#Gangrene from Ergot.#—­Gangrene may occur from interference with blood supply, the result of tetanic contraction of the minute vessels, such as results 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.