Volume 3

The Cyclopaedia of practical medicine : comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc. / edited by John Forbes ... Alexander Tweedie ... John Conolly.

Date:
1833-1835
Catalogue details

Licence: Public Domain Mark

Credit: The Cyclopaedia of practical medicine : comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc. / edited by John Forbes ... Alexander Tweedie ... John Conolly. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

    154/772 (page 142)
    M ith regard to the latter statement, nothing can be more obviously erroneous, as the in- tensity of the pain in all such cases is in itself sufficient to produce the secondary fever. How- ever far the former statement may be correct, we have not had sufficient opportunity to de- termine. We have seen the respiratory and mucous membranes red and vascular in one fatal case, the patient having died at the end of four days. In two other cases this mem- brane in both of these organs was pale, and without any appreciable lesion. These two patients were females, and had the inferior half of their bodies severely burnt from their clothes having caught fire : both of them lived seven or eight days. It is possible that the difference in the duration of the disease in these cases may have had some share in effect- ing the difference observed in the state of the mucous membrane after death. But it is of greater importance to observe that the secondary symptoms were equally severe in all the three patients. With regard to the local and general treat- ment of burns and scalds, we shall only observe that, in the latter, antiphlogistic measures, carried to the extent which the individual case demands, must always be had recourse to, although the secondary fever, when it occurs at an early period, and depends more on the shock which the system has received and the violence of the pain, is but little under the control of such measures. More benefit is derived from the administration of anodynes, and the use of those means which the surgeon has found to be most successful in allaying the local heat and pain of the injured part. Opiates are particularly useful in abating the great nervous excitement which accompanies this form of fever, and in procuring a tem- porary respite from suffering. It is of much importance to distinguish between the febrile excitement which imme- diately follows the injury, and the secondary fever which is the consequence of the subse- quent inflammation. As in the latter case, general bloodletting is always more or less useful. The same indication is pointed out when inflammation of an internal organ has taken place, although leeching and cupping are oftener to be preferred to the lancet. In stout young persons of a sanguine temperament it may be necessary to employ both. 2. Mortification from cold.—The local and general effects of intense cold are, in many respects, very similar to those produced by intense heat. If the degree of cold be not very great, the circulation and temperature, of the skin for example, when submitted to its influence, are increased, as is shewn by this tissue assuming a redder colour, and feeling warmer than before. On the contrary, if the cold be very intense, it may not give rise to any appreciable degree of local excite- ment ; the vitality of the skin, and even of the deeper-seated tissues at the same time, may be either greatly reduced or entirely de- stroyed by the direct operation of this physical agent. There is, however, this difference between the local effects of heat and cold, viz. that the former may produce complete disor- ganization of the tissues submitted to its action ; whereas the latter never produces such a change. In the former the local redness rapidly increases, in the latter it rapidly di- minishes ; and in the same manner does the sensibility increase and decrease under the influence of these agents respectively. (We are now speaking of the immediate, and not the subsequent effects of cold.) The general effects, or functional disorder produced by the immediate operation of cold, are very different from those produced by heat. If the cold has been limited in its operation to the ex- tremity of a limb, complete death of the part may ensue without any general functional de- rangement being induced. But if the whole body has been exposed to its operation, every function becomes depressed, and a state of lethargy soon succeeds, from which the patient is often not to be roused, either by the en- treaties of his friends or the best directed efforts of the physician. The symptomatic fever which follows the local effects of cold does not take place until inflammation has succeeded to these effects, for it depends exclusively on the presence of this morbid state; and hence the similarity said to exist between the symptoms of morti- fication from cold, and those of mortification from heat. It is, in fact, only after the oc- currence of inflammation that the local and general symptoms of mortification from these two causes acquire a striking similarity in kind, if not in degree. Although a state of gangrene and sphacelus of a limb or a portion of a limb may be in- duced by the direct operation of intense cold, we may not be able to determine the existence of either until inflammation has taken place. It is, however, said that the toes and fingers have been seen to fall off’, having been deprived of life on account of the intensity of the cold. But by far the most frequent occurrence of mortification is when a frozen limb is exposed to natural or artificial heat, as before a fire or during thaw. The blood that was before frozen thus regains its fluidity, and gangrene and spha- celus, if they were not previously, are now more or less rapidly induced. Under these circumstances, the skin assumes a dark red or livid colour, where it is in a state of gangrene or sphacelus, and the neighbouring skin ac- quires an erythematous blush, accompanied with a prickling or tingling sensation, and a feeling of weight or stiffness in the limb. By- and-bye phlyctente appear on the inflamed part of the limb, and grey, livid, or black spots on that part of it which is in a state of sphacelus. Then also putrefaction commences, and extends till its progress is arrested by the adhesive in- flammation. In this kind of mortification, as well as in every other, the extension of the sphacelus depends much on the degree of the subsequent inflammation, to subdue and still more to prevent the occurrence of which every means ought to be promptly and sedulously employed.