the body were immersed in a warmbath. No symptom of disturbed respiration, except a very slight croupy noise occasionally, had at any time been noticed.

On dissection all the abdominal and thoracic viscera were found presenting a most healthy appearance; the thymus gland however was of an unusual size, measuring about four inches in length, and weighing at least 2 or 3 ounces. No trace of any cerebral disease could be detected.

But it is not in young children only that an hyperthrophied state of the thymus has been discovered; it has been met with occasionally in adults and in old people; sometimes along with, at other times without, an affection of the heart or lungs. Unfortunately the descriptions of authors on this topic have been exceedingly vague and unexplicit; the texture of the enlarged gland is seldom specified, and we are left in utter uncertainty whether the organ had merely retained its infantile condition, or whether it had assumed other appearances from a more late deposition of new matter, (perhaps in proportion as the respiratory disturbance increased,) or lastly, whether the suspected enlargement was not in reality a morbid growth merely occupying the site of the thymus.

In the beginning of the last century Cowper and Budous recorded two cases which occurred in men who were about 30 years of age. The particulars of one of these are the following. The patient had laboured under dyspnoea from his infancy, and at length he died quite suffocated.

The pulmonary parenchyma was found studded with tuberculous deposit; the thymus gland had acquired an immense size, was indurated, scirrhous and cartilaginous, in part resembling the texture of a scrofulous or steotomatous tumour: it adhered very strongly to the large vascular trunks; occupied all the upper portion of the thoracic cavity, and had very obviously presented a great impediment to the free dilatation of the lungs. The heart was enlarged, and the pericardium was found distended with fluid.

Meckel (primus) describes the history of a soldier, 26 years of age, who had long suffered from paroxysms of dreadful anxiety and dyspnoea at first their recurrence was at considerable intervals, but afterwards they became much more frequent. In the upper part of the cavity of the anterior mediastinum there existed two large lobes of the thymus; each of these was three and a half inches long, and from six to ten lines in breadth; their texture was nearly the same as in the fœtus: they were cellular, and might be distended by blowing air into them; several considerable sized arteries and veins derived from the internal mammaries and inferior thyroids were distributed upon their substance: their colour was a reddish white; very little adipose matter existed in the surrounding_cellular substance. Tozetti in his "Raccolta di Opusculi Medico-practici, has recorded a case in which the thymus was found of extraordinary dimensions. The patient, a countryman, 57 years of age, had laboured during 20 years under occasional dyspnoea, the paroxysms had become gradually more frequent, and had been accompanied with dropsy of the chest and abdomen. The thymus measured four inches in length, three in breadth, and two in thickness; and its weight amounted to nine ounces. The texture was more solid and fleshy looking than is natural. To this enlarged mass there adhered a smaller tumor, which seemed to be of a scrofulous character. Tozetti attributes the dropsical effusions to the compression which the enlarged thymus exerted on the arterial and venous trunk. Hufeland, in his Journal of Practical Medicine, for the year 1806, has related a case of fatal angina pectoris, in which the only morbid lesion detected after death was an enormous fatty-like enlargement of the thymus gland, which occupied the whole of the anterior mediastinum.

5. Inflammation of the Thymus-Thymitis. It must be acknowlenged that this disease has seldom been ascertained, or even suspected during the life of the patient; but the occasional

occurrence of collections of purulent matter being found within its substance is sufficient to prove the existence of an antecedent phlegmasia. Sauvages indeed has enumerated in his nosology the symptoms which he considered as pathognomonic of this state; these are, a certain degree of impediment to deglutition and to speech, vomiting after eating, dyspnoea, and the external appearance of a tumefaction at the lower part of the neck. Portal, in his edition of Lieutaud, mentions the case of a child, two years of age, who died of convulsions. On dissection there was found an effusion into the pleura and pericardium; the thymus was prodigiously increased in volume, and on cutting it through a large cyst full of a blackish sanies was discovered. But the far greater number of examples of suppuration occurring in the substance of the thymus gland have been preceded by the existence of tuberculous matter, which very generally at the same time is found in the texture of the lungs. This tubercular degeneration is most commonly met with in strumous children; the substance of the gland becomes more dense and solid, and all traces of the cells gradually disappear, so that when the disease has existed for a considerable time, the thymus is found to present the appearance of a conglobate gland. The shameful inaccuracy of medical language has sometimes designated this morbid change by the term "scirrhus."

M. Cruveilhier has seen the thymus in a young infant, filled with tubercles in a state of suppuration, such as we observe in the lungs, in the last stage of phthisis.

Portal has alluded to the frequency of tubercles being found in the thymus and anterior mediastinum in rachitic children; and Lieutaud has recorded several instances of the same disease in adults who had died of consumption, or of other pulmonary affections.

In Haller's disputations we find the case of a young student who, after having suffered for a considerable time from attacks of homoptysis, was seized with a severe pain at the lower and anterior part of the neck, accompanied at

first with cough, and afterwards with difficulty of breathing and purulent expectoration. On dissection the lungs were found loaded with tubercles, and the thymus had acquired an unusual size, and contained within, a cavity full of pus, and which communicated with the trachea.

