1847.] Arteritis; its Symptoms, Causes, &c. 367 usually coincide with lesions of the same sort in the heart, and are developed at the same time, under the influence too of the same causes ;-in the first rank of which must be placed Rheumatic Disease." The necroscopic appearances of acute Arteritis are these: redness of the internal surface, thickening, injection and softening of the arterial parietes, a pseudo-membranous or even a genuinely purulent secretion in the cavity of the vessel, and the presence too of a sanguineous coagulum, with the consequent more or less complete obstruction of its tube. Occasionally, superficial ulcerations or erosions of the lining membrane are met with. Once or twice, pus has been found external to this membrane. It is because of the softening of the arterial walls that an inflamed vessel is apt to give way under the action of a ligature, as was first remarked by Dupuytren.* The morbid effects of chronic Arteritis are thus described by our author: "The vascular parietes become thickened and hypertrophied; the ulcerations become larger and deeper, and may end in perforations; or at length, the arteries undergo a calcareous or cretaceous degeneration, which renders them friable. In some cases, this degeneration affects their internal membrane alone. The whitish or yellowish points, striæ, patches or spots, so often observed on the inner surface of arteries, are the commencements or rudiments of this sort of accidental ossification (inchoamenta ossificationis, to use the language of Morgagni), in the same manner as the milky spots on the pericardium and pleura, are those of the cartilaginous or ossiform lamina so often met with after chronic pericarditis and pleurisy. However this may be, the furfuraceous, sandy, or pulverulent matter found on the inner surface of arterial tubes-in the form of points, scales, insulated spots or long lines-is removable, in whole or in part, with the nail or blunt edge of the scalpel. The lamina, which are fibrous, fibro-cartilaginous, or calcareous, are on the other hand so adherent to the internal membrane that they cannot be detached; they are in some degree incorporated with it. Occasionally, the calcareous productions project and form a sort of stalactitic deposit on the inner surface, which is generally unequal and rugous at the same time. These productions are often observed to be situated not on, but beneath the inner membrane of the artery." The symptoms, most truly indicative of Arteritis, are those which denote a more or less complete obstruction to the course of the red blood along the course of the vessel or vessels. Thus, when the disease occurs in any of the extremities, the limb becomes chilly and benumbed, and eventually mortifies. This morbid condition is not unfrequently met with in aged people; hence the term gangrena senilis, that has been usually applied to it. It is not, however, confined to old age. Most writers have affirmed that severe pain along the course of the affected artery is very generally present in this species of arteritis. But this is far from being a constant symptom. M. Bouillaud attributes it, when present, to irritation * Andral, in his Præcis d'Anatomie Pathologique, thus alludes to another morbid change of the arterial parietes. "The middle coat of the arteries may become atrophied, as well as hypertrophied. In the former case, the proper constituent tissue of the vessel becomes gradually more and more effaced, and it tends to return to the condition of mere cellular texture. In consequence of the attenuation of its parietes, the artery acquires the character and appearance of a vein; so that, when cut across, its sides fall together." of the nervous filaments which accompany certain arteries, especially those of the extremities. It is not present in inflammations of internal and other arteries which are not provided with sensory nerves. We have already said that Rheumatism is a frequent exciting cause of arteritis, as it is of Carditis. The existence of inflammation in the structures, immediately adjoining to arterial trunks, is probably another cause of these becoming involved in the same morbid action. This point in pathology has hitherto not received the attention which it deserves. Aorta. It is highly probable that this great trunk is very often the seat of inflammation, considering the frequency with which morbid deposits and other changes, the result of inflammatory action, are found to affect its tissue. "The redness, the thickening, the pseudo-membranes and the pus, the formation of sanguineous concretions, the softening, the ulceration, and all its consequences, subsequently the hypertrophy with dilatation or contraction of the tube of the vessel, the induration, the cretaceous or earthy degeneration, &c., are so many alterations which are induced by aortitis." In a case of double Pleuro-pneumony (that on the right side was towards the apex, that on the left towards the basis, of the lungs), M. Bouillaud diagnosticated, he tells us, the existence of inflammation and the presence of a coagulum in the ascending aorta, in consequence of the following auscultatory symptoms: " towards the left edge of the sternum, above and within (sternad to) the left mamma, there was a very strong blowing sound, which extended up to nearly the clavicle; it was isochronous with the pulse, and did not prevent the click-clack of the heart being heard." Two days subsequently, it was found that a "blowing and rubbing sound continued to be heard over the origin of the aorta; this sound resembled somewhat that known by the term piaulement, and became in some