Thomas Appleton, thirty-eight years of age, of a robust constitution,
was affected with excessive difficulty of breathing, occurring at
intervals of different duration. It commenced three years before his
death, and gradually increased. He was subject to palpitations of the
heart for at least two years before his death, and was distressed with
violent cough, attended with copious expectoration, which finally
became very bloody. The palpitation and dyspnoea were greatly
augmented by ascending stairs. His countenance was very florid.
Sometimes he was seized with violent head-ache and dizziness, which,
as well as the other symptoms, were greatly relieved by venesection.
About two months before death oedema of the legs appeared, which was
soon followed by frequent and alarming syncope. His pulse was
irregular, intermittent, hard, and vibrating. When lying down he
frequently awoke, and started up in great terror. His usual posture
was that of sitting, with his trunk and head bent forward, and
inclining to the left side. For some time before death a recumbent
posture threatened immediate suffocation; yet, three days previous to
the occurrence of that event, he sank back upon the pillow. He was, at
intervals, so much better as to think himself free from disease.
Slight delirium preceded his death, which occurred in January,
1809[8].
[Footnote 8: The symptoms in this case were related to me by
Dr. Warren, sen.]
DISSECTION,
EIGHTEEN HOURS AFTER DEATH.
The countenance continued florid. The inferior extremities were much
distended with water, and the cellular membrane abounded in fat.
The right cavity of the pleura contained a moderate quantity of water;
the left, scarcely any. The lungs were firm, condensed, and dark
coloured, from venous blood. The pleura, on the left side opposite to
the pericardium, appeared to have been inflamed, as there was an
effusion of coagulated lymph on its surface.
The pericardium was much distended with water. The heart, on the
anterior surface of which were some appearances of inflammation, was
very much enlarged. Its parietes were thickened; its cavities
unnaturally large, and filled with black coagulum. Each of the valves
had lost, in some degree, its usual smoothness, and those of the aorta
were, in some points, thickened, and partly cartilaginous.
The liver was small, and, when cut, poured out dark blood. Its tunic
was whitish, opaque, and corrugated.