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SURGICAL TECHNIC
:V>^°
SURGICAL TECHNIC
H Crxt^troofe on
OPERATIVE SURGERY
BY
FR. VON ESMARCH, M.D.
Professor of Surgery at the University of Kiel, and Surgeon-General of the German Army
AND
E. KOWALZIG, M.D.
Late First Assistant at the Surgical Clinic of the Universit\' of Kiel
TRANSLATED BY
PROFESSOR LUDWIG H. GRAU, Ph.D.
Formerly of Leland Stanford Junior University-
AND
WILLIAM N. SULLIVAN, M.D.
Formerly Surgeon of U.S.S. "Corwin"
Assistant of the Surgical Clinic at Cooper Medical College, San Francisco
EDITED BY
NICHOLAS SENN, M.D.
Professor of Surgery at Rush Medical College, Chicago
'â– 'â– Kurz unci Bii II dig'"
WITH FOURTEEN HUNDRED AND NINETY-SEVEN ILLUSTRATIONS
AND FIFTEEN COLORED PLATES
THE MACMILLAN COMPANY
LONDON: MACMILLAN & CO., Ltd.
I9OI
All rights reserved
Copyright, 1901,
By the MACMILLAN COMPANY.
XortoooB IBxcss
J. 8. Cuehin? a Co. — Berwick & Smith
Norwood Mats. U.S.A.
SUMMARY OF THE PREFACES OF THE FIRST
FIVE GERMAN EDITIONS
For promoting the interests of humanity in times of peace under the
symbol of the Red Cross,
p!rr iHajrst^ tijc ^rrman Empress,
on the occasion of the Vienna World's Exhibition, offered two prizes, one
of them to be awarded for the best Handbook of Surgical Technic.
The regulations of competition were the following : " The book should
present in as concise and intelligible a form as possible the various methods
of bandaging and dressing, as well as all surgical operations ; but above
all it should comprise the present advanced status of Surgical Technic,
in order to become the indispensable Guide Book and practical compan-
ion of every surgeon."
The jury selected to award the prize consisted of Professor B. von Lan-
genbeck in Berlin, Professor Billroth in Vienna, and Professor Socin in Basle.
Unanimously they awarded the first prize to the author of this Surgical
Technic.
The author strictly fulfilled the requirements of the competition, but
at the same time he purposed to make this handbook a practical aid to
memory.
In his opinion this could be better accomplished by illustrations than by
a cumbersome text. A glance at an illustration representing a dressing, an
operation, or an anatomical preparation, enables one to recall to memory
most rapidly all former knowledge concerning the same.
Hence the book contains manv illustrations and as concise a text as
vi AUTHOR'S PREFACE
possible. The author of course endeavored to iijcorporate all the extraor-
dinary progress which Surgery, and especially Surgical Technic, has made
during recent years.
At the end of the work three indexes of names, subject-matter, and
illustrations will largely facilitate the use of this book.
FRIEDRICH VON ESMARCH.
Skptembek 3, 1900.
PREFACE OF THE AMERICAN EDITOR
Professor von Esmarch, the senior author of this book, needs no
introduction to the medical profession of this country. His name and
fame are familiar to every educated physician. As an author and teacher
he has few equals. During the last few years he has been ably assisted
in his literary work by his former first assistant, Dr. Kowalzig.
It was a happy idea when the publishers decided to present the English
reading profession with a translation of the great works of Professor von
Esmarch in one volume. The translator had a difficult task. The motto,
" Kurz und biindig," characterizes the text. No superfluity of words, the
language is concise and precise. If there are any shortcomings in
the translation, it is an attempt on part of the translator to reproduce
the language of the authors as faithfully and as accurately as possible. The
great feature of this book are the numerous excellent illustrations which
embellish the text and which enable the reader to follow with his eyes
every step of all minor and major operations. The American editor has
added notes which appear in brackets in places where he deemed it
necessary to add to the text or to indicate his own views or methods
of practice.
N. SENN.
Chicago, 1901.
TRANSLATOR'S PREFACE
The translator believes he is rendering an important service to Ameri-
can and English surgeons in presenting an English translation of von
Esmarch's " Surgical Technic." Its excellence is acknowledged by all
European surgeons, and now that it has received the careful revision and
valuable notes from the hands of its learned editor, it may confidently be
regarded as the best handbook on the subject of Surgical Technic in the
English language.
