Report on the pathology of the diseases of the army in the East.
- Lyons, Robert D. (Robert Spencer Dyer), 1826-1886.
- Date:
- 1856
Licence: Public Domain Mark
Credit: Report on the pathology of the diseases of the army in the East. Source: Wellcome Collection.
Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.
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![exposed, and the great muscles of the thigh undermined in a more advanced stage. We have also known large htemoriiiages to he thus produced. In one or two cases only have we seen any parallel to this condition of things in the Englisli Hospitals. In one, an extensive phagadenic process laid hare some four or five inches of the anterior external surface of the tibia, with extensive destruction of the neighbouring muscles and other textures. In another instance of shell wound in the calves of both legs, extensive ulcera- tion had been established. The muscles beneath these ulcers were found to have under- . gone the fatty degeneration. In this case the patient, though affected with Scorbutus and Dysentery, liad apparently survived the first violence of the phagadenic process in his wounds, but the system did not possess suthcient power for the establishment of a repa- rative process. The long continuance of the diseased process and the inaction of the parts account for the fatty degeneration in tlie muscular structures. While in the active condition, the microscopic appearances presented by the debris of tissue in this class of cases consisted of ill-formed cells, approaching, in the more perfect, to the form of the pus cell. They vv^ere, however, more generally elongated, or of an irregular angular form, sometimes caudate and clear, being void of central granular deposit. A large amount of granular matter was the most abundant element, and when the matter from the raw and marginal aspect of the sore was examined, a few exudation corpuscles were found. Vibriones were abundant, as might be expected. In no respect do these appearances difi^er from those observed in Hospital Gangrene under other circumstances, and as it occurs in this country. We cannot leave this sul:>ject without expressing grave doubts as to the propriety of applying the term Hospital Gangi-ene to any of the varieties of this form of disease. Its essential characters do not seem to be those of a true Gangrenous process. True Local and General Gangrene.—The next class of cases which we shall notice embraces some very formidable and remarkable examples of disease. It includes instances of what may be termed local and general true Gangrenous processes. When once developed, the progress of this form of disease was rapid, and its issue invariably fatal. Treatment was ritterly unavailing ; and it is a process which, when once established, there seems no groiuid to hope will ever be under the control of art. With regard to its essential nature, we have been able to determine but little beyond that it most probably recognizes a general constitutional cause. As met with by us, it has been confined to cases of ampu- tation, chiefly, but not exclusively, in the lower extremity, and most frequently to opera- tions in the thigh. We have only knovni one instance in which the condition was but partially developed, and in whicli it did not prove directly fatal, but the patient did not ultimately recover. The most rapidly fatal case of this affection which we have seen, occurred in a lad, aged 18, who received a compound comminuted fracture of the right leg on the 8th of Sep- tember, for which amputation below the knee was performed on tlie same day. The patient progressed favourably, was in excellent, even hilarious spirits till within a few hours of death. On the third day, as tlie dressings vfere about to be removed for the first time, the patient, though apparently Avell as usual, was noticed to be somewhat pale, a little nervous, and with a peculiar expression of the eyes, which were preternaturally clear, exsanguinious, and lustrous. While the dressings were being taken off, he some- what gladly remarked that this process gave him ]io pain. On their removal, the entire stump to the knee Avas found of a dark greenish black colour, disorganized and friable, and perfectly insensible. A slight oozing of blood commenced ; and now, for the first time, the patient became suddenly and overwhelmingly alarmed with the idea of approach- ing dissolution. After a brief interval an extensi\'e hremovrliage guslied from the stump, and before it could be controlled by pressure on the femoral artery, a great loss of blood took place. Even the most careful pressure on the femoral artery did not entirely control the bleeding. The patient rapidly blanched, sank, and life was extinct within two or three liours. It is to be observed in connexion with this case, that owing to the occurrence of haemorrhage, death took place before the development of marked constitutional symp- toms which in other cases were found to attend this form of disease. In no other instance have we known tlie affection to have been so early fatal (third day). It more commonly appeared about tlie fourth, fifth, or sixth da}'-. It was generally preceded by pain, more or less severe, in the stump ; there were also symptoms of general constitutional disturbance, sometimes violent, tumultuous, of sudden occurrence, and not easily explicable ; but these were not constant, and in some of the very worst cases there vv^as little to indicate the danger of the patient, and he was himself the last to suspect it. In several instances the morbid state fully developed, though previously unsuspectod, was first indicated by a peculiar intense odour emanating from the parts and sensible at some considerable dis- tance, and which though difficult to be described, could never be mistaken after it had been once recognized. To those familiarised with it, this odour was perceptible upon entering the ward where the patient lay. On examining a stump thus affected, the flaps were found discoloured and gaping; the whole limb, was immensely distended, and in parts distinctly emphysematous; vesications filled with discoloured serum were not infrequently foun<l near the borders of the flaps; foetid gas and a sanious dark-coloui'ed fluid bubbled out from the wo mid ; the areolar and adipose tissues, discoloured and apparently dead, 0](https://iiif.wellcomecollection.org/image/b21300616_0131.jp2/full/800%2C/0/default.jpg)
