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“O glory of the Greeks! who first didst chase
Autopsy of Elias Hunt, with Remarks.
The October number of the Peninsular Journal contained some remarks on the case of Mr. Elias Hunt, then an inmate of St. Mary's Hospital, where he died from the conjoined effect of pulmonary tuberculosis and a valvular disease of the heart, inducing venosity of the blood. On the decease of Mr. H., a few weeks after the publication of that article, the thoracic viscera were removed and sent to the University for examination, where most of the members of the Clinical Class tlien were, who had during the life-time of the patient made a careful examination of his case. The result of the autopsic examination will be found in the note of Prof. Palmer inserted below.
University of Michigan, Nov. 30th, 1857. The heart was first examined. It was a little larger than natural for a man of Hunt's size; must have been moderately hypertrophied. This was general, but rather more perceptable in the walls of the auricles. The pericardium was adherent to the walls of one of the auricles. The endocardium was generally healthy. The columna carnæ, musculi pectinati and apertures of the organ, with the exceptions to be mentioned, were fully developed and normal.
The aortic valves were in an abnormal condition. Their free margins were not excessively, but decidedly thickened. There were plastic, fibrinous deposits in their structure, with no ossific, or scarcely what could be called cartilaginous appearance-not sufficient to com. pletely prevent their closure, but yet enough to so agitate the blood passing through the orifice and over them, as to give the bellows murmur, so distinctly heard during life. Regarding the mere postmortem appearances of these valves, I should not have judged that their condition very essentially interfered with the necessary function of the heart, though they fully accounted for the bellows or blowing sounds. The valves of one of the other apertures were thought to be very slightly, but not materially thickened. There had been at some time both endocarditis and pericarditis, but there was not evidence of these cardiac inflammations having occurred to a very great extent.
60_VOL. V. NO. IX.
The lungs were next inspected. There was rather more than the usual amount of the dark discoloration of their surfaces. Over a very large portion—nearly the whole extent of both lungs—there were evidences of old and very firm pleuritic adhesions—so much so, that in several places the lung substance was quite extensively lacerated in removing them from the chest. In the upper part of each lung there were several (from three to five) old cavities, from the size of a filbert to that of an almond. There were also in each, more recent tubercular formations—more on the right side than the left, and were in a state of softening and suppuration. Few or none of them had as yet found an opening into the bronchial tubes. These tubercles were generally distinct and for the most part about the size of a small filbert; some not larger than good sized peas. These tubercles were not numerous in either lung and occupied a space of but few cubic inches at the very apex of the lungs. The great mass of the lung substance on both sides was in an apparently normal condition.
Several enlarged and congested lymphatic glands were found attached to the upper part of the specimen, about the trachea. I have never witnessed so small an amount of tuberculous disease in one dying from simple phthisis pulmonalis. Neither was the heart disease at all sufficient to account for death, taken by itself. What was the special cause of death? The pleuritic adhesions doubtless restrained the action of the lungs, but could not have prevented respiration, so far as to have materially obstructed the aeration of the blood. The patient was a man of rather feeble vital energy, and seemed to have no desire to live. Had that condition of his mind anything to do with the result? What was the particular condition of the liver and other vital organs and functions? Perhaps in the condition of his mind, bis residence in the house without the ability to take much exercise, and in the original feebleness of his vital force, the conditions of his lungs and heart were sufficient to account for his death. would be glad of a more particular statement of the symptoms during the last two or three months of life, and your opinion of the cause of death.
I might mention that there was a moderate sized heart clot, but it presented nothing remarkable, having doubtless formed in articulo mortis. Very truly yours,
A. B. PALMER.
The autopsy in the foregoing case, although not limited to the lungs, was not conducted with the same care in reference to the abdominal viscera, as was bestowed upon those of the chest. The liver being that member of the digestive apparatus which suffers first in obstructive disease of the valves of the heart, was most particularly noticed. It was hypertrophied and had undergone that molecular change approximating fatty degeneration, so frequently seen in less complicated cardiac disease.
The interdependence of the liver and the lungs, both of which were embarrassed by the diseased condition of the heart, will throw some light upon the question propounded by Professor Palmer. In healthy digestion where more non-azotized food is taken into the system than
got rid of by the respiratory process, it must either be converted into fat, accumulate in the blood or be separated by the liver. In the case before us the digestion of food was carried on very satisfactorily until within the last four or five months of his life. The increase of hydro-carbon from that source superadded to the venosity of the blood induced by the condition of the heart, produced an asphyxia that rendered the last month or two of existence extremely distressing In such a state of the venous system effusions will take place, which in the present instance not only aggravated the suffering, but hastened his death.
Synchysis Oculi, or Dissolution of the Vitreous Humor.
