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In the preface to the first edition of this work it was stated that the purpose of the author was to make a book that would stand between the text-book and the compend. The very considerable success that has been accorded the effort seems to indicate that there was a distinct demand for such a book. In the new edition no attempt has been made to alter the character or to change the purpose of the Manual, although it has been practically rewritten, many entirely new articles added, and a majority of the old articles enlarged, restricted, or otherwise altered.

Many of the changes and additions have been made in response to the suggestions of reviewers and of teachers of surgery.

The changes are numerous, and it is impossible to enumerate them in this place. Among them may be mentioned the following: Sections have been added upon the Surgery of the Liver and Gall-Bladder, the Spleen, the Pancreas, the Female Breast, Wounds Inflicted by Modern Projectiles, Electrical Injuries, and the Use of the Röntgen Rays. The following operations have been described: Resection of the Gasserian Ganglion; Methods of Gastrostomy; Schede's Operation of Thoracoplasty; Use of the Murphy Button ; various new methods of Enterorrhaphy; Bodine's Method of Colostomy; Prevention of Hemorrhage in Hip-joint Amputation by Macewen's Method of Aortic Compression ; Edmund Owen's Operation for Harclip; Senn's Method of Resection of the Shoulder-joint, etc.




As in the previous edition, the writings of other authors have been extensively quoted, and the endeavor has been always to give proper credit.

The author desires to extend his cordial thanks to Mr. Thos. F. Dagney, of Mr. Saunders' editorial department, for much valuable aid rendered during the progress of the work through the press, and to Mr. R. W. Greene for making the index. 1629 Locust STREET, PHILADELPHIA,

June, 1898.


The aim of this Manual is to present in clear terms and in concise form the fundamental principles, the chief operations, and the accepted methods of modern surgery. The work seeks to stand between the complete but cumbrous text-book and the incomplete but concentrated compend.

Obsolete and unessential methods have been excluded in favor of the living and the essential. There has been no attempt to exploit fanciful theories nor to defend unprovable hypotheses, but rather the effort has been to present the subject in a form useful alike to the student and to the busy practitioner.

The opening chapter is devoted to Bacteriology because the author profoundly believes that without some knowledge of the vital principles of this branch of science the vast importance of its truths will be ill-appreciated, and there will be inevitable failure in the application of aseptic and antiseptic methods.

Ophthalmology, gynecology, rhinology, otology, and laryngology have not been considered, because of the obvious fact that in the advanced state of specialized science only the specialist is competent to write upon each of these branches.

In Orthopedic Surgery are discussed those conditions which must in the very nature of things often be cared for by the surgeon or the general practitioner (such as hip-joint disease, club-foot, Pott's disease of the spine, flat-foot, etc.). The limited space at command precluded the introduction of a special division on diseases of the female breast. A large amount of space has been devoted to Fractures and Dislocations, the enormous practical importance of these subjects calling for their full discussion. Operative Surgery is considered in separate sections, the most important procedures being fully described, giving also the instruments necessary, and the positions assumed by patient and operator.


This method has been adopted to fit the work for use in surgical laboratories.

Many systems, manuals, monographs, lectures, and journal articles have been consulted, and credit has been given in the text for statements and quotations. Special acknowledgment is due to the American Text-Book of Surgery, edited by Keen and White; to the surgical works of Ashhurst, Agnew, the elder Gross, Duplay and Reclus, Esmarch, Albert Koenig, Wyeth, and Bryant; to the Manual of Surgery edited by Treves; to the International Encyclopædia of Surgery edited by Ashhurst; to the Surgical Pathology of Billroth and of Bowlby; to the Diagnosis of E. Pearce Gould; to the Surgical Dictionary of Heath; to the Rest and Pain of Hilton; to the works on operative surgery of Barker, Jacobson, Treves, Stephen Smith, and Joseph Bell; to the Minor Surgery of Wharton; to the dictionary of Foster and of Gould; to the Principles of Surgery of Senn; to the orthopedic writings of Sayre; to the work on Discases of the Male Generative Organs of Jacobson; to the System of Genito-urinary Diseases edited by Morrow; and to the treatises on Fractures and Dislocations of Sir Astley Cooper, Malgaigne, Hamilton, Stimson, and T. Pickering Pick.

The Author returns his thanks to the numerous writers who courteously authorized the reproduction of special illustrations, and particularly to Professors Keen and White for their free permission to draw upon the American TextBook of Surgery, from which a number of pictures have been taken, distinctively those referring to Bandaging; to Mr.

ohn Vansant for the great amount of labor so ably and cheerfully performed; and to Dr. Howard Dehoney for the preparation of the Index. 2050 Locust Street, Philadelphia,

October, 1894.

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