ON IDIOPATHIC GANGRENE

John Craig
1845 The Lancet  
On the day previous to this number of THE LANCET coming to hand, a case of this description came under my care. The patient, who was about forty-two years of age, and unmarried, had been in a very weakly state of health for several years, and had ceased to menstruate. My first visit to her was about six days previous to the period above noticed, when she was complaining of sore throat, cough, and general pains, with febrile symptoms; and she informed me, that for such complaints, to which she
more » ... nts, to which she was subject, her former medical advisers used to bleed her. By the use of the common antiphlogistic means, however, her complaints were in a great measure removed in a few days; but, soon afterwards, she was seized with excruciating pains in the fingers of the left hand, and I was again sent for. I found her still labouring under severe pain, the extremities of the fingers were cold, and the nails, with the exception of that of the forefinger, were of a livid tinge; and the dorsum of the hand, to near the wrist, was slightly flushed, but retained the natural temperature. As her bowels were in a I axative state, I ordered her to take repeated doses of morphia, and a stimulating liniment was applied to the hand. I had seen a considerable number of cases of this description, and as all of them, with the exception of one, terminated either in the death of the patient, or in the loss of some important member of the body, I felt great anxiety for the safety of my delicate patient. Just as I was contemplating what course to pursue in the management of her case, and before deciding on what should really be done on making my second visit, your valuable journal seasonably came to my assistance, and Dr. Hutcheson's cases, on opening the book, were presented to my view. I instantly perused them, and, immediately afterwards, called on my patient. She told me that she had had another dreadful night and morning of pain, her screams occasionally having been heard in the street. The appearance of the pained parts now, especially the fingers, was of a dark, inky colour, and the coldness extended farther along the hand than at yesterday's visit. On proposing to bleed the patient, the friends were alarmed, seeing that mortification, as they said, had commenced; but she at once submitted, and ten ounces of blood were taken from her arm, when she became weak; blood, on cooling, was covered with a dense buffy coat. Twelve leeches were ordered to be applied to the back of the hand three hours after the bleeding at the arm, and a morphia and hemlock pill was ordered to be given repeatedly, according to the violence of the pain. As soon as the bleeding had ceased from the leech-bites, the pained hand was to be enveloped in a poultice made of linseed, flour, and yeast. Next morning I was informed that the patient had had a good night, and that after the use of the means prescribed, the pain, in a great measure, ceased. The fingers are still cold, and have assumed a pale, deathlike aspect, and without the sense of feeling. Fifth day.-Pain had been very severe last night, but the cause seemed to be neglect of the pills, which have considerable effect in subduing pain. The index finger and the thumb seem to have, in a great measure, escaped; for, although they are occasionally pained, they retain their natural heat and colour. The nails on the other three fingers are quite black, and the soft
doi:10.1016/s0140-6736(02)71147-1 fatcat:3johrwecubhdresvqll6iwyqoa