The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
The conventional applications to ulcers fall usually under two
categories--the _watery solutions_ and the _unguents_.
[Illustration: FIG. 13
Cicatricial deformity following specific ulcer. (Original.)]
Investigations in the laboratory have led to the employment of
peptonized preparations, among which are peptonized cod-liver oil and
some of the partially or predigested foods, such as _bovinine_, etc.
These appear to have the power of digesting sloughs and of causing a
speedy separation or disposal of everything necessary in the endeavor
to secure a healthy condition of the ulcerating surface and give most
satisfactory results. When sloughs are present it is an advantage to
dust over them papoid, caroid, etc., which have the power of catalytic
disposition of decomposing material without reference to the action of
bacteria. Under their use there seems to be a solution and disposition
of these dead products. With a foul ulcer--one from which the discharge
is more or less offensive, due usually to decomposition of sloughing
masses, not yet separated--the method of _continuous immersion in hot
water_, when it can be performed, is always valuable. But nothing
seems to equal _brewers’ yeast_ for this purpose. It may be applied on
absorbent cotton (which should be soaked in it) and covered with oiled
silk. Its curative property may be ascribed to the nuclein which it
contains in a nascent state. It will, when fresh, clean off a sloughing
surface better than anything I ever used.
Many ulcers are surrounded with such firm, indurated borders that it
seems impossible that any active regenerative process can arise from
such source. Hence, incisions have been practised for centuries. These
have been made radially from the centre or have been made parallel to
the margin of the ulcer, or sometimes the firm, dense tissues have
been minced or chopped by a series of cross-cut stabs or incisions;
as the result of which renewed activity has arisen, and an impetus
given to the healing process. These methods, however, have yielded
to that alluded to above. The ulcer in which granulation has come to
a standstill is often treated with the _sharp spoon_ or _curette_.
The result of this has been to provoke again a speedy renewal of
granulation efforts, and treatment by curetting is standard and
often useful. Actual cauterization of the ulcer with a view to such
complete destruction of its covering and border as shall lead to their
separation by the sloughing process is occasionally practised. This
is perhaps best performed with the actual cautery. It lacks, however,
the valuable features of the operative method, to be described below.
Modern methods have made it plain that it is often an absolute waste
of valuable time to resort to the older expedients of stimulation,
incising the edges, etc., and that one can accomplish by an operation
in perhaps three weeks what ten times that length of time would fail
to do by older methods.
Public-domain text, read in full here on John Shaqi.
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