THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 OF CALIFORNIA 
 
 PRESENTED BY 
 
 PROF. CHARLES A. KOFOID AND 
 MRS. PRUDENCE W. KOFOID 
 
THE 
 
 MORBID ANATOMY 
 
 OF 
 
 SOME OF THE MOST IMPORTANT PARTS 
 
 OF THE 
 
 HUMAN BODY 
 
 BY 
 MATTHEW BAILLIE, M. D. F. R. S. 
 
 I'HYSICIAN EXTRAORDINABY TO THE KING, FELLOW OF THE ROYAL COLLEGE OF 
 
 1'IIYSICIANS IX LONDON, AND HONORARY FELLOW OF THE BOYAL COLLEGE 
 
 OF PHYSICIANS IN EDINBURGH, &C. &C. &C. 
 
 THIRD AMERICAN FROM THE FIFTH LONDON EDITION 
 
 PHILADELPHIA : 
 
 PRINTED AND PUBLISHED BY HICKMAN AND HAZZARJ', 
 
 No. 15, North Front Street- 
 1820. 
 
I 
 
TO 
 
 
 
 DAVID PITCAIRN, M. D. 
 
 F. R. S. &c. &c. fcc. 
 
 AS A 
 
 TESTIMONY OF HIGH ESTEEM FOR 
 
 HIS CHARACTER, 
 AND OF GRATITUDE FOR MANY KIND 
 
 OFFICES, 
 
 THIS WORK 
 
 IS INSCRIBED, 
 BY HIS FAITHFUL FRIEND AND SERVANT 
 
 MATTHEW BAILLIE. 
 
 *?- '.'"- 
 
PREFACE 
 
 TO THE FIRST EDITION. 
 
 SOME diseases consist only in morbid actions, but do 
 not produce any change in the structure of parts : these 
 do not admit of anatomical enquiry after death. There 
 are other diseases, however, where alterations in the struc- 
 ture take place, and these, become, the proper subjects of 
 anatomical examination. 
 
 The object of this work is to explain, more minutely 
 than has hitherto been done, the changes of structure 
 arising from morbid actions in some of the most important 
 parts of the human body. 
 
 This, 1 hope, will be attended with some advantage to 
 the general science of medicine, and ultimately to its prac- 
 tice. It is very much to be regretted that the knowledge 
 of morbid structure does not lead with certainty to the 
 knowledge of morbid actions, although the one be the effect 
 of the other ; yet surely it lays the most solid foundation for 
 prosecuting such enquiries with success. In proportion, 
 therefore, as we shall become acquainted with the changes 
 produced in the structure of parts from diseased actions, 
 we shall be more likely to make some progress towards 
 a knowledge of the actions themselves, although it must 
 be very slowly. The subject in itself is extremely difficult, 
 because morbid actions are going on in the minute parts 
 of an animal body excluded from observation; but still 
 the examination of morbid structure is one of the most 
 probable means of throwing light upon it. 
 
 A second advantage arising from the more attentive 
 
vi PREFACE TO THE 
 
 examination of morbid structure is, that we shall be able 
 to distinguish between changes which may have some 
 considerable resemblance to each other, and which have 
 been generally confounded. This will ultimately lead to 
 a more attentive observation of symptoms while morbid 
 actions are taking place, and be the means of distinguishing 
 diseases with greater accuracy. When this has been done, 
 it may, perhaps, produce a successful enquiry after the 
 most proper method of treatment. 
 
 Another advantage arising from a more attentive obser- 
 vation of morbid structure is, that we shall be better fitted 
 to detect diseased alterations in the organization of parts 
 which are but little, or not at all known. This will lay 
 the foundation of our enquiry into the diseases themselves, 
 so that we shall add to our knowledge of the pathology of 
 the body, and perhaps also to our knowledge of remedies, 
 
 A fourth advantage still from observing attentively 
 morbid structure is, that theories taken up hastily about 
 diseases will be occasionally corrected. The human mind 
 is prone to form opinions, upon every subject which is 
 presented to it, but from a natural indolence is frequently 
 averse to inquire into the circumstances which can alone 
 form a sufficient ground for them. This is the most gen- 
 eral cause of false opinions, which have not only pervaded 
 medicine, but almost every other branch of knowledge. 
 When, however, the mind shall be oblidged to observe 
 facts which cannot be reconciled with such opinions, it 
 will be evident that the opinions are ill founded, and they 
 will be laid aside. We grant, it does not always happen 
 that men are induced to give up their opinions, or even to 
 think them wrong, upon observing facts which do not 
 agree with them, but surely it is the best means of pro- 
 
FIRST EDITION. vii 
 
 ducing this effect; and whatever change may be wrought 
 on the individuals themselves, the world will be convinced 
 which has fewer prejudices to combat. 
 
 A person who previously had attended very accurately 
 to symptoms, but was unacquainted with the disease, 
 when he comes to examine the body after death, and finds 
 some of the appearances that are described in this Treatise, 
 will acquire a knowledge of the whole disease. He will be 
 able to guide himself on such knowledge in similar cases, 
 and also to inform others. It may perhaps, too, lead him 
 to a proper method of treatment. 
 
 When a person has become well acquainted with dis- 
 eased appearances, he will be better able to make his 
 remarks, in examining dead bodies, so as to judge more 
 accurately how far the symptoms and the appearances 
 agree with each other ; he will be able also to give a more 
 distinct account of what he has observed, so that his data 
 will become a more accurate ground of reasoning for others. 
 
 The natural structure of the different parts of the human 
 body has been very minutely examined, so that anatomy 
 may be said to have arrived at a high pitch of perfection ; 
 but our knowledge of the changes of structure produced 
 by disease, which may be called the Morbid Anatomy, 
 is still very imperfect. Such changes have commonly 
 been observed only in their more obvious appearances, 
 and very seldom with much minuteness or accuracy of 
 discrimination. 
 
 Any works explaining morbid structure which I have 
 seen, are very different in their plan from the present : they 
 either consist of cases containing an account of diseases 
 and dissections collected together in periodical publications, 
 without any natural connection among each other : or con- 
 
Yiii PREFACE TO THE 
 
 sist of very large collections of cases, arranged according 
 to some order. In some of these periodical works, the 
 diseased structure has been frequently explained with a 
 sufficient degree of accuracy, but in all the larger works 
 it has been often described too generally. The descrip- 
 tions too of the principal diseased appearances, have been 
 sometimes obscured, by taking notice of smaller collateral 
 circumstances, which had no connection with them, or 
 the diseases from whence they arose. Both of these faults 
 too frequently occur, even in the stupendous work of 
 Morgagni de Causis et Sedibus Morborum, upon which, 
 when considered in all its parts, it would be difficult to 
 bestow too high praise. Besides, the bulk of these very 
 large collections prevents them from being generally in the 
 possession of practitioners, and also renders them more 
 difficult to consult. 
 
 In the present work it is proposed not to give cases ; 
 but simply an account of the morbid changes of structure 
 which take place in the thoracic and abdominal viscera, in 
 the organs of generation in both sexes, and in the brain. 
 This will be done according to a local arrangement, very 
 much in the same manner as if we were describing natural 
 structure, and will be accompanied with observations upon 
 morbid actions which may occasionally arise. My situa- 
 tion has given me more than the ordinary opportunities of 
 examining morbid structure. Dr. Hunter's collection 
 contains a very large number of preparations exhibiting 
 morbid appearances, which I can have recourse to at any 
 time for examination. Being physician to a large hospital, 
 and engaged in teaching anatomy, I have also very frequent 
 opportunities of examining diseases in dead bodies. This 
 work will therefore chiefly contain an account of the mor- 
 
FIRST FDITION. ix 
 
 bid appearances which I have seen myself; but I shall also 
 take advantage of what has been observed by others. It 
 is intended to comprehend an account of the most common, 
 as well as many of the very rare appearances of disease in 
 the vital and more important parts of the human body* 
 From the nature of this undertaking it is evident, that it 
 must be progressive : some appearances of disease will be 
 observed in future, with which we are at present totally 
 unacquainted, and others which we know very little of 
 now, will afterwards be known perfectly. 
 
 Although I have ventured to lay this work before the 
 Public, yet I am very sensible of its imperfections. Some 
 appearances are described which I have only had an op- 
 portunity of seeing once, and which, therefore, may be 
 supposed to be described less fully and exactly than if I had 
 been able to make repeated examinations. There are others 
 which I have seen long before I had formed any idea of 
 this undertaking, and which I may be supposed to have 
 observed less accurately than if I had had a particular ob- 
 ject in view. There are others still, which I have only 
 had an opportunity of examining in preparations. In some 
 of these, certain appearances may be supposed to be lost, 
 which might have been observed had they been examined 
 recently after death. All of these are sources of inaccu- 
 racy, which may be said in some degree to be unavoidable. 
 I have endeavoured, however, to be accurate ; and if the 
 Public should approve of my plan, I shall be very careful, 
 by the addition of new materials, and by repeated obser- 
 vations, to render this publication less imperfect. 
 
PREFACE 
 
 TO THE SECOND EDITION. 
 
 A SECOND Edition of this Treatise is now offered to 
 the Public. It is considerably enlarged, and I hope more 
 correct than the former. The additions are principally 
 derived from what I have remarked myself ; but they are 
 also taken from the observations of others, and more 
 especially from those of Dr. Soemmerring, Professor of 
 Medicine in the University of Mayence, one of the most 
 distinguished anatomists in Germany. He was pleased 
 to think so favourably of my attempt to improve the 
 knowledge of diseased appearances in the human body, as 
 to translate the first Edition of the Morbid Anatomy into 
 the German language, and to add to it many new Cases, 
 and copious Notes. It has given me the most sincere 
 satisfaction, to find that our observations and opinions 
 coincide so much with those of each other. Had the 
 plan of my work been different, I might have derived 
 much more assistance from the valuable labours of Pro- 
 fessor Soemmerring, but many of the additions which he 
 has made do not strictly fall within it. 
 
 To the Morbid Appearances I have attempted to sub- 
 join the Symptoms connected with them. This part of 
 the undertaking is attended with many difficulties, and I 
 feel very sensibly, how much the execution of it stands in 
 need of the kind indulgence of the Public. If this work 
 
PREFACE TO THE ki 
 
 shall ever come to another Edition, I hope to be able to 
 render the account of Symptoms less imperfect. 
 
 The difficulties which attend an attempt to ascertain the 
 symptoms of diseases, are derived from various sources. 
 The same symptoms are not uniformly connected with the 
 same changes of morbid structure in the body. In many 
 cases too the symptoms are nearly the same, where the 
 morbid changes of structure are very different. This is 
 particularly exemplified in diseases of the brain, and of the 
 heart. Patients often explain very imperfectly their feel- 
 ings, partly from the natural deficiency of language, and 
 partly from being misled by preconceived opinions about 
 the nature of their complaints. Medical men also, in ex- 
 amining into the symptoms of diseases, sometimes put 
 their questions inaccurately, and not unfrequently mislead 
 patients into a false description, from some opinion about 
 the disease which they have too hastily adopted. All of 
 these are formidable difficulties, which obstruct the progress 
 of our knowledge of the symptoms of diseases; but the 
 accumulated observations of many individuals will probably, 
 at length, in a great measure overcome them. 
 
 In describing the symptoms of diseases, I have not 
 entered into a minute detail. This belongs properly to the 
 plan of a writer, who proposes to take a full view of any 
 particular disease. I have mentioned those symptoms only 
 which are most constant, and most strongly characteristic 
 of the diseases to which they belong. Many diseased ap- 
 pearances are described in this work, to which there are 
 added no corresponding symptoms; and this depends upon 
 different causes. The first is, that there are many morbid 
 changes of structure in the body, the corresponding symp- 
 toms of which are not ascertained. The second is-, that 
 
xii SECOND EDITION. 
 
 many morbid changes of structure are produced by causes 
 which disturb the constitution so little, as to be attended 
 with symptoms too slightly marked for observation. The 
 third and last is, that rhe symptoms belonging to some 
 diseased appearances, fall so immediately under the cogni- 
 zance of the eye, or of the touch, as to be included in a 
 description of the diseased appearances themselves, and to 
 render any further account of them superfluous. 
 
 The account of symptoms is placed at the end of each 
 chapter, after the description of the diseased appearances, 
 that the anatomical part of the work may not be interrupted. 
 In a very few instances, however, the account of the symp- 
 toms has not been separated from the anatomical description 
 of the morbid appearances, viz. where so little of the 
 symptoms was known as not to admit of a distinct account 
 being given to them. 
 
 Besides an account of morbid appearances, a few cases 
 of malformation are blended in this work. They do not 
 strictly fall within its plan; I have, therefore, added only a 
 few, which are important, and which have almost all 
 occurred to my own observation. 
 
 
ADVERTISEMENT 
 
 TO THE FIFTH EDITION. 
 
 In the year 1807 a translation of my Treatise upon 
 Morbid Anatomy into the Italian language was made by 
 Dr. Gentilini, which was published at Pavia ; but a copy 
 of it was not sent to me by the Translator till about two 
 years ago. A new translation of this Treatise into the 
 French language has also been made in 1815 by Mr. 
 Guerbois, a surgeon of reputation at Paris. Both transla- 
 tions are faithful, and are accompanied with some judicious 
 notes, which I have read with attention and advantage. 
 The present edition of my book is somewhat enlarged, 
 and is corrected, according as some of my observations 
 have appeared to be extended or limited by greater ex- 
 perience, 
 
CONTENTS, 
 
 CHAPTER I. 
 
 Diseased appearances of the Pericardium. i 
 
 Inflammation of the pericardium. Adhesions of the pericardium 
 to the heart. Dropsy of the pericardium. Scrofulous tu- 
 mours in the pericardium. The pericardium almost dry. 
 The pericardium cartilaginous and bony. The pericardium 
 wanting. Symptoms. 
 
 CHAPTER. II. 
 
 Diseased Appearances of the Heart. 12 
 
 Inflammation of the heart. White spot upon the surface of the 
 heart. Polypus. Aneurysm of the heart. Aneurysm of the 
 arch of the aorta. Ossification of the coronory arteries. Ossi- 
 fication of the semilunar valves. semilunar valves thick and 
 opaque.' Rupture of the valves. Valves between the auricles 
 and the ventricles ossified. The same valves thick and opaque. 
 Rupture of the heart. Blood in the pericardium, without a 
 rupture of the heart. Mai-formations of the heart Heart 
 enlarged. Hydatids adhering to the heart. A portion of the 
 heart bony or earthy. Symptoms. 
 
 CHAPTER III. 
 
 Diseased Appearances in the Cavity of the Thorax. 32 
 
 Inflammation. Adhesions in the cavity of the thorax. Em- 
 
 pyema. Hydrothroax. Steatomatous tumours and hydatids. 
 
 The pleura almost dry. Ossification of the pleura. Symptoms. 
 
 CHAPTER IV. 
 
 Diseased Appearances of the Lungs. 41 
 
 Inflammation. Abscesses. Tubercles. Soft pulpy tubercle. 
 Water accumulated in the substance of the lungs. Lungs 
 distended with air. Air cells of the lungs enlarged. Air 
 vesicles attached to the edge of the lungs. Lungs changed 
 into a substance like liver. Lungs converted into bone. A 
 
CONTENTS. xv 
 
 solid tumour compressing the lungs. Earthy concretions in 
 the lungs. Hydatids.- Symptoms. 
 
 CHAPTER V. 
 
 Diseased Appearances of the Thyroid Gland, the Larynx, and the 
 parts contained in the Posterior Mediastinum. 53 
 
 Inflammation of the thyroid gland. Bronchocele. Scirrhus of 
 the thyroid gland. The thyroid gland converted into bone. 
 Larnyx. The cartilages of the larnyx converted into bone. 
 Ulcers in the cavity of the larnyx. Diseased appearances of 
 the parts contained in the posterior mediastinum. Diseased 
 appearances of the trachea. Inflammation of the inner mem- 
 brane of the trachea Appearances of the trachea in the croup. 
 Polypus Trachea scirrhous. Rings of the trachea ossified. 
 Ulcer of the trachea. Diseased appearances of the oesopha- 
 gus. Spasmodic stricture of the oesophagus. Stricture from 
 the puckering of the inner membrane of the oesophagus. 
 Stricture attended with ulcer. (Esophagus cartilaginous. 
 Fungus in the pharynx. Scrofulous swelling in the pharynx. 
 Pouch formed at the lower end of the pharynx. The de- 
 scending aorta aneurysmal. The vena azygos varicose. The 
 vena azygos ruptured. The thoracic duct varicose. Thoracic 
 duct obstructed. Thoracic duct ruptured. Absorbent glands 
 scrofulous. Absorbent glands scirrhous. Absorbent glands 
 bony. Diseased appearances of the anterior mediastinum. 
 Diseased appearances of the thymus gland. Symptoms. 
 
 CHAPTER VI. 
 
 Diseased appearances within the Cavity of the Abdomen. 77 
 
 Ascites. Chyle in the cavity of the peritonaeum. Inflammation, 
 of the peritonaeum. Adhesions in the cavity of the abdomen. 
 Scrofulous tumours adhering to the peritonaeum. Cancer- 
 ous tumours adhering to the peritonaeum. Cartilaginous ex- 
 crescences growing from the peritonaeum. Steatomatous tu- 
 mours adhering to the peritonaeum Hydatids in the abdo'men. 
 Air in the cavity of the abdomen. Symptoms. 
 
 CHAPTER VII. 
 
 Diseased Appearances of the Stomach. 88 
 
xvi CONTENTS. 
 
 Inflammation. Appearances in hydrophobia.Ulcers in the 
 stomach. Scirrhus and cancer of the stomach. Circumscribed 
 scirriious tumours in the stomach. Pouch formed in the 
 stomach. Stricture at the pylorus. Fungous tumours ob- 
 structing the pylorus. Stomach much contracted, or much 
 enlarged Stomach distended with air. Part of the stomach 
 disolved by the gastric juice Fatty tumours in the stomach. 
 Calculi in the stomach Morbid papillae observed in the 
 
 stomach Small-pox pustules said to be in the stomach 
 
 Symptoms. 
 
 CHAPTER VIII. 
 
 Diseased Appearances in the Intestines. 99 
 
 Inflammation. -Intus-susceptio. Ruptures. Hernia congenita. 
 i-Scirrhus and cancer of the intestines. Diseased change of 
 the intestines in dysentery. Thickened folds of the inner 
 membrane of the great intestines. Polypous tumours. A 
 milt-like tumour. Piles. Fistulae in ano. The rectum ter- 
 minating iu a cul-de-sac. The rectum terminating in the 
 bladder. Worms. Lumbricus teres. Tsenia solium. 
 Tsenia lata. Ascaris. Trichuris. Air accumulated in the 
 intestines. Bony matter in the intestines. Projecting ring 
 formed in the cavity of the jejunum. Concretions in the in- 
 testines. Small-pox pustules said to be in the intestines. 
 Mesentery inflamed Mesenteric glands scrofulous. Mesen- 
 teric glands cancerous. Mesenteric glands earthy or bony. 
 Symptoms. 
 
 CHAPTER IX, 
 
 Diseased Appearances of the Liver. 133 
 
 Inflammation of the membrane of the liver. Adhesions. Coats 
 of the liver converted into cartilage. Inflammation of the 
 substance of the liver. Common tubercle of the liver. 
 Large white tubercle of the liver. -Soft brown tubercles of 
 the liver. Scrofulous tubercles of the liver. Liver flaccid 
 with reddish tumours. Liver very soft in its substance. 
 Liver very hard in its substance. Hydatids. Cysts in the 
 liver containing an earthy matter. Rupture of the liver. 
 Worms said to be in the liver. Symptoms. 
 
CONTENTS. xvii 
 
 CHAPTER X. 
 
 Diseased Appearances in the Gall-bladder. 150 
 
 Inflammation of its coats. Adhesions. Ulcers in the gall- 
 bladder. Coats of the gall-bladder thickened, and hard tuber- 
 cles formed in them. Coats of the gall-bladder bony 
 Dilatation of the biliary ducts. Obliteration of the biliary 
 ducts. A preternatural canal of communication between the 
 gall-bladder and the stomach. Gall-stones. Bile. Gall- 
 bladder distended with bile. Hydatids in the gall-bladder. . 
 The, bladder wanting. Symptoms. 
 
 CHAPTER XL 
 
 Diseased Appearances of the Spleen. 161 
 
 Inflammation of the coats of the spleen Adhesions Coats of 
 the spleen cartilaginous. Inflammation of the substance of 
 the spleen. The spleen extremely soft. The spleen very- 
 hard. Tubercles in the spleen. Spleen very large Hydatids 
 in the spleen, Stony concretions in the spleen. The spleen 
 ruptured. Several small spleens. Spleen said to be wanting. 
 Symptoms. 
 
 CHAPTER XII. 
 
 Diseased Appearances of the Pancreas. 169 
 
 Abscesses of the pancreas. Pancreas hard. Calculi of the 
 pancreas. Steatomatous tumours Pancreas wanting.- 
 Symptoms. 
 
 CHAPTER XIII. 
 
 Diseased Appearances of the Kidneys and the Renal Capsules. 173 
 Capsule of the kidneys inflamed. Abscesses of the kidneys. 
 Scrofulous tubercles in the kidneys Kidneys scirrhous. 
 State of the kidneys in diabetes. Kidneys very soft. Hydatids 
 of the kidneys. Calculi of the kidneys. Kidneys earthy and 
 bony. Original varieties in the kidneys. Diseased appear- 
 ances of the renal capsules. Abscess in the renal capsules. 
 Renal capsules scrofulous. Symptoms. 
 
 CHAPTER XIV. 
 
 Diseased Appearances of the Bladder. 184 
 
 Inflammation of the peritonaea! covering. Inflammation of the 
 
 inner membrane, Ulcers, Scirrhus and cancer. Fungous 
 
xvui CONTENTS. 
 
 excrescences Polypus of the bladder. Elongations of the 
 inner membrane. Veins of the inner membrane of the bladder 
 enlarged and varicose. Cysts communicating with the bladder. 
 Muscular coat thickened. The bladder divided into two 
 chambers. Calculi. Bladder distended. Bladder contrac- 
 ted. The anterior part of the bladder wanting. The bladder 
 and the rectum communicating from mal -formation. Part of 
 the bladder in a hernial sack. Symptoms. 
 
 CHAPTER XV. 
 
 Diseased Appearances of the Vesiculae Seminales. 203 
 
 Vesiculse seminaies inflamed. Vesiculae seminales scrofulous. 
 
 Duels of the vesiculae seminales terminating in a cul-de-sac. 
 
 Vesiculae seminales very small. One of the vesiculse seminales 
 
 wanting. Vesiculae seminales scirrhous. Symptoms. 
 
 CHAPTER XVI. 
 
 Diseased Appearances of the Prostate Gland. 206 
 
 Abscess in the prostate gland. Scrofula of the prostate gland. 
 
 Scirrhus of the prostate gland. Calculi in the ducts of the 
 
 prostate gland. Ducts of the prostate gland enlarged. The 
 
 prostate gland preternaturally small. Symptoms. 
 
 CHAPTER XVII. 
 
 Diseased Appearances of the Urethra. 212 
 
 Abscesses. Fistulae. Stone in the cavity of the membranous 
 part of the urethra. Cowper's glands seldom observed to be 
 Diseased. Inner membrane of the urethra inflamed. Ulcers 
 in the urethra. Stricture. Caruncle. Enlargement of the 
 mucous glands of the urethra. A layer of earthy matter in 
 the urethra. Preternatural orifice of the urethra. Symptoms. 
 
 CHAPTER XVIII. 
 
 Diseased Appearances of the Testicles and the Spermatic Chord. 2 1 8 
 
 Hydrocele. Hydatids. Loose cartilages in the tunica vaginalis 
 
 testis. Adhesions. Testicle inflamed. Abscesses of the 
 
 testicle. Testicle Scrofulous. Testicle enlarged and pulpy. 
 
 Scirrrhus and cancer of the testicle. Testicle cartilaginous. 
 
 1 Testicle bony. A cyst adhering to a testicle containing a 
 
CONTENTS, xix 
 
 vena medinensis. The epididymis ending in a cul-de-sac.- 
 Stricture of the vas deferens. Testicles very small, and wasted. 
 Spermatic chord scirrhous. Veins of the spermatic chord 
 varicose. Water accumulated in the cellular membrane of 
 the spermatic chord. A sack containing water formed in the 
 spermatic chord. Symptoms. 
 
 CHAPTER XIX. 
 
 Diseased Appearances in the Female Organs. 228 
 
 Inflammation of the uterus. Malignant ulcer of the uterus. 
 Hardness and enlargement of the uterus. Tubercles of the 
 uterus. Polypus. The inversion of the uterus. Prolapsus 
 uteri. Stricture in the cavity of the uterus. The os uteri 
 contracted and closed up. Uterus bony. The uterus changed 
 into an earthy substance. A bony mass in the cavity of the 
 uterus. Stones in the cavity of the uterus. Dead foetus in 
 the uterus converted into an earthy mass. Water in the 
 cavity of the uterus. Hydatids in the uterus. Air in the 
 uterus Rupture of the uterus. Two uteri Natural varie- 
 ties in the uterus. Symptoms. 
 
 CHAPTER XX. 
 
 Diseased Appearances of the Ovaria. 243 
 
 Inflammation of the peritonaeal covering of the ovaria. Inflam- 
 mation of .the substance of the ovaria. Enlargement and 
 hardness of the ovaria. Ovaria enlarged and changed into a 
 pulpy substance. Ovaria scrofulous. Dropsy of the ovaria. 
 The ovaria changed into a fatty substance with hair and teeth. 
 A foetus in the ovarium. Shrinking of the ovaria. One 
 ovarium or both wanting Symptoms. 
 
 CHAPTER XXI. 
 
 Diseased Appearances of the Fallopian Tubes. 251 
 
 Inflammation of the Fallopian tubes Adhesions. Dropsy of 
 the Fallopian tubes. The Fallopian tubes terminating in a 
 cul-de-sac. An ovum in the Fallopian tube. A hard tumour 
 growing from a Fallopian tube. Diseased appearances of the 
 round ligaments, 
 
xx CONTENTS. 
 
 CHAPTER XXII. 
 
 Diseased Appearances of the Vagina. 256 
 
 Inflammation of the vagina Adhesion of the sides of the vagina. 
 
 Ulcers in the vagina. Scirrhous tumours in the vagina 
 
 Inversion of the vagina. The vagina very short. The vagina 
 widened The vagina very narrow.Symptoms. 
 
 CHAPTER XXIII. 
 
 .Diseased and Preternatural Appearances of the external Parts. 26$; 
 The hymen imperforated. The clitoris enlarged. The nymphae 
 enlarged. The external labia growing together, 
 
 CHAPTER XXIV. 
 
 Diseased Appearances of the Brain and its Membranes. 265 
 
 Inflammation of the dura mater. Scrofulous tumours connected 
 with the dura maiei . Spongy tumours growing from the dura 
 mater. Bony matter formed in the dura mater. Very strong 
 adhesion of the dura mater to the cranium. Diseased appear- 
 ances of the tunica arachnoides. -Veins of the pia mater turgid 
 with blood. The pia mater inflamed. Scrofulous tumours 
 adhering to the pia mater. Air in the vessels of the pia mater* 
 Hydatids -A part of the pia mater bony. Diseased Ap 
 pearances in the substance of the brain. Inflammation. - 
 Abscesses. Gangrene. The brain very soft. The brain very 
 firnl .A white firm substance formed in the brain. Encysted 
 tumours and Hydatids.- Bony tumours pressing upon the brain . 
 Bony ridges irritating the brain. Hdrocephalus. Water on 
 the surface of the brain, or between its membranes. Air 
 between the membranes of the brain and in its ventricles. 
 Blood effused or extravasated. Cavities in the brain containing 
 a serous fluid. Aneurysm of the internal carotid arteries on 
 the side of the sella turcica. Little bags in the plexus choroides. 
 Round tumours adhering to the plexus choroides. Earthy 
 matter in the pineal gland Pineal Gland said to be scirrhous. 
 Water in" the pineal gland. Diseased appearances of the 
 pituitary gland. Diseased appearances of the nerves. Mai 
 formations of the brain.- Symptoms- 
 
THE 
 
 MORBID ANATOMY 
 
 OF 
 
 SOME OF THE MOST IMPORTANT PARTS 
 
 OF THE 
 
 HUMAN BODY. 
 
 CHAPTER I. 
 
 DISEASED APPEARANCES OF THE 
 PERICARDIUM, 
 
 Inflammation of the Pericardium. 
 
 THE pericardium, or the membrane which surrounds 
 the heart like a bag, and is reflected upon its surface, 
 giving it a smooth external covering, is liable to inflam- 
 mation. This is not a very common disease, although it 
 happens sufficiently often to afford frequent opportunities 
 of examining its effects after death. The disease, from 
 its nature^ cannot be confined to any particular periods 
 of life; yet from what I have seen, I should believe that 
 it takes place more commonly when the body has been 
 for some time in its adult state, than either in childhood 
 or advanced age. 
 
 In inflammation of the pericardium, the membrane is 
 generally thicker than in its natural state, and is also a 
 little more pulpy. This change depends upon additional 
 
 A 
 
matter being thrown into the membrane by the increased 
 action of the small vessels which are distributed upon it. 
 It is also crowded with a very unusual number of minute 
 vessels, which contain florid blood. Upon the inside of 
 the pericardium there is a layer of a yellowish pulpy 
 matter, which commonly does not adhere firmly to it, but 
 may be easily separated. It generally extends over the 
 whole of its inner surface, and varies a good deal in its 
 thickness. In some instances it is as thin as a wafer, and 
 in others as thick as a half-crown. In this matter, which 
 is lining the pericardium, there is frequently to be seen a 
 slight red appearance, from small blood vessels which are 
 ramifying through it: but these are most distinctly detected 
 by filling them with the fine injection. They are some- 
 times numerous, and may be clearly traced passing from 
 the pericardium into the pulpy matter; in which I have 
 also seen small spots of florid blood. These newly formed 
 vessels afford a very convincing proof of this extravasated 
 matter possessing a living principle; for one cannot imagine 
 that blood vessels would shoot into, and form a number of 
 new branches in a substance which is dead.* Upon its 
 inner surface, this matter very frequently throws out little 
 irregular laminated processes, giving the appearance of a 
 lace- work, and junctions are often formed between that 
 portion of it lining the pericardium, which is reflected like 
 a bag, and that other portion lying upon the pericardium, 
 which is the immediate covering of the heart. This matter 
 has a very close resemblance, both in colour and structure, 
 to the coagulable lymph of the blood, and is probably 
 nothing else than this substance separated from the blood by 
 
 * This is an argument used by Mr. Hunter, in suppport of the living princi- 
 ple of the blood" " 
 
a particular action of the small vessels of the pericardium. 
 
 At the same time that this layer of pulpy matter is 
 formed upon the inner surface of the pericardium, there 
 is accumulated in its cavity more or less of a brownish or 
 yellowish fluid. There is sometimes only a few ounces 
 of it; at other times more than a pint. In it are floating 
 loose shreds of the pulpy matter formerly described, and 
 there is also occasionally some mixture of pus. This fluid 
 resembles in its properties the serum of the blood, and 
 has commonly been considered as the serum. 
 
 Inflammation of the pericardium sometimes advances 
 to form pus, although rarely. Of this I have seen one in- 
 stance. The pericardium was much thickened, was in- 
 flamed, and lined with coagulable lymph; but there was 
 no sign of ulceration in any part of it. This last circum- 
 stance will be more particularly taken notice of when we 
 come to speak of the diseased appearances of the pleura. 
 The pericardium in this case, contained more than a quart 
 of common pus. When that part of the pericardium is 
 inflamed which forms the immediate covering of the heart, 
 the muscular substance of the latter is occasionally in- 
 flamed to some depth. 
 
 When the pericardium, or any other membrane lining 
 a circumscribed cavity, is inflamed, and a layer of coagula- 
 ble lymph is formed upon its surface, a peculiar disposi- 
 tion is given to the coagulable' lymph by the action of the 
 small vessels which pour it out. This peculiar disposition 
 is its tendency to immediate coagulation. As soon as the 
 coagulable lymph is thrown out upon an inflamed surface, 
 one must suppose that it immediately coagulates. If it 
 did not immediately coagulate, but remained for some 
 time fluid, as in the spontaneous separation of the con- 
 
stituent parts of the blood in a bason after common 
 bleeding-, then the coagulable lymph would form a small 
 cake at the bottom of the serum, easily moveable from one 
 part of the cavity to another, and would not form a layer 
 adhering to the surface of the inflamed membrane. 
 
 The serum is generally in a much larger quantity, than 
 could take place in consequence of its mere spontaneous 
 separation from the coagulable lymph which is spread 
 upon the surface of the inflamed membrane. The blood 
 vessels, therefore, which are distributed in the layer of the 
 coagulable lymph, would seem to pour out some quantity 
 of serum. While the inflammation is receding, and the 
 coagulable nymph is changing into adhesions, the serum 
 is generally taken up from the cavity ; and this effect must 
 be supposed to be produced by the action of absorbent 
 vessels. The membrane of adhesions must therefore have 
 absorbent vessels belonging to it, which have probably 
 been formed by the elongation or growth of the absorbents 
 of the inflamed membrane, shooting into the coagulable 
 lymph. 
 
 Besides serum, we have mentioned that pus is some- 
 times found in an inflamed circumscribed cavity. When 
 this is the case, it seems extremely probable that the small 
 arteries, distributed in the layer of the coagulable lymph, 
 have poured out the pus. This, I believe, has not hitherto 
 been thought of; but it is difficult to conceive under these 
 circumstances any other source from whence the pus is 
 derived. If the pus be supposed to be formed by the arte- 
 ries which ramify in the inflamed membrane itself, then it 
 must transude through a layer of coagulable lymph, which 
 is often of considerable thickness, before it accumulates 
 in the cavity. This, however, is not likely; and as arteries 
 
pass from the original membrane into the layer of the co- 
 agulable lymph, it becomes more reasonable to suppose 
 that pus is formed by the arteries distributed in the co- 
 agulable lymph, than in the original membrane itself. 
 
 Adhesions of the Pericardium to the Heart. 
 
 In opening dead bodies, adhesions of the pericardium 
 to the heart, are not uncommonly found. The adhesion is 
 sometimes at different spots; at other times is extended 
 over the whole surface. It either consists of a thin mem- 
 brane, or of a more solid matter. When it is a thin mem- 
 brane, it resembles exactly the common cellular membrane 
 of the body; and when the matter is solid, it differs onl} r 
 a little from the coagulable lymph of the blootl, recently 
 poured out upon an inflamed surface. Whether the ad- 
 hesion be in the one way or the other, the matter of the 
 adhesion is in both cases capable of being rendered vas- 
 cular by injection. The adhesion too is in both cases 
 formed from the pulpy matter formerly explained, for I 
 have oftener than once had an opportunity of tracing its 
 gradual changes into each. Such adhesions are to be 
 considered as the consequence of inflammation, and shew 
 that an inflammation of the pericardium may be survived. 
 They connect the pericardium in different cases, more 
 closely or loosely to the surface of the heart. Where the 
 connection is close, the inflammation has probably been 
 more recent, and where it is loose, the inflammation has 
 probably been of older date, so that time has been given 
 for the adhesions to be elongated by the motion of the heart, 
 
 Dropsy of the Pericardium. 
 This disease is not uncommon, and I believe is most 
 
frequent at an advanced period of life. I have seen it, 
 however, in persons considerably under the age of thirty; 
 and it probably also happens occasionally in childhood. 
 I have seen oftener than once, both anasarca and ascites in 
 children under twelve years old, which is as improbable 
 as the accumulation of water in the pericardium. Water 
 is sometimes found accumulated in the pericardium, while 
 there is none in any other cavity; but generally it is ac- 
 companied with the accumulation of water in the other 
 cavities of the thorax. 
 
 This water varies a good deal in quantity, amounting 
 in some cases hardly to two ounces, and in others to more 
 than a pint. Although the quantity be large which may 
 happen to be accumulated, yet the pericardium is never 
 very much stretched ; but it always appears as if it could 
 contain a greater quantity. It is probable, therefore, that 
 the pericardium may really grow so as to keep pace with 
 the accumulation ; and this would seem to be necessary, 
 in order that the heart may have room for dilating its 
 several cavities. 
 
 The fluid which is accumulated, is of a brown colour, 
 having a darker or lighter shade in different cases, and 
 resembles in its properties the serum of the blood. If the 
 person should happen at the same time to have jaundice, 
 then the fluid has a yellow tinge from the bile. It has, 
 however, frequently a yellowish colour, like the serum, 
 without there being any reason to suppose that bile has 
 been circulating with the blood. 
 
 Scrofulous Tumours in the, Pericardium. 
 
 1 had once an opportunity of seeing two or three 
 scrofulous tumours, growing within the cavity of the 
 
pericardium, one of which was nearly as large as a Walnut- 
 They consisted of a white soft matter, somewhat re- 
 sembling curd or new cheese. The pericardium is a very 
 unusual part of the body to be attacked by scrofula, and 
 therefore this must be considered as a very rare appearance 
 of disease. 
 
 The Pericardium almost dry. 
 
 I have twice found (and it has been seen much oftener 
 by an anatomist,* whose authority is of great weight) the 
 pericardium so changed as to resemble a common ox's 
 bladder in some degree dried; or like a common peri- 
 cardium which has been for some time exposed to the air. 
 As the thorax and abdomen were entire in both cases, no 
 opening whatever having been made into either, this 
 effect could not arise from evaporation. Were this 
 capable of taking place, the appearance here noticed, 
 would be very usual in examining dead bodies, and the 
 internal parts generally would be aifected by the influence 
 of the same cause. It must be considered therefore as the 
 effect of a process which was going on during life. The 
 cause of this appearance is either a defect in the action of 
 the exhalent vessels of the pericardium, so that the fluid 
 which naturally lubricates this part, is not secreted in the 
 proper quantity: or it is an increased action of the ab- 
 sorbent vessels of the pericardium, by which the lubri- 
 cating fluid is taken up in larger proportion than it is de- 
 posited by the exhalent arteries. 
 
 * Mr. Hunter. 
 
The. Pericardium^ cartilaginous, and bony. 
 
 A portion of the pericardium, has in some instances 
 been observed to be converted into cartilage,"* and in 
 others into bone, f but both of these changes are very un- 
 common. 
 
 I had an opportunity lately of examining an instance 
 of the latter sort, in which the ossific process had spread 
 over a considerable portion of the pericardium. A carti- 
 laginous state of the pericardium has not fallen under my 
 own observation. 
 
 The Pericardium wanting. 
 
 A few instances have occurred, in which the pericardium 
 has been wanting, from a defect in the original formation. 
 When this deficiency takes place, the heart appears per- 
 fectly bare and distinct to the eye, upon removing the 
 sternum and the cartilaginous extremities of the ribs. The 
 external surface of the different cavities and blood vessels 
 of the heart is seen as distinctly as when the pericardium 
 is laid open in the natural structure of these parts. A 
 close and uniform adhesion of the pericardium to the 
 heart has sometimes been mistaken for this malformation, 
 but they are very different from each other. When 
 there is a close adhesion of the pericardium to the heart, 
 the external surface of the different cavities and blood 
 vessels of this organ does not come into view, upon re- 
 moving the sternum and a part of the ribs. The whole 
 of this appearance is as completely hid as in the healthy 
 structure. It is only when the adhesion is removed by 
 dissection that the external surface of the heart and blood 
 
 * See Morgagni cle Causis et Sr-dibus Morborum, Epist, XXII. Art. 1C 
 f See Ronctus, Tom. 1. p. 5R" 
 
dissection that the external surface of the heart and blodd 
 vessels comes into view. When there is an adhesion of 
 the pericardium to the heart, this membrane adheres at 
 the same time closely to the tendinous part of the dia- 
 phragm ; but when there is an original want of the peri- 
 cardium, the heart lies loose in the cavity of the chest, 
 having no connection whatever with the diaphragm, 
 and is covered by the pleura, like the lungs. I have had 
 an opportunity of seeing once an example of a want of 
 the pericardium, and have described it in the Medical 
 and Chirurgical Transactions.* 
 
 SYMPTOMS. 
 
 The symptoms attending inflammation of the peri- 
 cardium, cannot be distinguished in practice from in- 
 flammation of the substance of the heart. Wherever 
 the inflammation of the pericardium is violent, the muscu- 
 lar substance of the heart is inflamed to some depth, and 
 therefore the inflammations of both parts are often blended 
 together. The symptoms, which have been observed, 
 are Symptomatic Fever; pain in the region of the heart; 
 most commonly, but not constantly, palpitations, and 
 an irregular pulse: cough; difficulty of breathing; and 
 sometimes syncope. 
 
 * See page 91, Vol. I. 
 
 -T *^*t Rh tt^^^m 
 
 B 
 
10 
 
 * The symptom's attending the adhesions of the peri- 
 cardium to the heart are not so clearly marked as to be 
 well distinguished in practice. When the adhesions 
 are partial and long, so that the heart can enjoy a free 
 play within the pericardium, probably little or no in- 
 convenience is felt. But when the adhesions are close, 
 and extend generally over the surface of the heart, the 
 following symptoms have been observed, viz. a sense of 
 oppression, and sometimes of pain in the situation of 
 the heart; a pulse often irregular and intermittent ; diffi- 
 culty of breathing, and sometimes a dry cough. 
 
 When water is accumulated in the pericardium, the 
 symptoms are found to resemble very much those be- 
 longing to hydrothorax, and have not been clearly dis- 
 tinguished from them by authors. These symptoms will 
 be afterwards mentioned when we come to hydrothorax. 
 It may perhaps serve as some imperfect ground of dis- 
 tinction between the two diseases, that the feeling of 
 oppression is more accurately confined to the situation of 
 the heart, and the heart is more disturbed in its functions, 
 in dropsy of the pericardium, than in hydrothorax. It 
 ought at the same time to be remarked, that the two 
 diseases are often blended ; in which case, these grounds 
 of distinction cannot be applied. 
 
 The case of scrofulous tumours growing upon the 
 inside of the pericardium, which I have described, was 
 combined with tubercles of the lungs; and the person 
 
. 
 
 died with the common symptoms of pulmonary con- 
 sumption. Nothing occurred which led to any suspicion 
 of a disease in the pericardium. It is reasonable to sup- 
 pose, that when scrofulous tumours grow in the peri- 
 cardium 9 there will hardly be any inconvenience felt while 
 they are small ; but when they enlarge very much in size, 
 they will necessarily prevent the full dilatation of the 
 heart, and disturb its functions. This, however, will 
 probably be very difficult to be distinguished from the 
 disturbance produced by other causes, which must in 
 the same manner impede the free action of the heart; as, 
 for instance, the accumulation of water in the pericardium,, 
 
 The symptoms produced by a defect of the lubri- 
 cating fluid in the pericardium are at present unknown. 
 
12 
 
 *' 
 
 CHAPTER II. 
 
 DISEASED APPEARANCES OF THE HEART. 
 
 Inflammation of the Heart. 
 
 INFLAMMATION of the substance of the heart is a rare 
 disease, and is most commonly connected with an in- 
 flammation of the pericardium. When the pericardium 
 covering its surface is inflamed, the inflammation some- 
 times passes a little way into the substance of the heart. 
 That part of it becomes much more crowded with small 
 vessels than in its natural state, and sometimes are to be 
 seen in it a few spots of extravasated blood. The sub- 
 stance of the heart may however be inflamed, without 
 inflammation of the pericardium. I recollect an instance 
 of this sort, where no marks of inflammation could be 
 observed in that membrane, but where there was a little 
 more water than usual in its cavity. 
 
 Authors have mentioned cases of abscesses and ulcers* 
 of the heart, but these I am persuaded are extremely 
 rare. It happens still more rarely that the heart becomes 
 mortified, although this diseased state of it has also been 
 observed.! 
 
 White Spot upon the Surface of the Heart. 
 
 In opening dead bodies, there is very often to be seen 
 
 
 
 * Vid. Morgagni, Epist. XXV. Artie. 17. Vid. Bonet. Tom. I. p. 849; and 
 also Lieutaud, Tom. II. p. 27. 
 tVid. Lieutaud, Tom. II, p. 33 
 
13 
 
 upon the surface of the heart, a white opaque spot like 
 a thickening of the pericardium. This is sometimes 
 not broader than a sixpence; at other times as broad as 
 a crown-piece. It is most commonly on the surface of 
 the right ventricle, and is rarely to be seen either on the 
 surface of the left ventricle, or of the auricles, although 
 it is occasionally on both. 
 
 It consists of an adventitious membrane, formed on a 
 portion of the pericardium which covers the heart, and 
 may easily be dissected off, so as to leave the pericardium 
 entire. It is an appearance, I believe, of no consequence 
 whatever, and is so very common, that it can hardly be 
 considered a^ a disease, 
 
 Polypus. 
 
 This has been considered by the older anatomists, as 
 a very common and a very fatal disease. By many of 
 the moderns it has been rejected as a disease altogether. 
 It consists of a mass of coagulable lymph, which fills up 
 some of the large cavities of the heart, particularly the 
 ventricles, and extends into the neighbouring large vessels. 
 
 The coagulable lymph is of a yellowish white colour, 
 sometimes of a yellow colour, and has considerable firm- 
 ness. It fills up the cavity completely, or nearly so, in 
 which it is found; and in the ventricles it shoots out 
 processes among the fasciculi of the muscular fibres. 
 From this circumstance probably it has derived its name. 
 It also extends into the larger arteries which arise from 
 the ventricles, and is often moulded to the shape of the 
 semi-lunar valves at their origin. The examples of this 
 appearance which it has occurred to me to observe, have 
 been chiefly in preparations, and had undoubtedly taken 
 
14 
 
 place after death. In order that the circulation may be 
 carried on, it is necessary that the cavities of the heart 
 be free for the transmission of blood; and if any one of 
 its cavities should be plugged up, the circulation would 
 necessarily be stopped altogether. A polypus, however, 
 plugs up the cavity of the heart in which it is formed so 
 entirely, as to prevent the circulation. It may be said, 
 perhaps, that polypi are formed gradually, and that the 
 circulation is carried on for some time, although very 
 imperfectly. In by much the greater number of polypi, 
 however, when examined, there is the same sort of ap- 
 pearance throughout their whole substance; which shews 
 that the whole coagulum had been formed at the same 
 time. These circumstances seem to contradict strongly 
 the opinion, that polypi in general are formed during 
 life. When polypi are formed, I believe that the co- 
 agulation of the blood does not take place very quickly 
 after death. They are without any admixture of the 
 red globules of blood, and therefore the blood has been 
 sufficiently long in coagulating to allow the globules to 
 separate from the other parts, in consequence of their 
 greater specific gravity.* 
 
 The ordinary coagulation of the blood, which com- 
 monly do not fill up very fully the cavities of the heart 
 (although instances occasionally occur of this sort) take 
 place pretty soon after death, because the red particles 
 
 * In some instances, a coagulum of blood has been found, of a laminated 
 texture, in such parts of the heart as are most remote from the direct current 
 of the circulation. This laminated texture shews that the coagulation had 
 taken place during life, and in a gradual manner. Two cases of this kind have 
 been observed by Mr. Brodie, who is well known to the public, as an ex- 
 cellent anatomist and physiologist. Such cases of coagulation are much less 
 complete than those which have been generally called polypi, and which filj 
 up entirely one or more of the large cavities of the heart. 
 
15 
 
 of the blood are generally arrested in the coagulum. It 
 may be worth while to remark, that there is sometimes 
 found a portion of a coagulum in one of the ventricles of 
 a yellow colour, and with an oily appearance, so as to 
 resemble exactly fat. There is, however, no admixture 
 of oil in it, and it possesses all the ordinary properties of 
 the coagulable lymph. The yellow colour of a coagulum, 
 sometimes depends on a portion of the bile having cir- 
 culated with the blood during life, as in cases of jaundice; 
 but it takes place also when there is no reason to suppose 
 that bile is mixed with the blood. 
 
 Aneurysm of the Heart. 
 
 It sometimes happens, although I believe very rarely, 
 that the heart becomes aneurysmal. This disease consists 
 in a part of it being dilated into a pouch, which is com- 
 monly more or less filled with coagulated blood. Of this 
 disease I have only seen one instance. The apex of the 
 left ventricle was dilated into a pouch targe enough to 
 contain a small orange, was much thinner than in the 
 healthy structure, and was lined with a thick white opaque 
 membrane. There was hardly contained in it any 
 coagulated blood; but the quantity of the coagulated 
 blood, in an aneurysm, depends commonly on the size 
 of the bag. 
 
 This disease most probably arose from the muscular 
 structure at the apex of the ventricle having become 
 weaker than in any other part, so that when the ventricle 
 contracted upon the blood, it was pushed against the 
 weakened part, which was not fully able to resist its im- 
 petus, and therefore was gradually dilated. Had the 
 strength of the apex of the left ventricle been in due pro 
 
id 
 
 portion to that of the other parts, it would seem impossi- 
 ble that the aneurysmal swelling should ever have taken 
 place. 
 
 Aneuyrism of the Arch of the Aorta. 
 
 The most frequent situation of aneurysm within the 
 cavity of the thorax, is at the arch of the aorta. In this 
 disease the arch of the aorta is much enlarged beyond 
 its usual size, sometimes forming an uniform tumour; 
 sometimes a large swelling, which arises out of the arch 
 of the aorta by a neck or narrower portion; and sometimes 
 smaller swellings arise out of the larger one. Where the 
 swelling is uniform in its shape, there is reason to believe 
 that there has been a considerable dilatation of all the 
 coats of the artery. Where the swelling arises from the 
 arch of the aorta by a neck or narrower portion, the iqner 
 and middle coat of the artery have been burst or ulce- 
 rated, and a dilatation takes place in the outer coat, which 
 is strengthened by the condensation of the parts immedi- 
 ately surrounding it.* 
 
 The coats of the artery, both at the place where the 
 aneurysm is formed, and near it, are considerably altered 
 from their natural structure. They are more readily 
 divisible into different layers, than where the artery is 
 sound, and spots of bony matter are often formed in them. 
 These spots are frequently of a yellowish colour, and are 
 formed either in the internal membrane of the artery, or 
 immediately behind it. 
 
 The coats of the artery in the neighbourhood of the 
 aneurysm, are often found to be very irregular in their 
 
 * See Scarpa's well known work upon aneurysm, and an excellent treatise 
 on the Diseases of Arteries and Veins, by Mr. Hodgson in several passage?. 
 
17 
 
 texture, being in some places transparent and thin, in 
 others thick and opaque; and there is sometimes the ap- 
 pearance of a double internal membrane. The same sort 
 of structure is also sometimes to be found in the coats of 
 the aneurysm itself. The arteries near an aneurysm are dis- 
 eased to a greater or less extent in differeift persons; but I do 
 not recollect one instance in which they were totally free 
 from disease. 
 
 The disease sometimes ends fatally , by the enlarged 
 artery bursting, and the blood escaping into the cavity of 
 the pericardium; but it often has a further progress; the 
 swelling of the aneurysm gradually increases, till at length 
 it presses against the sternum, and the cartilaginous ex- 
 tremities of some of the ribs. This pressure occasions 
 a portion of the sternum and of the ribs to be absorbed, 
 and the tumour is thereby perceived externally. The 
 absorption of the sternum and ribs goes on very gradually, 
 and is not accompanied with the formation of pus. The 
 tumour gradually increases in size, till perhaps it is 
 as large as a child's head at birth ; a part of the skin be- 
 comes in some measure dead, and cracks from distention 
 at the highest point of the tumour; a portion of the 
 coagulated blood is forced out by the impetus of the 
 circulation, and the person, in general, is cut off in- 
 stantaneously. The blood sometimes oozes out slowly, 
 and the person sinks gradually under its loss. 
 
 Aneurysms at the arch of the aorta, as well as in every 
 other part of the arterial system, arise generally from the 
 coats of the artery being previously diseased, which are 
 thereby unable to resist sufficiently the impetus of blood 
 that strikes against them. This is obvious, both from 
 
18 
 
 the diseased structure of the coats of an aneurysm Itself,, 
 and of the artery in its neighbourhood. 
 
 I have also found very frequently diseased appearances 
 in the arch of the aorta, which had not advanced far 
 enough to produce aneurysm. These are white or yellow- 
 ish opaque spots? which present themselves to view in 
 looking upon the inner surface of the artery, and often 
 consist of a curdy or atheromatous matter which is 
 placed between the middle and inner coat. Under such 
 circumstances these coats of the artery are more easily 
 separable from each other than in the healthy state. 
 
 The reason why aneurysms take place more frequently 
 in the arch of trie aorta, than in any other part of the 
 arterial system, is its curvature, which exposes it to the 
 full impetus of the blood propelled by the strength of 
 the left ventricle. Aneurysms hardly ever happen in the 
 pulmonary artery, because there is no arch formed by 
 the pulmonary artery, and the blood readily passes by 
 two large branches into the substance of the lungs. 
 
