Coagulum

“ When the clarified juice of nutritious vegetables, such as cauliflower, asparagus, mangelwurzel, or turnips, is made to boil, a coagulum is formed, which it is absolutely impossible to distinguish from the substance which separates as a coagulum, when the serum of blood, or the white of an egg, diluted with water, are heated to the boiling point. This is vegetable albumen. It is found in the greatest abundance in certain seeds, in nuts, almonds, and others, in which the starch of the gramineae is replaced by oil. ”

“ Externally this coagulum might be taken for a cast of the interior of the uterus about three weeks after conception. This resemblance is even greater when the coagulum is cut into and laid open. A cavity is then found of shape almost triangular, with an open, smooth, and rounded orifice, the whole inside being lined by a pellucid silvery-looking membrane, not unlike a serous membrane. This membrane prolongs itself through the orifice, which it lines also, and passing outwardly, goes to join and merges into the coarser external covering of the coagulum. ”

“ Upon the same principle alkaline applications may be made to dissolve coagulated blood; suppose, for the sake of illustration, that the bladder should become filled with coagulum through hemorrhage from the prostate gland, and that the most serious consequences were to be apprehended from the distention; in such an emergency, a dilute and tepid solution of potass, if injected through the catheter, might prove eminently serviceable ”

“ In cases of phlegmasia dolens after child-birth, the same principle can sometimes be traced; thus, in a dissection performed by Mr. Lawrence, [15] the external and common iliac veins were filled with a substance like the laminated coagulum of an aneurism. "The tube was completely obstructed by this matter, adhering as firmly as the coagulum does in any part of an old aneurismal sac. In its centre was a cavity containing about a teaspoonful of thick fluid of the consistence of pus, of a light brownish red tint, and pultaceous appearance." ”

“ The absence or the cessation of the hemorrhage by the contraction of the wound, or the formation of a coagulum, is the first step toward a cure, and it was to one or other of these circumstances that most of those who survived the injury for several days or weeks owed their existence for the time, although they usually died from the effects of inflammation, more of the inner lining and outer covering than of the substance of the heart itself. ”

“ If the coagulum be allowed to remain, the vein in which it is formed soon becomes thickened; but, as the experiments cited [Pg 4] prove, this thickening is the effect and not the cause of the stagnation of the vitiated blood in the vessel.
II. When blood coagulates in a serous cavity, a thin pellicle forms upon its surface, and, becoming thickened by deposition from the fibrin of the blood, forms a cyst, which completely circumscribes the effusion. ”

“ Sédillot, in which he detected the globules of pus in the blood, the patients died of the disease; but in the researches instituted by M. Dance and others, the experiments were made upon animals in perfect health. In the latter, the pus cannot enter the circulation, as has already been shewn, or can only do so after the blood has partially or entirely coagulated round it, and the coagulum has subsequently become broken up. ”

“ The coagulation of the curd is the first change which the milk of any animal undergoes when introduced into the stomach. The coagulum of human milk is soft and flocculent, and not so thoroughly separated from the other elements of the fluid, as the firm hard coagulum or curd of cow's milk becomes from the whey in which it floats. ”

“ The usual economy of nature, however, is here exercised, with a precision proportionate to the strength of the patient. A simple wound in a vein, in healing by the first intention, will not obstruct the circulation through the vessel under ordinary circumstances. A coagulum will form, sufficient to unite together the divided edges, and the circulation of blood through the vessel will be uninterrupted; [Pg 7] but if the wound does not readily heal, coagula may form, which encroach more or less upon the cavity of the vein. ”

“ Capillary loops grow into the coagulum, and migrated leucocytes from the adjacent blood vessels destroy the red corpuscles, and are in turn disposed of by the developing fibroblasts, which by their growth and proliferation fill up the gap with young connective tissue. It will be evident that this process only differs from healing by primary union in the _amount_ of blood-clot that is present. ”

“ Considering the coagulum as a food for mankind, I should by no means feel disposed to recommend it; though it is certain that the natives eat of it freely: experience satisfies me, that it is extremely difficult of digestion; and that, when ate as a meal, much inconvenience, if not indisposition, will generally follow. Nor can I recommend the water of the young nut to persons whose bowels are not of the strongest ”

“ These changes may be expected in a more marked degree, when the obstruction depends upon coagulation of the blood, than when it arises from other causes, inasmuch as the coagulum usually extends to several veins at the same time.
In the experiments that have been made upon animals, it has been a matter of surprise that, while extreme pain was evinced upon the injection of irritating fluids into the veins, comparatively little or no suffering was produced, when similar experiments were performed upon the arteries. ”

“ When a slight discharge takes place, in consequence of a slip of the foot, or some other external cause, we may also derive advantage from the use of the injection, but not so certainly as in the former case; and if the discharge be considerable, the injection will fail. It is better, in this case, to trust to the formation of a coagulum. ”

“ Between the opening and the ligature, five large branches entered into or were given off by the artery, and through some of these blood was brought round by the collateral branches in an almost direct manner, so that the man’s life depended on the resistance offered by the small coagulum after the sac had given way ”

“ I must content myself with stating the conclusion to which I was led at the time I am speaking of, and which was confirmed by later investigation, viz., that the introduction of septic material into a vein may give rise to the rapid development of large nucleated cells which, growing at the expense of the original constituents of the coagulum, convert it entirely into a thick yellow liquid. ”

“ It has been shown upon very high authority, that the sides of a vein do not unite after venesection (as has sometimes been presumed to be Mr. Hunter's opinion) ; but that the divided edges only of the vessel are agglutinated by the coagulum, which "serves as a bed to the new membrane." But the case is different, should this first attempt at union fail; the sides of the vessel may then become united, and its cavity for a time obstructed (section iv) . ”

