Page images
PDF
EPUB

be operated on, from the axillary above the clavicle, the external iliac above the crural arch, and the carotid by the side of the trachea, down to their respective ramifications. The false aneurism should be opened opposite to the wounded part of the vessel, the tourniquet being previously applied, the coagula removed, and two ligatures placed on the artery, as in the preceding kind.

Varices are dilatations of the veins, occurring in parts where the return of the blood is contrary to gravity, or where pressure is made on the trunks so as to obstruct that return: hence they are most frequent in the legs. The affected vessels swell into irregular knots, in which the blood is at first fluid, but afterwards coagulated. The complaint at first is not painful, but afterwards becomes so, and gives rise to troublesome ulcerations. The vessel sometimes bursts, and considerable bleedings follow.

The cause should be removed, and a tight bandage applied, the horizontal position being preserved. When this treatment does not succeed, the trunk of the vein may be tied with two ligatures, and divided between.

Hemorrhoids, or piles, are varices often attended with hemorrhage. Leeches, cold applications, attention to regimen, open state of bowels, and balsam copaiva, are means of temporary palliation. radical cure may be effected by cutting off the excrescences with scissors, or tying them.

Α

Scrophula attacks particularly the lymphatic glands and bones, occasioning a soft indolent swelling in the former, and a softening, together with a carious affection, of the latter. After remaining enlarged for a long time, the skin, covering a scrofulous tumour, becomes of a light purple, and bursts, discharging an unhealthy matter, and leaving an ill-conditioned sore. Such attacks take place in several parts. They generally occur in peculiar constitutions, and the affection is considered hereditary. In the treatment we endeavour to give strength to the constitution; bark, sea-air, and sea-bathing, are particularly serviceable. Attention to the digestive organs is particularly necessary. Alkalies have generally been relied on, but without due grounds; acids deserve a preference. The local treatment is not of much importance. The suppurations should not be opened. The scrofulous affections of the bones will be considered under Joints.

This is an universal poison, derived from certain specific sores on the teats and udders of cows, and capable of being communicated by accidental contact, where the cuticle has been removed, or by means of inoculation, to the human subject. A person who has been thus affected is rendered for ever after incapable of receiving the small-pox infection. That subjects, who have taken the vaccine disease accidentally, were thereby secured from the small-pox, was popularly known in several of the dairy counties of England. But it was reserved for Jenner to show that the cow-pox could be propagated by inoculation, and that the inoculated disease possessed the same prophylactic power as the original disorder. It is not a merely local affection, but produces a general, though extremely mild, disturbance of the constitution, which is ordinarily so trivial as not to excite any alarm in the very youngest subjects. It seems probable, at present, that it is not an infallible security against the small-pox, although the number of failures is very small, when due allowance has been made for the mistakes of the ignorant, and the misrepresen tations of the designing. A small inflamed spot, distinguishable about the third day, shows that the inoculation has succeeded. This increases in size, becomes hard, and raises above the level of the skin. A small quantity of fluid can be discerned in the centre on the sixth day, and the pustule increases until the tenth day. This fluid will communicate the disease by inocculation. On the eighth day, when the pustule is fully formed, the constitutional effects begin to appear, and manifest themselves by slight pain in the part and axilla, head-ach, shivering, loss of appetite, &c. These subside spontaneously in one or two days. During the general indisposition, the pustule becomes surrounded with a broad circular inflamed margin, called the areola. Afterwards the fluid dries up, and a dark brown scab forms, which remains for about a fortnight.

