Lectures on the operations of surgery : and on diseases and accidents requiring operations / by Robert Liston ; with numerous additions by Thomas D. Mütter.

  • Robert Liston
Date:
1846
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on the operations of surgery : and on diseases and accidents requiring operations / by Robert Liston ; with numerous additions by Thomas D. Mütter. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

    73/592
    well made by Mr. Husband, of this city; and for some time past I have almost abandoned the use of the old adhesive plaster of the shops, which often in persons with a delicate skin, or children, produces troublesome irritation. In the first dressing of a wound, especially if a large one, we find it useful to apply strips of plaster to support the sutures, and before their application we should be careful to shave the parts if covered with hair, cleanse them thoroughly, and dry them. When the isinglass plaster is employed it should be cut into strips of an appropriate width and length, and then moistened on the glazed side with a wet sponge. When the ordinary adhesive plaster is used it should be heated by placing the strips around a bottle filled with hot water, or placing them upon a warm dish. In removing the strips we must always recol- lect to begin at each end, and having lifted up the strip until we reach the wound, we carefully turn it (the strip) upon its side, in doing which it is detached. I have seen much mischief result from an ignorant surgeon's tearing off the plaster, holding one end only between his finger and thumb.—T. D. M.] What is called the quilled suture is sometimes employed, but very rarely. It has been recommended by surgeons in cases where wounds are deep. The object, in muscular wounds, is to bring the whole surface together. The ligatures are passed deeply, in order to make pressure on the deep parts. The barrel of the quill is placed on the surface and a ligature tied over it. Then another quill is put into the folds of this ligature, and also tied. This suture is only employed in one operation—that for lacerated perineum. I have used it two or three times in cases of this kind. A third sort of suture is employed—the sutura circumlata, or twisted suture. I shall apply this when I come to speak of wounds of the face. Now there are a great many wounds which will not heal by the first intention. They are so made that they are attended by a loss of integument. This, I have no doubt, Mr. Cooper explained when treating of different wounds. These solutions of continuity must be dressed with a view to encourage suppuration as speedily as possible. It is well to relax the parts thoroughly, and to put them in such a position that their edges shall not be pulled much asunder. So long as there is bleeding you apply cold cloths to the part, and then by-and-by, as giving great relief to the patient, and being more congenial to the feeling of the part, you will apply warmth, either in the form of poultice or water-dressing. Lint, dipped in tepid water, may be applied, the pledget being double, of perhaps the patent lint, and barely larger than the sore ; this is covered by a more ample bit of oiled silk, to prevent evaporation, and this is to be continued till suppuration is freely established, and the wound begins to get clean; then, perhaps, you have to mode- rate the discharge a little by some astringent application. 6*
    digitised image 1
    digitised image 2
    digitised image 3