appearances on dissection. Upon opening the chest, the lungs on both sides were perfectly sound and collapsed. But, notwithstanding the collapse, the chest was filled more than it usually is when the lungs are sound. This indicated the existence of some foreign substance or morbid enlargement of some of the organs. The pericardium was found accordingly to be immensely distended by some fluid, which, when this bag was opened, was found to be blood, partly liquid and partly coagulated: the quantity was not less than three pints. It was purely blood, without the admixture of any fluid indicating inflammatory action. The external surface of the heart, and internal surface of the pericardium, were examined carefully, but no ruptured vessels, from which the blood might have flowed, were discoverable on either of these surfaces. The heart itself was perfectly sound, the valves were in good condition, and no disease existed in any of the large vessels. The lungs were free from adhesions, and were every where sound. The other viscera were in a sound state. A great deal of care and time were expended in trying to discover the source from which the blood had flowed into the pericardium, but in vain: a slight ecchymosis was observed about the root of the pulmonary artery. Dr. Baillie, in his Morbid Anatomy, says, 'Cases have occurred, though very rarely, in which a large quantity of blood has been accumulated in the cavity of the pericardium, but where no rupture could be discovered after the most diligent search, either in the heart itself, or in any of its vessels. This appears very wonderful, and not at all what any person would expect à priori. Two conjectures have occurred to me, to explain this phenomenon: 1st, that the blood-vessels on the surface of the heart have lost their compactness of tissue, so that the blood may have escaped by transudation. The other is, that the blood may have been poured out by the extremities of the small vessels, opening on the surface of that part chiefly of the pericardium forming the immediate cover of the heart, from their orifices

having been to a very uncommon degree relaxed.'

There is a case related by Dr. Alston, in the 6th volume of the Edinburgh Medical Essays, in which the disease of the chest was of long standing. Three pints of blood, which was partly coagulated and partly mixed with lymph, were found in the pericardium. No ruptured vessel was discovered either on the outer surface of the heart, or the inner surface of the pericardium. Upon pressing the heart, a bloody serum oozed out of a great many orifices on its surface, and principally near its base. No disease was discovered in the interior of the heart or large vessels. Dr. Baillie refers to two cases of extravasation of blood into the cavity of the pericardium, in which the source of the hæmorrhage could not, after the most careful examination, be discovered. In both these, functional disease of the heart had been observed for some time previous to the death of the patient. Vide Medical Observer, vol. 10, p. 330. Memoirs of Medical Society, vol. 1, p. 238.

Various opinions have been advanced respecting the sources from which, in the above cases, the blood was derived. One of the suppositions made by Dr. Baillie appears to me to approach the nearest to the truth, which is that the blood had oozed out of the small vessels on the internal surface of the pericardium immediately covering the heart. It is probable, I think, that the oozing, particularly in the case now narrated, arose from the condition of the blood, and the relaxed state of the fibres. It would appear that the disease was general, and that the shivering, faintness, and depression of spirits were not the effects of the flow of blood into the pericardium, but that this last was, like the affections stated, the effect or symptom of the general disease,

that in fact there existed a morbid state of the whole system, similar to that which takes place in purpura, in some kinds of epistaxis, hæmatemesis, and in bleeding from the bowels in typhus fever. The pain in the chest was in the first place, occasioned by the admission of blood into a cavity not

accustomed to the stimulus of that fluid. There is no reason to suppose that the action of the heart would be mechanically affected until the quantity of the blood was pretty considerable; for the blood would readily follow the dilatation of the pericardium, occasioned by the elasticity of the lungs, when the chambers of the heart had finished their contractions. No sound was perceived, on carefully examining the chest. Indeed no sound could be excited, as no fluid was poured from one vessel into another. For as the auricles expand as the ventricles contract, the change of place in the constituents of the fluid in the pericardium would be inconsiderable, and made with quietness.

There does not appear to be any symptom in this case that would have warranted the medical attendants in giving an unfavourable prognosis. As a matter of prudence, a less favourable one might have been made, but the same prudence would not permit the expression of a favourable prognosis in any case whatever."

