Gauze

“ A sterilized linen or cotton cap is placed upon his head and pulled down so that the scales or germs of any sort may not fall into the wound. Some surgeons of stout and comfortable habit, who are apt to perspire in the high temperature of an operating-room, will tie a band of gauze around their foreheads, to prevent any unexpected drops of perspiration from falling into the wound; while some purists muffle up the mouth and lower part of the face lightly in a similar comforter. ”

“ The chinosol gauze is especially used in ophthalmic surgery; for general surgery the cyanide gauze is chiefly employed. The various preparations of absorbent wool (Le. wool that has been freed of its grease, so that it readily takes up moisture) are used not only for outside dressings, but also as Sponges at the time of operation, and have to a great extent done away with the use of real Sponges. The gauzes in most cases are used not dry, but just wrung out of carbolic lotion, that their antiseptic influence may act at once. ”

“ In a true gauze harness the doups are connected with the mails or leashes of the harness, the harness twines, or leashes, acting as standards for the doups, so that any splitful of warp may be crossed or twisted differently from the others, and any kind of texture can be wrought along with the gauze without having to consider the one in connection with the other, as in the previous harness. ”

“ If the cord dressing is held in place by a gauze binder, the knitted band with straps is used from the beginning. Whether the binder be flannel or gauze, it must be applied firmly and with even pressure, but not tight. It is a mistake to think that a tight band strengthens the baby’s abdominal muscles for it has the opposite tendency. A tight band may give pain or discomfort and even cause colic or vomiting. ”

“ In this latter case the vagina and the cervical canal are packed with sterile gauze to check the hemorrhage, and after twenty-four hours it is removed. Then commonly the entire ovum comes away with the gauze, or what remains of it is taken out with a curette. ”

“ When a dressing needs changing from fouling of its outer parts, it is preferable to cut round the adherent part of the deep layers and apply some fresh gauze over the central scab rather than to remove it. ”

“ In aggravated ulcers, especially those accompanied by crusts, foul smelling discharges and various inflammatory conditions, the leg should be washed once or twice daily with soap and water, cleansed with a piece of sterile gauze, and shaved when necessary. ”

“ This primary gout of the stomach, as it is a torpor of that viscus, is attended with sensation of coldness, and with real defect of heat, in that part, and may thence be distinguished from the pain occasioned by the passage of a gall-stone into the duodenum, as well as by the weak pulse, and cold extremities; to which must be added, that it affects those only, who have been long afflicted with the gout, and much debilitated by its numerous attacks. ”

“ Next to rheumatism in the order of frequency, we must place those gastric derangements which pass under the denomination of pyrosis, gastralgia, morbid sensibility of the stomach, &c. It very seldom happens that a patient complains of a gnawing pain in the stomach, without also mentioning that he is subject to the ejection of a clear glairy fluid. There is often tenderness at the epigastrium, but the tongue, which, for the most part, assumes a pale, pasty, sodden look, occasionally, however, presenting nothing uncommon, has very rarely the red tip and margin, indicative of mucous inflammation. ”

“ I shall now briefly enumerate the symptoms of the gout, as they appear in the ligaments, the blood-vessels, the viscera, the nervous system, the alimentary canal, the lymphatics, the skin, and the bones of the human body, and here we shall find that it is an epitome of all disease.
I. The ligaments which connect the bones are the seats, of what is called a legitimate or true gout. They are affected with pain, swelling, and inflammation. The pain is sometimes so acute as to be compared to the gnawing of a dog. We perceive here the sameness of the gout with the rheumatism. ”

“ An inflammation of the liver so frequently attends the great potation of vinous spirit, there is reason to suspect, that this viscus itself becomes inflamed by sensitive association with the stomach; or that, when one termination of the bile-duct, which enters the duodenum is stimulated violently, the other end may become inflamed by sensitive association.
15. Podagra. The gout, except when it affects the liver or stomach, seems always to be a secondary disease, and, like the rheumatism and erysipelas mentioned below, begins with the torpor of some distant part of the system. ”

