colour of skin, condition of the pupils, of the respiration, and other points of importance to be observed, are all thought sufficiently described, as Dr. Scharlau observes in the seven words: "Christian Kämpfer, nineteen years old, weaver's apprentice." There is not the slightest indication whatever of the causes of the disease, unless the imagination seize upon the term, "weaver's apprentice," and survey Ch. Kämpfer wearily passing the shuttle to and fro in some dark damp cellar in Berlin, with typhus raging around, himself insufficiently fed, pale, languid, and anemious, previous to an attack of abdominal typhus. Again, the tongue is briefly described as being coated with a whitish fur: a description giving the reader no idea whatever of the true state of the tongue without again drawing on his imagination. Was it a thick coat, or a thin one? Was the tongue dotted with red points? Was it flat, or round, or jagged at the edges, or tremulous? On all these points Schönlein is silent.

In fact, the symptoms do not warrant the diagnosis at all as a case of abdominal typhus, taking even his own description of that disease, as given in his Pathology. Abdominal tenderness is one of his pathognomonic symptoms, yet here we have it expressly stated that there was no tenderness on pressure, and although we think that abdominal tenderness is in no respect pathognomonic, because we know, from our own experience, that there may be extensive ulceration of the intestinal mucous membrane, without any tenderness whatever, yet we would leave this unstated, and judge Schönlein by his own views. There are a few symptoms referrible to the head, the tongue is whitish, the pulse accelerated in the evening (as it is in all cases,) and scarcely accelerated in the morning, a little feverish heat of the skin, and it is pronounced a case of abdominal typhus.

We will say nothing about the treatment; our readers are well able to judge of that; but we do hope that the Germans will no longer blame English physicians for administering large doses of calomel. From three to four grains is three or four times a greater dose than we ordinarily administer, but when we read of scruple doses!

Of what disease did the young weaver die? Evidently not of abdominal typhus, as maintained by Schönlein, but of subacute arachnitis, consequent on either hydatid or tubercular disease of the brain. We say either hydatid or tubercular disease, because it is impossible to place any reliance on the description of the post-mortem appearances. The tubercles the size of beans in the cerebellum may possibly have been masses of echinococci or acephalocyst hydatids: similar smaller masses may have existed in the cerebrum, lungs, &c., and have been easily overlooked by so careless an observer as Schönlein here shows himself to be. Surely something might have been said respecting the state of the pulmonary mucous membrane of the heart and large vessels, stomach, liver, spleen; of all, or each of which there is not the slightest mention.

Turning from a case of acute to one of chronic disease, we select case 17. This was an individual suffering from a series of symptoms of very common occurrence. In the month of November, 1840, a weaver, aged 34 years, complains that for the last nine months he has experienced pain in the chest, when going up stairs or running, dry cough, palpitation, shortness of breath, and lassitude. He has an appetite, but after eating he feels a sensation of fulness and dragging in the epigastrium. He says he works in a spacious room, and has always been healthy, with the exception,

that about nine years ago, he had the itch for three weeks, which was cured by sulphur ointment; but subsequently he occasionally felt little pimples between the fingers when warm in bed, but which were never permanent. On a stethoscopic examination of the heart, signs of dilatation of the left ventricle, with hypertrophy, and valvular disease, were observed. The left lobe of the liver was found to be tumid, and the feet oedematous, particularly in the evening. The skin and bowels acted regularly, but the urine was scanty, and high-coloured. The case being diagnosed as one of cardiac disease, with partial enlargement of the liver and incipient dropsy, Schönlein next inquires, "what are the causes of this disease?" and the answer is, "we find in the anamnesis no other disease than the itch." Thereupon we have a dissertation on the nature of metapsoral diseases, of the existence of which Schönlein declares he has no doubt whatever. It is impossible to quarrel with a man's convictions, but we must be permitted to declare as firm a conviction on our part, that in this case a three weeks' attack of itch was not the cause of the disease. It is not improbable that rare ablution of the skin, and a neglect of personal cleanliness (so frequently coincident with scabies,) by impairing the cutaneous function, has occasionally induced renal disorder, and from this fons et origo malorum, other chronic diseases have arisen, which may thus have been mistaken for the legitimate sequelæ of scabies. We have noticed this case, however, rather to show the mode in which Schönlein hastily jumps to a conclusion in accordance with some preconceived hypothesis, rather than from a scientific and logical inquiry. The whole of the evidence from which the conclusion just stated is deduced is, we assure our readers, before them. There is positively no reference whatever to the condition of the kidneys, no inquiry as to the presence of albumen in the urine, nor in fact any suspicion of it.

