1911 Encyclopædia Britannica/Mortification

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19953461911 Encyclopædia Britannica, Volume 18 — MortificationEdmund Owen

MORTIFICATION, a term used in pathology and surgery, signifying a local death (Lat. mors) in the animal body. A portion of the body may die in consequence of the disturbance of its nutrition by inflammation, or of a cutting off of the blood-supply, as by pressure upon, or injury to, the blood-vessels. A comparatively slight injury affecting a portion of the body imperfectly supplied with blood may give rise to an inflammatory condition which in a healthy part might pass unnoticed, but which, in consequence of imperfect nutrition, may end in mortification. If the flow of arterial blood only is arrested, the part depending upon it for nutrition becomes numb, cold and shrivelled, and the form of mortification known as dry gangrene occurs. This is apt to be met with in oldish persons with diseased vessels and feeble heart-action, especially if the blood is rendered less nutritious by the presence of diabetes or of kidney disease. The rule of treatment in all cases of threatened mortification is to keep the part warm by flannel or cotton-wool, but to avoid all methods which unduly hurry the returning circulation. Such increase would give rise to excessive reaction, which, in tissues already weakened, might actually produce mortification. When the part is dead it should be wrapped up in dry antiseptic dressings to prevent putrefaction. The surgeon should then wait until the “line of demarcation,” a linear ulceration, between the living and the dead part is evident, and then, if the case permits, should amputate at a higher level. In spreading gangrene, in which acute sepsis is present, and in which no line of demarcation forms, the best chance for the patient is promptly to amputate high up in sound tissues. In these cases the blood is generally poisoned, and if the patient recovers from the primary shock of the operation, the disease may reappear in the stump, and lead to a fatal result.

Frost-bite.—Under the influence of cold, the blood-vessels contract, and less blood is conveyed to the tissues. Frost-bite is particularly apt to attack the feet, the hands, and the tips of the ears. The condition is unassociated with pain, for the reason that the nerves are benumbed. As no blood is passing into the skin, the parts look like tallow, and thus attract the attention of the companions of the frost-bitten man, who perhaps has no thought of there being anything amiss. But because the tissues are frost-bitten it does not follow that they will not recover. The great danger is that, as the blood in the vessels becomes thawed, there will so much reactionary flow through the tissues that acute inflammation will follow. And this inflammation of the damaged tissues is very likely to cause mortification. The re-establishment of the circulation, therefore, should be undertaken with the greatest possible care. The frost-bitten individual must not be brought near a fire nor even into a warm room. Nothing warm should come in contact with the affected parts. The best thing to do is to rub them with snow or with cold water. The thawing is associated with much pain, and in the case of the hand or foot this may be diminished by raising the part, so as to help the return of the venous blood to the heart. If mortification follows, the parts become black, and care should be taken to prevent their becoming invaded by the germs of putrefaction.  (E. O.*)