failed in alleviating the symptoms. The cough not only became more frequent, but the paroxysms of longer duration; the dyspnoea, on resuming the recumbent posture, more alarming, added to which, the patient now complained, at intervals, of a sense of syncope.

The system was, at this time, under the influence of mercury. At this period of the case, (October 8th,) Dr. Wm. Stokes was called in, and this gentleman, after a most careful examination of the chest, pronounced the lungs and heart to be healthy.

He considered the disease as depending chiefly upon nervous and spasmodic irritation of the respiratory organs, and advised expectorants and sedatives. Up to this period the cough had been hard and almost unattended by expectoration, which, however, became shortly afterwards abundant, and consisted chiefly of glairy viscid mucus.

Soon after the first interview with Dr. Stokes, the breathing became stridulous, the cough laryngeal, succeeding, in paroxysms, each full inspiration. The patient was unable to remain, even for the shortest time, in the horizontal position, without a most distressing sense of choking.

There was the same, or even increased fœtor of the breath. Notwithstanding these urgent symptoms, there was but little acceleration in the pulse or alteration in the temperature of the body. The urine was copious and natural, and the bowels free. Between the thyroid and cricoid cartilages the air passed as if over a roughened surface. The sound

on percussion over the larynx was remarkably dull. The voice at intervals was somewhat hoarse. No indication of disease existed in the lungs, or morbid appearances on inspecting the pharynx. On the 11th October it was suspected that laryngitis had set in. The treatment now consisted in the external application of leeches and extract of belladonna, also calomel, tartar emetic and sedatives taken internally.

No relief followed.

On the contrary, the symp

toms augmented in violence.

Having passed a

most distressing night, he was seized on the morning of the 18th October with a severe fit of coughing, which was at length subdued by help of an anodyne mixture; soon after taking which, he fell into a disturbed sleep.

At this period I was summoned to see the patient.

I found the stridulous breathing replaced by mucous rale; a total absence of vesicular expansion in the right side, and so obscured in the left, as scarcely to be heard. He was comatose, and in about half an hour after my arrival, after a deep inspiration, he suddenly expired.

Six weeks had elapsed since the commencement of the illness.

Post-mortem Examination thirty hours after death. -Little or no rigidity of the limbs; the muscles well developed and adipose tissue very abundant.

A small inguinal hernia of the left side, which first became apparent about four years ago.

The removal of the sternum was difficult, in consequence of the ossification of the cartilages of the ribs. The right lung was a little gorged with blood and rather dark-coloured, but it was free from adhesions, and in other respects perfectly healthy. On raising it and dividing its attachments, the knife suddenly entered a cavity, of the size of a pullet's egg, from which a most offensive odour was emitted. This cavity was formed by an abscess in a mass of enlarged bronchial glands, situated at the bifurcation of the trachea. It opened into the right bronchus, ulceration having destroyed a large portion of that tube. The inferior margin of the ulcerated opening was thickened and elevated: on the other side, the abscess communicated with the left bronchus, by an aperture of about half an inch in diameter, having inverted and thickened edges. Posteriorly, the abscess had made its way into the œsophagus by ulceration. The opening into that canal was capable of admitting a large-sized bougie. The abscess contained a quantity of calcareous matter, some very hard, some of a soft consistence. The whole, when first examined, was of a dark melanotic aspect. A triangular portion of the hard calculous matter had firmly wedged itself into the aperture communicating with the right bronchus.

The mucous membrane in both tubes (above the ulceration) was marked by a deep blush, which extended nearly as high as the thyroid cartilage. A small ulcer was discovered towards the inner edge

of the descending cornua of the thyroid cartilage on the right side.

The left lung was in a state of congestion like the right, but otherwise healthy. The heart was small but normal.

The liver was large and gorged with dark blood, but no traces of inflammation in it were discoverable.

The other portions of the abdominal viscera were not examined.

A portion of the calcareous mass taken out of the right bronchus was analysed by Dr. Burton, and found to consist of phosphate of lime.*

The foregoing case offers much matter for reflection. The real seat of disease was certainly not known, nor even suspected, during life, but, nevertheless, some points had been diagnosticated, which dissection fully verified. Auscultation had pointed out the healthy condition of the heart and of the lungs.

Percussion of the chest had dispelled the apprehension, at one period entertained, of effusion into the cavity of the pleura.

Laryngitis had been very clearly distinguished, as soon as the stridulous breathing and the hoarseness were added to the spasmodic cough.

Deep-seated dysphagia certainly did exist, and ought perhaps to have attracted more attention, but

* A preparation of the diseased mass was made, which is deposited in the Museum of the Medical Department of the Army at Chatham.

the peculiar nature and extreme rarity of this case, may well plead in extenuation of the diagnostic error committed.

It is scarcely possible to conceive a case wherein the appearances on dissection more satisfactorily explain the whole course of the phenomena during life. It is evident that the moment the foetor was noticed by the patient the abscess had opened into one, or probably into both, bronchial tubes. The sense of suffocation attending the recumbent position no doubt arose from the pressure of the large tumour upon the trachea, and probably by a portion of the calcareous mass slipping occasionally into the right bronchus, the aperture of which was so much larger than that of the left bronchial tube.

The sudden extinction of life may be accounted for by the calculus found wedged in the right bronchus, added to the partial obliteration of the left.

Spasmodic closure of the glottis was probably the last in the series of phenomena.

The observations of authors on the diseases of the bronchial glands, and of the cellular tissue in which they are imbedded, are few, and not characterized by great accuracy. Dr. Baillie's " Morbid Anatomy" is silent on this portion of pathology.

Laennec (chap. 9) remarks, that "inflammation of the bronchial glands is very little known, and appears very rare." He adds, that "Cretaceous matter and tubercle are the two kinds of accidental productions observed in these glands. The