and consists in ulceration of Peyer's glands; there is also sometimes a granular lymphy secretion." (Op. cit. p. 146.) 3d. With abscess in the liver, which is most common in the form of the disease leading to circular follicular ulcers. (p. 143.) On this subject Dr. Morehead remarks:

Complication with abscess in the liver constitutes a great proportion of the fatal cases of chronic dysentery. In one set of cases, those ranged by me underthe head of dysentery, the affection of the bowels was the primary and prominent disease; that of the liver coming on more or less obscurely as a secondary event. In the other set, the symptoms of hepatitis were the primary and most prominent, those of ulceration of the bowels succeeding, and being not very clearly indicated." (Op. cit. p. 149.)*

Of 30 fatal cases of dysentery, recorded in the same number of the Transactions by Dr. Morehead, we find twelve to have been attended by hepatic abscess. In contrast with this statement, we may put the following remark of Dr. Baly:

"Among the many hundreds of cases of dysentery which have occurred in the Milbank Prison, during the last seven years, not one has been complicated with hepatic abscess. The medical records of the establishment too, which reach back to the year 1824, affords no grounds for even a suspicion that such cases ever occurred among the prisoners." (p. 16.)

Dr. Baly explains this discrepancy of statement by supposing that "the malaria causing the dysentery, has at sometimes, and in some places, the property of predisposing to abscess of the liver, and at other times, and in other places has not this property." (Op. cit. p. 17.) He also attributes considerable influence to the effect of simple and spare diet in counteracting the tendencies towards hepatic disease. Into a full consideration of this important question, it is impossible now to enter. A superficial inquiry would be worse than useless, but we believe, that did our space allow us, we could explain some of the difficulties of the inquiry. We will at this time merely remark, that too much attention seems to have been given to abscess merely of the liver, without reference to other diseased conditions of the organ, such as simple congestion, enlargement, granulation, &c. Those who contend that secondary hepatic abscess is owing to absorbtion of pus, or of some hurtful matter from an ulcerated mucous membrane, or to a true phlebitis, seem to us too narrow in their views of dysentery and liver diseases. They have confined themselves to one phenomenon, and have disregarded other necessary conditions of the question.

That abscess of the liver occasionally, and indeed often arises from the causes now specified, viz. phlebitis and purulent absorbtion, is an undoubted

* With reference to the cicatrization of colonic ulcers with hepatic abscess, Dr. Morehead says: "It is a satisfactory fact, that cicatrization of ulcers of the mucous coat of the intestine will go on under circumstances which a priori would be considered most adverse, e. g. under the coexistence of abscess of the liver." This agrees with the observations of Parkes and others.

+ The experience of dysentery of the hospital ship "Minden," during the Chinese war, as detailed by Dr. Wilson, has been considered decisive as to the non-existence of hepatic abscess with that form of dysentery. But on this point it is necessary to wait for more evidence. It is premature to consider the peculiar and multiform diseases occurring during a campaign as proper cases for inquiries of this kind. Sir James M'Grigor has, with his accustomed liberality, permitted us to look over the admirable Reports sent home from China. It is evident from these, that during the campaign, the troops suffered from the several well-marked forms of malarious dysentery, either alone or combined with scurvy. Since they have been in barracks and cantonments, the Chinese dysentery is stated by several gentlemen to be assuming gradually the forms of common Indian dysentery, and to be com plicated with abscess and other diseases of the liver. But the subject is too important to be discussed here.

fact that they will account for all cases of abscess we cannot admit. Even Cruveilhier, who may be considered as one of the originators of this doctrine, never carried it to such an exclusive pitch as some of his followers have done. (See Livraison xl, p. 5.)

We cannot close our examination of this subject without noticing some extraordinary nervous symptoms observed by Dr. Baly at Milbank. Similar symptoms prevailed in the Penitentiary in 1823, and are detailed by Dr. Latham. These were at that period chiefly, "headache, vertigo, cramps, and twitchings of the limbs, delirium, convulsions, and apoplexy.' Dr. Baly has noticed cramps, chiefly of the extremities, and diminution of sensation in several cases; in other instances, there has been stupor and pseudo-hysterical symptoms. In one case there was a kind of modified cataleptic ecstacy. A man, aged 22, was attacked with profuse serous diarrhoea, possibly that modification of malarious dysentery to which we have already alluded. Bleeding, calomel, and opium proving inefficacious, metallic astringents, (sulphates of copper and zinc, we presume,) with opium, were employed.

"The new remedies immediately arrested the diarrhoea, but now a fresh train of symptoms presented themselves. The patient's mind seemed no longer to take cognizance of the impressions made on his senses. He sat up in bed frequently repeating half aloud a sentence consisting of two or three words. His eyes were open, but he did not seem to observe surrounding objects; when questions were put to him, he did not answer, or only repeated the last word or two of the question. When his chin was depressed, he mechanically protruded his tongue and kept it protruded until his lower jaw was raised again; he then withdrew his tongue and allowed his mouth to be closed. When his arm was raised, he kept it in the position given to it, till it was returned to its former place by another person. Food and medicine he swallowed when they were put into his mouth, but never expressed repugnance for the one or desire for the other. He appeared conscious of no suffering; his skin was cool, his tongue moist, pale, and nearly clean, and his pulse slow and rather full. In this state he continued three days; the nervous symptoms then passed off, and merely slight diarrhoea remained." (pp. 22-3.)

