456 MORBID ANATOMY.
projected abruptly into the cavity from five-eighths of an inch to an inch ; outline smooth, but form slightly lobula- ted. Externally, it also projected very abruptly into the peritoneal cavity ; the form was more rounded than that of the internal tumor, and there projected from it several well-defined little tumors, the largest of which was about the size of a nutmeg. The diameter of this external por- tion was about 2 in. As the muscular portion was very distinctly traceable to a considerable extent over this last portion, and the mucous membrane was continuous over the internal tumor, it was evident that it was situated in the submucous cellular tissue.
The structure was most remarkable. At the very ex- tremity of the external portion was a mass, nearly the size of an English walnut, and which looked like the result of an old tubercular deposit ; being quite firm or tough, pearly, with a large number of small, opaque, white spots, and a trace of cretaceous matter, but without any soft deposit. This mass was for the most part well defined, and there was nothing like it seen in any other part of the tumor. The mass above referred to, as being of the size of a nut- meg, was of a dark-red color, uniform in appearance, and as soft as a quite soft spleen. The remainder of the external portion looked not very unlike this last, but it was firmer and very much coarser in structure. The internal por- tion was firm at one extremity, but less so than a fibrous tumor would be. Towards the other extremity it was quite soft, as if the structure beneath was similar to that of the exter- nal portion, and in two places it looked as if the surface was about to give way. The interior of the tumor was occupied by a cavity of some size, well defined, but rather disposed to branch, having two free openings upon the mucous surface, and extending nearly through to the old tubercular-looking mass. The other organs were healthy.
The patient was a woman, sixty-seven years of age. For about a year before death she had nausea, gastric pain, and anorexia. Vomiting very rarely occurred, al- though nausea and a distressing faintness existed nearly all the time for the last four months. Rising in bed, or turning from side to side, would increase these symptoms.
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