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or less complete. In the former condition they tend to keep the orifice closed, even when a powerful force is in action to distend it; in the latter they are disposed to yield to the expulsor power of other muscles, still retaining contractile force enough to keep it closed when not thus distended; or if the relaxation be rendered complete and permanent by paralysis or section of the nerves, they no longer maintain the closure of the orifice. Now we do not admit that the dilatation of the os uteri is in any degree more dependent upon nervous agency than is the contraction of the fundus; and we cannot see that there is any more difficulty in accounting for its “disposition to relax” at this particular period, than there is for the “disposition to contract” on the part of the fundus; both changes being due, as it seems to us, to the very same cause, and that cause residing in the maturation of the uterine structures connected with the function of gestation. We are acquainted with only one sphincter in the body which has even the appearance of an active dilating power; this is the iris, upon the nature of whose actions (as our readers must be well aware) physiologists are not agreed. At any rate, if the dilatation of the pupil, as well as its contraction, be truly muscular, it is produced by the antagonistic action of a set of fibres passing radially across the circular fibres of the sphincter. Some have attributed the dilatation of the os uteri to the contraction of a set of fibres supposed to be implanted in the lip, and to pass in a straight line towards the fundus. Dr. Meigs favours this idea; but it is allogether repudiated by Dr. T. Smith, who does not need the assistance of any such fibres, finding all that he seeks in the “active dilatation” of the sphincter itself, excited through the nervous system. The Genesial Cycle.—We have perused with great attention the lecture in which the theory is propounded that bears the above designation; and we must own ourselves at some loss to discover what are the special ideas which the author desires to develope. We shall do our best to give a concise expression of them; being only deterred from doing so in the author's own words, by the length of the quotation that would be required to convey them. Dr. T. Smith in the first place brings systematically together the various “sympathies” and “synergies,” physiological and pathological, which indicate a close relation between the ovaries, uterus, and mammae. This relation was previously, we think, sufficiently appreciated both by physiologists and practitioners; the former having been in the habit of looking at these three organs as parts of the same apparatus, and as performing three distinct but mutually adapted offices in one function; the latter having the connexion forced upon their attention by phenomena of daily occurrence. Dr. T. Smith divides the reproductive life of the human female into a series of “great genesial cycles,” each of them composed of a period of ovarian, of uterine, and of mammary activity;-the ovarian commencing with puberty, continuing until conception takes place, and then giving place to the uterine; the uterine lasting for the term of gestation, and then being succeeded by the mammary; and on the termination of lactation, a fresh cycle commencing with the return of ovarian activity. Now in this it is obvious that there is but a formalization of facts which every one knew before; and this formalization (very different from the inductive process by which a true law is evolved) is valuable only in so far as it leads to further results. To refer the metastasis of activity, as Dr. T. Smith does, to the operation of the reflex function, is about as gratuitous a hypothesis as we have any where met with, although, as we have shown, such hypotheses are by no means unfrequent with our author : we might as well, it appears to us, refer the withering of the stamens and floral envelopes of a blossom, and the increase of the fruit, to a nervous system. Nothing is more common than this alternation of action among the different parts of the same apparatus; and where this involves the organic functions only, we do not see any difficulty in accounting for them in accordance with the general doctrines of nutrition. The succession of phenomena designated as the “great genesial cycle,” is repeated, however, on a small scale, according to our author, during every catamenial period; and he thinks that he thus satisfactorily accounts for the regularity of the monthly return of ovarian excitement.
“We know that it is the state of the ovaria at the ovarian period which produces the uterine secretion. This action continues for two, three, four, or five days or more, and then ceases. Now I believe that during the rest of the days of the catamenial cycle of twenty eight days, the breasts and uterus are exerting an influence on the ovaria of a slower and more moderate character, which gradually prepares them for the next ovarian excitement. Thus in a case in which the catamenial secretion and mammary disturbance lasts four days, there is, so to speak, a neural discharge from the ovaria to the uterus and mamma during, four days. At the end of this time, the activity of the ovaria declines, and there is now a neural discharge set up in the contrary direction, so that for twenty-four days the mammae and uterus are modifying and directing the actions of the ovaria. During the intervals between the catamenial flow, the uterus and mammae are acting upon the ovaria, causing them to prepare and mature the ovule or ovules of each ovulation, just as, during the days of the catamenial flow, the ovaria are acting on the uterus, causing it to pour out the catamenial secretion—the reason of the distinct ovarian periodicity being, that this action of the uterus and mammae upon the ovaria is prolonged for a greater number of days than the reaction of the ovaria upon these organs. According to this view, the twenty-four days is as much a periodicity as the four days of the catamenial flow. The twenty-four days are the term of the uterine and mammary periodicity, the four days are the term of the ovarian periodic excitement, and the entire catamenial period of twenty-eight days is the record of the time taken in one revolution of the reciprocal actions of the mammae and uterus upon the ovaria, and of the alternative action of the ovaria upon the uterus and mammae. If the catamenial flow had lasted fourteen days, and the apparent quiescence of the uterus had continued just an equal time, the cause of the periodic times of the sex would have been evident long ago; but owing to the disproportion between the uterine and ovarian times, the uterine and mammary phenomena of the intervals between the catamenial flow have never been recognised. All the facts of the case—and they might be multiplied—seem to me to point to a power of neural induction, excitation, or polarity, existing between the three principal organs of reproduction, and regulating and producing their functional revolutions or periods, just as simply and decisively as gravitation causes the motions of the heavenly bodies.” (p. 181.)
