it by its side, but on the contrary expand it by means of the entire hand; and take every opportunity of comparing the sensations derived from the lobules of this organ with those produced by pathological tumours. When, after believing we feel a tumour by pressing it laterally, we are unable to do so by pressing from before backwards, none in fact exists.

The means of treating this affection consists in part in modifying the form of the stays worn by the woman. The breast must be supported. As the fashion now leads to the breasts being widely separated from each other, the inner side often suffers pain from the traction exercised. The stays should be so made as to support the breasts towards the median line, bringing them nearer to each other, and carefully avoiding compressing them. This precaution alone often suffices, but we may also employ various liniments; and give iron, bismuth, valerian, &c., internally, according to the condition of the patient. It is not, however, in women of high life alone that we observe this affection, but examples are often met with among those of the lower classes.

GENERAL HISTORY OF THE SEVEN DIATHESES. By Professor

GAILLARD.

By diathesis we understand a pathological modification which exhibits itself in affections variable as to their seat, but identical in their nature. It is a change

in the organs and functions common to the entire economy; and when the morbid state is not so general as this, it affects at least some of the elements which enter into the composition of many organs. Thus rheumatism is seated in the fibrous tissue, and the herpetic diathesis occupies the skin and mucous membranes. Affections engendered by this cause put on special forms in relation to the diathesis whence they have arisen. Thus common ophthalmia is distinguished from syphilitic, and this from herpetic and scrofulous ophthalmia.

A diathesis is more than a mere simple disposition to a disease, and a person under its influence may be in a very serious condition long before any local symptom manifests itself. A person from whom a scirrhous tumour has been removed may remain for a long period without a relapse, and yet the cancerous matter eventually become deposited in some other part. It as it were hesitates, and if some external agent produces any local stimulation, it attacks this irritated part by preference.

Many persons look upon every disease as a mere local lesion, as bronchitis, arthritis. gastritis, &c., to which all medical appliances should be addressed; but the situation and extent of the anatomical lesion should not attract our attention so much as the general cause, which may give rise to a similar lesion in some other part of the economy. In this way a sprain complicated with scrofula may be allowed to degenerate into a white-swelling, or slight gastric irritation, under the rheumatic diathesis, may become developed into an obstinate gastralgia.

The diatheses constitute the humoral vitiations of the ancients, but they are not cachexia. A cachexia is a general condition of decay, a bad state of the general health usually consecutive to some serious or organic change. Certain diatheses may give rise to cachexia, but this term could not in general be applied to a gouty or rheumatic subject.

We must also distinguish a diathesis from the susceptibility to morbid causes, the vulnerability, which certain organs or apparatus may furnish. The vitality of the different organs may vary either above or below the normal mean, and the susceptibility in either case be increased. Such vulnerability may depend upon (1) congenital disposition: (2) hygeienic influences: (3) certain endemic or epidemic medical constitutions: (3) antecedent disease.

Considered in a general point of view the diatheses offer these characters in

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1. They act on several organs or regions simultaneously or successively. 2. They remain latent for a certain period, and then suddenly manifest themselves by various local lesions. 3. They perpetuate acute affections, interrupt their natural course, prevent the resolution of the disease, and lead to a chronic condition. 4. They obstinately persist, unless attacked by general measures. 5. They give rise to frequent relapses.

There are certain organs and tissues which each diathesis especially affects: thus rheumatism affects the fibrous tissue, syphilis the skin and mucous orifices, &c. But as these anatomical elements are common to many regions, the distinctive character of the diathesis is still maintained. That is, it produces at distant points local manifestations which are so identical that they alternate with, succeed, or displace each other, furnish analogous physical and physiological signs, and are modified by the same means of treatment.

Some diatheses are fixed or adherent to the organs which they attack. They may be met with at several points, but they leave with difficulty organs they have once attacked. This is the case with scrofulous, cancerous, and syphilitic affections, while others are mobile, and change their site with singular rapidity. This is the case with the rheumatic and gouty, and, in a less degree, the herpetic diathesis.

