Maya Brinjara, aged 37, intemperate,
a
smoker, height
5 ft.
7 in.; weight 120 lbs. (21st June 1867), 112 5 lbs. (1st January
1869),
82'5 lbs. now;
spare dark man, admitted
a
July
1st
1869, with fever, said to be of three days' standing, the exacerbations coming on at 7 A.M. and remaining till 4 a.m. next
morning.
Previous History.?Fever yearly during the rains, lasting fortnight or so, never had bowel complaint or syphilis ; habits intemperate, got drunk on Sendie" almost daily. Present Illness.?Began with vomiting after the evening a
"
meal on 27th ultimo ; has had deafness ever since, and looks and sleepy. Tongue white, furred; bowels free; pulse 100, weak; respirations 22, quiet; temperature in axilla
dull
103? 8 F.
lungs
Slight cough,
no
bronchial rales at
;
spitting, nipple
clearness on
both
on percussion over sides, most marked
Sleeps fairly well. Spleen extending three finger's breadth beyond margin of ribs; no marked anaemia of conjunctivae; heart not displaced, sounds normal, but weak ; no ascites, diarrhoea or ulcers of leg ; liver normal. Urine acid, amber, sp. gr. 100, contains indican,
in left.
no
albumen or sugar. Treatment.?One dose castor Arrack and
daily.
sinapisms
oil, quinine in solution, gr. xv. Prognosis not unfavour-
after 5th.
able. A glance at the attached chart will shew the fever to have been at its height, 36 hours, and 78 hours after admission (5th and 7th
day
of
disease).
of left
Incipient pneumonia
lung
was
detected 48 hours after admission, and the dry rubbing of pleurisy over the base of same lung 72 hours after admission, when burning heat of skin was noted. The exacerbations occur-
ring shew
36 and 60 hours after the fever had reached its height a fall of temperature of P.F^ and in 48 hours more the
temperature of exacerbation had declined 3? F. more, viz., to 101? F., above which it never again rose; this was the morning of
TO qioi qui qm qjst qm q;si qm qui q?8i qioc :
j
qu
iea ?s;ajo qij> q?9 qi9
q?8
GS ze 8Z 9R fz
16
8S f7.
wl -ds3H
osinj
jj oqi ijm oq opntn ?jraieop ?jtaiBsp oqi e^op e;op sq 3TI1 vtBqo }J?qo ijm oq apnea sq pajaanttoa jj p9?oaunoo oqj
} '(Jsaa
oi_ S9
I
8S
SB Tft nor fi 7, kit ia 88 1 Ra
9fi 9fi ?Z6
oOOI
,toi
?tc
pts
stajoisa
re
1
9e
H
ROT
ROT i
98^n
s
^
r1
w H ?tf elS
o8S
Ulf
,201
and Ulceration of Peyer's Glands.
V
Splenic Enlargement
ofOt
>/
(Continued from page 178). CASES Y/ITH ULCERATION OF PEYElt'S PATCHES. Case No. 33.?Feb. Remit., C. Pneumonia, Head Symptoms,
SOI
! V
.SOI
.
made.
realm la re a to tost 're'alrela 'rglar a re a re a re a re a iv area
Uh
District, Madras.
was
re area
frOTES ON PATHOLOGY. Poetee, M.D., F.R.C.S.I., M.R.I.A., Surgeon,
.901J
A.
3Uiv\? atuv^r
?y
8th when the note below
&o 'aHnxvaajiuM ?05? xhvho ao ivomrco lIjivho ivoiuho 'aaaxvaajreai ?o^? uotfMioja fo 'flt/iag 'j 'Q 'muomnsuj; TPV9J? osvanfj 'q^I -qatf -puii# 'muotanauj; 'uasidtj stMfo& 8sqofV(t 'uaaidg uoifnxaojii fo stMRa? sst[0}od puv pDdJl '/g osvshq; 'vfioj\[ 0B0 'vHdj\[ oSo '^g fjnsatf fpisatf : "tyva(j suiofdtufig amofdtuffgf
July
THE INDIAN MEDICAL GAZETTE.
