THEORIES ON THROMBOGENESIS PRIOR TO VIRCHOW

The first theory was ‘humoral theory’ for lower limb swelling following childbirth predominated prior to 1800. It was thought that during pregnancy, lochia accumulated in the lower limbs leading to swelling, post partum, this retained fluid was thought to be milk. But this theory was soon disputed by doctors towards the end of eighteenth century. Later it was thought that swollen leg following childbirth was result of clots in the blood vessels of legs.

Dr.William Hewson, surgeon and physiologist abandoned the theory of humours for lower limb swelling. He suggested ‘coagulable lymph’, which caused blood in veins and caused lower limb oedema.

Charles White, an eminent obstetrician, in the city of Manchester, described his theory on leg swelling in pregnant women. He thought that this swelling is due to rupture of the lymphatics from pressure of fetus head. He was the first to use the term, ‘phlegmatia alba dolens puerperarium’. Initially, they thought it could occur only in pregnant women, it was only after twenty years, they realized others also can be affected.

There were many doctors who questioned humoral theory and gave alternative explanations that eventually formed part of Virchows’ triad. 

The Swiss Physiologist, Albrecht Von Haller’s explanation was pressure on veins and the slowing of blood flow encouraged the development of thrombosis. Matthew Baillie, Laennec, John Ferriar and other eminent medical scientists  also gave similar explanation.

 Endothelial damage was suggested as a cause of thrombosis by surgeons Joseph Hodgson and Alexander Copland Hutchinson.

Gabriel Andral, distinguished French Pathologist, thought that venous thrombosis occurred due to something inherent in the blood, over 100 years even before the first identification of inherited thrombophilia.

The triad what we know today, hypercoagulability, stasis and endothelial damage were considered even decades before Virchow.

By the early nineteenth century, inflammation as major cause of thrombogenesis was being proposed. During this time, there were increased postmortem procedures, with thromboses frequently observed in association with abscesses and other signs of infection. This led to the thought that one must be linked to the other. 

John Hunter, the famous London surgeon, described ‘phlebitis’ as the cause of clotting and plugging in veins.

Charles Trye, a surgeon from Gloucester, England, stated that ‘ the obstruction to the return of the lymph may commence in the primary inflammation of trunk’ in reference to postpartum women.

Dr.David Davis, an eminent British obstetrician also concurred with the theory of inflammation causing thrombosis. 

The eminent French pathologist Jean Cruveilhier also advocated inflammation as the cause of thrombogenesis. His opinions were held in high regard and it was his work that Virchow was later to dispute in his work on venous thrombosis.

References :

1. Catherine N Bagot and Roope Arys. Virchow and his triad: a question of attribution. British Journal of Hematology. 143; 180-190.

2. Images from google images- wikipedia. 

                                                                                       Written by Dr.Priyavadhana