The treatment of wounds as based on evolutionary laws / by C. Pitfield Mitchell.

  • Mitchell, Charles Pitfield.
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: The treatment of wounds as based on evolutionary laws / by C. Pitfield Mitchell. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    under treatment by liquid dressings is not a controverting fact ; whether cicatricial tissue is formed depends on the rela- tion between the kinds and strengths of the organic actions needed for union, and the kinds and strengths of the actions circumventing the organism. If the organic actions reach the normc, repair may be effected despite improper treatment. So the once common practice of exposing the flaps of a wound to the air finds justification in the recondite principles o physical science.] Bleeding vessels are twisted or compressed.* The sub- stitution of torsion for the ligature has several advantages. With this practice the flap surfaces may be more equably co- adapted, a fertile cause of suppuration and secondary infec- tion is obviated, and, consequently, there is less need for the use of drainage-tubes, which we have seen to be only relatively serviceable. Hemorrhage having ceased, the wound should remain exposed to the air until the surfaces have become glazed with the dried plasma. The edges of the flaps are then brought into perfect coaptation by a sufficient number of metallic sutures, applied without straining or constricting the tissues. The cutaneous surface is again washed and dried, and special care taken not to allozu the cleansing materials to touch the flap borders. Plaster and every kind of chemical dressing applied directly to the skin across the line of union are eschewed, be- cause not called for in practice, and infringing the principle laid down as to the urgency of preserving intact the natural molec- ular organization of the tissues and fluids. When strapping is employed the edges of the flaps must be protected. The wound is now covered with a pad of absorbent cotton enveloped in two or three layers of washed linen of fine text- * “ Up to the end of 1874 we have had two hundred consecutive cases of amputa- tion of the thigh, leg, arm, and fore-arm, in which all the arteries have been twisted (one hundred and ten of them having been of the femoral artery), and no case of secondary hemorrhage—indeed, our house-surgeons never expect to be called to cases of secondary hemorrhage, now that torsion is the general practice of the hos- pital.” Bryant’s Manual of Practical Surgery, 3d American edition, edited by Dr. John B. Roberts, p. 965.