M.D. Henry Lee

“ The most characteristic circumstance, attending the extension of disease to different organs of the body through the medium of the blood, is that several parts of these organs, or even different organs, will be simultaneously attacked. ”

“ In a certain number of cases no lesion will be found in any of the veins of the body, but the uterine veins will be found to contain some unnatural fluid; at other times coagula of blood, which have lost their elasticity, gritty to the feel, and greyish or light brown in appearance, [Pg 20] will be found filling the veins or leaving intervals in them, where lymph or pus may be recognized. It matters little whether the unnatural fluids, thus found in the uterine vessels, have been absorbed from the cavity of the uterus, or are the product of venous inflammation. ”

“ 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. ”

“ If the constitution is good, and the coagulating power of the blood unimpaired, the union may be frequently interrupted, and yet be as frequently re-established in the same way. When from any local cause, or from any constitutional peculiarity, the union by the first intention fails at the seat of the injury, it may yet be attempted at some distance up the vein ”

“ It may appear unusual to speak of action going on in the blood; but, in so doing, we only illustrate the principle with which we commenced, viz., that "the blood has the power of action within itself." ”

“ The process of repair goes on frequently during a continued flow of blood over the part, and sometimes during the constant action of the muscles in the neighbourhood: at other times, an injured vein will be situated immediately in the bend of a joint, and will be subject to be continually bent and extended with the motions of the limb. In the structure of the bones, the veins lie in unyielding channels, and are consequently deprived of the assistance derived from the approximation of their sides, as in soft parts, during the process of reparation. ”

“ When the muscular structure is affected, suppuration takes place with great rapidity; portions of muscles may be found quite soft, and sometimes pultaceous, in circumscribed patches, around which the fibre is perfectly healthy. Pus is occasionally deposited on the exterior of muscles; and it will be then smeared over the surface, and rather infiltrated in the cellular tissue, than contained in a cyst. In the interior of muscles, there is the same absence of the natural limit to the inflammation ”

“ It has been already shown that the blood, when in a natural condition, has a tendency to coagulate around pus, and, probably, many other fluids, even out of the body (Experiments i, v) , [Pg 8] and that this property is exercised in a still more remarkable manner in the living vessels (see Experiments vii, viii) . Foreign matter, even after it has got into the veins, may then, by the same means, be prevented from proceeding farther towards the centre of circulation. The process that takes place under such circumstances, is strictly analogous to union by the first intention. ”

“ It will sometimes happen, that, after the symptoms of secondary inflammation of internal organs have commenced, an abscess will present itself near the surface of the body, and relief will be afforded to the part first affected; at other times, an obstinate and violent diarrhœa will precede recovery. Although the mode of treatment adopted may have little influence either in bringing on, or checking, such salutary actions, it is important to watch their occurrence, and perhaps still more important, to be careful not to mistake a remedial action for a symptom of the disease. ”

“ It has been shown upon very high authority, that the sides of a vein do not unite after venesection (as has sometimes been presumed to be Mr. Hunter's opinion) ; but that the divided edges only of the vessel are agglutinated by the coagulum, which "serves as a bed to the new membrane." But the case is different, should this first attempt at union fail; the sides of the vessel may then become united, and its cavity for a time obstructed (section iv) . ”

“ In those who die of secondary inflammations, the result of such actions may frequently be traced from the seat of the primary injury even to the heart itself; and, as it has already been shown that contaminated blood will communicate morbid action to the vessels in which it is contained (section iii) , there no longer remains any difficulty in accounting for the sudden way in which this disease may fall upon a particular organ, or the unexpected manner in which the symptoms may shift from one part of the body to another. ”

“ In experiments upon animals, it has always been found that the power of the constitution, in resisting the effects of the injection of pus into the veins, was much greater at the first than at any subsequent operation. This circumstance would appear to associate itself directly with the observations now made, and to afford another illustration of the power of healthy blood in resisting the entrance of some foreign matters into the system. ”

“ The most direct way in which diseased blood produces disease in the parts to which it is conveyed, is by communicating to them its own condition. Even foreign substances, which have no natural connexion with the body, may, in this way, be conveyed in the blood, and deposited in the organs of the body. ”

