In treating of the cure of caries, the first thing is, to determine
by what means the disease of the bone may be removed; and, secondly,
what modification our treatment must undergo, in consequence of
the caries belonging to the first or second species. From the very
earliest periods, we find the application of stimulating and corrosive
remedies recommended in this disease. The actual cautery, euphorbium,
mineral acids, scalding oil, the essential oils, and warm balsams,
have been universally employed, and frequently alternated with rasping
and perforating the bone. This proceeded from observing, that, on
the one hand, mild applications had no effect, and, on the other,
that the natural slowness of exfoliation was overcome by the use of
these more powerful remedies. A caries of a bone is correspondent to
a mortification of a soft part; and, therefore, it is impossible to
restore the diseased part to health, or life. Our chief object, then,
must be to prevent the disease from spreading, and to procure a speedy
separation of the dead portion. The first is much less under our power
than the second; for, it is most probable, that, in the majority of
instances, at least of those of a simple nature, the disease, from the
first, extends a certain length, affecting a portion of the bone, and
that it afterwards makes very little progress. There is, however, a
specific disease which affects the bone in common with the soft parts.
The bone becomes rough, and suppurates; and the soft parts have a
fiery appearance: This has been called the phagedenic caries. Cancer,
scrophula, lues, and other specific actions, also spread after they
are once induced. The second object is to be effected by such means
as operate upon the vitality and action of the part, and those which
act mechanically. Those which tend mechanically to remove the dead
portion, are perforations down to the sound part, which we know has
happened, by the bleeding which ensues; or, we may saw down this length
with a trephine. We thus, by cutting off the communication of part
of the diseased surface with the adjacent parts, kill it completely,
sooner than could otherwise happen, and likewise stimulate the parts
below to assume the ulcerative action, and throw it off. We may also
sometimes be able to turn out these portions with a levator. Those
which act more exclusively, by affecting the action of the part, are
stimulating applications; such as heat, acids, &c. The actual cautery
is so terrifying to the patient, that it is now laid aside; and it
is likewise liable to this objection, that it may, by its operation
on the neighbouring parts of the bone, produce disease in them. The
potential cautery is more useful, and may frequently be employed with
advantage, either in a solid form, as to callus, &c. or dissolved
in water, and applied with a pencil[37]. M. Sue, in his notes to
Ravaton’s Practique, &c. recommends l’eau mercurielle, or solution of
mercury, in nitrous acid.
Public-domain text, read in full here on John Shaqi.
Reviews
Reviews
No reviews yet
Be the first to share your thoughts on this work.
Join the Discussion
Join the discussion
Sign in to leave a comment or review.
Sign InorCreate an account