causes should at one time produce a continued, and at another, an intermittent fever, our author acknowledges his ignorance. Be it so; but we find fault with M. Dufau, for saying these fevers are cured by the same means. On the contrary, they generally require different modes of treatment-shewing, in our humble opinion, that the intermittent inflammatory irritation is different in its nature from continued inflammation. Our author, however, diverges so far from the doctrine of his master, as to allow that the irritation is not always in the stomach and bowels, though very often so. It may be in the brain, chest, or organs of the abdomen. But the fact is, that, in a majority of intermittent, and still more of continued fevers, the inflammatory irritation is so equally divided, during the paroxysm, among the great organs of the body, that it is utterly impossible to say which is the particular, or even the principal seat of the irritation. And when it does manifest itself more in one organ than another, we have no certain proof that it is the cause of the paroxysm in one class, or the continued excitement in the other class of fevers. There is just as much reason to conclude that its predominance in a particular organ is owing to previous predisposition in that organ, in consequence of which it suffers more than the rest during the general excitement which is raised in the hot fit of the ague, or the course of the continued fever.

The following are the conclusions to which M. Dufau has come, from the facts detailed, and many others which he has witnessed.

1mo. That there is such a thing as an intermittent irritation.

2ndo. That all, or almost all, the organs of the body are susceptible of this irritation.

3tio. That this irritation may be of a febrile or apyrectic nature→→→ that is to say, it may or may not be accompanied by sympathetic symptoms.

4to. That intermittent fevers are probably febrile intermittent irritations. 5to. That the phenomena of these fevers may be produced by intermittent irritation of any or all of the organs of the body.

We acknowledge that the doctrine of our author is ingenious, and that it is much more tenable than that of either Broussais or Clutterbuck, We believe, too, that its adoption would not be very dangerous in practice; because, while it leads to gentle and antiphlogistic measures in continued fever-and particularly to local depletion when any organ is threatened, it excludes not tonics, and especially the bark, arsenic, &c. where the fever is of an intermittent type. It is decidedly a much safer theory than that of Brown, or even of Cullen; but we do not see that it possesses much, if any, superiority over the eclectic doctrine, which regards fever as a general disease, often shewing determinations to particular organs, in which determinations consists the principal dangerand to guard against which the practitioner should be ever on the watch in order to obviate the local inflammation by local or general depletion.

2. PHLEGMATIA DOLENS.

It re

Dissection alone will not prove the pathology of a disease. quires the evidence of symptoms during life, and also the light which treatment may be enabled to throw on the matter. In respect to phlegmatia dolens, it is certain that not one case in twenty proves fatal. If therefore, every twentieth case shewed, on dissection, inflammation of the inguinal vein, the cause of the original swelling of the limb would not thereby be proved to be phlebitis. In fatal cases, there may be this organic lesion found, and yet, in favourable cases, it may not have existed. One unequivocal case of phlegmatia dolens shewing the vessels of the groin unaffected, ruins the theory if supported by 20 cases in the affirmative. The following authentic instance has been put on record by Mr. Fraser, Surgeon of the Civil Hospital at Gibraltar, in the January Number of the Ed. Journal.

Case. A. M. 25 years of age, a stout woman, was admitted into the hospital on the 7th January, 1826, eight days after a confinement, having her left leg, from the toes to the groin, swollen to twice its natural size; and conveying to the touch--" an elastic, doughy, œdematous feel, but with no serous infiltration, as the parts do not pit on pressure." The tumefaction extended up along the same side, to the mamma and even to the axilla. The febrile symptoms ran high, and took on a typhoid character. We need not detail the treatment, which was judicious; but as the mamma sloughed, she was in considerable danger for some days, and then rallied and promised to do well. On the 15th January, however, there came on symptoms of thoracic inflammation, under which she sank on the 17th of the same month, ten days after admission into hospital. We shall pass over all parts of the dissection, except that which bears on the subject under discussion. All the abdominal viscera were sound except the uterus, which exhibited marks of inflammation, the vessels being large, and the organ itself the size of a pine-apple.

