241 



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 (em- 

 boli) may be carried away. The small, wart like excrescences, occur- 

 ring sometimes in endocarditis, may occasioually form a foundation on 

 which a thrombi may develop. 



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

 return of blood from the body and the aeration in the lungs is im- 

 peded, and if death occurs it is owing to syncope rather than to stran- 

 gulation in i)ulmonary respiration. There will be hurried and gasping 

 breathing, paleness and coldness of the surface of the body, a feeble 

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

 coagulum is carried into the pulmonary artery from the right side of the 

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

 pulmonary apoplexy. When the clot is situated in the left cavities of 

 the heart or in the aorta, death, if it occurs, takes place either suddenly 

 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 iso- 

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

 and adherent or closely intertwined with the muscles of the papillag 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 addi- 

 tional coat to the aorta or other large vessels without producing much 

 obstruction. Thrombi, in some iustau.'3es, 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 may 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 dis- 

 turbed nutrition of a limb or organ, as well as the mingling of purulent 

 and gangrenous elements with the blood. 



Treatment. — The urgent symptoms 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 day. In cases 

 of great debility associated with a low grade of fever, stimulants and 

 tonics, and nitro-muriatic acid as an antiseptic, may be beneficial. 



DISEASES OF VEINS — PHLEBITIS. 



Intlammation of veins may be simple or diffuse. In simple phlebitis 

 the disease of the vein is confined to a circumscribed or limited portion 

 of a vein ; in diffuse it involves the vein for a long distance; it may even 

 extend from a limb or foot to the heart. 

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