withdrawal of nutritive supplies, has the quantity of its secretion diminished loses in breadth and thickness; nay, completely alters its shape by degrees; and, the longer the fast is prolonged, obtains a higher exponent as respects the weight of the body-ie., suffers a disproportionately greater atrophy than the body itself. The liver meanwhile loses weight at nearly the same rate as the body, or even less rapidly; but the spleen experiences a disproportionately smaller loss in relative weight than the thymus. The secretion of the gland at the same time becomes altered morphologically and chemically. From several experiments as to the effect of different kinds of food, it resulted: (1) That an abundant mixed nutriment, containing albuminous, fatty, and saline matters, increases the secretion of the thymus, and so makes the gland heavier. (2) That an exclusive fatty diet (with butter) relatively increases the fatty contents of the thymus, while the quantity of the microscopical-shaped constituents of the secretion diminishes; and that a continued administration of this aliment induces considerable wasting of the thymus. (3) That an exclusively starchy diet at first appears to increase the secretion of the thymus, as the gland becomes richer in water, swollen, and so appears relatively heavier than normally; but that at a later period the secretion in the gland ceases, so that it even completely atrophies, and approximates in its proportions of weight entirely to the condition which has been shown to exist in fasting animals; the liver and the spleen also behave nearly in the same manner as was then stated. The influence of appropriate food is well shown in a comparison of two childrenone of whom, two months old, had thriven splendidly at the mother's breast, and had a thymus of 522 grains weight; while the other, five months old, fed with artificial food, and in a fairly good condition, had a thymus of only 237 grains. Both children died suddenly, both thymuses were rich in secretion, but the latter did not attain nearly the average weight of the gland in the suckling period. The seventh chapter, respecting the influence of disease on the thymus, we must almost entirely pass over. The author shows that in acute diseases the absolute weight of the thymus, on an average, sinks 2-6 times, and the relative weight 41 times below the normal figure; while in chronic diseases its loss in absolute weight amounts in the mean to 6.5-fold, and in relative weight to 8.5-fold. In the chronic enteritis of suckling infants the atrophy of the thymus is most remarkable, its exponent of weight relative to that of the whole body being 2263 80, instead of the normal number, 289-81. Passing over two short chapters (VIII. and IX.), on the effect of various operations on the thymus, and on the transit of drugs into it, we come to Chapter X. on the Comparative Anatomy of the Gland. The thymus, the author finds, is subjected in all mammalia to the same laws of growth and involution; the case of the hybernators forms no exception. In them, however, there occur a pair of peculiar glands (the so-called fat glands), which have much external resemblance with the thymus, and, like it, have no excretory duct, but are dissimilar in internal structure. They are made up of nucleated fatty cells, lying in a fibroid stroma. These have been confounded with the thymus→→→ a mistake which we ourselves once committed. They are largest at the commencement of the winter sleep, and waste away towards its close. In all orders of reptiles, Friedleben believes it to be proved that a thymus is present, and that it is subject to the same laws of growth as the thymus of the higher vertebrata. In fishes he has made no examinations of his own, but on Ecker's and Leydig's authority believes it to be present in some. dos fiqeg 796 spod 15 vad Chapter XI. treats of the extirpation of the thymus, and its effects on the general system. The conclusions derivable from twenty experiments were: (1) That no animal died from conditions ascribable to the extirpation of the gland. (2) The removal of the spleen in young dogs has no injurious consequences to the life of the animal. (3) The simultaneous extirpation of the thymus and spleen, on the contrary, occasions a considerable depravation of the blood-making and formative processes, and leads at last to death from exhaustion. The weight of dogs whose thymus has been removed, compared with that of dogs in a normal state, shows a considerable excess of growth in the former; the animals being of the same litter, and the period of time of course being the same for both. A dog whose spleen had been removed also increased greatly in weight; five months after the operation he had gained 174-1 per cent. of his original weight A dog who had lost both spleen and thymus, on the contrary, at the end of forty-seven days had only gained 22.1 per cent. of weight (while one minus his thymus alone had gained in the same time 2439 per cent.), at the end of three months and a half his weight was 7-8 per cent. less than on the day of the operation. The comparative examination of the blood in the above animals gave some interesting results: (a) Relative to the blood cells. In a normal dog, the jugular vein blood showed for every 1000 coloured cells, 7:38 colourless.In a dog deprived of his