The principles and practice of modern surgery / by Robert Druitt.
- Robert Druitt
- Date:
- 1848
Licence: Public Domain Mark
Credit: The principles and practice of modern surgery / by Robert Druitt. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
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![quiet pulse, often with a nervous oppression, with a seeming difficulty of breathing and loathing of food, the patient is in a dangerous way. Fever shows powers of resistance ; the other symptoms show weakness, sinking under the injury.* Symptoms.—Shivering; succeeded by increased heat:f preternaturally frequent, hard, and vibratory pulse ;—pain and aching in the head, back, and limbs, with a sense of lassitude and weakness;—general deficiency of the secretions ; dry skin; dry and white tongue ; thirst; nausea and loss of appetite; constipation ; scanty and high-coloured urine ;—the blood generally buffed and cupped;—slight aggravation of the symptoms in the evening, often delirium in the night, and slight remission in the morning. Terminations.—(1.) If the patient recover, the urine becomes more copious, and deposits a lateritious, or brick-dust, sediment; the tongue becomes moist and clean, the skin cool and perspiring; the local inflam- mation either is resolved, or proceeds to a healthy suppuration ; and the return of the appetite and of the other natural functions indicates the pa- tient's recovery. The formation of pus often appears to be a natural crisis.I (2.) But if from the irreparable nature of the disease or injury, or from the irritability of the system, life is destined to be destroyed, the pulse becomes continually more frequent, and subsequently weak, irregular, and intermittent, the extremities cold, and life soon ceases with the failure of the circulation. Treatment.—The treatment of this fever is included in that of acute inflammation, of which it is the shadow. But it must be observed in this place, that when it is symptomatic of an inflammation that is unavoidable, (as after a compound fracture, and most other severe injuries,) it cannot be cut short, although its undue violence may be abated;—and that great care should be taken not to weaken the patient too much by depletion, especially if the part injured be not of vital importance, and its reparation will require time and strength. The indications are, to allay vascular action and nervous irritation, and to restore the secretions. And the means are, rest, low diet, aperient and febrifuge medicines, anodynes at bed-time when the bowels have been cleared, and general or local bleed- ing, if demanded by the exigencies of the case. We must add that pur- gatives should be avoided when it is likely that they may occasion an in- jurious disturbance of any diseased or injured part, as a compound frac- ture, for instance. Of the Pulse.—It may be convenient to say a few w'ords in this place about the pulse. The elements of the pulse are three ; namely, jirst^ the contraction of the heart, which propels blood into the arteries;—secondly^ the yielding and dilatation of the artery, which when felt constitutes the pulse ;§—and, thirdly, the return of the artery to its former calibre. Now * On the blood. Chap. iv. sect. 6. t Tlie increased heat of fever depends, according to Liebig, on an unnaturally rapid transformation and oxydation of the animal tissues, by which an unnatural amount of heat is generated, as well as of circulating force. Liebig's Animal Chemistry by Gre- gory, p. 256. In ordinary fever, the heat of the blood does not rise more than three or four degrees above the natural standard; but in scarlet fever it is said to have risen as high as 1 ] 6°. t Kpi(rtj, any important phenomenon in a disease (mostly an evacuation of some sort) by which the patient's safety or danger may be judged of. § The coats of arteries, says W. Hunter, are elastic, and therefore whatever dis- tends, must at the same time lengthen them, and thereby produce serpentine turns. Yet if the artery is perfectly straight, and the circulation tranquil, the dilatations will](https://iiif.wellcomecollection.org/image/b21049737_0037.jp2/full/800%2C/0/default.jpg)