degree stronger as it was traced up to the superior part of the sternum." patient died four days afterwards; and on dissection, the following appearances were discovered: The "The aorta-from an inch above its cardiac extremity to where it gives off its large branches-where it was in contact with the right lung, hepatised at its apex, exhibited on its external surface a beautiful redness, which contrasted strongly with the white colour of its other portions. The internal membrane of the arch of the aorta presented a uniform rosy hue, which, on the aortic valves assumed a bright red, not removable by washing, and which contrasted in a very marked degree with the whiteness of the lining membrane of the left ventricle, and also of the pulmonic valves. Commencing in the descending portion, and extending along the whole course of the ascending portion of the thoracic aorta, was a sanguineous coagulum, which became thicker and more and more organized as it approached the arch, where it was perfectly white, of the size of the small finger, and, in short, not unlike in colour and form the spinal marrow stript of its envelopes. It adhered to the walls of the aorta so strongly, as to require pretty strong traction to separate it. It became considerably larger, and was in some degree expanded where it entered the left ventricle, three-fourths of whose cavity were nearly filled with it, leaving only a narrow passage for the blood to pass along. The coagulum was reflected around the mitral valve, and insinuated itself into the (left) auricle where it was partly black and partly white, and was less dense than the portion 1847.] Inflammation of the Aorta & Pulmonary Artery. 369 in the ventricle. In its passage through the auriculo-ventricular orifice, it was entwisted around the chorda tendinea, to which it closely adhered. "The right ventricle also contained an enormous coagulum, which was dense, white and fibrinous, investing the tricuspid valve, and penetrating into the auricular cavity, which it filled almost entirely. The formation of this coagulum appeared to be more recent than that in the left cavities of the heart." The diagnosis of a cretaceous degeneration of the aorta, with hypertrophy and dilatation of its parietes, is declared to be in many cases practicable, by attention to the following circumstances: "By inspection, palpitation and percussion, the degree of dilatation and of the force of the arterial impulse, may be exactly ascertained. At the same time, palpitation enables us to recognise, when the inner surface of the vessel is very rough and rugose, a very decided vibratory fremitus; and, by auscultation, we may generally hear over the region of the aorta a blowing sound, which is usually double, and sometimes so strong that I have compared it to the sound of a curry-comb (bruit d'etrille)." We need scarcely repeat our author's opinion, that the usual causes of acute Aortitis are, rheumatism and the existence of inflammation of the lungs, or pleura in the immediate contiguity of the vessel. Pulmonary Artery.-On the subject of Inflammation of this vessel, M. Bouillaud's remarks are to this effect: * * * * "A case is related by M. Cruveilhier* of this disease occurring in a woman who had suffered from uterine and crural Phlebitis after delivery. * The trunk and divisions of the pulmonary artery were filled with firm coagula. In the former, they were white and coherent; in the latter, they were of a red colour, and adhered but loosely to the walls of the vessel. In the centre of the principal clot was a deposit of phlegmonous pus. There were traces of a lobular Pneumonia. An acute œdema was, in M. Cruveilhier's opinion, the result of this lesion. This idea is questionable; seeing that the pulmonary artery, although conveying venous blood, does not bring the blood back from an organ to the heart as proper veins do, but carries it to the lungs from the heart. I cannot therefore agree with M. Cruveilhier in attributing the pulmonary edema to the obstruction of the pulmonary artery. I have met with a great many cases of recentlyformed fibrinous coagula in the pulmonary artery, after severe Pneumonia, Pleurisy, &c." The paper of Mr. Paget "On Obstructions of the Branches of the Pulmonary Artery," in a recent volume of the Medico-Chirurgical Transactions, has directed the attention of physicians to a point in pathology which had previously been quite overlooked. *Anatomie Pathologique, XI. Livraison. An ample analysis of Mr. Paget's Paper will be found in the Number of this Journal for April, 1845. I. THE VEGETABLE KINGDOM; OR THE STRUCTURE, CLASSIFICATION AND USES OF PLANTS, ILLUSTRATED UPON THE NATURAL SYSTEM. By John Lindley, Ph.D. F.R.S. & F.L.S. Professor of Botany in the University of London and in the Royal Institution of Great Britain. With upwards of Five Hundred Illustrations. 