268 DISEASES OP THE HOESE. 



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 coina. 



Pathology. — ^When a coagulum is observed in the heart it may be- 

 come 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 oc- 

 curred 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 con- 

 tain a puslike 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 disturbed nutrition 

 of a limb or organ, as well as the mingling of purulent and gan- 

 grenous elements with the blood. 



Treatment. — The urgent symptoms • should be relieved by rest, 

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

 fibrinous clots. Alkalis are specially useful for this purpose. Car- 

 bonate of ammoiiia 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, OR PHLEBITIS. 



Inflammation of veins may be simple or diffuse. In simple phleb- 

 itis 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. 



Cwuses. — Phlebitis may be induced by contusions or direct injuries, 

 an extension of inflammation from surrounding tissue, such as in 

 abscess, formation of tumor, or malignant growth. It is often due 

 to embolism of infective material, gangrenous matter, etc. Blood- 

 letting from the jugular vein is occasionally followed by dangerous 

 phlebitis. 



