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.

    48/1274 (page 16)
    may prove fatal. For these reasons hemorrhage should, as much as possible, be prevented during the performance of an operation. When hjemorrhage occurs within twenty-four hours of an operation, it usually proceeds from imperfect ligature of the vessels or fi-om arteries bleeding after the commencement of reaction, which had not furnished blood whilst the patient was under the influence of the shock of operation. On recovery from anassthesia also, it not unfrequently happens that arteries begin to spout, which yielded little or no blood whilst the patient was insensible. In these circumstances, haemorrhage is of far less moment, and is less frequently fatal, than when it occurs at a later period, in consequence of some morbid condition of the wound, and frequently in association with local diffuse inflammation or general infective processes. Gangrene from purely local conditions, as in a limb from excessive traumatic violence, or in a strangulated hernia in consequence of prolonged strangulation of the gut before operation, is an occasional cause of death. Tetanus but rarely occasions death after operations in this country. When it does occur, it is more frequently after the lesser than after the greater operations that it develops itself. InterMil Inflammations of an acute character may cany off the patient after an operation in two ways. Inflammation of this kind may have existed antecedently to the operation, being the disease for which it is per- formed ; and, being unchecked by the operation, may continue its.course and destroy life. Thus, when a child dies after tracheotomy for diphtheria, death is not in general occasioned by the operation, but by the extension into the lungs of the disease for which it has been performed. Or the inflammation may be the consequence of the operation ; as when peritonitis occurs after the operation for strangulated hernia, or meningitis after the skull has been trephined. But it is not by the action of any of these direct results that an operation usually proves fatal. In the great majority of instances, death is occasioned in a more indirect manner by the development of infective inflammations, to which a neglect of hygienic laws acts as a powerful pre- disposing cause. Local and General Infective Diseases of septic origin, such as wound- diphtheria, hospital gangrene, erysipelas, pytemia and septictemia, were formerly frequent causes of death, more particularly in large towns. They were the dread of surgeons and the scourges of hospitals, and to them were probably due three-fourths of all deaths after operations. This proportion has, how- ever, been greatly reduced by improved methods of treating wounds, and greater attention to the sanitary arrangements of our hospitals. In the production of these diseases, an impure blood, loaded with effete materials retained through habitual disregard of the ordinary rules of health or through defective elimination by the kidneys and skin, acts as a potent predisposing cause. In these circumstances, it is not the extent of the wound that determines the dangerous results. A mere breach of surface, however trivial, is sufficient to form a starting point for these morbid processes. The am])utation of a toe may be as fatal as that of the thigh, or the removal of a small atheromatous cyst of the scalp as the ablation of the breast; the only additional danger essentially connected with the greater operation being the increased risk from shock and hseraorrhage.