809

obtained is always associated with organicmatters, it should be incinerated on a littleporcelain capsule over the spirit-lamp flame,and the residue redissolved in dilute sul-

phoric acid. This fluid is again to be neu-tralised with ammonia, a little acetic acidadded, and sulphuretted hydrogen againtransmitted. The sulphuret is now quitepure. It should then be washed, removed,dried in a water-bath, and carefully weighed.Of this black sulphuret-

Lastly, this sulphuret should be reducedto the metallic state by boiling it with a

little dilute nitric acid in a test tube, neu-tralising with ammonia, which strikes a

beautiful blue colour, reacidulating withsulphuric acid, and introducing pure ironwire.

The reasons why I prefer this process tothat of incineration and precipitation by theferrocyanate of potash, are briefly, becausethe sulphuretted hydrogen does not indi-cate copper in the substances in whichthat metal naturally exist; and secondly,because the combining proportions of theferrocyanate of potash have not yet beenascertained with sufficient precision.

Before I conclude, there is one pointwhich I would renting the Society is ofvital importance to be attended to in our

inquiries on any fatal case of poisoning bythis metal; it is, whether a cupreous eme-

tic has not been administered before death,and if it has been, what was the precisequantity of the dose? It is obvious, thata professional poisoner might endeavour toprotect himself from suspicion and convic-tion by the open administration of a copperemetic, under the pretence of ridding thestomach of any deleterious and unknownsubstance. In such a case it is evident, thatif to our question as to the quantity of

copper contained in the emetic, he replies,five grains, and that on analysis we find sul-phuret of copper equivalent to twelve grains,that the chemical evidence is as conclusiveas if seven grains had been detected whereno emetic had been given.

London, 5th March, 1831.

ST. THOMAS’S HOSPITAL.

CLINICAL LECTURE

DELIVERED BY

DR. ELLIOTSON,Feb. 21, 1831.

I DISEASE OF TIlE IIEART, LUXGS, AND: LIVER.

. SixcE my last lecture, Gentlemen, onepatient has died of chronic bronchitis anddisease of the heart. The case was that ofA. B., aged 40, whe said he had been ill a

year. -11 lost of the cases which now termi-nate fatally among us, I am happy to say,are cases of long-continued organic disease.

His symptoms were, difficulty of breath-ing, cough, and mucous expectoration. Theexpectoration was frothy, and sometimes,he said, dark. There is a great variety inthe character of the expectoration in chronicbronchitis. Sometimes it is clear, some-times opaque, sometimes frothy, sometimesblackish, grey, or bluish, sometimes yellow.I have seen it of a bile yellow. Sometimes

glary, sometimes nearly solid. Indeedthere is in different cases, and in the samecase at different times,no end to its varieties.There was likewise oedema of the legs. Onlistening over the chest, there was sonorousand sibilous rattle in various parts. Theman clearly laboured under bronchitis. Souo-rous rattle there was in almost every partof the chest. The chronic bronchitis was

’ inferred from this rattle, in combinationwith the other symptoms, and it was quitesufficient to give rise to the difficulty ofbreathing, to the expectoration, and to theoedema of the legs.

Notwithstanding, however, the clronicbronchitis was sufficient to explain all thesesymptoms, I, of course, examined his abdo-men, and 1 found there was more or lessfluctuation in it, and the liver was decidedlyenlarged and hardened. He therefore had,besides chronic bronchitis, ascites and dis-ease of the liver.On listening to the heart I found that it

beat too strongly, and that at the momentof the pulse a bellows-sound was heard,loudest in the situation of the left ventricle ; .that is to say, to the left of the sternum.This bellows sound occurred at the momentof the pulse, and immediately afterwardsthere was a short clear strong sound, suchas is ascribed by Laennec to the auricles,but much louder and clearer than the soundwhich is perceived in health. It was notloudest at the part where the bellows-soundwas heard, but higher up. The auricles aresituated above the ventricles, and this sound

