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

William Walsham

Date:: 1890

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

56/902 page 40

$burning charactor, ceases, and sensation is complotoly lost both to the touch and to other external stimuli. The skin, formerly red, becomes of a peculiar pale earthy colour, mottled in places with, patches of green or red. Now the cuticle separates in the form of blobs, or can be removed by gentle touching, leaving the dermis below ^\-et and slippery. A peculiar crepitant sensation is felt on pres- sure, on account of the formation of jmtrescent gases in the tissues, which, if cut into, are found stained and in- filtrated with a red fluid. The part next becomes blackish- brown, and exhales the peculiar odour of decomposing animal matter. iSupposing the process ceases to spread, ulceration is set up at the expense of the living tissue bordering upon the gangrenous part; a bright red line (the line of demarcation as it is called) is thus formed between the living and the dead ; this deepens, and finally the gangrenous part is thrown off in the form of a aphacelus or slough, leaving a healthj- granulating wovmd which cicatrizes in the usual way. The w in ate chanijcs which occiu' during the above process are as follows :—The infil- tration of the leucocytes and proliferation of the connec- tive-tissue cells are so excessive that the blood supply of the tissues at the focus of inilaurmation is cut ojf by the compi'ession and thrombosis of the smaller arteries and capillaries, and the jiart loses its vitality and dies ; the red corpuscles break down, and their hrrmoglobin is dis- solved in the albuminous fluid infiltrating the tissues, and stains them a deep red. Septic bacteria make their way through the skin and putrefaction sets in. The tissues disintegrate and liquefy, sulphuretted hydrogen and other j^^itresceut gases are generated, and the part rapidly passes through changes similar to those it would undergo if it were no longer in connection with the body. Unless bacteria enter, the tissues undergo fatty changes (necrobiosis), not putrefaction. When the gangrene ceases to spread, the living tissues immediiitely in contact with the dead iiart, owing to the irritation of its jiroscncc. be- come intensely congested (hence the rod line of d(^niarca- tion) and, subsequently, in consequence of their infiltra- tion with leucocytes and proliferated tissue cells, soften and break down into ]ius in the way described under Ulceration, and their cohesion being thus lost, the dead part is cast ofl'. Ilivmorrhage, during the ]irocess of se])aration, is jiroA ented by the thrombi filling the vessi'ls, which, sul>se(|Honlly. become ]i(M-manenlly sealed ;is ex-$

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

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