INTRODUCTION. 45 



formed when certain blood diseases are present, and 

 organic disease of various organs, together with the 

 special conditions of the patient, should be most carefully 

 considered. 



Professor Williams is careful to caution us lest we 

 operate with dirty instruments or hands or near a dissect- 

 ing room. The operation should be performed in a place 

 where there is lots of room, light and quietude. The 

 subject should be placed in position by skilled assistants, 

 and the necessary instruments and appliances should be 

 clean, in order, and placed under the charge of a special 

 assistant. Thoroughness, cleanliness, and judgment should 

 be the features of all operations. Emergencies as they 

 arise must be met and counteracted. Ha3morrhage, pro- 

 trusion of viscera, and collapse of the patient, are some of 

 the most formidable. 



Collapse consists in sudden interference with the heart's 

 action, the result of nervous shock. The patient ceases to 

 struggle, and loses all voluntary power, the limbs are 

 relaxed, the pulse scarcely perceptible and extremely 

 irregular, sighing, palor of visible mucous membranes, and 

 coldness of the body are present in most cases. 



In this state of affairs a free supply of fresh air must 

 be secured, and sometimes artificial respiration resorted to. 

 Stimulants must be administered and frictions applied to 

 the extremities and general surface. Extreme quiet and 

 stimulant tonics must constitute the after-treatment. 

 When death occurs from this cause, the blood is found 

 diminished in consistency and occupying all the cavities 

 of the heart, the right especially being engorged. 



In all cases after a serious operation the patient should 

 be kept in a well- ventilated house, and supplied with good 

 and not over nutritious diet, the necessity for stimulant 

 and tonic agents being estimated in accordance with the 

 case. 



The various forms of appliances and dressings will re- 

 quire special notice. An important rule to be observed in 

 operative surgery is to preserve every portion of structure 

 which can become useful, while removing all diseased parts 



