The physician will find a dry tongue, thirst, inclination for acid drink, sensibility of the epigastrium, vomiting, pains in the abdomen, and dry heat, accompanied with a strong and full pulse. These two instances will suffice to point out M. Broussais' mode of reasoning, and will easily convince us of the possibility of classing fevers according to his method. The diversity of impressions made upon the different individuals will easily present to the mind the several varieties of fevers as they are now classed in nosological tables. The limits we have adopted in beginning our observations on M. B.'s views, preclude us from dwelling longer on this portion of his labours; but induce us, at the same time, to proceed to a few considerations on the practical treatment suited to these views. These will occupy but a very few moments; for when we once agree to call a disease inflammatory, its treatment is decided.

Notwithstanding erroneous impressions which have found their way into this country, six leeches do not constitute the effective force of M. Broussais' TREATMENT. His work abounds with proofs of a vigorous and efficient practice. He proportions, indeed, his depletion to the degree of the disease, and the constitution of his patient; but when the case requires it, he directs general, as well as topical bleeding; nay, he accompanies these directions with instructions to enforce absolute diet, that is, no other nourishment except a solution of gum arabic, which he would deny, could he find a more inert substance. Next to the depleting remedies, diluent drinks and emollient injections hold the first rank; by increasing the general mass of secretions, and by gently evacuating the intestinal canal, they remove from the system a quantum of irritations by no means inconsiderable. And with this expectation active carthartics are more sparingly used, but in cases where the bilary secretions are vitiated, purgatives are freely recommended. M. B. is by no means a partisan of the methode expectante; on the contrary, he directs all his efforts towards arresting the course of fever as rapidly as it can be effected.

We have now presented what is conceived to be a general outline of his treatment, such as we have been enabled to collect it from his confused stile and obscure phraseology. A more satisfactory one will be obtained by carefully meditating his works which certainly deserve an English translation, and a place in the library of every judicious or ambitious practitioner.

We are perfectly conscious that the views here advocated are not yet those of the majority of our medical brethren, and though the author has no doubt that these views will ultimately

reign triumphant, still a due respect for the opinions of others which should ever preside in all our investigations, induces us to trespass a few moments longer. These moments shall be employed in a few cursory remarks, explanatory of some part of the preceding observations.

It is asserted by those who are opposed to the dissemination of the new theory, that M. B. discerns what no one else can see: that what he calls inflammation is so called by any other practitioner. To this it may with great truth be replied, that what he calls inflammation after death, is so called by Morgagni, Lieutaud, Portal, Prost, and others. The latter especially, whose work on examinations of dead bodies, deserves to be better known. Though we cannot consider ourselves bound to defend the particular views which M. Broussais entertains respecting the appearances inflammation presents after death, and though we do not regard this as the proper place for even a full exposition of what appears to us a very lucid demonstration of these appearances, yet we feel ourselves called upon to protest in a most positive manner, against all inferences from any source but the author's own words. It is our cordial belief that the ensemble of his observations are the best commentary on his doctrine.

That a structure so eminently endowed with vital properties as the mucous membrane, richly supplied with capillaries of the most delicate ramifications, and by its situation, as well as its functions constantly exposed to impressions of an irritating nature, should be very susceptible of inflammatory action, is a position not beyond the limits of probability, it is one which is sanctioned by all our information in physiology, as well as pathology. Let us admit for a moment, that the organs are much oftener the seat of inflammation than is generally conceded, is it necessary to constitute the disease that the viscus affected, should be agitated by the more violent pains of inflammatory action? May it not be disordered by a state of excitement, subversive of its healthy functions, whence morbid sympathies originating, may be diffused over the whole system? Such a state will be found to exist, the symptoms of which may not be evidently inflammatory, but as nearly as it can approach towards that stage.

The acknowledgment that general or essential fevers do not exist, appears so great an improvement in our nosological views, that as a mere theory it strikes the mind at once with its importance. Let us, however, apply the doctrine to practical purposes, and select, as the subject of this application, the low remittent fevers usually considered of a typhoid nature. In these cases the predominating symptoms do not evidently suggest the existence

of a local engorgement, although they do occasionally denote such lesions; yet post mortem examinations convince us, in these very cases, of the existence of numerous stages of visceral disorganization. But, according to the received opinions, it is heresy to admit these appearances to have been original. They must be secondary, and the result of the disease. Experience, however, true in its results, will justify or condemn the reputation of these principles.

WISSMANN ON NUDATION, CARIES AND NECROSIS *.

The author of this tract professes to make public some new observations on the subject of some diseases of bones, drawn from the clinical practice of Dzondi, Professor of Surgery, and Director of the Hospital in the University of Halle.