202
8th.?Pneumonia in first stage in left lung as high nipple in front and spine of scapula behind. Cough adhesive mucus, very little, not troublesome ; sputum scanty, and once or twice frothy blood tinged mucus after a fit of coughing; dyspnoea none; respirations 36, and 36'6 was the mean for the whole illness, the minimum being 20 on
July
as
the
2nd, and maximum 64 on day of death ; pain none in chest> head, liver, or anywhere ; delirium none till day before death when there was a little droiosiness from first with deafnes9, into coma on dny of death ; bronchitic rales preceded pneumonia in left base and were well-marked in right at time of death ; dulness on percussion over left base not well-marked ;
passed
heart found large after death, but in life its sounds were normal, but weak ; urine from pale yellow to high amber, about 38 ozs. daily, of sp. gr. 10145, contained no albumen, but indican was found on six occasions ; tongue white, furred, moist, never very
thickly
coated and
Bowels free but
never
dry.
diarrhoea ; pulse small, soft, rarely firm, mean beats per minute 96, maximum 108, and minimum 88 ; pungent heat of slcin well marked; parotitis none. Died comatose at noon of the 16th day from admission, and 19th day no
of the fever; there were no convulsions, headache, or contracted but there was slight delirium on the two nights predeath. The noteworthy features of the case were the
pupils, ceding
intestinal ulcers without bowel complaint; and the of pia mater
haemorrhage,
which is
so rare
occurrence
according to Reynolds
and may account for the absence of head drowsiness, and for the fatal issue which
symptoms, except
not anticipated prisoner had been in jail for two years without admission to hospital, except once for ulcer of the leg. The amount of hepatization in the left lung was very moderate, felt like deep-seated solidity, and the lung ?weighed little more than the right, which was only loaded with blood and mucus. The temperature sheet diverges widely from that of a case of typhoid fever. Case No. 42.?Tuberculosis of Lungs, Liver, Spleen, Peritoneum, Bronchial, Intestinal and Mesenteric, Glands. Ruttun Sing, Rajpoot, admitted on 5th June 1869 for diarrhoea of a week's standing, when he was found to be considerably emaciated and labouring under Phthisis Pulmonalis. Previous History.?Ague several times, syphilis with salivation and subsequent dysentery in 1866. Came under treatment for fever with looseness of bowels (Dys. Chron.) 4th September 1868, was discharged on 29th September, noted then thin and ansemic. Again from 5th to 18th November, when there was also cedema of ankles, and again from 1st to 14th Dec. 1868. Had fever, looseness of bowels, and cough, without other chest symptoms from 3rd to lltli January 1869 ; has lost 22 lbs. in weight during the past year. Present State.? Cough rather troublesome, harsh, and dry ; has had it off and on for three months (probably since last discharge from hospital on January 1st.) Spitting of blood ou two or three occasions some months ago when the cough first began. Dulness on percussion over left apex to 4th rib, also less marked iu right subclavicular rejoin. Clicldng and bronchial rales heard all over both sides, both before and behind, perhaps loudest clicking at a point in the base of the right lung. Ascites moderate, with some pain and more tenderness in till two
days
before death.
was
This
hypochondria.
Pain none, except in abdomen. Dyspnoea not complained of.
[August 1,
1875
Botoels loose.
Temperature 100? F.,
Pulse 112, soft and weak.
in
evening
102J F.
Sleeps well till 10 P.M., after which he passes a restless night. Siveating only on forehead when sleeping. Urine, 40 ozs., pale, hazy, neutral, sp. gr. 1010 ; when boiled with nitric acid becomes clear and amber coloured ;
Prognosis
no
sugar.
very unfavorable. Peogress.
