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.

    88/1262 (page 80)
    of any kind, have been injected into the blood, and in a very short time it has been found that micro-organisms were present in myriads. One attack distinctly predisposes to another. Pathology.—Micrococci, forming chains, are found abundantly in the super- ficial lymj)hatics of the skin where the rash is sj^reading—not where it is fading, nor where it has })assed away ; they are much more scarce in the interstices of the tissues (though these anatomically l^elong to the lymphatic system), and are scarcely found at all in the vessels of the part. The other local changes are merely tho.se that are present in ordinary inflammation—dilatation of vessels, accumulation of inflammatory e.xudation, and of leucocytes. In fatal cases the blood is usually said to be fluid and uncoagulated, staining the interior of the heart and vessels. The spleen is soft and diffluent, the kidneys are engorged, sometimes showing signs of a catarrhal or interstitial inflammation, and the lungs are much congested, the smaller vessel being plugged with granular mas.ses, which are supposed to be produced by the disintegration of white corpus- cles. A similar change has been described in the ve.s.sels of the brain. Symptoms, i. Constitutional.—These usually precede the local ones by some hours, occasionally longer. There is a rapid rise of temperature to 102° or 104° F., Avith chills, or even a rigor ; vomiting, epistaxis, and, in children, con- vulsions are of common occurrence. The skin is hot and dry, the tongue is coated with a thick, creamy fur, the bowels are confined, and there is headache with general depression. The temperature usually continues high for three or four days and then gradually sinks, assuming the remittent type, but as it rises again with every local extension its course is rarely uniform. In the worst cases the symptoms are of a tyi)hoid character almost from the first ; the eyes are jaundiced, the skin is a peculiar dusky yellow, the pulse is very small, frequent, and feeble, diarrhcea is often profuse and sometimes very offensive, albumin is present in the urine (perhaps owing to the catarrhal inflammation), and there is a constant, muttering delirium, which may be due to the plugging of the cerebral capillaries. 2. Local.—The redness nearly always begins at the margin of the wound, sometimes where the skin is continuous with mucous membrane, as at the angle of the eye, or on the mucous membrane, very rarely some distance off. At first it is a bright rose-red ; exceptionally, and only in severe cases, it has a dusky tinge. The edge is irregular, but always sharply defined ; even when the rash is advancing it always marches by steps, suddenly showing a well-marked border some distance off. The skin is .swollen, cedematous, and pits on pressure. The raised margin can be felt, it is so clear. Where there is an abundance of loose cellular ti.ssue, as in the eyelid or the scrotum, the swelling becomes enormous in a very short space of time, but the pain is very slight. When, on the other hand, the skin is tightly bound down, as over the nose or the pinna, the color is livid, the swelling slight, and the pain intense. Very often in these circumstances the epidermis is detached from the corium beneath, forming bullae, which af first contain clear serum, but .soon become full of pus. As the inflanmiation subsides these burst, dry up, and form scabs, but there is no ulceration or destruction of the cutis. In severe ca.ses the fluid they contain is stained with blood. The neighboring lymphatic glands are always swollen and tender ; very often this is the earliest sign, and it is usually ])resent before the blush shows itself. As the disease advances the redness involves one area after another, fading in the centre as it spreads by the circumference. Sometimes this continues for two or three days only, sometimes for much longer periods, until perhaps the greater part of the body has been traversed. Then the temi:)erature falls suddenly, the last- formed reel patch ceases to spread, the swelling disajjpears. the skin becomes wrinkled again, and the i)ain and tenderne.ss disapi)ear. Desquamation always follows a severe attack, and when the head is involved, the hair falls off. but it speedily grows again. In rare cases erysipelas is erratic, disappearing in one i)art and breaking out