BIBLIOGRAPHICAL NOTICES.
La Syphilisation etudiee comme methode curative et comme moyen
prophylactique des maladies vSneriennes, par C. Sperino,
Agregd a la Faculty M^dico-Chirurgicale de Turin etc. Paris,
1853.
Syphilization studied as a Curative and Prophylactic measure
in Venereal Diseases, etc.
No experiments have excited more interest amongst professional
men, than those recently performed in Europe, to test the value
of syphilization.
Without discussing the question whether syphilis was known
to the ancients or not, we may state that an accurate knowledge
of venereal diseases cannot be traced back further than John
Hunter. His experiments, indeed, repeated and modified by
Ricord, have led to the adoption of a system which has served
as a basis for the diagnosis and treatment of all venereal diseases.
The most important points Ricord established were :
1.	That chancre and blennorhagia are two distinct affections.
2.	That only indurated chancres are followed by constitutional
syphilis.
3.	That only indurated chancres require a constitutional
treatment.
4.	That secondary affections are not inoculable.
5.	That syphilis cannot be transmitted to animals.
Experiments performed by M. Auzias-Turenne, to test the
truth of this last proposition, led him to the observation of the
curious fact, that each successive chancre inoculated is smaller
than its predecessor. Several inoculations performed on a me-
dical student seemed to be followed by the same result; and these
gave rise to the doctrine of “ syphilization,” or the inoculation
of syphilitic virus as a prophylactic measure against syphilis, and
as a therapeutical agent for its cure. “ If,” says M. Auzias-Tu-
renne, “ each successive chancre is smaller than its predecessor,
must we not ultimately arrive at a point in which the constitution
is so impregnated with syphilitic virus as to be incapable of re-
ceiving new chancres ?” An individual who has arrived at this
point of syphilitic “saturation” he called syphilized ; the pro-
cess itself, syphilitic vaccination or syphilization.
Had the means of cure hitherto possessed, been found adequate
to the treatment of all syphilitic diseases, syphilization would
have attracted, at best, but a passing attention. But every one
knows how many old syphilitic affections prove refractory under
the usual method of treatment, and, therefore, every new agent
proposed is always eagerly tried. The hope, too, of acquiring
celebrity by discovering a new remedy for syphilis, excited many
to enter upon the field of experimentation, whilst others were in-
duced by the controversy to repeat Ricord’s experiments on
inoculation, with the view of testing their value. Thus originated
the experiments on inoculation and the discussions on syphiliza-
tion, which have so recently been agitating the profession abroad.
Amongst those who, without entering into the subject of syphi-
lization, confined their experiments to inoculation, we may men-
tion Prof. Waller, of Prague,* M. Vidal de Cassis,f M. Maiso-
neuve ;£ amongst those who made use of syphilization on patients,
M. Auzias Turenne, M. Diday, of Lyons, and M. Sperino, of
Turin. This latter observer, indeed, has recently published a
complete work on the subject, containing not only all that up to
the time had been written on syphilization, but also a report of
ninety-six cases, in which this method was employed with great
success. M. Sperino’s work occupies over 800 pages, chiefly
made up of the narration of cases. Of its contents, therefore,
we can ffive but the merest sketch.
* Ueber den contagioesen character der secundaeren syphilis; Prague,
1851.
1 Traite des Maladies Veneriennes; Paris, 1853,
tTraite pratique des Maladies Veneriennes. Par G. Maisoneuve, et Mon-
tonier; Paris, 1853.
Matter bearing on this subject will further be found in the Report of the
Paris Commissions to the Prefect of Police. (Report a M. le Prefet de Police
sur la question de savoir si M. le Dr. Auzias-Turenne peut etre autorise a
appliquer la Syphilization a l’infirmerie de la Prison St. Lazars ? par M. M-
Melier, Ricord, Denis, Conneau et Marchal de Calais), and in Ricord’s letter
on Syphilis (Leltres sur la Syphilis; Paris, 1852.)
The author states in his preface, that his experiments were
performed with the greatest care and precision, and the results
given with the loyalty of a man of honor. We are bound to be-
lieve him, although some of his facts seem almost incredible.
