Alexis Thomson and Alexander Miles - Manual of Surgery

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_Clinically_, loose bodies composed of fibrin constitute an unimportant
addition to the features of the disease with which they are associated.
They never give rise to the classical symptoms associated with impaction
of a loose body between the articular surfaces. Their presence may be
recognised, especially in the knee, by the crepitating sensation
imparted to the fingers of the hand grasping the joint while it is
flexed and extended by the patient.

The _treatment_ is directed towards the disease underlying the hydrops.
If it is desired to empty the joint, this is best done by open
incision.

[Illustration: FIG. 166.--Radiogram of Multiple Loose Bodies in
Knee-joint and Semi-membranosus Bursa in a man aet. 38.

(Mr. J. W. Dowden's case.)]

#Bodies composed of Organised Connective Tissue.#--These are
comparatively common in joints that are already the seat of some chronic
disease, such as arthritis deformans, Charcot's arthropathy, or synovial
tuberculosis. They take origin almost exclusively from an erratic
overgrowth of the fringes of the synovial membrane, and may consist
entirely of fat, the arborescent lipoma (Fig. 159) being the most
pronounced example of this variety. Fibrous tissue or cartilage may
form in one or more of the fatty fringes and give rise to hard nodular
masses, which may attain a considerable size, and in course of time may
undergo ossification.

Like other hypertrophies on a free surface, they tend to become
pedunculated, and so acquire a limited range of movement. The pedicle
may give way and the body become free. In this condition it may wander
about the joint, or lie snugly in one of its recesses until disturbed by
some sudden movement. A loose body free in a joint is capable of growth,
deriving the necessary nutriment from the surrounding fluid. The size
and number of the bodies vary widely. Single specimens have been known
to attain the size of the patella. The smaller varieties may number
considerably over a hundred.

[Illustration: FIG. 167.--Loose Body from Knee-joint of man aet. 25.
Natural size.

a = Convex surface. b = Concave surface.]

In arthritis deformans a rarer type of loose body is met with, a portion
of the lipping of one of the articular margins being detached by injury.
In Charcot's disease, bodies composed of bone are formed in relation to
the capsular and other ligaments, and may be made to grate upon one
another.

The _clinical features_ in this group are mainly those of the disease
which has given rise to the loose bodies, and it is exceptional to meet
with symptoms from impaction of the body between the articular surfaces.
Treatment is to be directed towards the primary disease in the joint, as
well as to the removal of the loose bodies.

[Illustration: FIG. 168.--Multiple partially ossified Chondromas of
Synovial Membrane, from Shoulder-joint, the seat of arthritis deformans,
from a man aet. 35.]

_Loose Bodies in Joints which are otherwise healthy._--It is in joints
otherwise healthy that loose bodies causing the classical symptoms and
calling for operative treatment are most frequently met with. They occur
chiefly in the knee and elbow of healthy males under the age of thirty.
The complaint may be of vague pains, of occasional cracking on moving
the joint, or of impairment of function--usually an inability to extend
or flex the joint completely. In many cases a clear account is given of
the symptoms which arise when the body is impacted between the articular
surfaces, namely, sudden onset of intense sickening pain, loss of power
in the limb and locking of the joint, followed by effusion and other
accompaniments of a severe sprain. On some particular movement, the
body is disengaged, the locking disappears, and recovery takes place.
Attacks of this kind may recur at irregular intervals, during a period
of many years. On examining the joint, it is usually found to contain
fluid, and there may be points of special tenderness corresponding to
the ligaments that have been overstretched. In cases in which there has
been recurrent attacks of locking, the ligaments become slack, the joint
is wobbly, and the quadriceps is wasted. The patient himself, or the
surgeon, may discover the loose body and feel it roll beneath his
fingers, especially if it is lodged in the supra-patellar pouch in the
knee, or on one or other side of the olecranon in the elbow. In most
instances the patient has carefully observed his own symptoms, and is
aware not only of the existence of the loose body, but of its erratic
appearance at different parts of the joint. This feature serves to
differentiate the lesions from a torn medial meniscus in which the pain
and tenderness are always in the same spot. As the body usually contains
bone, it is recognisable in a skiagram.

[Illustration: FIG. 169.--Multiple Cartilaginous Loose Bodies from
Knee-joint.]

