GANGRENE 389 



(lead tissue, and as a result such tissue contains all the innumerable 

 products of the decomposition of proteins and fats. Thus Ziegler 

 mentions as morphological elements that may be present in gan- 

 grenous tissue: Fat needles, the so-called "margarin" crystals (a 

 mixture of stearic and palmitic acids), fine acicular crystals of 

 tyrosine, globules of leucine, rhombic plates of triple phosphate, black 

 and brown nuisses of pigment, and crystals of hematoidin. In solu- 

 tion we also have, beyond a doubt, all the substances formed in the 

 decomposition of proteins, from proteoses and peptones down through 

 the different amino-acids to such final products as ammonia and its 

 salts, while CO.^ and 1L,S are abundantly given off. In addition 

 occur, undoubtedly, many of the ptomains which are formed by the 

 action of the bacteria upon the amino-acids derived from the pro- 

 teins." In the sputum from pulmonary gangrene there is but little 

 soluble protein, most of the nitrogen, of which there is much, is in 

 the formed elements. ^'^ The fetid plugs which occur in the bron- 

 chioles in gangrene, the "Dittrich's plugs," were found by Traube 

 to be composed chiefly of fatty acid crystals, and Schwartz and 

 Kayser ^^ ascribe their formation to the action of lipolytic staphy- 

 lococci. 



If the necrotic tissue is in contact with living tissue over a con- 

 siderable area, enough of these products of autolysis and putrefaction 

 may be absorbed to cause intoxication (sapremia) . At the same time, 

 the formation of such large quantities of crystalloids from the pro- 

 teins of the dead tissue leads to a dififusion of water into this area, 

 with consequent swelling, and often a lifting up of the skin in the 

 form of blisters. 



Emphysematous gangrene,^- usually produced by gas-forming 

 anaerobic bacteria, particularly by B. aerogenes capsulatus, may also 

 possibly be produced by B. coli communis in diabetic patients in 

 whose blood and tissues there may occur sufficient sugar to permit of 

 gas-formation. Ilitsehmann and Lindenthal ^^ found that the gas 

 produced in cultures by an anaerobic organism which they isolated 

 from a case of emphysematous gangrene, consisted of 67.55 per cent, 

 hydrogen, 30.62 per cent, carbon dioxide, and traces of ammonia 

 and nitrogen ; this corresponds to the statement of Welch and Nut- 

 tall that the gas in the tissues of infected animals is inflammable. 

 Dunham ^* found that the gas produced by B. aerogenes capsulatus in 

 cultures has the following composition : Hydrogen, 64.3 per cent. ; 



9 An interestinor observation concerning: gangrene of the lung has been made 

 by Eijkman (Cent. f. Bakt., Abt. 1, 1003 (35), 1), who found in this condition 

 bacteria that secrete an enzyme dissolving elastic tissue. 



loOrszag. Zeit. klin. Med.,' 1909 (67), 204. 



11 Zeit. klin. Med., 1905 (5G), 111. 



12 Complete literature bv Fraenkel, Ergebnisse der Pathol., 1902 (8), 403; and 

 by Welch, Johns Hopkins Hosp. Bull., 1900 (11), 185. 



13 Quoted by Fraenkel. 



14 Johns Hopkins Hosp. Bull., 1897 (8), 68. 