 Aneurysms in the arch of the aorta, as well as in every 
 other part of the arterial system, happen much more 
 rarely in women than in men. This arises from two 
 causes. The one is, that women, from their sedentary 
 life and temperance, are less liable to an increased impetus 
 of the blood, occasioned by excited circulation; the other 
 is, that the arteries in this sex appear to be less liable to 
 these diseased alterations of structure, which predispose 
 to aneurysm. 
 
 Ossification of the Coronary Arteries of the Heart. 
 
 The coronary arteries are occasionally ossified in a 
 greater or less degree. This state of them is, I believe ? 
 generally accompanied with ossified portions of the aorta 
 
at its origin, and sometimes with osssification of the semi- 
 lunar valves. 
 
 s~ 
 
 Ossification of the Semi-lunar Valves. 
 
 The three semi-lunar valves at the origin of the aorta 
 are often found diseased. The disease very commonly 
 consists in the deposition of a bony or earthy matter, and 
 would seem to be formed by a morbid action of some 
 very minute vessels which are distributed through the 
 substance of the valves. These vessels are so small, as 
 not to contain, in their natural state, the red globules of 
 the blood. 
 
 Similar valves at the origin of the pulmonary artery 
 are occasionally more or less ossified, but by no means 
 so frequently as those at the origin of the aorta. This 
 probably depends upon their partaking of the same dis- 
 position with the pulmonary artery itself, the coats of which 
 are much less subject to ossification than the coats of the 
 aorta. When the mass of ossification in these valves is large, 
 the aperture at the origin of these arteries becomes pro- 
 portionably narrowed, and there is much more difficulty 
 in the blood being propelled into them by the ventricles. 
 In consequence of this impediment, the ventricles become 
 considerably enlarged in their size, and this change, for 
 a reason lately given, is more apt to take place from this 
 cause, in the left than the right ventricle. 
 
 Semi-lunar Valves thick and opaque. 
 
 It frequently happens that the semi-lunar valves are 
 considerably thickened, and of an opaque white colour ,- 
 in this case, the coats of the artery in the neighbourhood, 
 I believe, are commonly thickened and diseased. 
 
20 
 
 When the semi-lunar valves have undergone this 
 change, the communication between the ventricles and 
 the two large arteries must also be somewhat narrowed, 
 and their office, as valves, must be more or less impaired. 
 Neither of these effects, however, will take place in the 
 same degree, as when there is a considerable deposition 
 in them of osseous matter. 
 
 Rupture of the Valves. 
 
 There is a preparation in Dr. Hunter's collection, 
 shewing one of the semi-lunar valves to have become 
 thickened, and to have been ruptured to a considerable 
 extent. It is very rare that such an occurrence happens, 
 and in the present instance the rupture was so large, that 
 I believe it must have proved almost immediately fatal. 
 
 Valves between the Auricles and the Ventricles ossified. 
 
 The valvular apparatus between the auricles and 
 ventricles, is liable to the formation of bony and earthy 
 matter in it, in the same manner as the valves which are 
 situated at the origin of the two large arteries, more 
 especially of the aorta, but by no means so frequently. 
 What this depends upon, it is very difficult to determine. 
 These valves may perhaps be considered as belonging 
 more to the venal than the arterial system, and it is certain 
 that ossification takes place very seldom in veins, although 
 very often in arteries. 
 
 The quantity of bony matter deposited in these valves 
 is often very considerable, and of an irregular form. The 
 aperture between the auricles and ventricles becomes 
 thereby narrowed, and the valves have their mobility more 
 or less impaired. 
 
The same Valves thick and opaque. 
 
 The valvular apparatus between the auricles and 
 ventricles is also occasionally thickened, having lost all 
 its transparency, and having an opaque white colour. 
 The chordae tendineas likewise become thicker than 
 natural; and the internal membrane lining the ventricles 
 is frequently at the same time a good deal thickened, ap- 
 pearing like a firm white membrane. When these valves 
 have been for a long time either very much ossified, or 
 thickened, the auricles of the heart are often found con- 
 siderably enlarged beyond their usual size. 
 
 I have also seen the valvular apparatus between the 
 auricle and the ventricle, in a state of inflammation, and 
 covered with a layer of coagulable lymph : but this I be- 
 lieve to be very uncommon. 
 
 Rupture of the Heart. 
 
 It sometimes happens, and I believe chiefly in those 
 who are advanced in life, that the heart at some part be- 
 comes thinner, and upon any great exertion bursts. The 
 blood escapes into the cavity of the pericardium, and the 
 person is instantly destroyed. 
 
 Of this accident I have seen one instance only ; but have 
 heard from the best authority of another. They both 
 happened to men; and I mention this circumstance, be- 
 cause men appear to be more subject to diseases of the 
 heart and blood vessels than women. It is probable 
 that persons dying from this cause have, on account of 
 the suddenness of their death, been supposed to die of 
 apoplexy. 
 
Blood in the Pericardium, -without a Rupture of the Heart. 
 
 Cases have occurred, although very rarely, in which a 
 large quantity of blood has been accumulated in the cavity 
 of the pericardium, but where no rupture could be dis- 
 cove^ed after the most diligent search, either in the heart 
 itself, or in any of its vessels. This appears very wonder- 
 ful, and not at all what any person would expect a priori. 
 Upon the supposition of there being no rupture, two 
 conjectures have occurred to me about the the manner 
 in which such an effect may have taken place, and they are 
 both attended with considerable difficulty. 
 
 The one is that the vessels upon the surface of the 
 heart, may have lost a part of the compactness of their 
 texture, so that the blood may have escaped through their 
 coats by transudation. The other is, that blood may have 
 been poured out by the extremities of the small vessels 
 opening upon the surface, of that portion chiefly of the 
 pericardium which forms the immediate covering of the 
 heart, from their orifices having been to a very uncom- 
 mon degree relaxed.* 
 
 Malformations of the Heart. 
 
 It also happens, although I believe very rarely that a 
 heart is so imperfectly formed as to allow of life being 
 continued for some length of time, in a very uncomfortable 
 state, but to be ultimately the cause of death. There are 
 two cases of this sort described by the late Dr. Hunter, f 
 and there is one specimen of this malformation preserved 
 
 *See Med. Observations, Vol. 4. p. 330. Memoirs of Med. Society, 
 Vol. 1. p. 238. 
 fVid. Medical Observations, Vol. 6. p. 291. 
 
23 
 
 In his collection. The malformation preserved in the 
 collection, consists in the right ventricle of the heart being 
 extremely small, and the pulmonary artery being very 
 small also which arises from it. At its origin from the 
 right ventricle it is completely impervious. The ductus 
 arteriosus is open, but forms likewise a small canal, and 
 terminates in the left branch of the pulmonary artery. 
 The right auricle is larger than it naturally is, from the 
 frequent accumulation of blood in it; and the communi- 
 cation between the two auricles, by means of the foramen 
 ovale, is much larger than usual. The child in whom 
 this malformation was found, had its skin of a very dark 
 colour, and had very laborious respiration, with violent 
 action of the heart. It lived only thirteen days. 
 
 In another case related by Dr. Hunter, the pulmonary 
 artery was very small, especially at its origin, and there 
 was a deficiency in the septum cordis, at the basis of the 
 heart, large enough to allow a small thumb to pass through 
 it. The person in whom this malformation of the heart 
 was found, lived about thirteen years. He never had a 
 fresh complexion, but it was always dark, or tending to 
 black. He was often seized with fits, especially when 
 there was any hurry upon his spirits, or there had been 
 any brisk motion of his body. 
 
 It is obvious that in these deviations from the natural 
 structure, a small quantity of blood only can pass through 
 the lungs to receive the benefit of respiration, and that 
 this will be more or less according to the degree of the 
 deviation. The blood will from this cause be of a dark 
 
24 
 
 colour, as it is well known that it receives the florid hue 
 from the influence of the air upon it in the lungs. Hence 
 the colour of the skin must be necessarily dtirk, and this 
 will be increased when the blood is accumulated more 
 than usual in the veins. It is natural to think that in such 
 structures of the heart, the circulation will be carried on 
 with much more difficulty when it is excited beyond its 
 usual standard. This may even be supposed to be in- 
 creased to such a degree as to produce fits, which hap- 
 pened in one of the cases. 
 
 There is an example also in Dr. Hunter's collection of 
 <\ heart from a child, which had a hole in the septum 
 ventriculorem at the basis of the heart, large enough to 
 allow a goose quill readily to pass through it. The child 
 was still-born at six months, and the hole in the septum 
 evidently arose from original malformation. This too is 
 described by Dr. Hunter in the sixth volume of the 
 Medical Observations. An instance somewhat similar to 
 this has been published by Dr. Pulteney, in the third 
 volume of the Medical Transactions; the person to whom 
 this monstrosity belonged, lived to near fourteen years 
 of age. 
 
 A very singular malformation of the heart, in a child 
 about two months old, came some time ago into my 
 possession, which I shall describe in this place. The 
 aorta in this heart arose out of the right ventricle, and the 
 pulmonary artery out of the left. There was no comuni- 
 cation between the one vessel and the other, except through 
 
25 
 
 the small remains of the ductus arteriosus, which was 
 just large enough to admit a crow quill. The foramen 
 ovale was a little more closed than in a child newly born. 
 The heart was of the common size for a child of two 
 months old, and, except for the circumstances which have 
 been stated, had nothing remarkable in its structure. In 
 this child a florid blood must have been always circulating 
 between the lungs and the left side of the heart, except 
 for the admixture of the dark blood which passed through 
 the small communication of the foramen ovale; and a 
 dark blood must have been always circulating between 
 the right side of the heart and the general mass of the 
 body, except for the very small quantity of florid blood 
 which passed into the aorta by the remains of the ductus 
 arteriosus. Life must, therefore, have been supported 
 for a very considerable length of time with hardly any 
 florid blood distributed over the body. I regret ex- 
 tremely that I have only been able to collect a very im- 
 perfect account of the child when alive. The child had 
 a most unusually livid skin, which arose from the very 
 small proportion of the florid blood in the general circu- 
 lation. The surface of the child's body felt colder than 
 that of a child properly formed and in good health; the 
 respiration was natural. When any similar malformation 
 shall occur, it could be wished that the heat of the surface 
 of the body, and of the internal parts, were measured 
 accurately by a thermometer. The heat of the internal 
 parts will be most conveniently measured by putting a 
 thermometer into the rectum.* 
 
 * This very singular malformation of the heart was given to me by Dr. 
 William Hyde Wollaston, who look much trouble in endeavouring to collect 
 information about the child, but without the desired success. 
 
 D 
 
Heart enlarged. 
 
 The heart is not unfrequently found enlarged. This 
 may occur in one or two of the cavities, or may extend 
 to all the cavities of the heart. This change will some- 
 times take place in a small degree, and sometimes the 
 heart is enlarged to twice or thrice its natural size. The 
 muscular parietes of the heart are sometimes thickened 
 along with this enlargement, but more commonly they 
 are as thin, or even thinner than in the healthy structure. 
 This state of the heart is generally accompanied with an 
 ossification or thickening of some of the valves, and has 
 depended upon the diseased condition of the valves as its 
 cause. It may however occur without any of the valves 
 being diseased, or any apparent disease in the structure 
 of the heart. Any cause which would produce a strong 
 and permanent impediment to the circulation of the blood 
 through the lungs, or to the current of blood in the 
 aorta near the heart, would in time produce an enlarge- 
 ment of it. The cavities of the heart in such cases are 
 generally filled with blood, which is partly fluid and 
 partly concreted into a loose coagulum. 
 
 Hydatids adhering to the Heart. 
 
 Hydatids* have occasionally been found adhering to the 
 heart ; but I have not met myself with any instances of 
 this sort. They do not appear to be of the same kind in 
 every part of the body ; but their nature will be explained 
 particularly, when I come to describe the diseased ap- 
 pearances of the liver and kidneys. 
 
 * See Morgagni, Epist. XXV. Art. 15. 
 
A portion of the Heart bony^ or earthy. 
 
 A portion of the heart has been observed to be con- 
 verted into bone.* Earthy matter has also been found de- 
 posited in the muscular substance of the heart. f Neither 
 of these appearances has come under my own observation, 
 end they are to be looked upon as very uncommon. 
 
 SYMPTOMS. 
 
 The symptoms which attend inflammation of the heart 
 are very much the same with those which belong to in- 
 flammation of the pericardium, viz. symptomatic fever; 
 more or less pain in the situation of the heart; palpitations; 
 an irregular pulse; cough; difficulty of breathing; and 
 often syncope. It would seem probable that the last 
 symptom is principally connected with inflammation of 
 the substance of the heart, and perhaps it may not be found 
 in a pure inflammation of the pericardium. The two 
 diseases, however, are very commonly blended together. 
 
 The symptoms which attend aneurysm of the heart, 
 are nearly similar to those which belong to aneurysm of 
 the arch of the aorta. 
 
 * See Morgagni, Epist. XXVII. Art. 16. See also Medical Communica- 
 tions, Vol. I. p. 228. 
 f See Bonetus, Tom. 1. p, 820, and p. 825, 
 
The place of the pulsation will be lower than in aneurysm 
 of the arch of the aorta, and the space occupied by the 
 pulsation will in general be larger than in aneurysm of 
 this part of the aorta. 
 
 The chief symptom which attends aneurysm of the 
 arch of the aorta, in an early stage of the disease, is a 
 strong pulsation in the chest. The pulsation is commonly 
 at the same time visible to the eye, when the chest is 
 exposed to view. We are not to conclude, however, 
 from this symptom only, that there is certainly an aneurysmu 
 I have felt the same kind of pulsation in other cases; as 
 for instance, where the pericardium was found strongly 
 to adhere to the heart; where there was a slight inflam- 
 mation upon the surface of the heart, with a little more 
 water than usual in the pericardium ; and where a morbid 
 enlargement had taken place in the heart without any 
 aneurysmal swelling. But when an aneurysm of the arch 
 of the aorta has advanced to a large size, a tumour begins 
 to be formed externally, accompanied with a strong pul- 
 sation. This I believe belongs only to aneurysm, and 
 becomes the most decided characteristic of this disease. 
 The pulse at the wrist in aneurysm of the arch of the 
 aorta is sometimes irregular; but often no irregularity 
 can be felt in it. There is generally more or less of pain 
 in the aneurysmal tumour, or in some other part of the 
 chest. Difficulty of breathing upon taking exercise also 
 commonly attends this disease, which is increased in pro- 
 portion as the disease advances, sometimes to a most 
 distressing degree. It is not very unusual for patients to 
 
29 
 
 be destroyed by the pressure of an aneurysm of the aorta 
 upon the lungs and the other important organs contained 
 in the chest, without the aneurysm bursting either ex- 
 ternally or internally. 
 
 Ossification of the coronary arteries would seem to 
 produce, or to be intimately connected with the symptoms 
 which constitute angina pectoris. These consist of a 
 pain which shoots from the middle of the sternum across 
 the left breast, and passes down the left arm, to near the 
 elbow, sometimes even to the wrist of the left hand. In 
 a few cases the pain has been known to shoot across the 
 right breast as well as the left, and to pass down the right 
 arm, either to near the elbow or the wrist. It is excited 
 by walking, more especially up an ascent, and by any 
 considerable emotion of the mind.* 
 
 The symptoms which are produced by a diseased 
 alteration in the structure of the valves of the heart, are 
 not so distinct as to be clearly discriminated in practice. 
 They consist of difficulty of breathing; of frequent 
 palpitations; of a weak and often an irregular pulse; and in 
 some cases there has been observed a disposition to fainting. 
 No observations have yet been made by which practi- 
 tioners can ascertain with any precision what set of valves 
 is diseased. 
 
 * See an excellent treatise upon this subject by Dr. Party, 
 
oO 
 
 The Symptoms which have been noticed as attending 
 gradual effusion of blood into the pericardium are a great 
 degree of faintness; difficulty of breathing; much anxiety 
 and oppression; a dull pain, and a sense of weight behind 
 the sternum. To these a -cold clammy sweat has been 
 observed to succeed, and to spread over the body. 
 
 When the heart is much enlarged, the disease is at- 
 tended with palpitations. These may not only be felt 
 by the hand, when applied to the left side, but may often 
 be perceived by the eye, even when the chest is covered 
 with the ordinary clothing. In one or two instances, I 
 have known the pulse at the wrist to beat with an unusual 
 degree of vigour, but much more commonly the pulse is 
 feeble and irregular. The muscular parietes of the heart 
 being generally thin in proportion to the enlarged size of 
 its cavities, the heart has little power to propel n in- 
 creased quantity of blood into the more distant branches 
 of the arterial system. At times there is much difficulty 
 of breathing; and there is a purplish hue of the cheeks and 
 lips. The colour is more deep in its tinge at one time 
 than another, according as the blood has been transmitted 
 with more or less difficulty through the lungs. The 
 causes which produce a morbid growth of the heart are 
 probably not all of them yet ascertained. The chief 
 cause is an ossification or thickening of some of its valves, 
 On some occasions the heart will become enlarged from 
 rheumatism attacking it.* 
 
 * Dr. Pitcairn has observed this in several cases, and is to be considered ac 
 the first person who made this important observation, Its accuracy has beer 
 
31 
 
 The symptoms produced by the formation of hydatids 3 
 in the cavity of the pericardium, are not distinctly known; 
 but they cannot be supposed to diier much from those of 
 water in the pericardium. In a case related by Morgagni, 
 the patient was subject to fainting. 
 
 . When a part of the heart is converted into an earthy 
 matter or bone, no morbid symptoms whatever have, in 
 some cases, been observed ; and in others there has been 
 palpitation of the heart, with difficulty of breathing.* 
 
 confirmed within these few years by different individuals, some of whom are 
 of high professional character, so that it may now be regarded as an established 
 pathological fact. 
 
 * Those who wish to consider this important subject more minutely, will 
 consult with great advantage the excellent work of Corvisart upon Diseases 
 of the Heart, 
 
CHAPTER III. 
 
 DISEASED APPEARANCES IN THE CAVITY OE THE 
 THORAX. 
 
 Inflammation. 
 
 THE pleura, or the membrane which lines the cavity 
 of the thorax, is very subject to inflammation. This 
 may take place at any period of life, but it is more frequent 
 at the age when the body is just arrived at the adult 
 state, and all its actions are carried on with vigour, than 
 either in childhood or in advanced age. The pleura ap- 
 pears to be more liable to inflammation than any mem- 
 brane lining those cavities which have no external opening, 
 as the peritonasum, the tunica vaginalis testis, and some 
 others. This may arise from the following causes. The 
 branches of the intercostal vessels, which are very nume- 
 rous, piercing through the substance of the intercostal 
 muscles, communicate a good deal by anastomosis, with 
 the external vessels on the sides of the chest. Hence 
 whatever may act upon these external vessels so as to 
 excite contraction in them, may be supposed capable of 
 producing an accumulation of blood, as well as an in- 
 creased action in the inner branches of the intercostals, 
 many of which are distributed upon the pleura. Many 
 of the inhabitants of this country, from their mode of 
 dress, have their chests much exposed to the influence 
 of a cold and very uncertain climate, and hence the blood 
 is frequently thrown inwards into the small vessels ramifying 
 
33 
 
 Upon the pleura. For these reasons probably the pleura 
 is more liable to inflammation than other membranes in- 
 vesting cavities which have no external opening-. This 
 is so much the case^ that one can hardly examine the 
 chest of any person who has arrived at the adult state, 
 without perceiving more or less the traces of a present or 
 former inflammation. 
 
 When the pleura is inflamed, it becomes thicker than 
 it is naturally, and in some degree pulpy. There are also 
 interspersed through it a great number of very small 
 vessels containing florid blood, and a layer of coagulable 
 lymph is at the same time formed upon its surface. This 
 layer is sometimes very thin, and at other times of con- 
 siderable thickness. It is either smooth upon its surface, 
 or it throws out many small flocculi, which exhibit the 
 appearance of a rich lace- work. A serous fluid is also 
 poured into the cavity of the thorax, in which are floating 
 many small broken laminse of the coagulable lymph; and 
 there is occasionally some mixture of pus. 
 
 The coagulable lymph covering the pleura which forms 
 the external membrane of the lungs, frequently adheres 
 to that which covers the pleura that is reflected on the 
 inside of the parietes of the chest, either in small portions, 
 or by extended surfaces* Upon such occasions I have 
 sometimes been able to trace the gradual change of the 
 adhesion, from the state of coagulable lymph to that of 
 cellular membrane. This coagulable lymph may be 
 shewn to be vascular by injection, as we have already 
 mentioned in the inflammation of the pericardium. When 
 the pleura is inflamed which covers the lungs, the substance 
 of the latter is frequently inflamed to some depth. 
 
Adhesions in the Cavity of the Thorax. 
 
 Adhesions are often found between that portion of the 
 pleura which covers the lungs, and that other portion of 
 it which lines the ribs, the intercostal spaces, and the 
 convex surface of the diaphragm, while there is no sign 
 whatever of present inflammation. These adhesions are 
 often partial, and then they are most commonly to be 
 found at the upper and posterior part of the chest ; but 
 they are sometimes extended over the whole cavity. They 
 either connect the parts together closely, in which case 
 they often consist of a firm thick membrane; or they 
 connect them loosely, and then they consist of a soft 
 spongy membrane, which exactly resembles the common 
 cellular membrane of the body. Such adhesions are the 
 consequence of inflammation, and are perhaps the most 
 common morbid appearance to be found in dead bodies. 
 
 Empyema. 
 
 Pus is not unfrequently accumulated in the cavity of 
 the chest, forming the disease called empyema. This 
 may either arise from the blood vessels of the pleura 
 being in such a state of inflammation as to form pus, or 
 from the bursting of some abscess in the lungs, so as to 
 evacuate its pus into the cavity of the thorax. When 
 pus is formed by an inflamed state of the pleura, there is 
 no occasion for ulceration to take place. The pleura is 
 found entire, but is covered with a layer of the coagulable 
 lymph. This fact has been long ago ascertained by the 
 late Dr. Hunter. The formation of the pus depends on 
 a certain mode of action in the vessels of the pleura, or 
 more probably of the layer of the coagulable lymph which 
 
35 
 
 covers it. The pus may either occupy the whole of one 
 of the cavities of the chest, or may be confined to a part 
 of it by adhesions taking place between the lungs and 
 that portion of the pleura which invests the ribs and the 
 intercostal spaces. When pus is evacuated into the cavity 
 of the chest by the bursting of an abscess in the lungs, 
 it is almost always confined within certain limits by ad- 
 hesions, in cases of empyema, for the most part, there 
 is not any particular appearance of the chest observable 
 on the outside : there is sometimes however a fullness to 
 be perceived externally on the side where the matter is 
 accumulated, and even occasionally an evident swelling 
 between two of the ribs, as of matter pointing. Ulceration 
 has also been known to take place in one of more of the 
 intercostal spaces, so that the matter has been evacuated 
 externally. There is an example in Dr. Hunter's col- 
 lection, where the matter had been evacuated from the 
 chest by several openings in the intercostal spaces. 
 
 Hydrothorax. 
 
 A watery fluid is not uncommonly found in one or both 
 cavities of the chest, forming the disease called hydro- 
 thorax. It is often attended with the accumulation of 
 water in other parts of the body, especially in the peri- 
 cardium, and in the cellular membrane of the lower ex- 
 tremities. The fluid in hydrothorax is commonly of a 
 brown or yellowish colour, but occasionally has a reddish 
 colour, arising from the mixture of the red globules of 
 blood. It resembles in its properties the serum. It is 
 found to vary a good deal in quantity in different cases, 
 sometimes amounting only to a few ounces, and at other 
 times to several quarts. When it is accumulated in very 
 
36 
 
 large quantity in either side of the chest, that side appears 
 to be fuller to the eye externally; and when the cavity is 
 laid open after death, the lungs on that side are found 
 more or less compressed. I have seen one of the lungs 
 so compressed from this cause as not to be larger than 
 the closed fist. 
 
 Water is likewise found in the cavity of the chest 
 where there are considerable adhesions. This shews that 
 a good deal of inflammation had formerly taken place, 
 which had probably, by .throwing out a considerable 
 quantity of serum, laid the foundation of the hydrothorax.* 
 
 Steatomatous 7 umours and Hydatids. 
 
 Steatomatous tumours and hydatids have sometimes 
 been found in the cavity of the pleura, but both these 
 morbid appearances are very rare.f 
 
 The Pleura almost dry. 
 
 In opening into the cavity of the chest, there is com- 
 monly found a good deal of moisture upon the surface of 
 the pleura. This is intended to lubricate the surface of 
 the cavity of the chest, for the more easy motion of the 
 lungs within it. Sometimes, however, I have seen the 
 moisture in very small quantity, so that the pleura might 
 almost be said to be dry. This was occasioned either 
 by a deficiency in the action of the exhalent arteries of the 
 pleura, or by an increased action of its absorbents. 
 
 Ossification of the pleura. 
 It sometimes happens, although I believe rarely, that 
 
 *This circumstance is illustrated in several instances by Mr. Cruikshanlr, 
 in his Treatise upon the Absorbent System. See 2d edition, p. 116. 
 f See Portal's Anatomic Medicale, Tom, v. p. 26 and 27. 
 
37 
 
 a portion of the pleura is converted into bone. This con- 
 sists of a thin plate, and sometimes extends over a conside- 
 rable surface of the pleura. In all the cases which I 
 have seen, the bony matter seemed to me to be exactly 
 like common bone. I have never seen it form a thick 
 irregular knob, but always a thin plate. The cause which 
 first excites this diseased process it is very difficult to 
 determine; but there can be no doubt that the bone is 
 formed by the small vessels of the pleura, which secrete 
 bony matter from the blood. This process is not peculiar 
 to the pleura, but takes place in almost every part of the 
 body; I believe, however, that it is more common in the 
 pleura, than in any other similar membrane. In the cases 
 which I have observed, this process seemed not to have 
 attended with much inconvenience. There was no in- 
 flammation found in the pleura surrounding the bone, nor 
 in the substance of the lungs under it. It is reasonable 
 to think, however, if the bone were to grow irregularly, 
 so as to form sharp processes, that it might excite in- 
 flammation, and lay the foundation of a fatal disease.'* 
 
 SYMPTOMS. 
 
 The symptoms which attend inflammation of the pleura 
 are very well ascertained. There is more or less of 
 symptomatic fever; an acute pain in some part of the 
 
 * A case is mentioned by Dr. Soemmering, where a part of the lungs was 
 found inflamed and suppurated under an ossification of the pleura. See 
 Soemmer. Germ. Translat. of the Morbid Anatomy, p. 43. 
 
38 
 
 chest, more commonly in the side, which is increased 
 upon inspiration; a great difficulty in lying upon the 
 diseased side; difficult respiration; a cough, which at first 
 is dry, but is afterwards accompanied with a secretion 
 and expectoration of mucus from the inner membrane of 
 the trachea and its branches. 
 
 There would often seem to be slight degrees of in- 
 flammation in the pleura, where the symptoms above stated 
 do not exist at all, or are so obscurely marked as to be 
 altogether overlooked. In examining the chest of adults 
 after death, it rarely happens that adhesions are not dis- 
 covered in some part of it, uniting the surface of the lungs 
 to that portion of the pleura which lines the parietes of 
 the chest. The marked symptoms of pleurisy, however, 
 are by no means so frequent. It seems, therefore, probable, 
 that slight inflammations may attack the pleura, sufficient 
 to throw out coagulable lymph, which is afterwards 
 changed into adhesions, and yet that persons thus affected 
 shall not be sensible of any disease in the chest. If this 
 supposition be not granted, then coagulable lymph may 
 be poured out upon the surface of the pleura, and ad- 
 hesions be formed without inflammation: but this con- 
 jecture is not so probable as the other. 
 
 Where adhesions in the chest are long, so as not to 
 impede the free motion of the lungs, respiration is not 
 sensibly affected by them. But where the adhesions are 
 short, tying as it were the lungs closely to the parietes 
 of the chest, and more especially if they be extended over 
 every part of the cavity, then respiration is difficult, and 
 
59 
 
 accompanied with a cough, but there are no symptoms 
 of fever. 
 
 Empyema may be distinguished with a good deal of 
 certainty, after inflammation of the pleura or of the lungs, 
 by rigors having taken place, by a remission of the pain, 
 by the cough and difficulty of breathing continuing, and 
 by the person being able to lie more easily upon the 
 diseased side than the other. There is sometimes a very 
 evident enlargement of the side where the matter is ac- 
 cumulated, and always a want of that hollow sound on 
 striking with the fingers the side where the empyema is, 
 which takes place upon striking the chest, where the lungs 
 are sound. 
 
 When water is accumulated in the chest, it can gene- 
 rally be sufficiently distinguished in practice by the 
 following symptoms. 
 
 There is great difficulty of breathing, and commonly 
 the patient cannot rest in bed unless the head and upper 
 part of the trunk be more or less elevated from the 
 horizontal posture. The sleep is often suddenly in- 
 terrupted by alarms and disagreeable dreams; the urine 
 is in very small quantity, and there is commonly .anasarca 
 of the legs. The pulse is generally, but not always, 
 irregular. There is a paleness in the countenance, with 
 a purple hue of the lips and of the cheeks, if the latter 
 should happen to have any tinge remaining. This effect 
 
40 
 
 is produced by the lungs being incapable of sufficiently 
 expanding themselves to receive the quantity of air which 
 is necessary for giving the usual florid colour to the blood 
 in the branches of the pulmonary artery, 
 
 When ossification of the pleura is of small extent, 
 respiration cannot be affected by it; but when it is large, 
 it must produce difficulty of breathing, either by preventing 
 the full expansion of the lungs, or the free motion of the 
 ribs, according to its situation : Some instances are known 
 of respiration being injured from this cause. 
 
 Where the ossification has produced inflammation of 
 the pleura and lungs, symptoms of inflammation will take 
 place as above described, but probably in some cases 
 there may be peculiar symptoms, depending chiefly on 
 the different irritability of different constitutions. In one 
 case there were paroxysms of convulsive difficulty of 
 breathing, palpitation of the heart, a quick irregular pulse, 
 and a distressing sense of instant suffocation.* 
 
 * See Mr. Weldon's Observations on Surgery, p. 75 and 76. 
 
41 
 
 CHAPTER IV. 
 
 DISEASED APPEARANCES OF THE LUNGS. 
 
 I 
 
 Inflammation. 
 
 INFLAMMATION of the substance of the lungs, I be- 
 lieve, seldom takes place without some similar affection 
 of the pleura; at least in the instances which I have seen, 
 this has been most frequently the case. When a portion 
 of the lungs is inflamed, its spongy structure appears 
 much redder than usual; the colour being chiefly florid, 
 but partly of a darker hue. This arises from a great- 
 number of the small vessels distributed upon the cells of 
 the lungs, being so enlarged as to admit the red globules 
 of the blood. There is also an extravasation of the 
 coagulable lymph into the substance of the lungs, and 
 sometimes of blood. The extravasated blood has been 
 said upon some occasions to be in very large quantity; 
 but this has never fallen under my own observation. 
 
 That portion of the lungs which is inflamed becomes 
 considerably heavier than in the natural state, from the 
 accumulation of blood in its vessels, and the extravasation 
 of the coagulable lymph; it therefore commonly sinks in 
 water. It feels like a solid substance when pressed by 
 the fingers, and there is no crackling of , air as in the 
 healthy structure. This however will be more or less 
 marked, according to the degree of the inflammation. 
 
 The pleura covering the inflamed portion of the lungs 
 fa also commonly affected with inflammation; it is crowded 
 F 
 
42 
 
 with fine red vessels, and has generally lying upon it a 
 layer of coagulable lymph. 
 
 This inflamed state of the lungs is to be distinguished 
 from blood accumulated in some part of them after death 
 in consequence of gravitation. From the body lying in 
 the horizontal posture after death, blood is generally ac- 
 cumulated at the posterior part of the lungs, giving them 
 there a deeper colour, and rendering them heavier. In this 
 case there will be found no crowd of fine vessels filled 
 with blood, nor will the lungs be found solid, but spongy 
 in their texture, and there will be no other mark of in- 
 flammation of the pleura. 
 
 Where blood too is accumulated in any part of a lung 
 after death, from gravitation, it is always of a dark colour; 
 but where blood is accumulated from inflammation, the 
 inflamed part will appear, in a great measure, florid. 
 
 Abscesses. 
 
 It is very common to find abscesses in the lungs. 
 These sometimes consist of small cavities containing pus, 
 and at other times the cavities are very large, so that the 
 greater part of the substance of the lungs has been de- 
 stroyed. These cavities sometimes communicate only 
 with branches of the trachea, which are destroyed in the 
 progress of the ulceration; at other times they open into 
 the cavity of the chest, emptying their contents there, 
 and forming the disease which is called empyema. When 
 abscesses are deeply seated in the substance of the lungs y 
 the pleura is commonly not affected; but when abscesses 
 are formed near the surface, it is almost constantly in- 
 flamed. The lungs round the boundaries of an abscess r 
 when it has arisen from common inflammation, are more 
 
43 
 
 in their texture, in consequence of coagulable lymph 
 being poured out during the progress of the inflammation. 
 When the abscesses are scrofulous, the texture of the 
 lungs in the neighbourhood is sometimes not firmer than 
 usual, but presents the common natural appearance. This 
 I believe to be principally the case when the abscesses 
 are small, and placed at a considerable distance from each 
 other. -When a portion of the lungs is crowded with 
 tubercles, and some of these are converted into abscesses, 
 the intermediate substance of the lungs is often of a very 
 solid texture. When blood vessels are traced into an 
 abscess of the lungs, I have found them, upon examination, 
 very much contracted, just before they reach the abscess, 
 so that the opening of their extremities has been closed 
 up entirely. On such occasions it will require a probe 
 to be pushed with a good deal of foree, in order to open 
 again their extremities. In these contracted vessels the 
 blood is coagulated, as it is under similar circumstances 
 in other parts of the body.* This change in the blood 
 vessels is, no doubt, with a view to prevent large 
 haemorrhages from taking place, which would be almost 
 immediately fatal. 
 
 Tubercles. 
 
 There is no morbid appearance so common in the lungs 
 as that of tubercles. These consist of rounded firm 
 white bodies, interspersed through their substance. They 
 are, probably, formed in the cellular structure, which 
 connects the air cells of the lungs together, and are not a 
 morbid affection of glands, as has been frequently imagined. 
 There is no glandular structure in the cellular connecting 
 
 See Dr. Stark's Works, p. 28. 
 
44 
 
 membrane of the lungs; and on the inside of the branches 
 of the trachea, where there are follicles, tubercles have 
 never been seen. They are at first very small, being not 
 larger than the heads of very small pins, and in this case 
 are frequently accumulated in small clusters. The smaller 
 tubercles of a cluster probably grow together, and form 
 one larger tubercle. The most ordinary size of tubercles 
 is about that of a garden pea, but they are subject in this 
 respect to much variety. They adhere closely to the 
 substance of the lungs, have no peculiar covering or 
 capsule, and have little or no vascularity. When cut into, 
 they are found to consist of a white smooth substance, 
 possessing a firm texture, and they often contain in part 
 a thick curdly pus. When a tubercle is almost entirely 
 changed into pus, it appears like a white capsule in which 
 the pus is lodged. When several tubercles of considerable 
 size are grown together so as to form a large tuberculated 
 mass, pus is very generally found upon cutting into it. 
 The pus is frequently thick and curdly; but when in 
 xonsiderable quantity, it is thinner, and resembles very 
 much the pus from a common sore. In cutting into the 
 substance of the lungs, a number of abscesses is some- 
 times found, from tubercles of a considerable size having 
 advanced to a state of suppuration. In the interstices 
 between these tubercles, the lungs are frequently of a solid 
 texture, from the cells being in a great measure obliterated. 
 The texture of the lungs on many occasions, however, 
 round the boundaries of an abscess, is perfectly natural. 
 
 I have sometimes seen a number of small abscesses 
 interspersed through the lungs, each of which was not 
 larger than a pea. The pus in these is rather thicker than 
 ivhat arises from common inflammation, and resembles 
 
45 
 
 scrofulous pus. It is probable that these abscesses have 
 been produced by a number of small scattered tubercles 
 taking on the process of suppuration. The lungs immedi- 
 ately surrounding these abscesses are often of a perfectly 
 healthy structure, none of the cells being closed up by 
 adhesions. 
 
 When tubercles are converted into abscesses, phthisis 
 pulmonalis is produced, one of the most destructive 
 diseases in this island. Tubercles are sometimes found 
 in the lungs of children at a very early age, viz. two or 
 three years old; but they most frequently occur a short 
 time before the completion of the growth. They are 
 apt likewise to be formed at rather an advanced age. 
 
 In cutting into the lungs, a considerable portion of 
 their structure sometimes appears to be changed into a 
 whitish soft matter, somewhat intermediate between a 
 solid and a fluid, like a scrofulous gland just beginning 
 to suppurate. This appearance I believe is produced by 
 scrofulous matter being deposited in the cellular substance 
 of a certain portion of the lungs, and advancing towards 
 suppuration. It seems to be the same matter with that 
 of the tubercle, but only diffused uniformly over a con- 
 siderable portion of the lungs, while the tubercle is cir- 
 cumscribed. 
 
 Soft pulpy Tubercles. 
 
 I have seen another sort of tubercle in the lungs, which 
 I believe to be very rare. It consists of a soft tumour, 
 formed of a light brown, smooth substance. This is not 
 contained in any proper capsule, but adheres immediately 
 to the common structure of the lungs. In cutting 
 through several of these tumours I did not find any of 
 
46 
 
 them in a state of suppuration. They were commonly 
 as large as a gooseberry, and were chiefly placed upon 
 the surface of the lungs; some, however, were scattered 
 through their substance, of a smaller size. These are 
 very different in their appearance from the common 
 tubercle last described. 
 
 Water accumulated in the Substance of the Lungs. 
 
 The structure of the lungs may be said to consist of 
 air cells, and the common cellular membrane of the body. 
 In this cellular membrane there is always some moisture, 
 which is necessary for the easy motion of one part of the 
 lungs upon another in their contraction and dilatation. 
 There is a considerable difference in the quantity of this 
 moisture in different persons, as may be seen by cutting 
 into the substance of the lungs; for under such circum- 
 stances there will always ooze out from the cut surface 
 more or less of an aqueous fluid mixed with globules of 
 air. Sometimes, however,, the quantity is so large that 
 it amounts to a disease, forming what may be called 
 anasarca of the lungs. It has not occurred to me to see 
 any well marked example of this disease, but it has been 
 observed by others.* It is hardly necessary to mention, 
 that in proportion to the accumulation of the water, the 
 air cells must be necessarily compressed, so that a sufficient 
 quantity of air cannot be admitted into the lungs for pro- 
 ducing the due degree of influence upon the blood. 
 
 Lungs distended with Air. 
 
 In opening into the chest, it is not unusual to find that 
 the lungs do not collapse, but that they fill up the cavity 
 
 * See Dr. Soemmering's German translation of the Morbid Anatomy, p. 45. 
 
47 
 
 completely on each side of the heart. When examined; 
 their cells appear full of air, so that a prodigious number 
 of small white vesicles are seen upon the surface of the 
 lungs immediately under the pleura. The branches of 
 the trachea are often at the same time a good deal filled 
 with the mucous fluid. This fluid had probably pre- 
 sented the ready egress of the air, so that it had gradually 
 distended the air cells of the lungs, and had prevented the 
 lungs from collapsing. 
 
 Air Cells of the Lungs enlarged. 
 
 The lungs are sometimes, although I believe very rarely, 
 formed into pretty large cells, so as to resemble somewhat 
 the lungs of an amphibious animal. Of this I have now 
 seen three instances. The enlargement of the cells can- 
 not well be supposed to arise from any other cause, than 
 the air being not allowed the common free egress from 
 the lungs, and therefore accumulating in them. It is not 
 improbable also, that this accumulation may sometimes 
 break down two or three contiguous cells into one, and 
 thereby form a cell of a very large size. 
 
 Air Vesicles attached to the Edge of the Lungs. 
 
 Vesicles containing air have occasionally been seen 
 attached to the edge of the lungs. They do not com- 
 municate, however, with the structure of this organ, but 
 are complete in themselves. Upon the first view, it 
 might be thought probable that they were merely some 
 of the air cells enlarged; but as they do not communicate 
 with any of the air cells, this opinion is not well founded. 
 It is most likely that they are a morbid structure, formed 
 in the same manner as the air vescicles attached to the 
 
48 
 
 intestines and mesentery of some quadrupeds, and that 
 the very minute blood vessels which ramify upon the 
 vesicles have the power of secreting the air.* 
 
 Lungs changed into a substance like Liver. 
 
 The lungs are sometimes converted into a solid sub- 
 stance very much resembling the liver. It has nearly the 
 same solidity, with the natural texture of the liver, and 
 the same general appearance of structure. 1 have only 
 seen an example of this change in a preparation, and I am 
 inclined to believe that it had been produced by a wide 
 extended inflammation, in which a large quantity of 
 coagulable lymph had been extravased into the substance 
 of the lungs. The extravasation would necessarily render 
 the texture of the lungs very solid; and the history of the 
 symptoms which have been observed to attend similar 
 morbid changes, supports this opinion. The symptoms 
 are those which are produced by an inflammation of the 
 lungs. 
 
 Lungs converted into Bone. 
 
 Part of the lungs is occasionally converted in a bony 
 substance; but this is a very rare disease. The small 
 vessels ramifying through the substance of the lungs under 
 such circumstances separate bony matter from the blood. 
 In the only instance which I have known of this complaint, 
 the process would appear to have been rapid. There 
 was great difficulty of breathing before the person died, 
 but this difficulty had been only for a very few weeks. 
 Each of the lungs was undergoing the same change of 
 structure, which had made considerable progress. In the 
 
 * See Hunter's Animal Economy, p. 165. 
 
49 
 
 particular case to which I allude, there had been a very 
 strong disposition to form bone in the constitution. A 
 very large bony tumour had been formed round one of 
 the knees of this person; and very soon after the knee and 
 leg were removed by amputation, the difficulty of breathing 
 began, which was occasioned by a part of the lungs being 
 converted into bone. In this case there was a transference 
 of the disease from an external to an internal part, similar 
 to the translation of gout or rheumatism. 
 
 A solid Tumour compressing the Lungs* 
 
 I have also seen a tumour as large as an orange, attached 
 to the lungs on one side by a loose membranous con- 
 nection, and in some degree compressing them; this tu- 
 mour consisted of a porous substance, which resembled 
 neither the structure of what is commonly understood 
 to be a scirrhous nor that of a scrofulous tumour, but 
 had an appearance somewhat peculiar to itself. 
 
 Earthy Concretions in the Lungs. 
 
 Earthy concretions have occasionally been found in 
 the lungs, although it is not a common appearance of 
 disease. These are generally small, but sometimes form 
 masses of a considerable size.* Even a considerable 
 portion of the lungs has been known to be changed into 
 an earthy substance. | These concretions consist of 
 phosphate of lime, united to a thick membranous sub- 
 stance, which retains the form of the concretion. J 
 
 * Vid. Morgagni, Epist. XVII. Art. 19. Epist. XV. Art. 25. 
 
 j-Vid. Morgagni Epist. XXII. Art 15. 
 
 t See Thompson's System of Chemistry, Vol. 4, p, 659- 
 
 G 
 
Hydatids 
 
 Hydatids are also sometimes formed in the lungs, ancl 
 are many of them brought up by coughing. They are 
 of the same sort with the hydatids formed in the liver ? 
 the nature of which we shall endeavour to explain 
 afterwards. 
 
 SYMPTOMS. 
 
 In inflammation of the substance of the lungs, the 
 symptoms correspond a good deal with those of pleurisy. 
 Indeed inflammation of the lungs is almost constantly 
 attended with inflammation of the pleura, so that it is 
 difficult to discriminate between them in practice. But 
 it is of little consequence to be able to do this, as the 
 means of cure are the same in both diseases. When 
 the inflammation of the lungs is pure, the pleura being not 
 affected, the pain in the chest has been observed to be 
 more obtuse than in pleurisy, and the pulse to be less 
 hard. The respiration is very difficult, and the veins of 
 the neck are sometimes observed to be distended with 
 blood, the face to be tumid, and there is a purplish hue 
 of the lips and cheeks. These effects arise from the venal 
 blood being transmitted with difficulty through the in- 
 flamed lungs. This is occasioned by an extravasation of 
 the coagulable lymph into a considerable part of their 
 substance, which both prevents the lungs from sufficiently 
 expanding themselves, and compresses many air cells. 
 
51 
 
 so that the proper quantity of air is not admitted into the 
 lungs for producing the full change of colour upon the 
 blood. 
 
 When inflammation of the lungs terminates in suppura- 
 tion, it may be known by rigors, by a dimunution of the 
 pain in the chest, by an expectoration of pus, and some- 
 times, when an abscess is large, by bringing up at once 
 a great quantity of pus, which is generally a little tinged 
 with blood. 
 
 When tubercles are forming in the lungs, but have not 
 advanced to suppuration, they are attended with a slight 
 cough, with occasional difficulty of breathing, with the 
 feeling of slight pains in some part of the chest, and with 
 a pulse somewhat accelerated. These are symptoms 
 which commonly usher in phthisis pulmonalis, and are 
 frequently overlooked, both by the patients themselves 
 and their friends. When the tubercles have begun to 
 suppurate, and abscesses to be formed, then there is an 
 expectoration of a thick pus, which is occasionally tinged 
 with blood, emaciation, debility, and that peculiar affection 
 of the system which is known by the name of hectic fever. 
 
 The symptoms attending the large brown tubercle 
 are unknown to me. 
 
 When the cells qf the lungs are much enlarged in their 
 
52 ,_ 
 
 size, persons have been remarked to have been long sub- 
 ject to difficulty of breathing, more especially on motion 
 oi the body; but I believe no symptom is at present known s 
 by which this disease may be discriminated from some 
 others incident to the chest. 
 
 In some cases in which the lungs have been converted 
 into a substance like the liver, symptoms have been ob- 
 served similar to those which attend inflammation of the 
 lungs. I am inclined to believe that this appearance of 
 the lungs is produced by an extensive extravasation of 
 coagulable lymph into their substance, during an attack 
 of inflammation. 
 
 When earthy concretions are formed in the lungs, 
 persons are more or less subject to difficulty of breathing, 
 and a cough. Occasionally some of these concretions 
 are coughed up, together commonly with a little blood ; 
 and by this circumstance alone can this disease be dis- 
 tinguished from some others which are incident to the 
 chest. This state of disease often leads to phthisis. 
 
 When hydatids are formed in the lungs, they produce 
 a cough, difficulty of breathing, and some frequency of 
 the pulse. They are occasionally forced up by a violent 
 fit of coughing ; and this circumstance only can discrimi- 
 nate the disease in the living body. 
 

 53 
 
 CHAPTER V. 
 
 DISEASED APPEARANCES OF THE THYROID GLAND, 
 THE LARYNX, AND THE PARTS CONTAINED IN THE 
 POSTERIOR MEDIASTINUM. 
 
 BEFORE we describe the diseased appearances of the 
 parts which are contained in the posterior mediastinum, 
 we shall take notice of the morbid changes to which the 
 thyroid gland and the larynx are liable. These are so 
 closely connected with the trachea, that a description of 
 their morbid changes could not be introduced so properly 
 in any other place. 
 
 Inflammation of the Thyroid Gland. 
 
 The thyroid gland is sometimes attacked with common 
 inflammation, but this happens rarely. There x are no 
 peculiar causes acting upon it to produce inflammation, 
 and it would seem to be as little liable to be affected with 
 this disease, as any gland in the body. When the thyroid 
 gland is inflamed, it exhibits the common appearances 
 which take place in the inflammation of the substance of 
 other parts. Its blood vessels are enlarged in their size, 
 and the number of branches which are capable of con- 
 taining the red globules of blood is increased. Hence it 
 appears much more vascular than in a natural state. It is 
 increased in its bulk, and feels considerably firmer to the 
 touch than when healthy ; and these effects are produced 
 partly by the increased quantity of blood which is circu- 
 
54 
 
 iating through it, and partly by the extravasation of co- 
 agulable lymph, and perhaps of blood into its substance. 
 
 Bronchocele. 
 
 The morbid change of structure to which the thyroid 
 gland is most liable, is that swelling of it called bronchocele. 
 This is apt to take place in different individuals of the 
 same family, and women are more liable to be affected 
 with it than men. It is more prevalent in some districts 
 of countries than in others, and those where it is most 
 prevalent are mountainous. 
 
 The swelling of the thyroid gland in bronchocele often 
 increases to a very large size, and sometimes grows 
 irregularly, forming projecting tumours upon the anterior 
 part of the neck. This irregularity of growth is more 
 common in that part of Savoy, where the disease is 
 endemial, than in Great Britain. 
 
 When a section is made of the thyroid gland affected 
 with this disease, it is found to consist of a number of 
 cells which contain a transparent viscid fluid. These 
 cells vary in their size in different parts of the same gland, 
 and in different swellings of the same kind in different 
 individuals. Some of them are so large as to be able to 
 contain a small pea, but most of them are of a smaller 
 size. The viscid fluid, when the gland has been pre- 
 served for some time in spirits, is changed into a trans- 
 parent jelly. From this account of the morbid change of 
 structure which takes place in bronchocele, it seems not 
 unreasonable to suppose that the swelling depends upon 
 a vitiated and increased secretion in the gland. The se- 
 cretion being in large quantity, gradually distends the 
 cells, increasing thereby their capacity, and this enlarge- 
 ment of the cells forms the general swelling of the gland. 
 
Scirrhous of the Thyroid Gland. 
 
 The thyroid gland sometimes becomes scirrhous, but 
 is not so liable to this disease as some other glands of the 
 body. When it is affected by this disease, it becomes 
 enlarged in its size, but not to any considerable degree, 
 and is hard to the feeling. When a section is made of 
 it, it is found to consist of a solid substance, with very- 
 little of that cellular structure which is so strongly marked 
 in bronchocele. 
 
 This gland is apt to become swelled and hard when 
 ulcers are formed at the upper end of the oesophagus. 
 This effect is sometimes produced by the ulcer of the 
 oesophagus spreading to the thyroid gland. The same 
 change, however, has been observed to take place where 
 the ulcer had not reached so far, and where the gland was 
 entire. This might lead to the opinion, that some ducts 
 of communication exist between the thyroid gland and 
 the upper part of the oesophagus. These ducts have been 
 supposed by several anatomists, but their existence has 
 never yet been demonstrated . 
 
 The Ihyroid Gland converted into Bone. 
 
 The thyroid gLnd, or a part of it is occasionally changed 
 in old people into a bony mass, but this disease is of 
 rare occurrence. It is commonly, I believe, a disease of 
 no consequence; but it is reasonable to think, that the 
 bony mass by an irregular growth might in some in- 
 stances so irritate the larynx, or the upper part of the 
 trachea, as to produce inflammation and ulceration of these 
 parts, and to prove ultimately fatal. 
 
Larynx. The Cartilages of the Larynx converted 
 
 into Bone. 
 
 The cartilages of the larynx sometimes become bony, 
 either at the middle or a more advanced period of life. 
 When the disposition to form bony matter in the larynx 
 is not very strong, portions of the thyroid cartilage only 
 are converted into bone; but when the disposition is 
 powerful, then all the cartilages are changed into a bony 
 substance. When this is the case, they become liable to 
 any changes which might take place in ordinary bone. 
 Accordingly, some of these cartilages so changed into 
 bone have been known to exfoliate, and to be thrown out 
 by a violent fit of coughing or vomiting. Dr. Hunter 
 had an opportunity of knowing an instance where the 
 cricoid cartilage, being converted into bone, was sepa- 
 rated by exfoliation, and afterwards coughed up. It is 
 not to be understood from what has been said, that the 
 cartilages of the larynx, when changed into bone, are 
 more liable to become dead and exfoliate than the com- 
 mon bones of the body. The instances in which they 
 have been known to exfoliate are, I believe, extremely 
 rare. 
 
 Ulcers in the Cavity of the Larynx. 
 
 The inner membrane of the larynx is very apt to be 
 inflamed, and this generally accompanies the inflammation 
 of the inner membrane of the trachea, as we shall have 
 occasion to mention afterwards. Sometimes, however, 
 an inflammation shall take place which is confined to the 
 cavity of the larynx, and it shall occasionally advance to 
 suppuration and ulceration. Of this I have known seve- 
 
ral instances. Suppuration is most apt to take place in 
 the sacculi laryngis: and the ulcers which I have seen 
 there, are sometimes attended with a scrofulous thickening 
 of the surrounding parts. 
 
 Diseased App earances of the Parts contained in the 
 Posterior Mediastinum. 
 
 By the posterior mediastinum, is meant that space 
 which lies between the laminae of the pleura, that pass from 
 the root of the lungs to each side of the spine. The 
 space is of considerable size, and contains a portion of 
 the trachea arteria, of the oesophagus, of the thoracic duct, 
 of the descending aorta, and the vena azygos, besides 
 some absorbent glands. 
 
 Diseased Appearances of the Trachea. 
 
