come thus associated with the ganglia of the sympathetic, whose office, anatomically considered, is to give origin to the gelatinous fibre. A few gelatinous fibres are found in both the motor and sensitive roots of the spinal nerves, but the quantity is so small when compared with the quantity found in other parts, as to preclude the idea that the sympathetic arises from them. Most probably these fibres are distributed to the vessels of the cord; as gelatinous fibres, which come from the gray branch of the thoracic ganglion, pass along the motor root in the direction of the spinal cord, and gelatinous fibres from the same source, also enter the ganglion on the sensitive root; both these sets of fibres evidently pass from the thoracic ganglion towards the spinal cord."—(L. c. p. 215.) Mr. Beck sums up this division of his enquiry by observing, we have thus two distinct and separate systems of nerves, one composed of gelatinous nervous fibres which have their origin at the different ganglia; the other composed of tubular nervous fibres which arise at the brain and spinal cord."

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He further has confirmed the opinion generally entertained that the so-called gelatinous fibres are in reality true nervous fibres, by ascertaining the facts that many small nerves are entirely composed of them, and that the ultimate distribution of many of them is to the arteries. The sole anatomical use of the ganglia is conceived to be "to give origin to the gelatinous fibres, to which end they are distributed irregularly over the body, in those situations where a supply of the gelatinous fibre is required. The true sympathetic system appears to be a system of gelatinous nervous fibres, which are distributed everywhere over the body, and which preside over the organic functions. It appears to exist independently of the brain and spinal cord, although the tubular fibres which come from the brain and spinal cord are associated with the gelatinous fibres in the larger branches of the sympathetic."-(L. c. p. 219.) All these are important details, confirming in many essential points the views arrived at by other modes of research; they also afford another illustration of Bell's one fundamental principle-the individuality of the primitive nervous fibres; and, by showing that the great sympathetic, with all its intricate plexuses obeys the same disposition as that established in the cerebro-spinal axis, prove that, throughout the entire nervous system, there is but one law of conduction.

We now come to that part of these researches which constitutes the main object of the whole enquiry, the anatomy of the nerves of the uterus. The clue to the cause of the discrepancy between these dissections of Mr. Beck, and those of Dr. Lee, is indicated by the following note, appended by the former gentleman to his paper, and dated May, 1846. In the progress of my dissections, I found that the structure considered by Dr. Lee as the hypogastric or utero-cervical ganglion' was a mass of dense fibro-cellular tissue enveloping several small ganglia and a nervous plexus, formed at the junction of the lateral hypogastric plexus with branches from the sacral nerves; that the vesical ganglia' were also a mass of fibro-cellular tissue, in about the centre of which were situated small ganglia; and that the remaining structures described as ganglia and plex

uses

were not nervous structures."-(L. c. p. 213.) What these nonnervous structures really consist of, according to Mr. Beck's views, may be understood by one of the references to the plates: "R. R. Portions of

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SIZE OF THE NERVES IN THE GRAVID UTERUS.

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the superficial layer of muscular fibres (of the uterus) which have been dissected out by Dr. Robert Lee, and described by him as nervous ganglia and plexuses. These muscular fibres adhere to the under surface of the peritoneum."-L. c. p. 234.

Our limits will not permit us to follow the intricate plexuses of nerves situated in the pelvis, so minutely followed and traced out by Mr. Beck; it would, however, be unjust towards that gentleman, if we did not state that his account differs in some respects from that of former writers, and that he has more successfully determined the source and disposition of those nerves than has hitherto been accomplished. One or two points are all that we can notice. The author has ascertained that there is an important difference in the constitution of the nerves supplying the bladder and vagina, organs endowed with a high degree of sensation, especially the vagina, and also with voluntary muscular power, when contrasted with those proceeding to the uterus, rectum and intestines; in the former case, the nerves contain a much larger amount of tubular (cerebro-spinal) fibres than in the latter. The precise arrangement, extent, and relations of the lateral hypogastric plexuses, springing from the inferior aortic plexus, of the sympathetic, of the branches of the sacral plexus, and of the pelvic plexus formed by the union of the two former, are most satisfactorily demonstrated. Among other points that have been ascertained, it appears that no branches of the sacral nerves are sent to the neck of the uterus, as some have imagined, upon physiological grounds to be the case.