810

was in the region of the auricles. I con. I understand that the lungs showed chro-cluded, therefore, that there was an im- nic bronchitis in every part; that the bron-pediment to the passage of the blood from chial tubes throughout the organ were verythe left ventricle into the aorta, and that an -much thickened, showing the nature of theauricle, or the auricles, were dilated, if La- disease ; that the lungs, too, were veryennec was right in ascribing the second heavy, and filled with frothy fluid, so thatsound to the auricles. "

on lifting up a section of them, a serous fluidThe state of the pulse justified me in poured forth, as it would from a sponge.

taking away a moderate quantity of blood. The lungs were pervious in every part, asI bled him to twelve ounces, put him upon they generally are in bronchitis; but thereslops, and on account of the great diiTiculty was a large collection of fluid in the tubesof breathing he experienced, and the degree and air-cells, and perhaps in the cellularof sonorous rattle, I carried the antiphlo- membrane, too, of the lungs; and conse.gistic plan still further, and gave him two quently, on squeezing them, the fluid notgrains of calomel three times a day, with only ran out, but ran out frothy. I’herea scruple of tincture of digitalis. On the was no effusion into the cavity of the chest23d I bled him again, but only to twelve on either side ; that of course could not be,ounces, as the disease was chronic. He because respiration was heard distinctly onseemed to have suffered an aggravation of each side, even to the lowest part. But inthe complaint from a fresh cold he caught, examining the heart, the evidenceof diseaseand was labouring under an acute attack, was very strong. There was more or lessbut as this acute attack was superadded to hypertrophy of the left ventricle; it wasa chronic disease, I considered it dangerous also dilated, and very considerable valvularto have recourse to active depletion. His disease existed, as you will see. The leftdiet was a little increased ; that is to say, ventricle is in a state of hypertrophy and di.lIe was allowed a portion of milk. Still the

latation ; the substance is not thickened, but

symptoms continued, and the pulse did not the cavity is larger than it should be, anddecline at the end of a month (the 21st of yet the thickness of the parietes is not dimi.December), and a fresh attack then appear- nished, consequently there must have beening to come on, his breathing being more dif- more or less additional substance to main.ficult, and the sonorous rattle increasing, I tain the natural thickness ; and this accountsbled him again to twelve ounces. His pulse for the original violence of the pulse, andbore -this so well, that, his symptoms still the strength of the heart’s action.continuing, I bled him again to about a pint, The pericardium was found coherentand in about a week more I cupped him on throughout. I wish particularly to directthe chest, and then lie went on well till it your attention to this, because some havewas found necessary to have recourse again, an idea that adhesion or cohesion of the pe.from the state of the pulse, to bleeding, ricardium is very dangerous; and someand on the 12th of January I bled him again have the very same idea of cohesions of theto ten ounces. His mouth, which was for- costal and pulmonary pleurs. Now I do

merly sore, being now well, and anotherfresh not believe that any harm in general arisesattack coming on, I gave him the calomel a from these adhesions. Some people think,second time, in doses of three grains twice if they have a pain in the side, they harea day. It was necessary, however, still to adhesion of the pleura, andmake themselvesgo on with small bleedings, which always very miserable. If they have, I do notafforded him very great relief, and the blood think any harm usually results from it; andwas always much cupped and buffed. He I believe that most of us, if we were ex-was bled on the 2lst of January to eight amined now, would be found to have someounces, on the 27th of January to twelve adhesions, though we are in good health;ounces, and on the 3d of this month (Feb.) and so it is with the pericardium. For myanother acute attack took place, makiug it own part, I have never seen the least symp-necessary to cup him on the chest to ten toms from even complete cohesion of theounces; the windows of the ward I found pericardium. I know very strong adhesionhad been set open to let out the smoke, and at a single spot will keep the heart there sohe had in consequence another severe at- close to the parietal pericardium, that whentack of acute bronchitis. However, the a person lies in a direction to draw the heartdisease having lasted so long, I could not from that situation, it will be put upon thebleed him more than once, and this afforded stretch, and give rise to a smarting pain.him as usual great relief. He was obliged This man had no symptom about the heart,to sit up in bed ; and he sank in the most but what was all referable to the bypertro-gradual manner, and died on the 14th of phy and valvular disease.this month. He was not inspected in the - A patient of one of my colleagues was ex-hospital, but some gentlemen were so kind amined last week, who died of chronic pleu-as to go to his residence, and make the ex- ritis, with empyema, and in him tbe pea.amination there. carjium was quite coherent in every point.

