In the case of children, he mentions various complaints, such as distortion of the eyes, tubercles about the neck, pain in the bowels, omental hernia, etc., which, upon inquiry, will be found to be the consequences of an attack of epilepsy.
The judgment to be formed in the case of ulcers is to be founded on the age of the patient, the situation of the sore, and its appearance.
Strumous tubercles, which end in suppuration, occur most frequently in young persons. Adults are subject to bad favi, internal cancers, and herpetic sores, after epinyetis, until they pass sixty. Old persons are subject to cancers, both deep-seated and superficial, which never leave them. They are particularly intractable when seated in the armpits, the loins, and the thighs.
Of affections of the joints, the most dangerous are those seated in the thumb and great toe. When there is a chronic sore on the side of the tongue the surgeon should examine whether it be not occasioned by the sharp edge of a tooth.[523]
The most dangerous wounds are those which implicate the large veins (blood-vessels), in the neck and groin; then those of the brain and liver; next, those of the bowels and bladder. These cases are all dangerous, but not uniformly fatal, as some suppose. Much depends upon constitution, as to liability to fever and inflammation after a wound. Sometimes, also, the wounds of smaller vessels prove fatal by inducing hemorrhage, fever, or delirium. In all recent wounds, however, the physician should endeavor to afford assistance.
Of spreading ulcers, the most fatal are such mortifications as are very deep, black, and dry; and those are bad and dangerous which are accompanied with a black ichorous discharge. Those which are white and mucous are less dangerous, but are more subject to relapse, and become inveterate. Herpes is the least dangerous of the spreading sores, but is most difficult to remove about deep-seated cancers.[524] An ephemeral fever, with very white and thick pus, is beneficial in such a case; also, sphacelus of a nerve, of a bone, or of both, in deep-seated and black mortifications. For a free discharge of pus takes place and carries off the mortification.
The prognostics in wounds of the head are given in nearly the same terms as laid down in the treatise on that subject, and therefore I need not enter minutely into an exposition of what is stated regarding them here. Those in the upper part of the head, more especially if they implicate a suture, are said to be particularly dangerous. The author directs the surgeon to inquire whether, at the time of the accident, the patient fell down or became comatose, as in this case greater danger is to be apprehended.
Large wounds of the joints, if they involve the connecting nerves, necessarily leave the limb maimed. Several other observations connected with these injuries are added, of which one of the most important is the direction to practice flexion and extension of the limb, frequently, with the view, no doubt, of preventing rigidity of the joint.
Large excisions in the arm becoming inflamed end in suppurations, which require to be evacuated by the knife or cautery. Injuries of the spinal marrow, whether from disease or accident, are attended with loss of motion and sensibility, retention of the alvine and urinary discharges; but, after a time, involuntary evacuations take place, which are soon followed by death. When the throat is frequently filled with blood, and there is no headache or cough, nor any other morbid symptoms, the physician should examine whether there be not an ulcer or a leech in the part.
With regard to the eyes, the prognostics are given with so much prolixity of detail that I must be content with a brief abstract of them. Much attention is paid to the characters of the discharge from the eyes in diseases of them, namely, of the glutinous matter and tears; thus, if the gum be white and soft, the tears mixed with it not very hot, and the swelling light and loose, under these circumstances the eyelids are glued up during the night, so that the eye is free of pain, and thus the disease is without danger, and of short duration. The other appearances of the eye, and the discharges, are also minutely given. When the discharge is green or livid, the tears copious and hot, a burning heat in the head, and pains darting through the head to the eye, there must necessarily be ulceration in the eye; and there is much reason to apprehend that it will burst. If, when one can get a sight of the eye, it should be found burst, and the pupil projecting above the rupture, it is bad and difficult to restore; and, if there be sloughing, the eye will be wholly useless. According to the form and depth of the ulcers must be the subsequent cicatrices. These are minutely described according to their different varieties. Mention is also made of the prognostics from the eyes in fevers, as described by the author in another work. It is most likely that allusion is here made to the first book of “Prorrhetics.” In conclusion, the surgeon is directed to pay great attention to the state of the urine in diseases of the eyes.