has ever occured under my own observation, that would incline me to think with him. It would not accord with the object of this paper to detail minutely the medical character and treatment of the erysipelas, as it existed in the hospital at this time; a few general remarks on these points are all that I shall offer. It was evidently a disease of debility, affecting those with most severity, who were already exhausted by previous illness, or whose systems were broken down by intemperance. Not a death occurred of an individual, who was either not debilitated by sickness, or whose constitution was not impaired by former indulgence in the use of ardent spirit. It seemed to demand, in most of the cases certainly, the treatment first recommended, I believe, by Dr. Fordyce, and since so successfully followed by Dr. Wells and many other eminent physicians of Great Britain,-I mean that of administering Peruvian bark in large and frequent doses, and keeping the affected parts bathed with diluted alcohol. Evacuants were rarely required; in a few instances, emetics or mild cathartics, followed immediately by the bark, were found useful. The bark was not given in such doses as Dr. Fordyce speaks of, that is, one drachm of the powder every hour; it is rare that the stomach will retain it in such quantities, and it is still more rare I believe that such a quantity is required. Dr. Wells, a firm believer of the correctness of this practice, never gave it to such an amount, nor did he think it necessary. It is difficult, during the delirium which so commonly attends the disease, to induce patients to take it in this form, and the sulphate of quinine was found to be an excellent substitute. In recurring to the records, the largest quantity of powdered bark administered to any patient with erysipelas, I find to have been one ounce in twenty four hours; a pint of brandy, however, was taken during the same period. Of the sulphate of quinine thirtysix grains were given in divided doses of six grains each, in the same length of time to another patient. Great use was made of wine, porter, brandy, the infusion of bark and the tincture of the sulphate of quinine as auxiliaries, and in some of the worst cases, these alone were employed, as the patients would reject everything but liquids. POLYPI IN THE HEART. By W. SIMPSON, Hammersmith, Eng. As doubts have been, and are still entertained, of the truth of true polypi having been found attached to the internal surface of the heart, the following account of a post mortem examination will not be uninteresting. I had been for some time attending a lady laboring under chronic bronchitis, attended with the usual symptoms of this complaint, namely, difficult respiration, with a cough and expectoration of frothy mucous or mucopurulent matter, or what, perhaps, might with more propriety be called a morbid secretion of mucus, possessing the natural tenacity of healthy mucus, but thicker, and of a greenish hue, coming up in patches. The difficulty of breathing increased in the morning, and the expectoration was more copious of course, from the accumulation of mucus during sleep. This complaint has not been inappropriate ly called by Dr. Badham, the winter cough, as it is always increased during the winter, and generally attacking those advanced in life, it usually terminates fatally in the fourth or fifth winter. Before the flood of light thrown on these diseases by Bichat's more particular description of the anatomy of the mucous membranes, it was, and is still called by many, humoral asthma. It has also been confounded by Dr. Thomas, in his Practice of Physic, with peripneumonia notha. These cursory observations are, no doubt, superfluous to some, but as this disease is yet but imperfectly understood by many, they are not wholly unnecessary. My patient had reached to the fifth season with this complaint, and from the emaciation and increased difficulty in breathing, it was easy to prognosticate that she would not get through this winter. OnThursday, December 14, not having seen her for a day or two, I was sent for, and found her sitting up as usual in her bedroom; she complained that her appetite, which had been heretofore good, began to fail; that her nights had been restless, her sleep being broken by the cough and expectoration. She therefore requested an opiate, which she had been occasionally in the habit of taking; I gave her a dose of Dover's powder, combined with squill, which she took early in the evening; and when her attendant left her at about one in the morning, she described herself as feeling comfortable. I was sent for in haste about eight o'clock, and found her just dead. Though this disease usually terminates rather suddenly, yet as it appeared unusually so in this case, I requested a post mortem examination, and on Sunday, December 17, accompanied by my intelligent friend and neighbor Mr. Perfect, we proceeded to the examination. On opening the thorax, we found the adhesions very considerable between the pleura pulmonalis and pleura costalis, so as to require much force in detaching the lungs from the chest and diaphragm. On opening the pericardium, there was an unusual quantity of effusion into this cavity, about five or