Report of fatal diseases and morbid appearances observed in the post-mortem examinations made at St. George's Hospital during the year 1843 / [Repr. from Lond. med. Gaz].

Henry Lee

Date:: [1844]

Credit: Report of fatal diseases and morbid appearances observed in the post-mortem examinations made at St. George's Hospital during the year 1843 / [Repr. from Lond. med. Gaz]. Source: Wellcome Collection.

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prostate gland, and in the same situa¬ tion were several tuberculated eleva¬ tions, varying in size from a pea to a hazel nut; some of these of the largest size were filled with a white milky fluid ; others contained a solid semi¬ transparent substance, and others again consisted of a yellow opaque matter re¬ sembling tubercular deposit. The re¬ maining part of the mucous membrane of the bladder was healthy. A ffections of the Urethra.—Ulcera¬ tion of the urethra permitting the escape of urine was fatal in three in¬ stances. In two of these the opening occurred in the bulbous portions, and in one in the membranous portion of the urethra : the consequent extrava¬ sation of urine was situated in the former cases between the perineal fasciae ; in the latter, within the triangular ligament. A fourth case may be allied to these, in which advanced disease of the kidneys accompanied a confirmed stricture. Diffuse cellular inflammation occurred in this case, without any extravasation of urine. Strangulated Hernia.— Of seventeen atients operated on for strangulated ernia during the year, six died. In one of the cases w^hich proved fatal the patient had been delivered shortly before the operation; in a second the patient was labouring under disease of the brain; and a third was suffering from an attack of fever before the hernia had become strangulated. One of the remaining cases died in conse¬ quence of mortification of the bowel, and twro proved fatal from inflammation of the intestine and peritoneum. In both these last cases, a sac, formed by the omentum, enveloped the bowrel, in addition to the ordinary peritoneal sac. A separate account of these cases will shortly appear, and therefore no farther observations upon them will at present be offered. Strangulation of the small intestine, unaccompanied by hernia, was in one instance the cause of death. A portion of the small intestine in the form of S had become inflamed, and the different portions glued together by recently effused lymph : a considerable mass wras thus formed, the base of which was encircled by another double fold of small intestine likewise retained in its position by recent adhesions. The passage of the bowel w7as by these means completely obstructed. A di¬ verticulum existed at one portion of the intestine, consisting of a canal about a quarter of an inch in diameter, and four inches long, considerably dilated at its closed extremity, and containing some foreign bodies. This did not appear to be connected with the cause of the obstruction of the intestine. The following cases proved fatal each in one instance. Hydatid cysts in the abdomen.— Erysipelas had in this case immediately preceded death. The body was greatly emaciated, but the abdomen enormously distended. The recti muscles were widely separated by the pressure of the abdominal contents, and the parietes consequently rendered so thin, that some small moveable tumors within the abdomen conveyed the sensation of being subcutaneous. On opening the abdominal cavity, numerous hydatid cysts were seen attached to the omen¬ tum : some of these were almost trans¬ parent, but in others the parietes had attained considerable thickness. A cir¬ cumscribed, soft, elevated growth, re¬ sembling a wrnrty excrescence, had de¬ veloped itself from the internal surface of several of these cysts. Almost every part of the abdomen was similarly oc¬ cupied by hydatids ; the contents of the cysts in the neighbourhood of the liver had assumed in several instances a yellow7 colour, while in contact with the intestine they appeared as though tinged with fecal matter. One very large cyst was situated upon the under surface of the liver, and had become partly imbedded in its substance. Another cyst of very large size wras situated above the liver, and by its pres¬ sure had made its way through the right side of the diaphragm, encroach¬ ing upon the corresponding flung. A smaller one upon the left side had also caused the absorption of the diaphragm and protruded into the cavity of the chest beneath the pericardium. Some small hydatid cysts were also developed from the peritoneum, covering the ab¬ dominal muscles. Hcematemesis.—The patient in this case died after repeated vomiting of large quantities of blood. On the upper part of the posterior wrall of the stomach the remains of an oval ulcer presented itself. It was perfectly healed, wflth the exception of one point, where a small rounded mamillary eminence projected from the

Report of fatal diseases and morbid appearances observed in the post-mortem examinations made at St. George's Hospital during the year 1843 / [Repr. from Lond. med. Gaz].

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