There are two methods of _removing the body_; the first and simpler
method is applicable when the body can be palpated, usually in the
supra-patellar pouch; it is preferably transfixed by a needle and can
then be removed through a small incision; otherwise, the joint must be
freely opened and explored, firstly to find the body and further to
remove it.

The characters of this type of loose body are remarkably constant. It is
usually solitary, about the size of a bean or almond, concavo-convex in
shape, the convex aspect being smooth like an articular surface, the
concave aspect uneven and nodulated and showing reparative changes,
healing over of the raw surface, and the new formation of fibrous
tissue, hyaline cartilage and bone, the necessary nutriment being
derived from the synovial fluid (Fig. 167). The body is sometimes found
to be lodged in a defect or excavation in one of the articular surfaces,
usually the medial condyle of the femur, from which it is readily
shelled out by means of an elevator. It presents on section a layer of
articular cartilage on the convex aspect and a variable thickness of
spongy bone beneath this.

The origin of these bodies is one of the most debated questions in
surgical pathology; they obviously consist of a portion of the articular
surface of one of the bones, but how this is detached still remains a
mystery; some maintain that it is purely traumatic; Konig regards them
as portions of the articular surface which have been detached by a
morbid process which he calls "osteochondritis dessicans."

_Multiple Chondromas and Osteomas of the Synovial Membrane._--In this
rare type of loose body, the surface of the synovial membrane is studded
with small sessile or pedunculated tumours composed of pure hyaline
cartilage, or of bone, or of transition stages between cartilage and
bone. They are pearly white in colour, pitted and nodular on the
surface, rarely larger than a pea, although when compressed they may
cake into masses of considerable size. With the movements of the joint
many of the tumours become detached and lie in the serous exudate
excited by their presence. They are found also in the diverticula of the
synovial membrane, in the shoulder in the downward prolongation along
the tendon of the biceps, in the hip in the bursal extension beneath the
psoas.

The patient complains of increasing disability of the limb, movements of
the joint becoming more and more restricted and painful. There is
swelling corresponding to the distended capsule of the joint, and on
palpation the bodies moving under the fingers yield a sensation as of
grains of rice shifting in a bag. If the bodies are so numerous as to be
tightly packed together, the impression is that of a plastic mass having
the shape of the synovial sac. The stiffness and the cracking on
movement may suggest arthritis deformans, but the X-ray appearances make
the diagnosis an easy one. We have observed two cases of this affection
in the knee-joint of adult women, one in the shoulder-joint of an adult
male (Fig. 168), and Caird has observed one in the hip. The treatment
consists in opening the joint by free incision and removing the bodies.

_Displacement of the menisci_ of the knee is referred to with injuries
of that joint.

INDEX

Abdominal aneurysm, 313
aorta, compression of, 269
embolus of, 93

Abscess, 46
acute circumscribed, 46
of bone, 448
Brodie's, 448
chronic, 139
cold, 139
embolic, 66
formation of, 47
Hilton's method of opening, 50
pointing of, 48
pyaemic, 287
residual, 141
of skin, multiple, 382
stitch, 51
treatment of, 49
tuberculous, 139, 141
peri-articular, 514, 517