L. H. GRAU.
San Fran'CISco, May, 1901.
TABLE OF CONTENTS
The Treatment of Wounds
. , . PAGE
Asepsis .........
Preparations for Aseptic Operations and Dressings 2
Purifying the Operating Room
Asepsis of the Surgeon and his Assistants
Sterihzation of Instruments
Sterilization of Sutures and Ligatures
Sterihzation of Sea and Gauze Sponges
Disinfection of the Patient .
13
Sterilization of the Dressing Materials j^
Aseptic Operations ... o
Antisepsis .......
Antiseptic Solutions .
. •••••••.. 23
Antiseptic Powders
The Drying a7id the Draining of the Wound
Dressings of the Wound
Changing the Dressings
The Position of the Patient
The Position of the Patient in Bed
Secondary Antisepsis
Permanent Antiseptic Irrigation . . . â–
The Antiphlogistic Treatmejit " * 61
Open Treatment of Wounds gg
Bandaging
Bandages ....... /-o
Bandages for the Head
Bandages for the Arm ' .
Bandages for the Trunk * * o
Bandages for the Leg ' c
Cloth Bandages ....... o
Bandages for the Head _ _ ' ?,c
Bandages for the Arm o
Bandages for the Trunk .' ' " 8q
Bandages for the Leg * So
Splints ••.....
Wooden Splints
Sheet Zinc Splints '.'.''" loi
Wire Splints . .
Glass Splints
^ 105
TABLE OF CONTENTS
Pasteboard Splints
Plastic Splints
Plastic Dressings
Starch Dressing .
Potash Silicate Dressing
Plaster of Paris Dressing
Application of Plaster of Paris Dressing
Removable Plaster of Paris Dressing
Strengthening Plaster of Paris Dressing
Fenestrated Plaster of Paris Dressing
Interrupted Plaster of Paris Dressing
Plaster of Paris Suspension Splints .
Position Dressings
Extension Dressings .
Extension by Weights
Elastic Extension and by Adhesive Plaster
Temporary Dressings
Temporary Splints
Antisepsis in War
The Soldier's Antiseptic Dressing Package
PAGE
1 06
no
no
III
112
"3
117
119
121
126
127
133
138
146
147
•53
159
160
168
170
Narcosis
General Anesthesia ......
Chloroform Antcsthesia ....
Course of Chloroform .An.^sthesia .
Awakening from Chloroform Aneesthesia
Unpleasant Occurrences after Anesthesia
Unpleasant Accidents during Anaesthesia
Action of Surgeon during Serious Accidents
Ether Anasthesia ....
Methods of Ether Anesthesia
Course of Ether Anesthesia
Danger from Ether Anesthesia
Awakening from Ether Anesthesia .
Combined Anesthesias
Other Anesthetics .
Local Ancesthesia (Analgesia)
Regionary Analgesia
Infiltration Analgesia
172
172
176
178
179
179
182
188
188
190
191
192
192
194
195
Si.MPLE Operations
Incision ................. 197
Puncture ................. 201
Tissue Destruction ............... 203
Union of Margins of the Wound ............ 209
Suture ................ 209
Removal of Foreign Bodies ............ 218
Removal of Bullets 219
TABLE OF CONTENTS xi
Operations for Prevention and Arrest of Hemorrhages and their Consequences
PAGE
Saving of Blood ............... 224
Bloodless Method .............. 225
Compression of Main Trunk of the Artery . . . . . . . . - . . 235
By Pressure of the P'inger (Digital Compression) ........ 235
By Artery Compressors or Tourniquets .......... 236
Improvised Artery Compressors ............ 240
Arresting Hetnorrhages in the Wound ........... 242
Compression of Wound .............. 242
Medicinal Hemostatics (Styptics) ........... 243
Ligation of Vessels (Ligature) ............ 243
Hemorrhage from Punctured and Gunshot Wounds ........ 247
Ligation of Arteries at the Place of Selection . . . . . . . . . .251
General Rules ............... 251
Ligation of Principal Trunks of Arteries .......... 254
Ligation of Common Carotid Artery ........... 256
External Carotid Artery ............. 257
Internal Carotid Artery ............. 258
Lingual Artery ............... 259
Subclavian Artery .............. 260
Vertebral Artery .............. 262
Axillary Artery ............... 263
Brachial Artery ................ 264
Radial Artery ............... 266
Ulnar Artery ............... 266
