considers to be a special morbid alteration, most observable in the mucous membrane. The tissue appears as if painted with a bluish or yellowishred colour, and spotted with red stellated points or centres, from which short tortuous little vessels go off like rays, and the blood escapes from these points or centres. Dr. Lanza designates this condition as hemorrhagic angionosis, that is, a special and primitive disease of the vessels, of which hemorrhage is the sole result. The titles of secondary, traumatic, and mixed hemorrhage are sufficiently explanatory, and we find nothing in the description or treatment of any of these varieties which differs from that laid down in British works on practical medicine. Epistaxis, stomatorrhagia, or hemorrhage from any part of the mouth and fauces, hæmoptysis, hæmatemesis, enterorrhagia, proctorrhagia or flow of blood from the anus, melæna, hæmaturia, and metrorrhagia, form respectively subjects of separate chapters.

Hæmoptysis as a primary disease, or simple flow of blood from the mucous membrane of the air-passages, is occasionally observed in Naples in plethoric persons, and is apt to recur at stated seasons for several years. This form is recognised by the absence of thoracic or other disease to which the hemorrhage could be attributed; the absence of fever; the usual marks of plethora; tendency to hemorrhage in other parts; absence of cough, except what is necessary to throw off the blood, the blood at first being red, afterwards brownish, and then almost colourless; and the rapid recovery of strength, although much blood may have been lost. The treatment of this form must be left rather to nature than to art, unless the quantity of blood lost is so great that danger is imminent. The greatest care should be used to prevent a return, by altering the habits of life which produced the state of general plethora.

Secondary hæmoptysis is considered,--1. As vicarious of another hemorrhage, as hemorrhoidal or uterine discharges, and is said to be rare at Naples. 2. As symptomatic of acute disease, as thoracic inflammations. 3. As symptomatic of a transitory contagious disease, measles, scarlatina, &c. 4. As a concomitant of endemic periodic fever, it is sometimes, but very rarely, observed in the tertian agues about Naples. 5. As a symptom of some radical or specific disease, as scurvy. Dr. Lanza alludes to a form which he calls scabbiosa, and says, that while many persons affected with itch are not subject to hæmoptysis, it is observable that most persons subject to hæmoptysis have at some time been affected with itch-a singular observation, if true. He says that this scabbiosa form of hæmoptysis is generally preceded, accompanied, or followed by some very severe disease of the air-passages. 6. As a symptom of sarconosi, whether ulcerative or tubercular. 7. As a symptom of disease of the heart and great vessels, or angionosis. 8. As a symptom of nervous diseases, whether apoplexy, paralysis, or spasmodic affections. These are the varieties of the secondary hæmoptysis.

Traumatic hæmoptysis is produced by wounds, foreign bodies in airpassages, inhalation of irritating vapours, &c. On tubercular hæmoptysis the author makes the following remarks:

"Hæmoptysis reasonably causes alarm, since of a hundred successive cases brought under our notice the following sad statistical report may be given: Of 100 cases, 90 are tubercular, and are followed by death, caused by the tubercular disease; and of the ten other cases not tubercular, but of the common primary or

secondary forms, five proceed from disease that is also fatal. We would only observe that the suffocative hæmoptysis, that is to say, the form which is so violent as to kill by itself, is not included in these statistics, because it is much less common than one per cent. Indeed, we have only met with it in three cases among several hundred cases of hemoptysis which we have observed in the course of our practice." (pp. 169-70.)

Of ninety cases of tubercular hæmoptysis, seventy are evidently owing to the existence of tubercle, and generally are observed in the early stage of the disease. In other cases it occurs and recurs at times for years, the tubercles remaining in an incipient stage, without producing the general symptoms of phthisis. Sometimes, also, the existence of some common cause leads the physician to overlook the presence of tubercles.

The other forms of hemorrhage are treated in the same order, but we find nothing particularly worthy of remark. The next classes of disease are the flussi and rattenimenti; the former consisting in superabundant, the latter in defective discharge from the body of any humour or secondary fluid. Dr. Lanza denies the truth of the hypothesis, that the profluvia depend upon relaxation of the solids or tenuity of the fluids, and the opposite condition upon contraction of the solids or density of the fluids; arguing that the only practically useful distinction of these orders of disease is, like the hemorrhages, into primary, secondary, traumatic, and mixed. In the primary forms, the flux or retention constitutes the sole symptom of disease, and does not depend upon morbid conditions of distant organs, nor upon any known traumatic cause-no other disease remaining when either the flux or retention has passed away. In the secondary forms, organic disease may be detected; in the traumatic, mechanical or chemical causes are evidenced; and in the mixed, the degree of flux or retention is out of proportion with the amount or intensity of visible disease or traumatic agency; astringents or aperients also having a direct action upon the fluids discharged or retained, to the prejudice of the principal disease or cause. After the exposition of these views, constipation, diarrhoea, and dysentery are treated at some length; gastroenteralgia of various forms being also included in this class of diseases, as invariably connected with some deranged secretion. Lead colic, hepatalgia, splenalgia, and common (as distinguished from the epidemic) cholera are the subjects of an appendix. The only extract we think it necessary to present is the following:

