The principles of surgery / by James Miller.

  • James Miller
Date:
1845
Catalogue details

Licence: Public Domain Mark

Credit: The principles of surgery / by James Miller. 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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    as the nitrate of silver; applied lightly to the raw surface; with sc intensity to the margins, so as to produce a slightly escharotic effect there, and bring them into a form more suitable for the commencement of cicatrization ; and pencilled, again lightly, over the surrounding skin, where swoln and discoloured, so as merely to blacken this, and obtain the sedative and purely antiphlogistic effect. A temporary increase of pain usually follows in the sore, but soon passes away, on the applica- tion of a soft light poultice, or the hot water-dressing ; and this epithem is continued until the re-application of the nitrate ; which may be daily, or only on each alternate day, according to the effect produced. Under this treatment, amendment *is often rapid and satisfactory; pain dimi- nishing, and soon ceasing to be inordinate, the margins losing their irritable characteristics, and the raw surface beginning to be studded with healthy granulations; then the ordinary simple treatment is assumed. But success is not invariable ; the pain may be permanently increased by the application, and the sore either becomes more and more irritable, or threatens to pass into the inflamed. In such circumstances more simply sedative means must be applied to the sore, the pencilling by nitrate of silver being still continued however to the surrounding in- tegument. An aqueous solution of opium may be used, five grains to the ounce; coniura, hyoscyamus, belladonna, or aconite, cautiously; and sometimes good effects are produced by a weak nitric-acid lotion —from two to five drops to the ounce of distilled water. When the sore is secondary to cutaneous eruption, a weak solution of arsenic is often very beneficial; and in such cases it is well to combine the inter- nal with the local use of this remedy. But in my opinion, neither arsenic nor nitric acid are suitable as early applications to this kind oi sore ; they are apt to stimulate instead of soothing; and should only be had recourse to as alteratives, after the characters of the sore have been somewhat modified by the previous use of more appropriate, because more truly sedative remedies. If even these fail to relieve, much bene- fit will sometimes follow continued exposure of the part to steam of hot wrater, of as high a temperature as can be conveniently borne. Should the light application of the nitrate of silver fail to remove congestion from the surrounding skin, leeches or punctures may sometimes, though rarely, be required. On the whole, as already stated, the most trustworthy and generally applicable local remedy is the nitrate of silver; used not oftener than daily, and usually but once in the forty-eight hours; applied with great lightness to the raw surface and surrounding skin, so as only to produce its slightest effect—the very opposite of escharotic—sedative, anodyne, and protective by the formation of an investing pellicle on the sore ; pressed firmly only on the margins; and they too come to be but ten- derly dealt with, so soon as they have undergone a favourable change. 6. The Inflamed Sore.—This presents the ordinary characters of ad- vancing ulceration, with accompanying inflammatory action ; and, as can be readily understood, is the most common original form of ulcer. Very often, however, it is of secondary occurrence ; for over-stimulation is not unlikely to happen in the treatment of ulcer of a healthy, or even of a sluggish kind. The raw surface is gradually disintegrating ; and
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