186 
CORRESPONDENCE. 
the back and lie for a minute or two, then arise. A rectal ex¬ 
amination revealed nothing. Percussion resulted in the finding 
of a dull spot about the size of a man’s head in the lower poste¬ 
rior part of the chest. Auscultation showed the respiration to be 
very superficial. Considering the displacement of lung tissue, 
the suddenness of attack, and the nervous shock, a probable 
diagnosis of rupture of the diaphragm, with hernia of the small 
intestine, was made. This belief was increased when, after a 
few hours’ time, the dull spot disappeared from the right side of 
the chest, grew larger on the left side, and gradually became 
tympanitic. That obstruction to the passage of food from the 
stomach existed, seemed conclusively proven by the frequent 
eructation of gases and vomiting of the contents of the stomach. 
Considering the case hopeless, grain doses each of atropine and 
morphine were given every four or six hours, with an occasional 
dose of ammonia and chloride of lime to relieve the stomach of 
gas. After a sickness of 35 hours, the patient died suddenly from 
a failure of the heart, and a post-mortem examination was made. 
The stomach was distended to its very greatest capacity with gas, 
partly digested food and fluids. On the floor of the left culde- 
sac, near the great curvature and near the line separating the 
dense from the soft mucous membrane, three ulcers were found. 
Judging from the appearance of the largest one, they had existed 
for a long time, and yet the patient had never been sick, was in 
the best condition possible, and was always a free, prompt driver. 
I forward you, by express, the specimen. 
On examining the small intestine, it was found to be greatly 
distended in the form of a sac, from near the pylorus backward, 
to the distance of twelve inches, where it terminated by a strict¬ 
ure which partly closed the canal. Yet it was sufficiently large 
to permit of the passage of the little finger. But little alimentary 
matter had recently passed the stricture. The mucous membrane 
lining the sac, and the stricture, was deeply discolored by blood. 
I should like to ask what caused the apparent great nervous 
shock ? Did the patient suffer from angina ? 
A. A. Holcombe, I.V.S.U.S.A. 
Fort Leavenworth, Kas., April 20, 1883. 
