de Pharmacie, Janvier, 1847), and also a substance resembling dextrin. It must also be stated, however, that Liebig endeavoured to detect sugar in the blood unsuccessfully. In such experiments, much must depend upon the method of investigation, and, as all those hitherto employed are liable to objection, it does not appear that we can give a distinct explanation of the destination of the sugar after it has left the intestines, although there is considerable evidence and probability in favour of the idea that a portion of the sugar derived from the starch of the food may circulate to a certain extent in the sanguineous system. But the circumstance which we observe, even out of the body, that starch and sugar rapidly change their forms when in contact with moist albuminous matter, would negative the notion that any considerable amount of sugar can exist in the normal blood. The rapidity, too, with which sugar can be converted into carbonic acid, renders the prospect still less likely. When we compare the formula of sugar and carbonic acid as represented by Liebig, we see that the only difference between these bodies is the replacement of hydrogen in the sugar by the oxygen of the atmosphere. (Liebig's Animal Chemistry, 3d edition, p. 108.)

Twelve atoms carbonic acid.

012

12

One atom grape sugar.
H,.
C13 12
12 0.

12

It is not necessary that the volatile form should be assumed at once by the sugar. On the contrary, it is probable that various intermediate stages are produced, such as, first, alcohol; then acetic acid, or lactic, butyric acids, &c., all tending to ultimate termination in carbonic acid, as represented by Liebig's formulæ.

But when such formulæ are exhibited to represent our notions respecting our present views of any chemico-physiological process, it should be borne in mind that the authors of such formulæ merely give them as indicating the direction in which such changes may occur, not as being absolute expressions of fact; and this must be considered as a great step in the progress of physiology. Within but a few years we had not the most distant idea that starch could be converted into the principal constituent of butter; but we now understand how this can be effected, and thus are able to appreciate the connexion between farinaceous and oily food, two classes of bodies which were formerly placed at the greatest possible distance from each other in our chemical arrangements, but which can now be made to pass rapidly into each other. Such inquiries as that to which we have alluded, together with many others which have of late occupied the attention of chemists, have originated in theoretical views, which, although not accurate in all their details, have been proved by subsequent researches to have been made in the right direction. Numerous voyages have been made towards the Arctic and Antarctic Poles: those who have commanded them, it is true, have not succeeded hitherto in reaching the desired goal; but they have all conducted their expeditions with proper precautions, and each voyager has added to the knowledge acquired by his predecessor.

ART. XIV.

Diagnostische und Pathogenetische Untersuchungen in der Klinik des Herrn Geh. Raths Dr. Schönlein, auf dessen Veranlassung angestellt, und mit Benutzung anderweiliger Beobachtungen, veröffentlicht von Dr. R. REMAK. Mit einer Kupfertafel.—Berlin, 1845.

Diagnostic and Pathogenetic Investigations in Dr. Schönlein's Clinical Works. By Dr. R. REMAK. With a Copper-plate.-Berlin, 1845. 8vo, pp. 250.

THE contents of this volume of observations are arranged chronologically, and are the results of his labours in Schönlein's clinique from the commencement of the winter session, 1843, to the end of the winter session, 1844. The three sessions occurring in this interval are represented by three separate departments: the first session yielding materials for eight articles, the second (the summer session of 1844) for three, and the third for ten. In consequence of this arrangement, we find observations on the same disease scattered through several parts of the book; thus we have three articles on abdominal typhus, and an equal number on pneumonia; and two on Bright's disease, glanders in the human subject, and on the signification and importance of the buffy coat of the blood. In addition to them, we have single articles on dysentery, scarlatina, spermatorrhoea, tubercle, the metamorphosis of thrombus, pus and mucus, porrigo lupinosa, fungi occurring in the mouth and intestinal canal, and certain forms of parasitic acari. From this ample store we shall endeavour to select the most important and practical matter.

Abdominal typhus. Remak has minutely described the microscopic characters of the excrements in this disease. After noticing the circumstance that the occurrence of crystals of ammoniaco-magnesian phosphate is not diagnostic of typhus, as Schönlein originally (Müller's Archiv, 1836) believed, he states that he failed in detecting any fixed relations between their quantity and the stage of the disease. They were generally the most frequent in the most liquid stools, and were rarest when numerous infusoria were present.

