The lungs adhere to the pleura posteriorly. On the right side there is more than an ounce of serum in the cells of the adhesion. On the left side, anteriorly, the lung adheres to the inferior part of the displaced portion of the second rib, and to the internal surface of the membrane which encloses the space devoid of muscular fibre.

The lungs are dense and of a deep livid color. A small part of the lower lobe of the left lung is entirely normal. The right lung adheres to the membrane heretofore mentioned, as well as to the surrounding parts, to an extent of one and a half inches in diameter. The rest of the anterior portion presents no pathological appearance.

The pericardium is attached to the heart throughout nearly the whole of its surface. The adhesions are easily broken. There is nearly a teaspoonful of fluid in the cavity and near the apex of the heart.

The heart is augmented in volume, the right auricle being more so than either of the other cavities.

The abdominal and pelvic viscera are normal. It is found that the wounds in the integuments do not precisely correspond with those of the parietes. This position of things undoubtedly facilitated a cure, and was probably owing to the fact, that the arms were raised at the moment of the occurrence of the accident.

The preparation now preserved in the museum consists of the anterior parietes of the thorax, including the sternum and the sternal half of the first five ribs. The whole of the cicatrices and other deformities are thus exhibited. The extremity of the shaft which inflicted the wound is also preserved in the museum. It penetrated the body to the distance of twenty-one inches. The portion of that length is five inches in circumference, in the middle, and air at the larger ortromity. The tug-iron underneath is three and a half inches in length. This undoubtedly entered the lungs.

The autopsy was performed under the direction of Sir William Blizzard by W, B. Harkness and William Clift, assisted by J. W, Parkinson,

REVIEW.

ART. XIII.-The Library of Practical Medicine. A System of Practical Medicine, comprised in a series of original dissertations. Arranged and edited by ALEXANDER TWEEDIE, M. D., F. R. S. &c. &c. Diseases of the Digestive, Urinary, and Uterine Organs. 8vo. pp. 516, Philadelphia: Lea & Blanchard, 1841.

THE pages of the present volume are devoted to the consideration of several classes of diseases, which have received very unequal attention from those who were engaged in the investigation of the laws of the economy in health and in a morbid condition. While some of them have been the subjects of study and inquiry from the earliest times, others, as those of the urinary and uterine organs, are indebted almost exclusively to the patient research of medical men during the last few years, for the advanced state in which their history has been placed, and which the dissertations we are about to examine, fully manifest. At the same time, the new facts which have thus been brought to light, are scattered through so many treatises, and are encumbered with so much foreign matter, that it is impossible for the student, or for those engaged in the full practice of their profession, to trace their relations, or even, in many instances, to inform themselves of their existence. We cannot, therefore, but welcome with satisfaction, a work in which they are grouped together in a clear and perspicuous manner, and which places before us under the sanction of distinguished names, as concisely as is consistent with distinctness, the exact state of knowledge in the matters treated of.

In the previous volume, the history of the diseases of the organs of circulation was commenced by Dr. Joy, but the examination extended to those only involving the heart and its investing membrane. The subject is here resumed, and the volume opens with several chapters relating to the diseases of the arteries and veins, thus completing the series of able papers upon the affections of the circulatory organs.

In the first chapter we are presented with an account of the functional disorder of the arteries, namely, neuralgia, and inordinate abdominal pulsation: which last, in the very great majority of cases, is altogether independent of organic disease in the aorta or large trunks proceeding from it, but is rather a symptom of disease in the neighbouring organs, and is, therefore, to be treated as such.

The history of arteritis follows, with a careful exposition of what may be considered its anatomical characters, and a caution against confounding the cadaveric redness so often met with in the arteries, with that resulting from disease. Other morbid appearances are noted, though it is doubtful whether they are all the results of acute or chronic inflammation; such as white cartilaginous patches, proved by M. Bizot to originate from the albuminous concretions of acute arteritis, and finally to supplant the membrane upon which they were at first placed; the yellowish atheromatous patches in the aorta and larger vessels, at first minute granules between the middle

and inner coats, gradually increasing and coalescing, finally ending in ulceration or ossification, thus weakening the coats, and causing rupture or aneurism, and a species of chronic softening of the inner coat, which may end in its laceration, rolling up, and consequent obliteration of the calibre of the vessel. The diagnosis of arteritis cannot be unequivocally established, and it is only by negative signs that we can for the most part arrive at any probable suspicion of its existence when it occupies the interior of the body.

