The homeopathic practice of surgery, together with operative surgery, illustrated by two hundred and forty engravings. By B.L. Hill, M.D., and Jas. G. Hunt, M.D. / Title Contents

Title Contents

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Entered according to Act of Congress, in the year 1855, BY B. L. HILL, M. D., & JAS. J. HUNT, M. D., In the Clerk's Office of the District Court of the United States for the Northern District of Ohio. HUDSON, OHIO: Stereotyped and Printed by the Hudson Book Company.

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PREFACE. To those who have been desiring the speedy publication of this work the first on Homeopathic Surgery —some explanation of its tardy appearance is due. The reasons may be summed up as follows: —The desire to make the work as perfect as possible, embracing both that knowledge already written and that evolved in the clinical experience of the Homeopathic profession; the difficulty and time consumed in obtaining and condensing communications from our physicians; the severe labor necessary

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Vi PREFACE. The work is designed as a text book for students, and an aid to practitioners generally. Inasmuch as practical experience in our Science dates back but a short time in this country, it can not be supposed that any one man would have sufficient experience in "Surgical diseases" (a considerable portion of which are of rare occurrence), to enable him alone to furnish the proper material for such a work. We are well aware that in all our attempts at produci

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PREFACE. VU with the promise of the desired contributions; which from time to time were received. To those who thus responded we tender our sincere thanks, particularly to that veteran in Homeopathy, Doctor C. Neidhard, of Philadelphia, for the number and completeness of his communications. Had each old experienced practitioner done as well, we have no doubt that the profession would have had much valuable matter- now lost to them. In the preparation of this work, in

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PART 1. CHAPTER I. INFLAMMATION IN ITS GENERAL ASPECTS. Inflammation- Inflammation not a disease, nor "the reparative principle"Etymology - Heat and other vital manifestations - Excess of, vascular or nervous? - Simplistic questions and varied researches - Acceleration or Retardation? — Chemical and Microscopical results- Inflammation not indispensable to recovery from local injury -Its stages up to "mortification," and particularly of suppuration. "INFLAMMATION," says the celebrated surgical p

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2 INFLAMMATION Modern chemistry would accept the definition, with the addition of "too fast." Liebig has a complete " Theory of Disease," founded on and confirming this simple idea. The slow combination with oxygen throughout the body, as well as in the lungs, is made not only to explain the problem of animal heat, but of the common morbid increase of temperature. The degeneration of the diseased parts, and the subsequent decomposition, of the whole, are accounted for on

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IN ITS GENERAL ASPECTS. 3 responding maxim, " Kings or sovereign bodies can do no wrong" is to common sense untrue, absurd, and practically mischievous. As the political doctrine alluded to, the divine right of kings, led to the servile corollary of "passive obedience," so the divine infallibility of nature points consistently to non-interference, and letting nature take her course in all cases. Strange as it may appear, this practical reductio ad absurdum has not daunted some

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4 INFLAMMATION and makes great use of this distinction, speaks also in perfect consistency of " too much health," or, " health above par." These expressions would be regarded by most as involving absurdity; and perhaps " healthy inflammation," though it is hardly possible to avoid its use, may come to be considered a contradiction in terms. Increase of other vital properties, besides that of heat, is so obvious in inflammation, that the fact has for a long time been consid

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IN ITS GENERAL ASPECTS. 5 would more frequently hold than "pain," if by that be meant spontaneous sense of suffering, without any external cause. A change of action tending to, if not, also, resulting from a change of structure, may be regarded essential to our modern idea of inflammation. Placing this characteristic tendency first, as more important than the sensible appearances, Druitt suggests the following definition as an amendment of one given in a French Medical Diction

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6 INFLAMMATION a prior, but almost synchronous change in its innervation, from the ganglionic system of nerves. An active determination of blood to the brain (for instance) may be for a while quite distinct from cerebritis, but is very apt to lead to some form of it. A cupping glass, producing all the external "signs" of inflammation, would actually cause that state, if not removed. Over-stimulation of a part by blood, even in its healthy state and flow, is itself irrit

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IN ITS GENERAL ASPECTS. fashionable, and still too prevalent, confidence in "starvation;" and at one period, not many generations back in the dark ages, patients, with certain fevers or inflammations, were absolutely refused fresh air! As to the great internal stimulus, the living fluid, or fluid life itself, it is unnecessary to point out to those who have witnessed the abuse of blood-letting, and wish to learn something better, —how destructive has been the consequence of a partial and supe

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8 INFLAMMATION phizing, is no doubt much safer than such hypothetical theorizing, yet it is in vain to protest against hypothesis and theory. All men theorize to the extent of their leisure and ability. The only question is between good theorizing and bad, reasoning with facts or without, or with few or many. It is speculation that stimulates observation and directs experiment. Hypothesis anticipates experience, and is only injurious when mistaken for it. Ideas are necess

