A system of practical surgery / by William Fergusson.

  • William Fergusson
Date:
1852
Catalogue details

Licence: Public Domain Mark

Credit: A system of practical surgery / by William Fergusson. Source: Wellcome Collection.

    131/878 (page 107)
    In gangrene the general object of treatment is to restore, if possi- ble, the healthy actions, and so avert the impending death of the part, which is very likely to ensue if a favourable change does not occur. In mortification, or sphacelus, (for the terms are synonymous,) the principal indications are to protect the remaining parts from destruc- tion, and to relieve the system of that portion which has become dead, as in this condition it can only be a source of irritation and continued disease. The part which has lost its vitality may be a portion of skin, mucous membrane, tendon, vessel, bone, or other individual tex- ture, singly and only to a small extent; possibly several of these tissues may be involved, or all the textures in a member may be in this condition at one and the same time. It will be evident, then, that the treatment must be varied and regulated in accordance with the nature and extent of the affection in each particular case. From what has been already stated, it may be observed that the cause of these conditions is often, in a great measure, beyond the in- fluence of the practitioner; but in many instances, and where the in- experienced might least suppose it, he has great facilities in obviating the worst results. Thus, if in the treatment of fracture of the lower extremity the heel is allowed to rest on a hard mattress, the pressure on the skin, by the weight of the limb and foot, may produce mortifi- cation,—a slough as large as a half-crown may form. If the sur- geon is on his guard, and, at the first alarm, so adjusts the pads and splints as to take off pressure from the part, no such event will happen. Again, if in severe inflammation of the^, scrotum, accom- panied (as it usually is) with copious effusion of serum, the part be not well suspended, and kept rather above the level of the pelvis, a slough in the skin is very likely to occur, and the same thing may happen in extensive oedema of the lower extremities. Here, too, the surgeon may, by attention to position, do much to avert the occurrence of this disease. Severe cold is a well-known cause of gangrene and mortification, especially if warmth be applied suddenly when the temperature is below the natural standard. The experience of Larrey in Russia, on the latter point, gave ample additional proof of this well-known fact; and hence, then, the propriety of restoring warmth to the parts gra- dually, by friction and otherwise. Intense heat is a frequent source of these conditions, as exemplified in scalds and burns. Sometimes a bandage may be too tight around a limb, when it will produce swelling in the part below, and, if not attended to, even partial death; the tightness of the orifice of the prepuce in paraphymosis may produce this, although I believe it does so more rarely than some apprehend; and the stricture in or about the neck of a hernial sac is a fertile source of these affections. If a tourniquet is kept long upon a limb, as is sometimes done in hemorrhages, oedematous swelling is sure to come on, and mortification would be a certain result were the constriction continued. The above are all palpable examples, where a little surgical skill