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SHEPHJEBU-M^D., CM, Surgeon to the Montreal General Hospital ; Professor of Anatomy and Lecturer on Operative Surgery, McGill University. MONTREAL : C3-A.ZETTE PRINTING- C0M:I»-A.NY. J 890. T vVuU-O RETROSPECT OF SITRGEIIY. By Francis J. Siikpiii i;!>, M.D., CM., M.R.C.S., Eng. Surgeon to the Montreal Genoml Hospital: Prof ossor of Anatomy iinel Lecturer on Opcrntivo Surgery, McOiU Univer.-iity. Operative Treatment of Enlarged Prostate.— '^hQ treatment of enlargement of the prostate is a problem which constantly presents itself to every surgeon, and so far its solution is not the most satisfactory. In a certain proportion of cases the judicious use of the catheter yields fairly good results, but in many of these cases a day comes when even the friendly cathete.- cannot be depended upon, and something else has to be tried. Cystitis or other accident may intervene, and to obtain relief operative measures are undertaken. The simplest operation is perineal section, and marked relief is often afforded, but very frequently this relief is only temporary. When the cause of the obstruction to the outflow of ui iue is hypertrophy of the prostate, no proce- dure which does not aim at removing this cause will prove of any permanent benefit. At the meeting of the British Medical Association hold at Leeds in August last, Mr. McGill opened a discussion on '^ The Retention of Urine from Trostatic Enlarge- ment " {BritUh Medical Journal, Oct. 1 1>, 1889). His paper was based on twenty-four operations of prostatectomy through a suprapubic incision, performed by various surgeons at the Leeds Infirmary, lie submitted and discussed the following proposi- tions : — (1) The prostatic enlargements which give rise to urinary symptoms are intravesical and not rectal. (2) The retention is caused by a valve-like action of the intra- vesical prostate, the urethral orifice being closed more or less completely by the contraction of the bladder and its contents. (3) That in many cases self-catheterism is the only treatment rcks the oneraLn might be blamed. He does not th.nk ,t matters much how the kidney is reached. Mr. Tait has several t.mes opened the abdomen expecting to find ovarian tumors, and has found t cancers of the kidney. The conclusions he draws from h,s ex erienee are that all tumors of the kidney, a 1 suppurat.ng kleys, and all kidneys with persistent, incnrable and unbear^ able pain in them, should be exposed by mc,s,on, la.d open and Troughly explored by the finger-tip. Stones may then be re- 1 edrabscesses drained, and hydatid or cyst.c growths removed Tith trifling risk. He also said that mere explorat,on m some cases of tumors leads in a mysterious way to a cure. Mr Brnee Clark related an interesting case where fadmg to find stone by needle puncture, he closed the wound. The patient, „"t bein. relieved, returned again. The kidney was agam ex- Ired tlis time by the linger, but no stone found, so the Wney ^rexcised, and on examining it a small, sharp stone, the s.a 8 of a pea, was found hidden away in one of the recesses of the organ. He advocated the removal of large diseased kidnejs by the anterior incision. Mr. Kendall Franks of Dublin called attention to a class of cases which were not uncommon, viz., those in which the diag- nosis of renal calculus was almost certain, and in which the symptoms clearly indicated the affected side, and yet in which, when the kidney was exposed, the most careful digital manipu- lation and the most systematic exploration with a long needle failed to detect the presence of a stone. In such cases formerly the wound was closed, or, as Mr. Morris had done, the organ was excised. Mr. Franks advocated incising the kidney in situ and searching for the stone systematically v/ith the finger. Mr, Franks laid stress upon the importance of leaving the wound in the kidney to granulate