Chapter III: Part I: On Inflammation of the Veins (2)

_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.

EXPERIMENT VII.

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.

EXPERIMENT VIII.

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 and below this, for several inches, the vein was filled with coagula, which effectually obliterated it. These coagula extended for several inches in the course of the circulation; but beyond them, in both directions, the vessel was pervious. The lungs presented some slight spots of congestion, but not of the same characteristic kind observed in Experiment VI. The other organs were healthy.

EXPERIMENT IX.[27]

[27] This, and the following experiments, are among those recorded by
M. Gaspard, referred to in the foregoing dissertation.

Two drachms of pus, somewhat fetid, derived from a large common ulcer, and diluted with a little water, were injected into the jugular vein of a middling-sized dog. The animal immediately made several convulsive efforts to swallow, and soon became faint. It showed indications of pain, and vomited more than six times in the course of the day. At the expiration of an hour, it appeared slightly relieved by an evacuation, and by passing turbid urine. In the evening, it was very ill; it lay upon its side with its legs extended; had a very feeble pulse and scarcely perceptible respiration. Ten hours after the experiment, it passed black, liquid, and extremely offensive motions; these were accompanied by immediate relief. 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.

EXPERIMENT X.

The last experiment was repeated on a greyhound with the same results: faintness, fever, vomiting, and repeated evacuations succeeded each other, with recovery after the first experiment, but not after the second. On opening the body, no lesion was observed, except that the inferior lobes of the lungs were gorged and almost hepatized.

EXPERIMENT XI.

Three drachms of recent pus, derived from the same patient as in the last experiments, were injected into the jugular vein of a small emaciated unhealthy dog. After the expiration of three minutes, there was an abundant evacuation of urine, followed by continued vomiting, and repeated ineffectual efforts to pass fæces. For nearly a quarter of an hour, there was a kind of emprosthotonos, rigidity of the limbs, and a death-like condition. Subsequently, fresh vomiting ensued, with very fetid liquid evacuations, which were followed by apparent relief; soon after, however, long continued tenesmus made its appearance, and terminated in death, five hours after the injection of the pus. On opening the body, the mucous membrane of the intestines was found red, swollen, and inflamed, especially in the colon and rectum.

EXPERIMENT XII.

Half an ounce of pus, similar to that used in the preceding instances, but more putrid, in consequence of having been longer kept, was introduced into the veins of a middling sized dog. The animal, as in the other cases, was seized with vomiting, accompanied by violent straining. Subsequently, strongly marked nervous symptoms made their appearance. The eyes wandered; there was extreme sensibility, and involuntary convulsive twitching over the whole body, accompanied by faintness, hiccough, and short piteous cries. The walk was unsteady, staggering, and without apparent object. There was furious delirium, ardent thirst, dyspnoea, palpitation of the heart, etc. This state lasted for nearly two hours, and the animal died in frightful convulsions, without having experienced any critical evacuations, as in the former cases.

_Post-mortem appearances._ On opening the body, while still warm, the venous blood was found very firmly coagulated, not parting with any of its serum when left at rest; the left ventricle of the heart showed, on its external surface, some stains of the colour of lees of wine, formed by a kind of concrete pellicle, which disappeared only after long rubbing and maceration. The other organs appeared healthy.

EXPERIMENT XIII.

Some beef was allowed to decompose in some dog's blood; half an ounce of the fluid resulting from the decomposition, was injected into the jugular vein of a little bitch. Immediately, the animal made several convulsive efforts to swallow, and soon became oppressed, uneasy, and faint. At the expiration of an hour, there was great prostration, accompanied by repeated gelatinous and bloody evacuations, and vomiting of bilious matter. The strength became gradually less, and the animal died three hours after the injection.

_Post-mortem appearances._ The lungs were found inflamed in a very peculiar manner. They were gorged with blood, of a violet or black colour, and presented many petechial spots, like small ecchymoses. These spots existed also on the left ventricle of the heart, in the spleen, in the mesenteric glands, in the gall-bladder, and even in the subcutaneous cellular tissue. The peritoneum contained some spoonsful of a reddish serum; but the mucous membrane of the digestive organs was found to have been principally affected. In the stomach it was slightly inflamed. In the intestines, but especially in the duodenum and rectum, it was of a livid colour, presenting many black spots, and covered by a gelatinous and bloody secretion, resembling lees of wine. The tissues in these parts were slightly thickened.

EXPERIMENT XIV.

The preceding experiment was repeated, by injecting into the jugular vein of a moderately large dog, an ounce of fluid, derived from the maceration of putrid beef in water. The animal very soon passed extremely offensive, liquid evacuations, with much urine. The breathing became quick and deep, the pulse small and quick. Repeated efforts were made to empty the bowels. There was great depression and want of strength. At the expiration of an hour, a kind of diarrhoea or dysentery made its appearance. Liquid, bloody, and fetid evacuations, continued for an hour and a half, when the animal died.

_Post-mortem appearances._ Livid, brown, and black patches were found scattered over the lungs. The intestinal canal was filled with a bloody mucous secretion, resembling the matter that had been voided; its mucous membrane was of a livid colour, as in the preceding case.

