DISEASES OF THE HOKSE, 245 



converted into pus, constituting- suppurative phlebitis. These sub- 

 stances occur most frequent!}" in those affections characterized by 

 f^reat exhaustion or debility, such as pneumonia, purpura hemor- 

 rhagica, endocarditis, phlebitis, puerperal fever, hemorrhages, etc. 

 These concretions ma}- form suddenl}- and produce instantaneous 

 death by retarding' the blood current, or they may arise gradually, in 

 which case the thrombi may be organized and attached to the walls of 

 the heart, or they may soften, and fragments of them (emboli) may 

 be carried awa3\ The small, wart-like excrescences occurring some- 

 times in endocarditis ma}- occasionally form a foundation on which a 

 thrombi maj' develop. 



Symjytoms. — When heart clot, or thrombus, exists in the right side 

 the return of blood from the bod}^ and the aeration in the lungs is 

 impeded, and if death occurs it is owing to S3'ncope rather than to 

 strangulation in pulmonar}" respiration. There will be hurried and 

 gasping breathing, paleness and coldness of the surface of the bod}", a 

 feeble and intermittent or fluttering pulse, and fainting. When a 

 fibrinous coagulum is carried into the pulmonary arter}" from the right 

 side of the heart, the indications are a swelling and infiltration of the 

 lungs and pulmonar}' apoplex}". When the clot is situated in the left 

 cavities of the heart or in the aprta, death, if it occurs, takes place 

 either suddenl}^ or at the end of a few hours from coma. 



Pathology. — When a coagulum is observed in the heart it may become 

 a question whether it was formed during life or after death. The 

 loose, dark coagula so often found after death are polypi. If the 

 deposition has taken place during the last moments of life, the fibrin 

 will be isolated and soft, but not adherent to the walls; if it be isolated, 

 dense, and adherent or closely intertwined with the muscles of the 

 papillae and tendinous cords, the deposition has occurred more or less 

 remote from the act of dying. Occasionally^ the fibrin may be seen 

 lining one of the cavities of the heart, like a false endocardium, or else 

 forming an additional coat to the aorta or other large vessels without 

 producing much obstruction. Thrombi, in some instances, soften in 

 their centers, and are then observed to contain a pus-like substance. 

 If this softening has extended considerably an outer shell, or cyst, only 

 m:iy remain. The sources of danger exist not only in the interruption 

 of the circulation of the blood, but also in a morbid state of the system, 

 produced by the disturbed nutrition of a limb or organ, as well as the 

 mingling of purulent and gangrenous elements with the blood. 



Treatment. — The urgent s3'niptoms should be relieved by rest, stim- 

 ulants, and the use of agents which will act as solvents to the fibrinous 

 clots. Alkalies are specially useful for this purpose. Carbonate of 

 ammonia may be administered in all cases of thrombus, and should be 

 continued for a long time in small doses several times a da}'. Incases 



