to note that the rabbit differs remarkably in the vascular supply of its auriculo-ventricular valves from other animals of the same class, such as the horse, dog, sheep, and pig. In the latter all parts of the valves including the chordæ tendineæ contained vessels. In the rabbit, however, and in man, Langer is positive that no vessels exist in the chordæ tendineæ, and that those in the membranous portion are few and isolated, being derived from arterioles of the supporting tissue of the myocardium.

Coen studied especially infantile and foetal hearts, and states that he was quite unable to detect any vessels in the semilunar valves. As to the auriculo-ventricular, he agrees with Luschka, except in so far that he could not discover vessels in the chordæ tendineæ. His conclusions are that isolated vascular branches occur occasionally but rarely in the elastic strata. Ramifications which touch the free border are rarer still, and it is most rare to find vessels in the chorda tendineæ.

The most recent researches on this subject have lately been conducted by Mons. J. Darier in the Laboratory of Histology of the College of France. In a very interesting paper which he communicated to "Archives de Physiologie normale et Pathologique" he describes carefully the methods by which he conducted the investigation and the results at which he arrived. Almost all his injections were made with Prussian blue and gelatine. Blue is a better contrast than red with the yellowish tinge of the tissues. Fine injections of the heart are extremely difficult, and this is especially the case with the human subject, in which the heart removed from an autopsy always contains clots of blood and air bubbles. After staining and fixing in Müller's fluid he stretched and dried the valves, and was able to obtain a satisfactory degree of transparency for microscopic examination. He considers the question of the sigmoid valve segments as finally settled. He agrees with Langer and Coen that in man the aortic and pulmonary valves never contain vessels in their normal state. There is no difference between the valves of the adult and infant. As to the auriculo-ventricular

valves their vascularity is almost the same in the case of adult

hearts and those of children more than two years old. In man in the normal state he says there are never to be found vessels in the fibro-elastic membranous portion of the auriculo ventricular valves. In the auriculo-ventricular valve of the young infant an apparent contrast, set up by the fact that they are more vascular, is shown not to be real. The fibro-elastic portion in the very young is less extensive and the muscular part is relatively greater. He insists that there are no vessels in the fibro-elastic part. In the pathological state we often find vessels throughout all the extent of the aortic, sigmoid, and mitral valves. These vessels must, according to Mons. Darier, be regarded as the result of a new formation under the influence of inflammation. The conditions which favour the development of this pathological vascularization are not properly understood, and deserve more attention at the hands of pathologists. Hæmatomata at the edges of the valves in the newly-born infant are probably the result of a process of degeneration of the vessels which exist in the valves in their foetal state.

Cardio-vascular nutrition and its relation to sudden deathDr. Frederick W. Mott, of Charing Cross Hospital, has written upon a number of cases of sudden death due to cardiac or aortic degenerations (Practitioner, Sep. 1888). In the case of heart disease fatty and fibroid degeneration form the principal causes of sudden death. The fatty change occurs in pernicious anæmia, severe anæmia, anæmia following severe hæmorrhage, high temperature, chronic Bright's disease, and phosphorus poisoning. Atheroma and calcification of the coronary arteries are by far the most important of the local causes of cardiac failure. The analogy of the coronary arteries to the vasa vasorum, which are found in all blood vessels of a certain calibre, is supported by the fact that coronary sclerosis is most frequently found associated with cardiac degenerations in the same way that periarteritis of the vasa vasorum is observed in connection with atheroma of the aorta. Dr. Mott believes that the intra-vascular blood has little, if anything, to do with the

nutrition of the internal coats of the heart and great vessels. The musculi papillares, columnæ corneæ, and trabecule of the heart are the structures which first show signs of fatty degeneration when there is obstruction of the coronary circulation. In a similar manner the subendothelial coat of the great arteries will be the first to experience the effects of malnutrition when there is periarteritis of the vasa vasorum.

Dr. Steel, in a paper on Mitral Obstruction and Regurgitation (Medical Chronicle, Manchester, May, 1888), finds an explanation of the accentuation of the first sound in cases of mitral stenosis in the fact that systole takes place before the left ventricle is fully distended. The auricle has not emptied itself before the ventricle contracts, and the current of blood flowing from auricle to ventricle is suddenly arrested by the contraction of the ventricle. The murmur is thus abruptly terminated by the first sound at the commencement of ventricular contraction. In discussing the causation of hæmic murmurs Dr. Steel does not accept the well-known explanation of Balfour, that the basic (apparently pulmonic) bruit is mitral regurgitant, conveyed to the left appendix auriculi. He revives a theory originally advanced by Sir Dominic Corrigan, that "veines fluides" are generated at or beyond the orifice of the pulmonary artery. This theory is also applicable to the functional aortic systolic murmurs often heard in anæmia. The apical systolic murmur he refers to dilatation of the left ventricle.

