Surgery, a practical treatise with special reference to treatment / by C.W. Mansell Moullin ; assisted by various writers on special subjects.
- Mansell-Moullin, C. W. (Charles William), 1851-1940
- Date:
- 1893
Licence: Public Domain Mark
Credit: Surgery, a practical treatise with special reference to treatment / by C.W. Mansell Moullin ; assisted by various writers on special subjects. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
51/1262 (page 43)
![In addition to this, the absorption must be stopped as soon as possible by the most thorough drainage and by encouraging the wound to secrete. Warm fomentations and warm baths are especially grateful; the tension is relieved ; the throb])ing pain sul)sides ; the blood circulates more easily; the plasma and the leucocytes pour out more freely through the walls of the vessels; the process of destruction ceases, and a barrier of vascular granulation-tissue is formed, to throw off dead cohering fragments and prevent the absorjjtion of any more of the poison. If the tension is completely relieved, the temperature falls to normal; if, on the other hand, the discharge is retained, it rises regularly of an evening, assuming the remittent type as suppuration follows, and gradually passes into hectic. Constitutional treatment should not be neglected, but so long as the cause continues at work, it can give but a very small measure of relief. Sai'r.f.mia. Sapra;mia, or septic intoxication, is the name given to the most intense variety of septic fever. It occurs under the same conditions and is caused in the same way—by the absorption from the surface of a wound of some ptomaine formed during fermentation. Probably the particular variety is not always the same and certainly putrefaction, with the formation of offensive gases, is not necessary. Clinically, it is probably very rarely met with by itself; but, like the preceding, it is present as a complication in all extensive wounds, especially tho.se in which a large amount of blood is allowed to accumulate and undergo decomposition exposed to the air. Substances of a similar character are formed in the decomposition of pre- served meats, sausages, and the like, and when swallowed cause all the symptoms of violent irritant poisoning—vomiting, purging, etc., followed by profound col- lapse, coma, and, if the dose is sufficient, death within a very few hours. The constitutional symptoms resemble to some extent those of septic fever, but they are much more severe. In most cases, those especially in which putrefac- tion is present, the wound is acutely inflamed ; but I have known it, after an amputation through the knee-joint, progress, to all appearance, as well as could be wished, while the patient's temperature was gradually rising higher and higher and the pulse becoming weaker and more feeble. The only local sign to attract attention was the presence of a thin serous discharge in enormous quantities. Much more frequently, however, putrefaction is present, and various forms of infective germs as well. The pathological appearances present no distinctive feature of any kind. The blood either does not coagulate or else forms a loose, soft, black clot which readily breaks down. The lining of the vessels and the endocardium are often stained, and sometimes marked by actual ecchymoses, which also occur on the serous surface of the viscera, and at times in their interior. The spleen is enlarged and softened ; the liver and the lungs are congested ; the structure of the viscera, on section, is confused and blurred, especially in the case of the kidneys; and the mucous membrane of the alimentary canal is frequently in a condition of acute inflammation, especially if the poisonous substance has been swallowed. When it is slowly absorbed from the surface of a wound, intestinal lesions are not usually present in man, though they are not uncommon in the case of animals. Decomposition after death, as in many other forms of sei)tic diseases, is unusually rapid. At the commencement there is usually a rigor or an attack of vomiting; the temperature sometimes rises rapidly, without any apparent reason, to 104° or 105° F.; sometimes, on the other hand, especially in the more severe cases, it rises a little at the first, and then falls again, even becoming subnormal. The pulse is quick and feeble, the respiration hurried and shallow. The extremities are cold, while the trunk, perhaps, is burning hot; the tongue is dry and brown, and the lips and teeth covered with sordes. Diarrhoea, with blood-stained stools, is usually](https://iiif.wellcomecollection.org/image/b21213744_0051.jp2/full/800%2C/0/default.jpg)
