chronic pneumonia, the point was common property. But here Dr. Evans lays rude hands on the bantling, and affirms he is its father. We simply demur until he shall have proved his paternity.

Dr. Evans holds that, in M. Fournet's book, there are "many old observations put forward with an imposing air of novelty, and many new assertions destitute of foundation," an opinion we should not have thought it necessary to notice, except from its furnishing, we would humbly suggest, a singularly appropriate epigraph for Dr. Evans's own second edition. This stern pathologist and modest lecturer considers M. Louis' "etiology illogical, his diagnosis rather meagre, and his treatment inadequate;" but, probably fearful of blasting the French author's reputation utterly, Dr. Evans condescends to observe, "I cannot but thank M. Louis for the candour and truthfulness of his observations." (p. 192.) Happy the man who receives thanks from so eminent a quarter: it is truly comforting to know that, after one may have learned to think lightly of having enjoyed the highest European reputation for some dozen years, and felt that even that earthly good is tainted with evil, a vote of thanks may come from Dr. Evans to renovate the delightful feelings of early

success.

Turn we next to the author's lectures on treatment, -a chapter which might be expected, in consideration of his early occupations, to be particularly instructive. These lectures open with various flourishes concerning "fond and devoted parents,"-rescuing victims from " the dark recesses of the lone and silent tomb," &c. &c., and next proceed to show that the profession has not advanced a step towards improved treatment of the disease since the days of Celsus. Anon the lecturer displays in learned phrase the folly of persons who treat symptoms of the same name always by the same remedies, and illustrates the said folly by sundry examples. Take one of these, and ab uno disce-"The night-sweats may depend on the rapid circulation of the fever of emaciation occurring in the relaxed condition of deficient growth; or they may be critical to the repeated forms of intercurrent pneumonias, tuberculization, and suppuration already referred to; or they may be vicarious to the natural discharges from other surfaces, as when they are accompanied by constipation." (p. 97.) Now, we very candidly confess our inability to comprehend what is meant by "the rapid circulation of the fever of emaciation occurring in the relaxed condition of deficient growth," -so that not for worlds would we dispute the reality of the influence which Dr. Evans ascribes to the thing, whatever it is. Secondly, we deny that any human being has ever proved, or even in any remote degree made it probable as a matter of fact, that the night-sweats of phthisis are "critical" to intercurrent pneumonias or other of the states mentioned. Thirdly, it has clearly been shown by Louis,* that the notion of the vicariousness of sweats in the disease is a mere fallacy, the offspring of fancy and not of observation.

Dr. Evans proceeds to inquire, "what, in fact, are the lesions in which phthisis pulmonalis necessarily consists?" The response informs us that among these "lesions" rank, for example, " diminished force of growth,"

De la Phthisis, p. 215, ed. 2. Paris, 1843.

and "an excessive nervous excitability." Very remarkable “lesions ;” let that pass, however. But we cannot let pass the following piece of inductive philosophy, designed for the instruction of youths about, sooner or later, to have on their heads the dreary responsibility of actually treating phthisis:

"We have likewise previously seen, that a diminution in the waste or decomposition of the tissues is equivalent to an increase of supply or growth; and it is a fact, independent of all theory, that a diminution in the amount of respiration will produce this effect. It was on the principle of neutralizing the operation of the inspired oxygen that Dr. Beddoes recommended inhalation of carburetted hydrogen in this disease; and there is no doubt that persons who had been weak and wasted, grew fat and strong under this treatment. Naphtha, creosote, and the non-nitrogenized articles of food, such as starch, gum, and sugar, will act in a similar manner. So that, you perceive, there are many ways by which we can oppose this first and predisposing lesion of phthisical disease.” (p. 100.)

Blessed man, says the student to himself; thrice blessed therapeutist! never shall emaciation (or, as my venerated master hath it, "diminished force of growth or reparation") exhibit its withered form in my path! with starch, gum, and sugar (no bad things, by the way), a dust of this, and a shake of that, along with a little creosote, I shall drive emaciation before me,and, please heaven, make my fortune. Now, it is plain that such is the interpretation any reflective student must put on Dr. Evans's doctrine; for a student can hardly be expected to see through the loophole of escape which Dr. Evans has so very neatly provided for himself by the simple use of the word "oppose:" we may "oppose" emaciation, says the innocent teacher, with the remedies I enumerate. No: had his young Irish auditors caught fully the sense of this little word, they would assuredly have reminded the learned man of the various attempts that have been made from time to time to keep out (or "oppose") the tide with a pitchfork, together with the provoking result, that the tide has hitherto invariably beaten the pitchfork in the long run. After this precious specimen of therapeutics, it seems sufficiently flat to turn to a point of pathology. Dr. Evans calls emaciation "this first and predisposing lesion of phthisical disease:" but what says clinical observation in the hands of Louis? Why, that in one half only of the patients observed by him* did loss of flesh appear among the first symptoms,-in none is it spoken of as their harbinger.

