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ROYAL COLLEGE OF SURGEONS. Gentlemen admitted Members on Friday, August 20, 1847-S. G. Bousfield; T. A. Rogers; W. H. Cook; E. B. Sinclair; W. A Roche; R. E. Jones; M. A. Levan; M. Halley; E. C. Curran; R. Gunn; J. Newton; D. G. Jones.

Gentlemen admitted Monday, August 23rd:-W. L. Cashel; R. T. Spark; C. Ferraley; T. W. Crosse; R. Abercrombie; J. M. Camplin; M. J. Booth; C. T. Wagstaff; W. O. J. Wollaston; B. F. Matthews.

SOCIETY OF APOTHECARIES.

Gentlemen admitted Licentiates, Thursday, August 12, 1847:-Benjamin Fielding Matthews, Bedford; Joseph Meldon Dempsey; Thomas Green, Grassmere.

Gentlemen admitted Thursday, August 19.-T. Hunter, R.N., Budleigh Salterton, Deron; M. F. Bush, Trowbridge; S. Griffith; J. Simmonds Nedham, Leicester.

Gentlemen admitted Thursday, August 26th:-Thos. Morris Ward, Ollerton; Patrick Downey, York; William Hand, Northwich; George Alfred Rhodes, Wakefield; Sherard Freeman Statham, Cranford, Middlesex; William Emerson.

OBITUARY.

Died, Aug. 9th, at Edinburgh, Andrew Combe, M.D. Dr. Combe was the author of several highly esteemed works on Popular Physiology and Hygiène, and deservedly respected by his numerous friends, and by his professional brethren.

Aug. 10th, at Condonstown, of fever, David Barry, Esq., M.D.

Aug. 17th, at Lakeview, Mountnugent, of fever, Thomas Draper, Esq., Medical Attendant of the Dispensary and Fever Hospital of Ballymachugh, Cavan.

Aug. 20th, at Roscommon, of fever, Stephen H. Browne, Esq., M.D., Surgeon to the Infirmary and County Gaol, Roscommon.

Aug. 26th, at Oxford, aged 47, John Wootten, Esq., M.D., of Balliol College, Physician to the Radcliffe Infirmary.

Aug. 28th, Kenrick Watson, Esq., of Stourport, F.R.C.S., one of the earliest members, and a member of

the Council, of the Provincial Medical and Surgical Association.

Sept. 1st, in Gloucester Place, aged 74, Sir Richard Dobson, M.D., F.R.S., &c., Inspector of Hospitals and Fleets, and a Knight of the Foreign Orders of St. Vladimir, and of Dannebrog.

Lately, at Frankfort on the Maine, Sir John Hamme, M.D.

BOOKS RECEIVED.

A Guide to the Use of the Buxton Waters. By William Henry Robertson, M.D., Physician to the Buxton Bath Charity. Fourth Edition revised. London: Churchill. 1847. pp. 32.

The Consciousness of Right and Wrong, a first Test of the Plea of Insanity in Criminal Cases, &c. By C. Lockhart Robertson, M.D., Medical Staff, attached to the Military Lunatic Asylum, at Yarmouth, &c. Edinburgh. 1847. 8vo. pp. 18.

Health of Towns and of London Associations. Unhealthiness of London, and the necessity of Remedial Measures, &c. By Hector Gavin, M.D., F.R.C.S.E., Lecturer on Forensic Medicine at Charing-Cross Hospital. &c., &c. London: Churchill. 1847. 8vo. pp. 69.

The Microscopic Anatomy of the Human Body, in Health and Disease, &c. By Arthur Hill Hassall, F.L.S., &c. Part X. London: Highley. 1847.

On the Structural Relation of Oil and Albumen in the Animal Economy, and on certain Physical Laws connected with the Origin and Development of Cells. By John Hughes Bennett, M.D., F.R.S.E., &c., &c. (Read to the Royal Society of Edinburgh, April 19, 1847.)

ᎬᎡᎡᎪᎢᎪ.

Page 456, col. 1, line 14 from foot, for measure parted read manner secreted; line 10 from foot, for hæmo rrhagia read menorrhagia.

Page 466, col. 1, line 16, for natural read mutual. Page 467, col. 1, line 5, for representation read representative.

Page 458, col. 2, in Mr. Higginbottom's paper, On the Use of Nitrate of Silver in Erysipelas, the quantity of water employed in the solution is erroneously stated at four ounces instead of four drachms. The prescription should stand thus:

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PROVINCIAL

MEDICAL & SURGICAL JOURNAL.

THE LAW OF THE MORPHOLOGY OR METAMORPHOSIS OF THE TEXTURES OF THE HUMAN BODY.

(Fourth Series of Experimental Researches.) By WILLIAM ADDISON, M.D., F.R.S., Malvern. (Concluded from page 342.)

