with numerous patches, also of a dark red colour and fungous appearance, which were considerably elevated above the level of the surrounding parts.

§ VII.-FUNGOUS ULCERATION OF THE CAPUT COLI AND

RECENT INFLAMMATION OF THE ILEUM, WITH A COATING OF FALSE MEMBRANE.

CASE XCIII-A seaman, for whose case I am indebted to the late Dr. Oudney, was affected with dysentery, accompanied with the usual symptoms. The stools were in general copious, and varied very much in appearance, being sometimes slimy, sometimes watery, and sometimes consisting of mucus mixed with green matters of various shades. There was fever with rapid emaciation; at first, he had acute pain, and afterwards a dull uneasiness over the lower part of the abdomen; and towards the conclusion, there was a sharp pain increased by pressure, confined to a small spot on the lower part of the abdomen, towards the right side. He died in about five weeks.

Inspection.-There were some superficial ulcerations of the mucous membrane towards the lower extremity of the colon; but the principal seat of the disease appeared to be the caput coli, in which there were numerous fungous projections ulcerated upon the surface. In the ileum four inches from its lower extremity, there was a portion in a state of recent inflammation and covered with false membrane. There were small abscesses in the liver, and the mesenteric glands were enlarged.

§ VIII. THE DISEASE IN THE ILEUM WITH DEPOSITION

OF FALSE MEMBRANE.

CASE XCIV.—A woman, aged about 30, in November 1827, was received into the clinical ward of the Royal Infirmary of Edinburgh, affected with symptoms of continued fever in a very mild form; and after five or six days she was considered as convalescent. She recovered strength so slowly, however, that she was allowed to remain in the hospital; and she went on for ten days without any symptom except weakness. She then seemed to relapse, complaining chiefly of headach and pain of the back. After this, she had sickness and a good deal of vomiting, and complained of pain, with some tenderness, referred to the region of the liver, which was relieved by topical bleeding. She still had sickness, with occasional vomiting; the pulse continued frequent and weak; her strength sunk rapidly; and she died in four days from the commencement of this relapse. There had been no diarrhoea; stools had been produced by enemata, and they were tolerably healthy.

Inspection. In the lower end of the ileum, a portion of the mucous membrane, eighteen inches in extent, was covered by a thin uniform film like the crust of aphthæ ; beneath it the membrane showed a high degree of redness. The peritoneum covering this portion of intestine showed some minute flakes of coagulable lymph for three or four inches. All the other parts were healthy.

For this important case I am indebted to Dr. Alison. The appearance described in it, and which also occurred in the ileum in the preceding case, is rather uncommon. differs entirely from the appearance of the disease as it oc

It

curred in the colon in the former cases, and which also will be found occurring in the ileum in the cases to be next described. In the present state of our knowledge, it is doubtful whether it is to be considered as a different stage of the disease, or as a state of the inflammation altogether distinct.

The deposition of false membrane on the surface of the mucous coat, however, is described by Dr. O'Brien* as a frequent appearance in the epidemic dysentery of Ireland. It occurred in his dissections both in the large and small intestines, but seems to have been most frequent and most remarkable in the colon and rectum. He describes it in some cases as occurring in patches; but in others, the mucous membrane was covered by a uniform layer of white lymph, which was in greatest quantity in the neighbourhood of the rectum; and it adhered to the surface of the membrane in rugged folds. Dr. Cheyne has mentioned the same appearance as occurring in the small intestine, in his able account of the Dysentery of Dublin of 1818.+

The appearances to be described as occurring in the Heum in the following cases, correspond with the appearances described in regard to the colon in cases LXXXVIII, and LXXXIX.

§ IX. THE DISEASE IN THE ILEUM FATAL IN THE

STATE OF RED ELEVATED PORTIONS WITH INCIPIENT ULCERATION.

CASE XCV.-A girl, aged 3 years, about three weeks before her death was attacked with vomiting, frequent calls

Trans. of King's and Queen's Colleges, vol. v.
Dublin Hospital Reports, vol. iii.

S

to stool, and pain in the abdomen; the evacuations were reported to have been frequent, slimy and fetid. After eight or ten days, when she was first seen by the late Dr. Oudney, she had frequent irregular febrile paroxysms; she had vomiting and frequent stools, which were of a clay colour, and the abdomen was tender upon pressure. Her tongue was white, and there was urgent thirst, especially during the febrile paroxysms. In this state she continued until a few days before her death, when she became oppressed and partially comatose, with frequent screaming and great unwillingness to be moved. The pulse varied from 130 to 150, and she had frequent stools which were now of a dull green colour, mixed with specks of yellow. The pupil was natural, and continued sensible to light, until a few hours before death, which happened on the 8th of February 1820.

-

Inspection. The ileum, from its termination in the colon to near the jejunum, was highly vascular, its minute vessels appearing as if injected. Its mucous membrane was covered with numerous irregular inflamed patches, which had a fungous appearance; they were considerably elevated above the level of the sound parts, and were covered with minute ulcerations. Some of these patches were the size of a shilling, others smaller; they were generally at the distance of an inch or two from each other, and the membrane in the intervals was healthy. The mesenteric glands were greatly enlarged and very vascular.

§ X.-THE DISEASE IN THE ILEUM FATAL BY GAN

GRENE.

CASE XCVI.-A woman, aged 25, was admitted into the Infirmary of Edinburgh, affected with pain over the

abdomen, tenesmus and diarrhoea. The pain intermitted occasionally, and was most severe on going to stool and on passing urine. The evacuations were free from scybalæ or blood. She had headach, thirst, some cough, nausea, occasional vomiting, and a pale emaciated look; pulse 72. She ascribed her complaints to cold, and they had been gradually increasing for three weeks. Various remedies were employed without benefit, consisting chiefly of opiates, absorbents and calomel. The disease went on for eight days more, and the following selection from the reports show a state of the functions of the bowels, which, when compared with the morbid appearance to be described, presents a case of very great importance.

(2d day) Two stools; severe tormina, which were relieved by fomentation.

(3d day) Nearly free from tormina; one stool; which seemed to consist of broth which she had recently taken, little changed.

(4th day) Two scanty evacuations without griping; abdomen hard and painful; vomited once; a mild enema produced a copious discharge and relieved the pain.

(5th day) Less pain; vomited several times; one stool thin and feculent; pulse 78; took six grains of calomel.

(6th day) Two stools; one of them thin and feculent, the other much tinged with blood; much pain before the evacuations; abdomen tense and painful; pulse 80; vomited a considerable quantity of slimy matter tinged with blood, and having some purulent matter mixed with it. She took gr. viii. of calomel.

(7th day) Two stools, thin, feculent, and of a natural appearance, but preceded by much pain; vomited repeatedly some greenish slimy matter, mixed with bloody pus;