. Atlas of clinical surgery; with special reference to diagnosis and treatment for practitioners and students. he ankle joint. jNIoist gangrenespread rapidly from the toes, and lymphangitisextended up the leg. The X-rays showed numerous calcareous depositsin the anterior and posterior tibial arteries. Ampu-tation was performed above the knee joint, after thesugar had been reduced from five to two per cent, by 375 three days treatment of the diabetes. After opera-tion the sugar diminished still further, and the tem-perature fell—two favorable signs. Secondary sutureof the stump was performed on
. Atlas of clinical surgery; with special reference to diagnosis and treatment for practitioners and students. he ankle joint. jNIoist gangrenespread rapidly from the toes, and lymphangitisextended up the leg. The X-rays showed numerous calcareous depositsin the anterior and posterior tibial arteries. Ampu-tation was performed above the knee joint, after thesugar had been reduced from five to two per cent, by 375 three days treatment of the diabetes. After opera-tion the sugar diminished still further, and the tem-perature fell—two favorable signs. Secondary sutureof the stump was performed on the fifth day and thewound healed in four weeks. After general treat-ment of the diabetes the sugar disappeared from theurine. The figure also shows other changes. On theinner side of the foot over the metatarsophalangealjoint is a large clavus, and another on the fifth nail of the great toe is affected with onychogry-posis, a common condition in old people who neglecttheir feet. As the nail caused trouble in walking, itwas removed under local anaesthesia. 376 y L^eiilieiiner, Alias. Tab. CXIII. Fie. 141. Arthritis urica. Rcbnian Company, Ncw?^?olk. ARTHRITIS URIC A (Gout;/Arthritis)Plate CXIII, Fig. 141. Gout is a disorder of metabolism which is oftentransmitted from father to son for generations. Ittherefore usually occurs among people with a hered-itary predisposition. It most often affects middle-aged men who indulge in high living and who taketoo little exercise. The disease is due to the deposit of urate of sodain various places, especially in the cartilages of thejoints. According to Pfeiffer there is no increase inthe formation of urate of soda, but only deficientelimination. The urate of soda deposits form yel-lowish-white masses in the cartilage, synovial mem-brane, tendons, subcutaneous and periarticular tis-sue, bursse, bronchi, intestinal mucous membraneand kidneys—in fact, in all the tissues and organs ofthe body. An acute attack of gout is caused byd
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