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.

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    endarteritis capable of causing vascular obstruction; and in future observations tbis question ougbt to be carefully investi- gated. It is noteworthy that both Boas and Murri mention syphilis along with ague as a probable determining factor in the production of hemoglobinuria (vide paragraph L). Relation to Peripheral Neuritis. Eaynaud's cases in respect to post-mortem evidence are defec- tive, except in a negative sense, as putting out of question any naked-eye vascular lesions adequate to explain the local asphyxia or tbe gangrene. The investigations which of late years have been made into the lesions of peripheral nerves have been ex- tended to some cases of gangrene. Whether these cases would have been accepted by Raynaud as clinically conforming to his type is a question ; but they deserve consideration. Tbe first was recorded by Mounstein (quoted by Hochenegg, Ueber Sym- metrische Gangran unci Locale Asphyxie. Vienna, 1886, p. 35). The patient was a man, aged 51, for whom amputation of the right leg in the upper third was performed on account of gan- grene of the foot, which had commenced two months previously. A week after the amputation was performed the patient succumbed, with a high temperature. His urine was natural. The gangrene had led to the separation of the first, second, and fifth toes, whilst the third and fourth were isolated; but the skin over all the toes was involved in the gangrenous process as well as that covering the heel, the inner side of the foot, and the dorsum. The vessels generally of the lower extremity were free from abnormal contents; only in the capillary vessels adjacent to the gangrenous focus were microscopic hyaline thrombi present. The posterior tibial artery showed many calcareous plates, but no thrombi adherent to them. The posterior tibial nerve was greatly thickened in its lower part; microscopic investigation showed great wasting of the myelin with collapse of Schwann's sheaths, and chronic inflammatory proliferation of the interstitial connective tissue, especially in the parts close to the gangrenous urea. The nerves in the left sound lower limb showed similar changes to those in the gangrenous lirnb. The nerve roots of tbe lumbar region were only affected with neuritis on the right side.