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outside is enlarged. During the deep inspiration, provided the swelling of the veins be not extreme, the venous pulsation is increased: if the veins become completely distended, pulsation cannot, does not take place; the constant full distension does not admit of variation. The venous pulsation is readily distinguished in the recumbent posture during ordinary inspiration. Each inspiration lessens the quantity of blood in the veins, each expiration increases it; so that here, in the act of respiration, we have a cause for another venous pulsation more. The mere jugular pulsation is any thing but an indication of disease, either in the pulmonary valves or elsewhere. In those diseases where the flow of the blood through the lungs and heart is impeded, the jugular veins contain more blood, and their pulsations are more visible than in health; but where the impediment is extreme the veins are in a state of constant distension, and no pulsation is visible. If, on the other hand, the circulation be feeble, and there is no resistance to the emptying of the venous blood into the heart, then the veins contain very little blood, and the venous pulsation is very slight, scarcely to be perceived."

Respiratory Movements in Children.-" In children, when compared with adults, the costal cartilages and sternum are very flexible. The inferior margins of the lungs are lower, being usually behind the sixth costal cartilage or sixth intercostal space; the liver is much larger, and the stomach and bowels are more distended in comparison with the size of the lungs; consequently the abdomen is more protruding, the seventh, eighth, ninth, and tenth ribs and their cartilages project more to the side, and the epigastrium and xyphoid cartilage are more prominent. The abdomen is greatly more developed than the chest; consequently, the precise lower margin of the lung and upper bound of the liver and stomach, where they lay behind the ribs and epigastrium, are very apparent, the latter bulging forwards suddenly, while the former generally falls in a little from the prominence over the superior costal cartilages. On a deep inspiration the descent of the diaphragin pushes down the liver and stomach, and draws the lungs down to the place previously occupied by these organs. The lungs descend to the seventh rib or sixth intercostal space, and the chest becomes narrower, after which the comparatively small lungs replace the more bulky liver and stomach. The xyphoid cartilage and the seventh and eighth ribs fall in, being pressed back by the weight of the atmosphere, and the edges of the opposed sixth and seventh costal cartilages approach each other."

The paintings of the great masters faithfully portray the great proportional abdominal development of children, and the distinctness of the boundaries between the thoracic and abdominal organs. The sternum is prominent at its upper portion in the region of the thymus, but falls in rather suddenly below. The costal cartilages, especially the third, fourth, fifth and sixth, are more prominent than the sternum, the bulging forward of the heart and lung coinciding with these prominences, which are most considerable on the left side. The liver and stomach push forward the lower costal cartilages and distend the abdomen between the eleventh rib and crest of the ileum. As the child grows older the disproportion between the abdominal and thoracic viscera becomes less, and the depression indicating their boundaries is less marked. At eleven or twelve the upper part of the chest and middle of the abdomen are about equally prominent. The measurement over the lower margin of the lung is in children greater in comparison with that around the chest under the axilla; and the measurement of the abdomen near the lower edge of the costal cartilages is still greater than that over the lower margins of the lung. These relative admeasurements alter as the child grows up, and at about the age of six the measurements over the axilla, over the lower margin of the lungs, and

over the lowest rib are nearly equal. There is little difference between the two sides. About the age of eleven or twelve, the difference of sex and habits of life begins to tell.

Emphysema.-The author concludes an elaborate exposure of the changes produced in the form of the chest by this disease, and of the physical signs by which it is recognized, with this passage.

"Emphysema is scarcely, I conceive, a distinct disease, but is one of the morbid conditions resulting from other diseases, or from repeated excessive inspirations excited by continuous labour. It is, I conceive, the result of repeated, irresistible, forcible, and vain attempts on the part of the patient to make up by deep inspirations for the deficiency in the arterialization of his blood; and of the difficulty in expelling the air from the already dilated cells through the narrow outlets. All the cases of emphysema that I have examined with care, have sprung from bronchitis, exposure to cold, damp, or disease of the heart. In all those cases that originated in bronchitis, the skin was soft, loose textured, perspirable, and susceptible of the influence of cold."

Bronchitis." The diseased vascular action, and the diseased mucus coating the vascular surface interfere with the arterialization of the blood. The patient is necessitated to inspire deeply and frequently, and, in time, the whole volume of the lungs becomes permanently enlarged. The whole outline of the chest, the diaphragm, and the relative seat of all the organs, present the characters of a constant deep inspiration, though not nearly to the same extent as in emphysema. Everything that has been said with regard to the position and form of parts in emphysema applies, though in a modified degree, to bronchitis. The former disease, emphysema, is only a necessary carrying out-an unavoidable development-of the latter disease, bronchitis. In bronchitis, the base of the lungs and the heart are much lowered; the impulse of the heart is generally in the epigastrium. The liver and abdominal organs are thrust down in like manner, though not to a like extent, as in emphysema. The extent to which the bronchitis has caused the lungs to dilate may, in the earlier stages, be invariably, and in the latter, generally, ascertained by comparing the seat of the depression, marking the site of the lower margin of the lung in the healthy state, with the present diseased site of that margin. A variable measure of the extent and severity of the disease is thus supplied us."