Achillo-bursitis, 432

Achillo-dynia, 422

Acidosis, 251

Acromion bursa, 429

Actinomycosis, 126

Active hyperaemia, 39

Acupuncture in aneurysm, 308

Acute arthritis of infants, 440
necrosis of bone, 439

Adductor longus muscle, rupture of, 408

Adenoma, 202
malignant, 209
sebaceous, 393
of skin, 393
varieties of, 202

Adiposus dolorosa, 186

Aerobes, 19

Air embolism, 265
hunger, 276

Albumosuria, 195, 474, 492

Aleppo boil, 129

Alexins, 22

Ambrine, 13, 238

Amputation neuroma, 344

Anaerobes, 19

Anaesthesia, after nerve injuries, 347

Analgesia, 347

Anaphylaxis, 23

Anatomical tubercle, 134

Anatomy. _See_ Surgical Anatomy

Anel's operation for aneurysm, 307

Aneurysm, 300. _See also_ Individual Arteries
abdominal, 313
acupuncture in, 308
amputation in, 310
by anastomosis, 298
Anel's operation for, 307, 310
arterio-venous, 263
axillary, 318
of bone, 498
brachial, 318
Brasdor's operation for, 308
cirsoid, 299
Colt's method of wiring for, 309
compression for, 308
consolidated, 304, 305
differential diagnosis of, 305
diffused, 302
digital compression in, 308
excision of, 307
of forearm and hand, 318
fusiform, 301
gelatin injections in, 309
Hunter's operation for, 307
iliac, 318
of individual arteries, 312
inguinal, 318
innominate, 314
intracranial, 316
of leg and foot, 320
ligation of artery for, 307
Macewen's acupuncture for, 308
Matas' operation for, 307
Moore-Corradi method, 308
natural cure of, 305
old operation for, 307
of ophthalmic artery, 317
orbital, 317
pathological, 301
pulse in, 304
rupture of, 306
sacculated, 302
suppuration in, 306
thoracic, 312
traumatic, 263, 310
treatment of, 306
varicose, 311
Wardrop's operation for, 308
X-rays in diagnosis of, 304

Aneurysmal varix, 311, 316, 318, 319, 320

Angioma, 284
arterial, 299
capillary, 294
cavernous, 297
racemosum venosum, 287
venous, 294

Angio-neurotic oedema, 348
sarcoma, 199

Angler's elbow, 406

Ankle, cellulitis of, 58

Ankylosis of joints, 503. _See also_ Individual Joints

Anoci-association, 253

Anthracaemia, 121

Anthrax, 119

Anti-bacterial sera, 23
-diphtheritic serum, 111
-streptococcic serum, 23, 109
-tetanic serum, 117

Antibodies, 22

Antigens, 22

Antiseptics, 242

Antitoxic sera, 23

Antitoxins, 22

Antivenin, 132

Aorta, abdominal, compression of, 269
aneurysm of, 313
embolism of, 93
ligation of, 314
pulsating, 305, 314

Arborescent lipoma, 423

Arseno-billon, 163

Arteries, anatomy of, 258
compression of individual, 269
contusion of, 260
digital compression of, 269
gangrene following ligation of, 94
gunshot wounds of, 263

Arteries, ligation of, for aneurysm, 307
punctured wounds of, 262
repair of, 266, 268
rupture of, 260
wounds of, 261, 262

Arterio-sclerosis, 282

Arterio-venous aneurysm, 310

Arteritis, varieties of, 282

Arthritis, 501. _See also_ Individual Joints
acute, 506
of infants, 440
deformans, 524
gonococcal, 510
neuropathic, 532
ossificans, 503
pneumococcal, 509
pyogenic, 506
rheumatic, 523
rheumatoid, 524
septic, 506
scarlatinal, 508
trade, 525
traumatic, 524
tuberculous, 512
urica, 522

Arthrolysis, 505

Arthropathies, 532
gliomatous, 534

Arthroplasty, 505

Articular caries, 502, 514

Artificial hyperaemia, 39

Ascites, chylous, 325

Asepsis, 18

Asphyxia, local, 97
traumatic, 254

Atheroma, 283

Avulsion of nerves, 375
of tendons, 411

Axilla, cellulitis of, 58
hygroma of, 328

Axillary aneurysm, 318
artery, embolus of, 93
lymph glands, 336
nerve, injuries of, 363

Bacilli, 19

Bacillus aerogenes capsulatus, 99
anthracis, 119
coli communis, 27
diphtheriae 109
drum-stick, 112
of Ducrey, 154
of glanders, 123
Klebs-Loffler, 109
of malignant oedema, 101
mallei, 123
pyocyaneus, 29
of soft sore, 154
of tetanus, 112
tubercle, 133
typhosus, 29, 452

Bacteria, death of, 21
general characters of, 18
pathogenic properties of, 19
pyogenic, 24, 29