When, towards the end of summer, common cholera appears epidemically among us, if we except the smaller mortality, and the comparatively few persons attacked, in no symptom or other character does it differ from the Indian cholera. Neither in the treatment have we found any difference; indeed, experience has taught us the following curative analogies between the two choleras: 1. That in both the use is beneficial, and the abuse injurious, of emetics of ipecacuanha. 2. That polypharmacy is equally injurious to both; and that the specifics hitherto vaunted have proved deceitful. 3. That simple lenitives and laxatives relieve gastro-enteric pains. 4. That opiates are more useful than other sedatives, provided the dose be moderate. 5. That mucilages and gums are the only astringents which are tolerated or useful. 6. That artificial warmth is useless and ill-supported. 7. That fasting is the grand remedy." (p. 282.)

Vomiting, volvulus, and diabetes are the subjects of successive chapters. In the treatment of diabetes Dr. Lanza restricts the diet as much as possible to milk, sends the patient to a dry, warm country place, and ad

ministers the carbonate of iron. Opium is given when sleeplessness occurs, and castor-oil when constipation renders an aperient necessary. Chapters follow on increased and diminished secretion of urine, perspiration, and saliva, nasal and bronchial mucus, tears, milk, and semen.

Another class of disease is denominated collections, the term implying abnormal retention of any fluid within the body, as serum, bile, air, fat, blood, &c. The volume is concluded by chapters upon different orders of this class of disease; the various species of dropsy, collections of air, jaundice, and obesity; but we have gone through them without observing anything particularly remarkable.

We here conclude our notice of this work. We have endeavoured to put our readers in possession of all the practical observations of importance which a careful perusal has afforded us, and at the same time to give an abstract of the contents of the work, without entering into any critical examination of the views and doctrines advanced, or of the propriety of the classification of diseases adopted by the author. The general impression upon our own minds on laying down the book is, that it is the production of a man of singular natural ability, and an acute observer, who is not well acquainted with, or has availed himself too little of, the published experience of others.

ART. VII.

1. The Elements of Materia Medica and Therapeutics. By JONATHAN PEREIRA, M.D., F.R.S., &c. Third Edition. Vol. I.-London, 1849. 8vo, pp. 898.

2. Traité de Thérapeutique et de Matière Médicale. Par A. TROUSSEAU, et H. PIDOUX. Troisième Ed. Tome I et II.- Paris, 1847. 8vo, pp. 896, 898.

3. Traité de l'Art de Formuler, ou Notions de Pharmacologie appliquée à la Médecine. Par le Docteur MIALHE.-Paris, 1845. 12mo, pp. 220. 4. Lectures on the Chemistry of Pathology and Therapeutics, showing the application of the Science of Chemistry to the Discovery, Treatment, and Cure of Disease. By ALFRED B. GARROD, M.D.-(Lancet, Vol. I and II, 1848.)

5. Lectures on the Influence of Researches in Organic Chemistry on Therapeutics, especially in relation to the Depuration of the Blood, delivered at the Royal College of Physicians. By Dr. GOLDING BIRD, A.M., F.R.S., &c. (Medical Gazette, 1848.)

IN the former part of this article we presented our readers with a general view of the present state of our knowledge as regards the chemical composition of the various solids and fluids of the animal body; and we endeavoured to show, first, that this knowledge is not yet so complete as to enable us to construct what may be termed their standard formulæ of chemical composition; and secondly, that notwithstanding great advances have been made in pathological chemistry, yet, from the circumstance of our being in want of those accurate data to which we have referred, we are not yet in a condition to make the fullest application of chemistry to the study and cure of disease. We also took a survey of the facts which have been made out with respect to the alterations which remedies produce

in the chemical composition of the animal structures and fluids. And now we come to the consideration of our fourth question, namely, What is the nature of the chemical changes to which the remedies themselves are subject during their passage through the animal economy?

A very slight glance at the writings of our leading therapeutists will show, that this extremely important question has not yet received its proper share of attention. Trousseau and Pidoux, for example, have hardly referred to it, and Dr. Pereira has dismissed it most hastily, saying that

"The precise nature of the changes which medicines undergo when they first come into contact with the body has been carefully investigated in a very few instances only. For the greater number of medicines accurate observations are still wanting; and we form our opinion of the nature of the changes principally by analogy, aided, in particular cases, by some isolated fact." (p. 88.)

