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thoscope, Dr. Jackson agreed with me in the belief that the sound of respiration could be heard at the upper part of the chest, and thinks it now probable that, at that time, (viz. a fortnight before death,) the upper part of the right lung might have admitted air. It appeared to me that the sound of respiration could be indistinctly heard at the very lowest point of the tumor, which led me to think it probable that the abscess might be below the diaphragm. Dr. J. however, concluded that the right thorax was the seat of the disease, though it could not be determined whether the pus was formed in the substance of the lung, or between the pleuras. He advised to watch carefully for any appearance of pointing externally, and if it should happen, that the abscess should be opened.

The tumor extended so low that it was evident the diaphragm was much pressed downwards, if indeed the tumor were not below it. From this time, the little patient began more evidently to sink; his breathing became every day more and more laborious, and he was obliged to choose the semi-erect position, inclining to the right side; until, for some days before his death, every power of his system, both mental and corporeal, was brought into requisition to assist in respiration, so that for several days and nights he could scarcely lose himself for a moment in sleep, without danger of suffocation. He finally died, apparently from the continued and increased pressure upon the bronchiæ, rendering it impossible for him to draw another breath. He retained his senses to the very last.

Twenty hours after death, (which took place on the 15th

exa

of April,) the body was mined. External appearance natural as to color; the whole body much emaciated; abdomen very large and hard, and particularly protuberant on the left side. The tumor on the right side very distinct, pressing out the three lower ribs, though without any appearance of pointing. Upon making an incision down over the sternum and linea alba, the integuments and muscles were found exceedingly thin. On opening into the abdomen, the liver appeared to occupy almost the whole of it; being forced out of its place by pressure above the diaphragm, which was observed to be protruded downwards quite into the abdomen. The ribs of the right side were forced apart by the distention from within, so that the muscular covering of the chest was very thin and accidentally, while removing the integuments, it was touched by the knife, and immediately there followed a jet of purulent matter to the height of nearly a foot. The opening was immediately enlarged, and the body turned over, that the remainder might be caught in a vessel; and as nearly as we could determine, about two quarts of a thin greenish pus, filled with floculi of coagulable lymph,were discharged. Upon minute examination, it was concluded that the lungs were sound on both sides, that the abscess was formed between the pleuras, and that the right lobe of the lungs was so entirely compressed by it as to be completely useless. The mediastinum was pressed considerably towards the left side. The left lobe of the lungs appeared small, but healthy.

Boston, April, 1828.

Additional Case. By JOHN WARE, disappeared, and the remaining

M. D.

In connexion with the preceding case, it will perhaps be interesting to relate one having some points of resemblance with it, par ticularly as it respects the appearances on dissection.

upper

part of the cavity of the chest had had escaped. been occupied by the gas which cular examination, the remains of On a more partithe lungs were found at the part of the cavity, without any breach of surface whatever, or actual loss of substance by ulceration, but compressed by the effusion of fluid and gas into the cavity of the pleura, to a size not larger than that of a man's fist. The form, relative size, &c. of the several lobes were perfectly distinct, although they had shrunk away into the appearance of little shrivelled knobs, and looked very nearly as they would have done after soaking for a long time in a strong alcoholic solution of corrosive sublimate. The pleura lining the chest had been highly inflamed, and was covered by a layer of dark colored coagulable lymph.

II.

William Parsons, aged 25, was admitted into the Boston AlmsHouse July 16th, 1824, in a state of great distress. He had received an injury upon the right side of the chest some time since, which had been followed by his present complaint. His symptoms were those of an advanced stage of unrelieved pneumonitis or pleurisy. The pain in the side was most excruciating; the respiration was short, laborious, hurried, was carried on with great agony, and could not be maintained in the horizontal posture without much distress. The pulse were very quick. The cheeks, lips and tongue livid; the extremities livid and cold. The stethoscope was not applied, but upon percussion A Case of Malignant Chickenpox. the left side of the chest gave the natural sound, whilst the right reBy D. HUMPHREYS STORER, M.D. sounded as if it were hollow. On the 29th of April, between 8 This patient was bled, blistered, and 9 o'clock, A. M., I was called and treated by mercurials. He to visit a child of Mr. James was relieved in some measure of Spear, in Front Street. The child, his distress, and was able in some degree to lie down ; but died Ju- lying in its mother's arms, in a a boy eight months old, was found ly 19th. comatose state. Before an opportunity was afforded me of making any inquiries, the mother very anxiously desired my opinion of the disease. Several vibices situated on the forehead and left temple, four or five in number, one or two of the size of a fourpence, and varying in color from a light brown to the darkest venous blood, first claimed my attention. It being impossible to

