A manual of the practice of surgery / by W. Fairlie Clarke.

  • Clarke, W. Fairlie (William Fairlie), 1833-1884.
Date:
1879
Catalogue details

Licence: Public Domain Mark

Credit: A manual of the practice of surgery / by W. Fairlie Clarke. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    brought on by wringing clothes, and using heavy irons. Both wrists were similarly affected, and both the flexor and extensor tendons were involved. Treatment.—A simiyle ganglion may frequently be ruptured by pres- sure or by a smart blow, and then the contained fluid is absorbed. Or it may be painted with tincture of iodine, or smeared with a mercurial oint- ment, or with an ointment composed of equal parts of ung. hydrarg. and ung. iodi, or blistered. While any of these measures are being adojjted it should be firmly bandaged so as to promote absorption, and fixed upon a splint, so that it may have perfect rest. If these means fail, the tumor may be punctured by a subcutaneous valvular incision, the contents let out into the surrounding tissues, and pressure again applied. Or the tincture of iodine may be injected, or the lining membrane scarified so as to set up adhesive inflammation. Or a couple of silk threads may be passed through it, as a seton; or it may be laid open and allowed to heal from the bottom; or, as a last resource, the cyst may be dissected out. The compound ganglion is a more severe affection, and will generally be found very obstinate. It must be treated on the same principles as the simple variety. The effect of rest, pressure, and counter-irritation must be patiently tried. If these means fail a seton may be introduced, or tincture of iodine injected, or the cavity laid freely open. But opera- tive measures must not be undertaken without great caution. If diffuse suppuration should occur in the sheath of the tendon, the most serious consequences might ensue. TENOSYNOVITIS. Sometimes the sheaths of tendons become acutely inflamed {tenosy- novitis). Such inflammation is generally caused by sprains, or by the violence which gives rise to dislocations. In addition to other symptoms of inflammation—heat, pain, tender- ness, loss of power—there is more or less swelling along the course of the tendon, arising from effusion into the sheath. When the surgeon examines the part a peculiar creaking sensation is communicated to his hand. This creaking of effusion has sometimes to be carefully distinguished from the crepitus of broken hone. Treatment.—The local treatment of acute inflammation of tendinous sheaths consists in rest, fomentations, leeches, and blisters. If the disease becomes chronic it must be dealt with as a compound ganglion. INFLAMMATION OF BUPtS^. Bursje may become acutely inflamed from external violence, irritation,, or undue pressure. The bursa over the patella is that which is most often affected in this way, constituting what is known as housemaid''s knee (Fig. 33). The bursa enlarges. There is excessive secretion, and the secreted fluid is apt to become purulent. The tumor is elastic, very painful and tender to the touch. The skin is hot, red, and (Dedematous. With this there is generally pyrexia—a quick pulse, a white-coated tongue, and constipation. Treatment.—The patient should have a light, unstimulating diet, and: 6