DESCRIPTIONS OF THROMBOSIS PRIOR TO VIRCHOW

Recently, World Thrombosis Day (WTD) was celebrated on October 13,2020. In the last post, we saw why October 13 was celebrated as WTD. There is a lot of work which Virchow did on thrombosis and hence he was honoured by celebrating his birthday as WTD.

But there were other people, who had also described thrombosis even before Virchow.

The first probable reference was in 1271. Raoul of Normandy, a 20 year old man, developed unilateral oedema in his right ankle, which subsequently extended up to his thigh with no obvious symptoms in the contralateral leg.

In 1576, Ambroise Pare first documented that blood could clot and congeal in a vein. He mentioned this in reference to superficial veins.

“they (the varicose veins) often swell with congealed dryed blood and cause pain which is increased by going and compression.”

Towards the end of the seventeenth century, childbirth as a cause of thrombosis was described. This may be because, at that time, there was shift from midwife doctors treating pregnant females and conducting delivery, leading to increased documentation. In 1668, Francois Mauriceau of Paris described a lady who had a permanently swollen leg following childbirth, which lasted for thirty-eight years. This was perhaps the earliest recording of prolonged post thrombotic syndrome.

Richard Wiseman, was a highly revered surgeon to Charles II, wrote about many cases in detail, especially about the clinical manifestations of venous thrombosis following childbirth, he saw during his career.

‘An Apothecary’s wife, living in my neighbourhood in the Old Bailey, after a hard child-bed labour was seized with fever and great pain in her right thigh, from the groin and hip downward to the knee, swelling the member round, without inflammation or discolouring of the skin.’

Wiseman has described two of the three factors subsequently ascribed to Virchow’s triad as causes of coagulating blood; stasis (depending of the part or from some other pressure upon the vessel) and hypercoagulability (by its own (blood) grossness, almost two hundred years before Virchow.

In the next post we shall see about theories on thrombogenesis prior to Virchow.

References:

Catherine N Bagot and Roopen Arya. Virchow and his triad: a question of attribution. British Journal of Haematology. 143; 180-190.

                                                                                   Written by Dr.Priyavadhana B