In the field-mouse, an animal immune to the bacillus of septicemia, Koch has produced, experimentally, a progressive gangrene from inoculations with chain micrococci not to be distinguished from the streptococcus pyogenes. He has also shown that the ptomainic products of bacterial activity may themselves cause the destruction of tissue, since, in the examination of specimens from the in oculated animals, the progressive necro sis was observed markedly in advance of the bacterial invasion.
Case of gaseous gangrene complicating a compound fracture of the right fore arm in a boy of 10 years, the bones com ing in contact with mud. For the first two days the patient did well, then the arm began to swell and became rapidly emphysematous and gangrenous, with a line of demarkation an inch above the elbow; the swelling was dusky in color and there was crepitation extending over the scapula and below the clavicle. Sev eral long incisions were made along the forearm and gas escaped with great force. Antiseptic measures were carried out and the condition of the arm rapidly im prove probably because of the relief from pressure on the blood-vessels by the gas. Amputation at the junction of the upper and middle third of the arm was necessary, however. The condition is be lieved to have resulted from infection with the bacillus aUrogenes capsulatus, but no bacteriological examination is re ported. Reports of 16 cases of infection by this micro-organism in literature, with 12 deaths and 4 recoveries found. C. P. Gildersleeye (Med. Record, Mar. 4, '99).
Study of the nature of the vascular lesions observed in fourteen cases of senile and diabetic gangrene. There is most probably a primary arteriosclerosis obliterans which terminates in throm bosis; the latter extends into the col lateral branches, abolishes the anasto motic circulation, and determines the occurrence of gangrene. lunge (Edin burgh Med. Jour., Sept., 1900).
Treatment. —Removal of the causative factors and especially those interfering with free circulation is the first indica tion. In strangulated hernia—for stance, section of the constricting this aim can be reached; in paraphimo sis, pressure from superficial tumors, bed-sores, tight bandages, etc., relief can be afforded in this way. In many cases, however, this resource is not available.
In obstruction due to thrombosis and arteriosclerosis, for example, all that can be done is to facilitate the return of the blood by judicious procedures. Ele vation of the part. with slight flexion of the extremity affected, gentle massage toward the heart, warmth, taking care to avoid "hot-bottle burns," which under such circumstances are easily inflicted, represent the minor indications.
When, notwithstanding prophylactic measures, the gangrenous process velops, disinfection of the area should at once begin. Iodoform, orthoform, aristol, and resorcin are valuable in this connection.
In a case of hospital gangrene in a young girl, resulting from ulcerations of the leg, applications of resorcin produced excellent results, in solutions of the strength of 1 in 50. Hallopeau (Semaine MM., June 11, '92).
Case of hospital gangrene cured by the application of bandages soaked in cam phorated ether. M. A. Coyon (Ann. de l'Inst. Pasteur, Nov., '90).
Remarkable results obtained in a dia betic who had had gangrene in one leg which necessitated amputation. The other leg became involved, and a suc cession of scabs formed on the foot. No pulse could be felt in the dorsal artery of the latter or in the posterior tibial. After a half-hour's massage the whole foot and leg were warmer, the tissues softer, and the tension less, and the dorsal artery could be felt so that the pulse could be counted. The method of work was principally by deep manipula tion in a downward direction to aid the arterial current, followed by upward friction, or effleurage, to aid the venous and lymphatic flow. Douglas Graham (Inter. Clinics, vol. iv, series 10, 1901).
The next object is to prevent infec tion of the healthy tissues beyond by products of decomposition. Any ac cumulation of offensive fluid or gas should be prevented by evacuating foci and treating the part with antiseptic lo tions. An excellent agent in this con nection is permanganate of potassium in 1-grain-to-the-ounce solution. Infiltrat ing abscesses should be followed up to the living tissues above, if needed, to thoroughly clear them of the infecting elements. Carbolic acid should not be used as a disinfectant, since it tends to lower the vital resistance of the tissues.