On the surgical complications and sequels of the continued fevers / by Willialm W. Keen.

Date:
1877
Catalogue details

Licence: Public Domain Mark

Credit: On the surgical complications and sequels of the continued fevers / by Willialm W. Keen. 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.

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    The altcmation of the two is the condition of health, and its artificial production will tend to restore healthful reaction. ChaiJinan’s ice and hot-water bags to the spine, alternate heat and cold directly to the parts, with proper friction and stimulating liniments, at once commend themselves to us. The constant current battery also m.ay prove an extremel}' useful aid, since it dilates the deep as well as the superficial vessels, and will aid the collateral circulation. But suppose gangrene actually occurs, what then ? Est- lander gives most judicious counsel here. We must remember that good results follow both to life and limb without opera- tion, especially if the gangrene be limited and the patient not too exhausted. We must not, therefore, be rash in our inter- ference. If amputation has to be done, the question as to where it should be done, depends on the probable extent of the gangrene; as to when, on the line of demarcation. In the non-thrombotic cases, as the line of demarcation is usually established within two or three weeks, and the disease is not then likely to be progressive, the amputation may be done but little above or even through it. It is, therefore, usually' best to wait for its form.ation. In the thrombotic cases, the clot and the gangrene are apt to be progressive. Until the line of demarcation forms, therefore, it is impossible to say precisely where the disease will stop. Yet we can gain some idea of the probabilities of tlie case from past experience. If the clot extend no further than the popliteal, the limb may escape gangrene altogether, and if it follow, I have found it limited in 9 cases, to tlic foot 4 times and to the upper calf in 5; if the clot extend into the femoral. I find the gangrene extended to the upper calf in 6 and to the thigh in 4 ; if the clot extend above I’oupart’s ligament, I find in 10 cases it was limited to the foot in one, the calf in .3, and e.xtended above the knee in 6. The results of amputation are good, giving 21 recoveries to 21 deaths, but the recoveries are largely after