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applied as early as they ought, the appearance of the firm, ramifying, bronchial coagula, was preceded by that of soft, cylindrical, white fibrous masses, which likewise assume the form of the bronchi, but usually follow the discharge of the firm coagula, and appear to indicate their softening. Schönlein is of opinion that in these cases there is a want of sufficient energy in the lungs to eject the bronchial coagula at the due time, and that consequently, they soften in the bronchi.

Although these coagula were detected by Remak in every case of pneumonia, yet in four cases of genuine bronchitis that fell under his observation, he could not discover the slightest trace of them, but simply granular cells in a mass of ropy mucus.

Schönlein regards the presence of the bronchial coagula in the expectoration as a certain evidence that exudation is going on, in which case, unless any violent reaction should call for its adoption, general bloodletting is replaced by cupping, mercurial and iodine frictions, calomel, and diuretic and cooling medicines, such as infusion of digitalis with nitrate of potash.

Glanders. Remak describes two cases of acute glanders occurring in the human subject, and states that Froriep usually sees several such cases annually. After giving a description of the microscopic appearances of the lardaceous, purulent masses met with in the lungs, muscles, &c., he mentions that in relation to the diagnosis of typhus fever, it is always of the greatest importance to ascertain whether the patient has exposed himself to the possible infection of glanders, and quotes the following

case:

"During the past session a waggoner aged thirty years entered the Clinique, having for the six previous days experienced shiverings, great depression, and pain in the muscles of the calf, thigh, and arm, on those parts being touched. The fever was moderate (pulse 90), the tongue moist and not coated; no appetite. Neither the urine nor the skin gave indication that the disease was of a rheumatic nature. From that day the pain disappeared from the affected muscles, but was felt in the left calf, in which a slightly red tumour, painful on pressure, began to form. The patient confessed that he had been engaged with diseased horses. On the third day there was pain in the muscles of the back, and in the region of the kidney, on pressure; blood-corpuscles and albumen were found in the urine, and continued to present themselves for several days. On the supposition that the disease was connected with the infection of glanders, Schönlein adopted Andral's plan of treatment with iodide of potassium, giving a scruple daily. The muscular pains, hæmaturia, and tumour then gradually disappeared. In the course of fourteen days he was altogether free from fever, but the affected muscles continued weak for a considerable time." (pp. 191-2.)

The disease in the two acute cases proved fatal on the second and fourth days respectively.

The buffy coat of the blood. A memoir of nearly forty pages on the signification of the buffy coat, and on the formation and production of the blood-corpuscles, terminates with the following practical remarks:

1. In order to arrive at a certain appreciation of the diagnostic and prognostic value of the buffy coat, it is requisite that the blood in all cases of venesection, should be collected in narrow and high vessels. It frequently happens that when broad vessels are used, and the coagulation proceeds irregularly, no buffy coat is formed, when if collected in another

manner it would have undoubtedly appeared-a fact which, although generally known, is very little attended to in a practical point of view. Since attention has been paid in Schönlein's Clinique to the mode of collecting the blood, and its coagulation has been carefully watched, a buffy coat, often of considerable extent, has been observed in every case. Although the mode of bleeding pursued by Schönlein in inflammatory cases, can only be adopted when the inflammation is of a high degree, yet in some cases of pneumo-typhus and in a case of glanders, there was an extensive buffy coat containing an extraordinary number of colourless blood-cells. As it is practically impossible to make an accurate quantitative analysis of the blood in every case of venesection, we should not neglect so simple a means of arriving at an approximate determination of the amount of fibrin.

2. The microscopic examination of the buffy coat in relation to the quantity of colourless blood-cells, may be made highly useful in determining its importance as indicative of the stage of inflammation. The absence of many colourless blood-cells in the buffy coat, affords a much more certain indication of an unusually large amount of fibrin arising from inflammation, than does the presence of a great number; the latter condition being generally dependent on the regeneration of blood after repeated venesection, and probably connected with an imperfect metamorphosis of the cellular elements of the blood in discrasic diseases, such as typhus, glanders, scurvy, and cancer.

Spermatorrhoea. From a long and interesting memoir on the subject drawn up from the observation of forty-five cases, we select the two following passages:

"Without the confession of the patient, the occurrence of a cartilaginous hardness of the corpora cavernosa affords diagnostic evidence of long-practised habits of onanism." (p. 153, note.)

"Gonorrhoea undoubtedly predisposes to spermatorrhoea, as was shown by Lallemand. But whether it be the gonorrhoea itself, or the balsam of copaiva taken to cure it, that causes this predisposition, it is difficult to say. I regard the latter as probable, since it has been noticed by Schönlein to induce baneful effects on many persons who have taken it for gonorrhoea in full doses, and for a long time, giving rise to Bright's disease." (pp. 168-9.)

