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College of Physicians in Edinburgh, and,moreover, one of the most distinguishednaturalists of the present day, could not pre-scribe in London for a single patient, unlessbe first submitted to fresh examinations,and although he might have been the mostunqualified person imaginable, yet be suf-fered to prescribe with impunity in anyother part of England ! i Neither could thesame eminent Professor dispense medicinesto any patient in England or Wales, withoutincurring heavy fines, unless he again sub-mitted to pass a certain examination beforea bodyof meu (the Society of Apothecariesin London), who by their own declarationsof their education and qualifications, mustnecessarily be greatly inferior to the candi-date that they would have to examine.All these and many more inconsistencies,

anomalies, and abuses, the like of which,Lord John Russell was assured, did notexist in any other country in Europe, hisLordship heard described with great atten-tion and the expression of astonishment,-concluding by observing, that if they wereproved really to exist in the profession bythe facts of the evidence, which the Medi.cal Association sought to have published,the fullest measure of reform could not betoo soon granted by a British Parliament.The Deputation then respectfully took

their leave, after a most important inter-view, which lasted upwards of three quar-ters of an hour.

The following note from Mr. Gore was I’then read :—

Whitehall, June 11,1838.SiR:—I am directed by Lord John Rus-

sell to acquaint you, that in compliancewith the representation made by you andthe other gentlemen who composed the De-putation on the 2nd instant, he communicat-ed with Mr. Warburton on the subject ofhaving the evidence taken before the Medi-cal Committee printed.Mr. Warburton states that he has obtain-

ed the authority of the House of Commonsto print that evidence, and that three vo-lumes have been already delivered to theMembers. The fire at the House of Com-mons dispersed some and destroyed othersof the papers; those that were not savedhad to be recopied from the short-handwriter’s notes, and the documentary evi-dence to be put together as well as the cir-cumstances would permit.Mr. Warburton adds that it will take

three months to superintend the printing ofthe oral evidence and the editing the docu-mentary, and that he proposes to proceedwith it in the recess. I am, Sir, your mostobedient humble servant.

Geore Webster, Esq., M.D., &c.,Dulwich.

CHARLES GORE.

HOPITAL DE LA PITIE.

TUBERCLE WITH DILATATION OF THE RIGHTCAVITIES OF THE HEART.

A WOMAN in the Salle St. Charles, aged35, of rather a strong constitution, has beenin hospital about seven days ; she has hadeleven children, all of whom she has nursed,and of whom there are but two living at pre-sent. For the last five years she has beenobliged to use a pessary, in consequence ofa prolapsus uteri. She complains of beingill for the last fourteen months, at the com-mencement of which period she was attack-ed with palpitations, and subsequently withinfiltration of the lower extremities. forwhich the patient could ascribe no cause ;nine months after this affection had com-menced, that is to say, five months ago, aparalvsis of the right side suddenly cameon, which has since continued. She has nothad haemoptysis; has had some slightcough, and a difficulty in breathing. Forthe first three or four days after she enteredthe hospital she was not able to keep thehorizontal position, in consequence of herdyspnoea; she was obliged to be placedsitting on a chair, with pillows behind herback. in which position she remained dur-ing the day,,and greater part of the night.She had from 40 to 60 respirations in aminute ; pulse 120 ; the inferior extremities

were very much infiltrated ; cheeks of a vio-let colour. Under the right clavicle, and atthe right side, respiration normal, exceptthat at intervals there was a sonorous rale;under the left clavicle there existed a sub-crepitant ronchus, which was at times in-terrupted by a large mUCO’IS rate ; there wasalso in the same situation a bronchophony,which was so defined and so well markedthat it approached more or less to pectorito.quy. At the same side posteriorly, in thetwo superior thirds of the chest, there weresubcrepitant ronchus, and bronchophony.Posteriorly, at the right side, respirationhealthy, with exception of what has beennoticed for the anterior part of this sameside. The beating of the heart was veryirregular; there existed no bruit de soujftetat the precordial region, nor in the trajectof the carotid arteries.. The patient statesthat she has lost much flesh since her palpi.tations have come on. She had slight coughand expectoration : in the fluid that she ex-

pectorated there were some spits of rathera round defined form, opaque, and of a yel-

low-whitish colour.This woman had been bled after being in

hospital two or three days, was allowed no-thing in the way of food or drink but infu-.sion of emollient herbs, and a little soup.She died the day before yesterday, notwith.standing that after the bleeding she foundherself relieved, and was able to rest in thehorizontal position in her bed after the time

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she was bled, during several hours, even upto her death. The day she had been bled,which was the third day before her death,there were a number of small incisions madein her right thigh, as it was much more infil-trated than the other; there was a littlequantity of a serous fluid which came fromwhere the incisions had been made.

