there is much tenderness in the region of the liver, without fever or general symptoms. If the inflammation be considerable, jaundice is not a common consequence, except when the concave surface is affected.

"It appears, however, that there is a state of the liver which gives rise to jaundice, and which does not amount to inflammation, though it is evidently allied to it. The circumstances, under which we are chiefly able to trace this affection, are when jaundice appears in connexion with inflammation of the lower part of the right lung. In a case of this kind, which had been accompanied by the usual symptoms of pneumonia, with the addition of violent hiccup, I found an abscess of the lower part of the lung in contact with the diaphragm, but could not detect any appearance of disease in the liver, except that it seemed to be rather paler than usual on the surface. Bonetus relates a similar case in which the disease was in the lungs, the liver being merely paler than natural. There had been fever with convulsions, and death in 15 days. It is probable, therefore, that the liver may be affected, in a manner analogous to that now referred to, from other causes which in a great measure elude our observation. To this principle we may perhaps refer some of those temporary cases of jaundice which appear to arise from disorders of the bowels,-also those cases which seem to be induced simply by external heat, and have been ascribed to overflow of bile. Jaundice is also occasionally observed in connection with disease of the heart, arising probably from the impeded return of the blood from the liver; and it has been known to supervene upon suppression of the hæmorrhoidal discharge and other evacuations which had become habitual. Portal has seen it supervene upon suppression of leucorrhœa; and he also mentions a woman who had been long affected with a copious and very fetid discharge from the arm-pits, and immediately became jaundiced, when she suppressed it by means of a preparation of alum." 372.

When jaundice arises from inflammation, the general remedies against such action must be adopted, and after the active symptoms have been overcome, further relief may be obtained from friction with mercury or iodine.

Dr. Marsh (Dublin Hospital Reports, vol. III.) has endeavoured to prove, that mucous inflammation of the duodenum has produced jaundice by closing up the mouth of the biliary duct, and others have asserted that collections of hardened fæces within the colon have given rise to the same effect. However this may be, there is no doubt but icterus occasionally depends upon intestinal derangement, and that enlargement of the pancreas, and diseases of the pylorus may occasion the absorption of bile.

It is questioned by the Dr. whether injuries of the head ought to rank among the causes of this disease; that they have been contemporaneous is certain, but this circumstance affords too feeble a presumption of their etiological relation, seeing that the same accident which injured the head may have disordered the biliary apparatus; but mental disquiet will certainly produce it; such cases are recorded by almost every writer upon this subject, and they furnish a striking reverse illustration of the sympathies which hold between the liver and brain.

ence.

PATHOLOGY OF THE SPLEEN.

The diseases of the spleen are very similar to those of the liver, but they are less frequent in their occurrence and less important in their influThe rank which this organ holds in the economy of life has not as yet been ascertained, the functions it is destined to perform are not well understood, and the diseases to which it is obnoxious have neither been carefully studied, nor clearly revealed. Our ignorance of its use during health has rendered us less alive to its conditions in disease, and the obscurity of its functions when natural, has made their study, when disordered, less interesting in its object, and less successful in its issue. But, like every other organ in the body, it is subject to inflammation, and inflammation may

terminate in the ordinary results of such action upon such texture;—in suppuration, ramollissement, hypertrophy, and induration. Besides these, it is not unfrequently affected with tubercles and hydatids, and it may give rise to hæmorrhage, or be lacerated, as the liver, by external violence.

We believe that active inflammation of the substance of the spleen has been seldom noticed, but whether this depends upon its singularity or obscurity has not been exactly ascertained. Portal describes an instance in a man who died of fever, in which pain of the left side, cough, dyspnoea, and palpitation were the accompanying symptoms. Our author has not witnessed any idiopathic case, but suspects that the symptoms are in general most obscure, when the inflammation is seated in the peritoneal coat. Chronic inflammation is, however, less rare, but its phenomena are obscure and its duration protracted.

