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ORIGINATING IN INFLAMMATION.
more laboured and very frequent breathing, rapid pulse, lividity of surface, and died December 29.
Six or eight ounces of serum in left pleura, and some loose masses of yellow lymph, with harder granules scattered through them. The whole left pleura, costal and pulmonary, very red and vascular, and studded with yellow granular tubercles, and with patches of lymph of the same color and density. The more diffused patches were between the lobes, and at their margins, here forming a layer a quarter of an inch thick; but they did not differ in color or density from the small granules, and there were gradations in size between these and the patches.
The left lung was partially consolidated by rounded tuberculous masses, some grey, some opaque yellow, without softening. The latter in color and consistence perfectly resembled the masses of lymph on the pleura.
Right lung partially adherent to the chest, the false mombranes boing dense, but not tuberculated. Tho lower lobes were almost completely consolidated by opaque yellow deposit, the masses of which appeared prominent through the pleura. When cut open, one large mass in the lowor lobe was quite yellow opaque, and tough like the lymph on the left pleura. In other parts there was a mottling of the red and black of the lung tissue, like the appearance of Castile soap. The upper lobe of this lung was in he first stage of inflammation; very red, fragile, exuding frothy serum; and a few granular tubercles were scattered through it. Weight of lungs: right, 21b. looz.; left, lib. 14oz.
Mucous membrane of larynx very vascular, with a few tubercles.
Mesenteric glands enlarged; and some contained yellow tuberculous matter, crude and soft.
Case 28.—Pleuritis. Phthisis.
John B., admitted February 4, 1840; robust laborer. Mother died of phthisis. Quite well till three weeks ago; when had chills, cough, and short breath, with great weakness, which have continued, with much loss of flesh. Sputa viscid and greenish; pulse frequent; skin hot; urine scanty.
Right side of cheat at lower part measures 1 \ inch more than left. Complete dulness and absence of breath-sound in lower two-thirds of right chest. About fourth and fifth ribs at side friction sound with respiration. Stroke clear above third rib in front; clear stroke and puerile breath-sound on left side.
Bled to 15oz. Twenty leeches to right side. Calomel and opium night and morning. Saline antimonial, ter die.
February 6.—Breath and cough much relieved. Pulse 101, sharp.
February 8.—Further relieved by blister, &c. Pulse 84; urine more copious.
February 18.—Continued better, with little complaint of breath or cough. Pulse 85. Gums sore from calomel. Less dulness and more breath heardin right chest, with loud friction sound.
February 27.—Breath has been getting shorter, and cough more troublesome, although he has been again blistered. Pulse 84. More dulness in right chest, and loud leather-creak at the side.
May 2.—Condition gradually become worse. Breath and cough always troublesome; only temporarily relieved by repeated blistering, &c. Pulse risen to 90. Expectoration now mucopurulent, sometimes rusty.
June 20.—Occasional sweats, and diarrhoea. Pulse 100. Losing flesh rapidly. Sputa viscid, purulent, sometimes streaked. Dulness of right chest increased; and now cavernous sounds heard above left mammilla.
Throat became aphthous, and died July 5.
Sectio 34 horis post mortem.
Body much emaciated.
Right pleura at posterior, contained a pint of turbid serum. Both pleurse strongly adherent to upper, front, and back walls of chest, and in many 'parts thickened by red tough false membrane, thickest on right side, behind and laterally.
Right lung large, dense to the feel, scarcely at all crepitant. On cutting into it the substance is found pervaded by solid matter in grey opaque masses of roundish shape, from size of walnut to that of cherry-stone; these in many points presented opaque yellowish specks; and in some parts small cavities; these were chiefly in upper part of lung; towards the base the lung was more generally red and tough, The same appearances to less extent in left lung; the lower lobe most free; with dilated marginal air-cells. At apex of left lung was a cavity of size of hen's egg; the walls composed of dense tissue, studded with soft yellow tubercle; superiorly quite thin, consisting chiefly of pleura, which was quarter of an inch thick at this spot. Bronchial glands, enlarged and soft.
Pericardium contains ^ii yellow serum.
Heart pale, large and flabby, containing fluid blood, staining liningmembrane; mitral valve thickened at free margins, by dense deposit under serous lining; attachments of aortic valves also thickened, and a little corrugated.
