throughout, even to the most minute twigs, such as botanists call protracted efflorescence.

VII. GLANDS OF THE SEVENTH ORDER.

A complicated 1 amification in a lobulated gland, with trunks continuous and entire between the lateral branches of the excretory ducts, and the ultimate terminations of which are vesicular.

"An entire and continuous trunk of the excretory duct, which does not terminate in ramifications, but sends off smaller branches laterally, which pursue their course continuously, through its own lateral ramification, from which lobules of different degrees of size arise. For each trunk connects the larger lobes with the lateral ramifications, and the branches form with the twigs lobules of a second order. Finally, the most minute lobules are formed out of the ultimate particles which grow upon the smallest offsets of the twigs. The origin of these lobules is explained by embriology.

To this class belong the salivary glands, the pancreas, the mammæ and lacrymal glands of many mammalia.

VIII. GLANDS OF THE EIGHTH ORDER.

A compound ramification in non-lobulated glands, the trunks dividing into irregular branches, with ccœal, twig-like, or vesicular terminations.

"In this order the trunk continues through the lateral branches; it is soon lost in its own ramifications, gradually terminating in the most minute twigs. But if the whole organ be very much evolved, the whole organ puts on externally the appearance of a species of parenchyma, as in the liver of some of the higher animals, in which the liver consists of a system of small and large lobules, but offers only segments and incisions, 'Segmenta et incisiones.' "

IX. GLANDS OF THE NINTH ORDER.

Formed by Tubes and Vessels, and not of ramose Cœca.

"The elements of these glands are very long tubes, of an equal diameter from their origin to their terminatinn, either straight or winding, sometimes bifurcated from the beginning, and becoming simple after giving off their branches."

Of these M. Müller describes six forms, but we need not particularize them.

The Twelfth Book presents us with a very brief

SUMMARY OF ANATOMICAL OBSERVATIONS ON THE INTIMATE STRUCTURE

OF GLANDS.

The facts, says the translator, which have been brought forward demonstrate, that:

"However much secreting organs may differ in their conformation, they exhibit a continuous series through the animal kingdom from a simple follicle, without ramifications, up to the most complicated structure; consequently that there is no distinction between the secreting organs of the invertebrata and those of the highest animals; simple tubular-shaped follicles and convoluted cœcal ducts pass by a continuous chain through the different series of animals into conglomerate glands.

Secondly, that this boundless variety in form has simply relation to an increase of secreting surface, within a circumscribed space.

Thirdly, that the sanguiferous system which conveys the materials for secretion, is nowhere continuous with the ducts which contain that secretion, and that their connexion is solely that of the surface of one set of vessels with the surface of the other, the secretions being eliminated through the coats of the vessels, similar to the process of secretion which is constantly going on in the air-cells of the lungs.

Fourthly, that the vascular network which surrounds the secreting ducts, whatever may be their form, is composed of blood-vessels infinitely more minute than the ducts themselves.

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Fifthly, that the evolution of glands is similar in all classes of animals, and that the most complicated glands of the highest animals, originate in the embryonic stage from a single tube, like the simple secreting organs of the lowest.

Sixthly, that there is no correspondence between the form of the secreting surface and its product, as the existence of the same form in the kidneys of one animal, and the testicles of another, unequivocally demonstrates.

Seventhly, that as numerous nerves may be traced accompanying the renal arteries in the horse, and ramifying upon their surface, in the substance of the kidney, it is most probable that nerves form an important part in the structure of all glands.

The Fifteenth Book is made up of:

PHYSIOLOGICAL COROLLARIES ON SECRETION, PARTICULARLY OF GLANDS.

The nature of Secretion has always puzzled physiologists, and it is left as much in the dark by Müller as he found it. But there are some phenomena on which observation throws light, and which it is right to be acquainted with.

"The only rational explanation," says Müller, "of secretion is, to consider it as a metamorphosis of the animal matter, which the blood undergoes in various ways, while circulating through the organs.' The arteries terminating only in the veins the vascular circle is, pro tanto, closed, yet it appears that a proper membrane to the minutest vessels is not always to be found, and that observation teaches that new currents of blood spring up in the substance of organs, both in the embryo and the adult; in consequence of which arrangement, "the substance of any organ itself imbibes the blood, and assimulating its particles, changes them to its own peculiar substance."

"This metamorphosis, into substance, is threefold:-1. Blood is changed into the substance of different organs in nutrition; 2. Blood is changed into a more fluid substance, which, passing through the walls of an organ, is denominated secretion; 3. Blood is changed into substance, and having passed through the walls of organs, is immediately indurated."

"This last manner of secretion does not differ much from the true and genuine secretion. For these hard particles thus deposited in the walls of an organ were fluid in the first instance, and it is in this way that the hair, feathers, shells, scales, and nails are produced."

