L E T T E R the S I X T Y - F O U R T H ;
Relates to disorders of the Thorax.

[Note to the reader: Morgagni and his translator Alexander use the ancient classification of the vessels and viscera of the thorax; thus what they call the aspera arteria is nowadays the trachea, whose intentional perforation constitutes a tracheostomy; the magna arteria or great artery is the aorta. The terms vena arteriosa for the pulmonary artery and arteria venosa for the left atrium with the pulmonary veins are rarely used, if ever. AB]

1. In proportion as the interval of time betwixt sending you my first letter, on the disorders of the head and the present year is greater; and in proportion as there are more parts in the head than in the thorax; so many the fewer observations had I the opportunity of making upon the disorders of this last mention'd cavity: so that I can easily comprize them all in this all in this one letter; wherein I shall, in the first place, declare what appearances I have seen in the lungs, and after that in the heart, and its large vessels.

2. A woman, of a middle age, had died in the hospital of an inflammation of the lungs, about the end of January in the year 1755 ; at which time I was teaching anatomy in the college. - And that I might go on to do this the more fully; there were carried thither from her body also (for I had the same supplies from several other bodies), together with those parts with which women are furnish'd for the sake of generation, and the secretion of urine; the viscera of the thorax itself, such as they were, together with the diaphragm. In examining those parts of the belly, I found some things which only deviated from the general rule of nature: and others which were entirely preternatural.
      In the number of the first was a roundish body, of the diameter of a full inch; of a reddish colour, and surrounded with its coat; which, although it was in the adipose membrane of the left kidney, yet was certainly neither the ren succenturiatus, which was double on that side, nor another very small kidney, nor a lymphatic gland; but rather another very small spleen, as the nature of it, when cut into, demonstrated.
      For in the circumference, as I have often observ'd in the spleen, it was of a bright red colour; and, in other respects, of a red colour degenerating into brown: so that, although the structure gave somewhat more resistance, to the knife than the spleen gives every one, who saw it readily allow'd it to be a spleen.
      The same left kidney was longer than the right: nor was this to be wonder'd at; as it was furnish'd with a double pelvis, one at the upper part, and another at the lower part; being quite distinct from each other, as the ureters were also: for these canals coming out, one from each pelvis, open'd at the usual part of the bladder, by an orifice (an appearance which it had never happen'd to that very experienc'd anaromist Eustachius (a: De Reinb. c. 19) to see but which I bave happen'd to see three times ai least (b: vid. Epist. 7. n.17 & Epist. 54. n.33); by an orifice, I say, proper to each; the one being at a little distance below the other.
      But whether that which I observ'd in the uterus related to disease, or only to the time of the menstrua being at hand, was a matter of doubt. For the upper part of the fundus was internally red; but, although the sanguiferous vessels were seen through the internal membrane by pressing the fingers underneath, no blood was discharg'd nevertheless, as is frequently the case at other times.
      Yet, certainly, those appearances which I saw in the trunk of the great artery, and its iliac branches, were to be referr'd to disease. That is to say, in the former were white spots internally, the beginnings of future ossifications; and in those branches, and on their internal surface likewise, parallel lines drawn in a longitudinal direction were prominent: and these lines could not be obliteratsd by any means; not even. by drawing both sides in opposite directions.-
      The thorax also exhibited diseas'd appearances; and still more than the fore-mention'd parts: yet there were some which are rather unusual than preternatural; For the diaphragm transmitted the venous blood, that came up from the belly, not through one foramen, but through two foramina (which I also found very late in the year 1759, and publicly demonstrated, in the body of a man); I say through two foramina very near to each other; in the same manner, for. instance, that I formerly told you of by three. Yet in the heart, the orifice of the coronary vein was not furnish'd with a membranous valve; but so cover'd with slender and frequent parallel filaments, going down from the upper part to the lower; as well on the right side, as on the left; in such a manner, that the blood could nevertheless pass through betwixt filament and filament; and still more through the middle of the orifice, where the filaments were entirely wanting.
      But as to the morbid state of the blood, hereto related the white polypous concretions, which were drawn out from the large vessels of the heart; and to the morbid constitution of the solid parts, related not only those tubercles, whereby the border of the va1vulae mitrales was become thicken'd; as I have seen at other times, and that not unfrequently; but particularly that which brought on the cause of death; I mean, a great part of one lobe of the lungs being swollen hard, heavy, and dense internally, and of a firm substance; which was not only of a colour dilutely red, like that of liver after being boil'd; such as I have very frequently seen in inflammations of the lungs; but also of a colour somewhat white, from purulent matter being mix'd with it, as it was natural to conjecture: and this purulency was concreted by the frost, which was very powerful and severe in that season.
      On the back part of the aspera arteria, the cellular membrane was so distended by the fluid detain'd therein, that the glands, which I formerly delineated there (c: Adv. I. Tab. 2. Fig. 1.), scarcely or not at all appear'd.

3. I have not made this one dissection only, that related to disorders of the thorax, since the time I sent such a great number in the twenty-first letter. For you have receiv'd the descriptions of others after that in other letters (d: Epist. 36. n. 23. & Epist. 75. n. 16.); particularly the last; which you will join with those, propos'd in that letter and in the twentieth, wherein the pleura was not free from infiammation; although the patients had been free from a sense of pungent pain.
      And, although I have not omitted to conjecture, by what means it had happen'd thus, when I gave you these observations; yet as very experienc'd men now teach us that the pleura is devoid of sensation, by the original institution of nature; which certainly no one could have prov'd at that time; I shall not be displeas'd, if, when that controversy shall be at length accommodaced to their opinton, you prefer their dogma to my conjectures; and, by this means, much more easily explain, not only those, but other observations similar thereto; among which is the observation made by that celebrated man Ignatius Vari (e: apud P. Tosetti sull' Insensib. & c. Lett. 4. n. 24.), and that which the same author has referr'd to, as formerly made by Petrus Crispus.
      Certainly each of them, in whatever manner you may choose to explain them, is well worthy to be transferr'd into the Sepulchretum.
      However, in regard to what relates to pains of the chest and sides, there are others; and these of more than one kind; which deserve your consideration; and in particular that, which, from an acute pain near the left side of the sternum, join'd with the signs of a peripneumony, seem'd to relate to an inflammation of the anterior part of the left lobe of the lungs; whereas, after the death of the patient, which was then unexpected, the celebrated Lieutaud (f: Mem. de l'Acad. R. des Sc. A. 1752. I. Mem.) found, that it had, in fact, related to an inflammation and suppuration of the membrane that invests the pericardium internally, and the heart externally.
      Yet this observation, which well deserves your reading, on account of the very remarkable seat of the disorder; and which you ought to compare with others of the same kind, that I shall tell you where to find below (g: N. 14.); belong'd to the class of inflammations nevertheless.
      But there are others which belong to quite another class of diseases; as for instance, that which you will read from the relation of John Larber, formerly my auditor, but now a learned and very experienc'd physician. Forr this author; in the annotations which he has interfpers'd in his edition of Palfin (h: Anat. Chirurg. Tom. 3. P. 6, c. 9.) relates of a young man; whom he saw labouring under a cough of long standing, a spitting of blood, and a recurrent pain of the right side; that he was freed from these complaints by having cough'd up a piece of stony matter, similar to white coral.
      And, in the same place, he takes notice of the lungs of a man; who had labour'd, for a long time, under the morbus niger of Hippocrates, and had died in the last stage of a marasmus; being flaccid: and in many parta of them he found hard little bodies, of the bigness of peas, and of a globular form.
      Which things, as he has added them to that observation of his author, wherein he relates that a stone was found by him, in the lungs of a soldier; not less than a pigeon's egg, and not unlike an egg in figure; I here take notice of also, that you may add these three observations to the former; and may compare them with some of those which I have collected for you in great number in the fifteenth letter (i: N. 19 & seqq.), when I discours'd upon calculi of the lungs, and their effects.