A case of this interesting and at the same time rare form of disease of the vitreous humor of the eye presented itself to my observation a short time since, in the person of Capt. B.....t, an inmate of the U. S. Marine Hospital in this city. His history of the case is as follows:
“In the spring of 1834, I was commissioned by a company of ship builders to superintend the construction of a brig; the greater amount of time I, however, spent in hunting, and especially in shooting squirrels. I always considered myself a "dead shot," in fact never missed, till alas ! one morning I took my rifle to pursue my usual pastime, and found I couldn't hit. Many times I tried, but, like the Irishman, “always hit where I missed before.” The next morning I saw a squirrel on a barn near by, (at least I thought I did,) but not having my gun with me, I thought I would take a “dart of my eye at him." So covering my left eye, I took aim with my right, when I could see neither barn nor squirrel."
This, he assures me, was the first he knew of his eye being affected in the least. He then consulted several occulists and distinguished physicians in the cities of New York, Boston, Cleveland and Chicago, and was told by them that a cataract was forming, which, by subjecting himself to an operation, could be removed; yet such was the sympathy between the two eyes, that the second might become implicated also and both be destroyed. He was advised therefore to let it alone, which he has done. He says, he has never been totally blind in the affected eye, being able to distinguish the outlines of objects that are brought within an arm's length and to the right of the axis of vision. He now thinks he can see a little direct before him, since he has been under treatment in the Hospital for the disease which took him there. (He was admitted the 10th of December, 1857.) He states that previous to his learning the condition of his eye, he had never known the least weakness in either organ, and since that time nothing unusual had occurred to it externally.
Up to the time he first became sensible of the state of his eye, be had always been healthy, not having had any venereal disease, nor had he ever taken any mercury that he was aware off; and in after years, when both under the venereal and mercurial influence, he noticed no appreciable difference in the condition of either eye. He never has received any blow (except of air) on the eye, gest no cause for its blindness. The eye preserves its usual outline, and if
any difference is firmer than the other. By a closer examination of the iris there is seen an oscillatory movement, instead of a regular contraction and relaxation. The color of the humor is of a dark brown. Flocculi can sometimes be seen in the movement of the humor, which is evidently the remnants of the capsule of the lens.
The left eye presents that curious variety of synchysis known as "sparkling,” in which upon a sudden motion of the eye looking upwards, he describes a shower of bright shining particles, starting from the bottom of bis eye and spreading over the surface. The trembling motion of the iris is distinctly seen, also the internal sparkling, as de
and can sug
scribed by Mr. Wilde of Dublin. In this eye the sight is not yet much impeded. He says, it is not so strong as it was.
The causes of this disease are as yet unknown in fact. Beer, is of the opinion that it is “owing to an abuse of mercurial medicines, especially calomel.” . In Mr. B.'s case, he had never taken calomel to his knowledge. Mr. Lawrence says: “It may be the result of chronic internal ophthalmia, or a gradual change in the consistence of the vitreous humor, unconnected with inflammation.” The latter is most probably the cause in Mr. B.'s ease. From his report we learn that distinguished oculists and physicians pronounced it a case of cataract. Mr. Lawrence says, as also Mr. McKenzie, " that cataract is often added to the other affection;" but no evidence now exists of any cataract, except the flocculi above mentioned, that it has been dissolved by the fluid vitreous humor, is the most probable solution of its absence. Says Mr. Lawrence: “Such a state of the vitreous humor cannot be remedied, and if a cataract exists, its removal will not improve vision.”
This latter assertion was examplified in the case of Mr. G. D., a merchant of this city, for the facts of which I am indebted to Dr. Pitcher, who some years since had all the natural and physical sigos of a cataract, and as he had lost his sight in that eye, by request of his attendant physician he submitted to its removal." This was done, but produced no benefit; it, however, demonstrated the existence of synchysis oculi. In Mr. D.'s case the eye was soft and boggy. Two years after the removal of the cataract, the eye began to protrude from the increase of the vitreous humor, until it was punctured to release the contents and relieve the patient of the pain and deformity.
Since writing the above cases, my attention has been called by Dr. Pitcher to a congenital form of this disease, in the person of Mrs. M. of this city. The external appearance of the eyes is large, and they rest in their orbits with a rocking or tremulous motion similar to the needle of the compass. The motion of the vitreous humor can be seen through the walls of the eye, but a very close inspection is required to see it through the pupil. The sight is myoptic, requiring double concave glasses of long focus. The lady has been in the constant habit of using a single eye-glass, which according to Mr. McKenzie should not be used, spectacles being always preferable.
This case possesses a double interest: first, the congenital synchysis, and second, the congenital myopia, which latter rarely occurs, "except as a consequence of a central cataract." Neither Mr. Lawrence, Mr.