JI Case of Cyanosis. By William Waters, M. D., Fredericktown,
Maryland.
Mr. Wm. R. Y., of small stature and delicate frame, aged forty
years, within seventeen days. According to the history given by
his mother, Mr. Y. gave no evidence of morbus coeruleus until he
was about six years of age ; the seizure at this time was ascribed by
her to an attack of measles, although the paroxysm came on after
his recovery, and followed exercise in running about the yard.
From that period until his death, he was subject to paroxysms on
exercise, mental emotions, and occasionally after eating a full
meal. The lividity affected his lips, face, hands and arms. When
slight, the lips only would be affected, and the shade would vary
from a partial blue tint almost to a black color of both lips and
face. An intimate friend and schoolmate (Mr. V. E.) informed
me, that at the age of ten years, he was in the habit of visiting
his mother’s about a mile from town. When he walked about half
a square a paroxysm of dyspnoea, palpitation, and lividity would
occur. To save time he would be obliged to carry him on his
back to the country. He also states that four years ago he visited
with him the same neighborhood, and they were four hours walking
a mile and a half, so greatly did exercise affect his respiration. I
have known Mr. Y. for the last twenty-five years, and believe,
that with the exception of cyanosis, his general health has been
pretty good ; and although of feeble constitution and general mus-
cular debility, he frequently acted in the capacity of a merchant.
I often observed him in a squatting position or sitting upon his
heels, with his body bent forwards, a position which gave him some
relief in respiration. When perfectly quiet his remissions would
extend to hours or days, but the slightest exertion at table would
bring on a paroxysm. For the last two years I have observed
more emaciation and debility. About six months ago he was taken
with symptoms of hectic fever and night sweats, although he con-
tinued to go about untiHhree months before death. About this time
I was called in and found him laboring under congestion of the lungs,
with hectic, attended with dyspepsia and frequent colic ; the latter
almost invariably produced by taking the least solid food. There
was no diarrhoea. About two months before dissolution he expec-
torated bloody sputa, which soon subsided under the usual reme-
dies, though there still remained some dyspnoea and cough, with
frequent lividity of his lips and face. His pulse was accelerated
and irritated, generally regular, though sometimes intermittent ;
the night sweats were heavy whether preceded by fever or not;
bowels generally costive, but readily acted upon by aperients or
injections. His cough became much more aggravated two weeks
before dissolution ; tympanites also occurred, followed by slight
oedema of the feet and ankles with ascites. The dyspnoea in-
creased to orthopnoea, and sputa mixed with blood were discharged
for four or five days before death, which eventually took place on
the 19th of February, 1850.
Autopsy twelve hours after dissolution, assisted by Dr. J. Gregg
Gibson, Mr. Wm. A. Waters, and P. Grove.
The emaciation of his frame was very great.
Thorax.—The pericardium contained some four or five ounces
of serum. The heart rather smaller than ordinary, right auricle
and ventricle much larger than the left. The right side of the
heart very much distended with blood, particularly the right
auricle and coronary veins, the latter were as much so as if
filled with a wax injection ; the right auricle was unusually
large, and the walls twice as thick as usual; the foramen ovale was
closed, but the fossa ovalis and annulus ovalis were located rather
higher up than usual, or nearer the descending cava. The right
auriculo-ventricular opening was larger than usual. The right
ventricle was much larger and thicker than the left; it was nine
lines thick, the columnae carneae were also thicker than in the left
ventricle, with some fibrinous deposites in the meshes of the
chordae tendineae. The Aorta arose from the right ventricle in
common with the. left ventricle, from the base of the interventricu-
lar septum. The aperture in the interventricular septum admitted
the passage of the middle finger with great freedom; indeed the
opening was three quarters to an inch in diameter between the
ventricles. The sigmoid valves of the aorta were normal.
Pulmonary Artery.—Here was a most serious malformation. It
arose from the ’right ventricle or interventricular septum, by a
small orifice only three or four lines in diameter ; the mouth of the
artery was encircled with a tendinous band, and that circular band
was crossed at the mouth by another band just in the rear of the
circular band, which lessened the diameter of the aperture or
mouth of the P. artery about one and a half lines; the larger
aperture being the mouth of the pulmonary artery, and the smaller
aperture terminating in a small blind sac a few lines in diameter
and length, ending in the muscular tissue of the heart. Beyond
this contracted mouth of the P. artery the vessel enlarged to its full
size, and contained tw > large semilunar valves in lieu of three.
Some fatty deposite was found between the mouth of the pulmo-
nary artery and the valves, and likewise in the blind sac.
The left auricle appeared normal in the interior, except that the
auriculo-ventricular opening was smaller than natural, barely ad-
mitting the little finger.	*
The left ventricle was small and concentrically thickened, the
wall about six lines thick, the column® carneae of the mitral valve
were smaller than those of the tricuspid.
The aorta arose from the upper and anterior end of the left ven-
tricle in common with the right ventricle, and also anterior to the
mitral valve. It looked more into the right than the left ventricle, as
the semilunar valves could be more readily seen in the right than
the left ventricular cavity.
The lungs were both adherent posteriorly to the plurese costales,
the lower portion of both were tuberculous, and the upper portions
were deeply engorged, and in places hepatized. The bronchial
glands were as large as hickory nuts, of a dark venous color. There
was also a calcareous deposite at the bifurcation of the right bron-
chi®.
.Abdomen.—Evacuated two gallons of water from the peritoneal
sac; surface of the intestines blanched.
Omentum absorbed entirely to the colon ; the transverse and
descending colon down to the rectum contracted to the size or dia-
meter of the index finger.
Liver studded with tubercles superficially, interior healthy as to
structure, but of darker color than usual, as if from venous conges-
tion. Spleen likewise darker than normal. Right kidney healthy,
the left engorged slightly in the cortical portion.