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sage of the blood from the left ventricleinto the aorta, and giving rise to the firstbellows sound. That the disease of thevalves was such as to incapacitate them forthe performance of their duty, and conse-quently they allowed the passage of someof the blood back again into the left ven-tricle, producing the second bellows sound.

Autopsy.—It will be seen that this diag-nosis was beautifully verified by the post.mortem appearances. The heart was foundconsiderably enlarged on the left side, andadherent at one spot to the pericardium.On opening the left ventricle every partwithin was seen to be much larger thannatural. The wall of the ventricle was notmuch, if any, thicker than it should havebeen, but the cavity was much enlarged,rendering it evident that there must havebeen a great addition of substance. On pass-ing the finger through the aorta from abovedownwards into the ventricle, the com-mencement of the aorta was found con-

strieted. The aortic valves were felt to bediseased, and in touch resembled whip-cord. On splitting the aorta open it wasvery obvious that the disease was such asto prevent the valves doing their duty.They were very much corrugated, thickened,and inverted, rendering them nearly useless,and from the edge of one there was a wartyexcrescence about three-eighths of an inchin length, hanging down towards the ven-triele. The mitral valve was also diseased,but the situation of the disease was such a1neither to impede its function, nor give an3stethoscopic sign.

’ At page 486 will be found a renewalof Dr. Elliotson’s admirable Clinical Lec-tures, which an overwhelming pressure ofmatter has prevented us from before con-cluding. We have three or four more, only,on hand, to complete the course, which weshall insert forthwith. In giving precedenceto other matter during the last two months,we may observe, that it would be difficultto select any portion of the usual contents ofa medical journal, the value and interestiattached to which would more readily ad-mit of delay in their publication than theclinical remarks of Dr. Elliotson. Theirworth is of the most permanent kind. We erefer to the lectures in this place, however,for the purpose of adding to the one on

epilepsy in our present number, the follow-ing note which was accidentally omittedfrom its proper place.

There was a very curious variety of epi-lepsy in Dr. Elliotson’s female ward. at thetime of the delivery of the lecture, pub-lished this week. In this case after theconvulsions were over, but while the uncon-ess still remained. the woman beganto hum a tune and dance, pointing her toes

and bending her wrists with what thenurses and patients considered, considerablegrace. The Doctor remarked on this case,on going through the ward one day, that heknew perfectly that there was no doubt inthe matter, and that such instances were tobe found in medical records, and had beenseen before by himself. This patient isstill in the hospital, and continues to singand dance, unconsciously, in the fit, as before.

WESTMINSTER HOSPITAL.

ANEURISM OF TIIE DESCENDING AORTA.-

DEATH.-POST-MORTEM APPEARANCES.

PATRICK DRISCOL, ætat. 35, a man wellset, of middle stature, and of healthy ap-pearance, was admitted under Dr. Bright onthe 12th of October last, with symptoms ofdyspepsia. He was a seaman, but had beenroving on land for the previous six months,and had indulged in every conceivable ex-cess, but especially in drunkenness. Hefirst complained of obstinate constipation,after this a tumefaction occurred in the leftiliac region, and which was removed by-purgatives, but it occasionally returned ac-companied with pain. The appetite fell off,

and he became subject to flatulence. Whenreceived into the hospital, the countenance, indicated derangement of stomach. Tongue, broad, flabby, and furred ; appetite bad,

fiatulence; bowels constipated; pulse 78,full, soft, and regular; the other emuncto-ries healthful in their function. A stomachicmixture of senna, gentian, and carbonate ofsoda, in due proportion prescribed.

17. The medicine produced little or nogood effect. The man complained of nau-

sea, the bowels became bound, and the

tongue more deeply furred, and severe paincame on in the lateral regions of the abdo-men. Eight ounces of blood to be drawn fromthe side by cupping. An injection of turpen-tine and castor oil to be given.

19. Pain diminished, bowels relieved bythe injection ; bladder irritable ; frequentmicturition ; skin dry ; pulse 84, full andsoft. A calomel pill to be swallowed at night,and a black dose in the morning.

24. The symptoms recited continuedwith slight variations, and were mitigatedby the same means as we have described.This morning acute pain was felt under theleft breasL, increased on each inspiration ;breathing accelerated, and attended with a

short cough; pulse 120, full and hard ;. countenance anxious. Verzesectimz to ten

; ounces, a blistev to the side, and a ctiaphoretic. draught every four hours.i 25. Anxietv of expression dimitiisbedspain somewhat alleviated, but still consi-

608

derable ; cough painful ; respiration rapid. IThe heart beats with great force, and a

grating sound; pulse 104, full, strong, andirregular; tongue pallid and clean ; bowelsopen ; other functions duly performed. Two

grains of calomel to be given every four hours.29. Pain in the region of the heart less-

ened. Vertigo on exertion; pulse 108,full and jerking incipient ptyalism; bowelsfreely open.