“ In the abdomen, and especially in the lower parts of the pelvis, this pleasant sensation of heat is more felt than in the chest—a fact which led to the application of gas to certain complaints in both sexes attended with torpor and debility of particular functions.
2. A sensation of twitching, formication, and even pain, is often the result of the gas-bath, especially in parts which have formerly been the seat of fractures, sprains, wounds, or severe gout or rheumatism. These pains are so acute as sometimes to force the patient to quit the bath before the usual time has expired. ”

“ The deranged Vayu makes the secretions from an ulcer, seated in any of the seven abovesaid principles such as, the skin, flesh, veins, ligaments, bones, joints and the abdomen, respectively coarse, and rough to the touch, brown, grey, frosty, or white like the cream of curd, and coloured like the washings of an alkali, like that of meat or paddy husks. ”

“ The gout is a disease of the whole system. It affects the ligaments, blood-vessels, stomach, bowels, brain, liver, lymphatics, nerves, muscles, cartilages, bones, and skin.
2. The gout is a primary disease, only of the solids. Chalk-stones, abscesses, dropsical effusions into cavities, and cellular membrane, and eruptions on the skin, are all the effects of a morbid action in the blood-vessels. ”

“ It sometimes happens, that after full living, the stomach becomes particularly affected, and the patient is troubled with flatulency, indigestion, loss of appetite, eructations, nausea, and vomiting, with great dejection of spirits, pain and giddiness of the head, disturbed recollection, or muddiness of intellect, as it is termed, with all the symptoms, which usually precede a regular fit of the gout, yet no inflammatory affection of the joints is produced. ”

“ George's Hospital, London, are masses of hair and string taken from the stomach and duodenum of a girl of ten. It is said that from the age of three the patient had been in the habit of eating these articles. There is a record in the last century of a boy of sixteen who ate all the hair he could find; after death his stomach and intestines were almost completely lined with hairy masses. In the Journal of the American Medical Association, March 1, 1896, there is a report of a case of hair-swallowing. ”

“ If a middle-aged woman of florid complexion and corpulent habit begins to complain of pain and stiffness in her knees with more or less swelling thereof, there is a very prevalent tendency to attribute not only her joint disorder to gout, but any gastric or nervous symptoms that she may simultaneously complain of are translated as being confirmatory of the assumption. ”

“ How elated we are, and rightly, when in an obscure form of arthritis we pounce on these objective criteria of gout, how apt to deem our diagnostic quest as ended, and with what fatal glibness the time-worn “gout” slips from our lips, sure, alas, of ready and almost complaisant acceptance. Fallacious inference, all too prevalent, that the presence of tophi stamps any concomitant arthritis as “gouty.” ”

“ When the lungs do not suffer, the bowels may, and with this complication there are, in addition to the stupor and torpor, tension and tenderness of the abdominal walls when pressed upon, manifestations of colic, great thirst, a coated tongue; yellowness of the membranes of nose and eyes, high-coloured urine, constipation, and dry faeces covered with mucus. Sometimes rheumatic swelling and tenderness takes place in the muscles and joints of the limbs, which may persist for a long time, often shifting from leg to leg, and involving the sheaths of tendons. ”

“ The free liver, fearing that Nemesis has overtaken him, is fertile [208] in suggestion. He has overwalked, his boot pinched him, or it is a sprain. Local appearances may be non-committal. There may be no swelling nor redness, and no access of pain at night. Still there is discomfort when he walks. The so-called sprain lingers, and one morning the great toe, instep, or ankle, is swollen, tender, flushed, and the victim’s fears and the physician’s suspicions are converted into certainty: it is gout!
Still in this matter of the onset I must not overlook the findings of my colleague James Lindsay. ”

“ The rosy drop of the face of some drinking people is produced like the gout described below, in consequence of an inflamed liver. In these constitutions the skin of the face being exposed to greater variation of heat and cold than the membranes of the liver, possesses more mobility than those hepatic membranes; and hence by whatever means these membranes are induced to sympathize, when this sensitive association occurs, the cutaneous vessels of the face run into greater degrees of those motions, which constitute inflammation, than previously existed in the membranes of the liver ”

