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Let us see if these various conditions are fulfilled in the

experiments of M. Magnus. The results given by thelast experiments show, in the most evident manner, thatvenous and arterial blood contains in dissolution carbonicacid, oxygen, and azote. If the experiments of M.Magnus are incontestible this must be considered anestablished principle in science. But, on examining therelative quantities of the gases in each kind of blood, wesoon discover manifest contradictions. Thus, whilst 100parts or volumes of arterial blood produced 6.49()7 ofcarbonic acid, the venous blood only gave 5.5041,although the relative proportions of the acid in each kindof blood ought to have been in a contrary ratio. Conse-quently, if there does not exist some unperceived error inthe results of M. Magnus, if I myself am not somehow orother deceived, the new theory of respiration must fall tothe ground along with the basis on which it is founded.The theory demands that the venous blood should con-tain more carbonic acid than the arterial, and the experi-ments themselves of M. Magnus show that the contraryis the case ; the arterial blood contains 18 per cent. morecarbonic acid than the venous.The same difficulty likewise presents itself with the

azote. The arterial blood ought to contain less than thevenous, and, from the tables of M. Magnus, it containshalf more.The proportions of the oxygen alone present themselves

in a favourable manner for this theory; 100 parts ofarterial blood having given 2.4178, and the venousblood 1.1703 only, or merely half.Examining the consequences of these results, with

reference to oxygen, M. Gay Lussac shows the absenceof positive data on the subject, and recalls other dataforeign to M. Magnus’s own experiments, but adopted byhim. These data are :-First. That according to H. Davy,a man expires, in one minute, thirteen cubic inches ofcarbonic acid. Second. That each pulsation of the heartfurnishes an ounce of blood, and that, calculating at 75a minute, 75 ounces of blood, or 115.7 cubic inches, passthrough the heart in the same space of time.

As, therefore, 115.7 cubic inches of blood contain 13 ofcarbonic acid, 100 of blood would contain 11 .23, a quan-tity which the blood could readily furnish, for M. Magnusadmits, from his experiments, that it contains more than20 per 100.

Here, adds M. Gay Lussac, it becomes necessary thatwe should understand how the union of oxygen with theblood takes place. Does the combination occur in virtueof affinity, or is it only in virtue of the law of dissolution ?M. Magnus reasons in view of this last hypothesis withregard to the carbonic acid and the azote. As to the

oxygen, it would seem, from his theory, that it mustcombine itself with the blood by affinity ; but from thedetails into which M. Gay Lussac enters, it appears thatthe objections and -the difficulties which present them-welves, are so numerous, that M. Magnus himself has notbeen able to admit such an opinion. M. Gay Lussacthinks that it is evident that all the gases which performa-part in the phenomena of respiration, whether they areabsorbed by the blood or emitted from it, merely obey asimple force of dissolution, according to the rules esta-blished by Dalton. ,

In order the better to enlighten the question we aretreating, adds M. Gay Lussac, we will examine it ondifferent data to the above. It appears from the recentexperiments of M. Bourgery, that an adult man, breathingfreely, introduces into the lungs, at each inspiration, halfa quart of atmospheric air. He inspires fifteen times in aminute, and the heart pulsates 60 times during the samelapse of time. Let us suppose, as before, that the heartsends into the lungs 75 ounces of blood in the space ofa minute. Let us suppose also, in common withseveral observers, that the air expired from the lungscontains a medium of 4 l-IOOths of its volume of car-bonic acid. We are then led to this conclusion, that asthe volume of air introduced into the lungs in one minuteis 7 quarts 5, whilst that of the blood which passes throughthem in the same space of time, is 2 quarts 3, or 3.2Mtimes smaller, it is necessary, according to the law ofDalton (admitting that venous blood dissolves its volumeof carbonic acid), that it should contain carbonic acid

