SURGERY. 



SURGERY. 



It is impossible exactly to define the boundary- 

 line between medicine and surgery. Suffice it 

 to say, that surgical diseases generally are those 

 situated in parts of the body accessible to touch 

 and to the direct application of remedies. Sur- 

 gery, therefore, includes the treatment of the 

 various injuries to which our bodies are constantly 

 exposed in the daily occupations of life or from 

 accidental circumstances. Most of those injuries 

 occur when least expected, and when professional 

 assistance is difficult to obtain. We intend, there- 

 fore, to give a few leading directions suitable for 

 cases of emergency not by any means with the 

 view of superseding the legitimate practitioner, 

 but that, in the interval which necessarily must 

 elapse between the occurrence of the accident and 

 the arrival of surgical assistance, the sufferer may 

 be intelligently cared for ; and that the surgeon 

 may not, as too often happens, find his skill of no 

 avail on his arrival, or have to use it to remedy 

 the hurtful effects of ignorant interference. In 

 country-houses, a medicine-chest should be kept, 

 which should contain some laudanum, chloroform, 

 sal-volatile, and quinine ; also some styptics, as 

 gallic acid. In the way of surgical appliances, 

 there should be at hand some adhesive plaster, 

 lint, and simple spermaceti ointment ; also some 

 roller bandages, three inches wide and eight yards 

 long. 



BLEEDING from wounds is either a general 

 oozing from the surface, or from veins, when the 

 blood flows in a continuous stream of a dark 

 colour, or from arteries, when it is of a bright 

 scarlet colour, and issues from the vessel in jerks. 

 If the bleeding be very profuse, and attendance 

 scanty, a tourniquet may be extemporised thus : 

 A handkerchief should be passed a few times round 

 the limb above the wound, and if the situation of 

 the main artery be known, a pretty hard pad should 

 be adjusted over it ; the handkerchief should then 

 be twisted sufficiently tight by means of a stick 

 inserted between two of its turns. 



In an ordinary cut, the best practice is to bring 

 the edges together, and wrap a piece of dry lint 

 round the part. If there be any difficulty in keep- 

 ing the cut surfaces in apposition, strips of plaster 

 should be placed across the wound at intervals, or 

 a few stitches, also at intervals ; at each stitch the 

 thread should be cut, and its ends tied in a com- 

 mon knot : this is called the interrupted suture, 

 and is most commonly in use among surgeons. 

 The best dressing for a healing wound is lint soaked 

 in tepid water, to which a few drops of carbolic 

 acid have been added. If the surface of the 

 wound appears soft and unhealthy, a lotion con- 

 taining one grain of sulphate of zinc to an ounce 

 of water is very useful. 



BURNS AND SCALDS. When heat is applied 

 to the surface of the body, either through a solid 

 or fluid medium, the injuries produced will be 

 almost alike, and their severity in proportion to 

 the temperature. Therefore, the directions for 

 the treatment of scalds will be applicable also to 

 burns. The first object, after the accident has 

 occurred, is to relieve the suffering; and cold 

 obtained by applying either ice or water seems 

 in most cases to have almost a specific power 

 in allaying pain and checking the advance of 



inflammation. In other cases, moderate warmth 

 is found more efficacious, and we must be guided 

 mainly by the sensations of the sufferer as to 

 which of these remedies we make use of. The 

 best local application is the Carron-oil, which 

 derives its name from the famous ironworks, 

 where it has been used for many years. It con- 

 sists of equal parts of olive-oil and lime-water, 

 and should be applied on linen rags or cotton- 

 wool. Blisters may be pricked, and the contained 

 serum allowed to trickle away, but on no account is 

 the raised skin to be removed. The dressings 

 should not be changed oftener than cleanliness 

 requires ; and as each portion of the old dressing 

 is removed, it must at once be replaced with 

 fresh, so that as little exposure as possible of the 

 burnt surface may take place. Great care must 

 be taken, in the treatment of a sore resulting from 

 a burn, that the contraction of the scar does not 

 cause distortion of the neighbouring parts. 



When the clothes catch fire, the person should 

 lie down on the floor, and roll herself, or be rolled, 

 in the rug, table-cover, or anything sufficiently 

 voluminous to stifle the flames ; and afterwards 

 the clothes, especially stockings, should be re- 

 moved with great care, lest the cuticle should 

 separate with them, which would materially in- 

 crease the sufferings of the patient 



SPRAINS. The ends of bones entering into 

 the formation of joints are covered with smooth 

 gristle or cartilage, so that their motions upon 

 each other may be smooth and unimpeded ; and 

 to insure this object, they have between them a 

 bag of a thin tissue, called synovial membrane, 

 which secretes a fluid to lubricate the cartilaginous 

 surfaces. They are bound to each other by strong 

 white fibrous tissue, adjusted so as to keep those 

 surfaces in their proper relations to each other, 

 without impeding their movements. These fibrous 

 bands are the ligaments. A sprain consists in a 

 wrench or strain of these ligaments. The synovial 

 membrane which is in contact with them partici- 

 pates in the injury, and immediately innan 

 pours its fluid into the joint, causing swelling ; 

 which, confined by the surrounding fibrous struc- 

 tures, gives rise to great pain and constitutional 

 disturbance. These symptoms vary in proportion 

 to the severity of the injury. Rest and fomenta- 

 tions of hot water to the joint are required. 



DISLOCATIONS. When the surfaces of the 

 bones forming a joint are displaced, and have no 

 longer their proper relations to each other, we 

 have a dislocation. The appearance of the joint 

 is altered, its movements limited, and there is 

 intense pain. The displacement may be partial 

 or complete ; it may be obvious to the most 

 ignorant observer, or so obscure as to puzzle the 

 most experienced surgeon. Soon after the occur- 

 rence of the injury, swelling takes place, accom- 

 panied by an increase of pain, and the constitu- 

 tional symptoms of inflammation soon make their 

 appearance. After the swelling has come on, it is 

 generally very difficult to detect the nature of the 

 injury, as the prominent points of bone can no 

 longer be traced ; therefore, the sooner the surgeon 

 is summoned the better, as the future usefulness 

 of the limb will depend upon his treatment of it ; 

 and if dislocation has taken place, the longer it* 

 reduction is delayed, the more difficult will it be. 



FRACTURES. These are of three kinds simpl** 

 when the bone is broken ; compound, when it is 



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