“ When the gout begins with torpor of the stomach, a painful sensation of cold occurs, which the patient compares to ice, with weak pulse, cold extremities, and sickness; this in its slighter degree is relievable by spice, wine, or opium; in its greater degree it is succeeded by sudden death, which is owing to the sympathy of the stomach with the heart, as explained below. ”

“ Hence the disease derives the general name gout (gutta) , from its resemblance to a drop (gutta) trickling or falling downward and flowing over the weaker organs, which receive the humor. For gout arises particularly from rheumatic causes. Now, as the humors are rather uncontrollable (male terminabiles) fluids, they flow towards the exterior and softer parts, like the flesh and skin, which receive their moisture and being soft, dilatable and extensible, there results some swelling. ”

“ Definition.—Gout is an hereditary disorder, the intrinsic element of which is an inborn instability of nuclein metabolism which may remain latent, but under the influence of extrinsic factors, infections, becomes manifest, as betokened by local inflammatory tissue reactions in joints or elsewhere the specific character of which is attested by the associated uratic deposition. ”

“ Now, as we hope to show later, local foci of infection are extremely common in the gouty. Such are especially frequent in the teeth, tonsils, naso-pharynx, etc. Is it not then extremely probable that organisms may, viâ the blood-stream, find their way to a joint, the resistance of whose tissues has been lowered by a trauma, however slight its degree? This I apprehend to be the true explanation of the undoubted intimate connection between traumatisms and arthritic outbreaks of gout. ”

“ The gizzard thus reduces into small particles whatever food the animal selects, that it may be more readily acted upon by the gastric juice in the stomach; for the gastric juice acts like any other solvent, and therefore acts most advantageously when the food is reduced into small parts.—The digestive organs of some of the lower orders of animals form a striking contrast to these. In the most simple apparatus with which we are acquainted, the stomach and the intestines are composed of a simple bag which has but one opening, which serves both to receive the food, and discharge the excrement. ”

“ GOUT (PODAGRA) .—A disorder of nutrition characterized by excess of uric acid in the blood, attacks of acute arthritis (inflammation of joints) with deposit of urate of sodium in and around the joints; with various general symptoms.
Causes.—Heredity; male sex, usually appears from thirty to fifty and rarely under twenty; from continued use of alcoholic liquors, especially fermented, with little or no exercise; too much meat. Unhygienic living with poor food, and excessive drinking of ale and beer may be followed by the "poor man's gout." It is common in lead workers. ”

“ XXX. Hence a paroxysm of gout is liable to recur on bleeding or purging; as the torpor of some viscus, which precedes the inflammation of the foot, is thus induced by the want of the stimulus of distention. And hence the extremities of the body, as the nose and fingers, are more liable to become cold, when we have long abstained from food; and hence the pulse is increased both in strength and velocity above the natural standard after a full meal by the stimulus of distention. ”

“ Is there any thing as to the state of the hardness or softness of the coats of the stomach, upon which any judgment can rest?—I should suspect that as it is inflamed, the coats of the stomach would be thickened and soft; for as the inflammation takes place, the parts increase in size. ”

“ The gout is always induced by general predisposing debility.
6. The remote causes of the gout which induce this debility, are, indolence, great bodily labour, long protracted bodily exercise, intemperance in eating, and in venery, acid aliments and drinks, strong tea and coffee, public and domestic vexation, the violent, or long continued exercise of the understanding, imagination, and passions in study, business, or pleasure, and, lastly, the use of ardent, and fermented liquors. The last are absolutely necessary to produce that form of gout which appears in the ligaments and muscles. ”

“ The most frequent primary seat of the gout I suppose to be the liver, which is probably affected with torpor not only previous to the annual paroxysms of the gout, but to every change of its situation from one limb to another. ”