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difference in the symptoms during life. In General Kyd's case, where the pouch arose near the base of the ventricle, and presented layer after layer of condensed fibrine, no apparent derangement of the heart's function occurred till the apex of the pouch gave way and caused instant death. In general, however, the aneurism rises from the apex of the ventricle, and in the majority of the cases on record, palpitation and dyspnoea were complained of during life.

Those who are curious to inspect a fine example of this rare disease, will have an opportunity of gratifying their curiosity by applying to Dr. Elliotson or Mr. Alcock, who, we are sure, will be happy to submit the above specimen for examination.

22. FATAL EDEMA OF THE GLOTTIS.

[Dr. Bright. Guy's Hospital.]

Leonard Evans, of remarkably stout frame, had enjoyed good health till about two years ago, when he had syphilis, which was completely cured. He had lately been subjected to sudden atmospheric vicissitudes, being a journeyman currier, in which occupation he was exposed to cold when the body was heated and perspiring. His habits had been regular and sober. Ten days before admission, he had been employed in washing skins, and got wet in his feet. The same evening, he perceived his legs swelling, and this swelling increased and spread till general anasarca was established. In this condition, he entered Guy's Hospital, on the 15th November. His urine was very scanty. Elaterium was prescribed. 18th. The swellings rather diminished, and a grain of elaterium was continued twice a day. 19th. There was a dark brown tinge in his urine, which coagulates by heat. Elaterium-jalap and cream of tartar. 21st. The anasarca a good deal reduced-makes six or eight pints of urine per diem, of a high brandy colour, which does not coagulate. Dec. 1. Complains of pain under his jaw; but the œdematous swellings are nearly gone. The urine is only four pints per diem, coagulates, and contains much blood. Bled to 3x. This

was repeated on the 2d, and half a grain of tartarized antimony, with two grains of opium, were given daily. 3d. Complains of sore throat; but he is walking about the ward, and appears much better. An ammoniated liniment to the throat. 4th. The throat relieved. 5th. He seemed much better all yesterday, and slept soundly during the night. This morning at 7 o'clock, he suddenly complained of great difficulty of swallowing and breathing, with severe sense of constriction in his throat and chest. Fourteen ounces of blood were taken from the arm, and sixteen leeches were applied to the throat and chest. An emetic was administered. But all was unavailing, and, at 11 o'clock of the same day, he expired.

Dissection. No anasarca-lungs rather gorged with blood, but otherwise healthy in structure. Heart and pericardium sound. Four ounces of fluid in each side of the chest. There was nothing very remarkable in any of the viscera, except the kidneys, which presented a very curious appearance. They were large and flabby, of the darkest chocolate colour, interspersed with a few white

points, and a great number of black, with a tinge of red-the whole having the appearance of polished fine-grained porphyry, or green stone. These colours pervaded the whole of the cortical substance of the kidney; but the natural striated appearance was not lost. From the left kidney, when cut through, a large quantity of blood oozed out, showing an unusual accumulation in the organ. These appearances are represented in the fifth plate of Dr. Bright's great work.

The epiglottis was next examined, and this was found to be greatly thickened by an oedematous effusion beneath the membrane on its upper side. "It was bent into the form of a pent-house with a sharp angle." The lower surface was also thickened, and presented a doubtful appearance of superficial ulceration. When the epiglottis was cut into, a considerable quantity of serous fluid oozed out, and the glottis itself was much contracted. Dr. B. properly observes, that there could be no doubt that the patient died of suffocation, from inflammation and consequent oedema, of the glottis and epiglottis. This we believe-and surely the case was precisely one where bronchotomy would have saved the life of the patient-at least for that time. Here, then, was an instance where the physician should have explained to the surgeon the state of the case, and strongly urged the operation. If the surgeon refused, and the dissection proved the physician right in his diagnosis, what would become of the surgeon? We doubt whether he would not be amenable to the laws of his country, if prosecuted for ignorance of his profession. This case shows that the education of the surgeon should be the same as that of the physician, and, consequently, that he should be as competent to ascertain the state of an internal malady as his medical coadjutor. In fact, we conceive that the physician also should be perfectly competent to perform operations himself in cases of emergency. If Mr. Key, or any other surgeon, had been called in by Dr. Bright, and shown the above case--and if, from punctilio, or from conceiving that he was not doing justice to his own part of the profession, by acting under a physician, he refused to perform tracheotomy-then, we say, the physician should have done it at his own risk and responsibility, rather than suffer a fellowcreature to be suffocated. This, then, is one of the evils of separating the study of the profession into distinct branches.

