,a ,,practical ,,guide ,,for ,,making ,,post-,,mortem ,,examinations1 ,,and ,,for ,,the ,,study ,,of ,,morbid ,,anatomy1 ,,with ,,directions ,,for ,,embalming ,,the ,,dead1 ,,and ,,for ,,the ,,preservation ,,of ,,specimens ,,of ,,morbid ,,anatomy4 ,,by ,a4 ,r4 ,,thomas1 ,m4 ,d4 ,professor of ,anatomy in the ,hahnemann ,medical ,college of ,philadelphia2 ,lecturer on ,artistic ,anatomy in the ,pennsylvania ,academy of ,fine ,arts1 and ,philadelphia ,school of ,design2 ,member of the ,american ,institute of ,homopathy2 ,general ,editor of ,american ,journal of ,homopathic ,materia ,medica1 ,etc41 ,etc4 ,,for ,,sale ,,by ,,boericke ,,tafel1 ,,new ,,york3 ,,philadelphia3 ,,no4 #ade ,,grand ,,street4 ,,no4 #fce ,,arch ,,street4 #ahgc4 ,entered according to ,act of ,congress1 in the year #ahgc1 by ,a4 ,r4 ,,thomas1 ,m4 ,d41 ,in the ,office of the ,librarian of ,congress at ,washington4 ,,james ,e4 ,,kryder1 ,,printer1 #cb ,,south ,,seventh ,,street1 ,,philadelphia4 ,,preface4 ,the following work has been prepared with a view of supplying a want1 the existence of which has long been felt by the author1 both in his private practice and public teaching4 ,no pretension is made of offering a complete work on ,morbid ,anatomy1 the object having been1 merely to present the practitioner and student with a practical guide for making post-mortem examinations1 to give them hints as to what they are to look for in such cases1 and1 finally1 to aid them in recognizing the various morbid appearances as they are exposed to view4 ,the work is divided into four parts4 ,parts ,i1 ,,ii and ,,iii1 corresponding to the three great divisions of the body--the ,head1 ,chest and ,abdomen4 ,part ,,iv1 is devoted to miscellaneous subjects1 and contains chapters on the ,bones2 ,joints2 ,tumors2 ,effects of ,poisons2 ,medico-,legal ,autopsies2 ,on ,embalming the ,dead2 and ,on the ,preservation of ,morbid ,specimen4 ,a few illustrative cases have been introduced1 and occasional reference made to morbid specimens in the ,museum of the ,hahnemann ,college4 ,the following works have been consulted in the preparation of the book1 and as few references have been made1 this general credit is felt to be due the several sources of information3 ,rokitansky's1 ,craigie's1 ,jones and ,sievecking's1 and ,green's ,pathological ,anatomy2 ,rindfleish's ,pathological ,histology2 ,paget's ,surgical ,histology2 ,raue's ,pathology2 ,murchison1 on the ,liver2 ,hope1 on the ,heart2 ,brinton1 on the ,stomach2 ,stewart1 on the ,kidney2 ,gross' ,surgery2 ,christison on ,poisons2 ,casper and ,taylor's ,medical ,jurisprudence4 ,acknowledgment should here be made of the valuable assistance rendered by ,drs4 ,w4 ,h4 ,bigler and ,john ,n4 ,mitchell1 in carrying the work through the press2 and of the kindness of ,mr4 ,j4 ,h4 ,gemrig1 in the loan of the electrotype plates which embellish the preliminary chapter4 ,conscious that the work is not without defects1 it is still presented to the profession1 with the hope that it may be found to answer the purpose for which it was designed4 ,a4 ,r4 ,,thomas1 #icg ,spruce ,street4 ,,march1 #ahgc4 ,,contents4 ,,page4 ,,preface1 #ae ,,introduction1 #ag ,,preliminary ,,chapter4 ,instruments and ,general ,directions1 #ba ,,part ,i4 ,,the ,,head ,,and ,,spine4 ,,chapter ,i4 ,,the ,,operation4 ,on the ,head and ,spine1 #bg ,,chapter ,,ii4 ,,pathological ,,conditions4 ,,section ,i4--,,of ,,the ,,skull1 #cd ,fracture2 ,caries2 ,thinning2 ,increased ,thickness1 #ce ,,section ,,ii4--,,the ,,membranes ,,of ,,the ,,brain4 #a4 ,the ,dura ,mater1 #cf ,inflammation2 ,thickening2 ,fibrinous ,clots1 #cg ,tubercular ,deposits2 ,tumors1 #ch #b4 ,arachnoid and ,pia ,mater4 ,pacchionian ,bodies2 ,inflammation2 ,serous ,effusions2 ,sanguineous ,effusions1 #ch ,,section ,,iii4--,,of ,,the ,,brain4 ,what to notice2 ,inflammation2 ,softening2 ,abscess2 ,hardening2 ,hypertrophy2 ,atrophy2 ,tumors of the ,brain2 ,adenoid ,tumors2 ,scrofulous ,tumors2 ,adipose ,tumors2 ,cholesteroma2 ,cartilaginous ,tumors2 ,calcareous ,deposits2 ,encysted ,tumors2 ,blood ,cysts2 ,cancer2 ,melanosis2 ,syphilitic ,tumors2 ,obstruction of ,arteries2 ,degeneration and ,calcification of ,arteries1 #dg ,,section ,,iv4--,,of ,,the ,,spinal ,,cord4 #a4 ,the ,membranes4 ,inflammation2 ,tubercular ,deposits2 ,serous ,effusion1 #fj #b4 ,spinal ,marrow4 ,inflammation2 ,softening2 ,hardening2 ,atrophy2 ,morbid ,growths1 #fb ,,part ,,ii4 ,,the ,,neck ,,and ,,chest4 ,,chapter ,i4 ,,operation ,,on ,,the ,,neck ,,and ,,chest4 ,,chapter ,,ii4 ,,pathological ,,conditions ,,of ,,the ,,organs4 ,,section ,i4--,,of ,,the ,,tongue4 ,cancer2 ,syphilitic ,ulcer2 ,tumors2 ,ranula2 ,hypertrophy1 #fh ,,section ,,ii4--,,of ,,the ,,larynx ,,and ,,trachea4 ,inflammation2 ,ulceration2 dema2 ,necrosis of ,cartilages2 ,abscess2 ,tumors2 ,false ,membranes1 #fi ,,section ,,iii4--,,of ,,the ,,pharynx ,,and ,,sophagus4 ,inflammation2 ,ulceration2 ,stricture2 ,dilatation2 ,tumors1 #gb ,,section ,,iv4--,,of ,,the ,,pericardium4 ,inflammation2 ,adhesions2 ,effusions2 ,morbid ,growths1 #gc ,,section ,v4--,,of ,,the ,,heart4 #a4 ,inflammatory ,affection4 ,pericarditis2 ,endocarditis1 #gf #b4 ,valvular ,affection4 ,thickening2 ,calcification2 ,atrophy1 #gg #c4 ,changes ,affecting ,size4 ,hypertrophy2 ,dilatation2 ,atrophy1 #gi #d4 ,morbid ,condition of the ,walls4 ,fatty ,degeneration1 #hb #e4 ,morbid ,growths4 ,tumors2 ,cancer2 ,melanosis2 ,hydatids2 ,ossification of ,coronary ,arteries2 ,abscess2 ,malformations2 ,aneurism2 ,rupture1 #hd #f4 ,displacements4 ,ectopia ,cordis2 ,transposition1 #hg #g4 ,contents of ,cavities4 ,heart ,clots1 #hh ,,section ,,vi4--,,the ,,aorta ,,and ,,arteries ,,generally4 ,inflammation2 ,fatty ,degeneration2 ,ossification2 ,aneurism2 ,rupture1 #ih ,,section ,,vii4--,,of ,,the ,,pleura4 ,inflammation2 ,plastic ,effusion2 ,adhesions2 ,serous ,effusion2 ,sero-,purulent ,effusions2 ,pneumothorax1 #ajc ,,section ,,viii4--,,of ,,the ,,lungs ,,and ,,bronchial ,,tubes4 ,pneumonia2 ,congestion2 ,red ,hepatization2 ,gray ,hepatization2 ,suppuration and ,abscess2 ,metastatic ,abscess2 ,gangrene2 ,pulmonary ,hmorrhage2 ,pulmonary ,apoplexy2 ,emphysema1 #ajf ,tubercular ,disease of the ,lungs1 #aag ,post-mortem ,appearances in1 #aah ,morbid ,growths4 ,cancer2 ,melanosis2 ,hydatids1 #abj ,the ,bronchial ,tubes4 ,bronchitis2 ,narrowing of2 ,dilatation of1 #abc ,the ,mediastinum4 ,inflammation2 ,abscess2 ,tumors1 #abf ,,part ,,iii4 ,,the ,,abdomen ,,and ,,pelvis4 ,,chapter ,i4 ,,the ,,operation1 #abg ,,chapter ,,ii4 ,,pathological ,,conditions ,,of ,,the ,,peritoneum ,,and ,,alimentary ,,tract4 ,,section ,i4--,,of ,,the ,,peritoneum4 ,congestion2 ,inflammation2 ,fibrinous ,exudations2 ,suppuration2 ,gangrene2 ,ascites2 ,morbid ,growths1 #acc ,,section ,,ii4--,,of ,,the ,,stomach4 ,post-mortem ,changes2 ,gastritis2 ,effects of ,poisons2 ,gastric ,ulcer2 ,hmorrhagic ,erosion2 ,softening2 ,cirrhosis2 ,atrophy2 ,dilatation2 ,morbid ,growths1 #acg ,,section ,,iii4--,,the ,,intestines4 ,malformations2 ,inflammation2 ,ulceration2 ,dilatation2 ,contraction2 ,displacements2 ,incarceration2 ,volvulus2 ,intussusception2 ,rupture2 ,ulcer and ,fissure of the ,anus2 ,fistul2 ,hmorrhoids2 ,morbid ,growths2 ,parasites1 #adi ,,section ,,iv4--,,the ,,pancreas4 ,anomalies2 ,hypertrophy and ,atrophy2 ,inflammation2 ,fatty ,degeneration2 ,dilatation of ,ducts2 ,cancer1 #afj ,,section ,v4--,,the ,,spleen4 ,congenital ,anomalies2 ,hypertrophy and ,atrophy2 ,displacements2 ,rupture2 ,inflammation2 ,thickening of ,capsule2 ,degeneration2 ,morbid ,growths1 #afb ,,section ,,vi4--,,of ,,the ,,liver4 ,normal state of2 ,congestion2 ,hmorrhagic ,effusion2 ,perihepatitis2 ,scar-like ,marks2 ,hepatitis2 ,secondary1 ,pymic or ,metastatic ,abscess2 ,degenerations of the ,liver2 ,waxy1 ,lardaceous or ,amyloid ,liver2 ,atrophy2 ,simple ,atrophy2 ,acute or ,yellow ,atrophy2 ,chronic ,atrophy2 ,cirrhosis1 or ,hob-nail ,liver2 ,hypertrophy2 ,morbid ,growths2 ,parasites1 #afe ,affections of the ,gall-,bladder and ,ducts4 ,inflammation2 ,dilatation2 ,morbid ,growths2 ,biliary ,calculi1 #ahi ,,chapter ,,ii4 ,,the ,,urinary ,,apparatus4 ,,section ,i4--,,the ,,kidneys4 ,congenital ,anomalies2 ,congestion2 ,hmorrhage2 ,nephritis2 ,pyelitis2 ,abscesses2 ,inflammation of ,capsule2 ,morbus ,brightii2 ,fatty ,degeneration2 ,dislocated ,kidney2 ,morbid ,growths2 ,parasites1 #aic ,the ,ureters4 ,dilatation2 ,inflammation2 ,morbid ,growths1 #bje ,the ,suprarenal ,capsules4 ,inflammation and ,degeneration2 ,hmorrhage2 ,morbid ,growths1 #bjg ,,section ,,ii4--,,the ,,urinary ,,bladder4 ,malformations2 ,dilatation2 ,hypertrophy2 ,contraction2 ,inflammation2 ,morbid ,growths2 ,parasites1 #bjh ,of the ,urethra4 ,malformations2 ,inflammation2 ,dilatation and ,contraction2 ,stricture2 ,rupture2 ,morbid ,growths2 ,urinary ,calculi1 #bab ,,chapter ,,iii4 ,,the ,,male ,,generative ,,organs4 ,,section ,i4--,,the ,,penis4 ,congenital ,anomalies2 ,hypertrophy and ,atrophy2 ,fracture2 ,paraphymosis2 ,balanitis2 ,herpes2 ,chancres2 ,morbid ,growths1 #bae ,,section ,,ii4--,,of ,,the ,,scrotum4 ,hypertrophy2 ,inflammatory dema2 ,morbid ,growths1 #bah ,,section ,,iii4--,,of ,,the ,,testicles4 ,congenital ,anomalies2 ,hypertrophy and ,atrophy2 ,inflammation2 ,hydrocele2 ,hmotocele2 ,varicocele2 ,morbid ,growths1 #bai ,,section ,,iv4--,,the ,,seminal ,,vesicles ,,and ,,prostate4 ,congenital ,anomalies2 ,inflammation2 ,tubercular ,deposits1 #bbf ,the ,prostate ,gland4 ,anomalies2 ,hypertrophy and ,atrophy2 ,inflammation2 ,abscess2 ,morbid ,growths1 #bbf ,,chapter ,,iv4 ,,the ,,female ,,generative ,,organs4 ,,section ,i4--,,the ,,pudenda ,,and ,,vagina4 #a4 ,the ,pudenda4 ,congenital ,anomalies2 ,hypertrophy2 ,inflammation2 ,morbid ,growths1 #bcj #b4 ,the ,vagina4 ,anomalies2 ,occlusion2 ,dilatation2 ,laceration and ,rupture2 ,inflammation2 ,morbid ,growths1 #bcj ,,section ,,ii4--,,the ,,uterus4 ,anomalies2 ,hypertrophy and ,atrophy2 ,hydrometra2 ,malpositions2 ,hmorrhages2 ,peri- or ,retro-,uterine ,hmotocele2 ,inflammation2 ,ulceration2 ,morbid ,growths1 #bce ,morbid ,conditions following ,parturition4 ,rupture2 ,puerperal ,inflammation1 #bda ,extra-,uterine ,pregnancy1 #bdd ,,section ,,iii4--,,the ,,ovaries ,,and ,,fallopian ,,tubes4 #a4 ,the ,ovaries4 ,malformations2 ,inflammation2 ,abscess2 ,morbid ,growths1 #bdg #b4 ,the ,fallopian ,tubes4 ,anomalies2 ,inflammation2 ,morbid ,growths1 #bea ,,section ,,iv4--,,the ,,mamm4 ,anomalies2 ,hypertrophy2 ,atrophy2 ,inflammation and ,abscess2 ,morbid ,growths1 #beb ,the ,male ,mamm1 #beg ,,part ,,iv4 ,,miscellaneous ,,subjects4 ,,chapter ,i4 ,,of ,,the ,,periosteum ,,and ,,bones4 ,,section ,i4--,,of ,,the ,,periosteum4 ,inflammation2 ,ulceration2 ,malignant ,disease1 #beh ,,section ,,ii4--,,of ,,the ,,bones4 ,inflammation and ,abscess2 ,caries2 ,necrosis2 ,rachitis2 ,mollities ,ossium2 ,morbid ,growths1 #bei ,the ,medulla1 #bfg ,,chapter ,,ii4 ,,diseases ,,of ,,the ,,joints4 ,malformations2 ,morbid ,condition of ,synovial ,membranes2 ,morbid ,condition of ,burs2 ,morbid ,condition of ,cartilage2 ,ulceration of ,cartilage2 ,chronic ,rheumatic ,arthritis2 ,scrofulous ,arthritis1 #bfh ,diseases of the ,spinal ,column1 #bgb ,,chapter ,,iii4 ,,of ,,tumors4 #a4 ,benign or ,non-,malignant ,tumors1 #bgd #b4 ,malignant ,tumors1 #bhf ,,chapter ,,iv4 ,,post-,,mortem ,,appearances ,,in ,,death ,,from ,,unnatural ,,causes4 #a4 ,death from ,poisoning1 #bid #b4 ,death from ,suffocation1 #cjj #c4 ,death from ,hanging or ,strangling1 #cja #d4 ,death from ,drowning1 #cjb ,,chapter ,v4 ,,medico-,,legal ,,questions4 #a4 ,method of ,conducting a ,medico-,legal ,autopsy1 #cjd #b4 ,questions ,relating to ,new-,born ,children1 #cjg #c4 ,supposed ,period of ,death1 #cab #d4 ,the ,probable ,cause of ,death1 #cag ,,chapter ,,vi4 ,,on ,,embalming ,,the ,,dead1 #cbj ,,chapter ,,vii4 ,,preservation ,,of ,,specimens ,,of ,,morbid ,,anatomy1 #cbf ,,introduction ,before entering upon the study of any subject1 it is of moment that the student be thoroughly convinced of the importance of the knowledge which he is about seeking to acquire1 since his zeal in its pursuit will1 in most cases1 be in proportion to this conviction4 ,we will1 therefore1 before entering upon the subject proper of this book1 present in few words1 some considerations on the importance of a study of morbid anatomy as revealed by post-mortem examinations4 ,the necessity of a study of anatomy and physiology by a medical student1 is now so universally recognized1 that an attempt to prove its importance would seem deserving only of ridicule2 but the ignorance of many practitioners on the subject of morbid anatomy1 shows that this study has yet to vindicate its claim as a necessary branch of a medical education4 ,from a purely theoretical standpoint1 the educated physician--one whose motto is ,esse1 non videri--after combating a disease in vain1 should not feel content to remain in ignorance of its real nature1 so far as discoverable by anatomical changes1 capable of being recognized after death1 even had he no prospect of adding thereby one jot to his practical acquaintance with disease or to his power to combat it2 yet his scientific conscience 7if we may be allowed the expression7 ought not to rest satisfied until1 in all doubtful cases1 his ante-mortem diagnosis be confirmed or overthrown1 and his conception of the case completed in all its details by a post-mortem examination4 ,besides this purely individual scientific interest1 there are weightier practical reasons for an acquaintance with this branch of medical science by the physician as practitioner4 ,among the almost innumerable questions upon medical1 theological1 and miscellaneous subjects which the ,american public feels at liberty to propound to its medical advisers1 none are of more frequent occurrence and none are more justifiable than the two3 8,what is the matter with the patient80 and 8,will he1 or can he1 recover80 and to none is an answer more imperatively demanded4 ,the public very naturally1 and with reason1 requires on the part of a physician the ability to make a diagnosis and a prognosis4 ,it will not be satisfied with being told that the name of the disease is of no importance1 that the doctor only wants to hear the symptoms2 that he does not cure diseases1 but removes the symptoms of disease1 c4 ,only an exceedingly well-trained public will accept these truisms as an equivalent for diagnostic skill4 ,hence1 it is the physician's interest1 as well as his duty1 as we shall see1 to seek1 in all cases1 to make a diagnosis1 no matter how difficult the task may prove to be4 ,the question how far his treatment will be modified by his diagnosis is a question of therapeutics1 and does not belong here2 but certain it is1 that a mere combatal of the symptoms as isolated phenomena cannot be regarded as fulfilling the whole duty of a conscientious physician4 ,the ability to make a diagnosis1 and consequently prognosis1 depends upon a knowledge of pathology1 with a knowledge of symptoms as signs of pathological states and changes2 and as such they must be critically examined and their true import discovered1 if possible4 ,thus treated1 we arrive1 by various processes of reasoning1 at a diagnosis1 under which the symptoms fall into their natural order of importance1 and we run but little risk of contending with remote subjective symptoms 7of great importance in differential therapeutics7 to the neglect of more important1 though perhaps less prominent ones4 ,besides this1 we are1 in a measure1 prepared to foretell the probable course of a disease1 and can1 therefore1 in many cases1 adopt anticipatory measures1 while in all we will be guarded against the error1 so often committed1 of ascribing to the remedy used the so-called 8aggravations10 which are often only natural symptoms of the unchecked and1 perhaps1 entirely uninfluenced morbid process4 ,such knowledge serves thus1 by purifying our experience1 to guard us against self-deception1 and to prevent us from misleading others by reports of cures of diseases existing only by virtue of a false diagnosis4 ,a knowledge of pathology1 furthermore1 places in our hands a thread which can guide us through the labyrinth of our vast materia medica1 and which enables us1 from the myriad of symptoms1 to eliminate the non-important ones4 ,it shows us the 8bearings0 of the medicines and their various specific ranges1 thus materially facilitating the choice of a remedy4 ,again1 medical science is virtually based upon pathology1 and we see1 therefore1 how important1 nay1 how absolutely necessary1 to the progress of the former is the study of the latter4 ,the practice of medicine as an art can never be advanced knowingly by those who neglect its cultivation as a science4 ,while each one may practice the art according to his own convictions1 true medical science stands above all the belittling1 bigoted prejudices of the schools4 ,here1 every one claiming the name of an educated physician can and ought to work4 ,the wild vagaries of former ages1 when philosophy set up purely theoretical views1 under which observed phenomena were compelled to arrange themselves1 have warned the present age to be guided solely by sober and exact observations and investigations2 and it needs no proof that1 in the advancement of our knowledge of disease1 these are best accomplished by frequent post-mortem examinations1 which thus become a necessary adjunct to a proper study of pathology4 ,in all cases of interest1 therefore1 the physician should feel it a duty which he owes to himself and the profession at large1 to seek permission to make a post-mortem examination2 but in order that the fullest benefit may be derived from the same1 he must know how to look for what he is in search of1 and how to recognize it when found4 ,to furnish this knowledge is the object of the following pages1 to which we herewith introduce the reader4 ,,preliminary ,,chapter4 ,,instruments ,,and ,,general ,,directions4 ,the ,post-mortem ,case1 as prepared by the instrument makers1 will be found to contain1 usually1 the following instruments3 ,illustration3 ,scalpels #a4 ,a set of ordinary dissecting scalpels1 four or five in number1 and of graduated sizes1 including one heavy cartilage knife4 ,illustration3 ,knife #b4 ,a brain knife with a long blade1 for slicing the brain4 ,illustration3 ,chisels #c4 ,chisels1 of one or both the accompanying forms1 for use in opening the head or spine4 ,illustration3 ,hammer #d4 ,an iron mallet or hammer1 with a hook on the end of the handle for tearing off the culvarium4 ,illustration3 ,enterotome #e4 ,an enterotome1 or scissors with blunt1 hooked point1 for splitting open the intestinal canal4 ,illustration3 ,saw #f4 ,a saw with movable back2 this arrangement permitting of a deeper cut1 in dividing large bones4 ,illustration3 ,rachitome #g4 ,the rachitome1 a chisel-like instrument1 to be used with the hammer in opening the spinal canal4 ,illustration3 ,saw #h4 ,the double saw1 used for dividing the lamin of the vertebr4 ,a side view of the instrument being given in the cut1 one blade only is seen4 ,the two are attached to one handle1 placed parallel with one another1 and about one and one-fourth inches apart4 ,after the soft tissues have been removed1 this saw is used by passing the spinous processes between the two blades1 and thus dividing both lamin at once4 ,illustration3 ,clamp #i4 ,a skull clamp1 for steadying the head while removing the calvarium4 ,after the removal of the scalp1 this instrument may be employed1 and be of much service for the above object4 ,it is applied by placing the open end of the instrument over the crown of the head1 turning down the screws1 and thus fastening it just above the line of division of the bone4 ,the arched end of the instrument now serves as a handle for turning or steadying the head4 #aj4 ,rib-shears1 for dividing the ribs where that operation is found desirable4 #aa4 ,a tube for inflating the lungs1 and an ordinary blowpipe4 #ab4 ,dissecting forceps1 tenacula in handle and with chain1 grooved director1 and assorted needles1 straight and curved4 ,while a post-mortem case with all of the above instruments is very convenient1 and important even1 where there is frequent occasion for its use1 still its absence should never deter the physician from making an examination where the ordinary dissecting case may be had2 and with the country physician generally1 this case is all that is absolutely essential1 as a common carpenter's saw and chisel may at any time be found1 in cases where the head is to be opened2 while for opening the chest and abdomen1 the dissecting case contains everything that is essential4 ,instruments used in post-mortem examinations should never be employed for operating upon the living1 without first being repolished by the instrument maker1 and the handles disinfected by careful cleaning in a solution of permanganate of potash4 ,,preliminary ,,preparations4 ,the ,preliminary ,preparations at the place of the operation should consist in providing a sponge for absorbing fluids2 newspapers and old cloths for filling cavities or wrapping up any morbid specimen that it may be desirable to preserve2 a couple of quarts of clean sawdust or wheaten bran for throwing into the cavities before closing them up1 and thus absorbing any excess of fluids2 stout thread or twine for tying intestines and closing the cavities2 lard or sweet oil for oiling the hands2 a couple of empty slopbuckets for receiving the fluids1 bloody water1 c41 and plenty of water1 hot and cold1 with towels and soap4 ,if the floor of the room is carpeted1 to protect it from accident1 a piece of old carpet1 or quilt1 or oilcloth should be spread alongside the table or box where the examination is made4 ,care should be observed to have all these matters provided before the operation is commenced1 when the door should be fastened1 that there may be no intrusion1 by accident or otherwise4 ,in preparing the body for examination1 if the head is to be opened and the body is in an ice-box1 it will be absolutely necessary that it be removed4 ,placing the cover of the box on the floor1 the body may be lifted out and placed on the same1 when both may be again placed on the top of the box or on a table1 for the examination4 ,if only the chest and abdomen are to be examined1 it will hardly be necessary to lift the body from the box4 ,in all cases1 the sheet in which the body is placed1 with the underclothing1 7the latter having been split down the centre17 should be carefully turned aside1 and care observed during the operation to avoid as much as possible soiling them with blood-stains4 ,precautionary ,measures4 ,that there is a certain amount of danger from absorption of virus in case of cuts or scratches received while conducting a post-mortem examination1 cannot be denied2 yet this danger is by no means common to every case4 ,in the great majority of instances1 probably no mischief whatever would follow such an accident1 the danger being confined almost wholly to cases of peritoneal inflammation1 erysipelas1 and certain malignant forms of disease4 ,in all cases1 however1 it will be well to look for any scratch1 cut1 or abraded point on the hands or fingers1 and first touching them with nitrate of silver1 cover them finally with collodian4 ,smearing the hands well with lard or olive oil will also aid much in preventing absorption4 ,should an accidental cut be received during the operation1 it will be prudent1 in all cases1 to wash the hands at once1 squeeze and suck the part1 to favor bleeding1 and1 finally1 touch with a crystal of nitrate of silver4 ,punctures with a needle or slight scratches which do not bleed are1 probably1 more dangerous than a free cut2 hence1 in cases of suspected danger1 when a puncture has been received1 it would be safer to make a free incision with a knife1 thus inducing bleeding1 which will favor the washing out of any virus1 and finally1 use the caustic4 ,time for ,making the ,examination4 ,as a rule1 post-mortem examinations should be made as soon after death as a due regard to the feelings of friends will permit1 say within twelve to twenty-four hours2 a longer delay would give time for such decomposition as not only to make the examination extremely disagreeable1 but1 from change of structure in tissues and organs1 much less satisfactory4 ,in cold weather1 however1 or where the body has been placed in ice soon after death1 as is the custom in most cities1 the examination may be postponed to any convenient time before the burial4 ,notes4 ,in all important cases1 notes should be taken down by an assistant1 on the spot1 as dictated by the operator2 heading these by the name and age of the patient and a brief sketch of the disease4 ,in medico-legal cases1 this is to be conducted with particular care1 as will be pointed out hereafter4 ,consent of ,friends4 ,much difficulty will sometimes be met in obtaining the consent of friends for a post-mortem examination1 the idea of the mutilation of the body of the deceased striking many with particular dread4 ,with a little tact and management1 however1 consent may1 in the majority of instances1 be obtained4 ,instead of speaking to a single member of the family and leaving him or her to bring the subject before others1 in all doubtful cases it will be better for the physician to see all the interested parties himself1 either together or separately1 and endeavor to interest them in the case1 by pointing out the peculiar character of the disease1 the satisfaction which the friends will themselves derive from a verification of the diagnosis of their physician1 while1 when too late1 they may regret having withheld their consent2 also the scientific interest which attaches to the case1 and the benefit which will no doubt accrue to medical science through a post-mortem examination1 and the possibility that the lives of others may depend upon a knowledge of the true state of this case4 ,these1 with like considerations1 adapted with ready tact to the class of persons to be persuaded1 will1 in the majority of instances1 be enough to overcome all scruples1 especially when joined to the assurance that the examination will be so conducted as to leave no visible trace of the operation with which to embitter the remembrance of the well-known countenance4 ,,part ,i4 ,,the ,,head ,,and ,,spine4 ,,chapter ,i4 ,,the ,,operation4 ,in opening the head for a post-mortem examination1 let a thick block be placed beneath the occiput1 when1 after having carefully parted and turned aside the hair1 an incision may be made through the scalp1 over the top of the head1 from ear to ear4 ,the back of the scalpel being placed next the head1 the point may be pushed in advance1 thus dividing the tissues without danger of injuring the edge of the instrument by bringing it in contact with the bone4 ,from the loose connection of the tendon of the occipitofrontalis muscle to the periosteum1 by the use of the handle of the scalpel1 the flaps of the scalp may readily be turned aside1 the anterior over the face1 the posterior on the back of the neck4 ,the skull clamp may now be applied1 which will be of great service in steadying the head while using the saw4 ,instead of dividing the skull in a circular manner1 as is usually done in the dissecting-room1 it will be better to start the saw above the frontal eminences and run obliquely down towards the mastoid process1 meeting this line by another commencing at the occipital protuberance and carried horizontally forwards1 thus giving a wedged form to the portion removed4 ,the advantage of this method consists in our being better able to hold the parts in position as they are replaced1 as in the old method1 from the readiness with which the parts move upon one another1 the calvarium is liable to slide forwards or backwards from its position1 thus producing an unsightly ridge across the forehead1 which will more or less plainly show through the integument4 ,with young children1 a strong pair of scissors may be used instead of the saw in dividing the calvarium4 ,in using the saw1 care should be observed not to injure the dura mater2 hence it will be better not to attempt to divide both tables with that instrument1 but rather depend upon the chisel or rachitome for breaking away the inner table4 ,to avoid the sound which would attend the use of the iron hammer1 which1 if heard by members of the family1 might excite unpleasant feelings1 a billet of wood or wooden mallet may be used2 or1 these not being at hand1 the head of the iron hammer may be muffled with a towel1 so as materially to deaden the sounds4 ,the inner table having been divided1 the calvarium may be pried off with the chisel1 or torn away with the hook on the handle of the hammer4 ,this1 from the close adhesion of the dura mater to the bones1 will generally require considerable force4 ,the calvarium having been removed1 and the superior longitudinal sinus opened1 and the condition of its contents noted1 the dura mater1 after its careful examination1 may be cut through with the knife or scissors in the line of the division of the bone4 ,the membrane may now be lifted up1 when adhesions will be found between its under surface and the pia mater1 along either side of the falx cerebri4 ,these should not be mistaken for results of inflammation1 as they sometimes are1 they being simply the points of entrance of the veins of the pia mater into the superior longitudinal sinus4 ,these having been divided1 with the falx near its attachment to the crista galli1 the whole may be turned back1 exposing the brain4 ,to remove the latter1 take away the block from beneath the head1 and lifting the anterior lobes of the brain1 divide successively the several pairs of nerves as they appear in sight1 with also the tentorium on either side1 and as the brain falls back into the left hand1 the knife may be passed down into the foramen magnum1 and the medulla oblongata and vertebral arteries divided1 when the whole may be lifted from its position4 ,more or less blood with the cerebro-spinal fluid will necessarily flow off during this operation1 to secure which1 a bucket should be placed beneath the edge of the table1 over which the head should slightly project4 ,in dropsy of the brain1 although the fluid is mainly in the ventricles1 it may escape during the operation and be caught in the same manner4 ,the external surface of the brain having been carefully examined1 the hemispheres may be sliced off to a level with the corpus callosum1 when1 by removing the latter1 the cavities of the lateral ventricles will be exposed4 ,after a careful inspection of the several objects seen here1 the fornix and velum interpositum may be removed1 opening thus into the third ventricle4 ,slices may now be taken off the corpora striata and optic thalami1 with deeper portions of the hemispheres1 and sections made of the crura cerebri cerebellum and medulla oblongata1 thus giving an opportunity of judging of the condition of all those parts4 ,after the removal and examination of the brain1 attention should be given to the base of the skull4 ,the lateral and other sinuses should be laid open1 the dura mater1 as far as possible1 torn away1 and the bones examined for fractures1 caries1 abnormal growths1 etc4 8,the simplest method for removing the ear for the sake of dissection is1 after the removal of the calvarium in the usual way1 to take out both the petrous bones together by means of two transverse vertical sections1 one in front of the two petrous bones and the other posterior to them4 ,the anterior of these sections should pass in a line a little anterior to the anterior clinoid processes1 and the posterior in a line through the posterior third of each mastoid process4 ,by means of these two sections1 the trumpet-shaped extremity of each ,eustachian tube1 a portion of the mucous membrane of the fauces1 and the whole of each petrous bone1 together with the mastoid processes1 can be taken out4 8,the disadvantage of this procedure is the disfigurement which is apt to ensue from the falling in of the face4 ,to avoid this disadvantage1 another mode of removing the ear may be resorted to4 ,this consists in taking out each petrous bone separately in the following manner3 ,the calvarium having been sawn off1 an anterior section is to be made in each side in the same line as in the above plan1 but extending only as far as the outer part of the body of the sphenoid bone2 a posterior section in each side is then to be made1 as in the first plan1 but not extending farther inwards than the basilar process of the occipital bone4 ,these two sections are to be made with a saw or with a chisel and hammer4 ,the apex of each petrous bone is then to be separated from the sphenoid and occipital bones1 and each petrous bone 7the outer ear and integument being detached and reflected downwards7 is to be drawn outwards1 taking care1 by inserting the scalpel deeply1 to remove as much of the soft parts as possible4 8,the organ of hearing having been removed1 the dissection may be conducted in the following manner3 ,the auditory nerve in its meatus should be first carefully examined1 presuming that a previous inspection has been made of the portion of the brain to which the portio mollis and portio dura nerves are attached4 ,the size of the external meatus having been ascertained by allowing a strong light to fall into it1 its anterior wall is to be removed by the cutting forceps4 8,the state of the epidermis1 the ceruminous glands and secretion1 the dermis1 periosteum and bone is to be noticed4 ,the outer surface of the membrani tympani is then to be examined2 also the state of its epidermoid and dermoid lamin1 its degree of tension1 and the amount of motion possessed by the malleus when pressed upon by a fine point4 ,the next step is to ascertain the condition of the guttural portion of the ,eustachian tube1 to lay open the cartilaginous tube with the scissors1 and then to expose the cavity of the osseous portion by means of the cutting forceps4 ,in doing this1 the tensor tympani muscle is exposed2 its structure should be examined1 and if it has not a healthy appearance1 portions of it should be submitted to microscopic inspection4 ,the upper wall of the tympanum is next to be cut away by means of the cutting forceps4 ,in doing this1 great care must be taken not to disturb or disconnect the malleus and incus1 which lie immediately beneath it4 ,after the tympanic cavity has been exposed1 the first step is to pull the tensor tympani muscle and ascertain how far it causes a movement of the membrana tympani and ossicles4 ,the incus and stapes are now to be touched with a fine point1 so as to ascertain their degree of mobility2 the tendon of the stapedius muscle is also to be pressed upon4 ,the condition of the mucous membrane of the tympanum and of the mastoid cells is then to be ascertained1 and any peculiarity of the cavity1 the existence of bands of adhesion1 etc41 to be noted4 8,the most delicate parts of the dissection1 viz41 that of the internal ear1 must now be undertaken4 ,the cavities of the vestibule and cochlea are to be exposed by removing a small portion of the upper wall of each4 ,before reaching the vestibule1 the superior semi-circular canal will be cut through and removed2 the membranous canal should be drawn out and inspected4 ,as the cavities of the vestibule and cochlea are laid bare1 it is desirable to see that the quantity of perilymph is natural1 as well as its color and consistence4 ,the outer surface of the membranous labyrinth having been observed1 it should be opened so as to expose the endolymph and otoliths1 portions of all which parts should be removed for microscopic inspection4 ,this having been effected1 the remaining membranous semi-circular canals are to be exposed1 and the connection of the base of the stapes to the fenestra ovalis carefully examined4 ,the last stage of the dissection consists in removing parts of the lamina spiralis1 in examining them microscopically1 and in exposing from within1 by following the course of the scala tympani1 the membrane of the fenestra rotunda4 8,the only part which now remains unexamined is the stapedius muscle2 in order to expose it1 the course of the aquductus ,fallopii1 beginning at the stylo-mastoid foramen1 should be followed until the base of the pyramidal eminence containing the muscle is reached40#a ,the ,eyes1 with the optic nerves1 may be most conveniently removed for examination1 by breaking up the roof of the orbit with the hammer1 and1 after the removal of the fragments of bone1 dissecting away the fat and muscles until the ball is exposed1 when1 with the scissors1 the tunics of the latter may be divided just behind the conjunctival attachment1 and the ball removed with the optic nerve4 ,the front portion of the eye being left in position1 by filling the cavity behind with a little cotton or paper1 any flattening may be prevented1 and thus any appearance of loss of parts avoided4 ,the examination having been completed1 the brain may be replaced1 the calvarium put in position1 the scalp brought over the same and united with stitches1 the arranging of the hair effacing all traces of the operation4 ,,the ,,spinal ,,cord4 ,for the removal of the spinal cord1 place the body in a prone position1 and make an incision the whole length of the back1 over the spinous processes of the vertebr4 ,then raise up and turn aside all the muscles with the integument1 exposing the lamin of the vertebr4 ,the latter may now be divided with the single or double saw1 the rachitome or chisel being used to complete the operation1 when the lamin1 with the spinous processes1 may be removed in one strip1 exposing the cord enclosed in its membranes4 ,the roots of the nerves may now be divided1 and the cord1 enclosed in its sheath1 removed2 care being observed not to handle the parts roughly while so doing4 ,the dura mater may now be split open for the examination of the cord4 ,should it be desired to preserve any portion for microscopic examination1 it may be suspended in a solution of bichromate of potass1 xx to xxx grs4 to the ounce of water1 and in a few days transferred to a solution of chromic acid1 ij grs4 to the ounce of water1 where it should remain until sufficiently hardened to be cut into thin sections4 ,the examination completed1 the parts may be replaced and the incision sewed up4 ,,chapter ,,ii4 ,,pathological ,,conditions4 ,section ,i4 ,,of ,,the ,,skull4 ,notice in examination1 condition of scalp2 cuts1 bruises1 extravasation of blood1 c4 ,cranium--,color1 smoothness or roughness of exposed surface2 fractures1 their position and relation to injuries of scalp4 ,removal of ,calvarium--,adhesion of dura mater2 inner surface of2 smooth or rough2 seat of same2 deposit of new bone2 depression of inner table2 thickening or thinning of4 ,state of fontanelles in children2 condition of frontal sinuses2 condition of base of skull noted after removal of brain2 fractures2 condition of petrous portions of temporal bones1 c4 ,fracture4 ,in a post-mortem examination of the head1 after death from a blow or fall upon that part1 a fracture may be disclosed of which there was no external trace4 ,owing to the greater thinness and brittleness of the inner table1 it is possible for this to be fractured without any corresponding injury to the external2 such fracture may possibly rupture some of the branches of the meningeal arteries1 which will be followed by the formation of a clot between the bone and dura mater1 the pressure of which may be sufficient to produce death4 ,owing to the same cause--greater brittleness of the inner table--when fracture of the outer exists1 that of the inner table will be likely to be more extensive1 accompanied perhaps with depression1 of which there is no external evidence4 ,again1 it will sometimes be discovered that fracture exists at a point opposite to that upon which the blow was received1 on the principle of the 8contre coup0 of the ,french2 thus1 the blow having been received on the occiput1 the fracture may be found in the frontal region2 or1 received on the top of the skull1 fracture may result at the base4 ,in falls from a height1 upon the top of the head1 the weight of the body1 acting through the cervical vertebr as a propelling force1 is very likely to produce fracture of the occipital bone4 ,caries may affect any of the bones of the head1 but in the majority of cases it will be the result of syphilitic or mercurial poisoning4 ,following an attack of periostitis1 the inflammation extends to the bone and gradually develops the carious ulceration4 ,while the condition is usually confined to1 or at least1 most strongly developed upon the outer table1 it may involve the entire thickness4 ,in syphilitic ulceration of the bones of the nasal cavity1 the disease may destroy the cribriform plate of the ethmoid bone1 and thus extend to the membranes of the brain4#b ,so also1 in caries of the petrous and mastoid portions of the temporal bone1 which sometimes results from scarlet fever1 the disease may extend to the inner surface1 resulting in the accumulation of pus within the cranial cavity4 ,along either side of the central portion of the inner surface of the calvarium may be usually seen1 at least in the heads of aged persons1 a number of irregular1 rough pits1 varying in size and depth1 which are not to be mistaken for disease of the bone1 they being simply impressions of the ,pacchionian glands4 ,thinning of the bones of the head will always indicate increased pressure from within1 induced by hypertrophy of the brain1 or1 as is more frequent1 hydrocephalus4 ,in the latter case1 not only thinning1 but complete absorption of the parietal and other bones may result4#c ,increased ,thickness will also sometimes be found4 ,this condition indicates diminished pressure from within1 as in atrophy of the brain4 ,the thickening results from a gradual remodeling of the inner table and diploe1 so that while the exterior of the skull may retain its normal size and form1 the inner table following the retiring and shrinking brain1 the interval between the two becomes filled with the thickened diploe4 ,it has been observed that this hypertrophy is greatest at those parts of the bones where ossification first commences1 as at the parietal and frontal eminences4 ,it is not confined to old persons1 though perhaps more frequent with them4#d ,section ,,ii4 ,,the ,,membranes ,,of ,,the ,,brain4 #a4 ,the ,dura ,mater4 ,notice color and general character of surface2 blood between it and bone2 position of2 quantity2 coagulated or not4 ,condition of bone--necrosed or fractured2 pus between dura mater and bone4 ,tumors--their position1 size1 c4 ,wounds--their position1 extent1 c4 ,open longitudinal sinus and note contents4 ,this membrane1 serving both as a periosteum to the inner surface of the cranial bones and as a support to a serous membrane--the reflected layer of the arachnoid--is subject to affections of a two-fold character1 those peculiar to the fibrous and serous portions4 ,inflammation of this membrane1 may involve either the outer fibrous1 or the inner serous layer4 ,in the former case1 the membrane appears congested1 red and more or less softened4 ,the inflammatory process may result in the formation of pus between the bone and dura mater1 and even in gangrene4 ,the disease may also extend to the adjacent portions of the pia mater and brain substance4 ,external injuries1 fractures of the bones of the skull1 inflammation of the periosteum1 otitis1 resulting in caries of the temporal bone1 may all be causes of inflammation of the outer portion of the dura mater4 ,inflammation of the inner surface of this membrane1 is marked by the presence of a net-work of delicate red vessels1 while the surface is covered by a soft1 grayish or yellow semi-purulent matter1 and may attend cases of pymic poisoning1 puerperal peritonitis1 or some of the exanthemata4 ,thickening of the fibrous portion of the dura mater may be found as a result of chronic inflammation1 either spontaneous or as the result of external injury4 ,from the identity of structure between this and other fibrous tissues of the body1 it is not unlikely that this thickening is often the result of a rheumatic form of inflammation4 ,external violence is1 however1 most commonly the cause of the change4 ,in one case1 the patient fell down stairs in a state of intoxication1 striking the head on the steps4 ,he continued in a state of insensibility for nine days1 when he began to show signs of returning consciousness1 taking food and drink1 but memory1 judgment1 and all the mental faculties were gone4 ,death ensued in about two years4 ,the dura mater of the left hemisphere was found greatly thickened4 ,the pia mater infiltrated with a large amount of serous fluid4 ,the convolutions were atrophied1 and about four ounces of serous fluid found in the ventricles4 ,the fornix was softened and the septum lucidum entirely destroyed4 ,fibrinous ,clots1 or ,thrombi1 will be occasionally found within the sinuses of the dura mater1 where they may have given rise to congestion of the brain1 with apoplectic effusions1 paralysis1 convulsions1 coma1 etc4 ,they may originate from injuries of the head1 inflammation of the dura mater1 pulmonary disease1 etc4 ,tubercular ,deposits are also sometimes found in this membrane1 appearing1 however1 mainly upon the arachnoid surface4 ,they present the usual character of tubercle1 having a whitish or grayish appearance1 with the consistence of cheese1 and scattered in small particles upon the surface4 ,they are found in tubercular meningitis1 7a disease common with children but rare with adults17 and in most of those cases of so-called acute hydrocephalus4 ,tumors of various kinds are occasionally found in the dura mater1 including cystic1 fibrous1 fatty1 osseous and cancerous growths4 ,the latter may cause such absorption of the bones of the skull1 as to appear on the exterior of the head4 ,in one case which came into the dissecting-room some years ago1 thin bony formations of the size of a silver quarter dollar were found in the tentorium1 and smaller ones in the falx cerebri4 ,nothing could be learned of the previous history of the case4 #b4 ,arachnoid and ,pia ,mater4 ,notice in examination1 contents of cavity of arachnoid2 serum or blood2 if former1 amount1 color1 odor2 if blood1 situation1 quantity1 fluid or coagulated2 adhesion of surfaces of arachnoid2 tubercles1 their position1 c42 color of membrane2 vascularity1 transparency1 or opacity4 ,sub-arachnoid fluid--quantity1 position1 color1 c4 ,pia mater--vascularity1 in points and entire2 serous effusion into substance of2 blood1 c42 position1 size1 c41 of clots2 granulations1 7tubercles17 number1 position1 c42 ,tumors--size1 position1 and character4 ,as morbid conditions of the arachnoid membrane are more common with its visceral layer1 and as these conditions usually involve the pia mater1 the two membranes are here noticed together4 ,they will be found presenting various degrees of congestion after death1 which will not necessarily be a positive indication of the extent of congestion during life4 ,pacchionian ,bodies4 ,along either side of the great fissure may be noticed within the pia mater of adults1 several small white bodies1 varying in number and size--the ,pacchionian bodies4 ,they may cause absorption and perforation of the dura mater1 and even of the bones of the skull4 ,being looked upon as the result of mere senile changes1 they do not indicate the presence of disease1 though repeated congestions of the brain appear to favor their more rapid development4 ,inflammation of these membranes1 or meningitis1 is a very common affection1 and is accompanied with an accumulation within its substance or beneath its layers1 of serum1 lymph1 or fibrine in various proportions4 ,it may be confined to circumscribed portions1 or involve a large portion of the membrane1 and even extend to the spinal cord4 ,adhesions between the two surfaces of the arachnoid sometimes result from this form of inflammation4 ,insanity in its various forms is most frequently accompanied with some morbid condition of these membranes4 ,in twenty-two cases of insane persons whose brains were inspected by ,dr4 ,marshall1 in twenty-one1 serous fluid1 varying in amount from one to twelve ounces1 was found in the ventricles1 and in seventeen of these twenty-one cases1 similar effusion was found in the sub-arachnoid space1 or within the substance of the pia mater4 ,while red injection of the membrane was found only in four cases1 yet other conditions--the effusions1 c4--were evidently the result of previous inflammation4 ,in nine cases were the arteries of the brain opaque1 thickened1 steatomatous1 or ossified2 conditions highly favorable for deranging the capillary circulation of the membranes or of the brain4#e ,the following statement gives the principal morbid changes of these membranes which have been found in cases of insanity3 #a4 ,injection1 more or less intense1 of the pia mater1 giving a red or scarlet appearance2 or1 where infiltrated with serous fluid1 presenting a pale gray color and increased in thickness4 #b4 ,the arachnoid 7the visceral layer7 becomes opaque and thickened1 resembling the dura mater or macerated parchment4 #c4 ,the meningeal injection may terminate in serous effusion1 either from the free surface of the arachnoid into the sub-arachnoid tissue1 7pia mater17 or from the choroid plexus into the ventricles4 #d4 ,albuminous exudations may be found upon the free surface of the arachnoid of the dura mater1 covering its whole extent1 or confined to definite portions4 #e4 ,adhesions of the two surfaces of the arachnoid may rarely be found4 ,it is most common in the great fissure1 and has been found in the ventricles4 #f4 ,blood may be effused upon the surface of the arachnoid or in the substance of the pia mater4 ,serous ,effusion4 ,as has been already intimated1 this may be found either in the cavity of the arachnoid--between the reflected and visceral layers--or within the ventricles4 ,in the former position1 the quantity is never large1 while in the latter1 it may amount to twelve or sixteen ounces1 and be present for many years4 ,when in such large quantity1 there will be great distension of the ventricles and thinning of the corpus callosum and fornix1 with destruction of the septum lucidum1 as well as more or less separation of the cranial bones4 ,it is only in children and before the bones of the head have become united1 that such large accumulations are possible1 as at a later period1 from the unyielding condition of the walls of the skull1 the presence of a single ounce1 particularly if suddenly formed1 would produce death4 ,in all cases1 the danger to life will be in proportion to the rapidity of the formation2 a very slow and gradual accumulation permitting either of an expansion of the cranial bones1 or a gradual absorption of brain substance1 thus preserving an approximation to the normal pressure on the brain tissue4 ,serous effusions1 like sanguineous1 are generally the result of over distension of the cerebral vessels1 either from mechanical obstruction1 or a weakened condition of the coats of the vessels1 with increased force in the action of the heart4 ,it generally attends tubercular meningitis1 and may be favored by an anmic condition of the system4 ,the symptoms during life1 attending a rapid effusion of serum1 are not so readily distinguished from those of sanguineous effusion1 as to enable us to pronounce with certainty in any given case as to the cause of the cerebral pressure4 ,sanguineous ,effusion--,apoplexy4 ,effusions of blood may be found between the bones and dura mater2 between the two layers of the arachnoid2 within the substance of the pia mater2 within the ventricles1 or within the brain substance4 ,blood clots will seldom be found between the bone and dura mater1 except as a result of mechanical injury1 and in the majority of cases as an attendant upon fracture4 ,if a fragment of the bone at the same time1 be driven through the dura mater1 then a clot may be found in the arachnoid cavity4 ,but in another class of cases1 where death has resulted from blows upon the head without producing fracture of the bones1 the whole surface of the brain in the region of the injury1 and not unfrequently in distant parts1 after the removal of the dura mater1 is found covered with a layer of blood1 which at first sight appears to be outside of the membranes2 but on close examination1 it is found that the blood is effused or infiltrated into the sub-arachnoid tissue1 and that it has escaped from the lacerated vessels in the pia mater4 ,the thickness of the layer varies4 ,it is generally in greater quantities at the sides and base of the brain1 and the inferior lobes and cerebellum may be covered by it4 ,it is usually thickest over the crura1 the pons ,varolii and medulla oblongata4 ,in the same class of cases the blood may be also effused into the ventricles4 ,these appearances are so uniformly the result of violence1 as to form a valuable piece of evidence in medico-legal inquiries1 to prove that such hmorrhage and death could not be the result of internal causes4 ,in the greater number of still-born children1 an examination of the head will show a similar condition of things4 ,the surface of the cerebrum generally1 with sometimes that of the cerebellum1 will be found covered with a layer of coagulated blood effused into the pia mater1 while the ventricles will often be filled with clots4 ,where the history of the case is not known1 it might at first be suspected that death was the result of violence inflicted after birth4 ,violence has1 to be sure1 been the cause of death1 but it is such violence as attends a protracted case of labor1 with1 perhaps1 a large head1 and a contracted pelvis of the mother4 ,the wonder is1 that from the great pressure to which the head is subjected during labor1 that so few children are still-born or do not die soon after birth1 from rupture of the cerebral vessels4 ,effusions into the ventricles1 may also be frequently the result of external violence4 ,the pia mater1 the vascular membrane of the brain1 we find carried into these cavities by means of the velum interpositum1 which forms the roof to the third ventricle1 while its borders extend into the lateral1 forming the choroid plexuses4 ,the effused blood may1 therefore1 extend along this membrane into the cavity of the ventricles4 ,again1 blood may be effused in any portion of the brain substance1 constituting true sanguineous apoplexy4 ,certain parts are much more frequently the seat of these effusions than others4 ,they are more common in the striated bodies or optic thalami--probably from the greater vascularity of those parts--but may be found in the corpora quadrigemina1 the pons ,varolii1 the crura cerebri1 or in the cerebral hemispheres1 and occasionally in the cerebellum4 ,the symptoms during life will vary according to the location of the effusion2 when in the pia mater1 or in other words1 outside of the brain1 paralysis will seldom attend1 though the coma may be profound1 with relaxation of the muscular system and sometimes convulsions4 ,when the hmorrhage is in the optic bed or striated body of one side1 from the decussation of fibres in the medulla oblongata1 paralysis of the opposite side of the body will follow2 while if the effusion has taken place in both hemispheres1 the palsy will be double-sided1 though probably more complete on one side than on the other4 ,effusions of blood into the corpora quadrigemina1 will most frequently be attended with muscular tremblings or convulsions1 and probably impaired sight1 with some change in the pupil4 ,when in the medulla oblongata1 convulsions1 followed by palsy1 deep coma1 and early death2 greater fatality attending effusions at this point1 probably1 than at any other4 ,when the effusion takes place in the cerebellum1 the loss of consciousness will be very temporary2 there may be relaxation of muscles without palsy or loss of sensibility1 and1 it is said1 frequent vomiting4 ,the amount of blood effused is subject to the greatest variation4 ,clots may be found as large as a hen's egg1 or smaller than a pea4 ,indeed1 violent apoplectic attacks1 ending in death1 may occur1 where the most careful examination will fail to detect any effused blood1 death being the result of extreme congestion of the membranes4 ,on the other hand1 the presence of a clot is not necessarily fatal1 evidence being abundant that they may be so far reabsorbed as to be followed by at least partial recovery4 ,the following cases will serve to illustrate these several conditions3 ,,case ,i4--,sudden ,death from ,cerebral ,congestion4 ,mr4 ,m----1 aged thirty-five years1 had always enjoyed good health4 ,for some months previous to death1 had been working very hard1 with a good deal of anxiety1 in arranging the affairs of a company of which he was secretary4 ,on the evening previous to his attack1 he retired at eleven o'clock1 well and in good spirits4 ,at three o'clock ,a4 ,m41 his wife was wakened by his heavy1 stertorous breathing1 attended with slight convulsive movements of the limbs4 ,in less than a half hour he was dead4 ,the post-mortem showed the heart1 lungs1 and abdominal organs to be in a perfectly healthy condition1 while the most careful examination of every portion of the brain failed to expose the least effusion of blood4 ,the ventricles and sub-arachnoid space contained a moderate amount of serum1 while the vessels of the pia mater were strongly engorged with blood4 ,,case ,,ii4--,apoplectic ,attack1 followed by ,death in ,three ,days2 ,clot found in ,thalamus4 ,mr4 ,j----1 aged sixty-one1 a butcher1 abstemious in his habits but plethoric in temperament1 was suddenly stricken down with an attack of apoplexy1 which left him with paralysis of the right side of the body1 with impaired speech and memory4 ,he gradually and almost entirely recovered4 ,ten months after1 while in the street1 he fell with another attack4 ,he partially recovered consciousness1 but had complete palsy of the left side1 and died in three days4 ,here1 the post-mortem revealed excessive congestion of the pia mater1 and a large clot1 the size of a hickory nut1 in the right optic thalamus4 ,in the left thalamus was a distinct trace of a clot1 7nearly absorbed1 however17 which had undoubtedly been effused in the attack ten months previously4 ,,case ,,iii4--,apoplectic attack1 followed by ,hemiplegia1 and ,death in ,five ,years4 ,charles ,e4 ,w----1 at the age of forty-seven had a sudden apoplectic stroke1 in ,january1 #ahfg1 followed by partial paralysis of right side4 ,in ,may following1 he had a second attack1 which greatly increased the hemiplegia1 impaired the articulation1 and weakened the memory and intellect4 ,his general health and strength gradually failing1 he died ,august1 #ahgb1 five years after the original attack4 ,post-mortem revealed a greatly thinned and dilated condition of the walls of the arteries of the base of the brain and the remnants of the original clot imbedded in the left optic thalamus1 the brain substance around being of a dark color and much softened4 ,from the appearance of the dark1 ragged remnant of the clot1 it must have been originally of about the size of a robin's egg4 ,,case ,,iv4--,death from ,congestion1 with ,serous ,effusion and ,softening4 ,mr4 ,f4 ,h----1 aged thirty1 had an attack of brain fever at twenty-three1 followed by attacks of severe pain in the head1 recurring every few days1 weeks or months4 ,these attacks were accompanied with slight convulsive symptoms and delirium1 the pain being of a most excruciating character1 and lasting from a few hours to two or three days4 ,the attacks were gradually increasing in severity1 but without any impairment of the faculties of the mind4 ,on a ,saturday night1 he was brought home with one of his worst attacks4 ,when ,i first saw the patient on ,sunday evening1 ,i found him in a half-delirious1 stupid condition1 yet when roused up1 giving satisfactory answers to questions1 but immediately sinking into his former condition1 and every one to five minutes starting suddenly up and1 with staring eyes and distorted face1 uttering piercing shrieks and screams1 and calling to those around to shoot him1 split open his head with a hatchet--anything to release him from his sufferings4 ,these paroxysms would sometimes be followed by a convulsive action of the diaphragm and abdominal muscles1 ending in his sinking into the same dull1 stupid condition as before4 ,in the interval of calm1 the respiration was remarkably slow and feeble1 with a slow irregular pulse of forty beats to the minute4 ,these symptoms becoming gradually worse1 he sank into a comatose condition early ,tuesday morning1 expiring at daylight1 sixty hours after the commencement of the attack4 ,the post-mortem revealed greatly enlarged ,pacchionian glands1 with extreme thinning of the skull over the same4 ,the pia mater was considerably congested4 ,upon turning the brain back for removal from the base of the skull1 there was a sudden gush of water from the ventricles1 sufficient of which was secured to show that the quantity could not have been less than two ounces4 ,upon opening the lateral ventricles1 these cavities were found unusually large from distension by the fluid1 while the septum lucidum and fornix were found in a soft1 pulpy condition1 the former being completely broken down and detached from the corpus callosum above4 ,the gray portions of the corpora striata were also softer and more easily broken up than was natural4 ,the appearance presented by a clot1 as well as the brain substance immediately around it1 will vary according to the time the patient survives the attack4 ,when death follows in a few days1 the clot will have a soft1 blackish appearance2 after a month or six weeks1 it becomes firm1 and assumes a deep brown color1 and at a still later period1 it becomes still more firm1 and of a pale red tint2 lastly1 it may become entirely absorbed4 ,peculiar changes also take place in the brain substance immediately around the clot1 which vary according to the time intervening between extravasation and death4 ,the portion immediately in contact with the clot is generally of a dark red or wine color1 or1 at a later period1 of a chocolate brown1 and of a soft1 pulpy consistency4 ,exterior to this1 the color is paler and of an orange tint1 and still further on1 of a bluish-white or yellow4 ,the change in structure and consistence of the brain1 immediately around the clot1 constitutes one form of softening soon to be noticed4 ,section ,,iii4 ,,of ,,the ,,brain4 ,notice before removal--size2 form2 symmetry2 space between surface of brain and calvarium4 ,after removal--parts at base1 their size1 symmetry1 color on surface1 infiltration with serum or blood4 ,removal of pia mater--degree of adhesion2 appearance of convolutions2 color2 consistence2 effect of stream of water4 ,ulcers--condition of brain around4 ,sloughs--relation to membranes1 condition of brain around4 ,deposits2 tumors1 wounds1 etc4 ,after section1 notice breadth and character of gray portions of convolutions2 color1 vascularity1 etc4 ,consistency--softened or hardened2 of white substance2 color4 ,blood-vessels--number and size of red points in different portions4 ,extravasation of blood--its situation2 fluid or coagulated2 amount or size of coagulum2 color1 etc4 ,cavities in brain substance2 their number1 shape and contents4 ,blood1 purulent1 or fluid2 its quantity and color4 ,condition of brain around2 cicatrices2 wounds2 adventitious substances1 as tumors1 calcareous masses1 tubercle cancer1 etc4 ,lateral ventricles--note any difference in the two2 contents2 amount of serum or blood4 ,choroid plexus--pale or congested2 cysts2 calcareous bodies2 their size and situation4 ,lining membrane of ventricles2 its vascularity1 roughness1 opacity1 etc4 ,septum lucidum--entire or lacerated2 consistence4 ,fifth ventricle--size1 contents1 etc4 ,third ventricle2 contents4 ,commissures--their condition2 middle1 broken or double4 ,optic thalami and corpora striati--size1 symmetry2 character of surface and interior2 if softened1 extent2 extravasation of blood1 etc4 ,condition of pineal gland2 corpora quadrigemina2 valve of ,vieussens1 etc4 ,medulla oblongata--degree of adhesion of membranes2 softening1 exact locality of2 condition about origin of nerves2 appearance upon section4 ,fourth ventricle--contents2 condition of floor1 etc4 ,cerebellum--examine with same care1 and note same points as in cerebrum4 ,inflammation4 ,acute inflammation of the brain substance is a rare disease1 except as the result of mechanical injury4 ,in such cases1 the disease is generally quite circumscribed1 being confined to the immediate region of the injury4 ,the brain becomes very vascular1 acquiring a red color1 which1 at a later period1 changes to a brown or greenish hue1 and becomes much softer than natural4 ,if a foreign body be lodged in the brain1 as a piece of bone1 or a bullet1 then the inflammation is likely to result in an abscess1 which will give rise to head-ache1 delirium with intolerance of light1 succeeded by convulsions1 coma and death4 ,subacute1 or chronic inflammation of the brain1 is much more common1 yet is accompanied with pathological changes similar to those of the acute form4 ,at first1 the inflamed portion becomes red and congested1 the color gradually changing to a crimson1 purple1 brown1 or claret color1 with more or less change of consistence4 ,the symptoms attending inflammation of the brain substance1 or cerebritis1 are not readily distinguishable from those of meningitis2 indeed1 in most instances the two diseases are1 to a certain extent1 combined2 as1 from the vascular connection between the brain and pia mater1 there might be a ready extension of inflammation from one to the other4 ,when1 however1 there is any sudden perversion of the sense of vision or hearing2 or if there are convulsions1 affecting mainly one side of the body2 or if coma succeeds the convulsions and is accompanied by one-sided paralysis1 we may expect to find evidence of inflammation of the cerebral substance1 with possibly that of the membranes also4 ,it is a fact to be borne in mind1 however1 that while in typhus and typhoid1 and perhaps some other forms of fever1 we may have symptoms strongly resembling those of idiopathic inflammation of the brain or its membranes1 still the post-mortem will reveal no trace of any such morbid condition4 ,softening4 ,to be able to recognize readily any change in the consistency of the brain1 clear ideas must first be had of the normal density of this organ4 ,this may be obtained from an examination of the brain of some of the lower animals--as the sheep or ox--that has been killed in a state of health4 ,we shall then find that the brain presents sufficient firmness to permit of its being handled without rupture of its substance1 and to allow of its being sliced into thin sections which will support their own weight4 ,the gray portion is somewhat softer than the white1 yet the fibrous character of the latter1 becomes apparent only after hardening in alcohol4 ,if put into pure water1 it continues unchanged for eight or ten hours1 and without any portion becoming dissolved1 or rendering the water any degree turbid4 ,the consistence of the brain varies1 normally1 at different periods of life4 ,in the ftus and at birth1 its softness approaches to semi-fluidity4 ,from this to the fifteenth or twentieth year1 it gradually acquires the firmness of the brain of the adult4 ,softening1 one of the most common variations from the normal condition1 is generally a mere result of inflammation of a chronic or sub-acute form1 accompanied with a fatty degeneration of nerve substance4 ,under the microscope1 the change is seen to consist in a disintegration of the nerve fibres1 the medullary substance breaking up into large masses1 and undergoing fatty metamorphosis4 ,it may take place either on the external surface of the organ1 or in the septum lucidum and fornix1 the corpora striata1 or optic thalami of the ventricle1 the central parts of the hemispheres1 the cerebellum1 or the crura cerebri1 in the order mentioned4 ,while this change is usually the result of inflammation1 as already mentioned1 it may accompany or succeed the following morbid conditions of the organ3 #a4 ,it may be the result of congestion of the vessels of some portion of the brain4 ,in this case1 the softened portion is reddish1 crimson1 or brown in color4 #b4 ,it may follow the effusion of blood in apoplexy4 ,the softened portion is then of a brownish color1 or1 if considerable time has elapsed1 it may be of a dirty ash color1 tending to green4 #c4 ,it may accompany or follow the process which terminates in serous effusions4 ,it is then of a milky-white color4 #d4 ,it may take place in the brain substance immediately around tumors1 when its color may present a variety of tints4 ,among the causes tending to induce this condition of the brain1 may be mentioned a diseased state of its blood vessels1 or their obstruction by fibrinous clots2 constitutional syphilis2 excessive mental labor1 or frequently repeated epileptic convulsions4 ,the consistency will be found to vary from a slight change from the normal condition1 to that of a soft1 pulpy1 or even cream-like condition4 ,the symptoms accompanying softening of the brain1 present a considerable variation4 ,among the more prominent1 may be mentioned an unsteady or tottering gait1 partial palsy1 thick and inarticulate speech1 feeble memory1 disordered intellect1 dull pain or heaviness in the head1 frequent drowsiness1 formication1 numbness or rigidity1 or occasional involuntary contraction of the muscles of the upper extremities4 ,abscess of the brain1 differs from softening1 to which it may have some points of resemblance1 in the purulent matter being contained in an irregular cavity1 lined with a more or less distinct membranous cyst4 ,flakes of lymph are frequently found in these abscesses1 giving the matter much the appearance of that contained in scrofulous abscesses1 and they are most commonly found in subjects who present the usual symptoms of the strumous diathesis4 ,while these collections are unquestionably often the result of inflammation1 yet it has been claimed that they may result from previous disease of a suppurative character in the lungs1 and perhaps other organs1 the purulent matter being taken up by the veins and carried into the general circulation1 and finally deposited in the substance of the brain4 ,abscesses may be found in any portion of the brain substance1 or the purulent accumulation may be found between the bone and dura mater1 or between the two layers of the arachnoid4 ,in the latter cases1 the disease may generally be traced to caries of some of the bones of the head1 as of the petrous or mastoid portions of the temporal1 or of the bones of the nasal cavity1 involving the cribriform portion of the ethmoid4 ,again1 abscesses in the brain may result from external violence1 as from a blow or fall upon the head4 ,it is remarkable1 that in these cases1 some months may elapse between the date of the injury and death4 ,hardening4 ,induration of the cerebral substance1 is a condition not readily distinguished during life from that of softening1 the two states being accompanied by symptoms of a similar character4 ,dr4 ,jones1 who has charge of the male department of the ,pennsylvania ,hospital for the ,insane1 and has had many opportunities for examining the brains of insane patients1 tells me that he found hardening1 nearly as frequently as softening1 in these cases1 and never could tell beforehand1 with certainty1 which condition might be present4 ,in hardening of this organ1 its density may be increased to that of boiled white of egg1 or it may approach in consistence to that of a brain that has been hardened in alcohol1 losing much of the sticky1 adhesive character when broken up by the fingers1 which marks the brain substance when in its normal state4 ,the cause of the change is not well known1 yet it is conjectured to be one of the results of inflammation1 inasmuch as it is generally found with its capillaries greatly loaded with blood1 while more or less fluid is found beneath the arachnoid and in the ventricles4 ,the induration may affect the greater part or even the whole of the cerebral mass1 or may be confined to particular portions or regions4 ,in a case recently examined for ,dr4 ,toothaker1 of this city1 where insanity of some years' duration1 and finally death1 had followed a severe injury of the head1 the brain was found so hard as to permit of fracture in the direction of the fibres1 thus readily tracing their course4 ,the symptoms that have most frequently been observed to accompany this change are1 defect and gradual loss of memory1 apathetic indifference1 slight difficulty of articulation1 followed by loss of sexual desire1 partial palsy1 fatuity1 wasting and death4 ,extreme induration is often found in the brains of idiots4 ,the whole organ may be found resembling in color and density boiled white of egg1 or even cheese4 ,the cerebral substance is shrunken1 dense1 and apparently quite void of vessels4 ,hypertrophy of the brain1 is a condition in which there is usually increased hardness as well as increased volume1 and is distinguished by flattening of the convolutions1 narrowing of the ventricles1 and a remarkable dryness of the whole organ with its membranes1 the change involving both the cerebrum and cerebellum1 and accompanied with an increase of weight1 all indicating increased nutrition1 or the deposit of new matter in the tissue of the brain4 ,thinning of the cranial bones may attend this condition1 increased internal pressure resulting in their partial absorption4 ,the causes of this form of disease are not generally understood4 ,the symptoms1 though always present1 are not uniform4 ,among them may be mentioned intense head-aches1 a weakened or perverted state of the intellectual faculties1 fits of giddiness1 accompanied with stupor2 finally1 convulsions1 with perhaps loss of sensation and motion1 the patient being unexpectedly cut off by an epileptic attack4 ,the disease has not been observed in persons over fifty4 ,in most cases1 the patients were between twenty and thirty4 ,in one instance1 however1 it was developed in a young girl of thirteen4 ,lead poisoning would seem to be an exciting cause1 it having1 in several instances1 been developed in painters and manufacturers of white lead4 ,atrophy4 ,in this condition1 there is found a general diminution of the volume of the brain1 and especially of the convolutions4 ,the latter are shrunk1 narrow1 and sometimes softened1 while the sulci are large and open1 the brain receding from the skull1 and the pia mater greatly injected with serous fluid1 giving the appearance of a jelly-like investment to the whole brain4 ,the brain substance is at the same time soft1 the ventricles enlarged and filled with fluid1 while a large amount of serum will flow from the sub-arachnoid space at the base of the brain1 and from the spinal canal4 ,while this condition of the brain might be looked upon as a result of pressure from the accumulated serum1 the absence of the usual symptoms of hydrocephalus1 with the known history of these cases1 renders it quite probable that the change commences as an actual loss of brain substance1 the place of the latter being supplied with serous fluid4 ,resulting from atrophy of the brain1 there will often be found an increased thickness of the cranial bones1 this being another conservative effort of nature to preserve the normal support and pressure upon the brain4 ,atrophy of the brain is sometimes found in old age and in various enfeebling diseases1 where all the organs suffer more or less waste from improper nutrition1 but it is so frequently found with drunkards1 especially those who have died with delirium tremens1 that this condition may1 in the large majority of cases1 be considered as the effect of intemperance4 ,several forms of atrophy may also be observed4 ,it may be confined to some portion of the convoluted surface1 or to one of the striated bodies or optic beds4 ,atrophy of the optic tracts1 or nerves of one or both eyes1 is not unfrequently associated with loss of sight from amaurosis4 ,tumors of the ,brain4 ,the brain1 like other parts of the body1 is subject to morbid growths of a great variety of forms4 ,the symptoms of tumors in the brain1 in many points1 present such resemblances to other forms of disease1 that it is usually the post-mortem alone1 that will determine the fact of their presence or character4 ,it may be said in general1 however1 that the effects of morbid growths in the brain will vary according3 #a4 ,to the changes in the surrounding cerebral substance2 #b4 ,to the size of the growth2 and #c4 ,to the position of the brain in which it may be developed4 #a4 ,the changes induced in the brain substance surrounding tumors are usually1 first1 derangement of the circulation1 and second1 as a result of this1 effusion of serum1 or finally1 softening of a greater or lesser amount of contiguous cerebral substance4 ,head-ache1 with epileptic attacks1 loss of memory1 irregular contraction of the muscles and partial paralysis may accompany the vascular derangement1 while as softening or pulpy destruction supervenes1 a general aggravation of all the symptoms will follow1 ending in death1 either with coma or by a sudden apoplectic attack4 #b4 ,tumors of the brain of a small size1 may be found after death from other causes1 that have evidently produced no symptoms during life2 and in other instances1 they have induced no change until a few days before death1 in which cases1 the convulsions1 paralysis and coma which precedes this result1 must be attributed to the vascular disturbance in the surrounding brain tissue4 #c4 ,the position of the tumor1 will modify to some extent the character of the symptoms manifested4 ,when in the anterior lobes1 loss or impairment of speech is said to attend4 ,while1 when in the corpus striatum1 the motions of the legs and arms are disordered4 ,the following are the more commonly recognized tumors of the brain3 ,adenoid1 or ,glandular-like ,tumors4 ,these are generally described as resembling an enlarged lymphatic gland1 both in color and density4 ,they may vary in size from a filbert to that of an orange4 ,there may be a single growth of this kind1 or several1 and they may be found in any part of the brain4 ,tubercular or ,scrofulous ,tumors4 ,under this head may be placed certain bodies of a white or pale yellow color1 firm1 like soft cheese1 sometimes granular and friable1 and consisting chiefly of a large proportion of albuminous matter4 ,they may be found first1 as one or more individual masses of considerable size2 or second1 sometimes as many minute rounded bodies1 distinct and separate from one another4 ,in examining the head of a hydrocephalic child of four years1 with ,dr4 von ,tagan1 we found attached to the underside of the middle lobe of the left hemisphere1 a body of a white cheesy consistence1 and of the size of half a hen's egg4 ,connected with the cerebellum1 was another tumor of the same character1 but smaller in size4#f ,tubercular masses of this kind1 may be found on the surface1 or imbedded in the substance of any portion of the cerebrum or cerebellum4 ,the second form of tubercular deposits1 are confined almost wholly to the gray matter of the surface4 ,in one case1 over two hundred of these bodies were found scattered through the gray matter of the cerebrum and cerebellum1 of the size of a pea or bean1 and of a pale yellow or bluish color4 ,when cut open1 the interior of the bodies was found to resemble boiled potatoes in consistency4 ,this form of disease is confined principally to children4 ,of thirty cases collected by ,dr4 ,p4 ,h4 ,green1 of ,london1 all were between the ages of nineteen months and twelve years4 ,adipose ,tumors4 ,under this name1 has been described a peculiar and quite rare form of disease of the brain1 in which either some portion of the brain itself1 or growths attached to or imbedded within the cerebral substance1 present a fatty appearance1 which by some has been denominated lardaceous degeneration4 ,the exterior of the tumor is smooth1 of a yellow color1 and the interior composed of adipose matter of ash color1 and semi-solid consistency4 ,cholesteroma4 ,this is another rare form of tumor of the brain1 consisting of white pearl-like1 glistening bodies1 varying in size from that of a pea1 to a walnut or small orange4 ,they are found mostly at the back of the brain1 and in the sub-arachnoid tissue4 ,when examined chemically1 the substance of these tumors is found to consist almost wholly of cholesterin4 ,cartilaginous ,tumors4 ,these are often spoken of as scirrhus in their nature4 ,they may be described as irregular in shape1 sometimes lobulated1 the interior yellowish in color1 of a cartilaginous hardness1 and arranged sometimes in streaks or bands1 in other cases1 in rounded masses4 ,at a more advanced stage1 from softening of the interior1 cavities begin to form1 which are filled with a semi-fluid or jelly-like substance4 ,death will generally ensue before this process is far advanced4 ,calcareous or ,bony ,deposits4 ,osseous formations are not unfrequently found connected with the membranes of the brain1 but rarely1 if ever1 with the brain substance4 ,calcareous deposits1 on the other hand1 have been found in almost every part of the brain4 ,in the brain of an idiot of sixteen1 the pons ,varolii1 crura cerebri and cerebellum1 contained so much earthy matter1 as to give difficulty in cutting with a knife 7,sir ,e4 ,home47 ,in the brain of a man who had long suffered from acute pain in the head1 a hard plaster-like concretion was found as large as a filbert4 ,these bodies are1 therefore1 not to be looked upon as genuine bony formations1 but rather as an infiltration of chalky substance into the brain tissue4 ,of the same nature1 are the calcareous deposits found in the pineal gland1 which1 although very constantly present after the age of eight or ten years1 can hardly be considered as normal products1 although it is well established that they exert no influence on the functions of the brain4 ,encysted ,tumors1 ,hydatids4 ,a variety of tumors of the encysted form have been found in the brain by different observers1 varying in size from a pea1 to that of an egg or orange4 ,their contents also1 have presented a great degree of variation4 ,while some have been filled with the cheesy substance of the ordinary steatome1 others have contained blood1 a jelly-like1 or even a limpid watery fluid4 ,it has been claimed by some1 doubted by others1 that the animal hydatid1 the cysticercus1 has been found in the human brain4 ,having unquestionably been observed in the eye1 the heart1 and other parts of the body1 it may also1 possibly1 sometimes be found in the brain4 ,this curious animal is now known to be but the larval form of one of the cestoid entozoa1 the ,tnia solium4 ,its position in the brain1 can only be accounted for1 by supposing that the embryo1 which in its first stage is very minute1 by piercing the coats of the stomach1 into which the egg has been taken with the food1 enters a blood-vessel1 and being carried into the brain1 lodges in some of the capillaries1 the walls of which it penetrates4 ,entering thus the brain substance1 it develops into the second larval form1 which consists of a small bag or cyst1 filled with a limpid fluid4 ,developed within the cyst1 yet capable of being thrust out1 is the head1 which presents four sucker-like processes1 surrounded by a circle of minute hooks1 which give it the power of active migration through the tissues4 ,in the pig1 the presence of these cysticerci constitutes measly pork1 which if taken into the stomach in a raw state1 the contained larv at once develop into the perfect worm1 the ,tnia solium4 ,blood ,cysts1 though not common1 have been found in the brain4 ,they consist of a membranous cyst1 which may be lobulated or contain smaller cysts1 the inner surfaces of which are lined with a vascular membrane1 from which escapes a bloody fluid4 ,cancerous ,tumors may be found in any portion of the brain1 and may present the several varieties of these malignant growths1 including fungus hmatodes4 ,while they are generally secondary with similar tumors in other parts of the body1 they may be primary in their origin4 ,they may acquire such a development as to cause absorption of both the dura mater and skull1 and thus appear upon the outside of the head4 ,in fungus hmatodes1 the enclosed substance consists of soft spongy matter1 of a brain-like consistency1 divided into lobular masses1 of a reddish shining aspect4 ,they are mainly found in young subjects1 sometimes in adults4 ,melanosis4 ,this form of morbid growth is occasionally found in the human brain4 ,the middle lobe of the left hemisphere of the brain of a subject in the dissecting-room1 was found to be attached to the dura mater by a melanotic mass1 resembling the dark bodies frequently found around the bronchial tubes4 ,its attachments were such as to render it doubtful whether it had its origin in the brain or in its membranes4 ,the gray substance of the brain of persons who have suffered malarial diseases1 is sometimes found presenting a blackish appearance from the dark pigment within its substance1 or within the pia mater4 ,syphilitic ,tumors are occasionally found in the brain1 situated near its surface4 ,their characters are not such as to permit of their ready recognition1 except when associated with syphilitic growths in other parts of the body4 ,they may vary in size from a pin's head to a cherry4 ,they present a rounded or irregular form1 a yellow color1 and are composed of spindle-shaped or round cells1 which may undergo a cheesy degeneration4 ,obstruction of ,cerebral ,arteries4 ,patients suffering from endocardial inflammations1 or from aneurism of the arch of the aorta1 or from any cause having fibrinous deposits forming in the heart1 are liable to have the same washed along the carotids1 and thus carried into the vessels of the brain1 thereby deranging the circulation through this organ4 ,the symptoms resulting1 are generally those of apoplexy4 ,hemiplegia1 with or without loss of consciousness1 follows4 ,softening of the cerebral substance follows as a result of the accident1 and it is not impossible but that the presence of these bodies is the general cause of this structural change of the brain4 ,the position of the embolus1 in fatal cases1 is usually in one of the middle cerebral arteries2 these vessels being in a more direct line with the internal carotids4 ,they may lodge1 however1 in the vertebrals or basilar1 yet through the circle of ,willis1 the several parts of the brain will still receive a partial supply of blood4 ,atheromatous ,degeneration1 and ,calcification of ,cerebral ,arteries4 ,the coats of the arteries of the brain in old people1 are liable to become infiltrated with atheromatous and calcareous matter to such a degree1 as to render them rigid1 and inelastic4 ,while the arteries of the base of the brain1 as the basilar1 the cerebrals1 or the communicating of the circle of ,willis1 are more liable to this change1 it may involve the smaller branches as well4 ,the increased thickness of the coats of the vessels1 results in a diminution of the calibre1 while they are enlarged in external circumference4 ,resulting from this state of the vessels1 we shall have disturbed circulation1 followed by effusion1 and in some cases by atrophy of the brain4 ,attending this condition1 are frequent attacks of stupor and insensibility1 lasting for several hours or even days4 ,again1 from the weakened condition of the coats of the vessels in these cases1 we may have an aneurism resulting1 the walls of which suddenly giving away1 death from hmorrhage speedily follows4 ,section ,,iv4 ,,of ,,the ,,spinal ,,cord4 ,notice in examination4 #a4 ,vertebr4--,condition of several parts2 caries1 etc4 #b4 ,vertebral ,canal4--,proportion to cord2 contained fluid2 serum1 pus or blood2 amount1 etc42 condition of spinal veins4 #c4 ,membranes of cord4--,bulging of any part2 thickening2 congestion2 morbid growths1 etc42 fluids within2 amount1 color1 etc4 #d4 ,spinal cord4--,weight2 size2 condition of fissures2 of interior1 as seen on section2 softening2 exact point of2 roots of nerves2 pressure upon1 etc4 ,from the continuity and identity of structures1 the spinal cord is subject to essentially the same diseases as those of the brain4 #a4 ,the ,membranes4 ,inflammation of the latter may exist alone1 or in connection with that of the membranes of the brain1 constituting cerebro-spinal meningitis4 ,inflammation of the dura mater is an uncommon occurrence4 ,the inflammation in spinal meningitis is almost wholly confined to the pia mater1 this being the more vascular of the membranes4 ,a pale reddish1 or sometimes purple color1 with a bloody jelly-like infiltration1 characterizes the earlier stage1 while at a later period the membrane presents a greyish or dirty yellow appearance1 from the presence of a thick pus-like substance covering the surface4 ,such inflammations may be either idiopathic1 rheumatic or traumatic in their origin4 ,in spotted fever the inflammation extends to the pia mater of the base of the brain1 and is remarkable from the epidemic form which it sometimes assumes4 ,tubercular deposits1 as well as tumors of various kinds1 may be found connected with the spinal membranes1 so similar to those described with the cerebral membranes1 as not to require separate notice4 ,serous effusion may be found in the spinal canal1 in the same cases when it exists in the cranial cavity1 and may be either a diffusion of fluid through the sub-arachnoid space1 that has been effused in the brain1 or it may originate from the membranes of the cord itself4 ,the fluid may be either between the vertebr and dura mater1 or between the latter and the pia mater4 ,a peculiar form of dropsy of the spine is sometimes found1 congenital in its nature1 and accompanied with a deficiency in the spinal column1 by means of which a cleft remains in the arch of one or more of the vertebr2 hence the name1 ,spina bifida1 as applied to this disease4 ,the effusion in these cases1 taking place before the vertebr are fully developed1 the pressure from within prevents the final closure of the canal posteriorly2 when1 from want of support at that point1 the membranes and covering tissues1 yielding to the pressure from the accumulating fluid1 gradually protrude at that point1 producing a rounded fluctuating tumor4 ,the disease is more frequently found in the lumbar region1 although it may occur in the dorsal or cervical1 and in some cases may involve the whole spinal column4 #b4 ,spinal ,marrow4 ,inflammation of this structure1 7myelitis17 presents the same character1 and may be followed by the same results as inflammation of the brain4 ,from the distension and engorgement of the capillaries of the inflamed part1 a bright red color may be presented1 not only on the surface1 but in the substance of the cord when exposed by division4 ,blood may also be found effused in the substance of the cord1 or between its membranes1 or between the bony walls and the dura mater4 ,softening of the spinal cord1 may arise either spontaneously1 or as a consequence of injury4 ,when spontaneously taking place1 a large portion of the cord may be involved4 ,the appearance presented1 is most usually that of a soft pulpy mass1 which easily breaks down upon the opening of the membranes4 ,when the result of injury1 the softening is generally confined to the portion involved in the original violence4 ,hardening of the spinal marrow1 7sclerosis17 may be one of the results of inflammation1 yet the accompanying symptoms may vary so slightly from those of other forms of spinal disease1 that the post-mortem alone1 will disclose the true nature of the difficulty4 ,in locomotor ataxy1 the posterior columns of the cord are usually affected with this change4 ,atrophy of the spinal cord1 differs from hardening1 in the shrinking which attends the progress of the disease1 although there may be increased density1 as in the former case4 ,the essential peculiarity of atrophy1 consists in an increased development of the fibrous elements of the cord1 which by pressure1 gradually destroys the elementary nerve constituents4 ,this disease is confined chiefly to men of a middle age1 and is generally the result of venereal excesses2 muscular over-exertion1 exposure to cold1 c41 may also be exciting causes4 ,morbid ,growths1 of various kinds1 and closely resembling those found in the brain1 as well as animal parasites1 are sometimes found in the spinal cord4 ,,part ,,ii4 ,,the ,,neck ,,and ,,chest4 ,,chapter ,i4 ,,operation ,,on ,,the ,,neck4 ,the parts which we may wish to examine in the region of the neck in a post-mortem examination1 include the tongue1 the larynx1 the trachea and the sophagus4 ,these may be removed together1 by first making a single1 straight incision from the chin1 down the central line of the neck to the sternum4 ,next turn aside the integument with the superficial structures1 separate the muscles of the tongue from their attachment to the jaw1 and divide the mucous membrane of the floor of the mouth on either side of the tongue1 when1 with the tenaculum1 the latter may be drawn down beneath the jaw4 ,the neck being well extended and the tongue forcibly drawn down1 the knife may be carried back on either side of that organ1 dividing the muscles and mucous membranes1 including the palatine arches and tonsils1 when the tongue may be so drawn down as to permit the knife to reach the posterior walls of the pharynx4 ,this being divided1 from the slight adhesion to the spinal column1 the whole may now be drawn down and removed together1 the trachea and sophagus being divided at the upper end of the sternum4 ,by the use of the enterotome1 the pharynx1 larynx and trachea may be laid open from behind1 which will fully expose their interior for careful examination4 ,after the examination of the parts is completed1 if it is desired to preserve the specimen1 the cavity remaining may be so filled with paper or rags1 as1 upon the closing of the part1 to leave little or no evidence of the absence of any portion4 ,through the mouth1 the buccal cavity may be examined1 when there may be noted the condition of the teeth1 gums1 tonsils1 palate1 etc42 the presence or absence of ulcers on any of these parts1 or of food or other foreign substances within the cavity4 ,,operation ,,on ,,the ,,chest4 ,in opening the thoracic cavity for an examination of its contents1 a straight incision may be made along the central line1 through the skin and superficial tissues1 from the upper end of the sternum1 to near the umbilicus4 ,if it is desired to examine the abdomen at the same time1 the incision may be carried on to the pubis2 otherwise1 ending just above the umbilicus1 a transverse cut may be carried from its lower end1 to the border of the chest upon either side4 ,these incisions being carefully carried through the muscles and peritoneum1 the flap thus formed may be lifted and turned up upon the chest1 and the peritoneum divided along the cartilages of the ribs4 ,the integument with the pectoral muscles may now be dissected up together1 and turned back as far as the union of the cartilages with the ends of the ribs4 ,with the heavy cartilage knife1 the former may now be divided near their union with the ribs2 care being observed not to permit the knife to pass into the chest1 and thus injure the lungs4 ,in aged persons1 and sometimes in the middle aged1 the cartilages will be found so ossified1 as to require the use of the saw or chisel in the place of the knife2 this being more frequently required with the first ribs1 than with any other4 ,the ligaments uniting the clavicle with the sternum1 having been divided1 the latter may be removed by commencing at the lower end1 and separating the diaphragm from its connections to the sternum and costal cartilages4 ,the sternum being now lifted from below1 the mediastinum may be divided1 this forming the only bond of union to the parts beneath1 except in cases1 where1 from pleuritic inflammation1 adhesions may exist between the lungs and costal cartilages4 ,the sternum having thus been removed1 the lungs will be found more or less collapsed from atmospheric pressure1 unless adhesions be so extensive as to prevent4 ,the attention may now be given to the pericardium and heart4 ,by making a small opening into the cavity of the former1 any dropsical fluid present may be removed and measured4 ,this may be accomplished1 by introducing the point of a syringe into the opening1 and carefully drawing the fluid into the same1 and then forcing it into some vessel4 ,or1 it may be carefully absorbed by a sponge1 and then squeezed out and measured4 ,the heart may be removed for examination1 by dividing the large vessels springing from its base4 ,in examining the cavities1 valves1 c41 the right auricles should first be opened1 by an incision along its base1 another meeting this at right angles1 thus making two angular flaps1 which may be turned aside1 exposing the interior4 ,in opening the ventricle1 let one incision be made parallel with1 and about one-third of an inch from the groove in the anterior surface dividing the right from the left ventricle1 commencing at the base and extending to the apex2 and another along the posterior groove1 meeting the former at the apex1 thus making a triangular flap1 which may be lifted1 exposing the interior of the cavity1 without injury to the tendonous cords4 ,the semilunar valves of the pulmonary artery may readily be exposed1 by splitting open that vessel1 and turning aside its walls4 ,the left side of the heart may be examined in the same manner4 ,the examination of the lungs may often be made in situ4 ,deep incisions may be made into their substance at various points1 or portions may be removed for examination4 ,if a more careful inspection is desired1 or if we wish to examine the bronchial tubes or aorta1 the whole thoracic viscera may be removed together4 ,to accomplish this1 divide the trachea and sophagus1 as they enter the chest1 with also the branches arising from the arch of the aorta4 ,carry the hands around either lung1 breaking up any adhesions which may be found1 and then by grasping the trachea and arch of aorta1 and dragging down upon the same1 the posterior mediastinum may be divided from above downwards1 the aorta and sophagus divided as they pass the diaphragm1 and the whole of the contents of the chest thus removed en masse4 ,placed upon a large tray1 they may now be examined in detail4 ,the bronchial tubes may be best inspected from behind1 laying open the passages with the scissors at their posterior walls4 ,by means of deep incisions1 extending from apex to base upon the anterior surface1 the condition of the interior of the organs may be carefully noted4 ,the examination completed1 all blood should be sponged from the cavity1 the organs replaced1 and any remaining vacancy filled with bran or sawdust4 ,the sternum now being placed in position1 the incision may be sewed up4 ,,chapter ,,ii4 ,,pathological ,,conditions4 ,section ,i4 ,,of ,,the ,,tongue4 ,notice in examination3 size2 form2 surface coated or clean2 furrowed or fissured2 marks of bites1 stains2 color generally2 vesicles2 ulcers2 sloughs2 tumors1 wounds1 etc4 ,the diseases of the tongue1 the appearance of which we may wish to examine after death1 include cancer1 syphilitic ulcers or tubercle1 tumors1 hypertrophy1 etc4 ,cancer is the only disease of this organ likely to result in death4 ,it is said to occur more frequently in females than males4 ,it may assume the various forms of this disease1 but is more frequently epithelial or scirrhus1 than medullary4 ,syphilitic ,ulcers or ,tubercle1 may be confounded with cancer1 and in some instances1 only a previous knowledge of the history of the case1 assisted by a microscopic examination1 would positively determine the diagnosis4 ,tumors of various kinds--encysted1 fatty1 fibrous and erectile--may be found in the substance of the tongue1 or underneath it in the floor of the mouth4 ,ranula is a peculiar form of tumor found under the tongue1 often attaining the size of a pigeon's egg1 and filled with a watery or albuminous1 or sometimes cretaceous matter4 ,the tumor is usually considered as arising from a dilatation of ,wharton's duct1 but of this there is doubt in some cases4 ,hypertrophy of the tongue is sometimes found1 where1 from an increase of the connective or areolar tissue1 without any change in the muscular fibres1 the organ has become greatly enlarged1 so as to cause deformity of the mouth1 or even of the whole lower part of the face4 ,this condition may involve the whole or a portion only of the tongue4 ,section ,,ii4 ,,of ,,the ,,larynx ,,and ,,trachea4 ,notice in examination3 #a4 ,contents--mucus2 lymph2 pus or blood2 amount2 foreign bodies2 false membranes1 etc4 #b4 ,larynx--condition of epiglottis2 dema1 ulcers1 sloughs1 polypi2 same of superior opening to cavity4 ,ventricles--condition of mucous membranes1 etc4 ,vocal ,cords--thickness1 color1 dema1 ulcers1 etc4 ,cartilages--condition of2 ossification2 caries1 etc4 #c4 ,trachea--contents2 mucous membrane2 cartilaginous rings2 ossification of2 caries2 denuded of mucous membrane1 etc4 ,inflammation1 ulceration1 dema1 necrosis of the cartilages1 tumors and false membranes are the more usual pathological conditions of these parts that may claim the attention in a post-mortem examination4 ,inflammation of the mucous membrane of the larynx 7laryngitis7 and trachea1 will appear as a diffused redness1 with some thickening of the membrane1 and within which may be traced many small1 congested blood-vessels4 ,it may be important to distinguish the redness of inflammation1 from that attending the early stage of decomposition1 which1 it is an interesting fact to know1 first appears in these parts4 ,immediately after death1 the mucous membrane is pale1 except in death from suffocation or laryngitis4 ,in a day or two it becomes of a dusky red1 which is distinguished from that of inflammation by the absence of congested vessels2 the redness of decomposition1 also1 having a superficial filmy appearance1 as if washed with dirty wine4 ,ulceration of the larynx commences in the mucous membrane1 but may extend to the deeper parts4 ,the more usual location is upon the epiglottis1 or on the margin of the glottis and vocal cords4 ,impairment of the voice to a greater or less degree1 will have attended either inflammation or ulceration of the vocal cords4 ,it is to be borne in mind1 however1 that aphonia may arise from some impairment of the nerves of the larynx1 in which case1 a post-mortem examination will fail to reveal any morbid condition of the mucous membrane or vocal cords4 ,pulmonary consumption we sometimes find accompanied with the presence of ulcers upon the posterior walls of the larynx1 with evidence of inflammation in the surrounding parts4 ,whether these arise from tubercles in the mucous membrane1 or ulceration of the mucous follicles1 is uncertain4 dema of the larynx1 is attended with great swelling of the mucous membrane1 from serous effusion into the submucous tissues1 and frequently attends chronic inflammation of the parts1 with ulceration4 ,it may1 however1 be of an erysipelatous character1 occurring as the result of exposure to infection4 ,the surface appears red1 pulpy and swollen1 from infiltration of the submucous tissue4 dema of the larynx1 is confined to the parts around the epiglottis1 and margins of the glottis1 never descending below the true vocal cords1 owing to the close adhesion of the mucous membrane to the fibrous structure of the cord1 without any intervening areolar tissue4 ,necrosis of the ,cartilages of the larynx1 may occur in the advanced stage of laryngitis with ulceration4 ,in this manner the epiglottis1 with the arytenoid1 the cricoid1 and even thyroid cartilages may1 to a greater or less extent1 be destroyed4 ,abscesses may also form1 where the cartilages are so much involved1 these in some cases breaking upon the outside1 and establishing fistulous communications through which air may escape during respiration4 ,tumors of the larynx1 may be found first1 outside of the cavity1 imbedded in some portion of its tissues2 and may include encysted1 fatty or fibrous tumors2 or1 second1 they may be found in the interior1 springing from the mucous membrane1 and resembling polypi in their form and structure4 ,they are sometimes granular or cauliflower-like in appearance1 and vary in size from a pea to a hazel-nut4 ,false ,membranes may be found in the larynx and trachea in fatal cases of croup or diphtheria4 ,in croup1 the membrane adheres but slightly to the mucous structure beneath1 which will be found red and congested1 but may form a complete tubular lining to both larynx and trachea1 extending also into the bronchial tubes4#g ,it is usually tougher in the larynx and upper portion of the trachea1 becoming softer and more gelatinous in the lower portion of the trachea and bronchial tubes4 ,much difference of opinion has been entertained as to the nature of this substance4 ,it may1 however1 be considered as a morbid secretion from the inflamed mucous surfaces1 in a semi-fluid form1 which1 in consequence of the presence of albuminous matter1 coagulates upon exposure to air4 ,the false membrane of croup may generally be distinguished from that of diphtheria by the fact1 ,first1 ,that the latter is usually confined to the fauces1 sometimes extending to the larynx1 rarely to the trachea4 ,second1 ,that diphtheritic membrane occurs more in patches1 is tougher1 is more directly incorporated with the mucous surface beneath1 and is removed with more difficulty4 ,third1 ,a microscopic examination shows the membrane to be composed mainly of fibrine in a fibrillated condition1 with granular corpuscles and pus cells4 ,section ,,iii4 ,,of ,,the ,,pharynx ,,and ,,sophagus4 ,notice in examination3 displacements2 their cause1 as by tumors1 etc42 dilatation2 contraction or stricture1 seat of2 calibre at stricture2 above1 below2 condition of mucous membrane2 ulcers1 etc4 ,contents of sophagus2 food1 foreign bodies1 wounds4 ,these parts are liable to inflammation1 ulceration1 stricture1 dilatation and new growths4 ,inflammation of these passages1 rarely occurs1 except as the result of mechanical injury1 as from the lodgment of a foreign body1 or from swallowing some caustic or highly irritating substance4 ,catarrhal or croupous inflammation of the mouth and tonsils1 may1 however1 involve a portion of the walls of the pharynx4 ,ulceration may result from the same causes1 and hence may be confined to a small portion or may involve the greater part of the tube4 ,stricture of the sophagus may be either spasmodic or organic4 ,the former usually occurs in hysterical women1 and may result from the irritation following the removal of some foreign body lodged in the canal4 ,never proving fatal of itself1 we seldom have the opportunity of examining a case of this kind4 ,organic stricture is found usually at the commencement of the canal1 sometimes at its lower end4 ,it may result from contractions attending the healing of an ulcer1 but is more frequently induced by a cancerous affection of the walls1 or by the projection of some morbid growth into its interior1 as from aneurism of the aorta1 or tumors1 abscesses1 c41 in the lungs or left lobe of the liver4 ,dilatation of the sophagus may result from the presence of stricture4 ,when the latter is near the cardiac orifice of the stomach1 the entire length of the tube may be involved4 ,the walls in these cases may be either thickened or thinned4 ,from the accumulation of food above the point of stricture1 the walls gradually yield to the distending force1 until a degree of dilatation is attained that is quite remarkable4 ,tumors of various kinds are occasionally found within the walls of the pharynx or sophagus including cystic1 fatty and fibrinous tumors of a polypoid form4 ,malignant or cancerous growths may appear in any part of the tube1 the epithelial form being more common4 ,beginning in the submucous tissue1 the disease will soon involve the whole circumference of the tube1 to the extent of from one to three or four inches1 producing a hardness of the tissues with more or less contraction4 ,ulceration ultimately taking place1 a dilated cavity may take the place of the original stricture4 ,section ,,iv4 ,,of ,,the ,,pericardium4 ,notice3 #a4 ,external characters--shape2 measurement2 amount of fat1 etc4 #b4 ,contents--serum2 quantity2 color2 how affected by heat2 blood2 quantity2 character2 source4 #c4 ,internal surface--adhesions2 their position1 extent and character2 as firm1 soft1 etc4 ,the pericardium is subject to the same affections as other serous membranes1 including inflammation1 adhesions1 effusions or morbid growths4 ,inflammation of the pericardium or pericarditis1 is characterized by an unusual dryness of the surface1 with injection of the vessels in the early stage1 while at a later period a layer of plastic lymph will be found adhering to the surfaces4 ,the deposit may be limited to some small portion1 or be distributed over the whole inner surface of the membrane and upon the exterior of the heart1 giving them the appearance of having been smeared over with some sticky substance4 ,often the surfaces are rough or villous in appearance1 like the mucous membranes of the intestines4 ,irregular calcareous patches are sometimes found in old chronic cases1 developed within the thickened portions of the membrane4 ,adhesions may also form between the surfaces in contact4 ,the whole cavity may in this manner become obliterated1 or bands of adhesion may be found here and there4 ,effusions may be found in the pericardium1 as in other serous cavities4 ,when the result of pericarditis1 the fluid will often contain floating shreds of lymph4 ,sometimes the fluid will be found highly albuminous1 and again bloody or mixed with pus4 ,this effusion may have taken place so early as to have prevented any adhesion of parts2 or it may not have commenced until union had taken place at certain parts1 when1 from the distension of the sac1 these bands may be found greatly elongated1 and stretching across the cavity in various directions4 ,when the effusion is but part of a general dropsy1 it will be clear1 while the surfaces of the membrane will be smooth and destitute of evidences of inflammation4 ,in quantity1 the fluid found in these cases may vary from a few ounces to a pint or more4 ,blood may sometimes be found filling the pericardium1 either from a wound of its walls1 rupture of the heart1 or from the bursting of an aneurism4 ,in scurvy1 purpura1 etc41 small patches of extravasated blood may be found in its walls4 ,morbid ,growths4 ,the more common of these1 found in connection with the pericardium1 are cancers4 ,they are usually secondary in their appearance1 and generally will have first developed in the mediastinum4 ,fibrous or cystic tumors have been noticed in a few rare cases1 while tubercles of the miliary form1 are not uncommon within this membrane4 ,section ,v4 ,,of ,,the ,,heart4 ,notice3 #a4 ,in situ--exact position and relation to surrounding organs2 shape2 size2 degree of firmness or flabbiness4 #b4 ,after removal--amount and kind of blood discharged from divided vessels2 shape of heart2 round or elongated2 apex formed by which ventricle2 amount of fat on surface2 relative size of each cavity4 #c4 ,right auricle--character and quantity of blood contained2 fibrinous clot4 ,lining membrane2 general condition of2 foramen ovale2 open or closed2 thickness1 consistence1 etc41 of muscular walls4 ,auriculo-ventricular opening2 its shape2 estimate of size by introducing fingers2 rough or smooth2 fibrous or calcareous deposits2 circumference4 #d4 ,right ventricle--nature and quantity of contents2 fluid blood2 blood clot2 fibrinous clot2 size2 attachments of same to muscular columns2 firm or soft2 size of cavity2 thickness and condition of muscular walls2 color1 firmness1 etc4 #e4 ,tricuspid valves--natural1 thickened1 thinned or contracted2 granulations2 patches of calcareous matter2 degree of flexibility2 can they close the opening8 ,condition of chord tendine2 length1 thickness1 flexibility1 rupture1 etc4 #f4 ,pulmonary opening--size and shape2 smooth or rough4 ,semilunar valves2 thin and smooth1 or thick1 rough and inflexible2 power of closing the opening2 will water pass through when poured in from above8 #g4 ,left side of heart--observe same as on right4 #h4 ,generalities--weight after removal of blood2 wounds2 morbid growths2 abscesses2 malformations2 aneurism2 rupture1 etc4 ,the several morbid conditions of the heart may be classified as follows3 #a4 ,inflammation of muscular walls4 ,carditis4 of serous membranes4 ,pericarditis4 ,endocarditis4 #b4 ,diseases of valves4 ,thickening4 ,ossification4 ,atrophy4 #c4 ,changes in the walls of the heart1 ,hypertrophy4 influencing the size of the cavities4 ,dilation4 ,atrophy4 #d4 ,morbid conditions of the walls alone4 ,fatty degeneration4 ,morbid growths4 ,ossification of coronary arteries4 ,malformations4 ,abscess4 ,aneurism4 ,rupture4 #e4 ,displacements4 ,congenital4 ,ectopia cordis4 ,pathological4 ,transposition4 #f4 ,contents of cavities4 ,heart clots4 #a4 ,inflammatory ,affections4 ,carditis4 ,inflammation of the muscular substance of the heart is by no means a common disease1 and when present1 is probably always associated either with endocarditis1 or more frequently pericarditis4 ,we may recognize this condition after death1 by the light yellow color of the heart2 with a relaxed1 flabby1 and in some instances a softened condition of the walls4 ,upon cutting into the muscular walls1 there will be found exuding a semi-purulent fluid and often small cavities1 varying in size from a pin's head to a small pea1 will be found filled with pus4 ,this condition may involve the whole heart1 or may be confined to one or more portions4 ,inflammation of the muscular substance of the heart1 may1 undoubtedly1 be one of the primary causes leading to aneurism or even to rupture4 ,the symptoms of this disease are not readily recognized during life1 being always combined with inflammation of the peri- or endocardium4 ,pericarditis4 ,affections of the pericardium have been noticed in the previous section4 ,endocarditis4 ,inflammation of the lining membrane of the heart 7endocardium7 most frequently occurs in connection with an attack of articular rheumatism4 ,it may1 however1 result from blows or injuries of the chest1 and has been induced by violent muscular efforts4 ,it is said also1 to be often connected with some vitiated condition of the blood1 as in pymia or ,bright's disease of the kidneys1 and has been noticed also in cases of measles1 typhus and puerperal fever4 ,endocarditis more frequently attacks the left1 than the right side of the heart4 ,the anatomical appearances1 are a loss of smoothness and transparency of the membrane1 with an injected condition of its vessels4 ,deposits of lymph may be found adhering to the free surface at various points1 or to the tendinous cords or valves1 giving a roughened1 or even warty appearance to all those parts4 ,these may become detached1 and swept on with the blood1 and finally lodging in some of the arteries of the head or extremities1 where they are known as emboli1 they may become a source of serious trouble4 ,the inflammation may extend to the muscular structure1 resulting in softening or the formation of purulent cysts4 ,it is1 however1 upon those folds of the lining membrane constituting the valves1 and particularly upon the left side of the heart1 that the effects of endocardial inflammations are especially manifested4 ,in this way originates most of the so-called #b4 ,valvular ,affections of the ,heart4 ,one of the most common of the results of inflammation extending to the valves1 is ,thickening4 ,this may depend either upon a deposit of lymph beneath or between the layers of membrane constituting the valves1 thus rendering them thick and inflexible while the surface is left smooth1 or1 at the same time1 a deposit upon the exterior may be found1 rendering them rough and even warty in appearance1 and so stiffened and irregular upon their borders as to greatly interfere with the performance of their functions1 and thus permitting regurgitation to take place at the imperfectly closed opening4#h ,the tendinous cords1 at the same time1 may be found thickened1 hardened1 and contracted1 or even ruptured1 while the auriculo-ventricular openings may also be found greatly contracted from the thickening of the base of the valves and the fibrous tissues forming the borders of the openings4 ,in one case the contraction on the left side of the heart was so great as scarcely to admit the little finger1 while the thumb should readily pass that opening4 ,the semilunar valves of the aorta are liable to the same changes1 their thickened condition preventing their folding back completely into the sinuses of the artery during the systolic action of the heart1 or of completely closing the vessel upon pressure from above4 ,calcification4 ,this condition of the valves may result from a progressive change from simple thickening with fibrinous deposits1 to a cartilaginous state1 accompanied with so-called bony1 or more properly calcareous patches1 which may involve large portions of the valves4 ,ossification of the valves upon the right side of the heart1 is but rarely found2 upon the left1 both the mitral and aortic valves are liable to this affection4 ,atrophy4 ,the aortic1 pulmonary1 and sometimes mitral valves1 are occasionally found greatly thinned2 and this condition may result either in a gradual stretching of the central portion of the valve from pressure of the blood1 giving rise to aneurism of the valves1 or1 it may become perforated with small irregular openings1 or1 from its weakened condition1 rupture may take place1 producing sudden death4 ,this condition appears to consist in a gradual wearing away of the substance of the valves1 from unusual brittleness of their structure1 the result probably of chronic inflammation4 ,again1 the valves may be found greatly contracted1 7stenosis7 hard and rigid1 which will be attended with imperfect closure and consequent regurgitation4 ,dilatation of the orifices without any change in the valves1 may also be found1 resulting in the same imperfect closure4 ,disease of the valves of the heart1 by obstructing the orifices1 is likely to result in #c4 ,changes ,affecting the ,size of the ,cavities4 ,hypertrophy4 ,hypertrophy of the heart1 is a condition in which there is an increased thickness of its walls1 and generally also enlargement of its cavities4 ,yet there may be thickening--very rarely however--with a diminution in the size of the cavities4 ,it may affect both sides of the heart1 but is frequently confined to the left ventricle4 ,the main cause of hypertrophy of the heart1 is the existence of some obstruction to the circulation1 either in the heart1 or some portion of the arterial system1 as by aneurism1 pressure of tumors1 etc41 or by disease of the kidneys4 ,it is most frequently1 however1 associated with disease of the valves or large arteries4 ,it may sometimes result from continued functional excitement1 and generally accompanies cases of partial adhesion of the surfaces of the pericardium1 while complete adhesion is more likely to be followed by dilatation or atrophy4 ,on the right side of the heart1 hypertrophy is usually the result of some obstruction to the circulation through the lungs1 as in an emphysematous condition of that organ4 ,the following measurements1 c41 of the normal heart1 will serve as a guide in judging of cases of enlargement3 ,size4 ,lnnec has stated1 that the heart in its normal condition1 is about the size of the closed fist of the individual4 ,this comparison1 however1 is not very satisfactory4 ,it will be usually found to measure about #e inches in length1 #c in its greatest width1 and #b in its extreme thickness1 from its anterior to its posterior surface4 ,weight4 ,from an examination of four hundred cases1 the average weight was found to be #i ounces in the male1 and #h ounces in the female4 ,in a robust1 muscular male1 the heart may1 however1 be found to weigh as much as #ab ounces1 and still be normal in all its parts4 ,thickness of ,walls4 ,right auricle1 #a line2 left1 #a lines4 ,right ventricle1 #a lines1 and left1 a little over #e lines1 or half an inch1 at its middle1 being a little thinner both at the base and apex4 ,size of ,orifices4 ,circumference of auriculo-ventricular opening of the right side1 nearly #d inches2 of left side1 #c inches2 of the pulmonary artery1 #b inches2 of aorta1 #b inches4 ,when enlarged1 the heart may be found measuring #f to #g inches in length1 as much in breadth1 and #ab to #af inches in circumference4 ,the weight may also be increased to #ae1 #bj or #be ounces1 and the walls may increase in thickness to nearly a-half inch1 and upon the left to over an inch4 ,hypertrophy of the heart1 has been divided into three forms3--#ast1 simple hypertrophy2 #b;d1 eccentric2 and #c;d1 concentric hypertrophy4 ,in the first form1 the walls are thickened1 while the cavities remain unchanged4 7,simple hypertrophy47 ,in the second form1 the thickening of the walls is attended with an enlargement or dilatation of the cavities4 7,eccentric hypertrophy4#i7 ,in the third form1 the thickening is attended with a diminution in the capacity of the cavities4 7,concentric hypertrophy47 ,it has been observed in cases where an examination has been made very soon after a sudden1 violent death1 attended with loss of blood1 as in decapitation1 etc41 that the cavities have been nearly obliterated1 while the walls were greatly thickened4 ,by maceration for a few days1 the ventricles have become relaxed to their natural size and capacity4 ,this state of the heart has been observed in persons in whom1 during life1 none of the symptoms of disease of the heart had been manifested1 and hence the condition is to be considered as the immediate effect of the peculiar character of the cause of death4 ,dilatation4 ,dilatation of the cavities of the heart1 is a condition which may also result from the presence of obstacles or impediments to the circulation1 as from ossification of the valves2 narrowing of the pulmonary or aortic orifices2 employments requiring powerful muscular efforts2 and in consolidation1 tubercular induration1 emphysematous condition of the lungs1 or fatty degeneration4 ,the muscular substance is usually soft and flaccid1 sometimes of a violet color1 again pale and yellowish4 ,the thinning may be so great1 as to reduce the thickest part of the left ventricle to two lines or even less1 when the walls will appear to be composed of but little more than a thin layer of fat covered with the pericardium4 ,three forms of dilatation are recognized3 active1 simple and passive4 ,active dilatation is associated with hypertrophy of walls1 constituting eccentric hypertrophy4 ,in simple hypertrophy1 the walls retain their normal thickness1 while the shape may be changed according to the cavity affected4 ,passive dilatation1 on the other hand1 is accompanied with thinning of the walls1 and usually results from fatty degeneration1 atrophy1 or some other change in the muscular fibre4 ,atrophy4 ,in this condition there is a uniform decrease in the size of the heart4 ,its cavities becomes small1 and its walls thin4 ,it usually attends diseases accompanied with great impoverishment of the blood1 as in cancer1 diabetes1 etc41 or may result from obstruction of the coronary arteries from calcification1 atheroma or thrombi4 ,paget mentions a case where the heart of a cancerous man1 fifty years old1 weighed only five ounces1 four drachms2 and that of a diabetic woman1 which weighed only five ounces1 one drachm4 ,it is usually accompanied with a general wasting of the tissues and organs of the body1 and frequently will be found associated with fatty degeneration1 which will now be noticed4 #d4 ,morbid ,condition of the ,walls ,alone4 ,fatty ,degeneration4 ,two forms of fatty diseases of the heart have been recognized4 ,in the first1 which should be known as 8fatty growth10 to distinguish from 8fatty degeneration10 there is an unusual quantity of adipose matter in those parts of the heart where more or less is usually found1 viz43--,along the furrows through which the vessels run1 and particularly about the base of the heart4 ,the fatty masses may dip more or less into the substance of the walls1 displacing the muscular fibres1 although the latter are generally normal in color and density1 even when imbedded in masses of fat4 ,this condition may be found in persons who are otherwise thin1 as well as in the obese4 ,but the more frequent form of fatty disease1 is that known as fatty degeneration4 ,in this1 we find upon opening the heart1 that it has lost the reddish-brown color characteristic of the muscular fibre in its normal condition1 and is pale1 soft and flabby4 ,the whole organ feels soft1 doughy and inelastic1 much like a heart beginning to decompose4 ,if the wall of the left ventricle be partly cut through1 the remainder is easily torn1 and the surfaces have a granulated appearance4 ,upon the inner surface1 beneath the endocardium1 numerous small thickly set spots1 or sometimes wavy lines1 of a pale buff1 or light yellow color1 may be noticed4 ,this appearance does not depend upon a deposit of fat among the muscular fibres1 but rather upon a change in that tissue2 and an examination with the microscope1 will show fatty degeneration of the fibre4 ,this condition of the heart1 may involve the whole organ1 or may be confined to one or more portions4 ,it is much less common in the auricles1 than in the ventricles1 and more frequent in the left ventricle than in the right4 ,it will be generally found more advanced in the upper portion of the septum of the ventricles1 and in the large1 fleshy columns of the left side2 or it may be found in these columns alone1 which accounts for the occasional rupture of the latter4 ,fatty ,degeneration may be associated with fatty growth1 or with hypertrophy1 or thinning and dilatation1 and may be the cause of rupture4 ,the general character of softness1 paleness1 and mottled color1 should lead to suspicion of the existence of this disease1 when a microscopic examination being resorted to1 the conclusion would be decisive4 ,a small portion of fibre1 examined with a power of #cjj or #djj diameters1 will present1 in fatty degeneration1 instead of the striated appearance of the normal fibre1 a granular appearance1 with numerous minute oil globules scattered through the fibre4 ,in the palest part of the heart1 the disease will be generally most advanced2 but even here1 the microscope will show some fibres in a healthy condition1 while others around them are rendered completely granular4 ,exhausting diseases of various kinds1 typhus and other severe fevers1 phosphorus poisoning1 etc41 may result in this peculiar condition of the heart4 #e4 ,morbid ,growths4 ,under this head may be placed tumors1 cancers1 melanosis1 and hydatids4 ,tumors of various kinds are occasionally found in connection with the heart4 ,fibrous tumors of a small size may develop within the muscular walls1 while syphilitic growths1 cysts1 and tubercular deposits may also1 in rare cases1 be discovered4 ,cancer4 ,cancer of the heart has been noticed in two forms--epithelial and medullary4 ,a man1 fifty-eight years old1 had an epithelial cancer of the eye1 which was removed4 ,two years after1 the man died with a large cancerous tumor over the parotid gland4 ,a post-mortem examination revealed a cancerous mass1 about an inch and a-half in diameter1 imbedded in the apex of the right ventricle and septum of the heart4 ,a microscopic examination revealed its epithelial character4#aj ,medullary cancer of the heart has been usually found associated with the same disease in the lungs and liver1 and forms an investing mass which may involve the whole organ4 ,melanosis of the heart presents the same character as in other parts of the body1 and is considered but a variety of the medullary cancer1 pigmentary matter being added4 ,it may be developed upon the surface1 or may infiltrate the substance of the whole organ4 ,hydatids have been occasionally found in the heart1 the most of which have probably been animal in their character1 7acephalocysts47 ,a female1 forty years old1 who had been suffering pain in the region of the heart for some months1 suddenly died1 after running rapidly up stairs4 ,one ounce of fluid was found in the pericardium4 ,a considerable tumor was found at the apex of the heart1 which slightly fluctuated4 ,this tumor was about three inches in diameter1 globular in form1 and encroached considerably upon the cavity of the right ventricle4 ,when laid open1 it was found to contain a large number of small cysts or hydatids1 varying in size from that of a small pea to that of a pigeon's egg1 the space between which was filled with a soft curdlike substance1 of a yellow color4#aa ,ossification of ,coronary ,arteries4 ,that condition of the arteries of the heart usually termed ossification is more properly one of calcification1 consisting of a deposit of hard1 gritty1 calcareous matter1 in which there is none of the true character of real bone1 no trace of bone-corpuscle or vascular canals ever being discovered in them4 ,chemical analysis has shown the deposits to be composed of #ej parts of animal matter1 with #dg of the phosphate and #b of the carbonate of lime in every #ajj4 ,this matter being deposited in circular layers1 the artery becomes gradually converted into a hard1 bony-like tube1 which may be traced with the finger along the grooves of the heart through which the coronary artery runs4 ,this is peculiarly a disease of old people1 and may accompany a similar condition of the arch of the aorta or of the semilunar valves1 and by interfering with the proper nutrition of the heart may result in other forms of disease1 as fatty degeneration1 dilatation1 c4 ,abscess4 ,abscess of the heart1 may unquestionably follow an attack of carditis1 or inflammation of the muscular substance4 ,the cut surface of the heart in these cases1 not unfrequently shows small cavities containing a purulent fluid1 and in some instances a distinct abscess is found4 ,a man1 sixty years old1 was suddenly attacked1 while at work1 with coma and great feebleness1 followed by death on the third day4 ,the left ventricle being opened1 an abscess was discovered near the apex1 irregular in form1 and containing a bloody1 purulent-looking fluid4 ,the coronary arteries were much ossified4 ,malformations of the heart1 are extremely rare in adults1 or even in children that have passed the early days of infancy4 ,they consist frequently in arrest of development of the auricular septum1 or1 in other words1 of a patulous foramen ovale1 which1 by permitting of a mixture of arterial and venous blood upon the left side of the heart1 results in early death4 ,i have in several instances found this foramen imperfectly closed in the adult heart1 but the opening has been so small--barely sufficient to permit the passage of a probe--as to offer little or no obstacle to the proper performance to the heart's function4 ,malformation of the heart is undoubtedly one of the many causes of death in utero1 which might be demonstrated by a post-mortem examination4 ,aneurism4 ,partial aneurism1 or false aneurism of the heart1 consists in the formation of a sac or pouch1 in some portion of the walls of the organ1 communicating with the cavity of the chamber1 in the walls of which it has been formed4 ,they may form in any part of the muscular walls of the heart1 but are more frequent in the left ventricle4 ,they would seem to result from a separation of some of the muscular fibres1 when1 by their retraction1 a cavity or pouch1 of a rounded or oval form results1 which1 in some instances1 has its walls composed of the pericardium alone1 there being a complete destruction of the muscular fibres4 ,the interior of these pouches1 may be found filled with layers of coagulated fibrinous deposits1 as in the case of aneurism of arteries2 or1 if they communicate with the ventricular cavity by a large opening1 they may be filled with a simple soft clot of blood4 ,the size of these aneurismal pouches1 vary from that of a cherry1 to a pigeon's egg1 or larger1 when they change much the usual figure of the heart1 by their projection upon the external surface4 ,the following conditions have been supposed to favor the formation of these aneurismal sacs3--#ast1 softening of the muscular tissue of the heart2 #b;d1 ulceration of the lining membrane2 and #c;d1 rupture of the muscular fibres4 ,rupture of the walls of the heart sometimes happens1 producing sudden death4 ,it may result from severe contusions of the chest1 in which case1 the auricles are more likely to give way4 ,more frequently1 rupture will result from softening of the walls in fatty degeneration or ulceration1 or from the bursting of an aneurism of the heart1 or from stenosis of the aorta4 ,in the latter cases1 the left ventricle will be usually the seat of the rupture4 #f4 ,displacements4 ,changes of ,position of the heart1 are by no means unfrequent4 ,they may be congenital in their origin1 or the result of disease in the surrounding organs4 ,of congenital displacement1 we may mention first3 ,ectopia ,cordis1 where1 from some arrest of development1 in the inclosing parts1 the heart may be found in some position other than its normal one4 ,from deficiency of the sternum and ribs1 the heart has been found protruding from the chest1 7ectopia pectoralis17 or from absence or deficiency of the diaphragm1 it may be found in the abdomen with the abdominal viscera4 ,such cases live but a short time after birth4 ,transposition of the heart is found in those cases where all the viscera1 abdominal and thoracic1 are exactly reversed in position4 ,a case of this kind was discovered in the dissecting-room a few years ago1 by ,dr4 ,r4 ,b4 ,weaver1 demonstrator of anatomy1 in the ,hahnemann ,medical ,college4 ,the heart was here upon the right side1 the aorta curving to the left2 the liver upon the left2 the stomach with its pylorus to the left2 the colon commencing in the left iliac fossa2 in short1 everything completely reversed in position4 ,the subject was a female of about thirty years1 and undoubtedly suffered no inconvenience from the abnormal positions4 ,the more frequent displacements of the heart1 however1 are those resulting from disease in the surrounding structures4 ,it may be crowded from its normal position1 by pleuritic effusions1 accumulations of air 7pneumothorax71 or even by a highly emphysematous lung4 ,displacements may also result from the presence of aneurismal or other tumors in the chest2 curvatures of the spine2 or from a hernial protrusion of some of the abdominal viscera through an opening in the diaphragm2 or the presence of tumors1 enlarged viscera1 dropsies1 etc41 within the abdomen4 #g4 ,contents of the ,cavities4 ,heart ,clots4 ,this subject is one that has until recently1 been but imperfectly understood2 and now even1 our knowledge relating to it1 is by no means complete4 ,enough is known1 however1 to convince us that heart clots1 are a more frequent cause of sudden death1 than has been heretofore supposed4 ,having in a recent paper1 read before the ,philadelphia ,county ,homopathic ,medical ,society1 quite fully treated of this subject1 ,i shall here merely transcribe the leading points of the same4#ab ,fibrinous heart clots1 polypus of the heart1 or fatty deposits1 as they are sometimes called1 differ from ordinary clots of blood1 in the absence of the blood corpuscles1 and hence1 presenting the buff color characteristic of the coagulated fibrin of the blood4 ,ordinary blood clots1 with the corpuscles entangled with the fibrin--and hence presenting the red color of blood--are usually found in the cavities of the heart and large blood-vessels after death1 but in greater quantity upon the right side4 ,color4 ,the shade of color presented by the fibrinous clot varies in different cases4 ,while buff is the prevailing color1 the shade varies from a light drab to a decided yellow4 ,consistency4 ,in this respect a good deal of variation is also found2 the difference depending1 probably1 in part upon the character of the disease1 and in part upon the rapidity or slowness of the formation2 those of a rapid or very recent formation1 having a soft1 fatty1 or jelly-like character2#ac while1 on the other hand1 those of a more gradual formation1 and with more sthenic forms of disease1 acquire a considerable degree of density1 the surface presenting a smooth appearance1 as if acted upon by a current of blood1 and in all respects resembling the dense fibrinous masses1 found blocking up the cavities of aneurismal tumors4 ,position4 ,in every case reported below1 the clot has been on the right side of the heart1 although in some1 a small1 soft clot has been found on the left4 ,i am not sure that ,i have ever found one of these clots on the left side of the heart of such a size and consistency1 or under such circumstances1 as to have led me to suppose that it might have been a cause of death4 ,the body of the clot is usually found in the ventricle1 extending from this1 either up into the pulmonary artery1 or through the opening into the auricle4 ,in all cases1 the clot has been more or less entangled with the tendinous cords of the valves and muscular columns of the heart1 requiring1 in some instances1 considerable force to tear it away from its attachments4 ,time of formation4 ,an important question to be decided in regard to these heart clots1 is the time of their formation4 ,are they ante or post-mortem in their origin8 ,and upon the solution of this query depends the conclusion as to whether they are the cause or the result of death in the cases where found4 ,that a fibrinous clot may sometimes be formed in the coagulation of the blood outside of the body1 is a fact well known2 as in the blood drawn from patients suffering from acute inflammatory affections1 where1 from the retarding of the coagulation1 the blood corpuscles1 from their greater specific gravity1 have time to fall towards the bottom of the vessel1 thus giving the 8buffy coat0 to the upper portion of the clot4 ,the same cause--retarded coagulation--unquestionably may give rise to a clot in the heart after death1 presenting the same character1 viz41 with the upper portion1 of the buff1 fibrinous character1 while the lower portion1 from the presence of corpuscles1 will present the appearance of an ordinary blood clot4 ,such clots are not unfrequently found after death4 ,but have we any evidence that the fibrin of the blood may be deposited1 forming clots within the vessels during life8 ,in proof of this1 we have only to refer to the result of the application of a ligature to an artery2 where the interval between the point of application and the first vessel coming off above1 will be filled with a fibrinous clot1 which performs an important part in the closing up of the vessel2 or1 to the well-known deposits of fibrinous layers within aneurismal tumors1 sufficient1 in many cases1 to so fill up the sac as to result in a cure2 therefore1 the favoring conditions being present1 it is not unreasonable to claim that fibrinous clots may form within the heart1 of such size and in such positions as to be an immediate cause of death4 ,causes4 ,in looking for the causes1 or conditions promoting the formation of these fibrinous deposits1 we have to consider1 first1 variations in the character of the blood itself2 and secondly1 peculiarities in its circulation and in the circulatory apparatus4 ,fibrin1 one of the normal constituents of the blood1 is estimated by physiologists as forming from #b to #c parts in #ajjj1 while it may fall as low as #a1 or rise to #g parts4 ,we find it reduced to the minimum quantity in all diseases which present a hmorrhagic tendency1 as in true typhus1 yellow fever1 certain malignant forms of disease1 and as the effect of many poisons1 both animal and vegetable4 ,in these cases1 the loss of fibrin results in the effusion of blood into the tissues1 producing petechial spots1 or upon the mucous surfaces1 giving rise to epistaxis1 black vomit1 hmaturia1 etc41 while very feeble1 if any1 coagulation of the blood will be found after death4 ,in scurvy1 however1 where we have a condition of the blood not unlike that above referred to1 there appears to be a marked tendency to the formation of clots1 as has been noticed by many observers1 and as has been verified by ,dr4 ,j4 ,c4 ,morgan1 in several cases which came under his notice while in the army4 ,but it is in cases where there is at least a relative increase of fibrin1 that heart clots are more liable to form4 ,such a condition we find in cases where1 while the fibrin remains normal in quantity1 the water of the blood1 the menstruum in which the fibrin is held in solution1 is below the normal standard1 this reduction favoring the tendency to deposit4 ,thus1 in all cases where there has been an exhausting and rapid flux from the bowels1 as in cholera1 or excessive purging from drastic cathartics1 or from the colliquative sweating of phthisis1 we have the favoring condition1 and death may be the immediate result of a fibrinous clot in the heart4 ,the most favorable condition1 however1 for the formation of heart clots1 is undoubtedly that in which there is an absolute increase of fibrin1 and this we find in a large number of diseases marked by acute inflammatory symptoms2 as in pleurisy1 pneumonia1 diphtheria1 croup1 acute rheumatism1 erysipelas1 puerperal fever1 etc4 ,in a large number of deaths from these diseases1 a post-mortem examination would undoubtedly bring to light a heart clot1 which has at least served to hasten1 if it has not been the immediate cause of the fatal termination4 ,again1 the formation of heart clots is evidently promoted by any circumstances or conditions1 resulting in great feebleness or languor of the circulation1 independent of variations in the amount of fibrin4 ,a complete stasis of the blood is certain to be followed by coagulation2 as in employment of pressure in the treatment of aneurism2 so in cases of great prostration of the powers of life1 attended with extreme feebleness of the circulation1 as #ast4 ,in cases of shock1 where life is not immediately destroyed2 #b;d4 ,in certain cases of poisoning1 as by opium1 where the action of the heart is greatly depressed2 and #c;d4 ,in syncope1 either with or without loss of blood4 ,in all of these cases the danger of the formation of the heart clot is very great1 and probably in a large number this is the immediate cause of death4 ,it is a fact well established1 that loss of blood1 either by hmorrhages or venesection1 is followed by an increased coagulability of that fluid2 hence1 the fearful hmorrhages which sometimes attend parturition1 if accompanied with syncope1 are in great danger of being followed by the formation of the heart clot1 and thus ending in death4#ad ,another circumstance tending to promote the formation of fibrinous clots in the heart1 is evidently to be found in the peculiar formation of the valves guarding the auriculo-ventricular openings4 ,it is well known how fibrin may be collected from fresh blood1 by beating the same with a bundle of twigs1 the latter soon becoming coated with shreds of fibrin2 so the chord tendine and fleshy columns of the heart1 between which the blood is continually being driven1 affords convenient points for collecting the same from the feebly circulating or overcharged blood2 and from the close intermingling of the tendinous cords1 with the substance of the clot1 it is probably upon these that the deposit first begins to form4 ,in explanation of the fact that fibrinous clots are almost universally found on the right or venous side of the heart1 notwithstanding that arterial blood is richer in fibrin than venous1 the following has been suggested to my mind3 ,first4 ,while venous blood contains a smaller proportion of fibrin1 may not its deoxydized condition favor the more ready deposit of this substance1 than by the more highly vitalized arterial blood8 ,second4 ,the feebler muscular power of the right side of the heart would necessarily be attended with a slower circulation through its cavities1 the partial stasis of the blood giving another condition favorable for the formation of a clot2 and ,third4 ,the valves of the right side of the heart1 present three flaps or folds1 instead of two as on the left1 and hence1 with their numerous tendinous cords1 offer an increased number of obstructing points1 around which the deposit may be made4 ,these several circumstances would seem sufficient to account for the admitted fact4 ,symptoms4 ,the symptoms attending the formation of fibrinous clots in the heart1 are usually sudden in their accession1 frequently attended with a chill1 and marked by great oppression in breathing1 coldness of surface1 and pallor of face and lips1 the latter symptom distinguishing from the dyspna attending croup1 asthma1 pneumonia1 etc41 where the face is livid from venous congestion4 ,the pulse is usually rapid and feeble2 the action of the heart labored1 palpitating1 and sometimes intermitting1 while auscultation will reveal a tumultuous churning-like action1 the normal sounds being quite undistinguishable4 ,pulsation of the jugulars will be present in most cases1 and where the clot greatly obstructs the play of the tricuspid valves1 a double pulsation will be likely to be noticed4 ,in the last stage1 a copious cold perspiration appears upon the whole surface of the body4 ,as might be anticipated1 fibrinous formations1 while of small size1 are sometimes washed away from their attachments and swept on with the current of blood into the arteries and carried to distant parts of the body1 as is sometimes the case also in aneurism1 thus producing the embolic masses often found blocking up arteries in different parts of the body4 ,when upon the right side1 the embolus would be carried into the pulmonary artery1 obstructing the circulation through the lungs1 and producing symptoms more or less grave1 according to the size of the clot4 ,upon the left side of the heart1 from the greater force of the circulation1 these bodies are probably more frequently swept away from their attachments and carried into the aorta1 and thus on1 perhaps1 through the carotids to the head1 or into the subclavian1 or down the aorta1 finally lodging in some of the branches of the lower extremities4 ,convulsions1 paralysis1 etc41 are not unfrequently produced by the lodgment of emboli in some of the arteries of the brain1 while1 when carried into the arteries of the extremities1 pain1 falling of temperature1 impairment of sensation1 contraction of muscles1 atrophy1 and even gangrene may result4 ,the following examples will serve to illustrate the class of cases to which ,i