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Deep Venous Thrombosis: Hunter, Cruveilhier, Virchow, and Present-Day Understanding and Clinical Practice

Paul S. Agutter, P. Colm Malone

Abstract


During the past 50 years, systematic misunderstandings of Virchow's contribution to the study of deep venous thrombo-sis (DVT) have distorted thought and opinion in this field. Virchow's main concern was with the formation of pulmonary emboli, not with the generation of venous thrombi per se. In particular, the elements of what has become known as ‘Vir-chow's triad' had nothing to do with the formation of thrombi but with their metastasis to produce emboli. Nevertheless, Virchow made two particularly important observations about venous thrombogenesis that have been largely overlooked since the 1950s: thrombi are initiated in valve pockets; and their initiation is associated with a massive local accumula-tion of leukocytes. He also distinguished clearly between in vivo thrombi and ex vivo blood clots. In this paper we ex-plore the background and motivation to Virchow's work, which lies in the earlier studies of John Hunter and Jean Cruveilhier, and the methods he used, particularly his reliance on the recently-improved microscope. We also consider the work of Virchow's successors and explore the circumstances leading to the eventual distortion of his legacy.

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