Illustrations of pulmonary consumption, its anatomical characters, causes, symptoms and treatment. With twelve plates, drawn and coloured from nature

Front matter

YALE MEDICAL LIBRARY

HISTORICAL LIBRARY

.*

Preface

The author of a new book may sometimes be compared to the voyager, who, after circumnavigating the globe, and viewing its mountains, islands, bays and rivers, returns home without having added much that is new to the chart he took with him : and yet, to continue the metaphor, we may, even under such circumstances, read the narrative with pleasure and instruction ; for while it revives and* confirms our previous knowledge, it perhaps throws some new light on remote and interesting objects.

It may be urged, that the subject of the following memoir has already occupied the ingenuity of so many able writers, as scarcely to leave room for a new idea: but a disease that has ever caused a large proportion of the mortality in almost all countries, and which attacks the human frame in every phasis of its development, from embryo existence to extreme old age, justly claims the untiring scrutiny of the physician.

Vlll PREFACE.

It has often surprised me, that of the works of Bayle and Louis, we have no American editions. Dr. Forhes's translation of Laennec, is executed with ^admirable precision and elegance ; and had it been republished in this country at the time the present volume was commenced, it is probable the latter would never have been offered to the public.

The work of Dr. Louis has not, to my knowledge, been translated into English : I am informed, however, that this very desirable object is likely soon to be realized, through the zeal and talent of my friend Dr. Gerhard.

It may reasonably be asked, what my opportunities have been for an inquiry of so much interest and difficulty, as that which forms the subject of this volume.

My attention was first particularly directed to the diseases of the lungs, by an attendance on the clinical lectures of the celebrated Laennec ; who, with astonishing acuteness of mind, and personal urbanity, combined the. faculty of imparting a portion of his enthusiasm to all who heard him.

On my return to this, my native city, I resolved to pursue with ardour an inquiry for which I had imbibed so strong an interest. But facilities are not always at our command ; and before I was able to realize them, several years had already elapsed. At length, in 1829,

PREFACE. IX

I received the appointment of physician to the Philadelphia Alms-house Hospital.

The wards of this institution habitually contain several hundred patients; exhibiting almost all the maladies to which man is subject, and especially those of a chronic nature, among which phthisis may be said to predominate. The deaths from this disease alone are little short of one hundred annually ; and the facilities of pathological investigation in this institution are unrivalled on the American continent.

To these advantages I have added others, derived from an extensive private practice; and have long made it a rule to preserve the histories of my cases, and to avail myself of every opportunity of comparing the opinion I had formed during the life of the patient, with the appearances of the body after death.

From a large number of cases thus recorded, I have selected for this work, such as best serve to give an idea of the various conditions of consumption ; and in many instances the cases are further illustrated by coloured plates.

On these lithographed illustrations I have bestowed the utmost attention ; the preparations from which they were derived, were placed, as soon as obtained, in the hands of an excellent artist, and every character,

A *

X PREFACE.

whether of organization or of colour, was immediately transferred to paper under my personal supervision.

In arranging the cases, many of which have chiefly an anatomical interest, I have, as a general rule, endeavoured to restrict the details to the points under consideration at the time, and to reserve whatever relates to the treatment of phthsis, for the last chapter : for it is obvious that unabridged histories of this kind would involve interminable repetitions, and extend the limits of this work far beyond the author's design.

In fact, my original plan embraced little beyond the pathological anatomy of the lungs ; but year after year the subject expanded before me, until I have been induced to examine it in nearly all its bearings.

Thus, after the manner of Laennec and Louis, I have commenced with an examination of the anatomical characters of consumption, and have endeavoured to trace its changes from the incipient granule to open abscess. Some brief remarks have been devoted to its pathology, followed by a more extended view of its causes, symptoms and treatment.

Perhaps I should apologize for introducing the initiatory chapter on the morbid changes of structure which accompany phthisis, especially as the remarks

PREFACE, Xi

under this head are wholly elementary. But it occurred to me that even a brief notice of those changes might be acceptable to many whose avenues to pathological information have been limited ; and especially as the chapter in question embraces some leading features in morbid anatomy, and principles of general application.

I much regret that with respect to the relative advantages of climate in different parts of this country, the details should be so meagre ; but notwithstanding my sedulous inquiries for facts of this kind, I have met with comparatively little success, although I am sensible that many sources of information may have escaped my^research.

