Edmund Owen

“ The most serious cases are those in which the aspect, the pulse, and the temperature of the patient fail to give warning of a very advanced state of disease. Every surgeon of experience has met with cases in which, though there is nothing pointing to the fact that the patient is on the brink of a disaster, the operation has shown that the appendix is mortified, and that it is surrounded with abundant foul matter. ”

“ Malignant disease of the bladder is almost always the warty form of cancer known as epithelioma. It springs as a sessile growth from the mucous membrane of the floor near the opening of one of the ureters, and, worrying the sensory nerves, causes irritability of the bladder and incontinence of urine. In due course septic germs reach the bladder, either from the urethra, the bowel, the kidneys or the blood-stream, and cystitis sets in. When ulceration has taken place, blood occurs in the urine, and the patient—generally beyond middle age—suffers dull or lancinating pains. ”

“ When a portion of animal tissue dies in consequence of an infection or injury, the death of that tissue taking place by gradual breaking down or disintegration, the process is termed ulceration and the result an ulcer. When the ulcer is spreading the place is painful and the surrounding parts are flushed with extra blood, but under appropriate treatment the destructive process ceases and the ulcer gradually heals. The bright surface of the ulcer becomes glazed over, and those changes take place in it which occur in an open wound. ”

“ More often, however, they make their way to the periosteum of the last bone of the finger, and involve it in a devastating inflammation which may end in death (necrosis) of the bone. Sometimes the germs find their way into the tendon-sheath, and, spreading into the palm of the hand, cause a deep abscess with, perhaps, sloughing of the tendon, and leaving a permanently stiffened finger. In some cases amputation of the finger is eventually called for. Whitlow is especially apt to occur in people who are out of health, as in them the micro-organisms of the disease meet with less resistance. ”

“ The taxis to be successful should be made in a direction opposite to the one in which the hernia has come down. The inguinal hernia should be pressed upwards, outwards and backwards, the femoral hernia downwards, backwards and upwards. The larger the hernia the greater is the chance of success by taxis, and the smaller the hernia the greater the risk of its being injured by manipulation and delay. In every case the handling must be absolutely gentle. If taxis does not succeed the surgeon must at once cut down on the tumour, carefully dividing the different coverings until he reaches the sac. ”

“ Closer investigation in recent times has, however, brought out the very striking fact that, if oxidation be measured in terms of energy liberated by it in the body, it makes but little difference, other things being equal, whether the animal is fasting or not. If more proteid or carbohydrate is oxidized at one time, correspondingly less fat is oxidized, but the total energy liberated as heat, &c., in the body is about the same, unless the diet is very excessive, when there is a slight increase of oxidation. ”

“ When the clot or the tumour, or whatever it is, has been removed, the disk of bone which, during the operation, has been kept in a warm liquid, is cut up into pieces which are put back into the opening and the skull flap is brought up into its proper position.
Fractures of the base of the skull are always serious, in that they may run across important nerves and large blood-vessels; passing through the roof of the nose, or the ear, they may be compound — that is to say, they may communicate with air- cavities from which pathogenic germs may readily enter the injured tissues. ”

“ The man who has chronic inflammation of a large artery, the result, for instance, of gout, arduous, straining work, or kidney-disease, and whose artery yields under cardiac pressure, has a spontaneous aneurysm; the barman or window-cleaner who has cut his radial artery, the soldier whose brachial or femoral artery has been bruised by a rifle bullet or grazed by a bayonet, and the boy whose naked foot is pierced by a sharp nail, are apt to be the subjects of traumatic aneurysm. ”

“ If at any time he should fail to perform the act of micturition, he ought not to strain, but should quietly wait for a little before making any further effort. Regularity in the times of making water is also of much importance.
Retention of urine may occur in paralysis of the bladder, or in conditions where the patient is suffering from an illness which blunts the nervous sensibility, such as apoplexy, concussion of the brain, or typhoid fever. It is, however, more commonly due to obstruction anterior to the bladder, as in stricture of the urethra or enlargement of the prostate. ”

“ Hence we may distinguish two types of respiration, the costal and the abdominal, according to the preponderance of movement of one or the other part of the body wall. In forced respiration the type is costal in both sexes, and so it is also in sleep. The cause of this difference between men and women has been variously ascribed (a) to constriction of the chest by corsets in women, (b) to a natural adaptation to the needs of child-bearing in women, and (c) to the greater relative flexibility of the ribs in women permitting a wider displacement under the action of the inspiratory muscles. ”

