LECTURES ON SURGERY,

1833 The Lancet  
with violent itching of the palms of the ' hands, and he, moreover, experienced the bad effects of chronic inflammation. Re-! traction of the flexor tendons of the fingers . in both hands, had s u ccessivcly taken place,! with a callous hardening of the investing I skin. The sheaths of the tendons refused their office, and adhered completely I throughout. This affection has been frequently met with. It is of an alarming' character, and is worthy of much practical attention. The coccygeal
more » ... he coccygeal paratrima, is, as is known, inflammation more or less acute of the mucous substance of the skin, dependent on the compression of too prolonged a decubilus. It is an ac:;ident common in hospitals, attacking scorbutic, typhoid, and adynamic patients. It is aggravated by the nature of the maladies of which it is the sad result, and often terminates in gangrenous degeneration. A man who had remained ten years on his back at the Hospice des Incurables became maniacal. All the back of his body became covered with ecchymoses and erythematous patches. The pain was terrible, and he could obtain no sleep. For the remaincler of his existence he lived in the most dreadful torture. cinus Effect rf'irnlrryuer Food. HAVING in the two last lectures endeavoured to point out the various circumstances which require attention previous to performing surgical operations, more particularly certain varieties of constitutions, differences of temperament, of age, of season, and states of the atm6sphere ; and having also endeavoured to point out the treatment necessary previons to the performance of operations, as well as the modes of conducting them, I have to consider the system of treatment which ought to be employed aj'ter operations have been effected. -Ejects of Syncope.—After an operation it is of great consequence to place the patient under circumstances where he may enjoy the most perfect tranquillity and uninterrupted sleep. It is a common practice to give wine and such-like cordials, with a view to relieve the state of syncope or depression which usually occurs during the performance of, or which follows, operations; but I would recommend you not to have recourse to those measures, and rather to consider such state of collapse favourable to the future recovery of the patient, as nothing will contribute more towards preventing the accession of any febrile symptoms. Of late years, particularly, I have strictly followed this practice,-a practice, it must be admitted, very opposite to that usually pursued; for, generally, when a patient becomes faint during an operation, not only is wine given, but the surgeon does not even proceed with the operation until the patient recovers from the syncope, or when syncope comes on after the operation, then it is the custom freely to give wine until the vital powers are restored. Instead of following these rules, you ought to take advantage of the insensibility of the patient in a state of syncope, and of the parts not being gorged with blood, to hasten with the operation, and, as has already been said, instead of using artificial means to restore the heart's action when syncope succeeds an operation, the longer that state is protracted the greater will be the check given to the occurrence of subsequent inflammation. Inflammatory S'yrngtoms.-There. are different classes of symptoms which may come on after an operation, and which, if not subdued, may either protract the cure, cause the complete failure of tho operation, or even destroy life itself. An inflamed state of the wound, accompanied by fever, is by far the most usual and the most dangerous state which can follow an operation ; for which reason I shall iirst direct your attention to this subject. It will be generally found, that within the first twenty-four hours, and often in even a shorter time, a very correct estimate may be formed of the probable degree of violence of the febrile attack which is likely to come on after an operation. It has been observed by Dupuytren, the most celebrated surgeon of our time, that of all , those who died at the Hotel Dieu after , operations, the majority perished in con-
doi:10.1016/s0140-6736(02)94935-4 fatcat:czqftrdpknfw7oqavpzsslr4j4