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IN ITS GENERAL ASPECTS. 9 flammation." One satisfactory test of the one-sidedness of such views is suggested by this author- that of availability in practice. Could the morbid state in question be really accounted for on either hypothesis, or any other " simple idea which fancy might fix upon," such state, so easily understood, could be as easily treated. If the question could be settled or arranged as the old kindred one in nosology, between diseases of increased or decrease

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10 INFLAMMATION In the investigation as to the nature of inflammation, the advocate of both sides of "the question" have found it necessary to vary and modify their enquiry, and make many limitations and discriminations not before thought of. The subject has not been allowed to remain as a merely curious and limited physiological or pathological question. Comparative Physiology and even Pathology have been brought to bear upon it. The enquiry has not been restricted to what

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IN ITS GENERAL ASPECTS. 11 fashion, appears really to be the result, not perhaps of inflammatory blood, but of a modification of the blood accompanying inflammation. There is found, on actual analysis, to be nearly as much as one per cent, more fibrin in the circulating fluid in some cases of inflammation than in health, and less than the average proportion in certain typhoid or non-inflammatory diseases. Fibrin appears to be the material of nutrition and of the reparative pro

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12 INFLAMMATION said by Carpenter to be " always conjoined with a depressed vitality of the tissues of some part of the body, which indisposes them to the performance of their regular nutritive operations; and this part may undergo a variety of changes, according to the degree in which it is affected." This "depressed vitality" is shown to involve a languor in the movement of the blood, with which the capillaries are distended. There is nevertheless a determination of blo

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IN ITS GENERAL ASPECTS. 18 scopic, or what may be called, from analogy to chemistry, atomic anatomy, the colorless corpuscle or molecule of fibrin, becomes a "primordial cell" or cytoblast. " Corpuscles" seems a correct name for these organic atoms, for they appear to have their own independent vitality, even anterior to being organized, or assimilated to already formed structures. The serous part of the blood or lymph is the first nutriment of these cell-germs, and hence call

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14 INFLAMMATION from structural injury to the solids, that "contused wounds" are so troublesome. In "lacerated wounds," the careful surgeon always removes clots of blood, and sponges out all he can that is yet fluid, as if still living, it must, in that situation, soon die and become a source of irritation. When the direct injury causing the inflammation has been greater, when the "depression of vitality" amounted more nearly to extinction, or when the inflammatory proce

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IN ITS GENERAL ASPECTS. 15 scesses, though limited by the effused and organizing fibrin, become ulcers, the pus "eating" its way out. If the original injury or the subsequent inflammation itself be so great as to cause the disorganization of a sensible amount of the solid structures, we have what is called sloughing. The difference between this result and that of mere suppuration being that the solid matter is not so easily converted into pus as the devitalized fluids. In thi

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16 INFLAMMATION cases," that of caustics, by the fact of their destroying these peculiar cells and the adjacent matter partially affected by them; and thus to draw another argument for the necessity for inflammation. He speaks of the inflammatory action beneath the surface killed by the caustic, as the only possible mode by which "fibrin can be effused and preparation made for filling up the breach of substance." The treatment he appeals to, is undoubtedly the best in ma

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IN ITS GENERAL ASPECTS. 17 The slight exaltation of vital action that seems necessary to the recuperative process, is but that process in operation, the performance of overwork and the making up of lost time, in the more active resumption of functions that have been impeded. When the amount of the injury, or the want of steady healthpreservative power in the constitution, is such that this resumption of increased business on the part of nature cannot be got through without evid

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18 INFLAMMATION CONTINUED foe the portion of society that can best be spared, to preserve the rest from destruction. Here, too, the analogy with inflammation holds strictly. The preservative process or means often turn out destructive to friends, more than to foes. The arming of society is often found an "inflammatory" and disorganizing business,a fatal necessity. CHAPTER II. INFLAMMATION CONTINUED UNDER ITS MOST PRACTICAL ASPECTS. " The four Signs" -Constitutional Symptoms- Ch

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UNDER ITS MOST PRACTICAL ASPECTS. 19 The pain may exist in or be referred to parts distant from the seat of the inflammation. In the hip disease the first complaint of the patient is often "pain in the knee." The character of the pain, as well as the amount, differs in the different structures and tissues. Throbbing is the characteristic of proper phlegmon or circumscribed inflammation in the cellular structure: and a dull heavy sensation that of the substance of most of the inte

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20 INFLAMMATION CONTINUED of temperature was discoverable. Hunter sometimes failed, after exciting artificial inflammation in animals, to ascertain any definite increase of heat. It has been generally allowed, however, that in the lower extremities, and other parts distant from the center of circulation, the inflammatory state raised the temperature a few degrees, -up to that of the heart or lungs; and this slight change was attributed wholly to the increased quantity, and more

