of stricture of the rectum. In a lady now under our care, the presence of an ovarian or uterine tumour in the pelvis, which presses upon the neck of the bladder, renders it impossible for the bladder to be emptied without the introduction of the catheter. The effects of these tumours in impeding the progress of the child through the pelvis during labour have been fully described by Dr. Park and Dr. Merriman in the third and tenth volumes of the Medico-Chirurgical Transactions.

When the ovarian cysts remain at the brim of the pelvis, in the progress of their enlargement they gradually produce all the usual consequences of interrupted circulation in the pelvic viscera and lower extremities. Attacks of inflammation occasionally take place in their capsules, by which they contract adhesions with the surrounding organs, and pus is poured out into their cavities. After a time effusions of dropsical fluid take place into the peritoneal sac, and sooner or later the patient dies exhausted from the long-continued pressure and irritation of the abdominal and other viscera.

situated in the anterior mediastinum, and adhered strongly to the sternum. It contained a sebaceous matter mixed with hairs, and a portion of a bone which appeared to be the superior maxillary bone. We are inclined to consider all these singular productions as wholly unconnected with conception in the bodies of the individuals in whom they have been found, and to view them as examples of that species of monstrosity which has been so fully described by Ollivier and Breschet, under the term Diplogénéses par pénétration.

Dr. Baillie states that the hairs are most of them loose in the fatty substance, but many of them also adhere to the inside of the capsule. Andral describes these hairs as sometimes intimately mixed up with the fatty matter, at other times as isolated from one another, or re-united into inex tricable tufts. Their two extremities are usually alike, and in all the cases which he has examined there has been no bulb. (Précis d'Anatomie Pathologique, tom. iii. p. 710.)

Meckel, however, observed their bulbs in one of the cases which he examined, where the hairs Encysted dropsy of the ovarium can generally were short and isolated, and were almost imbe distinguished from ascites by the following planted into the walls of the sac which formed the symptoms. The tumour commences on one side envelopment of the tumour. He relates also from of the abdomen, its surface is unequal, and its Tuniati, a case where the hairs had a white oval fluctuation, if felt at all, is very obscure. The extremity covered by a fine skin, which was conhealth is at first but little impaired, and the thirst, fined to the bulb, and was separated from it by scanty urine, and other symptoms which charac-an oleaginous fluid. (Memoire sur les poils et les terize general dropsy, are wanting. The catame- dents, &c. par F. Meckel dans le Journal Comnia are usually extremely irregular or altogether plementaire cahier, 15 & 65.) wanting. When both ovaria are diseased, Dr. These hairs differ greatly in length and colour; Seymour states that the menses are always ab- some are only a few lines in length, some several sent. Great difference is observed with respect inches; others have been seen which measured to the progress of the disease in different indivi- two feet three inches. Andral states that these duals; in some it would appear to become sta- hairs have not always a colour analogous to that tionary, or altogether cease to extend; while in of the hair of the individual in whom they are others it goes on much more quickly to a fatal ter- found. A negress had a cyst with cartilaginous mination. In some cases, if we are to credit the walls in the mesentery. This contained a sebahistories which have been given by authors, reco-ceous matter, in the midst of which were numevery has taken place from a fright, blows, or from sudden exertion. Dr. Mead relates a case where eighteen pints of water escaped by a rupture of the sac through the umbilicus; Dr. Blundell relates that a lady afflicted with ovarian dropsy, falling from a carriage, struck her belly against a In almost all the cases where teeth have been stone, and that a considerable discharge of urine found, they have been implanted into the fragoccurred: she recovered, married, and dying sub-ments of bony or cartilaginous matter, and have sequently of retroversion of the uterus, the cyst of her former complaint was found to have burst, and its contents effused into the abdominal cavity to have been absorbed.

rous hairs, of a colour entirely different from the woolly black locks of the African woman. They were smooth, soft to the touch, white or red, and some of a silvery hue, like those of an infant of the European race.

resembled the rudiments of maxillary bones and alveola. Meckel thinks that these accidental teeth are produced like ordinary teeth in capsules filled with a gelatinous fluid.