Granular cells resembling (but more delicate than) pus-corpuscles are frequently observable in the liquid evacuations. The whitish flocculi which we commonly notice in typhus evacuations, are merely fragments of undigested vegetable food. It is singular that cylinder-epithelium is never to be detected; in all probability the detached portions are altogether broken up within the intestinal canal. A small number of blood-corpuscles, more or less altered in form, may be often detected by the microscope; and fatglobules are by no means uncommon, even in cases in which no fatty matters have been administered. In one instance, on examining the diseased portion of the intestine, the epithelium investing it had a whitish appearance, arising from its cells being filled with minute dark (fat?) corpuscles.

The cryptogamic plants and the infusoria occurring in these cases are of comparatively little importance, and must be merely regarded as signs of the fermentation and putrefaction going on within the intestinal canal, in consequence of the deranged condition of the digestive functions.

Dysentery. Similar as are the ordinary appearances of the fæcal evacuations in dysentery and typhus, yet, examined under the microscope, they occasionally present striking differences. In the former, crystals of ammoniaco-magnesian phosphate are very rare, and the blood-corpuscles are not so much decoloured, nor so modified in form: moreover, long strings of coagulated fibrin are almost always intermingled with the corpuscles, indicating that the blood is derived from larger vessels and deeper structures. The granular cells already mentioned are, in this case, mixed with numerous flattened, spherical, and cylindrical epithelial cells, and the whole are imbedded in the structureless stroma (grundlage) of the mucus. Vibriones are scarcely ever present, but confervæ, and sometimes fermentationfungi, occur in great excess, and apparently in a direct ratio with the degree of acidity presented by the evacuation.

Bright's disease. Remak confirms the view maintained by Henle, that the cylinders occurring in the urine are not modified urinary canals, but simply coagula of fibrin moulded in those canals. He conceives that the granular appearance of the cylinders is due to the presence of urate of ammonia. He regards their presence as of great importance in enabling us to establish an early diagnosis of the disease, and states that by this means he has, on more than one occasion, determined the nature of the disease several weeks before the first appearance of albumen in the urine.

Scarlatina. In cases of scarlatina the urine often continues to deposit a white flocculent sediment for a considerable time after the process of external desquamation has ceased. This deposit consists, for the most part, of epithelial scales from the surface of the bladder; and as long as it continues to occur, the patient must be carefully watched, even though in all other respects his health be completely re-established.

Pneumonia. Remak has, as we have already mentioned, contributed three articles on this subject, extending collectively over the space of thirty-four pages. After noticing how few important facts have yet been elicited in the examination of the expectoration in inflammatory affections of the air-passages, he proceeds to remark that he is fully convinced that there exists a microscopic distinction between true pus-corpuscles and the mucus-corpuscles which occur in the expectoration in cases of pulmonary inflammation. The latter differ from the former, not merely in possessing the property of absorbing water, and consequently, of becoming swollen, but likewise in the circumstance that the substance in which the nucleus is imbedded, is a fine granular, almost pulverulent matter, in which, after saturation, molecular motions may be observed. It is only after imbibition that the burst and compressed mucus-corpuscles bear any resemblance to pus-corpuscles; and even in the purulent (?) expectoration occurring in the last stages of pulmonary expectoration, Remak has never detected cells, which, in the character of their granular contents, altogether correspond with pus-corpuscles from abscesses. Moreover, the granular cells occurring in puriform sputa are always deposited in a tenacious stroma peculiar to mucus, and never present in genuine pus.

In pneumonic expectoration he not unfrequently met with dark granular, roundish bodies, considerably larger than mucus-corpuscles, and probably identical with Gluge's inflammatory globule. As he has also noticed them in the tough mucus, loosened from the fauces on clearing

the throat, and likewise in the pulmonary vesicles of perfectly healthy cattle, it is difficult to decide their exact pathological importance. By far the most important of his observations in relation to the sputa in pneumonia is, that they invariably contain ramifying bronchial coagula. This peculiar form of expectoration may occur at different periods of the disease and in different quantities. It is not always easy of detection. Remak advises that the whole of the expectoration should be poured into a dark-coloured flat vessel filled with water, the colour enabling us to distinguish the white coagula from the mucous and puriform matter with which they are associated; or that the individual clots in which the presence of these coagula may be sus

pected, should be examined on a dark glass plate.

