credit of first practising percussion in this country, should have entirely overlooked this diagnostic measure in the above case, so late as 1815; long after we ourselves had drawn the attention of the profession to thoracic percussion and abdominal pressure," in formal papers on the subject.* A very superficial examination of the chest would have detected the state of things in the above case.

Case 2. Rebecca Neilson, aged 25 years, complained (12th Nov. 1820,) of oppression and difficulty of breathing; frequent cough; purulent expectoration; palpitation at the epigastrium, and beneath the right mamma; all which symptoms were increased by the slightest attempt at motion. She could only lie on the right side, and could not take in a full inspiration. The right side of the thorax was very sonorous, and the respiration was puerile there. The left side was dull, and there was an obscure sense of fluctuation. The entrance of the air into the air-cells was indistinctly heard in all parts of this side. The action of the heart was faintly heard in the præcordial region, and very evidently on the right side of the sternum. There was a small tumour, conveying an emphysematous feel, in the left side of the chest, where she had lately received a blow. Her complaint had been of some months' standing, and had followed sleeping in a damp bed. She died on the 24th of November, 12 days after she came under Dr. Duncan's care.

Dissection. There were four pints of purulent matter in the left side of the chest, by which the heart was pushed over to the right of the sternum. The pleura was somewhat diseased, and covered with false membranes. The left lung was not larger than a common sized spleen, and there was no communication between the interior of this lung, and the general cavity of the pleura at first discovered; but, after a more careful examination, an opening, the size of a goosequill, was found, terminating in a pretty large bronchial tube. The lung was partly sound, and partly hepatized There were a few ounces of serum in the pericardium.

Dr. Duncan has no doubt that there was originally a mixture of air with the fluid, but that it was absorbed. This is very probable.

Case 3. This was one of simple pneumo-thorax. The patient was a young man, who became phthisical after hæmoptysis. At first he could only lie on the right side, and was threatened with suffocation if he turned on the left." Suddenly, after his expectoration had been unusually copious, he could only lie on the left side, and, instead of having the placid tranquillity of a phthisical patient, he became affected with excruciating pains, which he described as if his inside were tearing out, and referred particularly to the lumbar region." Death soon put a period to his sufferings. On percussion of the corpse, the right side was

*See Medico-Chirurgical Journal: see, also, a translation of Desault's Memoir on this subject, in the 10th volume of the New Medical and Physical Journal, for 1815.-Ed.

much more sonorous than the left, which led our author to conclude that the right lung was more healthy than the other. On opening the body, however, the right side of the chest was found filled with air, and the lung compressed into a small space against the mediastinum. There was no communication between the air-tubes and the cavity of the chest. Dr. Duncan thinks that this was originally a case of empyema-and that, so long as the patient could lie only on his left side, the right was filled with purulent matter, which, in progress of time, had found its way into the bronchia,* and been discharged by the mouth, while air entering through the same passage into the cavity, changed the disease into pneumo-thorax.

Case 4. Margaret Mac Cromby, aged 32, was admitted the 13th July, 1827, having great dyspnoea, obliging her to lie with the head much raised-decubitus dorsalis-respiration much accelerated, 50 in. the minute; left ribs little elevated during inspiration; cough; scanty and difficult expectoration; pain in the left side of the chest; palpitation; profuse nocturnal perspirations; severe diarrhœa; pulse 136; great thirst. The sound, on percussion, is very obscure over the whole left side of the chest, except beneath the clavicle, where it is preternaturally clear and sonorous. On the right side, it is natural. No respiratory murmur can be heard in any part of the left side, except in a small space between the spine and scapula, where it is bronchial. The tintement metallique is distinctly audible on any sudden change of position. On the right side, the respiratory murmur is distinct in the superior lobe, and obscure in the lower portion. The heart is much displaced, its pulsations being most strong near the right mamma. On succession of the trunk, there is evident fluctuation.

