On the pathology of one form of encysted empyema / by Edward Latham Ormerod.

  • Ormerod, Edward Latham, 1819-1873.
Date:
1852
Catalogue details

Licence: Public Domain Mark

Credit: On the pathology of one form of encysted empyema / by Edward Latham Ormerod. 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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    [gelatinous appearance, from the infiltra- idon of serous fluid; and the anatomical ilharacters of pneumonia were lost at hhis point, ceasing at some lines’ dis- aance from the walls of the cyst, which nrere very firmly connected with both hhe visceral and parietal layers of the )ldeura. There were no tubercles in the uungs. The morbid appearances in the fol- oowing case supply an important link ■connecting the two stages ot the morbid (process under consideration described on that just detailed :— Case 2. — A woman, aged 23 years, lilied of fever, twelve months after hav- mig received a blow on her side, to tHiich accident she used always to refer hhe constant pain and cough which she lead suffered ever since. On examin- ittion of the chest after death, the right il leura was found free; the left (the idde of the injury) was universally ad- kerent; in front, by loose, easily sepa- rtiible agglutination of the two pleural mrfaces; behind, by a layer of flbro- eelluhir tissue, which was of uniform hhickness and consistency throughout, isxcept at the lower part: here it con- aained within its substance, nearer to the ibiilmonary than to the costal surface, a ii.iass of gelatinous-looking fibrin, fully 1 quarter of an inch thick. This mass ihaded off on the sides, gradually, into I lie substance of the false membrane in drhose interior it lay ; but was bounded i>y a tolerably distinct ring round its (idges, at the line where the two layers iff the false membrane diverged, as it ri^ere, or re-united to enclose it. It was ff a flattened oval form,measuring about ^ by 3i in., and crossed without entering Iihe interlobar fissure. A few tubercles u’ere scattered through the apex of the ijght lung. If I am right in referring the masses uiund in the obliterated pleural cavities in botli these cases to the same morbid irrocess, they would stand in the follow- II,ig order:—In Case 1, in the mass of ibrin which occupied the interlobar -ssure, we have an example of the larlie.st form of this series of morbid I'ppearances. The mass had contracted ccarcelj''any adhesions to the neighbour- ijig parts; it was of almost uniform consistence, within and without alike ; liad all the appearance of having ceen recently deposited ; and, if we must >ssign it a date, it would seem most \kely to have originated with the recent •ttal attack of pneumonia. Case 2 takes up the history a little further on. .■^ftcr about a year had elapsed from the pro- bable period of the deposition of the mass, we find that it had contracted ad- hesions, and become hard and tough on the surface, though within it still closely resembled the structure of the more re- cent product ill the previous case. Case 1 takes up the history of the morbid changes again, after a long but uncertain interval. The mass, in the angle between the ribs and diaphragm, which illus- trates this stage, now contained no longer a gelatinous fibrin in its interior, but a diffluent puriform matter, which waited only an opportunity to discharge itself. The case next following, where the dis- charge of the contents of the cyst was attended with fatal consequences, com- pletes the history of the internal changes. Case 3.—A man of middle age, of strumous constitution, working hard and living carelessly, had a severe attack of “inflammation of the left side.’’ But he got apparently well, and so continued for about seven years. Then he began to fail; he suffered from cough, and had that peculiar appearance which we so often see in the subjects of aneurism of the arch of the aorta. Nothing, how- ever, could be determined by repeated most careful examination, as suggested by this particular appearance, beyond comparative dulness and impermeability of the left side of the chest. He got rapidly worse. With the aggravation of the symptoms the case became move clear. Evidence was obtained of per- foration of the lung; and he died, with the physical and other signs of partial pneumo-thorax of the left side. Omitting the description of otlier changes not relating to the present sub- ject, there appeared, on dissection, al- most universal adhesion of the left ])leura. The pulmonary and costal sur- faces were closely united by dense, firm tissue, except for about a hand’s-breadth over the lower lobe behind, 'i'o this extent the two layers were separated by a collection of thick, curdy, puriform fibrin. 'I'he sac communicated, tlirough the substance of the lung, with a neigli- bouring bronchial tube, by a small, well-defined orifice. A very few small tubercles were scattered through the substance of the lungs. In this case the more urgent feverish symptoms, and, indirectly, those leading to the fatal termination, appeared clearly referable to the pointing, so to say, of this collection in the pleura. Quoting it