Part 2

After the use of much medicine, on the 6th of November, the effused fluids began to be absorbed, and passed out through the urinary organs with such rapidity, that on the 12th the dropsical enlargements had nearly disappeared. The pulse was much reduced, in hardness and frequency, by the medicine, and, as it fell, he became more easy. On the 10th the state legislature convened, and the call of business roused, like magic, the vigor of his mind; and the symptoms of his disease almost disappeared. During this session he made little complaint, dictated many important communications, and attended to all the duties of his office, without neglecting the most minute. As soon as the legislature adjourned, he declared, that his work was finished, and that he had no desire to remain longer in this world. He entreated that no farther means should be used to prolong his existence, and immediately yielded himself to the grasp of disease, which appeared waiting with impatience to inflict its agonies.

From this moment the distressing difficulty of breathing had very slight remissions. The consequent disposition to incline the superior part of the body forward, for the purpose of facilitating respiration, increased so much, that he frequently slept with his head reposed on his knees. The cough became occasionally very violent, and was always attended with an expectoration of a brown coloured mucus, sometimes tinged with blood. The abdominal viscera lost their activity. The face was sometimes turgid and high coloured, at other times pallid and contracted. A gradual abolition of the powers of the mind ensued, with a low delirium, and two short fits of phrenzy. The state of the circulation was very variable; the pulse at the wrists principally hard and vibrating, rarely soft and compressible; the less pulsations becoming more indistinct, and at length scarcely perceptible. No perfectly distinct beat of the heart was felt, but a quick undulating motion, not corresponding with the pulse at the wrist. Three days before death the arteries assumed this undulatory motion, corresponded with the motion of the heart, and, for forty-eight hours, lost the irregularity of pulsation.

Once or twice the expiring faculties brightened. On the 30th of November he awoke, as if from death, conversed very pleasantly for two or three hours, and humorously described scenes, which he had witnessed in his youth.

On the 4th of December came on the second attack of furious delirium. Insensibility, and great prostration of strength, ensued. The respiration became very slow, and obstructed by the accumulation of mucus in the lungs; the pulse very intermittent, then regular, and finally fluctuating. A hiccough commenced; coldness of the extremities and lividity of the face followed, and continued three days before death. On the 9th the incurvated posture was relinquished, and the head sunk back upon the pillow; the respirations then diminished in frequency, till they became only two in a minute; and at the end of twenty-four hours they very gradually ceased.

DISSECTION, NINE HOURS AFTER DEATH.

EXTERNAL APPEARANCE.

The whole body was much emaciated; the face pale and contracted. The hands were slightly oedematous. Discolourations, answering to the ribs, were observed on the thorax; many small purple spots, hard and prominent, on the back; excoriations on the nates; and purple spots, resembling incipient mortification, on the heel and toe.

THORAX.

The integuments of the thorax were free from fat: the cartilages of the ribs ossified in various degrees, some perfectly, others slightly. Upon laying open the cavity of the thorax, it was found to contain about three pints of water, the proportion being greatest on the left side.

The lungs were contracted into a smaller compass than usual, and were very firm to the touch. Their colour anteriorly was whitish, with small distinct purple spots; posteriorly, of a deep red, with similar spots. The right lobe adhered closely to the pericardium; it also adhered to the pleura costalis, by a great number of strong cords, which seemed to be elongations of the original adhesions. Some of them were nearly as hard as ligament, and many an inch in length. Internally the lungs presented a very compact structure. Their cells were crowded with mucus, and their vessels filled with black blood, partly fluid, and partly coagulated. Some portions were firmer and more condensed than others, but no tubercles were discovered.

The pericardium, viewed externally, appeared very large, and occupied almost the whole space behind the opening formed by removing the sternum and cartilages of the ribs. It was situated principally on the left side, and contained about double the usual quantity of water; but was principally filled by the enlarged heart, to which it adhered anteriorly about two inches, near its base. Its parietes were, in every part, very much thickened and hardened.

The heart presented nearly its usual colour and form, excepting on its anterior surface, which was somewhat discoloured by coagulated lymph. It was enlarged in bulk to, at least, one half more than the healthy size. The auricles and ventricles contained coagulated blood. The tricuspid valves were in a sound state. The left auricle was double the usual size. The left ventricle was enlarged, about three times thicker and much firmer than usual. The mitral valves were very much thickened, and near the insertion of their columnæ, which were sound, cartilaginous, so that they were quite rigid, and the opening made by them, from the auricle to the ventricle, was scarcely large enough to admit the passage of a finger. The semilunar valves of the aorta were ossified at their bases and apices, and the portion intermediate, between the base and apex, partly ossified, and partly cartilaginous, so as to render the valves very rigid. The aorta was at least one half larger than usual, especially at its arch. The arteria innominata, the carotid, and subclavian arteries, were uncommonly large and thick. The coronary arteries were considerably ossified.

