Part 3

DISSECTION, SIXTEEN HOURS AFTER DEATH.

The skin was of a yellow colour. The inferior extremities, quite to the groins, were oedematous.

The left cavity of the thorax was filled with water; the right contained only a small quantity. The pleura costalis, on the left side opposite to the heart, was thickened and covered with a very thick flocculent coat of coagulated lymph, and the pericardium opposite to it had the same marks of inflammation. The lungs on that side were pushed up into a narrow space. They were dense and dark coloured.

The pericardium contained little more than the usual quantity of water. The heart, which exhibited marks of some inflammation on its surface, was astonishingly large, and firm in proportion. Its cavities were principally filled with coagulum. The semilunar valves of the pulmonary artery had their bases slightly ossified, and the remaining part thickened. There were only two valves of the aorta, and these were disorganized by the deposition of ossific matter about their bases, and a fleshlike thickening of the other part. The parietes of the heart, especially of the left ventricle, were greatly thickened, and somewhat ossified near the origin of the aorta.

The liver had the same appearance as in case second.

CASE IV.

Thomas Appleton, thirty-eight years of age, of a robust constitution, was affected with excessive difficulty of breathing, occurring at intervals of different duration. It commenced three years before his death, and gradually increased. He was subject to palpitations of the heart for at least two years before his death, and was distressed with violent cough, attended with copious expectoration, which finally became very bloody. The palpitation and dyspnoea were greatly augmented by ascending stairs. His countenance was very florid.

Sometimes he was seized with violent head-ache and dizziness, which, as well as the other symptoms, were greatly relieved by venesection. About two months before death oedema of the legs appeared, which was soon followed by frequent and alarming syncope. His pulse was irregular, intermittent, hard, and vibrating. When lying down he frequently awoke, and started up in great terror. His usual posture was that of sitting, with his trunk and head bent forward, and inclining to the left side. For some time before death a recumbent posture threatened immediate suffocation; yet, three days previous to the occurrence of that event, he sank back upon the pillow. He was, at intervals, so much better as to think himself free from disease. Slight delirium preceded his death, which occurred in January, 1809.

DISSECTION, EIGHTEEN HOURS AFTER DEATH.

The countenance continued florid. The inferior extremities were much distended with water, and the cellular membrane abounded in fat.

The right cavity of the pleura contained a moderate quantity of water; the left, scarcely any. The lungs were firm, condensed, and dark coloured, from venous blood. The pleura, on the left side opposite to the pericardium, appeared to have been inflamed, as there was an effusion of coagulated lymph on its surface.

The pericardium was much distended with water. The heart, on the anterior surface of which were some appearances of inflammation, was very much enlarged. Its parietes were thickened; its cavities unnaturally large, and filled with black coagulum. Each of the valves had lost, in some degree, its usual smoothness, and those of the aorta were, in some points, thickened, and partly cartilaginous.

The liver was small, and, when cut, poured out dark blood. Its tunic was whitish, opaque, and corrugated.

CASE V.

A. B. a negro, about thirty-five years of age, had paroxysms of dyspnoea and violent cough, attended with oedema of the extremities and ascites, violent head-ache, dizziness, brightness of the eyes, palpitations of the heart, irregular, intermittent, slow, and soft pulse. These symptoms slowly increased, during three or four years, in which time the dropsical collections were repeatedly dispersed. He gradually and quietly died in the alms-house, in January, 1809.

DISSECTION.

On dissection, the cavities of the pleura were found to contain a considerable quantity of water. The pericardium was filled with water; the heart considerably enlarged; its parietes very thin, and its cavities, especially the right auricle and ventricle, morbidly large.

CASE VI.

Mrs. M'Clench, a washer-woman, forty-eight years of age, of good constitution and regular habits, was attacked, in the summer of 1808, with palpitations of the heart and dyspnoea on going up stairs, severe head-ache, and discharges of blood from the anus. These symptoms did not excite much attention. In the winter of 1808-9, all of them increased, except the palpitations. The inferior extremities and abdomen became distended with water; the region of the liver painful; the skin quite yellow; the pulse was hard, regular, and vibrating; the countenance very florid. Violent cough followed, and blood was profusely discharged from the lungs. This discharge being suppressed, evacuations of blood from the anus ensued, under which she died, in March, 1809.

DISSECTION.

The right cavity of the thorax was filled with water; the left contained none. The lungs were sound, but very dense, full of dark coloured blood, and, on the right side, pressed into the upper part of the thorax. The heart was one half larger than natural; its substance firm, and its anterior part, especially near the apex, covered with coagulated lymph. The right auricle and ventricle were large, and their parietes thin. The parietes of the left auricle and ventricle, particularly of the latter, were much thickened, and their cavities were filled with black coagulum.

The liver was contracted; its coat wrinkled, and marked with appearances of recent inflammation.

CASE VII.

To JOHN C. WARREN, M. D.

MY DEAR SIR,

Your important communication to our society, which is about to be published, will lay before the American public much more knowledge respecting the diseases of the heart, and large vessels, than has hitherto been presented to them. A case has lately fallen under my observation, having so much similarity to those of organic diseases of the heart, which have occurred to you, as to mark its affinity, yet with some differences, which characterize it as a variety. If the statement of it will add any value to your collection of cases, you are at liberty to publish it.

A. S. twenty-eight years of age, and of middle stature, was attacked, after a debauch, with pain in the region of the heart, which subsided, but returned a year after on a similar occasion. He then became affected with palpitations of the heart for six months, great difficulty of breathing, which was augmented by ascending an eminence, severe cough, dizziness, and violent head-ache, attended by a disposition to bend the body forward, and sudden startings from sleep. His pulse was always regular, and never remarkably hard. His countenance, till within a few weeks of death, presented the appearance of blooming health. His feet and legs did not swell at any period of the disease. He suffered exceedingly from flatulence, to which he was disposed to attribute all his complaints. This symptom might have been aggravated by his habits of free living, and occasional intoxication, which he acknowledged, and to which he traced the origin of his disease.

After death, water was discovered in the thorax; but the lungs had not that appearance of accumulation of blood, in particular spots, which is commonly observed in cases of organic disease of the heart. The only very remarkable morbid appearance about the heart was in the aorta, and its valves. The valves had lost their transparency, and were considerably thickened in various spots. The inner surface of the aorta, for about an inch from its commencement, was elevated and thickened, and the external surface singularly roughened and verrucated. This appearance was so peculiar, that no words will give a competent idea of it, and perhaps it would be sufficient for me to call it a chronic inflammation.