Remarks on the fibrinous element of the blood in relation to disease : read before the Medical Society of London, Nov. 15, 1851 / by Benjamin W. Richardson.

  • Richardson, Sir Benjamin Ward, (1828-1897)
Date:
1851
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Credit: Remarks on the fibrinous element of the blood in relation to disease : read before the Medical Society of London, Nov. 15, 1851 / by Benjamin W. 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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    cause of death by syncope,* * * § * and I find Cullen,f and many others, making the same allusion. A very interesting symptomatic fact with reference to these concretions is, that no symptom has attracted so much attention during their existence in the heart, as the vio- lent palpitations which they seem to induce ; and it is still more curious that a late author at the Royal Med. Chir. Society, in describing a case of the kind occurring in a patient of his own, speaks of violent palpitations of the heart as forming the chief peculiarities of the case.j Did the occasion permit, I could lay before you many cases illustrative of the effects of these concretions in producing sudden death, and proving that we might not be far from right in falling buck in this matter, on some of the observations of the old school. The subject, however, has not been entirely neglected in the present day. Dr. Hughes has pro- duced an elaborate paper on the subject, in which he has divided these con- cretions into different varieties, and has given a table containing a great many cases, with intent to show that such concretions are more commonly found on the arterial, than on the venous side of the system. I have looked over this table, I may add, and in addition have taken the pains to collect evidence on the subject from many more cases, and the result is, that I can second Dr. Hughes’ supposition, though at the same time I may re- mark, that the difference is not very striking. Dr. Hughes also affords further dis- tinctive marks of cadaveric and anti- cadaveric polypi, and speaking of'the efi'ects of these concretions in the living heart, he supplies cases of sudden death from their presence.§ In a paper read before the Medico- * Queye de Syncope et causis earn producen- tibus. Hall. Disp. Anat. vol. vii., Gottingen, 1735. t Cullen’s First Lines of Practice of Physic, edited by Gregory. Edin. 1829, vol. ii., Art. Syncope, p. 38. t Dr. Fletcher, of Birmingham. § Guy’s Hospital Reports, vol ii., p. 147. The subject has also been ably discussed by M. F. Fredault, in an Essay on Polypiform Concretions. He look6 upon these clots as pseudo-membra- ous transformations deposited from the plasma of the blood during life, and believes fully in the coagulation of blood in the body.—Archives G^n^rales de Alldecine, July, 1847. Chirurgical Society, Dr. Barclay has also briefly alluded to this subject; and from the observation of 79 cases in which the heart was examined, he is led to conclude that fibrinous concre- tions are most common in the young.* With this opinion I fully concur, and I think it accords admirably with the fact pointed out by Wagner, and other phy- siologists, that the fibrinous element exists in all animals in greater propor- tions during the first periods of life Lastly, it occurs to me that in some cases of death by asthenia, where these fibrinous concretions are found filling entirely the outlets and the cavities of the heart with an extension even into the bloodvessels, the very cessation of the act of life may be owing to their presence, the central organ of the cir- culation becoming literally choked by them. J n a case which I had an opportunity of inspecting in the month of August last, I was particularly struck with this occurrence:—A gentleman, who had been accustomed to business habits, was suddenly seized, while preparing for a continental tour, with considerable paralysis on the right side of the body. At the same time the lungs showed signs of tubercular deposit. He was kept quiet, and lived on for three months, being carefully supported throughout with good food, which he always took with appetite, and seemed to digest easily. He sank, however, and died by a gradual failure of the circula- tion. At the autopsy, the corpus stria-. turn of the left side was found a little softened, and the lungs were filled with miliary tubercles; the heart was soft, and the aortic orifice and the ascending part of the aorta were completely filled with a round, dense fibrinous cord, which had evidently been for some time in process of formation. The same thing was also found in the pulmonary artery, but the concretion was not quite so large and firm. A case differing somewhat from this in primary symptoms, but ending by asthenia in a similar manner, is re- corded by Dr. Corrigan in the Dublin Hospital Gazette.f A man was ad- mitted into the Richmond Hospital * Med. Chir. Trans., vol. xxxii., p. 135. Dr. Barclay does not, however, altogether incline to th theory of the direct depositions of fibrine. t Vol. ii., Dec. 15th, 1845.