In coming to the conclusion, that the three weeks' attack of the itch which occurred nine years previously to the examination of the patient, was the cause of the disease, Schönlein expressly observes, how important it is in the treatment of chronic diseases to know their causes. For this reason, he states why he came to the conclusion just mentioned: 1. The appearance of little papulæ between the fingers, after an attack of scabies, is, according to his experience, characteristic of a metapsoral disease. 2. To the objection, that so great an interval elapsed between the cause and the effect as nine years, he advances that diseases of the heart are insidious, and that in this case, the disease may have existed long before the patient became conscious of it. 3. No other cause to which the cardiac affection might be attributed could be detected: the man had never suffered from any rheumatic affection. We have just indicated a cause of the disease in the disordered renal function, but how could it be possible to learn the causes of the affection without due clinical inquiry? We have not a word as to the habits of the patient; whether he was cleanly or uncleanly, intemperate or sober. We are in ignorance too of the temperament and constitution of himself or his parents. Were the latter subject to rheumatic or arthritic diseases? Was the patient himself corpulent, or "pasty," or lean? Was his hair turning grey, his teeth firm or decayed, his eye dull and muddy, complexion florid or bilious? Had he had hemorrhoidal affections? These and similar inquiries are altogether omitted; but the itch was inquired after, and successfully, for

the chances are rather in favour of a poor weaver, aged 34, catching the contagion some time or other during his 34 years of life; consequently, no other disease can be discovered, and ergo the itch nine years ago was the cause! Can there possibly be a more lame, more impotent, more ridiculously absurd conclusion than this? After five days' treatment, Schönlein at last discovers that his patient had had an attack of rheumatic ophthalmia, previously to the cardiac affection, that his occupation would predispose to hepatic disease, and that he had in fact, on closer inquiry, no aversion to spirituous liquors.

Our readers will ask how the patient was treated. Digitalis, acetate of potass, and taraxacum, were given with the effect of improving the urinary secretion, both in quality and quantity, and with manifest relief to the patient. When it was found, that he was addicted to drinking, the moxa was ordered to be applied about half an inch from the left nipple, and the wound to be kept open as an issue.

We here close our criticism. We need not sum up. The candidate for fame has had a fair reviewal; the facts are before the large and intelligent jury constituted by the readers of the British and Foreign Medical Review. Their decision will, we believe, accord with our own,

The print and paper of the large volume on Pathology are wretched; but we believe Professor Schönlein is not responsible for the publication of this volume, or of that containing his clinical Lectures, as we understand they are given to the public without his imprimatur.

ART. III.

On Diseases of the Liver. By GEORGE BUDD, M.D. F.R.S. Professor of Medicine in King's College, London, and Fellow of Caius' College, Cambridge.-London, 1845. 8vo. pp. 402.

DR. BUDD commences his volume with observing that "there are no other diseases of such frequent occurrence, which it is so difficult to discriminate, and for the treatment of which, the medical practitioner has so few trustworthy guides," as diseases of the liver. (p. 1.) Surely diseases of the cerebro-spinal system must be excepted from this remark, of which the diagnosis is as difficult, the pathology as obscure, as any of those of the liver, and which, in a therapeutical point of view, are even more intractable and more perplexing. Still we admit that there is considerable truth in Dr. Budd's observation, and no one of any practical experience can fail to be sensible of the frequent unsatisfactory results of even the most carefully-considered treatment of hepatic diseases.

ANATOMY OF THE LIVER. We presume our readers to be acquainted with all the important points connected with the anatomy and physiology of the liver. Of these the author gives a sufficiently distinct sketch, for which we must refer to the work itself. We may here observe that a few points of curiosity, rather than of practical interest or importance, are still unsettled, in regard to the structure of the liver. Thus it is still sub lite, whether the blood of the hepatic artery passes into the extreme branches of the portal vein, before entering the hepatic veins. Mr. Kiernan believes that it does. It is not obvious that any change in therapeutics would be rendered necessary by the absolute decision of the question one way or another. Müller, among others, supposed that what has been so long

called the capsule of Glisson, was prolonged, as a sheath of cellular membrane, investing each lobule and separating it from contiguous lobules. Mr. Bowman, whose opinion is paramount with Dr. Budd, thinks he has discovered that there is no areolar tissue between the lobules. These lobules consist of masses of nucleated cells, which, as well as the ducts (which it seems also to secrete,) are the elaboratories of the bile. Among doubtful points, is the exact mode of connexion of the hepatic ducts with these nucleated cells.

As the nucleated cells, along with the capillaries in the meshes of which the cells lie, compose the lobules, and as the lobules compose the substance of the liver, with the exception of the several systems of vessels, it follows that nucleated cells and capillary vessels compose nearly the whole of the organ.

Mr. Kiernan is of opinion that no arteries enter the lobules.

