after perforation took place. The ulcer, which is in the anterior parietes, midway, is about the size of the thumb- nail ; and the perforation is about % in. in diameter. (Med. Jour. Vol. LXVII. p. 421.) 1862. Dr. F. E. Oliver. 2196. A shallow, ovoid, chronic ulcer, in the small curvature midway, about 1 in. by in., and in the base a perfora- tion about three lines in diameter. Almost directly oppo- site, and in the posterior parietes of the organ, is a second ulcer, deeper and more defined, and in extent 1 in. by | in. ; perforation being only prevented by external adhe- sions. The organ was collapsed, and otherwise healthy. The peritoneal cavity contained a large amount of pus, and of offensive gas ; and the liver was pushed very much upwards and backwards.
The patient was an ice-dealer, set. twenty-six years, and of good general health. Served in the civil war for four years, and was well during that time, excepting an attack of intermittent fever. Had also occasional cramps in the stomach, with vomiting of a greenish fluid. About two years ago, while pushing a large block of ice up an inclined plane, it slipped ; and, as he caught it with his pole, the end of this last came against the pit of his stom- ach, or near there. He was obliged, on account of the in- jury, to stop work ; and, ij. of senna having been pre- scribed, he took, by mistake, the same amount of the tincture of arnica. Soon after this he vomited a dark substance that is said to have looked like blood ; and from that time he was never well, though he attended to his busi- ness until the fatal perforation occurred.
There was generally free vomiting of a yellowish fluid r about two hours after eating ; without the food, but with relief, and usually without much nausea. Sometimes a day or two would pass without vomiting ; and several times he thought he saw blood in the matters vomited. Oppres- sion at the stomach was nearly a constant symptom, and there was quite often a pain that he compared to the " cut- ting with a dull knife," with an occasional cramp for an hour or two ; and, when going about in his wagon f he would lean forward and press upon the epigastrium. His appe- tite was quite good, and his bowels rather costive. In his
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