refer3 ,,case ,i4--,death from ,heart ,clot in ,anmia4 ,a lad1 #aa years old1 and very anmic1 went to school in the morning in his usual health2 while there was taken with a chill4 ,on his way home vomited freely4 ,the chill lasted for a long time1 and was accompanied with an oppression in breathing1 which gradually increased through the day and night1 and until the time of my first visit at #aa o'clock ,a4 ,m4 the next day4 ,i then found him extremely pallid1 lips bloodless1 perspiring freely1 suffering from great restlessness and distress1 with extreme dyspna2 mind wandering1 pulse irregular and feeble2 action of the heart very tumultuous1 the normal sounds being unrecognizable4 ,in the neck noticed a rapid rolling pulsation of the jugulars1 which presented two beats to one of the artery at the wrist4 ,at my second visit1 made at #d o'clock ,p4 ,m41 the patient had just expired4 ,the autopsy1 made twenty hours after death1 gave the following results3 ,upon opening the abdomen found the liver presenting a dark mottled appearance1 and highly congested2 other abdominal organs natural2 pericardium contained about one ounce of serum4 ,upon opening the right auricle of the heart1 found a firm fibrinous mass1 extending downwards through the ventricular opening1 and which1 upon the latter cavity being opened1 was found firmly attached to the tricuspid valves1 and entangled with the fleshy columns and tendinous cords4 ,the presence of such a body in this position1 and with such attachments1 it was evident1 must have so interfered with the passage of the blood from the auricle to the ventricle1 as1 upon the contraction of the former cavity1 to have caused a backward pressure into the veins1 and thus have produced the first of the double pulsations of the jugulars4 ,again1 the position of this clot1 preventing the closure of the valves upon the contraction of the ventricle1 there would have been a regurgitation into the auricle1 and the same backward flow into the veins1 thus producing the second pulsation of the jugulars seen during life4 ,,case ,,ii4--,death from ,heart ,clot in ,pregnancy4 ,a lady1 #bh or #cj years old1 also very anmic1 and three months pregnant1 had been suffering occasional fainting spells4 ,for some days before her decease she had suffered from dyspna1 and on that day1 after ascending a flight of stairs1 fell upon the floor1 and before a physician could be obtained breathed her last4 ,a post-mortem showed all the thoracic and abdominal viscera in a healthy condition1 while the right side of the heart contained a large fibrinous clot1 with attachments similar to those found in ,case ,i4 ,,case ,,iii4--,death from ,heart ,clot in ,diphtheria4 ,a boy1 #c years old1 had an attack of diphtheria4 ,the case presented no unfavorable symptoms until about the fourth day1 when he was taken with great restlessness and oppression in breathing1 and while sitting on the chamber at stool1 suddenly died4 ,the autopsy here again revealed the heart clot1 as in the other cases4 ,,case ,,iv4--,death from ,heart ,clot in ,consumption4 ,a man1 #cj years of age1 a furrier by trade1 was suffering from tubercular disease of the lungs4 ,he had never given up his work1 though he was much reduced in flesh1 had a bad cough1 diarrha1 and night sweats4 ,while at his employment1 he was one day taken with great oppression1 increased cough1 etc41 and in twenty-four hours expired4 ,the post-mortem showed that1 while the upper portion of both lungs contained large deposits of tubercles1 there were no abscesses1 and the lower portions presented sufficient sound lung tissue to have maintained life4 ,upon opening the heart the usual fibrinous clot was found in the right ventricle1 extending upwards into the auricle4 ,,case ,v4--,death from ,heart ,clot in ,rheumatism4 ,a strong colored man1 of #be years1 had an attack of inflammatory rheumatism4 ,the disease presented the usual characters1 the inflammation wandering from joint to joint4 ,during the second week he was suddenly attacked with great difficulty in breathing1 violent and irregular action of the heart1 and great distress1 followed by rapid prostration and death4 ,the post-mortem examination revealed thickened tricuspid valves1 with a firm clot of large size adhering to the same4 ,,case ,,vi4--,death from ,heart ,clot in ,debility4 ,a gentleman1 #ee years old1 who had been for some time in feeble health1 was taken1 upon rising in the morning1 with oppression and distress in the region of the heart1 dying in twelve hours4 ,the heart clot was found here1 as in the other cases1 upon the right side of the heart4 ,,case ,,vii4--,heart ,clot in ,death from ,over-dose of ,morphia4 ,a gentleman1 of about #ej years1 a physician1 was found one morning dead in his bed4 ,his health had been previously good1 excepting that he was troubled with neuralgia which gave him sleepless nights1 and for which he sometimes took morphia4 ,on the night previous to his death he came home and retired at a late hour4 ,an open bottle of morphia and small spatula were found on his desk next morning1 the spatula showing evidence of having been thrust deeply into the morphia1 and probably a large and over-dose carelessly removed and taken4 ,the autopsy here again revealed a large and firm fibrinous heart clot4 ,,case ,,viii4--,death from ,heart ,clot in ,acute ,gastritis4 ,a lady of about #fj years1 had an attack of acute gastritis1 but was considered convalescing1 and her physician 7,dr4 ,martin7 made his last visit in the evening4 ,the next morning she was found dead in her bed4 ,the post-mortem showed the spleen somewhat enlarged1 and its capsule greatly thickened4#ae ,other organs healthy1 while the heart contained an unusually large fibrinous clot1 which has been preserved in the ,college ,museum4#af ,the above include the more marked cases of death that have come under my notice1 where that result could1 in my mind1 be fairly attributed to the formation of fibrinous clots in the heart4 ,the following inferences may1 we think1 be fairly deduced from the several cases reported3 ,first4 ,in some instances the fibrinous clots are apparently the sole cause of death4 7,cases #a1 #b1 and #c47 ,second4 ,in other1 and a larger number of diseases1 as in acute rheumatism1 pneumonia1 croup1 etc41 which otherwise would recover1 a fatal termination results from the formation of heart clots4 7,cases #c and #e47 ,third4 ,in still other diseases1 which are of themselves necessarily fatal1 as in phthisis1 cholera1 etc41 death is often hastened by these formations4 7,case #d47 ,section ,,vi4 ,,the ,,aorta ,,and ,,arteries ,,generally4 ,notice3 #a4 ,before ,opening ,vessel--size2 course2 condition of external coat and surrounding tissues4 #b4 ,after ,opening ,vessel--character of blood within2 coagulated or not2 size1 color1 consistence1 etc41 of clot2 size of canal2 thickness of walls2 rigid or flexible4 ,lining ,membrane--smoothness2 transparency1 etc42 readiness of detachment2 thickness1 etc42 if rough1 the apparent cause2 fibrinous1 atheromatous or calcareous deposits4 ,middle ,coat--its thickness2 color2 deposits within1 and their character4 ,external ,coat--general condition4 ,,aneurisms3--#a4 ,external ,characters--size2 shape2 is the dilatation lateral or general in its relation to the vessel8 ,openings as seen externally2 size1 position1 etc42 blood effused2 quantity1 etc4 ,after opening1 notice--contents2 blood fluid or coagulated2 fibrinous contents2 laminations2 their thickness2 number2 density2 dryness2 difference between outer and inner layers4 ,channel for blood3 size2 character of inner surface2 how formed8 ,walls of aneurism3 how formed2 by all1 or one coat of artery4 ,size of artery above and below aneurism4 ,the diseases of the aorta1 and of arteries generally1 which may claim attention in a post-mortem examination1 are inflammation1 fatty degeneration1 calcification1 aneurism1 and rupture4 ,inflammation4 ,this process may be found involving either the outer or inner coats of arteries4 ,in the former case the walls appear thickened and infiltrated with a soft1 jelly-like substance1 which appears1 at a more advanced stage in some cases1 to degenerate into a purulent condition1 while in others1 great thickening of the coats1 or even obliteration results4 ,inflammation of the inner coat generally precedes atheromatous or calcareous deposits1 and is mostly confined to old persons4 ,the roughened inner surface thus produced1 may serve to collect fibrinous shreds from the blood1 and thus be the occasion of the formation of emboli4 ,inflammation of arteries may result from injuries1 from the presence of emboli1 or may be spontaneous in its origin4 ,while the more frequent seat of the disease is in the aorta1 it may occur in any other artery4 ,fatty ,degeneration1 or atheromatous disease of arteries1 is an important affection of those vessels1 and is usually associated with aneurism4 ,it is seen more frequently in the arch of the aorta1 and consists in the presence of fine white streaks1 situated in the substance of the lining membrane4 ,the disease may be found in children as young as from three to seven years of age1 but is more common with adults4 ,as the disease advances1 the middle coat becomes involved4 ,the streaks gradually change into large1 white1 opaque patches4 ,the middle coat becomes thinned1 loses its elasticity1 assumes a gray1 semi-transparent appearance1 and1 at a later stage1 becomes soft and cheesy1 and sometimes even undergoes a form of liquification into a creamy fluid resembling pus1 but dependent upon the abundant formation of fat globules1 with scales of cholesterine and granular matter4 ,while these destructive changes are going on in the inner and middle coats1 and tending to their rupture1 by a conservative process1 the outer coat1 upon which the strength of the vessel mainly depends1 becomes thickened and strengthened by the accumulation of plastic matter4 ,ossification4 ,ossification of the aorta1 like that of the coronary and other arteries1 consists rather in a process of calcification4 ,the deposits are largely confined to the arch1 and consist mainly of patches of calcareous matter of various sizes4 ,we seldom find the whole circumference of the vessel involved1 as in the case of smaller arteries4 ,the aortic valves will generally be found more or less loaded with the same deposits4#ag ,aneurism4 ,this disease is said to occur more frequently in the aorta1 than in any other artery4 ,it may be developed in any portion of this vessel or its principal branches1 but is more commonly found in the arch4 ,the walls of the vessel being weakened by fatty degeneration1 they become less and less able to resist the pressure of the contained blood1 and gradually yielding to the systolic force of the heart1 become more and more distended1 until the complete aneurismal sac is formed4 ,aneurism may be either true1 in which there is a dilatation of all the coats of the vessel1 or false1 where there is rupture of the inner1 and perhaps also of the middle1 and dilatation of the outer coat alone4 ,the latter form1 when developed upon the aorta1 may become very large1 and by pressure1 cause absorption of the sternum1 costal cartilages and ribs1 and even of the clavicle4 ,in some cases1 the inner and middle coat having ruptured1 the blood instead of being confined in a sac formed by the outer coat1 becomes diffused between the middle and outer1 or between the layers of the middle coat1 thus constituting what is known as dissecting aneurism4 ,in these cases1 the blood may extend the whole length of the aorta1 and even upwards upon the carotids to their bifurcation4 ,in an examination of an aneurismal sac1 the true aneurism will be recognized by the walls presenting all the coats of the artery1 and generally by the indication of the presence of atheromatous and calcareous deposits1 which are confined to the inner and middle coats4 ,in these cases also1 the communication between the sac and the aorta is large and free4 ,if the aneurism be false1 however1 there will be an absence of those deposits1 the opening into the artery will be comparatively small1 and the inner and middle coats will terminate abruptly at its margin4 ,the interior of aneurismal sacs will usually be found containing a quantity of fibrine deposited from the blood1 and arranged in concentric layers4 ,in color1 these fibrinous layers are of a light buff1 the outer layers being dry and firm1 while the inner ones are softer and more moist1 and the central portion1 at the same time1 filled with a dark mass of coagulated blood4 ,a spontaneous cure will sometimes be effected by a complete blocking up of the sac with fibrinous deposits1 thus preventing further dilatation or danger of rupture4 ,the following case1 which has been before reported1#ah shows a combination of both true and false aneurism1 with spontaneous cure of the latter3 ,,case4--,spontaneous cure of aneurism of ascending portion of arch of aorta1 with death from bursting of aneurism of descending portion into the sophagus4 ,mr4 ,h----1 of this city1 aged sixty years1 while walking in his yard one day after a hearty dinner1 was taken with a sudden sensation of faintness and nausea1 which was soon followed by vomiting the contents of his stomach1 with a considerable quantity of blood4 ,after entering his house1 the vomiting was frequently repeated1 and at each effort large quantities of pale blood ejected4 ,sinking rapidly1 in an hour he was dead4 ,twenty-four hours after1 ,i made a post-mortem examination4 ,upon exposing the chest1 found at the right border of the sternum1 just below the clavicle1 a hard1 inelastic tumor beneath the skin1 of the size of a small orange4 ,while not adherent to the integument1 it appeared firmly attached to the walls of the chest beneath4 ,upon turning aside the integument and pectoral muscles1 the tumor was found connected by a long pedicle to parts within the chest2 absorption of considerable portions of the sternal ends of the first and second ribs1 with the side of the sternum1 having resulted from pressure of the tumor upon those parts1 and finally permitting its appearance beneath the skin4 ,the removal of the sternum at once demonstrated the aneurismal character of the tumor by showing its connection with the ascending portion of the arch of the aorta1 while a section of the same1 exhibited the interior filled with dense concentric layers of fibrinous matter1 separable from one another1 the outer layers being dry and hard1 while the inner portion was less firm and moist4 ,this aneurism was plainly of the false variety4 ,the neck of the tumor was not much larger than the thumb1 and of sufficient length to reach from the arch of the aorta to the dilated sac beneath the skin1 outside the chest4 ,a further examination of the aorta brought to light a second and true aneurism of the descending portion of the arch1 the dilatation involving all the coats of the vessels1 and which1 having burst into the sophagus1 explained at once the cause of the hmorrhage and sudden death4 ,upon inquiring of the family1 ,i learned that the tumor upon the chest had been known to have existed for fifteen or twenty years2 that for some years the pulsations of the tumor were strong1 but that for many years all beating had ceased2 that he had never discontinued his work1 that of a carpenter1 and in fact1 it had given him so little trouble that he had never consulted a physician in regard to it4 ,for a year or so previous to death1 he had been troubled with a cough1 particularly upon exercising1 but otherwise had been in good health4 ,a remarkable and interesting feature of this case was1 the little inconvenience experienced by the patient from so grave a malady1 and one usually attended with great suffering4 ,rupture4 ,spontaneous rupture of the aorta is a very rare occurrence1 and probably never happens except the coats have first been weakened by disease4 ,hence1 in all of these cases1 there will be found atheromatous softening1 and generally thinning of the walls by dilatation4 ,in this condition1 some violent muscular effort may result in rupture at the most weakened point1 and this will be generally at that portion of the aorta within the pericardium1 the external coat being weaker here than at any other point4 ,where the dilatation of the diseased and weakened vessel has resulted in the formation of an aneurism1 rupture of this will be the more frequent termination4 ,this may take place into the sophagus1 as in the case reported1 or into the trachea1 the pericardium1 either pleural cavity1 or upon the surface of the body4 ,rupture of the coronary arteries1 of the arteries of the brain1 various branches of the abdominal aorta1 and arteries of the extremities1 have occasionally been found1 when softened by fatty degeneration or atheromatous disease4 ,section ,,vii4 ,,the ,,pleura4 ,notice3 ,condition of membrane--inflamed2 extent and position of2 thickened2 transparent or opaque2 rough or smooth4 ,contents--blood1 gas1 serum1 pus1 amount and probable source of4 ,adhesions--general or local2 firmness of1 etc4 ,like other serous membranes1 the pleura is liable to inflammation1 both acute and chronic1 with their results--plastic1 serous1 or purulent effusions1 adhesions1 etc4 ,inflammation4 ,the first change which is observed in inflammation of the pleura 7pleurisy7 is a loss of the shining1 transparent appearance of that membrane1 it becoming dull and opaque4 ,red injected vessels1 in minute ramifications1 sometimes radiating from single points1 in others more uniformly diffused1 will be noticed4 ,often the surface will present a red mottled appearance1 with here and there small points of extravasation4 ,this condition having existed for from six to twenty-four hours1 certain results follow--at least in the acute form--which give rise to what is known as ,plastic ,effusion4 ,soon after the inflammatory process is fully established1 there will appear upon the surface a small quantity of clear fluid1 which1 as it increases in quantity1 undergoes coagulation1 and thus gradually covers the surface with a jelly-like layer of variable thickness and honey-comb surface4 ,a thin fluid of a straw color1 will be found oozing from the surface1 which is increased as the coagulated membrane is cut or torn4 ,this condition may be extended over the whole surface of both the costal and pulmonary pleura1 or may be confined to a limited portion4 ,adhesions4 ,the two layers of the pleura being in immediate contact1 the consequence of this effusion of coagulated lymph will be an early adhesion of the applied surfaces4 ,this is accomplished by a blending of the layers of coagulated matter in contact1 and a gradual organization of the same by an extension of blood-vessels from the pleura into the new formation4 ,at the same time that these changes are progressing1 the watery part of the exudation trickles down to the most dependent portion of the cavity1 and there forms a serous or sero-purulent accumulation4 ,adhesions are more frequent at the upper portion of the lungs1 but may be found at any point1 as between the inner surface and the mediastinum1 or the lower surface and diaphragm2 or1 from repeated attacks of pleuritis1 involving different portions of the serous membrane1 the whole of the exterior of the lung may become united to the adjoining surfaces4 ,the strength of the adhesions will be somewhat in proportion to their age1 those of long standing requiring considerable force to break them up1 and in many instances the lung tissues becoming lacerated before the attachments can be torn away4 ,unusual thickness of the pleura is often found at points where no adhesions exist1 this being unquestionably the result of the effusion of plastic matter into the subserous tissue during an attack of inflammation4 ,serous ,effusion4 ,while in the majority of cases of pleuritic inflammation1 we shall find plastic effusions followed by adhesions of the inflamed with the adjoining surface1 in some instances a serous or watery fluid is rapidly poured out1 and1 accumulating in the pleural sac1 constitutes hydrothorax or dropsy of the chest4 ,the fluid in these cases may present a variety of shades of color1 from a pinkish or light straw color1 to a dark brownish shade4 ,it may be transparent or opaque1 and generally will be more or less albuminous4 ,the quantity may vary from a few ounces to three1 four1 or five pints1 or more4 ,when in large quantity1 the lung will be found more or less collapsed1 shrunken1 and pressed against the posterior walls of the chest and spinal column4 ,in the general dropsy attending diseases of the heart1 kidneys or liver1 effusions may take place into the pleural cavities1 to such an extent as to give rise to great dyspna from compression of the lungs4 ,sero-,purulent or ,puriform ,effusions1 consist in the presence of a quantity of granular particles with albuminous matter1 which subside to the bottom of the vessel when drawn off1 and always contains floating flakes of lymph4 ,it may be found in cases of both acute and chronic pleurisy1 and1 like serous effusions1 may be found in large quantity4 ,purulent ,fluid1 as found in the cavity of the chest1 consists of a white or cream-colored1 opaque1 and homogeneous fluid1 combined with more or less albuminous matter1 in the form of shreds and flakes1 yet destitute of the granular matter of the sero-purulent fluids1 and not separating into a fluid and solid portion when at rest1 as is the case with the latter4 ,it is a fact well established1 that genuine purulent matter may be formed in the pleural cavity1 as well as in other serous cavities1 without ulceration of any portion of the surface1 or discharge of an abscess into the same1 it being the result of a more advanced stage of the process which gives rise to the serous or plastic effusions4 ,it may be secreted directly from the capillaries of the inflamed surface1 or1 in some instances1 it would appear to be derived from the organized false membranes1 which have taken on a suppurative action4 ,pneumothorax4 ,air may enter the pleural cavity1 by perforation of the walls of the chest from external injury1 or1 as is more common1 by the destruction of the pulmonary portion of the membrane1 from the bursting of a distended air-cell1 or from softening of tubercular deposits1 or bursting of an abscess4 ,if there are but few or no adhesions1 the accumulation of air in the cavity may be accompanied by a more or less complete collapse of the lung1 as in hydrothorax4 ,this condition1 during life1 is not readily distinguished from emphysema1 both being accompanied with similar oppression in breathing1 distension of the chest1 and displacements of the heart1 and with increased clearness on percussion4 ,serous or sero-purulent effusions will frequently accompany the presence of air in the cavity1 and thus give rise to many of the peculiar physical signs which may have been noticed during life1 as metallic tinkling1 a splashing sound on shaking the chest1 etc4 ,section ,,viii4 ,,the ,,lungs ,,and ,,bronchial ,,tubes4 ,notice3 #a4 ,while in situ--degree of collapse2 adhesions2 position and character of2 wounds1 etc4 #b4 ,after removal--external character2 color2 peculiarity of shape2 adhesion of lobes2 puckerings at apex2 solid or compressible2 crepitation2 where most noticeable2 effect of inflation on color and size4 ,tubercular deposits--size2 location4 #c4 ,substance of lung--solid or porous when cut2 extent of solidified portions2 fluids escaping2 character and quantity of4 ,abscesses--position2 number2 size2 character of contents2 color2 odor1 etc42 condition of lung around cavities2 character of walls2 thick or thin2 smooth or rough2 crossed by bands2 communication with bronchial tubes4 ,gangrene--location and extent of4 ,bronchial tubes--contents2 contraction or dilatation2 measurements at1 above and below these points2 condition of mucous membrane2 congested or ulcerated2 walls of tubes2 thicker or thinner than natural4 ,extravasation of blood--7apoplexy of lung27 portion and extent of lung involved2 condition of surrounding tissue2 blood infiltrated or encysted4 ,adventitious deposits--cretaceous bodies2 situation2 size2 density2 condition of surrounding tissues4 ,tubercles--seat2 size2 number2 color2 density1 etc42 condition of surrounding tissue4 ,cancerous masses--size2 location1 etc4 ,carbonaceous deposits--around bronchial tubes2 beneath pleura4 ,result of placing entire lungs in water--do they sink or float8 ,if they sink1 is it rapidly or slowly8 ,if they float1 is it above1 below1 or at the surface of the water8 ,results with portions of each lung4 ,the pathological conditions of the lungs1 may be arranged as follows3--,inflammation and its results1 hepatization1 suppuration1 abscess1 gangrene1 hmorrhage1 pulmonary apoplexy1 emphysema1 tubercular disease1 morbid growths1 and parasitical animals4 ,when in a healthy condition1 the lungs will present the following appearance3--,upon opening the chest1 there will be a more or less complete collapse of both organs1 partly from atmospheric pressure1 and partly from the elasticity of the lung tissue4 ,they will then have a shrunken1 shrivelled appearance1 crepitating under pressure1 and have an ashen gray color4 ,if inflated1 the surface becomes smooth and shining1 showing an indistinct outline of the lobules1 which1 with the dark pigmentary matter seen here and there1 gives the surface more or less of a mottled appearance4 ,where pleurisy had previously existed1 there may be adhesions preventing the collapse of the lungs1 until these have been broken up4 ,when cut into1 healthy lung tissue has a soft1 spongy character1 the upper portions will be quite destitute of blood1 while the posterior portions may be more or less filled with that fluid from gravitation1 giving them a dark congested appearance4 ,inflammation and its ,results4 ,pneumonia1 or inflammation of the lungs1 may affect both the air cells1 when the latter become filled with fibrinous exudations1 and the connective areolar tissue1 which then become increased in quantity4 ,the following characters present themselves1 corresponding to the three recognized stages of the disease3--,first1 congestion2 second1 red hepatization2 third1 gray hepatization or softening4 ,congestion4 ,from the peculiar structure of the lungs1 in connection with the free circulation through the same1 these organs are peculiarly liable to the several forms of congestion4 ,in many cases of death1 without any original disease of the lungs1 there will be a tendency for these organs to become loaded with blood1 giving rise to post-mortem appearances1 often with difficulty distinguished from those of a pathological origin4 ,in this post-mortem1 or1 as it has been called hypostatic congestion1 the posterior and inferior portions of the lungs are chiefly affected1 as the blood after death1 obeying the law of gravitation1 sinks to the lowest point4 ,the congested portion presents a dark red color1 and though firmer than other portions1 crepitates under the finger and floats in water1 the latter circumstance serving to distinguish this form of congestion from that of an inflammatory origin4 ,if the congestion be confined to one lung1 or to the anterior parts of either1 we may safely attribute it to a pathological cause4 ,in all cases of congestion1 upon opening the chest1 although there may be no adhesions1 the lung does not collapse1 or does so feebly4 ,when cut1 it is found to be loaded with blood1 and upon pressure1 much bloody serum escapes1 while the divided bronchial tubes will be found filled with frothy mucus4 ,red ,hepatization4 ,this condition of the lungs soon follows that of congestion4 ,the change is a gradual one1 and is first marked by an effusion of serum and coagulable lymph into the connective tissue and air cells1 thus rendering the lungs more solid1 while as the change becomes complete1 the blood itself1 which had during the congestive stage been confined to the vessels1 is now found extravasated into the interstices of the tissues4 ,the portion of the lung thus affected is not only of a dark red or violet color1 but solid1 firm1 does not crepitate1 sinks when thrown into water1 and when cut and washed1 the section shows patches of a rough1 granular aspect1 totally different from that of healthy lung tissue4 ,the pleura in this condition may be wholly unchanged1 even though the solidification may have been of long standing4 ,gray ,hepatization1 which characterizes the third stage of pneumonia1 is known by the lung presenting a firm1 semi-solid1 inelastic1 and more or less incompressible character4 ,failing to collapse1 the lung is found more or less completely filling the chest4 ,the pleura will generally present evidences of inflammation in the presence of patches of lymph and more or less points of adhesions4 ,the upper lobe may be soft and compressible1 while the lower is solid from hepatization4 ,when divided with the knife1 the substance is found of a gray1 red1 or dirty yellow color2 compact1 but friable and easily broken down with the fingers1 while the smaller bronchial tubes are filled with fibrinous plugs4 ,bloody purulent matter1 with much turbid serous fluid1 will ooze from the cut surfaces4 ,pus globules will be detected in the escaping fluids by a microscopic examination4 ,resolution of a hepatized lung1 consists in the gradual softening of the effused substances within the smaller bronchial tubes and air cells1 and the discharge of the same by cough and expectoration4 ,inflammation of the lung usually commences in the lower lobe1 and while the disease here may extend to complete hepatization1 the middle lobe may be found merely congested1 while the upper is quite healthy4 ,inflammation may attack one or both lungs4 ,in the former case it is known as single1 and in the latter as double pneumonia4 ,from an examination of a large number of cases1 it has been ascertained that inflammation of the right lung is more frequent than that of the left in the proportion of about three to one1 and that single pneumonia is more common than double pneumonia in the ratio of six to one4 ,pneumonia is sometimes divided into ,catarrhal and ,croupous4 ,in the former1 the exudation contains little or no fibrinous matter1 while the bronchial mucous membranes are also involved1 the disease at the same time being confined mostly to the lobules of the lungs4 ,in the croupous form1 the exudation contains a large proportion of fibrine1 and the disease usually involves the greater part of a lobe1 or may extend to the whole of one or both lungs4 ,both forms of the disease may run through the three stages of congestion1 red and gray hepatization4 ,a peculiar form of inflammation of the lungs1 found mostly in children and young persons1 and usually chronic in character1 has been described as ,lobular ,pneumonia4 ,the inflammation here being confined to the lobules1 these1 after the disease is perfectly developed1 present the appearance of a multitude of rounded nodules1 of the size of small nuts1 scattered through the substance of the lungs4 ,the exterior of these is reddish1 firm1 and vascular1 while the interior is of a grayish color1 containing effused lymph1 with more or less purulent matter4 ,this form of pneumonia being frequently associated with diseases of the joints and bones1 as well as with inflammation and ulceration of the glands of the intestines1 it has been considered as depending upon a strumous diathesis1 and as1 in fact1 but the early stage of tubercular consumption4 ,seldom proving fatal in the early stage1 or before the disease has extended to the whole substance of the lung1 and perhaps resulted in the formation of cavities1 we much less frequently meet with this form of pneumonia in post-mortem examinations4 ,suppuration and ,abscess4 ,gray hepatization must be looked upon as a form of suppuration of the lungs2 as the purulent-looking fluid found infiltrating the tissues1 filling the air cells and smaller bronchial tubes1 upon a microscopic examination1 is found containing undoubted pus globules4 ,this1 however1 is not an abscess1 the matter not being confined within a cavity1 but diffused through the tissues of the part4 ,that a distinct abscess of the lungs may form1 as a result of pneumonia1 is generally admitted1 though they are usually small and confined to the lower lobes4 ,from softening of tubercular masses1 abscesses not unfrequently form in any portion of the lungs4 ,that they do not occur more frequently in pneumonia1 may result from the fact that the disease often proves fatal by suffocation1 before there has been time for it to have reached the suppurative stage4 ,the pleura over the seat of the abscess will generally be found much thickened1 and frequently adherent to the opposite walls of the chest4 ,pulmonary abscess may be wholly discharged by expectoration--the cavity communicating with the bronchial tubes--or it may discharge into the pleural cavity1 or when adhesions have first formed1 it may work its way between the ribs1 and the matter escape upon the surface of the body4 ,metastatic or ,secondary ,abscess4 ,this form of abscess in the lungs1 is well understood to be the result of suppuration in some distant part or organ1 which1 being attended with phlebitis of the part1 purulent matter is introduced into the circulation1 and thus conveyed to the lungs or perhaps the liver4 ,this original suppuration may be at the uterus after delivery1 or from a fistulo in ano1 psoas abscess1 or any other similar affection4 ,from the fact1 probably1 that the whole volume of the blood flows through the lungs1 at each round of the circulation1 these organs are more frequently affected with this form of abscess than any other1 it occurring next in frequency in the liver4 ,these abscesses may be recognized as spots of yellow pus1 varying in size from a pin's head to a walnut1 generally situated near the surface of the organ and surrounded by a dark1 well defined layer of congested tissue1 while beyond this1 the structure is in a healthy condition4 ,several of such abscesses may be found in various parts of the lungs4 ,gangrene4 ,gangrene of the lungs1 rarely results from an attack of ordinary pneumonia1 but appears more frequently to take place either as a concomitant of pestilential fevers in general1 or as an accompaniment of certain cases of tubercular vomic of the lungs1 or as a primary and peculiar species of inflammatory affection of those organs4 ,in the first instance1 a patient suffering a severe form of typhoid fever1 presents symptoms of pulmonary disorder1 as hurried respiration1 livid face1 cough1 first dry and soon moist1 with thick orange-colored and finally dark or bloody and extremely offensive expectoration1 and fetid breath4 ,with these symptoms are generally associated great feebleness1 delirium1 with tendency to gangrene of the extremities and prominent points of the hips1 sacrum1 etc42 and finally1 with increased difficulty in respiration and fetor of breath1 death ensues4 ,in the second case1 a patient suffering from clearly recognized tubercular disease of the lungs1 which has passed on to softening of tubercular masses1 and the formation of vomic1 has an aggravation of all his symptoms1 accompanied with the expectoration of a highly offensive dark matter1 plainly resulting from a gangrenous condition of the interior of a tubercular cavity4 ,in the third case1 the disease comes on at first as an affection of the lungs4 ,the attack commences either as pulmonary inflammation1 or bronchial disease1 or with spitting of blood with more or less pain in the chest4 ,the patient becomes rapidly worse1 the cough increasing1 with reddish-brown or bloody sputa1 and offensive breath4 ,the countenance is anxious and livid1 the eye heavy1 sometimes wild and glaring4 ,the fetid breath is not always an early symptom1 but when it does appear1 the disease in general tends rapidly to a fatal termination1 although recovery sometimes takes place4#ai ,the appearances after death1 in cases of gangrene of the lungs1 are of two kinds1 according as the disease is diffuse or circumscribed4 8,in the first case1 a mass of lung1 two and a-half or three inches wide1 but irregular in figure and outline1 is converted into a soft1 pulpy1 dark1 ash-colored substance1 which1 when it is handled or pressed by the fingers1 falls down into a loose1 moist mass1 emitting a fetid1 offensive odor1 without trace of the usual structure of the lungs1 except a few bronchial tubes1 and blood-vessels1 and shreds of filamentous tissue4 ,this mass is generally bounded by1 but it does not terminate abruptly in1 healthy lung4 ,it is soft1 dingy1 and infiltrated with a dark1 ash-colored1 dirty1 serous liquor4 ,occasionally the surrounding portion of the lung is hepatized or infiltrated with blood or bloody serum2 the bronchial tubes always contain much bloody1 viscid mucus2 and sometimes the pleura is reddened1 covered with lymph or adhesions1 and contains fluid in its cavity40 ,the portion of the lung thus affected is usually within the lower or middle lobe1 the upper portion being rarely involved4 ,in the second1 or circumscribed form1 a portion of the lung1 generally near the surface1 presents a dark-colored1 hard patch1 varying in size from a quarter1 to a half-dollar piece or more1 often quite circular1 and bounded all round by healthy lung4 ,this circular hard patch1 which resembles closely an eschar produced by caustic potash1 may adhere or be easily detached4 ,in the latter case1 it generally leaves a cup-like cavity1 the surface of which is firm1 granular1 with the blood-vessels and bronchial tubes closed1 and with the surrounding lung more softened1 but generally presenting marks of pleurisy1 pneumonia1 and bronchitis all combined1 which may be looked upon as an effort of nature to isolate and detach the diseased mass4 ,pulmonary ,hmorrhage--,hmoptysis4 ,discharge of blood from the lungs by coughing1 may result from a variety of causes1 among which may be mentioned3 #a1 mechanical shock or injury1 as in falls or blows upon the chest2 #b1 inflammatory action within the lungs2 #c1 disease of the heart2 #d1 disease of the arteries2 #e1 tubercular deposition2 #f1 tubercular destruction1 with ulceration of vessels4 ,in the first instance the expectorated blood may be copious or slight1 according to the severity of the injury4 ,if death soon results1 an examination of the lungs will disclose one or more of the bronchial tubes filled with blood1 which has plainly arisen from a rupture of some of the capillaries of the bronchial mucous membrane4 ,the blood discharged in many cases of the early stage of consumption1 and in young females after the suppression or retention of the menstrual flow1 is from the same source4 ,hmorrhage from the lungs may also take place as a result of tubercular deposits4 ,the presence of tubercular masses must necessarily produce more or less pressure on the adjoining vessels1 interfering with the flow of the blood through the same1 and thus inducing congestion1 and even rupture of some of the capillary branches4 ,again1 where tubercular masses have progressed to softening1 and a cavity has been formed1 the ulcerative process may open a large vessel1 and death result in a few minutes from excessive hmorrhage4 ,a post-mortem will here show the cavity1 as well as the bronchial tubes and trachea1 filled with coagulated blood4 ,the blood expectorated during the early stage of an attack of pneumonia1 is never copious1 consisting mainly of streaks of blood through the saliva1 while at a later stage1 from being more uniformly diffused1 it gives the peculiar rusty sputa characteristic of this disease4 ,the post-mortem appearances have already been given under the head of pneumonia4 ,certain forms of disease of the heart1 as ossification of the mitral valves1 with contraction of the orifice1 or in hypertrophy of the left ventricle1 with disease of the aortic valves1 are frequently attended with hmoptysis4 ,in either case1 the obstruction to the free circulation through the left side of the heart1 must induce an over distension of the pulmonary veins1 which1 upon some unusual exertion1 may readily result in extravasation through the bronchial mucous membrane1 causing the bloody expectoration which takes place during life1 or into the pulmonary connective tissue1 giving origin thus to what is known as ,pulmonary ,apoplexy4 ,the post-mortem appearances in these cases1 are as follows3--,the portion of the lung involved1 fails to collapse on opening the chest4 ,it is firm1 and of a dark red color2 and when cut into1 thick blood issues from the cut surfaces4 ,the portion involved may include from one to four cubic inches4 ,it will be found circumscribed with healthy lung tissue1 and looks not unlike a clot of venous blood2 these circumstances serving to distinguish it from hepatization1 which terminates more or less gradually in sound lung4 ,while these hmorrhagic effusions may1 in many cases1 cause early death by their size and number1 in others1 the clot may soften1 the lung around become inflamed1 or even gangrenous1 resulting in the formation of an irregular cavity filled with dark1 offensive1 semi-fluid contents4 ,in still other cases1 where the clot is small1 and in part within the air cells1 it may soften and become absorbed or coughed up1 and the air again enter the cells1 or these may contract into a fibrous indurated mass4 ,emphysema4 ,emphysema of the lungs1 is usually described as of two forms--vesicular and interlobular4 ,vesicular emphysema1 consists essentially in a dilatation or over-distension of a greater or less number of air cells1 resulting in giving the portion involved greater buoyancy in water1 from diminished specific gravity1 lessening the crepitation on pressure1 preventing collapse on the opening of the chest1 and rendering the affected portion more or less dry and bloodless4 ,from the loss of elasticity1 there will be during life1 a difficulty in the lungs emptying themselves of air as they should1 hence the patient will be subject to severe attacks of oppression upon the slightest aggravating cause4 ,if one lung only is affected1 the corresponding side becomes enlarged and less movable than the other2 the adjoining viscera1 as the heart or abdominal organs1 are more or less displaced1 the intercostal spaces swell out1 and the ribs becoming more horizontal1 give a barrel-shape to the chest1 which is quite characteristic of emphysema4 ,this distension of the air cells1 is more marked along the edges of the lungs1 the vesicles at these parts being probably the least supported4 ,patches of dilated cells may be found1 however1 at other parts1 which1 if superficial1 will project beyond the surface of the surrounding healthy portions1 and appear like large bladders1 from the coalescing of several vesicles4 ,this form of emphysema may be induced by any cause interfering with the ready escape of the air from any portion of the lungs1 especially if accompanied with severe cough1 as in many forms of bronchial disease1 enlargement of the bronchial glands1 etc4 ,interlobular ,emphysema1 consists in an effusion of air into the connective or areolar tissue of the lungs1 from a rupture of air cells or smaller bronchial tubes1 or from the laceration of the lungs from a broken rib1 when the air may accumulate in the pleural cavity1 constituting pneumothorax1 and may also be accompanied with emphysema of the chest1 neck and head1 from an escape of the air at the point of injury into the tissues of those parts4 ,this form of emphysema may involve a large part or the whole of the lung1 while the vesicular form is generally limited to definite portions4 ,by disturbing the circulation through the lungs1 emphysema is liable to induce dilatation of the right side of the heart4 ,from an evolution of gases within the lungs after death1 we may have similar appearances to that above described1 requiring some care to distinguish between the two4 ,in the latter case1 the general indications of decomposition1 with the ease with which these distended vesicles may be emptied by pressure1 will aid in determining the character of the case4 ,tubercular ,disease of the ,lungs4 ,i shall not attempt to present here the various theories that have been promulgated as to the nature and origin of tubercle1 contenting myself by giving a description of their anatomical characters1 as presented in the several stages of tubercular disease4 ,tubercle1 or tubercular matter1 may be described as consisting of a yellowish-white substance1 opaque1 friable and unorganized4 ,it may be deposited in most of the tissues or organs of the body1 but its more common seat is the free surfaces of mucous membranes1 though often found in connection with the serous4 ,tubercular deposits in the lungs1 are not uniformly distributed through all parts of those organs1 being in the large majority of cases confined to the upper and back part of the upper lobes1 and in those cases where they are more or less distributed through the whole lung1 they will be found more numerous and larger in those parts4 ,tubercles may exist as fine points1 not larger than a pin's head1 7miliary tubercle17 or the matter may accumulate in masses of the size of a kernel of corn1 of a cherry1 or of a robin's egg4 ,in other cases1 the pulmonic exudation in some portion of the lung attending an attack of pneumonia1 may become transformed into tubercular matter1 having an irregular outline and no distinct boundary1 7infiltrated tubercle47 ,tubercular matter is undoubtedly1 in most instances1 deposited within the air cells1 so filling these1 as to more or less interfere with the admission of the air1 and giving greater density to the portion of lung involved4 ,while the secreted matter is at first soft1 or semi-fluid and partially translucent1 it gradually acquires greater density1 becomes opaque and cheesy in its character1 and in all respects acting as a foreign body within the lungs4 ,sooner or later1 the presence of tubercles will excite inflammation in the surrounding tissues4 ,in this manner these bodies may become softened and their substance expectorated4 ,if large numbers be aggregated together1 the ulcerative process may completely destroy the tissues between1 an abscess or vomica resulting4 ,in the early stage of the disease1 before the inflammatory and ulcerative processes have been set up1 the presence of tubercular matter1 by interfering with the capillary circulation1 may give rise to a hmorrhage into the bronchial tubes1 constituting the hmoptysis so frequently present in this disease2 while at a later period1 from a destruction of some of the larger vessels from ulceration1 a profuse and even fatal hmorrhage may result4 ,post-mortem ,appearances4 ,in examining the lungs of those who have died after suffering the usual symptoms of pulmonary consumption1 we shall find the upper portion of one or both lungs1 more or less indurated1 and occupied by one or more irregular shaped cavities1 containing either air1 or air and a quantity of viscid1 puriform1 dirty-looking fluid4 ,generally the apex of the affected lung1 will be found firmly attached to the inner surface of the chest1 by means of a thick1 firm1 false membrane1 which unites the two layers of the pleura4 ,in some instances1 nearly or quite the whole surface of the lung will be found thus adhered1 while the lobes will also be united by an interlobular false membrane4 ,when the adhesions are confined to the upper portions of the lungs1 the pleura covering the lower portion will frequently be found more or less rough from albuminous exudation1 while a quantity of sero-purulent fluid will be found in the posterior part of the thoracic cavity4 ,the greater part of the upper lobe1 may be found converted into one irregular cavity2 more frequently1 the upper lobe presents two or three1 either isolated or communicating4 ,the largest1 when several are present1 is most commonly in the upper portion of the lobe4 ,when entirely or partially filled with matter1 such cavities are usually termed vomic or abscesses1 while when empty1 they are generally called tubercular cavities or excavations4 ,in the lower part of the upper lobes1 the cavities are few and small4 ,the middle lobe of the right lung1 rarely presents cavities1 while the lower lobes of both lungs are entirely free4 ,the whole of these parts1 however1 may be more or less indurated by the presence of hard1 irregular shaped masses1 the result1 probably1 of inflammatory action4 ,tubercular cavities present a considerable variety1 both in size and shape4 ,they may not be larger than a pea1 or bean1 or may reach the size of an egg1 or even of an orange4 ,always of an irregular shape1 they often consist of one large cavity1 communicating with two or three smaller ones4 ,the interior will be found traversed by bands1 or cords1 passing in various directions1 but generally taking a longitudinal course1 and probably the remnants of blood-vessels and bronchial tubes4 ,the tissues immediately around a cavity1 and forming its walls1 will be found firm1 inelastic1 almost cartilaginous in character1 and of a dark red1 or brown color4 ,the density of the structures is caused partly by tubercular deposits in the lung1 and partly by inflammatory induration4 ,while tubercular disease of the lungs is almost universally fatal1 there is reason to believe that1 in a very small proportion of cases recovery has taken place1 and the post-mortem appearances of the lungs have accorded with this view4 ,these appearances may be described as follows3 ,we sometimes observe in examining the lungs of individuals who may have died from diseases of other organs1 that the pleura covering the upper lobe of the lung1 presents1 at a certain point1 a puckered1 shrivelled appearance1 with a leather-like feel1 and with a rounded1 firm mass beneath4 ,upon dividing the latter with the knife1 the interior is found composed either of a soft substance like putty1 or more frequently of a chalky nature4 ,this is looked upon as a cicatrized or contracted vomica1 the putty or chalk-like contents being the residuary matter of the softened tubercle1 the thinner portion having been expectorated or removed by absorption4 ,in some instances1 these bodies are of almost a stony hardness1 grating against the knife4 ,in other cases1 cavities lined with a smooth1 semi-cartilaginous false membrane are found1 containing air only1 and with dilated bronchial tubes opening into the same1 no appearance of ulceration being visible1 everything indicating that a tubercular mass had once occupied the cavity1 its softening and expectoration having been followed by a healing of the inner surface4 ,morbid ,growths4 ,cancer4 ,malignant disease of the lungs is by no means frequent1 yet we have abundant evidence that cancer in its several forms may be developed in these organs4 ,colloid cancer1 has been usually found more or less infiltrated through the substance of the lungs1 while other forms appear in nodules or isolated tumors4 ,it is seldom1 perhaps1 that cancer exhibits itself as a primary affection of the lungs1 the disease first appearing in some other part1 and more frequently1 it is said1 in the bones or testicles2 operation for the removal of cancer in these parts being very liable to be followed by an early development of the disease in the lungs or other internal organs4 ,on the other hand1 where the cancer is connected with any organ whose veins form a part of the portal system1 as the stomach1 spleen1 pancreas1 intestines1 etc41 the disease does not so frequently extend to the lungs1 while in those cases the liver is more liable to become affected4 ,the encephaloid form of cancer1 is that more frequently met4 ,it may be connected either with the bronchial glands1 when the diseased mass will be mainly confined to the mediastinum1 and may consist of bodies varying in size from that of a cherry to that of a large apple1 or1 the disease may commence directly in the substance of the lungs1 the tumor rapidly increasing in size1 and crowding the lungs from their normal position4 ,after death1 the encephaloid mass may be found compressing the lungs into a very small space4 ,the tumor presents the usual character of this disease1 some of the lobules being soft and pulpy1 or brain-like1 others of a more firm1 cheese-like consistence4 ,melanosis4 ,two forms of melanotic deposits are observed in the lungs3 one1 true melanosis1 and frequently associated with encephaloid disease2 the other a deposit of carbonaceous matter from coal dust1 smoke1 etc41 which has been inhaled during life1 and distinguished as spurious melanosis4 ,true melanosis consists in a deposit of a dark pigmentary matter in the substance of the bronchial glands1 found at the bifurcation of the trachea1 and along the main bronchi4 ,the glands are at the same time enlarged4 ,the coloring matter may be solid1 or slightly fluid1 or pasty4 ,at the same time the melanotic matter may be infiltrated to some extent into the substance of the lungs1 or deposited in cysts within the same4 ,in spurious melanosis1 the dark carbonaceous matter is diffused more or less through the whole lung1 and may be seen distinctly through the pleura4 ,the bronchial mucous membrane is more or less tinged with the same substance1 and generally a quantity of black-colored fluid may be expressed from the cut surfaces4 ,hydatids4 ,acephalocysts or animal hydatids1 have not unfrequently been found in the lungs1 and in several instances they have been discharged by expectoration4 ,these cysts vary in size from a cherry to an egg1 and consist of a double membrane containing a limpid fluid within which other hydatids may be found1 of the same character as the parent cyst4 ,they may excite inflammation and suppuration in the tissues around1 and thus become discharged into the bronchial tubes1 the pleural cavity1 or through the diaphragm into the abdominal cavity4 ,cystic1 ,fibrous1 ,cartilaginous1 and other forms of tumors1 are occasionally found in the lungs1 and1 while they are generally small1 they may acquire such size as to become a source of trouble during life4 ,the ,bronchial ,tubes4 ,the examination of the trachea and bronchial tubes in post-mortem examinations1 is too frequently omitted4 ,the lungs having been removed from the chest1 they may be readily opened along their posterior aspect1 and the bronchial tubes traced into the substance of the lungs4 ,the pathological conditions of the bronchial tubes which may claim our attention1 are inflammation in its various forms1 obliteration1 and dilatation4 ,bronchitis4 ,bronchial inflammation has been divided into two varieties1 according to the portion of the tubes affected4 ,in one case the disease may be confined to the large and medium sized tubes2 it is then known as tubular bronchitis4 ,in the other1 it is seated principally in the terminal ends1 where the lining membrane is more delicate1 and the tubes much smaller1 and from this1 extending to the air cells1 forms what has been called vesicular bronchitis4 ,the latter form is closely allied to pneumonia2 in fact the two diseases pass into each other1 and in most cases probably coexist4 ,ordinary1 or tubular bronchitis1 is not often a fatal disease1 hence we cannot speak accurately of its anatomical characters2 yet1 being frequently associated with other forms of fatal disease1 we have opportunities of examining it under those circumstances4 ,the lining membrane is then found thickened1 rough1 of a dark red or brown color1 with more or less contraction of the calibre of the tube1 and covered with a viscid1 jelly-like mucus1 often streaked with blood1 and in some cases of a puriform character4 ,this form of bronchitis may occur as a primary disease1 or it may accompany tubercular consumption2 is frequent in cases of heart disease1 and may arise in the course of typhoid fever1 measles1 scarlet fever1 and small-pox4 ,vesicular bronchitis1 from its involving the smaller tubes and air cells1 is much more frequently fatal than the tubular form of the disease1 although in fatal cases the two forms will usually coexist4 ,in a post-mortem examination of these cases1 we find the bronchial membrane red and injected1 pulpy and thickened4 ,in a more advanced stage1 the air cells and smaller tubes are filled with a viscid1 puriform mucus1 which prevents the air from reaching the vesicles during life1 and the lungs from collapsing upon opening the chest after death4 ,minute ulcers are not uncommon upon the mucous membrane1 the effect of these1 being that of changing the character of the secretion from a transparent mucoid1 to an opaque purulent form4 ,bronchial inflammation1 as has been stated in another place1 may result in emphysema of the lungs4 ,in these cases1 a valvular-like obstruction is produced in some of the bronchial tubes1 which1 offering little impediment to the entrance of the air1 interferes with its escape1 and thus by producing increased pressure upon the air cells supplied by the obstructed tube1 a gradual dilatation or rupture ensues1 resulting in the former case in vesicular1 and in the latter1 in interlobular emphysema4 ,disease of the heart may also result from chronic bronchial inflammation4 ,not only respiration1 but the circulation may be so impeded as to exert a direct influence upon the heart4 ,from the difficulty which the blood encounters in flowing through the branches of the pulmonary artery1 the main trunk of that vessel becomes permanently dilated1 while the right ventricle1 from the increased force required to overcome the obstruction in the lungs1 becomes gradually dilated1 and at the same time1 perhaps1 hypertrophied4 ,from the union of the two ventricles1 the excessive action of the right may induce a similar action in the left1 and thus in time result in that hypertrophy of both ventricles1 which is sometimes found in persons who have suffered from chronic bronchitis4 ,narrowing or ,obliteration of ,bronchial ,tubes4 ,in some cases1 in carefully tracing the bronchial tubes1 we may find either a remarkable narrowness of the vessel1 or a complete closure of the same4 ,in the former cases1 there is a distinct thickening of the walls of the tube1 by an effusion of lymph1 or blood and lymph1 into the submucous tissues2 or1 from induration of the lung tissue around the smaller bronchial tubes1 from tubercular or other deposits1 a similar narrowing may result from external pressure4 ,complete closure may be found in any portion of the tubes1 in the large trunks1 arising from the main branches1 as well as in the smaller branches4 ,they may be detected by passing a blunt probe into the tubes4 ,the branches will frequently be found continuing from the points of closure1 as a fibrous cord4 ,the most common seat of these closures is in the upper lobe of the lung1 yet they have been found in the lower lobes4 ,the causes of obliteration of the bronchial tubes is not well understood1 yet1 they are more frequently observed in persons who have suffered repeated attacks of bronchitis1 or of chronic pneumonia4 ,dilatation of the ,bronchial ,tubes4 ,this condition of the bronchial tubes is more frequent in its occurrence than obliteration4 ,it takes place in two forms1 either several tubes are uniformly dilated1 like the fingers of a glove1 or a single tube may form a cavity1 by undergoing a sacular enlargement4 ,some mechanical obstruction1 by interfering with the free passage of air through the tubes1 will usually have caused the difficulty1 as an enlarged bronchial gland1 pressing one of the bronchi4 ,here the free exit of the respired atmosphere being prevented1 an accumulation of air takes place behind the narrowed point4 ,any impediment to the entrance or exit of the air into the lungs will produce irregular and forcible breathing1 and throw a greater strain upon those parts especially which are in the vicinity of the obstacle4 ,if1 at the same time1 the patient suffers an attack of asthma1 bronchial catarrh1 or whooping-cough1 the violence of the cough materially aids in developing the dilatation4 ,the degree of dilatation is greatly variable4 ,tubes which1 in their natural state1 are not larger than a crow-quill1 may1 especially in the lower and middle lobes1 reach the size of the finger1 while at various points1 sacular dilatations may occur1 which at first sight may appear as vomic1 but which upon more careful inspection1 prove to be dilated portions of the bronchial tubes4 ,the tubes in this state are usually filled with a puriform fluid1 upon the removal of which the lining membrane is seen to be reddened and softened1 or perhaps ulcerated4 ,this condition of the bronchial tubes may frequently be detected during life4 ,the voice is hoarse1 like a person in croup4 ,the cough is also hoarse and brazen1 while the breathing is difficult1 and mucus rattling is heard in the middle or lower portion of the lung4 ,the post-mortem appearances in cases of foreign bodies in the bronchial tubes1 may be readily anticipated and easily recognized4 ,the ,mediastinum4 ,inflammation may arise in the anterior mediastinum1 from fracture or caries of the sternum2 and in the posterior1 from injury1 inflammation1 caries1 or necrosis of the vertebr4 ,this inflammation may also result in the formation of an ,abscess2 or1 ulceration and perforation of the sophagus1 or inflammation of the lymphatic glands may lead to the same results4 ,these abscesses may reach large size1 resulting in displacement of the heart1 and may rupture into the pleural cavity1 the trachea or sophagus4 ,tumors of various kinds1 may also develop within this space1 including the several forms of cancerous growths4 ,the latter will frequently have their origin in the bronchial or lymphatic glands1 or1 perhaps1 in the remnant of the thymus gland4 ,,part ,,iii4 ,,the ,,abdomen ,,and ,,pelvis4 ,,chapter ,i4 ,,the ,,operation4 ,the cavity of the abdomen1 may be opened without disturbing that of the chest4 ,an incision from sternum to pubes1 down the central line1 and through the superficial structures1 should be followed by a careful division of the tendinous portions of the muscles and peritoneum1 for a sufficient space to admit two fingers1 when1 by introducing the same1 the remaining portion may be divided without risk of injury to the intestines4 ,a cross incision having been made at the umbilicus1 the angular flaps may be turned aside1 fully exposing the abdominal contents4 ,where the chest is opened at the same time1 the transverse incision will not be required4 ,the peritoneum1 with any serous or other contents having been examined1 the attention may be given to any special organ or part that may be involved1 or each may be taken up seriatim4 ,in many instances there will be no occasion for removing any of the viscera1 while in others1 one or all of the organs may require so careful an examination1 as to necessitate an entire removal from the body4 ,the small intestines may be removed en masse1 or in sections4 ,after applying double ligatures at the lower end of the ileum1 and just below the duodenum1 the bowel may be divided between these1 when1 by dividing the mesentery near its intestinal border1 with either the knife or scissors1 the whole mass may be removed4 ,by means of the enterotome1 they may now be rapidly laid open through their entire length1 the contents removed1 and the surface cleansed if desired for more careful inspection4 ,occasionally1 portions only of the small intestines will require examination4 ,by applying double ligatures1 above and below the portion to be examined1 the removal is effected without escape of the contents into the abdominal cavity4 ,in the removal of the colon1 either in sections1 or as a whole1 the same care should be observed in the application of the ligatures4 ,the rectum having been divided1 it may be lifted and rendered tense1 its attachments1 with those of the ascending transverse and descending colon1 being successively divided with the knife1 and thus the whole gut removed and afterwards split open with the enterotome4 ,the removal of the rectum1 for the examination of its whole length1 will usually require the removal of the other pelvic viscera1 directions for which will be given further on4 ,in all cases where the stomach is to be examined1 it will be better first to remove it from the body4 ,to accomplish this1 both omenta should be detached from the curves of the stomach1 which may be done either with the fingers or scissors4 ,the hand may now be carried down to the cardiac end of the stomach and the fingers forced around the sophagus without the use of the knife1 and a ligature placed upon that tube4 ,a ligature should also be placed just below the pyloric orifice1 and another an inch below this4 ,the knife or scissors may be used to divide the sophagus close to the diaphragm1 and the duodenum between the two ligatures2 the stomach may then be lifted from its position without loss of any of its contents4 ,if the object is merely to make a chemical analysis of the contents1 the stomach should be placed immediately in the vessel prepared for its reception1 and carefully sealed and labelled4 ,if1 on the other hand1 we may wish to examine the inner surface of the organ1 it may be freely opened along one of the curves with the scissors1 the contents removed1 and the mucous surface cleansed with a stream of water1 for more satisfactory inspection4 ,both the contents and the stomach1 may still be preserved for chemical examination1 should the circumstances of the case seem to require it4 ,from the manner in which the duodenum is bound down to the posterior abdominal walls by the peritoneum1 some little care will be required in its removal4 ,ligatures should be applied for retaining the contents1 as directed with the stomach4 ,the kidneys1 with the suprarenal capsules1 may be reached by lifting the intestines1 and tearing open the peritoneum with the fingers4 ,the gland may then be readily lifted from its position1 and the vessels divided with the knife4 ,to examine the interior1 the gland may be split open longitudinally along its convex border1 which will give a view of the cortical and pyramidal portions1 with the interior of the sinus and pelvis4 ,for microscopic examination1 portions should be hardened in alcohol or solution of bichromite of potassa4 ,the spleen may be easily removed from its position1 by dragging it from its bed1 in the left hypochondriac region1 and dividing its vessels and omental attachments to the stomach4 ,the pancreas may be brought into view1 by tearing open the great omentum just beneath the stomach1 when the gland may be seen behind the peritoneum1 extending transversely across in front of the aorta4 ,to remove it from its position will require some care1 owing to its being bound down to the posterior walls by the peritoneum1 and closely attached to the duodenum by its right extremity or head4 ,the liver may be generally examined in situ4 ,the condition and contents of the gall-bladder1 the size1 color1 density1 etc41 of the gland1 may all be noted without removal4 ,where1 however1 we may desire to ascertain the weight of the gland1 or to examine its posterior and upper surface1 its removal will be required4 ,where the chest has previously been opened1 this will not be a difficult operation4 ,in other cases1 the cartilages and ribs1 forming the lower boundary of the chest1 should be strongly elevated by an assistant2 the operator then1 by dragging down the liver1 having first divided the suspensory ligament1 may expose the coronary and lateral ligaments1 which will require care in their division1 to avoid opening through the diaphragm into the chest4 ,the fingers should be now freely used1 to peel the gland from the diaphragm4 ,from the close connection of the liver to the ascending vena cava1 this vessel will require to be divided at the upper border of the liver1 close to the diaphragm1 and again1 after the gland has been rolled from its bed1 at its lower border1 with also the portal vessels1 hepatic artery and duct1 which reach the transverse fissure through the border of the lesser omentum4 ,the liver may now be lifted from the body1 and placed in any convenient vessel for a more detailed inspection4 ,the ,pelvic ,viscera4 ,the whole pelvic viscera1 with the external organs of generation1 in either the male or female1 may be removed together1 in the following manner3--,apply a double ligature to the upper portion of the rectum1 and divide the gut between4 ,the peritoneum may now be divided around the border of the pelvis1 in the female1 at the same time1 cutting across the round and broad ligaments of the uterus1 when1 with the hand1 the bladder may be stripped down from the inner side of the pubes1 the rectum torn from the hollow of the sacrum1 and in the same manner the parts torn off from the sides of the pelvis1 using the knife only for dividing the more closely adhering points4 ,now1 after flexing the thighs upon the abdomen1 an incision may be made through the skin of the mons veneris just over the anterior commissure of the vulva of the female1 and over the penis of the male1 and then carried back upon either side of the genital organs1 meeting behind the anus1 near the point of the coccyx4 ,this incision may be carried through the superficial tissues1 down to the pubic arch1 when the crura of the penis1 or clitoris1 may be detached from the rami of the pubes1 by carrying the knife close to the bone4 ,the finger may now--after a slight use of the knife--be pushed beneath the arch of the pubis1 and made to appear in the pelvis4 ,taking this as a guide1 the knife may be introduced at this opening1 and carried deeply along the ramus of the ischium and pubis of either side1 dividing the levator ani muscle and pelvic fascia4 ,the bladder may now be drawn forward beneath the arch1 this followed by the rectum1 deep incisions being carried back to the tuberosities of the ischia and point of coccyx1 and thus the whole mass removed entire4 ,the external parts may afterwards be so drawn together by stitches1 as to make the absence of the external organs scarcely noticeable1 while a bundle of rags crowded into the pelvis from above1 will prevent the possible escape of any of the abdominal contents4 ,where the internal organs only1 are required to be removed2 after they have been detached upon all sides as before directed1 the knife may be carried down beneath the pubic arch1 and the urethra divided1 in the male1 just in advance of the prostate4 ,incisions may now be carried back upon either side of the bladder and rectum1 dividing the levator ani muscle1 when1 by drawing upwards upon the mass1 the rectum1 and in the female1 the rectum and vagina1 may be divided near their lower ends1 and the whole removed together4 ,in many cases it may be desired to remove the uterus of the female alone4 ,this may be done by dividing the broad and round ligaments upon either side1 when1 by dragging the uterus forcibly upwards1 the vagina may be cut across about an inch below the cervix1 and thus the organ removed4 ,in all cases1 a few rags should be crowded into the pelvis for the purpose of preventing the escape of any fluids4 ,in hospital cases1 where parts are to be exhibited to a class1 and especially if several organs are involved in the disease1 the whole thoracic and abdominal viscera may be removed together and brought before the class on a large tray4 ,this may be effected in the following manner3--,a single incision may be carried from the upper end of the sternum to the pubes1 and the sternum removed in the usual manner4 ,the trachea and sophagus1 with the large vessels of the arch of the aorta1 may now be divided at the root of the neck4 ,grasping the arch of the aorta and the trachea1 the whole thoracic contents may be stripped from the spinal column4 ,the diaphragm being now separated from its attachment to the ribs on either side and the spinal column1 the whole abdominal contents may1 in the same manner1 be dragged from above downwards1 the rectum tied and divided1 and the contents of the two great cavities removed entire and with little disturbance of the relation of parts4 ,in closing up the cavity after the examination is completed1 the viscera having been replaced1 a sufficient quantity of wheaten bran or clean sawdust should be thrown in to absorb any remaining fluids1 thus preventing their escape after the sewing up of the incisions4 ,,chapter ,,ii4 ,,pathological ,,conditions4 ,section ,i4 ,,of ,,the ,,peritoneum4 ,notice in examination3--#a4 ,contents of cavity--serum2 amount1 color1 coagulable or not2 pus--amount1 consistence1 odor1 source2 blood--amount1 source2 foreign bodies2 gall-stones2 worms4 #b4 ,condition of membrane--color1 transparency1 rough or smooth1 moist or dry1 thickness2 adhesions--position and strength of4 ,vascularity2 ulcers2 perforations2 tubercles2 tumors2 wounds1 etc4 ,this membrane we find liable to congestion1 inflammation1 gangrene1 effusions1 and morbid growths4 ,congestion of the peritoneum1 may result from obstructed circulation through the liver1 or ascending vena cava1 or from inflammatory action2 and may terminate in serous effusions into the abdominal cavity1 or thickening of the membrane4 ,the redness of congestion1 may be distinguished from that of inflammation1 by the larger vessels appearing more involved1 and by the absence of any plastic effusions4 ,inflammation of this membrane1 7,peritonitis17 may be either acute or chronic4 ,acute peritonitis1 in most instances1 commences at some one or more points1 and from this gradually diffuses itself over the membrane until it becomes general4 ,such point of inflammation may commence immediately