Four cases of gangrene / by Albert Vander Veer and Edgar A. Vander Veer.

  • Vander Veer, A. (Albert), 1841-1929.
Date:
1904
Catalogue details

Licence: In copyright

Credit: Four cases of gangrene / by Albert Vander Veer and Edgar A. Vander Veer. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    of Typhoid Fever, says, that gangrene of the extremities, in typhoid fever, is due to obstruction of the circulation. The three factors causing gangrene are altered blood, weakened heart, and the mechanical difficulties of the circulation in distant parts, especially the last two, still hold good, but there must be added to them the important r61e of the typhoid bacillus in assisting, and often, it may be, in directly precipi- tating, the coagulation of the blood, which is the cause of the obstruction. Four varieties of obstruction may therefore exist and sometimes co-exist: First, arterial emboli of cardiac origin; secondly, autochthonous thrombi in the arteries; thirdly, autochthonous thrombi in the veins; and. fourthly, probably, though he thinks there have been no cases absolutely demonstrated pathologically, thrombi in the small peripheral vessels. Arterial emboli of cardiac origin have been observed not only at postmortems, but clinically. Thus, Hayem observed the alteration of the heart two days before gangrene of both legs commenced, the first symptom being acute pain in the legs, with a sensation of cold. Pulsation disappeared first in the dorsalis pedis, then in the popliteal, then in the femoral. Amputation showed that, although the arterial walls appeared to be healthy, the femoral artery was partly obstructed by clot. Cases one, two and three are particularly of interest, in reference to the suddenness of the attack, the very decided arrest of the circulation, and eventually terminating in gan- grene of the parts. Another interesting point to be observed is the very complete obliteration of the blood vessels, scarcely a ligature being required, and no secondary hemorrhage occurring later on. S