Case of multiple gangrene of the skin in a nervous, anmmic girl, 21 years of age. After a burn upon the left hand a vesicular eruption attended by severe stinging pain appeared, at first limited to the left arm, but later distributed over the whole body. With the evacuation of the contents of the vesicles upon the left arm discoloration occurred, and an eschar formed which fell off after a considerable time. The defect healed with the forma tion of sear keloid. Upon other portions of the body the blebs were tensely filled with pure serum or serum and blood, and ruptured after a short time, laying bare the corium; these healed by granulation without the formation of an eschar. After several outbreaks recovery t3ok place, the affection having lasted over a year. The nervous system plays an im portant ride in the disease, which depends upon a trophoneurotic process. 1Iintner (Archiv f. Derm. u. Syph., B. 3S, H. 2. '97).
Case of symmetrical gangrene pro duced by embolism of one iliac artery. Patient died on the twenty-eight day.
In the left common iliac artery was an embolus adherent to the internal coat. which appeared normal. Secondary but non-adherent clots were prolonged down ward into the internal and external iliac, the femoral, and the deep femoral arter ies. A secondary clot ascended to the bifurcation of the aorta and then de scended in the right iliac and femoral arteries. All the secondary clots were soft and non-adherent; those on the right side especially floated in the arteries which they did not fill. The left kidney and the spleen were full of infarcts of the same nature as the iliac embolus. Widal and Nobecourt (Lancet, April 16, '9S).
Study of 15 specimens of gangrene. In cases due to arterial sclerosis a high grade sclerotic proliferation of the in tima is found. causing stenosis of the lumen of one or more of the main ves sels. It threatens the life of the ex tremity by closing the exit of the branches from the vessel involved, pre venting the formation of collateral cir culation. A secondary progressive thrombosis is also apt to develop on the changed arterial wall. Senile or dia betic gangrene, a localized petrifaction of the arteries, sometimes forms.
Binge (Archiv f. klin. Chin, Bd. H. 1, 1901).
Analysis of personal cases and of all the eases of gangrene following in fectious disease found in literature: 166 in all. The most frequent causes were typhoid and typhus fever, and after these influenza, puerperium, and pneu monia, in the order named. Scarlet fever was the cause in only 3 cases, and diphtheria in only 1. The commonest seat is in the legs, 122 cases having gan grene in this situation. There appears
to be no difference between the right and left legs, and gangrene of both legs is less common than of either separately. In 12S eases of which the result is known, 12 patients died. The percent age is inlich higher among women than among men. In 6:1 cases autopsy showed thrombosis in the main artery of the limb. Tn many of the others investi gation was not made. Eichhorst (Dent saes Archiv f. klin. Med., vol. lxx, 5-6, 1901).
grene foudroyante of French surgeons, is developed when to a necrotic process in the economy there is added a rapidly spreading emphysematous condition of the surrounding parts, with increased tension, crepitation, the formation of gaseous bullw, and a bronzed and streaky discoloration of the skin. The disease, once established, tends to spread rapidly to other parts of the body, and consti tutes the most fatal form of gangrenous trouble.
Gaseous gangrene may be produced by various micro-organisms, particularly, however, by the bacillus aerogenes cap sulatus, which, without having a specific action, behaves in man as a toxin sapro phyte upon tissues already seriously dam aged. The bacillus coil conu»unis, with other germs, may also cause gaseous gangrene. Muscatello (Rif. IVIedica, May 21, 22, 23, 1900).
Infectious gangrene of the skin is oc casionally observed. According to Cail laud (Rev. Mens. des Mal. de l'Enfance, Jan. and Mar., '97), this appears under two conditions: There may be a previ ous ulcerative skin-lesion, from and upon which the gangrene starts, or the gangrene may appear immediately after a non-ulcerative manifestation of the skin; it is not an occasional accident, but constitutes an essential element of the disease. Any cause which impairs general health predisposes to that con tagious affection, and existing ulcera tions and erosions serve as a door of entrance for the contagion.
Spreading traumatic gangrene, though usually developed in subjects suffering from general depraved health, occasion ally occurs in healthy subjects through infection of the wound by the anaerobic bacillus of malignant cedema of animals, and to which fowls are particularly sus ceptible. Through the experimental observations of Chauveau and Arloing, Brieger, Ehrlich, and others, the fact has been practically established that the same germ, which, on the one hand, may give rise in animals to malignant oedema, may, on the other, when ingrafted in man on tissue the seat of a moist grene, produce the emphysematous con dition.