id="pgepubid00010">CASE V.

A. B. a negro, about thirty-five years of age, had paroxysms of dyspnœa and violent cough, attended with œdema 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[9].

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 dyspnœa 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[10].

I am, my dear sir,
Your friend and obedient servant,
JAMES JACKSON.

CASE VIII.

Col. William Scollay, aged fifty-two, of a plethoric habit of body, was attacked, in the year 1805, with dyspnœa and palpitation of the heart, attended with irregularity of the pulse, and œdema of the lower extremities. By the aid of medicine, the dropsical collections were absorbed, and he recovered his health, so far as to follow his usual occupations, nearly a year; but was then compelled to relinquish them. The symptoms afterwards underwent various aggravations and remissions, till the beginning of the winter of 1808-9, when the attacks became so violent, as to confine him to the house. His face was then high coloured. The faculties of his mind were much impaired. The dyspnœa became more constant, and was occasionally attended by cough; the palpitations rather lessened in violence; the pulse was more irregular, and exceedingly intermittent. The abdomen and inferior extremities were sometimes enormously distended with water, and afterwards subsided nearly to their usual size. One of the earliest, most frequent, and distressing symptoms, was an intense pain in the head. About two months before death, a hemiplegia took place, but after a few days disappeared. This so much impaired the operations of the mind, that the patient afterwards found great difficulty in recollecting words sufficient to form an intelligible sentence. During the existence of the last symptom the pulse was regular.

He gradually expired, on the 15th of March, 1809.

DISSECTION, FIVE HOURS AFTER DEATH.

EXTERNAL APPEARANCE.

The countenance was somewhat livid and pale; the lips were very livid. The chest resounded, when struck, except over the heart. The abdomen was tumid, and marked by cicatrices like those of women, who have borne children. The superior extremities were emaciated, and marked like the abdomen. The lower extremities were œdematous.

THORAX.

The cartilages of the ribs were ossified. The left cavity of the pleura contained about twelve ounces of water; the right, about three ounces. The lungs, externally, were dark coloured, especially the posterior lobes; internally, they were very firm, and, in some places, as dense as the substance of the liver. A frothy mucus was effused from them in