over some inflamed1 or ulcerated1 or perforated spot in the intestines1 or in the peritoneal covering of an inflamed uterus1 liver1 etc41 or as the result of external injury4 ,in the early stage of peritonitis1 the injected vessels give the membrane a more or less red appearance1 which will be more marked in streaks and patches4 ,from the readiness1 however1 with which fibrinous exudation takes place from this membrane1 this redness is seldom very strongly marked1 and in some instances will scarcely be noticed1 unless the surface is carefully scraped1 thus removing the exudation4 ,small extravasations of blood are occasionally found in the substance of the membrane4 ,the muscular coat of the intestines1 where the peritoneal covering is involved1 may become infiltrated with serum1 the fibres relaxed and paralyzed1 thus permitting of the great tympanitic distension found in these cases4 ,chronic peritonitis1 is not a very common occurrence4 ,it may1 however1 follow an attack of acute peritonitis1 and is sometimes found in connection with ascites1 or tubercular deposits in the peritoneum4 ,in examining the body of a colored woman who had died of heart disease1 accompanied with general dropsy1 and who had suffered abdominal pain and tenderness for a number of weeks previous to death1 a large portion of the peritoneum1 particularly that reflected upon the abdominal walls1 was found intensely red1 the blood-vessels having an arborescent arrangement1 and being beautifully injected4 ,no plastic matter was found effused upon the surfaces4 ,the cavity contained some twelve quarts of serum4 ,fibrinous ,exudation1 as already observed1 readily follows inflammation of this membrane4 ,it will often be found as a uniform layer covering the whole surface of the peritoneum1 rendered more apparent1 however1 by separating parts1 when it appears as delicate bands or filaments1 stretching across the interspace4 ,in cases of acute inflammation1 this plastic effusion is often very great1 and frequently intermixed with purulent matter1 while the serous fluid1 which is poured out in considerable quantities in these cases1 is rendered turbid by the presence of numerous flakes of fibrin1 and quantities of pus cells diffused through the same4 ,more or less extensive and firm adhesion of parts may thus be induced1 the plastic matter effused becoming more and more firm1 and finally converted into dense bands of fibrous tissue4 ,mechanical obstruction and strangulation of the bowels1 may be induced by the presence of these bands1 stretching between parts1 and forming thus an opening through which the bowel passes1 and finally becomes incarcerated4 ,suppuration is not an unfrequent result of acute peritonitis2 the matter being found uniformly smeared over the whole surface1 or1 in some cases1 confined to a single part1 thus forming a circumscribed abscess4 ,adhesions having taken place around the boundaries of the suppurating surfaces1 in this manner the diffusion of the matter is prevented1 and its discharge into the intestinal canal1 or in some instances upon the surface of the body1 is promoted4 ,gangrene of the peritoneum may result from intussusception or hernial incarceration of some portion of the bowel1 when the part will appear as a softened1 dark1 offensive mass1 limited by a band of highly congested tissue4 ,ascites4 ,dropsical accumulations in the abdominal cavity1 may result from obstructed circulation1 caused by disease of the liver1 kidneys1 heart or lungs2 or from pressure upon the vena cava1 or portal vein1 by some abnormal growth4 ,the fluid effused may be nearly colorless1 or present various shades of yellow1 red or green1 and usually coagulates on the application of heat4 ,the peritoneum may appear unchanged1 or it may present a thickened1 opaque1 white or macerated appearance1 in chronic cases4 ,blood may be found in the peritoneal cavity1 as a result of wounds1 rupture of some of the abdominal or pelvic organs1 or bursting of an aneurism4 ,morbid ,growths4 ,tubercular ,deposits1 of the miliary form1 are not unfrequent in the peritoneum4 ,they may be diffused over the whole membrane1 as semi-transparent1 gray granules1 but more frequently are found on the under surface of the diaphragm1 in the neighborhood of the spleen1 and on the viscera generally1 while the parietal layer is more free4 ,the tubercles1 acting as foreign bodies1 give rise to inflammation1 usually of a chronic form1 but sufficient to result in exudation of lymph1 and the formation of adhesions between the adjoining surfaces4 ,softening of the tubercular deposits sometimes takes place1 and perforation of the intestinal wall results1 leading to an effusion of the intestinal contents into the peritoneal cavity4 ,cancer of the peritoneum1 is sometimes seen as a primary affection1 yet it more frequently extends to this membrane from some of the deeper parts4 ,the encephaloid variety may be met with1 but the colloid form is that most frequently seen4 ,the omentum is the occasional seat of this form of cancer1 the membrane in such cases becoming enormously increased in size4 ,tumors of various kinds1 including fibrous1 fatty1 and cystic1 may be found in the peritoneal cavity1 generally having had their origin1 however1 in the sub-peritoneal tissues4 ,fatty tumors may originate within the substance of the omentum or mesentery1 while cystic tumors may be found within the broad ligaments of the uterus or ovaries4 ,section ,,ii4 ,,of ,,the ,,stomach4 ,notice in examination3--#a4 ,external characters--position2 size2 form2 adhesions4 #b4 ,contents--quantity1 color1 odor1 reaction4 ,food--its nature1 degree of digestion4 ,blood--pure or mixed with food2 probable source4 ,foreign substances--powders1 metallic particles1 spirits1 fcal matter1 bile1 pus1 worms4 #c4 ,mucous membrane--general condition of2 color1 soft or firm1 rug present or absent2 thickness at various points2 ulcers2 their position1 size1 etc4 #d4 ,muscular coat--thickness2 visibility of fibres4 #e4 ,entire walls--transparency2 wounds2 perforations2 ruptures2 weight4 #f4 ,condition of orifices--constricted2 dilated4 ,tumors--position1 size1 character1 etc4 ,few organs of the body are subject to such a variety1 or to such early post-mortem changes as the stomach1 many of which1 being closely simulative of the effects of disease1 render a satisfactory examination of this organ1 in many instances1 very difficult4 ,therefore1 before entering upon an account of the morbid anatomy of the organ1 ,i shall briefly notice those changes which are post-mortem in their origin4 ,the ordinary interval which intervenes between death and a post-mortem examination1 is1 in most instances1 sufficient to seriously change the appearance even of the healthy stomach4 ,hence our knowledge of the healthy appearance of that organ1 at least1 previous to the experiments of ,dr4 ,beaumont upon the stomach of ,alexis ,st4 ,martin1 was quite imperfect4 ,post-,mortem ,changes4 ,among those changes taking place after death1 which are no evidence of disease during life1 may be mentioned3 ,first4 ,appearances of ,congestion4 ,very soon after death1 or at least within ten or twelve hours1 by gravitation of the blood1 the same hypostatic congestion will be found in the most dependent portion of the stomach1 that is seen in a more marked degree in the lungs1 or in the subcutaneous tissues4 ,second4 ,coloring of ,tissues4 ,not unfrequently1 the tissue of the stomach will be found strongly tinged by coloring matter of food or medicine1 such as the red color of wine or logwood1 or the black color of the metallic sulphurets1 etc4 ,third4 ,change of ,shape and ,size4 ,variations in the shape and size of the stomach from the normal standard1 are not unfrequently found after death4 ,it is sometimes found unusually small1 apparently from the influence of the rigor mortis1 the contraction necessarily resulting in increased thickness of the walls4 ,what is known as hour-glass contraction1 although sometimes congenital in its origin1 is frequently but a manifestation of the rigor mortis1 when it may be distinguished from the former by inflation4 ,extreme dilatation1 with thinning of the walls1 is also sometimes seen1 this condition resulting apparently from an absence of the post-mortem contraction4 ,fourth4 ,exfoliation of ,epithelium4 ,the stomach of young adults1 dying of some acute disease1 not unfrequently is found to have thrown off the epithelial layer of its mucous lining1 even when the examination is made soon after death1 and in cold weather4 ,in many of the healthiest animals slaughtered for food1 the same change has been noticed as early as two hours after death4 ,the detached cells are found floating in a thick mucus1 the microscope also showing that the gastric follicles have thrown off their epithelial lining1 with their pepsinous contents4 ,with this change commences the post-mortem digestion of the stomach1 to be soon noticed4 ,the younger and healthier the subject1 and the more acute the disease causing death1 as a general rule1 the more rapidly and effectively does this exfoliation take place4 ,it may affect only the summit of the folds into which the mucous membrane is thrown by the contraction of the muscular coat1 or it may uniformly involve the whole mucous surface4 ,fifth4 ,softening and ,perforation4 ,it is an interesting fact1 that while the tissues of the stomach during life are unaffected by the gastric juice--the vitality of the tissues enabling them to resist its solvent power--after death1 they immediately yield to its influence1 and hence results a greater or less degree of softening of the coats1 or even in some instances1 complete perforation of the walls1 the extent of the change depending upon the quantity of gastric fluid in the stomach at the time of death4 ,in these cases there is1 of course1 no evidence of inflammation1 while the tissues present a pulpy1 gelatinous appearance1 the walls being greatly thinned1 and breaking down under the slightest force4 ,in most instances1 probably the actual perforation is the result of the force employed in lifting the stomach from its position4 ,the opening in these cases is an irregular ragged hole1 with soft1 pulpy margins1 and will more frequently be found at the large or cardiac extremity of the organ4 ,in some extreme cases1 the process of softening has not been confined to the walls of the stomach1 but has extended to the adjoining organs1 as the spleen1 liver1 or diaphragm4 ,the whitish-gray and gelatinous appearances of these cases1 will enable us to distinguish them from ordinary cases of softening and perforation from ulceration4 ,this form of softening is especially observed in cases of sudden death immediately after a meal1 while the stomach contains a large quantity of gastric juice4 ,it is also seen much more frequently in children and young persons than in the aged1 or those dying from chronic forms of disease4 ,it has often been noticed in cases of consumption1 however1 which is to be accounted for upon the fact that many of these patients retain a good appetite to the last4 ,brinton1 is of the opinion1 that the solvent action of the gastric fluids upon the walls of the stomach1 is promoted by the presence of vegetable or starchy food3--7#a7 by offering little substance upon which the fluids can expend themselves2 and 7#b7 by producing by its decomposition1 an amount of acid1 favoring an energetic action of the gastric fluids2 while on the other hand1 the action of those fluids is retarded1 7#a7 by the presence of alkaline saliva1 or bile in any quantity2 and 7#b7 by the presence of animal food upon which the juices may act4 ,,case4--,perforation of the ,stomach in a child two years of age--death from ,hydrocephalus4 ,a child of ,mr4 ,t----1 in its second summer1 had an attack of hydrocephalus1 finally dying in convulsions4 ,the autopsy1 made twenty-four hours after death1 disclosed great congestion of the membranes of the brain1 with two ounces of serum in the ventricles4 ,upon opening the abdominal cavity1 all the viscera appeared healthy4 ,in lifting the stomach from its position1 a gush of colored fluid appeared from behind it1 which at once led to the suspicion of a rupture4 ,the whole organ was then carefully removed1 when a ragged rent1 through which the thumb could readily be passed1 was discovered at the posterior portion of the cardiac end4 ,the walls of the stomach at this point were extremely thin1 soft and jelly-like2 this condition being plainly the result of the post-mortem action of the gastric juice1 while the rupture was the immediate consequence of lifting the organ from its position4 ,pathological ,states of the ,stomach4 ,gastritis4 ,acute inflammation of the stomach rarely occurs1 except as a result of some chemical or mechanical irritation4 ,from the experiments of ,dr4 ,beaumont1 however1 we learn that the stomach is extremely liable to various grades of inflammatory action1 which passing rapidly through their several stages1 end finally in recovery4 ,by watching the effects of excesses in the use of alcoholic stimulants1 food1 condiments1 and of exercise after meals1 etc41 he observed that the pale1 pink color1 natural to the mucous membrane of the healthy stomach1 was exchanged for a somewhat livid erythematous redness1 which was distributed throughout the organ in irregular patches of various sizes1 and in its most intense form1 amounted to a kind of ecchymosis4 ,again1 he noticed an excessive growth of epithelium1 forming patches of false membrane like1 which at various points appeared distended by an accumulation of a puriform fluid beneath1 giving the appearance of little pustules4 ,the following forms of gastritis are generally recognized3 #a4 ,catarrhal ,gastritis4 ,this1 in its acute form1 is seldom seen in post-mortem examinations4 ,chronic ,catarrhal ,gastritis1 however1 is by no means uncommon1 and may be a result of the use of alcoholic drinks1 the presence of various irritating substances taken either as food or medicine1 and may attend many forms of chronic disease of other organs1 or may be caused by obstruction to the circulation from disease of the heart1 liver or lungs4 ,the post-mortem appearances are neither very marked1 nor constant4 ,the mucous membrane may be found red1 or of a dark color1 thickened and sometimes roughened4 ,the submucous and muscular coats may also be thickened1 while less frequently1 small ulcers may be found4 #b4 ,croupous ,gastritis4 ,this form is very rare1 and seldom diagnosticated during life1 but may be found with children who have died with croupous inflammation of the air passages1 when small patches of false membrane may be found adhering to the mucous surfaces4 ,it may be found in adults also1 as an attendant of certain grave forms of disease1 as typhus1 puerperal fever1 cholera1 dysentery1 or in death from irritating poisons4 #c4 ,phlegmonous ,gastritis1 is another very rare form of inflammation of the stomach1 in which the disease involves all the coats1 although originating in the submucous1 and may destroy the patient in a few days with symptoms of peritonitis4 ,the submucous tissues will be found filled with an exudation of a sero-plastic1 yellowish substance1 which produces thickening of the walls1 and which may be confined to a portion or involve the whole organ4 ,effects of ,poisons4 ,the effects of caustic and other irritant poisons upon the stomach1 as exposed by a post-mortem examination1 will vary according to the nature of the substance1 and the time it may have remained in the stomach4 ,redness in various degrees1 and of various shades1 ulceration1 softening and perforation1 may one or all1 be detected in different cases4 ,in large quantities1 the mineral acids may leave the mucous membrane black1 and of a soft1 tarry consistence1 readily breaking down upon handling the stomach4 ,the peculiar action of the several poisons will be noticed in another place4 7,see ,part ,,iv47 ,gastric ,ulcer4 ,ulceration of the mucous membrane of the stomach1 is much less frequent than of other portions of the intestinal canal1 except as a result of the corrosive action of poisons4#bj ,a peculiar kind of ulcer1 however--rare in this country1 but said to be common on the ,continent of ,europe and in ,england--is sometimes found1 which is of interest1 from its occurring in tissues otherwise healthy1 and often leading to a rapidly fatal termination4 ,rokitansky terms it the perforating gastric ulcer1 from its marked tendency to perforate the walls of the stomach4 ,it is situated in the region of the pylorus1 and more frequently at the posterior surface and near the lesser curve4 ,it is of a circular form1 of three to six lines in diameter1 and with as sharp edges as if a round piece of the walls had been punched out2 the edges being bevelled off1 however1 from within1 leaving the peritoneal opening less than that in the muscular or mucous coats4 ,being usually situated near the lesser curve of the stomach1 some of the larger blood-vessels are liable to become involved1 giving rise to hmorrhage more or less severe4 ,while but a single ulcer of this description is generally found1 two1 three or more1 may be present4 ,a peculiarity of this form of ulcer1 consists in its not being dependent upon irritation or inflammation1 but rather upon a loss of vital assimulative power in the part affected4 ,this form of ulcer may heal at any time previous to perforation1 and it is not uncommon to find a cicatrix in the mucous membrane of the stomach which has probably arisen in that way4 ,gastric ulcer is much more frequent in females than males1 and is mainly a disease of middle and advanced life4 ,hmorrhagic ,erosions4 ,the appearance of the stomach1 where there has been frequent vomiting of blood from this cause1 is thus described by ,rokitansky3 8,there are several roundish spots of the size of a pin's head or pea1 or narrow elongated streaks at which the mucous membrane appears dark red1 lax1 soft and bleeding1 and presenting a depression in consequence of loss of substance or slight erosion4 ,this condition is invariably accompanied by hmorrhage1 the effused blood being mixed1 in a more or less altered state1 with gastric mucus4 ,the erosions are often very numerous1 studding1 perhaps1 every part of the stomach except the fundus1 the pylorus being their chief seat40 ,this condition of the stomach is not peculiar to any form of disease1 or age1 but is frequently associated with intemperance4 ,it is rarely fatal1 except by inducing some other lesion of the stomach1 or by being united with some more general malady4 ,softening of the ,stomach4 ,we have already referred to that form of softening of the stomach1 which is attributed to the action of the gastric juice after death4 ,another form is sometimes met with1 which evidently takes place during life1 and in most instances is attributable to a chronic form of inflammation4 ,it is not always easy to distinguish the two forms of softening without a knowledge of the previous history of the case4 ,the distinction may1 however1 generally be made by attending to the following points3--#a4 ,the presence during life1 of symptoms of disease of the stomach4 #b4 ,appearances of congestion or inflammation1 as well as softening1 after death4 #c4 ,extension of the morbid change to other portions than that affected by post-mortem softening1 the latter being usually confined to the posterior portion of the cardiac end4 ,cirrhosis of the ,stomach4 ,in some obscure cases of gastric disease1 upon opening the abdominal cavity in a post-mortem examination1 we may at once notice a marked change in the appearance of the stomach4 ,it presents a peculiar whiteness and opacity1 an appearance which is partially due to a dulness of the peritoneal coat1 in marked contrast with its usual brilliancy2 at the same time the organ may be either larger or smaller than the average size4 ,upon removing the organ1 we find it greatly increased in weight and density1 and presenting a hard1 gristly feel1 and with so much elasticity as to fail to collapse4 ,an incision shows the walls uniformly thickened1 to the extent of six or eight times their normal condition2 the whole organ is comparatively bloodless1 a condition strongly in contrast with the usual appearance after death4 ,a close inspection of such a specimen1 shows the several coats--muscular1 mucous and fibrous--to be remarkably alike1 the thickening and increased density1 resulting from the presence of a generally diffused imperfect fibrous structure1 similar to that found in common fibrous tumors4 ,the several coats of the stomach will be found unequally affected by this deposit4 ,the submucous structure1 as seen in a vertical section1 being increased from ten to twenty fold1 while the serous with the subserous may be increased seven to ten fold4 ,the muscular tunic may be found from five to eight times its normal thickness1 while the mucous membrane proper1 is seldom more than double4 ,notwithstanding the bloodless character of the walls of the stomach in this disease1 the abnormal condition is unquestionably the result of a chronic form of inflammation4 ,the symptoms during life are usually obscure1 and although the hard contracted stomach may form a sort of epigastric tumor1 noticeable upon the surface1 the absence of acute symptoms1 with the age at which the disease makes its appearance--usually between twenty and thirty--permits of a ready distinction being made between this disease and cancer1 with which it might otherwise be confounded4 ,atrophy of the ,stomach4 ,this condition of the stomach can hardly be looked upon as an independent malady1 being rather an attendant of the general wasting of certain diseases1 particularly of pulmonary consumption1 marasmus1 and starvation4 ,the organ1 in these cases1 may be reduced to less than half its normal proportions1 while its walls may be thinned and frequently softened4 ,dilatation of the ,stomach1 is another condition that can scarcely be considered as a primary affection4 ,a great variation in the size of this organ is evidently compatible with health1 large eaters having necessarily large stomachs1 yet as the result of certain other morbid conditions1 dilatation to an enormous extent may be induced4 ,the following conditions may result in dilatation3 #a4 ,obstruction of the pylorus1 as in scirrhus of that portion of the stomach4 #b4 ,destruction of a segment of the muscular coat by ulceration1 or by becoming involved in a cancerous growth4 ,here the loss of contracting power1 permits of a gradual dilatation1 from the inability of the segment involved to aid in carrying on the contents1 their accumulation above this point aiding in the distension4 #c4 ,an acute form of dilatation is sometimes met with1 which can only be attributed to a paralysis of the muscular and secreting structures of the organ4 ,it occasionally happens to a patient recovering from a fever4 ,he has perhaps overindulged in eating1 as is not unfrequently the case with convalescents1 and is suddenly seized with intense pain in the stomach1 followed by rapid and great distension1 and finally death4 ,the autopsy discloses the stomach enormously distended1 and its contents1 including matters1 in some cases1 which were ingested many days before4 ,the mucous membrane appears but little changed1 while the muscular coat is so thinned and stretched1 as to appear like a scattered net-work of fibres4 ,morbid ,growths4 ,cancer4 ,this formidable disease occurs more frequently in the stomach1 than in any other organ of the body1 excepting the uterus of the female4 ,the disease is usually primary in this organ1 but frequently springs up secondarily in other parts4 ,the disease may occur in the three following forms--the scirrhus1 medullary1 and colloid2 while ,dr4 ,brinton adds a fourth1 the villous cancer of the mucous membrane4 ,the usual seat of the disease is at the pylorus4 ,it may involve a portion or the whole circumference of this opening1 and from this extend along the lesser curve4 ,in some cases1 it commences at the cardiac orifice1 and very rarely involves the whole organ1 the fundus usually remaining free4 ,the walls of the stomach may become greatly thickened in this disease1 the inner surface tuberculated and roughened1 and the cavity much diminished in size4 ,when situated at the pyloric end1 the disease seldom or never extends into the duodenum1 but when at the cardiac1 it generally involves the lower portion of the sophagus4 ,the fibrous or scirrhus form of the disease1 is by far more commonly met with than any other1 although it may be found occasionally combined with the medullary1 or both these with colloid4 ,indeed1 it is not improbable1 but that in many cases1 a growth originally scirrhus1 becomes gradually converted into one of the other forms4 ,in almost all cases1 cancer commences in the submucous tissue1 in the form of a dense mass1 of a white color4 ,when cut1 the surface presents a whitish-gray appearance1 contrasting strongly with the vascular mucous membrane of the stomach1 and presenting a distinctly striated appearance4 ,a small portion under the microscope1 or the juice scraped from the cut surface1 will show the peculiar cancer cell1 with granular matter4 ,encephaloid or medullary cancer1 may be developed upon or within the fibrous form1 or it may occur primarily as knotty tumors projecting through the mucous membrane4 ,the microscopic appearance is much the same as in the fibrous variety1 except that the cells are not so closely packed1 but are loosely held together by an abundant1 soft1 or liquid substance4 ,the colloid form of the disease1 may originate either in the mucous membrane itself1 or in the submucous tissue4 ,it is known by its presenting a tough1 fibrous-looking1 white tissue1 which1 arranged in intersecting bands1 incloses irregular spaces1 which are filled with a clear1 soft1 or semi-liquid material1 the proper colloid substance4 ,the villous cancer1 ,dr4 ,brinton describes as arising in the basement membrane of the mucous coat1 and as but a modification of the epithelial cancer of other parts of the body4 ,the mucous membrane covering cancerous growths1 is subject to a variety of changes4 ,it may become converted into a sort of fungoid growth1 which at points suppurates1 showing the submucous scirrhus tissue2 or it gradually softens1 giving rise to hmorrhages4 ,the cancerous mass itself1 may also soften or suppurate1 resulting perhaps in perforation and peritonitis2 or adhesions may take place1 followed by extension of the disease to the liver1 spleen1 pancreas1 kidneys1 etc4 ,cancer of the stomach1 in the great majority of cases1 occurs in persons between fifty and sixty years1 although it may appear as early as forty1 or as late as sixty4 ,males appear to be more subject to the disease than females1 in the proportion of four to three4 ,the obstruction which the presence of cancer of the stomach is liable to produce1 may result in one or more of the following conditions3 ,first1 hypertrophy of the muscular coat4 ,from increased nutrition1 the muscular fibres of the stomach may become considerably increased in size and darker in color1 thus better enabling them to overcome the obstruction1 which in some cases1 amounts almost to occlusion4 ,second1 dilatation4 ,this condition frequently attends the former1 and indeed is seldom seen alone4 ,it is confined to those cases where the cancer is at the pylorus1 and is more noticeable at the fundus of the organ4 ,third1 contraction4 ,this is seldom seen in connection with hypertrophy1 and is far less common than dilatation4 ,generally found in connection with cancer at the cardiac orifice1 it may be looked upon as the result of the constant regurgitation which the obstruction produces1 preventing thus the cavity of the organ from undergoing its normal distension1 by the presence of any quantity of food4 ,tumors4 ,with the exception of cancerous growths1 tumors of the stomach are by no means common4 ,fatty tumors are sometimes met with1 originating in the submucous tissues1 and as they increase in size1 they may crowd either inwards towards the gastric cavity1 or outwards towards the peritoneum4 ,fibroid tumors1 are also occasionally met with in the submucous tissues1 generally in the line of the lesser curve1 and about the cardiac orifice4 ,polypoid growths may also be found springing from the mucous surface1 presenting the character of those formations usually4 ,section #b4 ,,the ,,intestines4 ,notice in examination3--#a4 ,external characters--displacements1 as in hernia2 amount and condition of involved bowel4 ,invaginations--number1 position and size2 dilatations or contraction of intestines2 apparent cause of4 ,peritoneal coat--inflamed or not2 adhesions2 their position1 strength2 perforations1 etc4 #b4 ,contents--gas2 mucus2 blood2 pus2 fcal matter2 foreign substances1 etc42 particulars in regard to each4 ,entozoa--number and character4 #c4 ,mucous membrane--general condition2 congested1 inflamed1 ulcerated4 ,orifice of bile duct4 ,brunner's glands--inflamed1 enlarged or ulcerated4 ,peyer's patches--number1 situation1 general condition1 ulceration1 etc4 #d4 ,ccum with appendix vermiformis--length1 contents1 ulcers1 perforations1 etc4 #e4 ,rectum--prolapsus1 hmorrhoids1 fistul4 ,malformations4 ,the intestine is sometimes defective in some part of its course1 most usually near its lower extremity1 and generally accompanied with an imperforate condition of the anus1 7atresia ani47 ,this latter may be of various degrees1 consisting sometimes in a simple closure of the anus by a continuation of the integument over it2 in other cases the rectum terminates in a blind pouch at a greater or less distance from the anus4 ,sometimes the intestine is unusually short1 without any distinction as to size between the large and small intestines4 ,it may terminate at the umbilicus1 or in a cloaca common to it and the genito-urinary organs4 ,finally1 it may consist of several detached ccal portions4 ,andral notes the following malformations3--,a single straight canal from the termination of the sophagus to the commencement of the rectum2 a double duodenum2 two colons2 an unusually large1 and at same time1 double appendix vermiformis4 ,diverticula are not unfrequent4 ,they are ccal appendages1 resembling the finger of a glove1 one or more in number1 varying in length from a few lines to several inches1 and giving off at various points4 ,like the appendix vermiformis1 they may become a source of danger by affording a lodgement for indigestible matters4 ,in very rare instances the position of the intestines has been found completely transposed1 with a corresponding transposition of all the abdominal viscera1 or of only one organ4 ,inflammation4 ,vascular injection by itself cannot be taken as a decisive proof of the existence of inflammation4 ,obstruction to the free return of blood by the veins1 during life1 and the gravitation of blood to the most dependent parts1 after death1 especially after fevers1 can and do produce this very marked injection4 ,in general1 however1 the smaller and more isolated the patch of injection is1 the more likely it is to be inflammatory in its origin4 ,catarrhal inflammation may be either acute or chronic1 and may either attack the mucous membrane uniformly1 or be developed mainly in the villi and follicles4 ,in the acute form3 8,there is more or less intense redness and injection of the mucous membrane1 affecting its entire surface1 or appearing as punctiform reddening from affection of the villi1 or as a vascular halo surrounding the follicles2 relaxation of the tissue1 and intumescence of the mucous membrane1 equally affecting the entire surface1 or only the villi and follicles2 opacity of the mucous membrane and its epithelium1 from infiltration of the former and softening of the latter2 friability and softening of the mucous membrane4 ,the submucous cellular tissue is injected1 relaxed and infiltrated with a watery opaque fluid2 the secretion is at first copious and serous2 as the affection increases in intensity it becomes opaque1 viscid and puriform40 ,in the chronic form1 besides the above signs1 we have also a dark1 rusty1 livid discoloration1 sometimes pervading the entire mucous membrane2 the mucous membrane and its follicles are swollen1 the tissue has become more dense1 and the surface covered with an opaque1 grayish-white1 or puriform mucus4 ,polypoid excrescences are sometimes found upon the mucous membrane4 ,both the large and the small intestines may be affected by catarrhal inflammation1 although the chronic form seems to occur more frequently in the large4 ,the muscular coat of the intestines is also sometimes the seat of inflammation1 rarely if ever1 however1 as a primary disease1 but by extension from the serous covering or mucous lining4 ,croupous ,inflammation4 ,the mucous membrane is also subject to a chronic or sub-acute form of inflammation resulting in the production of an exudation much resembling that of croup4 ,sometimes it forms in a layer of some thickness1 pretty uniformly over the surface1 or appearing in the stools as tubular casts of the intestines2 sometimes it is very thin1 or consists of mere shreds4 ,the anatomical changes observed will be similar to those just noticed4 ,perityphlitis is an inflammation of the loose areolar tissue around the ccum1 occurring primarily or in consequence of typhlitis4 ,if not checked1 it ends in the formation of abscess in the right iliac fossa1 which may discharge either into the neighboring viscera1 or externally through the abdominal walls1 mostly near ,poupart's ligament4 ,peripractitis is an inflammation of the areolar tissue around the rectum4 ,the resulting abscess discharges either externally1 back of the anus1 or in the perineal region1 or internally into the rectum1 or more rarely into the bladder1 the vagina1 the uterus1 or into some other part of the intestines4 ,fistula in ano1 frequently originates in this manner4 ,ulceration4 ,ulceration may occur as the result of inflammations both catarrhal and croupous1 and whether commencing in the mucous or the muscular layer1 the ulcers may perforate the intestinal walls and give rise to an escape of the contents2 or the ulcers may cicatrize with the formation of the usual fibroid tissue1 which1 by subsequent contraction1 may give rise to puckering or obstruction4 ,in follicular ulceration of the colon1 after lientery or tedious diarrha1 the follicles are at first tumefied1 and project as smaller or larger1 round1 conical nodules on the internal surface of the intestine1 surrounded by a dark red vascular halo4 ,ulceration takes place in their interior2 an abscess with red1 spongy walls appears2 the follicle is eaten away1 and an ulcer of the size of a pea or lentil is formed4 ,the mucous membrane is extensively destroyed1 and with great rapidity4 ,the disease is always confined to the colon1 but when it runs a very rapid course1 it may be accompanied with catarrhal inflammation of the small intestines4 ,typhus ulcers4 ,in continued fevers where the disease especially attacks the intestines1 we find an ulceration of ,peyer's patches and the solitary glands1 which is called typhus ulceration by ,rokitansky1 and is thus described by him3--8,after a preceding hypermia around the solitary follicles1 and in and around ,peyer's patches1 there is an enlargement of the glandular structures1 followed by a softening and breaking down of the glandular mass4 ,the cavity remaining on the mucous membrane after the discharge of this mass constitutes the typhus ulcer4 ,its form is elliptical1 if a large patch has been destroyed2 round1 if a smaller patch or a solitary gland has been destroyed4 ,partial destruction of a patch will produce an ulcer of irregular shape4 ,the size varies also1 according to the amount of ulceration40 ,the margin of the ulcer is invariably formed by a well defined fringe of mucous membrane1 which is a line or more wide1 detached1 freely movable1 of a bluish-red1 and subsequently of a slaty or blackish-blue color4 ,the base of the ulcer is formed by a delicate layer of submucous tissue1 which covers the muscular coat4 ,the lower third of the small intestine is most liable to be involved in the ulcerative process1 the number and size of the ulcers increasing as they advance toward the ileo-ccal valve4 ,dysentery may also produce extensive ulceration of the colon1 with considerable loss of substance4 ,this loss may be repaired by cicatrization4 ,in some cases1 the cicatrix tissue1 condensed into fibrous bands1 forms projections into the cavity of the intestine1 and not unfrequently encroaches upon its calibre in the shape of valvular or annular folds1 giving rise to stricture of the colon4 ,dilatation4 ,disease of the nervous centres1 inflammation of its serous tissue1 or simple atony of the muscular fibres1 may be the cause of inaction of the intestine and consequent distension4 ,stricture will also produce distension above itself1 by an accumulation of the contents of the intestine4 ,in these latter cases1 the dilatation is often enormous4 ,contraction of the intestines may occur throughout a considerable extent1 or in a very small part4 ,in the former case1 it results from the canal having been for some time empty1 and is most likely to occur below a stricture4 ,it can hardly be considered in itself a morbid condition4 ,the second kind of contraction or constriction1 is generally morbid1 and may result either from external pressure by tumor or otherwise1 or from a disease of the tissue itself4 ,the cicatrices of ulcers which have assumed an annular shape1 are the most frequent causes of stricture originating in the intestine itself4 ,displacements4 ,the most common of these constitute the various forms of hernia4 #a4 ,inguinal ,hernia4 ,here the intestines escape by the inguinal canal1 and it is ,scrotal in man1 when they descend into the scrotum1 and ,pudendal or ,vulvar in woman1 when into the labia majora4 #b4 ,crural or ,femoral ,hernia2 when the intestines escape by the crural canal4 #c4 ,hernia at the ,foramen ,ovalis2 when the viscera escape through the opening which gives passage to the obturator vessels4 #d4 ,ischiatic or ,sciatic ,hernia2 when it takes place through the sacro-sciatic notch4 #e4 ,umbilical ,hernia2 when it occurs at or near the umbilicus4 #f4 ,epigastric ,hernia2 occurring through the linea alba1 above the umbilicus4 #g4 ,hypogastric ,hernia2 when it occurs through the linea alba1 below the umbilicus4 #h4 ,perineal ,hernia2 when it occurs through the levatorani and appears at the perineum4 #i4 ,vaginal ,hernia2 occurring through the parietes of the vagina4 #aj4 ,diaphragmatic ,hernia2 when it passes through the diaphragm4 ,a more detailed description of hernia belongs to works on surgery4 ,a hernia1 if not reducible1 may1 by becoming strangulated1 give rise to constipation1 hiccough1 vomiting1 and all the signs of violent inflammation4 ,gangrene supervenes1 with alteration of the features1 small pulse1 cold extremities1 and death4 ,incarceration1 is a form of mechanical obstruction of the bowels1 differing from hernia1 in there being no escape of the intestine from the abdominal cavity1 as in the latter case4 ,it may arise in various ways1 but the most frequent form is that in which a portion of intestine becomes constricted by means of fibrous bands which have formed as a result of peritoneal inflammation4 ,passing from one portion of the intestines to another1 or from the intestines to the abdominal walls1 a loop of bowel may slip beneath or between these bands1 and become so compressed1 as to interfere with the passage of the contents1 and result in great dilatation of the gut above the point of stricture4 ,complete strangulation may finally result1 and the patient die with symptoms of mechanical obstruction4 ,another1 but less frequent form of incarceration1 is where a portion of intestine slips through the foramen of ,winslow1 or through a congenital opening in the mesentery1 as in the following ,,case3--,death from ,strangulation of the ,bowel1 from becoming ,incarcerated in an opening in the omentum4 ,mary ,h----1 aged five years1 was taken suddenly with great pain in the bowels at #b o'clock ,a4 ,m41 having retired the night before in perfect health4 ,vomiting soon set in1 accompanied with great thirst1 and the whole body became bathed in a profuse cold perspiration4 ,the severe pain continued1 and the vomited matter became stercoraceous4 ,i saw the case at #aj o'clock ,a4 ,m41 and then found the child in a moribund condition4 ,the breathing was rapid2 pulse very small and frequent2 skin pale1 damp and cold2 eyes sunken and nose pinched4 ,rapidly sinking1 she died at #ab ,m4 ,autopsy twenty-four hours after death4 ,upon opening the abdominal cavity1 a large portion of the intestines was found of a dark purple or black color1 while the remainder was perfectly natural in color4 ,upon lifting the bowels and exposing the mesentery1 there was found an opening in the latter1 of sufficient size to receive the thumb1 and through which a large portion of the small intestines had become crowded1 producing such a twist in the border of the mesentery as to have produced complete strangulation of the bowel1 which had rapidly passed into a gangrenous state1 resulting in violent shock and death in less than twelve hours4 ,the opening was situated at about one inch from the intestinal border of the mesentery1 and was plainly congenital in its origin1 as indicated by its smooth and rounded edges4#ba ,another form of obstruction is sometimes found1 and known as ,volvulus1 in which a loop of bowel1 generally of the small intestines1 becomes twisted upon itself1 the constriction at the base of the loop1 finally resulting in complete closure4 ,intussusception1 or invagination of the bowels1 consists in the slipping of a portion of intestine into itself1 and generally from above downwards4 ,either the large or small intestines may be found in this condition1 but it is much more frequent in the lower portion of the small bowels4 ,from a few inches to a foot or more of the bowel may thus become slipped into itself1 and it may be found at more than one point4 ,from the constriction which must necessarily attend such a displacement1 congestion with hmorrhage may result1 or peritoneal inflammation1 gangrene1 and death1 with symptoms of mechanical obstruction4 ,in some rare cases1 the inner or invaginated portion of the bowel sloughs off1 adhesion takes place at the point of commencement of the intussusception1 and the patient recovers4 ,this form of displacement may be found in both children and adults1 where the appearance of the parts are such as to render it apparent that it had not been a source of trouble during life4 ,rupture of the intestines may result from severe injury by blows1 or from a crushing force applied to the abdominal walls4 ,penetrating wounds of the bowels may be followed by escape of the intestinal contents into the peritoneal cavity1 acute peritonitis1 and death4 ,if the bowel be empty at the time1 adhesions may form between the adjoining parts1 the wound thus closed1 and recovery follow4 ,prolapsus of the rectum consists in a protrusion of the mucous membrane or entire walls from the anus4 ,the only post-mortem change that may be detected is a relaxed condition of the coats of the bowel1 with congestion of the mucous membrane4 ,diseases of the ,anus4 ,these include ulcer and fissure of the anus1 fistula in ano1 and hmorrhoids4 ,ulcer1 and fissure of the anus1 usually accompany each other1 though either may exist alone4 ,the ulcer1 when present1 is found just within the anus1 while the fissure extends from this across the edge of the sphincter4 ,while these affections are trifling in their post-mortem appearance1 they are of great importance from the local trouble and constitutional irritation which they may produce during life4 ,fistula in ano1 consists in the presence of a false passage along side the rectum1 usually the result of a small abscess in the ischio-rectal fossa4 ,it is said to be complete when it opens at one end into the bowel1 and at the other through the integument near the anus2 and incomplete1 when it has but one opening1 whether that be on the surface or in the rectum4 ,hmorrhoids will be noticed under the head of ,morbid ,growths4 ,cancer1 in its various forms1 may be found in connection with the intestines1 where it is usually primary in its origin4 ,the scirrhus form is more frequently met with in the rectum1 and is likely to involve the whole circumference of the passage4 ,from the tendency which this form has to contract the parts1 stricture of the rectum is likely to result1 which may become a source of great suffering1 and finally of death4 ,other forms of cancer may be found in any portion of the intestines2 the colon and rectum1 however1 being their more frequent location4 ,cancer of the intestines is very liable to extend to the surrounding tissues and organs1 and in many cases1 perforations of the bowel1 or fistulous communications between the rectum and bladder in the male1 or uterus or vagina in the female1 may result4 ,tubercles1 generally of the miliary form1 may be found within the coats of the intestines1 principally confined to the peritoneal covering however4 ,they may occasionally be found in the mucous coat1 and in the walls of follicular ulcers of that membrane4 ,tumors of various kinds may be found in connection with the intestine4 ,fatty tumors may originate within the mucous membrane1 and project as polypoid growths into the cavity of the bowel2 or they may commence in the appendices epiploic1 and degenerate into a cystic tumor with fluid contents1 or become infiltrated with calcareous matter2 or the pedicle may become atrophied and the tumor detached1 and found free in the peritoneal cavity4 ,adenoid tumors may result from hypertrophy of the several forms of glands of the intestines1 and appear as soft1 rounded1 and perhaps pedunculated tumors1 which are liable to become ulcerated4 ,fibroid tumors of small size and polypoid form1 may be found in any part of the intestines1 and are generally considered as a result of chronic inflammation4 ,hmorrhoids or piles1 consist in a dilatation of the veins of the lower portion of the rectum1 with a thickening of their walls1 and increase of surrounding fibrous tissue4 ,they may be internal or external4 ,the contained blood may coagulate forming a thrombus4 ,the walls may rupture1 giving rise to hmorrhages1 or become inflamed and suppurate4 ,abnormal contents4 ,the normal contents of the bowels may be found mixed with the various products of inflammation1 including mucus1 serum1 blood and pus4 ,biliary calculi and foreign bodies of various kinds1 may be found1 which may have produced no effects1 or they may have served as nuclei1 around which the salts of lime1 bile1 mucus1 fcal matter1 etc41 may have accumulated1 producing intestinal concretions4 ,parasites4 ,the intestinal canal is infested by several forms of entozoa1 among which may be found the following3 ,ascaris lumbricoides2 the common round worm1 six to ten inches in length4 ,it may be single or in large numbers4 ,oxyuris vermicularis2 a small white worm1 measuring from two to four lines in length1 and found only in the large intestines1 and mainly in the lower part of the rectum1 where they may be present in large numbers4 ,trichina spiralis4 ,this parasite is found in the small intestine1 and only in its adult form4 ,it measures from less than a line1 to two lines in length4 ,the embryos penetrate the walls of the intestine1 and finally locate in the muscles1 where they remain encapsulated4 ,if a portion of this muscle is eaten by another animal1 the larv again become active1 and acquiring the mature sexual form1 reproduce1 the young embryos again migrating to the muscles4 ,tricocephalus dispar4 ,found only in the head of the colon1 and measures one and a-half to two inches in length2 neck long1 and body of male covered with wart-like appendages on one side4 ,distoma lanceolatum4 ,flat1 lancet-shaped1 and transparent1 a-half inch long1 one-quarter wide4 ,rarely found in upper portion of small intestines1 natural habitat appearing to be in the bile passages4 ,of tapeworms1 the following varieties may be found3 ,tnia solium4 ,head about the size of a pin-head1 and furnished with sucking disk and double row of hooks2 neck long and narrow2 body flat and jointed1 each segment about a-half inch in length2 body may be from ten to fifty or more feet in length4 ,tnia mediocanellata4 ,head truncated and destitute of hooks2 body jointed and of great length4 ,tnia flavopuncta4 ,very rare4 ,yellow spot at the middle of each joint4 ,bothriocephalus latus1 7broad tapeworm47 ,head long1 unarmed2 neck inconspicuous2 body composed of about two thousand joints2 mature joints broader than long4 ,section ,,iv4 ,,the ,,pancreas4 ,notice in examination3--#a4 ,external characters--malformations2 position2 size2 form2 adhesions4 #b4 ,substance--color2 consistence2 wounds2 abscess2 tubercular deposits2 cancer2 cysts4 #c4 ,ducts--calibre2 contents2 pus or blood1 etc4 ,anomalies of the pancreas are not common4 ,it is wanting only in very imperfect monstrosities4 ,excess of development is very rare4 ,sometimes the duct is double1 up to the point of its entrance into the duodenum4 ,hypertrophy and ,atrophy4 ,the former1 when it does occur1 which is rarely the case1 affects chiefly the cellular tissue which is interwoven with the glandular tissue4 ,atrophy often occurs spontaneously in old age1 or it may result from chronic inflammation or fatty degeneration4 ,the organ may be soft1 or of a leathery consistence4 ,inflammation4 ,the acute form rarely occurs1 and is marked by the same signs of inflammation as are observed in inflammation of similar organs4 8,chronic inflammation induces condensation1 induration of the cellular tissue1 obliteration of the acini1 and either permanent enlargement1 or subsequent atrophy of the gland40 ,fatty ,degeneration is of frequent occurrence in drunkards1 associated with fatty liver1 but due to the intrusion of the surrounding adipose tissue on the wasting organ4 ,dilatation of the ducts of the pancreas occurs from an obstruction of its outlets by pressure of a tumor1 or by the presence of calcareous concretions4 ,the dilatation may be uniform or saculated1 forming cysts which may attain a considerable size4 ,cancer1 only in the forms of scirrhus and encephaloid1 affects generally the head of the pancreas4 ,it may occur primarily or secondarily4 ,the ductus choledochus is frequently obstructed by the pressure of the tumor1 and jaundice produced4 ,the disease may extend to the duodenum1 the omentum1 the mesentery1 liver1 and even the suprarenal capsules and kidneys4 ,as secondary cancer1 it is most frequently an extension from a scirrhus pylorus4 ,section ,v4 ,,the ,,spleen4 ,notice in examination3 #a4 ,external characters--color1 size1 weight1 form1 adhesions2 surface smooth or rough2 capsule thickened1 etc4 #b4 ,substance--color2 consistence2 wounds2 rupture2 abscesses2 tubercle2 cancer2 degenerations2 tumors1 etc4 ,congenital ,anomalies4 ,in acephalous monsters the spleen is generally absent4 ,occasionally in subjects otherwise well developed1 it is wanting1 together with the stomach or the fundus of the stomach4 ,congenital displacements have been met with4 ,supernumerary spleens1 varying in number and small in size1 are frequently met with4 ,hypertrophy and ,atrophy4 ,probably no organ of the body is as liable to such great variations in size as the spleen4 ,the normal spleen in the adult1 in whom it attains its greatest size1 is usually about five inches in length1 three to four in breadth1 and an inch or an inch and a-half in thickness1 and weighs about seven ounces4 ,its size is increased during and after digestion1 and varies considerably according to the state of nutrition of the body4 ,in typhus the spleen is enlarged1 the parenchyma exceedingly soft1 its color a dirty red1 of different shades4 ,in leukmia it is also found greatly enlarged1 but of a denser consistence4 ,rokitansky states that the spleen not unfrequently measures sixteen inches in length1 seven in breadth1 and four inches in thickness1 and its weight may amount to twelve or fourteen pounds1 or1 according to others1 to twenty or even forty pounds4 7,huschke47 ,most of the hypertrophies of the spleen are accompanied not only by an engorgement of the very numerous vessels1 but by an alteration and increase of the red1 pulpy parenchyma4 ,atrophy may reduce the spleen to the size of a hen's egg or a walnut4 ,it takes place normally in advanced age4 ,displacements4 ,some of these are congenital3 thus it has been found by the side of the bladder2 in the right side of the thorax2 in the left thoracic cavity when the diaphragm was absent2 and external to the abdomen in large umbilical herni1 or where the abdominal walls had not closed4 ,other displacements are the result of disease4 ,the enlargement or distension of adjacent parts1 or increase in its own size with laxity of its ligaments1 causes it frequently to be displaced1 and even to descend into the pelvis4 ,rupture occasionally happens as the result of injuries4 ,spontaneous rupture in intense congestions during typhus1 cholera1 and the cold stage of ague1 has occurred4 ,this always proves fatal4 ,inflammation4 ,primary inflammation of the spleen is comparatively rare4 ,unless it ends in resolution1 it gives rise to the formation of laudable pus or fibrin1 which may either be contained in a circumscribed abscess1 and thence become obsolete1 or the cavity may enlarge until the pus penetrates into the left thoracic cavity1 the stomach1 the transverse colon1 or the peritoneum4 ,secondary splenitis is regarded as identical with pymic deposits4 ,the deposits are well defined1 always at the periphery1 cuneiform in shape1 the apex directed inwards4 ,their color is darker than the surrounding tissue1 and their consistence firmer4 ,they are either converted into a cellulo-fibrous callus1 which contracts and causes a cicatrix in the surface2 or 8into a puriform1 creamy mass2 or into a sanious greenish1 greenish-brown1 or chocolate-colored pulp40 ,there are also fibrinous deposits frequently found in the parenchyma of the spleen1 classed by some among the phenomena of secondary splenitis1 but regarded by others as a simple exudation of fibrin1 from an excess of this in the blood4 ,these deposits appear as a circumscribed yellowish mass1 with a margin of darker or lighter red congestion of increased consistence1 easily recognized when handling the part1 8and showing under the microscope a confused mass of granular with more or less oily matter infiltrated among the remains of the parenchyma4 ,they very commonly undergo fatty degeneration40 ,chronic ,thickening of the ,capsule of the spleen is of frequent occurrence4 ,it seems to take place at the expense of the parenchyma of the organ1 and may proceed to a very great extent4 ,it is usually pretty uniform4 ,ossification of the thickened fibroid layers is rare1 except in old persons4 ,amyloid ,degeneration of the ,spleen4 ,the disease may be limited to the ,malpighian corpuscles1 constituting the so-called 8sago spleen10 or it may extend and implicate the pulpy parenchyma between the corpuscles4 ,the sago spleen is more or less enlarged2 its weight and density are increased4 ,on section1 the surface appears smooth1 dry1 and studded with glistening sago-like bodies1 varying in size4 ,an iodine solution gives them a reddish-brown color4 ,in the more advanced stage1 where the pulp is infiltrated with the new material1 the organ generally is much larger than in the sago spleen4 ,it is hard and firm2 the capsule tense and transparent4 ,the cut surface is dry1 homogeneous1 translucent1 bloodless1 of a uniform dark1 reddish-brown color4 ,the organ can be cut like wax4 ,the corpuscles are obscured by the surrounding pulp4 ,morbid ,growths4 ,tuberculous matter is commonly deposited in the spleen1 only in connection with general tuberculosis4 ,it appears in the form of gray granulations1 miliary crude tubercles1 or yellowish cheesy masses of various sizes4 ,cysts have been observed in the capsule of the spleen4 ,they are small1 of conical shape1 and lightish red color1 containing numerous granular cells1 floating in a transparent liquid4 ,hydatid cysts may be found in the spleen alone1 or at the same time with one in the liver4 ,cancer is rare4 ,the encephaloid is the only form met with1 and generally only with similar disease in the liver1 stomach or omentum4 ,section ,,vi4 ,,of ,,the ,,liver4 ,notice3 #a4 ,external characters--relation to other organs and extent uncovered by cartilages of ribs2 adhesions--their extent1 position1 firmness1 etc4 #b4 ,after removal--weight2 measurements2 form2 color2 puckerings2 rough or smooth2 granulations2 tubercles2 cysts1 etc4 ,capsule--thickness1 transparency2 facility of removal2 appearance of liver substance beneath4 #c4 ,internal structure--appearance of cut and fractured surfaces2 fluids expressible2 appearance of lobules2 abscesses2 fistul2 calcareous deposits2 tubercles2 growths2 cysts2 wounds2 rupture1 etc4 #d4 ,gall-bladder--absent2 size2 shape2 adhesions4 ,cavity--obliterated4 ,contents--bile2 quantity1 color1 consistence2 mucus2 pus1 etc4 ,gall-stones--number1 size1 form1 color1 internal character4 ,walls--thickness2 deposits2 adipose or calcareous2 abscess2 tubercle2 cancer2 wounds2 rupture4 ,ducts--calibre2 dilated or contracted2 impervious2 from what cause8 contents2 condition of walls and mucous membrane4 ,the liver1 in its normal state in the adult1 will measure from ten to twelve inches in its transverse diameter1 from six to seven in breadth at its widest part1 and about three inches thick at the posterior border of the right lobe2 its weight being from three to four pounds4 ,the gland is much larger in infants in proportion to the size of the body4 ,in the adult1 the average weight of the liver is but one-fortieth of that of the entire body1 while in infancy1 it may be as much as one-thirtieth or even one-twentieth4 ,the natural color of the liver may be described as a reddish-brown or mahogany color1 yet the shade may vary to a considerable degree in different cases4 ,in studying the morbid anatomy of this organ1 we shall notice first1 changes peculiar to the liver itself1 and secondly1 those connected with the gall-bladder and gall-ducts4 #a4 ,diseases of the ,liver4 ,congestion4 ,from the large size and extensive distribution of vessels through the liver1 this gland is capable of containing a large amount of blood1 and in cases of retarded circulation in other parts1 as in the recession of blood from the cutaneous vessels in a chill1 the vessels of the liver may become greatly distended1 constituting what is known as congestion4 ,although the gland is closely invested with the capsule of ,glisson1 yet1 the elasticity of this membrane will admit of considerable distension1 and hence the great enlargement attending this condition of the gland4 ,congestion of the liver may be partial1 confined to one or more lobes2 or general1 involving the whole gland4 ,it may also be active or passive4 ,active congestion of the liver may result from blows or injuries over the region of the gland1 from suppression of hmorrhoid discharges1 or suppression of the menses in the female4 ,it will then be found presenting a deep red color1 may be greatly increased in size1 is more firm1 and before opening the body1 may be frequently felt below the margin of the ribs on the right side4 ,one of the most frequent causes of passive congestion of the liver1 is organic disease of the heart1 accompanied with obstruction in the circulation through the lungs1 giving rise thus to difficulty in emptying of the right side of the heart1 and of the venous system generally4 ,a chronic form of congestion of the liver may result from emphysema of the lungs1 large pleuritic effusions1 or tumors within the chest1 and is frequently found in persons of sedentary habits who have been 8high livers10 or in those who have used large quantities of alcoholic or fermented liquors1 or in the residents of hot climates or malarial districts4 ,temporary congestion of the liver1 although very extreme1 does not result in structural change2 but when arising from a permanent cause1 as disease of the heart1 etc41 it produces the following effects3--8,the distended capillaries of the portal-hepatic plexus press on the intervening cells2 these become in part atrophied or stunted2 in extreme cases almost destroyed2 in part they are gorged with yellow matter to such a degree that they appear as opaque masses4 ,the quantity of yellow matter thus formed is far greater than any that exists in a healthy state of the organ1 and as some of it is doubtless absorbed and carried into the blood1 we find in this circumstance some explanation of the icteric hue which is so often observed in such patients4 ,whether long-continued congestion produces still further changes is not yet made out clearly40#bb ,extreme congestion of the liver may sometimes result in ,hmorrhagic ,effusion1 the blood being either poured out near the surface1 and dissecting up the capsule1 or more deeply in the substance of the gland2 or1 rupturing the capsule1 it may escape into the peritoneal cavity4 ,such effusions may be found in new-born children after protracted and difficult labors1 or as a result of external violence1 and sometimes attend malignant fevers1 scurvy1 and purpura4 ,perihepatitis4 ,the peritoneal covering of the liver1 very frequently in post-mortem examinations1 presents appearances of having been attacked by inflammation1 in the presence of bands of adhesion connecting different portions of the surface of the gland to adjoining organs4 ,the whole of the upper surface will sometimes be found closely united in this manner1 to the diaphragm4 ,such appearances are sure indications of the existence at one time1 of an attack of peritoneal inflammation4 ,in a cirrhosed condition of the gland1 and over the seat of abscesses of the liver1 such adhesions almost universally form4 ,inflammation of the peritoneal covering of the under surface of the liver1 may result from an extension of the disease from an inflamed stomach or duodenum1 or from the presence of a biliary calculus impacted in some of the ducts2 such inflammation resulting in more or less extensive adhesion of the parts in contact4 ,the presence of hydatid or cancerous masses1 are not usually attended with these evidences of inflammation4 ,scar-like ,marks1 are not uncommonly found on the surface of the liver4 ,the peritoneum at these points seems drawn into the substance of the gland1 at the centre of the mark1 while radiating ridges extend in various directions1 to the distance of a-half to three-fourths of an inch4 ,the cause of these appearances is evidently inflammation of the peritoneum1 extending to the subserous tissue1 and perhaps to the liver substance4 ,hepatitis4 ,inflammation of the liver may be acute or chronic4 ,acute inflammation of the liver1 though a frequent occurrence in hot climates1 is seldom met with in cold or temperate4 ,the gland in this condition1 is found more or less swollen and enlarged1 and the tissues somewhat softened4 ,this condition may be confined to one or more lobes1 or involve the whole gland4 ,where a section is made1 the turgid swollen tissue rises above the peritoneal covering1 along the edges of the incision4 ,as the disease advances to a later stage1 the deep red color changes to a brownish or grayish-red1 patches of these being mingled with others of a yellowish-red or pale yellow4 ,acute inflammation of the liver may terminate in resolution1 when there will be a gradual restoration to a normal condition1 or in suppuration1 and the formation of an abscess2 the latter result being much more common4 ,abscess of the liver may involve the greater portion of the right or left lobe4 ,the substance of the gland immediately around the abscess1 will appear unusually red1 and perhaps a little hardened1 while other portions may present the appearance of health4 ,in some instances1 from a complete destruction of the hepatic tissue1 the peritoneal covering will form the only protection to the contained matter4 ,the quantity of purulent matter contained in these abscesses may vary from half a pint or less1 to one or two quarts4 ,the inflammation attending the formation of an hepatic abscess1 will usually extend to the peritoneum1 resulting in the formation of adhesions to the adjoining organs1 and thus preventing the abscess1 in many instances1 from discharging into the peritoneal cavity1 as it otherwise would be likely to do4 ,abscesses thus formed1 may discharge3 #ast1 by the adhesive process through the diaphragm into the chest1 and if adhesions had previously taken place between the diaphragm and lung1 by an extension of the ulcerative process1 the matter may find its way into the bronchial tubes1 and thus be discharged by expectoration2 #b;d1 by a similar process into the stomach1 duodenum or colon2 #c;d1 upon the surface of the body2 and #dth1 within the peritoneal cavity4 ,in the latter case1 death is inevitable2 in the others recovery is possible4 ,the following case illustrates discharge and recovery by the first method3 ,,case4--,abscess of the ,left ,lobe of the ,liver1 discharging through the diaphragm1 a portion of the matter expectorated1 the balance discharged upon the surface of the body--,recovery4 ,in the winter of #ahef-g1 ,i was called to see ,mrs4 ,b----1 aged #dj1 of ,broad street4 ,she had been given up by the physicians previously in attendance4 ,found her greatly emaciated1 suffering from a terrible cough1 and expectorating great quantities of excessively offensive matter4 ,diarrha1 hectic fever1 night sweats1 with occasional chills1 completed the picture1 and appeared to render the case perfectly hopeless4 ,upon inquiry1 learned that she had been taken ill some months previously1 with what the attending physician had pronounced as acute hepatitis4 ,after the usual acute symptoms1 the formation of an abscess became evident from the fulness in the region of the left lobe1 accompanied with chills1 hectic1 etc4 ,a violent cough1 with evidences of inflammation in the left lung1 accompanying the other symptoms1 the case was supposed to be complicated with tuberculosis4 ,the expectoration finally became greenish1 thick and exceedingly offensive1 indicating that the abscess had worked its way into the bronchial tubes4 ,in examining the chest1 after the case had been under my care a few days1 ,i noticed between the ninth and tenth ribs a fulness and slight redness4 ,after the application of poultices for a few days1 a distinct 8pointing0 appeared1 from which1 after the use of the lance1 came a most copious discharge of the same green1 offensive matter1 as was being discharged by expectoration4 ,from this time1 a slight improvement was noticed in the patient4 ,the external opening was carefully kept from closing4 ,the cough gradually improved4 ,little or none of the offensive matter was raised after the establishment of the external opening4 ,in six months the health was fully restored1 and now1 fifteen years after1 she is a stout1 healthy woman4 ,in the progress of formation of an abscess in the liver1 as branches of the portal or hepatic veins are reached1 inflammation of their coats is excited1 which results in their obliteration1 thus generally preventing the admission of pus into the venous system4 ,but as the enlarging abscess encroaches upon the hepatic ducts1 instead of these becoming closed by inflammation1 they ulcerate through1 and thus establish a communication between these vessels and the cavity of the abscess4 ,hence the pus contained in these abscesses1 is very likely to be mingled with more or less bile2 while at the same time1 a portion of the contents may be discharged through the common duct into the bowels4 ,abscess of the liver may result from inflammation and ulceration of the bile ducts1 from the irritation of impacted calculi1 or from the presence of intestinal worms that have entered by the ductus communis2 or from the lodgment of emboli in some branch of the portal vein or hepatic artery4 ,secondary1 ,pymic or ,metastatic ,abscess4 ,the liver is occasionally the seat of abscesses forming as a result of pymia1 induced by absorption of pus from some wound of a joint1 vein1 or bone2 or from a diffused abscess or erysipelas of the skin4 ,these abscesses usually contain a somewhat thin and oily-looking pus4 ,they also differ from ordinary abscesses in the rapidity with which they form1 a few days generally sufficing to give them a large size4 ,the insidious manner in which they form--the tissues breaking down1 as it were1 without any inflammation--constitutes a distinguishing feature of these collections4 ,pymic abscesses of the liver are usually many in number1 and varying in size from a pea to that of a walnut4 ,the gland is usually enlarged at the same time1 and in some cases to such an extent as to reach quite to the umbilicus4 ,this form of abscess is not confined to the liver1 but may be found in the lungs1 spleen1 in the joints1 or in the serous cavities1 and sometimes diffused through the connective tissues and muscles of the limbs or trunk4 ,degenerations of the ,liver4 ,waxy1 ,lardaceous1 or ,amaloyd ,liver4 ,in this form of disease1 the liver undergoes greater enlargement than in any other disease excepting cancer4 ,the enlargement is uniform in every direction1 so that the form of the gland is unchanged4 ,pain and tenderness are never prominent symptoms of this disease1 hence the liver may be manipulated during life with impunity1 the patient complaining only of weight and tightness in the right hypochondrium4 ,the progress of the disease is usually slow1 extending1 in most cases1 over several years4 ,the spleen1 kidneys and intestines will frequently be found presenting this change at the same time4 ,the tissue of the gland in these cases is very firm1 so that the organ generally retains its form when laid with its convex surface on the table4 ,the external surface is smooth and free from adhesions4 ,when cut1 a peculiar translucent substance is found infiltrated through the tissues1 giving it a firm1 glistening appearance1 known as waxy1 lardaceous1 amaloyd1 albuminous1 or sometimes scrofulous liver4 ,this substance is stained a deep red by the action of a weak solution of iodine4 ,the change appears to commence first1 in the small blood-vessels1 finally extending to the lobules1 appearing first in the centre1 and ultimately involving the whole lobule4 ,the disease is more common in males than females1 and is frequently caused by constitutional syphilis4 ,in some instances1 it would appear to be produced by a tubercular diathesis1 and coexists with some local form of scrofulous disease1 or by a long exposure to malarial influences4 ,fatty ,liver4 ,this form of disease we find in drunkards2 in persons who have been large eaters and sedentary in habit2 in several wasting diseases1 as in chronic diarrha1 and especially in phthisis pulmonalis4 ,there is a moderate degree of enlargement which affects all portions of the gland4 ,the consistency is softer1 and the resistance less than in waxy liver1 giving it a doughy feel4 ,the color varies1 but is usually lighter than normal1 approaching a yellow1 and more or less mottled4 ,when cut1 the substance presents a decidedly oily appearance1 both to the feel and sight4 ,the disease is unaccompanied with pain from first to last2 neither is its function materially interfered with1 hence jaundice is not usually a symptom of the disease4 ,a microscopic examination shows the lobules of the liver filled with fat globules1 which appear to have originated in the hepatic cells4 ,the change appears to commence at the circumference of the lobule1 the centre remaining normal in color1 thus giving a mottled appearance to the cut surface4 ,other organs are very liable to be affected at the same time by this form of disease1 as the heart1 kidneys1 etc41 the symptoms which the case presents1 such as albuminous urine1 tendency to dropsy1 dyspna1 etc41 arising from these organs1 rather than from the fatty liver4 ,pigmentary ,degeneration4 ,in cases of malarial poisoning1 we sometimes find the liver with other organs of the body1 as the spleen1 lungs1 brain1 kidneys1 etc41 presenting a peculiar dark color1 the result of the presence of a black or brown pigment in the blood1 filling the vessels of these organs4 ,the pigment appears to be formed of small granules either free or contained in irregular cells4 ,in the liver1 this pigment is found most abundant in the blood of the portal vein1 but may be present in the hepatic artery1 and in all the venous capillaries4 ,the liver may be normal in size1 or it may be atrophied or hypertrophied1 or may have undergone fatty or waxy degenerations4 ,granular ,degeneration4 ,a peculiar change in the liver substance is sometimes found after death from various acute or infectious diseases1 as the exanthemata1 pymia1 septicmia1 erysipelas1 typhus1 typhoid1 and yellow fever1 etc42 or from thrombosis of the portal vein1 abscesses or cirrhosis1 as well as in poisoning by arsenic1 phosphorus or antimony4 ,the change in the early stage consists in an accumulation in the liver cells1 of a fine granular substance1 soluble in alkalies1 and apparently of an albuminous nature2 and1 at a later stage1 of coarser shining particles of a fatty character1 and soluble in ther or alcohol4 ,atrophy of the liver may be divided into the following forms3 ,i4 ,simple ,atrophy4 ,,ii4 ,acute or ,yellow ,atrophy4 ,,iii4 ,chronic ,atrophy1 or ,cirrhosis4 ,simple ,atrophy4 ,by this1 we understand a diminution in the size of the liver1 without any alteration in its structure4 ,in this state1 the liver may be reduced to one-half its normal weight and bulk4 ,it is found to occur3 #a4 ,old age4 ,hence this form of atrophy is sometimes called 8senile atrophy40 ,with the loss of adipose tissue in advancing years1 there is also a tendency either to degeneration or wasting 7atrophy7 of many of the organs1 and especially of the liver4 ,in this manner1 the liver may be reduced to one-half its normal size and weight without any change of structure4 #b4 ,inanition1 arising either from an insufficient supply of food1 or from diseases which interfere with the assimilation of food1 may result in simple atrophy of the liver4 #c4 ,external pressure may also produce the same result1 as from tight lacing1 pleuritic1 pericardial1 or peritoneal effusions1 or from enlargement of organs1 or presence of tumors near the liver4 ,simple atrophy is rarely attended with jaundice unless pressure upon the bile ducts has been such as to obstruct the flow of that fluid4 ,acute1 or ,yellow ,atrophy4 ,in this somewhat rare form of disease1 the liver becomes rapidly atrophied1 accompanied with jaundice and cerebral symptoms4 ,after death1 the organ is found greatly reduced in size1 extremely soft and yellow1 with no appearance of lobules1 and upon microscopic examination1 the secreting cells found more or less changed into granular matter and oil globules4 ,the weight of the gland in these cases1 may be reduced from three to four pounds1 the average normal weight1 to less than two pounds4 ,this form of disease is frequently attended with hmorrhages1 particularly of the stomach and bowels1 and in some instances1 from the uterus or nose4 ,pregnant females suffering from this affection usually abort4 ,among the causes of this form of disease of the liver may be mentioned pregnancy1 dissipation1 constitutional syphilis1 malaria1 and the blood-poisoning of typhus fever4 ,females appear much more liable to the disease than males1 and most persons attacked are under middle age4 ,chronic ,atrophy1 ,cirrhosis or ,hob-nail ,liver4 ,the form of atrophy of the liver which we now have to consider1 is slow in its progress1 and is usually associated with abdominal dropsy4 ,the appearance and density of the gland varies to a considerable extent in different cases of chronic atrophy1 yet the usual appearance is that seen in what is known as cirrhosis1#bc or 8hob-nail liver10 also sometimes called 8gin-drinker's liver40 ,here the liver has become reduced in size1 from a slow destruction of the secreting tissue1 while1 at the same time1 the fibrous tissue of ,glisson's capsule has become thickened and hardened1 from a chronic inflammatory action1 often due to the use of spirituous liquors4 ,the outer surface presents a granular or nodulated character1 which has given rise to the term 8hob-nail10 as applied to this disease2 while1 upon section1 the interior presents firm fibrous bands1 surrounding yellow patches of secreting tissue4 ,while1 in the majority of cases1 this disease is plainly owing to an abuse of spirituous liquors1 in others1 it is found associated with disease of the heart1 or with constitutional syphilis1 where the patient has been strictly temperate4 ,the increased density1 in connection with the diminution of size1 and granulated character of the surface1 renders the disease readily recognizable in a post-mortem examination4 ,the early stage of this disease appears to be accompanied with a degree of enlargement of the gland1 resulting from the congestion attending the inflammation of the fibrous structure4 ,as this structure increases in density1 by pressure it causes a gradual absorption of the secreting lobules1 and thus results in a reduction in the size and weight of the organ4 ,the secreting cells of the lobules of the liver1 may undergo fatty change1 or they may become entirely destroyed4 ,thrombi may be found in the portal vein4 ,the hepatic artery and its branches become increased in size1 while the interlobular hepatic veins become quite destroyed4 ,the obstruction to the circulation through the liver1 resulting from these changes1 gives rise to the dropsical effusions usually found in this disease4 ,prominent among the symptoms attending this disease1 during life1 may be mentioned3--#ast4 ,diminished area of hepatic dulness4 #b;d4 ,ascites1 particularly in advanced stages of the disease1 although patients may die before dropsy sets in4 #c;d4 ,enlargement of the spleen--this being present at least in about one-half the cases4 #dth4 ,enlargements of the superficial veins of the abdomen1 from obstructed flow of the portal blood1 or from pressure upon the vena cava1 from abdominal distension4 #eth4 ,hmorrhoids1 epistaxis1 hmatemesis1 etc4 #fth4 ,the rare occurrence of decided jaundice4 #gth4 ,in all cases1 the advance of the disease is marked by progressive emaciation and debility1 the patient usually dying of exhaustion1 although in some cases death is due to an attack of pneumonia1 dema of the lungs1 or acute peritonitis4 ,hypertrophy4 ,we sometimes find an evident increase in the size of the liver1 without any alteration of structure1 or the presence of any prominent symptoms4 ,such cases may be considered as instances of simple hypertrophy4 ,this condition has been observed in cases of leukmia1 and in some exceptional cases of saccharine diabetes1 heart disease and phthisis4 ,morbid ,growths4 ,cancer of the ,liver4 ,every variety of cancer may be found in the liver1 though the scirrhus or medullary forms are more common4 ,the disease is invariably accompanied with enlargement1 and in some instances the increase is enormous4 ,the progress of the disease is rapid1 a few weeks in many instances1 a few months at the longest1 being required to fully develop the disease4 ,the enlargement is not uniform4 ,the surface becomes irregular and uneven1 nodules of various size are found projecting from its surface and borders1 which are usually harder than those of the surrounding portions4 ,the disease is nearly always accompanied with pain1 and considerable tenderness is felt upon touch4 ,jaundice is present in many cases1 but in ninety-one cases collected by ,frerichs1 fifty-two showed no symptoms of jaundice4 ,abdominal dropsy to any considerable extent1 rarely attends the disease1 although usually a small quantity of fluid will be found in the peritoneal cavity4 ,these characters will usually enable us to make a correct diagnosis of these cases during life4 ,the post-mortem examination1 discloses1 in the majority of cases1 a greater or less number of irregular1 rounded masses1 projecting from the surface of the liver1 and varying in size from a kernel of corn to an orange4 ,through the peritoneum1 these bodies present a light1 straw-colored appearance1 and when divided1 the interior is found of a whitish-gray color1 and of the consistence of tallow or cheese4 ,examined very carefully1 the substance has the appearance of infinitely minute granules1 aggregated together4 ,these masses may be confined to one of the lobes1 or involve the whole organ2 they are of an irregularly rounded or globular form1 and in some cases two or three appear to have coalesced into one mass4 ,in other1 and more rare cases1 the cancerous matter1 instead of being collected in masses1 is found more or less infiltrated through the liver substance1 as in ,case ,i4 ,they may soften1 and form cysts filled with a thin serous fluid1 or they may undergo a form of fatty degeneration4 ,in such cases the disease is liable to be mistaken for waxy degeneration4 ,in both1 there is a uniform hard enlargement1 but in the waxy enlargement1 the progress is slow1 and without pain1 and there is usually enlargement of the spleen1 with albuminuria1 and a syphilitic taint2 while in cancer there is no enlargement of the spleen1 or albuminuria1 and the course of the disease is rapid2 there is pain1 cachexia1 and often signs of cancer elsewhere4 ,cancer of the liver1 in the majority of instances1 is secondary to cancer of some other part1 as of the stomach1 rectum1 or female breast4 ,in more than one-third of the cases1 it is said to be secondary to cancer of the stomach4 ,cases are rare where the liver is primarily affected with cancer4 ,before thirty-five or forty years of age1 secondary cancer seldom occurs4 ,the following cases will serve to illustrate the two forms of cancer of the liver3 ,,case ,i4--,primary ,cancer of the ,liver1 with great enlargement--,rupture of ,stomach from post-mortem softening4 ,mrs4 ,k----1 aged #ch1 light complexion1 short and fleshy1 commenced complaining about ,new ,year's1 #ahfh1 of pain in the 8stomach10 as she expressed it1 with loss of appetite1 restlessness at night1 accompanied with weakness and prostration4 ,these symptoms continued for a couple of weeks1 when she commenced to complain of soreness in stooping1 and inability to wear her clothes tight4 ,this led to an inspection of the abdomen in bed4 ,i then found projecting below the margin of the chest on the right side1 a hard rounded tumor1 nearly of the size of the fist1 somewhat sensitive to the touch1 and evidently springing from the liver4 ,the pain daily increased in severity1 and coming on as it did1 in paroxysms1 resembled much the pain attending the passage of biliary calculi4 ,after she took to her bed1 which was in the latter part of ,january1 there was a rapid increase in the size of the liver1 with a marked aggravation of all the symptoms4 ,the pain was most agonizing2 slight chills occurred from day to day2 the flesh rapidly wasted1 and the outline of the lower border of the liver could be distinctly traced through the abdominal walls4 ,there were no symptoms of jaundice4 ,the skin was pale and waxen in hue4 ,in the latter part of ,february1 frequent epistaxis1 and bleeding of the gums set in1 while from the pressure upwards upon the diaphragm1 the lungs were so embarrassed as to give rise to great dyspna4 ,rapidly sinking1 she died on the first of ,march4 ,autopsy1 made thirteen hours after death4 ,anterior portion of the body pale2 posterior dark from gravitation of the blood4 ,rigor mortis scarcely noticeable4 ,upon opening the abdomen1 found four to six ounces of serum in the peritoneal cavity4 ,the liver was enormously enlarged1 filling a great portion of the abdominal cavity1 pushing the diaphragm high up into the chest1 and giving the lungs less than half their normal amount of room for expansion4 ,the upper surface of the right lobe was found adhered to the under surface of the diaphragm1 and to the anterior abdominal walls1 and the under surface to the stomach1 duodenum and transverse colon4 ,the surface of the liver was dark1 mottled1 and somewhat nodulated4 ,the whole gland was quite firm1 yet evidently just entering upon a softened stage at numerous points4 ,no trace of an abscess forming at any point4 ,upon lifting the left lobe of the liver1 a dark1 brownish fluid appeared behind the stomach1 the origin of which was not at first apparent4 ,the removal of the liver1 however1 completely exposing the stomach1 showed the posterior wall at the large end1 softened and ruptured4 ,this softening was evidently a post-mortem action of the gastric juice2 the rupture resulting from the tension upon the same1 in tearing away the adhesions between the stomach and liver4 ,upon the removal of the liver1 found it to weigh eighteen pounds4 ,the gall-bladder was empty and contracted4 ,the only portion of the gland not involved in the disease1 was one of the small lobes1 the lobus ,spigelii1 and a portion of the left lobe4 ,incisions1 showed the interior presenting a similar mottled appearance as the surface2 dark1 almost black spots1 intermixed with spots of brown and gray4 ,the blood-vessels of the liver were enlarged1 and filled with dark defibrinated blood4 ,no trace of coagulated blood1 in any of the blood-vessels of the body4 ,microscopic examination4 ,an examination of a small portion taken from the right lobe1 with a power of #cej diameters1 showed innumerable cells of an irregular outline1 and varying in size2 oil globules1 and granular matter4 ,the action of acetic acid1 rendered the nuclei of the cells faintly visible4 ,many cells of a large size were found filled with a growth of smaller ones4 ,all other organs of the body normal4#bd ,,case ,,ii4--,cancer of the ,liver1 secondary to ,cancer of the ,rectum1 with diffused ,abscess in the ,neck4 ,mr4 ,a----1 of ,doylestown1 ,pa41 aged #fj1 had been suffering for some months with symptoms of disease of the rectum1 with also inflammation of the bladder4 ,his passages were painful1 and accompanied with more or less bloody1 purulent matter4 ,his urine was thick1 at first from presence of large quantities of mucus1 later of pus4 ,his appetite and digestion were poor2 his color pale and cachectic4 ,some six months previous to death1 he commenced passing with his urine1 small quantities of seeds of berries1 tomatoes1 etc4 ,these gradually increased in quantity1 until1 for some weeks previous to death1 there was a free discharge of feculent matter from the bladder1 and at the same time much urine passed per rectum4 ,a few days before death1 there appeared a diffused swelling upon the front of the neck1 extending from the clavicles as high as the upper portion of the larynx4 ,there was no discoloration of the surface4 ,the swelling presented a boggy feel1 without any positive fluctuation4 ,on the #aeth of ,july1 #ahga1 ,i was called by ,dr4 ,george ,wright1 who had been treating the case for the past year1 and from whom ,i learned the above facts1 to make a post-mortem examination1 the patient having died the day before4 ,found the body very thin1 surface pale4 ,no serum in the peritoneal cavity4 ,upon lifting the small intestines from the cavity of the pelvis1 found the rectum closely adhered to the posterior surface of the bladder1 completely obliterating the recto-vesical cul-de-sac4 ,considerable dense scirrhus matter1 was found upon either side of the rectum and bladder4 ,upon removing the rectum and bladder1 a large opening 7one inch in diameter7 was found communicating between the two4 ,the edges of this opening were thick and ragged4 ,the walls of the bladder and rectum generally1 were thick and hard from scirrhus deposits4 ,the bladder contained considerable purulent and feculent matter1 with also a cherry-stone4 ,upon examining the liver1 found upon the under side of the left lobe1 a large cancerous mass1 imbedded in the substance1 but projecting from the surface1 and quite as large as a goose egg4 ,other portions of the liver healthy4#be ,the lungs were healthy4 ,the muscular walls of the heart were pale and soft1 while each of the cavities contained soft1 imperfectly formed fibrinous clots4 ,the right pleural cavity contained nearly a pint of serum1 while the pleura presented a red1 inflamed appearance4 ,in removing the sternum from its position1 noticed purulent matter beneath the upper end1 which appeared to come down from the neck4 ,upon carrying an incision upwards to the hyoid bone1 found the whole region of the neck infiltrated with pus1 without being confined by any limiting membrane or sac1 and evidently metastatic in its origin4 ,tubercles4 ,the peritoneum covering the liver1 like other portions of this membrane1 will sometimes 7more frequently with children7 be found filled with numerous minute tubercular particles1 the presence of which are liable to give rise to appearances of inflammation1 such as redness1 roughness1 and perhaps adhesions4 ,fibroid and ,cartilaginous ,tumors are of extreme rarity in the liver4 ,when present1 they exhibit the characters of those growths in other parts4 ,adenoid ,tumors have been detected in this gland4 ,they vary in size and number1 but are usually enclosed in a fibrous capsule1 and appear to be made up of glandular cells1 resembling the hepatic cells1 but of larger size and greater density4 ,vascular ,tumors are sometimes found in the liver1 consisting apparently of a compact1 irregular net-work of dilated veins1 held together by connective tissues4 ,of a dark1 almost black color1 they vary in size from a few lines to two or three inches in diameter1 and are very irregular in their outline4 ,cysts of small size are occasionally found1 developed either in the connective tissues1 or from a dilatation of bile ducts4 ,they may be found filled with serum1 or colored mucus and epithelial cells4 ,syphilitic ,tumors1 from the size of a pin's head to that of the fist1 may be found in the liver4 ,they are of a gray1 whitish or yellow color1 made up of cells of an irregular form1 which show a tendency to cheesy degeneration1 or to such softening as to give the appearance of an abscess4 ,blood-vessels of the ,liver4 ,the hepatic artery is sometimes found with aneurismal enlargements1 and rarely contains an embolus4 ,the portal vein is frequently found containing a fibrinous clot1 constituting thrombosis4 ,such clots may result from pressure on the vein from the presence of some morbid growth in the liver1 or from a tumor in the mesentery or some other part1 obstructing the portal vein below the liver2 or from suppurative disease of ulceration of the several organs from which the portal vein arises4 ,they may be a cause1 or result1 of phlebitis1 and may give rise to jaundice1 and sometimes to abscess of the liver4 ,dilatation of the portal vein may result from obstruction of the capillaries of the liver in chronic atrophy or cirrhosis2 or from the presence of thrombi1 or pressure by various morbid growths4 ,calcification1 not only of the portal vein within the liver1 but of its various branches of origin within the mesentery1 omentum1 etc41 may occasionally be met with4#bf ,the hepatic veins may be found presenting the same abnormal conditions as the portal vessels4 ,animal ,parasites4 ,the liver has long been known as a favorite resort for different parasitical animals1 the most common of which1 is that of the larval form of one of the tapeworms--the ,tnia echinococus--constituting when developed in the liver1 what is known as an acephalocyst or hydatid4 ,hydatid ,tumors of the liver1 arise in the following manner3--,the several tapeworms pass through three stages of development1 these never being completed however in the same animal4 ,the ,tnia echinococus1 acquires its adult form1 only in the intestines of the dog or wolf4 ,the mature segments1 each of which are filled with vast numbers of eggs1 are voided with the fces1 into which the eggs are discharged4 ,these soon develop into a minute embryo1 with one extremity provided with numerous little hooks4 ,if taken into the stomach of an herbivorous animal or man1 this embryo pierces the walls of the intestines1 enters a blood-vessel1 and finally lodges in some of the tissues or organs1 more frequently the liver1 where it develops into a sac-like body1 known as a cysticercus or hydatid1 the second larval form4 ,when the embryo is taken into the stomach of other animals1 no further development takes place4 ,while in the hydatid1 or second larval form1 by a peculiar process known as alternate generation1 there may be a reproduction of cysts to an almost endless extent within the parent cyst1 or secondarily in other parts4 ,the adult or third stage of development1 can only be attained within the intestinal canal of the dog or wolf4 ,these animals devouring a sheep or other ruminant1 or in some rare case perhaps a human being1 within which the hydatid has been formed1 the cysts thus taken into the stomach1 develop into the perfect worm1 from which segments containing the eggs are again discharged4 ,it would appear almost impossible for the embryo from these eggs1 to ever enter the human stomach1 but it is not difficult to understand that the fces of the dog containing the ova1 may enter a spring or stream1 from which the minute embryo may be taken with the water1 by either man or a lower animal2 or1 by attaching themselves to watercresses1 etc41 they may be eaten with these by the same4 ,hydatid tumors of the liver1 may vary1 greatly1 in size1 according to their age4 ,from an extremely minute cyst1 they may acquire such a size as to fill and distend the abdominal cavity1 crowding the several viscera from their position4 ,there may be one or several4 ,they may be confined to the liver1 or secondary cysts may appear in other organs4 ,when opened1 the interior is generally filled with numerous smaller cysts of various sizes1 each filled with a gelatinous fluid of varying degrees of density and color1 and within which1 by a careful microscopic examination1 may be detected--many times1 not always--numerous hooklets1 which have been detached from the minute heads4 ,the walls of the parent cyst may become greatly thickened1 or even calcified4 ,the contents may degenerate into a purulent mass1 with which may be mingled blood or bile4 ,the development of these tumors is usually slow1 and unattended with pain1 or functional disturbance of the liver4 ,after they have acquired a large size1 they may induce peritonitis1 resulting in extensive adhesions4 ,rupture of these hydatids sometimes take place1 this accident being followed by death1 or recovery1 according to the point at which the rupture takes place4 ,they may burst in the following directions3 #a4 ,through the diaphragm into the pleural cavity1 or into the substance of the lungs4 #b4 ,rarely into the pericardium4 #c4 ,into the peritoneal cavity1 resulting in acute peritonitis4 #d4 ,through the abdominal walls1 when recovery is possible4 #e4 ,into the stomach or intestines2 this being the most favorable point of rupture4 ,in fifteen cases of rupture into the intestines1 fourteen recovered4 #f4 ,into the biliary passages or large blood-vessels4 ,,case4--,large ,hydatid ,tumor of the ,liver--,death from ,exhaustion4 ,mr4 ,o----1 of this city1 aged #ge years1 noticed some two years previous to his death that his abdomen was enlarging4 ,an examination disclosed the presence of a large tumor descending from the region of the liver4 ,it was slightly fluctuating1 and unattended with pain or soreness4 ,he complained of nothing but weakness with vertigo4 ,all the functions of the body were natural4 ,a gradual increase of size took place1 with occasional attacks of inflammation1 until the abdomen acquired the dimensions of that of a woman at full term4 ,the oppression now became so great1 from the crowding of the lungs1 that ,i decided to resort to paracentisis4 ,some two quarts of a thick1 gelatinous fluid were drawn off from the tumor1 with several quarts of ascitic fluid from the peritoneal cavity4 ,the operation was followed by great relief4 ,rapidly refilling1 the oppression again became severe1 and the operation was repeated a few months later with similar results4 ,death finally followed from exhaustion4 ,the post-mortem revealed an immense tumor1 filling the abdominal cavity with extensive1 firm adhesions1 and crowding the lungs into the upper part of the chest4 ,the walls of the sac were thick and semi-cartilaginous1 and the interior divided into numerous compartments by septa passing in various directions4 ,these compartments were filled with a gelatinous fluid1 in which were innumerable cysts of various sizes1 each filled with a similar fluid as that with which they were surrounded4 ,the microscope showed the presence of numerous cholesterine scales in this fluid4 ,the weight of the entire tumor was over fifty pounds4 ,a portion was preserved and deposited in the ,college ,museum4#bg ,the following parasites are also sometimes found in the human liver1 or its ducts3 ,distoma hepaticum1 or liver fluke4 ,common in the bile passages of lower animals1 rare in that of man4 ,it is flat1 oval1 from two to four lines long1 and a-half to one line broad4 ,its presence in the hepatic ducts1 may give rise to enlargement1 some degree of obstruction1 or calcification4 ,distoma lanceolatum4 ,this parasite1 something smaller than the above1 is still more rare in the bile passages of man4 ,pentastoma denticulatum4 ,this animal is found as a small cyst1 with calcified walls1 and containing fatty and calcareous matter1 with the remains of the dead parasite4 ,it is considered as the larval form of a worm sometimes found in the nasal cavity of the dog1 and some other animals4 ,the ,ascaris lumbricoides may be found in some of the bile passages1 it having entered by the opening of the common duct into the intestine4 #b4 ,affections of the ,gall-bladder and ,ducts4 ,the gall-bladder is sometimes wanting1 this being the normal condition in the horse and some other animals4 ,when thus absent1 the hepatic ducts are so increased in size1 as to be able to contain the accumulating bile in the intervals of digestion4 ,inflammation of the gall-bladder and common duct1 involving their mucous lining1 is not uncommon4 ,such inflammation may be either catarrhal or suppurative4 ,catarrhal inflammation may result in thickening or calcification of the lining membrane of the ducts and bladder1 with the accumulation of such quantities of thick tenacious mucus1 as to become a source of impediment to the flow of the bile1 and thus give rise to jaundice4 ,such inflammation becoming chronic in the common duct1 may result in great dilatation of the gall-bladder1 from the accumulation of bile4 ,in many cases1 this form of inflammation would seem to have originated in the duodenum1 reaching the biliary passages by extension through the opening of the duct into the intestine4 ,it may also result from the presence of calculi or parasites in the passages1 or from inflammation of the liver4 ,suppurative inflammation may attend different forms of fevers1 or result from the presence of calculi4 ,the gall-bladder1 with the bile ducts1 in such cases1 may be filled with a purulent fluid1 or the same may be found infiltrated through their walls4 ,perforation of the walls of the gall-bladder may result from this form of inflammation1 with escape of contents into the peritoneal cavity1 inducing thus fatal peritonitis4 ,fistulous communication may also form between the bladder and colon1 duodenum or stomach1 or through the abdominal walls1 adhesions having first taken place between these parts4 ,dilatation1 both of the bladder and ducts1 may occur as a result of obstruction of the gall-ducts4 ,that of the former may be very great1 giving rise to a tumor that may be plainly felt through the abdominal walls4 ,dilatation of the ducts may involve either the common1 or large hepatic ducts1 or the smaller branches within the liver4 ,such dilatations may be sacculated in form1 or general1 involving the whole tube4 ,morbid ,growths4 ,cancer of the walls of the gall-bladder is not unfrequent1 and may be either primary or secondary4 ,the cavity of the bladder may in this way become obliterated1 and the common duct obstructed1 thus inducing jaundice4 ,in a case examined for the ,drs4 ,pettingill1 the gall-bladder was as large as the fist1 from scirrhus cancer2 its cavity obliterated2 adhered to the pylorus to which the disease had extended2 and the bile ducts greatly dilated and filled with a large quantity of puriform fluid4 ,the patient had been for many months extremely jaundiced4 ,fibroid tumors are very rarely observed in connection with the gall-bladder4 ,tubercular deposits may be found beneath its peritoneal covering4 ,biliary ,calculi4 ,the presence of biliary calculi1 or gall-stones in the gall-bladder1 or some of the ducts1 is a very common occurrence4 ,these bodies are composed of the elements of the bile1 largely however of cholesterine1 sometimes in an almost pure state1 in others1 more or less mixed with inspissated bile4 ,in many cases1 a nucleus of nearly pure cholesterine will be surrounded by a deposit of biliary matter mixed also with scales of cholesterine4 ,cholesterine is a peculiar spermaceti1 or fatty-like substance1 found not only in the bile1 but also in the nervous tissues1 insoluble in water1 but soluble in ther or boiling alcohol4 ,when found in a pure state1 it is of a yellowish-white color1 with the particles arranged in the form of shining thrombic scales4 ,gall-stones may occur of all sizes1 from a pin's head to that of a hen's egg4 ,when small1 they are generally numerous2 in some instances fifty to one hundred being found in the gall-bladder at one time4 ,when several are present in the bladder1 they will be more or less angular or polyhedral in form from contact and attrition with one another4 ,where there are but one or two1 the size may be considerable1 while the form will be rounded1 oblong or pear-shaped1 and more or less regular4 ,these bodies1 when first removed1 are usually heavier than water1 but1 after being dried1 become considerably lighter4 ,they are inflammable1 and may be reduced to almost pure charcoal by burning4 ,after having being exposed to the air for some time1 they are very liable to crumble more or less completely4 ,position4 #a4 ,gall-stones may be confined to the gall-bladder4 ,this is the position in which they are more frequently found4 ,there is every reason to believe that they may remain there for a long time without giving rise to any uncomfortable symptoms4 ,we frequently find them after death in the gall-bladder of persons who1 during life1 exhibited no symptoms of their presence4 ,they are liable1 however1 when present1 and particularly if numerous or large1 to give rise to a sense of weight and dragging in the part1 and to occasional attacks of pain1 derangement of the stomach and vomiting2 and may also excite inflammation and ulceration of the walls of the bladder4 ,the presence of gall-stones1 when in large numbers1 may frequently be detected through the abdominal walls1 as a hard resisting tumor1 which1 by grasping1 may be made to elicit a rattling sensation1 like pebbles in a bag4 #b4 ,gall-stones may become impacted in the neck1 or cystic duct of the gall-bladder4 ,in this case1 it is likely to give rise to an attack of biliary colic1 with vomiting1 etc4 ,as long as it remains in this position there will be no jaundice4 ,their presence1 however1 may excite inflammation2 yet we sometimes1 in post-mortem examinations1 find the neck of the gall-bladder blocked up by a calculus1 when no symptoms of such an obstruction existed during life4 #c4 ,gall-stones may form in some of the branches of the hepatic ducts within the liver4 ,this is not a common point for the formation of these bodies4 ,they are sometimes found1 however1 in cases of obstruction of the ductus communis4 ,the concretions may be small and rounded1 or branching casts of the tubes1 resembling pieces of coral4 #d4 ,gall-stones may be lodged in the ductus communis choledochus4 ,this is one of the most common situations for these bodies1 and they may reach the point1 either from the gall-bladder1 or from the ducts from the liver4 ,while in this position1 the calculus is likely to give rise to jaundice with paroxysms of severe pain1 which will be repeated from time to time1 until it passes into the intestines4 ,effects4 ,as already intimated1 gall-stones may remain for an indefinite period in the gall-bladder or ducts1 without giving rise to any symptoms4 ,in many instances1 also1 they may undoubtedly pass the ductus communis when small1 and be discharged by the bowels1 without the knowledge of the patient4 ,more frequently1 however1 the passage of these bodies is accompanied with paroxysms of severe pain1 the location and character of which will usually serve to indicate the true cause4 ,where1 however1 the body is too large to pass1 its presence in the gall-bladder or any of the gall-ducts1 may excite inflammation and ulceration in those parts1 and thus lead to perforation and discharge of contents into the peritoneal cavity4 ,,case4--,rupture of the ,gall-bladder1 with discharge of contents into the peritoneal cavity1 followed by peritonitis and death4 ,mr4 ,de ,k4 ,t----1 of this city1 aged about #fj1 had suffered from several attacks of severe pain in the region of the gall-bladder1 which ,i had diagnosed as biliary colic1 induced by the presence of a calculus4 ,one morning in ,june1 #ahfc1 while working in his garden1 he felt a sensation of something giving away in his side1 which was immediately followed by an attack of severe pain4 ,a chill and fever soon succeeded2 and1 in twenty-four hours1 a violent peritonitis set in1 resulting in death in four days4 ,autopsy1 thirty-six hours after death4 ,upon opening the cavity of the abdomen1 the peritoneal membrane was found intensely inflamed at all points1 and containing nearly a quart of greenish sero-purulent fluid4 ,slight plastic adhesions were found at various points1 uniting the intestines to the abdominal walls1 while old1 firm and extensive adhesions were found between the same and the liver and gall-bladder4 ,there were evidences that the latter had been largely distended1 yet1 through a distinct opening1 the contents had escaped into the peritoneal cavity1 leaving behind a single calculus of a regular oval form1 and one inch of its long diameter4#bh ,from the appearance of the part1 it would seem that the calculus had excited inflammation and ulceration in the walls of the gall-bladder1 destroying the latter so completely1 that the fluid contents were kept from escaping into the abdominal cavity1 only by the adhesions that had formed1 and that these had been probably torn away by the exercise of digging with the spade4 ,in many cases1 the adhesions which are induced by the inflammation1 will secure a more fortunate result1 favoring the working of the calculus1 by the ulcerative process1 either into the duodenum or colon1 and thus1 in most cases1 securing its passage per anum4 ,in such instances1 should an opportunity be had of examining the parts after death1 traces will be found remaining1 sufficient to indicate the point at which the escape into the bowel was effected4 ,in some rare instances1 gall-stones have been vomited from the stomach4 ,while it might be possible for such bodies to be carried from the duodenum into the stomach by a reversed peristaltic action1 it is more probable that1 in such cases1 the calculus has found its way into the stomach by a direct fistulous communication with the gall-bladder4 ,fistulous communications of a permanent character are sometimes left1 after an ulcerative discharge of a gall-stone into some portion of the intestinal canal4 ,gall-stones1 after entering the intestinal canal1 may become impacted1 thus producing intestinal obstruction4 ,many fatal cases of this character have been reported4 ,an interesting case of intestinal obstruction from this cause1 was reported by ,dr4 ,frieze1 of ,harrisburg1 at the meeting of the ,american ,institute of ,homopathy1 in ,philadelphia1 in ,june1 #ahga4 ,a lady sixty-five years of age1 had been suffering severe pain in the bowels for over a week1 with symptoms of obstruction1 when1 after a persevering use of injections1 she passed a calculus of a cylindrical form1 one and three-quarter inches in length1 and four and one-half inches in circumference1 and weighing four hundred and thirty-seven and one-half grains4#bi ,gall-stones have1 in a number of cases1 been discharged upon the surface of the body1 while in some rarer instances1 by the ulcerative process they have worked into the ureter1 and even into the vena cava and portal vein4 ,,chapter ,,ii4 ,,the ,,urinary ,,apparatus4 ,section ,i4 ,,the ,,kidneys4 ,notice3--,absence of either kidney1 or other abnormalities4 ,of each kidney1 note #a4 ,form1 size1 weight1 wounds1 etc4 #b4 ,capsule--thickness2 transparency2 facility of removal4 #c4 ,surface of kidney after removal of capsule--color2 smooth or lobulated1 size of lobules2 puckerings2 granulations2 cysts1 etc4 #d4 ,substance of kidney--consistence2 flaccidity1 etc42 fracture1 granular or not8 wounds1 rupture4 #e4 ,cut surface--color of pyramidal and cortical portions2 proportion of each2 amount of blood exuding from2 thickness of cortical portion2 color2 ,malpighian corpuscles2 their degree of visibility1 color1 etc42 appearance of stri in pyramidal portion1 color1 etc4 #f4 ,abnormal growths and deposits--cysts2 fibrinous masses2 tubercle2 cancer2 chalky masses2 abscesses1 etc4 #g4 ,pelvis of kidney--peculiarity of form2 contents2 fluid1 quantity1 quality1 purulent1 etc4 ,calculi--their size1 position1 etc4 ,walls of pelvis--their thickness2 transparency2 fistulous openings2 wounds1 etc4 #h4 ,ureters--size1 contents1 etc4 #i4 ,microscopic examination--make section with ,valentine knife1 from convex border through cortical portion1 and from base to apex of cone1 parallel with tubules2 place on slide and examine with varying powers1 from #ajj to #ejj diameters4 ,note condition of tubules--contents2 blood1 oily particles1 fibrinous1 waxy1 epithelial or other casts2 or denuded of epithelium and empty4 ,malpighian tufts--gorged1 ruptured1 filled with granular or oily matter1 or obliterated4 ,are crystals of any kind present1 as uric acid1 oxalate of lime1 etc41 minute cysts1 purulent infiltration1 tubercular1 cancerous or other deposits8 ,in the normal state1 in the adult1 each kidney will be found to be about four inches in length1 two inches in breadth1 and one inch in thickness1 of a firm consistency1 and of a deep1 red color4 ,the weight of the kidney varies from four ounces to six ounces1 being somewhat lighter in the female than in the male4 ,the left kidney is generally somewhat longer1 thinner and heavier than the right4 ,the fibrous capsule in which each kidney is enveloped is thin1 smooth1 and in a state of health is easily removed from the surface of the gland4 ,congenital ,anomalies4 ,although the absence of both kidneys is of rare occurrence1 it is not uncommon to find only one4 ,this may occupy its usual position1 and differ from the natural kidney only in being larger--the unsymmetrical kidney of ,rokitansky4 ,in other cases1 we find a more or less complete fusion of the two organs together--the solitary kidney4#cj ,either the lower parts of each are connected by a band of renal substance passing across the vertebral column1 constituting the horse-shoe kidney2 or there is only a single disk-like gland1 lying in the median line1 and situated much lower down1 even as far as the concavity of the sacrum4 ,congestion4 ,this1 and its consequences1 are the main features of hypermia of the kidneys1 which is of frequent occurrence4 ,this condition is almost always the result of some prior general affection1 such as the scarlatinal poison1 the suppression of perspiration1 or obstructive diseases of the heart4 ,in a simple congestion1 with perfect integrity of the renal tissue1 we find the kidney enlarged1 and its weight often doubled2 of a dark1 red color1 and dripping with blood when cut into4 ,the cortical substance is somewhat softened1 of a dark1 red color1 presenting in many cases small dark1 red spots1 the result of hmorrhagic effusion into and between the tubercles4 ,the ,malpighian tufts are distinctly visible on the cut surface1 as minute1 reddish1 semi-transparent grains4 ,in the medullary cones1 the congested vessels form long dark red streaks4 ,if the congestions have occurred in an otherwise healthy kidney1 the capsule can be readily peeled off4 ,a microscopic examination shows the ,malpighian and other capillaries loaded with blood1 extravasation sometimes taking place into the capsule of the latter1 and often into the channel of the fibres4 ,in extreme cases of hypermia and congestion1 a fibrinous exudation takes place1 which will be found coagulated in the tubes1 forming casts of their interior1 and consisting of a granular or homogeneous material1 entangling blood-globules1 and often some particles of detached epithelium4 ,hmorrhage4 ,as a result of acute congestion1 or from injury from falls1 blows1 or wounds of the kidneys1 blood may be effused1 either beneath its capsule1 or within the sinus1 constituting hmorrhage of the kidney4 ,nephritis4 ,this differs in no material respect from common inflammation of other parts1 and like it1 often passes into suppuration4 ,its most common causes are3--,excess in the use of irritating and alcoholic drinks2 abuse of diuretics2 blows or falls on the loins2 the presence of renal calculi2 and1 according to some authors1 a peculiar morbid state of the blood1 such as gives rise to carbuncles4 ,this disease can be distinguished from the inflammatory form of ,bright's ,disease1 during life1 by its generally affecting only one kidney1 by the much greater pain and tenderness in the lumbar region1 by the retracting of the testicles1 and the higher degrees of febrile excitement4 ,then1 too1 the deeply-colored urine which is voided1 contains little or no albumen4 ,in a case of nephritis1 unattended with the formation of pus1 a post-mortem would probably fail to distinguish it from the condition of congestion just considered4 ,where suppuration was about taking place1 the microscope shows the cortical tubes so distended and crowded together by infarcted epithelium1 as to be scarcely distinguishable2 in some parts the basement membrane gone1 and their contents a uniform mass of nuclei and granular matter4 ,the medullary tubes are also infarcted and opaque4 ,pyelitis4 ,inflammation of the walls of the sinus of the kidney1 is thus designated4 ,it may exist alone1 or in company with inflammation of the kidney1 constituting ,pyelonephritis4 ,it appears to originate1 in many cases at least1 secondarily to an attack of cystitis1 and would seem metastatic in its nature1 the ureter connecting the two inflamed organs1 escaping the disease4 ,it is a very serious1 and often rapidly fatal disease4 ,where the inflammation extends to the kidney tissue1 suppuration is likely to follow1 resulting thus in the formation of an abscess4 ,abscesses4 ,renal abscesses are found bordered by a red injected halo1 which gives rise to a friable product1 thus leading to an extension of the abscess4 ,the mucous membrane of the calices and the pelvis1 especially when a calculus is present1 is softened and inflamed1 and secretes a purulent fluid4 ,the process of suppuration may continue until the whole organ is converted into a pouch of pus4 ,then1 or even before the organ is quite destroyed1 the abscess may make its way by the usual process of absorption1 and discharge its contents into the calices1 to be carried off by the urinary passages2 into the ascending or descending colon1 or the duodenum1 to be passed with the fcal evacuations2 or1 after perforating the diaphragm1 into the bronchi1 whence they are removed by coughing2 or through the lumbar muscles2 or it may burst into the peritoneal cavity and cause rapid death4 ,this disease rarely attacks more than one kidney1 and the other healthy kidney generally enlarges and becomes capable of performing a double amount of work4 ,it is well to remember1 that a mass of softened fibrinous exudation1 bordered by a red halo1 may sometimes so far simulate an abscess1 that only the microscope can distinguish the one from the other4 ,inflammation of the ,capsule may take place and cause fibroid thickening1 more or less induration1 atrophy1 and obliteration of the organ4 ,the cortical substance generally suffers most1 and the surface is sometimes overspread with purulent matter1 while the tissue itself becomes sloughy or gangrenous1 or is only congested and softened4 ,morbus ,brightii4 ,bright's ,disease4 ,degenerative disease of the kidneys4 ,desquamative and un-desquamative nephritis4 ,in view of the impossibility of accurately defining the term ,bright's ,disease1 we will describe it in general as including those diseases of the kidneys which1 in some stage or other of their course1 are accompanied by albuminuria1 or dropsy1 or both4 ,and as it would be foreign to the object of this work1 to enter into an examination of the respective merits of the theories1 in reference to the nature and course of this disease1 we will adopt that classification which seems best adapted to our purpose1 and proceed to consider the morbid anatomy of ,bright's ,disease in its various forms and stages as first suggested by ,virchow in his ,cellular ,pathology1 and adopted and developed by ,stewart4#ca ,he distinguishes three forms--7#a7 the inflammatory1 7#b7 the waxy1 7#c7 the cirrhotic or contracting2 the first originating in the tubules1 the second in the vessels1 and the third in the connective tissue of the organ4 #a4 ,the ,inflammatory ,form4 ,this has three stages3 that of inflammation1 that of fatty transformation1 and that of atrophy4 ,the disease may prove fatal at any stage of its course4 ,in the first stage1 an exudation is poured out1 and a destruction of the epithelium takes place4 ,this exudation1 affecting a large number of tubules1 leads to enlargement of the organ1 and also to fatty degeneration of the epithelium2 its absorption or removal1 leads to ultimate atrophy4 ,there is also a fatty degeneration1 to which we will refer later1 which is unattended either with albuminuria or with dropsy1 and which does not1 therefore1 belong to this category4 ,in this stage of inflammation1 the organ is of the natural size1 or slightly enlarged2 its capsule is unaltered1 and can be peeled off readily2 its surface is smooth1 more or less congested1 often pink1 sometimes of a dark purplish color1 sometimes mottled1 pale and purple4 ,on section1 the cortical substance is found relatively enlarged1 and often congested4 ,the ,malpighian bodies stand out prominently from the surrounding tissues1 the congested vessels1 separated by a varying amount of white 7somewhat opaque7 deposit1 composed of the altered tubules4 ,the vascular spaces between the cones and the cortical substance are uniformly distended with blood4 ,the cones are usually redder than the cortical substances1 and from the engorgement of their vessels and the altered condition of their tubules1 they present a series of alternating red and white lines1 converging to the apex of the cone1 at which point the white distinctly predominates4 ,the pelvis of the kidney is natural4 ,examination with the higher powers of the microscope shows the ,malpighian bodies dense and granular4 ,the tubules are more bulky than natural1 and their epithelium is swollen1 granular and dense1 while within them is frequently seen a transparent homogeneous exuded material1 binding into one mass1 the epithelium of the tubules4 ,blood corpuscles are frequently found incorporated in this exuded material4 ,in the stage of fatty transformation1 the organ is enlarged2 its capsule natural2 its surface smooth or slightly lobulated4 ,it is pale and fatty in color1 and on its surface stellate vessels are frequently seen4 ,on section1 the cortical substance is pale1 of a yellowish-white color1 and increased in volume1 while the cones are pink1 and of natural color and size4 ,the ,malpighian bodies do not project prominently as in the first stage4 ,under the microscope we find the tubules to be irregularly distended with fatty granules1 contained for the most part within the walls of the epithelial cells1 which again are imbedded in a material that blocks up the tubules4 ,in the ,malpighian bodies1 oil globules and fatty cells are of frequent occurrence1 but the capillary tuft is natural4 ,in the last stage of this form1 that of atrophy1 both the bulk and weight of the organ are diminished1 its capsule although natural1 is less easily torn off than in health1 and on its removal the surface of the gland is found to be uneven1 with numerous depressions and elevations4 ,the color is1 as in the second stage1 mottled4 ,on section we find that1 while the cones have remained nearly of their natural size1 the cortical substance is small and atrophied1 and that which intervenes between the cones is greatly diminished4 ,in the cortical substance1 the ,malpighian bodies are not prominent1 while the vessels1 and especially the arteries1 are thicker and more prominent4 ,the pathological distinction between this stage of the inflammatory form1 and the cirrhotic or contracting kidney1 depends mainly upon the condition of the tubules and the relative amount of connective tissue4 ,when the atrophy is a consequence of inflammation1 many of the tubules show evidences of inflammatory action1 being blocked up with exudation and epithelium in process of fatty degeneration1 while in the cirrhotic there is little or none of this4 ,again1 in the cirrhotic the fibrous stroma is very greatly increased1 which is not the case in the inflammatory form4 ,in the latter1 too1 the capsule is more easily stripped off1 and the occurrence of cysts is less frequent than in the former4 ,the form of ,bright's ,disease1 of which we are treating1 is often complicated with hypertrophy of the heart1 affections of the lungs and bronchi1 inflammation of serous membranes1 derangements of the alimentary tract1 diseases of the brain1 affections of the eye1 liver and spleen4 #b4 ,the ,waxy or ,amyloid ,form4 ,this also has three stages3 that of simple degeneration of the vessels2 that in which a secondary alteration of the tubules is suspended2 and that of atrophy4 ,an increased secretion of urine characterizes this form from its earliest stages4 ,in all stages the vessels present to the naked eye more or less distinctly the appearance of boiled starch or sago1 while a little of the liquor iodi poured over the surface1 produces everywhere a yellowish color1 but the degenerated parts assume a reddish-brown1 mahogany-red1 or orange-red hue1 and stand out very conspicuously4 ,in the first stage1 the organs are of normal size1 weight and color1 the latter being however1 in some cases1 a little paler than usual4 ,their capsule is easily stripped off1 and their surface is smooth4 ,the waxy degeneration begins in the capillary tufts of the ,malpighian bodies1 and in the transverse fibres of the middle coat of the small arteries4 ,on these there are thickenings here and there1 presenting the same sago-like translucency as is seen in the tufts4 ,in the second stage1 the kidneys are increased in bulk and weight2 the capsule is easily stripped off1 and the surface smooth and pale4 ,the cortex is thick and white1 and presents much the appearance of white beeswax4 ,under the microscope1 we see the ,malpighian bodies and arteries degenerated as just described1 and in addition many of the tubules full of matter1 not dense and opaque as in the inflammatory form1 but tolerably transparent1 consisting of hyaline tube casts4 ,their epithelium is swollen1 and their basement membrane may also be waxy4 ,it is to this form of disease that the term 8waxy kidney0 is most applicable4 ,in the third stage1 that of atrophy1 the organ is reduced in bulk1 from about the natural size to a fourth or even less4 ,its weight is also diminished4 ,the capsule may be torn off without much difficulty4 ,the surface is rough1 granular1 and of a pale1 waxy color4 ,on section the cortical substance is found much diminished1 while the cones are nearly natural4 ,the ,malpighian bodies are large and closely grouped together2 the smaller arteries dilated and their walls thickened4 ,a few tubules remain distended1 but most are collapsed1 and are represented only by fibrous tissues4 #c4 ,the ,cirrhotic or ,contracting ,form4 ,this consists of an hypertrophy of the connective tissue of the organ1 and a consequent atrophy of all the other structures4 ,it has been termed also 8gouty kidney10 8intertubular or interstitial nephritis10 and 8granular kidney40 ,in the commencement of the process there is but little diminution in the size of the organ1 but the capsule is thickened and more adherent than natural1 and the surface is rough and granular4 ,the color is pale or reddish4 ,on section1 the cortical substance is found relatively diminished1 the diminution being most marked towards the surface4 ,the arteries are prominent1 their walls thickened and their cavities often dilated4 ,even to the naked eye1 and to the touch1 the increased density and fibrousness of structure are evident4 ,on the surface1 and in the substance1 cysts are frequently seen4 ,some are produced by dilatation of the ,malpighian capsules1 some by dilatation of the tubes1 and others from morbid growth of epithelial elements4 ,the tubes are compressed and atrophied by the new fibrous tissue4 ,they contain little of the opaque matter found in inflammatory cases1 but translucent hyaline matter is common4 ,all these characteristics become more marked as the disease progresses4 ,in the more advanced stages1 both the kidneys are much reduced in size1 but one may be more atrophied than the other4 ,throughout the whole course of the disease the cones are but little affected4 ,in gouty cases a deposit of chalk-like substance is occasionally found1 composed of needle-like crystals of urate of soda1 situated in the stroma of the organ1 as well as in the tubules4 ,in distinguishing a cirrhotic kidney from one in the third stage of the inflammatory or of the waxy disease1 besides the characteristic iodine test in the one case1 the following points of comparison will be useful3--,in the cirrhotic1 the capsule is more thickened and more adherent than in the other two forms4 ,in the cirrhotic1 the surface is very uneven1 frequently studded with cysts1 and presents little or no sebaceous-looking material2 in the inflammatory and the waxy1 the surface is less uneven1 cysts are much less common1 and in both1 particularly the inflammatory1 sebaceous-looking material is very abundant4 ,in the cirrhotic1 the stroma is greatly increased1 especially towards the surface2 in the inflammatory and waxy1 the stroma1 although increased relatively to the other tissues1 is not absolutely above the normal amount4 ,it must also be borne in mind1 that both the waxy and contracting forms may be secondarily affected with the inflammatory disease4 ,simple ,fatty ,degeneration of the ,kidneys4 ,we occasionally find1 along with fatty degeneration of the liver and of the muscular substance of the heart1 a fatty degeneration of the kidney1 without any trace of inflammation4 ,the kidneys are of about the normal size2 the surface smooth1 and the capsule not adherent4 ,the organ is more soft and flexible than natural1 and the surface is pale1 and mottled with sebaceous-looking deposits4 ,on section1 we find the abundant deposition of sebaceous-looking material to be mainly in the tubules of the cortical substance1 but also to be found in those of the cones4 ,the microscope shows that the deposit is not in the free cavity of the tubes1 but within the epithelial cells4 ,we may have the simple fatty degeneration in connection with exhausting disease1 old age1 or with excess of fatty food4 ,the adipose tissue in which the kidney lies embedded1 may increase to such a degree as to penetrate by the hilus into the substance of the organ1 impede its nutrition1 and induce a kind of atrophy4 ,rokitansky states that1 in the highest degree of this change1 the kidney presents the appearance of a mere mass of fat1 without the slightest trace of renal organization2 the urinary passages at the same time being atrophied and obliterated4 ,dislocated ,kidney4 ,as a result of over-exertion1 tight lacing1 or perhaps pregnancy1 the kidney sometimes becomes detached from its connections to the surrounding structures1 permitting of a change of position1 and constituting what is known as movable or dislocated kidney4 ,the right kidney is said to be more frequently affected in this manner1 and the condition is more common with females than males4 ,morbid ,growths4 ,tubercular ,disease1 though not of frequent occurrence1 does sometimes occur in the kidneys4 ,in most cases we find a deposit of tubercle in other organs1 especially in the lungs1 and often in various parts of the genito-urinary apparatus4 ,this disease is most liable to occur in the middle period of life4 ,it is found sometimes in the miliary form1 sometimes in larger masses4 ,in a very decided tubercular dyscrasia1 we find associated with the miliary granulations a considerable amount of hypermia of the organ2 but where the deposit is more chronic1 the surrounding tissue is quite pale4 ,the large masses are remarkably bloodless4 ,when the tubercular deposits extend to the renal tissue from the mucous membrane of the calices and the pelvis1 these cavities become remarkably enlarged1 and the whole organ is increased in size1 and appears rather pale4 ,the epithelial lining of the tubes is more or less opaque and granular1 or of an oily aspect4 ,by the softening and breaking down of the tuberculous deposits1 large cavities are formed1 containing a mixture of tuberculous detritus and pus4 ,fibrinous casts are sometimes found in great numbers in the tubes4 ,cancer4 ,secondary1 is of more frequent occurrence than primary cancer4 ,the scirrhus and colloid varieties are rarely1 if ever1 found4 ,encephaloid growths1 especially in children1 attain in the kidneys an enormous size4 ,cancer of the liver and right kidney1 or of the adjacent parts of the stomach1 or descending colon and left kidney1 frequently coexist according to the observations of ,m4 ,rayer and ,dr4 ,walshe4 ,the period of life between fifty and seventy is most liable to cancer of the kidneys4 ,the natural character of the urine excreted by cancerous kidneys is seldom changed until the encephaloid growth softens and breaks down1 when blood1 puriform matter and detritus may appear4 ,cystic ,tumors1 supposed to originate from a dilatation of the ,malpighian capsules1 are sometimes found4 ,the cysts vary in size from a pin's head to a small bird's egg4 ,they may be few or many in number1 and are filled either with a clear watery fluid1 or with a gelatinous or pigmentary substance4 ,the walls of the cysts are thin and smooth1 partly divided into compartments by imperfect septa4 ,they are confined to the cortical portion of the gland1 and may be imbedded in that substance1 or project from the surface4 ,the kidney may be unchanged in size1 or considerably enlarged4 ,the clinical symptoms of these cysts are very obscure1 and of the cause of their formation1 little is known4#cb ,cysts of a congenital origin1 are sometimes found in the kidney at birth4 ,they may be of great size1 and vast number1 and appear to result from a dilatation of the uriniferous tubes1 and ,malpighian capsules4 ,fibroid and ,adenoid tumors of small size are rarely found in the kidneys2 the former within the tubular1 the latter within the cortical portions4 ,parasites4 ,entozoa are occasionally found within the kidneys1 among which may be mentioned the hydatid1 or larval form of the ,tnia echinococus4 ,cysticercus cellulos4 ,the larval form of the ,tnia solium4 ,eustrongylus gigas4 ,a small cylindrical worm1 with the body tinged with red4 ,male--ten to fourteen inches long1 three lines wide4 ,female--three feet long1 six lines wide4 ,pentastoma denticulatum4 ,supposed to be the larval form of a worm found in the nasal cavities of some animals1 and consisting of a small sac1 with calcified walls4 ,the ,ureters4 ,as a congenital defect1 we find the ureter terminating in a cul-de-sac1 either in the vicinity of the kidney1 or of the bladder4 ,sometimes they are double or even triple1 but they generally unite before their vesical termination4 ,dilatation4 ,when the opening into or from the bladder has1 from some cause or other1 become greatly narrowed or obliterated1 the obstacle to the passage of the urine causes a dilatation of the ureters4#cc ,the sinus and calices at the same time1 dilate at the expense of the renal tissue1 so that we frequently find but a thin layer of cortical substance compressed against the investing capsule1 and the kidney converted into a number of pouches1 separated by the remains of the medullary cones4 ,the surface of the kidney is markedly lobulated4 ,the distention of the ureters may reach such a degree1 that they resemble a portion of small intestines1 their walls being at the same time somewhat thickened4 ,from an increase in length sometimes met with1 the ureters no longer lie straight1 but are thrown into coils or flexures4 ,with dilatation of the ureters1 we not unfrequently find coexisting a state of ,inflammation4 ,the mucous membrane is then found swollen and injected1 of a villous aspect1 and covered with a muco-purulent fluid4 ,sloughing may ensue with consequent perforation of the ureters and infiltration of the urine into the adjacent tissues1 producing an extension of the sloughing process or circumscribed abscesses4 ,the inflammation rarely exists as a primary disease2 its most frequent causes1 are the irritation from calculi1 or the extension of vesical disease4 ,it may extend to the sinus of the kidney1 constituting pyelitis4 ,morbid ,growths4 ,cancer of the urinary passages but seldom occurs1 and only when found elsewhere at the same time4 ,tubercles may occur in the ureters1 even when the kidneys are healthy1 but most frequently where they are involved at the same time4 ,these usually coexist with tuberculosis of some important organ4 8,the deposit takes place in the submucous tissue1 and forms1 when its progress is chronic1 gray granulations1 which become yellow1 soften1 and give rise to small circular ulcers4 ,when the disease is more acute1 larger patches of deposit are formed1 or the mucous membrane becomes infiltrated throughout with the tubercular product of inflammation1 which is at once detached as a cheesy1 purulent mass40 ,cysts1 containing a glutinous or hard matter1 about the size of millet-seeds or peas1 are occasionally found developed under the mucous membrane of the urinary passages4 ,the ,suprarenal ,capsules4 ,these bodies are sometimes entirely absent4 ,where one of the kidneys is absent or displaced1 the capsule may still be found in its normal position4 ,inflammation and ,degeneration4 ,inflammation of the bodies1 either acute or chronic1 appears to result in the following changes3 ,first1 the organs become slightly enlarged and infiltrated with a semi-translucent material1 of a grayish color1 soft1 homogeneous1 or slightly fibrillated1 or containing a few imperfect cells4 ,the substance resembles what is often seen in scrofulous disease of the lymphatic glands4 ,at a later period1 this substance gradually changes into a soft1 putty-like substance1 or into chalky concretions scattered through the body4 ,the whole substance of the organ may thus be destroyed4 ,it may1 at the same time1 be found more closely adherent to the surrounding organs4 ,dr4 ,addison has associated with these changes in the suprarenal capsules1 a peculiar bronzed condition of the shin sometimes seen1 and named from him 8,addison's ,disease40 ,hmorrhage occasionally occurs within the substance of the capsule1 forming a kind of cyst filled with blood4 ,it is more frequent with young children1 but is sometimes seen in adults4 ,morbid ,growths4 ,cancer4 ,primary cancer of these bodies is rare2 the secondary form may appear in connection with the same disease in the kidneys1 stomach or liver4 ,tubercles of the miliary form are rarely seen4 ,cysts1 both single and multiple1 and with varying contents1 may be found1 generally connected with the enclosing membrane4 ,section ,,ii4 ,,the ,,urinary ,,bladder4 ,notice3 #a4 ,external ,characters--malformations2 adhesions2 size2 ,wounds1 etc4 #b4 ,walls--their thickness2 condition of several coats2 morbid growths1 cancer1 tumors1 tubercles1 perforations2 sinuses2 rupture2 wounds4 #c4 ,contents--urine1 its quantity and characters2 blood1 its amount and source2 pus2 calculi1 number1 size1 position1 etc4 ,malformations4 ,among the most common of these1 may be mentioned extroversion1 where there is an absence of the anterior walls of the bladder1 with a deficiency in the corresponding portion of the abdominal parietes4 ,from the pressure of the abdominal viscera1 the posterior walls of the bladder will be crowded forward1 and protrude as a rounded tumor1 covered by a vascular mucous membrane1 while near the lower portion may be seen the orifices of the ureters1 through which the urine will be more or less constantly flowing4 ,malformations of the external organs of generation1 are liable to accompany those of the bladder4 ,the ,urachus sometimes fails to close before birth1 leaving thus an open passage from the fundus of the bladder to the umbilicus1 through which the urine may be noticed flowing after division of the cord4 ,dilatation4 ,this is of not unfrequent occurrence1 and is the result either of a paralysis of the muscular coat1 or of some obstacle to the outflow of the urine4 ,the dilatation may be uniform1 or we may find diverticula1 formed by a protrusion of the mucous membrane between the fasciculi of muscular fibres4 ,such partial distensions occur most frequently in the lateral portions1 the posterior surface1 or the neighborhood of the fundus1 and as we should be led to expect from the manner of their formation1 are generally destitute of a muscular tunic1 or have but a few scattered fibres4 ,calculi are sometimes found in these pouches after death1 the presence of which had escaped notice during life from their concealed position4 ,hypertrophy of the muscular coat of the bladder1 will generally be found attending cases of obstruction to the escape of the urine1 either from an enlarged prostate1 stricture of the urethra1 or from the presence of a calculus4 ,the muscular coat in these cases is greatly thickened1 the interlacing bundles of fibres appearing with great distinctness upon the inner surface4 ,as a result of this condition1 we usually find the bladder greatly contracted1 its capacity in some cases being reduced to one or two ounces4 ,inflammation of the mucous coat1 with dilatation of the ureters1 will also generally attend1 hypertrophy of the muscular walls4 ,contraction of the bladder is met with1 as the result either of irritation of the mucous membrane1 or hypertrophy of the muscular coat4 ,inflammation of the bladder is generally seen in its chronic form4 ,the appearances in acute cystitis are 8strong vascular injection of the mucous lining1 with brownish patches in the vicinity of the neck and fundus2 more or less thickening of the membrane1 with exudation of fibrin or pus on the surface1 or foci of the latter in its substance4 ,the mucous tissue may be ulcerated at several points1 softened or affected by commencing gangrene4 ,abscesses may form in the substance of the parietes1 and open either into the cavity of the bladder1 or upon its external surface4 ,sometimes the mucous membrane is almost completely destroyed1 a few shreds or filaments being the only traces remaining1 while the muscular tunic is left as if cleanly dissected4 ,this is probably the result of phagedenic ulceration40 ,the inflammation may spread from the mucous membrane to the muscular coat1 but it very rarely reaches the peritoneal covering4 ,in some cases it extends back along the ureters1 and even to the kidneys4 ,the morbid action is not often of idiopathic origin1 it is more frequently due to the extension of an attack of gonorrha1 to disease of the prostate1 to traumatic causes1 to protracted retention of urine1 or to the irritation produced by medicines or stimulating drinks4 ,it is sometimes owing to the constitutional poison of rheumatism or gout4 ,it is met with oftener in men than women1 and in adults than in children4 ,chronic cystitis1 called also catarrh of the bladder1 is very common in advanced age4 ,the morbid process is excited by some obstacle to the emission of the urine1 either paralysis of the viscus1 or a stricture1 or by presence of a stone in the bladder1 or by enlargement of the prostate gland4 ,it may also result from successive attacks of the acute form1 or from extension of urethral inflammation4 ,various degrees of vascular injection are presented1 with dark-reddish1 slate-colored or bluish-black discoloration1 more or less thickened induration of the parietes1 which assume an homogeneous1 lardaceous appearance4 ,an acute attack may supervene upon a state of chronic inflammation1 leading to ulceration1 suppuration1 perforation and extravasation of urine1 as in the case of primary acute cystitis4 ,chronic or sub-acute inflammation is often attendant upon paraplegia1 and proves the immediate cause of death4 ,morbid ,growths4 ,cancer as a primary disease1 is but rarely met with4 ,encephaloid1 forming nodulated prominences or cauliflower-like excrescences1 is the form which vesical cancer usually assumes4 ,they are developed in the submucous tissue1 but as they grow1 the mucous membrane is also destroyed1 and either an ulcer is produced or a soft luxuriant fungous mass4 ,tubercle in the form of separate granulations are sometimes met with about the fundus and neck of the bladder in the male1 and usually are accompanied with similar deposits in the testes1 prostate1 kidneys1 etc4 ,they are surrounded by more or less hypermia1 and by softening give rise to circular ulcers of the mucous membrane covering them4#cd ,tumors4 ,polypoid growths1 both of a fibrous and adenoid character1 may be found in the neck of the bladder1 both in children and adults4 ,they vary in size from that of a pea to a cherry4 ,cystic tumors of small size are sometimes found within the mucous membrane4 ,parasites4 ,the ,sarcina ventriculus1 a vegetable parasite1 is sometimes found in the bladder1 in cases of chronic cystitis4 ,of animal parasites1 the ,eustrongylus1 ,echinococus1 and ,ascarides1 have found their way into this organ from other parts4 ,of the ,urethra4 ,malformations4 ,as congenital malformation1 we need mention only ,epispadias1 fissure on the upper1 and ,hypospadias1 on the lower surface1 from arrest of development1 and complete closure of the opening1 ,atresia urethr4 ,inflammation of the urethra1 of the catarrhal kind1 the so-called gonorrha1 commencing at the anterior extremity1 may1 in severe cases1 extend backwards1 even into the bladder4 ,the lining membrane becomes swollen1 injected1 and covered with mucus or muco-purulent secretion1 at first thin1 then thicker1 and then1 as the inflammation subsides1 thin and pale again4 ,when a chancre coexists with gonorrha1 8the discharge has usually a grayish or reddish tint1 or sanious aspect40 ,from an extension of the inflammation deeper into the fibrous structure of the corpus spungiosum1 results1 sometimes1 an exudation of fibrin in the venous cells1 suppuration and abscess4 ,cowper's gland1 the prostate1 the vesicul seminales1 and the testicles1 may also be affected by an extension of the inflammation along the continuous mucous lining4 ,the contact of unhealthy vaginal secretions1 whether specific or not1 is the most frequent cause of urethritis4 ,dilatation and ,contraction4 ,dilatation is most frequently the consequence of obstruction to the flow of urine4 ,it occurs generally in the membranous portion1 which is expanded into a pouch1 occasionally as large as a small orange4 ,the mucous lining of these pouches appears 8injected and thickened1 presenting fungous vegetations1 and occasionally coated with lymph40 ,contraction may result from inflammation of the mucous membrane1 and finally end in stricture4 ,stricture is a very frequent result of inflammation of the urethra4 ,it usually is found in the anterior part of the membranous portion4 ,contusions and wounds also1 often produce stricture4 ,the simplest form of stricture is1 where the canal is partially closed by a fold of membrane passing across it1 leaving either a crescentric1 or annular opening4 ,in the most common kind of stricture the urethra is narrowed in a much greater extent of its course1 sometimes for an inch1 or more4 ,when the obstruction occasioned by a stricture is very great1 the urethra behind is dilated1 often inflamed and sometimes ulcerated1 so as to give rise to urinary fistula or effusion of urine4 ,rupture of the urethra may result from severe contusions1 or fracture of the bones of the pelvis1 and being followed by extravasation of blood and urine1 inflammation1 suppuration or gangrene may supervene1 or fistulous openings may be thus established4 ,morbid ,growths4 ,warty growths sometimes appear within the urethra near the meatus4 ,they are generally quite vascular1 and may cause considerable obstruction4 ,tubercles are of rare occurrence in the urethra4 ,cancer occurs only as an extension of the disease from the penis1 prostate gland or bladder4 ,urinary ,calculi4 ,calculi of different size1 form1 and chemical composition1 may be found in the urinary bladder1 ureters1 or sinus of the kidneys4 ,uric1 or lithic acid calculi1 are the most frequent in their presence4 ,they may vary in size1 from a pea to that of a hen's egg4 ,in color1 also1 they may vary from a fawn or light yellow1 to a dark1 almost mahogany tint4 ,the surface may be slightly tuberculated1 or smooth1 and the interior1 where a section is made1 has a concentric arrangement of layers around a central nucleus4 ,oxalate of lime calculi are next in frequency4 ,from the strongly tuberculated character of the surface1 they are frequently known as mulberry calculi4 ,they are of an irregular1 spherical form1 and usually single4 ,in color1 they are usually of a dark olive or brown1 but may be light and almost white4 ,they seldom acquire so large a size as the lithic acid variety1 are very hard1 and permit of a high polish4 ,phosphatic calculi are characterized by their softness1 which permits of their being readily crushed4 ,they are of a grayish-white color1 and frequently composed of alternate layers of other deposits4 ,they may be composed wholly of phosphate of lime1 or of a triple phosphate--ammonio-magnesian