Several patches of ulceration, with raised edges, in mucous membrane of colon and rectum; no increased redness. Mesenteric glands slightly enlarged in several parts. Liver large; substance fragile.
Case 29.—Phthisis after Pleuro-pneumonia.
Anne S., aged 42; admitted January 5, 1844. Tall, and has been very stout till the last four years. Has not been well fed in the last year. No serious illness till eighteen months ago, when she had severe pain in the side, which was called inflammation of the liver. Was ill for many weeks, and was bled, cupped, and blistered. There was tickling of throat, but not much cough till some time after, and it became much worse in November; lately with much opaque expectoration, and diarrhoea, and has become very ORIGINATING IN INFLAMMATION.
weak and thin. No return of catamenia since November. Pulse frequent; skin cool. Extensive dul nets in right chest, with loud cavernous sounds in upper regions, front and back. Loud puerile breath in left lung.
Pills, with \ grain sulphate of copper, opium, and creasote, three times a day, moderated the diarrlnen, but the cough became worse. Pyroxylic spirit was tried, but discontinued, as the purging returned, and continued till her death, which was preceded by an aphthous state of the mouth and inability to take food. The diagnosis given was extensive excavation and consolidation of right lung. Partial tubercles in left lung; tuberculous ulceration of intestines. Died February 5.
Body much emaciated. Five ounces turbid serum in left pleura, which posteriorly was patched with red and granular lymph. A few clusters of tubercles in the upper lobe of left lung, and some miliary granulations scattered below. Posterior parts of left lung red and congested, but lower part of upper lobe in state of soft grey consolidation, with a few small cavities. The right lung was generally and firmly adherent by dense cartilaginous deposit, which extended also botween the lobes. The whole right lung was in a state of dense grey consolidation, speckled with yellow spots, and the upper lobes riddled with numerous cavities, freely communicating. Liver healthy, but small; weighed 2 lb. 8 oz. Several tuberculous ulcers in the ileum, and much inflammatory redness through the small and large intestines.
Remarks.—In all probability this phthisis originated in the attack of pleuro-pneumonia which began the fatal illness, and ended in general consolidation of the right lung, the universal adhesions and dense thickening of the pleura between the lobes proving its inflammatory origin. Subsequently this lung caseated and softened, and miliary tubercles formed in the other lung.
Case 30.—Chronic Pleurisy. Phthisis.
John P.., aged 37; admitted July 26, 1844. Tailor. In good health till twelve months ago, after frequent exposure and often getting wet had cough and pains in limbs, with much weakness. Was out-patient of a hospital, with some relief; but in last two months has suffered with short breath, pain of right side, and temporary swelling of the legs. He also expectorated a quantity of dark stuff. Has lost much flesh, orthopnoea; urine very scanty; mouth aphthous. Chest movements imperfect, especially over right side, which is altogether dull, except above the second rib, where stroke is tubular, and breath and voice sounds are tubular, and also above the scapula. No vesicular sound, but agophony also below scapula. In left back breath puerile and stroke clear, but some dulness and tuliular sound with coarse crepitus below clavicle. Friction sound in left lower lateral and dorsal regions. Heart pushed to below the mammilla. Liver reaches to umbilicus.
A blister was applied, and ho was given blue pill, squill, and digitalis, with decoction of Iceland moss, acetate potass, and borax, ter die.
July 27.—Breath not better; urine still scanty, albuminous, specific gravity, 1019. Less friction sound in left back. Pills omitted, and 4 grains' cnlomel and \ grain hydrochlorate morphia given at bed-time. No relief followed, and he died on the 29th.