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The subject of the next chapter is aneurism of the aorta, which is introduced by a concise and perspicuous account of aneurisms in general, their nature, causes, symptoms, and results. Among the predisposing causes," says Dr. Joy, "one of the most influential, as has been remarked by Mr. Guthrie, (and our own experience is quite in unison with the observation,) is the inordinate use of spirituous liquors, by which apparently a subinflammatory condition of the coats of the vessel is induced, leading to their gradual softening and disorganization, whilst at the same time the force of the heart's contractions is inordinately increased to such a degree, that the weakened artery is no longer capable of sustaining them with impunity."

Aneurism of the aorta is then considered with reference to its situation within the thorax and within the abdomen. The means of determining its existence, and of distinguishing it from other affections, and more particularly, from affections of the heart, are very carefully and fully examined, while it is confessed that there is no positive evidence upon which we can rely until the disease has progressed so far as to have given rise to a tumour of considerable size:

"As regards the treatment of this affection, it is remarked that the voice of the judicious part of the profession, and of nearly all those who have of late devoted their attention more particularly to the treatment of cases of internal aneurism on a large scale, is, we think, at present, decidedly adverse to the propriety of enforcing the rigid plan of treatment practised by Valsalva and Albertini, except, perhaps, in individuals of a very robust constitution.' 'In aneurism of the aorta, an extremely lowering system is generally found to do more harm than good, by inducing arterial reaction, or a nervous and irritable state of the constitution incompatible with healthy reparatory action in any part of the system, by weakening the coats of the artery, as well as by giving rise to a thin watery condition of the blood, by which even the existing laminated concretions, so far from being augmented and consolidated by plastic lymph, are apt to get detached and washed away, one great bulwark against fatal rupture being thus speedily removed.' 'It appears incontestable, from several cases recently published by the most competent observers, that a tonic treatment, along with a reparative and rather generous diet, is in many instances much more applicable than the opposite.'

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Having examined all the diseases of the arteries, which belong properly to medicine, Dr. J. next proceeds to a consideration of the veins. After a few short preliminary observations on their general character, and the functional disorders of the veins, the subject of phlebitis is taken up and a condensed and rapid sketch of all the facts connected with this inflammation, either as the cause or consequence of disease in other organs, its anatomical characters, its connection with phlegmasia alba dolens and its treatment, is presented to the reader, who will be more inclined to regret its brevity than to find fault with its matter. As regards phlegmasia dolens, Dr. J. is inclined not to ascribe an exclusive influence to the veins in producing this disease, and believes that they are only implicated in com

mon with or even subsequently to several other tissues, more especially the subcutaneous cellular tissue, the inferior surface of the cutis vera, and the superficial nerves: and for this he assigns several reasons, such as the mode of origin of the affection; beginning always in the upper part of the limb, the neuralgic tenderness of the surface, the tense and elastic swelling, the type of fever so dissimilar to that in indisputable phlebitis, and the lower rate of mortality compared with that in the last.

Two short chapters, one on varicose veins, and the other on miscellaneous affections of the veins, such as their spontaneous perforation and laceration of their valves, obliteration of their cavity, &c., terminate this portion of the volume before us, and complete the history of the diseases of the organs of circulation.

The diseases of the organs of digestion are next considered, and occupy a space of 254 pages. The account of those relating to the mouth, throat, and alimentary canal generally, is from the pen of Dr. Symonds, of the Bristol General Hospital, with the exception of one chapter on diarrhea, by Dr. George Budd: that part which treats of the organs external to the alimentary canal, but concerned in the process of digestion, and a chapter relating to the disease of the spleen, are the work of Dr. Wm. Thomson.

These different classes of disorders are examined in the order in which they are mentioned, and a concise and compendious account of these very interesting and important complaints is given.

