Vetter's assertion, that gout and hemorrhoids may give rise directly to phthisis, though these two maladies, with their congener dyspepsia, often reduce the constitution to that cachectic condition, which is eminently favorable to the development of tubercular disease. In this part of our author's essay an ingenious tabular view is given of the amount of previous disease of all kinds in 119 patients, who ultimately died of phthisis. From this it appears that 44 out of 119 had previous hemoptysis, and 42 had bronchitis, and that the two maladies above named frequently occurred in the same individual. Bronchitis is considered by our author to be a frequent cause of the rapid development of phthisis in those already labouring under the tubercular diathesis, and he believes that acute affections are at all times peculiarly perilous to such constitutions.

Hemoptysis he regards as a symptom, and not as a cause of the tubercular disease; he has never met with it among the military without its being accompanied with more or less distinct evidence of the existence of tubercle in the lungs. Pneumonia is not, according to our author, a direct excitant of phthisis, but with Rokitansky and others, he believes that the hepatized lung, instead of returning to its natural condition, occasionally becomes the seat of tubercular deposit, and, moreover, that repeated attacks of pneumonia will hasten the development of tubercular cachexia. Pleurisy is regarded by Dr. Gellerstedt in the same light; the effusion induces a depressed vitality of the system, by mechanically obstructing the respiration, and thus favours the deposition of tubercle in the lung, but not necessarily in that portion of the pulmonary tissue which has been subjected to pressure from the accumulated fluid. In the same manner he explains the effects of fevers and dyspepsia in producing phthisis, though he allows that the researches of Todd and others have greatly benefited the early history of the disease, by pointing out the influence of dyspepsia in producing a cachectic condition of the system. Is not the dyspepsia, that seems to produce phthisis, sometimes a consequence of the debility of the digestive organs arising from an already existing tubercular diathesis? We are somewhat surprised to find that our author entertains opinions totally opposed to those of Boudet and others, in regard to the influence of intermittent fever upon tubercular disease. So far from believing that ague gives any immunity from phthisis, our author expressly regards it, from its depressing influence on the organs of nutrition, as one of the most cognizable causes of this disease. Perhaps the effects of ague under the climate of Sweden may be different from its agency under the milder sky of Algeria, where M. Boudet's investigations were principally made. But we are already exceeding our limits, and, in conclusion, we can only find space to present our readers with the short general table of antecedent diseases given by Dr. Gellerstedt:

The figures in the first, third, and fifth columns denote the number of individuals who had suffered from these antecedent maladies, first of those 119 who died of phthisis, then among 191 persons affected with this disease, and lastly among these two classes conjointly, while the per centage of each affection is given in the second, fourth, and sixth columns.

We would gladly have extended our analysis of this interesting essay, but we trust that enough has been here detailed to satisfy our readers that the productions of the Swedish school are entitled to our respect and attention; and that, while our learned brethren of Scandanavia emulate the best British and French writers in attentive personal investigation, they are inferior to none in their acquaintance with the progress of medical science throughout the world.

ART. IX.

Observations on the Nosological Arrangement of the Bengal Medical Returns; with a few cursory Remarks on Medical Topography and Military Hygiene. By FRED. J. MOUAT, M.D., Assistant Surgeon, Bengal Army, Professor of Materia Medica and Medical Jurisprudence in the Bengal Medical College.-Calcutta, 1845. 8vo, pp. 64.

HAVING been long deeply impressed with the advantages to be derived from the application to medicine of those strict rules of observation under which the exact sciences have made such rapid progress, we hail with pleasure the indications of an increasing attention on the part of the profession to that desirable object. The pamphlet now before us gives us good grounds to hope that the wide field of investigation, presented by our Indian possessions, is about to be cultivated with that zeal, and in that manner, which its extent and importance justly claim for it, and that a race is springing up who will turn to good account the magnificent opportunities they possess of studying the influence of climate upon, and the progress of disease among various races. An old author observes that "it is no shame not to know that which one has not had an opportunity of learning, but it is scandalous to profess knowledge and remain ignorant,' and this remark may be justly extended to those who have opportunities and neglect them.