Bacterial intoxication, 21

Bacteriology, surgical, 17

Baker's cysts, 539

Bazin's disease, 74, 169

Beck's paste in sinuses, 145

Bed-sores, 73, 103

Bence-Jones on albumosuria, 195, 474, 492

Biceps, bursa under, 430
dislocation of long tendon of, 409
rupture of, 407

Bier's artificial hyperaemia, 38

B.I.P.P., 143

Birth palsies, 362

Biskra button, 129

Bismuth gauze, 247
injections in sinuses, 145

Bites of animals, 223

Black eye, 219

Bleeder's joint, 531

Bleeders, 277
bruises in, 218

Blisters, 376
purulent, 55

Blocking of nerves for shock, 252

Blood, count, 30
cysts, 214, 220
transfusion of, 11, 253

Blood vessels. _See_ Arteries and Veins

Bloodless state, treatment of, 276

Blood letting, general, 42

Boil, 379
Aleppo, 129
Delhi, 129

Bone. _See also_ Individual Bones
abscess of, 448
aneurysm of, 498
angioma of, 491
atrophy of, 479
bacterial diseases of, 438
Brodie's abscess of, 448
cancer of, secondary, 499
caries of, 437, 438
changes in ulcers of leg, 79
chondroma of, 487
cysts of, 477, 500
diseases of, 434
due to staphylococcus aureus, 438
endothelioma of, 492
exostoses of, 191, 481
fibroma of, 491
fragility of, 479
grafting, 16, 436
gumma of, 464
hydatid disease of, 467
hyperostosis, 435, 464
hypertrophic pulmonary osteo-arthropathy, 480
hypertrophy of, 435
lipoma of, 491
lipping of, 527
malacia of, 473
marrow, function of, 434
myeloma of, 491
myxoma of, 491
necrosis of, 438
neuropathic atrophy of, 479
osteoma of, 481
osteomalacia of, 473
osteomyelitis of, 65, 437, 438, 451, 453, 473
fibrosa, 476
osteoporosis of, 437
osteopsathyrosis, 479
ostitis deformans, 474
Paget's disease of, 474
periosteum, function of, 435
periostitis, 437
pulsating haematoma of, 498
pyogenic diseases of, 438
regeneration of, 436
rickety affections of, 468
sarcoma of, 492
sclerosis of, 435
scurvy affecting, 473
secondary tumours of, 499
surgical anatomy of, 434
staphylococcal diseases of, 438
syphilitic diseases of, 461, 465
transplantation of, 436
tuberculous diseases of, 454
tumours of, 480
malignant, 492, 499
metastatic, 499
thyreoid, 500
typhoid, infection of, 452
X-ray appearances in diseases of, 445, 455, 485, 491, 496

Bovine tuberculosis, 136

Brachial aneurysm, 318
artery, embolus of, 93
compression of, 269
birth-paralysis, 362
fibrositis, 413
neuralgia, 371
plexus, lesions of, 360

Brain, joint affections in lesions of, 537
syphilitic lesions of, 161

Branchial dermoids, 211

Brasdor's operation for aneurysm, 308

Brodie's abscess, 448

Bruises, 218

Bubo, 329
bullet, 153
of soft sores, 155

Bullet bubo, 153

Bullets, embedded, 231
varieties of, 230

Burnol, 238

Burns, 233
classification, of, 234
electrical, 239
pathology of, 233
by X-rays, 239

Bursae. _See also_ Individual Bursae
adventitious, 426
affections of, 426
individual, 428
diseases of, 426, 428
haematoma of, 426
hydrops of, 427
hygroma of, 423
inflammation of, 426
injuries of, 426
loose bodies in, 427
syphilis of, 428
tuberculosis of, 428
tumours of, 427, 428

Cachexia, cancerous, 207

Calcanean bursa, 432

Calcification in arteries, 282
in muscles, 416
in tuberculosis, 136

Callosities, 376

Callous ulcers, 79, 84

Cancer, 202
arsenic, 395
of bone, 499
cachexia in, 207
chimney-sweep's, 395
colloid, 210
columnar epithelial, 209
contagiousness of, 205
cystic, 210
definition of, 202
degeneration of, 205
encephaloid, 210
_en cuirasse_, 204
glandular, 210
glandular infection in, 203
increase of, 207
of lymph glands, 340
medullary, 210
melanotic, 210, 341, 397
paraffin, 395
pigmented, 210
radium treatment of, 208
rodent, 210, 395
scirrhous, 210
of skin, 394
spread of, 204
squamous epithelial, 208
ulceration of, 205
varieties of, 208
X-ray, 208

Cancrum oris, 102

Cantharides plaster, 42

Capillaries, anatomy of, 258

Capillary angioma, 294
loops, 3

Carbolic gangrene, 95

Carbon-dioxide snow, 297

Carbuncle, 380

Carcinoma. _See_ Cancer

Caries, 437, 438
of articular surfaces, 502, 514
sicca, 438
syphilitic, 462
tuberculous, 455

