Heart very large-cavities all dilated -parietes thickened, particularly those of the left ventricle. Lining membrane of left auricle remarkably opaque, and mitral valve so diminutive and shrunk that it could not have performed its office efficiently. Aorta and branches healthy. The heart generally from within presented a peculiar mottled appearance, not dependent on any morbid condition of its lining membrane.

Abdomen. Liver, kidneys, &c. healthy. Left common and external iliac, and femoral veins obstructed by a coagulum. This must have existed for some days, as it adhered very closely in parts to the internal tunic of the vein, and presented the appearance of softening or pus in its centre, occasionally observed in polypi of the heart. Coats of the vein not perceptibly thickened or inflamed-no mechanical or other apparent cause for the obstruction in its cavity.

Cranium. Not examined.

Vesp. Empl. Canth, sterno.

Op. gr. 4, 6tis hor. Omr. H. Sal. seen by Mr. Hutch

8th. Blood much buffed, highly inflamed-pulse 84, sharp-skin cool, moisttongue furred-bowels costive—urine very free-expectoration of clear mucus tinged with blood. V. S. ad zxij. Hyd. Sub. gr. ij. Haust. Senn. cràs. On the 9th he was ins, the house apothecary, and ordered leeches to the sternum, effervescing draughts, and a cathartic enema. In the evening a mustard poultice was put on the right side, and next day digitalis in infusion of roses.

11th. Vomited three pints of green bilious matter since yesterday evening tenderness of right hypochondrium. Pulse 72, slightly hard-skin clammy hiccup.

Cal. gr. iij.-Op. gr. 4, 3tiis hor. Cuc. Cr. ad 3x. reg. hepatis. Posteà fotus.

Next day he died. We examined this patient for a few moments with the stethoscope on the 8th. Arterial pulsation was visible at the root of the neck on either side, and above the sternum. The bruit de scie with some inpulsion was distinct in the cardiac region. These signs seemed to indicate active enlargement of the heart, and probably pericarditis.

Sectio Cadaveris.-Thorar. Right side apparently more prominent than the left; old adhesions of pleuræ in the latter, and about three ounces of serum

about eight ounces in the former. Lungs ædematous and emphysematous -lower parts of both carnified.

Pericardium containing organized lymph, partly disposed in the form of bands, partly as a flocculent deposite.

Cavities of heart, more particularly of right ventricle considerably dilated; no hypertrophy of latter. Much hypertrophy of left ventricle, its parietes being three fourths of an inch in thickness at base, half an inch at apex. Valves natural - slight atheromatous deposites round the coronary arteries.

Abdomen. No marks of hepatic inflammation-kidneys, &c. natural. Cranium. Not examined.

Sectio Cadaveris. Body not much

CASE 5.

Pericarditis aneurismal

pouch at the origin of the aorta.

Henry Cook, æt. 29, a stone-sawyer, admitted Dec. 9, 1829, under the care of Dr. Chambers.

Pain across chest, especially in left side, increased by full inspiration which excites cough-dyspnoea on the least exertion-palpitation-throbbing of the head-decubitus on left side difficult. Pulse 120, full and sharp-skin cool tongue white-some thirst— anorexia bowels costive-urine high-coloured.

Has been disabled by illness from working for the last six weeks-was at first seized with pain in the epigastrium, which extended to the left side. Says he has not been feverish.

V. S. ad deliq. et rep. post hor. 8 nisi prius cessarit dolor.

H. Salin. c. Liq. Ant. T. 3j. 6tis. hor.

H. Sennæ cràs-D. Parcissima.

10th. Has been bled to 3xxx with some relief at the time but more this morning-still some pain in left side. Pulse 110, softer tongue furred blood buffed.

Thorax. Pleuræ on right side extensively united by old cellular adhesions; a little fluid in the posterior part of the cavity―pleuræ on left side not so extensively adherent; slight flakes of recent lymph on pleura pulmonalis, and more fluid than on opposite side. Lungs gorged with serum in upper lobes, carnified in lower.

Pericardium containing about 4 ozs. of straw-coloured clear fluid, with some bands of recent lymph extending across its cavity, particularly at the root of the aorta, where the two surfaces of the membrane adhered pretty firmly.

Some dilatation and more hypertrophy of the left ventricle of the heartright ventricle rather thicker than natural.. Valves sound.

Immediately above the semilunar valves the aorta presenting an aneurismal sac about the size of a duck's egg, covered in great measure by the united layers of the pericardium, but projecting in part within that cavity. The communication between the sac and the aorta was about an inch in diameter, and the margins of the aperture so abrupt and defined that the sac was evidently that of a false aneurism. The wall of the sac on one side was formed by the right side of the pulmonary artery, and this was so thin that it had either given way spontaneously or been accidentally injured in the examination, for a small rent was found in it by which a communication was established between the sac and the pulmonary artery. The semilunar valve of the pulmonary artery below the fissure was firmly united to the side of the vessel.

Dilatation of ascending arch of aorta some atheromatous deposites in the coats.