On dissection, when the skin had been removed and the cartilages of the ribs cut through, there was a great escape from the right side of a very fetid gas. When the sternum was removed, the right cavity of the thorax seemed to be half full of a dirty, whey-like sort of pus, with shreds of lymph floating in it. The lungs seemed at first to have entirely

distinguish the nature of the original eruption from these appearances, the mother was requested to undress the child. Upon examination, the body presented great marks of exhaustion. The glutei were found covered over their entire surface with petechia, most of them quite small, of a dark purple color. Upon each hypogastrium several vibices were observed, three or four of the size of a half cent, surrounded with a bright red areola,-in one or two instances nearly an inch in diameter, and in hardness and external appearance resembling the inflamed surface around the vaccine vesicle. Surface of extremities presented no unusual appearance breast and back of shoulders covered with well-marked vesicles of chickenpox. The extremities were cold: the temperature of the trunk of the body was considerably diminished. The radial arteries were scarcely perceptible to the touch. Some nausea was present, and slight hiccough. Upon being told the child was affected with chickenpox, the mother's anxiety was somewhat diminished, and from her I was enabled to collect the following history of the case.

Two of her children had just recovered from this affection, which was quite prevalent in the neighborhood at the time. Both

day of the 28th, no peculiar appearances were noticed; no increased febrile affection was observed; the breast was taken readily, and the excretions were natural. On the evening of the 28th, the vesicles on the forehead and abdomen began to change to a deeper red; and with this change in the appearance of the eruption, increased heat on the surface of the body, refusal of the breast, and incessant restlessness, were remarked. These symptoms continued until six in the morning, when the child appeared better, became more quiet, and nursed with some avidity. Between six and eight, however, the anxiety of the parents was increased by a return of heat and restlessness. During the night several evacuations of a natural appearance had occurred from the bowels: no urine was passed during the night, but between six and eight in the morning, the bladder was two or three times evacuated; urine presented no peculiarity.

As,

I determined immediately to endeavor to bring about a reaction by emetics; and accordingly wrote for an antimonial. however, during the few moments necessarily occupied by the examination, my patient evidently became more comatose, and the probability of relief less, I felt desirous for a consultation. Dr. of these children suffered but George Hayward was called. slightly no more than children The case was considered by him generally, with this disease. Symp- an uncommon one; he expressed toms of disease first showed them- his opinion decidedly, that unless selves in my patient on the morn- the system could be aroused withing of the 27th, when the vesicles in a short time, my patient must appeared in every respect similar sink. He advised the wine of to those of the other children, ipecacuanha in conjunction with with the exception of a greater the warm bath. I remained with degree of redness. During the the child till between one and day and night of the 27th, and the two o'clock. The exhibition of

three ounces of the wine of ipecacuanha, and four grains of tartarized antimony in divided doses, with every effort to procure vomiting by irritating the fauces, applying pressure to the epigastrium, and making frequent changes in the position of the body, produced no effect. The bowels were freely opened during the forenoon; evacuations therefrom, natural. Finding it impossible to excite the system by emetics, as a dernier resort cordials were ordered freely, and sinapisms were applied to the extremities. My patient gradually sunk, and expired at 10, P. M.

No alteration for the worse was observed in the petechiæ, or vibices, after 11 o'clock, A.M. I say, for the worse; a slight change did take place after the first application of the warm bath, which gave us some hope: the purplish tinge seemed to change to a lighter shade, as if vitality had not entirely ceased there. This alteration, however, was observed but for a few moments; the parts soon presented their former morbid characters.

