nated "stye," and on warts and vesicles, Mr. Travers makes remarks, and then introduces the subjects of lippitudo, diseased cilia, tinea ciliaris, and trichiasis, for which we must refer to the volume itself. With the following extract respecting ectropion, we shall conclude our analysis of the pathological division of Mr. Travers's work, of which we hope we have presented a fair outline. In our next number we shall analyse the therapeutical and operative portions of a volume which does honour, not only to the author, but to the country to which he belongs.

"The ectropion is the result of injury to the eyelid, as wound, burn, herpetic ulcer, or the sequela of chronic lippitudo. The tarsus of the lower palpebra sometimes falls outward from an apparent loss of elasticity, or the unequal action of the orbicularis muscle. The lid receding from the globe suffers the tears to collect in a pool between them. An unhealthy state of the conjunctiva is, if not the cause, as when villous and redundant, a certain consequence of its eversion and exposure. The case is much aggravated when coadhesion, after burns or neglected wounds, ulceration from any cause, or long enduring eversion, takes place between the skin of the eyelid and cheek. This case admits of palliation, but not of cure. I have much improved several cases by first detaching the fastened lid and forcing it to heal by granulation, and afterward, removing a triangular portion of the cartilage, according to the proposal of a modern author, for the correction of the eversion, which is the best remedy for such eversions as do not depend upon the protruded conjunctiva.* In this, which is the simplest case of ectropeon, the excision of the diseased conjunctiva is sufficient. Where the everted lid is adherent to the bone, there is a deficiency of cellular substance to produce granulations, and the case is, generally speaking, slightly if at all benefited by operation." 235.

IX.

General Elements of Pathology. By WHITLOCK NICHOLL, M.D. M.R.I. A.F.I. of the Royal College of Physicians, London; Member of the Medical and Chirurgical Society; Corresponding Member of the Association of King's and Queen's College of Physicians, Dublin. Octavo, pp. 233. Callow, London, 1820.

DR. PARRY has justly observed in the preface to his Elements of Pathology and Therapeutics, "As the great and

"This remedy results from considering the relative condition of the tarsus and skin at the base of the eyelid, in the two diseases, entropeon and ectropeon. In the first the integument is elongated, in the second the tarsus.

As

ultimate end of pathology is its application to practice, it is by this criterion alone that the value of any pathological system ought to be estimated." The study of pathology has certainly gained more general attention from the junior branches of the profession, since the publication of Dr. Parry's Elements, and not before it was most seriously called for. Will it be credited, that only eight years ago, the views which are now generally entertained, and which dissection, in a great measure has proved, of the relations existing between the vascular and nervous systems in health and disease, should have been ridiculed and laughed at? That in so short a period of time so great a revolution should have been effected in our pathological views, as to bring the majority of the thinking part of the profession to the same conclusions in regard to practice, is truly astonishing.-And in stating this, we have only to refer to the writings of the ancients, and attend to the relations of dissections handed down to us, and wonder why, for so long a period, incorrect opinions should have been entertained. When perusing the works of Morgagni, we cannot but be surprised that the appearances upon dissection which are so faithfully and minutely detailed, should not have called forth some new light in the treatment of diseases, more particularly in those of a spasmodic nature. The bounden duty of every medical man is to think for himself, and to endeavour by indefatigable perseverance, in scrutinizing the wonderful mechanism of our frames, to arrive at just conclusions of what constitutes the difference between health and disease. Palmam qui meriut ferat. It is to Dr. James Sanders, we believe, that we are particularly indebted for many of the pathological opinions at present entertained. Dr. S. did not allow the observations of the ancients to pass unnoticed, nor would he receive bare assertions for facts. During life, every symptom of disease was noted down, and after death, every part of the human body was carefully examined :for instance, in convulsive diseases the muscles spasmodically affected were noted down; and after death, they, together with their nerves and blood-vessels, were carefully dissected, and compared with others in a sound state. These observations were more particularly made upon the human subject, both by himself and pupils. Dr. Moulson had an

in the first case by removing a portion of the redundant skin we turn out the inverted tarsus, so in the latter by removing a portion of the elongated tarsus, we turn in the everted. It will be understood that it is only relatively that we speak of the elongation of the tarsus. It is everted, and strictured in the state of eversion by the skin."

opportunity of putting his views to the test, in five rabid dogs, independently of the numerous experiments he made upon horses and dogs in a healthy state. Dr. M. asserts that his practice and experiments are completely in unison. The observations on spasmodic and convulsive diseases by Dr. Moulson, which appeared in the third volume of the Monthly Series of this Journal, were the first which attracted particular notice, and novel as they then were supposed to be, was sufficiently proved by a contemporary editor demurring inserting them in his journal, because they were likely to induce a discussion: how far that may be we cannot say, but being well known to be Dr. Sander's opinions, they were not liked.

