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.

    194/878 (page 170)
    admirer of iodine in its different forms, and often wonder whether the remedy has not suffered in character from the overweening confidence of some of the zealous advocates for its supposed extraordinary powers : in numerous instances where improvement has taken place during its use, I fear that, as in the case of many other so called specifics, there has been too little note taken of those changes, both local and constitutional, which are the results of time and other circumstances. Operations for the removal of tumours may be amongst the most simple in surgery, or amongst the most difficult and dangerous which the surgeon is ever called on to perform. The smallest possible amount of skill or manual dexterity may suffice in one instance, whilst in another, anatomical knowledge, facility in the use of instruments, judgment to plan and courage to execute all the steps of the operation, are indispensably necessary. Encysted tumours may be operated on in a variety of modes. If of that kind commonly known under the name of ganglion (most fre- quently seen about the wrist and ankle), and if the cyst is not dense and strong, a little pressure with the fingers, a smart blow with the knuckle, or with a book or other solid substance, will cause it to burst; the fluid will be extravasated in the surrounding cellular tex- ture, and then absorbed; some inflammation will be excited, partly by the injury of the cyst, and partly, perhaps, from the extravasation; adhesion and obliteration of the sac will occur, and so the disease will be got rid of, and in the course of time no vestige of the sac will remain. Sometimes the sac cannot be burst, and then a needle may be pushed into it at one or more points, or a subcutaneous incision may be made to allow the fluid to escape into the surrounding texture. In either of these modes it may be well to scratch the interior of the sac, so as to induce inflammation; and whether these plans are fol- lowed, or the tumour is burst, a pad and bandage should be applied to keep the surfaces of the cyst in apposition. I have occasionally, in large collections of fluid in the sheaths of the tendons about the wrist, successfully introduced a single thread, much in the manner recom- mended for the treatment of aneurism by anastomosis. Sometimes tincture of iodine has been thrown into these cavities; and numerous other methods have been followed, all of them with the view of exciting inflammation within. Cysts often require to be freely laid open with the knife, and treated as we would an abscess after inci- sion : the housemaid’s knee and miner’s elbow, which, in their uninflamed state are in some measure like the cases under considera- tion, may be treated in this manner; but the sac, especially over the patella, is often so thick, that it is better to dissect it away entirely; indeed, in most instances, with the sac in this condition, it is the best mode of procedure. In cutting out such tumours, the sac may either be laid open, and theit partly torn and partly cut away with the knife or scissors, or it may be removed entire. One or other of the latter modes is required for the treatment of wens, for which