150

tions, and will afford the best securityagainst the return of the disease."—p. 181.The beneficial action of belladonna is

almost entirely mechanical, preventing bythe contraction of the iris the occurrence ofadhesions between its posterior surface orinternal circumference, and the capsule ofthe lens ; or breaking through such adhe-eions after they have been formed ; and thefriction of mercurial ointment with opiumupon the brow, though sometimes efficaciousill relieving the pain, can hardly be sup-posed to have any direct influence on the

progress of the disease.The removal of effused lymph from the

iris under the action of mercury, has gene-rally been attributed to increased activityof the absorbents. Mr. Lawrence thinks," that it has no such direct operation, andthat the removal of these depositions takesplace in consequence of the inflammationto which they owe their origin being ar-xested." This cannot, however, always bethe case, for morbid depositions in the eye,as well as in other parts of the body, havedisappeared under the use of mercury, sometime after the inflammation which had pro-duced them had entirely ceased. Of tur-

pentine, as employed by Mr. Carmichael inthis disease, Mr. Lawrence states, that heLas had no experience ; and though he hasmade a short extract from this gentleman’swork, showing the manner in which it is

to be employed, and observes, that the casesthere related exhibit the powers of the

remedy in a very favourable light - he doesnot give any opinion as to its probable effi-cacy in general.

Syphilitic ulceration of the eyelids, withthe account of which the book is concluded,is a much less common affection, and doesnot appear to have been particularly noticedby any other writer on syphilitic diseases.It affects all the tissues of the eyelid, whichit sometimes totally destroys, and may beeither chronic or acute, having in the lattercase a " phagedenic character, with red

margin; sharp edge, foul unequal surface,on which bloody points are seen, and beingattended with severe pain." It is very dis-

tinct, both in its progress and appearance,from cancerous ulceration of the palpebrse,the only disease with which it could possi-bly be confounded, and is most quickly andeffectually cured by the free use of mercury.

Medical Literature in central Africa. Tim-buctoo Biontlrty Journal, No. 28. Blacka-moor and Co. October, 1830.

WE have been favoured with the 28th No.of a monthly medical and surgical journal,published lately at Timbuctoo, in which,in a review of a work on consumption, the

critic states (p. 299) : " Chlorate of potashis not the best mode of employing chlorine ;"and in a subsequent sentence, that ‘ Medi.cines taken into the stomach can have little,if any, effect on diseases of the lungs.These sentences afford strong presump.

tive evidence that the works of Laennec or

Davy have not yet found their way into theinterior, and that tartar emetic and ipecaccuanha are unheard-of remeclies in pneu.monic’ affections. Massa Blackamoor, we

fear, ‘ ve pren vera mun o’ him pillo-oricalbeefor nigger vera mun savve pissick."

LONDON MEDICAL SOCIETY.

October 18, 1830.

Mr. CALLAWAY in the Chair.

LIABILITY OF SEROUS TISSUES TO ERYSIPE-

LATOUS INFLAMMATION.

TuE opinion that erysipelas can attack

only the skin externally, and, when seatedinternally, the mucous membranes, is held bysome of the members of this Society to beunsound ; but though the point has often beenagitated it has never been satisfactorily dis,cussed. The chief snpporterof the oppositedoctrine, however, Dr. WHITING, havingbeen urged to bring it fairly before the So-ciety, took advantage of some cases whichbad lately occurred to him, tending, in hisopinion, to show that the inflammation in

puerperal fever is erysipelatous, and this

evening detailed his views on the subject.It had long been supposed (he observed)

that erysipelas was a disease of the skin

only, and in systematic writings it had al-

ways been classed among the cutaneous dis-eases. lIe had himself long considered thisto be correct, but several cases had latelyfallen under his observation, which had con-vinced him that the erysipelas which attacks

’ the skin may, by extension of the inflammn-tion, encroach upon other textures. The cel-lular tissue was affected by the inflammation

’ dipping into it, and forming abscesses whichburrowed in various directions, differingfrom the common phlegmouous inflamma-

tion. There were many cases in which alsotlie mucous and muscular membranes were

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attacked. During the last session he related rather to be ascribed to two distinct causesa case of inflammation which began in the than to any.thing else. The general opinionthroat, from thence proceeded to the ear by was, that peurperal fever was contagious,