phosphate--or of a combination of the two4 ,cystine calculi are very rare2 they are yellowish in color1 of a waxy appearance1 and soluble in aqua-ammonia4 ,uric oxide calculi are extremely rare2 they resemble uric acid calculi1 but present a waxy appearance when polished4 ,,chapter ,,iii4 ,,the ,,male ,,generative ,,organs4 ,section ,i4 ,,of ,,the ,,penis4 ,notice3 ,malformations2 size2 condition of prepuce and glans2 chancres1 warts1 etc4 ,split open urethra and notice ulcers1 strictures1 etc4 ,congenital ,anomalies4 ,the penis may be very imperfectly developed1 even with a normal development of the other organs of generation1 although it more frequently occurs when the latter are themselves imperfect4 ,it occasionally happens that1 from an arrest of union in the median line of the penis1 a slit or fissure is left communicating with the urethra4 ,this commonly occurs in the under surface1 constituting ,hypospadias2 less frequently on the upper surface1 7,epispadias17 and only in cases of extroversion of the bladder4 ,the prepuce may be wanting4 ,congenital phymosis occasionally occurs1 usually associated with atrophy of the penis4 ,it is supposed by some1 to be a predisposing cause of cancer of the penis4 ,hypertrophy and ,atrophy4 ,in consequence of long-continued onanism1 the penis may become hypertrophied1 or as the result of chronic irritation and disease1 we may have an hypertrophy of the prepuce and of the body of the penis1 sometimes attaining an enormous size4 ,vidal has related and figured a case where the organ reached to below the knees1 and was as large as a thigh4 ,atrophy of the penis1 accompanied with obliteration of the cavernous textures1 occurs with atrophy of the testicles4 ,fracture of the ,penis has occurred from the giving way of the erectile tissue during coition1 in consequence of the state of hypermia of the penis4 ,the organ appears broken1 and cannot assume the erect condition beyond the part injured4 ,paraphymosis1 by the strangulation of the glans in front of a tight prepuce1 may1 if not relieved1 lead to inflammation1 and even gangrene4 ,balanitis commonly occurs as the result of local irritation1 not unfrequently set up by a gonorrha4 ,the prepuce is much swollen1 infiltrated and reddened4 ,the inflammation is generally complicated with inflammation of the internal lamina of the foreskin1 and the mucous membrane of the glans 7posthitis71 giving rise to excoriation1 exudation of coagulable lymph1 adhesion of the prepuce to the glans1 suppuration and ulceration4 8,when chronic1 it induces exuberant formation of epidermis2 and if the deeper parts of the parenchyma of the glans are involved1 obliteration1 cartilaginous induration and atrophy follow40 ,herpes of the ,glans and ,prepuce1 is characterized by the formation of small vesicles or excoriated points upon the mucous membrane of this region1 chiefly occurring in persons of a gouty habit of body1 with an irritable mucous membrane4 ,psoriasis of the prepuce1 produces a red1 thickened1 and fissured condition of the part4 ,phymosis is apt to occur as a consequence4 ,chancres4 ,these specific ulcerations form usually upon the glans1 although they may be found in the internal surface of the prepuce1 the frnum1 and near the meatus within the urethra4 ,the ,hunterian or hard chancre1 is nearly circular1 deep and excavated2 base and edges are as hard as cartilage1 but the hardness is circumscribed2 its color is livid or tawny4 ,it may occur upon the integument1 the glans1 or the body of the penis4 ,the non-indurated or soft chancre is more frequently found on the inner surface of the prepuce4 ,it appears as a foul1 yellowish1 or tawny sore4 ,indolent fungous granulations are subsequently thrown out1 unless it be situated upon the glans4 ,phagedenic chancres are of irregular shape1 their edges ragged or undermined1 their surface yellow and dotted with red streaks4 ,the surrounding margin of skin usually looks pulpy and dematous2 but is sometimes firm and of a vivid red4 ,the cicatrices left by chancres which have healed1 are whitish1 more or less hard1 striated and depressed4 ,morbid ,growths4 ,warts1 belonging to the class of epithelial tumors1 sometimes form on the glans1 or on the inside of the prepuce4 ,they are commonly the result of repeated inflammations4 ,cancer of the penis is of two distinct kinds1 occurring as scirrhus or as epithelioma4 ,according to ,dr4 ,walshe1 the disease may originate as a warty excrescence1 or as a pimple1 which discharges an excoriating fluid1 scabs1 and breaks out afresh1 while induration1 followed by ulceration1 advances at its base4 ,or it may infiltrate the glans1 so as to convert that part into an indurated mass2 or venereal ulcers may take on cancerous action4 ,when of the scirrhus form1 it usually springs from the ulcers behind the glans1 and may thence invade the neighboring parts of the organ4 ,epithelioma1 commencing as a tubercle in the prepuce1 may after a time give rise to a large1 irregular1 and sprouting mass1 having a granular fungous appearance4 ,in other cases1 it commences as a hard scirrhus mass1 of a pale1 reddish-white color1 situated on the glans1 or between the prepuce and the glans4 ,this increases in size1 cracks1 and allows the exudation of a serous fetid discharge4 ,ulceration then rapidly takes place4 ,secondary cancers1 except in the adjacent glands1 are not a common occurrence4 ,phymosis and the irritation caused by the retained secretion1 seem to act as an exciting1 and advancing age as a predisposing cause of cancer4 ,encysted tumors1 nvus and fibro-plastic tumors1 situated about the prepuce1 may also occur4 ,section ,,ii4 ,,of ,,the ,,scrotum4 ,notice3 ,general condition2 relaxed or contracted2 dema2 cancer2 tumors1 etc4 ,hypertrophy4 ,common hypertrophy of the integument of the corium sometimes occurs2 in this there is no alteration of the subcutaneous tissue4 ,in ,elephantiasis of the scrotum1 however1 the epidermis1 the corium1 and the subcutaneous areolar tissue1 are all1 especially the latter1 greatly hypertrophied4 ,the areolar tissue is converted into a large mass of fibrous material1 infiltrated with an albuminous and fibrinous fluid4 8,when the disease is confined to the scrotum1 and the enlargement becomes great1 the penis becomes drawn in and ultimately disappears1 while the elongated prepuce is continuous at a navel-like opening in the skin of the surface of the tumor40 ,the enlargement sometimes is enormous1 such a mass having been known to weigh two hundred pounds1 more than the weight of the rest of the body4 ,inflammatory dema of the scrotum is an erysipelatous inflammation of this region1 giving rise to great effusion into and swelling of the areolar tissue1 with a tendency to the rapid formation of a slough1 by which the integument may become so affected as to leave the testes and cords entirely denuded4 ,a peculiar form of this disease occurs as a sequence of small-pox and scarlet fever4 ,here there is a tendency to speedy gangrenous disorganization of the areolar tissue1 and of the covering of the generative organs4 ,morbid ,growths4 ,cancer4 ,epithelial cancer is the common form under which it attacks the scrotum4 ,this disease has appropriately been called chimney-sweeper's cancer1 as it appears to arise from the irritation of the soot lodging in the folds of the scrotum4 ,it commonly commences as a tubercle or wart1 which1 after a time1 cracks or ulcerates4 ,it spreads rapidly1 involving at last the greater part of the scrotum1 and sometimes invading the testes1 even extending to the groin and thigh1 destroying life by perforating the coats of some of the large vessels4 ,the glands of the groin are not always affected4 ,melanotic cancer of the scrotum has been observed4 ,fibrous tumors are sometimes developed in this part1 and may form a large mass when several are grouped together4 ,section ,,iii4 ,,of ,,the ,,testicles4 ,notice3 ,malformations2 position1 in scrotum1 inguinal canals1 or abdomen4 ,size2 consistence2 condition of coats4 ,tunica vaginalis--contents2 serum1 blood2 adhesions4 ,abscesses2 cysts2 tumors2 cancer2 tubercle1 etc4 ,congenital ,anomalies4 ,there is no sufficient evidence of the presence of more than two testicles4 ,they are both absent when the entire sexual apparatus is wanting1 and in some rare cases they are imperfectly developed1 or only one may exist4 ,it not unfrequently happens that at birth there is an apparent absence of one or both glands from an arrest or delay in their descent1 so that they lie in the groin1 the inguinal canal1 or the lower part of the abdomen4 ,sometimes they wander into other situations1 e4 g41 into the perineum close by the anus1 and through the crural canal4 ,if the descent does not take place within twelve months after birth it is rarely perfectly completed afterwards without being accompanied by hernia4 ,the organ is sometimes retroverted1 so that the epididymis is placed in front4 ,the vas deferens may be absent to a greater or less extent1 and even the epididymis has been found in great part deficient4 ,the vas deferens frequently terminates in a blind extremity before reaching the vesicula seminalis4 ,hypertrophy and ,atrophy4 ,true hypertrophy of the testicles does not occur but when attacked with inflammation1 or when the seat of morbid growths the glands may become greatly enlarged4 ,atrophy1 congenital or acquired1 is not unfrequent4 ,the effect of old age is very gradual1 the gland being often but very little diminished in size4 8,the testicle atrophied from disease is not only of diminished size and weight1 but is altered in shape1 being uneven and irregular1 and sometimes of an elongated form4 ,there is little or no trace of the proper glandular structure1 the organ being converted into fibrous tissue of a firm texture4 8,the testicle in an advanced stage of wasting1 not arising from disease of the gland1 usually preserves its shape1 but feels soft1 having lost its elasticity and firmness4 ,its texture is pale1 and exhibits few blood-vessels2 the lobuli and septa dividing the lobes are indistinct1 and the former cannot be so readily drawn out into shreds as before4 ,the epididymis does not usually waste so soon1 nor in the same degree as the body of the testicle4 ,fatty matter is also found in the glandular substance of atrophied testicles40 ,inflammation4 ,the serous covering of the testes1 the tunica vaginalis1 is liable to acute inflammation1 and is then affected as other serous membranes4 ,it becomes thickened and injected with blood1 and is coated with a variable quantity of fibrinous exudation4 ,serum is1 at same time1 effused into the cavity1 and rendered turbid by flakes of fibrin4 ,adhesions between the opposing surfaces commonly form4 ,the epididymis is apt to partake of the inflammation of the tunica vaginalis1 and vice versa4 ,orchitis and ,epididymitis1 may be acute or chronic1 primary or secondary4 ,in acute cases1 the testis is congested1 and of a darker hue than natural1 although not much enlarged4 ,the epididymis1 especially its lower part1 is much enlarged1 and feels thick1 firm and indurated4 8,the coats of the vas deferens are thickened1 and the adjacent vessels injected4 ,the tunica vaginalis is inflamed1 and its cavity contains the usual effusions40 ,suppuration may occur more frequently in primary orchitis1 rarely in the secondary form4 ,the pus is liable to burrow and disorganize the tissue of the gland4 ,by a subsequent absorption of the fluid part of the pus1 there is often left a whitish mass resembling tubercular deposit1 but distinguished from this by being contained in a cyst1 and by the altered condition of the adjacent gland tissue4 ,the epididymis not unfrequently remains enlarged1 presenting a hard1 knotty swelling at its lower part4 8,in old cases the epididymis acquires the density and consistence of cartilage1 and sometimes even of bone40 ,atrophy of the gland is a frequent result of inflammation4 ,chronic orchitis is characterized by the effusion of a yellowish1 homogeneous-looking matter1 in the substance of the testicle1 within the tubuli4 ,this deposit may shrink and contract1 inducing gradual atrophy of the testis1 or1 by adhesions and ulcerative absorption1 a fungous protrusion of the affected tissue may take place4 ,hydrocele4 ,simple ,hydrocele is a dropsy of the tunica vaginalis4 ,the fluid is usually clear1 and of a straw color1 sometimes turbid1 with albuminous flocculi1 and not unfrequently contains shining particles of cholesterine4 ,in old or very large hydrocele1 it is often dark-brown or chocolate colored from disintegrated blood4 ,its quantity is sometimes very considerable4 ,the position of the testicle may be altered by adhesions formed between the two layers of the tunica vaginalis2 these latter may also produce a multilocular hydrocele4 ,simple hydrocele may occur with some of the other varieties to be mentioned1 and also with inguinal hernia4 ,when serous effusion in the tunica vaginalis1 is associated with chronic orchitis or other diseases of the gland1 we have hydro-sarcocele4 ,in congenital hydrocele1 the dropsical tunica vaginalis retains its ftal communication with the peritoneal cavity4 ,encysted ,hydrocele4 ,in this variety the fluid is contained in cysts1 which may be situated 7#a7 beneath the visceral portion of the tunica vaginalis1 investing the epididymis2 7#b7 between the testicular portion of the tunica vaginalis and the tunica albuginea1 which are thus separated from each other2 7#c7 between the layers of the loose or reflected portion of the tunica vaginalis4 ,the two last mentioned varieties are of rare occurrence4 ,the cysts have thin fibrous walls1 a lining of tessellated epithelium1 and contents usually clear1 although sometimes mixed with various exudations of fibrin or even blood4 ,spermatozoa are very frequently found in the fluid of these cysts4 ,their presence is undoubtedly due1 as pointed out by ,cushing1 to the rupture of a neighboring seminal duct4 ,they are but rarely found in the fluid of common hydrocele4 ,diffused ,hydrocele of the ,cord1 gives rise to an oval or oblong1 irregular1 circumscribed tumor1 extending below and into the inguinal canal4 8,it consists in the enlargement of the cells of the areolar tissue1 and their distension with a white or yellowish serous fluid4 ,the inclosing fascial sheath is condensed and thickened1 and at the lower part of the swelling1 which is always the largest1 separates it completely from the tunica vaginalis40 ,encysted ,hydrocele of the ,cord forms a tumor of oval shape1 loosely attached to the vessels of the cord which pass behind it4 ,instead of a single cyst1 there may be a number1 forming a series along the cord4 ,hmatocele1 is a tumor formed by an effusion of blood from the vessels of the testis or of the spermatic cord1 into the cavity of the tunica vaginalis4 ,it may be traumatic or spontaneous1 and may attain a large size4 ,coagula are formed either in separate masses1 or in firm layers1 as in aneurism4 ,inflammation may be set up1 leading to fibrinous and serous effusion1 and to suppuration1 or the blood may putrify and gangrene result4 ,the tunica vaginalis is commonly thickened1 the testicle unaffected1 or in old cases atrophied from pressure4 ,diffused ,hmatocele of the ,cord results from the rupture of some vessels of the cord1 in consequence of which blood is effused within the spermatic fascia4 ,a tumor of enormous size may be formed should the bleeding continue1 or recur after having been arrested4 ,the usual cause is some strain or violent exercise4 ,varicocele is a morbid dilatation of the spermatic veins4 8,the enlarged veins hang down below the testicle1 and reach upwards into the inguinal canal2 and when very voluminous1 conceal the gland1 encroach on the septum1 and extend to the other side of the scrotum40 ,the left veins are more frequently affected than the right4 ,in an advanced stage of the disease1 the coats of the veins are thickened1 and do not collapse when cut across4 ,in cases of slight varicocele1 the nutrition of the testis is not interfered with1 but when large1 it produces marked atrophy4 ,morbid ,growths4 ,cancer is most frequently primary1 and generally attacks the body of the testis in the first instance1 the epididymis remaining for some time unaffected4 ,the scirrhus variety1 characterized by its great induration1 is rarely met with4 ,encephaloid is the ordinary form2 it commences as one or two masses among the tubuli1 which it gradually destroys4 ,the tunica albuginea is absorbed by degrees1 gives way1 and allows the growth to project into the scrotum and there freely vegetate4 ,the scrotum is slow to be involved in the disease1 but at first becomes distended1 sometimes to the size of a cocoanut1 and then gradually ulcerates4 ,the spermatic artery and the accompanying veins become greatly enlarged4 ,the cord may also be attacked with the disease1 while secondary cancers spring up in various places4 ,the lymphatic glands in the neighborhood become enlarged1 especially those in the iliac fossa4 ,the inguinal glands do not generally become affected until the skin has become involved in the disease4 ,intermixed with the encephaloid are commonly found masses of a bright yellow color1 supposed by some to be deposits of tuberculous matter1 but by others1 merely plastic matter undergoing fatty degeneration4 ,colloid and melanotic cancers have rarely been observed in the testes4 ,the tunica vaginalis is said to have been attacked with cancerous disease1 the testis remaining healthy4 ,cystic ,disease of the ,testis4 ,the cysts may be but few1 or very numerous4 ,the testis is proportionately enlarged1 indurated1 of a yellowish-white and opaque appearance1 and studded with cysts varying in size4 ,the contents are1 in the younger cysts1 a clear1 amber-colored fluid2 in the older ones1 more thick1 viscid1 highly albuminous1 and of a brownish color4 ,the cysts are sometimes imbedded in solid stroma1 probably of fibroid tissue2 sometimes small masses of enchondroma are found between them4 ,when of an innocent character1 the cystic disease is characterized by the presence of tessellated epithelium in the cysts2 when malignant1 by the presence of nucleated cancer cells4 8,occasionally cystic tumors of the testicle are met with1 in which the substance of the organ is atrophied or absorbed1 and its place occupied by one or more large thin-walled sacculi containing fluids of different color and consistence1 dark or fatty40 ,tubercles are not very unfrequent1 and appear sometimes in the body of the gland1 but oftener in the epididymis1 whence they may spread to the testis4 ,they occur as gray granulations1 infiltrated or encysted1 and varying in size from a pin's head to a plum-stone4 ,they are commonly found in all stages of development and disintegration in the same organ4 ,their presence in and between the tubuli produces inflammation1 suppuration and disorganization of the structure of the testis1 with which they become mixed1 so as to form a cheesy mass of a dirty buff color4 ,this may1 by ulceration1 perforate the scrotum1 and protrude as a fungous growth of a pale1 reddish-yellow granular mass4 ,this disease of the testis is frequently found in connection with pulmonary tubercle1 or general tuberculosis4 ,tubercular syphilitic sarcocele1 described by ,hamilton1 of ,dublin1 is a variety occurring in an advanced stage of constitutional syphilis4 8,cretaceous matter is occasionally met with in the testis1 doubtless the residue of tuberculous deposit which has softened and undergone calcareous change40 ,tumors4 ,fibroid tumors of small size are sometimes found developed within the visceral layer of the tunica vaginalis1 or within the substance of the cord4 ,fatty tumors may be found1 which have originated within the tunica albuginea1 the dartos1 or within the fibrous connective tissue of the cord4 ,cartilaginous tumors of small size1 originate with the substance of the gland1 and are frequently associated with cystic disease or cancer4 ,section ,,iv4 ,,the ,,seminal ,,vesicles ,,and ,,prostate4 ,notice3 #a4 ,seminal vesicles--present or absent2 size2 distended or empty2 contents4 ,condition of mucous lining2 inflamed1 thickened1 ulcerated1 perforated2 tubercular deposits1 etc4 #b4 ,prostate gland--abnormalities2 size2 density2 enlargement of middle or lateral lobes2 color of section2 appearance of inflammation2 abscess2 tumors2 cancer2 tubercle4 ,contents of ducts--calculi3 their position1 size1 etc4 ,congenital ,anomalies4 ,the vesicul seminales participate in the defective development of the testes1 being absent or imperfect when their related glands are so4 ,inflammation4 ,it is not uncommon for these bodies to be attacked with chronic catarrhal inflammation1 which causes a swelling of their mucous membrane1 the secretion of unhealthy mucus1 dilatation of the cavity1 and thickening of its walls4 ,ulceration1 perforation1 and the formation of abscess in adjacent parts1 may result4 ,tubercular ,deposits are occasionally met with1 chiefly in cases of extensive tuberculosis4 8,it appears as a thick1 yellow1 cheesy1 lardaceous1 fissured1 purulent layer1 replacing the mucous membrane40 ,it never occurs before puberty4 ,the ,prostate ,gland4 ,congenital ,anomalies4 ,when the organs of generation are imperfectly developed1 the prostate gland is generally found to be so too4 ,hypertrophy and ,atrophy4 ,hypertrophy is of frequent occurrence1 especially in connection with old age4 ,all the lobes may be enlarged equally1 or nearly so1 or one or the other of the lateral lobes alone1 or the middle lobe1 without any corresponding hypertrophy of the lateral4 ,hypertrophy of the middle lobe1 when considerable1 throws the neck of the bladder forward1 and increases the depth of its lower region1 so that calculi may lodge behind and below the prostate in its cavity4 ,the canal of the urethra becomes lengthened in its prostatic portion1 and may be narrowed by compression1 or considerably dilated1 so that the prostatic sinus may contain two or three ounces of urine4 ,the retained urine decomposing1 may cause irritation and inflammation of the bladder4 ,the texture of the enlarged gland is generally indurated1 though sometimes it is found to be looser and softer than natural4 ,on section1 the cut surface bulges above the level1 and the shades of color are more strongly marked than in health4 ,frequently single gland-lobules are found hypertrophied4 ,small cavities1 dilatations of the gland-follicles1 are occasionally met with1 sometimes empty and sometimes containing a yellow1 pus-like fluid1 the prostatic secretion in a thickened state4 ,atrophy1 with consolidated texture1 is found with atrophy of the testes4 8,eccentric atrophy is occasionally met with2 the cavities are dilated and the walls thinned1 in consequence of the increase in size of calculous concretions in its follicles4 ,cases sometimes occur1 in which the whole of one lobe1 or even the entire organ1 is converted into a thin fibrous capsule1 the proper substance of the gland being almost wasted40 ,inflammation4 ,as a result of suppressed gonorrhal discharge1 the prostate may be attacked with acute inflammation1 followed by suppuration1 or chronic enlargement1 or an irritable state of the gland1 with increased secretion4 ,abscesses1 single or multiple1 may occur1 and open into the bladder1 into the prostatic sinus of the urethra1 into the rectum1 or1 externally through the perineum4 ,ulceration rarely occurs4 ,morbid ,growths4 ,cancer of the prostate is rare2 encephaloid is almost the only form that occurs4 ,the gland is enlarged and the growth may perforate the mucous membrane of the bladder1 and vegetate in its cavity4 ,tubercles occasionally occur4 ,their softening and disintegration give rise to abscesses1 which pursue the same course as inflammatory abscesses4 ,fibrous tumors1 varying in size from that of a pea to a nut1 are of frequent occurrence2 sometimes but loosely attached to the hypertrophied gland4 ,cysts are of extremely rare occurrence1 commonly resulting from closure and dilatation of the gland-follicles4 ,concretions4 8,in greater or less numbers1 they are of almost constant occurrence in the prostatic cavities2 they may often be seen on making a section of the gland1 as reddish-yellow grains4 ,their form varies very much2 in the smaller it approaches the oval or circular2 in the larger it is more polygonal or triangular4 ,they are not unfrequently pale or colorless4 ,the contents of these semiorganized formations appear to be earthy matter 7phosphate1 with a little carbonate of lime71 tinged by the ordinary yellow pigment which is so often derived from the blood4 ,it is most probable that1 in ordinary healthy states1 these concretions undergo solution at an early period of their existence1 yielding up their contents to form part of the secretion of the gland4 ,but1 if this does not occur1 and they go on increasing in size1 they become the nuclei1 or are developed into prostatic calculi4 ,these are not unfrequently very numerous2 as many as fifty or sixty have been found in an atrophied1 dilated prostate4 ,the calculi sometimes cohere1 and form a large mass1 projecting into the membranous portion of the urethra1 which becomes in consequence much dilated4 ,the smaller calculi often escape into the bladder through the dilated prostatic ducts2 if they remain there1 they excite irritation of the mucous membrane and deposition of phosphates upon their own surface40 ,,chapter ,,iv4 ,,the ,,female ,,generative ,,organs4 ,section ,i4 ,,the ,,pudenda ,,and ,,vagina4 ,notice3 #a4 ,of the pudenda--malformations2 condition of the labia and clitoris2 size2 color2 abrasions2 ulcers2 eruptions2 tumors2 marks of violence1 etc4 ,orifice of urethra--growths around1 their number and size4 ,hymen--present or absent2 entire or lacerated2 imperforate4 #a4 ,the ,pudenda4 ,congenital ,anomalies4 ,in rare cases the external organs are entirely absent1 more frequently but partially developed4 ,the nymph may be found abnormally enlarged4 ,the clitoris may be abnormally long1 perforated1 or cleft4 ,many of the cases of so-called hermaphroditism are instances of an undue congenital development of the clitoris1 with an irregular development of the other organs of generation1 either external or internal1 or both4 ,hypertrophy4 ,we may find an hypertrophy of the labia1 due to a kind of solid dema1 perhaps originally dependent upon a fissure or ulcer of the part4 ,the nymph are often abnormally enlarged1 not necessarily as the result of an abuse of sexual indulgence4 ,in new-born infants1 they normally project beyond the labia majora4 ,the clitoris occasionally is enlarged1 elongated and pendulous1 and1 in some cases1 attains an enormous size4 ,a specimen preserved in the ,museum of the ,university of ,bonn1 is fourteen inches in circumference and weighs eight pounds4 ,there is no necessary connection between an habitual sexual indulgence and an enlarged clitoris4 ,varicose swellings of the labia may reach a considerable size1 and1 although not generally interfering with parturition1 have been known to be lacerated at that time with fatal issue4 ,as the result of external violence1 or during parturition1 suggillations often occur in the labia1 and may give rise to considerable swelling4 ,the tumor presents a tense1 smooth surface1 of a livid color1 thus distinguished from a varicose swelling1 with the peculiar vermicular character of its contents4 ,inflammation4 ,the cutaneous covering1 the mucous lining1 the cellular tissue1 and the sebaceous and mucous follicles1 may be the seat of inflammation1 resulting from external or internal causes4 ,eczematous and apthous inflammations may result from derangement of the digestive organs1 from pregnancy1 from a want of cleanliness1 or from excessive sexual indulgence1 and are of frequent occurrence4 ,the loose cellular tissue is especially favorable to dematous swelling1 and when the inflammation has a phlegmonous character1 extensive sloughing may result4 ,it occasionally occurs as an epidemic among those in early life4 ,the vulvo-vaginal glands are also liable to inflammation of a catarrhal1 herpetic or syphilitic character1 resulting in chronic ulceration1 or tedious discharges4 ,young children are frequently liable to a benignant inflammatory affection of these parts1 giving rise to much irritation and a muco-purulent secretion4 ,morbid ,growths4 ,warty excrescences1 arising from a syphilitic taint1 may affect the labia1 the entrance of the vagina1 and the clitoris4 ,they consist of groups of small pedunculated tumors1 producing a sort of mushroom appearance4 ,syphilitic mucous tubercles are described as round1 flattened tubercles1 raised above the surrounding tissues1 sometimes becoming elongated1 of a reddish-blue color1 and frequently ulcerated on the surface4 ,cystic tumors are also met with in the labia4 ,they consist of a membranous envelope1 containing a transparent1 glairy fluid1 and often attain a large size4 ,the mucous membrane surrounding the orifice of the urethra1 is liable to an hypertrophy of development1 giving rise to small vascular1 generally pedunculated tumors1 extremely sensitive during life1 and liable to become abraded4 ,elephantiasis may attack the labia majora1 the nymph1 or the clitoris1 and may attain to a great size4 ,it consists of the loose connective tissue of the part1 infiltrated with serum1 and covered either with the smooth skin1 or one which has become roughened by hypertrophy of the papill4 ,it may appear as a diffused hypertrophy1 or be furnished with a pedicle1 and resemble a polypus4 ,fibrous1 fatty and scirrhus tumors are also met with in this part of the system4 #b4 ,the ,vagina4 ,congenital ,anomalies4 ,the valvular fold of membrane which protects the virgin vagina1 the hymen1 may be imperforate or much indurated1 and of a cartilaginous consistency4 ,it may thus entirely close the vagina4 ,besides this1 we may find the vagina terminating in a cul-de-sac1 either with the uterus present or absent1 and the ovaries normal or abnormal4 ,the vagina may also be duplicated1 by a septum extending the entire length of the canal1 or only partially dividing it4 ,there may be at the same time a double uterus4 ,entire absence of the vagina is also met with1 the internal organs of generation being also absent1 or but imperfectly developed4 ,morbid ,states4 ,occlusion or stricture of the vagina sometimes occurs as the result of external injury1 or of cicatrization of ulcers4 ,dilatation1 or lengthening of the vagina1 also occurs4 ,the rigidity or laxness of the walls of the vagina1 varies much in different individuals1 according to constitution1 age1 and the effects of cohabitation and child-birth4 ,prolonged uterine or vesical disease1 often produces a very lax condition of the mucous membrane of the vagina4 ,in old women we often meet with this relaxed state1 which may amount to a complete prolapsus4 ,the anterior wall is particularly liable to be thus affected4 ,laceration and ,rupture4 ,external mechanical injuries may produce laceration of the vagina4 ,during parturition1 either from unusual rigidity1 or from want of care on the part of the attendant1 the lower portion of the canal is apt to give way when the labor pains are at their height4 ,the lesion may vary from a mere laceration of the fourchette1 to a rupture of the entire perineum1 from the vagina to the anus4 ,lacerations of the upper portions of the vagina also occur with rupture of the uterus1 or even independently of it4 ,lacerations of the vagina are not necessarily fatal1 but may result in vesico-vaginal fistula1 where a communication is established between the bladder or urethra1 and the vagina2 or in recto-vaginal fistula1 where the fistula opens into the rectum4 ,inflammation4 ,the mucous membrane of the vagina is frequently the seat of inflammation4 ,the commonest form is the catarrhal1 which may be acute or chronic4 ,in the first stage1 the passage is reddened1 heated and dry4 ,this is followed by an abundant secretion of white1 creamy mucus2 or of a more purulent discharge1 if the inflammation has anything of a specific character4 ,croupous inflammations1 in connection with general disease1 or a similar disease of the uterus1 may occur4 ,they produce a solution of the mucous membrane and the submucous tissue1 varying in shape and depth1 and not unfrequently resembling gangrenous destruction4 7,rokitansky47 ,a chronic thickening of the mucous membrane1 as the result of inflammation1 is occasionally met with4 ,the follicular1 syphilitic and carcinomatous ulcer also affect this part4 ,suppurative inflammation may result from injuries1 ending in the formation of an abscess in the fibrous structures1 which may burrow within the pelvic areolar tissue1 or extend into the labia4 ,gangrene sometimes results from injuries received during parturition1 or from a degeneration of croupous inflammation in a vagina affected with blenorrha of a gonorrhal or syphilitic origin4 ,morbid ,growths4 ,polypi and cysts are the varieties most frequently met with in this situation4 ,the polypi may be either fibro-vesicular1 or cellulo-vascular1 varying greatly in size4 ,the encysted tumors1 originate in an obstruction of the follicles of the part1 and contain a glairy1 transparent1 greenish1 or dirty-brown albuminous fluid4 ,myomatous tumors may be found developed within the muscular coat of the vagina1 the posterior wall being their usual position4 ,carcinoma may occur primarily1 or by an extension of the disease from the cervix uteri4 ,the form in which it appears is the encephaloid kind1 the appearance of which is described in connection with the uterus4 ,malignant epithelial growths are not met with in the vagina4 ,section ,,ii4 ,,of ,,the ,,uterus4 ,notice3 #a4 ,in situ--absence or malformations4 ,size1 and relation to surrounding organs and walls of pelvis2 high or low in pelvis2 versions2 flexions2 adhesions1 etc4 #b4 ,after removal--os2 size and shape1 round1 oval1 irregular1 etc4 ,lips--size2 form2 color2 condition of surface2 soft or firm2 rough or smooth2 abrasions2 granulations2 ulcers2 tumors1 etc4 ,external characters of body--size2 measurements2 weight2 tumors2 rupture2 consistence1 hard or soft4 ,after section--thickness of walls2 density2 condition of blood-vessels2 abscesses2 tumors1 etc4 ,uterine cavity--size and form4 ,contents2 serum2 size and condition2 blood2 mucus2 pus2 tumors4 ,condition of mucous lining1 cancerous growths1 etc4 ,according to the measurements of ,kilian1 the uterus in the virgin adult1 varies in length from twenty-four to twenty-six lines2 the greatest breadth is eighteen lines2 the thickness nine lines2 the cervix is from ten to twelve lines long2 its breadth from six to eight2 its thickness from five to six lines4 ,the length of the uterine cavity is twelve lines1 and its breadth nine lines4 ,after one or more births all these measurements increase from one-fifth to one-quarter4 ,the weight of the uterus varies from eight to twelve drachms1 and may1 after several pregnancies1 amount to two ounces4 ,congenital ,anomalies4 ,the entire absence of the uterus is an exceedingly rare occurrence1 and need not affect the health of the individual4 ,a seeming multiplication of the organ is occasionally met in the bilocular and horned uterus4 ,in the former1 a more or less perfect septum extends through the organ in the median line1 while in the latter1 the uterus is divided into two lateral portions1 by a prolongation of the angles or cornua1 giving a resemblance thus to a permanent form seen in many of the lower animals4#ce ,we may also find the so-called uterus unicornis1 where only one of the two rudimentary bodies from which the normal uterus is developed arrives at maturity4 ,all these kinds of uteri are capable of becoming impregnated1 but parturition1 although not necessarily fatal1 seriously endangers the life of the patient2 owing1 according to ,rokitansky1 partly to the want of the necessary dimensions of the part that undertakes the functions of the entire organ1 and partly to the obstacle opposed to the uniform development of the impregnated half by the unimpregnated half4 ,these circumstances favor rupture of the uterine walls4 ,hypertrophy and ,atrophy4 ,these are in part normal at the periods of puberty and change of life2 as a morbid state1 the first is of more frequent occurrence than the last4 ,either may affect the entire organ1 or only a part4 ,after the climacteric period the cervix often disappears entirely4 ,hydrometra4 ,as the result of inflammatory processes1 the os internum or the os externum may become occluded1 causing a retention of the secretions from the diseased mucous membrane of the uterus4 ,this secretion gradually changes into a sort of thin serum4 ,the uterus becomes dilated1 and we have hydrometra4 ,hmatometra is a condition where the uterus is dilated with serum mixed with blood1 or exclusively with retained menstrual blood4 ,this latter state is more frequently the result of congenital than of acquired atresia4 ,the amount of dilatation may vary greatly4 ,malpositions of the ,uterus4 ,these may be of two kinds3 7#a7 where the direction of the axis is changed2 or 7#b7 the organ becomes altogether displaced1 so that its relation to all the pelvic viscera is altered4 ,of the former class1 are ante- and retro-versions1 with flexions1 and lateral obliquities2 of the latter1 prolapsus procidentia and inversion4 ,inversion may occur spontaneously or as the result of manual interference in the removal of the after birth4 ,the fundus may pass but a short distance into the cavity of the organ1 or the uterus may be turned completely inside out4 ,inversion may also result in an unimpregnated uterus from the presence of fibrous polypi1 growing from the inner surface of the fundus4 ,these growths1 when complicating pregnancy1 favor inversion by disturbing the regular expulsive contractions4 ,hmorrhages4 ,an effusion of blood into the cavity of the uterus1 occurs normally at every period of menstruation2 from some morbid condition of the vessels of the uterus1 it may at times amount to an hmorrhage4 ,attending parturition1 it may be due to placenta prvia2 or following1 to atony or defective contraction of the uterine walls1 where we find the uterus maintaining its dilated condition with flabby and soft walls2 or to spasm or irregular contraction1 to which the term1 8hour-glass contraction10 has been applied4 ,the presence of polypoid tumors is frequently attended by hmorrhages4 ,peri- or ,retro-uterine ,hmatocele1 is an accumulation of menstrual blood1 generally in the utero-rectal cul-de-sac4 ,it may arise from rupture of a blood-vessel1 from defect in the excretion of the menses1 or from a morbidly profuse exhalation of blood from the genital organs4 ,the extravasation may be reabsorbed1 or may by perforation be discharged by the rectum or vagina1 or may lead to suppuration and the formation of an abscess4 ,inflammations4 ,the traces of acute catarrhal inflammation are but seldom to be discovered4 ,they present the same features as catarrhal inflammations of other mucous membranes1 congestion and swelling1 with a more or less abundant secretion of muco-pus4 ,in chronic catarrhal inflammations1 the membrane is found thickened1 of a brownish or slate-gray color1 with a more or less purulent secretion1 often blood-streaked4 ,the walls of the uterus may be atrophied or hypertrophied4 ,catarrhal erosions1 and follicular ulcers1 the result of the bursting or suppuration of the stopped-up follicles1 usually accompany catarrhal inflammations4 ,acute ,metritis4 ,here we find the organ swollen and congested1 and its substance of a darker color4 ,the mucous membrane shows symptoms of a catarrh1 and the peritoneal covering is also congested4 ,occasionally extravasations of blood are found in the substance or cavity of the uterus4 ,the inflammation may lead to the formation of abscesses within the uterine walls4 ,in ,chronic ,metritis the organ is generally much enlarged4 ,the walls are remarkably pale and dry1 thick and hard4 ,the mucous membrane almost always presents the appearances described under chronic catarrhal inflammation1 while the peritoneal covering frequently shows numerous adhesions to the neighboring organs4 ,ulcerations may be catarrhal1 with superficial erosions or follicular ulcers2 or syphilitic1 in the form of the hard and soft chancre2 or we may1 in rare cases1 have the corroding ulcer1 described by ,dr4 ,john ,clarke1 and differing from genuine carcinoma only in the absence of an indurated deposit4 ,morbid ,growths4 ,fibroid tumors are of most frequent occurrence4 ,they are found either imbedded in the texture of the uterus1 or protruding from its inner surface into the cavity1 or from some part of its external surface4 ,those projecting into the cavity of the uterus1 called also fibrous polypi or submucous tumors1 are most frequently met with4 ,their pedicles are generally situated just below the openings of the ,fallopian tubes1 although they spring also from the posterior wall and from the fundus1 less frequently from the anterior wall1 and still more rarely from the cervix uteri4 ,recent investigations go to show that these tumors are to be classed with the homologous1 rather than heterologous productions1 and that they are developments of true muscular tissue4 ,to the naked eye this structure varies in some respects2 at times they present a concentric disposition of fibres1 but more commonly an irregular1 wavy appearance1 without any uniformity of arrangement1 and in the latter case1 frequently with cavities containing blood1 a dark-colored gelatinous fluid1 or a clear serum4 ,under the microscope1 a fibrous structure is scarcely perceptible1 but elongated nuclei are seen1 imbedded in an amorphous stroma4 ,the vascularity of fibrous tumors varies4 ,the majority are but scantily provided with vessels4 ,the tumors imbedded in the uterine tissue form globular1 white1 glistening1 dense tumors4 ,there may be only one1 or they may be numerous1 and may vary in size from that of a pin's head to that of a melon4 ,these growths are subject also to secondary changes2 thus we may find abscesses in the very centre of fibroid growths1 or they may contain encysted melanotic tumors1 or a species of calcification may be developed4 ,fibrous tumors have not been observed before puberty1 but occur1 according to ,lee and ,bayle1 most frequently in virgins4 ,polypi and ,polypoid ,growths4 ,these growths--not to be confounded with the fibrous tumors1 as is frequently done--are soft and succulent1 and project into the cavity of the uterus1 or hang into the vagina4 ,they are attached by a pedicle of greater or less width1 to the surface from which they spring1 and are covered with the mucous membrane of the part4 ,they are essentially a morbid condition of the structures of the surface1 the mucous membrane1 the follicles1 or sebaceous crypts of the different parts of the uterus4#cf ,polypoid tumors may give rise to hmorrhages4 ,they may become inflamed1 suppuration or even gangrene supervening4 ,in this way the pedicle may be destroyed1 and the tumor be expelled4 ,cysts and ,tubercular ,deposits are extremely rare in the uterus4 ,the latter affect primarily the lining membrane1 where it occurs in the miliary form1 or accumulated in masses1 aggregated into nodules1 or forming a cheesy layer over the entire surface4 ,the uterine tissue may be secondarily affected1 and is then liable to become infiltrated with the morbid product4 ,traces of the disease are found also in the vagina as spots of ulceration1 and in the ,fallopian tubes4 ,cancer4 ,carcinoma of the uterus is of frequent occurrence4 ,the period of life in which it is most frequently met with1 is that between the fortieth and fiftieth years4 ,although met with in single women1 it is found most frequently among the married4 ,in general1 this disease attacks the cervix first1 whereby it is distinguished from fibroid growths4 ,many instances of supposed cancers1 prove on microscopic examination1 to be nothing more than an irregular thickening and induration of the cervix1 consequent upon chronic inflammation4 ,according to ,rokitansky1 the prevailing form of uterine cancer is the medullary carcinoma1 appearing as an infiltration of a white lardaceo-cartilaginous1 or loose encephaloid matter1 in which the uterine tissue is lost1 and giving rise to the characteristic nodulated surface of the cervical portion of the organ4 ,of rarer occurrence is the fibrous cancer1 consisting of dense1 whitish1 reticulated fibres1 containing in their meshes a pale-yellowish translucent substance4 ,its limits are not sharply defined1 but are lost in the uterine tissue4 ,nowhere does the destructive character of the cancerous disease manifest such virulence1 as when attacking the uterus4 ,the degeneration spreads more or less rapidly to the adjoining parts1 and1 in extreme cases1 the whole contents of the abdomen are matted together1 and present a frightful spectacle of disorganization and destruction4 ,cauliflower ,excrescence of the cervix1 is regarded by both ,rokitansky and ,renaud1 as a modification of encephaloid growth4 ,it appears as an irregular projection1 with a base as broad as any other part of it1 attached to some part of the cervix4 ,the surface has a granulated feel4 ,on removal from the body it collapses1 owing to its vascular character4#cg ,morbid ,conditions following ,parturition4 ,rupture of the ,uterus is not unfrequent as a concomitant of pregnancy in the horned or bilocular malformation of the organ4 ,it is also met with in the normal uterus4#ch ,a laceration of the os tinc occurs at every birth1 and so long as it does not extend beyond the circular fibres of the cervix is not dangerous4 ,the result is generally more disastrous when the rupture extends beyond this point4 ,it may penetrate the entire thickness of the organ1 so as to allow of the escape of the ftus into the abdominal cavity1 or only one layer of the walls may give way1 or only the peritoneal investment may be lacerated1 while the uterus itself remains uninjured4 ,rupture of the uterus may also result from external injury before parturition4 ,it is not necessarily fatal4 ,primipar are more liable to this accident than multipar4 ,puerperal ,inflammations4 ,where the uterus has itself been the main seat of inflammation1 we find that an exudative process has given rise to the formation of a yellowish or greenish1 more or less1 gelatinoid lining on its internal surface1 causing a ragged1 patchy appearance4 ,this exudation may be easily detached from the subjacent mucous membrane1 which1 according to the intensity of the disease1 is more or less reddened1 tumefied and softened4 ,this condition may penetrate to the deeper tissues1 and involve the entire thickness of the uterus1 which will then1 also1 be more or less softened and discolored1 infiltrated with a thin sanious product1 and even converted into a mere pulp4 ,the dirty-colored1 brownish1 flocculent matter that is found investing the inner surface of the uterus soon after delivery1 and which is merely the residue of the decidua1 must not be mistaken for the product of disease4 ,the ragged appearance of the part to which the placenta was attached1 due1 according to ,dr4 ,john ,clarke1 to the remains of the maternal portion of the placenta and the coagula of blood left after its separation1 is also liable to be the source of error4 ,in both cases1 however1 if the apparent exudation be scraped off1 which can easily be done1 we find the healthy surface underneath4 ,in putrescence1 the lowest form of uterine inflammation1 we find the internal layer of the organ covered with a thin1 opaque1 or more dense product1 varying in color from pale green to dark brown1 beneath which the tissue to a greater or less depth is converted into a similar pulp4 ,we sometimes find small abscesses within the muscular tissue without any perceptible change in the surrounding parts2 in most cases1 however1 the structure of the muscular fibre is entirely destroyed4 ,metrophlebitis4 ,inflammation of the venous channels and lymphatics of the uterus1 is a very frequent cause of the fatal termination of cases of puerperal fever4 ,tonnell found it present in one hundred and thirty-two cases out of two hundred and twenty-two4 ,besides the appearance of the vessels common to ordinary phlebitis1 we find the uterus studded with small abscesses which may be traced to the vessels4 ,the lymphatics may be primarily and coincidently affected1 or they may be attacked separately and secondarily2 the former is the more frequent4 ,they present the same varicose appearance as the veins1 and are thickened and distended with the purulent or sanious products of the inflammation4 ,puerperal ,peritonitis1 is the lesion most commonly associated with puerperal fever4 ,it may be confined to the surface of the organ1 particularly to the part surrounding the neck1 or may involve more or less entirely the whole sac4 ,in the sthenic forms1 the appearances presented1 resemble those of ordinary peritonitis4 ,in the low typhoid forms1 there is a peculiar absence of congestion and redness4 ,the ordinary character of the exudation1 is a copious effusion of an aplastic character1 of a dirty-yellow1 greenish1 or brownish hue1 in which flocculent particles of lymph are found floating1 while but small patches of a thin1 non-coherent exudation1 are observed in the peritoneal sac4 ,the smell of the fluid is distinctive1 differing from anything found in the human body in health or disease1 and after having been once noticed1 cannot fail to be recognized4 ,extra-uterine ,pregnancy4 ,this species of gestation may be considered under the following varieties1 receiving their names according to the part of the passage where the ovule becomes fixed3 #a4 ,abdominal ,pregnancy4 #b4 ,tubo-abdominal ,pregnancy4 #c4 ,tubal ,pregnancy4 #d4 ,interstitial ,tubo-uterine ,pregnancy4 #e4 ,utero-tubal ,pregnancy4 #a4 ,abdominal ,pregnancy4 ,this includes all cases in which the fecundated ovule fails to engage in the tube4 ,three varieties may occur4 ,the ovule may remain in the ruptured ovisac and there be developed1 giving rise to an internal ovarian pregnancy4 ,should it after escaping from the ,graafian vesicle adhere to the surface of the ovary1 we have an external ovarian pregnancy4 ,finally1 if the ovule1 escaping from the ovary1 fall into the peritoneal cavity1 and there undergo development1 a peritoneal pregnancy results4 ,in the last class1 the points to which the ovule may attach itself are exceedingly numerous4 ,the placenta has been found attached to the peritoneum covering the right or left iliac fossa1 sometimes to a part of the small or large intestine1 and sometimes to the anterior wall of the abdomen4 #b4 ,tubo-abdominal ,pregnancy4 ,this name is applied to those cases where the ovule having but just entered the tube1 is arrested by an obliteration or constriction of the canal1 and there undergoes development4 ,the placenta is attached in the interior of the tube1 and the ftus developed in the abdominal cavity1 and both are surrounded by a cyst1 the walls of which are partly made up by the walls of the dilated tube4 ,this includes also what has been described as tubo-ovarian pregnancy4 #c4 ,tubal ,pregnancy is the most frequent of all varieties of extra-uterine pregnancy4 ,the ovule is here arrested and developed at some spot within the tube1 between its abdominal extremity and the point where it enters the uterine walls4 ,the fibres of the enormously distended tube constitute the envelope of the ftal cyst4 #d4 ,interstitial ,tubo-uterine ,pregnancy4 ,here the ovule is arrested in that part of the tube that traverses the thickness of the uterine walls4 ,it may remain1 during its development1 enclosed by the tube1 or it may make its way through these and be developed within the muscular fibres of the womb itself4 #e4 ,utero-tubal ,pregnancy is a very rare but possible form of extra-uterine pregnancy4 ,the ovule may ingraft itself just at the internal orifice of the canal4 8,in this variety1 the ftus is found in the abdominal cavity2 the cord leaving the umbilicus enters the ,fallopian tube1 traverses its whole length1 and is inserted in the placenta1 which is itself attached to the internal surface of the uterus40 ,the tube has evidently been ruptured1 allowing the passage of the ftus into the peritoneum1 while the placenta remained in the uterus4 ,in all these pregnancies1 the ovule has originally its proper membranes1 the chorion and the amnion4 ,the structure of the walls of the enclosing cyst varies according to the species of extra-uterine pregnancy4 ,as a general rule1 the ftus exhibits nothing peculiar in its development4 ,the most common of the numerous alterations which it may undergo1 are putrescent dissolution of its soft parts1 and the separation of the various pieces of its skeleton2 a complete drying-up or mummification2 and transformation of all its tissues into an osseous or cretaceous substance4#ci ,in the tissues of the mother1 new or increased vascularity of those parts where the ovule is attached will be noticed1 while the womb will be found to have sympathized with the development of the ftus by an hypertrophy of its mucous membrane1 which1 however1 does not last more than a few months4 ,a gelatinous substance1 a kind of thick1 ropy mucus1 is also frequently found in the neck of the uterus4 ,these appearances are generally wanting in the womb1 where the pregnancy has advanced beyond term4 ,extra-uterine pregnancy generally terminates fatally4 ,in the abdominal form1 the pregnancy may progress to the later months of gestation1 when1 losing its vitality1 the ftus may decompose1 producing peritonitis and death1 or it may become encapsulated and gradually absorbed2 or by the ulcerative process1 the remains may be discharged into the intestinal canal1 or through the abdominal walls4 ,where the case has been diagnosed before death1 the dead ftus has been successfully removed by abdominal section4 ,in the varieties of tubal pregnancy1 rupture of the tube1 and death from hmorrhage usually takes place in the early months1 as in the following case3 ,,case4--,tubal ,pregnancy1 with ,rupture of the ,fallopian ,tube--,hmorrhage and ,death4 ,mrs4 ,c----1 aged thirty-three years1 four years married1 but childless1 had been indisposed for two weeks4 ,early in the morning of ,july #ith1 she was taken with severe pain in the lower abdomen1 nausea and vomiting1 rapid prostration1 increasing tumidity of the abdomen1 and death at #g o'clock ,p4 ,m4 ,thirty-six hours after death1 assisted by the attending physicians1 ,drs4 ,h4 ,j4 ,sartain and ,e4 ,calvin1 ,i made a post-mortem examination4 8,a quart of bloody serum was sponged out of the abdominal cavity1 then a pint and a-half of black coagula was removed1 when the pelvic viscera were exposed4 ,the right ,fallopian tube was found enlarged and ruptured1 within an inch of its connection with the uterus4 ,the ovule had lodged in the tube1 about half an inch from its outlet1 and there formed its attachments4 ,the oozing blood from the ruptured arterioles and venules of the tube1 had destroyed the outline of the embryo1 leaving a sort of granular debris lying in the fragments of the membranes1 which were detached from the inner surface of the tube4 ,the nidus measured externally about an inch in length1 and three-quarters of an inch in transverse diameter4 ,the walls of the uterus were slightly softened1 and the decidua had formed40#dj ,section ,,iii4 ,,the ,,ovaries ,,and ,,fallopian ,,tubes4 ,notice3 #a4 ,external ,characters of ovaries2 size2 color2 consistence2 soft and boggy1 or firm and hard2 surface smooth1 or rough1 irregular and fissured2 cysts beneath the surface1 or projecting from same4 ,characters on section--color1 density2 condition of stroma1 consistence1 etc4 ,corpora lutea3 number1 size1 situation2 cysts2 tumors2 abscesses2 tubercles2 cancer1 etc4 #b4 ,fallopian tubes--absent or malformed2 length2 size of canal2 thickness of walls2 condition of fimbriated extremity2 tumors1 tubercle1 cancer1 etc4 #a4 ,the ,ovaries4 ,malformations and ,malpositions4 ,the absence or arrest of development of one or both ovaries is occasionally met with4 ,the ovaries may be found in the labia majora as a congenital defect1 or in the inguinal or crural canal1 or in the foramen ovale1 as congenital or acquired herni4 ,inflammation is but rarely met with in post-mortem examinations in an isolated form4 ,it generally is associated with affections of the uterus or its appendages1 in connection with the puerperal condition4 ,it does1 however1 occur as an idiopathic disease1 and then generally attacks but one ovary4 ,in the congestive stage there is more or less engorgement with blood1 even amounting to extravasation1 enlargement and softening of the organ4 ,abscesses4 ,as a result of acute inflammation1 abscesses may form in the substance of the ovary4 ,these may reach considerable size1 and may burst into the peritoneal cavity1 resulting in death2 or they may discharge into the rectum1 vagina or bladder1 and end in recovery4 ,morbid ,growths4 ,ovarian ,tumors or ,ovarian ,dropsy1 are generic terms for a class of affections characterized by the formation of cysts1 which have a tendency to excessive development4 ,the disease affects married females more frequently than the single1 and the age from thirty to forty years is that most subject to it4 ,according to statistics1 the right ovary is more frequently the seat of the malady4 ,various forms of the disease are met with4 ,the cysts may be simple or unilocular1 compound or multilocular1 or cancerous4 ,simple cysts have but a single1 undivided cavity1 containing fluid1 and enclosed within the ovary or external to it4 ,we may find one or more1 varying greatly in size1 some being no larger than a pin's head or pea1 while others contain several gallons of fluid4 ,the contained fluid also1 presents great varieties2 it may be clear1 straw-colored1 highly albuminous1 or present a viscid1 glairy1 more or less opaque character2 or we may find it of a coffee color1 or greenish1 with a large quantity of oily matter floating on the surface4 ,in the latter cases the appearance is due1 as shown by the microscope1 to the presence of blood corpuscles and cholesterine plates4 ,these simple cysts may acquire an enormous size1 filling the abdominal cavity1 and crowding the viscera from their position4 ,in a case examined for ,dr4 ,b4 ,berens1 in #ahee1 a free incision was made through what appeared to be the abdominal walls alone1 when the cavity was found filled with a straw-colored1 slightly gelatinous fluid1 of which several gallons were removed4 ,upon extending the incisions and looking into the cavity1 it presented the appearance of an entire absence of all the abdominal viscera2 the spinal column projected at the posterior portion1 while above was seen what appeared to be the concave1 under surface of the diaphragm1 with no trace of liver1 stomach1 or other viscus4 ,a careful examination of the edges of the incision disclosed the divided walls of the cyst1 closely adhered to the abdominal parietes at all points4 ,with a little care1 these were gradually torn away1 when1 behind the tumor1 was found the atrophied viscera1 crowded and displaced upwards and backward into the smallest possible space4 ,pilo-cystic or ,dermoid cysts may be found containing hair and fatty matters4 ,these appear1 in many cases1 to be the remains of blighted ova enclosed in the body4 ,they are congenital in their origin1 and usually contain some ftal debris1 such as portions of bone1 teeth1 etc4 ,,case4--,ovarian ,cystic ,disease--fatal termination4 ,autopsy revealing presence of bone and teeth in small cyst4 ,the following interesting case occurred in the practice of ,dr4 ,william ,a4 ,read1 of this city1 from whom the appended statement has been received3 ,miss ----1 aged #db years1 after having been treated by several physicians1 came under the care of ,dr4 ,read for the treatment of what was diagnosed as an ovarian tumor4 ,paracentesis was resorted to1 with the result of drawing off a considerable quantity of gelatinous fluid1 but without any permanent benefit4 ,the disease pursued the usual course1 and the patient finally died of exhaustion4 ,the autopsy revealed a large multilocular tumor1 filling a large portion of the abdominal cavity4 ,upon removing the same from its pelvic attachments1 and opening one of the smaller cysts within the broad ligament1 the latter was found filled with a quantity of highly offensive fluid1 and containing one large1 irregular mass of bone1 in which were imbedded two well-formed teeth1 a smaller piece with one tooth1 and nine detached teeth found in the same sac1 making twelve in all4#da ,the first impression upon the discovery of such remains would naturally be1 that the case was one of extra-uterine pregnancy2 but in this instance1 the well known character of the lady was such as to preclude such a theory2 while the presence of the unbroken hymen was further evidence of virginity4 ,from the impossibility of conception having been the source of the bony and dental remains found in this and similar cases1 the problem can only be solved1 by supposing that1 two ova had been impregnated when this woman was conceived1 one of which1 in some manner1 became imbedded within the other1 so that at her birth this lady had within her abdomen the remains of her undeveloped twin4 ,these became encapsulated within the pelvis1 and finally induced the local disease1 which resulted in death4 ,that this is the correct explanation of such cases1 is confirmed by the fact that similar remains have been found within the bodies of males4 ,multilocular cysts disclose1 instead of a single cavity1 numerous chambers1 containing secondary1 and even tertiary cystic growths1 either sessile or pedunculated1 and with varying contents4 ,by the complicated form1 we understand that in which1 to some other diseased state of the organ--as hypertrophy1 fibrous tumors1 or carcinomatous growths--the cyst formation is superadded4 ,fibrous growths4 ,these are developed in the tissue of the ovary1 and present a globular form1 with well defined outline4 ,they may attain an enormous size2 the largest one on record1 occurred in the practice of ,dr4 ,simpson1 and weighed fifty-six pounds4 ,we occasionally meet with proofs of a tendency to so-called ossification1 in the presence of calcareous matter1 into which a portion of the tissue has been converted4 ,malignant disease of the ovary1 is by no means a rare affection4 ,it is generally limited to one side1 and appears as scirrhus1 encephaloid1 hmatoid1 melanotic1 or alveolar cancer1 either as an isolated growth1 or in the infiltrated form1 and generally as an addition to some other morbid formation4 ,it runs a rapid course1 although it has been met with even before puberty2 forty-one years was the average age at death according to the statistics collected by ,dr4 ,walshe4 ,cartilaginous tumors are extremely rare in the ovaries4 ,tubercles are occasionally found as small1 cheesy deposits4 #b4 ,the ,fallopian ,tubes4 ,congenital ,anomalies4 ,one or both of the tubes may be imperfectly developed1 in connection with an unsymmetrical development or total absence of the uterus4 ,the tubes may be occluded by the closure of one or both ends1 and the point of insertion into the uterus may be abnormal4 ,inflammation4 ,catarrhal inflammation is of not unfrequent occurrence1 and may lead to partial or total1 temporary or permanent closure of the channel of the tubes4 ,thus the fimbriated extremities may become agglutinated to the ovaries1 the broad ligament1 or the uterus itself2 or obliteration may occur at one or more points within the passage4 ,the continued accumulation of the secretion of the mucous membrane will cause distension1 either simulating a cyst formation1 or presenting the appearance of several saccular dilatations4 ,the dilatations1 containing mucus matter of a more or less purulent character1 or fluid of an heterogeneous constitution1 are rarely of large size1 although an instance is on record in which the distension amounted to five inches in diameter4 ,the morbid contents may be poured into the uterus1 or in less favorable cases the sac is ruptured1 and the contents are effused into the abdominal cavity4 ,morbid ,growths4 ,cysts of small size frequently affect the fimbriated extremities of the tubes4 ,we may also find fibroid growths1 carcinoma and tubercle2 the two latter commonly1 although not invariably1 secondary to similar diseases of the uterus4 ,section ,,iii4 ,,of ,,the ,,mamm4 ,notice3 #a4 ,external ,characters--abnormalities2 silvery lines on integument1 indicating previous enlargement2 sinuses2 firm1 or soft and flabby4 ,nipple--its size1 color1 retracted1 ulcers2 excoriations1 etc4 ,areola--size and color4 #b4 ,appearance on section--color of substance2 consistence of gland and fluids exuding2 abscesses2 tumors2 cysts2 cancer1 etc4 ,anomalies4 ,supernumerary mamm1 with the power of secreting milk during lactation1 have been observed in a number of instances4 ,the cases of absence of one or both mamm are rather to be classed as the result of arrest of development or atrophy4 ,a too early development of the glands in young children is occasionally met with1 where there is a precocious development of the organs of generation4 ,while the mammary glands in the male usually remain in a rudimentary state during life1 cases have occurred where they have acquired an increased size1 and have been stimulated to such a functional activity as to permit of the suckling of an infant4 ,hypertrophy and ,atrophy4 ,when puberty occurs1 the breasts naturally enlarge and often become tender2 and such a temporary enlargement very commonly accompanies menstruation4 ,an increase of size1 such as normally takes place during pregnancy1 between the fourth and ninth months1 will occasionally commence at puberty1 and go on until the organ attains an enormous size4 ,in some cases the breast has been found1 after death1 to weigh as much as twenty pounds1 the tissue being perfectly normal4 ,both breasts are usually affected1 although one is commonly more so than the other4 ,after the cessation of the menses1 the breasts normally begin to atrophy4 ,we may also have an atrophy of the breast following upon lobular hypertrophy1 as described by ,sir ,a4 ,cooper4 ,inflammation and ,abscess4 ,inflammation of the ,nipple and ,areola1 preceding or following a fissured state of the nipple1 usually occurs at an early period of lactation1 and especially with the first child4 ,abscess of the areola is often a consequence4 ,inflammation of the ,breast1 generally terminating in suppuration1 may occur in three positions3 either in the subcutaneous areolar tissue1 supramammary abscess2 or in the areolar tissue1 in which the gland is imbedded1 submammary abscess2 or in the gland itself1 mammary abscess4 ,chronic ,abscess of the ,breast may be of two kinds3 the diffused and the circumscribed or encysted4 ,the former may occur at all ages1 and in the single as well as in the married4 ,it usually appears in the submammary areolar tissue1 and may acquire a very large size2 and by pushing the mammary gland before it1 gives the breast a pointed1 conical shape4 ,chronic encysted abscess1 so closely simulates various tumors in this situation1 as to render a diagnosis in some cases very difficult during life4 ,it usually commences as a result of pregnancy2 sometimes as a consequence of lacteal inflammation2 but usually without any injury or other direct local cause4 ,an indolent1 indurated swelling forms1 and this may gradually soften in the centre1 although fluctuation may for a long time be very indistinct1 and even absent1 owing to the thick wall of plastic matter that is thrown around the collection of pus4 ,it is not unfrequently attended with retraction of the nipple4 ,syphilitic ulcers are also found affecting the nipple2 while eczematous and erysipelatous inflammation in this situation are of frequent occurrence4 ,morbid ,growths4 ,the mamm are frequently the seat of adventitious growths1 presenting the characters of non-malignant and malignant formations4 ,the most common of the benignant tumors is1 perhaps1 the ,adenoid ,tumor or ,adenocele4 ,this is most frequently met with in young women under thirty years of age1 seldom commencing at a later period than forty4 ,it may remain stationary for years1 or it may slowly increase or grow very rapidly to a great size4 ,it has frequently been mistaken for cancer1 but the otherwise good health of the patient1 the mobility of the mass1 the absence of all implication of the skin or glands1 the want of hardness and its circumscribed character1 are points of diagnostic value4 ,on removal1 it appears irregularly lobulated1 is encapsulated1 and its cut surface has a bluish or grayish-white color1 which1 on exposure to the air1 assumes a rosy tint4 ,on pressure1 drops of thick1 creamy fluid will often exude4 ,according to ,birkett1 the microscope shows it to consist of imperfectly developed hypertrophy of the glandular tissue1 the terminal cells of which are filled with epithelial scales4 ,this tumor sometimes simulates malignant disease by its extreme rapidity of growth1 especially where it developes later in life4 ,it then1 after section1 presents a lobulated1 glistening appearance1 somewhat resembling a mass of rice or sago jelly1 often having cysts interspersed throughout its substance containing fluid or semi-solid glandular tissue4 ,in rare cases1 the adenocele may return1 even after extirpation of the entire mammary gland4 ,cystic ,tumors4 ,these may occur as the unilocular cyst1 or as the cysto-sarcomatous tumor4 ,unilocular cysts usually occur as a small1 thin sac1 of about the size of a filbert1 containing a clear1 serous fluid1 imbedded in the glandular structure of the breast1 and movable under the skin4 ,as they increase in size or become multiple1 their contents may assume a greenish-brown or blackish tinge from effused blood4 ,according to ,brodie1 they are originally formed by a dilatation of the lactiferous tubes4 ,unilocular cysts occasionally attain an immense size at the same time that their walls remain thin and supple4 ,in some of these instances1 the fluid continues to the last1 of a truly serous character2 while in others1 it becomes more or less glairy or mucilaginous4 ,sometimes the walls of the cysts have been found to have undergone calcareous degeneration4 ,the cysto-sarcoma1 occurs as an isolated1 globular or oval1 and more or less movable cyst2 or there are numerous growths of this kind1 varying in size from a pin's head to a hen's egg4 ,the inner surface is smooth1 or it presents a broad-based1 lobulated1 cauliflower growth or warty excrescences1 and the substance of the surrounding gland is indurated and atrophied4 ,a retraction of the nipple may also be observed4 ,a transverse section shows a double sheath3 one proper to the cyst1 and the other the result of condensation of the adjoining textures4 ,the contents are either fluid1 of a limpid1 opalescent1 non-albuminous1 or a grumous1 brownish1 highly albuminous character2 or solid1 approaching the character of a fibroid deposit1 composed of a pale1 compact substance1 traversed by undulating fibrous lines1 which imperfectly divide it into lobes of various sizes and shapes4 ,hydatid cysts1 containing the echinococus1 occur in the female breast4 ,the tumor is firm to the touch1 and contains a clear fluid1 in which the microscope detects the tenacula of the echinococus1 the animalculum itself being attached to the internal wall of the cavity4 ,fibrous1 cartilaginous and osseous tumors1 are of doubtful or very rare occurrence4 ,carcinoma4 ,cancer affects the mamm more frequently than any other organ of the body4 ,the age from forty to fifty years seems most liable to its occurrence4 ,according to ,dr4 ,walshe1 the left side is more frequently affected than the right1 and both are but rarely involved4 ,all varieties of carcinoma have been met with in the breast2 but scirrhus is by far the most frequent form in which it occurs primarily4 ,the encephaloid variety is generally engrafted upon the scirrhus1 although it may also be primary4 ,the colloid form is the most rare4 ,scirrhus appears as a hard1 lobulated tumor1 imbedded in the adipose tissue of the gland1 causing adhesion to the skin and retraction of the nipple4 ,although at first movable1 it soon becomes firmly adherent to the subadjacent parts1 and involves more or less the gland tissue1 the muscles of the thorax1 and the adjoining glands4 ,instead of an isolated tumor1 there may be an infiltration of the various structures of the part from the commencement4 ,it will then have an ill-defined outline1 sending out branches into the adjacent tissues1 and involving in its mass the lacteal tubes and lymphatics4 ,these become contracted and flattened into many bands1 giving a peculiar appearance to this form of mammary cancer not observed in any other4 ,ulceration of the skin gradually follows near the nipple2 the edges of the sore are raised1 everted and puckered4 ,the surface is of a bluish-red color4 ,a purulent1 ichorous fluid1 of a faint1 fetid odor1 is secreted2 hmorrhage may ensue1 and the patient sinks from exhaustion4 ,the average time occupied by a scirrhus in reaching its full development is from two to three years4 ,when the ulcerative stage has once begun1 the system is soon broken1 and the disease proves fatal in from six months to two years4 ,the older the individual is at the first appearance of scirrhus1 the more slowly does it pass