Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
+Effects of Cold.+ The more serious effects consequent upon exposure to
sudden or prolonged cold are termed _frost bite_. In this condition
the feet are commonly affected, and very often the freezing is so
complete that upon thawing, the parts are found to be absolutely dead
or their vitality so impaired by the cold that after reaction,
strangulation and inflammation of the tissues occur, producing
gangrene. As in burns there are three degrees of freezing, viz.,
first, second and third. In the first, the redness, numbness and
tingling which follow exposure to intense cold are succeeded by loss
of power, usually commencing in the toes, and loss of sensation, the
parts becoming anemic and cold. In the second degree the skin is red
or bluish and is covered by blebs with clear hemorrhagic contents. If
the epidermis only is lifted up there is quick, scarless healing, but
in the majority of cases the deeper tissues are involved. In frost
bites of the third degree there are blebs and crusts which eventually
mortify. Parts hopelessly frozen are at first anemic, cold and
insensible but after reaction sets in they become swollen and
discolored or they shrivel up and contract. It is not unusual for the
part to show no change for some days and then to become blue or black;
a line of demarcation forms and the dead tissue sloughs off.
+Treatment.+ Reaction must be gradual. The room should be of low
temperature; the affected part should be immersed in ice water; gentle
friction or rubbing lightly with snow is oftimes efficacious. When the
temperature is normal, stimulating friction with soap liniment,
alcohol, and water and spirits of camphor with elevation of the parts,
is advisable. The room may be gradually warmed and the parts exposed
should then be covered with cotton. As reaction progresses warm,
stimulant drinks may be cautiously administered. If excessive reaction
takes place, evaporating lotions of alcohol and water may be used.
Where a large surface is frozen, prolonged immersion in a bath may be
employed after reaction has been established. When gangrene is
present, surgical intervention is imperative.
+Chilblain+ occurs in individuals with a feeble circulation or in the
anemic or strumous, though healthy young people are not immune. The
feet are very often attacked, especially the heel and the borders of
the feet, but any of the peripheral parts may be affected. The areas
are bluish or purplish red, swollen, cold to the touch, tender,
itching and burning. Neglect and friction will produce severer grades
of inflammation, with vesicles, bullae, pustules and ulceration or
even gangrene, with or without the formation of bullae. There may be a
favorable termination or fatal septicema may supervene.
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