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a, dries up, and the shrivelled brown skin is slowly separated by the growth of granulation tissue beneath and around it. Fingers, toes, or even considerable portions of limbs may in the same way be suddenly destroyed by severe trauma, and undergo mummification. If organisms gain access, typical moist gangrene may ensue, or changes similar to those of ordinary post-mortem decomposition may take place. _Treatment._--The first indication is to exclude bacteria by purifying the damaged part and its surroundings, and applying dry, non-irritating dressings. When these measures are successful, dry gangrene ensues. The raw surface left after the separation of the dead skin may be allowed to heal by granulation, or may be covered by skin-grafts. In the case of a finger or a limb it is not necessary to wait until spontaneous separation takes place, as this is often a slow process. When a well-marked line of demarcation has formed, amputation may be performed just sufficiently far above it to enable suitable flaps to be made. The end of a stump, after spontaneous separation of the gangrenous portion, requires to be trimmed, sufficient bone being removed to permit of the soft parts coming together. If moist gangrene supervenes, amputation must be performed without delay, and at a higher level. #Gangrene from Heat, Chemical Agents, and Cold.#--Severe #burns# and #scalds# may be followed by necrosis of tissue. So long as the parts are kept absolutely dry--as, for example, by the picric acid method of treatment--the grossly damaged portions of tissue undergo dry gangrene; but when wet or oily dressings are applied and organisms gain access, moist gangrene follows. Strong #chemical agents#, such as caustic potash, nitric or sulphuric acid, may also induce local tissue necrosis, the general appearances of the lesions produced being like those of severe burns. The resulting sloughs are slow to separate, and leave deep punched-out cavities which are long of healing. #Carbolic Gangrene.#--Carbolic acid, even in comparatively weak solution, is liable to induce dry gangrene when applied as a fomentation to a finger, especially in women and children. Thrombosis occurs in the blood vessels of the part, which at first is pale and soft, but later becomes dark and leathery. On account of the anaesthetic action of carbolic acid, the onset of the process is painless, and the patient does not realise his danger. A line of demarcat
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