"It were disgraceful, with this most spacious and admirable realm of nature before us, where the reward ever exceeds the promise, did we take the reports of others upon trust, and go on coining crude problems out of these, and on them hanging knotty and captious and petty disputations. Nature herself is to be addressed; the paths she shows us are to be boldly trodden; for thus, and whilst we consult our proper senses, from inferior advancing to superior levels, shall we penetrate at length into the heart of her mysteries."-HARVEY.

INFLAMMATION.-(Continued.)

The texture covering the outer and front part of the eye-ball is termed tunica conjunctiva, and is ranked as a mucous membrane. Analysed with a microscope, it is found in its natural and adult condition to be a thin, elastic, transparent, and simply fibrous texture, sparingly supplied with blood vessels. (Fig. I.) But in its embryonic or growing state, numerous nuclei and corpuscular forms are dispersed among the fibres,

especially along the interior margin of the walls of the nutrient vessels. (Fig. II.) The fluid excreted [by this texture in health is very small in quantity, merely sufficient to moisten the eye, and more resembling water than mucus.

CASE.

Inflammation of the Tunica Conjunctiva: Purulent Ophthalmia.-A labouring man, aged twenty-seven years, applied for relief from purulent ophthalmia in the left eye, which had existed seven days. The eye-lids were closed and much swollen, and upon my opening them, a large quantity of thick white matter escaped. On examiration, the cornea appeared almost buried beneath a very red texture-a fungosity "having a kind of fleshy appearance," into which the natural texture just described had become transformed.

With a pair of curved scissars I cut off a portion of this red and flesh-like mass, the patient at the time complaining of considerable pain. The texture thus removed was, upon trial, found to be strong, elastic, and not tearable; and on submitting it to examination

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Fig. II.-Nutrient vessels in the fibrous areolar texture of an infant two days old.

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determine which were due to refraction and which were not.

The fibres were of two kinds; the one simple and identical with those seen in the areolar textures, and in the fibrillated protoplasma (buffy coat) of the blood; the other thicker, with a double outline, and terminating in, or springing from, a cell at its extremity. With a little care I obtained a good view of, and was able to

with the microscope, it was found composed of numerous blood vessels containing the usual red and colourless particles, and of four distinct elements, colourless cells, fibres of different kinds, granular matter, and molecules. The colourless cells greatly predominated, occupying the interstices of the fibres. They were filled with molecules; and in some there was one, in others two or three larger rounded or oval particles termed nuclei, with a dark or light spot inace for a considerable distance, some of the smallest of their centre. Of these nuclei, it was impossible to say which were natural and belonged to the normal constitution of the cells, and which were spurious, or formed subsequently to the removal, by the corrugation of the molecular elements; and of the dark and light spots seen in the centre of these nuclei, I could not

the vessels, with a power 750. Their coats or walls were comparatively very thick-that is to say, they were on either side twice or three times the breadth of the slender blood-column still visible in their interior. They were composed of the four elements before mentioned-viz., colourless cells, fibres of two kinds,

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Fig. III-Vessels in the inflamed, red, and thickened conjunctiva, (purulent ophthalmia.)

nuclei, and molecules. (Fig. 3). No distinction among the pre-existing and new-formed normal fibrous

could be drawn between the fibres of the coats of the vessels and of the more distant texture; and it was impossible also to distinguish any difference between the colourless cells still visible in the blood, and those of the coats of the vessels of the texture distant from the vessels, and of the white opaque excretion, except it was observed, that the cells at the inner margin of

the vessels, those nearest to, or in actual contact with, the blood column were smaller, and had smaller nuclei than those at the outer margin of the vessels, and of the purulent excretion.

In this example, then, there was an increased redness and vascularity, an energetic nutritive activity, and new nutritive elements constituting the phenomenon termed inflammation. The physical and vital properties of the texture being at the same time exalted and not diminished; for the texture was not brittle, but equally, if not more strong, elastic, and untearable than before; it was not less but more sensible and impatient to the impressions of light and touch, and the microscopic analysis proved that its swelling in growth was due not to any retrograde change or transformation of the natural fibrous elements, but to the increased quantity of blood to the new vessels and the new cell-elements interspersed

elements.

It is unnecessary to give any account of the treatment of the case which resulted in "the injured eye being restored to its natural state;" and, (as before observed, with respect to the fractured bone,) the organ being restored to its natural state, the metamorphosis was natural; and being natural, it was also conformable or regular. During the progress of the cure, (that is to say, during the return of an abnormal nutritive activity and an irregular morphology, to normal nutrition and a regular morphology,) the following events and changes were noticed:-The eye became less impatient of the impressions from touch and light; the swelling or fullness of the eyelids diminished; the quantity of opaque white matter discharged was less, and the red and flesh-like texture diminished in bulk, and daily became paler and less vascular; the colour of the discharge at the same time altered; its whiteness and opacity diminished; it was more transparent and mucus-like, then thinner and more watery, the later stages of the diminishing vascularity and excretion being more rapidly passed through than the former.