 The inner membrane of the trachea is not uncommonly 
 inflamed to a greater or less degree, In this state it is 
 crowded with minute florid vessels, which give it a gene- 
 ral appearance of vascularity. When there is no in- 
 flammation, it appears in the dead body a white pulpy 
 membrane, and there are rarely to to be seen any red 
 vessels ramifying in it. While the inner membrane is 
 inflamed, the secretion from its glands is very much in- 
 creased, and therefore its cavity is found a good deal filled 
 with a mucous fluid; even pus is sometimes formed, and 
 both fluids are mixed with globules of air. This is the 
 state of the trachea in a very violent catarrh, and also in 
 some cases where there are scrofulous abscesses of the 
 lungs: the same appearances are also observable in the 
 inner membrane of the larynx, 
 H 
 
58 
 
 Appearances of the Trachea in the Croup. 
 
 When the inner membrane of the trachea is inflamed^ 
 it is sometimes lined with a layer of a yellowish pulpy 
 matter. This does not adhere firmly to the inner mem- 
 brane, but may be easily separated. It extends from the 
 upper part of the cavity of the larynx, into the small 
 branches of the trachea, which are distributed through 
 the substance of the lungs. There is at the same time 
 a good deal of mucus in the trachea and its branches, 
 together with a mixture of pus. This is the appearance 
 of the inside of the trachea, in patients who have died from 
 the croup. 
 
 Polypus. 
 
 The trachea and its branches are sometimes lined with 
 a layer of a yellowish or whitish matter, forming a sort of 
 tube, which is applied to the inner surface loosely. It 
 has not occurred to me to see any instance of it in the 
 dead bodies which I have examined; but I have seen 
 several examples of it in preparations. The inner mem- 
 brane of the trachea seems to be perfectly natural, and the 
 layer of adventitious membrane resembles exactly the 
 coagulable lymph which is formed in other parts of the 
 body; I have therefore no doubt of its being that sub- 
 stance. Since this disease (which is called polypus) lasts 
 for a long time, and is not attended with symptoms of 
 inflammation, it appears probable that the vessels of the 
 inner membrane of the trachea possess a power of sepa- 
 rating the coagulabie lymph from the blood, and that this 
 disease consists in a peculiar action of these vessels. 
 
 The trachea is sometimes filled with a solid substance. 
 
59 
 
 of the same kind with what we have described. Of this 
 I have only seen one instance, and it occurs, I believe, 
 much more rarely than the other. 
 
 The tubular substances which are thrown out from the 
 trachea in coughing, and which constitute the most or- 
 dinary form of polypus, were considered formerly, by 
 some anatomists of distinguished reputation, as blood 
 vessels. It is singular that they should have paid so little 
 attention to the appearance of these tubular substances as 
 to have mistaken them for blood vessels; and it is still 
 more singular, that it should never have occurred to them 
 upon reflection, that blood vessels of such a size could not 
 be coughed up, without a very large quantity of blood 
 passing along with them. 
 
 A more modern opinion about the nature of these tubu- 
 lar substances has been, that they consist of dried mucus. 
 This, although more plausible than the former, is equally 
 ill founded. The mucus which is secreted by the inner 
 membrane of the trachea, is exactly of the same kind 
 with that secreted by the inner membrane of the nose. 
 Every person is acquainted with the appearance of the 
 mucus of the nose when dried. The mucus of the 
 trachea, when dried, would have the same appearance. 
 The tubular substances coughed up in polypus of the 
 trachea, present an appearance to the eye very different, 
 and (as has been already observed) look exactly like the 
 coagulable lymph. The influence of the air in drying 
 the mucus would seem to extend but a little way from 
 the external surface of the body, for the mucus is fluid 
 in the posterior nostrils. 
 
60 
 
 Trachea sclrrhous. 
 
 The trachea I have seen narrowed in its diameter for 
 two or three inches, thickened in its substance,, and upon 
 the inner membrane were formed a number of little hard 
 tubercles. This state of the trachea was accompanied 
 with a scirrhous affection of some absorbent glands, which 
 closely adhered to it; and it appeared to me that the 
 disease in the glands had spread, so as to affect the 
 trachea. 
 
 Kings of the Trachea ossified. 
 
 The cartilaginous rings of the trachea occasionally be- 
 come ossified. When the ossification is inconsiderable, 
 the function of the trachea will hardly be affected by it ; 
 but where the rings are entirely ossified, the flexibility 
 of the trachea must be much lessened, and its cavity will 
 not admit of being so much contracted as in the healthy 
 state, by the action of the muscular fibres, which form a 
 part of its structure. In consequence of this the mucus 
 which is occasionally accumulated will not be so readily 
 expelled by coughing, and probably the air will not be 
 thrown out in so small a column, nor with so much mo- 
 mentum. 
 
 Ulcers of the Trachea. 
 
 The trachea is doubtless liable, like other parts of the 
 body, to the process of ulceration, from causes acting 
 immediately upon itself; but in the instances which I 
 have seen, the ulceration has been connected with ulcera- 
 tion of the oesophagus. As the oesophagus is more liable 
 to this disease, it is probable that in such cases the ulcera* 
 
61 
 
 tion has begun in the oesophagus, and spread to the 
 trachea. 
 
 Diseased Appearances of the (Esophagus. 
 
 The oesophagus is frequently lined with a layer of the 
 coagulable lymph, which is continued from the cavity of 
 the mouth. 
 
 This, it is said, sometimes extends over the whole 
 intestinal canal; but I believe this appearance to be ex- 
 tremely rare, and it commonly terminates at the lower 
 end of the oesophagus. The inner membrane of the 
 mouth is at the same time much more vascular than in its 
 natural state, shewing a deep red colour; but in exami- 
 nations after death the appearance of greater redness is 
 sometimes scarcely observable in the oesophagus. This 
 disease is known under the name of aphthae, and is much 
 more often to be observed in the living than the dead body. 
 
 Spasmodic Stricture of the (Esophagus. 
 
 The oesophagus is liable to stricture, produced by the 
 contraction of its muscular fibres at some particular part. 
 This disease is most common in women whose constitu- 
 tions are delicate and much subject to nervous influence. 
 When such a disease is examined in the dead body, the 
 oesophagus is found to be more or less contracted in some 
 part of it, and it feels harder than usual, as happens to all 
 muscles in a contracted state. There is no appearance 
 of diseased structure usually combined with it. I can 
 suppose, however, that this contraction might lay the 
 foundation of a permanent, and even a fatal disease. The 
 muscular fibres of the oesophagus might so press on the 
 inner membrane, as to excite inflammation in it, which 
 
62 
 
 might advance to suppuration, and would most probably 
 terminate fatally. 
 
 Stricture from the Puckering of the inner Membrane of 
 (Esophagus. 
 
 I once saw a very unusual stricture of the oesophagus. 
 It consisted in its inner membrane being puckered together, 
 so as to form a narrowness of the canal at a particular 
 part, which would hardly allow a common garden pea to 
 pass. There was no appearance, however, of diseased 
 structure in the inner membrane which was so contracted, 
 and the muscular part of the oesophagus surrounding it 
 was perfectly sound. I know that this disease was very 
 slow in its progress, for the person in whom it took place 
 had been for many years affected with a difficulty of 
 swallowing, and could only swallow substances of an 
 extremely small size, 
 
 Stricture attended with Ulcer. 
 
 The most common appearance of disease in the oesopha- 
 gus, is that of an ulcer in its cavity. Ulcers of the oeso- 
 phagus are sometimes of a common nature, but most 
 frequently they are attended with a scirrhous affection. 
 When they arise from common inflammation, the structure 
 of the oesophagus immediately surrounding the ulcer is 
 but little thickened, and there is the appearance of the 
 usual erosion in ulcers. When the ulcer is of a scirrhous 
 nature, ihe oesophagus in the neighbourhood is very much 
 thickened, and is very hard in its texture. When this 
 texture is examined, it either consists of an hard, uni- 
 formly fleshy substance, or this is a little intersected by 
 membranes, or it is gristly. Under such circumstances 
 
63 
 
 the canal of the oesophagus is always more or less narrow- 
 ed, and in some cases is almost wholly obliterated. It is 
 worthy of remark, that these ulcers happen most fre- 
 quently, either immediately under the pharynx, or near 
 the cardia. 
 
 Any substance capable of irritating the inner mem- 
 brane of the oesophagus, by having sharp hard projections, 
 will doubtless be more likely to affect the oesophagus, 
 where it first enters into it. In an oesophagus, therefore, 
 predisposed to scirrhus, such an accident may prove an 
 exciting cause, and the disease will more frequently take 
 place at its upper end. At the cardia too, there is a pecu- 
 liar arrangement of the muscular fibres, which are capable 
 of acting in some degree like a sphincter, and which 
 produce on many occasions a narrowness of the canal 
 there. This will render the oesophagus at the cardia more 
 liable to be injured by the passage of any hard substance, 
 and may ultimately lay the foundation of a scirrhous ulcer. 
 This is the account which the late Dr. Hunter used to 
 give of the frequent situation of ulcers at the upper and 
 lower extremities of the oesophagus, and it seems to have 
 great weight. It happens, however, most commonly that 
 ulcers of the oesophagus arise spontaneously, or in other 
 words, from causes within itself which we cannot ascer- 
 tain. When an ulcer takes place at the upper end of the 
 oesophagus, it is apt to spread into the substance of the 
 thyroid gland. In this case the gland becomes hard, 
 enlarged, and ulcerated : but in some instances it has been 
 known to enlarge, where the ulcer of the oesophagus had 
 not spread so far as to reach it. x 
 
 (Esophagus cartilaginous. 
 A portion of the oesophagus has been observed by 
 
64 
 
 some anatomists to be converted into cartilage, and to 
 have its diameter at that part very much diminished in 
 size.* 
 
 This was probably only a strong example of the gristly 
 texture above described. 
 
 Fungus in the Pharynx. 
 
 I have seen an instance of a fungus arising on the in- 
 side of the pharynx and the upper end of the oesophagus, 
 which is to be considered as a rare disease. When cut 
 into it appeared to have a fibrous structure, disposed in 
 some measure at right angles to the inner membrane upon 
 which it was formed, and was ulcerated on its surface. 
 
 Scrofulous Swelling in the Pharynx. 
 
 It has occurred to me likewise to see a scrofulous 
 swelling at the lower end of the pharynx and the begin- 
 ning of the (Esophagus. When cut into it appeared to 
 consist of the same kind of matter as a scrofulous absorbent 
 gland. It grew upon that side of the pharynx which is 
 next the larynx, and the patient for this reason had not 
 only lost almost entirely the power of swallowing, but 
 was not able to speak except in the smallest whisper. 
 
 Pouch formed at the lower end of the Pharynx. 
 
 The pharynx, at its lower extremity, has been known 
 to be dilated into a pouch of a considerable size, which 
 passed behind the oesophagus. This may be supposed to 
 be very rare, but there is an instance of it preserved in 
 Dr. Hunter's collection. The pouch in this case began 
 to be formed in consequence of a cherry-stone having 
 
 * Vid, Bonet. Tom. II. p. 32. 
 
65 
 
 rested there for some time, which had made a kind of 
 bed for itself. It remained in that situation for three 
 days, and then was brought up by a violent fit of coughing. 
 A part of the food always rested afterwards in the cavity 
 made by the cherry-stone, by which it was gradually 
 enlarged. At length, in the course of about five years, 
 the cavity was enlarged into a bag of considerable size, 
 sufficient to contain several ounces of fluid. This bag 
 passed down a good way behind the oesophagus, and the 
 oesophagus necessarily acquired a valvular communication 
 with it. In proportion as the bag enlarged, this valvular 
 communication would become more and more complete, 
 till at length every kind of food must have rested in the 
 bag, and could not pass into the oesophagus. In this way 
 the person was destroyed, The lower end of the pharynx 
 is, perhaps, the only part of the canal where such an acci- 
 dent can happen. The pharynx is not contracted gradu- 
 ally, so as to lose itself insensibly in the oesophagus, but 
 contracts itself rather suddenly at the lower end. Hence 
 a little recess is formed, in which an extraneous body may 
 occasionally rest. This would be most apt to happen at 
 the posterior part; so that if the recess should be en- 
 larged into a cavity, it would generally pass behind the 
 oesophagus. The particulars of this singular case have 
 been published in the Medical Observations.* 
 
 The descending Aorta. 
 
 There is hardly any other disease of the descending 
 aorta within the posterior mediastinum, than its enlarge- 
 ment. This will sometimes take place in a great degree, 
 and is attended with a diseased state of its coats. The 
 
 * See Medical Observations, Vol. Ill, p. 85, 
 
66 
 
 coats become irregularly thickened, and more readily 
 divisible from each other, than in a healthy state. Little 
 thin laminae of bone are frequently formed behind the 
 inner membrane, and small masses of curdly matter are 
 deposited there. It is rare that this part of the aorta 
 becomes enlarged, unless there be a general disposition 
 to enlargement over the arterial system. 
 
 The Vena Azygos varicose. 
 
 The vena azygos is very seldom diseased. I have 
 seen it, however, varicose, and very much enlarged. This 
 change in it took place from particular circumstances. 
 A considerable portion of the vena cava inferior had be- 
 come obliterated; in consequence of this, the usual vena 
 azygos, together with an uncommon one on the left side, 
 were the only channels through which the blood could 
 return by a circuitous route to the heart; they were there- 
 fore necessarily, from the impetus of the blood, much 
 enlarged in size, and for the same reason likewise varicose. 
 This case I have more particularly described in the 
 Medical and Chirurgical Transactions/* 
 
 Vena Azygos ruptured. 
 
 The vena azygos has been known to be ruptured, 
 
 when very much distended with blood.f Such a case 
 
 has not come under my own observation, and I believe 
 it to be very uncommon. 
 
 The Thoracic Duct varicose. 
 The thoracic duct also is subject to very few diseases. 
 
 * See p. 125; &c. Vol. I. 
 
 fVid. Morgagni, Epist. XXVI. Art. 29. 
 
67 
 
 I have never seen any other except that of its being very 
 much enlarged and varicose. 
 
 In the instance to which I allude, it was very nearly as 
 large as the usual size of the subclavian vein, but nothing 
 could be detected in the neighbouring parts, capable of 
 accounting for this appearance. There was no obstruction 
 at the entrance of the thoracic duct into the venal system, 
 which might naturally have been expected. This 
 diseased appearance of the thoracic duct has already been 
 taken notice of by Mr. Cruikshank in his Treatise on the 
 Absorbent System.* 
 
 Thoracic Duct obstructed. 
 
 The thoracic duct has been known to be obstructed 
 by an earthy matter deposited in its cavity. t It does not 
 necessarily happen when the thoracic duct is at some part 
 obstructed, that chyle is prevented from entering into the 
 system of blood vessels. The thoracic duct sometimes 
 sends off one or more considerable branches, which unite 
 again with the principle trunk. If tinder such circum- 
 stances an obstruction should take place in a part of the 
 principal trunk, between the origin and termination of 
 those branches, no bad effect would follow; one or more 
 of these branches would become enlarged, and convey 
 the chyle in its full quantity to the blood. 
 
 Thoracic Duct ruptured. 
 
 The thoracic duct has also been known to be ruptured; 
 although this is exceedingly rare. 
 
 * See Second edition, p. 207; and in it is represented in an engraving, 
 Plate V. f Vid . Lieutaud, Tom. II. p. 93. 
 
68 
 
 Absorbent Glands scrofulous. 
 
 The absorbent glands in the posterior mediastinum, 
 as well as in every other part of the body, are liable to 
 several diseases. The most common morbid affection is 
 scrofula. In this case they are frequently a good deal 
 enlarged, and sometimes feel a little softer to the touch 
 than in their healthy structure. When cut into, they 
 sometimes exhibit very much the natural appearance ; but 
 it is more common to find that some of them contain a 
 white, soft, cheesy matter, mixed with a thick pus : this 
 is the most decided mark of scrofulous affection. When 
 the absorbent glands in this situation are very much en- 
 larged, they necessarily produce some difficulty of breathing, 
 both by pressing on the lungs and the trachea. They 
 may occasion also some difficulty of swallowing. 
 
 Absorbent Glands scirrhous. 
 
 I have seen the absorbent glands in the neighbourhood 
 of the trachea affected with scirrhus, although it is a rare 
 disease in them. They were much 'enlarged and very 
 hard to the touch. When cut into they exhibited a hard 
 texture, somewhat intersected by membrane, so as to 
 resemble what is called scirrhus in other parts of the body. 
 The trachea in contact with these glands was also affected. 
 In this case the thyroid gland was scirrhous, and it is 
 probable that the disease spread from the thyroid to the 
 absorbent glands, and so to the trachea. 
 
 Absorbent Glands bony. 
 
 The absorbent glands near the trachea are sometimes 
 converted into a bony or earthy matter; and I think that 
 
69 
 
 this disease is more common in the absorbent glands at 
 the root of the trachea, than in any other part of the body. 
 These glands when so diseased, by pressing against the 
 trachea or oesophagus, occasionally produce ulcers in them. 
 
 The Anterior Mediastinum. 
 
 By the anterior mediastinum, is meant the space in- 
 closed between the laminas of the pleura, which pass from 
 the sternum to the pericardium ; it contains little else than 
 cellular membrane, with perhaps a small portion of fat; 
 and in the younger subject the thymus gland. 
 
 It is seldom found with any diseased appearance in it. 
 Abscesses are occasionally formed there, but rarely. 
 Water too is sometimes found in the cells of its cellular 
 membrane. I have also seen air accumulated in these 
 cells. 
 
 Fat is occasionally deposited in the mediastinum in 
 considerable quantity. When the quantity is very large, 
 it has been known to disturb the functions both of the 
 heart and lungs. 
 
 Scrofulous tumours have also been known to be 
 formed in the anterior mediastinum, but this morbid ap- 
 pearance occurs very rarely.* Two or three small ab- 
 sorbent glands are situated in the anterior mediastinum, 
 and these may be occasionally enlarged from scrofula, 
 but I do not recollect to have seen any instance of this 
 having taken place. 
 
 Diseased Appearances of the Thymus Gland. 
 The thymus gland is subject to few diseases, and is 
 
 * See Portal's Anatomic Medicate, Tom, V. p. 30. 
 
7t> 
 
 t>nly of temporary existence; few instances therefore of 
 morbid structure have been observed in it. 
 
 It would seem to be very little disposed to common 
 inflammation ; therefore abscesses have occurred in it very 
 rarely, and have been but little taken notice of by authors. 
 
 It is more liable to be enlarged in its size, and to 
 become hard in its texture. It once occurred to myself 
 to observe an instance of this sort, but I had not an 
 opportunity of examining it very minutely. 
 
 Small calculi have been said to be occasionally formed 
 in the thymus gland.* 
 
 SYMPTOMS. 
 
 Inflammation of the thyroid gland may be known by an 
 increase of its size and firmness, by a pain felt in it, which 
 is increased upon pressure, and which is probably also 
 increased during the act of swallowing. It may be dis- 
 tinguished from some other swellings of this gland, as 
 for instance from bronchocele, by its rapid progress, by 
 the feeling of pain, and by its not increasing to a very 
 large size. 
 
 It is worth while to remark, that practitioners ought 
 to be particularly cautious to prevent inflammation of the 
 thyroid gland from advancing to suppuration. If it should 
 suppurate, and the pus be evacuated externally, there 
 will be a scar in the neck; and if it should point internally, 
 
 * See Dr. Soemmering's German Translation, p. 61. 
 
71 
 
 it will probably make its way into the cavity of the larynx 
 or the trachea, and suffocate the patient. There is a 
 preparation in Dr. Hunter's collection, shewing this fatal 
 termination of inflammation in the thyroid gland. Every 
 means should be attempted to make the inflammation 
 terminate in resolution. When inflammation of the sub- 
 stance of any part terminates in resolution, the blood 
 vessels gradually return to their natural mode of action, 
 and their natural size : the deep seated absorbents are at 
 the same time excited to an increased exertion so as to 
 remove the blood and the coagulable lymph which had 
 been extravasated during the inflammation. This is one 
 of the chief uses of the absorbent vessels which are dis- 
 tributed through the substance of parts.* 
 
 Bronchocele may be distinguished from other swellings 
 of the thyroid gland, by its slow growth, by the size at 
 which it is capable of arriving, by its want of pain, by its 
 commonly occurring at an early period of life, by the 
 sensation it yields to the touch, which is that of more or 
 
 * In the reduction of some of the deeper seated parts of the body from a 
 state of enlargement to their natural size, there is a strong proof of a consent 
 or sympathy existing between the superficial and deeper seated absorbent 
 vessels. When, for instance, a swelled testicle is reduced to its natural size by 
 rubbing mercurial ointment upon the surface of the scrotum which covers it, 
 it cannot be supposed that any part of the ointment comes in contact with the 
 absorbent vessels belonging to the substance of the testicle ; yet these ab- 
 sorbents are excited to an increased action by the application of the ointment, 
 and the testicle is at length reduced to its natural size. This effect would 
 seem only capable of being explained upon the principle of a consent or sym- 
 pathy existing between the absorbents of the scrotum and the absorbents of 
 the substance of the testicle, by which, when the former are stimulated, tin 
 litter arc roused to an increased action, 
 
72 
 
 less firmness, but not of great hardness, and by the health 
 being unaffected by it. 
 
 Scirrhus of the thyroid gland may be distinguished 
 from other swellings of it, by its great hardness, by oc- 
 casional darting pains in the gland, and by this affection 
 being most apt to occur in persons of an advanced age. 
 The swelling likewise in scirrhus of the thyroid gland is 
 seldom so large as in bronchocele. 
 
 Ossification in the thyroid gland can only be ascer- 
 tained by an accurate examination of the part affected. If 
 the ossification be upon the surface of the gland, the bony 
 matter will be distinctly felt under the skin ; but if it should 
 be deeply seated, it will be felt more obscurely, so as to 
 leave the nature of the disease in some doubt. When, 
 however, it has made further progress, it will become 
 perfectly distinct. 
 
 When the cartilages of the larynx are converted into 
 bone, the voice has been remarked to become hoarse, or 
 sometimes to be changed into a whisper. This may be 
 easily explained by the cartilages of the larynx having lost 
 their flexibility, and therefore being rendered incapable of 
 those finer motions which it is reasonable to imagine must 
 have considerable influence upon the voice. In the 
 
73 
 
 cases which I have had an opportunity of examining, the 
 ligaments which join the cartilages together were natural 
 in their structure ; had they been changed into bone, all 
 the motions of the larynx would have been lost. It 
 would then have been useless as the chief instrument of 
 voice; but what would be the exact effect of such a 
 change upon various sounds transmitted through the 
 trachea and the larynx, it is extremely difficult to deter- 
 mine. In some instances where the cartilages of the 
 larynx have been converted into bone, there has occurred 
 a total inability of swallowing, which destroyed the pa- 
 tients. Upon examination after death, no disease was 
 observable either in the pharynx or the oesophagus. This 
 inability of swallowing was probably produced by some 
 of the ossified cartilages being enlarged posteriorly by a 
 morbid growth, so as to encroach very much upon the 
 cavity of the pharynx.* 
 
 When ulcers have taken place in the cavity of the 
 larynx, there is a fixed pain in the situation of this organ, 
 difficulty of breathing, and the patient can only speak in 
 a whisper. This state of the larynx is accompanied with 
 more or less of symptomatic fever. 
 
 The symptoms which attend catarrh are too generally 
 
 * This occurred in a case described by Dr. Travers, of Newark, in Part I. of 
 the Vllth Volume of the Medico-Chirurgical Transactions, p. 151 and 152. 
 Dr. Robertson of Greenwich Hospital had observed the inability of swallowing 
 5n one or two similar cases many years ago. 
 
 K 
 
74 
 
 known to require being mentioned. When there is & 
 sense of soreness in this disease, passing down the middle 
 of the chesty it arises from a considerable inflammation of 
 the inner membrane of the trachea. The inflammation 
 soon goes off, but the increased secretion from the glands 
 of the trachea 'often remains for a good while afterwards. 
 
 The inflammation of the inner membrane of the trachea, 
 which is sometimes to be found in consumptive patients, 
 continues more or less throughout the course of the disease 
 in the lungs. 
 
 The symptoms of the croup are, symptomatic fever, 
 difficulty of breathing, a wheezing or croaking noise in 
 inspiration, a hoarse voice, and a sort of ringing sound 
 during coughing: portions of a. whitish membrane and 
 pus are at the same time occasionally coughed up. It 
 may perhaps be reasonable to suppose that the whitish 
 membrane is.formed by some peculiar action of the blood 
 vessels of the inner surface of the larynx and the trachea, 
 which is superadded to inflammation. In common in- 
 flammation of the inner surface of the larynx and trachea, 
 there is merely an increased secretion of mucus, or some- 
 times of pus; but in the croup an adventitious membrane 
 is always formed. This gives some probability to the 
 supposition which we have made; and it may perhaps 
 serve to explain why the croup is so rarely cured by the 
 means Which are known to remove common inflammation,. 
 
 The symptoms which attend a polypus of the trachea 
 
75 
 
 are, difficulty of breathing, a dry cough, and a frequent 
 pulse, but without any signs of inflammation. These, 
 however, would not enable physicians to discriminate this 
 disease from several others, if portions of the polypus were 
 not frequently coughed up. The disease is apt to con- 
 tinue for a great length of time. 
 
 The symptoms attending spasmodic stricture of the 
 oesophagus characterize sufficiently the nature of the 
 disease. The difficulty of swallowing is not constant, but 
 occasional. It comes on and goes off* suddenly, and these 
 changes are frequent. There is no emaciation of the 
 body, and the person generally seems to be in good health* 
 
 The stricture of the oesophagus which depends upon 
 a puckering of the inner membrane, is slow in its progress. 
 It may continue for a great many years, and the person 
 seems to be in good health, except for the difficulty of 
 swallowing. The difficulty is constant, ' which will dis- 
 tinguish it from a mere spasmodic contraction of the 
 muscular fibres of the oesophagus. 
 
 The symptoms which belong to a stricture of the 
 (oesophagus depending on a scirrhous thickening and ulcer> 
 distinguish it sufficiently from the other two diseases. 
 
 The difficulty of swallowing is small at first, and 
 
76 
 
 gradually becomes worse, but is constant. When the 
 disease has made considerable progress, the food is fre- 
 quently rejected, and along with it occasionally there 
 passes up some pus. The pulse at first is natural, but in 
 the advanced stages of the complaint is frequent; and 
 towards its termination the body becomes extremely 
 emaciated. The parts in the neighbourhood of the disease 
 are irritated to an increased secretion, which often pro- 
 duces a cough or hawking. Although hardly any nourish- 
 ment, towards the end of this disease, can be got into the 
 stomach, yet the feeling of hunger is described as not 
 being distressing. 
 
 When there is a fungus or a scrofulous tumour in the 
 cesophagus, the symptoms correspond, I believe, very much 
 with those of the scirrhous stricture of the oesophagus 
 just described. 
 
77 
 
 CHAPTER VI. 
 
 DISEASED APPEARANCES WITHIN THE CAVITY OF 
 THE ABDOMEN. 
 
 Ascites. 
 
 ASCITES, or dropsy of the cavity of the abdomen, is 
 a very frequent disease, and is not confined to any sex or 
 age. I have seen several instances of it in children under 
 ten years old; but it is much more common at the middle, 
 and the more advanced periods of life. It is also more 
 common in the male than the female sex. When water 
 is accumulated in a large quantity in the cavity of the 
 abdomen, the superficial veins of the belly are generally 
 a good deal distended with blood, which probably arises 
 from the pressure of the water upon the deeper seated 
 veins; but this is sometimes hardly observable, even when 
 the accumulation of the water is very considerable. The 
 skin at the navel is also often protruded, yielding easily to 
 pressure; but this is not universally the case. On many 
 occasions the protrusion can hardly be seen, though the 
 water be accumulated in large quantity. In opening 
 into the cavity of the abdomen, a larger or less quantity 
 of an aqueous fluid is observed, which is generally of a 
 brownish colour, but its colour varies according to cir- 
 cumstances. When there is a scirrhous liver accompany- 
 ing the dropsy, the water is commonly of a yellowish or 
 greenish colour. This arises from a mixture of the bile 
 with the water, and under such circumstances there is 
 
78 
 
 almost always a jaundice colour of the skin. I have seeu 
 the water in ascites of chocolate or coffee colour; but this 
 appearance is rare. In a case of this kind which I ex- 
 amined more particularly, the water was thicker than that 
 of ascites usually is; but it had the common properties as 
 far as could be known from the application of heat and 
 of acids. When none of the viscera of the abdomen are 
 diseased the water in ascites resembles the serum of the 
 blood in its colour, as well as in its other properties. 
 
 While water is accumulated in the cavity of the ab- 
 domen, the intestinal canal is frequently found to be some- 
 what in a contracted state; but often too this is not ob- 
 servable. In many cases of ascites the liver is diseased, 
 being hard and tuberculated, as we shall explain particu- 
 larly when treating of the diseases of the liver. In some 
 cases too, the spleen has been found to be enlarged and 
 hard. 
 
 Ascites is not necessarily connected with the accumu- 
 lation of water any where else in the body; but it frequently 
 happens that it is accompanied with the accumulation of 
 water in the chest, and under the skin, particularly of the 
 lower extremities. 
 
 Chyle in the Cavity of the Peritoneum, 
 
 Chyle has been occasionally observed to have been 
 effused into the cavity of the peritonaeum, from the rupture 
 of some lacteal vessels; but this morbid appearance has 
 occurred very rarely. In the cases to which I allude, the 
 mesenteric glands were scrofulous, and some of the lacteals 
 were ruptured, probably from the great obstruction to the 
 passage to the chyle through these glands.* 
 
 * See Portal's Anatomic Medicale, Tom. V. p. 115, 
 
Inflammation of the Peritoneum. 
 
 The peritonaeum is not uncommonly inflamed, although 
 it is by no means so liable to this disease as the pleura. 
 There is a cause of inflammation in it peculiar to women, 
 which depends on a certain state of the womb after partu- 
 rition ; but there is also a variety of causes producing it, 
 which are equally applicable to both sexes, so that it is 
 frequently found in men, and also in women who have 
 not been pregnant. 
 
 When inflammation has taken place in the peritonaeum, 
 several appearances are observable in opening the body. 
 The peritonaeum is thicker than in its natural state, more 
 pulpy, and less transparent; and it is crowded with a 
 number of very small vessels, containing a florid blood. 
 When a portion of the inflamed peritonaeum is separated 
 from the abdominal muscles, there is commonly no ap- 
 pearance whatever of the inflammation having spread into 
 the muscles; but where the peritonaeum covers the in- 
 testinal canal, the inflammation is sometimes found to have 
 penetrated not only into the muscular coat of the intestines, 
 but even into the villous membrane. The reason of this 
 difference probably is, that the peritonaeum is less con- 
 nected with the abdominal muscles than with the intestinal 
 canal, so that the inflammation passes less readily from the 
 peritonaeum to the former than to the latter part. 
 
 Inflammation of the peritonaeum is sometimes slight 
 and partial ; at other times is great, and spread over the 
 whole membrane. When it is slight, and affects that 
 part of the peritonaeum which is connected with the in- 
 testinal canal, it often forms broad surfaces of inflam- 
 mation, which run like bands along the course of the 
 
80 
 
 intestines, and are bounded by the contact of different 
 portions of the intestines among themselves. In this case 
 the coats of the intestines are not thicker than usual, the 
 inflammation being slight, and confined to the peritonaeum 
 itself. Where the inflammation is great, the intestines 
 are much thicker, and more massy. This evidently 
 arises from the greater accumulation of blood in the small 
 blood vessels, as well as from the extravasation of fluids 
 into the substance of the intestines, in consequence of the 
 strong inflammatory action of the vessels. The mesentery 
 and mesocolon are much thicker than in their natural state, 
 and there is also a remarkable change in the omentum. 
 It is frequently as thick as a person's hand, and lies as a 
 circumscribed mass along the great curvature of the 
 stomach. The principal cause of this change in these 
 parts is the extravasation of the coagulable lymph into the 
 cellular membrane between the laminae of the peritonaeum 
 which form them. 
 
 In many places there is formed a layer of a yellowish 
 pulpy matter, gluing different portions of the viscera 
 together. This layer is sometimes thin: at other times is 
 of considerable thickness, and appears to be the coagulable 
 lymph of the blood. There is also a considerable quantity 
 of a brownish fluid in the cavity of the abdomen resembling 
 the serum, which is mixed with small shreds of the 
 coagulable lymph, and sometimes with pus, giving it a 
 turbid appearance. The quantity of the coagulable 
 lymph, and of the fluid, is sometimes large, in proportion 
 to the degree of the inflammation. In some instances, 
 instead of serum a large quantity of pus is found. Air 
 too is sometimes accumulated in the stomach and the 
 intestinal canal, which had been formed in the progress of 
 
 
81 
 
 the disease. At other times this air is wanting. The ac- 
 cumulation of air is most common when the inflammation 
 is slight, and passes in bands along the surface of the 
 intestines. 
 
 Adhesions in the Cavity of the Abdomen. 
 
 When there has been inflammation of the peritonaeum 
 either generally or partially, sufficient to have formed a 
 layer of coagulable lymph, and the patient has survived 
 the disease, the coagulable lymph is changed into a fine 
 transparent membrane, which is the membrane of ad- 
 hesions. The time which is occupied in the change of 
 the coagulable lymph into the membrane of adhesions, is 
 not very long; for I have had several opportunities of 
 tracing the gradual progress of the change from the one 
 into the other, while the inflammation appeared to have 
 been recent. This membrane consists of a cellular s*ib- 
 stance,. similar to the general cellular membrane of the 
 body, and has a moderate share of vasculnrity. It does 
 not naturally shew many vessels large enough to admit 
 the red globules of the blood ; but it shews its vascularity 
 upon slight degrees of inflammation, or when its vessels 
 have been filled with the fine injection. This membrane 
 is capable of elongating gradually by the motion of the 
 viscera upon themselves, so as ultimately to be attended 
 in general with very little inconvenience. I have very 
 often had an opportunity of observing these adhesions, 
 either joining all the viscera of the abdomen more or less 
 together, or joining some particular viscera to each other. 
 
 Scrofulous Masses adhering to the Peritoneum. 
 1 have several times had an opportunity of observing a 
 
white soft granulated matter adhering universally behind 
 the peritonaeum. In some places it formed a mass of 
 considerable thickness; in others, it was scattered in single 
 small masses. In one case I recollect that it formed a 
 substance as thick as my hand, between the peritonaeum 
 and the abdominal muscles, while it was scattered in small 
 separate portions in the mesentary and the peritonaeum, 
 covering the intestinal canal. The omentum I have 
 sometimes seen changed into a cake of this substance. 
 The matter itself appears to be scrofulous, for it resembles 
 exactly the structure of a scrofulous absorbent gland,, 
 before pus is actually formed. lam not at all certain how 
 jfar this appearance of disease should have been classed 
 along with those of the peritonaeum : it does not take place 
 (at least in the cases which I have seen) in the peritonaeum 
 itself but behind it, yet at the same time adhering to it. 
 It appears, however, upon the whole, to be placed here 
 with more propriety than it could have been any. where 
 else. 
 
 Cancerous Tumours adhering to the Peritoneum. 
 
 I have also seen some small cancerous tumours growing 
 from the peritonaeum. These were extremely hard, of a 
 ^hi e colour, and resembled exactly in their structure the 
 cancerous masses which are formed in the stamach. What 
 puts the appearance 1 allude to beyond a doubt, is, that 
 in the same body I found a cancerous tumour of the 
 stomach. The cancerous tumours of the peritonaeum 
 were not at all connected with this other, but were in that 
 part of the membrane which lines the recti abdominis 
 muscles, nearly opposite to the region of the stomach. 
 
83 
 
 Cartilaginous Excrescences growing from the 
 Peritoneum. 
 
 In one case I have seen a great many cartilaginous ex- 
 crescences growing from the peritonaeum. They were 
 of a small size, viz. most of them not larger than a garden 
 pea, and grew from every part of the membrane. They 
 were a little softer than the cartilages which cover the 
 extremities of the bones, but had the true structure of 
 cartilage. 
 
 Steatomatous Tumours adhering to the Peritoneum. 
 
 Steatomatus tumours have also been observed adhering 
 to the peritonaeum; but these are of very rare occurrence.* 
 
 Hydatids in the Abdomen. 
 
 Hydatids have occasionally been found to occupy a 
 portion, or even the whole of the cavity of the abdomen. 
 In such cases they are connected with the viscera, and 
 chiefly with the liver or spleen. They may, however, be 
 attached to any viscus or to any part of the peritonaeum. 
 This appearance of disease is uncommon. 
 
 Air in the Cavity of the Abdomen. 
 
 Air has been said to be occasionally accumulated in the 
 cavity of the abdomen, while little or none is contained in 
 the intestines, f This I believe to be a very rare occur- 
 rence. Air is not unfrequently accumulated in conside- 
 rable quantity in the intestinal canal, while there is none 
 
 * See Soenimering's German Translation, p, 7P. 
 f Vid. Lieutaud, Tom. I. p. 433. 
 
tit all in the cavity of the abdomen. When a large 
 quantity of air is accumulated in the bowels, they become 
 greatly distended, and their coats proportionably thin* 
 By the bowels lying in close contact with the peritonaeum 
 which lines the muscular parietes of the abdomen, there 
 is the same feeling of distension when the hand is pressed 
 against the surface of the belly, the same quick reaction 
 upon removing the hand, and the same hollow sound, 
 when the belly is struck by the fingers, as if the cavity 
 of the belly itself had been filled with air. This has 
 probably given rise to the opinion, that the air is often 
 contained in the cavity of the belly. I can believe r 
 however, that air may on some occasions be accumulated 
 in the cavity of the belly, but this is very uncommon. 
 A part of the intestine when very much distended with 
 air may burst, and a portion of the air may escape into the 
 cavity of the belly; or the small arteries of the peritonaeum 
 may secrete air in the same manner as it appears to be 
 formed by the inner membrane of the stomach and the 
 intestines. Portal has mentioned a remarkable instance 
 which he met with in a woman about fifty years of age, in 
 whose abdomen after death he found a large quantity of 
 air, not accompanied with any rupture of the intestines, 
 or with any organic disease of any of the abdominal 
 viscera.* 
 
 SYMPTOMS. 
 
 The symptoms which belong to ascites are almost toe 
 well known to require being mentioned. There is conv 
 
 * S^ee Portal's ^natomie Medicale, Tom. V. p. 3. 
 
85 
 
 monly a distinct feeling of fluctuation upon applying one 
 hand to the belly, and striking it with the other; the urine 
 is in small quantity, and of a deep colour; there is thirst, 
 often some feeling of feverish heat, and a pulse more 
 frequent than in health. The breathing is likewise diffi- 
 cult when the water is accumulated in very large quantity. 
 
 The symptoms attending inflammation of the perito- 
 naeum are a pain in the abdomen, together with some 
 swelling there, and a great sense of soreness to the touch. 
 The bowels are often costive, the pulse is frequent and 
 hard, and the other circumstances of symptomatic fever 
 are strongly marked. When the inflammation is slight, 
 I have known the pain to be very inconsiderable, and the 
 pulse to be little increased in its frequency, so that in- 
 flammation of the peritonaeum had not been suspected. 
 Upon examination, however, of the body after death, no 
 other diseased appearance than a slight inflammation of the 
 peritonaeum was discoverable. 
 
 There are no symptoms which mark the existence of 
 adhesions in the abdomen; and they seem to be attended 
 in general with no inconvenience to the functions which 
 are carried on in that cavity. If however, an adhesion 
 should form a chord crossing a portion of intestine, and so 
 pressing it, as to interrupt its cavity, it might produce a 
 fatal obstruction. 
 
The symptoms which belong to scrofulous and scirrhous 
 tumours of the peritonaeum are unknown to me. 
 
 I know of no symptoms produced by cartilaginous 
 excrescences growing from the peritonaeum. It is probable 
 that they are generally not observable, or not capable of 
 being discriminated. 
 
 Whenhydatids are accumulated in large quantity in the 
 abdomen, it will require some attention to distinguish 
 this disease from ascites. It may be distinguished, how- 
 ever, in the following manner. In the case of hydatids, 
 the feeling of fluctuation upon striking the belly with the 
 hand will either take place very indistinctly, or not at 
 all; whereas in ascites attended with no extraordinary 
 symptoms, it is always distinct. The swelling in ascites 
 is always uniform, but in an accumulation of hydatids 
 it will be more or less unequal In hydatids it will be 
 found, upon enquiry into the history of the case, that 
 the swelling first began in some determined place, where- 
 as in ascites there is a gradual swelling of the whole belly. 
 
 It will be more difficult to distinguish an accumulation 
 of hydatids from a dropsy of the ovarium than from 
 ascites. The distinction between the two diseases would 
 seem only capable of being determined by an accurate 
 enquiry into the history of the case. In dropsy of the 
 ovarium the swelling is first perceived on the side of the 
 lower part of the belly, and gradually increases upwards, 
 so as to occupy a great part of the cavity of the abdomen. 
 As hydatids most commonly grow from the liver, the 
 
87 
 
 swelling in this case will generally be first sensible at the 
 upper part of the belly, and spread downwards. Hydatids, 
 however, may be formed in any part of the abdomen, 
 and therefore were they to begin to be formed at the 
 side of the lower part of the belly, it seems hardly possi- 
 ble to distinguish the one disease from the other. 
 
88 
 
 CHAPTER VII. 
 
 DISEASED APPEARANCES OF THE STOMACH* 
 
 Inflammation. 
 
 It sometimes happens, although not very frequently 
 (unless poisons have been swallowed), that inflammation 
 takes place in the stomach, and spreads over a very con- 
 siderable portion of its inner membrane, or perhaps the 
 whole of it. It is much more common for inflammation 
 to occupy a smaller portion of the stomach. In such 
 cases the inflammation is generally not very violent. The 
 stomach upon the outside, at the inflamed part, shews a 
 greater number of small vessels than usual, but is com- 
 monly not much crowded with them. On opening into 
 the stomach, it is found to be a little thicker at the in- 
 flamed part, the inner membrane is very red from the 
 number of small florid vessels, and there are frequently 
 spots of extravasated blood. It does not often occur 
 that a common inflammation of the stomach proceeds to 
 form pus, or to terminate in gangrene. 
 
 When arsenic has been swallowed (which is the poison 
 most frequently taken) the stomach is affected with a 
 most intense degree of inflammation. Its substance be- 
 comes thicker, and there is a very great degree of redness 
 in the inner membrane, arising partly from the very great 
 number of minute vessels, and partly from extravasated 
 blood. Portions of the inner membrane are sometimes 
 destroyed from the violent action that has taken place in 
 
89 
 
 consequence of the immediate application of the poison. 
 I have also seen a thin layer of coagulable lymph thrown 
 out upon a portion of the inner surface of the stomach. 
 Occasionally too, some part of the arsenic is to be seen 
 in the form of a white powder, lying upon different 
 portions of the inner membrane. I have been informed, 
 that in two cases where arsenic had been swallowed, and 
 had destroyed the persons by producing violent inflamma- 
 tion of the stomach, ulcers were found upon examination 
 after death, at the lower end of the rectum. These 
 persons had never complained of any disease in the rectum 
 previously to swallowing the arsenic, and were apparently 
 in good health. This circumstance is stated from good 
 authority, and may have been produced by some of the 
 arsenic having passed along the whole track of the in- 
 testines, and being ultimately lodged between some of 
 the folds of the inner membrane of the rectum. 
 
 Appearances in Hydrophobia. 
 
 On opening the bodies of persons who have died from 
 hydrophobia, the inner membrane of the stomach is 
 frequently found inflamed at the cardia, and its great end. 
 The inner membrane of the pharynx and the oesophagus 
 is also inflamed. The membrane is not thickened by the 
 inflammation, but the inflammation spreads as in erysipelas, 
 shewing in some places a distinct line of boundary. This 
 inflammation is commonly not violent, and is sometimes 
 hardly observable. 
 
 Ulcers in the Stomach. 
 
 Opportunities occasionally offer themselves of observing 
 ulcers in the stomach. These sometimes resemble 
 M 
 
90 
 
 /common ulcers, in any other part of the body, but frequently 
 they have a peculiar appearance. Many of them are 
 scarcely surrounded with any inflammation, have not 
 irregular eroded edges as ulcers have generally, and are 
 not attended with any particular diseased alteration in the 
 structure of the stomach in the neighbourhood. They 
 appear very much as if, some little time before, a part 
 had been cut out from the stomach with a knife, and the 
 edges had healed, so as to present an uniform smooth 
 boundary round the excavation which had been made. 
 These ulcers sometimes destroy only a portion of the 
 inner coat of the stomarch at some one part, but occasion- 
 ally they destroy a portion of all the coats, forming a hole 
 in the stomach. When a portion of all the coats is de- 
 stroyed, there is sometimes a thin appearance of the 
 stomach surrounding the hole, which has a smooth surface, 
 and depends on the progress of the ulceration. At other 
 times, the stomach is a little thickened round the hole; 
 and at other tknes still, it seems to have the common 
 natural structure. 
 
 Scirrhus and Cancer of the Stomach. 
 
 This affection of the stomach is not very uncommon 
 towards an advanced period of life, and I think is more 
 frequently met with in men than in women. This may 
 probably depend upon the greater intemperance in the 
 one sex than in the other. 
 
 Scirrhus sometimes extends over almost the whole of 
 the stomach, but most commonly it attacks one part of it. 
 The part which is affected with scirrhus has sometimes 
 no very distinct limit between it and the sound structure 
 of the stomach, but most commonly the limit is very well 
 
91 
 
 marked. When scirrhus attacks a portion of the stomach 
 only, it is generally towards the pylorus. The principal 
 reason of this probably is, that there is more of glandular 
 structure in that part of the stomach than in any other; 
 and it would appear that glandular parts of the body are 
 more liable to be affected with scirrhus than other parts. 
 
 When the whole stomach, or a portion of it, is scirrhous, 
 it is much thicker than usual, as well as much harder in 
 its texture. When the diseased part is cut into, the 
 original structure of the stomach is frequently marked 
 with sufficient distinctness, but very much altered from 
 the natural appearance. The peritonaea! covering of the 
 stomach is many times thicker than it ought to be, and 
 has almost a gristly hardness. The muscular part is also 
 very much thickened, and is intersected by numerous 
 membranous septa. These membranous septa are, 
 probably, nothing else than the cellular membrane in- 
 tervening between the fasciculi of the muscular fibres, 
 thickened from this disease. The inner membrane is 
 also extremely thick and hard, and not unfrequently 
 somewhat tuberculated or irregularly elevated towards the 
 cavity of the stomach. 
 
 It frequently happens that this thickened mass is ulce- 
 rated upon its surface, and then a stomach is said to be 
 cancerous. Sometimes the inner membrane of the 
 stomach throws out a process which terminates in a great 
 many smaller processes, and produces what has been 
 commonly called a fungous appearance. 
 
 It also happens that the stomach at some part looses 
 entirely all vestige of its natural structure, and is changed 
 into a very hard mass, of a whitish colour, with some ap- 
 pearance of membrane intersecting it: or it is converted 
 
into a gristly substance, like cartilage somewhat softened. 
 The absorbent glands in the neighbourhood are at the 
 same time commonly enlarged, and have a very hard 
 white structure. 
 
 Circumscribed scirrhoits Tumours in the Stomach. 
 
 I have seen several instances of a scirrhous tumour 
 being formed in the stomach about the size of a walnut, 
 while every other part of it was healthy. This tumour 
 has most frequently a small depression near the middle of 
 its surface. While it remains free from irritation, the 
 functions of the stomach are probably very little affected 
 by it; when, however, it is irritated, it must occasion very 
 considerable disorder in the functions of the stomach, and 
 may perhaps lay the foundation of a fatal disease. 
 
 Pouch formed in the Stomach. 
 
 A part of the stomach is occasionally formed into a 
 pouch by mechanical means, although very rarely. I have 
 seen one instance of a pouch being so formed, in which 
 five halfpence had been lodged. The coats of the 
 stomach were thinner at that part, but were not inflamed 
 nor ulcerated. The halfpence had remained there for 
 some considerable time, forming a pouch by their weight, 
 but had not irritated the stomach in such a manner as to 
 produce inflammation or ulceration. 
 
 Stricture at the Pylorus. 
 
 The orifice of the stomach may be almost, or perhaps 
 entirely, shut up by a permanent contraction of its muscu- 
 lar fibres, either at the cardia or pylorus. This is likely, 
 however, to occur most frequently at the pylorus, because 
 
93 
 
 the fibres at this end of the stomach are more circular in 
 their direction, and possess a stronger contractile power. 
 Less contraction too, at the pylorus, will produce an ob- 
 struction in the canal, than at the cardia. I have seen one 
 instance of this contraction at the pylorus, which, even 
 there, is a very rare disease. The contraction was so 
 great as hardly to admit a common goose quill to pass 
 from the stomach into the duodenum, and it had pre- 
 vented a number of plumb stones from passing, which 
 were therefore detained in the stomach. 
 
 Fungous Tumdurs obstructing the Pylorus. 
 
 Some instances have occurred of the passage of the 
 pylorus being obstructed by fungous tumours growing 
 from narrow pedicles attached to this part of the stomach. 
 This morbid appearance, however, is very rare, and has 
 not fallen under my own observation.* 
 
 Stomach much contracted^ or much enlarged* 
 
 The stomach is sometimes found so contracted through 
 the whole of its extent as not to be larger than a portion 
 of the small intestine; and sometimes it is enlarged to 
 much more than its ordinary size. Neither of these ap- 
 pearances is to be considered as arising from disease. 
 They depend entirely on the muscular fibres of the 
 stomach being in a state of contraction or relaxation at the 
 time of death. It happens, I think more frequently that 
 the stomach is dilated than contracted. 
 
 Stomach distended with Air. 
 The stomach is very commonly found, in a dead body, 
 
 * See Portal's Anatomic Medicale, Tom. V. p. 205, 
 
94 
 
 flaccid and almost empty; but not unfrequently it is found 
 more or less distended with air: this air may have been 
 formed after death, but it is often formed during life. 
 When this is the case, we may suppose it is to be pro- 
 duced by a new chemical arrangement of the contents of 
 the stomach; but it also frequently happens that air is 
 separated from blood, in the blood vessels of the stomach, 
 and poured by the small exhalents into its cavity. This 
 has been more particularly taken notice of by Mr. Hunter, 
 in his essay upon Digestion,* and by myself, in a paper 
 which is published in the first volume of the Medical and 
 Chirurgical Transactions.! 
 
 Part of the Stomach dissolved by the Gastric Juice. 
 
 In looking upon the coats of the stomach at its great 
 end, a small portion of them there appears frequently to be 
 thinner, more transparent, and feels somewhat more pulpy 
 than is usual; but these appearances are seldom very 
 strongly marked. They arise from the gastric juice 
 resting on that part of the stomach in greater quantity than 
 on any other, and dissolving a small portion of its coats. 
 This is therefore not to be considered as the consequence 
 of a disease, but as a natural effect, depending upon the 
 action of the gastric juice, on the coats of the stomach 
 after death. When the gastric juice has been in con- 
 siderable quantity, and of an active nature, the stomach 
 has been dissolved quite through its substance at the great 
 end, and its contents have been effused into the general 
 cavity of the abdomen. In such cases the neighbouring 
 
 * See Dr. Hunters Observations on certain parts of the Animal 
 Economy, p. 164. 
 t See case of emphysema, p. 202. 
 
95 
 
 viscera are also partially dissolved. The instances, 
 however, of so powerful a solution are rare, and have 
 almost only occurred in persons who while in good health 
 had died suddenly from accident. If the powers of the 
 stomach were little impaired by diseases, this appearance 
 of the stomach after death would be very common. As, 
 however, they are very much injured by most diseases, 
 and by many totally destroyed, this appearance very seldom 
 takes place. The true explanation of these appearances 
 was first given by Mr. Hunter, and published at the 
 request of Sir John Pringle, in the Philosophical 
 Transactions.* 
 
 Fatty Tumours in the Stomach. 
 
 Tumours consisting of a fatty substance, have been 
 sometimes found in the stomach but they are to be con- 
 sidered as a very rare appearance of disease. Ruysch 
 relates that he has seen a tumour from the stomach of a 
 man which contained hair, together with some dentes 
 molares; and that he has preserved this in his collection.! 
 
 This preparation of Ruysch may be considered as ex- 
 hibiting an approach to the formation of a foetus in the 
 human stomach. Two cases somewhat similar to it, but 
 much more extraordinary, because the developement of 
 the ibetal structure was much more perfect, have within 
 a few years occurred in this country. J 
 
 * See Philosophical Transactions, Vol. 62, p. 447. 
 
 fVid, Ruysch, Tom. 2. Adversar. Anatomicor. Decad. Tert. 
 
 } One of these cases was published about thee years ago, by Mr. Highmefre, 
 Surgeon at Sherborne, in which the foetus was contained in a cyst, that com- 
 municated with the duodenum. The other was published by Mr. Yonng, in the 
 first volume of the Medico-Chirurgical Transactions, where the foetus was con. 
 tained in a cyst, that was situated between the laminae of the transverse 
 mesoQolon, p. 234. 
 
96 
 
 Calculi in the Stomach. 
 
 Calculi with different appearances have been described 
 as being occasionally found in the stomach. They have 
 never come under my own observation, and are to be 
 reckoned very uncommon.* Most of these calculi have 
 been found upon examination to be biliary, and had- been 
 conveyed from the duodenum into the stomach by an 
 antiperistaltic motion of this part of the small intestines. 
 
