The first documented case of DVT occurred more that 700 years ago in the middle ages. A 20 year old Norman cobbler, Raoul developed unilateral edema in the ankle and calf which the moved up to the thigh. His physician advised him to “wait and see”. Raoul’s symptoms worsened and he developed a leg ulcer. He visited St Eloi’s shrine, without any improvement. Then he visited the tomb of King Saint Louis. He spent some time in prayer to no avail. He then decided to collect the dust he found below the stone that covered tomb. He applied the dust direct to the ulcer. The story reports he was miraculously healed and was still alive 11 years later. After this story of Raoul, there was increased mention of DVT especially in pregnant and postpartum women.
During the Renaissance physicians thought that pregnancy-related DVT (leading or only cause of DVT) was the result of “evil humors”. It was thought that postpartum DVT was caused by retention of unconsumed milk in the legs (‘milk leg’). Therefore in the late 1700’s breast-feeding was encouraged to prevent DVT.
From 1784 – 1920’s treatment was evidence based. In 1676 Wiseman suggested DVT was a consequence of alteration of blood. In 1793 Hunter hypothesized it was a occlusion of a vein by blood clots. In 1784 Hunter performed ligations (ties) above the blood clot to prevent extension of the clot. Because there was no other treatment for Pulmonary Embolism (PE) this became widely used at the end of the 19th century. This could be done at the femoral, common femoral, iliac or inferior vena cava. Used until mid 20th century along with anticoagulants after they became available.
Since there was great fear of the blood clot migrating and becoming a PE, strict bed rest was prescribed and was the
cornerstone of DVT treatment from the end of the 19th century. Patient’s limbs were set in iron splints to prevent movement and special inclining beds were used to increase venous return.
During the 19th century it was thought that DVT was caused by inflammation of the vein wall, fever, postpartum and after septic surgical procedure. Treatment included anti-inflammatory medication and treatment for infection. Blood letting was popular (especially with leeches) as well as cupping, purging, applying ice or prescribed cold bath. These treatments started becoming obsolete in early 1900’s. Prior to 1930’s (before anticoagulant therapy) treatment was bed rest to fix thrombus, elevation and now application of heat with warm compresses to increase collateral circulation and reduce venous spasm. In hospitals Wright describes the preventative measures such as early ambulation, elastic compression, avoidance of dehydration and tightly applied adhesive strapping.
Next week we will continue with the last 100 years. In the meantime, keep wearing your support stockings and support socks!