Appearances in the abdominal cavity.

All the abdominal viscera were perfectly healthy, but the stomach was very much contracted, and its internal surface beautifully corrugated.

I have seen a similar appearance in the stomachs of two executed patients.

These stomachs are preserved in the Museum at St. Thomas's hospital.

There were slight marks of external violence on the sides and back.

CASE II.

A boy 17 years of age, was admitted into the infirmary on April the 4th, 1811. Some months previous to his admission he received a blow upon his knee ; inflammation and suppuration were the consequence; the ligaments covering the joint became very much thickened ; pus was continually passing out of the joint; there was great constitutional irritation, and as there was but little chance of saving the limb, it was deemed advisable to remove it. It was considered a favorable case to operate upon. About four days after the operation the boy began to complain of headach, and the stump assumed an unfavorable aspect. The former symptom was unregarded, and stimulants were freely exhibited, with a view of bettering the condition of the stump.The affection of the head daily increased in violence. The patient screamed with vehemence in the day time, and disturbed the whole ward by his moanings at night. He at length became delirious; his eyes looked glassy, but the pupils were but slightly dilated.

On the following day the patient became comatose. The stimulating plan was laid aside, and the antiphlogistic regimen adopted. Blood was twice taken from the temporal artery; once from the jugular vein ; and once from the arm ; in all about forty ounces. A blis

ter was applied to the scalp, and three grains of calomel were given every six hours. This practice was however adopted too late, to afford any reasonable ground to hope that it would be attended with success. The patient died on the 6th of May. The brain exhibited the same appearances as those related in the former case, except that there was a larger quantity of water contained in the lateral ventricles. There was throughout the whole of this case but a very slight dilatation of the pupil. I do not recollect that its diameter ever measured more than one line. The application of the strongest light would not however stimulate the iris to a further contraction. In Jesse Clissold's case the dilatation was considerably greater, but there was throughout its whole progress a tendency to contract, whenever a strong light was suffered to fall upon the eye.

The lad whose case is above narrated was of a scrophulous habit of body.

CASE III.

Mary Ann Nelson, aged three years, a sickly child, and of a very diminutive size, was admitted into the Infirmary on May the 1st, 1815, in order to be operated on for a hare lip.

The head was large, the skin delicate, and there were other marks of a scrophulous disposition about the patient. The operation was performed, and the lip at the end of three or four days began to unite. At this time she was attacked with severe pain in the head, screamed violently, and refused all nutriment. A cathartic powder was administered, and afterwards a grain of calomel every six hours. On the following day the child became comatose; and there was considerable dilatation of the pupils. A blister was applied to the head. The calomel was persisted in, and a scruple of mercurial ointment was rubbed upon the abdomen every night. This practice was unattended with the slightest

diminution in the violence of the symptoms; and on the 4th of June, the patient died. No opportunity occurred of ascertaining the state of the brain, but little doubt can exist of there having been considerable effusion into the ventricles.

I should have observed that the mouth was affected by the mercury.

CASE IV.

A sickly child, 4 years of age, with deformed rickety limbs, was placed under the care of the Surgeon of the week. A few days after her admission she was attacked with all the symptoms commonly attendant upon hydrocephalus internus. There was also great acceleration of the pulse and a hot skin. She screamed at intervals and refused all kinds of food. Two grains of calomel combined with eight of jalap were given to her, and afterwards a grain of calomel every six hours.

On the following morning she appeared somewhat better; her pulse was slower and her skin more cool. The body was directed to be sponged and the cathartic and calomel to be repeated. The next day she appeared much better; she had voided with her fæces two lumbrici, about four inches in length each; she took a little nutriment and did not complain of her head; the pupils were less dilated; the powder and calomel were repeated.

She passed on the following day another worm, and from this time gradually recovered. One grain of calomel combined with ten grains of tin filings were administered every morning for about a week, and the child left the house free from any hydrocephalic symptoms.

That this was a genuine case of hydrocephalus Internus may be disputed. I can only say, that I never saw a case in which the symptoms of the disease were more decidedly marked.

CASE V.

A boy, sixteen years of age, was admitted into the Infirmary for a tumor in the thigh. This tumor, upon more minute investigation, was ascertained to form the most dependent part of a psoas abscess. The lad complained of universal indisposition, and there was a slight acceleration of his pulse.

On the 23d of July he became feverish; skin hot, tongue dry, great pain in the head. A purgative was prescribed, and he was desired to be kept cool.

On the 25th, his pulse was hard and rapid, his face flushed, his skin hot; there was but a slight dilatation of the pupils, but he complained of excessive pain in the head. It was evident that the disease had made very considerable progress, and that no time was to be lost.

Ten ounces of blood were directed to be taken from the temporal artery, and the following medicines were prescribed.

R. Calom. ppt. gr. iij. 6ta. quaq. hor.

Mist. Salin. unc. viii. Inf. Digit. dr. vi. M. Capt. cochl. iij. 6ta. quaq. hor.

His body was likewise sponged with vinegar and

water.

26th. Pulse rather slower, skin cooler, pupils more dilated, delirium during the night, cannot be made to answer questions, bowels open.

The temporal artery was again opened, and twelve ounces of blood drawn from it; a large blister was applied to the head; the calomel and mixture were continued with an addition of two drachms of the infusion of the latter; a drachm and a half of strong mercurial ointment was rubbed upon each thigh at bed time.

27th. Pulse 130, but softer, pupil very much dilated, but contracts upon being exposed to a strong light, his stools pass involuntarily. Friction with the mercurial

ointment was directed night and morning; the calomel pill was omitted at bedtime, and a grain of opium with three grains of antimonial powder substituted,

28th. Salivary glands slightly affected; the patient could be roused, and replied readily to questions proposed. He swallowed a little food, tongue foul, pulse very frequent, pupils less dilated, fæces discharged involuntarily. In the afternoon he began to pick the bedclothes, became insensible to all external objects, and died on the following morning.

Examination.

The brain exhibited evident marks of active vascular action having existed. Upon cutting off the hemispheres numerous minute spots of blood exuded from the divided vessels. The texture of the brain itself was firm, and rather more glutinous than is usually met with. The ventricles did not contain so large a quantity of water as was expected to be found within them; only two ounces were collected, and about half an ounce escaped. I am inclined to believe, that a partial absorption had taken place previous to the death of the patient. The abdominal viscera were all in a healthy state. The psoas muscle had been formed into a funnel, for the reception of about three quarts of cream-coloured pus. Solid flakes of considerable magnitude were deposited at the bottom of the abcess; and would have effectually prevented the matter from passing thro' the canula of a trocar, had one been introduced into the tumor for the purpose of evacuating it. The lumbar vertebræ were all in a diseased state, and large pieces were easily chipped from them with a common scalpel. There had likewise been considerable absorption of the bones of the sacrum. There was no projection of the spinous processes externally, nor did they deviate from the straight line. When pressure was firmly made upon them, the boy, at his first admission into the hospital, said it gave him considerable pain.