He commences his work with a consideration of the value of ino-
culation, as applied to venereal diseases. Inoculation, he says,
has been recently practised for seven different purposes :
1.	To prove the existence of a syphilitic virus.
2.	To distinguish true from false syphilitic diseases.
3.	To establish the differences which exist between primary
and secondary syphilitic affections.
4.	To prove the efficacy of certain therapeutical agents called
preservatives.
5.	To ascertain if syphilitic diseases could be communicated
to animals.
6.	As a therapeutical measure against syphilis.
7.	As a prophylactic agent against this disease.
We pass over the first five propositions (mentioning only that
M. Sperino denies the difference between syphilis and blennor-
hagia) and revert to propositions six and seven, or the value he
attaches to inoculation as a prophylactic and therapeutical
agent. Speaking of its efficacy he says in his Report to the
Academy at Turin :
“ All recent chancres existing in women who were subjected to this
treatment disappeared spontaneously a few days after the appearance of
the artificial chancres. Indurated syphilitic ulcerations which had existed
for two or four years, and had resisted a treatment by mercury, by iodide
of potassium, or even by the acid nitrate of mercury, or the Vienna paste,
cicatrized rapidly after a few inoculations with pus taken from the recent
chancres of other women. Large and deeply rooted virulent ulcerations
cicatrised a short time after inoculation, and, what is more astonishing,
I saw in a woman who had a chancre and two inguinal buboes, in both
of which, distinct fluctuation could be felt, the pus absorbed and
disappear in a few days after the inoculation on the abdomen of several
artificial chancres. Mucous tubercles existing at the same time with the
chancres, disappeared under the powerful action of inoculated virus. A
large ulcer situated on the posterior portion of the pharynx, healed up
after the 5th inoculation. In one woman herpiginous ulcers having their
seat on the right leg cicatrized rapidly, whilst, at the same time, the
pains in the frontal bone disappeared after the development of the arti-
ficial chancres.
The harmlessness and the advantage of syphilitic inoculation, became
at last so well known to the patients, that they themselves, forgetting
their reluctance to the first trials, begged me to syphilise them, as their
companions had been thus cured.”
The method of producing the artificial chancres consists in
puncturing the skin with a lancet, on which venereal matter has
been collected. The place best suited is the thigh or abdomen.
The chancres thus produced do not differ in appearance from
ordinary chancres, except that, after repeated inoculations, they
become smaller. The number of inoculations necessary to pro-
duce syphilization we do not find mentioned; in some cases five,
in others sixty or more seem to have been necessary. The cica-
trices of these artificial chancres are very superficial, except
when they become gangrenous. During the treatment by syphili-
zation, baths and purgatives were freely employed ; the cicatrices
were dressed with simple cerate.
Now follows the report of ninety-six cases cured by syphiliza-
tion. To attempt a full analysis of these cases would carry us
far beyond the limits assigned to a review; we therefore select
but one of the most striking and interesting. (Observation I,
p. 116.)
“ Julia P., age 22, of a sanguine-lymphatic temperament and excel-
lent constitution, entered the hospital on the 29th of January, 1851.—
She has on her body several chancres, viz., an urethral chancre, evidently
indurated, a chancre in the fossa navicularis in size about 12 millimetres
and also indurated, and two large and irregular chancres situated on the
sides of the urethra. It is the second syphilitic infection under which
she labors. In 1845 she had an indurated chancre on the vulva, accom-
panied with a bubo in the groin, and mucous tubercles around the arms
and vulva. She was then treated with 40 mercurial inunctions. Con-
stantly returning vegetations obliged her to remain in the hospital during
the whole of the year 1846. As excision and cauterization did not pre-
vent their reproduction, I subjected her to a new treatment by inunction.
But even this did not triumph over the “ vegetative” power of the
vulvo-vaginal mucous membrane. The vegetations finally yielded to
deep incisions and repeated cauterizations. Since 1845 up to this day,
she has been sent nine times to the hospital with chancres, twice compli-
cated with urethral blennorhagia, and which have always been cured by
a simple local treatment.
