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

  • Clarke, W. Fairlie (William Fairlie), 1833-1884.
Date:
[1882], ©1882
Catalogue details

Licence: Public Domain Mark

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

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    stimulants should be given with caution, because it is hazardous to overstrain the diseased vessels. Question of amputation.—A question often arises whether we should resort to amputation in gangrene, and, if so, at what period of the disease. Upon this point the special circumstances of each case must go far to form our opinion. The general rule, how- ever, may be stated thus :—In gangrene resulting from a local cause—as au accident, ligature, or embolism—an amputation may be undertaken as soon as the discoloration of the tissues has indicated the extent of the affected part. But in the state of spontaneous gangrene it is well to wait for a decided line of de- marcation, and then to content ourselves with dividing the hard tissues and shaping the stump, ratlier than to perform a complete amputation. If the gangrene, though beginning in a local cause, shows a tendency to spread indefinitely, it should be treated as a case of spontaneous mortification, and no operation should be undertaken until a well-marked line of demarcation has declared itself. PROCESSES OF REPAIR. We may here conveniently consider the processes of repair. They are— (1) Immediate union.—This only occurs in slight and clean- cut wounds. When the oozing of blood has ceased, and the sur- faces have been brought into accurate apposition, they become directly incorporated with one another. In such a case there is no inflammation and no appreciable uniting medium. Even if a small part of the body, such as the point of a finger, is entirely cut off, the surgeon need not despair of union taking place. Though we have no Balsam of Fierabras—of which Don Quixote says he had the receipt in his head—and cannot promise that if a man were cut in two, stuck neatly together, and took two draughts of the Balsam, he would immediately become whole and sound as an apple (ch. x.), yet many cases are on record in which a small portion, after having been completely separated, has been replaced, and has united and grown as if it had only been partially, and not entirely, removed. (2) Z'nion hy adhesion—union by the first intention—can only take place between surfaces which are in apposition, and in persons whose general health is pretty good. It is attended with some degree of inflammation, enough to produce a layer of plastic material between the opposed surfaces. By this means they are glued together. There is union by adhesion. Gradually the layer of lymph becomes organized and assimilated to the adjacent tissues.