other kind of nerve (the so-called sympathetic branches) impulses, originating by whatever means, end in a quickening of the beat. They make the heart palpitate.

The heart may be affected by physical changes: the mere stretching of its walls, the mere distention of its cavities, modifies the inner swing of the muscular molecules, and hurries on a beat which otherwise would have taken a longer time in coming. This effect of stretching may be beautifully seen in the tender, delicate hearts of mollusks, as, for instance, in that of the common snail. The heart of a frog, or of a mammal, is choked when you tie up its vessels. Not so the snail's heart. By tying its aorta you do no more than put the walls of the heart on the stretch, and the result is a marked increase in the force and rate of the beat. Although the filling of the heart's cavities with blood cannot, as we have seen, be regarded as the essential cause of the beat, we must not forget that the inrush of fluid may be a supplementary cause, and may especially contribute to bring about the stroke of the ventricle, or auricle, just when it is wanted, namely, when the cavity is full.

The heart's beat may be affected by chemical means. What we call its nutrition is just a crowd of chemical action and reactions, and any strange reagent, thrown into the laboratory, will tell in some way or other. As the blood courses through the capillaries of the heart's flesh, the material of the fibre feels the presence in the blood of strange things, such as alcohol or poisons, or the elements of maladies, just as it feels the richness or poverty of the blood in the ordinary stuff needed for nutrition, and the beat is altered to match.

All these things, all these causes and changes, act upon the heart, not directly, as a stimulus acts directly on an ordinary muscle, but indirectly, by modifying, in ways to us at present obscure enough, the natural order of its molecular changes. If I might be permitted the use of a mathematical illustration, I would venture to speak of the beat of the heart as some power, say the nth power of ordinary muscular contraction, the value of n being determined by the personal energy of the heart's nutritive processes. The effect of everything that touches the heart is multiplied by the intensity of the heart's own changes. Hence it is that it is so sensitive-so true and

quick an index of the body's state. Hence, also, it is that it never wearies. Let me remind you of the work done by our hearts in a day. A man's total outward work, his whole effect upon the world, in twenty-four hours, has been reckoned at about three hundred and fifty foot-tons. That may be taken as a good "hard day's work." During the same time, the heart has been working at the rate of one hundred and twenty foot-tons. That is to say, if all the pulses of a day and night could be concentrated and welded into one great throb, that throb would be enough to throw a ton of iron one hundred and twenty feet into the air. And yet the heart is never

weary.

Many of us are tired after but feeble labors; few of us can hold a poker out at arm's length without, after a few minutes, dropping it. But a healthy heart, and many an unsound heart, too-though sometimes you can tell in the evening, by its stroke, that it has been vexed during the day, that it has been thrown off its balance by the turmoils and worries of lifegoes on beating through the night while we are asleep, and, when we awake in the morning, we find it at work, fresh as if it had only just begun to beat. It does this because upon each stroke of work there follows a period, a brief but a real period of rest; because the next stroke which comes is but the natural sequence of that rest, and made to match it; because, in fact, each beat is, in force, in scope, in character, in every thing, the simple expression of the heart's own energy and

state.

In the heart, then, we find-what we also found in the ciliate cell and in the protoplasmic corpuscle-an organ enjoying spontaneous movement, whose spring of action is within itself, the outcome of its own internal molecular changes. Like those of cilia, the movements of the heart are directed to some special end-in its case, to carry blood throughout the body. Unlike that of cilia, this purpose is grandly complex. The heart has to adapt itself to all the shifting moods of all parts of the body of which it is a member, and hence, infinitely more than are cilia, is it subject to countless influences from within and from without. And yet the heart is a muscle, having a definite muscular structure, like that of an ordinary muscle.

In work, it stands midway between protoplasm and muscle. The waves of its contractions move along its fibres in one direction only. It has lost the all-sidedness of protoplasm. But, unlike ordinary muscle, it retains the spontaneity of protoplasm. Corresponding to this quality of work may be noticed certain characters of structure. Though the heart is composed of striated fibres, its fibres are more cell-like than those of ordinary muscle. Striations are not so well marked-indeed, are often exceedingly obscure; the flexible, elastic fibre-sheath (the so-called sarcolemma) is absent; the substance of the fibre is often granular. In fact, in many respects, the muscular tissue of the heart, compared with ordinary muscular tissue, still retains many of its primordial protoplasmic features.

The essential unity of the rhythmic beat of the heart, and the amoeboid movement of protoplasm, are well shown by the history of the new-born heart. In the chick growing within the egg the heart begins to beat very early, while as yet it is built up of nothing but protoplasmic cells.

