Gangrene as a complication and sequel of the continued fevers, especially in typhoid / by William W. Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
[1896]
Catalogue details

Licence: Public Domain Mark

Credit: Gangrene as a complication and sequel of the continued fevers, especially in typhoid / by William W. Keen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    times differentiate the obstructed artery from the non- obstructed vein — an important point in prognosis. Week by week, sometimes day by day, the growth of the secondary coagulum may be traced upwards by the pro- gressive abolition of the arterial pulsation and by the up- ward march of the gangrene. If old cicatrices from burns, or unhealed cczematous ulcers, old fractures or varicose veins exist, all loci minoris resistentice, they will be among the earliest parts to yield. Blebs may form in the early stages, but most frequently they will dry up and the parts will mummify, although, as already indicated, moist gan- grene may supervene if a large clot form much higher up, or if, in addition to the artery, the vein also becomes extensively obliterated, .thus involving great masses of moist tissue, such as the thigh, in sudden ruin. As is generally seen in cases of dry gangrene, days or weeks will elapse, if the patient lives so long, during which nature as usual makes a powerful effort to rid herself of the dead parts by the establishment of a line of demarcation. On the establishment of this, the pain often ceases. In case the primary obstruction is in the vein and it be- comes obliterated, extensively and completely, by a throm- bus or by a simultaneous venous and arterial thrombosis, then the gangrene will be of the moist instead of the dry variety. It will present the usual appearance of moist <ran<rrene. The vessels at the the scat of the obstruction will be very tender and can be felt as hard cords. The clot will extend sometimes rapidly and widely, and the gan- grene will be more extensive in the area involved and far more acute in its disastrous clinical course, as would naturally be expected. In the variety of gangrene beginning in the peripheral vessels, the symptoms will vary somewhat. It is not so uniformly in the lower extremity, and is' much more frequently symmetrical. If small in extent, pain is not