respecting the manner in which the secretions in general are probably formed to wit, in successive crops of cells sprouting from the membrane which yields the secretion. The above observations on the cells and secretion of the molluscum contagiosum certainly afford no inconsiderable presumption in favour of this supposition, when we consider that morbid phenomena are rather illustrations of, than exceptions to, the natural course of organic operations.

It is very probable, as Bateman has suggested, that the atheromatous secretion is the means by which the disease is propagated, yet inoculation with it in the ordinary way has not succeeded in the hands of Dr Paterson or in mine. If we are to consider the disease as peculiar to the follicles, it is easily understood how simple inoculation, without attention to the precise point at which the matter is inserted, so as to insure its contact with a follicle, should fail in propagating the tubercles.

The treatment of the tubercles, in order to cause their speedy removal, ought obviously to consist of measures calculated to excite them to inflammation. Dr Paterson informs me that he has readily effected this purpose by touching them with caustic potass; of course the earlier this is done in the progress of each the better. A fine point of nitrate of silver introduced into the aperture would doubtless effect the same end.

ART. XII.-Postscript by Mr J. Massey, Nottingham, containing the conclusion of the Case of Collection of Biliary Fluid in the Thyroid Body. (See Vol. liv. pp. 454–548.)

SINCE last report, December 28th, the patient, from having imprudently exposed himself to severe weather, had rigors accompanied with general febrile excitement, and an increased accumulation of purulent matter had taken place at the lower part of the sac. There was considerable bilious derangement with sickness and vomiting of bilious matter. The purulent matter was freely evacuated by enlarging the opening at the inferior part, making it as depending as possible. It continued to discharge a serous fluid, varying more or less in quantity till March 13th 1841; at that period it was completely cicatrized, and he was quite well. The opening powder ordered, December 6, was repeated every other day for nearly a month ;-previous to which also was occasionally given a five grain calomel pill. These were required from the very confined state of the bowels. They procured but one evacuation. On the 7th January he omitted all opening medicine, and from that period to the present time, March 22d, the bowels have been regularly and daily relieved. This has not been the case for many years. He has lost the bilious tinge completely, and is gaining flesh. There is no abnormal appearance remaining except from the cicatrix, and a little fulness at the lower portion from the division of a few fibres of the sterno mastoid muscle by the last free incision made to evacuate the matter. I have forwarded the result of this interesting case, from the peculiar torpid state of the bowels at the time the sac contained the bilious fluid, and their very opposite state after its complete evacuation.

PART II.

CRITICAL ANALYSIS.

By

ART. I.-Elements of the Practice of Medicine. RICHARD BRIGHT, M. D., and THOMAS ADDISON, M. D., Physicians to Guy's Hospital, and Lecturers on the Practice of Medicine. Vol. i. London, 1839, 8vo. pp. 613.

THE Practice of Medicine, Practice of Physic, or Practical Medicine, is one of the complex departments of the healing art; that is, it consists of several simple or elementary branches; and from these elementary branches it derives much of the materials of which it consists. The simple or elementary branches of medical science are, Anatomy, healthy and morbid, Physiology, general and special, Animal Chemistry, Pathology, general and special, Materia Medica, and Pharmacy. From all these departments that denominated Practice derives a large proportion of its materials; and the correctness, amplitude, and efficacy of the latter always depend very much on the state of the former sciences.

Anatomy furnishes information on the structure, position, magnitude, component parts, and the relations of the organ or textures which may be the seat of disease. Physiology, by determining the healthy actions and functions of different organs, enables us to judge when these actions and functions are deranged,-what is the amount or kind of derangement,-what may be the probable cause of such derangement, and what may be the ultimate effects, if means be not adopted to remove it, and to re-establish the healthy state of the organ. Physiology in this manner becomes gradually converted, as it were, into pathology, the object of which is not only to trace the gradual or the sudden transition from healthy to morbid action, but to study the multiplied varieties of morbid structure,to contemplate the infinitely diversified forms of unhealthy action, -to understand their essential characters, not only as differing from healthy action, but their differential characters as distinguished from each other, and to estimate accurately the value of those external signs which indicate either the presence, the amount, or the peculiar kind of diseased action. Materia Medica, which, in its most extensive acceptation, includes the history and properties