A subject, however, of such paramount interest, cannot remain much longer uninvestigated; and I seize the present occasion to express a hope that the practitioners in various sections of the United States will give more attention to medical statistics, embracing especially the mean range of the thermometer, the prevalent diseases, comparative tables of mortality, the changes incident to the progress of cultivation and civilization, and an examination of the question, how far, in these varied localities, phthisis and scrofula appear to be conjoined.

Xll PREFACE.

Medical men attached to the army have great facilities for inquiries of this kind, and those who reside in the vicinity of the Indian tribes, have it in their power to communicate much valuable information. Dr. Kush, in his Medical Inquiries and Observations, speaks of consumption as a disease almost unknown among the aborigines of this continent ; while the late Professor Barton maintained the contrary opinion, derived, however, as I have reason to believe, from the prevalence of scrofula among some of the more northern tribes.

Few inquiries are more interesting to medical men, than those which illustrate the influence of the refinements of civilized life in the production of disease ; and in no instance can this question be examined with more interest than in reference to consumption.

As the result of several years of observation and reflection, I now submit this work to my professional brethren ; and if in its pages they meet with fewer novelties than they could have desired, I trust they will at least award me the merit of illustrating an intricate subject in a conspicuous manner : for it has not been my object to originate a striking hypothesis, or to advance imposing novelty in practice : but rather

PREFACE. X1H

to convey, with reasonable brevity, the results of my own observation and experience, compared with the views of those who have preceded me in this inquiry.

I cannot conclude this preface without expressing my grateful thanks to those resident physicians of the Philadelphia Alms-house Hospital, whose aid will be more specifically acknowledged in the course of the following pages ; and whose professional zeal and intelligence have been of infinite service to me in the pursuit of my inquiries.

Finally, whatever acknowledgments an author can owe to his publishers, I owe to mine, more especially for their unhesitating liberality in meeting the heavy expenses- inseparable from a work of this kind.

Contents

Page Chap. I. A brief view of those morbid conditions of the lungs and their appendages, which usually co-exist with phthisis, ... 9 II. Anatomy of tubercular matter, 18

III. Pathology of phthisis, 33

IV. Causes of consumption, 40

Chapter I

A BRIEF VIEW OF THOSE MORBID CONDITIONS OF THE LUNGS AND THEIR APPENDAGES, WHICH USUALLY CO-EXIST WITH PHTHISIS. .

In examining the lungs of persons who have died of Phthisis, we almost invariably find the tubercular affection complicated with organic lesions of a different character. It would be foreign to the plan of the present work to enter into the details of these numerous diseases; the following remarks are consequently of an elementary nature, designed chiefly to enable the observer to distinguish tubercular matter from the morbid changes that accompany it. Most, of these changes may be either causes or consequences of phthisis; although the nicest examinations do not always enable us to say which has been the primary, or which the consecutive affection.

PLEURISY.

Pleuritis. Inflammation of the pleura. — Acute Pleurisy is ushered in by severe, pungent, fixed pain, which is aggravated by every motion of the body, but especially by coughing and speaking, and by efforts at full respiration. The patient is most at ease when lying on the sound side. The pain spreads rapidly from the point of origin, often extending over the whole side of the chest, and even to the opposite side; in the latter case the disease is called a double pleurisy.

If these symptoms are not soon relieved, the disposition to cough increases in common with an aggravation of pain, dyspnoea, &c. The countenance assumes an expression of great anxiety, is of a livid colour, and a sense of suffocation continues almost to the moment of death.

Pleurisy commonly produces one or more of the following morbid changes in the pleura: these changes, however, do not necessarily involve the life of the patient; for every day's experience goes to show that they are often followed by restoration to health.

Adhesiotis. — One of the first consequences of inflammation of the pleura, is an exudation, on its internal surface, of coagulable lymph, which is in fact the fibrinous* portion of the blood. This is considered by Laennec as a kind of suppuration proper to serous membranes.t It consists of a yellow-, opaque exudation, at first not thicker than cream, but soon acquiring a firmer consistence. This appearance, which is the first stage of false membranes, is often in patches, or rounded granules on the pleura, other portions of the membrane presenting a spotted redness. The exudation soon becomes organized, firm, and almost inseparably attached, presenting most frequently the following characters:

Thread-like cords, and flattened bands, passing from one surface of the pleura to the other, diaphanous, and sometimes

* Chemical analysis has proved it to be pure fibrine : M. Andra] suggests wfth great probability, that this principle constitutes the basis of all organized morbid productions, both in parenchymatous and membranous tissues.

| L'Auscult, Med. t. i. p. 331.