20z7z of January, 1851, (the day she entered the hospital,) an in-
oculation was made on her left thigh, with the pus taken from her other
chancres ; a large pustule was the result, which soon changed into a
syphilitic ulcer ; the inoculation was repeated on the 31st, and another
pustule was the result.
27<A of February.—These two artificial chancres are cicatrized. Their
size is not over eight millimetres. Three of the chancres on the vulva are
in progress of cicatrization, and have diminished already considerably—
namely, the one on the fossa navicularis and the two occupying the side
of the urethra. The one situated on the canal and the orifice of the
urethra is still virulent, as three inoculations made with the pus it se-
cretes produced three pustules.”
3d of March. Two more inoculations which were repeated on the 10th
and 13th, with the pus taken from artificial chancres of another wo-
man. We have now altogether 6 chancres produced by inoculation.
20z7z. of March. The 6 chancres produced from the three last inocu-
lations are still open; their size varies between three and six millime-
tres. They are very superficial.
The chancres on the sides of the urethra, as well as the one in the
fossa navicularis, have headed. The urethral chancre is in process of
granulation, but its induration still persists. Four more inoculations
made with the pus taken from the chancre of another woman, who had
just entered the hospital, produced no effects.
3d of April. Four more inoculations; no result.
10^7t of April. All the artificial chancres are cicatrized.
21s2 of April. Three more inoculations; three more chancres.
'23th of April. Two more inoculations; no result.
29<7t of May. Three more inoculations on abdomen, and two on the
internal surface of the nymphaa; no result.
29<A of June. Julia P. has been received into the hospital as a
nurse. The induration of the urethra has not completely disappeared.
Some fungosities still remain in the urethral canal; they are touched
from time to time with the nitrate of silver. It is thought advisable to
continue from time to time the inoculations with the view of producing
a complete syphilization. On the seventh of July two new inoculations
without result. On the twentieth of July, six new inoculations without
without result.
31si of December, 1852. Julia P. is still in the hospital as a nurse.
Her health is excellent, and she has never had the slightest symptoms
of constitutional infection. In conclusion I may remark, that in this
case I observed two indurated chancres separated from each other by
long intervals of time. The first appeared under the use of mercurials;
the second 'by syphilization. I know that this case will find many in-
credulous persons amongst the followers of Ricord, but truth should
triumph over all theories.”
This is certainly a case which, if correctly stated, would tend
to prove the efficacy of syphilization. If the second chancre was
really indurated, it ought, according to the doctrines of Ricord,
to have been followed by a constitutional syphilis at furthest
within six months after the primary affection ; whilst M. Sperino
had an opportunity of examining the patient for nearly two
years, and could observe no secondary symptons.
We might add several more of these cases, and especially those
of inveterate constitutional syphilis, in which this treatment
seems to have been employed with great success, (see pp. 248,
337, 475,) but we can here but notice the principal facts they
contain, which are mostly in direct opposition to the doctrines
of Ricord, and may be grouped together as follows:
1.	Indurated chancres are often followed by suppurating bu-
boes.
2.	Non-indurated chancres may be followed by constitutional
syphilis.
3.	Blennorhagia may give rise to constitutional syphilis.
4.	Syphilization will cure when mercurials and Iodide of Po-
tassium fails.
Out of the ninety-six cases Mr. Sperino reports, we have fifty-
three affected with primary, and forty-three with constitutional
syphilis. Of these fifty-three cases of primary syphilis, fifty
were treated by syphilization, and only in two the treatment was
unsuccessful. In one case mercurial treatment was employed at
the same time. Out of the forty-three cases of constitutional
syphilis, six were treated by syphilization and the iodide of po-
tassium ; eight by means of syphilization, iodide of potassium,
and mercury ; two died, leaving twenty-three cases cured by sy-
philization only. A careful examination of the history of the
patients affected with primary syphilis will show that a great
many had non-indurated chancres, which probably would not
have given rise to any constitutional syphilis, and which would
have recovered under a simple local treatment. In the cases of
secondary syphilis, syphilization seems to have proved singularly
efficacious, and yet the occurrence of phagedenic ulcers after
inoculations, (a circumstance which M. Sperino himself admits,)
makes even here the remedy but little less dangerous than the
disease. The time employed for this treatment varies : one
case was cured in less than a month; foui’ in one to three
months; seven, three to six months; eight, six to nine
months; eight, nine to twelve months; twenty-one, twelve to
fifteen months; whilst twenty-seven required from fifteen to sev-
enteen months. A much longer period than would tend to prove
the efficacy of syphilization by any of the ordinary treatments.
