,a ,,practical ,,guide ,,= ,,mak+ ,,po/-,,mortem ,,exam9ations1 ,,& ,,= ,,! ,,/udy ,,( ,,morbid ,,anatomy1 ,,) ,,directions ,,= ,,embalm+ ,,! ,,dead1 ,,& ,,= ,,! ,,pres]vation ,,( ,,specim5s ,,( ,,morbid ,,anatomy4 ,,by ,a4 ,r4 ,,?omas1 ,m4 ,d4 ,pr(essor ( ,anatomy 9 ! ,hahnemann ,m$ical ,college ( ,philadelphia2 ,lectur] on ,arti/ic ,anatomy 9 ! ,p5nsylvania ,academy ( ,f9e ,arts1 & ,philadelphia ,s*ool ( ,design2 ,memb] ( ! ,am]ican ,in/itute ( ,homopa?y2 ,g5]al ,editor ( ,am]ican ,j\rnal ( ,homopa?ic ,mat]ia ,m$ica1 ,etc41 ,etc4 ,,= ,,sale ,,by ,,bo]icke ,,tafel1 ,,new ,,york3 ,,philadelphia3 ,,no4 #ade ,,gr& ,,/reet4 ,,no4 #fce ,,ar* ,,/reet4 #ahgc4 ,ent]$ accord+ to ,act ( ,congress1 9 ! ye> #ahgc1 by ,a4 ,r4 ,,?omas1 ,m4 ,d41 ,9 ! ,(fice ( ! ,libr>ian ( ,congress at ,wa%+ton4 ,,james ,e4 ,,kryd]1 ,,pr9t]1 #cb ,,s\? ,,sev5? ,,/reet1 ,,philadelphia4 ,,preface4 ,! foll[+ "w has be5 prep>$ ) a view ( supply+ a want1 ! exi/5ce ( :i* has long be5 felt by ! au?or1 bo? 9 8 private practice & public tea*+4 ,no pret5sion is made ( (f]+ a complete "w on ,morbid ,anatomy1 ! object hav+ be51 m]ely to pres5t ! practition] & /ud5t ) a practical guide = mak+ po/-mortem exam9ations1 to give !m h9ts z to :at !y are to look = 9 su* cases1 &1 f9ally1 to aid !m 9 recogniz+ ! v>i\s morbid appe>ances z !y are expos$ to view4 ,! "w is divid$ into f\r p>ts4 ,p>ts ,i1 ,,ii & ,,iii1 correspond+ to ! ?ree great divisions ( ! body--! ,head1 ,*e/ & ,abdom54 ,"p ,,iv1 is devot$ to miscellane\s subjects1 & conta9s *apt]s on ! ,bones2 ,jo9ts2 ,tumors2 ,effects ( ,poisons2 ,m$ico-,legal ,autopsies2 ,on ,embalm+ ! ,dead2 & ,on ! ,pres]vation ( ,morbid ,specim54 ,a few illu/rative cases h be5 introduc$1 & occasional ref]5ce made to morbid specim5s 9 ! ,museum ( ! ,hahnemann ,college4 ,! foll[+ works h be5 consult$ 9 ! prep>ation ( ! book1 & z few ref]5ces h be5 made1 ?is g5]al cr$it is felt to be due ! sev]al s\rces ( in=mation3 ,rokitansky's1 ,craigie's1 ,jones & ,sieveck+'s1 & ,gre5's ,pa?ological ,anatomy2 ,r9dflei%'s ,pa?ological ,hi/ology2 ,paget's ,surgical ,hi/ology2 ,raue's ,pa?ology2 ,mur*ison1 on ! ,liv]2 ,hope1 on ! ,he>t2 ,br9ton1 on ! ,/oma*2 ,/ew>t1 on ! ,kidney2 ,gross' ,surg]y2 ,*ri/ison on ,poisons2 ,casp] & ,taylor's ,m$ical ,jurisprud5ce4 ,ackn[l$gm5t %\ld "h be made ( ! valuable assi/ance r5d]$ by ,drs4 ,w4 ,h4 ,bigl] & ,john ,n4 ,mit*ell1 9 c>ry+ ! "w ?r\gh ! press2 & ( ! k9dness ( ,mr4 ,j4 ,h4 ,gemrig1 9 ! loan ( ! electrotype plates :i* embelli% ! prelim9>y *apt]4 ,consci\s t ! "w is n )\t defects1 x is /ill pres5t$ to ! pr(ession1 ) ! hope t x may be f\nd to answ] ! purpose = :i* x 0 design$4 ,a4 ,r4 ,,?omas1 #icg ,spruce ,/reet4 ,,m>*1 #ahgc4 ,,cont5ts4 ,,page4 ,,preface1 #ae ,,introduction1 #ag ,,prelim9>y ,,*apt]4 ,in/rum5ts & ,g5]al ,directions1 #ba ,,"p ,i4 ,,! ,,head ,,& ,,sp9e4 ,,*apt] ,i4 ,,! ,,op]ation4 ,on ! ,head & ,sp9e1 #bg ,,*apt] ,,ii4 ,,pa?ological ,,conditions4 ,,section ,i4--,,( ,,! ,,skull1 #cd ,fracture2 ,c>ies2 ,?9n+2 ,increas$ ,?ickness1 #ce ,,section ,,ii4--,,! ,,membranes ,,( ,,! ,,bra94 #a4 ,! ,dura ,mat]1 #cf ,inflammation2 ,?ick5+2 ,fibr9\s ,clots1 #cg ,tub]cul> ,deposits2 ,tumors1 #ch #b4 ,ara*noid & ,pia ,mat]4 ,pac*ionian ,bodies2 ,inflammation2 ,s]\s ,effusions2 ,sangu9e\s ,effusions1 #ch ,,section ,,iii4--,,( ,,! ,,bra94 ,:at to notice2 ,inflammation2 ,s(t5+2 ,abscess2 ,h>d5+2 ,hyp]trophy2 ,atrophy2 ,tumors ( ! ,bra92 ,ad5oid ,tumors2 ,scr(ul\s ,tumors2 ,adipose ,tumors2 ,*ole/]oma2 ,c>tilag9\s ,tumors2 ,calc>e\s ,deposits2 ,ency/$ ,tumors2 ,blood ,cy/s2 ,canc]2 ,melanosis2 ,syphilitic ,tumors2 ,ob/ruction ( ,art]ies2 ,deg5]ation & ,calcification ( ,art]ies1 #dg ,,section ,,iv4--,,( ,,! ,,sp9al ,,cord4 #a4 ,! ,membranes4 ,inflammation2 ,tub]cul> ,deposits2 ,s]\s ,effusion1 #fj #b4 ,sp9al ,m>r[4 ,inflammation2 ,s(t5+2 ,h>d5+2 ,atrophy2 ,morbid ,gr[?s1 #fb ,,"p ,,ii4 ,,! ,,neck ,,& ,,*e/4 ,,*apt] ,i4 ,,op]ation ,,on ,,! ,,neck ,,& ,,*e/4 ,,*apt] ,,ii4 ,,pa?ological ,,conditions ,,( ,,! ,,organs4 ,,section ,i4--,,( ,,! ,,tongue4 ,canc]2 ,syphilitic ,ulc]2 ,tumors2 ,ranula2 ,hyp]trophy1 #fh ,,section ,,ii4--,,( ,,! ,,l>ynx ,,& ,,tra*ea4 ,inflammation2 ,ulc]ation2 dema2 ,necrosis ( ,c>tilages2 ,abscess2 ,tumors2 ,false ,membranes1 #fi ,,section ,,iii4--,,( ,,! ,,ph>ynx ,,& ,,sophagus4 ,inflammation2 ,ulc]ation2 ,/ricture2 ,dilatation2 ,tumors1 #gb ,,section ,,iv4--,,( ,,! ,,p]ic>dium4 ,inflammation2 ,adhesions2 ,effusions2 ,morbid ,gr[?s1 #gc ,,section ,v4--,,( ,,! ,,he>t4 #a4 ,inflammatory ,affection4 ,p]ic>ditis2 ,endoc>ditis1 #gf #b4 ,valvul> ,affection4 ,?ick5+2 ,calcification2 ,atrophy1 #gg #c4 ,*anges ,affect+ ,size4 ,hyp]trophy2 ,dilatation2 ,atrophy1 #gi #d4 ,morbid ,condition ( ! ,walls4 ,fatty ,deg5]ation1 #hb #e4 ,morbid ,gr[?s4 ,tumors2 ,canc]2 ,melanosis2 ,hydatids2 ,ossification ( ,coron>y ,art]ies2 ,abscess2 ,mal=mations2 ,aneurism2 ,rupture1 #hd #f4 ,displacem5ts4 ,ectopia ,cordis2 ,transposition1 #hg #g4 ,cont5ts ( ,cavities4 ,he>t ,clots1 #hh ,,section ,,vi4--,,! ,,aorta ,,& ,,art]ies ,,g5]ally4 ,inflammation2 ,fatty ,deg5]ation2 ,ossification2 ,aneurism2 ,rupture1 #ih ,,section ,,vii4--,,( ,,! ,,pleura4 ,inflammation2 ,pla/ic ,effusion2 ,adhesions2 ,s]\s ,effusion2 ,s]o-,purul5t ,effusions2 ,pneumo?orax1 #ajc ,,section ,,viii4--,,( ,,! ,,lungs ,,& ,,bron*ial ,,tubes4 ,pneumonia2 ,conge/ion2 ,r$ ,hepatization2 ,gray ,hepatization2 ,suppuration & ,abscess2 ,meta/atic ,abscess2 ,gangr5e2 ,pulmon>y ,hmorrhage2 ,pulmon>y ,apoplexy2 ,emphysema1 #ajf ,tub]cul> ,disease ( ! ,lungs1 #aag ,po/-mortem ,appe>ances 91 #aah ,morbid ,gr[?s4 ,canc]2 ,melanosis2 ,hydatids1 #abj ,! ,bron*ial ,tubes4 ,bron*itis2 ,n>r[+ (2 ,dilatation (1 #abc ,! ,m$ia/9um4 ,inflammation2 ,abscess2 ,tumors1 #abf ,,"p ,,iii4 ,,! ,,abdom5 ,,& ,,pelvis4 ,,*apt] ,i4 ,,! ,,op]ation1 #abg ,,*apt] ,,ii4 ,,pa?ological ,,conditions ,,( ,,! ,,p]itoneum ,,& ,,alim5t>y ,,tract4 ,,section ,i4--,,( ,,! ,,p]itoneum4 ,conge/ion2 ,inflammation2 ,fibr9\s ,exudations2 ,suppuration2 ,gangr5e2 ,ascites2 ,morbid ,gr[?s1 #acc ,,section ,,ii4--,,( ,,! ,,/oma*4 ,po/-mortem ,*anges2 ,ga/ritis2 ,effects ( ,poisons2 ,ga/ric ,ulc]2 ,hmorrhagic ,erosion2 ,s(t5+2 ,cirrhosis2 ,atrophy2 ,dilatation2 ,morbid ,gr[?s1 #acg ,,section ,,iii4--,,! ,,inte/9es4 ,mal=mations2 ,inflammation2 ,ulc]ation2 ,dilatation2 ,contraction2 ,displacem5ts2 ,inc>c]ation2 ,volvulus2 ,intussusception2 ,rupture2 ,ulc] & ,fissure ( ! ,anus2 ,fi/ul2 ,hmorrhoids2 ,morbid ,gr[?s2 ,p>asites1 #adi ,,section ,,iv4--,,! ,,pancreas4 ,anomalies2 ,hyp]trophy & ,atrophy2 ,inflammation2 ,fatty ,deg5]ation2 ,dilatation ( ,ducts2 ,canc]1 #afj ,,section ,v4--,,! ,,sple54 ,cong5ital ,anomalies2 ,hyp]trophy & ,atrophy2 ,displacem5ts2 ,rupture2 ,inflammation2 ,?ick5+ ( ,capsule2 ,deg5]ation2 ,morbid ,gr[?s1 #afb ,,section ,,vi4--,,( ,,! ,,liv]4 ,normal /ate (2 ,conge/ion2 ,hmorrhagic ,effusion2 ,p]ihepatitis2 ,sc>-l ,m>ks2 ,hepatitis2 ,second>y1 ,pymic or ,meta/atic ,abscess2 ,deg5]ations ( ! ,liv]2 ,waxy1 ,l>dace\s or ,amyloid ,liv]2 ,atrophy2 ,simple ,atrophy2 ,acute or ,yell[ ,atrophy2 ,*ronic ,atrophy2 ,cirrhosis1 or ,hob-nail ,liv]2 ,hyp]trophy2 ,morbid ,gr[?s2 ,p>asites1 #afe ,affections ( ! ,gall-,bladd] & ,ducts4 ,inflammation2 ,dilatation2 ,morbid ,gr[?s2 ,bili>y ,calculi1 #ahi ,,*apt] ,,ii4 ,,! ,,ur9>y ,,app>atus4 ,,section ,i4--,,! ,,kidneys4 ,cong5ital ,anomalies2 ,conge/ion2 ,hmorrhage2 ,nephritis2 ,pyelitis2 ,abscesses2 ,inflammation ( ,capsule2 ,morbus ,brightii2 ,fatty ,deg5]ation2 ,dislocat$ ,kidney2 ,morbid ,gr[?s2 ,p>asites1 #aic ,! ,uret]s4 ,dilatation2 ,inflammation2 ,morbid ,gr[?s1 #bje ,! ,supr>5al ,capsules4 ,inflammation & ,deg5]ation2 ,hmorrhage2 ,morbid ,gr[?s1 #bjg ,,section ,,ii4--,,! ,,ur9>y ,,bladd]4 ,mal=mations2 ,dilatation2 ,hyp]trophy2 ,contraction2 ,inflammation2 ,morbid ,gr[?s2 ,p>asites1 #bjh ,( ! ,ure?ra4 ,mal=mations2 ,inflammation2 ,dilatation & ,contraction2 ,/ricture2 ,rupture2 ,morbid ,gr[?s2 ,ur9>y ,calculi1 #bab ,,*apt] ,,iii4 ,,! ,,male ,,g5]ative ,,organs4 ,,section ,i4--,,! ,,p5is4 ,cong5ital ,anomalies2 ,hyp]trophy & ,atrophy2 ,fracture2 ,p>aphymosis2 ,balanitis2 ,h]pes2 ,*ancres2 ,morbid ,gr[?s1 #bae ,,section ,,ii4--,,( ,,! ,,scrotum4 ,hyp]trophy2 ,inflammatory dema2 ,morbid ,gr[?s1 #bah ,,section ,,iii4--,,( ,,! ,,te/icles4 ,cong5ital ,anomalies2 ,hyp]trophy & ,atrophy2 ,inflammation2 ,hydrocele2 ,hmotocele2 ,v>icocele2 ,morbid ,gr[?s1 #bai ,,section ,,iv4--,,! ,,sem9al ,,vesicles ,,& ,,pro/ate4 ,cong5ital ,anomalies2 ,inflammation2 ,tub]cul> ,deposits1 #bbf ,! ,pro/ate ,gl&4 ,anomalies2 ,hyp]trophy & ,atrophy2 ,inflammation2 ,abscess2 ,morbid ,gr[?s1 #bbf ,,*apt] ,,iv4 ,,! ,,female ,,g5]ative ,,organs4 ,,section ,i4--,,! ,,pud5da ,,& ,,vag9a4 #a4 ,! ,pud5da4 ,cong5ital ,anomalies2 ,hyp]trophy2 ,inflammation2 ,morbid ,gr[?s1 #bcj #b4 ,! ,vag9a4 ,anomalies2 ,occlusion2 ,dilatation2 ,lac]ation & ,rupture2 ,inflammation2 ,morbid ,gr[?s1 #bcj ,,section ,,ii4--,,! ,,ut]us4 ,anomalies2 ,hyp]trophy & ,atrophy2 ,hydrometra2 ,malpositions2 ,hmorrhages2 ,p]i- or ,retro-,ut]9e ,hmotocele2 ,inflammation2 ,ulc]ation2 ,morbid ,gr[?s1 #bce ,morbid ,conditions foll[+ ,p>turition4 ,rupture2 ,pu]p]al ,inflammation1 #bda ,extra-,ut]9e ,pregnancy1 #bdd ,,section ,,iii4--,,! ,,ov>ies ,,& ,,fallopian ,,tubes4 #a4 ,! ,ov>ies4 ,mal=mations2 ,inflammation2 ,abscess2 ,morbid ,gr[?s1 #bdg #b4 ,! ,fallopian ,tubes4 ,anomalies2 ,inflammation2 ,morbid ,gr[?s1 #bea ,,section ,,iv4--,,! ,,mamm4 ,anomalies2 ,hyp]trophy2 ,atrophy2 ,inflammation & ,abscess2 ,morbid ,gr[?s1 #beb ,! ,male ,mamm1 #beg ,,"p ,,iv4 ,,miscellane\s ,,subjects4 ,,*apt] ,i4 ,,( ,,! ,,p]io/eum ,,& ,,bones4 ,,section ,i4--,,( ,,! ,,p]io/eum4 ,inflammation2 ,ulc]ation2 ,malignant ,disease1 #beh ,,section ,,ii4--,,( ,,! ,,bones4 ,inflammation & ,abscess2 ,c>ies2 ,necrosis2 ,ra*itis2 ,mollities ,ossium2 ,morbid ,gr[?s1 #bei ,! ,m$ulla1 #bfg ,,*apt] ,,ii4 ,,diseases ,,( ,,! ,,jo9ts4 ,mal=mations2 ,morbid ,condition ( ,synovial ,membranes2 ,morbid ,condition ( ,burs2 ,morbid ,condition ( ,c>tilage2 ,ulc]ation ( ,c>tilage2 ,*ronic ,rheumatic ,ar?ritis2 ,scr(ul\s ,ar?ritis1 #bfh ,diseases ( ! ,sp9al ,column1 #bgb ,,*apt] ,,iii4 ,,( ,,tumors4 #a4 ,b5ign or ,non-,malignant ,tumors1 #bgd #b4 ,malignant ,tumors1 #bhf ,,*apt] ,,iv4 ,,po/-,,mortem ,,appe>ances ,,9 ,,dea? ,,f ,,unnatural ,,causes4 #a4 ,dea? f ,poison+1 #bid #b4 ,dea? f ,suffocation1 #cjj #c4 ,dea? f ,hang+ or ,/rangl+1 #cja #d4 ,dea? f ,dr[n+1 #cjb ,,*apt] ,v4 ,,m$ico-,,legal ,,que/ions4 #a4 ,me?od ( ,conduct+ a ,m$ico-,legal ,autopsy1 #cjd #b4 ,que/ions ,relat+ to ,new-,born ,*ildr51 #cjg #c4 ,suppos$ ,p]iod ( ,dea?1 #cab #d4 ,! ,probable ,cause ( ,dea?1 #cag ,,*apt] ,,vi4 ,,on ,,embalm+ ,,! ,,dead1 #cbj ,,*apt] ,,vii4 ,,pres]vation ,,( ,,specim5s ,,( ,,morbid ,,anatomy1 #cbf ,,introduction ,be=e ent]+ ^u ! /udy ( any subject1 x is ( mom5t t ! /ud5t be ?or\ghly conv9c$ ( ! importance ( ! k :i* he is ab\t seek+ to acquire1 s9ce 8 zeal 9 its pursuit w1 9 mo/ cases1 be 9 proportion to ?is conviction4 ,we w1 !re=e1 be=e ent]+ ^u ! subject prop] ( ?is book1 pres5t 9 few words1 "s consid]ations on ! importance ( a /udy ( morbid anatomy z reveal$ by po/-mortem exam9ations4 ,! necessity ( a /udy ( anatomy & physiology by a m$ical /ud5t1 is n[ s univ]sally recogniz$1 t an attempt to prove its importance w\ld seem des]v+ only ( ridicule2 b ! ignorance ( _m practition]s on ! subject ( morbid anatomy1 %[s t ?is /udy has yet to v9dicate its claim z a necess>y bran* ( a m$ical education4 ,f a purely !oretical /&po9t1 ! educat$ physician--"o ^: motto is ,esse1 non vid]i--aft] combat+ a disease 9 va91 %\ld n feel cont5t to rema9 9 ignorance ( its real nature1 s f> z discov]able by anatomical *anges1 capable ( be+ recogniz$ aft] dea?1 ev5 _h he no prospect ( add+ !reby "o jot to 8 practical acqua9tance ) disease or to 8 p[] to combat x2 yet 8 sci5tific consci5ce 7if we may be all[$ ! expression7 ought n to re/ satisfi$ until1 9 all d\btful cases1 8 ante-mortem diagnosis be confirm$ or ov]?r[n1 & 8 conception ( ! case complet$ 9 all its details by a po/-mortem exam9ation4 ,besides ?is purely individual sci5tific int]e/1 !re are weighti] practical reasons = an acqua9tance ) ?is bran* ( m$ical sci5ce by ! physician z practition]4 ,among ! almo/ innum]able que/ions ^u m$ical1 !ological1 & miscellane\s subjects :i* ! ,am]ican public feels at lib]ty to prop\nd to its m$ical advis]s1 none are ( m frequ5t occurr5ce & none are m ju/ifiable ?an ! two3 8,:at is ! matt] ) ! pati5t80 & 8,w he1 or c he1 recov]80 & to none is an answ] m imp]atively dem&$4 ,! public v naturally1 & ) reason1 requires on ! "p ( a physician ! ability to make a diagnosis & a prognosis4 ,x w n be satisfi$ ) be+ told t ! "n ( ! disease is ( no importance1 t ! doctor only wants to he> ! symptoms2 t he does n cure diseases1 b removes ! symptoms ( disease1 c4 ,only an exce$+ly well-tra9$ public w accept ^! truisms z an equival5t = diagno/ic skill4 ,h5ce1 x is ! physician's int]e/1 z well z 8 duty1 z we %all see1 to seek1 9 all cases1 to make a diagnosis1 no matt] h[ difficult ! task may prove to be4 ,! "q h[ f> 8 treatm5t w be modifi$ by 8 diagnosis is a "q ( !rapeutics1 & does n belong "h2 b c]ta9 x is1 t a m]e combatal ( ! symptoms z isolat$ ph5om5a _c be reg>d$ z fulfill+ ! :ole duty ( a consci5ti\s physician4 ,! ability to make a diagnosis1 & consequ5tly prognosis1 dep5ds ^u a k ( pa?ology1 ) a k ( symptoms z signs ( pa?ological /ates & *anges2 & z su* !y mu/ be critically exam9$ & _! true import discov]$1 if possible4 ,?us treat$1 we arrive1 by v>i\s processes ( reason+1 at a diagnosis1 "u :i* ! symptoms fall into _! natural ord] ( importance1 & we run b little risk ( cont5d+ ) remote subjective symptoms 7( great importance 9 diff]5tial !rapeutics7 to ! neglect ( m important1 ?\gh p]haps less prom95t ones4 ,besides ?is1 we are1 9 a measure1 prep>$ to =etell ! probable c\rse ( a disease1 & c1 !re=e1 9 _m cases1 adopt anticipatory measures1 :ile 9 all we w be gu>d$ aga9/ ! error1 s (t5 committ$1 ( ascrib+ to ! rem$y us$ ! s-call$ 8aggravations10 :i* are (t5 only natural symptoms ( ! un*eck$ &1 p]haps1 entirely un9flu5c$ morbid process4 ,su* k s]ves ?us1 by purify+ our exp]i5ce1 to gu>d u aga9/ self-deception1 & to prev5t u f mislead+ o!rs by reports ( cures ( diseases exi/+ only by virtue ( a false diagnosis4 ,a k ( pa?ology1 fur!rmore1 places 9 our h&s a ?read :i* c guide u ?r\gh ! labyr9? ( our va/ mat]ia m$ica1 & :i* enables u1 f ! myriad ( symptoms1 to elim9ate ! non-important ones4 ,x %[s u ! 8be>+s0 ( ! m$ic9es & _! v>i\s specific ranges1 ?us mat]ially facilitat+ ! *oice ( a rem$y4 ,aga91 m$ical sci5ce is virtually bas$ ^u pa?ology1 & we see1 !re=e1 h[ important1 nay1 h[ absolutely necess>y1 to ! progress ( ! =m] is ! /udy ( ! latt]4 ,! practice ( m$ic9e z an art c nev] be advanc$ kn[+ly by ^? :o neglect its cultivation z a sci5ce4 ,:ile ea* "o may practice ! art accord+ to 8 own convictions1 true m$ical sci5ce /&s above all ! belittl+1 bigot$ prejudices ( ! s*ools4 ,"h1 e "o claim+ ! "n ( an educat$ physician c & ought to "w4 ,! wild vag>ies ( =m] ages1 :5 philosophy set up purely !oretical views1 "u :i* obs]v$ ph5om5a 7 compell$ to arrange !mselves1 h w>n$ ! pres5t age to be guid$ solely by sob] & exact obs]vations & inve/igations2 & x ne$s no pro( t1 9 ! advancem5t ( our k ( disease1 ^! are be/ accompli%$ by frequ5t po/-mortem exam9ations1 :i* ?us become a necess>y adjunct to a prop] /udy ( pa?ology4 ,9 all cases ( int]e/1 !re=e1 ! physician %\ld feel x a duty :i* he owes to himself & ! pr(ession at l>ge1 to seek p]mission to make a po/-mortem exam9ation2 b 9 ord] t ! fulle/ b5efit may be d]iv$ f ! same1 he mu/ "k h[ to look = :at he is 9 se>* (1 & h[ to recognize x :5 f\nd4 ,to furni% ?is k is ! object ( ! foll[+ pages1 to :i* we h]e) introduce ! read]4 ,,prelim9>y ,,*apt]4 ,,in/rum5ts ,,& ,,g5]al ,,directions4 ,! ,po/-mortem ,case1 z prep>$ by ! in/rum5t mak]s1 w be f\nd to conta91 usually1 ! foll[+ in/rum5ts3 ,illu/ration3 ,scalpels #a4 ,a set ( ord9>y dissect+ scalpels1 f\r or five 9 numb]1 & ( graduat$ sizes1 includ+ "o heavy c>tilage knife4 ,illu/ration3 ,knife #b4 ,a bra9 knife ) a long blade1 = slic+ ! bra94 ,illu/ration3 ,*isels #c4 ,*isels1 ( "o or bo? ! accompany+ =ms1 = use 9 op5+ ! head or sp9e4 ,illu/ration3 ,hamm] #d4 ,an iron mallet or hamm]1 ) a hook on ! end ( ! h&le = te>+ (f ! culv>ium4 ,illu/ration3 ,ent]otome #e4 ,an ent]otome1 or scissors ) blunt1 hook$ po9t1 = splitt+ op5 ! inte/9al canal4 ,illu/ration3 ,saw #f4 ,a saw ) movable back2 ?is arrangem5t p]mitt+ ( a deep] cut1 9 divid+ l>ge bones4 ,illu/ration3 ,ra*itome #g4 ,! ra*itome1 a *isel-l in/rum5t1 to be us$ ) ! hamm] 9 op5+ ! sp9al canal4 ,illu/ration3 ,saw #h4 ,! d\ble saw1 us$ = divid+ ! lam9 ( ! v]tebr4 ,a side view ( ! in/rum5t be+ giv5 9 ! cut1 "o blade only is se54 ,! two are atta*$ to "o h&le1 plac$ p>allel ) "o ano!r1 & ab\t "o & "o-f\r? in*es ap>t4 ,aft] ! s(t tissues h be5 remov$1 ?is saw is us$ by pass+ ! sp9\s processes betwe5 ! two blades1 & ?us divid+ bo? lam9 at once4 ,illu/ration3 ,clamp #i4 ,a skull clamp1 = /eady+ ! head :ile remov+ ! calv>ium4 ,aft] ! removal ( ! scalp1 ?is in/rum5t may be employ$1 & be ( mu* s]vice = ! above object4 ,x is appli$ by plac+ ! op5 end ( ! in/rum5t ov] ! cr[n ( ! head1 turn+ d[n ! screws1 & ?us fa/5+ x j above ! l9e ( division ( ! bone4 ,! ar*$ end ( ! in/rum5t n[ s]ves z a h&le = turn+ or /eady+ ! head4 #aj4 ,rib-%e>s1 = divid+ ! ribs :]e t op]ation is f\nd desirable4 #aa4 ,a tube = inflat+ ! lungs1 & an ord9>y bl[pipe4 #ab4 ,dissect+ =ceps1 t5acula 9 h&le & ) *a91 groov$ director1 & assort$ ne$les1 /raight & curv$4 ,:ile a po/-mortem case ) all ( ! above in/rum5ts is v conv5i5t1 & important ev51 :]e !re is frequ5t occasion = its use1 /ill its abs5ce %\ld nev] det] ! physician f mak+ an exam9ation :]e ! ord9>y dissect+ case may be _h2 & ) ! c\ntry physician g5]ally1 ?is case is all t is absolutely ess5tial1 z a common c>p5t]'s saw & *isel may at any "t be f\nd1 9 cases :]e ! head is to be op5$2 :ile = op5+ ! *e/ & abdom51 ! dissect+ case conta9s ev]y?+ t is ess5tial4 ,in/rum5ts us$ 9 po/-mortem exam9ations %\ld nev] be employ$ = op]at+ ^u ! liv+1 )\t fir/ be+ repoli%$ by ! in/rum5t mak]1 & ! h&les dis9fect$ by c>eful clean+ 9 a solution ( p]manganate ( pota%4 ,,prelim9>y ,,prep>ations4 ,! ,prelim9>y ,prep>ations at ! place ( ! op]ation %\ld consi/ 9 provid+ a sponge = absorb+ fluids2 newspap]s & old clo?s = fill+ cavities or wrapp+ up any morbid specim5 t x may be desirable to pres]ve2 a c\ple ( qu>ts ( clean sawdu/ or :eat5 bran = ?r[+ into ! cavities be=e clos+ !m up1 & ?us absorb+ any excess ( fluids2 /\t ?read or tw9e = ty+ inte/9es & clos+ ! cavities2 l>d or sweet oil = oil+ ! h&s2 a c\ple ( empty slopbuckets = receiv+ ! fluids1 bloody wat]1 c41 & pl5ty ( wat]1 hot & cold1 ) t[els & soap4 ,if ! floor ( ! room is c>pet$1 to protect x f accid5t1 a piece ( old c>pet1 or quilt1 or oilclo? %\ld be spread alongside ! table or box :]e ! exam9ation is made4 ,c>e %\ld be obs]v$ to h all ^! matt]s provid$ be=e ! op]ation is comm5c$1 :5 ! door %\ld be fa/5$1 t !re may be no intrusion1 by accid5t or o!rwise4 ,9 prep>+ ! body = exam9ation1 if ! head is to be op5$ & ! body is 9 an ice-box1 x w be absolutely necess>y t x be remov$4 ,plac+ ! cov] ( ! box on ! floor1 ! body may be lift$ out & plac$ on ! same1 :5 bo? may be aga9 plac$ on ! top ( ! box or on a table1 = ! exam9ation4 ,if only ! *e/ & abdom5 are to be exam9$1 x w h>dly be necess>y to lift ! body f ! box4 ,9 all cases1 ! %eet 9 :i* ! body is plac$1 ) ! und]clo?+1 7! latt] hav+ be5 split d[n ! c5tre17 %\ld be c>efully turn$ aside1 & c>e obs]v$ dur+ ! op]ation to avoid z mu* z possible soil+ !m ) blood-/a9s4 ,precaution>y ,measures4 ,t !re is a c]ta9 am\nt ( dang] f absorption ( virus 9 case ( cuts or scrat*es receiv$ :ile conduct+ a po/-mortem exam9ation1 _c be d5i$2 yet ?is dang] is by no means common to e case4 ,9 ! great majority ( in/ances1 probably no mis*ief :atev] w\ld foll[ su* an accid5t1 ! dang] be+ conf9$ almo/ :olly to cases ( p]itoneal inflammation1 erysipelas1 & c]ta9 malignant =ms ( disease4 ,9 all cases1 h[ev]1 x w be well to look = any scrat*1 cut1 or abrad$ po9t on ! h&s or f+]s1 & fir/ t\*+ !m ) nitrate ( silv]1 cov] !m f9ally ) collodian4 ,sme>+ ! h&s well ) l>d or olive oil w also aid mu* 9 prev5t+ absorption4 ,%\ld an accid5tal cut be receiv$ dur+ ! op]ation1 x w be prud5t1 9 all cases1 to wa% ! h&s at once1 squeeze & suck ! "p1 to favor ble$+1 &1 f9ally1 t\* ) a cry/al ( nitrate ( silv]4 ,punctures ) a ne$le or slight scrat*es :i* d n ble$ are1 probably1 m dang]\s ?an a free cut2 h5ce1 9 cases ( suspect$ dang]1 :5 a puncture has be5 receiv$1 x w\ld be saf] to make a free incision ) a knife1 ?us induc+ ble$+1 :i* w favor ! wa%+ out ( any virus1 & f9ally1 use ! cau/ic4 ,"t = ,mak+ ! ,exam9ation4 ,z a rule1 po/-mortem exam9ations %\ld be made z soon aft] dea? z a due reg>d to ! feel+s ( fri5ds w p]mit1 say )9 twelve to tw5ty-f\r h\rs2 a long] delay w\ld give "t = su* decomposition z n only to make ! exam9ation extremely disagreeable1 b1 f *ange ( /ructure 9 tissues & organs1 mu* less satisfactory4 ,9 cold wea!r1 h[ev]1 or :]e ! body has be5 plac$ 9 ice soon aft] dea?1 z is ! cu/om 9 mo/ cities1 ! exam9ation may be po/pon$ to any conv5i5t "t be=e ! burial4 ,notes4 ,9 all important cases1 notes %\ld be tak5 d[n by an assi/ant1 on ! spot1 z dictat$ by ! op]ator2 head+ ^! by ! "n & age ( ! pati5t & a brief sket* ( ! disease4 ,9 m$ico-legal cases1 ?is is to be conduct$ ) p>ticul> c>e1 z w be po9t$ out h]eaft]4 ,cons5t ( ,fri5ds4 ,mu* difficulty w sometimes be met 9 obta9+ ! cons5t ( fri5ds = a po/-mortem exam9ation1 ! idea ( ! mutilation ( ! body ( ! deceas$ /rik+ _m ) p>ticul> dread4 ,) a little tact & managem5t1 h[ev]1 cons5t may1 9 ! majority ( in/ances1 be obta9$4 ,in/ead ( speak+ to a s+le memb] ( ! family & leav+ him or h] to br+ ! subject be=e o!rs1 9 all d\btful cases x w be bett] = ! physician to see all ! int]e/$ p>ties himself1 ei!r toge!r or sep>ately1 & endeavor to int]e/ !m 9 ! case1 by po9t+ out ! peculi> "* ( ! disease1 ! satisfaction :i* ! fri5ds w !mselves d]ive f a v]ification ( ! diagnosis ( _! physician1 :ile1 :5 too late1 !y may regret hav+ )held _! cons5t2 also ! sci5tific int]e/ :i* atta*es to ! case1 & ! b5efit :i* w no d\bt accrue to m$ical sci5ce ?r\gh a po/-mortem exam9ation1 & ! possibility t ! lives ( o!rs may dep5d ^u a k ( ! true /ate ( ?is case4 ,^!1 ) l consid]ations1 adapt$ ) ready tact to ! class ( p]sons to be p]suad$1 w1 9 ! majority ( in/ances1 be en\gh to ov]come all scruples1 especially :5 jo9$ to ! assurance t ! exam9ation w be s conduct$ z to leave no visible trace ( ! op]ation ) :i* to embitt] ! remembrance ( ! well-kn[n c\nt5ance4 ,,"p ,i4 ,,! ,,head ,,& ,,sp9e4 ,,*apt] ,i4 ,,! ,,op]ation4 ,9 op5+ ! head = a po/-mortem exam9ation1 let a ?ick block be plac$ b5ea? ! occiput1 :51 aft] hav+ c>efully p>t$ & turn$ aside ! hair1 an incision may be made ?r\gh ! scalp1 ov] ! top ( ! head1 f e> to e>4 ,! back ( ! scalpel be+ plac$ next ! head1 ! po9t may be pu%$ 9 advance1 ?us divid+ ! tissues )\t dang] ( injur+ ! edge ( ! in/rum5t by br++ x 9 contact ) ! bone4 ,f ! loose connection ( ! t5don ( ! occipit(rontalis muscle to ! p]io/eum1 by ! use ( ! h&le ( ! scalpel1 ! flaps ( ! scalp may readily be turn$ aside1 ! ant]ior ov] ! face1 ! po/]ior on ! back ( ! neck4 ,! skull clamp may n[ be appli$1 :i* w be ( great s]vice 9 /eady+ ! head :ile us+ ! saw4 ,in/ead ( divid+ ! skull 9 a circul> mann]1 z is usually done 9 ! dissect+-room1 x w be bett] to />t ! saw above ! frontal em95ces & run obliquely d[n t[>ds ! ma/oid process1 meet+ ?is l9e by ano!r comm5c+ at ! occipital protub]ance & c>ri$ horizontally =w>ds1 ?us giv+ a w$g$ =m to ! portion remov$4 ,! advantage ( ?is me?od consi/s 9 our be+ bett] able to hold ! p>ts 9 position z !y are replac$1 z 9 ! old me?od1 f ! read9ess ) :i* ! p>ts move ^u "o ano!r1 ! calv>ium is liable to slide =w>ds or backw>ds f its position1 ?us produc+ an unsightly ridge across ! =ehead1 :i* w m or less pla9ly %[ ?r\gh ! integum5t4 ,) "y *ildr51 a /rong pair ( scissors may be us$ in/ead ( ! saw 9 divid+ ! calv>ium4 ,9 us+ ! saw1 c>e %\ld be obs]v$ n to injure ! dura mat]2 h5ce x w be bett] n to attempt to divide bo? tables ) t in/rum5t1 b r dep5d ^u ! *isel or ra*itome = break+ away ! inn] table4 ,to avoid ! s\nd :i* w\ld att5d ! use ( ! iron hamm]1 :i*1 if he>d by memb]s ( ! family1 might excite unpleasant feel+s1 a billet ( wood or wood5 mallet may be us$2 or1 ^! n be+ at h&1 ! head ( ! iron hamm] may be muffl$ ) a t[el1 s z mat]ially to dead5 ! s\nds4 ,! inn] table hav+ be5 divid$1 ! calv>ium may be pri$ (f ) ! *isel1 or torn away ) ! hook on ! h&le ( ! hamm]4 ,?is1 f ! close adhesion ( ! dura mat] to ! bones1 w g5]ally require consid]able =ce4 ,! calv>ium hav+ be5 remov$1 & ! sup]ior longitud9al s9us op5$1 & ! condition ( its cont5ts not$1 ! dura mat]1 aft] its c>eful exam9ation1 may be cut ?r\gh ) ! knife or scissors 9 ! l9e ( ! division ( ! bone4 ,! membrane may n[ be lift$ up1 :5 adhesions w be f\nd betwe5 its "u surface & ! pia mat]1 along ei!r side ( ! falx c]ebri4 ,^! %\ld n be mi/ak5 = results ( inflammation1 z !y sometimes are1 !y be+ simply ! po9ts ( entrance ( ! ve9s ( ! pia mat] into ! sup]ior longitud9al s9us4 ,^! hav+ be5 divid$1 ) ! falx ne> its atta*m5t to ! cri/a galli1 ! :ole may be turn$ back1 expos+ ! bra94 ,to remove ! latt]1 take away ! block f b5ea? ! head1 & lift+ ! ant]ior lobes ( ! bra91 divide successively ! sev]al pairs ( n]ves z !y appe> 9 sight1 ) also ! t5torium on ei!r side1 & z ! bra9 falls back into ! left h&1 ! knife may be pass$ d[n into ! =am5 magnum1 & ! m$ulla oblongata & v]tebral art]ies divid$1 :5 ! :ole may be lift$ f its position4 ,m or less blood ) ! c]ebro-sp9al fluid w necess>ily fl[ (f dur+ ?is op]ation1 to secure :i*1 a bucket %\ld be plac$ b5ea? ! edge ( ! table1 ov] :i* ! head %\ld slightly project4 ,9 dropsy ( ! bra91 al?\gh ! fluid is ma9ly 9 ! v5tricles1 x may escape dur+ ! op]ation & be caught 9 ! same mann]4 ,! ext]nal surface ( ! bra9 hav+ be5 c>efully exam9$1 ! hemisph]es may be slic$ (f to a level ) ! corpus callosum1 :51 by remov+ ! latt]1 ! cavities ( ! lat]al v5tricles w be expos$4 ,aft] a c>eful inspection ( ! sev]al objects se5 "h1 ! =nix & velum int]positum may be remov$1 op5+ ?us into ! ?ird v5tricle4 ,slices may n[ be tak5 (f ! corpora /riata & optic ?alami1 ) deep] portions ( ! hemisph]es1 & sections made ( ! crura c]ebri c]ebellum & m$ulla oblongata1 ?us giv+ an opportunity ( judg+ ( ! condition ( all ^? p>ts4 ,aft] ! removal & exam9ation ( ! bra91 att5tion %\ld be giv5 to ! base ( ! skull4 ,! lat]al & o!r s9uses %\ld be laid op51 ! dura mat]1 z f> z possible1 torn away1 & ! bones exam9$ = fractures1 c>ies1 abnormal gr[?s1 etc4 8,! simple/ me?od = remov+ ! e> = ! sake ( dissection is1 aft] ! removal ( ! calv>ium 9 ! usual way1 to take out bo? ! petr\s bones toge!r by means ( two transv]se v]tical sections1 "o 9 front ( ! two petr\s bones & ! o!r po/]ior to !m4 ,! ant]ior ( ^! sections %\ld pass 9 a l9e a little ant]ior to ! ant]ior cl9oid processes1 & ! po/]ior 9 a l9e ?r\gh ! po/]ior ?ird ( ea* ma/oid process4 ,by means ( ^! two sections1 ! trumpet-%ap$ extremity ( ea* ,eu/a*ian tube1 a portion ( ! muc\s membrane ( ! fauces1 & ! :ole ( ea* petr\s bone1 toge!r ) ! ma/oid processes1 c be tak5 out4 8,! disadvantage ( ?is proc$ure is ! disfigurem5t :i* is apt to ensue f ! fall+ 9 ( ! face4 ,to avoid ?is disadvantage1 ano!r mode ( remov+ ! e> may be resort$ to4 ,?is consi/s 9 tak+ out ea* petr\s bone sep>ately 9 ! foll[+ mann]3 ,! calv>ium hav+ be5 sawn (f1 an ant]ior section is to be made 9 ea* side 9 ! same l9e z 9 ! above plan1 b ext5d+ only z f> z ! out] "p ( ! body ( ! sph5oid bone2 a po/]ior section 9 ea* side is !n to be made1 z 9 ! fir/ plan1 b n ext5d+ f>!r inw>ds ?an ! basil> process ( ! occipital bone4 ,^! two sections are to be made ) a saw or ) a *isel & hamm]4 ,! apex ( ea* petr\s bone is !n to be sep>at$ f ! sph5oid & occipital bones1 & ea* petr\s bone 7! out] e> & integum5t be+ deta*$ & reflect$ d[nw>ds7 is to be drawn outw>ds1 tak+ c>e1 by ins]t+ ! scalpel deeply1 to remove z mu* ( ! s(t p>ts z possible4 8,! organ ( he>+ hav+ be5 remov$1 ! dissection may be conduct$ 9 ! foll[+ mann]3 ,! auditory n]ve 9 its meatus %\ld be fir/ c>efully exam9$1 presum+ t a previ\s inspection has be5 made ( ! portion ( ! bra9 to :i* ! portio mollis & portio dura n]ves are atta*$4 ,! size ( ! ext]nal meatus hav+ be5 asc]ta9$ by all[+ a /rong light to fall into x1 its ant]ior wall is to be remov$ by ! cutt+ =ceps4 8,! /ate ( ! epid]mis1 ! c]um9\s gl&s & secretion1 ! d]mis1 p]io/eum & bone is to be notic$4 ,! out] surface ( ! membrani tympani is !n to be exam9$2 also ! /ate ( its epid]moid & d]moid lam91 its degree ( t5sion1 & ! am\nt ( motion possess$ by ! malleus :5 press$ ^u by a f9e po9t4 ,! next /ep is to asc]ta9 ! condition ( ! guttural portion ( ! ,eu/a*ian tube1 to lay op5 ! c>tilag9\s tube ) ! scissors1 & !n to expose ! cavity ( ! osse\s portion by means ( ! cutt+ =ceps4 ,9 do+ ?is1 ! t5sor tympani muscle is expos$2 its /ructure %\ld be exam9$1 & if x has n a heal?y appe>ance1 portions ( x %\ld be submitt$ to microscopic inspection4 ,! upp] wall ( ! tympanum is next to be cut away by means ( ! cutt+ =ceps4 ,9 do+ ?is1 great c>e mu/ be tak5 n to di/urb or disconnect ! malleus & incus1 :i* lie imm$iately b5ea? x4 ,aft] ! tympanic cavity has be5 expos$1 ! fir/ /ep is to pull ! t5sor tympani muscle & asc]ta9 h[ f> x causes a movem5t ( ! membrana tympani & ossicles4 ,! incus & /apes are n[ to be t\*$ ) a f9e po9t1 s z to asc]ta9 _! degree ( mobility2 ! t5don ( ! /ap$ius muscle is also to be press$ ^u4 ,! condition ( ! muc\s membrane ( ! tympanum & ( ! ma/oid cells is !n to be asc]ta9$1 & any peculi>ity ( ! cavity1 ! exi/5ce ( b&s ( adhesion1 etc41 to be not$4 8,! mo/ delicate p>ts ( ! dissection1 viz41 t ( ! int]nal e>1 mu/ n[ be und]tak54 ,! cavities ( ! ve/ibule & co*lea are to be expos$ by remov+ a small portion ( ! upp] wall ( ea*4 ,be=e rea*+ ! ve/ibule1 ! sup]ior semi-circul> canal w be cut ?r\gh & remov$2 ! membran\s canal %\ld be drawn out & inspect$4 ,z ! cavities ( ! ve/ibule & co*lea are laid b>e1 x is desirable to see t ! quantity ( p]ilymph is natural1 z well z its color & consi/5ce4 ,! out] surface ( ! membran\s labyr9? hav+ be5 obs]v$1 x %\ld be op5$ s z to expose ! endolymph & otoli?s1 portions ( all :i* p>ts %\ld be remov$ = microscopic inspection4 ,?is hav+ be5 effect$1 ! rema9+ membran\s semi-circul> canals are to be expos$1 & ! connection ( ! base ( ! /apes to ! f5e/ra ovalis c>efully exam9$4 ,! la/ /age ( ! dissection consi/s 9 remov+ p>ts ( ! lam9a spiralis1 9 exam9+ !m microscopically1 & 9 expos+ f )91 by foll[+ ! c\rse ( ! scala tympani1 ! membrane ( ! f5e/ra rotunda4 8,! only "p :i* n[ rema9s unexam9$ is ! /ap$ius muscle2 9 ord] to expose x1 ! c\rse ( ! aquductus ,fallopii1 beg9n+ at ! /ylo-ma/oid =am51 %\ld be foll[$ until ! base ( ! pyramidal em95ce conta9+ ! muscle is rea*$40#a ,! ,eyes1 ) ! optic n]ves1 may be mo/ conv5i5tly remov$ = exam9ation1 by break+ up ! ro( ( ! orbit ) ! hamm]1 &1 aft] ! removal ( ! fragm5ts ( bone1 dissect+ away ! fat & muscles until ! ball is expos$1 :51 ) ! scissors1 ! tunics ( ! latt] may be divid$ j beh9d ! conjunctival atta*m5t1 & ! ball remov$ ) ! optic n]ve4 ,! front portion ( ! eye be+ left 9 position1 by fill+ ! cavity beh9d ) a little cotton or pap]1 any flatt5+ may be prev5t$1 & ?us any appe>ance ( loss ( p>ts avoid$4 ,! exam9ation hav+ be5 complet$1 ! bra9 may be replac$1 ! calv>ium put 9 position1 ! scalp br\ght ov] ! same & unit$ ) /it*es1 ! arrang+ ( ! hair effac+ all traces ( ! op]ation4 ,,! ,,sp9al ,,cord4 ,= ! removal ( ! sp9al cord1 place ! body 9 a prone position1 & make an incision ! :ole l5g? ( ! back1 ov] ! sp9\s processes ( ! v]tebr4 ,!n raise up & turn aside all ! muscles ) ! integum5t1 expos+ ! lam9 ( ! v]tebr4 ,! latt] may n[ be divid$ ) ! s+le or d\ble saw1 ! ra*itome or *isel be+ us$ to complete ! op]ation1 :5 ! lam91 ) ! sp9\s processes1 may be remov$ 9 "o /rip1 expos+ ! cord enclos$ 9 its membranes4 ,! roots ( ! n]ves may n[ be divid$1 & ! cord1 enclos$ 9 its %ea?1 remov$2 c>e be+ obs]v$ n to h&le ! p>ts r\ghly :ile s do+4 ,! dura mat] may n[ be split op5 = ! exam9ation ( ! cord4 ,%\ld x be desir$ to pres]ve any portion = microscopic exam9ation1 x may be susp5d$ 9 a solution ( bi*romate ( potass1 xx to xxx grs4 to ! ounce ( wat]1 & 9 a few days transf]r$ to a solution ( *romic acid1 ij grs4 to ! ounce ( wat]1 :]e x %\ld rema9 until suffici5tly h>d5$ to be cut into ?9 sections4 ,! exam9ation complet$1 ! p>ts may be replac$ & ! incision sew$ up4 ,,*apt] ,,ii4 ,,pa?ological ,,conditions4 ,section ,i4 ,,( ,,! ,,skull4 ,notice 9 exam9ation1 condition ( scalp2 cuts1 bruises1 extravasation ( blood1 c4 ,cranium--,color1 smoo?ness or r\ghness ( expos$ surface2 fractures1 _! position & relation to injuries ( scalp4 ,removal ( ,calv>ium--,adhesion ( dura mat]2 inn] surface (2 smoo? or r\gh2 seat ( same2 deposit ( new bone2 depression ( inn] table2 ?ick5+ or ?9n+ (4 ,/ate ( fontanelles 9 *ildr52 condition ( frontal s9uses2 condition ( base ( skull not$ aft] removal ( bra92 fractures2 condition ( petr\s portions ( temporal bones1 c4 ,fracture4 ,9 a po/-mortem exam9ation ( ! head1 aft] dea? f a bl[ or fall ^u t "p1 a fracture may be disclos$ ( :i* !re 0 no ext]nal trace4 ,ow+ to ! great] ?9ness & brittl5ess ( ! inn] table1 x is possible = ?is to be fractur$ )\t any correspond+ injury to ! ext]nal2 su* fracture may possibly rupture "s ( ! bran*es ( ! m5+eal art]ies1 :i* w be foll[$ by ! =mation ( a clot betwe5 ! bone & dura mat]1 ! pressure ( :i* may be suffici5t to produce dea?4 ,ow+ to ! same cause--great] brittl5ess ( ! inn] table--:5 fracture ( ! out] exi/s1 t ( ! inn] table w be likely to be m ext5sive1 accompani$ p]haps ) depression1 ( :i* !re is no ext]nal evid5ce4 ,aga91 x w sometimes be discov]$ t fracture exi/s at a po9t opposite to t ^u :i* ! bl[ 0 receiv$1 on ! pr9ciple ( ! 8contre c\p0 ( ! ,fr5*2 ?us1 ! bl[ hav+ be5 receiv$ on ! occiput1 ! fracture may be f\nd 9 ! frontal region2 or1 receiv$ on ! top ( ! skull1 fracture may result at ! base4 ,9 falls f a height1 ^u ! top ( ! head1 ! weight ( ! body1 act+ ?r\gh ! c]vical v]tebr z a propell+ =ce1 is v likely to produce fracture ( ! occipital bone4 ,c>ies may affect any ( ! bones ( ! head1 b 9 ! majority ( cases x w be ! result ( syphilitic or m]curial poison+4 ,foll[+ an attack ( p]io/itis1 ! inflammation ext5ds to ! bone & gradually develops ! c>i\s ulc]ation4 ,:ile ! condition is usually conf9$ to1 or at lea/1 mo/ /rongly develop$ ^u ! out] table1 x may involve ! entire ?ickness4 ,9 syphilitic ulc]ation ( ! bones ( ! nasal cavity1 ! disease may de/roy ! cribri=m plate ( ! e?moid bone1 & ?us ext5d to ! membranes ( ! bra94#b ,s also1 9 c>ies ( ! petr\s & ma/oid portions ( ! temporal bone1 :i* sometimes results f sc>let fev]1 ! disease may ext5d to ! inn] surface1 result+ 9 ! accumulation ( pus )9 ! cranial cavity4 ,along ei!r side ( ! c5tral portion ( ! inn] surface ( ! calv>ium may be usually se51 at lea/ 9 ! heads ( ag$ p]sons1 a numb] ( irregul>1 r\gh pits1 v>y+ 9 size & dep?1 :i* are n to be mi/ak5 = disease ( ! bone1 !y be+ simply impressions ( ! ,pac*ionian gl&s4 ,?9n+ ( ! bones ( ! head w always indicate increas$ pressure f )91 induc$ by hyp]trophy ( ! bra91 or1 z is m frequ5t1 hydrocephalus4 ,9 ! latt] case1 n only ?9n+1 b complete absorption ( ! p>ietal & o!r bones may result4#c ,increas$ ,?ickness w also sometimes be f\nd4 ,?is condition indicates dim9i%$ pressure f )91 z 9 atrophy ( ! bra94 ,! ?ick5+ results f a gradual remodel+ ( ! inn] table & diploe1 s t :ile ! ext]ior ( ! skull may reta9 its normal size & =m1 ! inn] table foll[+ ! retir+ & %r9k+ bra91 ! int]val betwe5 ! two becomes fill$ ) ! ?ick5$ diploe4 ,x has be5 obs]v$ t ?is hyp]trophy is greate/ at ^? p>ts ( ! bones :]e ossification fir/ comm5ces1 z at ! p>ietal & frontal em95ces4 ,x is n conf9$ to old p]sons1 ?\gh p]haps m frequ5t ) !m4#d ,section ,,ii4 ,,! ,,membranes ,,( ,,! ,,bra94 #a4 ,! ,dura ,mat]4 ,notice color & g5]al "* ( surface2 blood betwe5 x & bone2 position (2 quantity2 coagulat$ or n4 ,condition ( bone--necros$ or fractur$2 pus betwe5 dura mat] & bone4 ,tumors--_! position1 size1 c4 ,w\nds--_! position1 ext5t1 c4 ,op5 longitud9al s9us & note cont5ts4 ,?is membrane1 s]v+ bo? z a p]io/eum to ! inn] surface ( ! cranial bones & z a support to a s]\s membrane--! reflect$ lay] ( ! ara*noid--is subject to affections ( a two-fold "*1 ^? peculi> to ! fibr\s & s]\s portions4 ,inflammation ( ?is membrane1 may involve ei!r ! out] fibr\s1 or ! inn] s]\s lay]4 ,9 ! =m] case1 ! membrane appe>s conge/$1 r$ & m or less s(t5$4 ,! inflammatory process may result 9 ! =mation ( pus betwe5 ! bone & dura mat]1 & ev5 9 gangr5e4 ,! disease may also ext5d to ! adjac5t portions ( ! pia mat] & bra9 sub/ance4 ,ext]nal injuries1 fractures ( ! bones ( ! skull1 inflammation ( ! p]io/eum1 otitis1 result+ 9 c>ies ( ! temporal bone1 may all be causes ( inflammation ( ! out] portion ( ! dura mat]4 ,inflammation ( ! inn] surface ( ?is membrane1 is m>k$ by ! pres5ce ( a net-"w ( delicate r$ vessels1 :ile ! surface is cov]$ by a s(t1 grayi% or yell[ semi-purul5t matt]1 & may att5d cases ( pymic poison+1 pu]p]al p]itonitis1 or "s ( ! exan!mata4 ,?ick5+ ( ! fibr\s portion ( ! dura mat] may be f\nd z a result ( *ronic inflammation1 ei!r spontane\s or z ! result ( ext]nal injury4 ,f ! id5tity ( /ructure betwe5 ?is & o!r fibr\s tissues ( ! body1 x is n unlikely t ?is ?ick5+ is (t5 ! result ( a rheumatic =m ( inflammation4 ,ext]nal viol5ce is1 h[ev]1 mo/ commonly ! cause ( ! *ange4 ,9 "o case1 ! pati5t fell d[n /airs 9 a /ate ( intoxication1 /rik+ ! head on ! /eps4 ,he cont9u$ 9 a /ate ( ins5sibility = n9e days1 :5 he began to %[ signs ( return+ consci\sness1 tak+ food & dr9k1 b memory1 judgm5t1 & all ! m5tal faculties 7 gone4 ,dea? ensu$ 9 ab\t two ye>s4 ,! dura mat] ( ! left hemisph]e 0 f\nd greatly ?ick5$4 ,! pia mat] infiltrat$ ) a l>ge am\nt ( s]\s fluid4 ,! convolutions 7 atrophi$1 & ab\t f\r ounces ( s]\s fluid f\nd 9 ! v5tricles4 ,! =nix 0 s(t5$ & ! septum lucidum entirely de/roy$4 ,fibr9\s ,clots1 or ,?rombi1 w be occasionally f\nd )9 ! s9uses ( ! dura mat]1 :]e !y may h giv5 rise to conge/ion ( ! bra91 ) apoplectic effusions1 p>alysis1 convulsions1 coma1 etc4 ,!y may orig9ate f injuries ( ! head1 inflammation ( ! dura mat]1 pulmon>y disease1 etc4 ,tub]cul> ,deposits are also sometimes f\nd 9 ?is membrane1 appe>+1 h[ev]1 ma9ly ^u ! ara*noid surface4 ,!y pres5t ! usual "* ( tub]cle1 hav+ a :iti% or grayi% appe>ance1 ) ! consi/5ce ( *eese1 & scatt]$ 9 small p>ticles ^u ! surface4 ,!y are f\nd 9 tub]cul> m5+itis1 7a disease common ) *ildr5 b r>e ) adults17 & 9 mo/ ( ^? cases ( s-call$ acute hydrocephalus4 ,tumors ( v>i\s k9ds are occasionally f\nd 9 ! dura mat]1 includ+ cy/ic1 fibr\s1 fatty1 osse\s & canc]\s gr[?s4 ,! latt] may cause su* absorption ( ! bones ( ! skull1 z to appe> on ! ext]ior ( ! head4 ,9 "o case :i* came into ! dissect+-room "s ye>s ago1 ?9 bony =mations ( ! size ( a silv] qu>t] doll> 7 f\nd 9 ! t5torium1 & small] ones 9 ! falx c]ebri4 ,no?+ c\ld be le>n$ ( ! previ\s hi/ory ( ! case4 #b4 ,ara*noid & ,pia ,mat]4 ,notice 9 exam9ation1 cont5ts ( cavity ( ara*noid2 s]um or blood2 if =m]1 am\nt1 color1 odor2 if blood1 situation1 quantity1 fluid or coagulat$2 adhesion ( surfaces ( ara*noid2 tub]cles1 _! position1 c42 color ( membrane2 vascul>ity1 transp>5cy1 or opacity4 ,sub-ara*noid fluid--quantity1 position1 color1 c4 ,pia mat]--vascul>ity1 9 po9ts & entire2 s]\s effusion into sub/ance (2 blood1 c42 position1 size1 c41 ( clots2 granulations1 7tub]cles17 numb]1 position1 c42 ,tumors--size1 position1 & "*4 ,z morbid conditions ( ! ara*noid membrane are m common ) its visc]al lay]1 & z ^! conditions usually involve ! pia mat]1 ! two membranes are "h notic$ toge!r4 ,!y w be f\nd pres5t+ v>i\s degrees ( conge/ion aft] dea?1 :i* w n necess>ily be a positive indication ( ! ext5t ( conge/ion dur+ life4 ,pac*ionian ,bodies4 ,along ei!r side ( ! great fissure may be notic$ )9 ! pia mat] ( adults1 sev]al small :ite bodies1 v>y+ 9 numb] & size--! ,pac*ionian bodies4 ,!y may cause absorption & p]=ation ( ! dura mat]1 & ev5 ( ! bones ( ! skull4 ,be+ look$ ^u z ! result ( m]e s5ile *anges1 !y d n indicate ! pres5ce ( disease1 ?\gh repeat$ conge/ions ( ! bra9 appe> to favor _! m rapid developm5t4 ,inflammation ( ^! membranes1 or m5+itis1 is a v common affection1 & is accompani$ ) an accumulation )9 its sub/ance or b5ea? its lay]s1 ( s]um1 lymph1 or fibr9e 9 v>i\s proportions4 ,x may be conf9$ to circumscrib$ portions1 or involve a l>ge portion ( ! membrane1 & ev5 ext5d to ! sp9al cord4 ,adhesions betwe5 ! two surfaces ( ! ara*noid sometimes result f ?is =m ( inflammation4 ,insanity 9 its v>i\s =ms is mo/ frequ5tly accompani$ ) "s morbid condition ( ^! membranes4 ,9 tw5ty-two cases ( insane p]sons ^: bra9s 7 inspect$ by ,dr4 ,m>%all1 9 tw5ty-"o1 s]\s fluid1 v>y+ 9 am\nt f "o to twelve ounces1 0 f\nd 9 ! v5tricles1 & 9 sev5te5 ( ^! tw5ty-"o cases1 simil> effusion 0 f\nd 9 ! sub-ara*noid space1 or )9 ! sub/ance ( ! pia mat]4 ,:ile r$ injection ( ! membrane 0 f\nd only 9 f\r cases1 yet o!r conditions--! effusions1 c4--7 evid5tly ! result ( previ\s inflammation4 ,9 n9e cases 7 ! art]ies ( ! bra9 opaque1 ?ick5$1 /eatomat\s1 or ossifi$2 conditions highly favorable = d]ang+ ! capill>y circulation ( ! membranes or ( ! bra94#e ,! foll[+ /atem5t gives ! pr9cipal morbid *anges ( ^! membranes :i* h be5 f\nd 9 cases ( insanity3 #a4 ,injection1 m or less int5se1 ( ! pia mat]1 giv+ a r$ or sc>let appe>ance2 or1 :]e infiltrat$ ) s]\s fluid1 pres5t+ a pale gray color & increas$ 9 ?ickness4 #b4 ,! ara*noid 7! visc]al lay]7 becomes opaque & ?ick5$1 resembl+ ! dura mat] or mac]at$ p>*m5t4 #c4 ,! m5+eal injection may t]m9ate 9 s]\s effusion1 ei!r f ! free surface ( ! ara*noid into ! sub-ara*noid tissue1 7pia mat]17 or f ! *oroid plexus into ! v5tricles4 #d4 ,album9\s exudations may be f\nd ^u ! free surface ( ! ara*noid ( ! dura mat]1 cov]+ its :ole ext5t1 or conf9$ to def9ite portions4 #e4 ,adhesions ( ! two surfaces ( ! ara*noid may r>ely be f\nd4 ,x is mo/ common 9 ! great fissure1 & has be5 f\nd 9 ! v5tricles4 #f4 ,blood may be effus$ ^u ! surface ( ! ara*noid or 9 ! sub/ance ( ! pia mat]4 ,s]\s ,effusion4 ,z has be5 already intimat$1 ?is may be f\nd ei!r 9 ! cavity ( ! ara*noid--betwe5 ! reflect$ & visc]al lay]s--or )9 ! v5tricles4 ,9 ! =m] position1 ! quantity is nev] l>ge1 :ile 9 ! latt]1 x may am\nt to twelve or sixte5 ounces1 & be pres5t = _m ye>s4 ,:5 9 su* l>ge quantity1 !re w be great di/5sion ( ! v5tricles & ?9n+ ( ! corpus callosum & =nix1 ) de/ruction ( ! septum lucidum1 z well z m or less sep>ation ( ! cranial bones4 ,x is only 9 *ildr5 & be=e ! bones ( ! head h become unit$1 t su* l>ge accumulations are possible1 z at a lat] p]iod1 f ! unyield+ condition ( ! walls ( ! skull1 ! pres5ce ( a s+le ounce1 p>ticul>ly if sudd5ly =m$1 w\ld produce dea?4 ,9 all cases1 ! dang] to life w be 9 proportion to ! rapidity ( ! =mation2 a v sl[ & gradual accumulation p]mitt+ ei!r ( an expansion ( ! cranial bones1 or a gradual absorption ( bra9 sub/ance1 ?us pres]v+ an approximation to ! normal pressure on ! bra9 tissue4 ,s]\s effusions1 l sangu9e\s1 are g5]ally ! result ( ov] di/5sion ( ! c]ebral vessels1 ei!r f me*anical ob/ruction1 or a weak5$ condition ( ! coats ( ! vessels1 ) increas$ =ce 9 ! action ( ! he>t4 ,x g5]ally att5ds tub]cul> m5+itis1 & may be favor$ by an anmic condition ( ! sy/em4 ,! symptoms dur+ life1 att5d+ a rapid effusion ( s]um1 are n s readily di/+ui%$ f ^? ( sangu9e\s effusion1 z to enable u to pron\nce ) c]ta9ty 9 any giv5 case z to ! cause ( ! c]ebral pressure4 ,sangu9e\s ,effusion--,apoplexy4 ,effusions ( blood may be f\nd betwe5 ! bones & dura mat]2 betwe5 ! two lay]s ( ! ara*noid2 )9 ! sub/ance ( ! pia mat]2 )9 ! v5tricles1 or )9 ! bra9 sub/ance4 ,blood clots w seldom be f\nd betwe5 ! bone & dura mat]1 except z a result ( me*anical injury1 & 9 ! majority ( cases z an att5dant ^u fracture4 ,if a fragm5t ( ! bone at ! same "t1 be driv5 ?r\gh ! dura mat]1 !n a clot may be f\nd 9 ! ara*noid cavity4 ,b 9 ano!r class ( cases1 :]e dea? has result$ f bl[s ^u ! head )\t produc+ fracture ( ! bones1 ! :ole surface ( ! bra9 9 ! region ( ! injury1 & n unfrequ5tly 9 di/ant p>ts1 aft] ! removal ( ! dura mat]1 is f\nd cov]$ ) a lay] ( blood1 :i* at fir/ sight appe>s to be outside ( ! membranes2 b on close exam9ation1 x is f\nd t ! blood is effus$ or infiltrat$ into ! sub-ara*noid tissue1 & t x has escap$ f ! lac]at$ vessels 9 ! pia mat]4 ,! ?ickness ( ! lay] v>ies4 ,x is g5]ally 9 great] quantities at ! sides & base ( ! bra91 & ! inf]ior lobes & c]ebellum may be cov]$ by x4 ,x is usually ?icke/ ov] ! crura1 ! pons ,v>olii & m$ulla oblongata4 ,9 ! same class ( cases ! blood may be also effus$ into ! v5tricles4 ,^! appe>ances are s uni=mly ! result ( viol5ce1 z to =m a valuable piece ( evid5ce 9 m$ico-legal inquiries1 to prove t su* hmorrhage & dea? c\ld n be ! result ( int]nal causes4 ,9 ! great] numb] ( /ill-born *ildr51 an exam9ation ( ! head w %[ a simil> condition ( ?+s4 ,! surface ( ! c]ebrum g5]ally1 ) sometimes t ( ! c]ebellum1 w be f\nd cov]$ ) a lay] ( coagulat$ blood effus$ into ! pia mat]1 :ile ! v5tricles w (t5 be fill$ ) clots4 ,:]e ! hi/ory ( ! case is n kn[n1 x might at fir/ be suspect$ t dea? 0 ! result ( viol5ce inflict$ aft] bir?4 ,viol5ce has1 to be sure1 be5 ! cause ( dea?1 b x is su* viol5ce z att5ds a protract$ case ( labor1 )1 p]haps1 a l>ge head1 & a contract$ pelvis ( ! "m4 ,! wond] is1 t f ! great pressure to :i* ! head is subject$ dur+ labor1 t s few *ildr5 are /ill-born or d n die soon aft] bir?1 f rupture ( ! c]ebral vessels4 ,effusions into ! v5tricles1 may also be frequ5tly ! result ( ext]nal viol5ce4 ,! pia mat]1 ! vascul> membrane ( ! bra91 we f9d c>ri$ into ^! cavities by means ( ! velum int]positum1 :i* =ms ! ro( to ! ?ird v5tricle1 :ile its bord]s ext5d into ! lat]al1 =m+ ! *oroid plexuses4 ,! effus$ blood may1 !re=e1 ext5d along ?is membrane into ! cavity ( ! v5tricles4 ,aga91 blood may be effus$ 9 any portion ( ! bra9 sub/ance1 con/itut+ true sangu9e\s apoplexy4 ,c]ta9 p>ts are mu* m frequ5tly ! seat ( ^! effusions ?an o!rs4 ,!y are m common 9 ! /riat$ bodies or optic ?alami--probably f ! great] vascul>ity ( ^? p>ts--b may be f\nd 9 ! corpora quadrigem9a1 ! pons ,v>olii1 ! crura c]ebri1 or 9 ! c]ebral hemisph]es1 & occasionally 9 ! c]ebellum4 ,! symptoms dur+ life w v>y accord+ to ! location ( ! effusion2 :5 9 ! pia mat]1 or 9 o!r words1 outside ( ! bra91 p>alysis w seldom att5d1 ?\gh ! coma may be pr(\nd1 ) relaxation ( ! muscul> sy/em & sometimes convulsions4 ,:5 ! hmorrhage is 9 ! optic b$ or /riat$ body ( "o side1 f ! decussation ( fibres 9 ! m$ulla oblongata1 p>alysis ( ! opposite side ( ! body w foll[2 :ile if ! effusion has tak5 place 9 bo? hemisph]es1 ! palsy w be d\ble-sid$1 ?\gh probably m complete on "o side ?an on ! o!r4 ,effusions ( blood into ! corpora quadrigem9a1 w mo/ frequ5tly be att5d$ ) muscul> trembl+s or convulsions1 & probably impair$ sight1 ) "s *ange 9 ! pupil4 ,:5 9 ! m$ulla oblongata1 convulsions1 foll[$ by palsy1 deep coma1 & e>ly dea?2 great] fatality att5d+ effusions at ?is po9t1 probably1 ?an at any o!r4 ,:5 ! effusion takes place 9 ! c]ebellum1 ! loss ( consci\sness w be v tempor>y2 !re may be relaxation ( muscles )\t palsy or loss ( s5sibility1 &1 x is said1 frequ5t vomit+4 ,! am\nt ( blood effus$ is subject to ! greate/ v>iation4 ,clots may be f\nd z l>ge z a h5's egg1 or small] ?an a pea4 ,inde$1 viol5t apoplectic attacks1 end+ 9 dea?1 may occur1 :]e ! mo/ c>eful exam9ation w fail to detect any effus$ blood1 dea? be+ ! result ( extreme conge/ion ( ! membranes4 ,on ! o!r h&1 ! pres5ce ( a clot is n necess>ily fatal1 evid5ce be+ abundant t !y may be s f> reabsorb$ z to be foll[$ by at lea/ p>tial recov]y4 ,! foll[+ cases w s]ve to illu/rate ^! sev]al conditions3 ,,case ,i4--,sudd5 ,dea? f ,c]ebral ,conge/ion4 ,mr4 ,m----1 ag$ ?irty-five ye>s1 _h always enjoy$ good heal?4 ,= "s mon?s previ\s to dea?1 _h be5 work+ v h>d1 ) a good deal ( anxiety1 9 arrang+ ! affairs ( a company ( :i* he 0 secret>y4 ,on ! ev5+ previ\s to 8 attack1 he retir$ at elev5 o'clock1 well & 9 good spirits4 ,at ?ree o'clock ,a4 ,m41 8 wife 0 wak5$ by 8 heavy1 /]tor\s brea?+1 att5d$ ) slight convulsive movem5ts ( ! limbs4 ,9 less ?an a half h\r he 0 dead4 ,! po/-mortem %[$ ! he>t1 lungs1 & abdom9al organs to be 9 a p]fectly heal?y condition1 :ile ! mo/ c>eful exam9ation ( e portion ( ! bra9 fail$ to expose ! lea/ effusion ( blood4 ,! v5tricles & sub-ara*noid space conta9$ a mod]ate am\nt ( s]um1 :ile ! vessels ( ! pia mat] 7 /rongly engorg$ ) blood4 ,,case ,,ii4--,apoplectic ,attack1 foll[$ by ,dea? 9 ,?ree ,days2 ,clot f\nd 9 ,?alamus4 ,mr4 ,j----1 ag$ sixty-"o1 a but*]1 ab/emi\s 9 8 habits b ple?oric 9 temp]am5t1 0 sudd5ly /rick5 d[n ) an attack ( apoplexy1 :i* left him ) p>alysis ( ! "r side ( ! body1 ) impair$ spee* & memory4 ,he gradually & almo/ entirely recov]$4 ,t5 mon?s aft]1 :ile 9 ! /reet1 he fell ) ano!r attack4 ,he p>tially recov]$ consci\sness1 b _h complete palsy ( ! left side1 & di$ 9 ?ree days4 ,"h1 ! po/-mortem reveal$ excessive conge/ion ( ! pia mat]1 & a l>ge clot1 ! size ( a hickory nut1 9 ! "r optic ?alamus4 ,9 ! left ?alamus 0 a di/9ct trace ( a clot1 7ne>ly absorb$1 h[ev]17 :i* _h und\bt$ly be5 effus$ 9 ! attack t5 mon?s previ\sly4 ,,case ,,iii4--,apoplectic attack1 foll[$ by ,hemiplegia1 & ,dea? 9 ,five ,ye>s4 ,*>les ,e4 ,w----1 at ! age ( =ty-sev5 _h a sudd5 apoplectic /roke1 9 ,janu>y1 #ahfg1 foll[$ by p>tial p>alysis ( "r side4 ,9 ,may foll[+1 he _h a second attack1 :i* greatly increas$ ! hemiplegia1 impair$ ! articulation1 & weak5$ ! memory & intellect4 ,8 g5]al heal? & /r5g? gradually fail+1 he di$ ,augu/1 #ahgb1 five ye>s aft] ! orig9al attack4 ,po/-mortem reveal$ a greatly ?9n$ & dilat$ condition ( ! walls ( ! art]ies ( ! base ( ! bra9 & ! remnants ( ! orig9al clot imb$d$ 9 ! left optic ?alamus1 ! bra9 sub/ance ar\nd be+ ( a d>k color & mu* s(t5$4 ,f ! appe>ance ( ! d>k1 ragg$ remnant ( ! clot1 x mu/ h be5 orig9ally ( ab\t ! size ( a rob9's egg4 ,,case ,,iv4--,dea? f ,conge/ion1 ) ,s]\s ,effusion & ,s(t5+4 ,mr4 ,f4 ,h----1 ag$ ?irty1 _h an attack ( bra9 fev] at tw5ty-?ree1 foll[$ by attacks ( sev]e pa9 9 ! head1 recurr+ e few days1 weeks or mon?s4 ,^! attacks 7 accompani$ ) slight convulsive symptoms & delirium1 ! pa9 be+ ( a mo/ excruciat+ "*1 & la/+ f a few h\rs to two or ?ree days4 ,! attacks 7 gradually increas+ 9 sev]ity1 b )\t any impairm5t ( ! faculties ( ! m9d4 ,on a ,saturday night1 he 0 br\ght home ) "o ( 8 wor/ attacks4 ,:5 ,i fir/ saw ! pati5t on ,sunday ev5+1 ,i f\nd him 9 a half-deliri\s1 /upid condition1 yet :5 r\s$ up1 giv+ satisfactory answ]s to que/ions1 b imm$iately s9k+ into 8 =m] condition1 & e "o to five m9utes />t+ sudd5ly up &1 ) />+ eyes & di/ort$ face1 utt]+ pi]c+ %rieks & screams1 & call+ to ^? ar\nd to %oot him1 split op5 8 head ) a hat*et--any?+ to release him f 8 suff]+s4 ,^! p>oxysms w\ld sometimes be foll[$ by a convulsive action ( ! diaphragm & abdom9al muscles1 end+ 9 8 s9k+ into ! same dull1 /upid condition z be=e4 ,9 ! int]val ( calm1 ! respiration 0 rem>kably sl[ & feeble1 ) a sl[ irregul> pulse ( =ty beats to ! m9ute4 ,^! symptoms becom+ gradually worse1 he sank into a comatose condition e>ly ,tuesday morn+1 expir+ at daylight1 sixty h\rs aft] ! comm5cem5t ( ! attack4 ,! po/-mortem reveal$ greatly enl>g$ ,pac*ionian gl&s1 ) extreme ?9n+ ( ! skull ov] ! same4 ,! pia mat] 0 consid]ably conge/$4 ,^u turn+ ! bra9 back = removal f ! base ( ! skull1 !re 0 a sudd5 gu% ( wat] f ! v5tricles1 suffici5t ( :i* 0 secur$ to %[ t ! quantity c\ld n h be5 less ?an two ounces4 ,^u op5+ ! lat]al v5tricles1 ^! cavities 7 f\nd unusually l>ge f di/5sion by ! fluid1 :ile ! septum lucidum & =nix 7 f\nd 9 a s(t1 pulpy condition1 ! =m] be+ completely brok5 d[n & deta*$ f ! corpus callosum above4 ,! gray portions ( ! corpora /riata 7 also s(t] & m easily brok5 up ?an 0 natural4 ,! appe>ance pres5t$ by a clot1 z well z ! bra9 sub/ance imm$iately ar\nd x1 w v>y accord+ to ! "t ! pati5t survives ! attack4 ,:5 dea? foll[s 9 a few days1 ! clot w h a s(t1 blacki% appe>ance2 aft] a mon? or six weeks1 x becomes firm1 & assumes a deep br[n color1 & at a /ill lat] p]iod1 x becomes /ill m firm1 & ( a pale r$ t9t2 la/ly1 x may become entirely absorb$4 ,peculi> *anges also take place 9 ! bra9 sub/ance imm$iately ar\nd ! clot1 :i* v>y accord+ to ! "t int]v5+ betwe5 extravasation & dea?4 ,! portion imm$iately 9 contact ) ! clot is g5]ally ( a d>k r$ or w9e color1 or1 at a lat] p]iod1 ( a *ocolate br[n1 & ( a s(t1 pulpy consi/5cy4 ,ext]ior to ?is1 ! color is pal] & ( an orange t9t1 & /ill fur!r on1 ( a blui%-:ite or yell[4 ,! *ange 9 /ructure & consi/5ce ( ! bra91 imm$iately ar\nd ! clot1 con/itutes "o =m ( s(t5+ soon to be notic$4 ,section ,,iii4 ,,( ,,! ,,bra94 ,notice be=e removal--size2 =m2 symmetry2 space betwe5 surface ( bra9 & calv>ium4 ,aft] removal--p>ts at base1 _! size1 symmetry1 color on surface1 infiltration ) s]um or blood4 ,removal ( pia mat]--degree ( adhesion2 appe>ance ( convolutions2 color2 consi/5ce2 effect ( /ream ( wat]4 ,ulc]s--condition ( bra9 ar\nd4 ,sl\ghs--relation to membranes1 condition ( bra9 ar\nd4 ,deposits2 tumors1 w\nds1 etc4 ,aft] section1 notice bread? & "* ( gray portions ( convolutions2 color1 vascul>ity1 etc4 ,consi/5cy--s(t5$ or h>d5$2 ( :ite sub/ance2 color4 ,blood-vessels--numb] & size ( r$ po9ts 9 diff]5t portions4 ,extravasation ( blood--its situation2 fluid or coagulat$2 am\nt or size ( coagulum2 color1 etc4 ,cavities 9 bra9 sub/ance2 _! numb]1 %ape & cont5ts4 ,blood1 purul5t1 or fluid2 its quantity & color4 ,condition ( bra9 ar\nd2 cicatrices2 w\nds2 adv5titi\s sub/ances1 z tumors1 calc>e\s masses1 tub]cle canc]1 etc4 ,lat]al v5tricles--note any diff]5ce 9 ! two2 cont5ts2 am\nt ( s]um or blood4 ,*oroid plexus--pale or conge/$2 cy/s2 calc>e\s bodies2 _! size & situation4 ,l9+ membrane ( v5tricles2 its vascul>ity1 r\ghness1 opacity1 etc4 ,septum lucidum--entire or lac]at$2 consi/5ce4 ,fif? v5tricle--size1 cont5ts1 etc4 ,?ird v5tricle2 cont5ts4 ,commissures--_! condition2 middle1 brok5 or d\ble4 ,optic ?alami & corpora /riati--size1 symmetry2 "* ( surface & int]ior2 if s(t5$1 ext5t2 extravasation ( blood1 etc4 ,condition ( p9eal gl&2 corpora quadrigem9a2 valve ( ,vieuss5s1 etc4 ,m$ulla oblongata--degree ( adhesion ( membranes2 s(t5+1 exact locality (2 condition ab\t orig9 ( n]ves2 appe>ance ^u section4 ,f\r? v5tricle--cont5ts2 condition ( floor1 etc4 ,c]ebellum--exam9e ) same c>e1 & note same po9ts z 9 c]ebrum4 ,inflammation4 ,acute inflammation ( ! bra9 sub/ance is a r>e disease1 except z ! result ( me*anical injury4 ,9 su* cases1 ! disease is g5]ally q circumscrib$1 be+ conf9$ to ! imm$iate region ( ! injury4 ,! bra9 becomes v vascul>1 acquir+ a r$ color1 :i*1 at a lat] p]iod1 *anges to a br[n or gre5i% hue1 & becomes mu* s(t] ?an natural4 ,if a =eign body be lodg$ 9 ! bra91 z a piece ( bone1 or a bullet1 !n ! inflammation is likely to result 9 an abscess1 :i* w give rise to head-a*e1 delirium ) intol]ance ( light1 succe$$ by convulsions1 coma & dea?4 ,subacute1 or *ronic inflammation ( ! bra91 is mu* m common1 yet is accompani$ ) pa?ological *anges simil> to ^? ( ! acute =m4 ,at fir/1 ! inflam$ portion becomes r$ & conge/$1 ! color gradually *ang+ to a crimson1 purple1 br[n1 or cl>et color1 ) m or less *ange ( consi/5ce4 ,! symptoms att5d+ inflammation ( ! bra9 sub/ance1 or c]ebritis1 are n readily di/+ui%able f ^? ( m5+itis2 inde$1 9 mo/ in/ances ! two diseases are1 to a c]ta9 ext5t1 comb9$2 z1 f ! vascul> connection betwe5 ! bra9 & pia mat]1 !re might be a ready ext5sion ( inflammation f "o to ! o!r4 ,:51 h[ev]1 !re is any sudd5 p]v]sion ( ! s5se ( vision or he>+2 or if !re are convulsions1 affect+ ma9ly "o side ( ! body2 or if coma succe$s ! convulsions & is accompani$ by "o-sid$ p>alysis1 we may expect to f9d evid5ce ( inflammation ( ! c]ebral sub/ance1 ) possibly t ( ! membranes also4 ,x is a fact to be borne 9 m9d1 h[ev]1 t :ile 9 typhus & typhoid1 & p]haps "s o!r =ms ( fev]1 we may h symptoms /rongly resembl+ ^? ( idiopa?ic inflammation ( ! bra9 or its membranes1 /ill ! po/-mortem w reveal no trace ( any su* morbid condition4 ,s(t5+4 ,to be able to recognize readily any *ange 9 ! consi/5cy ( ! bra91 cle> ideas mu/ fir/ be _h ( ! normal d5sity ( ?is organ4 ,?is may be obta9$ f an exam9ation ( ! bra9 ( "s ( ! l[] animals--z ! %eep or ox--t has be5 kill$ 9 a /ate ( heal?4 ,we %all !n f9d t ! bra9 pres5ts suffici5t firmness to p]mit ( its be+ h&l$ )\t rupture ( its sub/ance1 & to all[ ( its be+ slic$ into ?9 sections :i* w support _! own weight4 ,! gray portion is some:at s(t] ?an ! :ite1 yet ! fibr\s "* ( ! latt]1 becomes app>5t only aft] h>d5+ 9 alcohol4 ,if put into pure wat]1 x cont9ues un*ang$ = eight or t5 h\rs1 & )\t any portion becom+ dissolv$1 or r5d]+ ! wat] any degree turbid4 ,! consi/5ce ( ! bra9 v>ies1 normally1 at diff]5t p]iods ( life4 ,9 ! ftus & at bir?1 its s(tness approa*es to semi-fluidity4 ,f ?is to ! fifte5? or tw5tie? ye>1 x gradually acquires ! firmness ( ! bra9 ( ! adult4 ,s(t5+1 "o ( ! mo/ common v>iations f ! normal condition1 is g5]ally a m]e result ( inflammation ( a *ronic or sub-acute =m1 accompani$ ) a fatty deg5]ation ( n]ve sub/ance4 ,"u ! microscope1 ! *ange is se5 to consi/ 9 a dis9tegration ( ! n]ve fibres1 ! m$ull>y sub/ance break+ up into l>ge masses1 & und]go+ fatty metamorphosis4 ,x may take place ei!r on ! ext]nal surface ( ! organ1 or 9 ! septum lucidum & =nix1 ! corpora /riata1 or optic ?alami ( ! v5tricle1 ! c5tral p>ts ( ! hemisph]es1 ! c]ebellum1 or ! crura c]ebri1 9 ! ord] m5tion$4 ,:ile ?is *ange is usually ! result ( inflammation1 z already m5tion$1 x may accompany or succe$ ! foll[+ morbid conditions ( ! organ3 #a4 ,x may be ! result ( conge/ion ( ! vessels ( "s portion ( ! bra94 ,9 ?is case1 ! s(t5$ portion is r$di%1 crimson1 or br[n 9 color4 #b4 ,x may foll[ ! effusion ( blood 9 apoplexy4 ,! s(t5$ portion is !n ( a br[ni% color1 or1 if consid]able "t has elaps$1 x may be ( a dirty a% color1 t5d+ to gre54 #c4 ,x may accompany or foll[ ! process :i* t]m9ates 9 s]\s effusions4 ,x is !n ( a milky-:ite color4 #d4 ,x may take place 9 ! bra9 sub/ance imm$iately ar\nd tumors1 :5 its color may pres5t a v>iety ( t9ts4 ,among ! causes t5d+ to induce ?is condition ( ! bra91 may be m5tion$ a diseas$ /ate ( its blood vessels1 or _! ob/ruction by fibr9\s clots2 con/itutional syphilis2 excessive m5tal labor1 or frequ5tly repeat$ epileptic convulsions4 ,! consi/5cy w be f\nd to v>y f a slight *ange f ! normal condition1 to t ( a s(t1 pulpy1 or ev5 cream-l condition4 ,! symptoms accompany+ s(t5+ ( ! bra91 pres5t a consid]able v>iation4 ,among ! m prom95t1 may be m5tion$ an un/eady or tott]+ gait1 p>tial palsy1 ?ick & in>ticulate spee*1 feeble memory1 disord]$ intellect1 dull pa9 or heav9ess 9 ! head1 frequ5t dr[s9ess1 =mication1 numbness or rigidity1 or occasional involunt>y contraction ( ! muscles ( ! upp] extremities4 ,abscess ( ! bra91 diff]s f s(t5+1 to :i* x may h "s po9ts ( resemblance1 9 ! purul5t matt] be+ conta9$ 9 an irregul> cavity1 l9$ ) a m or less di/9ct membran\s cy/4 ,flakes ( lymph are frequ5tly f\nd 9 ^! abscesses1 giv+ ! matt] mu* ! appe>ance ( t conta9$ 9 scr(ul\s abscesses1 & !y are mo/ commonly f\nd 9 subjects :o pres5t ! usual symptoms ( ! /rum\s dia!sis4 ,:ile ^! collections are unque/ionably (t5 ! result ( inflammation1 yet x has be5 claim$ t !y may result f previ\s disease ( a suppurative "* 9 ! lungs1 & p]haps o!r organs1 ! purul5t matt] be+ tak5 up by ! ve9s & c>ri$ into ! g5]al circulation1 & f9ally deposit$ 9 ! sub/ance ( ! bra94 ,abscesses may be f\nd 9 any portion ( ! bra9 sub/ance1 or ! purul5t accumulation may be f\nd betwe5 ! bone & dura mat]1 or betwe5 ! two lay]s ( ! ara*noid4 ,9 ! latt] cases1 ! disease may g5]ally be trac$ to c>ies ( "s ( ! bones ( ! head1 z ( ! petr\s or ma/oid portions ( ! temporal1 or ( ! bones ( ! nasal cavity1 involv+ ! cribri=m portion ( ! e?moid4 ,aga91 abscesses 9 ! bra9 may result f ext]nal viol5ce1 z f a bl[ or fall ^u ! head4 ,x is rem>kable1 t 9 ^! cases1 "s mon?s may elapse betwe5 ! date ( ! injury & dea?4 ,h>d5+4 ,induration ( ! c]ebral sub/ance1 is a condition n readily di/+ui%$ dur+ life f t ( s(t5+1 ! two /ates be+ accompani$ by symptoms ( a simil> "*4 ,dr4 ,jones1 :o has *>ge ( ! male dep>tm5t ( ! ,p5nsylvania ,hospital = ! ,insane1 & has _h _m opportunities = exam9+ ! bra9s ( insane pati5ts1 tells me t he f\nd h>d5+1 ne>ly z frequ5tly z s(t5+1 9 ^! cases1 & nev] c\ld tell be=eh&1 ) c]ta9ty1 :i* condition might be pres5t4 ,9 h>d5+ ( ?is organ1 its d5sity may be increas$ to t ( boil$ :ite ( egg1 or x may approa* 9 consi/5ce to t ( a bra9 t has be5 h>d5$ 9 alcohol1 los+ mu* ( ! /icky1 adhesive "* :5 brok5 up by ! f+]s1 :i* m>ks ! bra9 sub/ance :5 9 its normal /ate4 ,! cause ( ! *ange is n well kn[n1 yet x is conjectur$ to be "o ( ! results ( inflammation1 inasmu* z x is g5]ally f\nd ) its capill>ies greatly load$ ) blood1 :ile m or less fluid is f\nd b5ea? ! ara*noid & 9 ! v5tricles4 ,! induration may affect ! great] "p or ev5 ! :ole ( ! c]ebral mass1 or may be conf9$ to p>ticul> portions or regions4 ,9 a case rec5tly exam9$ = ,dr4 ,too?ak]1 ( ?is city1 :]e insanity ( "s ye>s' duration1 & f9ally dea?1 _h foll[$ a sev]e injury ( ! head1 ! bra9 0 f\nd s h>d z to p]mit ( fracture 9 ! direction ( ! fibres1 ?us readily trac+ _! c\rse4 ,! symptoms t h mo/ frequ5tly be5 obs]v$ to accompany ?is *ange are1 defect & gradual loss ( memory1 apa!tic indiff]5ce1 slight difficulty ( articulation1 foll[$ by loss ( sexual desire1 p>tial palsy1 fatuity1 wa/+ & dea?4 ,extreme induration is (t5 f\nd 9 ! bra9s ( idiots4 ,! :ole organ may be f\nd resembl+ 9 color & d5sity boil$ :ite ( egg1 or ev5 *eese4 ,! c]ebral sub/ance is %runk51 d5se1 & app>5tly q void ( vessels4 ,hyp]trophy ( ! bra91 is a condition 9 :i* !re is usually increas$ h>dness z well z increas$ volume1 & is di/+ui%$ by flatt5+ ( ! convolutions1 n>r[+ ( ! v5tricles1 & a rem>kable dryness ( ! :ole organ ) its membranes1 ! *ange involv+ bo? ! c]ebrum & c]ebellum1 & accompani$ ) an increase ( weight1 all indicat+ increas$ nutrition1 or ! deposit ( new matt] 9 ! tissue ( ! bra94 ,?9n+ ( ! cranial bones may att5d ?is condition1 increas$ int]nal pressure result+ 9 _! p>tial absorption4 ,! causes ( ?is =m ( disease are n g5]ally und]/ood4 ,! symptoms1 ?