and it is therefore designedly that I now call your attention to the subject, seeing that it is the professed opinion of many physicians that pneumonia, like articular rheumatism, may generally be traced to the influence of damp and cold. The results however of my own experience, as well as of that of many others whom I know, are quite opposed to this opinion. No doubt it often happens that pneumonic patients will be found to have been chilled some time before the attack came on; but assuredly the chill is not the only, nor even the principal, cause of the disease. If we enquire into the particulars of a case, we shall generally find that there was a predisposition to the malady present in the system at the time, and that the chill only accelerated the development of the mischief. It was merely the occasion, so to speak, of the explosion of a pre-existing morbid state; just in the same manner as a simple indigestion may be the exciting cause of a gastric inflammation in a person, in whom there is a strong disposition to this disease.

"But the same remark does not hold true of shivering when this occurs at the commencement of a disease. In my opinion it is an almost invariable sign of pulmonary inflammation. Whenever, therefore, this symptom is or has been present, the physician will do wisely to direct his attention to the chest; and very generally, at least according to my experience, he will find that an inflammatory process has been set up in the lungs-unless indeed some well-marked symptoms clearly point to another organ as the seat of suffering. I do not deny, as a matter of course, that an attack of peritonitis, enteritis, &c., is sometimes ushered in with shivering; all that I mean to assert is, that this symptom is infinitely more common as a precursor of pneumonia than of any other inflammation. Hence in practice, whenever any of my patients has a well-marked shivering fit, even although other symptoms indicative of disease elsewhere be strongly marked, I at once suspect that the lungs are more or less seriously affected. On very many occasions indeed, this symptom alone has sufficed to suggest to me the right diagnosis, while other medical men, who have seen the case at the same time, have formed a very different opinion.

"There is another character which equally deserves the attentive consideration of the physician-and that is the pain in the side. In pleuro-pneumonia the pain is generally seated in the region of the mamma, although the affected part of the lung does not correspond to this point, or perhaps extends much beyond it. It has been suggested, in the way of explanation, that there is a greater degree of friction between the pulmonic and the costal pleuræ at this point than at any other, and that this may be the cause of the phenomenon in question. But if such were the case, the pain should surely not be limited to so circumscribed a spot, but should extend over all the surface where this greater friction is experienced; and we might expect, moreover, that it should change its locality-which certainly does not hold true. No satisfactory explanation has hitherto been offered of this symptom, and we must therefore confess our ignorance upon the point."-Gazette des Hôpitaux.

Remarks.-M. Chomel surely attaches an undue importance to the occurrence of shivering as a distinctive sign of pneumonia: he represents it as almost pathognomonic of the disease. But are not all the Pyrexia usually ushered in with this symptom? and however frequent bronchitic and pulmonic inflammation unquestionably is, as a complication of febrile disorders, it cannot be regarded as of almost constant occurrence. No one symptom, however valuable, should ever be trusted to inordinately.

MM. ANDRAL AND GAVARRET ON THE DEVELOPMENT OF VEGETABLE PRODUCTIONS IN ALBUMINOUS FLUIDS.

In prosecuting their enquiries respecting the changes which the blood undergoes in the course of various diseases, the attention of these gentlemen was drawn to a communication which M. Liebig recently addressed to the Academy of Sciences, and in which—after stating that in his opinion fibrine and albumen were substances perfectly identical in their nature, and that he had obtained globules of blood from the former-he said, "I have succeeded in precipitating albumen in the form of globules, by adding a sufficient quantity of water to serum which has been rendered neutral by an acid."

Here was a most important announcement; and the question that immediately suggested itself for the consideration of the physiologist, was whether albumen could, by simply undergoing a change in form, constitute the nuclei of the red globules of the blood.

