A handbook of local therapeutics / edited by Harrison Allen.

Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: A handbook of local therapeutics / edited by Harrison Allen. Source: Wellcome Collection.

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    be lesions of the synovial vessels, or of the membrane itself. At the best, contusions exist in the subserous vessels which, becoming hyperemic, mav induce an attack of arthritis. The first indication, therefore, in the treatment of sprain is to control the impending inflammation. This can be satisfactorily accomplished by elevating and surrounding the articu- lation with cloths saturated with cold water or by an ice-bag. If a patient is seen immediately after the injury is sustained, great relief may . be secured by the application of a firm roller bandage about the joint; if the injury is in the ankle, the bandage should be carried from the toes to the knee. Cold, elevation, and pressure produce tonic contraction of the walls of the vessels, lessen the weight of the column of blood, and furnish mechanical support to the vessels themselves. As a consequence, they diminish the tendency to serous extravasation and swelling, and favor speedy restoration of normal functions. If the tension and throbbing of the joint do not soon begin to subside after the employment of cold applications, these must be immediately changed for hot ones. In severe pains Agnew states that he usually finds that warm applications give the greater comfort. As a means of controlling Hemorrhage, particularly the oozing of blood from the surface of a wound, or that occuring from the flaps of a stump after the principal vessels have been tied, cold water, or even ice water, was frequently used by the older surgeons. When such a stimula- ting effect of cold is desired it is best to project the water forcibly against the bleeding surfaces from the nozzle of a syringe, for this produces a stimulating effect by the impact of the water as well as by the cold. This is also an excellent means of controlling the oozing following the opera- tion for lithotomy. Care must be taken not to continue the local use of cold too long, as serious depression may follow. Water as hot as can be borne, namely, at a temperature from iio° to 130° F., is now more used as a hgemostatic than cold water, especially for the control of capillary oozing. This means of treatment was favorably brought to notice by the late Charles T. Hunter, of Philadelphia. We are in the habit of wetting a towel or napkin in hot water, squeezing out the redundant fluid and placing it against the bleeding surface, retaining it there with firm pressure for a short time. After its removal the surface will present a blanched appearance. In cases of oozing after the wound has been closed with stitches, and the drainage-tube has been inserted, the wound can be slightly distended by obstructing one end of the tube and injecting hot water through the other, permitting the water to remain for a minute and then draining it off. Care must be exercised, especially when a patient is under the influence of ether, that the water does not scald the part. In abdominal and pelvic surgery Profuse Bleeding from Torn Adhe-