difficulty attends the motions of the joints, after ascending great elevations, which arises from the diminution of the pressure of the atmosphere. So, too, the difficulty of moving the joints after long immobility is well known, and indeed mere immobility without active disease may lead to anchylosis. By maintaining the layers of the peritoneum in a state of perfect contact, and thus preventing the occurrence of secretion impeding the union, adhesion between these may be produced, which is not the case in regard to mucous membranes. The same ideas explain the ease with which adhesions between the parietes of serous cavities are formed after effusions. The danger attending wounds of the joints and serous cavities has been long known, but its explanation or prevention have not been suggested heretofore; but now that we are aware of the influence of the pressure of the atmosphere upon the mechanism of the exhalations, the determination of the results which may follow the cessation of this condition is easy. The air, penetrating freely into the serous cavities, then, impedes the mechanism of the secretion of their fluids, which should be induced by a periodical suction, exerted at the orifices of the exhalent vessels; these vessels, by the stoppage of such exhalation, become overcharged with the stagnated fluids, and the ill-consequences, so often seen, result.

A necessary consequence of this theory, is the institution of rules, which have indeed long prevailed empirically, viz. to endeavour as far as possible to exclude the air from the serous cavities and joints, and to promote its expulsion, as soon as possible, if already admitted.

V. The case of dislocation of the cervical vertebra we noticed some time since, and a re-perusal of the report does not induce us to change the opinion that we expressed, of its being very doubtful whether any dislocation had really taken place.

M. Guerin's works may be perused with advantage, and although we think that some of his conclusions are too general, and rather too hastily arrived, at, yet most of them are well illustrated by experiments, preparations, and allusions to cases which have fallen under his own observation. His theory of the production of deformities gives an intelligible explanation of a large class, the nature of which was heretofore involved in much obscurity; and his doctrines of subcutaneous surgery, susceptible as they are of an extensive application, demand the earnest attention of operating

surgeons.

*Medico-Chir. Rev. No. 67, p. 239.

OBSERVATIONS ON TUBERCULOUS CONSUMPTION, &c. &c. By J. S. Campbell, M.D. Senior Physician to the Marylebone General Dispensary, &c. 8vo. pp. 402. Bailliere, Oct. 1841.

THIS is a most laboured essay, more than half of which (221 pages) is taken up with recondite disquisitions on life, necessity, vital actions, tubercles, humoral pathology, inflammation, &c. &c. in which the author has evinced abundance of ingenuity, research, and talent for investigation.

We must, however, pass over the first part of the work, merely exhibiting the CONCLUSIONS which our author has drawn from the matters contained therein.

"In concluding this chapter it may be desirable to take a rapid glance at the points which it has been my endeavour to establish in the preceding pages. I have considered tubercular consumption not as a simple but compound affection, essentially consisting of distinct stages, and distinct varieties of morbid action, some of which are referrible to the organ immediately involved, and some to distant parts, their morbid influences being reciprocally propagated through the medium of the blood.

First, I have considered as, very generally, a demonstrable fact, that the malady is primarily ushered in by manifest derangement in those earlier actions of the process of nutrition by which the heterogeneous matters of aliment are converted into chyle.

Secondly, that the immediate influence of this error is directed to the blood, whose venous current becomes charged with unhealthy particles which the lungs fail to identify with the common mass in a due and proper manner.

Thirdly, that though this state of the blood exists, to a greater or less extent, in all cases of strumous habit, it does not necessarily lead to the actual location of tubercle either in the lungs or system.

Fourthly, that this condition of the blood forms one of the elements necessary to the production of the local affection, but that this requires for its full establishment, the presence of a peculiar structural condition of a portion of the capillary vessels connected with one or other of the circulations.

Fifthly, that the location of tubercles owns a mechanical cause, and depends on a change in the natural healthy relation which the particles of blood bear to the tubes through which it flows; and that tubercles are hence constituted by innumerable minute points contained within the calibre of obstructed vessels.

Sixthly, having in this manner attempted to trace the successive steps by which tubercular disease of the lung becomes established, I have approached the question of these phenomena which appear to depend on the re-action of lungs so circumstanced towards the system, endeavouring inferentially to show, that those are mainly dependant on an imperfect condition of the arterial blood, necessarily resulting, in many instances, from the existing condition of portions of the lung.