with occasional scanty clear mucous sputum for first week, after which it almost completely ceased. Clicking and rales remained little changed for the first three
Cough troublesome,
weeks, tlu-n gradually subsided till on 12th July they had so completely disappeared as to raise a doubt whether the diagnosis had not been wrong. Dulness.?Percussion note tinous effusion into pleurse)
so as
equal on both sides (from gelato give no aid towards solving
the doubts noted
on 12th J uly. began to disappear after the three weeks, when the looseness
Ascites end of set
in, the abdomen
was
first week, and by the of the bowels had well soft and retracted, then hard with
greater retraction, but without tenderness on pressure. Pain in right liypochondrium with tenderness and dull aching behind right shoulder (perihepatitis and pleurisy ?) was complained of on 10th June (5th day after admission), and continued to increase in severity till 16th, when the liver was enlarged projecting two fingers' breadth beyond costal margins in nipple line. The pain was most acute in the 8th intercostal space in the axillary line, and radiated up the front of the chest to the shoulder. This continued and was described on July 2nd as of a throbbing character, most felt now between 9th and 10th ribs in axillary line, with dull aching behind the shoulder and beneath the margin of the ribs ; he is unable After the setting in of the dysenteric to lie on the right side. diarrhoea on 24th June he complained of griping pains about
umbilicus, and a burning pain at the anus but no tenesmus. Dyspnoea not complained of. Respirations 36 on 12th June (acute perihepatitis) and 9 per minute on July 10th (brain effusion?); the mean of 2 i tnorning respirations is 241 per minute. (Edema of left chest and face
disappeared
after
setting
in
of dysenteric diarrhoea on 24th June, but that of the ankles remained to the end. Emaciation increased, intercostal spaces quite hollow, belly retracted and hard as a board. Weakness much complained of at last.
Appetite remained capricious to the last. Tongue, cleaned after admission, became white and dry on setting in of perihepatitis, and buff furred after a fortnight, when the liver
was
probably
affected.
Bowels.?One thin motion every other day till 24th June, when three pints were passed in three motions, of thin feculence, of an ochrey hue clouded with venous blood. The stools
became more copious, wera passed with griping and tenderness about the umbilicus and burning pain at anus, and were generally mud coloured, often very foetid and mixed with venous blood in masses or streaks ; sometimes they were
nearly
pure venous blood, or of the appearance of beef brine ; fluidity and fostid odour increased, but the griping less subsequently, probably from obtuseness of the nervous system in approaching
dissolution.
soft, till the inflammation set in, when it hard, remaining so ten days ; it again rose to 100, from weakness, two days before death. Mean of 25 days 88'5, maximum 100, minimum 64 (on 12th July) beats Pulse about 90 and
Respirations
36 per minute
principally abdominal; contraction of intercostals very evident. (Edema slight of feet and front of chest. Wasting most marked in arms and legs. Tongue slightly white, furred, appetite capricious.
rose
to 100
and became
per minute.
Temperature ranged from 100?F.
in
morning
to 102?F. in
August 1,
NOTES ON PATHOLOGY.?BY. A. PORTEK, M.D.
1877.]
evening for the first* three weeks, rising once (on evening of 15th day) to 103?F. During the next,+ week from 99?F. to 101?F., feeing 99*F. to 100?F., and 99?F. to 101?F. every other day; it t-henj fell to 98? to 99?F., and kept to this till midday of 14th July, when it fell to 973F., he dying four hours afterwards. Sleeplessness rather marked from pain latterly. Skin hot and dry during perihepatitis ; no regular night eweat ever ; felt cold to touch for some days before death. Urine taken once every three days from l7th June, (date of serous inflammation), gives as a mean of nine examinations, 36'3 ozs. of sp. gr. 1013'6, acid, rather high coloured, healthy
two, contained indican on four, and albumen on three occasions, to the amount of nearly one-half by volume, on 26th and 28tli June and one-fourth on 1st July. On the following day it contained no albumen, and remained healthy afterwards. The autopsy discovered no tubercles in the brain or coverings, Both lungs were but serum exuded from its cut surface. firmly fixed to the walls of the chest, diaphragm, and pericardium by old adhesions, into the interstices of which was infiltrated a jelly like substance, and they were studded all on
the size of a shelled almond in over with hard tubercles from the apices, to that of No. 1 shot in the lower lobes. There was incipient ulceration of the mucous membrane of the and the bronchial
larynx, glands were large, stuffed with tubercles, and jelly-like substance. The peritoneum was
surrounded by a dark slate coloured, studded with white
masses
of size of No. 1 to
6hot, of apparently organized lymph, and could be removed, leaving the membrane intact. A little straw-coloured fluid was found in the cavity. The liver was enlarged, cut surface dark chocolate green, studded with grey tubercles as big as No. 2 shot, and with small abscesses the size of castor-oil seed, which contained ochrey viscid pus ; tubercles larger than No. 1 shot generally are found with yellow centres shewing incipient softening ; the left lobe was not enlarged, and its tubercles were small and grey. The spleen was nearly black and its corpuscles were distended with tubercles. The kidneys were pale yellow B.B.
