INTRODUCTION. 



importance in deciding the matters pertaining to the details of 

 an operation. When there is any ojytlon in the case it pertains 

 wholly to the surgeon to determine the question. And when the 

 period of abeyance has terminated by his decision in fixing the 

 day and horn- when the contemj^lated treatment is to be applied, 

 the optional time becomes changed to the selected time. Of -course 

 it is not always left to the option of the practitioner to select the 

 moment for the accompUshment of his task. He must be gov- 

 erned by the nature of the case, and may be left without the 

 opportunity of exercising any discretion in the matter. The 

 urgency of the occasion may be extreme, with no interval allow- 

 able for deliberation or choice, and the only available time, the 

 peremptory present, must be accepted as that of necessity. 



The operation being now obhgatory, and the case understood, 

 the surgeon's next thought is the choice of the locality of the 

 operation, and that being finally decided, the point of selection 

 has been reached. The case may easily present such features that 

 this point becomes too obvious for hesitation by becoming that of 

 selection as well as that of necessity, as indicated by the seat of 

 the lesion or diseased process. With traumatic cases, there is, 

 of course, but a single point of interest — it is i\xG point of injury ! 



In surgical phraseology the terms method and procedure are 

 often used convertibly. There is between them, however, a dis- 

 tinction which, for the sake of precision, must not be lost sight of. 

 By method should be understood the princij)al and primordial 

 mode by which the operation is performed, while \>^ procedure is 

 meant the special modifications and successive stages by which 

 the manipulations of the operation itself are regulated. For ex- 

 ample, in the removal of a vesical calculus there is one method by 

 hthotrity and another by extraction, and with both are involved 

 the insertion of instruments into the urethral canal, one being the 

 jiTocedure with the catheter, and the other the procedure by the 

 injection of tepid water. Castration with clamps is a method, 

 when compared to double subcutaneous twisting {Mstournage) or 

 to torsion; and it is performed by two procedures, that by covered 

 and that by uncovered testicles. 



There are several important points which demand special at- 

 tention at the hands of the surgeon before beginning an operation. 

 Having finally reviewed the situation, and especially having men- 

 tally rehearsed the anatomical disposition of the region and the 



