76

and the entire length of the large intestines
were also in normal state; but the portion of
the peritoneum in connection with the stom-
ach and small intestines was considerably
inflamed. The stomach in situ was flaccid,
and when slit open was found to contain some
flatus, and a little over an ounce of a dark-
colored muddy fluid, probably altered bloody
oozings from the small secretory vessels of
the organ itself. In the preceding cases both
the convolutions or rugæ, and the villosity of
the mucous membrane, were almost flattened
down to comparatively a smooth surface; but
in this case the reverse obtained, both rugæ
and fibrillæ being more than ordinarily con-
spicuous, and throughout not only of a deep
dusky red color, but numerously studded
with pin head sized drops of recently exuded
blood over its entire surface. It is to be
remarked, too, that this membrane was very
considerably thickened compared with the
usual natural state, and that both it and
muscular tissue had lost their normal
coherence; and though this was not so
advanced to dissolution as in the case of Nos.
1 and 2, yet, generally, they could be detached
from one another so readily as to evince that
the former had been in progress to similar
disorganisation when death occurred. The
duodenum also was considerably inflamed,
greatly less, however, than the stomach, and
gradually so lessened downwards to the caput
cæcum coli. The jejunum, it may be re-
marked, though without reference to the
disease, was profusely lined by a viscous
bilious tinged mucous, which seemed to have
formed the nidus of worms, as six of the
lumbricoid species were found imbedded in
it, varying in length from eight to twelve
inches; and it may be further noted that the
patient, two days before death, vomited three
more of the same. All, excepting one, were
dead, and that one showed no sign of active
vitality, thus demonstrating that, whatever
the nature of the morbific matter was, it was
alike fatal to them as to humanity. The
œsophagus, excepting an inch or more of its
pharyngeal extremity, which was inflamed,
exhibited a fully healthful aspect. But the
pharynx was one entire mass of dark-colored
unbroken inflammation, excepting both ton-
sils, which were considerably furrowed by
ulceration. Not a particle of the membrane
which popularly characterises the disease
remained; but the mother reported that on
the night before death, when in the act of
vomiting, large portions of that deposit came
away. The tongue, excepting a small bit at
the back part covered with a dark fur, was
in nearly the normal state. The cellular
tissue all over the front of the neck was infil-
trated considerably by dark incongulated
blood. In conclusion, I may notice that,
while in the latter stages of the case the
odour was so offensive that no attendant
could continue long in the apartment, during
the autopsy no one was sensible of a more
than ordinary disagreeable smell, so that no
deodorising means were resorted to or found
necessary.

As, of the preceding cases, No. 1 was under
my care, though not under altogether the
treatment I now recommend, I think it is
well to append a short history of her case.

On Thursday, 4th July, aged 4 years,
complained of a soreness of throat, which, on
being examined on the following morning, it
was observed that on the right tonsil there
was a cream-colored speck less in size than
an ordinary split pea. On re-examining the
throat two hours afterwards, the speck was
noticed to have increased in size, and that
now there was a film of the same substance
on the membrane behind the velum. About
an hour and a-half after this the other side
of the posterior pharynx exhibited slight
patches of the same lymphy deposit. At
these examinations the pharynx generally
exhibited no obvious deviation from the nor-
mal healthy state, whether as referring to
tumefaction or inflammation; nor, indeed,
was there any appreciable general febrile
action. But some days previous, it was
remembered afterwards, she demonstrated so
far premonitory symptoms as to be less lively
and active than was her wont. From the
5th up to the close of the 10th the disease
progressed so slowly, in so far as the throat
affection, as apparently to be kept in check
by the means employed, though occasionally
she complained to her nurses of a feeling of
pain in the gastric region as well as throat.
Early on the morning of the 11th she began
to evince great restlessness, but without
marked reference of pain to any particular
part, though every now and again she desired
the region of the stomach and legs to be
gently hand-rubbed. This morning was the
last time from the commencement that the
caustic solution was applied to the pharynx,
when a considerable portion of very tough
matter covered the sponge. Henceforward
no lymphy deposit was to be observed on any
part of the pharyngeal apparatus, still it was
manifest that, though there was no such
formation, and no particular heat of skin, or
even dryness thereof, or that the pulse ever
beat higher than a hundred and eight, and
rarely so high, the disease though somewhat
obscure was neither overcome nor in abey-
ance. This was made manifest on the morn-