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the difficulty there appears to be in the absorption of the adventitious earthy parts.

"When the inflammation goes on to the formation of matter, suppuration is indicated by symptoms similar to the formation of matter in soft parts, although there is somewhat more difficulty in deciding upon it, as no external marks at first present themselves; but rigours, with an increased sense of weight of the diseased part, and a remission of the severity of the pain, will usually lead to a just diagnosis. But in abscess, the part of the bone affected soon becomes swollen, its periosteum becomes thickened, caries supervenes, and the matter is discharged by a process similar to the discharge of matter from soft parts; but the progress and reparation are slower."

Accidental Ossification is thus described:

"There are certain of the soft structures of the body, which are liable to accidental or unnatural depositions of bony matter, as the dura mater, pericardium, and even muscle. It generally happens, however, that the proportions of the animal and earthy parts are not the same as in the original bone. These deposits being sometimes as hard and polished as the enamel of the teeth, at other times soft and cretaceous, resembling moistened chalk. The former are most common in serous membranes, whilst the latter are not unfrequently met with in abscess of the lungs, in the uterus and ovaria."

Application of the Trephine." If there be a wound communicating with the bones of the skull, accompanied with fracture and depression, in such cases, although no untoward symptoms have as yet arisen, we are recommended immediately to trephine; but of the propriety of this step there seems to me some doubt. We should rather be led to judge of the necessity of the immediate application of the trephine by the degree of depression, and by the part of the skull injured; for as the quantity of diploe differs so much in different skulls, there is no evidence of the brain being injured until symptoms supervene; and I would therefore recommend that the patient should be most narrowly watched, and that the trephine should not be applied until symptoms point out the necessity. When compression arises from the formation of matter, which, as already mentioned, does not come on until some time after the accident, the surgeon is placed under the greatest difficulty to discover the precise seat of the injury, as it is not always at the part where the blow was inflicted. To ascertain this essential point, the scalp must be most carefully examined, and if a puffy appearance be found opposite to the part where the matter is situated, an incision is to be made through the part of the skull exposed, which will be found denuded, or at any rate its pericranium easily separable from it; the bone itself will be of an ash-colour, without any tendency to bleed. These circumstances will prove that you are justified in removing this portion of bone. I have seen my colleague, Mr. Key, under these circumstances, perform this operation with perfect success as far as relates to the evacuation of the matter, although the patient did not subsequently recover, in consequence of the extent of injury the brain had sustained."

The principal fractures are illustrated by lithographs.

THE PHYSIOLOGY OF INFLAMMATION AND THE HEALING PROCESS. By Benjamin Travers, F.R.S. 1844. 8vo. pp. 226.

TREATISE ON INFLAMMATION AS A PROCESS OF ANORMAL NUTRITION. By John Hughes Bennett, M.D., F.R.S.E. 1844. Octavo, pp. 80.

FROM the period of the researches of Hunter to the present day, the subject of inflammation has proved one of surpassing and abiding interest. That this should be the case can excite no surprise; for, while a correct theory of its production may amend or confirm many of the views of the physiologist, and clear up some of the numerous obscurities which beset the path of the pathological inquirer, the mere practical man, in deriving hence a knowledge of the true principles upon which its treatment should be based, becomes the possessor of by far the most powerful instrument for the relief of disease. It is true that the crude and exaggerated notions, according to which inflammation forms the basis and point of departure of all diseases, have done infinite mischief, not only by the ultra-depletory practices they encouraged during the day of their prevalence, but also by reason of opposite errors which have resulted from the re-action consequent upon their explosion; and yet the justice of Mr. Lawrence's statement, that few indeed are the diseases in which the inflammation of some organ is not a cause, effect, or concomitant circumstance, must, we think, be at ence acknowledged. Indeed, the very generality of the prevalence of inflammation, and the great variety of conditions under which it manifests itself in the economy, have led celebrated observers, as Andral, Magendie, &c., to repudiate the term as vague and inexpressive. Certain phenomena, however ill-expressed, are well-understood by this word, that are by no means represented in Andral's term hyperemia, which labours under the disadvantage also of expressing a state which may exist independently of inflammation. 66 Hence," says Drs. Alison and Bennett," it has been the object of British pathologists to give precision to the old term inflammation, rather than change it for another, perhaps more unsatisfactory." Investigations into the intimate structure of the various organs, and the anormal processes they are the subjects of, have been wonderfully forwarded in our times by means of the microscope, whose improved construction necessarily preceded any great advances in this direction. "It is remarkable, and at the same time conclusive of the soundness of Mr. Hunter's doctrines of inflammation," says Mr. Travers, "that the additions thus made to the illustration of this great subject of his researches, though materially affecting details, so far from invalidating, tend strongly to confirm the general principles which he has laid down, to carry out the views which he entertained, and to embody those which he left in shadow."

