A system of surgery / by James Miller.

  • James Miller
Date:
1864
Catalogue details

Licence: Public Domain Mark

Credit: A system of surgery / by James Miller. Source: Wellcome Collection.

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    such amendment is ushered in, if not partly caused, hy Sudden and great exaltation of the secernent function—so marked, as usually to be termed critical. The patient is bathed in a profuse and sustained perspiration. Or diarrhoea occurs. Or the urine flows copiously ; more aqueous ; less concentrated; at each evacuation less and less coloured; containing chlorides, and an increased quantity of sulphuric acid; and, on cooling, letting down a large quantity of sediment—resembling brick-dust, and hence termed lateritious—composed chiefly of urate of ammonia, more or less coloured by euroerythrin and pink pigment.* Hence the state of the urine comes to be important to the practitioner; scantiness, concentra- tion, and want of deposit, denoting persistence of the symptoms ; profuse flow with copious sediment, declension. Sometimes a discharge of blood takes place ; by the rectum, the urethra, the mouth, or the nose— according to the part affected. This is not unlikely to frighten the patient and his friends, and may alarm the practitioner. But the latter is highly culpable who, from such alarm, rashly interferes to stop the flow. His duty is to watch the event; withholding his hand, unless the bleeding should threaten to prove excessive. Such critical evacua- tions and discharges are usually preceded by rigor and exacerbation (then, too, let the practitioner wait, and beware of officious meddling), and are followed by marked relief of all the symptoms. But these symptoms of inflammatory fever, instead of declining, may advance ; and, combining persistence with intensity, may cause a fatal result. Protracted exercise of a muscle ultimately exhausts the irritabi- lity of that muscle, which then ceases to obey its stimulus. In like manner, excitation of the general system, if both great and prolonged, is certain to wear out the powers of that system ; and the patient sinks in consequence. Or the symptoms neither simply decline, nor simply advance, but undergo change. 1. On the occurrence of suppuration—profuse and long-continued, or in an internal and important organ, or in a patient previously much debilitated—they change their character, assuming the form of Hectic fever. 2. On the occurrence of mortification over a large surface, or in an internal and important part, or in a worn frame, they change to the Typhoid form ; tending to fatal collapse. 3. Or the local process, showing plainly what is termed the asthenic type, and hurrying on to serious suppurative and ulcerative disintegration of texture, the ac- companying fever may exhibit more or less of the characteristics of all the types here mentioned—constituting what is termed the Irritative. The blood, we have seen, undergoes serious change in the inflaming part ; and by a constant succession of such changes, the whole fluid comes at length to be altered almost to the same extent as that portion of it which has just emerged from the seat of local disease. In a case at once decided and advanced, draw blood directly from the inflaming part, as well as at a great distance from it; the two fluids will be found exhibiting nearly the same characters of change; and, as already said, both will shew an increase of temperature beyond the standard of health—which general increase has, no doubt, much to do with the heat and feverishness just described. Coagulation of the drawn * Parkes on the Urine in Health and Disease.
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