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Updated: June 3, 2025
He peered at him from under drooping eyelids, flanking a nose without a bridge, and my companion didn't like it. "He is admiring you," I remarked by way of consolation, as indeed he was. "What do you call it?" said A petulantly to a R.A.M.C. officer who was lunching with us. The latter looked at the boy with a clinical eye. "Necrosis syphilitic," he said dispassionately.
If these gain access, in the course of a few days the damaged area of skin becomes of a greyish colour, blebs form on it, and it undergoes necrosis, leaving an unhealthy raw surface when the slough separates. Heat and prolonged exposure to the Röntgen rays or to radium emanations act in a similar way.
It may lead to necrosis of a portion or even of the entire phalanx. This is usually recognised by the persistence of suppuration long after the acute symptoms have passed off, and by feeling bare bone with the probe. In such cases one or more of the joints are usually implicated also, and lateral mobility and grating may be elicited.
As the disease continues, the internal elastic layer is lost, the muscular coat begins to atrophy, and then small calcareous granules may begin to be deposited, which may form into plates. In the large arteries, the advance of the process differs somewhat. There may be more actual inflammatory signs, fatty degeneration may occur, and even a necrosis may take place.
Poncet hastened a cure in a case of necrosis with partial destruction of the periosteum by inserting grafts taken from the bones of a dead infant and from a kid. Ricketts speaks of bone-grafting and the use of ivory, and remarks that Poncet of Lyons restored a tibia in nine months by grafting to the superior articular surface.
The limb having been rendered bloodless, existing sinuses are enlarged, but if these are inconveniently situated for example, in the centre of the popliteal space in necrosis of the femoral trigone it is better to make a fresh wound down to the bone on that aspect of the limb which affords best access, and which entails the least injury of the soft parts.
Army surgeons are not altogether unfamiliar with these tricks, but compared with the artful Hindoos the British soldier is a mere child in such matters. Excision of the larynx has found its chief indication in carcinoma, but has been employed in sarcoma, polyps, tuberculosis, enchondroma, stenosis, and necrosis.
When gangrene occurs from such causes, it tends to be of the moist type. Much commoner is it to meet with localised areas of necrosis due to the excessive pressure of splints over bony prominences, such as the lateral malleolus, the medial condyle of the humerus, or femur, or over the dorsum of the foot.
If, however, the reaction induced by the infection is insufficient to check the growth and spread of the organisms, or to inhibit their toxin production, local necrosis of tissue may take place, either in the form of suppuration or of gangrene, or the toxins absorbed into the circulation may produce blood-poisoning, which may even prove fatal.
David: "I I was in the army ... at least in a police force ... I got wounded, had to go into hospital necrosis of the jaw ... I came home when I got well..." Blackbeard: "Necrosis of the jaw! That was a bad thing. But you seem to have got over it very well. I can't see any scar from where I am..." David: "Oh no.
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