We have to apologize to our readers for having left Mr. Travers's book so long unnoticed; the productions of his pen have been few but valuable, and anything original in this age of book making compilation is indeed acceptable. The present work is not likely to diminish his reputation, giving, as it does, an able description of the various phenomena attendant

upon

inflammation, and a succinct account of the progress of the healing process observed under the microscope in many experiments. Dr. Bennett, in the pamphlet, the title of which we have also placed above, endeavours, and we think with great success, to point out in a more distinct manner than has hitherto been done, what are the essential phenomena of inflammation, and to show the connexion of these with a perversion of nutrition, explicable by the cell theory. To present a complete analysis of works themselves so condensed would not be a very profitable labour, and we shall therefore notice only in each such portions as present most novelty and interest.

The Capillaries.-Upon these Dr. Bennett offers some interesting observations. Blood-vessels examined by the naked eye seem to consist of but three coats; but Henle has shown that in fact they are distinctly divisible into six layers, of each of which the intimate structure differs in arrangement. These coats diminish in number as the vessels approach the periphery, but even very minute ones continue to possess three of them. At length, in the true capillary or intermediate vessel, only one exists, consisting of a firm, transparent membrane, without the smallest opening, and thickly studded with variously-shaped nuclei.

"In the numerous demonstrations I have made of these structures, I was struck with the resemblance which the capillary vessel presented to the fibres of nonvoluntary muscles. I subsequently discovered that, if the mucous coat be carefully removed from a portion of intestine, (say in the rabbit,) and the remaining structure rendered transparent by acetic acid, a longitudinal and transverse coat, with longitudinal and transverse lines, formed by elongated nuclei. are apparent as in the coats of arteries. In short, the two structures in some demonstrations were so similar, that I should have had some difficulty in recognising one from the other, were the microscopic examinations alone attended to. Repeated examination of this fact, as well as numerous observations on the organic muscular fibre, have led me to the conclusion, that no structural difference exists between what is called the muscular coat in the intestines, and that constituting the third and fourth layers in arteries, as previously described. Neither does any essential difference exist between these last and the ultimate texture of the capillaries. If this opinion be correct, then it will be natural to suppose that their function is also similar.

"The term muscular fibres, as applied to this structure, gives rise to very erroneous notions. Persons naturally conceive that some relation exists between voluntary and non-voluntary muscle, whereas, no two elements can be more distinct. The fibres seen running longitudinally and transversely, as on the intestinal coats, the fibres of the bladder, stomach, &c., have no analogy whatever with the striated fasciculi of voluntary muscle. Their mode of contraction, also, is perfectly unknown. The fact, however, viz. that the structure hitherto called non-voluntary muscle is the same in the contractile coat of the muscles and intestines, the middle coat of the arteries and in the capillaries, leaves very little doubt in my mind, that the vital contractility possessed by all these tissues is the same, and dependent upon the same causes.' "" 26.

Of the Functions of the capillaries it is observed

"The more specific office of the capillaries and intermediate vessels is evidently, 1st, so to subdivide the blood that it may reach every portion of the organism, and enable its corpuscles to perform their function; 2d, to offer a membrane by means of which exosmosis and endosmosis may be effected.

What the connection may be between the vital properties of those vessels and the exudation of blood-plasma it is difficult to determine. We may remark. however, that the delicate homogenous structure they present, admirably fits them for acting as fine filters subjected to vital laws, retaining the solid corpuscules and granules, and allowing only the fluid portions to trausude. How far the circulation is influenced by the contractility of the capillaries is still a matter of inquiry.

"From these considerations, the importance of the capillaries, as connected with nutrition, will become apparent. So long as they only permit that amount of blood-plasma to exude which is capable of supplying the quantity dissipated by waste, so long they may be considered as performing their functions in a normal manner. But when circumstances induce such a change in them that the amount of exudation is materially diminished or increased, then an anormal state is occasioned. If the amount be diminished, atrophy will be produced, if it be increased, that peculiar pathological change, hitherto denominated inflammation, is constituted."

Direct effects of Stimuli and of Wounds.-Mr. Travers presents the following brief summary of appearances observed, and which were alike produced, whether the experiments were performed by the application of any stimulant substance, as salt or ammonia, or the infliction of a wound.

