Surgery : its theory and practice / by William Johnson Walsham.

  • William Walsham
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Surgery : its theory and practice / by William Johnson Walsham. Source: Wellcome Collection.

    152/898 page 136
    applied, and incisions made early before sloughing has hadjimeto take place, i.e., as soon as the parts become brawny. A number of small incisions made parallel to the long axis of the limb are pre- ferable to one long one. They should extend through the skin into the inflamed cellular tissue, the haemorrhage, which is often free, being readily stopped, if excessive, by plugging with iodoform or sal alembroth gauze, or like antiseptic material. Subsequently the wounds should be dressed antiseptically, well drained, and the sloughs removed from time to time as they form. At St. Bartholo- mew's Hospital a large charcoal poultice is with some a favourite form of dressing. Should diarrhoea set in it may be controlled by opium ; but this drug must be given cautiously when there is kidney mischief. In bad cases, where much skin has been destroyed or a joint irreparably damaged, amputation may ulti- mately be required, but should not, as a rule, be done whilst the disease is in progress. 3. Cellular erysipelas, or diffuse cellulitis, is aii acute, infective, and diffuse inflammation of the cellular tissue. It may occur in the subcutaneous or submucous tissues, in the inter-muscular planes, in the cellular tissue of the pelvis or orbit, in fact anywhere_ in the body where connective tissue exists. It may be due to various causes. Thus it may occur in the subcutaneous tissue after a scratch or puncture, particularly one inflicted in post-mortem room ; in the pelvic cellular tissue after parturition or the operation of lithotomy; and in the submucous tissue after an injury, as a sting of the throat by a wasp. Symptoms.—The constitutional symptoms resemble those already given under the preceding varieties of erysipelas, and though they may vary in intensity they are generally grave and soon assume an asthenic type, and become those of sapraemia as the septic products are absorbed from the decomposing sloughs. The local symptoms vary according to the part attacked. When the subcutaneous tissue is affected they are similar to those of cellulo-cutaneous erysipelas, save that the skin is not at first involved, but is only slightly reddened or mottled : the parts, however, feel hard and brawny, and become boggy as suppuration occurs. Later, the skin, as the vessels which supi)ly it are destroyed by the pressure of the inflammatory exudation in the subcutaneous tissue, loses its vitality, and rapidly becomes gangrenous and sloughs. The Treatment is like that of cellulo-cutaneous erysipelas. Inci- sions should be made early, and stimulating treatment is generajbj^^ required from the first. Hospital gangrene or sloughing phagedena is a rapidly spreading, infective inflammation accompanied by extensive slough- ing and ulceration. It most commonly affects an open wound, but Jias been known to follow injuries vhere there has been no break
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