awoke in great distress, with cough and oppressed breathing. When I saw her about 11 o'clock, her face was cadaverous; her breathing frightfully oppressed, with a rattling sound. The pulse was very frequent, and there was in the room an intolerable fœtor. My first impression was, that the parotid swelling had burst into the larynx; but upon opening it, healthy pus was discharged, while small quantities of frothy fluid, which she coughed up, were intolerably fetid. She died about twelve.

Inspection.-Betwixt the diaphragm and the upper surface of the liver, there was formed a distinctly defined cavity, lined by a cyst of coagulable lymph, and containing at least a pound of thin puriform matter of intolerable fœtor. The right lung adhered extensively to the diaphragm; and the diaphragm was perforated by a small opening, by which the matter from the abscess had passed freely into the bronchial canals, and it was traced as far as the trunk of the trachea. The liver was sound in its internal structure, but on its peritoneal coat there were some marks of inflammation. The intestines adhered to each other, through almost their whole extent, to the omentum, and to the parietes of the abdomen; so that no portion of intestine could be traced without tearing these adhesions, which were soft. Throughout this mass of disease, there were in several places cavities of various sizes, containing purulent matter; one of these on the right side seemed to communicate by a small canal with the great abscess above the liver. In the posterior part of the pelvis, behind the uterus, another great abscess was discovered, containing nearly a pound of thin fetid pus. It was formed by adhesions betwixt the intestine, the uterus, and the ovaria, so that it was completely cut off from the other parts, and remained entire, after the examination of them had been concluded.

That in this case the bowels should have continued to discharge their functions in the most healthy manner for a

fortnight, is perhaps one of the most striking facts that can be presented in regard to the pathology of the intestinal canal; and can only, I think, be accounted for by the supposition, that this remarkable extent of disease was entirely confined to the peritoneal coat.

CASE LXIII-A woman, aged 40, after exposure to cold in the beginning of November 1813, was affected with pain in the left side of the abdomen, at first remitting, but afterwards more constant, though without confining her to bed. This had continued for nearly a month, when I saw her in the beginning of December with symptoms of more active peritonitis, from which she was relieved by repeated blood-letting, and the other usual means. The bowels were at first obstinate, but soon yielded to the usual remedies, and the immediate urgency of the symptoms was thus soon removed; but from this time she continued liable to transient attacks of pain in the belly, which were usually relieved by purgatives and opiates.

After one of these attacks, more severe than usual, about the middle of January 1814, a hard swelling began to be observed on the left side of the abdomen, which gradually increased, with much pain and constitutional irritation, until the second week of February, when it broke and discharged a large quantity of very fetid pus. During this time her bowels were open, and the motions were natural. The discharge of matter now continued from the side, and several new openings were formed; but it gradually diminished, and all the openings were healed in the beginning of April. During the discharge she had been much emaciated and hectic, but she now began to improve; she was able to be out of bed in the end of April, and to walk out about the beginning of May. The attacks of pain in the abdomen still returned occasionally, but at longer intervals ;

and they were relieved as formerly by purgatives and opiates. On the 5th of May she was attacked by a violent paroxysm of pain, which did not yield to any of the remedies that were employed, and she died early in the morning of the 6th.

Inspection.-Almost universal adhesions of the intestines to each other, and to the parietes of the abdomen; some of these were recent and others of old date. At one place about the middle of the small intestine, its calibre was very much contracted, and at this spot the intestine was bound down by adhesions to the spine; above the contraction, the canal was dilated into a large sac. No trace remained of the abscess except the cicatrix in the integuments, which nearly corresponded in situation with the place where the intestine was so much contracted.

S V. PERITONITIS PASSING INTO ENTERITIS.

CASE LXIV.-A gentleman, aged 20, (3d September 1812) had pain and tenderness in the lower part of the abdomen; pulse from 84 to 90, and full; bowels natural. Was bled and took laxative medicine which operated fully. The bleeding was repeated on the 4th, and on the 5th and 6th, he was much better, complaining only of occasional griping, and his pulse was quite natural. Took laxative medicines which operated fully; the motions copious but rather watery and of a greenish colour. (7th.) Free from complaint in the morning, and the bowels open. In the afternoon, he complained that some laxative medicine had produced most unusual pain; and at night he had fixed pain in the upper part of the abdomen, with shivering followed by heat; pulse 84. Through the night had copious feculent evacuations, without relief of the pain, and repeat

ed vomiting. (8th.) Pulse 96; fixed pain in the abdomen, which was hard, tender, and tympanitic; repeated vomiting; the bowels obstructed; repeated blood-letting and all the other usual remedies were employed without relief. (9th.) Pain unabated; belly tympanitic; but less tender; vomiting abated; no stool except some very scanty discharges of watery matter; pulse from 100 to 126; hiccup. At night the pain abated; the bowels were moved, but sinking took place; and he died at nine in the morning of the 10th.

Inspection. All the intestines much distended and glued together by most extensive adhesions; omentum highly inflamed and adhering to the intestines. At the lower part of the small intestine, an extensive portion was gangrenous, and another at the lower part of the descending colon. The appendix vermiformis was gangrenous, and an opening had taken place in it through which liquid feces had escaped into the cavity of the abdomen.

CASE LXV.-A gentleman, aged 20, (10th December 1817) late at night, was found writhing and screaming from intense pain in the abdomen, every part of which was extremely tender to the touch; frequent vomiting; much dysuria; pulse 96 and soft. Had felt pain for several days, but it had increased on the evening of the 9th, with vomiting; took laxative medicine on the morning of the 10th, which operated freely three or four times; but after these evacuations the pain was much increased. He was largely bled; and on the 11th he was greatly relieved; pulse 90. The bleeding was repeated, and his bowels were moved by a mild enema. In the course of the day he had some paroxysms of pain, and vomited twice; but there was much less tenderness of the abdomen, except at one spot at the lower part of the right side, where it was still acute

ly tender; bowels open. Bleeding was repeated at night. (12th.) Pulse 90; no stool; less pain, but much tenderness; very little vomiting. Two small bleedings, no more being borne; large blister, &c. (13th.) Pulse very frequent; abdomen enlarged at the lower part and tender; no stool; urine scanty and passed with much pain. (14th.) Pulse 120; no stool; no urine; belly tympanitic; rapid exhaustion with much vomiting; died at night.

Inspection.-Extensive inflammation of the ileum; the inflamed parts were extensively glued together, and pressed down into the cavity of the pelvis, by the distention of the parts above, which were also inflamed but with less exudation. Bladder inflamed and collapsed; omentum inflamed; about a pound of puriform matter in the cavity of the peritoneum.

S VI-ENTERITIS.

CASE LXVI.—A young lady, aged 18, (4th March 1813) had pain and tenderness of the abdomen with vomiting; pulse 126. After repeated blood-letting, assisted by cold applications, tobacco injections, various laxatives, &c. continued through the 4th, 5th, and 6th, the inflammatory symptoms subsided; but the bowels continued very unmanageable, and were not moved in a satisfactory manner till the 12th. From the beginning of the attack she had complained of pain in the ear, which at first attracted little notice, but afterwards became more severe; and on the 22d she died of abscess of the cerebellum, as I have fully described in another place. From the 12th to

* Researches on the Pathology of the Brain, Case XLIII. (2d Edit.)