1, 1. Point out the Velum Pendulum Palati, which is very unequal on its surface, on account of the spasmodic constriction of the constrictor isthmii faucium, as pointed out by No. 2.

The Uvula is seen hanging down from the velum pendulum palati; the surface of it is also corrugated by the contraction of the azygos uvulæ muscle.

3, 3. Point out the Tonsils, which in this case were remarkably prominent.

4, 5. Point out portions of the Pharynx, turned back.

The

pharynx was opened from behind to shew the larynx, the membrane proper to which was thrown into a number of folds. The larynx was opened, so that the state of the mucous membrane which lines it may be seen; it was found to be of a deep crimson colour.

6. Points out a portion of the Gullet.

Fig. II. This figure was copied from a preparation, in which the cystic, hepatic, and common ducts, were very much enlarged, in consequence of gall-stones being lodged within them. The enlargement is much greater at some than in other parts of those ducts.

1, 1. A string which suspends the gall-bladder, marked by No. 2, 2.

3. Marks a remarkable dilatation of the Cystic Duct.

4. Points out the Hepatic Duct, which was much enlarged.
6, 6. Point out two Gall-Stones, which are lodged in the com-
mon duct.

7, 8. Point out two small probes, which were passed through the
common duct in its oblique course, between the coats of
the duodenum.

This portion of the common duct, which is naturally of smaller diameter than any other portion of the common duct, has been excessively enlarged, in consequence of gall-stones having been lodged within it; and it merits particular mention, that gall-stones impacted within the common duct frequently prove a cause of death.

9, 9. Two portions of string, by which the part of the duodenum which had been opened is suspended.

Cases of Apoplexy. By WILLIAM SHANAHAN, M. B. T. D. C. In a Letter to the Editors.

GENTLEMEN,

You will oblige me by publishing in your Journal the follow

ing cases of Apoplexy, which have been selected from a considerable number, in order to exhibit this destructive disease both in

its unmixed form, and in combination with other important maladies. The ordinary character of apoplectic invasion is exemplified by three cases, concisely detailed, in which the symptoms were of unequal violence: the union of apoplexy with epilepsy is illustrated by two cases; and the remaining four exhibit its complication with disease of the bronchial membrane, by which the danger is augmented, whilst the practical measures adopted for its removal are modified and controlled. I am, gentlemen, with great respect, your obedient servant,

KILKENNY, April 18. 1826.

WILLIAM SHANAHAN.

CASE.-Apoplexy, followed by Acute Bronchitis.

25th February 1820, 11. P. M.-I was hastily summoned to the assistance of Mr Thomas Kehoe, gardener to the late Marquis of Ormonde; the messenger told me that he was poisoned. I found him supported in an arm-chair by three men; his countenance was livid; the lips were pale; the pupils dilated; the breathing slow, laborious, and stertorous; he was profoundly comatose; the entire surface of the skin was singularly pallid, damp, and of a death-like coldness; no pulsation could be perceived in the radial, temporal, or carotid arteries. A slight rattling sound was observable during respiration. His relatives informed me that he was a healthy man, in his 29th year, of temperate habits, of great personal strength, and accustomed to much exertion; that, during the whole of that day, he had suffered from a severe tensive pain in his head, attended with an unusual dulness; that in the evening he had been persuaded to accompany some friends to a distillery, where the clerk furnished them with a liberal supply of new spirits, which they drank undiluted. On his return through the streets, Kehoe suddenly fell to the ground in a state of insensibility, and was removed by his companions into an adjoining public house, where, on the supposition of his being poisoned by the deleterious quality of the new spirits, they poured down his throat a large boatful of melted butter, which, they remarked, he swallowed with great difficulty. Failing in this attempt to excite vomiting, they stripped off all his clothes, and dashed upon him several pails of pump-water without effect: they then became exceedingly terrified, and carried him to his own house. By my direction he was laid in bed, and friction was diligently applied to the limbs; the following sharp clyster was injected without delay:

• His stature considerably exceeds six feet, and he is proportionally robust. NO. III. VOL. II. JULY 1826.

C

B Sulphatis soda Ziss; solve in decocti foliorum sennæ Zx; adde tincturae aloës, et olei terebinthinæ rectificati, utriusque Zij; ut fiat enema. This was retained for six minutes, when it came away as if from a paralytic rectum. The frictions continued for an hour, and had produced no change in the icy coldness of

the skin.

I now cut down upon the temporal artery, and opened it by an oblique incision; at first it yielded only a few drops, but after repeated smart strokes of my finger upon the artery below the orifice, blood began to flow so freely that 24 ounces were abstracted. It was now past midnight, and, ordering a repetition of the enema and of the frictions, I left the patient in the apothecary's care. On returning at 4 o'clock, I could perceive no change in his condition, but ventured to again open the artery, which, after some delay, was made to bleed very freely. When about 40 ounces had been withdrawn, slight twitchings were observed in the patient's face, he sighed heavily, opened his eyes, seemed agitated and confused, and at length emerged from insensibility so completely that he recognised his relatives who spoke to him. The blood was allowed to flow to the amount of about 60 ounces*. He complained of feeling intensely cold, of pain in his head, and that his mind was bewildered. I prescribed the immediate exhibition of a bolus, composed of 10 grains of calomel, 10 of scammony, and 20 of jalap; that he should be covered with warm blankets, and that strict quiet should be observed.

26th, 11 A. M.-I found him quite collected; the pulse 76 and strong; the cutaneous circulation re-established; the headache abated; he complained of the rattling in his breathing (now distinctly audible), and of something moving up and down in his windpipe,-a sensation which I attributed to the presence of some fluid forced into the rima glottidis, during the attempt made on the preceding night to excite vomiting. The following medicine was now prescribed; B Sulphatis magnesiæ Zij; manna 3ss; solve in infusi sennæ vij: adde tincturae jalapa 3iiss; fiat mistura, cujus sumat Ziss horis secundis. Orders were given to exclude from his room the numerous friends and relatives who were now assembled in the house; but these injunctions were disregarded; they thronged his room during the whole day, and at 8 P. M. he was annoyed by intense headache; his face was much flushed; his mind confused; eyes very vascular, and slightly intolerant of candle light; skin hot; tongue white;

The blood being received in a common wash-hand basin, the number of ounces was not exactly ascertained; but judging from other very large bleedings, which were much exceeded by the amount of this (the largest evacuation which 1 have ever witnessed), I am confident that the quantity has not been exaggerated.