Venereal disease. This arises from the. application of a peculiar morbid poison to the body, which affects various parts in succession. It first attacks the genitals of either sex, where it appears in the form of a circular ulcer or ulcers, with a white dirty concave surface, and thickened edge and basis, called chancres. These characters distinguish them from various other ulcerations and excoriations, to which the same parts are exposed. The matter abCow-pox (variola vaccinæ, vaccina, &c.) sorbed from these, causes swellings of the

Imyphatic glands, named buboes. After a certain length of time, an ulcerated sore throat appears, attended with a peculiar copper-coloured eruption on the skin. The ulcer of the throat is excavated, and the chasm appears foul on the surface, with an appearance like a white slough, and a defined edge. The eruptions vary considerably; they have generally a reddish colour; the cuticle peels off and forms again successively; at last a true scab appears, under which ulceration takes place. After some time swellings of the bones, called nodes, appear, and gradually suppurate. These are very painful, particularly at night. The affections of the throat, skin, and bones, form what are called the constitutional symptoms of the disease, or lues venerea.

The treatment of this disorder, in all its stages, consists in the exhibition of mercury, until it produces its peculiar effects on the constitution: these are, universal irritability, quick pulse, &c. toge. ther with increased secretion of saliva, soreness of the gums and mouth, &c. This action, excited by mercury, destroys the action of the disease in all its forms, and may be considered as a specific and certain cure of the disorder. The remedy is most frequently introduced by friction on the thighs; half a drachm being first employ. ed for half an hour every night, and in creased to two or three drachms. The pil. hydrarg. is the most common prepa ration for internal use; it may be taken at first in doses of five grains, morning and night. Hydrarg. calcin. gr. j. with opium, and corrosive sublimate, are less frequent modes of exhibiting mercury. Lastly, mercurial fumigations have been employed, by exposing the patient, naked, in a wooden box, to the fumes of the pulvis dydrarg. cinereus, thrown on a heated iron. The effect of mercury on the salivary secretion and gums is considered as the criterion of its action on the system at large; this should not be allowed to be come considerable, as the effects on the constitution are very pernicious. A very slight affection of the gums, continued from six to twelve weeks, will be adequate to the cure of most venereal complaints. The action of the remedy is usually maintained for a fortnight after the symptoms have disappeared, for the sake of security. Violent and long continued salivation often aggravates the complaint, and becomes the source of other disorders. Decoction of sarsaparilla, mezereon, guaiacum, &c. nitrous

acid, opium, and other remedies, have been employed in venereal cases; but the most that can be said of them is, that they are useful restoratives after the long employment of mercury. This is particu. larly the case with the nitrous acid.

There is not much to be said on the local' treatment of the different venereal symptoms. Chancres, when very small, have been destroyed by lunar caustic, or excision they may be dressed with mercurial ointment, or any solution of metallic salts; or with solution of opium if irritable. Buboes may be poulticed, if painful.

:

AFFECTIONS OF JOINTS.

White swelling attacks the larger articulations most frequently. It consists in an indolent tumour of the part, without affection of the skin, impairing the motions of the joint; arising from a diseased state of the bones and ligaments, which causes a general thickening of the superincumbent parts. The enlargement proceeds, the joint becomes painful, and abscesses form; the patient at last dying hetic. The treatment consists in subduing completely all increased action in the part by leeches, cupping, cold washes, &c. continued while there is any remains of pain or heat; and afterwards in keeping up a drain from the skin by means of caustic issues; or, what seems to be more advantageous, by Mr. Crowther's plan of blistering, and dressing the surface with unguentum sabinæ. These drains should be continued for six, twelve, or eighteen months. Perfect rest is indispensable. The constitution of the patient, which is frequently of the scrofulous kind, demands the greatest care: bark, sea air, &c. are therefore particularly proper in such cases. Where the joint is too thoroughly diseased, and the constitution is sinking, amputation must be performed.

Loose cartilaginous substances are most frequent in the knee, where they excite inflammation, and are very troublesome when they get between the ends of the bones. They must be removed by means of an incision over the inner surface of the internal condyle, where they can be easily fixed by an assistant; the wound should be closed instantly, and every attention paid to keep off inflammation.

Hydrops articuli occurs after inflammation or injury, and may be dispersed by blisters and savine ointment; or by friction with camphorated liniments or mercurial ointment, united with mercurial purges.

