G. CASES SHEWING THE ORGANISATION OF THE OUTER LAYER OF EXTRAVASATED BLOOD; REPORTED BY MR. HEWETT.
Case xxxix.[47] A middle-aged man received a severe injury of the chest; he lived eleven days after the accident, and during this time he never presented a single inflammatory symptom. The cavity of the left pleura was found completely filled with bloody fluid, and was subdivided into two compartments, by a portion of coloured fibrine, presenting a honeycombed appearance, which passed from the ribs to the lung. The lower compartment was itself subdivided into several others, by layers of coloured fibrine intersecting each other. Large portions of loosely coagulated blood were found in all the cavities; some of these clots were of a rusty colour, others approached nearer to the natural colour of the blood. The lung was compressed against the spine, and the whole surface of the pleural sac was coated by a false membrane, about two lines in thickness, formed by coagulated fibrine. The fibrine which lined the pleura pulmonalis and pleura diaphragmatica, presented on its inner surface a smooth and polished appearance, and in colour exactly resembled the yellowish fibrine found in the clots of the heart of this patient. So uniform was the coating, and so continuous was it throughout its whole extent, that it looked at first merely like thickened pleura; but this appearance was easily destroyed, by peeling off this adventitious membrane from the serous tissue, which there presented the same appearances as the pleura on the opposite side, with the exception of not being quite so smooth: there was neither thickening nor the slightest increase of vascularity in this pleura. A large rent, from which the hæmorrhage had proceeded, was found in the substance of the lung.
Case xl. A man was attacked with diffuse cellular inflammation of the inferior extremity, which terminated in two days with extensive gangrene of the skin. In the superficial and common femoral veins were extensive coagula; these did not completely fill the veins, but slightly adhered at different points to their internal coats. These clots still retained, in some places, the colouring matter of the blood, whilst at others the colourless fibrine alone remained; in both veins, the clots were enveloped in a perfectly transparent, smooth, and polished membrane, presenting the appearance of a serous tissue. In the structure of these membranes were several distinct arborescent vessels, minutely injected;[48] some of these vessels were of sufficient size to allow of the blood being made, by gentle pressure, to circulate through them; but no communication could be traced between these vessels and the coats of the veins. The membranes were easily peeled off from the surface of the clots with which they were in contact. The interior coats of the veins presented their natural colour and polished surfaces, except at the points where the slight adhesions above-mentioned existed.
FINIS.
RICHARDS, PRINTER, 100, ST. MARTIN'S LANE.