Carotid aneurysm, 314
artery, compression of, 269
tubercle, 269

Carpal ganglion, 214

Carron oil, 238

Cartilage, grafting of, 16
repair of, 7
ulceration of, 502, 514

Cartilaginous exostosis, 191, 481

Caseation in tuberculosis, 136

Catalepsy, 116

Catgut, infection by, 51
preparation of, 245

Cautery in haemorrhage, 271

Cavernous angioma, 298
lymphangioma, 327

Cellulitis, 52
in different situations, 58
diffuse, 52

Cephalic or Kopf tetanus, 116

Cerebro-spinal meningitis, 115

Cervical adenitis, 332
rib, 360

Chalk stones in gouty joints, 523

Chancre, concealed, 152, 153, 157
erratic, 153
extra-genital, 153
hard, 151
meatal, 152
multiple, 152
relapsing false indurated, 172
soft, 154
urethral, 152

Chancroid, 154

Charcoal poultice, 84

Charcot's disease, 533

Cheloid. _See_ Keloid

Chemiotaxis, 32

Chigoe, 130

Chilblain, 378

Chimney-sweep's cancer, 395

Chloroma, 200

Chondroma, 189, 487
multiple, 544

Chondromatosis, 488

Chondro-sarcoma, 189, 200, 487

Chordoma, 200

Choroiditis, syphilitic, 177

Chylorrhoea, 325

Chylo-thorax, 325

Chylous ascites, 325

Cicatrices, varieties of, 400

Cicatricial contraction, 4
tissue, 4

Circumflex nerve. _See_ Axillary Nerve

Cirsoid aneurysm, 299

Claw-hand, 369

Cloacae in bone, 443

Cocci, 18

Coeliac artery, aneurysm of, 313

Coley's fluid, 201

Collapse, 254

Collateral circulation, 267

Colles' law, 178

Colloid cancer, 210

Common peroneal nerve, 370

Compound palmar ganglion, 217, 423

Condylomata, 158, 174

Congenital fistulas, 60
telangiectasis, 294

Connective tissue, repair of, 6

Contracture of joints, 502
of muscles, 415
paralytic, 347

Contusions, 218

Cornea, syphilitic ulceration of, 177

Corns, 377

Corpora oryzoidea, 539

Counter-irritants, 37, 42

Craniotabes, 175, 176, 465

Crural fibrositis, 413

Crutch paralysis, 351

Cupping dry, 39
wet, 42

Cutis anserina, 36

Cyanosis, traumatic, 254

Cyst, 212
atheromatous, 389
Baker's, 539
blood 214, 220
of bone, 477, 500
dentigerous, 193
derma, 210
exudation, 212
ganglionic, 215
haemorrhagic, 220
hydatid, 213
implantation, 212
of joints, 538
lymph, 214
lymphatic, 219, 328
omental, 329
parasitic, 213
retention, 212
sebaceous, 212, 389
serous, 219
venous, 289

Cystic adenoma, 202
carcinoma, 210
hygroma of neck, 328
lymphangioma, 327, 328

Dactylitis, syphilitic, 176, 460, 466
tuberculous, 460

Dancer's sprain, 406

Deafness, syphilitic, 178

Deformities. _See_ Individual Regions

Delhi boil, 129

Delirium, in surgical patients, 255
traumatic, 257

Delirium tremens, 256

Dentigerous cyst, 193

Dercum on adiposus dolorosa, 186

Derma-cysts, 210

Dermatitis, 239, 292

Dermoids, 210

Diabetic gangrene, 96

Diarsenol, 163

Diapedesis of red corpuscles, 32

Diaphysial aclasis, 483

Diffuse aneurysm, 302
cellulitis, 52
fibromatosis, 194
lipomatosis, 187
neuro-fibromatosis, 355
osteoma, 485
suppuration, 52

