once suppressed, do not recur immediately after the suppressing cause has ceased, but not until the next normal period. There are, however, on the other hand, reasons to suspect that there is a rhythm in the organs of the nutritive functions also, which comprises a series of days. For it is remarkable, that in quartan fever the disturbance of nutrition is so much more marked, and the affection of the viscera so much more considerable, though supposing the paroxysm be viewed as excitement, the longer duration of the intermission may indicate a slighter affection of the nervous system. If six to seven days' periods in normal nutrition be admitted, the whole duration of many diseases would embrace exactly one or several such periods. The monthly rhythm of diseases is readily explained by the periodicity of the sexual functions in the female, and of nutrition in both sexes. Even the annual course of certain morbid symptoms may be referred to a yearly rhythm in the growth of the body. Henle would thus, speaking generally, refer morbid symptoms with daily rhythm to the nervous system; with monthly rhythm to the female sexual organs, or to the organs of nutrition; with annual rhythm to the organs of nutrition.

2. OF THE EVENTS OF DISEASE. death, or it passes into a new disease.

Disease ends either in recovery or in

Recovery. When a disease ends in recovery, without the interference of art, the recovery is said to take place spontaneously, or by the efforts of nature; but, properly speaking, recovery is spontaneous only when it is altogether independent of new influences of any kind, accidental as well as intentional; in other cases recovery is by art, or is accidental.

Spontaneous recovery may take place in two ways, viz.—1, in certain cases by the simple expulsion, or cessation of the cause; 2, in other cases in which the morbid process has continued, notwithstanding the removal or cessation of the cause, by the supervention of some action or event to which the morbid process itself has at last led, such as hemorrhage, the bursting of an abscess, &c. In all this there is no ground for the admission of a vis medicatrix Naturæ. Even if the process from disease to recovery were less clear than it is, an explanation which, notwithstanding its modern metamorphoses, still betrays its mythical origin, should be rejected.

The formative power with which the different structures are endowed is not roused by irritation for the protection of the body, but is rather turned from its object, and that to the injury of the body. After the irritation the conditions are re-established, under which it operates normally. Every reaction is a morbid symptom, it is the rest and restitution which succeed the irritation which are curative.

In addition to this power, which operates in the preservation of the individual during the disease, inasmuch as it operates generally for the preservation of life, sympathy and antagonism are often the means by which prejudicial influences are rendered innoxious and diseases cured. The injury, by the accidents it occasions, often brings about the cure. Irritation of the mucous membrane of the stomach excites vomiting, irritation of the glottis, coughing, and by means of these sympathetical movements matters are sometimes expelled, the continuance of which in the body would have been injurious. But that sympathy is eternal, this use merely accidental! Every poison does not occasion vomiting, nor every

noxious gas coughing. Coughing may arise from superficial inflammation of the trachea before there is anything to expectorate, and vomiting from injection of tartar emetic into the veins when evacuation of the stomach is quite useless.

Crisis. This name has been given to the sudden disappearance of the symptoms of a disease after some marked evacuation. The idea of crisis is a remnant of the mythical beginnings of medicine. According to the ancient views, crisis is the expulsion, by the curative powers of nature, of a materia peccans. The symptoms of excitement of pulse, increased heat, delirium, spasm, &c., were viewed as manifestations of the action by which the materia peccans was elaborated and its evacuation brought about, and therefore called critical exacerbation, or molimen criticum.

Testing the question of crisis empirically, Henle shows, from the statistical observations of late years, how small the number of cases is in which what could be called a crisis occurred in comparison with the number of those in which there was nothing of the kind.

Transition into another disease. The disease which passes into another undergoes a change of form or place.

In regard to change of form (Metaschematismus) many different distinctions have been made, as, for example, the conversion of acute into chronic disease, of one general disease into another, of one local disease into another, &c.; but all that has been or can be said on the subject is worthless, if regard be not at the same time bad to the cause of the disease. If a particular combination of symptoms is changed, in consequence of new causes, into another, it is evidently a figure of speech merely to call this the transition of one disease into another. It is really a new disease in the place of another. But if the second disease is developed out of the first, without new influences, as, for example, when congestion becomes inflammation, both are merely stages of one and the same process, and it is improper to separate them from each other under specific designations.

