CHAPTER VI. Of Gangrene and Mortification. (Part 2)

admit: I have used it as fomenta- tion, as poultice, as dressing: I have assisted it with every thing which has been usually thought capable of procuring, or assisting digestion ; still the distemper has continued its course, perhaps a little more slowly, but still it has ended in death. “ T am sorry to rob one of our great medicines of any part of its supposed merit, but as on the one hand, its claim, in this instance, is unjust, and as on the other, I - hope to add as much to the character of another, the res medica will be no sufferer. Some time ago, I had a patient labouring under this complaint, who from antipathy, obstinacy, or some other cause, could not be prevailed on to take bark in any form whatever. I made use of every argument but to no pur- pose: fomentation, poultice, and the usual dressings were applied in the usual manner ; the disease advanced VOL. 1. E a6 ELEMENTS OF SURGERY. some days more, some days less, and at the end of a fortnight, the small toes were all completely mortified 5 the great one became blackish, the foot much swollen, altered in colour, and the disease seeming to’ advance with such hasty strides, that I supposed a very few days would determine the event. The pain in the foot and ankle was so great, and so continual, as totally to de- prive the patient of sleep. On this account, and merely to procure some remission, I gave two grains of opium at night, which not having the desired effect, I repeated it in the morning. Finding, daring the follewing day, some advantage, I repeated the same dose night and morning, for three days ; at the end of which time the patient be- came quite easy, and the appearances on the foot and ankle were visibly more favourable. Encouraged by this, I increased the quantity of the medicine, giving one grain every three or four hours, taking care to watch its narcotic effect, and to keep the belly empty by glysters. In nine days from the first administration of the opium, all the tumefaction of the foot and ankle totally subsid- ed, the skin recovered its natural colour, and all the mor- tified parts plainly began to seperate ; in another week ahey were all loose, and casting off, the matter was good, and the incarnation florid. During the whole of this time I continued the use of the opium, varying its quan- tity as circumstances required, but never gave less than three or four grains in twenty-four hours. <¢ When the sloughs were all cast off, the bones sepa- vated, and I had only a clean sore to dress and heal, I gradually left off the medicine. “ To relate cases which are nearly, or at least materi- ally similar, is of no use: I shall therefore only say, that every opportunity, which I have had since of making the experiment, has still more and more convinced me of the value and utility of this medicine, and of its power of rescuing from destruction, persons under this affliction. BLEMENTS OF SURGERY. rg “¥ cannot say that it has never failed me: it certainly has; but then it has been under such cireumstances, as I think would faicly account for the faihere.” In addition to Mr. Potts account of this species. of mor- Gfication, I shall just add, that in the only case of it E have ever seen, the applicatien of a blister produced am immediate termination of the mortification. —