Suppuration seems also to be a rare occurrence, and the cases which have been recorded of it are few and unsatisfactory. M. Jacquinelle (Journal de Med.) relates one in which the young man complained of pain and fullness in the left hypochondre, palpitation, faintings, and emaciation. Before death the pain subsided, and a quantity of dark fetid matter was discharged by stool. The spleen was found much enlarged, and continued an abscess that had burst into the colon. Grotanelli records another, in which the abscess burst into the peritoneal cavity, and proved fatal in three days; M. Cazé another, which opened into the stomach, and was marked by vomiting of bloody pus and a sense of palpitation in the epigastre; and Heide another, which communicated with the external surface by a fistulous ulcer which extended from the spleen to the umbilicus, betwixt the peritoneum and abdominal muscles. These abscesses occasionally obtain a remarkable size; in the Mem. of the Acad. of Sciences instances are given, where viij. lb. were drawn off by tapping, and where xxx. lb. were found after death. In some of the Walcheren cases of fever Mr. Wardrop found the spleen converted into a mere cyst of puriform fluid.

Ramollissement is a very common appearance after some forms of general disease. In fatal cases of genuine typhus we believe it will seldom be found absent; and the Doctor considers it the only morbid result, when the patient dies with obscure and protracted symptoms of diseased spleen. In this affection the substance of the spleen is broken down into a semi-fluid resembling melted pitch, or black-currant jelly, which is rather contained within its peritoneum as a bag, than covered by it as an investment. It is sometimes attended by inflammatory symptoms and connected with inflammation of other organs, but more frequently it is unaccompanied by much constitutional sympathy, and proceeds unmarked by any very palpable phenomena. A man mentioned by Sennertus, after complaining for some weeks of loss of appetite and pain in the left side, was seized with bloody diarrhoea, and died in a few days. Upon inspection, the principal disease was in the spleen, which had degenerated into a bag of dark fetid matter like the lees of oil.

When the spleen is enlarged its vascularity is much increased, but its structure may remain unchanged, and the general health almost undisturbed. A woman is mentioned by Lieutaud, who had lived for 17 years with an enlarged spleen, that weighed after her death 32 pounds, and Dr. Crane observes, that the inhabitants of Lincolnshire are often affected with it for 20 years, without exhibiting much appearance of disease beyond a pale or yellowish aspect. In some cases, nevertheless, its effects are troublesome, disordering the bowels, deranging the stomach, destroying the strength, and favouring local hæmorrhage, or general dropsy.

"One of the most singular facts in the pathology of the spleen, is the very rapid manner in which enlargement of it takes place, and the equally rapid manner in which it subsides. Some of the cases of this kind which I have seen, appeared so very extraordinary, that I suspected some fallacy, until I found similar cases described as of frequent occurrence by writers on the diseases of India. Several years ago, I saw, along with Dr Combe, of Leith, a seaman who had contracted ague in England a few weeks before, and had returned to Leith with the disease going on in the usual manner. In the left hypochondrium, there was a firm defined tumour arising from beneath the margin of the ribs, and projecting downwards several inches. We agreed that our first object was to arrest the fever by the usual means, leaving this remarkable tumour for future consideration; but, on returning about a week after, I found that the fever had been easily arrested, and that the tumour was entirely gone." 385.

From the circumstance of remittent and intermittent fever being the most frequent cause of this disease, mercury was once largely employed in its treatment; but the effects which it often produced, in mortifying the mouth and sinking the strength, have lately discouraged its exhibition, and at present it is seldom thought of. If there be much tenderness in the region of the spleen, or symptoms of general excitement, topical bleeding should be followed by blistering, or a seton, and purgatives should be freely administered.

The natives of India appply the actual cautery and use a combination of aloes, garlic and vinegar; and the spleen powder of Bengal, which is described as endowed with almost specific virtue, is composed of rhubarb, jalap, scammony, and cream of tartar, with calomba powder and sulphate of iron.

Tubercles and Hydatids are frequently found in this organ; the former generally in connexion with tubercular disease in other parts, and the latter in cysts formed by its peritoneal coat. But neither is characterized by any peculiar symptoms, and cannot, therefore, be the subject of any specific treatment.

