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Updated: June 28, 2025
When an obliterative endarteritis is threatening a leg with anemic gangrene, or when one lies too long in the same position on a hard bed, there is threatening injury from local anemia, and as a result there is acute pain, but when the obliterative endarteritis threatens anemia of the brain, or when an embolism or thrombosis has produced anemia of the brain, there may be no accompanying pain.
The patient should drink large quantities of milk, which also increases the coagulability of the blood. Monro has observed remarkable results from the hypodermic injection of emetin hydrochloride in ½-grain doses. The processes known as thrombosis and embolism are so intimately associated with the diseases of blood vessels that it is convenient to define these terms in the first instance.
The gangrenous process seldom begins as suddenly as that associated with embolism, and, like senile gangrene, which it may closely simulate in its early stages, it not infrequently begins after a slight injury to one of the toes. It but rarely, however, assumes the dry, shrivelling type, as a rule being attended with swelling, œdema, and dusky redness of the foot, and severe pain.
There is no engorgement of either lungs or brain. 2. =Asphyxia=, or death beginning at the lungs, may be due to obstruction of the air-passages from foreign bodies in the larynx, drowning, suffocation, strangling, and hanging; from injury to the cervical cord; effusion into the pleuræ, with consequent pressure on the lungs; embolism of the pulmonary artery; and from spasmodic contraction of the thoracic and abdominal muscles in strychnine-poisoning.
In all cases of sudden death think of angina pectoris and the rupture of an aneurism. Aortic incompetence. Rupture of heart. Rupture of a valve. Rupture of aortic aneurism. Embolism of coronary artery. Angina pectoris. Cerebral hæmorrhage or embolism. Mitral and tricuspid valvular lesions if the patient exerts himself.
However, he sought an explanation of Benedetta's death, and hesitatingly ascribed it to aneurism, or possibly embolism. Thereupon Victorine, like a servant whose grief makes her the equal of her employers, boldly interrupted him: "Ah! Sir," said she, "they loved each other too fondly; did not that suffice for them to die together?"
"When a man dies by asphyxia, it means that the action of the muscles by which he breathes is stopped, or the work of his lungs prevented by injury, or the free passage of air arrested, as in drowning, or strangulation. It may also mean that embolism has taken place, and the pulmonary artery is blocked, withholding blood from the lungs. But it was not thus that any died in this chamber.
It may be necessary to administer an anæsthetic before rupturing strong fibrous adhesions, and this procedure must be carried out with caution, in view of such risks as fracture of the bone which is often rarefied or separation of an epiphysis. There is also the risk of fat embolism, and of re-starting the original disease.
The occurrence of endocarditis, as indicated by alterations in the heart sounds and the development of murmurs, may cause widespread infective embolism, and metastatic suppurations in the kidneys, heart-wall, and lungs, as well as in other bones and joints than those primarily affected.
3. =Coma=, or death beginning at the brain, may arise from concussion; compression; cerebral pressure from hæmorrhage and other forms of apoplexy; blocking of a cerebral artery from embolism; dietetic and uræmic conditions; and from opium and other narcotic poisons. The symptoms of this condition are stupor, loss of consciousness, and stertorous breathing.
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