The body was examined twelve hours after death, in presence of my friends Drs. Robinson and John Flint. No appearance of derangement could be seen in the lungs or heart. The abdomen being opened, the liver was found healthy, gall-bladder full of bile, spleen presented nothing peculiar. The stomach was considerably distended with flatus, containing no liquid whatever; its villous coat at the pylorus redder than at any other part, but not unusually So. The vessels of the mucous membrane of the duodenum, to the extent of three or four inches, were considerably injected, probably owing to the irritation pro

duced by emetic substances, which had passed through the stomach, and lodged there. The kidneys, in situ, presented somewhat of a singular appearance, being rather larger than usual, and very black, looking like clots of blood. Being removed from the body and their substance cut into, the parietes of the pelvis were found considerably hardened; cavities of the pelvis empty; ureters and bladder were seen perfectly healthy, Upon removing the scalp from the cranium, its inner surface was found considerably injected, those parts particularly, over the parietal bones. Between the integuments and cranium some water was effused: water was also effused under the arachnoid membrane. There was a slight degree of congestion in the vessels on the surface of the brain. The ventricles contained no unusual quantity of fluid. The substance of the brain showed no marks of disease.

Remarks.

It is worthy of remark, that the patient in whom this affection made its appearance, was a remarkably healthy, fine looking child,-the most robust of the family.

I am acquainted with no author who speaks of a similar termination of this disease. Heberden refers to an eruption which he conceives may be "malignant sort of chickenpox;" but which differs from the case above described, in the severity of the febrile affection preceding the disease, in the length of the disease itself, and in the vitality of the system not being exhausted; in a word, which resembles this case only in being an aggravated form of this affection.

Boston, May, 1828.

III.

From the London Med. Repository.

MALA PRAXIS.
ROLFE US. STANLEY.

A CASE of great interest to medical men was tried in the Court of Common Pleas about a fortnight ago. It was an action brought by a person named Rolfe against Mr. Stanley, Assistant Surgeon to St. Bartholomew's Hospital, to recover damages for an alleged neglect and want of surgical skill in the treatment of an injury of the knee-joint. We shall lay before our readers the evidence given on the occasion, as well as the charge of the learned judge to the jury, and leave them to form their own opinion of the merits of the case.

Mr. Sergeant Cross stated the case, and called the following wit

nesses:

Mr. Henry V. Garman stated that he is a surgeon-apothecary. On the 2d of December, 1826, he was in the neighborhood of Mile-end road, and was called to attend the plaintiff. He found him in a cottage about half an hour after the accident occurred. He appeared to have received a laceration of the right knee-pan, in which there was a hard and movable substance. He washed away all the superficial particles, and, after putting on some simple application, he took him home. He went first for Mr. Green, the surgeon, but not finding him at home, called for Mr. Stanley, who resides in Lincoln's Inn fields. He came in three hours after, and the patient's knee was more swollen. Mr. Stanley appeared to me to have made a proper examination, and he requested me to put the limb in splints, to pre

vent the motion of the joints, and keep the limb quiet.

Mr. James Rolfe, the father of the plaintiff, said he was not pre'sent when Mr. Stanley examined the plaintiff's knee, but when he came down stairs he prepared him for the worst. He said the plaintiff would have a stiff joint as long as he lived, and that he might be glad if nothing worse occurred. He added, that there was a shocking fracture, and about the fourth or fifth part of the knee-pan was broken off. The splints remained on for five or six days, when Mr. Stanley took them off and bent the knee, which caused such .excruciating pain, that the plaintiff was obliged to request him to desist. When the splints pressed on the hard substance, it made him quite sick with pain, and he was always pushing them down.. When this was told to the defendant, he said the patient must have patience. Mr. Stanley used sometimes to attend twice a-day for the first six days, and when spoken to on the subject, he said the knee-pan was broken, and the hard substance felt in that part was a portion of the knee-pan, broken off. On the 18th of January, he said he could not do any more for him, and that his cure depended more on himself than upon him, the defendant. When the plaintiff got well enough to be removed, he was sent to Hammersmith for a change of air. The wound then swelled as large as his head, and discharged a quantity of matter, in consequence of which it was necessary to call in Mr. Lilly. The plaintiff was not able to attend to business during this time.

Cross-examined-He did not walk to see the Duke of York's

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