Volume 1

The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen.

  • Erichsen, John
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen. Source: Wellcome Collection.

    36/1244 (page 6)
    hysterical women, with bnfc little strength of circulation, cannot bear up against severe surgical proceduros, and often sink after comparatively slight ones ; being apt to become depressed and to sink without rallying. Persons who are overloaded with fat are not good subjects for surgical operations. In them the circulation is usually feeble ; the wound heals slowly, and is apt to become sloughy; and general or local infective processes readily occui-. Short of actual structural disease of important organs, as the lungs, heart, or kidneys, I know no condition more unfavourable to success after operations than premature or excessive obesity. Patients with a high temperature should never be operated on except for the relief of that very condition which occasions the elevation of temperature, such as the accumulation of pus, or rapidly spreading gangrenous inflammation, or in one of those four great surgical emergencies that always and imder all cir- cumstances demand immediate operation ; viz.: 1, dangerous h^moiThage ; 2, impending asphyxia ; 3, strangulated hernia and intestinal obstruction ; and 4, over-distended bladder. The urgency of these conditions, which may be termed the four classes of primary surgical urgency, ovei-rides all other considerations. An individual of a sound constitution, that has never been impaired by excesses of any kind, whose habits have been temperate and sober, whose diet has been sufficient and of good quahty, whose mind has never been over- strained by the anxieties of business or the labours of a professional life, and whose existence has been spent in rural occupations and in the pure air of the country, is necessarily placed in a far more favourable position to bear the effects of any mutilation, whether it be the result of injury, or be inflicted by the Surgeon's knife, than the man whose physical powers are worn out by active and unceasing business avocations or professional work, whose nervous system is exhausted by his anxious labours ; and infinitely more so than the poor inhabitant of a large and densely peopled town, who has from earliest childhood inhaled an impure and foetid atmosphere, whose scanty diet has consisted of the refuse of the shops, or the semi-decomposed offal of the stalls, and whose nervous system has been iiTitated and at the same time exhausted in the daily struggle for a precarious livelihood, or over-stimulated by habitual excesses in strong drinks, by which he has hoped to purchase temporary for- getfulnesB of the cares of a sordid life. Though individuals with such different antecedents be placed under exactly the same hygienic circumstances the performance of an operation, yet the results will probably be very dissimilar, influenced as they must l)e by their past rather than liy their present condition. In the one case, the inflammation ]-esulting from the incision, and requisite for the cure of the wound, will not overstep the normal degree necessary for the healing process. In the other, it may assume a spreading form and ter- minate in some of those secondary affections which will ]iresently l)e adverted to as occasioning death under unfavourable hygienic conditions. Besides the general state of the patient's health, the CondUion of Important Organs must be taken into consideration before an operation is decided on. The state of the patient's Heart should be carefully looked to. Valvular disease of this organ, if earlv or slight, need not be an obstacle to most operations, even to those of expediency ; but fatty degeneration of the heart, as indicated by its feeble action, by irregularity and want of power in the circulation, bv breathlessness, and by a distinctly marked arcus senilis, should