He defines NUDATION as being a separation of the periosteum, or of a portion of a bone, so as to leave it exposed and bare. The discovery by the probe that a bone is bare, and deprived of periosteum, is not enough to determine the existence of nudation; the same circumstances being observed in the totally different affections of necrosis and caries. This is a mistake very commonly made in practice when the periosteum is destroyed, as in deep-seated whitlows, fistula lachrymalis, &c. Nudation is known by the periosteum being wanting in some part of the bone, its surface being either entire or partially removed, leaving the internal structure exposed. There is either no suppuration, or it is healthy and confined to the soft parts. The bare part of the bone has either not been at all exposed to the air, or for a very short space of time. There are no appearances of a groove in the circumference of the exposed part; that is, there are no signs of commencing absorption. There is not any inflammation of the internal parts of the bone. These signs, when all present, distinguish nudation from caries and necrosis. For if there be an unhealthy suppuration, either the bone has been exposed to the air, or has been long in a state of nudation, or it is affected with necrosis. If there be a groove in the circumference, the separation of the necrose portion has already commenced. If there be inflammation of the structure of the bone, caries is likely to be the consequence.

* De rite Cognoscendis et Curandis Nudatione, Carie, et Necrosi Ossium, Observationes Pathologico-Medica; Auctore L. Wissmann, M. et C. D. 8vo. Halæ.

The nature of the CAUSES may assist the diagnosis: they are of two kinds; accidents and diseases. The accidents are wounds of all kinds, incised, contused, and particularly punctured wounds; and fractures, and division of portions of bone. The diseases causing nudation are chiefly inflammation and suppuration, and all the affections which excite inflammation in the periosteum, as rheumatism, &c.

Nothing can be more favourable than the PROGNOSIS of nudation, unless it should be injudiciously treated. Many mistakes are made as to the nature and treatment of this affection, the destruction of the periosteum as perceived by the probe, being often considered as a proof of caries, and treated accordingly. The curative process consists in the adhesive inflammation and the effusion of coagulating lymph.

The TREATMENT recommended by M. Wissmann is simply a covering which may prevent the access of air and cold, and avoiding every thing which might irritate or disturb the exposed surface. No ointments, injections, frictions, tents, &c. are required. The wound is to be kept covered, leaving a free exit for matter. Suppuration rarely continues for any length of time, and the wound generally heals in from seven to fourteen days.

The word CARIES has no kind of relation to the disease it is employed to express. Caries is the effect of inflammation of a bone, and corresponds to the suppuration of soft parts. Hence it is commonly considered as ulceration of a bone, and in fact it is ulceration arising from and attended by inflammation. But as in soft parts there are two kinds of suppuration, the one healthy, and ending in cicatrization, the other malignant and destroying the parts still more; so also are there similar affections in bones. We sometimes observe an ulceration of bone ending in exfoliation, or recovering without it; on the contrary, frequent instances occur of malignant suppuration of bones, lasting for months and years, and destroying the parts in which it takes place. As in the soft parts this ulceration of bones is attended by ichorous discharges, fistulæ, &c.

The SYMPTOMS commonly ascribed to caries are nearly all uncertain, and many of them false. The loss of the periosteum, or the exposure of part of a bone cannot be considered as certain signs of caries, for we have already shewn that they attend nudation, without caries or necrosis. Roughness of the surface of a bone is uncertain, for it may be the consequence of an injury exposing the internal texture; while many bones also are naturally so rough as to give a deceptive impression when touched with a probe; and the irregularity of a bone in a state of necrosis, from the progress of absorption, may give rise to

the same deception. The colour given by the matter to a silver probe, or a plaster containing lead, has been considered as more certain. But the discharge from an ulcer complicated with caries or necrosis does not give this colour to a probe, &c. unless from confinement or other causes it has begun to putrefy. Besides, pus of any kind, if it be long retained in an abscess or ulcer, produces the same effect. The peculiar odour has often been mentioned, and it cannot be denied that it frequently attends the suppuration of a bone, but it is not always present in this case, and occurs in many malignant and fistulous ulcers. From these circumstances it is clear that the symptoms commonly supposed to indicate caries are by no means decisive. But caries must be considered as caused by or consequent upon inflammation. Hence it follows, that where there is caries, it must have been preceded by symptoms of infiammation; these are obtuse and deep-seated pain, gradual swelling of the bone, the colour of the cutis remaining unaltered; suppuration occurring under the periosteum in the substance of the bone: the soft parts then become affected, and the matter makes its way through the integuments, the periosteum being destroyed.

INFLAMMATION of the periosteum must not be mistaken for disease of the bone; in the former case the periosteum being destroyed, the consequence is nudation or necrosis of the bone, but not caries. It is by no means an easy matter to distinguish between these affections, the symptoms of both, except the pain and swelling, being nearly similar. When the bone is inflamed the pain is less acute, the swelling softer and more circumscribed; when the periosteum is inflamed, both the pain and swelling are more considerable and extend farther. If inflammation and suppuration of a bone have occurred, the symptoms before mentioned, the loss of periosteum, the roughness of the surface of the bone, and the peculiar odour of the discharge, may assist in confirming the diagnosis; particularly if other circumstances correspond. Among these is the carneous excrescence surrounding the apertures of fistula leading to carious bone. It rises to the height of about a line, forming a ring or sphincter, with a minute opening from a fourth to a tenth of a line in diameter, and giving exit to the pus. The author considers this appearance as caused by the nature of the pus secreted by the bone, or changed by its contact, and supposes it to be a salutary operation, intended to prevent the access of air, and to promote the processes of absorption and exfoliation. If this be the case, what are we to think of the practice of those who do not hesitate to dilate and cut the orifices of carious ulcers? This symptom might be considered as pathognomic,