Elements of Surgery

by Robert Liston

It is seldom that local abstraction of blood is at all required, and its employment in cases of morbus coxarius in weak constitutions, which it generally seizes upon, is very questionable. Neither is counter-irritation called for; and it is only in extreme cases, when the suffering is intense, that small blisters over the fore part of the joint, or a slight drain in that situation, or behind the trochanter, is admissible. The nitrate of silver rubbed on the surface causes vesication and discharge; and its early repetition is often followed by good effects. The tincture of iodine, or a liniment containing sulphuric acid, may sometimes be applied with the same view. There is no doubt whatever, that much of the benefit that attends upon counter-irritation, both in the human body and in the lower animals, is to be attributed to the rest that is at the same time enjoined, and often indispensable. It is thus that the firing and blistering of horses does good in the majority of the diseases of tendons, bursæ, bones, and joints. In some instances, it may be necessary to have recourse to soothing applications, as fomentations to affected joints, and to employ general antiphlogistic means suited to the age, strength, and constitution of the patient. In the greater number of cases in young subjects, after the stomach and bowels are unloaded, the system must be supported by tonics and nutritious food; none are more beneficial than the preparations of iron.

When the occurrence of anchylosis affords the only hope, this process ought to be encouraged by rest, and the limb at the same time kept in that position which will be most useful in after life; this will be effected here also by the employment of splints.

In cases of disease of the knee, ankle, elbow, or wrist joints, notwithstanding everything that can be done, the disease often runs its course, abscesses form and give way, the patient’s health declines, and he becomes emaciated and hectic. In such cases amputation, when not contraindicated by internal disease, must be had recourse to, as the only remedy. In some few instances, the excision of the diseased extremities of the bones may supersede this operation; but this will be discussed in a future part of the work. Every circumstance must be well weighed before mutilation be resorted to; and there can be little doubt that thousands of limbs have been saved by the employment of the means above mentioned, which would have been otherwise doomed to amputation.

Hydrops articuli will in general be got rid of by the use of friction, either dry or with liniments; by stimulating plasters or by blisters; and by the proper application of bandages. Mercurial ointments are used in this affection, and often with very great benefit. Electricity has been recommended.[10]

In neuralgic affections of joints, it is clear that the symptoms are to be combated by general and not by local means, at least of a severe nature. The patient must be amused and occupied, exercise in the open air must be enjoined, and attention paid to diet. The state of the digestive organs and secretions should be looked to, and corrected if need be. Medicines directed to the regulation of the functions of the uterus are essential in the majority of cases. When there is reason to suspect the lodgement of sordes or worms in the intestinal canal of children so affected, the balsam of copaiba, in doses of Ʒss., or more, on an empty stomach, followed, if need be, by brisk purgatives, will be found to answer admirably. Tonics, such as preparations of iron, of quina, &c., are then given with advantage: many apparently bad cases yield at once to such treatment.

As local applications, anodynes, fomentations, or cold lotions are employed, according to circumstances. Frictions with gently stimulating liniments, belladonna, veratria, &c., may be used as occasion demands. The patient must be encouraged to use the affected limb as much as possible; and the use of all severe and heroic remedies, as bleeding, blistering, counter-irritation, setons, issues, or moxas, discountenanced.

OF INFLAMMATION OF BONE, AND DISEASES THENCE ARISING.

Bones grow and are nourished by the same means, and are subject to the same laws, with other parts of the system. Like all the tissues of a white colour, particularly when their growth is completed, they are less freely supplied with bloodvessels and nerves than other parts. When incited action of the bloodvessels occurs in the harder textures, sensibility is roused to an exquisite degree, and the healthy and perverted processes often advance with great vigour and amazing rapidity.