Gangrene is a type of
tissue death caused by a
lack of blood supply.
Symptoms may include a change in skin color to red or black, numbness, swelling, pain, skin breakdown, and coolness.
[ The feet and hands are most commonly affected.] If the gangrene is caused by an infectious agent, it may present with a fever
Fever, also referred to as pyrexia, is defined as having a body temperature, temperature above the human body temperature, normal range due to an increase in the body's temperature Human body temperature#Fever, set point. There is not a single ...
or sepsis
Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...
.[
Risk factors include ]diabetes
Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...
, peripheral arterial disease
Peripheral artery disease (PAD) is an abnormal narrowing of arteries other than those that supply the heart or brain. When narrowing occurs in the heart, it is called coronary artery disease, and in the brain, it is called cerebrovascular disea ...
, smoking
Smoking is a practice in which a substance is burned and the resulting smoke is typically breathed in to be tasted and absorbed into the bloodstream. Most commonly, the substance used is the dried leaves of the tobacco plant, which have bee ...
, major trauma
Major trauma is any injury that has the potential to cause prolonged disability or death. There are many causes of major trauma, blunt and penetrating, including falls, motor vehicle collisions, stabbing wounds, and gunshot wounds. Dependin ...
, alcoholism
Alcoholism is, broadly, any drinking of alcohol (drug), alcohol that results in significant Mental health, mental or physical health problems. Because there is disagreement on the definition of the word ''alcoholism'', it is not a recognize ...
, HIV/AIDS
Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual ...
, frostbite
Frostbite is a skin injury that occurs when exposed to extreme low temperatures, causing the freezing of the skin or other tissues, commonly affecting the fingers, toes, nose, ears, cheeks and chin areas. Most often, frostbite occurs in the ha ...
, influenza
Influenza, commonly known as "the flu", is an infectious disease caused by influenza viruses. Symptoms range from mild to severe and often include fever, runny nose, sore throat, muscle pain, headache, coughing, and fatigue. These symptoms ...
, dengue fever, malaria
Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases, it can cause jaundice, seizures, coma, or death. S ...
, chickenpox
Chickenpox, also known as varicella, is a highly contagious disease caused by the initial infection with varicella zoster virus (VZV). The disease results in a characteristic skin rash that forms small, itchy blisters, which eventually scab ...
, plague
Plague or The Plague may refer to:
Agriculture, fauna, and medicine
*Plague (disease), a disease caused by ''Yersinia pestis''
* An epidemic of infectious disease (medical or agricultural)
* A pandemic caused by such a disease
* A swarm of pe ...
, hypernatremia
Hypernatremia, also spelled hypernatraemia, is a high concentration of sodium in the blood. Early symptoms may include a strong feeling of thirst, weakness, nausea, and loss of appetite. Severe symptoms include confusion, muscle twitching, and b ...
, radiation injuries, meningococcal disease
Meningococcal disease describes infections caused by the bacterium ''Neisseria meningitidis'' (also termed meningococcus). It has a high mortality rate if untreated but is vaccine-preventable. While best known as a cause of meningitis, it can al ...
, Group B streptococcal infection
Group B streptococcal infection, also known as Group B streptococcal disease or just Group B strep, is the infection caused by the bacterium ''Streptococcus agalactiae'' (''S. agalactiae'') (also known as group B streptococcus or GBS). GBS infecti ...
and Raynaud's syndrome
Raynaud syndrome, also known as Raynaud's phenomenon, eponymously named after the physician Auguste Gabriel Maurice Raynaud, who first described it in his doctoral thesis in 1862, is a medical condition in which the spasm of small arteries cau ...
.[ It can be classified as ]dry gangrene
Gangrene is a type of necrosis, tissue death caused by a ischemia, lack of blood supply. Symptoms may include a change in skin color to red or black, numbness, swelling, pain, skin breakdown, and coolness. The feet and hands are most commonly a ...
, wet gangrene
Gangrene is a type of tissue death caused by a lack of blood supply. Symptoms may include a change in skin color to red or black, numbness, swelling, pain, skin breakdown, and coolness. The feet and hands are most commonly affected. If the ga ...
, gas gangrene
Gas gangrene (also known as clostridial myonecrosis and myonecrosis) is a bacterial infection that produces tissue gas in gangrene. This deadly form of gangrene usually is caused by '' Clostridium perfringens'' bacteria. About 1,000 cases of gas ...
