primary indications here are precisely those enumerated under septicremia. More can be done, however, if the case is seen early. The thrombi being transported by the venous current and the early venous abscesses beginning close to the infectious wound, disinfection of the interior of the proxi mate part of the veins may arrest fur ther progress. A solution of mercuric bichloride, 1 to 2000, may be used for this purpose. If this cannot be done, a ligature may be placed around the sus pected vessel some distance above. Am putation performed early sometimes saves the case; it is fully warranted when the diagnosis is positive and the course of the disease is unfavorable. The medicinal and dietetic treatment is that outlined under SErriczniA.
An important measure in pyaemia is the prevention of bed-sores, which read ily form when the patient is allowed to remain in bed. Ile should be placed on air- or water- cushions; his position should frequently be changed, and the parts compressed should often be bathed with camphorated alcohol. Such a ease is a source of infection for wounds in other patients, and should therefore be isolated—preferably in a tent exposed to the sun's rays and allowing a free cir culation of air.
Gangrene.
Definition.—This term is usually at tributed to death or mortification of soft tissues, while the term is re served for death of osseous or cartilagi nous tissues.
Varieties. Gangrene is divisible into several varieties: moist gangrene, due to arrest of the vascular supply, and in which the parts are soft and pulpy: dry, or senile gangrene, or mummification oc curring in old age, in which the tissues become leather-like and wrinkled : spon taneous gangrene, a relatively rare form affecting the extremities and observed in apparently strong and young subjects; ergot gangrene, which occurs in individ uals who, in consuming rye or rye-bread. become exposed to ergot of rye: diabetic gangrene, which occurs as a complication of advanced diabetes; pressure gangrene due to pressure and which occurs occa sionally as a complication of bed-sores: and symmetrical gangrene, or Paynaud's disease, a paroxysmal form affecting mainly the tips of the fingers and toes.
Symptoms.—The symptoms vary greatly according to the primary patho genic factor and to a degree upon the location of the gangrenous process.
MotsT GANGRENE. — This variety is that most frequently met. owing to its frequent occurrence as a result of acci dents, irreducible hernia, etc. Being due to arrest of the blood, both in the arteries and veins, there is softening., or
liquefaction. The tiS•:=1.1el‘ vari ous shades, varying from bluish green, red, to black and blebs containing a very foul and ftetid liquid are formed, the mortifying tissues giving off gases composed mainly of sulphide of gen, ammonia. and volatile fatty acids.
This form is likely to occur after severe injuries, such as crushing, burning, or even frost-bite. It is also observed whin open wounds have been exposed to infec tion through imperfect or uncleanly dressings. l form of moist gangrene. also of traumatic origin, is sometimes witnessed after a large vascular trunk has been destroyed. which may spread with great rapidity.
In an average case the gangrenous area undergoes, as stated, a characteristic change of color. first the boundary line between the dead tissues and the living ones is imperfectly marked.
Where the progress of the necrotic process is arrested, however, through the vital resistance of the tissues, an area of inflammation interposes itself as a protecting wall, which becomes more or less perfect as the granulation tissue formed is healthy. This constitutes the Line of demarkation. The inflammatory process continuing beyond, ensues. and the dead tissues may thus be entirely separated from the living ones through Nature's efforts. The inflamed area is distinguishable from the healthy or gangrenous ones by its bright-red color. which changes to blue or black in the direction of the dead tissues.
Unfortunately Nature's efforts do not always and the morbid process may penetrate the limiting barrier, and invade the tissues beyond, extending oTadually until death ensues.
A green color not always indicative of of the inteAine. Case of eight-day incarcerated-henna loop in which a "fine-green Florentine-bronze color" had appeared. The loop was not reduced and the patient died four hours later, when tests 05 the green portion proved that it was not gangrenous. The portion of the intestine was filled with water at a strong pressure, and only an apparently sound part split. The intes tine can be colored green with bile alone, and a light-green color does not necessarily imply any alteration in the intestinal wall. A yellow-green, dark, black, or bottle-green are of worse sig nificance, but at the same time they do not necessarily indicate a serious de terioration in the intestinal wall. Begoin (Centralb. f. Chin, Dee. 2, '9S).