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not authorized to give any immediate reply to the communi-cation of the Deputation; nor could he undertake to state theintentions of the Council respecting a Supplemental Charter,as nothing had been definitively settled with regard to it by

‘

the Council; that he would communicate the observationsof the deputation to the Council at their first meeting, whichwould take place in February, and that the Council woulddoubtless give an early answer to the Association on the sub-jects to be submitted to their consideration.

HOSPITAL REPORTS.

UNIVERSITY COLLEGE HOSPITAL.ON PERICARDITIS.—By JOHN TAYLOR, M.D., Professor of

Clinical Medicine in University College, and Physician toUniversity College Hospital, London.

CASE 23.—A young man subject to rheumatism, after exposure tocold, had a third attack of the disease. On admission, therewere, also, hypertrophy of the heart, with mitral valve disease,and tubercles in the lungs. Pericarditis soon supervened,fol-lowed by double pleurisy, and by erysipelas of the face. Cure.- Remarks. Prentonitory symptom of pericarditis. Differ-ences between friction sound and bellows murmur. Cause ofthe vibratory tremor, and of the bulging and undulatory move-ment in the cardiac region. Complications. Explanatiora ofphysical signs. Diminution of signs of tacbercles during theadvance of the disease. Co-existence of friction sound, and ofrespiratory sounds, with effusion of serum in plettrœ.—Causes.No metastasis. Pleurisy also rheumatic. Connexion of ery-sipelas with rheumatism. Treatment. Appreciation of theeffects of mercury. Spontaneous cure of pleurisy. Duration.

WILLIAM M-, aged sixteen, admitted Tuesday, Jan. 10th,1843; a cabinet-maker; of slender conformation and palecomplexion; habits regular; father, mother, and sister, died ofconsumption. Six or seven years ago he had rheumatic fever,which continued for six weeks, since which time he has beensubject to pains in the head and limbs after exposure to cold.He was admitted into this hospital, under the care of Dr.Williams, on the 9th of last August, for acute rheumatism andendocarditis, and was discharged Sept. 20th. At that time hehad pain, more or less, in all the joints, and in the head;great pain in the region of the heart, increased on inspiration;slight cough, with a thin watery expectoration; the heart’simpulse was very sharp and abrupt, and felt over a large sur-face ; there was, also, a loud murmur, with the first soundheard best at the apex. He had previously had gonorrhoea,and there was a papular eruption over the epigastric and righthypochondriac regions. The following physical signs weresubsequently observed during the time the patient remainedunder Dr. Williams. The right side of chest moved less thanthe left; the sound, on percussion, was too dull on both sides,about an inch below the clavicles; supra-spinous fossa3 of theleft scapula duller than that of the right; respiration loud, andblowing on the left side, and bronchial on the right side,below the clavicles.The present attack commenced on the evening of Thursday,

January 5th. The patient took a walk in the evening, theweather being damp and foggy. He had previously beenwearing Wellington boots, but now had on shorter ones, andfelt his legs cold from the change. He stood talking in thestreet for a quarter of an hour, during which time he felt acold shivering. Had felt warm, but did not perspire duringhis walk. He returned home, and went to bed almost imme-diately, and got into a profuse perspiration, and was restless.He did not feel worse until Friday evening, when he had painin the head and thighs, and, at intervals, in the region of theheart. His breathing was short, but lie had no cough. Onthe Saturday he went to work, notwithstanding the pain inthe legs. In the evening the pains increased, and on Sundaymorning, he was unable to stand. He then obtained medicalaid, and took some opening medicines; but gradually gotworse, until his admission on the following Tuesday. On ad-mission, there were pains in the thighs and knees, extendingto the ankles, increased on motion, and during the night, butrelieved by the heat of the fire ; ankles and feet swollen ; oc-casional pain in the left shoulder; much heat of skin; slightheadach ; great thirst; appetite diminished ; tongue moist;covered with a thick pale-yellowish fur; no cough; dyspneea;occasional pain in the region of the heart; palpitations con-stantly, but more violent during the paroxysms of pain; norubbing sound in the cardiac region, but a bellows murmur atthe apex; urine high-coloured, scanty, covered with a pellicle,

and letting fall an abundant sediment. Ordered, venesectionto twelve ounces; and two grains of calomel, with one grainof opium immediately after. Also, a pill every eight hours,containing one grain each of opium, calomel, and tartarizedantimony. Low diet.

llth.—Some relief; but not much.12th.—The pains in the limbs are better. To have the

house physic.,

13th.-No increase of the pain nor of the palpitations. Dr.R. Quain observed a rubbing sound in the cardiac region. Tobe cupped over the heart to ten ounces.

