aged 73, admitted June 19th, 1857. Cough for above a year; severe for two months; face cyanosed; oedema of legs and ascites; dyspnoea, mucous expectoration, sibilant and moist râles over the whole thorax; dulness at the left base posteriorly, with obscurely blowing respiration. Heart beats feeble, irregular, and unaccompanied with râles. Urine dark, non-albuminous. Pulse feeble, irregular, 112. Diagnosis: pulmonary congestion, dilatation of right heart and consecutive anasarca; no indication of disease of the left heart. Death three days later. Autopsy: old, partial, but extensive adhesions between the pericardium and heart; cellular bands and recent false membranes uniting the two serous laminæ. Under the false membranes the surface of the heart was injected, dotted, and scattered over with small milk spots, slightly projecting and resembling tubercles. The parietes of the heart were slightly dilated and hypertrophied; the aortic valves thickened but moveable, and without malformation. M. Forget observes that this patient died of an old pericarditis, which prevented the occurrence of the characteristic friction sound, but gave rise to the tumultuous action of the heart, the pulmonary engorgement, and other symptoms. 4. A female, aged fifty-seven, admitted June 23rd, 1857. Dyspnoea for four months, with palpitation, cough, and abdominal pain; anasarca for six weeks; on admission, cyanosed, considerable cedema of lower and left upper extremities, considerable ascites; respirations fifty-six; sibilant and other râles throughout lungs; slight dulness and ambiguous vocal resonance at base and posteriorly; small, frequent, irregular, pulse; heartbeats feeble, obscure, irregular, not abnormal in sound; masked by pulmonary râles; no enlargement or extended dulness of præcordial region. Death on following day. Autopsy: straw-coloured effusion in pleura, hypostatic congestion of lungs; bronchi red and full of mucus. Pericardium containing about ten ounces of limpid serum; heart if anything reduced in size. Mitral and aortic orifices healthy. Chronic peritonitis. Professor Forget observes, with regard to these four cases, that they resemble each other in the general and in several local symptoms of disease of the heart, and by the absence in all of the blowing murmur characteristic of valvular lesions. They differed in presenting very dissimilar lesions. The first showed considerable alteration in the two orifices of the left heart; in the second there was no primary lesion of the heart; in the third there was old pericarditis with adhesions; and in the fourth secondary hydro-pericardium. As the symptoms in the four cases closely resembled each other, the diagnosis of necessity was deceptive or remained doubtful. The author draws the following conclusions. Wherever the obstruction in the venous circulation may be, the general symptoms are the same. Many cardiac lesions are only revealed by the general disturbance of the circulation, and have no symptoms peculiar to themselves; the majority of local symptoms of cardiac disease belong to several lesions, and even to diseases unconnected with the heart; the coarse blowing murmur is the most characteristic of local symptoms, and almost always indicates valvular lesion; the lesions most commonly indicated are narrowing and insufficiency of the valves; but the bruit is often absent in valvular lesions, and under these circumstances the diagnosis of cardiac affections is very obscure. Contributions to the Anatomy and Pathology of the Septum Ventriculorum. By HANS REINHARD. und Physiol., Band xii. Hefte 2 and 3.) Membranous Portion of the (Archiv für Patholog. Anat. This paper, which is a posthumous publication, investigates the relations of the triangular space at the base of the inter-ventricular septum, which is closed 42-XYT. 17 by fibrous membrane, a normal condition in the human heart.* It occupies the space lying between the internal and posterior aortic valves, the apex of the triangle pointing upwards; the base is from 15 to 20 millimetres (0.6 to 0.8 in.) in extent; the vertical diameter averages 9 millimetres (0.35 in.). The description of four specimens contained in the Wurzburg Museum is given, in which the triangular space of the septum was the seat of intra-cardiac aneurism :— 1. The heart of a young subject, presenting no external abnormity; thickening of the endocardium in the left ventricle; the pulmonary valve fenestrated; the mitral thickened, shortened, and slightly adherent at the edges. In the place of the thin spot under the semilunar valves there was the orifice of an aneurism in the left ventricle; the aneurism was cylindrical, and 0.35 in. deep; round the orifice the endocardium was laid