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bilious vomiting. His present illness came on six months ago with headache, vomiting and constipation. About the sixth day of his illness he became delirious, and was insensible for twenty-four hours. On recovering consciousness, he was unable to move the fingers of either hand, nor could he move the legs below the knees; the same parts were numb, as was also the tip of the tongue. He continued weak during the whole summer.
Two months ago he resumed his occupation, and remained at it until ten days
back, when the old symptoms of headache, vomiting and constipation returned.
On his admission into the hospital, the pulse was extremely small and feeble, the expression of the face pinched, the brows knitted. He vomited mucus containing altered blood of a dark brown colour; tongue clean; epigastric region full, especially towards the left side, where he has had some twitching pain and slight tenderness on pressure. Urine natural in colour and quantity, of a light brown colour, not coagulable by heat. He went on, day by day, with but slight symptoms of change. Skin cool; pulse moderate in frequency, but extremely feeble, so as scarcely to be felt at the wrist. On several occasions the depression was so great as to require the exhibition of decided stimulants. There was a continued tendency to sickness. The abdomen soft, with marked aortic pulsation. Bowels constipated; chest everywhere resonant; heart’s sounds normal; extent of dullness on percussion not increased. Slight traces of intermittency in the symptoms; the surface in the evening being cool, or even cold, and the following morning warm, as if from reaction.
Probable diagnosis.- The epigastric tenderness and pulsation, with frequent vomiting, and the ejected mucus and altered blood, point to an inflammatory condition of the gastric mucous membrane. But what