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April 1943


Author Affiliations

From the Peripheral Vascular Service, Baltimore City Hospitals.

Arch Surg. 1943;46(4):518-524. doi:10.1001/archsurg.1943.01220100062008

The staff of a large community hospital caring predominantly for charity patients is continually faced with the problem of managing cases of gangrene of the toes and feet due to arteriosclerosis. More often than not the patient does not apply for aid until the condition is well established and he is in an advanced toxic condition, or even moribund. The problem is usually complicated by the advanced age of the patient and the frequently associated heart disease, general toxicity and diabetes. It is now generally accepted1 that amputation of the leg is necessary if the gangrene has extended proximal to the toes. The operation often constitutes a desperate emergency for patients with far advanced toxicity, and the results in the past have been persistently discouraging. As the technic of spinal anesthesia improved, more patients withstood operation and the problem became more hopeful, but to save the life of an

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