The constitutional symptoms depend upon the amount of tissue involved. At first when an extremity is affected there may be but slight general disturbance; when, however, the gangrene ascends the limb, fever and other evidences of tox wmia appear.
The extension of gangrene depends to a great degree upon the nature of the cause and the general health of the pa tient. An injury, which, through in terruption of the circulation, is followed by gangrene, often remains circum scribed to the region in which the blood flow has been reduced or arrested, pro vided, however, the general condition of the patient is favorable. Persons in poor health, or individuals who have lowered their vital powers by the exces sive use of alcohol, overwork, insufficient food, etc., however, are much more posed to extension of the gangrenous process.
Complications incident upon the de structive nature of gangrene usually lie behind a fatal issue, when this occurs.
An artery may be eroded, giving rise to mortal hemorrhage; pymia and septi emmin through penetration into the ldood of pyogenic micro-organisms or their toxins, peritonitis through exten sion of the gangrenous process from a gangrenous hernia, etc., may be men tioned among the many death-producing conditions which can appear.
In the cases previously alluded to, in which gangrene spreads with great ra pidity, the so-called traumatic gangrene, the blood-supply is not only interrupted, from an extremity, but there is septic infection besides. In a few hours in such cases the gangrene may have spread up an entire extremity through the • agency of infectious bacteria. The skin becomes brownish red, black, or green; gas is rapidly formed, and the patient quickly succumbs to acute septic=ia, unless amputation has promptly relieved him of the source of infection. The
term "traumatic" is inapplicable to such cases, because it implies that this viru lent form of the disease is to be expected after traumatism.
The characteristic by which traumatic gangrene is most readily recognized is the subcutaneous development of gas. W. Evans (Lancet, Jan. 22, '98).
In truth, gangrene seldom occurs now adays owing to modern methods, and, even in severe injuries of an extremity witnessed in the average hospital case, separation of the dead tissues soon oc curs. Strict antisepsis in all surgical procedures adopted greatly limits the likelihood that a dangerous form of gan grene will appear. Yet even slight ex posure of a wound to infection may be followed in suitable environment by an active necrotic process endangering the life of the patient.
In DRY GANGRENE, of which senile gangrene is a type, there is a distinct absence of fluids, and the process of mortification is more a metamorphosis into an inorganic mass than a true de composition; hence the term "mummi fication" frequently applied to this form. The local blood-supply gradually di minishes, the tissues shrink, become dark brown or black, wrinkled, and the skin becomes leathery. It usually affects the toes, sometimes the fingers, and may spread to the plantar or palmar surfaces.
Remarkable case of twin labor de scribed where one twin was flattened and macerated, while the other had gan grene of the leg from constriction.
Though the infant lived but sixty-five hours, all the more prominent symptoms of dry gangrene became well established. Stolz (Wiener klin. Woch., Jan. G, '9S).