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.

    108/878 (page 84)
    inflammation, whether in one case it arrests its progress, or in another it hastens on the suppurative stage, and thus in a great measure changes the aspect of the disease. Why it should produce these dif- ferent effects, cannot readily be explained, nor can the most experi- enced surgeon always he certain which result will ensue. It is often a point of much interest to determine whether suppura- tion has actually occurred or not. When it happens on a surface, the physical characters of the secretion are usually sufficiently clear to de- note the circumstance : but if it takes place in deep-seated parts, there may not be the same facility for discrimination; so, whilst in some instances the event can scarcely be doubted, in others the most expe- rienced practitioner may be at fault. The only characteristic constitu- tional symptom denoting the first formation of matter, which has been deemed of much consequence, is that of shivering; but it is, in my opinion, less worthy of estimation than some seem to imagineit fre- quently happens in instances of disease where suppuration never ensues; it often occurs, even in a state of health; and equally often when it does happen, it may be overlooked. Shivering is a symptom which the surgeon is often deeply interested in, not so much, however, from the dread of suppuration, as that it denotes some peculiar condi- tion of the system fraught with much danger to life,—as for example, if within the first ten days after a capital amputation, or after litho- tomy, a patient is seized with shivering, there is much reason to anti- cipate a fatal result; and although this may not occur in all such instances, every practical surgeon must bear me out in the formidable estimation I have made of this symptom. But whether it has pre- ceded suppuration or not, the surgeon will seldom be thus satisfied that matter has formed. Swelling is not always a good criterion either, for though in some cases the continued accumulation of matter pro- duces most perceptible enlargement, tumefaction sometimes actually diminishes as matter is formed; whilst, in other instances of inflam- mation, it is conspicuously present, although suppuration is known to be a rare result, as in the eyelids, scrotum, and testicle. The undula- tory motion of the fluid, produced by percussion with the fingers, is one of the surest symptoms of suppuration having occurred: the feeling of fluctuation is well understood by the person who has once placed the fingers of one hand over the collection of matter, and tapped gently on the swelling with those of the other. But some surgeons seem more acute in their perceptions than others; and it is with all more difficult to detect the presence of matter when it is deep-seated and in small quan- tity, than when superficial and in abundance. Some practitioners trust chiefly to the sense of touch, and the history of the case; occa- sionally the eye alone suffices, whilst, in other instances where there is doubt, some exploring process may be resorted to, such as those which are described at p. 16. , It certainly seems awkward when a surgeon applies a cutting in- strument, in hopes of reaching matter, that none appears. Besides the unnecessary pain and injury inflicted on the patient, the surgeon