Gangrene

Gangrene, or Mortification, is the death of a portion of the animal body. Gangrene should be distinguished from ulceration. In the former a large portion of tissue and in the latter very minute portions are affected. Thus, gangrene has been termed molar death, and mortification molecular death of tissue. In gangrene the part of the body involved becomes cold, pale, and shrivelled; there is loss of sensation and general impairment of function. Sometimes the part may be from the outset swollen, sodden, and discoloured. The living tissues which surround the affected part become, after a while, clearly marked off from it by the formation of what is called the line of demarcation. The gangrenous portion or slough is thus ultimately separated and cast off from the body, and when this has occurred healing takes place with the formation of scar tissue. Gangrene is due either to direct destruction of tissue by external agents or to a cutting off of the supply of blood to the part affected; thus, as the result of a bum or from exposure to extreme cold [Frostbite], a slough is formed. A severe injury is apt to be followed by death of the tissues involved (traumatic gangrene). When the injured part or wounded surface becomes the seat of septic inflammation, the condition of things is much aggravated, and in such instances the terms phagedmna or hospital gangrene are used to describe the disease. Noma and cancrum oris etre varieties of phagedrena, which occur in poorly nourished children. In senile gangrene the rigid condition of the arteries produced by the atheromatous degeneration, commonly associated with advancing years, interferes with the normal supply of blood, and death of the affected tissues occurs. Lastly, the bed sores which occur in cases of prolonged illness and the curious condition known as ergotism, may be alluded to as varieties of gangrene. Treatment of gangrene consists in maintaining the strength of the patient and carefully protecting the diseased structures from cold, injury, and septic contamination. The question of removing the dead portions of tissue by amputation is, of course, a matter for the judgment of the surgeon.