506 MORBID ANATOMY.
the pylorus, is a defined and recent ulcer, 1J by % in. in extent, and corresponding to an adhesion that existed be- tween the intestine and the dilated hepatic duct. In the gall-bladder and ducts were about a dessert-spoonful of small, round, smooth calculi.
The patient was a large, fine-looking man, forty-nine years of age, who had been subject to colic. Five weeks before death he had an attack of pain across the upper part of the abdomen, followed by jaundice ; kept his bed for a few days, but was soon about his business. Nine days before his death he was attacked in the street with violent abdominal pain, nausea, and vomiting. The nau- sea soon subsided, but he had pain in paroxysms, with ten- derness till the last. During the last five days he had hemorrhage from the bowels, and under this he sank. The small intestine contained blood ; and from the ulcer in the duodenum there hung off a large coagulum. (See Amer. Jour, of Med. Sc., July, 1852.) 1852.
Dr. John Homans, Sen.
The ulceration of the duodenum, in the above case, when there was none upon the inner surface of the hepatic duct, is interesting in connection with a case of aneurism of the arch of the aorta in the Med. Soc.'s Cabinet (No. 373), , and in which the inner surface of the oesophagus is ulcera- ated, but that of the sac is not ; and with an aneurism of the arch of the aorta, that is figured by Cruveilhier (liv. 3, pi. 4) that burst into the oesophagus, and in which the inner surface of the trachea is ulcerated, but the corre- sponding part of the sac is not. The ulceration does not go on continuously from the diseased surface, or commence upon the inner surface of the cavity that contains some- thing that is to be got rid of, but it commences, indepen- dently, upon the healthy inner surface of the canal, into which an opening is to take place.
2400. Opening between the gall-bladder and duodenum, suffi- ciently large to admit the fore-finger ; besides a smaller one. The two organs are firmly adherent, and the gall- bladder is much contracted and thickened. The opening had recently given issue to a large gall-stone (No. 2405) that was found in the ileum, one foot above the caecum ;
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