Volume 2

A dictionary of practical medicine, comprising general pathology, the nature and treatment of diseases, morbid structures and the disorders especially incidental to climates, to the sex, and to the different epochs of life. With numerous prescriptions : a classification of diseases a copious bibliography, with references and an appendix of approved formulae / By James Copland.

  • Copland, James, 1791-1870.
Date:
1844-1858
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical medicine, comprising general pathology, the nature and treatment of diseases, morbid structures and the disorders especially incidental to climates, to the sex, and to the different epochs of life. With numerous prescriptions : a classification of diseases a copious bibliography, with references and an appendix of approved formulae / By James Copland. Source: Wellcome Collection.

    17/946 (page 9)
    organ or structure is endowed. — The situation of a part or structure at a distance from the centre of vital or nervous influence, and of circulation, has also some influence in favouring the termin- ation of inflammation in gangrene. Also, intense grades of inflammation in these parts may proceed until this result takes place, without causing death ; whereas inflammations of the more vital and central organs, as the heart, brain, &c., put an end to life before this change has supervened. 4. Various pathological states dispose not only to inflammation, but also to the supervention of gangrene. The most important fof these are — a. Disorder of the digestive organs, especially impaired energy of the organs most directly in- fluenced by the organic nervous system ;— b. A weak and irritable state of constitution ; — c. Exhaustion by previous disease, particularly by fevers and epidemic maladies ; —d. Interrup- tions of the excreting functions, and of the depu- rative action resulting therefrom ; — Morbid con- ditions of the blood, as in typhoid, malignant, and exanthematous fevers, in erysipelas, and in scurvy ; —f. Pre-existent functional or struc- tural changesina part, asimpeded circulation, con- gestion, &c. ;—g, Interrupted circulation in an adjoining organ, or obstructed return of the venous blood from the part affected. These con- ditions not merely predispose to inflammation, but also modify its characters, and favour most re- markably the occurrence of gangrene, especially when more than one of them are in operation ; as in erysipelas, in which we generally observe the inflammatory action supervene on marked disor- der of the digestive and excreting functions, on a morbid state of the circulating fluids, and on dis- ordered circulation in the part. 5. The Causes which induce inflammation also influence its termination in gangrene, but to a much less extent than the influences already no- ticed, unless they be of a disorganising or poison- ous kind, when they more properly fall under a different head. Intensity of the exciting causes, relatively to the excitability and susceptibility of the part, have some influence, especially when it is great ; the consequent vascular reaction, in con- nection with the morbid impression made by the cause upon the vital properties of the part, often rendering inflammation more acute and severe, and thereby more prone to exhaust vital power, or to pass into gangrenous disorganisation. But agents which excite inflammation, without produc- inga mechanical, chemical, or poisonous operation, do not very remarkably favour the occurrence of gangrene, independently of this circumstance, and of those already enumerated. The disposition to terminate in gangrene will doubtless be increased by the intensity of the local and general vascular action relatively to the state of constitutional power ; but such intensity of action will itself, in a great measure, result from the circumstances already enumerated. In a word, therefore, the causes of inflammation passing into gangrene, are those stated above, in connection, with peculiarity of temperament, constitution and habit of body, and with the intensity of local and general vascular action, relatively to vital resistance or power, cha- racterising the inflammatory state. 6. A. Of the Phenomena of Gangrene from Inflammation. —a. In respect of particular Tis- sues and Organs, — a. Of the integuments, — When inflammation is about to passinto gangrene, very evident changes take place in the colour, temperature, sensibility, and vital cohesion of the part. The redness becomes darker, or changes to a livid, violet, purplish, or black hue. The morbid- ly increased temperature and the augmented sen-~ sibility of the inflamed part are remarkably less- ened ; and the pain has disappeared from it, and extended to the surrounding structures. The vital cohesion of the part is much weakened, al- though its density is sometimes augmented. — Vesicles also appear on the surface, owing io the effusion of serum, or of a sanguinolent serum, under the cuticle. —These changes become more manifest as the gangrene passes into its second stage, or sphacelus. The colour becomes grey, yellowish grey, greenish, brown, or black, or va« rious intermediate shades. The vesicles are now enlarged, or the cuticle is entirely separated by the effusion of a bloody serum beneath it, which escapes and leaves the skin loosely covered by it, or partially denuded and discoloured. The in- tegument crepitates on pressure, is puffy, soft, cold, and insensible. It soon afterwards emits a ca- daverous and offensive odour, indicating that the gangrened part is quite dead, and is undergoing decomposition. 7.The emphysema and foetor of the part are proofs of the gangrene having arrived at complete mortifi- cation and putrefaction ; but the part may be completely dead without these phenomena being observed. Among the chief changes that occur after gangrene has taken place, are the spreading and limitation of it. The former is increased by whatever depresses the organic nervous power or contaminates the blood; and, as long as it con- tinues, the dark red or livid discolouration attend- ing it extends further and further, and gradually disappears in the surrounding sound skin. The latter change is promoted by whatever restores nervous energy, increases vital resistance, and promotes the assimilating and excreting functions. As soon as it commences, the livid or dark red discolouration of the circumference or margin of the gangrened part is more narrowed. Ulceration commences at the margin of the inflamed part, and separates from it, in the form of slough, the portion which had become gangrenous. The loss which is thus occasioned, is partially repaired. by the exudation of coagulable Ripe which, be- coming organised in the form of granulations, assume more and more of a membranous form, and constitute, in its complete state of reparation, the cicatrix,— A favourable change in the part and in the constitutional affection may occur atan early period of gangrene, and the result may be still more felicitous. In this case, the dark red or livid colour of the affected part becomes more cir- cumscribed, and assumes a brighter tint: the swel- ling subsides, and. the temperature gradually returns; all the functions, as well as the organis- ation, are preserved.— Gangrene of the skin always implicates toa greater or less extent the subjacent cellular tissue ; but this latter may be the primary and chief seat of this change. 8. B. Gangrene of the cellular tissue. — This tissue is more frequently, more extensively, and more rapidly affected by gangrene than any other part, more particularly where it is most abundant or is covered by aponeurotic expansions, which prevent contaminating fluids from reaching the