"func

Dr. Baly remarks, that these nervous symptoms were merely tional," that is, unattended by appreciable organic changes after death; and he ascribes their prevalence at Milbank to the general increased excitability of the nervous system, induced by long confinement. Prisoners, who have been long in prison, and are then suddenly transferred to the convict ships in the river, and thrown at once from perfect order and repose, into scenes of excitement, are occasionally subject to violent epileptiform convulsions. The same excitability which renders them liable to these attacks, may render them more liable to excito-motory actions when attacked by diarrhoea or dysentery in prison.

But we must bring our remarks to a conclusion, and regret that our limited space allows us to go into no detail on the many interesting subjects we have been compelled so cursorily to review. The symptoms and treatment of dysentery, detailed by Drs. Baly and Morehead, although highly important, present nothing unusual, or that call for special notice. Dr. Harty devotes 100 pages to the treatment of dysentery, and gives us a valuable account of the method adopted by many of the best writers. But those who have time to refer to this subject will do well to consult the work itself.

ART. IV.

1. Saggi di Clinica Medica, basati specialmente sopra le Osservazioni della Clinica del Professor MAURIZIO BUFALINI. Compilati dal Dottor F. BINI, Ajuto alla Clinica Medica della Scuola di Complemento e Perfezionamento nell' I. E. R. Archispedale di S. Maria Nuova di Firenze, e dall Dottor GHINOZZI. Vol. I, Fasc 1, 2, 3, 4, e 5; Vol. II, Fasc 1 e 2.- Firenze, 1843-5.

Essays on Clinical Medicine, founded especially on Observations of the Clinique of Professor M. BUFALINI. Compiled by Dr. F. BINI, Clinical Assistant of the School of Completion in the large Hospital of Florence, and by Dr. C. GHINOZZI.-Florence, 1843-5.

2. La Clinica Medica del Professore G. A. GIACOMINI. Esposizione compendiata del Dottore G. B. MUGNA.-Padova, 1836.

A Short Dissertation on the Clinical Medicine of Professor G. A. GIACOMINI. By Dr. G. B. MUGNA.-Padua, 1836. 8vo, pp. 147.

WE have placed the above works together with the view of contrasting the practical results of two opposite systems of medicine, both tested in the clinical wards of large Italian hospitals, under two physicians who are regarded by their fellow-countrymen as the rival leaders of what may be termed the vital and the organic schools, assisted by students and junior physicians, to whom we are indebted for this record of their observations. We reserve for another opportunity any examination of the theories or doctrines of Bufalini and Giacomini, but may now state that the former is a principal opponent of the Brownian doctrine of excitability which obtained such favour in Italy, and a supporter of the theory of the local origin of all diseases; all constitutional changes resulting from material or organic alteration in some part to which it is necessary to direct the treatment. Giacomini also is an opponent of Brown, but on different grounds; regarding most diseases as an increase of vital activity generally manifested under the type of inflammation. He combats the humoral pathology, and his commentator Mugna perfectly agrees with his views as to the inflammatory origin of disease, regarding delirium tremens as encephalitis, neuralgia as neurilemitis, tubercular phthisis as nothing more than chronic pneumonia, fevers as gastro-enteritis or arteritis; hectic fever, rheumatism, gout, chlorosis are all chronic arteritis; intermittent fever is intermittent subacute arteritis, and the constitutional irritation which follows severe operations is a diffusion of the inflammation from the divided ends of the vessels. His practice is in perfect accordance with his theory, bloodletting being his grand panacea for all human evils. The quantity of blood drawn in his wards is never less than eight ounces in the adult, more frequently fourteen or sixteen ounces. Very low diet was the general rule, barley-water or lemonade serving as ordinary beverages. On looking over the table of the cases and their treatment, which came under observation from 1830 to 1834, we were surprised at the extraordinary number of patients bled. 650 were treated, and after taking the trouble to add up the number stated to have been bled, we find this to be 504. We also added up the number in which the bleeding was repeated, and from the result it appears that 257 were bled once, 132 twice,

65 three times, 24 four times, 9 five times, 10 six times, 2 seven times, 4 eight times, 1 ten times. Besides this, leeches, calomel, tartar-emetic, and purgatives appear to have been employed with heroic vigour. Let us take a case, for example, of acute pneumonia in a labouring man, aged 33, of sanguineous temperament and strong constitution.

"The difficulty of respiration carried to the state of orthopnoea, dull deepseated pain over the whole thorax, speech interrupted by great anxiety, mucous rattle, which never ceased, because the cough could not expel the mucus from the air-passages; dry and tremulous tongue, meteorism of the abdomen, livid countenance, eyes fixed and prominent, and the conjunctiva injected; pulse very rapid and small, skin dry and arid; all these were phenomena which announced the case to be almost desperate.

