On the treatment of the hemorrhagic diathesis / by James Miller.

  • Miller, James, 1812-1864.
Date:
[1842]
Catalogue details

Licence: Public Domain Mark

Credit: On the treatment of the hemorrhagic diathesis / by James Miller. 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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    power, in a far higher degree than do the larger arteries, and more easily excited than that of the smaller, appears scarcely to admit of a doubt. It has been recently asserted by Schwann, that they possess the same kind of fibrous tissue in their walls, as do the large vessels ; and this cannot be regarded as impro- bable. That the contractile coat of the capillaries has for its office to regulate the calibre of the vessels, can scarcely be doubt- ed ; but any general permanent contraction would only occasion an obstacle to the circulation, as is shown by the effect of stimu- lating injections, which, if thrown into the vessels before their vitality has been lost, will not pass through the capillaries.”1 In health, then, these capillaries, by their own inherent contractility, regulate their calibre so as to favour due circulation within them, and if need be, can exert it to an unusual extent, so as to arrest the passage of fluid within them in toto, as doubtless they do in the ordinary cessation of hemorrhage from a recent wound. But if deficient in this contractility, or altogether deprived of it, there will be a consequent and proportionate failure in this most im- portant haemostatic means. The capillaries will then be but passive tubes, through which the blood continues to flow ; and that such a state of the capillaries and arterial tubes exists in the hemorrhagic diathesis, both reasoning and actual observation on dissection, sufficiently demonstrate. Thus, to constitute the hemorrhagic diathesis, we have not only the blood flowing through dilated and non-contractile tubes, but sent thither in greater volume than in ordinary and healthy circumstances, thinner and more fluent than in health, and little if at all able to arrest its own course by assuming the solid form. In addition, the capillary tunics are not only thin, but weak, and easily lacerable; a slight bruise produces serious ecchymosis; coughing may induce haemoptysis ; a sneeze brings on epistaxis ; diarrhoea occasions copious evacuations of blood by the rectum ; and extravasations are not unlikely to follow but slight causes within internal cavities. The whole circulating system, besides, is usually in an irritable and excited condition ; the pulse being considerably above the healthy standard, and the heart acting with unusual force and sharpness. Not unfrequently, a febrile condition at the same time exists ; and when it does exist, it in- creases the intensity of the diathesis.2 Such being the apparent causes of the disorder, we are now prepared to turn our attention to the cure. 1. Can we amend the faulty condition of the Hood? Were the red globules in excess, we could easily diminish their amount, thereby favourably increasing the proportion of the fibrin, by venesection ; and thus we should at once readily obtain blood