The bronchial coagula form ramifying cylinders pursuing a nearly rectilinear course, presenting a dichotomic arrangement, and gradually diminishing in length and thickness. The main stem is, however, usually thinner than the contiguous branches, and tapers off in a thread-like form at its free extremity. At the points of bifurcation we not unfrequently observe a slight dilatation, depending probably on a similar condition of the bronchial ramification. These cylindrical coagula are sometimes partially flattened, and are sometimes swollen at various points, the latter phenomenon being caused by inclosed air-bubbles.

The annexed engraving copied from Remak's treatise represents the natural size of different forms of these coagula.

These bronchial coagula are formed of extremely delicate threads running parallel to, and closely connected with, one another, and in most cases, either inclose or are covered with granular cells, closely resembling pus-corpuscles. Their strength and mode of arrangement are suggestive of areolar tissue, but the difference becomes marked on the addition of acetic acid; for although the fibres become perfectly transparent and a number of nuclei remain, yet they are evidently the nuclei of dissolved granular cells, and altogether different from the elongated variety occurring in areolar

tissue. Dr. Heintz has shown by a series "Ramifying bronchial coagula, spread on of chemical experiments that these co- Natural size. agula are formed of a protein-compound,

XLVI.-XXIII.

(From Plate, Fig. 4.)

13

but whether that protein-compound is fibrin or whether it contains oxyprotein is uncertain.

The bronchial coagula appear, in the majority of cases, between the third and seventh day of the disease, being rarely absent on the fourth and fifth. This observation applies, however, only to those cases in which the proper remedies have been applied from the commencement; for in a man in whom the disease was allowed to go on unchecked, and there were signs of hepatization before any treatment was adopted, they were not apparent till the fourteenth day.

The characters of the expectoration in the three stages of pneumonia are well known in the first stage the sputa consists of gray, stringy, viscid mucus, usually tinged with blood; in the second stage it consists of whitish, firm, clotted masses, whose white delicate fibres extend to the bottom of the vessel; and lastly, it forms soft roundish masses of a white or yellow (puriform) colour, without dependent mucus-fibrils. The bronchial coagula occur in the first and second but not in the third form. When they are found during the first stage they are very thin, not thicker than fine threads, and give off few branches; when present in the second stage they are stronger and ramify to a greater extent.

In making these examinations, the difference between the dependent white mucus-fibrils and the bronchial coagula may be easily discerned, even without the use of the microscope, by spreading the expectoration on a glass plate, when the white mucus-fibrils can be readily drawn out with a needle in the form of a delicate membrane, while the bronchial coagula, from their firmness, resist such an attempt, and are further rendered sufficiently conspicuous by their constant ramifications.

Remak next considers the connexion between the expectoration of these coagula, and the phenomena of auscultation and percussion.

The appearance of the delicate coagula imbedded in viscid mucus is generally simultaneous with that condition of the lungs in which the crepitation is the most marked while at the same time the sound evolved on percussion indicates that the substance of the lung is partially impervious to air; the firmer coagula usually occur at the period when the crepitation has given place to bronchial respiration, and the dullness on percussion indicates the existence of hepatization.

One important practical result deduced from Remak's observations, is that the earlier the expectoration of the coagula commences, and the more abundant and continuous it is, so much the more certain and speedy will be the cure. In the ordinary course of pneumonia in vigorous persons, the delicate coagula appear in the first viscid mucus that is expectorated, and continue increasing in quantity and size till the fifth day of the disease; decreasing gradually from that period, until white, easily compressible masses of a cylindrical but non-ramifying form appear in their place, exhibiting, under the microscope, indications of the fibrous structure of coagulated fibrin, and a multitude of granular mucus-corpuscles.

In the fifty cases of pneumonia observed by Remak, there were not more than four or five in whom even a partial diminution of the symptoms occurred previously to the appearance of the coagula in the expectoration, while in the great majority an amendment was first observed after their occurrence. In the few cases in which the proper remedies had not been