Phlebitis and thrombosis; the Hunterian lectures delivered before the Royal college of surgeons of England in March, 1906 . f changes in the blood ; in connection withvarious acute and chronic diseases; and in conditionsof great debility. When coagulation occurs in a living vein, it is oftendifficult to say whether the thrombus is the cause or theresult of phlebitis. If a vein is obstructed by a thrombusthe nutrition of the endothelium at once suffers, and ifthe clot contains micro-organisms they will soon invadethe intima, the resistance of which will be alreadylowered, and an endophlebitis w
Phlebitis and thrombosis; the Hunterian lectures delivered before the Royal college of surgeons of England in March, 1906 . f changes in the blood ; in connection withvarious acute and chronic diseases; and in conditionsof great debility. When coagulation occurs in a living vein, it is oftendifficult to say whether the thrombus is the cause or theresult of phlebitis. If a vein is obstructed by a thrombusthe nutrition of the endothelium at once suffers, and ifthe clot contains micro-organisms they will soon invadethe intima, the resistance of which will be alreadylowered, and an endophlebitis will ensue. But, on the other hand, there are numerous casesin which it is certain that the changes in the vein precedethe thrombosis; for instance, in the chronic inflamma-tion which occurs in connection with varix, in syphiliticendophlebitis, in tubercular invasion of the vein, and in 1 Wooldridge has shown that the plasma of peptonized blood, whichdoes not coagulate on the addition of fibrin ferment, coagulates freelyif in addition a stream of carbonic acid is passed through it. ( TheChemistry of the Blood, p. 294.). FIG. 4. — FEMORAL VEIN FROM A CASE OF INFECTIVE PHLEBITIS : SHOWINGGREAT THICKENING OF COATS OF VEIN AND DISINTEGRATING CLOT. [ To face p. 23. Phlebitis and Thrombosis 23 other degenerative changes. So also in septic inflam-mation spreading to the outer coat of a vein from aneighbouring focus, invasion takes place from v^ithoutinv^ards, and thrombosis does not occur till the intima isreached. The most serious of these conditions are those of septicorigin. Here the presence of micro-organisms gives riseto coagulation, and the clot has an infective characterwhich it communicates to any part to which it is process may begin in inflammation of the outer coatof a vein originating in a septic or suppurating wound, orin an infective focus, as in middle-ear disease or acutenecrosis of bone; this, spreading to the inner coats, leadsto endophlebitis and conse
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