\gh always pres5t1 are n uni=m4 ,among !m may be m5tion$ int5se head-a*es1 a weak5$ or p]v]t$ /ate ( ! intellectual faculties1 fits ( gidd9ess1 accompani$ ) /upor2 f9ally1 convulsions1 ) p]haps loss ( s5sation & motion1 ! pati5t be+ unexpect$ly cut (f by an epileptic attack4 ,! disease has n be5 obs]v$ 9 p]sons ov] fifty4 ,9 mo/ cases1 ! pati5ts 7 betwe5 tw5ty & ?irty4 ,9 "o in/ance1 h[ev]1 x 0 develop$ 9 a "y girl ( ?irte54 ,lead poison+ w\ld seem to be an excit+ cause1 x hav+1 9 sev]al in/ances1 be5 develop$ 9 pa9t]s & manufactur]s ( :ite lead4 ,atrophy4 ,9 ?is condition1 !re is f\nd a g5]al dim9ution ( ! volume ( ! bra91 & especially ( ! convolutions4 ,! latt] are %runk1 n>r[1 & sometimes s(t5$1 :ile ! sulci are l>ge & op51 ! bra9 rec$+ f ! skull1 & ! pia mat] greatly inject$ ) s]\s fluid1 giv+ ! appe>ance ( a jelly-l inve/m5t to ! :ole bra94 ,! bra9 sub/ance is at ! same "t s(t1 ! v5tricles enl>g$ & fill$ ) fluid1 :ile a l>ge am\nt ( s]um w fl[ f ! sub-ara*noid space at ! base ( ! bra91 & f ! sp9al canal4 ,:ile ?is condition ( ! bra9 might be look$ ^u z a result ( pressure f ! accumulat$ s]um1 ! abs5ce ( ! usual symptoms ( hydrocephalus1 ) ! kn[n hi/ory ( ^! cases1 r5d]s x q probable t ! *ange comm5ces z an actual loss ( bra9 sub/ance1 ! place ( ! latt] be+ suppli$ ) s]\s fluid4 ,result+ f atrophy ( ! bra91 !re w (t5 be f\nd an increas$ ?ickness ( ! cranial bones1 ?is be+ ano!r cons]vative ef=t ( nature to pres]ve ! normal support & pressure ^u ! bra94 ,atrophy ( ! bra9 is sometimes f\nd 9 old age & 9 v>i\s enfeebl+ diseases1 :]e all ! organs suff] m or less wa/e f improp] nutrition1 b x is s frequ5tly f\nd ) drunk>ds1 especially ^? :o h di$ ) delirium trem5s1 t ?is condition may1 9 ! l>ge majority ( cases1 be consid]$ z ! effect ( intemp]ance4 ,sev]al =ms ( atrophy may also be obs]v$4 ,x may be conf9$ to "s portion ( ! convolut$ surface1 or to "o ( ! /riat$ bodies or optic b$s4 ,atrophy ( ! optic tracts1 or n]ves ( "o or bo? eyes1 is n unfrequ5tly associat$ ) loss ( sight f amaurosis4 ,tumors ( ! ,bra94 ,! bra91 l o!r p>ts ( ! body1 is subject to morbid gr[?s ( a great v>iety ( =ms4 ,! symptoms ( tumors 9 ! bra91 9 _m po9ts1 pres5t su* resemblances to o!r =ms ( disease1 t x is usually ! po/-mortem alone1 t w det]m9e ! fact ( _! pres5ce or "*4 ,x may be said 9 g5]al1 h[ev]1 t ! effects ( morbid gr[?s 9 ! bra9 w v>y accord+3 #a4 ,to ! *anges 9 ! surr\nd+ c]ebral sub/ance2 #b4 ,to ! size ( ! gr[?2 & #c4 ,to ! position ( ! bra9 9 :i* x may be develop$4 #a4 ,! *anges induc$ 9 ! bra9 sub/ance surr\nd+ tumors are usually1 fir/1 d]angem5t ( ! circulation1 & second1 z a result ( ?is1 effusion ( s]um1 or f9ally1 s(t5+ ( a great] or less] am\nt ( contigu\s c]ebral sub/ance4 ,head-a*e1 ) epileptic attacks1 loss ( memory1 irregul> contraction ( ! muscles & p>tial p>alysis may accompany ! vascul> d]angem5t1 :ile z s(t5+ or pulpy de/ruction sup]v5es1 a g5]al aggravation ( all ! symptoms w foll[1 end+ 9 dea?1 ei!r ) coma or by a sudd5 apoplectic attack4 #b4 ,tumors ( ! bra9 ( a small size1 may be f\nd aft] dea? f o!r causes1 t h evid5tly produc$ no symptoms dur+ life2 & 9 o!r in/ances1 !y h induc$ no *ange until a few days be=e dea?1 9 :i* cases1 ! convulsions1 p>alysis & coma :i* prec$es ?is result1 mu/ be attribut$ to ! vascul> di/urbance 9 ! surr\nd+ bra9 tissue4 #c4 ,! position ( ! tumor1 w modify to "s ext5t ! "* ( ! symptoms manife/$4 ,:5 9 ! ant]ior lobes1 loss or impairm5t ( spee* is said to att5d4 ,:ile1 :5 9 ! corpus /riatum1 ! motions ( ! legs & arms are disord]$4 ,! foll[+ are ! m commonly recogniz$ tumors ( ! bra93 ,ad5oid1 or ,gl&ul>-l ,tumors4 ,^! are g5]ally describ$ z resembl+ an enl>g$ lymphatic gl&1 bo? 9 color & d5sity4 ,!y may v>y 9 size f a filb]t to t ( an orange4 ,!re may be a s+le gr[? ( ?is k9d1 or sev]al1 & !y may be f\nd 9 any "p ( ! bra94 ,tub]cul> or ,scr(ul\s ,tumors4 ,"u ?is head may be plac$ c]ta9 bodies ( a :ite or pale yell[ color1 firm1 l s(t *eese1 sometimes granul> & friable1 & consi/+ *iefly ( a l>ge proportion ( album9\s matt]4 ,!y may be f\nd fir/1 z "o or m individual masses ( consid]able size2 or second1 sometimes z _m m9ute r\nd$ bodies1 di/9ct & sep>ate f "o ano!r4 ,9 exam9+ ! head ( a hydrocephalic *ild ( f\r ye>s1 ) ,dr4 von ,tagan1 we f\nd atta*$ to ! und]side ( ! middle lobe ( ! left hemisph]e1 a body ( a :ite *eesy consi/5ce1 & ( ! size ( half a h5's egg4 ,connect$ ) ! c]ebellum1 0 ano!r tumor ( ! same "*1 b small] 9 size4#f ,tub]cul> masses ( ?is k9d1 may be f\nd on ! surface1 or imb$d$ 9 ! sub/ance ( any portion ( ! c]ebrum or c]ebellum4 ,! second =m ( tub]cul> deposits1 are conf9$ almo/ :olly to ! gray matt] ( ! surface4 ,9 "o case1 ov] two hundr$ ( ^! bodies 7 f\nd scatt]$ ?r\gh ! gray matt] ( ! c]ebrum & c]ebellum1 ( ! size ( a pea or bean1 & ( a pale yell[ or blui% color4 ,:5 cut op51 ! int]ior ( ! bodies 0 f\nd to resemble boil$ potatoes 9 consi/5cy4 ,?is =m ( disease is conf9$ pr9cipally to *ildr54 ,( ?irty cases collect$ by ,dr4 ,p4 ,h4 ,gre51 ( ,london1 all 7 betwe5 ! ages ( n9ete5 mon?s & twelve ye>s4 ,adipose ,tumors4 ,"u ?is "n1 has be5 describ$ a peculi> & q r>e =m ( disease ( ! bra91 9 :i* ei!r "s portion ( ! bra9 itself1 or gr[?s atta*$ to or imb$d$ )9 ! c]ebral sub/ance1 pres5t a fatty appe>ance1 :i* by "s has be5 d5om9at$ l>dace\s deg5]ation4 ,! ext]ior ( ! tumor is smoo?1 ( a yell[ color1 & ! int]ior compos$ ( adipose matt] ( a% color1 & semi-solid consi/5cy4 ,*ole/]oma4 ,?is is ano!r r>e =m ( tumor ( ! bra91 consi/+ ( :ite pe>l-l1 gli/5+ bodies1 v>y+ 9 size f t ( a pea1 to a walnut or small orange4 ,!y are f\nd mo/ly at ! back ( ! bra91 & 9 ! sub-ara*noid tissue4 ,:5 exam9$ *emically1 ! sub/ance ( ^! tumors is f\nd to consi/ almo/ :olly ( *ole/]94 ,c>tilag9\s ,tumors4 ,^! are (t5 spok5 ( z scirrhus 9 _! nature4 ,!y may be describ$ z irregul> 9 %ape1 sometimes lobulat$1 ! int]ior yell[i% 9 color1 ( a c>tilag9\s h>dness1 & arrang$ sometimes 9 /reaks or b&s1 9 o!r cases1 9 r\nd$ masses4 ,at a m advanc$ /age1 f s(t5+ ( ! int]ior1 cavities beg9 to =m1 :i* are fill$ ) a semi-fluid or jelly-l sub/ance4 ,dea? w g5]ally ensue be=e ?is process is f> advanc$4 ,calc>e\s or ,bony ,deposits4 ,osse\s =mations are n unfrequ5tly f\nd connect$ ) ! membranes ( ! bra91 b r>ely1 if ev]1 ) ! bra9 sub/ance4 ,calc>e\s deposits1 on ! o!r h&1 h be5 f\nd 9 almo/ e "p ( ! bra94 ,9 ! bra9 ( an idiot ( sixte51 ! pons ,v>olii1 crura c]ebri & c]ebellum1 conta9$ s mu* e>?y matt]1 z to give difficulty 9 cutt+ ) a knife 7,sir ,e4 ,home47 ,9 ! bra9 ( a man :o _h long suff]$ f acute pa9 9 ! head1 a h>d pla/]-l concretion 0 f\nd z l>ge z a filb]t4 ,^! bodies are1 !re=e1 n to be look$ ^u z g5u9e bony =mations1 b r z an infiltration ( *alky sub/ance into ! bra9 tissue4 ,( ! same nature1 are ! calc>e\s deposits f\nd 9 ! p9eal gl&1 :i*1 al?\gh v con/antly pres5t aft] ! age ( eight or t5 ye>s1 c h>dly be consid]$ z normal products1 al?\gh x is well e/abli%$ t !y ex]t no influ5ce on ! functions ( ! bra94 ,ency/$ ,tumors1 ,hydatids4 ,a v>iety ( tumors ( ! ency/$ =m h be5 f\nd 9 ! bra9 by diff]5t obs]v]s1 v>y+ 9 size f a pea1 to t ( an egg or orange4 ,_! cont5ts also1 h pres5t$ a great degree ( v>iation4 ,:ile "s h be5 fill$ ) ! *eesy sub/ance ( ! ord9>y /eatome1 o!rs h conta9$ blood1 a jelly-l1 or ev5 a limpid wat]y fluid4 ,x has be5 claim$ by "s1 d\bt$ by o!rs1 t ! animal hydatid1 ! cy/ic]cus1 has be5 f\nd 9 ! human bra94 ,hav+ unque/ionably be5 obs]v$ 9 ! eye1 ! he>t1 & o!r p>ts ( ! body1 x may also1 possibly1 sometimes be f\nd 9 ! bra94 ,?is curi\s animal is n[ kn[n to be b ! l>val =m ( "o ( ! ce/oid entozoa1 ! ,tnia solium4 ,its position 9 ! bra91 c only be acc\nt$ =1 by suppos+ t ! embryo1 :i* 9 its fir/ /age is v m9ute1 by pi]c+ ! coats ( ! /oma*1 into :i* ! egg has be5 tak5 ) ! food1 ent]s a blood-vessel1 & be+ c>ri$ into ! bra91 lodges 9 "s ( ! capill>ies1 ! walls ( :i* x p5etrates4 ,ent]+ ?us ! bra9 sub/ance1 x develops into ! second l>val =m1 :i* consi/s ( a small bag or cy/1 fill$ ) a limpid fluid4 ,develop$ )9 ! cy/1 yet capable ( be+ ?ru/ out1 is ! head1 :i* pres5ts f\r suck]-l processes1 surr\nd$ by a circle ( m9ute hooks1 :i* give x ! p[] ( active migration ?r\gh ! tissues4 ,9 ! pig1 ! pres5ce ( ^! cy/ic]ci con/itutes measly pork1 :i* if tak5 into ! /oma* 9 a raw /ate1 ! conta9$ l>v at once develop into ! p]fect worm1 ! ,tnia solium4 ,blood ,cy/s1 ?\gh n common1 h be5 f\nd 9 ! bra94 ,!y consi/ ( a membran\s cy/1 :i* may be lobulat$ or conta9 small] cy/s1 ! inn] surfaces ( :i* are l9$ ) a vascul> membrane1 f :i* escapes a bloody fluid4 ,canc]\s ,tumors may be f\nd 9 any portion ( ! bra91 & may pres5t ! sev]al v>ieties ( ^! malignant gr[?s1 includ+ fungus hmatodes4 ,:ile !y are g5]ally second>y ) simil> tumors 9 o!r p>ts ( ! body1 !y may be prim>y 9 _! orig94 ,!y may acquire su* a developm5t z to cause absorption ( bo? ! dura mat] & skull1 & ?us appe> ^u ! outside ( ! head4 ,9 fungus hmatodes1 ! enclos$ sub/ance consi/s ( s(t spongy matt]1 ( a bra9-l consi/5cy1 divid$ into lobul> masses1 ( a r$di% %9+ aspect4 ,!y are ma9ly f\nd 9 "y subjects1 sometimes 9 adults4 ,melanosis4 ,?is =m ( morbid gr[? is occasionally f\nd 9 ! human bra94 ,! middle lobe ( ! left hemisph]e ( ! bra9 ( a subject 9 ! dissect+-room1 0 f\nd to be atta*$ to ! dura mat] by a melanotic mass1 resembl+ ! d>k bodies frequ5tly f\nd ar\nd ! bron*ial tubes4 ,its atta*m5ts 7 su* z to r5d] x d\btful :e!r x _h its orig9 9 ! bra9 or 9 its membranes4 ,! gray sub/ance ( ! bra9 ( p]sons :o h suff]$ mal>ial diseases1 is sometimes f\nd pres5t+ a blacki% appe>ance f ! d>k pigm5t )9 its sub/ance1 or )9 ! pia mat]4 ,syphilitic ,tumors are occasionally f\nd 9 ! bra91 situat$ ne> its surface4 ,_! *>act]s are n su* z to p]mit ( _! ready recognition1 except :5 associat$ ) syphilitic gr[?s 9 o!r p>ts ( ! body4 ,!y may v>y 9 size f a p9's head to a *]ry4 ,!y pres5t a r\nd$ or irregul> =m1 a yell[ color1 & are compos$ ( sp9dle-%ap$ or r\nd cells1 :i* may und]go a *eesy deg5]ation4 ,ob/ruction ( ,c]ebral ,art]ies4 ,pati5ts suff]+ f endoc>dial inflammations1 or f aneurism ( ! ar* ( ! aorta1 or f any cause hav+ fibr9\s deposits =m+ 9 ! he>t1 are liable to h ! same wa%$ along ! c>otids1 & ?us c>ri$ into ! vessels ( ! bra91 !reby d]ang+ ! circulation ?r\gh ?is organ4 ,! symptoms result+1 are g5]ally ^? ( apoplexy4 ,hemiplegia1 ) or )\t loss ( consci\sness1 foll[s4 ,s(t5+ ( ! c]ebral sub/ance foll[s z a result ( ! accid5t1 & x is n impossible b t ! pres5ce ( ^! bodies is ! g5]al cause ( ?is /ructural *ange ( ! bra94 ,! position ( ! embolus1 9 fatal cases1 is usually 9 "o ( ! middle c]ebral art]ies2 ^! vessels be+ 9 a m direct l9e ) ! int]nal c>otids4 ,!y may lodge1 h[ev]1 9 ! v]tebrals or basil>1 yet ?r\gh ! circle ( ,willis1 ! sev]al p>ts ( ! bra9 w /ill receive a p>tial supply ( blood4 ,a!romat\s ,deg5]ation1 & ,calcification ( ,c]ebral ,art]ies4 ,! coats ( ! art]ies ( ! bra9 9 old p1 are liable to become infiltrat$ ) a!romat\s & calc>e\s matt] to su* a degree1 z to r5d] !m rigid1 & inela/ic4 ,:ile ! art]ies ( ! base ( ! bra91 z ! basil>1 ! c]ebrals1 or ! communicat+ ( ! circle ( ,willis1 are m liable to ?is *ange1 x may involve ! small] bran*es z well4 ,! increas$ ?ickness ( ! coats ( ! vessels1 results 9 a dim9ution ( ! calibre1 :ile !y are enl>g$ 9 ext]nal circumf]5ce4 ,result+ f ?is /ate ( ! vessels1 we %all h di/urb$ circulation1 foll[$ by effusion1 & 9 "s cases by atrophy ( ! bra94 ,att5d+ ?is condition1 are frequ5t attacks ( /upor & ins5sibility1 la/+ = sev]al h\rs or ev5 days4 ,aga91 f ! weak5$ condition ( ! coats ( ! vessels 9 ^! cases1 we may h an aneurism result+1 ! walls ( :i* sudd5ly giv+ away1 dea? f hmorrhage spe$ily foll[s4 ,section ,,iv4 ,,( ,,! ,,sp9al ,,cord4 ,notice 9 exam9ation4 #a4 ,v]tebr4--,condition ( sev]al p>ts2 c>ies1 etc4 #b4 ,v]tebral ,canal4--,proportion to cord2 conta9$ fluid2 s]um1 pus or blood2 am\nt1 etc42 condition ( sp9al ve9s4 #c4 ,membranes ( cord4--,bulg+ ( any "p2 ?ick5+2 conge/ion2 morbid gr[?s1 etc42 fluids )92 am\nt1 color1 etc4 #d4 ,sp9al cord4--,weight2 size2 condition ( fissures2 ( int]ior1 z se5 on section2 s(t5+2 exact po9t (2 roots ( n]ves2 pressure ^u1 etc4 ,f ! cont9uity & id5tity ( /ructures1 ! sp9al cord is subject to ess5tially ! same diseases z ^? ( ! bra94 #a4 ,! ,membranes4 ,inflammation ( ! latt] may exi/ alone1 or 9 connection ) t ( ! membranes ( ! bra91 con/itut+ c]ebro-sp9al m5+itis4 ,inflammation ( ! dura mat] is an uncommon occurr5ce4 ,! inflammation 9 sp9al m5+itis is almo/ :olly conf9$ to ! pia mat]1 ?is be+ ! m vascul> ( ! membranes4 ,a pale r$di%1 or sometimes purple color1 ) a bloody jelly-l infiltration1 *>act]izes ! e>li] /age1 :ile at a lat] p]iod ! membrane pres5ts a greyi% or dirty yell[ appe>ance1 f ! pres5ce ( a ?ick pus-l sub/ance cov]+ ! surface4 ,su* inflammations may be ei!r idiopa?ic1 rheumatic or traumatic 9 _! orig94 ,9 spott$ fev] ! inflammation ext5ds to ! pia mat] ( ! base ( ! bra91 & is rem>kable f ! epidemic =m :i* x sometimes assumes4 ,tub]cul> deposits1 z well z tumors ( v>i\s k9ds1 may be f\nd connect$ ) ! sp9al membranes1 s simil> to ^? describ$ ) ! c]ebral membranes1 z n to require sep>ate notice4 ,s]\s effusion may be f\nd 9 ! sp9al canal1 9 ! same cases :5 x exi/s 9 ! cranial cavity1 & may be ei!r a diffusion ( fluid ?r\gh ! sub-ara*noid space1 t has be5 effus$ 9 ! bra91 or x may orig9ate f ! membranes ( ! cord itself4 ,! fluid may be ei!r betwe5 ! v]tebr & dura mat]1 or betwe5 ! latt] & ! pia mat]4 ,a peculi> =m ( dropsy ( ! sp9e is sometimes f\nd1 cong5ital 9 its nature1 & accompani$ ) a defici5cy 9 ! sp9al column1 by means ( :i* a cleft rema9s 9 ! ar* ( "o or m ( ! v]tebr2 h5ce ! "n1 ,sp9a bifida1 z appli$ to ?is disease4 ,! effusion 9 ^! cases1 tak+ place be=e ! v]tebr are fully develop$1 ! pressure f )9 prev5ts ! f9al closure ( ! canal po/]iorly2 :51 f want ( support at t po9t1 ! membranes & cov]+ tissues1 yield+ to ! pressure f ! accumulat+ fluid1 gradually protrude at t po9t1 produc+ a r\nd$ fluctuat+ tumor4 ,! disease is m frequ5tly f\nd 9 ! lumb> region1 al?\gh x may occur 9 ! dorsal or c]vical1 & 9 "s cases may involve ! :ole sp9al column4 #b4 ,sp9al ,m>r[4 ,inflammation ( ?is /ructure1 7myelitis17 pres5ts ! same "*1 & may be foll[$ by ! same results z inflammation ( ! bra94 ,f ! di/5sion & engorgem5t ( ! capill>ies ( ! inflam$ "p1 a bright r$ color may be pres5t$1 n only on ! surface1 b 9 ! sub/ance ( ! cord :5 expos$ by division4 ,blood may also be f\nd effus$ 9 ! sub/ance ( ! cord1 or betwe5 its membranes1 or betwe5 ! bony walls & ! dura mat]4 ,s(t5+ ( ! sp9al cord1 may arise ei!r spontane\sly1 or z a consequ5ce ( injury4 ,:5 spontane\sly tak+ place1 a l>ge portion ( ! cord may be involv$4 ,! appe>ance pres5t$1 is mo/ usually t ( a s(t pulpy mass1 :i* easily breaks d[n ^u ! op5+ ( ! membranes4 ,:5 ! result ( injury1 ! s(t5+ is g5]ally conf9$ to ! portion involv$ 9 ! orig9al viol5ce4 ,h>d5+ ( ! sp9al m>r[1 7scl]osis17 may be "o ( ! results ( inflammation1 yet ! accompany+ symptoms may v>y s slightly f ^? ( o!r =ms ( sp9al disease1 t ! po/-mortem alone1 w disclose ! true nature ( ! difficulty4 ,9 locomotor ataxy1 ! po/]ior columns ( ! cord are usually affect$ ) ?is *ange4 ,atrophy ( ! sp9al cord1 diff]s f h>d5+1 9 ! %r9k+ :i* att5ds ! progress ( ! disease1 al?\gh !re may be increas$ d5sity1 z 9 ! =m] case4 ,! ess5tial peculi>ity ( atrophy1 consi/s 9 an increas$ developm5t ( ! fibr\s elem5ts ( ! cord1 :i* by pressure1 gradually de/roys ! elem5t>y n]ve con/itu5ts4 ,?is disease is conf9$ *iefly to m5 ( a middle age1 & is g5]ally ! result ( v5]eal excesses2 muscul> ov]-ex]tion1 exposure to cold1 c41 may also be excit+ causes4 ,morbid ,gr[?s1 ( v>i\s k9ds1 & closely resembl+ ^? f\nd 9 ! bra91 z well z animal p>asites1 are sometimes f\nd 9 ! sp9al cord4 ,,"p ,,ii4 ,,! ,,neck ,,& ,,*e/4 ,,*apt] ,i4 ,,op]ation ,,on ,,! ,,neck4 ,! p>ts :i* we may wi% to exam9e 9 ! region ( ! neck 9 a po/-mortem exam9ation1 include ! tongue1 ! l>ynx1 ! tra*ea & ! sophagus4 ,^! may be remov$ toge!r1 by fir/ mak+ a s+le1 /raight incision f ! *91 d[n ! c5tral l9e ( ! neck to ! /]num4 ,next turn aside ! integum5t ) ! sup]ficial /ructures1 sep>ate ! muscles ( ! tongue f _! atta*m5t to ! jaw1 & divide ! muc\s membrane ( ! floor ( ! m\? on ei!r side ( ! tongue1 :51 ) ! t5aculum1 ! latt] may be drawn d[n b5ea? ! jaw4 ,! neck be+ well ext5d$ & ! tongue =cibly drawn d[n1 ! knife may be c>ri$ back on ei!r side ( t organ1 divid+ ! muscles & muc\s membranes1 includ+ ! palat9e ar*es & tonsils1 :5 ! tongue may be s drawn d[n z to p]mit ! knife to rea* ! po/]ior walls ( ! ph>ynx4 ,?is be+ divid$1 f ! slight adhesion to ! sp9al column1 ! :ole may n[ be drawn d[n & remov$ toge!r1 ! tra*ea & sophagus be+ divid$ at ! upp] end ( ! /]num4 ,by ! use ( ! ent]otome1 ! ph>ynx1 l>ynx & tra*ea may be laid op5 f beh9d1 :i* w fully expose _! int]ior = c>eful exam9ation4 ,aft] ! exam9ation ( ! p>ts is complet$1 if x is desir$ to pres]ve ! specim51 ! cavity rema9+ may be s fill$ ) pap] or rags1 z1 ^u ! clos+ ( ! "p1 to leave little or no evid5ce ( ! abs5ce ( any portion4 ,?r\gh ! m\?1 ! buccal cavity may be exam9$1 :5 !re may be not$ ! condition ( ! tee?1 gums1 tonsils1 palate1 etc42 ! pres5ce or abs5ce ( ulc]s on any ( ^! p>ts1 or ( food or o!r =eign sub/ances )9 ! cavity4 ,,op]ation ,,on ,,! ,,*e/4 ,9 op5+ ! ?oracic cavity = an exam9ation ( its cont5ts1 a /raight incision may be made along ! c5tral l9e1 ?r\gh ! sk9 & sup]ficial tissues1 f ! upp] end ( ! /]num1 to ne> ! umbilicus4 ,if x is desir$ to exam9e ! abdom5 at ! same "t1 ! incision may be c>ri$ on to ! pubis2 o!rwise1 end+ j above ! umbilicus1 a transv]se cut may be c>ri$ f its l[] end1 to ! bord] ( ! *e/ ^u ei!r side4 ,^! incisions be+ c>efully c>ri$ ?r\gh ! muscles & p]itoneum1 ! flap ?us =m$ may be lift$ & turn$ up ^u ! *e/1 & ! p]itoneum divid$ along ! c>tilages ( ! ribs4 ,! integum5t ) ! pectoral muscles may n[ be dissect$ up toge!r1 & turn$ back z f> z ! union ( ! c>tilages ) ! ends ( ! ribs4 ,) ! heavy c>tilage knife1 ! =m] may n[ be divid$ ne> _! union ) ! ribs2 c>e be+ obs]v$ n to p]mit ! knife to pass into ! *e/1 & ?us injure ! lungs4 ,9 ag$ p]sons1 & sometimes 9 ! middle ag$1 ! c>tilages w be f\nd s ossifi$1 z to require ! use ( ! saw or *isel 9 ! place ( ! knife2 ?is be+ m frequ5tly requir$ ) ! fir/ ribs1 ?an ) any o!r4 ,! ligam5ts unit+ ! clavicle ) ! /]num1 hav+ be5 divid$1 ! latt] may be remov$ by comm5c+ at ! l[] end1 & sep>at+ ! diaphragm f its connections to ! /]num & co/al c>tilages4 ,! /]num be+ n[ lift$ f bel[1 ! m$ia/9um may be divid$1 ?is =m+ ! only bond ( union to ! p>ts b5ea?1 except 9 cases1 :]e1 f pleuritic inflammation1 adhesions may exi/ betwe5 ! lungs & co/al c>tilages4 ,! /]num hav+ ?us be5 remov$1 ! lungs w be f\nd m or less collaps$ f atmosph]ic pressure1 unless adhesions be s ext5sive z to prev5t4 ,! att5tion may n[ be giv5 to ! p]ic>dium & he>t4 ,by mak+ a small op5+ into ! cavity ( ! =m]1 any dropsical fluid pres5t may be remov$ & measur$4 ,?is may be accompli%$1 by introduc+ ! po9t ( a syr+e into ! op5+1 & c>efully draw+ ! fluid into ! same1 & !n =c+ x into "s vessel4 ,or1 x may be c>efully absorb$ by a sponge1 & !n squeez$ out & measur$4 ,! he>t may be remov$ = exam9ation1 by divid+ ! l>ge vessels spr++ f its base4 ,9 exam9+ ! cavities1 valves1 c41 ! "r auricles %\ld fir/ be op5$1 by an incision along its base1 ano!r meet+ ?is at "r angles1 ?us mak+ two angul> flaps1 :i* may be turn$ aside1 expos+ ! int]ior4 ,9 op5+ ! v5tricle1 let "o incision be made p>allel )1 & ab\t "o-?ird ( an in* f ! groove 9 ! ant]ior surface divid+ ! "r f ! left v5tricle1 comm5c+ at ! base & ext5d+ to ! apex2 & ano!r along ! po/]ior groove1 meet+ ! =m] at ! apex1 ?us mak+ a triangul> flap1 :i* may be lift$1 expos+ ! int]ior ( ! cavity1 )\t injury to ! t5don\s cords4 ,! semilun> valves ( ! pulmon>y art]y may readily be expos$1 by splitt+ op5 t vessel1 & turn+ aside its walls4 ,! left side ( ! he>t may be exam9$ 9 ! same mann]4 ,! exam9ation ( ! lungs may (t5 be made 9 situ4 ,deep incisions may be made into _! sub/ance at v>i\s po9ts1 or portions may be remov$ = exam9ation4 ,if a m c>eful inspection is desir$1 or if we wi% to exam9e ! bron*ial tubes or aorta1 ! :ole ?oracic visc]a may be remov$ toge!r4 ,to accompli% ?is1 divide ! tra*ea & sophagus1 z !y ent] ! *e/1 ) also ! bran*es aris+ f ! ar* ( ! aorta4 ,c>ry ! h&s ar\nd ei!r lung1 break+ up any adhesions :i* may be f\nd1 & !n by grasp+ ! tra*ea & ar* ( aorta1 & dragg+ d[n ^u ! same1 ! po/]ior m$ia/9um may be divid$ f above d[nw>ds1 ! aorta & sophagus divid$ z !y pass ! diaphragm1 & ! :ole ( ! cont5ts ( ! *e/ ?us remov$ en masse4 ,plac$ ^u a l>ge tray1 !y may n[ be exam9$ 9 detail4 ,! bron*ial tubes may be be/ inspect$ f beh9d1 lay+ op5 ! passages ) ! scissors at _! po/]ior walls4 ,by means ( deep incisions1 ext5d+ f apex to base ^u ! ant]ior surface1 ! condition ( ! int]ior ( ! organs may be c>efully not$4 ,! exam9ation complet$1 all blood %\ld be spong$ f ! cavity1 ! organs replac$1 & any rema9+ vacancy fill$ ) bran or sawdu/4 ,! /]num n[ be+ plac$ 9 position1 ! incision may be sew$ up4 ,,*apt] ,,ii4 ,,pa?ological ,,conditions4 ,section ,i4 ,,( ,,! ,,tongue4 ,notice 9 exam9ation3 size2 =m2 surface coat$ or clean2 furr[$ or fissur$2 m>ks ( bites1 /a9s2 color g5]ally2 vesicles2 ulc]s2 sl\ghs2 tumors1 w\nds1 etc4 ,! diseases ( ! tongue1 ! appe>ance ( :i* we may wi% to exam9e aft] dea?1 include canc]1 syphilitic ulc]s or tub]cle1 tumors1 hyp]trophy1 etc4 ,canc] is ! only disease ( ?is organ likely to result 9 dea?4 ,x is said to occur m frequ5tly 9 females ?an males4 ,x may assume ! v>i\s =ms ( ?is disease1 b is m frequ5tly epi!lial or scirrhus1 ?an m$ull>y4 ,syphilitic ,ulc]s or ,tub]cle1 may be conf\nd$ ) canc]1 & 9 "s in/ances1 only a previ\s k ( ! hi/ory ( ! case1 assi/$ by a microscopic exam9ation1 w\ld positively det]m9e ! diagnosis4 ,tumors ( v>i\s k9ds--ency/$1 fatty1 fibr\s & erectile--may be f\nd 9 ! sub/ance ( ! tongue1 or und]nea? x 9 ! floor ( ! m\?4 ,ranula is a peculi> =m ( tumor f\nd "u ! tongue1 (t5 atta9+ ! size ( a pigeon's egg1 & fill$ ) a wat]y or album9\s1 or sometimes cretace\s matt]4 ,! tumor is usually consid]$ z aris+ f a dilatation ( ,:>ton's duct1 b ( ?is !re is d\bt 9 "s cases4 ,hyp]trophy ( ! tongue is sometimes f\nd1 :]e1 f an increase ( ! connective or areol> tissue1 )\t any *ange 9 ! muscul> fibres1 ! organ has become greatly enl>g$1 s z to cause de=mity ( ! m\?1 or ev5 ( ! :ole l[] "p ( ! face4 ,?is condition may involve ! :ole or a portion only ( ! tongue4 ,section ,,ii4 ,,( ,,! ,,l>ynx ,,& ,,tra*ea4 ,notice 9 exam9ation3 #a4 ,cont5ts--mucus2 lymph2 pus or blood2 am\nt2 =eign bodies2 false membranes1 etc4 #b4 ,l>ynx--condition ( epiglottis2 dema1 ulc]s1 sl\ghs1 polypi2 same ( sup]ior op5+ to cavity4 ,v5tricles--condition ( muc\s membranes1 etc4 ,vocal ,cords--?ickness1 color1 dema1 ulc]s1 etc4 ,c>tilages--condition (2 ossification2 c>ies1 etc4 #c4 ,tra*ea--cont5ts2 muc\s membrane2 c>tilag9\s r+s2 ossification (2 c>ies2 d5ud$ ( muc\s membrane1 etc4 ,inflammation1 ulc]ation1 dema1 necrosis ( ! c>tilages1 tumors & false membranes are ! m usual pa?ological conditions ( ^! p>ts t may claim ! att5tion 9 a po/-mortem exam9ation4 ,inflammation ( ! muc\s membrane ( ! l>ynx 7l>yngitis7 & tra*ea1 w appe> z a diffus$ r$ness1 ) "s ?ick5+ ( ! membrane1 & )9 :i* may be trac$ _m small1 conge/$ blood-vessels4 ,x may be important to di/+ui% ! r$ness ( inflammation1 f t att5d+ ! e>ly /age ( decomposition1 :i*1 x is an int]e/+ fact to "k1 fir/ appe>s 9 ^! p>ts4 ,imm$iately aft] dea?1 ! muc\s membrane is pale1 except 9 dea? f suffocation or l>yngitis4 ,9 a day or two x becomes ( a dusky r$1 :i* is di/+ui%$ f t ( inflammation by ! abs5ce ( conge/$ vessels2 ! r$ness ( decomposition1 also1 hav+ a sup]ficial filmy appe>ance1 z if wa%$ ) dirty w9e4 ,ulc]ation ( ! l>ynx comm5ces 9 ! muc\s membrane1 b may ext5d to ! deep] p>ts4 ,! m usual location is ^u ! epiglottis1 or on ! m>g9 ( ! glottis & vocal cords4 ,impairm5t ( ! voice to a great] or less degree1 w h att5d$ ei!r inflammation or ulc]ation ( ! vocal cords4 ,x is to be borne 9 m9d1 h[ev]1 t aphonia may arise f "s impairm5t ( ! n]ves ( ! l>ynx1 9 :i* case1 a po/-mortem exam9ation w fail to reveal any morbid condition ( ! muc\s membrane or vocal cords4 ,pulmon>y consumption we sometimes f9d accompani$ ) ! pres5ce ( ulc]s ^u ! po/]ior walls ( ! l>ynx1 ) evid5ce ( inflammation 9 ! surr\nd+ p>ts4 ,:e!r ^! arise f tub]cles 9 ! muc\s membrane1 or ulc]ation ( ! muc\s follicles1 is unc]ta94 dema ( ! l>ynx1 is att5d$ ) great swell+ ( ! muc\s membrane1 f s]\s effusion into ! submuc\s tissues1 & frequ5tly att5ds *ronic inflammation ( ! p>ts1 ) ulc]ation4 ,x may1 h[ev]1 be ( an erysipelat\s "*1 occurr+ z ! result ( exposure to infection4 ,! surface appe>s r$1 pulpy & swoll51 f infiltration ( ! submuc\s tissue4 dema ( ! l>ynx1 is conf9$ to ! p>ts ar\nd ! epiglottis1 & m>g9s ( ! glottis1 nev] desc5d+ bel[ ! true vocal cords1 ow+ to ! close adhesion ( ! muc\s membrane to ! fibr\s /ructure ( ! cord1 )\t any int]v5+ areol> tissue4 ,necrosis ( ! ,c>tilages ( ! l>ynx1 may occur 9 ! advanc$ /age ( l>yngitis ) ulc]ation4 ,9 ?is mann] ! epiglottis1 ) ! aryt5oid1 ! cricoid1 & ev5 ?yroid c>tilages may1 to a great] or less ext5t1 be de/roy$4 ,abscesses may also =m1 :]e ! c>tilages are s mu* involv$1 ^! 9 "s cases break+ ^u ! outside1 & e/abli%+ fi/ul\s communications ?r\gh :i* air may escape dur+ respiration4 ,tumors ( ! l>ynx1 may be f\nd fir/1 outside ( ! cavity1 imb$d$ 9 "s portion ( its tissues2 & may include ency/$1 fatty or fibr\s tumors2 or1 second1 !y may be f\nd 9 ! int]ior1 spr++ f ! muc\s membrane1 & resembl+ polypi 9 _! =m & /ructure4 ,!y are sometimes granul> or caulifl[]-l 9 appe>ance1 & v>y 9 size f a pea to a hazel-nut4 ,false ,membranes may be f\nd 9 ! l>ynx & tra*ea 9 fatal cases ( cr\p or diph!ria4 ,9 cr\p1 ! membrane adh]es b slightly to ! muc\s /ructure b5ea?1 :i* w be f\nd r$ & conge/$1 b may =m a complete tubul> l9+ to bo? l>ynx & tra*ea1 ext5d+ also into ! bron*ial tubes4#g ,x is usually t\gh] 9 ! l>ynx & upp] portion ( ! tra*ea1 becom+ s(t] & m gelat9\s 9 ! l[] portion ( ! tra*ea & bron*ial tubes4 ,mu* diff]5ce ( op9ion has be5 ent]ta9$ z to ! nature ( ?is sub/ance4 ,x may1 h[ev]1 be consid]$ z a morbid secretion f ! inflam$ muc\s surfaces1 9 a semi-fluid =m1 :i*1 9 consequ5ce ( ! pres5ce ( album9\s matt]1 coagulates ^u exposure to air4 ,! false membrane ( cr\p may g5]ally be di/+ui%$ f t ( diph!ria by ! fact1 ,fir/1 ,t ! latt] is usually conf9$ to ! fauces1 sometimes ext5d+ to ! l>ynx1 r>ely to ! tra*ea4 ,second1 ,t diph!ritic membrane occurs m 9 pat*es1 is t\gh]1 is m directly incorporat$ ) ! muc\s surface b5ea?1 & is remov$ ) m difficulty4 ,?ird1 ,a microscopic exam9ation %[s ! membrane to be compos$ ma9ly ( fibr9e 9 a fibrillat$ condition1 ) granul> corpuscles & pus cells4 ,section ,,iii4 ,,( ,,! ,,ph>ynx ,,& ,,sophagus4 ,notice 9 exam9ation3 displacem5ts2 _! cause1 z by tumors1 etc42 dilatation2 contraction or /ricture1 seat (2 calibre at /ricture2 above1 bel[2 condition ( muc\s membrane2 ulc]s1 etc4 ,cont5ts ( sophagus2 food1 =eign bodies1 w\nds4 ,^! p>ts are liable to inflammation1 ulc]ation1 /ricture1 dilatation & new gr[?s4 ,inflammation ( ^! passages1 r>ely occurs1 except z ! result ( me*anical injury1 z f ! lodgm5t ( a =eign body1 or f swall[+ "s cau/ic or highly irritat+ sub/ance4 ,cat>rhal or cr\p\s inflammation ( ! m\? & tonsils1 may1 h[ev]1 involve a portion ( ! walls ( ! ph>ynx4 ,ulc]ation may result f ! same causes1 & h5ce may be conf9$ to a small portion or may involve ! great] "p ( ! tube4 ,/ricture ( ! sophagus may be ei!r spasmodic or organic4 ,! =m] usually occurs 9 hy/]ical wom51 & may result f ! irritation foll[+ ! removal ( "s =eign body lodg$ 9 ! canal4 ,nev] prov+ fatal ( itself1 we seldom h ! opportunity ( exam9+ a case ( ?is k9d4 ,organic /ricture is f\nd usually at ! comm5cem5t ( ! canal1 sometimes at its l[] end4 ,x may result f contractions att5d+ ! heal+ ( an ulc]1 b is m frequ5tly induc$ by a canc]\s affection ( ! walls1 or by ! projection ( "s morbid gr[? into its int]ior1 z f aneurism ( ! aorta1 or tumors1 abscesses1 c41 9 ! lungs or left lobe ( ! liv]4 ,dilatation ( ! sophagus may result f ! pres5ce ( /ricture4 ,:5 ! latt] is ne> ! c>diac orifice ( ! /oma*1 ! entire l5g? ( ! tube may be involv$4 ,! walls 9 ^! cases may be ei!r ?ick5$ or ?9n$4 ,f ! accumulation ( food above ! po9t ( /ricture1 ! walls gradually yield to ! di/5d+ =ce1 until a degree ( dilatation is atta9$ t is q rem>kable4 ,tumors ( v>i\s k9ds are occasionally f\nd )9 ! walls ( ! ph>ynx or sophagus includ+ cy/ic1 fatty & fibr9\s tumors ( a polypoid =m4 ,malignant or canc]\s gr[?s may appe> 9 any "p ( ! tube1 ! epi!lial =m be+ m common4 ,beg9n+ 9 ! submuc\s tissue1 ! disease w soon involve ! :ole circumf]5ce ( ! tube1 to ! ext5t ( f "o to ?ree or f\r in*es1 produc+ a h>dness ( ! tissues ) m or less contraction4 ,ulc]ation ultimately tak+ place1 a dilat$ cavity may take ! place ( ! orig9al /ricture4 ,section ,,iv4 ,,( ,,! ,,p]ic>dium4 ,notice3 #a4 ,ext]nal *>act]s--%ape2 measurem5t2 am\nt ( fat1 etc4 #b4 ,cont5ts--s]um2 quantity2 color2 h[ affect$ by heat2 blood2 quantity2 "*2 s\rce4 #c4 ,int]nal surface--adhesions2 _! position1 ext5t & "*2 z firm1 s(t1 etc4 ,! p]ic>dium is subject to ! same affections z o!r s]\s membranes1 includ+ inflammation1 adhesions1 effusions or morbid gr[?s4 ,inflammation ( ! p]ic>dium or p]ic>ditis1 is *>act]iz$ by an unusual dryness ( ! surface1 ) injection ( ! vessels 9 ! e>ly /age1 :ile at a lat] p]iod a lay] ( pla/ic lymph w be f\nd adh]+ to ! surfaces4 ,! deposit may be limit$ to "s small portion1 or be di/ribut$ ov] ! :ole inn] surface ( ! membrane & ^u ! ext]ior ( ! he>t1 giv+ !m ! appe>ance ( hav+ be5 sme>$ ov] ) "s /icky sub/ance4 ,(t5 ! surfaces are r\gh or vill\s 9 appe>ance1 l ! muc\s membranes ( ! inte/9es4 ,irregul> calc>e\s pat*es are sometimes f\nd 9 old *ronic cases1 develop$ )9 ! ?ick5$ portions ( ! membrane4 ,adhesions may also =m betwe5 ! surfaces 9 contact4 ,! :ole cavity may 9 ?is mann] become oblit]at$1 or b&s ( adhesion may be f\nd "h & !re4 ,effusions may be f\nd 9 ! p]ic>dium1 z 9 o!r s]\s cavities4 ,:5 ! result ( p]ic>ditis1 ! fluid w (t5 conta9 float+ %r$s ( lymph4 ,sometimes ! fluid w be f\nd highly album9\s1 & aga9 bloody or mix$ ) pus4 ,?is effusion may h tak5 place s e>ly z to h prev5t$ any adhesion ( p>ts2 or x may n h comm5c$ until union _h tak5 place at c]ta9 p>ts1 :51 f ! di/5sion ( ! sac1 ^! b&s may be f\nd greatly elongat$1 & /ret*+ across ! cavity 9 v>i\s directions4 ,:5 ! effusion is b "p ( a g5]al dropsy1 x w be cle>1 :ile ! surfaces ( ! membrane w be smoo? & de/itute ( evid5ces ( inflammation4 ,9 quantity1 ! fluid f\nd 9 ^! cases may v>y f a few ounces to a p9t or m4 ,blood may sometimes be f\nd fill+ ! p]ic>dium1 ei!r f a w\nd ( its walls1 rupture ( ! he>t1 or f ! bur/+ ( an aneurism4 ,9 scurvy1 purpura1 etc41 small pat*es ( extravasat$ blood may be f\nd 9 its walls4 ,morbid ,gr[?s4 ,! m common ( ^!1 f\nd 9 connection ) ! p]ic>dium1 are canc]s4 ,!y are usually second>y 9 _! appe>ance1 & g5]ally w h fir/ develop$ 9 ! m$ia/9um4 ,fibr\s or cy/ic tumors h be5 notic$ 9 a few r>e cases1 :ile tub]cles ( ! mili>y =m1 are n uncommon )9 ?is membrane4 ,section ,v4 ,,( ,,! ,,he>t4 ,notice3 #a4 ,9 situ--exact position & relation to surr\nd+ organs2 %ape2 size2 degree ( firmness or flabb9ess4 #b4 ,aft] removal--am\nt & k9d ( blood dis*>g$ f divid$ vessels2 %ape ( he>t2 r\nd or elongat$2 apex =m$ by :i* v5tricle2 am\nt ( fat on surface2 relative size ( ea* cavity4 #c4 ,"r auricle--"* & quantity ( blood conta9$2 fibr9\s clot4 ,l9+ membrane2 g5]al condition (2 =am5 ovale2 op5 or clos$2 ?ickness1 consi/5ce1 etc41 ( muscul> walls4 ,auriculo-v5tricul> op5+2 its %ape2 e/imate ( size by introduc+ f+]s2 r\gh or smoo?2 fibr\s or calc>e\s deposits2 circumf]5ce4 #d4 ,"r v5tricle--nature & quantity ( cont5ts2 fluid blood2 blood clot2 fibr9\s clot2 size2 atta*m5ts ( same to muscul> columns2 firm or s(t2 size ( cavity2 ?ickness & condition ( muscul> walls2 color1 firmness1 etc4 #e4 ,tricuspid valves--natural1 ?ick5$1 ?9n$ or contract$2 granulations2 pat*es ( calc>e\s matt]2 degree ( flexibility2 c !y close ! op5+8 ,condition ( *ord t5d9e2 l5g?1 ?ickness1 flexibility1 rupture1 etc4 #f4 ,pulmon>y op5+--size & %ape2 smoo? or r\gh4 ,semilun> valves2 ?9 & smoo?1 or ?ick1 r\gh & inflexible2 p[] ( clos+ ! op5+2 w wat] pass ?r\gh :5 p\r$ 9 f above8 #g4 ,left side ( he>t--obs]ve same z on "r4 #h4 ,g5]alities--weight aft] removal ( blood2 w\nds2 morbid gr[?s2 abscesses2 mal=mations2 aneurism2 rupture1 etc4 ,! sev]al morbid conditions ( ! he>t may be classifi$ z foll[s3 #a4 ,inflammation ( muscul> walls4 ,c>ditis4 ( s]\s membranes4 ,p]ic>ditis4 ,endoc>ditis4 #b4 ,diseases ( valves4 ,?ick5+4 ,ossification4 ,atrophy4 #c4 ,*anges 9 ! walls ( ! he>t1 ,hyp]trophy4 influ5c+ ! size ( ! cavities4 ,dilation4 ,atrophy4 #d4 ,morbid conditions ( ! walls alone4 ,fatty deg5]ation4 ,morbid gr[?s4 ,ossification ( coron>y art]ies4 ,mal=mations4 ,abscess4 ,aneurism4 ,rupture4 #e4 ,displacem5ts4 ,cong5ital4 ,ectopia cordis4 ,pa?ological4 ,transposition4 #f4 ,cont5ts ( cavities4 ,he>t clots4 #a4 ,inflammatory ,affections4 ,c>ditis4 ,inflammation ( ! muscul> sub/ance ( ! he>t is by no means a common disease1 & :5 pres5t1 is probably always associat$ ei!r ) endoc>ditis1 or m frequ5tly p]ic>ditis4 ,we may recognize ?is condition aft] dea?1 by ! light yell[ color ( ! he>t2 ) a relax$1 flabby1 & 9 "s in/ances a s(t5$ condition ( ! walls4 ,^u cutt+ into ! muscul> walls1 !re w be f\nd exud+ a semi-purul5t fluid & (t5 small cavities1 v>y+ 9 size f a p9's head to a small pea1 w be f\nd fill$ ) pus4 ,?is condition may involve ! :ole he>t1 or may be conf9$ to "o or m portions4 ,inflammation ( ! muscul> sub/ance ( ! he>t1 may1 und\bt$ly1 be "o ( ! prim>y causes lead+ to aneurism or ev5 to rupture4 ,! symptoms ( ?is disease are n readily recogniz$ dur+ life1 be+ always comb9$ ) inflammation ( ! p]i- or endoc>dium4 ,p]ic>ditis4 ,affections ( ! p]ic>dium h be5 notic$ 9 ! previ\s section4 ,endoc>ditis4 ,inflammation ( ! l9+ membrane ( ! he>t 7endoc>dium7 mo/ frequ5tly occurs 9 connection ) an attack ( articul> rheumatism4 ,x may1 h[ev]1 result f bl[s or injuries ( ! *e/1 & has be5 induc$ by viol5t muscul> ef=ts4 ,x is said also1 to be (t5 connect$ ) "s vitiat$ condition ( ! blood1 z 9 pymia or ,bright's disease ( ! kidneys1 & has be5 notic$ also 9 cases ( measles1 typhus & pu]p]al fev]4 ,endoc>ditis m frequ5tly attacks ! left1 ?an ! "r side ( ! he>t4 ,! anatomical appe>ances1 are a loss ( smoo?ness & transp>5cy ( ! membrane1 ) an inject$ condition ( its vessels4 ,deposits ( lymph may be f\nd adh]+ to ! free surface at v>i\s po9ts1 or to ! t5d9\s cords or valves1 giv+ a r\gh5$1 or ev5 w>ty appe>ance to all ^? p>ts4 ,^! may become deta*$1 & swept on ) ! blood1 & f9ally lodg+ 9 "s ( ! art]ies ( ! head or extremities1 :]e !y are kn[n z emboli1 !y may become a s\rce ( s]i\s tr\ble4 ,! inflammation may ext5d to ! muscul> /ructure1 result+ 9 s(t5+ or ! =mation ( purul5t cy/s4 ,x is1 h[ev]1 ^u ^? folds ( ! l9+ membrane con/itut+ ! valves1 & p>ticul>ly ^u ! left side ( ! he>t1 t ! effects ( endoc>dial inflammations are especially manife/$4 ,9 ?is way orig9ates mo/ ( ! s-call$ #b4 ,valvul> ,affections ( ! ,he>t4 ,"o ( ! mo/ common ( ! results ( inflammation ext5d+ to ! valves1 is ,?ick5+4 ,?is may dep5d ei!r ^u a deposit ( lymph b5ea? or betwe5 ! lay]s ( membrane con/itut+ ! valves1 ?us r5d]+ !m ?ick & inflexible :ile ! surface is left smoo?1 or1 at ! same "t1 a deposit ^u ! ext]ior may be f\nd1 r5d]+ !m r\gh & ev5 w>ty 9 appe>ance1 & s /iff5$ & irregul> ^u _! bord]s z to greatly int]f]e ) ! p]=mance ( _! functions1 & ?us p]mitt+ regurgitation to take place at ! imp]fectly clos$ op5+4#h ,! t5d9\s cords1 at ! same "t1 may be f\nd ?ick5$1 h>d5$1 & contract$1 or ev5 ruptur$1 :ile ! auriculo-v5tricul> op5+s may also be f\nd greatly contract$ f ! ?ick5+ ( ! base ( ! valves & ! fibr\s tissues =m+ ! bord]s ( ! op5+s4 ,9 "o case ! contraction on ! left side ( ! he>t 0 s great z sc>cely to admit ! little f+]1 :ile ! ?umb %\ld readily pass t op5+4 ,! semilun> valves ( ! aorta are liable to ! same *anges1 _! ?ick5$ condition prev5t+ _! fold+ back completely into ! s9uses ( ! art]y dur+ ! sy/olic action ( ! he>t1 or ( completely clos+ ! vessel ^u pressure f above4 ,calcification4 ,?is condition ( ! valves may result f a progressive *ange f simple ?ick5+ ) fibr9\s deposits1 to a c>tilag9\s /ate1 accompani$ ) s-call$ bony1 or m prop]ly calc>e\s pat*es1 :i* may involve l>ge portions ( ! valves4 ,ossification ( ! valves ^u ! "r side ( ! he>t1 is b r>ely f\nd2 ^u ! left1 bo? ! mitral & aortic valves are liable to ?is affection4 ,atrophy4 ,! aortic1 pulmon>y1 & sometimes mitral valves1 are occasionally f\nd greatly ?9n$2 & ?is condition may result ei!r 9 a gradual /ret*+ ( ! c5tral portion ( ! valve f pressure ( ! blood1 giv+ rise to aneurism ( ! valves1 or1 x may become p]=at$ ) small irregul> op5+s1 or1 f its weak5$ condition1 rupture may take place1 produc+ sudd5 dea?4 ,?is condition appe>s to consi/ 9 a gradual we>+ away ( ! sub/ance ( ! valves1 f unusual brittl5ess ( _! /ructure1 ! result probably ( *ronic inflammation4 ,aga91 ! valves may be f\nd greatly contract$1 7/5osis7 h>d & rigid1 :i* w be att5d$ ) imp]fect closure & consequ5t regurgitation4 ,dilatation ( ! orifices )\t any *ange 9 ! valves1 may also be f\nd1 result+ 9 ! same imp]fect closure4 ,disease ( ! valves ( ! he>t1 by ob/ruct+ ! orifices1 is likely to result 9 #c4 ,*anges ,affect+ ! ,size ( ! ,cavities4 ,hyp]trophy4 ,hyp]trophy ( ! he>t1 is a condition 9 :i* !re is an increas$ ?ickness ( its walls1 & g5]ally also enl>gem5t ( its cavities4 ,yet !re may be ?ick5+--v r>ely h[ev]--) a dim9ution 9 ! size ( ! cavities4 ,x may affect bo? sides ( ! he>t1 b is frequ5tly conf9$ to ! left v5tricle4 ,! ma9 cause ( hyp]trophy ( ! he>t1 is ! exi/5ce ( "s ob/ruction to ! circulation1 ei!r 9 ! he>t1 or "s portion ( ! art]ial sy/em1 z by aneurism1 pressure ( tumors1 etc41 or by disease ( ! kidneys4 ,x is mo/ frequ5tly1 h[ev]1 associat$ ) disease ( ! valves or l>ge art]ies4 ,x may sometimes result f cont9u$ functional excitem5t1 & g5]ally accompanies cases ( p>tial adhesion ( ! surfaces ( ! p]ic>dium1 :ile complete adhesion is m likely to be foll[$ by dilatation or atrophy4 ,on ! "r side ( ! he>t1 hyp]trophy is usually ! result ( "s ob/ruction to ! circulation ?r\gh ! lungs1 z 9 an emphysemat\s condition ( t organ4 ,! foll[+ measurem5ts1 c41 ( ! normal he>t1 w s]ve z a guide 9 judg+ ( cases ( enl>gem5t3 ,size4 ,lnnec has /at$1 t ! he>t 9 its normal condition1 is ab\t ! size ( ! clos$ fi/ ( ! individual4 ,?is comp>ison1 h[ev]1 is n v satisfactory4 ,x w be usually f\nd to measure ab\t #e in*es 9 l5g?1 #c 9 its greate/ wid?1 & #b 9 its extreme ?ickness1 f its ant]ior to its po/]ior surface4 ,weight4 ,f an exam9ation ( f\r hundr$ cases1 ! av]age weight 0 f\nd to be #i ounces 9 ! male1 & #h ounces 9 ! female4 ,9 a robu/1 muscul> male1 ! he>t may1 h[ev]1 be f\nd to weigh z mu* z #ab ounces1 & /ill be normal 9 all its p>ts4 ,?ickness ( ,walls4 ,"r auricle1 #a l9e2 left1 #a l9es4 ,"r v5tricle1 #a l9es1 & left1 a little ov] #e l9es1 or half an in*1 at its middle1 be+ a little ?9n] bo? at ! base & apex4 ,size ( ,orifices4 ,circumf]5ce ( auriculo-v5tricul> op5+ ( ! "r side1 ne>ly #d in*es2 ( left side1 #c in*es2 ( ! pulmon>y art]y1 #b in*es2 ( aorta1 #b in*es4 ,:5 enl>g$1 ! he>t may be f\nd measur+ #f to #g in*es 9 l5g?1 z mu* 9 bread?1 & #ab to #af in*es 9 circumf]5ce4 ,! weight may also be increas$ to #ae1 #bj or #be ounces1 & ! walls may increase 9 ?ickness to ne>ly a-half in*1 & ^u ! left to ov] an in*4 ,hyp]trophy ( ! he>t1 has be5 divid$ into ?ree =ms3--#a/1 simple hyp]trophy2 #b;d1 ecc5tric2 & #c;d1 conc5tric hyp]trophy4 ,9 ! fir/ =m1 ! walls are ?ick5$1 :ile ! cavities rema9 un*ang$4 7,simple hyp]trophy47 ,9 ! second =m1 ! ?ick5+ ( ! walls is att5d$ ) an enl>gem5t or dilatation ( ! cavities4 7,ecc5tric hyp]trophy4#i7 ,9 ! ?ird =m1 ! ?ick5+ is att5d$ ) a dim9ution 9 ! capacity ( ! cavities4 7,conc5tric hyp]trophy47 ,x has be5 obs]v$ 9 cases :]e an exam9ation has be5 made v soon aft] a sudd51 viol5t dea?1 att5d$ ) loss ( blood1 z 9 decapitation1 etc41 t ! cavities h be5 ne>ly oblit]at$1 :ile ! walls 7 greatly ?ick5$4 ,by mac]ation = a few days1 ! v5tricles h become relax$ to _! natural size & capacity4 ,?is /ate ( ! he>t has be5 obs]v$ 9 p]sons 9 :om1 dur+ life1 none ( ! symptoms ( disease ( ! he>t _h be5 manife/$1 & h5ce ! condition is to be consid]$ z ! imm$iate effect ( ! peculi> "* ( ! cause ( dea?4 ,dilatation4 ,dilatation ( ! cavities ( ! he>t1 is a condition :i* may also result f ! pres5ce ( ob/acles or imp$im5ts to ! circulation1 z f ossification ( ! valves2 n>r[+ ( ! pulmon>y or aortic orifices2 employm5ts requir+ p[]ful muscul> ef=ts2 & 9 consolidation1 tub]cul> induration1 emphysemat\s condition ( ! lungs1 or fatty deg5]ation4 ,! muscul> sub/ance is usually s(t & flaccid1 sometimes ( a violet color1 aga9 pale & yell[i%4 ,! ?9n+ may be s great1 z to r$uce ! ?icke/ "p ( ! left v5tricle to two l9es or ev5 less1 :5 ! walls w appe> to be compos$ ( b little m ?an a ?9 lay] ( fat cov]$ ) ! p]ic>dium4 ,?ree =ms ( dilatation are recogniz$3 active1 simple & passive4 ,active dilatation is associat$ ) hyp]trophy ( walls1 con/itut+ ecc5tric hyp]trophy4 ,9 simple hyp]trophy1 ! walls reta9 _! normal ?ickness1 :ile ! %ape may be *ang$ accord+ to ! cavity affect$4 ,passive dilatation1 on ! o!r h&1 is accompani$ ) ?9n+ ( ! walls1 & usually results f fatty deg5]ation1 atrophy1 or "s o!r *ange 9 ! muscul> fibre4 ,atrophy4 ,9 ?is condition !re is a uni=m decrease 9 ! size ( ! he>t4 ,its cavities becomes small1 & its walls ?94 ,x usually att5ds diseases accompani$ ) great impov]i%m5t ( ! blood1 z 9 canc]1 diabetes1 etc41 or may result f ob/ruction ( ! coron>y art]ies f calcification1 a!roma or ?rombi4 ,paget m5tions a case :]e ! he>t ( a canc]\s man1 fifty ye>s old1 weigh$ only five ounces1 f\r dra*ms2 & t ( a diabetic woman1 :i* weigh$ only five ounces1 "o dra*m4 ,x is usually accompani$ ) a g5]al wa/+ ( ! tissues & organs ( ! body1 & frequ5tly w be f\nd associat$ ) fatty deg5]ation1 :i* w n[ be notic$4 #d4 ,morbid ,condition ( ! ,walls ,alone4 ,fatty ,deg5]ation4 ,two =ms ( fatty diseases ( ! he>t h be5 recogniz$4 ,9 ! fir/1 :i* %\ld be kn[n z 8fatty gr[?10 to di/+ui% f 8fatty deg5]ation10 !re is an unusual quantity ( adipose matt] 9 ^? p>ts ( ! he>t :]e m or less is usually f\nd1 viz43--,along ! furr[s ?r\gh :i* ! vessels run1 & p>ticul>ly ab\t ! base ( ! he>t4 ,! fatty masses may dip m or less into ! sub/ance ( ! walls1 displac+ ! muscul> fibres1 al?\gh ! latt] are g5]ally normal 9 color & d5sity1 ev5 :5 imb$d$ 9 masses ( fat4 ,?is condition may be f\nd 9 p]sons :o are o!rwise ?91 z well z 9 ! obese4 ,b ! m frequ5t =m ( fatty disease1 is t kn[n z fatty deg5]ation4 ,9 ?is1 we f9d ^u op5+ ! he>t1 t x has lo/ ! r$di%-br[n color *>act]i/ic ( ! muscul> fibre 9 its normal condition1 & is pale1 s(t & flabby4 ,! :ole organ feels s(t1 d\ghy & inela/ic1 mu* l a he>t beg9n+ to decompose4 ,if ! wall ( ! left v5tricle be p>tly cut ?r\gh1 ! rema9d] is easily torn1 & ! surfaces h a granulat$ appe>ance4 ,^u ! inn] surface1 b5ea? ! endoc>dium1 num]\s small ?ickly set spots1 or sometimes wavy l9es1 ( a pale buff1 or light yell[ color1 may be notic$4 ,?is appe>ance does n dep5d ^u a deposit ( fat among ! muscul> fibres1 b r ^u a *ange 9 t tissue2 & an exam9ation ) ! microscope1 w %[ fatty deg5]ation ( ! fibre4 ,?is condition ( ! he>t1 may involve ! :ole organ1 or may be conf9$ to "o or m portions4 ,x is mu* less common 9 ! auricles1 ?an 9 ! v5tricles1 & m frequ5t 9 ! left v5tricle ?an 9 ! "r4 ,x w be g5]ally f\nd m advanc$ 9 ! upp] portion ( ! septum ( ! v5tricles1 & 9 ! l>ge1 fle%y columns ( ! left side2 or x may be f\nd 9 ^! columns alone1 :i* acc\nts = ! occasional rupture ( ! latt]4 ,fatty ,deg5]ation may be associat$ ) fatty gr[?1 or ) hyp]trophy1 or ?9n+ & dilatation1 & may be ! cause ( rupture4 ,! g5]al "* ( s(tness1 pal5ess1 & mottl$ color1 %\ld lead to suspicion ( ! exi/5ce ( ?is disease1 :5 a microscopic exam9ation be+ resort$ to1 ! conclusion w\ld be decisive4 ,a small portion ( fibre1 exam9$ ) a p[] ( #cjj or #djj diamet]s1 w pres5t1 9 fatty deg5]ation1 in/ead ( ! /riat$ appe>ance ( ! normal fibre1 a granul> appe>ance1 ) num]\s m9ute oil globules scatt]$ ?r\gh ! fibre4 ,9 ! pale/ "p ( ! he>t1 ! disease w be g5]ally mo/ advanc$2 b ev5 "h1 ! microscope w %[ "s fibres 9 a heal?y condition1 :ile o!rs ar\nd !m are r5d]$ completely granul>4 ,exhau/+ diseases ( v>i\s k9ds1 typhus & o!r sev]e fev]s1 phosphorus poison+1 etc41 may result 9 ?is peculi> condition ( ! he>t4 #e4 ,morbid ,gr[?s4 ,"u ?is head may be plac$ tumors1 canc]s1 melanosis1 & hydatids4 ,tumors ( v>i\s k9ds are occasionally f\nd 9 connection ) ! he>t4 ,fibr\s tumors ( a small size may develop )9 ! muscul> walls1 :ile syphilitic gr[?s1 cy/s1 & tub]cul> deposits may also1 9 r>e cases1 be discov]$4 ,canc]4 ,canc] ( ! he>t has be5 notic$ 9 two =ms--epi!lial & m$ull>y4 ,a man1 fifty-eight ye>s old1 _h an epi!lial canc] ( ! eye1 :i* 0 remov$4 ,two ye>s aft]1 ! man di$ ) a l>ge canc]\s tumor ov] ! p>otid gl&4 ,a po/-mortem exam9ation reveal$ a canc]\s mass1 ab\t an in* & a-half 9 diamet]1 imb$d$ 9 ! apex ( ! "r v5tricle & septum ( ! he>t4 ,a microscopic exam9ation reveal$ its epi!lial "*4#aj ,m$ull>y canc] ( ! he>t has be5 usually f\nd associat$ ) ! same disease 9 ! lungs & liv]1 & =ms an inve/+ mass :i* may involve ! :ole organ4 ,melanosis ( ! he>t pres5ts ! same "* z 9 o!r p>ts ( ! body1 & is consid]$ b a v>iety ( ! m$ull>y canc]1 pigm5t>y matt] be+ add$4 ,x may be develop$ ^u ! surface1 or may infiltrate ! sub/ance ( ! :ole organ4 ,hydatids h be5 occasionally f\nd 9 ! he>t1 ! mo/ ( :i* h probably be5 animal 9 _! "*1 7acephalocy/s47 ,a female1 =ty ye>s old1 :o _h be5 suff]+ pa9 9 ! region ( ! he>t = "s mon?s1 sudd5ly di$1 aft] runn+ rapidly up /airs4 ,"o ounce ( fluid 0 f\nd 9 ! p]ic>dium4 ,a consid]able tumor 0 f\nd at ! apex ( ! he>t1 :i* slightly fluctuat$4 ,?is tumor 0 ab\t ?ree in*es 9 diamet]1 globul> 9 =m1 & encroa*$ consid]ably ^u ! cavity ( ! "r v5tricle4 ,:5 laid op51 x 0 f\nd to conta9 a l>ge numb] ( small cy/s or hydatids1 v>y+ 9 size f t ( a small pea to t ( a pigeon's egg1 ! space betwe5 :i* 0 fill$ ) a s(t curdlike sub/ance1 ( a yell[ color4#aa ,ossification ( ,coron>y ,art]ies4 ,t condition ( ! art]ies ( ! he>t usually t]m$ ossification is m prop]ly "o ( calcification1 consi/+ ( a deposit ( h>d1 gritty1 calc>e\s matt]1 9 :i* !re is none ( ! true "* ( real bone1 no trace ( bone-corpuscle or vascul> canals ev] be+ discov]$ 9 !m4 ,*emical analysis has %[n ! deposits to be compos$ ( #ej p>ts ( animal matt]1 ) #dg ( ! phosphate & #b ( ! c>bonate ( lime 9 e #ajj4 ,?is matt] be+ deposit$ 9 circul> lay]s1 ! art]y becomes gradually conv]t$ into a h>d1 bony-l tube1 :i* may be trac$ ) ! f+] along ! grooves ( ! he>t ?r\gh :i* ! coron>y art]y runs4 ,?is is peculi>ly a disease ( old p1 & may accompany a simil> condition ( ! ar* ( ! aorta or ( ! semilun> valves1 & by int]f]+ ) ! prop] nutrition ( ! he>t may result 9 o!r =ms ( disease1 z fatty deg5]ation1 dilatation1 c4 ,abscess4 ,abscess ( ! he>t1 may unque/ionably foll[ an attack ( c>ditis1 or inflammation ( ! muscul> sub/ance4 ,! cut surface ( ! he>t 9 ^! cases1 n unfrequ5tly %[s small cavities conta9+ a purul5t fluid1 & 9 "s in/ances a di/9ct abscess is f\nd4 ,a man1 sixty ye>s old1 0 sudd5ly attack$1 :ile at "w1 ) coma & great feebl5ess1 foll[$ by dea? on ! ?ird day4 ,! left v5tricle be+ op5$1 an abscess 0 discov]$ ne> ! apex1 irregul> 9 =m1 & conta9+ a bloody1 purul5t-look+ fluid4 ,! coron>y art]ies 7 mu* ossifi$4 ,mal=mations ( ! he>t1 are extremely r>e 9 adults1 or ev5 9 *ildr5 t h pass$ ! e>ly days ( infancy4 ,!y consi/ frequ5tly 9 arre/ ( developm5t ( ! auricul> septum1 or1 9 o!r words1 ( a patul\s =am5 ovale1 :i*1 by p]mitt+ ( a mixture ( art]ial & v5\s blood ^u ! left side ( ! he>t1 results 9 e>ly dea?4 ,i h 9 sev]al in/ances f\nd ?is =am5 imp]fectly clos$ 9 ! adult he>t1 b ! op5+ has be5 s small--b>ely suffici5t to p]mit ! passage ( a probe--z to (f] little or no ob/acle to ! prop] p]=mance to ! he>t's function4 ,mal=mation ( ! he>t is und\bt$ly "o ( ! _m causes ( dea? 9 ut]o1 :i* might be demon/rat$ by a po/-mortem exam9ation4 ,aneurism4 ,p>tial aneurism1 or false aneurism ( ! he>t1 consi/s 9 ! =mation ( a sac or p\*1 9 "s portion ( ! walls ( ! organ1 communicat+ ) ! cavity ( ! *amb]1 9 ! walls ( :i* x has be5 =m$4 ,!y may =m 9 any "p ( ! muscul> walls ( ! he>t1 b are m frequ5t 9 ! left v5tricle4 ,!y w\ld seem to result f a sep>ation ( "s ( ! muscul> fibres1 :51 by _! retraction1 a cavity or p\*1 ( a r\nd$ or oval =m results1 :i*1 9 "s in/ances1 has its walls compos$ ( ! p]ic>dium alone1 !re be+ a complete de/ruction ( ! muscul> fibres4 ,! int]ior ( ^! p\*es1 may be f\nd fill$ ) lay]s ( coagulat$ fibr9\s deposits1 z 9 ! case ( aneurism ( art]ies2 or1 if !y communicate ) ! v5tricul> cavity by a l>ge op5+1 !y may be fill$ ) a simple s(t clot ( blood4 ,! size ( ^! aneurismal p\*es1 v>y f t ( a *]ry1 to a pigeon's egg1 or l>g]1 :5 !y *ange mu* ! usual figure ( ! he>t1 by _! projection ^u ! ext]nal surface4 ,! foll[+ conditions h be5 suppos$ to favor ! =mation ( ^! aneurismal sacs3--#a/1 s(t5+ ( ! muscul> tissue ( ! he>t2 #b;d1 ulc]ation ( ! l9+ membrane2 & #c;d1 rupture ( ! muscul> fibres4 ,rupture ( ! walls ( ! he>t sometimes happ5s1 produc+ sudd5 dea?4 ,x may result f sev]e contusions ( ! *e/1 9 :i* case1 ! auricles are m likely to give way4 ,m frequ5tly1 rupture w result f s(t5+ ( ! walls 9 fatty deg5]ation or ulc]ation1 or f ! bur/+ ( an aneurism ( ! he>t1 or f /5osis ( ! aorta4 ,9 ! latt] cases1 ! left v5tricle w be usually ! seat ( ! rupture4 #f4 ,displacem5ts4 ,*anges ( ,position ( ! he>t1 are by no means unfrequ5t4 ,!y may be cong5ital 9 _! orig91 or ! result ( disease 9 ! surr\nd+ organs4 ,( cong5ital displacem5t1 we may m5tion fir/3 ,ectopia ,cordis1 :]e1 f "s arre/ ( developm5t1 9 ! inclos+ p>ts1 ! he>t may be f\nd 9 "s position o!r ?an its normal "o4 ,f defici5cy ( ! /]num & ribs1 ! he>t has be5 f\nd protrud+ f ! *e/1 7ectopia pectoralis17 or f abs5ce or defici5cy ( ! diaphragm1 x may be f\nd 9 ! abdom5 ) ! abdom9al visc]a4 ,su* cases live b a %ort "t aft] bir?4 ,transposition ( ! he>t is f\nd 9 ^? cases :]e all ! visc]a1 abdom9al & ?oracic1 are exactly rev]s$ 9 position4 ,a case ( ?is k9d 0 discov]$ 9 ! dissect+-room a few ye>s ago1 by ,dr4 ,r4 ,b4 ,weav]1 demon/rator ( anatomy1 9 ! ,hahnemann ,m$ical ,college4 ,! he>t 0 "h ^u ! "r side1 ! aorta curv+ to ! left2 ! liv] ^u ! left2 ! /oma* ) its pylorus to ! left2 ! colon comm5c+ 9 ! left iliac fossa2 9 %ort1 ev]y?+ completely rev]s$ 9 position4 ,! subject 0 a female ( ab\t ?irty ye>s1 & und\bt$ly suff]$ no inconv5i5ce f ! abnormal positions4 ,! m frequ5t displacem5ts ( ! he>t1 h[ev]1 are ^? result+ f disease 9 ! surr\nd+ /ructures4 ,x may be cr[d$ f its normal position1 by pleuritic effusions1 accumulations ( air 7pneumo?orax71 or ev5 by a highly emphysemat\s lung4 ,displacem5ts may also result f ! pres5ce ( aneurismal or o!r tumors 9 ! *e/2 curvatures ( ! sp9e2 or f a h]nial protrusion ( "s ( ! abdom9al visc]a ?r\gh an op5+ 9 ! diaphragm2 or ! pres5ce ( tumors1 enl>g$ visc]a1 dropsies1 etc41 )9 ! abdom54 #g4 ,cont5ts ( ! ,cavities4 ,he>t ,clots4 ,?is subject is "o t has until rec5tly1 be5 b imp]fectly und]/ood2 & n[ ev51 our k relat+ to x1 is by no means complete4 ,en\gh is kn[n1 h[ev]1 to conv9ce u t he>t clots1 are a m frequ5t cause ( sudd5 dea?1 ?an has be5 h]et(ore suppos$4 ,hav+ 9 a rec5t pap]1 read be=e ! ,philadelphia ,c\nty ,homopa?ic ,m$ical ,society1 q fully treat$ ( ?is subject1 ,i %all "h m]ely transcribe ! lead+ po9ts ( ! same4#ab ,fibr9\s he>t clots1 polypus ( ! he>t1 or fatty deposits1 z !y are sometimes call$1 diff] f ord9>y clots ( blood1 9 ! abs5ce ( ! blood corpuscles1 & h5ce1 pres5t+ ! buff color *>act]i/ic ( ! coagulat$ fibr9 ( ! blood4 ,ord9>y blood clots1 ) ! corpuscles entangl$ ) ! fibr9--& h5ce pres5t+ ! r$ color ( blood--are usually f\nd 9 ! cavities ( ! he>t & l>ge blood-vessels aft] dea?1 b 9 great] quantity ^u ! "r side4 ,color4 ,! %ade ( color pres5t$ by ! fibr9\s clot v>ies 9 diff]5t cases4 ,:ile buff is ! prevail+ color1 ! %ade v>ies f a light drab to a decid$ yell[4 ,consi/5cy4 ,9 ?is respect a good deal ( v>iation is also f\nd2 ! diff]5ce dep5d+1 probably1 9 "p ^u ! "* ( ! disease1 & 9 "p ^u ! rapidity or sl[ness ( ! =mation2 ^? ( a rapid or v rec5t =mation1 hav+ a s(t1 fatty1 or jelly-l "*2#ac :ile1 on ! o!r h&1 ^? ( a m gradual =mation1 & ) m /h5ic =ms ( disease1 acquire a consid]able degree ( d5sity1 ! surface pres5t+ a smoo? appe>ance1 z if act$ ^u by a curr5t ( blood1 & 9 all respects resembl+ ! d5se fibr9\s masses1 f\nd block+ up ! cavities ( aneurismal tumors4 ,position4 ,9 e case report$ bel[1 ! clot has be5 on ! "r side ( ! he>t1 al?\gh 9 "s1 a small1 s(t clot has be5 f\nd on ! left4 ,i am n sure t ,i h ev] f\nd "o ( ^! clots on ! left side ( ! he>t ( su* a size & consi/5cy1 or "u su* circum/ances1 z to h l$ me to suppose t x might h be5 a cause ( dea?4 ,! body ( ! clot is usually f\nd 9 ! v5tricle1 ext5d+ f ?is1 ei!r up into ! pulmon>y art]y1 or ?r\gh ! op5+ into ! auricle4 ,9 all cases1 ! clot has be5 m or less entangl$ ) ! t5d9\s cords ( ! valves & muscul> columns ( ! he>t1 requir+1 9 "s in/ances1 consid]able =ce to te> x away f its atta*m5ts4 ,"t ( =mation4 ,an important "q to be decid$ 9 reg>d to ^! he>t clots1 is ! "t ( _! =mation4 ,are !y ante or po/-mortem 9 _! orig98 ,& ^u ! solution ( ?is qu]y dep5ds ! conclusion z to :e!r !y are ! cause or ! result ( dea? 9 ! cases :]e f\nd4 ,t a fibr9\s clot may sometimes be =m$ 9 ! coagulation ( ! blood outside ( ! body1 is a fact well kn[n2 z 9 ! blood drawn f pati5ts suff]+ f acute inflammatory affections1 :]e1 f ! ret>d+ ( ! coagulation1 ! blood corpuscles1 f _! great] specific gravity1 h "t to fall t[>ds ! bottom ( ! vessel1 ?us giv+ ! 8buffy coat0 to ! upp] portion ( ! clot4 ,! same cause--ret>d$ coagulation--unque/ionably may give rise to a clot 9 ! he>t aft] dea?1 pres5t+ ! same "*1 viz41 ) ! upp] portion1 ( ! buff1 fibr9\s "*1 :ile ! l[] portion1 f ! pres5ce ( corpuscles1 w pres5t ! appe>ance ( an ord9>y blood clot4 ,su* clots are n unfrequ5tly f\nd aft] dea?4 ,b h we any evid5ce t ! fibr9 ( ! blood may be deposit$1 =m+ clots )9 ! vessels dur+ life8 ,9 pro( ( ?is1 we h only to ref] to ! result ( ! application ( a ligature to an art]y2 :]e ! int]val betwe5 ! po9t ( application & ! fir/ vessel com+ (f above1 w be fill$ ) a fibr9\s clot1 :i* p]=ms an important "p 9 ! clos+ up ( ! vessel2 or1 to ! well-kn[n deposits ( fibr9\s lay]s )9 aneurismal tumors1 suffici5t1 9 _m cases1 to s fill up ! sac z to result 9 a cure2 !re=e1 ! favor+ conditions be+ pres5t1 x is n unreasonable to claim t fibr9\s clots may =m )9 ! he>t1 ( su* size & 9 su* positions z to be an imm$iate cause ( dea?4 ,causes4 ,9 look+ = ! causes1 or conditions promot+ ! =mation ( ^! fibr9\s deposits1 we h to consid]1 fir/1 v>iations 9 ! "* ( ! blood itself2 & secondly1 peculi>ities 9 its circulation & 9 ! circulatory app>atus4 ,fibr91 "o ( ! normal con/itu5ts ( ! blood1 is e/imat$ by physiologi/s z =m+ f #b to #c p>ts 9 #ajjj1 :ile x may fall z l[ z #a1 or rise to #g p>ts4 ,we f9d x r$uc$ to ! m9imum quantity 9 all diseases :i* pres5t a hmorrhagic t5d5cy1 z 9 true typhus1 yell[ fev]1 c]ta9 malignant =ms ( disease1 & z ! effect ( _m poisons1 bo? animal & vegetable4 ,9 ^! cases1 ! loss ( fibr9 results 9 ! effusion ( blood into ! tissues1 produc+ pete*ial spots1 or ^u ! muc\s surfaces1 giv+ rise to epi/axis1 black vomit1 hmaturia1 etc41 :ile v feeble1 if any1 coagulation ( ! blood w be f\nd aft] dea?4 ,9 scurvy1 h[ev]1 :]e we h a condition ( ! blood n unlike t above ref]r$ to1 !re appe>s to be a m>k$ t5d5cy to ! =mation ( clots1 z has be5 notic$ by _m obs]v]s1 & z has be5 v]ifi$ by ,dr4 ,j4 ,c4 ,morgan1 9 sev]al cases :i* came "u 8 notice :ile 9 ! army4 ,b x is 9 cases :]e !re is at lea/ a relative increase ( fibr91 t he>t clots are m liable to =m4 ,su* a condition we f9d 9 cases :]e1 :ile ! fibr9 rema9s normal 9 quantity1 ! wat] ( ! blood1 ! m5/ruum 9 :i* ! fibr9 is held 9 solution1 is bel[ ! normal /&>d1 ?is r$uction favor+ ! t5d5cy to deposit4 ,?us1 9 all cases :]e !re has be5 an exhau/+ & rapid flux f ! b[els1 z 9 *ol]a1 or excessive purg+ f dra/ic ca?>tics1 or f ! colliquative sweat+ ( ph?isis1 we h ! favor+ condition1 & dea? may be ! imm$iate result ( a fibr9\s clot 9 ! he>t4 ,! mo/ favorable condition1 h[ev]1 = ! =mation ( he>t clots1 is und\bt$ly t 9 :i* !re is an absolute increase ( fibr91 & ?is we f9d 9 a l>ge numb] ( diseases m>k$ by acute inflammatory symptoms2 z 9 pleurisy1 pneumonia1 diph!ria1 cr\p1 acute rheumatism1 erysipelas1 pu]p]al fev]1 etc4 ,9 a l>ge numb] ( dea?s f ^! diseases1 a po/-mortem exam9ation w\ld und\bt$ly br+ to light a he>t clot1 :i* has at lea/ s]v$ to ha/51 if x has n be5 ! imm$iate cause ( ! fatal t]m9ation4 ,aga91 ! =mation ( he>t clots is evid5tly promot$ by any circum/ances or conditions1 result+ 9 great feebl5ess or languor ( ! circulation1 indep5d5t ( v>iations 9 ! am\nt ( fibr94 ,a complete /asis ( ! blood is c]ta9 to be foll[$ by coagulation2 z 9 employm5t ( pressure 9 ! treatm5t ( aneurism2 s 9 cases ( great pro/ration ( ! p[]s ( life1 att5d$ ) extreme feebl5ess ( ! circulation1 z #a/4 ,9 cases ( %ock1 :]e life is n imm$iately de/roy$2 #b;d4 ,9 c]ta9 cases ( poison+1 z by opium1 :]e ! action ( ! he>t is greatly depress$2 & #c;d4 ,9 syncope1 ei!r ) or )\t loss ( blood4 ,9 all ( ^! cases ! dang] ( ! =mation ( ! he>t clot is v great1 & probably 9 a l>ge numb] ?is is ! imm$iate cause ( dea?4 ,x is a fact well e/abli%$1 t loss ( blood1 ei!r by hmorrhages or v5esection1 is foll[$ by an increas$ coagulability ( t fluid2 h5ce1 ! fe>ful hmorrhages :i* sometimes att5d p>turition1 if accompani$ ) syncope1 are 9 great dang] ( be+ foll[$ by ! =mation ( ! he>t clot1 & ?us end+ 9 dea?4#ad ,ano!r circum/ance t5d+ to promote ! =mation ( fibr9\s clots 9 ! he>t1 is evid5tly to be f\nd 9 ! peculi> =mation ( ! valves gu>d+ ! auriculo-v5tricul> op5+s4 ,x is well kn[n h[ fibr9 may be collect$ f fre% blood1 by beat+ ! same ) a bundle ( twigs1 ! latt] soon becom+ coat$ ) %r$s ( fibr92 s ! *ord t5d9e & fle%y columns ( ! he>t1 betwe5 :i* ! blood is cont9ually be+ driv51 af=ds conv5i5t po9ts = collect+ ! same f ! feebly circulat+ or ov]*>g$ blood2 & f ! close int]m+l+ ( ! t5d9\s cords1 ) ! sub/ance ( ! clot1 x is probably ^u ^! t ! deposit fir/ beg9s to =m4 ,9 explanation ( ! fact t fibr9\s clots are almo/ univ]sally f\nd on ! "r or v5\s side ( ! he>t1 not)/&+ t art]ial blood is ri*] 9 fibr9 ?an v5\s1 ! foll[+ has be5 sugge/$ to my m9d3 ,fir/4 ,:ile v5\s blood conta9s a small] proportion ( fibr91 may n its deoxydiz$ condition favor ! m ready deposit ( ?is sub/ance1 ?an by ! m highly vitaliz$ art]ial blood8 ,second4 ,! feebl] muscul> p[] ( ! "r side ( ! he>t w\ld necess>ily be att5d$ ) a sl[] circulation ?r\gh its cavities1 ! p>tial /asis ( ! blood giv+ ano!r condition favorable = ! =mation ( a clot2 & ,?ird4 ,! valves ( ! "r side ( ! he>t1 pres5t ?ree flaps or folds1 in/ead ( two z on ! left1 & h5ce1 ) _! num]\s t5d9\s cords1 (f] an increas$ numb] ( ob/ruct+ po9ts1 ar\nd :i* ! deposit may be made4 ,^! sev]al circum/ances w\ld seem suffici5t to acc\nt = ! admitt$ fact4 ,symptoms4 ,! symptoms att5d+ ! =mation ( fibr9\s clots 9 ! he>t1 are usually sudd5 9 _! accession1 frequ5tly att5d$ ) a *ill1 & m>k$ by great oppression 9 brea?+1 coldness ( surface1 & pallor ( face & lips1 ! latt] symptom di/+ui%+ f ! dyspna att5d+ cr\p1 a/hma1 pneumonia1 etc41 :]e ! face is livid f v5\s conge/ion4 ,! pulse is usually rapid & feeble2 ! action ( ! he>t labor$1 palpitat+1 & sometimes int]mitt+1 :ile auscultation w reveal a tumultu\s *urn+-l action1 ! normal s\nds be+ q undi/+ui%able4 ,pulsation ( ! jugul>s w be pres5t 9 mo/ cases1 & :]e ! clot greatly ob/ructs ! play ( ! tricuspid valves1 a d\ble pulsation w be likely to be notic$4 ,9 ! la/ /age1 a copi\s cold p]spiration appe>s ^u ! :ole surface ( ! body4 ,z might be anticipat$1 fibr9\s =mations1 :ile ( small size1 are sometimes wa%$ away f _! atta*m5ts & swept on ) ! curr5t ( blood into ! art]ies & c>ri$ to di/ant p>ts ( ! body1 z is sometimes ! case also 9 aneurism1 ?us produc+ ! embolic masses (t5 f\nd block+ up art]ies 9 diff]5t p>ts ( ! body4 ,:5 ^u ! "r side1 ! embolus w\ld be c>ri$ into ! pulmon>y art]y1 ob/ruct+ ! circulation ?r\gh ! lungs1 & produc+ symptoms m or less grave1 accord+ to ! size ( ! clot4 ,^u ! left side ( ! he>t1 f ! great] =ce ( ! circulation1 ^! bodies are probably m frequ5tly swept away f _! atta*m5ts & c>ri$ into ! aorta1 & ?us on1 p]haps1 ?r\gh ! c>otids to ! head1 or into ! subclavian1 or d[n ! aorta1 f9ally lodg+ 9 "s ( ! bran*es ( ! l[] extremities4 ,convulsions1 p>alysis1 etc41 are n unfrequ5tly produc$ by ! lodgm5t ( emboli 9 "s ( ! art]ies ( ! bra91 :ile1 :5 c>ri$ into ! art]ies ( ! extremities1 pa91 fall+ ( temp]ature1 impairm5t ( s5sation1 contraction ( muscles1 atrophy1 & ev5 gangr5e may result4 ,! foll[+ examples w s]ve to illu/rate ! class ( cases to :i* ,i ref]3 ,,case ,i4--,dea? f ,he>t ,clot 9 ,anmia4 ,a lad1 #aa ye>s old1 & v anmic1 w5t to s*ool 9 ! morn+ 9 8 usual heal?2 :ile !re 0 tak5 ) a *ill4 ,on 8 way home vomit$ freely4 ,! *ill la/$ = a long "t1 & 0 accompani$ ) an oppression 9 brea?