When the very able statistical Returns of the Army were presented to Parliament, Mr. Hume moved in the House of Commons for the production of similar returns from the army of the Hon. East India Company, which were ordered, but it was found on investigation, that no documents existed which were calculated to furnish materials for constructing comprehensive statistical tables. To remedy this for the future, and remove the stigma which cannot but attach to them for having so long neglected the opportunity of collecting materials for the advancement of medical science, the Medical Board in Bengal issued a new form of returns which we must say is the most artificial and unpractical (if we may coin a word) we have ever seen. The object of the present pamphlet is to point out some of the imperfections which attach to them.

In the statistical reports which have been already published in this country, three different nosological arrangements have been adopted; the navy having followed that of Cullen, while the army and the registrargeneral framed systems for themselves. We presume that Cullen's classification was followed by the navy authorities, simply because it was at the time of its adoption the best in common use: every one knows that it is a very defective one. Diseases are brought together which have no affinity to each other, either as regards their seat, or the causes likely to produce them. For example we find ophthalmia in the same class with lumbago, phthisis with hæmaturia, syphilis with icterus, aneurism with hernia humoralis, luxatio with hernia and prolapsus ani, &c.

In the military statistical reports, the arrangement of Cullen, which was used in the returns, was abandoned, and one of a more practical nature adopted. If we may judge by the benefits derived from the adoption of the suggestions founded on the results of these reports, the classification appears well suited to the investigation of the diseases of bodies of men at the period of life during which soldiers usually serve.* The statistical nosology followed in the reports of the registrar-general, is well adapted for the returns of a general population, but there are many peculiarities in the condition of the soldier which would lead us in any inquiry into the health of this class to prefer that employed in the military reports.

The classification adopted in the new forms issued by the Medical Board in Bengal, appears to be that of Dr. Mason Good. The diseases are divided into seven classes, viz. those of the digestive, respiratory, sanguineous, nervous, sexual, and excernent functions, and those from external violence. We will not stop to inquire with Dr. Mouat, what is meant by sanguineous function, digestive function, &c., but briefly notice a few of the objections to the classification.

The only disease under the head of " the respiratory function" is asthma. "This is an excellent illustration," says Dr. Mouat, "of the difficulty, if not impossibility, in the present state of our knowledge, of classifying diseases by any physiological arrangement such as that attempted in this table. It has a prima facie appearance of philosophic accuracy, which on closer investigation will not stand the test of rigid analysis, and is not found to answer any beneficial purpose." After adverting to the various

theories regarding the nature of asthma, he adds, "no conjectures or theoretical speculations are hazarded in placing it under the head of diseases of the respiratory organs. For the same reason, catarrh, pneumonia, pleuritis, bronchitis, and phthisis, ought to have been placed in the same order, as affecting this system,"-an opinion in which every practical man will probably concur.

We cannot afford space to follow our author through the remarks on the various classes, but we think it will be admitted that, for practical purposes, the classification must be very deficient which includes in the same category, fevers, ophthalmia, rheumatism, phthisis, syphilis, and ulcers; which associates cataract with delirium tremens, and

psora with

• For the arrangement adopted and the practical advantages which have arisen out of these Reports, see British and Foreign Medical Review for April, 1844, p. 313.

XLVI.-XXIII.

.9

In two instances the pericardium contained tubercular matter in the form of calcareous concretions. One of these was about the size of a walnut, and consisted of a cyst with thick walls, containing a substance in consistence and appearance exactly resembling whitewash.

The intestinal canal presented very frequent lesions, tubercular deposit having occurred there in 97 cases out of 119. It appeared in various forms: a. As granulations; in size and consistence resembling miliary tubercles, but differing from these in their colour, being whitish-yellow and opaque. They were not confined to the solitary or agminated glands, though they were rarely met with in the large intestines, their seat being almost always in the submucous cellular tissue of the ileum. b. As ulcerations; occurring in the usual form: but we cannot think our author justified in separating these two varieties, as it is most probable that tubercles always form where ulcerations are found, but have subsequently softened and have been carried away.

Tubercular ulceration of the stomach is of rare occurrence; Dr. Gellerstedt has observed this alteration not less than five times in 119 cases of death from phthisis. It remains, we think, to be proved that these ulcerations were really tubercular.

The mesenteric glands presented no other form of disease than tubercular infiltration, and were less frequently affected than the intestines, in the proportion of 44 to 97. Our author met with but five cases out of 46 in which the mesenteric and the bronchial glands were simultaneously tuberculous. He rarely observed the fatty degeneration of the liver so accurately described by Louis.