Upon this case we may be permitted to make a remark or two. We have no fault whatever to find with the treatment of the case, nor do we differ from the highly-talented narrator of it as to its pathology-or rather etiology. But we must say that the exploration of the chest was incomplete, and that percussion, added to auscultation, would undoubtedly have led to a grave prognosis. The state of the pericardium would have caused a dull sound, on percussion, over a very unusual space, and would have caused the greatest alarm in the mind of the medical practitioner accustomed to thoracic exploration. The want of any symptoms of enlargement of the heart, too, would have led to the inevitable conclusion that there was fluid of some kind in the pericardium. Thus, then, we see the great value of auscultation and percussion. In the present case, it would have saved the medical attendants from the suspicion (and indeed a justly founded one,) that they were unaware of the danger, and consequently of the nature of the disNothing could have saved the life of the patient, had the physician

ease.

been perfectly acquainted with the true state of the case; but his diagnostic and prognostic skill would not have suffered, had an accurate exploration been made.

We may take this opportunity of saying that, were we to be deprived of one of the two means of exploration, we would far rather give up auscultation than percussion. The latter is far more valuable than the former, though they prove auxiliary to each other.

We are sure that Dr. Carson will excuse these remarks, as they can have no other object than the good of the profession. Dr. C.'s reputation is far above the reach of censure, were we inclined to be censorious, which we are not. His brethren are deeply indebted to him for the candid manner in which he has narrated this interesting case.

TREATMENT OF CHOLERA IN IRELAND.

It appears from a small brochure, by Dr. Wilson, of Belfast, that cholera still lingers in several parts of Ireland, and has re-appeared in places formerly scourged by the epidemic. The object of this pamphlet is to denounce the mercurial treatment of cholera-not because it was less successful than the nonmercurial in its immediate effects; but on account of the injurious or fatal conSEQUENCES Which resulted to those who recovered from the disease. The following extract will illustrate the author's positions and opinions.

"In the hospital (Belfast,) the general plan of treatment consisted in bleeding the patient, if young and robust; then administering 10, 15, or 20 grs. calomel, with one or two grains of opium, repeated after various intervals, and washing all down with spirits and water. In the town, bleeding was scarcely ever had recourse to; and, as will be perceived by the quantity used (5 drachms among 1,656 patients,) calomel very sparingly. The mortality in the hospital was three times greater than that in the town. It is conceded, that the greater proportional mortality of the hospital over the town, is accounted

for by the greater severity of the cases which would be, of course, received there; and I am not disposed, like some others, to lay any of it to the charge of the treatment. The earlier application of remedies, and the generally more favourable aspect of the cases, may be assigned as the reason of the comparative low rate of mortality in the town; and partial as I am to the town treatment, and, in the same degree, hostile to the hospital, if I examine rigorously the circumstances under which each system was pursued, I can arrive at no other conclusion than that both modes are on a par, so far as the final issue of life or death is concerned; or, in plainer and more intelligible language, that no greater number of cures will be effected by the one than by the other. But, in regard to the CONSEQUENCES of the different treatments to those who survive, I must emphatically denounce the calomel, or hospital treatment, as immeasurably more destructive to the constitution. While we admit, that the greatest proportion of bad cases ought to be charged to the hospital, it is no less true, that many patients, with very mild or premonitory symptoms, found their way there also; for the instructions of the Board of Health to the medical inspectors were, to forward all cases, whither incipient or advanced, with the least possible delay, to the hospital, and to take charge of those patients at their own homes, who could not be prevailed upon to go there. At the commencement of the epidemic, and through the whole course of it, as was to be expected, many patients, with symptoms generated by terror, and not to be distinguished from the genuine disease, hurried in-and they, I presume, with all others labouring under the slighter forms of the disease, were subjected to the mercurial plan, which I have so strenuously condemned. From peculiar circumstances, the inhabitants of some districts of the town readily availed themselves of the hospital accommodation; while, in others, none, or very few, of those affected, went in. In one of these latter, an old naval surgeon, who acted as medical inspector, has recorded the names, ages, resi

dences, and symptoms of 253 patients, treated by him on the NON-MERCURIAL plan, and the deaths were only 18. I will here give the analysis of this document, which is among the records of the 'Belfast Board of Health.'