811

and yet he had experienced no sign of car-diac disease. My colleague had carefullyexamined him, and no symptom of cardiacdisease had been detected, nor had the manmade the slightest complaint that could bereferred to the heart, and yet the cohesionmust have been of long standing, However,the cohesion of the pericardium in this par-ticular case, illustrates another fact, thatwhere there is organic cardiac disease, as theresult of inflammation ; where the internalmembrane, for instance, is diseased from

previous inflammation, the pericardium is

generally affected also. Here there is con-siderable valvular disease, as I will show

you, of the membrane within, and the cohe-sion of the pericardium without. I presumethat pericarditis existed at one time, and hadglued the two portions of the pericardium to-gether. I

I have mentioned over and over again,that I believe the greater number of diseases Iwhich occur in the hearts of young persons,that is, in persons not past the prime of life,begin as inflammations, and inflammations,too, of the pericardium. That appears tohave been the case here. There was no

pericardial cavity externally to the heart,for the pericardium cohered at every point.The part which I now show you, is the

left ventricle laid open. Here are the aorticvalves, rather thickened; but the mitralvalve is the seat of great disease, thickened,cartilaginous, and ossified. The two portionsof which the valve consists, are completelygrown up together all around, and forma pouch. That portion of the internal mem-brane of the heart which proceeds from theaortic valves to form the mitral valve,which you see is continuous, is diseased,-grown up together into the form of a pouch.The opening of the valve is here necessarilyrather smaller than it should be. It is not,however, by any means so reduced as youfrequently see it. The aortic valves are alsothickened and fleshy to the feel. Notwith_standing the opening of the mitral valve is

necessarily diminished, it is by no means sodiminished as in many cases I could showyou. Here it is from beneath, and here yousee it from behind. Instead of openingimmediately forward, there is a sort ofchannel from a cohesion, a growing up ofthe two leaves of the valve. There is ossi- (fication here of the valve ; and the bone isvery well seen if you look at the valve fromthe auricle. It has been deposited, as usual,under the lining membrane. The bare bonehere has been in contact with the blood, theinternal membiane having given way andexposed it.

I have said that frequently the diminutionof the opening is more considerable thanwhat you have just seen, aud here is a spe-cimen of the same disease precisely, where

the opening is much more reduced. Yotisee the pouch-like appearance of the mitralvalve, the opening here is very inconsider-able ; I should say it is not more than a thirdor a quarter of its natural dimensions. Hereis another instance of the same effect, whichunfortunately is very common ; you see theopening from the left auricle behind intothe lett ventricle. It is well to look at

these things, because I know that manypersons who are not in the habit of openinghearts do not easily discover what is dis-ease and what is not. Persons easily faUout of the way of detecting morbid appear-ances in the distractions of private practice.Although this is familiar and common tous, yet when persons are not in the habitof opening hearts, there is great difficultyin detecting even considerable morbid ap-pearances. Here is a third specimen of thesame thing.When it is in the very highest degree,

as you notice it here, the opening is a merechink ; you would hardly suppose this tobe the mitral valve; the blood must havehad extreme difficulty in passing through,and the patient could not have lived amoment if the disease had become moreintense than in this specimen. The manfrom whom this was taken came to thehospital in a dying state, and died beforethe end of the week; you will find these