+1 :i* gradually increas$ ?r\gh ! day & night1 & until ! "t ( my fir/ visit at #aa o'clock ,a4 ,m4 ! next day4 ,i !n f\nd him extremely pallid1 lips bloodless1 p]spir+ freely1 suff]+ f great re/lessness & di/ress1 ) extreme dyspna2 m9d w&]+1 pulse irregul> & feeble2 action ( ! he>t v tumultu\s1 ! normal s\nds be+ unrecognizable4 ,9 ! neck notic$ a rapid roll+ pulsation ( ! jugul>s1 :i* pres5t$ two beats to "o ( ! art]y at ! wri/4 ,at my second visit1 made at #d o'clock ,p4 ,m41 ! pati5t _h j expir$4 ,! autopsy1 made tw5ty h\rs aft] dea?1 gave ! foll[+ results3 ,^u op5+ ! abdom5 f\nd ! liv] pres5t+ a d>k mottl$ appe>ance1 & highly conge/$2 o!r abdom9al organs natural2 p]ic>dium conta9$ ab\t "o ounce ( s]um4 ,^u op5+ ! "r auricle ( ! he>t1 f\nd a firm fibr9\s mass1 ext5d+ d[nw>ds ?r\gh ! v5tricul> op5+1 & :i*1 ^u ! latt] cavity be+ op5$1 0 f\nd firmly atta*$ to ! tricuspid valves1 & entangl$ ) ! fle%y columns & t5d9\s cords4 ,! pres5ce ( su* a body 9 ?is position1 & ) su* atta*m5ts1 x 0 evid5t1 mu/ h s int]f]$ ) ! passage ( ! blood f ! auricle to ! v5tricle1 z1 ^u ! contraction ( ! =m] cavity1 to h caus$ a backw>d pressure into ! ve9s1 & ?us h produc$ ! fir/ ( ! d\ble pulsations ( ! jugul>s4 ,aga91 ! position ( ?is clot1 prev5t+ ! closure ( ! valves ^u ! contraction ( ! v5tricle1 !re w\ld h be5 a regurgitation into ! auricle1 & ! same backw>d fl[ into ! ve9s1 ?us produc+ ! second pulsation ( ! jugul>s se5 dur+ life4 ,,case ,,ii4--,dea? f ,he>t ,clot 9 ,pregnancy4 ,a lady1 #bh or #cj ye>s old1 also v anmic1 & ?ree mon?s pregnant1 _h be5 suff]+ occasional fa9t+ spells4 ,= "s days be=e h] decease %e _h suff]$ f dyspna1 & on t day1 aft] asc5d+ a flight ( /airs1 fell ^u ! floor1 & be=e a physician c\ld be obta9$ brea!d h] la/4 ,a po/-mortem %[$ all ! ?oracic & abdom9al visc]a 9 a heal?y condition1 :ile ! "r side ( ! he>t conta9$ a l>ge fibr9\s clot1 ) atta*m5ts simil> to ^? f\nd 9 ,case ,i4 ,,case ,,iii4--,dea? f ,he>t ,clot 9 ,diph!ria4 ,a boy1 #c ye>s old1 _h an attack ( diph!ria4 ,! case pres5t$ no unfavorable symptoms until ab\t ! f\r? day1 :5 he 0 tak5 ) great re/lessness & oppression 9 brea?+1 & :ile sitt+ on ! *amb] at /ool1 sudd5ly di$4 ,! autopsy "h aga9 reveal$ ! he>t clot1 z 9 ! o!r cases4 ,,case ,,iv4--,dea? f ,he>t ,clot 9 ,consumption4 ,a man1 #cj ye>s ( age1 a furri] by trade1 0 suff]+ f tub]cul> disease ( ! lungs4 ,he _h nev] giv5 up 8 "w1 ?\gh he 0 mu* r$uc$ 9 fle%1 _h a bad c\gh1 di>rha1 & night sweats4 ,:ile at 8 employm5t1 he 0 "o day tak5 ) great oppression1 increas$ c\gh1 etc41 & 9 tw5ty-f\r h\rs expir$4 ,! po/-mortem %[$ t1 :ile ! upp] portion ( bo? lungs conta9$ l>ge deposits ( tub]cles1 !re 7 no abscesses1 & ! l[] portions pres5t$ suffici5t s\nd lung tissue to h ma9ta9$ life4 ,^u op5+ ! he>t ! usual fibr9\s clot 0 f\nd 9 ! "r v5tricle1 ext5d+ upw>ds into ! auricle4 ,,case ,v4--,dea? f ,he>t ,clot 9 ,rheumatism4 ,a /rong color$ man1 ( #be ye>s1 _h an attack ( inflammatory rheumatism4 ,! disease pres5t$ ! usual *>act]s1 ! inflammation w&]+ f jo9t to jo9t4 ,dur+ ! second week he 0 sudd5ly attack$ ) great difficulty 9 brea?+1 viol5t & irregul> action ( ! he>t1 & great di/ress1 foll[$ by rapid pro/ration & dea?4 ,! po/-mortem exam9ation reveal$ ?ick5$ tricuspid valves1 ) a firm clot ( l>ge size adh]+ to ! same4 ,,case ,,vi4--,dea? f ,he>t ,clot 9 ,debility4 ,a g5tleman1 #ee ye>s old1 :o _h be5 = "s "t 9 feeble heal?1 0 tak51 ^u ris+ 9 ! morn+1 ) oppression & di/ress 9 ! region ( ! he>t1 dy+ 9 twelve h\rs4 ,! he>t clot 0 f\nd "h1 z 9 ! o!r cases1 ^u ! "r side ( ! he>t4 ,,case ,,vii4--,he>t ,clot 9 ,dea? f ,ov]-dose ( ,morphia4 ,a g5tleman1 ( ab\t #ej ye>s1 a physician1 0 f\nd "o morn+ dead 9 8 b$4 ,8 heal? _h be5 previ\sly good1 except+ t he 0 tr\bl$ ) neuralgia :i* gave him sleepless nights1 & = :i* he sometimes took morphia4 ,on ! night previ\s to 8 dea? he came home & retir$ at a late h\r4 ,an op5 bottle ( morphia & small spatula 7 f\nd on 8 desk next morn+1 ! spatula %[+ evid5ce ( hav+ be5 ?ru/ deeply into ! morphia1 & probably a l>ge & ov]-dose c>elessly remov$ & tak54 ,! autopsy "h aga9 reveal$ a l>ge & firm fibr9\s he>t clot4 ,,case ,,viii4--,dea? f ,he>t ,clot 9 ,acute ,ga/ritis4 ,a lady ( ab\t #fj ye>s1 _h an attack ( acute ga/ritis1 b 0 consid]$ convalesc+1 & h] physician 7,dr4 ,m>t97 made 8 la/ visit 9 ! ev5+4 ,! next morn+ %e 0 f\nd dead 9 h] b$4 ,! po/-mortem %[$ ! sple5 some:at enl>g$1 & its capsule greatly ?ick5$4#ae ,o!r organs heal?y1 :ile ! he>t conta9$ an unusually l>ge fibr9\s clot1 :i* has be5 pres]v$ 9 ! ,college ,museum4#af ,! above include ! m m>k$ cases ( dea? t h come "u my notice1 :]e t result c\ld1 9 my m9d1 be fairly attribut$ to ! =mation ( fibr9\s clots 9 ! he>t4 ,! foll[+ inf]5ces may1 we ?9k1 be fairly d$uc$ f ! sev]al cases report$3 ,fir/4 ,9 "s in/ances ! fibr9\s clots are app>5tly ! sole cause ( dea?4 7,cases #a1 #b1 & #c47 ,second4 ,9 o!r1 & a l>g] numb] ( diseases1 z 9 acute rheumatism1 pneumonia1 cr\p1 etc41 :i* o!rwise w\ld recov]1 a fatal t]m9ation results f ! =mation ( he>t clots4 7,cases #c & #e47 ,?ird4 ,9 /ill o!r diseases1 :i* are ( !mselves necess>ily fatal1 z 9 ph?isis1 *ol]a1 etc41 dea? is (t5 ha/5$ by ^! =mations4 7,case #d47 ,section ,,vi4 ,,! ,,aorta ,,& ,,art]ies ,,g5]ally4 ,notice3 #a4 ,be=e ,op5+ ,vessel--size2 c\rse2 condition ( ext]nal coat & surr\nd+ tissues4 #b4 ,aft] ,op5+ ,vessel--"* ( blood )92 coagulat$ or n2 size1 color1 consi/5ce1 etc41 ( clot2 size ( canal2 ?ickness ( walls2 rigid or flexible4 ,l9+ ,membrane--smoo?ness2 transp>5cy1 etc42 read9ess ( deta*m5t2 ?ickness1 etc42 if r\gh1 ! app>5t cause2 fibr9\s1 a!romat\s or calc>e\s deposits4 ,middle ,coat--its ?ickness2 color2 deposits )91 & _! "*4 ,ext]nal ,coat--g5]al condition4 ,,aneurisms3--#a4 ,ext]nal ,*>act]s--size2 %ape2 is ! dilatation lat]al or g5]al 9 its relation to ! vessel8 ,op5+s z se5 ext]nally2 size1 position1 etc42 blood effus$2 quantity1 etc4 ,aft] op5+1 notice--cont5ts2 blood fluid or coagulat$2 fibr9\s cont5ts2 lam9ations2 _! ?ickness2 numb]2 d5sity2 dryness2 diff]5ce betwe5 out] & inn] lay]s4 ,*annel = blood3 size2 "* ( inn] surface2 h[ =m$8 ,walls ( aneurism3 h[ =m$2 by all1 or "o coat ( art]y4 ,size ( art]y above & bel[ aneurism4 ,! diseases ( ! aorta1 & ( art]ies g5]ally1 :i* may claim att5tion 9 a po/-mortem exam9ation1 are inflammation1 fatty deg5]ation1 calcification1 aneurism1 & rupture4 ,inflammation4 ,?is process may be f\nd involv+ ei!r ! out] or inn] coats ( art]ies4 ,9 ! =m] case ! walls appe> ?ick5$ & infiltrat$ ) a s(t1 jelly-l sub/ance1 :i* appe>s1 at a m advanc$ /age 9 "s cases1 to deg5]ate into a purul5t condition1 :ile 9 o!rs1 great ?ick5+ ( ! coats1 or ev5 oblit]ation results4 ,inflammation ( ! inn] coat g5]ally prec$es a!romat\s or calc>e\s deposits1 & is mo/ly conf9$ to old p]sons4 ,! r\gh5$ inn] surface ?us produc$1 may s]ve to collect fibr9\s %r$s f ! blood1 & ?us be ! occasion ( ! =mation ( emboli4 ,inflammation ( art]ies may result f injuries1 f ! pres5ce ( emboli1 or may be spontane\s 9 its orig94 ,:ile ! m frequ5t seat ( ! disease is 9 ! aorta1 x may occur 9 any o!r art]y4 ,fatty ,deg5]ation1 or a!romat\s disease ( art]ies1 is an important affection ( ^? vessels1 & is usually associat$ ) aneurism4 ,x is se5 m frequ5tly 9 ! ar* ( ! aorta1 & consi/s 9 ! pres5ce ( f9e :ite /reaks1 situat$ 9 ! sub/ance ( ! l9+ membrane4 ,! disease may be f\nd 9 *ildr5 z "y z f ?ree to sev5 ye>s ( age1 b is m common ) adults4 ,z ! disease advances1 ! middle coat becomes involv$4 ,! /reaks gradually *ange into l>ge1 :ite1 opaque pat*es4 ,! middle coat becomes ?9n$1 loses its ela/icity1 assumes a gray1 semi-transp>5t appe>ance1 &1 at a lat] /age1 becomes s(t & *eesy1 & sometimes ev5 und]goes a =m ( liquification into a creamy fluid resembl+ pus1 b dep5d5t ^u ! abundant =mation ( fat globules1 ) scales ( *ole/]9e & granul> matt]4 ,:ile ^! de/ructive *anges are go+ on 9 ! inn] & middle coats1 & t5d+ to _! rupture1 by a cons]vative process1 ! out] coat1 ^u :i* ! /r5g? ( ! vessel ma9ly dep5ds1 becomes ?ick5$ & /r5g!n$ by ! accumulation ( pla/ic matt]4 ,ossification4 ,ossification ( ! aorta1 l t ( ! coron>y & o!r art]ies1 consi/s r 9 a process ( calcification4 ,! deposits are l>gely conf9$ to ! ar*1 & consi/ ma9ly ( pat*es ( calc>e\s matt] ( v>i\s sizes4 ,we seldom f9d ! :ole circumf]5ce ( ! vessel involv$1 z 9 ! case ( small] art]ies4 ,! aortic valves w g5]ally be f\nd m or less load$ ) ! same deposits4#ag ,aneurism4 ,?is disease is said to occur m frequ5tly 9 ! aorta1 ?an 9 any o!r art]y4 ,x may be develop$ 9 any portion ( ?is vessel or its pr9cipal bran*es1 b is m commonly f\nd 9 ! ar*4 ,! walls ( ! vessel be+ weak5$ by fatty deg5]ation1 !y become less & less able to resi/ ! pressure ( ! conta9$ blood1 & gradually yield+ to ! sy/olic =ce ( ! he>t1 become m & m di/5d$1 until ! complete aneurismal sac is =m$4 ,aneurism may be ei!r true1 9 :i* !re is a dilatation ( all ! coats ( ! vessel1 or false1 :]e !re is rupture ( ! inn]1 & p]haps also ( ! middle1 & dilatation ( ! out] coat alone4 ,! latt] =m1 :5 develop$ ^u ! aorta1 may become v l>ge1 & by pressure1 cause absorption ( ! /]num1 co/al c>tilages & ribs1 & ev5 ( ! clavicle4 ,9 "s cases1 ! inn] & middle coat hav+ ruptur$1 ! blood in/ead ( be+ conf9$ 9 a sac =m$ by ! out] coat1 becomes diffus$ betwe5 ! middle & out]1 or betwe5 ! lay]s ( ! middle coat1 ?us con/itut+ :at is kn[n z dissect+ aneurism4 ,9 ^! cases1 ! blood may ext5d ! :ole l5g? ( ! aorta1 & ev5 upw>ds ^u ! c>otids to _! bifurcation4 ,9 an exam9ation ( an aneurismal sac1 ! true aneurism w be recogniz$ by ! walls pres5t+ all ! coats ( ! art]y1 & g5]ally by ! indication ( ! pres5ce ( a!romat\s & calc>e\s deposits1 :i* are conf9$ to ! inn] & middle coats4 ,9 ^! cases also1 ! communication betwe5 ! sac & ! aorta is l>ge & free4 ,if ! aneurism be false1 h[ev]1 !re w be an abs5ce ( ^? deposits1 ! op5+ into ! art]y w be comp>atively small1 & ! inn] & middle coats w t]m9ate abruptly at its m>g94 ,! int]ior ( aneurismal sacs w usually be f\nd conta9+ a quantity ( fibr9e deposit$ f ! blood1 & arrang$ 9 conc5tric lay]s4 ,9 color1 ^! fibr9\s lay]s are ( a light buff1 ! out] lay]s be+ dry & firm1 :ile ! inn] ones are s(t] & m moi/1 & ! c5tral portion1 at ! same "t1 fill$ ) a d>k mass ( coagulat$ blood4 ,a spontane\s cure w sometimes be effect$ by a complete block+ up ( ! sac ) fibr9\s deposits1 ?us prev5t+ fur!r dilatation or dang] ( rupture4 ,! foll[+ case1 :i* has be5 be=e report$1#ah %[s a comb9ation ( bo? true & false aneurism1 ) spontane\s cure ( ! latt]3 ,,case4--,spontane\s cure ( aneurism ( asc5d+ portion ( ar* ( aorta1 ) dea? f bur/+ ( aneurism ( desc5d+ portion into ! sophagus4 ,mr4 ,h----1 ( ?is city1 ag$ sixty ye>s1 :ile walk+ 9 8 y>d "o day aft] a he>ty d9n]1 0 tak5 ) a sudd5 s5sation ( fa9tness & nausea1 :i* 0 soon foll[$ by vomit+ ! cont5ts ( 8 /oma*1 ) a consid]able quantity ( blood4 ,aft] ent]+ 8 h\se1 ! vomit+ 0 frequ5tly repeat$1 & at ea* ef=t l>ge quantities ( pale blood eject$4 ,s9k+ rapidly1 9 an h\r he 0 dead4 ,tw5ty-f\r h\rs aft]1 ,i made a po/-mortem exam9ation4 ,^u expos+ ! *e/1 f\nd at ! "r bord] ( ! /]num1 j bel[ ! clavicle1 a h>d1 inela/ic tumor b5ea? ! sk91 ( ! size ( a small orange4 ,:ile n adh]5t to ! integum5t1 x appe>$ firmly atta*$ to ! walls ( ! *e/ b5ea?4 ,^u turn+ aside ! integum5t & pectoral muscles1 ! tumor 0 f\nd connect$ by a long p$icle to p>ts )9 ! *e/2 absorption ( consid]able portions ( ! /]nal ends ( ! fir/ & second ribs1 ) ! side ( ! /]num1 hav+ result$ f pressure ( ! tumor ^u ^? p>ts1 & f9ally p]mitt+ its appe>ance b5ea? ! sk94 ,! removal ( ! /]num at once demon/rat$ ! aneurismal "* ( ! tumor by %[+ its connection ) ! asc5d+ portion ( ! ar* ( ! aorta1 :ile a section ( ! same1 exhibit$ ! int]ior fill$ ) d5se conc5tric lay]s ( fibr9\s matt]1 sep>able f "o ano!r1 ! out] lay]s be+ dry & h>d1 :ile ! inn] portion 0 less firm & moi/4 ,?is aneurism 0 pla9ly ( ! false v>iety4 ,! neck ( ! tumor 0 n mu* l>g] ?an ! ?umb1 & ( suffici5t l5g? to rea* f ! ar* ( ! aorta to ! dilat$ sac b5ea? ! sk91 outside ! *e/4 ,a fur!r exam9ation ( ! aorta br\ght to light a second & true aneurism ( ! desc5d+ portion ( ! ar*1 ! dilatation involv+ all ! coats ( ! vessels1 & :i*1 hav+ bur/ into ! sophagus1 expla9$ at once ! cause ( ! hmorrhage & sudd5 dea?4 ,^u inquir+ ( ! family1 ,i le>n$ t ! tumor ^u ! *e/ _h be5 kn[n to h exi/$ = fifte5 or tw5ty ye>s2 t = "s ye>s ! pulsations ( ! tumor 7 /rong1 b t = _m ye>s all beat+ _h ceas$2 t he _h nev] discont9u$ 8 "w1 t ( a c>p5t]1 & 9 fact1 x _h giv5 him s little tr\ble t he _h nev] consult$ a physician 9 reg>d to x4 ,= a ye> or s previ\s to dea?1 he _h be5 tr\bl$ ) a c\gh1 p>ticul>ly ^u ex]cis+1 b o!rwise _h be5 9 good heal?4 ,a rem>kable & int]e/+ feature ( ?is case 01 ! little inconv5i5ce exp]i5c$ by ! pati5t f s grave a malady1 & "o usually att5d$ ) great suff]+4 ,rupture4 ,spontane\s rupture ( ! aorta is a v r>e occurr5ce1 & probably nev] happ5s except ! coats h fir/ be5 weak5$ by disease4 ,h5ce1 9 all ( ^! cases1 !re w be f\nd a!romat\s s(t5+1 & g5]ally ?9n+ ( ! walls by dilatation4 ,9 ?is condition1 "s viol5t muscul> ef=t may result 9 rupture at ! mo/ weak5$ po9t1 & ?is w be g5]ally at t portion ( ! aorta )9 ! p]ic>dium1 ! ext]nal coat be+ weak] "h ?an at any o!r po9t4 ,:]e ! dilatation ( ! diseas$ & weak5$ vessel has result$ 9 ! =mation ( an aneurism1 rupture ( ?is w be ! m frequ5t t]m9ation4 ,?is may take place into ! sophagus1 z 9 ! case report$1 or into ! tra*ea1 ! p]ic>dium1 ei!r pleural cavity1 or ^u ! surface ( ! body4 ,rupture ( ! coron>y art]ies1 ( ! art]ies ( ! bra91 v>i\s bran*es ( ! abdom9al aorta1 & art]ies ( ! extremities1 h occasionally be5 f\nd1 :5 s(t5$ by fatty deg5]ation or a!romat\s disease4 ,section ,,vii4 ,,! ,,pleura4 ,notice3 ,condition ( membrane--inflam$2 ext5t & position (2 ?ick5$2 transp>5t or opaque2 r\gh or smoo?4 ,cont5ts--blood1 gas1 s]um1 pus1 am\nt & probable s\rce (4 ,adhesions--g5]al or local2 firmness (1 etc4 ,l o!r s]\s membranes1 ! pleura is liable to inflammation1 bo? acute & *ronic1 ) _! results--pla/ic1 s]\s1 or purul5t effusions1 adhesions1 etc4 ,inflammation4 ,! fir/ *ange :i* is obs]v$ 9 inflammation ( ! pleura 7pleurisy7 is a loss ( ! %9+1 transp>5t appe>ance ( t membrane1 x becom+ dull & opaque4 ,r$ inject$ vessels1 9 m9ute ramifications1 sometimes radiat+ f s+le po9ts1 9 o!rs m uni=mly diffus$1 w be notic$4 ,(t5 ! surface w pres5t a r$ mottl$ appe>ance1 ) "h & !re small po9ts ( extravasation4 ,?is condition hav+ exi/$ = f six to tw5ty-f\r h\rs1 c]ta9 results foll[--at lea/ 9 ! acute =m--:i* give rise to :at is kn[n z ,pla/ic ,effusion4 ,soon aft] ! inflammatory process is fully e/abli%$1 !re w appe> ^u ! surface a small quantity ( cle> fluid1 :i*1 z x increases 9 quantity1 und]goes coagulation1 & ?us gradually cov]s ! surface ) a jelly-l lay] ( v>iable ?ickness & honey-comb surface4 ,a ?9 fluid ( a /raw color1 w be f\nd ooz+ f ! surface1 :i* is increas$ z ! coagulat$ membrane is cut or torn4 ,?is condition may be ext5d$ ov] ! :ole surface ( bo? ! co/al & pulmon>y pleura1 or may be conf9$ to a limit$ portion4 ,adhesions4 ,! two lay]s ( ! pleura be+ 9 imm$iate contact1 ! consequ5ce ( ?is effusion ( coagulat$ lymph w be an e>ly adhesion ( ! appli$ surfaces4 ,?is is accompli%$ by a bl5d+ ( ! lay]s ( coagulat$ matt] 9 contact1 & a gradual organization ( ! same by an ext5sion ( blood-vessels f ! pleura into ! new =mation4 ,at ! same "t t ^! *anges are progress+1 ! wat]y "p ( ! exudation trickles d[n to ! mo/ dep5d5t portion ( ! cavity1 & !re =ms a s]\s or s]o-purul5t accumulation4 ,adhesions are m frequ5t at ! upp] portion ( ! lungs1 b may be f\nd at any po9t1 z betwe5 ! inn] surface & ! m$ia/9um1 or ! l[] surface & diaphragm2 or1 f repeat$ attacks ( pleuritis1 involv+ diff]5t portions ( ! s]\s membrane1 ! :ole ( ! ext]ior ( ! lung may become unit$ to ! adjo9+ surfaces4 ,! /r5g? ( ! adhesions w be some:at 9 proportion to _! age1 ^? ( long /&+ requir+ consid]able =ce to break !m up1 & 9 _m in/ances ! lung tissues becom+ lac]at$ be=e ! atta*m5ts c be torn away4 ,unusual ?ickness ( ! pleura is (t5 f\nd at po9ts :]e no adhesions exi/1 ?is be+ unque/ionably ! result ( ! effusion ( pla/ic matt] into ! subs]\s tissue dur+ an attack ( inflammation4 ,s]\s ,effusion4 ,:ile 9 ! majority ( cases ( pleuritic inflammation1 we %all f9d pla/ic effusions foll[$ by adhesions ( ! inflam$ ) ! adjo9+ surface1 9 "s in/ances a s]\s or wat]y fluid is rapidly p\r$ out1 &1 accumulat+ 9 ! pleural sac1 con/itutes hydro?orax or dropsy ( ! *e/4 ,! fluid 9 ^! cases may pres5t a v>iety ( %ades ( color1 f a p9ki% or light /raw color1 to a d>k br[ni% %ade4 ,x may be transp>5t or opaque1 & g5]ally w be m or less album9\s4 ,! quantity may v>y f a few ounces to ?ree1 f\r1 or five p9ts1 or m4 ,:5 9 l>ge quantity1 ! lung w be f\nd m or less collaps$1 %runk51 & press$ aga9/ ! po/]ior walls ( ! *e/ & sp9al column4 ,9 ! g5]al dropsy att5d+ diseases ( ! he>t1 kidneys or liv]1 effusions may take place into ! pleural cavities1 to su* an ext5t z to give rise to great dyspna f compression ( ! lungs4 ,s]o-,purul5t or ,puri=m ,effusions1 consi/ 9 ! pres5ce ( a quantity ( granul> p>ticles ) album9\s matt]1 :i* subside to ! bottom ( ! vessel :5 drawn (f1 & always conta9s float+ flakes ( lymph4 ,x may be f\nd 9 cases ( bo? acute & *ronic pleurisy1 &1 l s]\s effusions1 may be f\nd 9 l>ge quantity4 ,purul5t ,fluid1 z f\nd 9 ! cavity ( ! *e/1 consi/s ( a :ite or cream-color$1 opaque1 & homog5e\s fluid1 comb9$ ) m or less album9\s matt]1 9 ! =m ( %r$s & flakes1 yet de/itute ( ! granul> matt] ( ! s]o-purul5t fluids1 & n sep>at+ into a fluid & solid portion :5 at re/1 z is ! case ) ! latt]4 ,x is a fact well e/abli%$1 t g5u9e purul5t matt] may be =m$ 9 ! pleural cavity1 z well z 9 o!r s]\s cavities1 )\t ulc]ation ( any portion ( ! surface1 or dis*>ge ( an abscess into ! same1 x be+ ! result ( a m advanc$ /age ( ! process :i* gives rise to ! s]\s or pla/ic effusions4 ,x may be secret$ directly f ! capill>ies ( ! inflam$ surface1 or1 9 "s in/ances1 x w\ld appe> to be d]iv$ f ! organiz$ false membranes1 :i* h tak5 on a suppurative action4 ,pneumo?orax4 ,air may ent] ! pleural cavity1 by p]=ation ( ! walls ( ! *e/ f ext]nal injury1 or1 z is m common1 by ! de/ruction ( ! pulmon>y portion ( ! membrane1 f ! bur/+ ( a di/5d$ air-cell1 or f s(t5+ ( tub]cul> deposits1 or bur/+ ( an abscess4 ,if !re are b few or no adhesions1 ! accumulation ( air 9 ! cavity may be accompani$ by a m or less complete collapse ( ! lung1 z 9 hydro?orax4 ,?is condition1 dur+ life1 is n readily di/+ui%$ f emphysema1 bo? be+ accompani$ ) simil> oppression 9 brea?+1 di/5sion ( ! *e/1 & displacem5ts ( ! he>t1 & ) increas$ cle>ness on p]cussion4 ,s]\s or s]o-purul5t effusions w frequ5tly accompany ! pres5ce ( air 9 ! cavity1 & ?us give rise to _m ( ! peculi> physical signs :i* may h be5 notic$ dur+ life1 z metallic t9kl+1 a spla%+ s\nd on %ak+ ! *e/1 etc4 ,section ,,viii4 ,,! ,,lungs ,,& ,,bron*ial ,,tubes4 ,notice3 #a4 ,:ile 9 situ--degree ( collapse2 adhesions2 position & "* (2 w\nds1 etc4 #b4 ,aft] removal--ext]nal "*2 color2 peculi>ity ( %ape2 adhesion ( lobes2 puck]+s at apex2 solid or compressible2 crepitation2 :]e mo/ noticeable2 effect ( inflation on color & size4 ,tub]cul> deposits--size2 location4 #c4 ,sub/ance ( lung--solid or por\s :5 cut2 ext5t ( solidifi$ portions2 fluids escap+2 "* & quantity (4 ,abscesses--position2 numb]2 size2 "* ( cont5ts2 color2 odor1 etc42 condition ( lung ar\nd cavities2 "* ( walls2 ?ick or ?92 smoo? or r\gh2 cross$ by b&s2 communication ) bron*ial tubes4 ,gangr5e--location & ext5t (4 ,bron*ial tubes--cont5ts2 contraction or dilatation2 measurem5ts at1 above & bel[ ^! po9ts2 condition ( muc\s membrane2 conge/$ or ulc]at$2 walls ( tubes2 ?ick] or ?9n] ?an natural4 ,extravasation ( blood--7apoplexy ( lung27 portion & ext5t ( lung involv$2 condition ( surr\nd+ tissue2 blood infiltrat$ or ency/$4 ,adv5titi\s deposits--cretace\s bodies2 situation2 size2 d5sity2 condition ( surr\nd+ tissues4 ,tub]cles--seat2 size2 numb]2 color2 d5sity1 etc42 condition ( surr\nd+ tissue4 ,canc]\s masses--size2 location1 etc4 ,c>bonace\s deposits--ar\nd bron*ial tubes2 b5ea? pleura4 ,result ( plac+ entire lungs 9 wat]--d !y s9k or float8 ,if !y s9k1 is x rapidly or sl[ly8 ,if !y float1 is x above1 bel[1 or at ! surface ( ! wat]8 ,results ) portions ( ea* lung4 ,! pa?ological conditions ( ! lungs1 may be arrang$ z foll[s3--,inflammation & its results1 hepatization1 suppuration1 abscess1 gangr5e1 hmorrhage1 pulmon>y apoplexy1 emphysema1 tub]cul> disease1 morbid gr[?s1 & p>asitical animals4 ,:5 9 a heal?y condition1 ! lungs w pres5t ! foll[+ appe>ance3--,^u op5+ ! *e/1 !re w be a m or less complete collapse ( bo? organs1 p>tly f atmosph]ic pressure1 & p>tly f ! ela/icity ( ! lung tissue4 ,!y w !n h a %runk51 %rivell$ appe>ance1 crepitat+ "u pressure1 & h an a%5 gray color4 ,if inflat$1 ! surface becomes smoo? & %9+1 %[+ an indi/9ct outl9e ( ! lobules1 :i*1 ) ! d>k pigm5t>y matt] se5 "h & !re1 gives ! surface m or less ( a mottl$ appe>ance4 ,:]e pleurisy _h previ\sly exi/$1 !re may be adhesions prev5t+ ! collapse ( ! lungs1 until ^! h be5 brok5 up4 ,:5 cut into1 heal?y lung tissue has a s(t1 spongy "*1 ! upp] portions w be q de/itute ( blood1 :ile ! po/]ior portions may be m or less fill$ ) t fluid f gravitation1 giv+ !m a d>k conge/$ appe>ance4 ,inflammation & its ,results4 ,pneumonia1 or inflammation ( ! lungs1 may affect bo? ! air cells1 :5 ! latt] become fill$ ) fibr9\s exudations1 & ! connective areol> tissue1 :i* !n become increas$ 9 quantity4 ,! foll[+ *>act]s pres5t !mselves1 correspond+ to ! ?ree recogniz$ /ages ( ! disease3--,fir/1 conge/ion2 second1 r$ hepatization2 ?ird1 gray hepatization or s(t5+4 ,conge/ion4 ,f ! peculi> /ructure ( ! lungs1 9 connection ) ! free circulation ?r\gh ! same1 ^! organs are peculi>ly liable to ! sev]al =ms ( conge/ion4 ,9 _m cases ( dea?1 )\t any orig9al disease ( ! lungs1 !re w be a t5d5cy = ^! organs to become load$ ) blood1 giv+ rise to po/-mortem appe>ances1 (t5 ) difficulty di/+ui%$ f ^? ( a pa?ological orig94 ,9 ?is po/-mortem1 or1 z x has be5 call$ hypo/atic conge/ion1 ! po/]ior & inf]ior portions ( ! lungs are *iefly affect$1 z ! blood aft] dea?1 obey+ ! law ( gravitation1 s9ks to ! l[e/ po9t4 ,! conge/$ portion pres5ts a d>k r$ color1 & ?\gh firm] ?an o!r portions1 crepitates "u ! f+] & floats 9 wat]1 ! latt] circum/ance s]v+ to di/+ui% ?is =m ( conge/ion f t ( an inflammatory orig94 ,if ! conge/ion be conf9$ to "o lung1 or to ! ant]ior p>ts ( ei!r1 we may safely attribute x to a pa?ological cause4 ,9 all cases ( conge/ion1 ^u op5+ ! *e/1 al?\gh !re may be no adhesions1 ! lung does n collapse1 or does s feebly4 ,:5 cut1 x is f\nd to be load$ ) blood1 & ^u pressure1 mu* bloody s]um escapes1 :ile ! divid$ bron*ial tubes w be f\nd fill$ ) fro?y mucus4 ,r$ ,hepatization4 ,?is condition ( ! lungs soon foll[s t ( conge/ion4 ,! *ange is a gradual "o1 & is fir/ m>k$ by an effusion ( s]um & coagulable lymph into ! connective tissue & air cells1 ?us r5d]+ ! lungs m solid1 :ile z ! *ange becomes complete1 ! blood itself1 :i* _h dur+ ! conge/ive /age be5 conf9$ to ! vessels1 is n[ f\nd extravasat$ into ! int]/ices ( ! tissues4 ,! portion ( ! lung ?us affect$ is n only ( a d>k r$ or violet color1 b solid1 firm1 does n crepitate1 s9ks :5 ?r[n into wat]1 & :5 cut & wa%$1 ! section %[s pat*es ( a r\gh1 granul> aspect1 totally diff]5t f t ( heal?y lung tissue4 ,! pleura 9 ?is condition may be :olly un*ang$1 ev5 ?\gh ! solidification may h be5 ( long /&+4 ,gray ,hepatization1 :i* *>act]izes ! ?ird /age ( pneumonia1 is kn[n by ! lung pres5t+ a firm1 semi-solid1 inela/ic1 & m or less incompressible "*4 ,fail+ to collapse1 ! lung is f\nd m or less completely fill+ ! *e/4 ,! pleura w g5]ally pres5t evid5ces ( inflammation 9 ! pres5ce ( pat*es ( lymph & m or less po9ts ( adhesions4 ,! upp] lobe may be s(t & compressible1 :ile ! l[] is solid f hepatization4 ,:5 divid$ ) ! knife1 ! sub/ance is f\nd ( a gray1 r$1 or dirty yell[ color2 compact1 b friable & easily brok5 d[n ) ! f+]s1 :ile ! small] bron*ial tubes are fill$ ) fibr9\s plugs4 ,bloody purul5t matt]1 ) mu* turbid s]\s fluid1 w ooze f ! cut surfaces4 ,pus globules w be detect$ 9 ! escap+ fluids by a microscopic exam9ation4 ,resolution ( a hepatiz$ lung1 consi/s 9 ! gradual s(t5+ ( ! effus$ sub/ances )9 ! small] bron*ial tubes & air cells1 & ! dis*>ge ( ! same by c\gh & expectoration4 ,inflammation ( ! lung usually comm5ces 9 ! l[] lobe1 & :ile ! disease "h may ext5d to complete hepatization1 ! middle lobe may be f\nd m]ely conge/$1 :ile ! upp] is q heal?y4 ,inflammation may attack "o or bo? lungs4 ,9 ! =m] case x is kn[n z s+le1 & 9 ! latt] z d\ble pneumonia4 ,f an exam9ation ( a l>ge numb] ( cases1 x has be5 asc]ta9$ t inflammation ( ! "r lung is m frequ5t ?an t ( ! left 9 ! proportion ( ab\t ?ree to "o1 & t s+le pneumonia is m common ?an d\ble pneumonia 9 ! ratio ( six to "o4 ,pneumonia is sometimes divid$ into ,cat>rhal & ,cr\p\s4 ,9 ! =m]1 ! exudation conta9s little or no fibr9\s matt]1 :ile ! bron*ial muc\s membranes are also involv$1 ! disease at ! same "t be+ conf9$ mo/ly to ! lobules ( ! lungs4 ,9 ! cr\p\s =m1 ! exudation conta9s a l>ge proportion ( fibr9e1 & ! disease usually involves ! great] "p ( a lobe1 or may ext5d to ! :ole ( "o or bo? lungs4 ,bo? =ms ( ! disease may run ?r\gh ! ?ree /ages ( conge/ion1 r$ & gray hepatization4 ,a peculi> =m ( inflammation ( ! lungs1 f\nd mo/ly 9 *ildr5 & "y p]sons1 & usually *ronic 9 "*1 has be5 describ$ z ,lobul> ,pneumonia4 ,! inflammation "h be+ conf9$ to ! lobules1 ^!1 aft] ! disease is p]fectly develop$1 pres5t ! appe>ance ( a multitude ( r\nd$ nodules1 ( ! size ( small nuts1 scatt]$ ?r\gh ! sub/ance ( ! lungs4 ,! ext]ior ( ^! is r$di%1 firm1 & vascul>1 :ile ! int]ior is ( a grayi% color1 conta9+ effus$ lymph1 ) m or less purul5t matt]4 ,?is =m ( pneumonia be+ frequ5tly associat$ ) diseases ( ! jo9ts & bones1 z well z ) inflammation & ulc]ation ( ! gl&s ( ! inte/9es1 x has be5 consid]$ z dep5d+ ^u a /rum\s dia!sis1 & z1 9 fact1 b ! e>ly /age ( tub]cul> consumption4 ,seldom prov+ fatal 9 ! e>ly /age1 or be=e ! disease has ext5d$ to ! :ole sub/ance ( ! lung1 & p]haps result$ 9 ! =mation ( cavities1 we mu* less frequ5tly meet ) ?is =m ( pneumonia 9 po/-mortem exam9ations4 ,suppuration & ,abscess4 ,gray hepatization mu/ be look$ ^u z a =m ( suppuration ( ! lungs2 z ! purul5t-look+ fluid f\nd infiltrat+ ! tissues1 fill+ ! air cells & small] bron*ial tubes1 ^u a microscopic exam9ation1 is f\nd conta9+ und\bt$ pus globules4 ,?is1 h[ev]1 is n an abscess1 ! matt] n be+ conf9$ )9 a cavity1 b diffus$ ?r\gh ! tissues ( ! "p4 ,t a di/9ct abscess ( ! lungs may =m1 z a result ( pneumonia1 is g5]ally admitt$1 ?\gh !y are usually small & conf9$ to ! l[] lobes4 ,f s(t5+ ( tub]cul> masses1 abscesses n unfrequ5tly =m 9 any portion ( ! lungs4 ,t !y d n occur m frequ5tly 9 pneumonia1 may result f ! fact t ! disease (t5 proves fatal by suffocation1 be=e !re has be5 "t = x to h rea*$ ! suppurative /age4 ,! pleura ov] ! seat ( ! abscess w g5]ally be f\nd mu* ?ick5$1 & frequ5tly adh]5t to ! opposite walls ( ! *e/4 ,pulmon>y abscess may be :olly dis*>g$ by expectoration--! cavity communicat+ ) ! bron*ial tubes--or x may dis*>ge into ! pleural cavity1 or :5 adhesions h fir/ =m$1 x may "w its way betwe5 ! ribs1 & ! matt] escape ^u ! surface ( ! body4 ,meta/atic or ,second>y ,abscess4 ,?is =m ( abscess 9 ! lungs1 is well und]/ood to be ! result ( suppuration 9 "s di/ant "p or organ1 :i*1 be+ att5d$ ) phlebitis ( ! "p1 purul5t matt] is introduc$ into ! circulation1 & ?us convey$ to ! lungs or p]haps ! liv]4 ,?is orig9al suppuration may be at ! ut]us aft] deliv]y1 or f a fi/ulo 9 ano1 psoas abscess1 or any o!r simil> affection4 ,f ! fact1 probably1 t ! :ole volume ( ! blood fl[s ?r\gh ! lungs1 at ea* r\nd ( ! circulation1 ^! organs are m frequ5tly affect$ ) ?is =m ( abscess ?an any o!r1 x occurr+ next 9 frequ5cy 9 ! liv]4 ,^! abscesses may be recogniz$ z spots ( yell[ pus1 v>y+ 9 size f a p9's head to a walnut1 g5]ally situat$ ne> ! surface ( ! organ & surr\nd$ by a d>k1 well def9$ lay] ( conge/$ tissue1 :ile beyond ?is1 ! /ructure is 9 a heal?y condition4 ,sev]al ( su* abscesses may be f\nd 9 v>i\s p>ts ( ! lungs4 ,gangr5e4 ,gangr5e ( ! lungs1 r>ely results f an attack ( ord9>y pneumonia1 b appe>s m frequ5tly to take place ei!r z a concomitant ( pe/il5tial fev]s 9 g5]al1 or z an accompanim5t ( c]ta9 cases ( tub]cul> vomic ( ! lungs1 or z a prim>y & peculi> species ( inflammatory affection ( ^? organs4 ,9 ! fir/ in/ance1 a pati5t suff]+ a sev]e =m ( typhoid fev]1 pres5ts symptoms ( pulmon>y disord]1 z hurri$ respiration1 livid face1 c\gh1 fir/ dry & soon moi/1 ) ?ick orange-color$ & f9ally d>k or bloody & extremely (f5sive expectoration1 & fetid brea?4 ,) ^! symptoms are g5]ally associat$ great feebl5ess1 delirium1 ) t5d5cy to gangr5e ( ! extremities & prom95t po9ts ( ! hips1 sacrum1 etc42 & f9ally1 ) increas$ difficulty 9 respiration & fetor ( brea?1 dea? ensues4 ,9 ! second case1 a pati5t suff]+ f cle>ly recogniz$ tub]cul> disease ( ! lungs1 :i* has pass$ on to s(t5+ ( tub]cul> masses1 & ! =mation ( vomic1 has an aggravation ( all 8 symptoms1 accompani$ ) ! expectoration ( a highly (f5sive d>k matt]1 pla9ly result+ f a gangr5\s condition ( ! int]ior ( a tub]cul> cavity4 ,9 ! ?ird case1 ! disease comes on at fir/ z an affection ( ! lungs4 ,! attack comm5ces ei!r z pulmon>y inflammation1 or bron*ial disease1 or ) spitt+ ( blood ) m or less pa9 9 ! *e/4 ,! pati5t becomes rapidly worse1 ! c\gh increas+1 ) r$di%-br[n or bloody sputa1 & (f5sive brea?4 ,! c\nt5ance is anxi\s & livid1 ! eye heavy1 sometimes wild & gl>+4 ,! fetid brea? is n always an e>ly symptom1 b :5 x does appe>1 ! disease 9 g5]al t5ds rapidly to a fatal t]m9ation1 al?\gh recov]y sometimes takes place4#ai ,! appe>ances aft] dea?1 9 cases ( gangr5e ( ! lungs1 are ( two k9ds1 accord+ z ! disease is diffuse or circumscrib$4 8,9 ! fir/ case1 a mass ( lung1 two & a-half or ?ree in*es wide1 b irregul> 9 figure & outl9e1 is conv]t$ into a s(t1 pulpy1 d>k1 a%-color$ sub/ance1 :i*1 :5 x is h&l$ or press$ by ! f+]s1 falls d[n into a loose1 moi/ mass1 emitt+ a fetid1 (f5sive odor1 )\t trace ( ! usual /ructure ( ! lungs1 except a few bron*ial tubes1 & blood-vessels1 & %r$s ( filam5t\s tissue4 ,?is mass is g5]ally b\nd$ by1 b x does n t]m9ate abruptly 91 heal?y lung4 ,x is s(t1 d+y1 & infiltrat$ ) a d>k1 a%-color$1 dirty1 s]\s liquor4 ,occasionally ! surr\nd+ portion ( ! lung is hepatiz$ or infiltrat$ ) blood or bloody s]um2 ! bron*ial tubes always conta9 mu* bloody1 viscid mucus2 & sometimes ! pleura is r$d5$1 cov]$ ) lymph or adhesions1 & conta9s fluid 9 its cavity40 ,! portion ( ! lung ?us affect$ is usually )9 ! l[] or middle lobe1 ! upp] portion be+ r>ely involv$4 ,9 ! second1 or circumscrib$ =m1 a portion ( ! lung1 g5]ally ne> ! surface1 pres5ts a d>k-color$1 h>d pat*1 v>y+ 9 size f a qu>t]1 to a half-doll> piece or m1 (t5 q circul>1 & b\nd$ all r\nd by heal?y lung4 ,?is circul> h>d pat*1 :i* resembles closely an es*> produc$ by cau/ic pota%1 may adh]e or be easily deta*$4 ,9 ! latt] case1 x g5]ally leaves a cup-l cavity1 ! surface ( :i* is firm1 granul>1 ) ! blood-vessels & bron*ial tubes clos$1 & ) ! surr\nd+ lung m s(t5$1 b g5]ally pres5t+ m>ks ( pleurisy1 pneumonia1 & bron*itis all comb9$1 :i* may be look$ ^u z an ef=t ( nature to isolate & deta* ! diseas$ mass4 ,pulmon>y ,hmorrhage--,hmoptysis4 ,dis*>ge ( blood f ! lungs by c\gh+1 may result f a v>iety ( causes1 among :i* may be m5tion$3 #a1 me*anical %ock or injury1 z 9 falls or bl[s ^u ! *e/2 #b1 inflammatory action )9 ! lungs2 #c1 disease ( ! he>t2 #d1 disease ( ! art]ies2 #e1 tub]cul> deposition2 #f1 tub]cul> de/ruction1 ) ulc]ation ( vessels4 ,9 ! fir/ in/ance ! expectorat$ blood may be copi\s or slight1 accord+ to ! sev]ity ( ! injury4 ,if dea? soon results1 an exam9ation ( ! lungs w disclose "o or m ( ! bron*ial tubes fill$ ) blood1 :i* has pla9ly aris5 f a rupture ( "s ( ! capill>ies ( ! bron*ial muc\s membrane4 ,! blood dis*>g$ 9 _m cases ( ! e>ly /age ( consumption1 & 9 "y females aft] ! suppression or ret5tion ( ! m5/rual fl[1 is f ! same s\rce4 ,hmorrhage f ! lungs may also take place z a result ( tub]cul> deposits4 ,! pres5ce ( tub]cul> masses mu/ necess>ily produce m or less pressure on ! adjo9+ vessels1 int]f]+ ) ! fl[ ( ! blood ?r\gh ! same1 & ?us induc+ conge/ion1 & ev5 rupture ( "s ( ! capill>y bran*es4 ,aga91 :]e tub]cul> masses h progress$ to s(t5+1 & a cavity has be5 =m$1 ! ulc]ative process may op5 a l>ge vessel1 & dea? result 9 a few m9utes f excessive hmorrhage4 ,a po/-mortem w "h %[ ! cavity1 z well z ! bron*ial tubes & tra*ea1 fill$ ) coagulat$ blood4 ,! blood expectorat$ dur+ ! e>ly /age ( an attack ( pneumonia1 is nev] copi\s1 consi/+ ma9ly ( /reaks ( blood ?r\gh ! saliva1 :ile at a lat] /age1 f be+ m uni=mly diffus$1 x gives ! peculi> ru/y sputa *>act]i/ic ( ?is disease4 ,! po/-mortem appe>ances h already be5 giv5 "u ! head ( pneumonia4 ,c]ta9 =ms ( disease ( ! he>t1 z ossification ( ! mitral valves1 ) contraction ( ! orifice1 or 9 hyp]trophy ( ! left v5tricle1 ) disease ( ! aortic valves1 are frequ5tly att5d$ ) hmoptysis4 ,9 ei!r case1 ! ob/ruction to ! free circulation ?r\gh ! left side ( ! he>t1 mu/ induce an ov] di/5sion ( ! pulmon>y ve9s1 :i*1 ^u "s unusual ex]tion1 may readily result 9 extravasation ?r\gh ! bron*ial muc\s membrane1 caus+ ! bloody expectoration :i* takes place dur+ life1 or into ! pulmon>y connective tissue1 giv+ orig9 ?us to :at is kn[n z ,pulmon>y ,apoplexy4 ,! po/-mortem appe>ances 9 ^! cases1 are z foll[s3--,! portion ( ! lung involv$1 fails to collapse on op5+ ! *e/4 ,x is firm1 & ( a d>k r$ color2 & :5 cut into1 ?ick blood issues f ! cut surfaces4 ,! portion involv$ may include f "o to f\r cubic in*es4 ,x w be f\nd circumscrib$ ) heal?y lung tissue1 & looks n unlike a clot ( v5\s blood2 ^! circum/ances s]v+ to di/+ui% x f hepatization1 :i* t]m9ates m or less gradually 9 s\nd lung4 ,:ile ^! hmorrhagic effusions may1 9 _m cases1 cause e>ly dea? by _! size & numb]1 9 o!rs1 ! clot may s(t51 ! lung ar\nd become inflam$1 or ev5 gangr5\s1 result+ 9 ! =mation ( an irregul> cavity fill$ ) d>k1 (f5sive1 semi-fluid cont5ts4 ,9 /ill o!r cases1 :]e ! clot is small1 & 9 "p )9 ! air cells1 x may s(t5 & become absorb$ or c\gh$ up1 & ! air aga9 ent] ! cells1 or ^! may contract into a fibr\s indurat$ mass4 ,emphysema4 ,emphysema ( ! lungs1 is usually describ$ z ( two =ms--vesicul> & int]lobul>4 ,vesicul> emphysema1 consi/s ess5tially 9 a dilatation or ov]-di/5sion ( a great] or less numb] ( air cells1 result+ 9 giv+ ! portion involv$ great] buoyancy 9 wat]1 f dim9i%$ specific gravity1 less5+ ! crepitation on pressure1 prev5t+ collapse on ! op5+ ( ! *e/1 & r5d]+ ! affect$ portion m or less dry & bloodless4 ,f ! loss ( ela/icity1 !re w be dur+ life1 a difficulty 9 ! lungs empty+ !mselves ( air z !y %\ld1 h5ce ! pati5t w be subject to sev]e attacks ( oppression ^u ! slighte/ aggravat+ cause4 ,if "o lung only is affect$1 ! correspond+ side becomes enl>g$ & less movable ?an ! o!r2 ! adjo9+ visc]a1 z ! he>t or abdom9al organs1 are m or less displac$1 ! int]co/al spaces swell out1 & ! ribs becom+ m horizontal1 give a b>rel-%ape to ! *e/1 :i* is q *>act]i/ic ( emphysema4 ,?is di/5sion ( ! air cells1 is m m>k$ along ! edges ( ! lungs1 ! vesicles at ^! p>ts be+ probably ! lea/ support$4 ,pat*es ( dilat$ cells may be f\nd1 h[ev]1 at o!r p>ts1 :i*1 if sup]ficial1 w project beyond ! surface ( ! surr\nd+ heal?y portions1 & appe> l l>ge bladd]s1 f ! coalesc+ ( sev]al vesicles4 ,?is =m ( emphysema may be induc$ by any cause int]f]+ ) ! ready escape ( ! air f any portion ( ! lungs1 especially if accompani$ ) sev]e c\gh1 z 9 _m =ms ( bron*ial disease1 enl>gem5t ( ! bron*ial gl&s1 etc4 ,int]lobul> ,emphysema1 consi/s 9 an effusion ( air into ! connective or areol> tissue ( ! lungs1 f a rupture ( air cells or small] bron*ial tubes1 or f ! lac]ation ( ! lungs f a brok5 rib1 :5 ! air may accumulate 9 ! pleural cavity1 con/itut+ pneumo?orax1 & may also be accompani$ ) emphysema ( ! *e/1 neck & head1 f an escape ( ! air at ! po9t ( injury into ! tissues ( ^? p>ts4 ,?is =m ( emphysema may involve a l>ge "p or ! :ole ( ! lung1 :ile ! vesicul> =m is g5]ally limit$ to def9ite portions4 ,by di/urb+ ! circulation ?r\gh ! lungs1 emphysema is liable to induce dilatation ( ! "r side ( ! he>t4 ,f an evolution ( gases )9 ! lungs aft] dea?1 we may h simil> appe>ances to t above describ$1 requir+ "s c>e to di/+ui% betwe5 ! two4 ,9 ! latt] case1 ! g5]al indications ( decomposition1 ) ! ease ) :i* ^! di/5d$ vesicles may be empti$ by pressure1 w aid 9 det]m9+ ! "* ( ! case4 ,tub]cul> ,disease ( ! ,lungs4 ,i %all n attempt to pres5t "h ! v>i\s !ories t h be5 promulgat$ z to ! nature & orig9 ( tub]cle1 cont5t+ myself by giv+ a description ( _! anatomical *>act]s1 z pres5t$ 9 ! sev]al /ages ( tub]cul> disease4 ,tub]cle1 or tub]cul> matt]1 may be describ$ z consi/+ ( a yell[i%-:ite sub/ance1 opaque1 friable & unorganiz$4 ,x may be deposit$ 9 mo/ ( ! tissues or organs ( ! body1 b its m common seat is ! free surfaces ( muc\s membranes1 ?\gh (t5 f\nd 9 connection ) ! s]\s4 ,tub]cul> deposits 9 ! lungs1 are n uni=mly di/ribut$ ?r\gh all p>ts ( ^? organs1 be+ 9 ! l>ge majority ( cases conf9$ to ! upp] & back "p ( ! upp] lobes1 & 9 ^? cases :]e !y are m or less di/ribut$ ?r\gh ! :ole lung1 !y w be f\nd m num]\s & l>g] 9 ^? p>ts4 ,tub]cles may exi/ z f9e po9ts1 n l>g] ?an a p9's head1 7mili>y tub]cle17 or ! matt] may accumulate 9 masses ( ! size ( a k]nel ( corn1 ( a *]ry1 or ( a rob9's egg4 ,9 o!r cases1 ! pulmonic exudation 9 "s portion ( ! lung att5d+ an attack ( pneumonia1 may become trans=m$ into tub]cul> matt]1 hav+ an irregul> outl9e & no di/9ct b\nd>y1 7infiltrat$ tub]cle47 ,tub]cul> matt] is und\bt$ly1 9 mo/ in/ances1 deposit$ )9 ! air cells1 s fill+ ^!1 z to m or less int]f]e ) ! admission ( ! air1 & giv+ great] d5sity to ! portion ( lung involv$4 ,:ile ! secret$ matt] is at fir/ s(t1 or semi-fluid & p>tially transluc5t1 x gradually acquires great] d5sity1 becomes opaque & *eesy 9 its "*1 & 9 all respects act+ z a =eign body )9 ! lungs4 ,soon] or lat]1 ! pres5ce ( tub]cles w excite inflammation 9 ! surr\nd+ tissues4 ,9 ?is mann] ^! bodies may become s(t5$ & _! sub/ance expectorat$4 ,if l>ge numb]s be aggregat$ toge!r1 ! ulc]ative process may completely de/roy ! tissues betwe51 an abscess or vomica result+4 ,9 ! e>ly /age ( ! disease1 be=e ! inflammatory & ulc]ative processes h be5 set up1 ! pres5ce ( tub]cul> matt]1 by int]f]+ ) ! capill>y circulation1 may give rise to a hmorrhage into ! bron*ial tubes1 con/itut+ ! hmoptysis s frequ5tly pres5t 9 ?is disease2 :ile at a lat] p]iod1 f a de/ruction ( "s ( ! l>g] vessels f ulc]ation1 a pr(use & ev5 fatal hmorrhage may result4 ,po/-mortem ,appe>ances4 ,9 exam9+ ! lungs ( ^? :o h di$ aft] suff]+ ! usual symptoms ( pulmon>y consumption1 we %all f9d ! upp] portion ( "o or bo? lungs1 m or less indurat$1 & occupi$ by "o or m irregul> %ap$ cavities1 conta9+ ei!r air1 or air & a quantity ( viscid1 puri=m1 dirty-look+ fluid4 ,g5]ally ! apex ( ! affect$ lung1 w be f\nd firmly atta*$ to ! inn] surface ( ! *e/1 by means ( a ?ick1 firm1 false membrane1 :i* unites ! two lay]s ( ! pleura4 ,9 "s in/ances1 ne>ly or q ! :ole surface ( ! lung w be f\nd ?us adh]$1 :ile ! lobes w also be unit$ by an int]lobul> false membrane4 ,:5 ! adhesions are conf9$ to ! upp] portions ( ! lungs1 ! pleura cov]+ ! l[] portion w frequ5tly be f\nd m or less r\gh f album9\s exudation1 :ile a quantity ( s]o-purul5t fluid w be f\nd 9 ! po/]ior "p ( ! ?oracic cavity4 ,! great] "p ( ! upp] lobe1 may be f\nd conv]t$ into "o irregul> cavity2 m frequ5tly1 ! upp] lobe pres5ts two or ?ree1 ei!r isolat$ or communicat+4 ,! l>ge/1 :5 sev]al are pres5t1 is mo/ commonly 9 ! upp] portion ( ! lobe4 ,:5 entirely or p>tially fill$ ) matt]1 su* cavities are usually t]m$ vomic or abscesses1 :ile :5 empty1 !y are g5]ally call$ tub]cul> cavities or excavations4 ,9 ! l[] "p ( ! upp] lobes1 ! cavities are few & small4 ,! middle lobe ( ! "r lung1 r>ely pres5ts cavities1 :ile ! l[] lobes ( bo? lungs are entirely free4 ,! :ole ( ^! p>ts1 h[ev]1 may be m or less indurat$ by ! pres5ce ( h>d1 irregul> %ap$ masses1 ! result1 probably1 ( inflammatory action4 ,tub]cul> cavities pres5t a consid]able v>iety1 bo? 9 size & %ape4 ,!y may n be l>g] ?an a pea1 or bean1 or may rea* ! size ( an egg1 or ev5 ( an orange4 ,always ( an irregul> %ape1 !y (t5 consi/ ( "o l>ge cavity1 communicat+ ) two or ?ree small] ones4 ,! int]ior w be f\nd trav]s$ by b&s1 or cords1 pass+ 9 v>i\s directions1 b g5]ally tak+ a longitud9al c\rse1 & probably ! remnants ( blood-vessels & bron*ial tubes4 ,! tissues imm$iately ar\nd a cavity1 & =m+ its walls1 w be f\nd firm1 inela/ic1 almo/ c>tilag9\s 9 "*1 & ( a d>k r$1 or br[n color4 ,! d5sity ( ! /ructures is caus$ p>tly by tub]cul> deposits 9 ! lung1 & p>tly by inflammatory induration4 ,:ile tub]cul> disease ( ! lungs is almo/ univ]sally fatal1 !re is reason to believe t1 9 a v small proportion ( cases recov]y has tak5 place1 & ! po/-mortem appe>ances ( ! lungs h accord$ ) ?is view4 ,^! appe>ances may be describ$ z foll[s3 ,we sometimes obs]ve 9 exam9+ ! lungs ( individuals :o may h di$ f diseases ( o!r organs1 t ! pleura cov]+ ! upp] lobe ( ! lung1 pres5ts1 at a c]ta9 po9t1 a puck]$1 %rivell$ appe>ance1 ) a lea!r-l feel1 & ) a r\nd$1 firm mass b5ea?4 ,^u divid+ ! latt] ) ! knife1 ! int]ior is f\nd compos$ ei!r ( a s(t sub/ance l putty1 or m frequ5tly ( a *alky nature4 ,?is is look$ ^u z a cicatriz$ or contract$ vomica1 ! putty or *alk-l cont5ts be+ ! residu>y matt] ( ! s(t5$ tub]cle1 ! ?9n] portion hav+ be5 expectorat$ or remov$ by absorption4 ,9 "s in/ances1 ^! bodies are ( almo/ a /ony h>dness1 grat+ aga9/ ! knife4 ,9 o!r cases1 cavities l9$ ) a smoo?1 semi-c>tilag9\s false membrane are f\nd1 conta9+ air only1 & ) dilat$ bron*ial tubes op5+ into ! same1 no appe>ance ( ulc]ation be+ visible1 ev]y?+ indicat+ t a tub]cul> mass _h once occupi$ ! cavity1 its s(t5+ & expectoration hav+ be5 foll[$ by a heal+ ( ! inn] surface4 ,morbid ,gr[?s4 ,canc]4 ,malignant disease ( ! lungs is by no means frequ5t1 yet we h abundant evid5ce t canc] 9 its sev]al =ms may be develop$ 9 ^! organs4 ,colloid canc]1 has be5 usually f\nd m or less infiltrat$ ?r\gh ! sub/ance ( ! lungs1 :ile o!r =ms appe> 9 nodules or isolat$ tumors4 ,x is seldom1 p]haps1 t canc] exhibits itself z a prim>y affection ( ! lungs1 ! disease fir/ appe>+ 9 "s o!r "p1 & m frequ5tly1 x is said1 9 ! bones or te/icles2 op]ation = ! removal ( canc] 9 ^! p>ts be+ v liable to be foll[$ by an e>ly developm5t ( ! disease 9 ! lungs or o!r int]nal organs4 ,on ! o!r h&1 :]e ! canc] is connect$ ) any organ ^: ve9s =m a "p ( ! portal sy/em1 z ! /oma*1 sple51 pancreas1 inte/9es1 etc41 ! disease does n s frequ5tly ext5d to ! lungs1 :ile 9 ^? cases ! liv] is m liable to become affect$4 ,! encephaloid =m ( canc]1 is t m frequ5tly met4 ,x may be connect$ ei!r ) ! bron*ial gl&s1 :5 ! diseas$ mass w be ma9ly conf9$ to ! m$ia/9um1 & may consi/ ( bodies v>y+ 9 size f t ( a *]ry to t ( a l>ge apple1 or1 ! disease may comm5ce directly 9 ! sub/ance ( ! lungs1 ! tumor rapidly increas+ 9 size1 & cr[d+ ! lungs f _! normal position4 ,aft] dea?1 ! encephaloid mass may be f\nd compress+ ! lungs into a v small space4 ,! tumor pres5ts ! usual "* ( ?is disease1 "s ( ! lobules be+ s(t & pulpy1 or bra9-l1 o!rs ( a m firm1 *eese-l consi/5ce4 ,melanosis4 ,two =ms ( melanotic deposits are obs]v$ 9 ! lungs3 "o1 true melanosis1 & frequ5tly associat$ ) encephaloid disease2 ! o!r a deposit ( c>bonace\s matt] f coal du/1 smoke1 etc41 :i* has be5 inhal$ dur+ life1 & di/+ui%$ z spuri\s melanosis4 ,true melanosis consi/s 9 a deposit ( a d>k pigm5t>y matt] 9 ! sub/ance ( ! bron*ial gl&s1 f\nd at ! bifurcation ( ! tra*ea1 & along ! ma9 bron*i4 ,! gl&s are at ! same "t enl>g$4 ,! color+ matt] may be solid1 or slightly fluid1 or pa/y4 ,at ! same "t ! melanotic matt] may be infiltrat$ to "s ext5t into ! sub/ance ( ! lungs1 or deposit$ 9 cy/s )9 ! same4 ,9 spuri\s melanosis1 ! d>k c>bonace\s matt] is diffus$ m or less ?r\gh ! :ole lung1 & may be se5 di/9ctly ?r\gh ! pleura4 ,! bron*ial muc\s membrane is m or less t+$ ) ! same sub/ance1 & g5]ally a quantity ( black-color$ fluid may be express$ f ! cut surfaces4 ,hydatids4 ,acephalocy/s or animal hydatids1 h n unfrequ5tly be5 f\nd 9 ! lungs1 & 9 sev]al in/ances !y h be5 dis*>g$ by expectoration4 ,^! cy/s v>y 9 size f a *]ry to an egg1 & consi/ ( a d\ble membrane conta9+ a limpid fluid )9 :i* o!r hydatids may be f\nd1 ( ! same "* z ! p>5t cy/4 ,!y may excite inflammation & suppuration 9 ! tissues ar\nd1 & ?us become dis*>g$ into ! bron*ial tubes1 ! pleural cavity1 or ?r\gh ! diaphragm into ! abdom9al cavity4 ,cy/ic1 ,fibr\s1 ,c>tilag9\s1 & o!r =ms ( tumors1 are occasionally f\nd 9 ! lungs1 &1 :ile !y are g5]ally small1 !y may acquire su* size z to become a s\rce ( tr\ble dur+ life4 ,! ,bron*ial ,tubes4 ,! exam9ation ( ! tra*ea & bron*ial tubes 9 po/-mortem exam9ations1 is too frequ5tly omitt$4 ,! lungs hav+ be5 remov$ f ! *e/1 !y may be readily op5$ along _! po/]ior aspect1 & ! bron*ial tubes trac$ into ! sub/ance ( ! lungs4 ,! pa?ological conditions ( ! bron*ial tubes :i* may claim our att5tion1 are inflammation 9 its v>i\s =ms1 oblit]ation1 & dilatation4 ,bron*itis4 ,bron*ial inflammation has be5 divid$ into two v>ieties1 accord+ to ! portion ( ! tubes affect$4 ,9 "o case ! disease may be conf9$ to ! l>ge & m$ium siz$ tubes2 x is !n kn[n z tubul> bron*itis4 ,9 ! o!r1 x is seat$ pr9cipally 9 ! t]m9al ends1 :]e ! l9+ membrane is m delicate1 & ! tubes mu* small]1 & f ?is1 ext5d+ to ! air cells1 =ms :at has be5 call$ vesicul> bron*itis4 ,! latt] =m is closely alli$ to pneumonia2 9 fact ! two diseases pass into ea* o!r1 & 9 mo/ cases probably coexi/4 ,ord9>y1 or tubul> bron*itis1 is n (t5 a fatal disease1 h5ce we _c speak accurately ( its anatomical *>act]s2 yet1 be+ frequ5tly associat$ ) o!r =ms ( fatal disease1 we h opportunities ( exam9+ x "u ^? circum/ances4 ,! l9+ membrane is !n f\nd ?ick5$1 r\gh1 ( a d>k r$ or br[n color1 ) m or less contraction ( ! calibre ( ! tube1 & cov]$ ) a viscid1 jelly-l mucus1 (t5 /reak$ ) blood1 & 9 "s cases ( a puri=m "*4 ,?is =m ( bron*itis may occur z a prim>y disease1 or x may accompany tub]cul> consumption2 is frequ5t 9 cases ( he>t disease1 & may arise 9 ! c\rse ( typhoid fev]1 measles1 sc>let fev]1 & small-pox4 ,vesicul> bron*itis1 f its involv+ ! small] tubes & air cells1 is mu* m frequ5tly fatal ?an ! tubul> =m ( ! disease1 al?\gh 9 fatal cases ! two =ms w usually coexi/4 ,9 a po/-mortem exam9ation ( ^! cases1 we f9d ! bron*ial membrane r$ & inject$1 pulpy & ?ick5$4 ,9 a m advanc$ /age1 ! air cells & small] tubes are fill$ ) a viscid1 puri=m mucus1 :i* prev5ts ! air f rea*+ ! vesicles dur+ life1 & ! lungs f collaps+ ^u op5+ ! *e/ aft] dea?4 ,m9ute ulc]s are n uncommon ^u ! muc\s membrane1 ! effect ( ^!1 be+ t ( *ang+ ! "* ( ! secretion f a transp>5t mucoid1 to an opaque purul5t =m4 ,bron*ial inflammation1 z has be5 /at$ 9 ano!r place1 may result 9 emphysema ( ! lungs4 ,9 ^! cases1 a valvul>-l ob/ruction is produc$ 9 "s ( ! bron*ial tubes1 :i*1 (f]+ little imp$im5t to ! entrance ( ! air1 int]f]es ) its escape1 & ?us by produc+ increas$ pressure ^u ! air cells suppli$ by ! ob/ruct$ tube1 a gradual dilatation or rupture ensues1 result+ 9 ! =m] case 9 vesicul>1 & 9 ! latt]1 9 int]lobul> emphysema4 ,disease ( ! he>t may also result f *ronic bron*ial inflammation4 ,n only respiration1 b ! circulation may be s imp$$ z to ex]t a direct influ5ce ^u ! he>t4 ,f ! difficulty :i* ! blood enc\nt]s 9 fl[+ ?r\gh ! bran*es ( ! pulmon>y art]y1 ! ma9 trunk ( t vessel becomes p]man5tly dilat$1 :ile ! "r v5tricle1 f ! increas$ =ce requir$ to ov]come ! ob/ruction 9 ! lungs1 becomes gradually dilat$1 & at ! same "t1 p]haps1 hyp]trophi$4 ,f ! union ( ! two v5tricles1 ! excessive action ( ! "r may induce a simil> action 9 ! left1 & ?us 9 "t result 9 t hyp]trophy ( bo? v5tricles1 :i* is sometimes f\nd 9 p]sons :o h suff]$ f *ronic bron*itis4 ,n>r[+ or ,oblit]ation ( ,bron*ial ,tubes4 ,9 "s cases1 9 c>efully trac+ ! bron*ial tubes1 we may f9d ei!r a rem>kable n>r[ness ( ! vessel1 or a complete closure ( ! same4 ,9 ! =m] cases1 !re is a di/9ct ?ick5+ ( ! walls ( ! tube1 by an effusion ( lymph1 or blood & lymph1 into ! submuc\s tissues2 or1 f induration ( ! lung tissue ar\nd ! small] bron*ial tubes1 f tub]cul> or o!r deposits1 a simil> n>r[+ may result f ext]nal pressure4 ,complete closure may be f\nd 9 any portion ( ! tubes1 9 ! l>ge trunks1 aris+ f ! ma9 bran*es1 z well z 9 ! small] bran*es4 ,!y may be detect$ by pass+ a blunt probe into ! tubes4 ,! bran*es w frequ5tly be f\nd cont9u+ f ! po9ts ( closure1 z a fibr\s cord4 ,! mo/ common seat ( ^! closures is 9 ! upp] lobe ( ! lung1 yet !y h be5 f\nd 9 ! l[] lobes4 ,! causes ( oblit]ation ( ! bron*ial tubes is n well und]/ood1 yet1 !y are m frequ5tly obs]v$ 9 p]sons :o h suff]$ repeat$ attacks ( bron*itis1 or ( *ronic pneumonia4 ,dilatation ( ! ,bron*ial ,tubes4 ,?is condition ( ! bron*ial tubes is m frequ5t 9 its occurr5ce ?an oblit]ation4 ,x takes place 9 two =ms1 ei!r sev]al tubes are uni=mly dilat$1 l ! f+]s ( a glove1 or a s+le tube may =m a cavity1 by und]go+ a sacul> enl>gem5t4 ,"s me*anical ob/ruction1 by int]f]+ ) ! free passage ( air ?r\gh ! tubes1 w usually h caus$ ! difficulty1 z an enl>g$ bron*ial gl&1 press+ "o ( ! bron*i4 ,"h ! free exit ( ! respir$ atmosph]e be+ prev5t$1 an accumulation ( air takes place beh9d ! n>r[$ po9t4 ,any imp$im5t to ! entrance or exit ( ! air into ! lungs w produce irregul> & =cible brea?+1 & ?r[ a great] /ra9 ^u ^? p>ts especially :i* are 9 ! vic9ity ( ! ob/acle4 ,if1 at ! same "t1 ! pati5t suff]s an attack ( a/hma1 bron*ial cat>rh1 or :oop+-c\gh1 ! viol5ce ( ! c\gh mat]ially aids 9 develop+ ! dilatation4 ,! degree ( dilatation is greatly v>iable4 ,tubes :i*1 9 _! natural /ate1 are n l>g] ?an a cr[-quill1 may1 especially 9 ! l[] & middle lobes1 rea* ! size ( ! f+]1 :ile at v>i\s po9ts1 sacul> dilatations may occur1 :i* at fir/ sight may appe> z vomic1 b :i* ^u m c>eful inspection1 prove to be dilat$ portions ( ! bron*ial tubes4 ,! tubes 9 ?is /ate are usually fill$ ) a puri=m fluid1 ^u ! removal ( :i* ! l9+ membrane is se5 to be r$d5$ & s(t5$1 or p]haps ulc]at$4 ,?is condition ( ! bron*ial tubes may frequ5tly be detect$ dur+ life4 ,! voice is ho>se1 l a p]son 9 cr\p4 ,! c\gh is also ho>se & braz51 :ile ! brea?+ is difficult1 & mucus rattl+ is he>d 9 ! middle or l[] portion ( ! lung4 ,! po/-mortem appe>ances 9 cases ( =eign bodies 9 ! bron*ial tubes1 may be readily anticipat$ & easily recogniz$4 ,! ,m$ia/9um4 ,inflammation may arise 9 ! ant]ior m$ia/9um1 f fracture or c>ies ( ! /]num2 & 9 ! po/]ior1 f injury1 inflammation1 c>ies1 or necrosis ( ! v]tebr4 ,?is inflammation may also result 9 ! =mation ( an ,abscess2 or1 ulc]ation & p]=ation ( ! sophagus1 or inflammation ( ! lymphatic gl&s may lead to ! same results4 ,^! abscesses may rea* l>ge size1 result+ 9 displacem5t ( ! he>t1 & may rupture into ! pleural cavity1 ! tra*ea or sophagus4 ,tumors ( v>i\s k9ds1 may also develop )9 ?is space1 includ+ ! sev]al =ms ( canc]\s gr[?s4 ,! latt] w frequ5tly h _! orig9 9 ! bron*ial or lymphatic gl&s1 or1 p]haps1 9 ! remnant ( ! ?ymus gl&4 ,,"p ,,iii4 ,,! ,,abdom5 ,,& ,,pelvis4 ,,*apt] ,i4 ,,! ,,op]ation4 ,! cavity ( ! abdom51 may be op5$ )\t di/urb+ t ( ! *e/4 ,an incision f /]num to pubes1 d[n ! c5tral l9e1 & ?r\gh ! sup]ficial /ructures1 %\ld be foll[$ by a c>eful division ( ! t5d9\s portions ( ! muscles & p]itoneum1 = a suffici5t space to admit two f+]s1 :51 by introduc+ ! same1 ! rema9+ portion may be divid$ )\t risk ( injury to ! inte/9es4 ,a cross incision hav+ be5 made at ! umbilicus1 ! angul> flaps may be turn$ aside1 fully expos+ ! abdom9al cont5ts4 ,:]e ! *e/ is op5$ at ! same "t1 ! transv]se incision w n be requir$4 ,! p]itoneum1 ) any s]\s or o!r cont5ts hav+ be5 exam9$1 ! att5tion may be giv5 to any special organ or "p t may be involv$1 or ea* may be tak5 up s]iatim4 ,9 _m in/ances !re w be no occasion = remov+ any ( ! visc]a1 :ile 9 o!rs1 "o or all ( ! organs may require s c>eful an exam9ation1 z to necessitate an entire removal f ! body4 ,! small inte/9es may be remov$ en masse1 or 9 sections4 ,aft] apply+ d\ble ligatures at ! l[] end ( ! ileum1 & j bel[ ! duod5um1 ! b[el may be divid$ betwe5 ^!1 :51 by divid+ ! mes5t]y ne> its inte/9al bord]1 ) ei!r ! knife or scissors1 ! :ole mass may be remov$4 ,by means ( ! ent]otome1 !y may n[ be rapidly laid op5 ?r\gh _! entire l5g?1 ! cont5ts remov$1 & ! surface cleans$ if desir$ = m c>eful inspection4 ,occasionally1 portions only ( ! small inte/9es w require exam9ation4 ,by apply+ d\ble ligatures1 above & bel[ ! portion to be exam9$1 ! removal is effect$ )\t escape ( ! cont5ts into ! abdom9al cavity4 ,9 ! removal ( ! colon1 ei!r 9 sections1 or z a :ole1 ! same c>e %\ld be obs]v$ 9 ! application ( ! ligatures4 ,! rectum hav+ be5 divid$1 x may be lift$ & r5d]$ t5se1 its atta*m5ts1 ) ^? ( ! asc5d+ transv]se & desc5d+ colon1 be+ successively divid$ ) ! knife1 & ?us ! :ole gut remov$ & aft]w>ds split op5 ) ! ent]otome4 ,! removal ( ! rectum1 = ! exam9ation ( its :ole l5g?1 w usually require ! removal ( ! o!r pelvic visc]a1 directions = :i* w be giv5 fur!r on4 ,9 all cases :]e ! /oma* is to be exam9$1 x w be bett] fir/ to remove x f ! body4 ,to accompli% ?is1 bo? om5ta %\ld be deta*$ f ! curves ( ! /oma*1 :i* may be done ei!r ) ! f+]s or scissors4 ,! h& may n[ be c>ri$ d[n to ! c>diac end ( ! /oma* & ! f+]s =c$ ar\nd ! sophagus )\t ! use ( ! knife1 & a ligature plac$ ^u t tube4 ,a ligature %\ld also be plac$ j bel[ ! pyloric orifice1 & ano!r an in* bel[ ?is4 ,! knife or scissors may be us$ to divide ! sophagus close to ! diaphragm1 & ! duod5um betwe5 ! two ligatures2 ! /oma* may !n be lift$ f its position )\t loss ( any ( its cont5ts4 ,if ! object is m]ely to make a *emical analysis ( ! cont5ts1 ! /oma* %\ld be plac$ imm$iately 9 ! vessel prep>$ = its reception1 & c>efully seal$ & labell$4 ,if1 on ! o!r h&1 we may wi% to exam9e ! inn] surface ( ! organ1 x may be freely op5$ along "o ( ! curves ) ! scissors1 ! cont5ts remov$1 & ! muc\s surface cleans$ ) a /ream ( wat]1 = m satisfactory inspection4 ,bo? ! cont5ts & ! /oma*1 may /ill be pres]v$ = *emical exam9ation1 %\ld ! circum/ances ( ! case seem to require x4 ,f ! mann] 9 :i* ! duod5um is b\nd d[n to ! po/]ior abdom9al walls by ! p]itoneum1 "s little c>e w be requir$ 9 its removal4 ,ligatures %\ld be appli$ = reta9+ ! cont5ts1 z direct$ ) ! /oma*4 ,! kidneys1 ) ! supr>5al capsules1 may be rea*$ by lift+ ! inte/9es1 & te>+ op5 ! p]itoneum ) ! f+]s4 ,! gl& may !n be readily lift$ f its position1 & ! vessels divid$ ) ! knife4 ,to exam9e ! int]ior1 ! gl& may be split op5 longitud9ally along its convex bord]1 :i* w give a view ( ! cortical & pyramidal portions1 ) ! int]ior ( ! s9us & pelvis4 ,= microscopic exam9ation1 portions %\ld be h>d5$ 9 alcohol or solution ( bi*romite ( potassa4 ,! sple5 may be easily remov$ f its position1 by dragg+ x f its b$1 9 ! left hypo*ondriac region1 & divid+ its vessels & om5tal atta*m5ts to ! /oma*4 ,! pancreas may be br\ght into view1 by te>+ op5 ! great om5tum j b5ea? ! /oma*1 :5 ! gl& may be se5 beh9d ! p]itoneum1 ext5d+ transv]sely across 9 front ( ! aorta4 ,to remove x f its position w require "s c>e1 ow+ to its be+ b\nd d[n to ! po/]ior walls by ! p]itoneum1 & closely atta*$ to ! duod5um by its "r extremity or head4 ,! liv] may be g5]ally exam9$ 9 situ4 ,! condition & cont5ts ( ! gall-bladd]1 ! size1 color1 d5sity1 etc41 ( ! gl&1 may all be not$ )\t removal4 ,:]e1 h[ev]1 we may desire to asc]ta9 ! weight ( ! gl&1 or to exam9e its po/]ior & upp] surface1 its removal w be requir$4 ,:]e ! *e/ has previ\sly be5 op5$1 ?is w n be a difficult op]ation4 ,9 o!r cases1 ! c>tilages & ribs1 =m+ ! l[] b\nd>y ( ! *e/1 %\ld be /rongly elevat$ by an assi/ant2 ! op]ator !n1 by dragg+ d[n ! liv]1 hav+ fir/ divid$ ! susp5sory ligam5t1 may expose ! coron>y & lat]al ligam5ts1 :i* w require c>e 9 _! division1 to avoid op5+ ?r\gh ! diaphragm into ! *e/4 ,! f+]s %\ld be n[ freely us$1 to peel ! gl& f ! diaphragm4 ,f ! close connection ( ! liv] to ! asc5d+ v5a cava1 ?is vessel w require to be divid$ at ! upp] bord] ( ! liv]1 close to ! diaphragm1 & aga91 aft] ! gl& has be5 roll$ f its b$1 at its l[] bord]1 ) also ! portal vessels1 hepatic art]y & duct1 :i* rea* ! transv]se fissure ?r\gh ! bord] ( ! less] om5tum4 ,! liv] may n[ be lift$ f ! body1 & plac$ 9 any conv5i5t vessel = a m detail$ inspection4 ,! ,pelvic ,visc]a4 ,! :ole pelvic visc]a1 ) ! ext]nal organs ( g5]ation1 9 ei!r ! male or female1 may be remov$ toge!r1 9 ! foll[+ mann]3--,apply a d\ble ligature to ! upp] portion ( ! rectum1 & divide ! gut betwe54 ,! p]itoneum may n[ be divid$ ar\nd ! bord] ( ! pelvis1 9 ! female1 at ! same "t1 cutt+ across ! r\nd & broad ligam5ts ( ! ut]us1 :51 ) ! h&1 ! bladd] may be /ripp$ d[n f ! inn] side ( ! pubes1 ! rectum torn f ! holl[ ( ! sacrum1 & 9 ! same mann] ! p>ts torn (f f ! sides ( ! pelvis1 us+ ! knife only = divid+ ! m closely adh]+ po9ts4 ,n[1 aft] flex+ ! ?ighs ^u ! abdom51 an incision may be made ?r\gh ! sk9 ( ! mons v5]is j ov] ! ant]ior commissure ( ! vulva ( ! female1 & ov] ! p5is ( ! male1 & !n c>ri$ back ^u ei!r side ( ! g5ital organs1 meet+ beh9d ! anus1 ne> ! po9t ( ! coccyx4 ,?is incision may be c>ri$ ?r\gh ! sup]ficial tissues1 d[n to ! pubic ar*1 :5 ! crura ( ! p5is1 or clitoris1 may be deta*$ f ! rami ( ! pubes1 by c>ry+ ! knife close to ! bone4 ,! f+] may n[--aft] a slight use ( ! knife--be pu%$ b5ea? ! ar* ( ! pubis1 & made to appe> 9 ! pelvis4 ,tak+ ?is z a guide1 ! knife may be introduc$ at ?is op5+1 & c>ri$ deeply along ! ramus ( ! is*ium & pubis ( ei!r side1 divid+ ! levator ani muscle & pelvic fascia4 ,! bladd] may n[ be drawn =w>d b5ea? ! ar*1 ?is foll[$ by ! rectum1 deep incisions be+ c>ri$ back to ! tub]osities ( ! is*ia & po9t ( coccyx1 & ?us ! :ole mass remov$ entire4 ,! ext]nal p>ts may aft]w>ds be s drawn toge!r by /it*es1 z to make ! abs5ce ( ! ext]nal organs sc>cely noticeable1 :ile a bundle ( rags cr[d$ into ! pelvis f above1 w prev5t ! possible escape ( any ( ! abdom9al cont5ts4 ,:]e ! int]nal organs only1 are requir$ to be remov$2 aft] !y h be5 deta*$ ^u all sides z be=e direct$1 ! knife may be c>ri$ d[n b5ea? ! pubic ar*1 & ! ure?ra divid$1 9 ! male1 j 9 advance ( ! pro/ate4 ,incisions may n[ be c>ri$ back ^u ei!r side ( ! bladd] & rectum1 divid+ ! levator ani muscle1 :51 by draw+ upw>ds ^u ! mass1 ! rectum1 & 9 ! female1 ! rectum & vag9a1 may be divid$ ne> _! l[] ends1 & ! :ole remov$ toge!r4 ,9 _m cases x may be desir$ to remove ! ut]us ( ! female alone4 ,?is may be done by divid+ ! broad & r\nd ligam5ts ^u ei!r side1 :51 by dragg+ ! ut]us =cibly upw>ds1 ! vag9a may be cut across ab\t an in* bel[ ! c]vix1 & ?us ! organ remov$4 ,9 all cases1 a few rags %\ld be cr[d$ into ! pelvis = ! purpose ( prev5t+ ! escape ( any fluids4 ,9 hospital cases1 :]e p>ts are to be exhibit$ to a class1 & especially if sev]al organs are involv$ 9 ! disease1 ! :ole ?oracic & abdom9al visc]a may be remov$ toge!r & br\ght be=e ! class on a l>ge tray4 ,?is may be effect$ 9 ! foll[+ mann]3--,a s+le incision may be c>ri$ f ! upp] end ( ! /]num to ! pubes1 & ! /]num remov$ 9 ! usual mann]4 ,! tra*ea & sophagus1 ) ! l>ge vessels ( ! ar* ( ! aorta1 may n[ be divid$ at ! root ( ! neck4 ,grasp+ ! ar* ( ! aorta & ! tra*ea1 ! :ole ?oracic cont5ts may be /ripp$ f ! sp9al column4 ,! diaphragm be+ n[ sep>at$ f its atta*m5t to ! ribs on ei!r side & ! sp9al column1 ! :ole abdom9al cont5ts may1 9 ! same mann]1 be dragg$ f above d[nw>ds1 ! rectum ti$ & divid$1 & ! cont5ts ( ! two great cavities remov$ entire & ) little di/urbance ( ! relation ( p>ts4 ,9 clos+ up ! cavity aft] ! exam9ation is complet$1 ! visc]a hav+ be5 replac$1 a suffici5t quantity ( :eat5 bran or clean sawdu/ %\ld be ?r[n 9 to absorb any rema9+ fluids1 ?us prev5t+ _! escape aft] ! sew+ up ( ! incisions4 ,,*apt] ,,ii4 ,,pa?ological ,,conditions4 ,section ,i4 ,,( ,,! ,,p]itoneum4 ,notice 9 exam9ation3--#a4 ,cont5ts ( cavity--s]um2 am\nt1 color1 coagulable or n2 pus--am\nt1 consi/5ce1 odor1 s\rce2 blood--am\nt1 s\rce2 =eign bodies2 gall-/ones2 worms4 #b4 ,condition ( membrane--color1 transp>5cy1 r\gh or smoo?1 moi/ or dry1 ?ickness2 adhesions--position & /r5g? (4 ,vascul>ity2 ulc]s2 p]=ations2 tub]cles2 tumors2 w\nds1 etc4 ,?is membrane we f9d liable to conge/ion1 inflammation1 gangr5e1 effusions1 & morbid gr[?s4 ,conge/ion ( ! p]itoneum1 may result f ob/ruct$ circulation ?r\gh ! liv]1 or asc5d+ v5a cava1 or f inflammatory action2 & may t]m9ate 9 s]\s effusions into ! abdom9al cavity1 or ?ick5+ ( ! membrane4 ,! r$ness ( conge/ion1 may be di/+ui%$ f t ( inflammation1 by ! l>g] vessels appe>+ m involv$1 & by ! abs5ce ( any pla/ic effusions4 ,inflammation ( ?is membrane1 7,p]itonitis17 may be ei!r acute or *ronic4 ,acute p]itonitis1 9 mo/ in/ances1 comm5ces at "s "o or m po9ts1 & f ?is gradually diffuses itself ov] ! membrane until x becomes g5]al4 ,su* po9t ( inflammation may comm5ce imm$iately ov] "s inflam$1 or ulc]at$1 or p]=at$ spot 9 ! inte/9es1 or 9 ! p]itoneal cov]+ ( an inflam$ ut]us1 liv]1 etc41 or z ! result ( ext]nal injury4 ,9 ! e>ly /age ( p]itonitis1 ! inject$ vessels give ! membrane a m or less r$ appe>ance1 :i* w be m m>k$ 9 /reaks & pat*es4 ,f ! read9ess1 h[ev]1 ) :i* fibr9\s exudation takes place f ?is membrane1 ?is r$ness is seldom v /rongly m>k$1 & 9 "s in/ances w sc>cely be notic$1 unless ! surface is c>efully scrap$1 ?us remov+ ! exudation4 ,small extravasations ( blood are occasionally f\nd 9 ! sub/ance ( ! membrane4 ,! muscul> coat ( ! inte/9es1 :]e ! p]itoneal cov]+ is involv$1 may become infiltrat$ ) s]um1 ! fibres relax$ & p>alyz$1 ?us p]mitt+ ( ! great tympanitic di/5sion f\nd 9 ^! cases4 ,*ronic p]itonitis1 is n a v common occurr5ce4 ,x may1 h[ev]1 foll[ an attack ( acute p]itonitis1 & is sometimes f\nd 9 connection ) ascites1 or tub]cul> deposits 9 ! p]itoneum4 ,9 exam9+ ! body ( a color$ woman :o _h di$ ( he>t disease1 accompani$ ) g5]al dropsy1 & :o _h suff]$ abdom9al pa9 & t5d]ness = a numb] ( weeks previ\s to dea?1 a l>ge portion ( ! p]itoneum1 p>ticul>ly t reflect$ ^u ! abdom9al walls1 0 f\nd int5sely r$1 ! blood-vessels hav+ an arboresc5t arrangem5t1 & be+ beautifully inject$4 ,no pla/ic matt] 0 f\nd effus$ ^u ! surfaces4 ,! cavity conta9$ "s twelve qu>ts ( s]um4 ,fibr9\s ,exudation1 z already obs]v$1 readily foll[s inflammation ( ?is membrane4 ,x w (t5 be f\nd z a uni=m lay] cov]+ ! :ole surface ( ! p]itoneum1 r5d]$ m app>5t1 h[ev]1 by sep>at+ p>ts1 :5 x appe>s z delicate b&s or filam5ts1 /ret*+ across ! int]space4 ,9 cases ( acute inflammation1 ?is pla/ic effusion is (t5 v great1 & frequ5tly int]mix$ ) purul5t matt]1 :ile ! s]\s fluid1 :i* is p\r$ out 9 consid]able quantities 9 ^! cases1 is r5d]$ turbid by ! pres5ce ( num]\s flakes ( fibr91 & quantities ( pus cells diffus$ ?r\gh ! same4 ,m or less ext5sive & firm adhesion ( p>ts may ?us be induc$1 ! pla/ic matt] effus$ becom+ m & m firm1 & f9ally conv]t$ into d5se b&s ( fibr\s tissue4 ,me*anical ob/ruction & /rangulation ( ! b[els1 may be induc$ by ! pres5ce ( ^! b&s1 /ret*+ betwe5 p>ts1 & =m+ ?us an op5+ ?r\gh :i* ! b[el passes1 & f9ally becomes inc>c]at$4 ,suppuration is n an unfrequ5t result ( acute p]itonitis2 ! matt] be+ f\nd uni=mly sme>$ ov] ! :ole surface1 or1 9 "s cases1 conf9$ to a s+le "p1 ?us =m+ a circumscrib$ abscess4 ,adhesions hav+ tak5 place ar\nd ! b\nd>ies ( ! suppurat+ surfaces1 9 ?is mann] ! diffusion ( ! matt] is prev5t$1 & its dis*>ge into ! inte/9al canal1 or 9 "s in/ances ^u ! surface ( ! body1 is promot$4 ,gangr5e ( ! p]itoneum may result f intussusception or h]nial inc>c]ation ( "s portion ( ! b[el1 :5 ! "p w appe> z a s(t5$1 d>k1 (f5sive mass1 limit$ by a b& ( highly conge/$ tissue4 ,ascites4 ,dropsical accumulations 9 ! abdom9al cavity1 may result f ob/ruct$ circulation1 caus$ by disease ( ! liv]1 kidneys1 he>t or lungs2 or f pressure ^u ! v5a cava1 or portal ve91 by "s abnormal gr[?4 ,! fluid effus$ may be ne>ly colorless1 or pres5t v>i\s %ades ( yell[1 r$ or gre51 & usually coagulates on ! application ( heat4 ,! p]itoneum may appe> un*ang$1 or x may pres5t a ?ick5$1 opaque1 :ite or mac]at$ appe>ance1 9 *ronic cases4 ,blood may be f\nd 9 ! p]itoneal cavity1 z a result ( w\nds1 rupture ( "s ( ! abdom9al or pelvic organs1 or bur/+ ( an aneurism4 ,morbid ,gr[?s4 ,tub]cul> ,deposits1 ( ! mili>y =m1 are n unfrequ5t 9 ! p]itoneum4 ,!y may be diffus$ ov] ! :ole membrane1 z semi-transp>5t1 gray granules1 b m frequ5tly are f\nd on ! "u surface ( ! diaphragm1 9 ! neighborhood ( ! sple51 & on ! visc]a g5]ally1 :ile ! p>ietal lay] is m free4 ,! tub]cles1 act+ z =eign bodies1 give rise to inflammation1 usually ( a *ronic =m1 b suffici5t to result 9 exudation ( lymph1 & ! =mation ( adhesions betwe5 ! adjo9+ surfaces4 ,s(t5+ ( ! tub]cul> deposits sometimes takes place1 & p]=ation ( ! inte/9al wall results1 lead+ to an effusion ( ! inte/9al cont5ts into ! p]itoneal cavity4 ,canc] ( ! p]itoneum1 is sometimes se5 z a prim>y affection1 yet x m frequ5tly ext5ds to ?is membrane f "s ( ! deep] p>ts4 ,! encephaloid v>iety may be met )1 b ! colloid =m is t mo/ frequ5tly se54 ,! om5tum is ! occasional seat ( ?is =m ( canc]1 ! membrane 9 su* cases becom+ enorm\sly increas$ 9 size4 ,tumors ( v>i\s k9ds1 includ+ fibr\s1 fatty1 & cy/ic1 may be f\nd 9 ! p]itoneal cavity1 g5]ally hav+ _h _! orig91 h[ev]1 9 ! sub-p]itoneal tissues4 ,fatty tumors may orig9ate )9 ! sub/ance ( ! om5tum or mes5t]y1 :ile cy/ic tumors may be f\nd )9 ! broad ligam5ts ( ! ut]us or ov>ies4 ,section ,,ii4 ,,( ,,! ,,/oma*4 ,notice 9 exam9ation3--#a4 ,ext]nal *>act]s--position2 size2 =m2 adhesions4 #b4 ,cont5ts--quantity1 color1 odor1 reaction4 ,food--its nature1 degree ( dige/ion4 ,blood--pure or mix$ ) food2 probable s\rce4 ,=eign sub/ances--p[d]s1 metallic p>ticles1 spirits1 fcal matt]1 bile1 pus1 worms4 #c4 ,muc\s membrane--g5]al condition (2 color1 s(t or firm1 rug pres5t or abs5t2 ?ickness at v>i\s po9ts2 ulc]s2 _! position1 size1 etc4 #d4 ,muscul> coat--?ickness2 visibility ( fibres4 #e4 ,entire walls--transp>5cy2 w\nds2 p]=ations2 ruptures2 weight4 #f4 ,condition ( orifices--con/rict$2 dilat$4 ,tumors--position1 size1 "*1 etc4 ,few organs ( ! body are subject to su* a v>iety1 or to su* e>ly po/-mortem *anges z ! /oma*1 _m ( :i*1 be+ closely simulative ( ! effects ( disease1 r5d] a satisfactory exam9ation ( ?is organ1 9 _m in/ances1 v difficult4 ,!re=e1 be=e ent]+ ^u an acc\nt ( ! morbid anatomy ( ! organ1 ,i %all briefly notice ^? *anges :i* are po/-mortem 9 _! orig94 ,! ord9>y int]val :i* int]v5es betwe5 dea? & a po/-mortem exam9ation1 is1 9 mo/ in/ances1 suffici5t to s]i\sly *ange ! appe>ance ev5 ( ! heal?y /oma*4 ,h5ce our k ( ! heal?y appe>ance ( t organ1 at lea/1 previ\s to ! exp]im5ts ( ,dr4 ,beaumont ^u ! /oma* ( ,alexis ,/4 ,m>t91 0 q imp]fect4 ,po/-,mortem ,*anges4 ,among ^? *anges tak+ place aft] dea?1 :i* are no evid5ce ( disease dur+ life1 may be m5tion$3 ,fir/4 ,appe>ances ( ,conge/ion4 ,v soon aft] dea?1 or at lea/ )9 t5 or twelve h\rs1 by gravitation ( ! blood1 ! same hypo/atic conge/ion w be f\nd 9 ! mo/ dep5d5t portion ( ! /oma*1 t is se5 9 a m m>k$ degree 9 ! lungs1 or 9 ! subcutane\s tissues4 ,second4 ,color+ ( ,tissues4 ,n unfrequ5tly1 ! tissue ( ! /oma* w be f\nd /rongly t+$ by color+ matt] ( food or m$ic9e1 su* z ! r$ color ( w9e or logwood1 or ! black color ( ! metallic sulphurets1 etc4 ,?ird4 ,*ange ( ,%ape & ,size4 ,v>iations 9 ! %ape & size ( ! /oma* f ! normal /&>d1 are n unfrequ5tly f\nd aft] dea?4 ,x is sometimes f\nd unusually small1 app>5tly f ! influ5ce ( ! rigor mortis1 ! contraction necess>ily result+ 9 increas$ ?ickness ( ! walls4 ,:at is kn[n z h\r-glass contraction1 al?