PLEURISY.

more than two inches in length. Their characters closely resemble those of cellular tissue.

Occasionally these cords attain a great thickness, and in some rare instances enclose adipose matter. (PI. XI. fig. 2.) (Case 18.)

Again, it is not unusual to find the entire surfaces of the pleura closely and directly adherent, by means of numerous layers of cellular tissue resembling the pleura itself. This structure is admirably seen when it co-exists with general dropsy.

Finally, there is a species of false membranes of a fibro-cartilaginous consistence, which results from long continued irritation of the pleura. It is formed by successive deposits of lymph between the natural membranes, separating the latter widely apart, and even attaining the thickness of an inch. Its colour assumes various shades of yellow and white, with a tinge of gray. (PI. XI. fig. 1. and PI. IX.) This substance also assumes a spheroidal form, and may be readily mistaken for tubercles.

It sometimes occurs that the secretion of coagulable lymph is accompanied with an effusion of red blood; this constitutes the hemorrhagic pleurisy of Laennec. (Case 14.)

Effusion. — Effusion into the cavity of the pleura does not necessarily follow the inflammation of that membrane, for it is often absent: but there is sufficient evidence that when it does occur it is mostly simultaneous with the inflammation itself, as Laennec has demonstrated. This fluid is sometimes in great quantity, compressing the lung and suspending its functions. (Case 26). It is serous, or sero-purulent, sometimes tinged with blood; it is also seen of a light wine-colour, and again of a milky or turbid hue, derived from the morbid secretions of the pleura, which are occasionally observed in floculent masses swimming in the fluid.

When, in consequence of a wound of the pleura, blood is effused into its sac, the disease is called Hemothorax.

That kind of effusion which is occasioned by ulcerous perforation of the pleura, will be more particularly noticed hereafter.

PNEUMONIA.

Peripneumonia. Pneumonitis. Inflammation of the lungs. — Inflammation of the lungs generally commences suddenly with a chill, and pain in some part of the thorax, followed by oppression, difficult respiration, cough and expectoration of a viscid mucus, more or less mixed with blood. The skin becomes hot, the pulse full and frequent, the breathing laborious and hurried, and the anxiety extreme.

According to the duration of pneumonia, it induces one or several of the following pathological conditions :

1. Engorgement. Engouement. — Inflammation of the lungs is confined, at least in its acute form, to the cellular tissue of those organs which in the first stage is engorged with blood, rendering them more dense than natural, and of a livid colour with a violet tinge. The sero-sanguineous fluid shows freely from an incision. If in this state the lungs be carefully washed, they resume their crepitancy and other natural characters.

This stage is susceptible of perfect resolution.

2. Red hepatization. Ramollissement rouge. (Andral.) Carnification. — This condition marks the second stage of pneumonia: it is readily identified by its deep red colour, its firm consistence, and its solid appearance; the lung no longer floats in water; and, if torn, presents a rough, granulated surface, like that of the liver. (PL III. fig. 2.) When cut into, scarcely any moisture escapes ; but if pressure be applied near an incised surface, a small quantity of sero-sanguineous fluid flows out. An incision also exposes numerous white points and lines, which

PNEUMONIA. 13

are unaltered portions of the blood-vessels and bronchial canals. I have known these points to be mistaken for tubercles. This stage is also susceptible of entire resolution.

3. Yellow hepatization. Purulent infiltration. Ramollissement gris. (Andral.) * Suppuration. — This is the third stage of pulmonary inflammation, and presents the following characters :

The lung is hard and granulated, as in the former stage, and has a remarkable straw yellow colour, mostly pale, but occasionally in young persons of a brighter hue. If the lung be cut, an opaque, viscid, yellowish fluid escapes, resembling pus. The yellow portions of lung are often interspersed with patches of red hepatization, giving the incised surface a marbled appearance, not unlike certain adipose conditions of the liver.

Resolution sometimes follows this stage of pneumonia.

4. Induration. Induration grise et rouge. (Andral.) — If, after hepatization has taken place, resolution does not follow, the lung gradually loses its red colour, and assumes a light gray tint. In some instances, however, it retains a dull red hue. This morbid structure is of a dense, dry consistence, often with a reticulated appearance from some remains of the air cells, and mostly interspersed with tuberculoid granulations. When incised it yields a sound not unlike that obtained by cutting a sponge. Tubercles frequently form in it. (PL IX.)

