the hurtful agents. 2. The organs on which the hurtful agents act. 3. The individuality of the subjects in which diseases are developed. Hurtful agents are divided into two classes, accordingly as they are of internal and external origin. The external may be, a, Alimentary, and act on the chylopoietic viscera. 6, Atmospheric, and act on the lungs and skin. c, Cosmic, operating on the nervous system. d, Chemical, which appear sometimes as injurious agents, sometimes as curative agents: poisons comprised in the last division may be arranged in two classes, the one being represented by arsenic, the other by prussic acid. e, Mechanical agents: these differ according to their mode of operation and the organ on which they act. Stone in the bladder or gall-ducts, and monstrosities belong to this head. Hurtful agencies of internal origin may consist, a, of increased or diminished power, physical or psychical, as paralysis of the muscles, loss of memory, &c.: b, in suppressed or increased secretion, as of the saliva, urine, &c. c, in a peculiar derangement of the soul, with which insensibility to other impressions is connected. The emotions belong to this class, which may be divided into the depressing and exciting.

The second circumstance determining the forms of disease is the organ on which the hurtful agent acts. All organs have a receptivity for hurtful agents, a predisposition to disease, which is greater or less as the organ is, or is not, in a state of evolution. The evolution may be either permanent or periodic; the former may be subdivided into the true period of evolution, or youth; middle age; and the period of involution, or old age. The physiological characters of these successive stages of development and decline are known, as well as their pathological relations, or (in Schönlein phrase) the receptivity of the organs during each stage.

The third circumstance determining the forms of disease, is the individuality of the subject on which the hurtful agencies operate. The points to be noticed specially under this head, are, the temperament, sex, and idiosyncracy.

Contagion. Schönlein breaks off abruptly from the true sequence of his ideas to the subjects of contagion and spontaneous generation. We, however, follow the master mediciner in his own way. There are hurtful agencies which originate in the organism, and excite disease, and which are communicable to another organism, and excite similar disease. They are developed from spontaneous diseases, either in solitary or many individuals. The contagions developed in solitary individuals have their origin in the so-called acrid humours (Schärfe, acrimonia.) Acrimony of the humours is understood to mean a peculiar derangement of the quality of the animal chemistry: as, for example, a peculiar condition of the blood, saliva, &c. Two particulars are to be noted regarding contagion: 1, the basis, or materies; 2, the ætherial or active principle. The materies may be in the form of a fluid, a vapour, or a gas. The nature of the active principle is unknown, but Schönlein thinks it allied to free electricity; because firstly, it is perceptible to the taste and smell, as is also galvanic action (!); secondly, because certain electrical bodies are the best media of contagion, as glass, resin, silk (!).

Symptoms of disease. Every hurtful agent acts only on its own proper organs: as, for example, the atmosphere on the lungs : consequently it excites only a local disease, and not a general affection in the widest sense. The egoistic principle, however, reacts against the injurious agent, and a

series of phenomena are developed, which were not manifest in the healthy organism. These phenomena are the symptoms of disease. There is, however, no true signum pathognomicum: dread of water, for example, is present in the more intense forms of typhus as well as of hydrophobia; but there are symptomata symptomatum. Symptoms are subject-objective, when they are expressed by the patient; object-subjective, when noted by the observer. They also may be symptoms of the cause of disease arising directly from the operation of the injurious agent; or symptoms of the disease, and originate in the reaction of the egoistic principle. If the hurtful agent is not intense, or if the organ be unimportant, the symptoms are local; if the contrary, the whole organism is implicated. According to Schönlein, this sympathy of the organism with the local affection constitutes fever.

Fever. Fever is rather the shadow of the disease than the disease itself. The mode of reaction of the egoistic principle is threefold. 1. It is sufficiently powerful to remove at once the injurious agent, and maintain the integrity of the system: this is erethismus. 2. The reaction is greater, and the struggle to remove the injurious agent more prolonged: this is synocha. 3. The reaction is too weak: this is torpor. If, for example, food acts injuriously on the alimentary canal, reaction of the egoistic principle takes place, vomiting follows, and the injurious agent is removed. Should the phenomena not cease here, but vomiting continue, and sensibility and irritability be developed, the reaction is too strong, and takes on the character of synocha ; but if vomiting do not supervene, the reaction is too weak, and it assumes the torpid form. Just then as reaction is threefold, every topical affection and every form of fever is threefold. Erethism is the centre, synocha and torpor the two poles. The stage of convalescence from either of the poles must be through the erethistic. If it go beyond this, paralysis (lähmung) takes place: the organs affected cease to perform their functions. This paralysis or lameness may affect the nervous system, when it induces paralysis properly so called; or it may affect the vascular system, and gangrene be developed. In every disease, whether local or general, the nervous and vascular systems are active. The affection of the former is shown by the subjective symptom pain: of the latter, by the objective symptoms redness, heat, and swelling.