These affections are not all produced by the same causes. Thus, scrofula and scorbutus arise from the exertion of a profound and lengthened modification of the solids and fluids of the economy by external causes. Syphilis and cancer are produced by a poisonous principle, a material and organic cause, circulating in the blood. Rheumatism, gout and herpes may also be explained upon this last principle. Diatheses are often hereditary, i. e., the new-born child possesses a particular vulnerability in certain systems, and an especial susceptibility in regard to certain modifying agents of the economy.

The prognosis of diatheses varies according to the nature of the diathesis, the intensity, seat, and duration of the local disease and the social position of the patient. This last is of great practical importance; for when the condition of life of the patient places at his disposal the resources of hygeiene and therapeu tics, and his habits are temperate, the physician is much more assured of the results. He may then attack the most obstinate disease, and impress modifications upon the economy which meet it at its point of departure. Still, it must be allowed, that the favoured classes of society are more delicate and susceptible, and less amenable to the employment of medicines. Chronicity and obstinacy are characteristics of the diathesis. The general condition is modified with difficulty. The means employed are tedious and insensible in their action. A diathesis is slow in forming and in disappearing.

Diatheses are often complicated with each other. A patient, suffering from the herpetic diathesis may contract syphilis and rheumatism, and manifest symptoms characteristic of these different causes. In general the phenomena are characteristic, but sometimes the diagnosis is rendered difficult. Rheumatic and syphilitic pains may be confounded. Herpes of the prepuce has been mistaken for chancre. M. G. believes, with many other authors, that rheumatism may supplant syphilis, and that it is an error to treat all articular swellings and pains which follow blenorrhagia as venereal.

The treatment must, above all things, be general, and adapted to the nature of the diathesis. It comprehends-1. Special modifiers, or to speak more exactly, such as are oftener employed with usefulness and efficacy in each diathesis. 2. Evacuants, as purgatives, sudorifics, blisters, issues, &c. These last seem to replace the pathological local fluxion induced by the diathesis, and constitute, as it were, a supplementary function. 3 Narcotics which modify the nervous system and vitality of organs. 4. Hygeienic modifiers. These are the most efficacious. With them we may frequently do without medicines, but nothing will replace them.

The diatheses are seven in number, viz., the scrofulous, scorbutic, herpetic, syphilitic, rheumatic, gouty, and the cancerous. Each of these, to be properly treated, would require a special article, but we can only notice one of the examples adduced by the author. A simple sprain is always cured quickly or slowly according to the prudence of the patient, but still it always is cured; and it is only under the influence of a diathesis it becomes a grave disease. "In the majority of instances," says Lisfranc, "the external violence is only a determining cause which fixes in the articulation a morbid principle existing in the economy."

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The diagnosis of diathesic diseases is established by several circumstances. 1. The disease is chronic and obstinately persisting. 2. The patient has already been the subject of rheumatic pains, herpetic eruptions, glandular swellings, or some other affections which announce the existence of a diathesis. 3. In the origin of the actual disease, the patient has been exposed to circumstances which radically modify the economy. Thus the prolonged action of cold and damp engenders rheumatism. 4. The local manifestations offer special characters which indicate the generative cause. 5. In cases of doubt we test the disease by special medications, and the advantageous or injurious results which ensue throw light upon its nature. A young lady, the subject of sub-cutaneous swellings and gnawing ulcers, which offered many of the characters of syphilis, was treated with Dupuytren's pills without advantage, but recovered shortly under the influence of bark, as the lesion was caused by a scrofulous diathesis. 6. If the antecedents enlighten us upon the existence of a diathesis, consecutive phenomena often demonstrate the reality of certain causes, which had been either only suspected or even misunderstood. A person labouring under gastralgia is seized with a pain in his shoulder, and the affection of the stomach ceases. A dry and irritating cough may disappear as soon as an eczema of the thigh manifests it self. Sometimes these diathesic symptoms appear several years after the cure of the disease, and explain to us its capricious progress, its unusual characters, and its obstinacy.

