Hospital Cleanings

case, but their more acute course, and their very diferent ptoms, would generally afford a distinction. They are, in ct, rather a gatric tympanitis, than a true obstruction of the stomach ; a diseased relaxation of the walls of the organ, rather than a mere occlusion of its terminal orifice. But the symptoms pointed to-(I) active ulcertion, and (2) a cicatrised ulcer. Did they therefore indicate the coincidence of at least one ulcer with one cicatrix, or the imperfect cicatrisation of a single ulcer ? To this question, again, I could find not even any conjectural answer durng life; save that the presence of two or more ulcers, or the coincidence of ulcer and cicatrix, is by no means uncommon, while the obstruction of the stomach by the contraction of a still unclosed ulcer is extremely rare. But the rarity of dilatation itself deprives this fact of all claims to specifc or diagnostic value. Iastly, it is almost impossible to decide, even by the aid of the necropsy, whether these ulcers were really cicatrising at the time of death. Comparing the symptoms of the patient at her admission with her subsequent amendment, it is difficult to avoid suspecting that for some time at least this process was taking place. But while it is my impression that the patient ultimately sank rather from the long inanition brought on by the number and duration of the lesions and the protracted vomiting which had preceded her admission, than from any extension of the ulcerative process during her stay in the hospital, I may confess that the appearances are equally reconcileable with the view of a recurrence of ulceratiou in the partially cicatrised ulcers. In any case, it is probable that a destructive process of some kind (absorption, ulceration, or dissolution) had attacked the feebly organised lymph last deposited in these cicatrices during the few hours that immediately preceded death.