A rupture of the heart is sometimes met with; but all the cases of reputed rupture are not such in reality. An aperture in the walls of the heart, through which blood escapes into the cavity of the pericardium, may result from ulceration as well as from rupture, or from a mixed process of one and the other; but whatever be the precise nature of the process by which this perforation of the heart is effected, it is undoubtedly of rare occurrence. Where it has been found, there has generally been at the same time some peculiar condition of the organ, which might be presumed favourable to its production. Its muscular substance has been so soft and loose of texture, that it could be pierced through by the weight of a probe[15]; or it has been converted into, or greatly intermixed with fat[16]; or its muscular fibres have been absolutely defective, leaving a certain transparent space, where the internal lining and the pericardium have been in contact, and served to maintain the completeness of the cavity, until the rupture has taken place[17]. Not that a rupture has not been found where the texture of the parts has seemed to offer no natural facilities to its occurrence--as in the case related by Harvey himself, who found a lacerated aperture in the left ventricle, capable of admitting his finger, through which blood had escaped into the pericardium, the walls of the ventricle being increased in thickness and strength, while an obstacle existed at the entrance of the aorta[18]. Here the heart must have torn itself asunder by the simple violence of its contraction, in contending against the impediment to the egress of blood from its cavity. This is an effect which would hardly be thought capable of being thus produced; but I can well believe it possible after having seen one of the recti muscles of the abdomen literally torn in twain, in a man who died of tetanus[19]. [To be continued.] DILATED ŒSOPHAGUS. _To the Editor of the London Medical Gazette._ SIR, Permit me to send the following case to you for insertion in the Gazette. Mary Blores, æt. 33, was admitted into the Middlesex Hospital on the 16th of November. She was in a state of extreme feebleness and emaciation. Those who brought her said that during the preceding month she had appeared to swallow nothing: what she took as food seemed to her to stop in the gullet, and after a few minutes returned. I found, however, that a large œsophagus-bougie passed readily into the stomach, meeting with no obstruction beyond a spasmodic resistance in the pharynx. A draught of milk and water was given her--she swallowed it without much effort, but it quickly returned. In the course of the afternoon a pint of beef tea was injected through an elastic tube into the stomach--it was thrown up directly.