appearances in accordance with the accountI have given to the public. It is the sub:

ject of’ my second engraving. I have said,that -

" In the natural state the valves are trans-lucent, fine, and flexible ; when the subjectof chronic inflammation, they become opaqueand yellowish, thick and rigid. These

changes are seen in dead subjects in variousdegrees, and may be considerable withoutreaching such a point as sensibly to disturbfunction." You cannot tell by any sign,during life, that a valve is much thickened oropaque, or even diseased in any way ; youcan only say there is an impediment to thepassage of the blood. If a valve is ever somuch diseased, and does not afford impedi-ment to the passage of the blood, or ceaseto prevent its retrogression, it is impossiblefor any one to tell before death that it isdiseased; it is only a change that impedesfunction which can be discovered, whichobstructs the course or ceases to preventregress. Their progress (I continue) also ad-

vances with various degrees of celerity.The surface of the valve may retain itssmoothness, though frequently we observeasperities from excrescence or deposition."In this preparation the valve, for exam-

ple, retains its smouthness; it is particu-larly smooth. whereas in the heart I now

show you the valve has numerous asperi-

812

ties from deposition. This is the case with you see the concave part of the slit towardsall the valves ; sometimes they are perfectly the root of the aorta, and its convexity back.smooth, very hard, and thickened ; in other wards.

cases they grow rougb. I have said-°And the extension of the" The induration varies in different points, valvular membrane is sometimes so con.

so that one portion is partly translucent, siderable that it appears to project into thewhile another is not only opaque and rigid, ventricle in the form of a pouch or a fume)."but even bony." That is the case here. This the French have described. " TheThere is a spot here which is translucent, semilunar valves stand firm and convex, as

quite smooth and thin, while in another if distended by repletion of their sacs, andpart of the same valve it is not only opaque grow up so as to leave only a small round orand rigid, but even bony ; it varies in differ- triangular opening in their middle,’’ Iuent points. this preparation which I have already shown

11 The induration at length amounts to you, here is the aorta and its three semilunarcartilage, and the part creaks when cut ; valves ; they have grown up so as to learethe last stage is complete ossification. As a tricornered opening. You see that thisthe thickening and induration proceed, the preparation exemplifies what I mentionedopening becomes narrow, both from the of the valves affording an impediment to thethickening of the edges and from the ap- fluid,from becoming so rigidtbat they cannotproach of the portions of the valves towards get out of the way. You see that their con.each other." The mere thickening of the vexity is just as if they were distended withedges will of course lessen the opening, but wool. When the impediment to the pro.the opening is lessened also from another gress of blood is considerable, I have saidcircumstance, namely,as the valves approach " the auricle behind is usually dilated andeach other they become rigid, and will not sometimes attenuated, sometimes of its

yield to the stream of blood. natural thickness, sometimes, though rarely," The several portions of the tricuspid thickened. Whether it be an auricalo-vell.

and bicuspid or mitral valves grow up tricular opening or a ventriculo-arterial, thiscompletely into a membrane with a very effect is the same. Occasionally, when a

small aperture in its centre." Here you ventrioulo-arterial opening is narrowed, thesee they have grown up completely into a ventricle behind is dilated or thickened, ormembrane with an aperture in its centre. both ; but frequently this is not the case.I have not an instance of it in the tricuspid The auricles suffer from being’ muscular tovalve, for disease in the tricuspid valve is only a certain extent, and throughout of Oldycomparatively very rare. insignificant thickness compared with the,

" And this aperture is sometimes, as ventricles." Now, in this instance, behindseen from the ventricle, and generally when the diseased spot the auricle is very muchviewed from the auricle, not circular but dilated,—much larger than it ought to be.