Cysts containing a fatty matter intermixed with The presence of these tumours in the ovaria has hair and teeth have frequently been met with sometimes given rise to serious obstacles to the either in the substance of one of the ovaria, or ad- delivery of the child in parturition, and to fatal hering to them by a narrow neck. They have inflammation after labour. The following exambeen found before the age of puberty, and conse-ple of this termination of the disease has been quently do not arise from impregnation. In Ruysch's Museum was a tumour of teeth and hair which he found in a man's stomach. A little under the right kidney of a dead gelding, Mr. Colman met with a cyst containing fatty matter, hair, and teeth and Mr. Brodie found a jaw, with full-grown teeth, in the bladder. Dr. Gordon met with a tumour in the thorax of a woman, which was considered during life to be aneurismal, but on examination after death appeared to be composed chiefly of the debris of a foetus, which was

recorded by Dr. Seymour at page 8: "A woman about thirty years of age, some weeks after delivery, having been admitted into St. George's Hospital under the late Dr. Young with symptoms of enteritis, which speedily proved fatal, the inferior portion of the small intestines was found inflamed, which inflammation appeared to have been excited by the presence of a tumour of the size of a large cricket-ball, which had become attached by a narrow neck to the left ovarium. Its proper coat was of a fibrous texture and of a purple co

lour, and inclosed a mass of sebaceous matter, | lar-shaped mass of cysts and tumours, the section penetrated throughout with long fine hair; after of which presents all the characters of hematoid removing which, a full-grown incisor tooth was fungus. This fatal affection usually runs its found attached to the fibrous coat." course with great rapidity, and soon after its com

"these masses are formed of fibrous, cartilagi. nous, or osseous tissue; in other cases they are almost entirely composed of encephaloid matter. The walls of the cysts are thick, and their cavities gradually enlarge until a tumour is formed, which fills not only the epigastrium, but the whole abdominal cavity. The outer surface of the tumour is unequal; in some points a fluctuation can be felt, while in others it has a hardness and density equal to bone." (Andral, Précis d'Anatomie Pa

Treatment of Ovarian Cysts and Tumours.-mencement the constitution of the patient is much Bloodletting, mercury, iodine, diuretics, emetics, more affected than in the organic diseases of the long-continued friction or percussion, and a va- ovaria which have already been described. riety of other remedies have all been employed in M. Andral has accurately described the changes encysted dropsy of the ovaria, and in most cases of structure produced in the ovaria by these mawithout the slightest benefit. Though the pro-lignant diseases. "Sometimes," he observes, gress of the disease cannot be arrested by these means, yet the uneasy sensations produced by it admit of considerable alleviation. Inflammation of the cyst, and irritation of the bowels from its pressure, which often arise, may both be mitigated by the occasional application of leeches to the abdomen, by fomentations, and the use of cathartics and anodynes. When the distension becomes great, recourse must be had to the trocar, and by a repetition of the operation of tapping, the life of the patient may be prolonged, and con-thologique, tom. iii. p. 708.) siderable ease and comfort may be thus obtained, under a complaint which sooner or later must terminate unfavourably. On the practice of extirpating the ovaria when diseased, it is not necessary to offer any observations, as it has been abandoned by all who have made themselves acquainted with the pathology of these organs. Several years ago, an eminent accoucheur of this metropolis made an incision through the abdominal parietes of a young woman who had a movable tumour in the belly, which he considered to be ovarian, and which he thought it possible to extirpate, as Mr. Lizars had done in similar cases with success. On laying open the abdomen, a large fibro-cartilaginous tumour presented itself, which was attached to the fundus uteri by a thick peduncle. A ligature was applied round this, and the tumour cut off; but death soon followed in consequence of gangrene taking place in that portion of the bowel which had come in contact with the cut surface. The impossibility of distinguishing ovarian from uterine tumours, where the operation is wholly unjustifiable, was strikingly illustrated by this case.

[Subsequent experience has shown the justice of these remarks. Of late, many operations have been performed by Dr. Clay, Mr. Walne, Mr. Southam, Mr. J. Atlee, and others, and some of them successfully. They are confirmative of views long ably urged by Dr. Blundell, (Researches, Physiological and Pathological, Lond. 1828,) and strengthened by additional arguments which he lately furnished to the writer, (Philadelphia Medical Examiner, Jan. 27, 1844,) that incisions into the peritoneal sac are not necessarily so serious as has been generally imagined. Still, the difficulty in knowing the exact state of the parts is a formidable objection to the operation. (See Art. Ovaires, (Pathol.) in Dict. de Med. xxii. 590; Paris, 1840; by Velpeau. Edinb. Med. and Surg. Journal, April, 1844, p. 467. Brit. and For. Med. Review, Oct. 1843, and Jan. 1844. Amer. Journal of the Med. Sciences, April, 1844, p. 456; and Medical Examiner, Aug. 24, 1844.)]

