night previous, and sufferings most acute till about nine o'clock in the morning, when she died. No post mortem made; but judging from the symptoms, the deep-seated tissues of the uterus and the peritoneum were inflamed. CASE 4.-Inflammation of the Iliac and Femoral Veins extending to the Vena Cava. Mrs. W., æt. 35, Newman Street. Confined 16th August, 1855, of her third child; labour natural. September 9, three weeks after birth of child, was suddenly attacked with pain in calf of right leg, with entire loss of power of the extremity. Mercurius 5, gtt. j, in 9 tablespoonfuls, 1 table-spoonful three times a-day. She remained much the same till the 13th, when there appeared much swelling; no discolouration; much tenderness from thigh to groin; loss of power and motion, and pain in the hypogastrium; temperature of limb increased; hot, pale, and glistening; pressure along the course of the crural vessels exciting intense suffering; the femoral vein enlarged and indurated as far as can be traced, and very sensitive; much pain in leg from ham to ankle, where some of the superficial vessels are hard and painful; pulse 80; tongue dry, brown, and thirst. Eight years since, after first child, had a similar attack, and the limb remained for a long time much weakened. Remained much the same until September 18, still under the Mercurius, when the heat and tension diminished, but the pain in the course of the vessels remained. The vein cannot be felt, and the thigh very tender. Cont. September 20th.-Has pain at umbilicus, loins and pubes; slight rigors; pulse 102; tongue foul, and thirst; pressure at umbilicus causes pain, but abdomen soft. Cont. 22nd. The limb nearly of its natural size; tenderness gone, but has attacks of acute pain in back and loins, and a rigor of an hour's duration this morning early, followed by profuse perspiration and slight delirium; skin hot and dry; pulse 120; bowels relaxed; tongue brown and parched; on pressing around the umbilicus complains of deep-seated pain and soreness. Arsenicum 3, gtt. j, in 9 tables-poonfuls, 1 table-spoonful every 3 hours. 23rd.-Rather improved; leg less in size. 24th. Another violent rigor; pulse rapid and feeble; the countenance denoting the greatest anxiety; leg less. Cont. 25th. The extremity nearly of its natural size, but had frequent vomiting, with pain in left side, increased by taking a deep inspiration; pulse 120; conjunctivæ suffused; prostration very great, with incessant cough; pulse 145; surface cold and clammy, and diarrhoea. 26th. All the symptoms much increased after seeing her yesterday. Died this morning. Post mortem.-Coats of inferior cava much thickened; its cavity occupied by a coagulum distending it to its greatest extent to about an inch below the vena cava hepatica, and firmly covered with a tough red membrane, so that it was with difficulty removed; the coagulum appeared similar in colour and consistence to coagulable lymph in parts, in others a yellow mass made up of lymph and pus; the left common iliac was plugged with the same substance; the right less than its usual size, containing a firm coagulum composed of layers of lymph; the internal iliac perfectly closed, and like a cord; the femoral vein less in size in its whole length, and adherent to the artery; the superficial and deep femoral were in the same condition, as also the saphena major and minor. CASE 5.—A poor woman who had been delivered by a midwife April 5, 1852, twelve days prior to my seeing her, was suffering severe pain in region of uterus, rigors and absence of lochia, pains extending to left groin down the inner part of the thigh, with much tumefaction of the extremity; the skin hot, pale and shining; pitting on pressure; much pain was incurred by the slightest pressure; the femoral vein in its whole course hard, as also the saphena; much prostration of strength; nausea; thirst and vomiting; tongue furred, brown and dry; pulse 112. Lachesis 3, in 9 table-spoonfuls, 1 tablespoonful every 3 hours. April 18th. The limb swollen and painful; much fever; tongue rather better; pulse 100; expresses herself as feeling better. Cont. 20th. The limb less swelled and painful; fever gone; tongue cleaner; great weakness in the extremity, and cannot move it at all. Arsenicum 5 every 3 hours, and hot fomenta tions to be kept applied. 25th.- Much better; says the fomentations gave much relief, and is able to move the limb without pain; the swelling quite gone, and the hardness of the saphena vein gone; still hardness of the femoral, but in a less degree. Cont. 30th,-Her health is returning, and is able to sit up; feels. no pain in the limb; pulse 80; tongue clean; appetite good; the foot and ankle slightly swelled; expresses herself as almost well. She eventually quite recovered. CASE 6. Mrs. ., æt. 56, a patient of a medical friend, had been in bad health some time; on walking out put her foot on a piece of turnip peel, and fell; when I saw her with my friend the femoral vein in its whole course was hard and painful to the touch; much swelling of the limb from Poupart's ligament to the knee, and disturbance of the whole system; the limb pale and pitting on pressure; tenderness of the hypogastrium; no power of moving the limb. Although this patient was suffering from disease of the heart, she quite recovered. CASE 7-A cooper employed in the City, July 7, 1856, while at work, punctured the palm of the right hand; diffuse cellular inflammation of the arm ensued, with enormous swelling of the limb nearly to the shoulder joint, with erysipelatous redness, rigors, rapid pulse, hot skin, perspirations, and flying pains over the whole body; much fever; thirst, and great pain in the limb; tongue coated thickly white; loss of appetite; vomiting; small collections of matter in the hand; hardness of the basilic vein; the countenance expressive of great anxiety; says he has not slept for nine days. Free incisions, hot fomentations to the arm, and linseed poultices to the hand. Arsenicum 3, gtt. j, one table-spoonful every 3 hours. July 8-Says the incisions gave him great relief; the arm much swelled; has fever and thirst, and feels better, having had some sleep. Cont. 10th.