14th.—Considerably relieved since the cupping; pulse 120;tongue dry; bowels open; no perspiration; heart’s impulsestrong, accompanied by a friction sound and bellows murmur;gums tender. The pill to be taken once a day only. To takea draught every four hours, containing fifteen minims ofwine of colchicum, twelve minims of tincture of opium, fifteengrains of carbonate of magnesia, and water an ounce and ahalf.

17th.—I saw the patient for the first time; perspires much atnight; countenance rather anxious; can lie only on the left sideor on the back; in health he lies upon the right side; has neverhad any particular difficulty of breathing; suffers habituallyfrom palpitations; has had no jactitation or syncope; no lividityof the lips; has headach and vertigo, and is troubled withdreams; no cough; no pain in the cardiac region, but has ten-derness on pressure. The chest is slightly more prominentover the heart than on the corresponding part of the rightside; impulse of the heart visible; a vibratory tremor is felt bythe hand, both with the systole and the diastole; the impulsetoo strong and too extended; dulness on percussion reachesupwards to the body of the left third rib, and is too extendedtransversely; there is a prolonged, softish, double frictionsound over the greater part of the cardiac region, and in a lessdegree at the top of the sternum; the sound seems superficialand resembles somewhat that produced by the crumpling ofmoderately soft paper; a very slight murmur is heard abovethe clavicle, and with the first sound only; below the leftnipple there is a loud, prolonged, soft bellows murmur withthe systole, very readily distinguishable from the rubbingsound heard a little higher; pulse ninety-six, moderately full,jerking slightly irregular, no thrill. To be cupped below theleft scapula to ten ounces.

18th.—Considerably relieved since the cupping; can lie oneither side; no palpitations; physical signs the same as yester-day ; vibratory tremor felt only as low as the left nipple; belowthis point the friction sound is scarcely heard, but only thebellows murmur.22nd.-Cardiac signs as before; a friction sound is now

heard in the region of the right nipple, and over the whole ofboth lungs, behind.-Left lung: Percussion under the clavicleas clear as in health, but less clear than under the right; be-hind, the resonance is very clear and somewhat tympaniticover the upper half, but duller over the lower half, apparentlyduller than in health, and is mixed with a tympanitic reso-nance from the stomach.-Respiration : Under the claviclethere is a muco-crepitant rhonchus, and a loud, rough, inspira-tory murmur; behind there is a large muco-crepitant rhonchus,or gurgling, of a somewhat metallic tone over the lower part,and at the junction of the clear with the dull portion; noamphoric respiration, nor distinct metallic tinkling; over theupper half, behind, the respiratory murmur is loud and rough,and perhaps bronchial in parts.—Right Lung: Between theclavicle and the upper border of the third rib the resonance isvery clear, but from this point to the bottom of the chest itis dull; behind, the resonance is clear above, but duller overthe lower half.—Respiration : Below the clavicle the murmursaccompanying both inspiration and expiration are too loudand rough; no rhonchi : behind, respiratory sounds loud andrough above, less so below; no rhonchi. The skin is coveredwith perspiration, and always is during sleep, by night or day;rheumatism nearly gone; lips slightly livid; no cough.February 2nd.—The double friction sound continues over

the heart, but is much fainter; the vibratory sensation stillexists; the murmur at the apex and impulse as before.

9th.-Friction sound over the heart quite gone; heart’saction rapid; impulse strong; a loud murmur at the apex asbefore, which is audible but less loud over the base, still lessat the top of the sternum, and not at all in the neck; secondsound healthy at the base; pulse smaller, rather jerking, soft.

