450 MORBID ANATOMY.
general appearance he did not look sick, though he had lost flesh.
Early in the night of Feb. 9th perforation took place, and he died on the 28th at 7 p. M. The pain at first was intense, and was very greatly increased by motion ; after- wards it was very considerably diminished, but occurred in paroxysms, and towards the last it was rather dull. Pressure, however, was very tolerably borne, and as well over the epigastrium as elsewhere. At first there was great pain, also, in the left shoulder, but this gradually subsided at the end of a week. To relieve the pain, there was given throughout about three grains of morphine daily, by enema. Tympanites was slight at first, but became very great after the ninth day, and so continued till death, causing great dyspnoea. Respirations from 30-50 per min- ute ; and the pulse, which was about 70 at first, rose at last to 120.
The very unusual time that the patient survived the perforation in this case was remarkable, as death usually occurs within forty-eight hours. And it may be a question whether the external injury above referred to, or the arnica, could have had anything to do with the formation of the ulcers, inasmuch as there were some gastric symptoms before these suspected causes occurred. (Med. Jour. Vol. LXXX. p. 168, April 8th, 1869.) 1869.
Dr. Chas. E. Hosmer, of Waltliam.
2197. Two ulcers in the small curvature, and toward the pylo- rus, about half an inch in diameter, very defined, with firm, smooth, sharply cut margins, and firm bases that seemed formed by the submucous cellular coat.
From a man, aet. thirty-eight years, who had had diar- rhoea for about nine months, and commencing with dysen- tery. On admission into the hospital (71, 241) he had a feeling of oppression and pain after taking food, that led Dr. Minot, the attending physician, to suspect chronic ul- cer of the stomach. (See No. 2285.) 1864. Dr. G. Ellis.
2198. A portion of the stomach, showing an elongated, super- ficial, ill-defined ulcer, about an inch in length. Surface partially discolored, with considerable thickening upon one side, and an appearance as if it had advanced far toward
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