thymus, the proportion of the latter was 11102 and in one deprived of his spleen, 151·11. Dr. Friedleben concludes that in the latter animals a part of the processes normally performed by the thymus and spleen, go on directly in the blood. (b) Relative to the solids of the blood. After extirpation of the spleen they were diminished 14 per cent. ; after extirpation of the thymus 16° per cent.; after extirpation of both organs, 20 per cent and after excision of a piece of the left vagns, as much as 95 per cent. This last result seems almost incredible. to extind ellousy oguel and The result of several experiments, as to the amount of carbonic acid exhaled by animals deprived of their thymus,was that there occurred a diminution of 14 per cent. as compared with the exhalation of a normal animal of like age and weight. Observations made as to the quantity of urine passed compared with the weight of the animals and that of their food, supply the following conclusions After the extirpation of the thymus, the tissue metamorphosis of the animal is altered a greater amount of nourishment is taken; the change of the same into blood constituents is accelerated; the blood erasis after wards becomes more allmminons and watery; the excretion of albu minates increased, that of carbonic acid diminished gathe excretion of water by perspiration greater, by urine less; the addition by growth absolutely greater, but relative to the amount of aliments taken, less than the normal figure.anopi zorth I 1 Analyses of bones showed that extirpation of the thymus induced a more copious deposition of salts, or of gluten tissue, which varied according to the age of the animal, but corresponded to the existing phase of bone development, and was also proportionate to the existing development phase of the thymus itself; so that the alteration of the bones corresponded accurately to the grade of development and activity of the thymus at the time it was removed from the auimal. Chapter XII., containing ninety pages, is devoted to disenses of the thymus. We can only glance very cursorily indeed at the general conclusions. Inflammation of the thymus the author considers to be exceedingly rare, one single case alone he grants to be well " constatirt." Purulent depôts occasionally occur in the thymus, probably for the most part of syphilitic origin. Tuberculosis is one of the most frequent pathological changes in the thymus ; it is, however, very necessary to be on one's guard not to confound common glandular tuberfculosis with the much rarer thymic affection. Among 73 cases of general or lung and bronchial-gland tuberculosis in children, the thymus was found by the author to be involved only three times. Indurations of the thymus have often been described, but only two the author believes to have really concerned the organ. Only 2 cases of carcinoma of the thymus have been recorded, and both are uncertain. The thymus may be compressed in cases of empyema. Of this the author gives 3 cases which came under his own observation; but as only the corresponding half of the gland was altered, we are rather disposed to think that the change was the result of inflammation, which had spread to and involved the tissue. D With respect to hypertrophy of the thymus, Friedleben can only find 11, or at the most 12 cases recorded, where it is certain this state existed. These he believes to have been instances of congenitally overlarge glands, not of mere excessive distention by the secreted product. In the period of childhood, no case has yet been observed where the excessive size of the thymus has co-existed with pathological phenomena referable to this cause. The effects which would be produced by an over-large thymus, would of course be symptoms of pressure on the large venous trunks, or on the bronchi or trachea, abiding breathlessness, swelling and lividity of the face, paroxysms of suffocation. In 7 cases of enlarged thymus, the phenomena of laryngismus were present, and the children sank either in an attack of the same, or in consecutive eclampsia, or in a bronchitic complication. In 3 other cases, laryngismus was certainly absent, I died of bronchitis, another of croup, and the cause of death in the third is not mentioned. The author now proposes the inquiry, whether the laryngismus in the cases in which it has occurred (seven-twelfths of the whole number), can be ascribed to the thymic hypertrophy After a very full and interesting description of the disorder, and discussion of the nature of the paroxysm, the author considers the question above proposed under as variety of heads, taking into account all the possible influential condi tions. This discussion extends to far too great a length for us to attempt to follow him, and we must therefore, as before, content ourselves with giving the ultimate conclusions. (1) That the thymus, neither in its normal non-enlarged state can hinder the respiration; (2) nor can it in either state disturb the circulation; (3) in neither state can it press on the respiratory nerve tracts; (4) consequently, neither in the normal nor hypertrophied condition can it interfere with the circulation of the brain, or with innervation of the muscles of the glottis; (5) neither in its normal nor hypertrophied condition is it capable of a periodic turgescence from blood-stasis. As a corollary