without using any means to close it. He advocated excision in casts of tubercular disease of the kidney. Nephro-Lithotomy. — Mr. H. A. Jacobson, in some clinical remarks delivered at Guy's Hospital (^British Medical Journal, Jan. 18, 1890) on the Symptoms and Conditions which justify Nephro-Lithotomy, makes remarks on the following symptoms : (1) Continued haeraaturia or passage of blood and pus ; (2) pain or tenderness in the loin and elsewhere ; (3) points connected with previous history, e.g., habitat, habits, lithiasis, oxaluria, passage of previous stones, renal colic ; (4) frequency of mic- turition ; (5) absence of any condition in the rest of the urino- genital tract to explain the symptoms ; (6) failure of previous treatment. The chief conditions simulating renal calculus are : (1) Lithiasis and to a less degree oxaluria ; (2) tubercular kidney ; (3) pyelitis, not tubercular ; (4) movable and (5) ach- ing kidney, especially if associated with (6) neuralgic conditions ; (7) disease in organs contiguous to the kidney ; (8) disease of lumbar spine ; (9) interstitial shrinking nephritis ; (10) malig- nant disease of the kidney, especially of the pelvis, and malig- nant disease around the 12th dorsal nerve (a case is reported). The chief practical points in the performance of nephro-lithotomy he considers to be as follows : (1) To count the ribs ; the last rib ma v be rudimentary and the 11th mistaken for it. 9 (2) To make a sufficiently free inciBion. (3) To pack away with sponges the colon, which is often troublesomely distended in these cases with flatus. (4) If a stone cannot be felt in pelvis or after palpation an- teriorly or posteriorly, the kidney should be drawn out as far as possible and carefully examined. (o) In puncturing the kidney, the calyces should be opened systematically. (6) When palpation and acupuncture fail to find the stone, then the kidney should be opened and carefully sounded. (7) Hemorrhage from kidney is easily arrested by careful, firm pressure. (8) Sources of difficulty in finding a stone are (a) mobile kidney, (b) stone in anterior part, and (c) stone in a sacculated kidney. (9) In large suppurating kidney first incise freely and drain kidney before performing nephrectomy. I cannot agree with Mr. Jacobson as to the method of explor- ing the kidney, and my experience has been that in those cases where the stone is small and hidden away in one of the calyces, there is often little chance of its being found either by palpation, needling, or the introduction of a sound, A free incision into the kidney and exploration with the finger is the only certain method of finding these calculi. I have several times cut down on the kidney for suspected calculus, palpated, needled and used the sound, yet failed to find the stone ; but in the last case I made a free incision into the posterior border of the kidney, intro- duced my finger, and soon came across a small stone encapsuled at upper end of organ. I have never had any difficulty in arrest- mg hemorrhage, and have never found it necessary to plug the wound with gauze ; pressure with sponge or finger easily arrests any hemorrhage, even when it is very free. 1 have no doubt at all that many of the so-called cases of nephralgia which have been operated on have been cases of stone undiscovered, because not thoroughly searched for with the finger through a sufliciently large incision. Br, E. L, Keyes of New York recently read a most interepting lA 10 paper on Nephro-Lithotomy before the Medical Society of the State of New York (^N. Y. Medical Record, Feb. 8th, 1890). His experience extends to six cases of actual or suspected stone- In one case the kidney was filled by a large-branched calculus weighing two ounces, which was extracted in pieces wiih great difficulty ; there was much hemorrhage, which was arrested by hot water. Dr. Keyes' conclusions are as follows : (1) The posterior exploratory incision upon a kidney suspected to contain stone is devoid of any serious danger when performed with proper care, and should be resorted to more often than it is. (2) The best incision is the transverse, below the 12th rib, with as much of a liberating incision downwards along the edge of the quadratus as may be required to gain ample room. (3) The kidney may be freely cut into and rudely lacerated with the finger, when the stone calls for it, without producing any hemorrhage which hot irrigations will not control. (4) It is better, in the case of a large branching calculus, to break it up and extract it in fragments rather than attempt to remove it entire. (5) So little danger attaches to the posterior incision that it seems wiser always to make it the first step, reserving peritoneal exploration for a later resource in cases where the posterior operation miscarries. Calculus Removed from the Ureter. — A paper was read at a recent meeting of the Clinical Society of London by Mr. Twynara of Sydney, New South Wales (^Lancet, Feb. 1, 1890), describ- ing how, in a child aged 8 years, a calculus was successfully removed from the ureter. The patient entered hospital suffering from pain in the abdomen and haematuria. Pain was felt over the pubes and at tip of penis after micturition. No stone in bladder. Distinct tenderness in left loin. High temperature. On Feb. 6th an exploratory incision was made in the left linea semilunaris and the left kidney and ureter examined, but no stone found. A calculus was found, however, in the right ureter two inches from the bladder, and when pressed upon could be felt through the rectum. The stone was removed by linear in- cision in a subsequent operation, because patient had a tempera- •<* i 11 i ture of 106*' and convulsions. Incision was made as if to tie the common iliac artery. Some difficulty was experienced in isolating the ureter, but it was ultimately accomplished and the stone removed with forceps through a linear incision. It weighed six grs. and was the size of a No. 12 catheter. The wound in the ureter was closed with fine silk, a drainage tube was intro- duced into the wound cavity, and the wound dressed with sali- cylated wool. Urine ceased to flow from wound on the fifth day, after which it rapidly healed, and the boy made a perfect re- covery. The striking points in this case were (1) the difficulty of diagnosis owing to the fact that a stone in the bottom of the right ureter caused pain in the region of the left kidney, (2) the novel method of removing a stone situated so low down in the ureter. [n his Harveian lectures on the Surgery of the Kidney, Mr. J. Knowsley Thornton {Lancet, Dec. 7th, 1889), in speaking of puncture and lumbar nephrotomy, briefly summarizes as follows : He would restrict puncture (1) to decide in doubtful cases be- tween solid and fluid tumors of the kidney ; (2) to relieve pain- ful distension when nephrotomy for some special reason is not at once advisable or possible ; (3) to remove urine, serum or pus from a very large tumor to reduce its bulk in the performance of nephrectomy ; (4) as a tentative attempt at cure in some cases of simple cyst or hydronephrosis ; (5) to localize the posi- tion of renal or circurarenal abscess when the physical signs are not clear enough for free incision ; and (6) to gain time and relieve harmful tension in some cases of calculous suppression. He would restrict the use of nephrotomy to (1) calculous sup- pression in which the incision seems preferable to mere puncture, with the chance of being able also to remove the stone ; (2) for the cure by subsequent drainage of simple cysts, abscesses and hydatids ; (3) for the cure by subsequent drainage of traumatic pyonephrosis or pyelitis, and in the early stages. of tubercular suppuration ; (4) for the possible cure of more advanced calculous or tuberculous suppurations