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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    everything they touch. For the same reason the coiiditioii of the uterus after parturition, with an enormous development of celhilar and lymphatic tissue in the region of the cervix, renders it particularly susce])til)le. Bruising and tearing the structures round in performing an operation—in other words, lowering their vitality and hlling them with extravasated blood— greatly increases the liability to it. It is partly owing to this, partly to the effect of renal disease, that diffuse inflammation of the pelvic cellular tissue is so common and so fatal after lithotomy when the calculus is a large one. In other cases it is due to the local effects of virulent chemical poisons. Diffuse celhditis of the neck, for example, may result from the sting of a wasp, and sloughing over a very large surface has been known to follow the bite of a poisonous snake. Probably the alkaloid injected into the tissues lowers their vitality to such an extent that they are unable to offer any resistance to the micrococci, which are constantly finding their way into the blood. Whether the extremely fatal form of diffuse cellulitis which accompanies post-mortem wounds in cases of puerperal peritonitis is due to a similar alkaloid, or whether, on the other hand, it is the result of septic infection (infection, that is to say, with a living organism) is uncertain. The fact that the virulence of the poison diminishes rapidly as putrefaction sets in is consistent with either view; the exceedingly early occurrence of the symptoms favors the former. Symptoms, i. Constitutional.—These vary greatly in severity, in the worst forms, such as those arising from post-mortem wounds, they are practi- cally the same as in spreading traumatic gangrene. They a.ssume a typhoid character almost from the first; there may be a rigor or a succession of chills : the temperature rises rapidly to 105° or 106° F.; the tongue is dry and brown, the skin burning hot, the face dusky, and the pulse so small and quick that it is scarcely possible to count it. Delirium may set in, sometimes with profuse sweating, within twenty-four hours, and the result may be fatal, from the most acute form of septic poisoning, within the first few days. In pelvic cellulitis after parturition or lithotomy, the effect is almost as rapid, the patient sinking into a semi-unconscious, wandering state, with an irregular, feeble pulse, extremely high temperature, and the most profound nervous prostra- tion. When the cellular tissue of the limb is concerned, where the poison is not so intense or the absorption so rapid, the symptoms are less .severe, and usually assume the sthenic form, but the fever continues high and very irregular for days and weeks; the emaciation and exhaustion are extreme; there is always the danger of pneumonia and pleurisy, or, if the head or face is involved (par- ticularly the orbit), of suppurative meningitis; and if the patient survives the period of sloughing and acute absorption, pyaemia not uncommonly supervenes or hectic and diarrhoea follow, or the prostration is so great that some comparatively slight disorder sets in and proves fatal. 2. Local.—These naturally vary with the structure of the part, but the swell- ing is always very great, soft and oedematous at first, then becoming hard and brawny, and later, as the cellular tissue sloughs, softening again and becoming boggy. On the scalp it is usually due to wounds that open up the sub-aponeurotic layers ; the cedema spreads rapidly over the vertex, extending down to the eyelids in front, to the superior curved line or the occipital bone behind, and the zygoma on either side. The skin is exceedingly tender, but there is very little redness ; the glands in the neck are enlarged and swollen, and there is always intense head- ache and not unfrequently delirium. When it involves the orbit, the eyelids are immensely swollen, the conjunctiva is reddened and chemosed, the globe is pushed forward and fixed, and the pain is most intense. If the symptoms do not soon subside, the cornea becomes opaque and sloughs, the eyeball is completely disorganized, and there is very great danger of the inflammation extending along the veins or lymphatics to the sinuses of the cranium or the meninges, leading to thrombotic pyasmia or acute meningitis. Diffuse inflammation of the cellular tissue of the neck is no less serious.
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