its substance, was cartilaginous; the columnæ carnes of this ventricle had also acquired a remarkable hardness approaching to that of cartilage, of which they had the physical characters."

In the fifth section the author treats of the conversion of the muscular tissue of the heart into a fatty substance. Haller, and Vicq. d'Azyr, with many other writers, have described the change of the muscles into a fatty substance, and certain modern anatomists have averred the same of the heart; but Corvisart, without denying the possibility of the fact, declares that he has not met with such an occurrence. Our readers will be aware that he does not mean those cases in which the heart is encumbered and loaded with fat, which is not an uncommon event.

The chapter on the induration or ossification of fibrous parts, contains much interesting matter. As a specimen we select a case of Contraction of the left Auriculo-ventricular Aperture.

"A blacksmith, aged 20 years, of a very robust constitution and of a sanguineous temperament, came into the Hospital of la Charité on the 4th of June, 1792. He came there, he said, on account of a dysentery with which he had been attacked in the winter, and which had caused him to lose much blood by stool. He never had had any other complaint, but he was subject to nasal hæmorrhages, to which he observed all his family were liable.

"For the last ten or eleven months he had been unable to take any violent exercise without experiencing some pain in the chest, and strong pulsations in the region of the heart. The nasal hæmorr hages had ceased for three months before he came into the Hospital. The palpitations, then more frequent, became also more violent, but still without being excessively distressing. He came to the Hospital for his pretended dysentery, and did not at all complain of the abovementioned symptoms, which he only acknowledged on being interrogated.

"As soon as I saw the patient, I suspected an organic lesion of the heart, and two days after I announced its existence in one of my private clinical conferences. Here follows what was most remarkable.

"On placing the hand on the region of the heart, strong, quick, and very irregular palpitations were felt. The patient could not lie on his back, in consequence of its producing a sense of threatening suffocation: he lay tolerably comfortably on the left side, but often awoke with startings, and said that he felt, while sleeping, violent blows on his body. The pulse was irregular, frequent, hard, weak, and rebounding: it had very irregular intermissions, and was altogether so variable, that it is difficult to convey a correct idea of it.

"This disease once recognized, the intensity of the symptoms readily enabled me to point out the prognostic: it was inevitable death. I omit giving a detailed account of the treatment, which con

sisted in small bleedings, mild diuretics, antispasmodics, and other palliatives, the inutility of which I had before pronounced.

"The symptoms soon made a very rapid progress, and the patient was convinced, from his own feelings, that he carried in his breast the cause of death. The sense of suffocation, which had existed for some time, became more and more alarming, the lower extremities began to swell considerably; a violent delirium came on, which lasted for near twenty-four hours; an excessive coldness of the limbs took place, and the patient died on the 29th of June, twenty-five days after his admission.

"The body was generally oedematous. There was a slight effusion in the cavities of the chest. The lungs were sound; the pericardium contained a little water. The heart was very voluminous, and all its cavities were gorged with blood.

"The right auricle and ventricle were in a natural state, except that they were enlarged, as was their aperture of communication. The left auricle was also dilated: its opening into the left ventricle was exceedingly contracted, and formed a kind of osseous slit, through which a thin coin could scarcely have passed; the part of the mitral valve which adapts itself to the orifice of the aorta, fitted but very irregularly.

"The large vessels were in a natural state.

"The organic derangement which I have described, was evidently the cause of the increased volume of the heart, and of death.

"It is clear that the disease of which the patient complained was not dysentery, but only an effect of sanguineous plethora, determined more particularly to the venous system of the lower belly. This may easily be explained; the left cavities of the heart, not properly emptying themselves, the right could not become unloaded; the blood, therefore, from the vena cava accumulated; and hence arose the sanguineous distention of the liver, so frequent in diseases of the heart, as also the hypogastric venous plethora, and the intestinal hæmorrhage, but not dysentery.

