ciple. What was the reason of this?-simply because one chemist followed the dicta of another, without examining the subject for himself. And so it has been with the examination of the blood and other fluids of the body in a state of disease. Have we any decisive experiments to prove that there is no appreciable difference between the blood of a person in perfect health and of one labouring under wellmarked gout? We are well aware of the great difficulty of conducting such experiments, and of the numerous sources of fallacy to which they are exposed; but certainly when we see that a large quantity of acid matter is eliminated from the system, either by the urine or by the formation of tophaceous nodosities about the joints during an attack, we naturally suspect that it previously existed (perhaps not in a free or easily recognised state) in the fluid from which every secretion is derived; and when we find, moreover, that by attention to diet, so as to avoid all indigestible and acescent food, and by the regular use of gentle alkaline remedies for a short time, the tendency to return of the disease is in a great measure prevented, our suspicions surely acquire the force of very reasonable presumptions.

Gout is the disease of all others which should be examined in all its bearings on those broad and comprehensive principles of analytic research, which M. Liebig has of late years introduced into the study of animal and vegetable chemistry. The peculiarities of the individual's constitution should be studied; the nature and composition of the food taken should be ascertained; the character and the amount of the excrementitious matters rejected from the system should be examined; and the influence, moreover, of diet on these should be carefully watched and noted. There is something faulty, we may rest assured, at some part or another of the elaborative process, by which the nutriment is converted into, and becomes assimilated with, the circulating fluids; some compound perhaps formed which is not formed in a state of perfect health, and which, acting as a noxious foreign matter, requires to be discharged at some emunctory-otherwise a morbid process, or in other words, a paroxysm of gout will be induced. For what is an ordinary attack of gout, but only a crisis of an antecedent illness, or, so to speak, an effort of the system to throw off some peccant matter which has become generated within the body? It would be easy to extend these remarks, and to point out how strictly this view of the disease is in accordance with the results of experience as to the most successful treatment of its various forms; but this we cannot do at present.—Rev.

M. TESSIER ON HEMOPTYSIS.

There is certainly nothing very original in the following remarks, except perhaps the style of language that is here and there employed. Surely our learned neighbours would do well to use a simple form of speech rather than have constant recourse to phrases which serve to mystify, not to explain.

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Hæmorrhage from the lungs may arise from various causes. Sometimes it is the result of a violent exertion or muscular effort, as running, rowing, lifting a heavy weight, &c. At other times, it is induced by the suppression of an accustomed discharge, as that from piles, &c. In a third set of cases it seems to be idiopathic and constitutional; it may then recur so frequently and so profusely as to cause the sudden death of the patient-as we recently saw in a strong athletic man, in whom however no very distinct lesion of the lungs was discoverable on dissection. In a fourth set of cases the loss of blood is connected with a tubercular state of the lungs; this complication is unfortunately the most frequent occurrence of all.

"Under the circumstances first alluded to, the treatment is very simple; the medical man should not be over officious; there is often no occasion for having

recourse to bleeding or other active measures; all that is necessary is to enjoin great quietude for a time, and to use such means as are best suited to prevent the recurrence of the hemorrhage. If, however, there be a tendency to its return, it will very generally be proper to draw blood, unless there be some wellmarked contra-indicating circumstances to dissuade the practice. For example, if the patient be at all phthisical, bleeding is to be used only with the greatest reserve, even although the pulse at the time be hard and concentrated. A most important therapeutic principle, with respect to the employment of this remedy, is that it should be in all cases subordinate to, and regulated by, the condition of the patient's constitution.

"Certainly the most precise index, as to the state of the vital forces and the functions of organic life, is the pulse. If this be hard, and if at the same time the disease is still in the state of concentration, there is a strong motive to draw blood, in consequence of the existing plethora, the exaggerated sanguification, and the tendency there must be to congestion in different parts of the body. By relieving the excess of the circulating fluids, we induce a critical change which is often most salutary.

"But in place of there being any genuine plethora, we may have to do with a case where the hæmoptysis co-exists with a dimunition in the energy of the vital forces, or again with a simple oppression of their activity, or lastly with a genuine. atony of the whole system. In such circumstances, we should carefully examine the existing state of all the great organs of the body, in order that we may discover how each function is performed; as it is not unfrequent to find that a disturbance of the stomach, or liver, or kidneys for example, has had something to do with the pulmonic affection. If there is a decided saburral state of the stomach present, we should have recourse to an emetic. Stoll observed great advantage from the practice in a number of cases, to which he gives the name of bilious or gastric hæmoptysis. By getting rid of the gastric disturbance, we remove one of the principal elements of the disease, and we reduce it to a state of greater simplicity. Having destroyed one of the morbid states, we attack the other by means of blood-letting and other remedies."

