Manual of Surgery Volume First: General Surgery. Sixth Edition. — John Shaqi
Manual of Surgery Volume First: General Surgery. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume First: General Surgery. Sixth Edition.
Thomson, Alexis
Surgery
The ideal means of helping the tissues is by removing the focus of
infection, and when this can be done, as for example in a carbuncle or
an anthrax pustule, the infected area may be completely excised. When
the focus is not sufficiently limited to admit of this, the infected
tissue may be scraped away with the sharp spoon, or destroyed by
caustics or by the actual cautery. If this is inadvisable, the organisms
may be attacked by strong antiseptics, such as pure carbolic acid.
Moist dressings favour the removal of bacteria by promoting the escape
of the inflammatory exudate, in which they are washed out.
#Artificial Hyperæmia.#--When such direct means as the above are
impracticable, much can be done to aid the tissues in their struggle by
improving the condition of the circulation in the inflamed area, so as
to ensure that a plentiful supply of fresh arterial blood reaches it.
The beneficial effects of _hot fomentations and poultices_ depend on
their causing a dilatation of the vessels, and so inducing a hyperæmia
in the affected area. It has been shown experimentally that repeated,
short applications of moist heat (not exceeding 106° F.) are more
efficacious than continuous application. It is now believed that the
so-called _counter-irritants_--mustard, iodine, cantharides, actual
cautery--act in the same way; and the method of treating erysipelas by
applying a strong solution of iodine around the affected area is based
on the same principle.
[Illustration: FIG. 6.--Passive Hyperæmia of Hand and Forearm induced by
Bier's Bandage.]
While these and similar methods have long been employed in the treatment
of inflammatory conditions, it is only within comparatively recent years
that their mode of action has been properly understood, and to August
Bier belongs the credit of having put the treatment of inflammation on a
scientific and rational basis. Recognising the "beneficent intention" of
the inflammatory reaction, and the protective action of the leucocytosis
which accompanies the hyperæmic stages of the process, Bier was led to
study the effects of increasing the hyperæmia by artificial means. As a
result of his observations, he has formulated a method of treatment
which consists in inducing an artificial hyperæmia in the inflamed area,
either by obstructing the venous return from the part (_passive
hyperæmia_), or by stimulating the arterial flow through it (_active
hyperæmia_).
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