After a difficult parturition, 15 months ago, she had considerable hæmoptysis, with much cough, which was relieved by venesection. During the summer, she continued pretty free from pectoral complaints; but they returned in the winter. Six weeks before the date of report, she was seized with rigors, acute pain in the left side of the chest, urgent dyspnoea, and increase of cough. These symptoms rapidly increased, with perspirations and progressive emaciation. She died on the 18th July.

Dissection. The left side was filled with air and purulent matter, the latter amounting to eight pints. The heart was pushed to the right side, beyond the median line. Two fistulous communications between the bronchia and the cavity of the pleura were detected by insufflation through the trachea. The lung on that side was greatly compressed and condensed, sinking in water. There was considerable serous congestion of the right lung, which was soft and pulpy. For several other interesting cases of empyema,and pneumo-thorax,

* We are glad to see that we are supported by the learned professor in using bronchia in the plural number. We think bronchium and bronchia better than bronchus and bronchi.

we must refer to the Journal already quoted. It gives us much plea→ sure to see that the study of auscultation and percussion are steadily, indeed rapidly advancing; and we think we are justified in asserting, that this Journal has been very conducive to this important improvement in medical science. We were the first to give an extended analysis of Lænnec's work,* and we have never ceased, during the last eight years, to enforce the value and the utility of the study of auscultation.

5. DISSECTION OF AN EPILEPTIC.

[Bicêtre.]

The following case is published by M. Bosc, of the Bicêtre. A young man, named Lecoq, aged 17 years, an epileptic, was received in the above institution in the month of December, 1826, and placed in a surgical ward, on account of a caries of the phalanges of one of his fingers. He was of feeble constitution, his limbs but little developed, and his flesh flabby and emaciated. His intellectual powers were almost annihilated, if they did ever exist. He made use of no words, except the monosyllables Yes and No. The epileptic fits were not frequent. He always slept on his right side in bed, with his head under the coverlet. He complained of no pain, but had a diarrhoea upon him during the three months before he died in the hospital. This complaint resisted all medicines, and was supposed to depend on ulceration of the intestines. The abdomen was extremely retracted. He wasted away gradually, and, at length, died.

Dissection. The cranium presented a sugar-loaf form. The meninges were sound. There were several depressions on the surface of the hemispheres corresponding to protuberances of the skull; and, in these depressions, as well as in several other parts of the brain, the cortical substance was soft, and almost diffluent. The anterior lobes of the brain were extremely little developed; the circumvolutions small and numerous; the anfractuosities shallow. It was found that the general surface of the brain was softened, as far as the cortical substance was concerned; but below this, the medullary matter was so indurated as to resemble the white of a hard-boiled egg. This extreme degree of induration was particularly observed over the lateral ventricles. The bottom of the same cavities presented considerable softening of the medullary substance. There was some serum in the ventricles. The cerebellum appeared sound, but was remarkably small. The spinal marrow was not examined. The contents of the thorax were natural. In the abdomen, the peritoneum was found to be the seat of extensive cronic inflammation, the convolutions of intestines being glued together by false membranes. There was a plentiful crop of miliary tubercles developed under the peritoneal covering. The mesenteric glands were in a state of disease. The intestines themselves appeared sound their mucous membrane was pale, and somewhat softened; * See Medico-Chirurgical Journal, for January, 1820.

and the mucous follicles were considerably developed in the colon and rectum, but unattended with any ulceration. There was no other change of structure discernible in any of the abdominal viscera, except some equivocal traces of disease in the liver.

The state of the brain sufficiently accounts for the condition of the intellectual faculties, and, on this, doubtless, were dependent the epileptic paroxysms. The state of the peritoneum proves, that chronic peritonitis may go on a long time without showing any very prominent symptom of its existence. The diarrhoea, which continued so long, and which, indeed, appears to have carried the patient off at last, was evidently not the result of inflammation of the mucous membrane of the intestines, to which it is usually referred. It is more probable that, in this case, as well as in many others, it was connected with derangement of the biliary secretion.--Bibliotheque Med.

