CASE OF OBSCURE DISEASE OF THE ABDOMINAL VISCERA.

715 action on the skin is thereby produced, doomed to die. Her disease gradually gave which gives a ready passage to the galvanic way, and, after some months had elapsed, influence. I would then bring the armed she appeared in a great measure to have ends of the wires (the other ends being recovered from its effects. She was, howher friends state, much altered in applunged into the cells of the trough, at such distance apart as to produce the desired in- pearance, and although she complained but tensity of action) in contact with the plates, little, there was a languor about her, which and maintain as strong an application, for gave alarm to her anxious mother, and eight or ten minutes, as the patient could caused her to think that all was not right. bear without complainina. Sometimes the Thus far the history of this case rests on positive, and sometimes the negative, wire the authority of the patient’s mother and will produce the most pungent sensation. friends. In July lastI first saw her, ten months after I would occasionally reverse them, so that the strongest sensation should be felt at the the commencement of the above-mentioned pit of the stomach, or in whatever part the illness. She then complained of headach, of pain might be most severe. If the pain and stiffness of the eyes, and of a peculiarly unspasm should extend over the whole region pleasant sound in the heart, which, she of the abdomen, I would occasionally let said, she always perceived while speaking. one plate remain on the pit of the stomach, She had a dull, languid look, and walked i and shift the other to various parts ofthe with a heavy, sluggish step. I, therefore, abdomen, where the pain might be severest; prescribed tonics, and told her relations, or, perhaps, a large plate fitted to the whole that as her strength increased, I had reason region of the stomach and bowels (lined to hope, that the unpleasant symptoms with cloth or sponge, and well moistened as which she had described would vanish. She, before directed) might answer the best however, remained nearly in the same state purpose. In the meantime, the internal ad- until the month of October, when she had ministration of spts. ammonia* asth. sulph., a slight attack of fever, which lasted for a in doses of fifteen or. twenty drops of the few days. Soon after recovering from this, former, and a teaspoonful of the latter, she became much emaciated, and as there every half hour, might be a useful auxiliary. appeared, at that time, to be a good deal of This, however, to be left to the judgment ofobscurity about her complaint, I thought it the attending phvsician. right to take her to London, in order to I feel very desirous that a fair experi- have the benefit of Dr. Blundell’s advice. ment should be made with the galvanic After a very careful inquirv into the nature battery, in a decided and well-marked case of her case, the Doctor said, that he did not of cholera; and you will confer a singular think there was any structural disease favour on me (and perhaps on some patient) within the cranium; that it was very difficult by having such an experiment instituted, to tell upon what the complaint depended, and letting me hear the result as soon as, but that he thought it was caused either by convenient. functional derangement of some of the abdominal viscera, or by disease of the mesenFrankfort, August 15th, 18SS. teric glands. He prescribed tonics and al. teratives, which were taken, for some time, without any benefit. On the contrary, her CASE OF OBSCURE DISEASE OF THE headach became daily more severe, and the ABDOMINAL VISCERA. emaciation went on with amazing celerity, until the girl became, in truth, a living By JOHN BROWN, Esq., C. M., Assistant- skeleton. poor About the month of December, Surgeon, Royal Navy. she said she felt a weight in her legs, which rendered it difficult for her to walk but she G. R., a young lady, aged eighteen was not confined to her bed until two days years, was, her mother says, about sixteen before her death. In the night of the 4th months ago, suddenly seized with headach, ult., I was suddenly called on to visit her. vomiting, and a pain in the belly, which I went immediately, and found her in a gradually increased in severity, until the dying state. Her pulse was low and fremuscles of the abdomen were contracted quent ; her breathing laborious and difficult. into bard knots. In this state, although she There was a rattling noise in her throat, and had the assistance of verv able medical her voice was weak and unnatural. Next Her day she seemed to be a little better. She men, she continued for several days. sutierings, according to her mother’s ac- breathed with less difficulty, and spoke witha count, were dreadful to behold, and her life stronger voice; still it was evident that dis. was despaired of by all who saw her ; yet, solution was fast approaching, and on the notwithstanding the fears of her friends, morning of the following day, when her and the gloomy predictions of her physi- friends thought her somewhat better, she cians, this younglady was not, at that time, suddenly expired without a struggle.