DISEASES OF BONES.

Necrosis is the death of the whole of a bony cylinder, excepting its articular portions; and is most frequent in the thigh and tibia. The periosteum separates from the affected bones, becomes thickened and vascular, and forms a new case surrounding the old bone, and at last absorb ing it. This process occupies many years, is attended with great pain and swelling of the limb at first, and subsequently with abscesses, which lead down to the old bone, and afford issue to copious fetid suppurations. In some instances the old bone, which is called the sequestra, has been removed by a surgical operation, particularly in the tibia. Where this cannot be admitted, blisters dressed with savine, or issues, will remedy the irritation and prevent suppuration, while the absorption of the old bone is going on. Leeches, cupping, &c. may be required, if inflammatory symptoms manifest them selves. Sometimes amputation is necessary, particularly in poor persons, whose circumstances will not admit of delay.

Exfoliation is the term applied to the death of a small portion of bone, in which generally the surgeon must wait until nature has separated the dead part.

Caries is a disease of the substance of a bone causing foul, ill-conditioned ulcers, and attended with occasional exfoliations. Means which reduce inflammation are proper at first, followed by counter irritation. Rickets is a disorder consisting in a flexibility of the bones, and consequent ly, a deformity of the part affected, occurring generally in weak children. The constitution should be strengthened, and mechanical means will often in an early stage have considerable effect in restoring the deformed part.

Fractures are either simple or compound. The former are usually attended with a distortion of the limb; with a grating or crepitus, perceptible on rubbing the broken ends against each other; with pain and swelling; and often with spasms of the muscles. The accident is remedied by the effusion of a soft vascular matter between the broken ends; and by the gradual deposition of earth in this; where it acquires a sufficient firmness to admit of the part being used again at various periods, from three to seven weeks. The new matter is called callus. The treatment must, consequently, consist simply in bringing the limb into its natu ral position, and retaining it there firmly, until the union is accomplished. m

effecting the former object, some force is often necessary, where the muscles have shortened the limb, as is frequent in the thigh; and this is termed extension. The latter end is attained by means of instruments called splints, which are firmly bound on the broken limb, including generally the joints which connect it to the neighbouring parts, and which of course must vary in their form, &c. according to that of the part on which they are placed.

Compound fractures are those in which there is an external wound, made by the broken bone, which generally protrudes through it. Here the violence suffered by the limb is much greater; inflammation of the surrounding parts, extensive abscesses, exfoliations of the broken ends, and great constitutional sympathy, may be naturally expected. Where the injury is very violent, the bone much shattered, and the soft parts lacerated considerably, immediate amputation may be performed. Otherwise close the external wound; lay the limb in its natural position, and keep it so; and pay strict attention to the constitution. Extensive abscesses, &c. may render amputation necessary at a subsequent time.

Dislocations, or luxations, are the displacements of the articular surfaces of bones, by external violence. Hence their symptoms arise from the altered form and impaired functions of the parts. The head of a bone is out of its natural socket, and is lodged in some unnatural situation; the limb cannot be moved by the patient; there is great pain, aggravated by the surgeon's examination. The bone must be restored, by means of force, to its proper place, and the limb kept quiet, until the effects of the violence are gone off. Compound dislocations must be treated on the same principles as compound fractures. Sawing off the end of the bone is quite unjustifiable in any case. If a luxation be unreduced for a few weeks, the bone in general cannot be replaced, and the patient becomes crippled. Dislocations are sometimes produced by diseases of the joints destroying the ligaments.

PARTICULAR SURGICAL SUBJECTS.

The great number of these, and the limits prescribed by the nature of this work, render it necessary for us to pass over several, and attend only to the more important.

Injuries of the head. Fractures of the

skull are not dangerous in themselves, but they indicate that considerable violence has been inflicted. We must guard against inflammation of the contents of the cranium, and continue the antiphlogistic regimen for three or four weeks. If the bone be even slightly depressed, the same plan may be pursued. Bleeding from the arm or temporal artery, saline purges, and diaphoretics, are usual

means.