With these tables of the time employed, M. Sperino terminates
the most important part of his work. The succeeding chapters
are lengthy and tedious. They consist mainly in a continued
repetition of what has already been said, and in an abuse of
Ricord and his followers. M. Sperino toils, too, to prove that in all
cases in which syphilization did not succeed after repeated in-
oculations, it could be attributed to some fault in inoculating.
He endeavors, indeed, to show that the celebrated case of Dr.
L------* who after more than two hundred inoculations, was not
yet syphilized, could be attributed to this. We will not follow M.
Sperino in the terminal chapter of his book, which are devoted to
an analysis of all the writings on syphilization, and to a corres-
pondence between himself and several syphilographs. The most
important conclusions M. Sperino arrived at, he himself states
to be:
*Dr. L------was presented to the Academyjn Paris, in June, 1853, by
Ricord, and a report read on his case.
1.	Syphilization will cause the symptoms of primary syphilis
to disappear.
2.	Syphilization, instead of being rejected as a prophylactic
measure of primary syphilis, ought, on the contrary, to be care-
fully studied in this point of view, as we have but a small number
of individuals completely syphilized, who have contracted a new
infection.
3.	Syphilization ought, as much as possible, to be limited to
the treatment of constitutional syphilis until we are certain that
syphilization prevents the syphilized from contracting a new in-
fection.
With these general deductions the work of M. Sperino termi-
nates. As to the truth of the principles on which the doc-
trines it professes are based, we refrain from giving an opinion.
A work containing a report of cases and with the motto non
verbis, sedfactis, can only be refuted with a sufficient number of
facts demonstrating the contrary. Whether repeated inocula-
tions make it impossible for new chancres to be contracted, future
researches will show. We have now already some observations
(as the one of Dr. L-----which will tend to show the fallacy of
even this view. As a therapeutical measure we do not see, even
if the statement of the cases be correct, any advantage syphiliza-
tion possesses in efficacy or in shortness of duration over the
remedies we at present employ. As a prophylactic measure it
is highly dangerous and demoralizing, and we agree with Ricord
in his exclamation at the Academy :
“ If, after all, syphilization, as it is at present presented to us, should
be true, it ought, nevertheless, to be legally prohibited as a prophylactic
measure, and rejected as a treatment.”
Lectures on Surgical Pathology, delivered at the Royal College
of Surgeons of England. By James Paget, F. R. S., late
Professor of Anatomy and Surgery to the College, Assistant
Surgeon and Lecturer on Physiology at St. Bartholomew’s
Hospital. Philadelphia. Lindsay & Blakiston, 1854. 8vo.
pp. (with index) 699.
This book consists of a series of lectures delivered by Mr.
Paget, a few years since, in the chair of Anatomy and Surgery
in the Royal College of Surgeons of England. Some of them
have already appeared in other forms. But their popularity has
happily induced the author to amplify and revise them, and pre-
sent them in this shape to the profession.
The title of the work is hardly expressive of its scope and
value. It is, indeed, nominally restricted to the pathology of
diseases which belong, in treatment, to the domain of surgery
rather than of medicine. But it is really illustrative of the gene-
ral subject of pathology, and will be read with equal interest and
instruction by both the physician and the surgeon.
Mr. Paget has long been ranked among the foremost minds of
the profession in Great Britain. And his pursuits have perhaps
especially fitted him for such a subject as that of this book. “En-
gaged in the simultaneous practice of surgery and teaching in
physiology,”—formerly Professor of Anatomy and Surgery, and
now Lecturer on Physiology—he has certainly enjoyed particular
advantages for “ illustrating the general pathology of the princi-
pal surgical diseases, in conformity with the larger and more
exact doctrines of physiology.” These advantages have been
admirably turned to account in the masterly work which now
commends itself to the notice of the American profession.
