Licence: In copyright
Credit: A manual of midwifery / by Alfred Lewis Galabin. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![cause, aud the entrance of septic material into the circulation. It is only the milder forms of septic infection, however, which are likely to lead to sudden death through embolism of the main trnnlc or largest branches of the pnlmonaiy artery. If the clot itself has a definitely septic character, and contains septic organisms, it quickly becomes disintegrated. Small fragments are then apt to be detached, and either plug small branches of the pulmonary arteiy, or pass through the pulmonary capillaries and cause minute emboli in other parts of the body. This condition has already been described in the chapter on puerperal fevers as leading to visceral pyojmia. The clot may, however, be apparently healthy, even though entrance of septic material has had something to do with the coagulation : perhaps because the influence has been that of sapracmia only, not septica3inia. In such case, if detached at all, it is more likely to bo detached in a considerable mass, and plug a largo branch or the main stem of the pulmonary artery. (Jonsiderable controversy has taken place as to whether individual cases should bo interj)retcd as embolism or as primary thrombosis of the ])ulmonary artery. On the one hand it is argued, and the argument has much weight, that it is not likely that coagulation should take place first in a situation where the current is so rapid as it is in the pulmonary arteries. On the other hand it is said that the pulmonary artery breaks up at once into a number of branches, which radiate from it at different angles to the several parts of the lung. Consequently a large extent of surface is pre- sented t(j the blood, aud tliere are numerous angular projections into the currents; both which conditions are calculated to induce the spontaneous coagulation of the fibrin.* This mode of bifurca- tion must also cause considerable retardation of the current, which may therefore become slow enough to allow coagulation when the heart’s action is greatly depressed. Extensive coagulation may be found in the pulmonary arteries and right heart after death, having the appearance of being due to thrombosis. It is to be remembered, however, that an embolus always causes the deposit of fresh fibrin on its surface, and thus leads to secondary thrombosis, extending backward toward the heart. A small primary embolus maj'^ thus escape detection. Moreover, it is often difficult to say whether the extensive thrombosis may not have been formed only during the death agony. Most of the best pathologists, however, are of opinion that embolism of the pulmonary arteries is much more frequent than primary thrombosis. An embolus is distinguished by its being more decolorised, and distinct in appearance from the thrombosis formed iqion it, and by its generally being situated at a point of * Himiiihry, On the Coagulation of the ]!Iood in the Venous feystcni iluring Life.](https://iiif.wellcomecollection.org/image/b21932645_0900.jp2/full/800%2C/0/default.jpg)
