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.
902/982 (page 872)
![lower part of the left lung, namely, impaired resonance, imperfect cntiy of ail', and loud, harsh friction. The auricular murmur was no longer audible, but there was a systolic murmur over the pulmonary artery, and obscuration of the pulmonai-y second sound, the coagulum interfering with the proper closure of the valves. Just at this time thrombosis of the right iliac vein appeared, and extensive phlegmasia dolens of the right leg was developed. The patient eventually completely recovered. Sir W. Broadbent’s interpretation was, that there was extension of the thrombus from the auricle into the ventricle and pulmonary artery, and consequent embolism of a branch of the jmlmonary artery. From cases in which signs of pulmonary obstruction have shown themselves without proving immediately fatal, and phlegmasia dolens has appeared shortly after, Playfair argues that the peri- ])heral thrombosis obviously followed the central, both being j)i'oduced by identical causes, and in the instance related above this seems to have been certainly the fact. They may be open, however, sometimes also to the interpretation that thrombosis in a ])clvic vein may first have led to the detachment of an embolus, and afterwards have extended to an iliac vein and produced phlegmasia dolens; or that thrombosis may have occurred succes- sively in two or more veins, as is often found to be the case. One fact about the clinical history is in favour of the view that embolism is much more frequent than primary thrombosis of the pulmonary artery. This is that, in the great majority of cases, the attack comes on with appalling suddenness, which forms one of its most striking characteristics. It is thus allowed that there is no difference in symptoms between embolism and what is interpreted as having been primary tlirombosis. It might be expected, however, that the onset of symptoms would be more gradual in thrombosis, as it seems to have been in the case recorded above, where thrombosis commenced in the right auricle. The cases which are most likely to be due to thrombosis com- mencing either in the auricle or in the pulmonary artery itself are those in which the symptoms of dyspnma come on within a few days after delivery, and in which they have been preceded by great depression of the circulation, owing to exhaustion from difficult labour, or hmmorrhage, or both. Symptoms and course.—The primary thrombosis in a pelvic vein, if such has existed, gives, as a rule, no sign of its presence. Hence the attack of dyspnoea, in the majority of cases, come on quite unexpectedly. In some cases the puerperal period has apparently progressed quite normally, and the patient may be beginning to get about again. Frequently, liowever, there has either been a protracted and exhausting labour, or there has been more or less pyrexia within the first week, indicating some degree](https://iiif.wellcomecollection.org/image/b21932645_0902.jp2/full/800%2C/0/default.jpg)
