General surgical pathology and therapeutics : in fifty-one lectures / by Theodor Billroth ; translated from the fourth German edition, with the special permission of the author, and revised from the eighth edition, by Charles E. Hackley.

  • Billroth, Theodor, 1829-1894. Allgemeine chirurgische Pathologie und Therapie. English
Date:
1881
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Licence: Public Domain Mark

Credit: General surgical pathology and therapeutics : in fifty-one lectures / by Theodor Billroth ; translated from the fourth German edition, with the special permission of the author, and revised from the eighth edition, by Charles E. Hackley. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

    763/806 (page 737)
    RESECTIONS. 73’7 When these operations were first done, they seemed so difficult that it was thought the joint should be exposed by large, deep flaps, so that ligaments and muscular insertions could be readily divided, and the ends of the bones sawed off. Later, as more Avas thought of making a useful joint, the operation was more carefully made; oblique sections of tendons and large wounds were avoided; the periosteum Avas preserved as much as possible, and also its connec- tion with tlie muscular insertions, by using the raspatorium instead of the knife; and in chronic inflammations operations were done in the thickened tissue, Avhere they were folloAved by less inflammation and febrile reaction than in healthy parts. JB. von Langenheck, more than any one, developed the indications for resections of joints, and perfected the methods of performing them; he also introduced the simple longitudinal incision, Avhich is noAv generall}' used for resec- tion of the shoulder, elbow, and hip ; for the knee an anterior flajj is made, with a broad base above. The instruments used for resections, except the chain-saw (of Jeffiray), are the same as recommended by T^on Langenheck: a strong knife, five to seven centimetres long, Avith straight edge and thick back ; this knife is introduced to the bone, and the entire incision made at one stroke; Avith a broad, small, more or less cui-ved, half- sharp raspatorium, the periosteum is scraped from the bone; the articular ligaments and some muscular attachments cannot always be detached in this way, and have to be divided close to the bone. When the ends of the bone have been entirely denuded of soft parts, they are saAved off, being held by bone-forceps, Avhile the soft ]3arts are held back with blunt hooks. Sharp edges of bone are to be removed Avith bone-nippers. Before the operation the patient is anaesthetized, and the limb to be operated on is rendered bloodless by the elastic bandage and carefully cleansed. After the operation the haemorrhage is to be carefully checked, and the wound Avashed with ncAV, clean sponges ; then the limb is placed in an apparatus to keep it perfectly im- movable, but not too tight, allowing the Avound to be free and the secretion to escape readily; the patient’s position should be easy, and changed Avithout disturbing the dressing. I have not found it Avell to fill the Avound Avith charpie and apply a bandage before loosening the pressure above the Avound; for iii so doing the Avhole bandage is so filled Avitli blood that it must be soon renewed. T prefer first checking the bleeding completely by liga- tion, acupressure, ice-Avater, etc.; then I introduce drainage-tubes, dipped in glycerine or carbolic-acid solution, to conduct the secretion into vessels placed beneath.