in folds. Viewed from the right ventricle, the sac was seen to project behind the bicuspid, and to present indications of secondary dilatations. The writer does not decide whether it is a congenital aneurism or not; nor could any serious derangement have arisen from it during life, as it was not of sufficient size; but had it existed longer, it would probably have been ruptured, as the parietes were very thin. 2. The second preparation was taken from a man aged fifty-three. The heart was hypertrophied; the endocardium of the left ventricle opaque. The mitral had thickened and shortened margins; the curtains of the aortic valves thickened; the left one was fenestrated. An aneurism was found in the left ventricle, the orifice being immediately under the right valve of the aorta, and of sufficient size to admit the tip of the forefinger; the muscular tissue terminated abruptly at the base of the orifice. Seen from the right side, a thin membranous sac, of the size of a pigeon's egg, was observed to project rather into the right auricle than the ventricle. At the projecting portion the bicuspid was deficient. The writer is inclined to assume a congenital malformation in the present instance. 3. This heart was probably from a child, being small. It presented in the septum of the auricles a partial defect, in the shape of a small orifice, above which the foramen ovale, which was completely closed, was distinctly visible. In the left ventricle the part corresponding to the membranous portion of the septum was absent; in its place was the orifice of an aneurismal sac, which, however, was not as patent as in the preceding cases, but was somewhat concealed by the anterior curtain of the mitral being attached to its margin by a tendinous cord, and by some tendons being even extended into the sac, and attached to its posterior wall. In the right ventricle the sac occupied the greater part of the upper part of the septum, and was bounded by a curtain of the bicuspid. 4. This heart showed traces of extensive pericarditis. The mitral was slightly thickened, the aortic orifice was surrounded by a hard, dense ring, that projected considerably. The right semilunar valve of the aorta was converted into an aneurism, which showed a perforation communicating with the ventricle. Another perforation was found in the membranous portion of the septum ventriculorum; the edge of the orifice was surrounded by ragged dendritic vegeta tions; the edges of the perforation were in mutual apposition, and required to be separated so as to show the opening. A considerable loss of substance was found in the tricuspid at the part directed towards the arterial cone. A considerable spot of softened muscular tissue existed in the auricular septum. A Contribution to the Question of Fatty Degeneration of the Heart. The author relates the histories of two cases of heart disease, in which, after death, the microscope showed the hearts to have undergone extensive fatty *The Reporter was the first to draw attention to this fact in the Manual of Pathological Anatomy (1854), by Drs. Jones and Sieveking, p. 315. Dr. Hauschka's and Dr. Peacock's observations on the subject were published in 1855. degeneration. The muscular tissue, on analysis and comparison with two analyses of healthy hearts, proved to contain less fat than the latter, as will be seen by the following numbers: Dr. Weber refrains from drawing a positive conclusion from these cases, but suggests that possibly what we term fatty degeneration consists, not so much in the deposition of fat as in the isolation of the fat, normally a constituent of the muscular fibril, owing to the retrograde metamorphosis of the tissues. Two Cases from the Practice of Dr. Liharzik. (Wochenblatt der Zeitschrift der k. k. Gesellsch. der Aerzte in Wien, Dec. 7 and 14, 1857.) The first of these two cases is in every way remarkable-both the accident itself, as the manner in which a cure was established, approaches the marvellous. A young gentleman, aged fifteen, was walking in the country with his tutor, and put an ear of barley into his month, with the stalk protruding from the mouth. While conversing he was suddenly seized with a cough, and the ear disappeared. He had one or two attacks of coughing, but he was so well in the evening, that an excursion was agreed upon for the next day. The weather prevented this; but the boy caught a cold from going to sleep in an open verandah, in consequence of which he was under medical treatment for some weeks. It was not till above three months after the disappearance of the ear of barley, which happened in Ischl, that Dr. Liharzik saw him immediately after his return home to Vienna; he then was in good health, and the