Surgery : its theory and practice / by William Johnson Walsham.

  • William Walsham
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Surgery : its theory and practice / by William Johnson Walsham. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    a little hotter than natural, nnd tender on pressure, but quite devoid of pain. The swelling and heat, however, may be so slight as to be almost imperceptible, or indeed may be said in some instances not to occur. If an attempt were made to draw the edges apart they would be found adherent to each other, and a few days later firmly united. All trace of redness and swelling about the edges will now have^ disappeared, a red streak only remaining to mark the line of the wound. This streak grows paler and paler, till ultimately a thin white line, which in com-se of time may become hardly perceptible, alone indicates the site of the injury. The above mentioned process, which should be attended by little or no constitutional disturbance, is known as healing by the first intention, and is the one which, other things being equal, is always aimed at by the surgeon in the treatment of wounds. Should, how- ever, the wound not admit of its surfaces being placed wholly m contact, or should it be improperly drained and not kept aseptic, distinct inflammatory redness and swel- ling of the edges will appear, and instead of subsiding and disappearing m a few days will increase and extend for some distance around; the parts become tense, there may be throbbing pain, union fails, and suppuration is set up. In the meantime the patient mav have a chill or even a distinct rigor, he complains of headache, the temperature rises, the pulse is increased in frequency the tongue becomes coated, the appetite lost, the skin hot and dry, the urme scanty and high coloured, the liowels become confined, and there may be restlessness and want of sleep and perhaps slight delirium {septic traumatic ferer). it now a free exit is established for the pus, and further iormentative or septic changes .are prevented, the constitu- tional disturbance subsides, and the surfaces of the wound become covered with granulations. Tlio granulations gradually hll up the wound, and wlien the level of tlie skm or mucous membrane is reached, (.]iithelium slowlv spreads from the edges of the wound over tlie granulation's till tlie>' are complotely covered in. A red scar is thus lett at the seat of tlie former wound, and though this in tile progress of time assumes a wliite colour, and becomes smaller from the contraction of the fibrous tissue into which the granulations are at hmgth converted, it is of a permanent character. The above method of repair IS knowii as heahng by the smnnl intention, or by granulations. •'
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