Reason vs. tradition in the treatment of certain injuries to the wrist-joint / by L.S. Pilcher.

  • Pilcher, Lewis Stephen, 1845-1934.
Date:
[between 1870 and 1879?]
Catalogue details

Licence: Public Domain Mark

Credit: Reason vs. tradition in the treatment of certain injuries to the wrist-joint / by L.S. Pilcher. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    ceiving us, has given unlooked-for success. They have strongly shaken the faith we had in the therapeutics preconceived by our predecessors and our masters, in forcing us to recognize that the application of immovable bandages in acute sprains has been the most powerful cause of the deplorable effects disclosed by the venerable surgeon of Val-de-Grace. Rest, immobilization ! Mobilization, use ! The Old and the New ! In support of the former, venerable tradition and great authorities; in support of the latter, few names, some recent experience. Placed in the crucible of clinical observation, the results given by the former are con- fessedly tedious, uncertain, often unsatisfactory, sometimes disastrous; by the latter, certainly no worse—they could not well be; on the con- trary, if its advocates may be believed, rapid, reliable, complete. But no medical fallacy, from the earliest times to the present, has pre- vailed, which has not been able to summon an ample clinical experience in its support—nothing so preposterous or incredible, the value of which has not been apparently clinically demonstrated, and in proof of which unlimited certificates may not be marshaled. Empiricism and rational- ism in medicine must be mutually corrective, if true progress and relia- ble inductions are to be made. A rational discussion, then, of the treatment of sprains, based upon a comprehensive appreciation of all the pathological conditions and pro- cesses presented in such an injury, is necessary to a true decision of the merits of different methods proposed. That method with which both empiricism and rationalism most completely square must be accepted by the scientific surgeon. No conclusion, however, can be considered as final; for the possibility will always exist either that we misinterpret what facts we have, or else that other facts exist not yet discovered by us— unknown factors, unexplored remainders, which, when they shall be- come known to us, will again modify our conclusions. As bearing upon a conclusion as to the rational treatment of sprains, I submit the following theorems as principles of pathology and physi- ology, which need no demonstration at my hands; they are our com- mon property—legacies received from Hunter and Paget and Simon: Sprains are subcutaneous injuries. In general, injuries which are subcutaneous seldom inflame. The most obvious immediate result of a sprain is swelling of the part. This is due partly to extravasation of blood, but usually much more to the rapid afflux of blood to and exudation of fluid from the vessels in the injured part. This active congestion, upon its subsidence, leaves the blood vessels of the part di- lated, and the blood stream more sluggish than natural for a time. If this condition is prolonged and intensified until complete stagnation of the blood current is produced, the initial condition of inflammation is supplied. The exudation consists chiefly of serum; mingled with it is a small proportion of