Volume 1

The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen.

  • Erichsen, John
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen. Source: Wellcome Collection.

    353/1244 (page 325)
    INFLAMMATION OF INCISED WOUNDS. wounds with loss of substauce which cannot be treated by the methods before described, such as those left after removal of the tongue or after operations on the anus and rectum, its effect in preventing putrefaction is undoubted, and there is no more efficient antiseptic application. In excision of the tongue its use has reduced the death-rate to less than half of Avhat it was. In such cases it is invaluable ; but in clean wounds which can be accurately brought to- gether the iodoform can only be regarded as^ a foreign body, the introduction of which is not necessary. If not used in too great quantity, however, it does not interfere with primary union. Mosetig v. Moorhof states that he has very rarely observed any symptoms of poisoning. When it does occur he asserts that it is almost invariably due to one of three causes. First, to the simul- taneous use of carbolic acid, which he believes interferes with the elimination of the iodoform by the kidney. Secondly, the nse of excessive quantities, especially in fat subjects, iodoform being soluble in fats ; and thirdly, to the presence of kidney disease or fatty heart. That it fails in the prevention of erysipelas is probably true. Its unpleasant smell is also no slight disadvan- tage. Taking everything into consideration, it may be said that the iodoform dressing is a reliable method of treating wounds, and in many cases is the most convenient that can be adopted. The methods of treatment here recommended are all of established utility, but numberless others have been tried and abandoned, or are at present being tested ; and probably we have not yet discovered either the best antiseptic or the best mode of dressing. The tendency of the present time is in favour of some of the forms of lasting absorbent dressing impregnated with some efficient antiseptic. The Surgeon should make himself familiar with various methods of treatment, and employ that which seems most suitable to the case. It can rarely happen in civil practice that he is so situated as not to be able to adopt some efficient antiseptic treatment provided that he has mastered the principles upon which that treatment is founded. Inflammation of Incised Wounds.—As before pointed out, a certain degree of inflammation is a necessary part of the healing of a wound by first intention. This should, however, be strictly limited to the tissues actually injured by the instrument which produced the wound, and should be very temporary in character. The simple traumatic inflammation, although patho- logically of such great importance, is clinically so shghtly marked by symptoms that it is frequently ignored ; and when we say that a wound is inflamed, we mean that some cause of inflammation other than the oi-iginal injury has been introduced, which is causing the process to extend beyond the area actually injured by the cutting instrument. The causes of such inflammation have already been so fully discussed that we need do no more here than recapitulate them. They are predisposing and direct. The predisposing causes are the same as those of inflammation in general (see page 162). The most important of these for wounds are : chronic ! alcohoHsm, insufficient and improper food, Bright's disease and diabetes, 1 scurvy, &c., and local malnutrition from disease of the arteries. The direct • causes are mechanical, as friction from want of rest, tension from tight • stitches or from insufficient drainage, or pressure from tight bandaging ; chemical, as the persistent contact with the raw surface of an irritating anti- ' septic or the products of putrefaction : and lastly, the true infective poisons, as those of erysipelas, pytemia, hospital gangrene, &c. In the vast majority