Pye's surgical handicraft : a manual of surgical manipulations, minor surgery and other matters connected with the work of house surgeons and surgical dressers / [Walter Pye].

Walter Pye

Date:: 1891

Credit: Pye's surgical handicraft : a manual of surgical manipulations, minor surgery and other matters connected with the work of house surgeons and surgical dressers / [Walter Pye]. Source: Wellcome Collection.

69/604 (page 45)

$Stimulating lotions, sucli as Lotio Arg. Nitratis grs. v to X to 5] of water, Lotio Zinci Sulph. grs. iv to §] of water, etc A treatment whicli is very frequently successful is to scrape the granulations completely away with the edge of a scalpel, or with a Volckman's spoon, such as is used tor the eradication of lupus. Another good plan is to apply Esmarch's indiarubber roller, without the strangulating cord, to the whole limb, including the bleeding sore, for not more than 24 hours. Or, finally, recourse may be had to cauterisation with fuming nitric acid, or with the actual cautery. . . That extremely rapid form of destructive inflammation, f^morrhage^^ known as sloughing phacjedmm or hospital gangrene, will_ be phagcaseua. considered later; here it must be mentioned only as being sometimes a cause of haemorrhage which is peculiar, mas- much as in the manner of its invasion of the tissues, it re- sembles the course of a malignant ulceration, and does not spare the blood-vessels, but atiecting their coats may cause the most furious bleeding. Vessels may of course frequently be destroyed hy ulceration without bleeding, from previous obliteration of their lumina. It is therefore in the most rapid forms only of this disease that bleeding takes place; this is also true of a haemorrhage from a somewhat similar cause, namely, that which is due to the destruction of large vessels by the formation of abscesses in dangerous regions. In such cases bleeding would be far more frequent but for the fact that time is given for the plugging of the vessels. It does however occur.* When, therefore, in a case of hospital gangrene, the dis- ease invades the neighbourhood of a large vessel {e.g., in sloughing phagedsena of the groin), the greatest watchfulness must be exercised, and some form of tourniquet be ready to be instantly applied if the vessel gives way, so that time may be gained to send for assistance. It is often very hard to decide upon the best means to adopt for the permanent arrest of this form of bleeding. If the vessel be small the thermo-cautery or nitric acid may be sufficient, but if it be a main trunk, it must be ligatured, and in that case the surgeon mil have to choose between the difficulties of securing a vessel itself diseased, in the midst * As in cases cited by Sir W. Savory in Med. Chirurg. Trans., Vol. LXIV., p. 21.$