intermittent pulse, and general prostration. His brother had left him for a few minutes, and on returning to his bed-side found his face deadly pale, his eyes fixed, and his hands cold: it was thought at first that he had merely fainted; but it was soon found that life was extinct.

The following report of the appearances found on dissection was drawn up by Dr. Vacca.

Sectio Cadaveris.-The body was not much emaciated, All the abdominal viscera were perfectly sound; only the venous system was unusually gorged with blood. On opening the thorax the lungs were observed to be singularly shrunk, especially the right one. Their colour was livid, and their surface was very uneven this unevenness was produced by a great number of transparent vesicles, varying in size from that of a pea to that of an almond. By far the greater number of these vesicles were on the anterior face of the lungs; few on the posterior. On compressing them they disappeared, and the air, with which they were filled, passed into the bronchi: they re-appeared on blowing air into the trachea. These vesicles did not communicate with the cellular tissue, which unites the air-cells together, so that the case must be regarded not as one of Emphysema, but of an abnormal dilatation of the air-cells. A great portion of the substance of the lungs, especially at their posterior part, was condensed, indurated, and in many places completely hepatised. The different lobes did not adhere together; neither was there any adhesion between the pulmonic and the costal pleuræ. The lymphatic glands of the bronchi were larger than usual; and the membrane of the air tubes was slightly engorged.

The pericardium was sound; it contained a small quantity of serosity. The heart was extremely soft and flaccid, so that it was readily torn with the fingers. Its right auricle was much dilated, and filled with blood. The walls of the corresponding ventricle were much attenuated; it was in them that the flaccidity of the muscular substance was most conspicuous. Within its cavity was a firm, fibrous, and whitish-coloured coagulum, which adhered very strongly to the columne carneæ. This coagulum had been most probably formed during the last moments of life. The right cavities of the heart did not exhibit anything unusual.

Baillie, in his Morbid Anatomy, and Lieutaud, in his Historia AnatomicoMedica, have related several cases of morbid change which have some resemblance with the present one; but I do not observe that either of these authors had ever found shrinking of the substance of the lungs, dilatation of part of the air-cells, hepatisation of a large portion of the pulmonic parenchyma, and an affection of the heart, in the same individual.

Pisa 12th Fevrier, 1817.

DOCTEUR VACCA BERLINGHIERI.

The following note from the late Dr. Warren (for many years one of the leading physicians in this Metropolis), in reference to the preceding report, will be also read with interest.

"I have shewn Vacca's account to Dr. Baillie, who considers the case as exhibiting a very unusual form of disease, and one which is evidently out of the reach of medicine. The state of the heart presented no unusual appearances; the flaccidity and tender structure of its fibres being met with very frequently in individuals whose constitutional powers have failed by slow decay: the appearance within the right ventricle was a coagulum of blood not uncommonly found in that situation after death. The condensation of the lungs is also not unfrequently met with, and justifies the opinion which Dr. Baillie held to you of such an alteration of structure being the probable cause of Mr. Horner's difficulty of breathing-which was never attributed to water in the chest, but to an obstruction in the circulation of the blood through the lungs, arising from some cause not easily distinguishable. The enlargement of the air-cells to the extent mentioned by Dr. Vacca is a disorder so rare, that there are only three instances to

be found in the anatomical collections with which Dr. Baillie is acquainted. The immediate cause of death appears to have been owing to the increase of the obstruction of the lungs to such an extent, as to have prevented the free passage of the blood through the branches of the pulmonary artery, by which the right side of the heart become gradually gorged with blood, and its action was slowly suspended.

PELHAM WARREN."

Remarks. This case is altogether an exceedingly interesting one, and forms a good theme for a little practical discussion. What was the primary complaint,—the fons et origo,' of the long-continued suffering, and finally of death? It was said at the time, and this too by men of the highest professional authority, that it was Emphysema or morbid dilatation of the air-cells with partial solidification of the substance of the lungs, and it was regarded, as we have seen from the preceding report, as an instance of an extremely rare form of disease. But it may be very fairly asked, was the pulmonary complaint the primary, or was it not rather the secondary, affection? Was it not the result of the dilated atonic condition of the heart? We think it was; and that the case of Mr. Horner was in fact one rather of cardiac, than of pulmonic, disease. From the want of energy in the ventricles, more especially in the right one, they were unable to propel with ease the stream of blood that was continually pouring in. The necessary consequence of this was, that the circulation through the lungs was more and more embarrassed, until a complete congestion took place in certain parts, and the pulmonary parenchyma thus became impervious to the air. The remaining portion of the lungs had to compensate for the deficiency, and had therefore extra duty to perform: hence the dilatation of the air-cells, and hence the dyspnoea and also the distress in the action of the heart. The history of the case seems to confirm this view of its pathology: the symptoms were always much aggravated by bodily exertion, and they were remarkably relieved by the use of opium-which no doubt tranquillised the movements of the heart for a time, and thus enabled it to discharge its contents more completely and more regularly.