when the patient will not submit to nephrectomy ; and (5) for the performance of nephro-lithotomy in some cases. Mr. Thornton strongly objects to lumbar nephrec- 12 tomy for tumors of the kidney, one of the objections being the possibility of not being able to find the kidney, an accident that has happened to experienced London surgeons in a large number of cases ; another, that a single kidney may be removed. He being an abdominal surgeon, is altogether in favor of the abdomi- nal method by the lateral incision of Langenbuch along the outer border of the rectus muscle. If it be necessary to drain, a Keith's glass tube is used, and should be cleaned each day under the spray. He says that, as a precise and scientific operation, there is no comparison between the abdominal operation and its lumbar rival. After the operatioii he allows no opium or stimulants, but if it is absolutely necessary to give a sedative, he gives potassium bromide and chloral injections per rectum. Mr. Thornton has only had a mortality of 20 per cent in his cases of nephrectomy. Wounds of the Kidney. — M. TaflBer of Paris, in an article on Wounds of the Kidney {Archiv GSn. de Med., March 1889), says that in cases of wounds of the convex edge of the kidney there occurs a copious hemorrhage from a network of veins in the cortical substance of the organ, this being easily arrested, however, by slight compression. Wounds of kidney are not followed by urinary infiltration ; they have a remarkable tendency to heal rapidly and without suppuration, — in 69 cases only seven suppurated. Hemor- rhage, in case of injury of the hilus, is, next to shock, the most important symptom, and this may be so profuse as to be followed by death from this cause alone. In bullet wounds, secondary hemorrhage is frequently observed. Haematuria in wounds of the kidney is characteristic, though not always present (18 in 31). Anuria is the exception. Under the head of complications may be mentioned prolapse of the kidney. This may occur w'thout any injury of the kidney having taken place. Suppurative processes are relatively infre- quent. Fistulas are very rare even after suppuration. Among 78 wounds of the kidney recorded in the surgical history of the war of the Rebellion, in only one case did a permanent fistula remain. Wrr^ 18 The prognosis in cases of wounds of the kidney must be cautiously given. Of course, if other internal organs are injured the case becomes much more serious. When a case presents itself it should be carefully cleansed antiseptically and precipitate nephrectomy should be avoided. Treatment of nome forms of Chronic Suppurating Kidneys by Perineal Puncture and Drainage. — In an article on the above subject, Mr. Reginald Harrison comes to the following conclusions {^Lancet, Dec. 7th, 1889) : (1) That in a large number of cases of simple suppurating pyelitis caused by obstruction below, the pus gradually and com- pletely disappears as the resistance to the urine is removed. This is exemplified in the ordinary treatment of urethral stricture by dilatation or otherwise. (2) That some advanced forms of chronic double suppurative pyelitis from obstruction below, where the suppuration continues to be excessive after the obstruction has been removed or re- lieved, are best treated by an opening in the perineum where the drainage is free and dependent and irrigation can be con- veniently employed. (3) Perineal puncture (elsewhere described by Mr. Harrison) best meets the requirements of these cases, and may be said to be free from risk. Mr. Harrison says that perineal puncture entails no prolonged confinement in bed. He has had patients going about ten days after operation. Mr. Harrison has devised a very simple contrivance consisting of a soft rubber drainage- tube for retention in the bladder by a T-bandage, to which is attached a continuation-tube fitted with a stop-cock, the