Case XI.
George English, æt. 25. For symptoms see page 141.
Abdomen. Numerous ragged ulcers in the cæcum, which, having destroyed the mucous, had laid the muscular coat quite bare; both the muscular and the peritoneal coats were blackened and in the first stage of sphacelation; an aperture of about the size of a sixpence had been formed in them through which a considerable quantity of fæces had escaped into the peritoneal cavity; in different portions of the mucous membrane of the other intestines there were slight patches of inflammation; omentum much thickened, adhering anteriorly to the abdominal peritoneum and posteriorly to the intestines; the latter were so agglutinated together, that it was impossible to trace their convolutions; the peritoneal sac contained four pints and a half of serum mixed with pus; the peritoneal coat of the liver adhered to the diaphragm all around, except at one point where a sac was formed which was filled with serum; substance of liver healthy; other viscera healthy. Head. Dura mater vascular; pia mater highly vascular; arachnoid healthy; more fluid than natural between the membranes and in the ventricles; substance of the brain pretty healthy. Thorax. [Right pleura vascular; superior and middle lobes of right lung contained numerous miliary tubercles; lower lobe, one or two in the first stage of suppuration; the under surface of this lobe adhered to the diaphragm with great firmness, shewing that the disease of the abdomen had extended to the thorax; pleuræ of left side contained two ounces of bloody serum; substance of left lung healthy; pericardium contained three ounces and a half of serum; left ventricle of heart full three-fourths of an inch thick.]
Case LXXXVI.
William Baker, æt. 26. Admitted on 15th day of fever: no account to be obtained of previous symptoms: too insensible to give any statement that can be depended on of his present feelings; points to lower part of chest and epigastrium as the chief seat of pain; abdomen tender on pressure; some cough; voice hoarse, husky, and feeble; no pain of head; pupils contracted; pulse 100, sharp.
16th. Six stools, two passed in bed; hiccup; frequent cough; respiration laborious; pulse 84.
20th. No perceptible change until to-day, when the stools, six in number, became mixed with blood; the expectoration is also tinged with blood; respiration more hurried and difficult; hiccup continues; pulse 120.
23d. Five stools in bed; hiccup gone; no sleep; great restlessness; pulse the same. Died next morning.
Abdomen. Peritoneal coat of intestines vascular; mucous membrane of small intestines, and especially of ilium, inflamed and ulcerated; near the caput coli a large ulcer had perforated the peritoneal coat, and through the opening, which was an inch and a half in diameter, a quantity of fæculent matter had escaped into the cavity of the peritoneum; spleen very much softened, easily breaking down under the finger. Head. Pia mater highly vascular; substance of brain slightly vascular; a small quantity of bloody serum effused into the lateral ventricles. Thorax. Mucous membrane of bronchi of dark red colour; tubes contained much frothy mucus; substance of both lungs gorged; [pleuræ of left side contained a pint and half of fluid; pericardium adherent to the pleura costalis; heart flaccid and pale.]
Case LXXXVII.