 |
Radiation.—The introduction of a tube of radium into the stricture and its retention there, the silk thread attached to the tube being secured to the cheek by a strip of plaster, is described by Hill and Finzi as the most valuable palliative measure that has so far been employed in cancer of the gullet; the capacity of swallowing may be regained to a considerable extent. The employment of radium is rendered easier and more efficient if it is preceded by gastrostomy.
The Roux-operation.—This consists in making a new gullet to replace that which is obstructed; the abdomen is opened and a loop of jejunum is isolated; its lower end is anastomosed—end to side—to the stomach; the intestine is brought upwards through a tunnel made for it between the skin and the sternum, and the upper end is brought out and fixed to the skin, in the supra-sternal notch. It has scarcely passed beyond the experimental stage.
CHAPTER XXIX
THE LARYNX, TRACHEA, AND BRONCHI[7]
Examination of the larynx—CARDINAL SYMPTOMS OF LARYNGEAL AFFECTIONS: (1) Interference with the voice: Hoarseness; Aphonia—(2) Dysphagia—(3) Interference with respiration: Diphtheritic laryngitis; Acute oedema of the larynx; Intubation of the larynx; Tracheotomy; Bilateral abductor paralysis; Syphilitic affections; Tuberculosis—Tumours: Papilloma; Epithelioma; Sarcoma—Foreign bodies in the air-passages: In the pharynx, larynx, trachea, bronchi.
[7] Revised by Dr. Logan Turner.
Examination of the Larynx.—For this purpose the examiner requires a laryngeal reflector with forehead attachment, one or two sizes of laryngeal mirror, a tongue cloth, and the means of obtaining good illumination. The source of light should be by preference placed opposite to and on the same horizontal plane as the patient's left ear. The forehead reflector is placed over the observer's right eye so that he may look through the central aperture, while at the same time he throws a good circle of light into the patient's mouth. The patient should be seated with the head thrown slightly back; the tongue is protruded and covered with the cloth, and held lightly but firmly between the finger and thumb of the left hand. A full-sized mirror, warmed so as to prevent the condensation of the breath upon it, is inserted with the reflecting surface turned downwards, and pressed gently against the soft palate so as to push that structure upwards. The handle of the instrument is carried towards the left angle of the mouth, and by slightly altering the plane of the reflecting surface of the mirror the different parts of the larynx are in turn brought into view. The movements of the vocal cords should be observed during both respiration and phonation, and for the latter purpose the patient should be directed to phonate the vowel sound "eh."
In the upper part of the mirror the epiglottis usually comes first into view: it is of a pinkish yellow colour, and presents a thin, sharply defined free margin. In front of the epiglottis are the median and lateral glosso-epiglottic folds passing forwards to the base of the tongue, and enclosing the two valleculae. Extending backwards and downwards from the lateral margins of the epiglottis are the two ary-epiglottic folds which reach the arytenoid cartilages posteriorly. Between the two layers of mucous membrane of which the ary-epiglottic folds are composed are the cartilages of Wrisberg and Santorini. In the interval between the two arytenoid cartilages is the inter-arytenoid fold of mucous membrane, which forms the upper margin of the posterior wall of the larynx. The upper aperture of the larynx is bounded by the epiglottis in front, the ary-epiglottic folds laterally, and the inter-arytenoid fold behind. In the interior of the larynx the vocal folds (true vocal cords) form the most prominent features, being conspicuous as two flat white bands, which form the boundary of the rima glottidis or glottic chink. Above each true cord, and parallel with it, the ventricular fold or false cord is evident as a pink fold of mucous membrane. Between the ventricular fold and the vocal fold on each side is a linear interval, which indicates the entrance to the ventricle of the larynx.
Direct Laryngoscopy.—The larynx may also be examined by the direct method by means of Jackson's or Killian's spatulae. After cocainisation of the base of the tongue, the soft palate, and the posterior surface of the epiglottis, the patient is seated upon a low stool and his head supported by an assistant. The light is obtained from a small lamp in the handle of the instrument or reflected from a forehead mirror. The spatula is warmed and introduced under the guidance of the eye, its end being passed over the epiglottis, and pressure exerted so as to draw the latter structure forward. In children a general anaesthetic is required, and the examination is made with the head hanging over the end of the table. Killian's "suspension laryngoscopy" affords the best method of examining the larynx in young children.
Tracheoscopy and Bronchoscopy.—Direct examination of the trachea and larger bronchi may be carried out in a similar way, by passing through the mouth and larynx metal tubes, after the method devised by Killian. This procedure is described as direct upper tracheoscopy and bronchoscopy. The examination may also be made through a tracheotomy wound—direct lower tracheoscopy. These procedures have proved of great service in the recognition of foreign bodies in the lower air-passages, and in their extraction; in the diagnosis of stenosis of the trachea, and of aneurysm pressing on the trachea.
CARDINAL SYMPTOMS OF LARYNGEAL AFFECTIONS
The cardinal symptoms of laryngeal affections are interference with the voice and with respiration, and pain on swallowing. Laryngeal cough of a croupy or barking character may be present, and is usually associated with a lesion of the posterior wall or inter-arytenoid fold. Haemoptysis is seldom of laryngeal origin, and unless the bleeding spot is visible in the mirror, the source of the bleeding is much more likely to be in the bronchi or lungs.
Interference with the Voice.—Hoarseness results from some affection of the vocal cords: it may be simple laryngitis, some specific cause such as tuberculosis or syphilis, or some condition which prevents the proper approximation of the cords, as in tumours and certain forms of paralysis. Huskiness of voice occurring in a middle-aged person, lasting for a considerable period, and unattended by any other local or constitutional symptom, should always arouse suspicion of malignant disease, and calls for an examination of the larynx. Should this reveal a congested condition of one vocal cord, associated with some infiltration, and should the mobility of the cord be impaired, suspicion of the malignant character of the affection is still further increased. The hoarseness in these cases is sometimes greater than the local appearances would seem to account for.
Aphonia, or loss of voice, sudden in origin, and sometimes transient, occurs more often in women, and is usually functional or hysterical in nature. Although the patient is unable to speak, she is quite able to cough. In these cases there is a bilateral paralysis of the adductor muscles, so that the cords do not approximate on attempted phonation; or the internal tensors may be paretic, leaving an elliptical space between the cords on attempted phonation. If the arytenoideus muscle alone is paralysed, a triangular interval is left between the cords posteriorly. There is no inflammation or other evidence of local disease.
The treatment of functional aphonia should be general and local; tonics such as strychnin, iron, and arsenic should be administered; the intra-laryngeal application of electricity usually effects a sudden cure. In obstinate cases the use of the shower-bath and cold douching, the administration of chloroform, and even hypnotism may be tried.
An examination of the lungs should be made in all cases of adductor paralysis, as this functional condition may be met with in early pulmonary tuberculosis.
Dysphagia.—Pain on swallowing, due to causes originating in the larynx, is usually associated with ulceration of the mucous membrane covering the epiglottis, ary-epiglottic folds, or arytenoid cartilages, that is, in connection with those parts with which the food is brought into direct contact.
The most frequent causes of such ulceration are tuberculosis, syphilis, and malignant disease. The differential diagnosis is often difficult from local inspection alone. The Wasserman test, the previous history, the state of the lungs and sputum, and the results of anti-syphilitic treatment may clear it up.
The treatment of dysphagia, apart from that of the disease associated with it, resolves itself into the use of local sedative applications, such as a weak cocain or eucain spray before meals, insufflations of acetate of morphin and boracic acid, and the use of a menthol spray. One of the best anaesthetic applications is orthoform powder, introduced by means of the ordinary laryngeal insufflator. Its action is more prolonged than that of any of the others, often lasting for from twenty-four to forty-eight hours.
Injection of the superior laryngeal nerve with a 60 per cent. solution of alcohol has been found satisfactory where other means have failed.
