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and the following case is an example in an adult. In adultsaffected with scarlatina these pains are more common thanin children, for the reason, as Dr. Kennedy states, that rheu-matism is a more frequent disease in adult than in early life.He does not refer to the additional complication of heart dis-ease, nor does Dr. Watson in his Lectures. The cases ofrheumatic complication observed by the latter were in children.Dr. Scott Alison has, however, drawn attention to heart diseasein his essay, "On Pericarditis, a Complication and Sequela ofScarlatina." Accepting his facts as correct, Dr. Watson as-cribes the articular affection and the cardiac disease, whetherthey occurred together or separately, to one and the samecause-namely, to the retention in the blood of a poisonousexcrement by the default of the principal emunctories, andespecially of the kidney.

It is well known that in scarlatina the serous membraneslining the three great cavities of the body are not unfre-

quently attacked with inflammation, and we see no reason whyothers, such as the pericardium, should escape. The details ofthe following case will be found, therefore, to possess consider-able interest.M. A. C-, a single woman, aged twenty-four years, a

brush-drawer, was admitted on the morning of the 6th of Sept.last. When first seen by Mr. J. D. Hill, the resident surgeon,she had all the symptoms of acute rheumatism, and complainedof her throat being sore. In the evening she was seen by Dr.O’Connor, and the history of the case was that two days beforeadmission she was taken suddenly ill with shiverings alternat-ing with flushes of heat; the throat became sore, and she hadheadache. Severe pains in all her limbs came on the followingday, and there was a burning heat all over her body. Her

symptoms now were, severe headache, pains in all her joints,especially in the hands, feet, and knees, which were muchswollen. There was also severe pain in the nape of the neck,extending to the shoulder-joints, the skin was morbidly hot anddry, the tongue and throat were red (the latter presenting anangry appearance), and the internal fauces were much swollen;the parotid glands were also much enlarged, and there wasgreat difficulty of articulation. There was a florid eruptionover the whole of the body and extremities. The pulse was120, bounding, but compressible; the heart was free from anysigns of disease; there was great thirst; the urine was scanty;and the bowels had not been relieved for three days, untilafter her admission to the hospital. The throat was pen-cilled with a stick of nitrate of silver, and a gargle of equalparts of hot vinegar and water was to be frequently used. A

draught, composed of nitrate and bicarbonate of potash, solu-tion of acetate of ammonia, and spirits of nitre, in water, wasordered every four hours. To have beef-tea, arrowroot, andmilk. The hands, feet, and knees to be wrapped round withcotton-wool.

Sept. 7th.-The painfulness of the throat and difficulty inswallowing are relieved; the surface of the body is not so dryor hot, but is intensely florid; there is no alteration in the

pains of the joints; she did not sleep in the night; the mouthand throat are more moist; and the pulse 120, not so bounding.A solution of the nitrate of silver (fifteen grains to the ounce)to be applied to the fauces.8th.-There is some improvement; the dy suhagia is not so

great; the skin is moister; the urine is more abundant; andthere is less thirst. The pains in the hands, feet, and kneesare still very severe, and the joints are swollen. She complainsof cough, and had no sleep last night. There is slight bron-chitis ; but the heart is free from any symptoms of disease.The pulse is 110, more compressible; the bowels not relievedsince the day of admission. To have castor oil directly, andsix drachms of hospital cough-mixture added to the draughtshe is now taking. The gargle to be continued.

There was progressive improvement; the pains in the jointswere gradually subsiding; and the patient had some sleep atnight, but only of short duration. The bronchial attack had

disappeared; there was no symptom of heart affection; and onthe 12ch desquamation was taking place, and she had a desirefor fish in addition to the beef-tea, arrowroot, and milk. Thethroat was much improved, and the swelling of the parotidand submaxillarv glands had nearly disaDDeared. The Dainsin the hands and feet, but especially in the joints of the thumbsand great toes, as well as in the knees, which were swollen,still continued severe. The draught to be taken every sixhours.

