has presented itself to our author in very different states of the constitution:-sometimes in connexion with fever-sometimes with gradual failure of the vital powers, and slow emaciation-but, in most instances, without symptoms indicative of much mischief in the respiratory organ. Its tendency, in all cases, is to unfit the lungs for their office, and consequently to destroy life. Six cases in illustration are detailed by our author, of which we shall notice one or two. Case 1. This was one of fever, in a man, 24 years of age, and who was not seen till the stage of collapse had taken place, with petechia on the surface. He seemed, however, to be recovering; but on the 27th day of his illness, there came on difficulty of breathing, &c. and he died on the 31st day of the disease. The lungs did not collapse when the sternum was raised. They were exceedingly soft in texture," and very much resembled the spleen when in a very soft state." In many places, there was a dark bloody fluid between the pleura pulmonalis and the parenchyma. The trachea was found full of a bloody serous fluid, as were the ramifications of the bronchia. In the air-cells the membranous appearance was lost, and only a soft pulpy matter was discoverable. We shall be able to notice only another case, which is an interesting one. Case 2. A young lady had been in a dubious state for two months, in consequence of cough, some trifling expectoration in the mornings, and occasional tinges of blood in the sputa. Three of the same family had died of consumption. The young lady, however, was "full of flesh," and was gaining rather than losing in that respect. Still she had an unhealthy aspect-the pulse about 76-the tongue clean-bowels regular-breathing free-catamenia regular. In short, she complained of nothing except a dry hacking cough on first getting up in the morning. On percussion, the chest emitted a natural sound on each side, and the respiration was heard over both sides. Perfect pectoriloquism was heard on the left side, between the second and third, and third and fourth ribs. Our author therefore concluded, that there was a cavity in the superior lobe of the left lung. It was considered to be of smal! extent, and therefore recovery possible-and, at all events, danger not imminent. Cupping between the shoulders was prescribed, and infusion of roses with tincture of digitalis every four hours. Mild unirritating diet. In a few days the blood disappeared from the expectoration, and the young lady considered herself as "in perfect health," except a trifling cough. Another examination with the stethoscope confirmed the former diagnosis of an excavation in the lungs. She went on for about a month pretty well, when one morning she brought up some blood, accompanied by a small quantity of purulent matter. Alum was added to the mixture above-mentioned, and the pil. aloes cum myrrha prescribed. The hæmoptysis proceeded no farther, and again she thought herself getting quite well. In ten days more, some hectic fever shewed itself, with some ill-looking expectoration. In three days from this period there was expuition of scarlet-coloured blood. She complained of pain between the shoulders. Quietude-alum, infusion of roses, tincture of digitalis-cupped between the shoulders. The hæmoptysis continued the next day, and a grain of superacetate of lead, with a quarter of a grain of opium, every two hours, were ordered. These means proved inefficient, and she died in a few days. On removing the lungs, they were found slightly adherent on the right side, and more so on the left. There was no appearance of purulent secretion in the trachea. The bronchia contained some sero-purulent fluid. On tracing the ramifications in the right lobes, the only appearances were, a rather suffused state of the blood-vessels in some partsthe lungs of a soft structure-and the air-vessels pervious throughout. This state obtained in the left side; "but on the upper and outer surface of the superior lobe appeared a cavity large enough to admit the half of a middle-sized orange, which had been prevented from opening into the cavity of the chest by the adhesion of the surface of the lung to the costal pleura; but it communicated freely with the bronchial tube." Pus was searched for, but could not be found:-Nor was there the smallest degree of hardness in the sides of this ulcer, indicative of the process of adhesive inflammation having been set up. On the contrary, the appearance was that of simple ulcerative absorption. Dr. Hastings has appended some judicious reflections to this and the other cases, for which we must refer to the original paper. We shall, however, quote one passage, as it bears upon a topic which we have once or twice introduced into this journal. "May not we also take advantage of such cases as the above, and by them enforce the necessity of treating certain varieties of pulmonary consumption by a strictly tonic plan? And may not this plan, so much reprobated by some authors, as not according with the results of examination after death, be found consistent with, or at least not opposed to, the evidence of morbid anatomy?" The organic changes which the lungs undergo in disease are extremely numerous, and many of them are quite insusceptible of diagnosis, by the most accurate pathologist, during life. A man lately came into St. George's Hospital, with the left side of the thorax somewhat bulged out, and completely devoid of sound or respiratory murmur, on percussion and auscultation. In the right side of the chest, the heart was seen and felt beating; but respiration could not there be heard, except high up near the clavicle, and backwards near the spine. The respiration was laborious, the lips blue, the pulse quick. No accurate history of the complaint could be obtained. The patient stated that he had been ill six weeks, with pain in the lower part of the sternum, cough, but no expectoration. It was pretty evident that there was fluid in the left side of the thorax, and as it might possibly be purulent, it was agreed, in consultation, that an opening should be made between the sixth and seventh ribs. This was done by Mr. Brodie, when a considerable quantity of sero-sanguineous fluid issued. The patient experienced great relief, and slept for some hours uninterruptedly after the operation. He gradually sank, however, and expired in a day or two. After the operation, the sound immediately returned in the right side, where the pulsation of the heart had previously been felt. The left side sounded hollow, of course, from the unavoidable admission of some air during the operation. On dissection, we understood that a large fungus hæmatodes had occupied and disorganized the left lung, as well as the corresponding portion of diaphragm, descending to the spleen. We think the physician (Dr. Hewett) who recommended, and the surgeon (Mr. Brodie) who performed the operation, were perfectly justifiable. The man was suffering great distress in breathing, and no one could tell what was the precise nature of the fluid in the chest. Its removal, therefore, was desirable, whatever might be its nature. The great relief which followed did more than compensate for the pain of the operation, which last was justifiable on the principle of Euthanasia. 