“ It has been observed, that inflammation after child-birth usually attacks the spermatic veins alone, and for the most part the one only on that side of the uterus to which the placenta has been attached. The hypogastric veins are comparatively rarely affected. The appearances observed upon dissection in the spermatic vein, usually terminate abruptly at its opening into the vena cava on the right side, or into the renal on the left. This fact is in perfect accordance with that observed by Mr. Arnott, that the coagulum in veins extends usually only to the nearest collateral branch ”

“ The circulation will then be obstructed in all the distant branches, and the blood, if long retained, will coagulate in them also. It will then part with its serum, and give rise to all the symptoms of inflammation in the distant vessels; a pulpy elastic swelling, accompanied with great pain, will then be the principal symptom, while the turgescence on the surface will be less than where the superficial veins have been mechanically compressed. It will, however, very frequently happen, that a vein in a part may be felt distended without any symptom of inflammation being present ”

“ When inflamed, its intervals become filled up by effusion from the vessels, and an abscess may be as accurately circumscribed in the hard as in the soft structures of the body. In a healthy constitution, the adhesive inflammation will, in this way, always precede the suppurative; but where the inflammation is not circumscribed by adhesion, the secretions may permeate from cell to cell in unadhering parts. In soft structures, a remedy is at hand for allowing the escape of the matter, by a free division of the parts ”

“ The general management of this disease, after the formation of purulent deposits has commenced, is probably as little satisfactory as any that come under the notice of the surgeon. The whole character of the affection is characterized by what has been aptly designated as action without power. The excitement of the system will imitate all the acts of genuine inflammation, without any of its healthy results; and loss of energy will appear immediately after, or even arise in conjunction with, the first symptoms of increased action. ”

“ The lungs did not readily collapse when the chest was opened. The auricles of the heart were greatly distended with black blood; the inner surface of the left ventricle presented a white patch, of about two square inches in extent; the lining membrane of the aorta, for several inches, was of a bright red colour; this extended round one-third only of the circumference of the vessel. No other structural change could be found in the heart or vessels, which would account for the symptoms observed during life. ”

“ In the cavity of the right pleura, were some patches of recently effused lymph, of a yellowish colour. In the lower lobe of the right lung, were several patches of secondary deposit; these were found in different stages of their formation, and some of them were of considerable size; some of the pulmonary veins, in the neighbourhood of those which had suppurated, were found to contain a fluid resembling pus. On the left side was a small abscess, under the pleura costalis. The liver was healthy in structure, rather larger than usual. Kidneys healthy. ”

“ I am certain that diseases resulting from purulent infection would not be stamped with the seal of incurability, and that nature, seconded by art, would triumph in the majority of cases, if the pus, which is incessantly renewed, did not incessantly renew the sources of infection. ”

“ 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 ”

“ The lymph deposited will be found lying in unorganized flakes, wanting its usual adhesive properties, and very slightly attached to parts, presenting little or no increased vascularity. The rapid manner in which these depositions take place, shows that they are separated from the blood without undergoing any very elaborate process. In this condition of the system, any organ upon which the disease falls, may rapidly become disorganized, or may readily mortify; and, after death, a tendency to rapid decomposition will be manifested. ”

“ If the coagulum be allowed to remain, the vein in which it is formed soon becomes thickened; but, as the experiments cited [Pg 4] prove, this thickening is the effect and not the cause of the stagnation of the vitiated blood in the vessel.
II. When blood coagulates in a serous cavity, a thin pellicle forms upon its surface, and, becoming thickened by deposition from the fibrin of the blood, forms a cyst, which completely circumscribes the effusion. ”

“ The serous membranes are peculiarly liable to be attacked by secondary inflammation; and, when affected, suppurate with the greatest readiness. They generally exhibit but a slight degree of vascularity, and sometimes scarcely appear more injected than in their natural condition. In the peritoneal cavity, large quantities of unorganised lymph are frequently poured out, mixed with turbid serum or pus. The synovial membranes of joints, when affected, appear to run directly into suppuration, and will become distended with pus in a very short space of [Pg 55] time. ”

