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 The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    21/372 (page 7)
    ■' Senile gangrene differs essentially from the preceding (nium- mififc gangrene) and from that which we have described as spon- taneous gangrene. It is quite erroneous to suppose that it is regularly preceded by arterial thrombosis. I have had frequent opportunities of examining it anatomically, and often I have been unable to find any trace of diminution of the calibre of the arteries, not even above the limits of the gangrene. Often, it is true, the arteries are found diseased, sometimes hardened, some- times atheromatous or calcareous, &c. Nevertheless I do not consider these lesions as a sufficient cause, because it is recog- nised that very extensive degenerations of arteries may exist without gangrene. It is very important to examine at the same time the condition of the muscular fibres of the heart; it may be atrophied, or have undergone fatty degeneration. Circulation becomes difficult in the remote vessels, particularly in the lower limbs; nutrition suffers, &c. Senile gangrene is there- fore essentially a necrosis from feebleness, and ought to be brought into proximity with gangrene following upon decubitus, and with those gangrenes which supervene in the ultimate phases of grave fevers, and affect the ears, the nose, the fingers, and the toes.* We see that the last word has not yet been said on the subject of gangrene, and on dry gangrene in particular. In the actual state of our knowledge, and in order to avoid confounding in a single description facts perhaps very incongruous, it becomes more and more necessary to give up an artificial unity which can only satisfy minds who care little for new researches; also it is necessary to establish in the history of gangrene divisions based upon pathological anatomy and etiology, and to study separately each of these varieties, subject to the bringing them together at a later period and discovering the bond which unites them and the law which dominates them. III. It is to this work of analysis (of which the attentive reading of modern works on gangrene has made me strongly feel the necessity) that I wish to contribute my part. I pro- * Virchow, Handbuch der speciellen Pathologie und Therapie, T. L, p. 289. There are many reservations to be made to the explanation given by M. Virchow. The degeneration of the heart and that of the vessels seem to me to be inseparable lesions, and it appears to me difficult to understand how a permanent and incurable cause, lik? that of cardiac atrophy, should produce effects which are often transient, and also difficult to explain cases which are followed by rccoveiy.