VII. Solutions of Continuity, and Ab- X. Changes of Extent, Volume, and normal communications.

VIII. Displacements and Deviations.

IX. Abnormal Adhesions, Connexions, &c.

Capacity.

XI. Foreign and retained substances.

XII. Changes in the configuration.

The first Class, including the Pyrexia or Fevers and Inflammations, is like Aaron's rod; for it nearly swallows up all the rest, according to M. Bouillaud's views of the matter: no less a portion of his work than three volumes and a half out of the five being occupied with a consideration of the diseases in question. Our readers may therefore expect to find an immense assemblage of maladies classified under the head of Inflammations and Fevers. The class is subdivided into three orders. These are-I. The genuine phlegmasiæ and continued fevers; including not only such diseases as are usually so denominated, but likewise the whole tribe of Cutaneous diseases, from small-pox and scarlatina to prurigo and scabies, as well as glanders, tuberculization of the lungs, and cholera-morbus ! II. Irritations properly so called, and Intermittent fevers; or active Neuroses (hyperneuries.) Besides agues, this order contains various convulsive and spasmodic diseases, such as asthma, neuralgia, epilepsy, chorea, mania, &c. III. The third order (which is complementary to the two preceding) comprehends the various products of inflammatory and irritative disease; such as active serous effusions, hypertrophies of different organs, and various morbid degenerations of structure.

The 2d Class is divided into two orders; the distinctive character of the one being the "complete abolition or simple diminution of the nutritive life common to all parts ;" and that of the other, the "complete abolition or simple diminution of the forces presiding over the special action of different organs." The former includes gangrene, local asphyxia, and atrophy; while in the latter we find all passive neuroses, paralysis, amenorrhoea, dysmenorrhoea, &c.

The chief members of the 3d Class, or the Ataxic Affections of the nervous centres, are 1, the various irregularities in the sounds and pulsations of the heart; 2, irregularities, incoherence in the co-ordinated movements of locomotion, articulation, &c.; and 3, irregularities, incoherence in the moral and intellectual functions.

The 4th Class is devoted exclusively to the reception of the three spe cies of Typhus-European, American (the yellow-fever,) and the Oriental (the plague.)

The 5th Class is somewhat akin to the Cachexia of other nosologists, and comprehends scrofula, cancer, scurvy, diabetes and several other urinary affections, entozoa, &c.

The 6th Class contains the numerous varieties of hæmorrhage, from apoplexy of the brain to the formation of petechiæ, vibices, and scorbutic ecchymoses.

We need not particularize the contents of the remaining six classes of this extraordinary nosological table, as they relate chiefly to surgical, maladies, congenital malformations, and so forth; nor have we any intention to examine critically its merits and demerits. We should think that there can be but one opinion on the subject, viz., that it is perhaps the

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very worst classification that ever entered into the head of learned doctor to propose. The identification of continued Fevers with genuine Phlegmasiæ; the divorcement of the different forms of Typhus from those of Typhoid fever, and the establishment of the former in a class by themselves, as if they were diseases altogether distinct and dissimilar from all others; the dissociation of Intermittent and Remittent fevers from those of a continued type, and their arrangement among the Neuroses; the strange amalgamation of bodily and mental disorders in the 3rd Class; these are a few out of the many glaring blemishes that deface the nosological scheme under review.

As the present article shall be confined exclusively to the consideration of our author's views on the very important subject of Fevers, it will be obvious that the 1st and 4th Classes of his Nosology are those which will chiefly occupy our attention. The great aim and object of all his remarks is to show that the so-called essential continued fevers are really and truly inflammations, either simple or complicated with a septic (typhoid) element; and this position he is now more than ever anxious to establish, seeing that "quite recently several authors of authority, (Andral, for example, Rev.,) retracing in some measure their steps, have endeavoured again to distinguish into two separate classes diseases which they formerly regarded as identical in nature. If a confident and unwavering hardihood of expression-founded, we verily believe, on a conscientious conviction of the truth of his observations-will ever make converts, few, who read the present work with an orthodox (query, popish ?) faith, would escape becoming Bouillaudists; unless, indeed, the inordinate zeal of the writer. to establish his own views suggested the idea of some weakness in the cause that he was advocating.

The subject of inflammation in general is discussed at great length. All that we can attempt to do is to select a few passages, which seem to explain the peculiar views of our author on the important question, how far inflammatory and febrile actions are to be considered as identical in their nature and phenomena.

