Page:A descriptive catalogue of the Warren Anatomical Museum.djvu/398

 376 MORBID ANATOMY.

discharge from the popliteal space, which last continued from that time at intervals, and was increasing. The last acute attack was a year before ; and he had kept his bed from that time.

On admission, the discharge amounted in three or four days to a pint, and was found to be coagulable. The limb was very much enlarged, flabby, and shrivelled about the knee, and covered with perspiration that had a sweetish odor ; temperature considerably increased ; lower two- thirds copper-colored. On several parts were clusters of bullse that were but little elevated, and had a deep cavity beneath, so that they could be inverted ; reappearing slowly when pressure was removed, and discharging a milky fluid when pricked. The discharge oozed guttatim, from a discolored spot on the ham a few lines in diameter ; the surface of the skin not being indurated, elevated, nor bro- ken. The inguinal glands were considerably enlarged, and the knee anchylosed. As to his general condition, the man looked bright, and reported himself as quite well, excepting the limb. In a few days spots appeared like those of erythema nodosum, and continued for some time ; and in July red lines along the thigh were noted. In De- cember, the thigh being very stiff, the adhesions were broken down ; and he afterward exercised more freely about the wards. In June, 1854, he left the hospital, and in April, 1855, he returned ; having had, meanwhile, about a dozen discharges from the limb. On the 19th of May the thigh was amputated at the upper third. The hemorrhage from the enlarged veins was so great that several of them were tied, and the patient died on the 31st, with tetanic symp- toms.

On dissection, the whole limb was very oedematous ; and enlarged lymphatics were seen, as before death, and espe- cially upon the inner and posterior surfaces, and about the popliteal space. The bullse, above referred to, marked the points where the lymph was confined, only by a thin, trans- parent cuticle, the rupture of which exposed its interior to the depth of a fourth of an inch in some cases. These cavities communicated with adjoining and similar ones by minute orifices in a dense and fibrous tissue, and these

�� �