Superficial Palmar Arch ............. 267
Abdominal Aorta . 268-269
Common and Internal Iliac Arteries ........... 270
Superior Gluteal Artery . . . . . . . . . . . . .271
Sciatic Artery ............... 271
External Iliac Artery .............. 272
Femoral Artery ............... 272
Popliteal Artery ............... 274
Anterior Tibial Artery ............. 275
Posterior Tibial Artery ............. 276
Transftisio7i and Infusion ............. 277
Bleeding ................. 282
Venesection ............... 282
Operation for Aneurisftis .............. 283
Ligation of Artery 285
Operation for Varices .............. 287
Ligation for Long Saphenous Vein ........... 288
Extirpation of Varices 288
Injuries of Walls of Blood Vessels 289
Operations on Tendons
Tenotomy ................. 290
Tenotomy of the Tendo Achillis 291
xu
TABLE OF CONTENTS
PAGE
Tendinorrhaphy ............... 292
Tendinoplasty 295
Operations on Nerves
Neurorrhaphy ................ 296
Neuroplasty ................ 297
Operations on Skin
.Skin Grafting (Transplantation) ............ 298
Skin Grafting according to Thiersch ..... ..o ... . 299
Plastic Operations .............. 301
Operations on Nails ............... 302
Operations on Bones
Osteoclasis .....
Osteotomy ......
Subtrochanteric Osteotomy
Supracondylic Osteotomy of the Femur
.Supramalleolar Osteotomy .
Direct Fixation of Bone Fragments .
Necrotomy .....
Osteoplastic Necrotomy
Amputations and Disarticulation
Indications ......
General Rules ......
Preparations .....
Division of Soft Parts
Circular Amputation (by One Incision)
Circular Amputation (by Two Incisions)
Amputation by forming Skin Flaps
Muscular Flaps .
Oval Incision
Sawing off Bones
Union of Wound
General Rules for Disarticulation
Reamputation
Protheses ....
305
307
308
308
309
309
312
315
316
3'7
3'7
3'8
3>S
320
324
325
326
326
331
334
Amputation and Disarticulation of Upper Exiremities
Disarticulation of Fingers .............. 336
Disarticulation of Third Phalanx 336
Disarticulation of Second Phalanx 336
Disarticulation at Metacarpophalangeal Joint 337
Disarticulation of All Fingers 339
Disarticulation of Thumb at Carpal Joint 340
TABLE OF CONTENTS xiii
PAGE
Oval Incision ............... 340
Lateral Plap Incision according to von Walther ......... 341
Disarticulation of Last Four Metacarpal Bones 341
Disarticulation of Wrist .............. 342
Circular Incision . 342
Flap Incision ............... 343
Radial Flap Incision .............. 344
Amputation of Forearm .............. 344
Disarticulation of Elbow Joint ............. 346
Circular Incision .............. 346
Flap Incision ............... 347
Oblique Incision .............. 347
Amputation of Arm ............... 348
Disarticulation of Arm at Shoulder Joint 350
Flap Incision ............... 350
Circular Incision . . . . . . . . . . . . . . 352
Oval Incision ............*... 353
Amputations and Disarticulations of Lower Extremities
Disarticulation of Toes .............. 354
In the Phalangometatarsal Joint ............ 354
Amputation of all Metatarsal Bones ............ 355
Disarticulation of Great Toe together with its Metatarsal Bone ....... 355
Disarticulation of Fifth Toe with its Metatarsal Bone ........ 356
Lisfranc's Disarticulation in Tarso-Metatarsal Articulations ... .... 357
ChoparCs Disarticulation at Tarsus . . . . . . . . . . • , . 359
Malgaigne' s Disarticulation of Foot below Astragalus ........ 362
Syme^s Disarticulation of Foot ............. 364
Pirogoff's Disarticulation of Foot ............ 367
Giiniher^s Modification of Pirogoff's Amputation ......... 368
Le Fort and von EsniarcKs Modification of Pirogoff's Amputation ...... 370
Amputation of Leg ............... 372
Bier^s Osteoplastic Amputation ............. 374
Disarticulation of Leg at Knee Joint ............ 377
Circular Incision .............. 377
