XXXI. DISEASES AND INJURIES OF THE LYMPHATICS .

Lymphangitis, 683. Lymphadenitis, 683: Acute Lymphadenitis, 683.
Chronic Adenitis, 684; Lymphangiectasis, 684; Lymphangioma, 684;
Elephantiasis, 684; Malignant Lymphoma, or Hodgkin's Disease (see
p. 203).

XXXII. BANDAGES.

Spiral Reversed Bandage of Upper Extremity, 686; Spiral Bandage of all the Fingers (Gauntlet), 686; Spiral Bandage of Palm or Dorsum of Hand (Demi-gauntlet), 686; Spica of Thumb, 687; Spiral Reversed Bandage of Lower Extremity, 687; Bandage of Foot covering Heel (American Bandage of Foot), 687; Bandage of Foot not covering Heel (French Method), 687; Spiral Bandage of Foot covering Heel (Ribble's Bandage; Spica of Instep), 688; Crossed Bandage of Both Eyes, 688; Borsch's Eye-bandage, 688; Barton's Bandage (Figure-of-8 of Jaw), 689; Gibson's Bandage, 689; Crossed Bandage of Angle of Jaw (Oblique Bandage of Jaw), 689; Spica of Groin (Figure-of-8 of Thigh and Pelvis), 690; Spica of Shoulder, 690; Velpeau's Bandage, 690; Desault's Apparatus, 691; Recurrent Bandage of Head, 692; Recurrent Bandage of a Stump, 692; T-Bandage of Perineum, 692; Handkerchief Bandages, 692. Fixed Dressings : Plaster-of-Paris Bandage, 692; Silicate-of-Soda Dressing, 693.

XXXIII. PLASTIC SURGERY

683

685

693

Displacement, 693; Interpolation, 694; Retrenchment, 694. Skingrafting, 694: Reverdin's Method, 694; Thiersch's Method, 695. XXXIV. DISEASES AND INJURIES OF THE GENITO-URINARY ORGANS. . 696 Hæmaturia, 696; Tests for Blood, 696; Bleeding from Kidney-substance, 697; Vesical Hemorrhage, including Hemorrhage from Prostate, 698; Urethral Hemorrhage, 698; Frequency of Micturition, 699; Mobile Kidney, 700. Injuries of Kidney: Laceration or Rupture, 702; Perforating Wounds of Kidney, 703; Renal Calculus, 703; Abscess of Kidney, 705; Pyelitis and Pyelonephritis, 706; Perinephritis, 706; Perinephric Abscesses, 706; Hydronephrosis, 707; Pyonephrosis, or Surgical Kidney, 708 Operations on the Kidney: Nephrotomy, 709; Nephrolithotomy, 709; Nephrectomy, 710; Lumbar Nephrectomy, 710; Abdominal Nephrectomy, 710; Nephrorrhaphy, 711. Retention of Urine, 711. Injuries of the Bladder: Contusion of the Bladder, 714; Rupture of Bladder, 715; Atony of Bladder, 716; Vesical Calculus, or Stone in Bladder, 717; Cystitis, 722; Tumors of Bladder, 725. Operations on Bladder: Lateral Lithotomy, 726; Suprapubic Lithotomy, 728. Crushing of Vesical Calculi, 730. Litholapaxy (Bigelow's Operation), 730. Cystotomy, 735. Growths in Female Bladder, 736.

XXXV. DISEASES AND INJURIES OF THE URETHRA, PENIS, TESTICLES,

PROSTATE, SPERMATIC CORD, AND TUNICA VAGINALIS. Perineal Bruises, 736; Rupture of Urethra, 737; Foreign Bodies in the Urethra, 740. Urethritis, or Inflammation of the Urethra, 741: Simple Urethritis, 741; Traumatic Urethritis, 742; Gouty Urethritis, 742; Eczematous Urethritis, 742; Tubercular Urethritis, 743. Gonorrhaa, 743: Subacute or Catarrhal Gonorrhoea, 744; Irritative or Abortive Gonorrhoea, 745. Chronic Urethral Discharges: Chronic Urethral Catarrh, 745; Chronic Gonorrhoea, 745; Gleet, 745. Gonorrhoea in the Female, 749. Stricture of Urethra, 750. Epispadias, 752; Hypospadias, 752. Chancroid, 752. Phimosis, 754. Fracture of Penis, 754; Gangrene of Penis, 754; Cancer of Penis, 754; Amputation of Penis, 755. Hypertrophy of Prostate Gland, 755; Retained Testicle, 757; Orchitis, 757; Castration, 758; Epididymitis, 758. Hydrocele, 758: Congenital Hydrocele, 759; Infantile Hydrocele, 759; Encysted Hydrocele of Cord, 759; Funicular Hydrocele, 760. Hæmatocele, 760. Varicocele, 760.