six ounces.There was also a slight effusion into the cavity of the chest. Having removed the heart, on examining it, the aorta was found somewhat increased in size, but there was no disease or ossification in it, or in the pulmonary artery. The heart itself was not enlarged, nor on opening the left auricle and ventricle were its parietes thickened. On slitting up the vena cava and right auricle and ventricle, a yellow fatty substance presented itself, beginning and attached by rather a broad basis in the internal surface of the right apendix auriculi, and becom ing somewhat expanded, extending across the auricle into the ventricle, and terminating in two long peduncles, about two inches in length. It was pretty firmly attached in its whole course. On examining the lungs, the minute ramifications of the bronchiæ and air cells contained morbid mucus; but there were no signs of inflammation or ulceration in the mucous membrane or substance of the lungs; no hepatization or obliteration in the air cells. The material point in this case is evi dently the polypus in the heart. Now the existence of these substances has been affirmed by Tulpius, Malpighi, and Pechlinus, whilst Therluringius and others have denied that true polypi have ever been found in the heart, and believed that they were merely the coagulated fibrin of the blood, formed in the moment of death, which substances Therluringius called pseudo polypi. In this opinion he has been followed by Mr. John Bell, who begins by supposing the question to be, whether blood sometimes coagulates, and forms polypi in enlarged hearts. Setting out with this idea, he argues on the improbability of blood's coagulating in the heart itself during life, and becoming washed pure, and of a firm consistence, thus constituting polypi. In this I entirely agree with Mr. John Bell; but did he suppose that polypi in other parts are formed by coagulated blood? Surely not; then why in the heart? That coagulated blood, or even the fibrin of the blood, should form a substance in the heart at the moment of death, or in the slow approaches to it, is not improbable; and call such substances pseudopolypi, or what you will, they are quite distinct from true polypi, which are substances organized and possessed of vitality, shooting out from mucous surfaces. there appears to me no reason whatever for supposing that polypi in the heart are different from polypi in the nose, in the uterus, or in the rectum. The internal coat of the heart, like all membranes which come in contact with air or fluids, and attached to internal parts of organs required to be in motion, is a lubricating or mucous membrane. The fluency And of Mr. John Bell's language, and the ingenuity of his reasoning, have deservedly made his works very generally read, and his opinions looked up to as authority. But when we consider that Mr. Bell denied the compressibility of the larger arteries by manual force, we must allow that he sometimes adopted opinions without mature deliberation. Whether the polypus in this case was the cause or consequence of the bronchial affection, is uncertain. I should rather say the latter. I am, however, quite satisfied, from the best of all evidence, that polypi are occasionally found shooting from the mucous membrane of the heart, as well as from other mucous surfaces. And I trust the publication of this case, and these observations, will lead to a more attentive examination of the heart in post mortem researches, when, I doubt not, the occasional existence of true polypi in it will be soon universally acknowledged. Lancet. Affecting the Tibial Nerve, cured CASE OF NEURALGIA, M. F., aged 33, of spare habit, She stated that she had been suffering, for three months past, with violent pain in the leg, which commenced at the inner side of the great toe, running along the inside of the tibia to the ham and to the groin, extending also across the lower part of the abdomen and to the loins. She described the pain as coming on rapidly,a shooting or stabbing kind of pain, and she said that it was brought on by the least pressure or friction. Ordered to take two drachms of the subcarbonate of iron, every six hours. Oct. 24. The pain is better below the knee. 28. The attacks of pain are less frequent and not so severe. The parts of which she principally complains now are the top of the foot and the knee; pressure and friction are borne without producing the pain as formerly. 31. Now only a dull aching felt along the bone; it is most severe at night, and prevents her from sleeping. Nov. 7. Not improved since the last report. Ordered to take half an ounce of the carbonate of iron three times a day. 11. The pain relieved, but there is still much soreness about the limb, with numbness at other parts. 18. The aching pain still continues to be felt along the tibia and at the knee; but she bears strong friction and grasping. 21. Ordered to use the mustard liniment. 