Many authors, over-jealous, as it seems to me, for the prerogative of nerve-cells, find satisfaction in affirming that these constituent cells of the young heart, though apparently alike in structure, are various, some being potentially nerve-cells, others potentially muscle. To my mind, each and every cell is not only potentially but actually both nerve and muscle. So long as they are still cells, that is, still tiny masses of untransformed protoplasm, each enjoys all the powers of life. What befalls them afterward is not gain, but limitation and loss. Some cells lose the power to move, and so become nerve-cells; other cells lose (to a great extent, at least) the power to originate impulses, and so become muscular.

Very interesting is it to watch how the slow, irregular, drawling movements of the primordial protoplasm are gradually transformed and gathered up into the sharp, short stroke of the heart's beat. We speak, in common language, of the heart of the chick as beginning to beat on the second or third day of incubation. It is then that its beat becomes obvious to our senses as a beat. But, in reality, it never does begin to beat. There is no sharp line of demarcation between the protoplasmic crawl and the true rhythmic spasm; the one, little

by little, merges into the other. To borrow an illustration from music, it might naturally be imagined that the matter took place in this wise: We might fancy that the tiny cells were marshalled in their places round the cavity of the heart, as musicians are marshalled in an orchestra, fully equipped with powers of rhythmic pulsation, but quiet and inactive; and then, that at a wave of the wand of the great conductor, at the moment when fuller life was breathed into every cell, all struck up in unison with the heart-beat. We might fancy, I say, that this was how the first stroke was wrought. But it is not so. To gain a truer image of the process, we must think of ourselves as listening with eagerness, a long way off, to a multitude of performers assembling together, each playing on the same instrument, but playing in a different way, though all trying to learn the same tune, and all gradually drawing near to us. As we listen to them with stretched ear, coming nearer and nearer; and, as at each moment more and more performers fall in to the one proper tune, the initial discordant noise as it gathers in intensity, also gradually puts on a definite form, and at last there comes a moment when we say, "Now I hear them! now they have the tune!" So it is with the growing heart. Looking at it earnestly with the microscope, we may fancy ourselves witnesses of how the cells, as they assemble together, little by little exchange the all-sided flow of protoplasm for the limited throb of a muscular contraction, gaining in force what they lose in form. And so there will come a moment when we can say, "Now I can see it beat ;" though, in reality, it has been beating a long time before.

ARTICLE VI.-Cases reported from the Poughkeepsie Dispensary. By EDWARD W. AVERY, A.M., M.D.

Sharp pains over left
Now flowing pains

FEB. 17th. Mary, single, American. ovary during past four menstrual periods. throughout the whole of the abdomen. Ache, dull, in the forehead for weeks. Gulps up wind after eating. Leucorrhoea two years. Since commenced had less menses, Nux-vomica, 1st, and Colocynthis, 1st, alternately.

Feb. 24th. Menorrhagia during past few days. Pains shooting from left ovary to right; also constant pains over left ovary with tenderness on pressure. Chamomilla, 1st.

March 4th. Entirely relieved.

March 11th. Bridget D- Irish, married. There was since miscarriage, some sharp pains in hypogastric. Frequently commence in stomach and extend to left iliac, thence to right; starting from stomach, pains shoot to left shoulder blade. Pressing with some soreness in iliac of left side. All worse when sitting. Dyspnoea at times. Nausea and burning in stomach. During aggravation of pains canine appetite with gnawing sensation. Aconite, 1st, and Rhus-tox. 1st.

May 3d, discharged cured.

April 1st. Wm. Z-, 37 years, American. Three years ago water commenced to drop from urethra. One year ago fæces were expelled involuntarily; since then has been unable to control sphincter ani. Virile organ normal. Muscles jerk. Hesitates in speaking. Belladonna, 1st.

April 7th. No change. Pass catheter; passes to sphincter vesical without obstruction. A little pressure causes it to enter bladder with a jerk. Nearly a pint of urine escapes. After walking has sharp pains from hip to feet. Bell. again same dilution.

May 1st. No pains. Much less water escapes. Retains fæces without exertion.

ARTICLE VII.-Margaretsville Retreat for the Insane.

A very general desire on the part of many members of our profession has been frequently expressed of late years, that there might be an insane asylum established in which the adherents of our school, and their relatives and friends, could receive homoeopathic treatment. The commencement of an enterprise having all the required legal advantages, has now been inaugurated.

During the recent session of the Legislature of this State, an act was passed incorporating the Margaretsville Retreat, an institution which, if sustained as it ought to be by homœopathists, will soon be made complete in all its appointments.