Curing

“ His sallow face, his shrivelled mouth, and nasal twang amused me, and in the quiet of the bookshop it was very agreeable to hear the confirmation of the incurable malady of a man abhorred.
"Have the doctors no hope of curing him?" I said, to stimulate the albino.
"Impossible."
"Let us hope it is possible, for the sake of literature."
"Impossible."
"But it seems to me that, in progressive paralysis, there are cases that have been cured."
"No, signor, no. He may live two, three, four years yet, but he cannot be cured." ”

“ Which is the most effectual means of curing Impostumes, that of dissolving, or that of bringing them to Suppuration?
That of dissolving 'em is without doubt the most successful, and that which ought to be us'd as much as is possible; nevertheless some Cases are to be excepted, wherein the Tumours or Abcesses are Critical and Malignant; for then the way of Suppuration is not only preferable, but must also be procur'd by all sorts of means, even by opening ”

“ There is that in thee, poor lad, which I feel too curing to my malady. Like cures like; and for this hunt, my malady becomes my most desired health. ”

“ With the present bettered quality of milk and the improved skill of makers in handling it, inflative cheese ought to now be foreign to the curing room. Bad taints are at present seldom met with, but slight ones creep in unawares, unless the maker is vigilant, and then it is his business to eradicate the ill-savor. Sour until acid has completely overcome the gas, grind twice, and give the curd a prolonged airing by frequent stirring. Try the prolonged stirring on common curds that are hot—too hot to go immediately to press—and notice how it will enhance the flavor of the cheese. ”

“ A few degrees of excess heat will produce a dry, hard curd, and a future dry, hard cheese. Judgment, discretion, and experience are necessary in applying salt to retain moisture. Salt itself is, of course, a moisture retainer, but a too heavy application hardens and stiffens the cheese structure and retards the curing of the product. Never salt more than enough to give and retain flavor and preserve quality. If the points we have given above have all been observed, then the proper proportion of moisture in cheese will be assured. ”

“ In the distant villages, where there is no hakim, and the priest’s amulet has failed to cure, the people either go untreated or treat themselves. A popular mode of treatment for diseases of bones and joints, and also for almost any pain in the chest, abdomen, or back, is the employment of the “actual cautery.” A piece of live charcoal is placed against the skin until a deep burn is produced; this is done [126] in two or three places, the scars, of course, remaining till the end of the patient’s life. ”

“ Slowly, with suppuration, and the formation of granulations, and leaving a large red scar, as when so much skin has been destroyed that the edges of the wound cannot be brought together, or so lacerated and bruised that life is destroyed in them, or separated by blood or exudation of matter, or if the injured parts have been disturbed, or the wound has not been properly cleaned and disinfected. Want of cleanliness leads to putrefaction and the formation of matter, which separates the sides of the wound. ”

“ A patient suffering from a suppurating wound becomes enfeebled from the discharge of pus, and should have his strength kept up by nourishing food. A surgeon will always endeavor to prevent the retention and decomposition of discharges, and to protect from external contamination. He will direct the time and means of dressing the wounds, but the nurse must remember that decomposed animal matter acts as a virulent poison introduced into the system as it may be through any abrasion of the skin. All instruments used about a wound must be thoroughly cleansed before being put away. ”

“ In thousands of cases of scurvy where scorbutic ulcers had broken out, gangrene supervened and the poor prisoner soon found surcease of pain, and misery, and starvation, in the grave. Amputation of a limb was not a cure for these cases; new scorbutic ulcers appeared, again gangrene supervened, and death was the almost inevitable result.
The prison was filled with sick and dying men, indeed well men were the exception, and sick men the rule. The hospital was filled to overflowing; the prison itself, was a vast hospital, with no physicians, and no nurses. ”

“ If, on the contrary, the hemorrhage is slight in amount or almost fails altogether; if it is venous in character; if the edges of the wound are only stained by imbibition of the blood, which is not infiltrated between the tissues, and the stain may be washed off; if the blood is not at all or only slightly clotted and the clots are soft; if the skin is not everted and the sides of the wound are smooth and lie nearly in contact ”

“ 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. ”

“ Wounds made during life might show the suggillation peculiar to bruises or traces of inflammation. Besides, the gaping nature of the lips of the wound, the fact of hemorrhage [431] having taken place and the coagulation of the blood, the infiltration of blood into the cellular tissue, etc., are surgical facts that would leave but little doubt as to the infliction of the wounds during life.
The cause of death is often a difficult matter to determine, as it may have been accidental, suicidal, or the result of homicide. ”

“ The first incision made, and the skin peeled around, an assistant hands a saw, and in the twinkling of an eye the limb is severed, and the stump, bleeding and smoking, is being sewn up by skilful hands almost before the poor fellow wakes up, wearied and exhausted by loss of blood, from what must have been to him, if we may judge by his moans and exclamations, a terrible dream. ”

“ When cuts bleed very much, tie a handkerchief tight above the wound, or place a finger on it until you can get a physician: in the country, persons should be supplied with a surgical needle and adhesive plaster, and have lint scraped and linen rags in a convenient place. Balsam apple put in a bottle when fresh, and whiskey poured on it, is an excellent application for fresh cute or bruises. For the stick of a needle or pin, try to make it bleed, and hold the finger in strong vinegar and salt, as hot as you can bear it, this will prevent a gathering. ”

“ In the examination of wounds either of the living or dead body, it should always be determined for medico-legal purposes whether there is about them fluid or coagulated blood or ecchymosis, that is, livid discoloration of the skin from effused blood. The color of the ecchymotic spot will give a valuable clew as to the time between the infliction of the wound and death. Putrefaction of such a wound must not be mistaken for gangrene. ”

