CARBOLIC-ACID GANGRENE.—Car bolic acid has caused gangrene in so many cases that it seems to merit a spe cial place among chemical agents capable of inducing this condition. Even in 2 per-cent. solution, this agent is capable of destroying the life of tissues. The majority of cases reported in which gangrene occurs were felons or slight disorders of the finger-tips or toes. Ac cording to Czerny (111iinch. med. Woch., Apr. 20, '97), the duration of the appli cation is more important than the strength of the solution, the anaesthetic action of the drug causing it to be left in situ prolonged periods at a time. The parts first become grayish white and eventually black. There is no pain, and the gangrene is only revealed by the appearance and the stiffness of the finger or toe affected.
Three cases in which applications of carbolic acid resulted in gangrene. A 2-per-cent. solution of carbolic acid can have a deleterious influence. Leusser • (Mfinch. med. Woch., No. 15, '90).
Case of disseminated gangrene of skin due to iodide of potassium. The ulcers were sharp-cut with slightly-elevated borders. The mucous membranes were unaffected. The urine contained neither sugar nor albumin, but the patient's gen eral health was bad. Audry (Annales de Derm. et de Syph., No. 11, '97).
Eighteen cases of gangrene of the fingers, the result of weak carbolic-acid dressings. This makes a total of 132 eases reported. Carbolic acid in any strength as a moist dressing is dangerous, and should never be used. F. B. Harring ton (Amer. Jour. Med. Sciences, July, 1900).
Etiology and Pathology.—The causes of tissue-death are divided by Tillmans ("Surgical Pathology," Rogers's transl.) into four general classes: 1. tion of the afferent flow of arterial blood without the development of a collateral circulation, such as may occur in the cases of thrombosis and embolism, or after ligation, or in consequence of the pressure of a tumor or inflammatory exudate. 2. Interruption of the effer ent flow of venous blood. 3. tion or stasis of the circulation in the capillary walls. 4. Death of the
cells without any disturbance of circula tion, due to poison, such as snake-bites, or to micro-organisms or the products of their metabolism, such as are found in infectious diseases of wounds; for ample, erysipelas, cellulitis, and septi caemia.
Local and general anaemia, venous stasis, disturbances of circulation from diseases of the vessels,—heart or lungs, —or disturbances of circulation due to inflammation—in short, faulty circula tion from any cause—increase the dis position to gangrene from the effects of chemical or thermal influences.
The special etiological factors have been already alluded to, while gangrene as a complication of various infectious diseases has been reviewed in the re spective articles upon the latter.
Two cases of gangrene observed fol lowing measles in children. In the first case the mouth became sore and later gangrenous. In the second ease the right side of the vulva was found covered with a dark, gangrenous spot, the size of a half-dollar, involving the right labia ma jora and minora, the clitoris, and the vagina in the region of the meatus uri narius. Death occurred in both cases.
G. E. Lochner (Albany :Med. Annals, Apr. 4, '96).
Case of a girl, aged 2 years, who, on the tenth day of an attack of measles, pre sented a plaque of gangrene the size of the palm of the hand upon the right lateral aspect of the thorax below the axilla. The periosteum of the subjacent ribs was laid bare, with a part of the great pectoral muscle. Cure resulted without functional impairment after a large abscess had developed in the inter nal aspect of the arm facing the gangre nous area. The author attributes the lo calization of gangrene to the habit which the child had of lying on its right side. The compression had produced thrombo sis of the long thoracic artery, with con sequent gangrene of the tissues, whose power of resistance had been weakened by the disease. Wunder (Winch. med. Woch., No. 20, S. 536, '97).