FIBRINOUS DEPOSITS IN THE HEART, 379 



meiiiorrhage ; and it is sometimes possible to make out the physical 

 signs which mark the progress of the flow into the pericardium. 



CHAPTER XII. 



FIBKINOUS DEPOSITS IN THE HEART. 



WE seldom dissect a body without finding in its heart a clot of 

 fibrin, especially in the right side of the organ. Sometimes the clot is 

 yellow, consisting entirely of fibrin, which has separated from the red 

 portion of the blood ; sometimes it contains red corpuscles, and is more 

 or less colored. Their tenacity is variable, and they are usually en- 

 tangled among the trabeculae, but may easily be separated from the 

 endocardium. In the bodies of persons who have died of pneumonia, 

 or other disease in which the fibrin of the blood is increased in quan- 

 tity, these coagula are found especially large, and, if removed from the 

 heart, long clots, forming prolongations into the arteries, are drawn 

 after them. These fibrinous clots, or false polypi of the heart, have 

 formed after death, or during the period of dissolution. The more pro- 

 tracted the latter, so much the longer is the blood, as it were, whipped 

 up in the heart, so much the more completely is the fibrin separated 

 from the red blood, and so much the more colorless and intimately en- 

 tangled in the trabeculae is the resulting clot. In other instances, the 

 coagula seem to have formed some time before death. The fibrin has 

 lost the elasticity and glitter of fresh fibrin, and is firmer, drier, and 

 yellower. The clots are tightly adherent to the endocardium, and we 

 sometimes find their interior decomposed into a puruloid, yellowish, or 

 brownish-red emulsion, or converted into a yellowish, cheesy mass. 

 No real pus is formed, but a mess of debris, in which colorless blood- 

 corpuscles must not be mistaken for pus-corpuscles. 



Sometimes we find fibrinous deposits in the heart, in the form of 

 rounded, wedge-shaped masses, in size from that of a millet-seed to 

 that of a nut (Laenneds vegetations globuleuse). If we examine their 

 mode of attachment more attentively, we perceive numerous roots prc*- 

 ceeding from the spherical vegetations, which are prolonged deeply into 

 and entangled among the meshes of the trabeculae. The source of th< 

 vegetations is to be sought there ; the spherical form is the result ot 

 subsequent deposit upon the clots first formed. Here, too, the soften- 

 ing just mentioned is found sometimes in the interior of the coagulum, 

 so that at last they may assume the appearance of sacs, with thin walls 

 and puruloid contents. We have already spoken of the deposits which 

 form upon roughened places on the endocardium, from endocarditis, 

 acute or chronic aneurism of the heart, and valvular disease. 



