The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
_Dry_ or _senile gangrene_ presents a very distinct contrast to
the moist type. It occurs generally in patients over fifty, often
as the result of causes which are slow of action. As a result of
the shrinking and corrugation of the tissues, with the dryness of
the same by evaporation, there is a peculiar appearance known as
_mummification_, the foot, for instance--the feet are usually first
involved--resembling the foot of a person who has been embalmed, except
that it is discolored. It is possible sometimes to have a combination
of moist and senile gangrene, especially when there has been infection
by which putrefaction is permitted. When from the outset putrefactive
processes are prevented, the gangrene of this type is almost invariably
dry. In practically all of the cases of this character there will be
found evidences of vascular disease, usually in the femoral artery
and its branches. Gangrene of the foot alone is most commonly due to
endarteritis, while gangrene of the foot and leg together are usually
due to embolism or thrombosis.
While disease of the vessel walls is usually of the type either of
endarteritis or arterial sclerosis, peculiar to the closing years of
life, and commonly affecting the lower extremities, gangrene due to
embolism of arteries or thrombosis, or both, may occur in the young,
and in the upper extremities as well, in the latter case the emboli
being detached from the heart, while thrombosis may be caused by a
tight splint or bandage, or even the use of crutches. I have repeatedly
amputated the arm as well as the leg for gangrene of this type.
=Signs and Symptoms.=--The appearance and the odor of a part will
indicate impending or actual traumatic gangrene. The pallor, the
coldness, the dryness of senile gangrene are also characteristic.
In the latter form constitutional symptoms are not indicative nor
essentially of septic type. As soon, however, as a process of
spontaneous separation begins putrefaction is inevitable and sepsis
unavoidable. In moist gangrene there is seldom acute pain. This is
one of the predominating subjective features of the senile form.
Hemorrhages occur, sometimes terminating fatally, in the moist forms
when large vessels are eroded. This is particularly true of the
_phagedenic_ or _hospital_ form. A recognition of their possibility may
enable us to avoid sudden death from this source.
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