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.

    38/1244 (page 8)
    the sick and wounded, such as is commonly met Avitli in the wards of an over- crowded or ill-constructed hospital* The proper regulation of the patient's Diet before and after an operation is of great consequence. On this ]3oint it is impossible to lay down any very definite rule, as much depends not only on the patient's previous habits of life, but on the nature of the operation itself; and, as this subject will be discussed at the end of the Chapter, it need not detain us here. It is not often, however, that in civil practice the insufficient quantity or the bad quality of the patient's food, with which he is supplied after the performance, influences materially the result of an operation. But in military and naval practice in time of war the case is far diiferent. The soldier or the sailor on active service is often exposed to serious injuries that necessitate the more important operations at a time when his constitutional poAvers have already been broken down by scurvy, dysentery, or some similar affection, resulting as much from the deficient quantity as fi'om the uuAvholesome character of the food with which alone he ■can be suj)plied. After the operation his only available nutriment may be -of the coarsest character, possibly salted, and imperfectly cooked. In such circumstances, and in the absence of efficient antiseptic treatment which is almost unavoidable in war, operation-wounds do not heal, or they assume a peculiar gangrenous character ; and the patient dies from septicsemia or pyemia, or from profuse diarrhoea with ulceration of the intestines. The mortality of operations becomes enormously increased ; and thousands of deaths Avhich have occurred in wars between the most civilised nations and the best appointed armies have been due to these causes. The Hygienic Conditions to which the patient is subjected after an operation will necessarily vary greatly according to the locality in and the circumstances under which it is performed—whether it is done in a private house, where the patient may be isolated, freed from the chance of all contamination, and surrounded by every sanitary precaution ; or in a hospital, where he may be exposed to emanations, possibly of a septic and infectious character, from other patients, Avhere the building may be impregnated by the exhalations from generations of sick and injured, and where sanitary measures may be ) neutralised by the conditions generated by a vast assemblage of sick under one roof. Then, again, the circumstances in which a patient is placed after an operation for an accident of civil life are necessarily very different from those that surround one who is exposed to the peculiar perils that are necessarily connected with military hospitals and ambulances in time of active war, and which will be more fully described in the chapter on Gunshot Avounds. In private practice, ill results may foUoAV operations from three different causes, viz. : self-infection of the patient, in consequence of the retention of decomposing and putrescent secretions in the wound ; conveyance of infection by the .Surgeon ; and general faulty sanitary arrangements of the house. In hospital practice these different sources of danger must necessarily exist to the same if not to a greater extent than in jnivate. In hospital, howeA'er, just as in private practice, these particular dangers are all preventable, and disease of a aeptic character ought not to be alloAved to generate itself through their medium. The frequency of such an occurrence is in the direct ratio of the want of ; » I would refer the reader wlio wishes to study this very inipoi-tant subject more deeply to my Lccliireg on Bospilalism and the Ctinses of Death after Operations. Longmans, 1874.