An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White.
- William Williams Keen
- Date:
- 1899
Licence: Public Domain Mark
Credit: An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White. 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.
![it by fibrous tissue that unites the previously separated wound-surfaces. Union by secondary intention is thus accom])lished Avithout suppuration or waste of nutritive material. As a rule, the most assiduous effort of the surgeon must be to prevent any accumulation of Ijlood or \vound-secretions in any Avound uhich he is called upon to treat. Perfect apposition may, again, be prevented by the presence of foreign matter between the wound- surfaces. Shreds of clothing, splinters of wood, sponges, bits of foreign matter of every conceivable character, at times are found in wounds, and their removal is to be carefully secured by the surgeon. For the protection of a wound it is requisite that it be guarded first from motion, since by motion the apposition of the wound-surfaces is disturbed, the delicate new adhesive material which has already been formed is ruptured, and the conditions of the original injury are renewed in tissues already weakened by that injury. The wound must be protected also from mechanical violence, such as rude handling, friction, and gross mechanical injuries of every kind. It must be protected from chemical irritants, and especially from the products of decomposition of retained secretions or of portions of dead tissue; and, lastly, it must be protected from infection from poisonous agents, especially the more common infecting organisms everywhere abounding in nature. The local nutritive conditions to which attention must be paid have to do with the circulation and the innervation of the parts to be repaired. A depend- ent position of the injured part or an impediment to the free return circulation by improper bandaging may produce excessive and persistent congestion and interfere with its repair. Temperature is not unimportant: prolonged cold w'ill impair nutrition, and too high a temperature may cause local death. Too great tension of wound-flaps or tension from pent-up secretions impairs local nutrition by obstructing the flow of blood in the capillaries, as well as by the reflex effects of irritated nerve-fibrils, and also mechanically prevents rest and coaptation of deeper parts. The details of treatment to be applied in every wound have their rational basis in the principles thus outlined, which will serve for the safe guidance of the practitioner. Treatment of Wounds.—Arrest of Hemorrhage.—To stop bleeding is the first care of the surgeon in his treatment of a Avound. The physi- ology of spontaneous hemostasis and the methods of securing artificial arrest of hemorrhage are given at length under Injuries of the Blood-vessels. The aim of the surgeon should always be to secure the arrest of bleeding by means that shall cause the least disturbance in the future repair of the wound. Unnecessary ligatures are therefore always to be avoided. When ligatures are unavoidable, those made of absorbable material, as catgut, are to be preferred, and the size of the thread should be as small as is consistent with the strength required to occlude the vessel. When non-absorbable mate- rials are used for ligatures, as silk thread, if it has been perfectly disinfected and primary union of the wound can reasonably be expected, this too may be cut off and left buried in the wound. The first and most generally applicable means for restraining hemorrhage is that of direct pressure made upon the bleed- ing point. This may be by the finger or by a tampon, or by an instrument, as a pressure-forceps. These means are often, in the nature of the case, but temporary expedients. In many instances, however, the temporary use of pressure will be all that will be required for the arrest of hemorrhage that at first was very abundant. When copious and continuous capillary oozing persists, it may frequently be controlled by pressure with compresses wrung out in water as hot as can be born by the hand—115° to 120° F. The use of heat as a hemostatic is to be preferred to cold, as being more favorable to local nutrition and subse-](https://iiif.wellcomecollection.org/image/b21217014_0135.jp2/full/800%2C/0/default.jpg)
