Sessional_Paper_1895 — Page 203

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MORBID ANATOMY.

On opening the abdomen in only a few cases could the spleen be seen coming below the ribs. It was however always somewhat enlarged and hyperæmic. In consistence it was softer than normal but not diffluent as is sometimes met with in malignant malarial cases The malpighian bo lies were always swollen and well marke. There were occasionally small punetate subcapsular hæmorrhages, these were never large on the surface of the spleen. In one or two post mortems consider- ably enlarged spleens were met with, but in my opinion the enlargements were principally due to malarial causes, and this seemed to be borne out by the greatly thickened and fibrous capsules. This would not be likely to happen in the course of a week's illness. Towards the end of the epidemic very few hemorrhages were found on the surface of the spleen, or in fact anywhere.

The liver as a rule showed no marked enlargement. It was generally soft and more friable than normal. Occasionally small haemorrhages were seen on the upper surface---punctate in character. It was generally somewhat paler than usual, but in two cases the substance was deeply bile-stained. The gall bladder was almost always full of dark brown tarry bile-on very few occasions post mortem was it found really distended. The kidneys were usually congested, with occasional small subcapsular hæmorrhages; none were seen in the substance of the kidney.

In the mesentery very large hæmorrhages were sometimes met with, and these seemed to be largest in cases where the glandular affection partook of a large hæmorrhagic character. Hæmorrhage on the serous coat of the stomach was not seen. On the mucous surface they were occasionally seen, and here again they were always punctate in character. The small intestine was occasionally inflamed somewhat, and here on several occasions Peyer's patches were distinctly affected, rising slightly above the surrounding surface, and presenting a retiform appearance. On a few occasions some of the solitary glands in the large intestine showed a similar inflammation. The mesenteric glands were almost always enlarged; some. times slightly, generally markedly, and occasionally considerably. When small they were of a dark blue or purple colour, with no hemorrhage into or around them. As the size of the gland enlarged there seemed to be a greater tendency to a sero-sanguineous effusion around, as in the case of the externally apparent buboes. Hæmorrhage into the ovary (considerable) was met with once, and also a hæmorr- hagic endometritis.

The lungs were generally somewhat congested and dark at their bases, and occasionally some fluid was found in the pleurae; but this was never seen in quantity say of a pint. Pneumonia was present in a few cases. Hæmorrhages were rare on the visceral pleura; on the parietal pleura they were not seen at all. In two or three cases of persons who died late (i.e, after the tenth day) in the disease mul- tiple abscesses were found, pyæmic in character. The bronchial glands were often enlarged although rarely to a great degree. I never saw any of the bronchial glands exhibit the hæmorrhagic type sometimes found in the mesentery. The larynx was sometimes congested and inflamed, but this was co-existent usually with large cervical glandular enlargement, though by no means invariably so.

In some of the early cases we found the left side of the heart firmly contracted, with the right side dilated. In almost every case examined the right side of the heart was dilated, but in some of these cases we were rather surprised to find the left contracted--it was perhaps to be expected that it might be empty or almost so, but not in the firm condition in which we found it. To my mind this calls for thoughtful consideration, and I regret that a reasonable explanation does not suggest itself to me at present. On a few occasions a small amount (a few ounces) of pericardial fluid was present. The substance of the heart in those who had been ill for several days was generally softer and paler than usual-inflamına- tion going on to fatty degeneration. Under the visceral pericardium on several occasions punctate hemorrhages were seen-none upon the endocardium. No fresh endocarditis or pericarditis was seen. Antemortem clots were frequently found, especially on the right side; these were generally small however, and did not fill

up the cavities, a large quantity of fluid dark watery blood being also present, whilst the vena cava were generally distended by the same fluid.

The thyroid gland was never enlarged except when evidently due to direct extension of the inflammatory mischief in the neck. The thymus in a child was in one case the seat of a large abscess, co-existent with pyæinic abscesses of the lungs.

On opening the skull the meninges were invariably found to be hyperemic, as was frequently the brain matter. In a few cases there was an increase of cerebro-spinal fluid, but this was seldom marked. Both the dural and pial

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