"Considered in itself, in its essential nature, Inflammation is one, and constitutes a single species; but, considered in relation to its complications, its causes, its degrees, and extent, &c., it exhibits numerous differences, and may be divided into a great number of species. As to its complications, that which is most worthy of attention, is the septic, putrid, or typhoid condition. What we have said of Inflammation in general is strictly applicable to Continued Fever in particular; a disease, which is nothing more than the result of a primary or secondary phlegmasia of the sanguineous apparatus." The supervention of the typhoid condition, in the course of an inflammatory disease, is attributed to the absorption into, or to the generation in, the system of certain morbid matters, which poison and infect the whole mass of blood. When this is the case, "there exists (to use the lucid description of our author) a sort of two-fold general state, composed of inflammatory re-action on the one hand, and a septic infection of the circulating fluids on the other-elements so different from each other, that the latter is characterised by a softened condition of the coagulum of the blood and the absence, or at least extreme softness, of the

coat, which is invariably present in all pure and simple inflamma

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tions." He describes this typhoid complication as being to the entire system what gangrenous decomposition, in consequence of local inflammation, is to a part: in the latter case, there is, so to speak, a local ty. phoid fever; while, in the former one, there is a general typhoid fever.” In the same spirit, he tells us, that the general state known by the name of fever is for the entire sanguineous system, what the inflammatory state is for that portion of the vascular system in a special diseased organ. In one word, acute fever is a general phlogosis of the vascular system, and inflammation of an organ is a local fever."

We come now to consider another question; and, as it is one that has important practical bearings, the reader, we trust, will be pleased to excuse the inconvenience of the occasional repetition of opinions, and, it may be, of nearly the same language.

"Is the division of Fevers into idiopathic or essential and symptomatic natural or legitimate? This grave question, which for the last 25 years has been discussed under every possible aspect, is not yet finally settled in the opinion of some physicians. Assuredly it would have been so, had the facts been presented to them by public lecturers and teachers with that perspicuity, force, and good faith, which constitute the very soul of science in general, and of medicine in particular. Unhappily this has not been the case. For the last 20 years that the author of this work has studied the great, the immense, question of fevers, he has neglected nothing that might contribute to the triumph of truth, and he still continues his devoted exertions; too happy if he might at length succeed in dissipating, past all chance of return, the uncertainties which still prevail on a subject of so much importance, and in introducing order and light, where as yet we meet with only darkness, confusion, and chaos."

After this flourish of words, the reader is informed that all (the diseases usually considered as) essential fevers have an element or character in common; to wit, that state of inordinate excitement of the system, which is indicated by increase of heat, and of the force and frequency of the cardiac and arterial pulse :-otherwise, says our critical author, the terin fever would be utterly inappropriate! This is a mere etymological quibble, that is utterly unworthy of any practrical writer. But M. Bouillaud does not appear to regard it so. Starting from it as a point, on he goes in the most amusing style of self-complacency and self-gratulation, pitying his poor confrères, who are still groping their way in darkness, while all is sunshine along his path. After alluding to the discordance of opinion that still prevails on the subject of the nature and cause of fever among the physicians of that metropolis, which is the centre of civilization, the eye of the whole world, (!) he thus modestly tells them how everything may be rectified::

"What must be done to put an end to the truly afflicting spectacle of such contradictory doctrines, this veritable anarchy that prevails in the midst of the foremost medical school of the universe?-an exact knowledge of facts, and an equally exact nomenclature, i. e., a nomenclature that might be a faithful representation of the seat and sort of lesion, simple or complicated, single or multiple, which characterises each of those morbid conditions that have been studied under the name of essential continued fevers. But then we must remember that, to understand pathological facts aright, we must observe them under all their aspects, and with the aid of all those exact methods with which the majority of medical men are as yet but very imperfectly acquainted. It is by following this

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method that the author of the present work has at length succeeded in solving, as far as the existing state of science will admit, the various questions appertaining to pyretological science. He has had the satisfaction of seeing his doctrines adopted by all the students that have duly attended his clinical instructions. He believes that they will be generally adopted by the whole of the rising medical generation, provided they be taught in worthy and suitable manner in lectures and books, as well as at the bed-side of the patient. But he is quite aware of the difficulties which oppose unity in the mode of instruction, and, if he regrets at having still so much to contend with for the triumph of what he knows to be the truth, this is not from any feeling of vanity, but solely and altogether from the sound and deep-felt interest he has in the welfare of humanity. Not a year passes but thousands of persons, affected with the so-called essential fevers, owe their lives to that treatment which he has been so fortunate as to propose; for these fevers, of a non-miasmatic origin, are invariably veritable inflammations at first."

It will naturally be asked, inflammations of what part, texture, or system?-Of the sanguiferous system, the blood and the blood vessels, replies M. Bouillaud. In accordance with this view, simple fever is described and treated of under the head of the Phlegmasiæ, and in the chapter, entitled, Of inflammations of the sanguineous apparatus in general, and of each of its divisions in particular." One of the opening passages in this chapter runs thus:

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"This phlegmasia-inflammation of the internal membrane of the sanguineous apparatus, or angeio-carditis*-so long unknown, is nevertheless one of the most frequent of all, whether it arises primarily and idiopathically, or consecutively to local phlegmasiæ. When simple, exempt from all foreign complication, it constitutes the pure inflammatory or angelotenic fever of Pinel, the synochus of other authors. When complicated with a septic, putrid, or typhoid element, it is the fever that has been called putrid, typhoid, or adynamic."

