(Concluded from page 198.)
When gangrene involves the entire knuckle strangulated the appearances are sufficiently characteristic. Chocolate or dark slate colored, denuded in patches of its peritoneum and in a collapsed condition, it fails to react to mechanical or chemical irritation. The odor is fetid before perforation has taken place. Where the strangulation has been very acute, as in the last case reported, the changes in and about the hernial sac need not be very marked. After the escape of a varying amount of turbid bloody fluid from the sac, the latter appears of a bright or dusky-red minus the glistening appearance of the normal serosa. When it is of older date one after another of the hernial coverings are involved in the inflammation. They are welded together, in turn to break down. A fecal abscess is the result. In the recent strangulation no difficulty is encountered in bringing the
RANSOHOFF J. THE MANAGEMENT OF GANGRENOUS HERNIA, WITH REPORT OF A CASE. Read in the Section of Surgery and Anatomy, at the Forty-third Annual Meeting of the American Medical Association, held at Detroit, Mich., June, 1892. JAMA. 1892;XIX(8):207–209. doi:10.1001/jama.1892.02420080001001
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