Clinical lectures and essays / by Sir James Paget ; edited by Howard Marsh.

James Paget

Date:: 1875

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Licence: Public Domain Mark

Credit: Clinical lectures and essays / by Sir James Paget ; edited by Howard Marsh. Source: Wellcome Collection.

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cise, looking older than their years, are very bad. They that are fat, florid, and plethoric, firm-skinned, and with good muscular power, clear-headed, and willing to work like younger men, are not indeed good subjects for opera-_ tions, yet they are scarcely bad. The old people that are thin and dry and tough, clear-voiced and bright-eyed, with good stomachs and strong wills, muscular and active, are not bad; they bear all but the largest operations very well. But very bad are they who, looking somewhat like these, are feeble and soft-skinned, with little pulses, bad appetites, and weak digestive power; so that they cannot, in an emergency, be well nourished. I have said that all the risks of doing badly are at their maximum in some among the old; but these are some of the risks for which they will always need your especial care. The old are, much more than others, liable to die of shock, or of mere exhaustion within a few days after the operation. They bear badly large losses of blood, long exposure to cold, sudden lowering of temperature, loss of food. Large wounds heal in them lazily; and hence a prolonged hability to secondary heemorrhage and other mischiefs of open wounds. Their stomachs, too, are apt to knock-up with what may seem to be no more than necessary food, though indeed it often is so; for many old people are in less peril with a scanty diet than with a full one. Their convalescence is often prolonged; and you may expect to meet sometimes with great disappointment in having your old patients die with some slight casual disease, as if exhausted by the long expense of vital power in healing large wounds. They get all but well; and then, after seeming for some —

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