with a very opaque fatty epithelium. In the mid-region, towards the greater curvature, there was a marked mammillated aspect; this very nearly disappeared after dissecting the mucous membrane from the submucous, and spreading it out. It was probably caused by some irregular contraction. The liver was excessively fatty.

A female, aged 87, died with universal jaundice; the femur was fractured by a fall some days before death. The liver was somewhat granular on the surface, and the Glissonian sheaths appeared somewhat thickened. The ductus communis choledochus was obstructed at its lower part by a soft mass of biliary pigment matter; the gall-bladder was hence enormously distended. The kidneys were wasted and granular. The stomach was very large; the mucous membrane was quite pale, but not manifestly unhealthy to the eye. Under the microscope, it was seen to be gravely altered; there was very little trace of tubes to be discovered even on repeated examinations; here and there were some traces of them, but in by far the greater part of the tissue they had perished. Their place was occupied by a quantity of nuclear particles, granulous, and some oily matter, and occasionally fat vesicles. The formation of nuclear particles had extended quite into the corium of the mucous membrane.

A man, aged 37, died with general peritonitis, after the recto-vesical operation, undertaken in consequence of the urethra being obliterated by stricture. The stomach appeared natural to the eye. In the middle and the splenic regions, the epithelium of the tubes consisted of small, stunted, atrophied particles, appearing more like empty vesicles than anything else; it was not fatty. In the pyloric third, the epithelium was not atrophied; large granular round and oval cells were present in the exuding contents of the tubes, besides free nuclei and granulous matter.

A stout man, aged 52, in apparent health, died with extravasation of blood within the cranium, after a blow. The mucous lining of the stomach had a dead white appearance, and seemed to be irregularly mammillated, or as if its surface was every here and there somewhat elevated. The epithelium of the tube was much atrophied; it consisted of stunted cells, granular matter, and ill-developed nuclei. The tubes themselves were wasted in some degree; their deep ends were most affected, and lay imbedded in a stratum of granular matter, containing numerous nuclear particles, which infiltrated the areolar tissue. Acetic acid brought the intertubular nuclei more plainly into view.

I do not intend on this occasion to enter into any detailed examination of the causes and nature of the above changes; I can only state that I am not inclined to regard them as of inflammatory origin. They seem to us to belong much more nearly to the class of pure and simple degenerations, occurring as primary morbid phenomena, from the decay of vital power. Hyperæmia has not appeared to form any constant or necessary element of these textural changes. In the case of the nuclear formations, it is clear that there is intertubular exudation; but we have no evidence to show that it is the product of inflammatory action; I should rather consider that, owing to derangement of the natural assimilative power, the plasma, which should have formed healthy epithelium and other structures, was developed into these abnormal organizations. The morbid action seems to acknowledge a relation to cirrhosis of the liver, and to changes of the like kind. The newly formed fibroid tissue in cirrhosis is often loaded with nuclei, quite similar to those produced in the gastric masses. It is of course a matter of great difficulty to study satisfactorily the genesis of these morbid states; for, although there is strong ground for supposing that they exist in many of the multitudinous valetudinarians who are the commonest subjects of medical treatment; yet, as such individuals live on for years, and often die of some acute malady, there is seldom an opportunity of examining the organ affected while the change is in progress. To this subject I hope to devote much attention in future years, and shall be very thankful to any confrère who will furnish specimens and brief histories of the symptoms existing during life.

The practical results which the above investigation, as far as it has extended, supplies, are-1. That we may expect not unfrequently to meet with cases where the digestive power of the stomach is permanently weakened by the decay of more or less of its glandular structure. 2. That, in a still greater number of cases, the digestive power is weakened from an atrophy of the epithelium, which, it is conceivable, may, by judicious administration of light nourishing food, cod-liver oil, and gentle tonics, be reproduced in a more healthy state. 3. That we must be cautious

in leeching or blistering epigastria for the removal of gastritis, which may have no existence. The further our observation extends, the more do we become convinced that the most hopeless diseases with which we have to contend are those depending on essentially chronic degenerations of organs. Who would not rather have to deal with an acute pneumonia or pericarditis, than with a case of confirmed morbus Brightii? How often does our healing skill hang its head in hopeless foreboding when our diagnosis has revealed the existence of an organic lesion! This must of course often be; but how needful then does it become that we should be thoroughly aware of these degenerative tendencies, and exercise the utmost vigilance to anticipate and stay those destructive changes which we are unable to reverse.-Association Med. Journal, Oct. 7, 1853, p. 874.

46.-CASE OF SARCINA VENTRICULI OF MANY YEARS' DURATION, TREATED BY THE HYPOSULPHITE OF SODA.

