The principles and practice of modern surgery / by Robert Druitt.

  • Robert Druitt
Date:
1854
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Licence: Public Domain Mark

Credit: The principles and practice of modern surgery / by Robert Druitt. 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.)

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    in a position as easy as it can be made,—cool air,—free ventilation,—the exclusion of light and sound,—with mental consolation, to allay doubts and fears, and inspire resignation and cheerfulness, are most potent aids to medical treatment, which without them would often be utter!} fruitless. Local Treatment.—In the local treatment of inflammation, the first hing to be done is to remove all exciting causes if possible, and to place the part at perfect rest, and in an elevated posture, so as to favour the re- turn of blood from it;—and then the indications are, to diminish the morbid heat and afflux of blood, and to allay irritation and pain. 1. The local means of abstracting blood are leeches, cupping, and scari- fications. In order to apply leeches, the parts should first be washed, and if they will not stick, a little milk or blood should be smeared on it, or some small punctures should be made with the point of a lancet; and the leeches should be well dried in a cloth. The best plan of stopping haemorrhage from leech-bites is to dip small pellets of lint in the tinct. ferri sesquichloridi, and press them on the holes for a few minutes, or to insert a finely pointed pencil of lunar caustic into them. Other plans are, to touch them with a red hot knitting needle, or to stitch them up with a very fine needle and silk, or to apply a small piece of matico leaf. But in order to prevent the very serious consequences that sometimes happen from this source to children and delicate persons, directions should always be given that the bleeding from leech-bites should be stopped before the patient is left for the night. Moreover it will be prudent to apply them over some bone, so that the pressure may be applied effectually. Again, leeches, if they stick too long, should be removed by touching them with salt, and should not be pulled off' forcibly; nor should they be applied to the eyelids or prepuce, otherwise they will probably be followed by cede- matous swelling, or even erysipelas. [The bite of the American leech is less severe than that of the Spanish and Swedish leeches, and protracted bleeding is less likely to follow it. As a general rule, therefore, the American leech is used on children, and on those surfaces from which the blood flows freely and abundantly. Six American leeches are supposed to abstract an ounce of blood, while the same quantity will be drawn by two, or at most by three, of the others.—Ed.] Cupping, when it can be adopted, is a more active measure, and relieves pain sooner than leeches. Scarifications or incisions are of use when inflamed parts are covered with a dense unyielding fascia, as in whitlow; or when there is great tension, as in phlegmonous erysipelas ; or when the inflamed part is infiltrated with an irritating fluid, as in extravasation of urine, or with unhealthy matter, as in carbuncle. 2. Cold applications are of use to diminish heat, and cause contraction of the capillaries ; but they should be applied continuously, otherwise the pain will be aggravated when the heat returns. The best lotion is one containing lead and spirit, as F. 55; it should be applied by means of a single piece of thin linen frequently changed; and care should be taken that the vapour may pass off freely, otherwise the cold lotion will soon be •.'onverted into a hot fomentation. In some severe cases, ice or frigorific mixtures (F. 56) may be applied in bladders. The following very effec- •ual means of applying a continuous degree of cold is recommended by * A most instructive commentary on the value of antiphlogistic remedies of various icinas, is to be found in Dr. Latham's second series of Lectures on subjects connected with clinical medicine.
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