XXXVI. AMPUTATIONS
Methods of Amputating: Circular Method, 764; Modified Circular
Method, 765; Elliptical Method, 765; Oval or Racket Method, 766;
Flap Method, 766. Special Amputations: Fingers and Hand, 767;
Disarticulation of a Metacarpo-phalangeal Joint, 768; Amputation of
Thumb, 768; Amputation at Wrist-joint, 768; Amputation through
Forearm, 769; Disarticulation of Elbow joint, 769; Amputation of
Arm, 770; Disarticulation at Shoulder-joint, 770; Amputation of Toes
and Foot, 771; Amputation at Tarso-metatarsal Articulation, 771;
Amputation through Middle Tarsal Joint, 773; Amputation at Ankle-
joint, 773. Amputations of Leg, 774: Sédillot's Leg Amputation, 774;
Modified Circular Amputation of Leg, 775; Amputation of Leg by a
Long Posterior and a Short Anterior Flap, 775; Amputation just below
Knee, 776; Disarticulation of Knee, 776; Amputation through
Femoral Condyles, 776; Amputation of Thigh, 777; Disarticulation
of Hip-joint, 777. Bronchocele, or Goitre, 778: Exophthalmic or
Pulsating Goitre, 780.

XXXVII. ASEPSIS AND ANTISEPSIS

Surgical Cleanliness, 780; Dry Antiseptic Method, 781. Preparations
for an Operation, 781: Disinfection of Instruments, 782; Antiseptic
Preparation of Patient, 782; Antiseptic Ligatures, 782; Antiseptic
Dressings, 783. Preparation of Marine Sponges, 784; Cleansing
Vagina and Rectum, 785; Senn's Decalcified Bone-chips, 785.

736

761

780

A MANUAL OF SURGERY.

I. BACTERIOLOGY.

BACTERIOLOGY is the science of micro-organisms. Though a science in the youth of its years, bacteriology has not only profoundly altered, but it has also revolutionized, pathology, and our views of surgery will be incomplete, misleading, and erroneous without its aid.

Micro-organisms, microbes, or bacteria are minute vegetable cells of the class fungi, many of them being visible only by means of a highly powerful microscope after they have been brightly stained. The contents of these cells is protoplasm enclosed by a structure like cellulose. The protoplasm can be stained by aniline colors, and the cellwall is more readily detected after treating it with water, which causes it to swell. Many of these organisms are colored, others are colorless. Some move (motile bacteria), others do not move; among the motionless ones may be mentioned the bacilli of anthrax and tubercle.

Definite knowledge of these minute bodies and of their actions dates from the study of fermentation by the celebrated Frenchman, Pasteur, who in 1857 asserted that every fermentation has invariably its own specific ferment; that this ferment consists of living cells; that these cells produce fermentation by absorbing the oxygen of the substance acted upon; that putrefaction is caused by an organized ferment;

that all organized ferments are carried about in the air; and that to entirely exclude air prevents putrefaction or fermentation. These statements, which were radical departures from accepted belief, inaugurated a bitter controversy, and in that controversy were born the microbic theory of disease, the doctrine of preventive inoculation, and antiseptic surgery.

The word microbe, which signifies a small living being, was introduced in 1878 by the late Professor Sédillot of Paris. At that time the nature of these bodies was in doubt; some thought them animal, and called them microzoaria; others thought them vegetable, and called them microphyta; the designation "microbe" does not commit us to either view. We now know them to be vegetable, but the term "microbe" has remained in use.

The fungi connected with disease in man are divided into three classes:

1. Yeasts, or Blastomycetes;
2. Moulds, or Hyphomycetes;
3. Bacteria, or Schizomycetes.

Yeasts are small cells which multiply by gemmation, these cells often sticking together and forming branches, and containing spores when nourishment is insufficient. They are thought to be vegetative forms of higher fungi (Green). The chief importance of these cells is that they cause fermentations; they never invade human tissues. Yeasts may dwell on mucous membranes, and even in the stomach. Oidium albicans is an yeast-fungus whose growth upon the mucous membranes of the mouth, pharynx, and oesophagus causes the disease known as "thrush.”

Moulds consist of filaments, each filament being composed of a single row of cells arranged end to end, and all filaments springing from a germinal tube which grows from a germinating spore. Moulds are largely connected with processes of decay. Some of them can grow upon inflamed