, internal gangrene, and necrotizing fasciitis
Necrotizing fasciitis (NF), also known as flesh-eating disease, is a bacterial infection that results in the death of parts of the body's soft tissue. It is a severe disease of sudden onset that spreads rapidly. Symptoms usually include red or p ...
.[ The diagnosis of gangrene is based on symptoms and supported by tests such as medical imaging.
Treatment may involve surgery to remove the dead tissue, ]antibiotics
An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention o ...
to treat any infection, and efforts to address the underlying cause.[ Surgical efforts may include ]debridement
Debridement is the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue. Removal may be surgical, mechanical, chemical, autolytic (self-digestion), and by maggot therapy.
In p ...
, amputation
Amputation is the removal of a limb by trauma, medical illness, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on indi ...
, or the use of maggot therapy
Maggot therapy (also known as larval therapy) is a type of biotherapy involving the introduction of live, disinfected maggots (fly larvae) into non-healing skin and soft-tissue wounds of a human or other animal for the purpose of cleaning out th ...
.[ Efforts to treat the underlying cause may include ]bypass surgery
Bypass surgery refers to a class of surgery involving rerouting a tubular body part.
Types include:
* Vascular bypass surgery such as coronary artery bypass surgery, a heart operation
* Cardiopulmonary bypass, a technique used in coronary artery ...
or angioplasty
Angioplasty, is also known as balloon angioplasty and percutaneous transluminal angioplasty (PTA), is a minimally invasive endovascular procedure used to widen narrowed or obstructed arteries or veins, typically to treat arterial atheroscle ...
. In certain cases, hyperbaric oxygen therapy
Hyperbaric medicine is medical treatment in which an ambient pressure greater than sea level atmospheric pressure is a necessary component. The treatment comprises hyperbaric oxygen therapy (HBOT), the medical use of oxygen at an ambient pressure ...
may be useful.[ How commonly the condition occurs is unknown.]
Signs and symptoms
Symptoms may include a change in skin color to red or black, numbness, pain, skin breakdown, and coolness.[ The feet and hands are most commonly involved.][
]
Causes
Gangrene is caused by a critically insufficient blood supply (e.g., peripheral vascular disease
Peripheral artery disease (PAD) is an abnormal narrowing of arteries other than those that supply the heart or brain. When narrowing occurs in the heart, it is called coronary artery disease, and in the brain, it is called cerebrovascular dise ...
) or infection. It is associated with diabetes
Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...
and long-term tobacco smoking.[
]
Dry gangrene
Dry gangrene is a form of coagulative necrosis Coagulative necrosis is a type of accidental cell death typically caused by ischemia or infarction. In coagulative necrosis, the architectures of dead tissue are preserved for at least a couple of days. It is believed that the injury denatures stru ...
that develops in ischemic
Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive). Ischemia is generally caused by problems w ...
tissue, where the blood supply is inadequate to keep tissue viable. It is not a disease itself, but a symptom of other diseases. The term ''dry'' is used only when referring to a limb or to the gut (in other locations, this same type of necrosis is called an infarction, such as myocardial infarction
A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may ...
). Dry gangrene is often due to peripheral artery disease
Peripheral artery disease (PAD) is an abnormal narrowing of arteries other than those that supply the heart or brain. When narrowing occurs in the heart, it is called coronary artery disease, and in the brain, it is called cerebrovascular dis ...
, but can be due to acute limb ischemia
Acute limb ischaemia (ALI) occurs when there is a sudden lack of blood flow to a limb.
Acute limb ischaemia is caused by embolism or thrombosis, or rarely by dissection or trauma. Thrombosis is usually caused by peripheral vascular disease (ath ...
. As a result, people with arteriosclerosis, high cholesterol, diabetes and smokers commonly have dry gangrene. The limited oxygen in the ischemic limb limits putrefaction
Putrefaction is the fifth stage of death, following pallor mortis, algor mortis, rigor mortis, and livor mortis. This process references the breaking down of a body of an animal, such as a human, post-mortem. In broad terms, it can be viewed ...
and bacteria fail to survive. The affected part is dry, shrunken, and dark reddish-black. The line of separation usually brings about complete separation, with eventual falling off of the gangrenous tissue if it is not removed surgically, a process called autoamputation.