 Morbid Papilla observed in the Stomach. 
 
 Papillae and pustules somewhat resembling the small- 
 pox have also been described as being formed on the 
 inner membrane of the stomach, but these are exceedingly 
 rare.f 
 
 Small-pox Pustules said to be in the Stomach. 
 
 Even true small-pox pustules have been said to be 
 found in the stomach of persons who died from this 
 disease. In later dissections, ' however, this appearance 
 has not been observed, and I am disposed to believe, 
 where it has been thought to exist, that some mistake has 
 been made. 
 
 SYMPTOMS. 
 
 In inflammation of the stomach, the following symptoms 
 are observed to take place: viz; pain in the epigastric 
 
 * Vid. Lieutaud, Tom. I. p. 17. 
 f Vid. Lieutau 1, Tom 1 p 23. 
 ; Vid. Lieutaud, Tom. I. p. 371. 
 
97 
 
 region, which is increased when any thing has been 
 swallowed, vomiting, often hickup, symptomatic fever, 
 with a small, frequent, and hard pulse, and a feeling of 
 great debility. 
 
 When a person has been poisoned by arsenic, the 
 following symptoms have commonly been observed, viz, 
 vomiting, great thirst, a burning feeling in the stomach, 
 severe griping pains, purging of a watery or viscid matter, 
 sometimes of blood, a sense of coldness, especially in the 
 extremities, a cold sweat, occasionally paleness of the 
 countenance, the countenance often swelled and flushed, 
 often faintness and languor, sometimes convulsions, some- 
 times palpitation of the heart, and sometimes vertigo.* 
 
 Hydrophobia is sufficiently characterized by the horror 
 which the patient expresses at the sight of any fluid that 
 is offered to him, by the great difficulty experienced in 
 swallowing, and by the strong alienation of mind which 
 often accompanies this dreadful disease. 
 
 I have reason to believe that ulcers of the stomach are 
 often slow in their progress. They are attended with 
 pain, or an uneasy feeling in the stomach, and what is 
 
 * See a very clear account of the symptoms produce by swallowing arsen& 
 in a Treatise upon this subject, lately published by Mr. Marshall. 
 
 N 
 
swallowed is frequently rejected by vomiting. Pus and 
 blood are likewise occasionally thrown up by vomiting. 
 
 Cancer of the stomach is attended with a sense of pain 
 in that organ, which varies a good deal in its degree in 
 different individuals. What is swallowed is commonly, 
 but not always, rejected by vomiting, and there is fre- 
 quently thrown up a dark coloured fluid, which has gene- 
 rally been compared, in its appearance, to coffee grounds. 
 The patient becomes at length emaciated, and the counte- 
 nance sallow; the pulse at the beginning of this dreadful 
 complaint is natural, but towards the close of it is frequent, 
 and this is accompanied with the usual symptoms of hectic 
 fever. Where the person is much emaciated, and the 
 cancerous swelling is situate^ near the pylorus, or along a 
 part of the great curvature of the stomach, it may be felt, 
 if its bulk be considerable, by a careful examination with 
 the hand in the living body. 
 
 The accumulation of air in the stomach, is accompanied 
 with an unpleasant feeling of distention there, and a 
 swelling may be felt externally in the epigastric region; 
 wind passes up by the oesophagus, and there are occasional 
 pains in the stomach produced by a spasmodic contraction 
 of some part of its muscular coat. 
 
CHAPTER VIIL 
 
 DISEASED APPEARANCES OF THE INTESTINES. 
 
 Inflammation. 
 
 THE intestinal canal is subject to inflammation from a, 
 variety of causes, and therefore we have frequent oppor- 
 tunities of observing its effects after death. When a 
 portion of intestine is inflamed, there is spread upon its 
 outer surface a number of small vessels, many of which 
 contain florid blood. When the intestine is cut into, so 
 as to exhibit its inner membrane, this appears highly 
 vascular from the small vessels of the villi being loaded 
 with blood, and a few spots of extravasated blood are 
 frequently to be seen in it. In inflammation of the in- 
 testines, the peritonaeum is often very little, or not at all 
 affected. When, however, the inflammation is very great, 
 the peritonaeum is also inflamed, and covered with a layer 
 of coagulable lymph. I have likewise seen, in violent 
 inflammation, scattered portions of coagulable lymph 
 thrown out upon the surface of the villous membrane: 
 this however is very uncommon. The intestine is at the 
 same time much more thick and massy than in a healthy 
 state, and its colour is sometimes very dark from a large 
 quantity of black extravasated blood. This state of the 
 intestine has often been mistaken for mortification. 
 
 It very commonly happens that inflammation of the in- 
 testines advances to suppuration and ulceration This 
 takes place where the inflammation is confined principally 
 
100 
 
 to the inner membrane of the intestines. The ulcer is 
 formed upon the inner surface; and I do not recollect to 
 have seen one instance where the ulcer had begun upon 
 the outer surface of the intestines and had spread inwards. 
 Ulceration, however, does not appear to be so common in 
 the small as in the great intestines. When it takes place 
 either in the one or the other intestine, it is attended with 
 considerable variety in its appearance; the edges of the 
 ulcer have sometimes considerable thickness : and some- 
 times they are not thicker than the healthy structure of 
 the intestine; the edges and general cavity of the ulcer are 
 sometimes ragged and at other times they are smooth, as 
 if a portion had been cut out from the intestine with a 
 knife. Sometimes through a considerable length of the 
 intestine (especially if it be the great one) the inner mem- 
 brane hangs in tattered shreds, occasioned by the great 
 ravage of the ulceration. I have also seen a considerable 
 portion of the intestine completely stripped of its inner 
 membrane, from the extent of this process, and its 
 muscular coat appeared as distinct as if the inner mem- 
 brane had been very carefully dissected off. In the 
 follicular glands, which are gathered together in little 
 oval groups, I think ulceration occurs more frequently 
 than in the other parts of the intestine. 
 
 When ulceration advances very actively, it sometimes 
 eats through the coats of the intestine entirely. When 
 this is the case, a portion of the contents of the intestine 
 occasionally passes into the general cavity of the abdomen, 
 producing inflammation there. This, however, does not 
 very often happen; most commonly that portion of the 
 gut where the ulcer is situated adheres by inflammation 
 to some other portion, or to a neighbouring viscus, and a 
 
 
101 
 
 communication is formed between the one and the other. 
 I have seen communications formed in this manner 
 between the rectum and the bladder in a male, and between 
 the rectum and the vagina in a female. I have even seen 
 a communication formed between the kidney and a por- 
 tion of the intestine from this cause, by which the pus 
 produced in the kidney was evacuated through the in- 
 testine. Such communications are the means of preserving 
 life (although in a very uncomfortable state,) for a much 
 longer time than it could be, were the matter to pass into 
 the general cavity of the belly. It would there produce 
 peritonaeal inflammation, which would soon destroy. The 
 inner membrane of the intestines is more disposed to 
 become ulcerated, than the inner membrane of any other 
 canal which has an external opening. Thus ulcers are 
 very rare in the inner membrane of the trachea or the 
 urethra, but very common in the inner membrane both 
 of the great and the small intestines. It is difficult to 
 assign a satisfactory reason for this difference. It probably, 
 however, depends upon the different structures and 
 functions of these parts. There is a good deal of re- 
 semblance between the structure of the inner membrane 
 of the trachea and the urethra. The secretion of the one, 
 likewise, is not very different from that of the other. The 
 inner membrane of the intestines has a structure and 
 secretion peculiar to itself. It is probable that upon 
 these circumstances depends its greater disposition to 
 ulcerate; but it is very difficult to explain how this should 
 be the case. 
 
 Inflammation of the intestines sometimes, although 
 rarely, advances to mortification. When this is the case, 
 the mortified part is of a dark livid colour, and has lost 
 
102 
 
 its tenacity; it is in this state very easily torn through, or 
 the fingers will pass through it as through a rotten pear- 
 The want of the natural tenacity, when attended with the 
 change of colour which we have mentioned, is the only 
 sure criterion of a part being mortified in examinations 
 after death. A portion of intestine may be of a very 
 dark colour, and yet may not be mortified. This dark- 
 ness of colour may be occasioned by a large quantity of 
 blood extravasated during a high degree of inflammation, 
 where the principle of life is maintained in full vigour. 
 Thus, we see blood effused into the cellular membrane 
 under the skin, producing a very dark appearance, yet 
 the parts are quite alive. It has often happened too, that 
 a very dark portion of intestine has been returned in the 
 operation for bubonocele, and yet the parts have recovered 
 their natural functions. This could never have happened 
 if the black portion of the intestine had really been 
 mortified. Under such circumstances, the mortified part 
 would have separated from the living, and the function 
 of the gut must have been destroyed. When a portion 
 of gut has been for some time mortified, a considerable 
 quantity of air is formed, which is accumulated in its 
 cavity. This is a part of the natural process which takes 
 place in all dead animal substances. I have known an 
 instance where a large portion of the great intestine (viz. 
 above a yard of it), had lost its living principle, and was 
 expelled through the anus. The person lived about three 
 weeks afterwards.* 
 
 See Medical and Chirurgical Transactions, Vol. 2. p. 144, 
 
103 
 
 Intus-Susceptio. 
 
 This is not a very uncommon disease, and is frequently 
 fatal. It consists in a portion of gut passing for some 
 length within another portion, and dragging along with 
 it a part of the mesentery. The portion of gut which is 
 received into the other, is in a contracted state, and is 
 sometimes of considerable length. It usually happens 
 that an upper portion of intestine falls into a lower; but 
 the contrary likewise occurs, although rarely. Intus- 
 su sceptic may take place in any part of the intestinal 
 canal, but it happens most frequently in the small in- 
 testines, and where the ileum terminates in the colon. 
 In this last situation, it appears to me to happen more 
 frequently than any where else. This, perhaps, depends 
 on the great difference in size between these two portions 
 of intestine. In opening bodies, particularly of infants, 
 an intus-susceptio is not unfrequently found, which had 
 been attended with no mischief: the parts appear perfectly 
 free from inflammation, and they would probably have 
 been easily disentangled from each other by their natural 
 peristaltic motion. At other times, however, so large a 
 portion of the gut passes within another portion of it that 
 cannot be disentangled, and the passage of the intestines 
 is obstructed, without any possibility of its being set free. 
 This is the fatal state of the disease, is sometimes 
 attended with inflammation, and is sometimes without it. 
 
 Ruptures. 
 
 A portion of the viscera of the abdomen frequently 
 passes out of that cavity, being lodged in a bag of 
 elongated peritoneum ; and this disease is called a rupture. 
 
104 
 
 It happens most commonly from some sudden and violent 
 concussion of the body, where the weaker parts of the 
 parictes of the abdomen give way. I once thought, and 
 it is, I believe, the general opinion, that ruptures occur 
 more frequently in fat than in lean people ; but from some 
 conversation which I have had with persons whose line 
 of life leads them to give particular attention to this 
 disease, I am disposed to think that this opinion is ill 
 founded. Ruptures are found to be as frequent in persons 
 who are not corpulent, as in those who are.* 
 
 There is hardly any viscus which has not at some time 
 or other, been found in the sack of a rupture, but most 
 frequently it is either a portion of the omentum, or of the 
 intestines, or of both. The bag formed by the peritonaeum 
 may be thrust out almost at any part of the belly; but this 
 happens most frequently at the ring of the external oblique 
 muscle, under Paupart's ligament, and at the navel: it 
 also sometimes takes place at other parts of the abdomen. 
 There is another situation where a rupture has been 
 known to happen, although very rarely, viz. through an 
 opening in the diaphragm into the thorax. The opinion 
 which would most obviously be formed about this is, that 
 a portion of the diaphragm had burst, and a part of the 
 intestines had protruded into the opening made in the 
 diaphragm. I am persuaded, however, that this opinion 
 will almost always be ill founded. It happens, sometimes, 
 but very seldom, that children are born with a hole in the 
 diaphragm, which is a malformation or monstrosity in this 
 part of the body. When the hole is large, a considerable 
 
 * The umbilical rupture should be considered as an exception to this remark* 
 for it is much more common in fat people than those of a spare habit. 
 
105 
 
 portion of the abdominal viscera passes into the thorax, 
 and so impedes the functions of the heart and lungs, that 
 children under these circumstances perish immediately 
 after birth. When the hole in the diaphragm is small, it 
 lays the foundation of the hernia or rupture which we have 
 just described, and which may be called, by way of dis- 
 tinction, the diaphragmatic hernia.* 
 
 It is well known that the most usual situation of a rup- 
 ture in the male, is at the ring of the external oblique mus- 
 cle; and this arises probably from the larger size of that 
 opening in the male than in*he female. The most usual 
 situation of a rupture in the female is known also to be 
 either under Paupart's ligament, or at the navel. The rea- 
 son of the frequency of the first situation, is the particular 
 shape of the pelvis in the female, by which there is a larger 
 empty space under Paupart's ligament, than in the male, 
 so that the viscera at that part are less firmly supported. 
 The reason why the second situation of a rupture occurs 
 often in the female, is, probably, frequent child bearing. 
 During pregnancy, at its advanced period, the navel opens, 
 or gives way, and where pregnancies have been frequent, 
 it probably never recovers its original strength, 
 
 The omentum is more commonly found in the sack of 
 a rupture than any of the viscera. This perhaps arises from 
 its being a loose mass, not being tied down to any particu- 
 lar situation, and therefore readily passes into any cavity 
 which communicates with the abdomen. When it has once 
 fallen down, it has no means of pulling itself out, like a 
 portion of intestine, which is another reason why it is so 
 
 A case of this kind has occurred to Dr Clarke, and has been published by 
 him in the 2d volume of the Medical and Chirurgical Transactions, p. 118. He 
 has been so obliging 1 as to give me the preparation which illustrates this hernia- 
 
 Q 
 
106 
 
 often found in a rupture. When it has remained long in 
 a sack, it forms a pretty compact mass, sometimes having 
 no connection with, but at other times adhering to the in- 
 ner surface of the sack. There is frequently no inflamation 
 produced in the omentum while in this situation, but oc- 
 casionally violent inftamation takes place, which may even 
 advance to mortification. 
 
 A portion of gut is very often lodged in the sack of a 
 rupture, either by itself, or along with a portion of the 
 omentum. The portion of gut is sometimes very small 
 but sometimes it is very considerable. Very often the func- 
 tions of the intestines go on properly in this situation, but 
 occasionally violent inflamation is produced, interrupting 
 their function, and often terminating fatally. This inflam- 
 mation is produced by the gut being strongly pressed at 
 the narrowest part of the sack, viz. at that part where the 
 sack immediately passes out of the cavity of the abdomen. 
 This inflamation exhibits the different appearances, upon 
 dissection, which we have so often related. The gut too, 
 is frequently found mortified: this is shewn by its dark 
 colour, by its want of proper tenacity, and by the air 
 which is formed within it. When the inflammation of the 
 gut in a sack has not been very violent, and has termina- 
 ted by resolution, it frequently leaves adhesions behind it 7 
 connecting the gut with the inner surface of the sack. It 
 is perhaps possible too, that adhesions may be formed by 
 long close contact, without inflammation. 
 
 When the sack of a rupture has not been of long stand- 
 ing, it consists of a thin, firm, white, opaque, membrane ; 
 this is a protuded part of the peritonaeum, somewhat thick- 
 ened by pressure.* When the sack has been of long stand- 
 
 * In some cases of umbilical hernia, Dr. Marshall has observed no distinct 
 appearance of peritonaea! sack. This must have arisen from the peritonaeum 
 
 
107 
 
 ing, it is often very thick, and evidently consists of a 
 number of layers. The sack upon the inside has a very 
 smooth surface, and the membrane which forms this 
 surface can be readily traced into the peritonaeum, lining 
 the cavity of the abdomen ; the outer surface of the sack 
 is more rough and coarse in its texture. The sack, where 
 it passes out of the cavity of the abdomen, has frequently 
 a narrow neck, or aperture, and is distended below into a 
 bag of considerable size. At other times, the communi- 
 cation between the sack and the cavity of the abdomen, 
 is by a larger opening* 
 
 Hernia Congenita. 
 
 In bubonocele the sack is usually quite distinct from 
 the sack of the tunica vaginalis testis. Sometimes, 
 however, there is no separation between them, and the 
 contents of the rupture are immediately in contact with 
 the body of the testicle: this kind of rupture is called the 
 hernia congenita. It was formerly supposed to arise from, 
 a portion of the sack of the rupture and of the tunica 
 vaginalis having given way, so that the contents of the 
 rupture fell into the cavity of the tunica vaginalis testis, 
 and came in contact with the testicle. Upon a little re- 
 flection, it might have been perceived that this could 
 hardly take place; though the true account of this appear- 
 ance was not known till it was explained by Dr. Hunter. 
 Baron Haller discovered, that till about the eighth month 
 the testicles do not descend into the scrotum, but are 
 situated in the cavity of the abdomen under the kidneys. 
 When they descend into the scrotum, the peritonaeum 
 
 having burst, in consequence of distention, and its ruptured edges being lotf: 
 by adhesion in the neighbouring partSi 
 
108 
 
 that covers them is necessarily drawn down along with 
 them through the ring of the external oblique muscle; it 
 then forms a bag, the upper extremity of which communi- 
 cates with the cavity of the abdomen. Baron Haller had 
 also observed, that in infants a portion of intestine some- 
 times falls down into this bag after the testicle, or along 
 with it, producing what he called the hernia congenita. 
 The communication between the bag and the abdomen is 
 commonly closed, sometimes a little before, and some- 
 times soon after birth. It appears, however, that if it 
 be prevented from closing at the usual time, it does not 
 afterwards, but remains open through life. Hence, if any 
 portion of an intestine, or of the omentum, falls into the 
 elongated sack of the peritonaeum, it must be in contact 
 with the testicle. When Dr. Hunter became acquainted 
 with the observations of Baron Haller upon the descent of 
 the testicles, he saw at once that the species of rupture 
 sometimes to be met with in adults, where a portion of 
 intestine or omentum is in contact with the testicle, might 
 be easily explained. His explanation corresponded with 
 that which we have just given, and has been universally 
 adopted by anatomists and surgeons. 
 
 Scirrhus and Cancer of the Intestines. 
 
 Scirrhus is a disease which takes place much more 
 commonly in the great than in the small internes, but 
 the latter are occasionally affected by it. I have seen a 
 scirrhous tumour and a cancerous ulcer in the duodenum. 
 In the great intestines, at an advanced period of life, 
 scirrhus is not uncommon : every portion of this intestine 
 is not equally liable to be affected by it, but it is to be 
 found much more frequently at the sigmoid flexure of the 
 
109 
 
 colon, or in the rectum, than any where else, which per- 
 haps may depend on the following circumstances. There 
 is certainly more of glandular structure in the inner mem- 
 brane of the great intestines towards its lower extremity, 
 than in any other part of it, and this sort of structure has 
 a greater tendency to be affected with scirrhus, than the 
 ordinary structures of the body : the gut too is narrower 
 at the sigmoid flexure than at any other part, and therefore 
 will be more liable to be injured by the passage of hard 
 bodies ; which, by their irritation, may excite the disease 
 of scirrhus in a part that was predisposed to it. 
 
 The scirrhus sometimes extends over a considerable 
 length of the gut, viz. several inches; but generally it is 
 more circumscribed. It exhibits the same appearances of 
 structure which were described when speaking of scirrhus 
 of the stomach. The peritoneal, muscular, and internal 
 coats are much thicker and harder than in a natural state. 
 The muscular too is subdivided by membranous septa, 
 and the internal coat is sometimes formed into hard irregu- 
 lar folds. It often happens that the surface of the inner 
 membrane is ulcerated, producing cancer. Every vestige 
 of the natural structure is occasionally lost, and the gut 
 appears changed into a gristly substance. When scirrhus 
 affects the gut, the passage at that part is always narrowed, 
 and sometimes so much so as to be almost entirely ob- 
 structed. The obliteration, or structure, would sometimes 
 appear to be greater than in proportion to, the thicknesss 
 of the sides of the diseased gut : this most probably de- 
 pends upon the contraction of the muscular fibres of the 
 gut, which, although diseased, have not altogether lost 
 their natural action. Where the passage is very much 
 obstructed, the gut is much enlarged immediately above 
 
110 
 
 the obstruction, from the accumulation of the contents in 
 that part of the intestine. While this disease is going on 
 in a portion of the intestine, adhesions are formed between 
 it and the neighbouring viscera, and the ulceration some- 
 times spreads from the one to the other. 
 
 The diseased Change of the Intestines in Dysentery. 
 
 The inner membrane of the great intestines I have seen 
 a good deal thickened, and formed into small irregular 
 tubercles, some of which were of a white, and others of a 
 yellowish colour; the peritonaea! and muscular coats were 
 also thicker and harder than in a natural state, and the 
 diameter of the intestine was a good deal contracted. In 
 some places too the inner membrane appeared abraded, 
 and the tubercles were sometimes fissured upon the sur- 
 face, so as to resemble a little common warts. This is not 
 a frequent appearance of disease, but it has generally been 
 found to take place in very severe dysenteries, such as 
 those which occasionally arise in camps. In the common 
 cases of dysentery, which take place during the autumnal 
 season in this country, the morbid appearances just de- 
 scribed are commonly not found ; at least no instance of 
 it has fallen under my observation- When such cases 
 prove fatal, a number of ulcers are discovered by examina- 
 tion after death, in the inner membrane of the great and 
 sometimes of the small intestines. 
 
 Thickened Folds of the Inner Membrane of the great 
 Intestines. 
 
 I have also seen the internal membrane of the great 
 intestines formed into broad thick folds, in which a con- 
 siderable quantity of blood was accumulated; these folds 
 
Ill 
 
 were perfectly independent of the state of contraction in 
 the muscular coat, and were very different in their ap- 
 pearance from the irregular puckering which is often seen 
 in the inner membrane of the great intestines. When 
 these folds were examined, they were found to consist of 
 an accumulation of cellular membrane, with the inner 
 coat of the gut reflected over it. 
 
 Upon the inner surface of the great intestine, about 
 two inches above the anus, little processes sometimes grow 
 from the internal membrane: they generally surround the 
 gut at short distances from each other, so as to form a 
 sort of circle. 
 
 Polypous Tumours. 
 
 Polypous tumours are occasionally formed in the great 
 intestines, but this morbid appearance is not of frequent 
 occurrence. They take place chiefly in the lower part of 
 the rectum, but they arc sometimes found as high up 
 as the sigmoid flexure of the colon. They grow from 
 the inner surface of the intestine by a narrow neck or 
 pedicle, and fill up according to their size more or less of 
 its cavity. I recollect to have met with one instance of a 
 polypus nearly as large as the fist, which grew in the 
 sigmoid flexure of the colon, and formed there a fatal 
 cause of obstruction. When the polypus is situated very 
 low down in the rectum, and more especially if it be not 
 large, it may be removed by a ligature, and the passage of 
 the intestine may become as free, as before the growth of 
 the polypus. 
 
 A Milt-like Tumour growing from the Mucous Membrane 
 of the Intestines. 
 
 Professor Monro, junior, has described a tumour 
 
growing from the mucous membrane of the intestines, of 
 a very peculiar kind, which he has called the milt-like 
 tumour. It is of very rare occurrence, and resembles a 
 good deal in its consistence and appearance the milt of 
 many fishes. It grows by a number of small processes 
 from the mucous membrane, and has a remarkable 
 offensive factor. I have never seen myself any instance of 
 this tumour, and I do not recollect to have heard it 
 mentioned in my communications with other anatomists.* 
 
 Piles. 
 
 Piles and fistula? in ano, are diseases which are ex- 
 tremely common, but which hardly ever become an object 
 of examination after death ; they have therefore not been 
 so commonly introduced into accounts of morbid appear- 
 ances, as others which much more rarely occur. Piles 
 are soft tumours commonly situated round the verge of 
 the anus, sometimes of a regularly bulbous, and some- 
 times of an irregular form. They are covered with a 
 very tender skin, which partly consists of the fine skin 
 immediately round the anus on the outside, and partly of 
 the inner membrane of the gut. The tumours are gene- 
 rally entire, but they have occasionally small openings, 
 through which a considerable quantity of blood is some- 
 times poured; they consist commonly of the veins round 
 the verge of the anus, much enlarged from the accumula- 
 tion of blood. These veins are branches of the internal 
 iliac vein, but they communicate largely with the lower 
 branches of the mesaraica minor. 
 
 The same sort of tumours are also frequently found 
 
 See Professor Monro junior's Morbid Anatomy of the Human Gullet, 
 Stomach and Intestines. 
 
113 
 
 within the cavity of the rectum, forming what have been 
 called, the internal piles; and these are occasioned by the 
 enlargement of some of the branches of the mesaraica 
 minor. Piles are a much more frequent disease in persons 
 who are advanced in life, than in those who are young. 
 They arise from repeated, and long continued impedi- 
 ments to the return of the blood from the lower part of 
 the rectum, and there has been much more opportunity 
 for these impediments to act in old, than in young 
 persons. They are also more common in women than 
 in men. This may arise from several causes: the uterus 
 during pregnancy must occasion a great impediment to 
 the return of the blood from the rectum ; this is so much 
 the case, that women who have been frequently pregnant 
 seldom escape piles. Women too are more apt to allow 
 of an accumulation of the proper contents of the rectum, 
 than men, which will produce some impediment to the 
 return of the blood from this part. 
 
 Fistula in Ano. 
 
 Fistulas in ano are narrow canals at the lower end of the 
 rectum, and are distinguished by the following circum- 
 stances: they have callous edges, a smooth internal surface, 
 and possess the power of secreting pus.* A disease of 
 this sort may consist of one canal, opening by a very small 
 aperture externally, at the side of the anus; or this canal 
 may be divided into several branches. The canal, be- 
 sides opening externally, has very commonly a small 
 opening into the gut itself : and sometimes there is a small 
 opening into the gut, without there being any externally 
 
 * Mr. Hunter has observed, in his lectures on Surgery, that fistulas have a 
 smooth internal surface, like a secreting surface, as, for instance, 
 P 
 
114 
 
 on the side of the anus. It is much more 
 however, to find only an external opening of the canal; or, 
 to find both an external opening, and another into the gut. 
 
 The Rectum terminating in a Cul-de-sac. 
 
 It is a species of monstrous formation not very un- 
 common, that the rectum does not terminate in the anus, 
 but in a cul-de-sac, without reaching the external surface. 
 Sometimes the extremity of the gut lies near the external 
 surface, but more commonly it is at some distance from 
 it. In these cases there is usually the appearance of an 
 anus, but the opening is more contracted than in the 
 natural structure. It seldom happens that this malforma- 
 tion can be effectually remedied by a chirurgical operation. 
 The opening which is made into the extremity of the gut 
 has generally such a disposition to close, that the benefit 
 which might naturally be expected from an operation is 
 frustrated. A few cases however have occurred in which 
 the operation has been successful. 
 
 The Rectum terminating in the Bladder. 
 
 I have also seen the rectum terminate in the bladder^ 
 from an original error in the formation, so that there was 
 no other external opening to the rectum than by the 
 urethra: this was in a child at birth: the malformation was 
 of such a kind, as neither to admit of a remedy by art, nor 
 to allow of life being continued. 
 
 The rectum has also been known to terminate in the 
 vagina, from a defect in the original formation; but this is 
 very uncommon. 
 
115 
 
 Worms. 
 
 Worms are formed in the intestines of man, as well as 
 of many other classes of animals; but not so frequently in 
 the former as in the latter. In most quadrupeds and fishes 
 it is extremely common to find a number of worms upon 
 opening their intestines. 
 
 The worms which are found in the human subject, may 
 be reduced to three general classes, viz. the lumbricus 
 teres; taenia; and ascaris. 
 
 Lumbricus Teres. 
 
 The lumbricus teres, or round worm, is much more 
 commonly found in the intestines of children, than in those 
 of persons full grown, or advanced in life, it is very usually 
 met with in the first, but rarely in the two last. The lum- 
 bricus teres is well known to differ from the common 
 earth worm, but many practitioners in this country have 
 made little inquiry into the circumstances upon which this 
 difference depends. The two species of worms, if attentive- 
 ly examined, will be found to differ a good deal from each 
 other in their external appearance. The lumbricus teres 
 is more pointed at both extremities, than the common 
 earth worm. The mouth of the lumbricus teres consists 
 of three rounded projections, with an intermediate cavity; 
 the mouth of the earth worm consists of a small longitu- 
 dinal fissure, situated on the under surface of a small 
 rounded head, Upon the under surface too of this worm 
 there is a large semi-lunar fold of skin, into which the 
 head retreats, or out of which it is elongated, but this is 
 entirely wanting in the lumbricus teres. The anus of the 
 lumbricus teres opens upon the under surface of the worm? 
 
116 
 
 a little way from its posterior extremity, by a transverse, 
 curved fissure; the anus of the earth worm opens by an 
 oval aperture at the very extremity of the worm. The 
 outer covering or skin in the lumbricus teres is less fleshy, 
 and less strongly marked by transverse rugae, than in the 
 earth worm. In the latter there is often to be seen a broad 
 yellowish band, surrounding the body of the wormjbutin 
 the lumbricus teres, this is entirely wanting, on each side 
 of the lumbricus teres there is a longitudinal line very 
 well marked; in the earth worm there are three longitudi- 
 nal lines upon the upper half of its surface, but these are 
 so faintly marked, as to be hardly observable. The lum- 
 bricus teres has nothing corresponding to feet; whereas the 
 earth worm has on its under surface, but more strongly 
 marked towards its posterior extremity, a quadruple row 
 of processes on each side, very sensible both to the eye, 
 and the finger, which manifestly serve the purposes of 
 feet in the locomotion of the animal. 
 
 The internal structure of these two species of worms is 
 also extremely different. In the lumbricus teres, there is 
 an intestinal canal, nearly uniform and smooth in its ap- 
 pearance, which passes from one extremity of the worm 
 to the other. Near the head of this worm, the canal is 
 narrower than it is any where else, and somewhat distinct 
 in its limits : this may be considered as the oesophagus. 
 In the earth worm, there is a large and complex stomach, 
 consisting of two cavities; and the intestinal canal in the 
 latter is likewise larger, and more formed into sacculi, than 
 In the former. The parts subservient to generation in 
 these two species of worms differ very much from each 
 other 5 in the lumbricus teres there is a distinction of sex. 
 the parts of generation being different in the male and in 
 
117 
 
 the female; in the common earth worm the organs of gen- 
 eration are the same in each individual, as this worm is 
 hermaphrodite. The appearance too of the organs of gen- 
 eration is extremely different at first sight in the one species 
 of animal and in the other. There is an oval mass situated 
 at the anterior extremity of the earth worm resembling a 
 good deal the medullary matter of the brain ; in the lum- 
 bricus teres this substance is wanting.* Those are the 
 principal differences between the one species of animal and 
 the other, which are obvious upon a very moderate atten- 
 tion to each. Many other differences would, doubtless, 
 be found by a person who might choose to prosecute their 
 anatomy minutely. 
 
 Tgnia, 
 
 The Tzenia which is most commonly found in the 
 human intestines, is of two kinds, viz. the taenia solium, 
 and the tsenia lata. 
 
 Taenia So Hum. 
 
 This taenia is frequently bred in the intestines of the 
 inhabitants of Germany, and occasionally, but rarely, in 
 those of the inhabitants of Great Britain. It consists of a 
 great many distinct portions, which are connected together 
 so as to put on a jointed appearance ; these joints are 
 commonly of a very white colour, but occasionally brown- 
 ish, which depends on a fluid of this colour that is found 
 in their vessels. The worm usually is very long, extending 
 often many yards, and seldom passes entire from the 
 
 * What this substance is I do not know, and I have only mentioned its resem- 
 blance to the medullary matter of the brain, in order to give a clearer descrip- 
 tion of it. 
 
118 
 
 bowels. This circumstance has prevented the extremities 
 of the tasnia from being often seen. 
 
 The head of this tsenia is somewhat of a square form, 
 with a narrowed projection forwards ; in the middle of this 
 projecting part, there is a distinct circular aperture, around 
 the edge of which grow curved sharp processes, Near 
 the angles of the square edge of the head, are situated four 
 round projecting apertures, at equal distances from each 
 other: this head is placed upon a narrow jointed portion 
 of the worm, of considerable length, and which gradually 
 spreads itself into the broader joints, of which the body of 
 the worm is composed. 
 
 The body of the tsenia consists of thin, flat, pretty long 
 joints, on one edge of which there is a projection, with a 
 very obvious aperture. In the same worm some of these 
 joints appear considerably longer than others, which 
 probably depends on one joint being contracted while 
 another is relaxed. The apertures which we have just 
 mentioned are generally placed on the opposite edges of 
 the contiguous joints; but this is not uniformly the case; 
 they are sometimes placed on the same edges of two, or 
 even several contiguous joints. When these joints are 
 examined attentively, there are frequently seen, in each of 
 them, vessels filled with a brownish fluid, and disposed in 
 an arborescent form. Around the edges of each joint, 
 there is also a distinct serpentine canal.* The last joint 
 of a taenial resembles very much a common joint rounded 
 off its extremity , and without any aperture. 
 
 * This, as well as the vessels disposed in an arborescent form, is very 
 distictly seen injected in some preperations which have been made, and given 
 *Q me by an ingenious Surgeon, Mr. Carlisle. 
 
119 
 
 Ttenia Lata. 
 
 The tsenia lata is bred very commonly in the intestines 
 of the inhabitants of Switzerland, but very rarely in those 
 of the inhabitants of Great Britain. The joints of which 
 it is composed are short and broad, and the aperture is not 
 upon the edge of each joint, as in the solium, but in the 
 middle of its flattened surface. Round these apertures are 
 short radiated vessels. The head is of an oval shape, and 
 so small that its minute structure is not visible to the naked 
 eye. Its tail terminates in two narrow processes, one of 
 which is longer than the other. 
 
 Other tsenia have occasionally been found in the human 
 intestines, but they occur very rarely, and have not fallen 
 under my own observation. 
 
 Ascaris. 
 
 The ascaris is a very small worm, which is often found 
 at the lower end of the rectum in children, and even more 
 frequently in adults than is commonly imagined. It is 
 white in its colour, and about half an inch in length; at the 
 extremity where its head is placed, it is a little narrowed, 
 and at the other extremity it terminates in a long, very 
 fine, transparent process. These worms are more or less 
 surrounded with mucus which is secreted in increased 
 quantity by the glands in the inner membrane of the rectum, 
 from the irritation occasioned by the worms. 
 
 Trichuris 
 
 This worm has been occasionally found in the great 
 intestines of man, and more especially the coecum. it re- 
 sembles a good deal the arscaris, but is considerably larger- 
 
126 
 
 and has a very long transparent tail. To their heads ib 
 attached a process or horn, which they can protrude or 
 retract. 
 
 There is nothing in the economy of animals more 
 obscure than the origin of intestinal worms; were they 
 found to live out of the bodies of living animals, one 
 might readily suppose that their ovula were taken into the 
 body along with the food and drink, and there gradually 
 evolved into animals. This, however, is not the case; 
 the\ do not seem capable of living for any length of time 
 in any situation, except within a living animal body, which 
 appears to be the proper place for their growth and 
 residence. We might therefore be led to another 
 supposition, viz. that intestinal worms are really formed 
 from the matter contained in the intestines, which previously 
 had no regular organization; but this idea is widely 
 different from all analogy in the production of animals, 
 where there has been any satisfactory opportunity of 
 examining this production. The origin, therefore, of such 
 animals is a subject of much obscurity, and probably will 
 not soon have any satisfactory light thrown upon it. 
 
 Air accumulated in the Intestines. 
 
 It is not unusual to find air accumulated in the intestinal 
 canal, in greater or less quantity; this air is sometimes, 
 but not constantly, accompanied with a slight inflamma- 
 tion of the peritonseum. In such cases the blood vessels, 
 creeping upon the intestines, are sometimes filled with air, 
 but frequently they are without it. Air is often let loose 
 into the intestines after death by putrefaction; but that 
 which we wish particularly to consider here, has been 
 formed during life. 
 
There are only two ways in which we can well con- 
 ceive air to be formed in the intestines: the one is, some 
 new arrangement in the contents of the intestines, by 
 which air is extricated : the other is, the formation of air 
 in the blood vessels of the intestines, and which air is 
 afterwards poured out by the extremities of the exhalent 
 arteries into the cavity of the intestines. That the blood 
 vessels of an animal body have th,is power there can be no 
 doubt; and I own I am inclined to think that this is a 
 mode by which air is not unfrequently accumulated in 
 the intestines. This air probably differs somewhat at 
 different times: in several trials which I have made, it 
 never shewed signs of containing any proportion of in- 
 flammable air, but always a very sensible proportion of 
 fixed air. It requires, however, to be examined by some 
 .person well acquainted with chemical experiments, ia 
 order that its ingredients may be exactly ascertained. 
 
 Bony Matter formed in the Intestines* 
 
 These are the most common appearances of diseased, 
 or preternatural structure in the intestines: but I have 
 likewise had an opportunity of observing others, which 
 are of rarer occurrence. In one or two instances, I have 
 seen a sort of bony matter formed upon the surface of the 
 inner membrane of the gut : I have even seen an adhesion 
 between two portions of intestine converted into bone. It 
 would appear, that almost every part of the body is occa- 
 sionally subject to this process. It may not improperly 
 be considered, as a natural process misplaced. An adhesion 
 being once formed, has the same power (as far as we know) 
 of running into different processes, as the cellular mem- 
 brane which makes a part of the original structure. It 
 
 Q 
 
122 
 
 may therefore form bone, as readily as cellular membrane^ 
 or some other membranes of the body, which have a re- 
 semblance to the membrane of adhesions, as the pleura, 
 and the peritonaeum. 
 
 Projecting Ring formed in the Cavity of the Jejunum. 
 
 I have seen one of the valvulas conniventes much larger 
 than usual, and passing round on the inside of the jejunum, 
 like a broad ring. The canal of the gut was necessarily 
 much narrowed at this ring, but no mischief had arisen 
 from it. This malformation, however, might have laid 
 the foundation of fatal mischief. Some substance too 
 large to pass, might have rested on the ring, and produced 
 there inflammation, ulceration, and ultimately death. 
 
 Concretions in the Intestines. 
 
 Concretions have occasionally been found in some part 
 of the cavity o the intestinal canal, especially in the great 
 intestine, but I have not met with any instance of this 
 kind, in the very numerous examinations of dead bodies, 
 which I have made. It may therefore be considered as 
 a rare occurrence. A great many specimens of these 
 concretions have been collected by Professor Monro, and 
 a clear account of them has been given by his son. They 
 are lamellated in their texture, of a colour between yellow- 
 ish brown and chesnut brown, contain generally a nucleus 
 in their centre, and are often of a large size. They con- 
 sist chiefly of phosphate of lime, a ^natter resembling a 
 good deal vegetable extractive, and a peculiar substance, 
 which is of small specific gravity, and has an appearance a 
 good deal like that of cork.* 
 
 * See Dr. Monro junior's. Morbid Anatomy of tlie Human Gullet, Stomach an 
 lujtestines. 
 
123 
 
 Small-fox Pustules said to be in the Intestines. 
 
 Small-pox pustules have been said to be sometimes 
 found in the intestines of persons who had died from this 
 disease,* How far this may have occasionally taken place, 
 I will not pretend to say, but late dissections, upon the 
 best authority, have not confirmed this fact. 
 
 Diseased Appearances of the Mesentery. Mesentery 
 inflamed. 
 
 The mesentery is often found in a state of inflammation; 
 although I believe this hardly ever takes place unless when 
 the peritonaeum generally is inflamed. When the mesentery 
 is inflamed, it becomes much thicker, and more massy, 
 than in its natural state ; the large blood vessels which 
 pass between its laminae and the absorbent glands, are also 
 very much obscured. These different appearances de- 
 pend upon the quantity of the coagulable lymph which is 
 poured out, during the inflammatory action. The peri- 
 tonaeum which forms the laminae of the mesentery is 
 crowded with small vessels, and is covered more or less 
 with a layer of the coagulable lymph. A small quantity of 
 pus is sometimes found on the surface of the inflamed 
 mesentery, and even abscesses have been observed between 
 its laminae; but this last appearance is very rare. 
 
 It very seldom happens, that the mesentery is found to 
 be gangrenous, unless different portions of the intestinal 
 canal be in the same state. When the intestines are 
 mortified, portions of the mesentery are sometimes found 
 in the same condition. The appearances exhibited in 
 
 * Yid. Lieutaud, Tom. I, p. 37L 
 
124 
 
 mortification are the same when it affects the mesentery, 
 as in any other part, and they have been already described. 
 
 Me sent eric Glands scrofulous. 
 
 The absorbent glands of the mesentery are frequently- 
 found to be scrofulous, and this is more apt to take place 
 in children, than in persons of a more advanced age. 
 When affected with this disease, the glands exhibit 
 different appearances, according to its progress : they arc 
 enlarged in their size, and are often somewhat softer to the 
 touch, than in a natural state. When cut into, they some- 
 times shew very much the natural structure ; but rhore 
 frequently they are changed, in part, into a white, soft, 
 curdly matter, and this is not uncommonly mixed with 
 pus. 
 
 Mesenteric Glands cancerous. 
 
 When a portion of the intestinal canal becomes cancer- 
 ous, some of the absorbent glands in the mesentery 
 generally become affected with the same disease: this 
 is in consequence of the matter of cancer being con- 
 veyed to those glands by those absorbent vessels. The 
 glands become enlarged in size, and are changed into 
 hard masses exhibiting a scirrhous, or a cancerous structure. 
 
 Mesenteric Glands earthy or bony. 
 
 The absorbent glands of the mesentery are sometimes 
 filled with an earthy, or bony matter; but this is to be 
 considered as a rare occurrence.* The absorbent glands 
 at the root of the lungs, are more liable to be affected 
 with this disease, 
 
 * Vid. Med. Transactions, Vol. I. p. 361. 
 
125 
 
 Hydatids have also been occasionally found adhering 
 to the mesentery. 
 
 Tumours, likewise, consisting of a fatty matter, have 
 been seen attached to the mesentery ; but these I believe 
 to be very uncommon. 
 
 SYMPTOMS. 
 
 Inflammation of the intestines is characterized by the 
 following symptoms, viz. an acute pain in the abdomen, 
 vomiting, obstinate costiveness, symptomatic fever, with 
 a frequent, small and hard pulse. The pulse, however, 
 is sometimes less affected than might have been supposed, 
 from the violence of the inflammation. 
 
 The symptoms attending intus-susceptio are similar 
 to those which belong to inflammation of the intestines, 
 and indeed this disease is not unfrequently -accompanied 
 with inflammation. It is however more likely to prove 
 fatal than simple inflammation of the bowels, as it does 
 not admit of any substantial benefit from medicine. 
 
126 
 
 When there is a rupture without any strangulation of 
 the intestine, the following symptoms take place, viz. a 
 pale swelling at the part affected, a slight pain occasion- 
 ally felt in the swelling itself, and spread somewhat over 
 the region of the belly, the swelling pushed out by 
 coughing, a disappearance of the swelling upon pressure, 
 or upon the person continuing for a considerable length of 
 time in a horizontal posture. When a rupture is large 
 and of long standing, it will often be incapable of being 
 reduced by pressure, even when there is no strangulation. 
 
 When strangulation takes place, the same symptoms 
 arise which belong to inflammation of the bowels, for 
 the strangulation produces inflammation. These consist 
 of a pain in the swelling, which is diffused over the abdo- 
 men, sickness, vomiting, obstinate costiveness, heat com- 
 monly a frequent, small, and a hard pulse : and towards 
 the fatal conclusion of the disease, there is hickup, with 
 a foetid yellow matter thrown out by the mouth. The 
 sickness I have heard described, as being infinitely more 
 distressing than the ordinary sickness of a deranged 
 stomach ; the pulse is 'sometimes, in such a case, not 
 increased in frequency beyond the standard of health; and 
 yet the inflammation of the bowel has been discovered 
 afterwards by the operation to be very great. This is an 
 important practical observation, because it shews that the 
 degree of inflammation is not to be judged of from the 
 pulse, and teaches that the operation should not be delayed, 
 after the proper efforts for reducing the rupture have failed, 
 because the pulse may happen to be little or not at all 
 accelerated. 
 
127 
 
 When a considerable quantity of pus is formed in cbn 
 sequence of an ulcer in the bowels, it is known by the pus 
 being evacuated by stool, which is frequently a little tinged 
 with blood. Severe pains are frequently felt in the bowels, 
 and there is a propensity to go often to stool. The pulse 
 is often at first not more frequent than in health, but is 
 afterwards a good deal accelerated. The appetite for food 
 is commonly not much impaired. 
 
 When the great intestine is attacked with scirrhus, the 
 disease has commonly made some progress, before it is 
 much attended to by the patient. At first there is but 
 little pain in the part affected, and the patient only ob- 
 serves that he is costive, or that the stools pass with some 
 difficulty. When the disease is more advanced, a consid- 
 erable pain is felt, more especially in passing a stool, and 
 there are occasional sympathetic pains about the os sacrum 
 and hips. When the stools are examined, they are com- 
 monly found to be narrow, to be more or less flattened, 
 often in some degree serpentine in their shape, and they 
 are sometimes besmeared with mucus, pus, and blood. 
 The pulse at the beginning of this disease is natural, but 
 towards its close becomes accelerated. In advanced stages 
 of the disease, the countenance is sallow, the strength is 
 much impaired, the body is much emaciated, and the 
 constitution at length altogether sinks. 
 
128 
 
 "iVhcn an ulcer of the rectum has spread to the bladder, 
 it is known by air often escaping along with urine, and 
 from the urine being sometimes more or less mixed with 
 faeces. Severe pain is occasionally felt in the lower part 
 of the belly. The pulse is sometimes accelerated, and 
 sometimes not more frequent than in health. 
 
 In dysentery, griping pains are felt in the abdomen, 
 which often arise to a considerable degree of severity. 
 The bowels are irritated to frequent evacuation, and gene- 
 rally discharge mucus tinged with blood, but sometimes 
 white lumps, membranous films, pus, and at. intervals 
 scybala. Tenesmus accompanies the evacuation of the 
 bowels ; and there is more or less of fever connected with 
 this complaint. 
 
 When a polypus is large and situated so high up in the 
 great bowel, as to be beyond the reach of an operation, it 
 must form at length >a fatal cause of obstruction. 
 
 The difficulty in passing the fasces must become greater 
 and greater, till the obstruction is complete. Patients are 
 generally sensible of the obstruction being at a particular 
 part of the bowel, and often sufier much from the accu- 
 mulation of fasces and of wind, above the polypus, and 
 from colicky pains. The stomach too is occasionally 
 affected with sickness and vomiting. When the polypus 
 is very low down in the rectum, and not very large, it 
 forms a partial obstruction to the passage of the faeces, 
 and can in general be removed by a ligature. 
 
129 
 
 The symptoms attending piles are swellings at the verge 
 of the anus, or in the rectum immediately above it, pain felt 
 at the anus during the passage of the faeces, frequently art. 
 evacuation of blood, and occasional feelings of irritation in 
 the parts affected* This disease is often preceded by other 
 affections, such as giddiness of the head, difficulty of breath- 
 ing, colicky pains, and pains in the loins. 
 
 The symptoms which attend the round worm of the 
 intestines are a swelled belly, emaciated extremities, an 
 offensive breath, and a deranged appetite. The appetite 
 is often greater than in health, but sometimes it is much 
 less. The stools are slimy; and the patient frequently" 
 picks his nose, and during sleep grinds his teeth. 
 
 Persons afflicted with the taenia, complain of a gnawing 
 uneasy feeling in the region of the stomach, which is re- 
 moved or diminished by eating. Their appetite is com- 
 monly somewhat voracious, but occasionally it is less than 
 natural. They have commonly an itching at the nose, 
 often nausea, colicky pains, and sometimes giddiness. 
 Some have a cough, and others occasional convulsions. 
 
 
 When ascarides are lodged in the rectum, there is an 
 uneasy feeling there, and a violent itehing at the anus. 
 R 
 
130 
 
 There is also a sense of heat in the parts, with occasional 
 tenesmus and mucus stools. The mucus is sometimes 
 mixed with blood, and along with it some living ascarides 
 are often discharged.* 
 
 The symptoms attending alvine concretions are not 
 likely to be always very distinctly marked. There is 
 sometimes nausea and vomiting, and often violent attacks 
 of pain in some part of the belly. There is frequently 
 costiveness, and sometimes watery, mucous and bloody 
 stools. When the disease has been of long standing, the 
 patient is generally much emaciated, and then the concre- 
 tion can be felt as a ball, on pressing with the fingers some 
 part of the bowels. This forms the most discriminative 
 symptom of the disease. When the ball has got low down 
 in the rectum, it will often, by compressing the bladder, 
 produce an obstruction to the evacuation af the urine. In 
 this situation the concretion can sometimes be removed 
 by a forceps, and sometimes will pass away without any 
 artificial assistance. 
 
 When air is accumulated in a moderate quantity in the 
 bowels, it is known to exist by some fulness of the abdomen, 
 and by the air shifting frequently its situation. This is 
 sometimes attended with a kind of gurgling noise, and 
 forms swellings in particular parts of the belly. A quan- 
 tity of air is sometimes expelled by the mouth and the 
 rectum. ' There is generally at the same time costiveness, 
 and occasional colicky pains. 
 
 * See Med. Trans, of the college Vol. I. p. 46. 
 
 
131 
 
 When air is accumulated in very large quantity, then, 
 it forms a very serious disease called tympanitis. Of 
 this I have seen a few instances. The belly is ex- 
 tremely swelled, with a very tense feeling, and there is a 
 quick reaction of the parts after removing the pressure of 
 the fingers from the belly, exactly similar to what takes 
 place in a common ox's bladder, distended with air. When 
 the belly in tympanitis is struck with the fingers, there is 
 exactly the same sound as when a bladder is "truck in the 
 same way, that is distended with air, but this sound never 
 takes place upon striking with the fingers the belly in 
 ascites. There is no sense of fluctuation in tympanitis, 
 but in ascites this is commonly distinct. There is often 
 difficulty of breathing, which is produced by the accumu- 
 lation of the air pushing up the diaphragm, and impeding 
 its free motion. There are severe colicky pains, and 
 quantities of air are frequently expelled both upwards and 
 downwards with a loud noise. The bowels are costive, 
 and there is a difficulty in making water, which is proba- 
 bly occasioned by the accumulation of air in the rectum. 
 
 The symptoms of an inflamed mesentery cannot be 
 separated from those which belong to inflammation of the 
 peritonaeum generally; and these symptoms have been 
 already described. 
 
 The symptoms which attend the enlargement of the 
 mesenteric glands from scrofula correspond very much? 
 
132 
 
 in the most striking circumstances, with the symptoms 
 which are produced by the common round worm of the 
 intestines. In both diseases there is a tumid belly, and 
 emaciated extremities. They are chiefly to be distin- 
 guished by worms not being discovered in the one disease, 
 notwithstanding the use of strong purgatives, while they 
 pass off from the bowels in the other. The startings, the 
 itching of the nose, and the grinding of the teeth, may 
 perhaps also form some ground of distinction between the 
 two diseases: they occur very commonly in worms, but 
 I believe rarely where the glands of the mesentery are 
 scrofulous. Some discrimination likewise between the 
 two diseases, may sometimes be derived from examining 
 strictly into the nature of the constitution. If decided 
 marks of scrofula shew themselves in an external part of 
 the body, they will lead a practitioner more satisfactorily 
 to the opinion, that the mesenteric glands are also affected 
 with the same disease. 
 
CHAPTER IX. 
 
 DISEASED APPEARANCES OF THE LIVEH. 
 
 Inflammation of the Membrane of the Liver. 
 
 THE external membrane of the liver is not uncom- 
 monly found in a state of inflammation. 
 
 This may take place when the peritonaeum generally 
 over the cavity of the abdomen is inflamed, or the in- 
 flammation may be confined to the membrane of the liver 
 itself. When it is confined to the membrane of the liver, 
 it is not frequently extended over the whole of it, but more 
 commonly takes place in that portion of it which covers 
 the anterior, or convex part of the liver. I have also seen 
 inflammation, or at least its effects, not unfrequently on 
 that side of the liver, which is in contact with the stomach 
 and the duodenum. 
 
 When inflammation takes place in the membrane of 
 the liver, it exhibits exactly the same appearances, which 
 have been described when speaking of the inflammation 
 of the peritonaeum, of which it is a part. It is crowded 
 with a great number of very minute vessels, which contain 
 florid blood, and is thicker than in its natural state. There 
 is also formed upon its surface, a layer of coagulablc 
 lymph: this layer is thicker on some occasions than 
 others, and often glues the liver, more or less completely 
 to the neighbouring parts. Some quantity of serous fluid 
 is at the same time poured out. 
 
134 
 
 Adhesions. 
 