3. Malignant Diseases of the Ovaria. — Sometimes the ovarium is affected with encephaloid disease, or it is converted into a large irregu

Dr. Seymour has also described this affection of the ovaria, and has pointed out the connection which often exists between it and cancerous and fungoid diseases in other parts of the body, as the pylorus, lymphatic glands, and even bony and muscular parts. This malignant disease, he remarks, may be recognised during life by the want of nutrition and broken health of the patient; the unevenness and rapid growth of the tumour, the simultaneous enlargement of glands in other parts of the body, and the occasional occurrence of lancinating pains in the part. The latter symptom is not constant. The pulse is quick and feeble, and as the disease proceeds there is hectic fever, and often aphthæ in the mouth, with an inexpressible sense of debility. (Diseases of the Ovaria, p. 61.)

This disease occurs even at an early period of life, and it appears to be excited in some instances by pregnancy, or to be called into activity by the process of impregnation. In the body of a young woman under twenty years of age, Dr. Carswell found on dissection an ovarian tumour of a malignant nature, as large as the gravid uterus at the full period. About five years ago we exam ined with Dr. Merriman and Mr. Prout the body of a woman about thirty years of age who had died from malignant disease of the right ovarium a few days after parturition. In the fourth month of pregnancy she began to suffer from a constant sense of uneasiness in the hypogastrium, irritability of stomach; the countenance became sallow, and the constitutional powers greatly reduced. The abdomen, not long after, began rapidly to enlarge, and before the end of the seventh month it had attained the size it usually acquires at the full period of pregnancy. An enormous cyst, which contained a dark-coloured gelatinous fluid, was found on dissection adhering to the right ovarium, and within this cyst were observed a number of tumours of different sizes and shades of colour, which when opened presented the true encephaloid or hematoid fungous character.

An interesting case of a similar description, in which the tumour at first offered an impediment to labour, and the performance of the Cæsarean operation was contemplated, has recently been recorded by Mr. Hewlett of Harrow, in the seven

I. PALPITATION, CONNECTED WITH PHYSICAL 5. Obesity. This causes palpitation in a threeCAUSES. Of these causes, some are inherent in fold way: a, by the plethora with which it is usuthe heart itself, and others are exterior to it. The ally accompanied; b, by the weight and inelasticauses inherent in the heart fall under the follow-city of the thoracic and abdominal parietes, whence ing heads :

two reasons: 1st, that the mass of blood is dimi- | dyspepsia, and it may result from so slight a denished by the concomitant emaciation; 2dly, that gree of it, that the patient is not conscious of supplementary respiration is established in the being an invalid. Slight acidity or flatulence, for previous portions of lung, which not unfrequently instance, is sufficient for its production. become hypertrophous.

7. Asthmatic bronchial constriction. This causes palpitation by preventing the expansion of the lungs, and consequently impeding the circulation through them.

8. Acute laryngitis. According to our observation in a considerable number of cases, this affection causes palpitation in an eminent degree. We ascribe it to the same cause as in the preceding case, 7. In the last stage the palpitation ceases; for the engorgement of the heart becomes so excessive that the organ struggles and flutters rather than palpitates, and the patient, if not immediately relieved, speedily dies of asphyxia.

9. Abdominal infarction: namely, from enlarged liver or spleen, morbid growths, ascites, ovarian dropsy, advanced utero-gestation, &c. These occasion palpitation, principally by preventing the free descent of the diaphragm, and thus obstructing the circulation through the lungs, but partly also by compressing the aorta, and opposing the passage of the blood through it.

Amongst the causes of abdominal infarction is to be ranged tight-lacing. We were consulted by a military officer, who had brought on constant palpitation and slight hypertrophy by the habitual use of the dumb-bells while tightly girthed round the waist.