Abdomen. Nothing particular.
Cranium. Not examined.

the Aorta at its Origin. Thomas Hill, CASE 6. Pericarditis-Aneurism of æt. 42, a paper-hanger, admitted last Autumn, under the care of Dr. Wilson.

On right side of inferior half of sternum a globular-shaped tumour, slightly prominent, not distinctly circumscribed, pulsating synchronously with the arterial pulse. Pulsation stronger and more superficial at two particular spots -tenderness of the integuments on pressure-tenderness over sternum and contiguous ribs. Pain shooting down right arm-occasional swelling of the same-puffiness of face-disposition to edema of legs. Dyspnoea-some orthopnoea-not much cough-palpitations-flatulence. Pulse sharp, vibratory-face rather florid and injectedurine scanty.

Attributes his complaint to over-exertion at his business a twelvemonth ago, shortly after which he became affected with constant darting pains in right side of thorax, increased upon exertion and attended with dyspnoea. About nine months ago first noticed the tumour, and about that time the swelling of the legs and palpitations first made their appearance.

Auscultation. Strong bruit de soufflet with much impulsion in tumour; former heard over a large space-stroke above right clavicle clearer than in tumour. Heart's action powerful, and accompanied with bruit de soufflet, not so whizzing as in tumour-auricular sound rough as well as ventricular.

Active enlargement of heart, especially ventricles. Aneurism of aorta very near its rise from the left ventricle, part of sac probably receiving a covering from the pericardium-depositions in coats of aorta-some dilatation of aorta beyond aneurismal sac.

The patient went on tolerably well from the time of his admission till about the middle of November. He was then attacked with cynanche tonsillaris, the right knee-joint swelled, erysipelas of the face, with much prostration, supervened, and on the 21st the patient died. Sectio Cadaveris. Face puffy-lower extremities slightly oedematous.

Thorax. Pleuræ on right side united by old adhesions-pleuræ in upper twothirds of left side united in the same manner, but containing below a few ounces of dark, turbid, sero-purulent fluid. Bosom of right lung attached

to the side of the aneurismal tumour, which projected into the right side of the chest; lung in this situation carnified. Lower lobe of left lung carnified also.

Surfaces of pericardium united closely and universally by old cellular adhesions. Heart actively enlarged, especially the left ventricle, but not to an extreme degree.

Whole arch of aorta much dilatedcoats puckered and uneven from atheromatous deposites, without any bone

internal coat generally sound. From the right side of the aorta, at its root, arose a pouch sufficiently large to contain a russet apple. It passed under the right border of the sternum, encroached on the right pleural cavity, and its superficial paries was in intimate connexion with the cartilages of the 2d, 3d, and 4th ribs. None of the cartilages destroyed. Sac nearly filled with a polypoid concretion, not laminated, and only partially adhering to its sides. Inner surface, both of the sac and di-. lated aorta, fissured and abraded in several places.

Cranium and Abdomen. Nothing particular.

Right Knee-joint. An ounce or more of pus in the cavity of this joint, without abrasion or ulceration of the cartilages.

CASE 7. Pericarditis-Fungus Hæmatodes of the left Lung, and Pleurisy.*

Benjamin Long, æt. 27, admitted, Dec. 16, 1830, under the care of Dr. Hewett.

Cough-cutting pain in left sidedecubitus on that side-inspiration imperfect and wheezing-expectoration of glairy, scanty mucus-emaciationdisposition to hectic.

First attacked, 6 weeks ago, with cough, dyspnoea and pain, frequent chills, succeeded by fever and thirst. For first fortnight spat some scarlet

* We shall notice this and the two succeeding cases very briefly, as they will, with one exception, form the subject of a future report for a different purpose.

blood. After three weeks' illness convalesced, but a fortnight ago had a relapse, and has since suffered from present symptoms. Was previously a healthy man.

On a subsequent and more careful examination of the chest, the left side was found to be contracted, universally dull on percussion, and devoid of respiratory murmur. The heart, too, was heard and seen acting more extensively than natural, but without increased impulsion or bruit de soufflet. On the 13th of March, examination of the heart by the stethoscope discovered more impulsion and slight bruit de soufflet. On the 24th, the left side of the chest, which had previously measured an inch less than the right, was found to have regained its natural dimensions. On the 30th, the patient was seized with a rigor and vomiting of glairy mucus, pain in the stomach and wildness of manner. Next day he was attacked with severe pain in the left side of the chest, the intercostal spaces were raised to the level of the ribs, ægophony was established, and this side now measured three quarters of an inch more than the right. On the 3d the patient died.

Sectio Cadaveris. Body emaciated. Thorax. Some old cellular adhesions between pleuræ on right side-no fluid. Some crude tubercles and one very small vomica in right lung. Partial adhesions of pleuræ on left side, with a pint or more bloody serum and a few flakes of lymph. This effusion, from its comparative clearness, was evidently of recent date. Left lung almost universally infiltrated with deposites of fungus hæmatodes, not encysted. The great bronchus on this side was pressed on by the malignant growth, its channel nearly obstructed, and its parietes assimilated to the disease. No part of the lung respirable in the least degree. One of the malignant deposites had pressed on the pericardium opposite the left auricle, and although the membrane was not ulcerated or destroyed, the morbid growth encroached on the cavity.