longitudinal, a mere slit. When seen even It is not, however, through an impedimentfrom the ventricle it is sometimes longitu- necessarily of the mitral opening that thedinal ; in this specimen the aperture, as left auricle will become dilated. If the ob.seen from the ventricle, is longitudinal; struction is at the mouth of the aorta, stillsometimes, however, it is round, as is here the auricle will often become dilated justseen, but generally when viewed from the as if it were at the auriculo-ventricularopen.auriale it is not circular, but longitudinal. ing, and that is the case in the present in.If you look, in the present instance, at it stance; sometimes you will see that it is thefrom the auricle, it is not circular but lon- right auricle that suffers dilatation, thoughgitudinal; and if you look at any of the the obstruction be at the mitral valve, orpreparations I have shown you from the even at the mouth of the aorta ; at so greatauricle, you will find the openings of that a distance will obstruction produce duiti-

shape." tion.In many cases it is a mere slit. Respect- The adhesive process exterior to the 1Jem

ing the particular longitudinal form,-the frequently binds down the proper auricles,crescent form of it, and the direction of that so that they cannot be discovered till torncrescent, as far as 1 know, the observation up. That is the case here, though the sinuswas made first by Mr. Adam of Ireland ; of the left auricle is greatly dilated.and that gentleman remarks that this slit is Let us now consider the symptoms in thisusually of a crescent form, with the con- case. In the heart there was heard a rerycavity towards the root of the aorta, and the loud clear sound after the pulse, just when it

convexity backwards. Now, you observe is supposed by Laennec that the auricles coii.here that the concavity is towards the root tract. This loud and clear sound not only wasof the aorta, and the convexity backwards. heard after the pulse immediately, and wasMr. Adam’s remark I believe to be perfect- followed by a pause, but it was heard loud-

ly accurate. The aorta is nearer the septum est at the upper part of the cardiac regionthan the opening of the mitral valve, and that is, where the auricles are situated, m

813

this there could be no doubt: it was heardby several gentlemen as well as myself, andamong others by a physician who is veryfamiliar with auscultation, and he was verymuch struck with the loudness of the soundin the auricular region immediately afterthe pulse; he concluded with me that ofcourse the auricle would be found dilated,and so you see it is. After this loud clearsound came a pause.Some difference of opinion exists as to the

time of the contraction of the auricle ; somemaintain that it takes place immediately afterthe contraction of the ventricles, some im-mediately before. Now, I do not mean to Imake any positive assertion on the point, Ibut one reason why I think Laennec is right,is this, that the sound ascribed by him tothe auricles, is loudest in the situation of Ithe auricles,-that affords a great probabilitythat he was right. Here was a case of dila-tation of one auricle, and the sound wasparticularly loud in the situation of one ofthe auricles, and occurred after the pulseand the heart’s stroke. ’

Respecting, however, the other sound-the sound that took place when the pulseoccurred, it must have arisen from an ob-struction to the blood leaving the left ven-tricle on its way into the aorta. Now, Ithink you will see clearly that though thedisease was here chiefly in the mitral valve,the aortic valves being only slightly thick-ened, not sufficiently to cause any impedi-ment, yet it is evident that the disease inthe mitral valves must have greatly impededthe flow of blood from the left ventricle intothe aorta. I do not know that this has everbeen attended to, but there being a greatdeposit of bone midway between the root orring of the mitral valve, and its edge, thereis a great projectiouof bone from the out-side of the pouch of the mitral valve intothe left ventricle, below the aortic valves,and this must have presented a very con-siderable impediment to the exit of theblood from the left ventricle. If I bringthe cut portion of the ventricle together, youwill find it difficult or impossible to pass yourfinger from the aorta into the left ventricle,or the reverse ; that you meet with great dif-ficulty from this bony, solid, immoveable,side of the mitral valve, though from no dis-ease of the aortic valves ; your finger passesthem easily. The bony valve stands out intothe left ventricle just there, and must haveoccasioned great obstruction during life.

