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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    in another ; and. in very exceptional instances, metastatic, suddenly subsiding aiid attacking some internal organ instead. Abscesses are uncommon, although occasionally the lymphatic glands break down and suppurate. \'ery often a relajjse occurs, sometimes two or three, but they are rarely so severe as the original attack. Acute suppurative arthritis, men- ingitis, pleurisy, and peritonitis have been recorded as complications; and occa- sionally in erysipelas of the face the mouth and fauces become involved, leading to erysipelatous laryngitis and cedema of the glottis. Pyaemia occasionally follows it ; and sometimes, especially after repeated attacks, a condition of solid cedema is left, which is very disfiguring when the face is concerned. Diagnosis.—The sudden rise of temperature, with headache, vomiting, and constipation ; the enlargement and tenderness of the neighboring lymphatic glands ; and the peculiarly sharply-defined margin of the redness, are character- istic. The last serves to distinguish it from simjjle lymphangitis. Erysipelas commencing in the mucous membrane of the fauces resembles ordinary catarrhal pharyngitis, but is infinitely more severe. The constitutional symptoms are even more marked than in the ordinary cutaneous form ; the throat is swollen and burning hot; the mucous membrane of the palate is thickened and of a brilliant red ; the voice is lost; swallowing is exceedingly painful; and the glands at the angles of the jaw are enlarged and very tender. The prostration in these cases is usually extreme, and, in addition to the ordinary risks, there is always the fear of the inflammation extending to the larynx. Prognosis.—The severity of the initial fever is no guide. [In youth and middle age recovery is the rule.] At the extremes of life; when the head, face, or chest is involved ; when the disease continues for any length of time, and particu- larly when there is old-standing nephritis, the prognosis becomes very grave. A dusky red, instead of bright eruption, jaundice, delirium, blood-stained bull^, and a sudden rise in the pulse-rate, without strength, are very serious omens. In many cases broncho-pneumonia sets in and proves fatal; in others signs of congestion of the brain ; in others, again, the symptoms resemble those of typhoid with diar- rhoea : or the i)atient sinks from exhaustion, worn out by the long-continued fever. Treatment, i. Constitutiojial.—It must always be remembered that, although the fever at the commencement of an attack may be sthenic, it tends very rapidly to assume a typhoid character. A purgative is nearly always required at first: even when there is diarrhoea it may usually be given with advantage, and particularly when, from the patient's appearance or habits, it is probable that the liver is congested. Afterward the bowels may be kept gently open by means of effervescent salines. In the slighter ca.ses nothing else is required, though quinine with mineral acids may be given to stimulate the appetite. In the more severe ones. Avhere the tongue is dry and brown, and the pulse is losing its strength and fullness, bark and ammonia with ether answer better than anything. If the temperature is high quinine or anti- pyrin may be given, but they appear to have little effect upon the disease. Per- chloride of iron, which, according to some, acts as a specific when given in large and frequent doses, has in my hands failed completely. I have often noticed a distinct improvement when it has been left off and quinine and carbonate of ammonia substituted. Stimulants are usually required, especially in the aged and in those who are accustomed to them. The guide to their administration is the condition of the tongue and the pulse. They .should always be given in small quantities at a time, and, if possible, with beef-tea, meat-jelly, milk, arrowroot, or other food that can be easily absorbed. The object is to sustain the action of the heart and supply it with strength until the activity of the poison begins to subside. Very often after the first day or two the patient will take liquid food readily, and then there is not the same necessity. 2. Local.—Many attempts have been made to check the spread of the micro- organisms in the tissues, but not with any great success. Injections of carbolic