Sectio 2 horis post mortem.—There were 10 pints of purulent serum in right pleura, with flakes of curdy lymph floating in it. Right lung compressed against mediastinum and spine, and middle dorsal ribs. Much tough opaque lymph over the surface of the lung in granules and in patches. On inflating the lung it became partly expanded, but was chiefly bound down by the deposits on the pleura. Texture of the lung flaccid, dry, dark purplish in colour, sinking in water; several small tubercles scattered through it, and a cluster of tubercles near the root, all dark greycoloured and gritty—some near surface paler. Left lung covered with recent false membrane, forming a series of rough ridges of granular texture. Several grey tubercles in this lung, chiefly in upper lobe. Lower lobe heavy and congested. Yellow cheesy matter in bronchial glands. Weight of lungs: left, 2 lb. 9oz.; right, 10 oz. Pericardium strongly adherent to whole heart; adhesions dense, especially over right ventricle, Heart, with pericardium, weighed 14 oz. Liver weight, 3 lb. 2 oz. Some granular irregularity of surface, with predominance of pale matter, and texture coarse. A few white tubercles scattered through it Both kidneys much congested : texture soft: on surface of right one cyst and one white tubercle: weight, 54 oz.: left, 5 oz. A few pale tubercles in spleen.
Case 81.—Chronic Pneumonia. Phthisis.
Mary D., aged 57, admitted January 27, 1843; married, one child. Generally good health till winter 1840, when she had a severe cold, followed by cough and loss of flesh and strength. Lost cough in summer, but did not recover her strength; and in the following winter the cough returned, and has continued ever since with increasing expectoration, shortness of breath, and loss of flesh. Much worse in last six months; often suffering from severe spasms of the stomach and chest, and failure of appetite. Profuse night sweats. Pulse 100. Sputa copious, in separate opaque clots. Dulness on percussion in both upper regions, most under right clavicle, where gurgling and cavernous breath.—Ordered mixture diluted nitric acid, tincture of hpnbane and hop, three times a day.
February 4.—Cough easier, but the expectoration very purulent, and weakness increases. Wine and full diet. Two grains sulph. quinine to be added to each dose of mixture.
7th.—Getting weaker. Expoctorntes with difficulty darker matter. Pulse thready, irregular. Dozes much, and is incoherent.
ORIGINATING IN INFLAMMATION. 187
With more wine there was some rallying, but she gradually sank, and died on the 18th.
Sectio 68 horis post mortem; body much emaciated. Right lung extensively and firmly adherent at apex by very tough old false membranes: slighter and more recent adhesions posteriorly; middle and lower lobes covered by opaque rugous membrane, in parts shreddy and hardly organised. At posterior part of apex was a cavity, size of hen's egg; its walls little more than the thickened corrugated pleura; it contained purulent and curdy matter; its internal walls very red, pretty smooth, with shreds of opaque lymph. The middle and posterior portions of this lung were firmly consolidated, and dark red on section, with mottled grey and opaque yellow patches. Another small empty cavity in the anterior of upper lobe. Anterior portions of middle and lower lobes were pale, distended with air, and very flaccid and thin to touch, with general dilatation of air-cells. Left lung partially adherent at apex, in which also was a cavity, rather smaller! than that in right lung, containing a little opaque liquid, and quite loose, an irregular calcareous nodule of the size of a horse-bean. Texture below this cavity much puckered, indurated, and mottled with perfectly black nodules for an inch downwards. A few clusters of very hard miliary tubercles were scattered through lower lobe of this lung; but the greater part was light, very pale, porous, and flaccid, with generally dilated air-cells (flaccid emphysema). Liver and kidneys small, and somewhat granular in parts.
Case 32.—Chronic Pleuro-pneumonia. Fibroid Phthisis.
A barrister, aged 45; March 18, 1843. Always delicate, with bilious tendencies. Has been more ailing since losing his wife in consumption last autumn. In November in Cheshire, and after getting chilled, he had what was called rheumatic influenza. On return to town he found his breath short, and perceived that he was breathing with one side only. He consulted several physicians, and got almost as many different opinions; and was blistered and physicked in various ways without much benefit. He persisted, however, in going to chambers till the last three weeks, when the breathing has become much shorter, with dry cough and raj-id loss of flesh. Pulse 100, easily quickened; tongue furred. Urine scanty, high coloured.
Left chest quite dull and rathercrmtracted in lower two-thirds, and without breath-sound or motion; upper third clear on percussion, with loud harsh breath; loose crepitus in mammary region. Right chest dull in lower half, without breath or voice: above, loud reedy vocal resonance. Heart pulsation felt in epigastrium. Liver dulness extended, with tenderness.
May 12.—After treatment with repeated blisters, and at first mercurial diuretic, and subsequently iodide potass, and sarza., great improvement took place in comfort and strength, although ho is still wasting and the breath continues short. No cough.