A soldier, 29 years of age, of robust constitution, was exposed, in the beginning of January, 1827, to severe cold in the night, as well as fatigue, and had the imprudence to quench his thirst with half-melted snow at the time. Next day, he was seized with pain in the left side of the chest, low down, accompanied by sense of oppression, cough, and some expectoration of a bloody quality. He did not apply for medical assistance, and remained several days without any. He remained more or less ill till the end of February, sometimes keeping his bed-sometimes doing duty. On the 1st of March, the symptoms of pleuro-pneumonia became so intense, that he was conveyed to the Hospital of the Guard, on the 4th of the same month. When examined, on the 5th, he was found to have acute pain in the left side of the thorax, below the nipple; laborious respiration; cough and sanguinolent expectoration; inability to lie on the right side. Percussion elicited a dull sound in the lower part of the left side; no respiratory murmur could be heard there by the stethoscope; and the "râle crepitant" was heard about the nipple. The upper part of the lung, on that side was ascertained to be sound. The pulse was hard, quick, and full; heat and pain at the epigastrium augmented by pressure; tension of abdomen; constipation; thirst, anorexia, white tongue; dry skin; interrupted sleep; cough, and embarrassment in the breathing. The diet was reduced low; and sixteen ounces of blood were taken from the arm, which was repeated on the 6th. On the 7th, 30 leeches were applied to the chest. On the 8th, the symptoms were all greatly ameliorated; and this amelioration continued during the 9th; but, on the 10th, they all returned as bad as before; the oppression being great, and the sanguinolent expectoration copious. He was bled again to 16 ounces, and leeches were applied to the lower part of the sternum. The patient went on, sometimes better, sometimes worse, till the 14th, when the VOL. VIII. No. 15.

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symptoms of thoracic effusion were very evident. The action of the heart was distinctly felt in the right side of the thorax-the left side was bulged out-fluctuation was evident, both to the patient and the medical attendants; pulse intermittent.

It was now clear, that nothing but the operation could afford any mitigation of the patient's sufferings, and Baron Larrey was the operator. The Baron made an incision between the second and third false ribs, equi-distant from the sternum and spine, and, cutting close along the superior edge of the third rib, gave vent to about 15 pints of sero-sanguinolent fluid. Air then began to enter the thorax, and the wound was closed. During this operation, the viscera, both of the thorax and abdomen, which had been pushed from their natural situations, by the large collection of fluid, were restored both to their site and function. The heart pulsated against the canula in the wound. The patient had some hours repose, but, towards the evening, fever became lighted up, and the oppression of breathing as bad as ever. The catheter was again introduced, and some more pints of fluid were drawn off. In the night, the patient suffered much, and fresh symptoms of effusion appeared. An elastic catheter drew off eight more pints of fluid. On the third day after the operation, the patient died.

Dissection. The pleura of the left side of the chest was completely disorganized, being of a deep brown colour, and, in some places, three or four lines in thickness. There were, also, layers of coagulable lymph, and many fragments of false membranes floating in the remaining fluid. The lower portion of lung, on this side, was disorganized, and completely imbibed with the same kind of fluid which was found in the sac of the pleura. There were about sixteen ounces of limped fluid in the pericardium. The heart was small and flabby. There were some traces of inflammation in the abdomen; but no disease worth relating.-Journ. Général de Medecine.

Remarks.--Although, on the principle of Euthanasia, it is just and proper, that issue should be given to collections of matter, or water, in the bags of the pleura; yet, we need seldom hope for permanent success, where the inflammation producing the effusion has continued long. There is generally so much disorganization in the lining membranes of the chest, and even in the lungs or heart, that little chance of recovery remains. It is somewhat more hopeful when abscess of the lung has burst into the chest, and an opening is soon given for the extravasation. In such cases, recovery is not exceedingly rare.

7. PULMONARY ABSCESS.

[Dr. Chambers-St. George's Hospital.]

One object of Dr. Chambers' paper is to show the very rare occurrence of suppuration of the lungs consequent on common inflammation. This last-mentioned process usually goes the length of causing an adhesive deposit in the pulmonary structure, not intense enough to induce