he Gullet and 620
Perforating the Larynx

284. Denture Impacted in Oesophagus 621

285. Radiogram, after swallowing an Opaque Meal, in a Man 626
suffering from Malignant Stricture of Lower End of Gullet

286. Diverticulum of the Oesophagus at its Junction with the 627
Pharynx

287. Larynx from case of Sudden Death due to Oedema of 637
Ary-Epiglottic Folds

288. Papilloma of Larynx 641

MANUAL OF SURGERY

CHAPTER I

INJURIES OF BONES

Contusions--Wounds--FRACTURES: _Pathological_; _Traumatic_;
_Varieties_--Simple fractures--Compound fractures--Repair of
fractures--Interference with repair--Gun-shot
fractures--SEPARATION OF EPIPHYSES.

The injuries to which a bone is liable are Contusions, Open Wounds,
and Fractures.

#Contusions of Bone# are almost of necessity associated with a similar
injury of the overlying soft parts. The mildest degree consists in a
bruising of the periosteum, which is raised from the bone by an
effusion of blood, constituting a _haematoma of the periosteum_. This
may be absorbed, or it may give place to a persistent thickening of
the bone--_traumatic node_.

#Open Wounds of Bone# of the incised and contused varieties are
usually produced by sabres, axes, butcher's knives, scythes, or
circular saws. Punctured wounds are caused by bayonets, arrows, or
other pointed instruments. They are all equivalent to compound,
incomplete fractures.

FRACTURES

A fracture may be defined as a sudden solution in the continuity of a
bone.

PATHOLOGICAL FRACTURES

A pathological fracture has as its primary cause some diseased state
of the bone, which permits of its giving way on the application of a
force which would be insufficient to break a healthy bone. It cannot
be too strongly emphasised that when a bone is found to have been
broken by a slight degree of violence, the presence of some
pathological condition should be suspected, and a careful examination
made with the X-rays and by other means, before arriving at a
conclusion as to the cause of the fracture. Many cases are on record
in which such an accident has first drawn attention to the presence of
a new-growth, or other serious lesion in the bone. The following
conditions, which are more fully described with diseases of bone, may
be mentioned as the causes of pathologica