Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
+Treatment.+ The treatment of phlebitis may be classified into
preventive and curative, the latter being subdivided into (_a_),
general or symptomatic, and (_b_), local or surgical.
The preventive treatment is summed up in the word asepsis. The
influence of asepsis in the management of wounds has completely
revolutionized surgical practice, and the old fatal types of pyemia
and septicema have now practically vanished.
Septic and pyogenic phlebitis still remain as consequences of
accidental wound contaminations and as a penalty for the neglect of
surgical cleanliness.
Prophylatic measures, by the use of internal remedies which diminish
the coagulability of the blood, such as Wright’s citric acid
treatment, are recommended for the prevention of thrombosis.
Antitoxins have not proven to be of benefit in this condition.
The curative treatment may be symptomatic, local, constitutional, or
surgical. The constitutional treatment is directed to the general
cause, if possible, as in the gouty, rheumatic, syphilitic, and
chloritic cases; beyond this, there is no specific treatment. The
antistreptococcal and staphylococcal sera are usually prescribed in
the septic forms, but thus far, more as a forlorn hope than with the
expectation of accomplishing any definite results. The symptomatic
treatment, on the other hand, is always indicated to diminish pain, to
support and strengthen the circulation, and to favor elimination. The
main reliance is to be placed upon the local treatment, combined with
good nursing, appropriate food, and moderate stimulation.
The local treatment is summed up in the following indications: (_a_),
immobilization and absolute rest of the affected limb; (_b_), elevated
position of the foot of the bed or of the limb to favor the drainage
of the venous current toward the trunk. The limb should be covered
with cotton batting and bandaged, over a gutter-splint of cardboard,
extending from the foot to the thigh, to immobilize the knee. In the
superficial inflammations, with much redness and heat, an even layer
of any of the kaolin mixtures may be applied between thin layers of
gauze, like an antiseptic poultice, over the entire extremity, and
especially over the inflamed parts. A saturated watery solution of 25
per cent. ichthyol, painted over the entire surface will also prove
decidedly beneficial in cases complicated with lymphangitis. Unguentum
Crede, mercurial ointment, and the so-called resolvent lotions have
been tried, but none of these can compare in their beneficial effect
with kaolin poultices, with or without ichthyol, or the liberal
application of broad compresses, thoroughly saturated with a weak lead
and opium lotion, which latter acts not only as a local astringent,
but as a marked sedative. Immobilization and rest should be maintained
for a month or more.
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