Dry gangrene is the result of chronic ischemia
Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive). Ischemia is generally caused by problems wi ...
without infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
. If ischemia is detected early, when ischemic wound
Arterial insufficiency ulcers (also known as ischemic ulcers, or ischemic wounds) are mostly located on the lateral surface of the ankle or the distal digits. They are commonly caused by peripheral artery disease (PAD).
Characteristics
The ulcer ...
s rather than gangrene are present, the process can be treated by revascularization
In medical and surgical therapy, revascularization is the restoration of perfusion to a body part or organ that has had ischemia. It is typically accomplished by surgical means. Vascular bypass and angioplasty are the two primary means of rev ...
(via vascular bypass or angioplasty). However, once gangrene has developed, the affected tissues are not salvageable. Because dry gangrene is not accompanied by infection, it is not as emergent as gas gangrene or wet gangrene, both of which have a risk of sepsis. Over time, dry gangrene may develop into wet gangrene if an infection develops in the dead tissues.
Diabetes mellitus
Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...
is a risk factor for peripheral vascular disease, thus for dry gangrene, but also a risk factor for wet gangrene, particularly in patients with poorly controlled blood sugar levels, as elevated serum glucose creates a favorable environment for bacterial infection.
Wet gangrene
Wet, or infected, gangrene is characterized by thriving bacteria and has a poor prognosis
Prognosis (Greek: πρόγνωσις "fore-knowing, foreseeing") is a medical term for predicting the likely or expected development of a disease, including whether the signs and symptoms will improve or worsen (and how quickly) or remain stabl ...
(compared to dry gangrene) due to sepsis resulting from the free communication between infected fluid and circulatory fluid. In wet gangrene, the tissue is infected by saprogenic microorganisms (''Clostridium perfringens
''Clostridium perfringens'' (formerly known as ''C. welchii'', or ''Bacillus welchii'') is a Gram-positive, rod-shaped, anaerobic, spore-forming pathogenic bacterium of the genus ''Clostridium''. ''C. perfringens'' is ever-present in nature an ...
'' or ''Bacillus fusiformis
''Lysinibacillus fusiformis'' (commonly abbreviated ''L. fusiformis'') is a gram-positive, rod-shaped bacterium of the genus ''Lysinibacillus''.Priest, FG, M. Goodfellow, and C. Todd. "A Numerical Classification of the Genus Bacillus." National C ...
'', for example), which cause tissue to swell and emit a foul odor. Wet gangrene usually develops rapidly due to blockage of venous (mainly) or arterial blood flow. The affected part is saturated with stagnant blood, which promotes the rapid growth of bacteria. The toxic products formed by bacteria are absorbed, causing systemic manifestation of sepsis and finally death. The affected part is edematous, soft, putrid, rotten, and dark.
Because of the high mortality associated with infected gangrene (about 80% without treatment and 20% with treatment), an emergency salvage amputation, such as a guillotine amputation
Amputation is the removal of a limb by trauma, medical illness, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on ind ...
, is often needed to limit systemic effects of the infection.[ Such an amputation can be converted to a formal amputation, such as a below- above-knee amputation.]
Gas gangrene
Gas gangrene is a bacterial infection that produces gas within tissues. It can be caused by '' Clostridium'', most commonly alpha toxin-producing ''C. perfringens'', or various nonclostridial species. Infection spreads rapidly as the gases produced by the bacteria expand and infiltrate healthy tissue in the vicinity. Because of its ability to quickly spread to surrounding tissues, gas gangrene should be treated as a medical emergency
A medical emergency is an acute injury or illness that poses an immediate risk to a person's life or long-term health, sometimes referred to as a situation risking "life or limb". These emergencies may require assistance from another, qualified ...
.
Gas gangrene is caused by bacterial exotoxin-producing clostridial species, which are mostly found in soil, and other anaerobes such as ''Bacteroides
''Bacteroides'' is a genus of Gram-negative, obligate anaerobic bacteria. ''Bacteroides'' species are non endospore-forming bacilli, and may be either motile or nonmotile, depending on the species. The DNA base composition is 40–48% GC. Unus ...
