49th. Abdomen has become swollen, tense, and tympanitic; no stool;
tongue the same; vomits every thing; a large black eschar on sacrum;
much discharge from the ulcer in the groin; cough frequent; pulse 120,
feeble; extreme prostration. Died in the evening.
_Abdomen._ Lower portion of ilium and commencement of cæcum contained
several ulcers, some of which were of large size; [peritoneal cavity
contained two pints of serum, mixed with pus and flakes of lymph;
intestines, liver, and abdominal parietes lined throughout with a coat
of lymph, easily removeable with the scalpel; intestines adherent to
each other and to the parietes of the abdomen.] _Head._ Arachnoid opake
and of milky colour; pia mater highly vascular; much effusion beneath it
and the arachnoid; several drachms of serum in the ventricles, and a
large quantity at the base of the skull; substance of the brain highly
vascular and much softened. _Thorax._ [In each cavity of pleura about
six ounces of fluid; posterior part of lungs condensed; a few recent
adhesions between the pleuræ of the right side;] other viscera healthy.
CASE LXXXV.
MARY BAKER, æt, 23, servant. Admitted on the 22d day of fever, which, in
addition to the ordinary symptoms, came on with nausea, anorexia and
purging; at present complains of a sense of heat in the abdomen without
pain; but there is uneasiness when firmly pressed; tongue white in
middle, red at edges, moist; thirst; bowels stated to be regular; pulse
104; no pain of chest or head.
23d. Abdominal symptoms the same; no sleep; some pain of head; pulse
120, weak; much sense of weakness.
24th. Tongue has become dry; three stools; pain of head gone; some
vertigo; delirium; expression of countenance anxious and sunk; pulse
120.
25th. Tongue more moist; three stools; slept better; expression of
countenance more natural; but the pulse has risen to 130 and is
extremely weak.
26th. More pain of abdomen on pressure; more prostration; delirium
continues; pulse 130, extremely weak. Died next day.
_Abdomen._ Peritoneal coat of small intestines highly vascular; mucous
membrane of lower part of ilium and cæcum full of ulcers, some of which
had penetrated through the muscular to the peritoneal coat; this latter
membrane was very dark and approaching to gangrene; peritoneal cavity
contained a considerable quantity of bloody serum; omentum dark and
inflamed; cardiac extremity of the stomach vascular; other viscera
healthy. _Head._ Dura mater adherent with more firmness than natural to
the skull; other membranes healthy; more fluid than natural in the
ventricles; substance of brain and cerebellum vascular. _Thorax._ Mucous
membrane of both bronchi highly inflamed; [left thoracic cavity
obliterated by old adhesions; left lung completely hepatized; right lung
loaded with blood and serum; right cavity contained a considerable
quantity of blood and serum; heart flaccid; both auricular valves very
dark.]
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