CASE OF DILATATION OF THE HEAR^T, &C. 341 
this last cavity ; and supposing that it existed during life (and 
it appears quite certain to me that, at least, the greater part did 
exist), there remained for the circulation of the venous blood 
but a very small passage at the part farthest from the centre of 
the heart, in the one case, from the left auricle to the ventricle, 
and, in the other, from the ventricle to the pulmonary artery. 
The superior part of the right auricle, like the inferior part of the 
ventricle on the same side, contained some liquid blood. The 
communication of the auricle with the vena cava was free. The 
clot was prolonged considerably into the pulmonary artery ; but 
the greater part of it was of recent formation, and probably after 
death. 
This mass, which I have mentioned above, was only free, as I 
have already said, on that surface which corresponded with the 
parts of the heart the farthest from the centre of that organ; it 
was at this surface only that the blood could circulate, for the 
other parts of the mass were close to the serous membranes of 
the cavities of the heart, and were affixed to them by fibrous 
prolongations. This mass was exactly moulded to the irregula¬ 
rities of the cavity which it filled. It almost entirely closed the 
auriculo-ventricular opening. 
It was formed of three sorts of fibrinous matter, which, exa¬ 
mined on the free surface and on that which was fixed, offered 
the following characters: — First, a layer of matter of the con¬ 
sistence of jelly, reddened with blood, and about an inch thick, 
surrounded the clot; then came a layer of yellow matter, much 
denser, but yielding a great quantity of fluid when pressed. This 
layer was not clearly separated from the third and deepest one. 
This third layer was white, very slightly coloured with yellow; 
the deepest parts of it were perfectly white ; it was much denser 
than either of the other layers, and contained very little liquid. 
In general, these layers,whether considered separately or together, 
and as forming; but one mass, were less dense and more coloured 
towards the open surface. That portion which appeared to me 
to have been formed the longest, and which was the least co¬ 
loured and the densest, was behind the tricuspid valves. 
I found no trace of organization in this mass, which was ho¬ 
mogenous, although I examined the substance of each layer, 
equally distant from the part that I have mentioned as being 
formed first. The membrane on which it was fixed presented no 
sign of lesion. 
There can scarcely be any doubt that, at least, a great part of 
this enormous clot existed before death ; and it is probable that 
its formation was owing to the stagnation, or, at least, to the 
slowness of the course of the blood through the right cavities : 
vol. vxi. y y 
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