in capillary canals. As M. Bourgery thus assimilates the pulmonary structure to the hepatic (as we regard the latter in England), so M. Burggraeve reduces the hepatic to the recognized view of the pulmonary.

From the parenchymatous structures, M. Burggraeve proceeds to the fluids, and we find nothing which calls for special notice in his observations on them. We pass on then to the tissues connected with motion, and here, too, we have little or nothing to remark. He divides them into passive, as bones, cartilages, &c., and the active, which he distinguishes into-1, the vibratile cilia; 2, the cavernous or hæmomyary; and 3, the muscular or neuromyary. M. Burggraeve is not successful in his nomenclature: "alpa, sang," and "pvei, mouvoir," will hardly reconcile us to such hard substitutes as the above for "erectile" and "muscular." Can it be that our author thinks he has discovered the root of the word "muscle" itself, and that the resemblance in form, which is supposed to have given occasion to the name, does not satisfy him? Whether this be so or not, it is most certain that our author, when he comes to Greek, μówv Badizel.*

The division of muscles into those of animal and those of organic life, does not satisfy M. Burggraeve, as being an imperfect division; and he complains equally of the vagueness of the terms voluntary, involuntary, and semi-voluntary: he suggests, therefore, the division into "muscles with levers," and "muscles without levers;" but how this division is preferable to the others does not appear, since, manifestly, the latter class will place in the same category the visceral, vermicular muscles, and the Platysma myoides and Palmaris brevis. The fact is, few things are effected in nature per saltum, and where we find vagueness (if so be) in things, we must make allowance for vagueness in words.

From M. Burggraeve's account of the tegumentary system, it is only necessary to refer to his observations on the mucous membrane of the tongue. It is well known that the papillæ of this organ have recently been examined by Dr. Todd and Mr. Bowman. M. Burggraeve differs from them and from M. Cruveilhier in his opinion concerning the Circumvallatæ papillæ.

"Frequently," he says, "the mucous membrane lining a follicle is elevated by subjacent glandular corpuscules. This gives the appearance of a papilla standing up from a depression, and surrounded by a raised margin; by this means the name of papilla has been applied to bodies, wholly unentitled to the name, as in the case of the lenticular papillæ distinguished by M. Cruveilhier under the denomination of perforated or calyciform. It is plain that neither their structure nor their function justifies us in identifying them with nervous papillæ: they are glands."

If

We conclude our review as we began it: M. Burggraeve has essayed a wide task in a small compass: and his space has been still more curtailed by mere catalogues of the facts of topographical anatomy. Such are his enumerations of the muscles, aponeuroses, blood-vessels, and nerves. in some parts our extracts have been few, our readers are at liberty to infer that, as it has not been our object to epitomise the work, but to abstract from it views which lay claim to novelty, the portions thus lightly touched on contain a rapid but faithful conspectus of the con

We may take occasion here, too, to protest against the unscholarlike look of Greek words written without their proper accents.

XLV.-XXIII.

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clusions of human physiology up to the time of the composition of the work. We add this qualification because, though we have not the first edition, we have evidence which leads us to suspect that it has not been so improved in the second edition, as to keep pace with the rapid evolution of physiological research. For instance, M. Burggraeve ascribes to Dumas an opinion which he is well known to have revoked: analyses, again, of certain fluids given by M. Burggraeve have undergone considerable alteration, and theories which he admits have been laid aside. It may be said, that the multitude of modifications of opinion which each year produces may well excuse an author's ignorance of some of them, and we admit this to the full. We even think that the very endeavours to throw into a consistent whole the facts which are daily brought to light in physiology is laudable, and the more so, because, when physiology, now in its infancy, shall be a few years older, we may have to look back on our present position from a distance far in advance, and books which are now text-books will have become obsolete:

Tam venerabile erit præcedere quatuor annis.

ART. IX.

Remarks on the Dysentery and Hepatitis of India. By E. A. PARKES, M.B., late Assistant Surgeon H. M. 84th Regiment.-London, 1846. 8vo, pp. 271.

Or the diseases incident to Europeans in tropical climates, there is perhaps none of more importance than dysentery, whether we consider the amount of mortality arising from it, or the permanently impaired health produced by alteration of structure in those who have laboured under it. In the army this is even more marked than in civil life, for the soldier, often necessarily exposed to the causes of disease, and frequently unwilling to submit to the necessary restraint when convalescent, suffers repeated relapses until the disease terminates either in death or in organic alterations of such a character as to render him permanently unfit for military service. Dysentery has consequently attracted much of the attention of the medical officers of the army, and many excellent works have been written upon it. There are still, however, many disputed points in regard to its pathology and treatment, especially in the frequent case of complication with other diseases; and much patient investigation and accurate observation will be requisite ere these can be settled on a satisfactory basis. The volume before us is a valuable contribution to this end, and is most creditable to the industry and talents of the author. It contains the

result of his observations while serving in the 84th regiment in India, and professes less to be a systematic work on the diseases treated of, than an endeavour to elucidate various points connected with them about which differences of opinion prevail, and to draw attention to the composite nature of all chronic abdominal diseases. "Before long," the author remarks, "a different mode of describing the allied abdominal diseases will be necessitated by increasing knowledge. Then it will be found, that each disease, when fully formed, is but a developed and prominent part of a

more general but partially latent affection. I am fully prepared to say, that a chronic affection of an abdominal organ never remains simple."