Nov. 3. Had a severe fit of syncopewhilst on the stool, for which he had a doseof sal volatile administered. Pulse 114,feeb!e; tongue exsanguous; skin cold ; faceand general surface pallid; pain in thelower part of abdomen. He moans conti-

nually. To discontinue the calomel; to taketen grains of Dover’s pouder every night, andto have a blister on the left lumbar region.

Nov. 5. He has stood erect to-day with-out fainting ; pain still remains in the leftiliac fossa ; pulse 108, feeble ; circulationmore active in the capillaries.

8. On attempting to sit on the close-stool, a syncope occurred, which lasted formore than half an hour ; the collapse wasvery considerable ; no pulse perceptibleon the radial artery during the parox-ysm. 4 wine-glassful of brandy and the fol.lowing MttTtMM :-

Laudanum, a drachm ;spirit 01’ sweet nitre, an ounce ;Camphorjulep, six ounces. :Mix; an

ounce every four hours.

12. The opium has produced a slightjaundice; the pain continues in the iliacfossa. The patient has the greatest dreadof moving ; no persuasion can induce himto sit up. He restrains all his naturalwants, and crouches at the bottom of hisbed; pulse 110 ; tongue cleaner; continuesthe remedies.

20. Another severe fit of syncope ; takesether and laudanum.

25. Feels stronger, but has pain of cheston inspiration; tongue flabby and bloodless ;his urine deposits a vermilion-like sedi-ment ; pulse 100, full; respiration 22 perminute as he sleeps. The fear of movingstill haunts him. A pill nf’sulphate of ii-ottand opium eve)-yfour hours.

28. Has rallied considerably ; is in no

pain ; countenance improved ; seldom ad.ventures to assume an upright posture;cannot lie on right side; respiration 24 ; onright side murmur very distinct, louderthan natural. Percussion gives a hollowsound, and the resonance of the voice isremarkably distinct. On the left side no

respiratory murmur is audible; percussionyields the son mat, but little resonance ofvoice ; pulse 120, full; appetite improved.Coutinues remedies; occasional catharticiven.

Dec. 6. Continued in statu quo since lastnotation, and without syncope. This morii-

ing at two o’clock the fainting fit occurred,which was relieved for a time by an anti-spasmodic draught. He was never com-

pletely roused. At one p.m. the pulse wasnot perceptible; he was ghastly; the re.spiration suspicious ; deglutition gone. Heexpired at two p.m.Examination of the Corpse tlaarty-sir hours

after death.The body not emaciated, but the surface

was pale, and the muscles were remarkablyexsllnguous when divided. On the left sidethe chest was dilated, and the parietes ofthe abdomen of a dark colour. Ou cuttingthrough the costal cartilages of the left side,the pleural bag was wounded, and a quan-tity of blood flowed out. This was collectedin a sponge, and the thorax exposed in theusual way. The left thoracic cavity wascompletely filled with blood, and the lungquite deprived of air, and pressed againstthe mediastinum. On the right side all waswell, and the lung natural. A small quan-tity of fluid was found in tte pericardium,and the heart was pale, its substance soft.ened, and its parietes thin ; the right ven.tricle being scarcely thicker than a healthyauricie. The heart itself was rather smah,contracted, and contained no blood. After

removing about three pints of coagulatedblood, no solution of continuity could bediscovered in the thoracic aorta or itsbranches. The pleura was thickened, andlayers of lymph were deposited on its sur-face, and were gradually lost in the clottedmass of blood which was incumbent onthem.The first unusual appearance in the abdo-

men was the course of the colon from its

hepatic fold, obliquely downwards to the

pelvis, till it was in contact with the blad-der. It then mounted as high as the spleen,thus forming a loop, and descended nor-mally on the left side. On turning asidethe stomach and intestines, a large dark-coloured tumour was discovered under the

peritoneum, extending the whole length ofthe mesentery. On incising the peritoneum,it was found much strengthened by sub-imposed layers of cellular membrane. The

spleen and adjacent kidney were ramollies; and discoloured. The tumour being opened,Lyielded a quart of coagulated blood, and in- its centre was discovered a sac sufficientlyspacious to contain the hemisphere of anadult brain. This was the aneurismal bag,and was fortified by strata of coagulatedlymph. On examining the abdominal aorta,f an aneurismal pouch as large as a kidney. was discovered on the right side, project-ing from near the origin of the cœliac axis.

