Now it is precisely in this point of view that the Humoral Doctrine of the ancients was most difficult and at fault; it had unravelled with surprising sagacity the physiological and pathological conditions of the fluids, in relation with their impressions and affections; but it failed to detect the circumstances of those impressions or affections which may be reflected in the aspect and structure of the humoral matter. The deficiency in this respect was doubtless owing to the imperfect state of the accessory branches of medical investigation, more especially in the departments of physical and chemical science.-Gazette Medicale.

Remarks. We may here very appropriately introduce one or two remarks on the state of the blood in Puerperal Fever, extracted from a recent article on this disease by Dr. Bouchut. "One of the most remarkable necroscopic characters," says he, "is the decoloration and liquifaction of the blood, and the small number of the coagula found in the vascular cavities. But, besides these changes, I have observed another alteration, which deserves the especial notice of pathologists, as it affords a strong argument in favour of the pyogenic etiology of the disease. On microscopic examination of the blood of a woman, who died from puerperal fever within 48 hours of seizure, I found, amidst the usual red globules, (which did not seem to be at all altered) a considerable number of larger globules, which appeared to be colourless and to be fringed at their edges: they were either grouped together in clusters of 4 or 10, or they were isolated and detached. The great number of these abnormal globules is opposed to the idea that they were the white globules, which always exist in healthy blood. Are we to suppose that pus-globules may become developed within the mass of the blood, without any previous inflammatory action? This opinion was ably supported by De Haen and Home; and M. Gendrin and other pathologists of the present day have endeavoured to prove that the pus-globule is nothing but the ordinary blood-globule somewhat changed."

In his recently published work on Pathological Chemistry (Paris 1843) M. Lheritier, the causes of the alterations of the Blood are arranged and described under the following five heads :

1. Those which vitiate the fluids, that serve for the formation of the blood itself. The chief source of these vitiations is unquestionably the unwholesome nature of the food on which the being lives.

2. Those which in any way disturb the normal operation of the functions of Secretion and Excretion. Of this nature are the changes which are apt to take place in the constitution of the blood, during the prevalence of great heat. It has been shewn by very exact observations that the increase of the atmospheric heat, more especially when the air is at the same time moist and charged with miasmatic effluvia, diminishes very considerably the action of the respiratory process on the blood, and that the Carbonic Acid and other impure elements, imperfectly eliminated in this way, are partly combined to form the Bile—then more abundant than usual, and often vitiated at the same time-and are partly excreted from the system by the surface of the skin and of the intestines. If the functions of these organs-the liver, the skin, and the bowels-which thus compensate for the diminished action of the lungs, are from any cause impeded, the matters, which should otherwise have been eliminated and discharged from the system, must remain behind and accumulate in the blood.

3. Those which contaminate the parts, with which they are brought in contact. To this class belong the cases where putrid matters are introduced into the blood, as well as most probably all contagious diseases.

4. Those which act on the vascular system directly, or indirectly through the medium of the nerves. Such are acids, alkalies and their subcarbonates, metallic salts, various astringents, alcohol, spirit of turpentine, &c.

5. Those which are constituted by the passage of matters formed within the

body itself into the circulating fluid. These matters are either the products of secretion, such as Bile, Urine and Milk-although the existence of these substances in the blood has never been perfectly demonstrated-or they are productions which are altogether abnormal and foreign to the organism in a state of health; of this nature are pus, cancerous matter, and various inorganic substances, such as ammonia, &c.

The following explanation of those cases of Jaundice that are apt to be induced by violent mental emotions, and which have usually been supposed to arise from a presumed Spasm of the biliary Ducts, deserves to be noticed.

This spasm of the hepatic duct," says he, "appears to me to be, if not impossible, at least not at all intelligible; and surely it is much more reasonable to suppose that the cause of the disease under such circumstances, as well as when it has followed injuries of the head, is attributable to the depression of the nervous system-a depression which throws the liver into a state of torpor, so that this organ no longer eliminates and secretes the constituents of the bile from the mass of blood. I therefore conclude that the form of Jaundice in question is owing, not to the resorption of the bile into the system, but rather to a defective or arrested secretion of it. Perhaps indeed there are certain cases of wounds of the head, where the functional condition of the liver has nothing to do with the yellow tint exhibited by the skin: the following case seems to prove this." Here the author relates a case of a man who, after having received a most severe blow on the left side of the head from a heavy stone falling upon him, was able to resume his work in three days, although at this time the entire upper extremity of the right side, from the shoulder down to the tips of the fingers, exhibited a deep icteric coloration. M. Lheritier suggests the following explanation of this phenomenon: "The blood undergoes within the tissues of the body certain transformations, the ensemble of which constitutes the process of Nutrition. But what is the agent that ultimately presides over these changes ?-the nervous system; well in the present case the brain had experienced a violent commotion, and, in consequence of this injury, there had ensued a sort of local anervia, so that the nutritive transformations were only imperfectly effected; the elements of the blood had not been properly elaborated, dissociated, and combined, and the yellow colouring matter of the bile, contained in this fluid, had therefore become extravasated under the skin."