After describing the microscopic changes observed in the structure of the lung suffering from Pneumonia, Mr. Sibson states, that the capillary branches of the pulmonary artery and vein are the primary seat of the disease.

"The coats of the artery are changed in structure and texture by a diseased modification in their cell life; they are at first too soft and yielding. The heart's force, through the medium of the blood, thrusts aside and dilates the softened walls, stretches, and lengthens them. At a later period, new material is formed within the vessels, which blocks up the affected capillaries. Parallel with this change is another going on in the capillaries of the same lung, but not in the same diseased part. The inner walls of the diseased capillaries thicken and approach each other, gradually lessening the calibre of the tubes, and at length meet, so as to close the capillaries; ultimately, all the capillaries become obstructed, and, at an advanced stage, destroyed. The air-cells are essentially and in form, subdivisions of the capillaries of the pulmonary artery and re-meetings in those of the pulmonary vein, each filamentous wall consists of a single vessel, and each related webbed wall consists of the interlaced capillary branches of that vessel. The bronchial tubes and the walls of the arteries themselves, are thickened and rendered fibrous by the new diseased vascularity."

We will conclude our extracts with the author's statement of the relative dimensions of the auricles, ventricles, and great vessels.

"During the years 1835 and 1836 I measured the valvular communications and great vessels of the heart. By inserting a graduated cone into the vessels or outlets, I ascertained their respective diameters. After a time I injected the cavities of the heart with plaster of Paris: when the plaster had hardened I cut out the casts of the cavities thus formed: I dipped each of the casts into water, noticing how much water the cast of each auricle, and of each ventricle displaced: I also measured the dimensions of the various vessels and communications. I did not arrive at a perfectly accurate estimate of the relative proportion of the cavities, and their outlets and inlets, by these means; but, as an approximation, I venture to submit the subjoined statements.

"In a girl, 14 years old, both cavities of the heart were enlarged: the injection distended the left cavities as completely as the right. The casts of the right and left ventricles each contained the same quantity of fluid, viz. 3 oz. and 6 drachms. That of the left auricle displaced 2 oz. and 6 drachms. If this example be a fair criterion, and I think it is, it may be stated that each ventricle contains, when distended, the same amount of fluid. If the ventricles empty themselves completely during their contraction, they must each hold the same quantity of blood. In the average of contractions, the same quantity of blood that is sent from the left ventricle must have been sent to it by the right ventricle, during an equal number of pulsations. During an inspiration the right ventricle receives and sends forth more blood than the left. During an expiration the left ventricle discharges more blood into the system than the right does into the lungs. But the two ventricles balance each other exactly, in the course of 6 or 7 beats, of 2 or 3 inspirations.

"The right auricle and right ventricle contain about an equal quantity of blood. The left auricle holds about three-fourths less blood than the left ventricle. "In the heart just referred to

The pulmonary artery was

Each pulmonary vein was about
The aorta was

The superior cava was

of an inch in diameter.

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The inferior cava was

"The communication between the right cavities had a long diameter of 1 inch and; but as this opening is irregularly oval, its area is not expressed by its diameter. Perhaps its area was of the area of a circle of the same diameter. The same remark applies to the left auriculo-ventricular opening, whose long diameter was about 1 inch and . The area of this opening was, perhaps of the area of a circle of like diameter.

"About 16 inches of the aorta would hold the contents of the right or left ventricle;

About 12 inches of the pulmonary artery,

About 9 or 10 inches of the combined pulmonary veins,

About 7 or 7 inches of the combined venæ cavæ

About 8 or 84 inches of a tube, the calibre of the right auriculo-ventricular communication, and

About 8 or 9 inches of a tube the calibre of the left auriculo-ventricular communication, would hold the contents of either ventricle."

We repeat this book does great credit to the industry of its author; and will prove an useful companion during the perusal of any of our modern treatises on Diseases of the Chest.

RELATION Medicale de CAMPAGNES ET VOYAGES DE 1815 A 1840, &c. Par M. le Baron Larrey. 8vo. pp. 412. Paris. Bailliere.

No work from the pen of Larrey-the surgeon of a hundred fights-can be devoid of more than usual interest. His vast experience and the practical turn of his ever-active intelligent mind give a force to all his precepts and remarks beyond what we are willing to concede to the majority of writers in these days. Not but that he is too apt to exaggerate the importance of his own views, and depreciate and talk slightingly of whatsoever differs from them; but, despite this very palpable blemish, his writings deserve to be generally known, inculcating, as they do, much that is sound in theory and valuable in practice.

