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WESTMINSTER HOSPITAL.

GANGRENE OF THE LUNGS, VOMICÆ, ANDPNEU:I1ATOSIS THORACIS, WITHOUT COM-

MUNICATION WITH THE BRONCTII?6.

APRIL 27, 1832. William Hill, a smith,thirty years o.d, had enjoyed a fair share ofhealth all his lifetime, but was never par-ticularly hale. He was much addicted to

drinking, and led a very irregular course oflife. He in consequence became very sus-ceptible of attacks of cold upon the lungs,which, however, were always quicklyremoved by rest, regimen, and medicine.In the winter-time, for the last few seasons,he had been annoyed with a pertinaciGuscough, which was short, frequent, and un-attended with expectoration. The surfaceof his body did not show any cicatrices orother vestiges of syphilitic action. Hewas well formed, of good symmetry, mode-rately fiue complexion, and well developedmuscular system. About a fortnight ago,this man was affected with pain of thehead and other febrile symptoms. He was

obliged to desist from work immediately,and was attended by the parochial doctor,but without any benefit, and on admissionto-dav he presented the following picture.Countenance and the whole respiratory ap-paratus expressive of anxiety. Breathingaccelerated; respiratory murmur enhancedon both sides of thorax ; sense of constric-tion and pain in the chest ; headach, nau-sea, and general debility; tongue coatedwith a brown fur; dry along its medianline ; red at its apex and edges ; no appe-tite ; bowels open ; urine copious andhigh-culoured ; pulse strong and hard ; skin liotand dry. A calomel and antimonial bolus tobe swallotced rlirectly ; venesection to sixteen iounces, and the following medicine every fourhours:—Take of ipecacuanha wine, three’,drachms; distilfed water, eight ounces. lllia,and 1ft an ounce of’ it be taken for a dose.

29. The blood drawn is highly buffedand cupped. Last night he was seized witha shivering fit, which was followed by heatand sweating. There is a loud rute sortore

on every aspect of the chest. He has anacute pain at the scrobiculus cordis ; tonguemoist and white; bowels open. 4 blister to

the pit of stomach; repeat mediciaes.Two p.m. Great excitement of respira-

tion and sanguiferous system ; has just re-covered from a fit of rigors, and breathes80 times per minute. Pulse quick, full,and hard ; tongue covered with dark brownfur ; kin hot and dry ; pressure on abdo-men produces great pain. He complains ofacute pain under the floating.ribs on both.ides, which is much aggravated by the act

of drinking. Rale sonore very loud. Vene-section to twelve ounces.30 Somewhat relieved by the loss of

blood, which is again buffed and cupped,but the respiration is still as rapid as ever,attended with occasional gasping. Percus.

sion dull on the right side of chest ; ratesonore loud and strong, but modified by apeculiar vibratory sensation. The voice is

feeble, and produces no pectoral reverbera-tion. The patient always refers the painto the epigastrium. Cupping of the sides;mustard cataplasm to abdomen.May 1. The pulse has, for the last two

days, been very irregular, varying everyminute in force, frequency, and character.The anxiety of the patient’s countenance israther augmented than diminished. Dysp.

naea intolerable ; rale sonore has a ringingcharacter. He expired at noon.

Necrotomy 48 Hours after Dealh.The patient was not much emaciated,

but his contracted visage even then com-memorated the agony of the struggle hehad undergone. Upon raising the sternumthe pleurae were discovered distended withair, and on opening these bags the lungswere seen compressed against the medias-tinum and vertebral column. There was onboth sides a large quantity of serum, inwhich were floating flocculi of lymph. A

strong gangrenous stench emanated fromthe lungs, and on separating a portion ofthe external surface of the superior left

lobe from the thoracic wall a large cavity

was opened, of which the greater part wasengraven in the substance of the lung. A

portion of its parietes, however, also con-

sisted in the costal pleura to which the lungwas adherent. This sac contained a drachmof highly offensive sanies, and was itselfgangrenous to a great extent. A small

aperture communicated with the inter-

pleural space, and was evidently the con-sequence of the sphacelatiou of the point ofthe pleura pulmonalis. The contents of thisvomlcal sac had escaped between the pleuræ,but no direct or satisfactory commuuieationcould be ascertained to exist between themorbid cavity and the bronchial tubes.Two other solutions of continuity, similarto the one just described, were discoveredcommunicating’ with smaller vomicse. On

making longitudinal incisions through thelungs, the substance or parenchyma wasfound to be in general pretty healthy, al-though, in consequence of the externalpressure, a few air-bubbles only could beperceived in them. Several small ab.scesses, of the same character aa the firstwere met with, dispersed through the sub.

