attacked, and the
disease seldom spreads beyond the phalanges or deeper than the skin.

The first evidence is that the fingers become cold, white, and
insensitive to touch and pain. These attacks of _local syncope_ recur at
varying intervals for months or even years. They last for a few minutes
or even for some hours, and as they pass off the parts become hyperaemic
and painful.

A more advanced stage of the disease is known as _local asphyxia_. The
circulation through the fingers becomes exceedingly sluggish, and the
parts assume a dull, livid hue. There is swelling and burning or
shooting pain. This may pass off in a few days, or may increase in
severity, with the formation of bullae, and end in dry gangrene. As a
rule, the slough which forms is comparatively small and superficial,
but it may take some months to separate. The condition tends to recur in
successive winters.

The _treatment_ consists in remedying any nervous or uterine disorder
that may be present, keeping the parts warm by wrapping them in cotton
wool, and in the use of hot-air or electric baths, the parts being
immersed in water through which a constant current is passed. When
gangrene occurs, it is treated on the same lines as other forms of dry
gangrene, but if amputation is called for it is only with a view to
removing the dead part.

#Angio-sclerotic Gangrene.#--A form of gangrene due to _angio-sclerosis_
is occasionally met with in young persons, even in children. It bears
certain analogies to Raynaud's disease in that spasm of the vessels
plays a part in determining the local death.

The main arteries are narrowed by hyperplastic endarteritis followed by
thrombosis, and similar changes are found in the veins. The condition is
usually met with in the feet, but the upper extremity may be affected,
and is attended with very severe pain, rendering sleep impossible.

The patient is liable to sudden attacks of numbness, tingling and
weakness of the limbs which pass off with rest--_intermittent
claudication_. During these attacks the large arteries--femoral,
brachial, and subclavian--can be felt as firm cords, while pulsation is
lost in the peripheral vessels. Gangrene eventually ensues, is attended
with great pain and runs a slow course. It is treated on the same lines
as Raynaud's disease.

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