end being retained in a belt around the patient's waist. (4) In cases of suppurating kidneys, where not too advanced, by making a dependent perineal opening, whatever remains of sound suppurating kidneys may be saved and life prolonged, whilst the comfort of the patient is materially added to. Ligature of the Common Iliac Artery for Hip-joint Ampu- tations. — Dr. Poffert of Giessen reports a case (^Deutsch. Med. Woch., No. 29, 1889) in which Prof. Bose had resorted to pre- liminary ligature of the common iliac artery as the first step in 14 a hip-joint amputation. The patient, a strong, healthy man, aged 40, had noticed for six months that his thigh had begun to swell above the knee, and that the past few weeks the swelling had increased rapidly and caused pain. Examination showed a tumor extending from the condyles to the groin, its upper limit being felt anteriorly under Poupart's ligament, and posteriorly a litde below the gluteal fold. The limb was cylindrical m shape, enlarged ; skin over tumor tense and shiny. Veins much dilated. No fracture of femur. Amputation was performed Dec. 11th, 1884. He first proceeded to tie the common iliac artery in the usual manner. The artery and vein were easily exposed, and seen to be surrounded by fat and enlarged glands. The vein and artery were ligated and the glands removed. The wound was closed, a drainage-tube being inserted at the lower angle. The amputation was now performed by anterior flap, consisting of only skin and fascia ; the posterior flap consisted of skin and muscular tissue, which here was healthy. Very little hemorrhage took place. The large wound was drained and closed with silk sutures. The pulse after the operation was excellent, and the patient made a rapid and perfect recovery. Tumor, a spindle-celled sarcoma, starting from bone. Four years after operation patient was perfectly healthy and free from return oi disesise. —{Qmtedin Annals of Surgery, Dec. 1889.) Tlie Use and Abuse of Drainage Tubes.— Mr. Rickman Godlee, in an interesting article on the above subject {Practi- tioner, Feb. 1890), comes to the following conclusions :— The advantages of doing without them are— (1) The healing is more rapid. (2) The scar is more uniformly linear. (3) The chance of failing with the antiseptic element is much diminished. Disadvantages are— (1) The temperature does not seem to keep so absolutely normal as we see it in perfectly drained wounds. (2) There is risk of blood or serum collecting under the flaps ; and while in many cases this may be absorbed, in others it will require removal, and then the cure is probably longer than it would have been if drainage had been employed at first. Dr. Hans Schmid of Berlin, in an article on the Changes in 15 • Value and in the Manner of Draining Woundu (Berliner Klinik, Hft. 11, May 1889), says that rubber tubes are fre- quently compressed by the dressings and bandages, and that their benefit is a delusion. Infection of wounds after operation is represented by two types— either a diphtheritic slough appears on both walls of the wound after union of the skin over the wound, or else a phlegmanous inflammation of the tissues obtains. In neither of these two cases are drainage tubes of any avail. Drainage tubes are frecjuently stopped at both ends by clots and granulations. They always act as foreign bodies, and may prove disastrous to an aseptic course by containing air. Finally, the presence of drainage tubes calls for an unnecessary change of dressing. Dr. Schmid has treated between 000 and 900 major surgical operative cases without drainage tubes, and in all cases he was contented with the results, and no case gave cause for serious apprehension, but once in a while retention of bloody serum occurred, which occasionally (if not speedily let out) would turn purulent.— (^Mo7, IC'J, lOi, 141, IM, W2, ZW, 240, 249, 1I52 Wouii.liof 157 Abiluminal Seution for relief ol Intua- Hunueution of lArge Bowel ....._.. 