To the Editor:—I have read the paper on "Arteriosclerosis Obliterans as a Cause of Ulcers of the Leg," by Shapiro and Nomland, in the Archives of January 1950, with great interest. Arterial disease is clearly a more important factor in the etiology of these ulcers than is generally recognized.
May I draw your attention to the pioneer work of John Gay on this subject, which has been sadly neglected? In the "Lettsomian Lectures of 1867," published in London by Churchill in 1868, and with the title of "On Varicose Diseases of the Lower Extremities," he described the results of his investigations on ulcers of the leg based on clinical observation and careful dissection. He stated (p. 161): "I distinguish three varieties of ulcer—the simple, venous and arterial." He described these types and the pathologic changes in the vessels found on dissection both at operation and autopsy. In a summary