Interference with Respiration.—It is only necessary here to refer to such causes of interference with respiration as may call for surgical treatment.
The chief forms of laryngitis to be considered in connection with the production of dyspnoea, are membranous or diphtheritic laryngitis and acute inflammatory oedema.
Diphtheria of the larynx is described on p. 110, Volume I.
Acute Oedema of the Larynx.—Oedema of the larynx may be inflammatory or non-inflammatory in origin. The former is the more common, and may arise in connection with disease of the larynx, such as tuberculosis or syphilis, or it may be secondary to acute infective conditions at the base of the tongue, or in the fauces or pharynx; more rarely it results from infective conditions of the cellular tissue or glands of the neck. The non-inflammatory form may be a local dropsy in renal or cardiac disease, may be induced by pressure on the large cervical veins, and in some cases it appears to follow the administration of potassium iodide in the treatment of laryngeal affections.
The oedema consists of an exudation into the loose submucous areolar tissue, which may be of a simple serous character or may become sero-purulent. The situations mainly involved are the glosso-epiglottic fossae between the base of the tongue and the epiglottis, the ary-epiglottic folds (Fig. 287), and the false cords. If the infective process commences in front of the epiglottis this structure becomes swollen and rigid, and often livid in colour—points which are readily discerned on examination with the mirror, or even without its aid in some cases. The patient complains of great pain on swallowing, and has the sensation of a foreign body in the throat. Should the oedema spread to the ary-epiglottic folds, either from the interior of the larynx or from the fauces and pharynx, dyspnoea becomes a prominent and grave symptom. The patient may rapidly become cyanosed, the inspirations assume a noisy, stridulous character, and great distress and imminent suffocation supervene. If laryngoscopic examination is possible, the ary-epiglottic folds may be found greatly swollen and the upper aperture of the larynx partly occluded. Digital examination may reveal the swollen condition of the parts. The urine should be examined for albumin and tube casts.
Treatment.—In the milder forms, the sucking of ice, the inhalation of medicated steam, or spraying with a solution of adrenalin, and the application of poultices to the neck, may suffice to relieve the condition. Scarification of the epiglottis and ary-epiglottic folds with a knife, followed by free bleeding, may give complete relief. Diaphoretic and purgative treatment should not be neglected. If suffocation is imminent, tracheotomy or intubation is called for.
In performing tracheotomy, a roller pillow is placed beneath the neck to put the parts on the stretch, and an incision is carried from the lower margin of the cricoid cartilage downwards for about 2 inches. The sterno-hyoids and sterno-thyreoids are separated; the cross branch between the anterior jugular veins, and any other veins met with, secured with forceps before being divided; and the trachea exposed by dividing transversely the layer of deep fascia which passes from the cricoid to the isthmus of the thyreoid. If the isthmus cannot be pulled downwards sufficiently, it may be divided in the middle line. All active bleeding having been arrested, the larynx is steadied by inserting a sharp hook into the lower edge of the cricoid cartilage, and the trachea is opened by thrusting a short, broad-bladed knife through the exposed rings. The back of the knife should be directed downwards, and the opening in the trachea enlarged upwards sufficiently to admit the tracheotomy tube. In children it is sometimes found necessary to divide the cricoid for this purpose (laryngo-tracheotomy). The slit in the trachea is then opened up with a tracheal dilator, and the outer tube inserted and fixed in position with tapes. The inner tube is not fixed, so that it may be coughed out if it becomes blocked, and that it may be frequently removed and cleaned by the nurse. The tube should be discarded as soon as the patient is able to breathe by the natural channel.
Intubation of the Larynx.—This procedure is employed as a substitute for tracheotomy, especially in children suffering from membranous and oedematous forms of laryngitis. As experience is required to carry out the manipulations successfully, and as its use is attended with certain risks which necessitate that the surgeon should be constantly within call, the operation is more adapted to hospital than to private practice. O'Dwyer's apparatus is that most generally employed. The operation consists in introducing through the glottis, by means of a specially constructed guide, a small metal or vulcanite tube furnished with a shoulder which rests against the false vocal cords. The part of the tube which passes beyond the true vocal cords is bulged to prevent it being coughed out.
In an emergency a gum-elastic catheter with a terminal aperture may be passed, as recommended by Macewen and Annandale.
Bilateral Abductor Paralysis.—Both recurrent nerves may be interfered with by such conditions as enlargement of the thyreoid, tumour of the oesophagus, or intra-thoracic tumour, or by injury in the course of operations for goitre. A gradually increasing inspiratory dyspnoea is developed, which at first is only noticed on exertion, when the desire for air is increased; later it becomes permanent, and even during sleep the stridor may be marked. Suffocation may become imminent. When the larynx is examined with the mirror, the vocal cords are seen to lie near each other, and on inspiration their approximation is still greater.
The treatment is directed to removing the cause of pressure on the nerves. In the majority of cases tracheotomy is called for and the tube must be worn permanently.
Syphilitic Affections of the Larynx.—Secondary syphilitic manifestations in the form of congestion of the mucous membrane, mucous patches, or condylomata, are occasionally met with, and give rise to a huskiness of the voice. These conditions usually disappear rapidly under anti-syphilitic treatment.
In tertiary syphilis, whether inherited or acquired, the most common lesion is a diffuse gummatous infiltration, which tends to go on to ulceration and to lead to widespread destruction of tissue. It usually attacks the epiglottis, the arytenoids, and the ary-epiglottic folds, but may spread and implicate all the structures of the larynx. Syphilitic ulcers are usually single, deep, and crateriform; the base is covered with a dirty white secretion, and the surrounding mucosa presents an angry red appearance. When the perichondrium becomes invaded, necrosis of cartilage is liable to occur.
Hoarseness, dyspnoea, and, when the epiglottis is involved, dysphagia, are the most prominent symptoms.
Cicatricial contraction leading to stenosis may ensue, and cause persistent dyspnoea.
The usual treatment for tertiary syphilis is employed, but on account of the tendency of potassium iodide to increase the oedema of the larynx, this drug must at first be used with caution. Intubation or tracheotomy may be called for on account of sudden urgent dyspnoea or of increasing stenosis. The stenosis is afterwards treated by gradual dilatation with bougies, which, if a tracheotomy has been performed, may conveniently be passed from below upwards. An annular stricture causing occlusion may be excised, and the ends of the trachea sutured.
Tuberculosis.—The larynx is seldom the primary seat of tubercle. In the majority of cases the patient suffers from pulmonary phthisis, and the laryngeal mucous membrane is infected from the sputum. The disease may take the form of isolated nodules in the vicinity of the arytenoid cartilages, of superficial ulceration of the vocal cords and adjacent parts, or of a diffuse tuberculous infiltration of all the structures bounding the upper aperture of the larynx. The mucous membrane becomes oedematous and semi-translucent. The nodules coalesce and break down, leading to the formation of multiple superficial ulcers. The parts adjacent to the ulcers are pale in colour. Perichondritis may occur and be followed by necrosis of cartilage and the formation of abscesses in the submucous tissue of the larynx or in the cellular tissue of the neck.
The voice becomes hoarse or may be lost, there is persistent and intractable cough, and in some cases dyspnoea supervenes. When the epiglottis is involved there is pain and difficulty in swallowing.
In the presence of advanced pulmonary phthisis the treatment is chiefly palliative, but if the disease in the lungs is amenable to treatment, and the laryngeal lesion limited, the electric cautery may be used. Tracheotomy may be called for on account of urgent dyspnoea.
Tumours.—The commonest form of simple tumour met with in the larynx is the papilloma. It may occur at any age, and is comparatively common in children. It most frequently springs from the vocal cords and adjacent parts, forming a soft, pedunculated, cauliflower-like mass of a pink or red colour, which may form a fringe hanging from the edge of the cord (Fig. 288), or may spread until it nearly fills the larynx. In children, the growths are frequently multiple and show a marked tendency to recur after removal. They sometimes disappear spontaneously about puberty.
