The principles and practice of gynaecology / by Thomas Addis Emmet.

  • Emmet, Thomas Addis, 1828-1919.
Date:
1880
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Licence: Public Domain Mark

Credit: The principles and practice of gynaecology / by Thomas Addis Emmet. 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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    Manchester, advises that no solid food be given until the patient asks for it. At any time after the first twenty-four hours, and within a week from the time of the operation, there may be an elevation of tempera- ture and an increase of pulse. Following these, if the progress is unfavorable, there may occur vomiting, pain over the abdomen, and tympanites, and later, diarrhoea of a most offensive character. These are the initial symptoms of peritonitis, and they may be followed in a short time by symptoms of septicaemia, and, later, of pyaemia. It is a question yet to be settled, whether septicaemia is not at the bottom of this unfavorable change. A certain amount of bloody and serous oozing always takes place when adhesions are broken up during the operation. Frequently this is promptly absorbed without producing the slightest disturbance ; but, under some unknown circumstances, it is absorbed very slowly, and in a few hours may undergo septic changes, and poison the whole mass of the blood. To secure the safe removal of this oozed fluid, and to keep down the patient's tempe- rature, is one of the problems of this branch of surgery. The reduc- tion of temperature does not insure the removal of the blood poison, but it renders the condition of the patient less critical. The higher the temperature above the normal, the greater will be the tissue waste, and the more seriously will the action of the kidneys and other excre- tory organs be impaired, even to the extent of total arrest, and of course, death. An increased action of the kidneys, skin, and other excretory organs is essential when blood-poisoning exists. A reduc- tion of the temperature to the normal (that is, when it is not brought about by exhaustion) favors functional activity, and secures a more rapid elimination of septic material, and affords time for the institution of remedial measures. Among the so-called antipyretics quinine is the only one which is worthy of confidence. In hospital practice it is advisable to prepare the patient by getting her moderately under the influence of this agent several days before the operation. This may be kept up after- wards by the daily use in small quantities; but should the necessity occur, from an elevation of temperature, the quinine must be then given in large doses to produce a marked effect. When the stomach is in too irritable a condition to retain it, the quinine in solution may sometimes be administered with advantage by means of the hypo- dermic syringe. The rectum should also be employed, under the circumstances, but the absorbing power of its mucous membrane is too slight to enable us to expect great results from the introduction