24th. Other wrist and knee have begun to swell and are excessively painful; left wrist and knee which had been more easy, again extremely painful; vomiting; respiration hurried; pulse 116, weak. Died.
Head. Much serum both in ventricles and at base. Thorax. Viscera healthy. Abdomen. Mucous membrane of the ilium ulcerated and extremely dark.
All the large joints swollen and red: on opening the knee joints they were found to contain several ounces of serum mixed with pus; the cellular tissue in the neighbourhood was partly inflamed, and partly mortified and sloughing: both wrists were in a similar condition.
Case XII.
James Solden, æt. 44, plasterer. For symptoms see page 155.
Head. Membranes of brain vascular; substance highly vascular; some effusion beneath the arachnoid. Thorax. Viscera healthy. Abdomen. Mucous membrane of ilium vascular; no ulceration; mesenteric glands enlarged.
Case XIII.
John Clark, æt. 17. For symptoms see page 156.
Head. Corresponding portions of the pericranium and dura mater detached from the occipital bone to the extent of four inches in length by three in width; coagulated blood effused between the dura mater and the cranium; vessels of the membranes turgid with blood; substance of brain vascular; effusion between the membranes; a little at base. Thorax. Viscera healthy. Abdomen. Mucous membrane of ilium greatly inflamed; cæcum ulcerated.
From the study of these cases we see that the process of disease is as uniform as that of health, or of any other process of nature; that certain phenomena constantly take place; that they follow a determinate order; that the events seldom or never vary; that their relations to each other never change; that in these cerebral cases of fever a preternatural fulness and apparently increase in the number of the blood-vessels of the brain and spinal cord, or of their membranes is always present; or that if a case do now and then occur in which even no preternatural vascularity can be discovered such an event is exceedingly rare; that this fulness and increase of the blood-vessels is either identical with, or passes into the state of inflammation; that the state of inflammation, after a certain period, produces results which are known to be effects of inflammatory action in other parts of the body; that these products of inflammation consist of a given number; that the whole of that number never concurs in any one case, but that two or more are frequently found in combination; that the laws by which any one of these is formed rather than any other are at present wholly unknown; while instances do occasionally occur, although they are extremely rare, in which the state of mere vascularity alone subsists without the formation of any inflammatory product that can be discovered.