PREGNANCY IN PHTHISIS.

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CHAPTER XXIII.

MISCELLANEOUS CASES.

Utero-Gestation in Phthisis-Arrest of Disease Twelve Years-Healthy Child born-Death Four Years after from Dropsy-Phthisis retarded Ten YearsThree living and two dead Children born during the time-Phthisis during Pregnancy-Death after Childbirth—Phthisis arrested before Marriage -Relapse after second Childbirth-Arrested again, and Two more Children -Phthisis after Injury to Chest, Two Cases-Pneumo-thorax from Perforation of Pleura-Four Cases, all recovered-Phthisis with Heart Disease -Recovery-Caseous Pneumonia arrested-Calcareous Expectoration after, and Eczema-Syphilis and Phthisis; Recovery-Senile Phthisis and Bronchial Glands enlarged-Phthisis arrested in Middle Age-Chronic Bronchitis for Thirty Years after-Death at Eighty-four from Hæmoptysis.

CASE 126.-Phthisis, arrested Twelve Years. A Child born.
Contraction of Chest. Emphysema and Dropsy.

Mrs. T―, æt. 28, September 18, 1848. Two brothers and two sisters have died of phthisis. For the last six years has been suffering from cough, and copious opaque expectoration, occasionally bloody, short breath, and wasting. Has spent several winters abroad with temporary amendment. Collapse and dulness in right front, with cavernous sounds in several spots, as from several small cavities. Dulness and larger cavernous sound above scapula. Partially obstructed breathing below. Tubular sound below left clavicle.-To take oil in nitric acid and orange tincture, and use cantharides liniment.

Under this treatment, with generous diet, great improvement took place in flesh, strength, and general health. The breath was always short, but the cough and expectoration much diminished, except in occasional attacks, which subsequently assumed the form of asthmatic bronchitis, lasting two or three weeks, relieved by salines and small doses of stramonium. The oil was omitted only on these occasions. The right side of the chest contracted much, and the size of the cavities diminished, with signs of emphysema below and in left lung.

In 1856 she became pregnant, and in due time was happily confined, under chloroform, giving birth to a fine baby, who has lived to grow up in

T

health. She continued in invalid health, but enjoying life and highly useful in it, till the end of 1859; when, without decided attacks, the breathing became so short and wheezy, that the least exertion became distressing. This was from a gradual increase of the emphysema, the resonance, crepitus and wheeze of which almost superseded the dulness and cavernous sounds in the right lung. The veins and cellular tissue in the neck also became swollen from the same cause. In this state, the oil did no good; some relief was derived from iodide of potass. and digitalis, which acted on the kidneys. Orthopnoea and dropsy followed, and she died in 1860. No examination allowed.

This is a remarkable instance of phthisis in its third stage being arrested; and, through the contraction of the scar-tissue, becoming converted into habitual asthma. See Chapter XIX.

CASE 127.-Phthisis retarded by Uterogestation.

A married lady, aged 30, who had lost two brothers from consumption, first consulted Dr. Williams, September 20, 1861. Had always been delicate, with small appetite. During the last two years had been living in bleak exposed situations; not wearing flannel. Cough came on six months ago, and constant ever since, with loss of flesh and shortness of breath. Catamenia absent for two months: patient is probably pregnant. Loud tubular voice, with dulness at and above right scapula.-Oil was ordered, with phosphoric acid and a bitter; and a South-coast residence recommended.

March 10, 1862.-Has wintered at Ventnor, going out of doors pretty regularly, and taking oil, and has gained flesh and strength. Expects confinement in two months. More dulness and tubular sounds at and above right scapula.

