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neither my name nor the names of Henle or Baum be placed before that of Dr Meissner, for I expressly represented myself and the others as only witnesses verifying the important fact. As Professor Bischoff dated his new paper (Giessen) the 25th of March, my letter to Leuckart having left (Göttingen) on the 17th, there can be no doubt of its having been through the latter that Bischoff was first prompted to institute his observations, the result of which directly contradicts what he had constantly maintained before.”
A Manual of Pathological Anatomy. By C. HANDFIELD JONES,
M.B., F.R.S., etc., and EDWARD H. SIEVEKING, M.D., etc. London. Small 8vo, 1854. Pp. 788. Transactions of the Pathological Society of London. Volume Fifth.
London. 8vo, 1854. Pp. 371. Transactions of the Belfast Clinical and Pathological Society for the
Session 1853–54, etc. Belfast. Small 8vo, 1854. Pp. 132.
The advancement of pathology during the last ten years may be truly said to have been extraordinary. Indeed all that refers to those morbid processes which may be now classified under the head of growth or nutrition has undergone a complete revolution. In the pathology of the neuroses, however, no great advance has been made since the introduction of the doctrines of Reflex Action by Dr Marshall Hall, and medicine, in consequence, is in this department still too dark and unsatisfactory-still too much oppressed by nonlogical distinctions and empirical rules. But in all that relates to changes in nutrition-to the circulatory, respiratory, digestive, absorbent, and secreting functions, it must be allowed that mighty beneficial changes have been accomplished. With regard to them the old nosologies have been happily exploded, never more to return. Even the most empirical practitioner has been constrained to follow in the wake of that rational system of treatment, which is dependent more upon accurate diagnosis and detection of the pathological condition of organs, and less upon the palliation of symptoms and indiscriminate faith in the action of drugs. The present state of medicine as a science, we believe to be one of rapid transition, which, before long, will bring about a new phase in its history. Its condition as an art, is that of gradual preparation for the advent of new principles. Every day exhibits the relinquishment of some old empirical notion—we no longer hear of a man cutting short inflammation with the lancet, or with calomel. The lancet is
vent condition asong, will brim believe to brugs.
now scarcely ever employed, and calomel is far more cautiously prescribed. The cultivation of morbid anatomy and pathology, has taught us better to discriminate between organic disease and functional derangements, and the result is a more just appreciation of spontaneous recoveries on the one hand, and of the effects of remedies on the other. Undoubtedly the next great step onwards in the improvement of medicine will be brought about, not by blind tentative efforts at curing diseases, but by laborious scientific researches, undertaken to discover their nature, and so determine the laws by which they are produced and influenced.
The Manual of Pathological Anatomy, by Drs Handfield Jones, and Sieveking, whilst it falls short in some parts of what we believe to be the actual state of our knowledge, must still on the whole be considered a great improvement upon all the British systematic works which have preceded it. It is judiciously arranged, ably compiled, and in some portions may justly claim the merit of contributing new and valuable matter to our store of scientific facts. We should have felt great pleasure in entering at some length into friendly controversy with the authors, on some points in which we differ from them, were we not frequently met with such phrases as “our limits forbid discussion," pp. 109 and 1.37, or “we cannot enter further into this question," p. 242—although such question is acknowledged to be at the very foundation of our pathological knowledge. Considering that this work is intended chiefly for students, we think it would have been useful had the authors indicated where the authorities on such controverted topics might have been consulted. Dr Sieveking, for instance, after alluding to the arguments of Dr Barrows, regarding the peculiarities in the circulation within the cranium, should have informed his readers how fallacious they had been proved to be by the late Dr John Reid, in an able paper which placed the views of Monro, Kelly, and Abercromby on a firmer basis than ever. We could, indeed, point to many omissions equally important, but entering as we do fully into the extreme difficulty of the authors in their attempt to reduce so extensive a subject into the compass of a manual, we would rather dwell on merits than on defects.
