Modern surgery, general and operative . nerve, a tendon, or a muscle isdiT.ded, and if such injury is discovered, sutmre at once (Figs. 109 and no).If the woimd is extensive or deep, it may be necessary to use buried suturesin order to keep the sides of the wound in contact. If the surface of a woundis approximated, but the depths are not, the dead space or caaty becomesfilled with fluid, and infection almost certainly occurs. If buried sutures havenot been used, such a cavity must be obliterated by the judicious applicationof pressure upon the surface. This is seciired by the adaptation of

Modern surgery, general and operative . nerve, a tendon, or a muscle isdiT.ded, and if such injury is discovered, sutmre at once (Figs. 109 and no).If the woimd is extensive or deep, it may be necessary to use buried suturesin order to keep the sides of the wound in contact. If the surface of a woundis approximated, but the depths are not, the dead space or caaty becomesfilled with fluid, and infection almost certainly occurs. If buried sutures havenot been used, such a cavity must be obliterated by the judicious applicationof pressure upon the surface. This is seciired by the adaptation of Stock Photo

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Modern surgery, general and operative . nerve, a tendon, or a muscle isdiT.ded, and if such injury is discovered, sutmre at once (Figs. 109 and no).If the woimd is extensive or deep, it may be necessary to use buried suturesin order to keep the sides of the wound in contact. If the surface of a woundis approximated, but the depths are not, the dead space or caaty becomesfilled with fluid, and infection almost certainly occurs. If buried sutures havenot been used, such a cavity must be obliterated by the judicious applicationof pressure upon the surface. This is seciired by the adaptation of a mass ofloose or fluffed-up gauze, and the firm application of a bandage or binder. An 270 Contusions and Wounds incised wound is usually closed with interrupted sutures (Figs, iii and 112).In adjusting the sutures, see that the edges of the wound are not inverted, butare neatly approximated with raw edge to raw edge. Tie the stitches firmlybut not tightly. If a stitch is tied too tightly it will make a ridge, as shown The right way..

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$. Modern surgery, general and operative. Fig. 353.—Fracture of middle of humerus. Fig. 354.—Apparatus for fracture of the hume-rus at any point above the condyles. fragment passes inward and upward because of the action of the biceps andtriceps. Injury of the niiiscidospiral nerve sometimes occurs. The nerve may Stock Photo$

RM2AGD91N–. Modern surgery, general and operative. Fig. 353.—Fracture of middle of humerus. Fig. 354.—Apparatus for fracture of the hume-rus at any point above the condyles. fragment passes inward and upward because of the action of the biceps andtriceps. Injury of the niiiscidospiral nerve sometimes occurs. The nerve may

RM2AGANGJ–. Modern surgery, general and operative. Fig. 548.—Section of median nerve; areasof anesthesia (heavy shading) and of dyses-thesia (light shading) on palmar surface ofhand (Bowlby). Fig. 549.—Section of median nerve; re-gions of anesthesia and dysesthesia ondorsal surface of hand (Bowlby). supplied by the median nerve. Interosseal flexion is impossible, and the op-ponents of the internssei, acting without normal antagonism, contract and pro-

RM2AKT1RG–Modern surgery, general and operative . Fig. 486.—Section of median nerve; areasof anesthesia (heaT^ shading) and of dyses-thesia (light shading) on palmar surface ofhand (Bowlby). Fig. 487.—Section of median nerve; re-gions of anesthesia and dysesthesia on dorsalsurface of hand (Bowlby). fingers than in the others because the lumbricales of the first two fingers aresupplied by the median nerve. Interosseal flexion is impossible, and the op-

RM2AGEK43–. Modern surgery, general and operative. Fig. 235.—Tenaculum. the latter around the vessel in such a manner that the catgut will include thevessel mth some of the surrounding tissue. Then tie the ligature (Fig. 241).This method is known as the application of a suture-ligature, and is pursuedin necrosis, atheroma, scar-tissue, sloughing, etc. Never include a nerve of anysize in the ligature. If this mode of ligation fails, we may try acupressure..

RM2AJ1HP4–Modern surgery, general and operative . penings enlarge (page 93). Fluidelements rarely leave the blood-vessels during active hyperemia, but theyoccasionally do. The wheals of urticaria are thus formed (Warren). Activehvperemiais often the first stage of an inflammation, but it is not of necessityfollowed by other inflammatory changes, and it can be caused by nerve sectionor nerve stimulation. The duration of active hyperemia is variable. If the irritation has beenbrief, the hyperemia is very transitory. In some cases dilatation with acceleratedcirculation is scarcely more than momentary, givi

RM2AG7ACD–. Modern surgery, general and operative. fibers that may be encountered are severed. The separatedaponeurosis of the external oblique muscle is then retracted. One has thenbrought into view the contents of the inguinal canal, the hernial sac and itsadhesions, the spermatic cord, the ilio-inguinal nerve, the internal abdominalring, the subserous fat, the cremaster muscle, the conjoined tendon, the internalobhque and its deficient origin at Pouparts ligament, the transversalis fascia,and the internal surface of Pouparts ligament. The sac is now dissected fromI Annals of Surgery, Nov., 1897. Trea