(t + 3.t6) X 4 = 17.0 per 100 of its own volume, inorder that it may give to the air in the lungs 4 1-100thsof its volume of carbonic acid, that is 13, representing, 13of oxygen. This is the minimum of carbonic acid thatthe blood should contain, and as the arterial blood alsocontains it, this minimum would be the difference ofthe quantities of carbonic acid contained in each kind ofblood.M. Magnus explains in a great measure the change in

the colour of the venous blood by the loss of carbonicacid which takes place in the lungs. Two reasons preventM. Gay Lussac adopting this opinion. The first is that ithas not been demonstrated that the venous blood getsrid of carbonic acid in the lungs ; the second is that sup-posing such were the case, the quantity of carbonic acidwhich it retains, according to M. Magnus, is so great inproportion to that which it emits, that such a remarkablechange in colour could not be explained by the loss of sosmall a portion.M. Gay Lussac closed his memoir by stating that the

theory of respiration supported by M. Magnus did notrest on a solid basis, that a fresh examination of thechemical phenomena of respiration had become neces-sary, and that he and M. Magendie were then engagedin making researches on the subject.

REVIEWS.

Scrofula; its Nature, Causes, and Treatment; and an the’ Prpiention and Eradication of the Strumous, Diathesis,

By W. TYLER SMITH, M.B. London : 1844.

! IT has often been a matter of surprise to us, that in theavalanche of medical monographs which every succeed-ing year brings forth, there should be few or none on adisease which forms so important a part of pathology asscrofula. And yet it is not owing to want of materials, forthere is scarcely any form of disease the knowledge of £

which has been more improved during the last twenty (Wthirty years. The labours of Laennec, Lugol, Louis,Andral, Baillie, Baron, Carswell, Sir James Clarke, andof many other writers, have tended directly to elucidatethe nature, connection, mode of manifestation, andtreatment of scrofulous diseases ; but no attempt haslately been made to connect the information which maybe derived from these various sources, and to present.tothe profession what our neighbours would call a corps dedoctrine. That such a task is fraught with considerabledifficulty no one who is acquainted with the subject camdeny. There are still many discordant opinions enter-tained by the highest authorities respecting the variouspoints which are above enumerated, and these discord:-ances can only be judged or reconciled by one who hashad great experience in scrofulous affections. This is themore true as scrofula is an essentially chronic disease,one the various phases of which require years, nay,generations, for their complete evolution in each indivi-dual instance. The knowledge, indeed, which is neces-sary to enable a physician to thus analyse, appreciateand co-ordinate the scattered elements of the pathologyof scrofula, can be obtained only by the experience of alifetime, or by a connection of years with those publicestablishments in which great numbers of scrofulous casesare congregated.We know not whether Dr. Tyler Smith presents

the above requisites, for he is extremely discreet, bothas to himself and as to his sources of information ; wecan, however, say unhesitatingly, that he has written avaluable work, one which will prove an acquisition to theprofession. We cannot state that his treatise containsmuch that is decidedly new, or that it is the last word ofscience, but.it certainly is a great improvement on thoseby which it has been preceded. It is written in a philo-

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sophical spirit of investigation and inquiry, equally distantfrom the credulity and fanciful theories of older writers,and from the scepticism of some modern physicians. The

sources of information which English medical literatureopens to the student have been duly resorted to and

appreciated. We do not, however, think that Dr. T.Smith has availed himself to the same extent of the more

recent French publications on this interesting subject.Dr. Smith’s work is divided into twelve chapters,which are headed as follows :-General View of theNature and Causes of Scrofula. On the Signs of theStrumous Diathesis. The Exciting Causes of Scrofula.Scrofulous Enlargement, Ulceration, &c. General Treat-

ment of Scrofula. On the Administration and Use ofIodine in Scrofula,. The Local Treatment of Scrofula.