-

the eustachian tube, crept by the lachrymal and this view was entertained by the mostduct to the eye, and finally spread in the form industrious observers and the best informedof erysipelas over the face. Now that case men. Dr. Gordon who first wrote on thedid not strike him at the moment in the subject, said that he could positively foretelsame point of view as that in which he now whether the patient would have it, merelyregarded it. The patient was attacked with by knowing who was the attending midwifeSl YeH’ dyspnoea, and the inflammation which or nurse. He said that he was scarcely everensued immediately after, progressed on- mistaken in this. This alone would leadwards until it destioyed life. This, he had him to say that there was some peculiaritythought, was owing to the state of the hrain, in the cause. Dr. Gordon statedin his workbut I;e now believed that erysipelas would that he would not venture positively to assertreally extend to the lungs and occasion death. that puerperal fever and erysipelas were oflIe had a patient who, a week ago, was the same specific nature, but he was con-attacked with severe inflammation on the villced that they were analogous in someEutfdce of the tonsils, with great enlarge- respect, for these two epidemics, in someJib nt. The next day the swelling subsided, instances to which he referred, began aboutand the inflammation appeared to be passing the same time, kept pace together, arrivedawav, when a difficulty of swallowing was at their acme together, and ceased at theexperienced, luwer down. Leeches and same time. Dr. Gordonhadpointedoutotherblisters were accordingly applied, and the reasons in favour of this conjecture, andpharynx was relieved, but then the patient similar views were entertained by Mr. Hey,complained of an affection of the bronchial Drs. Mackintosh, Hamilton, and Campbell,tube; presently the upper lobe of the lung ! to whose works Dr. Whiting referred.was attacked, producing pleuritis and pneu- These things, then, seemed to lead to themonia, with spitting of blood. The iiiflam- opinion that there was something similar inmatien shortly after, left the upper, and the causes which led to the production ofdescended to the lower lobes, the patient erysipelas and puerperal fever. Otherwiseexperiencing very great pain ; it subse- why were they both contagious, and why,quently passed through the diaphragm, and as it was well known they did, did they bothLnd that day reached the peritoneum, thus happen together? The small-pox andpresenting the erratic tendency of erysipelas, measles, the small-pox and scarlatina, andaud characters of the same description as many other diseases might be simultaneous,those of peurperal fever, the connexion be- but this was the result of accident, whichtween which and erysipelas it was his in- clearly was not the case with the otherteution to show. He had seen many such diseases. As to the morbid appearances,cases as these, but not knowing that erysipe- he had examined a vast number of pa-las would spread itself internally in this tients who had died of true puerperal fever,manner, he had not adopted an explanation and he had always found as much differenceon the ground which he was now disposed to between the inflammatory appearances andassume, that the erysipelas of the skin would those of common inflammation, as there wasspread from one suiface to another, or from between erysipelas and common inflamma-one texture to another, until it either expend- tion of the .kin.ed itelf, or destroyed the patient. Now, the Now erysipelas was erratic. It generallyquestion was, might he consider that lie was began in the womb, then proceeded to theborne out in the doctrine that puerperal groin, then to the umbilicus, and then per-fever was erysipelatous They all knew that haps went to the chest. It did not shut uppuerperal women were attacked by two dis- the bowels like common puerperal fever. Iteases, both of the abdomen. The one was did not require strong medicine. Takingremediable by antiphlogistic means ; the the average of cases, there was not the

other would go on, despite that treatment, same hardness and strength of pulse. Therewhich, indeed, rather did harm than other- was seldom occasion to use the lancet; in-wise. In what then did the difference be- deed its use was rather contra-indicated.tween these two diseases consist ? It might The state of the tongue was not the same ;b said,—in the difference between the con- it was not so dry nor so loaded in erysipe-st.tution of women. But how was it, pos- las as in common peritonitis. Then again,sible to believe this, for whether the women it could not be stopped so easily. It mightv..re weakly or strong, whether they lost be mitigated, but a week or ten days wouldblood or not, still the disease would prove elapse before it was completely cured.fatal. There was certainly nothing in the With regard to the post-mortem appear-constitution to determine the nature of the ances, when inflammation of the commondisease, and be decidedly thought, therefore, character had lasted ten days, it was

that the diiferencein the two diseases usual to expect to find adhesions. Now.he

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did not mean to say that there were no adhe. In these cases the blood was buffed, andsions in the true puerperal fever, but there the mercury carried to ptyalism.certainly were no organised adhesions. He The speaker having thus submitted ahad examined this point minutely, but he general outline of his views to the mem-had never been able to discover any-thing bers, Mr. Hooper read one of the cases ofbeyond mere agglutinations. Neither were puerperal fever, to which Dr. Whiting hadthere the same appearances in the cavity of referred. It did not present any featuresthe pelvis. Instead of the effusion there farther illustrative of the doctrine, and