and fatty. The jejunum contained one ulcer with raised edges and black base as big as a two-anna piece, and six solitary glands were distended with tubercle to the size of No. 1 shot, one of which showed ulceration in the centre with white ring surrounding. The ileum shewed similar distension and incipient
ulcerations of about half a dozen solitary glands. Peyer's patches generally were empty and nearly black ; one patch In near jejunum was stuffed with tubercle and ulcerated.
ascending colon were two circular ulcers with black base and edges: haemorrhage had taken place from hepatic and segmoid flexure. A few mesenteric glands enlarged from
raised
tubercular
deposit.
patient lived much longer than was expected, and disappearance of the more characteristic symptoms,
This
from the a
doubt
was
raised
whether the disease
was
not
chronic
dysentery, which hung about
pneumonia consequent patient as looseness of the bowels. on
the
Case No. 43.?Tuberculosis of Lungs, Spleen and Intestinal Glands.?Maya Brinjara, admitted 29th April 1871, complain-
of ague of five days' standing coming on daily at 10 A. m. The tongue is clean, bowels free, pulse 80, respirations 20. He is emaciated with oedema of feet and general debility. During his two imprisonment he has been under treatment
ing
year's
once, and that for *
6
a
few
days
100?-95F. 102? 100?
Mean Max. Min.
F.
F.
J
August
6 p.m. 101-19F. K'3? F. 100? F.
12
a.m.
Mean. 100?-3F. Max. 102? F. Min. 99?F.
in
only
6
a.m
98
a
smoker, height
5 ft.
7 in.; weight 120 lbs. (21st June 1867), 112 5 lbs. (1st January
1869),
82'5 lbs. now;
spare dark man, admitted
a
July
1st
1869, with fever, said to be of three days' standing, the exacerbations coming on at 7 A.M. and remaining till 4 a.m. next
morning.
Previous History.?Fever yearly during the rains, lasting fortnight or so, never had bowel complaint or syphilis ; habits intemperate, got drunk on Sendie" almost daily. Present Illness.?Began with vomiting after the evening a
"
meal on 27th ultimo ; has had deafness ever since, and looks and sleepy. Tongue white, furred; bowels free; pulse 100, weak; respirations 22, quiet; temperature in axilla
dull
103? 8 F.
lungs
Slight cough,
no
bronchial rales at
;
spitting, nipple
clearness on
both
on percussion over sides, most marked
Sleeps fairly well. Spleen extending three finger's breadth beyond margin of ribs; no marked anaemia of conjunctivae; heart not displaced, sounds normal, but weak ; no ascites, diarrhoea or ulcers of leg ; liver normal. Urine acid, amber, sp. gr. 100, contains indican,
in left.
no
albumen or sugar. Treatment.?One dose castor Arrack and
daily.
sinapisms
oil, quinine in solution, gr. xv. Prognosis not unfavour-
after 5th.
able. A glance at the attached chart will shew the fever to have been at its height, 36 hours, and 78 hours after admission (5th and 7th
day
of
disease).
of left
Incipient pneumonia
lung
was
detected 48 hours after admission, and the dry rubbing of pleurisy over the base of same lung 72 hours after admission, when burning heat of skin was noted. The exacerbations occur-
ring shew
36 and 60 hours after the fever had reached its height a fall of temperature of P.F^ and in 48 hours more the
temperature of exacerbation had declined 3? F. more, viz., to 101? F., above which it never again rose; this was the morning of
TO qioi qui qm qjst qm q;si qm qui q?8i qioc :
j
qu
iea ?s;ajo qij> q?9 qi9
q?8
GS ze 8Z 9R fz
16
8S f7.
