This report is taken chiefty from that drawn up for the hospital case-book by Mr. H. BEKCRAFT, the resident physician's assistant.) PERICARDITIS. CASE 30.-A female, aged thirty—one; admitted, after an illness of fourteen weeks, supposed to be ague; had had rigors and diarrhœa. On admxsszon: emaciation; sallow and blanched complexion; pungent heat of skin,; pains in hypochondria; signs of condensation of upper lobe of right lung, and of enlargement of the heart with valvular disease; also of

more »

... rgement of the liver and spleen; death after a fortnight. Morbid appearances, with remarks. Numerous imperfectly-cicatrized ulcers in the colon.-Symptoms: The disease probably dysentery; absence of tenesmus and bloody stools common in dysentery; and in what circumstances; means of diagnosis ; cause probably malaria. Bright's disease of the kidneys characters of the urine fallacious. Why no dropsy. Causes of the renal disease; sequetce. Moderately recent adhesion of the lungs, liver, and spleen, to the surfaces of the diaphragm; lobular pneumonia, especially in the right lung; signs of it; difficulty of distinguishing itfrom chronic disease of the lung; diagnostic value of pungent heatof skin; hypertrophy, with dilatation of left ventricle of heart. Old disease of mitral valve; signs. Anæmic murmur in aortic valves ; acute endocarditis, without any signs. Cause of the jerkingpulse. Universal soft-ish adhesions of pericardium; pericarditis latent. S'igns of adhesion of pericardium. Causes of the mitral-valve disease; of the hypertrophy with dilatation; in-, fluence of mitral-valve disease, and of adhesions of pericardixcm, upon hypertrophy. Causes of inflammations in pericardium, endocardium, pleurca, peritonceum, and lungs ; infection of the blood consequent on endocarditis the probable cause of the pneumonia; liver enlarged; cirrhosis in very early stage ; microscopic appearances.—Causes: Signsofacute hepatitisfallacious; spleen enlarged ; tubercle in spleen, yet none in lung ; pancreas enlarged and indurated.—Causes.—Summary view of tlbepathology of the case.-Treatment: Cure of inflammation of the pericardium and of the colon by the natural powers. ELIZABETH T-, aged thirty-one, admitted Friday, Oct. 17th, 1845; rather tall; of slender figure; fair complexion; married two years; has one child; has always been able to procure a sufficiency of the necessaries of life; has taken spirits occasionally, butneverto excess, and only about a pint of beer daily; has lived in Woolwich for some time past, and before her marriage served in a canteen shop; both parents are living and have enjoyed good health; has two brothers and two sisters, all of them delicate, but she does not know that they have been subject to any special disease. The patient has had several attacks of rheumatic fever, the last of which occurred eight or nine years ago; the attacks were very severe, and during one of them the heart was affected. When about eleven years of age, she had scrofulous abscesses about the neck; these got well on her removal to the sea-side, and have never returned; she continued well until her confinement, twelve months ago. The labour was protracted, flooding followed, and she has not been perfectly well since; she continued weakly, and had cough and pain in the chest, but recovered sufficiently to perform her household duties. Present illness.— Fourteen weeks ago, without any assignable cause, on rising in the morning, she felt giddy; soon afterwards she was cold, and then shivered very much for about an hour; next followed increased heat of the surface and free perspiration, which lasted about an hour and a half; she likewise had pain in all parts of the body. In the afternoon, the attack was repeated. She consulted a medical man, and took medicine, which proved to be aperient; the next day she felt pains all over, but had no rigor until several days after; the rigors have returned at irregular intervals, sometimes every two or three days, and sometimes at intervals of a week, or even a fortnight, and at no regular hour; she had a slight one on the morning of her admission, and had been free for a week before. About a month since she had an attack of acute rheumatism, which ceased a week ago. She has noticed, that during her illness her stools have been very white, " like a baby's," but at what precise period she does not remember. At various times in the course of her illness she has been much purged, and (she was carefully questioned on this point) is quite sure it was independent of any medicine. The urine, eight or nine weeks ago, was of the colour of porter. Her medical attendant called her disease ague; she never had ague before, and believes the disease does not occur in the part of Woolwich in which she has lived. Symptoms on admission.