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Show Sicc'riox lll.] DISEASES ()F Tlllfi ()RGANS ()F lthHl'I NATION. Si-jcriox Ill.. T.\m.i: lll. Flu. ].'-4TN[]IPI)I'(" [Hiram/(Info. II-I'I/I cruiser/Half jfl/lc/M/fs of HM» reins of Mr N/I/l/I'I/ Hm/ HIV/r, 2‘71!" 711/)". Urn" (/m/ N/III/Hl. from from); 1/71/11. mu] film/II. Al/WIIIN/III'I'I‘ II/u‘r-sscs' I'll ()sfeoinf/(Jill's of NH» Nines. aged thirty years. was wounded by a rille ball in the knee joint. It broke the tibia and shivercd the lower portion of the femur. Amputation was immediately resorted to. The stump seemed to had very well for some twelve days. There was scarcely any l'ever. ()n the thirteenth day he was taken with a severe The liver presented many slate-colored spots in its parencliyma. These were found. on incision. to be masses ol' concrete pus. with some degenerated liver tissue. ioth mingled. and presented a marblcd appearance. These were surrounded by slate colored cov- erings and had the appearance of being in the first stage ol‘ abecss ot' the glandular structure of the liver. in the lung there existed purulent l'oeusest .llri‘ushrlic A "Hess/ls), spiration. The wound became suddenly dry and covered with a greenish gray membrane (' dry gangrene) The muscles of the thigh becamei contracted. i The patient experienced no pain in the thorax. nor in the abdomen. even on strong pressure. The pulse gradually diminished in volume and force. (icneral loss ot‘bodily Fig. 1 presents the right lung. .\t the base (Bf) aml the posterior border of the inl'crior lobe ( I)'.I'.) the abcesses (-1..l..l.‘). which were small and irregular. pro- jected from the surface ol‘ the lung: they were sur- rounded by an indurated red circle. 7 The superior lobe is completely tree from any disease. Fig. 2 shows that the abcesses are not all supertieial. but that some of them occupy the internalportion of the organ. The pulmonary artery contains some very thick clots (YIN/Li). which are very adherent to the vascular energy and strength. wall (ILL/5) chill, followed by a strong lever and very profuse per- [)ies under very severe symptoms on the 18th day alter the first chill. I'ost-nuwimn.- The spleen is found much enlarged. Scattered in its structure were found many red spherical masses. (llaanorrhagie focuses). Incipient phlebitis of the splenic veins. The marrow of the stump ot the femur. and the spongy tissue ot~ the head oti that bone. were all Jilled with pus. Fig. 23 presents a portion ot‘ the lung that had undergone gray. or slate-colored. and yellow or purulent hepatization. trachea and into the bronchi without changing its tone. to the ear The fourth or purulent stage, or resolution, begins by a gradual or sometimes sudden metamorphosis of the exudation. The cell production of the, third stage gradually diminishes, the tibrinous strings attached to the alveolar wall loosen, and melt into a jelly-like mass, which encloses all sorts of corpuscular elements, forming a little lump in each air-cell. Both the corpus» of thi auscultator. Bronchial respiration will be heard mingled with some coarse vesicular rale, but without adventitious vesicular or line crepitating rhonchus. Percussion sound over the affected lung is perfectly dull, and the atiected portion 'an distinctly be marked. Tables l and ll of this section render a very correct representation of the various phases of the eroupose inflammatory process, and show several degrees of gravity of the second stage. T/tfrtt Stage. Yellow Hepatizalion. This stage is chieliy characterizml by the activity which the lung tissue, which was hitherto in a passive state, now displays. The epithelial and connective tissues of the alveolar parencliyma now react by a process of highly active cell-proliferation. In every interstice ot' the vessels large quantities of new cells are termed. The. whole surt‘ace. is covered with a many layered epithelial element mingled with great numbers of lymphoid bodies. This is a genuine condition of catarrhal inflammation. The increased cellular elements render the ailected lung still heavier, and more voluminous; its density and toughness also increase. The little tibrinous coagula are now not so prominent. Most remarkable is now the change of its color. The red is turned into yellew or yel- cular elements of the exudate. as well as those of parenchymatous origin, can be found in the spnta at that stage. (tencrally it is mixed with some broken-down blood corpusclcs and blood pigment. Treated with acetic acid. it will cause a precipitate of Maria, showing a change of librin into mucin. During the red hepatixatiou the sputa. treated with acetic acid, will clear