ventricle were healthy, but much distended by large coagula. The viscera of the abdomen were healthy; the brain presented no conditions of disease.

The first question you will naturally ask after witnessing this examination is, what is the pathological condition that can explain the remarkable suddenness of the death? Could the defective valvular structures be the cause of this instantaneous death? Not of themselves alone. Could the adhesion of the pericardium to the heart, with the large amount of lymph deposited at the base of the heart, produce instantaneous death? Certainly not; for quite as large an amount of endocardial and exocardial disorganization has been recorded in other cases, where the termination of the disease has been slow, tedious, lingering,-dropsical accumulations or pulmonary congestions at length putting an end to the patient's sufferings. Could the endocardial and exocardial conditions conjointly bring about this abrupt decease? I think they could; and the emptiness of the left ventricle conveys a hint how this death-stroke may have been produced conjointly by these morbid causes. To comprehend the full force of these conditions, we must not overlook the effect of pericardial disease upon the heart's movements,— that in pericarditis the heart's action becomes irregular, -its impulse increased,—its motions tumultuous; in fine, that when lymph becomes deposited about the heart, its actions become embarrassed, irritable, and unsteady. With a heart adhering to the pericardium, and surrounded by recently exuded lymph, can we wonder that so sensitive an organ should become irritated and uncertain in its motions. Do not forget this consequence of exocardial disease, especially

when recent.

Now, let us turn to the internal condition of the heart. The disorganization of the mitral valve proved, beyond all doubt, that regurgitation to a vast extent must have taken place during the systole. The dyspaca and hurried respiration declare this as well as the physical signs. Bear in mind the action of the ventricle and valve in a sound heart. The left ventricle contracts on the continued blood which is propelled forward through the aorta, the perfect mitral valve preventing any blood returning backwards into the auricle. During the systole the auricle is filling with blood, coming from the lungs, and the succeeding diastole of the ventricle receives the blood from the auricle, which is again propelled forward as before. But with an imperfect mitral valve, the ventricular contraction sends some blood forward through the aortic canal, but a portion is driven backwards through the imperfect auriculo-ventricular valve into the auricle; the current of blood in the pulmonary veins coming from the lungs is thus retarded, and this obstruction causes pulmonary congestion, cough, and suffocative dyspnoea. Now, in a heart, the movements of which are embarrassed, as this heart has been shown to have been, by pericardial adhesions and deposits of lymph, and where action was known at times to have been unsteady, tumultuous, and irritable, this faulty condition of the mitral valve, co-operating with unsteady and irritable action, might, it is conceived, have pro-duced a fatal condition in the following manner :-A'

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few beats, of increased impulse and power, accompanied by suffocative or pulmonary oppression, are followed by a beat of unsteady force; then the ventricle contracts again with spasmodic energy, drives the blood partially forward, partially backward, regurgitatingly, into, even beyond, the auricle, the backward impulse being felt even in the mouths of the pulmonary veins; so that at the ventricular diastole, the auricle empty, or nearly so, the ventricle receives nothing to stimulate its contractile action, and the whole heart fluttering, and embarrassed, and perturbed by surrounding and external hindrances, as well as by this new internal deficiency of its vital stimulus, and the right side, overloaded by blood accumulating there, unable to move forward from the obstructed state of the pulmonary circulation, the ventricle collapses upon a void, the life-current is arrested, and the patient instantly expires. Such is the brief category of conditions that are believed immediately to have led to dissolution.

