A system of surgery . e.—This form is also spoken of as senile gan-grene because it occurs more especially in old persons, seldom beforeforty years of age. In thisform the dead part driesup and becomes hard, thefat becomes liberated fromthe cells and infiltrates thetissue, so that the surfaceof the dead part becomesgreasy, while, as the resultof the fat soaking into theskin, it becomes more orless transparent, and ten-dons and other structuresmay be seen through gangrene spreads veryslowly, otherwise, of course,the part would not be dry,and it is generally due toa somewhat gradual dimi-
A system of surgery . e.—This form is also spoken of as senile gan-grene because it occurs more especially in old persons, seldom beforeforty years of age. In thisform the dead part driesup and becomes hard, thefat becomes liberated fromthe cells and infiltrates thetissue, so that the surfaceof the dead part becomesgreasy, while, as the resultof the fat soaking into theskin, it becomes more orless transparent, and ten-dons and other structuresmay be seen through gangrene spreads veryslowly, otherwise, of course,the part would not be dry,and it is generally due toa somewhat gradual dimi-nution in the calibre of the vessels leading to the dying part. As the ordinary putrefactivechanges do not take place, the odour from the part is comparativelyslight, though there is generally a distinctly musty smell. Thisform of gangrene usually begins in the lower extremity, especiallyin the toes, and may appear spontaneously after some slight goes on very slowly. Sometimes months may elapse before a F. Fis ;. 24.—Case of Dry Gangrene (senile). The pro-cess had gone on for about eight weeks beforethe photograph was taken. 130 GANGRENE. toe is completely dead (Fig. 24). During that time the patientcomplains much of pain, not only in the parts which are living, butalso in the parts which are apparently dead, the cause of this beingin the main that the nerves, especially the axis cylinders, are thelast structures to die. This pain leads to loss of sleep and thegradual exhaustion of the patient. In the early stage the generalcondition of the patient is usually good, but the pain keeps himawake, so that he soon becomes pulled down, his pulse becomesfeeble, and he often dies of exhaustion. Moist gangrene, on the other hand, progresses much morerapidly, and there is not time for the Liquids in the part which diesto evaporate. The consequence is that putrefaction takes place inthe dead tissue, and the chief symptoms are dependent on thisputrefactive process. Bullae fo
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