Selected Monographs.

  • New Sydenham Society.
Date:
1888
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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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    the interpretation. The fact, was gangrene supervening on typhoid fever ; the interpretation was the theory proposed by the author, of a gangrene caused by a vital inscrutable action, by a kind of metastasis. Without having recourse to these explana- tions, which are a little mystical, might one not to admit, since t}-phoid fever is frequently complicated with sloughs on the sacrum, and since pressure of itself is alone insufficient to explain them, that dry gangrene of the limbs might also occur ? When moreover we think of the excessive readiness with which coagula are formed after long illnesses, whatever their nature, we come to believe that it is sufficiently probable that blood concretions may form in the same way in the course of a malignant fever, all the more so that the facts of typhoid gangrene are not without examples in the history of science.* Thus this variety comes within the general law, and this is what seems to result from the new cases which have been since observed, f But the same thing does not hold, at least at present, with regard to the diabetic gangrene described by M. Marchal (of Calvi), and upon which the former professor of the Val de Grace has insisted for many years4 The nature of the lesions, the progress of the symptoms, the inflammatory appearance which precedes mortification, all seem opposed to the idea of a vascular obstruction. If these already numerous observations are con- firmed (M. Marchal possesses now more than forty of them) it will become necessary to admit a new variety. Finally, here is a statement which is not less disturbing for the vascular theory when stated in a too absolute manner :— M. Virchow, the great promoter of the doctrine of thrombosis and embolism, after having described ordinary mummified gangrene, declares that the so-called senile gangrene differs from it entirely. As his opinions on this point are little known in France, and as his authority is more often invoked than his writings read, I ask permission to cite from them a few passages :— * Vide Panaroli Jabrolog, Pentec. quinque. Hanov.. 1G54. Hildenbrand has recorded many cases of gangrene of the extremities in typhu*. Vide also La Motte, Observa- tions chirurgicales, T. 111., p. 346. + Trousseau, Clinique medicate de VHotel Dieu, T. i., p. 210. X Vide Remarques historiques sur la gangrene diabetique. UUnion medicah, 25 Juillet, 1861.