Inflammation has a threefold form: firstly, there is erethistic inflammation. In this form neither the venous nor the arterial system takes part, but the capillary system only. In extremely vascular structures, the capillary network is enlarged, the capacity increased, the organ reddened, the warmth exalted. In less vascular structures, new capillaries are formed. Secondly, there is synochal, or sthenic inflammation, in which all the preceding phenomena are more marked. The arteries themselves, as well as the capillaries, are implicated. The capillaries become arteries, and the arteries are dilated and their tunics thickened. Thirdly, there is the torpid or asthenic inflammation. In this form, venosity, or venousness, is the distinguishing characteristic. The veins are dilated and become varicose, and the capillaries change into veins, as in chronic ophthalmia, and the chronic inflammation of the mucous membrane in which polypi form. Inflammations may, however, be divided into arterial and venous; the former corresponding to the sthenic form, the latter to the asthenic.

Course of disease. Under this head Schönlein states the doctrines usually propounded by systematic writers as to the exacerbations and remissions of disease, tracing them, however, to telluric and lunar influences, albeit without clear and definite views as to the modus operandi of these influences. If we understand Schönlein aright, they are in fact more typical than real. Man is a microcosm, and just as the barometer and magnetic needle have their maxima and minima, so the pulse has a maximum and minimum, &c.

Doctrine of critical terminations. Schönlein adopts this to its full extent. The crisis may be general, and operate through the kidneys. When this crisis happens, a burning sensation is felt in the genital organs, and a feeling of dragging in the lumbar region and along the urethra experienced. With these there are joined a frequent desire to pass urine, a dry, rough skin, thirst, and sometimes an intermitting pulse. When the urine is critical, it must be secreted in due quantity; in the beginning, it exhibits a cloudy appearance near the surface (nubecula), and afterwards in the middle (suspensum), and lastly, a precipitate, or sediment, which is easily commingled, is reddish, and is somewhat raised in the middle. At the same time, the skin is moist and perspirable, or a copious sweat actually breaks out. When the crisis takes place through the skin, it is reddened, warm, and soft; the pulse becomes soft and small, the urine scanty; the perspiration must be general and clammy (kleberig); the skin must be warm afterwards, and the patient feel sensibly relieved. Sometimes there are other marks of a cutaneous crisis, as exanthems, and which must be considered as local crises. Of this kind are the vesicles which appear on the abdomen in typhus, and on the thorax and about the mouth and nostrils in peripneumonia.

Critical hemorrhages appear only in synochal diseases. They break out in various parts, but with reference to the organ affected and the peculiarities of the patient. Critical hemorrhages from the nose are most frequent in the young, and when the affected organ is situate above the diaphragm, particularly if the disease be synochal. The premonitory signs are redness and tension of the face, red watery eyes, spectral flashes, singing noises in the ears, itching of the nose, weight in the temples and headache, particularly of the back of the head. A discharge of a serous fluid often precedes the hemorrhage; the carotids beat violently, and the pulse is dicrotic. When the organ affected is below the diaphragm, the bleeding takes place from the nostril of that side in which the organ is situate: for example, in splenitis it is from the left nostril, in hepatitis from the right (?). Critical hemorrhages from the uterus are most usual in synochal diseases of organs situate above the diaphragm; those of the rectum occur only in adults in whom the seat of the disease is below the diaphragm.

All crises, except those operating through the skin and kidneys, are local, according to Schönlein's views; a proposition not only opposed to sound physiology, but to experience. A diarrhoea is often the indicant and outlet of a general critical effort, and so also is a bronchorrhoea.

The terminations of disease may be: 1. In complete restoration to health. 2, In imperfect restoration. The terminations of inflammation are: a. The formation of pus, which Schönlein considers to be the secretion from a newly-formed mucous membrane, constituted by nature for the

relief of the organism. b. In hydropical effusion. This is an electric process (!) modified by natural laws. It takes place where serous membranes are in contact, and are in polaric tension with reference to each other. Their natural function to excrete an aqueous vapour is exalted in disease, and water itself is poured out, the action being analogous to that between the earth and the atmosphere, in which the vapours or clouds are precipitated in the form of rain or dew. c. Effusion of plastic lymph. d. Gangrene. e. Arthritis; the serous tissues becoming the seat of earthy deposits.

Metastasis. A disease on disappearing may be immediately replaced by another. This process takes place according to three principal laws. 1. In tissues which having a fundamental similarity of structures are related to each other, as the muscles and the muscular fibres of the heart, bronchi, intestines, or the peritoneum and the synovial membranes. 2. In organs constituting a system, as the stomach, liver, and spleen in the chylopoietic system. 3. In organs which are in direct polarity, as the liver, which being rather the positive or oxygen pole is opposed to the spleen, the hydrogen, or negative pole.