II. PALPITATION FROM CAUSES OPERATING PURELY THROUGH THE NERVOUS SYSTEM.There are few affections which excite more alarm and anxiety in the mind of the patient than this. He fancies himself doomed to become a martyr to organic disease of the heart, of the horrors of which he has an exaggerated idea; and it is the more difficult to divest him of this impression, because the nervous state which gives rise to his complaint, imparts a fanciful, gloomy, and desponding tone to his imagination. Members of the medical profession are more apt than others to give way to these feelings; partly from their apprehensions being more keen, and partly from an impression too widely prevalent, that there is difficulty in distinguishing nervous from organic palpitation, and, consequently, that the patient must remain in a state of anxious uncertainty. It may be said for the consolation of such, that the diagnosis presents no difficulty, if to general signs is added a knowledge of those afforded by ausculation and percussion.

Nervous palpitation is dependent on dyspepsia, hypochondriasis, hysteria, chlorosis, gout, mental excitement, or a naturally irritable nervous temperament; and it presents different degrees, aspects, and habitudes, according as it depends on one or other of these causes. We shall describe its most common forms, and briefly advert to the connection between them and their causes.

1. The first and slightest degree is characterized by a tumbling or rolling motion of the heart, with a momentary feeling of fulness, tightness, and oppression. It is referable to an intermission of the heart's action, producing congestion; for the removal of which the succeeding beat is inordinately violent. This form occurs principally in

Dyspeptics do not in general experience a more aggravated form of palpitation, unless they are of a nervous temperament.

2. In the next degree there is a series of quick, weak, fluttering, irregular beats, with slight anxiety, acceleration of the respiration, and a quivering sensation in the epigastrium: this may last from a few minutes to half an hour or an hour, and occur only at distant and irregular intervals, or several times a day, especially when the patient is startled. It is apt to supervene at bed-time, keeping the patient wakeful and restless during a considerable part of the night.

This form presents itself in nervous and hypochondriacal dyspepsia, in hysteria, and in indi viduals who, either from disease or mental excitement, have fallen into a state of high nervous irritability. Amongst the latter class are to be ranked literary and scientific men, and hard students in general. This form occasionally, though rarely, occurs without any other apparent origin than a very slight degree of indigestion, the patient being otherwise strong and healthy.

Individuals, especially females, with naturally small or thin hearts, a class characterized by a delicate frame and a languid, feeble circulation, are predisposed to the variety of palpitation under consideration.

3. The next degree amounts to perfect palpita tion, consisting in increased impulse, sound and frequency of the beats, sometimes accompanied with irregularity of action, and generally with more or less anxiety, dyspnoea, and even orthopnoea. The attack may be only occasional, or may occur several times a day, or may even last with little intermission for several days together. This form is rare in pure dyspepsia, but is of common occurrence in dyspepsia complicated with hypochondriasis, or engrafted on a nervous tempera ment. It manifests itself principally, however, in hysterical subjects, and those remarkable for great nervous mobility and irritability. In a lady of the latter class we have seen it exist in an exquisite degree, being excited by the slightest causes. A word, a look, an idea, a movement, the most frugal meal, the most gentle stimulant, even a glass of water, sufficed to induce a violent fit, attended with heat and flushing; and she frequently passed a great part of the night in a state of the most distressing orthopnoea. The heart and lungs were sound, and she was restored to health by bitters, tonics, cold bathing, sea air, and a nutritious but unstimulating diet.

There are many individuals without any defi. nite ailment, yet calling themselves delicate or not strong, who, after a full meal, after any unusual fatigue, or any extraordinary mental excitement, become languid, listless, restless, sometimes drowsy, with heat, acceleration of the pulse and respiration, and a more or less extensive arterial throbbing. This is generally connected with slight palpitation; so slight, indeed, that the patient is seldom conscious of it. The symptoms usually subside after a little repose, especially a tranquil sleep.

Sometimes a slight degree of palpitation subsists

without intermission for years, especially in young persons of a constitution at once plethoric and nervous, and more particularly in females about the period of puberty.

We above adverted to palpitation from anæmia, whether occasioned by loss of blood or by defective sanguification. In this the blood is always in a thin and impoverished condition, from a deficiency of fibrine and an excess of serum, and the nervous system is generally in a highly irritable state. The variety is highly important, as it comprises a great number of cases, and requires a peculiar mode of treatment.

When the palpitation results from loss of blood, the phenomenon is denominated reaction. If the hemorrhage has been restricted to a brief period, as a few hours or days, the patient soon recovers; but if it has been protracted, as is often the case from piles, chronic dysentery, menorrhagia, polypus, or cancer of the uterus, &c. the case is much more obstinate and intractable; for not only is the state of anæmia fully established, in consequence of the system being reduced to a condition which renders it incapable of reproducing good blood; but, by the impoverished state of the fluids, a train of nervous symptoms is engendered, which greatly exasperates the malady. Under these circumstances we have repeatedly seen palpitation last almost without intermission for many weeks and even months, but gradually yield to tonic medicines, diet, and regimen.