'M Absoes*. Cerwliral 71. KIT " Cold. Healed by Iodoform llljl'Ctiolli. ■• . M " of Luiiir iirid Empyema. Sur- dical Troatment of, UW " I'erityplilitio 25, 20.2 " Pulmoimryi Operfttlvt^ Treat- ment of. 164,197 " Subdiai>hruRmatic 119 AbscenseM and llyilaiids of the Liver. 2.^1 Aoro-Mepraly . . . . . •, . • • •.• • • • ■ • 147 Air (8terili«od), Injection ot m Pleu- ritic Effusion. .m^ Amputation of the Breast, Statistics of 101, 229 Aneuriam, Treatment by the Intro- duction of Steel Wire into the Sac ., '» " Sequel of Ligature ot Car- otid for Aortic 144 42 1H8 149 256 Angioma, Treatment of . Anterior Media.^tinum, Irephining (Jladiolus for Pus in . ■ • Antisepsis. Influence of, on Kidneys. Antiseptic Dressing, Sir ,1. Lister's New ■■••, Antiseptic Irrigation of Joints 141 Antiseptics in Internal Urethrototny. 1.1 Appendicitis , ^. 181. 202 Appendix. Pathology of 154 Artlirectouiy .••:■••:•• '^v:, '** of kneo Joint in Chil- dren ... 1H9 A«opsis, a Simple Method of Obtain- ing 112 Aseptic Bone Cavities, Healing of — 200 Aspirator, Mishapf from Use of 209 Ball's Operation for Hernia 125 Barker's " ". *• ^^ ■••■ 127 Bladder, Construction ot a Now, after Excision 258 " Stone in .......120 " Keinoval of Foreign Bodies in 94 " Ruptureof 84 " Tumours of 94 " " diagnosis by Klec- tro-Endo8copic Cystoscope. 15'> Blood-Clot, Healing under ...;.... ;;« Bone, Cavities, Healing ot Aseptic . 200 " Excision of, to Promote Heal- iDg of Soft Parts 208 Pior Bone, Osteogenic Faotori in Develop- ment and Repair of 86 Brain, Sarcoma of 81 " .Hurgeryof 40,70,71, IM, 172, 21H, 226 ill Dublin 138 " Tapping and Irrigation of V«n- trlctenof 218 Breast, Kexults of O|>(*ralions in Cancer of 161, 329 " Hecuri-ence of Cancer after Excision of 230 " Statistics of Cancer of 2:il Bronchooeic, Surgical Treatment of 06,119, 2.'W Cachexia Struiniprivtt ♦>*) Cwcuin and Apiiondix, Pathology ol . . 164 CanoerofBrea.Ht, Diagnosis and Treat- ment of " " " Results of Opera- tions in 161, " " " Local Recurrence of, alter excision. • " " " StatiHtical Results of Operation. ■• " " " Statistie.t ot ....... Curbunole, Excision and Scraping of.. Carotid Artery, Treatment of Hemorr- hage of . •• " '■ .Scriuel of Ligature of, tor Aneurism Catgut Rings as a Substitute for Seiin's bone Plates Catheter- Life Treated by Permanent Perineal Opening ••■ Cerebral Abscess in Ear Disease. . .71, Hemorrhugo, Trephining tor " Surgery... 40, 70,71,137, i:«*, Cholecystotomy for Gall Slone.s .104, Cleft-Palate, Elements of Success in Operations for Club-root, Treatment of Cocaine „ ;•,•••• V j ;."•• " Cold Absces.x, Treated by Iodoform Injection,s ■ ■ ■• Colotomy, Inguinal r». Lumbar. 2n, Compresses (Hot) in Surgical Practice Croup, Intubation for Cy-sfio Tumours, Treatment ot CyAtiti 232 22SI n) 229 231 13<) 144 144 204 222 137 22.^. 172 264 158 42 67 S3 217 203 117 219 143 Tubercular . I-'-^ Cystoscope lor Diagnosis of Tumours ofthcBladder !«»'• Digital Divulsion for Pyloric Stenosis ^' Exploration of (Esophu*us for Removal of Foreiga Bodies* 20 98 IV INDEX. I'AOK Diphtheria, Intubation for 117 Disinfection of Hands ■ *! Dressing, New and Original Method ot 41 " Lister'.s New Anti,septio ... 260 Ear, Cerebral Abscess in Connection with Disease of • • • VI Electrolysis for Stricture 32, lb9 Klcphantiasiis, Operative Treatment of. ; • • 11" Einpyoma, Danger of Wounding Dia- uhrugin in Operations for 49 " Due to Hydatids Wi " Operative Treatment of. . 111,162,105 Enterostomy or Lapiirotoniy 156 Epididymitis or Orchitis, Treatment yf • 41 Epilepsy, Trephining for -S .Epiphysis, Separation of Lower, in Femur ■ ■;■ ^^' Erysipelas, Curative Action of, in Tumours • . 'J Surgical Treatment of, inChildren 248 " Treatment of. .53, 173, 246, 217 Excision of Bone to Promote Healing I ot Soft Parts ••• 208 I " " Dislocated Semilunar Car- tilage 2.1,212 " " Hio-cwcal Valve 203 " Tongue 151 " " Tubercular Hip -Joints with Primary Union. 