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the frequent dependence of some of the cases of the so-called "cirrhosis of the lung," on compression of the pulmonary tissue by old pleuritic effusions, there can be no doubt. In most instances the lung is found firmly adherent to the parieties by old cellular attachments, and often there is a thick layer of fibro-cartilaginous false membrane on the surface of the pulmonary pleura. Kecently I had the opportunity of examining a case in which an effusion in the left pleura had existed during six years, and had formed communications both with the bronchi and externally. In this case a portion of the lung was adherent to the parieties by fibro-cartilaginous attachments: the lung was greatly compressed, and the bronchial tubes much dilated,—the dilatation being more marked towards the periphery of the lung, where, indeed, some of the tubes were nearly the size of the little finger, and these cavities were evidently lined by natural epithelium. It is, however, unnecessary to urge the operation of this cause in producing dilatation of the tubes, as it is evident that if the lung be permanently collapsed from compression, the space not occupied by the contraction of the parieties must necessarily be compensated by the expansion of the tubes. On the other hand, Dr Gairdner is, doubtless, correct in the explanation which he gives of the mode of formation of the sacculated expansions, which open more or less abruptly from the tubes. Such cavities are not found to be lined by true epithelium, but by a dense fibrous layer, which has every appearance of being a new formation. In the specimen which I have referred to, as exhibited at the Pathological Society by Dr Hare, the lining of the large dilatations had a smooth glistening surface, and was in places crossed by fibrous bands; and, both to the naked eye and under the microscope, presented no appearance of true epithelium. The cavities in the lung in the case which is the subject of this communication affords decided evidences of having been produced by the mode referred to by Dr Gairdner. Their irregular form, the absence of any distinct lining membrane in some of them, and the existence of two or more communications with the bronchial tubes in others, sufficiently show that though some of the cavities were lined by a membrane apparently continuous with the mucous membrane of the bronchi, and though the bronchi generally were undoubtedly much dilated, the sacculated cavities had resulted from ulceration of the pulmonary substance, afterwards expanded during the act of inspiration, and not from simple dilatation of the tubes. It is not, however, equally clear what was the nature of the disease by which the ulceration of the pulmonary substance had been occasioned, and there was nothing in the history of the case, or in the appearance of the lung, to show whether the cavities had resulted from bronchitis with bronchial abscesses, or from consolidation and subsequent ulceration or softening of the tissue of the lung.
The second point of interest which the case presents is the difficulty which existed in deciding during life the precise nature of the disease of the lung. In its general features the case bore a close resemblance both to ordinary tubercular phthisis and to contraction of the lung succeeding to an empyema which had been evacuated through the bronchi. Indeed, after careful examination and consideration, I was led to conclude that the disease was of the latter description.
To phthisis it was closely assimilated by the frequent occurrence of more or less haemoptysis, by the cough and expectoration, by the emaciation, and the physical signs which evidenced the existence of cavities in the lung. On the other hand, the duration of the disease was much greater than in ordinary phthisis, the emaciation and the hectic symptoms were less marked than in a case of common consumption at so advanced a stage; and especially the absence of any evidence of disease of the left lung was irreconcilable with the idea of true tubercular disease. I was therefore, as before stated, led to suppose that the case was one of disease of the lung ensuing upon an empyema which had been evacuated through the bronchi; and the great contraction of the affected side of the chest, the mode in which the matter was expectorated by a kind of halfvomiting act, the profuseness of the expectoration, and its peculiar character, confirmed me in this opinion.
The pathologists of the Dublin school, to whom we are indebted for the illustration of this form of disease, have devoted much attention to its diagnosis. Dr Corrigan dwells much upon the absence of constitutional disturbance correspondent to the amount of pulmonary disease, the less marked hectic symptoms, and the signs of contraction of the chest, as distinguishing the cirrhosis of the lung from phthisis; and Dr MacDowell1 thinks that the slow progress of the case, the limitation of the affection to one lung, the greater extent of disease at the lower than at the upper parts of the chest; the predominance of the signs of consolidation over those of softening, the displacement of the neart, and the absence of hectic and of all signs of laryngeal affection, will sufficiently distinguish the disease from phthisis. Dr Stokes, in describing a case of the kind, attached much importance to the absence of haemoptysis ; but this, so far from being a frequent distinction between cirrhosis and phthisis, is really a feature in which the two affections closely correspond, for haemoptysis appears to be a very constant symptom in cases of cirrhosis. The signs pointed out by Dr MacDowell will, I think, generally enable us to effect a diagnosis between this affection and phthisis; but to distinguish some cases of cirrhosis from the second form of disease to which I have alluded, would appear to me to be extremely difficult. Indeed, after careful consideration of this case, and after having had the opportunity of observing several instances of chronic fistulous communication between the pleural cavity and the bronchi, I am incapable of pointing out any decided signs between that
1 Dublin Journal, 1852.
affection and the form of disease of which the case here related affords an example; and I am much inclined to doubt whether a decided differential diagnosis could be effected.
Article II.—An Experimental Inquiry into the Existence of u Sixth Seme, here called tlie Sense of Force. By Richard F. Battye, Esq., London.—(Concluded from p. 223.)
