572 DISEASES OF THE HEAD, NECK, VEINS, ETC. 



below the seat of puncture ; and Mr. Percivall, in treating on this 

 subject, has been at much pains to account for this peculiar dis- 

 position in the inflammation to extend so generally towards the 

 head when the jugular is punctured, and towards the heart when 

 it takes place in any other vein; being in the one instance 

 against the course of the circulation, and in the other with it, as 

 is invariably seen in the human being. To reconcile these seem- 

 ing discrepancies, Mr. Percivall observes, " that although the ob- 

 structed state of the vessel is not the exciting cause of the in- 

 flammation, it invariably directs the course of it. It therefore 

 remained to inquire in what manner the obstruction was pre- 

 vented in the previous course of other veins similarly affected, 

 as the saphena and plate vein of the horse, and the basilic and 

 cephalic of the human." Now these veins, Mr. Percivall ingeniously 

 argues, freely anastomosing with contiguous trunks, preserve a 

 continual flow of blood up to the obliterated part ; but above 

 this, such anastomosis does not exist, the communicating branches 

 being few and small ; consequently, the blood remains to coagu- 

 late and to continue the disease. The jugular is similarly situated 

 upwards, for it has no anastomosis to carry off the obstructed 

 blood above the puncture, in which direction, therefore, the in- 

 flammation proceeds, the obstruction being prevented downwards 

 towards the heart ; for, having once emptied itself, the inflam- 

 mation and tumefaction will prevent its receiving more blood, by 

 which means no offending coagulum remains. Thus Mr. Percivall 

 argues that the deviation from what is considered as a fixed law 

 in human pathology — that this infiammation always occasions 

 obliteration in the vein towards the heart — is thus reconciled, and 

 that " the same cause is operating under different circumstances." 

 — Lectures, vol. i., p. 103. 



Speaking to Professor Spence of this peculiar tendency in the 

 clot to extend upwards in inflammation of the jugulars, he kindly 

 showed me a specimen of inflammation of these veins in man, 

 where the thrombi extended upwards even to the cranial sinuses. 

 Prom this circumstance I think we may safely conclude that the 

 same law applies in man as in the horse. 



The best treatment for circumscribed phlebitis is the appli- 

 cation of a smart cantharides blister along the course of the in- 

 flamed part, and a cure will be effected in a very short time. 

 The blister is to be applied whether suppuration be present or 