ABDOMEN.

The omentum was destitute of fat. The stomach distended with flatus on the pyloric side; its cardiac extremity, lying under the liver, was pressed down and contracted. The liver was shrunk; its tunic corrugated, as if it had been distended, and bearing marks of inflammation; its substance harder than usual; its vessels, when divided, pouring out liquid black blood. The gall bladder was filled with bile. The kidneys were thicker, and more irregular in form, than is common. The abdominal cavity contained some water.

HEAD.

The bones of the cranium were unusually thick. The dura mater, which was thickened, and in many places bore marks of former inflammation, adhered to the bone at the vertex. On its internal surface, near the longitudinal sinus, there was a small ossified portion, half an inch long and the eighth of an inch thick. The convolutions of the brain were narrow, and very strongly marked. The pia mater bore marks of pretty extensive inflammation, and adhered to the dura mater at the vertex. The cortical substance ran deep into the medullary part of the brain. The ventricles contained about double the usual quantity of water; their parts were all remarkably well defined. The vessels of the pia mater, over the corpora striata, were unusually injected with blood. The velum interpositum was very firm; the plexus choroides uncommonly thick, but pale; the opening from the right to the left ventricle large. The vessels of the brain were generally not much filled with blood.

The blood appeared every where fluid, except in some portions of the lungs, and in the cavities of the heart. It was very dark coloured, perhaps more than ordinarily thin, and oozed from every part, which was cut.

The cellular membrane, in all dependent parts, effused, when cut, a serous fluid.

CASE II.

Mr. John Jackson, fifty-two years of age, had been affected for more than two years with palpitations of the heart, and paroxysms of dyspnoea. These symptoms increased in October, 1808, and were followed by strong cough, uneasiness in lying down, sudden startings in sleep, and an inclination to bend the body forward and to the left side. His cough, during the last part of his life, was attended with copious bloody expectoration. His countenance was florid; his pulse very irregular, though not quite intermittent. The occasional variations in the state of the disease were remarkable. Some periods were marked with uncommon mental irritability. Pain in the region of the liver, oedema of the inferior extremities, paucity and turbidness of the urine, yellowness of the skin, and great emaciation attended the latter stages of the disease. A degree of stupor occurred. The termination on the 30th of January, 1809, was tolerably quiet. Two days before death he sank into the recumbent posture, and his pulse became more regular.

DISSECTION, TWENTY-FOUR HOURS AFTER DEATH.

On opening the thorax, its right cavity was found to contain a large quantity of water; the left, a smaller quantity.

The lungs were of a firm, condensed texture, especially at the lower part, where their solidity was nearly equal to that of a healthy liver. They contained black blood.

The heart was much enlarged, and proportionally thickened. Its tunic was in some places covered with coagulated lymph, especially over the coronary arteries. Its cavities were filled with black coagulum, which in the right auricle and ventricle had a slight appearance of polypus. The semilunar valves of the pulmonary artery and aorta were unusually small, and their bases cartilaginous. Those of the aorta had lost their form, and were slightly ossified. The remaining valves were partially thickened. The arch of the aorta was very much dilated, its internal coat covered with a bony crust, which extended through the remaining thoracic portion, gradually diminishing. This portion was also considerably dilated.

The liver was indurated; its peritonæal coat exhibited a flaccid or wrinkled appearance, and bore marks of slight inflammation. The gall bladder was filled with bile, and the pancreas indurated.

CASE III.

Captain Job Jackson, forty-five years of age, a man of vigorous constitution, after an indisposition of some years continuance, was seized with palpitations of the heart and dyspnoea, occurring by variable paroxysms, especially on ascending an eminence, and attended by hardness, irregularity, and intermission of the pulse. To these symptoms were superadded dizziness and severe head-ache, a disposition to bend the body forward, sudden starting from sleep, with dread of suffocation, violent cough with copious expectoration, which for fifteen days before death consisted of black blood, distressing pain across the chest, especially on the left side, great oedema of the lower extremities, and paucity of urine.

He died painfully in January, 1809, after violent struggles for breath. The day before death the pulse became regular. He rested his head upon an attendant, and made no attempts to lie down for some days previous.