I do not recollect to have seen this noticedany-where,- the circumstance of disease ofa valve of one aperture, affecting a differentaperture ; indeed the obstruction is not

really of the aortic opening, but just beforeit. This quantity of bone offered no impe-diment at all to the progress of the blood

through the mitral valve; for the deposi-

tion has taken place in an outward direction,and caused the pouch of the mitral valve tobe permanently extended. This shows thetruth of what I said before ; that ausculta-tion will not tell you what valve is diseased,or how much it is diseased, or whether anyvalve is diseased at all ; it will only tell youthat there is an obstruction, and where thatobstruction is, but not what that obstruc-tion arises from. I recollect having had twopersons under my care, with a strong bel-lows-sound at the moment of the pulse, andin both instances loudest in the right half ofthe cardiac region, and not in the left. I ofcourse concluded there was an impedimentto the blood from the heart into the pulmo-nary artery, which is a very rare occurrence.On opening the parts, the pulmonary arterywas sound-the valves perfectly sound; butthere was a mass of cartilage extendingfrom the pericardium down into the sub-stance of the heart, and pressing on the rightventricle just below the origin of the pul-monary artery, precisely where this mass ofbone does in the left ventricle. The onlydifference between the cases was, that inthe others there was a mass of cartilage inthe substance of the heart, encroachingupon the right ventricle, impeding the pas-sage of the blood ; and here it is the mitralvalve become bony, and encroaching uponthe left ventricle, close to the spot of theblood’s exit. It is impossible to force the

finger from the aorta into the body of theventricular cavity, and the bellows-sound atthe moment of the pulse is fully explained.The disease of the mitral valve has also cer-

tainty lessened its opening, but not veryconsiderably, as the chief disease is not

towards its edge ; and the auriculo-ventricu-lar openings are in health so much largerthan the ventriculo-arterial, that they willbear some reduction without any impedi-ment to the flow of blood, and without bel-lows-sound. Whereas the ventriculo-arte-rial openings being smaller, afforded impedi-ment and bellows-sound, from the least lossof their proportion to the cavity of the ven-tricles.You see that the disease has not been con-

fined to the heart, but has extended to theaorta. Here are points and patches of yel-lowisli substance under the inner coat of theaorta, which would have been followed byulceration of it, or have become bony. In thelatter case, the inner coat would then havegiven way, and the blood would have rushedover the bare bone, as it must have done in

the interior of the mitral valve.A circumstance noticeable here, and which

you will obscrve in many diseases of theheart, was, that some little time before death,little or no bellows-sound was to be heard,

nor was there any strong impulse of the

heart. When the person becomes very much

814

enfeebled, the blood, is impelled with suchslight force from the different cavities of theheart, that the opening, though diminished,is nearly large enough for the passage of thequantity of blood that has to escape, andlittle or no bellows-sound is heard ; and oftenwhen the hypertrophy is considerable, youwill just before death by no means find theimpulse strong ; so that if you had not madeexaminations earlier, you could not say theperson was labouring under hypertrophy ofthe heart, at least not say so positively.

GASTRITIS.

There were some patients presented,Gentlemen, amongst whom were threewomen, and one of those had laboured un-der gastritis. The patient’s name was MaryTurner, aged 22, and she had been ill fourdays. She came here on account of pleuri-tis it was said, and I was desired to see heron account of pleurisy. On examining her,I found that she had no sharp pains aboutthe chest ; she had experienced these, shesaid, before she came in, but on exa,-niningthey were not then present. She had greatpain at the epigastrium, increased on pres-sure. It was very tender, and there was aburning sensation in the stomach, especiallywhen she took any-thing into it. There iwas great tenderness in the left hypochon-drium. You will very frequently find ten-

derness in the left hypochondrium wl.en thestomach is anected. from the larger curva-ture being situated there. She had head-ach, and felt exceedingly drowsy and weak.Her pulse was full and soft; it was not hardapd sharp as it frequently is in pleuritis; but,as in affections of most mucous membranes,it was full and soft. The tongue dry, andfaintly brown. Though it was a case of