The most prominent symptoms are hoarseness, aphonia, and dyspnoea, which in children may be paroxysmal.
The treatment consists in removing the growth by means of laryngeal forceps or the snare, under cocain and adrenalin anaesthesia. For the removal of multiple papillomata, the removal of the growths through Killian's tubes or by suspension laryngoscopy has now taken the place of the external operation in children. In a certain number of cases it has been found that the tumour disappears after the larynx has been put at rest by the operation of tracheotomy.
Cancer.—Epithelioma of the larynx is almost always primary, and usually occurs in males between the ages of forty and seventy. It is important to distinguish between those cases in which the growth first appears in the interior of the larynx—on the vocal cords, the ventricular bands, or in the sub-glottic cavity (intrinsic cancer)—and those in which it attacks the epiglottis, the ary-epiglottic folds, or the posterior surface of the cricoid cartilage (extrinsic cancer).
Clinical Features.—In the great majority of cases of intrinsic cancer the first and for many months the only symptom is huskiness of the voice, which may go on to complete aphonia before any other symptoms manifest themselves. When the larynx is examined in an early stage, the presence of a small warty growth on the posterior part of one vocal cord, or a papillary fringe extended along the free edge of the cord, should raise the suspicion of malignancy, especially if the affected cord is congested and moves less freely than its fellow. Early diagnosis is essential in intrinsic cancer, and the absence of enlargement of lymph glands, or of foetor and cachexia, must in no way influence the surgeon against making a diagnosis of malignancy. The impaired mobility of the affected cord is an important point in determining the malignant nature of the growth.
Intrinsic cancer may spread over the upper boundaries of the larynx and become extrinsic, or the disease may be extrinsic from the outset.
In cases of extrinsic cancer the early symptoms are much more marked, pain and difficulty in swallowing, and the secretion of frothy, blood-stained mucus being among the earliest manifestations. The cervical glands are infected early, sometimes even before there are any symptoms of laryngeal disease. Difficulty of breathing is also an early symptom on account of the growth obstructing the entrance of air. Tracheotomy may therefore be called for. In other respects the course and terminations are similar to those of intrinsic cancer.
When the growth spreads into the tissues of the neck the patient's sufferings are greatly increased. The oesophagus may be invaded with resulting dysphagia; the nerve-trunks may be pressed upon, causing intense neuralgic pains; the lymph glands become infected and break down, and the growth fungates through the skin. The general health deteriorates and death results, usually from septic pneumonia set up by the passage of food particles into the air-passages, from absorption of toxins, or from haemorrhage. The duration of this form of the disease varies from one to three years.
The treatment consists in removing the growth. In early and limited forms of intrinsic cancer laryngo-fissure (thyreotomy) gives good results; in more advanced cases the entire larynx must be removed—complete laryngectomy—and at the same time, or after an interval, the associated lymph glands are removed from the anterior triangle of the neck on both sides.
In cases in which excision is impracticable, the sufferings of the patient may be alleviated by performing low tracheotomy, and by feeding with the stomach tube or by nutrient enemata. In some cases the difficulty of feeding the patient may make it necessary to perform gastrostomy.
Sarcoma of the larynx gives rise to the same symptoms as cancer, and can seldom be diagnosed from it before operation.
Foreign Bodies in the Air-Passages.—Foreign bodies impacted in the pharynx usually consist of unmasticated pieces of meat or large tooth-plates, and they occlude both the food and the air-passages, frequently causing sudden death. They are considered with affections of the pharynx.
The bodies most frequently impacted in the larynx are small tooth-plates in the case of adults, and buttons, beads, sweets, coins, and portions of toys in children. These are drawn from the mouth into the air-passage during a sudden inspiratory effort, for example while laughing or sneezing. If the glottis is completely blocked, rapidly fatal asphyxia ensues. If the obstruction is incomplete, the patient experiences severe pain, difficulty of breathing, and a terrifying sensation of being choked. The irritation of the foreign body causes spasmodic coughing and retching, and may induce spasm of the glottis, with threatening suffocation.
Small round bodies may lodge in the upper aperture or in one of the ventricles, and give rise to hoarseness and repeated attacks of dyspnoea and spasmodic cough. Wherever the body is situated, the symptoms may suddenly become urgent from its displacement into the glottis, or from the onset of oedema. The position of the body may often be ascertained by the use of the X-rays.
Treatment.—If the symptoms are urgent, laryngotomy, which consists in opening the larynx below the glottis by dividing the crico-thyreoid membrane, or tracheotomy must be performed at once, and an attempt made to remove the foreign body thereafter. In less severe cases in adults, the throat should be sprayed with cocain, and the larynx examined with the mirror; in children, the direct method must be employed. In both instances an attempt should be made to extract the body by the direct method. As these manipulations are liable to induce sudden spasm of the glottis, the means of performing tracheotomy must be at hand. If it is found impossible to remove the body through the mouth, laryngotomy or tracheotomy should be performed, and the body extracted through the wound, or pushed up into the pharynx and removed by this route. In the case of small bodies, a strand of gauze pushed up from the tracheotomy wound, through the larynx and out of the mouth, catches the foreign body and carries it out (Walker Downie).
The foreign bodies that are most likely to become impacted in the trachea are tooth-plates with projecting hooks, and small coins. The position of the foreign body may be ascertained by the use of Killian's tracheoscope, or by means of the X-rays. If the body remains movable in the trachea, it is apt to be displaced when the patient moves or coughs, and it may be driven up and become impacted in the glottis, setting up violent attacks of coughing and spasmodic dyspnoea.
Tracheotomy should be performed at once, and the edges of the tracheal wound held widely open with retractors, the patient being inverted, or coughing induced by tickling the mucous membrane with a feather. The foreign body is usually expelled, but it may be inhaled into one of the bronchi. One of Killian's tracheal tubes may be introduced through the tracheotomy wound and the body extracted by means of suitable forceps.
Foreign Bodies in the Bronchi.—Rounded objects, which pass through the larynx, usually drop into one or other of the bronchi, usually the right, which is the more vertical and slightly the larger. The body may act as a ball-valve, permitting the escape of air with expiration, but preventing its entrance on inspiration, with the result that the portion of lung supplied by the bronchus becomes collapsed. The physical signs of collapse of a portion or of the whole lung may be recognised on examination of the chest. In some cases the body is dislodged and driven up into the larynx, causing severe dyspnoeic attacks and spasms of coughing. The irritation caused by the foreign body in the bronchus may set up bronchitis or pneumonia, and abscess of the lung may supervene. This has frequently followed the entrance of an extracted tooth into the air-passage, and it may be a considerable time before pulmonary symptoms arise. Sometimes the tooth is ultimately coughed up and the symptoms disappear. In some cases the physical signs closely simulate those of pulmonary phthisis.
The treatment consists in removing the body by the aid of Killian's or Jackson's tube passed through the mouth. If this is not successful, low tracheotomy is performed and the tube is passed through the tracheotomy opening.