through the various stages of its growth4 ,the axillary lymphatic glands are also in most cases found swollen1 hard1 and infiltrated with cancerous matter4 ,the pectoral muscles1 ribs and costal cartilages are also found more or less involved2 and a secondary affection of the pleura and lung is not unfrequent4 ,we may also look for dema of the extremity on the affected side1 caused towards the termination of the disease by direct interference with the venous circulation4 ,the encephaloid form occurs earlier in life1 and commonly runs a more rapid course4 ,its margin is less defined1 the base of the tumor being diffused among the healthy cellular membrane1 or other parts where it may be situated4 ,it differs from scirrhus also in this3 that the disease may advance to ulceration without any affection of the glands of the axilla4 ,the ,male ,mamm4 ,the structure of the male mamm resembles that of the female gland1 though in a rudimentary state2 hence we may find anomalies and morbid conditions in them similar to those found in the latter4 ,an increased number of mamm have been met with4 ,hypertrophy sometimes occurs4 ,there have been well authenticated instances of the secretion of milk by men4 ,the male breast may be the seat of non-malignant and malignant growths4 ,cancers1 simple cysts1 compound cysts1 and other tumors occur1 but exceptionally4 ,,part ,,iv4 ,,miscellaneous ,,subjects4 ,,chapter ,i4 ,,of ,,the ,,periosteum ,,and ,,bones4 ,section ,i4 ,,of ,,the ,,periosteum4 ,notice3 degree of vascularity2 thickness2 density2 detached or adhered2 effusions beneath2 serum or pus2 ulcerative destruction of2 condition of bone beneath1 etc4 ,inflammation of the periosteum occurs in the vicinity of chronic ulcers2 as essential to the reproduction of bone after fractures2 in consequence of syphilis or its mercurial treatment2 in rheumatism2 and as a manifestation of a scrofulous cachexia4 ,in incipient inflammation1 the membrane has a reddish tinge1 a humid1 succulent appearance1 and there is more or less of a serous effusion1 causing a slight separation from the bone4 ,as the inflammation advances1 the connection between the membrane and the bone becomes more lax1 and the effusion assumes a purulent character4 ,syphilitic inflammation of the periosteum is apt to appear in detached spots1 causing swelling1 induration1 the formation of new osseous matter and necrosis4 ,the periosteum of the skull1 sternum and tibia are most frequently attacked4 ,a malignant disease of the periosteum1 the consequence of long-continued or repeated attacks of inflammation1 is described by ,stanley4 ,it occurs on the bones of the hips1 and gives rise to the growth of a fungous excrescence upon the membrane4 8,this is sometimes soft and flocculent on its surface1 with a firm1 grayish1 gelatinous base2 at others it consists throughout of a firm1 gelatinous substance40 ,section ,,ii4 ,,of ,,the ,,bones4 ,notice3 #a4 ,surface of bone--smooth or rough1 firm and hard or soft2 periosteum present or destroyed2 caries2 necrosis2 tumors1 etc4 #b4 ,whole bone--weight and size increased1 or diminished8 bent or fractured8 #c4 ,appearance on section--density of different portions2 condition of cancellated portion2 destroyed1 or softened2 abscesses2 caries2 necrosis2 tumors1 etc4 #d4 ,medulla--density1 color1 vascularity1 morbid growths4 ,inflammation and ,abscess4 ,acute inflammation rarely takes place except in connection with mechanical injury4 ,inflammatory processes in bone1 give rise for the most part1 to an increase of medullary tissue1 and to softening of the osseous structure4 ,haversian canals and medullary spaces increase in size1 and ultimately become confluent by the gradual absorption of the surrounding osseous lamell4 ,the results of progressive inflammation are congestion1 exudation1 suppuration1 caries and necrosis4 ,an enlargement of the affected portion is invariably met with4 ,in case the exudation be absorbed1 or the inflammatory process be arrested1 the parts may return to their normal condition1 or the bone retains a permanently disorganized condition1 which may present either an increased condensation and induration1 as in gouty bone1 or an abnormal rarefaction of the bone1 as in the bones of rickety individuals4 ,the same state of rarefaction1 or osteoporosis1 according to ,lobstein1 is occasionally met with in advanced life1 as an effect of mal-nutrition4 ,suppuration1 with the formation of abscess1 may be diffused or circumscribed4 ,in circumscribed abscess1 we find a cavity generally in or near the epiphyses1 lined with a vascular membrane1 and thickening of the adjoining periosteum1 and of the surrounding cellular tissue4 ,caries4 ,caries1 a process of molecular disintegration1 may occur in all bones1 and in every part of their structure1 though it generally affects the cancellous tissue4 ,the carious bone is porous and fragile1 of a gray1 brown1 or blackish color1 partly broken down in softened masses1 and partly hollowed out into cells1 which contain a reddish-brown and oily fluid4 ,small portions of dead bone lie detached in the carious cavity4 ,the periosteal and medullary membranes1 and the bone around the carious portion1 will be found extremely vascular1 and in many cases1 compact masses of osseous tissue are deposited around the carious cavity4 ,caries of bone occurs as a result of inflammation1 and corresponds to ulceration of the soft tissues4 ,it frequently results from chronic suppurative arthritis1 when1 from destruction of the articular cartilages1 the disease attacks the cancellated structure of the extremity of the bone4 ,necrosis4 ,the death of a portion of osseous tissue1 or necrosis1 although frequently accompanied with caries1 is entirely distinct from it4 ,it attacks principally the compact tissue1 and is met with1 therefore1 most frequently in the shafts of long bones4 ,the necrosed portion is of a dirty1 yellowish-white color1 and has a dull1 opaque look2 after exposure to the air1 it gradually becomes of a green1 deep brown1 or black tint4 ,its boundaries are usually distinct1 but sometimes are so imperceptibly lost in the healthy tissue1 that it becomes difficult in the dead body to determine its exact limits4 ,necrosis results from causes which interfere with the nutrition of bone1 as from suppurative periostitis1 traumatic destruction of the periosteum1 or osteitis4 ,ulcerative destruction of the surrounding soft parts1 or the diminished vitality attending certain general diseases1 as typhus1 etc41 may also result in necrosis4 ,the death of a portion of bone is followed by inflammation at the dividing line1 which finally results in the separation of the dead portion or sequestrum4 ,this change is soon followed by the production of new bone1 in which process the periosteum and medulla may take part4 ,rachitis or ,rickets1 is essentially a disease of mal-nutrition1 most frequently affecting children between the first and third years1 although it does also occasionally occur later4 ,the lower extremities are the first to show the effects of the disease1 by a curvature commonly referred to too early attempts at walking4 ,a contortion of the bones of the pelvis1 of the spine1 the thorax1 the upper extremities1 and malformations of the skull1 may follow in the course of the disease4 ,the bone on analysis1 shows a decided diminution in the quantity of phosphate of lime1 and a uniform increase of fatty matter2 fluoride of calcium always present in healthy born1 is also wanting4 ,the joints are usually swollen1 and the epiphyses of the bones enlarged by the exudation of a reddish serum into the enlarged cancelli and canals1 the osseous corpuscles1 at the same time1 showing a deficiency or entire absence of earthy matter4 ,the periosteum is pulpy and thickened1 and more than usually adherent to the bone4 ,if a reparative process have been set up1 the deformity may have been greatly diminished1 or even entirely removed2 or a new deposit of bone taken place1 so as to afford a useful limb during life4 8,this supplementary ossification is found1 on vertical section of a long bone1 chiefly on the concave side1 so that this part of the shaft may present double and treble the thickness of the opposite side4 ,the structure1 at the same time1 is very dense1 and of ivory texture40 ,in flat bones1 as in those of the skull--which is commonly unduly large in rickety subjects--there is a uniform thickening4 ,in some cases the thickening affects the capacity of the foramina4 ,in a peculiar form of disease of the cranium described by ,elsasser1 the bone is atrophied1 soft and porous2 numerous openings are found along the lambdoidal suture1 and in the body of the bone1 with the exception of the occipital protuberance4 ,the perforations are filled up only by the dura mater and pericranium1 which are adherent to one another4 ,this disease is commonly met with between the third and sixth months of infant life4 ,mollities ,ossium1 or ,osteomalacia1 is regarded by some as a form of atrophy1 by others as identical with rachitis1 except that it attacks adults instead of children1 and by others as an essentially distinct osseous disease4 ,it is of rare occurrence1 and consists in perverted nutrition of the skeleton1 whereby the earthy phosphates are eliminated from the system by the kidneys1 while a deposit of fat takes place in the cartilaginous matrix4 ,as the bones of the trunk are especially liable to be attacked1 the individual affected becomes reduced in size by the collapse of the vertebral column4 ,it attacks females more frequently than males1 and the former chiefly after they have commenced child-bearing4 ,the disease presents two varieties--the waxy1 in which the bones1 especially those of the pelvis1 present a dirty1 dark-yellow color1 and remain greasy after drying2 and the fragile1 where the bones are of a snowy whiteness1 and of a light1 transparent1 open texture1 and so fragile that they give way under the mere pressure of the finger4 ,under the microscope1 we find the corpuscles and their canaliculi empty and transparent1 and only faintly visible1 and the ,haversian canals unnaturally enlarged4 ,morbid ,growths4 ,enchondromatous ,tumors1 are usually found in connection with some of the short bones1 more particularly those of the fingers and toes1 though the ribs1 vertebr1 sternum1 tibia and femur are sometimes attacked4 ,they may originate on the surface of the bone1 or within the cancellous tissue4 ,in the former case1 they exhibit a lobulated arrangement1 and are surrounded by a fibrous sheath2 in the latter1 the bone gradually expands with the development of the tumor4 ,the rapidity and extent of their growth vary4 ,in their microscopic characters1 the enchondroma resembles normal cartilage4 ,the central variety presents a semi-elastic feel1 and1 on section1 the knife passes through a thin1 crackling shell of bone1 and then exhibits a white1 cartilaginous mass1 which is occasionally found to contain some small cells2 while in some tumors there is an interlacement of fibrous tissue1 in which cartilage is imbedded4 ,the superficial variety is microscopically and chemically identical with the central form1 but has no osseous shell4 ,it is met with chiefly in the pelvis1 on the cranium1 and on the ribs4 ,there may be a partial ossification4 ,the disease is chiefly met with in early life4 ,osseous ,growths1 consisting of true bone1 are divided into exostoses and osteophytes4 ,the surface of the former is smooth2 their outline generally a segment of a circle or of an ellipse2 their cause3 an idiosyncracy of the individual1 not referable to any definite constitutional taint4 ,of the latter1 the surface is rough2 they do not form any well defined local1 circumscribed tumor2 are referable to rheumatic or gouty inflammation1 to syphilis or other causes4 ,exostoses are of two kinds3 the one1 hard and compact2 the other1 softer and more spongy4 ,the hard or ivory exostosis is extremely dense1 and whiter than the bone from which it springs1 but possesses a true bony structure4 ,it generally grows from flat bones1 and is of small size4 ,it has been known to necrose and to slough away from the parts on which it has been situated4 ,spongy exostoses often attain a considerable size1 and are very commonly multiple4 ,they differ from the compact variety in being composed of cancelli1 containing medullary matter1 and surrounded by a shell of bone4 ,they spring from the cancellous1 or compact tissue of the bone1 and their surface is continuous with that of the latter4 ,in some cases the cavity of the exostosis communicates directly1 or is continuous1 with the medullary cavity of the bone4 ,their most common seats are the tibia1 fibula and humerus4 ,the osteophyte chiefly affects the more vascular portions of bones1 as their articular ends1 their rough lines1 or1 in the skull1 the sutural cartilages2 being generally the product of an inflammatory process in the superficial part of the bone1 and in the periosteum4 ,fibrous ,growths always develop in the cancellous structure4 ,all the long bones and many of the flat bones are liable to this disease4 ,they present more or less elasticity1 are of a gray and opaque appearance1 and yield gelatin on boiling4 ,they may attain an enormous size4 ,cystic ,tumors are of rare occurrence1 and are generally met with in adults4 ,they may be unilocular1 usually filled with a solid mass of a fibro-cellular or fibro-cartilaginous character2 or multilocular1 with thin and serous1 sero-sanguinolent1 viscid or dark-colored contents1 often associated with central1 fibrous growths4 ,hydatid cysts have been met with4 ,according to ,stanley1 both the acephalocyst and the cysticercus cellulos have been found1 but more frequently the former4 ,tubercles are occasionally present in bone1 as the yellow1 opaque tubercles1 deposited chiefly in the spongy bones and the cancellous portions of long bones4 ,they may soften or become cretified4 ,vascular ,tumors are of not very frequent occurrence4 ,they are met with most commonly in the cancellous articular ends of the long bones2 although they have also been found in the pelvic bones1 the bones of the skull1 and in the ribs4 ,in the most frequent class of cases1 a new tissue is developed in the osseous structure1 and the tumor partakes of an encephaloid character4 ,a creamy1 curdy or brain-like1 soft1 and very vascular mass1 is formed as the essential constituent4 ,this will be found to present every shade of transition1 from a purely vascular tissue1 of an erectile character1 to true encephaloid cancer4 ,in a second1 more rare form of disease1 there is developed in the bone a vascular1 erectile growth1 closely resembling capillary nvus in its structure1 composed of an infinity of blood-vessels1 interlacing in every possible way1 so as to form a soft1 reddish-yellow tumor4 ,in a third form1 a hollow cavity is formed in the bone1 scooped out of the cancellous structure and filled with blood1 partly liquid and partly coagulated1 and having arterial branches freely opening into it4 ,according to the stage of the disease1 the blood is found in cells1 intersected by fibres1 or lamin and fibres1 the remains of the original osseous structure2 or in a more advanced stage1 in a single cavity4 ,the shell of bone surrounding the cavity is very thin and expanded1 being usually absorbed at one point1 where it often becomes at last perforated4 ,this last class constitutes true aneurism of bone4 ,cephalohmatoma1 met with in infancy on the cranial bones1 as a result of pressure during parturition1 is an effusion of blood between the pericranium and the bone1 commonly occurring on one of the parietal bones1 most frequently on the right side4 ,rare cases of internal cephalohmatoma have been recorded in which the effusion took place between the dura mater and the bones4 ,cancer of bone most frequently occurs in the head of the tibia and the lower end of the thigh bone1 occasionally in the humerus and in the jaws1 more especially about the antrum4 ,the encephaloid variety is the most frequent4 ,it is of two distinct forms3 in the one1 the morbid growth is central1 springing from the medullary canal2 in the other1 it is peripheral1 being attached to the compact osseous substance4 ,in the central form1 it is usually situated at or about the articular ends1 but always affects the whole of the bone by infiltration4 ,in the peripheral1 the more common form of cancer of the bone1 the osseous tissue is not so completely invaded2 for although the disease may be located upon1 or in intimate contact with the outer layers of the bone1 which are incorporated in it1 it does not extend into the cancellous tissue or the medullary canal4 ,in this form1 the muscles attached to the affected portion of bone will often be found extensively infiltrated with cancer cells4 ,encephaloid of bone is harder and more fibrous looking than the same affection elsewhere4 ,the cancer cell also is not so well marked1 and may indeed be absent altogether4 ,occasionally some colloid1 and more rarely melanotic matter1 is intermixed1 but scirrhus is never found in bone4 ,of the ,medulla4 8,it is yet to be determined in how far the medulla is liable to be primarily affected4 ,it varies in consistency according to the vigor of the individual2 while in dropsical and phthisical cases we find it thin and serous1 or yellow in icterus1 or very scanty in ivory condensation of a bone4 ,it exhibits greater firmness1 and a richer pink hue1 in habits tending to an inflammatory character4 ,the real seat of inflammation in bone is the membrane that lines its cavities4 ,it is1 therefore1 fair to infer that1 in all diseases dependent upon the state of the vascular system1 whether of an ordinary or of a malignant character1 the medulla is affected coincidently with1 if not previously to1 the bony tissue itself40 ,morbid growths1 of various kinds1 may be found within the medulla4 ,the ,cysticercus cellulos1 and ,echinococcus1 are said to have been detected within the medulla and periosteum4 ,,chapter ,,ii4 ,,diseases ,,of ,,the ,,joints4 ,malformations4 ,cases of congenital anchylosis1 the joints being absent1 have been met with2 also imperfectly developed joints1 with a partial or total absence of the ligaments4 ,supernumerary joints also occur1 either with the normal1 or with an excessive number of bones4 ,morbid ,conditions of the ,synovial ,membrane4 ,inflammation may be acute1 sub-acute or chronic4 ,it usually results from exposure to cold1 especially in rheumatic or syphilitic constitutions4 ,there is at first a congestion and increased vascularity of the membrane1 and a loss of its satiny polish2 the synovia is increased in quantity1 but becomes thin and serous1 and at a later period1 mixed with plastic material4 ,if the disease progress1 the vascularity and swelling of the membrane increase1 and it becomes turgid and distended with blood and effused fluids2 a thin1 purulent-looking fluid1 composed of granular corpuscles1 floating in a serous liquid1 is poured out1 and disintegration1 with thinning and erosion of the cartilage1 ensues2 or granulations are thrown out on the looser portions of the membrane1 and1 becoming injected with blood-vessels1 form fringed membranous expansions1 in contact with the ulcerating part of the cartilage4 ,in chronic synovitis1 the swelling from the accumulated serous fluid may become so considerable as to constitute a true dropsy of the joints--hydrarthrosis4 ,this same accumulation may1 however1 take place without any evidence of preceding inflammation4 ,pulpy ,degeneration of the ,synovial ,membrane is peculiar to the articular lining membranes1 nothing analogous having been found in the serous sacs4 ,the reflected portions of the synovial membrane are first attacked1 and converted into a light-brown1 pulpy substance1 from a quarter to a half1 or even a whole inch in thickness1 intersected with white membranous lines and red spots1 formed by small injected vessels4 ,the membrane of the cartilages are then invaded1 ulceration in the cartilages going on at same time1 till the ulcerating surfaces of the bone are exposed4 ,the disease almost always occurs before the middle period of life1 frequently can be traced to no cause1 but is occasionally the consequence of repeated attacks of inflammation4 ,it generally occurs in the knee1 but has been met with in the ankle and in a joint of the finger4 ,a growth of large villous processes1 presenting a shaggy appearance1 is sometimes observed4 8,they have sometimes the form of simple threads or flattened shreds1 or their free extremities are split into filaments or have a club shape1 or resemble melon-seeds hanging singly1 or in clusters from each stalk4 ,in many cases1 the healthy texture of the articulation is not materially affected40 ,morbid ,conditions of ,burs4 8,these small synovial sacs are liable to be affected much in the same way as larger ones4 ,they may be attacked by inflammation more or less acute or quite chronic1 resulting from rheumatism1 the abuse of mercury1 or some other constitutional affection2 or excited by violence or long-continued pressure4 ,the effusion which takes place may1 in cases of a chronic kind1 be a simple synovial or serous fluid2 but when the inflammation is more acute1 it is either a turbid serum1 with flakes of fibrinous matter floating in it1 or actual pus40 ,the walls of an inflamed bursa sometimes become very much thickened by the organization of layers of fibrinous effusion4 ,in cases of long-standing inflammation1 flat oval bodies1 resembling melon-seeds1 of a light-brown color1 are not unfrequently met with4 ,their origin is no doubt to be traced to the coagulated lymph effused in the beginning of the disease4 ,in the synovial sheaths surrounding the flexor tendons of the fingers1 as they pass under the annular ligament1 small bodies1 resembling grains of boiled rice1 are also occasionally found4 ,the so-called ganglions are small collections of fluid in bursal cavities of new formation1 and occur principally on the back of the wrist and forearm4 ,in the sheaths of the tendons of the hand1 these synovial accumulations may become so excessive1 as to greatly damage the usefulness of the member4 ,morbid ,conditions of ,cartilage4 ,the thickness of cartilage may be greatly increased1 while the tissue becomes soft and yielding4 ,in advanced age1 the articular cartilages become considerably thinned2 ossification of the cartilage occurs1 sometimes gradually with advancing years1 at others in connection with chronic rheumatic arthritis4 ,in joints apparently not diseased1 we sometimes find the cartilages more or less deficient at one or more points1 due to pressure and consequent partial atrophy4 ,sometimes its place is taken by a hard1 semi-transparent substance of a gray color1 with an irregular granulated surface1 the result of a fibrinous exudation4 ,the free surface of cartilages is occasionally found covered with a thin layer of lithate of soda1 as the result of gout4 ,loose cartilages may be found in the knee and other large joints2 they never contain any of the characteristic cells of cartilage1 and appear to consist solely of compressed fibrillating exudation4 ,they vary in size and number1 are more or less oval and flattened1 with a smooth surface1 and are sometimes attached to the synovial membrane by a pedicle of varying length4 ,in the latter case1 they are invested by a serous covering4 ,calcareous deposits are occasionally met with in them4 ,ulceration of ,cartilage may occur as an acute or sub-acute affection4 ,the cartilage corpuscles1 instead of being of their usual form1 will be found larger1 rounded or oviform2 and instead of two or three nucleated cells in their interior1 they contain a mass of them4 ,the cavities of the enlarged corpuscles open on the ulcerated surface1 by orifices of various sizes4 ,the texture of the ulcerating cartilage1 shows no trace of vascularity4 ,in most cases1 a vascular false membrane is found in opposition to the diseased part4 ,the membrane generally adheres with some firmness to the ulcerating surface1 in other instances it is loosely applied to it2 but in all cases the two surfaces are accurately moulded to each other4 ,if a portion of the false membrane be torn slowly off1 the cartilage will be found to be rough and honeycombed1 and into each depression on its surface1 a nipple-like projection of the vascular membrane will be seen to have penetrated4 ,chronic ,rheumatic ,arthritis is very frequent in the hip1 the shoulder1 the knee1 and the articulations of the hand4 ,the process consists essentially1 first1 in an hypertrophy of the articular cartilage1 generally at the margin1 and principally near to the articular surface4 ,secondly1 in the development of true osseous tissue in the hypertrophied cartilage4 ,we will1 therefore1 find irregular enlargement of the articulating head of the bone2 an absence of the articular cartilages1 or new osseous growths surrounding their margins2 and the synovial sacs presenting evidences of having been the seat of chronic inflammation4 ,scrofulous ,arthritis1 or ,white ,swelling1 attacks primarily the articular extremities of the bones4 ,they become very vascular and softened1 so that they can be readily cut with a knife1 while a characteristic transparent and afterwards a yellow1 cheesy substance is deposited in their cancelli4 ,as the disease advances1 the cartilage ulcerates1 and the osseous tissue gradually wastes and undergoes a true caries4 ,abscess forms in the joint1 and finds its way by ulceration to the external surface1 causing numerous and circuitous sinuses in the neighboring soft parts4 ,in some cases1 the disease may commence in the synovial membrane1 extending finally to the cartilages and ultimately to the bone4 ,the disease affects principally the joints of children1 and rarely occurs after the age of thirty4 ,the existence of scrofulous disease in other parts1 and the deposition of the yellow1 cheesy matter within the cancelli1 will serve to distinguish this disease from simple caries1 resulting from inflammation4 ,disease of the ,spinal ,column4 ,the joints of the vertebr are liable to nearly the same affections as more perfectly developed articulations4 ,the scrofulous disease just described may attack the cancellous tissue1 causing caries and the deposition of cheesy matter4 ,the first effects are generally perceptible where the intervertebral cartilage is connected with the bone1 or in the intervertebral cartilage itself1 although ulceration may commence on any part of the surface1 or even in the centre of the bone4 ,in some cases1 of rarer occurrence1 the bodies of the vertebr are affected with chronic inflammation1 with ulceration of the intervertebral cartilages as the consequence4 ,if not checked1 the disease proceeds to the destruction of the bodies of the vertebr and of the intervertebral cartilages1 leaving the posterior parts of the vertebr unaffected4 ,the necessary consequence is a curvature of the spine forward1 and a projection of the spinous processes posteriorly4 ,chronic inflammation of the bones sometimes extends to the membranes of the spinal cord2 and when the curvature is very great1 the cord may be so compressed that it cannot properly discharge its functions4 ,suppuration may take place at different stages of the disease1 sometimes earlier1 sometimes later4 8,the soft parts in the neighborhood of the abscess become thickened and consolidated1 forming a thick capsule1 in which the abscess is sometimes retained for several successive years2 but from which it ultimately makes its way to the surface1 presenting itself in one or another situation1 according to circumstances4 ,in the advanced stages of the disease1 new bone is often deposited in irregular masses on the surface of the bodies of the neighboring vertebr2 and where recovery takes place1 the carious surface of the vertebr above1 coming in contact with that of the vertebr below1 they become united with each other1 at first by soft substance1 afterwards by bony anchylosis40 ,where the bones are affected by scrofula1 bony anchylosis does not so readily take place as where they retain their natural texture and hardness4 ,occasionally1 portions of the ulcerated or carious bone lose their vitality1 and having become detached1 are found lying loose in the cavity of the abscess4 ,the pressure of a large abscess on the surfaces of the contiguous vertebr may cause an extensive caries far beyond the limits of the original disease4 ,,chapter ,,iii4 ,,of ,,tumors4 ,in giving a brief description of tumors1 the following classification has been adopted from ,gross1 as presenting the most practical and convenient arrangement of the subject3 ,i4 ,benign or ,non-,malignant ,tumors4 #a4 ,cystic ,tumors4 a4 ,simple ,cysts2 including ,serous1 ,mucous1 ,synovial1 ,colloid1 ,sanguineous1 ,salivary1 ,milk1 ,oil1 ,seminal1 and ,dermoid ,cysts4 b4 ,compound or ,proliferous ,cysts4 #b4 ,hydatid ,tumors4 #c4 ,myxomatous #d4 ,lipomatous #e4 ,fibrous #f4 ,cartilaginous #g4 ,osseous #h4 ,papillary #i4 ,polypoid ,tumors4 #aj4 ,myomatous #aa4 ,vascular #ab4 ,neuromatous #ac4 ,adenoid #ad4 ,lymphatic ,,ii4 ,malignant ,tumors4 #a4 ,sarcomatous ,tumors4 a4 ,the ,round ,celled4 b4 ,the ,spindle ,celled4 c4 ,the ,giant ,celled4 #b4 ,carcinomatous ,tumors4 a4 ,scirrhus ,tumors4 b4 ,encephaloid c4 ,melanotic d4 ,colloid ,tumors4 e4 ,epithelial ,i4 ,benign or ,non-,malignant ,tumors4 #a4 ,cystic ,tumors4 ,these are of very frequent occurrence1 and may acquire an extraordinary size4 ,their structure may be simple or very complex1 and we may accordingly divide them into simple or barren1 and compound or proliferous cysts4 ,they may be new formations or1 as in most cases1 merely hypertrophies4 ,they occur in nearly every organ and tissue of the body1 but are most frequently met with in the skin and mucous membranes1 the glandular organs1 and in the subcutaneous cellular tissue4 ,a4 ,simple ,cysts generally consist of a thin sac or cyst filled with contents1 varying according to the structure and function of the affected part4 ,the cyst itself may be solitary or multiple1 generally composed of a single layer1 its external surface being rough and adherent to the surrounding tissues1 while the internal surface is shining or glossy1 and in immediate but loose contact with the contents of the tumor4 ,according to the nature of their contents1 we may find the following varieties of simple cysts3 ,serous ,cysts4 ,their contents are generally of a thin1 watery character1 slightly saline in taste1 and consisting largely of albuminous material4 ,the walls are thin1 and at first translucent2 as they grow older they become thicker and denser4 ,mucous ,cysts generally contain a thick1 ropy1 glutinous material1 intermixed with epithelial matter4 ,sometimes the contents are thin and clear2 occasionally they resemble the fluid contained in a synovial bursa4 ,such tumors occur chiefly in connection with the mucous membranes1 are generally spherical or pyriform in shape1 and may attain the size of a ftal head4 ,synovial ,cysts are generally small in size1 rounded1 globular1 or hemi-spherical in shape1 with contents of a serous1 mucus1 glutinous1 colloid1 or of a jelly-like consistence1 and of a whitish1 opaque appearance4 ,they occur generally in the synovial sheaths of the tendons of the wrist1 and on the front of the patella4 ,the most characteristic types of synovial cysts are those known as ganglions and burs4 ,colloid ,cysts are rarely met with as independent structures2 they usually occur as accidental constituents of various kinds of morbid growths4 ,their contents vary in consistence between mucus and the thickest jelly1 8their color being generally whitish or pearl-like1 not unfrequently blended with shades of pink1 yellowish-brown1 or olive-green40 ,sanguineous ,cysts1 or hmatomata1 may be entirely new formations1 or may occur in a normal cavity4 ,their contents may consist either of pure blood or of blood mingled with serum and other substances4 8,the cyst wall is usually very thin and smooth2 but in some cases the inner surface has a peculiar fasciculated appearance1 not unlike that of the right auricle of the heart40 ,the cyst is commonly small1 and of a rounded or hemi-spherical shape4 ,salivary ,cysts are most frequent in connection with the sublingual gland1 constituting the so-called ranula4 ,the contents of these cysts are thick and ropy1 like the white of egg1 and consist essentially of saliva1 mixed with mucus and epithelial matter4 ,milk ,cysts are liable to be formed in the mammary gland during lactation4 ,their size varies4 ,their contents may be pure milk and perfectly liquid1 or mixed with caseous and epithelial substances4 ,oil ,cysts are of rare occurrence1 and usually of quite small size4 ,they occur most frequently in the skin or in some glandular organ1 especially the breast4 ,their contents are generally fatty matter1 with epithelial and other substances4 ,seminal ,cysts are never of independent growth4 ,they contain a fluid1 mostly serum1 with the characteristic spermatozoa held in suspension1 and only to be detected by the microscope4 ,the only true tumors of this kind are hydroceles of the spermatic cord4 ,dermoid ,cysts are usually congenital1 and1 in the majority of cases1 contain the debris of a blighted ovum1 such as hairs1 teeth and bone4 ,sebaceous tumors are a variety of dermoid cysts1 and contain sebaceous matter1 combined with epithelium and even hair1 oil or fat4 ,b4 ,compound or ,proliferous ,cysts are 8characterized by the existence of subordinate cysts1 occupied by different organized substances1 and giving rise to that peculiar arrangement known as multilocular or polycystic1 generally so conspicuous in this class of tumors40 ,when a number of cysts are crowded together1 their walls are frequently absorbed1 and irregular cavities1 varying in size and shape1 are thus formed4 ,their contents are of the most diversified character4 ,the cyst wall is thin at first1 but becomes thicker and firmer in a later stage4 ,proliferous cysts sometimes take on a malignant character1 of the encephaloid or epithelial type1 years after their origin4 ,they occur most frequently in the ovary1 the mamm1 and the thyroid gland4 ,in the first situation1 they not unfrequently attain an enormous size4 #b4 ,hydatid ,tumors4 ,these tumors occur most frequently in the liver1 ovary and uterus4 ,they consist of a distinct sac1 enclosing an entozoon1 parasite or vesicular worm1 8varying in volume between a mustard-seed and a small orange4 ,the entozoon is of a globular figure1 of a whitish1 semi-opaque appearance1 and composed of a vesicle or bladder1 filled with serous fluid1 and surrounded by a cellulo-fibrous capsule40 ,generally a number of them are found in a common cyst4 8,the contents of the animal are of a clear1 limpid character1 remarkably saline to the taste1 but destitute of odor and coagulability4 ,between the cyst and the parasite there is commonly a soft1 pulpy1 dirty-looking substance1 the precise nature of which is undetermined4 ,large hydatids sometimes contain several smaller ones1 one within the other40 8,the inner surface of the parasite is studded with numerous little bodies1 resembling diminutive fish-spawn1 hardly as large as a grain of sand1 of a spherical shape and of a grayish color1 each consisting of a delicate cyst1 filled with echinococci40 8,each echinococcus consists of a body and a head1 the latter being encircled by a row of teeth1 naturally concealed in a narrow cleft1 but capable of projecting itself4 ,the body1 composed of solid1 granular matter1 has a curiously speckled appearance1 due to the presence of numerous ovoid spots immediately beneath its outer coat4 ,the teeth1 or hooklets1 are spinous1 sharp1 and perfectly characteristic40 #c4 ,myxomatous ,tumors4 ,the ,myxomata or mucous tumor1 consists of mucous tissue1 a translucent and succulent connective tissue1 the intercellular substance of which yields mucin4 ,their characteristic features are elasticity and softness2 the older growths1 however1 are harder than the more recent ones4 ,they are of a pale1 greyish or reddish-white color4 ,they consist of a basement structure1 the proper stroma of the tumor1 and an intercellular substance1 pervaded by distinctly visible blood-vessels4 ,on being cut1 they yield1 on pressure1 the tenacious1 mucilaginous1 intercellular liquid1 in which may be seen the cellular elements of the growth4 ,the majority of the cells1 under the microscope1 are found to be angular and stellate1 with long1 anastomosing prolongations and trabecul4 ,others are isolated and fusiform1 oval or spherical in shape4 ,they usually possess one1 in some cases two distinct nuclei4 ,fat cells1 fibrous tissue1 both white and elastic1 and cartilage in varying proportions1 are often met with in the morbid mass4 ,they occur chiefly in the subcutaneous and intermuscular cellular tissues1 in the mucous cavities1 in the hilus of the kidney1 and in the nerves and bones4 ,when situated in superficial parts they may become pedunculated4 ,in the submucous tissue of the nose they constitute the gelatinoid polypus4 ,other perfect types of mucous tumors are seen in the polypi of the ear and the uterus4 #d4 ,lipomatous ,tumors4 ,the ,lipomata or fatty tumors are very common1 and may occur in any part of the body4 ,there may be but one1 or they may appear in very large numbers in different parts of the body4 ,they sometimes attain an enormous size4 ,they are lobulated1 and are usually surrounded by a fibrous capsule1 which separates them from the adjacent structures4 ,their consistence varies according to the amount of fibrous tissue that enters into their formation4 ,they frequently become pedunculated1 or assume a pyriform shape1 no doubt by reason of their weight1 by which they are gradually dragged out of their original shape1 as well as position4 ,they resemble in structure1 as also in appearance on section1 adipose tissue4 ,they consist of more or less round or polygonal cells1 distended with fluid fat1 and united into masses or lobules of various sizes by connective tissue1 which also forms a sort of capsule around the tumor1 and connects it more or less firmly to the parts around4 ,inflammation1 suppuration1 ulceration1 and even gangrene may occur in these growths4 ,they may also undergo at certain points1 fibrous1 cartilaginous or osseous degeneration4 ,cysts filled with various kinds of substances may also occasionally occur within them4 #e4 ,fibrous ,tumors4 ,the ,fibromata appear in very different parts of the body1 commonly in those which normally contain much fibrous tissue4 ,several may exist in the same organ1 more particularly in the uterus1 rarely do they coexist in separate organs4 ,their form is mostly spherical1 generally with a smooth1 even surface1 although not unfrequently it is lobulated1 or marked by numerous elevations and depressions4 ,they feel heavy and incompressible4 ,near a free surface they are prone to become pedunculated4 ,they may attain a very great size4 ,their vascularity is in proportion to the density of their structure1 some having but few vessels1 while others are highly vascular4 ,a distinct capsule is but seldom met with1 although the tissues around the tumors will usually be found a great deal condensed and thickened4 ,they consist essentially of fibres1 resembling those of areolar tissue4 8,sometimes the fibres are tolerably distinct and separate1 more often so interlaced and blended together1 or so imperfectly evolved that they cannot be made out as such4 ,yellow elastic fibres are not unfrequently mingled with the white40 ,growths of this kind are not1 in general1 liable to any great degree of change4 ,inflammation1 with injection and softening of the part may take place4 ,cretification may occur1 by which either the whole tumor may be converted into a calcareous mass1 or only the outer stratum surrounding the rest as a kind of shell4 #f4 ,cartilaginous ,tumors4 ,the ,enchondromata1 histologically resemble cartilage1 and like it consist of cells and an intercellular substance1 presenting all the variations observed in the normal tissue4 ,the intercellular substance may be hyaline1 fibrous1 or mucoid1 or as most frequently is the case1 all combined4 ,the cells are round1 oval1 spindle-shaped or stellate1 and may be very numerous1 or few in proportion to the matrix4 ,they enclose one or more nuclei1 and slightly granular contents2 sometimes a cell-wall cannot be distinguished4 ,in addition to the intercellular tissue1 the growth is usually divided into several lobes by bands of fibrous tissue4 ,the fibrous tissue in most cases1 forms a capsule around the tumor1 and separates it from the surrounding structures4 ,the enchondroma is met with most frequently in early life1 and occurs chiefly in connection with the osseous system1 principally the metacarpal bones1 and phalanges of the fingers1 where it may grow either from the periosteum or from the medulla4 ,it is met with also in the parotid and submaxillary glands1 in the testicle1 mamm and ovary1 and occasionally in the subcutaneous and intermuscular cellular tissue4 ,they may attain an enormous size4 8,to the hand1 it imparts the sensation of unusual firmness and solidity2 it is destitute of elasticity1 is generally distinctly circumscribed1 and is nearly always strongly adherent to the tissues from which it springs40 ,calcification and ossification of these tumors may occur4 ,in rare cases1 the skin covering the tumor ulcerates1 and a fungating mass protrudes4 ,although in general an innocent growth1 the enchondroma in some instances1 assumes a malignant form1 and recurs after extirpation4 #g4 ,osseous ,tumors4 ,the ,osteomata are tumors consisting of osseous tissue1 met with chiefly as outgrowths of the skeleton1 especially of the external and internal surfaces of the skull1 and of the thigh bone4 ,there are three classes1 the soft1 spongy or cancellous1 the compact1 and the eburnated osteoma4 ,the spongy1 which is the most common1 consists of cancellous osseous tissue4 ,the medullary spaces may contain embryonic tissue1 a fibrillated tissue1 or fat4 8,in its earlier stages1 it is often invested by a layer of cartilage1 of a greenish1 whitish1 slightly bluish1 or pearly aspect1 and of a hyaline character4 ,sometimes it is enclosed by a thin1 fibrous1 or fibro-cellular capsule1 a form of synovial bursa1 lubricated by serous or sero-oleaginous fluid40 ,the compact osteoma is generally more or less rounded1 with a nodulated surface1 and a broad base4 ,it is of a firm1 bony consistence1 and resembles1 as nearly as possible in structure1 the compact tissue of the long bones1 differing only in the arrangement of the ,haversian canals and canaliculi1 which is less regular than in normal bone4 ,the eburnated osteoma consists of dense osseous tissue4 ,the lamell are arranged concentrically and parallel to the surface of the tumor4 ,blood-vessels and cancellous tissue are both absent4 ,the tumor is of small size1 rounded1 globular or hemi-spherical in shape1 and generally smooth1 or slightly nodulated4 #h4 ,papillary ,tumors4 ,the ,papillomata resemble in structure ordinary papill1 and like these grow from cutaneous and mucous surfaces4 ,they consist of a basis of connective tissue1 supporting blood-vessels1 which terminate in a capillary net-work1 or in a single capillary loop1 the whole being enveloped in a covering of epithelium1 varying in character according to the surface from which the new formation springs4 ,these growths are sometimes very vascular4 ,on the skin we may have these growths as warts and horny growths4 ,these are commonly firm1 with a dense epithelial covering1 and are less liable to ulceration and hmorrhage1 than those growing on other parts4 ,but we have1 in the condylomata and venereal warts1 occurring around the anus and upon the external male and female genital organs1 instances of larger and more vascular forms on cutaneous surfaces4 ,on the mucous membranes1 the papillomata are softer and more vascular1 and have a less dense epithelial covering4 ,many of them constitute so-called mucous polypi4 ,they are met with on the tongue1 in the larynx and nose1 in the gastro-intestinal mucous membrane1 on the cervix uteri1 and in the bladder4 #i4 ,polypoid ,tumors4 ,these growths occur exclusively in the mucous cavities of the body1 and may attain a large size4 ,they occur most frequently in the nose and the uterus1 but are also met with in the ear1 maxillary sinus1 vagina and rectum1 while their presence in the larynx and throat is exceedingly rare4 ,they are usually solitary1 varying in size and shape according to the locality which they occupy4 ,four varieties are met with1 differing essentially in their structure4 ,the gelatinoid polypus1 the most common of all1 occurs almost exclusively in the nose4 ,it is of a jelly-like appearance1 irregularly pyriform in shape1 with a narrow pedicle1 sometimes nearly an inch in length4 ,it is nourished by a few straggling vessels1 which are often of considerable length and thickness4 ,the structure of the fibrous polypus is exceedingly dense and composed of fibres1 interlacing with each other in all directions4 ,it is tough1 hard and incompressible2 of a reddish1 purple or livid hue4 ,it is nearly always solitary1 may attain a large size1 and is usually attached firmly by a broad base1 and not by a pedicle4 ,the uterus1 nose and maxillary sinus1 are its most common sites4 ,the granular polypus1 is of rare occurrence4 ,it is met with chiefly in the uterus and in the ear4 ,it is generally small1 of a pale1 greyish1 or whitish color1 soft and fragile in consistence1 and globular1 conical1 or ovoidal in shape4 ,its structure is granular1 homogeneous and inelastic4 ,the vascular polypus1 attached usually by a narrow base1 is of a florid color1 of a soft consistence1 and not very large in size4 ,on section we find numerous vessels interspersed throughout a fibro-cellular tissue4 ,carcinomatous disease is more liable to supervene in the case of the fibrous growths1 than in the other of these formations4 #aj4 ,myomatous ,tumors4 ,the ,myomata are tumors consisting of muscular tissue1 either of the striated1 or nonstriated variety4 ,the former are exceedingly rare and generally congenital1 the latter are quite frequent and are never congenital2 but occur principally in elderly subjects4 ,they are met with most frequently in the uterus1 where they sometimes attain an immense size4 ,they form either distinctly circumscribed tumors of a globular1 conical1 or pyriform shape1 or ill-defined masses in the uterine walls4 ,when projecting into the cavity of the uterus1 or into the abdominal cavity1 they assume the shape of polypi1 with a narrow pedicle4 ,myomata may also occur in the prostate gland1 in the sophagus1 stomach and intestines4 8,in structure they consist of elongated spindle-shaped cells1 more or less isolated1 or grouped into fasciculi of various sizes1 with a varying amount of connective tissue40 ,maceration with dilute nitric acid1 is often necessary in order to isolate and display the muscular elements4 #aa4 ,vascular ,tumors4 ,the ,angiomata are tumors consisting of blood-vessels1 held together by a small amount of connective tissue4 ,they include the various forms of nvi1 the erectile tumors1 and aneurism by anastomosis4 ,they are generally met with as congenital affections4 ,their ordinary sites are the skin and mucous membranes1 especially about the head1 face and tongue4 ,they are soft and spongy1 easily compressible1 and very elastic1 varying in color according to the nature of their contents1 whether venous or arterial1 or both combined4 #ab4 ,neuromatous ,tumors4 ,true ,neuromata are tumors consisting almost entirely of nerve tissue4 ,the term has also been applied to growths of other kinds1 found in connection with nerves2 these are false or spurious neuromata4 ,true neuromata are of very rare occurrence4 ,they consist mainly of a new growth of nerve fibres4 8,they resemble in structure the cerebro-spinal nerves1 consisting of tubular fibres1 with a varying quantity of intertubular connective tissue1 and in some cases a few gray1 gelatinous fibres40 ,they usually exist as small1 single nodules1 solid to the touch1 firm1 inelastic1 and developed within the neurilemma of the affected nerve4 ,the most frequent seat of these growths is the extremities of divided nerves1 where they sometimes occur after amputation4 ,they may also exist in the course of the nerves1 in any situation1 singly1 or in great numbers4 #ac4 ,adenoid ,tumors4 ,the ,adenomata are new formations of gland tissue1 resembling in structure the racemose1 or tubular glands4 8,they consist of numerous small saccules or tubes filled with squamous or cylindrical epithelial cells4 ,these are grouped together1 being merely separated by a small1 though varying amount of connective tissue1 in which are contained the blood-vessels40 ,they are essentially local hyperplasias4 ,the new growth may remain in intimate relation with the adjacent gland1 or it may gradually become separated from it by the formation of a fibrous capsule4 ,the adenoma is usually a solitary tumor1 of a firm1 dense1 inelastic consistence1 of a whitish1 grayish1 or pale straw color1 seldom larger than a hickory nut4 ,on section1 the cut surface has a glistening appearance1 and in recent cases never yields any fluid on pressure4 ,it occurs in the mammary1 thyroid1 prostate1 and parotid glands1 and in the mucous follicles4 ,in mucous surfaces1 it gradually projects above the surface of the membrane1 so as to form a polypus1 and thus constitute the most common form of mucous polypus4 #ad4 ,lymphatic ,tumors4 8,the ,lymphomata are new formations consisting of lymphatic1 or as it is more commonly called1 adenoid tissue4 ,this tissue consists essentially of a delicate reticulum1 within the meshes of which are contained the so-called lymph corpuscles4 ,the reticulum is made up of very fine fibrils1 which form a close net-work1 the meshes of which are only sufficiently large to enclose a few1 or even a single corpuscle in each4 ,the fibrils usually present a more or less homogeneous appearance1 and amongst them there are a few scattered nuclei40 ,the lymphatic tumor is most frequently met with in the lymphatic glands of the neck1 axilla1 groin1 and mesentery1 and usually consists of several enlarged glands1 fused into one common mass of variable size1 shape1 and consistence4 ,the sectional surface is of a grayish1 light pink1 or reddish-yellow color1 and yields on pressure a whitish1 lactescent juice1 not unlike that of certain forms of carcinoma1 containing cells with one or more nuclei4 ,,ii4 ,malignant ,tumors4 #a4 ,sarcomatous ,tumors4 ,the ,sarcomata are tumors consisting of embryonic connective tissue4 ,this differs from the fully developed tissue1 in consisting almost entirely of cells1 which are also larger and rounder than those of mature tissue4 ,its intercellular substance1 instead of being fibrous1 is soft and amorphous or only obscurely fibrillated4 ,the cells of sarcoma are round1 spindle-shaped or stellate1 and exist either separately or in conjunction in the same tumor4 ,the latter is most frequently the case2 but one form generally predominates1 and according to the preponderance of one or the other kind of cell1 these tumors can be most conveniently classified as round-celled1 spindle-celled1 and giant-celled sarcomata4 ,round cells are found in all sarcomata1 and are often very small1 scarcely distinguishable from lymphatic cells1 or white blood corpuscles4 ,others are larger1 and contain an indistinct nucleus1 with one or more bright nuclei4 ,the fusiform or spindle-shaped cells are the so-called fibro-plastic cells4 ,they are long1 dimly granular1 pale bodies1 terminating at each end in a fine prolongation4 ,they are slightly granular1 and enclose a long1 oval nucleus1 with or without nucleoli4 ,in size they vary4 ,the giant or mother cells are the largest of human cells1 irregular in shape1 though usually more or less spherical4 ,they are finely granular1 and contain numerous round or oval nuclei1 each with one or more bright nucleoli4 ,the intercellular substance exists usually in small quantities4 8,it may be perfectly fluid and homogeneous1 or firmer and granular1 or1 less frequently1 more or less fibrillated4 ,chemically1 it yields albumen1 gelatin and mucin40 ,these growths may occur at any period of life1 but are most frequently met with between the twentieth and fortieth year4 ,it is most common in the skin and subcutaneous and intermuscular connective tissues of the extremities4 ,the periosteum and bones1 particularly the epiphyses of the long bones and the maxill1 the female breast1 the testicles1 and the eye1 are also liable to be attacked4 ,they usually arise as nodules1 single or multiple1 firm or soft1 and often attain an enormous size by their characteristic rapidity of growth4 ,they are liable to fatty degeneration1 with the production of cyst-like cavities4 ,calcification1 ossification and mucoid degeneration are also common4 ,sarcomata are decidedly malignant1 and are characterized by their rapid growth1 their great tendency to extend locally1 and to recur after removal1 and by their power of reproducing themselves in internal organs4 ,the ,round-celled ,sarcoma1 called also from its resemblance in many cases to encephaloid1 medullary1 encephaloid or soft sarcoma1 is of a uniform1 soft1 brain-like consistence1 and of a somewhat translucent1 greyish1 or reddish-white color4 ,the sectional surface1 on being scraped1 yields a juice rich in cells4 ,it is exceedingly vascular1 with the vessels often dilated and varicose4 8,it can be distinguished from encephaloid cancer by the absence of a fibrous stroma1 by the uniformity in the character of its cells1 and by the absence of any invasion of the surrounding structure in their growth other than the connective tissue from which they grow40 ,the ,spindle-celled ,sarcoma1 called also the fibro-plastic and recurring fibroid1 is most closely allied to the fibroma4 ,it consists essentially of fusiform cells1 with well-marked nuclei and thin processes1 sometimes split at the end4 ,they are nearly in close contact1 there being but little intercellular substance4 ,the cells are parallel and arranged in bundles1 which pass in all directions through the growth4 8,when cut1 this sarcoma grates under the knife1 and the surface exhibits a firm1 tough1 greyish or pale-yellowish appearance1 similar to that of ordinary fibrous growth4 ,after removal1 they are softer and more succulent when they recur40 ,they grow from the periosteum1 the fasci1 and from the connective tissue in other parts4 ,they are more frequently enclosed in a capsule than the other varieties4 ,the ,giant-celled ,sarcoma1 called also the myeloid sarcoma1 most frequently occurs in connection with bone4 ,they consist of large1 many nucleated cells1 mingled with round or spindle forms1 nearly in contact1 there being but a sparse intercellular substance4 ,on section1 the surface appears smooth1 compact1 shining1 greyish-white or greenish1 with blotches of a dark crimson1 brownish or pink hue4 ,the giant-celled sarcoma is not a benign affection1 but is the least malignant of the sarcomas4 #b4 ,carcinomatous ,tumors4 8,the ,carcinomata are new formations1 consisting of cells of an epithelial type1 without any intercellular substance1 grouped together irregularly within the alveoli of a fibrous stroma4 ,the cells are characterized by their large size1 by the diversity of their forms1 and by the magnitude and prominence of their nuclei and nucleoli4 ,in size they vary from to of an inch in diameter1 the majority being about five times as large as a red blood-corpuscle4 ,they are round1 oval1 fusiform1 caudate1 polygonal--exhibiting1 in short1 every diversity of outline4 ,the nuclei1 which are large and prominent1 are round or oval in shape1 and contain one or more bright nucleoli40 ,there is generally but a single nucleus1 two1 however1 are often met with1 and they are even still more numerous in the soft varieties of cancer4 ,the stroma varies in amount4 ,it consists of a fibrillated tissue1 forming by their peculiar arrangement1 alveoli of various sizes and shapes1 in which the cells are grouped4 ,the stroma varies in character according to the rapidity of its growth4 ,where its growth is rapid1 it will contain numerous round and spindle-shaped cells2 where it is slow1 or has ceased altogether1 the tissue will contain but few cells1 and will be dense and fibrous in character4 ,the latter condition is most frequently met with4 ,the blood-vessels are sometimes very numerous1 and are always limited to the stroma1 and never encroach upon the alveoli4 ,this serves to distinguish the carcinomata from the sarcomata1 since in the latter the blood-vessels ramify amongst the cells of the growth4 ,the carcinomata also possess lymphatics1 and it is owing to this that the lymphatic glands are so constantly involved in the disease4 ,cancers very rarely become encapsuled1 but generally invade the surrounding structures4 ,the epithelial elements are found infiltrating the tissues for some distance around the tumor1 so that there is no line of demarcation between it and the normal structures4 ,carcinomatous tumors are liable to certain alterations and transformations1 like other morbid growths4 ,fatty degeneration is the most common of these4 ,this occurs to a greater or less extent in all the varieties of cancer4 ,it produces softening of the growth1 which is often reduced to a pulpy1 cream-like consistence4 ,calcareous degeneration has been occasionally met with in encephaloid1 and in carcinoma invading bone4 ,inflammation1 softening1 and consequent ulceration1 are not unfrequent4 ,the varieties of carcinomata are3 7a47 ,scirrhus4 ,scirrhus1 fibrous1 hard or chronic cancer1 seldom occurs before middle age1 and more frequently in the female than male4 ,the liver1 mamm and uterus1 are particularly liable to be attacked4 ,it also occurs in the alimentary canal1 and in the skin4 ,scirrhus is characterized by the large amount of its stroma1 and its slow growth4 ,the tumor is firm1 hard and inelastic1 of variable shape1 and is often depressed in the centre1 owing to the contraction of the cicatricial tissue4 ,on section1 especially in the more matured stages1 the tumor exhibits a whitish1 glistening aspect1 intersected with fibrous bands1 the remains of normal tissue1 changed by disease4 ,it yields on being scraped1 a peculiar fluid1 the so-called cancer juice1 generally of a pale1 grayish1 turbid appearance1 rich in cells1 nuclei and granules1 sometimes of a whitish1 creamy hue4 ,this juice is evidently the result of disintegration1 and is hence but sparingly present in recent specimens4 ,it readily mixes with water1 and often contains a quantity of free oil4 ,scirrhus has but few blood-vessels4 ,nerves and lymphatics also exist4 ,it has a tendency to ulcerate1 and to contract adhesions with the structures surrounding it4 ,the lymphatic glands are also liable to be infected1 by the conveying of cancer elements to them through the lymphatic vessels situated in the scirrhus mass4 7b47 ,encephaloid4 ,encephaloid1 medullary1 soft or acute cancer1 differs from the preceding1 in the small amount of stroma1 the consequent softness of consistence1 and its rapid growth4 ,it is most common in the mamm1 eye1 testicle1 uterus1 liver1 lymphatic glands1 periosteum and bones4 ,the greatest number of cases occur between the twentieth and fiftieth years4 ,the cells are exactly similar to those of scirrhus1 but far more numerous1 while the stroma is not so well marked1 and much less fibrous1 and does not undergo a similar cicatricial contraction4 ,blood-vessels are very abundant4 ,the tumor varies in size from a pea to that of an adult's head1 its shape being generally ovoidal1 and its surface more or less lobulated4 8,it is of a soft1 brain-like consistence1 the central portions2 where fatty degeneration is most advanced1 often being completely diffluent4 ,on section1 it presents a white1 pulpy mass1 much resembling brain substance1 which is often irregularly stained with extravasated blood40 ,occasionally these tumors contain serous cysts of small size1 as well as other adventitious products4 ,when ulceration takes place2 the sore is characteristic4 8,its edges are thin1 undermined1 jagged1 or irregular1 while its bottom has a foul1 bloody1 fungous appearance4 ,the parts around are of a deep red1 livid1 or purple color40 7c47 ,melanosis4 ,melanotic1 or black cancer1 is probably merely the result of a pigmentation of the encephaloid4 ,it occurs most frequently in the eye and skin1 and is occasionally met with in the viscera4 ,the melanotic matter occurs in small masses1 of a rounded1 ovoidal1 or irregular shape1 with or without a cyst1 from the size of a pin's head to that of a walnut2 of a dull1 sooty1 brownish1 or black color4 ,they are generally invested by a distinct capsule1 formed out of the cellular tissue in their immediate vicinity4 8,under the microscope1 it is seen to consist of a fibrous net-work1 including numerous alveoli1 filled with free1 unadherent pigment cells1 occupied by colored granules1 a few of the larger or older ones containing sometimes a nucleus with its nucleolus4 ,free pigment granules are also found in great abundance40 7d47 ,colloid4 ,the colloid1 alveolar1 gelatiniform cancer1 is the most uncommon form of heterologous formations4 ,it is regarded by some1 as simply one of the preceding forms which has undergone mucoid or colloid change4 ,it is most frequently met with in the stomach1 the intestines1 and the periosteum2 and can appear at any age1 but is most common between the thirty-fifth and fiftieth year4 ,the tumor varies in size1 from the size of a marble to an adult head1 is globular or irregular in shape1 of a firm1 dense consistence1 with a rough1 knobby1 or distinctly lobulated surface4 ,the stroma1 of a fibrous character1 of a dull1 whitish1 grayish1 or pale-yellowish color1 and great density1 is so arranged as to form numerous alveoli of various sizes and shapes1 communicating with each other4 ,within these cavities is contained the gelatinous or colloid material1 which is a glistening1 whitish1 greenish1 or yellowish color1 and of the consistence of thin mucilage or ordinary jelly4 ,in the older cells it becomes more firm and opaque4 8,in the main1 it is perfectly structureless2 within it1 however1 are imbedded a varying number of spherical cells1 which also contain the same gelatinous substance4 ,these cells present a peculiar appearance2 they are large and spherical in shape1 and are distended with drops of the same gelatinous material as that in which they are imbedded4 ,many of them display a lamellar surface1 their boundary consisting of concentric lines40 7e47 ,epithelioma4 ,epithelioma1 cancroid1 or epithelial cancer1 grows in connection with cutaneous and mucous surfaces4 ,the cells1 usually containing a single nucleus1 resemble very closely those met with in the cutaneous surfaces1 and in the mucous membrane of the mouth1 only that they are larger1 their average being about of an inch4 ,in shape they are either rounded1 oval1 angular1 or elongated1 according to the pressure to which1 in their growth1 they are subjected4 ,they are closely packed together into nests1 assuming a concentric arrangement1 like the layers of an onion4 ,mixed up with the cells1 especially if the growth have made much progress1 are great numbers of free nuclei and granules1 and sometimes also crystals of cholesterine1 pigment cells and blood corpuscles4 8,the tumor itself is firm in consistence1 more or less friable1 and on section presents a grayish-white granular surface1 intersected with lines of fibrous tissue4 ,the cut surface yields on pressure1 a small quantity of turbid fluid1 and in most cases also a peculiar thick1 crumbling1 curdy material1 can be expressed1 which comes out in a worm-like shape1 like the sebaceous matter from the glands of the skin40 ,the ulcer formed has a foul1 fungating appearance1 with irregular granulated edges1 and a hard rough base4 ,the disease is more common in men than women1 and seldom occurs before the age of thirty-five or forty4 ,it is most frequently met with in the lower lip1 in the tongue1 prepuce1 scrotum1 78chimney-sweep's cancer107 labia1 eyelids1 cheeks1 in the uterus and bladder4 ,as it extends it may involve any tissue4 ,,chapter ,,iv4 ,,post-,,mortem ,,appearances ,,in ,,death ,,from ,,unnatural ,,causes4 #a4 ,death from ,poisoning4 ,in speaking of the lesions produced by poisoning1 we will confine our attention to the more common poisonous substances which are given1 or taken1 either intentionally or by accident1 and which may result in death4 ,sulphuric ,acid4 ,death from poisoning with this acid1 commonly results in from twelve hours to three days1 but sometimes life is prolonged for a week or a fortnight1 or for months1 and sometimes death may take place in an hour4 ,the morbid appearances met with will vary according to the quantity of the acid taken1 and the manner of its administration4 ,the appearances are in general as follows3 ,on the lips1 fingers1 or other parts of the skin1 spots and streaks of a brownish1 or yellowish-brown color are met with1 where the acid has disorganized the cuticle4 ,the mucous membrane of the tongue and fauces is white2 the pharynx is only in the rarest cases carbonized like the stomach1 is generally hard to cut1 as if tanned1 and of a gray color2 the vascular injections of its mucous membrane may be recognized4 ,the rima glottidis is sometimes contracted1 the epiglottis swelled1 and the commencement of the larynx inflamed4 ,the sophageal membrane is often completely detached1 or comes off in shreds2 and the passage shows traces of the corroding effects of the poison4 ,the outer surface of the abdominal viscera is commonly either very vascular or livid4 ,the stomach1 if not perforated1 is commonly distended with gases1 and contains a quantity of yellowish-brown or black matter1 and is sometimes lined with a thick paste1 composed of disorganized tissue1 blood and mucus4 ,the pylorus is contracted4 ,if the acid has been taken diluted1 the mucous membrane is merely excessively injected1 with blackness of the vessels1 and usually a softening of the rug1 or actual removal of the villous coat4 ,if the stomach be perforated1 the holes are commonly roundish1 with thin1 colored and disintegrated margins1 and surrounded by vascularity and black extravasations4 ,the inner coat of the duodenum often presents appearances closely resembling those noticed in the stomach4 ,sometimes1 especially in cases which are rapidly fatal1 it is not at all affected1 probably owing to the spasmodic contraction of the pyloric orifice4 ,the urinary bladder is commonly empty4 ,the blood is thickened1 and of an acid reaction4 ,nitric ,acid4 ,the appearances observed in cases of poisoning by this acid1 are similar to those noticed under sulphuric acid4 ,a difference of tint in the color produced by nitric acid on the skin1 lips and mucous lining of the mouth and sophagus1 being the only distinguishing mark4 ,whereas in the case of sulphuric acid the color is brownish1 in the case of nitric acid1 it is most frequently yellow4 ,oxalic ,acid4 ,this is a poison of great energy1 and so more frequently used for committing suicide than for purposes of murder4 ,it has often been taken by accident for ,epsom salt1 7sulphate of magnesia17 which it greatly resembles in general appearance4 ,it is the most rapid and unerring of all the common poisons1 and produces death generally within an hour1 although a large dose may prove fatal in two or three minutes1 and a smaller one may be survived for as long as twenty-three days4 ,the mucous membrane of the throat and sophagus look as if scalded1 and can easily be scraped off4 ,the stomach contains a thick fluid1 commonly dark1 like coffee-grounds4 ,the inner coat of the stomach is pulpy1 in some points black1 in others red4 ,the mucous membrane of the intestines is usually similarly1 but less violently affected4 ,in some cases1 the stomach and intestines have been found healthy4 ,phosphorus4 ,this substance has frequently1 in the form of heads of lucifer matches1 been the cause of death2 more frequently taken by accident1 or with the intention of committing suicide1 than with the design of destroying the lives of others4 ,the symptoms of phosphorus poisoning vary during life1 and after death the morbid appearances are not constant1 depending much upon the length of time that has elapsed before death4 ,in cases which have proved rapidly fatal1 the main appearances are those of irritation1 somewhat similar to those already described1 and due to the direct action of the poison4 ,in more protracted cases there is generally jaundice1 the blood is found in a state of complete fluidity1 non-coagulable1 and with very few corpuscles1 while ecchymoses and sanguineous effusions appear everywhere4 ,sometimes the stomach is distended with gas1 which stinks of garlic4 ,the mucous membrane is partly ash-colored1 partly of a dark1 purplish-red1 and exhibits gangrenous ulcers which penetrate deeply into the muscular coat4 ,in recent cases1 the whole contents of the stomach shine in the dark1 especially when gently warmed4 ,the liver is greatly altered1 an acute fatty degeneration is found to have taken place in its secreting structure4 ,the acini are sometimes found filled with fat1 even to bursting2 but more commonly they are wholly destroyed1 and oil and fat globules fill their place4 ,the secreting structures of the kidneys are also found in a state of fatty degeneration1 and the ducts are sometimes filled with exudation matter4 ,the heart and the muscles generally also show signs of the same fatty degeneration4 ,arsenic4 ,this is the poison most frequently chosen for the purpose of committing both suicide and murder4 ,arsenic produces two classes of phenomena1 one is purely irritant1 by virtue of which it induces inflammation in the alimentary canal and elsewhere2 and the other consists in a disorder of parts of organs remote from the seat of its application4 ,it is absorbed by the blood1 which in most cases of acute poisoning1 is found in a remarkable state of fluidity1 and can be detected in the liver1 the spleen1 and in the urine4 ,it acts with nearly the same energy1 whatever be the organ or tissue to which it is applied4 ,from two to three grains have proved fatal1 but an instance is recorded of recovery after a dose of sixty grains4 ,death may ensue in half an hour1 or may be delayed for nearly three weeks2 the usual time is perhaps from twelve to forty-eight hours4 ,there are some cases in which little or no morbid appearances are to be seen4 ,usually1 however1 traces of irritation will be discoverable4 ,in the mouth and throat they are often wanting4 ,the inner surface of the stomach may be red and inflamed1 or blackish from the extravasation of blood1 or softened1 or in some cases thickened1 with the rug raised and corrugated4 ,ulceration of the coats of the stomach is but rarely met with1 unless the patient have survived nearly two days4 ,the mucous secretion is generally increased in quantity1 sometimes thin1 and viscid1 as in its natural state1 but sometimes solid1 as if coagulated4 ,in the latter case1 it forms either a uniformly attached pedicle1 or loose shreds floating among the contents4 ,a very common appearance1 is the presence of a sanguinolent fluid1 or even actual blood in the cavity of the stomach4 ,the poison itself may also be found within the stomach4 ,the intestines may be congested and inflamed throughout their whole length1 but most frequently only in the duodenum and rectum4 ,within the chest1 redness of the pleura1 redness and congestion of the lungs1 have been noticed4 ,in general1 arsenic retards the process of putrefaction after death4 ,the forms in which arsenic is most frequently used for the purpose of poisoning1 are arsenious acid1 and the arsenite of copper1 ,scheele's green4 ,corrosive ,sublimate4 ,the appearances observed in the bodies of persons killed by this poison1 are very similar to those excited by the irritant poisons already noticed4 ,the mouth and throat are more frequently affected than by arsenic4 ,the tongue is often shrivelled1 and the papill at its root greatly enlarged4 ,the mucous membrane is swollen and whitened4 ,the same appearances are generally noticed in the sophagus4 ,the coats of the stomach and intestines1 more particularly the colon and rectum1 have been found congested and inflamed1 and sometimes destroyed1 either by a chemical decomposition of the tissues1 or by ulceration4 ,the bladder is often excessively contracted2 the kidneys usually much congested and inflamed4 ,inflammation of the peritoneum1 and effusion into its sac are frequent results of poisoning with corrosive sublimate4 ,hydrocyanic ,acid4 ,the poisons whose energy depends upon the presence of this acid1 surpass almost all others in rapidity of action1 and the minuteness of the quantity in which they operate4 ,the lesions produced are uncertain4 ,the spine and neck are stiff1 the abdomen retracted1 the skin usually livid4 ,the body1 generally the blood1 serous cavities1 stomach and the various tissues usually exhale1 for some time after death1 the characteristic odor of the acid4 ,turgescence of the venous system1 and emptiness of the arterial system1 are commonly remarked throughout the body4 ,the stomach and intestines are congested and red4 ,the liver and lungs are gorged with blood4 ,strychnia--,nux vomica4 ,in poisoning with this substance1 the rigidity