Vein-stones are roundish, oval, or cylindrical bodies found in the veins or in pouches connected with the veins, or sometimes in the connective tissue adjacent to a vein. Their size varies from that of a hempseed to that of a nutmeg. Externally they are white, but when divided they are found of a yellowish color at the centre. There is generally a central cavity, around which are disposed concentric laminæ such as are observed in vesical calculi. Chemically, these bodies are composed of an animal substance in which are deposited phosphate and carbonate of lime, and sometimes magnesia. The inner part is hard and brittle, the outer softer and more earthy.
Usually, phlebolithes are found loose in the vein, but if large they may be firmly impacted in the vessel, causing complete obstruction. Sometimes the outer portion is of a gelatinous texture, from which a delicate mesh extends to the wall of the vein and becomes incorporated with it.
Frequently these concretions occupy sacs or diverticula connected with the vein. Occasionally these sacs become detached from the vessel and are absorbed and removed, and the stone, then entirely outside of the vein, becomes enveloped in a fibrous cyst formed from the surrounding connective tissue.
Some doubt exists as to the manner in which these concretions are formed, but the probability is that a small clot first forms in the vessel, and that around this, as a nucleus, successive layers are deposited from the plasma of the blood. These layers then undergo chalky transformation by the deposit within them of salts of lime and magnesia. These formations seem to be conditioned by a slow current in a dilated vein. Hence they are most frequently found in the enlarged pelvic veins of old people, and especially about the neck of the bladder in those suffering from prostatic enlargement. They are also found in the varicose veins of the extremities.
Except in superficial situations they are usually not recognized during life. They seldom produce discomfort, and therefore rarely call for treatment. When accessible they may be excised if requisite, the vein being secured above and below if not already permanently occluded.22
22 Rokitansky, Path. Anat., Philadelphia, 1858.
THE CAISSON DISEASE.1
BY ANDREW H. SMITH, M.D.