 It is more common to see adhesions formed, which are 
 the consequence of a previous inflammation in the mem- 
 brane of the liver, than to see the membrane in an actual 
 state of inflammation. These adhesions are formed from 
 the coagulable lymph of the blood which undergoes a 
 gradual progress of change, as we have formerly described. 
 They consist very commonly of a fine transparent mem- 
 brane, which joins the surface of the liver to the neigh- 
 bouring parts. This junction may either be general, 
 over one extended surface of the liver, or it may consist 
 of -a number of processes of adhesion: the adhesion is 
 sometimes by a membrane of considerable length; and 
 sometimes the adhesion is very close, the surface of the 
 liver being immediately applied to the neighbouring parts. 
 The surface of the liver, where these adhesions are most 
 commonly found, is the anterior, by which it is joined to 
 the peritonaeum lining the muscles at the upper part of 
 the cavity of the abdomen. 
 
 When an abscess is formed in the substance of the liver, 
 and points externally, these adhesions are of great use in 
 preventing the pus from escaping into the general cavity 
 of the abdomen. Adhesions are also frequently found 
 connecting the posterior surface of the liver to the stomach, 
 and the duodenum; and these may also be useful in 
 abscesses of the liver, near its posterior surface, by pre- 
 venting the matter from passing into the general cavity of 
 the abdomen, and conducting it either into the stomach, 
 or the upper part of the intestinal canal. 
 
 Coats of the Liver converted into Cartilage. 
 A part of the coats of the liver is sometimes changed 
 
135 
 
 into cartilage. Of this I have seen a few instances; but 
 it occurs much more rarely in the liver than in the spleen. 
 The cartilage is smooth and thin, and soft in its texture. 
 
 Inflammation of the Substance of the Liver. 
 
 It does not often happen, in this country, that the 
 substance of the liver is found in an actual state of in- 
 flammation. Where its membrane- is inflamed, the sub- 
 stance is sometimes inflamed which lies immediately under 
 it; but it rarely happens that the general mass of the liver 
 is inflamed. In warmer countries, the substance of the 
 liver is much more liable to inflammation than in Great 
 Britain. When the liver is generally inflamed through its 
 substance, it is a good deal enlarged in its size, and of a 
 purple colour.* It is also harder to the touch, than in its 
 healthy state. Its outer membrane is sometimes affected 
 by the inflammation, and sometimes it is not. It is 
 attended occasionally with a jaundiced colour of skin, 
 arising from the bile not getting readily into the ductus 
 communis choledochus on account of the pressure of the 
 inflamed liver on the pori biliarii. When this inflammation 
 has continued for some time, abscesses are formed, and 
 then the active state of the inflammation very much sub- 
 sides. These abscesses are sometimes of a large size, so 
 as even to contain some pints of pus. Sometimes the 
 whole of the liver is almost converted into a bag containing 
 pus. When inflammations of the liver have been of con- 
 siderable standing, they are not uncommonly attended 
 
 * May not the purple colour arise from the accumulation of blood in the 
 branches of the vena portarum ? 
 
 As this vein performs the office of an artery in the liver, is it not probable, 
 that its small branches take on the, same actions as the small branches of an 
 artery during inflammation ? 
 
136 
 
 With ascites, and the water is of a yellow, or green colour, 
 being tinged by the bile. 
 
 The liver has sometimes been said to have been in a 
 state of mortification.* This however occurs very rarely, 
 and has never fallen under my own observation. 
 
 Common Tubercle of the Liver. 
 
 One of the most common diseases in the liver (and 
 perhaps the most common, except the adhesions, which 
 we have lately described), is the formation of tubercles 
 in its substance. This disease is hardly ever met with in 
 very young persons, but frequently takes place in persons 
 of middle or advanced age : it is likewise more common 
 in men than women. It is more apt to occur in those who 
 have been accustomed to drink spirituous liquors, but 
 it will likewise frequently take place in persons who have 
 not indulged in this bad habit, and who have lived with 
 general temperance. 
 
 The tubercles which are formed in this disease occupy 
 generally the whole mass of the liver, are placed very near 
 each other, and are of a rounded shape. They give an 
 appearance every where of irregularity to its surface. 
 When cut into, they are found to consist of a brownish 
 or yellowish white solid matter. They are sometimes of 
 a very small size, so as not to be larger than the heads of 
 large pins ; but most frequently they are as large as small 
 hazel nuts, and many of them are sometimes larger. 
 When the liver is thus tuberculated, it feels much harder 
 to the touch than natural, and not uncommonly its lower 
 edge is bent a little forward. Its size, however, is gene- 
 
 * Vid. Morgagni Epist. XXXI V. Art. 25. 
 Also see Portal's Anatomie Medicale, Tom. V. p. 306 f 
 
137 
 
 rally not larger than in a healthy state, and I think it is 
 often smaller. If a section of the liver be made in this 
 state, its vessels seem to have a smaller diameter than they 
 have naturally. It very frequently happens that in this 
 state the liver is of a yellow colour, arising from the bile 
 accumulated in its substance; and there is also water in 
 the cavity of the abdomen, which is yellow from the 
 mixture of bile. The gall-bladder is generally much 
 contracted, and of a white colour, from its being empty. 
 The bile, from the pressure of the hard liver upon the pori 
 biliarii, does not reach the ductus hepaticus, and therefore 
 cannot pass into the gall-bladder. The colour of the skin 
 in such cases is jaundiced, and in general it remains per- 
 manently so, as it depends on a state of liver scarcely liable 
 to change. This is the common appearance of what is 
 generally called a scirrhous liver: but it bears only a remote 
 resemblance to scirrhus, as It shews itself in other parts of 
 the body. I should therefore be disposed to consider it 
 as a peculiar disease affecting this viscus. When the 
 jaundice has continued for a long time, as is commonly 
 the case in this diseased state of the liver, the blood in all 
 the blood vessels of the tjody is either found not to be 
 coagulated at all after death, or to be coagulated very 
 loosely. Whether this be the constant state of the blood 
 in such cases or not, I am not able to determine. Most 
 probably however it is, as it is reasonable to think, that it 
 depends upon the chemical influence of a mixture of a 
 certain proportion of the but with the blood. 
 
 Large white Tubercle of the Liver. 
 
 Hard white masses are sometimes formed in the liven 
 They are often as large as a chesnut; but I have seen 
 S 
 
138 
 
 "them both a good deal larger and smaller than this size. 
 They are to be found near the surface of the liver in greater 
 number, than near the middle of its substance: two or 
 three frequently lie contiguous to each other, with a con- 
 siderable portion of the liver, in a healthy state, interposed 
 between them and a cluster of similar tubercles. They 
 consist of a firm, opaque, white substance, and are gene- 
 rally somewhat depressed, or hollow, upon their outer 
 surface. The liver in this disease is frequently a good 
 deal enlarged beyond its natural size. 
 
 These tubercles appear to be first formed round the 
 blood vessels of the liver, as is seen in making sections of 
 a liver in this state. While the liver is under such cir- 
 cumstances of disease, there is sometimes water in the 
 cavity of the abdomen, and at other times none ; the liver 
 is sometimes tinged in its colour, from the accumulation 
 of bile, and sometimes the colour of its substance between 
 the tubercles is perfectly natural. 
 
 The kind of tubercle which we have now descibed, is 
 much more rare than the other, and resembles more the 
 ordinary appearance of scirrhus in other parts of the body. 
 In one or two instances, however, I have observed a thick 
 sort of pus lodged in this species of tubercle resembling 
 very much the pus from a scrofulous sore ; and therefore 
 I am rather disposed to think that this tubercle may be of 
 a scrofulous nature, but no satisfactory opinion can be 
 formed upon this single circumstance. 
 
 S(ft brown Tubercles of the Liver. 
 
 I have also seen in the liver a number of soft tumours, 
 about the size of a walnut: they were principally situated 
 at the surface of the liver, and consisted of a smooth, soft, 
 
139 
 
 brownish matter. This is a very rare appearance of 
 disease : such tumours would by many be considered as 
 scrofulous, but there is no good evidence in support of 
 this opinion ; and there is certainly no resemblance between 
 this sort of tumour and either a scrofulous tubercle of the 
 lungs, or a scrofulous absorbent gland. About its real 
 nature nothing satisfactory is ascertained. 
 
 Scrofulous Tubercles of the Liver 
 
 Tubercles are occasionally found in the liver, which 
 bear a strong resemblance to the tubercles of the lungs ; 
 but this is a very rare appearance of disease. They have 
 the same size, the same structure, and the same feeling to 
 the touch, but are a little browner in their colour. In 
 the only instance which I have seen of this disease, the 
 tubercles were generally dispersed through the substance 
 of the liver at pretty regular distances, but did not render 
 the surface of the liver irregular, as in the common sort of 
 tubercle. From their appearance and structure I am 
 strongly disposed to consider them as scrofulous. 
 
 Liver flaccid, with reddish tumours. 
 
 1 have likewise seen the liver much more flaccid in its 
 substance than is natural, with reddish soft tumours, of 
 considerable size, interspersed through it, which contained 
 a thick sort of pus. I am not acquainted with the real 
 nature of these tumours, but I think it proper to mention 
 that they were found in a person whose general constitution 
 had strong marks of scrofula, and in whom also were 
 found many scrofulous absorbent glands on examining 
 the body. They probably may have belonged to thai 
 
140 
 
 species of disense, which is called the fungus haematodes.* 
 
 Liver very soft in its Substance. 
 
 The liver is not unusually found much more flaccid in 
 its substance than natural without any other appearance 
 of disease. It feels upon such occasions nearly as soft as 
 the spleen, and is commonly of a leaden colour. This 
 change must arise from a process which takes place 
 through its whole substance, and seems to be what Mr. 
 Hunter has called the interstitial absorption. By this 
 process is meant, the absorbents removing insensibly the 
 very minute parts out of the general mass of any structure 
 in an animal body without ulceration. This state of the 
 liver is very rarely, if ever, found in a very young person, 
 and is most common in persons who are advanced in life. 
 
 Liver very hard in its Substance. 
 
 There is a very contrary state of the liver, not at all 
 unusual, viz. where it is much harder than natural, and 
 when cut into, exhibits no peculiar structure. Upon the 
 surface of these livers, there is not uncommonly a thready 
 appearance of membrane, disposed somewhat in a radiated 
 form, and the lower edge is bent a little forwards. This 
 I believe to be the first step in the progress towards the 
 formation of the common tuberculated liver. I have some- 
 times seen very small tubercles formed upon a part of the 
 surface of such a liver, which were exactly of the common 
 sort. From this appearance, it is probable, that additional 
 matter is deposited in the interstices, through the general 
 
 * Such of my readers as may wish to examine these various tubercles more 
 minutely, will find an excellent account given of them by Dr. Fane in his 
 Fasciculi. 
 
141 
 
 mass of the liver, rendering it much harder, and that this 
 matter, together, perhaps, with part of the ordinary struc- 
 ture of the liver, is converted into tubercles. This har- 
 dened state of the liver is sometimes accompanied with a 
 beginning ascites, and sometimes is without it. 
 
 Hydatids. 
 
 There is no gland in the human body in which hydatids 
 are so frequently found as the liver, except the kidneys.* 
 Hydatids of the liver are usually found in a cyst, which is 
 frequently of considerable size, and is formed of very firm 
 materials, so as to give to the touch almost the feeling of 
 cartilage. This cyst, when cut into, is obviously lamina- 
 ted, and is much thicker in one liver" than another. In 
 some livers, it is not thicker than a shilling, and in others, 
 it is near a quarter of an inch in thickness. The laminae 
 which compose it are formed of a white matter, and on 
 the inside there is lining of a pulpy substance, like the 
 coagulable lymph. The cavity of the cyst I have seen, in 
 one instance, subdivided by a partition of this pulpy sub- 
 stance. In a cyst may be found one hydatid, or a greater 
 number of them. They lie loose in the cavity, swimming 
 in a fluid; or some of them are attached to the side of the 
 cyst. They consist each of a round bag, which is com- 
 posed of a white, semi opaque, pulpy matter, and contains 
 a fluid capable of coagulation. Although the common 
 colour of hydatids be white, yet I have occasionally seen 
 some of a light amber colour. The bag of the hydatid 
 
 * Although the hydatids of the liver, and the kidney, have got the same 
 name, yet frequently they differ from each other. Hydatids, however, occasion- 
 ally occur in the kidneys which are precisely of the same kind with those of 
 the liver. 
 
142 
 
 consists of two laminae, and possesses a good deal of con- 
 tractile power. In one hydatid this coat, or bag, is much 
 thicker and more opaque than in another, and even in the 
 same hydatid different parts of it will often differ in thick- 
 ness. On the inside of an hydatid, smaller ones are 
 sometimes found, which are commonly not larger than 
 the heads of pins, but sometimes they are even larger in 
 their size than a gooseberry. These are attached to the 
 larger hydatid, either at scattered irregular distances, or so 
 as to form small clusters; and they are also found floating 
 loose in the liquor of the larger hydatids. Hydatids of 
 the liver are often found unconnected with each other; 
 but sometimes they have been said to inclose each other 
 in a series, like pill-boxes. The most common situation 
 of hydatids of the liver, is in its substance, and inclosed 
 in a cyst; but they are occasionally attached to the outer 
 surface of the liver, hanging from it, and occupying more 
 or less of the general cavity of the abdomen. 
 
 The origin and real nature of these hydatids are not fully 
 ascertained; it is extremely probable, however, that they 
 are a sort of imperfect animalcules. There is no doubt 
 that the hydatids in the livers of sheep are animalcules : 
 they have been often seen to move when taken out of the 
 liver and put into warm water; and they retain this power 
 of motion, for a good many hours after a sheep has been 
 killed. The analogy is very strong between hydatids in 
 the liver of sheep, and in that of the human subject. In 
 both they are contained in strong cysts, and in both they 
 consist of the same white pulpy matter. There is un- 
 doubtedly some difference between them in simplicity of 
 organization; the hydatid in the human liver being a 
 simple uniform bag, and the hydatid in that of the sheep 
 
143 
 
 having a neck and mouth appended to the bag. This 
 difference need, however, be no real objection to the 
 opinion above stated. Life may be attached to the most 
 simple form of organization. In proof of this, hydatids 
 have been found in the brains of sheep, resembling almost 
 exactly those in the human liver, which have been seen 
 to move, and therefore are certainly known to be animal- 
 cules. The hydatids of the human liver indeed, have not, 
 as far as I know, been found to move when taken out of 
 the body and put into warm water; had this ever happened, 
 no uncertainty would remain. It is not difficult to see 
 a good reason why there will hardly occur any proper 
 opportunity of making this experiment. Hydatids are 
 not very often found in the liver: and the body is allowed 
 to remain for so long a time after death before it is ex- 
 amined, that the hydatids must have lost their living- 
 principle, even if they were animalcules. The probability 
 of their being animalcules; however, is very strong ; and 
 it appears even more difficult to account for their produc- 
 tion according to the common theory of generation, than 
 for that of intestinal worms. We do not get rid of the 
 difficulty by asserting that hydatids in the human liver are 
 not living animals, because in sheep they are certainly 
 such, where the difficulty of accounting for their produc- 
 tion is precisely the same. If any person should wish to 
 consider hydatids more minutely, he will find an excellent 
 account of them published by Dr. John Hunter in the 
 "first volume of the Medical and Chirurgical Transactions.* 
 
 * See Medical and Chirurgical Transactions, Vol. I. p. 34- 
 
144 
 
 Cysts in the Liver containing an earthy Matter. 
 
 Cysts are occasionally formed in the liver, containing 
 an earthy matter. The cysts are composed of a kind of 
 cartilaginous substance mixed with bone. The earthy 
 substance contained in the cyst is soft, smooth, and of a 
 brownish white colour. It is mixed with soft films re- 
 sembling a good deal in their appearance the coats of an 
 hydatid. 
 
 Rupture of the Liver- 
 
 The liver . is more liable to be ruptured by external 
 violence than any other gland of the body, which probably 
 arises from two causes: the one is, that in thin persons 
 the liver, more especially when large, lies near the surface 
 of the body, and therefore may be readily affected by a 
 strong external pressure. The other is, that the liver 
 consists of a structure, the part's of which are more easily 
 separated from each other by pressure, than those of 
 almost any other organ or structure in the body. Thus, 
 if the thumb or the finger be pressed against the liver 
 with agoo d deal of force, the liver gives way much in the 
 same manner as a rotten pear would do, although not so 
 readily. In this trial the effect does not depend upon the 
 liver being softened by putrefaction, because it will take 
 place in the liver of a person immediately after death. It 
 depends upon the peculiar structure of the liver, and there- 
 fore may take place in the liver of a person who is alive, 
 as well as of one who is dead. If the same degree of 
 pressure be applied to a muscle, or many glands of the 
 body, they are not ruptured, but recover the v selves after 
 the pressure has been removed. When ruptures have 
 
145 
 
 taken place in the liver, they have happened from some 
 strong pressure applied to the upper part of the abdomen; 
 as for instance, from the wheel of a carriage passing over 
 that part of the body. Little pain has been felt from such 
 an injury; which is a proof among many others of the 
 liver not possessing much sensibility; and some of the 
 persons to whom this accident has happened continued to 
 live after it for several days. 
 
 Worms said to be in the Liver. 
 
 Worms* have been said to be found in cysts of the 
 liver, as well as in the biliary ducts. Instances of this 
 sort are extremely rare, and have not come under my 
 own observation. 
 
 SYMPTOMS. 
 
 When the coats of the liver are inflamed, more especi- 
 ally upon its convex surface, the symptoms correspond 
 a good deal with those of pleurisy, in which the inflam- 
 mation has attacked the lower part of the pleura upon the 
 right side. There is acute pain in the part affected, 
 difficulty of breathing, cough, and symptomatic fever. 
 The two affections ifiay however be in general distinguished 
 from each other by the following circumstances. Where 
 the coats of the liver are inflamed the pain will be less in- 
 creased upon deep inspiration than where the pleura at 
 
 * Vid, Ueutaud, Tom. I. p. 194, 
 
 T 
 
the lower part of the right side of the chest is inflamed* 
 In inflammation of the coats of the liver there will be a 
 considerable increase of pain upon pressure immediately 
 under the margin of the ribs, on the right side, which will 
 not take place in inflammation of the pleura. 
 
 1 am not acquainted with any symptoms which attend 
 adhesions of the liver to the neighbouring parts. 
 
 When the substance of the liver is inflamed, there is an 
 obtuse pain in the right hypochondrium, and a pain is 
 often felt at the top of the right shoulder. The patient 
 can lie most easily on the side affected. There is more 
 or less of symptomatic fever, sometimes a dry cough, 
 sometimes hickup, sometimes vomiting, and occasionally 
 a yellow colour of the skin and eyes. Inflammation of 
 the substance of the liver sometimes takes place so very 
 slowly, that it is hardly attended with any pain, and the 
 constitution is not at all or very little affected with symp- 
 toms of fever. On such occasions an inflammation of the 
 liver is not suspected; till an abscess has actually been 
 formed, and begins to make its progress outwards. 
 
 I know of no peculiar symptoms by which the liver can 
 be ascertained, in the living body, to be studded with 
 tubercles. When, however, there is pain or an uneasy 
 
147 
 
 feeling in the region of the liver, together with a jaundiced 
 colour of the skin, which continues permanent, and water 
 is at the same time accumulated in the cavity of the 
 abdomen; there remains little doubt of the liver being 
 tuberculated. When the parietes of the abdomen are thin, 
 and water is accumulated in small quantity in that cavity, 
 the tubercles upon the anterior surface and the lower edge 
 of the liver can sometimes be distinctly felt by the fingers, 
 upon an attentive examination. 
 
 The symptoms which belong to the large white tubercle 
 t)f the liver, I cannot distinguish from those of the com- 
 mon tubercle. Sometimes, however, when the person is 
 thin and the tubercles are near the lower edge of the liver, 
 they can be distinguished by an external examination. 
 I believe that the large white tubercle is not so often 
 attended with jaundice and ascites as the other. 
 
 The symptoms which belong to the other tubercles of 
 the liver, are unknown to me. It is probable that there 
 are none which are discriminative. 
 
 When the liver is becoming hard in its substance, the 
 exact state of it cannot be determined in the living body, 
 unless the person be so thin that the liver can be distinctly 
 felt upon examination. This, however, will frequently 
 be very difficult, and on many occasions impossible; 
 because the liver, when hard, is commonly not increased 
 in its size, and the parietes of the abdomen are of con- 
 
148 
 
 siderable thickness. If there be some sense of uneasiness 
 in the region of the liver, along with a sallow countenance, 
 this disease may be suspected. It has sometimes happened, 
 however, that the liver has been discovered to be hard, 
 upon an examination after death, when no symptoms had 
 been observed during life, which led to an opinion of this 
 disease having taken place. 
 
 There are no symptoms which characterize, particularly, 
 the formation of hydatids in the liver, and this disease can 
 only be guessed at in the living body. It appears from 
 the history of some cases of this kind, that a pain is felt 
 in the right hypochondrium; but this may arise from 
 many other causes, 
 
 In two cases which have come to my knowledge, the 
 symptoms were similar to those which attend an attack of 
 gall-stones. There was a violent spasmodic pain near the 
 pit of the stomach, frequent vomiting, and jaundice, with 
 a pulse not accelerated. These attacks occurred frequently 
 in both cases after considerable intervals of tolerably good 
 health. 
 
 When hydatids are confined within the substance of 
 the liver, I do not see how it is possible that their existence 
 should be ascertained ; but when they are formed on the 
 outer surface of the liver, near its lower edge, their 
 existence may in some degree be ascertained by examina- 
 tion, more especially if the person be thin. When, 
 however, the parietes of the abdomen are thick, and the 
 hydatids, or their cysts are not distinct, but lie in contact 
 with each other, making an irregular tumour, it will hardly 
 
149 
 
 be possible to form an accurate opinion by an examina- 
 tion. If the tumour be formed gradually, and the general 
 health be little affected, it is probable that it consists of 
 hydatids. An accurate attention to the feeling, which 
 the tumour yields upon pressure, or upon striking it 
 gently with the hand, may also assist in forming a probable 
 conjecture about its nature. Where the tumour consists 
 of hydatids it will generally feel to a certain degree soft; 
 and if the hydatids should be very large, there may be 
 an obscure sense of fluctuation upon striking the tumour 
 with one hand, while the other is applied to the opposite 
 side of it. If moreover, the tumour should occupy a 
 great part of the cavity of the abdomen, and can be 
 clearly traced from the liver, as the source of its growth, 
 there can be but little doubt of the existence of hydatids, 
 under these circumstances. 
 
150 
 
 .CHAPTER X. 
 
 DISEASED APPEARANCES IN THE GALL-BLADDER, 
 
 Inflammation of its Coats 
 
 THE coats of the gall-bladder are very rarely inflamed, 
 without inflammation of the membrane which covers the 
 posterior surface of the liver. When inflammation attacks 
 this membrane, it naturally spreads over the outer coat of 
 the gall-bladder, which is a continuation of it, and may 
 affect the other coats of the gall-bladder, if it should /have 
 arisen to a violent degree. Inflammation, however, of the 
 outer coat of the gall-bladder will not commonly be 
 attended with inflammation of the others, because it is not 
 closely applied to them, there being interposed a consid- 
 erable quantity of cellular membrane. The appearances 
 of inflammation in the coats of the gall-bladder, are similar 
 to what take place in inflammation of the stomach or in- 
 testines. These have been already fully described, and 
 need not be repeated. 
 
 Adhesions. 
 
 It is a very common appearance, upon dissection, to 
 find the gall- bladder. connected by adhesions, either to the 
 small end of the stomach, or to the beginning of the 
 duodenum. These are the consequence of a previous 
 inflammation in the outer coat of the gall-bladder, and 
 resemble exactly the adhesions which we have already 
 described. 
 
151 
 
 Ulcers in the gall-Bladder. 
 
 It is rare that inflammation of the gall-bladder advances 
 to ulceration : the accumulation of gall-stones in it, as far 
 as I have observed, rarely produces this effect.* Ulcera- 
 tion of the gall-bladder, however, occasionally takes place, 
 and I believe almost always begins in the inner membrane. 
 Of this I have known two cases. In the one case, several 
 ulcers were found in the inner membrane of the gall- 
 bladder, while the other coats were not affected; and in 
 the other there was one ulcer, which had destroyed a 
 part of all the coats. 
 
 Coats of the Gall-bladder thickened^ and hard Tubercles 
 formed in them. 
 
 I have only had an opportunity once of observing this 
 change in the gall-bladder. Its coats were above a quarter 
 of an inch thick, and were studded with tubercles of a 
 considerable size, and very firm in their texture. The 
 liver to which this gall-bladder belonged was affected with 
 the same disease. 
 
 Coats of the Gall-bladder bony. 
 
 I have likewise seen the coats of the gall-bladder very 
 much thickened, and converted in many parts into a sort 
 of bony substance ; but this is to Ije considered as a very 
 rare appearance of disease. 
 
 * I have myself only seen one instance of inflammation and ulceration of 
 the gall-bladder produced by gall-stones. Dr. Soemmerring, however, has 
 seen a good many instances of ulcers in the inner surface of the gall-bladder, 
 from tjhe irritation of gall-stones. 
 
152 
 
 Diseased state of the Biliary Ducts. Their Dilatation 
 
 The most common diseased appearance of the biliary 
 ducts is their dilatation. The ductus hepaticus, ductus 
 cysticus, and ductus communis choledochus, are some- 
 times, dilated to an almost incredible size. I have seen 
 the ductus hepaticus and choledochus so much dilated as 
 to be nearly an inch in the transverse diameter. These 
 dilatations of the biliary ducts take place in consequence of 
 the passage of gall-stones and it is astonishing how large 
 gall-stones; sometimes are, which have been known to 
 pass into the duodenum. This ought to afford a strong 
 ground of comfort to persons who are labouring under so 
 distressing a complaint. 
 
 Obliteration of the Biliary Ducts. 
 
 An obliteration of any of the biliary ducts happens very 
 rarely, but instances of this disease have been discovered, 
 and they may be traced to the following causes. One 
 cause is a violent inflammation, which has taken place in 
 the inner surface of some of the biliary ducts, and has 
 terminated in an adhesion of its sides. This may be 
 supposed to arise most commonly from the irritation of a 
 rough gall-stone, in its passage toward- the duodenum. 
 A similar adhesion has been known to take place in other 
 canals of the body, inconsequence of violent inflammation 
 there, as, for instance, in the vagina. Another cause, 
 which may act upon the lower extremity of the ductus 
 communis choledochus, obliterating its cavity at that part, 
 is a violent inflammation of the duodenum at the entrance 
 of the duct; the extremity of the duct being involved in 
 the inflammation, may have its canal obliterated. To this 
 
153 
 
 may be added, as a third cause of obliteration, a scirrhous^ 
 or any other enlargement of the round head of the pancreas, 
 which may so press upon the lower extremity of the 
 ductus communis choledochus, as to annihilate its cavity. 
 It has only occurred to myself to have seen an instance of 
 obliteration in the* ductus cysticus; but Dr. Storer of 
 Nottingham, whose ability and industry in his profession 
 are well known, has favoured me with an account of two 
 cases of obliteration at the end of the ductus communis 
 choledochus. 
 
 A preternatural Canal of Communication between the 
 Gall-bladder and the stomach. 
 
 It may not be improper to take notice here, that I have 
 once seen an immediate communication, by a short canal, 
 between the gall-bladder and the small end of the stomach. 
 This lusus naturae is very rare, and but a few instances of 
 it have been recorded. 
 
 Gall- Stones. 
 
 It is not an uncommon appearance of disease in exam- 
 ining dead bodies, to find gall-stones, either in the gall- 
 bladder, or in some of the biliary ducts. The gall-bladder 
 is sometimes much enlarged in its size, and full of them. 
 In this case its coats are often a good deal thickened, 
 which arises partly from the pressure against the gall- 
 bladder, in consequence of the accumulation of the stones, 
 and partly from the efforts of the contractile power of the 
 gall-bladder, to expel them. The number of stones ac- 
 cumulated in the gall-bladder is sometimes very great; 
 above a thousand have been take,n out of one gall-bladder, 
 which are preserved in Dr. Hunter's collection. When 
 U 
 
154 
 
 there is a solitary gall-stone in the gall-bladder, it is occa- 
 sionally very large; I have known an instance of one which 
 was fully the size of a hen's egg. When there is but one 
 gall-stone either in the gall-bladder, or in the biliary ducts, 
 it is generally of an oval shape ; when there is a consid- 
 erable number, they acquire by rubbing upon each other, 
 in a small space, a great many sides and angles. 
 
 There is great variety in the external appearance of 
 gall-stones with respect to colour : some are whitish, 
 others are black ; they are also of a yellowish, a greenish, 
 a light brown, a dark brown, and a reddish-brown colour. 
 These are the principal varieties in colour, but there are 
 many other smaller differences which it is very difficult 
 to express in words. .Gall-stones differ also very much in 
 the state of their surface, some being very smooth, and 
 others a good deal roughened. 
 
 When cut or broken, gall-stones are commonly found 
 to consist of concentric laminae upon the outside, and in 
 the centre, of a radiated structure. The laminated part 
 bears sometimes a large proportion to the other, and 
 sometimes the contrary happens. The laminated and 
 radiated structures are sometimes compact, and sometimes 
 consist of a more loose matter. It likewise occasionally 
 happens that both the laminated and the radiated structures 
 are very obscure, and the gall-stone appears a good deal 
 like an uniform solid mass. The laminated part on the 
 outside very frequently consists of a different substance in 
 appearance, from the radiated structure in the centre; and 
 it is not unusual to find the structure in the centre to 
 consist of shining white crystallizations, which have a 
 good deal the look of mica or spermaceti. 
 
155 
 
 Gall-stones being very different both in their outward 
 appearance and their internal structure from each other, 
 we are naturally led to suppose that they may also differ 
 in their chemical properties. Upon this subject I can only 
 speak generally; but such trials as I have made, incline- 
 me to this opinion. Very few gall-stones yield a bitter 
 taste, which shews that commonly they do not consist of 
 inspissated bile ; but in some I have found the taste 
 intensely bitter. Almost all of them melt in the flame of 
 a candle ; but I have met with one sort of a very black 
 colour, which did not melt, but burnt exactly like a cinder.* 
 
 All the gall-stones which I have examined dissolve in 
 the nitric acid. They are separated into a fine black 
 powder when put into the sulphuric acid, especially if 
 exposed to a sand heat. By the muriatic acid they are 
 not acted upon at all in the common heat of the atmosphere; 
 and are even but little affected by it when* exposed to a 
 sand heat for a considerable time. 
 
 Most of the gall-stones which I have examined, are 
 either not very soluble in oil of turpentine in the common 
 heat of the atmosphere, or the process goes on very slowly: 
 one sort I have found to be in this heat altogether insoluble. 
 When put into this oil, and exposed to a sand heat, 
 they are much more readily acted upon. Some are con- 
 verted into a kind of oil, which sinks to the bottom of the 
 oil of turpentine ; others are partly soluble, tinging the oil 
 of turpentine of a brownish colour, and are partly separated 
 into a powder. 
 
 * Dr. Soemmerring considers these as inspissated bile, and mentions, that 
 they have no regular form, have a bitter taste, and are soluble in water. In some 
 trials which I made, they did not dissolve in distilled water, either cold or hot; 
 but they are bitter to the taste, and without any regular shape, or appearance 
 of crystallization., 
 
Most gall-stones appear not to be readily affected by 
 spirit of wine in the common heat of the atmosphere, but 
 are either partly or entirely soluble in it in a boiling heat.* 
 Such are the general results from a good many trials of 
 my own, but although I have paid a good deal of attention 
 to chemistry at an early period of my life, I should rest 
 upon them with little confidence, if they did not in a great 
 measure correspond with those of the experiments of 
 others who are more conversant than myself bocli with the 
 scientific and practical parts of chemistry. 
 
 Gall-stones according to the experiments of Gren, 
 consist of a substance possessing the properties of wax 
 and of lymph, f 
 
 A gall-sione,. consisting of a chocolate coloured sub- 
 stance on the outside and of white radiated lamellae upon 
 the inside, was found by Dr. Saunders to consist of a 
 resinous matter, with a small proportion of earth, appar- 
 ently the calcareous, and some mineral and volatile alkali. J 
 
 The gall-stones which Dr. Powell examined were found 
 to consist of resinous matter, carbon, and an animal sub-, 
 stance resembling dried mucus. This subject seems still 
 to be imperfectly known, and to require further investigation. 
 
 * When some biliary calculi are exposed to spirit of wine in a boiling state, 
 white flaky crystals are soon formed upon its cooling. When they are exposed 
 to spirit of wine in the common heat of the atmosphere, it is some weeks 
 before crystals begin to be formed, and they appear to be more pointed in 
 their shade than the former. These crystals were, I believe, first observed 
 by M.Poulletier de la Salle. See Elemens d'Histoire Naturelle et de Chimie, 
 par M. de Fourcroy, Tom. IV. p. 354. 
 
 f See Johnson's Animal Chemistry, Vol- II. p. 355- 
 
 t See Dr. Saunders's Treatise on the liver, p. 119, first edition. 
 
 See Dr. Powell's Observations on the Bile and its Diseases. 
 
157 
 
 Bile. 
 
 The bile in the gall-bladder is found to differ in different 
 bodies ; but this is too common to arise from disease, and 
 must depend on natural circumstances. It is sometimes 
 of a green, at other times of a brownish yellow, or a purer 
 yellow colour. The brownish yellow colour is the most 
 common. It is always more or less viscid, and the variety 
 in this respect is considerable : in man it generally appears 
 a good deal more viscid than in most other classes of 
 animals. In one case, I have seen 'it as ropy as the mucus 
 which is commonly coughed up from the trachea. I 
 recollect also another case, where the bile in the gall-bladder 
 resembled exactly the white of a raw egg. This kind of 
 substance is ascertained to form one of the constituent 
 parts of the bile, and in the present instance it would seem 
 that the other parts were wanting. Such an effect may 
 be supposed to have depended upon a very imperfect 
 action of the secretory structure of the liver. The liver in 
 this case was not sound, being studded with scrofulous 
 tubercles, and the absorbent glands of the mesentery were 
 affected with the same disease. 
 
 In opening dead bodies, the bile is almost always found 
 to have transuded in small quantity through the coats of 
 the gall-bladder, so as to tinge the neighbouring parts, 
 especially the small end of the stomach, and the beginning 
 of the duodenum. This is to be considered as a natural 
 effect, which has taken place after death, and not as a 
 diseased appearance. The coats of the gall-bladder, in 
 consequence of death, have lost that compactness by which 
 they were formerly able to confine the bile ; it therefore tran- 
 sudes in small quantity, and tinges the neighbouring parts. 
 
158 
 
 The Gall-bladder distended with Bile. 
 
 The gall-bladder is sometimes distended with bile so as 
 to be of nearly twice its usual size; at other times, there 
 is no bile at all in its cavity, and under such circumsances 
 it is white in its colour, and contracted into very small size. 
 
 Hydatids in the Gall-bladder. 
 
 '*' The gall bladder has been known to be distended to an 
 immense size, and to contain hydatids;* but this state of 
 it is to be considered as extremely uncommon. 
 
 The Gall-bladder -wanting. 
 
 The gall-bladder has also been known to be wanting 
 from a defect in the original formation.-)" It has never 
 occurred to me, to see an example of this kind of mon- 
 strosity; but it may be the more readily believed some- 
 times to happen, as the gall-bladder does not serve any 
 necessary purpose in the body. There are many classes 
 of animals which are naturally without a gall-bladder. 
 
 SYMPTOMS. 
 
 Inflammation of the coats of the gall-bladder is not 
 known to be distinguished by any peculiar symptoms. 
 They are probably much the same with the symptoms 
 
 Sec Medical Communications, Vol. I. p. 101. 
 t See Dr. Soemmering's Germ. Translat. p. 150, 
 
159 
 
 which attend inflammation of the membranous covering 
 of the liver. 
 
 An obliteration either of the hepatic duct or of the 
 ductus communis choledochus, must produce a jaundice 
 which is permanent, because it depends upon a cause 
 not liable to change. This will be extremely difficulty 
 to distinguish, in practice, from jaundice produced by a 
 hardened, or tuberculated state of the liver, for this cause 
 of jaundice may likewise be said to be generally permanent. 
 When the ductus cysticus only is obliterated, there will 
 be no jaundice, and little inconvenience will probably be 
 felt, unless the bile confined in the gall bladder should at 
 length irritate its coats. In this case inflammation may 
 be excited, which may advance to suppuration. I have 
 seen an ulcer of the gall-bladder, which appeared to be 
 produced by this cause. 
 
 While gall-stones remain in the gall-bladder, and no 
 attempt is made towards their passing through the ductus 
 cysticus, and ductus communis choledochus, very little 
 inconvenience is commonly produced by them. It 
 frequently happens that gall-stones are found in the gall- 
 bladder after death, where there was notlhe least suspicion 
 of their existence during life. When they pass through 
 the ducts, more especially if they be large in their size, 
 a most excruciating t pain is commonly felt about the pit 
 f the stomach: patients in this case express a muck 
 
160 
 
 stronger feeling of pain, than during a violent inflamma- 
 tion even in the most sensible parts of the body. They 
 often cry out, and writhe or twist their body into various 
 postures. When the pulse is felt during this exquisite 
 pain, it is sometimes found to be accelerated in a very 
 trifling degree, but generally it is not more frequent than 
 in health, and sometimes it is even slower. There is 
 languor, sickness, and vomiting; and the skin becomes in 
 the progress of the disease more or less of a yellow colour. 
 
161 
 
 CHAPTER XL 
 
 DISEASED APPEARANCES OF THE SPLEEN. 
 
 Inflammation . of the Coats of the Spleen. 
 
 THE, coats of the spleen are liable to inflammation; 
 but this rarely takes place unless the peritonaeum in the 
 neighbourhood be also affected. The proper capsule of 
 the spleen is so intimately connected with the peritonaeum 
 which is reflected over it, that it must necessarily partake 
 of any inflammation affecting that portion of the membrane* 
 When inflammation attacks the coats of the spleen, it 
 exhibits exactly the same appearances which have been 
 so often described. They become much more crowded 
 with florid blood vessels than in a natural state, are some- 
 what thicker, and throw out a layer of coagulable lymph 
 upon their surface. 
 
 Adhesions. 
 
 It is more common, however, to find adhesions formed 
 between the spleen and the neighbouring parts, than to 
 find its coats in an actual state of inflammation. These 
 adhesions consist of a white transparent membrane of more 
 or less firmness, and generally connect the broad surface 
 of the spleen, more or less closely to the diaphragm. 
 They often connect also the spleen to the great end of the 
 stomach, and a part of the transverse arch of the colon. 
 X 
 
162 
 
 Coats of the Spleen Cartilaginous. 
 
 The coats of the spleen are sometimes converted into 
 cartilage; and this disease may be considered in a great 
 measure as peculiar to the spleen. It is, at least, much 
 more common in this viscus than in any other. 
 
 The cartilage is generally to be found on the convex 
 surface of the spleen, and extends over more or less of it 
 in different cases. It is much thicker in one case than 
 another: in some being not thicker than a shilling, and 
 in others being four times as thick. It is generally formed 
 in a smooth layer, but occasionally it is somewhat irregu- 
 lar. I have also seen in some instances small spots of 
 cartilage over the whole surface of the spleen- It would 
 appear that ossifications* are sometimes to be found in 
 this cartilage, but in the cases which have come under 
 my own examination, bony matter was not to be observed. 
 The cartilage into which the coats of the spleen are 
 changed, is in general a good deal softer than that which 
 covers the extremities of bones. This diseased process, 
 it is natural to think, is slow in its progress, can hardly 
 produce any impediment to the functions of the spleen, 
 and is probably not marked by any peculiar feelings to 
 the patient. 
 
 Inflammation of the Substance of the Spleen. 
 
 It is very rare to find the substance of the spleen either 
 in a state of inflammation or suppuration; but such cases 
 have occasionally been observed and related by authors, f 
 
 * Morgagni has seen ossification of a part of the capsule of the spleen 
 Vid. Epist. X Art. 19 Epist. XIV. Art. 23. 
 f Vid. Lieutaud, Tom. I. p 22. 
 Vid. Portal's Anatomic Medicate, Tom. V. p. 333. and 334, 
 
163 
 
 Instances also have been related where the spleen had been 
 observed to be mortified;* but this is probably much 
 more rare than the former. 
 
 The Spleen extremely soft. 
 
 There is an appearance of the spleen which is very 
 common, and which perhaps is hardly to be considered 
 as a disease, but it is a very obvious deviation from its 
 healthy structure. The appearance to which I allude is 
 an extreme softness of the spleen, so that when its capsule 
 is broken (which under such circumstances is very tender) 
 the substance of the spleen seems to consist of little else 
 than a very soft, brownish-red mucus, intermixed with 
 a spongy fibrous texture. This appearance of the spleen 
 is hardly ever to be observed at a very early period of life, 
 but is very common in middle and more advanced age. 
 I believe that such a state of the spleen is not marked by 
 any peculiar feelings, so as to make the persons conscious 
 of any disease taking place, and is probably of very little 
 consequence in the general economy of the animal. Still, 
 however, it is not a state into which the spleen naturally 
 degenerates in the gradual decay of the body. 
 
 The Spleen very hard. 
 
 The spleen is sometimes much harder than natural, and 
 at the same time is generally a good deal enlarged. It will 
 occasionally be enlarged to five or six times its natural 
 size, and it then forms a tumour, very capable of being 
 distinguished by an examination in the living body. 
 When cut into, the natural structure seems to be pre* 
 
 * Vid, Lientaud, Tom, I. p. 226. 
 
164 
 
 served, except that it is much more compact, or solid than 
 it ought to be. 
 
 This state of the spleen is generally considered as 
 scirrhous ; but its structure is not similar to scirrhus in 
 other parts of the bodyi and its real nature is probably 
 at present not fully understood. When the spleen is in 
 this state, water is sometimes accumulated in the cavity 
 of the abdomen. 
 
 Tubercles in the Spleen. 
 
 The spleen is sometimes, although rarely, studded in its 
 substance with small tubercles, very similar to the scro- 
 fulous tubercles of the lungs. In one instance 1 have seen 
 some of these in a state of suppuration, and the pus was 
 thick and curdly, like scrofulous pus. 
 
 Spleen very large. 
 
 The spleen is sometimes found to be much larger in its 
 size than natural, but with a structure perfectly healthy; 
 and this more commonly happens to the spleen than to 
 any other viscus. Although it may be looked upon as a 
 monstrous growth of the spleen, rather than a disease, yet 
 it may produce inconvenience by its pressure, and by 
 altering in some degree the situation of the neighbouring 
 viscera. 
 
 Hydatidsin the Spleen. 
 
 Hydatids are occasionally formed in the spleen,* which 
 are of the same kind with those of the liver; but they are 
 much more common in the latter viscus, than in the 
 former. 
 
 * Vid. Morgagni, Epist. XXXVIII. Art, 34* 
 
165 
 
 Stony Concretions in the Spleen. 
 
 Stony concretions* have been found occasionally in the 
 spleen; but such cases are very rare, and have not fallen 
 under my own observation. 
 
 The Spleen Ruptured. 
 
 The spleen has been known sometimes to be ruptured, 
 in consequence of external pressure upon that side of the 
 body where it is situated. When the spleen is of the 
 common size, an accident of this kind can very rarely 
 take place, because it is well defended by the ribs of the 
 left side; but when the spleen is very large, so that a part 
 of it passes below the margin of the ribs into the cavity of 
 the flank, such an accident may very readily happen. 
 
 . Several small Spleens. 
 
 There is a variety in the natural formation of the spleen, 
 which I believe does not take place in that of any other 
 gland in the body. It consists in several small spleens 
 being formed besides the common one. They vary in 
 their size in different instances, but I have seen some of 
 them as large as a walnut. They are situated in the 
 omentum, near the great end of the stomach, are supplied 
 with blood vessels from the splenic artery and vein, and 
 have exactly the same structure as a common spleen. It 
 will probably make no difference with regard to the use of 
 the spleen, whether it be entirely formed of one mass, or 
 whether it consists of several distinct parts. 
 
 * Vid. Lieutaud, Tom, I. p, 231. 
 
166 
 
 Spleen said to be wanting. 
 
 The spleen has been said to be occasionally wanting, 
 as a defect in the natural formation, but this too is very 
 uncommon.* We know that an animal is capable not only 
 of existing, but also of enjoying apparent good health with- 
 out a spleen. The spleen has been cut out, by way of 
 experiment, from some quadrupeds, and they did not 
 appear to suffer any inconvenience from the want of it. 
 The human spleen has even been removed in a few 
 instances, and the persons have not only recovered, but 
 have enjoyed afterwards good health. It does not appear^ 
 therefore, very wonderful that a body should be formed 
 without a spleen, and c^rry on its vital functions without 
 any obvious imperfection. 
 
 SYMPTOMS. 
 
 When inflammation attacks the coats of the spleen, it is 
 attended with the same symptoms as an inflammation of 
 that portion of the peritonaeum, which lies in the left 
 hypochondrium. There is pain in that region, which is 
 more or less acute, according to the degree of the inflam- 
 mation; and this pain is increased upon pressure immedi- 
 ately upon the inside of the left margin of the ribs. If the 
 inflammation be considerable, it is accompanied with 
 symptomatic fever. 
 
 * Vid. Lieutaud, Tom. I. p. 234. 
 
167 
 
 The symptoms which have been described as belonging 
 to inflammation of the substance of the spleen, are a 
 fullness and sense of pain in the left hypochondrium. The 
 pain is increased upon pressure, and there is more or less 
 of symptomatic fever. In two cases of inflamed spleen, 
 examined by the late Dr. Hunter, where the inflammation 
 had advanced to suppuration, the patients could not define 
 accurately the seat of their pain, but the pain seemed to 
 travel a good deal over the general cavity of the abdomen. 
 In some instances palpitation of the heart, difficulty of 
 breathing, and vomiting have been observed to take place 
 in this disease. 
 
 An enlarged and hardened state of the spleen is not 
 suspected or known, till the disease has made a considera- 
 ble progress, so that the spleen is capable of being felt ex- 
 ternally. It is commonly attended with no pain, and will 
 even bear a pretty strong pressure, without any painful 
 sensation. It may be distinguished when the spleen has 
 arrived at a considerable size, by the situation and the 
 general shape of the tumour. The anterior edge of the 
 spleen can generally be felt distinctly by the hand applied 
 to the surface of the abdomen, under the margin of the 
 ribs upon the left side ; and the edge is sometimes dis- 
 tinguished by this examination to be notched. This 
 state of the spleen is often at length attended with dropsy. 
 
 There are no peculiar syrastoms which characterize the 
 
168 
 
 formation of hydatids in the spleen. A pain has been 
 remarked to be felt, in such cases, in the left hypochon- 
 drium ; but this also belongs to many other complaints. 
 When a swelling begins in the situation of the spleen, and 
 spreads very slowly into the cavity of the abdomen, being 
 somewhat soft to the feeling, and perhaps giving some 
 obscure sense of fluctuation, the disease may then be 
 reasonably supposed to depend on the formation of hyda- 
 tids in this organ. 
 

 169 
 
 CHAPTER XII. 
 
 DISEASED APPEARANCES OF THE PANCREAS. 
 
 THE pancreas is subject to very few diseases. It seU 
 dom happens, upon examining dead bodies, that it exhibits 
 any other than the healthy structure. 
 
 Abscess of the Pancreas. 
 
 Inflammation is very little apt to affect the pancreas. 
 It has only occured to me to see one instance of an abscess 
 formed jn it. It was a good deal enlarged in its size, and 
 contained a considerable quantity of thin pus.^ 
 
 Pancreas hard. 
 
 It is not very uncommon ^to find the pancreas much 
 harder than in its natural state, and at the same time it is 
 thicket and shorter than usual. There is, however, little 
 appearance to the eye of its structure being altered. This 
 I believe to be the beginning of a process, by which the 
 pancreas become truly scirrhous. It very seldom in this 
 state shews, in any part, the real scirrhous structure. But 
 I have seen this to be the case, which renders it very 
 probable, that the one is the beginning of a change into 
 the other. When the pancreas in any part assumes the 
 scirrhous structure, that part loses entirely its natural 
 appearance, and is converted into a hard uniform, white 
 
 * Portal however has met with several instances of abscess in the pancreas, 
 and has even seen it in some cases mortified, Vid. Tom. V. p. 351, 353 and 353 
 
 Y 
 
170 
 
 mass, intersected by membranes, like scirrhus in other 
 parts of the body. In some cases it has been observed, 
 in this state, to be considerably enlarged. 
 
 Calculi of the Pancreas. 
 
 Calculi are occasionally formed in the ducts of the 
 pancreas. Of this I have known only one instance. The 
 calculi were about the size of the kernel of a hazel nut, 
 with a very irregular surface, and of a white colour. 
 These stones dissolved in muriatic acid with the extrac- 
 tion of a large quantity of carbonic gas, and are found to 
 consist of carbonated lime.* It is not improbable, that 
 calculi formed in the pancreas may differ somewhat from 
 each other, as we find to happen in other calculi which arc 
 formed in the body ; but as this is a very rare disease in 
 the pancreas, it must be a long time before this point can 
 be fully ascertained. 
 
 Steatomatous Tumours. 
 
 Steatomatous tumours have been sometimes found 
 adhereing to the pancreas, but this morbid appearance is 
 extremely rare.f 
 
 Pancreas wanting 
 
 The pancreas has been said to be entirely wanting, as 
 a defect in the original formation 4" 
 
 * See Dr. Pemberton's Treatise upon the Abdominal Viscera, p. 9%* 
 f Vid. Portal's Anatomie Medicale, Tom. V. p. 356. 
 
 * Vid. Lieutaud, Tom. I. p. 247. 
 
171 
 
 SYMPTOMS. 
 
 I have only had one opportunity of seeing an abscess 
 in the pancreas. It was in a young man, a little beyond 
 the age of twenty. He did not complain of any fixed pain 
 in the situation of the pancreas, but had a good deal of 
 pain in different parts of the abdomen. This seemed to 
 be connected with spasmodic contractions of the intestinal 
 canal, which inclosed portions of wind, and also with 
 spasms of the abdominal muscles. There was sickness 
 and distention of the stomach more especially after eating, 
 and the food likewise sometimes occasioned a sense of 
 weight in that organ. He had a disposition to purging ; 
 made but little water ; and became at length dropsical. 
 His pulse was commonly about eighty.* In some cases 
 which are related in books, I find that patients with 
 abscesses in the pancreas have commonly complained of 
 pain in the back and lions, but they seem to have had no 
 peculiar symptoms. 
 
 When the pancreas becomes harder than in its healthy 
 state, it is often, I believe, not attended with any painful 
 sensations to the patient which are well defined. But it 
 sometimes happens, although rarely, that the pancreas 
 becomes much enlarged in its size, as well as hard in its 
 structure, undergoing those changes which belong to 
 scirrhus. In such cases, a long continued pain has been 
 
 * For the account of the symptoms in the above, case, I am indebted t'o 
 Dr. Wm, Herberden. 
 
172 
 
 remarked to exist in the epigastric region, and the stomach 
 has been affected with sickness. In one instance, of 
 which I have heard an account, besides the symptoms 
 already mentioned, there was a pain in the hips, and a 
 sense of numbness in one thigh and leg. 
 
 I am not acquainted with the symptoms which are 
 produced by the formation of calculi in the pancreas. If 
 the calculi should happen to be smooth and few in num- 
 ber they would probably occasion little pain or incon- 
 venience. But if they should be rough upon their 
 surface and numerous, they would probably produce a 
 good deal of irritation and pain in the pancreas, together 
 with sickness and vomiting; but it is not likely that we 
 should be able to guess at the cause of the irritation, unless 
 some of the calculi, having passed into the duodenum,, 
 should be evacuated by vomiting, or by stool. 
 
 
173 
 
 CHAP. XIII, 
 
 DISEASED APPEARANCES OF THE KIDNEYS AND THE 
 RENAL CAPSULES. 
 
 Capsule of the Kidneys inflamed. 
 
 I do not recollect to have seen the proper capsule of the 
 kidney inflamed, and I am disposed to consider it as a 
 rare morbid appearance. The reason, probably, why it 
 seldom occurs, is that the peritonaeum reflected over the 
 surface of the kidney has a very loose connection with it, 
 there being interposed between them a considerable quan- 
 tity of cellular membrane and fat. It seems very likely 
 that the principal reason why the capsules of some other 
 glands in the abdomen are so frequently inflamed, is their 
 close connection with the peritonaeum ; which membrane, 
 from circumstances it is perhaps difficult to ascertain, is 
 very liable to inflammation. When the capsule of the 
 kidneys is inflamed, the same appearances of inflammation 
 will take place, which have been so often noted. 
 
 Mscesses of the Kidneys. 
 
 When the substance of the kidneys is inflamed, it 
 frequently advances to suppuration, and perhaps there is 
 no considerable gland in the body so liable to form abscesses 
 as the kidneys. In some cases which I have seen, the 
 abscesses have appeared to be of a common nature ; but in 
 the greater number of cases, they have been scrofulous. 
 
