The author of the volume

their unknown course. before us was the clear-headed and stout-hearted pilot who did this, the undoubted preserver of the ship and her surviving crew, and the slight and simple way in which he speaks of his own exertions strikingly illustrates the old truth, that the brave man is ever modest.

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This detail may be considered perhaps as affording evidence rather of the confidence of these Sovereigns in the merit of the new invaluable resource, than of their personal respect and deference to Dr. Jenner. But it is true that Bonaparte, in the plenitude of his power, accorded their freedom from bondage to no less than nine captives, severally, at the request of Dr. Jenner, a homage to the benevolent author of so important a discovery, and that the Emperor of Austria and the King of Spain, paid equal attention to Dr. Jenner's intercession in behalf of individuals who were detained in their dominions.-Some Results of successful Practice of Physic, by Sir H. Halford. Essays, p. 317. V. There are few of our readers but must remember the melancholy impression, made on the public mind by the disastrous result of the expedition to the Niger, when this was made known in England through the newspapers. And none who remember this can forget that pathetic passage in the story, which represented the noble conduct of the surgeon, and the geologist of the expedition, when left alone in the far recesses of the Niger, amid their heroic companions, all stricken to death, or to death-like helplessness, by the fatal fever of the country. In this trying conjuncture, when the salvation of all on board depended on the speedy removal of the ship from her actual position, Dr. M'William took the navigation on himself, steering with his own hand, and piloting the vessel through all the intricacies of the river, while his companion worked the engine below. There is something very affecting, we had almost said sublime, in the picture thas presented to the imagination, of these two solitary men of science, assuming offices so foreign to their past habits and knowledge, stripped of all exterior cognizance of their class, standing as humble workmen at the helm and furnace, toiling by day, watching by night, while the force of the stream and the paddles was sweeping their ill-fated bark, freighted with their dying or dead companions, through the manifold dangers of

VI. Sir Astley Cooper was kind enough to make us acquainted with his researches on the structure and functions of the thymus gland, with which he was then occupied; and I am the more pleased to recall this circumstance, because it enables me to record a reply of Sir Astley's, which proves delightfully the perfect truth and honesty with which he conducts his researches and experiments. While he was pointing out to us, on a most delicate preparation, the two membranes which he has found in what he calls the reservoirs of the thymus, I said to him, "You said, and it is." "No," he replied, "It is, and I said." The scientific character of the great English surgeon breathes in this response.-Six Mois de Sejour en Angleterre par S. Pironde, D. M.-British and Foreign Medical Review, vol. 8, p. 534.

VII.-When Dr. Dimsdale inoculated Catherine the Second for the small-pox, that Princess (who, whatever might be the vices of her moral character, possessed a very enlarged and magnanimous mind,) took precautions for securing his personal safety in case of her death. Finding herself much indisposed on a particular day, she sent for Dimsdale, whom she had already remunerated in a manner becoming so great a sovereign. "I experience," said she, "certain sensations which render me apprehensive for my life. My subjects would, I fear, hold you accountable for any accident that might befull me. stationed a yacht in the Gulf of Finland, on board of which you will embark, as soon as I am no more, will convey you out of all danger." This anecdote, and whose commander, in consequence of my orders, Dimsdale's sons, above forty years ago.-Sir N. W. so honourable to the Empress, I heard from one of Wraxall's Posthumous Memoirs of his own Times, vol. 3, p. 199.

DR. SHEARMAN'S

I have therefore

INTERPRETATION OF

"THE MEDICAL REGISTRATION BILL."

TO THE EDITOR OF THE PROVINCIAL MEDICAL AND SURGICAL JOUNAL.

SIR,

Dr. Shearman, of Rotherham, has taken upon himself the office of interpreter of the Registration Bill, for the benefit of your readers, and he professes to foresee, not only how it will "come out from the Committee," but also how it will "work" in practice.

Dr. Shearman may be more competent than the Council of the Institute, as a body, but his letter in the Journal of May 19th, instead of proving his superiority, appears to me to reproach and abuse them by his misrepresentations; for he says in his first four reasons, that "the intended legalization of medical

A COURSE OF LECTURES ON CLINICAL

MEDICINE.

the heart's impulse was much augmented, tumultuous; great tenderness at the præcordia, shrinking from the

Hospital.

LECTURE XI.