4. But to those things that I have produc'd in the nineteenth letter (k: N. 40. & seqq.); which were not a few, and of various kinds; in regard to the long-agitated controversy, whether water be in the lungs and stomach of drown'd persons, or not, some dissections which I read not long ago relate. For that very accurate anatomist Meckel in describing the fifth (i: Sect. 1. Vid. Hist. de l'Acad. R. des Sc. de Berlin. A. 1755) of his observations upon the disorders af the heart, made upon a soldier, who had thrown himself into the river; says, that the lungs were entirely full of air and blood: that is to say, full of the latter within the vessels; which he found to be very tumid, with fluid blood, in the other viscera also, as in other drown'd persons: but if he had seen the stomach to be swollen with water, it does not seem that he would have omitted to mention the circumstance.
      Another dissection is that of an epileptic patient, who, having thrown himself into the cold bath, was soon after found suffocated therein. But in none of this man's viscera was any water found by the celebrated Weszpremus (m: Obs. Med. 8. 2.); who, when the aspera arteria was perforated, heard "the air, which was then contain'd in the lungs, rush out with a kind of whistling noise :" for which reason he thinks that it is not water, but air, which, being before "accumulated by repeated inspiration, and distending the vesiculae pulmonales," prevents the transit of the blood through the lungs; and consequently the circulation thereof through the whole body; and by this means kills those who are immers'd in water, "and perhaps strangulated persons."
      And as to what relates to strangled bodies, you may remember, what I suspected in that very same letter (n: N. 38), of the air being retain'd in their lungs, and dilating itself.
      However, in regard to drown'd persons; being mindful of those things that others, and I myfelf, bave seen by experience; I am the more in doubt, in proportion as I read the more attentively, another observation (o: Sub n. 9.) which the same celebrated man has immediately subjoin'd to the former.
      For when he endeavour'd to recal to life a certain sailor, who had been drown'd in the river Thames, and was not found, and taken out, till "after a quarter of an hour and half a quarter;" and had then no signs of life remaining in him; he did not immediately perforate the aspera arteria, but, at length, perforated it after consuming "a whole hour" in the use of other remedies: nor did he observe any sign of air bursting forth, as he says; and even, introducing a pipe through that foramen, forc'd in the air "at repeated times, so that, the vesicles of the lungs being inf1ated and other remedies being made use of, (all of which you will read were not without effect) he might push on the circulation of the stagnating blood; which he at length happily brought about.
      Nor indeed within the time of that cure, which exceeded two hours; that is to say, till "the dead sailor," as he at first seem'd to be, "was recall'd to life;" is any-thing said to have been thrown out of his mouth: so that we cannot reconcile this with our observations, and those of others; and in particular those of the very ingenious Haller, whose dissections; though not so much that which was made on a woman, who had been immers'd many hours, as on a cat, and dogs, which were immers'd for a very short time; it will be sufficient to have referr'd to here in a word, not only because you may see them taken notice of in that letter of mine (p: N. 45), but because you may see them propos'd afresh by him very lately (q: Mem. sur plusieurs phenom. de la respir. S. 4.); and, at the same time, learn, that he hitherto expressly asserts (r: Ut antea opusc. pathol. Obs. 62.); of the viscid spume, which arises from water agitated with air, in the lungs of drown'd persons, and is found therein; that it can "be forc'd out, and ejected from thence, by no art yet known to us;" and that, as long as it stagnates there, it prevents the necessary passage of the blood, from the right ventricle of the heart to the left.
      And this he the more convictedly asserts, after having tried that even the most violent shock of electricity is not sufficient for this purpose.
      Yet he himfelf also confesses, that there is the highest difficulty in conciliating his observations with the number of opposite ones, wherein art has excited the persons to life; so as to make the mind of the conciliator, not to mention others, acquiesce therein: and some observations of this kind I contrary to what you wou have expected, produces, in his Elements of the Physiology of the Human Body (s: Tom. 1. l.4. S. 5. . 11.), which he has lately publish'd, among the arguments for a matter which be there treats upon.
      But as, among the experiments which relate to that controversy; he had added some things which relate to another; that is to say, whether it be rightly argued from the lungs of a foetus swimming in water, that it was born alive, or not; I would have you attend to these things also and those that he deduces therefrom.
      For you will find fomething to add to what I have written to you, upon the cautious use of that medico-legal experiment, in the same nineteenth letter (t: n. 45. & seqq.); either when I consider'd a foetus, whose carcasse has been attack'd by putrefaction; or when I had one in my eye who has drawn in the air as it is coming out from the belly of its mother, and died in the very birth; or, finaily, whether one into whose mouth the air has been impell'd: for you will observe, that out of so many inflated lungs of foetusses, the air could not be press'd out from any, except in one lamb only, to such a degree, as to prevent the lungs from swimming any more in water.
      The remainder of this question, and any thing else that relates to the lungs, we at present omit. For now we must pass on to other things, whereof much is to be written; that is, to the disorders of the heart and its large vessels; beginning with the pulse, and with that very rare pulse, in regard to which; as I have already said, when I hinted ar its having been observ'd by me in an old man (u: Epist. 24. n. 33.), it might happen that I should sometime or other give the full history of it to you; I now send you the whole relation, as I gave you reason to expect.

