was manifested; the blackness was lost indefinitely, by a fainter shade in the adjacent skin. The forearm next showed the same character of lividness, first occurring to the fingers; but on the arm the expression was different; here it appeared in the form of purpura, in blotches at distinct points on the arm, chiefly on the back of the arm, from the wrist to the small head of the radius. The blotches were large, irregular in form, and in a few hours after their appearance some of them became slightly vesicular or bullous, the cuticle being somewhat raised by sero-sanious extravasation. During this change in the condition of the arm, there were no marks of that low, topical, inflammatory action, which accompanies gan grena sphacelus; the arm neither swelled nor became hot. The death of the limb seemed to be taking place in a manner purely passive.

"As soon as the livid tinge was perceived on the fingers of the left hand, the patient, notwithstanding the continuance of general feverous irritation, was put on a decidedly sustaining course; the quinine was exhibited freely, with the cordial mixture, (sub. carb. ammoniæ, aq. menth. et tinct. cardamom. so much commended by Mr. Cooper;) opium and camphor were given at night, the first liberally; the hand and arm were kept enveloped in fomentations of bark and chamomile, charged with spirit of camphor and tincture of myrrh. The supporting plan, prosecuted regularly for many days, and varied according to circumstances, made no satisfactory impression. The powers of life gradually declined, stupor supervened, and the patient expired on the twenty-first day after entering the hospital. The discolouration of the left arm never spread above the elbow-joint, and nothing of gangrene, nor any petechial or purpurous spots appeared on any other part of the body; there was no gangrenous fetor about the arm. For more than a week before the death of the patient, the diarrhea was inconsiderable.

“Examination.—For the purpose of tracing better the state of the arteries in the left arm, a pipe was introduced

into the left subclavian, and the fine injection thrown in as fully as possible; the arm was then removed at the shoulder-joint. The artery and vein, (cephalica magna,) had a very unusual relation to each other. The former was filled with the injection as far as the bend of the arm; its course was very serpentine, and two inches below the root of the superior profunda, made a sudden curve, so as to describe a semicircle an inch in diameter. This bend was apparently referrible to the state of the vein at that point. From the axilla downwards, the great vein was enlarged, and filled with semi-solid black blood; in two or three places above the doubling in the artery, the vein was dilated into distinct circumscribed tumours of moderate size, while at the place of sudden curvature in the artery, there was one of those tumours the size of a musket ball, and solid as if the contained blood was firmly coagulated. Round this great varix the artery turned close, to take afterwards its ordinary course to the bend of the arm. It was to this spot the patient pointed as the seat of pain in the arm. The external cellular coat of the artery exhibited a high red colour throughout its whole course, from the axilla to the bend of the arm; just above the turn of the artery round the great varix, its thickness was increased for the space of an inch, to more than three times its circumference in any other part. This enlarged portion of the artery was firm, and consisted not in aneurismal dilatation, but in general thickening of its coats all round, to one-third of an inch, by which its channel was very much diminished. The profunda superior was very much enlarged in its trunk, and involved at its branching in a plexus of veins, showing a number of varicose pouches filled with black blood.

"The roots of the radial, ulnar, and interosseal arteries, were full, round, and hard, apparently distended by injection; but it was found that the injection had not penetrated below the bend of the arm, and was stopped there abruptly by a plug of solid coagulum, which extended continuously through every trunk and considerable branch of

the forearm. There was no earthy deposit in the coats of the humeral or proper brachial arteries.

"The right arm was dissected without previous injection; the veins were large, but natural in appearance; no varices or other irregularity. The humeral artery, with an exception to be noticed directly, was of ordinary appearance, and regular in its course. At two fingers breadth below the root of the profunda, the artery was suddenly enlarged into a bulbous body, somewhat oval in shape, and about the size of a large almond; its walls very thick and spongy, with portions of loose flaky matter in their substance; the centre of the tumour contained a little pus, and immediately around the pus was a substance resembling the matter of crude tubercles. The enlargement of the artery then was the effect of steatomatous degeneration in its coats, and the tumour which had been found in the left humeral artery was the same morbid conversion, less advanced. The canal of the right artery was not quite obliterated at the point of disease; it was pervious there, but the passage very contracted, and not through the centre of the tumour, but on the side next the bone, and very near the surface. Although the continuity of the tube was preserved, it is probable that little if any blood passed through the diseased part of the artery; the passage through the tumour was very confined, and the trunk of the artery, directly above and below the enlargement, had a shrunk and wasted appearance. The profunda was very full in its trunk, and divided near its root into five principal branches, three of the largest taking a course down the arm.