In fine, many, or rather the great majority of, chronic diseases are maintained by general causes, and it is to these we should address our principal medical appliances.

NEW MEANS OF DISINFECTING DISSECTING ROOMS.

M. Sucquet has presented the Academy of Sciences with an account of his new mode of impeding the putrefaction of subjects used for dissection. He observes, the means which at present imperfectly accomplish that object, as arsenic, corrosive sublimate, &c., either injure the edges of cutting instruments, or prove de trimental to the health of those who use them. He employs two substances, namely, a solution of sulphite of soda and one of chloride (chlorure) of zinc. The first of these is injected into any large artery, returns by the veins, and even fills the lymphatics. It exerts no chemical effect upon the blood, but effectually cleanses out the minutest capillaries, so that other injections may be used afterwards. The volume, consistence, colour, &c., of parts are all preserved, and remain so, if the integument be undisturbed, so that air does not obtain access, for a month as an average period, but something even for 40 or 50 days, and that in a moist atmosphere at a temperature of 54°. The sulphite absorbs the oxygen given off by the tissues, and prevents it taking part in the putrefactive process.

This substance, however, does not protect from putrefaction for more than 20 days, when the integument is destroyed and the tissues exposed to the air; but the parts may be preserved for ever free from putrefaction by the use of the chloride of zinc. Parts required for further dissection should be immersed in it:

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and all those in which putrefaction is about to commence, should be daily sponged with it. Its action is instantaneous. Parts which have become green and softened are at once disinfected, all the tissues it comes in contact with becoming white and hard, It acts by precipitating the soluble portion of the animal fluids, as albumen, fibrin, &c., and it coagulates cerebral and fibrous tissue.

Both substances are expensive to purchase, but their preparation on a large scale, the formule for which the author supplies, may be conducted very economically; so that three or four shillings will defray the expenses of preserving each subject.-Archives d'Anatomie, 1846, p. 122.

(In the Annales d'Hygeiène for April is a short paper by M. Guerard, who was one of the Commissioners appointed to examine into the success of the experiments with these substances, which were carried on during several months at the Ecole Pratique. The field is a wide one, for during 1845 there were upwards of 1500 bodies received for dissection. At Clamart, where the process is also about to be adopted, the average exceeds 2800: so that the annual number of bodies dissected at Paris considerably exceeds 4000-an enormous number when compared with that furnished to the London Schools, where the difficulty in obtaining subjects seems to be annually increasing, and the supply of which is entirely inadequate for the proper teaching of anatomy. The more limited the supply, however, the more important the means here proposed for economizing it, providing it prove as efficacious as represented. M. Guerard's statement is most unequivocally favorable to it. He states that he has repeatedly visited the dissecting-rooms since it has been in use, and finds them utterly devoid of all offensive odours, and the complaints which used to be made on account of these, by the inhabitants of the locality, have entirely ceased. Bodies may be dissected for from 15 to 40 days, according to circumstances, without any attendant inconvenience.-Rev.)

ON TYPHOID FEVER. By M. BRICHETEAU.

M. Bricheteau has recently published some interesting papers upon this subject, of which our limits, however, forbid any prolonged notice. He maintains that the history of the disease proves that, forty years since, the intestinal canal did not present the lesions now so commonly remarked, for these must have been noted by such observers as Bayle, Dupuytren and Laennec. It may be laid down as a principle, therefore, that typhoid fevers, without absolutely changing their nature, present at certain epochs notable modification, sufficient to effect a change in their diagnosis and treatment. An illustration of this is also derived from the fact of no such considerable changes being observed in the epidemic fevers of Great Britain and Ireland. Even in France such lesions are absent in some epidemics, and are in others no-wise in proportion to the gravity of the symptoms; so that they cannot be considered the essential feature of the disease and its point of departure, although, from their dangerous character, they naturally have excited much attention.