On the Management of Scrofulous Children. The Eradi-

cation of the Scrofulous Diathesis. On the Treatment

and Removal of Scrofulous Scars and Deformities. On

the Marriages of Scrofulous Persons. On Medical Faith

and Royal Touching for Scrofula.What is the nature of scrofula ? This is a question

which has often been asked, but has not yet been satis-

factorily solved. Dr. Smith rejects the conceits of thewriters of former ages respecting the acidity or alka-linity of the blood or humours, and accepts the scarcelyless fanciful hypothesis of Dr. Todd, who having con-cluded, from experiments, that nutrition is composed oftwo processes-the production of organised lymph, andthe organisation or infusion of vitality into this organis-able matrix, " conceives that from a combination ofcauses this matrix, or coagulable fluid, may be depositedin a state below the natural and healthy standard;which, instead of forming living, normal tissue, degene-rates into an anormal, unorganised, and unorganisableproduct-tubercle."To prove how little is really known, even now, respect-

ing the true nature of tubercle, we may mention that, incontradiction to this theory, Bayle, Laennec, and Lugollook upon tubercle as an organised product, endowedwith distinct vitality and powers of nutrition,-- as, indeed,an abnormal tissue, which may be assimilated to cancer;and that Andral, along with a host of other pathologists,merely considering tubercle to be a product of secretion,carries his speculations no further.Another difficult point which Dr. Smith rather eludes

than attempts to solve, is the connection between scro-

fula and tubercle, and more especially between scrofulaand pulmonary tuberculisation. The uncertainty, doubt,and confusion which pervades all that has been written

on scrofula, in this respect, is also met with in Dr.

Smith’s work. It is evident that he has no clear percep-tion of the link that exists between scrofula and tubercle.

Thus, in page 3, he states that " the chief element in theactual formation of the disease is the presence of tuber-culous matter, which in scrofula is chiefly developed ordeposited in the glands, in the cellular tissue," &c. ; and

at page 6 and 7 he states " there is one striking pecu-liarity connected with scrofula which, perhaps, draws aline of demarcation between it and tubercular phthisis,namely, that the former disease may be developed with-out the actual presence of tuberculous matter." Again;;’ in some respects scrofula-though in the majority ittesembles consumption, in being cured by the samemorbid element-would seem to hold an intermediate

place between the softening of tubercle, as it occurs inthe lungs, and common suppuration." Indeed, we knowof no author who has been able to solve this problem,and therefore are not surprised to find Dr. Smith, like

many of his predecessors, so embarrassed as not to havedared to give a definition of the disease on which hetreats. The views of M. Lugol, of all living physicianscertainly the one who has had the greatest experience ofscrofulous disease, are, we think, correct, and at onceput the pathological question on its true basis. Theyhave not, however, hitherto been published by M. Lugol.He looks upon scrofula as a cachexia, with the intimatenature of which we are, and are likely to remain, totallyunacquainted. The highest manifestation of this cachexiais the production of tubercular matter, which is the

stamp, as it were, of the cachexia, and which may appearin any of the tissues of the economy. Along with thisproduction of tubercular matter, antecedently to it, orposteriorly to it, subacute chronic inflammations mayattack any of the tissues of the economy, but more espe-cially the mucous membranes, the skin, the bones, and thecellular tissue. These inflammations are manifestationsof the cachexia, and the cachexia is scrofula. If chronicinflammations present themselves in a child, we maysuspect that they are scrofulous, but we cannot assert itunless tubercles subsequently appear, or unless, from thepathological history of the relations of the child, it isevident that scrofula, or causes of scrofula, exist in thefamily. Thus does M. Lugol connect, as the result ofone common cachexia, various diseases which have been,and are still regarded by many practitioners, as separate ;or, at least, as diseases having but feeble connection toeach other; tabes mesenterica, struma, tubercular menin-

gitis, pulmonary phthisis, and all the scrofulous forms ofophthalmia, otorrhea, bronchitis, and all the scrofulousdiseases of the bones and joints which are described

