Manual of the principles and practice of operative surgery / by Stephen Smith.

  • Stephen Smith
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: Manual of the principles and practice of operative surgery / by Stephen Smith. 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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    II. PROGNOSIS. The prognosis is an estimate of the results which will follow any operation. It must depend j)rimarily upon the knowledge obtained in the diagnosis, and secondarily upon that larger int^uiry which seeks to discover tendencies and conditions affecting the ultimate is.>ue of diseases, and operative procedures undertaken for their cure. The chances of recovery after operations are so largely in- fiuenceil by the jjrevious state of the patient's constitution,^ that special inquiry ^^hould be made as to former diseases and their effects, and the existing organic and functional integrity of every inijiortant organ. Due attention should also be given to mental and physical peculiarities, and to those surrounding conditions which more or less directly modify the ordinary course of the malady under observation. The following considerations have a relative importance, and should have projx-r weight in deciding the probable issue of an operation : 1. The native bears operations better than the immigi-ant. 2. The sex which has the greatest endurance is the female.^ 3. The age is not in itself a barrier to any necessary operation,^ but witli it we connect the most regular average difference in capac- ity to bear operations;* the most favorable period is between five and fifteen; the next, between fifteen and thirty; after tlu'rty the risk to life is more than twice as great as it was at the same period after birth.5 Young and healthy children ■* are in danger through shock, ag- gravated by pain, but bear very well the loss of blood, and are little liable to pyajuiia after wounds. Old ])ersons * are likely to have or- ganic diseases and degeneracies, and feeble circulation, inducing congestions, due to sinking of the blood in the lungs, liver, intes- tines, and other dependent parts; are liable to die of shock, or mere exliaustion, and do not bear losses of blood, lowering of tempera- ture, or want of food; they convalesce slowly, or after partial re- covery fade, waste, and die; but the thin, dry, tough, clear-voiced, and bright-eyed, with good stomachs and strong wills, muscular and active, bear very well all but the largest operations. 4. Constitutional Diseases * influence operations as follows : Scrofula oive-s a considerable mortality, but its ill eflfects are seen chiefly in the imperfect healing of wounds, the swollen cellular tissue, the thin and lowly organized cicatrix, or indolent ulcers and sinuses; in the large majority of chronic cases the removal of a scrofulous part is followcil by improved health, but the patient remains scrofulous, and, if old, may not bear confinement well; sypliilis is liable to delay reparative action, and the operation in those who have tertiary sores may be followed by renewed tertiary symptoms; rheumatism 1 N. Chevers. 2 \\\ g. Savory. 3 s. D. Gross. * Siu J. Pagkt. 5 T. Holmes.