\gh sometimes cong5ital 9 its orig91 is frequ5tly b a manife/ation ( ! rigor mortis1 :5 x may be di/+ui%$ f ! =m] by inflation4 ,extreme dilatation1 ) ?9n+ ( ! walls1 is also sometimes se51 ?is condition result+ app>5tly f an abs5ce ( ! po/-mortem contraction4 ,f\r?4 ,exfoliation ( ,epi!lium4 ,! /oma* ( "y adults1 dy+ ( "s acute disease1 n unfrequ5tly is f\nd to h ?r[n (f ! epi!lial lay] ( its muc\s l9+1 ev5 :5 ! exam9ation is made soon aft] dea?1 & 9 cold wea!r4 ,9 _m ( ! heal?ie/ animals slaught]$ = food1 ! same *ange has be5 notic$ z e>ly z two h\rs aft] dea?4 ,! deta*$ cells are f\nd float+ 9 a ?ick mucus1 ! microscope also %[+ t ! ga/ric follicles h ?r[n (f _! epi!lial l9+1 ) _! peps9\s cont5ts4 ,) ?is *ange comm5ces ! po/-mortem dige/ion ( ! /oma*1 to be soon notic$4 ,! y\ng] & heal?i] ! subject1 & ! m acute ! disease caus+ dea?1 z a g5]al rule1 ! m rapidly & effectively does ?is exfoliation take place4 ,x may affect only ! summit ( ! folds into :i* ! muc\s membrane is ?r[n by ! contraction ( ! muscul> coat1 or x may uni=mly involve ! :ole muc\s surface4 ,fif?4 ,s(t5+ & ,p]=ation4 ,x is an int]e/+ fact1 t :ile ! tissues ( ! /oma* dur+ life are unaffect$ by ! ga/ric juice--! vitality ( ! tissues enabl+ !m to resi/ its solv5t p[]--aft] dea?1 !y imm$iately yield to its influ5ce1 & h5ce results a great] or less degree ( s(t5+ ( ! coats1 or ev5 9 "s in/ances1 complete p]=ation ( ! walls1 ! ext5t ( ! *ange dep5d+ ^u ! quantity ( ga/ric fluid 9 ! /oma* at ! "t ( dea?4 ,9 ^! cases !re is1 ( c\rse1 no evid5ce ( inflammation1 :ile ! tissues pres5t a pulpy1 gelat9\s appe>ance1 ! walls be+ greatly ?9n$1 & break+ d[n "u ! slighte/ =ce4 ,9 mo/ in/ances1 probably ! actual p]=ation is ! result ( ! =ce employ$ 9 lift+ ! /oma* f its position4 ,! op5+ 9 ^! cases is an irregul> ragg$ hole1 ) s(t1 pulpy m>g9s1 & w m frequ5tly be f\nd at ! l>ge or c>diac extremity ( ! organ4 ,9 "s extreme cases1 ! process ( s(t5+ has n be5 conf9$ to ! walls ( ! /oma*1 b has ext5d$ to ! adjo9+ organs1 z ! sple51 liv]1 or diaphragm4 ,! :iti%-gray & gelat9\s appe>ances ( ^! cases1 w enable u to di/+ui% !m f ord9>y cases ( s(t5+ & p]=ation f ulc]ation4 ,?is =m ( s(t5+ is especially obs]v$ 9 cases ( sudd5 dea? imm$iately aft] a meal1 :ile ! /oma* conta9s a l>ge quantity ( ga/ric juice4 ,x is also se5 mu* m frequ5tly 9 *ildr5 & "y p]sons ?an 9 ! ag$1 or ^? dy+ f *ronic =ms ( disease4 ,x has (t5 be5 notic$ 9 cases ( consumption1 h[ev]1 :i* is to be acc\nt$ = ^u ! fact t _m ( ^! pati5ts reta9 a good appetite to ! la/4 ,br9ton1 is ( ! op9ion1 t ! solv5t action ( ! ga/ric fluids ^u ! walls ( ! /oma*1 is promot$ by ! pres5ce ( vegetable or />*y food3--7#a7 by (f]+ little sub/ance ^u :i* ! fluids c exp5d !mselves2 & 7#b7 by produc+ by its decomposition1 an am\nt ( acid1 favor+ an en]getic action ( ! ga/ric fluids2 :ile on ! o!r h&1 ! action ( ^? fluids is ret>d$1 7#a7 by ! pres5ce ( alkal9e saliva1 or bile 9 any quantity2 & 7#b7 by ! pres5ce ( animal food ^u :i* ! juices may act4 ,,case4--,p]=ation ( ! ,/oma* 9 a *ild two ye>s ( age--dea? f ,hydrocephalus4 ,a *ild ( ,mr4 ,t----1 9 its second summ]1 _h an attack ( hydrocephalus1 f9ally dy+ 9 convulsions4 ,! autopsy1 made tw5ty-f\r h\rs aft] dea?1 disclos$ great conge/ion ( ! membranes ( ! bra91 ) two ounces ( s]um 9 ! v5tricles4 ,^u op5+ ! abdom9al cavity1 all ! visc]a appe>$ heal?y4 ,9 lift+ ! /oma* f its position1 a gu% ( color$ fluid appe>$ f beh9d x1 :i* at once l$ to ! suspicion ( a rupture4 ,! :ole organ 0 !n c>efully remov$1 :5 a ragg$ r5t1 ?r\gh :i* ! ?umb c\ld readily be pass$1 0 discov]$ at ! po/]ior portion ( ! c>diac end4 ,! walls ( ! /oma* at ?is po9t 7 extremely ?91 s(t & jelly-l2 ?is condition be+ pla9ly ! result ( ! po/-mortem action ( ! ga/ric juice1 :ile ! rupture 0 ! imm$iate consequ5ce ( lift+ ! organ f its position4 ,pa?ological ,/ates ( ! ,/oma*4 ,ga/ritis4 ,acute inflammation ( ! /oma* r>ely occurs1 except z a result ( "s *emical or me*anical irritation4 ,f ! exp]im5ts ( ,dr4 ,beaumont1 h[ev]1 we le>n t ! /oma* is extremely liable to v>i\s grades ( inflammatory action1 :i* pass+ rapidly ?r\gh _! sev]al /ages1 end f9ally 9 recov]y4 ,by wat*+ ! effects ( excesses 9 ! use ( alcoholic /imulants1 food1 condim5ts1 & ( ex]cise aft] meals1 etc41 he obs]v$ t ! pale1 p9k color1 natural to ! muc\s membrane ( ! heal?y /oma*1 0 ex*ang$ = a some:at livid ery!mat\s r$ness1 :i* 0 di/ribut$ ?r\gh\t ! organ 9 irregul> pat*es ( v>i\s sizes1 & 9 its mo/ int5se =m1 am\nt$ to a k9d ( ec*ymosis4 ,aga91 he notic$ an excessive gr[? ( epi!lium1 =m+ pat*es ( false membrane l1 :i* at v>i\s po9ts appe>$ di/5d$ by an accumulation ( a puri=m fluid b5ea?1 giv+ ! appe>ance ( little pu/ules4 ,! foll[+ =ms ( ga/ritis are g5]ally recogniz$3 #a4 ,cat>rhal ,ga/ritis4 ,?is1 9 its acute =m1 is seldom se5 9 po/-mortem exam9ations4 ,*ronic ,cat>rhal ,ga/ritis1 h[ev]1 is by no means uncommon1 & may be a result ( ! use ( alcoholic dr9ks1 ! pres5ce ( v>i\s irritat+ sub/ances tak5 ei!r z food or m$ic9e1 & may att5d _m =ms ( *ronic disease ( o!r organs1 or may be caus$ by ob/ruction to ! circulation f disease ( ! he>t1 liv] or lungs4 ,! po/-mortem appe>ances are nei!r v m>k$1 nor con/ant4 ,! muc\s membrane may be f\nd r$1 or ( a d>k color1 ?ick5$ & sometimes r\gh5$4 ,! submuc\s & muscul> coats may also be ?ick5$1 :ile less frequ5tly1 small ulc]s may be f\nd4 #b4 ,cr\p\s ,ga/ritis4 ,?is =m is v r>e1 & seldom diagno/icat$ dur+ life1 b may be f\nd ) *ildr5 :o h di$ ) cr\p\s inflammation ( ! air passages1 :5 small pat*es ( false membrane may be f\nd adh]+ to ! muc\s surfaces4 ,x may be f\nd 9 adults also1 z an att5dant ( c]ta9 grave =ms ( disease1 z typhus1 pu]p]al fev]1 *ol]a1 dys5t]y1 or 9 dea? f irritat+ poisons4 #c4 ,phlegmon\s ,ga/ritis1 is ano!r v r>e =m ( inflammation ( ! /oma*1 9 :i* ! disease involves all ! coats1 al?\gh orig9at+ 9 ! submuc\s1 & may de/roy ! pati5t 9 a few days ) symptoms ( p]itonitis4 ,! submuc\s tissues w be f\nd fill$ ) an exudation ( a s]o-pla/ic1 yell[i% sub/ance1 :i* produces ?ick5+ ( ! walls1 & :i* may be conf9$ to a portion or involve ! :ole organ4 ,effects ( ,poisons4 ,! effects ( cau/ic & o!r irritant poisons ^u ! /oma*1 z expos$ by a po/-mortem exam9ation1 w v>y accord+ to ! nature ( ! sub/ance1 & ! "t x may h rema9$ 9 ! /oma*4 ,r$ness 9 v>i\s degrees1 & ( v>i\s %ades1 ulc]ation1 s(t5+ & p]=ation1 may "o or all1 be detect$ 9 diff]5t cases4 ,9 l>ge quantities1 ! m9]al acids may leave ! muc\s membrane black1 & ( a s(t1 t>ry consi/5ce1 readily break+ d[n ^u h&l+ ! /oma*4 ,! peculi> action ( ! sev]al poisons w be notic$ 9 ano!r place4 7,see ,"p ,,iv47 ,ga/ric ,ulc]4 ,ulc]ation ( ! muc\s membrane ( ! /oma*1 is mu* less frequ5t ?an ( o!r portions ( ! inte/9al canal1 except z a result ( ! corrosive action ( poisons4#bj ,a peculi> k9d ( ulc]1 h[ev]--r>e 9 ?is c\ntry1 b said to be common on ! ,cont95t ( ,europe & 9 ,engl&--is sometimes f\nd1 :i* is ( int]e/1 f its occurr+ 9 tissues o!rwise heal?y1 & (t5 lead+ to a rapidly fatal t]m9ation4 ,rokitansky t]ms x ! p]=at+ ga/ric ulc]1 f its m>k$ t5d5cy to p]=ate ! walls ( ! /oma*4 ,x is situat$ 9 ! region ( ! pylorus1 & m frequ5tly at ! po/]ior surface & ne> ! less] curve4 ,x is ( a circul> =m1 ( ?ree to six l9es 9 diamet]1 & ) z %>p edges z if a r\nd piece ( ! walls _h be5 pun*$ out2 ! edges be+ bevell$ (f1 h[ev]1 f )91 leav+ ! p]itoneal op5+ less ?an t 9 ! muscul> or muc\s coats4 ,be+ usually situat$ ne> ! less] curve ( ! /oma*1 "s ( ! l>g] blood-vessels are liable to become involv$1 giv+ rise to hmorrhage m or less sev]e4 ,:ile b a s+le ulc] ( ?is description is g5]ally f\nd1 two1 ?ree or m1 may be pres5t4 ,a peculi>ity ( ?is =m ( ulc]1 consi/s 9 its n be+ dep5d5t ^u irritation or inflammation1 b r ^u a loss ( vital assimulative p[] 9 ! "p affect$4 ,?is =m ( ulc] may heal at any "t previ\s to p]=ation1 & x is n uncommon to f9d a cicatrix 9 ! muc\s membrane ( ! /oma* :i* has probably aris5 9 t way4 ,ga/ric ulc] is mu* m frequ5t 9 females ?an males1 & is ma9ly a disease ( middle & advanc$ life4 ,hmorrhagic ,erosions4 ,! appe>ance ( ! /oma*1 :]e !re has be5 frequ5t vomit+ ( blood f ?is cause1 is ?us describ$ by ,rokitansky3 8,!re are sev]al r\ndi% spots ( ! size ( a p9's head or pea1 or n>r[ elongat$ /reaks at :i* ! muc\s membrane appe>s d>k r$1 lax1 s(t & ble$+1 & pres5t+ a depression 9 consequ5ce ( loss ( sub/ance or slight erosion4 ,?is condition is inv>iably accompani$ by hmorrhage1 ! effus$ blood be+ mix$1 9 a m or less alt]$ /ate1 ) ga/ric mucus4 ,! erosions are (t5 v num]\s1 /udd+1 p]haps1 e "p ( ! /oma* except ! fundus1 ! pylorus be+ _! *ief seat40 ,?is condition ( ! /oma* is n peculi> to any =m ( disease1 or age1 b is frequ5tly associat$ ) intemp]ance4 ,x is r>ely fatal1 except by induc+ "s o!r lesion ( ! /oma*1 or by be+ unit$ ) "s m g5]al malady4 ,s(t5+ ( ! ,/oma*4 ,we h already ref]r$ to t =m ( s(t5+ ( ! /oma*1 :i* is attribut$ to ! action ( ! ga/ric juice aft] dea?4 ,ano!r =m is sometimes met )1 :i* evid5tly takes place dur+ life1 & 9 mo/ in/ances is attributable to a *ronic =m ( inflammation4 ,x is n always easy to di/+ui% ! two =ms ( s(t5+ )\t a k ( ! previ\s hi/ory ( ! case4 ,! di/9ction may1 h[ev]1 g5]ally be made by att5d+ to ! foll[+ po9ts3--#a4 ,! pres5ce dur+ life1 ( symptoms ( disease ( ! /oma*4 #b4 ,appe>ances ( conge/ion or inflammation1 z well z s(t5+1 aft] dea?4 #c4 ,ext5sion ( ! morbid *ange to o!r portions ?an t affect$ by po/-mortem s(t5+1 ! latt] be+ usually conf9$ to ! po/]ior portion ( ! c>diac end4 ,cirrhosis ( ! ,/oma*4 ,9 "s obscure cases ( ga/ric disease1 ^u op5+ ! abdom9al cavity 9 a po/-mortem exam9ation1 we may at once notice a m>k$ *ange 9 ! appe>ance ( ! /oma*4 ,x pres5ts a peculi> :it5ess & opacity1 an appe>ance :i* is p>tially due to a dulness ( ! p]itoneal coat1 9 m>k$ contra/ ) its usual brilliancy2 at ! same "t ! organ may be ei!r l>g] or small] ?an ! av]age size4 ,^u remov+ ! organ1 we f9d x greatly increas$ 9 weight & d5sity1 & pres5t+ a h>d1 gri/ly feel1 & ) s mu* ela/icity z to fail to collapse4 ,an incision %[s ! walls uni=mly ?ick5$1 to ! ext5t ( six or eight times _! normal condition2 ! :ole organ is comp>atively bloodless1 a condition /rongly 9 contra/ ) ! usual appe>ance aft] dea?4 ,a close inspection ( su* a specim51 %[s ! sev]al coats--muscul>1 muc\s & fibr\s--to be rem>kably alike1 ! ?ick5+ & increas$ d5sity1 result+ f ! pres5ce ( a g5]ally diffus$ imp]fect fibr\s /ructure1 simil> to t f\nd 9 common fibr\s tumors4 ,! sev]al coats ( ! /oma* w be f\nd unequally affect$ by ?is deposit4 ,! submuc\s /ructure1 z se5 9 a v]tical section1 be+ increas$ f t5 to tw5ty fold1 :ile ! s]\s ) ! subs]\s may be increas$ sev5 to t5 fold4 ,! muscul> tunic may be f\nd f five to eight times its normal ?ickness1 :ile ! muc\s membrane prop]1 is seldom m ?an d\ble4 ,not)/&+ ! bloodless "* ( ! walls ( ! /oma* 9 ?is disease1 ! abnormal condition is unque/ionably ! result ( a *ronic =m ( inflammation4 ,! symptoms dur+ life are usually obscure1 & al?\gh ! h>d contract$ /oma* may =m a sort ( epiga/ric tumor1 noticeable ^u ! surface1 ! abs5ce ( acute symptoms1 ) ! age at :i* ! disease makes its appe>ance--usually betwe5 tw5ty & ?irty--p]mits ( a ready di/9ction be+ made betwe5 ?is disease & canc]1 ) :i* x might o!rwise be conf\nd$4 ,atrophy ( ! ,/oma*4 ,?is condition ( ! /oma* c h>dly be look$ ^u z an indep5d5t malady1 be+ r an att5dant ( ! g5]al wa/+ ( c]ta9 diseases1 p>ticul>ly ( pulmon>y consumption1 m>asmus1 & />vation4 ,! organ1 9 ^! cases1 may be r$uc$ to less ?an half its normal proportions1 :ile its walls may be ?9n$ & frequ5tly s(t5$4 ,dilatation ( ! ,/oma*1 is ano!r condition t c sc>cely be consid]$ z a prim>y affection4 ,a great v>iation 9 ! size ( ?is organ is evid5tly compatible ) heal?1 l>ge eat]s hav+ necess>ily l>ge /oma*s1 yet z ! result ( c]ta9 o!r morbid conditions1 dilatation to an enorm\s ext5t may be induc$4 ,! foll[+ conditions may result 9 dilatation3 #a4 ,ob/ruction ( ! pylorus1 z 9 scirrhus ( t portion ( ! /oma*4 #b4 ,de/ruction ( a segm5t ( ! muscul> coat by ulc]ation1 or by becom+ involv$ 9 a canc]\s gr[?4 ,"h ! loss ( contract+ p[]1 p]mits ( a gradual dilatation1 f ! inability ( ! segm5t involv$ to aid 9 c>ry+ on ! cont5ts1 _! accumulation above ?is po9t aid+ 9 ! di/5sion4 #c4 ,an acute =m ( dilatation is sometimes met )1 :i* c only be attribut$ to a p>alysis ( ! muscul> & secret+ /ructures ( ! organ4 ,x occasionally happ5s to a pati5t recov]+ f a fev]4 ,he has p]haps ov]9dulg$ 9 eat+1 z is n unfrequ5tly ! case ) convalesc5ts1 & is sudd5ly seiz$ ) int5se pa9 9 ! /oma*1 foll[$ by rapid & great di/5sion1 & f9ally dea?4 ,! autopsy discloses ! /oma* enorm\sly di/5d$1 & its cont5ts1 includ+ matt]s1 9 "s cases1 :i* 7 +e/$ _m days be=e4 ,! muc\s membrane appe>s b little *ang$1 :ile ! muscul> coat is s ?9n$ & /ret*$1 z to appe> l a scatt]$ net-"w ( fibres4 ,morbid ,gr[?s4 ,canc]4 ,?is =midable disease occurs m frequ5tly 9 ! /oma*1 ?an 9 any o!r organ ( ! body1 except+ ! ut]us ( ! female4 ,! disease is usually prim>y 9 ?is organ1 b frequ5tly spr+s up second>ily 9 o!r p>ts4 ,! disease may occur 9 ! ?ree foll[+ =ms--! scirrhus1 m$ull>y1 & colloid2 :ile ,dr4 ,br9ton adds a f\r?1 ! vill\s canc] ( ! muc\s membrane4 ,! usual seat ( ! disease is at ! pylorus4 ,x may involve a portion or ! :ole circumf]5ce ( ?is op5+1 & f ?is ext5d along ! less] curve4 ,9 "s cases1 x comm5ces at ! c>diac orifice1 & v r>ely involves ! :ole organ1 ! fundus usually rema9+ free4 ,! walls ( ! /oma* may become greatly ?ick5$ 9 ?is disease1 ! inn] surface tub]culat$ & r\gh5$1 & ! cavity mu* dim9i%$ 9 size4 ,:5 situat$ at ! pyloric end1 ! disease seldom or nev] ext5ds into ! duod5um1 b :5 at ! c>diac1 x g5]ally involves ! l[] portion ( ! sophagus4 ,! fibr\s or scirrhus =m ( ! disease1 is by f> m commonly met ) ?an any o!r1 al?\gh x may be f\nd occasionally comb9$ ) ! m$ull>y1 or bo? ^! ) colloid4 ,inde$1 x is n improbable1 b t 9 _m cases1 a gr[? orig9ally scirrhus1 becomes gradually conv]t$ into "o ( ! o!r =ms4 ,9 almo/ all cases1 canc] comm5ces 9 ! submuc\s tissue1 9 ! =m ( a d5se mass1 ( a :ite color4 ,:5 cut1 ! surface pres5ts a :iti%-gray appe>ance1 contra/+ /rongly ) ! vascul> muc\s membrane ( ! /oma*1 & pres5t+ a di/9ctly /riat$ appe>ance4 ,a small portion "u ! microscope1 or ! juice scrap$ f ! cut surface1 w %[ ! peculi> canc] cell1 ) granul> matt]4 ,encephaloid or m$ull>y canc]1 may be develop$ ^u or )9 ! fibr\s =m1 or x may occur prim>ily z knotty tumors project+ ?r\gh ! muc\s membrane4 ,! microscopic appe>ance is mu* ! same z 9 ! fibr\s v>iety1 except t ! cells are n s closely pack$1 b are loosely held toge!r by an abundant1 s(t1 or liquid sub/ance4 ,! colloid =m ( ! disease1 may orig9ate ei!r 9 ! muc\s membrane itself1 or 9 ! submuc\s tissue4 ,x is kn[n by its pres5t+ a t\gh1 fibr\s-look+1 :ite tissue1 :i*1 arrang$ 9 int]sect+ b&s1 incloses irregul> spaces1 :i* are fill$ ) a cle>1 s(t1 or semi-liquid mat]ial1 ! prop] colloid sub/ance4 ,! vill\s canc]1 ,dr4 ,br9ton describes z aris+ 9 ! basem5t membrane ( ! muc\s coat1 & z b a modification ( ! epi!lial canc] ( o!r p>ts ( ! body4 ,! muc\s membrane cov]+ canc]\s gr[?s1 is subject to a v>iety ( *anges4 ,x may become conv]t$ into a sort ( fungoid gr[?1 :i* at po9ts suppurates1 %[+ ! submuc\s scirrhus tissue2 or x gradually s(t5s1 giv+ rise to hmorrhages4 ,! canc]\s mass itself1 may also s(t5 or suppurate1 result+ p]haps 9 p]=ation & p]itonitis2 or adhesions may take place1 foll[$ by ext5sion ( ! disease to ! liv]1 sple51 pancreas1 kidneys1 etc4 ,canc] ( ! /oma*1 9 ! great majority ( cases1 occurs 9 p]sons betwe5 fifty & sixty ye>s1 al?\gh x may appe> z e>ly z =ty1 or z late z sixty4 ,males appe> to be m subject to ! disease ?an females1 9 ! proportion ( f\r to ?ree4 ,! ob/ruction :i* ! pres5ce ( canc] ( ! /oma* is liable to produce1 may result 9 "o or m ( ! foll[+ conditions3 ,fir/1 hyp]trophy ( ! muscul> coat4 ,f increas$ nutrition1 ! muscul> fibres ( ! /oma* may become consid]ably increas$ 9 size & d>k] 9 color1 ?us bett] enabl+ !m to ov]come ! ob/ruction1 :i* 9 "s cases1 am\nts almo/ to occlusion4 ,second1 dilatation4 ,?is condition frequ5tly att5ds ! =m]1 & inde$ is seldom se5 alone4 ,x is conf9$ to ^? cases :]e ! canc] is at ! pylorus1 & is m noticeable at ! fundus ( ! organ4 ,?ird1 contraction4 ,?is is seldom se5 9 connection ) hyp]trophy1 & is f> less common ?an dilatation4 ,g5]ally f\nd 9 connection ) canc] at ! c>diac orifice1 x may be look$ ^u z ! result ( ! con/ant regurgitation :i* ! ob/ruction produces1 prev5t+ ?us ! cavity ( ! organ f und]go+ its normal di/5sion1 by ! pres5ce ( any quantity ( food4 ,tumors4 ,) ! exception ( canc]\s gr[?s1 tumors ( ! /oma* are by no means common4 ,fatty tumors are sometimes met )1 orig9at+ 9 ! submuc\s tissues1 & z !y increase 9 size1 !y may cr[d ei!r inw>ds t[>ds ! ga/ric cavity1 or outw>ds t[>ds ! p]itoneum4 ,fibroid tumors1 are also occasionally met ) 9 ! submuc\s tissues1 g5]ally 9 ! l9e ( ! less] curve1 & ab\t ! c>diac orifice4 ,polypoid gr[?s may also be f\nd spr++ f ! muc\s surface1 pres5t+ ! "* ( ^? =mations usually4 ,section #b4 ,,! ,,inte/9es4 ,notice 9 exam9ation3--#a4 ,ext]nal *>act]s--displacem5ts1 z 9 h]nia2 am\nt & condition ( involv$ b[el4 ,invag9ations--numb]1 position & size2 dilatations or contraction ( inte/9es2 app>5t cause (4 ,p]itoneal coat--inflam$ or n2 adhesions2 _! position1 /r5g?2 p]=ations1 etc4 #b4 ,cont5ts--gas2 mucus2 blood2 pus2 fcal matt]2 =eign sub/ances1 etc42 p>ticul>s 9 reg>d to ea*4 ,entozoa--numb] & "*4 #c4 ,muc\s membrane--g5]al condition2 conge/$1 inflam$1 ulc]at$4 ,orifice ( bile duct4 ,brunn]'s gl&s--inflam$1 enl>g$ or ulc]at$4 ,pey]'s pat*es--numb]1 situation1 g5]al condition1 ulc]ation1 etc4 #d4 ,ccum ) app5dix v]mi=mis--l5g?1 cont5ts1 ulc]s1 p]=ations1 etc4 #e4 ,rectum--prolapsus1 hmorrhoids1 fi/ul4 ,mal=mations4 ,! inte/9e is sometimes defective 9 "s "p ( its c\rse1 mo/ usually ne> its l[] extremity1 & g5]ally accompani$ ) an imp]=ate condition ( ! anus1 7atresia ani47 ,?is latt] may be ( v>i\s degrees1 consi/+ sometimes 9 a simple closure ( ! anus by a cont9uation ( ! integum5t ov] x2 9 o!r cases ! rectum t]m9ates 9 a bl9d p\* at a great] or less di/ance f ! anus4 ,sometimes ! inte/9e is unusually %ort1 )\t any di/9ction z to size betwe5 ! l>ge & small inte/9es4 ,x may t]m9ate at ! umbilicus1 or 9 a cloaca common to x & ! g5ito-ur9>y organs4 ,f9ally1 x may consi/ ( sev]al deta*$ ccal portions4 ,&ral notes ! foll[+ mal=mations3--,a s+le /raight canal f ! t]m9ation ( ! sophagus to ! comm5cem5t ( ! rectum2 a d\ble duod5um2 two colons2 an unusually l>ge1 & at same "t1 d\ble app5dix v]mi=mis4 ,div]ticula are n unfrequ5t4 ,!y are ccal app5dages1 resembl+ ! f+] ( a glove1 "o or m 9 numb]1 v>y+ 9 l5g? f a few l9es to sev]al in*es1 & giv+ (f at v>i\s po9ts4 ,l ! app5dix v]mi=mis1 !y may become a s\rce ( dang] by af=d+ a lodgem5t = indige/ible matt]s4 ,9 v r>e in/ances ! position ( ! inte/9es has be5 f\nd completely transpos$1 ) a correspond+ transposition ( all ! abdom9al visc]a1 or ( only "o organ4 ,inflammation4 ,vascul> injection by itself _c be tak5 z a decisive pro( ( ! exi/5ce ( inflammation4 ,ob/ruction to ! free return ( blood by ! ve9s1 dur+ life1 & ! gravitation ( blood to ! mo/ dep5d5t p>ts1 aft] dea?1 especially aft] fev]s1 c & d produce ?is v m>k$ injection4 ,9 g5]al1 h[ev]1 ! small] & m isolat$ ! pat* ( injection is1 ! m likely x is to be inflammatory 9 its orig94 ,cat>rhal inflammation may be ei!r acute or *ronic1 & may ei!r attack ! muc\s membrane uni=mly1 or be develop$ ma9ly 9 ! villi & follicles4 ,9 ! acute =m3 8,!re is m or less int5se r$ness & injection ( ! muc\s membrane1 affect+ its entire surface1 or appe>+ z puncti=m r$d5+ f affection ( ! villi1 or z a vascul> halo surr\nd+ ! follicles2 relaxation ( ! tissue1 & intumesc5ce ( ! muc\s membrane1 equally affect+ ! entire surface1 or only ! villi & follicles2 opacity ( ! muc\s membrane & its epi!lium1 f infiltration ( ! =m] & s(t5+ ( ! latt]2 friability & s(t5+ ( ! muc\s membrane4 ,! submuc\s cellul> tissue is inject$1 relax$ & infiltrat$ ) a wat]y opaque fluid2 ! secretion is at fir/ copi\s & s]\s2 z ! affection increases 9 int5sity x becomes opaque1 viscid & puri=m40 ,9 ! *ronic =m1 besides ! above signs1 we h also a d>k1 ru/y1 livid discoloration1 sometimes p]vad+ ! entire muc\s membrane2 ! muc\s membrane & its follicles are swoll51 ! tissue has become m d5se1 & ! surface cov]$ ) an opaque1 grayi%-:ite1 or puri=m mucus4 ,polypoid excresc5ces are sometimes f\nd ^u ! muc\s membrane4 ,bo? ! l>ge & ! small inte/9es may be affect$ by cat>rhal inflammation1 al?\gh ! *ronic =m seems to occur m frequ5tly 9 ! l>ge4 ,! muscul> coat ( ! inte/9es is also sometimes ! seat ( inflammation1 r>ely if ev]1 h[ev]1 z a prim>y disease1 b by ext5sion f ! s]\s cov]+ or muc\s l9+4 ,cr\p\s ,inflammation4 ,! muc\s membrane is also subject to a *ronic or sub-acute =m ( inflammation result+ 9 ! production ( an exudation mu* resembl+ t ( cr\p4 ,sometimes x =ms 9 a lay] ( "s ?ickness1 pretty uni=mly ov] ! surface1 or appe>+ 9 ! /ools z tubul> ca/s ( ! inte/9es2 sometimes x is v ?91 or consi/s ( m]e %r$s4 ,! anatomical *anges obs]v$ w be simil> to ^? j notic$4 ,p]ityphlitis is an inflammation ( ! loose areol> tissue ar\nd ! ccum1 occurr+ prim>ily or 9 consequ5ce ( typhlitis4 ,if n *eck$1 x ends 9 ! =mation ( abscess 9 ! "r iliac fossa1 :i* may dis*>ge ei!r into ! neighbor+ visc]a1 or ext]nally ?r\gh ! abdom9al walls1 mo/ly ne> ,p\p>t's ligam5t4 ,p]ipractitis is an inflammation ( ! areol> tissue ar\nd ! rectum4 ,! result+ abscess dis*>ges ei!r ext]nally1 back ( ! anus1 or 9 ! p]9eal region1 or int]nally into ! rectum1 or m r>ely into ! bladd]1 ! vag9a1 ! ut]us1 or into "s o!r "p ( ! inte/9es4 ,fi/ula 9 ano1 frequ5tly orig9ates 9 ?is mann]4 ,ulc]ation4 ,ulc]ation may occur z ! result ( inflammations bo? cat>rhal & cr\p\s1 & :e!r comm5c+ 9 ! muc\s or ! muscul> lay]1 ! ulc]s may p]=ate ! inte/9al walls & give rise to an escape ( ! cont5ts2 or ! ulc]s may cicatrize ) ! =mation ( ! usual fibroid tissue1 :i*1 by subsequ5t contraction1 may give rise to puck]+ or ob/ruction4 ,9 follicul> ulc]ation ( ! colon1 aft] li5t]y or t$i\s di>rha1 ! follicles are at fir/ tumefi$1 & project z small] or l>g]1 r\nd1 conical nodules on ! int]nal surface ( ! inte/9e1 surr\nd$ by a d>k r$ vascul> halo4 ,ulc]ation takes place 9 _! int]ior2 an abscess ) r$1 spongy walls appe>s2 ! follicle is eat5 away1 & an ulc] ( ! size ( a pea or l5til is =m$4 ,! muc\s membrane is ext5sively de/roy$1 & ) great rapidity4 ,! disease is always conf9$ to ! colon1 b :5 x runs a v rapid c\rse1 x may be accompani$ ) cat>rhal inflammation ( ! small inte/9es4 ,typhus ulc]s4 ,9 cont9u$ fev]s :]e ! disease especially attacks ! inte/9es1 we f9d an ulc]ation ( ,pey]'s pat*es & ! solit>y gl&s1 :i* is call$ typhus ulc]ation by ,rokitansky1 & is ?us describ$ by him3--8,aft] a prec$+ hyp]mia ar\nd ! solit>y follicles1 & 9 & ar\nd ,pey]'s pat*es1 !re is an enl>gem5t ( ! gl&ul> /ructures1 foll[$ by a s(t5+ & break+ d[n ( ! gl&ul> mass4 ,! cavity rema9+ on ! muc\s membrane aft] ! dis*>ge ( ?is mass con/itutes ! typhus ulc]4 ,its =m is elliptical1 if a l>ge pat* has be5 de/roy$2 r\nd1 if a small] pat* or a solit>y gl& has be5 de/roy$4 ,p>tial de/ruction ( a pat* w produce an ulc] ( irregul> %ape4 ,! size v>ies also1 accord+ to ! am\nt ( ulc]ation40 ,! m>g9 ( ! ulc] is inv>iably =m$ by a well def9$ fr+e ( muc\s membrane1 :i* is a l9e or m wide1 deta*$1 freely movable1 ( a blui%-r$1 & subsequ5tly ( a slaty or blacki%-blue color4 ,! base ( ! ulc] is =m$ by a delicate lay] ( submuc\s tissue1 :i* cov]s ! muscul> coat4 ,! l[] ?ird ( ! small inte/9e is mo/ liable to be involv$ 9 ! ulc]ative process1 ! numb] & size ( ! ulc]s increas+ z !y advance t[>d ! ileo-ccal valve4 ,dys5t]y may also produce ext5sive ulc]ation ( ! colon1 ) consid]able loss ( sub/ance4 ,?is loss may be repair$ by cicatrization4 ,9 "s cases1 ! cicatrix tissue1 cond5s$ into fibr\s b&s1 =ms projections into ! cavity ( ! inte/9e1 & n unfrequ5tly encroa*es ^u its calibre 9 ! %ape ( valvul> or annul> folds1 giv+ rise to /ricture ( ! colon4 ,dilatation4 ,disease ( ! n]v\s c5tres1 inflammation ( its s]\s tissue1 or simple atony ( ! muscul> fibres1 may be ! cause ( inaction ( ! inte/9e & consequ5t di/5sion4 ,/ricture w also produce di/5sion above itself1 by an accumulation ( ! cont5ts ( ! inte/9e4 ,9 ^! latt] cases1 ! dilatation is (t5 enorm\s4 ,contraction ( ! inte/9es may occur ?r\gh\t a consid]able ext5t1 or 9 a v small "p4 ,9 ! =m] case1 x results f ! canal hav+ be5 = "s "t empty1 & is mo/ likely to occur bel[ a /ricture4 ,x c h>dly be consid]$ 9 itself a morbid condition4 ,! second k9d ( contraction or con/riction1 is g5]ally morbid1 & may result ei!r f ext]nal pressure by tumor or o!rwise1 or f a disease ( ! tissue itself4 ,! cicatrices ( ulc]s :i* h assum$ an annul> %ape1 are ! mo/ frequ5t causes ( /ricture orig9at+ 9 ! inte/9e itself4 ,displacem5ts4 ,! mo/ common ( ^! con/itute ! v>i\s =ms ( h]nia4 #a4 ,+u9al ,h]nia4 ,"h ! inte/9es escape by ! +u9al canal1 & x is ,scrotal 9 man1 :5 !y desc5d into ! scrotum1 & ,pud5dal or ,vulv> 9 woman1 :5 into ! labia majora4 #b4 ,crural or ,femoral ,h]nia2 :5 ! inte/9es escape by ! crural canal4 #c4 ,h]nia at ! ,=am5 ,ovalis2 :5 ! visc]a escape ?r\gh ! op5+ :i* gives passage to ! obturator vessels4 #d4 ,is*iatic or ,sciatic ,h]nia2 :5 x takes place ?r\gh ! sacro-sciatic not*4 #e4 ,umbilical ,h]nia2 :5 x occurs at or ne> ! umbilicus4 #f4 ,epiga/ric ,h]nia2 occurr+ ?r\gh ! l9ea alba1 above ! umbilicus4 #g4 ,hypoga/ric ,h]nia2 :5 x occurs ?r\gh ! l9ea alba1 bel[ ! umbilicus4 #h4 ,p]9eal ,h]nia2 :5 x occurs ?r\gh ! levatorani & appe>s at ! p]9eum4 #i4 ,vag9al ,h]nia2 occurr+ ?r\gh ! p>ietes ( ! vag9a4 #aj4 ,diaphragmatic ,h]nia2 :5 x passes ?r\gh ! diaphragm4 ,a m detail$ description ( h]nia belongs to works on surg]y4 ,a h]nia1 if n r$ucible1 may1 by becom+ /rangulat$1 give rise to con/ipation1 hicc\gh1 vomit+1 & all ! signs ( viol5t inflammation4 ,gangr5e sup]v5es1 ) alt]ation ( ! features1 small pulse1 cold extremities1 & dea?4 ,inc>c]ation1 is a =m ( me*anical ob/ruction ( ! b[els1 diff]+ f h]nia1 9 !re be+ no escape ( ! inte/9e f ! abdom9al cavity1 z 9 ! latt] case4 ,x may arise 9 v>i\s ways1 b ! mo/ frequ5t =m is t 9 :i* a portion ( inte/9e becomes con/rict$ by means ( fibr\s b&s :i* h =m$ z a result ( p]itoneal inflammation4 ,pass+ f "o portion ( ! inte/9es to ano!r1 or f ! inte/9es to ! abdom9al walls1 a loop ( b[el may slip b5ea? or betwe5 ^! b&s1 & become s compress$1 z to int]f]e ) ! passage ( ! cont5ts1 & result 9 great dilatation ( ! gut above ! po9t ( /ricture4 ,complete /rangulation may f9ally result1 & ! pati5t die ) symptoms ( me*anical ob/ruction4 ,ano!r1 b less frequ5t =m ( inc>c]ation1 is :]e a portion ( inte/9e slips ?r\gh ! =am5 ( ,w9sl[1 or ?r\gh a cong5ital op5+ 9 ! mes5t]y1 z 9 ! foll[+ ,,case3--,dea? f ,/rangulation ( ! ,b[el1 f becom+ ,inc>c]at$ 9 an op5+ 9 ! om5tum4 ,m>y ,h----1 ag$ five ye>s1 0 tak5 sudd5ly ) great pa9 9 ! b[els at #b o'clock ,a4 ,m41 hav+ retir$ ! night be=e 9 p]fect heal?4 ,vomit+ soon set 91 accompani$ ) great ?ir/1 & ! :ole body became ba!d 9 a pr(use cold p]spiration4 ,! sev]e pa9 cont9u$1 & ! vomit$ matt] became /]corace\s4 ,i saw ! case at #aj o'clock ,a4 ,m41 & !n f\nd ! *ild 9 a moribund condition4 ,! brea?+ 0 rapid2 pulse v small & frequ5t2 sk9 pale1 damp & cold2 eyes sunk5 & nose p9*$4 ,rapidly s9k+1 %e di$ at #ab ,m4 ,autopsy tw5ty-f\r h\rs aft] dea?4 ,^u op5+ ! abdom9al cavity1 a l>ge portion ( ! inte/9es 0 f\nd ( a d>k purple or black color1 :ile ! rema9d] 0 p]fectly natural 9 color4 ,^u lift+ ! b[els & expos+ ! mes5t]y1 !re 0 f\nd an op5+ 9 ! latt]1 ( suffici5t size to receive ! ?umb1 & ?r\gh :i* a l>ge portion ( ! small inte/9es _h become cr[d$1 produc+ su* a twi/ 9 ! bord] ( ! mes5t]y z to h produc$ complete /rangulation ( ! b[el1 :i* _h rapidly pass$ into a gangr5\s /ate1 result+ 9 viol5t %ock & dea? 9 less ?an twelve h\rs4 ,! op5+ 0 situat$ at ab\t "o in* f ! inte/9al bord] ( ! mes5t]y1 & 0 pla9ly cong5ital 9 its orig91 z indicat$ by its smoo? & r\nd$ edges4#ba ,ano!r =m ( ob/ruction is sometimes f\nd1 & kn[n z ,volvulus1 9 :i* a loop ( b[el1 g5]ally ( ! small inte/9es1 becomes twi/$ ^u itself1 ! con/riction at ! base ( ! loop1 f9ally result+ 9 complete closure4 ,intussusception1 or invag9ation ( ! b[els1 consi/s 9 ! slipp+ ( a portion ( inte/9e into itself1 & g5]ally f above d[nw>ds4 ,ei!r ! l>ge or small inte/9es may be f\nd 9 ?is condition1 b x is mu* m frequ5t 9 ! l[] portion ( ! small b[els4 ,f a few in*es to a foot or m ( ! b[el may ?us become slipp$ into itself1 & x may be f\nd at m ?an "o po9t4 ,f ! con/riction :i* mu/ necess>ily att5d su* a displacem5t1 conge/ion ) hmorrhage may result1 or p]itoneal inflammation1 gangr5e1 & dea?1 ) symptoms ( me*anical ob/ruction4 ,9 "s r>e cases1 ! inn] or invag9at$ portion ( ! b[el sl\ghs (f1 adhesion takes place at ! po9t ( comm5cem5t ( ! intussusception1 & ! pati5t recov]s4 ,?is =m ( displacem5t may be f\nd 9 bo? *ildr5 & adults1 :]e ! appe>ance ( ! p>ts are su* z to r5d] x app>5t t x _h n be5 a s\rce ( tr\ble dur+ life4 ,rupture ( ! inte/9es may result f sev]e injury by bl[s1 or f a cru%+ =ce appli$ to ! abdom9al walls4 ,p5etrat+ w\nds ( ! b[els may be foll[$ by escape ( ! inte/9al cont5ts into ! p]itoneal cavity1 acute p]itonitis1 & dea?4 ,if ! b[el be empty at ! "t1 adhesions may =m betwe5 ! adjo9+ p>ts1 ! w\nd ?us clos$1 & recov]y foll[4 ,prolapsus ( ! rectum consi/s 9 a protrusion ( ! muc\s membrane or entire walls f ! anus4 ,! only po/-mortem *ange t may be detect$ is a relax$ condition ( ! coats ( ! b[el1 ) conge/ion ( ! muc\s membrane4 ,diseases ( ! ,anus4 ,^! include ulc] & fissure ( ! anus1 fi/ula 9 ano1 & hmorrhoids4 ,ulc]1 & fissure ( ! anus1 usually accompany ea* o!r1 ?\gh ei!r may exi/ alone4 ,! ulc]1 :5 pres5t1 is f\nd j )9 ! anus1 :ile ! fissure ext5ds f ?is across ! edge ( ! sph9ct]4 ,:ile ^! affections are trifl+ 9 _! po/-mortem appe>ance1 !y are ( great importance f ! local tr\ble & con/itutional irritation :i* !y may produce dur+ life4 ,fi/ula 9 ano1 consi/s 9 ! pres5ce ( a false passage along side ! rectum1 usually ! result ( a small abscess 9 ! is*io-rectal fossa4 ,x is said to be complete :5 x op5s at "o end into ! b[el1 & at ! o!r ?r\gh ! integum5t ne> ! anus2 & incomplete1 :5 x has b "o op5+1 :e!r t be on ! surface or 9 ! rectum4 ,hmorrhoids w be notic$ "u ! head ( ,morbid ,gr[?s4 ,canc]1 9 its v>i\s =ms1 may be f\nd 9 connection ) ! inte/9es1 :]e x is usually prim>y 9 its orig94 ,! scirrhus =m is m frequ5tly met ) 9 ! rectum1 & is likely to involve ! :ole circumf]5ce ( ! passage4 ,f ! t5d5cy :i* ?is =m has to contract ! p>ts1 /ricture ( ! rectum is likely to result1 :i* may become a s\rce ( great suff]+1 & f9ally ( dea?4 ,o!r =ms ( canc] may be f\nd 9 any portion ( ! inte/9es2 ! colon & rectum1 h[ev]1 be+ _! m frequ5t location4 ,canc] ( ! inte/9es is v liable to ext5d to ! surr\nd+ tissues & organs1 & 9 _m cases1 p]=ations ( ! b[el1 or fi/ul\s communications betwe5 ! rectum & bladd] 9 ! male1 or ut]us or vag9a 9 ! female1 may result4 ,tub]cles1 g5]ally ( ! mili>y =m1 may be f\nd )9 ! coats ( ! inte/9es1 pr9cipally conf9$ to ! p]itoneal cov]+ h[ev]4 ,!y may occasionally be f\nd 9 ! muc\s coat1 & 9 ! walls ( follicul> ulc]s ( t membrane4 ,tumors ( v>i\s k9ds may be f\nd 9 connection ) ! inte/9e4 ,fatty tumors may orig9ate )9 ! muc\s membrane1 & project z polypoid gr[?s into ! cavity ( ! b[el2 or !y may comm5ce 9 ! app5dices epiploic1 & deg5]ate into a cy/ic tumor ) fluid cont5ts1 or become infiltrat$ ) calc>e\s matt]2 or ! p$icle may become atrophi$ & ! tumor deta*$1 & f\nd free 9 ! p]itoneal cavity4 ,ad5oid tumors may result f hyp]trophy ( ! sev]al =ms ( gl&s ( ! inte/9es1 & appe> z s(t1 r\nd$1 & p]haps p$unculat$ tumors1 :i* are liable to become ulc]at$4 ,fibroid tumors ( small size & polypoid =m1 may be f\nd 9 any "p ( ! inte/9es1 & are g5]ally consid]$ z a result ( *ronic inflammation4 ,hmorrhoids or piles1 consi/ 9 a dilatation ( ! ve9s ( ! l[] portion ( ! rectum1 ) a ?ick5+ ( _! walls1 & increase ( surr\nd+ fibr\s tissue4 ,!y may be int]nal or ext]nal4 ,! conta9$ blood may coagulate =m+ a ?rombus4 ,! walls may rupture1 giv+ rise to hmorrhages1 or become inflam$ & suppurate4 ,abnormal cont5ts4 ,! normal cont5ts ( ! b[els may be f\nd mix$ ) ! v>i\s products ( inflammation1 includ+ mucus1 s]um1 blood & pus4 ,bili>y calculi & =eign bodies ( v>i\s k9ds1 may be f\nd1 :i* may h produc$ no effects1 or !y may h s]v$ z nuclei1 ar\nd :i* ! salts ( lime1 bile1 mucus1 fcal matt]1 etc41 may h accumulat$1 produc+ inte/9al concretions4 ,p>asites4 ,! inte/9al canal is infe/$ by sev]al =ms ( entozoa1 among :i* may be f\nd ! foll[+3 ,asc>is lumbricoides2 ! common r\nd worm1 six to t5 in*es 9 l5g?4 ,x may be s+le or 9 l>ge numb]s4 ,oxyuris v]micul>is2 a small :ite worm1 measur+ f two to f\r l9es 9 l5g?1 & f\nd only 9 ! l>ge inte/9es1 & ma9ly 9 ! l[] "p ( ! rectum1 :]e !y may be pres5t 9 l>ge numb]s4 ,tri*9a spiralis4 ,?is p>asite is f\nd 9 ! small inte/9e1 & only 9 its adult =m4 ,x measures f less ?an a l9e1 to two l9es 9 l5g?4 ,! embryos p5etrate ! walls ( ! inte/9e1 & f9ally locate 9 ! muscles1 :]e !y rema9 encapsulat$4 ,if a portion ( ?is muscle is eat5 by ano!r animal1 ! l>v aga9 become active1 & acquir+ ! mature sexual =m1 reproduce1 ! "y embryos aga9 migrat+ to ! muscles4 ,tricocephalus disp>4 ,f\nd only 9 ! head ( ! colon1 & measures "o & a-half to two in*es 9 l5g?2 neck long1 & body ( male cov]$ ) w>t-l app5dages on "o side4 ,di/oma lanceolatum4 ,flat1 lancet-%ap$1 & transp>5t1 a-half in* long1 "o-qu>t] wide4 ,r>ely f\nd 9 upp] portion ( small inte/9es1 natural habitat appe>+ to be 9 ! bile passages4 ,( tapeworms1 ! foll[+ v>ieties may be f\nd3 ,tnia solium4 ,head ab\t ! size ( a p9-head1 & furni%$ ) suck+ disk & d\ble r[ ( hooks2 neck long & n>r[2 body flat & jo9t$1 ea* segm5t ab\t a-half in* 9 l5g?2 body may be f t5 to fifty or m feet 9 l5g?4 ,tnia m$iocanellata4 ,head truncat$ & de/itute ( hooks2 body jo9t$ & ( great l5g?4 ,tnia flavopuncta4 ,v r>e4 ,yell[ spot at ! middle ( ea* jo9t4 ,bo?riocephalus latus1 7broad tapeworm47 ,head long1 un>m$2 neck inconspicu\s2 body compos$ ( ab\t two ?\s& jo9ts2 mature jo9ts broad] ?an long4 ,section ,,iv4 ,,! ,,pancreas4 ,notice 9 exam9ation3--#a4 ,ext]nal *>act]s--mal=mations2 position2 size2 =m2 adhesions4 #b4 ,sub/ance--color2 consi/5ce2 w\nds2 abscess2 tub]cul> deposits2 canc]2 cy/s4 #c4 ,ducts--calibre2 cont5ts2 pus or blood1 etc4 ,anomalies ( ! pancreas are n common4 ,x is want+ only 9 v imp]fect mon/rosities4 ,excess ( developm5t is v r>e4 ,sometimes ! duct is d\ble1 up to ! po9t ( its entrance into ! duod5um4 ,hyp]trophy & ,atrophy4 ,! =m]1 :5 x does occur1 :i* is r>ely ! case1 affects *iefly ! cellul> tissue :i* is int]wov5 ) ! gl&ul> tissue4 ,atrophy (t5 occurs spontane\sly 9 old age1 or x may result f *ronic inflammation or fatty deg5]ation4 ,! organ may be s(t1 or ( a lea!ry consi/5ce4 ,inflammation4 ,! acute =m r>ely occurs1 & is m>k$ by ! same signs ( inflammation z are obs]v$ 9 inflammation ( simil> organs4 8,*ronic inflammation induces cond5sation1 induration ( ! cellul> tissue1 oblit]ation ( ! ac9i1 & ei!r p]man5t enl>gem5t1 or subsequ5t atrophy ( ! gl&40 ,fatty ,deg5]ation is ( frequ5t occurr5ce 9 drunk>ds1 associat$ ) fatty liv]1 b due to ! intrusion ( ! surr\nd+ adipose tissue on ! wa/+ organ4 ,dilatation ( ! ducts ( ! pancreas occurs f an ob/ruction ( its outlets by pressure ( a tumor1 or by ! pres5ce ( calc>e\s concretions4 ,! dilatation may be uni=m or saculat$1 =m+ cy/s :i* may atta9 a consid]able size4 ,canc]1 only 9 ! =ms ( scirrhus & encephaloid1 affects g5]ally ! head ( ! pancreas4 ,x may occur prim>ily or second>ily4 ,! ductus *ol$o*us is frequ5tly ob/ruct$ by ! pressure ( ! tumor1 & jaundice produc$4 ,! disease may ext5d to ! duod5um1 ! om5tum1 ! mes5t]y1 liv]1 & ev5 ! supr>5al capsules & kidneys4 ,z second>y canc]1 x is mo/ frequ5tly an ext5sion f a scirrhus pylorus4 ,section ,v4 ,,! ,,sple54 ,notice 9 exam9ation3 #a4 ,ext]nal *>act]s--color1 size1 weight1 =m1 adhesions2 surface smoo? or r\gh2 capsule ?ick5$1 etc4 #b4 ,sub/ance--color2 consi/5ce2 w\nds2 rupture2 abscesses2 tub]cle2 canc]2 deg5]ations2 tumors1 etc4 ,cong5ital ,anomalies4 ,9 acephal\s mon/]s ! sple5 is g5]ally abs5t4 ,occasionally 9 subjects o!rwise well develop$1 x is want+1 toge!r ) ! /oma* or ! fundus ( ! /oma*4 ,cong5ital displacem5ts h be5 met )4 ,sup]num]>y sple5s1 v>y+ 9 numb] & small 9 size1 are frequ5tly met )4 ,hyp]trophy & ,atrophy4 ,probably no organ ( ! body is z liable to su* great v>iations 9 size z ! sple54 ,! normal sple5 9 ! adult1 9 :om x atta9s its greate/ size1 is usually ab\t five in*es 9 l5g?1 ?ree to f\r 9 bread?1 & an in* or an in* & a-half 9 ?ickness1 & weighs ab\t sev5 ounces4 ,its size is increas$ dur+ & aft] dige/ion1 & v>ies consid]ably accord+ to ! /ate ( nutrition ( ! body4 ,9 typhus ! sple5 is enl>g$1 ! p>5*yma exce$+ly s(t1 its color a dirty r$1 ( diff]5t %ades4 ,9 leukmia x is also f\nd greatly enl>g$1 b ( a d5s] consi/5ce4 ,rokitansky /ates t ! sple5 n unfrequ5tly measures sixte5 in*es 9 l5g?1 sev5 9 bread?1 & f\r in*es 9 ?ickness1 & its weight may am\nt to twelve or f\rte5 p\nds1 or1 accord+ to o!rs1 to tw5ty or ev5 =ty p\nds4 7,hus*ke47 ,mo/ ( ! hyp]trophies ( ! sple5 are accompani$ n only by an engorgem5t ( ! v num]\s vessels1 b by an alt]ation & increase ( ! r$1 pulpy p>5*yma4 ,atrophy may r$uce ! sple5 to ! size ( a h5's egg or a walnut4 ,x takes place normally 9 advanc$ age4 ,displacem5ts4 ,"s ( ^! are cong5ital3 ?us x has be5 f\nd by ! side ( ! bladd]2 9 ! "r side ( ! ?orax2 9 ! left ?oracic cavity :5 ! diaphragm 0 abs5t2 & ext]nal to ! abdom5 9 l>ge umbilical h]ni1 or :]e ! abdom9al walls _h n clos$4 ,o!r displacem5ts are ! result ( disease4 ,! enl>gem5t or di/5sion ( adjac5t p>ts1 or increase 9 its own size ) laxity ( its ligam5ts1 causes x frequ5tly to be displac$1 & ev5 to desc5d into ! pelvis4 ,rupture occasionally happ5s z ! result ( injuries4 ,spontane\s rupture 9 int5se conge/ions dur+ typhus1 *ol]a1 & ! cold /age ( ague1 has occurr$4 ,?is always proves fatal4 ,inflammation4 ,prim>y inflammation ( ! sple5 is comp>atively r>e4 ,unless x ends 9 resolution1 x gives rise to ! =mation ( laudable pus or fibr91 :i* may ei!r be conta9$ 9 a circumscrib$ abscess1 & !nce become obsolete1 or ! cavity may enl>ge until ! pus p5etrates into ! left ?oracic cavity1 ! /oma*1 ! transv]se colon1 or ! p]itoneum4 ,second>y spl5itis is reg>d$ z id5tical ) pymic deposits4 ,! deposits are well def9$1 always at ! p]iph]y1 cunei=m 9 %ape1 ! apex direct$ inw>ds4 ,_! color is d>k] ?an ! surr\nd+ tissue1 & _! consi/5ce firm]4 ,!y are ei!r conv]t$ into a cellulo-fibr\s callus1 :i* contracts & causes a cicatrix 9 ! surface2 or 8into a puri=m1 creamy mass2 or into a sani\s gre5i%1 gre5i%-br[n1 or *ocolate-color$ pulp40 ,!re are also fibr9\s deposits frequ5tly f\nd 9 ! p>5*yma ( ! sple51 class$ by "s among ! ph5om5a ( second>y spl5itis1 b reg>d$ by o!rs z a simple exudation ( fibr91 f an excess ( ?is 9 ! blood4 ,^! deposits appe> z a circumscrib$ yell[i% mass1 ) a m>g9 ( d>k] or light] r$ conge/ion ( increas$ consi/5ce1 easily recogniz$ :5 h&l+ ! "p1 8& %[+ "u ! microscope a confus$ mass ( granul> ) m or less oily matt] infiltrat$ among ! rema9s ( ! p>5*yma4 ,!y v commonly und]go fatty deg5]ation40 ,*ronic ,?ick5+ ( ! ,capsule ( ! sple5 is ( frequ5t occurr5ce4 ,x seems to take place at ! exp5se ( ! p>5*yma ( ! organ1 & may proce$ to a v great ext5t4 ,x is usually pretty uni=m4 ,ossification ( ! ?ick5$ fibroid lay]s is r>e1 except 9 old p]sons4 ,amyloid ,deg5]ation ( ! ,sple54 ,! disease may be limit$ to ! ,malpighian corpuscles1 con/itut+ ! s-call$ 8sago sple510 or x may ext5d & implicate ! pulpy p>5*yma betwe5 ! corpuscles4 ,! sago sple5 is m or less enl>g$2 its weight & d5sity are increas$4 ,on section1 ! surface appe>s smoo?1 dry1 & /udd$ ) gli/5+ sago-l bodies1 v>y+ 9 size4 ,an iod9e solution gives !m a r$di%-br[n color4 ,9 ! m advanc$ /age1 :]e ! pulp is infiltrat$ ) ! new mat]ial1 ! organ g5]ally is mu* l>g] ?an 9 ! sago sple54 ,x is h>d & firm2 ! capsule t5se & transp>5t4 ,! cut surface is dry1 homog5e\s1 transluc5t1 bloodless1 ( a uni=m d>k1 r$di%-br[n color4 ,! organ c be cut l wax4 ,! corpuscles are obscur$ by ! surr\nd+ pulp4 ,morbid ,gr[?s4 ,tub]cul\s matt] is commonly deposit$ 9 ! sple51 only 9 connection ) g5]al tub]culosis4 ,x appe>s 9 ! =m ( gray granulations1 mili>y crude tub]cles1 or yell[i% *eesy masses ( v>i\s sizes4 ,cy/s h be5 obs]v$ 9 ! capsule ( ! sple54 ,!y are small1 ( conical %ape1 & lighti% r$ color1 conta9+ num]\s granul> cells1 float+ 9 a transp>5t liquid4 ,hydatid cy/s may be f\nd 9 ! sple5 alone1 or at ! same "t ) "o 9 ! liv]4 ,canc] is r>e4 ,! encephaloid is ! only =m met )1 & g5]ally only ) simil> disease 9 ! liv]1 /oma* or om5tum4 ,section ,,vi4 ,,( ,,! ,,liv]4 ,notice3 #a4 ,ext]nal *>act]s--relation to o!r organs & ext5t uncov]$ by c>tilages ( ribs2 adhesions--_! ext5t1 position1 firmness1 etc4 #b4 ,aft] removal--weight2 measurem5ts2 =m2 color2 puck]+s2 r\gh or smoo?2 granulations2 tub]cles2 cy/s1 etc4 ,capsule--?ickness1 transp>5cy2 facility ( removal2 appe>ance ( liv] sub/ance b5ea?4 #c4 ,int]nal /ructure--appe>ance ( cut & fractur$ surfaces2 fluids expressible2 appe>ance ( lobules2 abscesses2 fi/ul2 calc>e\s deposits2 tub]cles2 gr[?s2 cy/s2 w\nds2 rupture1 etc4 #d4 ,gall-bladd]--abs5t2 size2 %ape2 adhesions4 ,cavity--oblit]at$4 ,cont5ts--bile2 quantity1 color1 consi/5ce2 mucus2 pus1 etc4 ,gall-/ones--numb]1 size1 =m1 color1 int]nal "*4 ,walls--?ickness2 deposits2 adipose or calc>e\s2 abscess2 tub]cle2 canc]2 w\nds2 rupture4 ,ducts--calibre2 dilat$ or contract$2 imp]vi\s2 f :at cause8 cont5ts2 condition ( walls & muc\s membrane4 ,! liv]1 9 its normal /ate 9 ! adult1 w measure f t5 to twelve in*es 9 its transv]se diamet]1 f six to sev5 9 bread? at its wide/ "p1 & ab\t ?ree in*es ?ick at ! po/]ior bord] ( ! "r lobe2 its weight be+ f ?ree to f\r p\nds4 ,! gl& is mu* l>g] 9 infants 9 proportion to ! size ( ! body4 ,9 ! adult1 ! av]age weight ( ! liv] is b "o-=tie? ( t ( ! entire body1 :ile 9 infancy1 x may be z mu* z "o-?irtie? or ev5 "o-tw5tie?4 ,! natural color ( ! liv] may be describ$ z a r$di%-br[n or mahogany color1 yet ! %ade may v>y to a consid]able degree 9 diff]5t cases4 ,9 /udy+ ! morbid anatomy ( ?is organ1 we %all notice fir/1 *anges peculi> to ! liv] itself1 & secondly1 ^? connect$ ) ! gall-bladd] & gall-ducts4 #a4 ,diseases ( ! ,liv]4 ,conge/ion4 ,f ! l>ge size & ext5sive di/ribution ( vessels ?r\gh ! liv]1 ?is gl& is capable ( conta9+ a l>ge am\nt ( blood1 & 9 cases ( ret>d$ circulation 9 o!r p>ts1 z 9 ! recession ( blood f ! cutane\s vessels 9 a *ill1 ! vessels ( ! liv] may become greatly di/5d$1 con/itut+ :at is kn[n z conge/ion4 ,al?\gh ! gl& is closely inve/$ ) ! capsule ( ,glisson1 yet1 ! ela/icity ( ?is membrane w admit ( consid]able di/5sion1 & h5ce ! great enl>gem5t att5d+ ?is condition ( ! gl&4 ,conge/ion ( ! liv] may be p>tial1 conf9$ to "o or m lobes2 or g5]al1 involv+ ! :ole gl&4 ,x may also be active or passive4 ,active conge/ion ( ! liv] may result f bl[s or injuries ov] ! region ( ! gl&1 f suppression ( hmorrhoid dis*>ges1 or suppression ( ! m5ses 9 ! female4 ,x w !n be f\nd pres5t+ a deep r$ color1 may be greatly increas$ 9 size1 is m firm1 & be=e op5+ ! body1 may be frequ5tly felt bel[ ! m>g9 ( ! ribs on ! "r side4 ,"o ( ! mo/ frequ5t causes ( passive conge/ion ( ! liv]1 is organic disease ( ! he>t1 accompani$ ) ob/ruction 9 ! circulation ?r\gh ! lungs1 giv+ rise ?us to difficulty 9 empty+ ( ! "r side ( ! he>t1 & ( ! v5\s sy/em g5]ally4 ,a *ronic =m ( conge/ion ( ! liv] may result f emphysema ( ! lungs1 l>ge pleuritic effusions1 or tumors )9 ! *e/1 & is frequ5tly f\nd 9 p]sons ( s$5t>y habits :o h be5 8high liv]s10 or 9 ^? :o h us$ l>ge quantities ( alcoholic or f]m5t$ liquors1 or 9 ! resid5ts ( hot climates or mal>ial di/ricts4 ,tempor>y conge/ion ( ! liv]1 al?\gh v extreme1 does n result 9 /ructural *ange2 b :5 aris+ f a p]man5t cause1 z disease ( ! he>t1 etc41 x produces ! foll[+ effects3--8,! di/5d$ capill>ies ( ! portal-hepatic plexus press on ! int]v5+ cells2 ^! become 9 "p atrophi$ or /unt$2 9 extreme cases almo/ de/roy$2 9 "p !y are gorg$ ) yell[ matt] to su* a degree t !y appe> z opaque masses4 ,! quantity ( yell[ matt] ?us =m$ is f> great] ?an any t exi/s 9 a heal?y /ate ( ! organ1 & z "s ( x is d\btless absorb$ & c>ri$ into ! blood1 we f9d 9 ?is circum/ance "s explanation ( ! ict]ic hue :i* is s (t5 obs]v$ 9 su* pati5ts4 ,:e!r long-cont9u$ conge/ion produces /ill fur!r *anges is n yet made out cle>ly40#bb ,extreme conge/ion ( ! liv] may sometimes result 9 ,hmorrhagic ,effusion1 ! blood be+ ei!r p\r$ out ne> ! surface1 & dissect+ up ! capsule1 or m deeply 9 ! sub/ance ( ! gl&2 or1 ruptur+ ! capsule1 x may escape into ! p]itoneal cavity4 ,su* effusions may be f\nd 9 new-born *ildr5 aft] protract$ & difficult labors1 or z a result ( ext]nal viol5ce1 & sometimes att5d malignant fev]s1 scurvy1 & purpura4 ,p]ihepatitis4 ,! p]itoneal cov]+ ( ! liv]1 v frequ5tly 9 po/-mortem exam9ations1 pres5ts appe>ances ( hav+ be5 attack$ by inflammation1 9 ! pres5ce ( b&s ( adhesion connect+ diff]5t portions ( ! surface ( ! gl& to adjo9+ organs4 ,! :ole ( ! upp] surface w sometimes be f\nd closely unit$ 9 ?is mann]1 to ! diaphragm4 ,su* appe>ances are sure indications ( ! exi/5ce at "o "t1 ( an attack ( p]itoneal inflammation4 ,9 a cirrhos$ condition ( ! gl&1 & ov] ! seat ( abscesses ( ! liv]1 su* adhesions almo/ univ]sally =m4 ,inflammation ( ! p]itoneal cov]+ ( ! "u surface ( ! liv]1 may result f an ext5sion ( ! disease f an inflam$ /oma* or duod5um1 or f ! pres5ce ( a bili>y calculus impact$ 9 "s ( ! ducts2 su* inflammation result+ 9 m or less ext5sive adhesion ( ! p>ts 9 contact4 ,! pres5ce ( hydatid or canc]\s masses1 are n usually att5d$ ) ^! evid5ces ( inflammation4 ,sc>-l ,m>ks1 are n uncommonly f\nd on ! surface ( ! liv]4 ,! p]itoneum at ^! po9ts seems drawn into ! sub/ance ( ! gl&1 at ! c5tre ( ! m>k1 :ile radiat+ ridges ext5d 9 v>i\s directions1 to ! di/ance ( a-half to ?ree-f\r?s ( an in*4 ,! cause ( ^! appe>ances is evid5tly inflammation ( ! p]itoneum1 ext5d+ to ! subs]\s tissue1 & p]haps to ! liv] sub/ance4 ,hepatitis4 ,inflammation ( ! liv] may be acute or *ronic4 ,acute inflammation ( ! liv]1 ?\gh a frequ5t occurr5ce 9 hot climates1 is seldom met ) 9 cold or temp]ate4 ,! gl& 9 ?is condition1 is f\nd m or less swoll5 & enl>g$1 & ! tissues some:at s(t5$4 ,?is condition may be conf9$ to "o or m lobes1 or involve ! :ole gl&4 ,:]e a section is made1 ! turgid swoll5 tissue rises above ! p]itoneal cov]+1 along ! edges ( ! incision4 ,z ! disease advances to a lat] /age1 ! deep r$ color *anges to a br[ni% or grayi%-r$1 pat*es ( ^! be+ m+l$ ) o!rs ( a yell[i%-r$ or pale yell[4 ,acute inflammation ( ! liv] may t]m9ate 9 resolution1 :5 !re w be a gradual re/oration to a normal condition1 or 9 suppuration1 & ! =mation ( an abscess2 ! latt] result be+ mu* m common4 ,abscess ( ! liv] may involve ! great] portion ( ! "r or left lobe4 ,! sub/ance ( ! gl& imm$iately ar\nd ! abscess1 w appe> unusually r$1 & p]haps a little h>d5$1 :ile o!r portions may pres5t ! appe>ance ( heal?4 ,9 "s in/ances1 f a complete de/ruction ( ! hepatic tissue1 ! p]itoneal cov]+ w =m ! only protection to ! conta9$ matt]4 ,! quantity ( purul5t matt] conta9$ 9 ^! abscesses may v>y f half a p9t or less1 to "o or two qu>ts4 ,! inflammation att5d+ ! =mation ( an hepatic abscess1 w usually ext5d to ! p]itoneum1 result+ 9 ! =mation ( adhesions to ! adjo9+ organs1 & ?us prev5t+ ! abscess1 9 _m in/ances1 f dis*>g+ into ! p]itoneal cavity1 z x o!rwise w\ld be likely to d4 ,abscesses ?us =m$1 may dis*>ge3 #a/1 by ! adhesive process ?r\gh ! diaphragm into ! *e/1 & if adhesions _h previ\sly tak5 place betwe5 ! diaphragm & lung1 by an ext5sion ( ! ulc]ative process1 ! matt] may f9d its way into ! bron*ial tubes1 & ?us be dis*>g$ by expectoration2 #b;d1 by a simil> process into ! /oma*1 duod5um or colon2 #c;d1 ^u ! surface ( ! body2 & #d?1 )9 ! p]itoneal cavity4 ,9 ! latt] case1 dea? is inevitable2 9 ! o!rs recov]y is possible4 ,! foll[+ case illu/rates dis*>ge & recov]y by ! fir/ me?od3 ,,case4--,abscess ( ! ,left ,lobe ( ! ,liv]1 dis*>g+ ?r\gh ! diaphragm1 a portion ( ! matt] expectorat$1 ! balance dis*>g$ ^u ! surface ( ! body--,recov]y4 ,9 ! w9t] ( #ahef-g1 ,i 0 call$ to see ,mrs4 ,b----1 ag$ #dj1 ( ,broad /reet4 ,%e _h be5 giv5 up by ! physicians previ\sly 9 att5dance4 ,f\nd h] greatly emaciat$1 suff]+ f a t]rible c\gh1 & expectorat+ great quantities ( excessively (f5sive matt]4 ,di>rha1 hectic fev]1 night sweats1 ) occasional *ills1 complet$ ! picture1 & appe>$ to r5d] ! case p]fectly hopeless4 ,^u inquiry1 le>n$ t %e _h be5 tak5 ill "s mon?s previ\sly1 ) :at ! att5d+ physician _h pron\nc$ z acute hepatitis4 ,aft] ! usual acute symptoms1 ! =mation ( an abscess became evid5t f ! fulness 9 ! region ( ! left lobe1 accompani$ ) *ills1 hectic1 etc4 ,a viol5t c\gh1 ) evid5ces ( inflammation 9 ! left lung1 accompany+ ! o!r symptoms1 ! case 0 suppos$ to be complicat$ ) tub]culosis4 ,! expectoration f9ally became gre5i%1 ?ick & exce$+ly (f5sive1 indicat+ t ! abscess _h work$ its way into ! bron*ial tubes4 ,9 exam9+ ! *e/1 aft] ! case _h be5 "u my c>e a few days1 ,i notic$ betwe5 ! n9? & t5? ribs a fulness & slight r$ness4 ,aft] ! application ( p\ltices = a few days1 a di/9ct 8po9t+0 appe>$1 f :i*1 aft] ! use ( ! lance1 came a mo/ copi\s dis*>ge ( ! same gre51 (f5sive matt]1 z 0 be+ dis*>g$ by expectoration4 ,f ?is "t1 a slight improvem5t 0 notic$ 9 ! pati5t4 ,! ext]nal op5+ 0 c>efully kept f clos+4 ,! c\gh gradually improv$4 ,little or none ( ! (f5sive matt] 0 rais$ aft] ! e/abli%m5t ( ! ext]nal op5+4 ,9 six mon?s ! heal? 0 fully re/or$1 & n[1 fifte5 ye>s aft]1 %e is a /\t1 heal?y woman4 ,9 ! progress ( =mation ( an abscess 9 ! liv]1 z bran*es ( ! portal or hepatic ve9s are rea*$1 inflammation ( _! coats is excit$1 :i* results 9 _! oblit]ation1 ?us g5]ally prev5t+ ! admission ( pus into ! v5\s sy/em4 ,b z ! enl>g+ abscess encroa*es ^u ! hepatic ducts1 in/ead ( ^! becom+ clos$ by inflammation1 !y ulc]ate ?r\gh1 & ?us e/abli% a communication betwe5 ^! vessels & ! cavity ( ! abscess4 ,h5ce ! pus conta9$ 9 ^! abscesses1 is v likely to be m+l$ ) m or less bile2 :ile at ! same "t1 a portion ( ! cont5ts may be dis*>g$ ?r\gh ! common duct into ! b[els4 ,abscess ( ! liv] may result f inflammation & ulc]ation ( ! bile ducts1 f ! irritation ( impact$ calculi1 or f ! pres5ce ( inte/9al worms t h ent]$ by ! ductus communis2 or f ! lodgm5t ( emboli 9 "s bran* ( ! portal ve9 or hepatic art]y4 ,second>y1 ,pymic or ,meta/atic ,abscess4 ,! liv] is occasionally ! seat ( abscesses =m+ z a result ( pymia1 induc$ by absorption ( pus f "s w\nd ( a jo9t1 ve91 or bone2 or f a diffus$ abscess or erysipelas ( ! sk94 ,^! abscesses usually conta9 a some:at ?9 & oily-look+ pus4 ,!y also diff] f ord9>y abscesses 9 ! rapidity ) :i* !y =m1 a few days g5]ally suffic+ to give !m a l>ge size4 ,! insidi\s mann] 9 :i* !y =m--! tissues break+ d[n1 z x 71 )\t any inflammation--con/itutes a di/+ui%+ feature ( ^! collections4 ,pymic abscesses ( ! liv] are usually _m 9 numb]1 & v>y+ 9 size f a pea to t ( a walnut4 ,! gl& is usually enl>g$ at ! same "t1 & 9 "s cases to su* an ext5t z to rea* q to ! umbilicus4 ,?is =m ( abscess is n conf9$ to ! liv]1 b may be f\nd 9 ! lungs1 sple51 9 ! jo9ts1 or 9 ! s]\s cavities1 & sometimes diffus$ ?r\gh ! connective tissues & muscles ( ! limbs or trunk4 ,deg5]ations ( ! ,liv]4 ,waxy1 ,l>dace\s1 or ,amaloyd ,liv]4 ,9 ?is =m ( disease1 ! liv] und]goes great] enl>gem5t ?an 9 any o!r disease except+ canc]4 ,! enl>gem5t is uni=m 9 e direction1 s t ! =m ( ! gl& is un*ang$4 ,pa9 & t5d]ness are nev] prom95t symptoms ( ?is disease1 h5ce ! liv] may be manipulat$ dur+ life ) impunity1 ! pati5t compla9+ only ( weight & tightness 9 ! "r hypo*ondrium4 ,! progress ( ! disease is usually sl[1 ext5d+1 9 mo/ cases1 ov] sev]al ye>s4 ,! sple51 kidneys & inte/9es w frequ5tly be f\nd pres5t+ ?is *ange at ! same "t4 ,! tissue ( ! gl& 9 ^! cases is v firm1 s t ! organ g5]ally reta9s its =m :5 laid ) its convex surface on ! table4 ,! ext]nal surface is smoo? & free f adhesions4 ,:5 cut1 a peculi> transluc5t sub/ance is f\nd infiltrat$ ?r\gh ! tissues1 giv+ x a firm1 gli/5+ appe>ance1 kn[n z waxy1 l>dace\s1 amaloyd1 album9\s1 or sometimes scr(ul\s liv]4 ,?is sub/ance is /a9$ a deep r$ by ! action ( a weak solution ( iod9e4 ,! *ange appe>s to comm5ce fir/1 9 ! small blood-vessels1 f9ally ext5d+ to ! lobules1 appe>+ fir/ 9 ! c5tre1 & ultimately involv+ ! :ole lobule4 ,! disease is m common 9 males ?an females1 & is frequ5tly caus$ by con/itutional syphilis4 ,9 "s in/ances1 x w\ld appe> to be produc$ by a tub]cul> dia!sis1 & coexi/s ) "s local =m ( scr(ul\s disease1 or by a long exposure to mal>ial influ5ces4 ,fatty ,liv]4 ,?is =m ( disease we f9d 9 drunk>ds2 9 p]sons :o h be5 l>ge eat]s & s$5t>y 9 habit2 9 sev]al wa/+ diseases1 z 9 *ronic di>rha1 & especially 9 ph?isis pulmonalis4 ,!re is a mod]ate degree ( enl>gem5t :i* affects all portions ( ! gl&4 ,! consi/5cy is s(t]1 & ! resi/ance less ?an 9 waxy liv]1 giv+ x a d\ghy feel4 ,! color v>ies1 b is usually light] ?an normal1 approa*+ a yell[1 & m or less mottl$4 ,:5 cut1 ! sub/ance pres5ts a decid$ly oily appe>ance1 bo? to ! feel & sight4 ,! disease is unaccompani$ ) pa9 f fir/ to la/2 nei!r is its function mat]ially int]f]$ )1 h5ce jaundice is n usually a symptom ( ! disease4 ,a microscopic exam9ation %[s ! lobules ( ! liv] fill$ ) fat globules1 :i* appe> to h orig9at$ 9 ! hepatic cells4 ,! *ange appe>s to comm5ce at ! circumf]5ce ( ! lobule1 ! c5tre rema9+ normal 9 color1 ?us giv+ a mottl$ appe>ance to ! cut surface4 ,o!r organs are v liable to be affect$ at ! same "t by ?is =m ( disease1 z ! he>t1 kidneys1 etc41 ! symptoms :i* ! case pres5ts1 su* z album9\s ur9e1 t5d5cy to dropsy1 dyspna1 etc41 aris+ f ^! organs1 r ?an f ! fatty liv]4 ,pigm5t>y ,deg5]ation4 ,9 cases ( mal>ial poison+1 we sometimes f9d ! liv] ) o!r organs ( ! body1 z ! sple51 lungs1 bra91 kidneys1 etc41 pres5t+ a peculi> d>k color1 ! result ( ! pres5ce ( a black or br[n pigm5t 9 ! blood1 fill+ ! vessels ( ^! organs4 ,! pigm5t appe>s to be =m$ ( small granules ei!r free or conta9$ 9 irregul> cells4 ,9 ! liv]1 ?is pigm5t is f\nd mo/ abundant 9 ! blood ( ! portal ve91 b may be pres5t 9 ! hepatic art]y1 & 9 all ! v5\s capill>ies4 ,! liv] may be normal 9 size1 or x may be atrophi$ or hyp]trophi$1 or may h und]gone fatty or waxy deg5]ations4 ,granul> ,deg5]ation4 ,a peculi> *ange 9 ! liv] sub/ance is sometimes f\nd aft] dea? f v>i\s acute or infecti\s diseases1 z ! exan!mata1 pymia1 septicmia1 erysipelas1 typhus1 typhoid1 & yell[ fev]1 etc42 or f ?rombosis ( ! portal ve91 abscesses or cirrhosis1 z well z 9 poison+ by ars5ic1 phosphorus or antimony4 ,! *ange 9 ! e>ly /age consi/s 9 an accumulation 9 ! liv] cells1 ( a f9e granul> sub/ance1 soluble 9 alkalies1 & app>5tly ( an album9\s nature2 &1 at a lat] /age1 ( co>s] %9+ p>ticles ( a fatty "*1 & soluble 9 !r or alcohol4 ,atrophy ( ! liv] may be divid$ into ! foll[+ =ms3 ,i4 ,simple ,atrophy4 ,,ii4 ,acute or ,yell[ ,atrophy4 ,,iii4 ,*ronic ,atrophy1 or ,cirrhosis4 ,simple ,atrophy4 ,by ?is1 we und]/& a dim9ution 9 ! size ( ! liv]1 )\t any alt]ation 9 its /ructure4 ,9 ?is /ate1 ! liv] may be r$uc$ to "o-half its normal weight & bulk4 ,x is f\nd to occur3 #a4 ,old age4 ,h5ce ?is =m ( atrophy is sometimes call$ 8s5ile atrophy40 ,) ! loss ( adipose tissue 9 advanc+ ye>s1 !re is also a t5d5cy ei!r to deg5]ation or wa/+ 7atrophy7 ( _m ( ! organs1 & especially ( ! liv]4 ,9 ?is mann]1 ! liv] may be r$uc$ to "o-half its normal size & weight )\t any *ange ( /ructure4 #b4 ,inanition1 aris+ ei!r f an insuffici5t supply ( food1 or f diseases :i* int]f]e ) ! assimilation ( food1 may result 9 simple atrophy ( ! liv]4 #c4 ,ext]nal pressure may also produce ! same result1 z f tight lac+1 pleuritic1 p]ic>dial1 or p]itoneal effusions1 or f enl>gem5t ( organs1 or pres5ce ( tumors ne> ! liv]4 ,simple atrophy is r>ely att5d$ ) jaundice unless pressure ^u ! bile ducts has be5 su* z to ob/ruct ! fl[ ( t fluid4 ,acute1 or ,yell[ ,atrophy4 ,9 ?is some:at r>e =m ( disease1 ! liv] becomes rapidly atrophi$1 accompani$ ) jaundice & c]ebral symptoms4 ,aft] dea?1 ! organ is f\nd greatly r$uc$ 9 size1 extremely s(t & yell[1 ) no appe>ance ( lobules1 & ^u microscopic exam9ation1 ! secret+ cells f\nd m or less *ang$ into granul> matt] & oil globules4 ,! weight ( ! gl& 9 ^! cases1 may be r$uc$ f ?ree to f\r p\nds1 ! av]age normal weight1 to less ?an two p\nds4 ,?is =m ( disease is frequ5tly att5d$ ) hmorrhages1 p>ticul>ly ( ! /oma* & b[els1 & 9 "s in/ances1 f ! ut]us or nose4 ,pregnant females suff]+ f ?is affection usually abort4 ,among ! causes ( ?is =m ( disease ( ! liv] may be m5tion$ pregnancy1 dissipation1 con/itutional syphilis1 mal>ia1 & ! blood-poison+ ( typhus fev]4 ,females appe> mu* m liable to ! disease ?an males1 & mo/ p]sons attack$ are "u middle age4 ,*ronic ,atrophy1 ,cirrhosis or ,hob-nail ,liv]4 ,! =m ( atrophy ( ! liv] :i* we n[ h to consid]1 is sl[ 9 its progress1 & is usually associat$ ) abdom9al dropsy4 ,! appe>ance & d5sity ( ! gl& v>ies to a consid]able ext5t 9 diff]5t cases ( *ronic atrophy1 yet ! usual appe>ance is t se5 9 :at is kn[n z cirrhosis1#bc or 8hob-nail liv]10 also sometimes call$ 8g9-dr9k]'s liv]40 ,"h ! liv] has become r$uc$ 9 size1 f a sl[ de/ruction ( ! secret+ tissue1 :ile1 at ! same "t1 ! fibr\s tissue ( ,glisson's capsule has become ?ick5$ & h>d5$1 f a *ronic inflammatory action1 (t5 due to ! use ( spiritu\s liquors4 ,! out] surface pres5ts a granul> or nodulat$ "*1 :i* has giv5 rise to ! t]m 8hob-nail10 z appli$ to ?is disease2 :ile1 ^u section1 ! int]ior pres5ts firm fibr\s b&s1 surr\nd+ yell[ pat*es ( secret+ tissue4 ,:ile1 9 ! majority ( cases1 ?is disease is pla9ly ow+ to an abuse ( spiritu\s liquors1 9 o!rs1 x is f\nd associat$ ) disease ( ! he>t1 or ) con/itutional syphilis1 :]e ! pati5t has be5 /rictly temp]ate4 ,! increas$ d5sity1 9 connection ) ! dim9ution ( size1 & granulat$ "* ( ! surface1 r5d]s ! disease readily recognizable 9 a po/-mortem exam9ation4 ,! e>ly /age ( ?is disease appe>s to be accompani$ ) a degree ( enl>gem5t ( ! gl&1 result+ f ! conge/ion att5d+ ! inflammation ( ! fibr\s /ructure4 ,z ?is /ructure increases 9 d5sity1 by pressure x causes a gradual absorption ( ! secret+ lobules1 & ?us results 9 a r$uction 9 ! size & weight ( ! organ4 ,! secret+ cells ( ! lobules ( ! liv]1 may und]go fatty *ange1 or !y may become entirely de/roy$4 ,?rombi may be f\nd 9 ! portal ve94 ,! hepatic art]y & its bran*es become increas$ 9 size1 :ile ! int]lobul> hepatic ve9s become q de/roy$4 ,! ob/ruction to ! circulation ?r\gh ! liv]1 result+ f ^! *anges1 gives rise to ! dropsical effusions usually f\nd 9 ?is disease4 ,prom95t among ! symptoms att5d+ ?is disease1 dur+ life1 may be m5tion$3--#a/4 ,dim9i%$ area ( hepatic dulness4 #b;d4 ,ascites1 p>ticul>ly 9 advanc$ /ages ( ! disease1 al?