Myocardite Infectieuse diphtherique.-Mons. Paul Huguenin contributes an instructive case of myocarditis due to diphtheria (Revue de Médecine, Paris, Oct., 1888). The patient, a man of robust build but of alcoholic habits, was admitted under Prof. Hayem with diphtheritis faucium. He died of cardiac failure after sixteen days stay in hospital. The autopsy revealed subpericardial ecchymoses, and arterial thromboses in the walls of the left ventricle. Microscopic examination showed parenchymatous and interstitial myocarditis with endarteritis proliferans of the coronary arteries. There was granular degeneration with loss of striation of the muscular fibres. The granular matter

S

which arranged itself around the nuclei of the muscle cells presented a fusiform appearance. Certain fibres also exhibited the change known as hyaline or glassy degeneration of Zenker (not Zenter). Death from cardiac failure is not uncommon in diphtheria. The patient may succumb early in the disease from acute myocarditis, or during convalescence from the chronic form attended by atrophy of the muscular elements.

Is Pernicious Anemia a Special Disease?-Dr. Hunter, in the Practitioner, August, 1888, concludes that the disease which is known as pernicious (if not necessarily progressive) anæmia must, on clinical and pathological grounds, be assigned a separate existence as a form of idiopathic anæmia. In other words, pernicious anæmia is not a form of symptomatic anæmia. The following features he cites as peculiar to this kind of idiopathic anæmia. 1. The marked oligocythæmia, which in certain cases is independent of the hæmorrhages. 2. The relative richness in hæmoglobin as contrasted with the high degree of oligocythæmia. 3. The presence in the blood of distorted corpuscles (poikilocytosis) and small yellow cells (microcytes). In pernicious anæmia the changes in the blood are essentially hæmolytic; in other diseases with symptomatic anæmia the blood-changes are due to defective nutrition, failure in hamogenesis.

Dr. West has written a paper on Cardiac Complications in Rheumatic Fever, based on six years' statistics at St. Bartholomew's Hospital (Practitioner, August, 1888). The cases suggest that the risk of cardiac complications in rheumatic fever is greater than some of the published statistics seem to show. An interesting fact is revealed in the larger proportion of women affected by mitral lesions. The proportions were reversed in aortic disease, the percentage of men being higher. Pericarditis occurred in 7.5 per cent. of the cases, being more frequent in males. The tables also exhibit the greater liability and increased risk of fatal result in the young.

Cardiac Dyspnea.—Fraenkel (Berliner Klin., Wochenschr., 1888), distinguishes two forms of cardiac dyspnoea, the con

tinued and the asthmatic. The former is typically observed in mitral stenosis, with pulmonary engorgement due to imperfect compensation. The asthmatic form occurs in cases of hypertrophy of the left ventricle with arterio-sclerosis. asthma he regards as really cardiac in origin.

Uræmic

ON CHILDREN'S DISEASES.

BY ANNIE E. CLARK, M.D.

Adenoid Vegetations in Children, their Diagnosis and Treatment. By Franklin H. Hooper, M.D. (Boston Med. and Surg. Jour., March 15th, 1888.)-Dr. Hooper says that the adenoid vegetations so frequent in the naso pharyngeal cavity of the child are too often overlooked. In his experience two years is the average age for the first symptoms to appear. The initial cause may have been an ordinary cold, but the child soon shows a tendency to repeated "colds in the head" which increase in frequency and duration, there is difficulty of breathing, especially at night, a dull heavy look about the eyes, and, in the majority of cases, a certain amount of deafness. By the time the child is six or eight years old, it will breathe with its mouth open, its facial expression is dull and stupid, or even idiotic-the half-open mouth is one of the constant symptoms. The child never sleeps soundly, its laboured breathing at night, especially when it has a fresh cold, is distressing to hear; the respiration will sometimes cease for a few moments and then recommence with the same noisy character as before, or the child wakes bathed in perspiration, screaming and frightened. In the morning the mouth is dry and the lips parched; during the day the child is languid and irritable. Most of the children are deaf, and their voices are stuffy and thick. At school, they are scolded by their teachers for inattention. Inspection of the cavity of the mouth usually reveals a high palatine arch. The