Manual of Surgery Volume First: General Surgery. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume First: General Surgery. Sixth Edition.
Thomson, Alexis
Surgery
_Artificial Hyperæmia._--As has been explained, the induction of
hyperæmia by the method devised by Bier, constitutes one of our most
efficient means of combating bacterial infection. The treatment of
tuberculosis on this plan has been proved by experience to be a valuable
addition to our therapeutic measures, and the simplicity of its
application has led to its being widely adopted in practice. It results
in an increase in the reactive changes around the tuberculous focus, an
increase in the immigration of leucocytes, and infiltration with the
lymphocytes.
The constricting bandage should be applied at some distance above the
seat of infection; for instance, in disease of the wrist, it is put on
above the elbow, and it must not cause pain either where it is applied
or in the diseased part. The bandage is only applied for a few hours
each day, either two hours at a time or twice a day for one hour, and,
while it is on, all dressings are removed save a piece of sterile gauze
over any wound or sinus that may be present. The process of cure takes a
long time--nine or even twelve months in the case of a severe joint
affection.
In cases in which a constricting bandage is inapplicable, for example,
in cold abscesses, tuberculous glands or tendon sheaths, Klapp's suction
bell is employed. The cup is applied for five minutes at a time and then
taken off for three minutes, and this is repeated over a period of
about three-quarters of an hour. The pus is allowed to escape by a small
incision, and no packing or drain should be introduced.
It has been found that tuberculous lesions tend to undergo cure
when the infected tissues are exposed to the rays of the
sun--_heliotherapy_--therefore whenever practicable this therapeutic
measure should be had recourse to.
Since the introduction of the methods of treatment described above, and
especially by their employment at an early stage in the disease, the
number of cases of tuberculosis requiring operative interference has
greatly diminished. There are still circumstances, however, in which an
operation is required; for example, in disease of the lymph glands for
the removal of inert masses of caseous material, in disease of bone for
the removal of sequestra, or in disease of joints to improve the
function of the limb. It is to be understood, however, that operative
treatment must always be preceded by and combined with other therapeutic
measures.
TUBERCULOUS ABSCESS
The caseation of tuberculous granulation tissue and its liquefaction is
a slow and insidious process, and is unattended with the classical signs
of inflammation--hence the terms "cold" and "chronic" applied to the
tuberculous abscess.
In a cold abscess, such as that which results from tuberculous disease
of the vertebræ, the clinical appearances are those of a soft, fluid
swelling without heat, redness, pain, or fever. When toxic symptoms are
present, they are usually due to a mixed infection.
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