Quotation from: Manual of Surgery

Written by: Alexander Miles and Alexis Thomson


#Diabetic Gangrene.#--This form of gangrene is prone to occur in persons
over fifty years of age who suffer from glycosuria. The arteries are
often markedly diseased. In some cases the existence of the glycosuria
is unsuspected before the onset of the gangrene, and it is only on
examining the urine that the cause of the condition is discovered. 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, oedema, and dusky redness
of the foot, and severe pain. According to Paget, the dead part remains
warm longer than in other forms of senile gangrene; there is a greater
tendency for patches of skin at some distance from the primary seat of
disease to become gangrenous, and for the death of tissue to extend
upwards in the subcutaneous planes, leaving the overlying skin
unaffected. The low vitality of the tissues favours the growth of
bacteria, and if these gain access, the gangrene assumes the characters
of the moist type and spreads rapidly.

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