Acute Rheumatism, with metastasis to the Heart.-Pericardial and endocardial disease; general character of the physical signs; affections of the mitral valve distinguished from those of the aortic.-Progress of the case; the treatment; sudden death.—Post-mortem examination.-Pathological conditions calculated to have brought about abrupt dissolution.-Treatment, when commenced after cardiac disease fully formed, less effective than when applied in the earliest stage. Necessity for constant vigilance for heart-disease in acute rheumatism.

Gentlemen,-The subject to which I am anxious to direct your attention to day is one of powerful interest in a pathological view,-pericarditis and endocarditis accompanying acute rheumatism,-the ravages of inflammation attacking the heart externally and internally. You have just left the post-mortem examination, and have witnessed the destructive effects of endocardial and exccardial inflammation. We will first examine the more prominent symptoms during life from the ward book, that you may the better understand the auscultatory signs of these destructive ravages; now that you can compare the cardiac disorganization with the altered murmurs you heard during life, you will also the better comprehend the fatal progress of such cases, and the principles that should guide you in their treatment.

E. S, a girl of 14, form well developed, rich auburn hair, and of wax-like complexion, was admitted on February 17th, having been suffering from acute rheumatism in all the principal joints for the last seven days. On the second day after the joints were attacked she suffered acute pain in the præcordia, with fluttering sensation, and feelings of suffocation, short dry cough, and hurried respiration. These symptoms are stated to have daily become aggravated till admission. There was synovial effusion in both knee-joints, with great tenderness on pressure, and acute pain on motion; the knuckles of both hands were red, tumid, hot, and painful; the skin was of a feverish heat; the external surface extremely pallid, even exsangueous looking; the bowels had been freely purged; the countenance was anxious; the pulse 140, soft and ful!, no hardness; No. 13, June 30, 1847,

and there was general præcordial dulness; there was a prolonged systolic murmur heard most distinctly at the apex of the heart, diminishing towards its base, and scarcely heard at the upper part of the sternum. These auscultatory murmurs were sufficiently intelligible to declare that the progress of inflammatory action had already affected the mitral valve, the prolonged murmur heard most distinctly at the apex of the heart accompanying the systole being distinctly referrible to a mechanical imperfection of the valve.

I have had occasion more than once during the present session to point out to you the means of distinguishing affections of the mitral, from similar conditions of the aortic, valves. An error in the organic integrity of either produces a murmur coincident with the systolic sound; but when the mitral valve is affected, this murmur is heard most distinctly towards the apex of the heart, and towards the left. When the aortic valves are the seat of disease, the murmur is heard chiefly over them, and at the base of the heart, and continues to be heard distinctly, even up into the carotids; and, with imperfection in the aortic valves, regurgitation would take place during the diastole, and the second sound would also be accompanied by a regurgitating murmur. In this case, at this period, we only had evidence of disease of the mitral valve within the heart. The increased impulse and tumultuous action indicated that the pericardium was involved, and that in all probability, from the extensive præcordial dulness, the sac of the pericardium was filled with fluid, or was probably adherent to the heart. As the cardiac affection had existed for five days before admission, the rubbing murmur, which is usually present when the pericardium is first affected, had disappeared, either from the sac becoming filled with fluid, or the two surfaces becoming united by exuded lymph.

There could be no mistake as to the disease we were here called on to heal: there was no difficulty in the diagnosis; the signs manifested to the ear were explicit enough; and had the case come under treatment at an earlier stage, much might doubtless have been done towards saving life. At first I had no reason to doubt, that severe as the symptoms were, they might be made to succumb to remedies. The further history of the case will illustrate the amount

N

of influence they exercised. The character of the pulse, soft, without any sensation of hardness or wiryness in it, together with the wax-like exsangueous aspect of the surface of the body, under any circumstances, would have forbidden venesection; and in the young, in acute rheumatism, I am very averse to bleeding from the arm. She was directed to be cupped to ten ounces, as near the region of the heart as possible; and that we might, if practicable, bring her quickly under the influence of mercury. Hydrarg. Chloridi, gr. iii., cum Pulv. Ipecac. Co., gr. v., were ordered every four hours, the bowels to be relieved with a purging draught in the morning, and she was ordered to be placed in a warm bath.

