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.

    198/864 page 182
    tui-bance. lu such ca.ses, ho-n'eyer, bony ankj'losis -W'lll generally ensue, though, in some instances the cartilages may escape destruction, and a faii-ly movable and u.seful joint may be obtained. Signs.—When the joint is laid freely open the nature of the injury is obvious, and any displacement or splriitering of the. bones can be ascertained by examination -^-ith the finger. When the -woimd is of a punctui-ed character and the incision in the skin is «ome distance from the joint, the signs are not always so apparent. In such cases an account of the depth towhic]i the instrument penetrated, and the direction in which it appeared to run, will help us to determine whether the syno-vial membrane has been entered. The escape of a glairy fluid like white of egg— the synovial secretion—will make the diagnosis certain. If in doubt, the case should be treated as if the jomt had been opened, but on no accouut should the woimd be probed for the pai'pose of settling the point. Should inflammation ensue the signs will be the same as those of acute arthi'itis (see Diseases of Joints). The treatment will depend on the size and character of the wound, the joint alt'ected, the nature of the comph- cations, and the age and constitution of the patient. The chief indications are to ])revent inflammation and its attendant consequences, or if the injury is of a very severe character, to endeavour to save the patient's life by the sacrifice of liis limb. Thus, if the wound is small and uncompbcated. an attempt should bo made to convert it into a subcutaneous wound by sealing itwith colcxhonized lint, or better by placing over it an antiseptic dressing, after having first thoroughly cleansed the skin and rendered it aseptic. One or more silver or chromic gut sutures may first bo inserted if the wound is too largo to be closed m this way. The limb should be then placed on a splint at perfect rest, and cold appli.Ml by means of an ice-bag or by Loiters tubes. Sliould infiamiiiation lollow, lialt a dozen leeches should be placed over the joint, and warm apidications be substituted for the cold; whilst, should the local and constitutional disturbance increa.se and the joint become distende.l, aspiration shoul. be praetise(l to relieve tension, opium given to soothe the pam. and the treatment ],ersoverod in. If, however, pus is withdrawn by the asi.irator, the joint .should be laid ireely open, drained, dl essed antisoptically and placed in the position in which, should ankylosis ensue, it will subsequently be
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