The science and art of surgery : being a treatise on surgical injuries, diseases, and operations / by John Erichsen ; edited by John H. Brinton.

  • John Eric Erichsen
Date:
1854
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Licence: Public Domain Mark

Credit: The science and art of surgery : being a treatise on surgical injuries, diseases, and operations / by John Erichsen ; edited by John H. Brinton. 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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    chloroform in Europe, have led to the almost entire abandonment of its use in this country.—Ed.] The incisions for the operation itself should be carefully and properly planned, so as to give sufficient space, with as little mutilation as possible, and in some cases they must be arranged with a view of subsequent extension, should the state of things discovered at the operation require it. They should be made freely without tailing, due attention being at the same time paid to the resis- tance of the tissues, so that the surgeon does not, by using too much force, plunge or jerk his scalpel or bistoury into the part. The scalpel should be set on a smooth ebony handle, which is less slippery than an ivory one when wetted with blood, and admits of greater delicacy of touch; it should be light in the blade, nearly straight-backed, and slightly bellied on the cutting edge. When very free and extensive incisions are required, as in the removal of large tumors, &c, Listen's spring-backed bistoury of proper size and shape, is a most convenient instrument. Whilst the incisions are being made, care must be taken that too much blood is not lost. This may be prevented most conveniently by the use of the tourniquet, or by an assistant compressing the main artery in the groin or axilla. If the seat of the operation be such as not to admit of this, the assistant must compress the bleeding vessels as they are divided during the operation; and as soon as it is concluded, he must remove his fingers from them one by one, to admit of their being ligatured. If oozing continue after all jetting vessels have been tied, this may be arrested by exposure to the air, or by pouring a stream of cold water upon the wound. In some cases the pressure of pad and bandage, and in others that of a sand-bag will arrest this bleeding, but in the majority of instances position and coaptation of the flaps will suffice. The sutures should be introduced at the time of the operation, whilst the patient is still under chloroform, but should be left to hang loose, and not be drawn tight until the wound is dressed. In this way the patient is saved the pain, which is always much complained of, of introducing the sutures at the time of the dressing. They should be made of dentist's twist, of moderate thickness, so as not to cut out readily, and need only be very fine in case of plastic operations, where scarring is objectionable. In some cases, where much tension is exercised, hare-lip pins are preferable to ordinary sutures. When the wound is small, and all oozing has ceased, its lips may at once be brought together. This may also be done even when large, if the patient be of a very irritable constitution and sensitive to pain, the whole dressing being per- formed whilst he is still under the influence of chloroform. But in general, when the wound is extensive, as in cases of amputation, I prefer, and almost invariably adopt, the plan recommended by Mr. Liston, of leaving the wound open, with a piece of wet lint interposed between its lips, for two or three hours, until its surface has become glazed; the lint is then carefully removed, any small coagula gently taken away, and the sides of the incision brought into ap- position, the sutures being drawn tight and tied. Long strips of plaster of moderate width should now be applied; these may either be of the isinglass or the common adhesive kind, both having advantages that recommend them in particular cases, with corresponding disadvantages that exclude them in others. The isinglass plaster is clean, unirritating, and being transparent, allows a good view of subjacent parts, but it has the disadvantage of loosening and stripping off when moistened by the discharges or dressings, which often renders it a very inefficient support. The common adhesive plaster is more irritating and dirty, but it is much stronger, and holds tighter, not loosening so readily when mois- tened. In large wounds, as in those of amputation, I prefer the isinglass for the first dressing, and leave it on until loosened by the discharges, and then use the common adhesive plaster for subsequent applications, when less irritation is likely to be induced.
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