Beginning with the affections of the mouth, we have presented to us an account of its different forms of inflammation, the aphthous, mercurial and ulcerous: this last is distinguished from a peculiar malignant disease, called gangrene of the mouth, which is considered by the author as an idiopathic affection, arising in young children of a debilitated habit, and living in unhealthy or crowded situations, or as one of the sequela of exanthematous diseases, and "gangrenous ab origine, any inflammation that may be found about the part is secondary only, bearing no causative relation to the gangrene. Both Dr. S. and the American editor agree that it cannot be attributed to the special action of mercury, though this may favour its development, especially when there is an epidemic tendency to the affection.

The diseases incident to the process of dentition are next briefly described under the heads of local symptoms, and remote affections, among which are included the derangements of the mucous membranes, of the skin, of the nervous system and febrile affections.

Inflammation of the tongue, the specific and common inflammation of the parotids, and angina, or inflammation of the throat are appropriately noticed in the three next chapters. Of these, the angina membranacea, or the diphtherite of Bretonneau, is more particularly dwelt upon, and attention is directed to that form, which beginning insidiously and rapidly extending its false membranes over the fauces, and into the air passages, is attended with a low and malignant type of fever, and would appear to be contagious in its nature. Its peculiar and fatal character, and the fact "that there is frequently observed an erythematous or papular eruption on different parts of the body," cause "little difficulty in arriving at the conclusion that it is a variety of scarlatina maligna." We quite "coincide with Dr. Tweedie, in the Cyclopedia of Practical Medicine, art. SCARLA'We are inclined,' he observes, to affirm that the scarlatina simplex, scarlatina angina, and the scarlatina or angina maligna, and the sorethroat without efflorescence on the skin, are merely varieties of one and

TINA.

the same disease.' It is scarcely necessary to add that the sore-throat here alluded to, is that which presents the same characters as are observed in cases where there is also the cutaneous affection."

A short chapter on the diseases of the oesophagus, which are generally of a chronic character, leads to the consideration of that important and much vexed subject, gastritis. After a condensed, but very clear description of the anatomical characters of congestion and inflammation of the gastro-enteric mucous membrane generally, and of the means of distinguishing these appearances from that of a physiological or cadaveric nature, an excellent detail is given of the symptoms, peculiar anatomical character, cause and treatment of the acute, sub-acute and chronic forms of inflammation. The last we are cautioned against mistaking for dyspepsia, which is considered as a purely functional disorder, and the mode of distinguishing the two is briefly pointed out. Much space is given to the consideration of the treatment, particularly of the chronic form, and the following, as it appears to us, very judicious language, is used respecting leeching.

"We are persuaded that one of the most frequent mistakes in practice is to apply leeches in too large a number in cases of gastritis; the consequence of which treatment is to exhaust the strength of the patient by the quantity of blood lost, before there has been time for reducing the morbid action in the stomach by the revulsive agency of the remedy, as well as to prevent its repetition. We believe that it is seldom necessary to apply more than six at a time, and sometimes three or four suffice. They may be applied daily for three or four days, or even a week, according to the strength and the degree of pain; and afterwards twice or thrice in a week."

Carcinoma, softening, ulceration and perforation of the stomach are each concisely treated in the next four chapters, and we then come to a consideration of the functional derangements of this important organ, viz., dyspepsia, gastralgia and gastrorrhea. Preliminary to the account given of dyspepsia, are some excellent general observations on the sources of the functional disorders of the stomach, which are traced to the large quantity of blood distributed to it, and its intimate sympathy with other organs, for which it is indebted for its liberal endowment of nerves, and in consequence of which it is believed that it receives scarcely less injury than it distributes. The increasing prevalence of gastric complaints is, as it appears to us, justly attributed to the condition of the "nervous systern, which, in the respective classes of the community, the unnatural hours, the enfeebling luxuries, the toil and excitement of the intellect, the commercial anxieties, the struggles of men, solicitè ambientes, callidè litigantes, or of others who, in a redundant population, subsist only by the most ardent and emulous exercise of their inventive faculties, are constantly perturbing and paralyzing."

Dyspepsia is then considered under these forms; two acute, the embarras gastrique of French authors, and the other under the name of bilious seizure, occasioned by the regurgitation of bile from the duodenum into the stomach; and a third, a chronic attack, and by far the most important.

This last, as was before mentioned, is considered as a purely functional disorder, uncomplicated with any structural alteration, or with appreciable permanent disease of the capillary circulation. The following is considered to be the pathology of the affection.

“We may reasonably infer that the fault is due, either to an insufficiency or