31, 40 Exsection of Intestiner ;;;••■ ^*'*' itlx tension in Pott's Disease and Ver- tebral Injuries ■■ 19° Eyeball, Enucleation of, with Trans- plantation and Reimplantation ot Eyes 41 Femur, Separation of Lower Epiphy- sis cf •,',•■■■ ■^ ' " Treatment of Ununited rrac- ture of 172 Flat- Foot, Operations on Tardus in. . . 208 Fractnre of Femur (Ununited) 172 " Patella 21 " •' Skull, Iniinediatc Treat- ment in 82, 140 195 106 106 171 106 6V (ji all-Bladder, Statistics of Operations Gall-stones, Surgery of . . . . . ■ ■ 102, " Obstructing the Intes- tines Galvano-Puncture in Enlarged Pros- tate ■ •••• • Gangrene (Pulmonary), Treated by Incision Gastrectomy (iastrorraphy ^f; Gastrotomy - . • • • ■ ; — ; •^- " for Digital Exploriition ot (Esophagus 98 Gladiolus, Trephining for Pus in An terior Mediastinum 108 Glands of the Neck, Surgical Treat- mentof 34,242, 2-13 Glottis, Intubation of. 54 Goitre, Extirpation of Isi " Ligature of Superior Thyroid Arteries for 66 " Operative Treatment of. . .65, 119 ?AOK Hands, Disinfection of 58 Healing Under Blood Clot 56 of Soft Parts Promoted by Excision of Bone 208 Heart, Removal of Noodle from 100 Hemorrhage, Cerebral, Trephining for 225 " Carotid, Treatment of. . 154 Tonsillar (Fatal) 145 Hemorrhoids, New Operation tor 69 •' Treatment ot, by Injec- tion 171 Hip-Joint, Primary Union after Ex- cision of li'l Hot Compresses in Surgical Practice. 303 Hydatid Cysts of Liver, rupture of . . 111?! M%J Hydatids of the Liver 108 Hydrogen Gas Rectal Inflation for Detection of Wounds of Intestines 153 " " Inflation of Stomach, for Detecting Perfor- ation 181 Hypertrophy of the Tonsils and its Treatment 220 Ilio-Crecal Valve, Excision of, for Carcinoma , 203 Infection, Physiological Resistance of the Peritoneum to 249 Inguinal Colotomy vermn Lumbar 215 Insanity following Surgical Opera- tions 212 Intestinal Obstruction Treated by Laparotomy 142, lh8, 202 Intestinal Surgery. , . .97, 142. 156, 202, 239 Intestines, Exsection of, a Method of Operating to Lessen the Dangers 206 Obstucted by Gall-stones lOt) '" Perforation of, treated by Laparotomy 141 " Resection of 239, 240 " Wounds of. Detected by Hydrogen Gas 153 Intubation of the Glottis... 54, 117 Intussusception of Large Bowel Treat- ed by Laparotomy 20<) Iodoform Injection in Cold Abscesses. 83 Irrigation of Joints 141 Joints, Antiseptic Irrigation of 141 Joint, Sacro-iliac, Trepliinicg in Dis- ease of 259 Kneo-Joint, Antiseptic Irrii tion of, 1 for Chronic Synovitis 24 I " Arthrectomy of in Chil- j dren.. 189 I Kidney, Kxtirpiition of 3, 7 , " Malignant Degeneration of.. VO : " Method of Examining. 89 " Stone and Kidney Mobility. ! 90, 92 Surgery of 1,89, 2it>, 240 " Influence of Antiseptics on. . 149 '■ " Suppuration of, Treated by I Drainage 11 Lanolin in Skin Diseases S-l Laparotomy for (iall -Stones lOO ! " " Obstruction of Intes- I tines 142 '' " Intussusception 200 " Results of, in Intestinal j Obstnictiim 156 I " or Entoioiiomy 156 INDEX. PAGE Leuoocythsemia, Splenotomy for 93 Ligature ot Carotid 144 Lip, Cancer of 51 Lister's (Sir Joseph) New Antiseptic Dressing 256 Liver, Hydatids of 108, 253 " Resection of Left Lobe 143 " Surgery of 250, 253 Lithotomy 17 Renal 9 '' Suprapubic 13 Lumbar, Choleoystotomy 25;-- Colotomy 215 Lung, Abscess of 164, 165 Macewen's Operation for Hernia 123 Meningeal Hemorrhage, Trephining in 5», 151 Mishaps from Use of Aspirator 20i> Mu£ilin Plasters in Skin Diseases 55 Naso-pharyngeal Tumours, Removal ot, by Operation 199 Neoplasms, Return of Extirpated ... 134 Nephralgia, Division of Capsule of Kidney for Keliefof 240 Nephrectomy 8, 40 " for Sarcoma 7 " by Combined Abdominal and Lumbar Sections. 9 Nephro-Lithotomy 10 " " after Nephrectomy 10 Nephrotomy 10 Nerve, Transplantation of, from Rab- bit to Man 146 Obstruction of Intestines Treated by Laparotomy 142 0