MORPHOLOGY OF THE TEXTURES.

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the physical and vital properties of a texture, and the function of the organ of which it forms a part. Thus in

some of the inflamed lobules is denser, and quite as coherent as the normal texture, grating against the edge of the knife like a fibro-cartilaginous texture, the morphology being of the abnormally ascending order, whilst the texture of other lobules is soft, brittle, and almost purulent. · In both conditions the air-cells are filled up and obliterated, and both, therefore, though differing essentially in their morphological types, are equally incompatible with, and destructive of, the respiratory function.

XV.-STHENIC AND ASTHENIC INFAMMATION:

ACUTE AND CHRONIC DISEASES.

In the case of inflammation of the outer texture of the eye-ball just related, the normal fibrous elements preserved their integrity, and the new corpuscular elements accumulated by the nutritive energy were discharged, or thrown off in the excretion. But now we have to examine analytically, other instances of inflammation in which the abnormal corpuscular elements, from the situation of the part affected, cannot be excreted, but become organized, assume a morphology, and constitute adventitious texture upon the normal structure.

I have avoided multiplying facts, about which there can, I think, be no reasonable question raised; and taking therefore this case as typical, it furnishes in-inflammation of the lung, (pneumonia,) the texture of telligible grounds of distinction between inflammatory and scrofulous diseases, and a rational explanation why the former, as a class, are susceptible of cure, with a return of healthy function, and why the latter, as a class, are so difficult. But first let us notice more particularly the points of relation or identity, and then the essential distinctions between inflammation and scrofula. Both inflammation and scrofulous diseases are found in the same textures-in living vascular textures, in which a nutritive action or metamorphosis is already going on; in both there is a more or less increased supply of blood,—an increased number of new vessels,-a new nutritive energy, and new cellular or protoplasma elements; these being the points of relation between inflammation and scrofulous disease. The essential points of distinction are, that in inflammation the natural elements remain, the new blood-vessels, the increased quantity of blood, and the new nutritive elements, being interspersed among the normal elements, which do not undergo any essential change, or retrograde transformation; on the contrary, the microscope proves that their amount is increased rather than diminished; and experience declares that the vital properties of the texture are exalted. Whereas in scrofulous diseases the microscope proves that the natural elements of the affected textures are changed and disappear, the new vessels, the increased supply of blood, and the new nutritive elements, establishing a morphology of a different kind, and of a lower grade than that necessary for the preservation of the normal elements, bones, cartilages, fibrous and the coherent parenchymatous textures, being reduced to highly vascular and energetic fungosities, or villous corpuscular textures, -excreting abundantly early protoplasmatous and corpuscular forms, to the prejudice and destruction of the higher natural elements, experience at the same time corroborating the testimony of the microscope, by testifying to the gradual disappearance of both the physical and vital properties of the affected textures.

Hence, therefore, in inflammation, when the nutritive energy and its accompanying phenomena have been subdued by appropriate treatment, the normal elements not having been destroyed, again resume their accustomed appearance and healthy functions; whereas, in scrofulous diseases, when the abnormal nutritive energy has been subdued, there are no longer the requisite normal elements to resume their usual appearance and healthy function. Hence the difficulty of curing these diseases; and why, when cured, we meet with opacities of the cornea, scars upon the skin, stiff joints, deformed bones, shortened fingers, and puckering in the lungs. But in the morphological study of disease, it is necessary to distinguish between

"In no part of the organism" says HASSE, "are the organized products of inflammation more marked than upon the free surface of the pleura, where we meet with solid and fluid matters of every gradation and variety."

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The first appearances of inflammation of the pleura consist in a congested state of its blood vessels, which are seen congregated here and there in dense though delicate nets beneath the still transparent membrane, which now, however, speedily loses its smoothness and transparency, becoming thicker and more dull. At numerous points the bright red colour deepens; these points are somewhat prominent, and crowd together, being encompassed with a progressively enlarging zone of congested blood-vessels. The first rudiments of an adventitious product now become perceptible, the points originally reddened presenting little dull white or yellowish spots, which rise above the serous surface, and often veil the inflammatory redness so thoroughly that it requires a practised eye at once to detect it. During the above proceeding in the serous membrane, the areolar texture between the fasciculi of the intercostal muscles, and also that between the pulmonary lobules, is distinguished by an increased vascularity, and its interstices are filled with a half-fluid, halfgelatinous effusion.

HASSE describes the adventitious products of inflam< mation of the pleura under the following heads :-The gelatinous, the conditional, the purulent, and the tubercular.