On the next day we found the symptoms materially relieved; the pain in the præcordium had disappeared; the impulse of the heart had much diminished, and its tumultuous action had subsided; the rheumatic inflammation in the hands and knees had also abated. The sounds of the heart were more distinct, and now, in addition to the systolic murmur heard the day before, there was one accompanying the second sound, and prolonged after it, and heard most distinctly just over the aorta, and still heard as the stethoscope was placed higher and higher towards the top of the sternum. Here was the ordinary evidence of disorganization of the aorta in addition to the mischief already noticed in the mitral valve. As the bowels were much relaxed and the pulse kept up, but still soft, two grains of calomel, half a grain of opium, and a quarter of a grain of the potassio-tartrate of antimony were given, in the form of pill, every four hours.

During the next two days she improved very much, the pulse going down to 100, and the heart's action continued quiet, with the same physical signs, yet without any indication of ptyalism. On the 22nd the symptoms became again aggravated, rheumatic pains recurring in all the limbs. The heart's impulse again much increased; dulness over the entire præcordial region and to a considerable extent around it; physical signs as before; respiration hurried, 40; breathing much oppressed at times; tongue red, inclined to become dry, moist at sides; urine clear; remedies continued. On the 24th, after having taken two grains of calomel every four hours for six days, faint signs of ptyalism presented themselves; the tongue became moister; the paroxysms of pain in the chest intermitted; the urine became loaded with lithates; the heart's action subsided, and she felt considerably relieved. The mercury was continued in smaller doses, and a blister was directed to be applied all over the præcordial region. On the 25th, the pulse rose rapidly, and with it an increase in the heart's impulse; a sharp paroxysm of pain in the region of the heart, with a recurrence of the opppressed breathing, indicated the necessity for a further topical bleeding. She was cupped from the side to eight

Ounces.

On the 26th, the report states that a great improvement took place after the last cupping; the pain had entirely subsided; she breathed quietly, 26 per minute; slept a little; heart's sounds appeared clearer, less muffled; but the other physical signs remained unchanged, and there was still the regurgitating murmur'

after the diastole. On the 28th, a very visible improvement is recorded,- -no pains, no dyspnoea, can move freely in bed, and has had some refreshing sleep; tongue moist; pulse 96, soft; heart's impulse not increased; signs as before. The amount of ptyalism produced was yet faint, and it being most desirable to obtain the full effect of mercury, a grain of calomel and half a grain of opium were continued night and morning. On the 1st of March a recurrence of a paroxysm of pain in the region of the heart and an attack of almost suffocative dyspnoea, spoke intelligibly | enough of the continuance of unsubdued inflammatory action, and as the calomel, so constantly administered, had failed to produce full salivation, mercurial inunction was about to be employed, but was counter-ordered on the second, as the gums manifested increased mercurial action. All the symptoms on this day underwent a palpable improvement; the pulse was quiet and soft; the tongue moist; the gums exhibited the puffiness and tenderness of salivation. On the morning of the third, she is reported to have passed a very good night, sleeping some hours; the pulse is stated as 90; respiration quiet; all external indications of rheumatic inflammation subsided; the tongue moist; countenance placid; and some craving for food. She sat up in bed at twelve at noon, and was eating her diet of rice pudding; she laid her plate down suddenly, inspired deeply and gaspingly two or three times, and expired.

So sudden a death after the aspects of improvement and hope which the last twenty-four hours had presented was remarkable. Let us see if the post-mortem examination will throw any light on the pathological cause of this unexpected dissolution.

Sectio cadaveris twenty-five hours after death.-The external aspect of the body presented the appearance of a wax model; no sanguineous gravitation or purpling of the dependent parts, but the whole surface pale white, almost of alabaster purity. The cavity of the chest presented no diseased conditions. The lungs were of a pale flesh tint; the grey mottling but faint; no pleuritic adhesions. The mucous membrane of the larynx and trachea was pale and healthy; some fine capillary injection of the bronchial tubes in the secondary sub-divisions becoming darker in the smaller tubes, with the presence of some frothy white mucus. The heart and pericardium were firmly glued together by an uniform layer of gelatinous lymph; the two, with some degree of force, were separated and detached. At the base of the heart this jelly-like exudation was deposited in much quantity. The heart was generally enlarged; the walls of the left ventricle firm, and its cavity completely empty; not a vestige of either fluid blood, or clot, could be found in it. The mitral valve was much disorganized; the edge or rim of the valve much thickened, studded with wart-like excrescences, forming an unyielding irregular patent ring, when viewed from the auricle; the left auricle contained a very small clot of blood. Two of the aortic valves were transparent and perfect, but one was pouched, and had an excrescence of lymph deposited on it; one isolated patch of white cartilaginous deposit was noticed in the aortic arch. The right auricle and