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
Catalogue details

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.

    790/794 (page 768)
    applied to the cleaned surface of the sore, and re- newed, every fifteen or thirty minutes, according to the time in which it becomes dry. When the heat and inflammation are considerable, great re- lief will be derived from the frequent application of linen cloths, moistened with cold water, which must be kept from weakening the arsenical solution by means of a small piece of oil-skin laid over the pieces of lint. When the disease extends into the track of a gunshot wound, Mr. Blackadder uses a syringe for cleaning the sore and introducing the solution. “ A slip of fine lint, well soaked in the solution, may also be inserted by means of a probe, into the bottom of the wound ; and when the open- ings are at no great distance (from each other), and not in the immediate vicinity of the large nerves, and blood-vessels, the lint may be drawn through the wound in the form of a seton.” (P. 53.) When the pain caused by the application is very severe, and the constitution is irritable, and debili- tated, Mr. Blackadder prescribes an opiate, though he remarks, that this practice will seldom be abso- lutely necessary. The morbid action in the sore is destroyed by the arsenical solution sooner, or later, in different cases: the best plan is to continue the application, until an insensible, dark-coloured, dry slough, occupies the whole surface of the sore, and until the patient is completely relieved from the burning and lancinating pain. After the slough is formed, Mr. Blackadder em- ploys an ointment, composed of equal parts of the oil of turpentine and the yellow resinous ointment, or, of two parts of Venice turpentine to one of the resinous ointment. “ These, being melted and mixed together, are to be poured over the sore, as hot as the patient can possibly bear.” A pledget of dry lint, or tow, and a bandage, are then ap- plied ; and this dressing may be renewed two or three times a day, the sore being each time care- fully washed with the solution of potass. As soon as any part of the slough is loosened, Mr. Blackadder removes it with a pair of curved scissors. With the view of expediting the sepa- ration of the slough, he sometimes employed a linseed-meal poultice, which had the desii’ed ef- fect, but was found to be too relaxing. When it is used, therefore, Mr. Blackadder found it expe- dient, at each dressing, to touch the new granu- lations with the nitrate of silver. After the detachment of the -slough, Mr. Blackadder dresses the sore with the above men- tioned ointment cold, or with the addition of a small proportion of the subacetate of copper. The pledget of this ointment is covered with a piece of oil-skin, lightly rubbed over with soap, and a firm bandage is applied to the whole limb. (See Obs. on Phagedcena Gangrccnosa, p. 49, &c. 8vo. Edinb. 1818.) The author declares, that, after the intro- duction of the above treatment (with the exception of stumps attacked with hospital gangrene), he never saw an instance, in which the remedy failed, when applied in time, and in a proper manner ■ “ that is, before the disease had made such pro- gress, as to preclude all rational hope of success from that, or any other mode of treatment.” (P.23.) In Dr. Iloilo’s Treatise on Diabetes, published in 1797, the opinion is plainly stated, that the pro- gress of hospital gangrene might be stopped by very active topical applications, and, in the same work, Mr. Cruikshank says, that, “ if an actual caustic were to be employed, we should have re-' course to the strong nitrous acid.” According to Mr. Blackadder, the oxygenated muriate of mer- cury, and the nitrous acid, were much recom- mended and employed by surgeons, an the 16th and 17th centuries, as escharotics, in cases of gan- grene and foul ulcers. (P. 113.) Several army- surgeons have informed me, that the undiluted ni- trous acid was successfully used as an application to hospital gangrene in the military hospitals at Antwerp, in the year 1815; but, that other strong acids had an equally good effect. Dr. J. Thom- son also notices, that, “ the application of caustic substances, such as the strong mineral acids, the solutions of potass, corrosive sublimate, and arsenic, seemed at Antwerp to arrest the progress of this sore, without exciting inflammation.” (Report of Obs. made in the Military Hospitals in Belgium.) Delpech was informed by some British surgeons, belonging to the Anglo-Portuguese army in the Pe- ninsula, that the muriatic acid was in common use in the hospitals of that army, as a local application for checking the ravages of hospital gangrene, being employed in a diluted state for slight cases, and in a concentrated caustic form for others. In St. Bartholomew’s Hospital, the undiluted nitric acid has been used with great success, as a local application to phagedenic gangrenous ulcers. “ If the disease be not far advanced (says Mr. Welbank), I at once apply the undiluted acid, after cleansing the surface with tepid w7ater, and absorbing the moisture with lint. Where, how- ever, there is a thick and pulpy slough, it is better to remove as much of it as possible, with forceps and scissors, before the application is made. The surrounding parts being then protected by a thick coating of lard, or cerate, I proceed to press steadily, and for some minutes, a thick pledget of lint, pre- viously immersed in the undiluted acid, on every point of the diseased surface, till it appears con- verted into a firm and dry mass. The parts may be then covered with simple dressings, and evapo- ration kept up by cooling lotions. As the appli- cation occasions more or less pain, from half an hour to one or two hours, I have generally given 20 or 30 drops of laudanum at the time of using it. It is always prudent, often necessary, to re- move the eschar at the end of 16 or 20 hours.” When the patients have become perfectly free from pain, and the parts below the slough are found healthy and florid, Mr. Welbank treats the sore as a common wound or ulcer, though he has found stimulating dressings generally the best, as the ce- raturn lapidis caliminaris, or a solution of two or three grains of the nitrate of silver in an ounce of distilled water. But, when there is a recurrence of pain at any point, or over the general surface of the sore, whether the affection be slight or severe, the slough superficial or deep, he recommends the employment of the undiluted acid again. (See Med. Chir. Trans, vol. xi. p. 369.) Pouteau, Dussassoy, Boyer, and Delpech, all bear testimony to the efficacy of the actual cautery, and they repeat the application of it, until the whole surface of the ulcer is converted into a firm hard eschar. Even the edges of the solution of continuity should not be spared—“ lls doivent etre torrefies et rbtis pour ainsi dire.” (Boyer, Ma- ladies Chir. t. i. p. 332.) The latter surgeon then covers the eschar with a thick stratum of bark, moistened with turpentine. This application is to , be removed in twenty-four, thirty-six, or forty-