\gh pati5ts may die be=e dropsy sets 94 #c;d4 ,enl>gem5t ( ! sple5--?is be+ pres5t at lea/ 9 ab\t "o-half ! cases4 #d?4 ,enl>gem5ts ( ! sup]ficial ve9s ( ! abdom51 f ob/ruct$ fl[ ( ! portal blood1 or f pressure ^u ! v5a cava1 f abdom9al di/5sion4 #e?4 ,hmorrhoids1 epi/axis1 hmatemesis1 etc4 #f?4 ,! r>e occurr5ce ( decid$ jaundice4 #g?4 ,9 all cases1 ! advance ( ! disease is m>k$ by progressive emaciation & debility1 ! pati5t usually dy+ ( exhau/ion1 al?\gh 9 "s cases dea? is due to an attack ( pneumonia1 dema ( ! lungs1 or acute p]itonitis4 ,hyp]trophy4 ,we sometimes f9d an evid5t increase 9 ! size ( ! liv]1 )\t any alt]ation ( /ructure1 or ! pres5ce ( any prom95t symptoms4 ,su* cases may be consid]$ z in/ances ( simple hyp]trophy4 ,?is condition has be5 obs]v$ 9 cases ( leukmia1 & 9 "s exceptional cases ( sac*>9e diabetes1 he>t disease & ph?isis4 ,morbid ,gr[?s4 ,canc] ( ! ,liv]4 ,e v>iety ( canc] may be f\nd 9 ! liv]1 ?\gh ! scirrhus or m$ull>y =ms are m common4 ,! disease is inv>iably accompani$ ) enl>gem5t1 & 9 "s in/ances ! increase is enorm\s4 ,! progress ( ! disease is rapid1 a few weeks 9 _m in/ances1 a few mon?s at ! longe/1 be+ requir$ to fully develop ! disease4 ,! enl>gem5t is n uni=m4 ,! surface becomes irregul> & unev51 nodules ( v>i\s size are f\nd project+ f its surface & bord]s1 :i* are usually h>d] ?an ^? ( ! surr\nd+ portions4 ,! disease is ne>ly always accompani$ ) pa91 & consid]able t5d]ness is felt ^u t\*4 ,jaundice is pres5t 9 _m cases1 b 9 n9ety-"o cases collect$ by ,fr]i*s1 fifty-two %[$ no symptoms ( jaundice4 ,abdom9al dropsy to any consid]able ext5t1 r>ely att5ds ! disease1 al?\gh usually a small quantity ( fluid w be f\nd 9 ! p]itoneal cavity4 ,^! *>act]s w usually enable u to make a correct diagnosis ( ^! cases dur+ life4 ,! po/-mortem exam9ation1 discloses1 9 ! majority ( cases1 a great] or less numb] ( irregul>1 r\nd$ masses1 project+ f ! surface ( ! liv]1 & v>y+ 9 size f a k]nel ( corn to an orange4 ,?r\gh ! p]itoneum1 ^! bodies pres5t a light1 /raw-color$ appe>ance1 & :5 divid$1 ! int]ior is f\nd ( a :iti%-gray color1 & ( ! consi/5ce ( tall[ or *eese4 ,exam9$ v c>efully1 ! sub/ance has ! appe>ance ( inf9itely m9ute granules1 aggregat$ toge!r4 ,^! masses may be conf9$ to "o ( ! lobes1 or involve ! :ole organ2 !y are ( an irregul>ly r\nd$ or globul> =m1 & 9 "s cases two or ?ree appe> to h coalesc$ into "o mass4 ,9 o!r1 & m r>e cases1 ! canc]\s matt]1 in/ead ( be+ collect$ 9 masses1 is f\nd m or less infiltrat$ ?r\gh ! liv] sub/ance1 z 9 ,case ,i4 ,!y may s(t51 & =m cy/s fill$ ) a ?9 s]\s fluid1 or !y may und]go a =m ( fatty deg5]ation4 ,9 su* cases ! disease is liable to be mi/ak5 = waxy deg5]ation4 ,9 bo?1 !re is a uni=m h>d enl>gem5t1 b 9 ! waxy enl>gem5t1 ! progress is sl[1 & )\t pa91 & !re is usually enl>gem5t ( ! sple51 ) album9uria1 & a syphilitic ta9t2 :ile 9 canc] !re is no enl>gem5t ( ! sple51 or album9uria1 & ! c\rse ( ! disease is rapid2 !re is pa91 ca*exia1 & (t5 signs ( canc] else:]e4 ,canc] ( ! liv]1 9 ! majority ( in/ances1 is second>y to canc] ( "s o!r "p1 z ( ! /oma*1 rectum1 or female brea/4 ,9 m ?an "o-?ird ( ! cases1 x is said to be second>y to canc] ( ! /oma*4 ,cases are r>e :]e ! liv] is prim>ily affect$ ) canc]4 ,be=e ?irty-five or =ty ye>s ( age1 second>y canc] seldom occurs4 ,! foll[+ cases w s]ve to illu/rate ! two =ms ( canc] ( ! liv]3 ,,case ,i4--,prim>y ,canc] ( ! ,liv]1 ) great enl>gem5t--,rupture ( ,/oma* f po/-mortem s(t5+4 ,mrs4 ,k----1 ag$ #ch1 light complexion1 %ort & fle%y1 comm5c$ compla9+ ab\t ,new ,ye>'s1 #ahfh1 ( pa9 9 ! 8/oma*10 z %e express$ x1 ) loss ( appetite1 re/lessness at night1 accompani$ ) weakness & pro/ration4 ,^! symptoms cont9u$ = a c\ple ( weeks1 :5 %e comm5c$ to compla9 ( sor5ess 9 /oop+1 & inability to we> h] clo!s tight4 ,?is l$ to an inspection ( ! abdom5 9 b$4 ,i !n f\nd project+ bel[ ! m>g9 ( ! *e/ on ! "r side1 a h>d r\nd$ tumor1 ne>ly ( ! size ( ! fi/1 some:at s5sitive to ! t\*1 & evid5tly spr++ f ! liv]4 ,! pa9 daily increas$ 9 sev]ity1 & com+ on z x did1 9 p>oxysms1 resembl$ mu* ! pa9 att5d+ ! passage ( bili>y calculi4 ,aft] %e took to h] b$1 :i* 0 9 ! latt] "p ( ,janu>y1 !re 0 a rapid increase 9 ! size ( ! liv]1 ) a m>k$ aggravation ( all ! symptoms4 ,! pa9 0 mo/ agoniz+2 slight *ills occurr$ f day to day2 ! fle% rapidly wa/$1 & ! outl9e ( ! l[] bord] ( ! liv] c\ld be di/9ctly trac$ ?r\gh ! abdom9al walls4 ,!re 7 no symptoms ( jaundice4 ,! sk9 0 pale & wax5 9 hue4 ,9 ! latt] "p ( ,febru>y1 frequ5t epi/axis1 & ble$+ ( ! gums set 91 :ile f ! pressure upw>ds ^u ! diaphragm1 ! lungs 7 s emb>rass$ z to give rise to great dyspna4 ,rapidly s9k+1 %e di$ on ! fir/ ( ,m>*4 ,autopsy1 made ?irte5 h\rs aft] dea?4 ,ant]ior portion ( ! body pale2 po/]ior d>k f gravitation ( ! blood4 ,rigor mortis sc>cely noticeable4 ,^u op5+ ! abdom51 f\nd f\r to six ounces ( s]um 9 ! p]itoneal cavity4 ,! liv] 0 enorm\sly enl>g$1 fill+ a great portion ( ! abdom9al cavity1 pu%+ ! diaphragm high up into ! *e/1 & giv+ ! lungs less ?an half _! normal am\nt ( room = expansion4 ,! upp] surface ( ! "r lobe 0 f\nd adh]$ to ! "u surface ( ! diaphragm1 & to ! ant]ior abdom9al walls1 & ! "u surface to ! /oma*1 duod5um & transv]se colon4 ,! surface ( ! liv] 0 d>k1 mottl$1 & some:at nodulat$4 ,! :ole gl& 0 q firm1 yet evid5tly j ent]+ ^u a s(t5$ /age at num]\s po9ts4 ,no trace ( an abscess =m+ at any po9t4 ,^u lift+ ! left lobe ( ! liv]1 a d>k1 br[ni% fluid appe>$ beh9d ! /oma*1 ! orig9 ( :i* 0 n at fir/ app>5t4 ,! removal ( ! liv]1 h[ev]1 completely expos+ ! /oma*1 %[$ ! po/]ior wall at ! l>ge end1 s(t5$ & ruptur$4 ,?is s(t5+ 0 evid5tly a po/-mortem action ( ! ga/ric juice2 ! rupture result+ f ! t5sion ^u ! same1 9 te>+ away ! adhesions betwe5 ! /oma* & liv]4 ,^u ! removal ( ! liv]1 f\nd x to weigh eighte5 p\nds4 ,! gall-bladd] 0 empty & contract$4 ,! only portion ( ! gl& n involv$ 9 ! disease1 0 "o ( ! small lobes1 ! lobus ,spigelii1 & a portion ( ! left lobe4 ,incisions1 %[$ ! int]ior pres5t+ a simil> mottl$ appe>ance z ! surface2 d>k1 almo/ black spots1 int]mix$ ) spots ( br[n & gray4 ,! blood-vessels ( ! liv] 7 enl>g$1 & fill$ ) d>k defibr9at$ blood4 ,no trace ( coagulat$ blood1 9 any ( ! blood-vessels ( ! body4 ,microscopic exam9ation4 ,an exam9ation ( a small portion tak5 f ! "r lobe1 ) a p[] ( #cej diamet]s1 %[$ innum]able cells ( an irregul> outl9e1 & v>y+ 9 size2 oil globules1 & granul> matt]4 ,! action ( acetic acid1 r5d]$ ! nuclei ( ! cells fa9tly visible4 ,_m cells ( a l>ge size 7 f\nd fill$ ) a gr[? ( small] ones4 ,all o!r organs ( ! body normal4#bd ,,case ,,ii4--,canc] ( ! ,liv]1 second>y to ,canc] ( ! ,rectum1 ) diffus$ ,abscess 9 ! ,neck4 ,mr4 ,a----1 ( ,doyle/[n1 ,pa41 ag$ #fj1 _h be5 suff]+ = "s mon?s ) symptoms ( disease ( ! rectum1 ) also inflammation ( ! bladd]4 ,8 passages 7 pa9ful1 & accompani$ ) m or less bloody1 purul5t matt]4 ,8 ur9e 0 ?ick1 at fir/ f pres5ce ( l>ge quantities ( mucus1 lat] ( pus4 ,8 appetite & dige/ion 7 poor2 8 color pale & ca*ectic4 ,"s six mon?s previ\s to dea?1 he comm5c$ pass+ ) 8 ur9e1 small quantities ( se$s ( b]ries1 tomatoes1 etc4 ,^! gradually increas$ 9 quantity1 until1 = "s weeks previ\s to dea?1 !re 0 a free dis*>ge ( fecul5t matt] f ! bladd]1 & at ! same "t mu* ur9e pass$ p] rectum4 ,a few days be=e dea?1 !re appe>$ a diffus$ swell+ ^u ! front ( ! neck1 ext5d+ f ! clavicles z high z ! upp] portion ( ! l>ynx4 ,!re 0 no discoloration ( ! surface4 ,! swell+ pres5t$ a boggy feel1 )\t any positive fluctuation4 ,on ! #ae? ( ,july1 #ahga1 ,i 0 call$ by ,dr4 ,george ,wright1 :o _h be5 treat+ ! case = ! pa/ ye>1 & f :om ,i le>n$ ! above facts1 to make a po/-mortem exam9ation1 ! pati5t hav+ di$ ! day be=e4 ,f\nd ! body v ?91 surface pale4 ,no s]um 9 ! p]itoneal cavity4 ,^u lift+ ! small inte/9es f ! cavity ( ! pelvis1 f\nd ! rectum closely adh]$ to ! po/]ior surface ( ! bladd]1 completely oblit]at+ ! recto-vesical cul-de-sac4 ,consid]able d5se scirrhus matt]1 0 f\nd ^u ei!r side ( ! rectum & bladd]4 ,^u remov+ ! rectum & bladd]1 a l>ge op5+ 7"o in* 9 diamet]7 0 f\nd communicat+ betwe5 ! two4 ,! edges ( ?is op5+ 7 ?ick & ragg$4 ,! walls ( ! bladd] & rectum g5]ally1 7 ?ick & h>d f scirrhus deposits4 ,! bladd] conta9$ consid]able purul5t & fecul5t matt]1 ) also a *]ry-/one4 ,^u exam9+ ! liv]1 f\nd ^u ! "u side ( ! left lobe1 a l>ge canc]\s mass1 imb$d$ 9 ! sub/ance1 b project+ f ! surface1 & q z l>ge z a goose egg4 ,o!r portions ( ! liv] heal?y4#be ,! lungs 7 heal?y4 ,! muscul> walls ( ! he>t 7 pale & s(t1 :ile ea* ( ! cavities conta9$ s(t1 imp]fectly =m$ fibr9\s clots4 ,! "r pleural cavity conta9$ ne>ly a p9t ( s]um1 :ile ! pleura pres5t$ a r$1 inflam$ appe>ance4 ,9 remov+ ! /]num f its position1 notic$ purul5t matt] b5ea? ! upp] end1 :i* appe>$ to come d[n f ! neck4 ,^u c>ry+ an incision upw>ds to ! hyoid bone1 f\nd ! :ole region ( ! neck infiltrat$ ) pus1 )\t be+ conf9$ by any limit+ membrane or sac1 & evid5tly meta/atic 9 its orig94 ,tub]cles4 ,! p]itoneum cov]+ ! liv]1 l o!r portions ( ?is membrane1 w sometimes 7m frequ5tly ) *ildr57 be f\nd fill$ ) num]\s m9ute tub]cul> p>ticles1 ! pres5ce ( :i* are liable to give rise to appe>ances ( inflammation1 su* z r$ness1 r\ghness1 & p]haps adhesions4 ,fibroid & ,c>tilag9\s ,tumors are ( extreme r>ity 9 ! liv]4 ,:5 pres5t1 !y exhibit ! *>act]s ( ^? gr[?s 9 o!r p>ts4 ,ad5oid ,tumors h be5 detect$ 9 ?is gl&4 ,!y v>y 9 size & numb]1 b are usually enclos$ 9 a fibr\s capsule1 & appe> to be made up ( gl&ul> cells1 resembl+ ! hepatic cells1 b ( l>g] size & great] d5sity4 ,vascul> ,tumors are sometimes f\nd 9 ! liv]1 consi/+ app>5tly ( a compact1 irregul> net-"w ( dilat$ ve9s1 held toge!r by connective tissues4 ,( a d>k1 almo/ black color1 !y v>y 9 size f a few l9es to two or ?ree in*es 9 diamet]1 & are v irregul> 9 _! outl9e4 ,cy/s ( small size are occasionally f\nd1 develop$ ei!r 9 ! connective tissues1 or f a dilatation ( bile ducts4 ,!y may be f\nd fill$ ) s]um1 or color$ mucus & epi!lial cells4 ,syphilitic ,tumors1 f ! size ( a p9's head to t ( ! fi/1 may be f\nd 9 ! liv]4 ,!y are ( a gray1 :iti% or yell[ color1 made up ( cells ( an irregul> =m1 :i* %[ a t5d5cy to *eesy deg5]ation1 or to su* s(t5+ z to give ! appe>ance ( an abscess4 ,blood-vessels ( ! ,liv]4 ,! hepatic art]y is sometimes f\nd ) aneurismal enl>gem5ts1 & r>ely conta9s an embolus4 ,! portal ve9 is frequ5tly f\nd conta9+ a fibr9\s clot1 con/itut+ ?rombosis4 ,su* clots may result f pressure on ! ve9 f ! pres5ce ( "s morbid gr[? 9 ! liv]1 or f a tumor 9 ! mes5t]y or "s o!r "p1 ob/ruct+ ! portal ve9 bel[ ! liv]2 or f suppurative disease ( ulc]ation ( ! sev]al organs f :i* ! portal ve9 arises4 ,!y may be a cause1 or result1 ( phlebitis1 & may give rise to jaundice1 & sometimes to abscess ( ! liv]4 ,dilatation ( ! portal ve9 may result f ob/ruction ( ! capill>ies ( ! liv] 9 *ronic atrophy or cirrhosis2 or f ! pres5ce ( ?rombi1 or pressure by v>i\s morbid gr[?s4 ,calcification1 n only ( ! portal ve9 )9 ! liv]1 b ( its v>i\s bran*es ( orig9 )9 ! mes5t]y1 om5tum1 etc41 may occasionally be met )4#bf ,! hepatic ve9s may be f\nd pres5t+ ! same abnormal conditions z ! portal vessels4 ,animal ,p>asites4 ,! liv] has long be5 kn[n z a favorite resort = diff]5t p>asitical animals1 ! mo/ common ( :i*1 is t ( ! l>val =m ( "o ( ! tapeworms--! ,tnia e*9ococus--con/itut+ :5 develop$ 9 ! liv]1 :at is kn[n z an acephalocy/ or hydatid4 ,hydatid ,tumors ( ! liv]1 arise 9 ! foll[+ mann]3--,! sev]al tapeworms pass ?r\gh ?ree /ages ( developm5t1 ^! nev] be+ complet$ h[ev] 9 ! same animal4 ,! ,tnia e*9ococus1 acquires its adult =m1 only 9 ! inte/9es ( ! dog or wolf4 ,! mature segm5ts1 ea* ( :i* are fill$ ) va/ numb]s ( eggs1 are void$ ) ! fces1 into :i* ! eggs are dis*>g$4 ,^! soon develop into a m9ute embryo1 ) "o extremity provid$ ) num]\s little hooks4 ,if tak5 into ! /oma* ( an h]bivor\s animal or man1 ?is embryo pi]ces ! walls ( ! inte/9es1 ent]s a blood-vessel1 & f9ally lodges 9 "s ( ! tissues or organs1 m frequ5tly ! liv]1 :]e x develops into a sac-l body1 kn[n z a cy/ic]cus or hydatid1 ! second l>val =m4 ,:5 ! embryo is tak5 into ! /oma* ( o!r animals1 no fur!r developm5t takes place4 ,:ile 9 ! hydatid1 or second l>val =m1 by a peculi> process kn[n z alt]nate g5]ation1 !re may be a reproduction ( cy/s to an almo/ endless ext5t )9 ! p>5t cy/1 or second>ily 9 o!r p>ts4 ,! adult or ?ird /age ( developm5t1 c only be atta9$ )9 ! inte/9al canal ( ! dog or wolf4 ,^! animals dev\r+ a %eep or o!r rum9ant1 or 9 "s r>e case p]haps a human be+1 )9 :i* ! hydatid has be5 =m$1 ! cy/s ?us tak5 into ! /oma*1 develop into ! p]fect worm1 f :i* segm5ts conta9+ ! eggs are aga9 dis*>g$4 ,x w\ld appe> almo/ impossible = ! embryo f ^! eggs1 to ev] ent] ! human /oma*1 b x is n difficult to und]/& t ! fces ( ! dog conta9+ ! ova1 may ent] a spr+ or /ream1 f :i* ! m9ute embryo may be tak5 ) ! wat]1 by ei!r man or a l[] animal2 or1 by atta*+ !mselves to wat]cresses1 etc41 !y may be eat5 ) ^! by ! same4 ,hydatid tumors ( ! liv]1 may v>y1 greatly1 9 size1 accord+ to _! age4 ,f an extremely m9ute cy/1 !y may acquire su* a size z to fill & di/5d ! abdom9al cavity1 cr[d+ ! sev]al visc]a f _! position4 ,!re may be "o or sev]al4 ,!y may be conf9$ to ! liv]1 or second>y cy/s may appe> 9 o!r organs4 ,:5 op5$1 ! int]ior is g5]ally fill$ ) num]\s small] cy/s ( v>i\s sizes1 ea* fill$ ) a gelat9\s fluid ( v>y+ degrees ( d5sity & color1 & )9 :i*1 by a c>eful microscopic exam9ation1 may be detect$--_m times1 n always--num]\s hooklets1 :i* h be5 deta*$ f ! m9ute heads4 ,! walls ( ! p>5t cy/ may become greatly ?ick5$1 or ev5 calcifi$4 ,! cont5ts may deg5]ate into a purul5t mass1 ) :i* may be m+l$ blood or bile4 ,! developm5t ( ^! tumors is usually sl[1 & unatt5d$ ) pa91 or functional di/urbance ( ! liv]4 ,aft] !y h acquir$ a l>ge size1 !y may induce p]itonitis1 result+ 9 ext5sive adhesions4 ,rupture ( ^! hydatids sometimes take place1 ?is accid5t be+ foll[$ by dea?1 or recov]y1 accord+ to ! po9t at :i* ! rupture takes place4 ,!y may bur/ 9 ! foll[+ directions3 #a4 ,?r\gh ! diaphragm into ! pleural cavity1 or into ! sub/ance ( ! lungs4 #b4 ,r>ely into ! p]ic>dium4 #c4 ,into ! p]itoneal cavity1 result+ 9 acute p]itonitis4 #d4 ,?r\gh ! abdom9al walls1 :5 recov]y is possible4 #e4 ,into ! /oma* or inte/9es2 ?is be+ ! mo/ favorable po9t ( rupture4 ,9 fifte5 cases ( rupture into ! inte/9es1 f\rte5 recov]$4 #f4 ,into ! bili>y passages or l>ge blood-vessels4 ,,case4--,l>ge ,hydatid ,tumor ( ! ,liv]--,dea? f ,exhau/ion4 ,mr4 ,o----1 ( ?is city1 ag$ #ge ye>s1 notic$ "s two ye>s previ\s to 8 dea? t 8 abdom5 0 enl>g+4 ,an exam9ation disclos$ ! pres5ce ( a l>ge tumor desc5d+ f ! region ( ! liv]4 ,x 0 slightly fluctuat+1 & unatt5d$ ) pa9 or sor5ess4 ,he compla9$ ( no?+ b weakness ) v]tigo4 ,all ! functions ( ! body 7 natural4 ,a gradual increase ( size took place1 ) occasional attacks ( inflammation1 until ! abdom5 acquir$ ! dim5sions ( t ( a woman at full t]m4 ,! oppression n[ became s great1 f ! cr[d+ ( ! lungs1 t ,i decid$ to resort to p>ac5tisis4 ,"s two qu>ts ( a ?ick1 gelat9\s fluid 7 drawn (f f ! tumor1 ) sev]al qu>ts ( ascitic fluid f ! p]itoneal cavity4 ,! op]ation 0 foll[$ by great relief4 ,rapidly refill+1 ! oppression aga9 became sev]e1 & ! op]ation 0 repeat$ a few mon?s lat] ) simil> results4 ,dea? f9ally foll[$ f exhau/ion4 ,! po/-mortem reveal$ an imm5se tumor1 fill+ ! abdom9al cavity ) ext5sive1 firm adhesions1 & cr[d+ ! lungs into ! upp] "p ( ! *e/4 ,! walls ( ! sac 7 ?ick & semi-c>tilag9\s1 & ! int]ior divid$ into num]\s comp>tm5ts by septa pass+ 9 v>i\s directions4 ,^! comp>tm5ts 7 fill$ ) a gelat9\s fluid1 9 :i* 7 innum]able cy/s ( v>i\s sizes1 ea* fill$ ) a simil> fluid z t ) :i* !y 7 surr\nd$4 ,! microscope %[$ ! pres5ce ( num]\s *ole/]9e scales 9 ?is fluid4 ,! weight ( ! entire tumor 0 ov] fifty p\nds4 ,a portion 0 pres]v$ & deposit$ 9 ! ,college ,museum4#bg ,! foll[+ p>asites are also sometimes f\nd 9 ! human liv]1 or its ducts3 ,di/oma hepaticum1 or liv] fluke4 ,common 9 ! bile passages ( l[] animals1 r>e 9 t ( man4 ,x is flat1 oval1 f two to f\r l9es long1 & a-half to "o l9e broad4 ,its pres5ce 9 ! hepatic ducts1 may give rise to enl>gem5t1 "s degree ( ob/ruction1 or calcification4 ,di/oma lanceolatum4 ,?is p>asite1 some?+ small] ?an ! above1 is /ill m r>e 9 ! bile passages ( man4 ,p5ta/oma d5ticulatum4 ,?is animal is f\nd z a small cy/1 ) calcifi$ walls1 & conta9+ fatty & calc>e\s matt]1 ) ! rema9s ( ! dead p>asite4 ,x is consid]$ z ! l>val =m ( a worm sometimes f\nd 9 ! nasal cavity ( ! dog1 & "s o!r animals4 ,! ,asc>is lumbricoides may be f\nd 9 "s ( ! bile passages1 x hav+ ent]$ by ! op5+ ( ! common duct into ! inte/9e4 #b4 ,affections ( ! ,gall-bladd] & ,ducts4 ,! gall-bladd] is sometimes want+1 ?is be+ ! normal condition 9 ! horse & "s o!r animals4 ,:5 ?us abs5t1 ! hepatic ducts are s increas$ 9 size1 z to be able to conta9 ! accumulat+ bile 9 ! int]vals ( dige/ion4 ,inflammation ( ! gall-bladd] & common duct1 involv+ _! muc\s l9+1 is n uncommon4 ,su* inflammation may be ei!r cat>rhal or suppurative4 ,cat>rhal inflammation may result 9 ?ick5+ or calcification ( ! l9+ membrane ( ! ducts & bladd]1 ) ! accumulation ( su* quantities ( ?ick t5aci\s mucus1 z to become a s\rce ( imp$im5t to ! fl[ ( ! bile1 & ?us give rise to jaundice4 ,su* inflammation becom+ *ronic 9 ! common duct1 may result 9 great dilatation ( ! gall-bladd]1 f ! accumulation ( bile4 ,9 _m cases1 ?is =m ( inflammation w\ld seem to h orig9at$ 9 ! duod5um1 rea*+ ! bili>y passages by ext5sion ?r\gh ! op5+ ( ! duct into ! inte/9e4 ,x may also result f ! pres5ce ( calculi or p>asites 9 ! passages1 or f inflammation ( ! liv]4 ,suppurative inflammation may att5d diff]5t =ms ( fev]s1 or result f ! pres5ce ( calculi4 ,! gall-bladd]1 ) ! bile ducts1 9 su* cases1 may be fill$ ) a purul5t fluid1 or ! same may be f\nd infiltrat$ ?r\gh _! walls4 ,p]=ation ( ! walls ( ! gall-bladd] may result f ?is =m ( inflammation1 ) escape ( cont5ts into ! p]itoneal cavity1 induc+ ?us fatal p]itonitis4 ,fi/ul\s communication may also =m betwe5 ! bladd] & colon1 duod5um or /oma*1 or ?r\gh ! abdom9al walls1 adhesions hav+ fir/ tak5 place betwe5 ^! p>ts4 ,dilatation1 bo? ( ! bladd] & ducts1 may occur z a result ( ob/ruction ( ! gall-ducts4 ,t ( ! =m] may be v great1 giv+ rise to a tumor t may be pla9ly felt ?r\gh ! abdom9al walls4 ,dilatation ( ! ducts may involve ei!r ! common1 or l>ge hepatic ducts1 or ! small] bran*es )9 ! liv]4 ,su* dilatations may be sacculat$ 9 =m1 or g5]al1 involv+ ! :ole tube4 ,morbid ,gr[?s4 ,canc] ( ! walls ( ! gall-bladd] is n unfrequ5t1 & may be ei!r prim>y or second>y4 ,! cavity ( ! bladd] may 9 ?is way become oblit]at$1 & ! common duct ob/ruct$1 ?us induc+ jaundice4 ,9 a case exam9$ = ! ,drs4 ,pett+ill1 ! gall-bladd] 0 z l>ge z ! fi/1 f scirrhus canc]2 its cavity oblit]at$2 adh]$ to ! pylorus to :i* ! disease _h ext5d$2 & ! bile ducts greatly dilat$ & fill$ ) a l>ge quantity ( puri=m fluid4 ,! pati5t _h be5 = _m mon?s extremely jaundic$4 ,fibroid tumors are v r>ely obs]v$ 9 connection ) ! gall-bladd]4 ,tub]cul> deposits may be f\nd b5ea? its p]itoneal cov]+4 ,bili>y ,calculi4 ,! pres5ce ( bili>y calculi1 or gall-/ones 9 ! gall-bladd]1 or "s ( ! ducts1 is a v common occurr5ce4 ,^! bodies are compos$ ( ! elem5ts ( ! bile1 l>gely h[ev] ( *ole/]9e1 sometimes 9 an almo/ pure /ate1 9 o!rs1 m or less mix$ ) inspissat$ bile4 ,9 _m cases1 a nucleus ( ne>ly pure *ole/]9e w be surr\nd$ by a deposit ( bili>y matt] mix$ also ) scales ( *ole/]9e4 ,*ole/]9e is a peculi> sp]maceti1 or fatty-l sub/ance1 f\nd n only 9 ! bile1 b also 9 ! n]v\s tissues1 insoluble 9 wat]1 b soluble 9 !r or boil+ alcohol4 ,:5 f\nd 9 a pure /ate1 x is ( a yell[i%-:ite color1 ) ! p>ticles arrang$ 9 ! =m ( %9+ ?rombic scales4 ,gall-/ones may occur ( all sizes1 f a p9's head to t ( a h5's egg4 ,:5 small1 !y are g5]ally num]\s2 9 "s in/ances fifty to "o hundr$ be+ f\nd 9 ! gall-bladd] at "o "t4 ,:5 sev]al are pres5t 9 ! bladd]1 !y w be m or less angul> or polyh$ral 9 =m f contact & attrition ) "o ano!r4 ,:]e !re are b "o or two1 ! size may be consid]able1 :ile ! =m w be r\nd$1 oblong or pe>-%ap$1 & m or less regul>4 ,^! bodies1 :5 fir/ remov$1 are usually heavi] ?an wat]1 b1 aft] be+ dri$1 become consid]ably light]4 ,!y are inflammable1 & may be r$uc$ to almo/ pure *>coal by burn+4 ,aft] hav+ be+ expos$ to ! air = "s "t1 !y are v liable to crumble m or less completely4 ,position4 #a4 ,gall-/ones may be conf9$ to ! gall-bladd]4 ,?is is ! position 9 :i* !y are m frequ5tly f\nd4 ,!re is e reason to believe t !y may rema9 !re = a long "t )\t giv+ rise to any uncom=table symptoms4 ,we frequ5tly f9d !m aft] dea? 9 ! gall-bladd] ( p]sons :o1 dur+ life1 exhibit$ no symptoms ( _! pres5ce4 ,!y are liable1 h[ev]1 :5 pres5t1 & p>ticul>ly if num]\s or l>ge1 to give rise to a s5se ( weight & dragg+ 9 ! "p1 & to occasional attacks ( pa91 d]angem5t ( ! /oma* & vomit+2 & may also excite inflammation & ulc]ation ( ! walls ( ! bladd]4 ,! pres5ce ( gall-/ones1 :5 9 l>ge numb]s1 may frequ5tly be detect$ ?r\gh ! abdom9al walls1 z a h>d resi/+ tumor1 :i*1 by grasp+1 may be made to elicit a rattl+ s5sation1 l pebbles 9 a bag4 #b4 ,gall-/ones may become impact$ 9 ! neck1 or cy/ic duct ( ! gall-bladd]4 ,9 ?is case1 x is likely to give rise to an attack ( bili>y colic1 ) vomit+1 etc4 ,z long z x rema9s 9 ?is position !re w be no jaundice4 ,_! pres5ce1 h[ev]1 may excite inflammation2 yet we sometimes1 9 po/-mortem exam9ations1 f9d ! neck ( ! gall-bladd] block$ up by a calculus1 :5 no symptoms ( su* an ob/ruction exi/$ dur+ life4 #c4 ,gall-/ones may =m 9 "s ( ! bran*es ( ! hepatic ducts )9 ! liv]4 ,?is is n a common po9t = ! =mation ( ^! bodies4 ,!y are sometimes f\nd1 h[ev]1 9 cases ( ob/ruction ( ! ductus communis4 ,! concretions may be small & r\nd$1 or bran*+ ca/s ( ! tubes1 resembl+ pieces ( coral4 #d4 ,gall-/ones may be lodg$ 9 ! ductus communis *ol$o*us4 ,?is is "o ( ! mo/ common situations = ^! bodies1 & !y may rea* ! po9t1 ei!r f ! gall-bladd]1 or f ! ducts f ! liv]4 ,:ile 9 ?is position1 ! calculus is likely to give rise to jaundice ) p>oxysms ( sev]e pa91 :i* w be repeat$ f "t to "t1 until x passes into ! inte/9es4 ,effects4 ,z already intimat$1 gall-/ones may rema9 = an indef9ite p]iod 9 ! gall-bladd] or ducts1 )\t giv+ rise to any symptoms4 ,9 _m in/ances1 also1 !y may und\bt$ly pass ! ductus communis :5 small1 & be dis*>g$ by ! b[els1 )\t ! k ( ! pati5t4 ,m frequ5tly1 h[ev]1 ! passage ( ^! bodies is accompani$ ) p>oxysms ( sev]e pa91 ! location & "* ( :i* w usually s]ve to indicate ! true cause4 ,:]e1 h[ev]1 ! body is too l>ge to pass1 its pres5ce 9 ! gall-bladd] or any ( ! gall-ducts1 may excite inflammation & ulc]ation 9 ^? p>ts1 & ?us lead to p]=ation & dis*>ge ( cont5ts into ! p]itoneal cavity4 ,,case4--,rupture ( ! ,gall-bladd]1 ) dis*>ge ( cont5ts into ! p]itoneal cavity1 foll[$ by p]itonitis & dea?4 ,mr4 ,de ,k4 ,t----1 ( ?is city1 ag$ ab\t #fj1 _h suff]$ f sev]al attacks ( sev]e pa9 9 ! region ( ! gall-bladd]1 :i* ,i _h diagnos$ z bili>y colic1 induc$ by ! pres5ce ( a calculus4 ,"o morn+ 9 ,june1 #ahfc1 :ile work+ 9 8 g>d51 he felt a s5sation ( some?+ giv+ away 9 8 side1 :i* 0 imm$iately foll[$ by an attack ( sev]e pa94 ,a *ill & fev] soon succe$$2 &1 9 tw5ty-f\r h\rs1 a viol5t p]itonitis set 91 result+ 9 dea? 9 f\r days4 ,autopsy1 ?irty-six h\rs aft] dea?4 ,^u op5+ ! cavity ( ! abdom51 ! p]itoneal membrane 0 f\nd int5sely inflam$ at all po9ts1 & conta9+ ne>ly a qu>t ( gre5i% s]o-purul5t fluid4 ,slight pla/ic adhesions 7 f\nd at v>i\s po9ts1 unit+ ! inte/9es to ! abdom9al walls1 :ile old1 firm & ext5sive adhesions 7 f\nd betwe5 ! same & ! liv] & gall-bladd]4 ,!re 7 evid5ces t ! latt] _h be5 l>gely di/5d$1 yet1 ?r\gh a di/9ct op5+1 ! cont5ts _h escap$ into ! p]itoneal cavity1 leav+ beh9d a s+le calculus ( a regul> oval =m1 & "o in* ( its long diamet]4#bh ,f ! appe>ance ( ! "p1 x w\ld seem t ! calculus _h excit$ inflammation & ulc]ation 9 ! walls ( ! gall-bladd]1 de/roy+ ! latt] s completely1 t ! fluid cont5ts 7 kept f escap+ into ! abdom9al cavity1 only by ! adhesions t _h =m$1 & t ^! _h be5 probably torn away by ! ex]cise ( digg+ ) ! spade4 ,9 _m cases1 ! adhesions :i* are induc$ by ! inflammation1 w secure a m =tunate result1 favor+ ! work+ ( ! calculus1 by ! ulc]ative process1 ei!r into ! duod5um or colon1 & ?us1 9 mo/ cases1 secur+ its passage p] anum4 ,9 su* in/ances1 %\ld an opportunity be _h ( exam9+ ! p>ts aft] dea?1 traces w be f\nd rema9+1 suffici5t to indicate ! po9t at :i* ! escape into ! b[el 0 effect$4 ,9 "s r>e in/ances1 gall-/ones h be5 vomit$ f ! /oma*4 ,:ile x might be possible = su* bodies to be c>ri$ f ! duod5um into ! /oma* by a rev]s$ p]i/altic action1 x is m probable t1 9 su* cases1 ! calculus has f\nd its way into ! /oma* by a direct fi/ul\s communication ) ! gall-bladd]4 ,fi/ul\s communications ( a p]man5t "* are sometimes left1 aft] an ulc]ative dis*>ge ( a gall-/one into "s portion ( ! inte/9al canal4 ,gall-/ones1 aft] ent]+ ! inte/9al canal1 may become impact$1 ?us produc+ inte/9al ob/ruction4 ,_m fatal cases ( ?is "* h be5 report$4 ,an int]e/+ case ( inte/9al ob/ruction f ?is cause1 0 report$ by ,dr4 ,frieze1 ( ,h>risburg1 at ! meet+ ( ! ,am]ican ,in/itute ( ,homopa?y1 9 ,philadelphia1 9 ,june1 #ahga4 ,a lady sixty-five ye>s ( age1 _h be5 suff]+ sev]e pa9 9 ! b[els = ov] a week1 ) symptoms ( ob/ruction1 :51 aft] a p]sev]+ use ( injections1 %e pass$ a calculus ( a cyl9drical =m1 "o & ?ree-qu>t] in*es 9 l5g?1 & f\r & "o-half in*es 9 circumf]5ce1 & weigh+ f\r hundr$ & ?irty-sev5 & "o-half gra9s4#bi ,gall-/ones h1 9 a numb] ( cases1 be5 dis*>g$ ^u ! surface ( ! body1 :ile 9 "s r>] in/ances1 by ! ulc]ative process !y h work$ into ! uret]1 & ev5 into ! v5a cava & portal ve94 ,,*apt] ,,ii4 ,,! ,,ur9>y ,,app>atus4 ,section ,i4 ,,! ,,kidneys4 ,notice3--,abs5ce ( ei!r kidney1 or o!r abnormalities4 ,( ea* kidney1 note #a4 ,=m1 size1 weight1 w\nds1 etc4 #b4 ,capsule--?ickness2 transp>5cy2 facility ( removal4 #c4 ,surface ( kidney aft] removal ( capsule--color2 smoo? or lobulat$1 size ( lobules2 puck]+s2 granulations2 cy/s1 etc4 #d4 ,sub/ance ( kidney--consi/5ce2 flaccidity1 etc42 fracture1 granul> or n8 w\nds1 rupture4 #e4 ,cut surface--color ( pyramidal & cortical portions2 proportion ( ea*2 am\nt ( blood exud+ f2 ?ickness ( cortical portion2 color2 ,malpighian corpuscles2 _! degree ( visibility1 color1 etc42 appe>ance ( /ri 9 pyramidal portion1 color1 etc4 #f4 ,abnormal gr[?s & deposits--cy/s2 fibr9\s masses2 tub]cle2 canc]2 *alky masses2 abscesses1 etc4 #g4 ,pelvis ( kidney--peculi>ity ( =m2 cont5ts2 fluid1 quantity1 quality1 purul5t1 etc4 ,calculi--_! size1 position1 etc4 ,walls ( pelvis--_! ?ickness2 transp>5cy2 fi/ul\s op5+s2 w\nds1 etc4 #h4 ,uret]s--size1 cont5ts1 etc4 #i4 ,microscopic exam9ation--make section ) ,val5t9e knife1 f convex bord] ?r\gh cortical portion1 & f base to apex ( cone1 p>allel ) tubules2 place on slide & exam9e ) v>y+ p[]s1 f #ajj to #ejj diamet]s4 ,note condition ( tubules--cont5ts2 blood1 oily p>ticles1 fibr9\s1 waxy1 epi!lial or o!r ca/s2 or d5ud$ ( epi!lium & empty4 ,malpighian tufts--gorg$1 ruptur$1 fill$ ) granul> or oily matt]1 or oblit]at$4 ,are cry/als ( any k9d pres5t1 z uric acid1 oxalate ( lime1 etc41 m9ute cy/s1 purul5t infiltration1 tub]cul>1 canc]\s or o!r deposits8 ,9 ! normal /ate1 9 ! adult1 ea* kidney w be f\nd to be ab\t f\r in*es 9 l5g?1 two in*es 9 bread?1 & "o in* 9 ?ickness1 ( a firm consi/5cy1 & ( a deep1 r$ color4 ,! weight ( ! kidney v>ies f f\r ounces to six ounces1 be+ some:at light] 9 ! female ?an 9 ! male4 ,! left kidney is g5]ally some:at long]1 ?9n] & heavi] ?an ! "r4 ,! fibr\s capsule 9 :i* ea* kidney is envelop$ is ?91 smoo?1 & 9 a /ate ( heal? is easily remov$ f ! surface ( ! gl&4 ,cong5ital ,anomalies4 ,al?\gh ! abs5ce ( bo? kidneys is ( r>e occurr5ce1 x is n uncommon to f9d only "o4 ,?is may occupy its usual position1 & diff] f ! natural kidney only 9 be+ l>g]--! unsymmetrical kidney ( ,rokitansky4 ,9 o!r cases1 we f9d a m or less complete fusion ( ! two organs toge!r--! solit>y kidney4#cj ,ei!r ! l[] p>ts ( ea* are connect$ by a b& ( r5al sub/ance pass+ across ! v]tebral column1 con/itut+ ! horse-%oe kidney2 or !re is only a s+le disk-l gl&1 ly+ 9 ! m$ian l9e1 & situat$ mu* l[] d[n1 ev5 z f> z ! concavity ( ! sacrum4 ,conge/ion4 ,?is1 & its consequ5ces1 are ! ma9 features ( hyp]mia ( ! kidneys1 :i* is ( frequ5t occurr5ce4 ,?is condition is almo/ always ! result ( "s prior g5]al affection1 su* z ! sc>lat9al poison1 ! suppression ( p]spiration1 or ob/ructive diseases ( ! he>t4 ,9 a simple conge/ion1 ) p]fect integrity ( ! r5al tissue1 we f9d ! kidney enl>g$1 & its weight (t5 d\bl$2 ( a d>k1 r$ color1 & dripp+ ) blood :5 cut into4 ,! cortical sub/ance is some:at s(t5$1 ( a d>k1 r$ color1 pres5t+ 9 _m cases small d>k1 r$ spots1 ! result ( hmorrhagic effusion into & betwe5 ! tub]cles4 ,! ,malpighian tufts are di/9ctly visible on ! cut surface1 z m9ute1 r$di%1 semi-transp>5t gra9s4 ,9 ! m$ull>y cones1 ! conge/$ vessels =m long d>k r$ /reaks4 ,if ! conge/ions h occurr$ 9 an o!rwise heal?y kidney1 ! capsule c be readily peel$ (f4 ,a microscopic exam9ation %[s ! ,malpighian & o!r capill>ies load$ ) blood1 extravasation sometimes tak+ place into ! capsule ( ! latt]1 & (t5 into ! *annel ( ! fibres4 ,9 extreme cases ( hyp]mia & conge/ion1 a fibr9\s exudation takes place1 :i* w be f\nd coagulat$ 9 ! tubes1 =m+ ca/s ( _! int]ior1 & consi/+ ( a granul> or homog5e\s mat]ial1 entangl+ blood-globules1 & (t5 "s p>ticles ( deta*$ epi!lium4 ,hmorrhage4 ,z a result ( acute conge/ion1 or f injury f falls1 bl[s1 or w\nds ( ! kidneys1 blood may be effus$1 ei!r b5ea? its capsule1 or )9 ! s9us1 con/itut+ hmorrhage ( ! kidney4 ,nephritis4 ,?is diff]s 9 no mat]ial respect f common inflammation ( o!r p>ts1 & l x1 (t5 passes into suppuration4 ,its mo/ common causes are3--,excess 9 ! use ( irritat+ & alcoholic dr9ks2 abuse ( diuretics2 bl[s or falls on ! lo9s2 ! pres5ce ( r5al calculi2 &1 accord+ to "s au?ors1 a peculi> morbid /ate ( ! blood1 su* z gives rise to c>buncles4 ,?is disease c be di/+ui%$ f ! inflammatory =m ( ,bright's ,disease1 dur+ life1 by its g5]ally affect+ only "o kidney1 by ! mu* great] pa9 & t5d]ness 9 ! lumb> region1 by ! retract+ ( ! te/icles1 & ! high] degrees ( febrile excitem5t4 ,!n1 too1 ! deeply-color$ ur9e :i* is void$1 conta9s little or no album54 ,9 a case ( nephritis1 unatt5d$ ) ! =mation ( pus1 a po/-mortem w\ld probably fail to di/+ui% x f ! condition ( conge/ion j consid]$4 ,:]e suppuration 0 ab\t tak+ place1 ! microscope %[s ! cortical tubes s di/5d$ & cr[d$ toge!r by inf>ct$ epi!lium1 z to be sc>cely di/+ui%able2 9 "s p>ts ! basem5t membrane gone1 & _! cont5ts a uni=m mass ( nuclei & granul> matt]4 ,! m$ull>y tubes are also inf>ct$ & opaque4 ,pyelitis4 ,inflammation ( ! walls ( ! s9us ( ! kidney1 is ?us designat$4 ,x may exi/ alone1 or 9 company ) inflammation ( ! kidney1 con/itut+ ,pyelonephritis4 ,x appe>s to orig9ate1 9 _m cases at lea/1 second>ily to an attack ( cy/itis1 & w\ld seem meta/atic 9 its nature1 ! uret] connect+ ! two inflam$ organs1 escap+ ! disease4 ,x is a v s]i\s1 & (t5 rapidly fatal disease4 ,:]e ! inflammation ext5ds to ! kidney tissue1 suppuration is likely to foll[1 result+ ?us 9 ! =mation ( an abscess4 ,abscesses4 ,r5al abscesses are f\nd bord]$ by a r$ inject$ halo1 :i* gives rise to a friable product1 ?us lead+ to an ext5sion ( ! abscess4 ,! muc\s membrane ( ! calices & ! pelvis1 especially :5 a calculus is pres5t1 is s(t5$ & inflam$1 & secretes a purul5t fluid4 ,! process ( suppuration may cont9ue until ! :ole organ is conv]t$ into a p\* ( pus4 ,!n1 or ev5 be=e ! organ is q de/roy$1 ! abscess may make its way by ! usual process ( absorption1 & dis*>ge its cont5ts into ! calices1 to be c>ri$ (f by ! ur9>y passages2 into ! asc5d+ or desc5d+ colon1 or ! duod5um1 to be pass$ ) ! fcal evacuations2 or1 aft] p]=at+ ! diaphragm1 into ! bron*i1 :5ce !y are remov$ by c\gh+2 or ?r\gh ! lumb> muscles2 or x may bur/ into ! p]itoneal cavity & cause rapid dea?4 ,?is disease r>ely attacks m ?an "o kidney1 & ! o!r heal?y kidney g5]ally enl>ges & becomes capable ( p]=m+ a d\ble am\nt ( "w4 ,x is well to rememb]1 t a mass ( s(t5$ fibr9\s exudation1 bord]$ by a r$ halo1 may sometimes s f> simulate an abscess1 t only ! microscope c di/+ui% ! "o f ! o!r4 ,inflammation ( ! ,capsule may take place & cause fibroid ?ick5+1 m or less induration1 atrophy1 & oblit]ation ( ! organ4 ,! cortical sub/ance g5]ally suff]s mo/1 & ! surface is sometimes ov]spread ) purul5t matt]1 :ile ! tissue itself becomes sl\ghy or gangr5\s1 or is only conge/$ & s(t5$4 ,morbus ,brightii4 ,bright's ,disease4 ,deg5]ative disease ( ! kidneys4 ,desquamative & un-desquamative nephritis4 ,9 view ( ! impossibility ( accurately def9+ ! t]m ,bright's ,disease1 we w describe x 9 g5]al z includ+ ^? diseases ( ! kidneys :i*1 9 "s /age or o!r ( _! c\rse1 are accompani$ by album9uria1 or dropsy1 or bo?4 ,& z x w\ld be =eign to ! object ( ?is "w1 to ent] into an exam9ation ( ! respective m]its ( ! !ories1 9 ref]5ce to ! nature & c\rse ( ?is disease1 we w adopt t classification :i* seems be/ adapt$ to our purpose1 & proce$ to consid] ! morbid anatomy ( ,bright's ,disease 9 its v>i\s =ms & /ages z fir/ sugge/$ by ,vir*[ 9 8 ,cellul> ,pa?ology1 & adopt$ & develop$ by ,/ew>t4#ca ,he di/+ui%es ?ree =ms--7#a7 ! inflammatory1 7#b7 ! waxy1 7#c7 ! cirrhotic or contract+2 ! fir/ orig9at+ 9 ! tubules1 ! second 9 ! vessels1 & ! ?ird 9 ! connective tissue ( ! organ4 #a4 ,! ,inflammatory ,=m4 ,?is has ?ree /ages3 t ( inflammation1 t ( fatty trans=mation1 & t ( atrophy4 ,! disease may prove fatal at any /age ( its c\rse4 ,9 ! fir/ /age1 an exudation is p\r$ out1 & a de/ruction ( ! epi!lium takes place4 ,?is exudation1 affect+ a l>ge numb] ( tubules1 leads to enl>gem5t ( ! organ1 & also to fatty deg5]ation ( ! epi!lium2 its absorption or removal1 leads to ultimate atrophy4 ,!re is also a fatty deg5]ation1 to :i* we w ref] lat]1 :i* is unatt5d$ ei!r ) album9uria or ) dropsy1 & :i* does n1 !re=e1 belong to ?is category4 ,9 ?is /age ( inflammation1 ! organ is ( ! natural size1 or slightly enl>g$2 its capsule is unalt]$1 & c be peel$ (f readily2 its surface is smoo?1 m or less conge/$1 (t5 p9k1 sometimes ( a d>k purpli% color1 sometimes mottl$1 pale & purple4 ,on section1 ! cortical sub/ance is f\nd relatively enl>g$1 & (t5 conge/$4 ,! ,malpighian bodies /& out prom95tly f ! surr\nd+ tissues1 ! conge/$ vessels1 sep>at$ by a v>y+ am\nt ( :ite 7some:at opaque7 deposit1 compos$ ( ! alt]$ tubules4 ,! vascul> spaces betwe5 ! cones & ! cortical sub/ance are uni=mly di/5d$ ) blood4 ,! cones are usually r$d] ?an ! cortical sub/ances1 & f ! engorgem5t ( _! vessels & ! alt]$ condition ( _! tubules1 !y pres5t a s]ies ( alt]nat+ r$ & :ite l9es1 conv]g+ to ! apex ( ! cone1 at :i* po9t ! :ite di/9ctly pr$om9ates4 ,! pelvis ( ! kidney is natural4 ,exam9ation ) ! high] p[]s ( ! microscope %[s ! ,malpighian bodies d5se & granul>4 ,! tubules are m bulky ?an natural1 & _! epi!lium is swoll51 granul> & d5se1 :ile )9 !m is frequ5tly se5 a transp>5t homog5e\s exud$ mat]ial1 b9d+ into "o mass1 ! epi!lium ( ! tubules4 ,blood corpuscles are frequ5tly f\nd incorporat$ 9 ?is exud$ mat]ial4 ,9 ! /age ( fatty trans=mation1 ! organ is enl>g$2 its capsule natural2 its surface smoo? or slightly lobulat$4 ,x is pale & fatty 9 color1 & on its surface /ellate vessels are frequ5tly se54 ,on section1 ! cortical sub/ance is pale1 ( a yell[i%-:ite color1 & increas$ 9 volume1 :ile ! cones are p9k1 & ( natural color & size4 ,! ,malpighian bodies d n project prom95tly z 9 ! fir/ /age4 ,"u ! microscope we f9d ! tubules to be irregul>ly di/5d$ ) fatty granules1 conta9$ = ! mo/ "p )9 ! walls ( ! epi!lial cells1 :i* aga9 are imb$d$ 9 a mat]ial t blocks up ! tubules4 ,9 ! ,malpighian bodies1 oil globules & fatty cells are ( frequ5t occurr5ce1 b ! capill>y tuft is natural4 ,9 ! la/ /age ( ?is =m1 t ( atrophy1 bo? ! bulk & weight ( ! organ are dim9i%$1 its capsule al?\gh natural1 is less easily torn (f ?an 9 heal?1 & on its removal ! surface ( ! gl& is f\nd to be unev51 ) num]\s depressions & elevations4 ,! color is1 z 9 ! second /age1 mottl$4 ,on section we f9d t1 :ile ! cones h rema9$ ne>ly ( _! natural size1 ! cortical sub/ance is small & atrophi$1 & t :i* int]v5es betwe5 ! cones is greatly dim9i%$4 ,9 ! cortical sub/ance1 ! ,malpighian bodies are n prom95t1 :ile ! vessels1 & especially ! art]ies1 are ?ick] & m prom95t4 ,! pa?ological di/9ction betwe5 ?is /age ( ! inflammatory =m1 & ! cirrhotic or contract+ kidney1 dep5ds ma9ly ^u ! condition ( ! tubules & ! relative am\nt ( connective tissue4 ,:5 ! atrophy is a consequ5ce ( inflammation1 _m ( ! tubules %[ evid5ces ( inflammatory action1 be+ block$ up ) exudation & epi!lium 9 process ( fatty deg5]ation1 :ile 9 ! cirrhotic !re is little or none ( ?is4 ,aga91 9 ! cirrhotic ! fibr\s /roma is v greatly increas$1 :i* is n ! case 9 ! inflammatory =m4 ,9 ! latt]1 too1 ! capsule is m easily /ripp$ (f1 & ! occurr5ce ( cy/s is less frequ5t ?an 9 ! =m]4 ,! =m ( ,bright's ,disease1 ( :i* we are treat+1 is (t5 complicat$ ) hyp]trophy ( ! he>t1 affections ( ! lungs & bron*i1 inflammation ( s]\s membranes1 d]angem5ts ( ! alim5t>y tract1 diseases ( ! bra91 affections ( ! eye1 liv] & sple54 #b4 ,! ,waxy or ,amyloid ,=m4 ,?is also has ?ree /ages3 t ( simple deg5]ation ( ! vessels2 t 9 :i* a second>y alt]ation ( ! tubules is susp5d$2 & t ( atrophy4 ,an increas$ secretion ( ur9e *>act]izes ?is =m f its e>lie/ /ages4 ,9 all /ages ! vessels pres5t to ! nak$ eye m or less di/9ctly ! appe>ance ( boil$ />* or sago1 :ile a little ( ! liquor iodi p\r$ ov] ! surface1 produces ev]y:]e a yell[i% color1 b ! deg5]at$ p>ts assume a r$di%-br[n1 mahogany-r$1 or orange-r$ hue1 & /& out v conspicu\sly4 ,9 ! fir/ /age1 ! organs are ( normal size1 weight & color1 ! latt] be+ h[ev]1 9 "s cases1 a little pal] ?an usual4 ,_! capsule is easily /ripp$ (f1 & _! surface is smoo?4 ,! waxy deg5]ation beg9s 9 ! capill>y tufts ( ! ,malpighian bodies1 & 9 ! transv]se fibres ( ! middle coat ( ! small art]ies4 ,on ^! !re are ?ick5+s "h & !re1 pres5t+ ! same sago-l transluc5cy z is se5 9 ! tufts4 ,9 ! second /age1 ! kidneys are increas$ 9 bulk & weight2 ! capsule is easily /ripp$ (f1 & ! surface smoo? & pale4 ,! cortex is ?ick & :ite1 & pres5ts mu* ! appe>ance ( :ite beeswax4 ,"u ! microscope1 we see ! ,malpighian bodies & art]ies deg5]at$ z j describ$1 & 9 addition _m ( ! tubules full ( matt]1 n d5se & opaque z 9 ! inflammatory =m1 b tol]ably transp>5t1 consi/+ ( hyal9e tube ca/s4 ,_! epi!lium is swoll51 & _! basem5t membrane may also be waxy4 ,x is to ?is =m ( disease t ! t]m 8waxy kidney0 is mo/ applicable4 ,9 ! ?ird /age1 t ( atrophy1 ! organ is r$uc$ 9 bulk1 f ab\t ! natural size to a f\r? or ev5 less4 ,its weight is also dim9i%$4 ,! capsule may be torn (f )\t mu* difficulty4 ,! surface is r\gh1 granul>1 & ( a pale1 waxy color4 ,on section ! cortical sub/ance is f\nd mu* dim9i%$1 :ile ! cones are ne>ly natural4 ,! ,malpighian bodies are l>ge & closely gr\p$ toge!r2 ! small] art]ies dilat$ & _! walls ?ick5$4 ,a few tubules rema9 di/5d$1 b mo/ are collaps$1 & are repres5t$ only by fibr\s tissues4 #c4 ,! ,cirrhotic or ,contract+ ,=m4 ,?is consi/s ( an hyp]trophy ( ! connective tissue ( ! organ1 & a consequ5t atrophy ( all ! o!r /ructures4 ,x has be5 t]m$ also 8g\ty kidney10 8int]tubul> or int]/itial nephritis10 & 8granul> kidney40 ,9 ! comm5cem5t ( ! process !re is b little dim9ution 9 ! size ( ! organ1 b ! capsule is ?ick5$ & m adh]5t ?an natural1 & ! surface is r\gh & granul>4 ,! color is pale or r$di%4 ,on section1 ! cortical sub/ance is f\nd relatively dim9i%$1 ! dim9ution be+ mo/ m>k$ t[>ds ! surface4 ,! art]ies are prom95t1 _! walls ?ick5$ & _! cavities (t5 dilat$4 ,ev5 to ! nak$ eye1 & to ! t\*1 ! increas$ d5sity & fibr\sness ( /ructure are evid5t4 ,on ! surface1 & 9 ! sub/ance1 cy/s are frequ5tly se54 ,"s are produc$ by dilatation ( ! ,malpighian capsules1 "s by dilatation ( ! tubes1 & o!rs f morbid gr[? ( epi!lial elem5ts4 ,! tubes are compress$ & atrophi$ by ! new fibr\s tissue4 ,!y conta9 little ( ! opaque matt] f\nd 9 inflammatory cases1 b transluc5t hyal9e matt] is common4 ,all ^! *>act]i/ics become m m>k$ z ! disease progresses4 ,9 ! m advanc$ /ages1 bo? ! kidneys are mu* r$uc$ 9 size1 b "o may be m atrophi$ ?an ! o!r4 ,?r\gh\t ! :ole c\rse ( ! disease ! cones are b little affect$4 ,9 g\ty cases a deposit ( *alk-l sub/ance is occasionally f\nd1 compos$ ( ne$le-l cry/als ( urate ( soda1 situat$ 9 ! /roma ( ! organ1 z well z 9 ! tubules4 ,9 di/+ui%+ a cirrhotic kidney f "o 9 ! ?ird /age ( ! inflammatory or ( ! waxy disease1 besides ! *>act]i/ic iod9e te/ 9 ! "o case1 ! foll[+ po9ts ( comp>ison w be useful3--,9 ! cirrhotic1 ! capsule is m ?ick5$ & m adh]5t ?an 9 ! o!r two =ms4 ,9 ! cirrhotic1 ! surface is v unev51 frequ5tly /udd$ ) cy/s1 & pres5ts little or no sebace\s-look+ mat]ial2 9 ! inflammatory & ! waxy1 ! surface is less unev51 cy/s are mu* less common1 & 9 bo?1 p>ticul>ly ! inflammatory1 sebace\s-look+ mat]ial is v abundant4 ,9 ! cirrhotic1 ! /roma is greatly increas$1 especially t[>ds ! surface2 9 ! inflammatory & waxy1 ! /roma1 al?\gh increas$ relatively to ! o!r tissues1 is n absolutely above ! normal am\nt4 ,x mu/ also be borne 9 m9d1 t bo? ! waxy & contract+ =ms may be second>ily affect$ ) ! inflammatory disease4 ,simple ,fatty ,deg5]ation ( ! ,kidneys4 ,we occasionally f9d1 along ) fatty deg5]ation ( ! liv] & ( ! muscul> sub/ance ( ! he>t1 a fatty deg5]ation ( ! kidney1 )\t any trace ( inflammation4 ,! kidneys are ( ab\t ! normal size2 ! surface smoo?1 & ! capsule n adh]5t4 ,! organ is m s(t & flexible ?an natural1 & ! surface is pale1 & mottl$ ) sebace\s-look+ deposits4 ,on section1 we f9d ! abundant deposition ( sebace\s-look+ mat]ial to be ma9ly 9 ! tubules ( ! cortical sub/ance1 b also to be f\nd 9 ^? ( ! cones4 ,! microscope %[s t ! deposit is n 9 ! free cavity ( ! tubes1 b )9 ! epi!lial cells4 ,we may h ! simple fatty deg5]ation 9 connection ) exhau/+ disease1 old age1 or ) excess ( fatty food4 ,! adipose tissue 9 :i* ! kidney lies emb$d$1 may increase to su* a degree z to p5etrate by ! hilus into ! sub/ance ( ! organ1 imp$e its nutrition1 & induce a k9d ( atrophy4 ,rokitansky /ates t1 9 ! highe/ degree ( ?is *ange1 ! kidney pres5ts ! appe>ance ( a m]e mass ( fat1 )\t ! slighte/ trace ( r5al organization2 ! ur9>y passages at ! same "t be+ atrophi$ & oblit]at$4 ,dislocat$ ,kidney4 ,z a result ( ov]-ex]tion1 tight lac+1 or p]haps pregnancy1 ! kidney sometimes becomes deta*$ f its connections to ! surr\nd+ /ructures1 p]mitt+ ( a *ange ( position1 & con/itut+ :at is kn[n z movable or dislocat$ kidney4 ,! "r kidney is said to be m frequ5tly affect$ 9 ?is mann]1 & ! condition is m common ) females ?an males4 ,morbid ,gr[?s4 ,tub]cul> ,disease1 ?\gh n ( frequ5t occurr5ce1 does sometimes occur 9 ! kidneys4 ,9 mo/ cases we f9d a deposit ( tub]cle 9 o!r organs1 especially 9 ! lungs1 & (t5 9 v>i\s p>ts ( ! g5ito-ur9>y app>atus4 ,?is disease is mo/ liable to occur 9 ! middle p]iod ( life4 ,x is f\nd sometimes 9 ! mili>y =m1 sometimes 9 l>g] masses4 ,9 a v decid$ tub]cul> dyscrasia1 we f9d associat$ ) ! mili>y granulations a consid]able am\nt ( hyp]mia ( ! organ2 b :]e ! deposit is m *ronic1 ! surr\nd+ tissue is q pale4 ,! l>ge masses are rem>kably bloodless4 ,:5 ! tub]cul> deposits ext5d to ! r5al tissue f ! muc\s membrane ( ! calices & ! pelvis1 ^! cavities become rem>kably enl>g$1 & ! :ole organ is increas$ 9 size1 & appe>s r pale4 ,! epi!lial l9+ ( ! tubes is m or less opaque & granul>1 or ( an oily aspect4 ,by ! s(t5+ & break+ d[n ( ! tub]cul\s deposits1 l>ge cavities are =m$1 conta9+ a mixture ( tub]cul\s detritus & pus4 ,fibr9\s ca/s are sometimes f\nd 9 great numb]s 9 ! tubes4 ,canc]4 ,second>y1 is ( m frequ5t occurr5ce ?an prim>y canc]4 ,! scirrhus & colloid v>ieties are r>ely1 if ev]1 f\nd4 ,encephaloid gr[?s1 especially 9 *ildr51 atta9 9 ! kidneys an enorm\s size4 ,canc] ( ! liv] & "r kidney1 or ( ! adjac5t p>ts ( ! /oma*1 or desc5d+ colon & left kidney1 frequ5tly coexi/ accord+ to ! obs]vations ( ,m4 ,ray] & ,dr4 ,wal%e4 ,! p]iod ( life betwe5 fifty & sev5ty is mo/ liable to canc] ( ! kidneys4 ,! natural "* ( ! ur9e excret$ by canc]\s kidneys is seldom *ang$ until ! encephaloid gr[? s(t5s & breaks d[n1 :5 blood1 puri=m matt] & detritus may appe>4 ,cy/ic ,tumors1 suppos$ to orig9ate f a dilatation ( ! ,malpighian capsules1 are sometimes f\nd4 ,! cy/s v>y 9 size f a p9's head to a small bird's egg4 ,!y may be few or _m 9 numb]1 & are fill$ ei!r ) a cle> wat]y fluid1 or ) a gelat9\s or pigm5t>y sub/ance4 ,! walls ( ! cy/s are ?9 & smoo?1 p>tly divid$ into comp>tm5ts by imp]fect septa4 ,!y are conf9$ to ! cortical portion ( ! gl&1 & may be imb$d$ 9 t sub/ance1 or project f ! surface4 ,! kidney may be un*ang$ 9 size1 or consid]ably enl>g$4 ,! cl9ical symptoms ( ^! cy/s are v obscure1 & ( ! cause ( _! =mation1 little is kn[n4#cb ,cy/s ( a cong5ital orig91 are sometimes f\nd 9 ! kidney at bir?4 ,!y may be ( great size1 & va/ numb]1 & appe> to result f a dilatation ( ! ur9if]\s tubes1 & ,malpighian capsules4 ,fibroid & ,ad5oid tumors ( small size are r>ely f\nd 9 ! kidneys2 ! =m] )9 ! tubul>1 ! latt] )9 ! cortical portions4 ,p>asites4 ,entozoa are occasionally f\nd )9 ! kidneys1 among :i* may be m5tion$ ! hydatid1 or l>val =m ( ! ,tnia e*9ococus4 ,cy/ic]cus cellulos4 ,! l>val =m ( ! ,tnia solium4 ,eu/rongylus gigas4 ,a small cyl9drical worm1 ) ! body t+$ ) r$4 ,male--t5 to f\rte5 in*es long1 ?ree l9es wide4 ,female--?ree feet long1 six l9es wide4 ,p5ta/oma d5ticulatum4 ,suppos$ to be ! l>val =m ( a worm f\nd 9 ! nasal cavities ( "s animals1 & consi/+ ( a small sac1 ) calcifi$ walls4 ,! ,uret]s4 ,z a cong5ital defect1 we f9d ! uret] t]m9at+ 9 a cul-de-sac1 ei!r 9 ! vic9ity ( ! kidney1 or ( ! bladd]4 ,sometimes !y are d\ble or ev5 triple1 b !y g5]ally unite be=e _! vesical t]m9ation4 ,dilatation4 ,:5 ! op5+ into or f ! bladd] has1 f "s cause or o!r1 become greatly n>r[$ or oblit]at$1 ! ob/acle to ! passage ( ! ur9e causes a dilatation ( ! uret]s4#cc ,! s9us & calices at ! same "t1 dilate at ! exp5se ( ! r5al tissue1 s t we frequ5tly f9d b a ?9 lay] ( cortical sub/ance compress$ aga9/ ! inve/+ capsule1 & ! kidney conv]t$ into a numb] ( p\*es1 sep>at$ by ! rema9s ( ! m$ull>y cones4 ,! surface ( ! kidney is m>k$ly lobulat$4 ,! di/5tion ( ! uret]s may rea* su* a degree1 t !y resemble a portion ( small inte/9es1 _! walls be+ at ! same "t some:at ?ick5$4 ,f an increase 9 l5g? sometimes met )1 ! uret]s no long] lie /raight1 b are ?r[n into coils or flexures4 ,) dilatation ( ! uret]s1 we n unfrequ5tly f9d coexi/+ a /ate ( ,inflammation4 ,! muc\s membrane is !n f\nd swoll5 & inject$1 ( a vill\s aspect1 & cov]$ ) a muco-purul5t fluid4 ,sl\gh+ may ensue ) consequ5t p]=ation ( ! uret]s & infiltration ( ! ur9e into ! adjac5t tissues1 produc+ an ext5sion ( ! sl\gh+ process or circumscrib$ abscesses4 ,! inflammation r>ely exi/s z a prim>y disease2 its mo/ frequ5t causes1 are ! irritation f calculi1 or ! ext5sion ( vesical disease4 ,x may ext5d to ! s9us ( ! kidney1 con/itut+ pyelitis4 ,morbid ,gr[?s4 ,canc] ( ! ur9>y passages b seldom occurs1 & only :5 f\nd else:]e at ! same "t4 ,tub]cles may occur 9 ! uret]s1 ev5 :5 ! kidneys are heal?y1 b mo/ frequ5tly :]e !y are involv$ at ! same "t4 ,^! usually coexi/ ) tub]culosis ( "s important organ4 8,! deposit takes place 9 ! submuc\s tissue1 & =ms1 :5 its progress is *ronic1 gray granulations1 :i* become yell[1 s(t51 & give rise to small circul> ulc]s4 ,:5 ! disease is m acute1 l>g] pat*es ( deposit are =m$1 or ! muc\s membrane becomes infiltrat$ ?r\gh\t ) ! tub]cul> product ( inflammation1 :i* is at once deta*$ z a *eesy1 purul5t mass40 ,cy/s1 conta9+ a glut9\s or h>d matt]1 ab\t ! size ( millet-se$s or peas1 are occasionally f\nd develop$ "u ! muc\s membrane ( ! ur9>y passages4 ,! ,supr>5al ,capsules4 ,^! bodies are sometimes entirely abs5t4 ,:]e "o ( ! kidneys is abs5t or displac$1 ! capsule may /ill be f\nd 9 its normal position4 ,inflammation & ,deg5]ation4 ,inflammation ( ! bodies1 ei!r acute or *ronic1 appe>s to result 9 ! foll[+ *anges3 ,fir/1 ! organs become slightly enl>g$ & infiltrat$ ) a semi-transluc5t mat]ial1 ( a grayi% color1 s(t1 homog5e\s1 or slightly fibrillat$1 or conta9+ a few imp]fect cells4 ,! sub/ance resembles :at is (t5 se5 9 scr(ul\s disease ( ! lymphatic gl&s4 ,at a lat] p]iod1 ?is sub/ance gradually *anges into a s(t1 putty-l sub/ance1 or into *alky concretions scatt]$ ?r\gh ! body4 ,! :ole sub/ance ( ! organ may ?us be de/roy$4 ,x may1 at ! same "t1 be f\nd m closely adh]5t to ! surr\nd+ organs4 ,dr4 ,addison has associat$ ) ^! *anges 9 ! supr>5al capsules1 a peculi> bronz$ condition ( ! %9 sometimes se51 & nam$ f him 8,addison's ,disease40 ,hmorrhage occasionally occurs )9 ! sub/ance ( ! capsule1 =m+ a k9d ( cy/ fill$ ) blood4 ,x is m frequ5t ) "y *ildr51 b is sometimes se5 9 adults4 ,morbid ,gr[?s4 ,canc]4 ,prim>y canc] ( ^! bodies is r>e2 ! second>y =m may appe> 9 connection ) ! same disease 9 ! kidneys1 /oma* or liv]4 ,tub]cles ( ! mili>y =m are r>ely se54 ,cy/s1 bo? s+le & multiple1 & ) v>y+ cont5ts1 may be f\nd1 g5]ally connect$ ) ! enclos+ membrane4 ,section ,,ii4 ,,! ,,ur9>y ,,bladd]4 ,notice3 #a4 ,ext]nal ,*>act]s--mal=mations2 adhesions2 size2 ,w\nds1 etc4 #b4 ,walls--_! ?ickness2 condition ( sev]al coats2 morbid gr[?s1 canc]1 tumors1 tub]cles1 p]=ations2 s9uses2 rupture2 w\nds4 #c4 ,cont5ts--ur9e1 its quantity & *>act]s2 blood1 its am\nt & s\rce2 pus2 calculi1 numb]1 size1 position1 etc4 ,mal=mations4 ,among ! mo/ common ( ^!1 may be m5tion$ extrov]sion1 :]e !re is an abs5ce ( ! ant]ior walls ( ! bladd]1 ) a defici5cy 9 ! correspond+ portion ( ! abdom9al p>ietes4 ,f ! pressure ( ! abdom9al visc]a1 ! po/]ior walls ( ! bladd] w be cr[d$ =w>d1 & protrude z a r\nd$ tumor1 cov]$ by a vascul> muc\s membrane1 :ile ne> ! l[] portion may be se5 ! orifices ( ! uret]s1 ?r\gh :i* ! ur9e w be m or less con/antly fl[+4 ,mal=mations ( ! ext]nal organs ( g5]ation1 are liable to accompany ^? ( ! bladd]4 ,! ,ura*us sometimes fails to close be=e bir?1 leav+ ?us an op5 passage f ! fundus ( ! bladd] to ! umbilicus1 ?r\gh :i* ! ur9e may be notic$ fl[+ aft] division ( ! cord4 ,dilatation4 ,?is is ( n unfrequ5t occurr5ce1 & is ! result ei!r ( a p>alysis ( ! muscul> coat1 or ( "s ob/acle to ! outfl[ ( ! ur9e4 ,! dilatation may be uni=m1 or we may f9d div]ticula1 =m$ by a protrusion ( ! muc\s membrane betwe5 ! fasciculi ( muscul> fibres4 ,su* p>tial di/5sions occur mo/ frequ5tly 9 ! lat]al portions1 ! po/]ior surface1 or ! neighborhood ( ! fundus1 & z we %\ld be l$ to expect f ! mann] ( _! =mation1 are g5]ally de/itute ( a muscul> tunic1 or h b a few scatt]$ fibres4 ,calculi are sometimes f\nd 9 ^! p\*es aft] dea?1 ! pres5ce ( :i* _h escap$ notice dur+ life f _! conceal$ position4 ,hyp]trophy ( ! muscul> coat ( ! bladd]1 w g5]ally be f\nd att5d+ cases ( ob/ruction to ! escape ( ! ur9e1 ei!r f an enl>g$ pro/ate1 /ricture ( ! ure?ra1 or f ! pres5ce ( a calculus4 ,! muscul> coat 9 ^! cases is greatly ?ick5$1 ! int]lac+ bundles ( fibres appe>+ ) great di/9ctness ^u ! inn] surface4 ,z a result ( ?is condition1 we usually f9d ! bladd] greatly contract$1 its capacity 9 "s cases be+ r$uc$ to "o or two ounces4 ,inflammation ( ! muc\s coat1 ) dilatation ( ! uret]s1 w also g5]ally att5d1 hyp]trophy ( ! muscul> walls4 ,contraction ( ! bladd] is met )1 z ! result ei!r ( irritation ( ! muc\s membrane1 or hyp]trophy ( ! muscul> coat4 ,inflammation ( ! bladd] is g5]ally se5 9 its *ronic =m4 ,! appe>ances 9 acute cy/itis are 8/rong vascul> injection ( ! muc\s l9+1 ) br[ni% pat*es 9 ! vic9ity ( ! neck & fundus2 m or less ?ick5+ ( ! membrane1 ) exudation ( fibr9 or pus on ! surface1 or foci ( ! latt] 9 its sub/ance4 ,! muc\s tissue may be ulc]at$ at sev]al po9ts1 s(t5$ or affect$ by comm5c+ gangr5e4 ,abscesses may =m 9 ! sub/ance ( ! p>ietes1 & op5 ei!r into ! cavity ( ! bladd]1 or ^u its ext]nal surface4 ,sometimes ! muc\s membrane is almo/ completely de/roy$1 a few %r$s or filam5ts be+ ! only traces rema9+1 :ile ! muscul> tunic is left z if cleanly dissect$4 ,?is is probably ! result ( phag$5ic ulc]ation40 ,! inflammation may spread f ! muc\s membrane to ! muscul> coat1 b x v r>ely rea*es ! p]itoneal cov]+4 ,9 "s cases x ext5ds back along ! uret]s1 & ev5 to ! kidneys4 ,! morbid action is n (t5 ( idiopa?ic orig91 x is m frequ5tly due to ! ext5sion ( an attack ( gonorrha1 to disease ( ! pro/ate1 to traumatic causes1 to protract$ ret5tion ( ur9e1 or to ! irritation produc$ by m$ic9es or /imulat+ dr9ks4 ,x is sometimes ow+ to ! con/itutional poison ( rheumatism or g\t4 ,x is met ) (t5] 9 m5 ?an wom51 & 9 adults ?an 9 *ildr54 ,*ronic cy/itis1 call$ also cat>rh ( ! bladd]1 is v common 9 advanc$ age4 ,! morbid process is excit$ by "s ob/acle to ! emission ( ! ur9e1 ei!r p>alysis ( ! viscus1 or a /ricture1 or by pres5ce ( a /one 9 ! bladd]1 or by enl>gem5t ( ! pro/ate gl&4 ,x may also result f successive attacks ( ! acute =m1 or f ext5sion ( ure?ral inflammation4 ,v>i\s degrees ( vascul> injection are pres5t$1 ) d>k-r$di%1 slate-color$ or blui%-black discoloration1 m or less ?ick5$ induration ( ! p>ietes1 :i* assume an homog5e\s1 l>dace\s appe>ance4 ,an acute attack may sup]v5e ^u a /ate ( *ronic inflammation1 lead+ to ulc]ation1 suppuration1 p]=ation & extravasation ( ur9e1 z 9 ! case ( prim>y acute cy/itis4 ,*ronic or sub-acute inflammation is (t5 att5dant ^u p>aplegia1 & proves ! imm$iate cause ( dea?4 ,morbid ,gr[?s4 ,canc] z a prim>y disease1 is b r>ely met )4 ,encephaloid1 =m+ nodulat$ prom95ces or caulifl[]-l excresc5ces1 is ! =m :i* vesical canc] usually assumes4 ,!y are develop$ 9 ! submuc\s tissue1 b z !y gr[1 ! muc\s membrane is also de/roy$1 & ei!r an ulc] is produc$ or a s(t luxuriant fung\s mass4 ,tub]cle 9 ! =m ( sep>ate granulations are sometimes met ) ab\t ! fundus & neck ( ! bladd] 9 ! male1 & usually are accompani$ ) simil> deposits 9 ! te/es1 pro/ate1 kidneys1 etc4 ,!y are surr\nd$ by m or less hyp]mia1 & by s(t5+ give rise to circul> ulc]s ( ! muc\s membrane cov]+ !m4#cd ,tumors4 ,polypoid gr[?s1 bo? ( a fibr\s & ad5oid "*1 may be f\nd 9 ! neck ( ! bladd]1 bo? 9 *ildr5 & adults4 ,!y v>y 9 size f t ( a pea to a *]ry4 ,cy/ic tumors ( small size are sometimes f\nd )9 ! muc\s membrane4 ,p>asites4 ,! ,s>c9a v5triculus1 a vegetable p>asite1 is sometimes f\nd 9 ! bladd]1 9 cases ( *ronic cy/itis4 ,( animal p>asites1 ! ,eu/rongylus1 ,e*9ococus1 & ,asc>ides1 h f\nd _! way into ?is organ f o!r p>ts4 ,( ! ,ure?ra4 ,mal=mations4 ,z cong5ital mal=mation1 we ne$ m5tion only ,epispadias1 fissure on ! upp]1 & ,hypospadias1 on ! l[] surface1 f arre/ ( developm5t1 & complete closure ( ! op5+1 ,atresia ure?r4 ,inflammation ( ! ure?ra1 ( ! cat>rhal k9d1 ! s-call$ gonorrha1 comm5c+ at ! ant]ior extremity1 may1 9 sev]e cases1 ext5d backw>ds1 ev5 into ! bladd]4 ,! l9+ membrane becomes swoll51 inject$1 & cov]$ ) mucus or muco-purul5t secretion1 at fir/ ?91 !n ?ick]1 & !n1 z ! inflammation subsides1 ?9 & pale aga94 ,:5 a *ancre coexi/s ) gonorrha1 8! dis*>ge has usually a grayi% or r$di% t9t1 or sani\s aspect40 ,f an ext5sion ( ! inflammation deep] into ! fibr\s /ructure ( ! corpus spungiosum1 results1 sometimes1 an exudation ( fibr9 9 ! v5\s cells1 suppuration & abscess4 ,c[p]'s gl&1 ! pro/ate1 ! vesicul sem9ales1 & ! te/icles1 may also be affect$ by an ext5sion ( ! inflammation along ! cont9u\s muc\s l9+4 ,! contact ( unheal?y vag9al secretions1 :e!r specific or n1 is ! mo/ frequ5t cause ( ure?ritis4 ,dilatation & ,contraction4 ,dilatation is mo/ frequ5tly ! consequ5ce ( ob/ruction to ! fl[ ( ur9e4 ,x occurs g5]ally 9 ! membran\s portion1 :i* is exp&$ into a p\*1 occasionally z l>ge z a small orange4 ,! muc\s l9+ ( ^! p\*es appe>s 8inject$ & ?ick5$1 pres5t+ fung\s vegetations1 & occasionally coat$ ) lymph40 ,contraction may result f inflammation ( ! muc\s membrane1 & f9ally end 9 /ricture4 ,/ricture is a v frequ5t result ( inflammation ( ! ure?ra4 ,x usually is f\nd 9 ! ant]ior "p ( ! membran\s portion4 ,contusions & w\nds also1 (t5 produce /ricture4 ,! simple/ =m ( /ricture is1 :]e ! canal is p>tially clos$ by a fold ( membrane pass+ across x1 leav+ ei!r a cresc5tric1 or annul> op5+4 ,9 ! mo/ common k9d ( /ricture ! ure?ra is n>r[$ 9 a mu* great] ext5t ( its c\rse1 sometimes = an in*1 or m4 ,:5 ! ob/ruction occasion$ by a /ricture is v great1 ! ure?ra beh9d is dilat$1 (t5 inflam$ & sometimes ulc]at$1 s z to give rise to ur9>y fi/ula or effusion ( ur9e4 ,rupture ( ! ure?ra may result f sev]e contusions1 or fracture ( ! bones ( ! pelvis1 & be+ foll[$ by extravasation ( blood & ur9e1 inflammation1 suppuration or gangr5e may sup]v5e1 or fi/ul\s op5+s may be ?us e/abli%$4 ,morbid ,gr[?s4 ,w>ty gr[?s sometimes appe> )9 ! ure?ra ne> ! meatus4 ,!y are g5]ally q vascul>1 & may cause consid]able ob/ruction4 ,tub]cles are ( r>e occurr5ce 9 ! ure?ra4 ,canc] occurs only z an ext5sion ( ! disease f ! p5is1 pro/ate gl& or bladd]4 ,ur9>y ,calculi4 ,calculi ( diff]5t size1 =m1 & *emical composition1 may be f\nd 9 ! ur9>y bladd]1 uret]s1 or s9us ( ! kidneys4 ,uric1 or li?ic acid calculi1 are ! mo/ frequ5t 9 _! pres5ce4 ,!y may v>y 9 size1 f a pea to t ( a h5's egg4 ,9 color1 also1 !y may v>y f a fawn or light yell[1 to a d>k1 almo/ mahogany t9t4 ,! surface may be slightly tub]culat$1 or smoo?1 & ! int]ior1 :]e a section is made1 has a conc5tric arrangem5t ( lay]s ar\nd a c5tral nucleus4 ,oxalate ( lime calculi are next 9 frequ5cy4 ,f ! /rongly tub]culat$ "* ( ! surface1 !y are frequ5tly kn[n z mulb]ry calculi4 ,!y are ( an irregul>1 sph]ical =m1 & usually s+le4 ,9 color1 !y are usually ( a d>k olive or br[n1 b may be light & almo/ :ite4 ,!y seldom acquire s l>ge a size z ! li?ic acid v>iety1 are v h>d1 & p]mit ( a high poli%4 ,phosphatic calculi are *>act]iz$ by _! s(tness1 :i* p]mits ( _! be+ readily cru%$4 ,!y are ( a grayi%-:ite color1 & frequ5tly compos$ ( alt]nate lay]s ( o!r deposits4 ,!y may be compos$ :olly ( phosphate ( lime1 or ( a triple phosphate--ammonio-magnesian phosphate--or ( a comb9ation ( ! two4 ,cy/9e calculi are v r>e2 !y are yell[i% 9 color1 ( a waxy appe>ance1 & soluble 9 aqua-ammonia4 ,uric oxide calculi are extremely r>e2 !y resemble uric acid calculi1 b pres5t a waxy appe>ance :5 poli%$4 ,,*apt] ,,iii4 ,,! ,,male ,,g5]ative ,,organs4 ,section ,i4 ,,( ,,! ,,p5is4 ,notice3 ,mal=mations2 size2 condition ( prepuce & glans2 *ancres1 w>ts1 etc4 ,split op5 ure?ra & notice ulc]s1 /rictures1 etc4 ,cong5ital ,anomalies4 ,! p5is may be v imp]fectly develop$1 ev5 ) a normal developm5t ( ! o!r organs ( g5]ation1 al?