The subjects treated in these lectures are the following:—
1. Nutrition, its nature, purpose, and conditions. 2. The con-
ditions necessary to healthy nutrition. 3. The formative pro-
cess ; Growth. 4. Hypertrophy. 5. Atrophy; Degeneration,
6.	Atrophy. 7. General considerations on Repair and Repro-
duction. 8. The Materials for the Repair of Injuries. 9 and
10. The process of the Repair of Wounds. 11. The Repair of
Fractures. 12. The Repair of Injuries in various tissues. 13. Phe-
nomena of Inflammation. 14. Products of Inflammation. 15.
Developments of Lymph. 16. Degeneration of Lymph. 17.
Changes produced by Inflammation in the affected part. 18.
Nature and Causes of Inflammation. 19. Mortification. 20.
Specific Diseases. 21. Classification of Tumours. 22. Simple or
Barren Cysts. 23. Compound or Proliferous Cysts. 24. Fatty
and Fibro-Cellular Tumours, Painful Subcutaneous Tumours. 25.
Fibrous Tumours. 26. Cartilage Recurring Fibroid and Fibro-
nucleated Tumours. 27. Cartilaginous Tumours. 28. Myeloid
and Osseous Tumours. 29. Glandular, and Vascular or Erectile
Tumours. 30. Scirrhous or Hard Cancer. 31. Medullary Cancer.
32. Epithelial Cancer. 33. Melanoid, Haematoid, Osteoid, Vil-
lous, and Colloid Cancers. 34. General Pathology of Cancer.
35. Tubercle.
We cannot attempt to follow Mr. Paget through these subjects
in detail. His views, however, on the highly interesting subjects
of the origin, progress, and products of inflammation, deserve to
be presented somewhat in extenso.
Mr. Paget thus sums up his conclusions as to the circumstan-
ces which may determine the characters of an inflammatory exu-
dation to be adhesive or suppurative.
“ To sum up, then, what may be concluded respecting the conditions
that, in the first instance, may determine the adhesive or suppurative
characters of an inflammatory exudation ; they are, ls£, The state of
the blood,—its diathesis or crasis,—the power of which is evident in
that the same material may be exuded in many inflamed parts in the
same person ; in that this material may exhibit peculiar characters cor-
respondent with those of the blood itself; and in that, in different per-
sons, an inflammation excited in the same tissue, and by the same stimu-
lus, will produce different forms of lymph, corresponding with differences
of the blood. 2 J, The seat of the inflammation, and the tissue or organ
affected ; of which the influence is shewn by cases in which, with the
condition of blood, different forms of lymph are produced in different
parts or organs. 3cZ, The severity, and acute or chronic character, of
the inflammatory process, according to which the product deviates more
or less from the character of the natural secretion or blastematous
effusion in the part.
“ The primitive character or tendency of any case of inflammation
might be represented as the resultant of three forces issuing from these
conditions.”
As regards the products of inflammatory exudation, we find
the following remarks :
“ Fibrous Tissue, as the result of the development of lymph, is found
when the exudation is interstitial in any fibrous tissue ; as in ligaments,
capsules of joints, and the like. The best examples of it are in the
laminated and nodular thickenings of the capsule of the spleen, or the
thickening and induration of the periosteum, or the capsule of the hip-
joint in chronic rheumatic arthritis. In all these cases the new material
is derived from repeated, but not acute, inflammations; therefore, pro-
bably, though excessive, it is not widely different from the normal ma-
terial for nutrition ; and, the conditions for nutrition being little dis-
turbed, it is developed into the exact likeness of the original texture
with which it is intermingled and confused.
11 As the fibro-cellular and fibrous tissues, formed from inflammatory
lymph, become more perfectly organized, they are prone to contract ;
imitating the contraction already described in granulations and scars
(p. 236j. Hence, in part, the contraction of the wall of the chest after
pleurisy, and the various displacements and deformities of organs that
have become adherent to adjacent parts ; hence, in part also, the con-
tractions of inflamed organs, as of the liver in cirrhosis ; hence, too, an
addition to the rigidity of joints when the parts around them have been
inflamed ; and hence, with yet greater mischief, the contractions of the
thickened valves and tendinous cords of the heart.