This poor girl's case illustrates most forcibly the irresistible progress of inflammation of the heart, when it has proceeded untreated or unchecked for a certain time. I believe that had this case come under treatment twenty-four or even forty-eight hours after the first symptoms of acute rheumatism had developed themselves, in all probability her life might have been spared. Had she been in the hospital thus early, we should have been on the constant watch for cardiac mischief, and ready to combat it the moment it declared itself in the faintest degree, for it is one of the characteristics and advantages of modern practice, that by the aid of the stethoscope, the earliest possible symptom of metastasis to the heart, may, by a watchful ear, be detected. In such cases you must not wait for pain in the chest, or palpitation, or uneasiness in the præcordia, or other complaint from the patient. In every case of acute rheumatism you should never omit to apply the stethoscope at every visit to the region of the heart; be always on the watch for cardiac mischief, the accustomed and educated ear will instantly detect the faintest rubbing murmur or other indication of metastatic inflammation, and will be as quickly ready to combat this fearful enemy to the ultimate safety of the patient. I have every reason to think that all the heart-mischief was perpetrated before the patient was admitted. The physical signs underwent no change, except a partial mitigation, during the time she lived and was under observation. Once or twice there was a' decided amelioration of the heart-symptoms; the cupping relieved her, and the aggravated action of the heart was for a time brought down; the opium allayed the constitutional irritability, and assuaged the rheumatic fever; but our chief ally was comparatively inoperative. Faint indications of salivation could with difficulty be obtained, and this, notwithstanding the large quantity of calomel employed. It is nevertheless, instructive to remark, how palpably relieved all the cardiac symptoms instantly became, so soon as the faintest trace of the constitutional operation of mercury was developed; but the full effect of this mineral could not be produced, and the beneficial change could not be sustained. The pathological conpition was more powerful than the mercury could

suggested and most active treatment of our art; but such cases ought not to dishearten us, for they teach us valuable lessons both in pathology and therapeutics; they demonstrate the morbid changes of structure that disease establishes, and they illustrate and develope the principles upon which such cases are to be successfully treated.

The peculiar delicacy and wax-like character of the complexion of this poor girl have already been noticed, It may seem a trifling matter to remark upon, but her general aspect was so illustrative of the old doctrine of the temperament, that I cannot forbear alluding to it. She possessed all the external characteristics of the so-called sanguine temperament, and to which especial susceptibility to acute inflammatory disease was attached. Light flowing auburn hair, fair and alabaster-like complexion, florid cheeks, a symmetrical form, full and early developed, with a mind vivacious and intelligent, and her disease the very concentration of inflammatory intensity. Without meaning to revive or discuss the obsolete question of the temperament, you may, nevertheles, remark, and be prepared to find, that among the youthful who present such characteristics as have been here described, there is a remarkable tendency, and almost special proneness, to acute inflammatory disease; and that when such subjects are attacked by inflammation, it is intense in its degree, often unmanageable, and speedily tends to a fatal termination.

THE LAW OF THE MORPHOLOGY OR METAMORPHOSIS OF THE TEXTURES OF THE HUMAN BODY.

(Fourth Series of Experimental Researches.) By WILLIAM ADDISON, M.D., F.R.S., Malvern. (Continued from page 315.)

XIV. INFLAMMATION CONSIDERED MORPHO

LOGICALLY.

Speaking of the formation of pus, he says, "the formation of pus is dependent on two very distinct In the first place a fluid must be circumstances. secreted or separated, to act as as a cyto-blastema; and, secondly, the pus-corpuscles must be formed in and from this cyto-blastema, which is always the fibrinous fluid, which has already been described in our observations on fibrinous dropsy, consequently the formation of pus must invariably be preceded by the exudation of a modified blood-plasma." ‡

Again, in another place, "The fibrin may coagulate, and thus give rise to false hydatids, apparent serous dropsy, induration of the affected organ, &c. Then follow the great number of changes which arise from the further development of the fibrin,-suppuration in the widest sense of the word, with all its modifications and forms, the formation of granular cells, and ulceration, epigenesis 'neubildungen' of the most varying kind, tumours, hypertrophies, concretions, changes of colour, softening, induration, &c."§

Dr. J. H. Bennett adopts, if he may not be considered the author of, the views and sentiments expressed by Vogel. "The term exudation," he says, "has been introduced into pathology not only to express the act of the liquor sanguinis (or lymph) passing through the vascular walls, but the fibrinous portion of the liquor sanguinis itself when it has coagulated."

"In every case the exudation constitutes a blastema for the growth of nucleated corpuscles, which differ in form, size, constitution, and power of further development. The various kinds of development of the exudation may be grouped under the following heads"; and here follow sixteen different forms, normal and abnormal, amongst which are enumerated "pus-cells," ," "carcinoma," "muscular tissue" "epidermis and epithelium." ||

its being unnecessary to enter upon any refutation of the contrary doctrine which I maintain. But I contend that these things are not shown,-that his book opens with, and is altogether based upon, a broad assumption with respect to exudation, and an unlimited cytogenesis in coagulated fibrin, for which there is no where in it, that I can find, a shadow of proof offered.