of all those agents and articles which are either useful in preserv ing health and warding off the attacks of disease, or removing disease when actually established, and consequently comprises not only the Materia Medica, properly so named, but also the Materia Alimentaria, with the kindred branch of dietetics, is another branch of science, which, though in several respects complex, that is, consisting of several simple or integral departments, as Natural History, Chemistry, Botany, and Pharmacy, is, nevertheless, in relation to practice, an elementary department. When pathological knowledge has enabled us to establish what are called curative indications, that is, has specified the objects to be attained, and the purposes to be accomplished in order to effect a cure, then the science of Materia Medica and Pharmacy, and especially its therapeutic department, informs the practitioner of the agents by which he is to accomplish these purposes.

Of all these elementary branches, pathology is certainly the most important, whether we advert to the value of the information which it professes to supply, or to the incessant and repeated reference which the physician is obliged to make to it. Without pathological knowledge, indeed, no rational practice of medicine can exist; and, in proportion as the former is correct and well-founded, the latter will be efficient and successful.

Pathology is, however, itself, not altogether a simple branch of medical knowledge. Besides implying a knowledge of healthy anatomy and physiology, it derives a large proportion of its information from morbid anatomy, or the facts disclosed by the careful inspection of bodies cut off by various diseases. Much also it derives from what may be termed morbid physiology, that is, the knowledge of the variations which the functions of the living body undergo in various stages of disease,-a branch chiefly to be cultivated, to be rectified and enlarged by careful clinical observation. In this division also, pathology has been much indebted to chemical experiment, and will certainly be still more indebted to that powerful and prolific source of correct knowledge. A large proportion also of information, sometimes altogether new, and always very important, it derives from observing and recording the effects of various injuries and accidents upon different parts and organs of the human body. These, by placing the parts in new, unusual, and unnatural situations, are often the indirect means of calling into action various powers and resources in the system, which, without the interposition of such extraordinary means, might have remained dormant and involved in obscurity.

The branch of medical knowledge thus constituted has been naturally divided into two departments,-General Pathology and Special Pathology.

By General Pathology is understood that branch of knowledge

in which are explained the nature of disease as distinguished from health; the principal or leading forms which it assumes; their general relations both to the state of health and also to each other; and the general causes by which diseases are induced, and, as far as may be practicable, the mode in which these causes operate. Special Pathology, on the other hand, is devoted to the examination and the explanation of the nature of particular diseases; attempts to ascertain the numbers of individual maladies; considers the proper characters which belong to each, and selects those by which they may be distinguished from each other; and, in short, studies all those minute details which tend to illustrate the nature and peculiar characters of particular forms of morbid action.

Many treatises on general pathology, of various degrees of merit, have been composed at different periods by different authors. Of these, some have treated the subject in connection with physiology; for instance, Stahl, Boerhaave, Eller, Gregory, Darwin, Sprengel, and Dr Alison. Others, again, have considered the subject more expressly by itself; and to this class may be referred the elementary treatises by Sauvages, (1732,) by Ludwig, (1754,) by Gaubius, (1758, 1763,) by Nietzki, (1766,) by Caldani, (1772, 1776,) by George Frederic Hildebrandt, (1795,) by Henke, (1806,) by Brandis, (1808,) by Burdach, (1808,) by Fanzago, (1813, 1816,) by Parry, (1815,) by Dalla Decima, (1819, 1823,) by Chomel, (1824,) by Van Coetsem, (1825,) by Hartmann, (1826,) and by Bufalini, (1828.)