Compression of the brain may be caused by fracture with depression, or from extravasation of blood under the skull. Its symptoms are, insensibility, dilated and immovable pupil, slow and labouring pulse, difficult and stertorous respiration. These demand the application of the trephine, for the purpose of elevating depressed bone, or removing effused blood. Compression may also be caused by suppuration of the dura mater. This happens several days after the accident, is indicated by peculiar symptoms, as Pain, feel of tightness, and puffy tumour of the integuments; and demands the use of the trephine.

into

Concussion of the brain is an injury of that organ produced by the blow, independent of actual fracture of the skull. After the first stunning subsides, there is sickness, contracted pupil, a degree of sensibility and irritability, and free respiration. The patient gradually goes a state of phrenitis. Copious and repeated bleedings from the temporal artery and arm, saline purges, low diet, &c. are the only means of safety, and must be followed up until the symptoms are subdued. Trepanning consists in removing, by means of a circular saw, a portion of the skull, in order to allow the elevation of depressed bone, or the evacuation of blood or matter. The scalp must be divided by an incision down to the bone, and the sides of the cut turned up; these are laid down again, and approximated, after the operation. Trepanning is not to be performed merely because there is a fracture or depression; but only when symptoms exist, showing that the brain is suffering from pressure.

Tinea capitis, or scald-head, is a superficial ulceration of the scalp, covered by thick dry scabs. Cleanliness is the most essential part of the treatment. The scabs must be removed, the head kept closely shaved, and the ulcers dressed with the ung. picis cum sulphure, or ung. hydr. nitr. or lotion of kali sulphuratum. Alterative medicines must be given at the same time.

VOL. XI.

Hare-lip is a deformitity existing from birth, attended frequently with a fissure in the jaw and palate. Its cure consists in paring the margin of the fissure, and bringing the edges into contact, where they are held by means of pins, and the twisted suture; which is a thread passed over the pins in the form of the figure 8. They thus unite by the first intention. It should not be performed on very young children, as they are less manageable, and are liable to convulsions. The removal of the edge of the fissure is performed by means of forceps, by which the lip is held firmly, leaving out the part which is to be cut off, and which the surgeon removes at one stroke of the knife.

The same operation is necessary for cancerous ulcers of the lip, which commence in ulcerated, wart-like excres. cences, and spread very destructively. They should be removed as soon as we can ascertain that they do not yield to our remedies.

Diseases of the antrum are, inflammation and suppuration of that cavity, and fungous growth from its surface. The former requires an opening by the extraction of one of the grinders, and the introduction of a pointed instrument through the socket. In the latter, the cavity should be trephined, and the fungus removed.

The noli me tangere, or spreading herpetic ulcer about the nose, is a very untractible complaint. Alterative medi cines should be given internally, together with cicuta, and even arsenic ung. hydr. nitr. ung. picis., solution of lunar caustic, and of arsenic, as topical applications.

Fistula lachrymalis arises from obstruction of the ductus nasalis, which causes a swelling in the corner of the eye, flux of the tears over the cheek, and afterwards a fistulous opening from the lachrymal bag. Its cure, in an early state, is by injecting warm water through the puncta, using a collyrium of white vitriol, and smearing the edges of the eye-lids with ung. hydr. nitr. In a more advanced state, an incision into the lachrymal bag is required, together with a forci ble removal of the obstruction, and the introduction of a straight silver nailheaded style.

DISEASES OF THE EYELIDS AND EYES.

Psorophthalmy and lippitudo, or inflammation of the edges of the eyelids, with ૨૧

itching, &c. ung. hydr. nitr. lowered, rubbed on at night with camel-hair pencils; vitriolic colyrium, and alterative medicines.

