On phlebitis of the great venous trunks of the neck subsequent to labour / by Alfred H. M'Clintock.

  • McClintock, Alfred H. (Alfred Henry), 1821-1881.
Date:
[1856]
Catalogue details

Licence: Public Domain Mark

Credit: On phlebitis of the great venous trunks of the neck subsequent to labour / by Alfred H. M'Clintock. Source: Wellcome Collection.

    4/10 (page 4)
    colour. The abdomen, when laid open, presented no morbid appearance; the liver was healthy. The uterus was rather large for this period—twenty-two days—after delivery ; its structure was remarkably soft and friable. Behind this organ, and deep in the pelvis, existed a small abscess. The mucous membrane of the large intestines seemed thickened, and was of a very dark colour, apparently from intense congestion. The kidneys were in an advanced stage of fatty degeneration. On dissecting back the integuments of the neck, and exposing the great venous trunks in this region, it was at once apparent that phlebitis, in its most marked form, had existed here. The deep jugulars, both subclavians, the upper part of each axil¬ lary, the right vena innominata, and superior portion of left, were the vessels engaged. In caliber they seemed enlarged, their coats were thickened, and internally they contained lirm plugs of coagula and lymph, the latter being the more external, and adhering very closely to the wall of the vessel. These formations extended down to near the superior cava, the lining membrane of which was redder than natural. The pulmonary valves were intensely red, as was the interior of the pulmonary artery,—contrasting strongly with the aorta, which presented its natural colour. In the right auricular appendix was a small incipient abscess. The tricuspid and mitral valves were in¬ tensely injected, so as to present a bright scarlet colour. The aortic valves contained some calcareous matter, but otherwise presented no abnormal appearance. The lining membrane of the heart itself was pale, and showed no traces of inflammation*1. Such is a very brief history of the symptoms and morbid appearances which this case presented. It will be remarked that, at an early period after parturition, the patient became affected with symptoms of low puerperal fever, the gastro-intestinal mucous membrane being the part on which the action of the poison seemed to be chiefly expended, though it is possible this diarrhoea may have had some connexion with the renal disease. A variety of circumstances concurred in this case to favour the development of puerperal fever. The kidneys were far ad¬ vanced in fatty degeneration; she had spurious pains for a con¬ siderable time before the setting-in of true parturient action; her labour was tedious (twenty-seven hours), and was followed by severe hemorrhage. Another circumstance there was in her case, yet more influential than all these together, in predispos¬ ing to the invasion of puerperal fever,—she had been seduced, a The preparation showing these morbid alterations was exhibited to the meet¬ ing, and is now in the Museum of the Lying-in Hospital.