At the conclusion of the lecture which contains the foregoing passage, we find Dr. T Smith giving utterance to the following speculation, which forms an appropriate pendant to it.
“By an extension of the same principle as that which I have been tracing between the organs of reproduction. I think we may acquire a better knowledge of intermittent fevers, perhaps of Asiatic cholera itself.” (p. 188.)
We cannot think it requisite to inflict on our readers any laboured demonstration of the utter baselessness of this hypothesis, which, though at first brought forward mere y as the author's belief, is aferwards spoken of as if it were the expression of observed facts. We can imagine the unsophisticated student imbibing it with all the gravity with which it is propounded; and learning with surprise, as he grows wiser, that the “neural discharge” is a pure invention of the author's, and that there is about as much ground for the belies in this “reciprocal action of the mammae and uterus upon the ovaria,” as there is in the doctrine of “lunar influence,” which, we recollect, was brought forward afresh in a new and specious form in our earlier days, and was very attractive to our young imagination. The consideration does not seem to have cecurred to Dr. T. Smith, that such mammary sympathies as present themselves in connex on with this monthly periodicity are coincident with the ovarian excitement, not reciprocal to it; many women having pains in the breasts, and some even forming a lactescent secretion, during every catamenial flow. But a theorist of his wonderful ingenuity, can have no difficulty in accounting for such apparent obstacles; in fact we shall not be in the least surprised if Dr. T. Smith should convert every one of the objections which we have advanced against his hypotheses, into triumphant demonstrations of their truth. Nothing is more easy to a sanguine speculator, mounted upon his Pegasus, than to dash through the petty obstacles which sober and cautious reasoners would build up in his course; and there is a certain fascination in thus giving oneself up to the exhilarating influence of rapid motion, witho t being troubled about the payment of turnpikes over which we leap, or the value of the crops we trample down, that is for a time extremely enticing. The misfortune is, that instead of making real progress, we are too often led back in our chase to the point from which we started, or are carried in the direction precisely opposite to that of our goal. And, as in the case of the hare and the tortoise, the cautious reasoner, who is content with a less rapid advance, but whose movement, however slow, is steadily progressive, generally wins the race in the end. z It has been with much regret that we have felt ourselves compelled to say so much in disparagement of Dr. T. Smith's hypotheses, and of the method of philosophising which he has thought fit to adopt. With nothing but a friendly feeling towards himself, we yet consider the interests of truth paramount; and the questions which he has raised, and the manner in which he has raised them, call for a full and free discussion. We trust that neither he nor our readers will consider that we have in any degree transgressed the bounds of candour and “ood feeling, in criticising his production as we have done. We again repeat that we consider that great merit is due to him for his labours, although, we cannot coincide in his own estimate of the value of his results; and we may add that the reader of his treatise cannot but be favorably impressed by the author's range of acquirement, his ingenuity and fertility of thought, and his very agreeable style, even when most widely dissenting from his views. We must postpone until our next Number the discussion of the practical portions of the two works before us.
Medico-Chirurgical Transactions. Published by the Royal Medical and Chirurgical Society of London. Vol. XXXI. Second Series, Vol. XIII.—London, 1848. 8vo, pp. 522. With Seven Plates.
We continue, from our last Number, our analysis of this volume; the interesting nature of whose contents gives occasion to this unusually lengthened notice of them.