8vo. pp. 911. London, 1846. II. OUTLINES OF STRUCTURAL AND PHYSIOLOGICAL BOTANY. By Arthur Henfrey, F.L.S., Lecturer on Botany at the Middlesex Hospital, late Botanist to the Geological Survey of the United Kingdom. With numerous illustrations. In three Parts. Part OneElementary Structures. Part Two-Organs of Vegetation. pp. 106. London. THERE is not one of the collateral departments of medicine which has presented a more altered appearance within the last fifteen or twenty years than the science of Botany, whether we regard the advances made in the establishment of philosophical and fixed principles to reason upon, or the manner in which the student of our art is initiated into a knowledge of the fundamental doctrines of this important and interesting handmaid of medicine. The time has not long passed since the study of botany, whether pursued by the professional student or the cultivator of general science, was a study of classification and of terms, and it might well be argued, that as manifold and imperious were the strictly practical duties of a professional career, it was but of slight importance, whether during our noviciate we paid much attention to mere catalogues and words. Now, however, the whole face of matters has changed; instead of the different kingdoms of Nature being severed from each other, each broken up again into minute portions, and regarded only in a few and comparatively unimportant relationships, the study of the organized creation has been viewed as a whole, the relations of development between apparently distinct portions shown, the analogies of structure and function, not only between particu lar groups of vegetable organisms beautifully evolved, but, even with the apparently opposed forms of animal existence, remarkable coincidence. of obedience to the same laws of evolution demonstrated to exist. The same philosophical principles of investigation which have been applied to the study of man and animals are now applied to that of plants. As there is General and Special Anatomy of the former, so there is of the latter; as there is History of Function of the one, so is there of the other. There proceed the functions of Digestion and Respiration in vegetable bodies as do these actions in other organisms, and the processes of Impregnation and Development are as complex in the one as in the other. It is true that, as yet, no analogues of the nervous centres or system have been satisfactorily demonstrated to exist in plants, but even in respect to this important endowment of the higher forms of organized creation, there are some writers who have expressed their belief of its existence, however modified it may be, in vegetable beings. No doubt can now exist that he 1847.] Past and present Mode of Study. 371 who wishes to have a right knowledge of the laws of life, and a due notion of what is denominated General Physiology, must apply his attention equally to plants and to animals. The laws of primary development form leading features of modern advanced physiology, and, as they are seen exhibited in both kingdoms of Nature, they must of necessity be studied. In such study it will be found that the laws of the one are nearly identical with those of the other, and that, however the more complex combinations which arise from the formative powers of the different races of beings at one part of the scale differ, yet originally all the forms of organized matter are made up of a series of minute structural elements which are identical in the two departments of Nature. Some persons have at times gone much further, or, as Mr. Henfrey remarks in his introduction, "Some philosophers have even denied the possibility of defining the limits between the organic and the inorganic world-between a cell and a crystal. Without admitting the validity of this view, which, although plausible in theoretical expositions, is practically negatived by very slight investigation, it must be allowed that the axiom natura non facit saltus, holds good so far as relates to the organic creation; the animal and vegetable kingdoms, so distinct and opposite both in appearance and function, when taken in their entirety, approach gradually by their lower tribes, until at the extreme point they meet in a simple cell which stands as it were on the limit." In former days, the lecturer on botany generally commenced his duties by giving his students definitions of terms, then followed an exposition of the artificial system of Linnæus, and these, varied with a description of different forms of roots, kinds of leaves and flowers, composed the staple of the learner's induction into "the lore of the green herb and the beeworshipped flower." Now, he unfolds to them comprehensive views of the development of elementary tissues, of the varied combinations of secondary structures arising from these, in fact they are as well grounded in the structural anatomy of a plant, as they are intended to be in the knowledge of that of man, and are shown the intimate relationship existing between the one and the other. Then follows the consideration of structure in action, in other words, the history of function is gone into; and, finally, the student has laid before him the advantages taken from known identities of structure, function and property, to arrange together the various denizens of the vegetable world in systematic groups, and the more important members of these groups as bearing a relation to medicine are described to him in detail. If, in considering the former two departments of the science of botany, he sees exhibited the close and intimate connexion between them and like departments of the history of animal life, in the latter he is no less struck with the valuable results which have accrued to the practical portion of his art-materia medica. How, by reasoning upon the law, that with like structure there is like property, he may avoid, in a strange climate, administering a hitherto to him unknown vegetable production, because the plant that yields it is connected by affinities to others in his own climate, which he has learnt to be of a deleterious nature. Or conversely how he may safely add to the available treasures he already possesses, the product of a plant which otherwise-were he ignorant of its congeners-he might be timid in employing. The student will find, to use the words of the author of the admirable work which is placed at the |