A system of practical surgery / by William Fergusson.

  • William Fergusson
Date:
1852
Catalogue details

Licence: Public Domain Mark

Credit: A system of practical surgery / by William Fergusson. Source: Wellcome Collection.

    105/878 (page 81)
    lucent appearance of the skin. A similar condition may be present independent of any apparent inflammatory action, as in the swollen state of the body which occasionally follows scarlet fever, or in ana- sarca resulting from diseased heart or kidneys. From whatever cause it may arise, the surgeon should remember, that unless the part attected (supposing the condition to be entirely local) be supported on a level with the rest of the body, or, at all events, be kept from a very dependent position, the swelling is almost certain to increase : hence the excellent rule of elevating a part affected with inflammation or any action of a somewhat similar kind. Thus, in the scrotum, if this species of enlargement is not attended to, and supposing the patient to be confined to bed, the swelling gets between the thighs, or falls so low between the groins, and produces so great distension of the skin, that ulceration, or mortification, may actually occur: again, if in a like condition of the hand or foot, these parts be allowed to lie below the level of the rest of the body, the same results may happen. By suspending the scrotum properly, or keeping the other parts suffi- ciently high, all such dangers may be avoided; and, indeed, unless position be properly attended to in the treatment of accident or disease, the state of oedema is exceedingly apt to occur,—even a little irregular pressure, from a bandage, or other cause, may occasion the same result. As a proof of the advantage of position in such cases, I may refer to’ the condition of the face, and particularly the eyelids in ordinary anasarca: during the night, when the patient is in the horizontal position, these become much swollen, but during the day, when he sits up, or has the head elevated, they assume their natural appearance, owing to the serum gravitating towards the more dependent parts, iiere there is little to be done, unless by constitutional means which shall act upon the absorbents and kidneys, but which need not be par- ticularly referred to; indeed, I allude to the circumstance for the sole purpose of showing the advantage of elevating a part, which happens to be in an cedematous condition, above the rest of the body, in as far as that can properly be accomplished. Sometimes the swelling of oedema seems so much greater than the skin can bear with impunity that it is advantageous to make punctures with a lancet to permit the escape of serum. This practice has, with some surgeons, the addi- tional recommendation of permitting at the same time the flow of blood and thus alleviating inflammatory action. In erysipelas, for example’ more particularly in the head and face, where the disease is often attended with great swelling, the plan of puncturing with a lancet has been much followed. I have often myself resorted to such treatment, especially in the oedema which attends the severe forms of phymosis and paraphymosis; but position, and the exhibition of a smart saline :athartic, may do much to obviate the necessity for the lancet. In acute :orms of this kind of swelling, the last-named means of treatment, and those usually followed for inflammation, may put all to rights again • md in certain cases, where the action seems chronic, friction, or the implication of a bandage, may be of service; both, however, must be a