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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    the International Text-Book on Surgery. In this the opinion is expressed that the embolus comes from the left side of the heart, is swept into the blood current, and, in cases of gangrene of the upper extremities, generally blocks the artery immediately below the axilla. Stengel, in his Text-Book on Pathology, expresses the opinion that emboli in the arterial circulation, following septic conditions, are formed in the blood by a peculiar fibrin ferment of the germs themselves. The circulation in the whole body, particularly in the heart, becomes sluggish, this ferment causes the blood to coagulate on the walls of the heart, and thus the thrombus, and eventu- ally the embolus, is formed. In the second case, that of a patient seventy years of age, the embolus might possibly have been caused by poor circu- lation, the patient having reached that time in life when the arteries are more or less atheromatous and the circulation sluggish; however, the fact of her having lived so long after the operation, and having made such a good recovery, would mitigate against this idea. In the third case there might possibly have been an acute endocarditis, due to the general septic condition of the patient, this endocarditis causing an exudate on the walls of the heart which was swept off and caught in the brachial artery. Some authors speak of secondary shock, that is vaso-motor disturbance. This condition has been recognized since the history of surgery has been recorded, but unquestionably it is many times confounded with concealed hemorrhage or infection. This secondary shock is developed up to an interval of several hours to one or two days after the opera- tion, and is dependent upon the formation of blood clots, which may cause death by directly embarrassing that organ, or, more remotely, by fragments becoming detached and plugging the arteries in the different parts of the body. In both of these cases reported, however, the period of the onset of the disease was so remote that this conjecture can be set aside. When one thinks of the sudden deaths following operations, it is generally found that the thrombus has formed in the venous circulation, and caused death by stoppage of the heart, or of the lung, the arterial circulation seldom being affected.