INDEX
Abducens nerve, 400
Abductor paralysis, 404, 639 splint, 221
Abscess. See Individual Organs and Regions
Accessory nasal sinuses. See Individual Sinuses nerve, 404
Acetabulum, fracture of, 125 tuberculous disease of, 210 wandering, 210, 227
Achillo-bursitis, 294
Acoustic nerve, 579
Acromion process, fracture of, 69
Actinomycosis. See Individual Organs and Regions
Adenoids, 578
Alveolar abscess, 507 process, fracture of, 519 tumours of, 513
Ambulant splint for ankle, 189 treatment of hip disease, 222
Amputation in compound fracture, 26
Anatomy. See Surgical Anatomy
Angina Ludovici, 548, 597
Ankle, deformities of, 273 diseases of, 238, 240 dislocations of, 194 fractures in region of, 186, 187 injuries in region of, 185 surgical anatomy of, 185 tuberculous disease of, 238
Ankylosis of joints. See Individual Joints
Anosmia, 399, 578
Anterior poliomyelitis, 242
Aphasia, 335
Aphonia, 636
Arm, upper, injuries of, 44
Arthritis. See also Individual Joints
Arthritis, septic, 34
Arthrodesis, 246
Astragalus. See Talus
Athetosis, 247
Atlo-axoid disease, 440 joint, fracture-dislocation of, 430
Auditory nerve, 403
Aural polypi, 558 vertigo, 555
Auricular appendages, 560
Avulsion of scalp, 322
Balkan frame splint, 150
Basedow's disease, 614
Bell's paralysis, 401
Bennett's fracture, 116
Bezold's mastoiditis, 566
Bier's constricting bandage, 12, 26
Black eye, 370, 484
Blepharospasm, 403
Bones, atrophy of, 2 contusion of, 1 fracture of, 1 gun-shot injuries of, 27 injuries of, 1 repair of, 8 wounds of, 1
Bow-knee, 271 -leg, 271
Box splint, 182
Brachial plexus, lesions of, 597
Brachio-thoracic triangle, 470
Bradford frame, 438
Brain, abscess of, 360, 374, 376, 378, 382 localisation of, 380 adhesions, 358 cerebral irritation, 342, 346 compression of, 347 differential diagnosis of, 350 concussion of, 341, 344 contusion of, 342 cyst of, haemorrhagic, 344 decompression operations on, 396 diseases of, 373 pyogenic, 373 foreign bodies in, 350 functions of, 331 haemorrhage into, 352 hernia of, 397 injuries of, 341 mechanism of, 343 repair of, 344 irritation of, 342, 346 laceration of, 342 lesions of, 341 localisation of centres in, 336 membranes of, 328 diseases of, 372 motor area of, 330 sclerosis of, 358 sensory mechanism of, 332 softening of, 342 surgical anatomy of, 328 syphilitic gumma, 395 traumatic oedema of, 343, 352 tuberculosis of, 395 tumours of, 393 localisation of, 394 wounds of, 357
Branchial carcinoma, 601 cysts, 598 fistulae, 585
Broken back, 427
Bronchi, foreign bodies in, 644
Bronchocele. See Goitre, 605
Bronchoscopy, 635
Bryant's triangle, 129
Bunion, 296
Cachexia strumipriva, 610
Calcaneus, fracture of, 193 separation of, tuberosity of, 193 spurs on, 294
Callipers, ice-tong, 165
Callus, absorption of, 10 excess of, 9 tumours of, 10 varieties of, 8
Cancrum oris, 497
Capitate bone, dislocation of, 114
Carcinoma. See Cancer
Cardiospasm, 624
Carotid artery, internal, injuries of, 356 gland, tumours of, 603
Carpal bones, dislocation of, 113 fracture of, 110
Carpo-metacarpal dislocations, 115
Cauda equina, injuries of, 419
Caudal appendage, 458, 459
Cavernous sinus, phlebitis of, 386
Cellulitis. See Individual Regions
Cephal-hydrocele, 321 traumatic, 390
Cephaloceles, 387
Cerebello-pontine angle, tumours of, 394
Cerebellum, abscess of, 381 tumours of, 394
Cerebral abscess, 360 apoplexy, 351 centres, 334 embolism, 351 hyperpyrexia, 348 irritation, 342, 346 localisation, 336 oedema, 352 palsies of childhood, 247 shock, 341, 344 softening, 358 tumours, 393 vomiting, 377
Cerebro-spinal fluid, 329, 339 meningitis, 378
Cerebrum. See Brain
Cerumen in ear, 561
Cervical auricles, 583 caries, 440 fascia, 583 ribs, 585 sympathetic, 405, 615
Charcot's disease of hip, 228
Chauffeur's fracture, 106
Cheilotomy, 228
Chiene's test, 129
Cilio-spinal reflex, 405
Cirsoid aneurysm of scalp, 326
Clavicle, absence of, 303 dislocations of, 49 fracture of, 45
Cleft palate, 475, 477
Club-foot, 273
Club-hand, 311, 312
Coccydynia, 127, 450
Coccyx, fracture of, 127
Cock-up splint, 77
Coin-catcher, 622
Colles' fracture, 102 reversed, 106 unreduced, 106
Compound dislocation, 40
Compression of brain, 347
Compression fracture of spine, 426
Concussion of brain, 344 of spinal cord, 413
Congenital deformities, 241. See Individual Regions dislocation, 43. See Individual Joints
Conus medullaris, injuries of, 419
Coracoid process, fracture of, 69 separation of epiphysis of, 70
Coronoid process, fracture of, 87
Coxa valga, 256, 261 vara, 136, 256, 257
Cranial nerves, affections of, 398. See Individual Nerves
Cranium. See Skull
Crepitus in fracture, 15, 30
Cricoid cartilage, fracture of, 593
Crossed-leg deformity, 224, 257
Cruciate ligaments, rupture of, 171
Cubitus valgus, 84, 308 varus, 84, 310
Cut-throat, 593
Deafness, varieties of, 553
Decompression of brain, 396
Deep sensibility, 332
Deformities of extremities, 241. See Individual Regions
Dental caries, 507 ulcer of tongue, 529
Dentigerous cysts, 517
Diplacusis, 554
Dislocation. See also Individual Joints and Bones compound, 40 congenital, 43 by elongation, 96 with fracture, 40 habitual, 43, 65 old-standing, 40, 65 pathological, 43 recurrent, 43 traumatic, 36 varieties of, 37
Displacement of semilunar menisci, 168
Dorsal abscess, 444
Drop-finger, 318 wrist, 76, 311
Dugas' symptom in dislocation of shoulder, 54, 55
Dupuytren's contraction, 314 fracture, 187, 188, 196 splint, 190
Dysphagia, 623, 636
Ear, 553. See also Tympanic membrane
Ear, aspergillus in, 562 boils, 562 cardinal symptoms of disease of, 554 deafness, 553, 554 deformities of, 560 discharge from, 555 earache, 554 eczema of, 562 foreign bodies in, 563 furunculosis of, 562 hearing tests, 555 inspection of, 556 middle, acute infection of, 564 chronic suppuration in, 565 inflation of, 558 noises in, 554 otorrhoea, 555 outstanding, 560 pain in, 554 physiology of, 553 polypi, 558 rupture of membrane of, 563 syringing of, 561 surgical anatomy of, 553 tumours of, 560 vertigo, 555 wax in, 561
Earache, 554
Ectropion, 483
Elbow, ankylosis of, 208 arthritis deformans of, 208 diseases of, 205 dislocations, congenital, 308 paralytic, 308 traumatic, 88, 92 examination of, 80 injuries in region of, 79 neuro-arthropathies of, 208 pyogenic diseases of, 208 sprain of, 96 surgical anatomy of, 79 tennis player's, 97 tuberculous disease of, 206
Empyema of knee, 232
Encephalitis, 376, 377
Encephalocele, 388, 389
Epicritic sensibility, 332
Epilepsy, 397 Jacksonian, 359 traumatic, 358
Epiphyses, separation of. See Individual Bones
