Licence: Public Domain Mark
Credit: The practice of medicine / by Thomas Hawkes Tanner. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
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![puncture or bite. To prevent absorption, a ligature is at the same time to be tied between the wounded part and the trunk. It will also be ad- visable to apply lunar caustic freely to the wound. In other respects the treatment must be that just mentioned. 10. THROMBOSIS: EMBOLISM.—The fact has long since been proved by many independent observers, that when the blood contains— either absolutely or relatively—a great excess of fibrin (hyperinosis), or when this fluid gets contaminated by the introduction of foreign par- ticles or other impurities, as well as when there exists any obstacle to the normal circulation, then fibrinous formations may take place during life in the heart, or in the arteries, or in the veins, or in the cerebral si- nuses, or in the portal S3Tstem. The symptoms which these solid sub- stances (formerly known as polypi) give rise to are such, that their ex- istence can with care be diagnosed. When a portion of fibrin coagulates in one of the arteries and is carried along by the blood-current, it will of course be arrested in the capillaries, if not before: when the solidifica- tion occurs in the veins, the clot need not necessarily be stopped till it reaches the lungs : when in the portal system, the liver capillaries will offer an obstacle to the further progress of the substance. And although it should be noticed that emboli may form in the lymphatics, yet the pas- sage of these vessels through glands must prevent the transit of any body for any great distance along them. Pathology.—Before entering upon this part of the subject, it is neces- sary to give an explanation of the terms employed. By thronibosis [dpdfiSoq = a clot of blood] is generally understood the partial or com- plete closure of a vessel, by a morbid product developed at the site of the obstruction. The coagulum, which is usually fibrinous, is known as an autochthonous clot or thrombus. The term embolism \^'E/x§oXoq = a, plug] is used to designate an obstruction caused b}r any body detached and transported from the interior of the heart or of some vessel. The migra- tory substance is an embolus. Thrombi or emboli vary in size—from a mass sufficient to obstruct the aorta, to a particle which can enter a capillary vessel. They consist not only of fibrin, but possibly of a fragment of gangrenous tissue, or per- chance of a portion of tubercle or cancer which has got drawn into a ves- sel. The formation of a thrombus in a bloodvessel may act primarily by causing complete or partial obstruction. The secondary disturbances are twofold: in the first place, larger or smaller fragments become detached from the end of the thrombus, and are carried along by the current of blood to remote vessels (embolism) ; or, secondly, the coagulum softens and becomes converted into a matter like pus,—constituting according to Virchow the process called suppurative phlebitis. These concretions are most frequently met with in diseases attended with great exhaustion or debility; and they have been especially found in cases of croup, diphtheria, scarlet fever, endocarditis, pneumonia, bron- chitis, phthisis, typhus, purpura, erysipelas, hemorrhage, and prostration from natural decay as well as from dissipation. With regard to croup, for example, my own experience would lead me to believe that death is](https://iiif.wellcomecollection.org/image/b21079961_0071.jp2/full/800%2C/0/default.jpg)
