mushy poultices to wounds; and against the excessive employment of bloodletting in the treatment of wounds." He exhibited his conservatism in still other ways. Thus, for example, he was very slow in reaching a decision to amputate a limb or to remove splinters or larger portions of loose bone from a wound, for he put greater trust in the reparative powers of Nature than did most of the surgeons of that day. Wuertz was also slower than were most of them in resorting to the operation of trephining the skull. His ideas with regard to the nature of gunshot wounds were not very clear, for he still believed that the projectile caused some burning and a certain degree of poisoning of the wound; but he condemned all unnecessary efforts at extraction, especially by means of complicated instruments. It was better, he said, to wait until the bullet or other missile manfested its presence at some easily accessible spot in the body.
The statements made above bring out some of the good features of Wuertz's treatise. This work, however, says von Gurlt, also contains not a few bad features, and among them he mentions the fact that it abounds in repetitions and in evidences of the author's superstitiousness.
Some of Wuertz's comments on the symptoms which occasionally develop in cases of injury to the head, and the suggestions which he makes as to the treatment that should be adopted, throw considerable light upon his mode of procedure in the presence of certain surgical phenomena. The following clinical lesson is based upon three hypothetical developments in a case of cranial injuries:—
(1) The patient's wound in the head, let us suppose, has to all
appearances healed, when it unexpectedly becomes swollen and
painful and begins to discharge again. What measures are
indicated under these circumstances? The wound should at once
be freely reopened, for it may confidently be assumed that such a
lighting up of the local symptoms is due either to a loose splinter
of bone that is trying to escape or to the presence of a small area
of bone caries. If, under these circumstances, you should not
establish a free opening a large abscess will surely collect in that
region and will soon make for itself a new outlet.
