Obituary.

PETER STEWART, M.D.

DR. PETER STEWART died on 10th May, 1883, after a long and painful illness. He was in his 70th year. By his death, Glasgow has lost one of her best known and most highly respected medical practitioners; a man of skill and worth; a physician in good repute among his professional brethren, and beloved by his patients.

He was born in Greenock on 16th November, 1813. His early boyhood was spent in the Highlands, and he received his education in the Grammar School of Paisley. Subsequently he studied medicine in the University of Glasgow, where he took the degree of M.D. in 1845. After obtaining his degree, Dr. Stewart repaired to Paris, where he pursued his medical studies for a period of two years. On returning to this country he commenced practice in Glasgow; but his health gave way, and he went as "assistant to England, where horse exercise and new surroundings restored his vigour. Once more returning to Glasgow, Dr. Stewart resumed his professional labours on the South Side, and here he succeeded in establishing an extensive practice. He worked hard, sparing no personal exertion or trouble in the discharge of his duty to his patients, a duty which was to him truly sacred.

In a profession which is acknowledged to be self-sacrificing, he was distinguished by a conscientious devotion to the interests of those under his care. In 1868 he removed to the north side of the river, taking up residence at Albany Place, Sauchiehall Street, which has since continued to be his home. His old patients on the South Side still clung eagerly to him, and, for their convenience, he kept consulting rooms at Bridge Street, where he regularly attended for consultation. great personal inconvenience and loss he faithfully attended his old and, in many cases, poor patients; they insisted on having him, and he would not break the old bond.

At

Dr. Stewart now entered on a phase of his life in which he certainly overtaxed his energies. The first distinct threatening of a breakdown was in 1876, when he contracted a severe pleurodynia by lifting a helpless patient into bed. He still continued to work hard-no call was neglected, his poor patients still having the strongest claim on his sympathies

and his services. Advancing years did not damp his ardour, and in spite of the remonstrances of his friends, he continued to meet all engagements.

About three years ago a decided failure in health took place. There occurred "faintings," together with a marked change of manner and indications of commencing laryngeal mischief. For the latter disorder resort was made to more genial climates, and eminent authorities were consulted. But the evil slowly and steadily progressed. Again returned to his residence in Glasgow, Dr. Stewart was confined to bed, and the suspicion of malignant disease of the larynx was confirmed.

He bore his sufferings with great fortitude. Even in his misery his mind was busy in devising means for the good of others. When suffocation seemed imminent, tracheotomy was performed, the result being decided relief.

For nearly three weeks his condition remained practically unchanged (with the exception of increasing mental aberration), but then rapid sinking took place, and he died quietly at half-past one o'clock on the morning of 10th May. Postmortem examination of the larynx revealed complete disorganisation, due to malignant disease.

During his illness he had the comfort and solace of the devoted and unwearied attention of his wife, daughter, and son-in-law; and after his return to Glasgow, old friends, lay and medical, flocked to his side, all eager to render any service in their power.

Dr. Stewart was elected a Fellow of the Faculty of Physicians and Surgeons in 1858, and in 1854-5, 1878-9, he was President of the Glasgow Southern Medical Society.

He was for some time one of the Managers of the Glasgow Royal Infirmary, in which capacity he exerted his influence for the better recognition of the services of the medical staff.

He was very fond of travel, and in company with his wife. and daughter, visited most of the countries of Europe, as well as various parts of America, Australia, and New Zealand.

In all the relations of life he was honourable and exemplary, and although not ostentatiously religious, he was a sincere Christian.

He has now gone to rest, but his memory will live in many grateful hearts.

No. 6.

2 G

Vol. XIX.

REVIEWS.

A Manual of Pathology. By JOSEPH COATS, M.D., with Three Hundred and Thirty-nine Illustrations. London: Longmans, Green & Co. 1883.

THE work before us forms a very handsome volume of over 900 pages, and, in its general appearance, it reflects great credit on printer and publisher. It has been printed in Glasgow at the University Press, and both in the letterpress and the numerous illustrations the highest excellence has been attained. The bulk of the illustrations are original, and the engraving has been done in Glasgow by Mr. Stephen Miller. To these also, nothing but praise can be awarded, and the merit is the greater, as microscopic illustrations are a severe test of the engraver's art, because their objects are outside his experience. In this regard the draughtsman shares at least equally with the engraver in the merits of the production.

It will not be expected, considering the relations of the author to this Journal, that the contents of the book will receive the same kind of criticism here as may be looked for in other Journals. It may be useful to our readers, however, to give some kind of summary indication of the scope and contents of the book.

