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Show 1.1: MORTIFICATION mom GREAT INJURIES. SLOUGHING 01" SORES. tion being obstructed, though not stopped, gangrene attackethe limb. The pulse is quick and vibrating, and compressible; the countenance pale, thin, and fallen; the liiub, oedematous, lies soft and dead-like ; the colour is a dark or obscure red; shooting pains are in the toes or fingers (and sometimes a rigor); new streaks of a deeper red, without any tumefac~ tion, may be seen, and then a vesicle appears, when the redness subsides. This vesicle discharges a brown fluid, and the surn face beneath is a dark purple or brown; the toes or fingers have vesicles on them; become black and shrink. Extreme cold, by abstracting the heat from the living surface more quickly than it can be generated by the circulating vessels, produces mortificationr‘ . The parts die from a cessation of irritability. There is no obstruction, and no great discolourationf. . , "AM-m u 3‘_5.'3§47'u-VK‘W-I-‘ :-.~ fl. _... 65W, mum ,1 Moriifimrion of Sores. Vlien the granulations of ulcers mortify, we see in the prominence of the granulations a small black spot, or a speck of dark coagulated blood extravasatcd r then the granulation fades and the good discharge fails. At the next dressing, the bottom of the ulcer is foul, with white or greenish shreds of the dead substance; and rapidly extensive wasting of the skin follows ; and the tendons or muscle hang relaxed out of the sore. There is a softness in the whole limb, and total want of action. The patients in whole wards of a foul hospital, will be thus affected, and a healthy sore will, ' Lesser degrees of cold than are sufficient. to procure mortiiication, es‘ pccially if heat be improperly applied, will bring on redness and tingling: (edema, and lividity, viz. chil'ulain. Sometimes it produces a serouskcllib sion, and raises the cuticle ; and then follows a painful ulcer. f It‘hcat be applied to a frOst-bitten part, then the sensible parts only are roused to action, and the redness which appears above the mortified place is a mark ofthe bad effects of this treatment, and the danger of the insensiblc and frost-bitten parts becoming absolutely mortified. The inference to be drawn from this is plain, that heat (a stimulus) must be \‘CTY graduallv ap~ 15 in the course of a few days, assume the appearance of a. halfdissected and neglected limb on a dissecting tableat. The accession of gangrene following concussion of a limb from extensive gun-shot wounds, or cannon-shot, is preceded by a heaviness, slight oedematous swelling, and leaden colour of the limbs. There are in several parts dark brownish spots or stripes. There are then lancinating pains : the skin blackens, and the cuticle separates. At first the patient is dull and insensible; afterwards there is distress and inquietude. The palcness and lowness in this instance is owing to the shock given to the nervous system. In the effect of cold, there is an obscure red and purple colour, with darkness of the nails; but here the paleness of death is on the countenance, in the eye, the nails, and the wounded limb. There is a mortification in the toes and feet of old peOple, which in the words of Mr. Pott, is unlike that from inflammation, from external cold, from ligature, or bandage. In some instances, it commences with little pain ; but often is preceded by uneasiness in the foot and ankle, especially during the night. The visible commencement is on the extremity or side of one of the lesser toes. There is a small black spot, then the cuticle is detached, and the skin under it is of a dark red colour. In a few days, the progress of the gangrene from toe to toe, and along the foot, is rapid, and proportionally painfulf. illornjimn'on sometimesfollows 112',qu actionjj. The parts have a florid. red colour, and erysipelatous inflammation spreads around. There is sometimes high irritalgiility, delirious rest- lessness, and great pain; then vesieations arise : then the pain * When this attack is made, the patient should have an emetic, and then :1 cordial drought, or warm wine and spice ; be removed if possible, and a. spiritous fomcntation put to the limb, and afterwards the carrot Poultice to the sure. i- It is a disease of debility attacking the extreme part of the vascular system. The system must be. supported by repeated opiates, while the part has the mildest t'oz'nentations. To stimulate is to endeavour to excite an ac- plied. Let us take the opposite accident to this, a burn or scald. Here is high excitement, and our application ought not to be such as may produce a rapid diminution of the beginning inflammatory action. Instead of cold ap- tion which the vascular power cannot sustain. plication, hot and stimulating are to be used ; and these are to be rrradu; llv 'When a limb is shattered, and we dread high inflammation, certain that hit lowered to the scale of natural action. a ‘ i Practically considered, there are two views to be taken of this subject. is mite allowed to gain a footing, there will be great danger, we endeavour m rand it oil'hy cold applieat‘ons, bleeding, and keeping the patient 10W: mg," |