leg were rather livid when first exposed, but not at all disorganized. It is remarkable that although there were some traces of florid blood in the anterior tibial artery, the femoral was found distended below the seat of the wound, with blood of the deepest modena hue. The colour of the calf of the leg was become very much darker since yesterday morning.

This patient's sensibility to warmth applied but just above the desiccated parts of his foot (although it was insensible to all other impressions) proves its nerves to have retained to the last some degree of vitality: and it may be worthy of inquiry, whether the drying of his toes, their cuticle remaining on, and the rapid desiccation of the limbs of some other patients, are not to be attributed (rather than to evaporation alone) to some degree of activity remaining in the absorbents of their affected limbs.

The state of this patient's limb, and the history of his case demonstrate that the powers of his constitution were expended to no beneficial end; no effort being made to separate the dead parts from the living, whilst the remains of life in the calf of his leg were to be preserved.

In conclusion I may mention an observation of my father's, which I find confirmed in the writings of others, that the pale, or white dry gangrene, as

it is more commonly called, takes place only where the veins of the parts affected are not obliterated; and that, on the contrary, the black dry gangrene is one result of the obliteration of both sets of blood vessels.

CASE

OF

ULCERATION AND RUPTURE

OF THE

STOMACH.

BY JOHN ELLIOTSON, M.D. CANTAB.

FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS, AND OF THE CAMBRIDGE PHILOSOPHICAL SOCIETY, AND PHYSICIAN TO ST. THOMAS'S HOSPITAL.

Read March 9th, 1824.

YESTERDAY week, Monday, March 1st, I was summoned, at half-past eight in the evening, to an unmarried lady, whom I had never seen before, about forty years of age, tall, thin, and of the melancholic temperament. She was standing in her bed-room, leaning on the neck of a female servant, and groaning with agony at the pit of the stomach. Her features, naturally long and sharp, seemed now unusually so; her swarthy pallid complexion was become cadaverous, and the expression of her countenance was that of the most dreadful suffering. She was shivering with cold, though before the fire, and her hands were icy and blue. Her pulse was a hundred and twenty, but neither full nor hard, nor particularly weak. Her breathing was very quick and short. She retched

every now and then, but vomited nothing more than the barley water she was drinking.

I was informed that she had been in this state rather above an hour: that she first complained of chilliness for about five minutes, and was observed to fix her eyes on vacancy for a minute or two, and then suddenly cried out with pain at the pit of the stomach. She was supposed to have taken cold by walking to church the preceding day, which was wet, instead of going in the carriage, as usual, with the rest of the family. She had dined upon pork a few hours before the attack, but assured me that, though very dyspeptic, she found pork agree with her better than any other kind of meat. Her bowels had been open in the morning. She had no hernia.

I instantly gave her sixty drops of tincture of opium. This was soon rejected, at least in part, and, as she found no relief, I gave her sixty more in twenty minutes. Twice more I repeated this dose, but without benefit. From the first there was pain of the epigastrium on pressure, but this evidently increased, although the constant agony remained as before. It was now near midnight, and I took a lancet from my pocket book and bled her in the arm to the amount of about twenty ounces. She did not become faint, nor did she experience the least relief, and the blood was found the next morning neither cupped nor buffy. I then

gave her the fifth dose of sixty drops of tincture of opium, and she soon found herself considerably better, but no drowsiness, headache, or other effect ever took place, except constipation and thirst, in producing which inflammation must have had a share.

The next day, she still remained better, but there was so much tenderness of the abdomen left that I prescribed a very large blister, and, to counteract the constipating agency of the opium, ten grains of calomel. She told me she was much better, and that she had "felt that life was ebbing fast the evening before, till she took the last dose of opium." There was great thirst, but no foulness of tongue.

On Wednesday-the third day, the tenderness was so great that the least pressure with the point of a finger was intolerable, and it now extended. all over the abdomen; the pulse was still a hundred and twenty, but small and feeble; the coldness, and the shortness and rapidity of respiration continued; the countenance was more ghastly than ever; the bowels had not been affected by the calomel; the tongue was still clean, but the thirst was undiminished, and she had been incessantly drinking water so hot that no one but herself could hold the glass from which she drank it. Five grains of calomel were ordered to be given every three hours till an evacuation was procured, and