M. Tessier then describes what he calls a nervous form of hemoptysis, which is apt to occur in highly excitable females. His remarks however on this subject are exceedingly unsatisfactory and obscure; we suspect that he describes the disease rather from fancy than from actual observation. Does he allude to the not unfrequent form of pulmonic hæmorrhage that is liable to occur, when the catamenial secretion is very irregular or perhaps totally suppressed? If so, we can understand him; but not otherwise; as we never saw a case of what we should think of calling nervous hæmoptysis. The following passage may possibly be meant to apply to the amenorrheic form of the disease.

"The hæmoptysis, which is apt to occur in anæmic subjects, requires the exhibition of steel, bitters, and balsamic medicines. We must be careful not to confound such cases of passive hæmorrhage from the lungs with that form of the disease, which is connected with the presence of tuberculous deposits. In passive hæmoptysis, the blood rejected is usually of a black colour, diffluent and not so plastic as in health; the pulse too is usually soft and weak, and the muscular system flabby."

M. Tessier then treats of an intermittent form of hæmoptysis, which requires the use of bark for its cure; and closes his general remarks by acknowledging that there is sometimes no little difficulty in forming a correct opinion of the pathology of pulmonary hæmorrhage, and in determining the exact nature of the prevailing morbid element in each form of it. He insists particularly on the necessity of perseveringly continuing any mode of treatment for a length of time; and, by way of illustration, he alludes to a curious case in the practice of his experienced colleague, M. Recamier, who, by bleeding a patient three hundred times (!) in the course of two years, succeeded in finally subduing une affection des plus rebelles."-Gazette des Hôpitaux.

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REMARKS ON PHTHISIS.

There is much good sense in the following clinical observations, by the physician of the Hôtel Dieu, on this, alas! too well-known disease of every country.

"It is important to discriminate correctly the different periods or stages of phthisis, and to distinguish the various forms under which the disease is apt to appear; as much depends on the first of these considerations how our prognosis should be formed, and on the second, what remedial means hold out the best promise of relief, if not of cure.

"Each of the periods of phthisis has its peculiar therapeutic indications that require to be fulfilled; and it not unfrequently happens that there is a contradiction between those pointed out by the local, and those by the constitutional symptoms.

"The age too of the patient is a very material point to be taken into account, in our prognostic consideration. As a general remark, it may be said that there is much greater chance of arresting the course of phthisis after the age of 35 years, than at an earlier period of life. We not unfrequently observe, that, after the mezzo cammin di nostra vita,' the disease remains stationary for a length of time; and its duration may then be protracted for two, three, or even more years. But even under such circumstances as these, a real cure is seldom or never effected; the progress of the disease may be retarded, but it is no less surely fatal at last. We may soothe the suffering; we may check the symptoms as they arise; but all the while the weakness goes on increasing, and the vital energies are becoming more and more exhausted. The patient himself, perhaps, will not admit this; but his attendants too distinctly recognise the melancholy truth, and are forced to allow that, although their friend is much easier than he may have been, he is not at all capable of standing more fatigue-quite the

reverse.

"If the medical man does not bear this constantly in mind, he may allow himself to be deluded by the reports made to him, and thus fall into the unpleasant mistake of believing that there is a positive amendment-even up to the very day before dissolution. It is necessary for him not to permit his hopes to at all control his professional judgment; otherwise he will most probably be much blamed afterwards for his want of sagacity.

"There is thus often very little or no correspondence between the condition of the local and that of the constitutional disease: the latter may be much modified by appropriate treatment, while the former is gradually becoming worse and worse. How rare is it that genuine vomica or pulmonary caverns ever undergo any salutary change! They may, indeed, under the influence of certain medications, contract somewhat in their dimensions, and the nature of their contents may become altered; but any real and permanent amelioration is not to be

expected.

"Nevertheless, it is the duty of the physician never to neglect the use of any means which may serve to allay each symptom of distress as it may arise. Much may be done in this way, to prolong the life and soothe the suffering of the patient."-Gazette des Hôpitaux.

Remarks. It has often occurred to us that medical men generally overlook far too much, in the treatment of such prolonged and distressing a disease as pulmonary consumption, the influence of the moral and religious feelings upon the progress and duration of the morbid changes. He, indeed, must be little of an observant practitioner, who has not remarked how much more rapid the course of one case is than that of another-quite independently of the extent of the existing lesion of the lungs, or of the general strength of the patient's constitution.

Now what is the cause-or, to speak more guardedly, one of the causes-of this difference? Is it not, (often at least.) the state of the sufferer's mind and feelings and does not much, very much, depend on the simple eircumstance whether these be calm and patient, or restless and unsubmissive?

The man, who regards every bodily affliction, not as a casual or chance occurrence, but as a chastening visitation of a Higher Power to try his faith, or to wean his worldly attachments, and who submits to them with a becoming composure, has a mighty advantage over him that views these things differently. Not only are the bodily sufferings of the former unquestionably less hard to bear at the time, in consequence of the greater tranquillity of his feelings, (for who has not found, in his own experience, that pain is worst borne when the mind is unhappy

Mensque pati durum sustinet ægra nihil)

but the very morbid change that is going on within the chest, is found to advance much more slowly and gradually to its fatal issue. And surely there is nothing to surprise us in this. Whatever disturbs the evenness of the circulation, will be observed to promote the progress of any structural disease: and how can it be otherwise? Do we not constantly find that, if there be any febrile re-action in the system, such processes as those of suppuration and ulceration are greatly accelerated? and is it not the daily practice of the experienced surgeon to use every physical means in his power to moderate and subdue such re-action after operations and accidents ?