ever,

716 Sectio Cadateris. there did not exist one symptom which Head.-The cranium and its contents ’ could point to the true seat of the complaint;

on opening the abdomen, such a mass perfectly healthy yet, of disease, in and around the duodenum and

found to be in a state. Thorax.—Viscera sound. Abdomen.The omentum was discoloured, with matter in some parts of it. The were

stomach, presented earthv pyloric to excite my stomach to the view as could notmefailwonder how, towards the surprise, and to make orifice of the

was

sound at its upper part, but life, such a state of things could orifice it was much thickened. The without being made manifest by unduodenum was diseased throughout its whole equivocal symptoms. But so it sometimes length ; its coats greatly thickened and dis- is in chronic affections of internal organs; coloured, but nothing like scirrhoushardI may say, they are too often surness was perceived, either in it or about rounded by an obscurity, which the keenest the pyloric orifice of the stomach. The rest cannot penetrate. Hence, men of the of the intestinal canal appeared to be frehealthy. That part of the peritoneum greatest talent and experience can which covers the duodenum and pyloric ori.quently do little more than offer doubtful fice of the stomach, was so much altered in conjectures respecting the proximate causes of such complaints; and when, as in the structure, that it was with difficulty the case, dissection exposes to the light present was inwere dissected. The spleen parts that which before was hidden in darkness, volved in a mass of diseased peritoneum, from which it was not easy to remove it. they can only express their astonishment, and acknowledge that the works of nature The pancreas was softer than natural ; the in truth, wondrous, and her ways past are, liver was dark-coloured, but in other reout. finding The was much spects healthy. gall-bladder With regard to the nature of the disease distended, and appeared to be morbidly transparent. The glands of the mesentery, of which I am now treating, it is not easy, the kidneys, and the viscera of the pelvis, I must say, to form anythinglike a satiswere in a sound state. , factory opinion. The alteration in the structure of the parts was so great, that one Remarks. can hardly believe it could have taken place Here then was found sufficient to account without having been attended by some for the girl’s illness and death; but it is symptoms, which would have led at least certainly very extraordinary, that during to a suspicion of its existence. But such the whole of the time I attended on her, until certainly was not the case, which renders within two days of her death, she never it very difficult to account for the manner in spoke either of her stomach or bowels. All she which the change in the structure of the duocomplained of was her head. In it the pain denum and surrounding’ parts was brought was constant and distressing ; and I must about; I shall, therefore, on this point, merely acknowledge, that I was not a little sur- say, that as the girl was obviously of astrumprised when I heard Dr. Blundell say, that ous habit, I think it probable that the severe he did not think there was any organic dis- attack which preceded her long illness, sease within the cranium. excited, while it lasted, scrofulous disease In chronic complaints of the head, ex- of the duodenum, which afterwards, without much pain in the part, went on perience has taught me to look more to the withcausing slow but sure steps, until it brought the of than to the painful its unfortunate victim to the constancy severity grave. feelings of the patient, as a mark or sign of structural disease of the brain. In this the little need be treatment Respecting young lady’s case, these feelings or symp- said. Looking at the case as Dr. Blundell toms were certainly both very constant aud did, I do not see what other plan could very severe; yet, on removing’ the skull- have been adopted. Had the complaint cap, and carefully examining the cerebrum, been caused either by functional derangecerebellum, aud medulla oblongata, not a ment of the viscera of the abdomen, or by vestige of disease could be perceived in any disease of the mesenteric glands, tonics and of those parts. On the other hand, chronic alteratives are the only medicines from affections of the stomach and duodenum which any benefit could have been expected. are in general easily discovered by the wellThey were tried in vain. The nature of the known symptoms of dyspepsia which at- disease was not understood, and I sliall only tend them; and when such complaints that had we been able to discover it, caused by structural disease, these symp-I i should, at the first, have pronouncedtbe toms are, for the most part, obstinate and case to be utterly hopeless. In the case now under considera- = severe. Woolwich. tion, however, with the exception of the B 8, Samuel-street, 1833. Feb.32nd, emaciation, which might have been caused by enlargement of the mesenteric was

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