The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
=Treatment.=--Danger comes from two sources--_septic intoxication_ and
_local phlegmons_ or gangrenous destruction. Each is therefore to be
combated. Treatment should consist of isolation. There is _no specific
internal treatment_ for this disease. Tincture of iron, which was long
vaunted as such, has proved unsatisfactory, and is of benefit only as
a supporting measure in a limited class of cases. _Constitutional_
measures should be employed: First, for the purpose of maintaining
_free excretion_ by bowels and kidneys; second, for the purpose of
_supporting_ and maintaining strength; third, for tonic and _stimulant_
measures in prostrated and debilitated patients; and, fourth, for the
purpose of _combating intestinal sepsis or intoxication_ from any other
source. The robust patients with this disease need no particular tonic.
The aged, the enfeebled, the dissipated, the prostrated individuals,
and the confirmed alcoholics are those who need vigorous stimulation,
partly by alcohol and quinine, and partly by strychnine, preferably
given hypodermically, and by the other diffusible stimulants by which
they may be kept alive. Pilocarpine, given subcutaneously and pushed
to the physiological limit, has been praised by some. If along with
prostration there occur restlessness and delirium, then anodynes and
hypnotics are serviceable, and should be administered to meet the
indication--morphine hypodermically and any of the agents which produce
sleep are now most beneficial. Finally, if there is any drug which
can be administered in doses sufficient to saturate the system with
an antiseptic which shall at the same time not prove fatal because
of toxicity, this is the ideal medicament for constitutional use
only. Such a drug is not known, but it will be well to give some near
approach to it internally, as by administering corrosive sublimate,
salol, naphthalin, or something else of this character in doses as
large as can be tolerated.
Should patients become violent it may be necessary to resort to
_mechanical restraint_--a strait-jacket, a restraining sheet, a
camisole, etc.
_Nourishment_ must be kept up by the administration of the easily
assimilable and predigested foods.
_Locally_ the number of remedies that have been resorted to is legion.
In a mild case of spontaneous erysipelas--_i. e._, where no infection
can be traced--it will sometimes be sufficient to put on a soothing
application, like a lead-and-opium wash. It often gives relief to have
the part protected from air contact, which may be done by a soothing
ointment or by dusting the part with a powder, such as bismuth oleate
or subnitrate, zinc oxide, etc., these being rubbed up with powdered
starch; or by a film of rubber tissue or of oiled silk. Brewers’ yeast
applied on compresses and covered with oiled silk is efficacious.
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