"There was no tenderness over the epigastrium or abdomen. The catamenia had been excessive and too frequent; they had appeared only a fortnight before, but never returned during her illness. An astringent mixture was given at first, but the hæmatemesis returned in a few hours to a further and alarming extent, and was accompanied by purging of large, dark-coloured stools. The depression becoming extremely dangerous, half an ounce of spirit of turpentine given in mucilage checked the bleeding effectually for the time, and repeated once or twice during the week on the first appearance of a return kept this well in check, so as to allow of attempts to recruit her strength by enemata of beef-tea, milk, &c., containing spirit, repeated at short intervals, the smallest quantities of fluids only being given by the mouth, as the slightest excess caused immediate vomiting, to which cause the return of the hæmatemesis seemed afterwards several times due; vomiting, however, occurred frequently without blood appearing, the turpentine itself being often rejected. "Various sedative medicines were tried to relieve the vomiting when present, but none seemed to agree with the stomach. The enemata were kept pretty well by her, and seemed to be absorbed largely; they were continued every two hours for a week or two, the amount of food given by the mouth being gradually increased, when, apparently from incaution in this particular, the bleeding returned after an interval of a month, but was at once checked by a repetition of the turpentine. She continued so for about two months longer, with one or two OBLITERATION OF THE PORTAL VEIN. 165 returns of the hæmorrhage, emaciation progressing steadily during that time, and was increased by an unmanageable attack of diarrhoea, which was attributed to the administration of a chalybeate mixture, but was checked by gallic acid. She had now a constant hacking cough, without dyspnoea, but with ejection of pellets of mucus, apparently from the back of the throat. At this time, after some pain in the left leg, it became œdematous, but recovered itself soon under the use of warm fomentations, friction, and the horizontal position. Ascites then appeared, and increased rapidly to a large extent, no pain attending it or other alteration in the symptoms. Towards the end of January, she sank the second day after a furious return of the hæmorrhage, no abdominal pain or hepatic enlargement having ever been present. The appetite generally continued good. The urine at first was copious and pale, latterly less in quantity, but sufficient. "The examination was made thirty-six hours after death. There was about a pint of dark fluid in each pleura; both lungs were crepitant and healthy. the heart was healthy and its cavities filled with dark coagula. The peritoneal cavity contained several quarts of clear fluid. Its serous membrane was smooth and transparent.. The spleen was rather large, and adhered to the diaphragm and contiguous walls of the abdomen. Its structure, on incision, was light-coloured, and rather denser than natural. On microscopic examination, it showed the usual cellular bodies with much granular and amorphous matter interposed. The stomach was of moderate size, and contained some pale-coloured liquid food. Its mucous membrane was pale and partly digested on its greater curvature towards its left extremity. No ulceration existed there, or in any part of the intestinal canal; nor any congestion of the vessels, except close around the entrance of esophagus into the stomach. The cœcum presented rather more strongly than usual the tesselated appearance often observed, and apparently due to decomposition of blood in the vessels around its follicles. "The walls of the small intestines were cedematous, and increased to at least three times their ordinary thickness; no cellular bodies being found within them when examined by the microscope, but apparently only serous infiltration. "The liver, on incision, was of the ordinary healthy colour and texture in every part; the hepatic venous branches were very evident, but the portal branches were exceedingly difficult to discover. On tracing the portal vein throughout its formative and distributive branches, it was found in every part completely filled by yellowish red fibrinous material; no central channel being left, but a red core being present there. "This obstructing material on microscopic examination, showed chiefly a granular amorphous basis, with obscure fibrillation, and scarcely a trace of cellular element, even of red blood cells, although distinctly red in some parts. The coronary and mesenteric veins felt like pieces of whipcord, cracking across in some parts when bent, and by their peculiar condition at once drawing attention to the portal vascular system; the corresponding arteries were not traced, but did not attract notice by any abnormal appearance, though frequently cut across. The gall OBLITERATION OF THE PORTAL VEIN. 167 bladder was nearly empty, but the duodenum contained a considerable quantity of bright yellow bilious matter, which was not continued beyond it. "The kidneys and pelvic organs were healthy. The vena cava ascendens was natural in its interior; the iliac and femoral vessels were not examined."1 1 Transactions of the Newcastle-upon-Tyne Pathological Society. CHAPTER VIII. CONDITION OF THE DIGESTIVE ORGANS IN DIABETES. THOSE who have of late years investigated the cause of diabetes, have interested themselves more with the circumstances favouring the physiological production of sugar than with the morbid appearances present in the bodies of those who have died of the complaint. Every one called upon to treat the disease must have observed, that the amount of saccharine matter in the urine depends greatly upon the nature of the food; and it is, therefore, only reasonable to conclude, that a careful inquiry into the condition of the digestive canal would be likely to throw some light on its pathology. I have, unfortunately, been able to examine the stomach and intestines with the microscope in three cases only; and in one I tested the digestive power of the gastric mucous membrane. In each case the mucous membrane of the stomach was partially dissolved by post-mortem digestion; although two of them were examined in the month of February. Considering the enormous activity of the digestion in persons affected with diabetes, we might expect to find the gastric mucous membrane increased in bulk. In one case, in which the post-mortem solution |