I cannot believe, with some authors, that gray induration ever results from simple chronic inflammation; but that, on the contrary, it is always preceded by acute inflammation, which not being resolved in its third stage, leaves the lung dense as in hepatization; the red globules and much of the granular structure having disappeared.

5. Abscess. — This is an extremely rare termination of simple pneumonia; so much so, that Laennec says he met with it but five or six times in many years.* The parieties of the cavity are formed by the surrounding pulmonary tissue, and the cavities themselves are generally very small. In a great number of dissections I have but twice met with this condition of the lung. {Cases 32 and 33.)

6. Gangrene of the lungs is of comparatively rare occurrence, but may be readily detected by its greenish or black colour, strongly contrasting with the yellow hue of tubercles, and by its intense foetid odour. Gangrene does not always follow pneumonia, but is sometimes an idiopathic affection.

It is an important fact, that pneumonia, in a vast majority of instances, commences in the inferior lobes of the lungs.

PLEURO-PNEUNONIA.

It is scarcely necessary to observe, that inflammation of the parenchyma of the lungs and of the pleura, frequently occur simultaneously, — a complication which embraces the morbid changes proper both to pleurisy and pneumonia.

BRONCHITIS.

Pulmonary catarrh.'f — This disease, so familiar to us by the names of cold and catarrh, is an inflammation of the mucous membrane lining the air-tubes of the lungs. It is at once recognized by its red colour, in some instances extremely bright, in others dull and mottled. The mucous membrane of the nose is often first attacked, the inflammation consecutively involving the larynx, trachea and bronchia. When it passes to the chronic state, ulceration follows, which may be recognized by numerous small, irregular, white spots; these, when examined, are found to be partial excavations in the mucous

* L'Auscult. Med. t. i. p. 164. — Boisseau, Nosog. Organique, t. ii. p. 421. j Called Peripneumonia notha by the older nosologists.

(EDEMA. EMPHYSEMA. 15

surface. (PI. XII. fig. 2.) When this inflammation becomes chronic in the larynx and trachea, ulceration is sometimes deep and extensive, even destroying the cartilages, and causing those alterations in the voice so common in phthisis. (PI. X.) The long continuance of catarrhal affections, especially that form of them called chronic mucous catarrh, sometimes occasions dilatation of the bronchia. In this pathological state, the air-tubes become preternaturally enlarged, their mucous membrane thickened, and of a violet hue. (Case 15.)

The mucous membrane of the bronchia is capable of secreting genuine pus ; and it will be hereafter shown that there is a form of bronchitis so resembling tubercular disease of the lung, as readily to be mistaken for it.

(EDEMA.

Hydrops pidmonum. Dropsy of the lungs. — This is an effusion of serum into the interstitial Cellular tissue of the lungs: the latter, when examined after death, may be pitted with pressure like the surface of the body in anasarca; they are much heavier than natural ; and on being cut and compressed, discharge a yellowish serum, after which they become again crepitant.

EMPHYSEMA.

Emphysema pidmonum. Pulmonary emphysema. — This is constituted by a distension of the air-cells in chronic catarrh, &c. The vesicles not unfrequently observed on the surface of the lung beneath the pleura, are caused by the escape of air from the cells within; the difficulty, however, of pressing the air -back into the bronchia, led Dr. Bailey erroneously to suggest that it was secreted by the minute blood-vessels.*

* Morbid Anatomy, p. 47.

PNEUMOTHORAX.

' The distension of the cavity of the pleura by air may originate variously, but in most instances is consequent to the absorption of the serum effused in pleurisy. The long continuance of such effusion presses the lung towards its root until permanent atrophy is established; if absorption is subsequently effected, the lung does not regain its bulk, and the serum is replaced by air. (Case 17.) In other instances the pleura is thus invaded from the bronchia, in consequence of ulceration. This affection appears also to be sometimes idiopathic.

HYDROTHORAX.

Dropsy of the chest. — This name is given to idiopathic dropsy of the pleura, and must be cautiously distinguished from effusion from pleurisy, or from perforation consequent to an ulcer in the lungs.

MALANOSIS.