Purulent ophthalmy. Red, swollen, and everted state of the eyelids, with discharge of purulent matter, particularly in children. Inject under the eyelids solutions of camphor, or the metallic salts. Ectropium, or eversion of the eyelids, followed by an indurated and callous state of the conjunctiva. Remove a portion of that membrane. Exactly the reverse of this is the trichiasis, or inversion; where the hairs rub against the eyeball, and where a portion of the skin of the eyelid must be removed. Hordeolum, or sty, requires an emollient poultice, and touching with argentum nitratum.

Ophthalmy, or inflammation of the eye, distinguished into the first, which is called the acute stage, attended with heat, pain, fever, &c. and the second, or chronic period, in which there is a weakness of the organ. Remedies of the first are; in slight cases, low diet and gentle purging, with keeping off the light; afterwards, in the chronic state, one of the following collyria. R Zinc. vitriolat. gr. v. aqu. rosa, iv. R Ceruss. acet. gr. viii. Aq. feniculi vi. Spt. vin. camph. gtt. x. In more severe cases, general and local bleeding; blisters to the temples, behind the ears, and to the nape of the neck; warm emollient applications to the eye, total darkness, and the antiphlogistic regimen in every respect. Where the chronic state has commenced, astringent colly ria, or the tinct. thebaica, dropped once or twice a day between the eyelids. When the complaint is very protracted, the state of the constitution in general, or of the digestive organs in particular,

often is the cause; hence alterative remedies, attention to regularity of the bowels, pure air, exercise, &c. become

necessary.

Opacity of the cornea, varying in extent or intensity, and hence divided into nebula, albugo, leucona, &c. often accompanied with varicous vessels in the conjunctiva. Collyria of corrosive sublimate; ung. hydr. nitr. to the opaque part, touching it with argent. nitr.; cutting the enlarged vessels of the conjunctiva. Ulcers of the cornea should be touched with argent. nitr.

Ptreigium is a reddish, loose, triangular membrane, growing over the cornea; and must be removed by an operation.

Staphyloma is a protrusion of the cornea between the eyelids, consequent on various affections of the eye, and always attended with entire destruction of the organ of vision. Cut away the projecting part, in order that the globe may collapse.

Prolapsus of the iris through a wound or ulcer of the cornea; if all the inflammation has subsided, touch the tumour repeatedly with argent. nitrat. until it is destroyed.

Hypopyum is the collection of a yellow purulent fluid behind the cornea, consequent on inflammation of the eye. If the ball should seem much distended, an opening may be made for its discharge; otherwise attend only to the complaint which causes it.

Dropsy of the globe terminates in protrusion of the organ through the eyelids, ophthalmy, and destruction of the part. The projecting cornea may be cut away, that the distended globe may collapse.

Cancer of the eye should be treated by extirpation of the organ, as soon as the disorder is recognised. The outer angle of the eyelids may be divided to give room; these parts should be preserved, unless included in the disease; and care must be taken not to penetrate the thin walls of the orbit in the operation.

Gutta serena, or amaurosis, is a paralytic affection of the optic nerve, inducing blindness: it may be either complete or incomplete; inveterate or recent; conmovable, and the pupil dilated; there is tinued or periodical. The iris is im

strabismus; insects, or loose substances, plaint is formed. The incomplete recent seem floating in the air before the comform of the disease is most frequently curable; the complete inveterate amaurosis seldom admitting of cure. The former generally arises from disorders in the primæ viæ, and should be treated with emetics, and the following pills: R gum sagapen. galban. sap. ven. à à 3 i. Rhei 3iss; antim. tart. gr. xvi; succ. liq. 3 i. M. fiant pilule granor v. Three to be taken morning and evening for six weeks. Bark, pure air, &c. must be resorted to afterwards. Such cases as arise from organic injury, or disease of the part, or are attended with exostoses of the neighbouring bones, or with acute and continued pain in the head and eye-brow, &c. afford little hope of success. Electricity has sometimes succeeded,

« PreviousContinue »