Epistaxis, 575
Epulis, 513
Ethmoidal cells, suppuration in, 577, 578
Eustachian catheter, 558
Extension by Hodgen's splint, 151, 159 by ice-tong callipers, 150, 158 by perineal band, 152 by Steinmann's apparatus, 150 vertical, 154 by weight and pulley, 220
Extra-dural abscess, 374
Eyeball, injuries of, 486
Eyelids, wounds of, 484
Face, cicatricial contraction of, 483 congenital malformations of, 474, 481 development of, 474 diseases of, 483 epithelioma of, 484 frog-, 581 injuries of, 482 rodent cancer of, 484 tumours of, 484
Facial cleft, 481 nerve, 400 paralysis, 400 spasm, 403
Facio-hypoglossal anastomosis, 403
False joint, 12
Fat embolism in fractures, 19
Femur, fracture of, in children, 135, 154 of condyles of, 162 of greater trochanter of, 139 of head of, 129 just below lesser trochanter of, 139 of lower end of, 157 of neck of, 130 of shaft of, 148 of upper end of, 129 incurvation of neck of, 257 separation of epiphyses of, 129, 139, 161
Fibula, absence of, 272 dislocation of, total, 167 fracture of, 165, 178, 183
Fingers, congenital contraction of, 313 deficiencies, 317 deformities of, 313 dislocation of, 121 drop-, 121, 318 Dupuytren's contraction of, 314 fractures of, 115 hypertrophy of, 317 injuries of, 115 mallet, 121, 318 supernumerary, 316 trigger, 318 webbed, 317
Flat-foot, 285 adolescent, 287 degrees of, 291 exercises for, 291 paralytic, 292 spasmodic, 292 static, 287 traumatic, 293 varieties of, 287, 294
Foerster's operation, 247
Foot, club-, 273 deformities of, 273 flat-, 285 hollow claw-, 284 injuries of, 185 movements of, 185 splay-, 285 surgical anatomy of, 185
Foot and mouth disease, 530
Footballer's knee, 172
Forearm, deformities of, 310 fracture of both bones of, 97 injuries of, 79 intra-uterine amputation of, 311
Fracture, 1. See also Individual Bones amputation in, 26 badly united, 10 Bennett's, 116 during birth, 3 chauffeur's, 106 clinical varieties of, 4 Colles', 102 comminuted, 6 complications of, 18 compound, 5, 24 crepitus in, 15 deformity in, 15 delayed union, 11 depressed, 5, 7 with dislocation, 40 displacement of fragments in, 7 Dupuytren's, 196 extension in, 26 fat embolism in, 19 fever in, 18 fibrous union of, 12 fissured, 5 greenstick, 5, 98 gun-shot, 27 indentation, 5 intra-uterine, 3 Jones', 194 longitudinal, 6 mal-union of, 10, 99, 183 massage in, 21 mechanism of, 14 multiple, 6 non-union, 9, 12 oblique, 6 old-standing, 87 open, 5 operation in, 24 pain in, 17 passive hyperaemia in, 12 pathological, 1 prognosis in, 19, 25 radiography in, 16 reduction of, 20 repair of, 8 retention of, 21 setting of, 20 shock in, 18 simple, 4, 8, 14, 19, 24 Smith's, 106 spiral, 6 splints in, 22 sprain-, 35 subcutaneous, 4 sub-periosteal, 6 transverse, 6 traumatic, 3 treatment of, 20, 25 un-united, 12, 78, 100, 101, 183 varieties of, 4 violence, forms of, causing, 3 X-rays in, 16
Frog-face, 581
Frontal sinus, suppuration in, 577
Gampsodactyly, 302
Genu recurvatum, 263 valgum, 264, 265 varum, 264, 271
Gingivitis, 508
Girdle-pain, 419
Glands, lymph. See Lymph Glands
Globus hystericus, 624
Glomus carotica, tumours of, 603
Glossitis, 530, 533
Glosso-pharyngeal nerve, 403
Goitre, 605 adenomatous, 610 colloid, 607 cystic, 607 exophthalmic, 614 fibrous, 607 intra-thoracic, 607, 609, 613 malignant, 612 non-toxic, 605 parenchymatous, 605 retro-sternal, 607, 609, 613 sudden dyspnoea in, 608-610 thyreoidectomy for, 610 toxic, 614 vascular, 607
Gooch's splinting, 22
Graefe's symptom, 614
Graves' disease, 614
Gravitation paraplegia, 414
Greenstick fracture, 5
Gumboil, 507
Gums, affections of, 508
Gun-shot injuries. See Individual Structures
Habitual dislocation, 43
Haemarthrosis, 33
Haematoma auris, 560 of periosteum, 1
Haematomyelia, 414
Haematorrachis, 414
Hallux dolorosus, 298 flexus, 298 rigidus, 298 valgus, 296 varus, 298
Hammer nose, 570 toe, 300
Hanche a ressort, 254
Hand, club-, 311, 312 deformities of, 310 injuries of, 102 surgical anatomy of, 102
Hare-lip, 475
Head injuries, 340 after-effects of, 358
Hearing, impairment of, 554 tests of, 555
Heel, painful affections of, 294
Hemianopia, 335
Hemi-glossitis, 530
Hernia cerebri, 397
Hiatal oesophagismus, 624
Hip, ankylosis of, 256 arthritis deformans of, 226 Charcot's disease of, 228 contractures of, 256 contusion of, 147 disease, 209 dislocations, congenital, 248 old-standing, 147 varieties of, 126, 142 examination of, 128, 211 hysterical, 229 injuries in region of, 127 loose bodies in, 229 neuro-arthropathies of, 228 osteo-chondritis deformans juvenilis, 228 paralytic deformities of, 255 Perthes' disease of, 228 pyogenic diseases of, 224 snapping, 254 sprain of, 147 surgical anatomy of, 128 Thomas' splint for, 222 tuberculous disease of, 210 abscess formation in, 217 bilateral, 224 deformities following, 223 diagnosis of, 218 dislocation in, 218 stages of, 211 treatment of, 220
Histrionic spasm, 403
Hoarseness, 635
Hodgen's splint, 151
Hollow claw-foot, 284
Homonymous hemianopia, 335
Hospital throat, 500
Humerus, fracture, of anatomical neck, 74 of condyles, 80 with dislocation of shoulder, 63 of head, 70 of lower end, 84 of shaft, 75 of surgical neck, 70 of tuberosities, 74 un-united, 78 separation of lower epiphysis of, 82, 84 of upper epiphysis of, 73
Hunch-back, 440, 444
Hydrencephalocele, 388, 389
Hydrocele of neck, 599
Hydrocephalus, 391 acute, 386, 391 chronic, 391
Hygroma of neck, 599 sacral, 459
Hyoid bone, fracture of, 593
Hyperaesthesia acustica, 554
Hyperpituitarism, 396
Hyper-thyreoidism, 609, 614
Hypoglossal nerve, 404
Hypophysis cerebri, tumours of, 396
Hypopituitarism, 396
Hysterical aphonia, 636 spine, 448 wry-neck, 592
Ice-tong callipers, 150
Iliac abscess, 445, 446
Ilium, fracture of, 126
Infantile paralysis, 242
Injuries. See Individual Regions
Internal derangements of knee-joint, 168
Inter-phalangeal dislocation, 200
Intra-cranial haemorrhage, 352 in newly born, 356 syphilis, 387, 395 tuberculosis, 386 venous sinuses, injuries of, 356
Intra-uterine amputation, 311
Intubation of larynx, 639 of oesophagus, 632
Ischaemic contracture of muscles, 85, 98, 310
Ischium, fracture of, 127
Jacksonian epilepsy, 359, 394
Jaw, lower. See Mandible upper. See Maxilla See also Temporo-mandibular Joint
Joints. See also Individual Joints Charcot's disease of, 228, 238 contusions of, 33 dislocations of, 36 false, 12 gun-shot injuries of, 34 injuries of, 32 sources of strength of, 32 sprains of, 35 wounds of, 34
Jones' fracture of fifth metatarsal, 194
Kernig's sign, 386
