A remarkable case of spontaneous gangrene / [Henry William Fuller].

  • Henry William Fuller
Date:
[1847]
Catalogue details

Licence: Public Domain Mark

Credit: A remarkable case of spontaneous gangrene / [Henry William Fuller]. Source: Wellcome Collection.

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    with, and the frequency of osseous or fatty degeneration of the arteries at that advanced period of life, it is not surprising that such local alteration should have been found coincident with this form of mortification : but as certain cases, as the one before us, occur independently of any such change,—as great ossification has been frequently found to be perfectly com¬ patible with a tolerably free circula¬ tion,—and as, whether ossification does or does not exist, the obstruction which ultimately gives rise to gangrene is in most cases brought about by the forma¬ tion of coagula in the arterial tubes,— the only question is, as to the origin and mode of production of these coagula. They have been usually re¬ garded as connected with, and depen¬ dent on, some of the following causes;— 1st. On ossification or some other disease of the heart and large vessels, or of the vessels supplying the diseased part.* 2d. On spicula of bone projecting from the internal coat of the arteries, or on some mechanical obstruction to the arterial circulation. 3d. On extreme old age, and its accompanying debility, or on deficiency of nervous energy, arising from an intemperate, irregular mode of life. 4th. On insuflficient or unwholesome food. 5th. On arteritis. Now, even admitting that some or all of these influences may sometimes be sufficient to give rise to coagulation, still, in the case before us, wre have ample evidence as to the non-existence of any of these alleged and commonly received causes of gangrene. The absence of the two first was clearly proved by post-mortem investigation. She had lived a regular life, was in the prime of life, in comfortable circum¬ stances, and in tolerably good health ; so, to her case at least, the 3d and 4th causes are manifestly inapplicable; and the absence of the 5th is equally certain when the circumstances of the case are fairly considered. But, as undue importance has been attached to this last alleged cause of senile gangrene,—as a principle of practice has been laid down in conformity with * Dr. Carswell denies the occurrence of this form of gangrene independently of a morbid state of the arterial system. See Article “ Mor¬ tification,” Cyclop. Pract. Medicine, this view of the disorder,—and as both the theory and plan of treatment have been sanctioned by the high name of Dupuytren*, and are still maintained and acted on by some practitioners, more especially on the Continent, I propose to enter somewhat in detail upon the points which bear on the question at issue. In the first place, then, the length of time which elapsed between the commencement of her illness and the production of gangrene is not a little remarkable. She was seized with violent pain on the 8th, and it was not till the 22d, or 14 days afterwards, that there was ocular evidence of local mischief. Her symptoms, in the mean¬ time, were by no means calculated to excite alarm: she complained of ex¬ cessive pain in the leg, was somewhat restless in her manner, and appeared to be in some way out of health; but the part affected remained perfectly cool, without redness or swelling; her tongue was moist and clean; her pulse soft, and but little accelerated; and the ordinary excretory functions were properly performed. What symptom, then, was there of inffammatory action, much less of inflammation of the arteries themselves ? We all know how severe, from the very first, are the constitutional symptoms produced by phlebitis; and surely the disturbance arising from arteritis can hardly be less so. As, then, it is but fair to suppose that the cause which ulti¬ mately gave rise to the obliteration of the vessels, and so to the production of gangrene, was from the first in action, we must either admit the occurrence of arteritis without local or constitutional symptoms of inflammation, or reject the supposition of arteritis as inappli¬ cable to the case before us. But again: the disease progressed to a fatal termination; and how did the post-mortem appearances bear out the suggestion of inflammatory action? There was not the slightest evidence of its occurrence. The arteries and veins were all blocked up by firm fibrinous coagula, but the coats of these vessels were in no way thickened or discoloured, nor did they bear any signs of inflammatory action; and, corresponding as this does with the * Lemons Orates de Clinique Chirurgicale, Tom. iv. p. 481.