"The first effect of a drop of stimulant fluid, or of a wound upon a transparent web (frog's foot), as seen in the field of a powerful microscope, is to arrest the circulation at the part. Around the point of absolute stagnation the column of blood oscillates, and the particles are seen to separate and congregate in small irregular masses, presenting varieties of shape, some being perfect ellipses, others spherical. The vessels are dilated, and in proportion their fulness is increased and their pink colour heightened. Still more remote from the stagnant centre, increased activity of circulation prevails. The point of stagnation-the very slow circulation in the part immediately surrounding it, the current still oscillating in parts and beyond this the more rapid and vigorous circulation, are manifested for several days. The contrasted appearance of one portion of the web stationary, and another in brisk circulation, is striking."

In a period varying from ten to twelve days, this condition of congestion of the parts disappeared, and the circulation became established over the whole web.

Theory of Inflammation.-Where the stasis of the circulation, however, is produced by a more considerable irritation, the distended vessels relieve themselves, either by rupture and consequent hæmorrhage, the effusion of serum, or the exudation of the liquor sanguinis or plastic element of the blood. Dr. Bennett attributes these early phenomena of the inflammatory state to a vital contractility and consequent relaxation of the capillaries, analogous to, if not identical with, spasm and paralysis of muscle; and to an increased attraction between the corpuscules of the blood and the surrounding parenchyma, by virtue of which these approach from their natural position in the centre to the sides of the vessels.

He also regards the anormal exudation of the liquor sanguinis or bloodplasma as the essential phenomenon of inflammation. That effusion frequently occurs independently of the inflammatory process, is familiarly known; for example, in various forms of dropsy of the limbs. It may

also precede or accompany the true inflammatory exudation, but is quite distinct in its nature. "The effusion of serum under compression," observes Mr. Travers, "oedema, or lesion, devoid of blood particles, as in sprain, is to be distinguished from the effusion of liquor sanguinis in wound and inflammation:-the former being the albumineo-aqueous and saline compound, forming the serum of the blood; the latter, the fibrinous consti. tuent separated either from the effused liquor sanguinis, or within the inflamed vessels; the last alone being susceptible of permanent organization. Dr. Bennett thus, too, endeavours to account for the distinction.

"Why it should happen that venous congestions are never accompanied by an exudation of blood-plasma, whilst arterial congestions are, is a point that no one yet has endeavoured to explain. To me it appears certain that all inflammatory effusions occur through the capillary or intermediate vessels, and not in such vessels as may properly be called arteries or veins. The vein is a very compound structure, and when distended to the utmost only permits the more fluid portions of the blood to pass through. The capillary vessel, on the other hand, is a most simple structure and exceedingly delicate, so that when distended we may readily understand that it admits not only the serum but the more inspissated liquor sanguinis to pass through also. But it is scarcely possible to suppose that the me chanical difference in the tenuity of the filtrating membrane should constitute the only distinction. It is impossible to reconcile the phenomena without having recourse to some active vital power of attraction between the blood and parenchyma, as formerly explained; a power which, operating in the one case and not in the other, causes different constituents of the blood to become exuded. We are compelled, in all our considerations of the subject, to go back to this explanation, as to an ultimate fact." 39.

The exudation of blood-plasma is then the only positive proof we have of the existence of inflammation; and the want of a recognition of it as the essential phenomenon has surrounded the descriptions of the disease with vagueness and inconsistencies. Thus, even in Mr. Travers's present work, he enumerates heat, redness, pain, and swelling, as the local symptoms of inflammation, any one or more of which may yet be absent; and when present, serve in part rather to characterize the preceding congestion than the inflammation itself; while he treats of the exudation merely as one of the effects or results of inflammatory action. A confusion of ideas upon the subject has led also Dr. Macartney to state that the presence of inflammation is opposed to the healing of wounds, while Sir A. Cooper maintains that this is impossible in its absence.

Constitutional Symptoms or Effects of Inflammation on the System. We transcribe some of Mr. Travers's excellent observations upon this subject.

"When the local inflammation is in such organs or of such amount as to rouse the system, this partakes (?) of the inflammation. The blood undergoes changes in passing through inflamed vessels which affect its natural properties. The brain and nerves become preternaturally excited by it, the functions of the entire digestive apparatus and of respiration are hurried and imperfectly performed; consequently the excretions are altered in quantity and in quality, and the vitiation of the blood increases from the suspension of the relief derived from its habitual and required issues; for what the blood in its circulation parts with, is as essential to its health as what it gains. Meantime the inflamed part undergoes

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