Volume 1

The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen.

  • John Eric Erichsen
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    47/1274 (page 15)
    the healthy, nor should the same appliances, dressings, or sponges be nsed for both. Wiiea this is not possible, the danger of infection may be greatly diminished by the free use of antiseptics to the wounds both of the infected and the healthy. Great care also should be taken in the purification of the bedding that has been used by patients suffering from septic disease ; the blankets especially are apt to harbour infection long, and must be thoroughly disinfected by heat or by efficient chemical antiseptics. 0. The Special Conditions directly excited by the Operation itself predisposed to by the circumstances that we have just been considering, and commonly leading to a fatal result, of wliich they are the immediate occasion, are the following :—Shock, Exhaustion, Htemorrhage, Gangrene, Tetanus, Pytemia, SepticiBmia, Erysipelas, and other Diff'use Inflammations. These causes of death are so various, and comprise so many distinct diseases, that I shall do little more here than mention them ; referring the reader to the different chapters in the body of the work, in which each is specially treated. The Shock of an Operation may prove fatal in various ways : froni the severity of the mutilation, as in a case of double amputation ; from the nervous centres being implicated, as in the removal from the face of large tumours that have connections with the base of the skull ; from fear, or from the state of nervous depression into which the patient has previously fallen, causing him to feel the influence of an operation disproportionately to its severity. These various effects of shock have, however, been much lessened since antesthetics have been generally administered in operative surgery. Antesthesia, however, does not remove the physical impression produced on the system by a severe mutilation ; hence the influence of a serious and prolonged operation is still manifested in the production of shock, of collapse, and of slow recovery, even though the patient have suffered no actual pain. Certain operations appear to exercise a peculiarly depressing effect on the nervous system, even though no pain be experienced. Thus, in castration, at the moment of the division of the spermatic cord, the pulse will sink markedly, even though the patient have been fully aneesthetised. Exhaustion, without any tangible local or constitutional disease, is an occa- sional cause of death after severe operations ; more ])articularly in delicate females, in feeble or debilitated subjects, in those who have lost much blood, or who have become weakened by protracted suppuration. A large number of the deaths formerly recorded as due to exhaustion were doubtless the effect of slow poisoning from the absorption of putrid matter from unclean and imper- fectly drained wounds. Hcemorrhagc, if very copious, may be immediately fatal; or may increase the shock so that the patient cannot i-ally ; or, by weakening him and lowering his vitality, it may render him more liable to be affected by unhealthy inflam- mations and septic processes, which fi'equently terminate in death. The danger from these secondary and indirect effects of excessive hasmorrhage is very great. Blood once lost is not easily replaced in advanced life, and at any period its excessive loss may permanently impair the constitution. It has been shown by experiment that animals previously weakened by loss of blond are more readily infected by pathogenic organisms than those iu a normal condition, and this explains the fact that patients Avho have lost much blood make slow recoveries, often interrupted by intercurrent diseases which