Vol. 60, 1909 - University of North Carolina at Chapel Hill

ORIGINAI. COMMUNICATIONS. 157
mainder of this paper, and have frequently must be left to God's Providence and the
quoted him. strength of the patient's constitution."
In his preface he states that he was lead The closure of an abdominal wound by
to attempt such a work "because of the suturing was termed gastroraphy and was
general ignorance and insufficiency of the resorted to only when the wound was so
young surgeon and student in this branch large that it was impossible to retain the
of Physic, which at the time universally intestine in any other manner, and when a
prevailed throughout Germany especially, large wound divided the muscles transand
because the generality of surgeons, be- versely, the peritoneum remaining intact,
ing unequal to the more difficult operations, In an operation concerned with a hernia
were content with being able to cure a slight the rule was to leave the peritoneal sac and
wound, open a vein or abscess, or at most all or most of the wound open, and to introset
a fracture or reduce a dislocation, leav- duce a tent; the wound was left to heal by
ing the rest to quacks." granulation. Heister tells us that in his
The necessary qualifications of a surgeon time the Russian surgeons frequently ligatas
laid down by Celsus, held good in 1700, ed the sac.
and were as follows: " He ought to have We are told that a great many cases of
quick, clear sight, intrepid mind, void of hydrocele in infants can be cured by fastall
tenderness, so as not to be at all moved Ing, chewing a little nutmeg every morning
by the outcries of his patient, to use no and breathing on the parts at the same time
more haste than is required, nor to cut less every day. When this failed it was customthan
is necessary." ar>' to bind a piece of caustic to the scrotum,
Prognosis concerning a wound or opera- retaining it there until the sac was open and
tion was given with reference to age of pa- the fluid had escaped, then to pack the sac
tient, the climate and as to whether the pa- with lint for a few days,
tieut was "Ilydropical, Consumptive, Scor- Before resorting to the use of instruments
bulical or Pocky." to elevate a depressed fracture of the skull
The care of wounds formed a large part a sternutatory powder was highly comof
the duty of a surgeon at this time on ac- mended, it being asserted that "the distencount
of the numerous wars and the fre- tion of the brain is so violent in the act of
quency of personal encounters. At the first sneezing that it will restore the depressed
visit the surgeon was called upon to pro- parts of the bone to their former situation."
nounce the wound either "curable or mor- It is interesting to note in this connection
tab" A wound was mortal when "it could that fracture of the skull by conire coup
not be remedied by all the art and industry was recognized and described by Hippoofman."
A curable wound was said to crates.
become mortal per accident, when the death Any preternatural enlargement of the
of the patient was "occasioned by his own body situated beneath the skin was called
ill conduct or by the ignorance or neglect a tumor, if it grew "from or upon the skin
of the surgeon, such as the failure to remove it was called a wart corn or excrescence."
a foreign body or to provide passage for In 1700 any new growth was either a
the discharge of blood from thorax or abdo- scirrhus or cancer. The definition of
men. scirrhus was 'any hard tumor situated
In wounds of the abdomen we find the beneath the skin and void of pain." The
following directions: "If you can discover tumor was thought to be due to the "inspisby
your eye or the touch that any viscus sation and induration of the fluids of the
situated in the abdomen has received a part, resulting from a previous inflammawound
from a sharp instruuient it will be tion." Trauma was the second factor in
advisable at the first dressing to fill the the production of a scirrhus, and when not
wound as tenderly as possible with a good due to either one of these causes it was
quantity of lint, well saturated with high ascribed to heavy phlegmatic, melancholic
rectified spirit of wine or spirit of turpen- habit of body." It was considered "no
tine, by this means the hemorrhage will be difficult matter to determine the principal
stopped, if no large blood vessel is divided, cause of a scirrhus." A scirrhus could
At the second or third dressing a tent should "cause inflammation, exulceration, cancer,
be introduced to provide proper passage for gangrene, tabes, stiffness or immobility in
the discharge of grumous blood and other the neighboring parts."
matters, which may kill the patient. If the A cure was attained with great difficulty,
patient is of plethoric habit of body it will palliative measures were not to be relied
be proper to bleed him, to prevent inflam- upon, and removal was difficult and danmation
and fresh effusion of blood. Also gerous because operative interference was
give him daily two or three doses of Mei- not indicated until there was great pain or
bomius's Balsam, which is of great efficiency the size of the tumor demanded it.
in healing internal wounds. Wh.nt remains When it could not be "dispersed, softened