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PREFACE

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THE FIRST EDITION.

THIS book is intended to be read by the senior student shortly before he goes in for his final examination, and after he has carefully studied a complete text-book of surgery. When I was about to present myself at the final examination for the Fellowship of the College of Surgeons, I felt the need of some such work. I had read not only more than one manual, but several special treatises and various essays. I had had at least ordinary opportunities of practical work, and I do not think I had wasted them. But I had made no complete series of surgical notes, nor could I possibly have made such a series without having unduly narrowed my reading or trespassed on the time spent in the hospital wards. And this very narrowing, still more this very trespassing, would have made me unqualified to make a good notebook at all. For, to make good notes, one should have some practical experience and some breadth of view. How many men have had to put aside as useless the

notes once laboriously made, but made with unripe knowledge, and with the bad judgment which such immaturity implies!

I am not dissuading students from taking notes while reading. The practice is highly to be commended for various reasons; for instance, it rivets the attention—an essential part of memory-and it frequently results in a note-book of high value, well worth re-perusal. But the more honestly that note-book is made, the more likely will the student be to find the examination drawing swiftly near and his reading creeping along but slowly. He feels compelled to desert his note-book, and frequently his text-book too. He either skims on to the end of the latter, haste and anxiety preventing him from thoughtfully studying it, or he leaves it altogether for the smallest 'Introduction' to surgery in the language. Now an 'Introduction' or 'Elementary Handbook' has its proper place in education; but that proper place is not the time just before a final examination, especially when it comes in to thrust out a more profound and elaborate treatise.

If the student knew that there was a short book accessible, containing the main facts and theories of surgery put concisely, classified and arranged in due order, and without superfluous explanation, he would be able to really study his familiar text-book up to the last month before his examination, relying upon such a short book to give form to any knowledge which then remained nebulous in his mind.

These considerations convince me of the justness of

the purpose of my book. Of its execution I will say nothing. The shortcomings of a book which, insignificant as it is, deals with questions of life and death, can scarcely be excused; they can only be lamented and condemned. But as I am convinced that it will do much more good than evil, and I believe I have done my best, I publish the work hopefully. These shortcomings would have been much greater if it had not been for the help in revision which has been given by Messrs. Alfred Street, Mills, Dunn, Alfred Back, Firth, and Charles Paget. Mr. Street has gone over the whole book. I cannot thank him too warmly. My friend and pupil, Mr. Charles H. Taylor, has made the Index of Names.

Messrs. Doran, Lyons, and Juler have added contributions on Ovariotomy, Toothache, and Ophthalmic Surgery respectively.

Mr. Juler desires acknowledgment to be made of the help given by Mr. W. Adams Frost and Mr. W. Langdon in the revision of the article on Ophthalmic Surgery.

Finally, I will express a hope that the practitioner, as well as the student, will occasionally find the book useful as a handy little work of reference.

20 PRINCES STREET, HANOVER SQUARE, W.

September 1881.

Erratum.

Page 28, line 5 from bottom, for 1-40 read 1-20.

INDEX OF SURGERY.

or not.

Abdomen, Contusions of.-Always examine patient very
carefully, but gently. Diagnose whether the viscera are injured
Three things protect against injury to the deeper struc-
tures, viz.: 1, thick and muscular abdominal walls; 2, empty
state of the viscera; and 3, the patient's foreseeing and expect-
ing the blow.

The parietal effects of a blow on the abdomen are, 1, rup-
ture of muscle; 2, mere bruising (which, however, may be very
serious in extent); 3, rupture of the peritoneum, with conse-
quent extravasation of blood into peritoneal cavity. Rupture
of a muscle causes temporary paralysis, swelling, &c. Some-
times the separation of the parts may be felt. Abscess may
follow contusion, burrow widely, and cause most troublesome
sinuses. Hæmorrhage from ruptured peritoneum may be fatal.
The collapse so produced is distinguished from the effect of
ruptured intestine by the comparative absence of great pain and
vomiting, and by positive signs of internal hæmorrhage.

A blow on the abdomen may cause serious and even fatal
collapse without visceral injury, possibly by damaging the ab-
dominal sympathetic system. Treatment.-Attend to collapse,
internal hæmorrhage, inflammation, and suppuration on gene-
ral principles. Avoid purgatives. In case of peritonitis, use
leeches, warm moist applications, and a liberal allowance of
opium. Mercury in case of sthenic inflammation. When
there is injury to a viscus, the particular one injured depends
chiefly upon the place where the force is applied. Each viscus

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