GANGRENE. 113 
the neighborhood of the centre of mortification. Though, let us re- 
mark, that if infectious gangrenes are ordinarily rapid in their progress, 
ordinary sphacels have but little tendency to radiate. The bistoury or 
the cautery are used only to permit the discharge of eschars infiltrated 
with liquids or the introduction of antiseptic preparations into the net- 
work of the tissues in order to prevent putrefaction, In the great ma- 
jority of cases, one uses either repeated carbolic or corrosive sublimate 
lotions upon the dead tissues and the surrounding parts, or continual 
bathing in those solutions. At this stage, the disorders produced by 
gangrene can be determined. There are cases where the sphacel has 
extended so much in width and in depth, and has made such ravages, 
that recovery of the patient cannot be expected. Gangrenes due to the 
obliteration of a vascular trunk demand the immediate killing of the 
animal. Those which involve only superficial layers—skin and tissues 
underneath—are sometimes serious in their consequences, when they 
are in the neighborhood of joints or tendons ; they often are complicated 
with synovitis, arthritis with or without necrotic accidents and after- 
ward cicatricial retractions. One must foresee these complications, 
avoid useless expense, and as quickly as possible come to a conclusion 
as to the future recovery of the patient. 
As soon as gangrene has ended its work the surrounding parts be- 
come inflamed, and by their reaction of the mortified territory is settled 
in its boundaries. This is a natural and constant phenomenon, which 
is accomplished more or less rapidly according to the extent of the 
slough and the vitality of the parts involved. If the separation is slow, 
it can be hastened by exciting reactionary phlegmasia with irritants 
(blisters, or any cantharidal preparations, etc.) ; if, on the contrary, the 
elimination of the gangrenous masses is accompanied by an intense 
inflammatory reaction, and the surrounding tissues are much swollen, 
then warm lotions, often repeated, of antiseptic solutions, pure or mixed 
with narcotic substances, according to the degree of the pain, should be 
employed. If the pain is excessive, preparations of cocaine are useful. 
As the boundary fissure increases, the pus increases; if its escape 
is prevented, or if it accumulates in the dividing trench, frequent disin- 
fecting washes, or the use of absorbing or antiseptic powders is good, 
as well as the making of counter openings and the placing of drains. 
The eschars, macerated by the pus, infested with numerous micro- 
organisms, putrefy rapidly, and spread over the wound liquids with re- 
pulsive odor, favoring infections and poisons the organism. In such 
cases, continued irrigation is beneficial. To it as well as to the antisep- 
tics one must also have recourse when there are important organs deeper 
down which may yet be healthy. Often the greater part of the slough is 
excised or removed by actual cauterization. This last mode is prefera- 
able to the use of potential caustics, which used to be placed on the 
