in ill-nourished persons who eat large quantities of coarse rye
bread contaminated with the _claviceps purpurea_ and containing the
ergot of rye. It has also occurred in the fingers of patients who have
taken ergot medicinally over long periods. The gangrene, which attacks
the toes, fingers, ears, or nose, is preceded by formication, numbness,
and pains in the parts to be affected, and is of the dry variety.

In this country it is usually met with in sailors off foreign ships,
whose dietary largely consists of rye bread. Trivial injuries may be the
starting-point, the anaesthesia produced by the ergotin preventing the
patient taking notice of them. Alcoholism is a potent predisposing
cause.

As it is impossible to predict how far the process will spread, it is
advisable to wait for the formation of a line of demarcation before
operating, and then to amputate immediately above the dead part.

BACTERIAL VARIETIES OF GANGRENE

The acute bacillary forms of gangrene all assume the moist type from the
first, and, spreading rapidly, result in extensive necrosis of tissue,
and often end fatally.

The infection is usually a mixed one in which anaerobic bacteria
predominate. The anaerobe most constantly present is the _bacillus
aerogenes capsulatus_, usually in association with other anaerobes, and
sometimes with pyogenic diplo- and streptococci. According to the mode of
action of the associated organisms and the combined effects of their
toxins on the tissues, the gangrenous process presents different
pathological and clinical features. Some combinations, for example,
result in a rapidly spreading cellulitis with early necrosis of
connective tissue accompanied by thrombosis throughout the capillary and
venous circulation of the parts implicated; other combinations cause
great oedema of the part, and others again lead to the formation of gases
in the tissues, particularly in the muscles.

These different effects do not appear to be due to a specific action of
any one of the organisms present, but to the combined effect of a
particular group living in symbiosis.

According as the cellulitic, the oedematous, or the gaseous
characteristics predominate, the clinical varieties of bacillary
gangrene may be separately described, but it must be clearly understood
that they frequently overlap and cannot always be distinguished from one
another.

#Clinical Varieties of Bacillary Gangrene.#--#Acute infective gangrene#
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