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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    given when the temjjerature is high, and stimulants—alcohol, ammonia, and ether— if the pulse shows signs of failing. Otherwise, nothing is of much avail ; the case usually terminates fatally in a few days [but it may be prolonged for many weeks. Mercurials, in minute doses, are said to be beneficial]. ANTHRAX. Anthrax, or malignant pustule, is an acute infectious disease, caused by a spe- cific bacillus. Woolsorters' disease is the same thing under a different form, and so is the splenic fever of cattle. The bacillus anthracis is the largest and most easily recognized of pathogenic organisms. It consists of rods, from five to ten micromillimeters in length, abruptly cut at the ends, and capable, under suitable conditions, of producing spores which possess the most extraordinary powers of resistance ; their tenacity of life is so great that catgut prepared for ligature in the ordinary way and kept in a dilute solution of carbolic acid has shown itself capa- ble of transmitting the disease. It can grow in the tissues, or in the blood, or outside the body, provided there is a sufficient supply of oxygen and the tempera- ture is kept up. Naturally, those are most exposed to it who have to deal with hides, wool, etc. : tanners, dock laborers, woolsorters, and others, but it may occur in butchers, and there is evidence to show that it has been transmitted by flies. The mode of entry is either through the skin—as in malignant pustule and some cases of malignant oedema—or through the mucous membrane of the respira- tory or alimentary tract (woolsorters' disease). In the former case, characteristic local changes precede the clinical symptoms; in the latter, the bacillus enters at once into the blood-stream, penetrating, so far at lea.st as the lungs are concerned, between the uninjured epithelial cells. Each of these forms, as the infection spreads through the body, may be attended at a later period by the primary lesion that is characteristic of the other; thus, if the patient lives sufficiently long, malignant pustule may develop upon the skin in a case of woolsorters' disease, and secondary intestinal anthrax may show itself in the course of malignant pustule. The bacilli themselves may be found in enormous numbers at the seat of infection, in the inflammatory effusion that is poured out round it, and in the fluid of the vesicles that lie upon it. They are also present in the blood, especially where, as in the spleen, the circulation is slow; and they exist abundantly in the ecchymoses that are found in the mucous membranes and under the serous coverings of the viscera. The period of incubation is very variable—from a few hours to ten days, and even more—probably depending upon the dose and upon the facilities for general distribution afforded by the anatomical structure of the part. The mode of action is, to a certain extent, mechanical, but the chief effect is due to the production of some substance Tan albumose, in all probability) at the expense of the tissues. In patients who have survived, the bacilli have been found in all the excreta, and in one remarkable case, recorded by Davies Colley, they were still present in the urine a month after the man had recovered from the attack. Recently, it has been shown by Hankin that an albumose possessing similar toxic properties can be extracted from a cultivation of anthrax, and, further, that minute doses of the same, given previously to inoculation, confer a certain degree of immunity, while large ones only hasten the result. Morbid Anatomy.—The pathological appearances in the case of anthrax are very similar to those that occur in other forms of acute blood-poisoning. Decomposition is rapid, the blood does not coagulate, all the viscera are congested, the spleen in particular, and sometimes the mesenteric glands are enormously en- larged. There is a blood-stained effusion in all the serous sacs, and hemorrhages are not unfrequently present in their walls. Ecchymoses are common, on the mucous surface of the intestine, sometimes forming raised blackened patches, which are surrounded by a zone of gelatinous infiltration, similar to that in the primary affection upon the skin, and occasionally sloughing has commenced already.
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