Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
At present the therapeutic use of the X-ray is rightly falling into
the hands of the dermatologist and the medical clinician. In surgery,
outside of the conditions mentioned above, its use is limited to
lupus, keloid, epithelioma, sarcoma and carcinoma, both before and
after operation.
CHAPTER XIX
+DRESSINGS AND BANDAGING; SOLUTIONS AND OINTMENTS; SKIN GRAFTING+
+DRESSINGS+
+Dressings.+ These may be either dry or wet.
_Dry dressings_ consist of gauze and bandage or of cotton and
collodion (the cocoon dressing.)
The most convenient form in which sterile gauze can be obtained is in
small squares in individual envelopes. Large packages are contaminated
with the first opening and are inconvenient.
The cocoon dressing is occlusive and should never be applied over an
infected area. It is applicable to sensitive areas for protection, and
to operated areas not liable to infection.
Protective varnishes, such as collodion, compound tincture of benzoin,
or pure ichthyol, are useful where little protection is indicated.
_Wet dressings._ Two distinct therapeutic actions may be derived from
the wet compress, depending upon whether or not an impervious covering
is employed. These actions are _antiphlogistic_ and _hyperemic_, and
these in turn may be either _antiseptic_ or _astringent_. The wet
dressing, without a covering, is cleansing and heat reducing, because
of evaporation. There should be frequent replenishment of the solution
in the treatment of any infected wound or where it is desirable to
reduce inflammation.
A wet dressing with an impervious covering is contraindicated in the
presence of pus, the warmth and moisture of such a dressing being
congenial to the growth and to the multiplication of bacteria.
It is evident, therefore, that a wet dressing with an impervious
covering can safely be employed only in conditions where the skin is
unbroken, such as sprains and bruises.
The two general therapeutic actions, aside from those of causing
hyperemia, are antiseptic and astringent. For the relief of pain and
for the reduction of inflammation, wet dressings are the most
effective form of treatment because (1) they are aseptic; (2) they
permit free drainage; (3) no new granulations are disturbed in
changing the dressing.
A great many different solutions are used and among these are:
1. sterile water;
2. ordinary saline solution (a teaspoonful of salt to a pint
of water);
3. saturated solution of boric acid (prepared by dissolving a
teaspoonful of boric acid powder in a pint of water);
4. Thiersch’s solution (prepared by dissolving 15 grains of
salicylic acid and 90 grains of boric acid in a pint of
water);
5. Burow’s solution (a solution of aluminium acetate prepared
by dissolving 675 grains of alum and 270 grains of lead
acetate in a pint of water.U.S.P. formula);
6. solution of bichloride of mercury (varying in strength from
1 to 3000, to 1 to 10000);
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