5. This man was a merchant, at Padua, of sixty-four years of age, of a square stature, and of a fat habit of body; but not to excess. He, having been formerly subject to a rheumatism, and contractions of the nerves, had been cur'd by medical remedies: so that notwithstanding he was taken up with many and various businesses continually, he was, nevertheless, in good health, to that very age which I just now spoke of; when, of a sudden, some circumstances happen'd, from whence he was seiz'd with very violent affections of the mind, with terror, fear, anger, and sadness.
      A few days after these commotions, a kind of vertigo coming on, he fell down. And, on the day following, he began to be troubled with convulsive motions, together with an attack aimilar to an epilepsy.
      This attack was short, but frequent, and was solv'd by the breaking forth of foetid eructations; a redness of the face sometimes coming on, and sometimes a paleness: but it was violent, by reason of the sense of narrowness and constriction of the fauces, which attended it continually; and by reason of the same constriction of the stomach also.
      The pulse was, at that time, strong indeed, but hard and rare: and the intestines and bladder excreted only a very small quantity.
      As venesctions had been repeatedly made use of, from the very beginning, to no purpose, the disease seem'd, to the physicians, to depend upon the stomach; especially as the patient was previously sensible that the fit was coming on from the sense of a kind of smoke, as it were, rising up from the hypochondria.
      Therefore, besides the more mild remedies against an epilepsy, they took care to cleanse the stomach, from time to time, by means of gentle eccoprotics; and to cleanse the intestines every day by the help of glysters.
      But if any thing mitigated the violence of the disorder, it was the oil of almonds fresh drawn; which they made use of from time to time.
      However, although the patient was, perhaps, never better, to appearance, than on the twenty-seventh day from the beginning of the disease; the attacks, which had been absent for some days, return'd so vehemently on this very day, that, besides the other circumstances which I have mention'd, he began to be averse to any kind of food whatever from that time: he alfo began to throw up, now and then, by vomitings, whatever he had taken in, to be troubled with a singultus, and to have a kind of foetid halitus; and although there had never been any difficulty of respiration, to spit up blood and putrid matter frequently.
      To these symptoms were added sweats, at the time of the extreme parts being cold, and every now-and-then a delirium.
      And in this manner; the symptoms sometimes being more violent, and sometimes more mild he went on to the thirty-fourth day of the disease and on that day, after having discharg'd by stool, bloody, grumous, and putrid matter, of the weight of almost three ounces; all the symptoms grew milder in a surprizing manner: nor did the pulse only, laying aside its rareness and hardness, return to its natural state soon after; but his former health was perfectly restor'd.
      This state of health lasted about four months, till after a short walk, and going up of stairs, those former convulsive attacks began again to come on; notwithstanding they were less frequent and shorter; and to bring back a rareness of the pulse.
      It was then the month of December. From which time, to the very beginning of June, the disease still continuing, and not yielding to remedies; I was then sent for to consult with the other physicians and heard that relation of the case which I have now given you; and found the patient to be such a one as you may learn from the letter I have mention'd.
      That rareness of the pulse in particular, was found by me to be so great, that the number of pulsations was less, by about two third parts, than it ought to be: and I had the same account from the other physicians, in regard to what they had before observ'd in the course of the disease.
      And this rareness, which was perpetual, and had been so for many months, was perceiv'd to be even much more considerable, as often as ever the attacks were at hand; so that the physicians were never deceiv'd, if, from the increase of the rareness, they foretold a paroxysm to be coming on: during the time of which the pulse not only became frequent, when compar'd with its former state, but so frequent, that it would have been call'd so in any patient.
      When I had heard these things, and had consider'd all the other circumstances; I answer'd, that the disorder seem'd, to me, to be complicated, and therefore to be such a one as could not be distinguish'd, in every refpect, without danger of an error.
      For this reafon, I said that nothing should be attempted rashly; but that we mut make use of those harmless remedies which had been wont to bring some relief.
      However, as the disorder, which had preceded some time before, the cause, beginning, and most of the symptoms of the present disorder, show'd that the nerves were affected, or at least drawn into consent; I said, that in order to mitigate, at least, the convulsive irritations of the nerves, a small quantity of opium might be tried; and if it should happen to be of any service; as it had been of much advantage in that fellow-citizen of mine (x: Epist. 9. n. 6. 7.) who labour'd under almost similar affections; that the cautious and well-tim'd use of it must not be neglected.
      And indeed the celebrated Jacob Piacentini, with whom I had had this consultation, related to me afterwards, that it had been tried by him; and not without some utility to the patient.
      But the disorder continu'd that summer nevertheless. At the end of which; the difficulty of respiration being encreas'd, together with the cough, and the expectorated matter being ting'd with a leaden colour; the attacks were also made more frequent, longer, and more violent; and the senses, which were perfect betwixt the paroxysms, as well as the memory, seem'd to be quite gone when they were present.
      Yet I learn'd, from those who had seen him on the twentieth day before death, that his pulse was strong nevertheless, but still rare. And his death happen'd, at length, on the last day but one of September, in the same year 1747; on which day three or four attacks had preceded.
      As the patient always had it in his power to lie on his back, or upon either of his sides, so, in lying upon his left side, be died like a suffocated person; his tongue being thrust out, and the vessels of his face being tumid quite to blackness. From the first beginning of the disease to the very last period, that is, for fifteen months, no fever ever appear'd, nor any pain of the head was troublesome.
      On the day following I was present at the dissection of the body, according to desire.
      The right cavity of the thorax contain'd many pints of water resembling urine; and the left cavity contain'd a considerable quantity too, but somewhat less than the other. The lungs; which no-where adher'd to the pleura, were no-where hard, but of a cineritious colour here and there, throughout the anterior surface; when cut into, did not show the least disorder in any part except that it was observ'd, in cutting into the superior lobe, on the left side, that, in many places, a white fluid, and puriform, rather than a purulent, matter was discharg'd; I suppose from the bronchia, which were cut into.
      In opening the aspera arteria also longitudinally; together with one of larger bronchia; not the least mark of disorder could be seen on the internal surface of that artery, besides a colour degenerating from redness into brown. Within the pericardium was a small quantity of water of the same kind with that in the thorax.
      But the heart was very large, by reason of the ventricles being dilated; and not from the parietes being become thicker: yet the columnae were enlarg'd; as I particularly remark'd in the right ventricle. The auricles in like manner, and all the valves, were enlarg'd; but found nevertheless; the orifices of the coronary arteries also, were unusually dilated.
      The great artery, likewise, was wider than is natural, quite to the beginning of the curvature. On the internal surface of that artery, a little above the valves I observ'd a few protuberances as it were; and the substance of the artery was there pretty thick, hard, and more white than usual. I also saw one of those protuberances where the same artery descended in the course of the thoracic vertebrae; for quite to that part did I order it to be open'd.
      But the pulmonary artery, and the lower par of the veins of the same name, and both the venae cavae, near to the heart, were internally and externally in a natural state. I saw a great quantity of black and fluid blood, without any, even the most slight, polypous concretion, in both the venae cavae but still more in the right auricle, and in both the ventricles.
      The belly being open'd, the intestines were found to be turgid with air in some measure; the small intestines covering the omentum; which was drawn up to the stomach. The liver was fomewhat hard, and inclin'd to a blue colour. The spleen was somewhat larger than when in a natural state.
      The stomach was also large: and the internal surface of it was of a red colour degenerating into brown; being of a black colour in some places: and this, as I suppose, from blood stagnating there very lately ; for the small intestines, also, were of a reddish colour externally.
      Yet these, and the colon; when examin'd with the hand, and turn'd about to one side and to the other; had not the least mark of disease that any of us could observe. Neither was there any hardness or disorder of any kind in the pancreas, or mesentery, in like manner.
      And, finally, we must not omit this circumstance; that, when first the intestines were mov'd to one side with the hand, a quantity of water, by no means incontiderable, appear'd under them.
      As to the dissection of the cranium, neither the place, nor the time, permitted us to attempt this enquiry.

