Notes of two interesting cases of pulmonic and cardiac disease / by J.W. Fleming.

  • Fleming, Jim (James William)
Date:
1860
Catalogue details

Licence: Public Domain Mark

Credit: Notes of two interesting cases of pulmonic and cardiac disease / by J.W. Fleming. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    ail irregular cavity, and this again opened into a branch of the upper broncliial division. The substance of the lung was solid, void of air, and contained a number of crude tubercles more or less advanced. The Heart Avas thrust entirely to the right of the mesial line, and on opening the pericardium, the left side of this organ pre- sented a perjDendiciilar plane surface, of which the in- terventricular septum formed the anterior margin ; the left ventricle being completely flattened and pushed under the right, so as to give the heart a triangular wedge-like shape, which it retained when jilaced on the table. The posterior half of the mitral valve was a little corrugated on the line of its centre, apparently from the pressure ; but the heart, though small, a]opear- ed perfectly healthy, the only change being in that of its shape. Abdomen :—The Liver weighed 5 lbs. 10 oz. and the upper surface of the left lobe was flattened and pushed obliquely downwards, and to the right. The lesions of the intestinal canal were unimportant, and such as are usually found in Phthisis. The other vis- cera appeared to be normal. Bemarks :—This case illustrates in a remarkable manner a symptom perfectly pathognomonic of cases of Pleuro-pulmonary fistuloe, namely, the expectoration at intervals of purulent matter in very large quantities, in an incredibly short space of time. It also shews the effects of pressure, by means of air, in changing the position and shape of important viscera. The explana- tion of the first phenomenon appears to be simply this, that during sleep,—for it took place chiefly in the morn- ing—the purulent secretion, going on in the sac of the pleura, rises above the level of the fistulous openings in the lungs, and when the patient awakes his exertions in coughing, to clear away mucus, or other matters ac- cumulated in the air passages, give rise to strong in- spiratory efforts, that of ncccssit}’’ introduces an extra