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142 DENTAL MEDICINE,

toms. Moist gangrene is a form of the disease where the death
of the soft tissue is followed by decomposition and putrefaction,
the result of the presence of micro-organisms entering either
through the air or the circulation. The decomposed tissue has
the characteristic odor of putrid animal matter, disintegrating and
liquefying. Gases form, causing puffiness of the part, pressure
on which causes crepitation. The symptoms of moist gangrene
are those of acute inflammation, great congestion and an intense
burning pain. The constitutional symptoms are a low type of
inflammatory fever, rapid feeble pulse, and low delirium.
A frequent cause of gangrene is inflammation of the walls of
the arteries (arteritis), which results in the formation of new tissue
within the walls of the vessels, and obstructs the flow of the blood.
Treatment.—The treatment of gangrene consists in efforts to
remove the primary cause, support the strength by a generous diet,
and use of stimulants. Digitalis is indicated in case of a feeble
heart, and bitter tonics to improve the appetite. When gangrene
attacks the face and mouth, the dead tissue should be removed
as soon as the line of demarkation is established, and the wound
treated on antiseptic principles. Boric acid solution and Thiersch
solution are valuable antiseptics for use in the oral cavity.
Necrosis.—Necrosis signifies the death of bone-tissue, and
corresponds to gangrene of soft parts. The degree of injury,
traumatic or idiopathic, which is required to cause necrosis, is
much less than that necessary to cause death of the soft tissues.
This is due to the fact that the external (superficial) layers of
bone receive their supply of blood from numerous small vessels
given off from the periosteum, and the separation of the perios-
teum from the bone, which sometimes occurs from the pus of
an alveolar abscess making its way between the bone and the
periosteum, deprives the external layer of bone of its blood-
supply and causes necrosis. The occurrence of stasis resulting
from the Haversian vessels of bone becoming obstructed owing
to the presence of inflammatory stimulus which demands a larger
blood-current and more blood-cells, and which these vessels can-
not supply, on account of their inability to enlarge, is another
reason for the susceptibility of bone to necrosis.