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the weight of its contents broke it up in several parts, thefluid, which was very acid, escaping through the rent thusformed. On opening the organ, the whole of the cardiacextremity was seen denuded of its mucous membrane; thegreat curvature was in the same state, but the mucous liningwas not destroyed along the lesser and pyloric extremities.The kidneys were slightly granular on the surface; the liverrather fatty, but otherwise healthy, as far as the unaided eyecould discern..

It is stated in the relation of this case (see above) that "overthe left nipple, and towards the epigastrium, a to and frocardiac friction-sound is heard, which is stronger on pressure."To the latter circumstance we would direct especial attention,as by slight pressure with the stethoscope, and the interventionof a card between the skin and the instrument, the bruit, which-ever it may be, is rendered very clear. Dr. Sibson was kindenough to point out this peculiarity to us in the wards of thishospital. ____

KING’S COLLEGE HOSPITAL.

HÆMORRHAGE FROM THE JEJUNUM; DEATH; AUTOPSY.

(Under the care of Dr. TODD.)THOUGH the theory of haemorrhage by exhalation is some-

what surrounded by obscurity, we now and then meet with ’,oases which afford striking proofs that the blood cannot haveescaped by any other way than exudation; and among theseinstances a perfectly unbroken intestinal mucous membrane I,after death from melæna, is one of the most unanswerable.When this form of passive hæmorrhage takes place in a patientdebilitated by want and mental distress, we are naturallyled to establish a comparison between the intestinal haemorrhageand purpura. For it is plain that both pathological phenomenaare originally the same, the difference being simply that theepithelium offers less resistance to the passage of blood thanthe epidermis. No doubt but the fluid of perspiration finds itsway through the cuticle, but we may suppose that in dia-phoresis there is more force acting from within, and more re-laxation of the vascular network.To return to haemorrhage from the bowels, it may be stated

that cases of this kind are of a very distressing nature, both asregards the patient and the physician, since it is extremelypainful to the latter to see the life-blood oozing from thesystem, and to observe the inadequacy of the means adoptedfor the control of the hæmorrhage. And the task becomesdoubly difficult in cases where bad nourishment and depressionof mind have been principally conducive to the haemorrhage,for it may be supposed that in such cases two powerful causesare acting at the same time-viz., increased fluidity of theblood, and want of tone in the vessels. It is evident that as-tringents, topically used, can only act upon the vessels of theaffected mucous membrane; and the aqueous condition of theblood remaining the same, it cannot excite surprise to see thebest directed means for arresting haemorrhage proving useless.It is here that prevention should be thought of, for by propermedicines and diet the condition of the circulating fluid maybe greatly improved, and this favourable result might in manyinstances altogether prevent, or render but very trifling, anattack of intestinal hæmorrhage.

It is to be regretted that in the following case the state ofthe portal circulation was not described, because passive in-testinal haemorrhage depending on this cause in a weak subjectis known to be almost certainly fatal, and the inefficacy of theremedies would thus be in some degree doubly explained. Itwill be seen below that the patient refused the enema of icedwater, which, if taken, might perhaps have turned the scale inhis favour; but he was a medical man, and hence a littletimorous. We would finally call attention to a circumstanceof the case which should not pass unnoticed : the patient hadsuffered from an attack of fever some months before being seizedwith the haemorrhage from the bowels, and one is naturallyinclined to inquire whether the fever left on the intestinalmucous membrane an impression which might be looked uponas a predisposing cause of the haemorrhagic attack. The

following brief details were obtained from the notes of Mr.Holderton, one of Dr. Todd’s clinical clerks :-Anthony de G-, aged forty-five years, a native of Poland,

and belonging to the medical profession, was admitted May 19th,1854, under the care of Dr. Todd.The patient states that last year he was an inmate of Guy’s

Hospital from November to January, suffering from feverbrought on by mental and bodily distress. Since that periodhe had enjoyed tolerable health until about a week beforeadmission, when he was attacked by dysentery, the evacuations

being principally composed of blood. The abdominal complaintwas accompanied by frequent fits of vomiting, and the patientcannot assign any cause for the severe symptoms under whichhe laboured. The motions from the bowels have been as manyas fourteen or fifteen per diem.

