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Spontaneous Gangrene

skin, spasm, disease, lesions, gangrenous and lesion

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the non-infectious general diseases may be included the curious condition in which apparently spontaneous gangrene becomes developed in various parts of the body. The lesions are often symmetrical, but are not so in every case. Sometimes the lower limbs are the parts affected ; but portions of the face and blink may be also attacked. Children, the subjects of this tendency, are not always cachectic or otherwise enfeebled ; although in many cases the gangrenous process occurs in convalescents from acute or depressing disease. After measles a special disposition to gangrene is occasionally discovered. The same tendency is displayed, but less frequently, after other acute specific diseases, as scarlatina, variola, varicella, and enteric fever ; and insanitary conditions generally, combined with poor food, have been cited as predisposing causes of the gangrenous lesions. It is said to be more common in colcl than in warm weather ; and some observers are disposed to look upon a low temperature of the air as one of the causes of the mischief.

In the case where the disease appears in a well-nourished child who has not previously been subject to any enfeebling influence, the etiology of the lesion is obscure. Raynaud, who was the first to describe a "symmetrical gangrene of the extremities," attributes the affection to a spasm of the ar terioles, followed by a migration of blood-corpuscles and transudation into the skin. He states that he has noticed, with the ophthalmoscope, spasm of the arterioles of the fundus occuli in these cases. The disease is some times associated with intermittent hmmaturia ; and Dr. Gee has reported the case of a little girl, aged five years, in whom gangrene of the vulva was combined with embolism of the kidney and the brain. Still, in many cases no lesion of the viscera or arterial system is discoverable on the closest in vestigation ; and no evidence has yet been brought forwarcl pointing to any centric or nervous defect capable of exciting mortification of the tis sues, although the symmetrical distribution of the lesions is suggestive in many cases of some such mode of origin. Dr. Nedopil, in explaining-the

mechanism by which spontaneous gangrene is produced, assumes the ex istence of a functional nervous derangement. This writer agrees with Raynaud in ascribing the arrest of circulation to a spasm of the walls of the arterioles in the part affected. He supposes that owing to irritation of sensory and centripetal nerves the reflex centre of the vasoconstrictors which control the circulation at the extremities of the limbs is excited. If the spasm be prolonged and be sufficiently intense to close the arterial channels, gangrene of the part may be induced.

Children of all ages may suffer from the disease. It may occur imme diately after birth, or may appear in later childhood. It is not always fatal ; but if the gangrene is extensive and penetrates deeply through the skin, it seldom terminates otherwise than unfavourably.

Gangrene as it affects the mouth and the lung is described elsewhere. In the present chapter gangrene of the skin and underlying tissues will alone be considered.

Morbid affect the healthy skin or may attack a blistered surface. In the first case the skin becomes dark blue in colour, and then almost black. Its consistence varies. Sometimes it is hardened and feels dry like parchment; in others it is softer and moist. At the mar gins of the gangrenous patch the skin is reddened and inflamed. Instead of blackened patches the gangrene may assume the form of ulcers limited in extent. These ulcers are circular in shape, with abrupt, clean-cut edges, and their depressed floor is formed of a gray or blackish slough. They may penetrate completely through the skin.

When gangrene attacks a blistered surface the lesion is usually more superficial than in the former case. It appears in the form of a lightish gray slough, marbled here and there with a violet tint.

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