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On The Surgery   

It Is the business of the physician to know, in the first place,
things similar and things dissimilar; those connected with things most
important, most easily known, and in anywise known; which are to be
seen, touched, and heard; which are to be perceived in the sight,
and the touch, and the hearing, and the nose, and the tongue, and
the understanding; which are to be known by all the means we know
other things.
2. The things relating to surgery, are- the patient; the operator;
the assistants; the instruments; the light, where and how; how many
things, and how; where the body, and the instruments; the time; the
manner; the place.
3. The operator is either sitting or standing, conveniently for
himself, for the person operated upon, for the light. There are two
kinds of light, the common and the artificial; the common is not at
our disposal, the artificial is at our disposal. There are two modes
of using each, either to the light, or from the light (to the
side?). There is little use of that which is from (or oblique to the
light), and the degree of it is obvious. As to opposite the light,
we must turn the part to be operated upon to that which is most
brilliant of present and convenient lights, unless those parts which
should be concealed, and which it is a shame to look upon; thus the
part that is operated upon should be opposite the light, and the
operator opposite the part operated upon, except in so far as he
does not stand in his own light; for in this case the operator will
indeed see, but the thing operated upon will not be seen. With
regard to himself when sitting, his feet should be raised to a
direct line with his knees, and nearly in contact with one another;
the knees a little higher than the groins, and at some distance from
one another, for the elbows to rest upon them. The robe, in a neat and
orderly manner, is to be thrown over the elbows and shoulders
equally and proportionally. With regard to the part operated upon;
we have to consider how far distant, and how near, above, below, on
this side on that side, or in the middle. The measure as to distance
and proximity is, that the elbows do not press the knees before, nor
the sides behind; that the hands be not raised higher than the
breasts, nor lower than so as that when the breast reposes on the
knees he may have the hands at right angles with the arm: thus it is
as regards the medium; but as concerns this side or that, the operator
must not be beyond his be beyond his seat, but in proportion as he may
require turning he must shift the body, or part of the body, that is
operated upon. When standing, he must make his inspection, resting
firmly and equally on both feet; but he must operate while
supporting himself upon either leg, and not the one on the same side
with the hand which he makes use of; the knee being raised to the
height of the groins as while sitting; and the other measures in
like manner. The person operated upon should accommodate the
operator with regard to the other parts of his body, either
standing, sitting, or lying; so as that he may continue to preserve
his figure, avoid sinking down, shrinking from, turning away; and
may maintain the figure and position of the part operated upon, during
the act of presentation, during the operation, and in the subsequent
position.
4. The nails should be neither longer nor shorter than the points of
the fingers; and the surgeon should practice with the extremities of
the fingers, the index-finger being usually turned to the thumb;
when using the entire hand, it should be prone; when both hands,
they should be opposed to one another. It greatly promotes a dexterous
use of the fingers when the space between them is large, and when
the thumb is opposed to the index. But it is clearly a disease when
the thumb is impaired from birth, or when, from a habit contracted
during the time of nursing, it is impeded in its motions by the
fingers. One should practice all sorts of work with either of with
either of them, and with both together (for they are both alike),
endeavouring to do them well, elegantly, quickly, without trouble,

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