The title of the work is A Manual of Pathology, and as the name is a somewhat general one, it will be found that the text does not confine itself to the mere details of Pathological Anatomy, but that the whole phenomena are brought under review, and an attempt is made to construct a complete picture of each disease. In the words of the Preface, "It will be acknowledged that the whole aim of pathological anatomy is to elucidate the actual vital processes of disease, and it has been felt by the author in lecturing on Pathology that the subject gains in interest and intelligibility when the etiology, anatomy and general pathology are all taken into account in forming a general conception of each morbid condition." No doubt this plan has caused an increase in the size of the volume, while it has perhaps made it less systematically complete than if pathological anatomy alone had been taken up; but it has probably rendered it much more readable, and more accessible to the general members of the profession.

The general body of the work is divided into two parts, the first including General Diseases; and the second Diseases of the Special Organs and Systems.

In the FIRST PART, the AFFECTIONS OF THE CIRCULATION AND OF THE BLOOD are first taken up. After a preliminary discussion of the arrangements concerned in the regulation of the distribution of the blood, the subjects of Hyperæmia and Anæmia are entered upon. GENERAL HYPERÆMIA is defined as "the condition in which the total quantity of blood in the body is in excess," and is regarded as equivalent to PLETHORA. In connection with this subject that of TRANSFUSION is incidentally introduced, as by this operation a condition of ARTIFICIAL PLETHORA may be induced in animals. By reference to. experiments, however, it is shown that any excess of blood introduced into the system is disposed of more or less rapidly. The subject is concluded in the following words, Having now seen that, by transfusion, an artificial plethora may be induced in animals, we may be prepared to admit the possibility of its existence in the human subject. It will presumably occur when the blood-forming organs are unduly active, and will manifest itself in an over-fulness of the capillaries and veins throughout the body, but especially in those of the abdominal viscera. Persons of vigorous digestion and active habits have often a florid appearance, as if the vessels, of the skin at least, were overfilled. The excess of blood is used, to a considerable extent, in the formation of fat, and we know that the subcutaneous adipose tissue and that of the abdomen are often much increased. But the observations mentioned above show that any excess of blood is disposed of with considerable rapidity, and we may infer that in the human subject a moderate tendency to plethora will be overcome. It will develop when the formation of blood keeps in advance of its destruction by the arrangements provided for that purpose."

Following on the discussion of Hyperæmia and Anæmia, the important subjects of THROMBOSIS and EMBOLISM are taken up. In regard to the latter, the different results of obstruction in arteries with or without anastomosing connections, are detailed, and the pathology of the hæmorrhagic infarction described, chiefly on the basis of Cohnheim's observations. This division concludes with a reference to embolism by oil and by air. In regard to the former the following observations are made.

"Oil or fluid fat not unfrequently gets into the blood-vessels. It does so where, by fracture of a bone or injury to the subcutaneous adipose tissue, the fat cells in the bone marrow, or adipose tissue are broken up so as to set free the oil, and, at the same time, the vessels and especially the veins are laid open so as to absorb the oil. Oil also occurs in the blood in

cases of diabetes, and, as in Fig. 10, may produce embolism. The oil is carried, of course, to the right heart, and on into the lungs where it sticks in the capillaries and the smallest arteries. If the capillaries are obstructed at considerable intervals then no evil results, the anastomosis being so free that no serious disturbance occurs, and the oil itself does not irritate. But, if a considerable number of small arteries near each other be obstructed or even a large number of capillaries, we may have a condition resembling the hæmorrhagic infarction. It has been found on experiment that abundant fat embolisms in the ear of a rabbit, by obstructing numerous capillaries, may lead to necrosis. In some cases the oil may, to some extent, pass through the lung capillaries, and it is found mostly in the Malpighian tufts of the kidney, one or two loops being here and there filled. There are a few rare cases on record in which extensive embolism has occurred in the smallest vessels of the brain, conjunctiva, skin, muscles, heart, intestines, liver, and kidneys, and has apparently been the cause of death."

The subjects of HÆMORRHAGE, OEDEMA and DROPSY, LEUKÆMIA, MELANÆMIA, URÆMIA, and DIABETES MELLITUS complete the section on Diseases of the circulation of the blood.

The next great subject is the important one of INFLAMMATION, and here the observations of Lister receive more consideration than they have sometimes obtained. The principal phenomena of inflammation are described under three heads-namely, the state of the vessels, the inflammatory exudation, and the changes in the tissues, including new formation. In connection with the last mentioned, the granulating wound is taken as the type of the inflammatory new formation. We may here quote the observations made in regard to the action of the tissues on dead tissue or foreign bodies

"Of considerable importance is the NEW-FORMATION of tissue AROUND FOREIGN BODIES. If a foreign body be introduced among the living tissues, if not very virulent in its own nature, it sets up a mild chronic inflammation, with the result of producing a vascular rudimentary tissue like granulations. If the foreign body be permeable by this tissue then the granulations will grow into it, and, as it were, devour it, replacing it first by their own rudimentary tissue, which afterwards gives place to connective tissue. As this connective tissue is comparatively small in bulk, and tends to contract more and more, the result of the whole process is an absorption of the foreign substance and the gradual disappearance of all trace both of it and of the tissue which has replaced it. But