DYSENTERY. Pathology. Our author agrees with those who maintain the inflammatory nature of dysentery, but considers it to be peculiar in this respect "that ulceration of the large intestines occurs with great rapidity, and, except in one rare form, a case never presents true dysenteric symptoms without ulceration being present."-This does not arise from the intensity of the inflammation, for in slight cases where the patient has died suddenly from some other cause, "the proofs of inflammation, apart from ulceration, are often only just visible on post-mortem examination;" and in severe cases where extensive ulceration has been found, it frequently happens there has been during life very little constitutional disturbance. Dr. Parkes attributes the rapidity with which ulceration occurs, "to the glands of the mucous membrane being particularly implicated in the inflammatory action."

We shall endeavour to give, as concisely as possible, the statements advanced by him in support of his views, referring our readers to the work itself for the corroborative evidence contained in the post-mortem examinations. "1. There exists on the inner coat of the large intestines, a set of solitary glands peculiar to that particular mucous membrane." These are very different from the common mucous follicles, are hardly visible when the mucous membrane is healthy, but are enlarged and very evident at the commencement of dysentery. They have been noticed by various writers, but their relation to the dysenteric ulceration has not been pointed out, and they have been described as pustules.

"I have considered them not to be large mucous crypts for the following reasons. They present the appearance of round opaque bodies, without apparent orifice, imbedded in the mucous membrane, and even apparently attached to the submucous cellular tissue. In the early stage of dysentery, their contents are white, yellowish, and apparently thickened and starchy. They are sometimes streaked or striated on the surface, and bear on the summit, in some cases, a small black point, which looks like an orifice closed up. This is not, however, general or even common. Under the microscope, the mucous membrane around them presents the usual appearance of honeycomb cells. In a dysenteric case which has lasted two or three days, they are still more obvious. A minute vascular ring surrounds them, and they become prominent and a little hardened to the touch. In distribution, these glands appear equally numerous in the sigmoid flexure as in the cæcum; and on this account, I am disposed to regard them as perhaps the excreting organs of the colon." (p. 4.)

"2. Inflammation and ulceration of these glands constitute the earliest morbid change in tropical dysentery, and the process from the small ulcered gland to the irregular spreading ulcer, may be traced in every stage. The first alteration in the glands is an enlargement of them and a change in their contents. The contained substance becomes thicker, and now resembles flour and water in appearance and consistence. In all probability, this condition occurs every day, and giving rise to slight diarrhoea, relieves itself, and the glands return to their normal condition... If, instead of thus relieving themselves by secretion, the glands continue enlarged for some time without being acutely inflamed, that appearance is presented which has been incorrectly compared by Ballingall and others to a variolous eruption. I have seen this several times, and the resemblance is about as great as might have been anticipated from the loose nature of the statement... If a greater degree of inflammation be present, the vessels around the gland become enlarged and conspicuous, and form a ring or halo spreading a short

distance into the mucous membrane. This condition presents the earliest symptoms of dysentery, viz. slimy stools, increased in number without blood, causing perhaps slight griping and tenesmus when passed, and generally unattended by pain on pressure. Immediately after this, and in severe cases during the very first days, ulceration begins and is always denoted by slimy and gelatinous stools, streaked with blood, and attended by tormina, tenesmus, and pain on pressure, varying according to the seat of the disease and its intensity” (p. 6.)

Such are the views entertained by our author of the nature and seat of dysentery; and on these he founds his division of it, when uncomplicated, into four stages: 1. That of enlargement and commencing ulceration of solitary glands: this is the condition described in the preceding quotations. 2. Of complete and spreading ulceration. 3. Of cicatrization. 4. Of abortive cicatrization, commonly called chronic dysentery; a disease which is a resultant of continued subacute inflammation, and ulceration, combined with ineffectual efforts to produce the cicatrizing process.

