Rupture of the inferior cava from disease, has been described by Dr. Squibb, in the Phi ladelphia Medical Examiner for 1847. " The vein at this point had been very much dilated, and its coats much diseased and thinned : a semiorganized mass or clot, which was con tained in the dilatation, was connected by its surface to the softened coats of the expanded vessel, and the rupture had occurred at the junction of the edge of this mass with the side of the vessel, and not at the projecting point of the dilatation. The tumour was on the anterior portion of the circumference of the vessel, and was overlapped by the edge of the liver, and by a portion of the stomach." Morgagni mentions the rupture of a varicose azygos vein, the result of extreme varicosity. Perforation of veins from suppurative inflam mation or ulceration is not uncommon. The cavities of the veins, especially in the stomach and uterus, are often laid open by the exten sion of malignant disease. But the commonest form of venous perforation is from the tegu mentary varicose ulcers of the leg, which is originally extrinsic to the vein.
The following enumeration of ruptured or perforated veins is from Andral. " It has been seen, first, in the superior cava, both within and without the pericardium ; second, in the inferior cava ; third, in the vena portal, both within and without the liver ; fourth, in the splenic vein ; fifth, in the jugular vein ; sixth, in the subclavian vein ; seventh, in the veins of the extremities ; eighth, in the veins that run between the coats of the intestines." Affixtions of the Valves of Veins are partly mechanical and partly dynamical. The most frequent change they suffer from is the result of the distension of the vein in which they are placed ; but they are occasionally the sub ject of the same changes as occur in the vessel itself. In varix the valves are not necessarily damaged, though from the increased size of the vessel in which they are placed they are disproportioned to their office, and become useless. Instances are mentioned by Stan ley, Langstaff, and Dr. R. Lee, where the valves in varix were quite healthy, thin, and transparent, but drawn aside and inadequate to cross the vessel's tube. The usual result of varix is to injure the valves : they then be come torn in shreds or perforated ; or the attached margin becomes detached, and the valve is reduced to a membranous thread, which stretches across the diameter of the vessel. In other instances the valves are ren dered opaque and thick,—the result of chronic inflammation. Whenever any affection of the
valves occurs, they are apt to become coated with lymph ; and when a vein is the seat of plastic inflammation, the valves usually be come ragged fringes of lymph.
Phlebolites. — The curious bodies called phlebolites, phlebolithes, or vein-stones, which have excited much interest in the pathology of veins, are true vascular calculi, —are cal culi or earthy concretions deposited from the blood in the veins ; and though their mode of formation differs considerably from those other bodies which form in other hollow or gans, and which we call calculi, they are still quite as much entitled etymologically to the same designation.
At a very early date, among the writings of Realdus, Columbus, and Bartholin, phlebolites were recognised and described ; hut it was not until Otto, Tiedemann, Cruveilhier, and Carswell devoted their attention to them they excited much interest. Matured phle bolites are, for the most part, oval or round ish bodies, sometimes irregular and flattened ; they are sometimes prolonged and much at tenuated at one extremity, corresponding to the distal end of the vein in which they are embedded. They vary much in size, from a grain of millet seed to a pea, or even to a hazel nut ; their form also differs. Dr. Lee describes a cylindrical vein stone, which was found in the right common iliac vein of the late Lord Liverpool ; it was an inch or more in length.
These concretions are of a yellowish or white colour ; they are of varying density, being sometimes of bony hardness, and at others much softer, with a firmer nucleus, which is always harder than the other parts of the stone. When sections are made the cut surface presents a series of concentric rings, — there being at different distances from the centre sufficient change of colour and density to mark each annulus ; so that the calculus is thus seen to be composed of successive concentric lamina', hardest in the centre, and gradually becoming softer in proceeding outwards. They are frequently seen sur rounded externally by a layer of plastic mate rial, looking like a membranous investment ; at other times they are firmly imbedded in a dense coagulum ; but in the majority of instances they are free from any covering. The hardest stones, however, contain, inter mixed with the calcareous matter, much soft animal material ; for, when desiccated, they diminish in size ; and, unless the layers have received equal proportions of earthy deposit, they become irregular.