Pale induration of the spleen is mentioned by Portal and Lieutaud, and black induration by Diemerbroeck; but the author has not met with either. Fournier relates a case of fatal hemorrhage from this viscus, and Lieutaud, Tulpius, and Chisholm, furnished examples of rupture by external violence. In addition to these diseases, the Doctor mentions infiltration of the substance of the spleen with a gelatinous fluid, deposition of fatty matter into its structure, an ossified or cartilaginous state of its external surface, diminution of size, and a stony degeration of its texture; but to enter into any detail of such affections would be fruitless.

PATHOLOGY OF THE PANCREAS.

Inflammation, ending in suppuration and gangrene, enlargement, induration, and calculous deposition, are the principal morbid conditions to which the pancreas seem liable; but our knowledge of either is very imperfect, and the symptoms of each ill-defined and obscure. Tulpius, Bartholinus, Guido Patin, Portal, Baillie, and Percival, have published cases of suppuration of this body, but the attending symptoms were exceedingly different. In one there were general pain of abdomen, spasm of abdominal muscles, nausea, a tendency to diarrhoea, and dropsy;—a second had jaundice and bilious vomiting, a tumour was perceptible in the epigastre, and bloody pus were discharged by stool;-and, in a third, death was preceded by three or four attacks of vomiting and syncope. A sphacelated state of this organ was found by Barbette as the only morbid appearance in a man who died of urgent vomiting after a short illness, and the same appearance occurred in a man mentioned by Greizil, who had been addicted to colic and died rather

suddenly, complaining merely of a sensation of internal cold. The following case will illustrate scirrhous induration of the pancreas; and the next, enlargement with a mixed state of disease.

A woman, æt. 40, complained of epigastric uneasiness and frequent vomiting, which would not permit any food to remain upon her stomach. In about a year she died without any other symptom, and, although quite exhausted, the integuments of her body were covered with fat, and those of the abdomen were coated with a layer two inches thick! The pancreas was found in a state of uniform scirrhus, without much enlargement. No other disease could be discovered.

A man, æt. 26, complained of pain in the left hypochondre, oppression at the stomach, indigestion, and gradual emaciation. But he had no vomiting, his bowels were very tractable, and external examination could detect no disease. After two years' continuance of these symptoms he died without any alteration in his case, except that jaundice had appeared a few days before death. The seat of the pancreas was found occupied by a mass, four or five inches broad and somewhat less in thickness, which adhered to the spine, and surrounded the aorta. It was partly composed of cartilage, and partly of alternate layers of yellowish and white matter, resembling medullary sarcoma. The other organs were healthy, except the liver, which was rather pale and somewhat enlarged.

Calculi have been found in the pancreas by De Graaf, Portal, and others. They seem to consist of carbonate of lime, and they vary in size from that of a pea to a hazel nut. In a man, who died of diseased aorta, Portal found twelve imbedded in this organ, which was likewise much enlarged; so that, like gall-stones in the gall-bladder, they may exist in great numbers without deranging the patient's health to any perceptible degree. Indeed, the same remark is applicable to most of the chronic diseases of this viscus.

“Many cases are on record of chronic disease of the pancreas, exhibiting the same diversity of symptoms which occurred in the examples now described, and nearly in the following proportion. Of twenty-seven cases which I find mentioned by various writers, six were fatal with gradual wasting and obscure dyspeptic complaints, without any urgent symptom In eight, there was frequent vomiting, with more or less pain in the epigas ric region; and thirteen were fatal, with long continued pain without vomiting. In some of these, the pain extended to the back; and in others, it was much increased by taking food. In several, there were dropsical symptoms; and in three or four there was jaundice from the tumour compressing the biliary ducts. In the morbid appearances, also, there was great variety; the pancreas being in some of the cases much enlarged, in others, in a state of scirrhous hardness with very little enlargement. It does not appear that any distinct relation can be traced betwixt the urgency of the symptoms and the degree of enlargement; for this existed in a great degree in some of the cases in which the symptoms were slight and obscure; and there was hardness with little or no enlargement in others, in which the symptoms were defined and violent." 396.

