865

HEPATISATION OF THELEFT LUNG,

AND

DISEASE IN THE RIGHT SIDE OFTHE HEART,

PRODUCED BY A FIT OF INTOXICATION.

M. D. THOMPSON, M.R.C.S.L.

To the Editoy- of THE LANCET.

SiR,-The insertion of the following casein your valuable Journal will oblige your’sobediently,

M. D. THOMPSON, M.R.C.S.L.Stalybridge, Feb. 23,1843.

The subject of this case had been em-ployed in tho card-room of a cotton factoryfor the previous fourteen years. About twoyears ago he had pericarditis and anasarca,from which he apparently wholly recoveredin a few weeks, by depletion and a course ofmercury. During the remainder of his lifehe had enjoyed good health until the 14thinst., when about three o’clock, p.m., he wasvisited by my intelligent pupil, Mr. Stop-wood, who thus describes the condition inwhich he then found him :-

11 On visiting J. W. on the 14th of Febru-ary, I found him a strong-built man, of thebilious temperament. His countenance ma-nifested considerable distress ; his breathingwas natural ; circulation weak, but regular ;pulse about 00 beats per minute, soft, andcompressible ; the skin was moist, but ratherbelow the natural heat ; the vessels of themembranae conjunctivas were injected withred blood ; but both he and his wife declaredthat such was their ordinary condition. Hecomplained of pain over the whole of hisbody, but particularly in the extremities,whichhe stated himself to be nearly inca-pable of moving. He had had for manyhours almost incessant vomiting, and his bedwas saturated with the ejected matters; hisstomach, he said, felt quite sore,’ whichhe attributed to his efforts to vomit. Uponquestioning him concerning the commence-ment of his illness, he confessed to havingdrunk a pint of strong rum about twenty-four hours previous to my seeing him, towhich he imputed his ailment. He hadvoided a considerable quantity of urine sincethe occurrence, but had had no evacuationfrom his bowels." ,On visiting him at ten o’clock, p.m., of the i

same day he was restless, and complainedof an acute pain opposite to the apex of theheart, increasing on respiration, and alsoconsiderable pain along the left side of hisbody, especially in the left arm and the leftleg. These limbs he stated to be nearlypowerless, an effect supposed to have beenoccasioned by having lain for several hoursupon them, in the cold, while under the in-fluence of the rum which he had previouslydrunk. His countenance was anxious andexpressive of great physical distress, his

tongue tremulous and coated, and his pulseslow and feeble.On percussion, a greater extent than na-

tural of the precordial region emitted a

dull sound, and on placing the ear to thesame part no impulse of the heart could bediscerned, but a distant rustling or friction-InW’lnUl’ was audible.On the 15th he was afflicted by a loud

tracheal rhonchus and suffocating dyspnoea,no pulse was distinguishable at either wrist,and he died in the course of the followingnight.

Suffice it to say, that the treatment of thiscase consisted of bleeding, calomel andopium, blisters, and sinapisms.

Sectio Cadave1’Ís.-On the chest beingopened the left lung was found compactlyfilling all the left side of the thorax; it was

very hard, in fact, completely hepatised,with the exception of a small portion of Itsupper lobe, its sections yielding, on beingfirmly pressed, a considerable quantity of adark-red grumous fluid and a greenish-whitemuco-purulent matter. The latter filled thebronchial tubes, the internal tunic of whichhad a dark reddish-brown appearance. The

right lung was apparently healthy. The leftpleuritic cavity contained a quantity ofserum. The diaphragm had a considerableconvexity upwards, so much so as to ele-vate greatly the apex of the heart. The pe.ricardium contained from one to two ouncesof turbid serum, with some Bakes of lymph,and the apex of the heart adhered to the pe-ricardium by a small membranous band.There were some deposits of lymph, of aboutthe magnitude of a sixpence, but of an ovalfigure, between the external serous and themuscular tunics of the heart. In the rightauricle and ventricle a thick white elasticsubstance, apparently organised fibrin wasdiscovered adhering in the ventricle so inti-mately to the columnae carneae that it couldnot be removed thence without laceration ofthe latter; it also extended along the tubeof the pulmonary artery, nearly obliteratingits calibre. The left ventricle was consider-ably hypertrophied.On the abdomen being opened the bowels

were found distended with wind, but no fur-ther indication of disease manifested itself

amongst the viscera of this cavity. Thehead was not examined.

