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
several times, with nearly similar results.
In June 1849, a tense inflamed swelling was opened in the perinæum of a patient, who had for years laboured under a very obstinate stricture. A quantity of matter first escaped, and subsequently serum, mixed with shreds of lymph and small quantities of pus and blood, continued to flow for some time. Portions of this mixed fluid were received into separate vessels; they coagulated on an average in about two minutes.
Two ounces and six drachms of blood were taken from a healthy horse, and two drachms of pus were mixed with it. The mass coagulated in three minutes and three-quarters.
A healthy male ass, three years old, was procured, and, with the assistance of Mr. Mayer, was made the subject of the following experiment, on the 23rd of September, 1848. Three drachms of pus were collected from an issue in the chest of a horse, which laboured under inflammation of the lungs. The pus thus obtained was quite pure and sweet, and having been warmed, was injected, by means of a syringe, into the left brachial vein of the ass. The animal lay quiet, till nearly the whole of the pus was injected; it then struggled, and a small quantity of the pus may have been lost. When the operation was completed, the sides of the vein were brought together with a pin, and the animal was allowed to get up. The vein above the opening could now be felt as a hard, unyielding cord, as high as it could be traced with the hand; but upon gentle pressure being made, so as to propel the blood in the course of the circulation, the hardness completely disappeared. The vein which, immediately after the operation, was hard and prominent, no longer presented anything remarkable to the touch. The animal now moved from side to side, as if inclined to lie down.
Two hours and a half after the operation, the pulse, which naturally was 36, had risen to 60; and the respiration from 12 per minute had increased to 26.
September 24th. Pulse 52; respiration 20; mouth hot; ears cold. In the evening the pulse became 48 and the respiration 16; he coughed occasionally.
25th. Pulse 48; respiration 12; some dullness of countenance, but he is lively and occasionally playful. The left fore-leg is swollen; the ears are very cold. In the afternoon he was killed, and the blood was allowed to flow from the body.
Post-mortem appearances. The wound in the left leg opened directly into the brachial vein, which was filled with lymph and a thin pus for a very short distance, both above and below the external opening; immediately above this, the vein was healthy, nor was there any appearance of disease in any of the other veins of the limb, nor in the veins leading to the heart. The glands in the axilla were swollen. The lungs were found studded irregularly in different parts, with circumscribed spots of livid congestion: these existed both upon the surface and in the substance of the lungs; they were generally about the size of a filbert, but in some places they occupied a single lobule, and were accurately circumscribed by its outline.
On the 23rd of November, 1848, about an ounce of perfectly pure pus (previously warmed) was injected into the right jugular vein of an aged ass; the vein immediately became "corded", and the blood appeared to have coagulated in the vessel. The operation did not much excite the breathing; but the pulse, which naturally was 35 in the minute, rose to 60, and subsequently fell to 55.
24th. The animal dejected; appetite indifferent. The vein can be traced as a thickened cord as far as the sternum. Respiration 12 (the natural standard); pulse 50.
25th. The parts around the vein much infiltrated with serum: pulse 55; respiration 12.
26th. The wound in the neck began to suppurate, and an abscess subsequently formed in the course of the vein, about midway between the opening and the sternum. The general symptoms continued, with very slight variation, until the 4th of December, when the animal was destroyed.
Post-mortem appearances. The jugular vein was found to have become inflamed only in the course of the circulation, and to be obliterated a short distance below the external opening. The surrounding parts were greatly infiltrated with serum and lymph, and several abscesses had formed in the immediate neighbourhood. The lungs did not present any well-defined patches of congestion, as in the last mentioned experiment.
A healthy ass, six years old, was operated on upon the 16th of November, 1848. The respiration was naturally 14 in the minute, and the pulse 38. About two ounces of highly offensive pus, obtained from the frontal sinus of a horse, were injected into the left jugular vein; the pus had unintentionally been mixed with water previous to its being injected. The vein became full during the operation, as though the blood in it were in a semi-coagulated state. The pulse now became 60, and the respiration 20 in a minute; slight rigors occurred in two hours.
November 17th. The animal is tranquil; appetite good; pulse 48, small and wiry; respiration 16. In the evening he was rather more excited; the vein was becoming inflamed downwards towards the heart; pulse 60; respiration 20.
November 18th. The vein was more inflamed, and slight suppuration was visible at the orifice of the wound. Respiration 16; pulse 55. From this period to the 23rd, the pulse continued from 55 to 60, and the respiration varied from 12 to 18.
November 26th. The swelling in the situation of the vein is rapidly subsiding; pulse 55; respiration 12.
The animal gradually recovered, and on the 26th of February, 1849, was made the subject of another experiment. The right jugular vein having been opened, two fluid ounces of pure healthy pus were injected, and propelled in the course of the circulation, by pressure upon the vein externally. The vein became tense during the operation, and sensibly resisted the attempts that were made to propel its contents towards the heart. Even forcible pressure was not sufficient to overcome the resistance offered to the return of blood. Soon after the operation, the animal had a rigor; the breathing became laborious, but not accelerated; pulse 57.
After the lapse of seven hours, the animal appeared dejected; he refused to eat or drink; the extremities were cold; breathing 16 in the minute; pulse 60, small and irregular.
February 27th. The vein can be felt thickened as far as the sternum. The general symptoms are the same as on the previous evening.
28th. There appears less constitutional irritation; pulse 60; respiration 14.
March 2nd. Appetite still indifferent; pulse 60; respiration 16.
From this date to the 7th, when the animal was destroyed, the general symptoms continued much the same, but the induration and swelling around the jugular vein, from the opening to the sternum, became greater.
Post-mortem appearances. The left jugular vein was found completely obliterated. The remains of a firm coagulum obstructed its canal for some distance below the opening which had been made into it, and terminated, below, in an elongated conical portion, which adhered to one side only of the vessel. On the right side, an abscess had formed in the course of the vein; and for two inches, the whole of the parts were imbedded in a confused mass of pus and lymph, in which it was impossible to distinguish the structure of the vein. Both above