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Show DISEASES OF THE ORGANS 0F RESPIRATION AC ["l‘E (‘l{()l'l'()SE l‘NlCt'MONlA. Size'rtox III.. TABLE 'I.. Flo. 1. ()et. J(th. Delirium. Tremor of the lips. (‘olor ot' the t'aee ntore livid. Lies on the healthy side with ease. ( \sE. Aeute eronpose pnetttuonia ot‘the whole of the lett lung; with adhesive pleuritis. Iv'amett. a law stttdent. 22 years old. was taken siek on the 22d of September. 18-. \ Patient had a violent headaehe about three days pre- vious, and became speedily prostrate. A (hill on the 19th; felt sotne better on the 2(lth: ate heartily. bttt soon at'terwards felt very uneomtin'table; tto dillieulty of Face purple. hands satne eolor. Lower extremDeliriotts. Very httrried breathing. I'ttlse ltitl. Tent. 97" Fahr. ['uable to swallow anything. Dies satne day. l'osf-mort‘mt.-.\ small quantity of etl'usion in the plettral eavity. Nearly the whole of the let't lung is indurated; very voluminous. and very heavy. lts t'ortn is not ehanged, bttt looks as il‘ in‘jeeted. or blown up to breathing tltat day; attribttted ltis uneomt'tirtable teeling its utmost. to indigestion. 7 21st. Dittieulty of brtathiug and lever; is very pros- trate. Attending physieian diagnosed intlannnation ot' the left, lttng. 22d. Livid eolor of the l'aee. very t‘aint. ‘annot sit up. Dttll sottnd on pereussion over the whole extent ol' the posterior border. and external surJaee ‘ot' the let't hing. Bronehial respiration attd brouehophony same side. Anterior surt'aee, normal. Very thirsty. Senseot' sul't'oeation; very thin and very l'requent pttlse. 'l‘em- l‘lxeessive shortness of breath. peratttre ltll" l"ahr. Slight laryngeal eough without expeetoration. Evening of saute day. shortness of breath slightly ditniuished. 23. 247. 23. 26. 27th general eondition ot' patient seein- ingly slightly improved. ['rine 1.0122 spee. gravity. Large deposit of phosphates readily preeipitable by nitrate ol' silver. 26‘. 25). litlth. Still further improvement. No shortness of breath. A slight eottgh. and expeetorates some tutt- ens. Dullness on pereussion over the let't. lung posteriorly. ()et. lst. Night sweats tor the lirst time the night pre- \iotts. l‘lxpeetorates some greenish tntteo-ptirttlent matter. Skin some hotter than the previous day. 'l‘emp. ltttl" ilt‘ahr. Ausenltation and pereussion same as the day Fig. 1 shows a deep depression on its internal surtitee. t'or the lodgement ot' the heart. At its base an equally deep depression eorresponding with the upper surl'aee ot'the diaphragm. .It‘issures ot' lobes distittetly diseernible on the same sttrl'aee. 'l‘he lobules' are distiuetly outlined on the surtitee ol' the lttng. amt seem to have been eaeh singly atl'eeted. 'l‘he superior lobe presents on its outer surt'aee 'l \iolet eolor ot‘ sotne ot‘ its lobttles. It is mneh depressed at that plaee. atnl the softness ol' its tissue. there. strongly eontrasts with the density and toughness ot' the stir- routriinglobttles(lid/.15). The purple eolor was title to severe serous intiltration and stasis (ll. the blood. It has all the eharaeteristies ot' iuliltrated eonneetive tissue. 'l‘he whole surlaee ot' the all'eeted lung was eovered 5th. ities very eold. with newly l'ormed vaseular networks (/../'.). and seat- tered all over with brownish and blue spots. 'l‘hese vessels belonged to the neoplastie pseudo-mem- brane. whieh was very thin. and eonld readily be remmed. Large vasettlar trttnks ( lil'.) emerged from below the pleura. the interlobttlar septa. and trout the ramilieations ol' the pleural eoverings ot' the lobules. (viseeral portion) The base ol' the lung was eovered with a Iisettdo-metuliraue intiltrated with blood (l'..ll./.). beti ire. Ill 'I'HOIJNI)'. MANY years ago. llasse. in his pathologieal anatomy ot' the respiratory organs. eorreetly observed. that the study ot‘ tll>t‘it*«t'>‘ ot' the organs ot' respiration has. more than any other. eon- trihttted toward the explanation ot‘ the nature ot' intlamtmttiou. Ninee that time the enormously aeeumulated labors ot‘ the best patht'ilogieal anatomists and pathologists have still t'urther shown that the eomplex phenotnena observed in the proeess ot‘ lullammation, ean be obsery‘ed in the ditlerent t'orms ot' l'ueumonia with nuteh more ease and greater eertainty than in a disease ot' any other organ, The struetural eomponents ol' those organs. eousist ot' epithelial tissue ot‘ several l'orms. large quantities ol eonneetivetissue thoroughly interwoven with those: not networks ot' blood vessels. in nearly immediate eoutaet with the epithelium ot' the lungs themselves. with an intervention ot' only an extremely tine layer ot' perivaseular strueture. 