1400 



VEIN. 



to the surface, has ruptured the large internal 

 veins. Portal tells us of a case of rupture of 

 the vena cava superior from a patient getting 

 into a cold bath : and Sense mentions the 

 rupture of the large internal veins as occurring 

 in the rigors of intermittents. 



Rupture of the inferior cava from disease, 

 has been described by Dr. Squibb, in the Phi- 

 ladelphia Medical Examiner for 1847. " The 

 vein at this point had been very much dilated, 

 and its coats much diseased and thinned : a 

 semiorganized mass or clot, which was con- 

 tained in the dilatation, was connected by its 

 surface to the softened coats of the expanded 

 vessel, and the rupture had occurred at the 

 junction of the edge of this mass with the side 

 of the vessel, and not at the projecting point 

 of the dilatation. The tumour was on the 

 anterior portion of the circumference of 

 the vessel, and was overlapped by the 

 edge of the liver, and by a portion of the 

 stomach." 



Morgagni mentions the rupture of a varicose 

 azygos vein, the result of extreme varicosity. 

 Perforation of veins from suppurative inflam- 

 mation or ulceration is not uncommon. The 

 cavities of the veins, especially in the stomach 

 and uterus, are often laid open by the exten- 

 sion of malignant disease. But the commonest 

 form of venous perforation is from the tegu- 

 mentary varicose ulcers of- the leg, which is 

 originally extrinsic to the vein. 



The following enumeration of ruptured or 

 perforated veins is from Andral. " It has been 

 seen, first, in the superior cava, both within 

 and without the pericardium ; second, in the 

 inferior cava ; third, in the vena portae, both 

 within and without the liver ; fourth, in the 

 splenic vein ; fifth, in the jugular vein ; sixth, 

 in the subclavian vein ; seventh, in the veins 

 of the extremities ; eighth, in the veins that 

 run between the coats of the intestines." 



Affections of the Valves of Veins are partly 

 mechanical and partly dynamical. The most 

 frequent change they suffer from is the result 

 of the distension of the vein in which they 

 are placed ; but they are occasionally the sub- 

 ject of the same changes as occur in the vessel 

 itself. In varix the valves are not necessarily 

 damaged, though from the increased size of 

 the vessel in which they are placed they are 

 disproportioned to their office, and become 

 useless. Instances are mentioned by Stan- 

 ley, Langstaff, and Dr. R. Lee, where the 

 valves in varix were quite healthy, thin, and 

 transparent, but drawn aside and inadequate 

 to cross the vessel's tube. The usual result 

 of varix is to injure the valves : they then be- 

 come torn in shreds or perforated ; or the 

 attached margin becomes detached, and the 

 valve is reduced to a membranous thread, 

 which stretches across the diameter of the 

 vessel. In other instances the valves are ren- 

 dered opaque and thick, the result of chronic 

 inflammation. Whenever any affection of the 

 valves occurs, they are apt to become coated 

 with lymph ; and when a vein is the seat of 

 plastic inflammation, the valves usually be- 

 come ragged fringes of lymph. 



Phlebolites. The curious bodies called 

 phlebolites^ phlebolithes, or vein-stones, which 

 have excited much interest in the pathology 

 of veins, are true vascular calculi, are cal- 

 culi or earthy concretions deposited from the 

 blood in the veins ; and though their mode 

 of formation differs considerably from those 

 other bodies which form in other hollow or- 

 gans, and which we call calculi, they are still 

 quite as much entitled etymologically to the 

 same designation. 



At a very early date, among the writings of 

 Realdus, Columbus, and Bartholin, phlebolites 

 were recognised and described ; but it was 

 not until Otto, Tiedemann, Cruveilhier, and 

 Carswell devoted their attention to them that 

 they excited much interest. Matured phle- 

 bolites are, for the most part, oval or round- 

 ish bodies, sometimes irregular and flattened ; 

 they are sometimes prolonged antl much at- 

 tenuated at one extremity, corresponding to 

 the distal end of the vein in which they are 

 embedded. They vary much in size, from a 

 grain of millet seed to a pea, or even to a 

 hazel nut ; their form also differs. Dr. Lee 

 describes a cylindrical vein stone, which was 

 found in the right common iliac vein of the 

 late Lord Liverpool j it was an inch or more 

 in length. 



These concretions are of a yellowish or 

 white colour ; they are of varying density, 

 being sometimes of bony hardness, and at 

 others much softer, with a firmer nucleus, 

 which is always harder than the other parts of 

 the stone. When sections are made the cut 

 surface presents a series of concentric rings, 

 there being at different distances from the 

 centre sufficient change of colour and density 

 to mark each annulus ; so that the calculus 

 is thus seen to be composed of successive 

 concentric laminae, hardest in the centre, 

 and gradually becoming softer in proceeding 

 outwards. They are frequently seen sur- 

 rounded externally by a layer of plastic mate- 

 rial, looking like a membranous investment ; 

 at other times they are firmly imbedded 

 in a dense coagulum ; but in the majority of 

 instances they are free from any covering. 

 The hardest stones, however, contain, inter- 

 mixed with the calcareous matter, much soft 

 animal material ; for, when desiccated, they 

 diminish in size ; and, unless the layers have 

 received equal proportions of earthy deposit, 

 they become irregular. 



Phlebolites have been made the subject of 

 chemical analysis. According to Gmelin, the 

 following is their composition : 



Animal matter 

 Phosphate of lime 

 Carbonate of lime 

 Magnesia and loss . .i\; 



This analysis has been repeated with the 

 same general results by Prout, Kemp, Hasse, 

 and Lehmann. They have since been sub- 

 mitted to another analysis by Schlossberger, 



