ULCER. 



fafcix, mufcles, ligaments, and tendons, together with the 

 nerves and blood-veffels. Artery Teems to be the texture 

 which refifts moft powerfully the deftruftive aftion of hof- 

 pital gangrene, as well as of mod other fpecies of mortifica- 

 tion. When, in the progrefs of hofpital gangrene, adhefive 

 inflammation does not occur, hemorrhage is liable to take 

 place, and, in fome inftances, to prove fatal. Even in cafes 

 in which diftinft hemorrhage does not occur, a thin bloody 

 fanies is often difcharged, which has a very offenfive fmell ; 

 and the pus, which begins to appear during the feparation 

 of the flough, or mortified part, often continues for days to 

 be reddened by an admixture of blood. 



The feverity and progrefs of the fymptoms in hofpital 

 gangrene, as well as the duration of the difeafe, are ex- 

 tremely different in different individuals. In fome, the fever 

 continues with unabated violence for a period of one or two 

 weeks. After fuffering an abatement, it is liable to recur ; 

 and the patient fometimes finks under a fecond or third 

 attack. When the affeAion has been very fevere, has con- 

 tinued long, or has returned frequently, the patient becomes 

 at laft generally afFefted with fever and obflinate diarrhcea. 

 This is a Ifate, from which, if patients recover, it is always 

 in a very flow and tedious manner. See Thomfon's Lec- 

 tures on Inflammation, p. 458 — 461. 



Hofpital gangrene (fays Boyer) is a fpecies of humid 

 gangrene, which attacks in fome degree epidemically the 

 wounds and ulcers of patients, who happen to be crowded 

 together in an unhealthy place. 



Its occafional caufes are ; the Ctuation of an hofpital 

 upon a low maHhy ground ; the vicinity of fome fource of 

 infeftion ; the uncleanlinefs of the individuals, or of the 

 articles for their ufe ; the crowded flate of the wards, 

 efpecially when they are fmall and badly ventilated ; laftly, 

 every thing that tends to corrupt the air which the patients 

 breathe. An infefted atmofphere may produce in the mofl 

 fimple wounds unfavourable changes, partly, as Boyer con- 

 ceives, by its immediate aftion on the furface of the wound, 

 but, no doubt, principally by its hurtful influence upon the 

 whole animal economy. The foregoing caufes have aKo 

 fometimes produced alarming and obtlinate gangrenes of an 

 epidemic kind, or, at leaft, a flate of the conftitution, under 

 the influence of which all wounds and ulcers conftantly took 

 on a bad afpeft, and were often comphcated with the molt 

 gangrenous mifchief. M. Vigaroux faw fuch an epidemic 

 difeafe prevail for twenty months in the two hofpitals of 

 Montpellier, and he flates, that the moft powerful antifep- 

 tics were of little avail againft the diforder, which often 

 invaded the flighteft fcratches. 



In general, this epidemic fpecies of gangrene is not 

 obferved in new-built hofpitals, nor in thole which are 

 erefted out of the central parts of cities, upon high ground. 

 Hofpital gangrene may occur in any feafon ; but it is mofl 

 common after the fultry heat of iummer. It comphcates, 

 without dillinftion, evei-y kind of folution of continuity. 

 However, it never attacks thofe of aU the patients in the 

 fame ward. It manifefls itfelf in different degrees on the 

 majority of them, and it is remarked, that the more exten- 

 five the folution of continuity is, the more it is expofed to 

 the diforder. But, occafionally, the difeafe is confined to a 

 part of the furface of fuch folution of continuity, while the 

 reft continues to make progrefs towards cicatrization. 

 Patients, who have efcaped infeftion once, are not on that 

 account exempt from the danger in future. 



A bilious conftitution, mental trouble, unwholefome or 

 infufficient food, a fcorbutic diathefis, great debility, and 

 fevers of a dangerous type, may become fo many predif- 

 pofing caufes of hofpital gangrene. 