deposited being a clear, semi-transparent Mr. Waller, Dr. Ryan, and Mr. Dendy,fluid, it was a muddy, dirty serum, with expressed an opinion that the case was oneflakes like the curd of cheese. With these of acute inflammation of the uterus.remarks he should presently introduce case The replies which were made may beto their notice, which had fallen under the stated in few words.care of himself and a surgeon who was now Mr. PEREIRA considered it impossible,present. He would also refer to a case according to the received definition of thementioned to him by Mr. Greenwood, term erysipelas, that erysipelas of the peri-where it having been necessary to pass a toneum could occur. The same disease incatheter in consequence of retention of principle might perhaps exist there, but ve.urine, inflammation came on two days after sication, an essential character of erysipe-the operation, and extended to the perito- las, could not take place in the peritoneum.neum, presenting all the characters of puer- Dr. Whiting had relied for one of his proofsperal fever. Mr. Travers also removed some upon the erratic character of the inflamma-excrescences from the verge of the anus, tion in the cases he had related ; but, by awhere erysipelatous inflammation came on, parity of reasoning, rheumatism must be

spread up the rectum, and speedily assumed considered to be erysipelatous also. Phleg-all the appearances of puerperal fever. The monous inflammation was an inflammationcase, however, to which he now wished to of the cellular structure terminating in ab-refer, was that of a middle-aged lady re- scess, but the inflammation which in the

siding on the other side of the water, whom cellular tissue was called phlegmonous,he had attended in child-bed. She bore two must, in serous membranes, if it couldchildren, and suffered a severe rigour ; re- occur there, be called by some other name, aaction came on, and a pain commenced in consequence which must be fatal to thethe region of the womb, which became very position of Dr. Whiting.tender, and enlarged. What was to be done Dr. RYAN also differed from Dr. Whiting,in such a case as this The variety of treat- who, he said. had only referred to authorsment recommended by practitioners was so on one side of the question. Dr. Ryan badgreat, that he did not know to what mea- attended cases exactly similar to those ofsures to resort; he thought it right, there- Dr. Whiting. He had bled the patientsfore, to read all the authors from whom generally, and applied leeches and blistershe could expect to obtain information on the without benefit, but after having given upsubject ; accordingly he referred to Gooch, the case as lost, he had tried calomel andHamilton, Armstrong, Gordon, Alackintosli, opium, and procured recovery.and Campbell, and made up his mind that Mr. DEKDY coincided in most respectsantiphlogistic measures would be the most with Dr. Whiting, and in reply to Mr. Pe-successful. Dr. Gooch was the last writer reira’s first objection, said it must be re-on the subject, and he recommended that membered that though the effusion in in-the patient should be bled to syncope ; flammation of the peritoneum was not de-twelve hours, therefore, from the tirstat- posited between two tissues, yet that it wastack, this (or nearly this) was done ; leeches deposited in the abdomen.were then applied ; she was purged from Dr. BLICKE, and one or two other gen-the first ; three grains of calomel every tlemen, made some observations on thethree hours, with a quarter or the eighth of treatment of puerperal fever, but the houra grain of tartrate of antimouy, and one of closing the meeting having by this timegrain of opium. She recovered, but the arrived, the discussion here closed. Dr.

ptogress was slow ; there was a gradual sub- AN’lliting and Mr. Hooper pledged theirsidence, but not what might be termed a re- judgment that the disputed cases bore ex-

moval, of the pain, which ceased, however, actly the characters of malignant puerperalbefore it reached the diaphragm. He had fever.attended another patient who was moribund, ____

and apparently past every chance of re- DOCTRINES OF INFLAMMATION.

covery ; as a last hope he gave ammonia,and the patient suddenly revived. In this Since our report of last week was writtencase he believed that the inflammation was we have taken some pains to collect the par-running its course, and stopped just short of ticulars of the discussion which occupiedlife, when the ammonia was administered. the members on the first evening of meet-

