قراءة كتاب On the origin of inflammation of the veins and of the causes, consequences, and treatment of purulent deposits
تنويه: تعرض هنا نبذة من اول ١٠ صفحات فقط من الكتاب الالكتروني، لقراءة الكتاب كاملا اضغط على الزر “اشتر الآن"
On the origin of inflammation of the veins and of the causes, consequences, and treatment of purulent deposits
to the sides of any part of the vascular system. The union thus formed may be permanent, or the coagulum may be again broken up and carried with the blood in the course of the circulation, as shown in Experiment vi. When this occurs, as is shown in the same experiment, other changes supervene in remote parts of the body. This tendency to coagulate around the foreign matter once impressed upon the blood, cannot be destroyed by the coagulum being mechanically broken up, as indeed is proved by the fact already mentioned, that after one attempt at union in a vein (in consequence of the introduction of foreign matter) has failed, another attempt is made immediately farther up the vessel. Under these last circumstances, we may find a vein partially obliterated at different points, leaving intervals where lymph or pus are secreted. If the purulent matter introduced is allowed to remain a short time only in the vein, no inflammation is produced (Experiment vi). But when any irritating fluid is detained there in consequence of the blood coagulating around it, adhesive, ulcerative, or suppurative inflammation, will be excited (Experiments vii and viii).
The slowness with which veins inflame when cut, tied, or bruised, has been made a subject of comment by different authors; and Mr. Travers, in particular, has endeavoured to reconcile "the infrequency of its occurrence" with the rapid and violent character of the inflammation in certain cases. Although, under ordinary circumstances, a wounded vein does not inflame, yet the annexed experiments show, that pus introduced into its cavity will produce inflammation, in which the system will sympathize. Other fluids besides pus will no doubt produce similar effects; but those of pus are here particularly noticed, as affording a good illustration of the series of changes produced by the introduction of foreign matter into the blood.
What the symptoms are which characterize the presence of pus, as distinguished from other secretions in the blood, it would probably be difficult to determine in cases as they occur in practice. The examination of the blood in these instances affords no very satisfactory information; for the characters of pus, when the blood has once coagulated round it, are so altered, that I know of no means by which a small quantity can be recognized, when it has once entered the circulation. The conclusions drawn from the different facts now stated are,—first, that inflammation of a vein, or phlebitis, is no essential part of the primary affection which precedes constitutional symptoms, even when morbid matter has found its way into the circulation through a vein. Secondly, that when inflammation of a vein does occur, in some instances at least, it is not the cause, but the consequence of the introduction of diseased or foreign matter into the blood. Thirdly, that although veins are with difficulty inflamed by any mechanical injury, they are susceptible of rapid inflammation, accompanied with constitutional disorder, whenever any irritating fluids are introduced into their cavities.
III. When the principal veins in a part become obstructed, it is natural to suppose that changes should be produced in the smaller veins which supply them. These changes may be expected in a more marked degree, when the obstruction depends upon coagulation of the blood, than when it arises from other causes, inasmuch as the coagulum usually extends to several veins at the same time.
In the experiments that have been made upon animals, it has been a matter of surprise that, while extreme pain was evinced upon the injection of irritating fluids into the veins, comparatively little or no suffering was produced, when similar experiments were performed upon the arteries. The foreign matter introduced in these cases would probably have the effect of coagulating the blood, as in the instances already mentioned. If this occurred in an artery, the supply of blood below the obstruction would be diminished; but if in a vein, the return of blood would be prevented: in the latter case, the continued influx of blood to the part would necessarily distend the capillaries.
In M. Cruveilhier's[14] experiment, of injecting ink into the veins of dogs, he found, that in thirty-six hours the legs swelled, and a number of bloody patches (foyers apoplectiques) were found in the substance of the muscles and the cellular tissues of the limb. The large veins were distended with adherent coagula of blood, and the smaller veins around the livid patches were also filled with coagulated blood. If the animal were allowed to live, the congested spots suppurated. The appearances thus produced in the muscles and cellular tissue of the limb were evidently not those of inflammatory action propagated along the coats of the veins, for the affection in the capillaries was circumscribed, and terminated in many places abruptly, leaving the veins in the immediate neighbourhood perfectly healthy; still less could the appearance produced depend upon the injected fluid finding its way through the veins (contrary to the course of the circulation) to the capillary system; nor, lastly, could it depend upon the ink finding its way into the general circulation, and producing its effects in its course a second time through the limb; for, not to mention that the capillaries of the lungs and other parts would be equally liable to be affected, one essential condition of the success of the experiment is mentioned to have been, that the fluid injected should not find its way along the vein in the usual course of the blood. We therefore conclude, that it was the coagulation of the blood in the large veins which caused the congestion of the capillaries, those veins remaining unaffected which could discharge their contents by some collateral channel.
In cases of phlegmasia dolens after child-birth, the same principle can sometimes be traced; thus, in a dissection performed by Mr. Lawrence,[15] the external and common iliac veins were filled with a substance like the laminated coagulum of an aneurism. "The tube was completely obstructed by this matter, adhering as firmly as the coagulum does in any part of an old aneurismal sac. In its centre was a cavity containing about a teaspoonful of thick fluid of the consistence of pus, of a light brownish red tint, and pultaceous appearance." The femoral vein was in this case also filled with a coagulum; but, as is observed in the account of the dissection, the red colour of that vein might have been caused by the clot everywhere in contact with it, and therefore cannot be deemed a proof of inflammation.
Mr. Guthrie[16] has published a case of inflammation of the