Mr. John Jackson, fifty-two years of age, had been affected for more
than two years with palpitations of the heart, and paroxysms of
dyspnoea. These symptoms increased in October, 1808, and were followed
by strong cough, uneasiness in lying down, sudden startings in sleep,
and an inclination to bend the body forward and to the left side. His
cough, during the last part of his life, was attended with copious
bloody expectoration. His countenance was florid; his pulse very
irregular, though not quite intermittent. The occasional variations in
the state of the disease were remarkable. Some periods were marked
with uncommon mental irritability. Pain in the region of the liver,
oedema of the inferior extremities, paucity and turbidness of the
urine, yellowness of the skin, and great emaciation attended the
latter stages of the disease. A degree of stupor occurred. The
termination on the 30th of January, 1809, was tolerably quiet. Two
days before death he sank into the recumbent posture, and his pulse
became more regular[5].
[Footnote 5: The symptoms of this patient were related by Dr.
Rand, sen. to whose politeness and love of medical
improvement I am indebted for the opportunity of examining
this and the following case.]
DISSECTION,
TWENTY-FOUR HOURS AFTER DEATH.
On opening the thorax, its right cavity was found to contain a large
quantity of water; the left, a smaller quantity.
The lungs were of a firm, condensed texture, especially at the lower
part, where their solidity was nearly equal to that of a healthy
liver. They contained black blood.
The heart was much enlarged, and proportionally thickened. Its tunic
was in some places covered with coagulated lymph, especially over the
coronary arteries. Its cavities were filled with black coagulum, which
in the right auricle and ventricle had a slight appearance of polypus.
The semilunar valves of the pulmonary artery and aorta were unusually
small, and their bases cartilaginous. Those of the aorta had lost
their form, and were slightly ossified. The remaining valves were
partially thickened. The arch of the aorta was very much dilated, its
internal coat covered with a bony crust, which extended through the
remaining thoracic portion, gradually diminishing. This portion was
also considerably dilated.
The liver was indurated; its peritonaeal coat exhibited a flaccid or
wrinkled appearance, and bore marks of slight inflammation. The gall
bladder was filled with bile, and the pancreas indurated.