Does change of climate hold out any prospect of benefit in such cases?-we think not. Rest and quietude in a pure atmosphere, passive exercise in a carriage when the weather is fine, great attention to the stomach and bowels, the use of mild tonics and antispasmodics, perhaps smoking, and certainly cheerful occupation of the mind-these are our chief remedies in such a case. To these we might be inclined to add, in most instances, a seton over the region of the heart. The grand thing is to form a correct diagnosis; the proper treatment follows almost as a matter of course.-Rev.

MISCELLANEOUS NOTICES.

1. Acupuncture in Neuralgia.

M. Lallemand of Montpellier has for many years been in the habit of using acupuncture in cases of genuine neuralgia with very decided benefit: against rheumatic pains, he says, it is quite inefficacious. We must therefore be careful to discriminate the cases for its employment; otherwise we shall certainly be disappointed. If the pain be limited to the trajet of the nerves, we may with tolerable confidence promise relief, if not a complete cure, of the suffering. M. Lallemand relates many cases: one we shall briefly notice. A man had for six months been afflicted with most severe pain along the whole course of the sciatic nerve; five needles were inserted along its tract, and left in for three hours. The application was repeated, at intervals of one or two days, four successive times; and the man was then completely cured.

2. Importance of Veterinary Medicine.

At the recent annual meeting at Strasbourg of the Scientific Association of France, M. Falk read a very sensible paper with the view of shewing the importance of medical men making themselves acquainted with Veterinary medicine. The utter neglect of this study is certainly to be regretted, as some valuable hints for the treatment of diseases in the human subject might be derived from what may be called Comparative Pathology. Every one in the present day recognises the importance of a knowledge of the anatomy of the lower animals ;-why not then of their diseases also?

The suggestion of M. Falk was well received by the Association.

3. French Gratitude to Medical Men.

We observe by one of the Paris Journals that the names of Percy, Desgenettes, and Larrey have been recently engraved on the famous Arc de Triomphe, at the Barriere de l'Etoile.

In some respects certainly, medical men occupy a higher position in society in France than in this country. For example, who ever heard of a doctor becoming a Baron, or peer of the realm with us? and yet every one knows that Portal, Dupuytren, and Cuvier occupied that dignified rank in the parliament of France; and where is the nobleman of Germany that might not be proud to be associated with a Baron Humboldt? True, the circumstance of a French peerage being merely personal, and not hereditary, makes a very material difference in the case; but then, why should there not be a certain number at least-we are no friends to an elective aristocracy, as a general question-of the most eminent men in the various departments of science being admitted to the highest honours of the state, without necessarily entailing upon their families the expensive title which they bore themselves?

By a recent Royal Ordonnance, M. Louis has been made an officer of the Legion of Honour, and M. Leuret a chevalier of the same Order.

Again, MM. Andral and Rayer-certainly two of the most distinguished names in French medicine of the present age-have been elected members of the Institute. "The selection of such men," says one of the Paris Journals, "shews very emphatically that this illustrious body looks as much to the scientific character as to the practical eminence of its candidates; in a word, that it wants not so much the mere skilful physician as the enlightened philosopher in its ranks."

4. Treatment of Gonorrhea.

"There are two opposite methods of treatment," says M. Vidal (de Cassis), "which I deem equally injurious; that which precipitates the issue (qui brusque le denouement) of the case, on the one hand, and that which awaits it with an almost complete inaction on the other. Both of these methods are apt to favour the extension, the displacement, or the chronicity of the disease. It is certainly remarkable that, in almost all the cases of nephritis supervening upon gonorrhoea which have occurred in my experience, the patients have taken the potion of Chopart, or some other resinous stimulating diuretic, more or less freely, from the commencement of the attack. Inflammation of the neck of the bladder is not unfrequent after such treatment. The same result is apt to occur when little or nothing is done to check the urethral discharge. The proper line of treatment, therefore, seems to be neither to try to stop the discharge suddenly, nor allow it to take its own course, and leave it to Nature's efforts to remove." (This remark is perfectly just; much mischief might be avoided by acting on M. Vidal's precept.)

5. Anecdote of Decandolle.

One day La Place being with M. Cretet, then minister of the interior, expressed

his regret to see Decandolle, the ornament of French Botany, sent as professor to Montpelier, as it was the intention of the Institute to have appointed him one of their members. "Your Institute! your Institute! exclaimed the minister. "I often wish that I could send a cannon-ball among you, and scatter the members over the whole of France. Is it not a lamentable thing to see all the light concentrated in Paris, and the Provinces in utter ignorance?"

