A remarkable case of spontaneous gangrene / [Henry William Fuller].

  • Henry William Fuller
Date:
[1847]
Catalogue details

Licence: Public Domain Mark

Credit: A remarkable case of spontaneous gangrene / [Henry William Fuller]. Source: Wellcome Collection.

    8/8 (page 8)
    tation during the spreading of spon¬ taneous gangrene), then it is clear that the tendency to gangrene being neces¬ sarily confined to the parts situated beyond the seat of obstruction, ampu¬ tation will have a fair prospect of success (if other matters are favour¬ able), even when the gangrene is in a spreading state. For if the operation be performed above the seat of pressure, the disease and its cause will be re¬ moved together; and even if it be not performed as high up in the limb as the seat of obstruction, still the parts below need not necessarily all pass into a state of mortification: for in many cases collateral circulation may have been established, sufficient to preserve the upper part of the limb, yet insuf¬ ficient to protect its extremity from the effects of defective nutrition. So that, in considering the propriety of ope¬ rating in gangrene arising from internal causes, this essential difference should be kept in view; and before any course of treatment be decided on, the cause of the mortification should, if possible, be ascertained. The practical question, indeed, appears to be, not so much whether there may or may not be ossification or otheT disease of the arterial tubes, but whether there exists any local mechanical cause to obstruct a free circulation in the part. If such an obstruction can be proved to exist, and the life of the patient appears to be endangered by the progress or con¬ tinuance of mortification, then it be¬ comes a question whether it would not be the safest plan to remove the part either above or below the seat of ob¬ struction ; and then, of course, the existence or non-existence of ossifica¬ tion of the vessels would materially influence the decision arrived at. But where no obstruction can be proved to exist, then an operation ap¬ pears to me inadmissible, unless a line 45, Half Moon Street, Piccadilly, July 20,1847. of demarcation has been fairly marked between the dead and the living parts; for whether the patient be old or young, whether the disease be or be not con¬ nected with ossification of the arterial tubes, it can no longer be regarded as a local disease, but must be looked upon as arising from causes exerting a wider and more general influence, and not to be removed by means of the scalpel. Where the vessels are more or less completely ossified, and the gangrene is dependent on such a cause, there is just a chance of recovery in the event of an opera¬ tion : but where no ossification or other cause of obstruction exists, the system itself, or the blood it contains, is at fault, and there cannot possibly be a prospect of success. One other point in reference to this case is, perhaps, worthy of remark : I mean the strange variation in colour which the affected limbs underwent. The skin, in the first instance, became mottled, and of a reddish purple colour; this \yas afterwards superseded by blackness, which yielded in its turn to vivid scarlet, and this again to an inky- black. The scarlet colour was most intense and most remarkable; but it can hardly have been an evidence of returning action, for there was no increased warmth in the part, and nothing at all indicative of such a change. I can only conceive it to have arisen as similar appearances are occa¬ sioned after death, viz. by exposure of the blood stagnating in a minutely injected membrane to the influence of the external air. The inky-black colour which supervened shortly before death, accompanied as it was by an intolerable stench, I should be inclined to refer to incipient decomposition. Whatever the cause of these various changes, I can find no record of similar appearances. Wilson and Ooilvy, 57, Skinner Street, Snowhill, London.