267 



On the Pathology of the Dropsy produced by Obstruction of the 

 Superior and Inferior Vence Cavce and the Portal Vein. — 

 Preliminary Communication. 



By Charles Bolton, M.D., Assistant Physician to University College 



Hospital. 



'(Communicated by Professor Sidney Martin, F.K.S. Eeceived December 19, 

 1906,— Eead January 17, 1907.) 

 (From the Pathological Laboratory, University College.) 



In August, 1903, I published a paper in the 'Journal of Pathology '(1), 

 In which I demonstrated a method of experimentally producing uncom- 

 pensated heart disease in an animal, which was compatible with life. This 

 method consisted in diminishing the size of the pericardial sac by stitches, 

 iso that the diastolic filling of the heart was impeded. The main symptoms 

 of this condition were dropsy and diminution in the amount of urine 

 •excreted. 



As the immediate result of this interference with the action of the heart, 

 there occurred a rise of pressure throughout the whole systemic venous 

 system extending as far back as the capillaries, and a fall of the mean 

 arterial blood-pressure. Further, I found that the pressure in all the veins 

 fell to the normal limit again within the space of about one hour, and that 

 subsequently, when dropsy was being produced, the venous pressure in all 

 parts of the body was normal, and the arterial pressure had almost recovered 

 itself. 



I wish to draw special attention to the fact that the venous pressure was 

 at first raised not only in the great veins near the heart, but also in the head, 

 limbs, and intestines, that it very rapidly reached the normal limit again, 

 and that the dropsy was produced whilst the venous pressure was normal, 

 the arterial pressure very little if at all lowered, and the capillary pressure 

 therefore not raised. 



My reason for so doing is because Starling's (2) theory of hydremic plethora is 

 founded upon the assumption that the venous pressure primarily falls below 

 the normal in the limbs and intestines, although it rises in the great veins 

 near the heart. The low venous pressure in the limbs and intestines, 

 according to Starling, initiates the absorption of lymph, which continues 

 until the capillary pressure in the limbs as well as in the trunk is raised 

 above normal by the hydrsemic plethora so produced. Dropsy is then brought 

 about by the raised capillary pressure. He also considers that there must be 

 .an alteration in the capillary wall, and he lays great stress upon this point. 



VOL. LXXIX. — B. X 



