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
Catalogue details

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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    111 addition to these symiJtoms, whicli are dependent ujjon tlie c;hanges in the blood, others arise from the local troubles. Any serous or synovial membrane may be affected ; abscesses may form in any part of the body, deep or superficial; the viscera may be riddled with them ; or they may be scattered through the sub- (utaneous tissue ; and wherever they occur, they are always diffuse. Many of these cannot be diagnosed ; metastatic ab.sce.sses in the lungs, for example, are always small, and cause but slight physical signs, w-hile the nervous system is so depressed that the pain, even when it is severe, is scarcely felt. Local tender- ness is always of very great significance ; and in most cases it is essential to insti- tute a thorough examination of the patient every day to make sure that no sup- ])urating focus anywhere is overlooked. Pyaemia varies very greatly in its intensity. In some cases—when, for example, it is due to acute osteomyelitis—it may prove fatal within the week, even before metastatic abscesses of any kind have been able to make their appear- ance. In others pericarditis, or some other lesion .so grave as to imperil life, sets in ahnost at once. Sometimes, on the other hand, it is very chronic, lasting even for months, with occasional rigors and abscesses, which in these cases are limited, or almost limited, to the subcutaneous tissues. So far as the progno.sis is con- cerned, a very great deal depends ui)on the locality of the secondary deposits. When the abscesses are superficial or confined to the joints, and when the fever does not run an extreme course, there is always the hope that recovery may follow, but at the expense of a long and tedious illness, with very likely one or more joints crippled and almost useless. Treatment.—When once pyaemia has developed, it does not appear possible to cut it short in any way ; all that can be done is to treat the symptoms as they arise, and prevent them from becoming themselves centres of fresh infection. Prevention, therefore, is all the more e.ssential—first, to prevent the poison devel- oping ; secondly, to prevent its being absorbed. Where it is practicable, every patient before operation should undergo a thorough course of preparation. It is a well-known fact that people in a robust state of health, taking active exercise, and consuming a large amount of food, are not nearly such good subjects for operation as those who have long been bed-ridden. Laid up suddenly, their bowels become confined, their liver is con- gested, the urine is thick and high-colored, and a certain amount of feverishness sets in. The surroundings should receive the greatest attention. Ventilation should be perfect; nothing tends to such depression as the constant breathing of air that has been fouled ; and absolute chemical cleanliness must be insisted on. Bed, bedding, instruments—everything, in short, that comes in contact with the patient—must be scrupulously clean. Outbreaks of pyemia have been traced to the sudden disturbance of accumulations of dust, but in the majority of instances it is probable the actual vehicle of the poison is some material object. A wound requires even greater care. Everything that tends to irritate the tissues in the neighborhood—want of rest, tension, friction, or decomposition— lowers their power of resistance and makes them more susceptible. Where the drainage is perfect, so that the discharges escape at once, and the surface of the wound is kept dry, so that decomposition cannot occur, suppuration may follow, but it will be limited to the surface, and there is little or no fear of the pyogenic micro-organisms either finding their way into the cellular tissue and cau.sing diffuse suppuration, or entering into the blood-stream and leading to thrombosis, soften- ing, and metastatic abscesses. Ab.scesses should be opened at once and thoroughly drained. Joints that are filled with pus must be treated in the same way, or irrigated with a continuous stream of water. At first, the cartilages and the synovial lining are unaffected, and if only the contents are evacuated in time, and no accumulation is allowed, the mischief may be prevented from extending farther, and a very useful articula- tion left. In many instances, however, either fibrous or bony ankylosis results.