6. From this full, as I promis'd you, and even prolix history; designedly omitting those circumstances which were the evident effects of the disease, and which would require a discourse longer than the history itself; I shall return only to those things which I said to the very celebrated Piacentini, and that very skilful public Prosector Mediavia; and to others who were prefent; immediately after the dissection of the body; I mean, that we had indeed seen a dilatation of the whole heart, and of the great artery: but that this certainly had not existed before the man's mind was struck and agitated by those very violent passions; for he was then in very good health: it therefore seem'd, that the beginning of this dilatation was to be accounted for from the very disturb'd motion of the spirits through the nerves; and in particular those which go to the heart and to that artery: and from the same nerves being now and then irritated, as they go to the stomach likewise, both that sense of a smoke, as it were, rising up from thence, and those paroxysms which follow'd that sense, were to be deduc'd; and that the first, and not very considerable, slowness of the pulse was, without doubt, to be ascrib'd to a certain disorder of the spirits and nerves, which, however, was not yet encreas'd and confirm'd.
      And if all these symptoms were first appeas'd by that bloody difcharg from the intestines; the cause may perhaps be conjectur'd without difficulty, by those who account for this discharge from the haemorroids, and are not ignorant of all the roots of the vena portarum; especially those that come from the stomach, and at length, open in common, into the trunk of that vein.
      Yet we are not therefore to deny, that this dilatation of the heart and great artery; especially after it had been encreas'd; had contributed any thing to the rareness of the pulse; as both of these parts were, by this means, less apt to contract themfelves than is necessary and particularly as the nerves suffer'd distraction by reason of the dilatation.
      However, that so great a rareness of the pulse is not solely, nor chiefly, to be attributed to causes of that kind, it would be easy to conceive from hence; that in so many other persons, in whom we found aneurisms of the heart, and great artery, still much larger than those, there were not pulses of this kind: so that, unless some other cause be added, it is very certain that such a symptom is not brought on.
      And it is very difficult to conjecture, what kind of additional cause this can be, unless we suppose it to be a certain disorder of the spirits and nerves.
      Thus far then I remember to have said at that time: and I now choose to confirm these things, as far as it is in my power, by another observation which relates to the pulse.

7. A rustic, who was already near eighty years of age, being admitted into the hospital; on account of a tertian intermittent fever; staid there so long, on the score of his poverty, after being cur'd, that, in the eighth month, he was seiz'd with a diarrhoea two or three times; and a slight fever coming on, he was gradually carried off thereby.
      In this last month his urine was thick, and had a kind of milky and inodorous fediment. There was no disorder of the respiration, nor yet of the pulse except that, having been before soft, and, as you would expect, both from the disorder, and from the age, of the patient low and small, it was so much diminish'd on the three last days of his life, that it could not be perceiv'd in any degree.
      The carcase being brought into the college, where I was teaching anatomy; for the end of January, in the year 1754, was coming on; I observ'd the following things in the belly.
      Within the lower part of the intestinum rectum the haemorroidal vessels were tumid.The other intestines were sound; as the stomach, pancreas and spleen were also. In the mesentery indeed, there were some glands which were not small when consider'd with respect to the age of the man; yet they were not morbid. The liver also was found; although contracted into itself and small: and the gall-bladder was very much distended with bile.
      The kidnies, if you look'd upon the external surface of them, were not in a very good state. But the bladder was perfectly sound. In the mean while the scrotum; of which the man had never made any complaint in the hospital though he had been there far so long a time; was observ'd not to be free from disorder on either side.
      For on the right side, within the tunica vaginalis; which was not more moist, than it naturally is; we found two calculi that were unconnected on all sides; one being pretty large, the other very small: but both of them hard. And the left tunica vaginalis, being much thicken'd, contain'd no calculus indeed; but a great quantity of water, which resembled a lixivium in its colour
      That part also of the vas deferens, which was within the water, was much thicken'd likewife; as the albuginea which invested the epididymis also was: and the epididymis was here connected closely te the testicle, by a larger tract than usual. Nor was a roundish corpuscle wanting near to the upper globe ef the epididymis; being prominent from the albuginea, and of the same kind which, as I have said in other letters to you (y: XXI. n. 19. & XLIII. o. 16. & seqq.), I have generally found in this species of the hydrocele.
      In the thorax, the lungs were found to be in a sound flate: and the surface of the heart was almost universally cover'd with a great quantity of hard fat. The sinus of the pulmonary vein was af such a size, that every one wonder'd at so great a dilatation; the fleshy fibres being prominent upon its interior surface.
      In all the valves of the great artery, we saw the corpusculum Arantii chang'd into a small indeed, but unequal, and in part bony, excrescence: and on the internal surface of the same artery, in the whole of that tract, in which it descended from the extremity of the curvature, quite to the diaphragm, were bony scales in several places; though not large, and but thin: and from thence, quite down to the division into the iliacs, and in the iliacs themselves, were only the beginnings of those scales; but these were very much crowded together, and render'd the internal surface unequal.
      The head, as I made use of other bodies afterwards I did not examine.

8. Therefore; to omit other things, and even those excrescences of the valves of the great artery; you very well see, that there was no peculiar disorder in the pulse even from so great a dilatation of the sinus of the pulmonary vein; notwithstanding it appears that the left ventricle of the heart, and consequently the great artery which proceeds therefrom, could no have receiv'd a proper, and always equal, quantity of blood (as is natutaliy the case) from a sinus so enlarg'd: nor could this sinus, in like manner, admit it from the lungs; since, by reason of its dilatation, it was no more in a proper state to constringe itself, so as to throw out alternately, such a quantity of blood, as the law of nature precisely requir'd; in order to make room for the new blood, that was about to come in from the lungs.
      Yet there was no disorder in the respiration which, nevertheless, has been frequent in such cases; as I have shewn on a former occasion (z: Epist. 24. n. 36.). We may, therefore, learn from hence, that not even the usual and frequent injuries do always and necessarily succeed to dilatations of the large vessels; not to mention that most unfrequent rareness of the pulse, on occasion of which I thought proper to send you this history.