110 patients had vomiting, purging, and cramps.

113 patients had vomiting and purging.

18 patients had vomiting & cramps. 6 patients had vomiting.

6 patients had griping, nausea, and slight cramps.

253

From this summary it will appear, that Cholera was met with, and successfully treated, out of doors, on a plan essentially different from that of the hospital; and he would be guilty of great hardihood, who would, after inspecting this list, pronounce that the genuine disease was only to be found in the hospital. Had these 253 patients been treated with calomel, many of them would not now have to congratulate themselves on the integrity of their constitutions, and their freedom from all the deleterious effects of mercurial irritation. The plan pursued with them embraced the use of opium, in a solid form, combined with camphor and Cayenne pepper; of laudanum, in conjunction with sulphuric æther and peppermint water; and of a cordial mixture, the basis of which was whiskey."

Dr. Wilson, in his zeal to banish mercury from the methodus medendi of cholera, has overstepped the boundaries of prudence in his anathemas against this useful, but perhaps often abused drug. He says the Army Medical Board has nearly banished mercury from the treatment of syphilis. Indeed! Dr. Wilson is somewhat behind the march of intellect on this point. The army surgeons are now treating venereal diseases in much the same manner as their most intelligent brethren in private practice-namely, by a judicious use of mercury. It is very true, however, that the anti-mercurial mania which prevailed several years ago, and

which still lingers among a considerable mass of the profession, is enriching most rapidly a class of sharp-sighted surgeons and physicians, who are widely employed in treating the "CONSEQUENCES"-not of mercury, but of the neglect of it.

Dr. W. thinks he uses a powerful argument against mercury, when he avers that many invalids come home from India with their constitutions ruined by mercury. We admit this fact, but we meet it by another, which Dr. Wilson has prudently, though, perhaps, not quite candidly, overlooked, viz. that for one constitution ruined in India by mercury, ten are preserved by it from the deleterious influence of the climate. Dr. W. leans on another cogent fact against mercury. "Why is it, at the present moment, that in every college and in every town in the empire, we meet with one or two veteran practitioners, who are gradually expelling mercury from the list of their medicinal agents?" We can tell Dr. Wilson why and how this is. It is because in every college and town in the empire, there may be even more than one or two veterean practitioners who are passing into the state of second childhood, and parting with what little intellect it pleased God to give them originally.

COMPOSITION OF THE PONTINE Marshes.

The following is the concise account of these celebrated seats of malaria by Dr. Weatherhead, who walked across them rather than use the legs of the quadrupedes who carry our nobility and gentry with such speed across these pestilent quagmires.

"The volume of water which escapes from under the lime-stone mountains of the Apennines is truly astonishing. The principal drains run on each side of the road, and more resemble wide canals than drains in the ordinary acceptation of the word. They are so well levelled that the stream of water cannot stagnate, but runs freely away. With the object of ascertaining the nature of the soil of these celebrated

marshes, I made excursions to the right and left of the road, where the water allowed me; and the result of my observations surprised me a good deal. The soil in most places is exceedingly superficial, often not deeper than two or three inches; and below this there is a foundation of solid stone. This last is a calcareous deposition from the waters flowing from under the mountains, and is precisely similar to the travertine found and formed in the neighbourhood of Tivoli. This sediment encases, and, in time, petrifies, the reeds and other tubular vegetables that grow in the soil, thus forming congeries of interrupted conduits for the lodgment of water. It is to this peculiarity of formation that the miasmata of the Pontine Marshes, in great part, owe their origin; but while there is no denying its pernicious influence to a certain extent, the degree of alarm this excites appears to me one of those common errors perpetuated by idle repetition, unconfirmed by personal investigation, and unreasonably exaggerated by the fears of the pusillanimous. In my way I passed above forty labourers at work, widening one of the drains; and, as far as I could judge by appearances, they all seemed robust and healthy, working with vigour under a scorching sun, and half up to their knees in water. Habit, it is true, is Nature's lieutenant, and we see elsewhere indigenæ thrive in a climate which is almost certainly fatal to a stranger not inured to it. Late in the evening I arrived at Terracina, where a comfortable bed and supper wore off the fatigue of the preceding day's march."