gastritis, the tongue was not red at the back,at the edge, or at the tip. It is by no

means a necessary consequence when thereis affection of the stomach that the tongueshould be red, either generally or at anyparticular spot, though it frequently is so.She told me she had been ill just in thesame way last year for four months. Herface and neck were universally and deeplyflushed. I cured her very simply by Meed-ing her to a pint, putting her upon slops, andgiving her a dose of castor oil every day.That was the whole of the treatment, andfiom being exceedingly ill she was perfectlywell, and presented on the 17th, havingbeen in exactly a fortnight. There were nosudorifics given, no antimonials, no mer-

cury—nothing at all but starvation, one

free bleeding (bleeding tiil she faintecl, anda pint was necessary for that purpose), andcastor oil daily.

’LF.UCORRIKEA.

There was likewise a case of leucorrhœa,

which it may be useful to consider, as show.ing that one treatment is not always required,in cases of discharge from mucous mem-branes. Leucorrhcea is very often an effectof mere general debility of the system, andparticularly of the vagina and uterus; butit sometimes is attended with very consi.derable irritation,-even inflammation of tLevagina, and that inflammation may extendto the womb. Many cases of leucorrhoM

begin as an active inflammation of the va-

gina, and it is impossible to distinguishthem as far as I know from active gonorrhna- perfectly impossible, except that you may,from the situation and life of the party,sometimes conceive gonorrlicea to be impos-sible. In this case, I have no doubt, it wasinflammatory leucorr6cea; for whilst thewoman was menstruating, she was exposedto cold and wet. The symptoms were, afrequent desire to make water, and invaria-ble relief on making it. She had a bearingdown both backwards and forwards, and aprofuse yellow discharge from the vagina.She had nausea, which is very common inall affections of the womb, and the cata-menia had suddenly stopped., The hyp0’gastrium, indeed the whole region below tuestomach, was excessively tender, and shewas very costive. Here were all the signsof active inflammation—great costiveness,great quickness of pulse, heat, and even

pain; and that inflammation was undoubt-edly most in the pelvis, from the pain beingthere, and increased on pressure immedi-ately above the pubes. It of course was lowdown in the pelvis, from the bearing downboth backwards and forwards; and clearlyin the vagina or uterus, on account of theprofuse discharge from the vagina.

Notwithstanding this was a case of lett-corrhœa I had her bled immediately to

twenty ounces ; had her put upon slops, anda number of leeches were applied to the

epigastrium day after day, aad she was

purged rebularly with castor oil; twentyleeches were put on again and again. Whenall the inflamm,tory symptoms were gotthe better of (and sometime afterward they

’ re-appeared, and leeches were again re-

quired) I ordered her au injection of thfnitrate of silver, two brains to an ounce ofdistilled water. She was going on well withthis, and I kept her on milk, when, on

catching cold, she was seized with a relapse,pain and tenderness, and a bearing down,so that I found it necessary on the 4th, andagain on the 8th of this month, to have re-course again to venesection. This got ridof the inflammatory symptoms, and nothingbut a profuse discharge now remained. Ihad no hesitation in continuing the nitrateof silver, for it never gave her any pain;indeed in a short tine I increased it to

three grains to the ounce, and that scarcclw

815

produced the !east pain, but it checked thedischarge. She now got up, and the dis-charge lessened so much, and she felt sostrong and well, that she told me she didnot think it necessary to stay here anylonger, and she went out, taking a quantityof injection with her. I am quite sure thatthe nitrate of silver forms one of the bestinjections you can employ in these cases.I will not say it is better than any, but Iam quite sure that it is inferior- to none, andbetter than many.

ACUTE RHEUMATISM.

