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.
![wido of till' (lisoiisc, tliroiigli healthy tissue if ])ossible; special care must be taken to ))revent infection of the oj)enitivc wound from the diseased mass that is excised. To ^uard against the results of possible infection, the exposed sur- face remainint; after the excision should be thoroughly mopped over with a strong solution of carbolic acid, 1 : 10, or oven with the pure acid, or of cldo- ride of zinc, 1 : 8, or the actual cautery may be applied. The innnediate appli- cation of the actual cautery at the seat of inoculation, whenever such an inocu- lation is recognized as having taken place, will destroy the virus and prevent subse(iuent evil. When excision of the entire infected area is impracticable, multiple deep crucial incisions should be made into it, accompanied by injec- tions of carbolic acid, 1 : 10, by means of a hypodermatic syringe, systemati- cally administered so as to diffuse the carbolic solution throughout the entire extent of the base of the affected tissue and through the surrounding healthy tissue. The punctures should be made just outside the borders of infiltration, the needle passed to the center of the infected area, and the solution slowly expelled as the needle is withdrawn. The carbolic solution should be mopped freely into the cuts, and injections should also be made into the substance of the diseased mass, so as to thoroughly saturate it with the antiseptic, while at the same time an ice-bag should be kept applied upon its surface, and the whole part sliould be enveloped in compresses saturated with sublimate solution, 1:1000. The carbolic injections maybe repeated every six hours until the disease is manifestly under control or until symptoms of carbolic-acid poisoning are developed. The treatment of the subsequent slough is to be conducted on general antiseptic principles. The constitutional symptoms of prostration and threatening collapse are to be met by stimulant, tonic, and supporting measures. HYDROPHOBIA (rABIES, LYSSA). Hydrophobia in man is an infectious disease resulting from the inoculation of a specific virus from an animal suffering from rabies. After a variable period of incubation following the primary inoculation, the disease declares itself by certain spasmodic muscular phenomena, followed by great general prostration and ultimate rapidly-ascending paralysis, significant of lesions of the spinal cord, in which organ, especially the medulla oblongata, the effects of the virus are chiefly centered. Etiology.—Hydrophobia in man is always the result of inoculations with the virus of a rabid animal, most frequently the dog (90 per cent.), less fre- quently cats, wolves, and foxes. Not all persons bitten by rabid animals develop hydrophobia. It is often impossible to secure reliable statistics on this point. In many cases, certainly, bites are inflicted by dogs supposed to be rabid, but that are in fact not so ; in other cases bites have been inflicted bv dogs really rabid in which the infecting saliva was wiped off by the clothing through Avhich the teeth passed, and the wounds Avere thus preserved from infection. In yet other cases wounds that were really infected have been subjected to adequate immediate cauterization, and thus the later development of the disease prevented. There is, however, sufiicient experience to warrant the general statement that about 12 to 14 per cent, of those who are bitten develop the dis- ease (Roux), and of these all die. As regards immunity, no relation is trace- able either to age or sex. While the ordinary medium of infection is the saliva of a rabid animal, the disease can also be produced by inoculation with other fluids and tissues of such an animal. All the conditions relating to the propagation, development, and](https://iiif.wellcomecollection.org/image/b21217014_0167.jp2/full/800%2C/0/default.jpg)