9. When I was writing to you of the inequality, and intermission, of the pulse (a: Ibid. n. 30.); and enquiring whether disorders of that kind could be accounted for from polypi, as many had done; you will remember, I think, that I paid so much regard to the doubts of that celebrated man Andrew Pasta, as to say, that until another experienc'd and learned man should arise, and very dearly, and effectually, take away from me all those doubts, I should so long be doubtful with Pasta whether polypi were form'd before death; especially any length of time; and yet that it was not very easy to remove from my breast these occaftons of doubting.
[The "polyps" Morgagni so frequently found in the heart and major vessels were most probably white thrombi, formed by post-mortem blood clotting; Pasta's hypothesis was therefore correct. AB]
      And I am so much the less displeas'd with myself, for having made these assertions, since I have lit on two writers, neither of whom I should suppose to have known any thing of that epistle of Pasta, if they did not refer thereto. But, at least, I do not think they have read it with attention.
      For both of them make some objections, which had been, already, more than sufficiently obviated by him. And one of them, moreover, thinks that all the reasonings of Pasta are sufficiently answer'd by one observation that he proposes; as if it were really very difficult to explain that observation, without supposing the polypus to have been form'd long before dearh.
      However, that polypus had, at least, been in the number of the few, which I also thought should be excepted. But it, nevertheless, does not belong to the species of the former; nor comes near to the nature of those which cannot be explain'd without difficulty.
      Yet, perhaps, that polypus, which was describ'd to me in a letter, bearing date the sixth of June, 1707, by that very eminent, and worthy friend of mine, John Anthony Stancari, who was, while living, professor at Bologna; would have been difficult to account for.
      The purport of his letter was, that, on this very day, had been shewn to him, by our friend Laurence Bonazoli, a segment af the vena cava of a woman, together with its emulgents; all which veins were much dilated: being furnish'd with coats in great measure cartilaginous, and even in some measure bony; but full of a hard and polypous substance, so that they seem'd to be entirely stopp'd up: however, in examining one of them more attentively, a kind of sinus was observ'd in that fubifance, through which the blood might, though with difficulty, be carried.
      And he said that it was asserted to him, by Bonazoli, that the iliac veins also, the venae pudendae and even the capillary veins, throughout the muscles of the abdomen, were full of the same polypous and hard substance.
      Yet as Bonazoli had open'd the belly of that woman hastily; and for no other reason, but that he might take out those parts which were neceffarily to be taken out, in order to prepare the parts of generation for the demonstration it was requisite he should make, in the manner it is generaily made; he had, besides those small capillary veins full of blood, but just observ'd a little serum effus'd betwixt the muscles, which was of a sanious nature, as it were; and in the cavity of the belly a very small quantity of water.
      But that, beginning his preparation very late, and when the carcase was already buried, he had then perceiv'd those circumstances which I have related of the cava, and of the other veins; so that he was much chagrin'd, he had neither open'd the thorax nor the head, and enquir'd into the state of the veins in those parts.
      And as nothing else could be learn'd in regard to the body after death, so no information could be got of her while living except that, in the hospital of St. Mary de Morte, where she had died, she had been taken for a dropsical woman; as she was universally tumid, and every-where of a livid colour, such as the skin is naturally of, where a great number of veins, turgid with blood, are lying beneath it: that she had breath'd with the greatest difficulty, and had always had a very low pulse; which, at the same time, gave but little resistance to the fingers of the physician who examin'd it.
      This history I have not describ'd to you with an intention to explain it by reafon of its being imperfect; but because it, in part, comes near to that of the moft excellent Haller, which I have endeavour'd to explain heretofore (b: Ibid.); and likewise, because it is one of the most rare at least, and that for more than one reason.
      But let us go on, from those things which I have written of polypi in the twenty-fourth letter, to those that I have hinted at in the latter part of the same letter (c: N. 35. & seqq.), upon the violent pulsations of all the arteries.

10. That these violent pulsations proceed not only from the abuse of wine, but particularly from the irritation of the nerves, I did not, merely conjecture then, but even promis'd that I would, at another time, confirm to you still more, by the example of a certain merchant.
      This man; who consulted me more than once, even after that time; had been begotten by a father, who was so far affected with a hypochondriac, or rather a melancholic sadness, that he sought for the end of his troubles by swallowing a large quantity of opium; and who, although he was soon after sorry for what he had done, and endeavour'd to throw it up by vomiting, yet found that his efforts were of no avail and died by the force of the poison.
      This accident struck the mind of his son, who was then a young man, with great terror and surprize. After which he addicted himfelf too much to the use of wine, and venery. And these abuses were succeeded by convulsive coughs, and a sense of stupor in his hands; which were at the same time so affected that he was not able to grasp and take up what he wish'd to lay hold of.
      After these symptoms, at length, began violent pulsations of the heart and arteries, throughout the body: so that it was not to be doubted, but these pulsations also were brought on by means of the nerves; especially as he was frequently oblig'd to bend his head and neck, and move his shoulders against his will and, at the end of some months, when the arteries pulsated with less violence, he was oblig'd to do thefe things more frequently, and in a greater degree: he likewise became subject to palpitations of the muscles which I myself saw in the calves of the legs; and to very troublesome contractions in the limbs, in the belly, and at the heart itself: and by these he was awak'd, even when he first dropp'd asleep, and could sleep no more.
      But the heart, although the arteries, as I have said, did not vibrate any more to that degree, did not only vibrate itself, but its vibrations were perceiv'd by the eye; not to mention the application of the hand; and especially in the intercostal space, at a little distance below the left nipple; where, for the extent of three or four inches, whatever was betwixt those two ribs, was rais'd up at every vibration: and if you touch'd this part with the hand, at that time of pulsation, it gave way almost like a bladder. What mischief happen'd to the man afterwards I do not know. What the disease then threaten'd, or rather what effect it had produc'd, you plainly perceive: and you are beyond a doubt sensible, from whence it had its origin.

11. Now, since we have begun to speak of aneurisms, I will not omit to add, on this occasion, what observations I have made on that subject, since that great number I sent you before. One relates to an aneurism of the heart, and the larger arterks; the other only to an aneurism of the aorta. The former of which was not suddenly fatal; but the latter almost instantaneously destructive.

