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

  • William Walsham
Date:
1896
Catalogue details

Licence: Public Domain Mark

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

    56/848 (page 54)
    where both the injury and the subsequent inflammation determine the death of the member. 2. Inflammatio7i causes gangrene in part by the pressure of the inflammatory exudation and the thrombosis of the vessels cutting off the nutritive supply, but chiefly by the action of the irritant causing the inflammation. The latter is especially the case in the septic and infective inflam- mations, the noxa here being either the products of putrefaction or micro-organisms, especially the streptococcus pyogenes. Some inflammations always terminate in gangrene, as carbuncle. The manner in which micro-organisms produce gangrene is not deter- mined, but it is believed to be due to the action of their products on the tissues. 3. Obsfi-iiction to the arterial supplx, as from liga- ture of the main artery, embolism, thrombosis or rupture of the arter}' supplying the part, and spasm of the arterioles due to long ingestion of ergot. 4. Obsfj-uction to the capillary circulation from thrombosis or pressure. As examples of this may be men- tioned, bed-sores from pressure of the part between the bed and a point of bone ; the death of the skin and bone in cellulitis and periostitis respectively from compression of the capillaries by the inflammatory effusion ; local sloughing from the pressure of a splint or a new growth ; cancrum oris from thrombosis of the capil- laries, &c. 5. Obstruction to the venous return as seen in strang- ulated hernia, paraphimosis, tight bandaging, &c. Obstructed venous return, however, is generally associated with obstruction to the arterial supply as well. The signs of gangrene vary considerably according to the cause. The general symptoms in the acute inflammatory form have already been given in the outline of the process (p. 51). Those of the special forms will be further mentioned under varieties of gangrene and elsewhere, as in section on Cancrum oris, &c. The Treatment, like the symptoms of gangrene, depends so much upon the cause and nature of the gangrene, that its details can only be given under the special varieties. Here, however, it may be said, that the general indications for treatment, whatever the variety, are—(i) To remove where possible the cause, as a tight bandage constricting a limb, putrefactive processes in wounds, tension, pressure, and so on. (2) To prevent gangrene, when threatened, from actually occurring by maintaining the warmth of the part, and endeavoring to reheve the embarrassed circulation by elevating the limb, and by gentle friction when there is venous congestion; and (3) When gangrene has actually occurred, to check it spreading; to promote the separation of the dead from the living ]jart, or remove it by amputation; to control as far as possible the formation of the products of putrefaction by keeping the part dry, and by the free use of antiseptics; to support the