The obfervations of Pouteau, and thofe of fome other 

 praftitioners, convincingly prove, that hofpital gangrene 

 may be communicated to the moft fimple wound, or nicer, 

 in a fubjeft of the beft conftitution, and breathing the pureft 

 air, by merely putting into contaft with fuch wound, or 

 ulcer, fponges, lint, or charpie, impregnated with the infec- 

 tion of this peculiar diforder. But this inoculation is con- 

 ceived to be more alarming, and to take efFeft the more 

 quickly, in proportion as patients have been more expofed 

 to the influence of fuch caufes, as are themfelves capable of 

 producing the difeafe, and alfo in proportion as the kind of 

 conftitution predifpofes to it. 



Although the contagious nature of hofpital gangrene has 

 been generally admitted by all the beft informed writers on 

 the fubjeft, we ought to notice, that the doftrine was not 

 confidered by Dr. Trotter as having a good foundation. 

 Modern authors, however, have not joined this latter gen- 

 tleman, and both Dr. J. Thomfon and Delpech beheve that 

 the diforder is infeftious. " The contagious nature of hof- 

 pital gangrene (fays profelTor Thomfon) appears to me to 

 be fufficiently proved, firft, by the faft that it may be 

 communicated by fponges, charpie, bandages, and clothing, 

 to perfons at a diftance from thofe infefted with it. Secondly ; 

 by its having been obferved to attack the flight wounds of 

 fiirgeons, or their mates, who were employed in drefGng 

 infefted perfons ; and that even in circumftances where the 

 medical men fo employed did not hve in the fame apartment 

 with the infefted. Thirdly ; by our being able often to trace 

 its progrefs diftinftly from a fingle individual through a fuc- 

 ceflion of patients. Fourthly; by its attacking recent wounds 

 as weU as old fores, and that in a fliort time after they are 

 brought near to a patient afFefted with the difeafe. Fifthly ; 

 by our being able to prevent the progrefs of the difeafe 

 in particular fituations, by removing the infefted perfon, 

 before the contagion, which his fores emit, has had time 

 to operate. Sixthly; by its continuing long in one par- 

 ticular ward of an hofpital, or in one particular fhip, 

 without appearing in other wards or Ihips, if pains be 

 taken to prevent intercourfe between the infefted and un- 

 infefted." (Leftures on Inflammation, p. 484.) But al- 

 though there can be no doubt of the difeafe fpreading 

 partly by its contagious nature, it appears to us equally 

 certain, that the number of cafes is alfo often increafed by 

 the continued operation cf the fame caufes which produce 

 the earlieft inftance of the diforder in any particular hofpital. 

 If this were not the cafe, upon what principle could we 

 account for the origin of the difeafe at all, fince the com- 

 mencement of the firft inftance cannot pofhbly be referred 

 to contagion ? 



It is alleged, that when once a patient has taken the in- 

 feftion, he cannot avoid the confequences, whatever precau- 

 tions he may adopt. Thus, Boyer informs us that he has 

 feen hofpital gangrene take place in wounded patients, who, 

 in the hope of efcaping this epidemic affeftion, had quitted 

 the infefted hofpital, and retired to elevated fituations, 

 where they breathed the moft falubrious air. Traite des 

 Maladies Chir. tom. i. p. 322. 



The duration of hofpital gangrene is various, according 

 to the extent of the wound, or ulcer affefted ; the confti- 

 tution of the patient ; the impreflion made by the putrid 

 efBuvia on the animal economy ; and the intenfity of the 

 diforder. Hofpital gangrenes have been known to continue 

 more than a month, m which circumftance, the patients 

 feldom recover. In ordinary cafes, the wound puts on a 

 favourable appearance again between the fixth and ninth 

 days ; and in flight examples, the amendment is manifefted 

 between the third and fifth. Whatever may be the period 



of 