stance of both lungs, distant from eachother, and abruptly separated from the sur.rounding tissue by a dense sac, These

255

were filled with putrid pus, and had nooutlet, either to bronchiee or pleura. Asmall cluster of white pulpy tubercles,forming altogether a nidus not so large asa small hazel nut, appeared in the course ofan incision through the apex of left lung.The whole of this little aggregate was en-closed in a thick membranous tissue, whichprobably formed the sac of the futurevomica. On the right side there was a

greater secretion of lymph amongst theserum than on the left, but without lung,though a due share of abscesses were pre-sent ; no tubercular deposits were en-

countered. The largest vomica on the

right side was in the upper part of the in-ferior lobe, and had an opening through thepleura. There was a remarkable healthi-ness in the texture of both lungs, even inthose portions which were in immediatecontact with the very walls of the vomtcse.These vomic:e were rendered apparentlyimpervious to the air of the bronchise, bythe coriaceous sacs which involved them.It is probable, however, that the air whichdistended the two pleurae penetrated thetexture of these sacs. The whole of themucous membrane was highly injected, andafforded indications of long-standing in-flammation. The projecting edges of mem.brane, seen at the axillas of the broncbiae,were universally thickened. The larynxwas sound. In the other divisions of the

body, no morbid traces were discernible.

ST. BARTHOLOMEW’S HOSPITAL.

CUT THROAT—HEMORRHAGE FROM THE

LINGUAL ARTERY.—DEATH.

MAY 1.5. - was admitted intoPowell’s Ward about five days ago. Hewas a man-servant, and in a state of highexcitement had seized a penknife, and in-flicted a wound just above the os hyoides.This act was preceded, we believe, by anattempt to drown himself. Upon admissionwe did not see the case, but there was, weunderstand, a good deal of hemorrhage,which appeared to be chiefly venous ; this

however, was shortly put a stop to withoutany vessels being secured, as it was notknown that any artery of consequence hadbeen divided. The state of the man’s mindsoon became tranquil, he lay calmly in bed,and seemed likely to go on very well.

Yesterday morning hemorrhage suddenlycame on, which the sister arrested by coldapplications. About eleven o’clock last

night, having returited by himself from theu,ater-closet, and got into bed, the attentionof the nurse was suddenly called to him by abrief ejaculatioll. She found him with red

blood streaming from his nose and mouth,and although Mr. -11’Wliinnie, the housesurgeon, arrived in a minute or two, he foundthe patient lifeless, having lost about threequarts of blood. This unexpected termi-nation of the case excited much interest inthe autopsy which was instituted to-day, andthe most rational way of accounting fordeath appeared to be the supposition thatsome vessel unknown to be wounded hadbeen plugged up by a clot of coagulum,which was disturbed by the exertion of

going to the water-closet. Upon examin-ing the body, the excessive pallor of theskin, the empty state of the heart, and thevascular condition of the brain, describedas present, under such circumstances, cameunder observation. There was an ounceand a half of fluid in the ventricles ofthe latter organ. Dissecting out the ves-sels around the wound, it was found thatthe lingual artery of the left side had been

divided, and the extremity lay exposed inthe gash which had been made. The otherblood-vessels remained entire. It is properto state, that the man had no instrumentwithin his reach with which he could have

effected a second cut. ’

ANOTHER CASE.—DEATH IN THREE WEEKS.

April 28th. A- B-, a strong, stoutman, setat. 56, was this morning brought toCoulsou’s Ward by some policemen. Thiswas another case of cut throat. The ac-

count given by the policempn was, thatabout one hour previously the man, whowas a cobbler, entered a barber’s shop.There he was shaved ; after which, takingup the razor in the barber’s absence, he in-flicted on his throat the present injury.His shirt, under-waistcoat. and upperclothes, are saturated with blood, but thereis now very slight hemorrhage. His face ispallid ; pulse scarcely perceptible. His

eyes are closed, and great determination isimprinted on his countenance. Once hehas opened his lips to exclaim, ’ I’m not avillain -marking some conflict in his mind.Upon removing his garments the wound

was found with some strappings on it, andligatures applied on two or three small ves-sels. The dressings being removed, onevery lare gash was discovered, dividingthe windpipe at the upper edge of the

thyroid cartilage, and extending far laterallyso as just to escape the great vessels. Be-sides this cut there were three smaller ones

transversely, and one perpendicularly downthe front of the larynx, but these were

merely through the integuments. Thewound was sponged and cleaned, and the

edges approximated by raising the head and

neck on pillows. Brandy was administeredimmediately on his admission, and con-