Exclude infection and trauma, and death from diabetic gangrene would disappear. At the New England Deaconess Hospital in the service of Dr. E. P. Joslin and myself, from January, 1923, to January, 1930, thirty-one deaths occurred in one hundred and eighty cases of diabetic gangrene or infection of the feet requiring amputation of the toes or legs. In only seven were the causes of death not directly due to infection. The spontaneous occurrence of gangrene, trauma or infection is as rare in the diabetic as in nondiabetic persons of a similar age. It therefore seems clear that although premature arteriosclerosis, differing somewhat from nondiabetic arteriosclerosis, is present in the diabetic patient, the frequency as well as the high mortality of gangrene are dependent on a specific diabetic factor which for lack of a better term I must call lowered resistance to trauma and infection due to the metabolic disturbance
ROOT HF. DIABETIC GANGRENE: MEDICAL TREATMENT AND PROPHYLAXIS. Arch Surg. 1931;22(2):179–194. doi:10.1001/archsurg.1931.01160020002001
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