Manual of Surgery Volume First: General Surgery. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume First: General Surgery. Sixth Edition.
Thomson, Alexis
Surgery
_General Treatment._--The patient should be kept at rest, preferably in
bed, to diminish the general tissue waste; and the diet should be
restricted to fluids, such as milk, beef-tea, meat juices or gruel, and
these may be rendered more easily assimilable by artificial digestion if
necessary. To counteract the general effect of toxins absorbed into
the circulation, specific antitoxic sera are employed in certain forms
of infection, such as diphtheria, streptococcal septicæmia, and tetanus.
In other forms of infection, vaccines are employed to increase the
opsonic power of the blood. When such means are not available, the
circulating toxins may to some extent be diluted by giving plenty of
bland fluids by the mouth or normal salt solution by the rectum.
The elimination of the toxins is promoted by securing free action of the
emunctories. A saline purge, such as half an ounce of sulphate of
magnesium in a small quantity of water, ensures a free evacuation of the
bowels. The kidneys are flushed by such diluent drinks as equal parts of
milk and lime water, or milk with a dram of liquor calcis saccharatus
added to each tumblerful. Barley-water and "Imperial drink," which
consists of a dram and a half of cream of tartar added to a pint of
boiling water and sweetened with sugar after cooling, are also useful
and non-irritating diuretics. The skin may be stimulated by Dover's
powder (10 grains) or liquor ammoniæ acetatis in three-dram doses every
four hours.
Various drugs administered internally, such as quinine, salol,
salicylate of iron, and others, have a reputation, more or less
deserved, as internal antiseptics.
Weakness of the heart, as indicated by the condition of the pulse, is
treated by the use of such drugs as digitalis, strophanthus, or
strychnin, according to circumstances.
Gastro-intestinal disturbances are met by ordinary medical means.
Vomiting, for example, can sometimes be checked by effervescing drinks,
such as citrate of caffein, or by dilute hydrocyanic acid and bismuth.
In severe cases, and especially when the vomited matter resembles
coffee-grounds from admixture with altered blood--the so-called
post-operative hæmatemesis--the best means of arresting the vomiting is
by washing out the stomach. Thirst is relieved by rectal injections of
saline solution. The introduction of saline solution into the veins or
by the rectum is also useful in diluting and hastening the elimination
of circulating toxins.
In surgical inflammations, as a rule, nothing is gained by lowering the
temperature, unless at the same time the cause is removed. When severe
or prolonged pyrexia becomes a source of danger, the use of hot or cold
sponging, or even the cold bath, is preferable to the administration of
drugs.
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