Moist Senile Gangrene. 595 



The brachial artery, when laid open, was found to be 

 atheromatous, and at its bifurcation had fibrinous clots, which 

 partly obstructed its lumen. The upper part of the ulnar artery 

 was patent, though atheromatous, but in the upper end of the 

 radial artery a firm clot completely occluded about an inch of 

 the lumen. On the radial side of the limb the gangrene 

 extends higher than in the ulnar side. Moreover, on the radial 

 side, and posteriorly, the line of demarcation is complete ; while 

 on the ulnar side, and anteriorly, it is incomplete. These 

 differences on the two sides may be associated with the differ- 

 ence in the patency of the respective arteries. Attention is 

 directed to the important parts of the arteries by means of blue 

 rods. 



This specimen may be taken as an illustration of what is 

 probably always the case in moist senile gangrene, i.e., that 

 besides a greatly impaired condition of the local circulation, 

 there is a septic fermentatiozi in the tissues. On this account, 

 so long as any circulation remains, it is in a condition of inflam- 

 mation. The tissues, moreover, which from their impaired 

 nutrition were unable to resist the entrance of sepsis, soon die 

 after it has been established. Thus an area of septic inflam- 

 mation once begun rapidly advances and soon ends in gangrene. 

 By the time the process has passed through the region whose 

 circulation has primarily been impaired, the patient may have 

 sunk from septic absorption, or the even previously well- 

 nourished tissues may have become hopelessly saturated with 

 decomposing fluids from the part beyond. The general 

 svmptoms of moist senile gangrene may be traced to septic 

 absorption and pain. G. C. 2792. 



Presented by G. M. Johnston, M.D., 1888. 



Othei' Forms of Gangrene. 

 11. 75. Gangrene from Constriction. —Left leg and gangrenour, 



foot of a child — in spirit, illustrating the above. 



The foot and leg liad been put up in plaster of Paris. After several 

 weeks the child was brought back, and when the plaster case was removed 