In the nucleated cells Mr. Bowman thinks he has discovered globules of oil or fat, and believes that it is in the increase of the size and number of these globules, that the fatty degeneration of the liver of phthisical and other patients consists. It is probable that these lobules must be, in some way, disintegrated or dissolved before they pass from the nucleated cells into the hepatic ducts.

THE BILE.-Composition and properties. With the appearance and properties of the bile, we must presume our readers to be acquainted. The degree of fluidity and its colour are extremely various, so that it is, perhaps, impossible to determine exactly what should be considered normal as regards either of these qualities. The darkness of tinge and the degree of dilution of bile depend on the length of time it has remained in the hepatic ducts, or in the gall-bladder. Consequently, several hours after the completion of digestion, and more especially after protracted abstinence from food, it is peculiarly dark and inspissated. At other times, its colour varies from yellow to a deep brown-black; but there is generally a shade of green mixed with the yellow, more especially in the bile of the gall-bladder. It feels oily and slightly adhesive, tastes bitter, but has little or no smell. It is readily raised, by agitation, into froth or foam. Schultz stated the specific gravity of ox bile at 1026 to 1030: and we are not aware that there is any authentic determination as to the gravity of human bile. The same physiologist had stated bile to be alkaline; and that one ounce of it, when tolerably inspissated, required one drachm of acetic acid for its neutralization; but Bouisson and Dr. Kemp have more recently determined that when normal and fresh, bile is neutral. When concentrated, it contains grayish-white or greenish particles, and some of the prism-like cells which bestud the mucous membrane of the gall-bladder. To these may be added, cholesterine scales and globules of oil. The former, Dr. Budd seems to think, seldom or never appear except as a consequence of disease of the gall-bladder. The following, according to Berzelius, is the constitution of cystic ox bile:

Phosphate of soda, of lime, and traces of a substance insoluble in alcohol

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Cholesterine, dissolved and in small quantity, appears also to exist in bile, but does not, unless in cystic disease, appear in the form of scales.

Sources and uses of the bile. The views entertained of the sources and uses of the bile have, of late years, undergone very important alterations. At one time, this fluid was regarded as almost wholly excrementitious; another supposed principal use was to promote the peristaltic action of the intestines. The present belief is, that the bile, far from being to a great extent excrementitious, is almost entirely re-crementitious; and though it seems probable that the evacuatory movement of the intestines is in part owing to this "natural purgative," as Dr. Budd terms it (p. 30,) yet doubtless that effect is less due to any isolated action of the bile, than to the normal stimulus of the fecal mass, as a whole.

The bile, in common with the excretions of the lungs and kidney, is probably, to a great extent, derived from the decomposition of the tissues of the body, but part of it also is, no doubt, educed from non-nitrogenized articles of food. Carbon is the substance chiefly eliminated by the liver, in like manner as it, along with hydrogen, is the chief constituent of the pulmonary excretion. But an important distinction obtains between the two cases. While the carbon of the lungs is united to oxygen, and excreted in a non-combustible state, the carbon of the liver is non-oxygenized, is still combustible, and is intended, not for excretion, but absorption. But the fact that the two organs secrete carbon, gives them a complementary relation, of which we avail ourselves in therapeutics.

The quantity of bile secreted by a man, daily, has been variously estimated, from a very few ounces to 24 ounces. Before the important and large recrementitious uses of the fluid were ascertained, and when the comparatively small quantity evacuated in the fæces was believed to form the whole amount, the bile secreted in the twenty-four hours was computed at from 3 to 5 or 7 ounces. Yet even Haller, who guessed that the bile served other purdoses than excrementition, estimated the quantity at from 17 to 24 ounces; and this calculation Schültz and Liebig adopt. There appear to us reasons (which we shall not here detail) for believing that from 11 to 14 ounces is the average quantity of the healthy adult secretion of bile, in the space of four-and-twenty hours.

To return now to the consideration of the uses of the bile. These seem to be various. First, then, the liver is, in part, an excrementory organ. The resin and the colouring matter are excrementitious matters. Secondly, the liver is a depuratory organ. The abdominal circulation returns through it, and, as Dr. Budd justly observes, (p. 28,) "the blood which has come from the stomach and intestines must necessarily be charged with many impurities besides those derived from the mere decay of the tissues. Along the extensive mucous tract with which everything we eat and drink is brought in contact, absorption is constantly going on, and various matters must therefore enter the portal vessels, not fit by their nature to form blood, or to serve any other purpose in the body. Many of these substances are removed from the blood in its passage through the liver." The part which the bile plays in digestion is more obscure and uncertain. Dr. Budd agrees with those who think that the share which the liver has in assimilation, has been over-rated. According to the most recent and approved views of physiologists and chemists, the solution of our food is