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
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.
90/1262 (page 82)
![acid and of sulphocarbolate of soda are recommended. American surgeons are said to have used bromine vapor and creasote with advantage. Salicylic acid is reported to have succeeded when injected hypodermically; and many other germi- cides have enjoyed a local reputation. In most cases, however, it answers better to treat the symptoms. Strong antiseptics in particular should be avoided, as the additional injury they inflict upon the tissues may cause sloughing. The burning pain can be relieved by excluding the air and using gentle pressure. Cold may be grateful to the patient, but care is required in employing it, for fear of lowering the vitality of the part too far. Oxide of zinc and starch are sometimes dusted thickly over the skin, but in many ca.ses they cause intoler- able itching. Extract of belladonna mixed with glycerin, and covered with a thick, soft layer of cotton-wool, is greatly to be preferred. Three or four coats of lead paint, mixed with glycerin to prevent its cracking, have a very satisfactory effect, partly, no douVjt, owing to the absorption of the lead and its action upon the capillaries; but the ordinary lead lotion is equally good if evaporation is checked by using five or six thicknesses of lint. In very mild cases the surface may be painted over Avith a strong solution of nitrate of silver in ether, or with collodion, or tincture of iodine, though the benefit is probably due to the mechanical effect upon the epidermis. Rest, gentle uniform pressure, and elevation, if the part will admit of it, are of material help in relieving the pain and inflammation. When the tension is extreme it is sometimes necessary to make a few punctures ; for want of this I have known the eyelids slough, but such circumstances are rarely met with in uncom- plicated erysipelas. [Occasionally the application of a blister to the sound skin, by temporarily occluding the lymphatics, may prevent the spread. The tincture of iodine is absorbed and is potentially germicidal. Vapor of bromine is useful in prevent- ing the spread to other patients.] SEPTIC INFECTION, OR TRUE SEPTICEMIA. In the strict sense of the term this name should be reserved for an acute specific disease caused by a micro-organism which multiplies in the l)lood, so that the most minute trace can communicate it by inoculation, as in the case of anthrax. It is not of necessity attended by septic fever or sapraemia, on the one hand, or by the local manifestations of pyaemia, thrombosis, embolism, or suppuration, on the other. The smallest wound is sufficient; there is a short period of incubation —eight or ten hours in acute cases—and the symptoms steadily increase in sever- ity. Sometimes it is known as progressive septicaemia to avoid confusion Avith sapraemia. That such a disease can be artificially produced l)y pure cultivations in animals is beyond doubt. Whether it ever occurs in man by itself, so that it can be distinguished from all other troubles that are caused by infective germs, is open to question. It must be remembered that after the injection of a minute quantity of a chemical poison into the blood, myriads of micro-organisms make their appearance, and care must be taken not to mistake effect for cause. It is possible that some of the exceedingly fatal ca.ses of post-mortem wounds that occur in connection with puerperal peritonitis are examples of septic infec- tion ; but, on the other hand, it is by no means improbable that they are really due to .sapraemia, the inoculation of a virulent poison (as happens sometimes from the bites of venomous reptiles) causing such extreme depression that the tissues either succumb at once, or are too much weakened to withstand the action of other germs. Other exam])]es are fortunately very rare. Pathological Appearances.—The changes found post-mortem are practi- cally the same as those in other acute specific fevers. Cloudy swelling is universal; the brain and pia mater are congested .; the spleen is enlarged ; and the number of white corpuscles in the blood apparently increased ; but in the most acute cases](https://iiif.wellcomecollection.org/image/b21213744_0090.jp2/full/800%2C/0/default.jpg)
