On the theory and practice of midwifery / By Fleetwood Churchill. With notes and additions by D. Francis Condie.
- Fleetwood Churchill
- Date:
- 1859 [©1851]
Licence: Public Domain Mark
Credit: On the theory and practice of midwifery / By Fleetwood Churchill. With notes and additions by D. Francis Condie. Source: Wellcome Collection.
Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.
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![tained that there is a general inflammatory state of the absorbents in this disease. Dr. Hull (1800) considered the proximate cause of this disease to be an inflammatory affection, producing suddenly a considerable effusion of serum and coagulable lymph into the cellular membrane of the limb. All the textures, muscles, cellular membranes, lymphatics, nerves, glands, and blood-vessels, he supposed to become affected. So far, the theories depended upon U priori reasoning, not upon patho- logical facts; and the first light thrown upon the subject by post mortem examination was by the late Dr. Davis, Professor of Midwifery in Univer- sity College, London, who, in 1817 examined the condition of the veins in a patient who had died with the disease, and found that they had evi- dently been the seat of extensive inflammation.* After this he taught that phlegmasia dolens resulted from this cause, and in May, 1823, published a paper with cases and dissections in the Med. Chir. Trans, vol. xv. In January, 1823, M. Bouillaud related several cases and dissections, in which the crural veins were obliterated in women who had suffered from oedema of the lower extremities after delivery ; and M. Bouillaud distinctly stated that he considered obstruction of the crural veins to be the cause, not only of the cedema of lying-in women, but of many partial dropsies. It is but just to remark, that although this bears an earlier date than * Morbid appearances observed on examining the body of Caroline Dunn, March 6, 1817: — The left lower extremity presented an uniform oedematous enlargement, -with- out any external discoloration, from the hip to the foot. This was found, on further examination, to proceed from the ordinary anasarcous effusion into the cellular sub- stance. The inguinal glands were a little enlarged, as they usually are in a dropsical limb, but pale coloured, and free from the slightest sign of inflammation. The femoral vein, from the ham upwards, the external iliac, and the common iliac veins, as far as the junction of the latter with the corresponding trunk of the right side, were dis- tended, and firmly plugged with what appeared externally a coagulum of blood. The femoral portion of the vein, slightly thickened in its coats, and of a deep red colour,, was filled with a firm bloody coagulum, adhering to the sides of the tube, so that it could not be drawn out. As the red colour of the vein might have been caused by the red clot everywhere in close contact with it, it cannot be deemed a proof of inflamma- tion. The trunk of the profunda was distended in the same way as that of the femora] vein ; but the saphena and its branches were empty and healthy. The substance filling the external iliac, and common iliac portions of the vein was like the laminated coag- ulum of an aneurismal sac, at least with a very slight mixture of red particles; the tube was completely obstructed by this matter, more intimately connected to its surface than in the femoral vein ; adhering indeed as firmly as the coagulum does to any part of an old aneurismal sac; but in its centre there was a cavity containing about a tea- spoonful of a thick fluid of the consistence of pus, of a lightish brown tint, and pulta- ceous appearance. The uterus, which had contracted to the usual degree, at such a distance of time from the delivery, its appendages and blood-vessels, and the vagina, were in a perfectly healthy state. There was not the least appearance of vascular con- gestion about the organ, nor the slightest distension of any of its vessels. Its whole substance was, on the contrary, pale, and the vessels everywhere contracted and empty. The state of the abdominal cavity and its contents were perfectly natural. That the substance occupying the upper part of the venous trunk and the fluid in its central cavity, had been deposited there during life, from inflammation of the vessels, does not admit of doubt. I am also decidedly of opinion, in consequence of its firmness, and close adhesion to the vein, that the red coagulum in the femoral vein was the result of a similar affection extending along the tube, and that the passage of the blood through it. in the whole tract submitted to examination, must have beeu completely obstructed before death.](https://iiif.wellcomecollection.org/image/b2103011x_0487.jp2/full/800%2C/0/default.jpg)
