culty of keeping the object from drying and maintaining it at an equable temperature, partly because the animals usually died after six or seven hours. In addition to the above, however, C. has seen the same pictures as have been sketched of the advanced stages of the process in the frog, in cases of spontaneous (epidemic) fibrino-purulent peritonitis and pleurisy in rabbits. For these reasons the author deems himself fully justified in applying his observations in the frog to mammals likewise. And it is unnecessary to point out expressly, that the laws disclosed in the mesentery are quite generally applicable to the inflammation of vascular organs. The special arrangement and distribution of the vessels, it is self-evident, will be of some influence in the individual case; for while in the mesentery,— rich in veins and relatively poor in capillaries, the vast majority of cells are furnished by the veins,-in organs better supplied with capillaries, as the serous coat of the intestine, the pleura, and especially the pulmonary tissue, the capillaries will have a larger share in the process;—a circumstance, which must manifest itself at once by the greater proportion of red blood corpuscles in the inflammatory infiltration or exudation, and C. reminds his readers of the rusty-colored exudation of a single lobar pneumonia. Nor is the value of these facts confined to vascular organs; they throw light also upon the events in the course of a keratitis, answering the question as to the origin of the pus corpuscles in the inflamed cornea.

Though the supreme importance of the subject tempts me to follow the author still farther in his generalisations, the already great length of the article compels me to bring it to a close. As regards the question, whether the described process of exudation, or better, emigration, is the only source of pus, to the exclusion of other possible modes of formation, the author leaves it in doubt, but is disposed to deny that the fixed corpuscles of the connective tissue have any share in producing pus corpuscles by division.

The experiments and observations communicated above, finally, remarks C., seem to make it necessary to modify the former theory of acute inflammation in some points; at least of that form of inflammation accompanied by suppuration (in the general sense, whether of cellular or purulent infiltration, of abscess, or of exudation) — that form with the celebrated four cardinal symptoms of which every physician first thinks when the word "inflammation" is spoken. Henceforth, the vessels will again occupy the foreground in this species of inflammation. Without vessels, no inflammation: the dilatation of the vessels, the injection and hyperæmia, is its necessary first stage; in vascular parts the vessels in them,-in non-vascular parts those of the neighborhood form the starting point of the inflammatory process. The second postulate for the development of an inflammation is the presence of spaces which allow of the locomotion and accumulation of colorless blood-cells; and as but very few bloodvessels border directly upon the larger cavities of the body, one tissue above all comes into consideration, which contains canalicular, dilatable spaces, and this is the connective tissue. Hence all suppuration remains intimately associated with all modifications of the connective tissue which contain the canaliculi described. Among the tissues of the connective substance but one is known in which such spaces are absent, viz.: cartilage. But in cartilage nobody has ever observed a true suppuration. All other connective tissues, as we know, are supplied with these canalicular spaces; they are the proper domain of suppuration; and this explains why suppurative processes in composite organs are always carried on in the interstitial tissue.

The author is far from proposing a new theory of inflammation; for a number of questions are still unsolved and awaiting experimental investigation. But there is a gain even in being able to put these questions with precision. Moreover, the facts developed by these experiments yield a few deductions and conclusions that will be welcome to the

physician and to the anatomist. They have confirmed on a secure basis the clinical experience of the initial hyperæmia. Further, they enable us to explain that an inflammation may terminate in resolution without any detriment to the integrity of the parts involved: the transuded plasma is morbid, and the immigrated corpuscles disperse into the vicinity and into the lymphatics, while the tissue remains unaltered, having sustained as yet no passive injury. They explain the beneficial effects of local and general blood-letting; and the influence of cold, which hinders the dilatation of the bloodvessels. Finally, the author refers to pneumonia, in the course of which such enormous numbers of pus corpuscles are accumulated in the alveoli, and yet neither the enclosing connective tissue, nor the epithelium of the alveoli show any sort of change sufficient to warrant us in supposing them the source of the pus corpuscles.