\gh x m frequ5tly occurs :5 ! latt] are !mselves imp]fect4 ,x occasionally happ5s t1 f an arre/ ( union 9 ! m$ian l9e ( ! p5is1 a slit or fissure is left communicat+ ) ! ure?ra4 ,?is commonly occurs 9 ! "u surface1 con/itut+ ,hypospadias2 less frequ5tly on ! upp] surface1 7,epispadias17 & only 9 cases ( extrov]sion ( ! bladd]4 ,! prepuce may be want+4 ,cong5ital phymosis occasionally occurs1 usually associat$ ) atrophy ( ! p5is4 ,x is suppos$ by "s1 to be a pr$ispos+ cause ( canc] ( ! p5is4 ,hyp]trophy & ,atrophy4 ,9 consequ5ce ( long-cont9u$ onanism1 ! p5is may become hyp]trophi$1 or z ! result ( *ronic irritation & disease1 we may h an hyp]trophy ( ! prepuce & ( ! body ( ! p5is1 sometimes atta9+ an enorm\s size4 ,vidal has relat$ & figur$ a case :]e ! organ rea*$ to bel[ ! knees1 & 0 z l>ge z a ?igh4 ,atrophy ( ! p5is1 accompani$ ) oblit]ation ( ! cav]n\s textures1 occurs ) atrophy ( ! te/icles4 ,fracture ( ! ,p5is has occurr$ f ! giv+ way ( ! erectile tissue dur+ coition1 9 consequ5ce ( ! /ate ( hyp]mia ( ! p5is4 ,! organ appe>s brok51 & _c assume ! erect condition beyond ! "p injur$4 ,p>aphymosis1 by ! /rangulation ( ! glans 9 front ( a tight prepuce1 may1 if n reliev$1 lead to inflammation1 & ev5 gangr5e4 ,balanitis commonly occurs z ! result ( local irritation1 n unfrequ5tly set up by a gonorrha4 ,! prepuce is mu* swoll51 infiltrat$ & r$d5$4 ,! inflammation is g5]ally complicat$ ) inflammation ( ! int]nal lam9a ( ! =esk91 & ! muc\s membrane ( ! glans 7po/hitis71 giv+ rise to excoriation1 exudation ( coagulable lymph1 adhesion ( ! prepuce to ! glans1 suppuration & ulc]ation4 8,:5 *ronic1 x induces exub]ant =mation ( epid]mis2 & if ! deep] p>ts ( ! p>5*yma ( ! glans are involv$1 oblit]ation1 c>tilag9\s induration & atrophy foll[40 ,h]pes ( ! ,glans & ,prepuce1 is *>act]iz$ by ! =mation ( small vesicles or excoriat$ po9ts ^u ! muc\s membrane ( ?is region1 *iefly occurr+ 9 p]sons ( a g\ty habit ( body1 ) an irritable muc\s membrane4 ,psoriasis ( ! prepuce1 produces a r$1 ?ick5$1 & fissur$ condition ( ! "p4 ,phymosis is apt to occur z a consequ5ce4 ,*ancres4 ,^! specific ulc]ations =m usually ^u ! glans1 al?\gh !y may be f\nd 9 ! int]nal surface ( ! prepuce1 ! frnum1 & ne> ! meatus )9 ! ure?ra4 ,! ,hunt]ian or h>d *ancre1 is ne>ly circul>1 deep & excavat$2 base & edges are z h>d z c>tilage1 b ! h>dness is circumscrib$2 its color is livid or tawny4 ,x may occur ^u ! integum5t1 ! glans1 or ! body ( ! p5is4 ,! non-indurat$ or s(t *ancre is m frequ5tly f\nd on ! inn] surface ( ! prepuce4 ,x appe>s z a f\l1 yell[i%1 or tawny sore4 ,indol5t fung\s granulations are subsequ5tly ?r[n out1 unless x be situat$ ^u ! glans4 ,phag$5ic *ancres are ( irregul> %ape1 _! edges ragg$ or und]m9$1 _! surface yell[ & dott$ ) r$ /reaks4 ,! surr\nd+ m>g9 ( sk9 usually looks pulpy & demat\s2 b is sometimes firm & ( a vivid r$4 ,! cicatrices left by *ancres :i* h heal$1 are :iti%1 m or less h>d1 /riat$ & depress$4 ,morbid ,gr[?s4 ,w>ts1 belong+ to ! class ( epi!lial tumors1 sometimes =m on ! glans1 or on ! inside ( ! prepuce4 ,!y are commonly ! result ( repeat$ inflammations4 ,canc] ( ! p5is is ( two di/9ct k9ds1 occurr+ z scirrhus or z epi!lioma4 ,accord+ to ,dr4 ,wal%e1 ! disease may orig9ate z a w>ty excresc5ce1 or z a pimple1 :i* dis*>ges an excoriat+ fluid1 scabs1 & breaks out afre%1 :ile induration1 foll[$ by ulc]ation1 advances at its base4 ,or x may infiltrate ! glans1 s z to conv]t t "p into an indurat$ mass2 or v5]eal ulc]s may take on canc]\s action4 ,:5 ( ! scirrhus =m1 x usually spr+s f ! ulc]s beh9d ! glans1 & may !nce invade ! neighbor+ p>ts ( ! organ4 ,epi!lioma1 comm5c+ z a tub]cle 9 ! prepuce1 may aft] a "t give rise to a l>ge1 irregul>1 & spr\t+ mass1 hav+ a granul> fung\s appe>ance4 ,9 o!r cases1 x comm5ces z a h>d scirrhus mass1 ( a pale1 r$di%-:ite color1 situat$ on ! glans1 or betwe5 ! prepuce & ! glans4 ,?is increases 9 size1 cracks1 & all[s ! exudation ( a s]\s fetid dis*>ge4 ,ulc]ation !n rapidly takes place4 ,second>y canc]s1 except 9 ! adjac5t gl&s1 are n a common occurr5ce4 ,phymosis & ! irritation caus$ by ! reta9$ secretion1 seem to act z an excit+1 & advanc+ age z a pr$ispos+ cause ( canc]4 ,ency/$ tumors1 nvus & fibro-pla/ic tumors1 situat$ ab\t ! prepuce1 may also occur4 ,section ,,ii4 ,,( ,,! ,,scrotum4 ,notice3 ,g5]al condition2 relax$ or contract$2 dema2 canc]2 tumors1 etc4 ,hyp]trophy4 ,common hyp]trophy ( ! integum5t ( ! corium sometimes occurs2 9 ?is !re is no alt]ation ( ! subcutane\s tissue4 ,9 ,elephantiasis ( ! scrotum1 h[ev]1 ! epid]mis1 ! corium1 & ! subcutane\s areol> tissue1 are all1 especially ! latt]1 greatly hyp]trophi$4 ,! areol> tissue is conv]t$ into a l>ge mass ( fibr\s mat]ial1 infiltrat$ ) an album9\s & fibr9\s fluid4 8,:5 ! disease is conf9$ to ! scrotum1 & ! enl>gem5t becomes great1 ! p5is becomes drawn 9 & ultimately disappe>s1 :ile ! elongat$ prepuce is cont9u\s at a navel-l op5+ 9 ! sk9 ( ! surface ( ! tumor40 ,! enl>gem5t sometimes is enorm\s1 su* a mass hav+ be5 kn[n to weigh two hundr$ p\nds1 m ?an ! weight ( ! re/ ( ! body4 ,inflammatory dema ( ! scrotum is an erysipelat\s inflammation ( ?is region1 giv+ rise to great effusion into & swell+ ( ! areol> tissue1 ) a t5d5cy to ! rapid =mation ( a sl\gh1 by :i* ! integum5t may become s affect$ z to leave ! te/es & cords entirely d5ud$4 ,a peculi> =m ( ?is disease occurs z a sequ5ce ( small-pox & sc>let fev]4 ,"h !re is a t5d5cy to spe$y gangr5\s disorganization ( ! areol> tissue1 & ( ! cov]+ ( ! g5]ative organs4 ,morbid ,gr[?s4 ,canc]4 ,epi!lial canc] is ! common =m "u :i* x attacks ! scrotum4 ,?is disease has appropriately be5 call$ *imney-sweep]'s canc]1 z x appe>s to arise f ! irritation ( ! soot lodg+ 9 ! folds ( ! scrotum4 ,x commonly comm5ces z a tub]cle or w>t1 :i*1 aft] a "t1 cracks or ulc]ates4 ,x spreads rapidly1 involv+ at la/ ! great] "p ( ! scrotum1 & sometimes invad+ ! te/es1 ev5 ext5d+ to ! gro9 & ?igh1 de/roy+ life by p]=at+ ! coats ( "s ( ! l>ge vessels4 ,! gl&s ( ! gro9 are n always affect$4 ,melanotic canc] ( ! scrotum has be5 obs]v$4 ,fibr\s tumors are sometimes develop$ 9 ?is "p1 & may =m a l>ge mass :5 sev]al are gr\p$ toge!r4 ,section ,,iii4 ,,( ,,! ,,te/icles4 ,notice3 ,mal=mations2 position1 9 scrotum1 +u9al canals1 or abdom54 ,size2 consi/5ce2 condition ( coats4 ,tunica vag9alis--cont5ts2 s]um1 blood2 adhesions4 ,abscesses2 cy/s2 tumors2 canc]2 tub]cle1 etc4 ,cong5ital ,anomalies4 ,!re is no suffici5t evid5ce ( ! pres5ce ( m ?an two te/icles4 ,!y are bo? abs5t :5 ! entire sexual app>atus is want+1 & 9 "s r>e cases !y are imp]fectly develop$1 or only "o may exi/4 ,x n unfrequ5tly happ5s t at bir? !re is an app>5t abs5ce ( "o or bo? gl&s f an arre/ or delay 9 _! desc5t1 s t !y lie 9 ! gro91 ! +u9al canal1 or ! l[] "p ( ! abdom54 ,sometimes !y w&] into o!r situations1 e4 g41 into ! p]9eum close by ! anus1 & ?r\gh ! crural canal4 ,if ! desc5t does n take place )9 twelve mon?s aft] bir? x is r>ely p]fectly complet$ aft]w>ds )\t be+ accompani$ by h]nia4 ,! organ is sometimes retrov]t$1 s t ! epididymis is plac$ 9 front4 ,! vas def]5s may be abs5t to a great] or less ext5t1 & ev5 ! epididymis has be5 f\nd 9 great "p defici5t4 ,! vas def]5s frequ5tly t]m9ates 9 a bl9d extremity be=e rea*+ ! vesicula sem9alis4 ,hyp]trophy & ,atrophy4 ,true hyp]trophy ( ! te/icles does n occur b :5 attack$ ) inflammation1 or :5 ! seat ( morbid gr[?s ! gl&s may become greatly enl>g$4 ,atrophy1 cong5ital or acquir$1 is n unfrequ5t4 ,! effect ( old age is v gradual1 ! gl& be+ (t5 b v little dim9i%$ 9 size4 8,! te/icle atrophi$ f disease is n only ( dim9i%$ size & weight1 b is alt]$ 9 %ape1 be+ unev5 & irregul>1 & sometimes ( an elongat$ =m4 ,!re is little or no trace ( ! prop] gl&ul> /ructure1 ! organ be+ conv]t$ into fibr\s tissue ( a firm texture4 8,! te/icle 9 an advanc$ /age ( wa/+1 n aris+ f disease ( ! gl&1 usually pres]ves its %ape1 b feels s(t1 hav+ lo/ its ela/icity & firmness4 ,its texture is pale1 & exhibits few blood-vessels2 ! lobuli & septa divid+ ! lobes are indi/9ct1 & ! =m] _c be s readily drawn out into %r$s z be=e4 ,! epididymis does n usually wa/e s soon1 nor 9 ! same degree z ! body ( ! te/icle4 ,fatty matt] is also f\nd 9 ! gl&ul> sub/ance ( atrophi$ te/icles40 ,inflammation4 ,! s]\s cov]+ ( ! te/es1 ! tunica vag9alis1 is liable to acute inflammation1 & is !n affect$ z o!r s]\s membranes4 ,x becomes ?ick5$ & inject$ ) blood1 & is coat$ ) a v>iable quantity ( fibr9\s exudation4 ,s]um is1 at same "t1 effus$ into ! cavity1 & r5d]$ turbid by flakes ( fibr94 ,adhesions betwe5 ! oppos+ surfaces commonly =m4 ,! epididymis is apt to p>take ( ! inflammation ( ! tunica vag9alis1 & vice v]sa4 ,or*itis & ,epididymitis1 may be acute or *ronic1 prim>y or second>y4 ,9 acute cases1 ! te/is is conge/$1 & ( a d>k] hue ?an natural1 al?\gh n mu* enl>g$4 ,! epididymis1 especially its l[] "p1 is mu* enl>g$1 & feels ?ick1 firm & indurat$4 8,! coats ( ! vas def]5s are ?ick5$1 & ! adjac5t vessels inject$4 ,! tunica vag9alis is inflam$1 & its cavity conta9s ! usual effusions40 ,suppuration may occur m frequ5tly 9 prim>y or*itis1 r>ely 9 ! second>y =m4 ,! pus is liable to burr[ & disorganize ! tissue ( ! gl&4 ,by a subsequ5t absorption ( ! fluid "p ( ! pus1 !re is (t5 left a :iti% mass resembl+ tub]cul> deposit1 b di/+ui%$ f ?is by be+ conta9$ 9 a cy/1 & by ! alt]$ condition ( ! adjac5t gl& tissue4 ,! epididymis n unfrequ5tly rema9s enl>g$1 pres5t+ a h>d1 knotty swell+ at its l[] "p4 8,9 old cases ! epididymis acquires ! d5sity & consi/5ce ( c>tilage1 & sometimes ev5 ( bone40 ,atrophy ( ! gl& is a frequ5t result ( inflammation4 ,*ronic or*itis is *>act]iz$ by ! effusion ( a yell[i%1 homog5e\s-look+ matt]1 9 ! sub/ance ( ! te/icle1 )9 ! tubuli4 ,?is deposit may %r9k & contract1 induc+ gradual atrophy ( ! te/is1 or1 by adhesions & ulc]ative absorption1 a fung\s protrusion ( ! affect$ tissue may take place4 ,hydrocele4 ,simple ,hydrocele is a dropsy ( ! tunica vag9alis4 ,! fluid is usually cle>1 & ( a /raw color1 sometimes turbid1 ) album9\s flocculi1 & n unfrequ5tly conta9s %9+ p>ticles ( *ole/]9e4 ,9 old or v l>ge hydrocele1 x is (t5 d>k-br[n or *ocolate color$ f dis9tegrat$ blood4 ,its quantity is sometimes v consid]able4 ,! position ( ! te/icle may be alt]$ by adhesions =m$ betwe5 ! two lay]s ( ! tunica vag9alis2 ^! latt] may also produce a multilocul> hydrocele4 ,simple hydrocele may occur ) "s ( ! o!r v>ieties to be m5tion$1 & also ) +u9al h]nia4 ,:5 s]\s effusion 9 ! tunica vag9alis1 is associat$ ) *ronic or*itis or o!r diseases ( ! gl&1 we h hydro-s>cocele4 ,9 cong5ital hydrocele1 ! dropsical tunica vag9alis reta9s its ftal communication ) ! p]itoneal cavity4 ,ency/$ ,hydrocele4 ,9 ?is v>iety ! fluid is conta9$ 9 cy/s1 :i* may be situat$ 7#a7 b5ea? ! visc]al portion ( ! tunica vag9alis1 inve/+ ! epididymis2 7#b7 betwe5 ! te/icul> portion ( ! tunica vag9alis & ! tunica albug9ea1 :i* are ?us sep>at$ f ea* o!r2 7#c7 betwe5 ! lay]s ( ! loose or reflect$ portion ( ! tunica vag9alis4 ,! two la/ m5tion$ v>ieties are ( r>e occurr5ce4 ,! cy/s h ?9 fibr\s walls1 a l9+ ( tessellat$ epi!lium1 & cont5ts usually cle>1 al?\gh sometimes mix$ ) v>i\s exudations ( fibr9 or ev5 blood4 ,sp]matozoa are v frequ5tly f\nd 9 ! fluid ( ^! cy/s4 ,_! pres5ce is und\bt$ly due1 z po9t$ out by ,cu%+1 to ! rupture ( a neighbor+ sem9al duct4 ,!y are b r>ely f\nd 9 ! fluid ( common hydrocele4 ,diffus$ ,hydrocele ( ! ,cord1 gives rise to an oval or oblong1 irregul>1 circumscrib$ tumor1 ext5d+ bel[ & into ! +u9al canal4 8,x consi/s 9 ! enl>gem5t ( ! cells ( ! areol> tissue1 & _! di/5sion ) a :ite or yell[i% s]\s fluid4 ,! inclos+ fascial %ea? is cond5s$ & ?ick5$1 & at ! l[] "p ( ! swell+1 :i* is always ! l>ge/1 sep>ates x completely f ! tunica vag9alis40 ,ency/$ ,hydrocele ( ! ,cord =ms a tumor ( oval %ape1 loosely atta*$ to ! vessels ( ! cord :i* pass beh9d x4 ,in/ead ( a s+le cy/1 !re may be a numb]1 =m+ a s]ies along ! cord4 ,hmatocele1 is a tumor =m$ by an effusion ( blood f ! vessels ( ! te/is or ( ! sp]matic cord1 into ! cavity ( ! tunica vag9alis4 ,x may be traumatic or spontane\s1 & may atta9 a l>ge size4 ,coagula are =m$ ei!r 9 sep>ate masses1 or 9 firm lay]s1 z 9 aneurism4 ,inflammation may be set up1 lead+ to fibr9\s & s]\s effusion1 & to suppuration1 or ! blood may putrify & gangr5e result4 ,! tunica vag9alis is commonly ?ick5$1 ! te/icle unaffect$1 or 9 old cases atrophi$ f pressure4 ,diffus$ ,hmatocele ( ! ,cord results f ! rupture ( "s vessels ( ! cord1 9 consequ5ce ( :i* blood is effus$ )9 ! sp]matic fascia4 ,a tumor ( enorm\s size may be =m$ %\ld ! ble$+ cont9ue1 or recur aft] hav+ be5 arre/$4 ,! usual cause is "s /ra9 or viol5t ex]cise4 ,v>icocele is a morbid dilatation ( ! sp]matic ve9s4 8,! enl>g$ ve9s hang d[n bel[ ! te/icle1 & rea* upw>ds into ! +u9al canal2 & :5 v volum9\s1 conceal ! gl&1 encroa* on ! septum1 & ext5d to ! o!r side ( ! scrotum40 ,! left ve9s are m frequ5tly affect$ ?an ! "r4 ,9 an advanc$ /age ( ! disease1 ! coats ( ! ve9s are ?ick5$1 & d n collapse :5 cut across4 ,9 cases ( slight v>icocele1 ! nutrition ( ! te/is is n int]f]$ )1 b :5 l>ge1 x produces m>k$ atrophy4 ,morbid ,gr[?s4 ,canc] is mo/ frequ5tly prim>y1 & g5]ally attacks ! body ( ! te/is 9 ! fir/ in/ance1 ! epididymis rema9+ = "s "t unaffect$4 ,! scirrhus v>iety1 *>act]iz$ by its great induration1 is r>ely met )4 ,encephaloid is ! ord9>y =m2 x comm5ces z "o or two masses among ! tubuli1 :i* x gradually de/roys4 ,! tunica albug9ea is absorb$ by degrees1 gives way1 & all[s ! gr[? to project into ! scrotum & !re freely vegetate4 ,! scrotum is sl[ to be involv$ 9 ! disease1 b at fir/ becomes di/5d$1 sometimes to ! size ( a cocoanut1 & !n gradually ulc]ates4 ,! sp]matic art]y & ! accompany+ ve9s become greatly enl>g$4 ,! cord may also be attack$ ) ! disease1 :ile second>y canc]s spr+ up 9 v>i\s places4 ,! lymphatic gl&s 9 ! neighborhood become enl>g$1 especially ^? 9 ! iliac fossa4 ,! +u9al gl&s d n g5]ally become affect$ until ! sk9 has become involv$ 9 ! disease4 ,int]mix$ ) ! encephaloid are commonly f\nd masses ( a bright yell[ color1 suppos$ by "s to be deposits ( tub]cul\s matt]1 b by o!rs1 m]ely pla/ic matt] und]go+ fatty deg5]ation4 ,colloid & melanotic canc]s h r>ely be5 obs]v$ 9 ! te/es4 ,! tunica vag9alis is said to h be5 attack$ ) canc]\s disease1 ! te/is rema9+ heal?y4 ,cy/ic ,disease ( ! ,te/is4 ,! cy/s may be b few1 or v num]\s4 ,! te/is is proportionately enl>g$1 indurat$1 ( a yell[i%-:ite & opaque appe>ance1 & /udd$ ) cy/s v>y+ 9 size4 ,! cont5ts are1 9 ! y\ng] cy/s1 a cle>1 amb]-color$ fluid2 9 ! old] ones1 m ?ick1 viscid1 highly album9\s1 & ( a br[ni% color4 ,! cy/s are sometimes imb$d$ 9 solid /roma1 probably ( fibroid tissue2 sometimes small masses ( en*ondroma are f\nd betwe5 !m4 ,:5 ( an innoc5t "*1 ! cy/ic disease is *>act]iz$ by ! pres5ce ( tessellat$ epi!lium 9 ! cy/s2 :5 malignant1 by ! pres5ce ( nucleat$ canc] cells4 8,occasionally cy/ic tumors ( ! te/icle are met )1 9 :i* ! sub/ance ( ! organ is atrophi$ or absorb$1 & its place occupi$ by "o or m l>ge ?9-wall$ sacculi conta9+ fluids ( diff]5t color & consi/5ce1 d>k or fatty40 ,tub]cles are n v unfrequ5t1 & appe> sometimes 9 ! body ( ! gl&1 b (t5] 9 ! epididymis1 :5ce !y may spread to ! te/is4 ,!y occur z gray granulations1 infiltrat$ or ency/$1 & v>y+ 9 size f a p9's head to a plum-/one4 ,!y are commonly f\nd 9 all /ages ( developm5t & dis9tegration 9 ! same organ4 ,_! pres5ce 9 & betwe5 ! tubuli produces inflammation1 suppuration & disorganization ( ! /ructure ( ! te/is1 ) :i* !y become mix$1 s z to =m a *eesy mass ( a dirty buff color4 ,?is may1 by ulc]ation1 p]=ate ! scrotum1 & protrude z a fung\s gr[? ( a pale1 r$di%-yell[ granul> mass4 ,?is disease ( ! te/is is frequ5tly f\nd 9 connection ) pulmon>y tub]cle1 or g5]al tub]culosis4 ,tub]cul> syphilitic s>cocele1 describ$ by ,hamilton1 ( ,dubl91 is a v>iety occurr+ 9 an advanc$ /age ( con/itutional syphilis4 8,cretace\s matt] is occasionally met ) 9 ! te/is1 d\btless ! residue ( tub]cul\s deposit :i* has s(t5$ & und]gone calc>e\s *ange40 ,tumors4 ,fibroid tumors ( small size are sometimes f\nd develop$ )9 ! visc]al lay] ( ! tunica vag9alis1 or )9 ! sub/ance ( ! cord4 ,fatty tumors may be f\nd1 :i* h orig9at$ )9 ! tunica albug9ea1 ! d>tos1 or )9 ! fibr\s connective tissue ( ! cord4 ,c>tilag9\s tumors ( small size1 orig9ate ) ! sub/ance ( ! gl&1 & are frequ5tly associat$ ) cy/ic disease or canc]4 ,section ,,iv4 ,,! ,,sem9al ,,vesicles ,,& ,,pro/ate4 ,notice3 #a4 ,sem9al vesicles--pres5t or abs5t2 size2 di/5d$ or empty2 cont5ts4 ,condition ( muc\s l9+2 inflam$1 ?ick5$1 ulc]at$1 p]=at$2 tub]cul> deposits1 etc4 #b4 ,pro/ate gl&--abnormalities2 size2 d5sity2 enl>gem5t ( middle or lat]al lobes2 color ( section2 appe>ance ( inflammation2 abscess2 tumors2 canc]2 tub]cle4 ,cont5ts ( ducts--calculi3 _! position1 size1 etc4 ,cong5ital ,anomalies4 ,! vesicul sem9ales p>ticipate 9 ! defective developm5t ( ! te/es1 be+ abs5t or imp]fect :5 _! relat$ gl&s are s4 ,inflammation4 ,x is n uncommon = ^! bodies to be attack$ ) *ronic cat>rhal inflammation1 :i* causes a swell+ ( _! muc\s membrane1 ! secretion ( unheal?y mucus1 dilatation ( ! cavity1 & ?ick5+ ( its walls4 ,ulc]ation1 p]=ation1 & ! =mation ( abscess 9 adjac5t p>ts1 may result4 ,tub]cul> ,deposits are occasionally met )1 *iefly 9 cases ( ext5sive tub]culosis4 8,x appe>s z a ?ick1 yell[1 *eesy1 l>dace\s1 fissur$1 purul5t lay]1 replac+ ! muc\s membrane40 ,x nev] occurs be=e pub]ty4 ,! ,pro/ate ,gl&4 ,cong5ital ,anomalies4 ,:5 ! organs ( g5]ation are imp]fectly develop$1 ! pro/ate gl& is g5]ally f\nd to be s too4 ,hyp]trophy & ,atrophy4 ,hyp]trophy is ( frequ5t occurr5ce1 especially 9 connection ) old age4 ,all ! lobes may be enl>g$ equally1 or ne>ly s1 or "o or ! o!r ( ! lat]al lobes alone1 or ! middle lobe1 )\t any correspond+ hyp]trophy ( ! lat]al4 ,hyp]trophy ( ! middle lobe1 :5 consid]able1 ?r[s ! neck ( ! bladd] =w>d1 & increases ! dep? ( its l[] region1 s t calculi may lodge beh9d & bel[ ! pro/ate 9 its cavity4 ,! canal ( ! ure?ra becomes l5g!n$ 9 its pro/atic portion1 & may be n>r[$ by compression1 or consid]ably dilat$1 s t ! pro/atic s9us may conta9 two or ?ree ounces ( ur9e4 ,! reta9$ ur9e decompos+1 may cause irritation & inflammation ( ! bladd]4 ,! texture ( ! enl>g$ gl& is g5]ally indurat$1 ?\gh sometimes x is f\nd to be loos] & s(t] ?an natural4 ,on section1 ! cut surface bulges above ! level1 & ! %ades ( color are m /rongly m>k$ ?an 9 heal?4 ,frequ5tly s+le gl&-lobules are f\nd hyp]trophi$4 ,small cavities1 dilatations ( ! gl&-follicles1 are occasionally met )1 sometimes empty & sometimes conta9+ a yell[1 pus-l fluid1 ! pro/atic secretion 9 a ?ick5$ /ate4 ,atrophy1 ) consolidat$ texture1 is f\nd ) atrophy ( ! te/es4 8,ecc5tric atrophy is occasionally met )2 ! cavities are dilat$ & ! walls ?9n$1 9 consequ5ce ( ! increase 9 size ( calcul\s concretions 9 its follicles4 ,cases sometimes occur1 9 :i* ! :ole ( "o lobe1 or ev5 ! entire organ1 is conv]t$ into a ?9 fibr\s capsule1 ! prop] sub/ance ( ! gl& be+ almo/ wa/$40 ,inflammation4 ,z a result ( suppress$ gonorrhal dis*>ge1 ! pro/ate may be attack$ ) acute inflammation1 foll[$ by suppuration1 or *ronic enl>gem5t1 or an irritable /ate ( ! gl&1 ) increas$ secretion4 ,abscesses1 s+le or multiple1 may occur1 & op5 into ! bladd]1 into ! pro/atic s9us ( ! ure?ra1 into ! rectum1 or1 ext]nally ?r\gh ! p]9eum4 ,ulc]ation r>ely occurs4 ,morbid ,gr[?s4 ,canc] ( ! pro/ate is r>e2 encephaloid is almo/ ! only =m t occurs4 ,! gl& is enl>g$ & ! gr[? may p]=ate ! muc\s membrane ( ! bladd]1 & vegetate 9 its cavity4 ,tub]cles occasionally occur4 ,_! s(t5+ & dis9tegration give rise to abscesses1 :i* pursue ! same c\rse z inflammatory abscesses4 ,fibr\s tumors1 v>y+ 9 size f t ( a pea to a nut1 are ( frequ5t occurr5ce2 sometimes b loosely atta*$ to ! hyp]trophi$ gl&4 ,cy/s are ( extremely r>e occurr5ce1 commonly result+ f closure & dilatation ( ! gl&-follicles4 ,concretions4 8,9 great] or less numb]s1 !y are ( almo/ con/ant occurr5ce 9 ! pro/atic cavities2 !y may (t5 be se5 on mak+ a section ( ! gl&1 z r$di%-yell[ gra9s4 ,_! =m v>ies v mu*2 9 ! small] x approa*es ! oval or circul>2 9 ! l>g] x is m polygonal or triangul>4 ,!y are n unfrequ5tly pale or colorless4 ,! cont5ts ( ^! semiorganiz$ =mations appe> to be e>?y matt] 7phosphate1 ) a little c>bonate ( lime71 t+$ by ! ord9>y yell[ pigm5t :i* is s (t5 d]iv$ f ! blood4 ,x is mo/ probable t1 9 ord9>y heal?y /ates1 ^! concretions und]go solution at an e>ly p]iod ( _! exi/5ce1 yield+ up _! cont5ts to =m "p ( ! secretion ( ! gl&4 ,b1 if ?is does n occur1 & !y g on increas+ 9 size1 !y become ! nuclei1 or are develop$ into pro/atic calculi4 ,^! are n unfrequ5tly v num]\s2 z _m z fifty or sixty h be5 f\nd 9 an atrophi$1 dilat$ pro/ate4 ,! calculi sometimes coh]e1 & =m a l>ge mass1 project+ into ! membran\s portion ( ! ure?ra1 :i* becomes 9 consequ5ce mu* dilat$4 ,! small] calculi (t5 escape into ! bladd] ?r\gh ! dilat$ pro/atic ducts2 if !y rema9 !re1 !y excite irritation ( ! muc\s membrane & deposition ( phosphates ^u _! own surface40 ,,*apt] ,,iv4 ,,! ,,female ,,g5]ative ,,organs4 ,section ,i4 ,,! ,,pud5da ,,& ,,vag9a4 ,notice3 #a4 ,( ! pud5da--mal=mations2 condition ( ! labia & clitoris2 size2 color2 abrasions2 ulc]s2 eruptions2 tumors2 m>ks ( viol5ce1 etc4 ,orifice ( ure?ra--gr[?s ar\nd1 _! numb] & size4 ,hym5--pres5t or abs5t2 entire or lac]at$2 imp]=ate4 #a4 ,! ,pud5da4 ,cong5ital ,anomalies4 ,9 r>e cases ! ext]nal organs are entirely abs5t1 m frequ5tly b p>tially develop$4 ,! nymph may be f\nd abnormally enl>g$4 ,! clitoris may be abnormally long1 p]=at$1 or cleft4 ,_m ( ! cases ( s-call$ h]maphroditism are in/ances ( an undue cong5ital developm5t ( ! clitoris1 ) an irregul> developm5t ( ! o!r organs ( g5]ation1 ei!r ext]nal or int]nal1 or bo?4 ,hyp]trophy4 ,we may f9d an hyp]trophy ( ! labia1 due to a k9d ( solid dema1 p]haps orig9ally dep5d5t ^u a fissure or ulc] ( ! "p4 ,! nymph are (t5 abnormally enl>g$1 n necess>ily z ! result ( an abuse ( sexual indulg5ce4 ,9 new-born infants1 !y normally project beyond ! labia majora4 ,! clitoris occasionally is enl>g$1 elongat$ & p5dul\s1 &1 9 "s cases1 atta9s an enorm\s size4 ,a specim5 pres]v$ 9 ! ,museum ( ! ,univ]sity ( ,bonn1 is f\rte5 in*es 9 circumf]5ce & weighs eight p\nds4 ,!re is no necess>y connection betwe5 an habitual sexual indulg5ce & an enl>g$ clitoris4 ,v>icose swell+s ( ! labia may rea* a consid]able size1 &1 al?\gh n g5]ally int]f]+ ) p>turition1 h be5 kn[n to be lac]at$ at t "t ) fatal issue4 ,z ! result ( ext]nal viol5ce1 or dur+ p>turition1 suggillations (t5 occur 9 ! labia1 & may give rise to consid]able swell+4 ,! tumor pres5ts a t5se1 smoo? surface1 ( a livid color1 ?us di/+ui%$ f a v>icose swell+1 ) ! peculi> v]micul> "* ( its cont5ts4 ,inflammation4 ,! cutane\s cov]+1 ! muc\s l9+1 ! cellul> tissue1 & ! sebace\s & muc\s follicles1 may be ! seat ( inflammation1 result+ f ext]nal or int]nal causes4 ,eczemat\s & ap?\s inflammations may result f d]angem5t ( ! dige/ive organs1 f pregnancy1 f a want ( cleanl9ess1 or f excessive sexual indulg5ce1 & are ( frequ5t occurr5ce4 ,! loose cellul> tissue is especially favorable to demat\s swell+1 & :5 ! inflammation has a phlegmon\s "*1 ext5sive sl\gh+ may result4 ,x occasionally occurs z an epidemic among ^? 9 e>ly life4 ,! vulvo-vag9al gl&s are also liable to inflammation ( a cat>rhal1 h]petic or syphilitic "*1 result+ 9 *ronic ulc]ation1 or t$i\s dis*>ges4 ,"y *ildr5 are frequ5tly liable to a b5ignant inflammatory affection ( ^! p>ts1 giv+ rise to mu* irritation & a muco-purul5t secretion4 ,morbid ,gr[?s4 ,w>ty excresc5ces1 aris+ f a syphilitic ta9t1 may affect ! labia1 ! entrance ( ! vag9a1 & ! clitoris4 ,!y consi/ ( gr\ps ( small p$unculat$ tumors1 produc+ a sort ( mu%room appe>ance4 ,syphilitic muc\s tub]cles are describ$ z r\nd1 flatt5$ tub]cles1 rais$ above ! surr\nd+ tissues1 sometimes becom+ elongat$1 ( a r$di%-blue color1 & frequ5tly ulc]at$ on ! surface4 ,cy/ic tumors are also met ) 9 ! labia4 ,!y consi/ ( a membran\s envelope1 conta9+ a transp>5t1 glairy fluid1 & (t5 atta9 a l>ge size4 ,! muc\s membrane surr\nd+ ! orifice ( ! ure?ra1 is liable to an hyp]trophy ( developm5t1 giv+ rise to small vascul>1 g5]ally p$unculat$ tumors1 extremely s5sitive dur+ life1 & liable to become abrad$4 ,elephantiasis may attack ! labia majora1 ! nymph1 or ! clitoris1 & may atta9 to a great size4 ,x consi/s ( ! loose connective tissue ( ! "p1 infiltrat$ ) s]um1 & cov]$ ei!r ) ! smoo? sk91 or "o :i* has become r\gh5$ by hyp]trophy ( ! papill4 ,x may appe> z a diffus$ hyp]trophy1 or be furni%$ ) a p$icle1 & resemble a polypus4 ,fibr\s1 fatty & scirrhus tumors are also met ) 9 ?is "p ( ! sy/em4 #b4 ,! ,vag9a4 ,cong5ital ,anomalies4 ,! valvul> fold ( membrane :i* protects ! virg9 vag9a1 ! hym51 may be imp]=ate or mu* indurat$1 & ( a c>tilag9\s consi/5cy4 ,x may ?us entirely close ! vag9a4 ,besides ?is1 we may f9d ! vag9a t]m9at+ 9 a cul-de-sac1 ei!r ) ! ut]us pres5t or abs5t1 & ! ov>ies normal or abnormal4 ,! vag9a may also be duplicat$1 by a septum ext5d+ ! entire l5g? ( ! canal1 or only p>tially divid+ x4 ,!re may be at ! same "t a d\ble ut]us4 ,entire abs5ce ( ! vag9a is also met )1 ! int]nal organs ( g5]ation be+ also abs5t1 or b imp]fectly develop$4 ,morbid ,/ates4 ,occlusion or /ricture ( ! vag9a sometimes occurs z ! result ( ext]nal injury1 or ( cicatrization ( ulc]s4 ,dilatation1 or l5g!n+ ( ! vag9a1 also occurs4 ,! rigidity or laxness ( ! walls ( ! vag9a1 v>ies mu* 9 diff]5t individuals1 accord+ to con/itution1 age1 & ! effects ( cohabitation & *ild-bir?4 ,prolong$ ut]9e or vesical disease1 (t5 produces a v lax condition ( ! muc\s membrane ( ! vag9a4 ,9 old wom5 we (t5 meet ) ?is relax$ /ate1 :i* may am\nt to a complete prolapsus4 ,! ant]ior wall is p>ticul>ly liable to be ?us affect$4 ,lac]ation & ,rupture4 ,ext]nal me*anical injuries may produce lac]ation ( ! vag9a4 ,dur+ p>turition1 ei!r f unusual rigidity1 or f want ( c>e on ! "p ( ! att5dant1 ! l[] portion ( ! canal is apt to give way :5 ! labor pa9s are at _! height4 ,! lesion may v>y f a m]e lac]ation ( ! f\r*ette1 to a rupture ( ! entire p]9eum1 f ! vag9a to ! anus4 ,lac]ations ( ! upp] portions ( ! vag9a also occur ) rupture ( ! ut]us1 or ev5 indep5d5tly ( x4 ,lac]ations ( ! vag9a are n necess>ily fatal1 b may result 9 vesico-vag9al fi/ula1 :]e a communication is e/abli%$ betwe5 ! bladd] or ure?ra1 & ! vag9a2 or 9 recto-vag9al fi/ula1 :]e ! fi/ula op5s into ! rectum4 ,inflammation4 ,! muc\s membrane ( ! vag9a is frequ5tly ! seat ( inflammation4 ,! commone/ =m is ! cat>rhal1 :i* may be acute or *ronic4 ,9 ! fir/ /age1 ! passage is r$d5$1 heat$ & dry4 ,?is is foll[$ by an abundant secretion ( :ite1 creamy mucus2 or ( a m purul5t dis*>ge1 if ! inflammation has any?+ ( a specific "*4 ,cr\p\s inflammations1 9 connection ) g5]al disease1 or a simil> disease ( ! ut]us1 may occur4 ,!y produce a solution ( ! muc\s membrane & ! submuc\s tissue1 v>y+ 9 %ape & dep?1 & n unfrequ5tly resembl+ gangr5\s de/ruction4 7,rokitansky47 ,a *ronic ?ick5+ ( ! muc\s membrane1 z ! result ( inflammation1 is occasionally met )4 ,! follicul>1 syphilitic & c>c9omat\s ulc] also affect ?is "p4 ,suppurative inflammation may result f injuries1 end+ 9 ! =mation ( an abscess 9 ! fibr\s /ructures1 :i* may burr[ )9 ! pelvic areol> tissue1 or ext5d into ! labia4 ,gangr5e sometimes results f injuries receiv$ dur+ p>turition1 or f a deg5]ation ( cr\p\s inflammation 9 a vag9a affect$ ) bl5orrha ( a gonorrhal or syphilitic orig94 ,morbid ,gr[?s4 ,polypi & cy/s are ! v>ieties mo/ frequ5tly met ) 9 ?is situation4 ,! polypi may be ei!r fibro-vesicul>1 or cellulo-vascul>1 v>y+ greatly 9 size4 ,! ency/$ tumors1 orig9ate 9 an ob/ruction ( ! follicles ( ! "p1 & conta9 a glairy1 transp>5t1 gre5i%1 or dirty-br[n album9\s fluid4 ,myomat\s tumors may be f\nd develop$ )9 ! muscul> coat ( ! vag9a1 ! po/]ior wall be+ _! usual position4 ,c>c9oma may occur prim>ily1 or by an ext5sion ( ! disease f ! c]vix ut]i4 ,! =m 9 :i* x appe>s is ! encephaloid k9d1 ! appe>ance ( :i* is describ$ 9 connection ) ! ut]us4 ,malignant epi!lial gr[?s are n met ) 9 ! vag9a4 ,section ,,ii4 ,,( ,,! ,,ut]us4 ,notice3 #a4 ,9 situ--abs5ce or mal=mations4 ,size1 & relation to surr\nd+ organs & walls ( pelvis2 high or l[ 9 pelvis2 v]sions2 flexions2 adhesions1 etc4 #b4 ,aft] removal--os2 size & %ape1 r\nd1 oval1 irregul>1 etc4 ,lips--size2 =m2 color2 condition ( surface2 s(t or firm2 r\gh or smoo?2 abrasions2 granulations2 ulc]s2 tumors1 etc4 ,ext]nal *>act]s ( body--size2 measurem5ts2 weight2 tumors2 rupture2 consi/5ce1 h>d or s(t4 ,aft] section--?ickness ( walls2 d5sity2 condition ( blood-vessels2 abscesses2 tumors1 etc4 ,ut]9e cavity--size & =m4 ,cont5ts2 s]um2 size & condition2 blood2 mucus2 pus2 tumors4 ,condition ( muc\s l9+1 canc]\s gr[?s1 etc4 ,accord+ to ! measurem5ts ( ,kilian1 ! ut]us 9 ! virg9 adult1 v>ies 9 l5g? f tw5ty-f\r to tw5ty-six l9es2 ! greate/ bread? is eighte5 l9es2 ! ?ickness n9e l9es2 ! c]vix is f t5 to twelve l9es long2 its bread? f six to eight2 its ?ickness f five to six l9es4 ,! l5g? ( ! ut]9e cavity is twelve l9es1 & its bread? n9e l9es4 ,aft] "o or m bir?s all ^! measurem5ts increase f "o-fif? to "o-qu>t]4 ,! weight ( ! ut]us v>ies f eight to twelve dra*ms1 & may1 aft] sev]al pregnancies1 am\nt to two ounces4 ,cong5ital ,anomalies4 ,! entire abs5ce ( ! ut]us is an exce$+ly r>e occurr5ce1 & ne$ n affect ! heal? ( ! individual4 ,a seem+ multiplication ( ! organ is occasionally met 9 ! bilocul> & horn$ ut]us4 ,9 ! =m]1 a m or less p]fect septum ext5ds ?r\gh ! organ 9 ! m$ian l9e1 :ile 9 ! latt]1 ! ut]us is divid$ into two lat]al portions1 by a prolongation ( ! angles or cornua1 giv+ a resemblance ?us to a p]man5t =m se5 9 _m ( ! l[] animals4#ce ,we may also f9d ! s-call$ ut]us unicornis1 :]e only "o ( ! two rudim5t>y bodies f :i* ! normal ut]us is develop$ arrives at maturity4 ,all ^! k9ds ( ut]i are capable ( becom+ impregnat$1 b p>turition1 al?\gh n necess>ily fatal1 s]i\sly endang]s ! life ( ! pati5t2 ow+1 accord+ to ,rokitansky1 p>tly to ! want ( ! necess>y dim5sions ( ! "p t und]takes ! functions ( ! entire organ1 & p>tly to ! ob/acle oppos$ to ! uni=m developm5t ( ! impregnat$ half by ! unimpregnat$ half4 ,^! circum/ances favor rupture ( ! ut]9e walls4 ,hyp]trophy & ,atrophy4 ,^! are 9 "p normal at ! p]iods ( pub]ty & *ange ( life2 z a morbid /ate1 ! fir/ is ( m frequ5t occurr5ce ?an ! la/4 ,ei!r may affect ! entire organ1 or only a "p4 ,aft] ! climact]ic p]iod ! c]vix (t5 disappe>s entirely4 ,hydrometra4 ,z ! result ( inflammatory processes1 ! os int]num or ! os ext]num may become occlud$1 caus+ a ret5tion ( ! secretions f ! diseas$ muc\s membrane ( ! ut]us4 ,?is secretion gradually *anges into a sort ( ?9 s]um4 ,! ut]us becomes dilat$1 & we h hydrometra4 ,hmatometra is a condition :]e ! ut]us is dilat$ ) s]um mix$ ) blood1 or exclusively ) reta9$ m5/rual blood4 ,?is latt] /ate is m frequ5tly ! result ( cong5ital ?an ( acquir$ atresia4 ,! am\nt ( dilatation may v>y greatly4 ,malpositions ( ! ,ut]us4 ,^! may be ( two k9ds3 7#a7 :]e ! direction ( ! axis is *ang$2 or 7#b7 ! organ becomes altoge!r displac$1 s t its relation to all ! pelvic visc]a is alt]$4 ,( ! =m] class1 are ante- & retro-v]sions1 ) flexions1 & lat]al obliquities2 ( ! latt]1 prolapsus procid5tia & inv]sion4 ,inv]sion may occur spontane\sly or z ! result ( manual int]f]5ce 9 ! removal ( ! aft] bir?4 ,! fundus may pass b a %ort di/ance into ! cavity ( ! organ1 or ! ut]us may be turn$ completely inside out4 ,inv]sion may also result 9 an unimpregnat$ ut]us f ! pres5ce ( fibr\s polypi1 gr[+ f ! inn] surface ( ! fundus4 ,^! gr[?s1 :5 complicat+ pregnancy1 favor inv]sion by di/urb+ ! regul> expulsive contractions4 ,hmorrhages4 ,an effusion ( blood into ! cavity ( ! ut]us1 occurs normally at e p]iod ( m5/ruation2 f "s morbid condition ( ! vessels ( ! ut]us1 x may at times am\nt to an hmorrhage4 ,att5d+ p>turition1 x may be due to plac5ta prvia2 or foll[+1 to atony or defective contraction ( ! ut]9e walls1 :]e we f9d ! ut]us ma9ta9+ its dilat$ condition ) flabby & s(t walls2 or to spasm or irregul> contraction1 to :i* ! t]m1 8h\r-glass contraction10 has be5 appli$4 ,! pres5ce ( polypoid tumors is frequ5tly att5d$ by hmorrhages4 ,p]i- or ,retro-ut]9e ,hmatocele1 is an accumulation ( m5/rual blood1 g5]ally 9 ! ut]o-rectal cul-de-sac4 ,x may arise f rupture ( a blood-vessel1 f defect 9 ! excretion ( ! m5ses1 or f a morbidly pr(use exhalation ( blood f ! g5ital organs4 ,! extravasation may be reabsorb$1 or may by p]=ation be dis*>g$ by ! rectum or vag9a1 or may lead to suppuration & ! =mation ( an abscess4 ,inflammations4 ,! traces ( acute cat>rhal inflammation are b seldom to be discov]$4 ,!y pres5t ! same features z cat>rhal inflammations ( o!r muc\s membranes1 conge/ion & swell+1 ) a m or less abundant secretion ( muco-pus4 ,9 *ronic cat>rhal inflammations1 ! membrane is f\nd ?ick5$1 ( a br[ni% or slate-gray color1 ) a m or less purul5t secretion1 (t5 blood-/reak$4 ,! walls ( ! ut]us may be atrophi$ or hyp]trophi$4 ,cat>rhal erosions1 & follicul> ulc]s1 ! result ( ! bur/+ or suppuration ( ! /opp$-up follicles1 usually accompany cat>rhal inflammations4 ,acute ,metritis4 ,"h we f9d ! organ swoll5 & conge/$1 & its sub/ance ( a d>k] color4 ,! muc\s membrane %[s symptoms ( a cat>rh1 & ! p]itoneal cov]+ is also conge/$4 ,occasionally extravasations ( blood are f\nd 9 ! sub/ance or cavity ( ! ut]us4 ,! inflammation may lead to ! =mation ( abscesses )9 ! ut]9e walls4 ,9 ,*ronic ,metritis ! organ is g5]ally mu* enl>g$4 ,! walls are rem>kably pale & dry1 ?ick & h>d4 ,! muc\s membrane almo/ always pres5ts ! appe>ances describ$ "u *ronic cat>rhal inflammation1 :ile ! p]itoneal cov]+ frequ5tly %[s num]\s adhesions to ! neighbor+ organs4 ,ulc]ations may be cat>rhal1 ) sup]ficial erosions or follicul> ulc]s2 or syphilitic1 9 ! =m ( ! h>d & s(t *ancre2 or we may1 9 r>e cases1 h ! corrod+ ulc]1 describ$ by ,dr4 ,john ,cl>ke1 & diff]+ f g5u9e c>c9oma only 9 ! abs5ce ( an indurat$ deposit4 ,morbid ,gr[?s4 ,fibroid tumors are ( mo/ frequ5t occurr5ce4 ,!y are f\nd ei!r imb$d$ 9 ! texture ( ! ut]us1 or protrud+ f its inn] surface into ! cavity1 or f "s "p ( its ext]nal surface4 ,^? project+ into ! cavity ( ! ut]us1 call$ also fibr\s polypi or submuc\s tumors1 are mo/ frequ5tly met )4 ,_! p$icles are g5]ally situat$ j bel[ ! op5+s ( ! ,fallopian tubes1 al?\gh !y spr+ also f ! po/]ior wall & f ! fundus1 less frequ5tly f ! ant]ior wall1 & /ill m r>ely f ! c]vix ut]i4 ,rec5t inve/igations g to %[ t ^! tumors are to be class$ ) ! homolog\s1 r ?an het]olog\s productions1 & t !y are developm5ts ( true muscul> tissue4 ,to ! nak$ eye ?is /ructure v>ies 9 "s respects2 at times !y pres5t a conc5tric disposition ( fibres1 b m commonly an irregul>1 wavy appe>ance1 )\t any uni=mity ( arrangem5t1 & 9 ! latt] case1 frequ5tly ) cavities conta9+ blood1 a d>k-color$ gelat9\s fluid1 or a cle> s]um4 ,"u ! microscope1 a fibr\s /ructure is sc>cely p]ceptible1 b elongat$ nuclei are se51 imb$d$ 9 an amorph\s /roma4 ,! vascul>ity ( fibr\s tumors v>ies4 ,! majority are b scantily provid$ ) vessels4 ,! tumors imb$d$ 9 ! ut]9e tissue =m globul>1 :ite1 gli/5+1 d5se tumors4 ,!re may be only "o1 or !y may be num]\s1 & may v>y 9 size f t ( a p9's head to t ( a melon4 ,^! gr[?s are subject also to second>y *anges2 ?us we may f9d abscesses 9 ! v c5tre ( fibroid gr[?s1 or !y may conta9 ency/$ melanotic tumors1 or a species ( calcification may be develop$4 ,fibr\s tumors h n be5 obs]v$ be=e pub]ty1 b occur1 accord+ to ,lee & ,bayle1 mo/ frequ5tly 9 virg9s4 ,polypi & ,polypoid ,gr[?s4 ,^! gr[?s--n to be conf\nd$ ) ! fibr\s tumors1 z is frequ5tly done--are s(t & succul5t1 & project into ! cavity ( ! ut]us1 or hang into ! vag9a4 ,!y are atta*$ by a p$icle ( great] or less wid?1 to ! surface f :i* !y spr+1 & are cov]$ ) ! muc\s membrane ( ! "p4 ,!y are ess5tially a morbid condition ( ! /ructures ( ! surface1 ! muc\s membrane1 ! follicles1 or sebace\s crypts ( ! diff]5t p>ts ( ! ut]us4#cf ,polypoid tumors may give rise to hmorrhages4 ,!y may become inflam$1 suppuration or ev5 gangr5e sup]v5+4 ,9 ?is way ! p$icle may be de/roy$1 & ! tumor be expell$4 ,cy/s & ,tub]cul> ,deposits are extremely r>e 9 ! ut]us4 ,! latt] affect prim>ily ! l9+ membrane1 :]e x occurs 9 ! mili>y =m1 or accumulat$ 9 masses1 aggregat$ into nodules1 or =m+ a *eesy lay] ov] ! entire surface4 ,! ut]9e tissue may be second>ily affect$1 & is !n liable to become infiltrat$ ) ! morbid product4 ,traces ( ! disease are f\nd also 9 ! vag9a z spots ( ulc]ation1 & 9 ! ,fallopian tubes4 ,canc]4 ,c>c9oma ( ! ut]us is ( frequ5t occurr5ce4 ,! p]iod ( life 9 :i* x is mo/ frequ5tly met )1 is t betwe5 ! =tie? & fiftie? ye>s4 ,al?\gh met ) 9 s+le wom51 x is f\nd mo/ frequ5tly among ! m>ri$4 ,9 g5]al1 ?is disease attacks ! c]vix fir/1 :]eby x is di/+ui%$ f fibroid gr[?s4 ,_m in/ances ( suppos$ canc]s1 prove on microscopic exam9ation1 to be no?+ m ?an an irregul> ?ick5+ & induration ( ! c]vix1 consequ5t ^u *ronic inflammation4 ,accord+ to ,rokitansky1 ! prevail+ =m ( ut]9e canc] is ! m$ull>y c>c9oma1 appe>+ z an infiltration ( a :ite l>daceo-c>tilag9\s1 or loose encephaloid matt]1 9 :i* ! ut]9e tissue is lo/1 & giv+ rise to ! *>act]i/ic nodulat$ surface ( ! c]vical portion ( ! organ4 ,( r>] occurr5ce is ! fibr\s canc]1 consi/+ ( d5se1 :iti%1 reticulat$ fibres1 conta9+ 9 _! me%es a pale-yell[i% transluc5t sub/ance4 ,its limits are n %>ply def9$1 b are lo/ 9 ! ut]9e tissue4 ,n[h]e does ! de/ructive "* ( ! canc]\s disease manife/ su* virul5ce1 z :5 attack+ ! ut]us4 ,! deg5]ation spreads m or less rapidly to ! adjo9+ p>ts1 &1 9 extreme cases1 ! :ole cont5ts ( ! abdom5 are matt$ toge!r1 & pres5t a frightful spectacle ( disorganization & de/ruction4 ,caulifl[] ,excresc5ce ( ! c]vix1 is reg>d$ by bo? ,rokitansky & ,r5aud1 z a modification ( encephaloid gr[?4 ,x appe>s z an irregul> projection1 ) a base z broad z any o!r "p ( x1 atta*$ to "s "p ( ! c]vix4 ,! surface has a granulat$ feel4 ,on removal f ! body x collapses1 ow+ to its vascul> "*4#cg ,morbid ,conditions foll[+ ,p>turition4 ,rupture ( ! ,ut]us is n unfrequ5t z a concomitant ( pregnancy 9 ! horn$ or bilocul> mal=mation ( ! organ4 ,x is also met ) 9 ! normal ut]us4#ch ,a lac]ation ( ! os t9c occurs at e bir?1 & s long z x does n ext5d beyond ! circul> fibres ( ! c]vix is n dang]\s4 ,! result is g5]ally m disa/r\s :5 ! rupture ext5ds beyond ?is po9t4 ,x may p5etrate ! entire ?ickness ( ! organ1 s z to all[ ( ! escape ( ! ftus into ! abdom9al cavity1 or only "o lay] ( ! walls may give way1 or only ! p]itoneal inve/m5t may be lac]at$1 :ile ! ut]us itself rema9s un9jur$4 ,rupture ( ! ut]us may also result f ext]nal injury be=e p>turition4 ,x is n necess>ily fatal4 ,primip> are m liable to ?is accid5t ?an multip>4 ,pu]p]al ,inflammations4 ,:]e ! ut]us has itself be5 ! ma9 seat ( inflammation1 we f9d t an exudative process has giv5 rise to ! =mation ( a yell[i% or gre5i%1 m or less1 gelat9oid l9+ on its int]nal surface1 caus+ a ragg$1 pat*y appe>ance4 ,?is exudation may be easily deta*$ f ! subjac5t muc\s membrane1 :i*1 accord+ to ! int5sity ( ! disease1 is m or less r$d5$1 tumefi$ & s(t5$4 ,?is condition may p5etrate to ! deep] tissues1 & involve ! entire ?ickness ( ! ut]us1 :i* w !n1 also1 be m or less s(t5$ & discolor$1 infiltrat$ ) a ?9 sani\s product1 & ev5 conv]t$ into a m]e pulp4 ,! dirty-color$1 br[ni%1 floccul5t matt] t is f\nd inve/+ ! inn] surface ( ! ut]us soon aft] deliv]y1 & :i* is m]ely ! residue ( ! decidua1 mu/ n be mi/ak5 = ! product ( disease4 ,! ragg$ appe>ance ( ! "p to :i* ! plac5ta 0 atta*$1 due1 accord+ to ,dr4 ,john ,cl>ke1 to ! rema9s ( ! mat]nal portion ( ! plac5ta & ! coagula ( blood left aft] its sep>ation1 is also liable to be ! s\rce ( error4 ,9 bo? cases1 h[ev]1 if ! app>5t exudation be scrap$ (f1 :i* c easily be done1 we f9d ! heal?y surface und]nea?4 ,9 putresc5ce1 ! l[e/ =m ( ut]9e inflammation1 we f9d ! int]nal lay] ( ! organ cov]$ ) a ?91 opaque1 or m d5se product1 v>y+ 9 color f pale gre5 to d>k br[n1 b5ea? :i* ! tissue to a great] or less dep? is conv]t$ into a simil> pulp4 ,we sometimes f9d small abscesses )9 ! muscul> tissue )\t any p]ceptible *ange 9 ! surr\nd+ p>ts2 9 mo/ cases1 h[ev]1 ! /ructure ( ! muscul> fibre is entirely de/roy$4 ,metrophlebitis4 ,inflammation ( ! v5\s *annels & lymphatics ( ! ut]us1 is a v frequ5t cause ( ! fatal t]m9ation ( cases ( pu]p]al fev]4 ,tonnell f\nd x pres5t 9 "o hundr$ & ?irty-two cases out ( two hundr$ & tw5ty-two4 ,besides ! appe>ance ( ! vessels common to ord9>y phlebitis1 we f9d ! ut]us /udd$ ) small abscesses :i* may be trac$ to ! vessels4 ,! lymphatics may be prim>ily & co9cid5tly affect$1 or !y may be attack$ sep>ately & second>ily2 ! =m] is ! m frequ5t4 ,!y pres5t ! same v>icose appe>ance z ! ve9s1 & are ?ick5$ & di/5d$ ) ! purul5t or sani\s products ( ! inflammation4 ,pu]p]al ,p]itonitis1 is ! lesion mo/ commonly associat$ ) pu]p]al fev]4 ,x may be conf9$ to ! surface ( ! organ1 p>ticul>ly to ! "p surr\nd+ ! neck1 or may involve m or less entirely ! :ole sac4 ,9 ! /h5ic =ms1 ! appe>ances pres5t$1 resemble ^? ( ord9>y p]itonitis4 ,9 ! l[ typhoid =ms1 !re is a peculi> abs5ce ( conge/ion & r$ness4 ,! ord9>y "* ( ! exudation1 is a copi\s effusion ( an apla/ic "*1 ( a dirty-yell[1 gre5i%1 or br[ni% hue1 9 :i* floccul5t p>ticles ( lymph are f\nd float+1 :ile b small pat*es ( a ?91 non-coh]5t exudation1 are obs]v$ 9 ! p]itoneal sac4 ,! smell ( ! fluid is di/9ctive1 diff]+ f any?+ f\nd 9 ! human body 9 heal? or disease1 & aft] hav+ be5 once notic$1 _c fail to be recogniz$4 ,extra-ut]9e ,pregnancy4 ,?is species ( ge/ation may be consid]$ "u ! foll[+ v>ieties1 receiv+ _! names accord+ to ! "p ( ! passage :]e ! ovule becomes fix$3 #a4 ,abdom9al ,pregnancy4 #b4 ,tubo-abdom9al ,pregnancy4 #c4 ,tubal ,pregnancy4 #d4 ,int]/itial ,tubo-ut]9e ,pregnancy4 #e4 ,ut]o-tubal ,pregnancy4 #a4 ,abdom9al ,pregnancy4 ,?is includes all cases 9 :i* ! fecundat$ ovule fails to engage 9 ! tube4 ,?ree v>ieties may occur4 ,! ovule may rema9 9 ! ruptur$ ovisac & !re be develop$1 giv+ rise to an int]nal ov>ian pregnancy4 ,%\ld x aft] escap+ f ! ,graafian vesicle adh]e to ! surface ( ! ov>y1 we h an ext]nal ov>ian pregnancy4 ,f9ally1 if ! ovule1 escap+ f ! ov>y1 fall into ! p]itoneal cavity1 & !re und]go developm5t1 a p]itoneal pregnancy results4 ,9 ! la/ class1 ! po9ts to :i* ! ovule may atta* itself are exce$+ly num]\s4 ,! plac5ta has be5 f\nd atta*$ to ! p]itoneum cov]+ ! "r or left iliac fossa1 sometimes to a "p ( ! small or l>ge inte/9e1 & sometimes to ! ant]ior wall ( ! abdom54 #b4 ,tubo-abdom9al ,pregnancy4 ,?is "n is appli$ to ^? cases :]e ! ovule hav+ b j ent]$ ! tube1 is arre/$ by an oblit]ation or con/riction ( ! canal1 & !re und]goes developm5t4 ,! plac5ta is atta*$ 9 ! int]ior ( ! tube1 & ! ftus develop$ 9 ! abdom9al cavity1 & bo? are surr\nd$ by a cy/1 ! walls ( :i* are p>tly made up by ! walls ( ! dilat$ tube4 ,?is includes also :at has be5 describ$ z tubo-ov>ian pregnancy4 #c4 ,tubal ,pregnancy is ! mo/ frequ5t ( all v>ieties ( extra-ut]9e pregnancy4 ,! ovule is "h arre/$ & develop$ at "s spot )9 ! tube1 betwe5 its abdom9al extremity & ! po9t :]e x ent]s ! ut]9e walls4 ,! fibres ( ! enorm\sly di/5d$ tube con/itute ! envelope ( ! ftal cy/4 #d4 ,int]/itial ,tubo-ut]9e ,pregnancy4 ,"h ! ovule is arre/$ 9 t "p ( ! tube t trav]ses ! ?ickness ( ! ut]9e walls4 ,x may rema91 dur+ its developm5t1 enclos$ by ! tube1 or x may make its way ?r\gh ^! & be develop$ )9 ! muscul> fibres ( ! womb itself4 #e4 ,ut]o-tubal ,pregnancy is a v r>e b possible =m ( extra-ut]9e pregnancy4 ,! ovule may +raft itself j at ! int]nal orifice ( ! canal4 8,9 ?is v>iety1 ! ftus is f\nd 9 ! abdom9al cavity2 ! cord leav+ ! umbilicus ent]s ! ,fallopian tube1 trav]ses its :ole l5g?1 & is ins]t$ 9 ! plac5ta1 :i* is itself atta*$ to ! int]nal surface ( ! ut]us40 ,! tube has evid5tly be5 ruptur$1 all[+ ! passage ( ! ftus into ! p]itoneum1 :ile ! plac5ta rema9$ 9 ! ut]us4 ,9 all ^! pregnancies1 ! ovule has orig9ally its prop] membranes1 ! *orion & ! amnion4 ,! /ructure ( ! walls ( ! enclos+ cy/ v>ies accord+ to ! species ( extra-ut]9e pregnancy4 ,z a g5]al rule1 ! ftus exhibits no?+ peculi> 9 its developm5t4 ,! mo/ common ( ! num]\s alt]ations :i* x may und]go1 are putresc5t dissolution ( its s(t p>ts1 & ! sep>ation ( ! v>i\s pieces ( its skeleton2 a complete dry+-up or mummification2 & trans=mation ( all its tissues into an osse\s or cretace\s sub/ance4#ci ,9 ! tissues ( ! "m1 new or increas$ vascul>ity ( ^? p>ts :]e ! ovule is atta*$ w be notic$1 :ile ! womb w be f\nd to h sympa?iz$ ) ! developm5t ( ! ftus by an hyp]trophy ( its muc\s membrane1 :i*1 h[ev]1 does n la/ m ?an a few mon?s4 ,a gelat9\s sub/ance1 a k9d ( ?ick1 ropy mucus1 is also frequ5tly f\nd 9 ! neck ( ! ut]us4 ,^! appe>ances are g5]ally want+ 9 ! womb1 :]e ! pregnancy has advanc$ beyond t]m4 ,extra-ut]9e pregnancy g5]ally t]m9ates fatally4 ,9 ! abdom9al =m1 ! pregnancy may progress to ! lat] mon?s ( ge/ation1 :51 los+ its vitality1 ! ftus may decompose1 produc+ p]itonitis & dea?1 or x may become encapsulat$ & gradually absorb$2 or by ! ulc]ative process1 ! rema9s may be dis*>g$ into ! inte/9al canal1 or ?r\gh ! abdom9al walls4 ,:]e ! case has be5 diagnos$ be=e dea?1 ! dead ftus has be5 successfully remov$ by abdom9al section4 ,9 ! v>ieties ( tubal pregnancy1 rupture ( ! tube1 & dea? f hmorrhage usually takes place 9 ! e>ly mon?s1 z 9 ! foll[+ case3 ,,case4--,tubal ,pregnancy1 ) ,rupture ( ! ,fallopian ,tube--,hmorrhage & ,dea?4 ,mrs4 ,c----1 ag$ ?irty-?ree ye>s1 f\r ye>s m>ri$1 b *ildless1 _h be5 indispos$ = two weeks4 ,e>ly 9 ! morn+ ( ,july #i?1 %e 0 tak5 ) sev]e pa9 9 ! l[] abdom51 nausea & vomit+1 rapid pro/ration1 increas+ tumidity ( ! abdom51 & dea? at #g o'clock ,p4 ,m4 ,?irty-six h\rs aft] dea?1 assi/$ by ! att5d+ physicians1 ,drs4 ,h4 ,j4 ,s>ta9 & ,e4 ,calv91 ,i made a po/-mortem exam9ation4 8,a qu>t ( bloody s]um 0 spong$ out ( ! abdom9al cavity1 !n a p9t & a-half ( black coagula 0 remov$1 :5 ! pelvic visc]a 7 expos$4 ,! "r ,fallopian tube 0 f\nd enl>g$ & ruptur$1 )9 an in* ( its connection ) ! ut]us4 ,! ovule _h lodg$ 9 ! tube1 ab\t half an in* f its outlet1 & !re =m$ its atta*m5ts4 ,! ooz+ blood f ! ruptur$ art]ioles & v5ules ( ! tube1 _h de/roy$ ! outl9e ( ! embryo1 leav+ a sort ( granul> debris ly+ 9 ! fragm5ts ( ! membranes1 :i* 7 deta*$ f ! inn] surface ( ! tube4 ,! nidus measur$ ext]nally ab\t an in* 9 l5g?1 & ?ree-qu>t]s ( an in* 9 transv]se diamet]4 ,! walls ( ! ut]us 7 slightly s(t5$1 & ! decidua _h =m$40#dj ,section ,,iii4 ,,! ,,ov>ies ,,& ,,fallopian ,,tubes4 ,notice3 #a4 ,ext]nal ,*>act]s ( ov>ies2 size2 color2 consi/5ce2 s(t & boggy1 or firm & h>d2 surface smoo?1 or r\gh1 irregul> & fissur$2 cy/s b5ea? ! surface1 or project+ f same4 ,*>act]s on section--color1 d5sity2 condition ( /roma1 consi/5ce1 etc4 ,corpora lutea3 numb]1 size1 situation2 cy/s2 tumors2 abscesses2 tub]cles2 canc]1 etc4 #b4 ,fallopian tubes--abs5t or mal=m$2 l5g?2 size ( canal2 ?ickness ( walls2 condition ( fimbriat$ extremity2 tumors1 tub]cle1 canc]1 etc4 #a4 ,! ,ov>ies4 ,mal=mations & ,malpositions4 ,! abs5ce or arre/ ( developm5t ( "o or bo? ov>ies is occasionally met )4 ,! ov>ies may be f\nd 9 ! labia majora z a cong5ital defect1 or 9 ! +u9al or crural canal1 or 9 ! =am5 ovale1 z cong5ital or acquir$ h]ni4 ,inflammation is b r>ely met ) 9 po/-mortem exam9ations 9 an isolat$ =m4 ,x g5]ally is associat$ ) affections ( ! ut]us or its app5dages1 9 connection ) ! pu]p]al condition4 ,x does1 h[ev]1 occur z an idiopa?ic disease1 & !n g5]ally attacks b "o ov>y4 ,9 ! conge/ive /age !re is m or less engorgem5t ) blood1 ev5 am\nt+ to extravasation1 enl>gem5t & s(t5+ ( ! organ4 ,abscesses4 ,z a result ( acute inflammation1 abscesses may =m 9 ! sub/ance ( ! ov>y4 ,^! may rea* consid]able size1 & may bur/ into ! p]itoneal cavity1 result+ 9 dea?2 or !y may dis*>ge into ! rectum1 vag9a or bladd]1 & end 9 recov]y4 ,morbid ,gr[?s4 ,ov>ian ,tumors or ,ov>ian ,dropsy1 are g5]ic t]ms = a class ( affections *>act]iz$ by ! =mation ( cy/s1 :i* h a t5d5cy to excessive developm5t4 ,! disease affects m>ri$ females m frequ5tly ?an ! s+le1 & ! age f ?irty to =ty ye>s is t mo/ subject to x4 ,accord+ to /ati/ics1 ! "r ov>y is m frequ5tly ! seat ( ! malady4 ,v>i\s =ms ( ! disease are met )4 ,! cy/s may be simple or unilocul>1 comp\nd or multilocul>1 or canc]\s4 ,simple cy/s h b a s+le1 undivid$ cavity1 conta9+ fluid1 & enclos$ )9 ! ov>y or ext]nal to x4 ,we may f9d "o or m1 v>y+ greatly 9 size1 "s be+ no l>g] ?an a p9's head or pea1 :ile o!rs conta9 sev]al gallons ( fluid4 ,! conta9$ fluid also1 pres5ts great v>ieties2 x may be cle>1 /raw-color$1 highly album9\s1 or pres5t a viscid1 glairy1 m or less opaque "*2 or we may f9d x ( a c(fee color1 or gre5i%1 ) a l>ge quantity ( oily matt] float+ on ! surface4 ,9 ! latt] cases ! appe>ance is due1 z %[n by ! microscope1 to ! pres5ce ( blood corpuscles & *ole/]9e plates4 ,^! simple cy/s may acquire an enorm\s size1 fill+ ! abdom9al cavity1 & cr[d+ ! visc]a f _! position4 ,9 a case exam9$ = ,dr4 ,b4 ,b]5s1 9 #ahee1 a free incision 0 made ?r\gh :at appe>$ to be ! abdom9al walls alone1 :5 ! cavity 0 f\nd fill$ ) a /raw-color$1 slightly gelat9\s fluid1 ( :i* sev]al gallons 7 remov$4 ,^u ext5d+ ! incisions & look+ into ! cavity1 x pres5t$ ! appe>ance ( an entire abs5ce ( all ! abdom9al visc]a2 ! sp9al column project$ at ! po/]ior portion1 :ile above 0 se5 :at appe>$ to be ! concave1 "u surface ( ! diaphragm1 ) no trace ( liv]1 /oma*1 or o!r viscus4 ,a c>eful exam9ation ( ! edges ( ! incision disclos$ ! divid$ walls ( ! cy/1 closely adh]$ to ! abdom9al p>ietes at all po9ts4 ,) a little c>e1 ^! 7 gradually torn away1 :51 beh9d ! tumor1 0 f\nd ! atrophi$ visc]a1 cr[d$ & displac$ upw>ds & backw>d into ! smalle/ possible space4 ,pilo-cy/ic or ,d]moid cy/s may be f\nd conta9+ hair & fatty matt]s4 ,^! appe>1 9 _m cases1 to be ! rema9s ( blight$ ova enclos$ 9 ! body4 ,!y are cong5ital 9 _! orig91 & usually conta9 "s ftal debris1 su* z portions ( bone1 tee?1 etc4 ,,case4--,ov>ian ,cy/ic ,disease--fatal t]m9ation4 ,autopsy reveal+ pres5ce ( bone & tee? 9 small cy/4 ,! foll[+ int]e/+ case occurr$ 9 ! practice ( ,dr4 ,william ,a4 ,read1 ( ?is city1 f :om ! app5d$ /atem5t has be5 receiv$3 ,miss ----1 ag$ #db ye>s1 aft] hav+ be5 treat$ by sev]al physicians1 came "u ! c>e ( ,dr4 ,read = ! treatm5t ( :at 0 diagnos$ z an ov>ian tumor4 ,p>ac5tesis 0 resort$ to1 ) ! result ( draw+ (f a consid]able quantity ( gelat9\s fluid1 b )\t any p]man5t b5efit4 ,! disease pursu$ ! usual c\rse1 & ! pati5t f9ally di$ ( exhau/ion4 ,! autopsy reveal$ a l>ge multilocul> tumor1 fill+ a l>ge portion ( ! abdom9al cavity4 ,^u remov+ ! same f its pelvic atta*m5ts1 & op5+ "o ( ! small] cy/s )9 ! broad ligam5t1 ! latt] 0 f\nd fill$ ) a quantity ( highly (f5sive fluid1 & conta9+ "o l>ge1 irregul> mass ( bone1 9 :i* 7 imb$d$ two well-=m$ tee?1 a small] piece ) "o too?1 & n9e deta*$ tee? f\nd 9 ! same sac1 mak+ twelve 9 all4#da ,! fir/ impression ^u ! discov]y ( su* rema9s w\ld naturally be1 t ! case 0 "o ( extra-ut]9e pregnancy2 b 9 ?is in/ance1 ! well kn[n "* ( ! lady 0 su* z to preclude su* a !ory2 :ile ! pres5ce ( ! unbrok5 hym5 0 fur!r evid5ce ( virg9ity4 ,f ! impossibility ( conception hav+ be5 ! s\rce ( ! bony & d5tal rema9s f\nd 9 ?is & simil> cases1 ! problem c only be solv$1 by suppos+ t1 two ova _h be5 impregnat$ :5 ?is woman 0 conceiv$1 "o ( :i*1 9 "s mann]1 became imb$d$ )9 ! o!r1 s t at h] bir? ?is lady _h )9 h] abdom5 ! rema9s ( h] undevelop$ tw94 ,^! became encapsulat$ )9 ! pelvis1 & f9ally induc$ ! local disease1 :i* result$ 9 dea?4 ,t ?is is ! correct explanation ( su* cases1 is confirm$ by ! fact t simil> rema9s h be5 f\nd )9 ! bodies ( males4 ,multilocul> cy/s disclose1 in/ead ( a s+le cavity1 num]\s *amb]s1 conta9+ second>y1 & ev5 t]ti>y cy/ic gr[?s1 ei!r sessile or p$unculat$1 & ) v>y+ cont5ts4 ,by ! complicat$ =m1 we und]/& t 9 :i*1 to "s o!r diseas$ /ate ( ! organ--z hyp]trophy1 fibr\s tumors1 or c>c9omat\s gr[?s--! cy/ =mation is sup]add$4 ,fibr\s gr[?s4 ,^! are develop$ 9 ! tissue ( ! ov>y1 & pres5t a globul> =m1 ) well def9$ outl9e4 ,!y may atta9 an enorm\s size2 ! l>ge/ "o on record1 occurr$ 9 ! practice ( ,dr4 ,simpson1 & weigh$ fifty-six p\nds4 ,we occasionally meet ) pro(s ( a t5d5cy to s-call$ ossification1 9 ! pres5ce ( calc>e\s matt]1 into :i* a portion ( ! tissue has be5 conv]t$4 ,malignant disease ( ! ov>y1 is by no means a r>e affection4 ,x is g5]ally limit$ to "o side1 & appe>s z scirrhus1 encephaloid1 hmatoid1 melanotic1 or alveol> canc]1 ei!r z an isolat$ gr[?1 or 9 ! infiltrat$ =m1 & g5]ally z an addition to "s o!r morbid =mation4 ,x runs a rapid c\rse1 al?\gh x has be5 met ) ev5 be=e pub]ty2 =ty-"o ye>s 0 ! av]age age at dea? accord+ to ! /ati/ics collect$ by ,dr4 ,wal%e4 ,c>tilag9\s tumors are extremely r>e 9 ! ov>ies4 ,tub]cles are occasionally f\nd z small1 *eesy deposits4 #b4 ,! ,fallopian ,tubes4 ,cong5ital ,anomalies4 ,"o or bo? ( ! tubes may be imp]fectly develop$1 9 connection ) an unsymmetrical developm5t or total abs5ce ( ! ut]us4 ,! tubes may be occlud$ by ! closure ( "o or bo? ends1 & ! po9t ( ins]tion into ! ut]us may be abnormal4 ,inflammation4 ,cat>rhal inflammation is ( n unfrequ5t occurr5ce1 & may lead to p>tial or total1 tempor>y or p]man5t closure ( ! *annel ( ! tubes4 ,?us ! fimbriat$ extremities may become agglut9at$ to ! ov>ies1 ! broad ligam5t1 or ! ut]us itself2 or oblit]ation may occur at "o or m po9ts )9 ! passage4 ,! cont9u$ accumulation ( ! secretion ( ! muc\s membrane w cause di/5sion1 ei!r simulat+ a cy/ =mation1 or pres5t+ ! appe>ance ( sev]al saccul> dilatations4 ,! dilatations1 conta9+ mucus matt] ( a m or less purul5t "*1 or fluid ( an het]og5e\s con/itution1 are r>ely ( l>ge size1 al?\gh an in/ance is on record 9 :i* ! di/5sion am\nt$ to five in*es 9 diamet]4 ,! morbid cont5ts may be p\r$ into ! ut]us1 or 9 less favorable cases ! sac is ruptur$1 & ! cont5ts are effus$ into ! abdom9al cavity4 ,morbid ,gr[?s4 ,cy/s ( small size frequ5tly affect ! fimbriat$ extremities ( ! tubes4 ,we may also f9d fibroid gr[?s1 c>c9oma & tub]cle2 ! two latt] commonly1 al?\gh n inv>iably1 second>y to simil> diseases ( ! ut]us4 ,section ,,iii4 ,,( ,,! ,,mamm4 ,notice3 #a4 ,ext]nal ,*>act]s--abnormalities2 silv]y l9es on integum5t1 indicat+ previ\s enl>gem5t2 s9uses2 firm1 or s(t & flabby4 ,nipple--its size1 color1 retract$1 ulc]s2 excoriations1 etc4 ,areola--size & color4 #b4 ,appe>ance on section--color ( sub/ance2 consi/5ce ( gl& & fluids exud+2 abscesses2 tumors2 cy/s2 canc]1 etc4 ,anomalies4 ,sup]num]>y mamm1 ) ! p[] ( secret+ milk dur+ lactation1 h be5 obs]v$ 9 a numb] ( in/ances4 ,! cases ( abs5ce ( "o or bo? mamm are r to be class$ z ! result ( arre/ ( developm5t or atrophy4 ,a too e>ly developm5t ( ! gl&s 9 "y *ildr5 is occasionally met )1 :]e !re is a precoci\s developm5t ( ! organs ( g5]ation4 ,:ile ! mamm>y gl&s 9 ! male usually rema9 9 a rudim5t>y /ate dur+ life1 cases h occurr$ :]e !y h acquir$ an increas$ size1 & h be5 /imulat$ to su* a functional activity z to p]mit ( ! suckl+ ( an infant4 ,hyp]trophy & ,atrophy4 ,:5 pub]ty occurs1 ! brea/s naturally enl>ge & (t5 become t5d]2 & su* a tempor>y enl>gem5t v commonly accompanies m5/ruation4 ,an increase ( size1 su* z normally takes place dur+ pregnancy1 betwe5 ! f\r? & n9? mon?s1 w occasionally comm5ce at pub]ty1 & g on until ! organ atta9s an enorm\s size4 ,9 "s cases ! brea/ has be5 f\nd1 aft] dea?1 to weigh z mu* z tw5ty p\nds1 ! tissue be+ p]fectly normal4 ,bo? brea/s are usually affect$1 al?\gh "o is commonly m s ?an ! o!r4 ,aft] ! cessation ( ! m5ses1 ! brea/s normally beg9 to atrophy4 ,we may also h an atrophy ( ! brea/ foll[+ ^u lobul> hyp]trophy1 z describ$ by ,sir ,a4 ,coop]4 ,inflammation & ,abscess4 ,inflammation ( ! ,nipple & ,areola1 prec$+ or foll[+ a fissur$ /ate ( ! nipple1 usually occurs at an e>ly p]iod ( lactation1 & especially ) ! fir/ *ild4 ,abscess ( ! areola is (t5 a consequ5ce4 ,inflammation ( ! ,brea/1 g5]ally t]m9at+ 9 suppuration1 may occur 9 ?ree positions3 ei!r 9 ! subcutane\s areol> tissue1 supramamm>y abscess2 or 9 ! areol> tissue1 9 :i* ! gl& is imb$d$1 submamm>y abscess2 or 9 ! gl& itself1 mamm>y abscess4 ,*ronic ,abscess ( ! ,brea/ may be ( two k9ds3 ! diffus$ & ! circumscrib$ or ency/$4 ,! =m] may occur at all ages1 & 9 ! s+le z well z 9 ! m>ri$4 ,x usually appe>s 9 ! submamm>y areol> tissue1 & may acquire a v l>ge size2 & by pu%+ ! mamm>y gl& be=e x1 gives ! brea/ a po9t$1 conical %ape4 ,*ronic ency/$ abscess1 s closely simulates v>i\s tumors 9 ?is situation1 z to r5d] a diagnosis 9 "s cases v difficult dur+ life4 ,x usually comm5ces z a result ( pregnancy2 sometimes z a consequ5ce ( lacteal inflammation2 b usually )\t any injury or o!r direct local cause4 ,an indol5t1 indurat$ swell+ =ms1 & ?is may gradually s(t5 9 ! c5tre1 al?\gh fluctuation may = a long "t be v indi/9ct1 & ev5 abs5t1 ow+ to ! ?ick wall ( pla/ic matt] t is ?r[n ar\nd ! collection ( pus4 ,x is n unfrequ5tly att5d$ ) retraction ( ! nipple4 ,syphilitic ulc]s are also f\nd affect+ ! nipple2 :ile eczemat\s & erysipelat\s inflammation 9 ?is situation are ( frequ5t occurr5ce4 ,morbid ,gr[?s4 ,! mamm are frequ5tly ! seat ( adv5titi\s gr[?s1 pres5t+ ! *>act]s ( non-malignant & malignant =mations4 ,! mo/ common ( ! b5ignant tumors is1 p]haps1 ! ,ad5oid ,tumor or ,ad5ocele4 ,?is is mo/ frequ5tly met ) 9 "y wom5 "u ?irty ye>s ( age1 seldom comm5c+ at a lat] p]iod ?an =ty4 ,x may rema9 /ation>y = ye>s1 or x may sl[ly increase or gr[ v rapidly to a great size4 ,x has frequ5tly be5 mi/ak5 = canc]1 b ! o!rwise good heal? ( ! pati5t1 ! mobility ( ! mass1 ! abs5ce ( all implication ( ! sk9 or gl&s1 ! want ( h>dness & its circumscrib$ "*1 are po9ts ( diagno/ic value4 ,on removal1 x appe>s irregul>ly lobulat$1 is encapsulat$1 & its cut surface has a blui% or grayi%-:ite color1 :i*1 on exposure to ! air1 assumes a rosy t9t4 ,on pressure1 drops ( ?ick1 creamy fluid w (t5 exude4 ,accord+ to ,birkett1 ! microscope %[s x to consi/ ( imp]fectly develop$ hyp]trophy ( ! gl&ul> tissue1 ! t]m9al cells ( :i* are fill$ ) epi!lial scales4 ,?is tumor sometimes simulates malignant disease by its extreme rapidity ( gr[?1 especially :]e x developes lat] 9 life4 ,x !n1 aft] section1 pres5ts a lobulat$1 gli/5+ appe>ance1 some:at resembl+ a mass ( rice or sago jelly1 (t5 hav+ cy/s int]sp]s$ ?r\gh\t its sub/ance conta9+ fluid or semi-solid gl&ul> tissue4 ,9 r>e cases1 ! ad5ocele may return1 ev5 aft] extirpation ( ! entire mamm>y gl&4 ,cy/ic ,tumors4 ,^! may occur z ! unilocul> cy/1 or z ! cy/o-s>comat\s tumor4 ,unilocul> cy/s usually occur z a small1 ?9 sac1 ( ab\t ! size ( a filb]t1 conta9+ a cle>1 s]\s fluid1 imb$d$ 9 ! gl&ul> /ructure ( ! brea/1 & movable "u ! sk94 ,z !y increase 9 size or become multiple1 _! cont5ts may assume a gre5i%-br[n or blacki% t+e f effus$ blood4 ,accord+ to ,brodie1 !y are orig9ally =m$ by a dilatation ( ! lactif]\s tubes4 ,unilocul> cy/s occasionally atta9 an imm5se size at ! same "t t _! walls rema9 ?9 & supple4 ,9 "s ( ^! in/ances1 ! fluid cont9ues to ! la/1 ( a truly s]\s "*2 :ile 9 o!rs1 x becomes m or less glairy or mucilag9\s4 ,sometimes ! walls ( ! cy/s h be5 f\nd to h und]gone calc>e\s deg5]ation4 ,! cy/o-s>coma1 occurs z an isolat$1 globul> or oval1 & m or less movable cy/2 or !re are num]\s gr[?s ( ?is k9d1 v>y+ 9 size f a p9's head to a h5's egg4 ,! inn] surface is smoo?1 or x pres5ts a broad-bas$1 lobulat$1 caulifl[] gr[? or w>ty excresc5ces1 & ! sub/ance ( ! surr\nd+ gl& is indurat$ & atrophi$4 ,a retraction ( ! nipple may also be obs]v$4 ,a transv]se section %[s a d\ble %ea?3 "o prop] to ! cy/1 & ! o!r ! result ( cond5sation ( ! adjo9+ textures4 ,! cont5ts are ei!r fluid1 ( a limpid1 opalesc5t1 non-album9\s1 or a grum\s1 br[ni%1 highly album9\s "*2 or solid1 approa*+ ! "* ( a fibroid deposit1 compos$ ( a pale1 compact sub/ance1 trav]s$ by undulat+ fibr\s l9es1 :i* imp]fectly divide x into lobes ( v>i\s sizes & %apes4 ,hydatid cy/s1 conta9+ ! e*9ococus1 occur 9 ! female brea/4 ,! tumor is firm to ! t\*1 & conta9s a cle> fluid1 9 :i* ! microscope detects ! t5acula ( ! e*9ococus1 ! animalculum itself be+ atta*$ to ! int]nal wall ( ! cavity4 ,fibr\s1 c>tilag9\s & osse\s tumors1 are ( d\btful or v r>e occurr5ce4 ,c>c9oma4 ,canc] affects ! mamm m frequ5tly ?an any o!r organ ( ! body4 ,! age f =ty to fifty ye>s seems mo/ liable to its occurr5ce4 ,accord+ to ,dr4 ,wal%e1 ! left side is m frequ5tly affect$ ?an ! "r1 & bo? are b r>ely involv$4 ,all v>ieties ( c>c9oma h be5 met ) 9 ! brea/2 b scirrhus is by f> ! mo/ frequ5t =m 9 :i* x occurs prim>ily4 ,! encephaloid v>iety is g5]ally engraft$ ^u ! scirrhus1 al?\gh x may also be prim>y4 ,! colloid =m is ! mo/ r>e4 ,scirrhus appe>s z a h>d1 lobulat$ tumor1 imb$d$ 9 ! adipose tissue ( ! gl&1 caus+ adhesion to ! sk9 & retraction ( ! nipple4 ,al?\gh at fir/ movable1 x soon becomes firmly adh]5t to ! subadjac5t p>ts1 & involves m or less ! gl& tissue1 ! muscles ( ! ?orax1 & ! adjo9+ gl&s4 ,in/ead ( an isolat$ tumor1 !re may be an infiltration ( ! v>i\s /ructures ( ! "p f ! comm5cem5t4 ,x w !n h an ill-def9$ outl9e1 s5d+ out bran*es into ! adjac5t tissues1 & involv+ 9 its mass ! lacteal tubes & lymphatics4 ,^! become contract$ & flatt5$ into _m b&s1 giv+ a peculi> appe>ance to ?is =m ( mamm>y canc] n obs]v$ 9 any o!r4 ,ulc]ation ( ! sk9 gradually foll[s ne> ! nipple2 ! edges ( ! sore are rais$1 ev]t$ & puck]$4 ,! surface is ( a blui%-r$ color4 ,a purul5t1 i*or\s fluid1 ( a fa9t1 fetid odor1 is secret$2 hmorrhage may ensue1 & ! pati5t s9ks f exhau/ion4 ,! av]age "t occupi$ by a scirrhus 9 rea*+ its full developm5t is f two to ?ree ye>s4 ,:5 ! ulc]ative /age has once begun1 ! sy/em is soon brok51 & ! disease proves fatal 9 f six mon?s to two ye>s4 ,! old] ! individual is at ! fir/ appe>ance ( scirrhus1 ! m sl[ly does x pass ?r\gh ! v>i\s /ages ( its gr[?4 ,! axill>y lymphatic gl&s are also 9 mo/ cases f\nd swoll51 h>d1 & infiltrat$ ) canc]\s matt]4 ,! pectoral muscles1 ribs & co/al c>tilages are also f\nd m or less involv$2 & a second>y affection ( ! pleura & lung is n unfrequ5t4 ,we may also look = dema ( ! extremity on ! affect$ side1 caus$ t[>ds ! t]m9ation ( ! disease by direct int]f]5ce ) ! v5\s circulation4 ,! encephaloid =m occurs e>li] 9 life1 & commonly runs a m rapid c\rse4 ,its m>g9 is less def9$1 ! base ( ! tumor be+ diffus$ among ! heal?y cellul> membrane1 or o!r p>ts :]e x may be situat$4 ,x diff]s f scirrhus also 9 ?is3 t ! disease may advance to ulc]ation )\t any affection ( ! gl&s ( ! axilla4 ,! ,male ,mamm4 ,! /ructure ( ! male mamm resembles t ( ! female gl&1 ?