12. A certain man had already lain two months in the hospital on account of many disagreeable symptoms; all of which were in the thorax. For besides a fistula, which did not reach to the cavity of the thorax, be labour'd under a palpitation of the heart; and a greater-than-natural pulsation.
      These two symptoms had begun a year before; not being constant indeed, but so frequently troublefome, that when the chest was laid bare, they appear'd to the eyes of everyone. The pulse, however, in the wrists, was not vibrating at least. But so great a quantity of puriform matter was expectorated, that, if any-one did not distinguish it from real purulency, he might suspect that this fistula penetrated into the cavity of the thorax.
      At length when the patient was dead, his body was dissected by our Mediavia; who is a very eminent physician, as well as an excellent anatomist; and the lungs were found to be in a sound state.
      But the heart was not sound: and for that reason it was, he took care it should be brought to me into the college; together with the neighbouring part of the large vessels; when I was teaching anaromy there, in the latter part of January, and in the year 1757.
      I saw, therefore, both the ventricles of the heart dilated; the thickness of the parietes, however, not being diminish'd. The trunk of the pulmonary artery was also more wide than it naturally is; but that of the aorta was very wide, quite to the beginning of the curvature: for the remaining part of it was wanting. The whole internal surface of it was white, very hard, and unequal.

13. I had examin'd the same parts of a certain beggar-man, which were brought into the college at the same time of year but two years before. What symptoms of disease this man had been previously affected with, I could not, for a certainty, learn; except that he had been affected with two slight ulcers in one of his legs, which be even then had: and that, on the days near to bis death, he had been troubled with a very frequent cough especially in che night-time, by the concussion of which I suppose the internal hemorrhage, as you will see, to have been accelerated.
      This man was brought into the hospital, in consequence of having been seiz'd with a syncope, as was said, of a sudden; wherein he was taken for a dying man; and though he soon after came to himfelf, he was nevertheless quite ignorant of all the circumstances which had then happen'd : he had, however, at that time, a turgid pulse, but one that did not resist the pressure of the physician's fingers who examin'd it.
      This physician was Jerom Trivisani; formerly my very assiduous auditor, now a learned man, and a physician of eminence: and he it was who related these things, and the following; for he had been present; with accuracy.
      When he enquir'd of the patient what was then troublesome to him, and where his uneasiness lay; he answer'd it was a pain in this place, and pointed to the lower part of one of his hypochondria.
      Trivisani had scarcely gone forwards, to see the patients that lay by him, when he was suddenly seiz'd with another attack; which certainly was not a true syncope; for although there was no pulse, yet the face was rather red: and when the spiritus salis armoniaci, as it is call'd, was put under bis nostrils, the patient agitated himself in some measure.
      Within half an hour, therefore, from the time this new attack had begun, he ceas'd to live; the intestinal excrements, from whence that pain in the lower part of the hypochondrium seems to have been, being previously discharg'd into the bed.
      When Mediavia dissected the body, he found the pericardium to be full of blood; and the great artery, in the whole of it that was in the thorax, to be dilated. He was willing, therefore, that this vessel, and the adjoining heart, should be examin'd by me.
      And the heart indeed, when look'd at internally and externally, was of a proper magnitude, and in a proper state. But the artery, from its very beginning at the heart, quire to the septum transversum, was wider than it naturally is; being the less in a state of dilatation, in proportion as it descended the more: except that, in a the middle of its descent, it grew broader for this reason; because it protuberated, on one side, into a segment of a hollow sphere, the orifice of which cavity, openingithin the aorta, was two fingers breadths in diameter.
      A lateral protuberance similar to this, but larger, occurr'd betwixt the heart and the first branch that took its origin from the curvature of the aorta; so that, if the man had liv'd any considerable time longer, it appear'd, that to the dilated trunk of the artery, two aneurisms, in the form of sacculi, would have been added besides; no small beginnings thereof being evidently existing in those protuberances. The three arteries also, which proceed from that curvature, were wider than usual; and, as well as the trunk af the whole artery, distinguifh'd here and there, on the internal surface, with the white beginnings of ossification: these ossifications were not large, however, nor thick, nor prominent internally, nor did they ulcerate the internal coat, as they frequently do, when they have attain'd to the hardness of a real bone: for this they had not done even where I found them carried on to this state of hardness; that is to say, in some few places of the trunk.
      However, at almost the interval of an inch and a half above the semilunar valves; I saw a slight transverse fissure; which would bave been equal in its length to half an inch of Bologna.
      To this fissure, on the external surface of the artery, but a little lower than that corresponded a foramen, the diameter of which had scarcely been equal to two lines of that inch: and the borders thereof were bloody and half lacerated; so that it was evident the blood had enter'd betwixt the coats, by means of this fissure; and that the external of these being, at length, broken through, it had been forc'd out into the pericardium.

