Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
+Moist Gangrene.+ When a part which has had its vitality seriously
interfered with becomes gangrenous, pain, which may have been present,
suddenly ceases, the part becomes insensitive, and the skin is cold,
pale, and mottled purple, green, and red, and finally dark colored;
blebs containing brownish serum form upon the surface; the wound, if
one is present, assumes a grayish color, and an offensive discharge
escapes from it; the dead tissue rapidly undergoes putrefactive
changes. Coincidentally with these changes in the dead tissues, the
living tissue in contact with it becomes red and swollen, and the
separation of the dead tissue from the living is affected by an
ulcerative inflammation, granulations from the living tissue lifting
off the slough.
The patient, at the same time, if the gangrenous process involves any
considerable extent of surface, exhibits the unconstitutional signs of
inflammation (fever, rapid pulse, etc.) and, in some cases, if the
septic infection is intense, may die from septicemia.
In both dry and moist gangrene, when the gangrenous process is
arrested, the dead tissue is separated from the living by a process of
inflammation; the living tissue, at its point of contact with the dead
tissue, and for some distance from it, becomes red and swollen, and
exhibits all the signs of acute inflammation. The line of contact
between the dead and the living tissue is known as _the line of
demarcation_, and the line of granulations which separates the dead
tissue from the living, is known as _the line of separation_.
The separation of the dead tissue is affected by granulations, which
spring up from the living tissue as a result of inflammation, and
there is also a certain amount of pus secreted from the granulations.
In moist gangrene, the lines of demarcation and separation are fairly
well developed. In dry gangrene, on the other hand, these lines are
usually imperfectly developed.
+Early Diagnosis.+ From the foregoing it will be observed that gangrene
is most common in those past middle life, and that its actual onset is
only a stage in an insidious process. This may be either due to
senility or to some constitutional disease. A slight abrasion alone is
sufficient to set up a train of symptoms out of all proportion to the
cause. In such a case, the operation of a small verruca or papilloma
may be followed by a violent inflammatory reaction, with rapid
extension into the entire foot or leg, resulting in gangrene.
Such cases have occurred, but could have been prevented if a proper
survey of the field had been taken and would have saved the
chiropodist much responsibility.
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