This was found to be nearly an inch thick,

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and protected by lamins of old fibrine. Onslitting up the aorta, it was discovered to locommunicate with three large cysts ; theone first descried, the one last mentioned,and another rather to the left side andlower. The anterior sides of these cystswere formed by layers of coagulum, im-pressed on the cellular tissue of the abdo-men. On the posterior aspect were thevertebrae of the dorsal and lumbar class indifferent degrees of absorption, the inter-vertebral substances being scarcely affectedat all. The cyst, the rupture of which wasthe immediate cause of death, was of im-mense size. It was bounded above by thewhole of the left pleura ; passing under thediaphragm it had denuded the ribs, theintercostal muscles, ligamentum arcinatum,and quadratus lumborum. The psoas mag-nus was flattened, and its substance soft-ened. The sides of the sac were linedwith blood in different stages of coagula-tion. A laceration in the pleura, admittingthe escape of blood from the aneurismal

cyst into the thoracic chamber, was appa-rently the immediate cause of the patient’adestruction.The viscera were moderately healthy.

The head was not examined.It is remarkable in this case, that no un-

natural pulsation existed over any part ofthe abdomen. Could this be due to the

great thickness of ttie cysts, and their beingextra-vascular? This supposition wouldappear countenanced in some degree by theoccasional deliquium, which was most pro -bably produced by the escape of a quantityof blood into the cellular tissue. This bloodremaining some time would become coagu-lated, and thus remain passive. The areaof the aorta was not obstructed, and thecirculation was enabled to proceed, as longas the resistance of the coagula was suf-ficiently strong to afford plugs to the lateralfissures of the artery. When the patientwas perpendicular, the weight of the columnof blood was too great to be thus confined,and a quantity escaped, as was evinced bythe fainting. The principal sac was so en-larged by these successive influxes, that itprojected considerably into the chamberproper for the lung, and much straitened thefunction of that organ.

THROAT CUT IN A FIT OF NERVOUS IRRI-

TAT’ION.-RECOVER Y.

George Slough, 43 years old, admittedon the evening of 83rd June, under Mr.Lynn. He was always a healthy man untilabout two years ago when at Brighton, fol-lowing bis employment of painter and gla-zier, he fell from a height on his head, andsuffered concussion of the brain. He wasa long while in the Sussex hospital, and

was ultimately discharged cured. He has,however, been ever since subject to occa-sional attacks of vertigo and epilepsy, andfrequent fits of depression of spirits. Hislife has always been regular, and his dietabstemious. During one of his melancholicparoxysms he drew a razor across his throat.A branch of the superior thyroideal arterywas divided, and some hemorrhage tookplace. When brought to hospital, it wasfound the man bad made a deep incisionbetween the os hyoides and thyroid carti-lages. The ligaments and muscles betweenthe two had been cut, and the fiuger couldbe passed into the wound, as far as the

mucous lining of the larynx, which, whentouched, produced a sense of suffocation.Deglutition was performed without dif-

ficulty, but the patient spoke with reluc-tance, on account of the alarm it excited inhis mind. The wound was covered with alarge coagulum, but this being carefullyremoved, and the surface washed with warmwater, the bleeding ceased. Three sutureswere made by Mr. Gill, the house-surgeon,and the patient composed himself to sleep.

July 5. The ill consequences of thewound have been prevented by an antiphlo-gistic and soothing treatment. Pultaceousfood has exclusively been allowed to him ;his mind is tranquil, and the wound is heal-ing with very little suppuration.

SARCOMATOUS TUMOUR OF TFIE NECK.

Frederick Benyon, aged 54, a man ofmiddle stature, and tolerably good consti-tution, who has spent part of his life as aseaman, and has been generally occupiedon land as a light porter, enjoyed a fairshare of health for the greater part of hislife, having never suffered from any diseaseexcept a bloody flux whilst in the WestIndies. He has been a married man, andnever addicted to irregular pleasures, andhas, consequently, been perfectly exemptfrom their usual attendant affections. Onthe 18th of January last; this man was ad-mitted under Mr. White with a tumour onthe left side of the neck and throat, appa·rently of a mild sarcomatous kiud, and ex-tending from the lobules of the ear down tothe middle of the clavicle, and from theright sterno-cleido mastoideus muscle acrossthe throat and left side of the neck over the

nape, as far as the external edge of the cer-vical part of the right trapezius muscle,thus including three-fourths of the circum-ference of the neck. The greater part ofthe surface of this tumour is an open ulcercovered with florid, large, and flabby gra-nulations, and bedewed with a laudable pus.Its margins are hard, livid, and projecting,and the whole tumour is immoveable. beingapparently amalgamated with the substance