All secretion takes place on a surface, whether it be that of an expanded membrane, or the more complex one of a gland. No open pores are necessary or discoverable.

"It is not the blood-vessels which secrete, but the surface of the membranes in which, as in all organs, the smallest blood-vessels produce the vascular rete or rete of currents."

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"These surfaces of secreting organs receive the circulating blood through the reticulated vessels, they imbibe it, are nourished by it, but they do not secrete the altered fluid particles in a liquid state from the blood-vessels, but from their own peculiar substance, which then flows out upon the membranes themselves, or in the appropriate ducts." No one," continues our author, "among the learned, contends that the mucus in the mucous membranes is separated by the blood-vessels truly it is the mucous membrane itself, imbued with the circulating blood, that takes up and changes the contained fluids, and melts outwardly into a diffluent mucus.

As secretion is not limited to the extremities of excretory ducts, not even a gland is necessary for secretion. Expanded membranes, glands, foliated processes, are only so many means of giving secretion effect.

SPIRIT OF THE FOREIGN PERIODICALS.

M. LISFRANC ON THE NECESSARY ALLIANCE BETWEEN MEDICINE AND SURGERY. "Or late years these two divisions of the healing art have contracted an indissoluble alliance. It is impossible to be a truly good surgeon without being a good physician also; or to be a good physician without having practical knowledge of surgical maladies. Who would think in the present day of amputating a limb, without having previously examined, with most minute care, the state of all the visceral organs? There may be a tubercular state of the lungs, or a latent inflammation of the intestinal tube, which needs only the general reaction, which necessarily follows every great operation, to explode with violence. How then can you guard against such mischief, unless you possess the knowledge requisite to detect the existence of these morbid states? The neglect of ascertaining the state of the inward organs, before having recourse to the use of the knife, has been the main cause of operative surgery having so often fallen into bad repute. Again, in severe injuries of the head, the chief danger, it is well known, arises from sympathetic disease induced in the brain or its membranes."

The following censure is liberal on the part of a Frenchman, as it exposeswe need not say, very deservedly and truly-the prevailing errors of his fellowcountrymen.

"A most pernicious heresy has sprung up among medical men of late years; to wit, that the nature of a disease being known, its treatment is so likewise.' As if it was sufficient to know the mere name of any weapon to be able to use it aright. This error has arisen chiefly from the unwise attempt to reduce under general rules numerous morbid individualities, each of which constitutes, so to speak, a separate exception. Thus, it has no doubt been the cause of those absurd systems of exclusivism in medical practice which have been so frequently brought forward-one set of men lauding on all occasions the use of the lancet, another the use of purgatives, a third of the chlorurets, and a fourth of tonics, in the treatment of one and the same disease. The history of medicine exhibits, it must be confessed, anything but a creditable picture of the professional sagacity, or even of the common sense, of its professors. One quarter of a century has very often been almost solely occupied in overthrowing what its predecessor had been engaged in building up; and such will ever continue to be the fate of physick, until medical men are properly impressed with the truth, that every case of a disease presents some individual difference or peculiarity arising from a multitude of causes, such as constitution, the state of the weather, the condition of the mind and feelings, &c. &c.

"I conjure you," adds M. Lisfranc, "to avoid being misled by opposite doctrines; such as you will hear professed elsewhere."

(This is a hit, we suppose, at M. Bouillaud and other followers of the Broussais regime, as well as at several other of the academicians who have been of late discussing the utility of purgatives in typhus.)

Absurd Practice in some of the Paris Hospitals.

M. Lisfranc, still commenting on the dangerous errors of exclusivism in medicine and on the extravagancies of certain modern reformers, continues. "Just look at the practice of some of these gentlemen in their hospitals! See them ordering the same dose of a medicine to twenty different patients, affected No. 81. 17

with the same malady; and the administration is entrusted entirely to some young inexperienced pupil, who cannot be expected to know how to accommodate a remedy to different cases. Then, according to the report made to him, the physician takes upon himself to commend or to condemn the treatment that has been pursued."

Such a tableau, drawn too by one of the leading hospital surgeons in Paris, strongly confirms the truth of the opinion which the Medico-Chirurgical Review has uniformly professed in reference to French medical practice. Every one has heard of the satire in one of Moliere's comedies, where the Doctor is represented as ordering all the patients on one side of a hospital ward to be bled, and all those on the other side to be purged, without reference to their maladies; and here we have the assurance of such a man as M. Lisfranc that the picture is not very inapplicable to some of his confreres at the present moment in the French metropolis. "Truth is strange, stranger than fiction."

-La Lans ette Française.

