istaken for it the secondary hydrothorax produced
by diseases of the heart.

On pursuing the examination, we found, behind the lungs, about five or
six ounces of yellowish serum in each cavity of the pleura, and about
one ounce in the cavity of the pericardium. The heart was then seen
enlarged to more than double its natural size. Its surface, especially
along the course of the branches of the coronary arteries, was
whitened by coagulated lymph. In the cavities of the heart, which were
all enlarged and thickened, particularly the left, were found portions
of coagulum mixed with fluid blood. Near its apex, over the left
ventricle, was a small soft spot which, to the finger, seemed like the
point of an abscess ready to burst. The tricuspid valves, and the
valves of the pulmonary artery, had lost somewhat of their
transparency, and were a little thickened, though not materially. It
is worthy of remark, that these valves have not exhibited any great
appearance of disease in any of these cases, while those of the left
side of the heart have scarcely ever been found healthy. So it
appeared in this case. The mitral valves were uniformly thickened, and
partly cartilaginous; the left portion adhered to the side of the
heart. The valves of the aorta had lost their usual form, were
entirely cartilaginous, and almost equal in firmness to the aorta,
which was cartilaginous under the valves, sound in other parts, and
rather small, compared to the size of the heart.

It may be thought that the symptoms, on which reliance was placed to
distinguish disorder of the valves of the aorta, are fallacious,
because it was supposed that these valves would be found ossified,
when they were in reality only cartilaginous. The difference, however,
would be small in the effects produced on the circulation by such a
state of the valves as existed in this case, and a very considerable
ossification; for, if the valves were rigid and unyielding, it is of
little importance whether they were rendered so by bone, or cartilage.
Whether the irregularity of the pulse in these diseases generally
depends on the disorganized state of the aortal, or other valves, we
have not at present observations sufficient to decide. In the sixth
case no irregularity of the pulse could be observed, although the
other symptoms were unequivocal, and no disease was found in the
valves; while, on the other hand, we find that the valves in the
fourth case were not importantly der