320 
PLEURISY AND RUPTURE 
on the same food, in a state of perfect health : but the affection 
of the thorax was decidedly much worse ; there was considerable 
cedematous swelling of the dewlap and the integuments under 
the jaw, and I immediately detected effusion into the cavity of 
the chest. I told Mr. Wright of this, and the immediate danger 
to life consequent upon it. The event justified the prediction ; I 
went again on the 16th, and found her dead.—The following 
were the appearances that presented themselves at the post¬ 
mortem examination: The first three stomachs were healthy, 
with a due portion of food in them; the fourth stomach was 
slightly inflamed, with a quantity of dirt, and several small pieces 
of coal or cinders in it; there was also a nail, a pin, and a small 
piece of wire, in the first stomach. The intestines had recovered 
their healthy aspect in a great measure, but there was a small 
quantity of serous fluid in the cavity of the abdomen. Upon 
opening into the thorax, about two gallons of purulent fluid es¬ 
caped. The lungs were in a state of complete collapse, and not 
more than half their natural size, and were completely attached 
to the ribs by a diseased secretion from the pleura. The most extra¬ 
ordinary appearance, however, was exhibited by the pericardium: 
a portion of it was found closely adhering to the left side of the 
heart ; on the right side there was a rupture of it, forming a 
foramen of an inch and a half in diameter, and it appeared as if 
the edges of this opening on one side had receded upon the sur¬ 
rounding parts. Adhesive inflammation had taken place, and 
there was a complete duplicature of the pericardium, which was 
altogether thickened and indurated to such an extent, as to pre¬ 
sent the appearance of tanned leather. 
Here, then, at any rate, I had firm ground for my original 
opinion of long-existing chronic disease. The pericardium did 
not exhibit that intense vascularity that one stage of acute in¬ 
flammation would produce ; nor was there that tendency to de¬ 
composition that would be the effect of a still greater extension 
of the same kind of inflammatory action, but there was, instead, 
a firm indurated half-organized substance, of fifty or sixty times 
its original thickness. Now, in the first instance, when this 
comparatively delicate membrane (from the disease consequent 
upon its rupture) had lost its healthy secreting action, a diseased 
one would be set up in its stead, and a deposition upon the 
whole of its internal surface must have taken place. A partial 
organization of this must have followed ; and this deposition, 
covering the original secreting surface, must have itself become 
the secreting surface. A fresh deposition must then have taken 
place, and a fresh organization have followed, and so layer after 
layer were added, till it became the hardened indurated mass which 