Reviews and Bibliographical Notices.

I.

DIE MENINGITIS CEREBRO-SPINALIS EPIDEMICA vom historisch-geographischen und pathologisch-therapeutischen Standpunkte bearbeitet von Dr. AUGUST HIRSCH, o. ö. Professor der Medicin an der Universität zu Berlin. Berlin: A. Hirschwald. 1866. 8vo., pp. 189. 2. EPIDEMIC MENINGITIS, or Cerebro-Spinal Meningitis. By ALFRED STILLE, M.D., Professor of the Theory and Practice of Medicine and of Clinical Medicine in the University of Pennsylvania; Physician to St. Joseph's Hospital and to the Philadelphia Hospital. Philadelphia Lindsay & Blakiston. 1867. Svo., pp. 178. Price, $2.00.*

Not very many years ago, the disease which the above treatises describe was a field of darkness and confusion, and its pathology the most uncertain thing in the world, though it boasts of a history dating back to the first years of this century. For we may assert that it is only within late years that the nature of the disease has been truly appreciated, and that we no longer read of it under the names of spotted fever and such like. "Nothing," says STILLE, "illustrates more clearly the value of morbid anatomy as an element of medical diagnosis than the inextricable confusion which involves nearly all of the descriptions of this disease which were written before the scalpel revealed the lesions which essentially belong to it."

Now, the scalpel has revealed it as a suppurative meningitis of the brain or spinal marrow, or both,-and here we have two classical works describing this dreaded epidemic disease, its nature, its symptoms and causes, and what little we know of the best way of treating it, in fresh, agreeable language,―forcible, perspicuous, and pointed;-two classical monographs, which will last us a small future as a summary of our knowledge on epidemic meningitis, and will never grow old. Our predicates apply equally to both works, though certainly there are differences between them. The authors are both well known and of fair

*The parallel work of NIEMEYER, 1865, has been reviewed at length in Vol. III. of this Journal, 1866, p. 71, to which we refer the reader.

repute as medical writers. HIRSCH's treatise is the senior of the two by a year, and of about one-fourth more bulk, than the more recent work of STILLE. In the former, the history of the disease is more fully discussed, in accordance with the predilections and forte of the author, and the discussion of the causes of the disease and its pathogenesis is very elaborate, while in STILLE'S treatise, therapeutics occupy a particularly large space. But there is one remark yet applying to both works before us with equal force, and one we are sorry to make, as it indicates that the subject is not yet quite ripe for being finally set aside :-both authors fill their pages with quotations,-which sometimes enliven the text, but more frequently obstruct the smooth reading of the book,— quotations that to us often appear unnecessary, irrelevant, and disturbing the harmony of the works. We had thought that Dr. STILLE was so completely and personally familiar with the disease, though perhaps not with every extreme variety that has been described in some epidemics, that he could have dispensed with that fullness of quotation which mars many of his pages by substituting his own experience as authority.

We will not follow the authors through the history, but enter at once upon the description of the disease. "No disease whatever," says STILLE, "wears such various masks of symptoms, behind which there is, nevertheless, a great uniformity of characteristic lesion. The degree and extent of these lesions, and the greater or less energy in the primary impressions of the morbid cause of the disease are the two elements, out of which this great variety in its phenomena arises."

The general symptomatology is described by both authors as consisting essentially, "in the cases which may be called regular," of a short premonitory stage, in which prostration, chilliness, and pains in the head, back, and limbs, and often vomiting, indicating cerebral irritation, are the most prominent features, which "gradually assume a graver aspect, or usher in a heavy chill, which, in its turn, is followed by alarming symptoms, and especially by excruciating pain in the head, a livid or pale and sunken countenance, and extreme restlessness";-severe pains in the neck and spine, and more or less tetanic contractions of the muscles of the neck and back: tetanus and trismus. To these symptoms are usually added delirium and hallucinations, complete loss of appetite, and, when the attack tends to a fatal issue, coma.