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CASE 472.—post-mortem examination
was made six hours afterwards. On opening the right pleural cavity we found the lung coated
with soft greenish colored lymph, and there was an effusion amounting to six ounces of yellow
pus and serum, separating into two strata, the upper serum, the lower pus, and having (under
the microscope) the usual pus corpuscles floating in a fluid with an abundance of unrecognizable
debris. There seemed to be also a thin layer of pus beneath the pleura anteriorly, giving that portion of the lung a yellowish color. The upper
lobe was apparently normal; the lower lobe posteriorly was congested, dark in color, and, on
division, revealed nodules of tissue of various sizes in all stages of pathological changes
from acute congestion to thorough hepatization and yellow softening. The diseased spots were in
dimension from the size of half an English walnut to that of a split pea, the large ones having
in the center a space white or yellow in color, and probably breaking down rapidly. The outline
of these solidified portions, on section, suggested the idea of embolism, since they were
somewhat triangular in shape, with the base at the pleural surface and the apex at the deepest
portion of the lung, giving the impression that a circumscribed area of lung nourished by a
single vessel had been destroyed by its occlusion. There was no recent effusion in the left
pleural cavity, but changes in the parenchyma similar to those on the right side were
discovered. An examination of the vessels of the stump revealed the existence of inflammation
of the artery and veins. Both the femoral artery and vein at the point of their escape from the
pelvis were normal. The femoral vein at the entrance of the saphena was filled with a
semi-organized clot, which extended through the saphena and femoral to a point two inches from
the cut ends of these vessels, where they had been divided on the face of the stump. (See
left-hand figure of PLATE XX, opposite p. 294.) These vessels, as
will be seen, are now hard and firm dark-red cords, of course entirely impervious. The artery
from the origin of the profunda to a point two inches from its cut termination was also
reddened, and its inner coat softened and easily removable. The phlebitis, with its occlusion
of the main venous trunks, accounted for the swollen and white condition of the stump, compared
above to the condition known as phlegmasia alba dolens. In making this dissection it was
observed that the inflammation, apparent in the artery and to some extent circumscribed (since
its lower extremity yet contained the clot formed on the application of the ligature and was
normal both in color and firmness, as well as that which occluded the veins), had extended
through the coats of these vessels from without. No pus was found in the veins, and no evidence
of inflammation except the marked redness of the coats and the firm and clotted coagulation of
the blood within." Wet preparations of the femoral and profunda arteries (Spec. 2246), the femoral and saphena veins (Spec. 3991), and the popliteal artery and vein (Spec. 2247), saved from the stump, were contributed to PLATE XX,
opposite p. 294.