"The temperament of the patient was sanguineous to an excess; it was that of all his family; he was subject to nasal hæmorrhage; ten or eleven months before his death, he could not move without bringing on palpitations. The bleeding at the nose ceased, the palpitations increased, and the intestinal hemorrhage came on. Is any thing more necessary to prove, that this disease was not dysentery? It was also unaccompanied by intestinal pains, teņesmus, or any other symptoms of this affection.”

Contraction of the right auriculo-ventricular aperture from cartilaginous or osseous induration, is rare. In the case stated by Corvisart of a man aged 60, the chief symptoms were bloatedness and violet hue of the face, lips, and neck; extreme difficulty of breathing; beating of the heart diffused and irregular; the pulse irregular, and not isochronous with the pulsation of the heart; confusion of ideas followed by drowsiness succeeded; the pulse sunk.

At the time of opening the body, the face was violet and blackish;

blackish; the lungs adhered on every side to the internal surface of the parietes of the chest. The right auricle was much enlarged; the tricuspid and mitral valves were cartilaginous, which diminished the diameter of each orifice; the pericardium contained some water; the dilated aorta had some ossified points on its internal membrane.

Two sections follow upon the cartilaginous or osseous induration of the auriculo-ventricular valves; and of the semilunar and sigmoid valves; lesions to which the heart is very subject, and which may partially exist without much inconvenience being experienced. They sometimes, however, prove fatal.

"A washerwoman, aged 76 years, was admitted on the 14th of May, 1803, into the Clinical Ward. This woman had never had good health; at the age of 67 years, she experienced so much difficulty in walking, that she was often obliged suddenly to stop. This first symptom was accompanied by palpitations. Her complaint did not become alarming for eighteen months after. At this time her extremities were so anasarcous, that she was obliged to give up work.

"When she came into the hospital, her countenance was livid, ker eyes were watery; the lower extremities, the arms, the hands, and the parietes of the abdomen, anasarcous, She had frequent nausea; her breathing was high, short, and interrupted; the palpitations were frequent; the chest, when struck, did not sound in the region of the heart; the pulse was quick, rather weak, and irregular. These symptoms were sufficient to point out the organ affected, and the danger of the disease.

"Thirteen days after her entrance into the hospital, this woman, whose disease during that time had made a rapid progress, died as if suffocated.

"The face, in this subject, was unequally black and livid; the brain in a healthy state; the lungs were flabby and anasarcous; and there was a small quantity of water in the two pleuras. The pericardium contained about half a pint of serum; the heart was not much enlarged beyond its natural size.

"The right ventricle was soft and flabby to the touch, as it usually is. The left, on the contrary, resisted pressure, with so much force and elasticity, that its parietes immediately returned to the state in which they were before they were compressed. The substance of this ventricle was so firm, that it preserved almost a cylindrical shape. A portion of this cylinder was covered by the pericardium; and the other part, forming the septum, projected into the right ventricle, the cavity of which it in a great degree occupied. Its fleshy parietes were fifteen lines thick.

"The left ventricular aperture was studded with many sharp and Osseous points, which, uniting near the septum, formed a substance of considerable size. The mitral valves were indurated only where they came into contact with the partly osseous circle of the ventricular

orifice,

erifice. The mouth of the aorta did not appear contracted, but the semi-lunar valves, by their arrangement, nearly closed up its area.

"These valves were not only indurated and ossified, but much thickened by the calcareous matter which was deposited between the two membranous folds which form them. Their osseous hardness kept them in a sunk and immoveable state. Their free edges approached so as to touch each other, and almost entirely to obliterate the area of the vessel. Had not the base of one of these valves, although ossified and thickened, preserved sufficient pliability to perform a kind of see-saw motion, which augmented, by a line or two at most, the opening for the passage of the blood, it would have had to pass out of this ventricle by an excessively narrow slit.

"The right ventricle was in a natural state. The auricles were not enlarged, but their parietes were so weak that in many places they were transparent, and tore, with the greatest ease, on separating them circularly from the base of the ventricle. All the cavities of the heart were distended with black blood, partly fluid and partly coagulated."

