suppuration, but sufficient to produce induration, or, as it is more commonly called, HEPATIZATION. In 15 years' observation at St. George's Hospital, Dr. C. has only met with three fatal cases of pure phlegmonous abscess of the lungs, out of nearly 600 dissections of pulmonary disease. Three or four cases have been cured in that peOne favourable and one fatal case of this rare disease are then related. Of these we shall take some short notice.

riod.

Case 1. A labourer, aged 34 years, was admitted on the 5th January, 1825, much emaciated, complaining of difficulty of breathing; heavy pain in the left side; troublesome cough; copious expectoration of a brownish colour and very fetid smell, with some admixture of blood. He cannot lie on either side, on account of his cough. He has no regular hectic fever, but occasional shiverings, flushings, and perspiration. The pulse was 130, and small; skin cool; tongue of a livid colour, smooth, and clean; bowels open, &c. He stated that some months previously, he had received a blow on his left side, ever since which he had had more or less pain in that part; but within the last month this pain had greatly increased, accompanied by the symptoms above detailed. He was put on milk diet, and to take saline draughts with acacia, digitalis, and vinum ipecacuanha. Extract of colocynth and lettuce were given at night. Under this treatment, the patient daily improved till the 21st January, when the mistura ferri comp. was given, with a pint of porter daily. By the 14th March, he had gained flesh--the cough was diminished; and all the functions nearly natural. He was now made an out-patient, and ultimately recovered.

While

Although there is very little proof in this case of pulmonary abscess, since all the above-mentioned phenomena often result from bronchitis; yet we have no inclination to question the accuracy of Dr. Chambers' diagnosis. Dr. C. speaks most respectfully of Laennec in the beginning of the paper; and yet not the slightest attention is paid to auscultation or percussion in the examination of the patient! The fetid nature of the expectoration seems to form the sole basis of the doctor's discrimination. Well! Be it so. Dr. Chambers is not the only one who scorns any thoracic examination of the mechanical kind. this paper was before us, a man presented himself with a sheaf of prescriptions from one of the very first physicians (in point of extent of practice) in this metropolis. They were almost all composed of guaiacum and the old farrago of medicines prescribed for rheumatism, which was pronounced to be the disease under which the poor man(a gardener at Pentonville) had laboured for two years-always getting worse. On stripping the thorax, the upper portion of the right side, under the clavicle, was bulged out, and the most common examination shewed an aneurismal state of the ascending aorta and innominata. The pulse at the right wrist, was annihilated by the pressure of the aneurism on the subclavian. There was pain all along that arm, and across the chest, with inability to lie down in bed. And this was the rheumatism for which he was, for more than a year, treated by a physician who

has received, at least, five hundred thousand pounds from the public; and whose fiat is fate! Now this same physician is a very good physician; and, had he been present when the man's thorax was bared, he would have detected the disease in one moment. But even this trouble will not be taken by any medical man, above the age of 45, in this metropolis; although the above age is that at which fools are said to be converted into physicians, without any study.

Case 2. J. Hayward, ætat. 45, admitted October 4th, 1826, much emaciated, complaining of difficult breathing, cough, expectoration of foul and highly offensive purulent matter, of a dark yellow colour, partly tinged with blood. Breath is very fetid; pain in both sides of the chest, aggravated by any attempt to breathe deeply. Lies on his back; pulse 110, small and sharp; skin hot; tongue red at the sides, and furred in the middle; bowels open; appetite indifferent. Says he was attacked eleven weeks ago, with symptoms of inflammation of the lungs, for which he was not bled. The symptoms subsided in a fortnight, and were followed by the above-mentioned expectoration, and the other symptoms already noticed. He was placed on fever diet; to lose eight ounces of blood; and to take saline medicines with antimony, &c. The blood was inflamed; pain relieved; pulse lowered to 80; and the cough rendered less troublesome. Rep. medicament. In this state he remained till the 8th of October, when a bowel complaint came on, which was relieved by small doses of Dover's powder; but, on the 14th, his strength seemed, all at once, to fail him, and wine and brandy were allowed. He died the next day.

Dissection. The lower lobe of the left lung was found to be hepatized posteriorly; in the right side were a few ounces of opake serum. The apex of the left lung was enveloped in thickened pleura, and when this lung was cut into, it disclosed two cavities, each the size of a small orange; one in the upper, one in the middle lobe. The first cavity was lined with a loose sloughy substance, and filled with dark yellow fetid matter. The second was empty, the pus having been expectorated through the bronchial tubes, which were seen communicating with it. This cavity also was lined with a very thin membrane of a dark colour. The lung in the neighbourhood of the abscess, was rather condensed, but there was no appearance of tuberculation in either of the lungs.

