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
Catalogue details

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.

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    the tissues along the lymphatics, the destruction may extend for an unlimited distance. These causes lead to one result: the tissues around the slough are injured ; their vitality is lowered, and they have lost the ])o\ver of resisting the pyogenic organisms which gain access to them. The lymph that pours through the walls of the vessels melts away ; the leucocytes perish and become pus corpuscles; the plasma can no longer coagulate ; the injured tissues undergo coagulation-necrosis, disappear, and add to the fluid already present \ and by degrees a layer of pus is formed, separating the dead material from the living lymph, which, as the surface melts away, is constantly renewed from the vessels round. If it is in the interior of the body, the slough is enclosed in an abscess, the micrococci having made their way through the blood-vessels or lymphatics, and having found a congenial soil in the damaged tissues that lie around it; if, on the surface, it lies on the surface of an ulcer, and the pyogenic germs have, in all probability, reached it through the skin. 3. liliere the vitality of the tissues is very seriously depressed. It is no longer now a question of molecular disintegration or ulceration ; the surrounding part perishes en masse ; the gangrene itself spreads. The conditions under which this occurs may be cla.ssified in the same way. (<7) The general nutrition may be in fault. I have known gangrene extend from the foot to the thigh in both legs, and prove fatal within thirty-six hours, with all the symptoms of the most profound collapse, after two primary amputa- tions, one on each foot, performed with the strictest antiseptic precautions. The vitality of the tissues, from the combined effects of Bright's disease, exposure, intemperance, and the carbolic spray, was so low that, uninjured, they were only just able to hold their own ; the least hurt killed them at once, and the contact of the tissues already killed was a sufficient irritant to destroy the vitality of those around. {U) The tissues may have been injured too seriously by the original cause. If amputation is performed for frostbite before the part has thoroughly recovered, the flaps are sure to slough. Their vitality is so low that they cannot withstand the additional hurt. {c) Another irritant may be added and comi)lete the destruction. Septic decomposition is the usual one. The ptomaines produced by this, if they are absorbed, act as the most powerful depressing agents, causing septic fever or saprsmia. If the tissues have already recovered from the original hurt, and are protected by a wall of newly developed vascular granulation-tissue, no ill-result follows; a slough on the surface of a healing ulcer causes very little disturbance, unless it is assisted by tension, friction, or other modes of irritation ; but if there has not jet been time for this, or if the vitality of the part is too depressed, sloughing of the most extensive description is almost sure to follow. As the greater includes the less, so, if the gangrene spreads, suppuration always occurs. Only as the pyogenic micrococci require time before they can produce much effect, in the worst form of spreading gangrene, the tissues perish too soon. The consequences of gangrene, in short, depend upon the state of the part that is living. If the tissues are healthy, uninjured, and well-protected, they are easily capable of resisting such an irritant as contact with dead material, and set about repair at once. If, however, they are weakened by constitutional or local causes, or if they are exposed to further injurious influences, mechanical or chemical, their power of resistance is enfeebled, and according to the proportion their strength bears to that of the combined irritants, either molecular or molar death follows—suppuration or gangrene—and spreads until it reaches a part that is capable of successful resistance.