vessels as to remove what is termed plethora, and in doing this the inflammation is generally rendered stationary and less painful; a second abstraction after a short interval (about 12 hours) is therefore necessary to produce a sensible impression on the vessels of the affected part. The practice of applying leeches to the skin, immediately over the inflamed viscus, appears to us very absurd, for the skin has no direct communication with the blood-vessels of the inflamed part. This practice is improperly termed topical bleeding, for the vessels of the seat of the disease cannot be more unloaded by it than those of the extremities. The blood coming from the general mass, the quantity taken is much too small, and the flow of it too slow, to afford essential relief; indeed, in consequence of the exposure of the part to the air, during the application of the leeches and the bleeding, it is very common to find the inflammatory symptoms in an aggravated state the following day. The abstraction of blood by the operation termed cupping, is never so beneficial as from a vein, although to the same extent, in consequence, perhaps, of the blood being chiefly arterial. The idea that arterial blood is more stimulating to the system than venous blood, is erroneous, for the only difference between them is the absence of carbon in the former, and if one is more stimulating than the other, we should think it was the latter, on account of containing carbon. The abstraction of venous blood must afford more relief to the lungs in cases of inflammation of them, their office being chiefly to separate the carbon from the blood. The idea that arterial blood is more stimulating than venous blood, originated in the supposition that the blood attracts oxygen from the atmospheric air during respiration. Instead of attracting oxygen, it is satisfactorily ascertained, that the oxygen of the air conveys carbon from the blood, in the form of carbonic acid gas.

Every surgeon of observation knows that inflammation (as we have above stated) commences in the nerves. After contusion or puncture the part first becomes painful, in a few hours the temperature increases, then ensue distention of blood-vessels and swelling. The swelling advances so as to distend the skin, when the pain generally abates considerably, and the process of suppuration commences. This is the progress of inflammation on the surface of the body, and when it takes. place in an internal part it is similar.

Now, what is the rationale of the phenomena of inflammation?

By the irritation of nerves, an impediment is produced to the transmission of the contents of the arteries through the minute vessels which connect them with veins, probably in consequence of spasmodic constriction. The arteries become distended, occasioning slight tumefaction, redness, and pulsating pain. From the increased action of the arteries to overcome the impediment, lymph escapes by the exhaling branches occasioning an increase of the swelling, and in a short time a diminution or cessation of pain, probably in consequence of compression of the irritated nerves. The effused lymph, by the action of the increased heat, is converted into pus. The veins of the part appear to be in an opposite state to the arteries, for the blood which escapes from laceration of the part is arterial. This appears to us to be the rationale of inflammation, and the different species of it depend on the parts which are most affected, as the nerves, blood-vessels, absorbents, &c.; from an

unhealthy state of the latter, probably arises that chronic species which occurs in scrofulous habits.

The system which connects the arterial with the venous system (not satisfactorily demonstrated by anatomists), through which the blood is conveyed from the extreme ramifications of arteries to the veins, is in a chemical, as well as a pathological point of view, a very important one in the animal economy. How the transmission of blood from arteries to veins is effected, is very mysterious. We find during the conveyance, it becomes charged with carbon. Of what process then is this product? We are inclined to believe, as we stated some years ago, that a species of combustion does take place in them, of which the productions of heat and carbon are the consequences. We have for some time been engaged in experiments to elucidate this fact. Fever probably commences in the brain and nerves, and is established by constriction of this connecting system.

That scrofula is a disease of debility, as asserted by Dr. Gregory, we very much doubt, for it occurs in the robust as well as in the debilitated or delicate. Indeed scrofulous enlargement of the glands of the neck and of joints, more often occurs in subjects in possession of rude health, than in those in an opposite state. Neither strength nor debility appears to have anything to do with its production. When the patient's sanguiferous system is overloaded, we uniformly have recourse to bleeding, and other debilitating treatment, and from this plan we have witnessed the most decidedly beneficial effects. The idea, which has but too generally prevailed, of its being a disease of debility, has led to maltreatment, and to fatal consequences. As we observed in our last number, after correcting the state of the digestive organs, and placing the constitution in a proper state with respect to the sanguiferous system, intestines, &c. the tincture of iodine will succeed in correcting the scrofulous diathesis, and curing its local attacks. Further experience has satisfied us, that this article is as much entitled to the term of antiscrofulous remedy, as mercury is to that of anti-syphilitic. Its salutary operation is not so speedy, but no less certain.