We have now faithfully followed our author through his Pathology of the Stomach, Duodenum, Liver, Spleen, and Pancreas, and have furnished our readers with ample materials for reflection upon a series of most interesting dieases until the appearance of our next, when we hope to resume the subject, and give an attentive digest of his Intestinal Pathology. Till that period we decline making any general criticisms, convinced that the diligence which we have displayed in the execution of our present article, and the spirit in which it has been written, will intelligibly communicate our sentiments of the author without the aid of direct eulogy, and will ensure for his re-appearance'a cordial welcome.

IV.

A LETTER TO THE RIGHT HON THE SECRETARY OF STATE FOR THE HOME DEPARTMENT, ON ANATOMY, &c. By G. J. Guthrie, F.R.S. Professor of Anatomy and Surgery to the Royal College of Surgeons, &c. &c. Octavo, stiched, pp. 37. Sams, London, 1829. Price One Shilling.

We hope and trust that the difficulties and even dangers which have long beset the study and the teaching of anatomy in this country are fast disappearing, together with most of those popular prejudices, lamentable, though honest, and not to be scoffed at, by which they were engendered. We believe that a better æra is dawning on our science, and that soon a parliamentary enactment will allow us to proceed unmolested in our pursuit, and—

All the clouds that lower'd o'er our house,

In the deep bosom of the ocean bury.

The scenes that have lately been witnessed in Edinburgh, and which have raised against a gentleman teaching anatomy in that city, a feeling almost as strong, and violence almost as great, as a former Edinburgh mob displayed against the unfortunate Captain Porteus, though afflicting to the profession, disgraceful to human nature, and horrible in every point of view, will yet, we are convinced, be attended in the end with beneficial results. They will display in their true colours the infamous miscreants called into action by the present laws against the open cultivation of anatomy, and shew that an over-regard for the dead has occasioned, is occasioning, and, we very much fear, will still occasion, the MURDER of the living.

"Murder most foul, as at the best it is,

But this most foul, strange, and unnatural."

Whilst all, however, fully acknowledge the evil, many opinions exist as to the nature of the remedy our state-physicians should apply. The Parliamentary Committee, and the Chairman, Mr. Warburton, in particular, are above all praise for the pains which they have taken in collecting evidence, and their talents in embodying that evidence into the recommendations to the Legislature, which form the pith of their REPORT. At the same time, it is not quite clear that all which might be said, has been said upon the subject, and on that account we have been led to take notice of the pamphlet, published within these few days by Mr. Guthrie. Without fully agreeing in all that that gentleman has advanced, we think that his remarks are deserving of attention, particularly in the quarter from which a bill on the subject is to emanate. The honourable gentleman, Mr. Warburton, who already has displayed such zeal and candour, will, we feel assured, glean all the information he can, before he ventures on the final step. Our space is so limited, that all we can do at present is, to place before our readers the plan and resolutions proposed by the distinguished author of the pamphlet, without indulging in any observations of our own.

"The following plan is proposed under this system, and I would recommend the supply of dead bodies for public dissection to be derived from the following sources :"1. All persons hanged, or otherwise executed, and for all offences whatsoever.

"2. All persons who die under sentence for criminal offences, whether in the hulks, gaol, penitentiary, or elsewhere.

"3. All persons who die in temporary or floating hospitals, in gaol, penitentiary, or other place of detention, or prison, from whatever cause they have been placed there, and who have no friends to bury them.

"4. All persons found dead, from whatever causes, in highways, canals, or otherwise, and who, having no friends to bury them, are sent to bone-houses for interment, at the expense of the parish or county.

5, and lastly. The poor who die in workhouses, having no friends to bury them, having expressed no wish on the subject, and having no respectable or decent relatives to express it for them, either before or after death.

"It is not proposed to interfere by regulations with the bodies of those who die without friends in regularly established hospitals; it being presumed that the surgeons of those institutions will properly apply them in the instruction of the students committed to their charge. In other words, it is not intended that the public schools of anatomy shall interfere with the private or public instruction delivered by surgeons in their own hospitals. "The means of supply being furnished, the following regulations are proposed, to ensure