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CASE 1.—en route from Richmond, Va., to his
home. He had severe and persistent vomiting, ejecting a
watery fluid mixed with bile and portions of undigested
food. He was more or less comatose from the first, but
sometimes answered questions rationally. There was no
epigastric or hepatic tenderness, and no evidence of pain
except on the 12th, when he complained of his right hip.
His tongue was dry, thirst excessive, urine copious and
passed involuntarily, and his bowels, although constipated,
were readily moved by enemata. Oxalate of cerium, creasote,
bismuth, morphia and chloroform with counter-irritants were
employed, without success, to check the vomiting. Only
raw eggs and small quantities of milk were retained.
Nourishing enemata were frequently administered. He died on
Post-mortem examination: Body moderately
emaciated. The brain was not examined. The thoracic viscera
were healthy. The liver was rather larger than normal, but
healthy. The stomach was normal in size and contained some
watery fluid; its mucous membrane was reddened and its
pyloric orifice contracted. At the commencement of the
duodenum there was a firm well-marked constriction, reducing
its calibre to less than half an inch in diameter. Around
this portion of the intestine were deposits of coagulable
lymph, and immediately below, on the posterior aspect of the
gut, was a perforation with thickened and introverted edges.
The gall-bladder was distended. The kidneys were normal.—