EXPERIMENT XV.

Two ounces and a half of thick fetid fluid, derived from the maceration of cabbage leaves in an equal quantity of water, for two days, at a temperature of 77 Fah., were injected into the right jugular vein of a moderate sized dog. During the operation, the animal made several efforts to swallow, and soon became faint, and vomited several times. Some hours afterwards, there was great uneasiness and oppression, with recurrence of the vomiting, and continued faintness during the day. After nine hours, a most copious and very fetid evacuation took place. The discharge was as black as soot, and composed of mucus, with a little fæcal matter, and a large quantity of what appeared to be corrupted blood. Some time afterwards, there was a second evacuation of bloody mucus, exactly resembling the first. On the following day, there was much loss of strength: the animal lay upon its side, or staggered as it walked. There was great and insatiable thirst, with a small feverish pulse. But the most remarkable symptom was the occurrence, at intervals, of palpitation of the heart, accompanied by extraordinary force and sound, resembling that produced by long continued hypertrophy of that organ, in consequence of aneurism[28] of one of the large arteries. On the third and fourth days, the animal was better, but there were still great thirst, fever, and occasional rejection of fluids from the stomach. On the fifth day, the symptoms became aggravated; there was extreme weakness, a tottering gait, excessive thirst, the eyes red and filled with gum; the nostrils were stuffed, swollen, and obstructed with mucus; and the lining membrane of the mouth was tumid, and of a violet red colour. 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.

[28] I once observed a similar condition in a young woman in St.
George's Hospital. Each pulsation of the heart could be heard with
great distinctness at a distance of two or three yards from the
patient; during the paroxysms, there was the greatest difficulty of
breathing; the countenance became anxious and livid, and a distinct
thrill was communicated to all the arteries. After death, the
countenance and upper part of the body were found livid from venous
congestion. 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.

_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. Its internal surface was of the colour of lees of wine, offering a singular contrast to that of the right side, which, however, contained a hard fibrinous concretion, two drachms and a half in weight, of a light yellow colour, and resembling grease in appearance. This was of the same consistence throughout, everywhere free, with the exception of a portion of the size of a finger nail, which adhered to an irregular and apparently inflamed spot on the inner surface of the ventricle; no appearance of the injected fluid could be recognized in this clot. It was continued of the same colour and consistence into the pulmonary artery, and into the vena cava, the vena azygos, the axillary, and even the right jugular vein.

The intestinal mucous membrane, especially in the rectum, the duodenum, and a small portion of the small intestines, was of a violet red colour. It was inflamed in longitudinal stripes and in patches, which gave a mottled appearance, even to the outer surface of the intestines, before they were opened. This discolouration was not accompanied by any thickening of the tissues, nor by ulceration, and appeared rather the result of ecchymosis or hæmorrhage. The lining membrane of the rectum was principally affected, and its mucous glands were swollen and very prominent. This intestine contained puriform fluid, resembling the matter evacuated before death. The other intestines contained a very thick greyish white mucus. The mesenteric glands were inflamed, and appeared as if infiltrated with blood. The gall bladder was mottled on its surface by brown and violet patches, and contained black, thick, ropy bile, resembling melted tar.

EXPERIMENTS XVI AND XVII.

_Shewing the effects of the introduction of Mercury into an artery._

An ounce and a half of mercury, mixed with water, was injected into the left carotid artery of a sheep. The animal immediately evinced pain, and stood immoveable upon its feet. The head was held down, there was stupor and heaviness, and the eyes were protruded and widely open. The fore legs subsequently became bent, and the head inclined over the right shoulder with a kind of convulsive rigidity, which continued till death. Two hours afterwards, the animal became comatose, with some convulsive motions of the limbs, and the left eye became red and inflamed. Death took place fifty hours after the operation.

_Post-mortem appearances._ The left eye was found in a state of suppuration, and contained mercury. Many of the branches of the left carotid artery also contained some mercury, which had not penetrated to the capillary system. All the organs supplied with these vessels were red, swollen, and inflamed, in consequence of the presence of the foreign matter. The thyroid gland, the tongue, the cheeks, and the lips, were, however, only affected as far as the median line, leaving the opposite halves pale and in their natural condition.

A drachm and a half of mercury, mixed with some warm water, was injected into the crural artery of a large dog. The animal evinced no pain, and walked resting slightly on the affected limb, which became sensibly colder. After the expiration of an hour, the animal refused its food, became restless, and indicated severe pain in the limb, which was now very hot. On the following day, the leg was swollen and oedematous. On the third day, there was extreme thirst, increased oedema, and great suffering. The animal was killed sixty hours after the operation.

_Post-mortem appearances._ No disease was found in any organ, excepting the affected limb. This was swollen and oedematous in every part; abscesses of different sizes had formed, which contained sanious fluid, mercury, and pus; some parts were in an incipient state of mortification, and gave out a considerable quantity of air. Globules of mercury were found in different parts, occupying usually the centre of the abscesses, and ran out upon the scalpel when incisions were made into the limb.

EXPERIMENT XVIII.