Post-mortem Examination.

On the thighs and abdomen some blackspots, the skin on the other parts of the bodyof the natural colour. There was no ramol-lissement of any part of the brain, nor anymorbid appearance which could account forthe paralysis which had existed. Larynxoffered nothing abnormal. Bronchia—inter-

nally the mucous membrane of a deep-redcolour, and a little thickened. Lungs,-theright lung was emphysematous in some

points. At the superior part the tissue wasa little hardened; in the superior lobe therewere some of the bronchia dilated. The leftlung was not emphysematous; but there ex-isted, in the superior part of the superiorlobe of this lung a cavern of a considerablesize which contained a liquid of a yellow-brownish colour; the walls of this cavernwere of a yellow colour, mixed with strise ofgreen ; the walls of this cavity seemed tobe nothing more than the pulmonary tissuehardened, and did not appear to be suffi-ciently distinct from the lungs, so as to offerthe appearance of false membranes. Theheart was considerably increased in size, theright auricle was greatly distended and con-tained a great quantity of blood, as did alsothe inferior vena cava; the cavity of theright ventricle was larger than it should bein its natural state, its walls were alsothicker and harder, the valves were healthyin the different cavities of the heart; the leftside of the heart was nearly in its normalstate. The pulmonary artery was thirty-sixlines in diameter at its origin from the heart,whilst the aorta was only thirty. Liver pre-sented nothing remarkable. Spleen wastwice as large as in its healthy state ; it wasnot otherwise diseased. Stomach containeda considerable quantity of gas. Small intes-tine was scarcely half the volume which it

presents in its natural state, its coats weresomewhat thickened. Uterus was healthy,two and a half inches in its largest diame-ters ; the cervix was not more developedthan it ought to be.M. Louis remarked that there existed

every sign of tubercles of the lungs, at thesame time that the dyspnœa, which had ex-isted was so intense as to lead a person tosuspect disease of the heart, because no af-fection of the lungs could cause such a diffi.culty of breathing except a double pneumo-nia in an advanced stage, or a double pleu-risy with considerable effusion, which wouldhave existed for some time, both those dis-eases acting in different manners, but pro

ducing the same effect, that is, the imperme.ability of the pulmonary tissue to air ; it wasevident from the stethoscopic signs, thatneither of those diseases existed, so it mnsthave depended on some disease of the heart,However, M. Louis only diagnosticatedphthisis, as there were no exact stetho.scopic signs of disease of the heart notwith-standing that the general symptoms of thisdisease existed ; for instance, the face pre.sented a violet colour, and there was infiltra.tion of the lower extremities. M. L. furtherremarked, that we often find dilatation ofall the cavities of the heart ; however thatit is tiore common to see one or two of itscavities dilated, as occurred in this case,He also added that Corvisart states in hiswork, that when there is dilatation of theright ventricle, its walls are thinner than inits normal state ;.but M. Louis stated thatin forty-five cases he had examined of dila.tation of the right side of the heart, he hasalways found the walls thicker than theyshould be; the same thing had occurred inthis case; the dilatation of the pulmonaryartery in this case was owing to the actionof the right side of the heart being increased,M. Louis had already observed six cases ofdilatation of the pulmonary artery corre.

sponding with dilatation of the right ventri,cle. Haemoptysis never exists in this affectionaccording to M. Louis, except that there aretubercles in the lungs; and even then hæ-

moptysis does not always occur, as ill thecase just related.

CHILDREN’S HOSPITAL, PARIS.

PURPURA HÆMORRHAGICA.

J. R., a girl, 14 years of age, was broughtto the hospital on the 9th of May, 1838,She is of strong constitution ; the face fullcoloured ; health habitually good. The girlhas not yet menstruated. For the last eightdays she has experienced a general feelingof malaise, &c., accompanied by pains aboutthe loins, headach, with alternations offlushing of the face, and slight shiveringwhich precede colicky pains and vomitingThe matter vomited was composed of alimentary substances and blood ; the vomiliagoccurred five or six times a day, and continuedup to the day of her entrance into the hos-pital. Since then she has complained muchof pain in the abdomen, augmented by pres.sure about the epigastrium and umbilicus ; constipation for 24 hours; thirst; the tonguered at the tip; pulse frequent; respirationnormal. These febrile symptoms have con-tinued for the last four days; twelve leecheshad been applied to the hypogastric and in’guinal regions ; the patient has lost a gooddeal of blood, and is now much reduced instrength. In addition to the symptoms justmentioned a number of spots appeared (onthe 6th of May) over the legs and the lower