The practice of surgery : a treatise on surgery for the use of practitioners and students / by Henry R. Wharton ... and B. Farquhar Curtis.

  • Wharton, Henry R. (Henry Redwood), 1853-1925
Date:
1902
Catalogue details

Licence: Public Domain Mark

Credit: The practice of surgery : a treatise on surgery for the use of practitioners and students / by Henry R. Wharton ... and B. Farquhar Curtis. 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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    ends, motile, witliout a capsule, and resembles the colon bacillus. It does not decolorize with G-ram's method: It is a facultative aerobic germ, but grows best without oxygen. It can be cultivated on the usual media, with abundant production of gas. The bacillus emphysematosus (Praenkel) is stouter than the bacillus of anthrax, non-motile, not encapsulated, and does not form siiores. It decol- orizes by the Gram method. It is anaerobic, and produces gas in growing upon agar and glycerin, but not on gelatin. These germs are found in the earth, and in faeces of man and auimals. They appear to have more or less close relations with the colon bacillus. All but one of them are anaerobic, and that germ grows best when oxygen is excluded, and the infections due to them are found generally in such in- juries as compound fractures, in which deep, narrow, undraiued wounds give the germs the oj)]3ortunity to grow iirotected from the air. They also appear to thrive best when foreign bodies or necrotic tissue are present in the wounds. Symptoras.—The clinical picture of the infections produced in man by all these germs is identical so far as our present knowledge goes. After a severe lacerated and contused injury of this nature, a dusky bronze hue appears in the skin near the wound and rapidly extends, so that in a few hours it may involve the entire extremity. We have seen it begin from a lacerated wound in the popliteal space of a young man and involve the thigh and entire trunk in twenty-four hours. Tlie color is due to deep hemorrhagic extravasations, and gradually changes into the darker and mottled discoloration characteristic of gangrene. The part becomes hard, brawny, and cedematous, and subcutaneous emi^hysematous crackling is felt, showing the presence of gas in the tissues, which sometimes extends into aj)parently healthy parts. If the patient survives long enough, the usual necrotic changes of moist gangrene take place. Extreme prosfcration accompanies the disease. If the infection is a pure one there are none of the ordinary changes of inflammation such as redness and suppuration, and the microscope shows a complete absence of emigration of leucocytes or multiplication of cells. But generally the infection is mixed with pyogenic germs, and suppuration occurs unless the process spreads so rapidly as to cause fatal sepsis before pus can be produced. In some cases the gas is produced in such quantities as to inflate the tissues and to cut off the circulation by its pressure. In such cases, the tissues become swollen and hard to the touch, and the patient may have great pain, and immediate gangrene occurs. As a rule, prostra- tion is the only symptom. The patient has no pain, and is generally apa- thetic. The temperature may be high, but in many cases it is not above normal. Treatment.—The infection being anaerobic, free incisions and the use of hydrogen dioxide are indicated. The incisions also relieve tension and thus check the spread of the infection and the gangrene. There are a num- ber of cases on record in which recovery was brought about by these meas- ures, in some of whicli the disease had reappeared in a stump after amputa- tion for the same lesion lower down. In spite of these exceptional cases