"On prosecuting the dissection, a chain of inflamed glands, from the size of a pea to that of a filbert, was seen extending from the distal point of the left iliac artery, amidst the cellular substance surrounding the sheath of the vessels, atlantad to the diaphragm, all as red as scarlet, and many purulent. The cellular substance around the iliac portion of artery also exhibited serous infiltration. The coats of the artery, with its vein, as well as the aorta, and vena cava descendens, were examined, but, upon slitting them up, not a trace of morbid action could be discovered. An incision was now made inside of the thigh down to the knee; the cellular substance was of the depth of two inches at the upper part, and infiltrated, as in the arm, but no serous exudation took place. Inflamed glands of the same description as related, skirted along the femoral sheath, from the groin to the popliteal space. In the groin three or four were seen as large as a pigeon's egg. The blood-vessels, as in the abdomen, were healthy. An incision was also made into the

right, or sound thigh, and the contrast between the healthy and the diseased was remarkable. The lips of the vagina were much swollen."

18.

That this was a genuine case of phlegmatia dolens, there can be no reasonable doubt; and that it disproves the proximate cause which Dr. Davies has contended for, we think must be admitted. We have all along contended that, in phlegmatia dolens, there is no one structure peculiarly affected as the invariable origin of the disease. We think it very probable, however, that when the veins of the groin happen to become affected in the course of the disease, the danger is then much greater, and death more likely to result. In such cases, Dr. Davies' doctrine would appear to be supported, if not proved. But the numerous recoveries, without any particular treatment-and such cases as that brought forward by Mr. Fraser, disprove the exclusive pathology of inflammation of the veins being the primary cause of the disease. The opinion of Dr. Hull, that the disease consists in a peculiar inflammation seated in the muscles, cellular membrane, and inferior surface of the skin," appears to be as near the mark as any that has yet been offered.

3. EXAMINATION, POST MORTEM, OF TAlma.

Great contrariety of opinion existed among the medical attendants of Talma, respecting the nature of the disease which terminated this great actor's life. The partisans of Broussais maintained that he was affected with chronic gastro-enterite"-while the others considered the enlargement of the abdomen, the nausea and vomiting, the great tenderness as well as tension of the parts, the obstinate constipation, &c. as more probably dependent on an organic obstruction to the free course of fæcal matters, and therefore predicted a fatal termination of the disease. Dissection proved the justice of this last opinion. There were present at the dissection (which was performed by M. Breschet) Messrs. Biett, Dupuytren, Fouquier, Broussais, and several others. Six inches from the termination of the rectum, there was found a stricture, and, in fact, a complete obliteration of the intestine. Above this stricture the rectum and colon were prodigiously distended, and in some places sphacelated and perforated, so as to give exit to stercoraceous matters into the cavity of the pelvis. The whole line of the intestinal canal was greatly distended with gas and fæcal matters. Traces of inflammation were found, of course, in various parts of the intestines, and were evidently the consequences of the retention of fæces. The stricture in the rectum was probably of long standing; for Talma had experienced, for years past, a difficulty in evacuating the bowels. He would frequently go in great haste to the water-closet, thinking there was a copious motion to come away, and yet, when the attempt was made, nothing but air, or a small quantity of liquid fæces would escape.

There was another morbid appearance on dissection, which is worthy of notice. At the apex of the heart there was a small aneurismal tu

mour or pouch, filled with concentric layers of fibrin, situated in the left ventricle, the parietes of which had grown remarkably thin at that part. It was about the size of a pigeon's egg. No symptom during life led to the suspicion of such a disease going on in the heart. But it was remembered that, one evening, after having enacted the part of Orestes in the play of Andromache, Talma felt himself strangely agitated, restless, and anxious for some time, which symptoms gradually subsided. But it is supposed that the internal membrane of the ventricle then gave way, and that the expedient of nature to fortify the part, by the deposition of coagulable lymph, was only a temporary or palliative cure.