It appears to me probable that the predis-posing cause of disease in this case was ex-

i treme nervous exhaustion, so extreme as toapproximate closely to death, and accord-ingly to occasion a diminished quantity ofblood in the left side of the heart and thearteries, with a proportionate increase of

* As it is doubted whether or not thearteries possess an independent power ofcontraction, I beg to state that lately, in oneinstance, after having firmly tied two ligatures, two inches from each other, on a

866

strongly pulsating umbilical cord, whichwas then divided betwixt them, I observedthe arteries on the placental side of the corddivided, to continue pulsating for severalmoments subsequently.

blood in the right side of the heart and theveins, in consequence of the former possess-ing greater irritability and contractility thanthe latter. I also consider the excitingcauses to have been gravitation and cold, oc-casioning the condition of the lung termed byDr. Williams hypostatic, and that the proxi-mate endocarditis, pericarditis, and pneumo-nia agonisantium (as thus termed by Laen-nec), were the effect of the struggle occa-sioned by the distention of the right side ofthe heart, and the obstruction of the rightpulmonary artery, arising from its engorgedcapillaries.The practical inference deducible from the

above case is, I think, that no individual ina state of intoxication should be permitted tolie in any single posture for a long periodwithout intermission, or in a cold place.

FUNCTIONS OF THE LYMPHATICSYSTEM.

To the Editor of THE LANCET. ’,SiR,-Dr. Carpenter has written to me a

note in which he claims priority in thedeclaration of the new functions assigned tothe lymphatic system, and has forwardedme several pages of the proof-sheets of his« principles of Human Physiology," pub.lished twelve months since, which contain Ithe enunciation of this doctrine. i

I have already privately assured thisgentleman that I had never seen his work,and bad not been made acquainted with hisviews in any manner, so that my originality Iis not affected. j

Dr. Carpenter has freely and clearly z’stated the principle in question, and thus ’,far I recognise his claim and give him creditfor philosophical acuteness. He draws myattention to the following passage, as declara-tory of the general principle :- ," It may be stated, then, as a general fact,

that the function of the absorbent system isto take up and to convey into the circulatingapparatus such substances as are capableof appropriation to the nutritive process,whether these substances be furnished bythe external world or be derived from thedisintegration of the organism itself."The words printed in italics show that

Dr. Carpenter believed that the waste mat-ter of the system was capable of being re-converted into nutritive matter ; a position,in my opinion, inconsistent with the laws ofphysiology, and altogether insusceptible ofproof. I have avoided this view of thequestion on this account.

My sole principle is, that the unorganisedadipose matter receives the necessarychanges, fitting it Bfor organisation, in thelymphatic vessels. It is true that Dr.Carpenter recognises the probability of thetransformation of oily matter into albumenby the agency of the blood in the lactiferoussystem ; and so also did Miiller, althoughthis physiologist failed to observe that whichwas apparent to Dr. Carpenter, namely, theanalogy between the two systems of vessels.The principle, as announced by Dr. Car-penter, rests entirely upon this analogy.The principle, as contended for by me, restsupon evidence more direct. I have endea-voured to prove what before could only besuspected.The demonstration of this view, resting

upon the constituents of the lymph itself,the changes undergone in the ovum, and inthe application of the laws of metamorphosis,give me not only a claim to originality in thegeneral principle, granted by Dr. Carpenter,but also to priority in the adoption of directinductive argument. The announcement,also, that uric acid or its elements is the

azotising principle, necessarily flows out ofmy mode of reasoning, and is wholly mine.I shall not dilate upon the importance ofthis principle, both physiologically and

pathologically.I have much satisfaction in remarking

that Dr. Carpenter, with a quick apprehension of its value, has considered that it addsmuch force to the doctrine first suggested byhim that the blood was the means of effect-ing the changes in the lactiferous vessels;for after the withdrawal of uric acid fromthe blood to perform this office, its remainingelements pass through the liver to be secretedin the form of bile, and Liebig has shownthat bile + urine = animal flesh, or there-abouts."

This view, also, completes the chain ofevidence I have brought forward respectingthe pathology of typhus ; for if uric acid benot separated from the blood in the lactifer-ous vessels, owing to any morbid conditionof these vessels, the blood will not be pre-pared for the formation of bile; the liver

will, in consequence, suffer an arrest, or de-rangement of function, and uric acid andoily matter will appear more abundantly inthe urine. Let me further add the proba-bility that the red particles are mainly instru-mental in the performance of these azotisingprocesses.

Dr. Carpenter will doubtless be pleasedto see the further application of the pointwhich his discrimination made evident.The process of the conversion of oily matterinto albumen is one of those importantchanges of which (to use the words of Dr.Carpenter) ., we are yet entirely ignorant."If my exposition has contributed to render