25. The report of today from the patient is, that the "pain is nearly gone." She only used the liniment three times, and it appeared to aggravate the pain. 28. Quite well. Left the hospital a few days after the date of this report. It will be observed, on perusing this case, that the severity of the pain was much diminished shortly after the patient had commenced taking the carbonate of iron; in fact, its character was changed from the shooting, stabbing pain of tic douloureux, to a dull aching; but this latter symptom, it will also be seen, remained for some length of time unre lieved. In referring to this circumstance, Dr. Elliotson remarked to the pupils that he had, on several occasions, observed a similar result from the exhibition of the carbonate of iron. He said, that he did not pretend to offer any explanation of the why and the wherefore, but simply mentioned it as a pathological fact worthy of notice.-Ib. ANOMALOUS NERVOUS AFFECTION, In which the Symptoms resembled those of Angina Pectoris, cured by the exhibition of Carbonate of Iron. The following case would appear to be a peculiar affection of the nerves, called the intercosto humerales, on the left side of the body. As we know that these nerves become sympathetically affected in some diseases of the heart, as in angina pectoris, where one of the principal diagnostic marks of the disease is pain shooting from the side of the chest, in the course of the nerves down the arm; it is a fair presumption, that nerves which are thus sympathetically affected may also be the primary seats of disease. We are not, however, disposed to deny that the nerves were affected in this case, from some remote irritation; but it certainly was not apparent, and the disease only yielded to a medicine which appears to have a direct power over the nervous system. The patient, a spare woman, 36 years of age, was admitted on the 7th of September under the care of Dr. Elliotson. She stated that she had been ill seven months with violent pain in the left side of the chest, occurring at intervals. She described the pain as shooting from the region of the heart, over the left breast; sometimes down the arm to above the elbow, and occasionally to the wrist; it also extended to the back. At the same time, during the paroxysms, she felt great difficulty of breathing, amounting to a sense of suffocation. The attacks of pain, which were frequent, but not of long duration, were produced by pressure or friction, or even by making deep inspirations. But there was one fact which is especially worthy of notice, namely, that the pain was not induced by walking quick; with the exception of this, the other symptoms had, as Dr. Elliotson remarked, a close resemblance to angina pectoris; there was, however, no irregularity of the pulse. The stethoscope was used, but it indicated nothing. From the time of admission to the 7th of November, a period of two months, the patient was respectively bled, blistered, and cupped. Digitalis, colchicum, and prussic acid, were exhibited, each for a considerable length of time, and without benefit. Dr. Elliotson, as a dernier resource, determined on exhibiting the carbonate of iron; and, on the 7th, prescribed half an ounce, to be taken three times a day. The reports made on the 11th, 14th, and 18th, show that the pain was progressively diminished, and the patient left the hospital on the 23d of November, quite well.-Ib. A CHERRYSTONE IN THE BRONCHIA, Dr. Webster has related a case of this kind in the 5th No. of the Medical and Physical Journal. A lad, 14 years of age, swallowed a broken cherrystone, which slipped into the trachea, and produced a violent fit of coughing, with difficulty of breathing, and sense of suffocation. Twelve days after the accident he came under Dr. W.'s care, the above mentiened symptoms still continuing without intermission, and with the addition of pain under the sternum. The stethoscope showed the foreign body in the left bronchium, at the bifurcation of the trachea, thereby almost entirely obstructing the air from passing into the left lung. "On further investigation, it was also ascertained that the lung was sound, though collapsed. By percussion on the left side of the chest, a deaf sound was perceived, but in the right cavity everything seemed healthy."* The patient had only expectorated some frothy mucus since the accident-pulse 120, small and sharp-great thirst--cough violent. Leeches, blister, antimonials,-low diet, absolute repose. He was relieved by these means. On the 16th day he was again bled, blistered, and the same medicines continued. These measures were repeated afterwards. From this period till the 68th day, the symptoms varied but little, and he was reduced to a state of extreme exhaustion. On the 30th day, it was ascertained by the stethoscope, that the air permeated more freely the left lung, particularly the upper portion. On the 68th day abovementioned, he coughed up a large quantity of fetid pus, in which was found the cherrystone. From this time the patient gradually recovered, and was convalescent by the ninetieth day. * There must surely be some mistake here. If the lung was collapsed, air must have supplied its place, or water. In the former case, the sound would have been the lung was gorged, not collapsed. This the reverse of deaf. We should say that state would explain the phenomena. How was the cherrystone discovered by the stehimself would not have been able to dethoscope. We apprehend that Laennec tect such a small body in the lungs. |