Klapp's four-footed exercises for scoliosis, 472
Knee, ankylosis of, 264 arthritis deformans of, 237 bow-, 271 Charcot's disease of, 238 cold abscess of, 234 contracture of, 264 deformities of, 236, 264 diseases of, 229 pyogenic, 237 tuberculous, 231 dislocations of, 165 congenital, 262 empyema of, 232 footballer's, 172 genu-recurvatum, 263 valgum, 265 varum, 271 hydrops of, 172 hysterical diseases of, 238 injuries in region of, 155 injuries of semilunar menisci, 167 internal derangement of, 168 knock-, 265 loose bodies in, 238 rugby, 165 rupture of cruciate ligaments of, 171 sprains of, 171 surgical anatomy of, 155 tuberculous disease of, 231 clinical types of, 231 deformities following, 236 extra-articular abscess in, 234 white swelling of, 233
Knock-knee, 265
Kocher's method of reducing dislocation of shoulder, 58
Kyphosis, 461, 462
Laryngitis, 637
Laryngoscopy, 635
Larynx, cancer of, 641 cardinal symptoms of affections of, 635 diphtheria of, 637 examination of, 634 foreign bodies in, 642 fracture of, 593 inflammation of, 637 intubation of, 639 oedema of, 637 paralysis of, 639 surgical anatomy of, 634 syphilis of, 639 tuberculosis of, 640 tumours of, 640 wounds of, 594
Laryngo-tracheotomy, 638
Lateral curvature of spine, 463 sinus. See Transverse Sinus ventricles, bursting of abscess into, 381 haemorrhage into, 342
Leg, bow-, 271 fracture of bones of, 178 congenital deficiencies of, 272 injuries of, 155 rickety deformities of, 271
Lepto-meningitis, 376
Leucokeratosis, 530
Leucoplakia, 530
Ligaments, cruciate, rupture of, 171
Lingual dermoids, 537
Lip, chancre of, 491 chronic induration of, 491 cracks of, 491 cysts of, 493 double-lip, 491 epithelioma of, 493 fistulae of, 482 hare-lip, 475 herpes of, 490 lymphangioma of, 492 macrocheilia, 492 mucous cysts of, 493 strumous, 491 syphilis of, 491 tuberculosis of, 491 tumours of, 492 ulcers of, 491
Lipoma nasi, 570
Liston's long splint, 152
Little's disease, 247, 357
Longitudinal sinus, phlebitis of, 385
Lordosis, 461
Ludwig's angina, 548, 597
Lumbar abscess, 445 puncture, 338
Lunate bone, dislocation of, 114 fracture of, 110
Luxation. See Dislocation
Lymphangiomatous macroglossia, 540
Macrocheilia, 492
Macroglossia, 540
Macrostoma, 481
Madelung's deformity of wrist, 313
Malar bone. See Zygomatic Bone
Malformations. See Individual Regions
Mallet finger, 318
Mandible, actinomycosis of, 512 cleft of, 481 dentigerous cyst of, 517 dislocation of, 523 old-standing, 524 fixation of, 526 tumours of, 517
Manus valga, 109, 313 vara, 313
Massage in fractures, 21
Mastoid, suppuration in, 566
Maxilla, affections of, 510 fracture of, 519 tumours of, 514
Maxillary sinus, suppuration in, 577
Meninges, surgical anatomy of, 328
Meningitis, 360, 374 basal, 377 cerebro-spinal, 378 serous, 377 spinal, acute, 453 chronic, 452 tuberculous, 433 syphilitic, 387 tuberculous, 386
Meningocele, 388 spinal, 454
Meningo-encephalitis, 376
Meningo-myelocele, 454
Mercurial gingivitis, 508 glossitis, 530
Metacarpals, fracture of, 115, 116
Metatarsals, diseases of, 240 fracture of, 194
Metatarsalgia, 295
Micrencephaly, 393
Microstoma, 481
Middeldorpf's splint, 72
Middle-ear disease, cerebral abscess due to, 378
Middle meningeal haemorrhage, 352
Mid-tarsal dislocation, 199
Miller's method of reducing dislocation of shoulder, 60
Mobile semilunar meniscus, 168
Morbus coxae, 210
Morton's disease, 295
Motor areas, 330 tracts, 331
Mouth, affections of, 496 floor of, 499 roof of, 498
Mumps, 546
Musculo-spiral nerve. See Radial Nerve
Myelitis, compression, 453 haemorrhagic, 453 spinal, 453 syphilitic, 453 tuberculous, 433
Myelocele, 455
Myxoedema, post-operative, 610
Nasal affections. See Nose bones, fracture of, 567 ducts, injuries of, 567
Naso-pharynx, affections of, 567 tumours of, 580
Navicular bone, dislocation of, 115 fracture of, 110, 194
Neck, actinomycosis of, 598 boils of, 598 branchial carcinoma, 160 bursal swellings in, 599 carbuncles of, 598 cellulitis of, 597 cervical auricles, 583 fascia, 583 ribs, 585 cicatricial contraction of, 592 contusion of, 592 cystic lymphangioma of, 599 cysts of, 598 blood, 599 branchial, 598 bursal, 599 dermoid, 598 fistulae of, 584, 585 hydrocele of, 599 hygroma of, 599 injuries of, 592 malformations of, 583 paraffin epithelioma of, 602 potato-like tumour of, 603 stiff, 587 surgical anatomy of, 582 thyreo-glossal cysts in, 538 tumours of, 598, 599 wounds of, 593 wry-, 587
Nelaton's line, 129
Nerve anastomosis, 246
Nerve roots, injuries of, 420
Neuralgia, trigeminal, 400
Neuro-arthropathies. See Individual Joints
Neurone lesions, 334
Node, traumatic, 1
Nose, adenoids, 578 anomalies of smell, 578 artificial, 570 asthma, reflex, 578 bleeding from, 575 carcinoma of, 573 cardinal symptoms of nasal affections, 571 concretions in, 575 deformities of, 568 discharge from, 574 displacement of cartilages of, 567 emphysema of, 568 erectile swelling of, 572 examination of, 570 foreign bodies in, 574, 576 fracture of, 567 hammer, 570 lipoma nasi, 570 obstruction of, 572 ozaena, 575 polypi of, 573 potato, 570 reflex symptoms, 578 rhinitis, 575 rhinoliths, 575 rhinophyma, 570 saddle, 567, 568 sarcoma of, 580 septum of, deviations, 573 haematoma, 573 ridges, 573 spines, 573 sunken-bridge, 568 suppuration in accessory sinuses, 576 swelling of turbinated bones, 572 traumatic saddle, 567
Nystagmus, labyrinthine, 555
Oculo-motor nerve, 399
Odontoid process, fracture of, 430
Odontoma, 517
Oedema glottidis, 637
Oesophagismus, hiatal, 624
Oesophagitis, 623
Oesophagoscopy, 617
Oesophagospasm, 624
Oesophagus, carcinoma of, 629, 631 cicatricial contraction of, 628 compression of, 624 dilatation of, 625 diverticula of, 625 examination of, 616 foreign bodies in, 619, 621, 623 inflammation of, 623 intubation of, 632 paralysis of, 625 rupture of, 618 spasm of, 624 stricture of, cicatricial, 628 malignant, 629 spasmodic, 624 surgical anatomy of, 616 swallowing of corrosive substances, 618 syphilis of, 623 tuberculosis of, 623 tumours of, 629 varix of, 623 wounds of, 618 X-ray examination of, 617
Old-standing dislocations, 40. See also Individual Joints
Olecranon, fracture of, 85 separation of epiphysis of, 87
Olfactory nerve, 399
Ophthalmia, sympathetic, 487
Ophthalmoplegia externa, 400
Optic nerve, 399
Orbit, aneurysms of, 490 cellulitis of, 487 contusions of, 484 emphysema of, 486 eyeball, injuries of, 486 foreign bodies in, 485 fractures of, 485 injuries of, 484 tumours of, 487 wounds of, 485
Os magnum. See Capitate Bone