153

ing, as it formed a continuation of the de- or cysts, that there was a perpetual attemptbate with which the last session closed. at organisation in them, and that the fluidsThe subject in dispute involved the merits and matter deposited for such purpose were

of certain pathological opinions formerly ad- thrown off as abortive, and became convertedvanced by Mr. Stephens ; namely, First, that into pus, or dead matter; he also arguedpus formed in the course of disease was not a that Mr. Lloyd’s description of a scrofuloussecretion, but rather a conversion of parts, enlargement favoured his opinion, as it

perished or disorganised by disease, into a showed that it was the original tumour

fluid matter, and Secondly, that inflammation which was discharged as pus, and not awas not, as is supposed, an agent of disease, fresh secretion.but an agent of restoration only. In support The opposers of the latter opinion,of the former of these opinions, Mr. Stephens amongst whom were Dr. Whiting, Mr.cited the example of a scrofulous gland, Proctor, and one or two other gentlemen,which when about to suppurate might be felt argued that Mr. Stephens’s opinion con-softening, and resolving into a fluid rough demned the treatment of inflammation alto-matter, first in the centre, and gradually gether, and if such ideas were enter-

through the whole tumour. It was in the tained, what were we to do in the treat-

failure ofnature’spowerto absorb the tumour, mentof disease? Dr. Whiting asked Mr.that she threw it off in the form of fluid cor- Stephens how he would explain inflamma-ruption. He contended that this was a more tion of the lungs produced by a commonprobable and more natural process than the cold, upon his principles. Cold had pro.one commonly supposed, where, previous to duced the inflammation, but when the in-suppuration, the tumour was said to be flammation was produced what had we totaken up by the absorbents, and matter se- do with the cold ? What had we to treat

creted in its place. If the tumour was ab- but the inflammation 1sorbed the cure was effected, and there w as In reply to these various objections, Mr.no need of suppuration. In support of the Stephens stated that he did not wish it to belatter opinion, Mr. Stephens drew an ana- understood that inflammation was not to be

logv between fever and inflammation. In opposed by any treatment ; he believed thatfever there was a certain effect produced the reaction or inflammation of a part wasupon the body, by some morbific agent, almost always to an excess, and of coursewhether contagion, miasma, or any other required control ; but he did not agree withcause, which, whether it operated by conta- modern pathologists, who seemed to think ifminating the blood, producing internal con- they could prevent inflammation from takinggestions, or in whatever way, required a re- place altogether, or could quell it at its com-action of the vital powers to get rid of the meneement, they would get rid of all dis-cause or its effects, and this reaction was ease. He believed that in every case therethe fever; and the same he believed was a cause existing, visible or iuvisibleoccurred in inflammation. Inflammation he (like contagion), which excited and sup-believed was the reaction of a part against ported the inflammation ; with regard tosome disease or injurious agent affecting cold producing inflammation of the lungs,such part; he believed that it was quite and that when produced, the inflammationdistinct from the disease itself, and he differ- was all we had to combat, the cold no longered from modern pathologists, who seemed existing, he argued that the cold had pro-to consider inflammation, whenever !it duced certain effects upon the lungs, whe-ocetirred, as the sole diseased agent. He ther of congestion, interruption of the func-beheved it to be a restorative agent only. tion, &c., or some other injury which re-The arguments used in opposition to the quired a reaction to remove it ; he believed

former of these opinions by Dr. Blicke, Mr. that inflammation of the lungs was neverLlovd, and some other gentlemen, were, cured upon the principle of quelling allthat pus was often discharged from cysts, action ; it had a natural cure, namely bywhich had been emptied, and from sinuses, expectoration, and the remedies inducingwhtch it would be difficult to account for this were the true remedial measures;upon the supposition of a conversion of further, to explain, he would suppose a

surrounding parts into pus. Mr. Lloyd piece-of wood thrust into the flesh, andalso stated that it was not the gland itself the surgeon overlooking this, contentingwhich enlarged in scrofula, but a deposite of himself with combating the inflammationwhite caseous matter, surrounded by layers only, what would be the result of his treat-of adhesive matter, which formed the en- ment, compared with that of one who lookedlargement, and which was afterwards dis- upon the piece of wood as the injurious orcharged as pus. diseased agent, and removed it’! The in-The answer to these objections by Mr. flammation under the latter treatment, would

Stephens was, that he did not think it was require no combating, it would die away ofsolid parts only which became converted itself; he believed, in all cases, some causeinto pus; he believed, in the case of sinuses produced some effect, whether of functional

154

derangement, contamination (like vaccine application of a few more leeches. The pa-virus applied), or congestion, for the removal tient seemed to be convalescent till theof which the reaction or inflammation was morning of the 22nd, when he bad a severeestablished, rigour, succeeded by heat and profuse per-

