whole nervous and vascular system; Schoenlein boasts to have recognized, by a rigor, the transition of an inflammation from the peritoneum to the vena porta. The possibility that inflammation of the vena portæ may be accompanied by an inflammatory fever, cannot be denied; the observations, which are before us, establish only that form of fever which has heretofore been recognized as adynamic or nervous; this form of fever proves, in our cases, only the existence of pyæmia. In the second and third of the detailed cases seems to exist no doubt but what the advent of the inflammation of the vena portæ was announced by rigor; and even in the fourth and fifth cases was rigor the first symptom of the inflammation of the vena porta. The pulse was, throughout, accelerated, and beat ninety-two to one hundred and twenty times in a minute. The skin, was, in every case very hot; in the first, at first dry, afterwards profuse perspiration, as was the case in all the other cases, and in two cases there were miliariæ; in the fourth case, petechiae. In the mucous membranes we find in the first case pulmonary catarrh; in the second and third cases croup (?) of the mucous membrane of the fauces as consequences of pyæmia; and also in the third case acute catarrh of the small and large intestines from pyæmia. General peritonitis followed plainly in consequence of pyæmia in the third case. The pyæmia manifested its deleterious influence in the reproductive sphere by a speedy disappearance of fat and muscular substance; it caused but slight deviation in the nervous system; the cerebral symptoms in the third case, must be ascribed to the encephalitis. Two of the patients showed a peculiar gloomy expression, apparently emanating from deep suffering. If, therefore, some observers mention delirium, stupor, distortion of features, wakefulness or coma as symptoms of inflammation of the vena portæ, these symptoms can, according to the author's observations, be deduced from pyæmia. Particularly worthy of regard, as symptoms, are the enlargement of the liver, jaundice, pyæmia, and enlargement of the spleen; but, supported even by these, the diagnosis cannot be positive.

Duration, Course, and Termination. The shortest time of illness in the recorded cases, was three, and the longest, forty seven days. According to this difference of duration, has this disease been distinguished into acute and chronic;

but this is unimportant. Likewise has the acute been divided into an inflammatory and adynamic stage; as cause of the adynamic condition was, in all cases, pyæmia observed. The termination of inflammation of the vena portæ in health cannot be doubted; but has as yet not been observed. The most frequent termination was in suppuration, which, to recognize at the sick bed, seems to be difficult. A consequence of the suppurative pylephlebitis is the formation of abscesses in the liver; adhesion and obliteration take place in the trunk, or, more frequently, in the branches and rami of the vena porta; this termination manifests itself by enlargement of the spleen, hyperæmia of the mucous membrane of the intestinal canal and stomach, swelling of the hemorrhoidal veins, hyperæmia of the peritoneum, ascites, &c., &c.—all symptoms which can be traced to mechanical hyperæmia and its consequences. The most frequent termination, death, took place in all the cases observed; in our cases it was caused partly by pyæmia, partly by scirrhous dyscrasia, and scirrhous degeneration of the stomach and of the liver. Complications, also, can cause death. Some were cause, others consequence of pyæmia; others were caused by scirrhous discrasia; ascites and anasarca were consequences of granulation of the liver and of scirrhous of the liver and its krasis.

Etiology. The author considers the case, observed and described by Balling, as primary pylephlebitis; there was to be found, neither in the cadaver nor at the sick bed, a cause of the disease, and the diseased condition reached in the tunics of the blood vessels to a higher degree, and seemed to be of an older date, than in the blood itself. As causes of the primary pylephlebitis, are to be mentioned traumatic influences and cold. Almost all the cases of inflammation of the vena portæ, which have, as yet, been observed, are secondary, i. e. the coagulation of the diseased blood is the primary and most essential occurrence, after which inflammation of the tunics of the veins is developed. That this has also been the case in the five cases recorded, is shown by the author in detail. According to the observations of others, pylephlebitis appears also frequently as secondary disease; it is developed in consequence of inflammation of the substance of the liver, abscesses of the liver, of the bilia

ry ducts, of the spleen, or in consequence of the inflammation of other veins. We know nothing certain as to a peculiar predisposition to pylephlebitis ; it may occur frequently in the newborn, on account of the frequency of inflammation of the umbilical vein at that age, which inflammation is then easily transmitted to the vena porta. We know nothing as to the influence of age and sex. We cannot deny that the prognosis must generally be unfavorable. As long as the diagnosis is doubtful, there can nothing be said of the treat

ment.

The above account has been translated from "Schmidt's Jahr. Bucher der in-and auslandischen Jesammten medicin," No. 8, 1847. This is, consequently, the latest inquiry on record into this rare disease. As the translator can find hardly any mention of inflammation of the vena portæ in any of the usual works on the practice of medicine, and as the observations are not sufficiently numerous yet to have any certain diagnosis, &c., of the same, and as, moreover, there is a discrepancy in relation to the pathology, symptomatology, &c., of the cases already published, he has considered it a service to the profession of this country, to translate also the leading features of the remarks on this disease, which are contained in the " Encycklopædie der Gesammten Medicin von Carl Chr. Schmidt, Med. and Chir. Doctor," vol. 6., Leipzig, 1842.

