A dictionary of practical surgery: comprehending all the most interesting improvements, from the earliest times down to the present period ... forming a catalogue of surgical literature arranged according to subjects / by Samuel Cooper.

  • Samuel Cooper
Date:
1838
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Licence: Public Domain Mark

Credit: A dictionary of practical surgery: comprehending all the most interesting improvements, from the earliest times down to the present period ... forming a catalogue of surgical literature arranged according to subjects / by Samuel Cooper. Source: Wellcome Collection.

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    With regard to internal medicines, while irrita- tion and febrile heat accompany hospital gangrene, diluent acid drinks are proper, such as nitrated whey sweetened with syrup of violets, lemonade, &c. Blood-letting is admissible in but few in- stances ; not merely because the orifice made by the lancet may, according to some accounts, be- come gangrenous, but because the fever, which accompanies hospital gangrene, is usually of the typhoid character. ( Thomson, p. 493.) Mr. Blackadder, like Dr. Thomson, does not entertain a favourable opinion of venesection, as a general practice, though he would not object to the abstraction of a small quantity of blood, when, owing to the plethoric habit of the patient, previous treatment, and other causes, an inflammatory action in the system is present. The same practice, under similar conditions, is also sanctioned by Dr. Boggie. (Edinb. Med. Clxir. Trans, vol. iii. p. 34.) Mr. Blackadder conceives, that all danger of the disease attacking the wound made with the lancet may be obviated, if care be taken that the arm of the patient, the hands of the surgeon, his lancet, and the subsequent dressings, be perfectly free from contamination, and that the patient be pre- vented from undoing the bandage, or touching the incision made with the lancet, before it is cica- trised. (P. 135.) Dr. Boggie has bled many in this disease, but never seen a single instance of gangrene after the operation. ( Edinb. Med. Chir. Trans, vol. iii. p. 35.) Mr. Blackadder thinks, however, that blood-letting should be avoided as much as possible, particularly when the previous injury has been extensive. “ A general debility of the system, is one of the symptoms which are most to be dreaded ; for, when once it takes place, there is no other disease in which it is removed with greater difficulty.” (P. 137.) How different these sentiments are from those of Dr. Ilennen, who, in speaking of the effects of venesection, when the disorder was accompanied with an inflammatory diathesis, employs the following expressions : “ The very patients themselves implored the use of the lancet.” For several months “weused no other re- medy, either as a cure or preventive.”—“ We never observed any of the lancet-wounds assume a gan- grenous appearance, although previously, in almost every other instance, the slightest puncture fes- tered.” (On Military Surgery,]). 224. ed. 2.) Mr. Welbank also states, that moderate venesection may be adopted with advantage while the disease is superficial, and the constitution not much affect- ed, particularly in plethoric habits. (Med. Chir. Trans, vol. xi. p. 368.) In the beginning of the constitutional attack, Pouteau and Dussassoy particularly recommended emetics; and Air. Briggs, Dr. J. Thomson, and Dr. Ilennen, are all advocates for this practice, though the latter gentleman makes his evidence rather ambiguous, by a subjoined note, in which he mentions that want of success, &c. led to the trial of venesection. (Op. cit. 222.) As for Air. Blackadder, he deems the employment of emetics at the commencement of hospital gangrene useful only when the stomach is foul. (On Phagedeena Gangrcenosa, p. 134.) Dr. Boggie found emetics generally very inferior to purgatives. (Edinb. Med. Chir. Trans, vol. iii. p. 37.) He chiefly approves of them when the stomach is loaded, and the fever of a bilious character. In the early stage of the case, writers seem all to agree about the utility of purgative and laxative medicines. When there is debility, good generous wine should be allowed, either by itself, or mixed with lemonade, according to circumstances. Bark is in general more hurt- ful than useful: Air. Welbank objects to it gene- rally, on account of the common disposition to diarrhoea in the advanced stages of the disease (Med. Chir. Trans, vol. xi. p. 368.) ; and Dr. Hennen assures us, that he has seen great harm done by large and injudicious doses of this drug, before full evacuations had taken place, and the sloughs begun to separate. Boyer allows, however, that it may be beneficially given, when the feverish heat has abated, and the debility is very great. In all stages of this disease, unattended with diarrhoea, acids are proper. The sulphuric acid is that which is given with most success ; but the acidulous tartrate of potassa is also an excellent medicine. From two drams to half an ounce may be given every day, and the best plan is to make an acid drink with it, which should be sweetened and strained. In severe cases, attended with a quick and feeble pulse, depression, restlessness, and anxiety, an opiate becomes necessary. “ So long as we wish to excite a degree of moisture on the skin (says Professor Thomson), Dover’s powder, or lau- danum with antimonial wine, form in general the best opiates.” This gentleman, however, is not an advocate for the employment of opium, in the early stage of hospital gangrene, while the heat and other febrile symptoms are at their height. (See Lectures on Inflammation, p. 494, 495.) According to Air. Welbank’s experience, narcotics are beneficial, and he has seen a most irritable state of the stomach improve rapidly, and a foul furred tongue become clean, on the administration of large doses of opium at regular intervals. (See Med. Chir. Trans, vol. xi. p. 368.) Camphor, in large and frequent doses, was highly praised by Pouteau. From what has been said of internal remedies, it is evident, that none of them can be regarded as means at all to be depended upon, for arresting the ravages of hospital gangrene, however advantage- ous they may prove in pallialing general symptoms, removing particular complications, enabling the system to support the effects of the local disorder for a greater length of time, or, in a few cases, even placing nature in a condition to throw off1 the diseased parts herself, and communicate to the subjacent living flesh a healthy action. If credit can be given to several of the authors, who have had the most extensive opportunities of attending to the nature of hospital gangrene, the local treatment is far more effectual than internal medicines. “ I was told by several of the French surgeons (says a late visiter to Paris), that they did not rely at all on internal means for stopping the progress of hospital gangrene, and that their experience had proved them to be insufficient, if not wholly ineffi- cacious. Dupuytren, in reply to the account I gave him of the practice and opinions of English surgeons on this subject, assured me, that he had no confidence in any but local applications, and that internal remedies alone, as far as he had found, did almost nothing.” The same remark has been made in a modern publication on hospital gangrene (Delpech, Mem. sur la Complication dcs Plaies, &;c. 1815), “ although it seems to be rather at variance with its being a constitutional and con-