14. Similar histories to these you have already had from me, particularly in the twenty-firsth letter (d: n. 13. & seqq.); by way of remark to which I have observ'd many things, and among these, some that relate to the present likewise: and these, therefore, we have no occasion to repeat here.
      But if you should desire rather to read observations of other aneurisms; you will find one not far unlike ours, in the Programma (e: De Aneur.), which Waltherus, formerly an illustrious professor, publish'd at Leipzic in the year 1738: and you may find a great number of different histories, in the treatise of that ingenious physician at Pistoia, Anthony Matani (f: De aneurism. Praecord. Morbis.), whether you would consider them as made on the heart, which he saw of a very large size and that from perpetual gluttony (g: 7), in one patient, and in another af a magnitude more than twice its natural (h: not. ad 9); or on the whole genus arteriosum as in an old man (i: 27), through the whole of whose body, innumerable aneurisms were dispers'd; or on the great artery, as in a young man (k: 50), the cavities of whose thorax and belly were occupied with an aneurism, in confequence of an inveterate lues venerea; or in a man (i: 7) whose aneurism, adhering to the esophagus, had open'd a way for the blood through that canal by which means the stomach was fill'd.
      I could wish he had been willing, or able, to compleat the histories; by the addition of those symptoms that had preceded, which were peculiar to the aneurism; or at least by those which had appear'd last of all before death; as he did in that man (m: Ibid.), in whom the abdomen, growing tumid before death, resembled an ascites; whereas the tumour was not from water, but from blood, which had flow'd down from the trunk of the same aorta; about the emulgent arteries, where it was eroded; into the cavity of the belly; and in him, in like manner (n: 63), whom the rupture of the pulmonary artery had carried off by pouring out its blood, within the contiguous bronchium, as I suppose, in prodigious quantities; and from thence into the fauces.
      But this is the very thing of which we ourselves, not to mention other anatomical physicians, are every now and then complaining; I mean, that we cannot always have a proper knowledge of the symptoms which have attended the disease, or preceded death: and this not only for other reasons sometimes, but frequently for this reason also, that the bodies which we, for the most part, dissect, being those of the lower classes of the people, it happens, much more frequently than we could wish, that by reason of very great poverty, or very great ignorance, their disorders are either not observ'd, or not understood.
      This is the very complaint of that celebrated man Meckel (o: Hist. de l'Acad. R. des Sc. de Berlin A. 1755 & A. 1756), prefix'd to the first of his two sections, into which he has divided his otherwife accurate, and not common, observations of the disorders of the heart, which he had been collecting for the space of many years.
      Nevertheless, read them attentively. For they deserve your notice if any others do; as they relate not only to the present subject, but are, in a peculiar manner, proper to be added to the Sepulchretum: nor are they all deficient in their signs; nay some have the history of the disease very accurately express'd.
      Add to this, that explications, which are certainly very pertinent, are here and there interpos'd; and useful animadversions are thrown in, in order to distinguish the nature and feat of the disorders in question; as, for instance, that we do not suffer ourselves to be carried away, at any time, by the appearances of anxieties and difficulty of breathing, and rashly accuse the lungs of such patients, as harbouring the disease; but that, well weighing all the circumstances, we impute the disease to the heart, as it becomes us to do, where we judg'd the lungs to be sound; unless it should happen (as he has admonish'd us in another piace (p: Hist. A. 1757) with equal justice) that the cause of those symptoms is in the belly; which circumstance being quite unobserv'd, is the reason, more frequently than is imagin'd, why any curative method, applied to the thorax, is hurtful, rather than salutary.
      When you read those observations therefore, whether of inflammations of the pericardium and heart, and of suppurations of this viscus; or rather of the fat wherewith it is overspread; or of cohesions of the pericardium and heart, either by means of a steatomatous matter, whereby the heart is more over compress'd; or, as more frequently is the case, by a kind of net-work, as it were, and fibres; and these tied chiefly to the apex; or of the valves belonging to the heart, being either ossified, as it is call'd, or grown tumid, so as in part, to stop up the passage of the orifices; or, on the other hand, of the laceration, and almoft total destructon of those parts; or of the enlargement of one or other of the cavities of the heart; or of the dilatatian or constriction of the arteries that go off from thence; or of interna roughness, small ulcers, and ossification in the grear artery itself; or, finally, of the dilatation, not of one or other, but of both; that is, not only of the heart, but of the aorta; when therefore you read observations of this kind, if you happen to call to mind some that I have formerly written to you, which are nearly similar to many of these in their circumstances; I know that you will be very ready to compare them together.
      And this was the reason why I pointed out these observations to you, and is the reason, at the same time, why I refer you also to a description of an aneurism of the same great artery, and of the heart moreover; which another of that famous Royal Academy, I mean that eminent man Roloff (q: Hist. A. 1757), has given.
      For you may compare it with that description, which I sent to you in the twenty-sixth letter (r: N. 9), of a man, whom the same disease of the aorta had carried off; the same bones being in part consum'd, and the blood effus'd outward in like manner; and you may learn why this other man did not, however, immediately perish, as mine did.
      But as to my hoping, that you would find something not quite unlike the observation of Verlichius; in that dissertation which I mention'd, when speaking of the case of Trombelli in the fame letter (s: N. 40); I was disappointed in this hope, when, at Iength, having procur'd that dissertation, I found the question not to be of steatomata, which had been form'd in the coats of the great artery, but of concretions adhering in the cavity of this vessel, when dilated to twice its natural size: and of concretions which have not any very close connexion with the side of the artery; so that I perceiv'd these might be consider'd as polypous concretions, which had been form'd gradually in the manner of strata, in aneurisms.
      But of the two observations of the heart being ruptur'd, that I have promis'd you (t: Epist. 27, n. 10), and that were communicated to me, by that very eminent physician, and friend of mine while living, Laurence Mariani, we may now pass over the first, whereof he had written in the year 1750; as you will read it given at large, since then, by Galeati (u: Vid. Commen. de Bonon. Sc. Inst. Tom. 4 in opusculis), the very person who made the observation, and who attended to the cure of the patient for the chief part.
      The other, however, I will immediately describe, as I receiv'd it in Mariani's letters dated the fifteenth af March, in the year 1755; and that so much the more readily, because, by this means, the number of those observations will be encreas'd, in regard to which there can be no doubt; if we consider those things that had preceded, and those appearances that were found, when blood was seen to be effus'd within the pericardium; whether this blood had been previously discharg'd by the force of disease, or after death by the carelessness of dissecters only: that is to say, dissecters who do not at all observe, that, while they open'd the pericardium, they had, at the same time, wounded the parts included therein; for persons are not wanting who suspect that it might have happen'd thus, even in most of these observations; how little colour soever they may have for their suspicion.

15. A physician of fifty-eight years of age; being very hypochondriac, if any person in the world was, and of a pale and sallow complexion; was, in the beginning of the year just now mention'd, seiz'd with a pain which rose up from the belly to the thorax; not without some convulsive motions, and an anxiety of respiration. These symptoms indeed were much mitigated by repeated blood-letting. But all the symptoms returning in the samne manner, on the following day, they carried off che patient in a very short time.
      The belly shew'd no mark of disorder, except in the liver, and the intestine ileum; the latter of which was livid in some degree for a considerabie space, and the former of a much larger size than it naturally is.
      But in the thorax we found blood effus'd within the pericardium and this had flow'd thither, through three foramina, from the left ventricle of the heart. This ventricle was so dilated, as to form a cavity of three times the magnitude it generally forms.

16. I believe that this physician, as I wrote back to Mariani would not have died of this disorder; or, at least, not so soon by a considerable time; if he bad not been so subject to the hypochondriac disorder: and not only because he would not have been oppress'd with so frequent and strong internal and hypochondriac convulsions, from whence I account for the dilatation of the left ventricle of the heart, and, finally, the perforations thereof; the blood, for instance, being very frequently confin'd within that ventricle, which, for this reason, was irritated to contract itself more strongly, and expel its contents; but because be would have endeavour'd to obviate the beginning and progress of his aneurism, if he had not, a is frequently the case, referr'd the symptoms of it to the hypochondriac disorder.
      For, without doubt, this very great detriment too frequently arises from the last-mention'd disorder, that, by reason of the greater part of the signs, which are common to this, and to organical disorders, physicians hesitate too long on the method of cure; not on in the cases of others, but particularly in their own; and readily believe the disorder to be that of the two which they would wish it to be; I mean, the more slight: in consequence of which persuasion, they neglect to do what is necessary to be done for themselves.
      However, although when I promis'd you this observation, I suppos'd that the instances of rupture in the right ventricle of the heart, were much more rare than those of the left; I do not, at present, believe them te be so much more rare as I then did, notwithstanding I still believe them te be more rare.
      For when I was accidentally looking for something else; in a certain dissertation (x: De mort. subit. non vulg. caus. thes. 8) of the celebrated Christian Vater; I lit on the diffection of a soldier, who died in aestu venereo, not much unlike that which I had produc'd from Bohn (y: Epist. 27, n. 1), except that a violent and long-continu'd dancing had also preceded; and that the rupture was found to be in the right ventricle.
      But besides this, I see that two examples, of the rupture of the same ventricle from other causes, are lately referr'd to by the illustrious Haller (z: Elem. Physiol. Corp. Hum. Tom. 1, l. 4, S 4, 13). And in the works of this author, you will meet with many testimonies of other authors: but some of their books I have not by me at present; and the observations of others, relative to the internal disorders of the thorax, which I have read formerly, I am not capable of retaining in my memory: otherwise I certainly should not have omitted them among others which I have produc'd; but I should, without doubt, have quoted some which would make more to my purpose, and would seem to be more worthy of your regard.
      I would therefore wish you to seek them there (a: Ibid. 10, 14, 16, 18 & S. 3, 17 & l. 2. S. 2, 9), and sfelect such observations, as you may join to those that have occurr'd to me, while I was writing letters to you, wherein I consider'd the dilatations of the cavities of the heart, and the vessels adjoining thereunto; and either the cause of these, and, in particular, the disorders of the valves, or the effects thereof, as the preternatural respirations, pulses, syncopes, and internal hemorrhages. If you do this, you will have many things to add to the Sepulchretum.