Melanosis is the name given by Laennec to masses of a black, or blackish-brown colour, occasionally found in the lungs, especially in tuberculous persons. This matter, according to the later views in pathology, is merely an excess of secretion of the pigmentum nigrum, modified no doubt by disease; in fact, it seems to bear much the same relation to the pigmentum nigrum that tuberculous matter does to the healthy albuminous secretions of the pulmonary tissue. Melanosis is mostly seen in amorphous masses, or irregular laminas, as represented (PI. III. fig. 2), or in black spots in the cellular tissue immediately beneath the pleura. (PI. XI. fig. 1.) It is sometimes encysted, and looks then not unlike a bronchial gland. Pathologists also speak of this secretion in the fluid form, a modification I have

CONCRETIONS IN THE LUNGS AND BRONCHIAL GLANDS. 17

not witnessed. I am disposed to think that melanosis is less frequent in this country than in Europe. In the Parisian hospitals, Bayle met with it in about a twelfth part of his autopsies.

CALCAREOUS CONCRETIONS.

These substances are frequently observed in the lungs and bronchial glands. They are mostly encysted (PI. III. fig. 2.), and give a gritty sensation to the fingers. Their consistence, however, is much varied, and they appear to be an intermediate link between tubercles and bony concretions. Analysis shows them to consist of ninety-six parts in the one hundred of saline substances, the remainder being animal matter. M. Andral considers them tubercles that have undergone an earthy transformation, an opinion that requires further proof.

, OSSEOUS CONCRETIONS.

•

Bony masses are frequently secreted by the arteries in the lungs and their appendages: in the former they are mostly rounded, and enclosed in a cyst; in other instances they have a rough surface, by which they are firmly attached. In the bronchia, they are branched in the direction of the air-tubes. In the glands they are often grouped.

DISEASED BRONCHIAL GLANDS.

These bodies are particularly subject to hypertrophy: when cut their substance is pulpy, traversed by white lines. They often contain tubercles, and calcareous and osseous concretions. (PL XII. fig. 2.) Again, they are occasionally softened, wholly or partially, into a yellowish, cheese-like substance.

Various minor pathological conditions of the thoracic viscera, will be noticed in the course of the following pages. c

Chapter II. Anatomy Op Tubercular Matter

Tuberculous matter presents itself in two very different forms, one of which is concrete, the other gelatinous: both of these varieties assume several different appearances.

These are granules mostly of a yellowish or greenish gray colour, sometimes diaphanous, sometimes opaque, varying in size, under ordinary circumstances, from a fig-seed to a cherry-stone. They are either isolated or grouped, in the latter instance forming considerable masses ; but if these be examined in their incipient state by reflected light, or with a glass, they are found to consist of an aggregation of the granules above mentioned.

These bodies are found on inspection to be extremely irregular in size; hence, in a state of aggregation, the masses are also extremely irregular, rounded, ovoidal, angular, stellated, &c. (PL I. II. III.)

Tubercles of this kind are sometimes in masses of a deep brownish-red colour, interspersed in others of a yellowish tint, giving the lung a marbled or mottled appearance. (PL I. fig. 2.)

It is obvious that pulmonary tubercles derive their gray

* Grandines of the older writers.

CRUDE TUBERCLES. GRAY INFILTRATION. 19

colour from the pigmentum nigrum, as Laennec has supposed ; whence they are often of a much darker tint in advanced life, as seen in those that surround the encysted abscess, PL V. fig. 1.

When vast numbers of miliary tubercles reach the periphery of the lung, their rounded surface causes a partial displacement of the pleura; so that on removing the latter, the lung appears as if covered with a pustular eruption. (PL II. fig. 1.)

CRUDE TUBERCLE.

This is called the second stage of tubercular matter, and certainly it is so in reference to the diaphanous variety, in which the transformation commences by one or more opaque points, and ultimately involves the whole mass. When the change is complete, the tubercular substance has a yellowish white tint, a texture approaching cartilage, but more humid and less compact,* and when cut into it is smooth and polished. (PL II. fig. 3.)

It is certain, however, that tubercles often make their appearance in the opaque form, rendering the crude transformation, or rather the first part of the suppurative process, much less obvious. (PL I. fig. 2.)

GRAY INFILTRATION.

Matiere grise demi-transparente. (Louis). — It is common to observe masses more or less considerable, of a light gray, translucent appearance, smooth, moist and shining when incised, and seemingly dense, but breaking readily under the fingers. No trace of air-vesicles remains; here and there are seen opaque spots of various shades of white and yellow,

* Laennec, L'Ausc. Med. t. i. p. J2.

marking the progressive transition into the suppurative stage. Sometimes the crude transformation simultaneously pervades the whole mass. So also vomicae form in various places, even while the surrounding portions still retain their original morbid characters. (PI. III. fig. 1.)

