Joseph Bell - A Manual of the Operations of Surgery

To retain the small size of the work and to keep it up to date have been the Author's aim in the Fifth Edition.

Having been asked, year after year, by the members of my Class for Operative Surgery, to recommend to them some Manual of Surgical Operations which might at once guide them in their choice of operations, and give minute details as to the mode of performance, I have been gradually led to undertake the production of this little work.

My aim has been to describe as simply as possible those operations which are most likely to prove useful, and especially those which, from their nature, admit of being practised on the dead body.

In accordance with this plan, neither historical completeness of detail, nor much variety in the methods of performing any given operation, is to be expected. Hence, also, many omissions which would be unpardonable in the briefest system of Surgery are unavoidable. For example, excision of tumours and operations for necrosis are hardly mentioned, because for these no special instructions can well be given; for, while general principles may guide us to what should be done, the special circumstances of each case must dictate how it is to be done.

In such a work as this, to attempt originality would be undesirable and intrusive; a judicious selection, a faithful compilation, are all that can be expected.

That the selection of operations may sometimes show "Northern Proclivities" is possible; and this is perhaps not unnatural to a scholar and teacher in the Edinburgh School.

An earnest endeavour has been used to make the references correct and copious: for any mistakes or omissions the author would crave indulgence.

The four plates which precede the letterpress were drawn on wood (from original photographs) by Mr. D.W. Williamson, Melbourne Place, and the lines of incision for the various operations were added by the author.

The rough woodcuts scattered through the work were drawn on wood by the author, and for their roughness he, not his engraver, is responsible. He also hopes that the references in the letterpress will be accepted as sufficient acknowledgment of the true ownership, in those few instances in which the idea of the diagram has been borrowed.

It has been thought unnecessary to introduce woodcuts of surgical instruments, as the illustrated catalogues lately published by Weiss, Maw, and others, are sufficiently accurate.

In excuse of the frequent baldness and brevity of the style, the author must point to the size and price of the work. Its composition would have been easier had its dimensions been greater.

Though intended chiefly to guide the studies, on the dead subject, of students and junior practitioners, the author ventures to hope that the Manual may be useful to those who, in the public services, in the colonies, or in lonely country districts, find themselves constrained to attempt the performance of operations which, in the towns, usually fall to the lot of a few Hospital Surgeons.

5 Castle Terrace, Edinburgh,

July 1866.

PLATE I.

1. Ligature of Aorta—Sir A. Cooper's incision.

2. Ligature of Aorta—South and Murray's incision.

3. Ligature of Common Iliac.

4. Ligature of External Iliac—Sir A. Cooper's.

5. Ligature of Femoral in Scarpa's triangle.

6. Ligature of Femoral below Sartorius. 1 1 This line is placed too low down; it should be in the middle third of the thigh.

7. Ligature of Innominate.

8. Ligature of third part of Left Subclavian.

9. Ligature of Axillary in its first part.

10. Ligature of Axillary in its third part.

11. Ligature of Brachial.

12. Amputation of Arm by double flaps.

13. Amputation at Shoulder-joint (1st method), showing portion of skin left uncut till the conclusion of the disarticulation.

14. Amputation at Ankle-joint by internal flap—Mackenzie's.

15-16. Amputation of Leg just above the Ankle-joint.

17-18. Amputation below Knee—modified circular.

19. Amputation through Condyles of Femur—Syme, and Pl. III. 5.

20. Amputation at lower third of Thigh—Syme, and Pl. III. 6.

A. Excision of Head of Humerus.

B. Excision of Knee-joint; semilunar incision.

PLATE II.

1. Amputation at lower third of Fore-arm—Teale's.

2-2. Amputation at Shoulder-joint by large postero-external flap—2d method.

3-3. Amputation at Shoulder-joint by triangular flap from deltoid—3d method.

4-5. Amputation through Tarsus—Chopart's.

6-7. Amputation at Knee-joint.

8. Amputation by Single Flap—Carden's, and Pl. IV. 16.

9-10. Amputation of Thigh—Teale's.

A. Excision of Hip-joint.

B-B. Excision of Ankle-joint—Hancock's incisions.

PLATE III.

1. Ligature of Popliteal.

2. Amputation at Elbow-joint—posterior flap.

3. Amputation at Shoulder-joint—posterior incision of first method, and Pl. I. 13.

4. Amputation at Ankle-joint—Mackenzie's, and Pl. I. 14.

5. Amputation through Condyles of Femur—Syme, and Pl. I. 19.

6. Amputation at lower third of Thigh—Syme, and Pl. I. 20.

7. Amputation at Knee—posterior incision.

8. Amputation of Thigh—Spence's, and at Pl. IV. 18.

9. Amputation at Hip-joint, and Pl. IV. 20.

A. Excision of Shoulder-joint—deltoid flap.

B. Excision of Shoulder-joint by posterior incision.

C. Excision of Elbow-joint—H-shaped incision.

D. Excision of Elbow-joint—linear incision.

E. Excision of Hip-joint—Gross's.

F. Excision of Os Calcis.

G. Excision of Scapula.

PLATE IV.

1. Ligature of Carotid.

2. Ligature of Subclavian (3d stage)—Skey's incision.

3. Amputation at Wrist-joint—dorsal incision.

4. Amputation at Wrist-joint—palmar incision.

5. Amputation at Fore-arm—dorsal incision.

6. Amputation at Fore-arm—palmar incision.

7. Amputation at Elbow-joint—Anterior flap, and Pl. III. 3.

8. Amputation at Arm—Teale's method.

9. Amputation at Shoulder-joint—1st method, and Pl. III. 3.

10-11. Amputation of Metatarsus—Hey's.

12-13. Amputation at Ankle—Syme's.

14-15. Amputation of Leg—posterior flap—Lee's.

16. Amputation at Knee-joint—Carden's, and Pl. II. 8.

17. Amputation of Thigh—B. Bell's.

18. Amputation of Thigh—Spence's, and Pl. III. 8.

19. Amputation of Thigh in middle third.

20-20. Amputation at Hip-joint, and Pl. III. 9.

A. Excision of Wrist—radial incision.

B. Excision of Wrist—ulnar incision.

Ligature of Arteries.—In a work of this nature there is no room for any discussion of the principles which should guide us in the selection of cases, or of the pathology of aneurism, or the local effects of the ligature on the vessels. One or two fundamental axioms may be given in a few words:—