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larly in children. The diagnosis is usually difficult in consequence of its affecting certain patches of the lung, often of small extent, and frequently occupying the centre of a lobe. In certain epidemics, catarrh is peculiarly apt to take on this form, and the typhoid symptoms occurring sometimes rapidly in the course of bronchitis, are frequently attributable to this complication, and the consequent increased impediment to the aeration of the blood. Hasse states that a further distinction between catarrhal and ordinary pneumonia consists in the presence of plastic exudation in the bronchia leading to the hepatized lobules. That there always is a bronchitis of the tubes in immediate connexion with the affected lobules is certainly true, but we much doubt whether the exudation is always or even generally of a plastic character. The very peculiarities of the pneumonia would be, in our opinion, an argument against this statement of Hasse. But the special characters of this affection, both in a pathological and therapeutical point of view, are deserving of further investigation.

Dilatation of the bronchi Hasse describes as of three forms, the first consisting of a single spherical or pouch-like protrusion of the walls of the tube, the second constituted by a series of these cystic dilatations, and the third of distinct character, formed by the uniform dilatation of a number of tubes throughout their whole length, making the portion of lung to which they go appear to consist exclusively of tubes widened to many times their natural size. The former two, or spherical, forms are produced chiefly by bronchitis and tubercular disease of the lungs. The influence of bronchitis is probably exerted in the following way :

“First, the air-passages are stripped of their epithelium-lining in the ordinary manner, their canals becoming loaded in part with a mucous secretion, in part plugged with fibrinous exudation. This latter occurrence takes place chiefly within certain of the lesser twigs, occasioning a collapse of the adjunct air-cells. The space thus set free is sought to be filled up by expansion of the neighbouring parts, giving rise in the majority of cases to emphysema; where, however, the collapse does not occur close beneath the surface of the lung, but at a greater depth and near a larger bronchial tube, and where it comprehends a larger tract of pulmonary substance, the result is bronchiectasis. These circumstances do not, however, suffice for the formation of a bronchial cavity; the parietes of the involved bronchial tube must needs have previously suffered the changes pointed out by Stokes, namely, loss, through inflammation, of elasticity in the longitu dinal, and of contractile power in the annular fibres, with consequent incapacity on the part of either to resist the mechanical influence of forcible inspiration, or of violent cough. It is difficult to say whether Stokes is right in believing that a saccular protrusion of the mucous membrane is caused by yielding of the fibres;-such, however, may probably be the case, where the dilatation is onesided, and its principal portion external to the axis of the bronchial tube. The analogy, likewise adverted to by Stokes, with the forms of aneurism, must, on the other hand, fall to the ground, as untenable." P. 297.

We see no reason, however, for dissenting from the opinion of Stokes in reference to the analogy between these bronchial and aneurismal dila. tations; on the contrary, it affords, we think, the most plausible explanation. With regard to the third variety, or the cylindrical dilatations, Hasse adopts a similar theory to that of Corrigan, who has termed the disease scirrhosis of the lung.

The cylindrical form of bronchiectasis arises where the pulmonary cells

have become extensively obliterated by previous pneumonia, and the bronchial tubes been constrained by the pressure of the air to fill up the space vacated, before the parietes of the thorax have had sufficient time to collapse. In like manner, pleurisy may give rise to dilatation, where the effusion is of a character to keep the pulmonary cells long compressed, without subsequently affording them an opportunity for due expansion. "The bronchial tubes not being similarly encumbered, are the more liable to yield to the pressure of the air inspired." If, in addition, the parietes of the air-passages have lost somewhat of their elasticity from the previous inflammation, this passive (as Hasse terms it) dilatation will be the more likely to occur. We doubt, however, whether the dilatation occurring in these circumstances is so entirely a passive phenomenon, as Hasse supposes. Why should not the air-cells give way rather than the bronchial tubes, unless indeed it be assumed, that this is prevented by their being filled with inflammatory products, in which case there is no space vacated, and requiring to be supplied by the distended bronchia? We are rather inclined, with Dr. Corrigan, to believe that contraction of the surrounding tissue is an important, if not the main, cause of the distension of the bronchia. We have looked in vain in Gross's work for any explanation of this or any other form of dilated bronchi.

Emphysema of the Lung.-Hasse is disposed to coincide with the majority of writers who have followed Laennec in assigning chronic catarrh as the main cause of the most important and frequent variety, viz., that which consists in dilated air-cells.

"My own observation," he says, "of the entire course, the duration, and the general character of the disease, induces me, to a certain extent, to agree with the majority. Catarrh is, without doubt, the principal occasional cause of emphysema; and hooping-cough, in particular, is evidently capable, within a very short space of time, of affecting the highest degree of dilatation in the pulmonary cells. The character and real import of emphysema must, however, be admitted to depend on other causes, as yet not thoroughly made out. P. 304.

