109 
I temporary improvement; good night’s rest followed. This morning restless and 
! very delirious. Resists all attempts at passive motion. Urine passed involuntarily, 
j Pupils widely dilated notwithstanding the administration of large amounts of mor- 
: phine. Yesterday had 9 grains between 2 and 10 p. m. Face and spots not so dusky 
j as yesterday. Lungs examined anteriorly and found as at last note. Harsh sounds 
i at right apex. 
I June 28; Bled 1 ounce last night. Very restless and delirious - this morning. 
IMorphine, grains 4.5 from 7 to 10 a. m., with no apparent effect. Lungs edematous. 
Patient died at 11.30 o’clock a. m. 
Autopsy, 3 hours after death: Body of well-nourished woman, showing no marks 
of violence except some small scabbed abrasions on the leg, phlebotomy incision on 
arm, and needle puncture below left breast and on arms. Purple discoloration on 
dependent portions of body. All measly eruption has disappeared from the upper 
portion of body. Posterior of body blue, shows many spots, very dark blue or purple, 
from 1 to 3 or 4 mm. in diameter. Over the left buttock and coccyx are a few purple 
areas ( 1 by 4 to 6 cm. ) that look like extravasations. Slight bloody discharge from the 
vagina. Calvarium being removed shows outer surface of dura injected, but otherwise 
normal. Removal of dura shows some adhesions at the vertex between the membranes 
and the brain substance. Area of adhesions small. Veins on surface of brain are dis- 
tended with blood. Vo pus or lymph seen. Base of skull and dura normal. Ventricles 
opened and appear normal, except for some distension of the veins. Small amount of 
bloody serum, blood of which very probably came from cut veins, in one lateral ventri- 
cle. Cerebrum on section appears about normal. Basal ganglia on section appear nor- 
mal. Section of medulla, pons, and cerebellum shows nothing abnormal. Incision 
from manubrium to pubis shows good amount of subcutaneous fat. Muscles well devel- 
oped and of good color. Peritoneum normal. Removal of sternum shows remnants 
of thymus gland. Pleural cavities normal, except a few adhesions between the left 
lung and the pericardium; latter contains an apparant excess of clear straw-colored 
serum. Heart distended with blood. Left ventricle partially contracted. Removal 
of right lung shows it lead color on upper surface, very dark posteriorly. Several dark 
spots one-eighth inch in diameter, apparently old, anteriorly. Entire lung edematous. 
Posterior portion extremely congested; in a condition of hypostatic pneumonia, and 
sinks in water. Bronchial glands enlarged and black. Removal of left lung shows 
same appearance as right except the pneumonic area is less marked and less exten- 
sive. Heart on removal seems normal, muscle well nourished; left side contains 
chicken fat and red clots. A'alves normal. Right side contains a few small clots, white 
and red. Valves apparently normal. First part of aorta normal. Arch of aorta 
seems unusually small, just permitting little finger to enter. Examination of abdomen 
shows peritoneum normal, considerable amount of straw-colored serum present. 
Organs in normal relation and position. Spleen enlarged and bound down by pos- 
terior adhesions and adhesions to stomach. Soft, easily torn; slaty -purple in color. 
Liver apparently somewhat enlarged; paler than usual, with yello^^■ish tinge, which is 
probably fat. Section of liver is decidedly pale; what little blood flows is also very 
pale; tissue is firm, though not apparently fibroid. Gall bladder distended with 
fluid bile, duct patulous. Vo gallstones. Gross appearance of left suprarenal shows 
it apparently normal. Size of left kidney 13 by 7 by 6 cm. Section shows the cor- 
tex little if at all altered. Capsule is adherent, carrying substance in removal. 
Areas of distinct pallor scattered over the surface. Right suprarenal appears con- 
gested, otherwise normal. Right kidney 12 by 7 cm. Cortex pale and thickened. 
(Doctor Alills thinks it normal.) Capsule adherent in same way. Pancreas appar- 
ently normal. Stomach shows injection about cardiac end, otherwise appears normal. 
Intestines removed, opened, and washed. Upper portion appears normal. Solitary 
glands and Peyer’s patches appear somewhat swollen. Cecum shows considerable 
injection, which continues more or less throughout the colon. The uterus is enlarged 