from these, the author concludes that the thymus can never cause laryngismus, that there is no asthma thymicum. The thirteenth and concluding Chapter opens with a series of thirtythree propositions, summing up the author's conclusions; after which he gives his final judgment, that the thymus is an organ which during the growth of the body ministers to nutrition and blood-development, and thereunth to building up of the tissues. The remaining part of the chapter is occupied with a review of the opinions held by previous writers. We have thus presented our readers with an analysis of the whole volume, which, indeed, appeared to us the only course that lay open to us. A work of so original a character cannot be fairly criticised in detail, except by those who have had opportunity and a call to labour in the same field. We have derived much pleasure and profit from the perusal of this masterly effort, which is in itself a monument of the author's diligence, patience, and acumen. We commend it most heartily to the notice of British physicians, and cannot doubt that at translation of it will soon make it as generally accessible as it ought to be. REVIEW XI. 1. Practical Observations on the Operations for Strangulated Hernia. By J. H. JAMES, F.R.C.S., Consulting Surgeon to, and late Senior Surgeon of, the Devon and Exeter Hospital; Consulting Surgeon to the Exeter Dispensary.-London, 1859. pp. 95. 2. Practical Observations on the Radical Cure of Inguinal Hernia, By C. HOLTHOUSE, F.R.C.S., Surgeon to the Westminster Hospital, and Lecturer on Surgical Anatomy in its Medical School; Surgeon to the South London Ophthalmic Hospital, &c.—London, 1858. pp. 38. ... MR. JAMES's name is a sufficient guarantee that what he thinks worthy of presentation to the public is the result of extended experience and unprejudiced observation, nor will this little work in any way damage the reputation which his former contributions to practical surgery have obtained. The basis of the treatise before us is statistical; it contains 6 a table of all the operations for hernia which Mr. James has had the opportunity of performing, during an experience extending over thirtyseven years, the first operation recorded bearing date October 18th, 1821. The total number of these operations is thirty-six, and they are tabulated on the plan adopted in South's Chelius,' the fatal cases, however, being separated from those which recovered, and further, the deaths in private practice from those in hospital. The reason of the latter subdivision is one which applies strictly to country practice only viz., that the distance of the patient's residence often forms an important feature in the case. Besides these statistics of his own, Mr. James discusses those which are furnished in the periodical returns from all the metropolitan hospitals in the Medical Times and Gazette.' Let us first turn our attention to this statistical view of the question. It is a startling fact, which, however, we can see no reason to doubt after the data given by Mr. James, that half, if not more, of all the cases of strangulated hernia operated on in London hospitals die. This is proved by the returns collected by the reporters of the Medical Times,' from accounts furnished by the officers of the various institutions. These statistics may, indeed, be so far considered imperfect, that cases are left in the reports "under treatment," the result of which is never recorded, but this defect of course operates to diminish the apparent number of deaths. These records for three years (apparently 1854, 1855, 1856, but Mr. James is not very precise upon this point) give a gross total of 391 cases, and 194 deaths from all causes. It is true that this gross total of deaths may be somewhat diminished by excluding cases in which death is produced by other diseases; still, by far the greater number died of causes connected either with the disease or the operation. Nor is the inference to be drawn from Mr. James's own tables a much more encouraging one; for here, notwithstanding the supposed favourable influence of country air, and although the list is composed partly of private patients who are likely to seek relief sooner than the persons who come into hospitals, the mortality is 14 out of 36. We do not see what objection can be urged against these statistics, or the conclusion that they enforce-viz., that the rate of mortality in operations for strangulated hernia is, in the long run, above one-third of the number of cases operated on. Nor will it be said at the present day, that much can be hoped from extended study of the disease or further improvements in the operation. To the question of the supposed improvement effected in the latter direction, by the more extended introduction of Petit's mode of operating, Mr. James addresses himself with great effect, showing beyond question that, as far as our experience of the latter has gone, it seems to be quite as fatal as the old operation, considering that it is applicable only to the less formidable cases. This conclusion is also that of Mr. Prescott Hewett, from a comparison of 75 cases operated on at St. George's by the old method, with 69 cases reported by Mr. N. Ward from the London Hospital, in about one-half of which the sac was not opened.* • Medical Times and Gazette, vol. ii. p. 315. 1854. די |