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UNDER. ITS MOST PRACTICAL ASPECTS. 21 and not in " single file." As the inflammation advances new vessels may also be formed, thus adding to the degree of redness. This varies with the structure of the part, the kind of inflammation, its amount, stage, &c. It is greater, for instance, on mucous membranes than on the skin. There is said to be " uniform redness" in Erysipelas, "capilliform" when only some of the capillaries are rendered visible, as in conjunctivitis. There may be

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22 INFLAMMATION CONTINUED below their average of functional power. The secretion proper to the part is always modified or checked at the commencement of inflammation, but subsequently it is often greatly increased and mingled with the products of diseased action. Structural change becomes chiefly manifest in chronic inflammation, the acute ending in complete destruction or more or less incomplete restoration. Increase of weight is often a marked symptom or sensation of the patien

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UNDER ITS MOST PRACTICAL ASPECTS. 23 result of a dyscrasia, predisposing the individual to inflammation, or to an unfavorable modification of it, when produced from ordinary causes. Thus, scrofulous swellings or other inflammations in scrofulous patients, are easily excited, but difficult to reduce. Their progress is tedious; and a thin fluid, with curdy matter, takes the place of serum and healthy fibrin, or of consistent "healthy pus." After these explanations, it is hardly nec

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24 INFLAMMATION CONTINUED often sufficiently distinct. Hence the kind, as well as degree of danger, is different in the two cases. Such expressions as "Adhesive Inflammation, Suppurative, Ulcerative or Gangrenous Inflammation," must be understood as descriptive, as denoting degrees, stages or accidental tendencies of the same action, rather than distinct kinds of diseased action. All these peculiarities may depend on the state of the patient's constitution, the part affected, an

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UNDER ITS MOST PRACTICAL ASPECTS. 25 vigor and freedom from aberration of " the restorative principle," i. e., by recovery from local injury without, or with little, inflammation. It is a familiar observation, that " some people's flesh will not heal like others." Some are in danger of bleeding to death from the smallest wound, and are hence said to be of a hemorrhagic diathesis. Others, it might be also said, have a suppurative or gangrenous or at least inflammatory diathesis. "A

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26 INFLAMMATION CONTINUED posed cutis is liable to suffer from cold air; from which, however, it is protected, if not artificially, by a thickening of the matter effused into what is called a scab. Small and distinct elevations of the cuticle are called " vesicles." If they contain pus instead of serum, they are distinguished as "pustules," and the process of their formation "pustulation." Pimples, rashes, &c., might perhaps be mentioned as peculiar results of cutaneous inflamma

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UNDER ITS MOST PRACTICAL ASPECTS. 27 ened and indurated. Their liability to ulceration and gangrene has been disputed. Tendons and Ligaments are both described by Sir Astley Cooper as "not very susceptible of inflammation," at least in healthy persons. The pain, however, produced by injuries of the former, particularly punctures, is more than a set-off for this exemption, oftener producing tetanus than in any other part. The synovial membranes connected with the ligaments, are ve

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28 INFLAMMATION CONTINUED of the joint or bone with which it is connected. All the usual phenomena of inflammation take place in the BONES; their gangrene and mortification, however, are usually spoken of under distinct names, as " caries and necrosis." The result of their suppuration is often diagnostic, "bone-pus" being so rarely healthy, that it is synonymous with ichor, generally foetid, and often quite dark. CAUSES. - Of the "proximate cause" of Inflammation enough was sai

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UNDER ITS MOST PRACTICAL ASPECTS. 29 membranes, appearing to divert the excessive activity or "force" then generated. This is one reason why it is often spoken of as a termination. The pain attending this process is "thrilling," while in SUPPURATION it is dull and throbbing, with a peculiar sensation of uneasiness in the part. When the suppurating tumor is near the surface, the formation of matter is preceded by flush on the skin above, and followed by the tumor rising and becoming

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30 INFLAMMATION CONTINUED taken back into the blood, and thrown by it on internal parts, are well known. Abscess, as a result of suppuration, has been before explained. The pus is confined by the inflammatory effusion itself. The abscesses produced by acute inflammation generally run their course, including the necessary ulceration for the discharge of matter, in less than three weeks. The situation of the matter has, however, much to do with the period, as well as the amount o

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UNDER ITS MOST PRACTICAL ASPECTS. 31 of the new structure. These are red in color, and generally-protected by a covering of pus. They rise in successive layers, as the fibrin is thrown out, and the vessels from the parts beneath elongate and branch through them. After the cavity is completely filled up, and closed over with skin, "the granulative structure is absorbed and a contracted cicatrix is left." When divided parts, or the walls of emptied abscesses are not brought toge