Well, the restlessness of the feelings is a fever of the mind; and this cannot long continue without inducing its namesake condition in the bodily frame. The subject of the mutual re-action of mind and body is one the most important that can engage the attention of medical men; and yet it has never been treated as its value demands. We are all too much taken up with the physique, and too little with the morale of our therapeutic resources; and hence it is that most of us seem to think that we have amply fulfilled all our duty, if we but use our best skill in selecting from the materia medica the most appropriate remedies.

As a matter of course, we cannot enlarge upon this subject at present; but we are unwilling to lose the opportunity of expressing our own opinion of the vast importance of a religiously tranquil state of the mind in moderating the progress of organic disease, and therefore in prolonging life, as well as in blunting, at the time, the sharpness of all those aches and ills which flesh is heir to.-(Rev.)

CASES OF PLEURITIC EFFUSION, WITH REMARKS

In the present dearth of novel and instructive matter in the Continental Journals, we select the reports of two cases of this very serious affection, which we find recorded in the clinical lectures of M. Tessier at the Hôtel Dieu. On no disease has the improved pathology of modern times thrown more light than on this. Its diagnosis may now, in most instances, be satisfactorily established by means of auscultation, and we are moreover possessed of several potent curative means, if there has been no unnecessary delay in having recourse to them.

Case 1.-The first case occurred in a woman, who was admitted into the hospital with pleuro-pneumonia on the left, and simple pneumonia on the right side. The inflammation of the substance of the lungs was quickly arrested by bleeding, &c., but the pleuritic symptoms did not so readily yield, and effusion nto the left thoracic cavity was the consequence, so copious that the heart was

pushed over to the right side. Repeated blistering and the use of purgative and diuretic medicines failed to cause the absorption of the fluid.

The case had been in this state for about a month, when it was determined to make a trial of Galvano-puncture. The two first applications had a remarkable effect; for there was almost immediately afterwards found to be a diminution of the effusion to about four finger-breadths below the clavicle, the resonance on percussion having again become normal over this extent. After several other applications of the Galvano-puncture, the resolution of the disease appeared to be almost complete; the resonance being re-established over more than two-thirds of the chest. The patient, feeling himself to be so much better, insisted on leaving the hospital before a perfect cure was effected.

one.

Case 2.-The pleuritic effusion in this instance, also, was on the left side, and had supervened in a very similar manner to what took place in the preceding There was a visible enlargement of the left side; no respiratory murmur could be heard over it, and the sound on percussion was uniformly very dull, even in the sub-clavicular region. Symptoms, however, of a partial resorption began to make their appearance, and hopes were therefore entertained that the lung was not so much shrunk and contracted in volume, as it is usually found to be when the entire cavity of the chest has been filled with fluid-a state of the lungs that requires a long time before they recover their natural dimensions, even after the effusion has been dissipated.

It is in consequence of such an occurrence as this-the non-expansion of the lungs after the resorption of a copious pleural effusion-that many of those depressions and irregularities of one side of the chest, which are not unfrequently observed in deformed children, are to be traced. We have very little doubt, says M. Tessier, that, if the devolopment and progress of many cases of deformity in children were attentively watched, it would be found that they were often attributable to a pleural effusion that had become rapidly absorbed, while the lung had never recovered its normal dimensions.

This state of things is also not unfrequently observed in women-who, it should always be remembered are, in many respects, like children, both in their organization and in the diseases to which they are liable.

It is often stated, in books and lectures, that pleurisy is not a grave disease, and that it will generally give way to very simple treatment. This is a great error; inflammation of the pleura should never be regarded otherwise than as apt to be very serious in its consequences.

The treatment of the disease, when at all severe, will often require much practical discretion. For if bleeding and other depletory measures be carried too far, or their use continued too long, the tendency to effusion will be increased, while the active powers of the system may be too much lowered for the necessary absorption to take place with sufficient promptitude.

It is sometimes not an easy thing to determine the exact time when the change of treatment should be made. Now, it is in such cases, that the real value of auscultation cannot fail to be appreciated. If the effusion has already become very considerable, and the vital power has been much reduced. before a correct diagnosis has been formed, the medical man will be placed in a very difficult and often most perplexing situation. The time for the further employment of antiphlogistic remedies is past, and yet the use of stimulants is not unattended with danger.

A fatal termination may be the consequence of an officious or mistaken treatment, as well as of the progressive aggravation of the disease, or of an inflammatory attack on the other side of the chest, with or without effusion at the same time. There is always very great danger in such cases as these. The fluid may, indeed, be withdrawn by operation; but the lung will probably not be in a state to recover its normal expansiveness, and the respiration is, therefore, No. 94.-18