Gouty retinitis, chorio-retinitis, and neuro-retinitis / by Charles Stedman Bull.

  • Bull, Charles Stedman, 1844-1912.
Date:
[1893]
Catalogue details

Licence: Public Domain Mark

Credit: Gouty retinitis, chorio-retinitis, and neuro-retinitis / by Charles Stedman Bull. 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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    More recently observers have begun to recognize corre- sponding changes in the veins, and to regard phlebo-sclerosis as a systemic disease analogous to'diffuse arterio-sclerosis. Some years ago Sack described a condition which he called a chronic fibrous endo-phlebitis, and stated that it not infrequently ap- peared as a local lesion in consequence of local stasis in the venous system. Huchard in 1889 and Spillmann in 1890 both used the term phlebo-sclerosis to describe this process. Ac- cording to the latter, phlebo-sclerosis in gouty persons may be both circumscribed and diffuse, the latter being met with in the small veins. The same<pathological changes occur in the vaso vasorum, with an abnormal development of nuclei around the small capillaries. It is shown by his investigations that the venous lesions develop progressively and simultaneously with the arterio-sclerosis, without, however, ever ending in the profound alterations which change the arteries into rigid tubes. {Gaz. hebd. de MM. et de Chir., Oct. 11, 1890.) Pokrovsky has made still more extensive investigations upon thirty cases. Microscopically the veins showed no marked changes, though they were sometimes found studded with cir- cumscribed, irregular elevated white patches, both soft and hard. He concluded from his investigations that chronic in- flammation of the arteries, so called, arterio-sclerosis, or chronic endarteritis deformans, is accompanied by analogous, though less intense, morbid changes in the veins. The most frequent process is a compensatory, diffuse, fibroid endo-phlebitis, analo- gous to Thoma’s compensatory diffuse endarteritis. The endo- phlebitis commences with the appearance in the intima of the veins of many young cells, which are subsequently transformed into fibrous connective tissue. The young cells are supplied mainly by proliferation of the elements of the intima. Besides this diffuse inflammation there is a circumscribed nodose thickening of the venous walls, which is usually associated with retrogressive metamorphosis, and is analogous to the nodose arterio-sclerosis. As regards the regressive changes, the most frequent is hyaline degeneration, met with in all the coats of the veins. Fatty degeneration rarely occurs. In cases of intense endo-phlebitis the media frequently undergoes an inter-