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6. Ossification and Calculi of the Thymus. As in the conglobate and conglomerate glands in different parts of the body, we occasionally find calcareous concretions which have been attributed by many to the induration, or solidification of their peculiar juices, so in the case of the thymus, similar changes have been observed. It is very doubtful, however, whether a truly ossific deposit has ever been discovered in the substance of the thymus, although numerous cases of such a change are on record; for the truth is, that medical writers have frequently applied the term ossification" to every sort of solid and dense concretion, whatever be its nature and characters. There is however this important distinction between a bony and a calculous deposit, that the former contains in addition to its phosphate of lime, an animal gelatine which is never found in any calculus. And, again, all ossific formations are organised substances, being nourished by their proper bloodvessels, and susceptible of absorption; whereas calculous concretions are completely inorganic. Some authors have insisted too much upon the mere differences of consistence in the two deposits; but this is a very uncertain criterion to distinguish them by. Chemical analysis is the only sure test. Vater, Harder, Hoffman, and others, have recorded examples of calcareous degeneration of the thymus.

CLINICAL RESEARCHES ON THE MEDICINAL EFFECTS OF DIGITALIS.

The reports of medical men on the powers and properties of this potent drug have been strangely conflicting and inconsistent with each other. Cullen

affirmed that the direct physiological operation of foxglove is to weaken and retard the action of the heart and arteries; Dr. Sanders has on the other hand maintained that it first quickens the pulse; and lastly, Orfila and others have not obtained any steady or uniform results, either the one way or the other. Equally discordant have been the statements of different authors respecting the therapeutic effects of digitalis. If we are to believe Drs. Bidault and Currie, it is of great efficacy in all inflammatory diseases;-Clutterbuck considered it as the only specific against fever;-asthma and epilepsy have been said to be under its immediate control; Darwin, Fowler, and Beddoes would lead us to suppose that it is able to cure hæmoptysis and even phthisis, and Hufeland has pompously eulogized it as the most heroic of all anti-scrofulous remedies!! That it possesses beneficial powers in quickening the action of the absorbents, and in increasing the flow of urine in certain cases of dropsy will be disputed by few; but that it has cured encysted dropsies of the ovarium, must surely be the mere fantasy of a fond admirer.

The following researches were instituted, and very carefully pursued, for the purpose of arriving if possible at some satisfactory conclusions respecting the physiological and therapeutic effects of digitalis. It was exhibited sometimes in the form of powder recently prepared, and possessing all the aromatic qualities of the fresh herb; at other times, of a watery or alcoholic extract; and lastly of infusion. The extracts were obtained in the following manner, according to the directions of Professor Soubeiran, the director of the Central Pharmacy of Hospitals. The juice of the fresh herb, procured by expression, was gently heated, for the purpose of coagulating the vegetable albumen; it was then filtered, and evaporated in a water bath to a proper consistence. The alcoholic extract was obtained by slowly evaporating a concentrated tincture of the leaves.

It may be mentioned that most of the following cases have been derived from the clinique of Professor Andral, at the Hôpital de la Pitié

EXPERIMENTS WITH THE POWDER.

CASE 1. Hypertrophy and Dilatation of the Heart-48 grains of Digitalis in 6 days.

March 24th. A woman, aged 60, was admitted with the following symptoms. Impulsions of the heart very strong; upon any effort of the breathing as in coughing, blowing the nose, &c. they become so violent, that they caused her to faint away, and the extremities to become cold and benumbed. The pulse is 68; the number of respirations in the minute only 14. She suffers much from headach, noises in the ears, confusion of sight, with a pricking sensation in the eyes, pain in the region of the kidneys, and general anasarca of the lower limbs. These symptoms are of three months' duration; but it is nearly a twelvemonth since she had an attack of severe dyspnoea, from which period she dates the commencement of her illness. She was ordered four grains of digitalis to be taken in the course of the day.

25th. Pulse 92-Respirations 38-8 grains of digitalis ordered.

This quantity was continued every day until the 30th without any very appreciable results on the circulatory and digestive functions. The medicine was then discontinued, and the patient kept upon a light emollient diet. On the 4th of April she was seized with almost constant fits of fainting, and with distressing anxiety. Pulse 96, and the palpitations stronger than ever. Respirations 36. A more decided antiphlogistic regimen was now adopted, but with little relief to the symptoms.

A small bleeding was practised; the blood was not inflamed, but the action of the heart was somewhat reduced, the number of pulsations being then only 64, and of the respirations 22.

He was ordered three grains of the digitalis, and this dose was increased to 6, and then to 12 grains, on the two following days; no perceptible effects were produced. Sixteen grains were prescribed; the pulse fell four beats, and the palpitations were less violent. On the following day, a scruple divided into five doses, was taken. The patient vomited his food, and experienced a good deal of nausea; but these symptoms ceased during the evening. Pulse 64. The dose was, however, diminished to 12 grains. During the course of the day, he vomited twice and complained somewhat of vertigo. The pulse was 60, and the number of respirations

28.

digitalis was ordered, and, on the following day, the dose was increased to four grains; the pulse had fallen to 52, but now was 60. Twelve grains ordered. Pulse 46-breathing more free, and also more pure, on auscultation. Sixteen grains ordered; pulse 41-respiration 16. Twenty grs. ordered; pulse 40. On the following three days, the dose of the foxglove was reduced to 16 grains.