M. LISFRANC ON SOME OF THE DISEASES OF THE MAMMA.

"Women will come to you complaining of pains in their breasts; you examine them, but finding no mark of swelling, heat, or redness in the parts, you may be tempted to tell them that there is very little the matter with them. Be on your guard; the mischief may exist elsewhere, and the mamma may be only sympathetically suffering. Direct your attention to the state of the uterus; and always bear in mind that each menstrual effort determines a consentaneous increase of vital energy in the mammæ: in some cases, this increased sensibility exists from one monthly period to another, and will give rise to constant sharp pains in the glands.

By relieving the existing uterine irritation, the distress in the mamme will speedily subside.

In another set of cases, however, these pains in the mammæ may arise from a neuralgic affection of their own nerves, quite unconnected with any uterine ailment.

Now, although there may be no signs of inflammatory action present, the surgeon should never neglect the relief of these neuralgic pains: more especially as the very existence of severe pain in any part, and especially if that part be of a glandular texture, is apt to induce an insidious chronic excitement of the capillary vessels, which may ultimately terminate in morbid structure.

Let us now consider another set of cases, in which the symptoms are again different.

"A woman, without having received any blow or injury on her breasts, may experience in one or both of them a dull heavy pain, which is more or less severe at times, but which seldom ceases entirely: its chief seat exists usually at one spot, which, however, exhibits no visible signs of engorgement or inflammation. What are we to think of such a case, which is of very frequent occurrence? We should suspect that there exists, either in the granulations of the gland or in its cellular tissue, a chronic inflammatory action, which is, as it were, still latent, but which if neglected will almost inevitably lay the foundation of some serious degeneration of tissue.

We have said that such a state of things may come on without having been preceded by any external violence to the mamma. In some cases however, as might be imagined, it follows upon a blow or other injury-the immediate effects of which, having been removed at the time by leeches, &c. may have been entirely forgotten. A fixed pain continues, nevertheless, in one point, felt per

haps only on pressure; it is usually more troublesome at each catamenial period; and yet there may be no visible engorgement or hardness even then. In such a case as this, be assured that there exists a latent chronic inflammation. I have repeatedly seen engorgements in the first place, and subsequently degenerations of structure, supervene, after the lapse of three, six, or twelve months, in women who had neglected to use the means which I had recommended at the time. The use of over-tightly laced stays, which keep up an unnatural compression of the mammæ, is a not unfrequent cause of permanent mischief."

"In the treatment of chronic tumours of the mamma, the first thing to do is to ascertain whether there be any latent and disguised inflammatory action in or around the swelling. This may generally be easily determined by observing the effects of pressure with the fingers. Whenever there is decided pain, even although this be only of a dull character, we may apprehend the existence of vascular excitement in the part. Under such circumstances the application, to be repeated in 8 or 10 days if necessary, of leeches and then of laudanised poultices, is the most important remedy. The arm of the affected side should be constantly suspended in a sling; the diet should consist of light food; and tepid baths should be used twice or thrice a week.

The practice of smearing the mamma with a thick layer of strong mercurial ointment, to be renewed four or five times in the twenty-four hours, and to be continued steadily for a few days, as recommended by M. Serres, is approved of by M. Lisfranc. He also recommends the internal use of certain deputative decoctions, made with saponaria, scabiosa, and some bitter roots, and also of small doses of hemlock-the powder of which, in the dose of a grain at first to be rapidly increased, he greatly prefers to the extract.

When all traces of inflammatory action have quite ceased, we should then commence the employment of discutient means. Compression by means of strapping and of bandages, &c. is one of the best of these. It is a remedy, however, that should be used with great caution at first; as it is very apt to reexcite inflammatory action.

Douches, of simple and afterwards of aromatised vapour, have sometimes the most pleasing effects on indolent tumors of the mammæ.

Friction with various ointments and embrocations-containing the ioduret of lead, the hydriodate of ammonia and of potash, various preparations of mercury, &c. may often be used at the same time with advantage. Indeed, in the management of most chronic complaints, it is a most useful practice to combine the use of various means at one and the same time. Thus in the present set of cases, the vapour-douches, compression, and friction may be all employed together, not omitting the administration of appropriate remedies internally, of which the hydriodate of potash in conjunction with bitter infusions is perhaps one of the best."

The following remarks of M. Lisfranc on the advantages of local bleedings in cases of genuine scirrhous and cancerous disease are of practical importance. "Twenty years ago, it was pretended that cancer might be cured by antiphlogistic remedies. M. Lallemand, of Montpelier, published several cases of cancer of the lip as cured by these means; Broussais also narrated some similar cases, and I myself added few.

But cancer of the skin is not cancer of the cellular, and far less that of the glandular, tissue. Nevertheless I attempted to cure ulcerated cancer of other parts without having recourse to extirpation of the diseased parts; and in these attempts I often observed that the ulceration in the centre of the diseased swelling became for a time arrested, and as it were withered, but speedily began to spread as before, while the amelioration of the circumference was progressive and permanent. At that time I was content with merely observing and recording the fact, without endeavouring to explain it; but gradually opportunities of