Flap Incision ............... 378
Oblique Incision .............. 379
GrittVs and Others' Osteoplastic Amputation ......;.. 380
Amputation of Thigh .............. 380
Disarticulation of Thigh .............. 383
By an Anterior Large and a Posterior Small Flap ........ 383
Transfixion, Manec's Puncture Method .......... 383
VeiscJi's Circular Method . . ............ 386
Resection of Joints
Indications ................ 389
General Rules for Resections 390
xiv TABLE OF CONTENTS
Resection of Upper Extremities
PAGE
Resection of Fingers 394
Resection of Lower Articular Ends of Radius and Ulna ........ 395
Total Resection of Wrist .............. 399
By V071 Langenl'eck's Dorsal Radial Incision ......... 399
By Kocher's Dorso-Ulnar Incision ........... 401
Resection of Elbow Joint .............. 403
By Listoii's T Incision ............. 403
By von Laugenbeck's Simple Longitudinal Incision ........ 40^
By Hueterh Bilateral Longitudinal Incision ......... 406
By Ollier's Bayonet Incision ............ 407
By Nelatoti's Angular Incision ............ 408
By Kocher's Hook-shaped Incision ........... 408
Resection of Olecranon .............. 409
Resection of Shoulder Joint . . . . . . . . . . . . .411
By Z'(?w Za«^^«i^^(:-^'j Longitudinal Incision . . . . . . . . .411
By von Langenbeck' s .'\nterior Longitudinal Incision (Old Method) . . . . -413
By C//z>r'j Anterior Oblique Incision. .......... 415
By Kocher''s Posterior Curved Incision . . . . . . . . . .415
Resection of Articular Surface and Neck of Scapula {von Esiiian/i) ...... 417
Resection of Scapula
By von Langenbeck' s Angular Incision „ . . . . . . . . .418
By Ollier's Subperiosteal Resection . . . . . . . . . . .418
Partial Resection of Scapula . . . . . . . . . . . . .419
Resection of Clavicle ............... 419
Resection of Lower Extremities
Resection of Articulations of the Toes ........... 420
Peterson's Resection of Articulation of the Great Toe ........ 420
Resection of Ankle Joint .............. 421
By von Langenbeck' s Bilateral Incision . . . . . . . . . .421
By Konig's Bilateral Incision ............ 425
By Kocher's External Lateral Transverse Incision ........ 426
By Girard's External Oblique Incision .......... 427
By Lauenstein's Curved Incision ........... 428
By Hueter's Anterior Transverse Incision .......... 428
Resection of Astragalus .............. 428
By Vbgt's Anterior Longitudinal Incision .......... 428
Resection of Os Calcis .............. 429
By Ollier's External Angular Incision .......... 429
By Guerin's Spur Incision ............. 430
By Kocher's Angular Incision . . . . . . . . . . . .4^0
Tarsectomy ••••............ 430
Resection of Remaining Tarsal Bones .......... 430
Osteoplastic Resection at the Tarsus, according to yl/?Vi//zV3- ^F/«a'm/;-(7^ . . . .431
Operations for Clubfoot •••........... 433
Operations for Flatfoot 434.
TABLE OF CONTENTS xv
PAGE
Resection of Knee Joint 435
By Textor's Anterior Curved Incision 435
By Hahji's Curved Incision ............ 439
By von Volkmann'' s Transverse Incision .......... 440
By von Langetibeck' s Curved Lateral Incision ......... 440
By Hueter^s Internal Longitudinal Incision ......... 442
By Kocher's External Curved Incision .......... 443
Puncture of Knee Joint .............. 444
Drainage of Knee Joint .............. 444
Resection of Hip Joint .............. 445
By A. Wkiiis Posterior Curved Incision 445
By V071 Langenbeck' s External Longitudinal Incision ........ 446
By Kocher^s Posterior Longitudinal Incision ......... 449
By Lilcke-Schede's Anterior Longitudinal Incision ........ 450
By Hueter's Anterior Oblique Incision . . . . . . . . . -451
By Oilier^ s Resection of the Trochanter .......... 452
Arthrotomy for Congenital Dislocation of Hip Joint ......... 453
Resection of Ilium 454
Operations on the Head
Resection of the Vault of the Cranium . . . •' . . . . . . . 455
