what thicker, but its cavity, as also the cavities of both auricles, were much smaller than natural. The valves were all healthy, but there was a blush of redness in the inside of the aorta, the calibre of which vessel was much reduced. The tumour measured 14 inches in length, and 43 in breadth, and weighed, with the heart, 4 pounds.

The viscera of the abdomen were all healthy.

The consideration of the symptoms which were developed in the case of Attenborough, affords much that is interesting and instructive, as well from the novelty of the disease, as the difficulty which was experienced in forming a diagnosis. The growth of a tumour of any description within the cavity of the chest is of very rare occurrence, and there are but few such cases on record. An account, then, of one in which the tumour acquired so great a magnitude, and with so little disturbance to the animal economy until a short period before death, cannot fail to be an important addition to the science of pathology, which has latterly become so important a branch of medical knowledge.

I regret much that I have been unable to trace the previous history of this case, further than the account which the patient himself gave me, that, previous to his confinement in jail, he had never been at all ill, and that, as far as he knew, none of his family were ever affected with any glandular disease. That the tumour could have been developed, and attained such a size from the period of his first complaint, about three months before his death, is not at all consonant with what we know of the growth of adipose tumours; for although they attain a very great magnitude, they increase in size but slowly. How, then, are we to account for its not giving rise earlier to uneasy sensations, when even in its earliest stages it must have pressed an organ so essential to life as those contained within the chest?

The symptoms from the first assumed a paroxysmal character, in consequence, I suppose, of the par vagum and sympathetic nerve being involved in the diseased mass. This, connected with his own statement, that the cause of the sense of suffocation which he found so distressing, was situated at the commencement of the larynx, and a blush of inflammation, which was visible on examining the pharynx, led me to suppose, on the morning of the 1st of May, that he was labouring under an attack of ædema glottidis; and with this opinion Drs. Bell and Scully, who saw the case with me, coincided. He at that time complained little of the swelling, which was situated over the thyroid gland; and our belief that it was merely an enlargement of that body, gave us reason to suppose that, although the operation of tracheotomy would be very doubtful in its termination, it might be performed if necessity should compel us.

The state of the surface of the heart in this case was very remarkable. In the report of the post mortem examination, I have stated that it seemed as if the process of ulcerative absorption had been going on for some time; and I do not know any other term by which I can so well express the appearance which it presented; and what renders it more worthy of observation, the opposed surface of the pericardium was perfectly smooth; nor was there any fluid contained in the pericardial cavity.

The immediate cause of death was the effusion into the pleura, which must have taken place very rapidly, as, until a few hours before his death, he was able to sit up in bed, and lie equally well on either side.

I cannot give any information as to the stethoscopic indications for some time previous to his death, as, in consequence of the tenderness of the surface of the chest, from the repeated blistering and use of the tartar emetic ointment, he was unable to bear the application of the instrument.

BIBLIOGRAPHICAL NOTICES.

Smith's American Medical Almanac.1

We drew favourable attention to the two first impressions of this useful annual. That for this year contains, amongst other useful matters of daily interest, an account of the present condition of the various medical schools of the United States; with brief essays on practical subjects that are important to all.

Dr. Lindsly's Introductory Lecture.

The title of Dr. Lindsly's lecture indicates its general objects. It is devoted to an examination of the peculiar features of the profession in the countries of Europe most distinguished for their scientific reasearches, as well as in this country. We might differ from the respectable author in certain of his estimates of men and things, but on the whole approve of his views, which are evidently suggested by an ardent desire for the advancement of his profession.

Fourth Annual Report of the Trustees of the Vermont Asylum for the Insane.3

We are indebted to Dr. Rockwell-the superintendent for this report, which, like the reports from all our insane establishments, contains much that is gratifying to the philanthropist and the physician. The institution appears to be in a most wholesome state. Would that we had a similar establishment in Pennsylvania! It cannot be postponed long, under the powerful feelings of interest excited in every charitable bosom towards the most helpless of the human family, whose condition in the absence of such institutions is wretched in the extreme.

Operation for Strabismus.

This novel operation has been practised to a great extent by several of our surgeons. Professor Pancoast informs us that he has performed it nine times, and with great success. It seems, indeed, to be admirably adapted for the removal of a most unsightly deformity.

The American Medical Almanac for 1841; designed for the daily use of Practising Physicians, Surgeons, Students, and Apothecaries. By J. V. C. Smith, M. D., Editor of the Boston Medical and Surgical Journal. Vol 3, continued annually. 24mo, pp. 148. Boston, 1841.

