Clinical reports of the surgical practice of the Glasgow Royal Infirmary / by John MacFarlane.

  • MacFarlane, John, 1796-1869.
Date:
1832
Catalogue details

Licence: Public Domain Mark

Credit: Clinical reports of the surgical practice of the Glasgow Royal Infirmary / by John MacFarlane. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    the foot and ankle were cold and oedematous; the pulse was one hundred and twenty in the minute; the heat of tlie skiu Wiis increased; the tongue was fui-red; and the thirst urgent. The leg and foot were at this time in very opposite states of disease : the former had the action of its vessels morbidly increased, while the latter had its vitality nearly destroyed. The foot was therefore ordered to be frequently rubbed with a warm stimulating liniment, and the external heat continued; an evaporating lotion was applied to the leg; his bowels were freely opened; and he had two grains of opium every four hours. On the 9th, the ligature separated, being the 12th day from the operation, and in two days more the wound was healed. The points of the toes, heel, and Sole of tlie foot, were hard, shrivelled, and black, but he was still able to move them. On the 15th, a dark erysipelatous redness commenced at the ankle, and extended to near the knee, which, after con- tinuing tliree days, was removed by the application of cam- phorated spirit of wine. The internal malleolus and front of the ankle were povered with livid vesications,—the emaciation and debility were daily increasing,—the pulse was a hundred, and feeble,—the tongue was smooth and florid,—the fauces were covered with aphthae,—deglutition was impeded,—and he complained of anxiety and restlessness. The aneurism in the right ham was increasing rapidly; and, as in the opposite limb previous to the operation, there now existed, on the inner side of the tumour, a part more prominent than the rest as large as a hen's egg, over which the integuments were thin, inflamed, and glistening. He was ordered a generous diet, consisting of animal food, wine, porter, &c. On the 21st, the lividity of the foot and ankle was increase ing; and, in ponsequence of acute pain in both limbs, he re- quired to take, for several days, from six to ten grains of opium daily. It was not, however, till the 13th of May that the whole foot became involved in the gangrene. At this time the cuticle was detached, leaving the subjacent parts livid, flaccid, and emphysematous. There was a copious discharge of fetid sanious matter from the ankle, where a large slough had separated, exposing the tpfi(lo Achilles aiid li-ont of the joint.