"It is, on the whole, surprising how rapidly dilatation of the pulmonary cells may take place, although it requires time to attain such a height as to manifest itself by physical signs. The means whereby catarrh effects a dilatation of the cells, are purely mechanical. In catarrh, the lesser bronchial twigs are obstructed, partly by tenacious mucus, and partly by the swollen mucous membrane. During inspiration, the action of the muscles is powerful enough to impel the air through these obstacles: expiration, which is carried on rather through the force of elasticity than through the medium of the comparatively feeble expiratory muscles, is less complete. Thus more air is inhaled than exhaled, and the surplus, expanding through the natural warmth, ultimately overcomes the resistance due to the elasticity of the pulmonary texture. On the other hand, the more forcible acts of expiration-coughing for example-will rather compel the surrounding vesicles to yield to the pressure of the dilated ones, than allow the air, contained within the latter, to surmount the obstacle to its natural exit. In like manner, swellings of the bronchial glands, &c., or tubercular deposits within the lungs, may give rise to emphysema, by the compression of bronchial tubes, -as shown by Reynaud, Andral, Carswell, and others." P. 305.

These mechanical causes are doubtless efficient to a certain extent, and in a certain number of cases. But the undoubted hereditary origin of the disease in a large proportion of cases, as first clearly shown by Jackson,

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and since amply confirmed, together with the history of the disease, in many instances where no such hereditary tendency can be discovered, and an accurate estimate of the structural changes attending the disease, have long since satisfied us that, in the large majority of cases, some original weakness or defect in the walls of the air-cells, and the structure of the lungs generally, is the true and main source of the disease. In other cases, probably, there is an induced weakness of the walls of the pulmonary cells, the result of catarrhal or other previous disease. The account which Gross gives of the disease is meagre and defective in the extreme. After strangely asserting that the specific gravity of an emphysematous lung is "increased!" he goes on to observe, “vesicular emphysema is rarely observed before the age of fifty!" The whole of his observations, on its pathological relations and modes of origin, are contained in the following brief passage:-"It is a very common attendant on tubercles, aneurismal tumours of the heart and aorta, enlargements of the bronchial glands, and asthmatic disorders. Amongst the occasional causes may be enumerated whatever has a tendency to over-distend the air-cells of the lungs, as playing upon wind instruments, singing, and loud screaming!" (P. 440.) Considering that loud screaming is to be reckoned among the occasional causes, we should scarcely have expected the statement that it is "rarely observed before the age of fifty." No allusion whatever is made to the labours of his distinguished and lamented countryman Jackson, although he alludes to Louis, whose deductions were mainly drawn from the data collected by his pupil Jackson.

In remarking on the peculiar shape of the thorax in aggravated cases, Hasse observes, "Louis mentions another kind of projection, or rather filling up, of the supra-clavicular region, which gives a plumpness, he says, to the otherwise emaciated neck. I believe this appearance to have been present in the cases noted by that accurate observer, but have never myself witnessed it. Indeed, I have mostly found, above the vaulting of the chest, and above the clavicles, a decided pit or depression, wherein are displayed, almost like thick, tense cords, the cervical muscles of inspiration, which in general play a subordinate part, but here, where the operation of the principal inspiratory muscles is defective, become prominently active." P. 310.

We can ourselves bear testimony to the accuracy of Hasse's statement, having directed particular attention to this physical sign, and never, in a single instance, met with the filling up of the supra-clavicular region of which Louis speaks, but, on the contrary, with Dr. Stokes, have found the triangular spaces answering to the insertion of the sterno-mastoid and scaleni muscles singularly deep.

The chapter on Tuberculosis of the Lung is carefully compiled and full of instruction. We have, however, so recently brought this subject before the attention of our readers, that it is the less necessary to enter into any detailed examination of Hasse's views. Moreover, as the researches of Mr. Addison and Mr. Rainey have appeared since the publication of Hasse's work, he has been precluded from availing himself of the observations of these gentlemen, which are of great interest and importance in connection with the minute anatomy of tubercle. We cannot, however, here avoid alluding briefly to the very careful observations of Mr. Rainey.

That gentleman has, we think, incontrovertibly shown the truth of the opinion of Carswell and others, (and adopted by Hasse,) that the common opaque yellow tubercle is thrown out into the cavities of the air-cells. In proportion as these become distended by the accumulating tubercular matter, the inter-cellular vascular plexuses become compressed, obliterated, and eventually destroyed, together with the walls of the air-cells. In this way several cells are thrown into one, several tubercles become amalgamated into an irregular mass, penetrated here and there by the crescentic edges of the partially destroyed cell-walls, and on careful examination, presenting occasionally detached fragments of the remains of the intercellular plexuses and their corresponding cell-walls. We have thus two important causes of derangement of the respiratory function. Not only is the supply of blood to one part of the lung cut off by the obliteration of its vessels, but also an almost necessary congestion of adjoining portions induced, and thus a tendency to hæmoptysis established.