 When a kidney is attacked with scrofula, and the 
 
174 
 
 disease lias advanced to suppuration, it exhibits different 
 appearances, according to the progress it has made. 
 Sometimes there are only one or two circumscribed 
 abscesses, containing a curdly pus, without any thing 
 being particularly observable in the inner surface of the 
 abscesses. Frequently, however, the inner surface of the 
 abscesses is lined with a pulpy matter. These abscesses 
 generally first destroy the mamillary portion of the kidney; 
 and when they advance very far, they destroy almost the 
 whole structure of the kidney, converting it into capsules 
 which surround a number of imperfect cavities that are 
 lined with this pulpy substance. 
 
 The capsule into which a kidney is changed by the 
 progress of this disease, is on some occasions thicker 
 than on others, frequently of considerable hardness, and 
 seems sometimes to be slightly laminated, When a 
 kidney is so affected, it is not uncommon for the pelvis 
 and ureter to partake of the disease, and a calculus is 
 sometimes found either in the abscess, or in the pelvis of 
 the ureter. In some cases of this kind, a considerable 
 number of calculi have been found.* 
 
 Scrofulous Tubercles in the Kidneys. 
 
 It is not unusual (as we have stated above) for scrofulous 
 abscesses to take place in the kidneys, but it occurs very 
 rarely that scrofulous tubercles are formed in them. I 
 have seen, however, an instance of this kind, and the 
 tubercles resembled most exactly the common tubercles 
 of the lungs. None of them were in a state of suppuration. 
 
 * In such cases, it is very probable that the calculus or calculi are the 
 immediate cause of the other disease, the constitution being at the same time 
 disposed to it. By the irritation of the calculi, inflammation and suppuration 
 are produced in the kidney, and these partake of the nature of the constitution. 
 
175 
 
 Kidney scirrhous. 
 
 The kidney I have once seen converted into a hard, 
 uniform substance, somewhat intersected by membrane, 
 in which the natural structure of this gland was entirely 
 lost. The kidney was at the same time very much en- 
 larged in its size. This alteration of structure I should 
 call scirrhus, because it exactly resembles scirrhus in other 
 parts of the body: it occurs very rarely in the kidneys. 
 
 State of the Kidneys in Diabetes. 
 
 Opportunities do not frequently occur of examining 
 the state of the kidneys in diabetes. I have once, however, 
 been able to make this examination in a satisfactory man- 
 ner, where a person had been long affected with diabetes, 
 and had been a patient under my care in St. George's 
 Hospital. In both kidneys the superficial veins were 
 much fuller of blood than usual, forming upon their surface 
 a most beautiful network of vessels. The whole substance 
 of the kidneys was much more vascular than in a healthy 
 state, approaching a good deal in appearance to what takes 
 place in inflammation. In both of them there was a very 
 small quantity of a whitish fluid, somewhat resembling 
 pus: but there was no appearance of ulceration whatever. 
 The artery, the vein, the lymphatic vessels, and the nerves 
 of both kidneys were in their natural state. The liver, at 
 the same time, I examined with care, because it has been 
 thought by some to be the chief source of disease in diabetic 
 patients, but it was perfectly sound. The stomach and 
 intestines were also examined with attention, but no ap- 
 pearances occurred in them which are not very common. 
 
176 
 
 Kidneys very soft. 
 
 I have also seen the substance of the Iqdney converted 
 into a soft loose mass, resembling almost exactly the 
 appearance of common spunge. On the surface there 
 were many round interstitial cavities scattered at irregular 
 distances ; and when the substance of the kidney was cut 
 into, it exhibited the same spongy structure. The blood 
 vessels of the kidney were seen ramifying very distinctly 
 through the spongy mass. There was no appearance of 
 pus in the kidney, nor was there the most distant resem- 
 blance between this process, and the effects produced by 
 suppuration. It was a process of a peculiar kind, by 
 which a considerable portion of the kidney was removed 
 by the action, probably, of absorbent vessels and it 
 seemed to act much more on the cortical than the tubular 
 part of it. I am not at all exaggerating the effect of this 
 diseased process when I say, that the kidney was rendered 
 fully as soft as a common sponge. When shaken in 
 water, the parts all separated from each other, somewhat 
 like the unravelling of the shaggy vessels of the placenta. 
 Such an appearance of kidney, but in a much smaller de- 
 gree, has fallen two or three times under my own observation. 
 
 Hychtids of the Kidneys. 
 
 The formation of hydatids is not an uncommon disease 
 in the kidneys. There are sometimes ' one or two con- 
 siderable hydatids on the surface of the kidney, lying 
 between its substance and- capsule; at other times, they 
 are more numerous. These hydatids do not appear to be 
 of the same nature with the hydatids of the liver : they are 
 not inclosed in firm cysts ; their coats are also thinner, and 
 
177 
 
 less pulpy; and not uncommonly they are almost as thin 
 as any membrane of the body. I do not recollect to have 
 seen any instance of small hydatids of this sort attached to 
 the coats of larger hydatids in the kidney, as may be 
 frequently observed in the liver. It is therefore probable, 
 that the hydatids which are commonly found in the kidney, 
 depend on a diseased alteration of the structure of this 
 organ, and are not distinct organized simple animals. 
 
 Sometimes, however, the true hydatid is formed in the 
 kidneys, having exactly the same nature with that which 
 grows in the liver. It has occured to me to be able to 
 examine particularly a case of this kind after death, and 
 I shall describe at some length what came then under my 
 observation. The right kidney, in a soldier, was conver- 
 ted into a bag capable of containing* at least three pints of 
 fluid, and only a very small part of the kidney at the lower 
 end retained its natural structure. The bag was of con- 
 siderable thickness, was obscurely laminated, and had a 
 cartilaginous hardness upon its inner surface. It was full 
 of hydatids, which differed very much from each other in 
 their size, some of them being as large as a small orange, 
 and others not larger than the head of a pin. Some of 
 the small hydatids were lodged in little cavities formed in 
 the inner surface of the bag. Their coats were in general 
 easily separable into two laminae, and varied a good deal 
 in thickness in different hydatids. This difference made 
 one hydatid look opaque, while another was transparent. 
 Even in the same hydatid there was often a difference in 
 the opacity, or transparency of its coat at different parts. 
 Some hydatids had, adhering to their inner surface, a 
 cluster of small hydatids, which looked like small pearls ; 
 others had hydatids even of a considerable size floating 
 Z 
 
178 
 
 lobse in their cavity ; and others contained only a fluid* 
 The fluid in many was transparent, but in some hydatids 
 it resembled whey. Some of the small hydatids had fre- 
 quently been passed along with the urine, when the person 
 was alive. It required an increased exertion of the mus- 
 cular power of the bladder to drive them through the 
 urethra, and the bladder, by this exertion, had acquired a 
 stronger muscular coat, as in other cases of obstruction 
 to the free passage of the urine. 
 
 Calculi of the Kidneys. 
 
 The formation of calculi is not peculiar to the kidneys, 
 but it is a more frequent disease in them than in any other 
 part of the body. Small granules of stone are sometimes 
 found in the tubular portion of the kidneys; but it is more 
 common to find a calculus of considerable size lodged 
 either in some part of the substance of the kidney, or 
 in the pelvis of the ureter. 
 
 The last situation is by much the most frequent. When 
 a stone in its situation is so large as not to be capable of 
 passing through the ureter, it is afterwards gradually in- 
 creased in size, from the contact of the urine. In its 
 growth, it necessarily follows the branches of the pelvis, 
 which are called infundibula, and is therefore of an arbo- 
 rescent form. Such calculi vary in their colour and 
 surface ; they are sometimes of a light brown, sometimes 
 of a dark brown, and sometimes of a white colour. They 
 are also sometimes smooth, and sometimes a little rough- 
 ened on their surface. Of the nature of urinary calculi 
 we shall speak afterwards, when we come to take notice 
 of the diseased appearances of the bladder. When a stone 
 hi the pelvis of the ureter has increased to a very consider- 
 
179 
 
 able size, it almost entirely prevents the urine from passing 
 into the ureter. The urine is therefore accumulated in 
 the pelvis above the stone, and hence enlarges the pelvis 
 very much, as well as the cavity in the kidney itself. 
 From the pressure too of the urine behind the stone, the 
 pelvis of the ureter, besides being enlarged, is thrust out 
 from the substance of the kidney. If the interruption to the 
 passage of the urine from the kidney arises from some ob- 
 struction in the lower extremity of the ureter, or at the 
 neck of the bladder, or in any part of the urethra, not only 
 the pelvis of the ureter is then enlarged, but the ureter 
 itself. I have seen the ureters of both kidneys enlarged 
 from this cause to twice or thrice their natural size. 
 
 Whatever be the nature of the obstruction, if the pelvis 
 of the ureter be very much enlarged from the accumulation 
 of the urine, the cavity of the kidney is at the same time 
 enlarged. As this process advances, the substance of the 
 kidney becomes more and more compressed, is gradually 
 absorbed, and its cavity becomes enlarged in proportion. 
 The substance of the kidney is, at length, in a great mea- 
 sure lost, and is converted into a capsule, containing a 
 great many cells, which communicate with each other. 
 The capsule is sometimes very thin, and the whole mass 
 a great deal larger than the natural size of a healthy kidney. 
 It is worthy of remark, that the urine is secreted even 
 when the natural structure of the kidney is almost entirely 
 lost. This is seen both in the derangement of the kidneys 
 now under consideration, and when they are converted 
 into a mass of hydatids. It would appear from this fact, 
 that a very small portion of the natural structure of the 
 kidneys is capable of separating very nearly the ordinary 
 quantity of the urine. 
 
180 
 
 Kidneys earthy and bony. 
 
 The kidneys have been said to be converted into an 
 earthy substance.** A kidney has also been known to 
 become ossified, f Such appearances have never come 
 under my own observation, and I am persuaded are ex- 
 tremely rare. 
 
 Original Varieties in the Kidneys. 
 
 The kidneys are subject to a good deal of variety in 
 their natural circumstances, from original formation. The 
 two kidneys are sometimes found to be joined together: 
 they are sometimes situated before the lumbar vertebras, 
 and sometimes on the sides of the pelvis. They are oc- 
 casionally very small in their size, and the kidney on one 
 side is sometimes wanting ; when this is the case, the size 
 of the other kidney is larger than ordinary. 
 
 It is very difficult to assign a satisfactory reason why 
 there should be such variety in the kidneys; but we 'can 
 see that there is little disadvantage to the animal functions 
 produced by this variety. 
 
 The kidneys are not large in their size, and therefore 
 may be changed in their situation without any sensible 
 inconvenience. As their function is independent of relative 
 situation, it must be precisely the same, wherever the 
 kidneys are placed. 
 
 When the kidneys are small, the secretion of the urine 
 may be very nearly in the common quantity, from a greater 
 activity in carrying on their function; or such persons 
 may be disposed to sweat more than usual, to counter- 
 
 ** Vid. Lieutaud, Tom. I. p. 282. 
 f See Medical communications, Vol. I. p. 416-. 
 
 
181 
 
 balance the deficiency of the urine. We know very well 
 that the secretions of the sweat and the urine are vicarious. 
 When a kidney is wanting, the other being of a large size 
 is probably capable of doing the office of two kidneys. 
 
 Diseased Appearances of the Renal Capsules. 
 
 The renal capsules are scarcely ever found diseased. 
 The dark coloured substance in their centre, which natu- 
 rally has some consistence, is occasionally very soft, so 
 as almost to be fluid. This is probably what is meant by 
 authors, when they say that they have found in the cavity 
 of the renal capsules a fluid like ink. Their description 
 may be considered as being a little exaggerated. 
 
 Abscess in the Renal Capsules. 
 
 The renal capsules are very seldom attacked with in- 
 flammation, and therefore abscesses have very rarely oc- 
 curred in them. There is much variety in the different 
 parts of the body, with regard to their susceptibility of 
 being excited to inflammation. A few cases of abscesses 
 in the renal capsules are related by authors. 
 
 Renal Capsule Scrofulous. 
 
 It has occurred to me to see only one instance of 
 scrofula in the renal capsules. In this case, the renal 
 capsule affected by it was very much enlarged in its size, 
 being nearly as large as a kidney, and was changed into 
 the same kind of white matter, which is observable in a 
 scrofulous absorbent gland. 
 
 The renal capsules have also been observed to be changed 
 into a cartilaginous substance, but this morbid appearance 
 occurs very rarely.* 
 
 * See Dr. Soemmerring's German Translation, p. 170, 
 
182 
 
 Little granules of stone have been found in the sub- 
 stance of the renal capsules.* 
 
 SYMPTOMS. 
 
 When the kidneys are inflamed, more or less pain is felt 
 in the situation of these glands, and the pain commonly 
 shoots along the course of the ureters. There is a sense 
 of numbness in the thigh, and in the male there is often a 
 retraction of the testicle, or a feeling of pain in it. When 
 one kidney is affected, these symptoms are only felt upon 
 that side. The urine is voided frequently, and is some- 
 times of a pale, but more commonly of a deep red colour. 
 The stomach sympathizes with this state of the kidneys, 
 for it is affected with sickness and vomiting : the bowels 
 are at the same time often costive, and subject to colicky 
 pains. These sensations are accompanied with more or 
 less of symptomatic fever. 
 
 When pus is formed by the progress of the inflamma- 
 tion, it may be known by its being mixed with the urine, 
 and this will be more distinctly marked in proportion to 
 the quantity of the pus. 
 
 The symptoms which belong to a scirrhous state of the 
 kidneys are unknown to me, and I do not find that they 
 are distinctly marked by authors. 
 
 * Vid. Lieutaud, Tom. I. p. 286. 
 
183 
 
 There would seem to be no particular symptoms which 
 belong to the formation of hydatids in the kidneys. Pain 
 is commonly felt in the loins during their formation; there 
 has been remarked to be symptomatic fever, nausea, and 
 vomiting: but these symptoms belong also to some other 
 diseases. This disease, therefore, can only be ascertained 
 by hydatids passing occasionally through the urethra along 
 with the urine. In such cases, there must sometimes be 
 a difficulty in making water, from an hydatid interrupting 
 the passage of the urine, either at the neck of the bladder, 
 or in some part of the urethra. 
 
 The symptoms which are produced by calculi irritating 
 the kidneys correspond very much with the symptoms 
 attending the inflammation of these organs. The irritation 
 from calculi, however, may be distinguished from simple 
 imflammation of the kidneys, by these additional symp* 
 toms, viz. by red crystals being often deposited from the 
 urine as soon as it is voided, by blood being sometimes 
 mixed with the urine, and by the pain of the loins being- 
 much increased upon any jolting motion of the body. 
 
 Diabetes is distinguished by the urine being much in- 
 creased beyond the natural quantity, by its being more or 
 less sweet to the taste, and of a colour somewhat re- 
 sembling whey. There is great thirst, and often, although 
 not always, a voracious appetite for food. The pulse is 
 commonly not quicker than natural, and the body becomes 
 at length much emaciated. 
 
184 
 
 CHAPTER XIV. 
 
 DISEASED APPEARANCES OF THE BLADDER. 
 
 Inflammation of the Peritoneal Covering. 
 
 THAT portion of the peritonaeum, which covers a part 
 of the bladder, is not very often inflamed by itself, but it 
 partakes of the inflammation which extends over this 
 membrane generally. The appearances accompanying its 
 inflammation have been already described. Inflammation 
 of the peritonaea! covering of the bladder does not fre- 
 quently extend to its muscular coat. The peritonaeum 
 and the muscular coat of the bladder are but loosely con- 
 nected together, as a considerable quantity of cellular 
 membrane is interposed between them. This loose con- 
 nection is necessary, in order that the peritonaeum may be 
 accommodated to different states of distention of the 
 bladder, and it has also the effect of preventing inflamma- 
 tion from spreading readily from the peritonaea! covering 
 of the bladder to its muscular coat. When the inflam- 
 mation subsides, adhesions are frequently left behind, 
 connecting the bladder more or less to the neighbouring 
 parts; in a female, to the uterus, and in u male to the 
 rectum. 
 
 Inflammation of the inner Membrane. 
 
 The inner membrane of the bladder is occasionally in* 
 flamed. When this happens, the inflammation is some- 
 times extended over the whole cavity, or is sometimes 
 
185 
 
 confined to a particular portion of it. The portion which 
 is most frequently inflamed is that near the neck of the 
 bladder, This may arise from two causes; the one is, 
 that in this situation, or near it, some obstruction is fre- 
 quently found to the passage of the urine, which may 
 produce irritation, and bring on more or less of inflamma- 
 tion; the other is, that inflammations of the urethra occa- 
 sionally extend some way within the cavity of the bladder, 
 and even sometimes over the whole of it. It is well 
 known that the inner membrane of the bladder, in the 
 dead body, hardly shews vessels which are large enough 
 to carry red blood in its natural state: but when it is 
 inflamed, it is crowded with a prodigious number of ex- 
 tremely fine blood vessels, and there may even be some- 
 times seen small spots of extravasated blood. When the 
 inflammation is in a high degree, the muscular coat of the 
 bladder may be affected; but as this is only loosely attached 
 to the inner membrane, the inflammation will not very 
 readily pass from the one to the other. 
 
 Ulcers. 
 
 Inflammation of the inner membrane of the bladder 
 advances sometimes to the formation of pus, and abscesses 
 and ulcers are occasionally produced. These, when the 
 inflammation has been of the common sort, exhibit the 
 ordinary appearances which have often been described. 
 They sometimes advance so far as to destroy a portion of 
 the bladder entirely, and to form communications between 
 it and the neighbouring parts; as with the general cavity 
 of the abdomen, with the rectum in the male, and the 
 vagina in the female. When the communication is formed 
 with the general cavity of the abdomen, the urine escapes 
 
186 
 
 into it, producing there general peritonaea! inflammation, 
 of which I recollect a very striking example.' When the 
 communication is formed with the vagina or the rectum, 
 the urine will escape by these passages, producing in 
 them more or less of irritation and inflammation. 
 
 When abscesses take place in the bladder, they are 
 produced more frequently from local violence, than from 
 a previous spontaneous inflammation. One of the most 
 common causes of violence is the incision of the bladder 
 in the operation of lithotomy. When the part has been 
 very much irritated in the operation, or the constitution 
 is such as to be excited to violent action by the common 
 degree of irritation, an ulcer is formed at the lips of the 
 wound, and spreads more or less into the cavity of the bladder. 
 
 It sometimes happens, although I believe very rarely, 
 that the whole of the inner membrane of the bladder is 
 destroyed by ulceration, and its muscular fibres appear as 
 bare as if they had been nicely dissected. In the case 
 where I recollect this process to have taken place most 
 completely, the bladder, was almost filled with a scrofulous 
 pus. There was a curdly white matter mixed with pus, 
 Xvhich had exactly the same appearance with that formed 
 by the suppuration of a scrofulous absorbent gland. 
 
 Scirrhus and Cancer. 
 
 From the contiguity of the bladder to parts which are 
 very liable to scirrhus or cancer, it sometimes partakes of 
 this disease ; but I do not think that it is often separately 
 affected by it. The disease on some occasions spreads to 
 the bladder from the rectum, and on others from the uterus; 
 under such circumstances the bladder becomes very thick 
 and hard, and exhibits the ordinary cancerous structure. 
 
187 
 
 Communications too are generally formed either with the 
 rectum, the uterus, or the vagina. 
 
 I believe, however, that the bladder has sometimes been 
 independently affected with scirrhus and cancer, and that 
 scirrhous tumours have been formed in its cavity, but, as I 
 have stated above, these morbid appearances are very rare.* 
 
 Fungous Excrescences. 
 
 Sometimes fungous excrescences arise from the inner 
 surface of the bladder, either in one mass, or in separate 
 portions. Upon examination they are found to consist of 
 a loose fibrous structure. When they are situated a little 
 behind the neck of the bladder, which is not uncommonly 
 the case, they must produce a considerable obstruction to 
 the passage of the urine. A stronger action will, therefore, 
 be required in the bladder to expel the urine, and its mus- 
 cular coat will be consequently thickened. Accordingly 
 it is often found thickened in these cases, and it is not 
 improbable that even where the situation of the fungus 
 may not obstruct the passage of the urine into the urethra, 
 its presence may still irritate the bladder, so as to excite 
 it to more frequent and stronger actions than in a natural 
 state, and the muscular coat may become thereby more or 
 less thickened. 
 
 Polypus of the Bladder. 
 
 A polypus sometimes grows from the inner surface of 
 ihe bladder; but this morbid appearance occurs very 
 rarely. I have only seen one example of it, and in this 
 instance it filled up the greater part of the cavity of the 
 bladder. It was very irregular in its shape, consisting of 
 
 * Vid. Portal's Anatomic Medicale, Tom. V. p. 409 and 410, 
 
188 
 
 various projecting masses, and seemed pretty firm in its 
 texture. 
 
 Elongations of the inner Membrane. 
 
 I have also known the inner membrane of the bladder 
 elongated in some parts, so as to form irregular processes. 
 These when cut into, were found to consist of a consid- 
 erable quantity of cellular membrane, intermixed with a 
 little fat. The process producing such an appearance was 
 probably a slow one, and was probably also not attended 
 with pain. If these elongations were to be situated at a 
 distance from the neck of the bladder, they would probably 
 not produce any inconvenience ; but if situated near the 
 neck of the bladder, they might occasion extreme difficulty 
 in making water, and even lay the foundation of a fatal 
 disease. 
 
 Veins of the inner Membrane of the Bladder enlarged^ 
 and varicose. 
 
 Some instances have occurred in which the veins of the 
 inner membrane of the bladder have become enlarged and 
 varicose, similar to the enlargement of the veins of the 
 lower part of the rectum, in piles. This will be most apt 
 to happen were there has been a considerable impediment 
 to the return of the blood by the veins of the bladder, as 
 in cases where the absorbent glands, upon the sides of the 
 cavity of the pelvis, have become much enlarged, or where 
 any tumour has been formed within the pelvis, which has 
 a good deal compressed these veins,* 
 
 * Vid. Portal's Anatomic Medicale, Tom. V. p. 411 
 
,189 
 
 Cysts communicating 'with the bladder. 
 
 Cysts are sometimes found connected very intimately 
 with the bladder, and communicating with its cavity. 
 These in some instances have been observed to be of a 
 large size, being perhaps half as large as the usual size of 
 the bladder itself. There is some difficulty in explaining 
 the manner in which they are formed. If we suppose 
 them to be formed in the cellular membrane, upon the 
 outside of the bladder, it is extremely difficult to explain 
 how they should communicate with its cavity, unless by 
 ulceration, which does not take place. If we suppose 
 them to be pouches from the bladder itself, it is still diffi- 
 cult, in some instances, to explain why they should be 
 formed at all, and why they should arrive at so large a size. 
 The latter supposition, however, seems to be the most 
 reasonable and I am persuaded it will apply to the greater 
 number of cases where such cysts exist. 
 
 Muscular Coat thickened. 
 
 One of the most ordinary changes in the bladder, from 
 its natural structure, is the great thickening of its muscular 
 coat. In a natural state, the muscular coat of the bladder 
 (when it is moderately distended) consists of thin layers 
 of muscular fibres, running in different directions. These 
 are probably, altogether, not more than the eighth of an 
 inch in thickness. The muscular coat of the bladder, 
 however, is occasionally found at least half an inch thick. 
 This arises from an additional quantity of muscle being 
 formed in consequence of extraordinary efforts being 
 necessary in the bladder. These efforts take place when 
 there is any considerable difficulty in making water, as 
 
190 
 
 happens when the prostate gland is a good deal enlarged, 
 when there is a stone in the bladder, or when there are 
 strictures in the urethra. It is usual, therefore, to find 
 this thickening of the muscular coat of the bladder when 
 there is any of these diseases. When the bladder is 
 thickened, the fasciculi of which its muscular coat is com- 
 posed become much larger ; but never, or at least very 
 seldom, acquire the full red colour which muscles of the 
 same size have in other parts of the body. This is a de- 
 viation from the general plan of nature with regard to the 
 increase of muscles from exercise. When muscles are 
 enlarged in size from exercise, they also become of a deep 
 red colour. There is no other instance in the body, as 
 far as I recollect, of a muscle being so much enlarged 
 beyond its natural size, in consequence of increased exer- 
 tion, as the muscular coat of the bladder. 
 
 Between the fasciculi of the muscular fibres, little 
 pouches are formed by the inner membrane. This arises 
 from the pressure of the urine against the inner membrane 
 of the bladder, which is impelled by the strong powers of 
 the muscular coat. These pouches are often large enough 
 to admit the end of the finger, and contain occasionally 
 small calculi. The bladder in this state admits of very 
 little distention, so that it is capable of containing little 
 \vater: hence the inclination to make water is frequent, 
 and frequent efforts of the muscular coat are required, 
 which increase more and more its thickness. It is much 
 more common to find this appearance of the bladder in the 
 male than in the female, because in the latter there are 
 fewer causes to produce it : since in that sex there is a 
 want of the prostate gland altogether, and the urethra being 
 short and wide, obstructions seldom take place in it. When 
 
191 
 
 the muscular coat of the bladder has been thickened, I 
 believe that it has been sometimes mistaken for scirrhus. 
 
 The Bladder divided into two Chambers. 
 
 The urinary bladder has sometimes been observed to 
 be divided into two chambers, which communicate with 
 each other; but this has happened very rarely. I have 
 not had an opportunity myself of examining this singular 
 disease, but I have received an account of such a case 
 from Dr. Ash, which had many years ago fallen under his 
 observation. The upper chamber of the bladder in this 
 case was generally much distended with urine, so that a 
 round tumour could be easily distinguished by the touch 
 above the pubes. When a catheter was introduced into 
 the bladder, a few ounces only of urine came away, and 
 the tumour above the pubes remained the same as before. 
 When the patient stood up, a quart of water sometimes 
 passed away involuntarily, the tumour very much subsided, 
 and the complaint was relieved for the time. After the 
 death of the patient, the bladder was found upon examina- 
 tion to be divided into two chambers by a firm membra- 
 nous substance, and the aperture of communication was 
 almost obliterated. 
 
 There seem to me to be only two ways in which a 
 division of the bladder into two chambers can happen. 
 The one is by a morbid growth of the inner membrane, 
 forming a ridge at some particular part, and at length by 1 
 a continuation of this process, making a septum more or 
 less complete in the bladder I have seen the cavity of 
 the sesophagus very much narrowed at one part by a 
 permanent ridge being formed in its inner membrane. 
 Something of the same kind I have also seen in a parf 
 
192 
 
 of the small intestines. We may therefore readily admit 
 the possibility of a similar process taking place in the 
 inner membrane of the bladder. 
 
 Another way in which the bladder may be supposed 
 capable of being divided into two chambers, is by a very 
 strong contraction of its transverse muscular fibres at 
 some particular part. This will be analogous to the hour- 
 glass contraction of the uterus, which is known occasion, 
 ally to take place. When a complaint of the bladder 
 depending upon its being divided into two chambers has 
 been temporary, it is reasonable to suppose that it has 
 arisen from the last cause; when it has been permanent 
 it is more likely to have arisen from the first. 
 
 Calculi. 
 
 Calculi are not uncommonly found in the bladder, and 
 are confined in their formation to no particular period of 
 of life. They are formed in very young chilclren, and 
 also in persons of middle and advanced age. This disease 
 is nut so frequently met with in the female as in the male, 
 which may depend on two causes; the one is, that there 
 is not so strong a tendency to their formation in that sex ; 
 and the other cause is, that stones escape through the 
 urethra in women, which would be detained in the bladder 
 of men, and lay the foundation there of larger calculi. 
 
 The stones which are found in the bladder, are either 
 originally formed in the kidneys, and pass through the 
 ureters into the bladder, or they are first formed in the 
 bladder itself. When the latter circumstance takes place? 
 the earthy matter is sometimes first deposited round some 
 extraneous body, which becomes the nucleus of the 
 calculus, but most frequently no nucleus, whatever is to 
 
193 
 
 be observed. The nuclei which I have seen, have been 
 small portions off lead (probably broken of from a leaden 
 bougie) small nails, and little masses of hair. In short, 
 any extraneous body which may happen to be introduced 
 into the bladder, may become a nucleus. It is natural to 
 think that such nuclei are more common in the calculi 
 found in the bladder of women than of men, because their 
 urethra is wider and shorter, so that an extraneou s body 
 can be much more easily introduced into their bladder. 
 
 The calculi of the bladder either lie loose in it, or are 
 confined to some fixed situation from particular circum- 
 stances. When they are of a small size, they are sometimes 
 lodged in pouches, or sacculi, formed by the protrusion 
 of the inner membrane of the bladder between the fasciculi 
 of its muscular fibres. A calculus also is occasionally 
 attached to an excrescence of the bladder, so as to be kept 
 in a fixed situation. 
 
 There is frequently one calculus only in the bladder at 
 a time, and then it is usually of an oval form ; but there 
 are often more, and the calculi by rubbing upon each 
 other in a narrow space acquire flat sides and angles. 
 Calculi have sometimes a smooth uniform surface but most 
 frequently the surface is granulated. These granules arc 
 commonly placed very near each other over the whole 
 surface of the calculus, giving it a certain degree of roughness. 
 They are, however, occasionally gathered into clusters on 
 particular parts of the surface of a calculus. These granules 
 are sometimes of a smaller and sometimes of a larger size, 
 and in different calculi are more or less elevated. Some 
 calculi have an irregular porous structure upon the sur- 
 face, instead of being granulated. 
 
 Calculi when divided by the saw, or broken, exhibit 
 
194 
 
 most coitimonly a laminated structure. These laminae 
 are disposed in concentric curves, and are applied together 
 with more or less compactness: in some calculi the laminae 
 adhere together very slightly. They differ in their thick- " 
 ness in different calculi : and the laminated structure 
 sometimes pervades uniformly the whole mass of the 
 calculus ; while at other times different portions of it are 
 interrupted by a coarse porous texture. In some calculi 
 no laminated structure whatever is observable, but it is 
 entirely porous. 
 
 The colour of calculi varies considerably. They are 
 most frequently of a brown colour, which is sometimes 
 of a lighter and sometimes of a darker shade. They are 
 also sometimes of a white, and often of a yellowish colour. 
 It is remarkable, that different portions of the same calculus 
 are frequently of a different colour. Some laminae, for 
 instance, are perfectly white, while the other laminae are 
 brown. In this sort of mixture, I have most commonly 
 found the white laminae on the outside, and the brown 
 laminae in the middle; but this distribution probably 
 varies in different calculi. 
 
 The specific gravity of urinary calculi differs very con- 
 siderably, as they differ a good deal in their compactness ; 
 but they are in general nearly twice the specific gravity 
 of water. 
 
 It is only within a few years that the chemical analysis 
 of urinary calculi has been ascertained with sufficient 
 accuracy, and they have been found to consist of seven 
 species very different from each other. 
 
 The first species is more common than the others, and 
 consists of a particular acid called lithic acid, mixed with 
 some gelatinous matter, and in some instances with a 
 
195 
 
 very small proportion of lime. Its texture is partly lam- 
 inated and partly porous. Its colour is brown, varying 
 a good deal in the depth of its shade, and sometimes with 
 a very slight yellowish tinge. The chemical properties 
 of this species of urinary calculi were first ascertained by 
 Scheele and Bergman. 
 
 The second species is the triple phosphat, which consists 
 of the union of phosphoric acid with magnesia and ammo- 
 nia It has externally a sparkling crystalline appearance, and 
 hardly ever occurs in a pure state; but this triple salt 
 often enters into a composition of other calculi, and more 
 especially into that, which is called the fusible calculus.* 
 
 The third species consists of crystals which are formed 
 by the combination of phosphoric acid with magnesia and 
 ammonia : these are mixed with some phosphorated lime, 
 and generally with some lithic acid. It is of a white colour, 
 is more irregular in its shape than some of the other 
 species and consists partly of a laminated and partly of a 
 porous structure, It is fusible by the blow-pipe, and 
 therefore has commonly been called the fusible calculus. 
 
 The fourth species consists of the acid of sugar 
 and acid of phosphorus united with lime; together 
 generally with some lithic acid in the interstices. This 
 species is knotted on its outer surface somewhat like 
 a mulberry, and from this circumstance it has commonly 
 been called the mulberry calculus. It is of a dark brown 
 colour, and consists of an irregularly laminated structure. 
 The lamina? of which it is composed often vary in their 
 colour, some of them being dark, and others of a white 
 colour. The white laminae are commonly towards the 
 outer part of the calculus, although its colour be dark, 
 
 * See Dr. Marcel's excellent Essay upon Calculcus Disorders, 
 
196 
 
 The fifth species consists entirely of phosphorated lime, 
 and has been called the bone-earth calculus. It is of a 
 light brown colour, and its laminae slightly adhere to each 
 other. For an accurate analysis of these three last species 
 of urinary calculi, we are chiefly indebted to Dr. Wm. 
 Hyde Wollaston. 
 
 The sixth species consists of carbonat of lime, mixed 
 with a little animal matter and water, and was discovered 
 lately by Mr. Crumpton.* 
 
 A seventh species of calculus has lately been discovered 
 by Dr. Win. Hyde Wollaston. He has only met with 
 two instances of it, and therefore it must be considered as 
 being very rare. It resembles the calculus containing 
 the triple phosphate of magnesia: its substance is not 
 distinctly laminated, but rather appears like a mass con- 
 fusedly crystallized. This species of calculus readily 
 unites with acids and alkalies, contains a small proportion 
 of oxygen, and appears to be an oxyd of a peculiar kind. 
 Dr. Wollaston has given it the name of the cystic oxyd.f 
 
 Not unfrequently a calculus shall consist of some 
 of the different species above described, arranged in 
 alternate strata : and sometimes it shall consist of the in- 
 gredients of different species of calculi combined together 
 without, or with very little distinct appearances of stratifi- 
 
 cation.J 
 
 The matter of calculus in the bladder is generally formed 
 into one or more circumscribed masses, yet it sometimes 
 happens that the whole bladder is filled with a substance 
 like mortar. Of this I recollect one striking example ; 
 
 * See Thompson's System of Chemistry, Vol. 4, page 671. 
 
 jSec Philosophical Transactions, Part 2. 1810. 
 
 tSee Dr. Marcel's Essay upon Calculous Disorders, p, 88 and 90. 
 
197 
 
 the earthy matter in this case could not be entirely removed 
 from the bladder, but a great many small irregular portions 
 still adhered to the sides of its cavity. Within the last 
 three years I have met with another instance in which the 
 matter of calculus put on the appearance and consistence 
 of mortar, but was in small quantity. It was connected 
 with a chronic inflammation of -the inner membrane of the 
 bladder, and processes of coagulable lymph attached to 
 the inner membrane were encrusted with the calculous 
 matter. This disease had continued for many years, and 
 was combined with stricture of the urethra. 
 
 Bladder distended. 
 
 In opening dead bodies, the bladder is occasionally 
 found to be very much distended, and to occupy the 
 lower part of the cavity of the abdomen. This might 
 arise from some accidental circumstance of the water being 
 accumulated, while the muscular coat of the bladder still 
 possessed its proper powers ; or the muscular coat of the 
 bladder may have been paralytic, and therefore not capable 
 of expelling the water. 1 do not think it is possible to 
 discriminate between these two different cases by any 
 examination after daath, but they can always be ascertained 
 by a careful inquiry into their history. 
 
 Bladder contracted. 
 
 The bladder is also found contracted to such a degree 
 as hardly to have any cavity. This is sometimes not to 
 be considered as a disease, but simply as having arisen 
 from a very strong action of the muscular coat of the 
 bladder previously to death. 
 
 Not unfrequently when the inner membrane of the 
 
198 
 
 bladder has been long in an irritable state, the muscular 
 part of it from the habit of contracting upon small quanti- 
 ties of urine, looses the power of being distended, and 
 remains more or less permanently contracted. 
 
 The anterior Part of the Bladder wanting. 
 
 The anterior part of the bladder is occasionally wanting, 
 and instead of it there is a very soft vascular flesh, situated 
 externally at the lower part of the abdomen. This soft 
 vascular flesh is usually formed into irregular projecting 
 masses, and in the living body is covered with a thick 
 ropy mucus. The two ureters open somewhere upon 
 this vascular flesh, distilling gradually the urine upon its 
 surface, which the mucus is intended to protect against 
 the stimulus of that fluid. When there is such a forma- 
 tion of the bladder, I believe that there is always a de- 
 ficiency of the bone at the symphysis pubis, and also a 
 monstrous formation of some of the organs of generation. 
 This species of monstrosity I have described at large in 
 the Medical and Chirurgical Transactions.* 
 
 77ze Bladder and the Rectum communicating from 
 original Malformation. 
 
 Another kind of monstrous formation in the bladder 
 occasionally happens, viz. that at its depending part there 
 is a communication between it and the rectum, the latter 
 being continued into the former. Of this I have seen one 
 instance; and it has been already taken notice of, when 
 treating of the diseased and preternatural appearances of 
 the intestines. 
 
 * See Medical and Chirurgical Transactions, Vol. I. p. 189. 
 
199 
 
 Hernia of the Bladder. 
 
 The bladder, or a portion of it, has been known to 
 protrude as a hernia through the abdominal ring, or under 
 Paupart's ligament. As the anterior part of the bladder, 
 which has no peritonaea! covering, protrudes first, the 
 hernia is not contained in a hernial sack. If the hernia 
 be large, the bladder drags down a portion of peritonaeum, 
 forming a true hernial sack above it, but still the bladder 
 is on the outside of the sack.* 
 
 SYMPTOMS. 
 
 In inflammation of the bladder, a pain is felt in the 
 perinseum, or above the pubes, accompanied with a 
 fullness or a swelling there. There are frequent attempts 
 to make water, which is evacuated in small quantity and 
 with great pain; or there is a total retention of the urine, 
 with a strong desire to void it. The rectum is affected 
 from its connection with the bladder, and is excited to 
 tenesmus. The stomach likewise takes a part in the 
 disease, and is affected with sickness and vomiting. In 
 some cases there is delirium. When pus has been formed 
 in consequence of the inflammation, it is known by being 
 mixed with the urine which is evacuated. 
 
 When the bladder has become affected by an ulcer 
 spreading to it from the neighbouring parts, it may be 
 
 suspected by the pain and difficulty which occur in 
 
 i 
 
 * See Pott oi\ Ruptures, p. 226. 
 
making water. When the ulcer has made further progress, 
 and a communication has thereby taken place between the 
 bladder and the uterus, or between the bladder and the 
 vagina, or between the bladder and the rectum, it may be 
 distinguished by the urine passing either through the 
 vagina or the anus, attended with pain and irritation; or 
 by air, or by feculent matter occasionally passing through 
 the urethra. 
 
 When two chambers are just beginning to be formed 
 in the bladder, very little inconvenience is probably felt, 
 because the communication between them at this time 
 is very large. Under such circumstances it seems hardly 
 possible to detect the nature of the disease in the living 
 body; but when the disease has made a considerable 
 progress, and the communication between the two 
 chambers has become very narrow, it may be ascertained, 
 or at least conjectured about with great probability, from 
 the following circumstances. There will then be a con- 
 siderable circumscribed tumour above the pubes in the 
 situation of the bladder when distended, much less urine 
 will be made than the natural quantity, and the tumour 
 will not be sensibly lessened by it; or if a catheter be 
 introduced, little urine will be evacuated, and the tumour 
 above the pubes will still remain the same. But it will 
 occasionally happen, by some particular attitude of the 
 body, that the urine will pass from the upper chamber of 
 the bladder ii)to the lower, and from this it will be 
 evacuated by the urethra; under such circumstances there 
 will be a much larger quantity of urine made than usuaL 
 
201 
 
 the tumour above the pubes will disappear, and the patient 
 will receive immediate relief, which will continue till there 
 is another accumulation of urine. 
 
 The existence of fungous excrescences from the inner 
 surface of the bladder may probably be ascertained in some 
 instances during life by the introduction of a catheter, but 
 in general we cannot be certain of the real nature of the 
 disease till the parts are examined after death* When the 
 excrescence is situated near the neck of the bladder, there 
 will be more or less difficulty of voiding the urine. In 
 other instances the patient makes water at short intervals; 
 and often feels the desire, and strains in order to make 
 water when there is little or none in the bladder. The 
 urine is frequently tinged with blood. But these symp- 
 toms are common to this and other diseases, and the 
 symptoms alone do not therefore furnish us with any 
 certain marks by which the disease may be distinguished. 
 
 The symptoms which belong to a polypus formed in the 
 bladder are unknown to me; but they are probably much 
 the same with those which attend fungous excrescences 
 in the bladder. 
 
 The symptoms which attend calculi in the bladder are 
 well known. There is an uneasy sensation at the orifice of 
 2C 
 
202 
 
 the urethra after making water, or after exercise. When 
 the calculus is large, a dull pain is generally felt at the 
 neck of the bladder. The attempts to tnake water are 
 frequent, and it often passes drop by drop, or the stream 
 is suddenly interrupted. The urine deposits a large pro- 
 portion of a mucous sediment, which is produced by the 
 mucous glands at the neck of the bladder being irritated 
 by the calculus to an increased secretion. The urine is 
 also occasionally tinged with blood, from some small blood 
 vessels being ruptured by a rough part of the stone, and 
 this is most apt to happen after some jolting motion. 
 There is tenesmusj in consequence of the connection of 
 the rectum with the bladder, and the sympathy which has 
 been established between their respective functions. 
 
 When the calculous matter is soft, resembling mortar, 
 there is great pain and difficulty in making water, which 
 is voided frequently, and in small quantity ; portions of 
 this matter are occasionally discharged, along with the 
 urine, and generally mixed with a ropy mucus tinged 
 with blood. 
 
203 
 
 CHAPTER XV. 
 
 DISEASED APPEARANCES OF THE VESICULjE 
 
 SEMINALES. 
 
 THE diseased appearances of the vesiculse seminales 
 are but little known, because from their situation these 
 bodies cannot be seen without a good deal of dissection ; 
 whereas many of the viscera come immediately into view, 
 when the cavity in which they are lodged is simply laid 
 open : diseased appearances, however, have been occasion- 
 ally observed in the vesiculse seminales. 
 
 
 Vesiculte Seminales inflamed. 
 
 It has never occurred to me to observe the vesicular 
 seminales inflamed by themselves, although they are, doubt- 
 less, liable to this disease, like other parts of the body. 
 I have seen them, however, involved in the natural conse- 
 quences of inflammation with the surrounding parts. 
 Thus I have seen the posterior surface of the bladdre, 
 the vesiculse seminales, and a portion of the rectum ad- 
 hereing with unusual firmness together, in the same manner 
 as other parts of the body do after inflammation. Some 
 few instances, however, have occurred, in which so great 
 an inflammation had been e^xcited in the vesiculse seminales$ 
 as to terminate in suppuration.* 
 
 * See Dr. Soemm.erring's German Translation, p. 194r 
 
204 
 
 Vesiculae Seminales scrofulous. 
 
 The vesiculae seminales are also affected with scrofula. 
 I recollect to have seen one of the vesiculse seminales 
 filled with true scrofulous matter, the distinguishing cha- 
 racteristic of which has been often mentioned. 
 
 Ducts of the Vesicults Seminales terminating in a Cul-de-sac. 
 
 The ducts ofthe vesciulae seminales open naturally by two 
 distinct orifices into the cavity of the prostate gland, but 
 they are occasionally wanting, and the vesiculae seminales 
 terminate in a cul-de-sac. The vasa differentia are at the 
 same time without their natural termination, for they end 
 in the cul-de-sac of the vesiculae seminales. This is a 
 species of monstrosity which is very rare, but it is of great 
 consequence, because it prevents the semen from passing 
 into the urethra, and frustrates one of the most important 
 functions in the animal economy. An instance of this 
 sort of malformation is preserved in Dr. Hunter's collection. 
 
 Seminales very small. 
 
 The vesiculae seminales differ a good deal in their size 
 in different adult bodies, and indeed it is very common for 
 the one to be considerably smaller than the other; but I 
 have oftener than once seen both of them so small that they 
 must have been very little able to fulfil the intentions for 
 which they were formed. 
 
 One ofthe Vesiculte Seminales wanting. 
 
 One of the vesiculae seminales is occasionally wanting 
 altogether. Under such circumstances I believe that the 
 extremity of the vas deferens upon that side is generally 
 
205 
 
 enlarged and tortuous, becoming a sort of substitute for 
 it. This was at least the case in the instance which I 
 have seen of this mode of formation. The extremity of 
 the vas deferens has at all times a structure similar to that 
 of the vesicular seminales, and renders therefore this con- 
 jecture very probable. 
 
 Seminales scirrhous. 
 
 The vesicular seminales have also been observed to be 
 scirrhous; but this is very uncommon,*' 
 
 Small stones have also been seen in the vesiculae sem- 
 inales, but they have not fallen under my own observation ; 
 and they are of very rare occurrance.f 
 
 SYMPTOMS. 
 
 The symptoms which attend diseases of the vesiculce 
 seminales, have not been attempted to be discriminated 
 by authors, and must, from circumstances, be very difficult 
 to ascertain. It has only occurred to myself to observe 
 some diseased changes of them in the dead body; and I 
 have had no opportunity of tracing the symptoms which 
 accompany these changes during life. 
 
 * See Morgagni, fipist. XL VI. Art. 5. 
 
 See Soemmerring's Germ. Translat. p. 193. 
 
206 
 
 CHAPTER XVI. 
 
 DISEASED APPEARANCES OF THE PROSTATE GL 
 
 Abscess in the Prostate Gland. 
 
 THE prostate gland is not often found in a state of 
 common Inflammation. I have seen, however, an abscess 
 in it, without any uncommon thickening and enlargement 
 of the gland, and where- the pus appeared to be of the 
 common sort. This must be considered as being a 
 common abscess, and must have been preceded by the 
 ordinary sort of inflammation. 
 
 Scrofula of the Prostate Gland. 
 
 The prostate gland is sometimes scrofulous. I have 
 seen, in cutting into it, precisely the same white curdly 
 matter, which is formed in a scrofulous absorbent gland. 
 In squeezing it also, I have forced out from its ducts a 
 scrofulous pus. 
 
 Scirrhus of the Prostate Gland. 
 
 The most common disease of the prostate gland is a 
 scirrhous enlargement of it. The prostate, gland, it is 
 well known, is naturally about the size of a large chesnut, 
 but when it is affected with scirrhus, it is often enlarged to 
 the size of the fist. In this enlarged state, when cut into, 
 it exhibits a very solid, whitish, or brown substance, with 
 membranous septa running through it in various directions, 
 which are, often very strongly marked. This is the com- 
 mon appearance of scirrhus in other parts of the body. 
 
207 
 
 When the prostate gland is a good deal enlarged, 
 cavity becomes deeper from the growth of its sides, and 
 the posterior extremity forms a considerable projection 
 into the cavity of the bladder, which interrupts the passage 
 of the urine into the urethra.* According to the degree 
 of this projection, the urine is passed with greater or less 
 difficulty, as well as an instrument for drawing it off. 
 When the projection is very great, it has sometimes been 
 found impossible to pass an instrument over the projection, 
 and an artificial passage has been made through it acci- 
 dentally, by which the urine has been evacuated. Under 
 such circumstances the gland has been known not to be 
 irritated by the violence used in making this new passage, 
 and life has been prolonged for a greater length of time 
 than it would have been otherwise. Still, however, the 
 instrument ought to be made to pass over the projection, 
 if possible; and we should never run the risk, by injuring 
 the gland, of bringing on immediately fatal consequences. 
 Sometimes in the progress of the enlargement the 
 prostate gland grows irregularly, and a winding passage 
 is formed through it, by an alteration in the shape of its 
 cavity. This increases the difficulty to the patient of 
 making water, and to the surgeon of introducing an in- 
 strument. When the prostate gland is enlarged, its 
 internal surface is sometimes ulcerated, but commonly it 
 is not.-f Fistulous communications are sometimes formed 
 
 * Sir Everard Home has lately discovered that this posterior projection is 
 owing to the enlargement of a small separate lobule of the prostate gland, not 
 hitherto known. 
 
 | Although I hav.e given the name of scirrhus to this affection of the prostate 
 gland from its hardness, and the similarity of its structure to that of scirrhus 
 in some other glands, yet it would seem to be essentially different from it 
 This disease has little or no disposition to run into ulceration, and it is capabl.- 
 of subsiding, which would not be the case if it were a true scirrhus. 
 
208 
 
 between an enlarged prostate gland and the rectum. Both 
 of these effects are generally produced by an uncautious 
 introduction of catheters or bougies. 
 
 It is obvious too, from what has been mentioned, that 
 in an enlarged state of the prostate gland, the 'difficulty of 
 making water must be very great. This difficulty excites 
 extraordinary and very frequent efforts in the bladder to 
 overcome it. Its muscular coat becomes consequently 
 much stronger and thicker, than in the natural state. A 
 prostate gland therefore, is never found enlarged to any 
 considerable degree, without the bladder having undergone 
 this change in its muscular coat. This disease is hardly 
 ever to be found in a young person, but is not at all un- 
 common at an advanced period of life. 
 
 Calculi in the Ducts of the Prostate Gland. 
 
 There is another disease of the prostate gland, which 
 occasionally takes place, although it is by no means so 
 frequent as the former, viz. a formation of small calculi, 
 which are lodged in its ducts. They are usually of the 
 size of a small pea, and those which I have seen have been 
 of a brown colour, which is lighter or darker in its shade. 
 They have been found by Dr. Wm. Hyde Wollaston to 
 consist of phosphorated lime in the state of neutralization. 
 
 Ducts of the Prostate Gland enlarged. 
 
 The prostate gland is sometimes seen with its cavity 
 very much widened, and its ducts enlarged. In the 
 natural state of the gland, the orifices of its ducts can 
 hardly be seen, but they sometimes are so much enlarged, 
 as to be capable of admitting a crow quill. When the 
 ducts are so enlarged, there is always a great obstruction 
 
209 
 
 .4o the passage of the urine through the urethra, arising 
 most commonly from stricture there. The urine, either 
 passing in very small quantity, or being entirely prevented 
 from passing, is accumulated in the cavity of the prostate 
 gland and the bladder. The effect of this accumulation 
 is, that the cavity of the prostate gland is widened, and 
 the ducts very much enlarged. The bladder too, from 
 making extraordinary efforts to overcome the obstruction % 
 has its muscular coat gradually thickened, and often to a 
 very considerable degree. Attending, therefore, this state 
 of the prostate gland there is a thickened bladder, and 
 an obstructed urethra. 
 
 The Prostate Gland pretcrnaturally small. 
 
 I have also seen the prostate gland of an extremely 
 small size, so that it could hardly be considered as being 
 fit for its office. It was attended with a monstrous for- 
 mation of the urinary bladder and some of the organs of 
 generation, and has been particularly described by me in 
 the Medical and Chirurgical Transactions.* 
 
 SYMPTOMS. 
 
 The symptoms which attend inflammation of the pros- 
 tate gland have been little taken notice of by authors. It 
 is reasonable to think, that there will be a sense of paia 
 more or less acute at the neck of the bladder, with much 
 difficulty in making water, or a complete obstruction to 
 
 *See page 194, Vol. I. 
 
 2D 
 
210 
 
 this evacuation, and probably tenesmus. This disease 
 may be distinguished from a scirrhous enlargement of 
 the prostate gland, by its quick progress, and by the 
 pain which is felt in it. 
 
 When the prostate gland is affected with scrofula, little 
 inconvenience is probably felt at an early state of the 
 complaint; but if the gland should increase very consid- 
 erably in its size, those symptoms must necessarily arise 
 which depend upon its enlargement, and which are just 
 about to be mentioned. 
 
 When the prostate gland becomes enlarged from 
 bcirrhus, there is a difficulty in voiding the urine, and 
 a small quantity only is discharged at a time, so that 
 the bladder is kept always nearly full. There is some- 
 times a total inability to evacuate the urine. In some 
 cases the fasces are passed with difficulty, and when the 
 operation is over, there is still a feeling of something 
 more to be discharged. The straining which attends the 
 evacuation of the urine and the fasces not unfrequently 
 forces out mucus, which has been secreted by the gland. 
 A bougie or catheter is either passed into the bladder 
 with difficulty, or on some occasions is not capable of 
 toeing passed at all. 
 
Calculi occur so rarely in the prostate gland, that their 
 symptoms have been little taken notice of by authors. 
 When the calculi are very small, so as to be confined 
 entirely within the ducts of the prostate gland, it is prob- 
 able that little inconvenience is produced by them. When 
 they are larger, and form a projection into the cavity of 
 the prostate gland, there must necessarily be difficulty in 
 voiding the urine, and there will be the same feeling 
 when a sound or catheter is attempted to be passed into 
 the bladder, as if an urinary calculus had got fixed or 
 impacted into the neck of the bladder. 
 
CHAPTER XVIL 
 
 DISEASED APPEARANCES OF THE URETHRA. 
 
 Abscesses. 
 
 ABSCESSES are occasionally formed in the membranous 
 part of the urethra. These may arise from an inflam- 
 mation, produced by some latent cause, as abscesses are 
 formed in any other part of the body; but they happen 
 most frequently from an obstruction to the passage of 
 urine through the urethra. This obstruction is produced 
 generally by a stricture in some part of this canal, and 
 most frequently it is at or near the bulb of the corpus 
 spongiosum urethrae. The urine being forced by the 
 efforts of the bladder behind the stricture, irritates that 
 part, producing inflammation and suppuration ; the abscess 
 breaks externally, and the urine is evacuated by this 
 opening. 
 