The author thus speaks of the much controverted question, respecting the size of the nerves in the unimpregnated and impregnated uterus:

"THE SIZE OF THE NERVES.-The size of the nerves in both these dissections (that is of the unimpregnated and impregnated uterus) is essentially the same, and when the nerves are carefully compared, no doubt is left that the nerves of the gravid uterus have undergone no change in size; nor any change in position, except. that consequent upon the development of the organ. Yet at first sight the nerves of the unimpregnated uterus appear even larger than those of the gravid uterus; this, however, is due to the manner in which they are arranged. In the unimpregnated state of the uterus, the nerves of the lower portion of the hypogastric and pelvic plexuses, are crowded and packed together so as to occupy a much smaller space than they do in the gravid state of the uterus. The consequence of this is, that the nerves of the former present a wavy arrangement, which gives them the appearance of greater thickness and plumpness."-L. c. p. 221.

We may remark that we have observed in the œsophagus of the Boa Constrictor, a part subject to occasional distension, a wavy disposition of the nerves exactly similar to that above described by Mr. Beck, and which would indicate that, in pregnancy, the uterine nerves-we say nothing of the gangliia-are unfolded rather than enlarged.

As to the number of nerves belonging to the uterus, it is, according to the author, remarkably small; a few isolated branches are traced, "which pass on as distinct fine cords, dividing and sub-dividing, but not uniting with each other." The lower part of the organ is supplied by the lateral hypogastric plexus; the middle and upper part has a distinct branch from the inferior aortic plexus; whilst the fundus receives a branch from the nerve, which, coming off from the renal plexus, accompanies the spermatic artery. Mr. Beck also speaks of another set of nerves, minute in size, assuming a plexi

form arrangement around the vessels, and having the distinctive character of forming here and there minute ganglia.

With respect to the vessels of the uterus, the author is inclined to think that they do not diminish in size after parturition, but are only contracted in their cavity, ready to be again stretched out upon a larger portion of blood being sent to the organ.

In consequence of the great interest that the controversy respecting the merits of Dr. Lee's and Mr. Beck's papers has excited, we have deemed it desirable to furnish our readers with all the details bearing upon the question; and the nature of the enquiry is the best apology for the many anatomical facts contained in the present article. As to the merits of the case, it seems, according to our judgment, that further examinations are required for finally arriving at the truth; and it is especially desirable that the disputed textures-we allude particularly to the large masses which Dr. Lee contends are true ganglia-should be examined microscopically in a perfectly recent condition; and this is an examination which that gentleman should have made forthwith. Under such circumstances the existence or nonexistence of the nerve-corpuscles, the only certain test of ganglionic substance, would definitely determine the question, and no other kind of proof will be deemed satisfactory by impartial persons. It may not be superfluous to add that, having examined the dissections both of Dr. Lee and Mr. Beck, we are inclined to receive those of the latter gentleman as demonstrating the real structure, although we were among those who formerly admitted the accuracy of Dr. Lee's preparations. Nothing can exceed the beauty of Mr. Beck's specimens; and the plates illustrative of them are equally to be admired.

As we have had occasion, in the first part of this article, to refer in condemnatory language to the proceedings connected with the award of the Royal Medal to Mr. Beck, it is proper to state that our remarks were aimed at what we deem to be the vicious system permitted to exist in a national institution, and were not intended to depreciate the value of these very important researches, which merit, as they will doubtless receive, the highest praise.

THE SANATIVE INFLUENCE OF CLIMATE. By Sir James Clark, Bart., M.D. F.R.S. Fourth Edition, royal 12mo. pp. 412. London, 1846.

A WORK of long established reputation like the present seldom calls for more than a passing notice in a quarterly review, unless, indeed, the quantity of additional matter which a new edition contains be such as fairly to demand a more ample examination. That the fourth edition of the "Sanative Influence of Climate" has been carefully revised by its distinguished author, and that its contents have been considerably enlarged, is quite true; but it is not so much for this reason that we are induced to devote a page or two to its consideration, as for the purpose of expressing our earnest caution to young medical men against attaching so great an impor

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EFFECTS OF CHANGE ON CONSUMPTIVE PATIENTS.

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tance in the treatment of many maladies to a change of climate from our own shores to distant countries as has been, and we fear still is, too frequently done. That a vast deal of suffering and positive mischief has often been committed by physicians indiscreetly sending patients affected with consumption, to different parts of the continent and other regions, in the vain hope of a southern climate being capable of effecting what no spot in our own country was supposed able to do, cannot be disputed by any one who is at all acquainted with the melancholy history of that disease. Some of the very places, which, a few years ago, were so strongly recommended as most adviseable residences for phthisical individuals, are now admitted to be utterly inappropriate. Nice, for example, once stood very high in estimation; and now what does our experienced author tell us ?"little benefit is to be expected from the climate. Indeed the cases of consumption which ought to be sent to this place are of rare occurrence." And what do we learn from Drs. Renton and Heineken respecting the majority of the poor sufferers that are sent out to Madeira ? "Of the thirty-five cases reported by Dr. H., several died before they reached the island, three within a month of their landing, and five or six in about six months. Of forty-seven cases of the same class of invalids in Dr. R.'s report, more than two-thirds died within six months of their arrival in the island.” Was it not a cruel and disgraceful thing on the part of medical men to have lent their sanction to, nay, to have suggested the propriety of, a distant change of climate in the greater number of these melancholy cases? Without pursuing this subject further, we have no hesitation in expressing our decided opinion that the favourite practice of sending consumptive patients to Madeira and various places in the south of Europe has, within the last forty years been productive of much greater harm than good. Let it never be forgotten that it is almost solely in the threatened and incipient cases that any decided benefit can be anticipated from a residence in a warm climate. That the young members, more especially the sons, of a consumptive family may often have their health and strength improved by residing for a few years in Madeira or one of the West India İslands, we are ready to admit; but, if the tubercular disease be fairly established, we are only precipitating the mischief by advising such a change.

