DOI: 10.7925/drs1.ucdlib_280601
title: Purulent cysts in the parietes and cavities of the heart

description: Watercolour medical illustration depicting purulent cysts. It has the alternative reference number 1293, P1B and 15a on the front. The Richmond Hospital Museum reference is C.e.29. The entry for this in P263/1 pg. 28 reads 'Purulent cysts in the Heart. Dr Stokes'. The typescript note in the left corner reads 'Purulent Cysts in the Parietes and Cavities of the Heart'. The typescript note on the back begins '3. Phlegmasia Dolens; Interlobular Pneumonia; Purulent Cysts in the Ventricles of the Heart'.
description: Scope and content: The full typescript note in the left corner reads 'Purulent Cysts in the Parietes and Cavities of the Heart'. The typescript note on the back reads '3. Phlegmasia Dolens; Interlobular Pneumonia; Purulent Cysts in the Ventricles of the Heart – Dr Stokes presented the recent specimens taken from the body of a male patient who died of phlebitis, in whose case there were several points of interest, to which, in connexion with the specimens, he begged leave to direct the attention of the Society. It was an instance of chronic phlebitis, and was complicated with other morbid phenomena. The subject of the case had been for two months under his observation in the Meath Hospital, and during that time there was no intermission of the symptoms. The history of the case was this: the subject was of Italian parentage, and had been a Temperance Society man for some time, but had broken his pledge and become addicted to drinking. When he was admitted into the Meath Hospital, he presented many of the appearances of delirium tremens, and gastric irritation, with a certain degree of fever. Mr Parr, the intelligent apothecary of the hospital, who examined this patient carefully, detected the existence of pneumonia in the right lung. The pulse was very rapid, ranging, while he was in hospital from 130 to 150; it was but once during that period observed to be so low as 120; this remarkable quickness of the pulse continued up to the time of death. The other important phenomena of the case were these: there was, during the entire period, disease of the inferior portion of the right lung, progressing slowly, and obstinately resisting treatment, a circumstance which agrees well with the characters of specific irritation; there was a persistent crepitus audible in the lung, which varied so as to be at some times much smaller than at others; at the root of the lung there was bronchial respiration; there were all the symptoms of dry pleurisy. That there was also phlebitis was indicated by the condition of the left leg; which had the appearance of a limb that had been some time affected with phlegmasia dolens. This patient died at last completely exhausted and broken down, appeared quite anemic, and had all the symptoms that might be expected to occur in a case of purulent poisoning of the blood. The principal results of the examination after death, were exhibited in the specimens then on the table, which Dr Stokes proceeded to describe. The abdominal vena cava, and the veins of the lower extremities, were carefully examined. In the cava was found a coagulum adherent to the lining membrane of the vein, which, when the coagulum had been detached, was observed to be in that situation slightly red and villous; this redness was quite decided; the surface of the coagulum was rough. In the femoral vein were similar clots, and in the thigh the artery, vein, and nerve were all agglutinated together; the canal of the saphena vein was obliterated, and felt hard, like a cord; this obliteration extended as far as the vein was traced, but was most remarkable in the lowest branches. These appearances were in the left limb. As to the heart, the right ventricle contained a number of small white tumours between the carneae columnae; these tumours are the same as those which Mr O'Ferrall has met with, and designated purulent cysts of the heart. There were some dark coloured coagula and creamy matter in this ventricle, but its lining membrane presented none of the anatomical characters of inflammation. In the left ventricle were similar deposits of purulent matter, contain in cysts; their contents were of a creamy consistence. There was three large cysts in the ventricle; they adhered very slightly to the parietes of the heart. The inferior lobe of the right lung was solidified; a section of it, made when it was recent, exhibited a marbled surface, resembling red granite. In ever pact of the lung that was cut into, there was an analogous matter to be found in the heart, and sometimes granular points. There was a general phlebitic inflammation of the lung, but no abscess had been formed within it; there were similar deposits in the upper portion of the lung, and also in the lung of the opposite side, with some intervening portions of healthy tissue, agreeing with the interlobular pneumonia of Andral and Cruveilhier, a name which is objectionable, as conveying as improper idea of the nature of the disease. It is very remarkable that there was no purulent deposition in the liver, spleen, kidney, joints or muscles. This case observed by Dr Stokes, was one of those of phlegmasia dolens which are most dangerous. Of that disease, all the cases that occurred might be arranged in two classes; in one the first obvious symptom is the rapid swelling of the affected limb; in the other, which is by far more serious, there are severe constitutional symptoms long before the leg becomes tumified(sic). Cruveilhier had observed, and Dr Stokes's experience enabled him to confirm the observation, that the most dangerous cases are those which arise from a poisoning of the blood; when the disease is localised, there is a chance that the patient may recover. It was worth while to consider whether the condition of the lung which he had just pointed out, depended on a mechanical deposition, or was the result of a specific irritation of the lung. He thought it more probable that the latter was the case, which would be most analogous to what occurs in other specific inflammations. He would add, that as to the diagnosis of such cases, perhaps it would be made from observing the obstinacy against remedial means – at least, all those we are at present possessed of. He was not, however, without hopes that a specific remedy might yet be discovered. – (Museum, Richmond Hospital)'.
description: Numbering/sequence: Original reference number: 1293.
description: Date details: This illustration is undated, approximate dates are given based on dates for the entire collection.