ON SPONTANEOUS GANGRENE FROM ARTERITIS 
AND THE CAUSES OF COAGULATION OF THE 
BLOOD IN DISEASES OF THE BLOOD.VESSELS 
Read before the Medico-Chirurgical Society of Edinburgh, March 17, 1858. 
[Edinburgh Medical Journal, April 1858.] 
Mr. PRESIDENT AND GENTLEMEN.—The case which I have the honour 
to bring before you this evening is one of spontaneous gangrene in a child. 
The patient was a girl, six years old, who, having had scarlet fever nine months 
previously, and afterwards suffered severely from dropsy, was seized about the 
middle of July last with deadly whiteness and coldness of both lower limbs up 
to a little above the knees. Her mother describes them as having resembled 
wax In appearance. She and her neighbours rubbed the legs perseveringly, 
and, after an hour or two, the left limb recovered its warmth and usual aspect, 
but the other continued in the same state for about two days, when the mother 
observed some pale blue discoloration between the ankle and the calf. This 
increased, spreading downwards to the foot; and, at the same time, under- 
going various changes of tint to pink, red, and green, till, at the end of four 
weeks, the limb presented the appearance depicted in this sketch. [Not here 
reproduced.| At this time she was brought to the Royal Infirmary, and was 
admitted into one of the senior surgeon’s wards, where, in the temporary absence 
of Mr. Spence, she came under my care. Her general health appeared remark- 
ably good, considering all that she had gone through: her tongue was clean 
and moist, and her appetite good, and though her pulse was very quick, viz. 
148, this was not to be regarded as a serious symptom in one so young, with 
such a source of irritation present. Accordingly, three days later, a line of 
demarcation having distinctly declared itself, I performed amputation im- 
mediately above the knee. Very little blood was lost in the operation, which 
did not accelerate the pulse or impair the appetite even for a day. Three days 
later, the constitution was evidently experiencing relief from the removal of 
the disease: the pulse was reduced to 112, and her general aspect improved. 
The stump healed kindly, and the result was in all respects satisfactory. 
The amputated limb having been laid open on its posterior aspect, the 
gangrene was found to have extended somewhat higher in the deep parts than 
