448 MORBID ANATOMY.
two inches and a half. In the centre of this thickened portion an old ulcer, about % in. by in. in diameter, with bevelled edges, and extending through to the liver ; and at the lower edge perforation had taken place. (Med. Jour. Vol. LXII. p. 21.) 1861.
Dr. T. E. Francis, of Brookline.
2192. The ulcer here commences at the pylorus, and involves the entire thickness, and almost the entire circumference of the organ. Parietes very little thickened or indurated ; but beneath the ulcer is a cavity larger than itself. The base of the ulcer, or rather of the cavity beneath it, which is formed by the pancreas, is perfectly smooth, with a free opening upon one side, into the peritoneal cavity.
From a gentleman, set. seventy-two years, who had been subject to pain in the epigastrium for about twenty years, coming on two or three hours after taking food, and pass- ing through to the back. He suffered also from dyspepsia, flatulence, foul eructations and constipation. About a month before his death he was in bed, with a very morbid countenance, and was supposed to have a malignant dis- ease of the stomach ; there being a vomiting of blackish matter, and a very distinct tumor in the epigastrium. This last, however, disappeared in a week or ten days ; and as the patient was otherwise relieved, the diagnosis was then doubtful.
The symptoms of perforation were less marked than usual ; and the patient had been out, and about as well as usual, a few days before. 1861.
Dr. J. B. S. Jackson.
2193. An ulcer, 1 in. long, of an oval form, and without
thickening. Perforation 2 or 3 lines in diameter, and looking as if a piece of the base had been punched out. 1862.
2194. Ulcer from an insane woman. It is in the small curva-
ture, midway, and about as large as the finger-nail. The perforation, from which the patient died, is quite large. 1865. Mr. R. L. Dryer, med. student.
2195. The same. From a woman, set. forty-eight years, who
had been generally healthy, and died about fourteen hours
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