In the treatment of the different forms of Dyspepsia, Sir James Clark is inclined to lay much more stress upon the particular locality abroad to be recommended than we should deem at all necessary. That change of air, change of scene, change of diet, and change of occupation are better remedies in a host of dyspeptic and hypochondriacal affections than all the pharmaceutical formulæ in the world, who will deny? But surely all these things might be generally had within the limits of our own dear land, if people were but brought to think so.

We fear that Sir James' book has had the effect of making many, especially among the wealthier classes, imagine that they must forthwith go upon the Continent to find relief for certain stomach ailments, which might be just as readily got rid of in their own country, provided some very simple hygienic rules were attended to. The following passage will serve as an example of what we think may sometimes be fairly objected to the present work; viz. in attaching an undue importance to mere peculiarity of climate in the treatment of different morbid affections. After

describing the different forms of dyspepsia, Sir James tells us that each form requires a different climate for its relief:

"The patient with gastritic dyspepsia should not, for example, go to Nice, nor the South-east of France. In such cases, the South-west of France, or Devonshire is preferable, and Rome and Pisa are the best places in Italy. On the other hand, in atonic dyspepsia, in which languor and sluggishness of the system, as well as of the digestive organs prevail, with lowness of spirits and hypochondriasis, Nice is to be preferred to all the other places mentioned; and Naples will generally agree better than Rome or Pisa; while the south-west of France and Devonshire, and all similar climates, will be injurious. In the nervous form of dyspepsia, a climate of a medium character is the best, and the choice should be regulated according as there is a disposition to the gastritic or the atonic form.”

Now in truth Dyspepsia, with all its accompanying and induced disorders, is generally much more influenced by the food that is taken into the stomach than by the air that is inhaled into the lungs. Travelling about, too, from one place to another is, on the whole, vastly preferable in all such cases to a stationary residence in any spot, however genial may be its climate. If people must go abroad, then it may be perfectly true that "Rome is the best residence in Italy in gastritic dyspepsia, and Nice the best climate in the purer cases of atonic dyspepsia ;" but we verily believe that the soft air of Devonshire or the Isle of Wight, and the keener breezes of Wales and Scotland would answer quite as well for the health, and a great deal better for the purse, and often for the morals too.

Within the last five years there has started into notice a new candidate for hygienic distinction as a resort for invalids ;-Egypt. Sir James, in the present edition of his work has, for the first time, drawn the attention of his readers to the land of old Nile.

We give the following extract as containing his opinion, formed not from personal examination, be it remembered, but from what has been published by Clot-Bey, Dr. Cumming, and one or two other writers.

"From the description which has been given of the climate, may be inferred the character of the diseases and deranged states of health which will derive benefit from a winter passed in Egypt. Invalids requiring a dry, warm, exhilarating climate will find it here. Certain forms of dyspeptic disorder of long standing, with their consequences, chronic affections of the mucous membranes of the respiratory and other organs of an atonic and congestive kind, and chronic rheumatism may be numbered as among the diseases likely to be benefited; and there is a large class of persons suffering from a state of deranged health which scarcely admits of definition, and yet is well known as one of the many consequences of sedentary habits, prolonged and anxious mental exertions, irregularity of living, &c. who will derive great advantage from a winter spent on the Nile. But the patients, whom I have had chiefly in view in giving this brief notice of the climate of Egypt, are young men whose health has become deranged from the causes already mentioned, or from others of an analogous kind, and to such a degree as to excite apprehension lest the disordered condition of their system might end in consumption. For this class of invalids, suffering from disordered health rather than actual disease, and not so delicate as to be injured by the inconveniences and mode of life to which they would be subjected during a winter in Upper Egypt, the climate seems to me peculiarly well adapted. In the case of invalids also, returning from India for the recovery of their health, and to whom it is important to avoid arriving in England at an unfavourable season, it may be