On fibrinous deposition in the heart / by Benjamin Ward Richardson.

  • Richardson, Sir Benjamin Ward, (1828-1897)
Date:
1860
Catalogue details

Licence: Public Domain Mark

Credit: On fibrinous deposition in the heart / by Benjamin Ward Richardson. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    jftbrtnous ©{position in tlje Heart CHAPTER I. N opening the bodies of the dead, we find any blood that may be in the heart in one of three conditions. (a.) As a coagulated red clot, hut with no surrounding serum. In this latter re- spect, the blood differs from ordinary blood drawn from the body, and set aside for coagulation. It must not be assumed, however, that in the dead body serum does not separate. It does separate, the same as in cases where blood is drawn ; but it appears to me that for some time after death an osmotic action is continued in the body, by which the serum is removed. When, some hours pre- viously to the injection with wax, the vessels of the subject preparing for dissection are injected with a watery solution containing arsenic or sulphate of zinc, the solution thus thrown in does not remain in the vessels ; it is absorbed and received into the soft parts, where the capillaries are so plenti- fully distributed. This same kind of absorption, I presume, removes the serum as it is extricated from the clot, thus leav- ing the post mortem red clot free of serum. (6.) There is another condition of blood found after death, in which perfect fluidity of blood is maintained. This fluidity —which, by the way, is very rare—is met with in two classes of oases. In some instances, from chemical changes going on during life, the coagulability of the fibrine is destroyed. In cases of typhus—I mean true petechial typhus—this condition has been observed; it has also been seen in scurvy, yellow fever, and in examples where water has been largely intro- duced into the circulation in the lower animals. The fixed alkalies carried on to a poisonous result, will cause the same fact. Cyanide of potassium and antimony lead to a like phe- nomenon. If blood thus obtained be set aside, it will not coagulate, although placed in conditions the most favourable to coagulation. In another class of cases, the blood may be found fluid in the heart, not because the coagulating process is destroyed, but because the conditions favourable to coagu- lation are not presented. The law on this point seems to be this. If in any given case the life of a person is suddenly extinguished while yet the blood is in a state of perfect fluidity in the vessels, and if in the cause which produced death no portion of the closed circuit of the vascular system is opened, and if the vessels are themselves filled with blood, then the volatile alkaline solvent by which the blood has been held fluid is retained, and the blood remains fluid until it is exposed to the air. On such exposure, however, coagulation takes place; but, as the temperature of the blood falls after death to the tem- perature of its surrounding medium, the coagulation will be slow, as compared with that of warm blood drawn from a living man. The period required for coagulation, in short, will be the same as it would be in a mass of newly drawn blood sud- denly reduced in temperature from 98° to the temperature of the dead. This condition of fluid blood after death is met with in instances where the death has suddenly occurred from shock, from chloroform syncope, from hanging and other varieties of asphyxia, and the like. (c.) The third class of cases embraces those in which the blood is found in the heart with the fibrine separated; and as these are the cases of most interest to us at this time, I may leave the others without further note, in order patiently to trace out, and as nearly as possible in the order described, the following points. i. The various forms of concretion in the heart, and the modes by which they are produced. ii. The conditions of disease under which concretions are produced, and the periods in the course of a disease at which they occur. in. The symptoms indicating fibrinous deposition, and the point at which the deposition has taken place, iv. The value of a knowledge of the subject of fibrinous deposition, in the practical treatment of disease. B