Selected Monographs.

  • New Sydenham Society
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Selected Monographs. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    These last circumstances are evidently of a nature to leave a doubt in the mind upon the clinical estimate which is to he made of the fact with which we are concerned. Although convinced, on account of the excessive slowness and dissemination of the sphacelus, that this lesion depended in our patient upon a purely functional circulatory trouble, I am by no means able to prove that there was no obstruction in the arterioles. But even if one admits as certain the absence of all obliteration, it appears to me very difficult to include this case in the noso- logical group of symmetrical gangrenes. It is true that both inferior extremities were invaded, but the attacks occurred at long intervals from one another, and differed considerably in intensity. So that in reality there was rather alternation than symmetry of the phenomena on the two sides. This inequality was still more pronounced in the upper limbs, of which only the left suffered from gangrene. For my part, when called upon to give advice as to the treatment to be followed, I was of opinion that one might attempt without risk of harm the use of continuous currents, but . without any great expectation of benefit. This treatment was employed regularly during twelve days without leading to the least improvement. I do not enlarge here upon the other therapeutic attempts which were made; everything failed completely, oxygen baths included. Finally, the gangrene was limited by the sole efforts of nature, and the patient, entirely discouraged by the uselessness of remedies, returned to America, not yet cured, at the beginning of November. I considered that I ought to place this unsuccessful case alongside the facts of recovery which I have recorded above. The latter are, I submit, none the less valuable, just for the reason that the therapeutic indication is related to an order of facts clearly defined to which the history of our American patient presents only a dubious analogy. I ought to add that as regards the intensity of the symptoms, our cases of cure were distinctly slight cases. Would the electrisation of the cord bring about equally rapid ameliorations in those grave cases of local asphyxia of which I have reported examples, and which induce almost at the very onset extensive symmetrical gangrenes ? It is at least permissible to doubt it. The best means to avoid disappointment is to guard against exaggerated hopes. It would be premature with a number of observations so
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