XVI. Contributions to the statistics of valvular disease of the heart; by A. Whyte Barclay, M. D., Physician to the Chelsea, Belgrave, and Brompton Dispensary, and Medical Registrar of St. George's Hospital. The present paper neither contains, nor professes to contain. any suggestions for the improvement of diagnosis, except in as far as a priori probabilities may be available, nor does it hint at any novel principle for the guidance of practice. It consists of a tabulated statement of the necroscopic appearances of 79 bodies in which more or less valvular disease was discovered, and of the sex, 'age, and cause of death of the sufferers, preceded by some remarks which may be considered as a running commentary upon the whole. Much patient industry is required for the collection and arrangement of the materials of such a record of facts, which is calculated to throw great light upon the history and relations of the particular disease under discussion. We cannot pretend to give an adequate sketch or analysis of a memoir of this kind, but shall content ourselves with extracting some of the more striking facts and inferences that are deducible from the numerous observations here detailed. Out of 419 cases occurring during 'two years at St. George's Hospital, in which the condition of the organs of circulation was ascertained, 79 detailed in the table were found to present various modifications of valvular disease; so that 18.8 per cent. is the proportion in which we may expect to meet with these lesions in persons dying of all diseases. As regards the frequency with which the different valves were affected, it appears that in 36, or 45 per cent, the aortic and mitral were so simultaneously, in 26, or 33 per cent. the aortic alone, and in 17, or 22 per cent. the mitral alone. The age of the patient seems to have a marked influence upon the production of fibrinous deposit, since in the first 18 cases in which the age varied from 12 years to 34, it occurred 16 times, while it is on y mentioned 5 times in the remaining 51, in which the age ranged from 34 to 79 years. Atheroma, on the contrary, is more abundantly developed as life advances. Of 113 instances out of the 419, in which it was met with on the valves or at the origin of the aorta, the numbers falling in different decades of age give, as compared with the whole numbers of deaths in the corresponding decades— 12 per cent. as the rate of its occurrence between 20 and 30; 21 per cent. between 30 and 40, and also between 40 and 50 ; .43 per cent. between 50 and 60, and also between 60 and 70; 54 per cent. above 70. Valvular disease is superadded in about two fifths of the cases of w
atheroma, but in a little more than half of these is the valve found in a condition of atheromatous degeneration; and it does not appear from Dr. Barclay's researches that the mitral valves are more liable to atheromatous disease than the aorta, though a contrary statement has been made by several pathologists. a
The frequency with which the aortic and mitral valves are simultaneously affected in connexion with rheumatic fever is very remarkable. Of 15 cases traced to this disease, out of the 79, there were 13 in which both valves thus suffered together; and of another series of 35 cases similarly circumstanced, there were 28 in which both were implicated. In the few remaining cases in which either valve was separately diseased, it appeared that there was no distinction between them as to the frequency of this occurrence. Hypertrophy, dilatation, and atrophy re equally found as consequence of severe lesion of the aortic and of the mitral valves, and of adherent pericardium, and sometimes would seem to exist in a considerable degree of development, with a condition of valves in no way proportionate to the muscular changes.
Deviations from the healthy and normal condition of the kidney are noticed forty-one times in the table. In 28 cases the disease was granular degeneration; in 5 the kidney was large and mottled. It is remarkable that, while of 61 cases of atrophied kidney, 29 are coincident with valvular disease, only 5 cases out of 21 of those in which the kidney was large and mottled presents examples of endocardial affections; very nearly 50 per cent. in the one condition, and scarcely 25 per cent. in the other. And in comparing these two forms of disease, we find that, while contraction with thickening of the valve exists in numerous cases of granular degeneration, only one ambiguous instance is recorded as coincident with a large and mottled kidney; a result which agrees with the fact that endocarditis occurs in the former without complications, and is not found in the latter, except under such conditions as would seem to develope it where the kidneys were healthy.
“Were I,” writes the author some pages farther on, “to allow myself to speculate on blood-poison as a cause of endocarditis, of which acnte rheumatism and granular degeneration are supposed to furnish us with examples, I might inquire why it is that in the one the inflammatory action is so liable to extend to both sets of valves, while the other does not exhibit any marked deviation from the ordinary statistics which I have obtained for all forms of cardiac lesion together? whence the liability to a recurrence of endocarditis is derived, when no subsequent affection of the joints has been observed or why, in the last stages of granular degeneration, when epilepsy or coma marks the transmission of the poison to the brain, recent inflammation is so rarely found, and evidence of previous disease is of such constant occurrence " But for the present it must suffice to point out these as inferences which may be fairly drawn from the statistics now presented.” (p. 203.)
It results from the author's investigations that acute rheumatism has some, but no great, influence in developing atheroma, since he found that all the cases of diseased heart gave a proportion of 45 per cent of atheroma in general, and 25 per cent. of atheroma of the valves; while diseased hearts, connected with rheumatic fever, give, as the corresponding proportions, 53 and 27 per cent.
We here terminate our notice of a paper which must be consulted in 7–iv. 4