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Constitutional Symptoms in Surgical Cases.

When a patient sustains an injury of any kind, it is a very common practice on the part of the surgeon to treat the local injury, and to pay no attention to the constitutional symptoms, unless the shock is pronouncedly severe and its influence upon the heart and nervous system are plainly marked.

I have long held that the indications for medical treatment should be carefully studied in every surgical case and promptly met. At first in these cases, the shock shows itself by general weakness, by a feeble pulse and usually by retarded respiration. If the pulse be carefully studied, it will be found that it is an index of the degree of shock in its influence upon the sympathetic nervous system; also upon the circulation and the tendency to local congestion.

This latter condition can be determined also a little later on, by the appearance of the eyes, and as time passes, there will be tongue appearances which will show that atony or inactivity of the gastrointestinal tract are progressing, and these will need treatment. The full character of the impression upon the heart must be well studied, and immediate stimulation of the heart will be suggested by careful observation.

In cases where the extent of the injury cannot be estimated upon, as in the case of internal injury, some opinion can be formed of its extent by close observation of the action of the heart, circulation and respiration as named.

To meet the common indications, we have the emergency stimulants. At first, if there are evidences of a primary congestion, belladonna or atropin are directly called for. If a profound impression is made upon any organ, with a marked tendency to stasis with pain, hot applications and belladonna or glonoin will render excellent preliminary service.

Where there has been a direct injury to the brain or spinal cord, ergot is almost invariably demanded to prevent local stasis and to assist in maintaining a proper equilibrium in the circulation. This can be well combined with belladonna. Later, when the circulation is partly re-established, if there is laceration, much muscular soreness, or muscular pain upon movement, it is well to give small doses of arnica at frequent intervals. Aconite or gelsemium should be given for fever.

Where there is severe shock threatened with much pain, a hypodermic of morphin at the onset is demanded; but where the pain or distress is not severe at first, but slowly increases in intensity, the above remedy may abate it or a simple course may be adopted in which a grain of morphin and two drams of sodium bromid are added to two ounces of water, and a teaspoonful given every ten or fifteen minutes until the patient is soothed and the pain disappears.

This is a remarkably satisfactory course if there is a tendency to increasing nervous excitement or agitation from fear or apprehension with a slight injury. Where from laceration or contusion there is danger of subsequent infection, it is an excellent plan to give echinacea or the calcium sulphid in small doses from the first.

These are only general suggestions, but they should lead to a careful consideration of every injury, and make it possible to restore the patient very much more quickly than to leave all the conditions to nature except the plainly marked surgical conditions.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.

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