Admitting it very possible,-nay, probable, that portions of the lymph or protoplasma of blood may exude through the walls of the capillary vessels, and fibrillate, or form, as Dr. Bennett states, "a coating of granular matter on their exterior,” what proof have | we that either the granules or the fibres, or any other element of the exudation, acts in an unlimited manner as a cyto-blastema for all kinds of cells, muscular fibre, pus, and epithelium? None whatever; nor is there any indication of a natural order or law in such an interpretation; for coagulated fibrin can be hypothetically made to produce just what the pathologist may happen to find by an assumed "unlimited" cytogenesis, while the fact of an increased amount of colourless blood-cells becoming stationary upon the walls of the vessels of irritated textures, is made to appear anomalous and unnecessary. It is true Dr. Bennett states that he has long doubted the truth of the asserted fact of the colourless cells of blood accumulating in unusual numbers in irritated vessels, and that he thinks "the observers who have stated these circumstances to have occurred, have mistaken the nuclei of the epidermic cells in the web of the frog's foot for these structures." The "Narative of Experiments," published at the end of the third series of my Experimental Researches, nay, the short extracts quoted by Dr. Bennett† himself, prove conclusively that the mistake he supposes did not occur either to Dr. Williams or myself. The question Dr. Bennett here raises is simply one of fact, and as such I leave it to be determined by future observers, making, however, this remark, that Dr. Williams mentions Mr. Toynbee as having drawn his attention to the phenomenon.

But, to return, the metamorphosis of lymph may be watched in progress in the lymph of newly drawn blood, and fibres are seen forming in it so abundantly as to render the materials coherent and solid, but there are no appearances indicating a cell-genesis ; and it is contrary to all analogy to assume that the same fluid matter can form indifferently either cells or fibres. In the lymph of newly-drawn blood, and in recent healthy pus, we see with the microscope multitudes of well-formed cells, and free molecules and granules, similar to those seen within the cells, but we do not see a corresponding number of transitional forms or young cells, nor has any evidence been

Loc. cit, p. 287. * Loc. cit.

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afforded to show that the molecules or granules are cell-germs.

Again, a great deal has been asserted respecting, and many important functions have been attributed to, certain particles seen in the interior of cells, termed nuclei ; but the fact that similar particles may be produced by chemical re-agents, and may be seen forming in consequence of their application, by the corrugation of the interior contents of the cells has been neglected. Nothing has been more common during my researches, than for me to see in pus, in mucus, and in lymph, corpuscles, or cells, filled with active molecules, uniformly distributed throughout the cell, and to observe, on the application of a dilute acid or other extraneous matter, the molecular material shrink up into two or three small rounded or oval particles, leaving the space between them and the cell-wall clear and perfectly transparent. It can scarcely be supposed that such particles or spurious nuclei when set free by the subsequent rupture or dissolution of the cell-wall, possess the property of a cell-genesis, and microscopical observers have given no discriminating rule by which to distinguish the chemically-formed and inert nuclei from those natural ones to which they attribute such varied functions. It is upon these grounds I adhere to the conclusion that the colourless cells of lymph and pus are unmetamorphosed blood-cells. Divested of its technicalities the inquiry is simply whether the colourless cells so abundantly excreted by healing and ulcerating, or inflamed and suppurating textures, are non-metamorphosing colourless blood-cells, or whether they are the molecules, granules, or nuclei of the exudation grown into cells. The exudative theory answers the latter alternative of the question in the affirmative, and assumes a cito-genesis in lymph and coagulated fibrin.

The advocates for this theory concede that coagulated fibrin, to be the subject of a cell-multiplication or suppuration, so as to discharge or excrete an abundance of pus cells, must become vascular-be permeated by currents of blood. Now, as blood contains abundantly colourless cells, which may be seen withdrawn from the red circulating current, and become stationary in the protoplasma space, so the weight of. evidence is therefore, I conceive, in favour of my conclusion.

Finally, it appears to me from my investigations, that the law or order of Nature is, universally in all living structures, that incoherent cells precede the coherent, cellular, and fibrous textures. Therefore for fibres, fibrous textures, fibrin in solution, or fibrin coagulated, to act as a cyto-blastema and be metamorphosed backward into cells, would be an anomaly or exception to be adopted only upon proof.

