A manual of the practice of surgery / by W. Failie Clarke.

  • William Fairlie Clarke
Date:
[1882], ©1882
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Licence: Public Domain Mark

Credit: A manual of the practice of surgery / by W. Failie Clarke. 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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    friction of the patient's clothes, or some similar cause. According to Mr. Hilton, a spot may sometimes be found where the extreme sensibility resides; and then careful examination may detect filaments of denuded nerves. In such a case an incision across the course of the nerve will destroy sensation and secure physio- logical rest. The treatment consists in removing everything that can fret the sensitive surface, and then touching the part thoroughly all over with nitrate of silver. This may be repeated every two or three days. During the intervals the sore should be dressed with sedative or anodyne applications—e.g., nng. plumbi acetatls, or lead lotion with laudanum. (P. 24.) Constitutional treatment is here of the utmost importance. The secretions must be regulated, the health improved by tonics, and nervous irritability allayed by sedatives or narcotics in full doses. 5. The inflamed ulcer may either arise from an aggravation of the original inflammation, or it may be induced by excessive stimulation. The marcjins are red and swollen. The surface is soft and friable, emitting a profuse and unhealthy discharge. There is heat and pain in the part with constitutional febrile symptoms. The treatment should be mildly antiphlogistic. Aperients and salines should be given, while the part is elevated, and constantly fomented or poulticed. To do this thoroughly, the patient should lie in bed with his leg raised on a pillow, and protected from the bedclothes by a cradle. Sometimes leeches may be requisite. When the inflammation has been subdued, water-dressing is all that will be needed. 6. The pJiacfedcBnic ulcer, when it is not syphilitic, is merely an advanced stage of the foregoing. The ulceration spreads rapidly, the tissues breaking down and becoming disintegrated. When sloughs form round the margins of the wound, and the tissues perish en masse, the disease is called sloughing pJiagedcena. These varieties of ulceration are commonly accompanied by a good deal of pain and constitutional disturbance. They indi- cate that the patient is in bad health from some cause which de])resses the system and vitiates the blood—the exhalation from drains, for example. They are frequently associated with syphilis, and, when this is the case, they often commence in the disintegration of a subcutaneous gumma. The treatment consists in placing the patient in favourable hygienic conditions, restoring his general health, destroying the ulcerating surface by escharotics,—the strong nitric acid, for examjjle—and dressing the sore with antiseptic or stimulating lotions. (l<\ 12, 13, 25.)