AFFECTION OF THE (ESOPHAGUS AND JUGULAR. 43 
first time), about three gallons of gruel in the course of the day 
were passed down. 
30M. — Nearly the same ; and although, while attempting to 
drink, a great quantity of gruel was continually returning 
through the nostrils, still she managed to swallow nearly as 
much as the day before. 
From this time the paralysis increased, the eye becoming af- 
fected, and the lower lip more pendulous. She gradually became 
worse, and on the 5th she died. 
Up to this period every thing was conjectural ; but a post- 
mortem examination satisfactorily accounted for the symptoms, 
the immediate cause still remaining unexplained. 
On examining the head, and removing the inferior maxillary, 
nothing more than ordinary was to be seen. The tongue, pa- 
late, larynx, &c. all looked healthy; but on removing the larynx 
and oesophagus together, I found a considerable quantity of 
coagulated blood situated immediately superior to the oesopha- 
gus, and which, I should think, at first must have been more than 
a pint. It had evidently been produced by the rupture of one 
division of the superior branch of the jugular. The coagulum 
was to so great an extent, that it had produced a great degree of 
pressure on the head of the oesophagus, and thus prevented its 
action ; for, on examination, it lay as flat against the larynx as it 
was possible for it to do, and it was with difficulty that I could 
pass any thing through it. Being so compressed, it appeared as 
if, from the constant and violent exertion to remove the food 
— not being able to swallow — the membrane had been forced 
backwards so as to form a sac, sufficiently large to hold an 
egg, into which no doubt the tube went in the attempt to 
pass it. 
The party belonging to her did not like — acting upon the old 
adage, £< as long as there is life there is hope” — to throw a chance 
away by destroying her ; however, there is no doubt that she died 
from regular exhaustion. 
The mucous and salivary fluids being streaked with blood, I 
conceive to have been caused by the rupture of some superficial 
vessel in the air-passages, brought on by the suffocating distress 
that took place on the onset. Absorption of the clot likewise, 
I think, accounts for the disappearance of some of the external 
swelling, and thereby partially admitting of deglutition. The 
real cause of the mischief will probably never be ascertained, but 
T have very little doubt that it was the result of some external 
injury. 
Case II. — This is one which I have never before met with, 
and which, perhaps, I never may meet with again. 