“ Adipose Tissue may be formed, if not directly from inflammatory
lymph, yet in the fibro-cellular tissue of completely organized adhesions.
I think it is not often so formed ; but, lately, Dr. Kirkes found a lung
of which all the anterior part was covered with well-organized false
membrane ; and in part of this was a quantity of perfect adipose tissue,
more than four ounces in weight.
li Elastic Tissue is sometimes abundantly formed in the adhesions de-
veloped from inflammatory lymph. I have not seen it except in such
as are completely organized ; and I think it is, in this case, as in the
formation of scars, a late production. I believe, also, with Virchow,
that its formation depends, in some measure, on the membrane that is
inflamed ; pleural adhesions being most favorable to it. In these it is
often abundant ; its principal, but always slender, filaments lying in
the same general direction as those of the fibro-cellular tissue.
<£ Epithelium I have already mentioned as covering the surfaces of
well-formed adhesions. I know of no observations proving whether the
epithelial cells are developed directly from the lymph, or are a later con-
struction from materials derived from the blood of the adhesion’s vessels ;
but it is not rare to find, in inflammation of serous membranes, recent
lymph-cells presenting many characters indicative of development towards
epithelium ; flattened and enlarged, and having circular or oval clear
nuclei.
“ Bone is often .formed from inflammatory lymph. It may appear as
a late transformation of lymph that has been organized into perfect
fibrous tissue ; as in the osseous plates that are sometimes found in the
false membranes of the pleura, or in the pericardium. In most of these,
however, there is not true bone, but an amorphous deposit of earthy
matter, which is imbedded in the fibrous tissue, or which (as Rokitansky
holds) is the residue of the degenerated and partially absorbed tissue.”
Again, on the formation of blood-vessels in effused lymph :
“ 1. The direct observations supposed to prove that blood is formed
in lymph are very liable to fallacy, through the facility with which blood
may be accidentally mixed with the lymph, in consequence of haemor-
rhage during life or after death, or in the preparation of the specimens.
Where these sources of fallacy have been avoided, I have never seen
anything suggestive of a transformation of lymph into blood.
“ 2. The development of blood from tissue-cells is limited, naturally,
to the earliest period of embryo-life, as if it needed the greatest amount
of force for development; afterwards, blood is not formed except through
a long process of elaboration, and with the aid of many organs. Its for-
mation, therefore, in the mal-conditions of inflammation is very im-
probable.
“ 3. In no specimen of inflammatory lymph have I seen appearances of
transitions from lymph-cells to blood-cells, such as we may see in the
lymph of the lymphatics, both before and after it is poured into the
blood-vessels.
“ 4. Neither in any lymph have I seen appearances of such stellate
cells as the interstitial bloodvessels of the early embryo are formed from ;
nothing comparable with them has ever come into view.
11 5. In the formation of vessels for granulations and the walls of
chronic abscesses, all is favorable to the belief that they grow up from
the bloodvessels of the adjacent parts ; and there are no structures to
which the lymph bears so close analogy as it does to these, or to which
it is so likely to be conformed in the production of its vessels.
“ On the whole, therefore, although direct observations are wanting,
I think we may conclude that all the vessels of inflammatory lymph are
formed by outgrowth from adjacent vessels, as in the process of repair,
and that through these vessels, not by its own development, it derives
its supply of blood.”
We conclude these extracts with Mr. Paget’s views on the in-
timate nature of inflammation.
11 If we consider the quantity of organic formation effected during the
inflammatory process, in the proper substance of the inflamed part, it
is evidently less than in health. All the changes described in the last
lecture are examples of diminished or suspended nutrition in the tissues
of the inflamed part ; they are all characteristic of atrophy, degene-
ration, or death. The tissues become soft, or quite disorganized ; they
are relaxed and weakened ; they degenerate, and remain lowered at once
in structure, chemical composition, and functional power j or else, after
degeneration, they are absorbed, or are disintegrated, or dissolved, and
cast out ; they die in particles or in the mass. During all the process
of inflammation there is no such thing as an increased formation of the
natural structures of the inflamed part ; they are not even maintained;
their nutrition is always impaired, or quite suspended. It is only after
the inflammation has ceased that there is an increased formation in some
of the lowly organised tissues, as the bones and cellular tissue.