Porrigo lupinosa. Remak carefully examined the scabs in a large number of cases of porrigo lupinosa, in order to ascertain whether the fungous structures contained in them were always identical. His observations on this point coincide with those instituted by Schönlein at Zürich, Fuch's and Langenbeck at Göttingen, Gruby at Paris, and Bennett at Edinburgh, and thus tend to show that geographical position exerts no influence on the species of the vegetable parasite.

A hair is usually found in the centre of each scab, and around the hair there are concentric furrows, dividing the scab into a number of rings averaging the fourth of a line in breadth. The scab increases by the augmentation of the external ring.

On cutting through one of the older scabs, after its removal from the body, we observe two distinct strata separated by a boundary line; the one next to the skin being thin, whitish and brittle, while the other is thick and yellow, forming the free surface of the scab. In the white

layer is the thallus, while in the yellow the filaments (Sporidienträger) and sporidia predominate. After a copious description of the microscopic characters of these minute fungi, he proceeds to consider the place they ought to hold amongst the cryptogamia. From the examination of specimens sent by him to G. R. Link and Dr. Klotzsch, those botanists are of opinion that the favus-fungus is a distant species, and not to be classed under either torula or oidium. The latter rather inclines to regard it as a species of the genus sporotrichum. Remak proposes for it the name of achorion Schönleini, derived from achor, the old name for favus; and gives the following botanical characters of the plant:

"Achorion Schönleini nobis, orbiculare, flavum, coriaceum, cuti humanæ præsertim capitis insidens; rhizopodion molle, pellucidum, floccosum, floccis tenuissimis, vix articulatis, ramosissimis, anastomoticis (?); mycelium floccis crassioribus, subramosis, distincte articulatis, articulis inæqualibus irregularibus in sporidia abeuntibus; sporidia rotunda, ovalia vel irregularia, in uno vel pluribus lateribus germinantia.

He then proceeds to relate a series of experiments on the distribution and growth of these fungi, and gives a circumstantial account of a successful attempt at inoculating his own arm. The mode of formation of the scab, and the chemical character of fluids conducing to the development of the fungi are then considered.

We shall terminate our notice of this section with a quotation containing a sound practical truth-one that should never be lost sight of in the treatment of this class of diseases:

"Eruptions on the heads of children appear to take the place of other morbid processes in more important organs; they are found to alternate with chronic inflammation and mucous discharges of the conjunctiva and cornea, and of the external auditory meatus, with enlargement and suppuration of the cervical glands, with enlargement and atrophy of the mesenteric glands, and probably also with tubercles of the lungs, bones, and intestinal canal. . . . It is very possible that the irritation and suppuration of the skin, produced by the growth of the fungous scabs, may in certain cases exercise a favorable influence on the condition of the organism." (p. 213.)

Fungi in the mouth and intestinal canal. In his observations on the microscopic characters of the aphthæ of children, and of adults (during typhus), Remak found that a single aphtha often contained several species of fungi, and that the species of fungi occurring in different aphthæ on the same individual exhibited no constant relationship; also that while one aphtha contained numerous fungi, others on the same individual contained none at all. Hence it appears that the loosening (auflockerung) and ulceration of the mucous membrane is the primary phenomenon, and that the fungi are only produced under favorable chemical conditions. It has been long known that the presence of aphtha is usually associated with an excess of acidity in the primæ viæ, and it is very probable that a putrid condition of the surface of the mucous membrane would accelerate the conversion of sugar and starch into lactic acid, and thus afford a favorable soil for the growth of these fungi.

Even in health there are produced during sleep a quantity of confervæ in the cavity of the mouth, which adhere to the mucous membrane and the teeth. They are probably occasioned by the decomposition of particles of food, or of mucus. In a young man suffering from hoarseness, Remak

found that the mucus which was secreted in great quantity by the soft palate, contained a large number of ramifying thallus-filaments. In diseases of the air-passages in which the epithelium of the mouth and throat is being frequently abraded and renewed, traces of cryptogamie plants may be generally detected in the expectoration. In the bronchial coagula of pneumonia patients (vide supra p. 505), Remak constantly found a peculiar variety of bifurcating, ramifying thallus-filaments, whose length and degree of development indicated that they could not have formed subsequently to the expectoration of the coagula.