23. FRACTURE AND DEPRESSION OF THE FIRST DORSAL

VERTEBRA.

[Guy's Hospital.]

A labourer, 30 years of age, was admitted, on the first October under Mr. Bransby Cooper, with paralysis of the inferior half of the body. He had fallen from a ladder, with a "HOD" on his back, and against which his spine struck when he reached the ground. He was taken up insensible, and, when received into hospital, was in that state of collapse which often succeeds severe injuries. On examination, a depression was discovered about the last cervical or first

dorsal vertebra, without any wound. He is now sensible, and answers questions rationally. The functions of all parts receiving nerves from the spine, above the injury, are undisturbed, and vice versa. The breathing is almost solely carried on by the diaphragm, as the chest remains dilated, in consequence of the loss of power in the abdominal muscles, while the inspiratory muscles are unpara lyzed. He has feeling as low as the third rib. To be cupped (re-action having taken place) to 20 ounces--ten grains of calomel -bladder to be emptied by the catheter occasionally. 2d Oct. Much in the same state has had no stool-cannot void his water. To be bled from the arm--enemata-catheterism every 12 hours. 3d. In statu quo. Blood not inflamed. No action in the bowels. 4th. The same--bowels still inactive--enema. 5th. Bowels cleared of a large quantity of fæcal matters-no alteration for the better. Mr. Cooper and his dressers are said to have declared several times, that there was no depression of the spinous processes. 8th. Exten sive sloughs were observed on the nates. Of this, the patient was not, of course, sensible. The patient exhibited little difference in his symptoms till the 14th October, when his urine was observed, for the first time, to be ammoniacal. On the 16th, the ammoniacal odour was much stronger-and the fatal event was evidently approaching, as the sloughs were spreading, and the various func tions becoming more interrupted. He died on the 21st Oct.

Dissection. The subject being placed on the table, the spine was again examined. The dissector's reporter, and Dr. Hodgkin, declared there was a depression-Mr. Cooper and dressers maintained their original opinion. The membranes of the spinal marrow were more vascular than natural, and rendered tense by a quantity of serous effusion underneath. Opposite the depression, (which was found in the place above-mentioned) the membranes were lacerated, and the medulla itself completely pressed out, forming a knob, adherent to the upper portion of the thus divided spinal column. This upper portion was reddened and softened for a space of two inches from the laceration. The lower portion was not so red, but much softer-especially the posterior column, in the centre of which was a brownish disorganized matter. The body of the vertebra was fractured, and slightly displaced. The articulating processes were overlooked; but it is concluded that they were fractured. One of the lungs was inflamed and œdematous. There was nothing particular in the abdomen. The coats of the bladder were slightly thickened, and the mucous membrane, at the most depending part, "was elevated in fungoid granulations, of a dark colour; and, on their surface, small ulcers might be detected." There were also some small ulcerations near the caput gallinaginis. -DISSECTOR.

Remarks. The above case is interesting in several points of view. In the first place, it appears to have been a case where the spinal column was completely destroyed at the part where the fracture existed; and yet the patient lived 21 days-dying, at last, as much (or probably more) from the sphacelation on the nates, as the divi VOL. VIII. No. 15.

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sion of the spinal marrow. In the second place, it is rather unusual that the ammoniacal character of the urine should not have appeared till the 14th day after such an injury to the spine, and consequent paralysis of the bladder. We suspect there was some mistake here. In the third place, considering that the coats of the bladder almost always sustain injury from this ammoniacal urine, should not the urine be drawn off at shorter intervals than 12 hours? Would it not be better to leave a gum catheter in the bladder ? We know, indeed, that in many of these cases, the urine is ammoniacal from the moment it is secreted in the kidneys; but this makes a still stronger argument for the frequent removal of the fluid, than if the change took place by mere remora in the bladder. In the fourth place, we think it was hardly worth the report, er's while, to make so much to do about the existence or nonexistence of the disputed depression in the line of the vertebræ. If the depression was so equivocal as to be denied by the surgeon and his dressers, no particular line of practice, as to an operation, was to be grounded on it. Where there was any suspicion of local injury, then local depletion was indicated-and this appears to have been practised. While we advocate freedom of speech and of opinion on all matters of medical science, we should be sorry to see the bad example of the LANCET's reporters followed by those of any other journal,

24. DISEASES OF THE ENCEPHALON.

[M. Raikem. Hôpital de Voltera.]

