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

  • William Walsham
Date:
1889
Catalogue details

Licence: Public Domain Mark

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

    157/864 page 141
    has occurred, provided there be no wound. In the latter case, warm a.ntiseptic dressings must be substituted for the poultices. _ Incisions, however, should be made early before sloughing has had time to take place, i.e., as soon as the parts become brawoiy. A number of small incisions made parallel to the long axis of the limb are preferable to one long one. They should extend through the skin into the inflamed cellular tissue, the hemorrhage, which is often free, being readily stopped if excessive by plugging with iodoform or sal alembroth gauze, or like antiseptic uiaterial. Subsequently the wounds should be dressed antiseptically, well drained, and the slouo-bs re- moved from time to time as they form. At St. Bartholo- mew's Hospital a large charcoal poidtice is a favourite form of dressing. Should diarrhoea set in it may be con- trolled by opium; but this drug must be given cautiously when there is kidney mischief. In bad cases, where much skm has been destroyed or a joint irreparably damaged, amputation may ultimately be required, but should not, as a rule, be done whilst the disease is in progress. 3. Cellular Erysipelas, or diffuse cellulitis, is an acute, infective, and diffuse inflammation of the cellu- lar tissue. It may occur in the subcutaneous or submu- cous tissues, in the intermuscular planes, in the cellular tissue of the pelvis or orbit, in fact anywhere in the body where cellular tissue exists. It is probable that it does not always depend upon the same specific virus, and hence, although it spreads by the lymphatics and lymph spaces like cutaneous erysipelas, it is not like it a definite infective disease. It may be due to various causes. Thus it may occur in the subcutaneous tissue after a scratch or puncture, particularly one inflicted in the -j^ost- mortem room or by the bite of a venomous reptile or stino- of an insect; in the ])elvic cellular tissue after partimtion or the o])eration of lithotomy; and in the 'submucous tissue after an injury, as a sting of the throat by a wasp. Sijmptoms.—The constitutional symptoms resemble those aln^ady given under the ])rocoding va.riotics of erysipelas, and though they may vary in intensity they arc generally grave and soon assume an asthenic type, and become those of saprtomia as the sojitic ])rodiicts are absorbed Irom the decomposing sloughs. The local symntoms vary according to the part attacked. When the subcuta neous tissue is affected they are similar to tliose of collulo cutaneous erysipelas, save that the skin is not at first
    digitised image 1
    digitised image 2
    digitised image 3