14th.—The pains in the joints are very much relieved, beingonly in the thumb and great toe of the right foot and hand;the knee is swollen, but free from pain. The desquamation isvery abundant. ’lhe bowels have not been relieved for two

days. She sleeps better at night; the pulse is 90, but feebleand very compressible. To have castor oil directly, with adraught composed of six grains of citrate of quinine and ironand one ounce of cinnamon-water every six hours.

16th. -The pulse is feeble and the patient complains of beingvery low. To have half an ounce of brandy immediately, tobe repeated every four hours.

17th.—The pains have nearly disappeared from the handsand feet; but this evening Mr. Hill, the resident surgeon, wassuddenly sent for, as the patient appeared to be getting worse:He ordered brandy and beef-tea to be injected into the bowelevery three hours, on account of the very prostrate conditionshe was in ; and she complained of pain in her chest, with afeeling of suffocation.

18th.—Dr. O’Connor found the patient suffering from generalfeverish disturbance. She complained of severe pain in theregion of the heart, with a feeling of constriction. She wasrestless; pulse. 135 and hard; respiration 40; the carotids werepulsating visibly. On examination of the chest, an intensepericardial friction sound was observed. A blister, four inchessquare, was immediately applied over the heart, to be keptopen with a dressing of equal parts of savine and mild mercu-rial ointments. A grain and a half of calomel and three grainsof Dover’s powder every three hours, and the saline mixturewith bicarbonate of potash, the same as first ordered, to begiven every four hours. The brandy to be discontinued.On the evening of the 19th there was less pain in the region

of the heart; the feeling of constriction was not quite so urgent;pulse 124, hard, but regular; the friction-sound had becomemore general.

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On the 21st there was 2. marked improvement in the wholeof the symptoms: the anxiety and feeling of depression werenot so great; the feeling of constriction and hurried breathingwere less; pulse 110, soft, and more full; impulse of the heartdiminished. The fliction-sound continued distinct over thewhole region, but was not so intense, and approached more toa bellows murmur.On the 22nd there was mercurial action. The symptoms

generally had abated, and she had some sleep the previousnight. Ordered liquor of acetate of ammonia every six hours.The powders and the mercurial dressing to be discontinued.From this date there was rapid progress towards improvement,and in a few davs she was able to take the half-diet of thehospital.

Oct. 3rd.—The friction-sound has altogether disappeared;there is slight bellows murmur; feels weak; the pulse is 90;respiration 20; sleeps comfortably at night; appetite improving.Ordered, citrate of quinine with iron and infusion of quassiaythree times a day.

10th.—She regains strength slowly; all symptoms of uneasi.ness about the heart have departed; there is slight swellingat the ankles; sleeps well; pulse 80, fuller. The dose of thecitrate of iron and niiiniiie increased to eight grains To havea pint of stout daily, as brandy and wine disagree; and fulldiet.

17th.—There was progressive improvement; the swelling atthe ankles has disappeared; but on account of complaining ofpains of a severe character in the legs she was ordered fivegrains of iodide of potassium in infusion of calumba and tinc-ture of bark, three times a day. The pains ceased in a fewdays, and on the 22nd of October she left the hospital com-pletely restored, the phenomena, of the heart being perfectlynatural.Un the 6th of this month (November) the patient presented

herself at the hospital, free from any rheumatic pains or cardiacdisease.

LONDON HOSPITAL.

CASES OF INDURATED CHANCRE OF THE LIP.

(Under the care of Mr. ADAMS.)CASE 1.—A fine, healthy-looking young woman presentedherself at the hospital with a sore on the red margin and centre

of the lower lip. It was slightly elevated above the surface ofthe lip; just moist, painless, and seated on a distinctly indurated base. Below the jaw, the submaxillary lymphatic glandswere enlarged, indolent, indurated, and painless. While under

treatment, sore-throat, roseola., and syphilitic lepra followed indue course.