Trephining ................ 457
Craniectomy ............... 461
Osteoplastic Resection of the Skull ........... 463
Cerebral Topography .............. 465
Opening of the Skull at the Base of the Squamous Portion of the Temporal Bone . . 468
Exploratory Perforation of the Skull ........... 469
Lumbar Puncture .............. 470
Ligation of the Middle Meningeal Artery .......... 470
Opening of the Mastoid Process ............ 473
Opening of the Lateral Chambers of Antrum ......... 474
Opening of the Frontal Sinus ............ 475
Resection of the Maxilla .............. 476
Resection of the Alveolar Process ........... 476
Resection of the Whole Upper Jaw ........... 477
Resection of Both Upper Jaws ............ 481
Osteoplastic Resection of the Upper Jaw .......... 482
Osteoplastic Resection of Both Upper Jaws ......... 483
Opening of the Antrum of Highmore . . . . . . . . . . . 485
Resection of the Lower Jaiv ............. 487
Resection of the Alveolar Process 487
Resection of One-half of the Lower Jaw .......... 487
Resection of the Maxillary Arch 489
Resection of the Articulation of the Lower Jaw 491
Resection in Ankylosis ............. 491
Subperiosteal Resection of the Lower Jaw 492
xvi TABLE OF CONTENTS
PAGE
AWve Stretching and Nerve Resection 493
Supraorbital Nerve 494
Supramaxillary Nerve 49^
With Temporary Resection of the Malar Bone 49^
Inframaxillary Nerve 499
Retrobuccal Method 5^2
Temporary Resection of the Lower Jaw 5°^
Temporary Resection of the Zygomatic Arch 504
Lingual Nerve 5°"
Mental Nerve 5o6
Intracranial Resection of the Ganglion CJasseri 5^7
Facial Nerve 5^9
Nervus Accessorius Willisii (Spinal Accessory Nerve) 510
Brachial Plexus 5"
Crural Nerve 5"
Sciatic Nerve 5^2
Popliteal Nerve 5^3
Plastic Operations on the Face 5 '4
Blepharoplasty (Plastic Surgery of the Eyelids) 514
Cheiloplasty (Plastic Surgery of the Lips) 517
Stomatoplasty (Plastic Surgery of the Mouth) 526
Meloplasty (Plastic Surgery of the Cheeks) 5^7
Rhinoplasty (Plastic Surgery of the Nose) 53°
Total Rhinoplasty 53°
Partial Rhinoplasty 539
Correction of Saddle or Collapsed Noses 54'
Plastic Operations fur Congenital Fissure Formations of the Oral Region
Harehp and Maxillary Fissure . " 544
Single Cleft of Lip (Harelip) 544
Double Harelip 54^
Double Harelip and Maxillary Fissure 54^
Single Harelip and Cleft Palate . . , 55°
Cleft Palate 55^
Staphylorrhaphy (Closing Cleft of Soft Palate) 551
Uranoplasty (Closing Cleft of Hard Palate) 555
Palatal Protheses, Obturators 55^
Oi'kkations involving the Facial Cavities
In the Orbit 5^1
Extirpation of the Eyeball 5^2
Enucleation of the Eyeball ......••••••• 5"^
Exenteration of the Bulb .........•.•• 5^3
In the Ear 5^3
Foreign Bodies in the External Auditory Meatus 5^3
TABLE OF CONTEXTS xvii
PAGE
In the Xares -c..
Inspection of Xares •■•.......,.. -5-
Tamponing the X'ares ,55
Removal of X'asal and X'asopharyngeal Polypi -5j;
Removal of Mucoid Polypi _ ,gg
Removal of X^'asopharyngeal (Fibrous) Polypi -yi
Division of the N^ose in the Median Line rjz
Resection of X'asal Process of the Upper Jaw -y2
Temporary Detachment of the N'ose - -,
Turning X'ose upward -_ .
Adenoid Vegetations in X'asopharyngeal Cavity ^yy
Contraction of X'ostrils ... - ^
Deviation (Scoliosis) of the Septum of the X'ose -go
Subperichondrial Resection of the Septum (Petersen) ego
In the Oral Cavity .gj
For Inspecting the Cavity of the Mouth rgj
Extraction of Teeth •••......... rg.
Acquired Defects of the Palate rgo
Tonsillotomv ..... -^t
Extirpation of Tonsils ......" cq.
Amputation of the Uvula ........... co-
operations on the Tongue , cn-
Excision of a Wedge-shaped Portion from the Tip of the Tongue :g-
Amputation of the Tongue -gg
Temporary Lateral Resection of the Lower Jaw 600
Temporary Resection of the Lower Jaw in the Median Line 602
Operation for Ranula 504.