The chapter on Excrescences of the Auriculo-ventricular and Semilunar Valves, contains some interesting cases, and practical observations.

The Fourth Class of our author's arrangement comprehends Diseases which affect at the same time several Tissues of the Heart. Carditis is the head of the first section. This formidable disease, it seems, is less known than its importance would lead us to suppose: in many instances it exists where not suspected, and Corvisart has therefore divided it into occult, and manifest. The cases of the former adduced by the author are too valuable to be omitted, although our extracts have already been numerous.

"A cleaner of shoes, aged 67 years, of a sanguineous temperament, had for thirty years been subject to a distressing dyspnea, and frequent colds, but had never felt palpitations.

"On the 24th of April, 1803, the breathing being more than usually difficult, he felt a slight pain in the middle and interior part of the left side of the chest; two days after he spat blood, and on the 29th was admitted into the Clinical Ward. He had then a little pain in his head; his countenance was animated; his eyes brilliant; his tongue whitish; the breathing a little difficult, with wandering pains in the chest, but no palpitations. His pulse was weak, irregular, intermittent, and not the same in each wrist. On the following day, the respiration was more difficult, noisy, and rattling; the pain in the chest had greatly increased; he had delirium, and talked much. In the morning he got up several times to the window to breathe; he did the same at mid-day, lay down and died unexpectedly on the 7th day of the disease.

"The pain in the chest, the difficulty in breathing, and the external examination, had, from the second day, convinced me of the existence of peripneumony; the brilliant eye, the talkativeness, the seat of the

3

pain,

pain, and the characters of the pulse, indicated to me that the inflammation had extended to the heart, without leading me to suspect any particular derangement in the texture of that organ.

"At the time of opening the body, the countenance was unequally livid and violet, and the subcutaneous veins was gorged with blood. The brain was in a good state.

"The right lung, throughout adherent to the pleura, was flabby, very extensible and ædematous. The left lung was covered throughout a great part of its surface, particularly near the pericardium, with a pseudo-membranous crust several lines thick. The costal pleura of this side appeared to have been the seat of inflammation.

"The pericardium contained about a pint of a purulent and flaky fluid; its internal surface was covered with a membranous-like substance, the superficies of which had numerous elevated points upon it. "The heart, of the natural size, was soft and flabby. The fleshy parietes of the ventricles and auricles were of a pale yellow; a fatty substance might be said to be deposited between their fleshy fibres, which seemed separated from each other. A vascular kind of network was perceptible upon the surface, and even on the interior substance of the fleshy parietes of the heart. By gently pressing the fleshy substance between the fingers, it was easily reduced to the consistence of a pap, and of a dull pale color. All the cavities of the heart contained polypiform concretions, which extended even into the cavities of the vessels.

"The abdominal viscera were all sound.

"To this fact, and which I will call obscure acute carditis, I will add two others perfectly analogous, and in which the diagnostic was as obscure as the pathological state was evident on opening the body.

"A young person came into the Clinical Ward, laboring under a disease of the chest, with a pale and wan countenance, and œdematous legs; she coughed much, and had a puriform expectoration, Finding little relief from the medicines which she took, she quitted the hospital.

"She soon returned, and the same means were again employed, as I still entertained the idea that it was a pulmonary affection: but, on a more careful examination, I observed that she had constantly a small pulse; and the lips being bloated and violet, a symptom not common in pure phthisis, I used percussion with more care, and found that the chest, which sounded well on the right side, gave no sound on the left. This, and several other symptoms, made me think that the left cavity was full of liquid. The belly was so distended with water, that I ordered paracentesis, which gave vent to a considerable quantity; but the patient died in a few days.

"On opening the body, the pericardium was distended with a purulent fluid. The surface of the heart was covered with a layer of lymphatic matter; the heart itself was small, contracted, soft and pale, even in the interior of its substance. The interior surface of the pleura was only affected on the right side."

"A woman was received into the Clinical Ward. She had ascites, for which she received the usual treatment; was tapped several times, without finding more relief than is usually experienced

in