"The humeral artery was dissected out of the arm, and with it an inch or two of the branches in the forearm containing the coagula described; the concreted blood could not be pressed out, and now after twelve months maceration in dilute alcohol, the coagulum is perfect as ever, showing a deep purple hue of the branches as far as it extends."

It is probable that the forearm depend. ed mainly, if not altogether, on the supply by the branches of the profunda, through the anastomotics; the state of the latter branches could not be satisfactorily ascertained, as the arm had not been injected. The cellular coat of the right humeral artery had nothing of that strong red tinge, which was very obvious over the whole trunk of the artery in the left arm.

The

"The heart was much enlarged and flaccid; the right auricle uncommonly capacious; the descending and ascending cavas dilated in a very remarkable degree, before entering the auricle. The right ventricle was dilated, and its wall thin; the root of the pulmonic artery expanded in a pouch-like form, its coats attenuated, and the central points of its semilunar valves chalky. left auricle as usual. The left ventricle large, flaccid, and thin. The coronary arteries hard and friable. The root of the aorta much dilated; at the arch swelled into a bag-like expansion, twice as capacious as the healthy form of the vessel at that point; its semilunar valves full of concretions. The enlargement of the aorta, more regular in figure, continued down the trunk through the chest and abdomen, and the whole track of the vessel, from the ventricle to the bifurcation, was studded with calcareous formations in large patches, smooth and firm, and as usual, lying between the coats. At the arch, the patches of calcareous matter were particularly large, two or three of the plates equal in surface to a twenty-five cent piece, and exceeding an inch in length. The carotids and subclavians did not show any degeneration of their coats; the veins of the neck were uncommonly large and distended with black blood. The lungs were sound, but unusually dark and heavy, from engorgement of the pulmonary veins. In the abdominal cavity there was no manifest lesion of any of the structures; the mucous coat of the small intestines showed some patches of slight phlogo. sis. The encephalon was not examined. "The appearance of the inferior extremities was natural.”

We think with Dr. Wright, that the

Thorax. Pleuræ on left side universally united by old, elongated cellular adhesions-pleuræ on right side universally and almost inseparably adherent. Left lung crepitous, but not perfectly so, throughout, gorged with blood in its inferior parts, with serum in its superior-right lung more filled with blood and less crepitous than the left, and sufficiently dense in parts to sink in water. No tubercles in either lung.

Two layers of pericardium closely and completely bound together by old adhesions no thickening of the membrane.

Heart very large, chiefly from hypertrophy and dilatation of left ventriclecavities of other chambers dilated, but their parietes little altered in density. Valves and aorta sound.

Abdomen. Liver rather large, and of nutmeg colour in its interior-kidneys healthy.

Cranium. Not examined.

CASE 2. John Copas, æt. 24, a gardener, admitted Oct. 14th, 1829, under the care of Dr. Chambers.

Diffuse rheumatism, worse when warm and aggravated by sweating-slight oedema of legs-dyspnoea-orthopnoea -most extensive and strong action of heart, agitating nearly the whole chest -bruit de soufflet. Pulse 120, strong -skin cool, pallid-tongue cleanbowels open twice daily-urine free.

Had acute rheumatism eight years ago, and again four years ago, and heart has been affected since the first attack; has been able to work except at intervals, when he has suffered from attacks of dyspnoea with hæmoptysishas generally lain on the left side in consequence of feeling uneasy on the right.

Blue pill with squill and digitalis, senna with supertartrate of potass, and a.diuretic draught of nitric æther and juniper, &c. were prescribed, but the patient died suddenly on the morning after his admission.

Sectio Cadaveris. Surface generally leuco-phlegmatic and puffy-lower extremities ædematous.

Thorax. Pleuræ on both sides closely

and universally united by old cellular adhesions. Lungs gorged with blood and serum in dependent parts, with air elsewhere, but not hepatized.

Layers of pericardium generally adherent, in some parts closely, in others more loosely-no fluid.

Heart of enormous size from hypertrophy and dilatation, nearly in equal proportions; hypertrophy of left ventricle very remarkable. Mitral valves slightly thickened and roughened but without bone; aperture not at all narrowed. Semilunar valves of aorta thickened; one of them shrivelled, and another so loosely connected at either end that it nearly hung back into the ventricle, and was incapable of presenting any barrier to the reflux of blood from the aorta.

Arch of aorta dilated without deposites-a few atheromatous patches in the descending thoracic at its com

mencement.

Abdomen. Liver rather large-kidneys natural.

Cranium. Clear serous effusion between arachnoid and pia mater-none in ventricles. Arteries of brain pretty healthy, carotids only being slightly opaque.