The observations of Dr. Gregory, on an excess of health favoring disease, and of inflammation occurring in debilitated constitutions, are puerile. Health has its limits or standard, and where the vital powers run too high, they are in a morbid state, and, therefore, improperly termed an excess of health. As to the fact, that inflammation of the lungs, following measles, militates against the idea that inflammation is an excess of health, every medical man practically acquainted with the disease, knows that irritation of lungs is an uniform attendant on it; that, in fact, the contagion acts in some degree on the lungs, and as the affection of the skin decreases, that of the lungs often advances.

The Doctor's remarks on the pulse, are equally absurd. The pulse, in cases of internal inflammation, affords no indication as to the necessity of bleeding. When the lungs are inflamed, the pulse often appears to be weak, in consequence of the impediment the loaded state of vessels, and probably the parenchyma of the lungs, occasions to the free transmission of blood through them by the heart. After the abstraction of a few ounces of blood, the pulse indicates plethora, and the blood, which before ran down the skin in a small stream, is thrown out at the distance of half a yard, in as full a stream as the orifice will admit of.

BILIOUS COMPLAINTS.-(Continued from fol. 961).-Dr. Ayre, finding the title he gave the first edition of his work, viz. "An Essay on Marasmus," not sufficiently attractive, has availed himself of the fashion of the day in adopting one, for his eight-and-sixpenny book, which is more likely to promote its sale, viz. "Practical Observations on the Disorders of the Liver, and the other Organs of Digestion, which produce the SEVERAL forms and varieties of the Bilious Complaint." The learned Doctor is of opinion that "the term bilious is frequently applied, in an indefinite mauner, to disorders of the stomach, in which the functions of the liver are undisturbed; whilst many important affections, in the strictest sense bilious, are known only by names which, by not corresponding to the phenomena they represent, convey erroneous notions of their pathology. In the bilious disorders," says he, "there are essentially present, a functional change in the liver and a deficient and morbid secretion of bile, as evidenced by the colour and conditions of the stools; the symptoms of which constitute the disorder, remaining during the period of the discolouration of the fæces, and only subsiding, and at length disappearing, as the evacuations progressively return to their natural state." Dissection has satisfactorily proved, that the dark or tar-like colour and offensive odour of the fæces, depend more on a disordered state of the colon than on that of the liver, the contents of the small intestines having no such appearance. Organic disease of the colon is always attended with dark and offensive stools, and an acrid fluid thrown into the rectum uniformly produces motions of the samne appearance. The principal part of the fæcal discharge is secreted by the colon. The Doctor states that "two exceedingly well marked cases of biliary disorder came lately under his notice, the fatal termination of which in melana (a discharge of black grumous viscid blood, or bloody fœtid matter from the intestines, by stool or by vomiting), enabled him, by means of dissection, satisfactorily to ascertain the relation which the latter bears to the former."!! The cases we give in his own words: "The patient was a young girl, thirteen years of age, who was affected with a severe cough, which was worst during the night, attended with an expectoration of thick, but whitish matter. She was much troubled in her breathing, retched occasionally when she coughed, and brought up from the stomach a tough sourish phlegin. She had pain in her left side, and an increase in her cough when lying on that side; chilliness, followed by fever, and thirst towards evening; profuse perspiration about the head and breast during the night, at the same time that her feet were cold. She had also much pain in her head, stomach; and bowels. The appetite was extremely bad, the pulse quick, the tongue foul and dry during the night, the bowels were alternately loose and costive, and the discharge from them extremely black and offensive; and her strength and flesh so reduced that she was unable to walk without assistance. She had been ill six months, and during the first three of them she had a craving appetite, and the stools were dark and slimy; she was then also drowsy and listless, often complaining of chilliness during the day, sleeping unusually sound in the night, but so reluctant to get up at the usual hour in the morning, as to weep when required to rise. The appetite afterwards failed, whilst the fever and

VOL. VI.

4 H

debility increased: the cough and unnatural appearances in the stools still becoming worse.

"About two months previously to my seeing her, she had a fit which continued half an hour, and during which there was a blackness about her mouth and under her eyes, an appearance often observable afterwards, though in a slighter degree whenever she was worse. She had been under medical treatment, and had lately taken twenty drops of a mixture, consisting of equal proportions of the tincture of fox-glove and the sweet spirit of nitre." (!!!) "During the three days I attended her, she continued to part with the same black stools which she had been discharging for some time before, which I found on examination to be excessively offensive, and of a tar-like appearance. The cough became very much abated, but the other symptoms were not much relieved, and her general appearance indicated the most immediate danger. On the fourth day, there was an indistinct tinge of dark venous blood, through her motions, and on the following morning I learnt, that more unequivocal signs of it appeared in the evening, and during the following night the motions consisted of little else but dark venous blood, which poured from her as she lay. A few hours before she expired, her complexion became blanched to a degree of whiteness I never witnessed in any one before."

