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

  • William Walsham
Date:
1890
Catalogue details

Licence: Public Domain Mark

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

    58/902 page 42
    influences. They, therefore, indude those already given under Inflammation (page 6), and amongst them may ha pspecially mentioned old age, feeble action of the heart, chronic congestion of a part, deteriorated blood as m diabetes and Bright's disease, and impairment or loss of nerve influence from injury or disease of the nerve- centres or nerve-trunks. Excitinq fa!(.ses.—These may be considered under the following heads :—1. Physical or chemical af/encici. which act by directly destroying the vitality of the tissues. Among these may be mentioned mechanical violence, as a severe cru.shing of part of a limb ; excessive heat, as m burns and scalds; intense cold, as in fro-st-bite ; chemical action from strong acids, alkalies, putrid secretions, and the like. Although these may act by dii-ectly killing the tissues of the part their action is often aided by inflam- mation, as seen for instance in a crushed foot, where both the injury and the subsequent inflammation determine the death of the member. 2. Injhimmaiion causes gauo-rene in part by the pressure of the inflammatory exudation and the thrombosis of the vessels cutting off the nutritive supply, and in part by the action of the irritant causing the inflammation. The latter is especially the case in the septic and infective inflammations, the noxa here beino' either the products of putrefaction {pfomnmcs) or micro-orsi'anisms, especiallv the streptococcus pyogenes. Some inflammations always terminate m gangrene _ as carbuncle and malignant pustule. The manner m winch micro-organisms act in producing gangxene is not deter- mined. 3. Ohstruciion to the arterial suppl)/. as from li'vature of the main artery, embolism, thrombosis or rupture of the artery supplying the part, and spasm ot tlie arterioles due to loii- ingestitm of in'got. -J. Ohsfr>,rt;on t„ the capillary circulation from Ihromliosis or pressure. As examples of this may bo mention.'d. b,.d-sores iroiii pressure of the part between Iho bed and a point of bone; the d(>ath of the skin and bono in cellulitis and periostitis r(-spectivelv from compression of tlie capillaries by the iuflanimatorv effusion : local sloughing from 111e pressure of a splint or a iicvv growtli : .•.■lucrum oris h-om thrombosis .,f tlic cajiillaries. .Vc. r,. < ihMrvrf >on to the rc)w>if< relin-u as seen in strangnlatcd liernia, paraphimosis, tirrht bandagiii-. (llistrucled venous relurn. ho\Ccver isgenerally asso.aatcl with obstruction to tho arterial sup])ly as Avell.
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