of the body which exists during life1 is frequently retained for hours after death4 ,there is congestion of the membranes of the brain and spinal cord4 ,the stomach is frequently quite natural in appearance1 as also the intestines1 although occasionally signs of irritation are noticed in both4 ,alcohol4 ,in death from alcohol1 the body is slow to putrify1 and the internal organs exhale no cadaveric odor1 but rather that of recent flesh1 or in some cases a faint odor of brandy4 ,the appearances constantly found are1 hypermia of the brain1 sometimes cerebral hmorrhage2 hypermia of the large abdominal veins1 or hypermia of the lungs and heart1 and always visible fluidity and dark color of the blood4 ,carbonic ,oxide4 ,this is the poisonous ingredient of illuminating gas1 and is generated by burning charcoal4 ,it is usually in one of these forms that it is the cause of death4 ,the most characteristic appearance after death1 is the bright cherry-red color of the heart4 ,there is1 also1 hypermia of the lungs and of the right side of the heart4 ,opium4 ,in cases of death from this substance1 lividity of the skin is usually present4 ,turgescence of the vessels of the brain1 and watery effusion into the ventricles are generally met with4 ,the lungs are sometimes found gorged with blood4 ,the stomach is occasionally red1 but decided inflammation is rare4 ,the blood is always fluid1 and the body is apt to pass rapidly into putrefaction4 #b4 ,death from ,suffocation4 ,by suffocation is meant that condition in which the system is prevented from receiving the necessary amount of oxygen through the lungs4 ,the term is generally restricted to a condition arising from the obstruction of the air passages1 either internally1 or from without1 or from the breathing of irrespirable gases4 7,the latter form being attended also by blood-poisoning1 which we have already noticed47 ,the appearances noticed are the following3 ,the face may be more or less bluish-red1 swollen1 with protruding eyes1 or differing in no respect from that observed after other kinds of death4 ,froth is often observed coming out of the mouth4 ,there is a universal and unusual fluidity and dark color of the blood4 ,hypermia of the right side of the heart1 while the left is either entirely empty or contains only a few drachms of blood1 hypermia of the lungs and congestion of the pulmonary artery1 are seldom wanting4 ,in the case of new-born children1 ,caspar has noticed capillary ecchymoses1 resembling petechi1 beneath the pulmonary pleura1 upon the aorta1 or the surface of the heart1 and even upon the diaphragm1 which gives the parts a spotted appearance4 ,the mucous membrane of the larynx and trachea are more or less injected1 of a cinnabar-red1 either in patches or uniformly over the whole surface4 ,a deposit of soot upon the tracheal membrane1 points to suffocation in smoke4 ,there is usually present in the trachea a greater or less amount of fluid1 consisting of a mixture of air1 mucus1 and blood1 in the form of frothy vesicles1 or colorless1 or bloody foam4 ,the more gradual the suffocation has been1 the greater the quantity of this fluid4 ,it may exist also in the bronchial tubes1 and can be forced out by careful pressure on the lungs4 ,foreign bodies of every kind may be found in the trachea4 ,we find also as secondary results of the foregoing1 hypermia of the abdominal and cranial organs4 #c4 ,death from ,hanging1 ,throttling and ,strangling4 ,in these cases1 death may result from simple cerebral congestion 7apoplexy71 from simple congestion of the thoracic organs 7cardiac or pulmonary apoplexy71 from a combination of the two 7apoplexy and asphyxia71 or1 as is very frequently the case1 from neuro-paralysis 7nervous apoplexy74 ,the internal appearances will therefore vary1 or1 as in the last case1 no lesions can be detected4 ,the face may in some cases be livid1 with protruding eyes and tongue2 but in many cases the countenance is like that of any other corpse4 ,turgescence of the male and even of the female genitals has been noticed in some cases4 ,the mark of the cord about the neck may be wanting1 and is nearly always more or less interrupted1 and presents many varieties of appearance4 ,it maybe of a dirty1 yellowish-brown color1 cutting hard and leathery2 or of a bright blue or dirty-reddish color1 soft to cut2 or it may have little or no color1 and also soft to cut4 ,patches of excoriation are also sometimes visible1 if the cord have been hard and rough4 ,a similar mark of the cord may be produced after death4 ,in cases of throttling1 the marks of fingers may often be recognized1 as round or semi-circular1 or perfectly irregular patches1 of a dirty1 brownish-yellow color1 hard to cut1 and not ecchymosed4 ,rarely they are of a dirty-bluish color and ecchymosed4 #d4 ,death from ,drowning4 ,physiologically considered1 death from drowning is to be regarded as identical with death from asphyxia or strangling1 and hence the results of the dissection1 do not differ from those just mentioned4 ,those drowned may die from cerebral hypermia1 the rarest form2 from pulmonary hypermia2 from both combined2 or from neuro-paralysis4 ,death from hypermia of the thoracic organs1 and death from paralysis1 are of almost equal frequency in cases of drowning4 ,the countenance is pale1 in most cases not swollen1 the eyes shut1 and when asphyxia has been the cause of death1 there is commonly froth over the mouth4 ,if the body has been in the water for two or three days in summer1 or eight to ten in winter1 the face is rather reddish1 or bluish-red--the commencement of putrefaction1 which in bodies in water1 begins in the head and extends from above downwards1 and not in the abdominal coverings4 ,an almost constant appearance is the cutis anserina1 a phenomenon entirely independent of the temperature of the water in which the person has been drowned4 ,the hands and feet have a livid1 grayish-blue color1 and the skin is corrugated in longitudinal folds1 provided the body has not been taken out of the water within about eight hours after death4 ,sand1 gravel1 mud1 etc41 are often found under the finger-nails4 ,contraction of the penis and scrotum in men who have fallen into the water alive1 is an almost constant appearance4 ,the lungs are greatly increased in volume1 completely fill and distend the cavity of the chest1 and are not firm and crepitating like healthy lungs1 but feel like sponge4 ,the trachea and large bronchial tubes are frequently filled with frothy mucus4 ,the spasmodic closure of the glottis1 will prevent the entrance of water into the lungs while life continues1 but after death it may enter in small quantities4 ,in the stomach is often found some of the fluid in which the drowning has taken place4 ,,chapter ,v4 ,,medico-,,legal ,,questions4 #a4 ,method of ,conducting a ,medico-,legal ,autopsy4 ,in making medico-legal examinations of human bodies1 the greatest care must be taken not to omit the examination and recording of any of the appearances presented2 since a point trifling in itself1 may1 in the course of the subsequent legal process1 prove of great importance4 ,it may sometimes be necessary for the physician to examine the exact spot and the locality in which the body has been found1 to ascertain the position in which it was discovered1 etc41 and also to inspect the clothing4 ,in cases of suspected poisoning1 the utmost precautions are to be used in making the autopsy4 ,all the viscera are to be carefully examined1 and the stomach and intestines1 with their contents1 are to be removed in the manner already described4 ,they are then to be opened1 examined in separate vessels1 either entirely new1 or thoroughly cleansed immediately before being made use of4 ,after a careful examination1 they are to be placed in perfectly clean or new glass jars1 without the addition of any foreign substance2 the jars are then to be securely corked and labelled1 and handed over to the chemist for analysis4 ,should the jars have to remain any time in the hands of the physician1 they are to be kept under lock and key1 in some place to which none but himself has access4 ,portions of other organs1 especially of the liver1 spleen1 kidneys and brain1 should also be preserved with the same care for future analysis4 ,the results of the examination are to be taken down on the spot1 by an assistant1 in ink1 and after having been read through by the physician at the close of the examination1 are to be signed by him4 ,all these precautions will be found of great value1 in saving from innumerable petty annoyances1 at the hands of the 8learned members of the bar10 if the case should be brought before court4 ,in the external inspection of the body1 we should notice3 #a4 ,the ,sex4 ,even after the external parts of generation have been completely destroyed1 the sex may still be ascertained by a reference to the growth of hair around these parts4 ,a circumscribed arc of hair on the mons veneris1 is distinctive of the female1 while its prolongation1 however slight1 from this point towards the umbilicus1 marks the male4 #b4 ,the ,age4 ,in the case of known bodies this is not of any importance1 in unknown bodies it is1 however1 necessary4 ,the physician can only conjecture from appearances1 which1 even in the living body1 are very deceptive1 and he will do well1 therefore1 to allow tolerably wide limits to this conjecture4 #c4 ,the ,size4 ,the length of the body must be ascertained by actual measurement in a straight line1 from the crown of the head to the sole of the heel4 #d4 ,the ,general ,condition of the ,body4 ,lean or fat1 etc4 #e4 ,color and ,condition of the ,hair4 #f4 ,color of the ,eyes1 if still recognizable4 #g4 ,number and ,condition of the ,teeth4 ,in the case of unknown bodies1 an accurate description is always advisable1 with a view to future identification4 #h4 ,special ,marks or ,deformities4 ,scars1 tattoo-marks1 excess or defects of limbs1 marks of disease1 as ulcers1 etc41 should all be accurately noted4 #i4 ,injuries or ,wounds1 which appear to have been the cause of death1 should be carefully described4 ,in the case of wounds1 their position and direction with reference to the neighboring fixed points of the body1 and their exact length and breadth1 must be recorded4 #aj4 ,of the ,body itself1 the parts deserving of particular examination are the natural openings of the ears1 nose1 mouth1 anus and female genitals2 the neck and the hands4 ,in the internal examination or dissection1 the three great cavities--the head1 thorax and abdomen--should all be opened4 ,in some cases1 it may be important to open also the spinal canal4 ,the first thing to be observed on opening each of these cavities1 is the position of the organs they contain2 next1 whether there be any fluid effusions present2 and lastly1 the external and internal appearance of each separate organ4 ,in every case1 that cavity should be opened first1 in which there is the greatest probability of finding the cause of death4 ,in the case of new-born children1 however1 the abdomen must be first opened in order that the natural position of the diaphragm may be observed undisturbed4 ,in examining the base of the skull for injuries1 we must not omit to remove the periosteum1 which might otherwise conceal small fissures4 ,in examining the thoracic organs1 if it be particularly desired to observe the amount of blood contained in them1 and we do not wish to apply ligatures1 we examine the heart first1 leaving it in its natural horizontal position1 and opening it by a lateral longitudinal incision on both sides4 ,this gives us a distinct idea of the actual amount of blood in all the cardiac cavities4 ,the lungs are next cut into1 and last of all the large blood-vessels4 ,this procedure is to be followed1 e4 g41 in cases of suffocation1 where it is of particular importance to determine the amount of blood in these organs1 and where the blood is peculiarly fluid4 ,in determining the amount of blood in the venous trunks1 it will be sufficient to examine the vena cava ascendens4 ,in penetrating wounds1 the wound is of course to be examined as far as possible before disturbing any of the organs4 ,the result of the external and internal examinations1 thus thoroughly conducted1 are to be noted down at the time1 and are not to be trusted to memory4 ,it is of the utmost importance that this rule be observed4 ,in presenting a written or verbal report before court1 the physician should be careful to furnish merely a description of the post-mortem appearances1 and not to give an opinion as to their probable or possible cause or causes1 unless called upon to do so4 ,he should also avoid prolixity and1 as much as possible1 the use of technical terms1 unintelligible to nonprofessionals4 ,his answers to direct questions should be concise and decided if possible1 but where this is not possible1 he should not hesitate to state that the dissection has not afforded him any facts which could enable him to give a positive answer4 #b4 ,questions relating to ,new-,born ,children4 ,the body of a dead infant is found1 and the physician may be called upon to answer the following questions1 one or all3--,was the child mature8 ,was it born alive8 ,if so1 what was the cause of its death8 ,was the child mature8 ,among the various signs of ftal maturity1 such as the firm1 tense skin1 of the usual pale corpse-color1 the hair upon the head1 the weight and length of the body1 the diameters of the head1 shoulders and hips1 the horny nails reaching to the tips of the fingers1 the absence of the pupillary membrane1 etc41 the most infallible1 is the presence of the centre of ossification of the inferior femoral epiphysis4 8,the easiest way to find this1 is to make a horizontal incision through the skin and superficial tissues over the knee-joint down to the cartilages4 ,the patella is then to be removed1 and the end of the femur made to protrude through the incision4 ,thin horizontal sections are then to be removed from the cartilaginous epiphysis1 at first more boldly1 but so soon as a colored point is observed in the last section1 then very carefully1 layer by layer1 till the greatest diameter of the osseous nucleus is attained4 ,this appears to the naked eye as a more or less circular bright blood-red spot in the midst of the milk white cartilage1 in which vascular convolutions can be distinctly recognized40 ,when there is no visible trace of this centre of ossification1 the ftus can be no more than from thirty-six to thirty-seven weeks old4 ,in still-born children1 the commencement of this nucleus indicates a ftal age of thirty-seven to thirty-eight weeks2 when it possesses a diameter of from three-quarters to three lines1 it shows the ftus must have attained a uterine age of forty weeks4 ,when the osseous nucleus measures more than three lines1 we may conclude that the child has lived after birth4 ,isolated exceptions are occasionally met with1 when1 however1 concomitant appearances1 such as1 in the one case1 defective ossification of the skull1 or in the other1 peculiarly advanced development1 will guard us against mistakes4 ,was the child born alive8 or1 ,did it live during and after its birth8 and1 ,if so1 how long8 ,these questions are intimately connected1 and in order to be able to answer them1 we must in our examination note the following points3 ,the position of the diaphragm1 is a good diagnostic sign4 ,the diaphragm will necessarily be higher where there has been no respiration1 natural or artificial1 than where the child has actually breathed4 8,its position is most easily ascertained by making a longitudinal incision through the skin and superficial cellular tissue1 from the chin to the pubis1 in the mesial line1 dissecting these from the thorax on both sides1 next carefully opening the abdominal cavity1 introducing the finger of one hand into it1 and pressing it up to the highest point of the concavity of the diaphragm1 and then with one finger of the other hand reckoning off the intercostal spaces from above downwards till both fingers correspond4 ,the rule is1 that the highest point of the concavity of the diaphragm in children born dead1 is between the fourth and fifth ribs1 and in those born alive1 between the fifth and sixth40 ,where respiration has been but transitory1 the diaphragm will remain very nearly in its ftal position4 ,the lungs1 from lying quite posteriorly in the ftus1 come to fill the cavity of the chest1 the more perfectly respiration has been established4 ,in the ftus1 the left lung is never found even partially covering the heart4 ,where respiration has been but transitory and imperfect1 the volume of the lungs will not be much increased4 ,the presence of dark bluish-red1 insular patches in the lungs1 no matter what may be their ground color1 proves that respiration has taken place4 ,the crepitant spongy consistence of the lungs of a live-born child1 is readily distinguished from the compact1 resistent liver-like lungs of one still-born4 ,the hydrostatic test for the presence of air in the lungs1 is of all1 the surest for deciding whether respiration has taken place4 ,the vessel used should be at least one foot in depth1 eight or ten inches in diameter1 and filled with pure cold water4 ,the buoyancy of the lungs depends upon the greater or less completeness with which the pulmonary tissue is permeated by the air4 ,only one lung may float1 generally the right one1 or only single lobes1 or only a few pieces into which the lung has been and must be divided1 in order accurately to apply the test4 ,artificially inflated ftal lungs1 may be distinguished from those lungs which have respired1 by the presence1 in the case of the latter1 of the bluish-red mottling above referred to1 and the escape of bloody froth when the substance of the lungs is cut into1 and slight pressure applied4 ,the general appearance of putrescence in the lungs1 will serve to distinguish the buoyancy arising from the gaseous products of putrefaction1 from that due to respiration4 ,careful attention to the foregoing points1 will enable us to answer with certainty whether the child was born alive4 ,how long did the child live after its birth8 ,the question can be approximately answered with reference to the first few days1 by attention to the following points3 ,if there are no traces of blood1 or of that peculiar unctious substance1 the vernix caseosa1 on the body1 sufficient time must have elapsed since its birth1 to have afforded leisure and opportunity for cleansing it4 ,the contraction of the umbilical arteries in living children1 does not occur sooner than after eight or ten hours4 ,the mummification of the cord commences after two1 three1 or even four days1 and the putrefaction only after a much longer time4 ,mummification of the cord takes place as well after death as before1 but not in water1 nor in the liquor amnii4 ,if the umbilicus has already cicatrized1 the child must be at least five days old4 ,the stomach immediately after birth1 contains a small quantity of quite white1 transparent1 seldom somewhat bloody1 inodorous mucus1 very tough1 or a trifling quantity of the colorless liquor amnii4 ,if milk be found1 it shows that some time must have elapsed since the birth4 ,in the large intestines meconium is still to be found1 two1 three1 or even four days after birth4 ,the age of a child1 evidently older than five or six days1 can only be determined by general appearances4 ,what was the cause of death8 ,we will here refer only to those injuries and kinds of death as can only occur in new-born children1 and to those post-mortem appearances which might lead to error in regard to them4 ,during labor1 death to the child may result from cerebral hypermia1 or from injuries to the cranium1 which are then unattended by traces of violence on the body1 and are frequently due to imperfect ossification of the bones1 detected by holding the bones up to the light after removal of the periosteum4 ,prolapse and pressure of the cord1 and coiling of the cord around the neck1 may produce all the appearances of death by suffocation4 ,the mark of the cord runs uninterruptedly round the neck1 is broad1 circularly depressed1 grooved1 never excoriated1 and everywhere quite soft4 ,a mummified1 parchmentlike1 unecchymosed depression1 with or without excoriations1 points to intentional strangulation4 ,subsequent to birth1 the child may have been killed by falling on its head on the floor1 if the birth has been very rapid4 ,the probable results of such a fall1 would be rupture of the cord2 premature separation of the placenta1 with its consequences2 concussion of the brain and hypermia1 or actual hmorrhage within the skull2 and fracture of the skull bones4 ,the fractures are almost exclusively confined to the parietal bones1 one or both1 chiefly in the region of the vertex4 ,comminuted fracture of several bones of the skull1 speak against an accidental death by a fall4 ,the absence of any signs of violent usage on other parts of the body1 or about the head1 with simple fracture of the skull1 speaks for an accidental death4 ,the child may also have been suffocated by the mother in violent attempts at self-delivery4 ,the visible signs of this will consist merely of scratches and nail-marks upon the face or neck4 ,very severe injuries are never produced in this way4 ,we must be careful not to mistake the common blood-coagulum usually found under the aponeurosis on the child's head for the result of violence2 nor the folds of the skin1 in fat children particularly in winter1 produced by the movements of the head1 and which remain strongly marked in the solidified fat1 for the mark left by the cord in a case of actual strangulation4 #c4 ,supposed ,period of ,death4 ,the answer to the question as to the probable time of death1 is often of the utmost importance4 ,to be able to determine this1 we must have regard to the various appearances following death1 previous to putrefaction1 and to the chronological succession of the phenomena of external and internal putrescence4 ,a4 ,signs of ,death previous to ,putrefaction4 ,respiration and circulation have entirely ceased4 ,the eyes have lost their lustre4 ,there is no vital reaction to stimulants4 ,the body grows ashy-white4 ,a particularly florid complexion may retain its color for some days after death4 ,neither the red or livid edges of ulcers1 nor red1 black or blue tattoo-marks disappear after death4 ,an icteric hue existing at death never becomes white1 and ecchymoses retain in every case1 the hue they had at the time of death4 ,most bodies become quite cold in from eight to twelve hours4 ,fat bodies and those of persons killed by lightning1 or by suffocation1 retain the heat longer than others2 in water1 bodies cool rapidly4 ,a general relaxation of the muscular system occurs immediately after death4 ,a body presenting only the above signs1 has been dead from eight to twelve hours at the longest4 ,in from twelve to eighteen hours the eye-balls become soft and inelastic1 and feel flaccid4 ,the muscles on those parts of the body on which it lies1 become flattened by the weight of the body4 ,in from eight to twelve hours after death1 hypostases resulting from the gravitation of the blood in the capillaries1 begin to form on all the depending parts of the body4 ,the most important are the external hypostases--for they are liable to be confounded with ecchymoses1 and consequently with traces of violence committed previous to death4 ,an incision into the discolored spot should always be made1 when1 if it be an hypostasis--a post-mortem stain--there will be no escape of effused fluid or coagulated blood1 as there will be if it be an ecchymosis1 the result of violence previous to death4 ,the color of these post-mortem stains varies from a livid or coppery-red to a reddish blue4 ,they are extremely irregular in form1 and are never elevated above the surrounding skin4 ,they are formed after every kind of death4 ,internal hypostases occur in the brain1 in the sinuses and veins of the pia mater of the posterior hemispheres1 even after death from hmorrhage4 ,they must not be confounded with cerebral hypermia4 ,in the lungs1 hypostases are of constant occurrence1 and are carefully to be distinguished from the signs of ante-mortem pulmonary congestion and pneumonia4 ,in the intestines and kidneys1 hypostases are also noticed4 ,in the heart we find no hypostasis1 but clots1 or 8cardiac polypi10 which are the coagulated fibrine of the blood1 formed in most cases after death4 ,their presence proves that coagulation of the blood may take place after death4 ,the last sign of the earliest stage of death is the rigor mortis4 ,it passes from above downwards1 beginning on the back of the neck and lower jaw1 passing on into the facial muscles1 the front of the neck1 the chest1 the upper extremities1 and last of all1 the lower extremities4 ,it begins variously after eight1 ten1 or twenty hours1 and may last from one to nine days4 ,in the mature new-born infant it is feeble and very transitory4 ,a low temperature1 and the existence of alcoholization1 favor the long duration of cadaveric rigidity4 ,a frozen body is stiff as a board from head to foot1 whereas in rigor mortis the extremities1 particularly at the elbows and knees1 preserves a certain amount of mobility4 ,a body in which only the signs thus far mentioned are present1 may be presumed to have been dead from two to three days at the longest4 ,b4 ,the ,process of ,putrefaction4 ,the progress of putrefaction is modified by the following conditions3 ,by age4 ,the bodies of new-born children putrefy more rapidly than others2 those of very aged persons much more slowly4 ,by the condition of the body4 ,fat1 flabby and lymphatic corpses putrefy more quickly than lean ones1 for an abundance of fluid is very favorable to decomposition4 ,by the kind of death4 ,the process is rapid after death from exhausting diseases1 from injuries attended with much mutilation1 from suffocation1 from narcotic poisons4 ,it is slower after sudden death in healthy persons1 after death from poisoning with phosphorus1 sulphuric acid and alcohol4 ,by the access of atmospheric air4 ,whatever prevents this1 retards decomposition4 ,thus1 bodies buried in the earth1 or lying in water1 or clothed1 putrefy less rapidly than those exposed to the direct influence of the air4 ,by the quantity of moisture1 which in addition to its own1 can and does reach the body from without4 ,the more moisture1 the more rapid the process4 ,by the temperature of the air1 or of the water in which the body is lying4 8,at a tolerably similar average of temperature1 the degree of putrefaction present in a body after lying in the open air1 for one week 7or month71 corresponds to that found in a body after lying in the water for two weeks 7or months71 or after lying in the earth in the usual manner for eight weeks 7or months407 7,caspar47 ,in bodies lying in the air1 external putrefaction begins with a greenish coloration of the abdominal coverings1 in from twenty-four to seventy-two hours after death1 according to the modifying conditions just noticed4 7,in bodies lying in water1 the process of putrefaction begins in the face1 head as far as the ears1 and the upper part of the neck1 with a livid1 bluish tinge1 rapidly becoming a brick-red1 and proceeds downwards in the same relative manner as about to be described47 ,within the same period1 the eye-ball becomes soft1 yielding to the pressure of the finger4 ,after three to five days from the period of death1 the discoloration has spread over the whole abdomen and external genitals1 and spots make their appearance on other parts4 ,in from eight to ten days the discoloration has spread over the whole body1 and the peculiar odor is developed4 ,the abdomen is distended with gas2 the cornea has fallen in and become concave4 ,the nails are still firm4 ,in fourteen to twenty days after death1 the whole body is of a bright-green1 mixed with red and brown4 ,the epidermis is raised here and there in blisters1 and in other parts patches of it are quite stripped off4 ,maggots cover the body4 ,from the continued development of gas1 the whole body is bloated1 and has a gigantic appearance4 ,the nails are detached at their roots and lie loose1 and are easily separable4 ,the hair is loose and easily pulled out4 ,since this stage may continue many weeks or even months1 we cannot distinguish a body in this state after one month1 from one in the same condition after from three to five months4 ,after from four to six months1 or sooner in the case of bodies that have lain in warm and moist media1 the cavities of the body are opened by the continued development of gas2 the skull has separated from the neck1 and the brain has run out2 the orbital cavities are empty2 all the soft parts have commenced to break down into a soft pulp1 or are partly already broken down and dissolved1 leaving entire bones exposed4 ,the bones of the extremities are often separated by the destruction of the fasci and ligaments4 ,no trace of a physiognomy is discernible4 ,the doubtful sex of the deceased can only be determined from the external peculiarities of form1 or the hair about the pubis1 or by the presence of a uterus1 which withstands decomposition longer than any other soft organ of the body4 ,internally1 the process of putrefaction begins in the trachea and larynx4 ,the brain in children up to the end of the first year1 is next attacked4 ,next the stomach1 intestines and spleen1 and then the omentum and mesentery4 ,the liver is usually compact and firm1 even some weeks after death4 ,putrefaction commences on its convex surface4 ,the brain of the adult follows next in the succession of putrefying organs4 ,several months usually elapse before putrefaction of the heart has advanced very far4 ,in the lungs decomposition begins about the same time as in the heart1 sometimes earlier4 ,the kidneys1 urinary bladder1 sophagus1 pancreas1 diaphragm and larger arterial trunks then succumb1 and last of all the uterus4 #d4 ,the ,probable ,cause of ,death4 ,although in general1 a careful examination of a body found dead1 will readily reveal the true cause of death1 yet instances frequently occur where attempts at concealing it1 or peculiar circumstances in connection with the death1 may render the task more difficult4 ,we confine ourselves here to a brief notice of some of the more important points to be kept in view1 in rightly estimating the relative value of post-mortem appearances1 and in guarding against possible mistakes4 ,rough handling1 falls and blows1 occurring a short time after death1 may produce excoriations and pseudo-ecchymoses1 which cannot by sight be distinguished from such as are the result of violence inflicted during life4 ,wounds inflicted during life are distinguished from those inflicted after death1 by the entire absence in the case of the latter1 of any signs of vital reaction1 as inflammation1 hmorrhage1 suppuration1 swelling or cicatrization of the edges of the wound1 etc4 ,but in the case of very sudden death from wounding of an important organ1 these traces of vital reaction may also be wholly wanting4 ,again1 injuries are often produced on dead bodies1 by the instruments used to recover them from the places in which they have been discovered4 ,contused wounds seldom represent the exact dimensions of the weapon employed4 ,blunt weapons may merely contuse and disfigure1 or lacerate1 or fracture bones1 or produce rupture of internal organs4 ,healthy organs never rupture spontaneously1 and can only be ruptured by external violence4 ,the inspection of the position1 direction1 depth1 breadth1 and number of wounds1 compared with the weapon with which they have been inflicted1 often furnish the means of approximately judging of the position of the perpetrator when he committed the deed1 and even his object and bodily strength4 ,in judging whether fractures have been produced before or after death1 we must remember that it is very difficult to fracture the bones of a dead body4 ,hence1 for example1 considerable injuries of the cranial bones1 particularly of the base of the skull1 have most probably been produced during life4 ,a fracture of the ribs in the dead body is never splintered4 ,in deciding whether a case is one of suicide or homicide1 besides the previous state of mind of the deceased1 the posture and position of the body1 hands1 etc41 the appearance of the clothing1 and the character of the wounds or injuries1 are the points to be particularly noted1 as well as the absence or presence of evidences of robbery4 ,gunshot wounds produced upon dead bodies1 are never as deep as similar ones would be in a living body2 the track of the bullet can be distinctly traced2 and the edges of the wound show no appearance of vital reaction4 ,hence they can readily be distinguished from such as have been produced during life4 ,burning of a dead body does not in general produce vesication2 by exceedingly intense heat it may1 however1 be produced4 ,the bull1 however1 last but a few minutes1 never contain serum1 but only watery vapor1 and never exhibit any trace of the bounding line of redness1 nor any trace of color on their basis4 ,they are1 therefore1 easily distinguished from burns inflicted during life4 ,in distinguishing between spontaneous apoplexy and cerebral hmorrhage the result of injuries1 it will be sufficient to note that1 in the former case1 but a very small amount of blood is effused1 so that the discovery of very extensive and considerable extravasation of blood within the cranial cavity1 can be regarded as a proof of the application of external violence4 ,in the case of a dead body found hanging1 it is in most instances to be regarded as a case of suicide1 unless the examination of the body should show external marks of violence1 or internal signs of death from another cause4 ,where a body has been found in the water1 the question may arise whether it was alive or dead when it entered the water4 ,the investigation of the body will reveal the cause of death4 ,the surest sign that the body was alive when it was thrown or fell into the water1 is the presence in the stomach of some of the fluid in which it was lying1 if this fluid be such as is never voluntarily drank4 ,whether the drowning was a case of suicide or homicide1 it is sometimes impossible to determine4 ,all the various circumstances of time and place1 and concomitant appearances1 must be minutely investigated1 in order to hope to arrive at a probable conclusion4 ,in the case of supposed poisoning1 where the fact of the administration of poison has been proved1 and the person has died with symptoms attributable to poisoning1 and the post-mortem appearances reveal no other cause of death--then the death is to be regarded as the actual results of the poison1 whether its existence in the body can be proved by chemical analysis or not4 ,only such poisons are used by suicides as a general thing1 as are known to be certain poisons1 and such as have a very disagreeable taste are1 from this fact1 hardly ever used for the purpose of murder1 except in the case of very small children1 or persons rendered insensible by any means4 7,caspar47 ,,chapter ,,vi4 ,,on ,,embalming ,,the ,,dead4 ,from the earliest times1 the attention of mankind has been given to the preservation of the bodies of the dead4 ,with the ancient ,egyptians1 the art was carried to its highest degree of perfection4 ,the motive which led these people to devote so much care to this object1 is still conjectural2 yet it would seem to have originated1 in part at least1 as a sanitary measure1 for preserving the purity and healthfulness of the atmosphere4 ,while so little is known of the method by which they produced such wonderful results1 as to have placed the process among what have been termed the 8,lost ,arts10 yet1 from a careful examination of a large number of mummies1 it would appear that the operation consisted3 ,first4 ,in the removal of the abdominal and thoracic viscera1 through an opening in the left side beneath the ribs2 and of the brain through the nostrils1 by breaking through the crebriform plate of the ethmoid bone2 or through the mouth1 by boring through the basilar process of the occipital bone4 ,second4 ,subjecting the body for a long time to the action of an alkali1 7natron17 after having filled the cavities with various gums and spices1 etc41 and thus removing the fatty portions4 ,third4 ,a rapid desiccation1 after further additions of balsams1 resins1 etc4 ,fourth4 ,enveloping the whole body in numerous bandages saturated with gum or bitumen4 ,modern nations1 have long practiced evisceration1 in connection with the use of various substances for preserving bodies4 ,in the middle ages1 the art of embalming consisted in mixing aromatic substances with salt1 and filling the bodies with the same4 ,henry ,i4 of ,england1 is said to have been thus embalmed in #aace4 ,long and deep incisions were made in various parts of the body1 these filled with the composition1 and then carefully sewed up1 the body afterwards enveloped in a beef's skin1 and enclosed in a coffin4 ,louis ,c4 ,bils1 a nobleman of ,holland1 and ,ruysch1 a ,dutch physician1 in the latter part of the seventeenth and beginning of the eighteenth centuries1 acquired great celebrity from their success in embalming bodies4 ,both died1 however1 without imparting their secrets to others4 ,the discovery of the preservative properties of corrosive sublimate in #agfb1 was soon followed by its employment by ,chaussier1 ,beclard and ,larrey1 in the preserving of bodies4 ,dr4 ,franchina of ,naples1 employed arsenic also1 with considerable success2 but from the danger to dissectors1 where these poisons had been employed1 their use after the discovery of the preservative properties of chloride of zinc1 was quite discontinued4 ,the latter substance1 with carbolic acid1 constitutes the best antiseptis known at the present time1 and these are more generally employed than any other for preserving dead bodies4 ,the objects of the process of embalming at the present day1 are threefold3 #ast4 ,it permits the delay of burial where this is desirable from the absence of friends2 or of the ready transportation of the bodies of those who may have died a long distance from home1 and that free from decay and post-mortem change4 #b;d4 ,as a sanitary measure in large towns and cities1 where many bodies are placed in family vaults1 instead of being buried in the ground4 #c;d4 ,for the preservation of bodies for the purpose of anatomical study4 ,for either of these objects1 it is desirable that the process be simple1 easy1 quick and inexpensive4 ,frequently in the large cities1 and occasionally in the country1 the physician will be called upon to perform this operation1 but without some information upon the subject1 he will be unable to comply with the request4 ,the operation at the present time1 consists simply in filling the vascular system with a preserving fluid1 by injecting the same into some one or more of the arteries2 the substance employed being either carbolic acid or chloride of zinc in solution2 the latter1 from possessing greater preserving power without the disagreeable odor of the carbolic acid1 being much more frequently employed4 ,preparation of the ,zinc4 ,in the large cities1 the chloride of zinc may be obtained of the manufacturing chemists ready made2 but in the country1 the physician may manufacture the solution himself1 by the following process3 ,place in an open stone jar1 ten pounds of muriatic acid1 and add to the same1 old scrap sheet zinc1 ad libitum4 ,it should be frequently stirred1 and allowed to stand in the open air for from twelve to twenty-four hours1 or until the acid has so acted upon the zinc as to have become thoroughly neutralized1 forming thus a saturated solution of the chloride of zinc4 ,the quantity required of this solution to preserve a body1 will depend upon the state of the weather1 in connection with the size of the body1 cause of death1 etc42 more being required in hot weather1 or in a large body1 or in such diseases as are followed by a tendency to rapid putrefaction4 ,in all cases1 however1 the rule should be to throw in as much as the vessels will hold1 varying the strength according to the weather1 character of the body1 etc4 ,with young1 thin subjects1 and cool weather1 the chloride may be diluted one-half with water2 but in warmer weather1 and with a large body full of fluids1 a proportion of two-thirds zinc1 or even stronger may be required4 ,it will be well to commence by throwing in a weaker solution1 which1 by not constringing the small vessels1 will pass more readily into the extremities1 and follow by a stronger for filling the large vessels of the trunk4 ,dr4 ,vivodtsef of ,st4 ,petersburg1 employs a mixture of carbolic acid and alcohol4 ,taking alcohol of about ninety degrees1 he adds one-fifth its weight of carbolic acid2 there being required of this mixture1 a quantity equal to about one-half the weight of the body to be injected4 ,it may be thrown into the vessels in the same manner as the solution of the chloride of zinc4 ,the high price of alcohol in this country1 would constitute an objection to the use of this substance1 even if it afford advantages over the zinc1 which it probably does not4 ,instruments ,required4 ,for the satisfactory performance of this operation1 there will be required the anatomical syringe4 ,this instrument consists of a brass cylinder and piston1 of a capacity of twelve to sixteen ounces1 with a movable stop-cock1 and series of graduated pipes for arteries of different size4 ,each pipe has a small rim or shoulder at the point to be introduced into the vessel1 above which the ligature is applied1 which thus holds the pipe more securely in its position4 ,the absence of the anatomical syringe should not1 however1 deter the physician from attempting this operation1 as1 by a little preparation1 the common gum-elastic family syringe1 of the ,mattson or a similar pattern1 may be made to answer the purpose4 ,the point of the small or child's rectum pipe may be reduced with a file1 and a shoulder prepared1 about one-fourth of an inch from the end1 for securely holding it when tied in the vessel4 ,an apparatus of a complicated character1 and working by atmospheric pressure1 has been devised for this purpose2 but while it possesses very few advantages over the syringe described1 it is expensive and not easily managed4 ,the ,operation4 ,in the dissecting-room1 it is usual to open the chest and inject through the arch of the aorta2 but in other cases1 one of the common carotids1 and better the right1 may be selected4 ,extend the head1 placing thus the muscles upon the stretch1 and along the inner border of the right sterno-cleido-mastoid muscle1 make an incision two inches in length1 through which may be exposed the upper portion of the common carotid artery4 ,after detaching the vessel from the surrounding structures1 it should be raised upon the handle of a scalpel and two ligatures passed around1 one of which is to be tightly tied1 high up1 upon the vessel4 ,below this1 a longitudinal slit1 one-half inch in length1 should be made in the vessel1 for receiving the pipe of the syringe1 which1 when in position1 should be securely tied with the second ligature1 just above the rim4 ,the stop-cock joint may now be fitted to the pipe4 ,to permit of the escape of as much of the blood as possible1 an opening may be made into the jugular vein1 ligatures being passed beneath the vessel--one above and one below the opening--that it may be closed at the proper time4 ,the antiseptic fluid having been prepared in a convenient vessel1 the syringe1 after having been carefully examined and found in good working order1 should be slowly filled1 adjusted to the stop-cock joint1 the cock opened1 and the syringe slowly discharged4 ,shutting off the cock1 to prevent escape of the fluid1 the syringe may now be detached1 refilled and again discharged1 the process being repeated until the vessels are filled with the fluid1 which may be known from the resistance offered to its introduction4 ,after a few syringefuls have been thrown into the vessels1 the blood will be seen flowing more or less freely from the jugular1 and which will gradually change to the clear antiseptic fluid2 then the vessel may be tied1 to prevent any further loss4 ,to facilitate the flow of the fluid into the vessels of the extremities1 free flexion and extension of all the limbs should be made2 and after some minutes1 another effort made to force in more of the fluid4 ,a successful filling of all the vessels may be known by the distension of the superficial veins of the chest and arms1 accompanied with an escape of a dark fluid from the nostrils and1 perhaps1 mouth1 from an oozing of the fluid through the capillary vessels of the mucous membranes of the head4 ,if the extemporized gum syringe be used1 its pipe should be tied in the vessel as in the other case1 the opposite end of the tube placed in the vessel of fluid1 and the same thrown in by pressure of the ball4 ,the operation being completed1 a ligature should be tightly placed around the artery below the pipe1 the latter removed and the incision sewed up4 ,changes ,resulting from the ,operation4 ,as the vessels become filled during the operation1 the abdomen will gradually swell1 the chest become more round and full1 the face and eyelids become puffy1 while the superficial veins will appear full and dark from the contained blood4 ,in a few hours the skin assumes a pale1 ashen hue1 with a parchmentlike feel1 which will be a sure indication of the success of the operation4 ,in a few days the puffed appearance of the face will have disappeared1 when no further change will be noticed1 until after several weeks the ears1 with the tip of the nose1 and ends of the fingers1 begin to shrivel and dry up4 ,,chapter ,,vii4 ,,preservation ,,of ,,specimens ,,of ,,morbid ,,anatomy4 ,many valuable and interesting pathological specimens are continually being lost1 from a want of knowledge1 or a careless neglect on the part of the physician4 ,that the fullest benefit may result from a post-mortem examination1 any rare or interesting specimen should be carefully preserved4 ,should the physician feel no interest in forming a cabinet of morbid anatomy for himself1 he should then deposit the specimen in the anatomical museum of some medical school1 where it may be permanently preserved1 and the profession thus benefited4 ,all specimens of soft tissues designed for preservation1 should first be soaked in water which is changed daily1 until all blood is removed4 ,if the weather be warm1 it will be necessary to add to the water each time1 either a small proportion of alcohol1 or some antiseptic1 as carbolic acid1 chloride of zinc1 corrosive sublimate1 or common salt4 ,after all blood is removed1 the specimen may be put into alcohol of a strength proportionate to the size of the specimen1 and then allowed to remain until thoroughly 8cured40 ,small specimens are dried up1 shrunken and nearly spoiled in many cases1 by the use of too strong alcohol1 while on the other hand1 large ones1 by diluting the alcohol with the large amount of water contained1 would be likely to spoil in a weak preparation4 ,large specimens1 particularly in warm weather1 should have deep incisions made at a few points1 for the better penetration of the preserving fluid4 ,before being permanently put up1 the specimen should be carefully trimmed1 and everything interfering with the best display of the essential point removed4 ,while either of the antiseptics mentioned above will answer for 8curing0 a specimen1 for permanent suspension1 there is no substitute for alcohol4 ,other fluids may preserve1 but they will also become turbid1 throw down a precipitate1 and in cold weather are liable to freeze1 while from their high specific gravity1 many light specimens will float on or near the surface4 ,if the specimen has been thoroughly 8cured0 before suspension1 very dilute alcohol will answer for that purpose3 equal parts of pure water and alcohol of ninety-five degrees1 in all except the larger specimens1 being abundantly strong4 ,delicate1 light specimens will sometimes float in such a dilution1 in which case it should be made stronger4 ,the best form of anatomical jar is made with ground glass stoppers1 with a hook on the under side of the latter for suspending the specimen4 ,although expensive1 these jars1 by effectually securing the alcohol from evaporation1 as well as from the greater facility with which the spirits may be changed1 which will sometimes be required1 will give better satisfaction than any other4 ,where the common jar without a stopper is used1 great care will be required in closing up1 to prevent loss by evaporation4 ,there should first be prepared a circular plate of thick sheet lead1 to rest on the top of the neck of the jar4 ,the specimen having been suspended by a string1 carried through by a large needle1 and at two different points1 is to be fastened to the disk of lead by means of two holes1 punched by an awl1 about half an inch apart1 near the centre4 ,the portion of string above the lead1 with the holes also1 should now be carefully covered with sealing-wax1 otherwise1 by capillary attraction1 the alcohol will keep the bladder covering continually wet1 and finally rot it out4 ,over the lead is now to be stretched a piece of moistened bladder1 and wound with twine around the neck of the jar4 ,when dry1 this is to be covered with a coat of black varnish2 this again when dry1 being followed by a second layer of bladder and varnish4 ,wet preparations should be kept where they may have a free exposure to sunlight4 ,if placed in a dark closet1 they become damaged in texture1 and acquire a dark and unpleasant color2 this is particularly the case with the ligamentous and nervous tissues4 ,dr4 ,brunetti of ,padua1 who has invented a new process for preserving certain kinds of specimen1 and who received a gold medal some years ago at the ,paris ,exposition1 gives the following particulars of his method3 8,the process comprises four several operations1 viz43 #a1 the washing of the piece to be preserved2 #b1 the degraissage1 or eating away of the fatty matter2 #c1 the tanning1 and #d1 the desiccation4 8#a4 ,to wash the piece ,m4 ,brunetti passes a current of pure water through the blood-vessels and the various excretory canals1 and then he washes the water out by a current of alcohol4 8#b4 ,for destroying the fat he follows the alcohol with ether1 which he pushes1 of course1 through the same blood-vessels and excretory ducts2 this part of the operation lasts some hours4 ,the ether penetrates the interstices of the flesh and dissolves all the fat4 ,the piece1 at this point of the process1 may be preserved any length of time desired1 plunging it in ether1 before proceeding to the final operations4 8#c4 ,for the tanning process ,m4 ,brunetti dissolves tannin in boiling distilled water1 and then1 after washing the ether out of the vessels with distilled water1 he throws this solution in4 8#d4 ,for the drying process ,dr4 ,brunetti places the pieces in a vase with a double bottom filled with boiling water1 and he fills the places of the preceding liquids with warm1 dry air4 ,by the aid of a reservoir1 in which air is compressed to about two atmospheres1 and which communicates by a stop-cock and a system of tubes1 first to a vase containing chloride of calcium1 then with another heated1 then with the vessels and excretory ducts of the anatomical piece in course of preparation1 he establishes a gaseous current which expels in a very little time all the fluids4 ,the operation is now finished4 8,the piece remains supple1 light1 preserves its size1 its normal relations1 its solid elements1 for there are no longer any fluids in it4 ,it may be handled without fear1 and will last indefinitely40 ,for the preservation and hardening of tissues for microscopic examination--as sections of tumors1 glands1 membranes1 spinal cord or brain1 etc4--,mller's fluid may be employed1 which is prepared as follows3 bichromate of potassa1 #ge grains2 sulphate of soda1 #ce grains2 dissolved in six ounces of water4 ,the specimen should be suspended in this fluid until sufficiently hardened to permit of a satisfactory examination4 ,preparation of ,bones4 ,pathological specimens of bones1 may be prepared either by boiling or maceration4 ,the method by boiling should be employed1 however1 only where the texture of the specimen is firm and solid1 as in cases of united fracture1 etc42 and in these cases1 care will be required to avoid injuring the specimen by too long exposure to the process4 ,maceration1 however1 is the better method for all cases1 and the only one to be employed in cases where the bone is softened by caries or necroses4 ,the specimen having been roughly stripped of the soft tissues1 is to be thrown into a vessel of water1 the latter being changed every day1 as long as it becomes colored by the blood4 ,it is now to be left until the putrefactive process has so softened the tissues that they may be easily removed1 when1 after being thoroughly washed in soda water1 it may be dried and mounted4 ,if the weather be cold1 it will be absolutely important that the macerating be conducted in a warm room1 else the process will be so slow as to convert the tissues into a form of adipocere1 quite arresting the putrefactive process1 and greatly damaging the specimen in its beauty and value4 ,in this connection1 it may be observed that bones from a subject that has been injected with chloride of zinc1 can never be successfully macerated1 the zinc having a sort of tanning effect upon the tissues1 which enables them to resist the putrefactive process4 ,boiling is the only method by which such specimens can be cleansed4 ,where a bone has been properly macerated and dried1 and especially if from a young subject1 it will be found white and quite free from grease2 but when taken from old subjects1 or when prepared by boiling1 it may be required to be subjected to a bleaching process for removing the grease and improving the color4 ,by exposure to the sun1 with frequent washing in chlorine and soda water1 the appearance of the specimen may be greatly improved1 or what is still better1 by covering the specimen for a few days in sulphuric ether1 which will effectually dissolve out all the grease1 and then washing and exposing to the sun for a few days1 it will be left beautifully white and clean4 ,for permanent preservation1 the specimen should finally be mounted on a block or board1 in such a manner as best to expose its interesting points4 ,,index4 ,,page ,abdomen1 method of opening1 #abg ,abdominal dropsy1 #ace ,alcohol1 poisoning by1 #bii ,anatomical syringe1 #cbc ,anus1 diseases of1 #aeg fistula of1 #aeg hmorrhoids1 #aei ulcer in1 #aeg ,aorta4 7,see ,arteries47 ,apoplexy1 cerebral1 #da pulmonary1 #aae ,arachnoid1 examination of1 #ch ,arsenic1 poisoning by1 #big ,arthritis1 chronic rheumatic1 #bga scrofulous1 #bga ,arteries1 aneurism of1 #ii calcification of1 #ii examination of1 #ih fatty degeneration of1 #ii inflammation of1 #ih ossification of1 #ii rupture of1 #ajb ,arteries1 cerebral4 atheromatous degeneration of1 #fj calcification of1 #fj obstruction of1 #ei position of clot in obstruction of1 #ei ,atresia ani1 #adi urethr1 #bab ,autopsy1 medico-legal1 method of conducting1 #cjd ,biliary calculi1 #ahh effects of1 #aij position of1 #ahi ,bladder1 gall-4 7,see ,gall-bladder47 ,bladder1 urinary4 contraction of1 #baj catarrh of1 #baj cancer of1 #baa dilatation of1 #bji examination of1 #bjh hypertrophy of1 #bji inflammation of1 #baj malformations of1 #bjh parasites in1 #bab removal of1 #aca tubercles in1 #baa tumors in1 #baa ,bones1 abscess of1 #bei cancer of1 #bff caries of1 #bfj examination of1 #bei inflammation of1 #bei morbid growths in1 #bfc necrosis of1 #bfj rickets in1 #bfa suppuration of1 #bei tumors in1 #bfc tubercles in1 #bfe ,brain1 appearance of1 in health1 #dh abscess of1 #ej atrophy of1 #ec blood cysts in1 #ei calcareous deposits in1 #ef examination of1 #bi hardening of1 #ea hypertrophy of1 #eb hydatids in1 #eg inflammation of1 #dg membranes of1 #cf removal of1 #bi softening of1 #dh tumors of1 #ed ,bright's disease1 #aig cirrhotic or contracting form1 #bja inflammatory form1 #aig waxy or amyloid form1 #bjj ,bronchial tubes1 dilatation of1 #abe examination of1 #ajf1 #abb inflammation of1 #abc narrowing of1 #abd obliteration of1 #abd ,bronchitis1 #abc ,buccal cavity1 examination of1 #fe ,burning1 ante-mortem distinguished from post-mortem1 #cah ,cancer1 of bones1 #bff black1 #bia colloid1 #bib encephaloid1 #bia epithelial1 #bic of gall-bladder1 #ahh ,cancer1 of heart1 #hd hard1 #bij of intestines1 #aeh of kidneys1 #bjd of liver1 #agg of lungs1 #abj of mamm1 #bef1 #beg of mediastinum1 #abf medullary1 #bia melanotic1 #bia of ovaries1 #bej of sophagus1 #gc of penis1 #bag of prostate gland1 #bbh of pancreas1 #afa of peritoneum1 #acf of spleen1 #afe of suprarenal capsules1 #bjh of scrotum1 #bai of stomach1 #adf of scirrhus1 #bij of testicles1 #bbd of tongue1 #fh of ureters1 #bjf of urinary bladder1 #baa of urethra1 #bad of uterus1 #bdj of vagina1 #bcd ,calculi1 urinary1 #bad ,calvarium1 removal of1 #bh ,carbonic oxide1 poisoning by1 #bii ,carditis1 #gf ,cerebral arteries1 #ei ,cerebritis1 #dh ,cerebro spinal meningitis1 #fa ,chest1 examination of1 #fe ,children1 new-born1 medico-legal question relating to1 #cjg ,chloride of zinc1 preservative properties of1 #cba ,colon1 removal of1 #abh ,corrosive sublimate1 poisoning by1 #bih preservative properties of1 #cba ,cystitis1 #baj ,death1 signs of1 previous to putrefaction1 #cab probable cause of1 #cag ,diphtheria1 false membranes in1 #ga ,disinfectants for instruments1 #bd ,dropsy of abdomen1 #ace of brain1 #dj of chest1 #ajc of heart1 #gd of ovaries1 #bdh of testes1 #bbb ,drowning1 death from1 #cjb1 #cji ,duodenum1 removal of1 #abi ,dura mater1 inflammation of1 #cf1 #fa fibrinous clots in1 #cg thickening of1 #cg tubercular deposits in1 #ch tumors in1 #ch ,ear1 examination of1 #ca removal of1 #bi ,embalming1 method of1 by ancients1 #cbj objects of1 #cba instruments required1 #cbc the operation1 #cbd changes resulting from1 #cbe ,embolism of cerebral arteries1 #ei ,endocarditis1 #gg ,enteritis1 #adi ,epididymitis1 #bba ,epispadias1 #bab1 #bae ,exostoses1 #bfc ,eyes1 removal of1 #cb ,fallopian tubes1 anomalies of1 #bea inflammation of1 #bea morbid growths in1 #bea ,fistula in ani1 #aeg ,fractures1 ante-mortem distinguished from post-mortem1 #cah ,ganglions1 #bgj ,gall-bladder and ducts1 #ahg cancer of1 #ahh dilatation of1 #ahh gall-stones in1 #ahi inflammation of1 #ahg tumors in1 #ahh tubercles in1 #ahh ,gastritis1 #ada catarrhal1 #ada croupous1 #ada phlegmonous1 #ada ,gums1 examination of1 #fe ,gunshot wounds1 ante-mortem distinguished from post-mortem1 #cah ,hanging1 death from1 #cja1 #cai ,hmatocele1 #bbc ,hmoptysis1 #aad ,hmorrhage1 pulmonary1 #aad uterine1 #bcg ,hmorrhoids1 #aeg ,head1 caries of bones of1 #ce examination of1 #bg removal of membranes of brain1 #bh removal of calvarium1 #bh removal of brain1 #bi thickening of bones of1 #ce thinning of bones of1 #ce ,heart1 atrophy of1 #hb abscess of1 #hf aneurism of1 #hf cancers in1 #hd displacements of1 #hg dilatation of1 #hj ectopia cordis1 #hh examination of1 #ff1 #ge fatty degeneration of1 #hb fatty growth of1 #hb hydatids in1 #hf hypertrophy of1 #gi inflammation of1 #gf melanosis of1 #hd malformations of1 #hf morbid condition of1 #ge normal size of1 #hj ossification of arteries of1 #he rupture of walls of1 #hg stenosis of1 #gi tumors in1 #hd transposition of1 #hh valves of1 #gg ,heart clots1 causes of1 #ia color of1 #hi consistency of1 #hi time of formation of1 #ij position of1 #hi ,hepatitis1 #afh ,hernia1 #aed ,hydrarthrosis1 #bfh ,hydrothorax1 #ajd ,hydrocele1 #bbb congenital1 #bbb diffused1 #bbc encysted1 #bbb simple1 #bbb ,hypospadias1 #bab1 #bae ,hydrocyanic acid1 poisoning by1 #bih ,instruments1 #ba disinfectants for1 #bd ,intestines1 cancer of1 #aeh contraction of1 #aec dilatation of1 #aec displacement of1 #aed examination of1 #adi inflammation of1 #aej incarceration of1 #aee malformations of1 #adi obstructions of1 #aee1 #aef parasites in1 #aei rupture of1 #aeg tubercles in1 #aeh tumors in1 #aeh ulceration of1 #aeb wounds of1 #aeg ,intussusception1 #aef ,joints1 burs of1 morbid conditions of1 #bfi cartilage of1 morbid conditions of1 #bgj inflammation of synovial membrane1 #bfh malformations of1 #bfh rheumatic inflammation of1 #bga scrofulous inflammation of1 #bga ,kidneys1 anomalies of1 #aid abscesses of1 #aif ,bright's disease of1 #aig congestion of1 #aid cancer of1 #bjd cysts in1 #bjd dislocation of1 #bjc examination of1 #aic fatty degeneration of1 #bjb hmorrhage of1 #aie inflammation of1 #aie inflammation of capsule of1 #aig parasites in1 #bje removal of1 #abi size and weight of1 #aic tubercles in1 #bjc ,larynx1 abscesses of1 #ga examination of1 #fd1 #fe1 #fi false membranes in1 #ga inflammation of1 #fi necrosis of cartilages of1 #gj dema of1 #gj tumors of1 #ga ulceration of1 #gj ,liver1 abscess of1 #afi1 #aga atrophy of1 #agd blood-vessels of1 #ahb congestion of1 #aff cancer of1 #agg degenerations of1 #aga examination of1 #acj1 #afe effusion hmorrhagic of1 #afg fatty1 #agb hypertrophy of1 #agg inflammation of1 #afh parasites in1 #ahc1 #ahf removal of1 #acj size of1 #afe tubercles in1 #aha tumors in1 #ahb ,lungs1 appearance in health1 #ajg appearance1 post-mortem1 #aah1 #abj abscess of1 #aaa apoplexy of1 #aae congestion of1 #ajg cancer of1 #abj examination of1 #fg1 #ajf emphysema of1 #aaf gangrene of1 #aab hepatization of1 #ajh hmorrhage of1 #aad hydatids in1 #abb inflammation of1 #ajg1 #aji melanosis of1 #aba suppuration of1 #aaj tubercles in1 #aag tubercular cavities in1 #aai tumors in1 #abb ,mamm1 anomalies of1 #beb atrophy of1 #beb abscesses of1 #bec cancer of1 #bef1 #beg examination of1 #beb inflammation of1 #bec tumors in1 #bed ulcers in1 #bed ,medico-legal questions1 #cjd external inspection of body1 #cje internal examination1 #cjf ,mediastinum1 abscess of1 #abf cancerous growths in1 #abf inflammation of1 #abf tumors of1 #abf ,medulla1 spinalis1 #fb oblongata1 effusions in1 #dc of bone1 disease of1 #bfg ,membranes of the brain4 appearance of1 in meningitis1 #ci examination of1 #cf morbid changes of1 in insanity1 #dj removal1 of #bh serous effusion into1 #dj sanguineous effusion into1 #da ,membranes1 spinal1 tuberculous deposits in1 #fa tumors in1 #fa ,meningitis1 #ci cerebro-spinal1 #fa tubercular1 #ch ,metritis1 #bcg1 #bdb ,metrophlebitis1 #bdc ,morbus ,brightii1 #aig ,mouth1 catarrhal or croupous inflammation of1 #gb examination of1 #fd ,myelitis1 #fb ,mller's fluid1 #cbi ,neck1 examination of1 #fd ,nephritis1 #aie ,nitric acid1 poisoning by1 #bie ,nux vomica1 poisoning by1 #bii sophagus1 cancer of1 #gc dilatation of1 #gc examination of1 #gb inflammation of1 #gb stricture of1 #gb tumors in1 #gc ulceration of1 #gb ,opium1 poisoning by1 #cjj ,orchitis1 #bba ,osseous growths1 #bfc ,osteomalacia1 #bfb ,osteophytes1 #bfc ,ovaries1 abscesses in1 #bdg cysts in1 #bdh dropsy of1 #bdh examination of1 #bdg inflammation of1 #bdg malignant disease of1 #bej tumors1 tubercles1 etc41 of1 #bea ,oxalic acid1 poisoning by1 #bie ,palate1 examination of1 #fe ,pacchionian bodies1 #ci atrophy of1 #afa ,pancreas1 anomalies of1 #afj cancer of1 #afa dilatation of ducts1 #afa examination of1 #afj fatty degeneration of1 #afa hypertrophy of1 #afa inflammation of1 #afa removal of1 #abi ,parasites in bladder1 #bab in brain1 #eg in heart1 #hf in intestines1 #aei in kidneys1 #bje in liver1 #ahc1 #ahf in lungs1 #abb in spinal cord1 #fc ,pelvic viscera1 removal of1 #acj ,penis1 anomalies of1 #bae atrophy of1 #bae balanitis of1 #baf chancres on1 #baf cancer of1 #bag examination of1 #bae fracture of1 #baf hypertrophy of1 #bae herpes of1 #baf paraphymosis of1 #baf psoriasis of prepuce1 #baf tumors of1 #bah warts on1 #bag ,pericardium1 adhesions in1 #gd blood in1 #gd examination of1 #gc inflammation of1 #gc morbid growths in1 #ge ,peritoneum1 blood in result of violence1 #ace congestion of1 #acc cancer of1 #acf dropsical accumulation in1 #ace exudation1 fibrinous1 on1 #acd examination of1 #acc gangrene of1 #ace inflammation of1 #acc suppuration of1 #ace tubercular deposits in1 #acf tumors of1 #acf ,peritonitis1 #acc puerperal1 #bdc ,perihepatitis1 #afg ,peripractitis1 #aea ,perityphlitis1 #aea ,pharynx1 examination of1 #fe1 #gb inflammation of1 #gb tumors in1 #gc ulceration of1 #gb ,phosphorus1 poisoning by1 #bif ,pia mater1 examination of1 #ch inflammation of1 in spotted fever1 #fa ,pleura1 adhesions in1 #ajc examination of1 #ajc effusions into1 #ajc inflammation of1 #ajc ,pleurisy1 #ajc ,pneumonia1 catarrhal1 #aji croupous1 #aaj double1 #aji lobular1 #aaj single1 #aji ,pneumothorax1 #aje ,poisoning1 death from1 #bid ,post-mortem examinations1 #bd preliminary preparations for1 #bd in medico-legal cases1 #cjd ,pregnancy1 abdominal1 #bdd extra-uterine1 #bdd tubal1 #bde utero-tubal1 #bde ,preparation of bones1 #cbi by boiling1 #cbi by maceration1 #cbi bleaching of1 #ccj ,preservation of specimens of morbid anatomy1 #cbf process of ,dr4 ,brunetti1 #cbh ,prolapsus of rectum1 #aeg ,prostate gland1 anomalies of1 #bbg atrophy of1 #bbh cancer of1 #bbh cysts in1 #bbh concretions in1 #bbi examination of1 #bbf hypertrophy of1 #bbg tubercles in1 #bbh tumors in1 #bbh anomalies of1 #bcj ,pudenda1 examination of1 #bcj elephantiasis of1 #bcb hypertrophy of1 #bcj inflammation of1 #bca tubercles in1 #bcb tumors in1 #bcb warty excrescences on1 #bca ,putrefaction1 process of1 #cad ,pyelitis1 #aif ,pyelonephritis1 #aif ,questions relating to new-born children1 #cjg was the child mature81 #cjg was it born alive81 #cjh how long did it live81 #caj what was the cause of death81 #caa ,rachitis1 #bfa ,rectum1 prolapsus of1 #aeg removal of1 #abh ,sclerosis of spinal cord1 #fb ,scrotum1 cancer of1 #bai examination of1 #bah elephantiasis of1 #bah hypertrophy of1 #bah inflammation of1 #bai ,seminal vesicles1 anomalies of1 #bbf examination of1 #bbf inflammation of1 #bbf tubercles in1 #bbg ,signs of death1 #cab ,skull1 caries of bones of1 #ce examination of1 #cd fracture of1 #cd thinning of bones of1 #ce thickening of bones of1 #ce ,spinal cord1 atrophy of1 #fc examination of1 #fj inflammation of membranes of1 #fj morbid growths in1 #fc parasites in1 #fc preservation of specimens of1 #cc removal of1 #cc softening of1 #fb ,spinal column1 disease of1 #bgb ,spinal canal1 serous effusions in1 #fa ,spina bifida1 #fa ,spleen1 anomalies of1 #afb atrophy of1 #afb cysts in1 #afe cancer of1 #afe displacements of1 #afc degeneration of1 #afd examination of1 #afb hypertrophy of1 #afb inflammation of1 #afc removal of1 #abi rupture of1 #afc size of1 normal and abnormal1 #afb thickening of capsules of1 #afd tubercles in1 #afd ,spotted fever1 inflammation of pia mater in1 #fa ,stomach1 atrophy of1 #ade ,beaumont's experiments on1 #adj cirrhosis of1 #add cancer of1 #adf cancer in1 results of1 #adh dilatation of1 #ade examination of1 #acg erosions1 hmorrhagic1 of1 #adc inflammation of1 #adj post-mortem changes in1 #acg poisons in1 and their effects1 #adb softening of1 #adc tumors in1 #adh ulcers in1 #adb ,strangling1 death from1 #cja ,strychnia1 poisoning by1 #bii ,suffocation1 death from1 #cjj ,sulphuric acid1 poisoning by1 #bid ,suprarenal capsules1 #bjg cancer of1 #bjh cysts in1 #bjh hmorrhage of1 #bjh inflammation of1 #bjg tubercles in1 #bjh ,testicles1 atrophy of1 #bbj anomalies of1 #bai cancer of1 #bbd cystic disease of1 #bbe dropsy of1 #bbb examination of1 #bai hmatocele of1 #bbc hypertrophy of1 #bbj inflammation of1 #bba tubercles in1 #bbe tumors in1 #bbf varicocele of1 #bbc ,teeth1 examination of1 #fe ,throttling1 death from1 #cja ,thrombi in sinuses of dura mater1 #cg ,tongue1 cancer of1 #fh examination of1 #fh hypertrophy of1 #fi ranula of1 #fh syphilitic ulcers of1 #fh tubercles of1 #fh tumors of1 #fh ,tonsils1 catarrhal or croupous inflammation of1 #gb examination of1 #fe ,tubercular disease of lungs1 #aag tubercular cavities in1 #aai meningitis1 #ch ,tumors1 adenoid1 #bhe benign1 #bgd in brain1 #ed in bones1 #bfc in bladder1 #baa classification of1 #bgd cystic1 #bgd cartilaginous1 #bhj carcinomatous1 #bhh in dura mater1 #ch fatty1 #bgi fibrous1 #bgi in ,fallopian tubes1 #bea in gall-bladder and ducts1 #ahh hydatid1 #bgg in heart1 #hd in intestines1 #aeh lipomatous1 #bgi lymphatic1 #bhe in larynx1 #ga in lungs1 #abb in liver1 #ahb myxomatous1 #bgh myomatous1 #bhd malignant1 #bhf in mediastinum1 #abf in mamm1 #bed neuromatous1 #bhd osseous1 #bha in sophagus1 #gc in ovaries1 #bea papillary1 #bhb polypoid1 #bhc in pharynx1 #gc in pericardium1 #ge in peritoneum1 #acf in pudenda1 #bcb in prostate gland1 #bbh in penis1 #bah sarcomatous1 #bhf in spinal cord1 #fc in stomach1 #adh in tongue1 #fh in testicles1 #bbf in uterus1 #bch in vagina1 #bcd vascular1 #bhd ,ureters1 cancer of1 #bjf cysts in1 #bjg defects of1 #bje dilatation of1 #bjf inflammation of1 #bjf tubercles in1 #bjg ,urethra1 contraction of1 #bac cancer of1 #bad dilatation of1 #bac inflammation of1 #bab malformations of1 #bab rupture of1 #bac stricture of1 #bac tubercles in1 #bad warty growths in1 #bac ,uterus1 anomalies of1 #bce atrophy of1 #bcf cysts in1 #bdj cancer in1 #bdj examination of1 #bce excrescences1 cauliflower1 etc41 #bda hmatometra1 #bcf hypertrophy of1 #bcf hydrometra1 #bcf hmorrhages of1 #bcg inflammation of1 #bcg1 #bdb1 #bdc malpositions of1 #bcf removal of1 #acb rupture of1 #bda tubercles in1 #bdj tumors in1 #bcj ulcerations of1 #bch ,vagina1 anomalies of1 #bcb dilatation of1 #bcb examination of1 #bcj gangrene of1 #bcd inflammation of1 #bcc laxity of1 #bcb laceration of1 #bcb rigidity of1 #bcb rupture of1 #bcc stricture of1 #bcb tumors of1 #bcd ,valves of heart1 aneurism of1 #gi atrophy of1 #gh calcification of1 #gh contraction of1 #gi thickening of1 #gg ,volvulus1 #aef ,vulva4 7,see ,pudenda74 ,white swelling1 #bga ,wounds1 death from1 #cag contused1 appearance of1 #cag post-mortem distinguished from ante-mortem1 #cag ,zinc1 preparation of1 for embalming1 #cbb quantity of1 required1 #cbb ,,errata4 ,on page #ba1 last line1 for 8culvarium10 read calvarium4 #be1 fifteenth line1 for 8collodian10 read collodion4 #gi1 last line1 for 8that organ10 read those organs4 #ic1 thirteenth line1 for 8affords10 read afford4 ----- ,footnote #a3 ,toynbee on the ,ear4 ,footnote #b3 ,see ,no4 #eji1 ,college ,museum4 ,footnote #c3 ,id1 #dgc4 ,footnote #d3 ,see ,no4 #dij1 ,college ,museum4 ,footnote #e3 8,morbid ,anatomy of the ,brain1 in ,mania1 c410 by ,andrew ,marshall1 ,m4 ,d4 ,footnote #f3 ,see ,no4 #achf1 ,case ,t1 ,college ,museum4 ,footnote #g3 ,see ,no4 #abie1 ,case ,r1 ,college ,museum4 ,footnote #h3 ,see ,no4 #ache1 ,college ,museum4 ,footnote #i3 ,see ,no4 #achg1 ,college ,museum4 ,footnote #aj3 ,paget's ,pathology1 p4 #ehf4 ,footnote #aa3 ,medico-,chirurgical ,trans4 xvii4 p4 #ejg4 ,footnote #ab3 ,see ,hahnemannian ,monthly for ,may1 #ahga4 ,footnote #ac3 ,in one case1 the clot presented a marked resemblance to the abdominal fat of the goose1 both in color and consistency4 ,footnote #ad3 ,meigs' ,treatise on ,obstetrics1 p4 #cjh4 ,footnote #ae3 ,no4 #adgj1 ,college ,museum4 ,footnote #af3 ,no4 #acdd1 ,college ,museum4 ,footnote #ag3 ,no4 #ache1 ,college ,museum4 ,footnote #ah3 ,see article on ,spontaneous ,cure of ,aneurism1 with cases in ,new ,york ,transactions of ,hompathic ,medical ,society for #ahfh1 page #agj4 ,footnote #ai3 ,see case of recovery reported by ,dr4 ,r4 ,koch1 in ,american ,jour4 of ,hom4 ,mat4 ,med41 ,vol4 ,,iv41 p4 #abc4 ,footnote #bj3 ,see ,nos4 #acji and #acea1 ,college ,museum4 ,footnote #ba3 ,see ,no4 #aejf1 ,college ,museum4 ,footnote #bb3 ,jones and ,sieveking's ,pathological ,anatomy4 ,footnote #bc3 ,cirrhosis1 as applied to this condition of the liver1 has reference to the yellow color1 due to the presence of large quantities of yellow pigment contained in the secreting cells2 hence the application of the term to diseases of the lungs1 kidneys1 etc41 which resemble cirrhosis of the liver1 not in color1 but in density of the tissues1 is obviously inappropriate4 ,footnote #bd3 ,see ,no4 #adie1 ,college ,museum4 ,footnote #be3 ,see ,no4 #adif1 ,college ,museum4 ,footnote #bf3 ,see report of case of 8,ossification of ,veins10 by ,james ,kitchen1 ,m4 ,d41 in ,american ,journal of ,homopathic ,materia ,medica for ,december1 #ahga1 page #adc4 ,footnote #bg3 ,see ,no4 #aejj1 ,college ,museum4 ,footnote #bh3 ,specimen ,no4 #acbi1 ,college ,museum4 ,footnote #bi3 ,see ,no4 #accf1 ,college ,museum4 ,footnote #cj3 ,see ,no4 #abei1 ,college ,museum4 ,footnote #ca3 ,bright's ,disease1 by ,t4 ,grainger ,stewart4 ,footnote #cb3 ,see ,no4 #aejg1 ,college ,museum4 ,footnote #cc3 ,specimen ,no4 #abfj1 ,college ,museum4 ,footnote #cd3 ,see ,no4 #abfa1 ,college ,museum4 ,footnote #ce3 ,see ,no4 #cei1 ,college ,museum4 ,footnote #cf3 ,see ,no4 #cbi1 ,college ,museum4 ,footnote #cg3 ,see ,no4 #cca1 ,college ,museum4 ,footnote #ch3 ,see ,nos4 #cce and #cfj1 ,college ,museum4 ,footnote #ci3 ,see ,nos4 #cbe and #cbf1 ,college ,museum4 ,footnote #dj3 ,see ,no4 #adgf1 ,college ,museum4 ,footnote #da3 ,see ,nos4 #acdj and #acda1 ,college ,museum4 ---------------------------------------- -------------------------------- ,,transcriber',s ,,notes ,page ,changed from ,changed to #bcg defect in the excretion of the defect in the excretion of the menses1 or form a morbidly menses1 or from a morbidly #cjj oxygen though the lungs4 ,the oxygen through the lungs4 ,the term is generally restricted term is generally restricted ,typos fixed2 non-standard spelling and dialect retained4 ,enclosed italics font in underscores4