OCCLUSION OF THE INFERIOR VENA CAVA, AS A RESULT OF INTERNAL TRAUMA (DISSECTING VARIX?): The Case of the late Dr. W. Rivers Pollock
Authors: S. G. Shattock
Journal: BMJ (1913)

THE parts WhliChl 'orlml the subject of this commn-iiiication wNere bequeathte(d to the Royal College of Surgeons, for (lissectioli, by tlhe late Dr. WV. Rivers Pollock, at the time of hiis deatlh (1909) Obstetric Physician to the Westminster Hospital; alnd this he did, bjy reason of the siDgu'lar, if niot uniquie, cliniical hiistory conniected witlh hlis disease.I mfiay first give the latter, tlhen describe tlle specimen, and finally make a slhort comment on the case. History.In 1884, Pollock, wlhen about 24 years of age, and in a coiadition of perfect lhealthl, won the 120 yards lhurdle race in the Camtibridge University sports-16' seconds.In the samne year he rani successfully for Calmlbridge against Oxford, performing the same feat in 16 seconds.Rie lheld his breatlh during the wlhole timile.This record lhas since been equalled; and was broken in 1907 by K. Powell, of King's College, Cambridge.Immediately after the race was over lie lay on the grass, and witilin a few seconds com-tplained of pain in the lumnlbar spinal region.He was put to bed, whler'e he remiained for six niiontlis.Oedema of tlhe legs, anid to a lesser degree of the abdomien and scrotuiIi, supervened at once, and persisted for the period meentioned.Whilst ki bed, the superficial veins began withiin a few days to dilate, and this dilata- tioni slowvly progressed.Duiring tlle rest of life the distended veins were sup- lorted by the systematic use of carefully adjusted elastic pants reaching as hiiglh as tlle tllorax.Albtum-iinuria appeared directly after the event, and persisted throuhllout life.Deatli occurred on October 5tlh, 1909-tweinty-five yeai-s later.Mr. Artlhur Evans, wlio attenided the patient duiring tlle last six yeai's of lhis life, iniformiis me that lhe was subject to attacks of phlebitis and tlhromlbosis in the enilarged ,saphenous veiiis, these attacks beiDg leadily brouiglht oni- for exailile, by the pressure of a crease in the elastic p-anlts.On Septem-ber 25th, 1909, tlie patient nioticed soene tenderness and discoloration belhind the riglht internal iinalleolu-s; this extenided to the dorsumll of tlhe foot; on the 29th the temperature was founnd to be 100( F., and lie lhad a slight rigor.The Ilext day hiis thlroat became sore, miiid on October 1st the sigoos of well-marked tonsillitis alp)peared, tllc lesion on tIm foot having vanislhed.The tliroat becamie more painful, anid tile temliperatture lkept up.Oni October 4th, tlle riglit tolsil was freely incised unlder gas; miot lilore tilan tlhree or foulr dirops of pis escalped.Deathl toolk place oni tllh day followinig, and was attributed to tonsillitis and septicaemiiia.Dr. J. N. Bernstein, who made the autopsy, tells ine tlhat, altlhough carried out within six lhours after deatlh, thlere was suchl a degree of generalized emplilysema as to render a satisfactory examination of the viscera imipossible.Description of the SpCecimzen.Tile preparation compriscs the superior and ilnferior venae cavae, wanting their cardiac termninations.Tile riglt azygos vein is considerably dilated.Except for its highlest part, tlle wlhole of the portion of the inferior cava preserved is converted into a flat im- lervious ribboln, wlhichl is most contracted and thinnest for a distance of 6.5 cm.(21 in.) opposite and below tile renal veins.A portion h-as been cut away frolmi tile front of tlle vessel below tlho veins last niamed, slhowing thlat its lumiien is completely occluded.The common iliac veins and tlle portions of thle external and internal preserved are Read before the Pathological Section of the Roy0al Society of Mledicine.