“ Painful micturition, due to obstruction, is also a symptom traceable directly to the condition of the urine. The disposition of chylous urine to coagulate has already been alluded to. The coagulation taking place in the bladder, it is the clot which sometimes obstructs the urethra and makes urination difficult or impossible. Plugs of coagulum are ejected, sometimes with considerable force, after prolonged straining, and with this comes relief to the symptoms, which may be reproduced through the operation of the same cause. ”

“ As already mentioned, the blood is the nutritive fluid of animals. When this fluid is coagulated, a thick, jelly-like mass floats in the serum, called coagulum. This coagulated mass is composed of fibrin, and red globulated matter. The color of the red globules is owing to the presence of iron, though some physiologists think it depends on an animal substance of a gelatinous character.
Observation. That portion of the serum which remains fluid after coagulation by heat has taken place, is called se-ros ́i-ty. It is more abundant in the blood of old, than in that of young animals ”

“ Its surface, especially along the course of the branches of the coronary arteries, was whitened by coagulated lymph. In the cavities of the heart, which were all enlarged and thickened, particularly the left, were found portions of coagulum mixed with fluid blood. Near its apex, over the left ventricle, was a small soft spot which, to the finger, seemed like the point of an abscess ready to burst. The tricuspid valves, and the valves of the pulmonary artery, had lost somewhat of their transparency, and were a little thickened, though not materially. ”

“ A mercurial Water made of Sublimate and Aqua Calcis, made a very considerable whitish Coagulation, and rendred it all a thick Jelly, which being held over the Fire, turned to a Curd and a Serum. A Solution of Roman Vitriol produced a Coagulation likewise; so did Allum dissolved in Water, but it made a greater Alteration in some than it did in others, though the Mucilages were taken from subjects of the same Species. Saccharum Saturni did inspissate it, which appeared to be a true Coagulation, because with the Fire they would turn to a distinct Coagulum and Serum. ”

“ Reasons to explain the danger are not far to seek, for the numerous small muscular branches, along with the superficial epigastric, circumflex, and pudic trunks, reduce the chances of a good coagulum in the common femoral to a minimum, even without taking into consideration the shortness of the trunk before the great profunda femoris is given off. For the common femoral artery is only from one to two{17} inches in length, and if there are some rare cases in which it is a little later in its bifurcation, there are others in which it divides nearer to Poupart's ligament. ”

“ In addition to the lesions described above, there are usually gastro-intestinal inflammation, œdema of the peritoneum and pleura, in the lung as well as in the serosæ, (pneumonia is not uncommon especially in sheep) , intestines, kidneys and muscles, hæmorrhagic spots are not uncommon, the blood forms a loose black coagulum, and the encephalon is anæmic and softened. ”

“ In hemorrhages she produces a faintness, which occasions a coagulum in the open vessels; so that the further passage of blood through them is obstructed.
[37]
In wounds of the flesh and bones she discharges foreign matter by exciting an inflammation, and supplies the waste of both with new flesh and bone.
II. There are cases where the efforts of nature are too feeble to do service, as in malignant and chronic fevers.
III. There are cases where the efforts of nature are over proportioned to the strength of the disease, as in the cholera morbus and dysentery. ”

“ The simple experiment of mixing some pus with healthy, recently drawn blood, will at once shew that such a combination cannot circulate in the living body. It will be found that the blood coagulates round the globules of pus, and forms a solid mass which will adhere to the first surface with which it comes in contact; and it will be evident, that it is not till the coagulum thus formed is broken up or dissolved, that its elements can circulate with the blood. ”

“ A weak, thin, watery solution, aside from doing poor work, is much more liable to diffuse itself and be carried into the circulation like a hypodermic of morphia, than a solution sufficiently strong to act as a cauterant, destroying the tissue, forming a compact and an insoluble coagulum and strangulating the circulation at once.
A solution, weak or strong, when deposited to any depth beneath the surface, with live tissue and the circulation passing on all around it, will of necessity excite pain, inflammation and a slough, the same as a splinter in the flesh. ”

“ These red particles are flattened disks; in man they are round. Their size is variable, being in man from one four-thousandth to one eight-thousandth of an inch in diameter, but larger in other animals.
The blood contains a large quantity of albumen, partly dissolved and remaining in the serum after coagulation, partly in a solid state, forming the great mass of the globules.
In the living body the blood also contains fibrine in solution, but this separates soon after extraction from the body; it assumes a solid form, and investing, as a sponge, the red globules, forms with them the coagulum. ”

“ Its removal can be carried out with the aid of a spoon, and by means of gentle irrigation (hot saline at a temperature between 110° and 115° Fahrenheit) . It is usually impossible to remove the whole of the coagulum, but the greater portion can be got rid of in the manner described.
The dura mater is approximated above by the cross-union of the four apical sutures, whilst the downward prolongation is also sutured except at the most dependent point, where a rubber drainage-tube is inserted beneath the dura mater and brought out through the scalp-flap (see Fig. 56) . ”

“ The prominence, as noticed by Claparède and Balbiani, is situated on the flatter side of the ovum. Sections at this stage shew the same features as the previous stage, except that (1) the cells throughout are smaller, (2) those of the thickened hemisphere of the ovum more columnar, and (3) the cumulus is formed of several rows of cells, though not divided into distinct layers. In the next stage the appearances from the surface are rather more obscure, and in some of my best specimens a coagulum, derived from the fluid surrounding the ovum, covers the most important part of the blastoderm. ”