Cardiac hypertrophy with constriction and incompetency of the mitral valve following rheumatic fever; sudden apoplectic seizure; paralysis of whole of left side; death in eight days : obstruction of right middle cerebral artery by a firm mass of fibrin and softening of brain.

Date:: [1858?]

Credit: Cardiac hypertrophy with constriction and incompetency of the mitral valve following rheumatic fever; sudden apoplectic seizure; paralysis of whole of left side; death in eight days : obstruction of right middle cerebral artery by a firm mass of fibrin and softening of brain. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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$into the smaller branches entering the substance of the brain at the locus perforatus anticus, as far as they can be traced. The Coagulum with which they are filled is firm and hard, and adheres strongly to the walls of the vessels. The basilar arteries, and other portions of the circle of Willis are quite free. Microscopic examination reveals extensive fatty degeneration of the ganglion- cells of the right corpus striatum, while in many parts of this body, nothing but fatty debris can be found. The capillaries and smaller arteries of this part have also undergone a highly marked fatty degeneration of their walls. Thorax Opened.—RigJd Lung.—Bronchi considerably injected, even into the finest divisions, and contain much reddened mucus. In the posterior part of the middle lobe there is a spot of pul- monary apoplexy of about three inches in diameter, of a dark purple colour, hard and resistent to finger, and evidently recent. In the centre of this spot there is found a branch of the pulmon- ary artery occluded by a fibrinous coagulum which is firmly adherent to its walls, but its further ramifications cannot be satis- factorily followed. Pulmonary tissue in other parts healthy. Left Lung.—Characters of Bronchi same as on right side. Pulmonary tissue perfectly healthy throughout. Heart.—Amount uncovered by lung abnormally large. Per- icardium opened, contains about 2 oz. of a clear yellow serum. Heart is very much enlarged. This is especially the case in the right auricle, which measures If inches in length, by 2^ inches in breadth ; and when distended with blood \ \ inches in depth. Breadth of heart at base, 5 inches ; length of ventricle from Conus Arteriosus to apex 5| inches. Right Auricle.—Greatly distended with a dark clot of firmly coagulated blood. Walls much thickened. Musculi pectinati strongly developed. Considerable thickening of walls of vense- cav0e superior and inferior, both at orifice of auricles, and ex- tending for some distance into veins. In auricular appendage there is a firm fibrinous coagulum, of a dark reddish grey colour, very firmly adherent to walls and to musculi pectinati, and presenting the appearance of having existed for some time pre- viously to death. It nearly fills the auricular appendage, and extends also into the auricle, where it is firmly interlaced among the musculi pectinati. Its edges are rough and irregular. Tricuspid Valve, admits easily the thumb, and the tips of four fingers of observer. Right ventricle is greatly distended with a dark clot of firm well coagulated blood. Walls of ventricle in central part are | of an inch in thickness, not quite ^ inch at apex. Considerable thickening has taken place at the edges of the flaps of the valves. Chordae tendineoe attached to the an-$