 Fistula. 
 
 While the obstruction in the urethra continues, the 
 opening made by the breaking of the abscess is not dis- 
 posed to heal up, but a fistulous orifice is gradually form- 
 ed. This is surrounded with parts somewhat thickened 
 and hard, as fistulse are generally. The most common 
 situation for these fistulous openings is behind the scrotum, 
 because the most common situation of the stricture is / 
 at or near the bulb of the corpus spongiosum urethrae. 
 Not uncommonly there are more tha one of these 
 
213 
 
 openings, leading to short canals which run in different 
 directions. 
 
 Stone in the Cavity of the membranous Part of the Urethra. 
 
 The cavity of the membranous part of the urethra I 
 have seen distended into a bag large enough to contain a 
 hen's egg. This bag was occasioned by a large stone 
 having lodged there. The stone had probably been 
 driven intp the cavity of the membranous part of the 
 urethra, by the stream of urine from the bladder, but was 
 too large to pass by the same means through the whole 
 length of the urethra; it therefore stuck in that situation, 
 and was gradually increased to the size which we have 
 described, by the contact of the urine, similar to the 
 growth of a stone in the pelvis of the ureters. 
 
 Cjotvper's Glands seldom observed to be diseased. 
 
 I d#; not recollect to have seen Cowper's glands 
 diseased, which are situated near this part of the urethra. 
 They are doubtless liable to changes from disease, like 
 other parts of the body ; but they are small and difficult 
 of access, so that they have very seldom become an object 
 of examination. 
 
 Morgagni mentions one of them being converted into 
 a ligamentous substance;* and the excretory duct of one 
 in another instance being obliterated.! 
 
 Inner Membrane of the Urethra inflamed. 
 
 The inner membrane of the urethra is very liable to be 
 inflamed, particularly at its anterior extremity, and the 
 
 * See Morgagni, Epist. XLIV. Art. 3. 
 | See Morgagni, Epist. XUY. Art. 12, 
 
214 
 
 inflammation occasionally spreads over the whole extent 
 of the canal. This exhibits no appearance different from 
 the inflammation of membranes lining secretory canals 
 which open externally. The membrane is much more 
 crowded with small blood vessels than in a natural state, 
 and there is an increased secretion of the glands which 
 open upon it. The inflammation is often not confined to 
 the inner membrane of the urethra, but spreads into the 
 substance of the corpus spongiosum, affecting both its 
 cellular structure and its glands. Under these circum- 
 stances the corpus spongiosum is enlarged and harder 
 from the extravasation of the coagulable lymph into its 
 cells, and is more vascular than in a natural state. The 
 glands being increased in size from the inflammation, 
 become sensible to the touch, like very small rounded 
 tubercles. 
 
 Ulcers in the Urethra. 
 
 Ulcers are also seen occasionally in laying open the 
 Urethra, but these are not frequent. This canal when 
 inflamed has little disposition to ulcerate, as happens also 
 to some other canals in the body, as for example the 
 trachea. 
 
 Stricture. 
 
 The most ordinary diseased appearance of the urethra 
 is stricture. This consists in a part of the canal being 
 narrowed, or perhaps altogether obliterated. It may take 
 place in any part of the canal, but it is most frequent at or 
 near the bulb of the corpus spongiosum urethrae. This 
 stricture sometimes consists simply of an approximation 
 of the opposite sides of the canal, so as to form a line of 
 
215 
 
 obstruction; at other times the canal is narrowed for sonfe 
 length. The inner membrane at the stricture, sometimes 
 exhibits the natural appearance; sometimes it is a little 
 thickened, and occasionally its surface is abraded or 
 ulcerated. These two last effects are generally produced 
 by bougies; and sometimes false passages have been made 
 into the corpus spongiosum urethrse, in consequence of 
 employing too much violence in the use of this instrument. 
 There is often more than one stricture in the same urethra. 
 It sometimes happens too that the stricture is more on one 
 side of the canal than the other, so that the passage there 
 is crooked. 
 
 Caruncle. 
 
 A small fleshy excrescence sometimes grows in the 
 .urethra. This is called a caruncle, and used formerly to 
 be considered as the most common ca.use of obstruction 
 in this canal; but since dissections of dead bodies have 
 become more frequent, it has been found in reality to be 
 very rare. 
 
 Enlargement of the Mucous Glands of the Urethra. 
 
 Not unfrequently one of the small mucous glands of the 
 urethra becomes enlarged and hard from inflammation, 
 making a tumour of the size of a pea, or bigger, which 
 projects towards the canal of the urethra, and narrows its 
 diameter. This is usually the consequence of gonorrhoea, 
 but it may arise from inflammation brought on by the 
 improper use of bougies, or in any other way. < 
 
 A layer of earthy Matter in the Urethra. 
 I have known one instance of a thin laver of earthv 
 
216 * 
 
 matter extending from the bladder through the whole 
 Jength of the urethra. 
 
 Preternatural Orifice of the Urethra. 
 
 The urethra sometimes does not open at the projecting 
 extremity of the glans penis, but under it, where the 
 the frasnum is naturally situated; and in such cases there 
 is no fraenum. It consists of a small rounded opening, 
 much less than the natural termination in the glans. I 
 have known an instance in this structure of parts, of a 
 canal being formed besides the urethra, about two inches 
 in length, which terminated at one extremity in a cul-de- 
 sac, and at the other opened on the glans, where the 
 urethra commonly does. How far this variety may be 
 frequent, I cannot pretend to determine. This deviation 
 in the structure is not to be considered as a disease, but 
 simply as a malformation of parts, and is not attended with 
 any material inconvenience, as far as I know. 
 
 There are some other diseased appearances of the penis, 
 such as ulcers, phymoses, paraphymoses, &c. These are 
 external, are much more commonly met with in the living, 
 than Jn the dead body, and are very well known; I shall 
 therefore omit them entirely. 
 
 SYMPTOMS. 
 
 The symptoms which attend the inflammation of the 
 inner membrane of the urethra, are too well known to 
 require being mentioned. 
 
217 
 
 In stricture of the urethra there is difficulty in making 
 water, which is greater or less according to the degree of 
 the stricture; the stream of urine is small, sometimes 
 forked, sometimes scattered, and sometimes the urine 
 passes away in drops only. There is frequently also an 
 increased secretion of mucus from the urethra, resembling 
 a gleet. Various other symptoms may take place, in 
 consequence of the parts in the neighbourhood of the 
 stricture being affected; and even the constitution is 
 sometimes much disturbed by this local irritation, ex- 
 hibiting very different symptoms in different individuals. 
 
 When the urethra is obstructed by the growth of a 
 caruncle, no symptoms are known by which it may be 
 distinguished from a case of common stricture. 
 
CHAPTER XVIII. 
 
 DISEASED APPEARANCES OP THE TESTICLES, AN/> 
 THE SPERMATIC CHORD. 
 
 Hydrocele. 
 
 HYDROCELE, or a collection of water in the tunica 
 vaginalis testis, is a very common disease, and is confined 
 to no particular period of life. It is not unfrequent in very 
 young children, and in them, most commonly disappears 
 without any chirurgical treatment. The bag in which the 
 water is accumulated is of a pyramidical shape, and 
 approaches more or less towards the ring of the abdominal 
 muscle, according to the degree of accumulation. It some- 
 times extends almost to the ring itself. The bag is also 
 more or less thick in different cases : it is often scarcely 
 thicker than the tunica vaginalis in its natural state ; some- 
 times, when the accumulation is large, it is three or four 
 times as thick, and is obviously laminated. In such cases 
 too the testicle is a good deal compressed, and has some- 
 times been known to waste in consequence of this com- 
 pression. The fluid which is accumulated is of a yellow- 
 ish, a greenish, or brown colour, and resembles in its 
 properties the serum of the blood. This disease, in persons 
 who are advanced in life, is sometimes combined with a 
 scirrhous state of the testicle, which will be afterwards 
 particularly described. 
 
 In almost all cases of hydroccle the water is contained 
 in one bag, but in a few instancea it has been known to 
 
219 
 
 be contained in several cysts. Of this I recollect a re- 
 markable example which occurred a few years ago. This 
 variety is probably produced by repeated partial inflamma- 
 tions on the inner surface of the tunica vaginalis, and 
 occasioning adhesions, which put on the appearance 
 of cysts. 
 
 Hydatids. 
 
 Hydatids have sometimes been found in the cavity of 
 the tunica vaginalis testis, either loose or adhering; they 
 are, I believe, not very uncommon, but I have had no 
 favourable opportunity of examining them accurately. 
 
 Loose Cartilages in the Tunica Vaginalis Testis* 
 
 Small cartilages are sometimes found loose in the cavity 
 of the tunica vaginalis testis, as in some of the joints in 
 the body, more especially the knee joint. They do not 
 however occur in the former so frequently as in the latter. 
 They must once have been attached to some part of the 
 inner surface of the tunica vaginalis testis, by very small 
 processes or peduncles, and by the motion of this tunic 
 upon the testicle they must have been separated. They 
 afterwards continue to lie loose in the cavity of the tunica 
 vaginalis testis, and are, I believe, attended with no in- 
 convenience. An example of this kind has been seen by 
 myself, and it has not unfrequently been observed by 
 others. 
 
 Adhesions. 
 
 The tunica vaginalis is frequently found adhering to the 
 surface of the testicle. The adhesion is sometimes ex- 
 tended over the whole surface, but frequently consists 
 
220 
 
 only of scattered processes of membrane. The adhesions 
 are sometimes fine, but sometimes they have considerable 
 thickness, and connect the tunica vaginalis to the body 
 of the testicle more or less closely in different cases. They 
 are produced by some previous inflammation in the 
 tunica vaginalis testis, as adhesions are formed after in- 
 flammation in the cavity of the chest, or the belly. 
 
 Testicle inflamed. 
 
 The substance of the testicle itself is frequently in- 
 flamed, but this disease is commonly removed by art, 
 and hardly ever becomes an object of examination after 
 death. It exhibits, however, precisely the same ap- 
 pearances as the inflammation of the substance of other 
 parts, and therefore does not require to be particularly 
 described. When the testicle is inflamed, the vas de- 
 ferens sometimes partakes of the inflammation, its coats 
 becoming considerably thickened, and in some instances 
 the veins of the spermatic chord becoming varicose.* 
 After the inflammation of the testicle has subsided, it is 
 not unusual for a hardness and fullness of the epididymis 
 to remain for a considerable length of time, or even 
 through life. This depends on the matter which had 
 been extravasated during the inflammation, not being 
 afterwards entirely absorbed. 
 
 Abscesses of the Testicle. 
 
 Abscesses too are occasionally formed in the testicles, 
 from the progress of common inflammation, and are 
 attended with the same circumstances as abscesses in 
 other parts. 
 
 * See Mr, Hunter on the Veneral Disease, p. 54, 
 
221 
 
 Testicle scrofulous. 
 
 The testicle is sometimes completely changed from its 
 natural structure, and converted into a truly scrofulous 
 mass. Upon such occasions it is generally enlarged, and 
 when cut into shews a white, or yellowish-white, curdly 
 substance, which is sometimes more or less mixed with pus. 
 
 Testicle enlarged and pulpy. 
 
 The testicle is sometimes much enlarged, and converted 
 into an uniform, pulpy matter, in which its natural struc- 
 ture is entirely lost. This sort of change has been some- 
 times mistaken for scirrhus, but it is very different from 
 what is called scirrhus in other parts of the body, and 
 what is also found in the testicle itself. 
 
 Scirrhus and Cancer of the Testicle. 
 
 The testicle is also found much enlarged, and changed 
 into a hard mass, which is generally more or less intersec- 
 ted by membranes. In this there is no vestige of the 
 natural structure, but cells are frequently observable in 
 it containing a sanious fluid, and sometimes there is a 
 mixture of cartilage. This state of the testicle I consider 
 as the true scirrhus, and according to the progress of the 
 disease, the epidydimis and the spermatic chord are more 
 or less, or not at all, affected. This disease not unfre- 
 quently advances to form a foul deep ulcer with thickened 
 edges, or throws out a fungus, and then it is called the 
 true cancer of the testicle. 
 
 Testicle cartilaginous* 
 The testicle I have seen much enlarged and changed 
 
222 
 
 into a mass of cartilage. There was also in the case to 
 which I allude, an ulcer near the centre of the cartilage, 
 and in some places an imperfect appearance of cysts, or 
 cells. The cartilage did not seem different in any essential 
 property from common cartilage, but was a little softer. 
 This I consider as depending upon the same general 
 diseased process with the scirrhus just described, for 
 sometimes both structures are blended together in the 
 same testicle. 
 
 Testicle bony. 
 
 . The testicle is sometimes converted into bone. A 
 few instances only of this disease have fallen under my 
 observation, and in them the bony process had not exten- 
 ded over the whole substance of the testicle, but had 
 affected it partially. 
 
 A Cyst adhering to a Testicle containing a Vena Medinensis. 
 
 I have seen a testicle with a small firm cyst adhering 
 to it, which contained a worm of that sort called vena 
 medinensis. This is a worm of considerable length, with 
 a smooth surface and an uniform appearance ; at the pos- 
 terior extremity it terminates in a slender hook-like process, 
 and at the anterior there is a rounded opening or mouth. 
 This testicle had probably belonged to a man who had 
 visited some of those climates in which the vena medinen- 
 sis is found, and who had brought it over with him to 
 this country. 
 
 The Epididymis ending in a Cul-de-sac. 
 
 The testicles have sometimes this sort of mal-formation, 
 that the epididymis does not terminate in a vas deferens, 
 
223 
 
 but in a cul-de-sac. In these cases it is evident that the 
 semen cannot be evacuated by the urethra, and that the 
 person must therefore be incapable of procreation. In 
 Dr. Hunter's collection, a preparation of this sort is pre- 
 served ; and Mr. Hunter has given a representation of 
 it in his book upon the Animal Economy.* 
 
 Stricture of the Fas Defer ens. 
 
 I have also seen a portion of the canal of the vas deferens 
 obliterated by stricture. This had not been an original 
 fault, but was the effect of a diseased process, similar, 
 probably, to that which produces stricture in the urethra, 
 and must have prevented the semen of one of the testicles 
 from reaching the cavity of the prostate gland. 
 
 Testicles very small, and wasted 
 
 The testicles are sometimes exceedingly small in their 
 size. I have known one case, in a person of middle age, 
 where each of them was not larger than the extremity of 
 the finger of an adult. This, as appeared from its history, 
 arose from a fault in the original formation, and was 
 attended with a total want of the natural propensities. It 
 is much more common for a testicle to waste either 
 spontaneously, or in consequence of a previous inflam- 
 mation, or compression, so as gradually to disappear 
 entirely, f 
 
 Sometimes one testicle, and sometimes both, remain 
 in the cavity of the abdomen through life, so that a person 
 appears to have only one testicle, or to be without them 
 altogether. The testicle or testicles, I believe, are in 
 
 * See page 47, plate V. 
 t See Hunter on the Venereal Disease* p, 209. 
 
224 
 
 these cases of a small size; and Mr. Hunter suspects that 
 they are by no means so perfect, as when they descend 
 into the scrotum.* 
 
 Diseased Appearances of the Spermatic Chord. Spermatic 
 Chord Scirrhous. 
 
 The spermatic chord is also liable to diseased alterations 
 of structure ; one of the most common is that of its be- 
 coming scirrhous. This I believe to be very rarely, if at 
 all, an original disease of the chord, but always, or 
 almost always spreads to it from the testicle. In the 
 early state of a scirrhous testicle the spermatic chord is 
 perfectly sound; but when the disease has existed for a 
 considerable time, and does not remain stationary, the 
 chord becomes at length affected. Under such circum- 
 stances it is changed into a hard mass, exhibiting the same 
 appearance of structure as the testicle itself. During the 
 last stage the disease advances to the loins, so as to affect 
 the absorbent glands there. 
 
 Feins of the Spermatic Chord varicose. 
 
 A disease of the spermatic chord which is not uncommon, 
 is an enlargement of its veins. The veins of the spermatic 
 chord are numerous, and support a very long column of 
 blood. This last circumstance, added to some impedi- 
 ments which occasionally take place to the return of the 
 blood, renders the veins frequently enlarged. This 
 enlargement varies very much in different cases, arising 
 from the degree and the continuance of the impediment. 
 When the enlargement of the veins is very considerable, 
 they also become varicose, and the spermatic chord is 
 
 * See Mr. Hunter's Observations on certain parts of the Animal Econo- 
 my, p, 18. 
 
 
225 
 
 changed into a bulky mass, soft to the feeling, and capable 
 of being readily diminished upon pressure. In this state 
 of the spermatic chord, the testicle is sometimes wasted. 
 
 Water accumulated in the Cellular Membrane of the 
 Spermatic Chord. 
 
 Water has sometimes been known to be accumulated in 
 the cells of the cellular membrane, which envelopes the 
 vessels of the spermatic chord. The cellular membrane 
 of this part of the body is in considerable quantity, and 
 when water is accumulated in its cells, a large swelling is 
 formed in the situation of the spermatic chord, which is 
 readily diminished upon pressure. When pressure is 
 used, the swelling is diminished, not only by a part of 
 the water being forced into the cells of the chord within 
 the abdominal ring, but also by its being forced into the 
 cellular membrane under the skin of the lower part of the 
 belly. Many pints have been known to be accumulated 
 in these cells. It has never occurred to myself to see 
 this disease, and therefore I have had no opportunity of 
 examining the nature of the fluid; but I presume it is of 
 the same sort with what is usually found in anasarca. 
 
 A Sack containing Water formed in the Spermatic Chord. 
 
 A sack has also been known to be formed in the sper- 
 matic chord, consisting of a firm white membrane, and 
 containing a fluid, which most probably is of a serous 
 nature. Both of these cases have been particularly tie- 
 scribed by Mr. Pott, in his treatise upon Hydrocele.* 
 
 * For the first case, See Pott on Hydrocele, p, 39. For the second, see 
 Pott on Hydrocele, p. 57. 
 
 2F 
 
226 
 
 SYMPTOMS. 
 
 The existence of hydrocele in the living body, may be 
 determined by the shape of the tumour, which is in some 
 degree pyramidal, by the resistance which it gives upon 
 pressure, by want of pain in it, and by the health being 
 not affected by it. Where the tunica vaginalis is thin, 
 and the swelling is placed between the eye and a lighted 
 candle, in will appear transparent. Where the tunica 
 vaginalis, however, is thick, the transparency will be lost, 
 and the tumour to the feeling will be harder, and less 
 compressible. But still it will not have the same degree 
 of hardness as a scirrhous testicle, and will want some 
 other characteristic marks which belong to the latter 
 disease. 
 
 The formation of hydatids in the tunica vaginalis testis 
 is attended with symptoms which correspond very much 
 with those of hydrocele ; and this case can only be distinctly 
 known by laying open the sack. 
 
 An inflamed testicle may be distinguised from a scirrhous 
 one in the living body, by a slight attention to the appear- 
 ances, and to the history of the case. The progress of 
 the disease, in an inflamed testicle, is commonly rapid, 
 and the skin of the scrotum immediately covering it has 
 
227 
 
 usually a blush of inflammation ; but in a scirrhous testicle, 
 the progress of the disease is slow, and the skin of the 
 scrotum retains its natural colour, unless it be really 
 affected by the disease. The surface of the tumour in 
 an inflamed testicle is uniform and smooth, but in a scirr- 
 hous testicle is often irregular. 
 
 When a testicle is scrofulous or pulpy, it may be dis- 
 tinguished from a scirrhous testicle by its greater softness, 
 by the little pain which is felt in it, and by the absence 
 of some symptoms which generally attend scirrhus of 
 this gland, and which are just about to be mentioned. 
 
 A scirrhous testicle may be ascertained in the living 
 body by its great hardness, and by the pain that is often 
 felt in it, which darts along the spermatic chord to the 
 loins. Its progress is commonly slow, the spermatic 
 chord becomes ultimately diseased, and the general health 
 at length much impaired. When it throws out a fungus, 
 or forms an ill-conditioned ulcer, these become additional 
 external marks of the nature of the disease. 
 
 The encysted tumour of the spermatic chord, containing 
 water, resembles, in some appearances, hydrocele. It 
 may, however, be distinguished from it by the testicle 
 being felt separate and entire under the tumour, which m 
 hvdrocele is never the case. 
 
28 
 
 CHAPTER XIX. 
 
 3>lSEASED APPEARANCES IN THE FEMALE ORGANS, 
 
 Inflammation of the Uterus. 
 
 WHEN the uterus becomes inflamed, it takes place 
 almost always under the same circumstances, viz. very 
 soon after parturition. The inflammation is sometimes 
 confined to the uterus itself, or its appendages, but the 
 peritonaeum in the neighbourhood is most commonly 
 affected, and frequently over its whole extent. The 
 uterus when inflamed, exhibits the same appearances as 
 the inflammation of the substance of other parts, and these 
 are principally observable in its body or fundus. The 
 inflammation is frequently found to creep along the ap- 
 pendages of the uterus, especially the Fallopian tubes and 
 ovaria. It often advances to suppuration, and the pus is 
 generally found in the large veins of the womb.* When 
 the peritoneeum is also afiected by inflammation, it exhibits 
 the same appearances which we formerly described, when 
 treating of the inflammation of this membrane ; but the 
 extravasated fluid, and the coagulable lymph, are frequently 
 in a large proportion to the degree of the inflammation.! 
 
 Malignant Ulcer of the Uterus. 
 It is not unusual for an ulcer to be formed in the uterus, 
 
 See Dr. Clark's Essays, p. 69 and 70. 
 
 | Dr. Clarke, who has examined a great many women that have died after 
 parturition with inflammation of the peritonseum, has observed this particularly. 
 See Dr. Clarke's Essays, p. 136. 
 
229 
 
 of a very malignant nature. This is most apt to happen 
 in women at the middle period of life, or at a more ad- 
 vanced age; but it sometimes happens in women who 
 may still be said to be young- The ulcer generally begins 
 in the cervix uteri, and the uterus is at the same time 
 somewhat harder and larger than in the natural state. It 
 does not, however, grow to any considerable size. The 
 ulcer spreads from the cervix to the fundus uteri, and 
 it is not unusual to see the greater part of the fundus 
 destroyed- by it, the rest being changed into a tattered 
 ulcerated mass. The ulceration is not always confined 
 in its boundaries to the uterus, but sometimes spreads 
 into the neighbouring parts, as the vagina, the bladder, 
 and the rectum, making communications between them, 
 and producing dreadful havock. This disease of the 
 uterus is generally considered as cancer, but it differs in 
 some of its appearances from what is acknowledged to be 
 the true cancer in other parts of the body.* 
 
 Enlargement and Hardness of the Uterus. 
 
 It sometimes happens, although not very often, that the 
 uterus enlarges in its size, and becomes much harder 
 than in its natural state. This change corresponds in 
 some respects to that of scirrhus in other parts of the body, 
 and commonly extends over the whole of the uterus. It 
 is difficult to say to what size the uterus may at length 
 arrive, in the progress of this disease, but I have seen it, 
 in one case, astlarge as the gravid uterus at the sixth 
 
 * This diseased change I formerly confounded with the scirrhous enlarge- 
 ment of the uterus, considering them as varieties of the same disease, and 
 therefore blending their description together; but in consequence of the 
 accurate observations of Dr. Adams, in his Essay upon Morbid Poisons, I have 
 thought it proper to separate them. 
 
230 
 
 month. If a transverse section be made of the uterus i n 
 this state, it is found to consist of a hard substance, inter- 
 sected by thick membranes. Ulceration hardly ever takes 
 place in this condition of the uterus. I recollect one 
 instance, in which there was some appearance of it, but 
 I may have made this remark too hastily, and may have 
 been deceived. Tubercles are -occasionally formed in 
 this state of the uterus, being, as it were, imbedded in its 
 substance, and they have a structure very much resem- 
 bling that of the uterus itself. 
 
 Tubercles of the Uterus. 
 
 Hard tubercles often grow from the uterus, which are 
 either imbedded in its substance, or arise from its outer 
 surface. They vary a good deal in their size, viz. from 
 that of a hazel nut, to more than the size of the fist. They 
 are irregular in their shape, but are commonly rounded, 
 and are often in some degree knotted. These when cut 
 into, exhibit a hard whitish substance, intersected by 
 membranous septa, which are commonly very thick and 
 strong. They have little or no disposition to ulcerate. 
 The uterus in this state of disease, is generally of the 
 natural size, and possesses the healthy structure, but 
 occasionally it is much enlarged. 
 
 A mass of the same kind is sometimes found in the 
 cavity of the uterus, and often grows to a very large size. 
 I have seen it a good deal larger thaif a child's head at 
 birth. This mass when cut into, exhibits precisely the 
 same appearances as those which we have so lately de- 
 scribed. It is remarkable, that such masses within the 
 cavity of the uterus commonly do not adhere in any part 
 closely to it, but are connected with it loosely, by the 
 
intervention of cellular membrane, and small blood vessels, 
 so that they can be very easily peeled off, without in- 
 juring the structure of the uterus. The uterus itself is 
 more or less enlarged according to the bulk of the mass 
 it contains, but it appears to be perfectly healthy in its 
 structure. 
 
 Polypus. 
 
 Polypus forms a very common disease of the uterus. ; 
 and may take place almost at any period of life; it is more 
 frequent, however, at middle or advanced age, and rarely 
 happens in persons who are young. By a polypus is 
 meant a diseased mass, which adheres to some part of the 
 cavity of the uterus, by a sort of neck or narrower 
 portion. It is of different kinds; the most common kind 
 is hard, and consists of a substance, divided by thick 
 membranous septa. When cut into, it shews precisely 
 the same structure of the tubercle of the uterus just de- 
 scribed; so that a person looking upon a section of the one 
 and the other, out of the body, could not at all distinguish 
 between them. This sort of polypus varies very much 
 in its size, some being not larger than a walnut, and others 
 being larger than a child's head. It adheres by a 
 narrower portion or neck, which varies a great deal in its 
 size, and in its proportion to the body of the polypus. 
 The largest polypus I ever saw was suspended by a neck 
 hardly thicker than the thumb ; and I have seen a poly- 
 pus, less than the fist, adhering by a neck fully as thick 
 as the wrist. 
 
 The place of adhesion also differs considerably. It is 
 most commonly at the fundus uteri, but it may take 
 place in any other part; and I have seen a small polypus 
 
232 
 
 adhering just on the inner part of the lip of the os uteri. 
 When a polypus is of any considerable size, there is gene- 
 rally one only; but I have occasionally seen on the inside of 
 the uterus, two or three small polypi, and in some instances, 
 several polypi have been known to grow from the uterus 
 in succession. 
 
 Another sort of polypus takes place in the uterus, 
 which consists of an irregular, bloody substance, with a 
 number of tattered processes hanging from it. This when 
 cut into exhibits two different appearances of structure; the 
 one appearance is that ^of a spongy mass, consisting of 
 laminae, with small interstitial cavities between them; the 
 other is that of a very loose texture, consisting of large 
 irregular cavities. It is very obvious, that in proportion 
 as a polypus grows, the cavity of the uterus must be en- 
 larged, and the same change must take place in the vagina, 
 when a polypus protrudes from the uterus into this canal. 
 
 The Inversion of the Uterus. 
 
 The inversion of the uterus occasionally takes place, 
 and principally from two causes, viz. from the weight 
 of a polypus, or from violent pulling, in attempts to 
 remove the placenta. When the inversion is incomplete, 
 the fundus uteri forms a tumour within its cavity; there 
 is at the same time an appearance of fissure upon the 
 outside of the uterus, where the fundus usually is ; and 
 the Fallopian tubes, the round ligaments, and the ligaments 
 of the ovaria, are drawn inwards at both edges of the 
 fissure. The uterus, particularly after labour, is some- 
 times inverted entirely, the inner surface being exposed, 
 and the fundus uteri forming a large tumour within the 
 vagina, and in some cases even on the outside of the lab ia. 
 
233 
 
 Prolapsus Uteri. 
 
 The uterus sometimes leaves its natural situation and 
 fails downwards, so as either to get to the external parts, 
 or out of the body entirely. This is most apt to happen 
 when women have a large pelvis, and where the soft parts 
 have been very much relaxed by repeated and severe 
 labours. This disease is called prolapsus uteri, and will 
 be explained more particularly when we come to treat .of 
 the diseases of the vagina. It is much more frequent 
 than the other disease called the inversio uteri. 
 
 Stricture in the Cavity of the Uterus. 
 
 A stricture is sometimes formed within the cavity of 
 the uterus, so that its cavity at one part is obliterated 
 entirely. This I believe almost always to take place at 
 one part, viz. where the cavity of the fundus uteri termi- 
 nates, and that of the cervix begins, for in this place the 
 cavity of the uterus is narrowest. As the sides of the 
 cavity round this place lie very near each other, and form 
 naturally a small aperture, it is probable that some slight 
 inflammation may unite the parts together, and shut up 
 the aperture ; or the parts may gradually approach each 
 other without this cause, as in strictures of the urethra. 
 
 The Os Uteri contracted, and closed up. 
 
 The os uteri has been found to be so contracted, as to 
 have its passage in a great measure obliterated;* and it 
 has even been known to be closed up, by the growth of 
 an adventitious membrane. f 
 
 * Vid. Morgagni, Epist. LXVII. Art. 11. 
 f Vid. Morgagni, Epist XLVJ. Art. 17. 
 
 2G 
 
234 
 
 Uterus bony* 
 
 The substance of the uterus is sometimes more or less 
 converted into bone. This arises from a particular morbid 
 action of its blood vessels, by which they secrete from 
 the blood bony matter, and it is a very rare disease. 
 
 The Uterus changed into an earthy Substance. 
 
 The uterus has also been known to be converted into 
 an earthy substance.* It is probably of the same kind 
 with the earth of bones ; and this disease probably differs 
 only from the former, in there being a less proportion of 
 animal gluten, to combine the earthy particles together. 
 
 A bony Mass in the -Cavity of the Uterus. 
 
 In the cavity of the uterus. a bony mass is sometimes 
 found. When this is the case, I suspect that the hard 
 fleshy tubercle within the cavity of the uterus, such as 
 we lately described, has been converted into bone. This 
 at least had taken place in the only instance which I have 
 known of this disease (for a great part of the tubercle still 
 remained unchanged) and I think it very probable, that 
 such a change most frequently happens, where these bony 
 tumours are found. 
 
 Stones in the Cavity of the Uterus. 
 
 Stonesf have sometimes been found in the cavity of 
 the uterus. These are described by authors as varying 
 in their appearance, some being of a dark, and others of 
 a light colour. About their nature they are silent, and I 
 
 * Vid. Lieutaud, Tom. I. p. 323. 
 f Vid. Lieutaud, Tom. I. p. 339. 
 
235 
 
 can say nothing of it from my own knowledge, as it has 
 never occured to me to see an instance of this disease. 
 Such concretions are probably formed from matter thrown 
 out by the small arteries which open upon the internal 
 surface of the uterus, and are in some degree analogous 
 to the concretions which are formed in some glands of 
 the body. 
 
 Dead Foetus in the Uterus converted into an earthy Mass. 
 
 It has also been known to happen, that a dead foetus has 
 remained for a long time in the cavity of the uterus, and 
 has there been gradually changed into an earthy mass pre- 
 serving the shape of the child.* 
 
 Water in the Cavity of the Uterus. 
 
 Water has sometimes been known to be accumulated 
 in the cavity of the uterus in very large quantity.! In 
 some cases fifty, sixty, or even a hundred pints, have 
 been said to be accumulated. This water is sometimes 
 bloody in its appearance, and sometimes of a yellowish 
 colour. Of its nature I cannot speak particularly, as I 
 ha.ve never seen an instance of this disease. I think it 
 probable, however, that the water accumulated in the 
 cavity of the uterus, resembles in its properties the serum; 
 and that it is poured out by the small curling arteries of 
 the uterus. In cases where water is really accumulated 
 in the cavity of the uterus, one must suppose a stricture 
 of the cervix, otherwise the water would escape gradually 
 into the vagina as it is formed. I am disposed to believe, 
 however, that where water has been said to be accumula- 
 
 * See Cheselden's Anatomy of the Bones, plate LVI. 
 
 - Vid. Lieutaud, Tom. I. p. 319, p. 333. 
 
236 
 
 ted in the cavity of the uterus, it has frequently been 
 really in one or more large hydatids formed in that cavity.* 
 
 Hydatids in the Uterus. 
 
 Large masses of hydatidsf have also been found in the 
 cavity of the uterus. Whether these be commonly of the 
 same kind with what occasionally grow in the placenta, 
 or like those in other parts of the body, I cannot determine, 
 as it has not occurred to me to see an example of this 
 disease. The hydatids of the placenta are a good deal 
 different from those of the liver, kidneys, and some other 
 parts of the body. They consist of vesicles of a round or 
 oval shape, with a narrow stalk to each, by which they 
 adhere on the outside of one another. Some of these 
 hydatids are as large as a walnut, and others as small as a 
 pin's head. A large hydatid has generally a number of 
 small hydatids adhering to it by narrow processes. Of 
 their real nature nothing is known, but they are probably 
 animals of a very simple structure. In the same quad- 
 ruped different species of hydatids will sometimes occur, 
 and therefore the same thing may take place in the human 
 subject. I believe that the hydatids said to be found in 
 the uterus, have not uncommonly been only hydatids of 
 the placenta, which had been retained there. 
 
 Air in the Uterus. 
 
 Air has sometimes been known to be accumulated in 
 the cavity of the uterus, but this occurs very rarely, and 
 has not, except in one instance, fallen under my own 
 
 * Dr. Denman has had an opportunity of observing a case, where water 
 was accumulated in one large hydatid of the uterus. 
 | Vid. Lieutaud, Tom. I. p. 335. 
 
237 
 
 observation. The air when so accumulated sometimes 
 escapes through the os uteri with a noise somewhat sim- 
 ilar to that which is occasioned by the escape of air from 
 the rectum. This air is probably formed by the small 
 blood vessesls of the uterus in a manner analogous, to 
 secretion, and its properties are at present unknown.* 
 
 Rupture of the Uterus. 
 
 These are the various diseased apperances which are 
 well ascertained to take place in the uterus. I have to 
 add, that the womb is not unfrequently ruptured, which 
 is rather to be considered as an accident than a disease. 
 This, perhaps, never takes place but in the pregnant uterus, 
 and at the time of labour; and it chiefly arises from the 
 too violent action of the muscular fibres of the uterus 
 upon the child, when there is more than the ordinary re- 
 sistance to its expulsion. The ruptures which I have seen 
 have been commonly in the side of the womb, and of 
 considerable extent. The peritonaeum covering the womb 
 sometimes remains whole, and there is a large mass of 
 black coagulated blood lying between it and the uterus, 
 where the rupture has taken place. This black appearance 
 is occasionally mistaken for mortification. 
 
 Two Uteri. 
 
 It has sometimes happened, although very rarely, that 
 two uteri have been formed in the same person instead of 
 one. In this case there is but one ovarium and one 
 Fallopian tube to each. The vagina is at the same time 
 divided by a septum into two canals, each of which con- 
 ducts to its proper uterus. In the case which is described 
 
 * Vid. Portal's Anatomic Medicale, Tom. V. p. 525. 
 
238 
 
 iu the Philosophical Transactions,* a communication 
 was formed at one part through the septum; but how far 
 this generally takes place in such a kind of monstrosity, 
 I cannot determine. 
 
 Natural Varieties in the Uterus. 
 
 The uterus varies a good deal in its size in different 
 persons, in some being fully twice as large as it is in 
 others. It differs also somewhat in the thickness of its 
 substance. There is some difference too in its situation, 
 being often placed nearer one side of the pelvis than the 
 other. All of these are to be considered as varieties in 
 the natural formation, and not as disease. f 
 
 SYMPTOMS. 
 
 In inflammation of the uterus, there is a sense of pain 
 and tension in the hypogastric region, and the pain is 
 increased upon pressure there, or upon touching the os 
 uteri. The stomach is affected with vomiting, and the 
 bowels are sometimes costive, and sometimes disposed to 
 looseness. The whole constitution is roused into action, 
 exhibiting those symptoms which have been called fever, 
 and the pulse has commonly a great degree of frequency. 
 When the peritonaeum is inflamed over the general sur- 
 
 * See Philosophical Transactions, Vol. LXIV. p. 474. 
 
 j A very excellent and ample account of these diseases of the uterus lias 
 been lately published by Mr. Clarke, which may be consulted by medical 
 practitioners with great advantage. 
 
239 
 
 face of the abdomen, or to a considerable extent, there is 
 a general swelling of that cavity, with pain and extreme 
 tenderness upon pressure, and the feverish symptoms 
 are increased. 
 
 In the malignant ulcer of the uterus there is a sense 
 of pain in the hypogastric region, which is often very 
 violent. At the same time there is commonly felt a dull 
 pain round the hips and down the thighs. Mucus, pus, 
 and blood are frequently discharged by the vagina, and 
 the quantity of blood is sometimes very large. The pulse 
 at the beginning of this dreadful disease is natural, and 
 the general health is but little impaired, but when it is 
 far advanced, the pulse becomes quick, the countenance 
 sallow, and the body emaciated. 
 
 If in the progress of the disease a communication should 
 be formed between the vagina and the urinary bladder, 
 the urine will then pass off by the vagina. Some of the 
 glands of the groin, in advanced stages of the disease, 
 often become hard and enlarged in their size. 
 
 In the scirrhous enlargement of the uterus, there are 
 a few symptoms to characterize it till the disease has 
 made considerable progress. There is pain in the hy- 
 pogastric region and round the hips, which is more or 
 less acute in different cases; but this is common to it 
 with several other diseases. When the disease, however, 
 is a good deal advanced, it may be ascertained by an ex 
 
240 
 
 animation by the vagina. The os tincae will then feel 
 enlarged and hard, and there will be an unusual sense of 
 weight against the finger from the increased size of the 
 uterus. A tumour may at the same time be distinctly felt 
 above the pubes. This disease is commonly attended with 
 mucous discharges from the vagina, and profuse dis- 
 charges of blood at the monthly periods. The pulse is 
 generally natural, and the health not much impaired. 
 
 When tubercles formed upon the outer surface of the 
 uterus or imbedded in its substance are small, and the 
 uterus is nearly of its natural size, little inconvenience is 
 probably produced by them. When the tubercles how- 
 ever are large, they will, according to their size and 
 situation, produce more or less difficulty in passing the 
 urine, or in passing the freces. When a tubercle grows 
 from the anterior surface of the fundus uteri, and is large, 
 and the patient rather of a spare habit, its existence and 
 nature may be satisfactorily ascertained by an examination 
 in the living body. 
 
 The symptoms which attend a polypus of the uterus, 
 are mucous and occasional bloody discharges by the 
 vagina, with frequent pains round the hips. When it has 
 made considerable progress in its growth, it may be 
 ascertained by an examination by the vagina. Even 
 without this examination, it may be distinguished from 
 an ulcer of the uterus, by attention to the history of its 
 
241 
 
 progress, and by the general health being much less 
 affected in this case than when an ulcer has been formed. 
 The glands of the groin are, I believe, never affected from 
 a polypus, but are often tainted by absorption in advance^ 
 s tages of the ulcerated uterus. 
 
 When there is a part of the fundus uteri inverted, 
 forming a tumour in the cavity of the uterus, there are no 
 symptoms by which it can be sufficiently distinguished in 
 the living body. It is attended with a profuse haemorr- 
 hage, and if the patient should survive, the menstrual 
 flux is in very large quantity, together with very copious 
 mucous discharges in the intermediate times. When 
 the inversion is complete, it can be ascertained by an 
 examination of the tumour, but is not distinguished by 
 any peculiar symptoms. The attempts which have been 
 made to return the uterus to its natural situation, have 
 almost alwavs been unsuccesful. 
 
 Prolapsus uteri is attended with more or less of pain 
 in the loins and also with a pain in the groins which shoots 
 down to the labia. There is more or less of a mucous 
 discharge from the vagina, and sometimes there is stran- 
 guary. There is also a sensation of bearing down, and 
 of weight in the region of the parts affected. These 
 symptoms disappear or are very much lessened, when the 
 patient has been for a short time in a horizontal posture. 
 The exact circumstances belonging to this complaint 
 2H 
 
242 
 
 cannot however be fully ascertained without an examina- 
 tion, and therefore the patient should be always advised 
 to allow of an examination being made. 
 
 There are no symptoms by which dropsy of the uterus 
 can be distinguised from some other conditions of this or- 
 gan, and therefore it is only known in consequence of the 
 evacuation of the water, by the vagina. 
 
 There will of course be more or less enlargement of 
 the uterus, and fullness of the hypogastric region, in pro- 
 portion to the accumulation of the water, and this will 
 subside when the water is evacuated. 
 
 The existence of hydatids in the uterus is not distin- 
 guished by any characteristic symptoms, and is only 
 known in consequence of their expulsion, by the contrac- 
 tile power of this viscus. This generally takes place ? 
 and is attended with pains resembling very much the 
 pains of labour. 
 
 A rupture of the uterus can only be fully ascertained 
 by an examination. It is attended with pain, with a sense 
 of something having given way in the belly, and with 
 almost an immediate vomiting of a chocolate -coloured 
 matter. The uterus gives up its natural efforts for the 
 expulsion of the child, so that the labour pains cease; 
 the child is retracted, and generally escapes, either wholly 
 or in part, into the cavity of the abdomen. 
 
243 
 
 CHAPTER XX. 
 
 DISEASED APPEARANCES OF THE OVARIA. 
 
 Inflammation of the Peritoneal Covering of the Ovaria. 
 
 THE portion of the peritonaeum which covers the 
 ovaria I believe is seldom inflamed, unless where the in- 
 flammation has spread to it from the uterus, or where it 
 has attacked this membrane generally. It is not unusual, 
 however, for it to be inflamed under both of these circum- 
 stances ; and it shows the same appearances as the inflam- 
 mation of the peritonaeum covering any other part. Ad- 
 hesions too are frequently found, joining the ovaria to the 
 neighbouring parts, which had been the consequence of 
 such an inflammation. 
 
 Inflammation of the Substance of the Ovaria. 
 
 Where the uterus has been inflamed to a considerable 
 degree, as after parturition, the substance of the ovaria 
 has also been occasionally attacked by the inflammation 
 spreading to it. The ovaria are then enlarged, are harder 
 than in a natural state, and are highly vascular; very com- 
 monly pus is found to have been formed. 
 
 Enlargement and Hardness of the Ovaria. 
 
 The ovaria sometimes become considerably enlarged, 
 and are converted into a whitish hard mass, which is more 
 or less intersected with membranous septa. This change 
 of structure is similar to what takes place in the fleshy 
 
244 
 
 tubercle oi the uterus lately described, and I believe has 
 no tendency to ulcerate, but it occurs much more rarely, 
 than this disease of the uterus. These hard masses have 
 sometimes a disposition to be converted into bone; and in 
 this way most frequently, I believe, the ovaria become 
 bony. The bony substance into which they are con- 
 verted has sometimes a greater admixture of earth than 
 the natural bones of the body. 
 
 Ovaria enlarged and changed into a pulpy Substance. 
 
 The ovaria are sometimes very much enlarged, and 
 converted into a pulpy matter of a smooth uniform texture. 
 Cells are often formed in a part of this substance, which 
 contain a fluid. 
 
 Ovaria scrofulous. 
 
 The ovaria are sometimes changed into a true scrofulous 
 matter, intermixed with cells. 
 
 Dropsy of the Ovaria. 
 
 The most common disease of the ovaria is dropsy. 
 The whole substance of an ovarium is sometimes con- 
 verted into a capsule containing a fluid. The capsule is 
 frequentl} r of a large size: it consists of a white firm 
 membrane, and contains an aqueous fluid, capable of being 
 partly coagulated. 
 
 When the ovaria have become dropsical, and their 
 natural structure has entirely disappeared, it is very com- 
 mon for them to be converted into a number of cells, 
 which communicate with each other by considerable 
 openings, and to be prodigiously enlarged. An ovarium 
 in this case may be so increased in size as to occupy 
 
245 
 *i 
 almost the whole cavity of the abdomen. The ovaria are 
 
 also sometimes converted into a congeries of cysts, which 
 have no communication with each other. These vary 
 a good deal in their size, some being not larger than a 
 hazel nut, and others as large as an orange. Their coats 
 are sometimes thin, sometimes of considerable thickness, 
 and consist of a compact, white, laminated membrane. 
 They contain either a serous fluid, with which I have seen 
 some slimy matter mixed, or a thick ropy fluid, or a kind 
 of jelly. This jelly is sometimes so tough that it can be 
 drawn out to a considerable length, and when it breaks, it 
 passes back with a great deal of elastic force. Different 
 cysts in the same ovarium will sometimes contain different 
 sorts of fluid, a circumstance which one would not expect 
 a priori. 
 
 It sometimes also happens, although rarely, that some 
 pus is found in one or more cysts of a dropsical ovarium, 
 mixed with the serum or the jelly which is accumulated 
 there. This has been produced by inflammation in some 
 part of the inner surface of the ovarium, occasioned 
 probably by the great distention of that part, in conse- 
 quence of the accumulation of fluid there. A large 
 quantity of pus has sometimes been found, where in- 
 flammation has been extended over a large portion of the 
 inner surface of the ovarium, and this has most frequently 
 taken place, where inflammation has been produced in 
 consequence of the operation of tapping the ovarium. 
 
 These cysts, I believe, have been occasionally con- 
 founded with hydatids, to which they bear some re- 
 semblance. They are however really very different. They 
 have much firmer and less pulpy coats than hydatids; they 
 contain a different kind of fluid, and they are different! v 
 
246 
 
 connected among themselves. Hydatids either lie un- 
 connected with each other, or a large hydatid incloses a 
 number of small ones; or smaller hydatids adhere to the 
 coats of those which are larger. Cysts of the ovarium 
 adhere to each other laterally by pretty broad surfaces; 
 do not inclose each other; and appear to have no power 
 analogous to generation as hydatids have, by which smaller 
 cysts are formed, that are attached to those of a larger size. 
 It appears not improbable, that these cysts are formed by 
 a gradual enlargement of the small vesicles which make 
 a part of the natural structure of the ovaria. 
 
 The Ovaria changed into a Fatty Substance with 
 Hair and Teeth. 
 
 The ovaria is sometimes converted into a fatty sub- 
 stance, intermixed with long hair and teeth, which is 
 surrounded by a capsule consisting of a white strong 
 membrane. The hairs are most of them loose in the fatty 
 substance, but many of them also adhere on the inside 
 of the capsule. Teeth too are formed, but are generally 
 incomplete, the fangs being wanting. These sometimes 
 arise immediately from the inner membrane of the capsule, 
 and are sometimes connected with an irregular mass of 
 bone. Such productions have been commonly considered 
 as very imperfect ova, in consequence of impregnation; 
 but there is good reason to believe that they can take 
 place without any intercourse between the sexes, I have 
 described a case, which has been published in the Philo- 
 sophical Transactions, where it was hardly possible that 
 impregnation could have happened. The girl in whom 
 this change of the ovarium was found, could not from all 
 appearances have been more than twelve or thirteen years 
 
247 
 
 old; the hymen was perfect; and the uterus had not re- 
 ceived that increase of bulk which is usual at puberty. 
 The other marks of puberty were also wanting. From 
 these circumstances I should judge the womb to have 
 been incapable of the stimulus of impregnation. A tu- 
 mour, consisting of teeth and hair, was preserved by the 
 celebrated Ruysch* in his collection, which he says was 
 found in a man's stomach. If this -be true (which there 
 seems to be no reason to doubt), it puts my conjecture 
 beyond dispute. This production could not possibly, 
 under such circumstances, have any connection with im- 
 pregnation ; and if it occurs without it in one part of the 
 body, there can be no good reason why it may not also 
 take place without impregnation in another part. These 
 productions are much more frequent in the ovaria than 
 any where else, probably because the process which forms 
 them bears some analogy to generation, in which the 
 ovaria are materially concerned. I must still therefore, 
 whatever objections have been made to it, retain my for. 
 mer opinion. These masses in the ovaria are commonly 
 about the size of a large orange, f 
 
 * Vid. Ruysch, Tom. II. Adverser. Anatomicor. Decad. tert. 
 
 f I have very lately met with the same kind of fatty substance intermixed 
 with hair, and the body of one tooth covered with enamel, in the ovarium of a 
 young woman about eighteen years of age. In this case the uterus was rather 
 less than its usual size in the adult when unimpregnated, and there was no 
 membrana decidua whatever formed in its cavity. It appeared therefore, to 
 be undergoing no change similar to what happens when there is an ovum grow- 
 ing in the ovarium or the Fallopian tube. The hymen too was perfect, the 
 edge of the membrane being quite sound and natural, and the aperture in it 
 being remarkable small. These circumstances do not amount to demonstrative 
 evidence, but still must be considered as a very strong confirmation of the 
 truth of the opinion above stated. 
 
 I have been informed by Mr. Colman, that a dead gelding was some time 
 ago examined, in which a cyst was found a little under the right kidney, con- 
 
A Foetus in the Ovarium. 
 
 A foetus is sometimes found in the ovarium. This 
 seldom arrives at the full size, but its formation as far as 
 it goes is commonly perfect. When this happens, all 
 
 taining a fatty matter, hair, and some teeth. This fully establishes the truth 
 of the opinion above stated. 
 
 The particulars discovered by dissection are very curious, and are so clearly 
 atated by Mr. Colnvan, that I shall take the liberty of subjoining the account of 
 then\ in his own words : 
 
 " A bay gelding, seven years old, belonging to the Royal Horse Artillery at 
 Woolwich, was attacked with a contagious and incurable disease, (viz. glanders) 
 in consequence of which I recommended that the horse should be destroyed. 
 After the morbid parts concerned in this disease had been examined, Mr. 
 Percivall, Veterinary Surgeon to the Most Honourable Board of Ordnance, 
 (whose attention to anatomy and his profession in general deserves the highest 
 enconiums) accidentally opened the cavity of the abdomen, and discovered a 
 tumour about the size of a horse's testicle, of an oblong form, a little below the 
 right kidney, and loosely attached, by a long slender neck, to the peritoneum. 
 Mr. Percivall removed this tumour without supposing that the contents were 
 peculiar, but as the inner parts felt as if they were of a bony nature, a longitu- 
 dinal section was made with a saw completely through its substance. It now ap- 
 peared that the other cyst of the tumour contained two small molar horse-teeth, 
 and one incisor tooth, with a portion of bone attached to this tooth resembling 
 the jaw. The remainder of the tumour was composed of about two-thirds of 
 fat and one-third of hair ot a black colour contained in a separate cyst. The 
 molar teeth which were fortunately divided by the saw longitudinally near the 
 rentre, had the same arrangement of enamel and bony matter as natural horses' 
 teeth. Two very small blood vessels were observed going from the neck of 
 the tumour into its substance, but they were not attended to till the section had 
 been made. As the history of the animal from its birth could not be procured, 
 it cannot be ascertained whether both testicles had previously been removed. 
 It is posible that one testicle might have remained in the abdomen, and the 
 form, situation, and size of the tumour, rather favour this supposition. But 
 wether blood vessels were formed from the neighbouring parts to produce 
 this peculiar organization, or whether the teeth and hair were produced by 
 the spermatic vessels, the process is equally curious and inexplicable. This 
 phcenomenon, however, fully establishes the opinion of Dr. Baillie, that when 
 teeth and hair and fat are found in the ovarium, impregnation is not necessary 
 to their formation, and therefore it is highly probable, that in no instance it has 
 been the cause of these extraordinary productions in the ovaria." 
 
249 
 
 vestige of the ovarium is lost, and instead of it there is a 
 bag of some firmness containing the foetus; to this bag 
 upon the inside is attached a placenta, and a part of the 
 chorion. The bag can be ascertained to be the ovarium, 
 by tracing upon it the Fallopian tube and the spermatic 
 vessels, from their origin to their termination. The uterus 
 in such cases is considerably larger than when unimpreg- 
 nated, and in its cavity there is formed the membrana 
 decidua. This shews that the uterus takes on the same 
 changes, although imperfectly, which it does in the ordi- 
 nary circumstances of pregnancy. The spermatic vessels 
 are also enlarged, in order to supply a sufficient quantity 
 of blood to the ovum which is growing in the ovarium. 
 
 Shrinking of the Ovaria. 
 
 The ovaria commonly shrink towards old age, and are 
 changed in their structure. They are diminished to half 
 their natural size, are somewhat tuberculated on their 
 surface, and are hard. When cut into, the vesicles, which 
 make a part of their natural structure, are found to be 
 filled with a white solid matter. 
 
 One Ovarium or both -wanting. 
 
 An ovarium on one side has been known to be wanting; 
 but this is extremely rare. An example of this kind is 
 preserved in Dr. Hunter's collection. Some instances 
 have been recorded, in which no vestige of an ovarium 
 could be observed on either side. 
 
 9,1 
 
250 
 
 SYMPTOMS. 
 
