manent cure, I shall feel contented in the idea, that my labour in ARTICLE VI.-On Restoring the Lower Lip. By S. CHISHOLM, M.D., Inverness. William Monro, from the parish of Urquhart, aged 60, was admitted to the Northern Infirmary in January last, having the whole of the lower lip involved in a cancerous disease. Owing to some family circumstances, he had to leave the house without having had any operation performed on him, and during his absence, applied to a medical gentleman in a neighbouring county, who excised the lip in the usual way, (V), bringing the parts together with the twisted suture. As might however be expected, from the great loss of substance, the parts, shortly after the operation, gave way. Repeated attempts to produce adhesion proved equally unsuccessful, and the man was re-admitted to the Inary about the end of March. On re-admission, the whole of the under lip, from angle to angle, and down to the chin, as represented in the plate, Fig. 1, was wanting. The saliva was constantly flowing down over the chin. I first made an incision from the lower part of the breach in the lip, obliquely down to the side of the chin, as pointed out by the line A. Then a somewhat semilunar incision, (line B), from near the angle of the mouth to the termination of the first, and separated the flap thus formed from its connection with the gum underneath. The same was done on the other side, and the two flaps brought together with the twisted suture, as represented in Fig. 2. The parts healed kindly, and the man left the institution, extremely thankful for the result of the operation, which succeeded to my utmost satisfaction. INVERNESS, 28th May 1842. ARTICLE VII.-Observations on the Development of the Blood Corpuscles in the Chick, with the various changes which they present from their first appearance to their full development; with some remarks on these changes. By WILLIAM MACLEOD, Esq., Surgeon, late Assistant to Dr John Reid in the Pathological Department of the Edinburgh Royal Infirmary. Previous to 1838, physiologists were wholly unacquainted with any general law by which the development of structure could be form, lustre, and general appearance, being only more transpa rent when in solution; and that the coagulum formed during boiling has the same microscopic characters. 7. That the ultimate globular molecules of this animal matter possess the same microscopic characters as the ultimate globules or granules of albumen, caseum, fibrine, and gelatine. 8. That when thrown down from their solution by means of certain chemical agents, deposited naturally, or forming the pellicle, these minute globules or granules often arrange themselves into rounded agglomerations, which can scarcely be recognised to differ from pus or fibrinous corpuscles. 9. That ether removes, as a thick mucilaginous-looking fluid, all animal matters, as albumen, caseum, gelatine, &c., from their watery solutions. 10. That ether has the very same action as the animal matter in the urine of the pregnant female, removing it both from the natural sediment, and from its solution in the clear urine, in the form of a thick mucilaginous-looking fluid, when, like that of albumen, caseum, and gelatine, it floats on the surface of the watery portion of the liquid, but is itself covered by the free and pure ether. 11. That ether has the very same action on the pellicle of animal matter termed kiestein. 12. That ether does NOT so remove salts from watery fluids, whether they consist of crystals held in suspension, or are in a state of solution. 13. That the minute globular molecules or granules, of which this peculiar animal matter consists, are rendered more distinctly visible to the microscope when thus removed by means of ether; and no perceptible difference can be detected between the appearance of those molecules removed from the natural sediment, and those removed from the clear urine, or from the kiestein pellicle. 14. That the ultimate globules or molecules of albumen, fibrine, caseum, and gelatine, are also rendered much more distinct in consequence of being removed from their watery solution by means of ether, and when compared, under a powerful microscope, with the ultimate globules of the peculiar matter of urine, cannot be recognised to differ in any respect, either in size, form, lustre, general appearance, or in the agglomerated forms which they assume. 15. That all saline bodies, which are truly salts, and not animal matter, mistaken for salts, assume the crystalline arrangement, recognisable at least by the microscope. 16. That the matter met with in the urine of the pregnant female, never assumes the crystalline arrangement. 17. That salts undergo complete solution in water. 18. That animal matters are only apparently dissolved in watery fluids, but that their ultimate globular molecules may at all times be rendered at once apparent, by the addition of any agent which will not alter their properties, but only render them somewhat more opaque. 