Without noticing the inflammatory lesions of the heart and blood.vessels alleged to be found in all fatal cases of Synochus, let us ascertain what our author says respecting the condition of the blood itself, and see how far his dicta correspond with the hæmatological observations of Andral and some other of the leading physicians of the French metropolis. M. Bouillaud affirms that the blood is uniformly strongly buffy and cupped, exhibiting all the characters that we see in cases of pneumonia and acute rheumatism. It is truly surprising, he says, that distinguished authors, Pinel for example, should assert that in inflammatory fevers the appearances of the blood drawn are very variable, and do not present any well-marked diagnostic features; and then he adds, with most amusing simplicity: "Whenever we meet with the buffy coat of the blood, such as I have described, we may confidently assert that there exists a general inflammatory diathesis, a phlogosis of the sanguineous system, a sanguine fever."

Before concluding his remarks on the state of the blood in Synochus, we are favoured with the following very satisfactory (!) mention of the recent researches of MM. Andral and Gavarret on this subject.

*The appellation of angeio-hemitis, proposed by Professor Piorry, is, in our author's opinion, preferable; as it points to the state of the blood, as well as of the blood-vessels.

"The blood, in cases where the characters described above are present, contains a larger proportion of fibrine than exists in a state of health. The buffy coat is in a great measure composed of this fibrine. Whence this excess of fibrine? MM. Andral and Gavarret unhappily leave us in a state of complete ignorance on this point. May we not attribute it to a sort of pseudo-membranous secretion from the inflamed membrane (the inner coat) of the blood-vessels and heart?"

Whether any of our readers will be better able to diagnosticate a case of fever after reading the following observations, we cannot determine; we must leave it to themselves to say :

"How shall we establish the differential diagnosis between a primitive, idiopathic, essential fever, and one that is secondary, sympathetic, and symptomatic. The thing is by no means so easy, even in the present day, as many physicians imagine; and it is not surprising that our predecessors, with their imperfect methods of observation, should have quite mistaken certain kinds of phlegmasiæ, and have designated, by the epithet of essential, fevers that are symptomatic of these very phlegmasiæ. I have often witnessed the very opposite mistake committed, and seen, for example, attributed to a phlegmasia of the glands of Peyer, a fever that was quite independent of it; I have seen a case of small-pox, before the eruption had made its appearance, mistaken for one of typhoid or enteromesenteric fever, &c., &c. It is only by a profound acquaintance with the positive signs, by which the various local phlegmasiæ are indicated, that we can hope to distinguish the two species of fever (essential and symptomatic) from each other. When these signs are really awanting, then we must acknowledge that the fever exists by itself, i. e., independently of any local inflammation, and is strictly and truly idiopathic; but it should always be borne in mind that some deep-seated local phlegmasiæ may exist with scarcely any appreciable manifestation of symptoms. It is told of a celebrated observer, that on one occasion, being exceedingly annoyed at not finding any visceral lesion in a fever patient, whom he believed to have had a gastro-enterite, he stuck the point of the scalpel into various parts of the corpse, when, lo! a quantity of purulent matter gushed out from a wound made in one of the thighs. This case was certainly not favourable to the doctrine of the essentiality of fevers; but it showed by the double error committed, on the one hand, that a continued fever may be attributed to a phlegmasia which does not exist, and on the other, that the phlegmasia, which really caused the fever, may be entirely overlooked. Many years ago, I witnessed a very similar case. A woman died of continued fever. No trace of any visceral lesion was discoverable upon dissection; and the physician was much puzzled to find the point de depart of the fever, when at length he detected a vast abscess situated immediately in front of the vertebral column."

It is scarcely necessary to point out the absurd mistake here of confounding together Synochus and Hectic fever, as if they were merely different degrees of the same morbid action. Our author, indeed, afterwards tells us that the latter fever, whether it be primitive or only symptomatic, is never the simple consequence of an angeio.carditis, but that there is always a greater or less degree of vitiation of the blood from the admixture of purulent matter. Surely such a humoral lesion is not present in cases of synochus; and, if not present, why not dissociate, it may be asked, the one from the other?

It is amusing to observe how very nearly, every now and then, M. Bouillaud is becoming an essentialist, in spite of himself. When speaking of the causes of synochus, he enumerates, first of all, over-feeding, excessive exercise, exposure to great heat or to alternations of temperature, and then he proceeds as follows: