APPENDIX

Elizabeth Cooper. On the 26tli of September tlie symptoms remained the same, but the patient more exhausted and feeble. 29th. Has continned to sink rapidly. She is quite free from pain, but so exhausted that she can hardly speak or cougb. The expectoration is considerably more abundant, and consista of muco-purulent rounded portions. Cannot sleep much from laryngeal spasm, wbich cornes on at such times ; the voice, however, is natural, though in a whisper, but there is much dysphagia. The tongue continues to be covered with aphthæ, The patient manifests much intolérance of light.

She continned to sink, and died on the 3rd of October, at 4 o’clock, A.M.

Post mortem examination at 3 o’clock p.m. October 4th. The body was excessively emaciated,

Left lung. — The pleural surfaces ’were adhèrent over the ■whole of the upper portions of the left lung, by bands of false membrane, which admitted of being broken down by the finger, and at the apex of the superior lobe (that portion which passes up beneath the clavicie) very closely by a thick tubercular layer inseparably connected with the lung itself. When the lung was removed from the chest a complété cap, or hollow cône of tuberculous matter, with some small portions of lung, were left behind from this cause.

The lung itself was a mass of softening and softened tubercles, gradually shaded off inferiorly, the only sound portion being over a small space inferiorly and posteriorly. The superior lobe was especially affected, and, when eut into, showed no sound parts, but a tissue replete with softening, and softened tubeycles, which was dripping with pus, but without any decided cavity or cavities. There was much purulent fluid in the lower lobe of the

îung, but many of thc tubercles were Icss softcned tlian in the upper lobe.

Riffkt lung. — The pleural surfaces were adhèrent in an exactly sirailar manner hcre as on the left side, and the removal of the lung left the same hollow cône of tubcrculous matter beneath the clavicle. There was a small portion of adematous, but crépitant, and otherwise healthy lung situated superiorly and anteriorly. Ail other parts of the lung were loaded with softening tubercles, but free from caverns.

Heart. — The heart was of small size, otherwise healthy.

Larynx and Trachea. — The mucuous membrane lining the posterior wall of the trachea, throughout its whole length, was covered with a layer of tuberculous matter, which, on being scraped off, showed a vascular and abraded surface, with three or four superficial ulcers. The epiglottis was vascular, and there was a considérable lump of softened tubercle in the left arytænoepiglottic ligament.

LouiSxV Willett. On the 9th of October Louisa Willett applied at the Blenheim-street Infirmary after her return from Margate. She stated that during the use of baths she had some return of shortness of breath and cough, but that these symptoms were now much better. Her thumb was completely healed, leaving an unsightly cicatrix, and a stiff joint ; and she was in the enjoyment of much better health. During her résidence in Margate she had become stronger and stouter. Both sides of her chest sounded equally well on percussion ; there was no morbid résonance of the voice ; and the respiratory murmurs were perfectly normal on both sides.

She complained of a sense of distention in the epigastric région after dinner, attended by shortness of breath, and slight cough. She was directed Mist. Tonie, ^i ter die.

W. OSTELL, FEINTER, H ART-STEEET, BLOO.MSBURY.