Select clinical cases : including cases of labio-glosso-laryngeal paralysis, exophthalmic goitre, arterial pyaemia, general chronic arteritis, saturnine gout / by Samuel Wilks.

  • Wilks, Samuel, Sir, 1824-1911.
Date:
[1870]
Catalogue details

Licence: Public Domain Mark

Credit: Select clinical cases : including cases of labio-glosso-laryngeal paralysis, exophthalmic goitre, arterial pyaemia, general chronic arteritis, saturnine gout / by Samuel Wilks. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    case of the blocking of a large vessel and the resulting local symptoms, but under it should he included the equally im- portant and common case of the obstruction of the smaller arteries, with attendant constitutional symptoms. I have for many years been in the habit of insisting upon this both in the post-mortem room and in the wards. Formerly, I was accustomed to show from a strictly pathological point of view how changes occurred in the arterial system analogous to those which take place in the venous :—that as in phlebitis some morbid matters, products of inflammation, being taken up by a vein and carried inwards through the circulation, give rise in the internal organs to depositions of a similar kind in them, so in the arterial system disintegrating fibrin of the blood may be carried from the centre of the circulation to the peri- phery, and there give rise to further deposits of a like fibrinous matter. Latterly, I have been enabled to show clinically that in both cases there are attendant febrile symptoms with cha- racteristic arthritic pains and occasional rigors ; and that just' as there is a venous pysemia having its source on the outside of the body, so there is an arterial pysemia having its origin within. The term ‘ pysemia’ is, of course, not used in its strict etymological sense; but then it must be remembered, that a rigid application of the word is not required in the more ordi-- nary case of contamination of the venous blood; it is for the objectors to use the term “ septicaemia.” This form of affection, I believe, is far from uncommon, as pointed out in a lecture, of which an extract is given in ‘ British Med. Journal5 of March, 1868. That it is overlooked arises from the circumstance that a severe organic disease exists generally at the same time, and that this is considered sufficient to account for the symptoms and death. A patient, for example, is in hospital for valvular disease of the heart arising, perhaps, from rheumatism at some former period; whilst under observation he may have febrile attacks attended by articular pains, but these are regarded as touches of the primary complaint; and when after death the valves are seen covered with vegetations, and the spleen and kidneys full of softeuing fibrinous masses, these are in no wise regarded as having been instrumental to the fatal event, but as mere acci- dents of the disease. It must, however, have often, 1 believe,