It was only in two instances out of all his dissections that Dr. Gellerstedt found tubercular matter in other parts of the body when it did not exist in the lungs. In both these cases its site was the bronchial glands, and in one a cyst full of tubercular matter existed in the pericardium.

It will be thus seen that the proportion of cases of tubercular degeneration of the intestinal canal is much greater in Dr. Gellerstedt's reports than in those of Louis or of Lombard. Our author accounts for this, by supposing that the intestinal canal is more frequently affected in Stockholm than in Geneva or Paris, yet the statistics of typhoid fever give a contrary result.

Tubercles of the lungs accompanied Bright's disease of the kidney, in the proportion of 7 per cent.

From these minute but interesting results of his post-mortem examinations, Dr. Gellerstedt next passes to the obscure subject of the pathology of phthisis, and attempts to lay before us a full history of the origin and development of tubercle. With the physiologists of the present day our author believes tubercle to commence like other tissues, healthy or diseased, as a cytoblastema, yet with Vogel, he believes that something more is wanting to produce tubercular matter, some vitiation of that vital influence that develops the cytoblastema into healthy tissue, but which, when weakened in any way, causes the same cytoblast to pass into pseudoorganization, such as tubercle or schirrus. The germination (if we may use the term) of a cytoblast, is the same for all the tissues of the body, but the cells which are developed as nuclei in the original vesicle, first show the different tissues to which they are to be adapted, as a chemical [?]

change takes place in their parietes, and under a vitiated influence they are altered sometimes to tubercle, which in its highest stage of development consists of cells, with more or less of granular matter lying between them. This hypothesis will, of course, be well known to many of our readers, and we have therefore merely noticed it as the doctrine which is adopted by the writer of this essay. Dr. Gellerstedt believes that tubercle may appear under different forms, either as miliary tubercle (the gray semitransparent granulation of authors), or as crude tubercle, nearly, if not quite opaque, and of a yellowish white colour. He does not, however, seem to infer that from either of these two forms we can trace the peculiar appearance termed tubercular infiltration. It will be known to most of our readers, that of late the opinions of the best pathologists have tended to regard this alteration as of inflammatory origin, as being, in fact, the result of a species of scrofulous pneumonia. Dr. Gellerstedt allows. that this may possibly be the case, in so far as that pneumonic hepatization may in scrofulous subjects be converted into tubercular hepatization, which in due time may soften, and leave excavations in the lungs.

"But," he adds, "I have never observed such a process to give rise to granular tubercle, except in those cases where the tubercular disease has advanced rapidly with symptoms of pneumonia; and I have then invariably found the tubercular deposit to be of a yellowish white colour, granular, and indistinctly circumscribed, and bearing a strong resemblance to the hepatization and abscesses occurring in the lung after phlebitis."

We have already seen that our author is opposed to the doctrine of the inflammatory origin of tubercle, but he acknowledges that the formation of tubercle and the process of inflammation present many points in common; though, if we trace them carefully, we always find that their mode of development is totally distinct and dissimilar.

The signs of inflammatory action discovered by the microscope in the form of exudation-corpuscles, are easily, he thinks, explained by the fact that tubercles act as a foreign body, and irritate the surrounding parenchyma. The condition of the blood, too, in phthisis, has been much insisted on by the advocates of the inflammation theory; but the cause of the increase of fibrine in that fluid is undoubtedly, he believes, the presence of the tubercular masses, which are already sufficiently far advanced to irritate and inflame the surrounding parenchyma. In fine, Dr. Gellerstedt candidly acknowledges that the influence determining the formation of tubercle in the body has as yet eluded observation; and with other pathologists, he takes refuge in the doctrine of a depression of nervous or vital influence to explain its origin.

In every instance he has found tubercle to occur only as infiltrated into the parenchyma of the various organs wherein it occurred, nor has he ever seen it lying loose in the bronchi, as described by Dr. Carswell.

As to its mode of increase, tubercle has been generally supposed to grow by juxtaposition, and not as in organized bodies by intussusception. Dr. Gellerstedt considers tubercle to be of a low standard of organization, and therefore to be incapable of developing a union between itself and other tissues. The further progress of tubercle from the original cell is produced, he thinks, by the neighbouring blood-vessels, from whence a