"Inflammation of the vena porta" says Dr. Eisenmann in the above work, "occurs upon the whole but rarely, yet there are a goodly number of observations at our command, namely, a case by Bouilland,* two by Reynaud,† one by Dance,‡ one by Bonie, one by Balling,|| one by Schoenlein,¶ two by Andral,** one by Aullier,†† one by Cruveilhier, and one by Mohr.§§ Schoenlein has also recently observed a case at Berlin. It is

Archiv. Gener. 1823, Juin.

+ Journ. Hebdom. II, and Revue Med. 1839.

Archiv. Gener. 1828, Dec., 1829, Feb.-20 observations.

Clinique des Hopitan, 1829, May.-Bullet. des Sciences Med. xvi, 216.

Zur Venenentzundung, page 310.

Baczynski Diss. de Venæ Portarum Inflaminatione, Zurich, 1838. Schmidt's Jahrb. xxii, 110.

**On these four cases compare Baczynski's Dissert.

+ Central Zeitung, 1840, Nov. 29. Schmidt's Jahrb. xxii, 110.

On these four cases compare Baczynski's Dissert.

Gentral Zeitung, 1840, No. 29. Schmidt's Jahrb. xxviii, 50.

also to be noticed, that those cases of inflammation of vena portæ are not included which are observed in newborn infants, where the inflammation proceeded from the umbilical vein.

The inflammation of the vena portæ can, like that of other veins, proceed from the inside of the vein and extend to the outside of the same; but the inflammation can also originate in the surrounding tissues, and extend itself to the external and from thence to the internal membrane of the vena portæ ; and if, in Reynaud's case, the vena portæ and cava were closed externally by exudation; if in Aullier's was found, in the vena portæ, blood of the consistence of cream, but in the liver, abscesses, and other vestiges of inflammation; if, finally, in Cruvcilheir's case the cellular tissue of the vena porta was infiltrated with pus; then we can well assume, that in these cases the inflammation proceeded from without to within, whilst in the cases of Dance, Bonic, Balling, and others, the course of development of the disease took its direction from within to without.

The anatomical changes and the physiological anomalies are the same with the vena portæ as with inflammation of other veins, and it is added to it only the functional derangements of the vena portæ and of the liver. This inflammation can take an acute and a chronic course. Baczynski deduces from nine cases, the following picture of the acute inflammation of the vena portæ : (a) Inflammatory stage, local symptoms: sudden pain in the regio epigastrica and in the hypochondrium dextrum, without (?) obvious causes; this pain returns like colic, increases on pressure very much, and extends itself gradually over the whole abdomen; heat, deep (low?) in the hypochondrium; the abdomen is dense, full, or in the beginning retracted, or only moderately swelled; hard, but is not meteoric; veins of the abdominal parieties distended, extending thus to the chest and axilla. General symptoms: fever, which takes place sometimes before, sometimes with, and sometimes after the local symp. toms; severe chill, (rigor) which lasts from one to two hours and is followed by heat; quick, soft, weak, and small pulse;

*Compare with this Dr. Waller's opinion on pages 1 and 2. Transl.

Vol. I. No. 1.-2.

dry and turgescent skin; tongue dry and covered back with thick, white mucous; abdomen very warm; thirst and red fauces, continued heaviness of the head, vertigo, debility, anxiety and restlessness of mind, wakefulness, constipation, scanty, red urine with a sediment like brickdust. After a while appear difficulty of breathing, tossing, and an icteric hue of the skin. (b) Adynamic stage: it commences from the third to the eighth day of the disease. The first stage never lasts to the fourteenth day. The progress of the disease is frequently very obscure. Local symptoms: the pain and heat of the abdomen disappear entirely; a throbbing sensation in the abdomen, and sometimes in other parts of the body. The abdomen swells more. General and sympathetic symptoms: retching, vomiting of a black substance resembling dissolved soot, pressure on the abdomen produces stitches and retching, palpitation, irregular and unequal pulsation of the heart, great anxiety, the face is distorted and covered with perspiration, mouth, nostrils, and the trembling tongue, have a dark color, great debility, unconsciousness, anxious, staring eyes, dilated pupil, which was contracted, sopor, aoma with delirium, automatic motion of the hand to the abdomen, very small pulse, which cannot be counted any more. A great deal of dark blood runs from the anus shortly before death, the strength continues sinking, the countenance becomes hippocratic, the extremities are cold, and death takes place in the course of seven days."

Baczynski has either not observed, or has omitted to notice, the chill or rigor which announces the commencing suppura

tion.

"The chronic form, as described by Baczynski: Disagreeable weight in the scrobiculum cordis, a feeling as if every thing in the abdomen were arrested in its function. Little heat in the region of the liver; pain in that region from the commencement; abdomen somewhat swelled and painful on pressure yellow hue of the skin; distention of the veins of the abdomen and extremities, then feeble febrile excitement, in the evening frequent alternations of chilliness and febrile heat; skin dry, temperature little elevated; pulse quick and soft, and again slow and weak. Dyspeptic symptoms, vomiting of dark green matter, mixed with blood; tardy stools;