Seventhly, that this condition depends on a continuance of the pulmonic circulation through parts of the organ to which air no longer finds admission.

Whether these conclusions are warranted by the observations and reasonings contained in the preceding pages, must be determined by others than the author. I shall only here add, that as they were gradually arrived at by a careful examination of the malady, both in its vital and physical relations, so they have also appeared to afford a somewhat substantial foundation, on which to rest principles of treatment, whether directed to its alleviation or cure. To this portion of the subject it is now my duty to proceed." 217.

TREATMENT.

At the fourth chapter the important-the most important, because tangible-portion of the work begins, with "Is CONSUMPTION CURABLE?" We regret that our author did not, at once, refer to that noted "FELLOW" of Ely-place-that dignified member of our Profession-that eminent "BELLOWS-MENDER" of Holborn, who daily hints in the newspapers, that he can "stop holes in the lungs" with as much ease as his Brother Tinkers can mend the bottoms of saucepans. This would have saved a world of disquisition, the result only of which we shall here quote for the edification of the profession, and the consolation of the HEctic.

"Passing over, therefore, for the present, any further allusion to the means by which consumption is most surely indicated, and assuming that the evidence of its existence in the cases subsequently stated, was tolerably perfect, I shall proceed at once to consider the methods of treatment employed, and the principles on which this rests as directly connected with the general pathology of the disease set forth in the preceding pages; and I do so with the preliminary statement of my conviction, founded on no very limited experience, that as a matter of fact, phthisis is not only frequently arrested in its progress, or remedied after full development by some obscure sanative effort of the system, but that, besides this, it is a disease amenable to the control of remedial means when these are applied in a proper manner, and directed under the guidance of a rational patho logy." 221.

Whether the latter part of the passage, which we have marked in italies, correspond with the general experience of the medical world, we leave to our readers. It is rather at variance with our own experience.

The term cure is somewhat qualified by our author. By this phrase he does not mean to "imply the entire restoration of function and organization," but "such an approach to this as enables the individual, under certain limitations and modes of management, to carry on life without inconvenience," &c. We are quite ready to agree with Dr. Campbell, that Nature has given man such an ample apparatus for respiration, that a portion of lung may be rendered unfit for its ordinary functions, and yet the individual may go on performing the common duties of life for many years. We know hundreds of people who have considerable portions of lung hepatized perhaps tuberculated-and only experience dyspnea on making much exertion, with thinness and debility. If, therefore, we can devise the means of preventing the further deposit of tuberculous matter, before the lungs are too much charged with this destructive agent, we may prolong life, and even insure a comparative degree of health.

"The pathology of consumption, already sufficiently explained, recognizes three stages:—

First, A primary stage, connected with erroneous action of the digestive organs, in consequence of which the matter of tubercle is presumed to be produced.

Secondly, A deteriorated state of the blood induced by this, during the continuance of which, that fluid presents one of the conditions necessary to the formation of tubercles, their location being contingent on a peculiar pulmonic organization, whose presence is therefore essential to a full production of the

disease.

Thirdly, A stage of re-action towards the entire organs and functions of the body, as a direct result of tubercles after their location, the intensity of this being dependant not on their amount alone, but also on the peculiar influence which they frequently exert on the pulmonic circulation.

The indications of cure, which arise as direct corollaries out of these positions, are consequently three also:

First, To counteract that morbid state of the digestive organs originating the matter, without which tubercles cannot be produced.

Secondly, To accomplish a solution of this matter, after it has passed into the blood, and thus arrest its local deposition, presumed to depend on mechanical retention in the extreme vessels of the pulmonary artery.

Thirdly, To place and retain the patient under such circumstances, in reference to his medical, dietetic, and general treatment, as seem on rational principles best calculated to meet those evils which result, from the existing state of his respiratory organs, thus affording time for removal by the natural process of softening of such tubercles as already actually exist." 225.

Our author acknowledges it as very improbable that we can remove the hereditary disposition to struma, and that we can only hope to counteract this tendency by improving the state of the digestive functions, and purifying the blood of its noxious ingredients. Dr. C. believes that strumous dyspepsia may exist without tuberculous deposition, but the latter never takes place without "strumous dyspepsia." Whether this be absolute or not, no harm can ensue from paying great attention to the said dyspepsia when it presents itself to our observation. It is characterized by two sets of symptoms-irritation of the mucous membrane of the bowels, and depraved secretions, especially of the liver. The papillæ of the tongue are red and prominent, often projecting through a dirty whitish fur, occupying the back and central surface, leaving the edges clean and bright red. The tongue itself is generally moist, flabby, and tremulous-sometimes dry and glazed, when the disease is intense. The tendency of the bowels is towards constipation, the evacuations being seldom healthy.