Too much praise cannot be bestowed upon those individuals, who with their best endeavours, strive to add their mite to our circulating knowledge. It gives us pleasure to see men of talent, such as Dr. Nicholl, advancing just views of the human economy, and thereby establishing correct therapeutical knowledge. The plain and unostentatious manner in which these elements are ushered before the public, clearly realizes the motto affixed to the title page :"Hoc opusculum ut in publicum ederem, non fecit profecto inanis, ac popularis auræ captandæ cupiditas, sed eo adductus sum, ut multis meorum æqualium hinc inde errantibus viam monstrarem, et aliquantulum munirem." This book is divided into sections, the first of which contains an outline of the human economy. "The organized body" is described "as consisting of a system of supply and waste; of a nervous system; of various assemblages of contractile fibres, which are called muscles; and of a fundamental structure, which consists of bones, of cartilages, and of the varieties of membrane." The system of supply and waste, consists of the vascular system, and of its two appendages, namely, the alimentary canal, and the pulmonary air-cavities. The various functions of the vascular and nervous systems, together with the respiratory and digestive organs, are here cursorily treated of, but under cach distinct head, each division of the subject is regularly analyzed. These elements are written much after the manner of Dr. Parry's, but are not so fully treated of, as proofs and illustrations of what is advanced are not brought forward as in Dr. P.'s work. These are very necessary to the student, in order to command his attention, and give to him a taste of examining for himself. Simple ipse dixits do not pass so currently as in former times, and therefore it is necessary to bring conviction to the mind before any assertion can be received as true. In saying this, we by no means call in question the

truth of Dr. Nicholl's views of the subject he treats of, for great praise is due to him for bringing together in so concise a form, a view of the functions of the human body.

According to Dr. N. no one part of the body is independent of another, and that it is by an equilibrium being sustained between the various functions of the human body that health is constituted. "For the functions of the vascular system would cease, if those of the nervous and muscular systems were suspended. The functions of the nervous systems would cease, if the offices of the vascular system were suspended. And the muscular system would be inert, were it not for the influence which it derives from the vascular and nervous systems." P. 14. In other words, in the chapter of general inferences, "there is a certain state of the several parts of the economy; a certain state of the several functions of each part; a certain mutual relation, and balance, and exchange of influence, between all these several parts and functions; which constitute that condition of living man to which the term health is applied." "The term disease embraces every state of the economy, which is different from that condition which is termed health.”

The pathological views contained in this work are what are generally entertained by the profession at large. The manner in which they are drawn up alone differs-thus in describing congestion of the arteries of the brain: "should the tonicity of the cerebral arteries be so far lessened, that those vessels become over-distended with blood: or if, in consequence of the receipt of an increased quantity of blood by those vessels, an increased flow should take place from the cerebral exhalants; in either of these cases, inordinate compression of the cerebral substance may arise." P. 29. Arterial turgescence is but very rarely to be met with upon dissection; we in general only find the veins of the brain turgid. If an aneurism of the internal carotid arteries on the side of the sella turcica be alluded to, it is an exceedingly rare occurrence: the internal carotid arteries are very apt, in persons of an advanced age, to become ossified, and the same morbid change may be traced along their branches -in such cases, the deposit of ossific matter in the arteries would be a sufficient proviso against those vessels becoming over-distended with blood.

Dr. Nicholl seems to agree in opinion with those who believe that the generation of heat in the human body is dependent upon the combined action of the nervous and vascular systems. That it is so, there can be no doubt; yet, at the same time, we must not lose sight of the circulation on the brain and nerves. Two or three hemiplegic cases

have occurred in our practice since Mr. Earl's cases and observations were published in the seventh volume of the Medico-Chirurgical Transactions, wherein the temperature of the paralyzed side considerably exceeded that of the unaffected side: the reverse generally being the case. How such was to be accounted for, it would be worse than useless to theorize about, as dissection, if any thing, could alone have afforded any clue to it.

"In many cases," Dr. N. says, "the act of retching is called forth by what I have termed revived sensation, as when the mention, or the sight of a substance, which has formely excited vomiting, causes the act of retching to be reproduced, although there be no impression repeated on the stomach. Whatever produces great disgust, as the mention, or the sight, of a disagreeable substance which may never have been admitted into the stomach, may bring on retching." P. 109.

An illustration or two of the above would add a zest to the study of the subject, and engage more the attention of the junior members of the profession than the bare citation of the circumstance. We can mention one, out of many instances, where a medical friend, for some months after recovery from a fever, was thrown into a violent fit of retching at the mention of the word antimony: had he been in the midst of his dinner, or enjoying himself with his friends, an allusion to antimony would instantly induce retching. The manner in which muscular contraction is produced is thus stated :

"The contraction of a muscle is produced by the transmission of nervous power to its fibres from cerebral substance, as from cranial, or spinal brain; this transmission is accomplished through the medium of nerves, along which we conceive the nervous power to be conveyed, in a direction from their cerebral to their anti-cerebral extremities. Whatever, then, causes the transmission of this power to muscles, will produce contractions of their fibres; and by whatever nerve this power is conveyed, contraction will take place in all those muscular fibres among which the anti-cerebral terminations of that nerve are distributed." P. 124.

We perfectly coincide with Dr. N. in his general pathological views; yet we cannot but repeat our regret at his not having advanced proofs and illustrations so as to have enlivened the subject. The dependence existing between the vascular and nervous systems may be proved in a variety of ways; and also, of muscular contraction being dependent upon the combined action of the vascular and nervous systems. Examples are continually occurring in the surgical department, in proof of what is advanced :-in the operation of popliteal aneurism, both the temperature and muscular Vol. II. No. 5.

Τ