Selected monographs.

  • New Sydenham Society.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    132/372 (page 118)
    unci proximate cause, which always escapes more or less our observation, but the appreciable mechanism by which the facts are linked together one with another, the morbid process, in one word. Let us pass in review the principal known causes of spontaneous gangrene; if we are able to demonstrate that none of these are adequate to explain the phenomena thus far recorded, that will be already a first step towards the solution of the question. And first, Arteritis. Thank heaven I have not to express any opinion either upon its frequency, or upon the share which belongs to it in the different arterial changes, or to the part which it plays in gangrene in general. I take this ready made, if I may so say, from the hands of its partisans with the anatomical and semeiological characters which are attributed to it; then I place on the opposite side the cases which we have ±o interpret. These cases are of two kinds ; some have been followed by autopsy, others have recovered. The first are far the less numerous. In many of them from the outset the idea of any inflammatory state of the blood- vessels is excluded. I will cite amongst others that of Case IX., in which I myself made the autopsy. Two only lend themselves to a certain extent to this hypothesis, viz., that of Dr. Bernard Henry (Case XVII.), and that of Dr. Topinard (Case XVIIL). I have already quoted Dr. Henry's description and shown how -defective it is. The femoral and brachial arteries presented nothing which deviated from the normal state, but we found them adherent to the bone and closed along the line of demarca- tion. When dealiDg with a phrase which it is impossible to understand, it would be best perhaps to abstain from any judg- ment whatever. It seems to me, however, that these few words are enough to exclude arteritis, because the lesion, whatever its nature, was circumscribed to a very limited part of the vessels ; now one of the most constant characters of arteritis is that it always occupies a considerable extent of the vessel without any well-marked line of demarcation. M. TopinarcVs description would seem more conclusive : the internal surface of the arteries was of a bright vermilion tint, extended in a continuous manner—not in points or patches, not disappearing after more than forty-eight hours of maceration. But if any one thing clearly results from the discussions to