March, 1868. Has wintered three years at Torquay, one at Hyères, and one at St. Leonards; generally taking oil once daily, with strychnia and other tonics; sometimes with the addition of hypophosphite of soda. Has had three children, two living and one dead; and, though weak and oppressed through confinements, has recovered pretty well, and her general health is not worse than it was seven years ago. Has had several attacks of bronchitis, and has never lost cough, which has been remarkably harsh and grating, but less so during the last four years, when there has been more or less opaque expectoration, sometimes tinged with blood. In that time there have generally been cavernous sounds, moist or dry, in right scapular and subclavian regions. Now there are dulness, contraction, loud tubular or dry cavernulous sounds in upper right chest, most marked in the back, but blended with vesicular breath-sound. Long expiration in upper left lung. Patient seems weaker, thinner, and her breath is shorter. May 13, 1869. Was very languid all last summer, and her breath extremely short, but gained strength in the winter at St. Leonards, from which she has just returned. Cough was not bad till March, when she had

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fresh cold and bronchitis, affecting both lungs; but, although now better, still has increased cough and occasional opaque expectoration. Loud tubular or cavernous sounds in upper right chest, with occasional crepitation there and at left apex. Stomach more fastidious than ever, and rarely takes oil, but pretty regularly glycerine with hypophosphite of soda and strychnia, or salicine once daily. In this feeble state she proved to be pregnant; and, after much oppression and weakness, gave birth to an imperfectly-formed fœtus about the seventh month.

Again there was a gradual recovery, so far as to permit of her being again removed to St. Leonards, where she remained till March, always suffering much from weakness, breathlessness, and cough; yet still in a limited manner enjoying the society of her family.

On her return to town, in the spring of 1870, there was increased feebleness of all functions; more frequent, but less violent cough, and more of the opaque kind of expectoration. The dulness and cavernous sounds had hardly, if at all, spread in the right upper lobe; but there was crepitus mixed with harsh puerile breathing in the middle right lobe and in the upper lobe of the left lung.

Even in this condition she again proved to be pregnant, and lived long enough to give birth to a dead child at the full term at the end of the year 1870, ten years from the commencement of the disease in the lung; having borne three living and two dead children within that time. The surviving children are well grown and hitherto healthy.

CASE 128-Phthisis during Pregnancy. Death after Childbirth. Mrs. R., aged 33, first saw Dr. Williams, February 4, 1859. Several of her maternal cousins had died of consumption. Had delicate health from 16 to 25, was married at 24, and improved in health afterwards, especially during pregnancies, of which she had four. Now pregnant four months; and has been living since October in a damp cottage in Scotland, and has had a cough ever since accompanied by wasting.

Dulness, crepitation, and tubular sounds at and above both scapulæ, most marked on the left side.-Patient was ordered cod-liver oil in a tonic of phosphoric and hydrocyanic acids and tincture calumbo, to use a crotonoil liniment, and to winter at St. Leonards.

April 27. Returned from St. Leonards, where she has taken oil regularly, and gained in flesh and strength, with decrease of cough, which has increased during the last fortnight. Dulness and crackle in the upper part of both lungs, most marked on the left side. This patient was prematurely confined at the end of May, and sank ten days later.

On post-mortem examination, in the lungs, tubercles with a great deal of emphysema were found at both apices, and a cicatrix and remains of a cavity at the right. Grey tubercles were also scattered through the lower lobes, the left one being in a state of pneumonic consolidation. The heart was large, both ventricles were dilated, and the walls easily lacerated.

CASE 129.-Phthisis, Third Stage, arrested.

Marriage, Two Children. Abscess in Rectum. Lung diseased again, and Cavity. Again arrested. Two more Children.

Miss H., æt. 23, July 13, 1863. (Father and brother asthmatic.)-Two years ago had a cough for seven months, and was much reduced. An eminent City physician, who was consulted, said that she would not live six weeks. She was taken to Torquay, and took oil and tonics, and gradually improved. Last winter the cough was moderate, but there came a swelling in left axilla, which gradually subsided, and now it is hardly perceptible. No cough at present, only wheezing occasionally. Some dulness, and a croak on deep breath with tubular sounds above right scapula. Breathsound generally good.-To continue oil and tonic in winter.

