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tailed on the different organs, as demonstrated by dissection. This is an interesting part of my subject, and will, I doubt not, open a new field for the speculation of the patho. logist. In this part as well as the former, I shall endeavour to point out the viscera "most deranged by each form of the disease. It will be recollected that the intermittents and remittents, &c. degenerating or rather assuming the continued or typhoid type, most frequently terminated fatally. Of all the bodies which I dissected, I only find the particulars of 80 cases in my note book, 36. of which were of this form, and were, generally speaking, first in point of time, 26 hydropic and 18 dysenteric..
In these the chief organ affected was the spleen. This viscus was always enlarged, often weighing from three to five pounds. Its substance was extremely soft and easily de. ranged. Tubercles were often found on its surface. Inflammation and ulceration, not only of its peritoneal coat, but also of its substance, were frequently observed. These ulcers were found in all their various stages and forms, from the most minute to the almost complete exulceration of the whole lienteric mass. Of this last the following is a remarkable example.
Richard Mullan was readmiited with continued fever, which soon terminated fatally. On opening the abdomen, a large sac was found to occupy all the left hypochondrinc region. It was firmly 'united to the stomach, diaphragni, .and all the neighbouring viscera. It contained near two quarts of bloody purulent matter, in the midst of which floated the spleen quite detached, and so much ulcerated and wasted as to appear only a sinall mass of bloody matter without any capsule; for its proper peritoneal coat was found to -have formed the basis of the sac. The lower surface of the diaphragm, which 'scemed to compose the superior part of this sac, was inflained and deeply ulcerated. There were many other cases of this ulceration of the spleen, some of which being sented on its superior surface, where it comes in contact with the diaphragm, had corroded and destroyed that musclep so as to form a communication between the thorak and abdomen, into the former of which they were found sometimes to have discharged their purulent contents.'. adt Hard štony concretions were also frequently found on it, and in one or two instances its capsule had become cartilaginous. There was likewise an instance of accidental death from a rupture of this organ. Two of the convalescents disputing in their ward proceeded to blows, and one having fallen, his adversary was observed to have struck him while down with his foot. Ile rose, however, of his own accord,
and and ascended his birth, where he expired in a few minutes. Soon after the abdomen was found to have swelled considerably, and on inspecting the body there were found several pounds of fluid blood diffused in it. The rupture or rather laceration of the spleen was about an inch and half in length, and situated on that part of it which lies in contact with the stomach. It was also much enlarged and very soft.
The liver was the vext grand organ or which this disease. was found to have made rapid progress towards its destruction. Its most common appearance was preternatural enlargement, flaccidity, and, induration or condensation. It was also frequently covered with coagulable lymph and adhered to the surrounding viscera. Inflariimation and ulceration, not only of its coat, but also of its substance, were often detected. These were not, however, of so frequent occurrence in this organ as in the spleen. -Jts substance often exhibited a mottled friable appearance, with a deficiency of the secretion of bile in the biliary ducts, although the gall bladder was, in general, discovered to be quite full, and often distended with dark inspissated bile resembling tar. ...llydatids were also sometimes found in its substance. A bag of this kind was once discovered in the substance of the livcr, which contained ncar a quart of limpid fluid. Tbis was retained in a large sac, the structure of which appeared very white and cartilaginous. Tubercles were likewise sometimnes observed in it.
Het The gall bladder was sometimes found in an inflamed state. In general it was distended with dark green viscid bile; soinctimes, however, it was much contracted; gall-stoncs were often detected in it....
The stomach was for the most part found natural. It was often, however, much contracted from its middle to the py, lorus. In many cases it was considerably distended with Hatus. In a few instances inflammation and ulceration of its coats were discovered. . . . . . . .or?
These ulcers of the stomach do not exactly resemble those of other parts of the body. In these cases, there is little cirqumjacent inflammation. The ulcer appears of a circular forn, with smooth edges, and little inflammation. At first view they appear as it cut out with an edged instrument.* In many cases the stomach was considerably corroded by the gastric juice, particularly towards its greater curvature. Thę peritoneum was in many cases much diseased. Its most frequent appearance was that of inflammation and adhesion. Its surface was often covered with purulent matter. Those duplicatures of the peritoneum which form the omenta, were * Vide Baillic's Murbid Anatomy.
