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قراءة كتاب On the origin of inflammation of the veins and of the causes, consequences, and treatment of purulent deposits
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On the origin of inflammation of the veins and of the causes, consequences, and treatment of purulent deposits
phlebitis being produced; but this is only in accordance with what is observed in cases where purulent or other fluids have been directly injected into the blood. The examination of the blood, or of the vessels, in such cases, will by no means invariably indicate the presence of foreign matter after it has once become thoroughly mixed with the blood, nor will inflammation of the vein through which the fluid passes, be by any means invariably produced.
When a foreign substance is introduced into an artery, any immediate effects upon the blood may naturally be looked for in the system of capillaries which it supplies. If the blood then coagulates, local symptoms alone, will, in the first instance, be produced, and the constitution will remain unaffected. M. Magendie,[24] indeed, asserts that fluids injected into the arteries of animals, return quickly through the corresponding veins, and that this takes place even more rapidly in the living than in the dead body. If this were universally true, it would matter little whether foreign matter were introduced into the arterial or venous system. The effect upon the constitution would be the same in either case. But if, as is now maintained, extraneous matter introduced into the blood may, under certain circumstances, produce its coagulation, then the effects will be confined, more or less completely, to the first system of capillaries which the blood meets with in the natural course of its circulation, and the constitution will be affected only in consequence of the changes which then take place. M. Gaspard has shown that greasy fluids, and such as contain sediments, do not find their way readily from the small arteries into the veins. They become entangled in the intermediate capillaries, and there produce, first patches of local congestion, and subsequently serous effusion and abscesses. Some clear fluids, on the other hand, such as solutions of tartar emetic, of opium, and of nux vomica, when introduced into an artery, pass readily in the course of the circulation, and produce their full effect upon the constitution; and in such cases no irritation is manifested in the capillaries through which they pass. The first of these poisons produces vomiting and purging, the second stupor, and the third tetanic rigidity, exactly in the same manner as if they had been introduced into the stomach, or injected into a vein.
There are yet another class of substances differing in their effects from both of the former; and under this head are classed infusion of tobacco, solution of acetate of lead, putrid fluids, etc. These are distinguished from the first class above mentioned, as not offering in themselves any mechanical impediment to the circulation of the blood, and from the second, as not producing the same constitutional symptoms when injected into an artery as when thrown into a vein. M. Gaspard found that, when introduced into an artery, the infusion of tobacco neither produced vomiting nor stupor, the solution of acetate of lead did not act upon the intestines, and the putrid fluids did not produce the evacuations usually observed after their introduction into the system by other means. All these substances, however, were found to produce violent local irritation in the parts to which the branches of the injected artery were distributed, and the constitutional symptoms were those produced in consequence of the local irritation, and not those which would arise directly from the action of those poisons upon the system.
In Experiment xx, seven or eight cubic inches of common air were gradually injected into the carotid artery of a dog, and half an hour afterwards an ounce of water, to which seventy drops of medicinal prussic acid had been added, was thrown into the same vessel; none of the peculiar effects of the poison followed this operation. At the expiration of another quarter of an hour, an ounce of a saturated solution of nux vomica was likewise injected, still without producing any constitutional symptoms. It is very remarkable in this experiment, that M. Gaspard[25] should have considered that the elasticity of the air contained in the vessels was sufficient to counteract the impetus of the blood, and thus to prevent the progress of the poison along the vessels, especially when we find him stating that, on a post-mortem examination, the smaller vessels appeared to have been obstructed by very hard clots of blood.
(a). On the 25th of September, 1848, having procured four small vessels of equal sizes, I placed in the first some dilute sulphuric acid, in the second some offensive pus, and in the third some water. The fourth vessel was left empty. They were then all equally warmed, and some blood from the jugular vein of a healthy horse was received into each of them so as to fill them to the same level. They were now stirred with separate pieces of wood. At the expiration of two minutes (noted by a watch), the contents of the second vessel had become coagulated into one uniform mass. The contents of the first vessel (containing the acid) were thickened and of a dark brown colour; in the third and fourth cups the blood was of its natural fluidity, but darker coloured in the cup containing water than in the other. At the expiration of ten minutes, the blood contained in the fourth cup had begun to coagulate; the blood and water still remained fluid. At the expiration of a quarter of an hour, the blood had completely coagulated in the fourth cup, containing blood alone; and had very partially coagulated in the third cup containing the blood and water.
(b). Four vessels were taken, each capable of holding three fluid ounces. In the first was placed half an ounce of cold water, in the second half an ounce of dilute sulphuric acid, and in the third half a drachm of pus, which was quite fresh and sweet. All the vessels were then quickly filled with blood, from the jugular vein of a horse. The contents of each vessel were stirred. The blood and dilute sulphuric acid became thick, and changed in colour almost immediately, as in the first experiment, but did not coagulate. The pus and blood coagulated in six minutes, and the mass was firm in seven. The pure blood coagulated in twelve minutes and was firm in sixteen. The blood and water coagulated in about the same time, but took nineteen minutes to become firm.
The above and the following experiments were made at the suggestion of the author, in conjunction with Mr. T. W. Mayer,[26] veterinary surgeon.
An abscess was opened in the groin and a quantity of pus received into a gallipot; some blood from the divided vessels was also received into the same vessel; they were then stirred together, and in two minutes the mass coagulated. Some blood taken from the same patient in the same manner, but not mixed with pus, coagulated in eleven and a half minutes.
On the 20th of January, 1849, an inflamed and suppurating abscess was opened, and the blood and pus which flowed from it were mixed together. They coagulated in two minutes and twenty seconds. This experiment was repeated