The last articulation to which I shall refer, is the radio-carpal articulation, or the wrist-joint. This joint, like the elbow-joint, has no intervening articular fibro-cartilage, saving the triangular disc, between the cuneiform bone and the ulna; hence there is nothing to materially hinder the propagation of force in the same line of direction to that of the joint towards which it is tending. The carpal bones are small, well bound together by ligaments, and contain considerable hard compact tissue. The metacarpal bones also, with the phalanges, are well adapted to transmit force from their apices to the carpus, and thence to the synovial membrane of the joint. The synovial membrane is always well lubricated with synovia, is extensive, very complete in its continuity, and enjoys a high degree of sensibility to the slightest mechanical injury, or from the mildest form of inflammation that can affect that membrane. In every thing it is a joint well adapted to determine the correctness or validity of the present hypothesis. Again, between the ulna and cuneiform bone, there is a cartilaginous disc, covered with the same synovial membrane as the radial surface on one side, whilst the same disc is partially covered, and also the rounded head of the ulna, with the membrana sacciforma, on the opposite side; but this last named synovial membrane is very imperfect in many, and, in its location between the ulna and the fibrous disc, it is rarely found lubricated with synovia, or appears to fulfil the function of facilitating motion, but rather is lodged in this part as a point of attachment to retain it in situ, whilst the remaining part of the sac fulfils the function of aiding motion during pronation and supination between the radius and ulna, and is usually found slightly lubricated with synovia. These remarks, upon the membrana sacciforma, are made with the view of marking the contrast between the synovial sacs of the articulation of the inferior maxillary and the ulna, both of which have an inter-articular fibro-cartilage, and a double synovial membrane covering them; but the slightest reflection will immediately suggest the difference between the two, in extent, function, and sensibility.
This digression is not made without weighty reasons, since the writer is of opinion that the membrana sacciforma, in its relation to the head of the ulna, does not assist in the least in supplying consciousness of weight to this part of the wrist joint; and, moreover, that the triangular fibrous disc acts (as a damper in a piano-forte) in suppressing any consciousness of weight, arising from impressions made upon the principal synovial membrane of the joint, when this membrane, by inverting the hand, is placed in close contact with the cuneiform bone and the head of the ulna, whereby, when any weight is thrown upon this part of the articulation, consciousness of weight ceases to be experienced.
Without, then, making any further digressions, by soliloquizing upon the beauties and excellencies of that most perfect piece of mechanism, which either nature or art have completed—the hand— I will at once enter upon the detail of a few experiments.
Supposing I place in my hand a thick heavy book, say Ainsworth's Dictionary, I instinctively place the hand and forearm in one line of direction, and gently raise and depress the extremity, whereby a tolerable estimate of its weight is obtained. Again, if I still retain trie book (elevated on the fingers and thumb), and invert the hand, as far as I conveniently can, taking care not to abduct the elbow, but retaining it at the same relative distance from the side of the body, I shall find the amount of weight at first experienced to be considerably diminished. To perform this experiment without raising and depressing the hand and forearm is the best.
But, in place of holding upon the hand a considerable weight, suppose a halfpenny or a shilling be placed upon the fingers, I shall instinctively invert the hand; but supposing that volition overcomes instinct, and the hand is extended in a straight line with the forearm, as in the first experiment, all feeling of weight will disappear, and especially if the hand is, of the two, rather everted.
Now, in place of slightly everting the hand, let the hand be inverted as much as can he accomplished with convenience, and the shilling be placed with the fingers slightly flexed, between the third and little finger, and the hand be gently raised and depressed, or rather gently raised and quickly depressed, when more weight will be experienced than in any other position in which the weight can be placed in the hand.
Here, then, are four experiments: with the first, by having the hand extended in a straight line with the forearm a large weight is well and easily discerned; hut in the third experiment, with the hand still retained in the same position, a very small weight scarcely can, if at all, be discerned. Again, by inverting the hand, the larger weight, as in the second experiment, is less perfectly estimated and felt; whilst, as in the fourth experiment, by retaining the hand in that position, the smaller weight is well discerned, and the more it is inverted, without inconvenience to the experimenter, the greater is the feeling of weight experienced.
How, then, are these contrasts to be explained? With the larger weight, as in the first and second experiments, there is little difficulty in readily comprehending the rationale; thus, when the hand is extended in a straight line with the forearm, the scaphoid and
HEW SERIES. XO. IV. APHII, 1855. 2 0
semi-lunar bones, which articulate with the radius, are placed in exact opposition to each other, and, consequently, there is a large free surface of synovial membrane, well adapted to receive force, in any direction in which it may be tendered from the hand, impressed with the resultant force of two antagonizing forces, whose course, in their common diagonal, is the natural stimulus, in the nerves there distributed, to excite in them the sense or feeling of weight; therefore, according to all fair modes of reasoning, when the hand is thus placed in relation to the forearm, weight ought to be well estimated
But for the same reason that, in the first instance, weight ought to be easily and well estimated, in the latter it ought not so to be: since, by inverting the hand, the scaphoid and semi-lunar are not so closely approximated to the radius as is the cuneiform with the ulna, and, consequently, the chief synovial surface is very imperfectly impressed with its appropriate stimulus, and therefore the amount of weight experienced is less marked and evident (vtdi fig. 5).
The third and fourth experiments cannot be so easily explained, but, I think, quite as satisfactorily; but to arrive at a correct explanation more analysis is required. All facts are not equally evi