The organ of intellect-the seat of the soul-the principal centre of the nervous system-the source of sensation, reflection, and volition is surely a part of our corporeal fabric, the diseases of which must excite the highest interest in the mind of the medical practitioner. Medical politics may engross attention, for a short time, but the practice of our profession will prove the topic of most permanent interest in the long run. We do not, therefore, deem it necessary to make any apology for entering on the analysis of a long and important train of observations on diseases of the encephalon, chiefly drawn from the clinical wards af the HÔPITAL ST. ANTOINE, while the author was an élève interne of that institution, matured, however, by subsequent reflection and hospital practice. The first part of this Memoir, and not the least valuable, is a minute detail of 27 cases, with the appearances on dissection; which cases form, of course, the basis of the pathological, diagnostic, and therapeutic deductions. We can only select from these cases a few of the more interesting specimens, and then proceed to an analysis of particular symptoms.

Case 1. A widow-woman, aged 44, was received into the Hôr. ST. ANTOINE, on the 18th October. At the beginning of the month, she became affected with erysipelas of the left leg, to which some empyrical wash was applied, and the erysipelas disappeared in three or four days. But now she was seized with fever, dyspnoea, sanguineous expectoration, and pains in both sides of the chest, which

symptoms had continued six days, when she arrived in the hospital. She had then intense head-ache-flushed face-loaded tonguethirst pain and tenderness of the abdomen-diarrhoea-quick breathing, thoracic oppression, and frequent cough, with expectoration, containing vermillion blood. The chest sounded well posteriorly; but she could ill bear percussion on the left side and in front. Venesection to 10 ounces-blister to the original seat of the erysipelas diluents. 7th day. Expectoration easier, and the symptoms mitigated; but towards mid-day, a strong exacerbation. which gained its acmé about four o'clock, when V. S. was repeated to 16 ounces, the blood issuing from the vein with astonishing impetuosity. 8th day. Somewhat better. 9th day. Complained of fixed pain under the ensiform cartilage, increased by coughing and by pressure. Numerous leeches. At mid-day a violent exacerbation. In the night, the right side of the body became paralyzed, as to motility, but not as to sensibility--no distortion of the mouth-→ partial power of speech-breathing deep-cessation of the cough -pulse hard and frequent. Phlebotomy to 20 ounces. In the evening, there was some stertor-constipation-involuntary discharge of urine-difficult deglutition-pupils contracted. There is no report till the 19th day, when the organs of sense were somewhat more susceptible of impressions. She was thus bled again; but in the evening she was found comatose, and died that night.

Dissection. The sinuses and veins of the dura mater were nearly empty of blood, as were the cerebral veins generally--no extravasation at the base of the skull-capillaries of the pia mater injected. In the left hemisphere, when carefully sliced, were found several portions of brain, distinctly circumscribed, which were soft ened, discoloured, and in some places almost diffluent. In the centres of some of these portions was found a matter resembling pus, or honey. In the left ventricle was some serous effusion, and the parietes of this cavity were strongly injected. There was no other phenomenon of importance in the brain, except that the petrous portions of the temporal bone, on both sides, were found of a vivid red colour, and perforated by numerous little holes, so as to resemble the spongy part of the long bones.

In the chest, there were some marks of inflammation--some por tions of lung hepatized or gorged-the mucous membrane of the bronchia of a vivid red colour, and the ultimate ramifications filled with a bloody fluid. There was nothing particular in the abdomi nal viscera.

Case 2. A young girl of 11 or 12 years of age, was received into the hospital, in the beginning of September, affected with mucoenteric fever, which, in a few days, put on a bad character, presenting the phenomena of delirium, loquacity, involuntary dejections, irregular breathing, small and unequal pulse, &c. Camphor, stimulants, blisters, &c. were employed. (This was in 1809.) About the 21st day, somnolency, passing into coma, took place, with dilatation of the pupils, paralysis of the right side, abolition of speech, involuntary stools, &c. During the whole of October, the patient

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