CASE 3. Mary Wood, æt. 18, unmarried, admitted Oct. 28th, 1829, under the care of Dr. Seymour.

Severe pain in chest, referred to lower part of left side, aggravated by deep inspiration, and preventing her from taking a full inspiration-cough without expectoration- dyspnoea-playing of alæ nasi-countenance pallid and rather anxious. Pulse 120-tongue whitebowels open.

Present symptoms commenced about a fortnight ago with severe pain below the left nipple; has been twice bled, blistered, and leeched, with some but not permanent relief. Two years ago had acute rheumatism for great part of Winter, and was leeched about the wrist, &c. Since that time she has suffered from shortness of breath on exertion, and been subject to palpitation, flatulence, and pain in the præcordia.

V.S. ad 3xvj. Hirud xx. pect. vesp. Postea fotus.

Hyd. sub. gr. iij. Op. gr. 4. Conserv. cynosb. q. s. ut ft. pil. ter die sum.

29th. P. 100, not strong-pain in left side of chest and hypochondriumblood not buffed or cupped; (it was not got very freely.)

H. Senn. stat. H. cetac. c. Tt. op. m xxv. h. 8. Interm. alia.

31st. Complains of very severe pain in the side-tongue loaded-bowels not open.

H. Senn. stat. Op. gr. j. Ext. hyos. gr. ij. ft. pil. h. s. s.

On Nov. Ist, she referred her pain to the left false ribs and sternum, which parts were tender to the touch. Was ordered senna draught, warm bath in the evening, soap and opium pill with ext. col. c. every night, and a draught of ammoniated tincture of valerian in camphor mixture thrice daily.

On the 3d, when we examined her, she had dyspnoea-pain in left side of chest on inspiration-decubitus on that side-pulse quick and rather sharpaction of heart stronger than natural to the touch-arteries of neck beating strongly. By percussion, the dull sound in the region of the heart was extensive; by auscultation, the heart's action was heard more extensively than usual, especially on left side-the sound of the ventricle was prolonged, dull, and closely approaching to the bruit-de-soufflet -the impulsion was increased.

Dilatation and hypertrophy of the heart, after pericarditis-probably adhesions of the pericardium.

On the 5th a belladonna plaster was applied to the region of the heart, a draught of tinct. castor. with subcar bonate of ammonia ordered twice daily, and an anodyne pill prescribed at night. On the seventh these medicines were omitted and the patient was put upon calomel and opium, with occasional morning doses of senna. On the 10th the pulse was 120, sometimes intermitting, the cough troublesome, but unaccompanied with puriform expectoration. A blister was applied and ordered to be kept open, and on the 13th she felt relieved. On the 15th she complained of pain in the region of the heart increased by coughing-pulse sharp but not strong. Blister repeated

-beef-tea and arrow-root. On the 17th she had no pain whatever, and the calomel was only exhibited at night; on the 19th the mouth was rather sore and the mineral was omitted altogether.

-22d. Very ill-great anguish in countenance and urgency of respirationaction of heart tumultuous, heard over great space, and attended with decided bruit de soufflet. Opium at night and another blister. On the 23d the pain' was relieved, but the aspect presented an extraordinary pallor; she lay on the right side on account of the blister, but otherwise preferred the left.

Infus. digital. Ziij. Sp. æth. nit. 3ss. Aq. pur. 3x. Syrup. zing. 3j. bis die. Rep. opium.

A partial relief followed this alteration of treatment, but a sudden change for the worse took place in the night of the 26th, and on the next day she appeared to be sinking, and had all the symptoms of a person under the dele->› terious influence of digitalis. Ether mixture and brandy were employed, with the effect of arousing her from the state of collapse into which she had fallen, but the gleam was a brief one, the improvement fleeting, and on the 30th this unfortunate young woman expired. For a day or two before her death the left lower extremity was observed to be swollen and oedematous, but not painful, or at least not severely so.

Sectio Cadaveris. Body much emaciated left lower extremity pitting on pressure.

Thorax. Pleuræ on both sides adherent anteriorly and laterally; posteriorly containing about a pint or rather less of serum. Bosom of either lung united to pericardium, and the latter attached by recent bands of lymph to the anterior wall of left side of chest. Right lung gorged with air above, with serum below; its lower lobe condensed and hepatized left lung also filled with air and serum, and rather condensed inferiorly. No tubercles in either lung.

Two surfaces of pericardium inseparably and closely united ; in some places a distinct layer of lymph interposed, in others the adhesions intimate, cellular, and organized.