Edward Adams

“ The prognosis of contusions is a matter of every day importance, and it is sometimes extremely difficult to prognosticate accurately. The determining forces are principally the nature and violence of the contusing force, the tissues and organs involved, and the general condition of the patient. Even the injury of the tissues that may be easily inspected, such as the skin, may be much more severe than is apparent. In tissues of low vitality, such as synovial membrane, cartilage and ligaments of a joint, repair is proportionately delayed, whereas in highly vascular tissue it is more rapid. ”

“ Septicemia may be defined as an acute febrile affection, characterized by marked nervous, cutaneous and visceral manifestations, and due to the introduction into the system of bacteria and their toxins from an infected wound. It applies to diseases which present poisons in the blood that are of parasitic origin, the parasite itself being either present or absent in the blood. Septicemia, in strong contrast to the definition of toxemia, would include diseases arising from the invasion of the tissues and fluids of the body by animal or vegetable parasites or their poisonous products. ”

“ The movements of a dislocated joint are usually limited. If any movement of the end of one of the bones is felt, it is always at an abnormal point. Pain is referred to the dislocated joint and the patient is unable to use the limb.
Treatment. As a rule, a dislocation should be reduced as soon as the diagnosis is made, and, if necessary, an anesthetic should be administered.
When reduction has been accomplished, the bone often goes back with a snap, the contour of the limb is restored, and the movements of the joint are free again. ”

“ This is the process of primary union in a wound in which there is not a marked cavity or a loss of tissue on any of the exposed surfaces of the body, and no matter how closely the edges of such a wound may lie in contact, it can heal by no other method. Even the closest apposition of the sides of a wound cannot prevent the interposition of a thin layer of clot and the partial death and absorption of a very thin layer on its surfaces. ”

“ Any cause that lowers the vitality by depressing the [Pg 12] system, reduces the resistance to bacteria and is therefore apt to favor their growth. Exhausting diseases such as anemia, obesity, alcoholism, diabetes, fatigue, or even exposure to cold, are instances. Germ growth is also favored by the presence of dead, or injured tissues, of blood clots, of foreign substances, and above all, by the presence of some of the substances in which the germ has already been growing at the time of its inoculation, and containing some of its toxins. ”

“ If shoes were made fan-shaped, like the imprint of a bare-foot in the sand, instead of having the greatest width across the ball of the foot, they might look strange at first, but they would be comfortable for all time. Those then who care more for comfort than for style, as most of us falsely profess to do, would have both cornless and comely feet. ”

“ At times it is impossible to differentiate from syphilis, which, however, is quite uncommon, but with which tuberculosis has many symptoms in common. The history of the individual, and a blood examination will generally suffice. If the disease is advanced to the stage of abscess and sinus formation, there can be no doubt as the nature of the trouble.
Very often the disease in the articular ends of the bones advances slowly, giving very little pain and no appreciable swelling or atrophy. There may be only an unwillingness to use the part very much, and the disease may very well be overlooked. ”

“ Bacteria are minute fungi, each consisting of a single cell enclosed in a cell membrane of cellulose which can be demonstrated by iodine, the latter causing the protoplasm to retract from the cell wall. There is no nucleus or central core. Some of the bacteria are colorless, others pigmented, yellow, blue or red. The cells vary in shape and in size in different species as well as in their mode of growth, and [Pg 7] are named in accordance with these peculiarities. The round or oval cells are called cocci; the rod-shaped organisms are termed bacilli. ”

“ DISEASES OF THE NAILS—INGROWN NAIL VERRUCA OR WART
Definition. A verruca is a circumscribed overgrowth of all the layers of the skin, varying in size from a pin’s head to a small nut. These growths may be single or multiple, and may come and go without any special reason. Verruca plantaris, or plantar wart, is observed on the sole of the foot; it may be single or multiple. It is very painful; it may be the size of a pea and is often mistaken for a callosity, from which it may be distinguished by the pain on pressure, and the tendency to bleed when the horny layer is removed. ”

“ To be able to resist the invasion of any species of bacteria, one is said to be refractory to or immune against that variety of germs.
Serum therapy is based on the demonstrated fact of immunity, and of the possibility of producing it by injecting the serum of immunized animals. In many infectious diseases, one attack protects an individual for a lifetime and one form of disease may protect against even a more virulent form, as vaccination protects against smallpox. ”

“ Inflammation may result in resolution, suppuration, necrosis or sloughing, or in the establishment of a chronic state.
Resolution. Resolution is the termination of an inflammation by the gradual cessation of all the changes which have occurred. The pain subsides, the circulation becomes more normal, and the exudate is absorbed, or makes its [Pg 33] way to the free surface of the body, where drainage occurs either spontaneously or by incision. ”

“ Regeneration of Tissues. The reparative powers of the tissues of the human body are considerable, although not comparable with those of the lower animals, in the [Pg 36] lowest orders of which the reproduction of an entire limb, or even one-half of the body, may take place. In order to understand the regeneration of tissue, we must first consider briefly the life history of the cells.
A cell consists of a mass of protoplasm, generally enclosed in a cell membrane, and containing a nucleus and nucleolus. ”

“ There should be the usual care of the bowels, skin and kidneys, but in our zeal over the local treatment, we should not forget that we have to care for a patient whose blood is loaded with toxins, and whose lungs, stomach, kidneys, and other organs are congested and filled with emboli. At first, dress the burns daily, gently wiping away the discharge of serum and broken down cells, which is poisonous and irritating, with dry gauze or cotton. ”

