PATHOLOGICAL SUPPLEMENT

TO THE

THIRTY-EIGHTH ANNUAL REPORT

OF THE

GOVERNMENT HOSPITAL FOR THE INSANE

TO THE

SECRETARY OF THE INTERIOR.

1893.

SYNOPSES OF POST-MORTEM EXAMINATIONS IN ONE HUNDRED AND

FOUR CASES OF MELANCHOLIA.

63

SYNOPSES OF POST-MORTEM EXAMINATIONS IN 104 CASES OF

MELANCHOLIA.

Case 2. (On post-mortem records.)

J. McB.; aged 25; single; teamster; nativity, Scotland. Duration of mental disease, two and a half months. Autopsy, thirty-one hours after death. Body much emaciated.

Cranium.-Skull normal in size and shape; the Pacchionian depressions present as usual and in addition there were several depressions in the inner table which were found to correspond with varicose enlargements of the dural veins. The superior longitudinal sinus was sacculated and the enlargements were in direct communication with the dural veins. Tough ante-mortem clots were found in the sinuses and the meningeal veins. The dura mater seemed slightly thickened along the superior longitudinal sinus and the adhesions to the pia arachnoid in this region were abrormally

firm.

Brain: The weight was not ascertained, but it seemed about the average. Brain tissue very soft, probably in part due to post-mortem change; with this exception nothing abnormal could be discovered in any part of the brain.

Thorax.-Pleuritic adhesions on both sides; about 4 ounces of fluid in the left pleural cavity and 2 ounces in the right. The lungs were in an advanced stage of tubercular disease.

Heart: Pericardial fluid increased; heart normal in size; valves all normal. Abdomen.-Spleen weighed 10 ounces; pulp very soft. Other abdominal organs were normal.

Case 13 (1892).*

J. Y.; aged 28; single; soldier; nativity, England. Duration of mental disease, two years.

Autopsy, seventeen hours after death. Body much emaciated; skin and conjunctivæ intensely jaundiced; hemorrhagic extravasations in the subcutaneous tissue of the right axillary region.

Cranium.-Tissues of the scalp and the skull bones were stained a deep yellow; cerebro-spinal fluid yellowish and slightly increased in quantity. Antero-posterior diameter of skull, 7 inches; transverse, 5 inches. Shape of skull normal; dura mater normal, except the jaundiced condition, which was present in all the tissues of the body.

Brain: Weight, 48 ounces. The membranes, vessels, and brain tissue showed no evidences of disease. The brain tissue was less jaundiced than the membranes. The spinal cord showed no alteration of the nervous structure, but a few bone flakes were found in the pia mater at the lower end.

Thorar. Slight increase of pleural fluid; adhesions on right side. The lungs were œdematous and congested posteriorly, and throughout the pulmonary tissue were great numbers of hemorrhagic extravasations of large size.

Heart: Weight, 8 ounces. The valves of right side normal; aortic and mitral valves showed slight thickening and contraction. The aorta was somewhat atheromatous at its origin.

Abdomen.-The spleen weighed 64 ounces; tissue much softened.

Kidneys: Weight of left, 5 ounces; right, 5 ounces. Small calculus in pelvis of left, renal tissue bile-stained but otherwise normal. Bladder normal.

Liver: Weight, about 60 ounces. The organ contained in all parts large numbers of secondary cancerous nodules, varying in size from one-eighth of an inch to over an inch in diameter. The nodules did not project far from the surface and the shape

* See summary.

5380- -5

65

of the organ was but little altered. The gall-bladder contained 6 ounces of turbid fluid, without a trace of bile, and also two large calculi. The cystic bile duct was obstructed, the hepatic and common ducts were enormously dilated, the latter at least three-fourths of an inch in diameter. The liver tissue was a deep brownish color and deeply bile-stained.

The primary cancer was found to be situated in the head of the pancreas. It was about 2 inches in diameter at its largest portion and involved the pancreatic and common bile duct, obstructing both.

Case 40.

H. G.; aged 65; single; late soldier; nativity, Germany. Duration of mental disease over eleven years.

Autopsy, six hours after death. Body well nourished; erysipelatous eruption on face and scalp.

Cranium.-Antero-post erior diameter, 74 inches; transverse, 6 inches. The skul was of the usual thickness, but the diploë was nearly obliterated; dura mater was abnormally adherent to the bone.

Brain: Weight, 52 ounces. Pia mater slightly opaque and unusually adherent to the dura along the falx major. Convolutions were somewhat shrunken over the convexity; vessels at the base of brain, atheromatous; ventricles slightly dilated; brain tissue somewhat cedematous.

Thorax.-Pleuritic adhesions on both sides. Tubercular pleuritis of right side, and tubercular disease of both lungs.

Heart: Weight, 14 ounces. The pericardium contained a slight increase of fluid, and the surfaces were covered by lymph. Valves of right side normal; those of left side showed some chronic valvular disease, and the walls of the left ventricle were hypertrophied.

Abdomen.-Weight of spleen, 34 ounces; capsules wrinkled; pulp soft.

Kidneys: Weight of left, 4 ounces; right, 4 ounces. Capsules easily removed; surfaces granular; cortex thin. Urinary bladder normal.

Liver and other abdominal organs were free from disease.

Case 64.

P. D.; aged 35 years; single; soldier; nativity, Ireland. Duration of menta disease, eight years.

Autopsy, two hours after death. Body much emaciated.

Cranium.-Antero posterior diameter, 7 inches; transverse, 5 inches. Skull and dura mater normal.

Brain: Weight, 39 ounces. Pia mater dematons; adhesions to the dura mater along the margins of the great longitudinal fissure and between the median surfaces of the frontal lobes firmer than usual. Convolutions shrunken; ventricles somewhat dilated; ependyma slightly granular; gray commissure absent. Arteries at the base slightly atheromatous.

Thorax.-Pleuritic adhesions on both sides; lungs in an advanced stage of tubercular inflammation.

Heart: Weight, 73 ounces. Pericardium showed diffused opacity over both layers, and contained 44 ounces of fluid. Valves of right side normal; aortic valves normal; mitral valve slightly thickened at its free margins; heart muscle pale and soft. Abdomen.-Weight of spleen, 44 ounces; pulp pale and soft.

Kidneys: Weight of left, 5 ounces; right, 5 ounces; capsules not adherent; pyramids and cortex pale. Bladder normal.

General tubercular peritonitis, with ulceration of the intestines.

Case 69.

M. J.; aged 44; single; soldier; nativity, Ireland. Duration of mental disease one year.

Autopsy, six hours after death. Body emaciated; bedsore over right trochanter; signs of hemorrhage from the rectum.

Cranium.-Antero-posterior diameter, 7 inches; transverse, 5 inches. Skull and dura mater normal; cerebro-spinal fluid much increased.

Brain: Weight, 41 ounces. Pia mater opaque and thickened, but easily removed from the cortex. Convolutions atrophied over the convexity; ventricles dilated; gray commissure absent. Arteries at base of brain atheromatous in patches. Section showed edema of the brain tissue and enlargement of the perivascular spaces. Thorax.-Pleuritic adhesions on both sides, and on separating these adhesions abscesses of the lungs were opened. In both lungs were many gangrenous abscess-like