wl -ds3H
osinj
jj oqi ijm oq opntn ?jraieop ?jtaiBsp oqi e^op e;op sq 3TI1 vtBqo }J?qo ijm oq apnea sq pajaanttoa jj p9?oaunoo oqj
} '(Jsaa
oi_ S9
I
8S
SB Tft nor fi 7, kit ia 88 1 Ra
9fi 9fi ?Z6
oOOI
,toi
?tc
pts
stajoisa
re
1
9e
H
ROT
ROT i
98^n
s
^
r1
w H ?tf elS
o8S
Ulf
,201
and Ulceration of Peyer's Glands.
V
Splenic Enlargement
ofOt
>/
(Continued from page 178). CASES Y/ITH ULCERATION OF PEYElt'S PATCHES. Case No. 33.?Feb. Remit., C. Pneumonia, Head Symptoms,
SOI
! V
.SOI
.
made.
realm la re a to tost 're'alrela 'rglar a re a re a re a re a iv area
Uh
District, Madras.
was
re area
frOTES ON PATHOLOGY. Poetee, M.D., F.R.C.S.I., M.R.I.A., Surgeon,
.901J
A.
3Uiv\? atuv^r
?y
8th when the note below
&o 'aHnxvaajiuM ?05? xhvho ao ivomrco lIjivho ivoiuho 'aaaxvaajreai ?o^? uotfMioja fo 'flt/iag 'j 'Q 'muomnsuj; TPV9J? osvanfj 'q^I -qatf -puii# 'muotanauj; 'uasidtj stMfo& 8sqofV(t 'uaaidg uoifnxaojii fo stMRa? sst[0}od puv pDdJl '/g osvshq; 'vfioj\[ 0B0 'vHdj\[ oSo '^g fjnsatf fpisatf : "tyva(j suiofdtufig amofdtuffgf
July
THE INDIAN MEDICAL GAZETTE.
202
8th.?Pneumonia in first stage in left lung as high nipple in front and spine of scapula behind. Cough adhesive mucus, very little, not troublesome ; sputum scanty, and once or twice frothy blood tinged mucus after a fit of coughing; dyspnoea none; respirations 36, and 36'6 was the mean for the whole illness, the minimum being 20 on
July
as
the
2nd, and maximum 64 on day of death ; pain none in chest> head, liver, or anywhere ; delirium none till day before death when there was a little droiosiness from first with deafnes9, into coma on dny of death ; bronchitic rales preceded pneumonia in left base and were well-marked in right at time of death ; dulness on percussion over left base not well-marked ;
passed
heart found large after death, but in life its sounds were normal, but weak ; urine from pale yellow to high amber, about 38 ozs. daily, of sp. gr. 10145, contained no albumen, but indican was found on six occasions ; tongue white, furred, moist, never very
thickly
coated and
Bowels free but
never
dry.
diarrhoea ; pulse small, soft, rarely firm, mean beats per minute 96, maximum 108, and minimum 88 ; pungent heat of slcin well marked; parotitis none. Died comatose at noon of the 16th day from admission, and 19th day no
of the fever; there were no convulsions, headache, or contracted but there was slight delirium on the two nights predeath. The noteworthy features of the case were the
pupils, ceding
intestinal ulcers without bowel complaint; and the of pia mater
haemorrhage,
which is
so rare
occurrence
according to Reynolds
and may account for the absence of head drowsiness, and for the fatal issue which
symptoms, except
not anticipated prisoner had been in jail for two years without admission to hospital, except once for ulcer of the leg. The amount of hepatization in the left lung was very moderate, felt like deep-seated solidity, and the lung ?weighed little more than the right, which was only loaded with blood and mucus. The temperature sheet diverges widely from that of a case of typhoid fever. Case No. 42.?Tuberculosis of Lungs, Liver, Spleen, Peritoneum, Bronchial, Intestinal and Mesenteric, Glands. Ruttun Sing, Rajpoot, admitted on 5th June 1869 for diarrhoea of a week's standing, when he was found to be considerably emaciated and labouring under Phthisis Pulmonalis. Previous History.?Ague several times, syphilis with salivation and subsequent dysentery in 1866. Came under treatment for fever with looseness of bowels (Dys. Chron.) 4th September 1868, was discharged on 29th September, noted then thin and ansemic. Again from 5th to 18th November, when there was also cedema of ankles, and again from 1st to 14th Dec. 1868. Had fever, looseness of bowels, and cough, without other chest symptoms from 3rd to lltli January 1869 ; has lost 22 lbs. in weight during the past year. Present State.? Cough rather troublesome, harsh, and dry ; has had it off and on for three months (probably since last discharge from hospital on January 1st.) Spitting of blood ou two or three occasions some months ago when the cough first began. Dulness on percussion over left apex to 4th rib, also less marked iu right subclavicular rejoin. Clicldng and bronchial rales heard all over both sides, both before and behind, perhaps loudest clicking at a point in the base of the right lung. Ascites moderate, with some pain and more tenderness in till two
days
before death.