(This is but a very fanciful conjecture; the yellow discolouration of the upper extremity may have had nothing to do with the formation or excretion of the bile, and was, in all probability, merely of that kind that so generally follows upon bruises and other injuries).

OBSERVATIONS UPON PULMONARY GANGRENE.

The principal results of M. Boudet's researches on this subject are these :1. Gangrene of the lungs appears to be more frequent in childhood than at any other period of life.

2. It is essentially of the same nature as those other forms of Gangrene that are developed spontaneously, or under the influence of putrescent fever.

3. In the child, Gangrene, when it affects the lung, is rarely limited to this organ; usually several other parts of the body are similarly affected at the same time.

4. The lower and posterior parts of the lungs are most frequently the seat of the disease. We have often occasion to observe that it manifests a remarkable tendency to attack the adjacent organs: thus we not unfrequently find the mediastinum, and the pleura, and sometimes the oesophagus also, involved in the

destructive process. It may extend by the mere contact of the sphacelated matter, inducing gangrene in the parts with which it comes in contiguity.

5. Gangrene of the lungs may appear in three different forms: in distinct patches, in nuclei or circumscribed masses, and in a diffused and extensive superficies.

6. It may be circumscribed, and a cure may then be effected in the child as in the adult. In such circumstances, the gangrenous corruption becomes surrounded by an organised pseudo-membrane, so that, in course of time, it is perfectly isolated from the adjacent tissues.

7. Local causes-such as inflammation, the existence of tubercles, &c.-do not seem to have any direct influence on the production of pulmonary Gangrene. 8. Like other spontaneous gangrenes of childhood, this form seems to be always developed under the influence of causes which act on the entire system. Thus, an unsound constitution, shattered health, imperfect or unwholesome nourishment, &c. are observed to predispose to its occurrence. But the proximate cause of the disease is unquestionably a morbid alteration of the mass of blood, consecutive upon Scurvy, Measles, Scarlet-fever, and such like maladies, and which is characterised during life by the appearance of purple spots on the surface, softening of the gums, hæmorrhage from various parts, &c. and after death, by patches of ecchymosis, and sanguineous suffusion, and by the extreme fluidity or dissolved state of the blood. In a chemical point of view, this state of things is most probably the result of a diminution in the proportion of the fibrine, and an excess in that of the alkaline ingredients of the blood.

9. The usual symptoms of Gangrene of the lungs are dulness on percussion over the affected part, resonance of the voice, mucous or gurgling râle, fætor of the breath, greenish colour of the sputa, and a peculiar expression of the features, that cannot be well described by words.

In reference to the treatment of this disease, M. Boudet makes the following remarks:-"It is almost always after Measles or Scarlet-fever that gangrene of the lungs has been observed to occur. Therefore, as a means of prevention, the first step to be taken should be to keep, as far as in our power, children from being exposed to the contagion of the disease. The children who may be affected with it, should be carefully separated and kept apart from the other inmates of an establishment, like that of the Hôpital des Enfans. Moreover, as it has been shewn by the most satisfactory researches, that the Exanthemata in question are generally more severe and complicated in children that have not been vaccinated, I should most strongly urge upon all parents, as well as medical inen, a more punctual attention to this most necessary precaution."

Whenever, during the progress of Measles or Scarlet-fever, there is observed any tendency to the occurrence of hæmorrhage, or sponginess of the gums, or purpural eruption on the skin, the physician should diligently examine the state of the lungs; for it is in such a state of the system that pulmonary Gangrene is generally developed. The patient should immediately be ordered the free use of a beverage made with lemon-juice or with sulphuric acid: the affected parts of the mouth should be touched with nitric or muriatic acid; acid and antiseptic gargles should be used frequently, and the body and limbs should be sponged with an aromatic acid lotion. Dr. Boudet assures us that he has seen, in the Salpetrière, many cases in the most advanced stage, and seemingly in a desperate condition, recover under the diligent employment of acid medicines, internally and externally administered. The acids serve to counteract the excessive Alkalinity of the Blood, while the cordials give tone to the system, and enable it to resist the tendency that exists to the loss of the Fibrine. The application of a blister or a sinapism to the legs is often a useful adjuvant; and in many cases decoction of bark, with port wine and other tonics, may be advantageously exhibited. Some physicians have spoken well of the use of the Chlorurets, given

internally as well as freely applied to the surface of the body and to the gums. As it is the lower and posterior part of the lungs that is generally affected, the position of the patient should be frequently altered, so that the seat of the disease may not always be in a depending position.-L'Experience.

MICROSCOPIC ANATOMY OF TUBERCLES.

The following are some of the most important conclusions of an elaborate Memoir, that was recently communicated to the Academy of Sciences.

1. The constant Microscopic Elements of tubercles are these: a, molecular granules; b, a hyaline interglobular substance; and c, the proper corpuscles, or globules of tuberculous matter. These globules contain a number of molecular granules, but no distinct nuclei. They are not affected by water, ether, and the feeble acids; but they are dissolved by the strong acids, as well as by ammonia and caustic potash.