-Much improved; the swelling of the arm much reduced; the wounds in the hand looking healthy, and a copious discharge of pus; tongue much cleaner; the appetite returned, and altogether looking better. Cont. 17th. Very much better; the arm quite its natural size, and has no pain in the hand; he came to me after this, and gradually recovered. ON THE TREATMENT OF ORGANIC DISEASES OF THE HEART, BY PROFESSOR HENDERSON. NEXT in importance to the power of preventing and of curing diseases is, of course, that of lessening the sufferings which are produced by maladies which do not admit of being cured-of prolonging life, in some measure of comfort, under circumstances which forbid the entire recovery of health. The proper exercise of this function of the physician requires, I think, often as much professional experience, sometimes much more pathological knowledge, and generally more patience and forbearance than are usually demanded for the success of endeavours to cure diseases that are still remediable. No doubt the patience and forbearance which are necessary are required by the sufferer as well as by the physician, for both are liable, in the absence of these virtues, to seek a transitory relief from pain or importunity, in the employment of means which, in many instances, more than counterbalance, by lasting evil, the temporary calm which they had occasioned. But it is oftener I believe, owing to his misunderstanding the exact nature of the case of disease he has in hand, and the manner in which it is the cause of the sufferings he desires to relieve, that the physician has recourse to expedients which either fail altogether of their object, or add eventually to the miseries they were intended to soothe. In no class of organic diseases are mistakes of this kind more common than among those of the heart, and apparently because of the common error of regarding whatever sufferings are endured by those who labour under these maladies, as the consequences of the organic mischiefs alone, whereas they very often are the consequences of a superadded functional disturbance of the action of the diseased organ-8 disturbance not the necessary effect of the mere organic change, but of a cause or causes which in one way or another make the diseased organ to act, in respect to frequency, regularity, or force of its pulsations, in a different manner from that in which it would act if such cause or causes of additional disorder were absent the organic, anatomical change in its constitution remaining the same. These observations apply with especial force to two of the most common of the organic diseases of the heart: eccentric hypertrophy of the ventricles (which, in its worst forms, is usually associated with incompetency of the aortic valves), simple narrowing, and patency, of the left auriculo-ventricular orifice, with their customary attendant, eccentric hypertrophy of the right ventricle. These are the diseases of the heart in the course of which I have most frequently met with occasional exacerbations of suffering from dyspnoea, dropsical effusions, and the other accompaniments of advanced heart disease; but no doubt any organic disease of the heart which entails either a liability to interruption of the free passage of the blood through the organ, or to increased energy in the propulsion of blood from its chambers, may, owing to the operation of causes of irritation which excite the organ into unusual frequency, or unusual vigour of contraction, or both together, present examples of the same exacerbations, which, under suitable management, may be remedied for the time, or may be sustained or aggravated by improper treatment until a prematurely fatal issue is the consequence. To advert first to the cases of narrowing, and of patency of the left auriculo-ventricular orifice: it will be easily understood how a considerable increase in the frequency of the contractions of the heart must operate in retarding the passage of blood through the organ, when it is remembered that every contraction occasions, in the case of simple narrowing, a temporary stoppage in the current of blood passing from the auricle to the ventricle, already made too slow and difficult by the diminution of the passage, and that, in the case of patency, every contraction of the ventricle is the cause of a reflux of blood into the auricle. While the heart is beating with moderate frequency and regularity, the transmission of blood through it, if the disease be not in its most advanced stage, may be effected with a facility sufficient to prevent discomfort, and |