On local asphyxia and symmetrical gangrene of the extremities / by Maurice Raynaud ; translated by Thomas Barlow.

  • Raynaud, Maurice R., 1834-1881.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: On local asphyxia and symmetrical gangrene of the extremities / by Maurice Raynaud ; translated by Thomas Barlow. Source: Wellcome Collection.

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    subjaceut skin is fouud rosy aud smootb. Ou examining it attentively it is seen tbat tbe papillæ bave beeu more or les» oroded, and tbat tbey présent at tbe maximum point of tbe lésion a pale violet colour ; tbe skin soon recovers its normal appcarance. Tbe wbole process takes about a fortnigbt for comidetion. If tbe gangrené at tbe very outset appears in ail its intensity tbere are no pblyctenulæ, tbe tendency to mummi- lication becomes manifest, tbe nail becomes quite black, au entire pbalanx takes on a more or less dark colour, and rapidly becomes as dark as cbarcoal. One migbt believe tbeu in a pro- found alteration. But at tbe end of a few days an inflammatory circle appears at tbe base of tbe toe. It becomes more and more pronounced as it approacbes tbe extremity. A tbick viscous liquid similar to plastic lympb oozes out of tbe circumference, aud becomes bardeucd iuto brownisb crusts. Tbeu a true sup- puration of bealtby cbaracter appears at tbe limit of tbe disease aud under tbe free border of tbe nail. Tbe slougb becomes mobile, detacbes itself, and on witbdrawing it we find tbat it is 1 or 2 millimétrés tbick ; on its surface tbe papillæ are seen neatly marked out ; tbe deep asiiect is soft and tomentose. Tbe remaining living parts are rougb, witb flesby granulations wbich soon cicatrise. It is in tbis form tbat I bave seen a slougb form ou tbe tip of tbe coccyx, and in anotber case I bave seen brown patcbes appear symmetrically on tbe two beels, tben disappear by exfoliation. Fiually, in tbe most pronounced cases ail tbe forms already prescribed présent tbemselves in different degrees ou tbe Angers and toes—viz., tbe parcbment-like condition, witb tapering of tbe ends of tbe digits, tbe livid marblings along tbe track of tbe superficial veins, tbe bullæ, &c. Tbese last, I repeat, are formed at tbe expeuse not ouly of tbe epitbelial layer, but of a part of tbe derma itself. In tbe parts wbicb are most attacked tbere is a real carbonisation, wbicb terminâtes at leugtb in tbe fall of a tbird or a balf of tbe uugual pbalanx. Tbe wbole is accom- panied by a veiy sligbt œdema of tbe lower part of tbe limb. It tbe nail bas not been attacked at its root, a siugular tbing bap- pens—viz., tbat tbe elimiuatory circle, becoming more and more bollowed out, tbe slougb ends by detacbing itself along tbe wbole of its circumference, except at its upper part, wbere it reraains adbereut to tbe nail. Tbis continuing its growtb forwards from