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If leakage occurs into the tissues, the extravasated blood may occlude the vein by pressure, and the symptoms of arterial aneurysm replace those of the arterio-venous form, the systolic bruit persisting, while the venous hum disappears.
Whether the person is sick in bed, miserable though up and about, or beginning to feel the first sensations of slight incapacity for his life work, his ability properly to circulate this one thirteenth of his weight through the various arterial and venous channels and capillary tracts must, with the increasing tension and speed of our lives, be taken into consideration.
Steps must be taken to facilitate the venous return from the ulcerated part, and to ensure that a sufficient supply of fresh, healthy blood reaches it. The septic element must be eliminated by disinfecting the ulcer and its surroundings, and any other sources of irritation must be removed.
I believe that in the management of a case of glaucoma, whether it be chronic or chronic with sub-acute exacerbations, the greatest care with the aid of an expert clinician must be exercised to find out exactly what mean pressure of the arterial and venous system best conforms with the patient's general welfare, and I am bitterly opposed, and I think with right, to the sudden reduction of tensions, except in emergencies, without a perfect understanding of the facts I have ventured to indicate.
Thus venous are the reports of Hannibal's death; but when the news of it came to the senators' ears, some felt indignation against Titus for it, blaming as well his officiousness as his cruelty; who, when there was nothing to urge it, out of mere appetite for distinction, to have it said that he had caused Hannibal's death, sent him to his grave when he was now like a bird that in its old age has lost its feathers, and incapable of flying is let alone to live tamely without molestation.
The return flow of the blood to the heart through the veins is sluggish and stagnant because the force from behind, that is, the arterial blood pressure, is obstructed by the uric acid which clogs the minute capillaries that form the connection between the arterial and the venous systems.
The cells of the dark red, carbonised or venous, blood, which have absorbed carbonic acid from the animal tissues, give this off in the respiratory organs; they receive instead of it fresh oxygen, and thus bring about the bright red colour that distinguishes oxydised or arterial blood.
Wherever this has been done, the venous and lymphatic vessels in the intestines do not absorb the food materials and these pass through the digestive tract and out of the body without being properly digested and assimilated. During the destructive stages of typhoid fever, the intestines become denuded by the sloughing of their membranous linings.
These gills are made nearly upon the same model as we have already seen in those of fishes; and although their form and arrangement differ in different species, yet the principle is always the same: they are tufts of leaflets springing from stems, up and down which run two tubes; one which brings the blood from the venous reservoirs, the other which carries it to the heart.
I should wish also that such persons were carefully shown the eleven pellicles which, like so many small valves, open and shut the four orifices that are in these two cavities, viz., three at the entrance of the hollow veins where they are disposed in such a manner as by no means to prevent the blood which it contains from flowing into the right ventricle of the heart, and yet exactly to prevent its flowing out; three at the entrance to the arterial vein, which, arranged in a manner exactly the opposite of the former, readily permit the blood contained in this cavity to pass into the lungs, but hinder that contained in the lungs from returning to this cavity; and, in like manner, two others at the mouth of the venous artery, which allow the blood from the lungs to flow into the left cavity of the heart, but preclude its return; and three at the mouth of the great artery, which suffer the blood to flow from the heart, but prevent its reflux.
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