Surgery, a practical treatise with special reference to treatment / by C.W. Mansell Moullin ; assisted by various writers on special subjects.

  • Mansell-Moullin, C. W. (Charles William), 1851-1940
Date:
1893
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Licence: Public Domain Mark

Credit: Surgery, a practical treatise with special reference to treatment / by C.W. Mansell Moullin ; assisted by various writers on special subjects. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    vein, and there is no certain method of separating one condition from the other. Faihire of sight due to ana;mia of the retina, constant yawning or deep sighing inspirations, and throwing the arms about over the head, are very suggestive of hemorrhage, but nothing more; and a great deal of blood may collect in the abdominal cavity without causing any marked degree of dullness. Prognosis.—The condition of the pulse and the temperature together give the best clue (always provided there is no hemorrhage), but a great deal depends upon the kind of injury. Shock may prove fatal almost instantaneously, or it may be very severe at first and gradually pass off; or, especially after extensive injuries, it may steadily grow worse and worse, until at length the pulse fails com- pletely. The maniacal form is nearly always fatal. Whether an operation should ever be performed during the continuance of shock is a question that depends u])on the injury. So far as primary amputations are concerned, I am sure that the best course to follow is to stop the hemorrhage, prevent decomposition by wrapping up the limb in a strong solution of corrosive sublimate (i part in 500), and leave it, not until reaction is beginning, but until it has thoroughly set in—and this may not be for more than forty-eight hours. It is impossible at first to say whether the patient will live or not; when in this condition, an operation will almost certainly prove fatal. Even when reaction is commencing, the same result is highly probable. I have on more than one occa- sion seen a patient's face suddenly change and felt the skin grow cold again as the bone was being sawni through ; while if the hemorrhage is stayed and decompo- sition prevented (as it can be in nearly every case), the patient at least can come to no harm. The exception to this is where it is necessary to perform an operation, such as opening the abdomen, for the arrest of hemorrhage. This must, of course, be done at once. Ether is the anaesthetic usually recommended for operations in these cases, but chloroform is as safe if given in very small quantities ; a patient suffering from shock is already almost insensible to pain, and requires very little to produce complete anaesthesia. Treatment.—Hemorrhage must, of course, be stopped at once ; crushed limbs rarely bleed from the large vessels, but often there is a considerable amount of general oozing, which is serious in such a condition as this. Very hot water (with corrosive sublimate), and afterward firm bandaging, is the most satisfactory method. The elastic tourniquet should not be used, as it is liable to cause slough- ing. Where a mass of muscle projects from the end of a crushed stump and persists in oozing, it may be ligatured and cut away. Warmth is the first essential—hot blankets round the patient, and hot bottles outside these. Stimulants are usually required, but they must be given in very small quantities, at intervals of half an hour, and careful watch must be kept upon the condition of the pulse ; as it improves the intervals can be lengthened. If there is much sickness, a larger amount may be injected into the rectum. Subcu- taneous injections are sometimes resorted to when the patient is insensible and an immediate effect is desired. Ether, perhaps, acts more rapidly than brandy, but its effect is more evanescent. In many cases ammonia may be given with advan- tage, either wath the brandy (liq. ammoniae aromat., 3j) or even, if the heart is certainly failing, hypodermically, by intravenous injection, as in cases of snake- bite. Strychnia, digitalis, and other drugs from which much was expected, have all proved fallacious ; a very small quantity of morphia {yi gr.), locally, is beneficial, relieving the pain and so diminishing one cause of the depression. Transfusion with blood or with a saline solution is of very little use, if any, in shock uncomplicated with hemorrhage. Possibly a certain amount of benefit may be derived from raising the limbs, surrounding them with cotton-wool, and then bandaging them, so as to diminish as far as possible the area over which the blood in the body has to be distributed.
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