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32 TREATMENT OF INFLAMMATION, class of physicians in question, bleeding is now the exception in cases where it was once the rule. Its direction by the authors is accompanied with so many conditions and qualifications, that a. cautious beginner can never be sure when he is warranted in resorting to this once never-failing expedient. Still it is the remedy of the books, and sufficiently relied on for other better means to be habitually neglected, even when that also is omitted. A l

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TREATMENT OF INFLAMMATION. 33 secured "resolution;" if not, suppuration or sloughing must generally ensue. Now blood-letting, by merely lessening the general amount of the circulating fluid, can certainly have no direct tendency to bring about this desirable result. The amount removed is drawn in at least equal proportion from all other parts, which then have an inadequate instead of a superabundant supply. The inequilibrium must therefore be increased instead of lessened. Th

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84 TREATMENT OF INFLAMMATION. the brain. It is a cold, clammy death-sweat. In the natural action of this function, the whole surface of the body is in the active condition, warm and red, and the pulse full and soft. Experience confirms physiology in showing that blood-letting cannot effect the object for which it is practiced. It is now, indeed, sometimes said that the bleeding is rather a preventive than a curative measure; that it is chiefly useful as a means of gaining tim

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TREATMENT OF INFLAMMATION. 35 for inflammation are now so many, that they will no doubt become the rule, even among Allopaths. It is well known that Homeopathists have always proscribed blood-letting. TOPICAL BLEEDING is a very different measure from venesection, but this is liable to many of the same objections,. The same quantity of blood, taken just seen, from their systems not knowing when to give the fainting sign of "hold, enough!" but the fat and some of the f

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36 TREATMENT OF INFLAMMATION. slowly and gradually from the small vessels of the part, will not produce the same immediately dangerous effects. There is no shock produced upon the general system, the vessels having time to contract so as to reduce their calibre to the amount of fluid contained. Still, if much blood be taken, even in this way, evil consequences must ensue. But the great objection to local bleeding is, that the necessary applications cannot be made directly to

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TREATMENT OF INFLAMMATION. 37 rounding ones nearly exhausted also, it is confessed that little or no good can be done. LEECHES are, in some countries, and by some practitioners in this country, the most approved means of local depletion. But of these agencies in surgery it may be said, as of blood-letting in general, that the cautions necessary to be observed in their use, nearly amount to a prohibition.* Besides, they must not be applied directly to the part inflamed;

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38 TREATMENT OF INFLAMMATION. Dismissing the subject of abstracting blood, together with cathartics, &c., as measures not only unnecessary, but highly injurious, since healthy organs are attacked in order to relieve diseased, the vital force is impaired, and the means employed have no special adaptation to the end proposed,-we will speak briefly of the SPECIFIC OR HOMEOPATHIC TREATMENT. Its simplicity, its harmlessness, is in as strong contrast to other modes, as it is superior in

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TREATMENT OF INFLAMMATION. 39 superior to the depleting means usually employed, will be needed, and in some cases, Belladonna, Bryonia, Cantharis, Mere, &c., are useful. (For the particular indications for each remedy, see WOUNDS, ABSCESS, DISLOCATIONS and FRACTURES.) The local applications will be spoken of in connection with the different classes of injuries, but we would state here the general rule for their use. Immediately upon the occurrence of an injury, and until consider

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40 THE DIFFERENT KINDS OF WOUNDS, &C. CHAPTER V. THE DIFFERENT KINDS OF WOUNDS, ERYSIPELAS, TETANUS, AND HYDROPHOBIA. DEFINITIONS - Simple, &c. - Cuts, Bruises, &c. - their respective importance, pain, bleeding and danger - TREATMENT - Incised Wounds and HemorrhageCompression, Styptics and Ligatures -Punctured and Penetrating Wounds - Suppuration - Lacerated and Contused - Irritation, Gangrene, &c. - Gunshot Wounds - their varieties and peculiarities - Probing, &c. - Calendula - Poiso

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THE DIFFERENT KINDS OF WOUNDS, &C. 41 — the incised; the punctured and penetrating (distinguished by their depth); the contused and lacerated (often connected); those occasioned in any way by explosion of gun-powder, and called for convenience "gun-shot wounds;" and lastly, those that, besides the mechanical injury, are the means of introducing into the body some poisonous substance. 1. An Incised Wound is, in plainer English, "a cut" — more precisely defined as a "solution of contin

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42 HEMORRHAGE, PAIN AND DANGER. a ball, may inflict severe injury. The stratum of air impelled before the ball, or contained between the ball and the skin, is doubtless sufficiently condensed to impart a decided impulse to the surface that is grazed. The subject of cannon balls will be found more curious than practically important, except to surgeons in the navy or army. The rifle or pistol balls, with which the surgeon is more likely to be concerned, generally make at once a punctu