CHAPTER IV. 

 ELEMENTARY OPERATIONS. 



Under this term are understood those of a simple nature, as 

 perhaps an incision or puncture, or the insertion of sutures, and 

 other implicated manipulations, but which form the foundation 

 and belong to the operative generalities of the domain of major 

 surgery. They will be treated under the two principal heads of 

 division or dieresis, and reunion or synthesis. 



DIVISION. 



This is a very common sui-gical step, of which the object is 

 the separation of tissues from each other. Gourdon has recog- 

 nized six principal modes by which to divide tissues, viz.: by in- 

 cision, dissection, puncture, resection, ligature and cauterization. 

 Varying, somewhat, from this view, and considering resection as 

 an operation specially appropriate to bony structures, and liga- 

 ture as adapted to the cellular tissues, and classifying cauteriza- 

 tion as i)rincipally a means of puncture, we prefer, with Peuch 

 and Toussaint, to reduce the consideration of these modes of 

 division to three, ^dz.: incision, dissection and puncture. 



A. — Incisions. 

 Any methodic division of soft tissues made with a sharp 

 instrument is an incision. The basis of the majority of surgical 

 operations, their purpose is to allow the escape of the contained 

 fluid from a cavity, to enlarge the -size of a wound, to make 

 counter openings, to extract foreign bodies, to remove pathologi- 

 cal growths, to destroy abnormal adhesions, to expose tissues to 

 be operated upon or tumors to be removed, to facilitate the re- 

 duction of displaced organs, etc., etc. The bistoury, the scalpel, 

 the sage knife and the scissors are the cutting instruments most 

 commonly used for making incisions. Sometimes, however, the 

 amputation knife, the tenotome, the hemiotome, with lancets, or 



