A system of practical medicine . relative fulnessof these vessels. Again, if the thrombus has existed sufficiently1 Lancet, 1893, ii. pp. 619, 1001. ^ Deutsche Klinik, 1867, ix. p. 437. 394 DISEASES OF THE BLOODVESSELS OF THE BBAIX. long, it may extend from the lateral sinus into the internal jugularvein for such a distance as to block the communication of this vesselwith the external jugular. It can be readily seen that in such case theexternal jugular, instead of being less prominent than normal, is unusu-ally distended. Further, if, as just stated, the thrombus extends into theinternal jugu
A system of practical medicine . relative fulnessof these vessels. Again, if the thrombus has existed sufficiently1 Lancet, 1893, ii. pp. 619, 1001. ^ Deutsche Klinik, 1867, ix. p. 437. 394 DISEASES OF THE BLOODVESSELS OF THE BBAIX. long, it may extend from the lateral sinus into the internal jugularvein for such a distance as to block the communication of this vesselwith the external jugular. It can be readily seen that in such case theexternal jugular, instead of being less prominent than normal, is unusu-ally distended. Further, if, as just stated, the thrombus extends into theinternal jugular vein, the signs of deep-seated phlebitis of the neck arepresent. There is tenderness over the course of the internal jugular,and the vessel is firm and resistant to the touch—i. e. cord-like. Thepatient also tends to incline the head toward the side of the inflamedvein, so as to relieve the tension upon the vessel as much as possible, as Fig. 52. ^^^;>..Comnmnication through parietal foramen with externalveins of Ext. jugular vein Int. jugularveinDiagram showing the communications existing between the superior longitudinal and lateralsinuses and the external veins, indicated in the figure by* (Leube). well as to relax the adjacent muscles. Septic infection of the lung andgeneral sepsis occur as the disease advances. In rare cases there maybe excessive slowing of the pulse, hoarseness, aphonia, spasm of thesterno-mastoid and trapezius, difficulty of deglutition, and even interfer-ence with respiration. When occuriing these symptoms are properly tobe attril)utcd to irritation of the ])neumogastric, s])inal accessory, andglosso-pharyngcal nerves : these structures are involved in the jugularforamen, where they accompany the jugular vein. Inflammation ofthe vein sufficient to involve those contiguous structures must be of ahigh grade, ])rol)al)ly always purulent. It must be repeated, however,that involvement of these nerves is rare. Tiirombosis of the cavernous sin
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