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These two cases are considered by this very intelligent physician, as fair specimens of the disease under discussion. In the absence of precise information of the early symptoms (which can seldom be obtained from the uneducated classes,) Dr. C. thinks that the phenomena above described will be generally decisive of its real character." The appearance and smell of the expectoration totally different from those which belong to the sputa of tuberculous consumption." "In apostema of the lungs, the expectoration is of a brownish or greenish-yellow colour, and has an intense odour of putrefaction." "This colour was correctly compared, in my hearing, by a physician of considerable experience, particularly in diseases of the lun to that of rotten eggs;

an appearance in the expectoration, which, he said, he had long been accustomed to consider, when joined with fetor, as holding out a more favourable prospect of recovery to the patient, than that of ordinary purulent matter." This appearance is doubtless owing to the admixture of pus and blood with the particles of sloughy lung which form the parietes of the abscess. In those cases which terminate favourably, the dark colour of the expectoration disappears, and its fetor gradually decreases. The difference between this kind of sputa and the white or yellow, and inodorous expectoration of tubercular phthisis, is obvious enough. The next distinctive mark is the absence of hectic fever, after the abscess is fairly opened into the air tubes. There is also a want of that clear complexion and bright colour so generally attendant on real phthisis. On the contrary, there is a dull muddy sallowness. At the same time, Dr Chambers does not mean to say that these distinctions are clearly marked and infallible in all cases. There are exceptions here as well as in other diseases. Still the foregoing distinctions may serve to guide our prognosis.

In respect to the treatment, it will be seen. by the cases above detailed, that the separation of the sphacelated part of the lung, of which the parietes of the abscess are formed, is often accompanied, even in an advanced period of the complaint, with attacks of inflammatory action, requiring depletory measures. As soon, however, as this stage has passed over, the patient will often be found to thrive and fatten under the administration of chalybeates and other tonics, with nutritious diet-means which may be resorted to, even when the cough is troublesome, and the expectoration purulent and bloody.

Before closing his paper, Dr. Chambers very modestly ventures on a little bit of theory, to which, indeed, the best constructed minds are occasionally disposed. It is on the long disputed mode of formation in tubercles of the lungs. His impression is, that the original nuclei of these tubercles are formed in the mucous glands or follicles of the membrane lining the extreme air-cells and air-tubes-" these glands or foilicles being choked up with their own coagulated secretions, and, often coalescing with each other, become. as I conceive, the source of irritation, and subsequent ulceration, of the surrounding tissue." This theory is probably as good as any other that has yet been formed, not even excepting the hydatid theory of Dr. Baron. But we should be glad to see how Dr. Chambers will apply this doctrine to tuberculation of the serous membranes, and of the medullary or cortical substance of the brain-states of disease almost as common as tubercles in the mucous follicles of the lungs. Dr. C. promises to return to this subject, and we throw out the above hint merely to afford his ingenuity an additional field for the acquisition of laurels. "We conquer difficulties by daring to oppose them." There are few physicians possessed of more excellent judgment than Dr. Chambers; but medical theory is an enterprize of such a hazardous and arduous nature, that we tremble for our bravest and wisest friends, when we see them fairly embarked in it. To none do we wish more complete success than to Dr. Chambers.-Med. and Phys. Journal.

8. HOSPITAL REPORT FROM THE VAL DE GRACE. BY M. BROUSSAIS. [For November, December, January, February, and March. 1826-7.] M. Broussais's doctrine has lately been assailed, through the medium of the practice which it inculcates. It has been said that the success of the Professor in the VAL DE GRACE has not been equal to that of other physicians entertaining different views from the founder of the new doctrine. It is hardly fair to judge of a doctrine or practice by comparative success in different hospitals-or even in the same hospital at different times, or under different physicians. A man may have a run of bad or good luck in the reception of patients, as well as in throwing dice or playing at cards-and this may give a very pleasing or gloomy cast to the numerical results at the end of the quarter or half year. M. Broussais has caused his aide-major (M. Cassimir Broussais) to present a semestral report from the Val de GRACE, appealing, for the authenticity and truth of the report, to the records of the institution, and the evidence of those who walked the

hospital at the time. Nothing can be more unexceptionable than this plan. with the reservations above alluded to-and we shall now proceed to give an analysis of this report.

