The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
So far as concerns the character of the wound, which is most likely
to be followed by septicemia, there is but little to be said. Wounds
made by infected tools, the butcher’s knife, the anatomist’s scalpel,
etc., are the most dangerous. All forms of phlegmonous erysipelas,
many cases of gangrene following frostbite, nearly all instances of
traumatic gangrene, most cases of carbuncle, and, in fact, all similar
lesions, are likely to be followed by septicemia. The so-called
spontaneous cases have an equally infectious origin, though one which
is concealed. In unrecognized instances of appendicitis, for instance,
and in many other conditions, although the path of infection may not be
easily traced, it is, nevertheless, always present, and can be found
if diligent search is made. The nasal cavity, the tonsils, the teeth,
the middle ear, the deep urethra, and the rectum are often overlooked
as offering possibilities for septic infection which may follow this
general type.
=Treatment.=--This should be both local and general. Local treatment
should consist in complete and absolute removal of the active cause.
This comprises the reopening of wounds, evacuation of clot, cutting or
scraping away of sloughs and gangrenous tissue, with cauterization of
the exposed living tissue, in order that absorption may be prevented,
and will often include amputation or extirpation of a part. For
tissues which are not too completely riddled by disease, and lost
beyond possibility of redemption, _continuous immersion in hot water_
offers the best possible prospect. By it putrefaction seems checked,
the separation of dead from living tissues is accelerated, relief of
pain or discomfort is afforded, and disinfection of material which is
foul and infectious is guaranteed. An excellent local application is
the mixture of resorcin 5 parts, ichthyol 10 parts, ung. hydrarg. 40
parts, and lanolin 45 parts, already mentioned in Chapter IV, or the
application of _brewers’ yeast_. (See chapter on Ulcers.) Of great
value also will be found the silver ointment of Credé (_Unguentum
Credé_). This permits of absorption of silver through the unbroken skin
(as in the case of ung. hydrarg.), and the dissemination throughout
the system of the antiseptic virtues of the silver itself. To ensure
its greatest efficiency this ointment should be thoroughly rubbed
in, especially over parts which are not too tender. Many cases of
septic infection promptly yield under the influence of the argentine
preparations which Credé has lately introduced.
In suitable cases also the subcutaneous injections of
_antistreptococcic serum_ will be followed by beneficial effects. The
earlier the injection is given the better the prospect of benefit.
Evidence is strongly in favor of this serum as a prophylactic measure,
especially before operations, when septic pneumonia or other septic
accidents are feared.
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