On the origin of inflammation of the veins / and of the causes, consequences, and treatment of purulent deposits

by M.D. Henry Lee

M. Dance, and, since his time, equally accurate observers, have, on the other hand, failed to detect the characters of pus in the blood, even when that fluid had been injected into the veins of living animals. The results of these different observations may perhaps be reconciled, by considering the influence exercised upon the globules of pus by the blood, before its coagulating power has been impaired. This subject appears not to have hitherto occupied the attention of pathologists.

In all the cases quoted by Dr. Sédillot, in which he detected the globules of pus in the blood, the patients died of the disease; but in the researches instituted by M. Dance and others, the experiments were made upon animals in perfect health. In the latter, the pus cannot enter the circulation, as has already been shewn, or can only do so after the blood has partially or entirely coagulated round it, and the coagulum has subsequently become broken up.

In the act of coagulation under these circumstances, the appearances of the globules of pus are changed,—these being perhaps mechanically compressed by the contraction of the fibrine,—so that the most experienced eye can no longer recognise them.

Pus, mixed with healthy recently drawn blood, out of the body, will entirely lose its characters in this way; and as the coagulation, is by no means retarded in the living vessels, we may, without fear of contradiction, affirm, that globules of pus cannot be detected when introduced into the vessels in small quantities, and mixed with healthy blood.

In cases where, from long-continued disease and the repeated introduction of vitiated fluids into the circulation, the blood has lost its power, there appears no reason to doubt the correctness of Dr. Sédillot's observations; and it is probable that pus-globules may then circulate with those of the blood.

In experiments upon animals, it has always been found that the power of the constitution, in resisting the effects of the injection of pus into the veins, was much greater at the first than at any subsequent operation. This circumstance would appear to associate itself directly with the observations now made, and to afford another illustration of the power of healthy blood in resisting the entrance of some foreign matters into the system.

From the consideration of these facts, and of the experiments previously recorded, it becomes evident, that the introduction of pus into the system through an injured or inflamed vein, can rarely be the first step towards purulent infection of the system. Some change must previously have passed in the blood, by which its coagulating power is impaired, or some unusual mechanical means must have been employed, before the pus can find its way in the course of the circulation. The contradictory statements which have been made by those who have injected pus into the veins, may thus be reconciled, by taking into account the power exercised by the blood in the experiments which have been made. There can be little doubt that, while, in some instances, a portion of the pus has been forced into the general circulation, in the great majority of cases it has been detained in the vein into which it was first introduced, and has never become part of the circulating fluid. We accordingly find some experimenters recording the secondary diseases which they observed, while in other hands these appearances were not produced.

Dr. Sédillot[30] has attempted to prove that the globules, or solid parts of pus, must be introduced into the system, in order to produce well-marked indications of purulent infection. But this hypothesis would not only appear to be at variance with the oft-repeated experiments of MM. Gaspard and Cruveilhier, in which similar effects were produced by the injection of mercury and of putrid fluids, but would also leave unexplained the mode of the introduction of these globules, where there is evidence that the disease has been communicated through the lymphatic system. The changes which all substances undergo in their passage through the absorbent glands, would at once forbid the idea that globules of pus could be thus introduced unchanged into the circulation; and yet we have direct evidence (Case [xxix]) that irritating fluids are conveyed in this way into the system, and lead to the formation of secondary abscesses.

Another class of cases, in which there would be difficulty in admitting the doctrine of the introduction of pus in substance into the circulation, presents itself, where, in the primary affections (as in Case VI), no evidence can be obtained of the original lesion having suppurated. The fluids effused in such cases may be serum, lymph, or blood, mixed in different proportions; and yet the constitutional symptoms will be exactly similar to those which follow the formation of pus in other instances. There may exist, both in the primary and in the secondary affection, every intermediate gradation between the healthy secretion of a part, and the formation of pure pus, or pus mixed with blood or lymph, without any of the essential characters of the disease being absent. An inflamed bursa, or a punctured wound, without the formation of pus, (Cases [iv] and [v]), may give rise to symptoms as severe, and consequences as fatal, as any that arise from the direct introduction of pus into the system. The secondary affections, in such cases, may run their course and prove as speedily fatal, as where well-formed purulent deposits have taken place. The most severe constitutional symptoms will sometimes be followed by the effusion of bloody fluid only, in one of the serous cavities (Case [xxx]). It would be unphilosophical, even were it practicable, to refer such cases to a different disease, merely because the accidental circumstance of the formation of pus is wanting. The origin of the affection in such instances may be as well-marked, the poison can often be traced as distinctly into the system, and the secondary disease may be as clearly connected with the primary, as in any case where pus has been originally formed. In some cases again, the constitutional symptoms which accompany, or are followed by, effusions into distant parts of the body, begin before sufficient time has elapsed to allow the supposition that pus can have been fully formed at the original seat of injury. Such instances occasionally, although rarely, present themselves in extensive burns and scalds, occurring in enfeebled habits, and after amputation of the limbs in scrofulous children.