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almost clustered. The structure of these follicles agrees exactly with that of the follicles of lymphatic glands.
We may therefore regard this whole series of apparatuses as nearly equivalent to the lymphatic glands properly so called, and a swelling of the spleen will, under certain circumstances, furnish just as abundant a supply of colourless blood-corpuscles, as is the case when a lymphatic gland enlarges. This possibility explains how it is that, for example, in cholera, where the change in the solitary glands and Peyer's patches forms the chief part of the disease, and where the swelling of the other lymphatic glands is much less marked, we meet at an extremely early period with a considerable increase in the colourless corpuscles. Hereby is explained moreover why, in such cases of pneumonia as are connected with great swelling of the bronchial glands, an increase in the number of colourless bloodcorpuscles likewise takes place, which is generally wanting in those forms of pneumonia which are not connected with such swelling. The more the irritation extends from the lung to the lymphatic glands, the more abundantly noxious fluids are conveyed from the lung to the glands—the more manifestly does the blood undergo this change. • Upon examining these different pathological processes in this manner one by one, it is really impossible to discover anything at all, which in a morphological point of view, could even in a remote degree justify the assumption of a condition such as might be called pyaemia. In the extremely rare cases, in which pus breaks through into veins, purulent ingredients may, without doubt, be conveyed into the blood, but in such instances the introduction of pus occurs for the most part but once. The abscess empties itself, and if it be large, an extravasation of blood is more apt to ensue than the establishment of a persistent pyaemia. Perhaps we shall at some future time succeed, in the course of such a process in discovering pus-corpuscles with REFUTATION OF A MORPHOLOGICAL PYEMIA. 195
well-defined characters in the blood; at present, however, the matter stands thus, that it can most positively be maintained that nobody has hitherto succeeded in demonstrating by arguments capable of supporting even gentle criticism, the existence of a morphological pyaemia. This name therefore must, as designating a definite change in the blood, be entirely abandoned.
MARCH 17, 1858.
Pyiemia and phlebitis.—Thrombosis.—Purifonn softening of thrombi.—True
and false phlebitis.—Purulent cysts of the heart. Embolia.—Import of prolonged thrombi.—Pulmonary metastases.—Crumbling
away of the emboli.—Varying character of the metastases.—Endocarditis
and capillary embolia.—Latent pyaemia. Infectant fluids.—Diseases of the lymphatic apparatuses and secreting organs.—
Chemical substances in the blood; salts of silver.—Arthritis.—Calcareous
metastases.—Diffuse metastatic processes.—Ichorrhaemia.—Pyaemia as a
collective name. Chemical dyscrasiae.—Malignant tumours, especially cancer.—Diffusion by
means of contagious parenchymatous juices.
Gentlemen,—I was interrupted the last time in my description of pyaemia by the termination of the lecture, just as I was about to discuss the nature of the connection between this disease and certain affections of the vessels.
As soon as it was found necessary to abandon the original view, in accordance with which the mass of pus which was believed to be seen in a vein, was considered to have made its way in (been absorbed) through an opening in its walls, or through its yawning extremity, recourse was had to the doctrine of phlebitis, which is still the one most current. It was imagined that the pus which was regarded
as the really noxious matter, was furnished as a product of secretion by the wall of the vessel (John Hunter). This doctrine, however, presented some difficulty, because it was soon pretty generally allowed that a primarily purulent inflammation of the veins did not occur, but that, as was first distinctly shown by Cruveilhier, at the commencement a clot of blood is always present. Cruveilhier himself was so greatly surprised at this observation of his, that he connected a theory with it which was beyond all medical comprehension. He concluded namely from the impossibility of explaining why inflammations of the veins began with coagulation of the blood, that inflammation in every case whatever consisted in a coagulation of the blood. The impossibility of explaining phlebitis seemed to him to be got over by raising coagulation into a general law, and by referring every inflammation to a phlebitis on a small scale (capillary phlebitis). Cruveilhier was the more induced to assert this in consequence of his entertaining similar views with regard to other morbid processes, and believing that cysts, tubercles, cancer, and in short all important processes, accompanied by changes susceptible of anatomical demonstration, really ran their course within special, minute veins imagined by him. This manner of thinking, however, continued so entirely alien to that of the great majority of learned and unlearned physicians, that the separate conclusions propounded by Cruveilhier, which were adopted in medical science in part as drawn up by him, were altogether misunderstood.
Cruveilhier was right in this point, as indeed has since been more and more acknowledged, namely, that the socalled pus in the veins in the first instance never lies against the wall of the vein, but always first appears in the centre of the previously existing clot of blood which marks the outset of the process. He imagined that the pus was secreted from the wall of the vessel, but that it did not
remain there, but by means of "capillary attraction" made its way to the centre of the clot. This was a very singular theory, which can only be approximatively comprehended by assuming, as it was still the custom to do in Cruveilhier's time, pus to be a simple fluid. But apart from these extremely obscure interpretations, the fact remains constant, against which even now no argument
can be advanced, that before a trace of inflammation is visible, we find a clot, and that shortly afterwards in the middle of this clot a mass displays itself, which differs in appearance from the clot, whilst on the other hand it exhibits a greater or less resemblance to pus.
With this observation as my starting point, I have endeavoured to clear up the doctrine of phlebitis, as far as lies in my power, by substituting for the mysticism which pervaded Cruveilhier's interpretation, merely a statement of the real facts. We do not know that inflammation as such has any necessary connection with coagula; on the contrary, it has turned out that the doctrine of stasis rests upon manifold misinterpretations. Inflammation may unquestionably exist when the current of blood within the vessels of the
Pig. 69. Thrombosis of the saphenous vein. S. Saphenous vein. T. Thrombus: v, v' thrombi seated on the valves (valvular) in process of softening, and connected by more recent and thinner portions of coagulum. C. Prolongation of the plug, projecting beyond the mouth of the vessel into the femoral vein C.