“ So far, then, as the proper substance of the inflamed part is con-
cerned, there appears to be decreased action ; that is, decreased forma-
tion. There may be, indeed, an increased absorption ; but this is also,
in one sense, characteristic of decreased exercise of vital force ; since all
absorption implies a previous degeneration of the part absorbed. Nor
can we justly call this, in any sense, ‘ increased action,’ till we can
shew how absorption is an action of vessels.
“ Thus far, one of the constituents of the inflammatory process, one
of the characters in which it differs, in respect of quantity, from normal
nutrition, is a defect in the nutrition of the proper substance of the in-
flamed part.
“ But it is characteristic of the complete process of inflammation, that,
while the inflamed structure itself suffers deterioration, there is a pro-
duction of material which may be peculiarly organized. Here, there-
fore, may be an evidence of increased formation, of increased action.
“ Doubtless, in relation to the productive part of the inflammatory
process, the expression “ increased action” may be in some sense justly
used ; for the weight of an inflamed part, or of the material separated
from it, may be much increased by the formation of organized matter.
But the quantity of organized matter formed in an inflammation must
not be unconditionally taken as a measure of increase in the exercise of
the vital forces ; for it is to be observed, that the material formed pre-
sents only the lowest grades of organization, and that it is not capable
of development, but rather tends to degeneration, so long as the inflam-
mation lasts.
“ It may be but a vague estimate that we can make of the amount of
force exercised in any act of formation ; yet we may be sure that a com-
paratively small amount is sufficient for the production of low organisms,
such as are the fibrinous and corpuscular lymphs of inflammation. The
abundant production of lowly organized structures is one of the fea-
tures of the life of the lowest creatures, in both the vegetable and ani-
mal kingdoms. And, in our own cases, a corresponding abundant pro-
duction is often noticed in the lowest states of vital force ; witness the
final inflammations, so frequent in the last stages of granular degenera-
tion of the kidneys, of phthisis, of cancer, and other exhausting diseases.
In all these, even large quantities of the lowly organized cells of inflam-
matory lymph may be formed, when life is at its last ebb. And with
these cases those correspond which shew the most rapid increase of
tubercle and cancer, and of lowly organized tumors, when the health is
most enfeebled, and when the blood and all the natural structures are
wasting.
“ From these considerations we conclude that the productive part of
the inflammatory process is not declaratory of the exercise of a large
amount of formative or organizing force; and this conclusion is confirmed
by observing that development, which always requires the highest and
most favored exercise of the powers of organic life, does not occur while
inflammation lasts. The general conclusions, therefore, may be, as well
from the productive, as from the destructive, effects of the inflammatory
process, that it is accomplished with small expenditure of vital force ;
and that even when large quantities of lymph are slowly organized, such
an expression as ‘ increased action’ cannot be rightly used, unless we
can be sure that the defect of the formative power, exercised in the
proper tissue of the inflamed part, is more than counterbalanced by the
excess employed in the production and low organization of lymph.
“It may be said that the signs of inflammation are signs of increased
action. But these are fallacious, if again, by increased action be meant
any increased exercise of vital force. The redness and the swelling of
the inflamed part declare the presence of more blood ; but this blood
moves slowly ; and it is a quick renewal of blood, rather than a large
quantity at any time in a part, that is significant of active life. An
abundance of blood, with slow movement of it, is not characteristic of
activity in a part; it often implies the contrary, as in the erectile tissues,
and the cancellous tissue of bones.
“ The local increase of heat is too inconstant to afford ground for
judging of the nature of inflammation. When manifest, it is not, I
think, to be exactly compared with that of an actively growing part, or
of one which is the seat of ‘determination’ of blood, or of ' active con-
jestion.” In these cases the heat is high, chiefly because the blood,
brought quickly from the heart, is quickly renewed ; but in an inflamed
part the blood is not so renewed; it moves more slowly. The heat may,
indeed, be in some measure ascribed to this condition ; for the quickly
moving blood around the inflamed part may communicate its heat to that
which is moving more slowly. But the proper heat of inflammation (I
mean that which is measureable by the thermometer) cannot, I think,
be wholly thus explained. Some of it is probably due to the oxi-
dation of the degenerating tissues ; a process which we might safely
assume to be rapidly going on in the more destructive inflammations,
and which is, indeed, nearly proved by some of the evidences of the in-
creased excretion of oxidized substances in inflammations, especially by
the increase of phosphates in the urine during inflammation of the brain.