'' and anaerobic streptococci. These environmental bacteria may enter the muscle through a wound and subsequently proliferate in necrotic tissue and secrete powerful toxins that destroy nearby tissue, generating gas at the same time. A gas composition of 5.9% hydrogen, 3.4% carbon dioxide, 74.5% nitrogen, and 16.1% oxygen was reported in one clinical case.
Gas gangrene can cause necrosis, gas production, and sepsis. Progression to toxemia and shock
Shock may refer to:
Common uses Collective noun
*Shock, a historic commercial term for a group of 60, see English numerals#Special names
* Stook, or shock of grain, stacked sheaves
Healthcare
* Shock (circulatory), circulatory medical emergen ...
is often very rapid.
Other types
* Necrotizing fasciitis
Necrotizing fasciitis (NF), also known as flesh-eating disease, is a bacterial infection that results in the death of parts of the body's soft tissue. It is a severe disease of sudden onset that spreads rapidly. Symptoms usually include red or p ...
, also known as hemolytic streptococcal gangrene, is a very rare infection that spreads deep into the body along tissue planes. It is characterized by infection with ''S.pyogenes'', a gram-positive cocci bacteria.
* Noma
Noma, NoMa, or NOMA may refer to:
Places
* NoMa, the area North of Massachusetts Avenue in Washington, D.C., US
** NoMa–Gallaudet U station, on Washington Metro
* Noma, Florida, US
* NOMA, Manchester, a redevelopment in England
* Noma Distr ...
is a gangrene of the face common in Africa and Asia, with 99% of cases occurring there, whereas the disease is practically non-existent in other continents.
* Fournier gangrene
Fournier gangrene is a type of necrotizing fasciitis or gangrene affecting the external genitalia or perineum. It commonly occurs in older men, but it
can also occur in women and children. It is more likely to occur in diabetics, alcoholics, or th ...
is a type of necrotizing fasciitis that usually affects the genitals and groin.
* Venous limb gangrene may be caused by heparin-induced thrombocytopenia and thrombosis.
* Severe mesenteric ischemia
Intestinal ischemia is a medical condition in which injury to the large or small intestine occurs due to not enough blood supply. It can come on suddenly, known as acute intestinal ischemia, or gradually, known as chronic intestinal ischemia. The ...
may result in gangrene of the small intestine
The small intestine or small bowel is an organ in the gastrointestinal tract where most of the absorption of nutrients from food takes place. It lies between the stomach and large intestine, and receives bile and pancreatic juice through the p ...
.
* Severe ischemic colitis may result in gangrene of the large intestine
The large intestine, also known as the large bowel, is the last part of the gastrointestinal tract and of the digestive system in tetrapods. Water is absorbed here and the remaining waste material is stored in the rectum as feces before being r ...
.
Treatment
Treatment varies based on the severity and type of gangrene.
Lifestyle
Exercises such as walking and massage therapy may be tried.
Medication
Medications may include pain management, medications that promote circulation in the circulatory system
The blood circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the entire body of a human or other vertebrate. It includes the cardiovascular system, or vascular system, tha ...
and antibiotics. Since gangrene is associated with periodic pain caused by too little blood flow, pain management is important so patients can continue doing exercises that promote circulation. Pain management medications can include opioids and opioid-like analgesics. Since gangrene is a result of ischemia
Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive). Ischemia is generally caused by problems wi ...
, circulatory system management is important. These medications can include antiplatelet drug
An antiplatelet drug (antiaggregant), also known as a platelet agglutination inhibitor or platelet aggregation inhibitor, is a member of a class of pharmaceuticals that decrease platelet aggregation and inhibit thrombus formation. They are effecti ...
, anticoagulant, and fibrinolytics
Thrombolysis, also called fibrinolytic therapy, is the breakdown ( lysis) of blood clots formed in blood vessels, using medication. It is used in ST elevation myocardial infarction, stroke, and in cases of severe venous thromboembolism (massiv ...
. As infection is often associated with gangrene, antibiotics
An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention o ...
are often a critical component of its treatment. The life-threatening nature of gangrene requires treatment with intravenous antibiotics in an inpatient setting. Antibiotics alone are not effective because they may not penetrate infected tissues sufficiently.