by authors.Speaking of the causes of scrofula, Dr. Smith asserts

that the lymphatic temperament is the great predisposingcause of scrofula, an opinion which we think by no meansproved. He mentions, along with all authors, the here-ditary nature of scrofula, and admits that the diseasemay omit to attack one generation, and yet attack thesucceeding one. M. Lugol, who has been nearly thirtyyears physician to the Hospital St. Louis, with nearlytwo hundred scrofulous patients under his care, and whohas nearly monopolised, during the greater part of thattime, the scrofula consultation practice in the higher ranksof French society, has repeatedly stated to us his dis-belief in this doctrine. He has recently expressed hisopinions at some length on this subject in the work hehas just published on the causes of scrofula. Dr. Smith

lays great stress on the great influence of a poor diet inthe production of scrofula, and also mentions the similareffects of a vitiated atmosphere. We think, however, thathe has scarcely attributed sufficient importance to thislatter cause, which is as powerful, if not more powerful,an agent in the creation of the scrofulous cachexia. The

children of our artisans in towns are often more abun-

dantly and better fed than those of agricultural labourers,and yet the latter are infinitely less subject to scrofula thanthe former. We should class these causes according totheir importance, in the following order: -Hereditarypredisposition, vitiated atmosphere, bad and spare food.’

Dr. Smith gives a very elaborate description of thesigns of the strumous diathesis. These signs, are, how-ever, nothing more than the exaggerated characteristicsof the lymphatic temperament. They are quite distinctfrom those which, according to M. Lugol, indicate the11 scrofulous complexion." It would be melancholy in-deed, were all whose general habit corresponds with Dr.Smith’s description, to be threatened with scrofula. Such,

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however, we have not found to be the case as far as ourexperience goes. The following is M. Lugol’s very differ-ent portrait of the strumous diathesis :-" Scrofulousfamilies may be recognised by the general debility of theorganisation of the children composing it. Their physicalforms are devoid of harmony ; the trunk and the ex-

tremities are not proportionally developed ; the head is

too large ; the limbs are imperfectly connected with thebody, which is too long or too short, and also present thesame inequality in length. The articulations are too

voluminous. Their stature is also either too short or too

tall; the digestive functions are in a continual state ofatony. The face is pale; the eyelids are black; the

breath is fetid ; the skin and cellular tissue is either ex-

tremely thin-emaciated, or else peculiarly hypertrophied.With many children the skin is dry, and covered withpapulæ of lichen and prurigo." We perfectly agreewith Dr. Smith, in his assertion that dyspepsia doesnot generally precede or accompany scrofulous affec-

tions, as Dr. T. J. Todd maintains. We have repeatedlybeen struck with the ease with which scrofulous children,and scrofulous adults, digest the large quantities of foodthey often take. At the same time there can be nodoubt that it is seldom properly assimilated. We well

remember M. Lugol’s sister of charity quaintly statingto us, in reply to a question on this subject: " The un-fortunates are always hungry, and die eating."The account which Dr. Smith gives of scrofulous en-

largement, &c., is most complete, if we test it by theworks of English writers, but certainly rather incompleteif tested by the latest contributions to the pathology ofscrofula which have appeared in France, and more

especially by M. Lugol’s lectures and opinions. As,however, the latter are not published, we have no rightto find fault on that score. We should have wished,nevertheless, to see the history of tuberculisation at dif-ferent ages, and in different organs, followed out to a

greater extent. In early infancy, the lungs are often theseat of tubercles. In the first stages of childhood it is inthe mesenteric glands that tubercular matter is princi-pally deposited (tabes mesenterica), whereas in moreadvanced childhood, it is in the superficial lymphaticglands and cellular tissue. At the age of puberty, thelungs again become the principal seat of tuberculisation.This variable localisation in the economy of the tubercu-lar effort is well worthy of attention. Again, we miss a fullaccount of the chronic scrofulous inflammations of themucous membranes, skin, &c., as also of the bones. The

latter may either be the seat merely of inflammation andcaries, or of tubercular deposit. The history of thedisease is different in the two cases, and requires eluci-dation.The part of Dr. Smith’s work with which we are the