 As the ovaria are very seldom inflamed, unless when 
 inflammation has at the same time attacked the uterus ; it 
 is not known whether there be any particular symptoms 
 which characterize inflammation of the ovaria. Inflam- 
 mation of the ovaria cannot at present be distinguished by 
 its symptoms, from inflammation of the uterus. 
 
 A hard state of the ovaria, is with difficulty determined 
 in the living body. When an ovarium of this kind has 
 increased to a large size, and lies upon the side of the 
 pelvis, and the person is at the same time of a spare habit, 
 it may in some measure be ascertained by an accurate 
 examination of the tumour through the parietes of the 
 abdomen. The tumour will feel much harder than where 
 an ovarium is enlarged by dropsy, or filled with cysts. 
 When the ovarium is not capable of being accurately 
 examined, the opinion about the existence of this disease 
 must rest much more upon probable evidence, than upon 
 any clear proof. 
 
 Dropsy of the ovarium cannot be ascertained in a very 
 early stage of this disease. But when it has made con- 
 siderable progress, so as to have formed a swelling at the 
 lower part of the belly, it may commonly be ascertained 
 
251 
 
 by an accurate examination, and attention to the history 
 of its growth. The tumour is generally on one side of 
 the abdomen more than the other, according as the right 
 or left ovarium is affected. There is often an inequality 
 in the surface of the swelling, and an obscure kind of 
 fluctuation is felt upon striking with the hand the parietes 
 of the abdomen, which cover the swelling. The health 
 is commonly very little affected by this disease, and it is 
 slow in its progress, so that life will often be continued 
 with tolerable comfort under it for many years. The 
 quantity of the urine is sometimes little diminished below 
 what is usual in health, and the absorbents of the ovarium 
 are hardly capable of being excited to a vigorous action 
 by medicine. There have been few instances, therefore, 
 of a dropsy of the ovarium being cured = 
 
252 
 
 CHAPTER XXL 
 
 DISEASED APPEARANCES OF THE FALLOPIAN TUBES. 
 
 Inflammation of the Fallopian Tubes. 
 
 WHEN the uterus is inflamed to a considerable degree, 
 the inflammation often spreads along the Fallopian tubes : 
 they become, in this case, highly vascular, and when cut 
 open, sometimes contain blood in their cavities. The 
 inflammation may even advance to suppuration, when 
 their cavities become loaded with pus. 
 
 Adhesions. 
 
 When the peritonaeum generally, or some part of it, in 
 the neighbourhood of the Fallopian tubes, is inflamed, the 
 external covering of these tubes, which is a continuation 
 or the peritonaeum, also partakes of the inflammation. 
 This, when it subsides, generally terminates in adhesions 
 of the Fallopian tubes to the contiguous parts. It is not 
 unusual to find the fimbriated extremity of the Fallopian 
 tubes adhering to the ovaria ; or when the previous in- 
 flammation has been considerable, to find the fimbriated 
 appearance entirely lost, and the body of the Fallopian tube 
 apparently terminating on the surface of the ovarium. 
 Under such circumstances there is no aperture towards 
 this end of the Fallopian tubes, and it has lost its power 
 of conveying the ovum from the ovarium to the uterus. 
 
 The very small aperture by which the Fallopian tube 
 
253 
 
 communicates with the cavity of the uterus, is sometimes 
 obliterated, but not so often as the aperture of that extrem- 
 ity next to the ovarium. 
 
 Dropsy of the Fallopian Tubes. 
 
 When the fallopian tube has its apertures closed at both 
 extremities, it is sometimes dilated into a considerable 
 tortuous cavity. This when laid open appears occasion- 
 ally subdivided by small partial septa, and contains an 
 aqueous fluid, which is capable of being partly coagulated. 
 This fluid is undoubtedly supplied by the secretion of the 
 small arteries belonging to the inner membrane of the 
 Fallopian tube, which is naturally very vascular. It may 
 be called dropsy of the Fallopian tube. The quantity of 
 fluid which is generally accumulated in this state of the 
 Fallopian tube is not considerable, but sometimes, although 
 very rarely, it has been known to amount to many pints.* 
 
 The Fallopian Tubes terminating in a Cul-de-sac. 
 
 The Fallopian tubes I have seen without any aperture 
 or firmbriated extremity, from a defect in the original for- 
 mation, and terminating in a cul-de-sac. Under such 
 circumstances they were of course incapable of performing 
 their office as subservient to generation. 
 
 An Ovum in the Fallopian Tube. 
 
 The Fallopian tube is sometimes dilated into a bag 
 containing an ovum. This arises from the ovum being 
 stopped in its progress from the ovarium to the uterus. 
 When it is so stopped, it does not die but is gradually 
 
 * Vid. Portal's Anatomie Medicate, Tom. V. p. 543. 
 
254 
 
 evolved, as if it had been lodged in the cavity of the uterus. 
 This, among many others, is a proof that the uterus is not 
 the only organ which is fitted to evolve an ovum, but that 
 other parts of the body can perform this office. While 
 the ovum is enlarging, the Fallopian tube is more and 
 and more dilated, forming a thin bag round the ovum. 
 The blood vessels passing to the ovarium and the Fal- 
 lopian tube where the ovum is contained, are gradually 
 enlarged, in proportion to the increase of the ovum, in 
 order to supply it with a sufficient quantity of blood. 
 While this process is going on in the Fallopian tube, 
 the uterus increases in bulk so as to be fully twice its 
 natural size, and becomes more vascular. The cavity of 
 its fimdus is also lined with a membrana decidua, and 
 the cervix uteri is plugged up with jelly. The uterus 
 therefore undergoes a variety of changes, exactly similar 
 to those which take place in natural pregnancy. The 
 ovum sometimes makes considerable progress in the 
 Fallopian tube, and has been known to advance even to 
 the full period of gestation ; but more commonly it dies 
 at an early period. In the course of the evolution of the 
 ovum, the Fallopian tube has been known to rupture, and 
 the person to die from internal haemorrhage. A very 
 clear and accurate account of such a case has been pub- 
 lished by Dr. Clarke, in the Medical and Chirurgical 
 Transactions.* 
 
 Hard Tumour growing from a Fallopian Tube. 
 
 I have seen a hard round tumour growing from the 
 outer surface of one of the Fallopian tubes. This when 
 
 * See page 261, Vol. 2. 
 
255 
 
 cut into exhibited precisely the same appearance of str,uc- 
 ture as the tubercle which grows from the surface of the 
 uterus, viz. it consisted of a hard white substance, which 
 was intersected by strong membranous septa. This, 
 however, I believe to be a very rare appearance of disease. 
 
 Diseased Appearances of the round Ligaments. 
 
 The round ligaments partake of the inflammation of 
 the uterus, when " it is considerable, and has spread to its 
 appendages. They are also, doubtless, subject to other 
 diseases, but these are very rare, and have not fallen under 
 my own observation, nor do I know of their having been 
 particularly taken notice of by authors. 
 
 SYMPTOMS. 
 
 The symptoms which attend the different morbid chan- 
 ges of the Fallopian tubes are at present not known ; and 
 they must, from the circumstances belonging to them, be 
 very difficult to ascertain. 
 
CHAPTER XX1L 
 
 DISEASED APPEARANCES OF THE VAGINA. 
 
 Inflammation of the Vagina. 
 
 THE internal surface of the vagina, riear the outward 
 opening*, is frequently inflamed, especially from the appli- 
 cation of the venereal poison, but this hardly ever becomes 
 the subject of examination after death. 
 
 Adhesion of the, Sides of the Vagina. 
 
 A very violent inflammation has sometimes been known 
 to take place in the vagina, which has terminated in the 
 mutual adhesion of the sides of the cavity. Thrs adhesion 
 is sometimes extended over a great part of the cavity, but 
 I believe is often more confined, producing a stricture in 
 some one part. 
 
 Ulcers of the Vagina. 
 
 Ulcerations are not unusual* in the vagina. They some- 
 times appear like spots of the internal surface, removed 
 as it were by a knife, and sometimes there is a foul 
 ragged ulcer. When this last is the case in any considera- 
 ble degree, the ulcer has commonly not originated in the 
 vagina, but has spread to it from the womb. When the 
 ulcer spreads very much, communications are often made 
 with the neighbouring parts, producing a most miserable 
 state of existence. Thus communications are sometimes 
 formed between the vagina and the rectum, or the vagina 
 and the bladder. 
 
257 
 
 Hard Tumours in the Vagina. 
 
 Hard tumours occasionally grow in the vagina itseli 
 (although, I believe, rarely) when the uttrusis unaffected. 
 When cut into, they exhibit a structure very similar to 
 that of the tubercle of the uterus, which has been lately 
 described. 
 
 Inversion of the Vagina. 
 
 One of the most common diseases of the vagina is its 
 inversion, or prolapsus: this is more apt to happen wl. 
 the natural formation of the pelvis is large, where the 
 ternal opening at the vulva is wide, and where the parts? 
 are generally relaxed. The prolapsus is more or less m 
 different cases; in some the uterus does not pass out at the 
 external parts, and in others the inversion of the vagina is 
 complete, at the extremity of which is situated the os 
 uteri. The protrusion has then different shapes; it some- 
 times forms a l c ^:ge rounded mass, and sometimes it is 
 narrower and more elongated, extending, perhaps, five 
 inches from the surface of the body. When this last has 
 been the case, it has been sometimes mistaken for that 
 species of monstrous formation called hermaphrodite. 
 We may here take an opportunity of mentioning, that 
 although in some of the common quadrupeds a real 
 hermaphrodite structure has occasionally been found, yet 
 it has hardly ever occurred in the human subject.* 
 
 * Although the examples of what have been called hermaphrodites in the 
 human species have, when strictly examined, been hitherto found to belong 
 to the male or the female sex; yet Dr. Storer of Nottingham has favoured me 
 with an account of a person so strongly marked as a hermaphrodite, that no 
 doubt can, I think, be reasonably entertained of this being the case. The person 
 to whom this singular monstrosity belongs, is still alive, and has been carefully 
 
 2K 
 
258 
 
 When the vagina has been long subject to inversion, its 
 inner surface becomes in many parts drier and harder than 
 natural ; it is likewise apt to be occasionally inflamed from 
 external irritation, which not uncommonly advances to 
 ulceration. 
 
 In inversion of the vagina and prolapsus of the uterus, 
 if the cavity of the pelvis be examined, the fundus only 
 of the uterus can be seen with its appendages very im- 
 perfectly, or the whole of the uterus is hid entirely : the 
 bladder then appears to be in contact with the rectum. In 
 this state of the uterus and its appendages, I have known 
 adhesions formed between them and the neighbouring 
 parts. These must have rendered the reduction of the 
 uterus and the vagina to their natural situation very diffi- 
 cult, and, perhaps, till the adhesions were a good deal 
 elongated, impossible. 
 
 examined by Dr. Storer, and other medical gentlemen, very able to judge con- 
 cerning it ; I shall therefore take the liberty of inse4ng here, the account 
 which Dr. Storer was so obliging as to send me. 
 
 The person bears a woman's name, and wears the apparel of a woman. She 
 has a remarkable masculine look, with plain features, but no beard. She had 
 never menstruated; and on this account she was desired by the lady with whom 
 bhe lived as servant, to become an outpatient at the Nottingham Hospital. At 
 this time she was twenty-four years of age, and had not been sensible of any bad 
 health, but only came to the hospital in order to comply with the wishes of her 
 mistress. Various medicines were tried without effect, which led to the suspi- 
 cion of the hymen being imperforated, and the menstrual blood having accumu- 
 lated behind it. She was, therefore, examined by Mr. Wright, one of the 
 surgeons to the hospital, and by Dr. Storer. 
 
 The vagina was found to terminate in a cul-de-sac, two inches from the ex- 
 ternal surface of the labia. The head of the clitoris, and the external orifice of 
 the meatus urinx, appeared as in the natural structure of a female, but there 
 were no nymphs. The labia were more pendulous than usual, and contained 
 each of them a body resembling a testicle of a moderate size, with its chord. 
 The mammx resembled those of a woman. The .person had no desire or 
 partiality whatever for either sex. 
 
259 
 
 The Vagina very short. 
 
 The vagina is sometimes very short. I have seen H 
 not more than half its natural length. This is an original 
 defect in the formation of the part, and can only be ascer- 
 tained by an examination* 
 
 The Vagina widened. 
 
 The vagina is sometimes very much stretched or 
 widened by large tumours which are lodged in it : these 
 are chiefly polypi ; and when they have been removed by 
 art, the vagina, if it has not been for a long time stretched, 
 recovers nearly its natural size. 
 
 The Vagina very narrow* 
 
 The vagina has occasionally been found to be very 
 much contracted with regard to its transverse diameter, 
 from a defect in the original formation. This, however, 
 occurs very rarely, and may in some degree be remedied 
 by art. 
 
 SYMPTOMS. 
 
 The symptoms which attend inflammation of the inner 
 membrane of the vagina and the labia, are too well known 
 to require any description. 
 
 An adhesion of the sides of the vagina can only be 
 
260 
 
 distinctly known by .an examination. It may, however, 
 be strongly suspected where there has been a previous 
 violent inflammation of the vagina, and since that period 
 there has been no menstrual discharge, together with an 
 unfitness for the usual intercourse between 'the sexes. 
 When the adhesion has extended over a considerable 
 part of the vagina, it is hardly possible by an operation to 
 separate the adhering surfaces, and to restore the original 
 canal. I have known attempts of this kind to fail in the 
 most skilful hands ; and it requires much nicety of man- 
 agement to avoid making an opening into the bladder or 
 the rectum. Where the extent of the adhesion is smali, 
 it is very capable of being remedied by an operation, 
 except perhaps very near the internal extremity of the 
 vagina. As it is impossible, when the adhesion is com- 
 plete, to know, a priori, whether it be of large or of small 
 extent, it is almost always proper to attempt an operation; 
 but this should only be done by a surgeon who is dextrous 
 in the management of the knife, and with extreme caution. 
 Where there is merely a narrow line of adhesion, this 
 may probably be discovered by the accumulation of 
 the menstrual blood behind it ; and it is possible that this 
 accumulation may at length break through the adhesion, 
 and render an operation unnecessary, it would be absurd, 
 however, to put off an operation which under such cir- 
 cumstances must be very slight, for the very uncertain 
 chance of this effect taking place. 
 
 Ulcers in the vagina can only be determined with ac- 
 curacy by an examination of that passage in the living 
 
261 
 
 body. They are attended with more or less pain, and 
 with a discharge of pus; but both of these symptoms 
 belong also to inflammation of the vagina, without any 
 ulceration whatever. 
 
 The symptoms attending an inversion of the vagina, 
 and a prolapsus uteri have been already explained in the 
 chapter upon diseases of the uterus. As the exact cir- 
 cumstances of the disease can never be known, except by 
 an examination in the living body, such an examination 
 should always be strongly recommended to the patient. 
 
 The existence of tumours growing in the vagina can only 
 be accurately ascertained by an attentive examination. 
 
CHAPTER XXIII. 
 
 DISEASED AND PRETERNATURAL APPEARANCES 01 
 THE EXTERNAL PARTS. 
 
 The Hymen imperforated 
 
 THE hymen is sometimes found without a perforation 
 in it, so that the vagina is completely shut up at its exter- 
 nal extremity. This is an original mal-formation, which 
 is frequently not discovered till the age of puberty, when 
 the menstrual blood is accumulated behind it. It is of 
 little consequence, as it can be easily remedied by a slight 
 operation. 
 
 The Clitoris enlarged. 
 
 An enlarged clitoris is also a natural deformity, less 
 common than the other, but a more unfortunate one. At 
 birth, the clitoris in such a case is often larger than the 
 penis of a male child of the same age. It has a well formed 
 prepuce and glans, together with a fissure at its extremity, 
 so as to resemble almost exactly the external appearance 
 of the male organs. These cases have given rise to a 
 mistake, with regard to the sex, and females have been 
 often baptized for males. On most occasions, however, 
 where there is an enlarged clitoris, the sex may be deter- 
 mined by the following circumstances. The labia are 
 well formed, and when handled, no round bodies are felt 
 in them like the testicles. The fissure at the extremity 
 of the glands does not lead to any canal of the urethra ; 
 
 : 
 
263 
 
 but under the glans, and at the posterior extremity of the 
 fissure, there is an opening which leads immediately td 
 the bladder. I should believe, that by putting a small 
 straight probe into this orifice, and passing it into the 
 bladder, it could be at once determined, on most occasions, 
 whether the child was male or female.* If the child 
 should live to grow up, the clitoris enlarges, but not in 
 the same proportion as the penis would do. Such cases 
 have been often mistaken for hermaphrodites. 
 
 The Nymphtf enlarged. 
 
 The nymphse are not unfrequently enlarged beyond 
 their natural size. This sometimes happens to one only, 
 and sometimes to both. When the nymphae are very 
 much enlarged, they pass considerably beyond the surface 
 of the body, and have the same sort of covering with the 
 labia, losing by their exposure the fine, vascular, sensible 
 covering of the natural nymphae. This is a monstrous 
 formation of no great consequence, unless the enlargement 
 be excessive, and even then the nymph as can be extirpated 
 by art. 
 
 The external Labia growing together. 
 
 The two external labia are sometimes united together 
 by a fine line of junction, at the upper end of which are 
 situated the meatus urinae, and the glans of the clitoris. 
 This sort of monstrous formation is not at all common, 
 and is very easily remedied. When the external labia 
 
 * Supposing the child to be a female, the probe will pass readily throughout 
 a short straight canal; but supposing it to be a male, the probe will neither pass 
 in a straight direction, nor without some degree of curvature being given to ils 
 shape, and the canal will be found to be of a considersble length. 
 
264 
 
 are separated by a slight operation, all the parts behind 
 are found perfect. 
 
 The two labia are sometimes joined together by a con- 
 tinuation of the common skin, so that the appearance of 
 labia is lost entirely. This defect may also be remedied 
 by art, and the parts within will be found to be well formed. 
 
 The external parts, particularly the inside of the 
 nymphae, and the vestibulum, are subject to inflammation 
 and ulcers from common causes, and especially from the 
 application of the venereal poison. These diseases, although 
 they are very often the subject of solicitude during life, 
 yet are seldom examined after death, and therefore we shall 
 omit them here altogether. 
 
 It is unnecessary to subjoin any account of symptoms 
 to this chapter. 
 
CHAPTER XXIV. 
 
 DISEASED APPEARANCES OF THE BRAIN AND ITS 
 MEMBRANES. 
 
 Inflammation of the Dura Mater. 
 
 THE dura mater is sometimes found in a state of in- 
 flammation. When this is the case, many extremely fine 
 vessels filled with florid blood, are seen in the inflamed 
 portion of it, which pass between the dura mater and the 
 cranium. These fine vessels are seldom so crowded as 
 in most other parts of the body when inflamed, which 
 arises from the nature of the membrane itself. Jn its 
 natural state there are few blood vessels ramifying through 
 it; and therefore when it is inflamed, it does not appear so 
 much crowded with vessels as other parts do which are 
 naturally more vascular. Still, however, a person well 
 acquainted with the natural appearance of the dura mater, 
 would be as much struck with the difference of its appear- 
 ance when inflamed as he would be with that of any other 
 part of the body. 
 
 The dura mater during a state of inflammation some- 
 times forms a layer of coagulable lymph, which adheres 
 to its inner surface like an adventitious membrane; but 
 this is very uncommon, 
 
 When the dura mater is inflamed, adhesions are some- 
 times formed between it and the other membranes of the 
 brain, so that for a considerable extent they adhere 
 together; but this appearance of disease is also rare. The 
 2L 
 
266 
 
 reason why diseased adhesions between the membranes of 
 the brain are rare, probably is, that coagulable lymph is 
 seldom formed upon their surface during inflammation. 
 This may be considered as a kind of peculiarity be- 
 longing to the membranes of the brain, for they bear 
 some analogy to the membranes which line the circum- 
 scribed cavities of the body, and these last most com- 
 monly form coagulable lymph upon their surface when 
 they are inflamed. 
 
 It is not unusual when the dura mater has been inflamed, 
 especially in consequence of some external violence, for 
 suppuration to take place, and pus to be found covering' 
 a portion of the membrane. 
 
 The dura mater is likewise sometimes eroded by 
 ulceration, but this is by no means frequent; it is more 
 common in violent injuries of the head, for a portion of 
 it to become mortified. 
 
 Scrofulous Tumours connected -with the Dura Mater. 
 
 Scrofulous tumours are sometimes formed, which are 
 connected with the dura matter, but this happens very 
 rarely. These resemble precisely the structure of a scro- 
 fulous absorbent gland, and occasionally there is found in 
 them a curdly pus. 
 
 Spongy Tumours growing from the Dura Matter. 
 
 Spongy tumours also grow from the dura mater, but 
 they are very uncommon. Such tumours, as far as I have 
 had an opportunity of examining them, are pulpy to the 
 touch, and of a distinct fibrous structure. 
 
267 
 
 Bony Matter formed in the Dura Mater. 
 
 One of the most common diseased appearances of the 
 dura mater, is the formation of bony laminae in some part 
 of it. These are generally very small, being not larger 
 than the nail of a finger? but they are also occasionally of 
 a much larger size. They are thin, and frequently very 
 irregular in their edge. They are not to be found indif- 
 ferently in every part of the dura mater, but are almost 
 always adhering at the superior longitudinal sinus, or its 
 falciform process. In some of them the proportion of the 
 earth to the animal part is larger than in common bone. 
 There is often one of these ossifications only ; but some- 
 times there are more of them. The falciform process has 
 been said to be occasionally found almost entirely converted 
 into bone ; but this last appearance is very rare. 
 
 Very strong Adhesion of the Dura Mater to the Cranium. 
 
 There is at all times a strong adhesion between the 
 dura mater and the inside of the cranium. This adhesion 
 is principally formed by the small blood vessels which pass 
 from the one to the other, and likewise by a close appli- 
 cation of the fibrous structure of the membrane to the bone. 
 In a natural state, however, the dura mater can be perfectly 
 separated from the cranium ; yet it sometimes happens 
 that the adhesion is so strong, as to render it impossible 
 to separate the two completely. The dura mater in such 
 an attempt is torn in different parts into two laminae, one 
 of which adheres to the bone, and the other lies upon the 
 pia mater. Whether this preternatural strength of adhe- 
 sion arises from ' a previous state of inflammation in the 
 
-~ 268 
 
 dura mater, or from some other cause, I cannot determine; 
 but it is not at all an uncommon appearance. 
 
 
 Diseased Appearances of the Tunica Arachnoides. 
 
 Diseased appearances of structure are very rare in the 
 tunica arachnoides, and have almost been entirely over- 
 looked by writers. The only diseased appearance of this 
 coat which I have observed, is that of its becoming a good 
 deal thicker than it is naturally, so as to be a tolerably firm 
 membrane. In this, as well as in its natural state^ no blood 
 vessels are to be seen ramifying upon it ; or at least they 
 are extremely few. It is also separated at some distance 
 from the pia mater, by a serous fluid being interposed 
 between the one and the other. 
 
 Diseased Appearances of the Pia Mater. Veins of the 
 Pia Mater turgid -with Blood. 
 
 The most common diseased appearance of the pia 
 mater is that of its veins being turgid with blood. This 
 depends upon some impediment to the free return of the 
 blood from the head towards the heart, which may arise 
 from a variety of causes, and is very different from an 
 inflamed state of the pia mater. The smaller branches of 
 its arteries, filled with a florid blood, are not more nume- 
 rous in this state than is natural, but its veins are much 
 more distended with a dark blood. 
 
 The Pia Mater inflamed. 
 
 When the pia mater is inflamed, it is upon the whole 
 more difficult to distinguish this condition of it from its 
 natural state than in any other membrane of the body. 
 This depends upon the great number of very small vessels 
 
269 
 
 which naturally ramify upon it. In inflammation of the 
 pia mater, these small vessels are much more numerous 
 than in its natural state, are filled with a florid blood, and 
 form by their anastomosis, a beautiful net- work. It does 
 not frequently occur, when the pia mater is inflamed, that 
 it becomes so uniformly red as to shew no interstices be- 
 tween its vessels, a circumstance which happens in the 
 inflammation of some other membranes. The processes 
 arising from the under surface of the pia mater are also 
 more crowded with vessels than usual, and there is a stron- 
 ger adhesion between them and the substance of the brain. 
 
 It very rarely happens that any layer of coagulable 
 lymph is formed in the inflammation of the pia mater 
 which is so very common in inflammation of the pleura 
 and the peritoneum. When the pia mater is inflamed to 
 a high degree, pus is cominonly formed ; I have seen it 
 effused over the whole upper surface of the brain, in 
 consequence of an inflammation of the pia mater. 
 
 Close adhesions, over a large extent of surface, have 
 been seen between the pia and dura mater, which are 
 probably the consequence of inflammation ; but these are 
 rare, and have not fallen under my own observation. 
 Adhesions however of a small extent are not very un- 
 common. 
 
 Scrofulous Tumours adhering to the Pia Mater 
 
 I have seen a number of scrofulous tumours adhering 
 to the inside of the pia mater. They exhibited the true 
 scrofulous structure, which has been often explained, and 
 are very uncommon, 
 
270 
 
 9 Air in the Vessels of the Pia Mater. 
 
 It is not unusual to find some of the vessels of the pia 
 mater filled with air. This may be generated by putre- 
 faction, but it is also sometimes seen when no process of 
 this kind appears to have taken place. Under such cir- 
 cumstances, it is probable that air is extricated by some 
 new arrangement in the constituent parts of the blood. 
 
 Hydatids. 
 
 Little cysts* containing water (which are generally 
 called hydatids), have been seen adhering to the pia mater; 
 but this is a very rare appearance of disease. 
 
 A Part of the Pia Mater Bony. 
 
 It occasionally happens, although I believe very seldom, 
 that a portion of the pia mater is converted into bone. It 
 has not occurred to me to observe such a change of 
 structure in this membrane, but Dr. Soemmerring men- 
 tions that a specimen of this disease is preserved in his 
 collection. 
 
 Diseased Appearances in the Substance of the Brain. 
 Inflammation. 
 
 The substance of the brain, under which I include 
 both the cerebrum and cerebellum, is liable to inflamma- 
 tion, although* it is not very common, when no external 
 injury has been applied to the head. When inflammation 
 takes place, it is rarely extended over any large portion of 
 the brain, but is rather confined to one or more distinct 
 parts of it. In this state of disease the inflamed portion 
 
 ' Vid. Lieutaud, Tom. II. p. 145. 
 
271 
 
 becomes of a red colour, although this is seldom very in- 
 tense. When cut into, the colour is found to arise from 
 a great many small vessels, which are filled with blood. 
 If the inflamed portion be upon the surface of the brain, 
 the membranes in the neighbourhood are also commonly 
 inflamed. The part which is inflamed has no peculiar 
 hardness, but yields nearly the same sensation to the touch,, 
 as it would do in a healthy state. 
 
 Abscesses. 
 
 Inflammation of the brain frequently advances to suppu 
 ration, and abscesses are formed in it. When these. arc 
 of a large size, the weight of the pus breaks down the 
 structure of the neighbouring parts, and they look simply 
 as* if they had been destroyed, or very much injured by 
 the pressure. When the abscesses are small, there is an 
 ulcerated appearance of the cavity in which the pus is 
 contained. 
 
 Gangrene. 
 
 Portions of the brain occasionally become gangrenous^ 
 especially after violent injuries of the head; but I believe 
 this appearance of disease is extremely rare, where an 
 inflammation of the brain has taken place from any other 
 cause. I have met, however, with one instance of this ; 
 a portion of the brain at the inflamed part was of a very 
 dark brown colour, and as soft as the most rotten pear. 
 
 The Brain very soft. 
 
 It is extremely common, when the brain is examined 
 in a person who has been dead for several days, to find 
 such a softnes of its substance, that it can, hardly admit of 
 
being cut, so as to leave a smooth surface, and the smallest 
 pressure of the fingers breaks it down into a pultaceous 
 mass. The brain, .however, will sometimes retain, for 
 several days the firmness and resistance which it had during 
 life ; yet this is by no means common. Neither of these 
 appearances is to be considered as produced by disease. 
 Sometimes, however, a part of the medullary substance 
 of the brain becomes morbidly soft, and loses its natural 
 texture, acquiring nearly the consistence of a custard. 
 Dr. John Hunter, physician to the army, has observed 
 this in the medulla of the hemispheres of the brain, near 
 the lateral ventricles. He has met with this appearance 
 in cases of fatuity, where the persons were advanced in 
 life, and also combined with effusions of blood in apoplexy. 
 1 have likewise met with one or two instances of the same 
 diseased change of structure in a part of the medullary 
 substance of the brain. 
 
 The Brain very firm. 
 
 The brain is sometimes found to be considerably firmer 
 than in its healthy state, to be tougher, and to have a 
 greater degree of elasticity than usual ; it will bear to be 
 pulled out with some force, and will readily re- act so as 
 to restore itself, or when pressed will recover its former 
 shape. Under such circumstances the ventricles are 
 sometimes found to be enlarged in their size, and full of 
 water. The brain has even been said to become so hard and 
 dry as to be friable between the fingers; 'and the medullary 
 substance, in these cases, is represented as being much 
 lighter than in a natural state. It is probable, however, 
 that these accounts are a good deal exaggerated. It has 
 been remarked that in such cases the cerebellum is very 
 often unaffected. 
 
273 
 
 A white firm Substance formed in the Brain. 
 
 It is not very unusual to see a white substance formed 
 in the brain of an uniform smooth texture, and possessing 
 a considerable degree of hardness. The brain adheres to 
 this substance, and round its edge appears often more 
 vascular than usual. The substance is scrofulous in its 
 nature, for I have had an opportunity of seeing it converted 
 into a scrofulous pus. More than one of these substances 
 are frequently formed in the brain at a time. 
 
 It is also not unusual to find rounded masses of the 
 same sort of substance, lying as it were imbedded in the 
 brain, or in its interstices ; some of these I have seen as 
 large as a walnut. When such tumours are formed, it 
 happens frequently that there is an increased quantity of 
 water in the lateral ventricles of the brain. 
 
 Encysted Tumours and Hydatids* 
 
 Encysted tumours containing a serous fluid* have 
 sometimes been found in the substance of the brain ; but 
 they have never come under my own observation, and 
 are very uncommon. 
 
 In one instance I have been informed from good au- 
 thority, that hydatids were accumulated in the lateral 
 ventricles of the brain, but this is still a more uncommon 
 apearance of disease than the other. They seemed to be 
 of the same nature with hydatids of the liver, f 
 
 * Vid. Lieutaud, Tom. If. p. 194, 195. 
 
 f This case was communicated to me by Mr. Burnall, who attended the 
 patient, and examined the appearances after death. 
 
 2M 
 
274 
 
 Bony Tumours pressing upon the Brain. 
 
 Bony tumours are sometimes formed in the cranium, 
 which press upona part of the brain. They most commonly 
 consist of an irregular mass, which is formed of bony 
 processes, with a fleshy substance filling up the interstices 
 between them. Of this sort of tumour there are several 
 examples in Dr. Hunter's collection. 
 
 It has sometimes happened, but very rarely, that all 
 the bones of the cranium have become extremely thick- 
 ened, and have encroached, by their growth, upon the 
 cavity which contains the bruin. Of this there is a re- 
 markable specimen in Mr. Hunter's collection, where the 
 bones of the cranium are at least three times as thick as in 
 the natural state. They are also, in the case to which I 
 allude, much more spongy than usual in their texture. 
 
 A nodule of a substance having the appearance of ivory, 
 has also been known to be formed in the bones of the 
 cranium, and to protrude considerably into its cavity. 
 This too occurs very rarely, but a specimen of it is pre- 
 served in Mr. Hunter's collection.* Whatever may be 
 the variety in the morbid processes which produce these 
 changes of structure in the bones of the cranium, their 
 
 * This nodule of ivory is formed in one of the orbits, and I am not sure whether 
 it may not be the eye converted into this substance. The nodule is of consider- 
 able size, and projects some way into the cavity of the cranium behind the orbit, 
 
275 
 
 effects upon the functions of the brain must be nearly the 
 same, as they form a permanent cause of compression. 
 
 Bony Ridges irritating the Brain. 
 
 Upon the inner surface of the basis of the cranium there 
 is always some irregularity. This consists in numerous 
 ridges and small eminences with depressed surfaces in- 
 terposed between them. It happens occasionally that there 
 is a morbid growth of these eminences and ridges, forming 
 sharp spicula and sharp edges of bone. These run into 
 the brain, and irritate very violently the nervous system. 
 
 Hydrocephalus. 
 
 One of the most common appearances of disease in the 
 brain, is the accumulation of water in its ventricles ;* this 
 generally takes place when a child is very young, and 
 even sometimes before birth. The water is accumulated 
 in greater or less quantity in different cases. It some- 
 times amounts only to a few ounces, and occasionally to 
 many pints. When the quantity of water is very conside- 
 rable, the fornix is raised at its anterior extremity in con- 
 sequence of its accumulation, and an immediate opening 
 of communication is thereby formed between the lateral 
 ventricles, f From this cause too a part o the water 
 
 * Sir Everard Home has known an instance where water was accumulated in 
 large quantity in the third ventricle, and had forced its way between the fine 
 laminae of the medullary substance which compose the septum lucidum, 
 without escaping into either of the lateral ventricles. This may be said to be 
 a new situation of hydrocephalus, and is of very rare occurrence. 
 
 f A distinguithed author has, in a late publication, insisted very strongly 
 upon the existence of an immediate communication between the two lateral 
 ventricles of the brain, and has expressed great surprise that it has been denied 
 by several teachers of anatomy in London. Without entering into any dispute 
 about this matter, which in itself is of no great importance, I shall briefly 
 
passes very readily into the third ventricle, and from thence 
 into the fourth. The water is of a purer colour, and more 
 limpid, than what is found in dropsy of the thorax or 
 abdomen. It appears, however, to be generally of the 
 same nature with the water that is accumulated in both 
 of those large cavities. In some trials which I have made, 
 it partly coagulated upon the application of the common 
 acids, exactly like the water in hydrothorax and ascites, 
 or like the serum of the blood. But there is much variety 
 in the quantity of the coagulable matter. In some instan- 
 ces the water in hydrocephalus contains a small proportion 
 of coagulable matter, and in others it is almost entirely 
 free from it. 
 
 When water is accumulated in the ventricles to a very 
 
 < 
 
 large quantity, the substance of the brain, especially upon 
 the sides and at the upper surface, is so thin, as almost to 
 appear to be a sort of pulpy bag, containing a fluid. The 
 scull too upon such occasions is very much enlarged in 
 size, and altered in its shape. The cranium is exceedingly 
 large in proportion to the size of the face. The projec- 
 tions are very considerable at the centres of ossification, 
 
 mention what appears to me to be the real state of the circumstances. The 
 fornix at its anterior extremity lies loose upon a part of the thalama nervorum 
 opticorum and there is a small chink on each side of the fornix leading obliquely 
 downwards from the lateral ventricles to the anterior extremity of the third 
 ventricle. While the fornix is allowed to remain in its natural situation, 
 there seems to me to be no immediate communication between the lateral 
 ventricles. But when the fornix is elevated (which may be very easily done) 
 then the lateral ventricles communicate directly with each other; and 
 the communication is more or less according to the degree of the eleva- 
 tion. It may be said, that the lateral ventricles still communicate together 
 by means of the third ventricle. This, however, is not properly an imme- 
 diate communication between the two lateral ventricles, unless any two 
 cavities which communicate with a third, may be properly said to commu- 
 nicate directly or immediately with each other, 
 
277 
 
 from whence the frontal, parietal, and occipital bones were 
 originally formed, and the membranous divisions between 
 these several bones are very wide. When the scalp is 
 removed, so as to give an opportunity of looking imme- 
 diately upon the cranium, the bones are found to be very 
 thin, often not thicker than a shilling, and there are fre- 
 quently broad spots of membrane in the bone. The 
 reason of this last appearance is that ossification takes place 
 in many points of the membrane in such cases in order to 
 make a quicker progress, but the water accumulates too 
 rapidly for it, so that spots of membrane are left not con- 
 verted into bone. When such appearances take place in 
 hydrocephalus, the disease has been of long continuance, 
 occasionally for some years. 
 
 Water upon the Surface of the Brain, and between its 
 Membranes. 
 
 Water is also sometimes formed under the pia mater s 
 and upon the surface of the brain, but very rarely in any 
 considerable quantity. There is, generally, at the same 
 time a greater quantity than natural in the ventricles. 
 
 The most common situation of water between the 
 membranes of the brain, is between the tunica arachnoides 
 and the pia mater. In this case the water is commonly 
 effused in small separate portions between these two 
 membranes, and at other times is effused over a large 
 extent. The fluid when seen through the tunica arach- 
 noides appears commonly like a very thin jelly, but it is 
 always a fluid, and resembles the serum of the blood. 
 The blood vessels of the pia mater are generally in such 
 cases more distended with blood than is natural, but this 
 does not always occur. The tunica arachnoides is gene- 
 
278 
 
 rally thicker than usual, and has a certain degree of opacity . 
 Sometimes there is a little more water than usual in the 
 ventricles of the brain, and sometimes there is only the 
 natural quantity. Not unfrequently in these cases there 
 is more or less water in the theca vertebralis ; but this does 
 not happen, except when the quantity of water effused 
 between the tunica arachnoides and the pia mater is 
 considerable. 
 
 It is related by authors, that water has been formed 
 occasionally between the dura mater and the cranium.* 
 From the nature of the adhesion between the cranium and 
 this membrane one would not easily be led to suspect an 
 accumulation of water between them, and such cases are 
 at least to be considered as very uncommon. 
 
 Air between the Membranes of the Brain, and in its 
 
 Ventricles. 
 
 Air has been said to have been sometimes collected in 
 considerable quantity between the membranes of the brain, 
 and even in its ventricles. I do not recollect to have 
 observed either of these morbid appearances, and I believe 
 them to be extremely rare.f 
 
 Blood effused or extravasated. 
 
 Blood is frequently found effused within the cavity of 
 the cranium in various situations. It may either be poured 
 out by the rupture of some vessel in the substance of the 
 brain itself, or into some of the ventricles. It is frequently 
 effused upon the surface of the brain, or upon some of its 
 
 * Vid. Lieutaud, Tom. II. p. 229, 230. 
 
 Vid. Portal's Anatomic Medicale, Tom. IV. p. 70, and 71. 
 
279 
 
 membranes. This is most apt to happen where the effu- 
 sion is in consequence of external violence. 
 
 The quantity of blood which is effused from the rupture 
 of vessels in the brain is frequently very considerable. It 
 is commonly found in a coagulated state, and the texture 
 of the brain in the neighbourhood is often very much hurt 
 from the pressure. Blood is not equally liable to be effu- 
 sed into every part of the substance of the brain. Where 
 an effusion has taken place without external injury, it is 
 almost constantly found in the medullary part of one of 
 the hemispheres, and often near the lateral ventricles, so 
 that a quantity of blood has at the same time escaped into 
 one or both of these cavities. It sometimes happens that 
 the brain is very soft in its consistence at the place of this 
 effusion, a remark which has been made by Dr. John 
 Hunter. 
 
 When blood is extravasated within the cavity of the 
 cranium from some external injury, the. vascular system 
 is usually sound, except for the rupture which may have 
 happened. But when extravasation happens within the 
 cavity of the cranium, without external injury, the vascular 
 system of the brain is almost always diseased. It is very 
 common in examining the brains of persons who are con- 
 siderably advanced in life, to find the trunks of the internal 
 carotid arteries upon the side of the sella turcica very 
 much diseased, and this disease extends frequently more 
 or less into the small branches. The disease consists in 
 a bony or earthy matter being deposited in the coats of the 
 arteries, by which they lose a part of their contractile and 
 distensile powers, as well as of their tenacity. The same 
 sort of diseased structure is likewise found in the basilary 
 artery and its branches. 
 
280 
 
 The vessels of the brain under such circumstances of 
 disease, are much more liable to be ruptured than in a 
 healthy state. Whenever blood is accumulated in unusual 
 quantity, or the circulation is going on in them, with unusual 
 vigiour, they are liable to this accident, and accordingly 
 in either of these states, extravasations of blood frequently 
 happen. Were the internal carotid arteries and the bas- 
 ilary artery not subject to the diseased alteration of struc- 
 ture which we have described, effusions of blood within 
 the cavity of the cranium, where there has been no previous 
 external injury, would probably be much more rare. 
 
 Cavities in the Brain containing a serous Fluid. 
 
 Cavities containing a serous fluid are sometimes ob- 
 served in the substance of the brain. They almost 
 constantly occur in the medullary part of the hemispheres, 
 and the substance of the brain immediately surrounding 
 these cavities is tough and smooth, so as to resemble a 
 membrane. They would appear to be the remains of 
 the cavities formed by extravasated blood, in cases of 
 apoplexy, where the patients have not been cut off im- 
 mediately, but have lived afterwards for some months or 
 years. The extravasated blood would seem in such cases 
 to have been dissolved, and taken up by absorption; but 
 the injury is not repaired, and a cavity remains afterwards, 
 filled with a serous fluid.* 
 
 * I had an opportunity of observing, lately, a well marked case of this sort, 
 i a person who had several attacks of apoplexy, and at length was cut off by one 
 of them. Dr. John Hunter has observed a good many instances of it, and a case 
 o< urred some years ago to Mr. Wilson, lecturer on anatomy, whose accuracy is- 
 well known, where the cavity which remained was of a very large size. 
 
281 
 
 Aneuyrism of the internal Carotid Arteries on the Side of 
 the Sella Turcica. 
 
 The internal carotid arteries are very apt in persons of 
 an advanced age, to become ossified, and the same morbid 
 change may be traced along their branches. It occurs, 
 however, very rarely that they are distended at any part 
 into an aneurysmal sack, like the arteries in some other 
 parts of the body. I have been informed of an instance 
 of this kind, where both the internal carotid arteries, on 
 the side of the sella turcica, were distended into a little 
 aneurysm.* One of these aneurysms was about the 
 size of a cherry, and the other was somewhat smaller. It 
 is remarkable that in the only two instances which have 
 come to my knowledge, of aneurysms being formed in 
 the arteries of the head and brain, there has been an 
 aneurysm in both arteries in the same situation, and at the 
 same time. I once met with an aneurysm in each of the 
 carotid arteries at the origin of the internal carotids, and 
 in the case just described, there was an aneurysm in each 
 of the two internal carotid arteries upon the side of the 
 sella turcica. 
 
 Diseased Appearances of the Plexus Choroides. Little 
 Bags in the Plexus Choroides. 
 
 The most common diseased appearance of the plexus 
 ehoroides is that of little round transparent bags, which 
 adhere to it, and which have commonly been called hy- 
 datids. They are generally more transparent in their coats 
 than hydatids, are commonly about the size of a garden 
 
 * I owe my acquaintance with this case to Sir Gilbert Blane, 
 
282 
 
 pea, but sometimes, they have been seen as large as a 
 gooseberry. From several examinations which I have 1 
 made of them, they would seem to be formed by a disten- 
 sion of the vein which runs along the edge of the plexus 
 choroides. I have been able to distend them fully with 
 air, by making an opening into this vein, and inflating air 
 into it through a small blow-pipe. 
 
 Hound Tumours adhering to the Plexus Choroides. 
 
 Tumours sometimes adhere to the plexus choroides. 
 They are small in their size, of a round shape, and occur 
 but rarely. They seem to be of the same kind with the 
 round tumours which are sometimes found imbedded in 
 the brain, and I believe are scrofulous. 
 
 Diseased Appearances of the Pineal Gland. Earthy 
 Matter in the Pineal Gland. 
 
 A little earthy matter is almost constantly found tn the 
 pineal gland. It is sometimes in very small quantity, but 
 not unfrequently the quantity is very considerable. . The 
 particles of the earth do not adhere strongly together, but 
 are easily separable by pressure between the fingers. This 
 earthy matter consists chiefly of phosphate of lime,* and 
 is so commonly found in the pineal gland, that it cannot 
 well be considered as a disease. I think, however, that in 
 some instances I have found this gland without any dis- 
 position of earthy matter. 
 
 Pineal Gland said to be scirrhous. 
 
 The pineal* gland has been mentioned by authors as 
 being sometimes scirrhous. I have felt it on some occa- 
 sions a little firmer than on others; but it has never oc- 
 
 * See Thomson's System of Chemistry, Val. 4, p. 658, 
 
283 
 
 curred to me to observe that alteration of structure in .it 
 which could be properly called scirrhous, and I believe it 
 to be a very rare disease. 
 
 Water in the Pineal Gland. 
 
 The pineal gland has been found to be very much 
 distended with a limpid water;* but this too is very 
 uncommon. 
 
 Diseased appearances of the Pituitary Gland. 
 
 This gland is very little liable to be affected- by disease. 
 It has only occurred to me to observe in it one morbid 
 change. It was, in that case, enlarged to twice its natural 
 size, and was converted into a substance, possessing an 
 obscurely fibrous structure. 
 
 Diseased Appearances of the Nerves. 
 
 It rarely happens that any of the nerves within the cavity 
 of the cranium appear diseased. I have, however, some- 
 times seen a nerve a good deal smaller in its size than it 
 ought to be, softer in its texture, and of a less opaque 
 colour ; this I recollect to have been particularly the case 
 with one of the optic nerves in a person who was blind 
 of one eye.f 
 
 The nerves vary a good deal in their size in different 
 persons, as a part of their original formation, without 
 there being any disease whatever. 
 
 * Vicl. Morgagni, Epist. LXII. Art." 15. 
 
 f I have seen an instance of a considerable tumour being formed in a nerve- 
 The tumour was very solid in its texture, of a yellowish white colour, and 
 larger in its size than a goose's egg. The nerve seemed to be in some 
 measure lost in the tumour, and in one part of it a fibrous structure could 
 be observed pretty distinctly, simflar to that of a nerve. This swelling oc- 
 curred in one of the axillary nerves, and was extirpated by Sir Everard 
 Home, at St. George's Hospital. 
 
284 
 
 Mai-formations of the Brain. 
 
 These are the principal diseased changes which take 
 place in the brain and its appendages. I have just to add, 
 that the brain is subject to great variety from original 
 monstrous formation. A great part of what is usually 
 called the cerebrum is sometimes wanting, while the cer- 
 bellum, and the medulla spinalis are entire ; sometimes 
 there is hardly any vestige of either the cerebrum or 
 cerebellum, and the medulla spinalis is very much dimin- 
 ished in size : at other times there is a total want of the 
 brain, and there is no appearance of the medulla spinalis. 
 In this case, one should expect a want of nerves through- 
 out the whole body. It is, however, not so; nerves are 
 found distributed in the common way, through the limbs, 
 and the dorsal nerves can be seen arising from a membrane 
 somewhat resembling the dura mater in the canal behind 
 the vertebrae. When there is a total want of brain, it 
 sometimes happens that there is a medulla spinalis, which, 
 however, is of a very small size. In cases of deficiency 
 in the brain, the cranium is nearly upon a level with the 
 two eyes, and there is often upon the scalp a soft spongy 
 excrescence. This is generally divided into distinct pro- 
 tuberant masses, and is covered with a fine skin, capable 
 of being rendered very vascular by injection. When cut 
 into the spongy excrescence consists of pretty large cells, 
 which are filled with a sort of grumous matter. 
 
 There is also frequently, instead of this excrescence, a 
 bag growing from the skin of the scalp, and passing down- 
 wards so as to cover more or less of the back of the trunk. 
 This bag sometimes consists of a fine membrane, with 
 little strength; and sometimes it is rather thick, with 
 considerable firmness. It some'times communicates with 
 the cavity of the cranium by a considerable opening ; and 
 

 85 
 
 sometimes the communication is very small. It is filled 
 with an aqueous fluid, and in some instances there is also 
 in it a portion of the brain. 
 
 SYMPTOMS. 
 
 Inflammation of the dura mater is not distinguished by 
 any peculiar symptoms. The symptoms which belong 
 to it, are the same with those which attend inflammation 
 of the other membranes, and even differ but little from 
 the symptoms which take place in inflammation of the 
 brain itself. The symptoms are, pain in the head, delirium, 
 symptomatic fever, and sometimes convulsive motions. 
 
 When tumours have been found adhering to the dura 
 mater, or the other membranes of the brain, a long con- 
 tinued pain in the head has commonly been remarked, 
 sometimes delirium, sometimes convulsions, and some- 
 times, it has been said, the ordinary symptoms of apoplexy. 
 
 Where bony matter has been formed in the dura mater, 
 with sharp processes growing from it, convulsive motions 
 have very commonly occurred in various parts of the body, 
 often a continued pain in the head, sometimes delirium, 
 and sometimes temporary fits of insanity. 
 
 In cases where the veins of the pia mater have been 
 found turgid with blood, stupor has very frequently oc- 
 curred, sometimes delirium, and sometimes, even apoplexy 
 in its perfect form. 
 
The symptoms of inflammation in the pia mater, are 
 the same with those which attend inflammation of the 
 dura mater, and they have been already noticed. 
 
 In inflammation of the substance of the brain, there is 
 pain in the head, delirium, symptomatic fever, and some- 
 ' times coma. 
 
 Where an abscess has been formed in the brain, pain, 
 delirium, and coma, have been remarked, sometimes a 
 paralysis of a part of the body, and sometimes convulsions. 
 The last symptom has been observed most frequently to 
 occur when the abscess has been formed in the tuberculum 
 annulate or in the medulla oblongata, or in the neighbour- 
 hood of these structures, so that the pus could affect them 
 by its pressure. 
 
 Where the brain has been found to be more firm and 
 elastic than is natural, mania has been often known to 
 have occurred. I have been informed, however, lately, 
 from the best authority, that this state of brain is not 
 common in maniacs ; and that in them it is generally not 
 more firm, nor more elastic, than in people whose minds 
 have always seen sound. 
 
 The symptoms which have been observed to attend the 
 formation of solid, or encysted tumours in the brain, are 
 a permanent pain in the head, which is occasionally very 
 violent, sometimes delirium, sometimes convulsions, and 
 sometimes, it has been said, the common symptoms of 
 apoplexy. It is worthy of remark here, that when tu- 
 mours of any kind press upon the thalami nervorum opti- 
 corum, or the optic nerves themselves, within the cranium, 
 
287 
 
 vision generally becomes impaired in various ways;* and 
 that when tumours press upon the tuberculum annulare, 
 or the medulla oblongata, convulsions are very apt to occur. 
 In the case where hydatids were accumulated in the 
 lateral ventricles, the person had been subject for a long 
 time to pain in his head, which was often violent, and 
 towards the close of the disease, had several convulsion 
 fits, in one of which he expired. Neither his sight nor 
 hearing were impaired. 
 
 The symptoms of hydrocephalus, are a pain in the head, 
 stupor, convulsive motions, picking of the nose, grinding 
 of the teeth during sleep, occasional flushings of the face, 
 a motion of the head occasionally upon the pillow from one 
 side to the other, occasional sighing, and towards the latter 
 end of the disease, a dilatation of the pupils and squinting. 
 The stomach is commonly affected with sickness, and the 
 bowels are with difficulty acted upon by purgative medi- 
 cines. In the beginning of this disease, the pulse is fre- 
 quent but regular; when the disease has made a further 
 progress, it is slow and irregular; and towards the latter end 
 of the disease, it becomes again more regular and and fre- 
 quent. When the progress of the disease has been very 
 gradual, and the patient has continued to live for some 
 months, or even years, the functions of the brain have been 
 found in many instances, to be less impaired than might 
 have been expected, till near its close/ 
 
 * I have known one case in which the optic nerves at their junction were 
 pressed by a tumour as large as a gooseberry, and yet the pupils were not 
 dilated, nor the eye sight impaired, till within a day or two of the person'? 
 death, There was only a very violent pain in tlfe fore part of the hesftf 
 
Where blood has been effused upon any of the mem- 
 branes of the brain, the patient is more or less in a comatose 
 State, according to the degree of the effusion, or the different 
 susceptibility of the brain in different individuals to be 
 affected by pressure. Innumerable instances shew, that 
 the brain will have its functions impaired in very different 
 degrees, from the same apparent degree of injury. 
 
 When blood is effused into the substance of the brain, 
 apoplexy is produced, which is attended with the following 
 symptoms, viz. coma; generally stertorous breathing; a 
 paralysis, commonly of one half of the body; and often con- 
 vulsive motions. The pulse is slow, full, and generally very 
 strong. When the patient is not cut off at once, but lives 
 for some time after the attack, the hemiphlegia, which is 
 almost constantly an effect of this disease, is generally upon 
 the opposite side of the body from that of the brain, in 
 which the effusion of blood has taken place. This would 
 seem to shew, that the right side of the body derives its 
 nervous influence from the left side of the brain, and the 
 left side of the body its nervouS influence from the right 
 side of the brain. In a few instances, however, the hemi- 
 phlegia has occurred on the same side of the body with 
 the effusion.* 
 
 * Dr. John Hunter has made some very accurate dissections relative to 
 apoplexy, and its consequences, which formed the subject of the Gulstonian 
 lectures, read by him, 1796, before the College of Physicians. By these lectures, 
 I have been enabled to give a more satisfactory account of the appearances 
 connected with this disease, tfyan I should have been otherwise. 
 
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