By DR. R. NEALE, late Physician's Assistant University Colloge Hospital.

[The patient in this case, 9 years since, was first seized with vomiting, after having suffered from pains in the abdomen for some time previously. During the last three years, however, the vomiting has become much more frequent-three or four times a-week-the vomited matters being like "beer grounds," and intensely acid. The pain, however, has decreased.]

Examination of Fluid vomited Feb. 1, 1853.-Quantity about Oij. Thick, viscid, adherent as synovia, being with difficulty poured out of a wine-bottle. Aspect peculiar, the upper portions being "barm or yeast-like," the lower more resembling gruel. Reaction very acid. The microscope exhibited numerous sarcina with the yeast-plant, and sporules of the penicillum glaucum

On Feb. 23rd he commenced treatment. To save space, I may say, that he was ordered the diet of a patient suffering from diabetes mellitus, with the following medicine:

B. Ammon. sesquicarb. gr. iij ; inf. quassiæ 3j. Fs. haustus ter die sumendus.
B. Sulph. sublim. 3j.—3 ij. pro re natâ si alvus non soluta sit.

On Feb. 23rd, previous to commencing the above, a careful examination was made of the fluid ejected the previous day.

Chemical Characters, &c.-Not viscid; diffluent as water; opalescent; no yeast appearance. On being poured,

1. Into a glass, the upper part, after standing an hour, appears like pale milk and water; when held up to window, cannot discern bars through it. Smells acid, not unlike the well-known odour of brewing. Reaction intensely acid, effervescing with carb. soda.

(a) A portion being boiled in a test-tube, becomes slightly clearer, due to fat rising and forming a ring on the surface, and a slight (albuminous) deposit falls. (b) Nitric acid, added cold, no change; hot, the fluid becomes slightly yellow (carbazotic acid); clears more than in (a).

(c) Muriatic acid: cold, no change; hot, as in (b), excepting the yellow colour is not produced.

(d) Acetic acid: cold, no change; hot, as in (c).

(e) Liquor potassæ: when boiled with one third vol. of liq. pot., the usual indica tions of the presence of sugar. The man had not been forbidden that article of diet previous to the examination.

2. The sediment of the fluid, after standing an hour, occupies about 1-20th of the glass, and is quite white.

Microscopical Examination.—1-4 object glass, No. 2 eye-piece, equal to 500-600

diam.

1. Supernatant liquid: drops taken from the surface and several inches below contain only oil-globules and sporules of fungi in great abundance, with a few epithelial scales; no sarcinæ..

2. Sediment: made up of immense multitudes of epithelial scales, sarcina, sporules of penicillum glaucum (?), with a few pieces of muscular fibre here and there; besides which last objects, were others of the same reddish colour, unstriated,

irregular in shape, and apparently made up of an innumerable multitude of minute specks not larger than pins' points when magnified with this high power. At first they were believed to be portions of muscular fibre partially decomposed; but further examination negatived this view. There appeared to be transition forms between these masses and the true sarcina. Have they anything to do with the reproduction of the latter? No torulæ seen in field. Size of sarcinæ, 1-666—1-500 inch diam.

March 2. Much the same; if anything rather easier since taking the sulph. and ammonia.

A table, exhibiting at a glance his state up to the time of commencing the hyposulphite, and kept by himself, will, when compared with another, kept since that period, show the effects of the remedy more strikingly than making a daily report of the case. The first of these tables will be found at the end of the report of

March 23.

Urine about a pint, straw-coloured, very faintly acid; sp. gr. 1031; a white flocculent precipate of 1-12th its volume. Liquor potassæ gives, when boiled with it, a slight brown colour. The microscope shows only a very few crystals of uric acid, mixed with epithelial scales. Ejecta watery, less opalescent than last report; quantity about two quarts; intensely acid; sp. gr. 1016. When boiled with liquor potassæ, does not become so brown as does the urine.

Microscopical Characters.-Sarcinæ very abundant, larger than last report, and of various shapes, mixed with epithelial scales; also large, dark round masses, together with others less regular in shape, of the same general aspects, exactly resembling the compound crystals of uric acid and urate of ammonia, figured in Dr. Garrod's plate of the urinary deposits. The murexid test carefully applied, showed the presence of abundance of uric acid in the ejecta.

23rd.-To-day saw the patient, who says he feels better; the bowels are not so costive since taking the sulphur, and the motions are neither so black nor so hard. On the 17th he passed a very white motion, he says; he has not vomited for nearly a week, but has not yet commenced the hyposulphite, since I was anxious once more to examine carefully the ejecta before he did so, to determine, if possible, the nature of the singular masses noticed in last report. He has not taken the ammonia mixture for nearly a week. Yesterday (22nd) he vomited about a quart of wheylooking fluid, with a thin stratum of fat on the surface, and depositing a light-coloured sediment of one-fourth its volume. Reaction intensely acid, smells strongly of sulphur, due to medicine; sp. gr. 1020.