MM. Andral and Gavarett set about repeating the experiments of the distinguished German chemist, and they found to their astonishment that the corpuscles-more or less exactly rounded in shape-which were thus developed in serum treated in the manner mentioned above, were in truth the rudimentary forms of a vegetable substance, in many respects very similar to that found in certain fluids after the act of fermentation. Having ascertained the existence of this vegetable in the serum of the blood, they extended their examination to other albuminous fluids, as the white of the egg, various morbid effusions, the serous part of purulent matter, &c.; and in all these their alkalinity being first neutralised by the addition of an acid-the microscopic vegetable was discovered. The description which they give of their experiments is as follows:

"Fresh and pure serum of blood, after being rendered slightly acid by very diluted sulphuric acid, was mixed with about twice its quantity of distilled water. The liquid, at first quite transparent, becomes almost immediately cloudy in consequence of albuminous-looking matter becoming suspended in it. This amorphous matter gradually falls down to the bottom of the vessel, and collects there as a greyish-coloured sediment, while the supernatant liquor recovers its transparency, which it continues to retain, although very curious phenomena are soon developed within it. If, at the end of about twelve hours or so, a drop of this fluid be placed on the object-glass of a microscope, we observe diffused through it a number of vesicles, of a spherical or oval shape, quite independent one of another, and all perfectly diaphanous. Some of them appear to be empty; others seem to contain a sort of amorphous semis;' while a third set are observed to inclose a few distinct globules irregularly dispersed within their transparent cavities. It is always at the surface of the fluid, where this is exposed to the action of the air, that these vesicles are found to be first developed. Other changes are not long of making their appearance. The surface of these bodies soon begins to push out buds, which are similar in appearance and contents to the parent vesicles themselves, and which gradually lengthen into stems-these again giving out branches, and the branches giving out smaller ones, to an almost indefinite increase. All these divisions and subdivisions terminate in culs-desac or blind ends, so that the entire individual forms but one cavity closed at every point.

"Hitherto we have described the vegetable as formed, at its point of development, of a single vesicle, from which are given out buds, stems, and so forth; but there is another mode of formation which we shall now endeavour to explain.

"Instead of remaining solitary, the vesicles may be agglomerated in groups of twos or threes together, so as to constitute a complete system. From the simultaneous development of all these vesicles are produced hollow stems; some of

which, as they increase, assume a moniliform appearance; while others retain a cylindrical shape, the hollow of the cylinders being divided into compartments by transverse septa. These new individuals, generated by the fusion of several vesicles into one, always terminate, as in the former instance, in blind culs-desac, and are observed to be either empty or partially filled with globules or with amorphous semis.'

The phenomena now described are observable in the serum for four days or so, after it has been treated with the sulphuric acid. During this time, the fluid has become more or less completely turbid from flocculi of mucilaginous matter becoming suspended through it. These flocculi, if examined with the microscope, exhibit an inextricable meshwork, formed by the crossing and recrossing in all directions of the stems and branches of the vesicles, in the midst of which (meshwork) are observed numerous vesicles in different stages of development. At about the end of the fourth day, a new series of phenomena is observable; and what our authors have called the second period of development may then be said to commence.

"The surface of the fluid becomes covered with irregular patches, like floating islands, which the naked eye might take for accidental impurities deposited by the atmosphere. By the microscope, however, we find that they are composed of innumerable vesicles of various sizes, and very variously arranged-in some places, irregularly and at random; in others, with greater or less symmetry in straight or

curved lines, or in the manner of arborisations.

"Amid this serum, which is found to be composed of an accumulation of genuine germs, and in the most superficial layers of the fluid, we are not long of detecting all those vegetable forms which were observed during the first four days, but which are now less simple in appearance and more varied in character. About the twelfth day, the entire surface of the fluid is covered with a thick membranous crust, which adheres to the sides of the vessel, and is formed by the interlacement of the numerous vegetable productions that have become developed.