This variety, like the following one, manifestly results from an abundant secretion of tuberculous matter through a large portion of parenchyma at the same time: masses very similar in appearance, however, result from the slower process of miliary accretions, especially when the latter, assuming an angular form, coalesce into a uniform mass, as may be inferred from PI. II. fig. 2.

GELATINOID INFILTRATION.

This substance is in some instances harder, in others softer, than jelly. Its other physical characters vary greatly, it being sometimes semi-transparent and rose-coloured, but more commonly colourless, or grayish, or of an olive tint. It fills the interstices between common tubercles, or pervades the parenchyma in a homogeneous manner. In the latter state it often, when first secreted, resembles a mucilage, or more strictly the white of an egg, and has all the appearance of a nearly pure albumen, which it undoubtedly is. Although Laennec has given the name of colloid matter to this last variety, I am entirely satisfied that it is merely a form of tubercular disease, and of course subject to the same transmutations. (PI. III. fig. 3.)

Thus I conceive that the hypothesis of Cruveilhier, which supposes tubercular matter to be primarily secreted in the fluid state, is not unfrequently realized.

The two subjoined cases afford some interesting facts in relation to this subject.

GELATINOID INFILTRATION. 21

Case 1. Phthisis with gelatinoid infiltration, and interspersed miliary tubercles. — J. L., a weaver, aged forty-one years, black hair, dark complexion and* much emaciated, had been confined in the lower cells of the Alms-house hospital for about three years, on account of lunacy. On the 3d of February 1833 this man was removed to the medical ward with a troublesome cough and extreme dyspnoea. He was immediately cupped over the chest, and blistered in the evening, but died the same night.

Autopsy, assisted by Dr. Mason, thirty-six hours after death.

Thorax. Right lung free, and contained a few tubercles towards the apex.

Left lung totally disorganized and adherent to the pleura costalis ; its superior lobe was solidified by gray and gelatinoid infiltration ; the latter was distinct from the former, of a pale violet colour and diaphanous : interspersed through it were great numbers of opaque, yellow points, the size and colour of fig-seeds, which were obviously the radicles of transformation into crude tubercular matter. The surrounding gray infiltration had already attained this change, portions of it having began to suppurate.

The remainder of the lung was occupied by a series of large cavities, communicating freely even to the diaphragm, and crossed in every direction by cords of condensed pulmonary tissue.

Bronchial glands enlarged.

Mucous membrane highly inflamed.

Heart firm, smaller than natural.

Liver not obviously diseased.

Other organs not examined.

Remarks. — The gelatinoid infiltration is an example of tubercular matter secreted in the^emi-fiuid form; it is evidently a rapid secretion, and appears in some instances to be converted into crude tubercle by a process almost equally rapid, until the lung becomes a dense, and seemingly inorganic mass, without a trace of respiratory structure. The following is a striking example:

Case 2. A. W., a mulatto female, aged thirty, was admitted into the Alms-house hospital towards the close of 1831 with a violent catarrh, and was a few weeks thereafter discharged cured. She was re-admitted in December 1832 with a troublesome cough, severe pain in the right side of the chest, and profuse night-sweats : these appearances were successively followed by purulent expectoration, dyspnoea, oedema of the feet, and occasional hemoptysis. Her appetite was good, but her person emaciated and languid. The stethoscope detected cavities in the right lung, from its apex to its base ; the gurgling of fluid in these cavities was so strikingly distinct, that I repeatedly called the attention of the clinical class to it. This woman lingered until April 20, 1833, when she died.

Autopsy, assisted by Drs. Simpson, Allen and Postell, seventeen hours after death. Body extremely emaciated.

Thorax. Right lung firmly adherent posteriorly ; the superior lobe contained a large funicular abscess, the cords still slightly pervious, and obviously the remains of blood-vessels : this cavity communicated with others to the base of the lung ; the entire lung around the cavities was infiltrated and solidified, the tuberculous matter being of various shades of rose or violet, gray and yellow — the latter colour forming the parietes of the cavities for a line or more in thickness, and pervading the mass in irregular spots and lines. This yellow matter was obviously the crude transformation of the violet or rose-coloured portion, which appeared to have originally infiltrated the entire superior lobe. The violet mass was diaphanous, in some places shaded with gray, and contained disseminated specks of black pulmonary matter. (PI. VII.)