only thing that alarmed his parents was the repeated occurrence of a short cough, accompanied by the expectoration of dark-grey mucus, which was occasionally tinged with blood. Dr. Liharzik found that the left thorax was normal throughout; the right thorax did not expand fully on deep inspiration; anteriorly the percussion and respiratory murmurs were normal, but along the back the percussion was dull, and at the lower angle of the scapula the respiratory murmur was indefinite and indistinct. Dr. Liharzik, not being able to believe that the ear could have slipped through the glottis, diagnosed chronic pneumonia. There was little or no fever for some time; but about a fortnight after his return, dyspnœa, increased, cough, and febricitations set in; two days after (on the 15th of October), during a severe attack of cough, he suddenly threw up half a coffeecupful of foetid pus, streaked with blood. Professor Oppolzer, who was consulted about this time, diagnosed traumatic pneumonia, produced by the presence of the ear of barley. Repeated expectoration of large quantities of pus, tinged with blood, took place, but the patient's strength did not fail. On the night of the 28th of October, after continuous and very harassing cough, the ear of barley was ejected with great force. Enveloped in pus and mucus, it lay in the mouth with the stalk outwards, so that the patient could draw it out. It appeared that, previously to its passage into the respiratory passage, one lateral half had been bitten off, so that the part swallowed only contained two rows of grain. The cough and expectoration soon diminished after this occurrence; the fever subsided, and, at the time of the report, the patient was convalescent. The second case is also one of considerable interest, in which a large abscess over the region of the heart caused symptoms inducing a belief that the heart itself was dislocated, and lay upon, instead of within, the thorax. Contributions to a more accurate Knowledge of the various Forms of Typhus. By PROFESSOR LEBERT, in Zuric. (Vierteljahrsschrift für die Practische Heilkunde. xiv. Jahrgang. 1857. In this paper, which is the first of a series, the author dwells upon the characters of what he calls "abortive typhus," and which he thinks it the more important thoroughly to understand, because by that means we may learn to appreciate the value (or rather the uselessness) of abortive methods of treatment. Dr. Lebert speaks of his "abortive typhus" as being identical with what we call febricula. Among 800 cases of "abdominal typhus" (typhoid fever), which he has observed in Zuric, not less than 170, or above 20 per cent., belonged to this denomination. The diagnosis between the abortive and the complete form of the disease is often impossible during the first three or four days, and is only rendered certain towards the end of the first week, or in the course of the second, by the entire or comparative absence of the features characteristic of confirmed typhoid. Such are-delirium, stupor, diarrhoea, with the characteristic evacuations, roseola, enlargement of the spleen, bronchitis, fuliginous covering of the tongue and lips, loss of power, and emaciation. All these symptoms may, however, occur in more or less feeble indications; at the same time"abortive typhus" is not at all contagious, while true typhoid is very much Dr. Lebert is of opinion that curative proceedings are of little use, and that the success of the abortive method of treatment boasted of by some writers is to be explained by the fact of the frequent occurrence of the undeveloped form of the disease. In one-seventh of all the cases of abortive typhus, moreover, the abortive treatment by emetics and purgatives had been employed before the admission of the patients into the hospital, and the consequence had been rather to enfeeble them, and to protract the disease. Dr. Lebert, from all his observations and experiments, concludes that the disease is ab initio either abortive or complete. His treatment in the abortive form is mainly expectant and symptomatic, with mild nutritive diet.* So. QUARTERLY REPORT ON SURGERY. By JOHN CHATTO, Esq., M.R.C.S.E., London. I. On a New Operation for Hydrocele. By M. CARRON DU VILLARDS. (Moniteur des Hôpitaux. 