"Beneath this serum, the fluid contains a multitude of vesicles and vegetable forms in different stages of evolution. If the serum be removed, another layer is speedily formed; and this phenomenon is repeated several times, until the whole fluid becomes putrid. We have seen this process of production continued for at least a month; at a certain period, spots of mouldiness appear on the sur

face of the membrane."

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MM. Andral and Gavarret proceed to shew that the same phenomena are observable in other albuminous fluids, and conclude their observations by stating: that, whatever be the origin of the albuminous fluid, and whether it be the product of healthy or of diseased action, if we only render it slightly acid and then dilute it with distilled water, we shall find, with the aid of a microscope, that an infusory vegetable becomes developed in it, under the influence of the oxygen of the atmosphere.”—Gazette Medicale.

MEMORANDA ON PHLEGMASIA DOLENS.

Although there is nothing novel or very striking in the following observations of M. Tessier, one of the physicians of the Hôtel Dieu in Paris, there is a practical tone about them which renders them acceptable. The author, like most of his countrymen, is apt to adopt exclusive opinions upon any subject to which he directs his especial attention—the favourite one of M. Tessier being the disease known by the names of purulent cachexy, purulent infection, purulent resorption, &c. and which, after all, seems to be close akin to, if not identical with, hectic

Case 1.-A woman, who left the Maternité Hospital on the ninth day after her confinement, caught cold, and was seized with a sharp pain in the left side, which induced her to enter the Hôtel Dieu. By the use of cupping, &c. the symptoms were soon relieved; but then a painful swelling of the upper part of the right thigh supervened: the tumefaction gradually extended over the entire limb, from the hip down to the very foot. There was considerable pyrexia present, but no symptoms of any gravity. Under the use of very simple means, the swelling and pain left the right thigh, and settled in the left one, following exactly the same course as it had done before. At first there was great tenderness in the groin, extending along the inner side of the thigh, in which part a hard somewhat knotty cord could be distinctly felt: this was unquestionably the saphana vein. The woman ultimately recovered perfectly. Subsequently the crural nerve became the seat of neuralgic suffering, and occasionally there was a tendency in the pain to settle in the abdominal parietes. Repeated purgatives were given with the view of preventing a localisation of the disease. (We should have preferred the use of warm baths, perhaps sarsaparilla, quinine, &c.—Rev.)

Remarks. This was a mild case of the disease; as indeed most of those are which come on two or three weeks after delivery. The most dangerous cases usually supervene at a much earlier period, and are generally ushered in with shivering and other unpleasant symptoms. The puffy swelling of the limb too is almost always much greater; it is usually accompanied with more or less erythematous redness of the parts, and has a strong tendency to terminate in suppuration. The two sets of cases therefore are very different, and require very different modes, or perhaps we should rather say degrees, of treatment. In the one, simple emollients and febrifuges will usually suffice; but in the other, much more vigorous and energetic means must be used,

Of late years it has been the fashion with many writers to substitute the term phlebitis for the old one of phlegmasia dolens. This is certainly not right; as it is not invariably or necessarily the vein or veins that are chiefly affected. The disease in some cases is seated in the lymphatic vessels; while, in others, it seems to be confined in a great measure to the cellular tissue. When the case is really one of phlebitis, we can generally feel a hardened cord or cords along the inner side of the limb, and the disease is observed usually to commence with an oedematous swelling of its upper extremity, just below the point where the vein has become obstructed or obliterated. This arises from the circuinstance that the blood, in the veins lower down in the limb, finds a way through anastomosing branches, whereas at this point it meets with an impediment.

