The complete death of a part of the body, and its change into a black, stinking, cold, and insensible mass, with which the other parts of the system have discontinued all organic connection, is what we call mortification. That form of it which is most common is said to be humid, on account of the moisture of the dead parts. It is the result of nature having walled off by her antitoxin the scene of the battle, and while she has lost the original battle and the original field, has nevertheless succeeded in keeping out the enemy from the remainder of the system. The enemy feeds on the dead tissue, setting up a putrid, stinking cesspool of filth.
Gangrene. Before the mortified part is completely dead, and, consequently, while its recovery is supposed to be possible, the condition of the part is called gangrene. Diabetes is shown by the presence of sugar in the urine, and kidney trouble is shown by the presence of albumen in the water; these are probably the two most common causes of gangrene in the extremities.
Sphacelus is the name given to it after its entire death.
Sloughing is the process of separating the dead matter, and the substance separated is a slough.
The causes of mortification are quite numerous. The most common are, stoppage of the circulation by inflammation, by mechanical causes which obstruct the passage of the blood, by chemical agents and poisons, and by local or general debility.
In a bad constitution, which bears disease poorly, mortification is very dangerous.
Treatment. In treating mortification, three things are to be aimed at, to stop its progress, to promote the separation of the dead from the living parts, and to heal the ulcer which is left after the separation.
To stop the progress of mortification, we must remove its cause. If it be inflammation, treat that according to the principles laid down, but do not weaken the constitution. As soon as the inflammation has subsided, particularly if the system be weakened, tonic bitters and a nourishing diet must be had. When there is fever, with great excitement of the nervous system, delirium, picking of the bed clothes, etc., the patient should have anodynes (121) and antispasmodics (87), (91), (90), drafts upon the feet, and such other local remedies as the case may require. Here opium and stimulants are of paramount importance.
It is of little use to put anything upon the mortified part, except with a view of lessening the stench. For this purpose, lay upon the part lint soaked in a solution of chloride of lime or soda, or a solution of pyroligneous acid, or of creosote.
Very little can be done to hasten the separation of the dead part from the living; but while it is taking place, a common flax seed poultice, mixed with a little powdered charcoal, may be kept on it.
The ulcer left after the separation is to be treated like other ulcers. A dressing of bovinine and five per cent solution of carbolic acid, equal parts, will be found to hasten the granulation.
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