SPONTANEOUS GANGRENE is rarely ob served. It may be met with in subjects who apparently are in excellent health, but affected, as autopsies have shown, by arteriosclerosis. The arteries are narrowed, and thrombi are sometimes widely disseminated through the af fected limb. This renders spontaneous gangrene particularly malignant, and amputation of the limb is often sary, preferably above the knee. Unlike other varieties, it gives rise to acute fering, owing to involvement of the local nervous supply, the principal branches of which are often found greatly thick ened. Spontaneous resolution is rarely observed in this form.
Form of gangrene which is compara tively common in Japan. It begins spon taneously in the form of fissures or ulcers of the toes, then advances slowly until a line of demarkation is formed between the sound and diseased tissue. In some cases the gangrene heals under suitable treatment; in others it advances con tinuously and extends to the thigh. Thirty-four cases, of which only one was in a woman. The disease was most fre quent between thirty-eight and forty seven years, showing a marked differ ence from senile gangrene. In all of the
cases the radial pulse was hard and dif ficult to feel. The most important le sions in the examination of the tissues were found in the arteries of the part, namely, obliterating endarteritis; or an organized thrombus. In nine of the cases, along with the obliterating en darteritis, there was a cellular infiltra tion in the tissues, which he regarded as showing the syphilitic character of the process. Raga (Virchow's Archiv, clii).
Fifteen cases of spontaneous gan grene of the legs in the puerperium. It may be due to embolism detached from a diseased heart-valve and lodged in the anterior tibial artery, or from arterial thrombosis extending from the placental site to the iliac vessels. The gangrene is usually dry, and the pain very severe, and forms a distinct line of demarkation. Diagnosis is estab lished by severe pain, discoloration, coldness, with loss of sensibility in the part. Wormser (Centralb. f. Gyniik., Jan. 26, 1901).