M. Bricheteau observes that the contagious character of typhoid is not admitted in Paris, although believed in some of the provinces; but he is certainly in error in stating that the contagion of typhus is generally admitted in this country, and that a vigorous sequestration is consequently insisted upon. He is more correct as to the treatment which prevails here, for certainly the bleeding + and antiphlogistics employed by many in Paris, would meet with few approvers in London. In explanation, he observes that inflammatory lesions are more common in Paris, as its climate is less debilitating than that of London. Sydenham, who had studied disease at Montpelier, acknowledged that his practice was too vigorous at the commencement of his career in London; and many No. 105. 18

other practitioners have observed that bleeding is much less easily borne in that capital than in Paris.

E. Bricheteau believes, however, that typhoid cannot be looked upon as a phlegmasia, inasmuch as neither the season of the year at which it occurs, the treatment it requires, the order of sequence of the abdominal symptoms, or the measures which relieve these, favour this view. "By seizing on this inflammation as a basis of treatment, we commit the error of neglecting the cause for the effects of the disease." M. Delaroque, of the Hôpital Necker, and others, believe the symptoms of typhoid are due to the irritating effect of vitiated bile and other secretions which are thrown out upon the intestinal mucous membrane, and are then absorbed, poisoning the economy. Andral, Bouillaud, and Louis, are cited in proof of the enormous quantities of such secretions which are found after death, while the success of the purgative treatment pursued by M. D. is adduced in corroboration of this view. Other observers explain all the symptoms of typhoid by a primary alteration in the condition of the blood. The dissolved state of this fluid has been often observed by both the older and modern practitioners, and symptoms identical with those of typhoid have been induced by injecting putrid matters into the veins-the blood losing its plasticity as in typhus.

Conclusions. The placing the seat of typhoid in the intestinal canal, the cerebro-spinal system, the blood or its secretions, seems to me of very little consequence, since this disease affects simultaneously or successively every portion of the economy. We find, first, the phenomena incidental to a disturbance of the nervous system, in which disturbance the circulation soon participates. Almost immediately afterwards, diarrhoea and other symptoms of intestinal irritation present themselves, as also the rale which proves the pulmonary organs are not unaffected. Other symptoms soon show that the various secretions are either perverted or temporarily suspended. The affection seems to prevail in some degree everywhere, and to have its special seat nowhere. It is truly the morbus totius substantiae of the old, physicians. It is often epidemic, and sometimes contagious, presenting much analogy with many pestilential fevers, typhus, sweating-sickness, and intense epidemic influenza-diseases to none of which a precise seat can be attributed. It follows that the treatment of typhoid should be mixed, being composed of measures as various as the lesions to be combated. Sometimes diluents and antiphlogistics, sometimes evacuants, at others alteratives, tonics, anti-septics, or sedatives may be required. In fact, to adopt any exclusively curative method, would be to apply a determinate medication to an unknown pathological condition.-Gaz. Méd. Chir., Nos. 13, 15, 17 & 23.

ENGLISH AND FRENCH MEDICAL PERIODICALS.

The Gazette Médicale, for June 13th, publishes an article upon the English Medical Periodicals. That it is replete with error will not excite the surprise of those who are aware how completely everything relating to this country is misunderstood in France, and who recollect the ludicrous mis-statements of M. Malgaigne, (Méd. Chir. Rev., Jan., p. 284,) at the Medical Congress, in reference to the posi tion and acquirements of our general practitioners. Still, writers who profess the instruction of their readers upon any point, should at least inform themselves of the facts, and we regret our space will only permit our indicating one or two instances in which the present one has disregarded these. He states that the Quarterly Medical Reviewers of this country confine themselves to the insertion of mere verbatim extracts from the works they examine, carrying these sometimes to the extent of a third or fourth of the publication in hand, without any attempt