Vol. IX. No. 1. January 1, 1888. THE COLLEGE AND CLINICAL RECORD. TYPHOID FEVER, COMPLICATED WITH. A Clinical Lecture delivered at the Pennsylvania Hospital De 10th, 1887, BY J. M. DA COSTA M.D., existence of pyæmia. The liver is free from pyæmic patches, either in its structure or upon its surface. The kidneys are large and congested, but show no sign of the pyæmic process. The peritoneum and pleura are not thickened. It would therefore appear that this is one of those rare cases of suppurating gland in the course of typhoid fever; and it is very evident that the exhaustion produced by the suppurating process in one already weakened by a low Physician to the Hospital, and Professor of the Prace 30ed188ever was the main cause of death. cine in the Jefferson Medical College. Reported by WILLIAM H. MORRISON, M.D. GENTLEMEN:-I have here some specimens from a case of typhoid fever, which are instructive simply as specimens. There is nothing very remarkable about the case itself, except, perhaps, the fact that the death was due to a rare complication of typhoid fever, namely, a suppurating bubo. These specimens give us strikingly fine illustrations of typhoid fever lesions. The Peyer's patches show the characteristic lesions, ulcerated in the centre, but the peritoneum is intact. There is also rather more involvement of the solitary glands than is usually seen. As near as could be determined, the patient died at the end of the second or the beginning of the third week of the disease. I also show you the spleen. It is enlarged to twice its normal size, its vessels are engorged, and its pulp softened. The occurrence of the bubo in the left groin at once suggested the possibility of specific disease. The man, from the time of his admission, was so ill that it was impossible to get an accurate account of his previous history; but so far as we are able to judge, the bubo was not specific. It was limited to the left side; no ulcer or cicatrix was found on the penis, and there was no enlargement of the post-cervical or of the glands in any other part of the body. The external evidence would therefore lead us to believe that the bubo was not specific. The question of pyæmia suggests itself; but there is no evidence of this condition. The spleen, as you have seen, does not indicate the ATED WITH CHRONIC MITRAL REGURGITANT DISEASE. The case which I now bring before you is one of great clinical rarity. This boy, an Italian, 17 years of age, was admitted to the hospital December 5th-five days ago. He came in very ill, prostrated, extremely pale, breathing short, and with every evidence of being in great danger. It was difficult to obtain his history, partly on account of his condition and partly because of his inability to communicate with us in an intelligible manner; nevertheless, we have been able gradually to elicit the following statements: He has been in this country two years, chiefly engaged at "tailor work." While in Italy he had occasional sharp pains in the cardiac region, but no other symptoms of cardiac distress. Never, indeed, had he any acute illness; never acute rheumatism or rheumatism in any form. He did not have palpitation or dyspnoea. These are his statements; how accurate they are I cannot say. One of them, that with reference to the absence of dyspnoea, I should fairly question. His present illness began about one month. ago, with a chill, followed by severe pain in the cardiac region. Dyspnoea and palpitation then appeared. The pain in the cardiac region was of a sharp, acute character. There was no pain in any other part of the body. On admission, as I have already stated, he was very ill. His temperature was only 99°; the tongue was clean and the bowels constipated. The face was somewhat swollen, so much so as to suggest the presence of a kidney affection; but the examination of the |