was much disease of the mesenteric glands, and the liver was considerably enlarged. The lungs were sound.

CASE LXXXII.—A lady, aged 24, had been in delicate health through the winter, 1823-4, being affected chiefly with cough and palpitation of the heart. In the end of April 1824, these symptoms ceased, and she began to complain of pain of the abdomen, which affected her chiefly in walking; it was sometimes a sharp stinging pain, and sometimes a dull uneasiness. She continued to go about, but her health was somewhat impaired. She had dyspeptic symptoms, occasional vomiting, irregular bowels, hysterical affections, and a long train of symptoms, which were often considered as in a great measure imaginary. On one occasion only she complained of so much pain in the abdomen that a bleeding was employed, and the pain was immediately removed. In this manner the complaint went on till about the middle of July, when she felt herself much better, and was preparing to go to the country. She was then suddenly seized with acute pain and tenderness over the whole abdomen, accompanied with vomiting, costiveness, and frequent pulse. This attack continued two days, and then subsided, having been relieved by topical bleeding and laxatives; and she returned to nearly her former state, except that she was more reduced in flesh and strength, and her pulse continued frequent. Her bowels were now easily kept open; but the stools were thin and very offensive; she was considerably emaciated, with a look of exhaustion, bad appetite, and a frequent pulse. The abdomen was natural to the feel, except at the lower part, where there was an irregular knotty hardness, with some tenderness. In this state I saw her for the first time, along with Dr. Thomson and

Mr. Newbigging, in the end of July. She was much exhausted, with a small frequent pulse, but without much suffering; the lower part of the abdomen was tumid and painful. On the following day the exhaustion suddenly increased, and she died at night.

Inspection. The first incision through the parietes of the abdomen gave vent to a large quantity of purulent matter of remarkable foetor, which was collected to the amount of several pounds. The lower part of the small intestines, the uterus, and the urinary bladder, were firmly agglutinated to each other, and to the parietes of the abdomen, except where they left irregular cavities, lined with a thick deposition of yellow flocculent matter, and containing a puriform fluid. In the upper part of the small intestines, there were also very extensive adhesions, but of a different character, being pale and membranous, and without any of the yellow flocculent matter, which was so abundant below. The peritoneal coat of the liver was covered by an extensive deposition of yellow flocculent matter, and there was a similar deposition on the lower surface of the diaphragm on the right side. The thoracic viscera were healthy.

CASE LXXXIII.-A child, aged 5 years, had been observed for some months to be rather out of health, but without any complaint that could be discovered, except that the abdomen had become somewhat tumid. The appetite was pretty good, and the bowels were regular. No other symptom was remarked, until about a week before his death, when the bowels became obstructed with some vomiting, and great enlargement of the abdomen. I saw him, along with Dr. Begbie, a few days after the occurrence of these symptoms; the bowels did not yield to any remedies that were employed; the belly became more and

more tumid; and he died about the end of a week from the commencement of this attack.

Inspection.-There were extensive adhesions of the bowels to each other, some of which seemed of old date, and others more recent. There was extensive disease of the mesenteric glands, and of the chain of glands by the side of the spine.

§ III.-CHRONIC PERITONITIS SUPERVENING UPON

MEASLES.

CASE LXXXIV.-A boy, aged 5 years, (Sept. 1813) was much emaciated, with a dry wrinkled skin, and a small frequent pulse. He complained of constant pain in his bowels; the abdomen was a little enlarged, but soft; he had little appetite, and his bowels were irregular, being sometimes confined, and sometimes rather loose. About two months before I saw him, he had passed through measles in a very mild form; but a few days after the termination of the disease, he began to complain of pain in his belly, which had continued from that time with progressive loss of flesh and strength. Various remedies were employed without benefit. He became gradually more and more emaciated, with constant pain in the belly, and occasional diarrhoea; and died in the end of November. There had been no cough at any period of the disease.

Inspection. In attempting to open the abdomen in the usual manner, it was found impossible, owing to close and extensive adhesions of the intestines to the parietes in every direction. They were also found to adhere so extensively to each other, that it was impossible to distinguish one intestine from another; and the intestines adhered likewise to the stomach, to the liver, and the urinary blad

der. In the cavity of the peritoneum, there were found large quantities of coagulable lymph, in the form of a consistent transparent jelly. The mesenteric glands were much enlarged; and the liver was also somewhat enlarged, but healthy in its structure. The lungs were studded with numerous tubercles, but they were all in a solid state; and there was considerable effusion in the cavity of the pleura.

§ IV. CHRONIC PERITONITIS OF THE COLON SUPer

VENING UPON AN INJURY.

CASE LXXXV.-A man, aged 21, a carter, (July 1818) was emaciated to a great degree, with effusion in the abdomen, and anasarca of the legs; some difficulty of breathing; pulse small and frequent; bowels quite open, sometimes rather loose; complained of pain extending across the upper part of the abdomen; some time before, it had been chiefly referred to the right hypochondrium, and had been treated as an affection of the liver. In the beginning of the year, he had received a blow on the abdomen, by a piece of coal which fell upon him as he was unloading a cart, and from that time he had complained of uneasiness in the abdomen, but not so severe as to confine him from his work, until some weeks after, when he received another injury by being squeezed between his cart and a wall. After this, the pain in his bowels increased, and he had frequent attacks of nausea and some vomiting; but these symptoms ceased after a short time, and the complaint then went on in a gradual but obscure manner, till the time when I saw him. He died in the end of July.

Inspection. The liver was healthy. The arch of the

colon, and the descending colon, were covered by an extensive deposition of coagulable lymph, and had formed most intimate adhesions to the parietes of the abdomen, and to all the neighbouring parts. They formed a mass of disease, the parts of which could not be separated from each other, and in which were included the stomach and several turns of the small intestine. The coats of the colon were much thickened, especially on the left side, where they were in some places half an inch in thickness. The pancreas was hard, and contained several small abscesses. In the cavity of the peritoneum, there was copious effusion of a whey coloured fluid. The lungs were healthy.

§ V.-CHRONIC PERITONITIS COMPLICATED WITH

DISEASE OF THE OMENTUM.

CASE LXXXVI.-A gentleman, aged 54, of a full habit, and previously enjoying good health, about Christmas 1823, complained of nausea and loss of appetite. After a few days, he was seen by Dr. George Wood, who found his tongue white, his bowels irregular, and his pulse a little frequent. His nights were restless, and his general feelings extremely uncomfortable, but without any defined uneasiness, except some obscure and wandering pains extending along both sides of the abdomen, sometimes into the back, and sometimes along the sides of the thorax. He had continued in this state for about three weeks, when I saw him along with Dr. Wood in the middle of January 1824. His look was then anxious, but without much wasting; tongue white; pulse about 96; little appetite; a good deal of thirst. He complained of an undefined uneasiness across the epigastric region, and about the sides of the abdomen, which was increased by the ho