was
This
hypochondria.
Pain none, except in abdomen. Dyspnoea not complained of.
[August 1,
1875
Botoels loose.
Temperature 100? F.,
Pulse 112, soft and weak.
in
evening
102J F.
Sleeps well till 10 P.M., after which he passes a restless night. Siveating only on forehead when sleeping. Urine, 40 ozs., pale, hazy, neutral, sp. gr. 1010 ; when boiled with nitric acid becomes clear and amber coloured ;
Prognosis
no
sugar.
very unfavorable. Peogress.
with occasional scanty clear mucous sputum for first week, after which it almost completely ceased. Clicking and rales remained little changed for the first three
Cough troublesome,
weeks, tlu-n gradually subsided till on 12th July they had so completely disappeared as to raise a doubt whether the diagnosis had not been wrong. Dulness.?Percussion note tinous effusion into pleurse)
so as
equal on both sides (from gelato give no aid towards solving
the doubts noted
on 12th J uly. began to disappear after the three weeks, when the looseness
Ascites end of set
in, the abdomen
was
first week, and by the of the bowels had well soft and retracted, then hard with
greater retraction, but without tenderness on pressure. Pain in right liypochondrium with tenderness and dull aching behind right shoulder (perihepatitis and pleurisy ?) was complained of on 10th June (5th day after admission), and continued to increase in severity till 16th, when the liver was enlarged projecting two fingers' breadth beyond costal margins in nipple line. The pain was most acute in the 8th intercostal space in the axillary line, and radiated up the front of the chest to the shoulder. This continued and was described on July 2nd as of a throbbing character, most felt now between 9th and 10th ribs in axillary line, with dull aching behind the shoulder and beneath the margin of the ribs ; he is unable After the setting in of the dysenteric to lie on the right side. diarrhoea on 24th June he complained of griping pains about
umbilicus, and a burning pain at the anus but no tenesmus. Dyspnoea not complained of. Respirations 36 on 12th June (acute perihepatitis) and 9 per minute on July 10th (brain effusion?); the mean of 2 i tnorning respirations is 241 per minute. (Edema of left chest and face
disappeared
after
setting
in
of dysenteric diarrhoea on 24th June, but that of the ankles remained to the end. Emaciation increased, intercostal spaces quite hollow, belly retracted and hard as a board. Weakness much complained of at last.
Appetite remained capricious to the last. Tongue, cleaned after admission, became white and dry on setting in of perihepatitis, and buff furred after a fortnight, when the liver
was
probably
affected.
Bowels.?One thin motion every other day till 24th June, when three pints were passed in three motions, of thin feculence, of an ochrey hue clouded with venous blood. The stools
became more copious, wera passed with griping and tenderness about the umbilicus and burning pain at anus, and were generally mud coloured, often very foetid and mixed with venous blood in masses or streaks ; sometimes they were
nearly
pure venous blood, or of the appearance of beef brine ; fluidity and fostid odour increased, but the griping less subsequently, probably from obtuseness of the nervous system in approaching
dissolution.
soft, till the inflammation set in, when it hard, remaining so ten days ; it again rose to 100, from weakness, two days before death. Mean of 25 days 88'5, maximum 100, minimum 64 (on 12th July) beats Pulse about 90 and
Respirations
36 per minute
principally abdominal; contraction of intercostals very evident. (Edema slight of feet and front of chest. Wasting most marked in arms and legs. Tongue slightly white, furred, appetite capricious.
rose
to 100
and became
per minute.