General Therapeutics. We do not pretend, be it understood by our readers, to give anything like a detailed view of the system of Schönlein. Eleven hundred pages of closely-printed German are not so easily reduced in our crucible. The foregoing paragraphs must therefore be considered as exhibiting the general nature of his pathological views. In the following, we intend in like manner to give a general view of his therapeutics.

The first step in therapeutics is the examination of the patient, which comprises two points of notice, the object and the method. The object includes the form and character of the disease. The form depends on the three circumstances already stated; the character depends on the mode in which the egoistic principle reacts against the hurtful agents, and may be erethistic, synochal, or torpid. If the disease be considered as a struggle between the egoistic and planetary principles, it may be, 1, vital-2, morbid.

The examination of a patient may be either genetic or analytical. The genetic traces the history of the patient, notes the sex, age, temperament, and other personal characteristics; the mode of origin of the disease, the cause as assigned by the patient, the previous state of health, &c. These are followed by a detailed inquiry into the condition as to structure and function of every organ, and system of organs.

The indications of treatment are founded on the anamnesis, the diagnosis, the prognosis, and the idea of the disease. From these arise two classes of indications, namely, indications of life, and indications of disease; the object of the former being to maintain the integrity of the organs, of the latter to remove the disease from the organism. The latter is subdivided into the indicatio causalis; indicatio curatoria, and indicatio urgens or palliativa.

The indications of treatment vary as the character of the disease varies. If it be erethistic, the reaction against the hurtful agent is usually not greater than is necessary to remove it from the system; here the expectant method is alone necessary. When the disease has the synochal type, the reaction is greater than necessary, and must be checked. This may be done by two methods: the one the antiphlogistic, applicable to the vas

dar system; the other the sedative, applicable to the nervous system. Bloodletting is the principal of the indications in the former method, narcotics are the chief of the sedative remedies. It is interesting to observe the transition from the pure bitters to the pure narcotics; simply by the former containing less carbon. Quassia in large doses will act as a narcotic. The first class of narcotics, represented by opium and the papaveraceæ, acts on the cerebral system; the second acts primarily on the ganglionic system, and only secondarily on the cerebral. Belladonna, hyoscyamus, lactuca, &c., belong to it, and are best given in powder or extract. The third class acts on the spinal system, the communicating link between the cerebral and ganglionic. Prussic acid is at the head of this class, which comprises all vegetables containing the acid, as the amygdala amara, prunus lauro-cerasus, &c. A fourth class comprises those vegetables which contain an active principle, as cicuta, nicotiana, &c., and which act on the nervous system in general. To the soothing class of remedies belong also all those in which carbon predominates over hydrogen, comprising also the mucilaginous and fatty compounds, as aloes.

The diseases characterized by torpor, require to be treated by the roborant and excitant method. The excitants are: 1. Ammonia, and its preparations, which act directly on the vascular system: containing an excess of hydrogen, it is the counterpart of the narcotics, in which carbon predominates. 2. Those which act on the cerebral system are compounds of hydrogen and include animal secretions, as musk, ambergris, the poison of serpents, alcohol, &c. Among the excitants of the spinal cord are nux vomica, rhus toxicodendron, but especially arsenic and its compounds. The excitants of the ganglionic system are the fetid gums, anemone pulsatilla, certain metals as copper and silver; and "animal magnetism, a neutral product of two indifferent things, of which the one acts as the brain, the other as the heart, while here the soul is requisite in action on the one hand, and the will on the other." A long list of excitants of the chylopoietic, cutaneous, serous, muscular, and sexual systems, with minor subdivisions, is given, all of which, with a more detailed exposition of the doctrine of crises we shall pass over-to notice,

The natural system of Schönlein. We know disease by its phenomena or symptoms only; these therefore must constitute the basis of a natural system of classification. They indicate either derangement of function or change of structure. In disease of the heart, for example, the pulse may be smaller, or intermittent, the heart changed as regards firmness, thickness, colour, &c. In inflammation of the eye, there is redness, a structural change; impaired vision, a functional change. In forming a natural system, as well as either diagnosis, or prognosis, it is essential that the true value of symptoms be noted, and the accidental distinguished from the essential. Schönlein thinks that great errors have been made by combining distinctive and non-essential characters. Changes in the form and appearance of organs are more important than a change of colour. The chemical composition of the urinary secretion is more important than its quantity in a given time. Every phenomenon or symptom of disease has an absolute and a relative value. Delirium is a symptom of absolute value; but there may be delirium from cerebral disease, and the delirium of intoxication, in which cases its value is relative. A knowledge of the