510

of the adjoining tissues. It gives no painor inconvenience, and is not tender to thetouch. Since the setting in of the hotweather, the discharge has increased, andamounts now (2nd of July) to about fourounces daily. The patient’s general healthis not much impaired. He swallows, di-gests, and sleeps, well. The bowels are

regularly open. Pulse 90, strong, and full.In September, 1831, whilst shaving, he

perceived a tumour and stiffness of motionon the left side of the neck. This was aboutthe size of a marble; it was not painful.It grew rapidly, and having attained thesize of a hen’s egg, broke in November,and discharged a quantity of blood and pus.Poultices were applied, according to theorder of the surgeon at the Charles StreetDispensary, but a fungous growth sprungout of the ulcer, and could not be restrainedby astringents. On attaining the magni-tude described, he applied, and was ad-mitted into this hospital.

Since admission, the object of his treat-ment has been to sustain his health, andproduce the absorption of the excrescence.Iodine has been exhibited in gradually-augmented doses, his diet has been full,and lunar-caustic washes and regulatedbandaging have been resorted to. It isimagined the size of the tumour has di-minished, but there is a difference of opi-nion on this point. He still continues toeat his allowance, and his spirits do notflag, but his colour is fading, and otherharbingers of deteriorated health are everyday becoming manifest.

ANEURISM OF POPL1TEAL ARTERY-TREAT-

MENT BY COMPRESSION.

Richard Bigland, aetat. 30, a tall wen-formed, muscular man, of ostensibly soundconstitution, was admitted June 25, 1832,with popliteal aneurism. He is a gardener,and having had pretty constant employ-ment, he has lived well, and has neverbeen given immoderately to drinking or

vpnerv. He had the venereal disease butonce, and that mildly. His health was un-

interrupted, except in one instance, manyyears ago, when he was attacked with brainfever. About eighteen months since hewas troubled with a pain in the ham, ex-tending upwards and into the calf of theleg, whenever he made any unusual exer-

tion. He continued at his work, however,unsuspicious of any harm, and without anyvery great aggravation of 1-is symptoms.He became aware of a greater beating inthe affected limb than in the other, andwhich frequently interrupted his employ-ment, and at last compelled him to desistaltogether. About a month ago he appliedto Mr. Lynn, in Parliament Street, who

discovered an aneurismal tumour in thepopliteal space of left leg, and had himimmediately brought into the hospital.During the formation of the disease, hishealth was not at all affected. When ad.mitted, the pulsation over the entire sur.face of the tumour was distinct ; pressureon the common femoral annulled the pulsa.tion, and lessened the size of the tumour.. Pressure on the part itself also producedthe same effect.

His colour is good. Pulse 80, regular,steady, soft. Action of heart in all re-

s pects natural; respiration perfectly health.ful ; appetite and digestion good; tonguewide and clean ; bowels naturally open. Heis placed on middle diet. He takes nomedicine but salts and senna on occasions,Mr. Lynn has determined to adopt the

Italian plan of pressure on the superficialfemoral, and this day the system is com.menced. The leg and foot are bandagedup to the knee, a tight roller applied to thethigh, and over that an ordinary tourni.quet, with which gradual pressure is to bemade. He has had a slight degree of pres-sure for about six hours, and feels con.

siderable numbness in the inferior part ofthe limb. The pulsation is however quiteperceptible, though less strong in the tu.mour. The circulation generally is not asyet accelerated.

LONDON HOSPITAL.

CASE OF RECTO-VAGINAL FISTULA.

On Wednesday, 13th June, Mr. Scott

operated on B. C., mtat. 30, an Irishwoman,for a fistulous communication between therectum and vagina, which has been existingfor about ten weeks.

This patient, who does not give the mostintelligent account of the manner in whichthe accident occurred, states, that in her firstlabour, which took place about ten weekssince, during the passage of the child’s beadin the vagina during a very severe pain,the midwife who attended her, thinking tohasten the passage of the child, passed herhand up the vagina, at which time she felt

something give way in the vagina.On examination a fistulous communication

was discnvfred from the rectum to the vd-gina, by which a considerable portion of thefaeces pass through this fistulous openinginto the vagina, thus rendering the womanan object of misery to herself. She appliedat this hospital for relief, being wlline tosubmit to an operation, if necessary, andwas accordingly admitted on the 24th May,under the care of Mr. Scott, forthe purpose

I of operation.