“ Any stitches that may have been introduced are tight, and the deep ones may be cutting into the tissues. There is heat, and a constant burning or throbbing pain, which is increased by pressure. If the stitches be cut, pus escapes, the wound gapes, and its surfaces are found to be inflamed and covered with pus.
The open method is the only safe means of treating such wounds. The infected surface may be sponged over with pure carbolic acid, the excess of which is washed off with absolute alcohol, and the wound either drained by tubes or packed with iodoform gauze. ”

“ The opinions held by the older surgeons respecting [55] the nature of these injuries, already briefly adverted to in the historical remarks on the subject, sufficiently explain their object in making incisions—namely, to convert what they regarded as a poisoned into a simple wound, and to obviate tension, and prevent strangulation of neighboring tissues by tumefaction or inflammation arising in its track. Even so late as 1792, Baron Percy, in his Manuel du Chirurgien d’Armée, writes: “The first indication of cure is to change the nature of the wound as nearly as possible into an incised one.” ”

“ In cases of violent fixed pains, with swelling and threatening of matter forming, incision may be sometimes practised with relief to the patient, but is not to be had recourse to unless there is a risk of the bone suffering. Local abstraction of blood is advantageous, and may, if necessary, be followed by counter-irritation, as the application of blisters or sinapisms. Friction with stimulating substances, or with opiate liniments, is often useful when the disease begins to yield, the pain and puffiness of the parts being thereby dispelled. ”

“ When the process of gangrene is checked, the skin immediately beyond the mortified part becomes of a brighter hue, and is affected by a more healthy species of inflammation, which ultimately terminates in ulceration, with purulent discharge, and thereby forms what is called the line of demarcation between the dead and the living parts; the process, commencing in the integuments, gradually extends to the deeply seated parts, so that the mortified portion is ultimately attached to the living merely through the medium of bone or ligament. ”

“ When the discoloured state of a portion of the skin is such as to render it doubtful whether it is due to injury or to changes after death, an incision should be made to ascertain whether there is blood effused into the textures, constituting true ecchymosis, or merely gorging of the vessels of the skin, or discoloration from infiltration of the colouring matter of the blood, which takes place in depending parts of a dead body. ”

“ There is naturally a strong objection on the part of a delicate and susceptible female to submit to a professional examination, and consequently it is rarely done, until the urgent necessity of the case, lest death should ensue, induces the patient to consult her medical adviser, that he becomes acquainted with the real nature of the case. Where there is ulceration of the piles, and they are very numerous, and the bleeding frequent and profuse, the only effectual cure is their removal. ”

“ A sharp curette is practically of no use for this purpose, and only wounds the skin, and by reason of retentive shreds of tissue may cause infective inflammation.
The opening into the skin should be made with a fine bistoury, the skin be dissected off from the elevated connective [256] tissue, and the latter extirpated by dipping cuts of a fine small, sharp-pointed, half-rounded scissors. The operation can be done neatly and painlessly under eucain anesthesia. ”

“ Hospital No. 2, in which I lay, was inconveniently crowded with severely wounded officers. After my third week, an epidemic of hospital gangrene broke out in my ward. In three days it attacked twenty persons. Then an inspector came out, and we were transferred at once to the open air, and placed in tents. Strangely enough, the wound in my remaining arm, which still suppurated, was seized with gangrene. The usual remedy, bromine, was used locally, but the main artery opened, was tied, bled again and again, and at last, as a final resort, the remaining arm was amputated at the shoulder-joint. ”

“ It is rather remarkable that the bleeding is not so profuse as might be expected from the severity of the torture, and soon ceases, probably from the fact of their extreme exhaustion and debility; the want of sustenance and sleep, checks the natural circulation, and is at the same time an admirable preparation for the tortures, and enables them to bear the infliction without the same degree of pain that might, under other circumstances, result in inflammation and death. ”

“ The poor wretch saw the instruments handed one by one by the assistant, and heard the surgeon’s calm directions and his remarks on the case. The barbarous practice of arresting bleeding by the application of red-hot irons to the surface of the wound had indeed ceased three centuries before, when that humane reformer, Paré, 90 displaced it with the method of tying the open blood-vessel, but the patient’s blood gushed forth before him until arrested, into the sawdust spread to receive it, and the sight and the hot odour of it oftentimes mercifully caused him to faint. ”

“ Definitions.—Surgically a wound means a solution of continuity and refers to every such lesion produced by external violence or developing spontaneously. The medico-legal acceptation of the term is much broader and includes any injury or lesion caused by mechanical or chemical means. Vibert [601] quotes Foderé as defining a wound medico-legally as, “Every lesion of the human body by a violent cause of which the results are, singly or combined, concussion, contusion, puncture, incision, tear, burn, twist, fracture, luxation, etc. ”

“ To minimize the hæmorrhage, adrenalin may be added to the cocaine solution. The curette is made to encircle the granulation and cuts through its attachment with a firm movement, limited to the area of the granulation. Curetting should not be done in a haphazard fashion, but deliberately under good illumination. If bleeding occurs it must be arrested before further curetting takes place. ”

“ The wounded came and went in an unbroken stream. The tables were always occupied. I went from one to another, unwound bandages, held up limbs for amputation, fetched splints, padding, gauze, or new bandages. I was too busy to think or to feel any horror. I was vaguely conscious of nausea and of a hot, stifling atmosphere heavy with the fumes of chloroform and ether.
Some of the wounded had arms that hung by shreds of muscle and sinew. Others had feet that were nothing but masses of clotted blood, lumps of torn flesh, and bits of bone tied up in blood-sodden linen parcels. ”