Osteo-chondritis deformans juvenilis, 228
Os trigonum tarsi, 193
Otitis media, 564
Otorrhoea, 555
Ozaena, 575
Pachymeningitis, 374, 433
Palate, affections of, 498 cleft, 477
Palmar fascia, Dupuytren's contraction of, 314
Panophthalmitis, 487
Paracusis of Willis, 554
Paralysis, abductor, 404, 639 Bell's, 401 conjugate, 335 crossed, 334 facial, 400 infantile, 242 spastic, 247 of sterno-mastoid, 404 of tongue, 542 of trapezius, 404
Paraplegia dolorosa, 448 gravitation, 414 spastic, 451
Para-thyreoid glands, 604
Parosmia, 578
Parotid, carcinoma of, 552 duct, affections of, 544 fistula, 544 inflammation of, 545 injuries of, 543 mixed tumours of, 549 recurrent enlargement of, 547 sarcoma of, 552 surgical anatomy of, 543 tuberculosis of, 549 tumours of, 549
Parotitis, 545, 547
Patella, absence of, 262 dislocation of, 177 congenital, 262 floating, 171, 229 fracture of, 173 injuries of, 173
Patheticus nerve, 400
Pathological dislocation, 43 fracture, 1
Pelvis, fractures of, 122 injuries of, 122
Periodontitis, 507
Peri-oesophagitis, 623
Periosteum, haematoma of, 1
Peri-tonsillitis, 501
Perthes' disease, 228
Pes arcuatus, 273, 284 calcaneo-valgus, 273, 282, 284 calcaneo-varus, 273, 282, 284 calcaneus, 273, 282 cavus, 273, 282, 283, 284 equinus, 273, 280 excavatus, 284 planus, 285, 287 transverso-planus, 294 valgus, 273, 285, 287 varus, 280
Phalanges of fingers, injuries of, 119, 121 of toes, injuries of, 194, 200
Pharyngeal dimple, 626
Pharyngitis, varieties of, 500
Pharynx, affections of, 500, 619 foreign bodies in, 619, 642 tumours of, 504
Phlebitis. See Individual Vessels
Phosphorus necrosis of jaw, 510
Pigeon-toe, 298
Pituitary body, tumours of, 396
Plaster-of-Paris splints, 23
Pneumatocele capitis, 326
Pneumogastric nerve, 403
Poliomyelitis, anterior, 242
Politzer's inflation of middle ear, 558
Polydactylism, 303, 316
Polypi. See Individual Organs
Poroplastic felt, 23
Post-anal dimple, 459
Posterior nerve roots, resection of, 247
Post-nasal obstruction, 578
Pott's disease of spine, 431 fracture, 186 with inversion, 191 puffy tumour, 375, 406
Premaxillary bone, 474
Protopathic sensibility, 332
Pseudarthrosis, 12
Psoas abscess, 445
Pubes, fracture of, 123
Pulpitis, 507
Pyorrhoea alveolaris, 509
Quinsy, 501
Radial nerve, implicated in fracture of humerus, 76
Radio-carpal joint, dislocation of, 112
Radio-ulnar joint, inferior, dislocation of, 112 superior, synostosis of, 310
Radius, absence of, 310 avulsion of tubercle of, 88 dislocation of, 94 fracture of lower end, 102 of shaft, 100 of tubercle, 88 of upper end, 88 separation of epiphyses, 88, 109, 110 subluxation of, 96
Railway spine, 422
Ranula, 549
Recurrent dislocation, 43
Reduction of dislocations. See Individual Joints
Retro-pharyngeal abscess, 441, 442, 505
Rhinitis, 575
Rhinoliths, 575
Rhinophyma, 570
Rhinoscopy, 570, 571
Rib hump, 466
Ribs, cervical, 585
Round shoulders, 462
Rugby knee, 165
Sacral hygroma, 459
Sacro-coccygeal fistulae, 459 sinuses, 459 tumours, 459
Sacro-iliac joint, tuberculosis of, 446
Sacrum, fracture of, 127
Saddle nose, 567, 568
Salivary calculi, 545 fistulae, 544 glands. See Parotid, Submaxillary, Sublingual Mikulicz's disease of, 547 recurrent enlargement of, 547 surgical anatomy of, 543 tuberculosis of, 548 tumours of, 549
Scalp, abscess of, 323 air-containing swellings of, 326 aneurysms of, 326 avulsion of, 322 cellulitis of, 322, 406 cirsoid aneurysm of, 326 contusion of, 320 cysts of, 323 dangerous area of, 321 diseases of, 323 emphysema of, 326 erysipelas of, 323 haematoma of, 320, 366 infective conditions of, 323 injuries of, 320 lupus of, 323 pneumatocele of, 326 surgical anatomy of, 319 tumours of, 324 wounds of, 321 complications of, 322
Scaphoid. See Navicular
Scapula, congenital elevation of, 303 displacements of, 303, 306 fracture of, 67 separation of epiphyses of, 69, 70 winged, 306
Schlatter's disease, 165
Scissors-leg deformity, 224, 257
Scoliosis, of adolescents, 465 congenital, 465 exercises for, 472 habitual, 465 paralytic, 464 postural, 465 rickety, 464 static, 463
Sculler's sprain, 97
Semilunar menisci of knee, injuries of, 167
Sensation, varieties of, 332
Separation of bony processes, 6 of epiphyses. See Individual Bones
Shock, cerebral, 341, 344
Shoulder, ankylosis of, 204 arthritis deformans of, 203 contusion of, 66 diseases of, 201 deformities of, paralytic, 308 dislocation of, with fracture of humerus, 63 dislocation of, 52 congenital, 306 old-standing, 65 paralytic, 308 recurrent or habitual, 65 varieties, 53 examination of, 44 injuries of, 44 loose bodies in, 204 neuro-arthropathies of, 203 pyogenic diseases of, 203 sprain of, 66 Sprengel's, 303 surgical anatomy of, 44 tuberculosis of, 201
Sigmoid sinus, phlebitis of, 384
Sinus phlebitis, 383 thrombosis, 360
Skull, contusion of, 361 diseases of, 406 fracture of, 361 base, 367 anterior fossa, 369 middle fossa, 370 posterior fossa, 371 comminuted, 364 compound infected, 382 by contre-coup, 362 depressed, 364 fissured, 363 gutter, 364 indentation, 364 pond, 364 punctured, 364 vault, 361 injuries of, 360 necrosis of, 406, 407 osteomyelitis of, 406 periostitis of, 406 surgical anatomy of, 328 syphilis of, 407 tuberculosis of, 407 tumours of, 407
Smell, anomalies of, 399, 578
Smith's fracture of radius, 106
Smoker's patch on tongue, 532
Snapping hip, 254
Sore throat, varieties of, 500
Spastic paralysis, 247 paraplegia, 451
Speech centres, 335
Sphenoidal cells, suppuration in, 578
Spina bifida, 453 occulta, 457
Spinal accessory nerve, 404
Spinal cord, concussion of, 413 diseases of, 431 functions of, 331, 412 haemorrhage into, 413 injuries of, 413 at different levels, 416 localisation of, lesions in, 410, 412 membranes of, 412 partial lesions of, 420 in Pott's disease, 433 reflex centres in, 412 segments of, 412 surgical anatomy of, 411 total transverse lesions of, 415 tuberculosis of, 433 tumours of, 450 haemorrhage, 413
Spine, railway, 422
Splay-foot, 285
Splints, 22 abduction; for hip, 221 frame, for arm, 72 ambulant, for ankle, 189 Balkan frame, 150 box, 182 Bradford frame, 438 "cock-up," 77 for Colles' fracture, 106 Dupuytren's, 190 Hodgen's, 151 Liston's long, 152 Middeldorpf's, 72 Syme's stirrup, 190 Taylor's, for hip, 222 Thomas', arm, 72 double, 439 hip, 222 knee, 149, 159, 235 wheel-barrow, 439
Spondylitis, traumatic, 427
Sprains of joints, 35 fracture, 35, 171 sculler's, 97
Sprengel's shoulder, 303
Status lymphaticus, 602
Steinmann's apparatus, 150
Stenson's duct, 543
Sterno-mastoid, haematoma of, 588
