Gangrene as a complication and sequel of the continued fevers, especially in typhoid / by William W. Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
[1896]
Catalogue details

Licence: Public Domain Mark

Credit: Gangrene as a complication and sequel of the continued fevers, especially in typhoid / by William W. Keen. 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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    fifthly, the perivascular tissues in the same neighborhood; and, finally, if there are no visible coagula, then the gan- grenous tissues themselves should be examined. In two cases in my table, ergot had been freely given in consequence of hemorrhage. Were these the only cases of gangrene, one might suppose that this had had a determining influence, but as gangrene followed in 88 other cases, in none of which was this drug administered, its exhibition must be considered as merely incidental. As a foundation for our study of the pathology of typhoid gangrene, let me recall a few of the facts which have been demonstrated bacteriologically. First, not a few cases of typhoid fever suffer from a mixed infection. This is much more apt to lead, however, to other disorders than gangrene. For example, as I shall show hereafter, there have been a number of cases of tetanus, of erysipelas and of malignant pustule, due, of course, to a mixed infection of the typhoid and these specific bacteria. In addition to that, the large number of cases of suppura- tive disorders in various organs, bones, spleen, muscles, etc., presume the presence of the ordinary pyogenic bac- teria, and their presence has been proved by stain and culture. In two cases in my table, pyemia or septicemia, a rare condition is noted. » One by Wagner* commenced with a crural phlebitis relatively early in the disease (the ninth day), death occurring from pyemia on the eighteenth day. In another reported by Spillman,| gangrene of the lips occurred, probably from carious teeth, and the patient died from staphylococcus septicemia, the aureus beim; found in the spleen, kidneys and liver. They had probably ob- tained entrance from the mouth. That mixed infection should occur in typhoid fever is not at all remarkable, since the intestinal ulcers and, in a large minority of the cases * Briefly mentioned in the British Medicnl Journal, 1891, i., 18. t Mere. M6d. 1896, No. 13, 146.