I now return to the external treatment. When the dressings described,
§ X, XI, XII. have begun to procure a discharge of matter, the use of
the vulnerary powder and oil of turpentine must be laid aside; but
we must continue to assist and promote the suppuration for several
days, sometimes even to the eighth; by dressing with the digestive,
I shall hereafter mention, by keeping the parts constantly covered
with emollient fomentations, and by avoiding to cleanse the wound
too much, either by too strong compression, or by wiping it with
too much exactness each time of dressing. We ought to be very much
on our guard with respect to these two last points, till there be a
sufficient suppuration; afterwards a somewhat stronger compression may
be allowed, and the sore may be wiped with more exactness, but still,
nevertheless, but very gently. For suppuration is the work of nature,
an effort of the sound parts, by which they throw off whatever is
vitiated and noxious; and it is the business of the surgeon to assist
this salutary operation, by removing, with his instruments, such parts
as are intirely corrupted; but this ought to be done, at least as much
as possible, without causing any discharge of blood[14]. He must not,
however, confine his attention to the soft parts only, but must have an
eye likewise to the bones; and, after having examined them carefully,
and even made what dilatations may be necessary for this examination,
he must remove, at each dressing, whatever is carious, and all the
splinters that can be extracted without violence; after which they
may be covered with the balsam for the bones, § X. and the soft parts
dressed, as circumstances may indicate, either with dry lint, or with
some digestive ointment, especially that which I shall describe bye and
bye, quickened with a little essence of myrrh.
All these dressings should be finished as expeditiously as possible,
in order not to leave the sore too long exposed to the air, especially
the cold air, which may be avoided by dressing the patient in a room
moderately warm, and by holding a few live coals near the part which is
dressed.
When there is a large suppuration the wound must be dressed twice a
day, beginning always, as I said before, with carefully examining
the state of the bone, with removing such shivers as are separable,
with rasping and trepanning where there may be occasion; leaving to
nature, assisted by the balsam, § X. what cannot be extracted by manual
assistance.
The digestive ointment for the fleshy parts, which I commonly use, and
which I have already recommended, is the following; _Oil olive, half
a pint, and an ounce of red saunders boiled together, till the oil
acquire a deep red colour; when it is strained, add a pound of yellow
wax, and a pound and a half of turpentine; when the whole is mixed
and melted together over a gentle fire, a little balsam of Peru may be
added._
This medicine is principally of service in cases where, on account
of the proximity of the bones, we would not chuse too plentiful a
suppuration.