Stomatitis, varieties of, 496
Subclavicular dislocation of shoulder, 62
Sub-conjunctival ecchymosis, 369
Sub-coracoid dislocation of shoulder, 54
Subdural abscess, 376
Sub-glenoid dislocation of shoulder, 62
Subgluteal abscess, 446
Sublingual gland, inflammation of, 548 ranula of, 549 surgical anatomy of, 543 tumours of, 552
Submaxillary gland, calculi of, 545 inflammation of, 548 peri-adenitis of, 548 recurrent enlargement of, 547 surgical anatomy of, 543 tuberculosis of, 549 tumours of, 552
Subspinous dislocation of shoulder, 62
Sub-taloid dislocation, 198
Superior sagittal sinus, phlebitis of, 385
Supernumerary fingers, 316 toes, 303
Surgical anatomy, of ankle, 185 of brain, 328 of ear, 553 of elbow, 79 of forearm, 79 of foot, 185 of hip, 128 of knee, 155 of meninges, 328 of neck, 582 of oesophagus, 616 of parotid gland, 543 of salivary glands, 543 of scalp, 319, 328 of shoulder, 44 of sublingual gland, 543 of submaxillary gland, 543 of thymus gland, 582 of thyreoid gland, 604 of tongue, 528 of tympanic membrane, 557 of vertebral column, 411 of wrist, 102
Swallowing, difficulty in, 623, 636 pain in, 623, 636
Syme's stirrup splint, 190
Symonds' tube, 632
Symphysis pubis, separation of, 122
Syndactylism, 303, 317
Synovitis, septic, 34
Syphilis. See Individual Organs
Syringo-myelocele, 455
Tail-like appendage, 458, 459
Talipes equino-varus. See also Pes acquired, 279 congenital, 274
Talus, dislocation of, 196 fracture of, 192
Tarso-metatarsal dislocation, 200
Tarsus, diseases of, 240 dislocations of, 196 fractures of, 192 tuberculosis of, 240
Taste, anomalies of, 578
Taylor's splint for hip, 222
Temporal abscess, 380
Temporo-mandibular joint, arthritis of, 525 arthritis deformans of, 525 dislocation of, 523 fixation of, 525 internal derangements of, 524 suppuration in, 525 tuberculosis of, 525
Tendons, lengthening of, 248 transplantation of, 245
Tennis elbow, 97
Tetany, 610
Thomas' flexion test for hip disease, 215 splints, 72, 149, 159, 222, 235, 439
Thoracic duct, 597
Throat, hospital, 500
Thrush, 496
Thumb, dislocation of, 119 fracture of, 116 stave of, 116
Thymic asthma, 603
Thymus death, 603 gland, affections of, 602 surgical anatomy of, 582 stenosis, 602
Thyreo-glossal cysts, 538, 583, 599 fistulae, 538, 583 tumours, 538
Thyreoid cartilage, fracture of, 593 gland. See also Goitre accessory, 604 adenoma of, 610 carcinoma of, 281 goitre, 605. See also Goitre inflammation of, 605 malignant, 612 physiological hyperaemia of, 604 sarcoma of, 281 surgical anatomy of, 604 syphilis of, 605 tuberculosis of, 605
Thyreoidectomy, 610
Thyreoidism, acute, 610
Thyreoiditis, 605
Thyreotoxicosis, 614
Tibia, absence of, 272 fracture of, 183 upper end of, 162 head of, 162 separation of lower epiphysis of, 192 upper epiphysis of, 165 tuberosity, avulsion of, 165 and fibula, fracture of, 178
Tibio-fibular articulation, inferior, dislocation of, 196 superior, dislocation of, 167
Tinnitus aurium, 554
Toes, clawing of, 280 deformities of, 296 dislocation of, 200 fracture of phalanges of, 194 hammer-, 300 hypertrophy of, 302 pigeon-, 298 supernumerary, 303 webbing of, 303
Tongue, absence of, 540 atrophy of, 540 bifid, 540 cancer of, 534 inoperable, 537 cysts, 537 dental ulcer of, 529 foot and mouth disease, 530 foreign bodies in, 529 glossitis, 530 gumma of, 533 hemi-glossitis, 530 inflammatory affections of, 530 leucokeratosis, 530 leucoplakia, 530 macroglossia, 540 malformations of, 540 mucous patches on, 533 nervous affections of, 540 neuralgia of, 540 paralysis of, 542 sarcoma of, 536 sclerosing glossitis, 533 smoker's parch, 532 spasm of, 542 surgical anatomy of, 528 syphilis of, 533 -tie, 540 tuberculosis of, 532 tumours of, 534, 537 ulcers of, 532, 536 wounds of, 529
Tonsil, calculi of, 503 hypertrophy of, 502 infective conditions of, 500 inflammation of, 500 Luschka's, 579 naso-pharyngeal, 579 quinsy, 501 syphilis of, 503 tuberculosis of, 503 tumours of, 504
Tonsillitis, varieties of, 500
Tooth, wisdom, impaction of, 508
Torn semilunar meniscus, 170
Torticollis, 587. See Wry-neck
Trachea, foreign bodies in, 643 fracture of, 593 scabbard, 608 thymus stenosis of, 602 wounds of, 595
Tracheoscopy, 635
Tracheotomy, 638
Transplantation of tendons, 245
Transverse sinus, phlebitis of, 384 tarsal dislocation, 199
Trapezius, paralysis of, 404
Traumatic apoplexy, 355 cephal-hydrocele, 321, 390 epilepsy, 358 insanity, 360 neurasthenia, 345, 358 node, 1 oedema of brain, 352 spondylitis, 427
Trendelenburg's test, 252
Trigeminal nerve, 400 neuralgia, 400
Trigger finger, 318
Trochlear nerve, 400
Tuberculosis. See Individual Organs
Tumours. See Individual Organs
Tympanic antrum, suppuration in, 566 membrane, lesions of, 557 perforation of, 557 rupture of, 557, 563 surgical anatomy of, 557
Typhoid spine, 448
Ulna, deficiency of, 311 dislocation of, 94 fracture of upper end, 85 lower end, 110 shaft, 100 separation of epiphysis of, 87, 110
Uvula, bifid, 477 elongation of, 499
Vagus nerve, 403
Valsalva's method of inflating ear, 558
Venous sinuses, intra-cranial injuries of, 356
Ventricles, lateral, bursting of abscess into, 381 haemorrhage into, 342
Vertebral column, actinomycosis of, 448 arthritis deformans of, 449 blastomycosis of, 448 compression fracture of, 426 congenital deformities of, 458 deviations of, 461 diseases of, 431 dislocations of, 424, 427, 428 fracture-dislocation of, 427 fractures of, 425, 426, 427 hydatid cysts of, 448 hysterical affections of, 448 injuries of, 423 kyphosis, 461, 462 lateral curvature of, 463 lordosis, 461 malignant disease of, 447 osteomyelitis of, 431, 448 Pott's disease of, 431 scoliosis, 463 sprains of, 423 surgical anatomy of, 411 syphilis of, 447 tuberculous disease of, 431 tumours of, 447 twists of, 423 typhoid, 448 wounds of, 430
Vertigo, 555
Visual centres, 335
Volkmann's ischaemic contracture, 85, 98, 310 supra-malleolar deformity, 273
Wandering acetabulum, 210, 227
Wax in ear, 561
Webbed fingers, 317 toes, 303
Wens, 324
White swelling of knee, 233
Winged scapula, 306
Wisdom tooth, impaction of, 508
Wounds. See Individual Regions and Organs
Wrist, diseases of, 208 dislocation of, 111, 112 congenital, 313 drop-, 311 injuries of, 102 Madelung's deformity of, 313 sprain of, 115 surgical anatomy of, 102 tuberculous disease of, 208, 209
Wry-neck, 587 acute, 587 hysterical, 592 permanent, 588 rheumatic, 587 spasmodic, 591 transient, 587
Xerostomia, 547
X-rays in fracture, 16
Zygomatic bone, fracture of, 519
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