It is with no small satisfaction that we observe a pathological doctrine for which we have long contended, and which has constantly been brought forward in the pages of this journal, at length recognized to be correct, notwithstanding the great authorities who have hitherto opposed it. Thus Dr Handfield Jones observes
" It really seems far too exclusive and one-sided a view to consider only the blood and the vessels as the agents concerned in hyperemia, the common initiatory step of inflammation, and to deny to the essential elements of the part any share in the production of a state by which they are so importantly affected. We therefore recognize an increased attraction of the blood towards the part which is stimulated, as one cause of active hyperæmia, and the principal, and we regard the dilatation of the arteries as a secondary, but not unimportant.
But the influence which the tissues exert on the circulation, in virtue of their “nutritive power," we may be sure is not only an attraction which may be increased or diminished, but also an alteration which the attracted blood undergoes, and, having undergone, is either repelled or pushed on by the advancing current. We may illustrate this motive influence by the example of light bodies, when acted on by electricity. Two pith balls, one of which is in a negative, and the other in a positive state, will attract each other strongly ; but as soon as they both become negative or positive, they forcibly repel each other. Some similar relation must subsist between the blood and the tissues, The arterial blood is heterogeneous to the tissue, and is attracted to it. Having become venous, it is no longer so, and it ceases to be attracted, perhaps even is repelled. Now, we may conceive the attractive force to persist, or even to be exalted, while the change impressed in nutrition may be greatly lessened. Blood will then accumulate in the part, from not having undergone that vital change which it should, and the part will be hyperæmic. This would be the case in active hyperæmia of a morbid kind-in that which forms the first stage of common inflammation, in which the vital endowments of the part are lowered, and its functional activity lessened. In healthy hyperæmia, on the other hand, the attractive and the changing influences are both increased. The blood does not accumulate, but only ministers adequately to the increased functional activity of the part. We are anxious to avoid, as far as possible, speculating beyond the limits of actual observation, but we would ask, whether some such interpretation as we have offered be not necessary to explain the different event in two cases of suckling females, one of whom has the child put to the breast early, and by the mental and psychical influence brought to bear, has the functional activity of the gland aroused, so that the hyperæmia as it arises is converted into a copious flow of healthy milk; while the other, who has the child kept from her for two days, and whose mamme are left unaroused and unstimulated, suffers from overwhelming hyperæmia, which issues in inflammation and suppuration.”—Pp. 86, 87.
Dr Jones considers hyperæmia to be of three kinds; 1st. Hyperæmia, or excess of blood in a part with diminished motion. This he calls congestion. 2d. Ilyperæmia with increased motion. This he says is determination of blood. 3d. Hyperæmia in which the blood is partly increased and partly diminished. This is inflammation. The attempt to define congestion and inflammation according to the rapidity of the current of blood in a part, strikes us as being open to very grave objections. In the first place, the condition of the true capillaries seems to us to be always the same when they are relaxed and truly congested. What the author calls congestion, is that obstructed state of the veins which causes venous congestion and dropsy, a condition of the part more dependent on difference in the seat and cause of the morbid accumulation of blood, than of the rapidity in its current. Then the so-called phenomena of determination of blood as evinced by increased pulsation in the arteries leading to a congested or inflamed part, is certainly not a cause, but rather a result of the lesion in the extreme vessels. Lastly, that in inflammation there is at one and the same time in a part both increased and diminished motion, is a condition that has never been seen—and that its existence can in any way be proved by bringing together an observation of Mr Lawrence on a patient, and another observation by some one else, on the transparent parts of animals placed under a microscope (p. 102), is what we cannot understand. We agree with Dr Jones in considering the neuro-pathological theory of inflammation to be untenable, neither do we attach great weight to the increased spissitude of the blood theory, supported by Mr Wharton Jones, and which is rather favoured by our author.
