Manual of Surgery Volume First: General Surgery. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume First: General Surgery. Sixth Edition.
Thomson, Alexis
Surgery
_Treatment._--Soft sores heal rapidly when kept clean. If concealed
under a tight prepuce, an incision should be made along the dorsum to
give access to the sores. They should be washed with eusol, and dusted
with a mixture of one part iodoform and two parts boracic or salicylic
acid, or, when the odour of iodoform is objected to, of equal parts of
boracic acid and carbonate of zinc. Immersion of the penis in a bath of
eusol for some hours daily is useful. The sore is then covered with a
piece of gauze kept in position by drawing the prepuce over it, or by a
few turns of a narrow bandage. Sublimed sulphur frequently rubbed into
the sore is recommended by C. H. Mills. If the sores spread in spite of
this, they should be painted with cocaine and then cauterised. When the
glands in the groin are infected, the patient must be confined to bed,
and a dressing impregnated with ichthyol and glycerin (10 per cent.)
applied; the repeated use of a suction bell is of great service.
Harrison recommends aspiration of a bubonic abscess, followed by
injection of 1 in 20 solution of tincture of iodine into the cavity;
this is in turn aspirated, and then 1 or 2 c.c. of the solution injected
and left in. This is repeated as often as the cavity refills. It is
sometimes necessary to let the pus out by one or more small incisions
and continue the use of the suction bell.
_Diagnosis of Primary Syphilis._--In cases in which there is a history
of an incubation period of from three to five weeks, when the sore is
indurated, persistent, and indolent, and attended with bullet-buboes in
the groin, the diagnosis of primary syphilis is not difficult. Owing,
however, to the great importance of instituting treatment at the
earliest possible stage of the infection, an effort should be made to
establish the diagnosis without delay by demonstrating the spirochæte.
Before any antiseptic is applied, the margin of the suspected sore is
rubbed with gauze, and the serum that exudes on pressure is collected
in a capillary tube and sent to a pathologist for microscopical
examination. A better specimen can sometimes be obtained by puncturing
an enlarged lymph gland with a hypodermic needle, injecting a few minims
of sterile saline solution and then aspirating the blood-stained fluid.
The Wassermann test must not be relied upon for diagnosis in the early
stage, as it does not appear until the disease has become generalised
and the secondary manifestations are about to begin. The practice of
waiting in doubtful cases before making a diagnosis until secondary
manifestations appear is to be condemned.
Extra-genital chancres, _e.g._ sores on the fingers of doctors or
nurses, are specially liable to be overlooked, if the possibility of
syphilis is not kept in mind.
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