On the origin of inflammation of the veins: and of the causes, consequences, and treatment of purulent depositsLee, Henry, M.D.
History
On the origin of inflammation of the veins: and of the causes, consequences, and treatment of purulent deposits
Lee, Henry, M.D.
Blood; Veins -- Diseases
If water be injected into the cancellous structure of bone, it will
find its way out in drops through the apertures of the nutritious
vessels. The ready communication which is thus shown to exist
between the interior of bones and the veins, has been but too often
exemplified by M. Cruveilhier's experiments of introducing mercury
into their cancellous structure, and finding it subsequently in the
vascular system. This fact assumes peculiar significance, when taken
in conjunction with the very large proportion of cases, in which some
portions of bone will be found to have been involved in the primary
lesion, in those who have died of secondary inflammations. Of fifty-two
consecutive cases, occurring in surgical hospital practice, of which I
have preserved notes, in no less than forty-one was some portion of the
osseous system implicated.
Again, in the third class of cases above-mentioned, if the vena cava be
injected after parturition, the injection will very speedily find its
way into the uterus.[20] The ready communication which is thus shown to
exist between the vascular system and the local affection, in each of
the three large classes of cases which usually give rise to subsequent
disease, would of itself afford at least a very remarkable coincidence.
But more direct evidence presents itself of the way in which the system
becomes contaminated in these affections: thus, after an operation
for hæmorrhoidal tumours, an effusion of lymph and pus has been found
in the hæmorrhoidal veins,[21] from thence the same appearances have
been traced to the inferior mesenteric vein, and the severity of the
secondary affection, indicated both by the symptoms and the post-mortem
appearances, has fallen upon the liver. These circumstances all tend to
point to the venous system as the means by which morbid matter in such
instances is introduced: and the still more conclusive facts afforded
in the production of secondary disease, by injecting fluids into the
veins,[22] allow scarcely a doubt to remain upon the mind, that the
unprotected veins are the channels, in a very large proportion of
cases, through which the blood becomes infected.
[20] DANCE. Archives Générales de Méd. vol. xviii, p. 480, Dec. 1828.
[21] In cases where pus has been found in veins surrounded by coagula,
its presence and detention there have been differently accounted for.
M. Cruveilhier appears to have imagined that the loose coagula act as
filters, through which the blood passes, while the pus is retained.
(_Dict. de Méd. et de Chir._ t. xii, p. 641.) The true explanation of
the way in which coagula form round pus in the veins has already been
given.
[22] See M. Gaspard's experiments.
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