There is a remarkable difference between the pathogenetic relations of the achorion and the fungi growing in the cavity of the mouth, and probably also in aphth. The achorion takes deep root in the sound uninjured cutis, which indeed seems to be the only place where it attains its full development. The fungi of the mouth, throat, and air-passages are, on the other hand, merely secondary products, formed from the decomposition of the mucous membrane and of foreign substances (fragments of food, &c.) in contact with it, and are analogous to fungi which, under proper chemical conditions, become developed out of the body. The achorion may be just as correctly termed a parasitic plant as the acarus scabiei or a. folliculorum may be termed parasitic animals; but these fungi can no more be regarded as true parasites any more than the infusoria which are abundantly present in the fluid putrid evacuations from the bowels in typhus.

A microscopic examination of the brown, chocolate-like masses observed in the sour vomited matters in cases of cancer of the stomach, has led to the interesting discovery that they consist for the most part of yeastplants. In one case the fermentation was accompanied by a well-marked development of gas, and there was an obvious separation of the yeast into an upper and lower stratum.

We have endeavoured in the preceding pages to lay before our readers an abstract of the most important facts and observations contained in Remak's volume, and it only remains for us to express our earnest hope that this is only the commencement of a long series of our author's diagnostic and pathogenetic investigations."

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ART. XV.

Practical Remarks on Near Sight, Aged Sight, and Impaired Vision; with Observations upon the Use of Glasses and on Artificial Light. By WILLIAM WHITE COOPER.-London, 1847. 8vo, pp. 216.

WE cannot agree with Mr. Cooper, that there is a "paucity of works of authority in the English language, upon Near and Aged Sight, the use of Glasses, and Impaired Vision." Beer's Pflege have long been familiar to the English reader, under the spurious title of 'The Art of Preserving the Sight, by an Experienced Oculist.' Adams's 'Essay on Vision,' Kitchener's Economy of the Eyes,' Ross on the Use and Abuse of Spectacles,' Walker's Philosophy of the Eye,' Franz on the Eye,' Hunter on the Influence of Artificial Light,' and many other works might be mentioned, which expressly embrace the subjects which Mr. Cooper proposes "ta

elucidate." We should still be glad, however, to hail a new and more complete work on the preservation of sight, than any that has hitherto appeared; and that whether it was intended for the popular reader's instruction, or for that of the medical practitioner.

Mr. Cooper's work is divided into six chapters, which treat of Light, Myopia, Presbyopia, Spectacles, Inflammation and other diseases of the Eye and their treatment, and Artificial Light. Upon these various topics there is much information put down in Mr. Cooper's pages; but as he has evidently had in his eye, as worthy of imitation, our old familiar friend, who aimed to kill two dogs with one stone, what he says is half addressed to the popular reader, half to the medical, and we fear will be found satisfactory to neither. For example, he gives in his first chapter, an account of the anatomy of the organ of vision. Now, neither of the above parties will thank him for so scanty a statement respecting the nerves of the iris, or the lenticular ganglion as that contained (page 29) in this single short sentence-"The nerves which supply the iris are derived from the lenticular ganglion." "So we have often been told," will the medical reader be disposed to remark, "and we know very well how the lenticular ganglion is made up of a sensitive root and a motive root, and how its branches, the ciliary nerves, sink into the annulus albidus of the choroid; but since Mr. Cooper was in an "elucidating" mood when he wrote his book, we wish he had thrown some light on the final distribution of these nerves, which, if they go at all to the iris, send but a very small proportion of their filaments to that membrane." "Lenticular ganglion!" exclaims the nonprofessional reader. "What is that? The nerves of the iris are derived from it? I am just as wise as when I began." This may serve to show the futility of works on anatomy recommended for popular use, but written in the sketchy manner of Mr. Cooper.

We are not satisfied that the scientific parts of Mr. Cooper's work will be found everywhere correct, nor that their faults will escape detection even by the merest tyro in medicine. His frontispiece, for instance, is, he says, a vertical section of the eye, but this must be a mistake, as the optic nerve is represented entering the eye much below the axis. At page 15, he tells us, that the crystalline lens is "the most important of the refracting media of the eye;" whereas every well-informed medical student knows, that the crystalline does not refract the light entering the eye nearly so much as the cornea, and that, although the crystalline may be removed, and yet the person continue to see, we cannot take the same liberty with the cornea or the vitreous humour, without destroying vision. Even evacuation of the aqueous humour will, till that fluid is regenerated, affect sight much more than removal of the crystalline. At page 35, Mr. Cooper says, "If, before a hole made in the window-shutter of a darkened room, a double convex lens be placed, an inverted picture of the scene without will be portrayed by the lens upon a piece of white paper." Now, the merest tyro knows that the inverted picture is portrayed before the lens is applied to the hole; in other words, that the hole forms the picture, which the lens merely renders brighter and smaller. At page 37, he tells us, that "for single vision it is essential that our eyes be so adjusted, that the image formed in each shall fall on corresponding points of the retina.” Physiologists have given the name of corresponding points to those parts of

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