14th.—Erysipelas of the face appeared yesterday. Apply asolution of nitrate of silver to the face. To take three grainsof calomel.

18th.—Erysipelas gone.23rd.—Discharged.

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SUMMARY OF THE CASE, WITH REMARKS.

Symptoms and diogn.osis.-On the patient’s admission, thereexisted enlargement of the left ventricle of the heart; shownby the strong impulse, and also regurgitant disease of themitral valve; proved bv the systolic bellows murmur, audiblechiefly over the apex of the organ. The history of the caseshowed that these affections had their origin at a date con-siderably anterior to that of the present illness.There is some doubt about the exact time when the peri-

carditis made its appearance. The first unequivocal sign ofit-viz., the friction sound-was noticed Jan. 13th, but pain inthe cardiac region had been complained of once or twicebefore this date. On the patient’s admission there was somepain, which is mentioned again on the 10th, but is not furthernoticed until the 13th, when, although there was undoubtedpericarditis, it had not increased. This pain may have hadits seat in the integuments, or it may have been a premonitorysymptom of an inflammation not yet developed-or it mayhave been a symptom of pericarditis then existing, but notsought for and not discovered. As a means of diagnosis, thepain was, as usual, of little value; it is not once mentionedafter the friction sound was observed, except on the 17th,when there was a little pain on pressure only. There wereother general symptoms, but none of them characteristic-viz., some anxiety of the countenance; pain in the head, andvertigo; inability to lie upon the right side, and a little irre-gularity, with a jerking character of the pulse. All thesesymptoms continued but a short time.The friction sound was of that kind which has been com-

pared to the noise made by the crumpling of soft paper in thehand. It was double, but whether the systolic or diastolicportion was the louder, is not stated. The rubbing sound wasmost readily distinguishable from the bellows murmur, whichwas present at the same time, by-1. Its character, alreadynoticed. 2. Its equable diffusion over nearly the whole of thecardiac region, whilst the valvular murmur was limited to theregion of the apex. 3. Its temporary duration: it continuedabout twenty-one days.There could not have been much serous effusion, for the

dulness on percussion did not extend upwards higher than thethird rib.The vibratory tremor appears to have depended upon the

pericarditis, and not upon the valvular disease, for-1. Itaccompanied both movements of the heart. 2. It was co-extensive with the friction sound, for on the 18th both pheno-mena are stated to be perceptible as low as the left nipple,but not lower, whereas the bellows murmur existed in itsgreatest intensity at a point below this. 3. Its duration was

apparently temporary, no mention having been made of itafter the friction sound had ceased.

Bulging of the cardiac region, and a visible (undulatory?)movement with each systole are mentioned only after thepericarditis had supervened; it is probable, however, thatboth existed before, and that they were due to the hyper-trophy. They were independent of adhesions of the pericar-dium, and probably, also, of any serous effusion.

Complications.—1. Phthisis: The existence of tuberculardisease in the apex of both lungs appears to be clearly provedby the history of the case, and especially by the physical signsnoticed at different periods.-2. Pleuritis, &c.: On Jan. 22nd,and during the progress of the pericarditis, an extensivelydiffused pleurisv supervened. This was shown by a frictionsound on the right side in front, and over the whole of bothsides behind. It is a somewhat intricate problem to trace totheir respective causes all the physical signs referable to thelungs and pleuræ now, and at a former period, observed.(a.) During the six months which had elapsed since thepatient’s first discharge from the hospital, some emphysemamight have been developed in the upper lobes of the lungs, asfrequently happens in the neighbourhood of tubercles; hencethe greater clearness on percussion, and less amount of bron-chial respiration now than formerly, notwithstanding the ad-vance of the tuberculous disease. (b.) Some effusion of serumprobably accompanied the plastic exudation into both pleurae,and so pressed the lungs upwards against the summit of thethoracic cavity. Hence, the dulness on percussion inferiorlyon both sides, and the compression of the lung, would be anadditional cause of the unusual resonance over the upper por-tions of the chest, for this is now ascertained to be an occa-sional effect of pleuritic effusion. The existence of rhonchion the left side, of respiratory sound on the right, and of fric-tion sound on both, is no objection to this view, the fact beingwell established, that a certain amount of serum in the pleuradoes not prevent the production and transmission of suchsounds. (c.) The supposition that perforation of the left

pleura, had occurred with the formation of hydro-pneumo-thorax, would explain some of the signs observed, but appearsto be less consistent, upon the whole, with other signs, andwith the subsequent progress of the case. It is to be regrettedthat there is no record of the condition of the lungs andpleuræ later than the date of the signs just considered.-3. Erysipelas of the face made its appearance at an advancedperiod in the progress of the case.