There cannot, we think, be any doubt that Mr. Rainey's views afford the true explanation of those appearances observed in tubercles which have induced many to believe them to be vascular. It is strong confirmation of these views, that the vessels which are not unfrequently seen, appear, for the most part, as arcs of circles, of the same radius as the plexuses between the air-cells, and of which they are the unabsorbed fragments. The following passage, from the Postscript to Mr. Rainey's paper in the last volume of the Medico-Chirurgical Transactions, is so important in connection with the general pathology of tubercle, that we shall be excused for extracting it. A rabbit, whose lungs, liver, kidney, mesentery, and other parts, presented numerous tubercles, all of a scrofulous character, was injected with fine injection.

"Some parts of the lungs were studded with white masses of different sizes; others, even as much as a third of a lobe, appeared very much like a lung which had never respired. On examining the latter, I perceived, in the arterial trunks leading to those parts, distinct masses of white granular matter mixed with the injection; and, continuing the examination, I found that this appearance was due to all the capillaries being literally choked up with this same matter. The aircells were free from it and contained air. The white masses in the other parts appeared to be produced by the vessels being filled with this matter, as in the preceding, and also by its escape into the air-cells and surrounding structures. On examining the kidney, I found that the vessels were filled in the same manner as in the lungs. I mentioned this to Mr. Quekett, who told me that he had, in scrofulous cases, seen strumous matter mixed with blood which had been pressed out from an artery going to a diseased part."

Hasse justifies himself for classing glanders with affections of the respiratory organs, in consequence of the disease originally and chiefly impli cating the nostrils and air-passages. In our present state of comparative ignorance on this subject, the classification may be admitted. Hasse, however, has nothing new to offer on the subject, and it is not even mentioned by Gross.

From his own experience, as well as that of others, Hasse has attempted to draw up such an historical account of cancerous tumours in the respiratory organs as shall assist in the detection of the disease during life. The account, though very succinct, is valuable and instructive.

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TUSON ON THE FEMALE BREAST.

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"Cancer of the lung is incomparably more frequent in males than in females. Out of 22 cases, collected by myself, 5 concern women, and 17 men. In childhood the disease is unknown. Of the above 22 cases, 9 occurred between the 20th and 29th years; 8 between the 30th and 39th; 2 between the 40th and 49th; 2 between the 50th and 59th; and 1 between the 70th and 79th years. The morbid disposition is, accordingly, greatest in the prime of life." P. 370.

In almost every instance the tumours in the lungs were medullary, he having only once met with the colloid variety. The medullary cancer was chiefly found in isolated masses; and in the form of infiltration, only where the lungs were the part originally affected, and primary infiltration appears to be characterized by one lung being exclusively involved, the other remaining exempt. From the statistics collected by Dr. Walshe, it would appear that the right lung is the one affected in two-thirds of the cases. These points are of practical importance in reference to the diagnosis. It is an important fact, that cancer in organs whose veins are tributary to the portal system, does not appear to spread to the lungs, although it is known very often to lead to corresponding disease in the liver. This limitation of the disease to the capillary range of the portal vein, Hasse observes, is the more remarkable when we consider the promptness with which medullary cancer, in particular, proceeds from one cluster of lymphatic glands to others situated in the remotest parts of the body. It is also remarkable that the lung shews no disposition to disseminate the morbific elements of which it is the seat; and in the case of primary cancer of the lungs there does not appear to be a single well-marked instance of other internal organs becoming secondarily affected. Cancerous disease of the lungs never co-exists with scrofulous tubercles.

The remaining Sections of Hasse's work, on cysts in the respiratory organs, pseudo-melanosis, and diseases of the thymus and thyroid glands, our limits compel us to pass over. We have already given a sufficiently full abstract of the work to enable our readers to judge of its character, and we trust to justify the opinion we have expressed of its merits. For the purposes of reference the book would have been much improved by a more methodical division of the Chapters and Sections.

With Professor Gross's work we need not longer occupy the time of our readers, as it is not likely ever to obtain a place in the literature of this country, where we have so many much better works. The coloured drawings and engravings with which it is illustrated are so coarse as to be for the most part quite useless and altogether beneath criticism.

THE STRUCTURE AND FUNCTIONS OF THE FEMALE BREAST AS THEY RELATE TO ITS HEALTH, DERANGEMENT AND DISEASE. By E. W. Tuson, F.R.S., F.L.S., Surgeon to the Middlesex Hospital. London: John Churchill, 1846.

We have always thought it very desirable that surgeons or medical officers to the larger hospitals in this country should publish the result of their experience, when they have filled their stations for fifteen or twenty years.