A system of practical medicine. By American authors. Vol. 1 : $b Pathology and general diseases
History
A system of practical medicine. By American authors. Vol. 1 : $b Pathology and general diseases
Medicine -- Practice
Litten,[22] on the contrary, who has furnished a recent contribution
to this subject, claims that the hemorrhagic results of embolism are
not accomplished through venous regurgitation, unless increased venous
tension is produced by coughing, vomiting, and like efforts. His
experiments lead him to maintain that arterial blood from surrounding
tissues is supplied to the obstructed region through the anastomosing
capillaries. The force is not sufficient to drive the blood through
the capillaries into the veins beyond, but an accumulation takes place
in the capillaries, which become dilated and distended. The escape of
blood-corpuscles and {65} serum then takes place, the more freely, as
Weigert[23] suggests, the larger and more numerous are the
pre-existing spaces in the organ. Hence the infarction becomes the
most characteristically developed in such organs as the lungs and
spleen. Causes which obstruct the venous flow, as well as those which
increase the arterial tension, promote the hemorrhagic infarction.
[Footnote 22: _Untersuchungen über den hemorrhagischen Infarct.,
etc._, Berlin, 1879.]
[Footnote 23: _Virchow's Archiv_, 1878, lxxii. 250.]
A necrosis of the part whose direct arterial supply is cut off takes
place when the structure of the organ affected is such that the
admission of arterial blood is wholly interfered with. This is the
case in the heart and kidneys, and to a less extent in the spleen. The
opportunity is presented for the diffusion of a fibrinogenous fluid,
lymph or blood-serum, through the cells of the organ which contains
the other essentials for coagulation, and the dead part presents the
characteristics attributed by Weigert[24] to death from clotting of
the protoplasm, coagulative or ischæmic necrosis.
[Footnote 24: _Ibid._, 1880, lxxix. 87.]
Embolism of the cerebral arteries produces softening of the brain, not
a hemorrhagic infarction or a yellowish necrosis. Weigert attributes
this result, on the one hand, to the absence in the brain of abundant
cells from which are to be had the ferment and fibrino-plastic
material necessary for coagulation, and, on the other, to the closure
of the spaces into which blood might collect by the rapid swelling of
the tissues from the exuded lymph.
The hemorrhagic results of embolism are also met with in obstruction
of branches of the mesenteric artery, which is considered by Litten,
at least from its function and in connection with its sluggish
current, to correspond with a terminal artery.
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