ing, as it were, the blood from the vessels so easily supplied by the very numerous and freely-communicating capillaries, and from the difficulties which would thus be presented to the formation of coagula. Now, we know, on the contrary, that immediate danger is comparatively slight, notwithstanding, as stated by Bichat, and verified by others, that the lungs, especially when inflamed, are more frequently than any other organs, flooded with an immense quantity of blood. Bichat well says, "Voyez le poumen d'un péripneumonique; en le fendant vous diriez au premier coup d'œil, que ce sont les solides qui y sont augmentés, il a souvent comme l'aspect du foie dans la masse pesante qu'il représente; mais mettez-le macérer, blentôt, tout s'echappera en fluides. Or, examinez comparativement la peau, l'estomac, le foie, les reins, etc., devenus le siége d'unee inflammation aiguë qui a fait succomber le sujet; ils ne présentent rien d'approchant de ce surcroit énorme de fluid dont le poumon inflammé dans sa substance est surchargé." Again; what prevents the occurrence of exhausting hemorrhage when there are abscesses and excavations in the lungs, surrounded by perfectly healthy structure, without even the intervention of false membrane? According to Baillie, this is "principally the case when the abscesses are small and placed at a considerable distance from each other." Yet, even then, we would suppose that the blood would be continually forced out into the cavity by the action of the lungs, while the free communication of the capillaries would furnish an ample supply. The preceding remarks are also applicable to an excavation from pulmonary gangrene; for, as Andral says, "the parietes of this cavity are, in general, not lined by any false membrane; the pulmonary parenchyma which surrounds it is in some cases perfectly healthy."

In the pathological conditions of the lungs there are appearances which are very peculiar, viz: the abrupt and perfectlydefined margin that frequently exists between the healthy and diseased parts. These singular boundaries, as if marked out with a pencil, are found in no other organ, except, perhaps, in the brain. In inflammation, or as the effects of inflammation, in other organs, the surrounding tissue is involved; and as we recede from the point of most active disease, the remote parts are less affected, but there are no lines of demarcation; indeed, we can scarcely pronounce where a healthy condition commences, whereas, in very VOL. 7, NO. 8-41.

many of the diseases of the lungs, the separation between the morbid and healthy parts is perfectly defined, as has been remarked by every pathologist. Addison says that, "especially in certain atonic forms of pneumonia, these changes are confined to individual lobules, more or less remote from each other, the common cellular membrane forms a distinct boundary to the infiammation." Grisolle speaks of isolated lobules being the seat of pneumonia; and Andral alludes continually to this disease as being circumscribed. With respect to pulmonary apoplexy, Laennec observes, that "it is always very exactly circumscribed, the induration being as considerable at the point of termination as in the centre. The pulmonary tissue around is quite sound and crepitous." Andral makes the same remark. He also, in his Clin. Méd., has very interesting observations and facts upon the lobular nature of tubercles, but they are too long to be transcribed.

The experiments of Dr. Marshall Hall on the batrachia, will not apply to warm-blooded animals. In Roget's Animal and Vegetable Physiology, it is beautifully shown how, as we ascend from the lower order in the scale of beings to the most perfectly organized, the pulmonary structure materially varies, so that analogy will not hold good between the different orders of beings. He observes, that in the frog a limited portion only of the blood thrown out from the heart goes to the lungs, so that any inconvenience from intimate communication of the capillaries is prevented; and proceeds to show the perfect and well-developed structure of the lungs of the mammalia. He states, also, that the torpid and coldblooded reptiles are separated from the mammalia by a very wide interval; for though the former respire air, that air influences but a part of the blood, as the pulmonary is only a branch of the general circulation.

It is allowed by the best anatomists and physiologists, that the capillaries are differently arranged in each organ, being so modified as to accommodate themselves to the tissues through which they ramify. Bichat considers it certain that their distribution and formation differ in the tendons, aponeuroses, muscles, etc.

If we admit that there is no anastomosis between the capillaries of the lungs, we can satisfactorily explain many points in the physiology and pathology of the pulmonary organs. 1. We can easily perceive how, in pulmonary hemorrhage, the arterioles or capilla

ries, having no collateral supply of blood to instantly rush in and keep them distended, readily contract, and allow the formation of coagula, which effectively prevent excessive loss of blood. 2. We can explain why, in small abscesses where there is not a false membrane between the parietes and healthy structure, there is not a continual flow of blood into the cavity, for as the capillaries discharge themselves they shrink; although in large cavities where, from extent of surface, an exhausting hemorrhage might occur, nature provides a false membrane. 3. We can read understandingly the facts recorded by Bayle, Laennec, Andral, Barth, and indeed by all the correct and skillful pathologists. We understand why pulmonary inflammation, congestion, apoplexy, gangene, etc., are so exactly circumscribed and defined; and why in inflammation we do not, as in other tissues, always observe a gradation in the degree of engorgement, as we recede from the centre of disease. We find the correctness of Andral, when he describes inflammation as attacking isolated points of the pulmonary tissue; and when he speaks of even vesicular pneumonia, of which Grisolle observes, that "Billiet and Barthez seem to show that this lesion, described by Andral, is only vesicular bronchitis, in which a portion only of the pulmonary vesicles are iuflamed and distended with puriform fluid." We see reasons for Andral's statement, that "even in those parts where the hepatization seems most perfect, it rarely happens that some small bronchial tube may not be found still permeable to air; and we sometimes find, that when the lobe of a lung which appeared uniformly hepatized throughout, is dried and carefully examined, we can discover some capillary tubes and air-cells which, instead of having their calibre diminished, are very considerably dilated, and are at the same time free from any appearance of congestion." 4. We can understand when we turn to physical signs, why the crepitous râle is so frequently accompanied by the respiratory murmur. We also ascertain why crepitous râle without respiratory murmur, shows very considerable engorgement; and when respiratory murmur is present, much of the lung is still healthy. We likewise advance towards an explanation of lobular pneumonia in children, and account for the frequent relapse and only apparent convalescence in pulmonary inflammation, from small lobules and vesicles remaining in a condition of active disease, after all physical and

