572 DISEASFS OF THE HEAD, XECK, VEINS, ETC. 



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

 subject, has been at much pains to account fcr 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 6b- 

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

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

 remained to inquire in what manner the obstruction was pre- 

 vented in the previous course of other veins similarly aff"ected, 

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

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

 argued, 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 ofif the obstructed 

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

 flammation proceeds, the obstruction being prevented downwards 

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

 mation and tumefaction will prevent its receiving more blood, by 

 which means no oftending coagulum remains. Thus Mr. Percivall 

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

 in human pathology — t/iat this injlammation always occasioms 

 obliteration in tlie vein towards tlie Juart — is thus reconciled, and 

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

 — Lectures, voL i., p. 103. 



Speaking to Professor Spence of tliis peculiar tendency in the 

 clot to extend upwards in inflammation of tlie jugulai-s, he kindly 

 shoM-cd me a specimen of inflammation of tliese veins in man, 

 where the thrombi extended upwards even to tlie a-anial sinuses. 

 From this circumstance 1 think wo may safely conclude that the 

 same law applies in man as in the horse. 



Tlie best treatment for cii-cumscribcd phlebitis is the appli- 

 cation of a smart cantharides blister along tlio course of tlie iu- 

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

 The blister is to ba applied whether suppuration be present or 



