Statistical report of the major operations performed by Professor Spence in the Edinburgh Royal Infirmary / by George Kirkwood ; with remarks by Professor Spence.

  • Kirkwood, George.
Date:
1875
Catalogue details

Licence: Public Domain Mark

Credit: Statistical report of the major operations performed by Professor Spence in the Edinburgh Royal Infirmary / by George Kirkwood ; with remarks by Professor Spence. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    12/17 (page 11)
    Besides these more important operations, there were a number of minor operations—e.g., for piles, fistula, hydrocele, etc. A few general remarks may be added as to the treatment, con- stitutional and local, which is adopted in Mr. Spence’s wards. E.xcept in urgent cases, patients are never operated on until a careful examination of their constitutional state has been made, and any abnormal conditions combated as far as possible. Accordingly, patients are kept under observation for some time prior to operation, and, by careful attention to the various secretions and excretions, their general health is so improved that the chances of a successful result are much increased. 'Their diet is carefully regulated, tonics are given, and derangements of the stomach or bowels are at once treated. The state of tlie urinary system receives special attention, an examination of the urine being made from day to day. The urine is more particularly attended to in strumous patients, in whom renal affections are so apt to occur; and, by means of this frequent examination, morbid conditions of the urinary organs are detected at an early period, and improved as far as possible by appropriate remedies. Similarly, the respiratory, integumentary, and circulatory systems are observed: the chest is examined, the temperature is taken morning and evening, and the state of the cutaneous secretions is watched. Before and after all operations the preparations of iron are used, either alone or along with dilute phosphoric acid, and very generally such remedies as the chlorate of potash and the hyposul- phite of soda are given, so as to improve the state of the blood and render the patients more able to resist septicmmic conditions. The use of these supposed antise])tic remedies is especially resorted to where, as in cases of necrosis, malignant disease, etc., the blood is in an unhealtliy condition prior to cqieration, and where the patient is peculiarly liable to become aflected by the absorption of putrid matters. Very often alcoholic stimulants are given, but their administration is regulated to a great extent by the character of the pulse, and by the state of the patient’s strength. In all cases of exhausting disease —such as caries, necrosis, strumous affections of joints, and malignant disease,—stimulants are found of the greatest service; and when wounds are assuming a weak action the good effect of stimulants is often very marked. As regards the local treatment of wounds, the principles which are attended to are cleanliness, and simple dressings so arranged as to be easily undone, and to allow the free escape of discharge, which depressed ; .and on removing the outer table with the trephine, the inner table was found to be splintered, the orbital plate of the frontal bone being involved. As soon as the splintered i)ai-ts had been removed the patient complained of paiii, which he had not done during the operation (no chloroform was used). Although he occasion- ally became drowsy after this, he ultimately made a good recovery.