Anæmia arising simply from defective sanguification, as in chlorosis, of the male as well as the female, places the patient in circumstances very similar to those last described; and the palpitation is of the nature above noticed as the third degree. Here, also, we have seen it last, with little intermission, for several weeks and even months. In a medical gentleman, the heart bounded violently 120 to 150 times per minute for upwards of four months. Bleeding exasperated the affection, and the blood drawn was very serous, and so deficient in fibrine as scarcely to form a coagulum. This state of the blood, in connection with palpitation and arterial throbbing, constitutes, in our opinion, an important feature in the pathology of purpura hemorrhagica; for in several well characterized cases which we have seen, and in others which have been communicated to us, the conditions alluded to existed in an eminent degree,

Nervous palpitation may give rise to hypertrophy, (see HYPERTROPHY, exciting causes;) but it is surprising how long the heart will in most cases resist this affection; and when the palpitation is subdued, how soon it will recover itself after undergoing slight enlargement. According to our observation it rarely requires less than a year, and sometimes several, of very constant palpitation, to produce confirmed hypertrophy.

Every variety of nervous palpitation may be attended with arterial throbbing; and the throbbing may be either universal, or limited to a particular part, even to individual arteries, especially the aorta and carotids. Hence, nervous palpitation is, in general, more audible to the patient than organic, the sound appearing to rush through his ears, especially when he reposes on his side in bed, since each arterial throb causes a rustling movement of his pillow.

The contraction of the heart in nervous palpitation is less remarkable for force than for an abrupt, bounding, and jerking character, and on this the arterial throbbing is mainly dependent; since the vessels receive the jerk communicated to the blood by the impulse of the heart. (Treatise on Diseases of the Heart, by Dr. Hope, page 74 to 78.)

Diagnosis of Nervous Palpitation. 1. General Signs.— Nervous palpitation may be discriminated from organic by the presence of some or all of the following signs, viz. by its not being excited, but, on the contrary, relieved by corporeal exercise of such a nature as would certainly disturb the action of a diseased heart; by its disposition to supervene while the patient is at rest, especially at the commencement of the night when be lies wakeful in bed; by a fluttering in the epigastrium; by the general prevalence of nervous symptoms; by the affection being aggravated when the nervous symptoms undergo an exacerbation; by the pulse and the action of the heart being natural during the intervals between the attacks; and by the intervals being long when the general health is good. Nervous palpitation, in short, is intermittent, its causes being only occasional; whereas organic palpitation deserves the epithet of continued, its causes being constant.

To the above category of diagnostic signs, some add, as characteristic of nervous palpitation, an increase of it after meals, or when the stomach is loaded or deranged, and an amelioration produced by dyspeptic remedies; but as the stomach produces the same effects when there is disease of the heart, these signs are not pathognomonic of nervous palpitation. To this point we would particularly direct the attention of practitioners; because many, in forming their diagnosis of the affections in question, regard the dyspeptic signs as paramount in value to all others.

Though nervous palpitation is often attended with various familiar nervous affections of the head, as pain, or sensations of heat or cold confined to particular parts and coming and going suddenly, temporary vertigo, tinnitus, and confusion of the sight, not increased by lying down or stooping; it is not, when purely nervous, accompanied with genuine signs of cerebral determination or congestion: there is no universal throbbing headach, with weight and tension, increased by stooping or the recumbent position; no stunning sounds and pains in the head on suddenly lying down or rising up; no permanent somnolency, apoplectic stupor, or regular apoplectic fits, as in hypertrophy, &c.

2. Physical Signs." In nervous palpitation," says Laennec, "the first impression which the application of the stethoscope to the region of the heart produces on the ear, shows at once that this organ has not great dimensions. The sound, although clear, is not loud over a great extent; and the shock, even when it at first appears strong, has little real impulsive force, for it does not sensibly elevate the head of the observer. This last sign appears to me the most important and the most certain of all, when we add to it the frequency of the pulsations, which is always greater than in the natural state. Most commonly it is from eighty-four to ninety-six per minute." This is a