Microscopical Characters, 500-600 diameter.—A drop of the sediment contains numerous sarcina, but not so numerous as last report; also many of the "round balls" insoluble when boiled in hot water, varying in size from 1-1000 to 1-400 inch diameter. When held to the light, these "balls" glitter just like the ordinary crystals of uric acid. They have no resemblance to the balls composing sulph. sublim. which he is taking. When rubbed between two pieces of glass, they give a sensation of grittiness; unaffected by acetic acid, hot or cold. Nitric acid dissolves most of the largest balls; does not affect (apparently) many of the smaller ones.

A few drops of sediment, evaporated carefully after the addition of a drop of nitric acid, and afterwards exposed in the usual way to the vapour of ammonia, give the characteristic murexid tint. None of the irregular masses were noticed in the field. Urine acid, much more so than last report; amber-coloured, with a copious light pink deposit; sp. gr. 1035; quantity Oij.

B. Soda hyposulph. 3 iv.; infus. quassi 3 xij. Ft. mist. cujus capiat cochl. j. magn. ter die.

Diet as before.

April 2. To-day saw patient, who came six or seven miles, and appeared fatigued by the journey. He states, that he feels decidedly better since the change in medicine, and that his symptoms are altered in many respects; he certainly appears much improved in his general aspect. Still complains of costiveness and sickness, but says the ejecta are much altered to what they used formerly to be, and are not nearly so abundant.

Examination of Matters Vomited.-Thin, pale, slightly opaque, very acid, with a thin white scum on surface, and a slight white deposit on standing. Sp. gr. 1015. Boiled with liq. pot., becomes reddish-brown, showing a moderate amount of sugar

to be present. The "scum," under microscope with former power, exhibits numerous fungus sporules and many "round balls," but no sarcinæ. "The sediment" consisted of numerous epithelial scales, sporules, "large round balls," some irregular in shape. Here and there in the field were scattered deep blood-red balls, or cells, one two-thousandth to one one-thousandth inch diam.; in some cases aggregated in masses. Sarcinæ not nearly so numerous as formerly, and their crucial markings are far more distinct than ever they have yet appeared. The middle portion of the fluid contained merely fungus sporules. Urine Oiss. to Oij., acid, more so than formerly. Sp. gr. 1050. With liq. pot., gives plain indications of the presence of sugar. Under the microscope, exhibits only a few octohedral oxalates.

B. Soda hyposulph, 3 vj., inf. quass. 3 xij., 3 ss. ter die; diet as before. May 2. Better: not seen. Rep. mist. ut antea.

5th. Saw patient to-day, at his own home, he being too weak to visit me; states that, when he last came (April 2), the walk much fatigued him, and that he has since suffered from severe prostration. The sickness has greatly abated, and the vomited matters are greatly altered in appearance, not at all like the "yeast vomit." He discontinued the mixture a fortnight before the 2nd inst., but not the sulphur, which he continued to take as an aperient. He did not take any other medicine except a simple aperient powder.

B. Sulph. præcip. 3j. ad 3 iss. pro re natâ, et omit. sulph. sublim.

B. Ol. jecor. aselli 3j, ter die. Pergat in usu mist. ut antea.

14th. I received the following letter:

"Since taking the oil and the fresh kind of sulphur, together with the mixture, I have been a great deal better, and have nothing to send you (ejecta). My stomach and bowels have been very easy, and motions more regular."-Medical Times and Gazelle, June 18, 1853, p. 624.

47.-REMARKABLE CASE OF FOREIGN BODIES IN THE STOMACH AND DUODENUM.

By JOHN MARSHALL, ESQ., Assistant Surgeon to University College Hospital.

[The patient, Mrs. B—, æt. 41, was in December, 1842, a fortnight after the birth of her fifth child, affected with hæmatemesis, vomiting a wash-hand basinful of blood. The succeeding faintness and prostration were extreme, and her recovery was very slow. Mr. Marshall continues:]

