Sudden death from plugging of the pulmonary veins in a pregnant lady : read at the Medical Society of London / by Edward Smith.

  • Smith, Edward, 1818?-1874.
Date:
[1853]
Catalogue details

Licence: Public Domain Mark

Credit: Sudden death from plugging of the pulmonary veins in a pregnant lady : read at the Medical Society of London / by Edward Smith. 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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    I am better,” and expired. The face was deeply livid, and the body bent, so that the chin approached her knees. When 1 saw her, the face was blanched, and she lay stretched on the bed. Having learned several of these particulars within a few minutes after my arrival, I became anxious as to the propriety of perform- ing the Caesarian section, to save the child; but, since so long a period had already elapsed after the death of the mother, since I had neither stethoscope nor scalpel with me, having been summoned from church ; since, moreover, I knew nothing of the case pre- viously, and could not fully persuade the husband and friends of the reality of their loss, I determined not to perform it. By the kindness of Mr. Bartlett, I had the opportunity of assisting Dr. Jackson and himself at the post-mortem examination, forty hours after death, and of making the requisite microscopic investigation of the tissues. The features had lost somewhat of their pallor, and a fluid, very slightly sanions, was exuding from the mouth and nostrils. The under part of the body, as it lay on the table, was not only greatly congested, but presented many well-marked, purplish-black petechiae. The left leg was not swollen or inflamed. The blood was black and fluid universally, except in the pulmonary veins, where the whole tube was filled by a cylinder of coagulum, having a central clot of blood, enclosed by two layers of condensed fibrin, the outer one of which was colourless, and the whole so firm in texture, that it could be handled and pressed with impunity. It was not strongly adherent to the lining membrane of the vein. The number of white corpuscles was considerably beyond the normal standard. The heart was flaccid, and rather enlarged on the right side. The tissue was undergoing the process of granular degeneration, or the first step of the process of fatty degeneration, and move particularly on the right side. The left side was empty —without coagula, even.' The right ventricle contained, and the right auricle was distended with, fluid, black blood. The valves were healthy. The arteries were preternaturally small, so much -so that the aorta at its bifurcation could not admit the end of a small little finger, and the capacity of the external iliac was not greater than that of a swan’s quill. Neither blood nor coagula were found within any of them, nor were any of them ruptured. The veins were immensely and universally distended, and appeared to be as much larger as the arteries were smaller than the natural size. The inferior cava was fully an inch and a quarter in diameter. The most remarkable enlargement, however, was in the ovarian veins; but whether this enlargement was greater than is usual at the full term of utero-gestation, before labour has commenced, I cannot tell. They were about twelve inches in length, by three-quarters of an inch in breadth, and passed in a curved direction from the ovarian plexus in the broad ligaments, along the iliac fossa;, to the front of the vena cava on the right, and to the renal vein on the left side. The left was the larger of the two. The right one nar thinner coats, so that the dark blood within it was more evident, and terminated by an opening so constricted, that a crow-qun