'l‘he singularly thin yet highly elastie eellular epithelium, the existenee ot' whit-h ltas been denied time and again and repeatedly proven. 'l‘he sphinetral musenlar arrangement in the int'udibular entranees. the strong tibrotts t'rame work of the interwllular septa and their relations with the submueous tisstte ot' the bronehii on the one haud.and with the Jteriehondrium ol'the bronehial eartilages on the other hand. The enormous (luantities ot‘ nerve istruetures. tibres. plexuses. ganglia; the glandular struetures. both mueous and r-s‘ ot' other varieties: the abundant network ot‘ lymphatie vessels; the large lymphglands and lym]iht'ollieles. All these make it a wondert'ully eomplex anatomieal eomposition. liy the side ot' their anatomieal peeuliarity is the high itilpot‘tttttt'e ot' their physio~ logieal l‘unetion: " the supply ot‘athmospherie air to the blood and elimination ol' earbouie aeid and vapor withstanding the great multiplieity of respiratory organs in the graded seale of elements of their struetural arrangement ol water t'rom it." Notform observable in the animal life. the essential are so simple. that they t sible. 'l‘he physiologieal t'unetion itselt' is also based ttpon om. ot' the plainest laws ot' nature. that is: the dill'usion ot‘ gases through a permeable membrane. All these eharaeteristie sitnplieities' and eomplexities make intlannnation ot‘the lungs at onee an obit-et of extensive study, and a lield t'or aetitlis‘ition ot‘ eleal' patltologieal notions ot' the esseuee natttre ol the pt'oeess' ol' intlannnation, ltt order to present a pieture ot' the ditl'erent varieties ot' phenomeua. manit'ested in intlatnmatory diseases ot' the lungs in so limited a seope as the nature of this work requires, it is neeessarv to traee its outlines in broad lines. The details ean only be tilled itt here and there. 'l‘he pathologieal anatomy must here maintain its lirst right. though. ot eourse. the elinteal side must be as l'hys'ieal signs. alone readily observable by our elearlv delined. senses. indieate the two parallel phenomena ot' the morbid altera- tions and tnorbid manites'tations during lit'e. (I'M/owl sump/mos.) [lilie t‘ltttttg‘e oli sotltttl ol' the thorax oy'el' :I solitlilietl lung. tlie rattling. rasping. grating. gurgling noises. diseovered in ansenhation. only tell its that there is a eertain quantity ot'eonlined llllllltl in some I ethity‘. that a movable surt'aee. whieh ought to be smooth. has beeome rough and uneven: that a portion ot‘ the viseera has bet-ome tilled with liquid or solid substanees in plaee ot' the gases. whieh they ought uortttally to eontain. \\'hat is the nature ot the proeess whit-h brought this about. the simple elinieal observations will not reveal. Yet it is ol' vast moment to the lite ol‘ the patient to know how it was brought about. and how it is to end: and. espeeially. what eau be done to ehange its eonditiou. t'roupose pneumonia t'urnishes the best opportunity or" illustrating how :1 liistolttg'lt'nl [ii'tu-ess'. the several phases oli \\'lii<'l1 r-wtsisl only of the bring/no fog/«Ho r o/‘ u very line no m/n'roo with as tnueessarily sueeeed eat-h other, ean explain the visible alteration ot' the organie tissue, the mmlitieation ol‘ its t'unetion and the pereeptible physieal symptoms resulting theret'rom. Step by step eaeh phase ot‘ tnorbid manifestation ean be traeed. thin a layer ot' blood. and spread out over as wide a surt'aee as pos- I'V/‘s/ -\l[t/!/l,-7vl‘lli' Vessels oi. either a whole lobe. or a large por- |