[The hbove forms a condensation of the spiration. On the following day he hadarguments employedin the discussion of this another rigour, and in the evening it was re-subject.] peated. The 24th was passed without one,

and the patient suffered only from debility,and very considerable irritability. From

GANGRENE OF THE LUNG. the occurrence of the first rigour I had given.,.

him quinine ; and it may be important toThe following case of well-marked gan- observe that he was repeatedly seen during

grt-ne of the lung was read by Mr. HOWELL his illness by Mr. Callaway, who must havein the courts of last session, and intended to observed as well as myself, that the patienthave been included in a report of the pro- had no cough nor any dyspnoea, neither didceedings in No. ;3 U, but was mislaid. I ever find his pulse aùove 100 beats in the

1 was seut for in the evening of the 5th of minute. Remembering these circumstancesAugust, 1829, to Mr. G. G., aged 26 years, I was astonished to find in the morning ofand learnt that he had been indisposed the 25th that the evening before he had beenfor several davs, and had applied leeches, suddenly attacked with an inclination to spitand taken physic, but had not been visited up something, and that by slightly coughingby any medical man. I ascertained that he he expectorated a large quantity of diffluenthad been very feverish, and had suffered greenish pus, emitting the most distressing-much pain and tenderness in the lower part ly offensive odour. The pulse had becomeof the right side of the abdomen ; that lie accelerated to 120, and possessed a verywas very lestless and occasionally sick. The peculiar character, described by Mr. Calla-pulse was under a hundred, and not very way " as if the muscular power of the arterycharacteristic of active inflammation. Upon had ceased to act." The countenance hud

examining him more particularly, I found he assumed an anxious character ; the skin andhad pain and tenderness in the right renal eyes were yellow, the former had a peculiar,region, extending through the abdomen in moist, glassy, appearance. The patient wasthe course of the ureter. The urine was lethargic, and disinclined to conversation,small in quantity, high-coloured, and, upon but upon any allusion being made to thestanding, deposited a large quantity of uric state he was in, he expressed his confidenceacid. He had pain in the hips passing down of ultimate recovery. In this alarming statethe thighs, but had never any retraction of matters I)r. Thomas Davies or New Broadof either testicle. The bowels had been Street saw the patient; thepathognomonicreadily and actively purged. I concluded signs of his case were then as follows :-that lie was passing some calculi from the Fœtid expectoration, puriform, and occasion-kidneys, and that consequent irritation had ally tinged with blood ; slight cough, butproduced inflammation in that part, perhaps no dyspno3a unless disturbed; absence ofextending to the ureter. I bled the patient respiration in the inferior half of the rightmoderately, and was particularly struck lung, with slight rale crepitant, and dul-with the exhaustion the loss of a small quan. ness of percussion. Dr. Davies gave his

tity of blood seemed to produce ; I directed opinion that the disease was gangrene ofsuch medicines as I thought p;oper, and the lower lobe of the right lung. A coil-that he should be fomented. On the 6th I tinuation of augmented doses of sulphate offound him in every respect better ; the quinine with an expectorant and a lightblood presented but very slightly those nutritious diet was advised. Suffice it to

marks denoting inflammatory disease. On say, the plan was anxiously and carefullythe 7th lie complainell of a recurrence of puraned for several days, but the expectora-pain, and the symptoms of disorder of the tiou continued, retaining its offensive cha-urinary system; was again sick and veiy racier, the patient rapidly declined, and dtedrestless. The pulse justifying me, I ab- on the evening of the 3rd of September.stracte(I more blood from the arm, and The body was examined early next morn-applied a dozen leeches to the lower part of ing, Dr. Davies, Mr. Callaway, and myself,the right side of the abdomen in the situa- being present. There were old adhesions oftion of the caput coli. These measures the upper part of the right lung, the uppereffectually relieved him, and for several lobe of which was healthy, whilst the infe-

ensuing days the only inconvenience he rior was filled with a dark bloody serum,suffered was from occasional vomiting, for yielding a gangrenous odour ; an irregularwhich he drank abundantlv of effervescing cavity in the inferior lobe of the right lung,mediciue. On the 18th he had again a little about the size of a walnut, parietes dark,paiu in the situatiou of the right kidney, lined by a thin false membrane of some firm-which was, however, soon relieved by the ness, and filled by a thick, dark, grumous

155

matter, of a fcetid odour ; adhesion of thediaphragmatic face of the inferior lobe withthe diaphragm. The left lung was adherentto the costal pleura, but otherwise perfectlyhealthy.