There had been occasionally vomiting and considerable nausea; but these symptoms were by no means constant. The tongue presented a natural appearance, and the cerebral functions were undisturbed; the pulse remained at about 40. As the symptoms gradually subsided, the dose of the medicine was again raised to a scruple per diem, and on the following day, to 30 grains; the patient vomited twice in the course of the night-pulse 40, somewhat irregu lar in its action. Thirty-six grains ordered; nausea during the whole of the day-pulse 37-respiration 13-cough and expectoration much less. Fortyeight grains ordered; vomiting returned bowels relaxed-pulse 42, irregular as before. The use of the digitalis was now suspended; the nausea, however, and vomitings continued to recur, the pulse remained at 40, and the respiration at 15-tongue natural-cough quite gone, and the patient left the hos pital on the 5th of April, much relieved.

Remarks. It will have been observed that, in this patient, the pulse fell on second day of the treatment, when the dose of the digitalis was only two grains; the bowels were then somewhat relaxed, but this relaxation did not increase with the increase of the dose. The stomach began to be disturbed with nausea and vomitings; the pulse fell below 40, and, at the same time, the cough and expectoration abated. These symptoms continued, with little variation, till the completion of the cure. During the whole period, the condition of the tongue remained unaffected, and there never was any epigastric tenderness. Neither the salivary nor urinary secretions were affected.

CASE 4.-Rheumatism-Hypertrophy of the Heart-37 grains in 4 days.

The patient, a servant, 18 years of age, had for five years, during the Winter months, been troubled with attacks of general rheumatism, and each attack was usually followed by palpitations of the heart. The breathing was always more or less short and distressed; pulse 120, thready-respiration 32-dyspnoea almost constant-the action of the heart sometimes very violent-the dull sound in the cardiac region more extended than natural, and the impulsions of the heart might be heard over every part of the thorax. An incipient bruit de soufflet perceptible; a subcrepitant råle heard on both sides behind.

The patient was bled, and the blood exhibited a partial buffy crust; symptoms not affected-four grains of digitalis ordered. Although the dose was raised first to 9 and then to 12 grains, the action of the heart was not at all abated, and the urinary secretion not increased indeed, during these two days, a dropsical effusion into the cellular membrane had taken place. The patient was, therefore, bled again, and the blood now presented a stronger crust than before; the digtalis was discontinued. On the following day, there were frequent vomitings and almost constant nausea, and the pulse had fallen to 68, and had become irregular-the respirations were 34. By rest and quiet for a few days, this patient was enabled to leave the hospital.

Remarks. The interesting feature of this case is, that the digtalis seemed to be almost quite inert until the second bleeding, when what are deemed its specific effects were first developed.

Our limits prevent us from detailing the particulars of the other cases in which the powdered digtalis was exhibited; we shall, therefore, merely mention their leading features.

In a man, 38 years of age, who had long laboured under pulmonary emphysema, and, at the period of his admission into the hospital, was suffering from acute bronchitis, accompanied with some symptoms of an affection of the heart, venesection and active purg

ation were employed with decided advantage, the pulse having fallen from 96 to 68. Eight grains of the foxglove were now ordered, and this dose raised, on the following days, to 12, 20, and 25 grains, with the effect of lowering the pulse to 56. Half a drachm was then prescribed, but, as vomitings and nausea supervened, the dose was reduced to 16 grains. Next day the pulse had risen to 72; the quantity of urine was not increased, and, as the head was somewhat confused, the use of the drug was discontinued. On the day after, the pulse fell to 52, and the number of respirations from 24 to 16. This state or amendment continued for several days, and, when the patient left the hospital, the pulse was slow, and the palpitations less violent.

In a case of phthisis, in a state of cavernous ulceration, the digtalis was administered in doses of 6, 12, 16, and 20 grains, on the four days preceding the death of the patient; the pulse, which was at first 128, rose each day, till it arrived at 160.

In another case of phthisis, the digitalis, was taken for four days, in doses of 8, 12, and 16 grains, when it produced considerable disturbance of the gastric functions, and the pulse became somewhat slower; but in spite of these occurrences, the medicine was continued in larger doses, and the vomitings and nausea, instead of being thereby aggravated, actually subsided, and the pulse remained unchanged. On the following day, however, the stomach distress returned, and the use of the drug was abandoned. The pulse had become somewhat irregular, but scarcely abated in frequency.

Such are the results of the experiments in which the powder of the herb was employed; we shall now briefly allude to the results of the exhibition of the aqueous extract.

To a man 38 years of age, who had long suffered from dyspnoea, without any concomitant symptoms of diseased heart, and when his pulse was 72 and his respiration 20, 16 grains were given; on the following day the pulse was 68. The dose increased to a scruple; pulse 60. The dose 36 grains; pulse 54.