1 6 SURGERY. 



clean, at first moist, but afterwards dry and glazed or aphthous. 

 The bowels are constipated, or else attended with a diarrhoea, termed 

 colliquative. The palms and soles burn, and there is. great thirst. 

 Respiration is rapid and short. The pulse is frequent and small. 

 At noon there is increased fever preceded by a chill; at night there 

 is perspiration, most profuse towards morning. The eyes are bright, 

 though sunk in hollow orbits; and though there may be sleepless- 

 ness, lassitude, and debility, yet the mind is clear and the spirits are 

 good. 



5. Ulceration. — Hunter supposed that it was entirely the re- 

 sult of absorption. It is more properly a vital softening of a texture 

 changed by inflammation and suppuration ; becoming disintegrated 

 and fluid, it passes away with the pus. The more violent the inflam- 

 mation, the more rapid is the destruction ; the term phagedenic is 

 applied to those ulcerations in which the part is apparently eaten or 

 consumed with unusual rapidity. Congestion is a predisposing 

 cause of ulceration. The skin, mucous membranes, and cellular 

 tissue, yield more rapidly in ulceration than the vascular, nervous, 

 and fibrous tissues. Those of intemperate habit, and of scrofulous 

 or syphilitic taint, are most liable to its ravages. The parts most 

 likely to be affected are those whose circulation is weak and languid, 

 such as the lower extremities, and parts ne\yly formed, such as cica- 

 trices, callus, and tumours. 



6. Mortijicalion. — This term includes the dying and death of a 

 part from injury or disease. Gangrene denotes the process of 

 dying, and is recognised by the following signs. Redness is changed 

 into a livid hue ; circulation is arrested, so is effusion, and there is 

 less tension. Pain and heat abate, often suddenly. Putrescence 

 commences, and there is an offensive smell. Phlyctense, or vesicles 

 filled with putrid serum, appear over the skin. Sphacelus is the 

 completion of the gangrene. The part is cold and insensible ; 

 shrunken, soft, and flaccid; crepitates distinctly, owing to its con- 

 taining gas, the result of putrescence ; vital action has ceased, and 

 the colour becomes black if the parts are exposed to the air. A 

 slough is a small sphacelation. Nature makes an effort to throw off* 

 an injurious mass. The living part in contact with the dead in- 

 flames ; and, in consequence, the abrupt livid line is bordered by a 

 diffuse, red, and painful swelling — the line of demarcation ; this 

 vesicates, the vesicle bursts, puriform matter is dischari^ed, and an 

 inflamed and ulcerating surface is disclosed — the line of se]?aratio?i. 

 The furrow deepens ; skin and cellular tissue yielding first, the ten- 

 don and arteries resisting for some time. No hemorrhage occurs 

 during gradual division of the parts; the arteries are sealed by the 

 effusion of fibrin during the inflammation. But when the mortifica- 

 tion is rapid, as in acute hospital gangrene, arteries are found playing 