19. That the animal matters of the urine, those of gelatine, albumen, caseum, &c., are possessed of these peculiar properties of animal matter, and their ultimate globular molecules may in many cases be even seen by means of first-rate instruments, without any additions being made to the fluid which holds them in solution. 20. That former experimentalists scem in many cases, (perhaps in all?) to have described this animal matter met with in the urine, as the lithate or urate of ammonia, from its possessing a few characters in common with that salt; and from the chemical agents employed for ascertaining its presence decomposing that animal substance, and giving rise to the formation of an animal acid-the uric or lithic acid; just in the same way as these chemical agents act on several other substances, converting them into animal or vegetable acids. 21. That this animal matter is probably more easily decomposed by chemical agents, in consequence of its being thrown off as a useless excrescence; its elements being perhaps thereby rendered more disposed to enter into new combinations. Lastly, That I was perfectly justified in describing this as a new animal matter, and applying to it the term of gravidine. 21 RUTLAND STREET, 15th July 1842. ARTICLE V.-Observations on Pericarditis and Endocarditis, and the best modes of Treatment in these Diseases. By EDWARD OCTAVIUS HOCKEN, M.D., &c. &c. Rheumatic inflammations of the pericardial and endocardial investments of the heart are so comparatively common and well understood, that all authors refer to these in their descriptions of pericarditis and endocarditis; whilst, on the contrary, other varieties are so uncommon, that what we really do know of these diseases, is derived from the clinical investigations of the rheumatic forms. In my following remarks I shall confine myself to the rheumatic inflammations of these tunics solely. Rheumatic inflammations of the heart are confined to particular forms of this malady, (rheumatism), and to particular varieties of this form. To explain my allusion, I may state, that I am considering rheumatism as divisible into the specific or gonorrhoeal, and the common or atmospheric varieties, whilst the VOL. FOR 1842, NO. IX. 5 0 latter is again divisible into the muscular, articular, &c. Now in the first division, or the gonorrhoeal, the heart is, as far as I am aware, always exempt from inflammatory disease, showing in this, as in many other particulars, a marked difference from common rheumatism. In the second, or atmospheric form, the heart suffers only in the articular variety, in which, as is but too well known, its external and internal investments are so frequently and dangerously involved. I wish to lay particular stress on this frequency of occurrence and danger, and on the necessity of constantly and carefully watching for and searching after the symptoms which lead us to disguise their very commencement. If we could rely on our statistical records of rheumatism, it would be found that at least one in every two cases of acute articular atmospheric rheumatism, would present some disease of the heart; frequently, however, not discovered, and very rarely terminating in immediate death. But although these cases rarely prove immediately fatal, they generally lay the foundation for future disease and future death, the two diseases pericarditis and endocarditis having an inverse ratio in these respects-the first more frequently terminating in immediate death, and less frequently in future disease, the latter less frequently killing per se, but when once fully formed, and detectable by the ear, never receiving a subsequent cure, but sooner or later originating valvular disease, of which the acute endocarditis laid the foundation. The two investments of the heart more frequently suffer together than alone; but I have remarked that endocarditis is much more common as a separate disease than pericarditis, and that where the latter affection has occurred, the former is almost sure to come on; hence, then, it is well, not so much to consider them separately, as to include them together in a general consideration of the rheumatic affections of the heart. All our experience tends to prove that these diseases are never cured unless stopped at once-that however well the patient may apparently become, if the pericardium has become adherent, and the valvular action attended with a bellows murmur, his recovery is apparent only, and not real-that the seeds of future disease are laid, which it requires time only to quicken into fatal and fearful activity, which although slow, is nevertheless sure, and finally successful. If we examine these patients when apparently recovered from all disease, the bellows murmur still remains, and will be found to continue in all its original intensity for months and years after the original attack, although the heart's action may be healthy, and no other morbid symptom exists. Our prognosis under such circumstances cannot be favourable, for who can doubt its ultimate termination, and that by and by the affected valves will become more and more implicated, and mark |