It is far from proved, indeed, that this source of heat is sufficient for the
explanation of the increase in an inflamed part ; and it may be at once
objected that we have no evidence that the hottest inflamed parts are
those in which the most destructive processes are going on. Still, in
relation to the question, how far the increased heat is a sign of the quan-
tity of formative force that is being exercised, we may argue that, as the
general supply of heat in our bodies is derived from oxidation or com-
bustion of wasted tissues or of surplus food, so, in these local augmen-
tations of beat, the source is rather from some similar destruction of or-
ganized substances, than from increased formation of them. If it be so,
increased heat will give no ground for regarding the inflammatory pro-
cess as the result of a greater exercise of formative force than is em-
ployed in ordinary nutrition ; none for speaking of it as increased nu-
trition, or increased action. Rather, this sign may be added to the evi-
dences that the inflammatory process presents, of diminished formative
force, and of a premature and rapid degeneration, in the affected part.”
The Medical Formulary : being a Collection of Prescriptions,
etc., etc. By Benjamin Ellis, M. D., late Professor of Ma-
teria Medica in the Philadelphia College of Pharmacy. Tenth
Edition, Revised and much Extended. By Robert P. Thomas,
M. D., Professor of Materia Medica in the Philadelphia Col-
lege of Pharmacy. Philadelphia, Blanchard & Lea. pp.
(with index) 296.
This standard old favorite is here introduced for the tenth time
to the American profession, under the editorial supervision of
Dr. R. P. Thomas. Numerous improvements and additions
have been introduced, and “ all the formulae embracing officinal
articles have been brought to the standard of the National Phar-
macopoeia.”
Yellow or Malignant Bilious Fever in the Vicinity of South
Street Wharf, Philadelphia, 1853. By Wilson Jewell, M. D.
pp. 40.
Dr. Jewell’s valuable and interesting report on the Yellow
Fever which prevailed in our city last summer, (as read before
the College of Physicians, Aug. 3 and Sept. 7, 1853,) is here
presented in pamphlet form. Our readers have already had the
benefit of a synopsis of this report in the editorial columns of our
journal for September and November. The more detailed his-
tory of the Fever, however, as contained in the report, should
be generally read.
A Treatise on the Venereal Disease^ By John Hunter, F. R. S.
With Copious Additions. By Dr. Philip Ricord. Edited
with Notes. By Freeman J. Bumstead, M. D., Physician
to the North-Western Dispensary, New York. Philadelphia :
Blanchard & Lea, 1853. 8vo. pp. (with index) 520.
This many-headed book presents us the great Treatise of John
Hunter on the Venereal Disease, surrounded with a rather com-
plicated net-work of “ notes and additions.” The original trea-
tise of Hunter (of the edition of Mr. G. G. Babington, and
including the contributions of Sir Everard Home,) was published
in Paris in 1840, with annotations by M. Ricord. The volume
before us consists of a translation by Dr. Bumstead of M. Ri-
cord’s annotations, and a reprint of Mr. Babington’s edition,
with notes and additions by the American editor. The additions
to the original text are thus four-fold; and the usual editorial
brackets present the rather startling array of interpolated
names—“Ricord,” “Home,” “Editor,” and “G. C. B.”
Exception may, we think, be not unreasonably taken, in some
particulars, to this mosaic style of publication. But we must
admit that an acceptable service has been performed in present-
ing this book to the profession. The observations of John Hun-
ter on the Venereal Disease, must, as Mr. Babington justly
observes, “always form an essential part of the study of every
surgeon who wishes to make himself acquainted with the disease
of which it treatsand upon the value of the facts and opi-
nions of Ricord, which are engrafted on it, we need not dwell.
The notes and additions of the American editor are judicious
and interesting. An index has been added, too, which cannot
fail to increase the usefulness of the work.