. . .' very
very frequently nearly absorbed. In many cases nothing of it remained but a plexus of vessels attached to the stomach and colon, of a dark or greenish colour.
The intestines were in general natural. The most common discased appearance, was that of inflammation and consequent adhesion. Intus-susceptio was also frequently observed.
The kidneys were for the most part healthy, except in those cases of dropsy which shall be hereafter mentioned. Stones were sometimes found in the pelvis of the kidney, as well as in the ureters.
The morbid appearance which the thoracic viscera often exhibitel, was also very various and considerable.
Inflammation of the pleurą and lungs, with all its consequenccs, was, however, the most common. In some instances the surface of the lungs was thickly encrusted with a cartilaginous substance. It was very common to find the substance of the lungs anasarcous, and sometimes their struc-, ture was so far changed and condensed as to resemble the liver.
The pericardium was also soinetiines found inflamed, and formed adhesions with the heart. It almost always contained a preternatural collection of serous fluid.
The heart itself did not escape the inroads of this destructive disease. Its adipose substance was often dropsical, and it was not unusual to find depositions of coaguable lymph on its surface. : In one instance the surface of the right ventricle was found much inflamed and ulcerated, especially towards its superior part which approaches the auricle. On opening the ventricle the tricuspid valves were discovered to be in it complete state of ossification, by which the opening between the auricle and ventricle was nearly obliterated. The sympa toms of this patierrt were so vicarious as to induce his medical attendants to suppose that he was allected with a cancer of the stomach.
Brain. This intricate organ was not so frequently investi. gated as I could have wished, and principally for this obvi. ous reason, that it required a greater leugth of time for this purpose than could be obtained. There were, however, sufficient demonstrations of the brain to show its general appearance in this disease. It was for the most part natural; there seemed, however, a great determination of blood to this organ, its vessels being in general found turgid. Adhesions of the dura mater to the surface of the brain, and depositions of lymph were often detected. A superabundant quantity of water was very often discovered in the ventricles.---In one or two cases death suddenly occurred while the patient la boured under salivation. In one of these that I inspected, 4 quantity of blood was effused between the brain and dura
mater, similar to the appearance observed in cases of apo, plexy. The swelling of the neck and throat being so much increased as to impede the blood returning from the head, is generally supposed to be the cause of such unexpected occurrences.
I must not forget to mention that large collections of puru- . lent matter in different parts of the body often proved fatal. :. These critical abscesses were in general situated on the lumbar region, the thighs, legs, and shoulders,' &c. :. The matter detached the cellular substance and fascia from the muscles, insinuating itself between them, and thus : formed sinuses and fistulous openings in distant and different parts. These openings were so numerous, and disa charged such quantities daily, that the poor sufferers were rendered horrible spectacles. They often continued in this state for months before death terminated their wretched existence.
With respect to the morbid appearance of the hydropic form of the disease, I have little to add to the above-mentioned organic derangements. Here, however, the kidneys always seemned more flaccid and wasted than natural. The Jiver appeared always less or more diseased, and the whole of die peritoneum was: often found to have formed various and extensive adhesions and indurations of its substance. In one case where the hydropic patient was affected with a cutaneous eruption, the whole of the peritoneum exhibited a similar appearance to that of the surface of the body. . . * The thorax was most frequently the seat of these complaints. Perhaps this may be explained by its being more liable to inflammatory attacks than any other cavity of the body. Adhesions of the lungs, pleura and pericardium were found in almost every instance. The substance of the lungs was very frequently anasarcous, and on pressing them, the water was discharged as from a wet sponge. Tbe pericardium was often much distended with fluid, wlien no other cavity was found to contain any preternatural quantity, measuring often from two to twelve ounces. This preternatural collection of water in some of the cavities was one of the most frequent occurrences met with, under almost every form of this malady. This was not only contained in the abdominal and thoracic cavities, but was frequently found to exist in the ventricles of the brain itself. *..
In the dysentery, which was the third and last most common form of this disease, the morbid appearance was mostly confined to the intestines ; but as the patients all laboured, in some degree, under the influence of the original complaint,
. , . the