and a sense of impending suffocation also accompany this pain. He complains also of want of sleep, and says that he feels hungry, but is with difficulty persuaded to eat anything, the stomach having for the last week been very irritable. On making a stethescopic examination of the thorax, the respiration was found to be puerile, especially "anteriorly, and in the upper and middle lobes of the right lung. The heart's sounds obscured entirely the respirations in the left. The area of precordial dulness was increased, and the friction sounds of pericarditis, with tumultuous action of the heart, were easily recognised. His countenance was expressive of anxiety, and respiration was almost impossible, except in the upright position. The liver did not present any evidences of enlargement; and his case was set down as one of pericarditis. The treatment consisted in the administration of alkalies, with counter-irritants and the free exhibition of diffusible stimulants. On the second day after his admission, the pain in tho region of the heart became more severe, and blood, which presented the buffed and cupped appearance of inflammation, was drawn by cupping from over the seat of pain, to the amount of two and a half ounces. The relief afforded was marked, but only transitory. Anodynes were prescribed every night to procure sleep and soothe pain. On the morning of the third day from his admission, he expressed himself as better, the dyspnoea being less urgent, and the anodyne administered on the previous evening having procured for him refreshing sleep. On examining him now with the stethoscope, it was evident that effusion into the pericardium had commenced, and had gone on to a considerable extent through noea

CASES FROM PRACTICE. piq-p

"PROjM

By William

EUROPEAN GENERAL HOSPITAL, BOMBAY.

THE

Nolan, M.B.

&

A.B., Univ. Due., M.R.C.S

Assistant-Surgeon,

Indian

.,

Army.

PERICARDITIS ; HEPATIC ABSCESS SIMULATING RUPTURE OF THE ABSCESS INTO THE PERICARDIUM; DEATH, AUTOPSY. William Milne, aged 25 years, born in Aberdeen, Scotland, 2nd Mate on board the Steamer General Havelock, from Liverpool was admitted into the European General Hospital on May 30th, 1867. History.?With the exception of the month or five "weeks immediately preceding his admission, his health has always been excellent?has in fact not known what it is to be sick. He has just recovered from a gonorrhoea, and his gums show traces of recent salivation. He has latterly become quite unfit for the performance of his duties, the least exertion being productive of pain. This he described as sharp and lancinating in character, starting from a little below the left nipple, and extending upwards towards the shoulder and down the arm of the same side. Dysp-

178

THE INDIAN MEDICAL GAZETTE.

the night. A large blister was applied. About 2 o'clock on the same day ho was seized with severe pain over the apex of the heart, while at the same time the dyspnoea became more

oppressive.

In this condition he lingered about four hours, and died in the evening, evidently suffering great pain. Autopsy, 13 hours after death. JRirjor mortis well marked. Body in good condition. Forward bulging of left chest, the area of precordial dulness being nearly doubled. On removing the thoracic parietes, attention was directed to the pericardium, which The was found to contain 20 oz. of a sero-sanguinolent fluid. heart itself was covered with lymph, which was soft and easily broken up. There was adhesion between the opposed surfaces posteriorly and at the apex, the fluid being confined to the anterior and upper parts of the sac, which was increased to its normal size, and was very vascular detached pieces of lymph floated in the effused fluid. Near the apex of the heart, and where the pericardium and diaphragm are united, an opening with thin ulcerated edges, and capable of easily admitting the little finger, was discovered. Through this pus was observed to be making its way, and to be mingling with the already effused fluid.

nearly three times throughout. Small

[July 1,

1867.

the abdominal parietes, a large abscess was exleft lobe of the liver. Its form was circular, and was large enough to contain a medium sized cocoanut. Its anterior wall was formed by the ensiform cartilage and abdominal parietes Inferiorly it was bounded by what little liver substance remained between this organ and the stomach, and towards the mesial line it was quite separated from the right lobe by the ligamentum suspensorium. The lining membrane was about quarter of an inch in thickness, the only tendency to point being at the place above described. The weight of the liver was 4 lbs. and 13 oz. avoirdupois. The lungs were congested, especially the left, which was also compressed and flattened. There were slight old pleural No endocarditis existed, nor was adhesions on both sides. there any valvular disease. The kidneys presented no morbid appearances. On opening the stomach, and exposing the whole intestinal canal, great injection of the former, and reddening The jejunum of the entire mucous surface, was observed. presented a similar condition. There are two points of interest connected with this case : ls?. The difficulty of diagnosis with an abscess so situated. 2nd. The rarity of an abscess discharging itself into the On

posed

reflecting in the

pericardium.