THE NEW ZEALAND GAZETTE. 253

in normal state; but the portion of the
peritoneum in connexion with the stomach
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-coloured muddy
fluid, probably altered bloody oozings from the
small secretory vessels of the organ itself. In
the preceding cases both the convolutions or
ruge, and the villosity of the mucous mem-
brane, were almost flattened down to compara-
tively a smooth surface; but in this case the
reverse obtained, both ruge and fibrillæ being
more than ordinarily conspicuous, and through-
out not only of a deep dusky red colour, 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 dis-
solution 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 disorganization
when death occurred.

The duodenum also
was considerably inflamed, greatly less, how-
ever, than the stomach, and gradually so
lessened downwards to the caput cæcum coli.
The jejunum, it may be remarked, 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, except
ing 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-coloured
unbroken inflammation, excepting both tonsils,
which were considerably furrowed by ulcera-
tion. Not a particle of the membrane which
popularly characterizes 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 infiltrated considerably
by dark incoagulated 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 deodorizing 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-coloured speck less in size than an
ordinary split pea. On re-examing 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 mem-
brane 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 de-
viation from the normal 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 pro-
gressed 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 refer-
ence 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 pharyn-
geal 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 abeyance. This was made manifest on the
morning of the 14th by vomiting up at
successive times small quantities of a coffee
ground looking fluid, which at first gave
uneasiness to the attendants, they supposing
that these ejectments were the strong beef tea
which, to save disturbing the stomach, for
some previous days had been exhibited in the
form of enema. Her bowels were at no time
confined, but about two hours before death she
passed a copious slaty-coloured stool, and
about the same time there issued a considerable
bleeding from the nose.

P. WILSON,

Colonial Surgeon, Taranaki.