The principles and practice of modern surgery / by Roswell Park ... with 722 engravings and 60 full-page plates in colors and monochrome.

  • Roswell Park
Date:
1907
Catalogue details

Licence: Public Domain Mark

Credit: The principles and practice of modern surgery / by Roswell Park ... with 722 engravings and 60 full-page plates in colors and monochrome. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    has been excessive or the other (hsturhaiHcs marked, we may carry out a certain line of treatment for the purpose of hmiting all these unpleasant features. On the other hand, if seen late, when exudation has been copious and when pain and other disturb- ances are due to its ])resence, a distinctly different course will be adopted. Toward the end first mentioned—namely, the limitation of hyperemia—we may adoj)t local and general measures. Local measures include graduated j)re.ssure, providing this is not intolerable to the patient, so equalized that outside of the ves.sels it shall equal that inside. This may be done by careful bandaging, extreme care being taken that the pressure be applied from the very extremity of the limb; otherwise, passive exudation might be augmented and gangrene be precipitated. Elevation of a limb will often accomplish the same purpose. Cold, which is in effect an astringent and which tends to contract bloodvessels, is another measure in the same direction, and if applied early will do much to limit the degree of the attack. This may be a])plied as dry or moist cold, and should be gradually mitigated as the con- gestion subsides. It acts through the \asomotor system, and is a measure to be resorted to with caution. An efficient way of applying dry cold can be extemporized by a few yards of rubber tubing, held in place by wire or sewed in place to a piece of cloth, through which a stream of cold water is permitted to pa.ss. Heat is another efficient means, acting, however, in a rather different way. Heat is a measure to be employed to hasten the disa|)pearance of exudation—in other words to quicken resorption, which it does by ecpializing blood pressure, dilating the caj)illaries, stimulating the lymphatic current, and in every way helping to clear the tissues of that which has left the bloodvessels. It is necessary also, at least in extreme cases, to employ some detergent or derivative measures, including bloodletting, to which we do not resort sufficiently often. When used for this purpose, depletion should be applied at the area involved, if possible. This may be done either as venesection, by leeching, either with the natural or the artificial leech, or by a series of minute punctures or incisions, which give relief to tension, permit the rapid escape of fluid exudate, and often save tissues from the disastrous effects of strangulation. In some cases of deep-seated congestions these measures are inappli- cable, and venesection at the point of election—say the cephalic vein in the arm—may be followed by great benefit. Another method of depletion is by administration of cathartics, such intestinal activity being stimulated as shall lead to copious watery evacuations. The salines rank high as measures directed to this end, but in emergency much stronger and more drastic drugs nuiy be administered, such as jalap, calomel, elaterium, etc. Diaphoretics and diuretics help to reduce temperature and in some degree to deplete, but their action is usually slow. When exudation is considerable in amount and confined to some one of the body cavities, it is often best combated, if at all obstinate, by the method of aspiration. This includes any suitable suction apparatus by which the fluid may be withdrawn through a small needle or cannula, the operation being trifling in difficulty, but one to be performed under strictest aseptic precautions, lest infection of an exudate already at hand be ])ermitted. Certain individuals, especially the neurotic, will need more or less anodyne, particu- larlv when local apjjlications fail to give relief. Sometimes a small dose of nior])hine administered hypodermically will act magically in making efficient those measures which would otherwise be inefficient. In little children some anodyne or hypnotic will be of great service. Under all circumstances it is well to keep the lower bowel emptv, and certain elderly individuals with weak and enfeebled hearts will need the stimulation to be afTorded by digitalis, quinine, and alcohol, or preferably strychnine administered subcutaneously. In cases of chronic hyperemia and its consecpient hyperj^lasias (induration, thick- ening, etc.) there is no one measure so generally applicable and efl'ective as the continued use of cold-water dressings. These are generally s])oken of as cold wet packs, and may be continued—constantly or intermittently—for many days. Massage is also an invaluable agent in the reduction of swelling and tissue overpro- duction. It promotes absorption, even of acute effusions, by equalizing the blood and hastening the lymph circulation, and under its scientific application it is surprising how firm exudates and old adhesions seem to disappear.