27. DEATH AFTER REMOVAL OF A TESTICLE. The fatal accidents which succeed wounds and operations, not in themselves very formidable, have recently attracted much attention, and ought to be accurately investigated, post mortem, as this investigation must be attended with great advantages. The post-mortem research, in the following case, is imperfect, as we shall presently shew. A man was received, under Mr. Lawrence, with an enlarged testis, of several years' standing. Various means of reduction were employed, but in vain; and, the man being otherwise in apparent good health, the testicle was removed. It was found to be of scirrhous construction. After the operation, the patient experienced symptoms resembling enteritis, and died at the end of seven days, "without any apparent urgent cause." Dissection. The wound had suppurated freely, but no adhesion had taken place. The viscera of the abdomen appeared healthy, at first view, but a portion of intestine in the pelvis was found highly vascular and red for the space of six inches, and its internal surface ulcerated. A tumour, not very dissimilar in structure to that of the diseased testis, was discovered attached to the kidney.-Lancet, No. 179. The state of the lungs and liver is not specified, and no mention is made of the brain. The mere redness of the intestine, for so small a space, and the ulceration of its mucons membrane, do not afford physiological explanation of the patient's death, and we are convinced that a further and more minute investigation would have disclosed lesions in the cerebral, pulmonary, or biliary apparatus. We cannot, therefore, too often or too strongly urge our brethren to examine all the great cavities of the body, when they are seeking for the cause of death, else they will frequently deceive themselves and others. Quarterly Periscope OF PRACTICAL MEDICINE; BEING The Spirit of the Medical Journals, Foreign and Domestic ; WITH COMMENTARIES. PART II. HOSPITAL REPORTS. "Ore trahit quodcunque potest, atque addit acervo." 1. PLEURISY AND ABSCESSES AFTER SURGICAL OPERATIONS. [Clinique de Perfectionnement.] PART I EVERY practitioner must have observed that, when a suppuration is established in a part, and another local inflammation set up in the same individual, a large suppuration is often established in the secondarily part with surprising rapidity. This is still more remarkable when the intercurrent phlogosis occurs in a part not tending naturally to suppurate, or where the product of inflammation differs from that of common suppuration, as, for example, in the arachnoid, the pericardium, the synovial membranes, the tunica vaginalis testis; and, above all, in the peritoneum and pleura. This species of superinduced phlegmasia is particularly deserving of the practitioner's attention, because it is one that frequently occurs; one whose causes, symptoms, and march are but little in consonance with those which we observe in other inflammations of the same organs or parts; and, finally, because the treatment must be different. It is in public hospitals, particularly after great surgical operations, and suppurations of any extent, that we have the best opportunities of witnessing facts of this kind. It is with the laudable view of inviting attention to, and throwing some light upon this important subject, that M. Velpeau has presented his brethren with some clinical reports in the present paper. Case 1. Petrel, 39 years of age, of good constitution, and never before having experienced any severe illness, was received into the HOPITAL DE PERFECTIONNEMENT, on the 8th January, 1826. He had *M. Alf. Velpeau. Revue Medicale, Decembre, 1826. VOL. VI. No. 12. 2 M had his right thumb crushed the evening before. Abscesses formed deep in the hand, wrist, and fore-arm; and ultimately such disorganization of parts took place, that it was necessary to amputate the arm on the 8th February. From this time till the 15th every thing appeared to do well; but at the latter date, he had a shiver, and fever followed. The features became shrunk, the respiration was impeded; yet the patient could lie on either side, had no cough, and felt no pain in any part of the chest. On the 16th he complained of sharp pain in the stump, extending to the shoulder. Suppuration was less free in the wound, and the parts looked unhealthy. The breathing still continued short, the pulse was small and irregular, but not very quick, the tongue moist and not coated. During the 17th and 18th the same symptoms continued, the debility increasing. On the 19th the patient died." Dissection. The stump was flabby and unhealthy. The encephalon and its envelopes were sound. The abdominal viscera, examined with the greatest care, presented no trace of disease. The left thoracic cavity, however, contained a large quantity of thin creamy and puriform fluid, resembling a mixture of whey and matter, but containing no flocculent or albuminous materials, thus differing from those collections which we find after death in common inflammation of the pleura. On draining out the fluid from the cavity, the pleura was every where found covered with a coat of purulent matter exactly resembling that which had come from the stump, and without any trace of that albuminous concretion which we see in pleurisy. The membrane, being washed and cleaned, was scarcely altered from its natural appearance and polish. The lung of this side was reduced to one-third its natural dimensions. It was not inflamed. In the left side of the chest, every thing was sound. Case 2. A young man, 26 years of age, had the middle finger of his right hand so badly crushed by a log of wood, on the 18th of May, 1826, that amputation was necessary some days afterwards. On the 6th, 7th, and 8th of June, the hand became swelled and very painful, with corresponding sympathetic fever. On the 9th there was an abun. dant suppuration. 10th. The inflammation and swelling reached the middle of the forearm. 12th. The matter was thin and of bad quality, but there was now very little fever-the abdomen was drawn in and tense-tongue white and moist. 13th and 14th. The disease made rapid progress, and two incisions were made, when a large quantity of pus escaped. The most attentive examination did not detect any disease in the thorax or abdomen. Nevertheless the patient was evidently hastening to the grave. On the 16th, in the evening, a considerable space of pleuritic inflammation was discovered by the stethoscope in the right side of the chest, and the respiration became very short. The pulse was neither fuller nor quicker than natural. A blister to the seat of inflammation. 17th. No pain was now felt in the right side of the chest-the breathing was free-but the chest sounded dull in that side, and no respiratory murmur could be heard there. 18th. The patient reported himself better, and complained only of weakness in conse |