On the causes of mortality after amputation of the limbs. Pt. II. Diseases / by J.H. James.

  • John James
Date:
1850
Catalogue details

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.'] and the malady are originally quite local, however much the system may be ultimately contaminated; the other, where the local cause has, ab origine, inflicted a disor- ganizing effect on the whole system. The cases from injury which were spoken of in the first memoir, and which, if subjected to what are called intermediate amputations, so seldom succeed. Those cases which arise from a vice of the constitution, of the blood I may say, and which derive their cause from a general cachochymy, as O’Halloran and the ancients termed it, are no subjects for amputation. When the cause is local, and when the blood is not originally disorganized or subsequently contaminated, if amputation be performed before it becomes so, we may well expect success, and such are the cases which come under the present division, arising from the sudden and accidental interruption of the circulation in an extremity, whether from a mere wound, 'or rupture of a large vessel, or its ligature ; but it must be under- stood that concurrent circumstances may make a material difference, by disabling the powers of the part, and in disposing it to limit the gangrene. Thus, in a case of simple wound of a great vessel, when gangrene ensues, at the very extremity of a limb, amputation, if early resorted to, will generally succeed j but where a great vessel has given way, from injury or otherwise, and the blood has been largely and forcibly driven into the tissues of the limb, or when an aneurism has occasioned that formidable and painful cedematous condition which precedes gangrene, the moment that occurs, the inflammatory effort fails to limit its progress in very many cases, apd spreading gangrene not only extends to the point where the circulation is hich invades the parts above, and thepa^Lare such is its character that it contaminates the blood, unable to Yihen, therefore, amputation is performed in these resist the ' ru. • • '1 disposition cases as at a late period the result too oiteu is similar Ind to that where it is instituted for gangrene, ensuing on system be- severe injuries, and from a similar cause, that it fails comes con- taminated. pingrene, where It does not arise from the state of the system, may be consi- dered under the followina heads —i.e., 1st, when the cause and malady are quite local, al- beit the system may become contaminated, such are the cases now spoken of; 2dly, where the cause is a sudden and violent injury, at once affect- ing both the part and general system. When the cause is strictly local and the blood has not become contamina- ted, ampu- tation com- monly suc- cessful. But if concurrent circum- stances have influenced the part, such as large or active ex- travasation, or an active or painful oedemafrom aneurism.