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.

    154/878 (page 130)
    always greatest risk within the first few days ; but, as with other violent changes effected on the system, some internal viscus may become the seat of secondary inflammation, and death from a secondary cause may be the result. The upper part of the small intestine has been found in a state of ulceration on its mucous surface within a few weeks after such primary injuries. . . The mildest form of mischief from cold where the surgeon’s advice is asked for, is chilblain, which may be said to be a sluggish kind of in- flammation induced partly by cold and partly by heat; perhaps in reality the condition is more the result of the latter than the former, for, if the change from cold to heat were less abrupt than it usually is in examples of the kind, there would probably be no such affection. Chilblain is only seen during the most inclement season of the year, when the toes and fingers, perhaps the ears and tip of the nose, are liable to be chilled out of doors, and suddenly heated again in the house, but more especially if the part be brought near a fire. The disease shows itself as a small dusky-red, elevated spot, which is most conspicuous while the person is warm. At this time, too, there is a painful tingling sensation, which induces a desire to rub and scratch the affected part. There may be one chilblain only, or there may be many ; and sometimes the hands and feet are covered with them, when they cause great annoyance. In some instances slight vesica- tion appears, and at other times, if the feet be much exposed, ulcera- tion and sloughing may ensue. In mild cases, where the skin is unbroken, a stimulating lotion is perhaps the best application which can be used. The camphor or ammonia liniment, or these in their compound shape, may give relief; one or other of them may be used in conjunction with the soap liniments, or the latter may serve by themselves, or with a small proportion of turpentine, or tincture of cantharides. Many nostrums have been used for these complaints, and occasionally they seem to be of use; but I am doubtful if any ap- plication possesses such virtue as to lead to a confident hope of cure from its use. If the temperature of the air becomes mild, the affection ceases spontaneously, and perhaps it is at this particular time that the remedy in use acquires its good character. If ulceration or sloughing be present, poultices and stimulating dressings must be used until the sore assumes a healing aspect, when simple dressings will complete the cure. . If the temperature of a part be much and long depressed, there is great danger of its immediate death; and should the heat be too speedily restored, there is equal danger from reaction,—an excess, as it were, of that milder excitement which induces chilblain simply. The inflammation under these circumstances speedily assumes a gan- grenous character, mortification ensues, and the part must be separated as a slough, or amputated by the surgeon. Portions of the feet are frequently lost in this way, and a sketch of such a condition will be found on a future page, as an example where Chopart’s incisions for partial amputation may be adopted with advantage, in preference to