We cannot, however, regard this as a very complete expression of the truth; for, as we shall presently find, by taking a review of the labours of Mialhe, Golding Bird, Wöhler, Bernard and Barreswill, Bouchardat and Sandras, and some others, a great deal has been done towards the elucidation of this most interesting subject. In fact, we may regard the work of Mialhe as a very tolerable attempt to represent the changes to which medicines are subject during their passage through the animal system, and we shall therefore especially direct the attention of our readers to it; premising that although we are far from admitting the truth of every proposition which has been laid down by our author, or from admiring the manner in which he has too often arrived at a conclusion, yet we shall not stop to censure him for so doing, believing that our time might be better occupied, and that, as Dr. Whewell states, false theory often proves more advantageous to science than the absence of theory, or, as Lord Verulam expressed it, "truth more readily emerges out of error than out of confusion."

It is our duty, moreover, to say that, considering the difficulties which Mialhe has had to encounter in the pursuit of his very original inquiries, and the manner in which he has surmounted these difficulties, he is deserving of more respect than has been awarded to him by any of the authors which are now before us. The researches of Mialhe have chiefly been made since the month of July, 1841, at which time he announced in the Paris Academy of Medicine, that he would one day demonstrate by means of experiment

"That, for an internal remedy to have a general action on the organism, it must be soluble, or susceptible of becoming so, by reason of chemical changes taking place in the interior of our organs." (p. 17.)

Since then, he has done everything in his power to fulfil his promise; for he has not only been occupied in inquiring into the nature of the chemical changes which take place when medicines are mixed together, but he has also been engaged in studying the nature of the changes to which the various remedies are subject, when they are exposed to the action of acids, alkalies, and salts, under circumstances similar to those which exist in the interior of the living body. And from a careful consideration of the many facts which have thus been brought to light, it may be said that Mialhe has done much towards establishing the truth of the following propositions :

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1. That a remedy must be absorbed, before it can exert any remote action on the animal economy.

2. That the remedy must be soluble, or susceptible of becoming so, in the fluids of the living body, before it can be absorbed.

3. That most remedies are subject to chemical changes during their passage through the animal system.

4. That these changes are regulated by ordinary chemical laws, and that they may therefore be foretold, and even made available in the cure of disease.

Acting on his faith in these propositions, Mialhe has undertaken to give an interpretation to many hitherto unexplained phenomena, and to place the art of prescribing upon a sounder and more scientific basis than it has hitherto occupied. He has, for example, endeavoured to explain how it is that many individuals are remarkably prone to the operation of particular drugs; why it is that certain insoluble remedies, such as calomel, oxide of iron, &c., act more powerfully when they are administered in small and repeated doses, than when they are given in larger doses at longer intervals; why some medicines are apt to remain in the system, and to become localized in their action, while others are rapidly carried off by the secretions; why some compounds act quickly, and others require time for their operation; and lastly, by constantly keeping his first two propositions in view, he has been enabled to construct formulæ, whereby he secures to every medicine its complete absorption, and therefore its full amount of remedial action.

If, says Mialhe, a medicine is soluble, and is not decomposed by the fluids of the alimentary canal, it is absorbed at once; but if it is insoluble, then it requires the intervention of the acids, alkalies, or saline compounds contained in the digestive fluids, in order to obtain an entrance into the circulation. It is in this way that the metals, the greater number of the metallic oxides, and certain salts, are dissolved by the acids of the gastric juice; the metalloids, the insoluble acids, certain insoluble salts, oils, resins, balsams, &c., are rendered soluble by the alkaline matters contained in the intestinal fluids; whilst other insoluble salts, such as calomel, sulphate of lead, chloride of silver, &c., are acted on and dissolved by the alkaline chlorides which are present throughout the whole course of the alimentary canal.

After considering the changes to which these substances are individually subject, Mialhe comes to the following conclusions:

Ist. That the metals are not endowed with any therapeutical action while they retain their metallic form; but he asserts that, with the exception of the noble metals, they are all readily acted upon by the air, acids, and alkaline chlorides contained in the digestive canal, and they then acquire the faculty of operating on the animal body. In this way metallic arsenic is rapidly converted into arsenious acid; and in the same manner antimony, mercury, lead, tin, bismuth, zinc, iron, &c., are first oxydized by the fluids of the stomach, and then, by being transformed into chlorides or double chlorides, they become soluble, and gain access to the circulation. By viewing the subject in this light, Mialhe is enabled to explain the action of the perpetual pile of the ancients, of metallic mercury when it is admitted into the system, and of iron filings when they are given for the cure of chlorosis.