254 Epidemics. 



more quickly on the lungs than the lungs do on the heart. 

 This, in some measure, may account for the diminished 

 respiratory function in cholera, though the heart is the first 

 organ markedly depressed. 



Leaving cholera, it may be truly said that neither does 

 the work of sympathy stop at pure function, but it acts 

 oddly as a nutrient disturbing element ; for it is by no means 

 limited to rheumatism to have metastasis from the heart to 

 the lungs, as pneumonia, and back again to the heart. This 

 metastasis every now and then occurs in mere chronic con- 

 gestion of the lungs. And, without attempting to be in 

 the most remote manner personal, we have known physicians 

 of deserved reputation each scouting the diagnosis of his 

 professional brother, from one saying one month that there 

 is intense congestion of the lungs, the next month the other 

 saying that there is no disease of the lung whatever, but 

 there is enlargement and hypertrophy of the heart, and the 

 feet beginning to slightly pit, the sequence of a progressive 

 disease of the heart of one or two years' standing, But, on 

 the days both examined, both conditions were present in the 

 manner indicated, minus a proper history for two years' 

 valvular disease or narrowing of the aortic orifice. 



Such cases are very tiresome, and, what perhaps is worse 

 still, the prognosis is so very annoying, for usually a fatal 

 result is hinted at, if not directly affirmed. But, having now 

 seen seven of these strange cases, they have served quite as 

 a caution against hurried prognosis, for all ought, upon 

 scientific grounds, to have died ; but, according to an old 

 Roman maxim " divide and conquer" all the cases in which 

 this metastasis could be well proved recovered after a very 

 trying and lengthened illness, and entirely contrary to ex- 

 pectation in the first three cases. 



Having diverged from the more direct subject of examina- 