• "Pathological Anatomy," Syd. Ed,, 1847, p. 181.

In all cases of inflammation of the pleura, a gela- | operation has been sometimes once or twice repeated, The first operation frequently gives vent to a clear serum, but when a second or third is required, an opaque and flaky pus escapes. The former occurrence denotes that the gelatinous and conditional products have undergone a fibrous morphology, analogous to that of the protoplasma of the blood when withdrawn in venesection, and it is well known to be the most favourable to the recovery of the patient; whereas the latter occurrence denotes an unconformable morphology and is unfavourable. Moreover, persons who have recovered from an attack of pleurisy, and have afterwards died of other diseases, have been carefully examined; and in such cases the adventitious products of the pleurisy, are found fibrous or fibro-cartilaginous; whereas, in those who die of pleurisy, we find the conditional and purulent products-the early, soft, vascular, and corpuscular excreting textures.

tinous product is speedily diffused between the costal and pulmonary surfaces, blood-vessels form in it with surprising rapidity, and where the two surfaces approach each other, a few days appear sufficient to effect a tolerably firm coalition between them.

The conditional products consist for the most part of several homogeneous or else distinctly different layers, largely investing, and adherent to, the pleura. They tear easily, and display a pseudo-fibrous texture. Their surface directed to, and adherent on, the pleura, corresponds in character to that membrane; but their free surface facing the cavity of the pleura is usually soft, and displays a villous fabric. When these conditional products are present, the cavity of the pleura usually contains a considerable amount of either a light-brown, or a reddish, or else a flocculent fluid, bearing, it would seem, a close relation both in quantity and quality to the false membrane itself.

In the purulent form of the product, the surface of the pleura is dull, and of a dingy grey, covered with very soft granulations, or with soft and brittle puriform false membranes, which are either loosely adherent to the pleura, or else float as soft flakes in the collected fluid.

"The tubercular constitution," says HASSE, "is the frequent source of peculiar modifications; it changes the products of nutrition, and exerts a palpable influence upon the formative process when heightened by inflammation." The peculiar modifications here alluded to have been treated at length in the present memoir, and it remains only to remark, that tuberculous matter frequently manifests itself in the false membranes of the preceding conditional form, which, as HASSE remarks, is inaccessible to the vascularity pervading the texture in which it is embedded.

Hence, then, it appears that as scrofulous diseases are retrograde morphological conditions of the growing normal textures, and chiefly, therefore, observed in children and youth, so inflammatory diseases are asthenic, and the constitution bad, when the products accumulated by the nutritive energy or inflammation, persist in a morphological type or growth, which is below or retrograde in comparison with the texture from which they spring. The truth of this conclusion cannot be rightly estimated during life by the health of the patient, and it is necessary again to point to the distinctions between the mor phology, which has regard to the forms of elements and textures, and the office or function of the organ of which they form a part. The morphology of the adventitious products of pleurisy may be conformable, assuming a type identical with that of the texture from which they arise; but if they be so abundaut or so related as to impede the motions of the lung, the function of the organ will be impaired, and, notwithstanding the conformability of the morphology of the pleuritic products, the nutrition of the whole body will thereby be asthenically inclined; and thus many persons who have recovered from an attack of pleurisy, (considered in its inflammatory form,) have from this source, had their constitutions weakened, and incurred a liability to asthenic forms of disease for the future.

These observations regarding the distinction between sthenic and asthenic diseases, and the conclusions deduced therefrom, are further illustrated and con

Now, the gelatinous and conditional products of pleurisy, are early morphological forms, consisting of protoplasma and slightly cohererent cells, which, when they become organized and vascular, are in all respects analogous to an embryonic texture, and it appears that by the subsequent morphology of these elements, the sthenic or asthenic character of the disease, and the good or bad constitution of the patient are determined. For if a severe form of pleurisy be cured, it is so by the gelatinous and conditional, or purulent products, the soft vascular excreting textures,-undergoing the fibrous or fibro-cartilaginous metamorphosis. So also, if a scrofulous joint or a pulmonary consump-firmed by the history and phenomena of gout and tion be cured, it is by the same morphological forms, the soft, vascular, excreting textures, passing onward into the non-excreting and less vascular fibrous or fibro-cartilaginous types; and in all these instances we say the constitution of the patient is good. In cases of severe pleurisy, the cavity of the pleura has been opened to allow of the escape of the fluid and non-adherent matters accumulated within it, and the

phlebitis. Gout is a sthenic disease. The ordinary phenomena of a first attack of gout,-the pain, heat, redness, and swelling, are well-known; but the morphological results of this increased nutritive energy have not been accurately regarded. Their conformable character, however, in the first or early paroxysms, is shewn by a copious exfoliation of the cuticle or epidermis over and for a long distance around the part

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