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rational signs of functional derangement have dissappeared.Finally, we comprehend the cause of the following phenomena observed by Stokes: "I have frequently seen," says he, "all the signs of solidification subside within two days, and have even observed great modifications in the course of a few hours. On this subject more extensive observation is wanting." We have thus demonstrated how, by being composed of an aggregate of isolated portions, the lungs are protected from the extension of disease; and how, but for this safeguard of nature, organs so essential to existence would be more liable to permanent injury, when a portion of their tissue is incapable of performing its functions.

Editorial Department.

Books Reviewed.

Diseases of the Lungs and Air-Passages. By Henry Wm. Fuller, M. D. From the second and revised London edition. Philadelphia: Henry C. Lea, 1867. Commencing with the principles of physical diagnosis, and their application to the investigation of diseases of the lungs, the author proceeds to a complete discussion of all subjects pertaining to diseases of the respiratory organs and their proper treatment. He gives the topography of the walls, and describes and illustrates with wood cuts the contents of the various regions of the chest; shows the importance and value of inspection and physical examination of the chest, and describes the methods of making these examinations; points out most clearly what is to be observed and the import and significance of symptoms elicited from the alterations which the various organs undergo in disease.

In part second we have the Pathology, Diagnosis, Symptoms and Treatment of Diseases of the Lungs. Pleurisy, Pneumonia, Bronchitis and Pulmonary Consumption are the diseases which have received principal attention. All the numerous questions concerning tubercular disease, not yet settled, are discussed, and the opinions of the author and the facts sustaining his opinions are introduced. Hereditary transmission of the disease, age at which consumption occurs, influence of cold and wet and the atmospheric changes in producing or predisposing to it, furnish favorite topics, upon which the author entertains opinions not wholly in harmony with the generally received doctrines of authors or the public. Upon one single point we quote our author, because we can so heartily endorse most of his views, and have often presented and urged the same against strong opposition. "Fistula in ano is another symptom which must not be lightly dealt with.

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As long as the discharge is insignificant in amount, it is advisable to confine our efforts to treatment of the constitutional malady, and not to disturb the fistula. But I do not hold with those who maintain that a fistula in ano occurring in the course of phthisis ought never to be interfered with. In some instances the discharge is profuse, and constitutes an important source of waste; the patient is so distressed and alarmed at its continuance, that no treatment can be of avail until his nervous apprehensions are overcome. He can neither eat nor sleep for thinking of it, and his whole system is depressed in consequence. In such cases I have known the greatest benefit result from an operation, combined with an issue in the arm, the use of proper diet and administration of cod-liver oil, quinine, iron and other appropriate remedies. Not only has the fistula healed, but the general health has improved, the patient gained flesh, and the physical signs of pulmonary disease have greatly lessened." If the statement of "combined with an issue in the arm" had been omitted, the sentiment would have been worthy a recent author. This part of it we believe the effect of routine in sentiment and practice, and such issue useless and injurious—injurious in proportion to its size and the irritation and ulceration it occasions.

Our new books are better than our old ones, our knowledge is greater and more definite, and our practice of medicine and views of disease are constantly growing more correct and satisfactory, but the mistakes and errors of the past, however clearly pointed out and well defined, are rejected and abandoned only by degrees. The author of this book has done his part faithfully, and furnished the medical public a clear, philosophical, correct and valuable work upon diseases of the lungs and air-passages. It has many attractions for the medical student,in its first part especially, while the practical portion of the work as embodied in its second division, renders it a valuable guide in the treatment of all diseases of the lungs.

A Practical Treatise on the Diseases of Children. By D. Francis Condie, M. D., Fellow of the College of Physicians, Member of the American Medical Association, etc., etc. Sixth edition, revised and enlarged. Philadelphia: Henry C. Lea, 1868.

Dr. Condie's Treatise on Diseases of Children is so favorably known and so highly appreciated by the profession, that any extended notice of it is altogether unnecessary, while declarations of approval could be only a repetition of commendations already many times expressed. The present edition has again been thoroughly revised and every important advance in the knowledge of infantile disease has been incorporated in the respective sections, so that as the work now appears it will continue to be an accurate and faithful guide in the treatment of children, and be regarded as one of the most complete works in this department of medicine. Much attention in the commencement of the work has been devoted to a consideration of the hygienic management of children, which embraces a discussion of the influence of light, temperament, cleanliness, bathing, clothing, food, sleep, exercise and moral treatment. It is remarkable that in the face of the acknowledged influence of hygienic regulations as a preventive of disease, and the neglect of which is the cause of nearly all the ails of childhood, physicians