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from observation, I should say that the latter membrane was
the part which was the most peculiarly liable to injury and
death from this disease ; and it is by no means clear, to my
apprehension, that this is not frequently the commencement
of the complaint. The injury generally proceeds with aug-
menting rapidity, especially when it has affected the deeper
parts : and it is while in the act of rapidly spreading that it
occasions gangrene.
In the production of gangrenous sloughs, it much resem-
bles the descriptions usually given of sloughing ulcers. A
portion of the parts immediately subjacent to the ulcer los-
es its life ; this rapidly separates, and, before or after a com-
plete removal, a fresh slough is formed in the same manner.
They are generally black, with ash-coloured edges. I have
not been able to discern a change of colour, the production
of vesicles, or any material tumefaction, as antecedent to the
gangrene. There is, generally, by this time, an increased
heat in the parts, with the sensation termed "calor mordens."
The discharge, now, for the first time, becomes acrimonious,
giving pain when it comes in contact with cuts in the fingers,
and excoriations are produced on all parts in contact with
the sloughing ulcerations, as the lips, the cheeks, the tongue,
and the adjoining surface of the part where the ulcer is situ-
ated.
As soon as the external gangrene has reached the level of
the edge of the body socket, and frequently much sooner,
the adjacent portion of the latter is found deprived of its life,
forming a necrosis. The death of the periosteum in the sock-
et, at least that of the fang of the tooth, precedes, by some
interval of time, that of any portion of the bone itself.
When gangrene is formed, a fever of irritation is generally
developed. In regard to the time at which this takes place,
there is a great diversity in different constitutions." It has