\gh 9 a rudim5t>y /ate2 h5ce we may f9d anomalies & morbid conditions 9 !m simil> to ^? f\nd 9 ! latt]4 ,an increas$ numb] ( mamm h be5 met )4 ,hyp]trophy sometimes occurs4 ,!re h be5 well au!nticat$ in/ances ( ! secretion ( milk by m54 ,! male brea/ may be ! seat ( non-malignant & malignant gr[?s4 ,canc]s1 simple cy/s1 comp\nd cy/s1 & o!r tumors occur1 b exceptionally4 ,,"p ,,iv4 ,,miscellane\s ,,subjects4 ,,*apt] ,i4 ,,( ,,! ,,p]io/eum ,,& ,,bones4 ,section ,i4 ,,( ,,! ,,p]io/eum4 ,notice3 degree ( vascul>ity2 ?ickness2 d5sity2 deta*$ or adh]$2 effusions b5ea?2 s]um or pus2 ulc]ative de/ruction (2 condition ( bone b5ea?1 etc4 ,inflammation ( ! p]io/eum occurs 9 ! vic9ity ( *ronic ulc]s2 z ess5tial to ! reproduction ( bone aft] fractures2 9 consequ5ce ( syphilis or its m]curial treatm5t2 9 rheumatism2 & z a manife/ation ( a scr(ul\s ca*exia4 ,9 incipi5t inflammation1 ! membrane has a r$di% t+e1 a humid1 succul5t appe>ance1 & !re is m or less ( a s]\s effusion1 caus+ a slight sep>ation f ! bone4 ,z ! inflammation advances1 ! connection betwe5 ! membrane & ! bone becomes m lax1 & ! effusion assumes a purul5t "*4 ,syphilitic inflammation ( ! p]io/eum is apt to appe> 9 deta*$ spots1 caus+ swell+1 induration1 ! =mation ( new osse\s matt] & necrosis4 ,! p]io/eum ( ! skull1 /]num & tibia are mo/ frequ5tly attack$4 ,a malignant disease ( ! p]io/eum1 ! consequ5ce ( long-cont9u$ or repeat$ attacks ( inflammation1 is describ$ by ,/anley4 ,x occurs on ! bones ( ! hips1 & gives rise to ! gr[? ( a fung\s excresc5ce ^u ! membrane4 8,?is is sometimes s(t & floccul5t on its surface1 ) a firm1 grayi%1 gelat9\s base2 at o!rs x consi/s ?r\gh\t ( a firm1 gelat9\s sub/ance40 ,section ,,ii4 ,,( ,,! ,,bones4 ,notice3 #a4 ,surface ( bone--smoo? or r\gh1 firm & h>d or s(t2 p]io/eum pres5t or de/roy$2 c>ies2 necrosis2 tumors1 etc4 #b4 ,:ole bone--weight & size increas$1 or dim9i%$8 b5t or fractur$8 #c4 ,appe>ance on section--d5sity ( diff]5t portions2 condition ( cancellat$ portion2 de/roy$1 or s(t5$2 abscesses2 c>ies2 necrosis2 tumors1 etc4 #d4 ,m$ulla--d5sity1 color1 vascul>ity1 morbid gr[?s4 ,inflammation & ,abscess4 ,acute inflammation r>ely takes place except 9 connection ) me*anical injury4 ,inflammatory processes 9 bone1 give rise = ! mo/ "p1 to an increase ( m$ull>y tissue1 & to s(t5+ ( ! osse\s /ructure4 ,hav]sian canals & m$ull>y spaces increase 9 size1 & ultimately become conflu5t by ! gradual absorption ( ! surr\nd+ osse\s lamell4 ,! results ( progressive inflammation are conge/ion1 exudation1 suppuration1 c>ies & necrosis4 ,an enl>gem5t ( ! affect$ portion is inv>iably met )4 ,9 case ! exudation be absorb$1 or ! inflammatory process be arre/$1 ! p>ts may return to _! normal condition1 or ! bone reta9s a p]man5tly disorganiz$ condition1 :i* may pres5t ei!r an increas$ cond5sation & induration1 z 9 g\ty bone1 or an abnormal r>efaction ( ! bone1 z 9 ! bones ( rickety individuals4 ,! same /ate ( r>efaction1 or o/eoporosis1 accord+ to ,lob/e91 is occasionally met ) 9 advanc$ life1 z an effect ( mal-nutrition4 ,suppuration1 ) ! =mation ( abscess1 may be diffus$ or circumscrib$4 ,9 circumscrib$ abscess1 we f9d a cavity g5]ally 9 or ne> ! epiphyses1 l9$ ) a vascul> membrane1 & ?ick5+ ( ! adjo9+ p]io/eum1 & ( ! surr\nd+ cellul> tissue4 ,c>ies4 ,c>ies1 a process ( molecul> dis9tegration1 may occur 9 all bones1 & 9 e "p ( _! /ructure1 ?\gh x g5]ally affects ! cancell\s tissue4 ,! c>i\s bone is por\s & fragile1 ( a gray1 br[n1 or blacki% color1 p>tly brok5 d[n 9 s(t5$ masses1 & p>tly holl[$ out into cells1 :i* conta9 a r$di%-br[n & oily fluid4 ,small portions ( dead bone lie deta*$ 9 ! c>i\s cavity4 ,! p]io/eal & m$ull>y membranes1 & ! bone ar\nd ! c>i\s portion1 w be f\nd extremely vascul>1 & 9 _m cases1 compact masses ( osse\s tissue are deposit$ ar\nd ! c>i\s cavity4 ,c>ies ( bone occurs z a result ( inflammation1 & corresponds to ulc]ation ( ! s(t tissues4 ,x frequ5tly results f *ronic suppurative ar?ritis1 :51 f de/ruction ( ! articul> c>tilages1 ! disease attacks ! cancellat$ /ructure ( ! extremity ( ! bone4 ,necrosis4 ,! dea? ( a portion ( osse\s tissue1 or necrosis1 al?\gh frequ5tly accompani$ ) c>ies1 is entirely di/9ct f x4 ,x attacks pr9cipally ! compact tissue1 & is met )1 !re=e1 mo/ frequ5tly 9 ! %afts ( long bones4 ,! necros$ portion is ( a dirty1 yell[i%-:ite color1 & has a dull1 opaque look2 aft] exposure to ! air1 x gradually becomes ( a gre51 deep br[n1 or black t9t4 ,its b\nd>ies are usually di/9ct1 b sometimes are s imp]ceptibly lo/ 9 ! heal?y tissue1 t x becomes difficult 9 ! dead body to det]m9e its exact limits4 ,necrosis results f causes :i* int]f]e ) ! nutrition ( bone1 z f suppurative p]io/itis1 traumatic de/ruction ( ! p]io/eum1 or o/eitis4 ,ulc]ative de/ruction ( ! surr\nd+ s(t p>ts1 or ! dim9i%$ vitality att5d+ c]ta9 g5]al diseases1 z typhus1 etc41 may also result 9 necrosis4 ,! dea? ( a portion ( bone is foll[$ by inflammation at ! divid+ l9e1 :i* f9ally results 9 ! sep>ation ( ! dead portion or seque/rum4 ,?is *ange is soon foll[$ by ! production ( new bone1 9 :i* process ! p]io/eum & m$ulla may take "p4 ,ra*itis or ,rickets1 is ess5tially a disease ( mal-nutrition1 mo/ frequ5tly affect+ *ildr5 betwe5 ! fir/ & ?ird ye>s1 al?\gh x does also occasionally occur lat]4 ,! l[] extremities are ! fir/ to %[ ! effects ( ! disease1 by a curvature commonly ref]r$ to too e>ly attempts at walk+4 ,a contortion ( ! bones ( ! pelvis1 ( ! sp9e1 ! ?orax1 ! upp] extremities1 & mal=mations ( ! skull1 may foll[ 9 ! c\rse ( ! disease4 ,! bone on analysis1 %[s a decid$ dim9ution 9 ! quantity ( phosphate ( lime1 & a uni=m increase ( fatty matt]2 fluoride ( calcium always pres5t 9 heal?y born1 is also want+4 ,! jo9ts are usually swoll51 & ! epiphyses ( ! bones enl>g$ by ! exudation ( a r$di% s]um into ! enl>g$ cancelli & canals1 ! osse\s corpuscles1 at ! same "t1 %[+ a defici5cy or entire abs5ce ( e>?y matt]4 ,! p]io/eum is pulpy & ?ick5$1 & m ?an usually adh]5t to ! bone4 ,if a rep>ative process h be5 set up1 ! de=mity may h be5 greatly dim9i%$1 or ev5 entirely remov$2 or a new deposit ( bone tak5 place1 s z to af=d a useful limb dur+ life4 8,?is supplem5t>y ossification is f\nd1 on v]tical section ( a long bone1 *iefly on ! concave side1 s t ?is "p ( ! %aft may pres5t d\ble & treble ! ?ickness ( ! opposite side4 ,! /ructure1 at ! same "t1 is v d5se1 & ( ivory texture40 ,9 flat bones1 z 9 ^? ( ! skull--:i* is commonly unduly l>ge 9 rickety subjects--!re is a uni=m ?ick5+4 ,9 "s cases ! ?ick5+ affects ! capacity ( ! =am9a4 ,9 a peculi> =m ( disease ( ! cranium describ$ by ,elsass]1 ! bone is atrophi$1 s(t & por\s2 num]\s op5+s are f\nd along ! lambdoidal suture1 & 9 ! body ( ! bone1 ) ! exception ( ! occipital protub]ance4 ,! p]=ations are fill$ up only by ! dura mat] & p]icranium1 :i* are adh]5t to "o ano!r4 ,?is disease is commonly met ) betwe5 ! ?ird & six? mon?s ( infant life4 ,mollities ,ossium1 or ,o/eomalacia1 is reg>d$ by "s z a =m ( atrophy1 by o!rs z id5tical ) ra*itis1 except t x attacks adults in/ead ( *ildr51 & by o!rs z an ess5tially di/9ct osse\s disease4 ,x is ( r>e occurr5ce1 & consi/s 9 p]v]t$ nutrition ( ! skeleton1 :]eby ! e>?y phosphates are elim9at$ f ! sy/em by ! kidneys1 :ile a deposit ( fat takes place 9 ! c>tilag9\s matrix4 ,z ! bones ( ! trunk are especially liable to be attack$1 ! individual affect$ becomes r$uc$ 9 size by ! collapse ( ! v]tebral column4 ,x attacks females m frequ5tly ?an males1 & ! =m] *iefly aft] !y h comm5c$ *ild-be>+4 ,! disease pres5ts two v>ieties--! waxy1 9 :i* ! bones1 especially ^? ( ! pelvis1 pres5t a dirty1 d>k-yell[ color1 & rema9 greasy aft] dry+2 & ! fragile1 :]e ! bones are ( a sn[y :it5ess1 & ( a light1 transp>5t1 op5 texture1 & s fragile t !y give way "u ! m]e pressure ( ! f+]4 ,"u ! microscope1 we f9d ! corpuscles & _! canaliculi empty & transp>5t1 & only fa9tly visible1 & ! ,hav]sian canals unnaturally enl>g$4 ,morbid ,gr[?s4 ,en*ondromat\s ,tumors1 are usually f\nd 9 connection ) "s ( ! %ort bones1 m p>ticul>ly ^? ( ! f+]s & toes1 ?\gh ! ribs1 v]tebr1 /]num1 tibia & femur are sometimes attack$4 ,!y may orig9ate on ! surface ( ! bone1 or )9 ! cancell\s tissue4 ,9 ! =m] case1 !y exhibit a lobulat$ arrangem5t1 & are surr\nd$ by a fibr\s %ea?2 9 ! latt]1 ! bone gradually exp&s ) ! developm5t ( ! tumor4 ,! rapidity & ext5t ( _! gr[? v>y4 ,9 _! microscopic *>act]s1 ! en*ondroma resembles normal c>tilage4 ,! c5tral v>iety pres5ts a semi-ela/ic feel1 &1 on section1 ! knife passes ?r\gh a ?91 crackl+ %ell ( bone1 & !n exhibits a :ite1 c>tilag9\s mass1 :i* is occasionally f\nd to conta9 "s small cells2 :ile 9 "s tumors !re is an int]lacem5t ( fibr\s tissue1 9 :i* c>tilage is imb$d$4 ,! sup]ficial v>iety is microscopically & *emically id5tical ) ! c5tral =m1 b has no osse\s %ell4 ,x is met ) *iefly 9 ! pelvis1 on ! cranium1 & on ! ribs4 ,!re may be a p>tial ossification4 ,! disease is *iefly met ) 9 e>ly life4 ,osse\s ,gr[?s1 consi/+ ( true bone1 are divid$ into exo/oses & o/eophytes4 ,! surface ( ! =m] is smoo?2 _! outl9e g5]ally a segm5t ( a circle or ( an ellipse2 _! cause3 an idiosyncracy ( ! individual1 n ref]able to any def9ite con/itutional ta9t4 ,( ! latt]1 ! surface is r\gh2 !y d n =m any well def9$ local1 circumscrib$ tumor2 are ref]able to rheumatic or g\ty inflammation1 to syphilis or o!r causes4 ,exo/oses are ( two k9ds3 ! "o1 h>d & compact2 ! o!r1 s(t] & m spongy4 ,! h>d or ivory exo/osis is extremely d5se1 & :it] ?an ! bone f :i* x spr+s1 b possesses a true bony /ructure4 ,x g5]ally gr[s f flat bones1 & is ( small size4 ,x has be5 kn[n to necrose & to sl\gh away f ! p>ts on :i* x has be5 situat$4 ,spongy exo/oses (t5 atta9 a consid]able size1 & are v commonly multiple4 ,!y diff] f ! compact v>iety 9 be+ compos$ ( cancelli1 conta9+ m$ull>y matt]1 & surr\nd$ by a %ell ( bone4 ,!y spr+ f ! cancell\s1 or compact tissue ( ! bone1 & _! surface is cont9u\s ) t ( ! latt]4 ,9 "s cases ! cavity ( ! exo/osis communicates directly1 or is cont9u\s1 ) ! m$ull>y cavity ( ! bone4 ,_! mo/ common seats are ! tibia1 fibula & hum]us4 ,! o/eophyte *iefly affects ! m vascul> portions ( bones1 z _! articul> ends1 _! r\gh l9es1 or1 9 ! skull1 ! sutural c>tilages2 be+ g5]ally ! product ( an inflammatory process 9 ! sup]ficial "p ( ! bone1 & 9 ! p]io/eum4 ,fibr\s ,gr[?s always develop 9 ! cancell\s /ructure4 ,all ! long bones & _m ( ! flat bones are liable to ?is disease4 ,!y pres5t m or less ela/icity1 are ( a gray & opaque appe>ance1 & yield gelat9 on boil+4 ,!y may atta9 an enorm\s size4 ,cy/ic ,tumors are ( r>e occurr5ce1 & are g5]ally met ) 9 adults4 ,!y may be unilocul>1 usually fill$ ) a solid mass ( a fibro-cellul> or fibro-c>tilag9\s "*2 or multilocul>1 ) ?9 & s]\s1 s]o-sangu9ol5t1 viscid or d>k-color$ cont5ts1 (t5 associat$ ) c5tral1 fibr\s gr[?s4 ,hydatid cy/s h be5 met )4 ,accord+ to ,/anley1 bo? ! acephalocy/ & ! cy/ic]cus cellulos h be5 f\nd1 b m frequ5tly ! =m]4 ,tub]cles are occasionally pres5t 9 bone1 z ! yell[1 opaque tub]cles1 deposit$ *iefly 9 ! spongy bones & ! cancell\s portions ( long bones4 ,!y may s(t5 or become cretifi$4 ,vascul> ,tumors are ( n v frequ5t occurr5ce4 ,!y are met ) mo/ commonly 9 ! cancell\s articul> ends ( ! long bones2 al?\gh !y h also be5 f\nd 9 ! pelvic bones1 ! bones ( ! skull1 & 9 ! ribs4 ,9 ! mo/ frequ5t class ( cases1 a new tissue is develop$ 9 ! osse\s /ructure1 & ! tumor p>takes ( an encephaloid "*4 ,a creamy1 curdy or bra9-l1 s(t1 & v vascul> mass1 is =m$ z ! ess5tial con/itu5t4 ,?is w be f\nd to pres5t e %ade ( transition1 f a purely vascul> tissue1 ( an erectile "*1 to true encephaloid canc]4 ,9 a second1 m r>e =m ( disease1 !re is develop$ 9 ! bone a vascul>1 erectile gr[?1 closely resembl+ capill>y nvus 9 its /ructure1 compos$ ( an inf9ity ( blood-vessels1 int]lac+ 9 e possible way1 s z to =m a s(t1 r$di%-yell[ tumor4 ,9 a ?ird =m1 a holl[ cavity is =m$ 9 ! bone1 scoop$ out ( ! cancell\s /ructure & fill$ ) blood1 p>tly liquid & p>tly coagulat$1 & hav+ art]ial bran*es freely op5+ into x4 ,accord+ to ! /age ( ! disease1 ! blood is f\nd 9 cells1 int]sect$ by fibres1 or lam9 & fibres1 ! rema9s ( ! orig9al osse\s /ructure2 or 9 a m advanc$ /age1 9 a s+le cavity4 ,! %ell ( bone surr\nd+ ! cavity is v ?9 & exp&$1 be+ usually absorb$ at "o po9t1 :]e x (t5 becomes at la/ p]=at$4 ,?is la/ class con/itutes true aneurism ( bone4 ,cephalohmatoma1 met ) 9 infancy on ! cranial bones1 z a result ( pressure dur+ p>turition1 is an effusion ( blood betwe5 ! p]icranium & ! bone1 commonly occurr+ on "o ( ! p>ietal bones1 mo/ frequ5tly on ! "r side4 ,r>e cases ( int]nal cephalohmatoma h be5 record$ 9 :i* ! effusion took place betwe5 ! dura mat] & ! bones4 ,canc] ( bone mo/ frequ5tly occurs 9 ! head ( ! tibia & ! l[] end ( ! ?igh bone1 occasionally 9 ! hum]us & 9 ! jaws1 m especially ab\t ! antrum4 ,! encephaloid v>iety is ! mo/ frequ5t4 ,x is ( two di/9ct =ms3 9 ! "o1 ! morbid gr[? is c5tral1 spr++ f ! m$ull>y canal2 9 ! o!r1 x is p]iph]al1 be+ atta*$ to ! compact osse\s sub/ance4 ,9 ! c5tral =m1 x is usually situat$ at or ab\t ! articul> ends1 b always affects ! :ole ( ! bone by infiltration4 ,9 ! p]iph]al1 ! m common =m ( canc] ( ! bone1 ! osse\s tissue is n s completely invad$2 = al?\gh ! disease may be locat$ ^u1 or 9 intimate contact ) ! out] lay]s ( ! bone1 :i* are incorporat$ 9 x1 x does n ext5d into ! cancell\s tissue or ! m$ull>y canal4 ,9 ?is =m1 ! muscles atta*$ to ! affect$ portion ( bone w (t5 be f\nd ext5sively infiltrat$ ) canc] cells4 ,encephaloid ( bone is h>d] & m fibr\s look+ ?an ! same affection else:]e4 ,! canc] cell also is n s well m>k$1 & may inde$ be abs5t altoge!r4 ,occasionally "s colloid1 & m r>ely melanotic matt]1 is int]mix$1 b scirrhus is nev] f\nd 9 bone4 ,( ! ,m$ulla4 8,x is yet to be det]m9$ 9 h[ f> ! m$ulla is liable to be prim>ily affect$4 ,x v>ies 9 consi/5cy accord+ to ! vigor ( ! individual2 :ile 9 dropsical & ph?isical cases we f9d x ?9 & s]\s1 or yell[ 9 ict]us1 or v scanty 9 ivory cond5sation ( a bone4 ,x exhibits great] firmness1 & a ri*] p9k hue1 9 habits t5d+ to an inflammatory "*4 ,! real seat ( inflammation 9 bone is ! membrane t l9es its cavities4 ,x is1 !re=e1 fair to inf] t1 9 all diseases dep5d5t ^u ! /ate ( ! vascul> sy/em1 :e!r ( an ord9>y or ( a malignant "*1 ! m$ulla is affect$ co9cid5tly )1 if n previ\sly to1 ! bony tissue itself40 ,morbid gr[?s1 ( v>i\s k9ds1 may be f\nd )9 ! m$ulla4 ,! ,cy/ic]cus cellulos1 & ,e*9ococcus1 are said to h be5 detect$ )9 ! m$ulla & p]io/eum4 ,,*apt] ,,ii4 ,,diseases ,,( ,,! ,,jo9ts4 ,mal=mations4 ,cases ( cong5ital an*ylosis1 ! jo9ts be+ abs5t1 h be5 met )2 also imp]fectly develop$ jo9ts1 ) a p>tial or total abs5ce ( ! ligam5ts4 ,sup]num]>y jo9ts also occur1 ei!r ) ! normal1 or ) an excessive numb] ( bones4 ,morbid ,conditions ( ! ,synovial ,membrane4 ,inflammation may be acute1 sub-acute or *ronic4 ,x usually results f exposure to cold1 especially 9 rheumatic or syphilitic con/itutions4 ,!re is at fir/ a conge/ion & increas$ vascul>ity ( ! membrane1 & a loss ( its sat9y poli%2 ! synovia is increas$ 9 quantity1 b becomes ?9 & s]\s1 & at a lat] p]iod1 mix$ ) pla/ic mat]ial4 ,if ! disease progress1 ! vascul>ity & swell+ ( ! membrane increase1 & x becomes turgid & di/5d$ ) blood & effus$ fluids2 a ?91 purul5t-look+ fluid1 compos$ ( granul> corpuscles1 float+ 9 a s]\s liquid1 is p\r$ out1 & dis9tegration1 ) ?9n+ & erosion ( ! c>tilage1 ensues2 or granulations are ?r[n out on ! loos] portions ( ! membrane1 &1 becom+ inject$ ) blood-vessels1 =m fr+$ membran\s expansions1 9 contact ) ! ulc]at+ "p ( ! c>tilage4 ,9 *ronic synovitis1 ! swell+ f ! accumulat$ s]\s fluid may become s consid]able z to con/itute a true dropsy ( ! jo9ts--hydr>?rosis4 ,?is same accumulation may1 h[ev]1 take place )\t any evid5ce ( prec$+ inflammation4 ,pulpy ,deg5]ation ( ! ,synovial ,membrane is peculi> to ! articul> l9+ membranes1 no?+ analog\s hav+ be5 f\nd 9 ! s]\s sacs4 ,! reflect$ portions ( ! synovial membrane are fir/ attack$1 & conv]t$ into a light-br[n1 pulpy sub/ance1 f a qu>t] to a half1 or ev5 a :ole in* 9 ?ickness1 int]sect$ ) :ite membran\s l9es & r$ spots1 =m$ by small inject$ vessels4 ,! membrane ( ! c>tilages are !n invad$1 ulc]ation 9 ! c>tilages go+ on at same "t1 till ! ulc]at+ surfaces ( ! bone are expos$4 ,! disease almo/ always occurs be=e ! middle p]iod ( life1 frequ5tly c be trac$ to no cause1 b is occasionally ! consequ5ce ( repeat$ attacks ( inflammation4 ,x g5]ally occurs 9 ! knee1 b has be5 met ) 9 ! ankle & 9 a jo9t ( ! f+]4 ,a gr[? ( l>ge vill\s processes1 pres5t+ a %aggy appe>ance1 is sometimes obs]v$4 8,!y h sometimes ! =m ( simple ?reads or flatt5$ %r$s1 or _! free extremities are split into filam5ts or h a club %ape1 or resemble melon-se$s hang+ s+ly1 or 9 clu/]s f ea* /alk4 ,9 _m cases1 ! heal?y texture ( ! articulation is n mat]ially affect$40 ,morbid ,conditions ( ,burs4 8,^! small synovial sacs are liable to be affect$ mu* 9 ! same way z l>g] ones4 ,!y may be attack$ by inflammation m or less acute or q *ronic1 result+ f rheumatism1 ! abuse ( m]cury1 or "s o!r con/itutional affection2 or excit$ by viol5ce or long-cont9u$ pressure4 ,! effusion :i* takes place may1 9 cases ( a *ronic k9d1 be a simple synovial or s]\s fluid2 b :5 ! inflammation is m acute1 x is ei!r a turbid s]um1 ) flakes ( fibr9\s matt] float+ 9 x1 or actual pus40 ,! walls ( an inflam$ bursa sometimes become v mu* ?ick5$ by ! organization ( lay]s ( fibr9\s effusion4 ,9 cases ( long-/&+ inflammation1 flat oval bodies1 resembl+ melon-se$s1 ( a light-br[n color1 are n unfrequ5tly met )4 ,_! orig9 is no d\bt to be trac$ to ! coagulat$ lymph effus$ 9 ! beg9n+ ( ! disease4 ,9 ! synovial %ea?s surr\nd+ ! flexor t5dons ( ! f+]s1 z !y pass "u ! annul> ligam5t1 small bodies1 resembl+ gra9s ( boil$ rice1 are also occasionally f\nd4 ,! s-call$ ganglions are small collections ( fluid 9 bursal cavities ( new =mation1 & occur pr9cipally on ! back ( ! wri/ & =e>m4 ,9 ! %ea?s ( ! t5dons ( ! h&1 ^! synovial accumulations may become s excessive1 z to greatly damage ! usefulness ( ! memb]4 ,morbid ,conditions ( ,c>tilage4 ,! ?ickness ( c>tilage may be greatly increas$1 :ile ! tissue becomes s(t & yield+4 ,9 advanc$ age1 ! articul> c>tilages become consid]ably ?9n$2 ossification ( ! c>tilage occurs1 sometimes gradually ) advanc+ ye>s1 at o!rs 9 connection ) *ronic rheumatic ar?ritis4 ,9 jo9ts app>5tly n diseas$1 we sometimes f9d ! c>tilages m or less defici5t at "o or m po9ts1 due to pressure & consequ5t p>tial atrophy4 ,sometimes its place is tak5 by a h>d1 semi-transp>5t sub/ance ( a gray color1 ) an irregul> granulat$ surface1 ! result ( a fibr9\s exudation4 ,! free surface ( c>tilages is occasionally f\nd cov]$ ) a ?9 lay] ( li?ate ( soda1 z ! result ( g\t4 ,loose c>tilages may be f\nd 9 ! knee & o!r l>ge jo9ts2 !y nev] conta9 any ( ! *>act]i/ic cells ( c>tilage1 & appe> to consi/ solely ( compress$ fibrillat+ exudation4 ,!y v>y 9 size & numb]1 are m or less oval & flatt5$1 ) a smoo? surface1 & are sometimes atta*$ to ! synovial membrane by a p$icle ( v>y+ l5g?4 ,9 ! latt] case1 !y are inve/$ by a s]\s cov]+4 ,calc>e\s deposits are occasionally met ) 9 !m4 ,ulc]ation ( ,c>tilage may occur z an acute or sub-acute affection4 ,! c>tilage corpuscles1 in/ead ( be+ ( _! usual =m1 w be f\nd l>g]1 r\nd$ or ovi=m2 & in/ead ( two or ?ree nucleat$ cells 9 _! int]ior1 !y conta9 a mass ( !m4 ,! cavities ( ! enl>g$ corpuscles op5 on ! ulc]at$ surface1 by orifices ( v>i\s sizes4 ,! texture ( ! ulc]at+ c>tilage1 %[s no trace ( vascul>ity4 ,9 mo/ cases1 a vascul> false membrane is f\nd 9 opposition to ! diseas$ "p4 ,! membrane g5]ally adh]es ) "s firmness to ! ulc]at+ surface1 9 o!r in/ances x is loosely appli$ to x2 b 9 all cases ! two surfaces are accurately m\ld$ to ea* o!r4 ,if a portion ( ! false membrane be torn sl[ly (f1 ! c>tilage w be f\nd to be r\gh & honeycomb$1 & into ea* depression on its surface1 a nipple-l projection ( ! vascul> membrane w be se5 to h p5etrat$4 ,*ronic ,rheumatic ,ar?ritis is v frequ5t 9 ! hip1 ! %\ld]1 ! knee1 & ! articulations ( ! h&4 ,! process consi/s ess5tially1 fir/1 9 an hyp]trophy ( ! articul> c>tilage1 g5]ally at ! m>g91 & pr9cipally ne> to ! articul> surface4 ,secondly1 9 ! developm5t ( true osse\s tissue 9 ! hyp]trophi$ c>tilage4 ,we w1 !re=e1 f9d irregul> enl>gem5t ( ! articulat+ head ( ! bone2 an abs5ce ( ! articul> c>tilages1 or new osse\s gr[?s surr\nd+ _! m>g9s2 & ! synovial sacs pres5t+ evid5ces ( hav+ be5 ! seat ( *ronic inflammation4 ,scr(ul\s ,ar?ritis1 or ,:ite ,swell+1 attacks prim>ily ! articul> extremities ( ! bones4 ,!y become v vascul> & s(t5$1 s t !y c be readily cut ) a knife1 :ile a *>act]i/ic transp>5t & aft]w>ds a yell[1 *eesy sub/ance is deposit$ 9 _! cancelli4 ,z ! disease advances1 ! c>tilage ulc]ates1 & ! osse\s tissue gradually wa/es & und]goes a true c>ies4 ,abscess =ms 9 ! jo9t1 & f9ds its way by ulc]ation to ! ext]nal surface1 caus+ num]\s & circuit\s s9uses 9 ! neighbor+ s(t p>ts4 ,9 "s cases1 ! disease may comm5ce 9 ! synovial membrane1 ext5d+ f9ally to ! c>tilages & ultimately to ! bone4 ,! disease affects pr9cipally ! jo9ts ( *ildr51 & r>ely occurs aft] ! age ( ?irty4 ,! exi/5ce ( scr(ul\s disease 9 o!r p>ts1 & ! deposition ( ! yell[1 *eesy matt] )9 ! cancelli1 w s]ve to di/+ui% ?is disease f simple c>ies1 result+ f inflammation4 ,disease ( ! ,sp9al ,column4 ,! jo9ts ( ! v]tebr are liable to ne>ly ! same affections z m p]fectly develop$ articulations4 ,! scr(ul\s disease j describ$ may attack ! cancell\s tissue1 caus+ c>ies & ! deposition ( *eesy matt]4 ,! fir/ effects are g5]ally p]ceptible :]e ! int]v]tebral c>tilage is connect$ ) ! bone1 or 9 ! int]v]tebral c>tilage itself1 al?\gh ulc]ation may comm5ce on any "p ( ! surface1 or ev5 9 ! c5tre ( ! bone4 ,9 "s cases1 ( r>] occurr5ce1 ! bodies ( ! v]tebr are affect$ ) *ronic inflammation1 ) ulc]ation ( ! int]v]tebral c>tilages z ! consequ5ce4 ,if n *eck$1 ! disease proce$s to ! de/ruction ( ! bodies ( ! v]tebr & ( ! int]v]tebral c>tilages1 leav+ ! po/]ior p>ts ( ! v]tebr unaffect$4 ,! necess>y consequ5ce is a curvature ( ! sp9e =w>d1 & a projection ( ! sp9\s processes po/]iorly4 ,*ronic inflammation ( ! bones sometimes ext5ds to ! membranes ( ! sp9al cord2 & :5 ! curvature is v great1 ! cord may be s compress$ t x _c prop]ly dis*>ge its functions4 ,suppuration may take place at diff]5t /ages ( ! disease1 sometimes e>li]1 sometimes lat]4 8,! s(t p>ts 9 ! neighborhood ( ! abscess become ?ick5$ & consolidat$1 =m+ a ?ick capsule1 9 :i* ! abscess is sometimes reta9$ = sev]al successive ye>s2 b f :i* x ultimately makes its way to ! surface1 pres5t+ itself 9 "o or ano!r situation1 accord+ to circum/ances4 ,9 ! advanc$ /ages ( ! disease1 new bone is (t5 deposit$ 9 irregul> masses on ! surface ( ! bodies ( ! neighbor+ v]tebr2 & :]e recov]y takes place1 ! c>i\s surface ( ! v]tebr above1 com+ 9 contact ) t ( ! v]tebr bel[1 !y become unit$ ) ea* o!r1 at fir/ by s(t sub/ance1 aft]w>ds by bony an*ylosis40 ,:]e ! bones are affect$ by scr(ula1 bony an*ylosis does n s readily take place z :]e !y reta9 _! natural texture & h>dness4 ,occasionally1 portions ( ! ulc]at$ or c>i\s bone lose _! vitality1 & hav+ become deta*$1 are f\nd ly+ loose 9 ! cavity ( ! abscess4 ,! pressure ( a l>ge abscess on ! surfaces ( ! contigu\s v]tebr may cause an ext5sive c>ies f> beyond ! limits ( ! orig9al disease4 ,,*apt] ,,iii4 ,,( ,,tumors4 ,9 giv+ a brief description ( tumors1 ! foll[+ classification has be5 adopt$ f ,gross1 z pres5t+ ! mo/ practical & conv5i5t arrangem5t ( ! subject3 ,i4 ,b5ign or ,non-,malignant ,tumors4 #a4 ,cy/ic ,tumors4 a4 ,simple ,cy/s2 includ+ ,s]\s1 ,muc\s1 ,synovial1 ,colloid1 ,sangu9e\s1 ,saliv>y1 ,milk1 ,oil1 ,sem9al1 & ,d]moid ,cy/s4 b4 ,comp\nd or ,prolif]\s ,cy/s4 #b4 ,hydatid ,tumors4 #c4 ,myxomat\s #d4 ,lipomat\s #e4 ,fibr\s #f4 ,c>tilag9\s #g4 ,osse\s #h4 ,papill>y #i4 ,polypoid ,tumors4 #aj4 ,myomat\s #aa4 ,vascul> #ab4 ,neuromat\s #ac4 ,ad5oid #ad4 ,lymphatic ,,ii4 ,malignant ,tumors4 #a4 ,s>comat\s ,tumors4 a4 ,! ,r\nd ,cell$4 b4 ,! ,sp9dle ,cell$4 c4 ,! ,giant ,cell$4 #b4 ,c>c9omat\s ,tumors4 a4 ,scirrhus ,tumors4 b4 ,encephaloid c4 ,melanotic d4 ,colloid ,tumors4 e4 ,epi!lial ,i4 ,b5ign or ,non-,malignant ,tumors4 #a4 ,cy/ic ,tumors4 ,^! are ( v frequ5t occurr5ce1 & may acquire an extraord9>y size4 ,_! /ructure may be simple or v complex1 & we may accord+ly divide !m into simple or b>r51 & comp\nd or prolif]\s cy/s4 ,!y may be new =mations or1 z 9 mo/ cases1 m]ely hyp]trophies4 ,!y occur 9 ne>ly e organ & tissue ( ! body1 b are mo/ frequ5tly met ) 9 ! sk9 & muc\s membranes1 ! gl&ul> organs1 & 9 ! subcutane\s cellul> tissue4 ,a4 ,simple ,cy/s g5]ally consi/ ( a ?9 sac or cy/ fill$ ) cont5ts1 v>y+ accord+ to ! /ructure & function ( ! affect$ "p4 ,! cy/ itself may be solit>y or multiple1 g5]ally compos$ ( a s+le lay]1 its ext]nal surface be+ r\gh & adh]5t to ! surr\nd+ tissues1 :ile ! int]nal surface is %9+ or glossy1 & 9 imm$iate b loose contact ) ! cont5ts ( ! tumor4 ,accord+ to ! nature ( _! cont5ts1 we may f9d ! foll[+ v>ieties ( simple cy/s3 ,s]\s ,cy/s4 ,_! cont5ts are g5]ally ( a ?91 wat]y "*1 slightly sal9e 9 ta/e1 & consi/+ l>gely ( album9\s mat]ial4 ,! walls are ?91 & at fir/ transluc5t2 z !y gr[ old] !y become ?ick] & d5s]4 ,muc\s ,cy/s g5]ally conta9 a ?ick1 ropy1 glut9\s mat]ial1 int]mix$ ) epi!lial matt]4 ,sometimes ! cont5ts are ?9 & cle>2 occasionally !y resemble ! fluid conta9$ 9 a synovial bursa4 ,su* tumors occur *iefly 9 connection ) ! muc\s membranes1 are g5]ally sph]ical or pyri=m 9 %ape1 & may atta9 ! size ( a ftal head4 ,synovial ,cy/s are g5]ally small 9 size1 r\nd$1 globul>1 or hemi-sph]ical 9 %ape1 ) cont5ts ( a s]\s1 mucus1 glut9\s1 colloid1 or ( a jelly-l consi/5ce1 & ( a :iti%1 opaque appe>ance4 ,!y occur g5]ally 9 ! synovial %ea?s ( ! t5dons ( ! wri/1 & on ! front ( ! patella4 ,! mo/ *>act]i/ic types ( synovial cy/s are ^? kn[n z ganglions & burs4 ,colloid ,cy/s are r>ely met ) z indep5d5t /ructures2 !y usually occur z accid5tal con/itu5ts ( v>i\s k9ds ( morbid gr[?s4 ,_! cont5ts v>y 9 consi/5ce betwe5 mucus & ! ?icke/ jelly1 8_! color be+ g5]ally :iti% or pe>l-l1 n unfrequ5tly bl5d$ ) %ades ( p9k1 yell[i%-br[n1 or olive-gre540 ,sangu9e\s ,cy/s1 or hmatomata1 may be entirely new =mations1 or may occur 9 a normal cavity4 ,_! cont5ts may consi/ ei!r ( pure blood or ( blood m+l$ ) s]um & o!r sub/ances4 8,! cy/ wall is usually v ?9 & smoo?2 b 9 "s cases ! inn] surface has a peculi> fasciculat$ appe>ance1 n unlike t ( ! "r auricle ( ! he>t40 ,! cy/ is commonly small1 & ( a r\nd$ or hemi-sph]ical %ape4 ,saliv>y ,cy/s are mo/ frequ5t 9 connection ) ! subl+ual gl&1 con/itut+ ! s-call$ ranula4 ,! cont5ts ( ^! cy/s are ?ick & ropy1 l ! :ite ( egg1 & consi/ ess5tially ( saliva1 mix$ ) mucus & epi!lial matt]4 ,milk ,cy/s are liable to be =m$ 9 ! mamm>y gl& dur+ lactation4 ,_! size v>ies4 ,_! cont5ts may be pure milk & p]fectly liquid1 or mix$ ) case\s & epi!lial sub/ances4 ,oil ,cy/s are ( r>e occurr5ce1 & usually ( q small size4 ,!y occur mo/ frequ5tly 9 ! sk9 or 9 "s gl&ul> organ1 especially ! brea/4 ,_! cont5ts are g5]ally fatty matt]1 ) epi!lial & o!r sub/ances4 ,sem9al ,cy/s are nev] ( indep5d5t gr[?4 ,!y conta9 a fluid1 mo/ly s]um1 ) ! *>act]i/ic sp]matozoa held 9 susp5sion1 & only to be detect$ by ! microscope4 ,! only true tumors ( ?is k9d are hydroceles ( ! sp]matic cord4 ,d]moid ,cy/s are usually cong5ital1 &1 9 ! majority ( cases1 conta9 ! debris ( a blight$ ovum1 su* z hairs1 tee? & bone4 ,sebace\s tumors are a v>iety ( d]moid cy/s1 & conta9 sebace\s matt]1 comb9$ ) epi!lium & ev5 hair1 oil or fat4 ,b4 ,comp\nd or ,prolif]\s ,cy/s are 8*>act]iz$ by ! exi/5ce ( subord9ate cy/s1 occupi$ by diff]5t organiz$ sub/ances1 & giv+ rise to t peculi> arrangem5t kn[n z multilocul> or polycy/ic1 g5]ally s conspicu\s 9 ?is class ( tumors40 ,:5 a numb] ( cy/s are cr[d$ toge!r1 _! walls are frequ5tly absorb$1 & irregul> cavities1 v>y+ 9 size & %ape1 are ?us =m$4 ,_! cont5ts are ( ! mo/ div]sifi$ "*4 ,! cy/ wall is ?9 at fir/1 b becomes ?ick] & firm] 9 a lat] /age4 ,prolif]\s cy/s sometimes take on a malignant "*1 ( ! encephaloid or epi!lial type1 ye>s aft] _! orig94 ,!y occur mo/ frequ5tly 9 ! ov>y1 ! mamm1 & ! ?yroid gl&4 ,9 ! fir/ situation1 !y n unfrequ5tly atta9 an enorm\s size4 #b4 ,hydatid ,tumors4 ,^! tumors occur mo/ frequ5tly 9 ! liv]1 ov>y & ut]us4 ,!y consi/ ( a di/9ct sac1 enclos+ an entozoon1 p>asite or vesicul> worm1 8v>y+ 9 volume betwe5 a mu/>d-se$ & a small orange4 ,! entozoon is ( a globul> figure1 ( a :iti%1 semi-opaque appe>ance1 & compos$ ( a vesicle or bladd]1 fill$ ) s]\s fluid1 & surr\nd$ by a cellulo-fibr\s capsule40 ,g5]ally a numb] ( !m are f\nd 9 a common cy/4 8,! cont5ts ( ! animal are ( a cle>1 limpid "*1 rem>kably sal9e to ! ta/e1 b de/itute ( odor & coagulability4 ,betwe5 ! cy/ & ! p>asite !re is commonly a s(t1 pulpy1 dirty-look+ sub/ance1 ! precise nature ( :i* is undet]m9$4 ,l>ge hydatids sometimes conta9 sev]al small] ones1 "o )9 ! o!r40 8,! inn] surface ( ! p>asite is /udd$ ) num]\s little bodies1 resembl+ dim9utive fi%-spawn1 h>dly z l>ge z a gra9 ( s&1 ( a sph]ical %ape & ( a grayi% color1 ea* consi/+ ( a delicate cy/1 fill$ ) e*9ococci40 8,ea* e*9ococcus consi/s ( a body & a head1 ! latt] be+ encircl$ by a r[ ( tee?1 naturally conceal$ 9 a n>r[ cleft1 b capable ( project+ itself4 ,! body1 compos$ ( solid1 granul> matt]1 has a curi\sly speckl$ appe>ance1 due to ! pres5ce ( num]\s ovoid spots imm$iately b5ea? its out] coat4 ,! tee?1 or hooklets1 are sp9\s1 %>p1 & p]fectly *>act]i/ic40 #c4 ,myxomat\s ,tumors4 ,! ,myxomata or muc\s tumor1 consi/s ( muc\s tissue1 a transluc5t & succul5t connective tissue1 ! int]cellul> sub/ance ( :i* yields muc94 ,_! *>act]i/ic features are ela/icity & s(tness2 ! old] gr[?s1 h[ev]1 are h>d] ?an ! m rec5t ones4 ,!y are ( a pale1 greyi% or r$di%-:ite color4 ,!y consi/ ( a basem5t /ructure1 ! prop] /roma ( ! tumor1 & an int]cellul> sub/ance1 p]vad$ by di/9ctly visible blood-vessels4 ,on be+ cut1 !y yield1 on pressure1 ! t5aci\s1 mucilag9\s1 int]cellul> liquid1 9 :i* may be se5 ! cellul> elem5ts ( ! gr[?4 ,! majority ( ! cells1 "u ! microscope1 are f\nd to be angul> & /ellate1 ) long1 ana/omos+ prolongations & trabecul4 ,o!rs are isolat$ & fusi=m1 oval or sph]ical 9 %ape4 ,!y usually possess "o1 9 "s cases two di/9ct nuclei4 ,fat cells1 fibr\s tissue1 bo? :ite & ela/ic1 & c>tilage 9 v>y+ proportions1 are (t5 met ) 9 ! morbid mass4 ,!y occur *iefly 9 ! subcutane\s & int]muscul> cellul> tissues1 9 ! muc\s cavities1 9 ! hilus ( ! kidney1 & 9 ! n]ves & bones4 ,:5 situat$ 9 sup]ficial p>ts !y may become p$unculat$4 ,9 ! submuc\s tissue ( ! nose !y con/itute ! gelat9oid polypus4 ,o!r p]fect types ( muc\s tumors are se5 9 ! polypi ( ! e> & ! ut]us4 #d4 ,lipomat\s ,tumors4 ,! ,lipomata or fatty tumors are v common1 & may occur 9 any "p ( ! body4 ,!re may be b "o1 or !y may appe> 9 v l>ge numb]s 9 diff]5t p>ts ( ! body4 ,!y sometimes atta9 an enorm\s size4 ,!y are lobulat$1 & are usually surr\nd$ by a fibr\s capsule1 :i* sep>ates !m f ! adjac5t /ructures4 ,_! consi/5ce v>ies accord+ to ! am\nt ( fibr\s tissue t ent]s into _! =mation4 ,!y frequ5tly become p$unculat$1 or assume a pyri=m %ape1 no d\bt by reason ( _! weight1 by :i* !y are gradually dragg$ out ( _! orig9al %ape1 z well z position4 ,!y resemble 9 /ructure1 z also 9 appe>ance on section1 adipose tissue4 ,!y consi/ ( m or less r\nd or polygonal cells1 di/5d$ ) fluid fat1 & unit$ into masses or lobules ( v>i\s sizes by connective tissue1 :i* also =ms a sort ( capsule ar\nd ! tumor1 & connects x m or less firmly to ! p>ts ar\nd4 ,inflammation1 suppuration1 ulc]ation1 & ev5 gangr5e may occur 9 ^! gr[?s4 ,!y may also und]go at c]ta9 po9ts1 fibr\s1 c>tilag9\s or osse\s deg5]ation4 ,cy/s fill$ ) v>i\s k9ds ( sub/ances may also occasionally occur )9 !m4 #e4 ,fibr\s ,tumors4 ,! ,fibromata appe> 9 v diff]5t p>ts ( ! body1 commonly 9 ^? :i* normally conta9 mu* fibr\s tissue4 ,sev]al may exi/ 9 ! same organ1 m p>ticul>ly 9 ! ut]us1 r>ely d !y coexi/ 9 sep>ate organs4 ,_! =m is mo/ly sph]ical1 g5]ally ) a smoo?1 ev5 surface1 al?\gh n unfrequ5tly x is lobulat$1 or m>k$ by num]\s elevations & depressions4 ,!y feel heavy & incompressible4 ,ne> a free surface !y are prone to become p$unculat$4 ,!y may atta9 a v great size4 ,_! vascul>ity is 9 proportion to ! d5sity ( _! /ructure1 "s hav+ b few vessels1 :ile o!rs are highly vascul>4 ,a di/9ct capsule is b seldom met )1 al?\gh ! tissues ar\nd ! tumors w usually be f\nd a great deal cond5s$ & ?ick5$4 ,!y consi/ ess5tially ( fibres1 resembl+ ^? ( areol> tissue4 8,sometimes ! fibres are tol]ably di/9ct & sep>ate1 m (t5 s int]lac$ & bl5d$ toge!r1 or s imp]fectly evolv$ t !y _c be made out z su*4 ,yell[ ela/ic fibres are n unfrequ5tly m+l$ ) ! :ite40 ,gr[?s ( ?is k9d are n1 9 g5]al1 liable to any great degree ( *ange4 ,inflammation1 ) injection & s(t5+ ( ! "p may take place4 ,cretification may occur1 by :i* ei!r ! :ole tumor may be conv]t$ into a calc>e\s mass1 or only ! out] /ratum surr\nd+ ! re/ z a k9d ( %ell4 #f4 ,c>tilag9\s ,tumors4 ,! ,en*ondromata1 hi/ologically resemble c>tilage1 & l x consi/ ( cells & an int]cellul> sub/ance1 pres5t+ all ! v>iations obs]v$ 9 ! normal tissue4 ,! int]cellul> sub/ance may be hyal9e1 fibr\s1 or mucoid1 or z mo/ frequ5tly is ! case1 all comb9$4 ,! cells are r\nd1 oval1 sp9dle-%ap$ or /ellate1 & may be v num]\s1 or few 9 proportion to ! matrix4 ,!y enclose "o or m nuclei1 & slightly granul> cont5ts2 sometimes a cell-wall _c be di/+ui%$4 ,9 addition to ! int]cellul> tissue1 ! gr[? is usually divid$ into sev]al lobes by b&s ( fibr\s tissue4 ,! fibr\s tissue 9 mo/ cases1 =ms a capsule ar\nd ! tumor1 & sep>ates x f ! surr\nd+ /ructures4 ,! en*ondroma is met ) mo/ frequ5tly 9 e>ly life1 & occurs *iefly 9 connection ) ! osse\s sy/em1 pr9cipally ! metac>pal bones1 & phalanges ( ! f+]s1 :]e x may gr[ ei!r f ! p]io/eum or f ! m$ulla4 ,x is met ) also 9 ! p>otid & submaxill>y gl&s1 9 ! te/icle1 mamm & ov>y1 & occasionally 9 ! subcutane\s & int]muscul> cellul> tissue4 ,!y may atta9 an enorm\s size4 8,to ! h&1 x imp>ts ! s5sation ( unusual firmness & solidity2 x is de/itute ( ela/icity1 is g5]ally di/9ctly circumscrib$1 & is ne>ly always /rongly adh]5t to ! tissues f :i* x spr+s40 ,calcification & ossification ( ^! tumors may occur4 ,9 r>e cases1 ! sk9 cov]+ ! tumor ulc]ates1 & a fungat+ mass protrudes4 ,al?\gh 9 g5]al an innoc5t gr[?1 ! en*ondroma 9 "s in/ances1 assumes a malignant =m1 & recurs aft] extirpation4 #g4 ,osse\s ,tumors4 ,! ,o/eomata are tumors consi/+ ( osse\s tissue1 met ) *iefly z outgr[?s ( ! skeleton1 especially ( ! ext]nal & int]nal surfaces ( ! skull1 & ( ! ?igh bone4 ,!re are ?ree classes1 ! s(t1 spongy or cancell\s1 ! compact1 & ! eburnat$ o/eoma4 ,! spongy1 :i* is ! mo/ common1 consi/s ( cancell\s osse\s tissue4 ,! m$ull>y spaces may conta9 embryonic tissue1 a fibrillat$ tissue1 or fat4 8,9 its e>li] /ages1 x is (t5 inve/$ by a lay] ( c>tilage1 ( a gre5i%1 :iti%1 slightly blui%1 or pe>ly aspect1 & ( a hyal9e "*4 ,sometimes x is enclos$ by a ?91 fibr\s1 or fibro-cellul> capsule1 a =m ( synovial bursa1 lubricat$ by s]\s or s]o-oleag9\s fluid40 ,! compact o/eoma is g5]ally m or less r\nd$1 ) a nodulat$ surface1 & a broad base4 ,x is ( a firm1 bony consi/5ce1 & resembles1 z ne>ly z possible 9 /ructure1 ! compact tissue ( ! long bones1 diff]+ only 9 ! arrangem5t ( ! ,hav]sian canals & canaliculi1 :i* is less regul> ?an 9 normal bone4 ,! eburnat$ o/eoma consi/s ( d5se osse\s tissue4 ,! lamell are arrang$ conc5trically & p>allel to ! surface ( ! tumor4 ,blood-vessels & cancell\s tissue are bo? abs5t4 ,! tumor is ( small size1 r\nd$1 globul> or hemi-sph]ical 9 %ape1 & g5]ally smoo?1 or slightly nodulat$4 #h4 ,papill>y ,tumors4 ,! ,papillomata resemble 9 /ructure ord9>y papill1 & l ^! gr[ f cutane\s & muc\s surfaces4 ,!y consi/ ( a basis ( connective tissue1 support+ blood-vessels1 :i* t]m9ate 9 a capill>y net-"w1 or 9 a s+le capill>y loop1 ! :ole be+ envelop$ 9 a cov]+ ( epi!lium1 v>y+ 9 "* accord+ to ! surface f :i* ! new =mation spr+s4 ,^! gr[?s are sometimes v vascul>4 ,on ! sk9 we may h ^! gr[?s z w>ts & horny gr[?s4 ,^! are commonly firm1 ) a d5se epi!lial cov]+1 & are less liable to ulc]ation & hmorrhage1 ?an ^? gr[+ on o!r p>ts4 ,b we h1 9 ! condylomata & v5]eal w>ts1 occurr+ ar\nd ! anus & ^u ! ext]nal male & female g5ital organs1 in/ances ( l>g] & m vascul> =ms on cutane\s surfaces4 ,on ! muc\s membranes1 ! papillomata are s(t] & m vascul>1 & h a less d5se epi!lial cov]+4 ,_m ( !m con/itute s-call$ muc\s polypi4 ,!y are met ) on ! tongue1 9 ! l>ynx & nose1 9 ! ga/ro-inte/9al muc\s membrane1 on ! c]vix ut]i1 & 9 ! bladd]4 #i4 ,polypoid ,tumors4 ,^! gr[?s occur exclusively 9 ! muc\s cavities ( ! body1 & may atta9 a l>ge size4 ,!y occur mo/ frequ5tly 9 ! nose & ! ut]us1 b are also met ) 9 ! e>1 maxill>y s9us1 vag9a & rectum1 :ile _! pres5ce 9 ! l>ynx & ?roat is exce$+ly r>e4 ,!y are usually solit>y1 v>y+ 9 size & %ape accord+ to ! locality :i* !y occupy4 ,f\r v>ieties are met )1 diff]+ ess5tially 9 _! /ructure4 ,! gelat9oid polypus1 ! mo/ common ( all1 occurs almo/ exclusively 9 ! nose4 ,x is ( a jelly-l appe>ance1 irregul>ly pyri=m 9 %ape1 ) a n>r[ p$icle1 sometimes ne>ly an in* 9 l5g?4 ,x is n\ri%$ by a few /raggl+ vessels1 :i* are (t5 ( consid]able l5g? & ?ickness4 ,! /ructure ( ! fibr\s polypus is exce$+ly d5se & compos$ ( fibres1 int]lac+ ) ea* o!r 9 all directions4 ,x is t\gh1 h>d & incompressible2 ( a r$di%1 purple or livid hue4 ,x is ne>ly always solit>y1 may atta9 a l>ge size1 & is usually atta*$ firmly by a broad base1 & n by a p$icle4 ,! ut]us1 nose & maxill>y s9us1 are its mo/ common sites4 ,! granul> polypus1 is ( r>e occurr5ce4 ,x is met ) *iefly 9 ! ut]us & 9 ! e>4 ,x is g5]ally small1 ( a pale1 greyi%1 or :iti% color1 s(t & fragile 9 consi/5ce1 & globul>1 conical1 or ovoidal 9 %ape4 ,its /ructure is granul>1 homog5e\s & inela/ic4 ,! vascul> polypus1 atta*$ usually by a n>r[ base1 is ( a florid color1 ( a s(t consi/5ce1 & n v l>ge 9 size4 ,on section we f9d num]\s vessels int]sp]s$ ?r\gh\t a fibro-cellul> tissue4 ,c>c9omat\s disease is m liable to sup]v5e 9 ! case ( ! fibr\s gr[?s1 ?an 9 ! o!r ( ^! =mations4 #aj4 ,myomat\s ,tumors4 ,! ,myomata are tumors consi/+ ( muscul> tissue1 ei!r ( ! /riat$1 or non/riat$ v>iety4 ,! =m] are exce$+ly r>e & g5]ally cong5ital1 ! latt] are q frequ5t & are nev] cong5ital2 b occur pr9cipally 9 eld]ly subjects4 ,!y are met ) mo/ frequ5tly 9 ! ut]us1 :]e !y sometimes atta9 an imm5se size4 ,!y =m ei!r di/9ctly circumscrib$ tumors ( a globul>1 conical1 or pyri=m %ape1 or ill-def9$ masses 9 ! ut]9e walls4 ,:5 project+ into ! cavity ( ! ut]us1 or into ! abdom9al cavity1 !y assume ! %ape ( polypi1 ) a n>r[ p$icle4 ,myomata may also occur 9 ! pro/ate gl&1 9 ! sophagus1 /oma* & inte/9es4 8,9 /ructure !y consi/ ( elongat$ sp9dle-%ap$ cells1 m or less isolat$1 or gr\p$ into fasciculi ( v>i\s sizes1 ) a v>y+ am\nt ( connective tissue40 ,mac]ation ) dilute nitric acid1 is (t5 necess>y 9 ord] to isolate & display ! muscul> elem5ts4 #aa4 ,vascul> ,tumors4 ,! ,angiomata are tumors consi/+ ( blood-vessels1 held toge!r by a small am\nt ( connective tissue4 ,!y include ! v>i\s =ms ( nvi1 ! erectile tumors1 & aneurism by ana/omosis4 ,!y are g5]ally met ) z cong5ital affections4 ,_! ord9>y sites are ! sk9 & muc\s membranes1 especially ab\t ! head1 face & tongue4 ,!y are s(t & spongy1 easily compressible1 & v ela/ic1 v>y+ 9 color accord+ to ! nature ( _! cont5ts1 :e!r v5\s or art]ial1 or bo? comb9$4 #ab4 ,neuromat\s ,tumors4 ,true ,neuromata are tumors consi/+ almo/ entirely ( n]ve tissue4 ,! t]m has also be5 appli$ to gr[?s ( o!r k9ds1 f\nd 9 connection ) n]ves2 ^! are false or spuri\s neuromata4 ,true neuromata are ( v r>e occurr5ce4 ,!y consi/ ma9ly ( a new gr[? ( n]ve fibres4 8,!y resemble 9 /ructure ! c]ebro-sp9al n]ves1 consi/+ ( tubul> fibres1 ) a v>y+ quantity ( int]tubul> connective tissue1 & 9 "s cases a few gray1 gelat9\s fibres40 ,!y usually exi/ z small1 s+le nodules1 solid to ! t\*1 firm1 inela/ic1 & develop$ )9 ! neurilemma ( ! affect$ n]ve4 ,! mo/ frequ5t seat ( ^! gr[?s is ! extremities ( divid$ n]ves1 :]e !y sometimes occur aft] amputation4 ,!y may also exi/ 9 ! c\rse ( ! n]ves1 9 any situation1 s+ly1 or 9 great numb]s4 #ac4 ,ad5oid ,tumors4 ,! ,ad5omata are new =mations ( gl& tissue1 resembl+ 9 /ructure ! racemose1 or tubul> gl&s4 8,!y consi/ ( num]\s small saccules or tubes fill$ ) squam\s or cyl9drical epi!lial cells4 ,^! are gr\p$ toge!r1 be+ m]ely sep>at$ by a small1 ?\gh v>y+ am\nt ( connective tissue1 9 :i* are conta9$ ! blood-vessels40 ,!y are ess5tially local hyp]plasias4 ,! new gr[? may rema9 9 intimate relation ) ! adjac5t gl&1 or x may gradually become sep>at$ f x by ! =mation ( a fibr\s capsule4 ,! ad5oma is usually a solit>y tumor1 ( a firm1 d5se1 inela/ic consi/5ce1 ( a :iti%1 grayi%1 or pale /raw color1 seldom l>g] ?an a hickory nut4 ,on section1 ! cut surface has a gli/5+ appe>ance1 & 9 rec5t cases nev] yields any fluid on pressure4 ,x occurs 9 ! mamm>y1 ?yroid1 pro/ate1 & p>otid gl&s1 & 9 ! muc\s follicles4 ,9 muc\s surfaces1 x gradually projects above ! surface ( ! membrane1 s z to =m a polypus1 & ?us con/itute ! mo/ common =m ( muc\s polypus4 #ad4 ,lymphatic ,tumors4 8,! ,lymphomata are new =mations consi/+ ( lymphatic1 or z x is m commonly call$1 ad5oid tissue4 ,?is tissue consi/s ess5tially ( a delicate reticulum1 )9 ! me%es ( :i* are conta9$ ! s-call$ lymph corpuscles4 ,! reticulum is made up ( v f9e fibrils1 :i* =m a close net-"w1 ! me%es ( :i* are only suffici5tly l>ge to enclose a few1 or ev5 a s+le corpuscle 9 ea*4 ,! fibrils usually pres5t a m or less homog5e\s appe>ance1 & among/ !m !re are a few scatt]$ nuclei40 ,! lymphatic tumor is mo/ frequ5tly met ) 9 ! lymphatic gl&s ( ! neck1 axilla1 gro91 & mes5t]y1 & usually consi/s ( sev]al enl>g$ gl&s1 fus$ into "o common mass ( v>iable size1 %ape1 & consi/5ce4 ,! sectional surface is ( a grayi%1 light p9k1 or r$di%-yell[ color1 & yields on pressure a :iti%1 lactesc5t juice1 n unlike t ( c]ta9 =ms ( c>c9oma1 conta9+ cells ) "o or m nuclei4 ,,ii4 ,malignant ,tumors4 #a4 ,s>comat\s ,tumors4 ,! ,s>comata are tumors consi/+ ( embryonic connective tissue4 ,?is diff]s f ! fully develop$ tissue1 9 consi/+ almo/ entirely ( cells1 :i* are also l>g] & r\nd] ?an ^? ( mature tissue4 ,its int]cellul> sub/ance1 in/ead ( be+ fibr\s1 is s(t & amorph\s or only obscurely fibrillat$4 ,! cells ( s>coma are r\nd1 sp9dle-%ap$ or /ellate1 & exi/ ei!r sep>ately or 9 conjunction 9 ! same tumor4 ,! latt] is mo/ frequ5tly ! case2 b "o =m g5]ally pr$om9ates1 & accord+ to ! prepond]ance ( "o or ! o!r k9d ( cell1 ^! tumors c be mo/ conv5i5tly classifi$ z r\nd-cell$1 sp9dle-cell$1 & giant-cell$ s>comata4 ,r\nd cells are f\nd 9 all s>comata1 & are (t5 v small1 sc>cely di/+ui%able f lymphatic cells1 or :ite blood corpuscles4 ,o!rs are l>g]1 & conta9 an indi/9ct nucleus1 ) "o or m bright nuclei4 ,! fusi=m or sp9dle-%ap$ cells are ! s-call$ fibro-pla/ic cells4 ,!y are long1 dimly granul>1 pale bodies1 t]m9at+ at ea* end 9 a f9e prolongation4 ,!y are slightly granul>1 & enclose a long1 oval nucleus1 ) or )\t nucleoli4 ,9 size !y v>y4 ,! giant or "m cells are ! l>ge/ ( human cells1 irregul> 9 %ape1 ?\gh usually m or less sph]ical4 ,!y are f9ely granul>1 & conta9 num]\s r\nd or oval nuclei1 ea* ) "o or m bright nucleoli4 ,! int]cellul> sub/ance exi/s usually 9 small quantities4 8,x may be p]fectly fluid & homog5e\s1 or firm] & granul>1 or1 less frequ5tly1 m or less fibrillat$4 ,*emically1 x yields album51 gelat9 & muc940 ,^! gr[?s may occur at any p]iod ( life1 b are mo/ frequ5tly met ) betwe5 ! tw5tie? & =tie? ye>4 ,x is mo/ common 9 ! sk9 & subcutane\s & int]muscul> connective tissues ( ! extremities4 ,! p]io/eum & bones1 p>ticul>ly ! epiphyses ( ! long bones & ! maxill1 ! female brea/1 ! te/icles1 & ! eye1 are also liable to be attack$4 ,!y usually arise z nodules1 s+le or multiple1 firm or s(t1 & (t5 atta9 an enorm\s size by _! *>act]i/ic rapidity ( gr[?4 ,!y are liable to fatty deg5]ation1 ) ! production ( cy/-l cavities4 ,calcification1 ossification & mucoid deg5]ation are also common4 ,s>comata are decid$ly malignant1 & are *>act]iz$ by _! rapid gr[?1 _! great t5d5cy to ext5d locally1 & to recur aft] removal1 & by _! p[] ( reproduc+ !mselves 9 int]nal organs4 ,! ,r\nd-cell$ ,s>coma1 call$ also f its resemblance 9 _m cases to encephaloid1 m$ull>y1 encephaloid or s(t s>coma1 is ( a uni=m1 s(t1 bra9-l consi/5ce1 & ( a some:at transluc5t1 greyi%1 or r$di%-:ite color4 ,! sectional surface1 on be+ scrap$1 yields a juice ri* 9 cells4 ,x is exce$+ly vascul>1 ) ! vessels (t5 dilat$ & v>icose4 8,x c be di/+ui%$ f encephaloid canc] by ! abs5ce ( a fibr\s /roma1 by ! uni=mity 9 ! "* ( its cells1 & by ! abs5ce ( any invasion ( ! surr\nd+ /ructure 9 _! gr[? o!r ?an ! connective tissue f :i* !y gr[40 ,! ,sp9dle-cell$ ,s>coma1 call$ also ! fibro-pla/ic & recurr+ fibroid1 is mo/ closely alli$ to ! fibroma4 ,x consi/s ess5tially ( fusi=m cells1 ) well-m>k$ nuclei & ?9 processes1 sometimes split at ! end4 ,!y are ne>ly 9 close contact1 !re be+ b little int]cellul> sub/ance4 ,! cells are p>allel & arrang$ 9 bundles1 :i* pass 9 all directions ?r\gh ! gr[?4 8,:5 cut1 ?is s>coma grates "u ! knife1 & ! surface exhibits a firm1 t\gh1 greyi% or pale-yell[i% appe>ance1 simil> to t ( ord9>y fibr\s gr[?4 ,aft] removal1 !y are s(t] & m succul5t :5 !y recur40 ,!y gr[ f ! p]io/eum1 ! fasci1 & f ! connective tissue 9 o!r p>ts4 ,!y are m frequ5tly enclos$ 9 a capsule ?an ! o!r v>ieties4 ,! ,giant-cell$ ,s>coma1 call$ also ! myeloid s>coma1 mo/ frequ5tly occurs 9 connection ) bone4 ,!y consi/ ( l>ge1 _m nucleat$ cells1 m+l$ ) r\nd or sp9dle =ms1 ne>ly 9 contact1 !re be+ b a sp>se int]cellul> sub/ance4 ,on section1 ! surface appe>s smoo?1 compact1 %9+1 greyi%-:ite or gre5i%1 ) blot*es ( a d>k crimson1 br[ni% or p9k hue4 ,! giant-cell$ s>coma is n a b5ign affection1 b is ! lea/ malignant ( ! s>comas4 #b4 ,c>c9omat\s ,tumors4 8,! ,c>c9omata are new =mations1 consi/+ ( cells ( an epi!lial type1 )\t any int]cellul> sub/ance1 gr\p$ toge!r irregul>ly )9 ! alveoli ( a fibr\s /roma4 ,! cells are *>act]iz$ by _! l>ge size1 by ! div]sity ( _! =ms1 & by ! magnitude & prom95ce ( _! nuclei & nucleoli4 ,9 size !y v>y f to ( an in* 9 diamet]1 ! majority be+ ab\t five times z l>ge z a r$ blood-corpuscle4 ,!y are r\nd1 oval1 fusi=m1 caudate1 polygonal--exhibit+1 9 %ort1 e div]sity ( outl9e4 ,! nuclei1 :i* are l>ge & prom95t1 are r\nd or oval 9 %ape1 & conta9 "o or m bright nucleoli40 ,!re is g5]ally b a s+le nucleus1 two1 h[ev]1 are (t5 met )1 & !y are ev5 /ill m num]\s 9 ! s(t v>ieties ( canc]4 ,! /roma v>ies 9 am\nt4 ,x consi/s ( a fibrillat$ tissue1 =m+ by _! peculi> arrangem5t1 alveoli ( v>i\s sizes & %apes1 9 :i* ! cells are gr\p$4 ,! /roma v>ies 9 "* accord+ to ! rapidity ( its gr[?4 ,:]e its gr[? is rapid1 x w conta9 num]\s r\nd & sp9dle-%ap$ cells2 :]e x is sl[1 or has ceas$ altoge!r1 ! tissue w conta9 b few cells1 & w be d5se & fibr\s 9 "*4 ,! latt] condition is mo/ frequ5tly met )4 ,! blood-vessels are sometimes v num]\s1 & are always limit$ to ! /roma1 & nev] encroa* ^u ! alveoli4 ,?is s]ves to di/+ui% ! c>c9omata f ! s>comata1 s9ce 9 ! latt] ! blood-vessels ramify among/ ! cells ( ! gr[?4 ,! c>c9omata also possess lymphatics1 & x is ow+ to ?is t ! lymphatic gl&s are s con/antly involv$ 9 ! disease4 ,canc]s v r>ely become encapsul$1 b g5]ally invade ! surr\nd+ /ructures4 ,! epi!lial elem5ts are f\nd infiltrat+ ! tissues = "s di/ance ar\nd ! tumor1 s t !re is no l9e ( dem>cation betwe5 x & ! normal /ructures4 ,c>c9omat\s tumors are liable to c]ta9 alt]ations & trans=mations1 l o!r morbid gr[?s4 ,fatty deg5]ation is ! mo/ common ( ^!4 ,?is occurs to a great] or less ext5t 9 all ! v>ieties ( canc]4 ,x produces s(t5+ ( ! gr[?1 :i* is (t5 r$uc$ to a pulpy1 cream-l consi/5ce4 ,calc>e\s deg5]ation has be5 occasionally met ) 9 encephaloid1 & 9 c>c9oma invad+ bone4 ,inflammation1 s(t5+1 & consequ5t ulc]ation1 are n unfrequ5t4 ,! v>ieties ( c>c9omata are3 7a47 ,scirrhus4 ,scirrhus1 fibr\s1 h>d or *ronic canc]1 seldom occurs be=e middle age1 & m frequ5tly 9 ! female ?an male4 ,! liv]1 mamm & ut]us1 are p>ticul>ly liable to be attack$4 ,x also occurs 9 ! alim5t>y canal1 & 9 ! sk94 ,scirrhus is *>act]iz$ by ! l>ge am\nt ( its /roma1 & its sl[ gr[?4 ,! tumor is firm1 h>d & inela/ic1 ( v>iable %ape1 & is (t5 depress$ 9 ! c5tre1 ow+ to ! contraction ( ! cicatricial tissue4 ,on section1 especially 9 ! m matur$ /ages1 ! tumor exhibits a :iti%1 gli/5+ aspect1 int]sect$ ) fibr\s b&s1 ! rema9s ( normal tissue1 *ang$ by disease4 ,x yields on be+ scrap$1 a peculi> fluid1 ! s-call$ canc] juice1 g5]ally ( a pale1 grayi%1 turbid appe>ance1 ri* 9 cells1 nuclei & granules1 sometimes ( a :iti%1 creamy hue4 ,?is juice is evid5tly ! result ( dis9tegration1 & is h5ce b sp>+ly pres5t 9 rec5t specim5s4 ,x readily mixes ) wat]1 & (t5 conta9s a quantity ( free oil4 ,scirrhus has b few blood-vessels4 ,n]ves & lymphatics also exi/4 ,x has a t5d5cy to ulc]ate1 & to contract adhesions ) ! /ructures surr\nd+ x4 ,! lymphatic gl&s are also liable to be infect$1 by ! convey+ ( canc] elem5ts to !m ?r\gh ! lymphatic vessels situat$ 9 ! scirrhus mass4 7b47 ,encephaloid4 ,encephaloid1 m$ull>y1 s(t or acute canc]1 diff]s f ! prec$+1 9 ! small am\nt ( /roma1 ! consequ5t s(tness ( consi/5ce1 & its rapid gr[?4 ,x is mo/ common 9 ! mamm1 eye1 te/icle1 ut]us1 liv]1 lymphatic gl&s1 p]io/eum & bones4 ,! greate/ numb] ( cases occur betwe5 ! tw5tie? & fiftie? ye>s4 ,! cells are exactly simil> to ^? ( scirrhus1 b f> m num]\s1 :ile ! /roma is n s well m>k$1 & mu* less fibr\s1 & does n und]go a simil> cicatricial contraction4 ,blood-vessels are v abundant4 ,! tumor v>ies 9 size f a pea to t ( an adult's head1 its %ape be+ g5]ally ovoidal1 & its surface m or less lobulat$4 8,x is ( a s(t1 bra9-l consi/5ce1 ! c5tral portions2 :]e fatty deg5]ation is mo/ advanc$1 (t5 be+ completely difflu5t4 ,on section1 x pres5ts a :ite1 pulpy mass1 mu* resembl+ bra9 sub/ance1 :i* is (t5 irregul>ly /a9$ ) extravasat$ blood40 ,occasionally ^! tumors conta9 s]\s cy/s ( small size1 z well z o!r adv5titi\s products4 ,:5 ulc]ation takes place2 ! sore is *>act]i/ic4 8,its edges are ?91 und]m9$1 jagg$1 or irregul>1 :ile its bottom has a f\l1 bloody1 fung\s appe>ance4 ,! p>ts ar\nd are ( a deep r$1 livid1 or purple color40 7c47 ,melanosis4 ,melanotic1 or black canc]1 is probably m]ely ! result ( a pigm5tation ( ! encephaloid4 ,x occurs mo/ frequ5tly 9 ! eye & sk91 & is occasionally met ) 9 ! visc]a4 ,! melanotic matt] occurs 9 small masses1 ( a r\nd$1 ovoidal1 or irregul> %ape1 ) or )\t a cy/1 f ! size ( a p9's head to t ( a walnut2 ( a dull1 sooty1 br[ni%1 or black color4 ,!y are g5]ally inve/$ by a di/9ct capsule1 =m$ out ( ! cellul> tissue 9 _! imm$iate vic9ity4 8,"u ! microscope1 x is se5 to consi/ ( a fibr\s net-"w1 includ+ num]\s alveoli1 fill$ ) free1 unadh]5t pigm5t cells1 occupi$ by color$ granules1 a few ( ! l>g] or old] ones conta9+ sometimes a nucleus ) its nucleolus4 ,free pigm5t granules are also f\nd 9 great abundance40 7d47 ,colloid4 ,! colloid1 alveol>1 gelat9i=m canc]1 is ! mo/ uncommon =m ( het]olog\s =mations4 ,x is reg>d$ by "s1 z simply "o ( ! prec$+ =ms :i* has und]gone mucoid or colloid *ange4 ,x is mo/ frequ5tly met ) 9 ! /oma*1 ! inte/9es1 & ! p]io/eum2 & c appe> at any age1 b is mo/ common betwe5 ! ?irty-fif? & fiftie? ye>4 ,! tumor v>ies 9 size1 f ! size ( a m>ble to an adult head1 is globul> or irregul> 9 %ape1 ( a firm1 d5se consi/5ce1 ) a r\gh1 knobby1 or di/9ctly lobulat$ surface4 ,! /roma1 ( a fibr\s "*1 ( a dull1 :iti%1 grayi%1 or pale-yell[i% color1 & great d5sity1 is s arrang$ z to =m num]\s alveoli ( v>i\s sizes & %apes1 communicat+ ) ea* o!r4 ,)9 ^! cavities is conta9$ ! gelat9\s or colloid mat]ial1 :i* is a gli/5+1 :iti%1 gre5i%1 or yell[i% color1 & ( ! consi/5ce ( ?9 mucilage or ord9>y jelly4 ,9 ! old] cells x becomes m firm & opaque4 8,9 ! ma91 x is p]fectly /ructureless2 )9 x1 h[ev]1 are imb$d$ a v>y+ numb] ( sph]ical cells1 :i* also conta9 ! same gelat9\s sub/ance4 ,^! cells pres5t a peculi> appe>ance2 !y are l>ge & sph]ical 9 %ape1 & are di/5d$ ) drops ( ! same gelat9\s mat]ial z t 9 :i* !y are imb$d$4 ,_m ( !m display a lamell> surface1 _! b\nd>y consi/+ ( conc5tric l9es40 7e47 ,epi!lioma4 ,epi!lioma1 cancroid1 or epi!lial canc]1 gr[s 9 connection ) cutane\s & muc\s surfaces4 ,! cells1 usually conta9+ a s+le nucleus1 resemble v closely ^? met ) 9 ! cutane\s surfaces1 & 9 ! muc\s membrane ( ! m\?1 only t !y are l>g]1 _! av]age be+ ab\t ( an in*4 ,9 %ape !y are ei!r r\nd$1 oval1 angul>1 or elongat$1 accord+ to ! pressure to :i*1 9 _! gr[?1 !y are subject$4 ,!y are closely pack$ toge!r into ne/s1 assum+ a conc5tric arrangem5t1 l ! lay]s ( an onion4 ,mix$ up ) ! cells1 especially if ! gr[? h made mu* progress1 are great numb]s ( free nuclei & granules1 & sometimes also cry/als ( *ole/]9e1 pigm5t cells & blood corpuscles4 8,! tumor itself is firm 9 consi/5ce1 m or less friable1 & on section pres5ts a grayi%-:ite granul> surface1 int]sect$ ) l9es ( fibr\s tissue4 ,! cut surface yields on pressure1 a small quantity ( turbid fluid1 & 9 mo/ cases also a peculi> ?ick1 crumbl+1 curdy mat]ial1 c be express$1 :i* comes out 9 a worm-l %ape1 l ! sebace\s matt] f ! gl&s ( ! sk940 ,! ulc] =m$ has a f\l1 fungat+ appe>ance1 ) irregul> granulat$ edges1 & a h>d r\gh base4 ,! disease is m common 9 m5 ?an wom51 & seldom occurs be=e ! age ( ?irty-five or =ty4 ,x is mo/ frequ5tly met ) 9 ! l[] lip1 9 ! tongue1 prepuce1 scrotum1 78*imney-sweep's canc]107 labia1 eyelids1 *eeks1 9 ! ut]us & bladd]4 ,z x ext5ds x may involve any tissue4 ,,*apt] ,,iv4 ,,po/-,,mortem ,,appe>ances ,,9 ,,dea? ,,f ,,unnatural ,,causes4 #a4 ,dea? f ,poison+4 ,9 speak+ ( ! lesions produc$ by poison+1 we w conf9e our att5tion to ! m common poison\s sub/ances :i* are giv51 or tak51 ei!r int5tionally or by accid5t1 & :i* may result 9 dea?4 ,sulphuric ,acid4 ,dea? f poison+ ) ?is acid1 commonly results 9 f twelve h\rs to ?ree days1 b sometimes life is prolong$ = a week or a =tnight1 or = mon?s1 & sometimes dea? may take place 9 an h\r4 ,! morbid appe>ances met ) w v>y accord+ to ! quantity ( ! acid tak51 & ! mann] ( its adm9i/ration4 ,! appe>ances are 9 g5]al z foll[s3 ,on ! lips1 f+]s1 or o!r p>ts ( ! sk91 spots & /reaks ( a br[ni%1 or yell[i%-br[n color are met )1 :]e ! acid has disorganiz$ ! cuticle4 ,! muc\s membrane ( ! tongue & fauces is :ite2 ! ph>ynx is only 9 ! r>e/ cases c>boniz$ l ! /oma*1 is g5]ally h>d to cut1 z if tann$1 & ( a gray color2 ! vascul> injections ( its muc\s membrane may be recogniz$4 ,! rima glottidis is sometimes contract$1 ! epiglottis swell$1 & ! comm5cem5t ( ! l>ynx inflam$4 ,! sophageal membrane is (t5 completely deta*$1 or comes (f 9 %r$s2 & ! passage %[s traces ( ! corrod+ effects ( ! poison4 ,! out] surface ( ! abdom9al visc]a is commonly ei!r v vascul> or livid4 ,! /oma*1 if n p]=at$1 is commonly di/5d$ ) gases1 & conta9s a quantity ( yell[i%-br[n or black matt]1 & is sometimes l9$ ) a ?ick pa/e1 compos$ ( disorganiz$ tissue1 blood & mucus4 ,! pylorus is contract$4 ,if ! acid has be5 tak5 dilut$1 ! muc\s membrane is m]ely excessively inject$1 ) blackness ( ! vessels1 & usually a s(t5+ ( ! rug1 or actual removal ( ! vill\s coat4 ,if ! /oma* be p]=at$1 ! holes are commonly r\ndi%1 ) ?91 color$ & dis9tegrat$ m>g9s1 & surr\nd$ by vascul>ity & black extravasations4 ,! inn] coat ( ! duod5um (t5 pres5ts appe>ances closely resembl+ ^? notic$ 9 ! /oma*4 ,sometimes1 especially 9 cases :i* are rapidly fatal1 x is n at all affect$1 probably ow+ to ! spasmodic contraction ( ! pyloric orifice4 ,! ur9>y bladd] is commonly empty4 ,! blood is ?ick5$1 & ( an acid reaction4 ,nitric ,acid4 ,! appe>ances obs]v$ 9 cases ( poison+ by ?is acid1 are simil> to ^? notic$ "u sulphuric acid4 ,a diff]5ce ( t9t 9 ! color produc$ by nitric acid on ! sk91 lips & muc\s l9+ ( ! m\? & sophagus1 be+ ! only di/+ui%+ m>k4 ,:]eas 9 ! case ( sulphuric acid ! color is br[ni%1 9 ! case ( nitric acid1 x is mo/ frequ5tly yell[4 ,oxalic ,acid4 ,?is is a poison ( great en]gy1 & s m frequ5tly us$ = committ+ suicide ?an = purposes ( murd]4 ,x has (t5 be5 tak5 by accid5t = ,epsom salt1 7sulphate ( magnesia17 :i* x greatly resembles 9 g5]al appe>ance4 ,x is ! mo/ rapid & un]r+ ( all ! common poisons1 & produces dea? g5]ally )9 an h\r1 al?\gh a l>ge dose may prove fatal 9 two or ?ree m9utes1 & a small] "o may be surviv$ = z long z tw5ty-?ree days4 ,! muc\s membrane ( ! ?roat & sophagus look z if scald$1 & c easily be scrap$ (f4 ,! /oma* conta9s a ?ick fluid1 commonly d>k1 l c(fee-gr\nds4 ,! inn] coat ( ! /oma* is pulpy1 9 "s po9ts black1 9 o!rs r$4 ,! muc\s membrane ( ! inte/9es is usually simil>ly1 b less viol5tly affect$4 ,9 "s cases1 ! /oma* & inte/9es h be5 f\nd heal?y4 ,phosphorus4 ,?is sub/ance has frequ5tly1 9 ! =m ( heads ( lucif] mat*es1 be5 ! cause ( dea?2 m frequ5tly tak5 by accid5t1 or ) ! int5tion ( committ+ suicide1 ?an ) ! design ( de/roy+ ! lives ( o!rs4 ,! symptoms ( phosphorus poison+ v>y dur+ life1 & aft] dea? ! morbid appe>ances are n con/ant1 dep5d+ mu* ^u ! l5g? ( "t t has elaps$ be=e dea?4 ,9 cases :i* h prov$ rapidly fatal1 ! ma9 appe>ances are ^? ( irritation1 some:at simil> to ^? already describ$1 & due to ! direct action ( ! poison4 ,9 m protract$ cases !re is g5]ally jaundice1 ! blood is f\nd 9 a /ate ( complete fluidity1 non-coagulable1 & ) v few corpuscles1 :ile ec*ymoses & sangu9e\s effusions appe> ev]y:]e4 ,sometimes ! /oma* is di/5d$ ) gas1 :i* /9ks ( g>lic4 ,! muc\s membrane is p>tly a%-color$1 p>tly ( a d>k1 purpli%-r$1 & exhibits gangr5\s ulc]s :i* p5etrate deeply into ! muscul> coat4 ,9 rec5t cases1 ! :ole cont5ts ( ! /oma* %9e 9 ! d>k1 especially :5 g5tly w>m$4 ,! liv] is greatly alt]$1 an acute fatty deg5]ation is f\nd to h tak5 place 9 its secret+ /ructure4 ,! ac9i are sometimes f\nd fill$ ) fat1 ev5 to bur/+2 b m commonly !y are :olly de/roy$1 & oil & fat globules fill _! place4 ,! secret+ /ructures ( ! kidneys are also f\nd 9 a /ate ( fatty deg5]ation1 & ! ducts are sometimes fill$ ) exudation matt]4 ,! he>t & ! muscles g5]ally also %[ signs ( ! same fatty deg5]ation4 ,ars5ic4 ,?is is ! poison mo/ frequ5tly *os5 = ! purpose ( committ+ bo? suicide & murd]4 ,ars5ic produces two classes ( ph5om5a1 "o is purely irritant1 by virtue ( :i* x induces inflammation 9 ! alim5t>y canal & else:]e2 & ! o!r consi/s 9 a disord] ( p>ts ( organs remote f ! seat ( its application4 ,x is absorb$ by ! blood1 :i* 9 mo/ cases ( acute poison+1 is f\nd 9 a rem>kable /ate ( fluidity1 & c be detect$ 9 ! liv]1 ! sple51 & 9 ! ur9e4 ,x acts ) ne>ly ! same en]gy1 :atev] be ! organ or tissue to :i* x is appli$4 ,f two to ?ree gra9s h prov$ fatal1 b an in/ance is record$ ( recov]y aft] a dose ( sixty gra9s4 ,dea? may ensue 9 half an h\r1 or may be delay$ = ne>ly ?ree weeks2 ! usual "t is p]haps f twelve to =ty-eight h\rs4 ,!re are "s cases 9 :i* little or no morbid appe>ances are to be se54 ,usually1 h[ev]1 traces ( irritation w be discov]able4 ,9 ! m\? & ?roat !y are (t5 want+4 ,! inn] surface ( ! /oma* may be r$ & inflam$1 or blacki% f ! extravasation ( blood1 or s(t5$1 or 9 "s cases ?ick5$1 ) ! rug rais$ & corrugat$4 ,ulc]ation ( ! coats ( ! /oma* is b r>ely met )1 unless ! pati5t h surviv$ ne>ly two days4 ,! muc\s secretion is g5]ally increas$ 9 quantity1 sometimes ?91 & viscid1 z 9 its natural /ate1 b sometimes solid1 z if coagulat$4 ,9 ! latt] case1 x =ms ei!r a uni=mly atta*$ p$icle1 or loose %r$s float+ among ! cont5ts4 ,a v common appe>ance1 is ! pres5ce ( a sangu9ol5t fluid1 or ev5 actual blood 9 ! cavity ( ! /oma*4 ,! poison itself may also be f\nd )9 ! /oma*4 ,! inte/9es may be conge/$ & inflam$ ?r\gh\t _! :ole l5g?1 b mo/ frequ5tly only 9 ! duod5um & rectum4 ,)9 ! *e/1 r$ness ( ! pleura1 r$ness & conge/ion ( ! lungs1 h be5 notic$4 ,9 g5]al1 ars5ic ret>ds ! process ( putrefaction aft] dea?4 ,! =ms 9 :i* ars5ic is mo/ frequ5tly us$ = ! purpose ( poison+1 are ars5i\s acid1 & ! ars5ite ( copp]1 ,s*eele's gre54 ,corrosive ,sublimate4 ,! appe>ances obs]v$ 9 ! bodies ( p]sons kill$ by ?is poison1 are v simil> to ^? excit$ by ! irritant poisons already notic$4 ,! m\? & ?roat are m frequ5tly affect$ ?an by ars5ic4 ,! tongue is (t5 %rivell$1 & ! papill at its root greatly enl>g$4 ,! muc\s membrane is swoll5 & :it5$4 ,! same appe>ances are g5]ally notic$ 9 ! sophagus4 ,! coats ( ! /oma* & inte/9es1 m p>ticul>ly ! colon & rectum1 h be5 f\nd conge/$ & inflam$1 & sometimes de/roy$1 ei!r by a *emical decomposition ( ! tissues1 or by ulc]ation4 ,! bladd] is (t5 excessively contract$2 ! kidneys usually mu* conge/$ & inflam$4 ,inflammation ( ! p]itoneum1 & effusion into its sac are frequ5t results ( poison+ ) corrosive sublimate4 ,hydrocyanic ,acid4 ,! poisons ^: en]gy dep5ds ^u ! pres5ce ( ?is acid1 surpass almo/ all o!rs 9 rapidity ( action1 & ! m9ut5ess ( ! quantity 9 :i* !y op]ate4 ,! lesions produc$ are unc]ta94 ,! sp9e & neck are /iff1 ! abdom5 retract$1 ! sk9 usually livid4 ,! body1 g5]ally ! blood1 s]\s cavities1 /oma* & ! v>i\s tissues usually exhale1 = "s "t aft] dea?1 ! *>act]i/ic odor ( ! acid4 ,turgesc5ce ( ! v5\s sy/em1 & empt9ess ( ! art]ial sy/em1 are commonly rem>k$ ?r\gh\t ! body4 ,! /oma* & inte/9es are conge/$ & r$4 ,! liv] & lungs are gorg$ ) blood4 ,/ry*nia--,nux vomica4 ,9 poison+ ) ?is sub/ance1 ! rigidity ( ! body :i* exi/s dur+ life1 is frequ5tly reta9$ = h\rs aft] dea?4 ,!re is conge/ion ( ! membranes ( ! bra9 & sp9al cord4 ,! /oma* is frequ5tly q natural 9 appe>ance1 z also ! inte/9es1 al?\gh occasionally signs ( irritation are notic$ 9 bo?4 ,alcohol4 ,9 dea? f alcohol1 ! body is sl[ to putrify1 & ! int]nal organs exhale no cadav]ic odor1 b r t ( rec5t fle%1 or 9 "s cases a fa9t odor ( br&y4 ,! appe>ances con/antly f\nd are1 hyp]mia ( ! bra91 sometimes c]ebral hmorrhage2 hyp]mia ( ! l>ge abdom9al ve9s1 or hyp]mia ( ! lungs & he>t1 & always visible fluidity & d>k color ( ! blood4 ,c>bonic ,oxide4 ,?is is ! poison\s +r$i5t ( illum9at+ gas1 & is g5]at$ by burn+ *>coal4 ,x is usually 9 "o ( ^! =ms t x is ! cause ( dea?4 ,! mo/ *>act]i/ic appe>ance aft] dea?1 is ! bright *]ry-r$ color ( ! he>t4 ,!re is1 also1 hyp]mia ( ! lungs & ( ! "r side ( ! he>t4 ,opium4 ,9 cases ( dea? f ?is sub/ance1 lividity ( ! sk9 is usually pres5t4 ,turgesc5ce ( ! vessels ( ! bra91 & wat]y effusion into ! v5tricles are g5]ally met )4 ,! lungs are sometimes f\nd gorg$ ) blood4 ,! /oma* is occasionally r$1 b decid$ inflammation is r>e4 ,! blood is always fluid1 & ! body is apt to pass rapidly into putrefaction4 #b4 ,dea? f ,suffocation4 ,by suffocation is meant t condition 9 :i* ! sy/em is prev5t$ f receiv+ ! necess>y am\nt ( oxyg5 ?r\gh ! lungs4 ,! t]m is g5]ally re/rict$ to a condition aris+ f ! ob/ruction ( ! air passages1 ei!r int]nally1 or f )\t1 or f ! brea?