The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
=Treatment.=--Here, as in all other instances, the first effort of the
surgeon should be to remove the cause. This may be done by _local_, or
may require _constitutional_ measures. If a definite local cause can be
established, its removal may be a slight or may entail a more or less
serious surgical operation. Aside from this disposal of the exciting
agent, treatment should be divided into the general and the local.
General treatment is scarcely called for when dealing with healthy
ulcers; but in all those instances where the constitutional condition
of the patient is below par, or where there is a general poisoning
or infection underlying the ulcer itself, prompt and energetic
constitutional treatment should be at once instituted. In scurvy, for
instance, the diet and hygienic surroundings of the patient should
be rectified immediately. In syphilis no lasting nor deep impression
can be made on local manifestations without general constitutional
treatment. In tuberculosis and the other surgical infections much will
be accomplished by internal medication, by proper hygiene, as well as
by local applications or operation. The importance of these general
measures is likely to be underestimated, and many fail to realize the
advantage of combining suitable internal and external therapeutic
measures.
=Local Treatment.=--First of all may be mentioned the insistence upon
repose which induces _physiological rest_. The ulcer may then show a
tendency to heal. This may necessitate wearing a splint or restraining
apparatus, or confinement in bed, depending upon the location of the
ulcer. Physiological rest will be enforced sometimes by stretching a
sphincter in order to temporarily paralyze it in cases of irritable
rectal ulcer, where the principal pain is produced by the reflex spasm
of its fibers. Again, the eye with irritable ulcer of the cornea is
sometimes kept so tightly closed by the same kind of spasm there that
it may be necessary to divide the lids, or the orbicularis muscle at
the angle of the lids, in order to make access to the part. This is
carrying out the principle of physiological rest, because it permits
proper exposure and treatment.
The healthy and healing ulcer needs no treatment except protection.
Epithelial covering will probably keep pace with filling of the
depression by granulations, and all that is necessary to do is to
prevent external irritation. Should there be excess of discharge, the
simplest absorbent dressing, with enough antiseptic material to prevent
putrefaction by contamination with the bacteria of the surrounding
air, should be employed. The ulcer which is becoming tardy in its
repair may be stimulated by silver nitrate, zinc chloride, or other
caustic applications, which act as a spur to the sluggish granulations,
destroying those with which it comes in contact, but stimulating those
below to do their duty more promptly.
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