On the causes of mortality after amputation of the limbs. Pt. II. Diseases / by J.H. James.
- John James
- Date:
- 1850
Licence: Public Domain Mark
Credit: On the causes of mortality after amputation of the limbs. Pt. II. Diseases / by J.H. James. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![Acute Sphacelus.'] produced by these cases, the collateral evidence, as regards the small amount of mortality from mere amputations, will tend to support the propriety of the operation in many instances. Amputations for Sphacelus, ensuing on the interruption of the circulation through the great vessels, or in aneurismal cases. The pro- In determining the propriety of amputation in any amp^utation sphacelus, its causes and nature must be duly in any case considered. The main question to be determined is, deter^ined^ whether the general system, being originally affected, byits causes ]ja,s produced it, or whether, if arising from a local and nature. i i i i ° cause, that has imparted such an influence to the system as to render the mere removal of the part ineffectual. This question may be examined with reference to the part actually dead; the secretions and actions around it; and the condition of the system It is little probable that the dead part, unless shut up, acts in any other way than as unoffending foreign matter, at least in those cases of chronic sphacelus just described this does not appear to be the case, for they may exist for weeks or years without the least reason to suppose that they have been the means of introducing septic matter into the constitution ; and even if shut up, as in carbuncle and carbnncular abscesses (where the inflam- mation is of the limited class), it does not seem probable that they necessarily occasion a taint of the blood; for, formidable as the symptoms are, if we make the useful experiment of a free crucial incision, the symptoms sub- side with great rapidity, which could hardly be the case if the blood had been largely impregnated with-septic matter. It is not the dead substance in these cases which produces the symptoms, but the poisonous secretions thrown out, and the sympathetic effect on the system, which those secretions in their turn produce (speaking still of the limited class of gangrenous inflammation.) In the spreading class, we have superadded to this sympathetic effect, the contamination of the blood. I may be permitted to observe, that in both classes the generally. The part ac- tually dead has little in- fluence. As appears from the phenomena of sphacelus senilis and carbnncular abscesses. The symp- toms rather depend up- on sympa- thetic affec- tion, from the poison- ous secre- tions thrown out, and (whe- ther they are absorb- ed or not) the actions they give rise to. In the limited](https://iiif.wellcomecollection.org/image/b22368462_0030.jp2/full/800%2C/0/default.jpg)