Of the whole of this second class of writers, the general method has been pretty much the same. They have explained, or attempted to explain, the characters and peculiarities of disease in general, whether consisting in mere morbid or perverted, or disordered action, or dependent on, or connected with, more or less change in the constitution of one or more of the tissues, or of the organs of the human frame. They have attempted to distinguish, describe, and illustrate the nature and tendency of the leading forms of morbid action. They have endeavoured to investigate the origin of diseases, and to develope the nature and operation of those circumstances which act or seem to act as causes. And lastly, they have undertaken to estimate the nature and value of the external morbid phenomena or symptoms which are either felt by the patient or fall under the observation of the physician, and to discover and explain the relation subsisting between these external phenomena and their internal causes, and in this manner to employ them as useful guides in ascertaining the presence or absence, the nature and the degree of morbid action, or morbid structure, or of both. This department of general pathology, which has received the name sometimes of symptomatology, sometimes of semiotics, (Semeiotice) (nusov signum,) has at all times occupied a large proportion of the attention and labour of writers on general pathology;

and in not a few instances, particular treatises have been devoted to this subject alone, as was done by Christopher Godfrey Gruner of Jena, (1775,)* Berkenhout, (1784,)+ Rougnon of Besançon, (1786,) Sprengel of Halle, (1801,)§ Landré-Beauvais of Paris, (1813,) || John Fr. Henry Albers of Bonn, (1834,) ¶ and A. F. Schill of Tubingen, (1836.) **

It cannot be doubted that this is a most important department of pathological learning; and, in proportion to the amount of correct information which any physician possesses on this subject, he will be faithful and accurate as an observer, skilful as a reasoner from facts, always safe as a practitioner, and often efficient and successful. So great, however, are the changes which have taken place in the cultivation of this division of science, and so much has it been extended, modified, and rectified of late years, that it may be said to be, as to all the diseases of the heart and lungs, and many of those of the nervous system, to be entirely new. It hence results, that in almost all the systems of general pathology, the department of semiotics would require to be very much new-modelled before it could be of much practical use. The best treatises in this point of view are doubtless those of Landré-Beauvais, Albers and Schill, the last of which has been translated by Dr Spillan.++

Such is the general character of most of the treatises on general pathology, and such in general the method of treating the subject. In some, the order or arrangement is a little different from that of others; but the general method is the same. Thus, in some instances, the department of etiology, or that devoted to the general history of the causes of disease, occupies the first or the second place, and in others it occupies the third; while the symptomatology is placed in the second division. To give some idea of the different modes of treating the subject adopted by different authors, we may notice here the methods of arrangement observed by two of the most recent writers on the subject, Van Coetsem of Ghent, and the late Dr Hartmann of Vienna.

Semiotice Physiologicam et Pathologicam Generalem Complexa. In usum Praelectionum Academicarum conscripsit Christ. Godofr. Gruner, M. D., etc. Halae Magdeburg. 1775, 8vo. Pp. 687.

Symptomatology, by John Berkenhout, M. D. London, 1784. 8vo. Pp. 124. This short treatise is rather an index to other works, or a dictionary of terms, than a system of symptomatology. It contains also a nosological lexicon or glossary. Considerationes Pathologico-Semioticae de omnibus humani corporis functionAuctore N. F. Rougnon. Vesontione Fasc. i. et ii. 1786, 1788.

ibus.

§ Kurt. Sprengel Handbuch der Semiotik, Halle, 1801.

|| Semeiotique ou Traité des Signes des Maladies, par A. T. Landıé Beauvais. Paris, 1813, 8vo.

Johan. Fr. Heinr. Albers Lehrbuch der Semiotik fur Vorlesungen bearbeit Leipzig, 1834, gr. 8vo.

A. F. Schill Grundriss der Pathologischen Semiotik zum Gebrauche bei Vorlesungen. Tubingen, 1836, gr. 8vo.

tt Outlines of Pathological Semeiology, translated from the German of Professor Schill with copious notes by D. Spillan, M. D. London, 1839, 12mo. Pp. 236.