ST. THOMAS’S HOSPITAL.

CLINICAL LECTURE

DELIVERED BY

DR. ELLIOTSON,

Oct. 18, 1830.

, very thirsty ; the bowels had been freelyPLEURISY,

open the day before from medicine.ON Thursday last, Gentlemen, twelve pa- Now this, Gentlemen, was a very well-

lieuts were received into the hospital under marked case of inflammation of the pleura,my care; six of them men, and six women. and as such I bring it under your notice.Of the-e cases, there were among the women, In the first place it was clear that she labour-one of acute pleurisy, one of chronic bron- ed under an internal inflammation. The painchitis, two of peritonitis (one of them rather increased by pressure and every mechanicala chronic or subacute case, the other acute cause that could be applied,-deep inspira-but partial), one of dropsy of the whole of tion, which would stretch, and cough whichthe body, with peritonitic ascites (ascites would shake,-and the pyrexia, the fever-antl peritonitis), and one of hemiplegia. isliness, the heat, thirst, and quick pulse,Among the men were three cases of rheu- proved this. That this inflammation was

matism, one of chronic inflammation of the seated in a serous membrane, was shown bybip after a strain, one of incipient universal the pungent, stabbing character of the pain,palsy, or double hemiplegia, one of disease as though a knife were plunged in, and theof the spine and chronic dysentery. firmness of the pulse : that this serous mem-From amongst these I shall select the case brane was the pleura, appeared by its seat

of pleurisy, and one of the cases ofrheuma- on the side, below the breast, where, or attism; my reason for fixing upon both, is, a level with the breast, the pain of acutebecause the chest is remarkably affected in pleurisy is generally felt. In pleurisy, also,this rheumatic case, and the two will form you always have, as in this woman, a shortboth a good comparison and contrast, it cough, and it is short, because to coughbein; sometimes difficult for a young prac- deep would give intolerable pain ; the dis-tttioner to distinguish between pleuritic and ease irritates to coughing, but the patient isrheumatic pain of the chest,-between compelled to restrain the cough forcibly.pneumonia (using the word in a general The cough is usually dry, because the seat

sense) and rheumatism of the external part of irritation is the pleura, not the secretingof the thorax. The case of pleuritis occurred surface of the bronchiæ and air-cells; or ifin a woman of the name of Lydia Poole, not dry, the expectoration is scanty. In thea,,ed j6, a charwoman by occupation, of a present case the cough, though short, wasspare habit, who had been ill two days be- loose,-the expectoration copious, becausetore her admission on Thursday. Accord- she laboured under chronic catarrh, and theing to her account she has been subject to pleuritic cough necessarily discharged thecough and copious expectoration for the last copious mucus of the bronchiæ. The breatb-tlnrty years. On Tuesday, the 12th inst. ing was very difficult. This is necessarilyshe was employed in washing aud scouring, the case in pleuritis, though it may ariseand went to bed at night quite well. In the also from ten thousand other causes. Thecourse of the day her feet had got very difficulty in this case arises from the painwet, and at night after she had been asleep which is experienced by stretching theabout an hour, she awoke with a pain in her pleura in attempting to breathe deeply.le1t side which was increased on inspiration. fhe patient cannot make a full inspira-(Jn Wednesday she experienced alternately tion, for very agony ; the breathing, there-great heat and cold, shiverings and flushes, fore, is shallow, and to compensate for theaml her habitual cough and the pain in her shallowness of the inspirations, they becomeside increased. She was so alarmingly ill more frequent. The countenance was ex-on Thursday that her friends brought lier to pressive of extreme anxiety, the features

the hospital I found her in bed, a shorttime after her admission, and she was thencomplaining of a violent stitch in the left

side in the situation of the seventh, eighth,ninth, and tenth ribs. Her cough was veryfrequent, very short, and agonising, so in.tense did it invariably render the pain in theside ; her respiration also was quick andshort.The " stitch" was increased by moving

in bed, and the least pressure made her ex-claim with pain. On applying the stetho-scope to the left side, I found that the respi-ration was not so distinctly to be heardthere as it was on the other side, where nopain was felt. The pulse was 104, and ratherwiry, that is, rather small and hard ; theskin was hot ; the tongue white ; she was