Surgery
Surgical removal of all dead tissue, however, is the mainstay of treatment for gangrene. Often, gangrene is associated with underlying infection, thus the gangrenous tissue must be debrided to hinder the spread of the associated infection. The extent of surgical debridement needed depends on the extent of the gangrene and may be limited to the removal of a finger, toe, or ear, but in severe cases may involve a limb amputation.
Dead tissue alone does not require debridement, and in some cases, such as dry gangrene, the affected part falls off (autoamputates), making surgical removal unnecessary. Waiting for autoamputation, however, may cause health complications as well as decreased quality of life.
After the gangrene is treated with debridement and antibiotics, the underlying cause can be treated. In the case of gangrene due to critical limb ischemia
Chronic limb threatening ischemia (CLTI), also known as critical limb ischemia (CLI), is an advanced stage of peripheral artery disease (PAD). It is defined as ischemic rest pain, arterial insufficiency ulcers, and gangrene. The latter two cond ...
, revascularization can be performed to treat the underlying peripheral underlateral artery disease.
Ischemic disease of the legs is the most common reason for amputations. In about a quarter of these cases, the other side requires amputation in the next three years.
Angioplasty should be considered if severe blockage in lower leg vessels ( tibial and peroneal artery
In anatomy, the fibular artery, also known as the peroneal artery, supplies blood to the lateral compartment of the leg. It arises from the tibial-fibular trunk.
Structure
The fibular artery arises from the bifurcation of tibial-fibular trunk int ...
) leads to gangrene.
Other
Hyperbaric oxygen therapy
Hyperbaric medicine is medical treatment in which an ambient pressure greater than sea level atmospheric pressure is a necessary component. The treatment comprises hyperbaric oxygen therapy (HBOT), the medical use of oxygen at an ambient pressure ...
treatment is used to treat gas gangrene. It increases pressure and oxygen content to allow blood to carry more oxygen to inhibit anaerobic organism growth and reproduction.
Regenerative medical treatments and stem-cell therapies have successfully altered gangrene and ulcer prognosis.
History
As early as 1028, flies
Flies are insects of the order Diptera, the name being derived from the Greek δι- ''di-'' "two", and πτερόν ''pteron'' "wing". Insects of this order use only a single pair of wings to fly, the hindwings having evolved into advanced m ...
and maggot
A maggot is the larva of a fly (order Diptera); it is applied in particular to the larvae of Brachycera flies, such as houseflies, cheese flies, and blowflies, rather than larvae of the Nematocera, such as mosquitoes and crane flies.
...
s were commonly used to treat chronic wounds or ulcers
An ulcer is a discontinuity or break in a bodily membrane that impedes normal function of the affected organ. According to Robbins's pathology, "ulcer is the breach of the continuity of skin, epithelium or mucous membrane caused by sloughing o ...
to prevent or arrest necrotic spread, as some species of maggots consume only dead flesh, leaving nearby living tissue unaffected. This practice largely died out after the introduction of antibiotics, acetonitrile
Acetonitrile, often abbreviated MeCN (methyl cyanide), is the chemical compound with the formula and structure . This colourless liquid is the simplest organic nitrile (hydrogen cyanide is a simpler nitrile, but the cyanide anion is not clas ...
, and enzyme
Enzymes () are proteins that act as biological catalysts by accelerating chemical reactions. The molecules upon which enzymes may act are called substrates, and the enzyme converts the substrates into different molecules known as products. A ...
to the range of treatments for wounds. In recent times, however, maggot therapy
Maggot therapy (also known as larval therapy) is a type of biotherapy involving the introduction of live, disinfected maggots (fly larvae) into non-healing skin and soft-tissue wounds of a human or other animal for the purpose of cleaning out th ...
has regained some credibility and is sometimes employed with great efficacy in cases of chronic tissue necrosis.
The French Baroque composer Jean-Baptiste Lully
Jean-Baptiste Lully ( , , ; born Giovanni Battista Lulli, ; – 22 March 1687) was an Italian-born French composer, guitarist, violinist, and dancer who is considered a master of the French Baroque music style. Best known for his operas, he ...
contracted gangrene in January 1687 when, while conducting a performance of his ''Te Deum
The "Te Deum" (, ; from its incipit, , ) is a Latin Christian hymn traditionally ascribed to AD 387 authorship, but with antecedents that place it much earlier. It is central to the Ambrosian hymnal, which spread throughout the Latin Ch ...