To Dr. Weatherhead's account of the composition of the Pontine Fens we do not demur; but we cannot say that the aspect of the inhabitants made the same impression on us that it did on our pedestrian traveller. The workmen in these morasses are mostly convicts, and those which our author saw may have been a fresh batch from the Papal prisons or the mountains. But we venture to say, that no people would long retain the semblance of health in such localities.

LIGATURE OF THE CAROTID ARTERY.

Our readers will remember some notice which we took of Mr. Preston's caseligature of the carotid artery for epilepsy. In the last volume of the Calcutta Transactions, we find Mr. Preston renewing the subject; and he there informs us that the epileptic patient on whom he operated in February, 1831, has not had any return of his epilepsy, and is in perfect health. Another patient also, on whom the operation was performed, has regained, in a great degree, the use of the paralytic arm, and is quite free from pain in it. In the present paper Mr. P. takes occasion to observe that the operation in question is applicable to more affections than epilepsy. We shall now take a glance at some cases detailed in this volume.

CASE 1. Headach and partial Paralysis. This was a robust man, a native trumpeter, aged 24 years, admitted into Garrison hospital, at Cuddalore, 10th of August, 1831. He had been in hospital several times before, once for intermittent fever, and afterwards for headach.

"The symptoms under which he at present suffers are as follow: constant pain in the head, particularly the fore part; when he speaks his mouth and face are drawn to the right side; although his muscles are large, he is extremely feeble, and unable to walk without support; there is an appearance of idiotcy in the expression of his countenance and manner, but his judgment is not impaired; his stools frequently pass away involuntarily; there is partial loss of motion in the left arm and leg; complete loss of vision of the right eye, without any apparent change of structure; this he says was produced by inflammation consequent upon a blow; vision of the left eye greatly impaired; wanders very much at night; evacua

tions natural.

A very slight and temporary relief was obtained by the exhibition of iodine, by a seton to the neck, and a blister to the head. His present symptoms are precisely those detailed above, and appear to me attributable to

increased arterial action within the cranium; with a view of diminishing which I have determined after much consideration, upon tying the right common carotid artery."

The right carotid artery was accordingly tied on the 2d of September, and

on the seventh he was free from headach-was much stronger in his limbs, and had lost the appearance of imbecility. He continued however to shew some disposition to delirium at night. He had not the proper control over his facial muscles, and could not command the expression of the face. On the 27th he walked five miles, and was much fatigued. This was followed by some fever. His vision was impaired.

"On the 3d of October, his vision was not improved, although the head was quite free: he was ordered calomel and opium three times a day. On the 6th there was slight salivation, but no improvement of vision. As the affection of the sight was attributed to some return of the state of the brain for which the first operation was performed; a ligature was applied to the left common carotid artery on the 10th of October. He felt very weak after the operation, although very little blood was lost. He was discharged on the 11th of November: vision continued imperfect; but in every other respect he had entirely recovered his health. He was subsequently discharged, on account of the defect of vision."

The above was what we would call bold practice.

Case 2. A man aged 51 years, was admitted on the 22d August, 1831. He was a short stout man with very short neck, and its muscles much contracted, so as to draw the head down upon the chest. The eyes were full, prominent, and had a strained appearance. man had been subject to epileptic fits (coming on six or seven times in the month) for six years past.

This

"His present symptoms are, complete loss of power of the right half of the body, with very great impediment to utterance; the muscles of the face and tongue are drawn to the left side when put in action. This attack of