—She is very much emaciated; the face and general surface are quite blanched, and, at the same time, sallow; no cedema of any part; the lips, although pallid, have a slightly livid tint; countenance anxious; skin burning hot; pulse 120; great prostration of strength, with pains and soreness in all the limbs; no redness, swelling, or tenderness, in any of the joints; sleeps little, but has no pain in the head; she lies recumbent, and upon the right side, the breathing being easiest in this position; the respirations are short and frequent, being forty-eight per minute ; they are chiefly costal; the diaphragm moving very little; the ribs on the left side move more freely than those on the right; has no pain in the chest; coughs but little, and expectorates, in small quantity, a glairy, colourless, pituitous fluid; the circumference of the chest, a little below the mammae, is twentyeight inches and a quarter; the right half measuring fifteen inches; the respiratory sound is louder under the right clavicle than the left, and is somewhat bronchial; over the upper part of the right side, behind, it is extremely bronchial; no crepitation; on percussion, the sound is distinctly duller under the right than the left clavicle; behind, there is dulness on the right side from the apex to opposite the fifth dorsal ver-tebr2e; then, for the space of two inches, the sound is clearer on the right side than on the left, and, lastly, there is dulness again over the lower third; on the right lateral surface there is dulness in the axilla, below this, an interval of clearness, and, lower again, a dull sound over the hypochondrium; an undulatory movement is very distinctly visible in the cardiac region, over a space extending from the left nipple to within an inch of the right; dulness on percussion in the cardiac region extends upwards to the third rib; on both sides of the sternum downwards to the margin of the chest, and as far towards the right side as the nipple ; the impulse is much increased, and is felt over a far greater space than in health ; the apex beats between the fifth and sixth ribs ; there is a loud systolic bellows murmur, most intense at the apex, but very distinct at the base and top of the sternum, audible also above the right clavicle, and at the lower angle of the left scapula; the murmur is less loud over the space intervening between the heart's base and apex than at either of these two points ; the second sound is not materially altered. Pulse 120, full, soft, jerking, and has a slightly thrilling character; inordinate pulsation of the carotid arteries; tongue furred ; no appetite; considerable thirst; abdomen much fuller than natural. There is general tenderness on making firm pressure, but not on merely pinching the skin; the tenderness is greater in the upper than in the lower region of the abdomen, and over the right side than the left; there is no dragging sensation felt in the right hypochondrium either when lying down or walking; the liver can be felt a little below the ribs, and more so in the epigastric than in the hypochondriac region ; percussion over the lateral surface of the hypochondrium yields a dull sound, no higher than opposite to the lower end of the sternum ; bowels freely open ; stools dark-coloured, and of a moderate consistence. Over the region of the spleen there is a dull sound on percussion over a space of four inches perpendicularly, and of six or seven inches transversely; urine copious, strongly acid, specific gravity 10.12 ; contains a slight excess of phosphates, and about one-sixth of its bulk of albumen. To have ten leeches over the right hypochondrium, and afterwards a linseed-meal poultice, and to take two grains of calomel every four hours. Oct. 18th.-After the application of the leeches, the pain diminished much ; has now no pain, and very little tenderness over the right hypochondrium ; has pain of a cutting character in the left hypochondrium; it is aggravated in paroxysms, and also by lying upon the back; tenderness on pressure between the last rib and the crest of the ilium on the left side ; the left side of the chest moves as much as the right in respiration; pulse 100, smaller, and less jerking; bowels moved four or five times, motions dark-coloured ; had a sinapism on the left side this morning. To have eight leeches over the left hypochondrium, and to take half a grain of opium with each dose of the calomel. 20th.-The patient is paler ; the surface is still hotter than natural; complains of pain when she lies upon the back; more pain in the left hypochondrium than the right; the ribs on the left side move more freely than on the right; the intercostal depressions are less visible over the lower part of the right side than the left ; the pulsation of the arteries of the