The present volume gives us a rapid review of the closing scenes of his long and memorable career. It has been published upwards of two years; but has hitherto escaped our notice, until very recently. The delay however is not of much consequence; and we therefore gladly take this opportunity of making our readers acquainted with its contents, and of enlivening the tædium of purely professional discourse with the amusing anecdotes of an old campaigner's note-book.

In the four volumes of the "Memoires de Chirurgie Militaire et Campagnes," Larrey has given a most graphic and instructive description of the leading wants of his chequered life, by flood and field, from the year (1787) when he started as assistant-surgeon in the French navy, down to the first capitulation of Paris in 1814. It is therefore with the view of completing his professional biography that he has brought out the volume which we now propose to consider. The following summary of its contents is given, as nearly as possible, in the author's own words, that the narrative may lose nothing of the amusing gossip of the original.

On my return from the grand army at Fontainebleau, a few days before the departure of Napoleon for Elba, I resumed my very responsible duties as Inspector General of the medical department, and Surgeon of the Imperial Guard. I had proposed to His Majesty to accompany him to the place of his exile; but he graciously refused my offer, saying, "You belong to the army, and you must follow it; it is not without regret that I part from you, M. Larrey."

My health at this period had suffered much from the cruel vicissitudes which we had met with in the terrible campaigns of Russia, Saxony and France, as well as from the chagrin I felt at the banishment of the Emperor. For a length of time I was the prey of a gloomy melancholy, which might perhaps have ended fatally, but for the hope I still cherished of seeing once more my illustrious protector. I had indeed formed the project of visiting him in his island, when the unexpected news of his debarkation in France arrived at Paris. He reached Paris on the 20th March; and one of his first acts, on taking possession of the Tuileries, was to summon me to his presence. Alluding to his having left me without fortune, he animated my heart with these words; Continue your labours, M. Larrey, and I yet hope to be able to recompense the sacrifices which you have made and the services which you have rendered to our wounded.”


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While all was bustle and activity in the metropolis in effecting the reorganization of the army, steps were taken for holding the fete of the Champ-de-Mai-a very unnecessary and uncalled-for ceremony under the then existing circumstances. But this, like many other inconsiderate acts of that period, was suggested to the Emperor by the secret triumvirate which had already conspired for his final overthrow. It was about this time that he addressed the Deputies of the department of the HautesPyrenées in the following language, when he presented the new tricolour flags to the different regiments: Gentlemen, I am pleased to have the opportunity of sending you this flag by your compatriot Larrey, who adorns humanity by his bravery and disinterestedness: he has saved a great many of our soldiers in the deserts of Lybia, by sharing with them his little stock of water and spirit, which he needed so much for himself." As my colleague, Baron Percy, had contrived to supersede me at headquarters as first surgeon of the grand army, I had made up my mind to retire from active duty and devote my time to arranging the materials for the fourth volume of my surgical narrative, when Count Drouot waited upon me to invite me, in the name of the Emperor, to accompany him in his campaign, and direct the ambulances of the guard. I could not resist the appeal, and at once to depart, We left Paris on the 9th of June; but at least in Pown case-not with those feelings of confidence that used to anate me in all our former expeditions. My mind was haunted with the preservent that this campaign would prove disastrous to France. The night of one of our grenadiers, on the evening of our first day's march, stretched out in a corn-field by the wayside with his head shattered to pieces, added to the gloom of my ideas, and it was not without the worst forebodings that I continued my route towards the frontier.

On the 16th we fought the battle of Fleurus (Ligny)-the scene of Marshal Jourdan's famous victory in the days of the Republic. The result was not decisive; either from our not profiting, to the full extent, from the advantage gained, or from the Emperor being diverted from following up his success with his usual promptitude and decision by persons around him who were interested in his overthrow. While our army rested for twenty-four hours after this conflict, the enemy was enabled to rally their forces and resume an advantageous position. On the morning of the 18th, they were discovered along the line of Waterloo. The battle on this field had not long been joined, before the Prussian and English columns gave signs of confusion and retreat; but, at this time, torrents of rain came down and materially impeded the operations of our artillery, the ground becoming so soft and miry that our gun-carriages could not be moved. The agents of the traitors that existed in cur own army, as well as of the enemy's officers, taking advantage of this contre-temps, spread themselves among the ranks, calling out to the artillerymen, "Save yourselves who can; cut the traces of the horses and be off, for you are surrounded on every side by the columns of the enemy." An eye-witness of these treacheries, I longed to acquaint the Emperor of them; but the wounded on every hand were calling out for my assistance, and, in addition to this imperative duty, I had to look after my ambulances. The enemy's cavalry. now made repeated and most destructive charges upon our lines, and their daring was not a little increased by their knowing full well that ours

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