+ ( irrespirable gases4 7,! latt] =m be+ att5d$ also by blood-poison+1 :i* we h already notic$47 ,! appe>ances notic$ are ! foll[+3 ,! face may be m or less blui%-r$1 swoll51 ) protrud+ eyes1 or diff]+ 9 no respect f t obs]v$ aft] o!r k9ds ( dea?4 ,fro? is (t5 obs]v$ com+ out ( ! m\?4 ,!re is a univ]sal & unusual fluidity & d>k color ( ! blood4 ,hyp]mia ( ! "r side ( ! he>t1 :ile ! left is ei!r entirely empty or conta9s only a few dra*ms ( blood1 hyp]mia ( ! lungs & conge/ion ( ! pulmon>y art]y1 are seldom want+4 ,9 ! case ( new-born *ildr51 ,casp> has notic$ capill>y ec*ymoses1 resembl+ pete*i1 b5ea? ! pulmon>y pleura1 ^u ! aorta1 or ! surface ( ! he>t1 & ev5 ^u ! diaphragm1 :i* gives ! p>ts a spott$ appe>ance4 ,! muc\s membrane ( ! l>ynx & tra*ea are m or less inject$1 ( a c9nab>-r$1 ei!r 9 pat*es or uni=mly ov] ! :ole surface4 ,a deposit ( soot ^u ! tra*eal membrane1 po9ts to suffocation 9 smoke4 ,!re is usually pres5t 9 ! tra*ea a great] or less am\nt ( fluid1 consi/+ ( a mixture ( air1 mucus1 & blood1 9 ! =m ( fro?y vesicles1 or colorless1 or bloody foam4 ,! m gradual ! suffocation has be51 ! great] ! quantity ( ?is fluid4 ,x may exi/ also 9 ! bron*ial tubes1 & c be =c$ out by c>eful pressure on ! lungs4 ,=eign bodies ( e k9d may be f\nd 9 ! tra*ea4 ,we f9d also z second>y results ( ! =ego+1 hyp]mia ( ! abdom9al & cranial organs4 #c4 ,dea? f ,hang+1 ,?rottl+ & ,/rangl+4 ,9 ^! cases1 dea? may result f simple c]ebral conge/ion 7apoplexy71 f simple conge/ion ( ! ?oracic organs 7c>diac or pulmon>y apoplexy71 f a comb9ation ( ! two 7apoplexy & asphyxia71 or1 z is v frequ5tly ! case1 f neuro-p>alysis 7n]v\s apoplexy74 ,! int]nal appe>ances w !re=e v>y1 or1 z 9 ! la/ case1 no lesions c be detect$4 ,! face may 9 "s cases be livid1 ) protrud+ eyes & tongue2 b 9 _m cases ! c\nt5ance is l t ( any o!r corpse4 ,turgesc5ce ( ! male & ev5 ( ! female g5itals has be5 notic$ 9 "s cases4 ,! m>k ( ! cord ab\t ! neck may be want+1 & is ne>ly always m or less int]rupt$1 & pres5ts _m v>ieties ( appe>ance4 ,x maybe ( a dirty1 yell[i%-br[n color1 cutt+ h>d & lea!ry2 or ( a bright blue or dirty-r$di% color1 s(t to cut2 or x may h little or no color1 & also s(t to cut4 ,pat*es ( excoriation are also sometimes visible1 if ! cord h be5 h>d & r\gh4 ,a simil> m>k ( ! cord may be produc$ aft] dea?4 ,9 cases ( ?rottl+1 ! m>ks ( f+]s may (t5 be recogniz$1 z r\nd or semi-circul>1 or p]fectly irregul> pat*es1 ( a dirty1 br[ni%-yell[ color1 h>d to cut1 & n ec*ymos$4 ,r>ely !y are ( a dirty-blui% color & ec*ymos$4 #d4 ,dea? f ,dr[n+4 ,physiologically consid]$1 dea? f dr[n+ is to be reg>d$ z id5tical ) dea? f asphyxia or /rangl+1 & h5ce ! results ( ! dissection1 d n diff] f ^? j m5tion$4 ,^? dr[n$ may die f c]ebral hyp]mia1 ! r>e/ =m2 f pulmon>y hyp]mia2 f bo? comb9$2 or f neuro-p>alysis4 ,dea? f hyp]mia ( ! ?oracic organs1 & dea? f p>alysis1 are ( almo/ equal frequ5cy 9 cases ( dr[n+4 ,! c\nt5ance is pale1 9 mo/ cases n swoll51 ! eyes %ut1 & :5 asphyxia has be5 ! cause ( dea?1 !re is commonly fro? ov] ! m\?4 ,if ! body has be5 9 ! wat] = two or ?ree days 9 summ]1 or eight to t5 9 w9t]1 ! face is r r$di%1 or blui%-r$--! comm5cem5t ( putrefaction1 :i* 9 bodies 9 wat]1 beg9s 9 ! head & ext5ds f above d[nw>ds1 & n 9 ! abdom9al cov]+s4 ,an almo/ con/ant appe>ance is ! cutis ans]9a1 a ph5om5on entirely indep5d5t ( ! temp]ature ( ! wat] 9 :i* ! p]son has be5 dr[n$4 ,! h&s & feet h a livid1 grayi%-blue color1 & ! sk9 is corrugat$ 9 longitud9al folds1 provid$ ! body has n be5 tak5 out ( ! wat] )9 ab\t eight h\rs aft] dea?4 ,s&1 gravel1 mud1 etc41 are (t5 f\nd "u ! f+]-nails4 ,contraction ( ! p5is & scrotum 9 m5 :o h fall5 into ! wat] alive1 is an almo/ con/ant appe>ance4 ,! lungs are greatly increas$ 9 volume1 completely fill & di/5d ! cavity ( ! *e/1 & are n firm & crepitat+ l heal?y lungs1 b feel l sponge4 ,! tra*ea & l>ge bron*ial tubes are frequ5tly fill$ ) fro?y mucus4 ,! spasmodic closure ( ! glottis1 w prev5t ! entrance ( wat] into ! lungs :ile life cont9ues1 b aft] dea? x may ent] 9 small quantities4 ,9 ! /oma* is (t5 f\nd "s ( ! fluid 9 :i* ! dr[n+ has tak5 place4 ,,*apt] ,v4 ,,m$ico-,,legal ,,que/ions4 #a4 ,me?od ( ,conduct+ a ,m$ico-,legal ,autopsy4 ,9 mak+ m$ico-legal exam9ations ( human bodies1 ! greate/ c>e mu/ be tak5 n to omit ! exam9ation & record+ ( any ( ! appe>ances pres5t$2 s9ce a po9t trifl+ 9 itself1 may1 9 ! c\rse ( ! subsequ5t legal process1 prove ( great importance4 ,x may sometimes be necess>y = ! physician to exam9e ! exact spot & ! locality 9 :i* ! body has be5 f\nd1 to asc]ta9 ! position 9 :i* x 0 discov]$1 etc41 & also to inspect ! clo?+4 ,9 cases ( suspect$ poison+1 ! utmo/ precautions are to be us$ 9 mak+ ! autopsy4 ,all ! visc]a are to be c>efully exam9$1 & ! /oma* & inte/9es1 ) _! cont5ts1 are to be remov$ 9 ! mann] already describ$4 ,!y are !n to be op5$1 exam9$ 9 sep>ate vessels1 ei!r entirely new1 or ?or\ghly cleans$ imm$iately be=e be+ made use (4 ,aft] a c>eful exam9ation1 !y are to be plac$ 9 p]fectly clean or new glass j>s1 )\t ! addition ( any =eign sub/ance2 ! j>s are !n to be securely cork$ & labell$1 & h&$ ov] to ! *emi/ = analysis4 ,%\ld ! j>s h to rema9 any "t 9 ! h&s ( ! physician1 !y are to be kept "u lock & key1 9 "s place to :i* none b himself has access4 ,portions ( o!r organs1 especially ( ! liv]1 sple51 kidneys & bra91 %\ld also be pres]v$ ) ! same c>e = future analysis4 ,! results ( ! exam9ation are to be tak5 d[n on ! spot1 by an assi/ant1 9 ink1 & aft] hav+ be5 read ?r\gh by ! physician at ! close ( ! exam9ation1 are to be sign$ by him4 ,all ^! precautions w be f\nd ( great value1 9 sav+ f innum]able petty annoyances1 at ! h&s ( ! 8le>n$ memb]s ( ! b>10 if ! case %\ld be br\ght be=e c\rt4 ,9 ! ext]nal inspection ( ! body1 we %\ld notice3 #a4 ,! ,sex4 ,ev5 aft] ! ext]nal p>ts ( g5]ation h be5 completely de/roy$1 ! sex may /ill be asc]ta9$ by a ref]5ce to ! gr[? ( hair ar\nd ^! p>ts4 ,a circumscrib$ arc ( hair on ! mons v5]is1 is di/9ctive ( ! female1 :ile its prolongation1 h[ev] slight1 f ?is po9t t[>ds ! umbilicus1 m>ks ! male4 #b4 ,! ,age4 ,9 ! case ( kn[n bodies ?is is n ( any importance1 9 unkn[n bodies x is1 h[ev]1 necess>y4 ,! physician c only conjecture f appe>ances1 :i*1 ev5 9 ! liv+ body1 are v deceptive1 & he w d well1 !re=e1 to all[ tol]ably wide limits to ?is conjecture4 #c4 ,! ,size4 ,! l5g? ( ! body mu/ be asc]ta9$ by actual measurem5t 9 a /raight l9e1 f ! cr[n ( ! head to ! sole ( ! heel4 #d4 ,! ,g5]al ,condition ( ! ,body4 ,lean or fat1 etc4 #e4 ,color & ,condition ( ! ,hair4 #f4 ,color ( ! ,eyes1 if /ill recognizable4 #g4 ,numb] & ,condition ( ! ,tee?4 ,9 ! case ( unkn[n bodies1 an accurate description is always advisable1 ) a view to future id5tification4 #h4 ,special ,m>ks or ,de=mities4 ,sc>s1 tattoo-m>ks1 excess or defects ( limbs1 m>ks ( disease1 z ulc]s1 etc41 %\ld all be accurately not$4 #i4 ,injuries or ,w\nds1 :i* appe> to h be5 ! cause ( dea?1 %\ld be c>efully describ$4 ,9 ! case ( w\nds1 _! position & direction ) ref]5ce to ! neighbor+ fix$ po9ts ( ! body1 & _! exact l5g? & bread?1 mu/ be record$4 #aj4 ,( ! ,body itself1 ! p>ts des]v+ ( p>ticul> exam9ation are ! natural op5+s ( ! e>s1 nose1 m\?1 anus & female g5itals2 ! neck & ! h&s4 ,9 ! int]nal exam9ation or dissection1 ! ?ree great cavities--! head1 ?orax & abdom5--%\ld all be op5$4 ,9 "s cases1 x may be important to op5 also ! sp9al canal4 ,! fir/ ?+ to be obs]v$ on op5+ ea* ( ^! cavities1 is ! position ( ! organs !y conta92 next1 :e!r !re be any fluid effusions pres5t2 & la/ly1 ! ext]nal & int]nal appe>ance ( ea* sep>ate organ4 ,9 e case1 t cavity %\ld be op5$ fir/1 9 :i* !re is ! greate/ probability ( f9d+ ! cause ( dea?4 ,9 ! case ( new-born *ildr51 h[ev]1 ! abdom5 mu/ be fir/ op5$ 9 ord] t ! natural position ( ! diaphragm may be obs]v$ undi/urb$4 ,9 exam9+ ! base ( ! skull = injuries1 we mu/ n omit to remove ! p]io/eum1 :i* might o!rwise conceal small fissures4 ,9 exam9+ ! ?oracic organs1 if x be p>ticul>ly desir$ to obs]ve ! am\nt ( blood conta9$ 9 !m1 & we d n wi% to apply ligatures1 we exam9e ! he>t fir/1 leav+ x 9 its natural horizontal position1 & op5+ x by a lat]al longitud9al incision on bo? sides4 ,?is gives u a di/9ct idea ( ! actual am\nt ( blood 9 all ! c>diac cavities4 ,! lungs are next cut into1 & la/ ( all ! l>ge blood-vessels4 ,?is proc$ure is to be foll[$1 e4 g41 9 cases ( suffocation1 :]e x is ( p>ticul> importance to det]m9e ! am\nt ( blood 9 ^! organs1 & :]e ! blood is peculi>ly fluid4 ,9 det]m9+ ! am\nt ( blood 9 ! v5\s trunks1 x w be suffici5t to exam9e ! v5a cava asc5d5s4 ,9 p5etrat+ w\nds1 ! w\nd is ( c\rse to be exam9$ z f> z possible be=e di/urb+ any ( ! organs4 ,! result ( ! ext]nal & int]nal exam9ations1 ?us ?or\ghly conduct$1 are to be not$ d[n at ! "t1 & are n to be tru/$ to memory4 ,x is ( ! utmo/ importance t ?is rule be obs]v$4 ,9 pres5t+ a writt5 or v]bal report be=e c\rt1 ! physician %\ld be c>eful to furni% m]ely a description ( ! po/-mortem appe>ances1 & n to give an op9ion z to _! probable or possible cause or causes1 unless call$ ^u to d s4 ,he %\ld also avoid prolixity &1 z mu* z possible1 ! use ( te*nical t]ms1 un9telligible to nonpr(essionals4 ,8 answ]s to direct que/ions %\ld be concise & decid$ if possible1 b :]e ?is is n possible1 he %\ld n hesitate to /ate t ! dissection has n af=d$ him any facts :i* c\ld enable him to give a positive answ]4 #b4 ,que/ions relat+ to ,new-,born ,*ildr54 ,! body ( a dead infant is f\nd1 & ! physician may be call$ ^u to answ] ! foll[+ que/ions1 "o or all3--,0 ! *ild mature8 ,0 x born alive8 ,if s1 :at 0 ! cause ( its dea?8 ,0 ! *ild mature8 ,among ! v>i\s signs ( ftal maturity1 su* z ! firm1 t5se sk91 ( ! usual pale corpse-color1 ! hair ^u ! head1 ! weight & l5g? ( ! body1 ! diamet]s ( ! head1 %\ld]s & hips1 ! horny nails rea*+ to ! tips ( ! f+]s1 ! abs5ce ( ! pupill>y membrane1 etc41 ! mo/ infallible1 is ! pres5ce ( ! c5tre ( ossification ( ! inf]ior femoral epiphysis4 8,! easie/ way to f9d ?is1 is to make a horizontal incision ?r\gh ! sk9 & sup]ficial tissues ov] ! knee-jo9t d[n to ! c>tilages4 ,! patella is !n to be remov$1 & ! end ( ! femur made to protrude ?r\gh ! incision4 ,?9 horizontal sections are !n to be remov$ f ! c>tilag9\s epiphysis1 at fir/ m boldly1 b s soon z a color$ po9t is obs]v$ 9 ! la/ section1 !n v c>efully1 lay] by lay]1 till ! greate/ diamet] ( ! osse\s nucleus is atta9$4 ,?is appe>s to ! nak$ eye z a m or less circul> bright blood-r$ spot 9 ! mid/ ( ! milk :ite c>tilage1 9 :i* vascul> convolutions c be di/9ctly recogniz$40 ,:5 !re is no visible trace ( ?is c5tre ( ossification1 ! ftus c be no m ?an f ?irty-six to ?irty-sev5 weeks old4 ,9 /ill-born *ildr51 ! comm5cem5t ( ?is nucleus indicates a ftal age ( ?irty-sev5 to ?irty-eight weeks2 :5 x possesses a diamet] ( f ?ree-qu>t]s to ?ree l9es1 x %[s ! ftus mu/ h atta9$ a ut]9e age ( =ty weeks4 ,:5 ! osse\s nucleus measures m ?an ?ree l9es1 we may conclude t ! *ild has liv$ aft] bir?4 ,isolat$ exceptions are occasionally met )1 :51 h[ev]1 concomitant appe>ances1 su* z1 9 ! "o case1 defective ossification ( ! skull1 or 9 ! o!r1 peculi>ly advanc$ developm5t1 w gu>d u aga9/ mi/akes4 ,0 ! *ild born alive8 or1 ,did x live dur+ & aft] its bir?8 &1 ,if s1 h[ long8 ,^! que/ions are intimately connect$1 & 9 ord] to be able to answ] !m1 we mu/ 9 our exam9ation note ! foll[+ po9ts3 ,! position ( ! diaphragm1 is a good diagno/ic sign4 ,! diaphragm w necess>ily be high] :]e !re has be5 no respiration1 natural or artificial1 ?an :]e ! *ild has actually brea!d4 8,its position is mo/ easily asc]ta9$ by mak+ a longitud9al incision ?r\gh ! sk9 & sup]ficial cellul> tissue1 f ! *9 to ! pubis1 9 ! mesial l9e1 dissect+ ^! f ! ?orax on bo? sides1 next c>efully op5+ ! abdom9al cavity1 introduc+ ! f+] ( "o h& into x1 & press+ x up to ! highe/ po9t ( ! concavity ( ! diaphragm1 & !n ) "o f+] ( ! o!r h& reckon+ (f ! int]co/al spaces f above d[nw>ds till bo? f+]s correspond4 ,! rule is1 t ! highe/ po9t ( ! concavity ( ! diaphragm 9 *ildr5 born dead1 is betwe5 ! f\r? & fif? ribs1 & 9 ^? born alive1 betwe5 ! fif? & six?40 ,:]e respiration has be5 b transitory1 ! diaphragm w rema9 v ne>ly 9 its ftal position4 ,! lungs1 f ly+ q po/]iorly 9 ! ftus1 come to fill ! cavity ( ! *e/1 ! m p]fectly respiration has be5 e/abli%$4 ,9 ! ftus1 ! left lung is nev] f\nd ev5 p>tially cov]+ ! he>t4 ,:]e respiration has be5 b transitory & imp]fect1 ! volume ( ! lungs w n be mu* increas$4 ,! pres5ce ( d>k blui%-r$1 insul> pat*es 9 ! lungs1 no matt] :at may be _! gr\nd color1 proves t respiration has tak5 place4 ,! crepitant spongy consi/5ce ( ! lungs ( a live-born *ild1 is readily di/+ui%$ f ! compact1 resi/5t liv]-l lungs ( "o /ill-born4 ,! hydro/atic te/ = ! pres5ce ( air 9 ! lungs1 is ( all1 ! sure/ = decid+ :e!r respiration has tak5 place4 ,! vessel us$ %\ld be at lea/ "o foot 9 dep?1 eight or t5 in*es 9 diamet]1 & fill$ ) pure cold wat]4 ,! buoyancy ( ! lungs dep5ds ^u ! great] or less complet5ess ) :i* ! pulmon>y tissue is p]meat$ by ! air4 ,only "o lung may float1 g5]ally ! "r "o1 or only s+le lobes1 or only a few pieces into :i* ! lung has be5 & mu/ be divid$1 9 ord] accurately to apply ! te/4 ,artificially inflat$ ftal lungs1 may be di/+ui%$ f ^? lungs :i* h respir$1 by ! pres5ce1 9 ! case ( ! latt]1 ( ! blui%-r$ mottl+ above ref]r$ to1 & ! escape ( bloody fro? :5 ! sub/ance ( ! lungs is cut into1 & slight pressure appli$4 ,! g5]al appe>ance ( putresc5ce 9 ! lungs1 w s]ve to di/+ui% ! buoyancy aris+ f ! gase\s products ( putrefaction1 f t due to respiration4 ,c>eful att5tion to ! =ego+ po9ts1 w enable u to answ] ) c]ta9ty :e!r ! *ild 0 born alive4 ,h[ long did ! *ild live aft] its bir?8 ,! "q c be approximately answ]$ ) ref]5ce to ! fir/ few days1 by att5tion to ! foll[+ po9ts3 ,if !re are no traces ( blood1 or ( t peculi> uncti\s sub/ance1 ! v]nix caseosa1 on ! body1 suffici5t "t mu/ h elaps$ s9ce its bir?1 to h af=d$ leisure & opportunity = cleans+ x4 ,! contraction ( ! umbilical art]ies 9 liv+ *ildr51 does n occur soon] ?an aft] eight or t5 h\rs4 ,! mummification ( ! cord comm5ces aft] two1 ?ree1 or ev5 f\r days1 & ! putrefaction only aft] a mu* long] "t4 ,mummification ( ! cord takes place z well aft] dea? z be=e1 b n 9 wat]1 nor 9 ! liquor amnii4 ,if ! umbilicus has already cicatriz$1 ! *ild mu/ be at lea/ five days old4 ,! /oma* imm$iately aft] bir?1 conta9s a small quantity ( q :ite1 transp>5t1 seldom some:at bloody1 inodor\s mucus1 v t\gh1 or a trifl+ quantity ( ! colorless liquor amnii4 ,if milk be f\nd1 x %[s t "s "t mu/ h elaps$ s9ce ! bir?4 ,9 ! l>ge inte/9es meconium is /ill to be f\nd1 two1 ?ree1 or ev5 f\r days aft] bir?4 ,! age ( a *ild1 evid5tly old] ?an five or six days1 c only be det]m9$ by g5]al appe>ances4 ,:at 0 ! cause ( dea?8 ,we w "h ref] only to ^? injuries & k9ds ( dea? z c only occur 9 new-born *ildr51 & to ^? po/-mortem appe>ances :i* might lead to error 9 reg>d to !m4 ,dur+ labor1 dea? to ! *ild may result f c]ebral hyp]mia1 or f injuries to ! cranium1 :i* are !n unatt5d$ by traces ( viol5ce on ! body1 & are frequ5tly due to imp]fect ossification ( ! bones1 detect$ by hold+ ! bones up to ! light aft] removal ( ! p]io/eum4 ,prolapse & pressure ( ! cord1 & coil+ ( ! cord ar\nd ! neck1 may produce all ! appe>ances ( dea? by suffocation4 ,! m>k ( ! cord runs un9t]rupt$ly r\nd ! neck1 is broad1 circul>ly depress$1 groov$1 nev] excoriat$1 & ev]y:]e q s(t4 ,a mummifi$1 p>*m5tlike1 unec*ymos$ depression1 ) or )\t excoriations1 po9ts to int5tional /rangulation4 ,subsequ5t to bir?1 ! *ild may h be5 kill$ by fall+ on its head on ! floor1 if ! bir? has be5 v rapid4 ,! probable results ( su* a fall1 w\ld be rupture ( ! cord2 premature sep>ation ( ! plac5ta1 ) its consequ5ces2 concussion ( ! bra9 & hyp]mia1 or actual hmorrhage )9 ! skull2 & fracture ( ! skull bones4 ,! fractures are almo/ exclusively conf9$ to ! p>ietal bones1 "o or bo?1 *iefly 9 ! region ( ! v]tex4 ,comm9ut$ fracture ( sev]al bones ( ! skull1 speak aga9/ an accid5tal dea? by a fall4 ,! abs5ce ( any signs ( viol5t usage on o!r p>ts ( ! body1 or ab\t ! head1 ) simple fracture ( ! skull1 speaks = an accid5tal dea?4 ,! *ild may also h be5 suffocat$ by ! "m 9 viol5t attempts at self-deliv]y4 ,! visible signs ( ?is w consi/ m]ely ( scrat*es & nail-m>ks ^u ! face or neck4 ,v sev]e injuries are nev] produc$ 9 ?is way4 ,we mu/ be c>eful n to mi/ake ! common blood-coagulum usually f\nd "u ! aponeurosis on ! *ild's head = ! result ( viol5ce2 nor ! folds ( ! sk91 9 fat *ildr5 p>ticul>ly 9 w9t]1 produc$ by ! movem5ts ( ! head1 & :i* rema9 /rongly m>k$ 9 ! solidifi$ fat1 = ! m>k left by ! cord 9 a case ( actual /rangulation4 #c4 ,suppos$ ,p]iod ( ,dea?4 ,! answ] to ! "q z to ! probable "t ( dea?1 is (t5 ( ! utmo/ importance4 ,to be able to det]m9e ?is1 we mu/ h reg>d to ! v>i\s appe>ances foll[+ dea?1 previ\s to putrefaction1 & to ! *ronological succession ( ! ph5om5a ( ext]nal & int]nal putresc5ce4 ,a4 ,signs ( ,dea? previ\s to ,putrefaction4 ,respiration & circulation h entirely ceas$4 ,! eyes h lo/ _! lu/re4 ,!re is no vital reaction to /imulants4 ,! body gr[s a%y-:ite4 ,a p>ticul>ly florid complexion may reta9 its color = "s days aft] dea?4 ,nei!r ! r$ or livid edges ( ulc]s1 nor r$1 black or blue tattoo-m>ks disappe> aft] dea?4 ,an ict]ic hue exi/+ at dea? nev] becomes :ite1 & ec*ymoses reta9 9 e case1 ! hue !y _h at ! "t ( dea?4 ,mo/ bodies become q cold 9 f eight to twelve h\rs4 ,fat bodies & ^? ( p]sons kill$ by lightn+1 or by suffocation1 reta9 ! heat long] ?an o!rs2 9 wat]1 bodies cool rapidly4 ,a g5]al relaxation ( ! muscul> sy/em occurs imm$iately aft] dea?4 ,a body pres5t+ only ! above signs1 has be5 dead f eight to twelve h\rs at ! longe/4 ,9 f twelve to eighte5 h\rs ! eye-balls become s(t & inela/ic1 & feel flaccid4 ,! muscles on ^? p>ts ( ! body on :i* x lies1 become flatt5$ by ! weight ( ! body4 ,9 f eight to twelve h\rs aft] dea?1 hypo/ases result+ f ! gravitation ( ! blood 9 ! capill>ies1 beg9 to =m on all ! dep5d+ p>ts ( ! body4 ,! mo/ important are ! ext]nal hypo/ases--= !y are liable to be conf\nd$ ) ec*ymoses1 & consequ5tly ) traces ( viol5ce committ$ previ\s to dea?4 ,an incision into ! discolor$ spot %\ld always be made1 :51 if x be an hypo/asis--a po/-mortem /a9--!re w be no escape ( effus$ fluid or coagulat$ blood1 z !re w be if x be an ec*ymosis1 ! result ( viol5ce previ\s to dea?4 ,! color ( ^! po/-mortem /a9s v>ies f a livid or copp]y-r$ to a r$di% blue4 ,!y are extremely irregul> 9 =m1 & are nev] elevat$ above ! surr\nd+ sk94 ,!y are =m$ aft] e k9d ( dea?4 ,int]nal hypo/ases occur 9 ! bra91 9 ! s9uses & ve9s ( ! pia mat] ( ! po/]ior hemisph]es1 ev5 aft] dea? f hmorrhage4 ,!y mu/ n be conf\nd$ ) c]ebral hyp]mia4 ,9 ! lungs1 hypo/ases are ( con/ant occurr5ce1 & are c>efully to be di/+ui%$ f ! signs ( ante-mortem pulmon>y conge/ion & pneumonia4 ,9 ! inte/9es & kidneys1 hypo/ases are also notic$4 ,9 ! he>t we f9d no hypo/asis1 b clots1 or 8c>diac polypi10 :i* are ! coagulat$ fibr9e ( ! blood1 =m$ 9 mo/ cases aft] dea?4 ,_! pres5ce proves t coagulation ( ! blood may take place aft] dea?4 ,! la/ sign ( ! e>lie/ /age ( dea? is ! rigor mortis4 ,x passes f above d[nw>ds1 beg9n+ on ! back ( ! neck & l[] jaw1 pass+ on into ! facial muscles1 ! front ( ! neck1 ! *e/1 ! upp] extremities1 & la/ ( all1 ! l[] extremities4 ,x beg9s v>i\sly aft] eight1 t51 or tw5ty h\rs1 & may la/ f "o to n9e days4 ,9 ! mature new-born infant x is feeble & v transitory4 ,a l[ temp]ature1 & ! exi/5ce ( alcoholization1 favor ! long duration ( cadav]ic rigidity4 ,a froz5 body is /iff z a bo>d f head to foot1 :]eas 9 rigor mortis ! extremities1 p>ticul>ly at ! elb[s & knees1 pres]ves a c]ta9 am\nt ( mobility4 ,a body 9 :i* only ! signs ?us f> m5tion$ are pres5t1 may be presum$ to h be5 dead f two to ?ree days at ! longe/4 ,b4 ,! ,process ( ,putrefaction4 ,! progress ( putrefaction is modifi$ by ! foll[+ conditions3 ,by age4 ,! bodies ( new-born *ildr5 putrefy m rapidly ?an o!rs2 ^? ( v ag$ p]sons mu* m sl[ly4 ,by ! condition ( ! body4 ,fat1 flabby & lymphatic corpses putrefy m quickly ?an lean ones1 = an abundance ( fluid is v favorable to decomposition4 ,by ! k9d ( dea?4 ,! process is rapid aft] dea? f exhau/+ diseases1 f injuries att5d$ ) mu* mutilation1 f suffocation1 f n>cotic poisons4 ,x is sl[] aft] sudd5 dea? 9 heal?y p]sons1 aft] dea? f poison+ ) phosphorus1 sulphuric acid & alcohol4 ,by ! access ( atmosph]ic air4 ,:atev] prev5ts ?is1 ret>ds decomposition4 ,?us1 bodies buri$ 9 ! e>?1 or ly+ 9 wat]1 or clo!d1 putrefy less rapidly ?an ^? expos$ to ! direct influ5ce ( ! air4 ,by ! quantity ( moi/ure1 :i* 9 addition to its own1 c & does rea* ! body f )\t4 ,! m moi/ure1 ! m rapid ! process4 ,by ! temp]ature ( ! air1 or ( ! wat] 9 :i* ! body is ly+4 8,at a tol]ably simil> av]age ( temp]ature1 ! degree ( putrefaction pres5t 9 a body aft] ly+ 9 ! op5 air1 = "o week 7or mon?71 corresponds to t f\nd 9 a body aft] ly+ 9 ! wat] = two weeks 7or mon?s71 or aft] ly+ 9 ! e>? 9 ! usual mann] = eight weeks 7or mon?s407 7,casp>47 ,9 bodies ly+ 9 ! air1 ext]nal putrefaction beg9s ) a gre5i% coloration ( ! abdom9al cov]+s1 9 f tw5ty-f\r to sev5ty-two h\rs aft] dea?1 accord+ to ! modify+ conditions j notic$4 7,9 bodies ly+ 9 wat]1 ! process ( putrefaction beg9s 9 ! face1 head z f> z ! e>s1 & ! upp] "p ( ! neck1 ) a livid1 blui% t+e1 rapidly becom+ a brick-r$1 & proce$s d[nw>ds 9 ! same relative mann] z ab\t to be describ$47 ,)9 ! same p]iod1 ! eye-ball becomes s(t1 yield+ to ! pressure ( ! f+]4 ,aft] ?ree to five days f ! p]iod ( dea?1 ! discoloration has spread ov] ! :ole abdom5 & ext]nal g5itals1 & spots make _! appe>ance on o!r p>ts4 ,9 f eight to t5 days ! discoloration has spread ov] ! :ole body1 & ! peculi> odor is develop$4 ,! abdom5 is di/5d$ ) gas2 ! cornea has fall5 9 & become concave4 ,! nails are /ill firm4 ,9 f\rte5 to tw5ty days aft] dea?1 ! :ole body is ( a bright-gre51 mix$ ) r$ & br[n4 ,! epid]mis is rais$ "h & !re 9 bli/]s1 & 9 o!r p>ts pat*es ( x are q /ripp$ (f4 ,maggots cov] ! body4 ,f ! cont9u$ developm5t ( gas1 ! :ole body is bloat$1 & has a gigantic appe>ance4 ,! nails are deta*$ at _! roots & lie loose1 & are easily sep>able4 ,! hair is loose & easily pull$ out4 ,s9ce ?is /age may cont9ue _m weeks or ev5 mon?s1 we _c di/+ui% a body 9 ?is /ate aft] "o mon?1 f "o 9 ! same condition aft] f ?ree to five mon?s4 ,aft] f f\r to six mon?s1 or soon] 9 ! case ( bodies t h la9 9 w>m & moi/ m$ia1 ! cavities ( ! body are op5$ by ! cont9u$ developm5t ( gas2 ! skull has sep>at$ f ! neck1 & ! bra9 has run out2 ! orbital cavities are empty2 all ! s(t p>ts h comm5c$ to break d[n into a s(t pulp1 or are p>tly already brok5 d[n & dissolv$1 leav+ entire bones expos$4 ,! bones ( ! extremities are (t5 sep>at$ by ! de/ruction ( ! fasci & ligam5ts4 ,no trace ( a physiognomy is disc]nible4 ,! d\btful sex ( ! deceas$ c only be det]m9$ f ! ext]nal peculi>ities ( =m1 or ! hair ab\t ! pubis1 or by ! pres5ce ( a ut]us1 :i* )/&s decomposition long] ?an any o!r s(t organ ( ! body4 ,int]nally1 ! process ( putrefaction beg9s 9 ! tra*ea & l>ynx4 ,! bra9 9 *ildr5 up to ! end ( ! fir/ ye>1 is next attack$4 ,next ! /oma*1 inte/9es & sple51 & !n ! om5tum & mes5t]y4 ,! liv] is usually compact & firm1 ev5 "s weeks aft] dea?4 ,putrefaction comm5ces on its convex surface4 ,! bra9 ( ! adult foll[s next 9 ! succession ( putrefy+ organs4 ,sev]al mon?s usually elapse be=e putrefaction ( ! he>t has advanc$ v f>4 ,9 ! lungs decomposition beg9s ab\t ! same "t z 9 ! he>t1 sometimes e>li]4 ,! kidneys1 ur9>y bladd]1 sophagus1 pancreas1 diaphragm & l>g] art]ial trunks !n succumb1 & la/ ( all ! ut]us4 #d4 ,! ,probable ,cause ( ,dea?4 ,al?\gh 9 g5]al1 a c>eful exam9ation ( a body f\nd dead1 w readily reveal ! true cause ( dea?1 yet in/ances frequ5tly occur :]e attempts at conceal+ x1 or peculi> circum/ances 9 connection ) ! dea?1 may r5d] ! task m difficult4 ,we conf9e ourselves "h to a brief notice ( "s ( ! m important po9ts to be kept 9 view1 9 rightly e/imat+ ! relative value ( po/-mortem appe>ances1 & 9 gu>d+ aga9/ possible mi/akes4 ,r\gh h&l+1 falls & bl[s1 occurr+ a %ort "t aft] dea?1 may produce excoriations & pseudo-ec*ymoses1 :i* _c by sight be di/+ui%$ f su* z are ! result ( viol5ce inflict$ dur+ life4 ,w\nds inflict$ dur+ life are di/+ui%$ f ^? inflict$ aft] dea?1 by ! entire abs5ce 9 ! case ( ! latt]1 ( any signs ( vital reaction1 z inflammation1 hmorrhage1 suppuration1 swell+ or cicatrization ( ! edges ( ! w\nd1 etc4 ,b 9 ! case ( v sudd5 dea? f w\nd+ ( an important organ1 ^! traces ( vital reaction may also be :olly want+4 ,aga91 injuries are (t5 produc$ on dead bodies1 by ! in/rum5ts us$ to recov] !m f ! places 9 :i* !y h be5 discov]$4 ,contus$ w\nds seldom repres5t ! exact dim5sions ( ! weapon employ$4 ,blunt weapons may m]ely contuse & disfigure1 or lac]ate1 or fracture bones1 or produce rupture ( int]nal organs4 ,heal?y organs nev] rupture spontane\sly1 & c only be ruptur$ by ext]nal viol5ce4 ,! inspection ( ! position1 direction1 dep?1 bread?1 & numb] ( w\nds1 comp>$ ) ! weapon ) :i* !y h be5 inflict$1 (t5 furni% ! means ( approximately judg+ ( ! position ( ! p]petrator :5 he committ$ ! de$1 & ev5 8 object & bodily /r5g?4 ,9 judg+ :e!r fractures h be5 produc$ be=e or aft] dea?1 we mu/ rememb] t x is v difficult to fracture ! bones ( a dead body4 ,h5ce1 = example1 consid]able injuries ( ! cranial bones1 p>ticul>ly ( ! base ( ! skull1 h mo/ probably be5 produc$ dur+ life4 ,a fracture ( ! ribs 9 ! dead body is nev] spl9t]$4 ,9 decid+ :e!r a case is "o ( suicide or homicide1 besides ! previ\s /ate ( m9d ( ! deceas$1 ! po/ure & position ( ! body1 h&s1 etc41 ! appe>ance ( ! clo?+1 & ! "* ( ! w\nds or injuries1 are ! po9ts to be p>ticul>ly not$1 z well z ! abs5ce or pres5ce ( evid5ces ( robb]y4 ,gun%ot w\nds produc$ ^u dead bodies1 are nev] z deep z simil> ones w\ld be 9 a liv+ body2 ! track ( ! bullet c be di/9ctly trac$2 & ! edges ( ! w\nd %[ no appe>ance ( vital reaction4 ,h5ce !y c readily be di/+ui%$ f su* z h be5 produc$ dur+ life4 ,burn+ ( a dead body does n 9 g5]al produce vesication2 by exce$+ly int5se heat x may1 h[ev]1 be produc$4 ,! bull1 h[ev]1 la/ b a few m9utes1 nev] conta9 s]um1 b only wat]y vapor1 & nev] exhibit any trace ( ! b\nd+ l9e ( r$ness1 nor any trace ( color on _! basis4 ,!y are1 !re=e1 easily di/+ui%$ f burns inflict$ dur+ life4 ,9 di/+ui%+ betwe5 spontane\s apoplexy & c]ebral hmorrhage ! result ( injuries1 x w be suffici5t to note t1 9 ! =m] case1 b a v small am\nt ( blood is effus$1 s t ! discov]y ( v ext5sive & consid]able extravasation ( blood )9 ! cranial cavity1 c be reg>d$ z a pro( ( ! application ( ext]nal viol5ce4 ,9 ! case ( a dead body f\nd hang+1 x is 9 mo/ in/ances to be reg>d$ z a case ( suicide1 unless ! exam9ation ( ! body %\ld %[ ext]nal m>ks ( viol5ce1 or int]nal signs ( dea? f ano!r cause4 ,:]e a body has be5 f\nd 9 ! wat]1 ! "q may arise :e!r x 0 alive or dead :5 x ent]$ ! wat]4 ,! inve/igation ( ! body w reveal ! cause ( dea?4 ,! sure/ sign t ! body 0 alive :5 x 0 ?r[n or fell into ! wat]1 is ! pres5ce 9 ! /oma* ( "s ( ! fluid 9 :i* x 0 ly+1 if ?is fluid be su* z is nev] volunt>ily drank4 ,:e!r ! dr[n+ 0 a case ( suicide or homicide1 x is sometimes impossible to det]m9e4 ,all ! v>i\s circum/ances ( "t & place1 & concomitant appe>ances1 mu/ be m9utely inve/igat$1 9 ord] to hope to arrive at a probable conclusion4 ,9 ! case ( suppos$ poison+1 :]e ! fact ( ! adm9i/ration ( poison has be5 prov$1 & ! p]son has di$ ) symptoms attributable to poison+1 & ! po/-mortem appe>ances reveal no o!r cause ( dea?--!n ! dea? is to be reg>d$ z ! actual results ( ! poison1 :e!r its exi/5ce 9 ! body c be prov$ by *emical analysis or n4 ,only su* poisons are us$ by suicides z a g5]al ?+1 z are kn[n to be c]ta9 poisons1 & su* z h a v disagreeable ta/e are1 f ?is fact1 h>dly ev] us$ = ! purpose ( murd]1 except 9 ! case ( v small *ildr51 or p]sons r5d]$ ins5sible by any means4 7,casp>47 ,,*apt] ,,vi4 ,,on ,,embalm+ ,,! ,,dead4 ,f ! e>lie/ times1 ! att5tion ( mank9d has be5 giv5 to ! pres]vation ( ! bodies ( ! dead4 ,) ! anci5t ,egyptians1 ! art 0 c>ri$ to its highe/ degree ( p]fection4 ,! motive :i* l$ ^! p to devote s mu* c>e to ?is object1 is /ill conjectural2 yet x w\ld seem to h orig9at$1 9 "p at lea/1 z a sanit>y measure1 = pres]v+ ! purity & heal?fulness ( ! atmosph]e4 ,:ile s little is kn[n ( ! me?od by :i* !y produc$ su* wond]ful results1 z to h plac$ ! process among :at h be5 t]m$ ! 8,lo/ ,arts10 yet1 f a c>eful exam9ation ( a l>ge numb] ( mummies1 x w\ld appe> t ! op]ation consi/$3 ,fir/4 ,9 ! removal ( ! abdom9al & ?oracic visc]a1 ?r\gh an op5+ 9 ! left side b5ea? ! ribs2 & ( ! bra9 ?r\gh ! no/rils1 by break+ ?r\gh ! crebri=m plate ( ! e?moid bone2 or ?r\gh ! m\?1 by bor+ ?r\gh ! basil> process ( ! occipital bone4 ,second4 ,subject+ ! body = a long "t to ! action ( an alkali1 7natron17 aft] hav+ fill$ ! cavities ) v>i\s gums & spices1 etc41 & ?us remov+ ! fatty portions4 ,?ird4 ,a rapid desiccation1 aft] fur!r additions ( balsams1 res9s1 etc4 ,f\r?4 ,envelop+ ! :ole body 9 num]\s b&ages saturat$ ) gum or bitum54 ,mod]n nations1 h long practic$ evisc]ation1 9 connection ) ! use ( v>i\s sub/ances = pres]v+ bodies4 ,9 ! middle ages1 ! art ( embalm+ consi/$ 9 mix+ aromatic sub/ances ) salt1 & fill+ ! bodies ) ! same4 ,h5ry ,i4 ( ,engl&1 is said to h be5 ?us embalm$ 9 #aace4 ,long & deep incisions 7 made 9 v>i\s p>ts ( ! body1 ^! fill$ ) ! composition1 & !n c>efully sew$ up1 ! body aft]w>ds envelop$ 9 a beef's sk91 & enclos$ 9 a c(f94 ,l\is ,c4 ,bils1 a nobleman ( ,holl&1 & ,ruys*1 a ,dut* physician1 9 ! latt] "p ( ! sev5te5? & beg9n+ ( ! eighte5? c5turies1 acquir$ great celebrity f _! success 9 embalm+ bodies4 ,bo? di$1 h[ev]1 )\t imp>t+ _! secrets to o!rs4 ,! discov]y ( ! pres]vative prop]ties ( corrosive sublimate 9 #agfb1 0 soon foll[$ by its employm5t by ,*aussi]1 ,becl>d & ,l>rey1 9 ! pres]v+ ( bodies4 ,dr4 ,fran*9a ( ,naples1 employ$ ars5ic also1 ) consid]able success2 b f ! dang] to dissectors1 :]e ^! poisons _h be5 employ$1 _! use aft] ! discov]y ( ! pres]vative prop]ties ( *loride ( z9c1 0 q discont9u$4 ,! latt] sub/ance1 ) c>bolic acid1 con/itutes ! be/ antiseptis kn[n at ! pres5t "t1 & ^! are m g5]ally employ$ ?an any o!r = pres]v+ dead bodies4 ,! objects ( ! process ( embalm+ at ! pres5t day1 are ?reefold3 #a/4 ,x p]mits ! delay ( burial :]e ?is is desirable f ! abs5ce ( fri5ds2 or ( ! ready transportation ( ! bodies ( ^? :o may h di$ a long di/ance f home1 & t free f decay & po/-mortem *ange4 #b;d4 ,z a sanit>y measure 9 l>ge t[ns & cities1 :]e _m bodies are plac$ 9 family vaults1 in/ead ( be+ buri$ 9 ! gr\nd4 #c;d4 ,= ! pres]vation ( bodies = ! purpose ( anatomical /udy4 ,= ei!r ( ^! objects1 x is desirable t ! process be simple1 easy1 quick & inexp5sive4 ,frequ5tly 9 ! l>ge cities1 & occasionally 9 ! c\ntry1 ! physician w be call$ ^u to p]=m ?is op]ation1 b )\t "s in=mation ^u ! subject1 he w be unable to comply ) ! reque/4 ,! op]ation at ! pres5t "t1 consi/s simply 9 fill+ ! vascul> sy/em ) a pres]v+ fluid1 by inject+ ! same into "s "o or m ( ! art]ies2 ! sub/ance employ$ be+ ei!r c>bolic acid or *loride ( z9c 9 solution2 ! latt]1 f possess+ great] pres]v+ p[] )\t ! disagreeable odor ( ! c>bolic acid1 be+ mu* m frequ5tly employ$4 ,prep>ation ( ! ,z9c4 ,9 ! l>ge cities1 ! *loride ( z9c may be obta9$ ( ! manufactur+ *emi/s ready made2 b 9 ! c\ntry1 ! physician may manufacture ! solution himself1 by ! foll[+ process3 ,place 9 an op5 /one j>1 t5 p\nds ( muriatic acid1 & add to ! same1 old scrap %eet z9c1 ad libitum4 ,x %\ld be frequ5tly /irr$1 & all[$ to /& 9 ! op5 air = f twelve to tw5ty-f\r h\rs1 or until ! acid has s act$ ^u ! z9c z to h become ?or\ghly neutraliz$1 =m+ ?us a saturat$ solution ( ! *loride ( z9c4 ,! quantity requir$ ( ?is solution to pres]ve a body1 w dep5d ^u ! /ate ( ! wea!r1 9 connection ) ! size ( ! body1 cause ( dea?1 etc42 m be+ requir$ 9 hot wea!r1 or 9 a l>ge body1 or 9 su* diseases z are foll[$ by a t5d5cy to rapid putrefaction4 ,9 all cases1 h[ev]1 ! rule %\ld be to ?r[ 9 z mu* z ! vessels w hold1 v>y+ ! /r5g? accord+ to ! wea!r1 "* ( ! body1 etc4 ,) "y1 ?9 subjects1 & cool wea!r1 ! *loride may be dilut$ "o-half ) wat]2 b 9 w>m] wea!r1 & ) a l>ge body full ( fluids1 a proportion ( two-?irds z9c1 or ev5 /rong] may be requir$4 ,x w be well to comm5ce by ?r[+ 9 a weak] solution1 :i*1 by n con/r++ ! small vessels1 w pass m readily into ! extremities1 & foll[ by a /rong] = fill+ ! l>ge vessels ( ! trunk4 ,dr4 ,vivodtsef ( ,/4 ,pet]sburg1 employs a mixture ( c>bolic acid & alcohol4 ,tak+ alcohol ( ab\t n9ety degrees1 he adds "o-fif? its weight ( c>bolic acid2 !re be+ requir$ ( ?is mixture1 a quantity equal to ab\t "o-half ! weight ( ! body to be inject$4 ,x may be ?r[n into ! vessels 9 ! same mann] z ! solution ( ! *loride ( z9c4 ,! high price ( alcohol 9 ?is c\ntry1 w\ld con/itute an objection to ! use ( ?is sub/ance1 ev5 if x af=d advantages ov] ! z9c1 :i* x probably does n4 ,in/rum5ts ,requir$4 ,= ! satisfactory p]=mance ( ?is op]ation1 !re w be requir$ ! anatomical syr+e4 ,?is in/rum5t consi/s ( a brass cyl9d] & pi/on1 ( a capacity ( twelve to sixte5 ounces1 ) a movable /op-cock1 & s]ies ( graduat$ pipes = art]ies ( diff]5t size4 ,ea* pipe has a small rim or %\ld] at ! po9t to be introduc$ into ! vessel1 above :i* ! ligature is appli$1 :i* ?us holds ! pipe m securely 9 its position4 ,! abs5ce ( ! anatomical syr+e %\ld n1 h[ev]1 det] ! physician f attempt+ ?is op]ation1 z1 by a little prep>ation1 ! common gum-ela/ic family syr+e1 ( ! ,mattson or a simil> patt]n1 may be made to answ] ! purpose4 ,! po9t ( ! small or *ild's rectum pipe may be r$uc$ ) a file1 & a %\ld] prep>$1 ab\t "o-f\r? ( an in* f ! end1 = securely hold+ x :5 ti$ 9 ! vessel4 ,an app>atus ( a complicat$ "*1 & work+ by atmosph]ic pressure1 has be5 devis$ = ?is purpose2 b :ile x possesses v few advantages ov] ! syr+e describ$1 x is exp5sive & n easily manag$4 ,! ,op]ation4 ,9 ! dissect+-room1 x is usual to op5 ! *e/ & inject ?r\gh ! ar* ( ! aorta2 b 9 o!r cases1 "o ( ! common c>otids1 & bett] ! "r1 may be select$4 ,ext5d ! head1 plac+ ?us ! muscles ^u ! /ret*1 & along ! inn] bord] ( ! "r /]no-cleido-ma/oid muscle1 make an incision two in*es 9 l5g?1 ?r\gh :i* may be expos$ ! upp] portion ( ! common c>otid art]y4 ,aft] deta*+ ! vessel f ! surr\nd+ /ructures1 x %\ld be rais$ ^u ! h&le ( a scalpel & two ligatures pass$ ar\nd1 "o ( :i* is to be tightly ti$1 high up1 ^u ! vessel4 ,bel[ ?is1 a longitud9al slit1 "o-half in* 9 l5g?1 %\ld be made 9 ! vessel1 = receiv+ ! pipe ( ! syr+e1 :i*1 :5 9 position1 %\ld be securely ti$ ) ! second ligature1 j above ! rim4 ,! /op-cock jo9t may n[ be fitt$ to ! pipe4 ,to p]mit ( ! escape ( z mu* ( ! blood z possible1 an op5+ may be made into ! jugul> ve91 ligatures be+ pass$ b5ea? ! vessel--"o above & "o bel[ ! op5+--t x may be clos$ at ! prop] "t4 ,! antiseptic fluid hav+ be5 prep>$ 9 a conv5i5t vessel1 ! syr+e1 aft] hav+ be5 c>efully exam9$ & f\nd 9 good work+ ord]1 %\ld be sl[ly fill$1 adju/$ to ! /op-cock jo9t1 ! cock op5$1 & ! syr+e sl[ly dis*>g$4 ,%utt+ (f ! cock1 to prev5t escape ( ! fluid1 ! syr+e may n[ be deta*$1 refill$ & aga9 dis*>g$1 ! process be+ repeat$ until ! vessels are fill$ ) ! fluid1 :i* may be kn[n f ! resi/ance (f]$ to its introduction4 ,aft] a few syr+efuls h be5 ?r[n into ! vessels1 ! blood w be se5 fl[+ m or less freely f ! jugul>1 & :i* w gradually *ange to ! cle> antiseptic fluid2 !n ! vessel may be ti$1 to prev5t any fur!r loss4 ,to facilitate ! fl[ ( ! fluid into ! vessels ( ! extremities1 free flexion & ext5sion ( all ! limbs %\ld be made2 & aft] "s m9utes1 ano!r ef=t made to =ce 9 m ( ! fluid4 ,a successful fill+ ( all ! vessels may be kn[n by ! di/5sion ( ! sup]ficial ve9s ( ! *e/ & arms1 accompani$ ) an escape ( a d>k fluid f ! no/rils &1 p]haps1 m\?1 f an ooz+ ( ! fluid ?r\gh ! capill>y vessels ( ! muc\s membranes ( ! head4 ,if ! extemporiz$ gum syr+e be us$1 its pipe %\ld be ti$ 9 ! vessel z 9 ! o!r case1 ! opposite end ( ! tube plac$ 9 ! vessel ( fluid1 & ! same ?r[n 9 by pressure ( ! ball4 ,! op]ation be+ complet$1 a ligature %\ld be tightly plac$ ar\nd ! art]y bel[ ! pipe1 ! latt] remov$ & ! incision sew$ up4 ,*anges ,result+ f ! ,op]ation4 ,z ! vessels become fill$ dur+ ! op]ation1 ! abdom5 w gradually swell1 ! *e/ become m r\nd & full1 ! face & eyelids become puffy1 :ile ! sup]ficial ve9s w appe> full & d>k f ! conta9$ blood4 ,9 a few h\rs ! sk9 assumes a pale1 a%5 hue1 ) a p>*m5tlike feel1 :i* w be a sure indication ( ! success ( ! op]ation4 ,9 a few days ! puff$ appe>ance ( ! face w h disappe>$1 :5 no fur!r *ange w be notic$1 until aft] sev]al weeks ! e>s1 ) ! tip ( ! nose1 & ends ( ! f+]s1 beg9 to %rivel & dry up4 ,,*apt] ,,vii4 ,,pres]vation ,,( ,,specim5s ,,( ,,morbid ,,anatomy4 ,_m valuable & int]e/+ pa?ological specim5s are cont9ually be+ lo/1 f a want ( k1 or a c>eless neglect on ! "p ( ! physician4 ,t ! fulle/ b5efit may result f a po/-mortem exam9ation1 any r>e or int]e/+ specim5 %\ld be c>efully pres]v$4 ,%\ld ! physician feel no int]e/ 9 =m+ a cab9et ( morbid anatomy = himself1 he %\ld !n deposit ! specim5 9 ! anatomical museum ( "s m$ical s*ool1 :]e x may be p]man5tly pres]v$1 & ! pr(ession ?us b5efit$4 ,all specim5s ( s(t tissues design$ = pres]vation1 %\ld fir/ be soak$ 9 wat] :i* is *ang$ daily1 until all blood is remov$4 ,if ! wea!r be w>m1 x w be necess>y to add to ! wat] ea* "t1 ei!r a small proportion ( alcohol1 or "s antiseptic1 z c>bolic acid1 *loride ( z9c1 corrosive sublimate1 or common salt4 ,aft] all blood is remov$1 ! specim5 may be put into alcohol ( a /r5g? proportionate to ! size ( ! specim51 & !n all[$ to rema9 until ?or\ghly 8cur$40 ,small specim5s are dri$ up1 %runk5 & ne>ly spoil$ 9 _m cases1 by ! use ( too /rong alcohol1 :ile on ! o!r h&1 l>ge ones1 by dilut+ ! alcohol ) ! l>ge am\nt ( wat] conta9$1 w\ld be likely to spoil 9 a weak prep>ation4 ,l>ge specim5s1 p>ticul>ly 9 w>m wea!r1 %\ld h deep incisions made at a few po9ts1 = ! bett] p5etration ( ! pres]v+ fluid4 ,be=e be+ p]man5tly put up1 ! specim5 %\ld be c>efully trimm$1 & ev]y?+ int]f]+ ) ! be/ display ( ! ess5tial po9t remov$4 ,:ile ei!r ( ! antiseptics m5tion$ above w answ] = 8cur+0 a specim51 = p]man5t susp5sion1 !re is no sub/itute = alcohol4 ,o!r fluids may pres]ve1 b !y w also become turbid1 ?r[ d[n a precipitate1 & 9 cold wea!r are liable to freeze1 :ile f _! high specific gravity1 _m light specim5s w float on or ne> ! surface4 ,if ! specim5 has be5 ?or\ghly 8cur$0 be=e susp5sion1 v dilute alcohol w answ] = t purpose3 equal p>ts ( pure wat] & alcohol ( n9ety-five degrees1 9 all except ! l>g] specim5s1 be+ abundantly /rong4 ,delicate1 light specim5s w sometimes float 9 su* a dilution1 9 :i* case x %\ld be made /rong]4 ,! be/ =m ( anatomical j> is made ) gr\nd glass /opp]s1 ) a hook on ! "u side ( ! latt] = susp5d+ ! specim54 ,al?\gh exp5sive1 ^! j>s1 by effectually secur+ ! alcohol f evaporation1 z well z f ! great] facility ) :i* ! spirits may be *ang$1 :i* w sometimes be requir$1 w give bett] satisfaction ?an any o!r4 ,:]e ! common j> )\t a /opp] is us$1 great c>e w be requir$ 9 clos+ up1 to prev5t loss by evaporation4 ,!re %\ld fir/ be prep>$ a circul> plate ( ?ick %eet lead1 to re/ on ! top ( ! neck ( ! j>4 ,! specim5 hav+ be5 susp5d$ by a /r+1 c>ri$ ?r\gh by a l>ge ne$le1 & at two diff]5t po9ts1 is to be fa/5$ to ! disk ( lead by means ( two holes1 pun*$ by an awl1 ab\t half an in* ap>t1 ne> ! c5tre4 ,! portion ( /r+ above ! lead1 ) ! holes also1 %\ld n[ be c>efully cov]$ ) seal+-wax1 o!rwise1 by capill>y attraction1 ! alcohol w keep ! bladd] cov]+ cont9ually wet1 & f9ally rot x out4 ,ov] ! lead is n[ to be /ret*$ a piece ( moi/5$ bladd]1 & w\nd ) tw9e ar\nd ! neck ( ! j>4 ,:5 dry1 ?is is to be cov]$ ) a coat ( black v>ni%2 ?is aga9 :5 dry1 be+ foll[$ by a second lay] ( bladd] & v>ni%4 ,wet prep>ations %\ld be kept :]e !y may h a free exposure to sunlight4 ,if plac$ 9 a d>k closet1 !y become damag$ 9 texture1 & acquire a d>k & unpleasant color2 ?is is p>ticul>ly ! case ) ! ligam5t\s & n]v\s tissues4 ,dr4 ,brunetti ( ,padua1 :o has inv5t$ a new process = pres]v+ c]ta9 k9ds ( specim51 & :o receiv$ a gold m$al "s ye>s ago at ! ,p>is ,exposition1 gives ! foll[+ p>ticul>s ( 8 me?od3 8,! process comprises f\r sev]al op]ations1 viz43 #a1 ! wa%+ ( ! piece to be pres]v$2 #b1 ! degraissage1 or eat+ away ( ! fatty matt]2 #c1 ! tann+1 & #d1 ! desiccation4 8#a4 ,to wa% ! piece ,m4 ,brunetti passes a curr5t ( pure wat] ?r\gh ! blood-vessels & ! v>i\s excretory canals1 & !n he wa%es ! wat] out by a curr5t ( alcohol4 8#b4 ,= de/roy+ ! fat he foll[s ! alcohol ) e!r1 :i* he pu%es1 ( c\rse1 ?r\gh ! same blood-vessels & excretory ducts2 ?is "p ( ! op]ation la/s "s h\rs4 ,! e!r p5etrates ! int]/ices ( ! fle% & dissolves all ! fat4 ,! piece1 at ?is po9t ( ! process1 may be pres]v$ any l5g? ( "t desir$1 plung+ x 9 e!r1 be=e proce$+ to ! f9al op]ations4 8#c4 ,= ! tann+ process ,m4 ,brunetti dissolves tann9 9 boil+ di/ill$ wat]1 & !n1 aft] wa%+ ! e!r out ( ! vessels ) di/ill$ wat]1 he ?r[s ?is solution 94 8#d4 ,= ! dry+ process ,dr4 ,brunetti places ! pieces 9 a vase ) a d\ble bottom fill$ ) boil+ wat]1 & he fills ! places ( ! prec$+ liquids ) w>m1 dry air4 ,by ! aid ( a res]voir1 9 :i* air is compress$ to ab\t two atmosph]es1 & :i* communicates by a /op-cock & a sy/em ( tubes1 fir/ to a vase conta9+ *loride ( calcium1 !n ) ano!r heat$1 !n ) ! vessels & excretory ducts ( ! anatomical piece 9 c\rse ( prep>ation1 he e/abli%es a gase\s curr5t :i* expels 9 a v little "t all ! fluids4 ,! op]ation is n[ f9i%$4 8,! piece rema9s supple1 light1 pres]ves its size1 its normal relations1 its solid elem5ts1 = !re are no long] any fluids 9 x4 ,x may be h&l$ )\t fe>1 & w la/ indef9itely40 ,= ! pres]vation & h>d5+ ( tissues = microscopic exam9ation--z sections ( tumors1 gl&s1 membranes1 sp9al cord or bra91 etc4--,mll]'s fluid may be employ$1 :i* is prep>$ z foll[s3 bi*romate ( potassa1 #ge gra9s2 sulphate ( soda1 #ce gra9s2 dissolv$ 9 six ounces ( wat]4 ,! specim5 %\ld be susp5d$ 9 ?is fluid until suffici5tly h>d5$ to p]mit ( a satisfactory exam9ation4 ,prep>ation ( ,bones4 ,pa?ological specim5s ( bones1 may be prep>$ ei!r by boil+ or mac]ation4 ,! me?od by boil+ %\ld be employ$1 h[ev]1 only :]e ! texture ( ! specim5 is firm & solid1 z 9 cases ( unit$ fracture1 etc42 & 9 ^! cases1 c>e w be requir$ to avoid injur+ ! specim5 by too long exposure to ! process4 ,mac]ation1 h[ev]1 is ! bett] me?od = all cases1 & ! only "o to be employ$ 9 cases :]e ! bone is s(t5$ by c>ies or necroses4 ,! specim5 hav+ be5 r\ghly /ripp$ ( ! s(t tissues1 is to be ?r[n into a vessel ( wat]1 ! latt] be+ *ang$ e day1 z long z x becomes color$ by ! blood4 ,x is n[ to be left until ! putrefactive process has s s(t5$ ! tissues t !y may be easily remov$1 :51 aft] be+ ?or\ghly wa%$ 9 soda wat]1 x may be dri$ & m\nt$4 ,if ! wea!r be cold1 x w be absolutely important t ! mac]at+ be conduct$ 9 a w>m room1 else ! process w be s sl[ z to conv]t ! tissues into a =m ( adipoc]e1 q arre/+ ! putrefactive process1 & greatly damag+ ! specim5 9 its beauty & value4 ,9 ?is connection1 x may be obs]v$ t bones f a subject t has be5 inject$ ) *loride ( z9c1 c nev] be successfully mac]at$1 ! z9c hav+ a sort ( tann+ effect ^u ! tissues1 :i* enables !m to resi/ ! putrefactive process4 ,boil+ is ! only me?od by :i* su* specim5s c be cleans$4 ,:]e a bone has be5 prop]ly mac]at$ & dri$1 & especially if f a "y subject1 x w be f\nd :ite & q free f grease2 b :5 tak5 f old subjects1 or :5 prep>$ by boil+1 x may be requir$ to be subject$ to a blea*+ process = remov+ ! grease & improv+ ! color4 ,by exposure to ! sun1 ) frequ5t wa%+ 9 *lor9e & soda wat]1 ! appe>ance ( ! specim5 may be greatly improv$1 or :at is /ill bett]1 by cov]+ ! specim5 = a few days 9 sulphuric e!r1 :i* w effectually dissolve out all ! grease1 & !n wa%+ & expos+ to ! sun = a few days1 x w be left beautifully :ite & clean4 ,= p]man5t pres]vation1 ! specim5 %\ld f9ally be m\nt$ on a block or bo>d1 9 su* a mann] z be/ to expose its int]e/+ po9ts4 ,,index4 ,,page ,abdom51 me?od ( op5+1 #abg ,abdom9al dropsy1 #ace ,alcohol1 poison+ by1 #bii ,anatomical syr+e1 #cbc ,anus1 diseases (1 #aeg fi/ula (1 #aeg hmorrhoids1 #aei ulc] 91 #aeg ,aorta4 7,see ,art]ies47 ,apoplexy1 c]ebral1 #da pulmon>y1 #aae ,ara*noid1 exam9ation (1 #ch ,ars5ic1 poison+ by1 #big ,ar?ritis1 *ronic rheumatic1 #bga scr(ul\s1 #bga ,art]ies1 aneurism (1 #ii calcification (1 #ii exam9ation (1 #ih fatty deg5]ation (1 #ii inflammation (1 #ih ossification (1 #ii rupture (1 #ajb ,art]ies1 c]ebral4 a!romat\s deg5]ation (1 #fj calcification (1 #fj ob/ruction (1 #ei position ( clot 9 ob/ruction (1 #ei ,atresia ani1 #adi ure?r1 #bab ,autopsy1 m$ico-legal1 me?od ( conduct+1 #cjd ,bili>y calculi1 #ahh effects (1 #aij position (1 #ahi ,bladd]1 gall-4 7,see ,gall-bladd]47 ,bladd]1 ur9>y4 contraction (1 #baj cat>rh (1 #baj canc] (1 #baa dilatation (1 #bji exam9ation (1 #bjh hyp]trophy (1 #bji inflammation (1 #baj mal=mations (1 #bjh p>asites 91 #bab removal (1 #aca tub]cles 91 #baa tumors 91 #baa ,bones1 abscess (1 #bei canc] (1 #bff c>ies (1 #bfj exam9ation (1 #bei inflammation (1 #bei morbid gr[?s 91 #bfc necrosis (1 #bfj rickets 91 #bfa suppuration (1 #bei tumors 91 #bfc tub]cles 91 #bfe ,bra91 appe>ance (1 9 heal?1 #dh abscess (1 #ej atrophy (1 #ec blood cy/s 91 #ei calc>e\s deposits 91 #ef exam9ation (1 #bi h>d5+ (1 #ea hyp]trophy (1 #eb hydatids 91 #eg inflammation (1 #dg membranes (1 #cf removal (1 #bi s(t5+ (1 #dh tumors (1 #ed ,bright's disease1 #aig cirrhotic or contract+ =m1 #bja inflammatory =m1 #aig waxy or amyloid =m1 #bjj ,bron*ial tubes1 dilatation (1 #abe exam9ation (1 #ajf1 #abb inflammation (1 #abc n>r[+ (1 #abd oblit]ation (1 #abd ,bron*itis1 #abc ,buccal cavity1 exam9ation (1 #fe ,burn+1 ante-mortem di/+ui%$ f po/-mortem1 #cah ,canc]1 ( bones1 #bff black1 #bia colloid1 #bib encephaloid1 #bia epi!lial1 #bic ( gall-bladd]1 #ahh ,canc]1 ( he>t1 #hd h>d1 #bij ( inte/9es1 #aeh ( kidneys1 #bjd ( liv]1 #agg ( lungs1 #abj ( mamm1 #bef1 #beg ( m$ia/9um1 #abf m$ull>y1 #bia melanotic1 #bia ( ov>ies1 #bej ( sophagus1 #gc ( p5is1 #bag ( pro/ate gl&1 #bbh ( pancreas1 #afa ( p]itoneum1 #acf ( sple51 #afe ( supr>5al capsules1 #bjh ( scrotum1 #bai ( /oma*1 #adf ( scirrhus1 #bij ( te/icles1 #bbd ( tongue1 #fh ( uret]s1 #bjf ( ur9>y bladd]1 #baa ( ure?ra1 #bad ( ut]us1 #bdj ( vag9a1 #bcd ,calculi1 ur9>y1 #bad ,calv>ium1 removal (1 #bh ,c>bonic oxide1 poison+ by1 #bii ,c>ditis1 #gf ,c]ebral art]ies1 #ei ,c]ebritis1 #dh ,c]ebro sp9al m5+itis1 #fa ,*e/1 exam9ation (1 #fe ,*ildr51 new-born1 m$ico-legal "q relat+ to1 #cjg ,*loride ( z9c1 pres]vative prop]ties (1 #cba ,colon1 removal (1 #abh ,corrosive sublimate1 poison+ by1 #bih pres]vative prop]ties (1 #cba ,cy/itis1 #baj ,dea?1 signs (1 previ\s to putrefaction1 #cab probable cause (1 #cag ,diph!ria1 false membranes 91 #ga ,dis9fectants = in/rum5ts1 #bd ,dropsy ( abdom51 #ace ( bra91 #dj ( *e/1 #ajc ( he>t1 #gd ( ov>ies1 #bdh ( te/es1 #bbb ,dr[n+1 dea? f1 #cjb1 #cji ,duod5um1 removal (1 #abi ,dura mat]1 inflammation (1 #cf1 #fa fibr9\s clots 91 #cg ?ick5+ (1 #cg tub]cul> deposits 91 #ch tumors 91 #ch ,e>1 exam9ation (1 #ca removal (1 #bi ,embalm+1 me?od (1 by anci5ts1 #cbj objects (1 #cba in/rum5ts requir$1 #cbc ! op]ation1 #cbd *anges result+ f1 #cbe ,embolism ( c]ebral art]ies1 #ei ,endoc>ditis1 #gg ,ent]itis1 #adi ,epididymitis1 #bba ,epispadias1 #bab1 #bae ,exo/oses1 #bfc ,eyes1 removal (1 #cb ,fallopian tubes1 anomalies (1 #bea inflammation (1 #bea morbid gr[?s 91 #bea ,fi/ula 9 ani1 #aeg ,fractures1 ante-mortem di/+ui%$ f po/-mortem1 #cah ,ganglions1 #bgj ,gall-bladd] & ducts1 #ahg canc] (1 #ahh dilatation (1 #ahh gall-/ones 91 #ahi inflammation (1 #ahg tumors 91 #ahh tub]cles 91 #ahh ,ga/ritis1 #ada cat>rhal1 #ada cr\p\s1 #ada phlegmon\s1 #ada ,gums1 exam9ation (1 #fe ,gun%ot w\nds1 ante-mortem di/+ui%$ f po/-mortem1 #cah ,hang+1 dea? f1 #cja1 #cai ,hmatocele1 #bbc ,hmoptysis1 #aad ,hmorrhage1 pulmon>y1 #aad ut]9e1 #bcg ,hmorrhoids1 #aeg ,head1 c>ies ( bones (1 #ce exam9ation (1 #bg removal ( membranes ( bra91 #bh removal ( calv>ium1 #bh removal ( bra91 #bi ?ick5+ ( bones (1 #ce ?9n+ ( bones (1 #ce ,he>t1 atrophy (1 #hb abscess (1 #hf aneurism (1 #hf canc]s 91 #hd displacem5ts (1 #hg dilatation (1 #hj ectopia cordis1 #hh exam9ation (1 #ff1 #ge fatty deg5]ation (1 #hb fatty gr[? (1 #hb hydatids 91 #hf hyp]trophy (1 #gi inflammation (1 #gf melanosis (1 #hd mal=mations (1 #hf morbid condition (1 #ge normal size (1 #hj ossification ( art]ies (1 #he rupture ( walls (1 #hg /5osis (1 #gi tumors 91 #hd transposition (1 #hh valves (1 #gg ,he>t clots1 causes (1 #ia color (1 #hi consi/5cy (1 #hi "t ( =mation (1 #ij position (1 #hi ,hepatitis1 #afh ,h]nia1 #aed ,hydr>?rosis1 #bfh ,hydro?orax1 #ajd ,hydrocele1 #bbb cong5ital1 #bbb diffus$1 #bbc ency/$1 #bbb simple1 #bbb ,hypospadias1 #bab1 #bae ,hydrocyanic acid1 poison+ by1 #bih ,in/rum5ts1 #ba dis9fectants =1 #bd ,inte/9es1 canc] (1 #aeh contraction (1 #aec dilatation (1 #aec displacem5t (1 #aed exam9ation (1 #adi inflammation (1 #aej inc>c]ation (1 #aee mal=mations (1 #adi ob/ructions (1 #aee1 #aef p>asites 91 #aei rupture (1 #aeg tub]cles 91 #aeh tumors 91 #aeh ulc]ation (1 #aeb w\nds (1 #aeg ,intussusception1 #aef ,jo9ts1 burs (1 morbid conditions (1 #bfi c>tilage (1 morbid conditions (1 #bgj inflammation ( synovial membrane1 #bfh mal=mations (1 #bfh rheumatic inflammation (1 #bga scr(ul\s inflammation (1 #bga ,kidneys1 anomalies (1 #aid abscesses (1 #aif ,bright's disease (1 #aig conge/ion (1 #aid canc] (1 #bjd cy/s 91 #bjd dislocation (1 #bjc exam9ation (1 #aic fatty deg5]ation (1 #bjb hmorrhage (1 #aie inflammation (1 #aie inflammation ( capsule (1 #aig p>asites 91 #bje removal (1 #abi size & weight (1 #aic tub]cles 91 #bjc ,l>ynx1 abscesses (1 #ga exam9ation (1 #fd1 #fe1 #fi false membranes 91 #ga inflammation (1 #fi necrosis ( c>tilages (1 #gj dema (1 #gj tumors (1 #ga ulc]ation (1 #gj ,liv]1 abscess (1 #afi1 #aga atrophy (1 #agd blood-vessels (1 #ahb conge/ion (1 #aff canc] (1 #agg deg5]ations (1 #aga exam9ation (1 #acj1 #afe effusion hmorrhagic (1 #afg fatty1 #agb hyp]trophy (1 #agg inflammation (1 #afh p>asites 91 #ahc1 #ahf removal (1 #acj size (1 #afe tub]cles 91 #aha tumors 91 #ahb ,lungs1 appe>ance 9 heal?1 #ajg appe>ance1 po/-mortem1 #aah1 #abj abscess (1 #aaa apoplexy (1 #aae conge/ion (1 #ajg canc] (1 #abj exam9ation (1 #fg1 #ajf emphysema (1 #aaf gangr5e (1 #aab hepatization (1 #ajh hmorrhage (1 #aad hydatids 91 #abb inflammation (1 #ajg1 #aji melanosis (1 #aba suppuration (1 #aaj tub]cles 91 #aag tub]cul> cavities 91 #aai tumors 91 #abb ,mamm1 anomalies (1 #beb atrophy (1 #beb abscesses (1 #bec canc] (1 #bef1 #beg exam9ation (1 #beb inflammation (1 #bec tumors 91 #bed ulc]s 91 #bed ,m$ico-legal que/ions1 #cjd ext]nal inspection ( body1 #cje int]nal exam9ation1 #cjf ,m$ia/9um1 abscess (1 #abf canc]\s gr[?s 91 #abf inflammation (1 #abf tumors (1 #abf ,m$ulla1 sp9alis1 #fb oblongata1 effusions 91 #dc ( bone1 disease (1 #bfg ,membranes ( ! bra94 appe>ance (1 9 m5+itis1 #ci exam9ation (1 #cf morbid *anges (1 9 insanity1 #dj removal1 ( #bh s]\s effusion into1 #dj sangu9e\s effusion into1 #da ,membranes1 sp9al1 tub]cul\s deposits 91 #fa tumors 91 #fa ,m5+itis1 #ci c]ebro-sp9al1 #fa tub]cul>1 #ch ,metritis1 #bcg1 #bdb ,metrophlebitis1 #bdc ,morbus ,brightii1 #aig ,m\?1 cat>rhal or cr\p\s inflammation (1 #gb exam9ation (1 #fd ,myelitis1 #fb ,mll]'s fluid1 #cbi ,neck1 exam9ation (1 #fd ,nephritis1 #aie ,nitric acid1 poison+ by1 #bie ,nux vomica1 poison+ by1 #bii sophagus1 canc] (1 #gc dilatation (1 #gc exam9ation (1 #gb inflammation (1 #gb /ricture (1 #gb tumors 91 #gc ulc]ation (1 #gb ,opium1 poison+ by1 #cjj ,or*itis1 #bba ,osse\s gr[?s1 #bfc ,o/eomalacia1 #bfb ,o/eophytes1 #bfc ,ov>ies1 abscesses 91 #bdg cy/s 91 #bdh dropsy (1 #bdh exam9ation (1 #bdg inflammation (1 #bdg malignant disease (1 #bej tumors1 tub]cles1 etc41 (1 #bea ,oxalic acid1 poison+ by1 #bie ,palate1 exam9ation (1 #fe ,pac*ionian bodies1 #ci atrophy (1 #afa ,pancreas1 anomalies (1 #afj canc] (1 #afa dilatation ( ducts1 #afa exam9ation (1 #afj fatty deg5]ation (1 #afa hyp]trophy (1 #afa inflammation (1 #afa removal (1 #abi ,p>asites 9 bladd]1 #bab 9 bra91 #eg 9 he>t1 #hf 9 inte/9es1 #aei 9 kidneys1 #bje 9 liv]1 #ahc1 #ahf 9 lungs1 #abb 9 sp9al cord1 #fc ,pelvic visc]a1 removal (1 #acj ,p5is1 anomalies (1 #bae atrophy (1 #bae balanitis (1 #baf *ancres on1 #baf canc] (1 #bag exam9ation (1 #bae fracture (1 #baf hyp]trophy (1 #bae h]pes (1 #baf p>aphymosis (1 #baf psoriasis ( prepuce1 #baf tumors (1 #bah w>ts on1 #bag ,p]ic>dium1 adhesions 91 #gd blood 91 #gd exam9ation (1 #gc inflammation (1 #gc morbid gr[?s 91 #ge ,p]itoneum1 blood 9 result ( viol5ce1 #ace conge/ion (1 #acc canc] (1 #acf dropsical accumulation 91 #ace exudation1 fibr9\s1 on1 #acd exam9ation (1 #acc gangr5e (1 #ace inflammation (1 #acc suppuration (1 #ace tub]cul> deposits 91 #acf tumors (1 #acf ,p]itonitis1 #acc pu]p]al1 #bdc ,p]ihepatitis1 #afg ,p]ipractitis1 #aea ,p]ityphlitis1 #aea ,ph>ynx1 exam9ation (1 #fe1 #gb inflammation (1 #gb tumors 91 #gc ulc]ation (1 #gb ,phosphorus1 poison+ by1 #bif ,pia mat]1 exam9ation (1 #ch inflammation (1 9 spott$ fev]1 #fa ,pleura1 adhesions 91 #ajc exam9ation (1 #ajc effusions into1 #ajc inflammation (1 #ajc ,pleurisy1 #ajc ,pneumonia1 cat>rhal1 #aji cr\p\s1 #aaj d\ble1 #aji lobul>1 #aaj s+le1 #aji ,pneumo?orax1 #aje ,poison+1 dea? f1 #bid ,po/-mortem exam9ations1 #bd prelim9>y prep>ations =1 #bd 9 m$ico-legal cases1 #cjd ,pregnancy1 abdom9al1 #bdd extra-ut]9e1 #bdd tubal1 #bde ut]o-tubal1 #bde ,prep>ation ( bones1 #cbi by boil+1 #cbi by mac]ation1 #cbi blea*+ (1 #ccj ,pres]vation ( specim5s ( morbid anatomy1 #cbf process ( ,dr4 ,brunetti1 #cbh ,prolapsus ( rectum1 #aeg ,pro/ate gl&1 anomalies (1 #bbg atrophy (1 #bbh canc] (1 #bbh cy/s 91 #bbh concretions 91 #bbi exam9ation (1 #bbf hyp]trophy (1 #bbg tub]cles 91 #bbh tumors 91 #bbh anomalies (1 #bcj ,pud5da1 exam9ation (1 #bcj elephantiasis (1 #bcb hyp]trophy (1 #bcj inflammation (1 #bca tub]cles 91 #bcb tumors 91 #bcb w>ty excresc5ces on1 #bca ,putrefaction1 process (1 #cad ,pyelitis1 #aif ,pyelonephritis1 #aif ,que/ions relat+ to new-born *ildr51 #cjg 0 ! *ild mature81 #cjg 0 x born alive81 #cjh h[ long did x live81 #caj :at 0 ! cause ( dea?81 #caa ,ra*itis1 #bfa ,rectum1 prolapsus (1 #aeg removal (1 #abh ,scl]osis ( sp9al cord1 #fb ,scrotum1 canc] (1 #bai exam9ation (1 #bah elephantiasis (1 #bah hyp]trophy (1 #bah inflammation (1 #bai ,sem9al vesicles1 anomalies (1 #bbf exam9ation (1 #bbf inflammation (1 #bbf tub]cles 91 #bbg ,signs ( dea?1 #cab ,skull1 c>ies ( bones (1 #ce exam9ation (1 #cd fracture (1 #cd ?9n+ ( bones (1 #ce ?ick5+ ( bones (1 #ce ,sp9al cord1 atrophy (1 #fc exam9ation (1 #fj inflammation ( membranes (1 #fj morbid gr[?s 91 #fc p>asites 91 #fc pres]vation ( specim5s (1 #cc removal (1 #cc s(t5+ (1 #fb ,sp9al column1 disease (1 #bgb ,sp9al canal1 s]\s effusions 91 #fa ,sp9a bifida1 #fa ,sple51 anomalies (1 #afb atrophy (1 #afb cy/s 91 #afe canc] (1 #afe displacem5ts (1 #afc deg5]ation (1 #afd exam9ation (1 #afb hyp]trophy (1 #afb inflammation (1 #afc removal (1 #abi rupture (1 #afc size (1 normal & abnormal1 #afb ?ick5+ ( capsules (1 #afd tub]cles 91 #afd ,spott$ fev]1 inflammation ( pia mat] 91 #fa ,/oma*1 atrophy (1 #ade ,beaumont's exp]im5ts on1 #adj cirrhosis (1 #add canc] (1 #adf canc] 91 results (1 #adh dilatation (1 #ade exam9ation (1 #acg erosions1 hmorrhagic1 (1 #adc inflammation (1 #adj po/-mortem *anges 91 #acg poisons 91 & _! effects1 #adb s(t5+ (1 #adc tumors 91 #adh ulc]s 91 #adb ,/rangl+1 dea? f1 #cja ,/ry*nia1 poison+ by1 #bii ,suffocation1 dea? f1 #cjj ,sulphuric acid1 poison+ by1 #bid ,supr>5al capsules1 #bjg canc] (1 #bjh cy/s 91 #bjh hmorrhage (1 #bjh inflammation (1 #bjg tub]cles 91 #bjh ,te/icles1 atrophy (1 #bbj anomalies (1 #bai canc] (1 #bbd cy/ic disease (1 #bbe dropsy (1 #bbb exam9ation (1 #bai hmatocele (1 #bbc hyp]trophy (1 #bbj inflammation (1 #bba tub]cles 91 #bbe tumors 91 #bbf v>icocele (1 #bbc ,tee?1 exam9ation (1 #fe ,?rottl+1 dea? f1 #cja ,?rombi 9 s9uses ( dura mat]1 #cg ,tongue1 canc] (1 #fh exam9ation (1 #fh hyp]trophy (1 #fi ranula (1 #fh syphilitic ulc]s (1 #fh tub]cles (1 #fh tumors (1 #fh ,tonsils1 cat>rhal or cr\p\s inflammation (1 #gb exam9ation (1 #fe ,tub]cul> disease ( lungs1 #aag tub]cul> cavities 91 #aai m5+itis1 #ch ,tumors1 ad5oid1 #bhe b5ign1 #bgd 9 bra91 #ed 9 bones1 #bfc 9 bladd]1 #baa classification (1 #bgd cy/ic1 #bgd c>tilag9\s1 #bhj c>c9omat\s1 #bhh 9 dura mat]1 #ch fatty1 #bgi fibr\s1 #bgi 9 ,fallopian tubes1 #bea 9 gall-bladd] & ducts1 #ahh hydatid1 #bgg 9 he>t1 #hd 9 inte/9es1 #aeh lipomat\s1 #bgi lymphatic1 #bhe 9 l>ynx1 #ga 9 lungs1 #abb 9 liv]1 #ahb myxomat\s1 #bgh myomat\s1 #bhd malignant1 #bhf 9 m$ia/9um1 #abf 9 mamm1 #bed neuromat\s1 #bhd osse\s1 #bha 9 sophagus1 #gc 9 ov>ies1 #bea papill>y1 #bhb polypoid1 #bhc 9 ph>ynx1 #gc 9 p]ic>dium1 #ge 9 p]itoneum1 #acf 9 pud5da1 #bcb 9 pro/ate gl&1 #bbh 9 p5is1 #bah s>comat\s1 #bhf 9 sp9al cord1 #fc 9 /oma*1 #adh 9 tongue1 #fh 9 te/icles1 #bbf 9 ut]us1 #bch 9 vag9a1 #bcd vascul>1 #bhd ,uret]s1 canc] (1 #bjf cy/s 91 #bjg defects (1 #bje dilatation (1 #bjf inflammation (1 #bjf tub]cles 91 #bjg ,ure?ra1 contraction (1 #bac canc] (1 #bad dilatation (1 #bac inflammation (1 #bab mal=mations (1 #bab rupture (1 #bac /ricture (1 #bac tub]cles 91 #bad w>ty gr[?s 91 #bac ,ut]us1 anomalies (1 #bce atrophy (1 #bcf cy/s 91 #bdj canc] 91 #bdj exam9ation (1 #bce excresc5ces1 caulifl[]1 etc41 #bda hmatometra1 #bcf hyp]trophy (1 #bcf hydrometra1 #bcf hmorrhages (1 #bcg inflammation (1 #bcg1 #bdb1 #bdc malpositions (1 #bcf removal (1 #acb rupture (1 #bda tub]cles 91 #bdj tumors 91 #bcj ulc]ations (1 #bch ,vag9a1 anomalies (1 #bcb dilatation (1 #bcb exam9ation (1 #bcj gangr5e (1 #bcd inflammation (1 #bcc laxity (1 #bcb lac]ation (1 #bcb rigidity (1 #bcb rupture (1 #bcc /ricture (1 #bcb tumors (1 #bcd ,valves ( he>t1 aneurism (1 #gi atrophy (1 #gh calcification (1 #gh contraction (1 #gi ?ick5+ (1 #gg ,volvulus1 #aef ,vulva4 7,see ,pud5da74 ,:ite swell+1 #bga ,w\nds1 dea? f1 #cag contus$1 appe>ance (1 #cag po/-mortem di/+ui%$ f ante-mortem1 #cag ,z9c1 prep>ation (1 = embalm+1 #cbb quantity (1 requir$1 #cbb ,,errata4 ,on page #ba1 la/ l9e1 = 8culv>ium10 read calv>ium4 #be1 fifte5? l9e1 = 8collodian10 read collodion4 #gi1 la/ l9e1 = 8t organ10 read ^? organs4 #ic1 ?irte5? l9e1 = 8af=ds10 read af=d4 ----- ,footnote #a3 ,toynbee on ! ,e>4 ,footnote #b3 ,see ,no4 #eji1 ,college ,museum4 ,footnote #c3 ,id1 #dgc4 ,footnote #d3 ,see ,no4 #dij1 ,college ,museum4 ,footnote #e3 8,morbid ,anatomy ( ! ,bra91 9 ,mania1 c410 by ,&rew ,m>%all1 ,m4 ,d4 ,footnote #f3 ,see ,no4 #achf1 ,case ,t1 ,college ,museum4 ,footnote #g3 ,see ,no4 #abie1 ,case ,r1 ,college ,museum4 ,footnote #h3 ,see ,no4 #ache1 ,college ,museum4 ,footnote #i3 ,see ,no4 #achg1 ,college ,museum4 ,footnote #aj3 ,paget's ,pa?ology1 p4 #ehf4 ,footnote #aa3 ,m$ico-,*irurgical ,trans4 xvii4 p4 #ejg4 ,footnote #ab3 ,see ,hahnemannian ,mon?ly = ,may1 #ahga4 ,footnote #ac3 ,9 "o case1 ! clot pres5t$ a m>k$ resemblance to ! abdom9al fat ( ! goose1 bo? 9 color & consi/5cy4 ,footnote #ad3 ,meigs' ,treatise on ,ob/etrics1 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 ,spontane\s ,cure ( ,aneurism1 ) cases 9 ,new ,york ,transactions ( ,hompa?ic ,m$ical ,society = #ahfh1 page #agj4 ,footnote #ai3 ,see case ( recov]y report$ by ,dr4 ,r4 ,ko*1 9 ,am]ican ,j\r4 ( ,hom4 ,mat4 ,m$41 ,vol4 ,,iv41 p4 #abc4 ,footnote #bj3 ,see ,nos4 #acji & #acea1 ,college ,museum4 ,footnote #ba3 ,see ,no4 #aejf1 ,college ,museum4 ,footnote #bb3 ,jones & ,sievek+'s ,pa?ological ,anatomy4 ,footnote #bc3 ,cirrhosis1 z appli$ to ?is condition ( ! liv]1 has ref]5ce to ! yell[ color1 due to ! pres5ce ( l>ge quantities ( yell[ pigm5t conta9$ 9 ! secret+ cells2 h5ce ! application ( ! t]m to diseases ( ! lungs1 kidneys1 etc41 :i* resemble cirrhosis ( ! liv]1 n 9 color1 b 9 d5sity ( ! tissues1 is obvi\sly inappropriate4 ,footnote #bd3 ,see ,no4 #adie1 ,college ,museum4 ,footnote #be3 ,see ,no4 #adif1 ,college ,museum4 ,footnote #bf3 ,see report ( case ( 8,ossification ( ,ve9s10 by ,james ,kit*51 ,m4 ,d41 9 ,am]ican ,j\rnal ( ,homopa?ic ,mat]ia ,m$ica = ,decemb]1 #ahga1 page #adc4 ,footnote #bg3 ,see ,no4 #aejj1 ,college ,museum4 ,footnote #bh3 ,specim5 ,no4 #acbi1 ,college ,museum4 ,footnote #bi3 ,see ,no4 #accf1 ,college ,museum4 ,footnote #cj3 ,see ,no4 #abei1 ,college ,museum4 ,footnote #ca3 ,bright's ,disease1 by ,t4 ,gra+] ,/ew>t4 ,footnote #cb3 ,see ,no4 #aejg1 ,college ,museum4 ,footnote #cc3 ,specim5 ,no4 #abfj1 ,college ,museum4 ,footnote #cd3 ,see ,no4 #abfa1 ,college ,museum4 ,footnote #ce3 ,see ,no4 #cei1 ,college ,museum4 ,footnote #cf3 ,see ,no4 #cbi1 ,college ,museum4 ,footnote #cg3 ,see ,no4 #cca1 ,college ,museum4 ,footnote #ch3 ,see ,nos4 #cce & #cfj1 ,college ,museum4 ,footnote #ci3 ,see ,nos4 #cbe & #cbf1 ,college ,museum4 ,footnote #dj3 ,see ,no4 #adgf1 ,college ,museum4 ,footnote #da3 ,see ,nos4 #acdj & #acda1 ,college ,museum4 ---------------------------------------- -------------------------------- ,,transcrib]',s ,,notes ,page ,*ang$ f ,*ang$ to #bcg defect 9 ! excretion ( ! defect 9 ! excretion ( ! m5ses1 or =m a morbidly m5ses1 or f a morbidly #cjj oxyg5 ?\gh ! lungs4 ,! oxyg5 ?r\gh ! lungs4 ,! t]m is g5]ally re/rict$ t]m is g5]ally re/rict$ ,typos fix$2 non-/&>d spell+ & dialect reta9$4 ,enclos$ italics font 9 und]scores4