pious, liquid, and of a feculent appearance; there was much pain and some tenderness of the abdomen; pulse 120; skin hot; countenance febrile and anxious; tongue very loaded. A full bleeding was now employed with very great relief, but there was no encouragement for carrying it farther. It was followed by blistering, calomel and opium, opiate injections, &c. but on the following day the symptoms had returned, and from this time they resisted every remedy. The pulse continued from 120 to 130, and it soon became weak, with a parched tongue and typhoid aspect, so that it was necessary to give her wine and brandy. The vomiting recurred occasionally, but it was not urgent; the evacuations from the bowels were, on some days, rather frequent; on others, not above three or four in the day; and she sometimes passed a whole night without any disturbance; but, however she might be in this respect, her aspect never improved from a febrile and anxious expression, characteristic of much disease. There was occasional pain in the bowels, but not much tenderness after the first three days. On the fourth day of the disease, I saw one motion which was scanty and consisted of bloody mucus, but the evacuations were in general copious, thin, and of a feculent appearance. In the early period of the case, they presented nothing different from those of diarrhea; about the fifth and sixth days, they became extremely fetid, and, though of a feculent appearance when they were first discharged, they separated on standing, and deposited at the bottom of the vessel, a quantity of a thin puriform fluid of remarkable fœtor, and variegated with small round spots of blood; on the two last days of her life, they became of a dark brown colour, and of a more watery consistence, with less appearance of feculent matter. She had now the aspect of an advanced state of typhus, with a small frequent pulse and some delirium, and she

1

died on Tuesday the 15th, being the ninth day of the disease.

Inspection.-The small intestines were externally healthy, except a tinge of redness on the lower part of the ileum; the colon had a thickened appearance, with a tinge, on various places, of a dark red colour, which seemed deep seated as if shining through the peritoneal coat; about the sigmoid flexure and the upper part of the rectum, there was slight deposition of false membrane. The mucous membrane was healthy in the stomach, and in the upper part of the small intestine. In the ileum there began to appear spots of increased vascularity, which were at first at considerable distances from each other, but afterwards became more numerous; and, for about twenty-four inches at the lower end of the ileum, the whole mucous membrane was of a uniform deep red colour, without any remarkable change in its structure. In the caput coli, the same dark red state of the membrane continued; and it was here covered by numerous well defined ulcers, some of them the size of a sixpence. In the ascending colon, there was a more irregular state of disease, consisting of wandering undefined ulceration, variegated with dark fungoid elevations of portions of the mucous membrane. In the arch of the colon, the disease assumed a different character: for it there consisted of small well defined ulcers, the size of split peas or smaller; they were quite distinct from each other, and the mucous membrane betwixt them was of a pale colour and quite healthy. In the descending colon, the whole of the mucous membrane showed one continued surface of disease,-being of a dark brown colour, fungoid and spongy, without any defined ulceration. It is difficult to describe the appearance at this place; it might perhaps be compared to the surface of very coarse cloth of a loose fabric, and of a dull brown colour; and the mucous membrane,

along the part so affected, was uniformly and greatly thickend. Along this portion, also, all the coats of the intestine were considerably thickened, and in some places were almost of cartilaginous hardness. This state of disease extended from near the commencement of the descending colon to within two inches of the extremity of the rectum; here it ceased abruptly, and the small portion that remained showed only marks of recent inflammation or increased vascularity.

This very remarkable case shows nearly all the modifications of disease of the mucous membrane; and I confess I found it difficult to believe that it had been the result of a disorder of only nine days' duration. But the body was full in flesh, and showed no appearance of previous disease; and all that I could learn was, that, about four years before her death, the patient had an attack which was said to have been similar to that of which she died; and that she occasionally complained of some uneasiness in her bowels; but that, up to the day of the attack, she was apparently in perfect health, and able for a great deal of exercise. I likewise ascertained, that her bowels were habitually rather costive, requiring the frequent use of gentle laxatives.

SV. THE DISEASE IN THE COLON FATAL BY EXTEN

SIVE ULCERATION WITH PERITONITIS.

CASE XCI.-A girl, aged 8. I saw her for the first time on the 9th of January, 1826, and obtained but an imperfect account of the history of her complaints. She had been confined to bed about five days, and had repeated vomiting; but it had not been urgent, having occurred chiefly when medicine was given her. The bowels

COLON, FATAL BY ULCERATION WITH PERITONITIS. 253

had been loose, but not very troublesome; the motions had been sometimes mucous, but not remarkably morbid ; and some that I saw were quite healthy. The belly had been for some days tense and tympanitic, with much tenderness upon pressure, but no actual complaint of pain. When I saw her on the 9th, the pulse was frequent, the face pale, but full, as if from cedema, and there was some oedema of the legs; breathing oppressed and anxious; bowels moderately open, and the stools feculent and healthy; the abdomen was tumid, and at the upper part tympanitic; and there was some tenderness upon pressure. I saw her again on the 10th, and found that the bowels had been moderately moved, and the stools were feculent and healthy; there had been some vomiting, but not urgent; the pulse was weak, and her strength was sinking; and she died suddenly in the afternoon. On farther inquiry, I learned that she had been liable to cough for several months; but that no alarm had been taken, until about five weeks before her death, when some anasarca was observed in her legs. For this she had been under medical treatment, but her general health had been so little affected, that she had danced at a children's party on the 2d of January, two days before the commencement of the fatal attack.

Inspection.-The left lung was a mass of tubercular disease; the right was tolerably healthy. In the cavity of the abdomen, there was more than a pound of purulent matter with much flocculent deposition. The spleen was enlarged and entirely enveloped in a covering of false membrane; the liver was completely covered in the same manner. The whole tract of the small intestine was contracted and healthy. The colon, through its whole extent, was distended, and of a bright red colour; it was thickened in its coats, and its appendicula were very turgid and of a

bright red. This appearance was presented by the whole tract of the colon and the caput cæcum; and the mesocolon was also of a bright red colour, and much thickened. Internally, the colon presented nearly one continued surface of ulceration of the mucous membrane, which was most remarkable about the sigmoid flexure, in the ascending colon, in the left side of the arch, and in the caput cæcum. There was a little of it at the commencement of the ileum, but the rest of the small intestine was healthy.

§ VI. THE DISEASE CONFINED TO THE CAPUT COLI AND

PART OF THE ASCENDING COLON,THE PATIENT DYING OF AN AFFECTION OF THE BRAIN.

CASE XCII-A girl aged 6, was affected with severe and obstinate diarrhoea, which reduced her to great weakness and emaciation. It subsided after three or four weeks, and was succeeded, after a short interval, by severe pain in the belly, headach, and vomiting, the bowels being then rather bound; the pulse was from 30 to 40 in a minute; the urine was high-coloured, and diminished in quantity. The headach continued, with vomiting, and a constant spasmodic action of the right arm and leg; and after seven days, she sunk into coma, and died in two days. The pulse continued from 30 to 40, till a few days before death, when it rose to 70, and occasionally to 80. I did not see this case during the life of the patient, but was present at the examination of the body.

Inspection.-There was considerable effusion in the ventricles of the brain, with ramollissement of the septum and of the cerebral substance surrounding the ventricles. The inner surface of the caput coli, and of a great part of the ascending colon, was of a dark red colour, and covered