As the subject for a paper, this topic sounds large, for the majority of surgical procedures is based upon previous infection. For example: An infected appendix is followed by an appendectomy; an infected gall bladder, by a cholecystectomy; pus tubes, by a general sub-total hysterectomy. That this general removal of internal parts could be avoided many times, goes without saying, if the patients had heeded the first warnings which Nature gave, but humans are slow to place themselves under observation and treatment, until an operation is deemed imperative. Thus the internist has little chance to be of aid.
In addition to his inevitable major surgery, there is also that branch of surgery, dealing with infections of external parts, due to injuries which break the continuity of skin and allow infecting organisms to enter the tissues. These injuries may be as simple as the pulling out of a hair, the scratch from a pin, a hang nail or a silver in the finger, a bruise, a bled or a blister, the pricking of a pimple.
All of these are harmless and heal perfectly, if no infection occurs, or if the patient is in his usual perfect health, so that one pays little or no attention to them. But if the injured person is exhausted by long hours, is depleted through worry, or ill from any cause, the simple injury suddenly develops a virulent infection; there is redness and heat with red streaks going from the point of injury toward the heart.
These red lines show the channels of the lymphatic circulation which is seeking to localize the infection, by carrying the products of infection to the nearest node, before it becomes systemic, or develops into general septicaemia, a condition dreaded by both the laity and physician, because of its destructive action on life and limb. When these signs of sepsis manifest themselves there is no further delay and the doctor is asked for quick assistance.
Around the seat of the injury is swelling and heat, and throbbing pain is complained of by the patient. Upon examination some fluctuation may be felt, so under asepsis, a liberal incision is made.
If pus has already formed, it will come to the surface of the incision and the relief afforded, can be seen in the patients face.
If time will permit, (and it should be taken), the part of the body having the infection, is submerged in hot water, just as hot as the patient will stand. The part is kept submerged from one-half to one hour, constantly adding hot water to keep the temperature high. If no pus was found upon opening, some will appear by the end of the period of submersion, and the patients, sense of relief well repays the time spent.
Upon the removal from the water, a wick of gauze is pushed well down into the wound to prevent closure, the part is dressed in sterile gauze saturated with glycerine and creolin, 16 to 1, and the whole covered by a sterile bandage. If there was no fluctuations or severe pain no incision is made, but the patient is given the same treatment because it many be possible to abort the formation of pus, or if not, the treatment will show it up at the next visit.
As the patient leaves the office, he is given Hepar sulph. 6th if pus was found; if no pus, Hepar sulph. 30 th 200th to be taken every 2 to 4 hours. When first seen, if the condition shows symptoms of septicaemia, Silica, Hecla lava, or tincture of Echinacea is prescribed, or whatever remedy may be indicated. Also the patient is given some tablets of Chlorazene, made by the Abbott Laboratories, of Chicago. These are the Dakin solution used so much during the war, and as they release chlorine when put in the hot water, the patient gets (or is sure he gets) an antiseptic solution to bathe the part in, all of which has a useful mental effect.
He is instructed that two to four hours after the submersion in the office, he is to carefully remove the dressings, prepare his hot water as was done in the office, put in two Chlorazene tables, and submerge the part for one-half to one hour; then to re-dress in the same dressings in the same way as was done of the office. The procedure is repeated every two to four hours until his return to the office 24 hours later. It is very interesting to see how much more the patient is enthused about recovery by this work he does at home, than when the doctor does it all. The enthusiasm helps to build his morale, for a patient headed toward general septicaemia is a scared patient.
This line of therapy is followed, enlarging the incision if necessary, increasing or decreasing the frequency of the submersions, until at least 48 hours have elapsed with no pus found at a regular dressing. The wound is then dressed under sterile vasolene saturated gauze, until healing has occurred.
When the injury occurs upon the body, a submersion of the whole body in a bath tub may be ordered, or the placing of hot Turkish towels over the injury will do the work.
The success of the medical-surgical-hydro-thermic method depends upon the use of all the elements mentioned, but the heat of the water is especially important. A warm bath will accomplish nothing, and the application of dry heat is not beneficial. The water must be hot, the hottest the patient will stand. The doctor must test the water himself. Not until the patient gets the real relief from the very hot water of his first application can be trusted to regulate the temperature for himself, therefore, the benefit of the first treatment in the doctors office. In this connection, the story of little Joe will illustrate; Joe is a little five-year-old, who last winter, fell on the frozen ground in a vacant lot and cut his leg on a broken milk bottle.
He was brought to the hospital with a bruised, ragged wound, cut to the periosteum, dirty and not bleeding too well. Under gas anaesthesia the wound was cleaned as well as possible and sutured, with a faint hope that his youth might allow healing by first intention. At the end of two days, this hope faded and pus appeared, necessitating the removal of the sutures on the third day. There was nothing to do but treat the septic condition and prevent a general septicaemia.
Joe had been taken home on the same day that the accident had occurred, so it meant going to his home to do the work. The hot water was prepared, with Joe crying with pain. He was invited to put his foot in the water. He did, but removed it so quickly, accompanied with a howl, that we saw something was wrong. By dint of much cooling and persuasion, the leg slowly went back. Cautiously the temperature was raised, the pain began to subside and Joes tears changed to smiles, as he said, “More hot water, more”. Joe was all ready for each application and he insisted that the water be hot. He even used to get his parents up in the middle of the might to give him a hot bath, if his leg pained.
It required some weeks to clear the pus, and some time longer to granulate the would. Whenever the healing slowed, Joe called for his hot leg bath.
Water, being a solvent, softens the tense, infiltrated tissues; the heat is homoeopathic to the inflammation or heat in the part, the action of the hot water causes relaxation, pinched nerves are released, the increased blood supply in the part is allowed to flow out, which lessens the congestion, and a fresh blood supply can come in, bringing phagocytes and needed repair material. Between the periods of submersion, the excess water in the tissues is removed by the dehydrating action of the glycerine in the dressing.
The creolin prevents further infection, while the artificially speeded up circulation slows down to normal. Then, as the hot water is again applied, the increased circulatory action, removes products of waste and a new blood supply comes in. In the meantime the internal remedy is aiding in raising the resisting powers of the patient and thus the union of forces is at work all time, striving to restore the patients to normal, removing the general septicaemia.
The writers attention was first called to the action of creolin and glycerine during his college days in the dispensary. The value of a physician, whose left index finger showed infection two days after he had lanced a jaw abscess on a child. A brother physician was consulted, the finger was dressed and Hepar sulph. given internally. At the next dressing a free incision was made, followed by a good show of pus. At the fourth dressing a cross incision was made and Pyrogen prescribed.
However, the infection went merrily on with lots of pain. At the fifth dressing another confrere suggested the application of hot water. The patient went home, rigged up a small gas flat and with flame turned low furnishing a constant supply of hot water, in which he placed the whole hand and practically cooked the infection out. After the first application the pain ceased, but for ten days the treatment was continued with the result that the finger was restored to normal and the loss of a life, or at least an arm, was prevented.
Up to the beginning of the heat treatment there had not been the least response to treatment and the patient was growing steadily worse.
