70 ON SPONTANEOUS GANGRENE FROM ARTERITIS AND 
in the skin; the mortified tissues, including the posterior tibial nerve, were 
congested in a manner closely simulating inflammation, but of a duller tint, 
and exactly as far as this congestion extended, the posterior tibial venae comites 
were turgid, and evidently contained coagulated blood. In the upper part of 
the limb the veins were flaccid and empty, and all the tissues appeared healthy, 
except that the popliteal artery, for an inch and a half from its lower end, was 
the seat of intense congestion, which also implicated slightly the cellular tissue 
about the vein and nerve. [These appearances were represented in a coloured 
drawing.| On laying open the vessels, the vein was found pervious and healthy, 
except that its coats seemed a little thicker than natural, but the artery was 
filled at the congested part with a coagulum, an inch and a quarter in length, 
partly pinkish and partly dark in colour. There was no appearance of any 
inflammatory exudation having taken place into the interior of the vessel, 
but the clot lay everywhere in contact with the internal coat, to which it was 
firmly adherent, so much so, as to tear away a portion of it when removed. 
Beneath the lining membrane were to be seen transverse red streaks, which 
appeared due to congestion of the circular coat of the vessel. [A sketch of the 
vessel and its contained clot was now exhibited.} The coagulum extended 
down the anterior tibial artery as far as to the commencement of the gangrene, 
but the companion veins were empty and perfectly natural in appearance, as 
also was the posterior tibial artery. 
These pathological appearances clearly indicate that the primary disease 
was inflammation of the arteries, accompanied by coagulation of the blood 
within them, obstructing the supply of the nutrient fluid, and so inducing 
death of the lower part of the limb. This conclusion is in harmony with the 
previous history, which was from the first that of arterial obstruction. 
This case is of practical interest, as illustrating the principle that spontaneous 
gangrene may be entirely local in its cause, and that in such cases the greatest 
benefit may be anticipated from removal of the mortified part, provided the 
constitution be in a state fitted, as regards age and in other respects, for bearing 
the operation. 
But my chief reason for bringing the case now before the Society is because 
it appears a distinct example of inflammation of the coats of a vessel determin- 
ing coagulation of the blood within it, without the exudation of lymph into its 
interior. Not that there is any novelty connected with such an occurrence, 
but because this effect of arteritis and phlebitis, long recognized by all sound 
pathologists, appears to be of peculiar interest at the present juncture, in con- 
nexion with the recent publication of the last Astley Cooper Prize Essay, in 
which Dr. Richardson of London propounds the theory, that the coagulation 