"The second stage is characterized by the existence of ulcers, more or less numerous, of various shapes, sizes, and degrees of development, round, oblong, or irregular; if small and round, often with raised edges; if irregular, with flat and levelled edges. In the same case every form may be seen, from the commencing punctiform ulcer, to the complete large spreading ulcer with lymph on its surface in nodules or layers. This period is attended with various kinds of stools: first, these are slimy and gelatinous, becoming more and more bloody; then the stools become scanty, lymphy and shreddy, streaked with blood, or watery, muddy, and with sanious discharges. At a later period the stools become like the washings of meat, dark, and perhaps offensive. If the ulcers heal, the stools become generally, first, like lymph floating in an albuminous fluid; then yellow feculence, streaked with blood, is mixed with this, and then the stools recover gradually their healthy appearance." (p. 11.)

In describing the third stage, or that of cicatrization, Dr. Parkes combats the opinion, held by many writers, that ulceration exists only in the advanced stages of the disease, and refers to dissections of several cases, the subjects of which were cut off by coup de soleil at an early period of dysentery. The process of cicatrization of the ulcers is thus described by him:

"After a certain time, in dysentery, when the inflammation has diminished, lymph begins to be effused over the surface of the ulcer, and between the muscular fibres, if these form its floor. In an ulcer disposed to heal, the lymph is regularly diffused over the surface, forming a gelatinous-looking coating, which becomes gradually darker in colour, rises to a level with the edges of the ulcer and the surrounding membrane, and then slowly contracts, puckering to a greater or less extent the adjacent mucous membrane. After an uncertain length of time, varying from one to four months, the only marks by which it can be distinguished from normal mucous membrane are by its greater and darker vascularity, its greater smoothness and peculiar slightly glistening appearance, and by the slight contraction round it. In the majority of instances, however, the process is less regular than this; from some cause or other, greater quantities of lymph are deposited on some parts of the ulcer than on others, and hence results a granular or nodular appearance, which after a time disappears, and the false membrane becomes levelled and uniform. In some cases the lymph is deposited between the muscular fibres, apparently compressing these; the ulcer is then healed, that is to say, it will not spread, and no blood escapes from it. Afterwards on this compressed muscular floor lymph is slowly deposited." (p. 17.)

After recording a number of dissections (which appear to have been very carefully made) illustrative of the different stages of the disease, our author gives a table of the principal changes found in the other abdominal organs, in twenty-five cases which proved fatal in the garrison at Moulmein. That most frequently diseased was the liver, which in seven cases contained abscesses. These were found in the same number out of 39 cases treated by Dr. Innes, 84th regiment. Mr. Marshall states that they occurred in about the same proportion among the troops in Ceylon.

Hepatic abscess. Abscess of the liver has, by some writers, been considered to be always the primary affection, and the dysentery in these cases to be consecutive to, and arising from it. This, however, is held by some of the best authorities to be erroneous. Agreeing, in this respect, with Annesley, our author divides the cases of suppuration in the liver, into those in which the disease is primary, or antecedent to the dysentery, and those in which it is secondary, or consecutive to it; subdividing the latter into (a) declared, and (b) latent.

The connexion between hepatitis and dysentery, although generally recognized, has never been satisfactorily explained. In primary hepatitis it has been supposed by Annesley and others, that the dysentery is caused by the morbid state of the biliary secretion. Dr. Parkes dissents from this opinion, and hazards the conjecture that it is caused by the absence of secretion altogether. In support of this, he adduces the fact that in some cases when hepatitis has terminated in partial suppuration, and bile is still secreted, although altered in appearance, there is no dysentery; whereas when, from extent or peculiar situation of abscess, no bile is secreted, dysentery appears to supervene."

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Passing over the description of the symptoms of secondary hepatic abscess, with the illustrative cases and dissections, we come to the subject of diagnosis. This is universally admitted to be extremely difficult, from the obscurity of the symptoms, and their close resemblance to those of chronic dysentery, especially when that is complicated with functional disorder of the liver. We agree with our author that "it is only by a study of the phenomena, from day to day, that a correct diagnosis can be given;" but we do not think he has stated sufficiently clearly, or fully, the various points of difference which may assist in arriving at a correct conclusion. One point on which he differs from many writers deserves to be noticed :

"Cases in which pus has been absorbed and discharged with the urine have never been observed by me. I have seen thick, apparently purulent, deposits in the urine, and have heard them called decidedly purulent; but these are mere collections of vesical mucus, of a particular kind; and exactly similar appearances are seen in pyelitis and catarrhal inflammation of the bladder, where there is no suspicion of pus being formed anywhere. These deposits are soluble with effervescence in acetic and nitric acids. No coagulation was ever observed from heat or nitric acid." (p. 98.)

This opinion corroborates that of Dr. Budd:

"It has been supposed by some medical men in India, that the pus in an abscess of the liver may be absorbed and eliminated as pus in the urine. But this notion is evidently erroneous. Pus-globules, from their large size, cannot directly enter the blood-vessels, or escape from them. The matter in the urine, supposed to be pus, was probably a deposit of phosphates. During the severe constitu