OCR Text |
Show SUPPURA'IIL'JR . fir "villilfhnllh . 50W" 'lNDlAli' u. . , .~ 3,." - ~----"\. <._~_:~x: "My .¢1=n"~z'. W'v-A .» ~.,J-¢ ._.},,_A.msa._-'m.-1~.zi.;.~ :. I. , or MORTIHCATION. 13 External parts assume the changes consequent upon wounds more rapidly than internal parts; and sometimes the skin has run its changes, and is healed, while sources of irritation and suppuration remain deep in the wound. On the other hand, if adhesion is not procured at the surface, it is difficult to ensure it in the depth of the wound ; because whatever the disposi. tion to action is at the edge of a sore or wound, it is apt to run by continuous sympathy to the bottom. Our general rule, therefore, is to procure adhesion, but to provide a depending orifice, if we are in expectation that matter will be formed; or carefully to watch the local and constitutional symptoms of the formation of abscess, when we shall have entirely closed the wound. In regard to the formation of matter deep in the body con~ runs along the surfaces, destroying their natural action, and (unlike the phlegmon which terminates by producing adhesion and coagulable lymph in the surrounding parts) it has no terminatlon to its action while the disposition remains. It attacks surfaces chiefly ; such surfaces, when capable of high sequent on wounds, there are distinctions to be observed arising from the different natures of the two intlanimations, which Tnn approach of mortification or gangrene is betrayed by a remarkable but indescribable change in the patient's coun- tenance; often a peculiar wildness of aspect ; and anxious, may have been produced. An abscess or collection of matter consequent upon phlegmon, is attended with adhesion of the cellular membrane which confines the fluid ; and though it has a tendency to the surface, and falls naturally downward, yet this progress is gradual. But when erysipelas follows a wound, its course is irregular ; it has no natural termination ; and it will insulate the skin from the part below, and destroy the cellular membrane with a rapidity which the young surgeon does not look for. he suppuration, if such it may be railed, which attends it, is accompanied with an irregular dissolving of the cellular membrane, and sloughing, and to the feel it is soft, quaggy, and irregularée. his inflammation '~‘ For example, a man tore the skin on the outside of his knee, upon a rusty nail. The infiannuation was slight, but the wound shewed no disposi- tion either to heal or to suppurate, It became irritable, and a dark inflam« mation surrounded it, This ditihsed itself upon the thigh, even to the hauneh, attended with very little tunicfaction, A bad discharge followed ; and now the probe passed upwards a great way, and. the whole outer skin of the thigh was separated from the fascia. Had this wound been of a difiL-rent nature, had it taken a phlcgmonous action, then-the matter would hBVC j"opened about the insertions of the tendons, insinuated itself backward be Fund the joint, and dreoped do an gradually between the heads of the gas; action, as the skin, are inflamed; but in the cellular mem- brane, which is a part of which the vessels are endowed with little activity, it creeps from call to cell, and often kills it; the skin soon loses its support, and mortifies in large flakes. I have seen the whole side of the head, or the integuments of the outside of the thigh, fall off in black flakes. APPROACH OF MORTIFICATIOX. delirious look ; great languor and depression ; vomiting ; a quick, thrilling, compressible, intermitting pulse. I shall first suppose that in cmasareous swelling of the legs, and great debility of the system, attended with a small fluttering pulse, a spot is seen, watery, and in which first the distended thin cuticle disappears; and afterwards little grains or spots, of a black purple or lake colour, are seen on the surface. This is the beginning of mortification. This spreads with a marbled mixture of blue, yellow, and dark red colour. Then other spots form ; the pulse becomes very low and tremulous, and the patient sinksa'c. Gangrene often begins ina small black spot, and the extent of the part immediately tending to the same state, is marked by oedema, or emphysematous inflammation of the cellular membrane. In consequence of obstruction of circulation after the tying of a great vessel, or of the pressure of a tumour, See. the circula. 5* The surgeon must therefore study the strength of the constitution, and cause of the edema, before he ventures to puncture or scaz‘ify ; for this moraifrcatien is peculiarly apt to follow that. operation. 4." mmacs .. |