The fibrinous and all the other constituents of the

See the Experiments, p. 12, Second Series of Researches, and observations thereon, pp. 20 to 23,

26th. Going on favourably, and from this date, till the 4th of May, had the æther three times daily, and

THREE CASES OF

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Owing to carelessness on the part of the patient's friends, he did not get so many pills as ordered; he had, however, about thirty, and his teeth were not

affected.

The foregoing case differs from all other cases that I have met with, in having so many days threatened before it made its real attack The severity of the spasms, by being less marked on the chest than on the other parts of the body, afforded a better opportunity for the administration of the æther, at the same time that the great congestion of the lungs and head consequent on violent spasms of the chest was in great measure prevented. The marked influence of the æther on the spasms in their worst state, and the stiil more marked influence on the great rigidity of the muscles in the chronic state, prove it to be an agent of great power in spasmodic action of the muscles. Even three weeks after the invasion of the disease, the legs and thighs were so rigid as to require the exertion of all my power, added to the patient's own exertion, to flex them on the abdomen, but after having had the æther he flexed and extended them himself with facility.

In using the æther at first I was careful not to give it him in its strongest state, owing to its great effect on the already excited muscles of the throat, but afterwards he had it as strong as we could give it him, using hot water to increase the evaporation, and

exhausting from one and a half to two ounces of the strongest æther at each administration. The spasms were always allayed by it, increasing during the interval, making him long for our re-visiting him; his only cry was that we did not give him enough of it.

This case, and one reported formerly from the North Dispensary, seem to me to be as convincing proofs of the efficacy of æther as any that have appeared. The case I allude to was the reduction of a dislocation of the femur into the ischiatic notch, of five weeks' duration, less two days, and the patient, a powerful navigator, forty years of age. Two sets of pullies were applied to him with different fastenings to the thigh; the strain was kept up by one set, but the other set was also kept up so nearly to the same strain, that on the slightest slip of the principal pullies, the second set took their place. The strain was kept for one hour and a half, and during the whole of the time he was under the influence of the æther. It was about six weeks afterwards before he could walk freely.

June 10, Everton, Liverpool.

ACCOMPANIED BY THE USUAL SYMPTOMS OF CANCER OF THE UTERUS.

By E. J. SHEARMAN, M.D., Rotherham, Member of the Royal College of Physicians.

(Read before the Sheffield Medical Society, March 4, 1847.) In the Dublin Medical Journal for 1842, Dr. "the disease of cancer uteri, is too Montgomery says, universally recognized as one of the most frightful scourges of humanity, to render it necessary for me to attempt any description of its horrors, or to impress on even the most junior of my hearers the importance of closely studying the phenomena of an affection, hitherto found so utterly intractable by every known means; and which, when once fully established, entails upon the unhappy sufferer, one unbroken train of miseries, from which it has been truly said, ' temporary relief can be found only in opium, and permanent rest only in the grave.' But I am perfectly convinced, from many years' observation, that something may be done, to stem, at its source, the torrent of agonies that will otherwise overwhelm the patient; nay, I firmly believe it may, in many instances, be altogether turned aside, and the victim be rescued from the sad fate impending over her."

·

Agreeing perfectly in this opinion, and having during the last twenty years of my practice met with many anomalous cases simulating cancer uteri, which, (until the late improvements in the diagnosis of such

cases,) were allowed to run their uninterrupted course,

I am induced to lay before the members of this Society the following cases, which have occurred in the last two years, and which I hope are not altogether uninteresting, as they have long been submitted to the tests of sight, touch, and manual manipulation,— methods, which until very lately, have not been fully made use of by medical practitioners for ascertaining

such diseases.

CASE I.

A single lady, aged 48, consulted me in June, 1845, in order to obtain relief from the pains produced by what her medical attendant called "cancer of the womb." She gave me the following history of her disease:-Two years ago she was, and had been all her life, perfectly regular; she was menstruating at the time she received a very sudden and heart-rending shock by the sudden death of a valued friend; the catamenial discharge suddenly stopped, and never re-appeared in a healthy form. From that time to the present she has suffered from occasional sharp pains in the back and loins, traversing along the crest of the ilia and groins, often shooting down the front of the thighs; and this pain was attended with frequent discharges of sanious fluid, mixed with clotted blood, in various quantities. Latterly these pains have taken on a periodical type and increased in violence, commencing about seven