Dr. Todd ordered one grain of calomel and one of opium tobe taken every third hour. The evacuations remained, how-ever, as numerous and of the same nature as before, so that astarch enema was administered, and ordered to be repeated iffound inefficient.On the next day, at eleven in the morning, it was found

that the patient had had a quiet night; he was free from pain,and had not had any return of the purging. But towards twoo’clock in the afternoon the alvine discharges began again, themotions consisting almost entirely of blood, and the pulse beingvery weak. Brandy was given at short intervals until Dr. Toddsaw the patient, when one grain of acetate of lead, with half a.

grain of opium, were ordered to be taken every third hour, asalso iced water injections; the latter, however, the patientrefused. The purging continued incessantly until ten o’clockat night, when delirium, gaping, and hiccough came on, thepoor man tossing himself from side to side, and seeming ingreat distress. He died in a state of extreme exhaustion atfour o’clock in the morning.

Po8t-morte-m examination, eighty-four hours after death.-Atolerably well-made, muscular man, of medium height, pre-senting nothing externally worthy of notice. The brain andthoracic viscera were found healthy, the vessels of the formerorgan being rather full of blood than otherwise. On openingthe abdomen and turning up the omentum, the first ten ortwelve inches of the jejunum appeared of a dark, damaskcolour, which was gradually lost below that point. Theexternal surface of the bowel was smooth and glistening, andthere was no appearance of peritonitis. Above and below, theintestines appeared healthy, both internally and externally.Peyer’s patches were normal, and there was no evidence any-where of abrasion of surface. The bowels contained a consider.able quantity of highly offensive blood, of the same dark hueas noticed in the jejunum. The livid portion of the latter.presented much the same colour internally as on the outersurface; it was much thickened and gorged with blood, butthere was no ulceration, and the mucous membrane was easilydetached. Under the microscope, the vessels were seen muchdistended with blood, but the mucous membrane was entire.Kidneys healthy,; spleen enlarged; rectum perfectly healthy.

LONDON HOSPITAL.

ANEURISM OF THE OPHTHALMIC ARTERY; DELIGATION OF THECAROTID.

(Performed by Mr. CURLING.)DELIGATION. of the carotid artery, though pretty often per-

formed, is nevertheless an operation of much importance, andshould never pass unnoticed. Indeed, the results of thisoperative measure are of so hazardous a kind that every casein which it is resorted to should be carefully noted, were itmerely for the sake of facilitating the framing of statisticaltables. But if the deligation of the carotid is worthy of fixingour attention, the fact of its being undertaken to promote theconsolidation of an ophthalmic aneurism makes it still moreimperative upon us to direct the attention of our readers to thecase. Aneurisms of the ophthalmic artery are avowedly rare,and when we heard of the present case we felt greatly in.terested, as just at the same time another case of aneurism ofa vessel very seldom attacked-viz., the glutæal, had for sometime past been the subject of conversation in surgical circles.But those who thought that a case of the latter kind hadactually been seen at King’s College, under the care of Mr.Fergusson, were misinformed, as there had been but a suspicionthat a pulsating tumour, situated over the left sacro-iliacsynchondrosis, of a thin and debilitated patient, was connectedwith the glutseal artery. Various circumstances have sincemade it clear that the swelling is owing to other causes, thenature of which we shall state when we come to report thecase, which has certainly excited more than common interest.Being on the subject of aneurisms of vessels seldom so

attacked, we may say that a patient presented himself a fewdays ago to Mr. de Méric, at the German Hospital, Dalston,who had a flattened tumour on the right temple, pulsatingstrongly, and yielding to the ear a very distinct bruit; the eyeon the corresponding side was much pushed forwards, and thesight very dim. The case is under observation.As to Mr. Curling’s case, it would seem that it is of a

traumatic kind, for the patient, who is about forty-nine years