There was a woman presented who camein with acute rheumatism, and she had alsopain in the chest, particularly over the re-gion of the heart, and a dry cough. I hadrecourse, not to local bleeding, but to gene-ral bleeding, and vinum colcliici, half adraclim three times a day, under whichtreatment she got well, but the case pre-sented nothing novel to you.There was a case of bronchitis, in a man,

sent awav cured, and one of rheumatism.But the most interesting cases were,-the ,disease of the heart, the gastritis, and the in-flammatory leucorrboea.

UNIVERSITY OF LONDON.

REPLY TO A SENIOR STUDENT’S ACCOUNT OFSOME RECENT EVRNTS IN THE MEDICAL

SCHOOL.

To the Editor of THE LANCET.SIR,-—" Audi alteram partem," is so pe-

culiarly characteristic of your useful andvaluable journal, that I shall make no apo-logy for intruding the following obsenationsupon your notice.

Conscious, Sir, as I am, that any publisli-ed accounts of intestine dissensiops takingplace amongst any part of the members of aninstitution (which, although rising, is hotyet in its infancy) must be detrimental toits interest, I should have been the last per-son to open a correspondence on the sub-ject which occupied the pages of your lastNumber. But the lists having’ been entered,the gauntlet thrown down, I lose no time inaccepting the challenge, and I have nodoubt of being able to prove the party feel-ing. and incorrectness, of at least some parts iof " the full and correct statement" given iby your correspondent. !

Last session, as your informant has stated, c

certain gentlemen, seventeen in number I ibelieve, did make complaints to the Council, iof the defective state of part of the anatomi- ikal instruction given in the University of cLondon. But what were those complaints ?

; They did not then pretend to say, that Pro.

. fessor Pattison was unable to teach any partof anatomy. No! they dared not then make

so unblushing, so groundless a charge. Thespirit of turbulence and disaffection had notthen risen to such a height ; it had not thenbroken down all the mounds and bulwarksof decency, decorum, and respect. They, only said iBIr. Pattison had given an ircom-: plete course of general anatomy, which, I

believe, was not then much cultivated it;any of the metropolitan schools ; that hehad not given the descriptive anatomy ofthe viscera and some other organs, in a suf-

ficiently comprehensive manner. Whetherthere was or was not a cause for these reamonstrances, I will not undertake to deter-mine ; but what was the result Why, inorder, if possible, to satisfy even the mostcaptious and discontented, Mr. Bennett was,at Mr. Pattison’s request, made a joint pro-fessor with him ; and in order fully to meetthe wishes of these gentlemen, the above-mentioned branches were comprehended inMr. Bennett’s division, whilst Mr. Pattisoncontinued lecturing upon that department ofthe course in which he had given the great.est satisfaction. But the demon of mischiefonce raised, was not so easily to be exor-cised. Many of these same gentlemen againcame forward, and entered their formal pro-test against the total incompptency of theirProfessor, and demanded his immediate ex-pulsion. What a goodly set of judges! Ihad, indeed, imagined at the commence-

ment of the present session, that the stormwas finally hushed, for in a conversation Ihad with a gentleman who was very activein the affair last year, he expressed himselfquite satisfied with the new arrangements.But, alas! the tempest, though partiallyquelled, had not finally subsided. ’ A Se-nior Student" says, "meetings were held,at which no personal feelinn was expressed,no party spirit evinced." Could any meet-ing be clesignated by such terms, when theopponents ot the measure, the advocates furtheir Professor, were denied a hearing ? Yetsuch was the case. At the first meeting outhe subject, the arguments of those whowere tiie friends of impartiality and order,the foes of injustice and confusion, were an-swered, not by calm debate, but by noiseand clamour, aud the open modest avowal," We are determined to do it, and we will’have no opposition." The address thus mo-clestly proposed and carried, taxes llr. Pat-tison with " a want of svstematic arrange-ment, a superuciat manner of treating theconnexion of parts, the commission of pai-pable uncorrected errors, a want of sudden tinterest, and an inaptitude in communicat-ing information." I shall speak of thee

charges separateiy.For a refutation of the first, a plain state-