whole proceeding is accomplished more rapidly in one than in the other, and it is frequently quite impossible to distinguish tubercle from typhus matter. He, moreover, quotes Engell as an authority, that in proportion to the weakness of the vital powers, so the facility for tubercular deposition is increased.

It would, indeed, be a work of supererogation to give a detail of many of the well-known causes productive of tuberculosis. I may, however, just allude to the fact, that nearly all the writers of the present day have abandoned the ancient hyphothesis of inflammation being ranked as the common cause of this disease Every fact observable, both in man and in the lower animals, shows that whatever tends to depress and lower the system renders it eminently liable to a deposition of tubercle. Most of the cows kept in the stables at Paris die phthisical, (Louis), which effect certainly cannot be ascribed to cold. Phthisis, again, is more frequent at old age, with females than males, (Louis.) The occupations of seamen, butchers, and tanners are, on the other hand, generally considered unfavourable to the occurrence of consumption, (Sir J. Clark.) Lombard calculated that the disease is only one-half as prevalent among persons in easy circumstances as it is among the great bulk of the population. Phthisis also frequently follows both continued and intermittent fever, so close as to make them appear exciting causes; and to this list we might also add dyspepsia. The disposition of this disease, again, appears to be strongest in that condition of the body called lymphatic; whereas, when the system seems to be more highly vitalized, such as probably occurs in pregnancy, this condition appears to retard, if not to suspend, its progress; and finally, as Dr. Todd observes, "it is easy to understand how this nutritive matrix, either from deficient vitality, or some other condition, may be formed of a nature below the standard of organization, and how in this state the nutritive molecules may, instead of tissue, be converted into tubercles; "—all which evidence corroborates my views, that the first stage of phthisis may strictly be considered as one in which the vital force is acting with diminished resistance.

It has recently been advanced that the condition of the body favourable to the development of cancer is almost incompatible with that of tuberculosis, or, as Mr. Simon observes, "the one excludes the other." In cancer, this author alleges there is an obstinate excess of vitality, which will not be quenched. Now, if the first step favourable to the deposition of tubercle be a want of vital power, does the foregoing fact concerning cancer antithetically uphold my proposition as to the first stage of tuberculosis? or, in other words, as the organism is acting with more than a normal energy in one disease, and with a diminished vital power in the other, does this, I repeat, account for tuberculosis and cancer being incompatible in the same body?

From the foregoing, we draw the following conclusions:

1st. That the ratio of mortality from phthisis, in publicans, is less

than one-fourth of the ordinary ratio among other classes of the adult population.

2nd. That the first step in tuberculosis seems to consist in some molecular change in the substance of the body-probably owing to a deficient vital attractive power among the particles-and that compounds like alcohol act by sustaining this attraction.

3rd. That phthisis is characterized by an excess of oxygen circulating in the system; and that when the blood becomes too highly carbonized from various diseases, tubercles are not deposited-to wit, in cyanosis, &c.

4th. That deposits similar in constitution to tubercle are produced under other circumstances than phthisis, and that this always occurs when the vital system is lowered-as, for instance, in typhus; and, on the other hand, when the vital force seems to be in excess, which takes place in cancer, tubercles are seldom if ever formed.

Lastly. From these we infer that the treatment most likely to prevent deposition will be generous living-wine, beer, &c.-with tonics; and that medicines containing much carbon, as cod-liver oil, tannic acid, &c., are of use, as furnishing a pabulum by which the excess of oxygen in this disease may become saturated, without acting upon the tissues.-Lancet, Feb. 25, 1854, p. 207.

38.-CO-EXISTENCE OF TUBERCULOSIS WITH CYANOSIS; PRODUCTION OF HEMIPLEGIA BY DETACHMENT OF FIBRINOUS DEPOSIT FROM THE HEART.

By DR. H. FEARNSIDE, Physician to the Preston Dispensary. The case, of which an outline is given below, supplies an important correction, and also confirmation, of opinions which have been recently promulgated.