It is asserted by the reporter, that when M. Broussais takes his turn of duty in the VAL DE GRACE, he desires that the worst cases may be sent to his wards. This is magnanimous-more so than wise, perhaps. In the five months above specified, there were entered 438 patients, of whom 20 died, or about one in twenty-two. This certainly is not a very great mortality, considering that an epidemic raged during part of the time, before which, the mortality was only one in thirty fiveand that 86 cases remained in hospital from the preceding semestre. M. Cassimir asserts, (and there can be no reason to disbelieve him) that many were sent to the VAL DE GRACE, in the above period, merely to die. This happens in all hospitals, and must ever prevent a fair estimate of medical treatment. We do not deem it necessary to give the whole table of maladies. Suffice it to say, that there were three aneurisms of the heart-76 cases of acute bronchitis-8 of colitis7 of duodenitis-3 of encephalitis-60 of acute gastro enteritis-15 of hypertrophy of the heart-35 of intermittent irritation (ague)4 of laryngitis-79 of acute pleuritis-29 of other acute inflammations of the thorax.

1. Pleuritis. Of the 79 cases of acute pleuritis, only one proved fatal, and that from purulent effusion into the cavities of the pleura and pericardium. This inflammation had commenced five days before the patient's entrance into hospital. In all these cases of pleuritis, the disease was combated by the application of leeches to the pained part. In 29 cases venesection preceded leeching. In general. a single application of 15, 20, or 30 leeches was sufficient. In three cases only was it necessary to have recourse a third time to leeching. Emollient cataplasms always succeeded the leeches, and diluent mucilaginous drink was plentifully given. In six cases it was necessary,

to blister after leeching, and, in four of these, the measure was successful. It was remarkable that, in most of these cases, the pulse fell immediately the blisters had risen. In two cases, however, they were applied too soon, and the râle muqueux and fever obliged M. Broussais to have recourse to more leeches. In the great majority of cases, bronchitis preceded the pleurisy, which induced M. Broussais to suppose that the inflammation of the mucous membrane, having arrived at the ultimate ramifications of the bronchia, passed on to the serous membrane, and then produced the corresponding phenomena. When the bronchitis persisted, which was generally the case, leeches were applied under the clavicles, at the top of the sternum, and wherever the râle muqueux could be heard.

These thoracic inflammations were far from being uncomplicated. In 20 cases, at least, there was considerable gastric irritation, which yielded, however, to leeching the epigastrium. In two cases there was evident duodenitis-and, in three instances, the inflammation spread to the other intestines, producing diarrhoea-and to the brain, giving rise to delirium. These cases are detailed at length, but we pass them over.

There were very few instances of relapse in these pleuritic cases. The medium period of residence in hospital was 23 days. It is remarked, however, that M. Broussais never permits a soldier to leave the hospital till he is so completely recovered as to enter immediately on his military duties.

one.

2. Acute Bronchitis. Of 76 cases of this disease, M. Broussais lost General and local bleeding, especially the latter, was principally trusted to the leeches being applied to the places mentioned above. There were seldom more than 20 leeches applied at first-and afterwards a small number were applied wherever the râle could be distinctly heard. Blisters were employed in only seven cases. In about 20 cases of bronchitis the inflammation spread to the mucous membrane of the stomach, requiring leeches to the epigastrium. It was surprising to see how soon the detraction of blood from this quarter calmed the irritation of the whole system and reduced the fever. In many of these cases the appetite came on quickly after the leeches, and it was difficult to restrain the patients from committing excesses. More relapses, however, were occasioned by exposure to atmospherical vicissitudes than by imprudence in diet. The mean term of residence in hospital for this inflammation was 14 days. One case proved fatal. The young man had had cough during the whole of the winter, and was affected with acute bronchitis fifteen days before he was sent to the hospital He was then spitting up large quantities of purulent matter, and was unable to lie down in bed. He died on the fifth day after he was received into hospital. The trachea and bronchia were found filled with muco-purulent matters, and the lining membrane intensely reddened. The parenchyma of the lungs was, in some places, hepatized. The mucous membrane of the stomach, and also of the jejunum, was inflamed. The patient, therefore, evidently died of suffocation from the effusion into the air-passages.