The idea of change of place of disease or metastasis had its origin, like that of crisis, in the mythical pathology. The materia peccans, supposed to be wandering about in the body in disease, was, according to that pathology, in crisis excreted by an organ not itself diseased, whilst in metastasis it was supposed to throw itself on an organ and occasion disease in it, a disease, however, sometimes curative, and then called critical. The transference of a disease from within outwards, with benefit to the patient, was thus also called crisis; and transference of a disease from without inwards, with injury to the patient, metastasis, in the limited acceptation.

Modern humoral pathology has sought, in accordance with the enlargement of chemical and physiological knowledge, to determine more accurately the nature of the supposed materia peccans, and the way in which it wanders. In regard to the first point, it has scarcely done more than institute hypotheses; and as to the second, it has agreed that the bloodvessels and absorbents convey the morbid matter, taking it up from one place and depositing it in another. When a general disease passes into a local, it supposes that the blood deposits in a particular organ the matters which occasioned the impurity of it, on which the general disease depended. When, on the contrary, a local disease passes into a general, the blood takes up the morbid matter from the particular part affected.

According to this modern view, a disease, in order to be recognized as

metastatic, must be the consequence of the cessation or non-appearance of another, and that what in the case of the one disease is repelled, and breaks out in the other, is a constituent of the blood. In the application of that idea of metastasis, a double error has been committed:-1, the causal connexion has been, often on too light grounds, presupposed, and any second disease, without farther inquiry, taken for a secondary one; 2, on the strength of the principle of explanation adopted, a number of hypothetical morbid matters, has been admitted, and the multifarious means by which the anormal action might be transferred from one organ to the other overlooked.

It is thus necessary to strike out from among the metastases the cases in which the supposed causal connexion does not exist, and in which the disease, erroneously put down as metastatic, is not owing to the first having ended. Having excluded the pseudo-metastases, Henle adduces the different modes in which true metastasis comes about, i. e. the different modes in which the arrestment of morbid processes gives occasion to the origin of morbid vital manifestations in other places; but he observes in regard to them that there is not one which perfectly corresponds to the definition of metastasis as given by the humoral pathologists. The common character is indeed transference of the morbid process, but in no case does this take place by the vessels taking up and transporting an already existing morbid deposit from one place to another. He does not indeed call in question the possibility of such a process, but says that its actual occurrence must be only under rare conditions, and suggests, as an example, certain of the so-called purulent metastases; those cases, viz. in which the sudden collapse of unopened abscesses is followed by the appearance of a sediment in the urine, purulent effusion into the serous sacs, or copious expectoration of matter from the lungs. In such a case, however, he remarks, that it could be the plasma only of the pus which is absorbed and again deposited; the corpuscles must remain where they were, and the corpuscles in the newly deposited pus must be of new formation.

Death

Death. Death should be called natural, necessary or normal only when it occurs after the completion of the typical period of life. under any other circumstances should be called unnatural, accidental, or abnormal.

Death is cessation of the nutritive interchange. The sign of it is definitive stoppage of the function; if the function of an organ is striking, its death is soon recognised; in the opposite case the death of a part may remain for some time undetected. When the hairs in typhus fever die, the circumstance is not recognised; until they begin to fall out during convalescence; death of the brain, on the contrary, is instantly recognised. All possible causes of accidental death, as well of the whole organism, as of individual organs, may be grouped under the two following heads. 1. Want of vital excitants, viz. oxygen and heat, which are supplied to the individual organs by the blood.

2. Alteration of the organic substance by physico-chemical influences, by which it becomes incapable of the typical reception of vital excitants. Death may be like disease, general or local. Death is general when the destructive influence strikes all parts at the same time, as in the case of electricity and prussic acid, which at once destroy irritability in all the tissues. Local death is the result of a locally acting influence, or a

local disease. Local death, even the inactivity of organs, occasioned by temporary conditions, by the action of which the vital excitants are supplied to the others, necessarily induces general death. Such organs are the heart, lungs and medulla oblongata. These organs stand in a peculiar reciprocal relation: each sends to the other and receives from it the conditions of its vital manifestations. The innervation of the respiratory muscles depends on the medulla oblongata, the energy of the medulla oblongata on the decarbonization of the blood, in effecting which circulation and respiration must combine. Thus the loss of any one of the three links of the chain is fatal.

The outline which has now been given of Professor Henle's work will, we believe, afford the reader an idea of its spirit and scope, and justify the opinion as to its general excellence, expressed at the commencement of this article. We have thought it unnecessary to enter into any criticism of details.

ART. II.

Medico-Chirurgical Transactions. Vol. XXIX.-London, 1846. pp. 352. Eleven Plates.