Diphtheria, 109
antitoxin in, 111
intubation in, 111

Diplococci, 19

Dislocation of nerves, 351, 369
pathological, 514
of tendons, 408

Double cyanide gauze, 247

Drainage of wounds, 222

Dressings, surgical, 247

Drill-bone, 418

Drop-finger, 411
-foot, 370
-wrist, 365

Drunkard's palsy, 351, 364

Duchenne's paralysis, 361

Ducrey's bacillus, 154

Duodenum, ulceration of, in burns, 236

Dwarf, rickety, 469
syphilitic, 178

Eburnation of articular surfaces, 557

Ecchondroses, 527

Ecchymosis, 218

Echinococcus, 213

Echthyma, 158

Eczema, varicose, 292

Elbow, angler's, 406
cellulitis of, 58
tennis, 406

Electricity, injuries by, 239

Electrolysis in angioma, 297

Elephantiasis, varieties of, 360, 384, 386

Embolism, 281
air, 265

Embolism, fat, 254
of individual arteries, 93

Embolus, 281

Emigration of leucocytes, 32

Emotional shock, 251

Emphysema, 99, 102

Emprosthotonos, 214

Empyema of joints, 501, 518

Encephaloid cancer, 210

Endarteritis obliterans, 282
syphilitic, 161

Endo-aneurysmorrhaphy, 307

Endothelioma, 196
of bone, 492

Epicritic sensibility of nerves, 343

Epidermis, grafting, 12
repair of, 4

Epiphysial cartilage, 434
junction, 434
in rickets, 469

Epiphysiolysis, 440

Epiphysitis, 437
syphilitic, 465

Epithelial tumours, 201

Epithelioma, 208
chimney-sweep's, 395
lupus, 384
paraffin, 395
in scars, 402
sinus, 500
of skin, 394
trade, 395
varieties of, 208
X-ray, 395

Epithelium grafting, 12
repair of, 6

Epulis, 491

Erb's paralysis, 361

Erysipelas, varieties of, 107

Erythema pernio, 378
nodosum, 442

Evaporating lotions, 41

Exfoliation, 438

Exophthalmos, pulsating, 317

Exostosis, 191, 481
bursata, 481
cancellous, 481
cartilaginous, 191, 481
false, 192
ivory, 481
multiple, 483
spongy, 191, 481
subungual, 191, 404, 481

Explosives, wounds by, 231

External iliac artery, embolus of, 93

External popliteal nerve. _See_ Common Peroneal Nerve

Extravasation of blood, 259

Exudates, varieties of, 33

Exudation cysts, 212

Eye, syphilitic lesions of, 160, 176, 177

Facial artery, compression of, 269
erysipelas, 107

Fainting, 249

Farcy, 125

Fascia, grafting of, 16

Fat embolism, 254
grafting of, 16

Fatty hernia, 187
tumours, 184

Feet, trench, 96

Femoral aneurysm, 318
artery compression of, 269
embolus of, 93
lymph glands, 323

Fever, 35

Fibro-adenoma, 202

Fibroblasts, 3

Fibroid, recurrent, of Paget, 199, 392, 420
uterine, 195

Fibroma, 194
of bone, 491
diffuse, 194
recurrent, of Paget, 199, 392, 420
of skin, 391
varieties of, 194

Fibromatosis, diffuse, 194

Fibro-myoma, 195

Fibro-sarcoma, 199

Fibrositis, varieties of, 372, 412

Filaria Bancrofti, 326

Filarial disease, 326

Finger, chancre of, 154
drop-, 411
mallet-, 411

Fingers, gouty affections of, 523
whitlow of, 55

Finsen light treatment, 138

Firearms, wounds by, 225, 227, 230

First intention, healing by, 2

Fistula, 60
congenital, 60
lymphatic, 325
varieties of, 60

Fluctuation, 49

Fomentations, 37, 41

Foot, cellulitis of, 58
drop-, 370
Madura, 129
perforating ulcer of, 73

Forci-pressure in haemorrhage, 271

Forearm, aneurysm of, 318
cellulitis of, 58

Foreign bodies, embedded, 6, 231

Fracture, pathological, 444

Fraenkel's pneumococcus, 28

Fragilitas ossium, 479

Friedlander's pneumo-bacillus, 28

Frost-bite, gangrene from, 95

Furunculus orientalis, 129

Galyl, 163

Ganglion, 214, 215, 217
compound palmar, 217, 423

Ganglionic neuroma, 353

Gangrene, 86
acute infective, 99
emphysematous, 102
from angio-sclerosis, 98
bacterial varieties of, 99
from burns and scalds, 95
cancrum oris, 102
carbolic, 95
from chemical agents, 95
clinical types of, 86
varieties of, 88
from constriction of vessels, 94
diabetic, 96
dry, 86
embolic, 92
from ergot, 98
from frost-bite, 95
gas, 102
from interference with circulation, 86
following ligation of arteries, 94
line of demarcation in, 87
malignant oedema, 101
moist, 87
noma, 102
phagedaena, 153
Raynaud's disease, 97
senile, 88
traumatic, 94
from trench feet, 96
white, 93
from whitlow, 99