But Dr. Evans hasn't half done "opposing" yet: hear him in the second lecture again:

"After this rapid review of the lesions which constitute pulmonary consumption, and the means which we possess of baffling them, I think you will already be inclined to agree with me, that there is nothing necessarily fatal or incurable in this disease; but that, on the contrary, it is just as tractable as other chronic diseases." (p. 102.)

Why, this is next door to Professor Holloway's pill and the wafer advertisements of the sham Dr. Locock: the wafers ensure perfect cure of consumption in ten minutes, we believe; so that Dr. Evans may be considered so far to be outdone. We are very sorry for him: but from

many strange things we see in this strange book, we suppose the defeat is not quite irreparable.

66

It will probably be expected that we should say something of St. John Long's "treatment" and "nostrum." Dr. Evans tells us concerning the first," the principal, or, indeed, to speak more correctly, the sole element in St. John's treatment was counter-irritation." As respects the second (that is, the nostrum), it appears there was none; for, though the turpentine and strong acetic acid liniment was the composition this manslayer chiefly employed, we sometimes," says Dr. Evans, “made an alteration in the liniments." It is reported (and, as we believe, correctly) that an individual among the aristocracy, eminent among the eminent for the soundness of scientific judgment characteristic of that branch of the community, gave St. John Long £3000 for his secret! Poor woman, she got the vinegar and turpentine receipt; and may she be happy with it,the very worst and most uncertain counter-irritant that still holds a place among the long list of such.

Dr. Evans indulges no less in singular words than in singular therapeutical ideas where did he find the terms "lymphy," "lungy,' ""enterital," &c. &c., which occur passim in his pages? Where, too (and these examples are jotted down as being the first that catch our eye in turning over the leaves), did he become acquainted with his method of spelling the words "Aritæus" (p. 27); "Cyrrosis" (p. 12, twice); "gum-ammonia" (p. 105); "albuminaria" (p. 121), &c. &c.? But if English orthography fares badly with Dr. Evans, it has no right to complain, -for the French is ten times worse off. The book closes with a professed transcript from Andral's Clinique Médicale, which throughout contains on an average about two errors of spelling per line;-there is not a single accent from beginning to end; and we venture to affirm that there is not a Frenchman from Calais to Toulon who could read the extract without real difficulty.

ART. VIII.

Delle Alterazioni Patologiche delle Arterie per la legatura e la torsione, Esperienze ed Osservazioni di LUIGI PORTA, Professore di Clinica Chirurgica nell' I. R. Universita di Pavia. Con tredici Tavole in Rame.Milano, 1845.

Experiments and Observations on the Pathological Alterations of Arteries by ligature and torsion. By LUIGI PORTA, Professor of Clinical Surgery in the Royal University of Pavia. With thirteen copper-plates.Milan, 1845. Folio, pp. 439.

BELIEVING that the alterations induced in the arterial system by the ligature had never been scientifically demonstrated, Dr. Porta took advantage of his situation in the University of Pavia to apply himself to the task, by experimenting on animals, and by gathering from his own practice and that of others, facts in human pathology illustrating the question. He commenced his experiments in 1835, and has continued them during nine

years, making upwards of 600 upon 270 animals. Most of them have been made upon dogs, as these animals are more easily obtained, and offer a closer analogy in physical organization with man than others; but sheep, goats, horses, asses, oxen, and rabbits, have been also used. The greater number were instituted in the Clinical School with the assistance of students, and preparations in the museum are further proof of authenticity. The object of the author has been to solve the following problems:

1. What becomes of a ligature abandoned upon an artery; does the material of which it is formed influence the results of the operation, and, if so, what material is the most suitable?

2. What alteration does the artery undergo in the different methods of ligature and torsion, and which of the two methods merits the preference? 3. What change in the circle of the arteries succeeds obliteration of the principal trunks, and, consequently, what is the power of the arterial system in opening the channels necessary for the preservation of the limbs ?

These inquiries are preceded by certain anatomical considerations upon the arteries. It appears that the arteries of the larger animals are much more tenacious than those of man, and those of dogs are one degree, and of goats and sheep two degrees, more fragile and weak. This, of course, varies with the age of the animal. We pass over a long description of the various coats of arteries, as we find nothing here peculiar to the author, until he comes to treat of the vascularity of the internal coat, when he argues that what is generally considered to be stellated injection of the capillaries which permeate this tunic proceeds from injection of the vessels of the middle coat being seen through the transparent internal

one.