In the autumn of 1845 I found her complaining of frequent sickness, with pain at the epigastrium, and in the left groin. On examining the abdomen, I discovered a hard tumour in the left iliac fossa, which moved freely across the abdomen, as she turned from side to side. The size and shape of this tumour were very like an ordinary placenta, one edge much thicker than the other; the thickest edge much harder, and imparting to the fingers the feeling of its being very heavy. She stated that she had felt this substance for some months, and whenever she turned in bed it always moved, and caused nausea, but gave her no pain when she was quiet, nor was it tender to the touch. She suffered much from flatulence, and pain between the shoulders shooting through to the left breast. The catamenia had not appeared for three months, and she believed she was pregnant. The bowels were torpid, and she was obliged frequently to take her usual aperient of blue pill and colocynth. The nausea increased, and the stomach rejected everything; large quantities of a green ropy mucus, occasionally with blood, were thrown up, all of which was carefully examined, without detecting anything which would throw light on the case. Numerous remedies were employed to allay her distressing sickness, but were all equally unavailing, and the emaciation and exhaustion became so great, that her death was daily expected. One teaspoonful of pale brandy was now given every hour, and not an atom or drop of anything beside. From this time the vomiting ceased. After continuing this for two days, a little food was allowed, and she gradually gained strength and flesh, and in four months was able to walk two miles, and looked almost as well as usual.

During this illness, Dr. Cowan, of Reading, visited my patient; he was greatly interested in her case, and expressed himself to be as much puzzled as I was re

specting the nature of the tumour, which he compared to a cannon ball rolling across the abdomen.

Nearly five years elapsed before any serious symptoms returned. The pain between the shoulders was often complained of, and there was occasional sickness. Much difficulty was experienced in keeping the bowels in order; the secretions were generally healthy in colour, and formed. Occasionally the face and limbs became oedematous, but an aperient pill, with a little gin in gruel taken at bedtime, would always remove these symptoms in two or three days. The catamenia never returned after the illness of 1845.

On the 8th of October, 1850, I again saw her in consultation with Mr. Corsellis, of B. From him I learned that she had been ill three weeks, that all her old symptoms had returned. Incessant vomiting, with pain between the shoulders, had reduced her to a state of great weakness and emaciation. A few hours after my visit, severe spasmodic pain came on in the bowels, and quickly terminated her sufferings.

Post-mortem.-Eighteen hours after death, with the assistance of Mr. Corsellis, I examined the body. The thoracic viscera were healthy, and free from adhesions. On opening the abdomen the stomach was found drawn down to the pubes, and in its form resembled a champagne bottle. The pyloric end lay beneath the arch of the pubes, and the duodenum under a portion of the sigmoid flexure of the colon, from which it was traced to the pancreas, which was drawn down considerably out of its norinal position. The liver was large, and paler than natural. The gall-bladder distended with bile. The spleen and pancreas were healthy, but small. The kidneys rather hypertrophied. The bladder small. The uterus and ovaria healthy. The intestines were of very small calibre. The cæcum and colon resembled the small intestines, the bands and sacciolated appearance being scarcely discernible. The jejunum and ileum containing a little ropy mucus, and there was some fæcal matter in the rectum. No ulceration was apparent throughout the whole length of the intestinal canal, nor was there found the slightest peritoneal attachment or appearance of inflammation within the cavity of the abdomen.

Having tied the oesophageal end of the stomach and the duodenum, I removed these organs. The stomach contained about a pint of semi-fluid matter, and felt very like the crop of a fowl; the duodenum resembled a large sausage stuffed with lead. On cutting into the stomach I found it partially filled with some gruel-like fluid, and in the lower half-which evidently constituted the tumour during life-an immense number of pins, of a purple black colour, not corroded, varied in size, all bent or broken, many very pointed. The pyloric half of the stomach presented a remarkably thickened condition of the villous coat, being highly vascular, and raised in rugous elevations like the stomach of an ox. The muscular coat also was greatly hypertrophied. The weight of the pins contained in the stomach was nine ounces. An incision made into the duodenum displayed a mass of pins very lightly packed, of various shapes, similar to those found in the stomach, and wholly obstructing the tube. These weighed a pound, as nearly as I could ascertain without removing them.

Her husband could scarcely believe the truth of what he saw, when we showed him the contents of the stomach, for he affirmed that he had never seen his wife put pins into her mouth. A son, 17 years of age, said that he had often observed his mother biting pins, and believed that she swallowed them. She took them out of her thimble with her tongue, having previously bent the head and point together. When his mother corrected him for any bad habit, he would say-Why do you eat pins? This reply always silenced her. He stated that the servants when shaking the carpets frequently remarked on the number of bent pins they found.

Mrs. B——— had a keen appetite, and would always partake of any food she fancied, however improper or indigestible. I have known her eat cold boiled pork when unable to raise herself in bed, having four days previously vomited a large quantity of blood. Of her early history I can learn but little. A sister informs me that, when a child, she was fond of eating starch and slate pencil-and she remembers her biting pins. When seventeen years of age she vomited blood, and remained for some months an invalid, until sent for change of air to Bath.-Med. Chirurgicol Transactions, 1852, p. 65.