the exudat \ and dissolve the tibrin. leoubtedly a very notable quantity of the mucin is derived also from the epithelial cells ot' the bronchial and alveolar epithelium. l'ortions of an affected lung are very slippery and slimy, and can be readily crushed between the thumb and linger, and indis cate a. condition of great softening. The grayish-white ainemic substance contains no tibrinous granules as before, but a considerable quantity of concrete amt sott pus. This whole stage is a conversion of the exudate into a, read- ily soluble substance. which is generally expectorated by the lungs. The Fast portion of this mass is normally absorbed or converted into fat and removed by the circulation. The disagreeable cough produced by these now excrementitious substances, which cannot lowish white, cream color. This is due to a still further diminu- tion of the vascular contents, produced by the enormous pressure exerted upon them by the swollen tissue. The blood corpuscles and tibrinous tissue gradually become discolored, and the purulent elements l)ccmne more prominent. liven in this stage some blood-vessels are still kept open and their blood in motion, by the increased pressure upon the unail'ected branches of the pulmonary artery. In this stage. there is a gradual weakening of the whole heart. The right ventricle has struggled hard to maintain the circulation of the pulmonary artery, in branches still tree from inllanin'iation by an over-pressure. and the lett. in order to keep up the nutrition of the heart, and form a term porary hypertrophy of the right. ventricle and maintain the elasticity of the arteries. The force of the heart enters here as the great arbitrator ot' the fate of the patient. The danger to the life of the patient in the second stage is bloodpoisoning and amemia ot' the brain. The great mass of the blood is not sutticiently aerated, for in those vessels where it can still tlow. it passes with such swit'tncss that it has not the necessary time tor the exchange of gases. In the stagnant vessels there is barely any ditl'usion at all. .\ deep state of stupor and yellow tinge of the skin indicates a lack ot' arterialization ot' the blood. As the crouposc pneumonia all'ects mostly the lower lobes, the swollen portion moves backwards and ascends sometime above the third rib posteriorly, (see Tab, 1. l‘lg‘. 1,) whilst in front it barely touches the thorax. The middle and the upper butt of the superior lobe occupy nearly the whole anterior thoracic surface. whilst laterally it is covered by the interior and half ot the superior lobes. ln the third stage the lung has lost very much of its toughness and dryness: on the contrary, the all'ected portions commence to yield to an impress ot' the linger: and it' a large part ol' a lobe or a whole lobe is affected. distinct imprints of the ribs. against which the swollen lung was pressed, will be visible. be readily removed by the bronchi, partly on account of the still contracted sphinetral entrances ot‘ the int'undibnla, aml partly from insullicicnt elasticity of the parenclrvma, is very harassing to the patient, and causes sleeplessncss and great uneasiness, and continues until the whole mass has become liquitied and readily removed. The det'ervesceney in the third and fourth stages generally increases and constitutes longer remissions in the fever. Toward the end of the fourth stage healthy individuals commence to feel notably improved, and with the gradual cessation of antenna (in measure as the exudate is removed ) the appetite and system gain in proportion. The circulation is often established in the relaxed lung tissue in an overwhelming manner, and there are sometimes produced ruptures of that tissue, with extravasations into the pleural cavity. These are. as a rule. soon reabsorbed. This lack of elasticity of the lung tissue persists in some cases for a long time, and keeps the patient in a very uneasy condition. l‘llYSIt'Al. tilt Ulidlit'T'lVli .\'\'_\ll"l‘t).\l.\' I.\' At‘I'TlC (‘ltttl'l'tlh‘li l'Nl‘ll‘MUNIA. The intlammation ot' the pulmonic parenchyma produces several alterations in the phenomena of sound, discoverable by auscultation and percussion. The catarrhal condition, always present to a greater or lcsscr extent in pmannonia. also the moditicd respiratory processes taking place. determine the altered phonetic nianit'cstatlons. during the several stag he ot‘ the intlammation. Nut/ml on I'Ircnssio/t [It "11' First Slog/c, .\s long as the pulmonic parcnclrvma is not tilled with exudation. and its contractility is not altered. the sound will not «litter trom the normal. however much the vessels may be tilled. ()nly |