2 Medical Science and the Medical Profession in Europe and the United States, an Introductory Lecture. By Harvey Lindsly, M. D., Professor of Obstetric Medicine in the Columbia College, Nov. 1840. 8vo, pp. 35. Washington, 1840.

3 Pp. 15. Montpelier, Vermont, 1840.

ART. I.-EFFICACY OF HYDRIODATE OF POTASSA IN THE CURE OF RHEUMATISM.

BY E. D. CONNOR, M. D.

Demopolis, November 24th, 1840.

Dr. R. Dunglison,

Dear Sir,-Allow me to add another to the many proofs of the efficacy of the Hydriodate of Potassa in the cure of Rheumatism.

Yours, respectfully,

E. D. CONNOR, M. D.

C. D. C, aged 49, has for several years past been complaining of slight rheumatism in the right shoulder and arm, but in every other respect is in perfect health. Being of quite a sanguine temperament, and fond of good living, he allowed the disease to run its course until the last summer, when in the month of May he was taken with violent pains in both the upper extremities and left ancle, with great derangement of his general health, accompanied with great nervous irritability, so much so, indeed, as to ren der him almost a sleepless being. He applied for medical aid, and being in what is termed good circumstances, procured the best the country could afford. The whole list of remedies commonly used in the cure of this disease was run down, and no relief was obtained. In July I saw him in consultation with my former preceptor, who at the time was busily engaged in practice, and left the care of the case to myself; and having seen colchicum used by yourself with great good effect, I put him on the use of it, but derived no benefit from it. Much time passed in the use of various reputed remedies, and the patient grew worse daily, until about the middle of August, when he became almost helpless; and from the great nervous irritability his mind seemed to be failing, and was fast advancing into second childhood. I mention this to show that time had not done any thing towards the cure. On the first of September I was able to procure some of the hydriodate of potassa; I commenced the use of it in the proportion of thirty grains to the ounce of water, of which solution I gave him twelve drops three times daily, increasing a drop each day; when, much to my astonishment, in one week's time he was so far enabled to use his right arm as to shave himself, and in three weeks was entirely well, and has since that time enjoyed perfect health. When I last saw him, about ten days ago, he said that he never in his life felt better. I neglected to state above, that during the whole course of the disease, from May to September, proper attention was paid to diet.

ART. II.—MEDICO-CHIRURGICAL TRANSACTIONS.

Concluded from page 218.

The preponderance in number of the communications in the present volume are the pathological, which we shall now take in the order of their occurrence. The first comprises Cases of Spasmodic Disease accompanying Affections of the Pericardium; by Richard Bright, M. D., F. R. S., President of the Society, Physician Extraordinary to the Queen, &c. These cases are three in number; and in each of them the pericardium was seriously implicated; and it appeared to the author that the phrenic nerve was the more immediate means of communicating irritation to the spinal chord. In the first case, severe chorea came on after symptoms which bore a good deal the character of acute rheumatism. The patient died about the 16th day after the occurrence of the spasmodic symptoms; and on examination, the heart, pericardium, and contiguous part of the lungs, bore distinct marks of considerable recent inflammation.

In the second case, trismus, and convulsive affections, bearing sometimes a tetanic character, followed on acute rheumatism, and, in twenty hours from their attack, proved fatal. Severe inflammation was found in the chest, particularly on the pleura of its right side, and on the right side of the pericardium, down which the phrenic nerve runs.

The third case was one of much glandular disease in a female of 17, where phthisis pulmonalis was suspected; and where severe dyspnea, resembling that of hysteria, supervened, and assisted in gradually wearing out the patient. Extensive glandular disease was found in the abdomen; but the chest and lungs were free from all tubercular deposit.

"The heart and pericardium formed a hard mass, firmly glued to the sternum by the white fungoid matter deposited in the anterior mediastinum, so that on raising the bone, they were round like a hard tumour attached within.

"The heart itself presented a curious specimen of disease: a thick layer of yellow malignant matter lined and covered the pericardium, both the portion attached to the heart and the reflected portion; the two deposits were strongly glued together in most parts, and were a quarter of an inch in thickness. In other parts the two layers were easily torn from each other. The phrenic nerve was seen on the right side, passing down, pressed upon, and almost imbedded in this diseased mass.."-P. 17.