'', he stabbed his own toe with his pointed staff (which was used as a baton). The disease spread to his leg, but the composer refused to have his toe amputated
Amputation is the removal of a limb by trauma, medical illness, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on indiv ...
, which eventually led to his death in March of that year.
French King Louis XIV
, house = Bourbon
, father = Louis XIII
, mother = Anne of Austria
, birth_date =
, birth_place = Château de Saint-Germain-en-Laye, Saint-Germain-en-Laye, France
, death_date =
, death_place = Palace of Vers ...
died of gangrene in his leg on 1 September 1715, four days prior to his 77th birthday.
Sebald Justinus Brugmans
Sebald Justinus Brugmans (24 March 1763, Franeker – 22 July 1819, Leiden) was a Dutch botanist and physician. He was the son of naturalist Anton Brugmans (1732-1789).
Brugmans studied philosophy, mathematics and physics at the Universities ...
, Professor at Leyden University
Leiden University (abbreviated as ''LEI''; nl, Universiteit Leiden) is a public research university in Leiden, Netherlands. The university was founded as a Protestant university in 1575 by William, Prince of Orange, as a reward to the city of Le ...
, from 1795 on Director of the Medical Bureau of the Batavian Republic, and inspector-general of the French Imperial Military Health-Service in 1811, became a leading expert in the fight against hospital-gangrene and its prevention. He wrote a treatise on gangrene in 1814 in which he meticulously analyzed and explained the causes of this dreadful disease, which he was convinced was contagious. He completed his entry with a thorough evaluation of all possible and well experienced sanitary regulations. His work was very well received and was instrumental in convincing most later authors that gangrene was a contagious disease.
John M. Trombold wrote: "Middleton Goldsmith, a surgeon in the Union Army
During the American Civil War, the Union Army, also known as the Federal Army and the Northern Army, referring to the United States Army, was the land force that fought to preserve the Union (American Civil War), Union of the collective U.S. st ...
during the American Civil War, meticulously studied hospital gangrene and developed a revolutionary treatment regimen. The cumulative Civil War hospital gangrene mortality was 45%. Goldsmith's method, which he applied to over 330 cases, yielded a mortality under 3%." Goldsmith advocated the use of debridement and topical and injected bromide
A bromide ion is the negatively charged form (Br−) of the element bromine, a member of the halogens group on the periodic table. Most bromides are colorless. Bromides have many practical roles, being found in anticonvulsants, flame-retardant ...
solutions on infected wounds to reduce the incidence and virulence of "poisoned miasma". Copies of his book were issued to Union surgeons to encourage the use of his methods.
Father Camille Bulcke also died of gangrene on 17 August 1982.
Etymology
The etymology
Etymology ()The New Oxford Dictionary of English (1998) – p. 633 "Etymology /ˌɛtɪˈmɒlədʒi/ the study of the class in words and the way their meanings have changed throughout time". is the study of the history of the Phonological chan ...
of gangrene derives from the Latin
Latin (, or , ) is a classical language belonging to the Italic branch of the Indo-European languages. Latin was originally a dialect spoken in the lower Tiber area (then known as Latium) around present-day Rome, but through the power of the ...
word and from the Greek
Greek may refer to:
Greece
Anything of, from, or related to Greece, a country in Southern Europe:
*Greeks, an ethnic group.
*Greek language, a branch of the Indo-European language family.
**Proto-Greek language, the assumed last common ancestor ...
(γάγγραινα), which means "putrefaction
Putrefaction is the fifth stage of death, following pallor mortis, algor mortis, rigor mortis, and livor mortis. This process references the breaking down of a body of an animal, such as a human, post-mortem. In broad terms, it can be viewed ...
of tissues".[Liddell & Scott's Lexicon, Oxford University Press, 1963 edition] It has no etymological connection with the word green
Green is the color between cyan and yellow on the visible spectrum. It is evoked by light which has a dominant wavelength of roughly 495570 Nanometre, nm. In subtractive color systems, used in painting and color printing, it is created by ...
, despite the affected areas turning black, green, or yellowish brown.
References
External links
*
{{Authority control
Health effects of tobacco
Symptoms and signs: Vascular
Necrosis
Wikipedia medicine articles ready to translate