17. Before I make an end of speaking of sudden deaths, from aneurisms of the great artery, or of the heart, and their rupture; you will, perhaps, ask me whether I think that those deaths had happen'd among the ancients also, from the same cause.
      It certainly cannot be denied that many died suddenly even in those times as I remember to have shewn in other letters to you (b: Epist. 26 n. 1); and could now confirm, if there were occasion, even from Cicero himself, whose words, for instance, are these (c: Orat. pro A. Cluentio): " But he perish'd by a sudden death. Let us suppose it the case; yet this circumstance would not give us sufficient cause to suspect poison, by reason that may persons die the same kind of death."
      Why, therefore, may we not suppose, that, among the number of sudden deaths which then happen'd, some of this kind, whereof we are speaking, happen'd also? Is it less probable for this reason, that in thofe times they were more abstemious in their pleasures, and did not indulge their passions in many respects wherein the men of our days are by no means abstinent?
      From their histories, and books, it appears, that they had indulg'd their passions and appetites still more. And although it by no means appears therefrom, that they were infected with the lues venerea; which, after having been, at length, brought from America into other regions, is itself also one of the great number of causes of disorders of this kind, in the heart and arteries; yet, as they abus'd the other causes of these disorders, still more than the men of our days, I do not at all see, why we should not suppose them to have been subject to their bad effects in the same manner.
      And I am still more confirm'd in my opinion, when I call to mind thofe dispositions to these diseases, which you will remember that I have already acknowledg'd, with Lancisi (d: Epist. 27. n. 6), to have existed from the first formation of the animal. For who can contend that the bodies of the ancients were entirely free from these dispositions?
      You, therefore, redily perceive, that those persons are approv'd by me, who have thought that nearly the same answer should be given to others, who have made the same enquiry as yourself.

18. And now I was about to seal up this letter, when an occasion was given me, of making an observation, which would naturally belong to the letter wherein we treated of the disorders of the pulse, and of the encreas'd magnitude of the heart; as we do at present. I will therefore add it bere.

19. A man, of almost sixty years of age, had died, in the hospital, of a difficulty of breathing, on the beginning of the twenty-sixth of January, of the year 1759. He had complain'd of nothing, from the time of his coming into the hospital, but of this difficulty; nor had he gain'd the least advantage from any other remedy but venaesection: and the advantage he gain'd from this was very little and short.
      On the tenth day before his death, scarcely any pulse could be perceiv'd, and still less on all the days which follow'd: whereas the man was in his perfect senses even to the last; took his food with pleasure; and was able to move himfelf in bed: and indeed, if you except the last day, he was always capable of raising himself up, as often as ever any very considerable difficulty of breathing, which oblig'd him to fit in an erect posture, came on; and this action he even perform'd with a kind of impetus.
      His face was of a red colour inclining to that of violets. He expectorated nothing which was morbid; except that, two days before death, some blood spittings appear'd. As to what relates to the beginnings of the disease, and its causes; it was not in our power to learn any thing of this kind: for the man was a foreigner, and consequently not known here. Yet it was suspected that he had been given to drinking.
      The belly and thorax being open'd, by our Mediavia, in the hospital, he inform'd me that in the latter was some water, but in the former a great deal more; and that the stomach was very large; in the thorax, also, the right lobe of the lungs adher'd closely to the pleura.
      This lobe, together with the left, and the other parts that are within the thorax, he took care should be brought to me; according to my desire: and this he did likewise in regard to those in the belly, the large vessels, and all those that belong to the urinary organs, and the organs of generation, in general; as I was then teaching anatomy in the college.
      I therefore examin'd them accurately; nor did I see any-thing morbid in the lungs. The pericardium was dilated, and, as the fluctuation shew'd, contain'd a fluid, which was a small quantity of water; and that of a yellow colour; with which we soon after obferv'd the internal surface of the heart and arteries, when laid open, te be ting'd universally; as they also reported the serum of the blood, when taken from the living body, to have been.
      The heart was large: all its cavities except one, that is the left auricle, being enlarg'd, but the thickness of the parietes not extenuated; nay, it was even increas'd in several places, as well as the length in all the parts of the heart; and particularly in the columnae.
      The right auricle itself, being most manifestly enlarg'd both in length and breadth, shew'd the internal fasciculi to be very thick and protuberant. In this cavity was a great quantity of blood; as there was also in both the ventricles: and this was very black and half-concreted, but had nothing of a polypous appearance.
      The aggeres, or tubercles, of the valves of both arteries, were more prominent than usual but, although there was something of a bony formation near to one of the semilunar valves; there was no where any thing of that kind in any of the valves themselves. In one of the valves, however, which lie below the orifice f the vena cava, and, in like manner, in the lesser mitral valve, we observ'd a kind of cartilaginous hardness in some places.
      The pulmonary artery was found to be not dilated, and the great artery was undilated likewife. But in this last-mention'd vessel, when laid open, quite to the iliacs, and wip'd clean; although those whitenesses, which are the marks of future ossification, were not wanting in some places; there was, nevertheless, nothing really bony any where; except in one place only, which was far from the heart, and inconsiderable in its size.
      As to what remains; the urinary bladder; which I inspected together with those parts I have spoken of, before the seventieth hour after death; had already begun to degenerate from a somewhat livid colour into that of a green; but this was only externally for internally it was in a natural state, as you will also learn from a circumstance, which, as I cannot explain it here in a few words, I shall not omit (e: Vid. Epist. 66, n. 10) at a more convenient place and time

20. You perceive that when I adjoin'd this history, I was taken up with occupations of a public nature. For which reason you will not be surpriz'd, that I added nothing upon this subject. Farewel.