742 APPENDIX.
tion. In a case already reported (No. 1626) the same amputation had been performed. 1870.
Dr. R. M. Hodges.
3669. A portion of the heart, showing a clot adherent to the mitral valve, and that was the cause of instantaneous death.
From a woman, set. fifty-eight years, who was recovering from a mild attack of pneumonia, and had had no cardiac affection previously, so far as known. She awoke in the night, and apparently as well as she had been ; asked what o'clock it was, and died instantly.
The clot was about as large as the top of the thumb ; and acted, as Dr. E. thought, like a ball valve, to prevent the passage of the blood. It had evidently formed before death, though only recently ; surface partially decolorized, and the interior, on incision, resembled the lees of red wine. The mitral valve was somewhat diseased ; but the heart was otherwise healthy ; and the lungs, though not hepatized, showed that they had been inflamed. 1870.
Dr. C. Ellis.
3670. A large mass of a white, dryish, crumbling material, and partly cretaceous, in the place of the bronchial glands. Cut open and dried ; with a portion of the trachea and bronchi. From a woman who had disease of the heart. 1869. Dr. H. H. A. Beach.
3671. Photograph of a case of elephantiasis Arabum, for which amputation was performed by Dr. S., at the junction of the middle and upper thirds of the thigh.
The patient was a woman, fifty years of age, and the disease had been coming on for a little more than six years ; having commenced with an attack of erysipelas in the foot, after working very hard in a damp cellar. There was ulceration upon the inside of the leg, with a watery dis- charge ; and last July a large abscess formed upon the upper part of the leg, that nearly proved fatal. The limb was generally much congested, and very sensitive, so that opiates were required. At the time . of the operation, which was done at the request of the patient, the ankle measured 2 ft. 1 in. in circumference ; the calf of the
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