Causes.—1. Of the phthisis : There was a strong hereditarypredisposition to this disease. Both parents and a sister diedof it.-2. Of the rheumatism: The immediate cause was ex-posure to cold, and; as usual, the effect followed quickly;rigors were experienced at once, and the articular painswithin twenty-four hours.-3. Of the pericarditis.- There ap-pears to have been no metastasis of the rheumatism. Thereis no proof that the pericarditis did not exist from the first,and the rheumatism continued long after the heart becameaffected. The rheumatism was of the sub-acute, as distin-guished from the acute variety, and the present was the thirdattack. On a former occasion it seems to have attacked theendocardium alone, and now the pericardium only suffered.- 4. Of the plettritis: The pleuritis and pericarditis were pro-bably two independent effects of the same cause. There isnothing to show that the inflammation extended from thepericardium to the pleurse, and the fact that both pleurae wereaffected is opposed to such a supposition.-5. Of the erysipelas:Erysipelas and some other cutaneous affection are some-times associated with rheumatism. In many, and, perhaps,in all such cases, both diseases depend upon a morbid con-dition of the blood. This state of the blood may be conceived(for it has yet to be proved) to consist in the presence or inthe excess of a single or of several morbid or healthy elements.In the present case, a papular eruption seems to have accom-panied the former attack of rheumatism.

Treatment.—For the rheumatism the patient was at oncebled to twelve ounces, and took calomel, opium, and tartaremetic in grain doses. On the 14th, the gums became affected.The pericarditis had been detected only the day before, andappears, therefore, to have supervened when salivation wasapproaching. The course of the pericarditis appears to havebeen altogether uninfluenced by the mercury, for the frictionsound continued after, the gums became sore, during a periodof time greater than its average total duration in cases ofpericarditis in general. This fact. together with the occur-rence of pleurisy eight days after the attection of the gums, isopposed to the general opinion respecting the power of calomelto subdue or to shorten the duration of inflammation of serousmembranes. The tartarized antimony produced no sickness,but neither this remedy nor the calomel and opium joinedwith it appeared to stop the rheumatism. Colchicum wassubsequently given, and after having been continued for eightdays, the rheumatism ceased. It is not stated whether purgingwas produced or not. The patient was twice cupped-onceover the region of the heart, and once below the left scapula,and on both occasions with benefit. The pain ceased after thefirst cupping, and after the second the patient could lie in anyposition. The pleuritis does not appear to have been treatedat all, yet it seems to have run but a brief course; and, judgingby the patient’s condition when discharged, it had probablyaltogether ceased. The erysipelas was treated by a lotion ofnitrate of silver. The attack does not appear to have beensevere.

Duration: 1. Of the rheumatism, about seventeen days.-2. Of the pericarditis, not less than twenty-one days.-3. Ofthe valvular disease and hypertrophy, either six or sevenyears or five months, according as it occurred in the first orsecond attack of rheumatism, there being no proof to whichof the two it should be referred.-4. Of the phthisis andpleuritis, uncertain.-5. Of the erysipelas, about six days.

OBITUARY.

JOSEPH CONSTANTINE CARPUE, F.R.S.’VITH sincere regret we record the decease of that excellentman and distinguished lecturer and surgeon, Mr. CARPUE.The lamented subject of this memoir was born in London,

on the 4th of May, 1764. He was descended from a Spanishfamily, members of the Roman-catholic Church; and hisfather, a gentleman of small fortune, resided at Brook Green,in the county of Middlesex. He was intended for the church,and received the elements of his education in the Jesuits’College at Douay. At the age of eighteen he was impressedwith a strong desire to travel, and being limited in his re-