Extirpation of the Parotid go-
Extirpation of the Submaxillary Gland go-
Salivary Fistula gQ_
Subhyoid Phar}-ngotomy go8
Lateral Pharyngectomy gjo
Retropharyngeal Abscesses gjo
OPEK.A.TIOXS ox THE X'eck
Opetiing of the Air Passages, Bronchotomy gj,
Laryngotomy gj2
Median Thyrotomy gj2
Transverse Thyrotomy gj .
Infrathyroid Laryngotomy gj .
Subhyoid Laryngotomy gjc
Tracheotomy •••........ gi-
High Tracheotomy gjg
Intubation gj
Inferior Tracheotomy g2o
Tamponade of the Trachea g2o
Extirpation of Larynx g2j
xvni
TABLE OF CONTENTS
Operations for Goitre {^Struma)
Parenchymatous Injection .
Puncture with Subsequent Injection
Incision with Suturing Cyst Wall to Sl>
Extirpation of Struma
Resection of Goitre
Enucleation of Goitre .
Ligation of Arteries .
Palliative Operations .
Ligation of the Isthmus of the Thyroid Gland
Operations on the (Esophagus
Introduction of the Oesophageal Tube
Foreign Bodies in the (E^sophagus
Strictures of the CEsophagus .
External (Esophagotomy
Oesophageal Diverticula .
Tenotomy of the Sternocleidomastoid
Extirpation of Sternocleidomastoid
Operations for Cervical Ttimors
PAGE
625
625
625
626
626
630
631
631
633
633
635
635
637
639
640
644
644
646
646
Operations on the Breast
Ligation of the Innominate Artery
Ligation of the Internal Mammary Artery
Resection of the Manubrium Sterni
Resection of the Ribs
Opening of the Thoracic Cavity
Thoracocentesis .
Puncture with Aspiration
Thoracotomy
Pneumotomy
Pericardiotomy .
Operations on the Mammary Gland
Incision of the Mammary Gland
Extirpation of the Mammary Gland
Amputation of the Breast with Clearing out of the Axilla
651
652
653
655
657
657
659
661
664
666
666
666
666
667
Operations on the Abdomen
Opening Abdominal Cavity by Puncture ........... 672
Laparotomy (Coeliotomy) .......... .... 673
Laparotomy for Ileus .............. 676
Operations on the Stomach and the Intestines 678
Gastrotomy 678
Gastrorrhaphy ............... 679
Gastrostomy ............... 680
By Establishing an Oblique Fistula 682
TABLE OF CONTENTS xix
PAGE
Resection of the Pylorus 685
Gastro-enterostomy . . . . . . . . . . . . . . 690
Pyloroplasty ............... 696
Enterotomy ............... 697
Enterostomy (Colostomy) ............. 697
Formation of an Artificial Anus ............ 699
Enterorrhaphy ............... 702
Resection of the Intestine ............. 706
Enteroanastomosis .............. 708
Local Exclusion of Diseased Intestine .......... 710
Resection of the Vermiform Appendix . . . . . . . . . • 711
Anus Pr?eternaturalis .............. 712
Operations for Hernia . . . . . . . . . . . . . .714
Taxis ................. 717
Herniotomy ............. . . 718
Radical Operation for Hernia ............ 722
For Inguinal Hernia ............. 722
For Femoral Hernia ............. 730
For Umbilical Hernia , . . . . . . . . . . . -731
Operations on the Liver and the Gall Bladder .......... 732
Operation for Echinococcus of the Liver .......... 732
Cholecystotomy ............... 733
Cholecystostomy ............... 734
Cholecystectomy ............... 735
Choledochotomy ............... 736
Operations on the Spleen .............. 738
Splenectomy ............... 738
Splenopexy ................ 739
Operations on the Kidney .............. 740
Nephrotomy ................ 740
Nephrectomy ............... 740
Nephropexy ............... 745
Ureterotomy ............... 746
Operations on the Pelvis
Operations on the Urethra and the Bladder . . . . . . . . . . 747
Calheterism ............... 747
Stricture of the Urethra ............. 754
Internal Urethrotomy. ............. 759
External Urethrotomy .......'...... 761
L^rethroplasty ............... 764
Foreign Bodies in the Urethra and the Bladder 766