6. Poverty of Medical Men: how to eke out a livelihood.

"One of the most certain signs, (says a writer in the French Medical Gazette), of the decadence' of a profession, is the necessity which many of its members experience, to seek for supplementary resources. Medicine is a most noble profession, but in the present day it is certainly one of the worst trades (industries) going. It is all very well to talk of dignity and high feelings; let it be remembered that a doctor has a stomach as well as a heart to attend to. In Paris alone, there are not fewer than 2,000 medical men, and it may be readily supposed that a great number of them scarcely ever get a fee. How then are they to live, until practice comes?-by turning their talents, whatever these may be, to the best account. The other day, I called on a confrere, whose circumstances I knew to be in not a very flourishing condition; I found him busily engaged in painting a portrait; he said that he had sold several of late. But what is your object? said I-' renforcer le metier,' was his answer. If a patient called, he put down his palette, doffed his blouse, slipped on his black coat, and with a grave and becomingly professional countenance went to his consultation-room; no sooner was the interview over, than he returned to his studio, resumed his working dress, and set to his painting again with all the cheerfulness of a brave heart. I could not help saying, Apollo is god of the arts as well as of medicine.'

"Several young medical men have exerted themselves with success in the way of inventions industrielles ;' for example, in the manufacture of portable liquid gas, in the construction of a night-telegraph, in preserving timber for ship-buiding, &c.

"The lamp C- , we owe to the ingenuity of an intelligent physician, who is practising in the suburbs, and who thus diffuses both light and health around him.

"Not a few imitate the example of Boerhaave, Pinel, and others, and give instructions in languages, mathematics, &c. translating, perhaps, Virgil and Horace in the morning to one set of pupils, and Hippocrates and Celsus in the evening to another. Often the wife, too, lends a helping hand à renforcer le metier,' either in the way of teaching, letting lodgings, or perhaps keeping a little magazine of linen, or silk goods, &c.-whatever, in short, brings grist to the mill !"

7. Compliment to English Genius.

In a clever defence of the Montpelier School of Medicine from the reproach of having been always too metaphysical in its doctrines, a writer in the French Medical Gazette, says "The professors, in their lectures, not unfrequently allude to the elementary principles of sound reasoning or logic, and endeavour to test the truth of any novel questions in medical science by appealing to them, on the ground that general philosophy embraces, properly speaking, a code or rule to guide us in deciding upon all matters in detail. Thus it is that our pupils will be found to study the works of the great metaphysicians in conjunction with those of the most celebrated observers of facts, such as Bacon and Hippocrates, Locke and Sydenham." Of these four names, England claims no fewer than three.

8. Quinine in Rheumatism.

Several of the hospital physicians in Paris have been of late experimenting on the effects of quinine in rheumatism, in consequence of the recent recommendation of this remedy by M. Briquet. His colleague at the St. Louis Hospital, M. Devergie, has published the reports of a good many cases of the disease, acute as well as chronic, in which he administered quinine with decidedly good effects. In some of those where the inflammatory symptoms ran high, bleeding and other antiphlogistic measures were used at first; but in most the remedy was given from the commencement of the seizure. The dose to adult patients varied from fifteen to thirty grains per day. At the close of his communication, he says:" In my opinion, too much importance cannot be attached to this discovery of M. Briquet." Discovery, indeed!-was not the use of bark in rheumatism strongly advocated by Dis. Fordyce and Haygarth, more than sixty years ago? and is not mention made of the practice in every English treatise on Practice of Physic? But this only en passant.

Neither bark nor its alkaloid salt will ever become a general remedy in rheumatism of the acute kind, except towards the decline of the attack, when the inflammatory symptoms have been subdued, and the pains have become more or less of a neuralgic kind. In chronic rheumatism, especially where the system is feeble and torpid, the use of the decoctum cinchonæ, or of a solution of quinine, is often of very great benefit, either alone or in conjunction with diaphoretic and sedative remedies.

9. Anti-Neuralgic Pills.

Dr. Eisenmann of Munich, in a well written paper on the general employment of alterative medicines, points out the utility of combining two or more of them together in certain cases of disease. He dwells particularly on some cases of severe neuralgia, which are more or less connected with an agueish state of the system, but which nevertheless resist the effects of bark alone. If however, he says, a medicine, which acts on the nervous system, be combined with the bark, we shall often succeed in effecting a cure. He strongly recommends a combination of quinine, strychnine, and extract of belladonna. [The remark is very rational and just.]

10. Usual Course of Rheumatism in the Horse.

M. Tessier remarks that M. Boullay, one of the most experienced veterinary surgeons in Paris, assures him that the ordinary course of rheumatic inflammation in the horse is the very reverse of what is usually the case in the human subject. In the latter, as all know, the affection of the joints is primary, and that of the pleura, pericardium, or other internal part is consecutive or secondary; whereas, in the former, pleuritis is generally the primary, and the arthritis the secondary affection.

11. Successful Case of Cæsarian Operation, successful both for mother and child. The report of this case is contained in the number of the Journal de Medecine de Lyon, for last February. The woman was 35 years of age, exceedingly deformed from rickets, and pregnant with her second child; the first had been extracted by embryotomy. The necessary incisions were made, and the child, and afterwards the placenta, extracted in the course of two or three minutes. The child cried lustily when taken out, and continued to thrive. The mother was threatened with peritonitis; but this fortunately subsided, and the wound was nearly quite healed by the fortieth day after the operation.