8vo,

I. On the minute anatomy and pathology of Bright's disease of the kidney, and on the relation of the renal disease to those diseases of the liver, heart, and arteries, with which it is commonly associated; by George Johnson, M.D.

THE secreting cells of the kidney, in a healthy state, contain a variable quantity of oil-globules, always considerably less than those of the liver. In kidneys affected with Bright's disease, the quantity of oil-globules is very greatly increased. The true definition, therefore, of the affection is, in Dr. Johnson's opinion, "an exaggeration of the fatty matter which exists naturally in small quantities in the epithelial cells of the healthy organ;" the disease being precisely analogous to the fatty degeneration of the liver. The accumulation does not take place simultaneously and equally in every part of the tubes. Those portions which form the pyramids do not become gorged in any great degree, except in cases where the disease has been of long duration, and in which the cortical portion of the kidney has become wasted. Neither is it common in the expanded portion of the tube which, as Mr. Bowman has shown, forms the investment of the Malpighian plexus.

The cells and tubes, thus engorged, comprise the surrounding capillary plexus, and give rise to congestion of the Malpighian plexus. This congestion leads to transudation of the serum of the blood, and sometimes to rupture of the delicate vessels, and the consequent escape of the colouring matter and fibrin of the blood. These constituents of the blood pass into the tubes, and so become mixed with the urine. Their escape from the blood-vessels is the result therefore of a mechanical impediment to the return of the blood through the veins, precisely as in the experiments performed by Dr. George Robinson, formerly noticed in this Journal. (Brit. and For. Med. Rev. XVIII, 366.) The atrophy of the kidney is also a result of the same compression, which materially interferes with the nutrition of the organ.

XLVIII-XXIV.

.3

In

It has been frequently observed by pathologists that some affection of the liver coincides with the presence of Bright's disease: this affection Dr. Johnson believes to be most commonly fatty degeneration. twenty-two cases examined by him, this state of the liver was most marked in 17; and in four of the remaining there was a decided increase of fat in the hepatic cells. He has also observed that in most cases the arteries have been found more or less affected with atheroma and steatoma, deposits which Mr. Gulliver has shown to be of a fatty nature.

All these facts point in the same direction, and would lead us to look for the source of the disease in some disorder of the processes of digestion and assimilation.

"The processes of primary or secondary assimilation, or both, fail with regard to this fatty matter, which, not undergoing the changes requisite for its ready elimination from the system, or for its application to the nutrition of the tissues, is thrown into the circulation. An effort is made to carry it off by the liver and kidneys; the fat finds its way into the secreting cells of these glands; its escape from these parts in a free state is a slow and uncertain process, and, finding no material in sufficient quantity with which to pass off in a state of combination, the fat accumulates in, and obstructs, the glands."

Such is a sketch of our author's views on this very important subject; they are sufficiently ingenious, but we refrain from giving our assent, until more extended observation shall enable us to decide with more assurance of having found the truth.

II. Report of a case of ligature of the left subclavian artery, between the scaleni muscles, attended with some peculiar circumstances; by J. C. Warren, M.D., Professor of Anatomy and Surgery, in Boston, U. S. A.

This is a very remarkable case. The patient, while in a state of intoxication, fell and struck his left shoulder against the kerbstone, on the evening of December 23, 1843. His shoulder was dislocated, and violent efforts were made for its reduction; but as these were supposed to fail, he was sent to the hospital. The parts were so much swollen and bruised, that the condition of the joint could not be ascertained for two days. It was then found that no dislocation existed. On the night of the 20th, he had a violent fit of coughing, and felt something give way in his shoulder. On the 30th, it was discovered that there was no pulse in the left arm, and that sensation and motion were destroyed. There were also some appearances of mortification. On the 27th January, a swelling formed in the axilla, and advanced gradually, till the 4th February, when it burst, and a gush of coagulum, with some fluid dark-coloured blood was discharged. Three days afterwards, there was a sudden and most profuse hemorrhage, which almost proved fatal. He rallied a little during the night, and next morning the subclavian was tied, but with great difficulty. During the operation the pleura was wounded, and a small quantity of air entered the chest. The condition of the patient now gradually improved, and the arm began to assume a more healthy appearance. The ligature separated on the thirteenth day: and seven days afterwards there was some secondary hemorrhage, but it was easily controlled. After this he had two attacks of congestive pneumonia, from which he recovered. Distinct pulsation was not felt in the radial artery until the 4th of February, 1845, 361 days after the operation. On June 15th, his general health