures must be made, as have been defcribed upon the veffels, &c. just above the diaphragm, and in the other juft below it, and upon the rec tum. 849. If called upon to perform this office when the body is become very putrii, it will be abf. lutely neceffary to have fuch parts of it well walled with warm vinegar and brandy, and then fprinkled with lavender water, or fome such oderiferous antiputrefcent liquor, before the examination, in order to correct the fench, and defend us against the noxicus quality of the fluvia: a precaution, the neg.ect of which may be attended with very diretul effects. CHAP. XXXVII. OF EMBALMING DEAD 850. In the early ages of the world, the prac← tice of embalming dead bodies was very commen, particularly among the Egyptians; but it ha long been difuf-d in almoft all countrics, except for great perfonages. See EMBALMING. following directions are taken from Mr Gouch, to whom they were communicated by a person of great character, and well acquainted with the modern practice of embalming this kingdom, The 851. After evifceration, as has been directed in opening a dead body, and containing the i cifer farther upwards, even it to the mouth, as e, f predicabre, practicable, without cutting the fkin of the neck, 852. After the application of the cerecloth, ABDOMEN, Wounds of the, 36 39 : 6567 : paracentefis proves Gooch's machine, 779. furgery in Arabia, 17. ing them well everywhere, the face, being close INDE X. 799: method of performing 449-451, 453. ,754, 755. ANTISEPTICS, 122. his system of surgery, 21: his ARM, luxations of the bones of ARTERIES, Wounds of, 32: fu- 13. B. BAG, fufpenfory, 601. BANDAGES, BANDAGES, prescribed by Hip- BREASTS of women, cancer in furgeons, 19 BELL, Mr Benj. his formula of BRONCHOTOMY, operation of, BUTTOCKS, excoriation of the, BENIGN Node, 277. BOILS of the gums, 488, 489. C.. CALCULUS. See STONE. CAPSULAR ligaments, collec- CARIOUS ulcers, 125, 136, 137: CARTILAGCIOUS Concretions in CATARACT, 432: treatment of DIVARICATION of the offcous |