Embolism, of the Spleen and Kidney, from Fatty Softening of the Mitral Valve, probably following Endocarditis

W. W. KEEN
1868 American Journal of the Medical Sciences  
descending colon a fourth of an inch thick, extensively ulcerated; the pia mater congested, the sinuses full of blood; the arachnoid opaque, with numerous adhesions, and serous effusion beneath it and into the ventricles. The body was much emaciated, and spotted with petechiae. Gastric Ulcer; Death from Exhaustion.-Dr. Geo. Pepper exhibited the specimen, and said: J. D. R., set. 52, white, American; married; father healthy; mother died of phthisis pulmonalis at the age of 53. Fifteen years ago
more » ... Fifteen years ago he first began to suffer from dyspeptic symptoms. These consisted principally of a sensation of epigastric oppression and vomiting ; this latter generally coming on one or two hours after eating. These symptoms were much benefited by attention to diet, yet never entirely disappeared. His general health, however, suffered compara¬ tively little, and he was able to attend to his business, which was that of a plumber. During this time he emaciated rapidly, and presented the ap¬ pearance of confirmed ill health. In 1863, in the call for the militia, he entered the service as captain of an infantry company, and was on duty about seven weeks, during which time he was much exposed to cold and wet. The change of food also affected him most unfavourably ; the vomiting, which hitherto had been only occasional, now became almost constant, and on two occasions was accompanied by the ejection of con¬ siderable quantities of fluid resembling coffee-grounds. He also suffered from severe diarrhoea, which ceased, however, soon after his return home. His health never recovered from this severe shock; the vomiting per¬ sisted obstinately, and was accompanied by severe epigastric pain, which was paroxysmal in character, appearing with great regularity every night about twelve o'clock, and after having prevented sleep, by its intensity, for about two hours, would gradually subside. He commenced to fail rapidly, losing flesh, strength, and spirits. At this time he submitted to various empirical plans of treatment, but gained nothing by it-taking numerous patent remedies, and being cupped, blistered, packed in wetcloths, &c. He could now take no solid food, but lived entirely on milk and light animal broths. His bowels acted regularly, and the other func¬ tions were performed normally. When first seen, Feb. 28th, '67, he was very weak and exceedingly emaciated; mind clear, spirits good; considerable desire for food, but any indulgence was surely followed by pain and vomiting. No cough, no hectic irritation ; surface always harsh and dry; pulse frequent, small, and feeble; tongue clean, surface presenting a perfectly raw and stripped appearance; mucous membranes pale, and the whole aspect almost irre¬ sistibly suggesting the presence of carcinomatous disease. Bowels regu¬ lar ; passages normal; urine free-clear, red colour-sp. gr. 1018, acid; no albumen, no deposit-The vomiting, preceded by severe epigastric pain, now followed even the lightest food. The matters ejected were intensely acid, and contained sarcinse ventriculi, torulae cerevisise, vibriones, and altered food. Abdomen scaphoid; a slight enlargement could be felt in the epigastrium, which had slight pulsation communicated to it from the aorta. On placing the ear over this spot a distinct, single rough murmur could be heard ; this could not be detected at any other point. The epigastric region appeared slightly tumid ; pulsation occa¬ sionally visible; there was no sensitiveness on moderate pressure. The vomiting was allayed by subnitrate of bismuth ; the severe pain by belladonna, conium, and hyoscyamus. Any attempt to more than merely 1868.] Pathological Society oe Philadelphia. in
doi:10.1097/00000441-186801000-00017 fatcat:2zod2viubjaqbjt44dxrghf7uy