“ But in those aneurysms which are fusiform dilatations of the vessel there is but slight chance of such cure, for the blood sweeps evenly through it without staying to deposit clot or laminated fibrine. ”

“ But experience has amply shown that in the early stages of the disease, mercury, at least for the present, is the only drug on which reliance can be placed. Guaiacum was at one time extensively used, and somehow or another sarsaparilla acquired a bubble reputation; but the practical surgeon of to-day ignores these drugs in the treatment of syphilis. Still, mercury must be prescribed with great judgment. For a man worn out by alcoholic or other excesses, or with health broken down by tuberculosis or other exhausting disease, mercury must be given with great caution. ”

“ If it were certain that the attack of appendicitis would subside and become quiescent, it would be wise to wait. But it too often happens that the first attack is, indeed, the last. Acute appendicitis is one thing; relapsing appendicitis is another. The latter condition is very manageable.
Inasmuch, then, as it is impossible to know what direction the disease will take, whether to quiescence or to disaster, it is for the greatest good in the greatest number of cases that the inflamed appendix be removed by operation whilst the disease is still limited to the appendix. ”

“ Synovitis.—When a joint has been injured, inflammation occurs in the damaged tissue; that is inevitable. But sometimes the attack of inflammation is so slight and transitory as to be scarcely noticeable. This is specially likely to occur if the joint-tissues were in a state of perfect nutrition at the time of the hurt. But if the individual or the joint were at that time in a state of imperfect nutrition, the effects are likely to be more serious. As a rule, it is the synovial membrane lining the fibrous capsule of the joint which first and chiefly suffers; the condition is termed synovitis. ”

“ Since the circulation, no less than the breathing, is concerned in the supply of oxygen to and removal of carbon dioxide from the tissues, it can readily be understood that defective circulation, such as occurs, for instance, in uncompensated valvular affections of the heart, may affect the breathing and hinder the normal respiratory exchange. Conversely, also, defects in the aeration or oxygen-carrying power of the blood may be compensated for by increase in the circulation. ”

“ If we were to perform the same operation of removing a part of the chest wall in a body not first frozen we should find, on the other hand, that the contents of the thorax are not by any means in such circumstances bulky enough to fill up the space provided for them. If we were to measure the organs carefully we should find that those which are hollow and whose cavities communicate with the regions outside the thorax are all larger in the frozen corpse than in that which was not frozen. ”

“ Unlike whooping-cough, smallpox or pleurisy, syphilis is not a disease which, left untreated, cures itself in the course of time. Syphilis is a disease which peculiarly calls for treatment, and that treatment, to be effectual, must be prolonged. To: promote the healing of an ulcer, or to get rid of a cutaneous eruption, the result of syphilis, is not to treat syphilis. It is merely to free the patient of a symptom of the disease. ”

“ The relative frequency of fracture of the bone and dislocation of the joint depends on the strength of the bones above and below the joint relatively to the strength of the joint itself. The strength of the various joints in the body is dependent upon either ligament or muscle, or upon the shape of the bones. In the hip, for instance, all three sources of strength are present; therefore, considering the great leverage of the long thigh bone, the hip is rarely dislocated. ”

“ The teaching of modern surgery is that a small incision into the abdomen and a prompt withdrawal of the invaginated piece of bowel can be trusted to do all that, and more than, infection can effect, without blindly risking a rupture of the bowel. It is certain that when the surgeon is unable to unravel the bowel with his fingers gently applied to the parts themselves, no speculative distension of the bowel could have been effective. ”

“ Hence the variable condition of the air as regards temperature, degree of moisture, and density, is liable to produce directly various changes in the lungs, or to predispose them to disease; and the contamination of the air with various pathogenic germs and irritating particles in the shape of dust, is a direct source of many lung affections. ”

“ Rheumatic tetanus is as unreal a disease as that just mentioned. The germs themselves do not wander from the wound to multiply in the blood as in infecting diseases, but remaining at the wound elaborate a terribly poisonous substance (a toxin) which makes its way along the nerve-trunks to the spinal cord. Even prompt amputation, however, is likely to prove ineffectual as regards cure, for the germs in the wound have in this growth set free so virulent a poison (toxin) that the nerves of the voluntary muscles all over the body are hopelessly under its influence. ”