Remarques sur l'auscultation des femmes encientes, faites pendant les années 1835 et 1836 dans l'Institut impérial de la Maternité à St. Petersbourg; which I find analysed in the Gazette Médicale de Paris, 1838 (p. 808). M. Hoefft enclosed in a small jar hermetically sealed, a watch surrounded by cotton; he then placed the small jar in another vessel full of water which he surrounded with a cloth. By varying the position of the jar in the larger vessel, he discovered that the power of hearing the tic-tac of the watch was modified by the greater or less conductibility of the body transmitting the sound: for, when the watch was near one of the sides of the vessel, it was heard equally well, by applying the stethoscope to one or the other of the extremities of the latter; whilst, when the watch was near the centre of the fluid, it was heard much less distinctly.

If all accoucheurs have been unanimous in admitting the cause of this double sound in the pulsations of the fœtal heart, they have been far from agreeing upon the interpretation which should be given to the second, noticed by M. Kergaradec under the name of the placental sound, because he regards it as indicating the situation of the placenta. This is also Laennec's opinion, who, however, does not think it produced by the placenta itself, but by the arterial branch serving principally for the nutrition of the placenta. Laennec founds his opinion on the experiment of Dr. Ollivry of Quimper, who has four times assured himself, by introducing the hand into the womb immediately after the exit of the child, that the point where he had heard the pulsations with a blowing sound before accouchment, corresponded exactly with the attachment of the placenta; and M. Ollivry adds that, if a new proof were necessary for the support of this opinion, it would be found in this fact: that the blowing sound ceases at the very instant when the umbilical cord is cut. (Laennec, op. cit., vol. ii, p. 464).

But further researches by MM. Paul Dubois and Nægelé have shown that the opinion of Laennec and M. Kergaradec is erroneous, and that what these authors have designated under the name of placental sound, takes place in the vessels of the

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uterus, and ought to be called uterine blowing (Paul Dubois), uterine sound (Nogelé). Indeed this uterine sound is subject to frequent change of place, and to be heard sometimes in one spot and sometimes in another, or else in two places at once: the placenta, therefore, is not concerned in its production. This uterine sound is nevertheless of great importance, because, being heard long before the pulsations of the fœtal heart, and as soon as the womb is sufficiently developed to reach the level of the pubis, it may serve to make us suspect the existence of a product of conception in the uterus, if, however, it be not shown that the development of the uterus by any tumor whatsoever, may not occasion the production of a similar blowing sound.

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Be this as it may, it nevertheless follows from what has just been said, that auscultation is a valuable means of recog nising the life of the foetus in its mother's womb; the existence of the double pulsation is an incontestable proof of it. Nægelé even lays down the inverse proposition as a principle, and thinks that the non-perception of the double pulsation is a sign of the death of the foetus. But obstetrical auscultation is yet surrounded with too many difficulties, for one to be always sure, that the sound which is not perceived does not exist; it may be that it does not reach the ear on account of something that eludes observation-this is the only conclusion that can be drawn from its absence.

It was hoped that we might be able, by means of auscultation, to detect multiple pregnancy, and to suspect this kind of pregnancy every time that the double foetal pulsation was heard at two opposite points of the abdomen. It appears from the Clinical Review of the Obstetrical Institute of Paris for the year 1830-31, by Professor Lovati, that in a woman who presented this double pulsation at the fundus of the uterus on the left, and in the right iliac region at the same time, a double pregnancy was diagnosticated on this single sign, and at the delivery they were astonished to see with what precision the stethoscope had indicated not only the number of fœtuses, but also the position of each of them: for one presented the thighs

in the fourth position (left sacro-posterior); the other, the occiput in the second position (right occipito anterior). But, in the end, these double pulsations in divers points of the uterus were heard in so many women whose pregnancy was simple, that the uncertainty of this sign had to be admitted. However, M. Paul Dubois thinks that during labor, and when the rupture of the membranes has permitted the waters to escape, and consequently leaves no chance for the foetus to change its position, the presence of two children may be discovered; but then the two double pulsations must be heard simultaneously, situated in two opposite points, and conseM. Paul Dubois, quently the one stronger than the other.

who has sometimes heard them in this case, has always found them synchronous with each other, and thinks that they can be thus simultaneonsly heard only after the rupture of the two amniotic sacs, or at least of one of them.