“ In edematous swelling in general, the flannel appears very suitable, as it is soft to the skin and accommodates itself to the greater or less distension of the limb, arising from the increase or diminution of the fluid. The bandage should be at least six yards long, if required for an ordinary adult, and the width should be from two to three inches. Every portion of the limb, from the toes to the knees, should be equally and evenly compressed. Compression is of such absolute importance that without it everything else will be comparatively ineffectual. ”

“ An accidental wound is infected and must be well washed out with an antiseptic solution. A clean wound, made by the surgeon, need not be irrigated, in fact, irrigation with an antiseptic fluid leads to necrosis of tissues, causes a profuse flow of serum and necessitates drainage. If clots have gathered in a wound, they must be removed, as their presence will prevent [Pg 46] accurate coaptation of the edges. In an infected wound, they are washed out with a stream of corrosive sublimate solution. In a clean wound, they are washed out with hot salt solution. ”

“ A fracture which only involves a portion of the thickness of the bones, so that its continuity has not been entirely lost or a fragment has not been completely detached, is called an incomplete fracture. A fracture which involves the entire thickness of the bone, so that it is divided into two or more distinct fragments, is called a complete fracture. ”

“ Syphilis is a chronic, infectious, and sometimes hereditary, constitutional disease. Its first lesion is an infecting area or chancre, which is followed by lymphatic enlargements; eruptions upon the skin and mucous membranes; affections of the appendages of the skin, (hair and nails) ; chronic inflammation and infiltration of the cellulo-vascular tissue, bones and periosteum, and later, often by gummata. This disease is caused by a microorganism known as the spirochaeta pallida or treponema pallidum of Schaudinn and Hoffmann. ”

“ The air can be a medium of wound infection to a certain extent, and dry air contains more spores and bacteria than moist air, but Koch demonstrated the fact that atmospheric microbes were chiefly of innocuous character, and wound infection usually could be traced to bacteria or spores being brought into direct contact with wounds, by the clothing, or by the skin of the patient, or by the hands of the surgeon, or by unclean surgical instruments and dressings. ”

“ The primary area of infection is always in the bone marrow. The bony trabeculae and the cortex are destroyed only secondarily. The process nearly always begins in the diaphysis, but then may extend into the epiphysis and produce suppuration of the joint. Once the organisms have gained access to the marrow, they produce a toxin which causes necrosis of the adjacent marrow cells, and this necrosis may extend over a very considerable portion of the bone before marked infiltration with leucocytes occurs. ”

“ The bad cases, especially where gangrene or serious infection exists, may require amputation, but unless this can be done in sound tissue with adequate innervation, a perforating ulcer may develop upon the area exposed to the pressure of an artificial limb. Resection of joints is usually of little benefit. The most satisfactory operative results in this class of ulcers have been obtained by stretching the posterior tibial nerve, together with scraping the ulcer, or, better, by excising it, followed by immediate suture of the wound. ”

“ The high temperatures are fatal to bacteria, moist heat being more destructive than dry heat, and adult cells are more easily killed than spores. A temperature less than 212°F. will kill many organisms and boiling will kill every pathogenic organism that does not form spores. Some spores are not destroyed after prolonged boiling and some will withstand a temperature of 120°C. As a practical fact, however, boiling water kills in a few minutes all cocci, most bacilli, and all pathogenic spores, though anthrax and tetanus are harder to kill than are the spores of other bacteria. ”

“ An abundant amount of pus is soon formed; the synovial membrane, the bone ends and the joint capsule are actively inflamed, and soon become disorganized. Perforation of the capsule is followed by infection and suppuration of the tendons and other structures about the joint, which soon affects the superficial structures and forms an opening through the skin. The pain is intense, generally worse at night; the swelling is great and fluctuation is distinct; the skin is red and hot, and the parts above and below are edematous. Any attempt at motion increases the suffering. ”

“ Heat has the effect of dilating the blood vessels and hastens repair in bruised, strained, or torn tissues. This is a variety of hyperemia treatment which is especially useful in the absence of bacteria. In infected areas the growth of bacteria, and increased pus formation, would be encouraged and heat is contraindicated.
We are yet without an antiseptic material which can be used in sufficient strength to affect the growth of germs and yet not injure the patient. Injury of the part treated, and absorption into the circulation are both to be avoided. ”

“ An atypical tumor is one of epithelial or connective tissue origin in which, though the cells are the same as those in the tissue from which it grows, their arrangement is quite different. They are malignant.
The most important classification of tumors is that into benign and malignant.
A benign tumor is one in which there is no tendency to rapid growth; the symptoms are purely local, and the general health is not affected, except indirectly.
On the other hand a malignant tumor is one which takes on a rapid growth with a tendency to infiltrate or [Pg 153] adhere to surrounding tissues ”

“ In the treatment of localized pain or inflammation, cold is used in a number of ways, largely depending upon the will of the physician and the means of the patient. The simplest, cheapest, and perhaps the best method of using cold, is to place cracked ice in a rubber bag, the latter to be thoroughly watertight, lay it over the inflamed part, surrounding it with a towel so as to prevent the moisture, which appears on the surface from condensation, from wetting the clothing. ”