most pleased is that which is devoted to the treatment ofthis formidable disease, and to the management of scrofu-lous children. It is written with great care and judgment,and leaves little else to be said on the subject. The greattherapeutic value of iodine is duly recognised, and ampledirections given for its use. At the same time

proper stress is laid on the efficacy of tonics, ape-

rients, &c., which are undoubtedly most useful whendiscreetly used. The hygienic rules laid down by Dr.Smith are full and judicious. The chapter on the treat-ment and removal of scrofulous scars has a practicaltendency which must render it valuable. We are sorryto have to end our review of Dr. Smith’s work by dissent.but we cannot agree that the royal touch, to which

he devotes his last claper, could have any local efficacy,

We admit that the favourable impression produced onthe patient’s mind may have had, in some cases, 2kfavourable effect, and may have tended to increase theefficacy of a judicious, well-ordained treatment; but, evenin these cases, we should deny to it any local influence ;and when no other treatment was resorted to, it couldnot have been of any avail whatever. The cachcxise arenot forms of disease in which hope and confidence alonesuffice to work a cure. The composition of the solids andfluids has to be modified. ’

BRITISH AND AMERICAN MEDICALJOURNALS.

THE EMPLOYMENT AND ACTION OF DIGITALIS IN CERTAINDISEASES OF THE HEART.

IN the Northern Journal of Medicine we find a commu-nication from Professor Henderson on this subject.Agreeing fully in the power which digitalis possesses ofdiminishing the frequency of the heart’s action, and thesalutary influence which it consequently exerts over

many of its diseases, the author wishes to show that inall those diseases this influence is not the same; in someinstances the use of this agent being injurious rather thanbeneficial. Thus, for example, as had been previouslypointed out by Dr. Corrigan, in cases of patency of theaortic valves,

" The characteristic operation of digitalis is so muchless beneficial than in other diseases of the heart, or isactually so injurious that it becomes a highly importantpractical rule to abstain from the prolonged or repeatedadministration of it in the disease in question." .

The operation of this influence is thus explained by Dr.Henderson :-

’

" Patency of the aortic opening, at that period when,the ventricles are being filled, necessarily admits of re-gurgitation from the aorta, the effects of which are aitoverloading of the left ventricle, and gradually anenlargement of it. Such being the tendency and issue ofthe overloaded condition of the organ which results fromthis regurgitation, it will be granted that whatever in-creases the amount of the regurgitation must acceleratethe progress of the enlargement. That the less frequentlythe heart beats the greater will be the opportunity forthis regurgitation, is sufficiently obvious ; and hence it isthat the prolonged employment of digitalis cannot but beinjurious when the aortic valves are not competent fortheir office."On the other hand, the most favourable results are

. found to follow the use of this drug in disease affectingthe mitral valves. Disease of these valves gives rise toone of two effects, or to both at the same time, viz., ob-struction to the flow of blood from the left auricle to itscorresponding ventricle, or to regurgitation of the samefluid from the ventricle to the auricle : —" When either of these occurrences amounts to a con-

siderable degree, and is of long continuance, hypertro.phy of the right ventricle supervenes, and then it is thatthe sufferings from dyspnoea are developed, and thatdropsical effusions take place. The circulation throughthe heart is materially impeded, and the lungs -partlyfrom this cause, and partly from the augmented power ofthe right ventricle-placed, as it were, between two fires,become overloaded with blood, and distressed with thesense of suffocation. And not only so, but the wholevenous circulation becomes retarded, and congestion$occur in distant viscera. Superadded to the meremechanical imperfections which result from the diseasesof the opening, and the hypertrophy of the right ventri-cle, an increased frequency of the actions of the heartvery commonly attends, either as a permanent occursrence, or as an occasional event dependent on bronchiticattacks, and, usually, in proportion to this frequency arethe distress from dyspnoea and the amount of thedropsy."