"The matter extruded is mixed with mucous or gelatinous discharges, sometimes tinged with blood, and various depraved secretions which render the stools frothy, green, and fœtid; on other occasions the motions are of a colour considerably lighter than that of health, from an apparent suspension of the biliary secretion, while on others the liver acts with an augmented activity, of which a bilious diarrhoea is the result.

During this state of things, the abdomen is, almost constantly, tumid and drummy, the appetite capricious, though generally keen and craving, but nutrition languishes almost in proportion to the quantity of food which is received, and the lower extremities especially become weak and emaciated, sometimes appearing like slender dangling appendages to an inordinately bulky trunk." 229.

We need hardly remark that every medical practitioner is constantly in the habit of seeing daily such symptoms as the above in numerous cases, not one case in twenty of which leads to consumption, or indicates that disease, unless the fatal congenital or hereditary disposition or predisposition exists in the lungs themselves to receive these tuberculous deposits—or, where repeated attacks of inflammation in pulmonary structure itself have not occurred. This, indeed, is acknowledged by the author himself.

"The condition which they (the symptoms above mentioned) announce may

become engendered, we have reason to think, even in a body of the most healthy structure, from various causes, such as bad or deficient food, impure air, and the like, especially during the earlier periods of life, but it is certainly more commonly found and more readily excited in those persons, stamped by what has been termed, a phthisical diathesis-a form of constitution undoubtedly transmitted downwards from parent to child, and often found to prevade the members of a whole family through many generations." 230.

We may safely pass over the signs of phthisical diathesis as familiar to every student who walks a hospital. Although disordered conditions of the digestive organs and depraved secretions may doubtless accelerate the progress of tubercular deposition in the lungs or even occasion that deposition, we firmly believe that another cause, or class of causes, is far more efficient, and far more frequent-we mean irritation or inflammation in the air-passages, induced by cold, by damp, by imperfect clothing, and various atmospheric impressions, in consequence of which an afflux of blood, whether good or bad, is kept up in the lungs, and tubercular deposits accelerated or produced. While we attend to this portion of etiology, however, we have no objection to keep a strict eye on the one now under consideration-STRUMOUS DYSPEPSIA. Dr. Campbell's remarks on diet are judicious. In cases of this kind, it ought to be easy of digestion and containing nutriment of easy extraction by a disordered apparatus.

"Experience appears to determine that this is best accomplished by the employment of a mild farinaceous diet, which possesses the advantage of being converted into chyle, without producing that irritation of the digestive organs which more highly animalized articles but too generally excite. In milk we have presented to us an intermediate fluid, which from the very earliest ages has been extolled in the treatment of consumption in all its forms, and is not less adapted to its preliminary stage of which we now treat. There are very few cases in which it will not agree with the stomach, and should, in combination with the farinaceous food already named, form a large part of the diet employed." 235.

We are not prepared to go the whole length with our author on this point. The chief period of tubercular consumption lies between the age of fifteen and thirty-five, and when the digestive functions are much impaired, and the secretions vitiated. We shall find, in a majority of cases that milk will not agree, and, if the object be easy and complete digestion, plain animal food will answer better than milk. In respect to farinaceous food, it may be recommended where there is a tendency to inflammatory action in the respiratory apparatus, but it certainly is not the very best kind of nutriment for those who are disposed to strumous affections.

In the mean time we have morbid secretions to correct, local irritations to subdue, vigour to communicate to weakened organs of digestion, and many other indications to fulfil, not very easily done-the one ofen clashing with the other. In hepatic derangements, the author very properly condemns the frequent recourse which is had to calomel, when small doses of the pil. hyd. or the hyd. cum creta would be better. Thus a grain or two of the latter medicine with a little rhubarb and ginger, given every or every second night, till the colour of the secretions becomes natural, will be preferable to the chloride of mercury in most cases. When cough and irritation of the pulmonary apparatus show themselves at an early period of the disease, our author places great dependence on ipecacuanha com