BLOOD, MORBID CONDITIONS OF THE. 



man but in the larger warm-blooded animals, 

 and adverts to a disease, la gourme, common 

 among horses, which arises from a coagulation 

 of the blood in the large arteries and veins and 

 in the heart. Thackrah is of the same opinion, 

 and Dr. George Burrows, who has made the 

 changes which take place in the blood when 

 its circulation is stopped in the living body, 

 the subject of the Croonian Lectures of the 

 present year, states that " there can be but 

 little doubt that in some cases the blood coa- 

 gulates in the heart during life. The firmness 

 of the clots found in its cavities after death 

 their close adhesion to the lining of the heart 

 the presence of various fluids in the centre of 

 these clots the occasional organization of the 

 coagulated masses, and their partial conversion 

 into structures which are similar to new growths 

 in other parts of the body are facts which 

 lead us to the conviction that the blood often 

 coagulates in the heart long prior to death." 



That such coagulation may take place during 

 life I am willing to admit, but I am by no 

 means led to the conviction that such an event 

 often occurs. To the formation of a firm coa- 

 gulum I am persuaded that rest is absolutely 

 necessary, and I must consider it as a very rare 

 occurrence that the contents of the cavities of the 

 heart should be at rest during life. The usual 

 appearance of false polypi is such as would 

 take place in blood that coagulated very slowly, 

 whether in or out of the body. Mr. Thackrah 

 has proved that the blood when at rest coagu- 

 lates much more slowly in living vessels, 

 among which his experiments include vessels 

 recently removed from living animals,* than in 

 those that are dead ; and I conceive that the 

 human body, long after the heart has ceased to 

 beat, and when it is, in the common accepta- 

 tion of the term, dead, is still endowed, like 

 the vessel just separated from the living animal, 

 with a sufficient share of vitality to keep the 

 blood which is in the heart and larger vessels 

 in a fluid state, and thus to permit its coagula- 

 tion to take place at length far more slowly 

 than under ordinary circumstances. The fol- 

 lowing fact will perhaps be considered to have 

 some interest as bearing on this point. I was 

 engaged in the post-mortem examination of a 

 gentleman who had died apoplectic from soft- 

 ening of the brain, which had given rise to effu- 

 sion into the ventricles and under the pia mater; 

 and being desirous of examining the fluid thus 

 effused, I collected it with a clean sponge, by 

 successively dipping this into the ventricles, and 

 squeezing the fluid into a small cup. With a 

 view to increase the quantity, I used the sponge 

 also in soaking up some of the same fluid 

 which had been caught in the calvaria, but 

 was somewhat tinged with red particles. The 

 cup was set apart till the conclusion of the ex- 

 amination, which lasted an hour and a half, 

 when, on proceeding to transfer its contents to 

 a phial, I was not a little surprised to find that 

 a bulky clot of a rose colour and perfectly dis- 

 tinct was formed in the fluid. The examina- 

 tion in question took place twenty-two hours 



421 



after death. As long as galvanism will stimu- 

 late the muscular structures to convulsive 

 movement, so long at least may we conceive 

 such a portion of vitality to remain us will in- 

 fluence the state of the blood. The fluid thus 

 circumstanced exhibits the same phenomena, 

 though in a more marked degree, which we ob- 

 serve in buffed blood out of the body. The 

 red particles subside and leave the liquor san- 

 guinis free from colour. In due time this 

 separates into fibrine and serum : the coagula- 

 tion takes place uniformly and universally, and 

 in the larger cavities and vessels a colourless 

 clot is left, which is moulded into their exact 

 shape. The serum drains off, and washes away 

 the red particles into the more depending and 

 distant vessels. Thus it is that where we find 

 polypi in the heart, we often find the descend- 

 ing aorta and the vena cava inferior filled with 

 fluid, in which there is no fibrine at all. The 

 firmness of a polypus affords no proof that it 

 existed during life, or rather before respiration 

 and circulation had ceased ; for what can be 

 firmer than the buffed coat which we often see 

 formed out of the body ? Its close adhesion to 

 the lining of the heart is generally in appearance 

 only, and is occasioned by the exactness with 

 which it has adapted itself to every cavity and 

 sinus, and enveloped every column, and the 

 force with which the heart itself has contracted 

 upon it. The presence of fluid in the centre, 

 however difficult to account for, is also occa- 

 sionally met with in the crassamentum of blood 

 abstracted from the arm ;* and even purulent 

 matter, said to be found in false polypi, is oc- 

 casionally formed out of the body. " In some 

 rare cases I have seen the fibrine," says Andral, 

 " assume a different aspect. The b!ood had 

 no clot, and instead of it we observed at the 

 bottom of the basin a kind of homogeneous 

 purulent matter of a deep brown or dirty grey 

 colour, and rather resembling sanies than 

 blood." 



With regard to the existence of organization, 

 it seems to me that sufficient distinction has 

 not usually been made between those cases 

 where the lining membrane of the cavities of 

 the heart or vessels has been ruptured, and 

 which in so far are of the character of aneu- 

 rism, and those where that membrane has re- 

 mained entire. I am willing to admit that 

 where there is a lesion of surface, adventitious 

 growths will readily spring from it; but their 

 substance is furnished from the structure be- 

 neath, and not from the circulating fluid. As 

 an instance, I may mention the case of a youth 

 who, being in perfect health, received a sudden 

 shock from the unexpected discharge of a pistol 

 close to his ear. He immediately felt conscious 

 that something had given way in his heart, and 

 from that hour suffered from palpitation, occa- 

 sional syncope, with the usual symptoms of 

 obstructed circulation, and died of general 

 dropsy at the end of eighteen months. On ex- 

 amination after death the mitral valve was 

 found to be obstructed by a fringe of excre- 

 scences, originating no doubt from a rupture of 



* Thackrah on the Blood, p. 85, cxpt. lii. & liii. 



See Hewson, p. 69 and 70. 