Temperature ranged from 100?F.
in
morning
to 102?F. in
August 1,
NOTES ON PATHOLOGY.?BY. A. PORTEK, M.D.
1877.]
evening for the first* three weeks, rising once (on evening of 15th day) to 103?F. During the next,+ week from 99?F. to 101?F., feeing 99*F. to 100?F., and 99?F. to 101?F. every other day; it t-henj fell to 98? to 99?F., and kept to this till midday of 14th July, when it fell to 973F., he dying four hours afterwards. Sleeplessness rather marked from pain latterly. Skin hot and dry during perihepatitis ; no regular night eweat ever ; felt cold to touch for some days before death. Urine taken once every three days from l7th June, (date of serous inflammation), gives as a mean of nine examinations, 36'3 ozs. of sp. gr. 1013'6, acid, rather high coloured, healthy
two, contained indican on four, and albumen on three occasions, to the amount of nearly one-half by volume, on 26th and 28tli June and one-fourth on 1st July. On the following day it contained no albumen, and remained healthy afterwards. The autopsy discovered no tubercles in the brain or coverings, Both lungs were but serum exuded from its cut surface. firmly fixed to the walls of the chest, diaphragm, and pericardium by old adhesions, into the interstices of which was infiltrated a jelly like substance, and they were studded all on
the size of a shelled almond in over with hard tubercles from the apices, to that of No. 1 shot in the lower lobes. There was incipient ulceration of the mucous membrane of the and the bronchial
larynx, glands were large, stuffed with tubercles, and jelly-like substance. The peritoneum was
surrounded by a dark slate coloured, studded with white
masses
of size of No. 1 to
6hot, of apparently organized lymph, and could be removed, leaving the membrane intact. A little straw-coloured fluid was found in the cavity. The liver was enlarged, cut surface dark chocolate green, studded with grey tubercles as big as No. 2 shot, and with small abscesses the size of castor-oil seed, which contained ochrey viscid pus ; tubercles larger than No. 1 shot generally are found with yellow centres shewing incipient softening ; the left lobe was not enlarged, and its tubercles were small and grey. The spleen was nearly black and its corpuscles were distended with tubercles. The kidneys were pale yellow B.B.
and fatty. The jejunum contained one ulcer with raised edges and black base as big as a two-anna piece, and six solitary glands were distended with tubercle to the size of No. 1 shot, one of which showed ulceration in the centre with white ring surrounding. The ileum shewed similar distension and incipient
ulcerations of about half a dozen solitary glands. Peyer's patches generally were empty and nearly black ; one patch In near jejunum was stuffed with tubercle and ulcerated.
ascending colon were two circular ulcers with black base and edges: haemorrhage had taken place from hepatic and segmoid flexure. A few mesenteric glands enlarged from
raised
tubercular
deposit.
patient lived much longer than was expected, and disappearance of the more characteristic symptoms,
This
from the a
doubt
was
raised
whether the disease
was
not
chronic
dysentery, which hung about
pneumonia consequent patient as looseness of the bowels. on
the
Case No. 43.?Tuberculosis of Lungs, Spleen and Intestinal Glands.?Maya Brinjara, admitted 29th April 1871, complain-
of ague of five days' standing coming on daily at 10 A. m. The tongue is clean, bowels free, pulse 80, respirations 20. He is emaciated with oedema of feet and general debility. During his two imprisonment he has been under treatment
ing
year's
once, and that for *
6
a
few
days
100?-95F. 102? 100?
Mean Max. Min.
F.
F.
J
August
6 p.m. 101-19F. K'3? F. 100? F.
12
a.m.
Mean. 100?-3F. Max. 102? F. Min. 99?F.
in
only
6
a.m
98
