53 



OPERATIONS (of SURGERY). 



Operating is an inferior part of a surgeon^s duty : yet 

 its neat and expeditious performance will gain him much 

 applause, while the contrary will lose him much of his 

 reputation. 



It is a hundred times more gratifying and creditable to 

 save a limb or to dissolve a stone, than to have recourse to 

 an operation, however clever the operator. It is proper 

 and highly creditable for a surgeon to be able to operate at 

 a moment^s notice, if required ; but whenever there is a 

 doubt, it is his duty to give the patient the benefit of that 

 doubt. Hence "the advantages of modern surgery consist 

 (not in multiplying operations, but) in limiting the expendi- 

 ture of blood and pain, and often averting altogether the use 

 of operation s.^^ Whilst, however, many operations are 

 averted, others are introduced successfully for diseases, 

 tumours, distortions, &c., which before were considered in- 

 curable. It is not only necessary to study anatomy well, 

 but (to operate) the knowledge must be kept up by dissection. 

 Pain is saved by dividing the skin from within outward, 

 instead of the contrary, and boldly, at once. And when 

 large incisions are required use large knives. The parts 

 being kept on the stretch is of great importance in making 

 a free incision. All knives must be used on the principle of 

 the saiv. By a magnifying glass you will see some are set 

 backwards, some forwards. A razor is set differently from 

 a dissecting knife. (Liston^s Introductory Lecture, in the 

 'Lancet' for June 1st, 1844.) 



Incisions (in operating) should always be made in the 

 direction of the muscular fibres underneath. One cut falling 

 into another at right angles affords two flaps \l / One flap 

 is raised by making two incisions meet at a point, forming, 

 by this juncture, either an acute or obtuse angle, thus /\ }^ 

 Four flaps are made by making two incisions cross each 



other, thus r-- ' " ~ Diseased skin may require removal, but 

 its saving is always of the gi'eatest import. 