It is now generally taught by pathologists, that a venous condition of the blood is eminently antagonistic to tubercular development and deposit. The doctrine is thus broadly laid down by Rokitansky: "All cyanoses, or rather all forms of disease of the heart, vessels or lungs, inducing cyanosis of various kinds and degrees, are incompatible with tuberculosis, against which cyanosis offers a complete protection; and herein we find a key for the solution of the immunity against tuberculosis afforded by many conditions which at first sight appear to differ so widely from one another."

A similar statement is made by Mr. Simon in his excellent 'Lectures on General Pathology: "There is one signal peculiarity which attends this chronic venous condition of the blood, which I must not leave unmentioned. Not only in extreme cases of cyanosis, but in all chronic diseases where, from any cause whatever, there is defective arterialization of the blood, the patient enjoys one privilege. He is exempt (perhaps absolutely, but at least all but absolutely, exempt) from tubercular disease."

In the subject of the following report, cyanosis of the most perfect description was associated with equally well-marked tuberculosis. T. W., a stout young man, aged 19, was first seen by me in the autumn of the year 1852. He was the son of robust parents, and his brothers and sisters were strong and healthy. Shortly after birth, his complexion was noticed as somewhat livid and blue, but the circumstance appears to have attracted no special attention for some years, until the occurrence of an accident, to which his friends ascribed his subsequent bad health. On the occasion referred to, being then seven or eight years of age, he fell into some water, and was in imminent danger of drowning. Some time afterwards, he spent the whole of a cold winter's night in the open air, having been inadvertently shut up in the yard of an unoccupied house. An illness of some duration, but the precise nature of which cannot now be ascertained, was the result. The darkness of his complexion became more conspicuous, and he began to suffer from cough, and difficulty of breathing, on any rapid movement; but his general growth and development were not arrested or impaired; he became an apprentice in a foundry ; and at the time when he fell under my notice, his size and stature were not inferior to those of other young men of similar age. A few months before the period mentioned, his breathing became still more embarrassed, and his feet and legs were observed to be swollen at night; and for the preceding two months, he had been unable to follow his employment. When he consulted me, his face appeared swollen, and was darkly livid; his hands were blue and cold; and the lower limbs œdematous. His respiration was short and quick, and he had a frequent cough, with considerable expectoration. The heart's action was unnaturally strong and frequent; the cardiac dulness on percussion extended from above the fourth rib to the lower margin of the chest, and from an inch to the left of a line descending from the mammilla to the right border of the sternum. Both sounds were normal over the apex, and occasionally both were heard distinct and clear over the base of the organ; more frequently, however, the first sound was rough and murmurish, and over the second and third left costal cartilages a fine but lound grating murmur was heard. The superficial veins were dilated and prominent. There was some want of resonance on percussion under the clavicles, where the breath sound was harsh, and mixed with coarse crepitation, especially on the right side. Elsewhere, the breath sound was obscured by sonorous and liquid rhonchi, but there was no evidence of pulmonary condensation. The secreting organs were sluggish in their action; the bowels torpid; the urine high coloured and scanty.

Such were the phenomena which the case presented on the first and only opportunity which I had of examining it last year. When I next saw the patient (about two months ago), he was moribund. I found that in the interval he had been gradually declining in health, his cough having become more constant, his breathing more difficult,

and the dropsy more considerable. Four days previously he had been down stairs, and, whilst there, had suddenly, and without any premonitory symptoms, been attacked with paralysis of the left side of the body. I found him in bed, breathing heavily, and panting: his face was swollen, and of a dark purple hue: he was rather deaf, but his intelligence was not impaired; his replies to questions were correct. There was extreme restlessness; he was continually desirous of being moved. Considerable anasarca of the lower part of the body was present. The paralysis affected both motion and sensation, and was complete. The heart was beating tumultuously and irregularly, and the pulse was small, rapid, and indistinct. There was marked dulness on percussion under both clavicles; and on the right side, loud cavernous respiration and gurgling were audible. Over the rest of the lungs, loud mucous and sonorous rhonchi were heard, and so loudly as greatly to obscure the heart's sounds. He died on the following day, and his body was examined about twenty-four hours after death.

