VEIN. 



1401 



who has given his results more in detail, as 



follows : 



Phosphate of lime - 50' 1 



Phosphate of magnesia - 13*7 



Carbonate of lime - - 8*3 



Organic matter - - 20'4 



Water - - - - G'l 



Loss - - - - ]vt 



100- 



These, then, are phlebolites completely ma- 

 tured. In those lesy completely developed 

 the phlebolite consists of an altered coagulum, 

 in the centre of which is earthy matter, sur- 

 rounded by white fihrinous concentric layers. 

 Cloquet has described one, which was not 

 fully formed, in which the calcification was 

 incomplete. It was taken from the inferior 

 cava, and consisted of a fibrinous mass, con- 

 taining a calcareous centre, from which a 

 number of rays of the same substance passed 

 through tr fibrinous matter toward the cir- 

 cumference. Cloquet describes one of similar 

 structure, which he saw in Soemmering's mu- 

 seum, and which was also taken from the inferior 

 cava. In a still more primitive condition these 

 calculi are recognisable. " On drying the 

 coagula found within dilated veins, previously 

 to their having coalesced with the internal 

 membrane, they shrink together, grate under 

 the knife, and exhibit calcareous induration 

 at certain points, even in cases where it had 

 not been at all suspected."* 



As regards the origin and development of 

 phlebolites, only one opinion is now enter- 

 tained, namely, that they are developed from 

 modified coagula. Andral, however, gives the 

 following explanation. After speaking of cal- 

 careous degeneration of the coats of veins, he 

 goes on to say, " these calcareous concretion*, 

 instead of lying between the coats of the 

 veins, sometimes push the internal membrane 

 before them, and project into the interior of 

 the vessel ; the membrane in such cases ge- 

 nerally contracts behind the concretion, and 

 forms a peduncle, which serves to attach it to 

 the side of the vein. It is probable that these 

 peduncles are sometimes ruptured or ab- 

 sorbed, and thus the concretion is completely 

 detached from its connection, and drops loose 

 into the vessel. This rationale may serve to 

 explain the origin of some of those calcareous 

 concretions which have been found in the 

 centre of the venous coagula.f 



Hodgson imagined that phlebolites were 

 formed in the neighbouring textures, and 

 found their way into the veins by progressive 

 absorption. 



Dr. Carswell has described and illustrated 

 the true method of their formation in detail, 

 exhibiting their successive changes in the pro- 

 gress of maturation. At first a coagulum of 

 blood is formed, which becomes condensed 

 and laminated in the centre ; the colouring 

 matter of the blood subsequently becomes ab- 



* Hasse's Pathological Anatomy. 



t Andral, Precis. d'Anatom. Pathol. torn. ii. 



sorbed, and leaves ordinary yellow fibrin ; this 

 also becomes lamellated throughout. After 

 this calcification commences in the centre and 

 proceeds outwards till the whole is calcareous. 



This mode of formation is maintained also 

 by Otto, Tiedemann, Lobstein, Cruveilhier. 

 Errhman, Briquet, and Basse. 



The position of the phlebolite within the 

 vein, and the condition of the vein and phle- 

 bolite respectively, are subject to much variety. 



Jn the dilated pouches, which sometimes 

 form in the sides of the veins, coagula are fre- 

 quently produced, which may terminate in 

 phlebolites. The pouch being filled, the walls 

 become atrophied, the inner surface becomes 

 rough and cellular, and closes firmly round 

 the calculus, sometimes making it appear ex- 

 ternal to the vein. At other times, not only 

 the pouch, but the entire calibre of the vein, 

 becomes implicated and stuffed with calcifying 

 coagulum ; in this case a portion of the tube 

 becomes obliterated. In other instances the 

 phleboliie is free in the cavity of the vein, is 

 loose and movable, and the vessel that con- 

 tains it is still permeable to the circulating 

 current. Such phlebolites, though loose and 

 movable, are frequently surrounded by coagula 

 of blood ; sometimes by a layer of fibrin. They 

 have occasionally been surrounded by a thin 

 layer of fibrin, and attached at one point to the 

 side of the vein by a sort of peduncle, the re.st 

 of the body hanging free into the cavity of the 

 vessel. Tiedemann very naturally suggests that 

 in these cases the peduncle is produced by the 

 effusion of coagulable lymph, the result of 

 inflammation, caused by the presence of a 

 foreign body. 



Phlebolites have been discovered in very 

 many of the veins : they have been found in 

 the vena cava inferior, the renal, the dorsal, the 

 common iliac, anterior and posterior tibial, the 

 saphena and other superficial veins of the 

 lower extremities, the hypogastric veins ; also 

 in the uterine, the vaginal, spermatic, vesical, 

 prostatic, and haemorrnoidal, veins. They have 

 likewise been seen in the splenic and mesen- 

 teric veins. Their most frequent and most 

 abundant position is in the veins of the pelvic 

 viscera. In number they vary considerably : 

 there are generally, though not always, more 

 than one. Tiedemann found thirty-six in the 

 spermatic veins of one individual, fifteen in 

 one, and twenty-one in the other. 



They occur almost always after middle age. 

 They 'produce no injury or inconvenience ; 

 nor is their presence known, except in a few 

 situations, during the life of the individual. 



There are some general circumstances re- 

 lative to phlebolites which are striking and 

 curious. They always occur in veins below 

 the diaphragm, in depending veins, in 

 veins which circulate their blood against the 

 force of gravity. 



According to Hasse, they always occur in 

 conjunction with phlebectesis. 



They frequently, perhaps generally, occur in 

 veins returning the blood from diseased organs, 

 from a diseased testicle or prostate, from 

 an ulcerated rectum, from an inflamed or 