_Shewing the effect of the injection of Oil into an artery._

Three drachms of olive oil were thrown into the crural artery of a large dog. Slight pain was experienced, and the limb became evidently cold, and the pulse under the tendo-Achillis could no longer be felt. Two hours afterwards, a like quantity of oil was again injected. The leg now began to inflame, and became tender. The following day, the whole limb was oedematous, much swollen, and very painful. Twenty-nine hours after the first experiment, the muscles of the thigh and leg, as well as the cellular tissue, were found in some places gorged with blood, and inflamed in livid patches; in others, infiltrated with yellow serum and gelatinous exudations. No oil could be detected in the affected parts.

EXPERIMENT XIX.

An ounce of putrid water, in which some beef had been macerated, was injected into the crural artery of a middling-sized dog. The artery having been tied, the pulse ceased below the tendo-Achillis; the limb, however, preserved its usual degree of heat, offering a contrast in this respect to the last experiment. A considerable degree of fever and restlessness followed the operation; this continued the whole day and the following night, without any vomiting or evacuations, which so constantly followed similar operations upon the veins. The next day the limb was very painful, but not swollen; there was thirst, with the ordinary secretion of fæces and urine. On the third day, the animal was evidently better; the appetite had become almost natural, and he could walk more easily, although the limb was still very painful. In the night, there were some soft, almost liquid, evacuations. The fourth day, the animal was evidently recovering, when an ounce and a half of very fetid and very concentrated fluid (derived from the maceration of beef), was injected into the crural artery of the opposite limb. The animal immediately evinced pain, accompanied by very violent and remarkable palpitation of the heart. It walked lame, keeping the leg raised, and soon became feverish and uneasy. The symptoms were exactly the same as after the first experiment. The leg became gradually more and more painful, extremely sensitive, but not infiltrated with serum. During the night, there was much expression of pain, and the animal was in continual motion. Death occurred nineteen hours after the second injection. The limb had become swollen only within five or six hours previous to death.

_Post-mortem appearances._ The limb presented a very large quantity of bloody fluid infiltrated in all the tissues. The superficial muscles were black, and presented more or less the appearances of gangrene. The deep muscles existed as such no longer, but were entirely disorganized, and converted into a putrid pulp, resembling masses of the red lees of wine, extremely fetid, and disengaging a quantity of gas. The limb first injected was still swollen, and presented, in the interior of the adductor muscles, two or three cavities filled with a putrid bloody serum. In the chest, the lungs were healthy, as were also the right cavities of the heart; but the left cavities presented several reddish-black spots, scattered over their external surface. In the left auricle was a firm yellowish-white coagulum, adhering to an inflamed spot on its inner surface. The intestinal canal was filled with a brownish red fluid, resembling altered blood, which, in the stomach and duodenum, was of the colour of soot. The mucous membrane of these organs, as well as of the jejunum and rectum, were gorged with blood, of the colour of the lees of red wine, but without any inflammatory thickening of their coats.

EXPERIMENT XX.

_Shewing the effect of the introduction of Air into an artery._

Seven or eight cubic inches of common air were injected gradually into the crural artery of a large dog. A peculiar rustling noise, depending upon the admixture of the air with the blood, accompanied the operation. No particular symptoms followed; but after some minutes the corresponding vein became distended with frothy blood, which moved with difficulty, and became stagnant in the vessel. The whole limb crepitated upon pressure, but no untoward symptom presented itself for more than half an hour. An ounce of water, to which seventy drops of medicinal prussic acid had been added, was now injected into the same artery. This produced no apparent effect upon the constitution.

A quarter of an hour after, an ounce of saturated solution of nux vomica was injected into the same vessel. This also was followed by no particular symptoms. An hour after the first injection, half an ounce of a weak infusion of tobacco was introduced into the same artery. Excessive pain immediately followed, accompanied by great rapidity of breathing. The animal now appeared as if he were going to die; however, he slowly recovered, appeared giddy and inclined to vomit, and kept himself in a continual state of restlessness. This condition was succeeded by fever, accompanied by extreme sensibility of the limb, and irregularity of the pulse. At the expiration of some hours, he appeared better; the pulse became more regular and less feverish, but the leg continued swollen, and extremely painful upon pressure. During the night, the pain returned, indicated by howling and restlessness. There were several evacuations of fæces and urine. The following morning, there was great prostration with much fever, and apparent suffering. The limb was slightly emphysematous, swollen, inflamed, and infiltrated with serum.

On the following day, two ounces and a half of water, in which some nux vomica had been boiled, were injected into the crural artery of the opposite limb. The dog expressed no pain; but, at the expiration of ten or twelve minutes, slight convulsive motions became evident, which were gradually converted into violent tetanic spasms. The animal threw himself backwards with his limbs extended, and died, after repeated convulsive attacks, an hour and a half after the last injection.

_Post-mortem appearances._ On opening the body, _no unusual appearances were observed in the limb_ upon which the last experiment had been tried, but the opposite one was tumid and emphysematous, infiltrated with a greyish red frothy serum of a fetid odour. _The small vessels were obstructed by firm clots of blood._ The gall-bladder was greatly distended; and the intestinal canal contained a quantity of yellowish mucus.