CASE 2.-A young man presented himself amongst Mr.Maunder’s out-patients with a sore on the centre of the upper

475

lip, and was transferred as an in-patient to Mr. Adams. Thesore was seated on a speci6caHy indurated base, the indurationbeing at this time somewhat concealed by accidental inflamma-tory exudation; surface slightly fretted, discharging pus; snb-maxillary glands much enlarged and very painful. Whileunder observation, sore-throat, lepra, and alopecia set in,while the glands gradually besanie less and less painful andsmaller. The sore for some time bad no tendency to heal.

INDURATED CHANCRE OF THE LIP.

(Under the care of Mr. C. F. MAUNDER.)CASE 3.-A man, about fifty years of a.ge, presented himself

amongst the out-patients, with a. sore on the centre of the lowerlip. It was seated on an indurated base ; its surface was some-what coucealed by a scab, formed apparently partly of blood,and partly of pus ; it was painless, and attended by enlarged,indolent, indurated, and painless glands. Mercury was pre-scribed, and under its influence (although the patient was un-fortunately only a fortnight under observation) the sore tookon healthy action, and the enlarged glands had almost disap-peared.These three cases, which have been lately under observa-

tion at the London Hospital, are worthy of record, becauseeach and all were considered bv some surgeons to be examples ofepithelioma. In Cases 1 and 2, neither the age of the patientsnor the short existence of the sores, attended as they were byan adenopathy, was in favour of epithelioma ; whilst the ip-pearance of secondary symptoms clearly indicated the nature ofeach case. In Case 3, age was in favour of epithelioma ; butthe beneficial eff.;ct of mercury dissipated any doubt previouslyexisting in the minds of some. Ealarged glands attendant onthe indurated chancre usually appear before the expiration oftwelve days from the origin of the sore, while the enlargedglands follow epithelioma generally not earlier than after thelapse of twelve months.

Medical Societies.

PATHOLOGICAL SOCIETY OF LONDON.

TUESDAY, NOVEMBER 5TH, 1861.

DR. COPLAND, PRESIDENT.

RUPTURE OF THE LIVER, TWO CASES, ETC.

DR. MURCHISON showed one specimen of considerable rupturefrom a person killed in a recent railway accident; the otherspecimen was less extensive. An example of rupture of thediaphragm was also shown, through which a large portion ofthe liver and the stomach escaped into the chest. A case of

rupture of the stomach was like wise exhibited. It was remaik-able that the blood was in a fluid state in one of these cases.

Dr. COPLAND believed it was common, in death from injuriesto any of the internal organs supplied from the great ganglionicsystem, for no coagulation of the blood to take place.In answer to a question from Dr. O’CONNOR, Dr. MURCHISON

stated that death Was iu’mediate after the rupture of the liver.Dr. PEACOCK exhibited a

HEART WITH AN OPEN DUCTUS ARTERIOSUS.

The specimen was removed from a man thirty years of age,whose previous history was not known, and who died suddenlyat St. Thomas’s Hospital before he could be placed in bed.The heart was of large size, and presented marked hypertrophyand dilatation of both ventricles, but more especially of theright. It weighed 120¼ oz. avoirdupois. The pulmonary arterywas of full size, and gave origin to the ductus arteriosus in theusual situation ; the latter was freelv open, and of sufficientcapacity to give passage to a, writing quill. The whole aortawas of small size, but the ascending aorta was relatively large.Beyond the origin of the left subciavian artery the vessel dimi-nished considerably in capacity, and expanded after the entranceof the ductus arteriosus. Dr. Peacock regarded the case as anexample of a permanently pervious condition of the ductusarteriosus resulting from congenital contraction of the portionof the aorta distal to the left subclavian artery.The same gentleman also exhibited a specimen of an

