On spontaneous gangrene from arteritis and the causes of coagulation of the blood in diseases of the blood-vessels / by Joseph Lister.

Date:
[1858?]
Catalogue details

Licence: Public Domain Mark

Credit: On spontaneous gangrene from arteritis and the causes of coagulation of the blood in diseases of the blood-vessels / by Joseph Lister. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    2/18 (page 2)
    under my care. Her general health a])peared remarkably good, considering all that she had gone through: her tongue was clean and moist, and her appetite good, and though her pulse was very quick, viz. 148, this was not to be regarded as a serious symptom in one so young, with such a source of irritation present. Accord- ingly, tliree days later, a line of demarcation having distinctly de- clared itself, I performed amputation immediately above the knee. Very little blood was lost in the operation, which did not accelerate the pulse or impair the appetite even for a day. Tliree days later, the constitution was evidently experiencing relief from the removal of the disease: the pulse was reduced to 112, and her general as- pect improved. The stump healed kindly, and the result was in all respects satisfactory. The amputated limb having been laid open on its posterior aspect, the gangrene was found to have extended somewhat higher in the deep parts than in the skin; the mortified tissues, including the posterior tibial nerve, were congested in a manner closely simulating inflammation, but of a duller tint, and exactly as far as this conges- tion extended, the posterior tibial venae comites were turgid, and evi- dently contained coagulated blood. In the upper part of the limb the veins were flaccid and empty, and all the tissues appeared healthy, except that the popliteal artery, for an inch and a half from its lower end, was the seat of intense congestion, which also implicated slightly the cellular tissue about the vein and nerve. [These appearances were represented in a coloured drawing.] On laying open the ves- sels, the vein was founcf pervious and healthy, except that its coats seemed a little thicker than natural, but the artery was filled at the congested part with a coagulum, an inch and a quarter in length, partly pinkish and partly dark in colour. There was no appearance of any inflammatory exudation having taken place into the interior of the vessel, but the clot lay everywhere in contact with the internal coat, to which it was firmly adherent, so much so, as to tear away a portion of it when removed. Beneath the lining membrane were to be seen transverse red streaks, which appeared due to congestion of the circular coat of the vessel. [A sketch of the vessel and its con- tained clot was now exhibited.] The coagulum extended down the anterior tibial artery as far as to the commencement of the gangrene, but the companion veins were empty and perfectly natural in appear- ance, as also was the posterior tibial artery. These pathological appearances clearly indicate that the primary disease was inflammation of the arteries, accompanied by coagula- tion of the blood within them, obstructing the supply of the nutrient fluid, and so inducing death of the lower ))art of the limb. This conclusion is in harmony with the previous history, which was from the first that of arterial obstruction. This case is of practical interest, as illustrating the principle that spontaneous gangrene may be entirely local in its cause, and that in such cases the greatest benefit may be anticipated from removal of