RM2AKM627–Modern surgery, general and operative . d, and the superficial wound isclosed with sutures of silkworm-gut. Intracapsular Extirpation.—This operation is warmly advocated by theMayos. The preservation of the posterior portion of the capsule protects therecurrent laryngeal nerve and greatly lessens the risk of injuring the parathy-roids. Ether is given unless there is grave respiratory difficulty with myocardialdegeneration, and half an hour before administering the ether the patient isgiven a hypodermatic injection of gr. of morphin and y-^^ gr. of atropin. Theether is continued by intratrach

RM2AGAPFX–. Modern surgery, general and operative. rs,which are supplied by theanterior thoracic nerve. Theskin over the lower part ofthe muscle is usually anesthetic.Musculocutaneous Nerve.—Division of this nerve producesparalysis of the biceps and ofthe brachialis anticus muscles(paralysis of the forearm flex-ors). This palsy becomesespecially evident when theforearm is supinated, becausein this position the supinatorlongus can no longer act as aflexor of the elbow. There isanesthesia of the radial side ofthe forearm anteriorly andposteriorly. The Musctdospiral or RadialNerve.—Division of this nervehi

RM2AGAAE4–. Modern surgery, general and operative. involved there will be peripheralfacial palsy of the same side. If the sixth nerve is involved internal strabismuswill arise because of palsy of the external rectus muscle. Tumors of the Hypophysis Cerebri.—The hypophysis cerebri is a ductlessgland of immense importance to the economy. It is present in all vertebrates.If the anterior lobe is removed death follows. If the anterior lobe is damagedor partially removed developmental disturbances occur. The pars intermediaof the posterior lobe furnishes a very active substance which is called pituitrinwhich

RM2AGANWY–. Modern surgery, general and operative. xof the index and the middle finger (Gowers). The sensory changes aftermedian paralysis are quite variable—sometimes widespread and complete,at other times trivial, and occasionally absent. Gowers says that if there isanesthesia it is usually of the palmar surface, but it may also occur on the dorsalaspect of the ends of the first two fingers. The Ulnar Nerve.—When this nerve is divided there is paralysis of theflexor carpi ulnaris, of the ulnar portion of the deep flexor, of the muscles ofthe little finger, of the abductor polHcis, and of the inner end

$Modern surgery, general and operative . ent varies with thesituation of the fracture and the direction of the force. If the fracture is abovethe insertion of the deltoid, the lower fragment is pulled up by the triceps,biceps, and deltoid, and pulled out by the deltoid, and the upper fragment ispulled inward by the arm-pit muscles. In fracture below the deltoid this mus-cle is apt to pull the lower end of the upper fragment outward, while the lowerfragment passes inward and upward because of the action of the biceps andtriceps. Injury of the muscidospiral nerve sometimes occurs. The nerve maybe Stock Photo$

RM2AM03BD–Modern surgery, general and operative . ent varies with thesituation of the fracture and the direction of the force. If the fracture is abovethe insertion of the deltoid, the lower fragment is pulled up by the triceps,biceps, and deltoid, and pulled out by the deltoid, and the upper fragment ispulled inward by the arm-pit muscles. In fracture below the deltoid this mus-cle is apt to pull the lower end of the upper fragment outward, while the lowerfragment passes inward and upward because of the action of the biceps andtriceps. Injury of the muscidospiral nerve sometimes occurs. The nerve maybe

RM2AGD82X–. Modern surgery, general and operative. ries of the Bones and Joints only pain, but paralysis of the muscles supplied by the nerve, and surfaceanesthesia. In most cases this condition is recovered from in a few weeks,but sometimes it lasts a long while or even permanently. In musculospiralparalysis the patient is unable to extend the wrist and fingers or to supinatethe forearm. There is complete loss or impaired sensation in the lowerhalf of the outer and anterior aspect of the arm and in the middle of the backof the forearm as far as the wrist (Scudder, in The Treatment of Fractures).The ner

$Modern surgery, general and operative . reswells rapidly and decidedly. There isbleeding because of laceration of the gum;saKva dribbles constantly; the patient sup-ports the jaw with the hand; great painexists (possibly from injury of the nerve),and deformity is present, shown by in-equality of the teeth if the fracture is an-terior to the masseter, the anterior frag-ment going downward and backward andthe posterior fragment going upward andforward. The downward displacement isdue to muscular action (action of the digastric, geniohyoid, and geniohyo-glossus). The backward displacement is due Stock Photo$

RM2AM095K–Modern surgery, general and operative . reswells rapidly and decidedly. There isbleeding because of laceration of the gum;saKva dribbles constantly; the patient sup-ports the jaw with the hand; great painexists (possibly from injury of the nerve),and deformity is present, shown by in-equality of the teeth if the fracture is an-terior to the masseter, the anterior frag-ment going downward and backward andthe posterior fragment going upward andforward. The downward displacement isdue to muscular action (action of the digastric, geniohyoid, and geniohyo-glossus). The backward displacement is due