4 * 



Sl'RGERY. 



any great cavity, such us the thorax or abdomen, 

 and when there may occur an opening for the ad- 

 mission of air into those cavities, a small incision 

 is always to be performed. 



Abscesses are likewise opened by the applica- 

 tion of caustic. This is the most agreeable mode 

 to timid patients, as the caustic acts slowly, but 

 produces a long continued pain, while the pain of 

 incision instantly gives off. There is another ob- 

 jection against this mode, that all active caustic 

 diffuse their operation over a greater surface, or in 

 other words, destroy a greater portion of the in- 

 teguments than is necessary, and ultimately this 

 method inflicts greater pain and nervous irritation 

 than incision. 



The opening of an abscess by seton or issue, is 

 sometimes necessary, as by this means a drain is 

 established, and a gradual vent given to the matter. 

 A needle of a flat, spear-pointed shape, threaded 

 with glovers' silk or beat thread, is to be introduced 

 through the lower part of the abscess, and ac- 

 cording to the size of the abscess, is to be the 

 thickness of the thread; or a blunt silver probe, 

 with an eye and thread, may be used, and an inci- 

 sion made at its entrance and exit. When the 

 needle or probe has been passed through the tumour, 

 the needle may be withdrawn, and a portion of the 

 thread or cord left at each end. In about thirty- 

 six or forty hours after this cord or thread has been 

 introduced, it may be drawn out as far as to allow 

 all the part that was within the cavity to be cut 

 off, and the same is to be done daily until the matter 

 is completely evacuated. Thus a regular and slow 

 discharge of the matter is procured, the sides of the 

 abscess gradually contract, and at last adhere firmly 

 to one another by the slight inflammation kept by 

 the thread or cord of the seton needle. (See Plate 

 87, fig. 10.) A loop ought, as in all other cases of 

 issue, to be left, that is, the cord must be doubled, 

 so as to draw in the bught, as a sailor would term it, 

 of a new and clean cord, and this may be gradually 

 diminished in size, so that the cord may be in this 

 manner withdrawn, without any unpleasant or dis- 

 agreeable effects. There are many tumours, espe- 

 cially those of a scrofulous character, in which 

 this mode of operating may be employed with de- 

 cided advantage. 



The next operation in domestic surgery is one of 

 almost every day's occurrence. A wound is inflicted 

 by a knife or other sharp instrument, and when no 

 very important branch of an artery is divided, 

 the dressing is of the most simple description, viz. 

 to bring into contact the sides or lips of the 

 wound, and keep them in that state by adhesive 

 plaster. It is necessary to heat the plaster at the 

 fire; if it is a pretty extensive wound, and requires 

 the resinous, or adhesion plaster if only a small 

 scratch or very superficial, the common black or 

 white court plaster maybe employed, which merely 

 requires being moistened by the tongue or gently 

 brushing it over with water. Where, however, the 

 wound is deeper and more extensive, slips of 

 resinous plaster may be cut of about half an inch in 

 breadth, and of such a length as to have a hold of 

 each side of the wound for two or more inches, ac- 

 cording to the situation. An assistant, holding the 

 sides of the wound together, the first slip, which 

 should be a little broader than the others, should be 

 applied over the middle of the wound, and in this 

 manner the lips of the wound are to be kept together 

 till the -wound is covered and kept together by the 

 plaster. It is sometimes necessary to cut a longer 



and wider clip, notched a slit ui tin -id-. l>\ <ci-;sor?, 

 and applied over the other slips. A piece of linen 

 or calico rag, or surgeon's lent, may then be 

 covered with Turner's cerate, and placed over the 

 other dressing, and a soft handkerchief or other 

 bandage placed over it, so as to secure the whole. 

 It is not perhaps necessary to state that even the 

 most trifling wounds should be washed or cleaned 

 previous to dressing. 



There is another mode of dressing wounds, 

 especially where no adhesive plaster is to be pro- 

 cured, and that is bringing the edges of the wound 

 together, and keeping them so by a soft cotton ban- 

 dage, and then pouring over the covered wound the 

 compound tincture of myrrh, sometimes called the 

 tincture of myrrh, and aloes, or the compound 

 tincture of benzoin, sometimes called friar's balsam, 

 or genuine Riga balsam. Either of these tinctures 

 or balsams will form a close resinous covering to 

 the wound, which should be moistened as often 

 as it gets dry, and if it has been properly dressed, 

 and no foreign substance has been allowed to remain, 

 it will generally be found united, or nearly so, in 

 the course of a few days. The compress in this 

 case which is placed over the wound should be 

 four or five folds, that it may retain the necessary 

 quantity of the balsam. 



There is a black appearance seen over wounds 

 that have been dressed with adhesive or diachylon 

 plaster, which is sometimes taken as a symptom of 

 gangrene or mortification; but it is the chemical 

 effect or union formed by the discharge from the 

 wound forming a black sulphuret of lead, as oxide of 

 lead in conjunction with the sulphureted hydrogen, 

 enter into the composition of the adhesive or 

 diachylon plaster. 



In children and persons of delicate skins, an 

 unequal mode of applying the plaster sometimes 

 produces little pustular eruptions around the wound ; 

 but the removal of the dressing, and the application 

 of cooling dressing, such as a compress kept wet 

 with solution of sugar of lead, or even a rag covered 

 with the ointment of sugar of lead, will soon remove 

 the eruption. In such unstable habits, it is neces- 

 sary to administer an occasional gentle laxative, 

 such as a seidlitz powder, night and morning, during 

 the cure; or two drachms of Epsom salts in a wine 

 glass of ginger tea twice a day. 



With respect to stitching simple incised wounds, 

 this is seldom necessary; extensive wounds, how- 

 ever, of the lip or face, sometimes require to be 

 stitched, in order to prevent deformity; at other 

 times, where professional aid is at hand, the edges 

 are kept together by harelip pins. Slight wounds 

 of the lips or face may be kept together by the 

 adhesive plaster, properly applied. 



When an extensive wound of the upper or lower 

 lip requires to be stitched, one or two stitches 

 may be used in the following manner; but in no 

 case do we recommend its adoption by any person 

 ignorant of surgery where professional aid can be 

 easily procured. If flat or crooked needles cannot 

 be had, four needles of the size which tailors use 

 for sewing on buttons, and with an eye capable of 

 holding an ordinary sized silk thread after it has 

 been waxed and doubled, or even of three threads, as 

 a fine thread is too sharp, and liable to cut through 

 the lips of the wound. A needle is then put on 

 each end of the ligature ; this prepared and passed 

 in through the lips of the wound from within 

 outwards, so that there may be an end of the thread 

 on the outside of each lip of the wound, and unless 