“ As many circumstances, besides mere debility, tend to depress the vital powers, so tonic medicines, and a generous diet, must not be looked upon as the only preventive modes of treatment. Each case that occurs in practice may present some peculiarity; in one case, the patient will be found to have previously suffered from diabetes; in another, from disease of the spleen; and in a third, from organic disease of the kidney ”

“ The veins which terminate upon the placental surface of the uterus are necessarily open when this organ is distended, and become more or less perfectly closed when it contracts. In cases when the contraction is incomplete, innumerable open-mouthed orifices are left bathed in secretions, which are often offensive and undergoing decomposition; the natural protection to the vessels then, is the coagulation of the blood in them. ”

“ As soon as constitutional symptoms manifest themselves, neither general nor local bleeding affords any advantage. A portion of the materies morbi is, no doubt, abstracted with the blood; but, as it is constantly being reproduced, the constitution is only deprived of the power it would otherwise have of resisting the disease." [43] In accordance with this remark, M. Gaspard found that animals, which recovered after the injection of a certain quantity of pus into their veins, often died when the experiment was repeated. ”

“ The consequences of the disease appear to hang about the system, long after the cause which gave rise to it has ceased. The pulse will sometimes continue irritable, and there will be a tendency to derangement of the secretions of the skin, bowels, and other organs, accompanied by [Pg 70] occasional slight attacks of fever. In this condition, an alterative course of mercury, combined with sarsaparilla, has been found beneficial. These remedies, by stimulating the activity of the excreting organs, may assist the constitution in throwing off the disease ”

“ The animal regained its appetite, eat and drank freely, and went to sleep. The day following, it appeared nearly well. On the third day, three drachms of the same pus were injected into the opposite vein; after the lapse of a certain time, there occurred, as in the first instance, faintness, vomiting, and frequent desire to pass urine; twelve hours after the injection, frequent liquid, white, and very fetid motions were passed, and the animal died at the expiration of twenty-four hours. On opening the body, no alteration was found either in the intestines or other organs. ”

“ Hunter, "bleeding should be performed with great caution: even a quick, hard pulse, and sizy blood, are not always to be depended upon as sure indications of bleeding being the proper method of the resolution of the inflammation; more must be taken into the account. The kind of blood is of great consequence to be known; for although it should prove sizy, yet if it lies squat in the basin, and is not firm in texture, and if the symptoms at the same time are very violent, bleeding must be performed very sparingly, if at all ”

“ Large portions of loosely coagulated blood were found in all the cavities; some of these clots were of a rusty colour, others approached nearer to the natural colour of the blood. The lung was compressed against the spine, and the whole surface of the pleural sac was coated by a false membrane, about two lines in thickness, formed by coagulated fibrine. The fibrine which lined the pleura pulmonalis and pleura diaphragmatica, presented on its inner surface a smooth and polished appearance, and in colour exactly resembled the yellowish fibrine found in the clots of the heart of this patient. ”

“ Affections of the spleen, produced by the introduction of foreign matter into the blood, are probably not so readily recognised as similar affections in the lungs and liver. For, although the spleen is often found to be diseased in those who die from infection of the blood, yet it is comparatively seldom that secondary abscesses have been found in it. ”

“ The effects of this shock are often much aggravated by loss of blood, and a very scanty diet actually makes the patient more liable to some kinds of inflammation. Our mode of practice ought to be rather to sustain his powers by allowing him wholesome nourishment, and not to add to the influence of the other depressing causes, the still worse one of starvation. ”

“ Some change must previously have passed in the blood, by which its coagulating power is impaired, or some unusual mechanical means must have been employed, before the pus can find its way in the course of the circulation. The contradictory statements which have been made by those who have injected pus into the veins, may thus be reconciled, by taking into account the power exercised by the blood in the experiments which have been made. ”

“ In the middle of the day, there was a liquid greyish white evacuation, resembling pus in its odour, consistence, and appearance, mixed with some clots of putrified blood. Death occurred during the following night.
Post-mortem appearances. The mucous membrane of the eyes, nose, and mouth, was red or violet, and covered by a very abundant thick mucus. The lungs were of a dark colour, with some black patches, but still crepitant. The left ventricle of the heart presented several brown stains, resembling ecchymoses, which penetrated into its tissue. ”