On a Case of Tympanic Abscess having an Unusual Termination
Authors: J. Moorhead
Journal: BMJ (1878)

20 s-P*1SZ!T YPEThCAL -SVURNAY OA us&', r 8. 3L*" du698 minutcytsts on the.ss~.The cortices were slitt l ed, and.the convexities of both Udneyt were coarsely gran4av The right one had some-Ibregular fitrous thickening of the capsul .the capsules separated in fragments.but were only a little adthereAL There was no lardaceous change.The spleen was small and firm * i weighed 4 ounces.The liver weighed 533 ounces; it was sligtly hobnailed on the upper surface, aad very slightly cirrhosed on the lower surface.The vailing hue of the sections was yellow.The liver was not lardaceous; and although, under the microscope, some of its cells were rther too fatty, there was no well-marked fatty disease of it.it may be added that, under microscopial examination, both the cellh and the misute vessels of severl of the cerebral convolutios exhibited morbid changes.Of the minute vessels, some showed hyper- plasia of 'the nmclei of their walls, others had irreg-iar-molecular deposits here and there in their walU, and others had a byaline appearance.In the medulla oblongata, beneath the foor of the fourth ventricle, the walls of the minute vessels were irregularly thick.ened at points by finely molecular deposits in or.trpon'them.The nerve-cellg also had undergone some granular 'degeneration.. CASE II.Ckironic Pnsanity: Phthisis Patmonal wit/4 Brunrtit&: Cardiac Change: Ckeyne-Sbokes Respiratiaff.-T.D., of the-8th Regi- ment, died in September i876, at the age of 44.He was an old inmate, the subject of chronic mania with periods of-mena depressior, but latterly without active mental symptoms.At the age of 43, he be- came affected with latent pulmonary phthisis, and died about-a yea-n afterwards.During the Iast few' months of life, he had a softand rapid ptalhe, usuallya little above io0 in the minute, with dyspncea, and a bluiish colour and coldness of the face and hand.It was only when bronch- itis supervened that any cough or expectorati-on was noticeable.The heart-sounds were comparatively feeble,, the impulse was only felt dis- tinctly at the epigastrium, and the first sound was heard!more clearlr the tban elsewhere.The patient restedbnthe right side.Generalised bronchitis came on four weeks, before death.Towards the close of life, slight pneumonia aand pleurisy attacked the base of the right lng;-tuber2osis spread in other parts * emaciation progressed -the dyspncea was.considerable; the purplish lividity and-chilliness of the face and hands increased; perspiration was free; the pulse continued slightly above moo; and the respiration varied from 32 to 37per-minute.Nine days before death, and thenceforward until that tok plice, the- Cheyne-Stokes respiration was noticed.Respiration was laboured, mhainly thoracic, rather loud, increasing-in depth, loudness, and fre- quency in a crescendo movement; then graduallfr dinxinishing in these respects, until it ceased altogether for a period, afterw hich the cycle- was renewedL The only coincident abnormalty made note of-in the characters of the heart-sounds -was their weakness.. Abstract of Necr.opsy.The consistence of the braTn was slightly diminished; the fornix was soft; the membranes were slightly cedema- tons.There was ffilIvascularity of the brain-substmce.The crebrum weighed 42Y( ounces; the cerebell'am, 5X; the pons VarollV and" me- dati oblongata, r ounce.The Heart weighed 12rV ounces;.it was flabby, dilated; its apex was situated somewhat below and to the-right- of the usual site.The muscular substance of the' heart, examined with the microscope, showed some granuloiktty degeneration, and the transverse Atrim had not' their norme disti nctness.All the cavities contained black clot, and by-it the right-cavities of the heart and the large veins emptying themselves inta both auricles were gorged.The