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
Catalogue details

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.

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    benefit in producing absorption in an enbirged gland or a 'weeping sinew, (jr of an exudation which is slow to disappear. Iodine may be used for the same purpose, but probably acts in virtue only of its power to produce a local irrita- tion on the surface, not from any special sorbefacient (juality ])ossessed by it. Compression is a valuable agent ki the treatment of both the eai'iy and the late stages of inflaunnation. In the acute stage it restrains the tendency to exces- sive swelling of the part and the collection of serous or bloody discharges between the lips of a wound. It must be applied, however, with great care during this period, as sloughing or even gangrene may be the result of tight bandages on a part when the circulation is enfeebled by injury. In the later stages com- pression may be employed with great advantage, and is one of the most val- uable agents which the surgeon possesses to promote absorption and resolution. It is most useful in chronic inflammation. The beneficial effect of pressure upon a varicose ulcer by plaster or a rubber bandage is an admirable illustra- tion of this power, as is also the effect produced upon the serous eff'usion in a knee-joint by elastic bandages made of rubber or flannel. A most efficient ttieans of obtaining compression of the knee-joint is with compressed sponge: two coarse sponges may be flattened over-night under a heavy piece of furni- ture ; one is put on either side of the joint, which is placed on a posterior splint; a long cotton bandage is now firmly applied, after which a stream of water is allowed to trickle into the sponges. This dressing may be left on for one or two days, sufficient moisture being supplied to keep the bandages tight. Cold and heat are used for the purpose of reducing the hyperemia and to relieve pain. Cold may be applied either by evaporating lotions or by the use of ice. Evaporating lotions can be used on exposed parts, but must be changed very frequently to have the desired eff'ect. They are less used than formerly. Ice may be applied in thin rubber bags. Cold can also be applied by the ice-coil, by means of which a current of ice-water is allowed to flow through a coil of rubber or metal tubing over the part. Care must be taken to avoid freezing the superficial layers of the skin if a prolonged use of the remedy is intended. The ice-bag is comforting in cases of rapid swelling folloAving injury, to a tender and swollen knee-joint, or to an inflamed throat. It is dangerous in cases of extreme congestion, as in strangulated hernia. Heat may be applied in the form of fomentations, hot-water bags, or the hot douche. It acts, doubtless, in various Avays. A hot fomentation when first used produces a powerful counter-irritation ; later, it acts through the circulation, relieving stasis and favoring an absorption of exudation. If the heat be main- tained at a high point by frequent application of the hot douche, a constriction of the blood-vessels takes place, and congestion is thus diminished. The flax- seed poultice is now discarded in the treatment of wounds, but may still be used with advantage Avhen no wound exists. The antiseptic poultice, now used for wounds in certain cases, is practically a hot fomentation to which some anti- septic agent has been added. Incisions are often of great value in certain types of inflammation, even when suppuration has not taken place. In cases of intense congestion of the inflamed part, Avhen the integuments are thick and brawny, one or more incis- ions are followed by a free gush of blood and serum which greatly relieves the tension of the part and wards off' not only threatening deep-seated supjiuration, but also gangrene of the parts. The incision should be made completely through the skin and cellular tissue, but should not be over two inches in length in most cases. Early interference of this kind is imperatively needed in the rapidly spreading forms of inflammation such as occur often in the hand and forearm, which may not only ruin a hand, but endanger a life.