About the time of Talma's death, the late General Kyd, of Albemarle-street, aged 73, died suddenly, without having evinced any symptom of disease of the heart during life. He was examined by Dr. Johnson and Mr. Hicks, who attended him for some years past, and precisely the same aneurismal pouch jutting from the left ventricle, as that described in Talma's case, was found. It was situated, however, near the base of the ventricle, at no great distance from the origin of the aorta. In the General's case, the centre of the aneurismal dilatation had given way, while the patient was asleep, and about eight ounces of blood were extravasated into the pericardium. The general had eaten a hearty dinner, and went to sleep, from which he never awoke. This excellent and universally respected officer had led a very active early life in India, whence he retired more than 20 years ago, to enjoy an age of ease, after a youth of labour. But soon after his return to Europe, he became hypochondriacal, and the malady increased as age advanced. For the last ten years of his life, he presented one of the most exquisite, though melancholy instances of this mysterious complaint that has perhaps ever been witnessed. Without exhibiting any mark of local or general disease, that was at all tangible, he became convinced that he was dying-or at least that he had but a few days or even hours to live. This too, at a time when he ate and drank heartily, and when all the secretions and excretions were healthy. He invariably, however, complained of an intense pain extending from the rectum, up along the line of the colon, and indeed along the small intestines, to the stomach. He never admitted that he was a moment free from this pain, though he would forget it sometimes for hours, when engaged in conversation with his friends. Whenever he recollected himself he reverted to the perennial source of his misery. It was discovered, some four or five years ago, that he had a small stone in the bladder, and it was now hoped that a key to this mysterious pain was found out. Sir Astley Cooper quickly removed the stone, but as soon as the wound was healed the malady returned as bad as ever. For a considerable period, before his death, the patient was almost invariably better and worse on alternate days. During the bad day, he would eat and drink very little, asserting that he was dying:-next day he would be better, and then he would eat and drink heartily-and so he went on. It is natural to suppose that the medical attendants were anxious to ascertain what was

the state of the intestinal canal, in which the patient had complained of such intense pain for so many years. The body was examined with the greatest care, and not a vestige of disease could be detected in any portion of the alimentary passage, inside or out. The brain was also carefully dissected, but nothing unusual was observed. The aneurismal pouch of the left ventricle of the heart was the only deviation from apparently healthy structure in the whole body, and there can be little doubt that this was of comparatively recent date, and that it could have had nothing to do with the hypochondriacism of twenty years' duration, and with the feeling of agonizing pain in the intestines for more than ten years.

Here there was a neurosis of many years duration leaving no cognizable trace of disease after death. The sense of pain in the intestinal canal, however it might have been exaggerated by the patient, cannot be supposed to have had no existence. On the contrary, there is every reason to believe that the unnatural sensibility of the first passages was the cause of the hypochondriacism as well as of the pain in those parts. This supposition is strengthened by the fact, that the patient was always worse after free living, and always better after the day of abstinence.

General Kyd was a man of vigorous mind as well as body, and before he retired from active service, was of a remarkably cheerful disposition, fond of music, and every rational enjoyment, and yet temperate in the luxuries of the table. The sudden change to retirement soon began to shew itself in hypochondriacal feelings, and the patient endeavoured to amuse the mind by rambling over the classic scenes of Italy and Greece. But in this tour he did not pay so much attention to the physique as to the morale. He did not sufficiently exercise the body in proportion to his indulgence of the imagination in surveying antiquities, pictures, statues, &c. and the consequence was that he returned nearly as bad as when he commenced his tour. The due equilibrium between mental and corporeal exercise was not maintained, and little or po good resulted. The case altogether was a very instructive one for those who study the phenomena of hypochondriasis, and the multiplicity of features which it assumes in different individuals.

Before closing this short article, we may be permitted to express our surprise that the nature of Talma's disease was not more early discovered. A stricture within six inches of the anus was surely no very difficult matter to ascertain; and from the post-mortem examination there is every reason to believe that a timely use of the bougie would have prevented the obliteration of the canal, and consequently the death of the patient from that cause. Had the stricture of the rectum been discovered in time, and its closure prevented, it is highly probable that Talma, like Moliere and Palmer, would have expired on the theatre of his renown. This would have been a much easier death than that to which he was doomed by the terrible malady in question, and much more in consonance with the life of this great tragedian.