The lividity of the face, extremities, and posterior parts of the body, was very great.

Chest. There were very strong adhesions between the upper parts of both lungs and the walls of the chest. A cavity capable of containing an ordinary sized orange, was found in the apex of the right lung, and connected with it were a number of smaller cavities. The walls of the principal one were formed chiefly by thickened pleura, and a number of obliterated vessels projected from its irregular internal surface. A large quantity of tubercular matter, both grey and yellow, but chiefly the latter, was dispersed throughout the upper lobe, and collected in masses around the excavations. Some tubercular deposit was also found in the lower lobe of the lung. The upper lobe of the left lung was similarly affected, but to a less extent; several cavities existed there, but they were small ones, and the surrounding tubercular matter was less abundant.-Association Med. Journal, March 10, 1854, p. 222.

39.-ON THE ACTION OF COD-LIVER OIL AS A CURATIVE AGENT IN THE TREATMENT OF DISEASE.

By DR. R. M. GLOVER, F.R.S.E., Lecturer on Chemistry at the Royal Free Hospital Medical College.

Oils, alcohol, and the carburetted hydrogen of mines, constantly inhaled by the coal-miners, all agree essentially in affording to the blood large quantities of combustible substances; and I may mention along with this, that I have known, during my experience, many instances of young surgeons of small fortunes being compelled to go a voyage in a Greenland ship, and thus saved for some time at least from hereditary phthisis. Now during these voyages there is great consumption of nutritious substances, and perhaps not a little of alcoholic fluid.

I infer that the efficiency of the oils, and generally speaking, the hydro-carburets in tuberculosis, is due to some chemical influence which they exercise. This is supposing my premises admitted.

In the last part of Dr. Pereira's work, just published, the editors, in seeking to explain the operation of cod-liver oil, attempt to return to the idea that it is due to the iodine and bromine in the oil. They say-"as the oil contains iodine, and as it proves most successful in those maladies in which this element proves successful, it has been suggested that iodine is its active principle. Taufflied, however, denies this, and asserts that the properties of the two are not identical, for the one succeeds where the other fails. Is bromine the active agent? (It must not be forgotten that iodine and bromine are combined organically with some of the constituents of this oil, and in such manner that they are not to be immediately recognised by the ordinary tests. This fact may perhaps tend to develope a peculiar action of iodine and bromine, and endow them with an efficacy not otherwise attainable.)”

Now in 100 parts of oil there are never more than 0.04 parts iodine, and as iodine exists in all fish, what possible virtue can it have, especially as it no doubt exists combined with alkaline or earthy bodies? A fabulous reputation seems attached to bromine. I have taken the bromide of sodium to my dinner instead of common salt.

The fact is that all the chlorides, bromides, and iodides are analogous; they afford a beautiful illustration of the greatest law ever observed in therapeutics, and of which very few seem to be capable of realizing an adequate idea-viz., that the chemical properties of bodies are exactly imitated by their physiological and medicinal properties.

Some years ago, as an illustration of this great law, I selected the group of chlorine, bromine, and iodine, so closely related in their chemical and physical properties, and as the compounds of bromine had been least examined they were especially chosen; and I think I proved that the physiological activity of these bodies was as their solubility, and their facility of decomposition, with this allowance, that as chlorine is the more active element of the three, chemically, so it and its compounds are the more active of the three physiologically, eæteris paribus. We find everywhere bromine and its compounds occupying an intermediate place between the others physiologically as as they do chemically.

In the electro-positive salts-say, the chloride, bromide, and iodide of potassium-the chloride is the least easy of decomposition and the least soluble, the bromide more so, the iodide most, in the ratio of their activity. When we come to the electro-negative compoundssay, those of mercury-when the affinities come to be inverted, there the physiological and medicinal powers are inverted also; for instance, iodine will decompose the chloride of mercury, while it will not decompose the chloride of potassium, and the chloride here is the most active, the bromide less so, the iodide least. Now I account for this