The discovery of M. Kergaradec has been fruitful in impor tant results. We feel of what interest it is to ascertain the life of the foetus, before deciding on this or that obstetrical operation. Thus, to give an example, let us suppose a case of procidentia of the cord: when it shall have been replaced in the uterus, how are we to ascertain the success of this maneuvre? the integrity of the double pulsations of the fœtal heart will be the only certain sign, and if it be ascertained, the natural termination of the labor may be awaited, whilst the progressive feebleness of these pulsations would prove the contrary and justify the intervention of art.

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I ought, however, in conclusion, to recall the wise precept of M. Paul Dubois, who does not wish that the accoucheur should seek solely in the state of the foetal circulation reasons for acting or for waiting, because being independent of the brain, it could not often indicate to us the nearly fatal effects already produced on this organ by the protraction, the difficulties, or the accidents of labor. Furthermore, as M. Nagelé says, “auscultation is not intended to take the place of exploration by touching; it is a valuable auxiliary added to the other means of investigation, and in conjunction with them must furnish to accoucheurs the most certain rules of conduct."

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Selections from American and Foreign Journals.

Minule Anatomy of Fatty Degeneration of the Liver.The author observes, that in order to make the subsequent description intelligible, he will premise a few words on the minute structure of the lobules of the liver.

Mr. Kiernan has well described the vascular element of these minute representatives of the organ. It consists of a capillary plexus intervening between the portal and hepatic veins. The diameter of the capillaries in this plexus is very large, being nearly twice that of a blood globule; while the diameter of the capillaries in most other textures is the same as that of the blood-globule, and in some (as the muscular) even less, so that the blood-globules only pass along by undergoing elongation. This large size of the capillaries of the liver, probably, has reference to the deficiency of propelling power in the portal circulation. This portal hepatic plexus may be termed solid, as it is extended in all directions, and presents areolae of nearly the same dimensions in whatever plane it is cut. These areola are in general not larger than the diameter of the vessels which form them, so that a well-injected specimen might appear to be composed of little else than vessels.

In the interstices of this capillary plexus lies the secreting portion of the bile-ducts. If a thin section of an uninjected lobule be examined with a sufficient magnifying power, it is seen to be almost entirely made up of small, irregular, angular particles, each containing a circular or oval nucleus, within which is a minute point or two, the nucleolus. These particles have a determinate outline, are of some thickness, and possess a fine granular aspect. They also contain (which is very remarkable) one, two, or more globules of fatty matter, irregularly placed, and of somewhat variable bulk.

The microscope at once reveals the seat of the fatty depos ite in the diseased state of the organ. Instead of containing a few minute scattered globules, the nucleated particles are gorged with large masses of it, which greatly augment their bulk, and more or less obscure their nuclei.

This simple description developes the whole anatomical condition of the disease, as well as explains its rougher characters, the bulk, the color, and the freedom of the circulation. The particles, lying in the interstices of the capillary plexus, enlarge slowly and equably, in such a manner as to exert no injurious pressure on the vessels, while their new contents impart that peculiar hue which characterizes the disease. It also throws no little light on the nature and source of the disease. It seems to show that the fat is an increase of a normal constituent, and not a formation altogether unnatural in kind; thus distinguishing it from the fatty degenerations of other tissues, where fat is deposited in situations from which it is naturally absent. It likewise indicates an increased activity in the secreting action of the liver, for a considerable period before death, though why the accumulation of fat should occur within the nucleated particles does not so clearly appear. To explain that fully, will require a more complete knowledge than we yet possess of the chemical affinities at play within these small laboratories of nature.-MR. BowMAN, Lancet, Jan. 1842.

Fatty liver-(Extract from the Reports of the Boston Society for Medical Improvement, MARCH 24, 1842.) Dr. STRONG exhib ited a specimen of exceedingly fatty liver, taken from a child seven months old. For a short time it was nursed by its mother; but, owing to some irregularity in its bowels, which was supposed to be occasioned by the bad state of health of the mother, who was suffering at the time from sore mouth and other difficulties, it was transferred to another nurse. This proving of no benefit, it was weaned. The bowels, notwithstanding, continued in a bad state. The appetite, however, was voracious. It appeared well nourished, bright, and was precocious in its intelligence. A month since, the child began to be sick at the stomach. The discharges became very frequent, eighteen or twenty a day, and, for the most part, of bloody mucus. The abdomen became full and firm, and the child presented all the symptoms of cholera infantum. Treatment, of various kinds, had not the slightest influence upon the dis