Considerable quant'ty of serum, with flakes of lymph, in the cavity of the pericardium, the opposite surfaces of which were more opaque than natural.

The membrane was corrugated, and in some places slightly reticulated. Heart itself not enlarged or otherwise diseased-great vessels healthy.

CASE 8. Slight Pericarditis-Pneumo-thorax on right Side.

James Smith, æt. 21, a footman, admitted March 8th, 1830, under the care of Dr. Hewett

Pain under lower half of sternum, which is not raised by inspiration-dyspnoea-some cough-no expectoration. Decubitus on left side, but is obliged to change his position frequently in consequence of cough. Pulse 140, very small-aspect pallid and strumous.

Ill six days, but had a bad cold previously. Was first seized suddenly with severe pain in the lower part of right side of chest, for which he has been actively treated. Has been subject to winter cough.

On the 10th he was examined by the stethoscope, and the presence of pneumo-thorax with bronchial communication discovered without difficulty. The dyspnoea, &c. increased, the right side became larger than the left, the hectic was severe, and to render the case even more hopeless than before, the absorbents in the left arm became inflamed in consequence of the puncture made in bleeding before his admission into the hospital. The contractions of the heart were extremely rapid, but no bruit de soufflet existed, or at least we discovered none. On the 4th of April the patient died.

Sectio Cadaveris. Pneumo-thorax with about a quart of green sero-purulent fluid in the right side of the chest, Pleuræ coated with "concrete pus," and presenting in one or two parts some long bands of adhesion between them. At the inferior part of the middle lobe of the lung, very near the spine, a fistulous opening leading into a vomica about the size of a horse-bean, and communicating through it with a large bronchial tube. Lung itself generally carnified. Pleuræ on left side free from inflammation, but united by some old adhesions. Lung containing some tubercles, and one or two very small vomicæ.

Heart pushed over towards the left

side. About an ounce and half of greenish serum in the pericardium, with some flocculi of loose recent lymph: Heart not at all enlarged, or altered in structure.

Abdomen. Some inflammation of the peritoneum covering the diaphragm and liver.

Cranium. Not examined.

CASE 9. Chronic Pericarditis-Pneumo-thorax on Right Side.* George Canning, æt. 23, a gardener, admitted Nov. 11th, 1829, under the care of Dr. Chambers.

This patient had pain in the right side of the chest, dyspnoea, cough, hectic. He had been subject to cough for some time, and had suffered from the more severe symptoms for eleven days. They had been combated by active depletory measures. On applying the stethoscope the signs of pneumo-thorax in the right side were apparent. He remained in the house till the 19th of January when he died. During the interval between his admission and decease the cough and hectic had continued, the expectoration was never more than suspicious and always scanty, he was successively attacked with pain in both sides of the chest and in the præcordia, his dyspnoea was occasionally severe, and latterly he had some orthopnœa likewise. He never complained of palpitations, nor was the stethoscope applied after the day of his admission.

Sectio Cadaveris. Pneumo-thorax, liquid effusion, and fistulous communication with bronchi in right side of chest. Thick layer of lymph and concrete pus on pleuræ. Lung compressed and carnified. Old adhesions of pleuræ on left side-several groups of miliary tubercles in left lung.

Heart pushed considerably to the left. A quantity of bloody serum in the pericardium, and reticulated lymph, not very recent, deposited on both its surfaces. Heart little, if at all enlarged, and rather flaccid. Valves and great vessels healthy.

This case having already been detailed in a former number, we shall merely glance at it.

ON

M. DUPUYTREN'S SENTIMENTS UNION BY THE FIRST AND SECOND INTENTION.*

Ir may be interesting, perhaps înstructive, to British surgeons to hear the opinions of so eminent a Frenchman as M. Dupuytren, on the subject of union by the first intention. We know there are some gentlemen in this country who conceive their practice to be as near as possible to perfection, and measure the errors of their neighbours by the scale of distance from their own standard. Truth, however, is not so exclusive as prejudice, error is first cousin to bigotry, and all candid men will consider what is said on both sides of a question, before they decide the issue. The following remarks are extracted from the clinical lectures of M. Dupuytren.

It would appear that several amputations of the upper or lower extremities were performed last Winter at the Hôtel Dieu, and afforded the surgeon of that establishment an opportunity of delivering his sentiments and detailing the results of his experience. The ancient surgeons did not argue the advantages, or otherwise of union by the first intention, because by their modes of operating and dressing they could not well obtain it. The mode of procuring that desirable event was discovered in England, adopted with ardour in Ger. many, and, although employed by Dessault, condemned in the first instance,

• Journ. Hebdomad. No. 75. Mars, 1830.