SURGERY. 
the artery of a limb ; impeding tlie return 
of the venous blood; continued topical pres- 
sure in a weak constitution; cold, when 
followed by the opposite extreme ; are 
causes of this description. A peculiar mor- 
tification, beginning at the toes ot old per- 
sons, and proceeding upwards, is of this 
kind. 
When the mortification has stopped, a 
defined boundary separates the dead and 
living parts; the lymphatics remove the 
connecting matter, so as to form a groove, 
in which suppuration commences ; and this^ 
groove extends deeper and deeper until 
complete separation is effected. Our treat- 
ment must be directed to the object of 
sfopping the disorder; in which view atten- 
tion to the constitutional disturbance, that 
is usually very great, is of primary impor- 
tance. The state of the digestive organs 
will demand particular attention. The great 
pain frequently requires opium. Cold washes 
while the inflammation continues high ; and 
afterwards a poultice of bread or linseed, 
alone, or in combination with very finely 
powdered charcoal, are the best topical 
means. Amputation of a limb can never be 
allowed, until the line of separation between 
the dead and living parts is clearly formed. 
When tlie inflammation has abated, and the 
separation is going on, (which should in ge- 
neral be left entirely to nature) the consti- 
tution should be strengthened by every 
means both of food and diet. Hence bark, 
with wine and aromatic confection; fer- 
mented liquors, and a nourishing diet, be- 
come proper. Bark, how'ever, is by no 
means so universally beneficial in mortifica- 
tion as many surgeons suppose : if sympa- 
thetic inflammatory fever be present, or 
derangement of the chylopoietic organs, it 
would certainly be hurtful; but, where de- 
bility shows itself, this remedy must be in- 
stantly employed. Opium is often very 
serviceable-; and it has been represented by 
Mr. Pott as almost a specific in the mortifi- 
cation of the toes and feet of old persons, 
where it must be used in a very free way. 
The same remedy will be of service in other 
cases, where the disorder is preceded and 
accompanied with great pain, but not in- 
flammation. ' 
Erysipelas is a species of superficial in- 
flammation, in which the red colour is tinged 
more or less with yellow, particularly to- 
wards tlie termination; it spreads rapidly 
and widely ; there is swelling, without much 
elevation, hardness, or circnmscription. 
The skin is glossy, and its colour disappears 
oii pressure. Tlie pain is of a burning or 
itching kind. It often changes its seat ; and 
is attended, when it recovers, with desqua- 
mation of the cuticle. Sometimes vesicles 
are formed. It seldom suppurates ; but 
when it does, the abscesses are very exten- 
sire, as adhesions seldom take place, to 
limit the expansion of the matter. Morti- 
fication ensues in some instances. 
The. constitutional affection varies con- 
siderably; according to the degree of local 
disturbance. Languor, head-ache, loss of 
appetite, nausea, vomiting, oppression of 
the stomach, and foul taste in the mouth, 
precede. It is most dangerous in the face, 
and attended with the greatest disturbance, 
often amounting to delirium. 
Disorder of the chylopoietic viscera, and 
suppressed perspiration, are tlie most pro- 
minent causes of the complaint. Mild pur- 
gatives, diaphoretics, and the antiphlogistic 
regimen, are sufficient in the slighter cases. 
In more severe attacks, calomel, combined 
with other purges, and antimonials, is pro- 
per. Emetics, where the stomach is much 
distressed. Bark may be required after the 
'disorder subsides. Cold washes, or poul- 
tices, to the part, as they seem to agree: the 
former are preferable, on the principle of 
checking the inflammation. 
Carbuncle is a very violent unhealthy kind 
of inflammation, attended with a painful 
deep discolouration of the skin, a very re- 
markable thickening and induration of that 
part, and gangrenous suppuration under it, 
occurring usually at the back part of the 
trunk, and often constituting a symptom of 
the plague and other malignant fevers. Its 
size varies considerably. Openings form in 
the swelling, and give issue to a very offen- 
sive discharge; and in the end extensive ' 
mortification ensues. The fever, which is 
at first inflammatory, soon becomes typhoid ; 
and strong marks of chylopoietic derange- 
ment are generally attendant. 
The swelling must be completely laid 
open by a free incision through the brawny 
skin, so as to discharge all the matter and 
sloughs. Purgatives and emetics are pro- 
per for the disturbed digestive organs ; and 
the debility wliich remains after the disorder 
has subsided, demands strengthening inedi-, 
cines and food. Opium when the pain is 
excessive. 
Boils are similar to carbuncles, except 
that they are smaller, and require the same 
treatment ; the state of the chylopoietic 
organs must be particularly regarded. 
(Edema is an unusual accumulation of 