"Bleeding to 15 ounces was practised, and 2 drachms of the cherry laurel-water given. On the second day no improvement, but the orthopnoea was more severe, mental aberration, carpologia. Bleeding to a pound, and the same dose of cherry laurel-water. He died on the evening of the third day." (Mugna, p. 42.)

Injection, adhesion, and effusion of the pleura were discovered; hepatization of one lung and gangrene of the other. We may learn from this case, and remarks scattered through the volume, that none of the symptoms usually regarded here as expressly contradicting bleeding, were so interpreted by Giacomini. Indeed we are told that

"Whether inflammation be acute or chronic; if suppuration have or have not taken place; if it be accompanied by marasmus, or even if it be about to extinguish life, it is still always the same, and requires the same means to subdue it; that expectoration in pulmonary diseases can never be assisted by stimulant remedies, but may always be promoted even in the last extremity by bleeding and antiphlogistics; that nutrition is not supported in the sick by so-called nutriments, but by the means which check the disease which causes the imperfect nutrition." (Mugna, p. 129.)

We have seen from the numbers bled how these views were carried out in practice, and our readers will doubtless look with interest for the statistical results. These are given in the annexed table :

Number of patients treated in the clinical ward

Total number discharged

Total number cured

Number discharged into other wards, not perfectly cured

Number of deaths

Number of slight diseases, or those easily curable

Number of severe and dangerous cases difficult of cure, incurable excluded

Mortality per cent., those cases excluded which did not complete the cure in the clinical ward

650

617

585

22

33

204

409

15

51

4} 213

Mortality per cent. upon the severe and dangerous diseases alone, the slight cases and those easily curable being excluded; the incurables also excluded Mortality per cent. upon both severe and slight diseases, incurables excluded We regret that no similar table is appended to the work of Bufalini, in order that we might compare them together. Neither can we gather from the work any account of his treatment, except in the essays on lead colic, delirium tremens, chorea, and fevers, written by Drs. Bini and Ghinozzi, which fill up the text; but we know from the other writings of their master, and from having followed his hospital visits at Florence, that he practises

13 of these died on the day of admission or the day following; the two others were cases of hydrophobia.

a cautious and rational empiricism much opposed to the indiscriminate bloodletting of his rival. His pathological views also render him much more strict in his diagnosis and logical in his deductions from symptoms. This is especially seen in the care with which thoracic diseases are discriminated, while Mugna never refers to physical diagnosis, apparently establishing the character of these diseases by general symptoms alone. The total number of cases treated in the clinique of Bufalini in seven years was 1026. Of these 102 died, 732 were cured, and 192 are described as "incomplete result," that is to say, either imperfectly cured or discharged into other wards. The numbers of slight and serious cases are not given, but however considered, it appears that the per centage of deaths is much greater, and that of cures much less than in the practice of Giacomini. Probably this may be partly explained by the latter, as we should judge from the table of his cases, having selected acute diseases as a general rule for his clinical wards; Bufalini those of a chronic character, with a greater regard to their diagnosis, as illustrated by their pathology. We must also in fairness add, that much looseness appears in the manner in which diseases are stated to be cured in the tables of his rival. Thus we see a case of ascites cured in 10 days, cases of rheumatic fever in 3 and 4 days, peritonitis in 2 days, quartan intermittent in 6 days, hæmoptysis in 9 days, hepatitis in 6 days, and so on. Now this alone is enough to make one sceptical, when called upon to admit the extraordinary success of treatment; at the very best, if the diagnosis of the above cases was correct the result could only have been what Bufalini would style "incomplete."

We fear that we cannot carry the contrast between these teachers much farther, because each selecting his own cases for the clinique, would naturally prefer examples bearing out his own ideas. Thus, in the tables of Giacomini, a large proportion of cases are seen to be inflammatory, aud his depleting system appears to have worked well, whereas in those of Bufalini, organic diseases occur in a much greater number. Without any common startingpoint, therefore, we cannot form a correct opinion of relative success. To do this it would be necessary to obtain information as to the severity of each case; the intensity and duration of the disease before and after the admission of the patient; the various complications of the disease, and the treatment before and after admission. Then, again, varieties of climate, manners, and customs, diet, and social position of the patients must be considered. This is a kind of information which it is impossible to afford in a statistical table, and that which constitutes the real difficulty in the study of medical statistics.

In another paper we have alluded to the successful treatment of pneumonia on the homoeopathic system, or perhaps we may say, have there shown that the natural progress of this disease in the majority of cases is towards recovery.

We should have made a calculation of Giacomini's success with his bleedings, but as it does not appear that physical diagnosis is much practised in his wards, we might be reasoning on an unsound basis, but it may be interesting to show the result of Bufalini's more mild system-142 cases of pneumonia were treated by him. Of these the result gives 113 cures, 18 deaths, 11 incomplete result. In 82 of these cases the disease was complicated by bronchitis or pleuritis, or gastric disturbance. Of the