HARTFORD COUNTY.

DR. CHARLES A. LINDSLEY,

Chairman of Committee on Matters of Professional Interest, &c.

I am fortunate in being enabled to send you several interesting and important contributions to the subject of Diphtheria, as developed and directed by your series of questions-also a few "cases of interest." The only epidemic influence that has had lodgment in the county the past year, has been Catarrhal, and this widespread, and very active, but not often fatal; manifesting itself by the symptoms peculiar to the organ involved.

Its Ophthalmic seizure has been well described in a paper by Dr. Bowen. Very truly yours,

L. S. WILCOX,

Reporter for Hartford County.

A CASE OF PSEUDO-LEUCOCYTHÆMIA-WUNDERLICH.

Hodgekin's Disease-Trousseau's Adenia.

By L. S. WILCOX, M. D., HARTFORD.

Mr. J. H., a student, age 26, came under my observation September 9, 1875. He remembered that at graduation in 1873, (his friends say two years earlier,) he was suffering from an enlarged lymphatic gland in the arm-pit. He spent a year West in a malarial region, and returned subject to attacks of debility without any known cause.

During the past year, these attacks had been growing both more severe and more prolonged, at times confining him for a week or more. I found him in bed, a well-formed man, with dark hair, eyes, and complexion, and ruddy cheeks and lips, muscles soft, skin dry and furfuraceous to an extreme degree-numerous very large lymphatic glands in both axillæ, and all about the neck. Spleen not enlarged, nor the liver-heart and lungs sound-abdominal walls shrunken, tense and inelastic like a slackened drum head, pulse and temperature normal, tongue a little red, and slightly covered with a yellowish coat; bowels constipated, and if moved by injections, the injections gave great pain; urine normal in quantity and quality.

He complained of debility and a distressing sense of fatigue. He was chagrined because he could not find cause for his constant weariness. In the early part of every night he suffered severe pain in the splenetic region and right hip, nowhere else. His appetite was generally good,

and food did not distress him; mind, hopeful, but impatient. The nature of the malady was suspected, but not made clear, until its course and symptoms had been observed for several weeks.

The normal urine, and the normal ratio of the white and red corpuscles of the blood were inconsistent with the theory of true Leucocythæmia, while false; that is Pseudo-Leucocythæmia, which it proved to be, could not be satisfactorily established without the element of duration.

His pain early yielded, apparently, to tonic remedies-Iron and Quinine, and especially, Phosphorus.

Thenceforward the disease advanced by successive alternate stages of improvement and relapse. His appetite and digestion continued good and firm to the end, the early constipation yielding to free, and, at last, to too frequent movements of the bowels. His eyelids became, for a time, swollen and reddened, and somewhat suppurative' with Erythema, and spots of Ecchymosis appeared in small numbers upon his limbs. The pulse was normal till a week before death, when it rose to one hundred or more, to fall back to natural, and then to rise and fall at intervals. His temperature was never above 98°, and the last month of his life, usually one or two degrees below. The last two or three days, the thermometer at 95° was not affected.

Six weeks before death there was a very slight anasarca, so uniformly diffused as to give the appearance of increasing flesh. Ere long this general dropsy as it increased, began to have favorite deposits, principally in the vicinity of the larger joints, but at last, the fluid seemed to be gathered up from all other parts, and poured in immense quantities into the pleural cavities, and to some extent, into the pericardium, thus precipitating death.

This case of Pseudo-Leucocythemia in contrast with a case of Leucocythaemia, presented in the Transactions for 1874, exhibits these points.

Post Mortem-Nine hours after death-by Dr. Chamberlain. Rigor Mortis absent, body greatly emaciated, a furfuraceous condition of the epidermis, moderate oedema of the extremities especially the lower, suggillations in dependent portions of the body, anterior portion of the neck bluish purple. The axillary glands were greatly enlarged, one quite as large as a pullet's egg, the cervical all markedly enlarged, the inguinal to a less degree; the enlargement was more decided on the left side of the body. There was also a decided enlargement of the bones of the left knee joint, inner aspect, and of the head of the right fibula. There was scarcely any adipose tissue discoverable, the muscular was of a healthy color. Thorax-the lungs were fairly filled with air,— slightly oedematous, lower portions of both lobes splenified, sinking in water, there were no adhesions; each pleural cavity contained about a quart of clear serum. The bronchial and tracheal glands were enlarged from the size of a pea to a black walnut. A glandular growth covered the posterior surface of the sternum especially the upper portion, and a chain of enlarged lymphatics near sixth intercostal space, right side. The pericardium contained about three ounces of clear serum; there was no evidence of inflammation. The valves were normal, heart measured length three and a half inches, breadth two and three-quarter inches. The blood in the heart was fluid, which was the condition throughout the body. Abdominal Cavity.-Spleen hard and nodulated, capsule thickened apparently normal in size. The left kidney was somewhat enlarged and hard, the right apparently healthy. The mesenteric glands were all greatly enlarged.

There was a large glandular mass occupying the situation of the attachment of the mesentery lying over the abdominal aorta, and covering it laterally, dipping down on each side of the spine. This growth involved the tail of the pancreas, it was not adherent to the duodenum. The mass extended to the promontory of the sacrum where it divided, sending off branches right and left, which became continuous with the line of glands over Poupart's ligament. The character of this growth is well shown in the accompanying plate.

Microscopic examination of the growths showed them to be of a glandular nature-hypertrophied glandular tissue.

By WM. SHAW BOWEN, M. D., OF HARTFORD.

This remarkable affection has received numerous names from the various authors who have described it since St. Ives first wrote in 1722. To Dr. Graves, in 1829, is due the merit of modern research, and he was followed by Dr. Basedow, who gave the most complete account. It is