A plate of the appearances is given. The alternation of chorea with acute rheumatism has been long known or suspected; and that pericarditis follows, and, through the medium of the phrenic nerve, produces in the spine that affection which gives rise to convulsive paroxysms, there is, he thinks, every reason to believe. He is not of opinion with some authors, that inflammation in or about the spine is necessary to the production of chorea.

In addition to the authorities referred to by Dr. Bright, it may be observed, that pericarditis, with choreiform symptoms, is mentioned by Dr. Craigie as having been observed by him, and also by Dr. Roeser, of Bartenstein. (Practice of Physic, vol. ii. book ii. chapter iii. § iii. p. 151.)

Memoir on Typhlo-Enteritis; or Inflammation and Perforative Ulceration of the Cacum, and of the Appendix Vermiformis Caci; by John Burne, M. D., Physician to the Westminster Hospital, Lecturer on the Practice of Medicine, &c. This paper may be regarded as a continuation of one on the same subject which appeared in the twentieth volume of the Medico-Chirurgical Transactions, and it contains several additional cases, in further illustration of the pathology of the cæcum and appendix.

The liability of the cæcum to have a lodgment of undigested substances in it, produces irritation and great disposition to symptomatic inflammation in this part of the alimentary canal; which latter, when it occurs, usually

terminates by resolution; the subsidence of the spasm and removal of the inflammation allowing the muscular coat of the cæcum to resume its functions. No instance of perforative ulceration of the cæcum from internal disease has occurred to the author; but perforative ulceration from without he states to be common, owing to abscesses resulting from perforation of the appendix vermiformis bursting into the cæcum. Several interesting cases are given of inflammation of the appendix, and perforative ulcerations of that portion of the gut, and their consequences. The author is of opinion that Dupuy has formed an erroneous conclusion, when he viewed the occurrence of abscesses bursting into the cæcum as having originated in its cellular texture, instead of being secondary, and consequent on perforative ulceration of the cæcum or its appendix. He does not conceive that there is any reason for supposing that inflammation of the mucous membrane of the cacum can ever give rise to inflammation in the adjacent subcæcal cellular tissue.

Case of Carditis; by Thomas Salter, Esq., F. L. S., of Poole. The case occurred in a man of 50; and the principal symptoms were dull and heavy, but not lancinating, pain in the lower part of the chest, rather inclining to the left side; very severe oppression and distress in breathing, increased at intervals, but never quitting him; a frequent and small pulse; inability to lie down, and a feeling as if he could not live. There was no cough, nor sign of pulmonary affection, and frequently considerable uneasiness in the left upper arm. The symptoms continued to a certain extent for about six weeks; but they were most severe and alarming for sixty-five hours only before death.

On examination, the heart was found to be rather larger than natural, and of moderate firmness; large white or yellowish coagula were contained in the cavities; and commencing ossification was discovered in the ascending aorta, but no disease in the lining membrane of the heart, or in the valves. The muscular substance of the left ventricle was of a light yellow hue and fibrous texture; and exhibited purulent matter at the surfaces of the various sections that were made in it. In some parts, small cavities filled with purulent matter were found, varying from the size of a pin's head to that of a small pea.

The pericardium exhibited "unusual vascularity," which was attributed by the author to inflammation; though there was neither on this nor on the surface of the jejunum, (which was likewise stated to be much inflamed,) any effusion of coagulable lymph, which might have been expected to appear under such circumstances.

On the Softening of Coagulated Fibrine; by George Gulliver, F. R. S., Assistant Surgeon to the Royal Regiment of Horse-Guards. The author's object in this paper is to ascertain the differences which exist between various modifications of animal matter and pure purulent matter; and he has been able to infer, that softened fibrine, which has generally been regarded as a purulent fluid, is, notwithstanding, of an essentially different character. His experiments and observations were made on fibrine from the heart; on that obtained from venous blood by agitation; on the fibrinous concretion formed by inflammation on the pleura of a dog; on softened fibrine in the heart and aorta; and on softened fibrine in the veins. His general deductions are the following, viz.

"1st. That coagulated fibrine, when removed from the body and subjected to a blood heat, commences to soften in about forty hours, assuming the colour and consistency of pus, but easily distinguishable from it by microscopic and chemical examination.

"2d. That the purulent-like fluid found in the fibrinous clots of the heart and arteries, and so frequently in the veins, is essentially distinct from pus, and analogous to, if not identical with, softened fibrine.