In phlebitis, as in arteritis, the first phenomenon of the inflammatory process— of whatever character this process may be, suppurative or resolutive-is always the formation of a coagulum within the vessel. If suppuration occurs, the question at once arises, where is the pus formed, on the surface or in the substance of the clot? In ordinary phlegmon we know that this formation always goes on from the centre towards the circumference; and we may therefore presume that, in cases of suppurative phlebitis, the matter will be formed in that part of the vein corresponding to the middle of the coagulum. Authors have differed not a little among themselves on the point under consideration. Some have contended that the pus is secreted by the inner surface of the vein, and becomes effused within its tube; but then the difficulty arises, how can any effusion take place, seeing that the tube is completely obstructed by a coagulum? Others have said that it is secreted by the membranous envelope of the coagulum; but then we ask where is this envelope? We cannot see it. If we examine carefully for ourselves the phenomena in question, we find that the pus is situated in the centre and on the periphery of the coagulum; sometimes, but not commonly, between the two. We cannot suppose that imbibition has anything to do with this, as there is no matter to be found in the intermediate points. The

pus is therefore contained in the cyst, so to speak, of the coagulum, and is thus prevented from commingling with the current of the adjoining circulation. There is always, in this case, an adhesive phlebitis, which precedes and sets limits to the inflammatory process. When pus is found on dissection blended with the mass of the blood, as for example in cases of glanders, &c. it does not proceed from any one vein that has become inflamed, but is formé de tout pieces dans la circulation'-i. e. is a spontaneous and intrinsic product of the circulating fluid.

Case 2.-A woman was twice bled during an attack of acute rheumatism. After the second operation, the arm became swollen and painful. In the course of a few days, a small quantity of pus could be made to ooze out from the wound, by pressure along the course of the cephalic vein. The swelling extended upwards to the axilla; and alarming constitutional symptoms-repeated shiverings, yellowness of the surface, thirst and dryness of the tongue, delirium, diarrhoea, &c.-supervened. The diagnosis was obvious; we had to deal with a case of traumatic phlebitis occurring during the course of a rheumatic attack. A number of leeches were applied on the arm night and morning, and it was kept continually in a bath; at the same time, quinine was administered in frequently repeated doses. Under this treatment the constitutional disease subsided in the course of a few days, and the local symptoms, with the exception of the swelling, were much abated-in short, a simple oedema was now substituted for a diffused phlegmon. After the lapse of ten days, all the symptoms had entirely ceased; but then a painful swelling of the mamma of the same side came on; fluctuation became perceptible in it, and the abscess, although rather deep-seated, was accordingly opened. Eventually the patient left the hospital quite well.

M. Tessier in commenting upon this case, considered it an example of phlebitis, symptomatic of a purulent condition of the system," and contended that it is impossible to give any satisfactory explanation of the phenomena in such like cases upon any mechanical theory of a mere admixture of pus, secreted from an inflamed vein, with the current of the circulation. How, for example, can we thus account for the sudden appearances of those phlegmons and abscesses which are often so rapidly developed, and go on either to suppuration or to resolution in the space of 24 hours or even less, and all too without any previous inflammatory process?

In a practical point of view, the consideration of these phenomena is not less important. If, under such circumstances we attempt to arrest the progress of suppuration by making compression along the trajet of the inflamed vein, the chances are that an extensive diffused suppuration-similar to what we so frequently observe in the surgical wards-will be the result. It is often quite impossible to give a satisfactory explanation of the manner in which the particular symptoms are engendered; and therefore the only rational mode of treatment consists in accommodating our remedies to the indications presented by each case.

Case 3.-The secretion of milk suddenly ceased in a woman soon after her confinement, and symptoms of meningitis quickly followed. These soon gave way under active treatment; but then the patient was attacked with general feverishness, accompanied with cough, the expectoration of rusty sputa, and other signs of pneumonic inflammation. This was succeeded by a slight attack of peritonitis; which was followed in its turn by the occurrence of a phlegmasia dolens. Now this succession of morbid actions, or rather of different localisations of the same disease, was observed to decrease progressively in intensity from the meningitis in the first place, to the inflammatory affection of the lower extremity, which eventually terminated by a slow resolution.

It is not unfrequent to observe the very reverse of what happened in the present case; viz. where the metastasis of the disease takes place from the less to