1857. No. 128.) M. CARRON DU VILLARDS, a French practitioner in the Antilles, has devised a modification of Larrey's operation for hydrocele, in consequence of the bad effects which result from injection in that part of the world. The accidents produced by it are tetanus, acute hematocele, suppuration, acute orchitis, easily passing into the condition of induration, gangrene, and, when only weak injections are employed, relapse. The author has himself never met with this consecutive tetanus, but practitioners settled at Cuba have assured him that it is of frequent occurrence there. He has, however, met with a great number of cases of hematocele consequent on injection, either with or without organie transformation of the tunica vaginalis. So frequent are these accidents, that a great number of persons repair to the United States for the purpose of having [ Want of space compels us to postpone the remainder of the Report, containing some interesting matter relating to abdominal and other diseases.-En.] the injection performed. In such bad repute is it among the Creole population and practitioners, that they content themselves with repeated palliative punctures by means of a lancet, the frequent repetition of which almost always leads to the degeneration of the tissues of the scrotum described by Larrey. The author has very frequently met with this form of elephantiasis of the scrotum in the Antilles, where it is known as the Barbadoes disease. The operation which he has devised in lieu of injection, has now been performed by himself in 50 cases, producing 48 radical cures, and only 2 failures; and subsequently to the presentation of the memoir, M. Camilleri and others have operated 187 times, with but 7 relapses. It is attended with no accidents and but little pain, is adapted for all the complications and varieties of hydrocele, is of easy execution, and requires little confinement or after-treatment. The patient is placed on a high bed, with his buttocks well raised by means of a cushion, and the situation of the testis having been recognised, the operator, taking the lower part of the hydrocele in his hand, while an assistant presses it downwards, punctures the most dependent part of the tumour with a strong and narrow lancet, which he passes slowly in. As soon as fluid escapes, he slides a long narrow trocar along the blade of the lancet, keeping the point of the instrument within the canula until the upper boundary of the tumour is reached. Having reached this point, the canula is pressed against the tissues, so as to project them somewhat externally, in order to be certain that neither the cord nor a pulsating vessel can be felt in front of it. A piece of cork is next placed against the projected tissues, and against this the trocar is forcibly driven by the application of the palm of the hand to the handle of the instru ment. A counter-opening is thus at once effected, just as the jewellers pierce the ears for ear-rings. The stiletto of the trocar is now withdrawn, and replaced by a grooved silver wire, which traverses the two apertures, and is left in situ on the removal of the canula. Spirit lotions are applied around the scrotum, and during twenty-four hours a slight discharge of fluid takes place. After this period, inflammation is set up and the secretion is no more reproduced. The scrotum becomes afterwards red, hard, and painful, as in acute orchitis, but it rarely requires treatment. More frequently it has been found necessary to encourage action by placing stimulant ointments in the groove of the wire. On the twelfth day (the patient being usually able to get up by the third) the wire is removed, the patient wearing a suspensory until the twenty-fifth or thirtieth day, by which time he is usually radically cured. II. On Urethral Intermittent Fever. By M. CHASSAIGNAC. (Moniteur des Hôpitaux, 1857. No. 135.) This is the name M. de Chassaignac attaches to the febrile attack which all surgeons have observed as a consequence of catheterism, and which, if it were desired to indicate the cause giving rise to it, might be termed catheteric fever. It is a curious point to determine, whether the contact of the instrument with the entire length of the urethra is necessary for the production of the paroxysmal attacks, or whether it is sufficient for one portion of the canal to have undergone such contact, and in that case, which portion. Judging from the facts known to him before the case which gave rise to these observations came under his notice, M. Chassaignac was disposed to believe that neither the membranous nor the prostatic portion of the urethra was the portion in question. Thus he never met with an instance of such febrile paroxysm being produced after catheterism in the female, nor is he aware of any one who has ever met with one. A natural inference would be that it is not observed in woman, because the paroxysm arises from the contact of the instrument with a portion of the urethra which does not exist in her. An opportunity offered itself for confirming this conjecture, by the counter-proof of the induction of the paroxysm by the exclusive catheterism of the portion of the urethra |