On opening the body with his late friend and colleague, Mr. Dunning, he "found some old adhesions of the pleura to the right side; but not the least disease to any part of the lungs. The right auricle of the heart and vessels leading to it were empty. There was a very small quantity of bile on the gall bladder. In making incisions in different parts of the liver, scarcely any blood issued from it or from the vessels leading to it. It's texture and bulk were perfectly natural, but it had that blanched appearance, which might be expected to be seen in an organ that had been emptied of its blood and washed."

66

We are at a loss to conjecture, on what ground the learned Doctor pronounced the disease of this unfortunate young woman, an exceedingly well marked case of biliary disorder."-We discover no symptom whatever of it, nor do the appearances on dissection justify any such conclusion.-That the poor girl evidently died of intestinal hæ morrhage, is most satisfactorily proved, not only by the evacuation of blood downwards, but also by the pallid or "blanched appearance" of the viscera and of the skin. The Doctor has, for reasons best known to himself, declined to notice the treatment he adopted.-Does not this case afford a lamentable proof, how easily a practitioner can make occurrences bend to preconceived opinions, or to attachment to a particular theory? The Doctor having expressed his admiration of the purging system of Dr. Hamilton, and the chylopoietic function system of Mr. Abernethy, he should have noticed which of the two he had employed in this instance.-If the former, the speedy fatal termination of the case may be accounted for, on scientific principles. The unfortunate girl was a patient of the "Sculcoates Dispensary, of Hull."

The subject of the other case, was a female of seventy-five years of age, who was also a patient of the Sculcoates Dispensary. At my first visit,' says the learned Doctor, "I learnt that there had been two discharges

from her bowels of a very large quantity of dark blood, preceded and attended by much sickness, and an oppressive weight at the stomach. The appetite had become prostrate, the tongue foul, the pulse feeble but of natural frequency: during the five preceding months, she had been weary and languid, and particularly drowsy, falling asleep at her meals, and even lying down on the floor to sleep; her appetite had been gradually growing worse, and latterly she felt the desire to eat, but was unable to do so on making the attempt; her knees and ankles had ached considerably, her spirits had been depressed, and her memory, vision, and hearing were impaired. Ten days preceding the attack she had felt a load at the pit of her stomach, with frequent nausea. The bowels had been kept regular by some pills. During the six hours subsequent to my first seeing her, she parted with seven more discharges, each consisting of upwards of two pints of pure venous blood. The excessive debility, thus induced, rendered her situation utterly hopeless, and during the three days she survived, she had all the symptoms of the worst form of typhus."

The Doctor's friend and colleague, Mr. Casson, obligingly attended to examine the body. The same appearances were exhibited in this as in the former case. The liver was completely emptied of its blood, as well as the right auricle and ventricle of the heart, and the large veins. leading to it. The structure of the liver, and all the other organs, notwithstanding her age, appeared healthy. Both the liver and the intestines had a blanched appearance. The latter were lined throughout with a dark-coloured slimy matter, similar to what was passed after the hemorrhage stopped. There was some bile in the gall bladder, of a darker colour than natural, and a few inches of the inner part of the duodenum were tinged with the bile, which was probably owing to an escape of some of it from the gall bladder after death. The stomach contained some nearly colourless fluid, and exhibited, in every respect, a natural and healthy appearance.

"In these cases, if I mistake not," says the Doctor, may be discovered the assemblage of symptoms, which are proper to the biliary disorder, so as to warrant the inference, that the hemorrhage in them was the mere effect of the disorder."!!! "I say in these cases, for though the mucous lining of the bowels in them was free from all morbid appearances, yet I am satisfied that a hemorrhage may take place from it, since my friend Dr. Armstrong informs me, that he has met with some cases where large quantities of blood had been thus lost, and where, after death, the mucous membrance of the bowels was found in some places highly injected."

Surely this is too contemptible for animadversion. Hemorrhage from the internal surface of the intestinal canal, the effect of disordered function of the liver, although on dissection that viscus was free from any organic disease!!! Distention of veins of the abdominal viscera is always more or less attendant on organic disease of the liver, in consequence of the mechanical obstruction it occasions to the return of blood from them to the heart, but in the preceding cases, the liver was not organically affected, and was in as healthy a state as any other viscus. In the latter case, as in the former, the Doctor has not condescended to acquaint his readers with the scientific treatment he adopted to restore the poor old