Reports of Societies

1906 Boston Medical and Surgical Journal  
read this paper. He considered the venous system as divided naturally into two departments, -the superficial and the central. The veins of the first were peculiarly subject to various external stimuli and might be used to deduce conclusions as to the state of the circulation in all other parts of the vascular circuit. Of the internal veins, those of the splanchnic system formed a homogeneous group which, from its great capacity and special relation to arterial blood pressure through the
more » ... through the depressor nerve of the heart and the vasomotor center, made it necessary to consider the splanchnic circulation in every estimate of arterial blood pressure. He considered the physiology of the depressor nerve as applied to clinical conditions and described his blood pressure gage for measurement of venous blood pressure, consisting of a spiral spring on a piston with a disk at the bottom, any pressure on the button causing tension of the spiral spring and enabling one to read off the amount of pressure. He said that blood pressure in the superficial veins depended upon the ratio of input to outflow, the former being greatly increased by muscular exercise and somewhat by heat; the latter was decreased by cold, causing contraction of veins, and by obstruction to the entrance of blood into the heart. In some persons, he said, venous pressure falls, in others rises, during digestion, the digestive rise being probably due to obstructive elevation of pressure in the right auricle. The movements of respiration, aside from their aspirating effect on the venous blood, had fundamental importance as an aid to the transfer of blood from arteries to veins. With deep inspiration the peripheral veins swelled and the pressure within them increased. This was often evident with ordinary inspiration. It could be demonstrated by a strip of paper gummed on one side, stuck by the side of a vein of the hand or forearm and resting across the vessel like a lever. It could be shown that both cardiac and respiratory variations of arterial blood pressure were frequently transmitted through the capillaries. He considered the relations of venous to arterial pressure in diseased conditions and the characteristically high venous pressure in gout and lithemia. In arteriosclerosis there was low venous pressure with rise of that pressure when the cardiac circulation was impaired. RUPTURE OF THORACIC ANEURISM INTO SUPERIOR VENA CAVA. Dr. W. Howard Fussell, Philadelphia, reported this case in which diagnosis was made before death. On the third day after the beginning of the symptoms he had appeared with the face blue, neck and chest edematous, as were also the arms, though at that time physical signs of aneurism could not be made out. He rapidly developed pleural effusions, and the other symptoms increased in severity ; on the fourth day there was a systolic murmur and increased heart dullness; no difference in pulse, but difference in blood pressure; left 189, right 160. Died of exhaustion forty-one days after entering the hospital. The loud continuous murmur, said to. be characteristic of this condition, was absent. presented this contribution, the case being that of a man, who, while engaged in the hardest kind of labor, was suddenly seized with the classic symptoms of rupture of the aorta into the cava. The first appearance was that of striking cyanosis of the head, face and hands, his face being swollen and eyes closed by edematous lids. Breathing became more labored and edema greater and the patient died on the fifth day. The heart itself was large and flabby. Dr. J. H. Musser, Philadelphia, in the discussion of the subject, exhibited a specimen that had produced pressure upon the esophagus, the patient, thirty-one years of age, admitted with signs of aneurism. In this case there was bronchial pneumonia and sudden death. Dr. J. P. C. Griffith, Philadelphia, presented the specimen upon which the paper of Beebe and himself had been based, the case being that of a Chinaman, and there was a loud sounding murmur absolutely continuous. Of the twenty-nine cases they had collected all showed a characteristic continuous murmur.
doi:10.1056/nejm190607051550108 fatcat:cyog7lbc6nfwtcalq6p2y67c34