ANEURISM OF THE DESCENDING THORACIC AORTA,

which had produced laryngeal symptoms from pressure on theleft recurrent nerve, had given rise to haemoptysis from involv-

ing the lung, Lud finally produced death byrnpturiug into theleft pleural cavity. The man from whom the specnnen wasremoved was thirty-five years of age and a scaffold builder.He was received into St. Thomas’s Hospital on the 12th ofJune last, and had then suffered from dyspnœa for twelvemonths, but was able to follow his work till a week before hisadmission into the hospital. When Hrst seen, he had consider-able dyspnœa,, increased on exertion; spoke with a peculiar,hollow, interrupted, and feeble voice; and had a loud, ringing

cough. There was a prominence of considerable size below themiddle and outer end of the left clavicle, and the sound onpercussion was there entirely dull ; respiration was abolished,and replaced by abnormal pulsation and feeble double murmur.The left external jrynlar vein was much distended. Atthe base of the heart there was a feeble diastolic sound, propa-gated down the left side of the lower part of the sternum; andthe pulse was somewhat of a regurgitant character, but equalin the two wrigLs. Some time after his admission he began to

spit blood, and continued to do so for a considerable period,but never in large Quantities. The left radial pulse also be-came fuller and firmer than the right. While in the hospitalthe external prominence almost entirely disappeared. He diedsuddenly by syucope on the 29th of October, having been firsttaken with faintness an insensibility at about one o’clock inthe morning. From this state he rallied in about an hour, andthen suddenly expired while getting out of bed at about seveno’clock. The aneurismal sac was found to arise from the de-scending portion of the arch of the aorta, immediately beyondthe origin of the left subclaviau artety. It involved the poste-rior and right, side of the vessel, and was of an oblong form, itslargest diameter being about three inches, and from abovedownwards it was fully the size of a large orange. On the

right and posterior part it had pressed upon the bodies ofseveral of the vertebicB, causing their denudation and absorp-tion. On the left the sac involved the upper lobe of the leftlung: it had also compressed the main branches of the lowerlobe, and so caused collapse of that portion of the lung. Theaneurism had opened by a small aperture, not larger thanwould admit an ordinary probe, into the cavitv of the leftpleura, and about four pounds of coagulated blood were foundin that cavity. The left recurrent laryngeal nerve, whenmaking its turn round the aorta, must have been compressedbetween the vessel and the sac. The upper part of the sacrose above its point of origin, and formed the prominence ob-served beneath the clavicle during life. The heart, and espe-ciaily the left ventricle, was somewhat hypertrophied anddilated. The aortic valves were thickened, and the right seg-ment was introverted and contracted at its free edge, and wasconsiderably beneath the level of the other segments, so as toallow of regurgitation from the aorta into the ventricle. Theresults of the examination after death ver fully illustrated thevarious symptoms which had been observed during life.

Dr. COPLAND pointed out, as a remarkable circumstance inthis cise, that the bloody sputum was not direct from the aneu-rism ; that it was from interference with the circulation throughthe lung, which was pressed upon by the sac of the aneurism.

Dr. CRIf’P asked if Dr. Peacock thought that Valsalva’streatment would not contribute to maintain life longer thanany other ii3cde in these cases?

’ Dr. Pt:ACCCH thought it very unlikely. He agreed withDr. Stokes, that if nbrin was to be formed, it would be bynourishing the system, and not by lowering it. He had adopted.in this case rest, perfect quiet of mind and body, and fairnatritions diet. Incompetency of the aortic valves, he thought,especially contramdicated Valsalva’s treatment.

Dr. COPLAND agreed with Dr. Peacock.

DISEASE OF THE AORTIC VALVES.

Dr. R. BENNE T presented this preparation, the peculiarityof which was, that the disease of these valves, although veryslight anatomically considered, had been productive of verymarked symptoms and of the gravest changes, leading in nolong period to depth. He described the physical signs met

with duting life.DISEASE OF SUPRA-RENAL CAPSULES.

Dr. MONTGOMERY showed these and a portion of the skinfrom a very typical case of Addison’s disease in a boy. The

deeply bronzed skin and the disease of the supra-renal capsuleswere the only abnormal conditions found throughout the body.He died apparently of debility, slowly increasing in spite of alltreatment.

; CASTS OF TEETH IX SYPHILIS.

Mr. NUNN showed two casts from the teeth of two un