9 



counted 134. The patient complained of great thirst, but ap- 

 parently suffered no pain. On the morning of March 10 he was 

 again seen. The subsultus of the hands was marked and there was 

 some muttering delirium. The pulse was 120, of high tension 

 but not dicrotic. His condition at this time suggested t3'phoid 

 fever — a diagnosis, in fact, adhered to by one of the hospital staff — 

 yet upon a careful analysis of the symptoms of the case the diagnosis 

 of typhoid hardly seemed justifiable, and the serum again gave no 

 Widal reaction. At 11.30 a. m. of this day a second intestinal 

 hemorrhage occurred, about 300 cubic centimeters of dark blood 

 being passed. On the following day the intestinal symptoms seemed 

 a little improved, l)ut the leucocytosis and fever continued. On 

 March 12, at 3.30 p. m., 400 cubic centimeters of fresh l)lood was 

 passed from the rectum. The temperature dropped to 101° and 

 the pulse became very weak and counted 140. An hour later 

 another hemorrhage of about 200 cubic centimeters occurred. At 

 6.30 p. m. a large amount of clotted blood was passed. The 

 patient comjilainod of great exhaustion and weakness. At 8 p. m. 

 another large hemorrhage occurred and at midnight and again at 

 12.30 a. m. smaller hemorrhages were passed. The pulse gradually 

 weakened and increased in rapidity. Finally it no longer could 

 be counted. The patient became very delirious and died during 

 the night. Shortly before death there was a dark-brown watery 

 stool. 



At autopsy a large aliscess measuring 12 centimeters in diameter 

 was found in the right lobe of the liver situated superiorly and near 

 the posterior surface. The liver was not enlarged. The gall 

 bladder and ducts were normal. The spleen also showed no patho- 

 logical change. The walls of the large intestine were not partic- 

 ularly thickened and there was no excessive oedema of the sub- 

 mucous coat. In the ascending, transverse, and upper portions of 

 the descending colon there were about fifty or sixty ulcers scattered 

 here and there, generally with even margins and with clean bases. 

 Their edges were very slightly undermined. They measured from 

 about 3 to 12 millimeters in diameter and about 1^ to 2 millimeters 

 in depth. Approximately 5 centimeters below the caecum was an 

 ulcer filled with a lightly adherent clot. On removal of the clot 

 a freshly thrombosed vessel could be detected. At the edge of 

 the ulcer the vessel was injected and could be traced with the 

 naked eve for about 1 centimeter in the sul)miicosa. There was no 