February 27, 1868.-Except an inflammatory attack with some bloodspitting in 1864, had no illness, and was so well that in 1865 she married, and has had two children, the last five months ago. After each confinement has had an abscess at the rectum. After exposure three months ago, cough returned, and has since had pain in the chest, with croaky noise, and much opaque expectoration. Has taken no oil lately, only hypophosphite of lime and quinine. Dulness and croaky obstruction in left chest, most upper. Tubular sounds above right scapula.

May 15, 1868.-Was better till end of April, when there came more pain of left side and shoulder. Cough and opaque expectoration, and much wheezy feeling in the chest. Abscess of rectum still discharging. Croaky cavernous sound, with dulness in left front, less behind.-Chest to be blistered with acetum cantharid., effervescing saline, with opiate. To resume oil and tonic as soon as possible.

June 9, 1869.-Two months ago was confined with her third child. Had been remarkably well all winter, taking the oil and hypophosphite. In March cough and expectoration returned. Dulness and defective breath in upper left, but very little croak; and breath below improved. Tubular sounds and subcrepitus above right scapula.-To continue oil with quinine and sulphuric acid.

February 16, 1871.-Soon lost cough and continued well, with only morning expectoration, till last November, when she was confined a fourth time; and since has been weakly, with more cough and bad appetite. Not able to suckle the baby. Is not reduced in flesh, but gums recede. Only slight collapse and dulness below left clavicle. Tubular sounds above both scapula, but vesicular sounds heard everywhere.—To resume oil with phosphoric acid, hypophosphite soda, strychnia, and calumbo.

The arrest and removal of the lung disease in this case seemed to be aided by uterogestation, and perhaps by the rectal abscess.

PHTHISIS AFTER INJURY TO THE CHEST. 277

CASE 130.-Phthisis after Injury to the Chest. Cavities arrested. Living Twelve Years.

A gentleman, aged 25, of consumptive family, was first seen by Dr. Williams, October 6, 1857. A year ago, he was kicked by a horse in the left side of his chest, and since has experienced occasional pain there. A month ago, after a severe chill, coughed up an ounce and a half of blood; a less amount since, and has lost flesh and strength. At present there is a slight cough and yellow expectoration. Dulness, large tubular sounds in both scapular regions, some deficient breathing in left lung.

May 12, 1859.-After passing a winter at Pau, and taking oil for two months, he improved greatly in general health, the physical signs remaining about the same.

Last autumn he again brought up blood to the amount of 2 ounces. He spent last winter in Somersetshire. At present has pain in the left side, and is weak. No oil; a tonic has been taken. More obstruction and subcrepitus in upper left chest. Large tubular sounds above the right scapula.

October 20.-Had been taking iron tonic and oil for six weeks, and improved much during the summer; but still has morning expectoration and occasional hæmoptysis. Extensive dulness and obstructive sounds in left front. Large tubular (or cavernous) sounds above right scapula.

August 2, 1860.-Wintered at Pau, and remained pretty well, being able to ascend mountains. Considers that he has gained flesh and strength, but always has cough and expectoration. Loud dry cavernous sounds in upper left. Coarse crepitation below in front. Large tubular sounds in upper right chest.

June 20, 1861.-Passed the winter at Pau, doing well till the last four months, when he was bitten in the leg by a dog, erroneously supposed to be mad. Cauterization was largely used, which much weakened him. Since coming north has had some pain in right. chest, but little cough; and lately coryza and sore throat. Dulness, obstructive crepitation in left lung, with cavernous sounds in the upper portion, and some contraction of left chest. Tubular sounds above right scapula.

April 29, 1864.-Has just finished his sixth winter at Pau. Cough and expectoration moderate, and breath improved. Two years ago a liver attack reduced him much, but he has regained his strength, and now walks some miles. Physical signs much the same.

December, 1869.-Has spent five winters in the south of England, and remained pretty well, being only short-breathed, and having little cough; but a year ago had pain in right front chest, which returned six weeks ago, and he brought up a teaspoonful of blood. Dulness, cavernous sounds at and above left scapula. Considerable amount of crumpling crepitation and obstruction in left front. Tubular sounds and coarse crepitation above right scapula.

The remarkable chronicity of this case, and the absence of general