We are compelled to take notice of the following passage, in consequence of its containing a statement we believe-indeed we can prove to be erroneous :-“ After tubercle in any quantity has softened, and a cavity been formed from which the tubercular detritus is afterwards eliminated, a cure may still take place; but it is a much rarer occurrence than in the former cases, and perhaps never attains to the complete closure and cicatrization of the cavity. This, at least, applies to the lungs; in other parts, there is no doubt that a tuberculous ulcer may heal up and cicatrize.”—P. 148. Does Dr Handfield Jones seriously mean to assert that a tubercular cavity ever completely closes or cicatrizes? If so, we can assure him that in Edinburgh there is a preparation that would convince him to the contrary, and we would especially refer him to the description and figure of it in the March Number of this Journal, for 1850, p. 233. Dr Sieveking seems to hold on this subject a different opinion, as, according to him, tubercular cavities of the lung may disappear altogether, leaving a dense white fibrous tissue, ramifying irregularly in the surrounding tissue, p. 453.
Dr Handfield Jones, as is well known, has paid great attention to the morbid anatomy of the stomach and liver, and has thereby truly advanced our knowledge of their pathology. We would point especially to his chapters on these subjects as a proof of the correctness of an opinion we have long held, that such are the kind of researches which are now required, and that until every organ in the body has been similarly investigated, we cannot hope that the diseases to which they are liable, can ever be understood.
The different chapters on spinal pathology contributed by Dr Sieveking are well written and judiciously put together. They consist, for the most part, of careful compilations from authoritative works, and exhibit extensive knowledge and reading on the part of the author.
This book is copiously illustrated by woodcuts, some of which are very good, in others there has been a failure. Among the former, we would especially point out the woodcuts illustrative of the morbid changes in the heart, stomach, and liver. Figure 17 is not a good representation of a fibrous tumour, and we would advise the substitution of something better in the next edition. The section on vegetable parasites is ridiculously short, and illustrated by a something about the size of a fourpenny piece, said to represent the structure of Favus-partly from Lebert, too! We would again advise a reference to the pages of this Journal for July 1850, pp. 51 and 53, for something better.
Of the transactions of the Pathological Society we can speak with unqualified approbation. The numerous careful observations, accompanied as they now are by admirable delineations of the minute structure of morbid lesions, will place such volumes as the present and the former ones, amongst the most valuable additions to our annual medical literature. Here again we recognise decided progress, as must ever be the case, when men having, in the first place, rendered themselves qualified for the task, seriously determine to investigate for themselves, with a sincere desire to discover truth. Amidst so much that is excellent we shall not venture to particularise, but shall extract, in future Nos., a few of the more remarkable contributions for our Periscope. We cannot, however, omit saying, that the editorial department of these Transactions must have cost great labour; and, if we are correct in attributing it to the zeal of Dr Richard Quain, we can only remark, that notwithstanding the great ability displayed, such is only what was to be expected from his well-known enthusiasm and successful cultivation of pathological science.
Nor must the Transactions of the Belfast Society be overlooked. Though the letterpress and plates will not vie with the brilliant production of its elder sister institution in London, every page in it exhibits a laudable ambition not to lag behind in the task of selfimprovement; and the sketches appended, comparatively rough though they be, demonstrate to the sagacious inquirer, that Belfast also possesses men who cultivate pathology with earnestness, and in a right direction,
Förhandlingar vid Svenska Läkare-Sällskapets Sammankomster.
Stockholm: 1854. Proceedings of the Swedish Medical Society. Stockholm : 1854.
Pp. 270. Svenska Läkare-Sällskapets Nya Handlingar. Stockholm : 1854. New Transactions of the Swedish Medical Society. Stockholm:
1854. Pp. 417. UNLIKE the proceedings of many of our Medical Societies, the zeal in which appears to undergo many singular fluctuations, or rather revolves in something like cycles, each with its culminating point occurring at intervals, those of the Medical Society of Stockholm seem of late to have been steadily and conspicuously advancing, as well in the greater development as in the higher quality of their efforts. The report for the year 1853, which we have just had the gratification of having placed in our hands, is distinguished beyond those we have previously seen, for the copiousness, and, we think also, for the value of its details. From the manner in which these
NEW SERIES.– NO. II, FEBRUARY 1855.