2. The opinion of certain pathologists, that tuberculous deposit and its globules are only modifications of purulent matter, is contradicted by the result of microscopic inspection; the differences between them are strong and decided. The corpuscles of the latter are considerably larger, of a regularly spherical shape, and contain from one to three nuclei: they are, moreover, usually free and isolated; whereas those of tuberculous matter are, especially in the crude state of tubercles, closely joined together. The globules of Cancerous matter are twice or even four times as large, and they contain a nuclei, in which again from one to three nucleoli are often observable.

3. In Sarcocele, and also in Scirrhous and Encephaloid tumors of the mammæ, we not unfrequently find a yellowish cheesy-looking substance, which much resembles genuine tuberculous matter; but a careful examination with the microscope clearly shews that it consists entirely of globules of Cancer infiltrated with fat.

4. When tubercles soften, their interglobular substance liquifies, the globules separate from each other, and may then, by absorbing a certain portion of the fluid, become larger: this change does not constitute an increased growth, but, on the contrary, the commencement of the process of decomposition.

5. The pus, which is found blended with the softened tuberculous matter, is supplied by the surrounding tissues, and is by no means the result of any transformation of the matter itself; but the pus, it must be confessed, quickly alters it, and renders its elements much less easily recognizable.

6. The globules of softened tubercles become ultimately dissolved in a granular fluid, and thus the ramollissement of their substance passes fairly to the state of diffluence.

7. The cretaceous condition of tuberculous matter presents under the microscope the appearance of amorphous mineral granules, blended often with crystals of cholesterine and colouring matter. A part of the tuberculous globules is then removed by absorption, while the other portion remains for a long time in an unchanged condition.

8. Occasionally we find in tuberculous deposit corpuscles of fat, melanosis, greenish-coloured globules, and crystals which have the form of those of the ammoniaco-magnesian phosphate. Besides these admixtures, we may find, blended along with them, the elements of inflammatory and suppurative action, and various sorts of epithelial exsudation; all of which tend to modify the essential microscopic features of the tubercles.

9. The seat of tubercles in the lungs is usually the inter-vesicular elastic cellular (or areolar) tissue: sometimes, however, they are secreted into the airvesicles themselves, and into the capillary bronchial tubes.

10. The semi-transparent grey granulations of the lungs are composed of tuberculous granules, interglobular substance which is more abundant and more transparent than in the yellow tubercles, and of pulmonary fibres more or less altered in their appearance. They are not invariably the " point de depart" or primary condition of the miliary yellow tubercles; as these latter are sometimes developed as such, from the very commencement of their deposition.

11. Microscopic examination most decidedly exposes the fallacy of the opinion, that the grey granulation is the product or effect of inflammatory

action.

12. A vomica or tuberculous excavation is in every respect analogous to a tuberculous ulcer of the skin or intestinal canal; it is not necessarily preceded by, or the result of, the suppurative process. As a general remark, it may be asserted that Phthisis is accompanied with an ulcerative diathesis.

13. The fluid of pulmonary excavations contains the following elements: a, tuberculous matter, with globules which are either much more turgid than usual, or are altogether diffluent; b, globules of pus sometimes in small quantity; c, puoïd globules; d, granular globules; e, globules of mucus or of muco-pus; f, blood globules; g, pulmonary fibres; h, black pigment; i, epithelium shreds; j, crystals; and k, globules of fat. (Surely there is a good deal of hair-splitting nicety in such an enumeration as this.)

14. The cavity of a Vomica is lined with a pyogenic membrane, the formation of which may be regarded as a Curative effort of Nature to isolate the cavity from the surrounding tissue, and thus to favour its cicatrisation. The cicatrisation is in mary cases promoted by a new secretion of fibrous matter, and occasionally also of a chalky deposit at the same time.

15. The thickening of the pleura over the seat of tuberculous deposit is the result not of inflaınmation alone, but also of an augmented nutrition or hypertrophe, in consequence of the increased flow to it of the blood, which formerly permeated the (now obliterated) capillary vessels of the surface of the lungs. It thus becomes a supplementary organ of circulation in Phthisis, and serves to increase the Anastomoses with the Aortic Circulation by its intimate adhesions with the parietes of the chest.

15. The Liver is often the seat of extensive tuberculous deposit; and this lesion may readily be mistaken for Cancerous transformation. The distinctive microscopic characters are most to be trusted to in the pathological diagnosis of such cases.

16. The fatty degeneration of the Liver and Heart-so accurately described by M. Bigot-exhibits a tendency to the internal deposit of fatty matter in Phthisis, while all the fat of the external parts of the body is at the same time entirely absorbed.

17. We occasionally find a quantity of tuberculous deposit in old membranous deposits on the Pericardium. In a case, where the Pericardium adhered firmly to the surface of the heart and all the surrounding parts, numerous Anastomoses between the ramifications of the Coronary vessels and those of the surface of the lungs were found to have been established.-Gazette Medicale

PROFESSOR FORGET ON ADHESIONS OF THE PERICARDIUM.

The substance of this active Professor's remarks on this subject is contained in the following observations, with which he closes a lengthened narrative.

1. Pericarditis often terminates in general or partial adhesions of the heart with its enveloping Capsule.

2. These adhesions seem to succeed more especially to the dry (without effusion) form of the disease in question.