Examining the larger arteries of the chest and neck in horses, dead of acute inflammation after ligature of the carotids, I have seen vessels morbidly injected on the external surface appear on the internal surface of the inner coat. This is more easily observed in the principal arteries of large animals, on account of the greater caliber of their rasa vasorum. In all these cases, however, if the artery be split, and the last fine layer of the internal tunic be removed by fine forceps in the situation of the injection, this layer is found to be without vessels." (p. 12.)

"Still vessels that do not exist, or that cannot be demonstrated in the normal texture, appear and may be shown after inflammation. I have already said that in dissecting large arteries, inflamed by the action of the ligature, we not unfrequently discern around them a network of small vessels, which pass from the cellular sheath, permeate the strata of the middle coat and appear on the external surface of the inner coat. Then if this coat be thickened, or if coagula and false membranes occupy the channel of the truncated artery, vessels are sometimes observed passing from the seat of the ligature, or traversing the walls of the divided vessel, and by a plastic power regenerating themselves in the bosom of the new formations. At times, also, within the clot of blood which plugs the artery, as I shall show hereafter, conspicuous vessels are prolonged which communicate with the external vessels. This phenomenon is much more rare and more difficult to demonstrate than is commonly supposed; but it offers a perfect analogy to what is observed in the nerves and mucous membranes, the ultimate layer of which never presents vessels in its texture, after injection of the finest coloured liquids ;

while the products of inflammation formed on the surface, lymph, cellular tissue, or false membrane, present vessels in large quantity, which spring from beneath, and are easily seen and injected." (p. 13.)

I. After these preliminary observations, the author passes on to describe his experiments made to determine the effects of ligature, and the influence which a diversity in its material exercises upon the artery to which it is applied. In his experiments upon the material of ligatures he has wisely confined himself to such as are most applicable in practice-catgut, silk, prepared and crude, flax and hempen threads, and hair-and as the results have shown no palpable difference between crude and prepared silk, or flax and hemp, the species of ligature are reduced to four-three of animal matter, catgut, silk, and hair; and one vegetable, flax or hemp. These substances were applied as simple threads upon the principal arteries of animals, by different processes, and the ligature left for various periods from a few days to three years. Among the number of experiments we shall state the result of the more important as briefly as possible.

Several experiments with catgut upon the carotids and femoral arteries of dogs and sheep are first related. They are of considerable interest, but we find it would be impossible, without the plates, to give any correct idea of the changes produced; and the conclusions of the author being apparently justly founded, probably this is all that most of our readers would require. These conclusions are thus stated:

"Among the substances applicable to the ligature of arteries, catgut is doubtless the most strong and homogeneous. A series of eighty experiments proves that even of small diameter it has sufficient strength to compress an artery, divide its proper coats, and maintain them in mutual contact until obliteration or division is perfect; but it differs from the other ligatures, as it does not always divide the internal wall at the moment when the knot is formed, but becoming lax by a process of softening, it sometimes allows the artery to reopen. This, however, does not interfere with the success of the operation, when the relaxation is gradual and the internal plug is formed in time.

"Still, from the experiments instituted, and partly related above, it appears that catgut a day, or even some hours, after its application, excites adhesive inflammation in the cellular sheath of the artery, and becomes covered by a stratum of plastic lymph, olivary in form, which surrounds and buries it. This lymph at first becomes modelled into a soft, gelatinous, adherent tissue, which gradually becomes atrophied, and generally leaves a simple cellular web; or a ligamentous substance more close and opaque, designed to isolate the ligature and the artery; or more rarely suppurative inflammation is set up in the seat of ligature, and a circumscribed abscess is formed when the ligature remains, until it is thrown off. The catgut relaxes, softens, dissolves, and becomes confounded with the surrounding cellular tissue; or the artery upon which it rested being consumed, it becomes dry and stiff, and lays bare in the layers of the cellular tissue; or becomes concealed in the peculiar tissue of the cord remaining between the truncated extremities of the vessel; or confined in a cyst, or coating of the plastic lymph which at first formed around it. The new cyst is at first simple and cellular, but afterwards it acquires consistence, and offers in its walls an external layer, strong aud coriaceous, and a species of epithelium, or internal rosy, soft, mucous layer, containing the ligature and some secreted matter. This cyst is generally small, resembling a grain of rice or millet, and when thus small it is ordinarily attached and closely adherent to the ligature, following all its irregularities, thus partly assisting in the process of solution. But sometimes, by exorbitant exhalation, it becomes enlarged to the