(From mors, death, and fio, to produce). A mortification. Sphacelus, ignis frigi-dus. Hippocrates uses sphacelus in different senses, sometimes confining it to a corruption of the bone, which, in the language of Celsus, is called vitiari; but these words are used in general to express the corruption of the flesh as well as bones. A mortification of the soft parts only Hippocrates styles sapron, mydosen, and sepomenon. The word sphacelus was used by the ancients to express violent pains and inflammations terminating in mortification, as well as the withering of any part. Galen confines the term sphacelus to an incipient gangrene.
Boerhaave considers gangrene as a beginning mortification. Mr. Pott calls it gangrene in the cellular membrane and the skin, but when attacking the muscles, sphacelus. A mortification in the bone is called a caries. Dr. Cullen considers the mortification not as a genus of disease, but as a termination of inflammation; and he divides it into gangraena and sphacelus. In the first, after an inflammation, the part becomes livid, soft, has little sensibility, and is often covered with ichorous vesicles; in the second after a gangrene, the part becomes black, flaccid, easily lacerating, without sensation or heat, and attended with the foetor of putrid flesh; the malady quickly spreading: the latter is, therefore, an higher degree of the former.
A mortification is, the death and consequent putrefaction of one part of the body while the rest is alive. Celsus describes its progress in the following terms. The flesh is black or livid, dry or parched, and the external skin generally full of blackish pustules: then that which is next to it is pale or livid, almost aerugi-nous, and without sensation. It is still worse in an inflammation, since all the symptoms spread at once, the ulcer into the pustulous place, the pustules into that which is pale and livid, the pale or livid into that which is inflamed, and that which is inflamed into that which is sound.
It is singular that this subject has so long remained in a state of so much confusion, not only with respect to its nomenclature, but to its causes and treatment. We have found in no author a connected and systematic view of the subject; and we must, therefore, on this, as on several other occasions, endeavour to unite the scattered limbs and supply the deficient links. In this enquiry we shall employ the term mortification as a generic one.
The simple idea of mortification is, as we have already said, the death of a portion of the body while the rest continues alive, often in a sound state. This partial death may arise from general or local causes. The general causes are fever, or great debility; each occasionally attended with a dissolved state of the fluids. Fevers attended with mortification are the violent inflammatory ones, with local inflammation, or the jail and hospital fevers. Diseases of debility are those of old age, anasarca, scurvy, bruises, and causes which check the circulation of the blood, or impede the nervous influence. In these cases, the life of the part is destroyed by the violent excitement, or the tone of the constitution gradually diminished, by advancing age, a sedentary life, or an unalimentary diet. In internal inflammations we cannot see the progress, but it is probably the same as in the external parts. In the latter the pain ceases, the purulent matter becomes acrid and sanious; air bubbles are set at liberty, collecting in small vesications, under the skin, or distending the whole organ by an emphysematous swelling. A slight delirium comes on, with either dejection of spirits, or with a calm serenity of mind; but, in each case, attended with a peculiarly wild expression of countenance; though sometimes with a very peculiar expression of serenity, with a blackness under the eyes. The pulse is usually quick, low, and often intermitting. In the earlier stages, deep incisions are attended with a discharge of blood still florid; but the skin, the muscles, and the cellular membrane, soon melt down into a brownish offensive mass. See Inflammatio.
In the jail and hospital fevers, depositions sometimes take place, resembling, at first, in appearance, critical abscesses, but rather of the nature of the anthrax or carbuncle, running rapidly into mortification; and, when these do not appear, discolorations, apparently slight will be observed on the skin, which often run deep, and the mischief is concealed till no longer within the reach of art.
Mortifications, from debility, are frequent in old age, and these are sometimes chiefly local. When attended with great pain, they are highly distressing; but they sometimes occur without being perceived. Mr. Pott first pointed out the painful kind, as the subjects of treatment different from that which had been usually recommended: the other kinds are the dry., and what has been styled the white gangrene. In the dry gangrene the parts shrivel, the fluids are observed, but no putrefactive fermentation can take place without moisture. The part remains attached, for a time, like an extraneous one, and may be amputated above the mark, which separates the dead from the living portion; but nature at last often makes the separation, as in other gangrenes. The white gangrene., sometimes mentioned, seems rather to be a paralytic insensibility than truly gangrenous.
In general, the topical gangrenes of advanced life are owing to ossifications of the arteries, and we suspect the pains attending those described by Mr. Pott are owing to the effort of the arteries above, endeavouring to conquer the obstruction. We have instances of similar pains in paralytic limbs, when sensation is recovering, and in anasarcous ones, when the water is removed. What adds to the probability of the cause is, that the pains occur some time previous to the darkness appearing on the skin, which is usually first observed between the toes.
Water, collected for a long time, in the lower extremities, presses on the nerves and arteries, destroying both sensibility and irritability. In such cases, a slight wound often becomes gangrenous, and the vesicles, raised by the water, and by which it is occasionally discharged, sometimes cover a deep mortification. Such consequences are not, however, common, and when mortification, in such instances, does follow, it is superficial, and often easily removed. See Anasarca.