214. The plegmasiæ readily associate with scurvy, but are not caused by it—on the contrary, they are often the cause of scurvy, as we daily see in the gums. 215. Unimportant. 216. Dropsy acknowledges for its physiological causes, obstacles to the course of the circulation, sanguineous and serous -chronic phlegmasia-diminished capillary action—imperfect assimilation-and debility. 217. Irritation presents natural intermissions in a state of health.* 218. Morbid irritation may also present an intermittent character in any organic apparatus or system of the body. 219. Morbid irritation may assume the continued form in an apparatus, in a moderate degree, with periodical exasperations, falling back, in the intervals, to its ordinary level. In these intervals, when moderate, it excites but few sympathies; but in its stage of exacerbation it develops a great number :-these are the remittent fevers of authors. 220. Intermittent and remittent irritations are always accompanied with exaltation of the sensibility and contractility, and consequently with congestion, as well in the principal seat of the irritation, as in those parts which sympathise with it. 221. These intermittent and remittent irritations are, in fact, phlegmasiæ, hæmorrhages, neuroses, or sub-inflammations, which exhaust themselves, and terminate by some critical metastasis or discharge. If they fail to terminate in this way, they become continued phlegmasiæ, hæmorrhages, neuroses, or sub-inflammations, acute or chronic. 222. Intermittent and remittent fevers are periodical gastroenterites, in which the encephalon and the other viscera are sympathetically irritated, the same as in continued fever, and may become the principal seats of irritation or even inflammation, periodical or continued. 223. Each regular paroxysm of intermittent fever is a signal or sign of a gastro-enteritis, the irritation of which is transported to the surface, especially to the cutaneous exhalents, and thus a crisis of the paroxysm is produced. If the irritation is not • We think it would have been more correct for M. Broussais to have said, "excitement, or rather excitability, presents natural intermissions, in health;" and we rather think that this is what he means, for in the next proposition he talks of morbid irritation presenting intermissions. In this country we consider all irritations as morbid-giving the term excitement to the healthy state. See an interesting paper on intermittent irritations in the Periscope of this number. thus completely dissipated, the fever is remittent ;-if not dissipated at all, the fever takes the continued form.* 224. The masked, latent, disguised, or local fevers of authors, are periodical irritations of different systems or apparatuses, internal or external, but in which the heart is little influenced, and the general temperature but slightly exalted. 225. Those fevers which are called pernicious or malignant, do not differ from other fevers, except in violence, and in the danger of local congestions. 226. The dropsies which succeed intermittent fevers, always depend on one of the five causes or physiological modifications indicated in proposition 216. 227. The more ordinary external causes of intermittent fevers are atmospheric vicissitudes;-but every thing which acts on the animal economy in the way in which atmospheric vicissitudes act, may originate, and more especially reproduce these fevers.† 228. The cause of the periodicity of certain painful affections, and of certain convulsions, (as epilepsy) is not known. 229. Rheumatism is a phlegmasia of the fibrous and synovial structures, produced by atmospheric transitions; and it is not therefore surprising that it should sometimes take an intermittent or periodical character. 230. The articular periodical phlegmasia become wandering * The doctrine of fever as here delineated, is, to say the least of it, extremely ingenious. Indeed, with a very slight modification, it stands a chance of being the most durable theory which has ever yet been constructed. There is a strong disposition in the professional world to view fever as almost invariably dependent on topical inflammation, though they are not agreed as to the locality of the phlogosis. It has been seen that, in M. Broussais' views, inflammation and irritation are only different grades of the same thing, and there can be little doubt that, in every fever, there is local irritation, in one or more organs. This narrows the question much; for we can readily conceive the existence of both a continued and intermittent irritation, though, when the term is extended to actual inflammation, the idea of periodicity is repugnant to our notions of pathology. The only other difficulty which we have in admitting M. Broussais' theory, is the original locality of the febrific irritation. The extensive chain of sympathies between the stomach and various other organs, and still more the intimate relation that subsists between the sensorium and the stomach, must render it extremely difficult to say where the irritation first commences. Upon the whole, the theory of M. Broussais, thus explained, and somewhat farther modified, appears to us extremely feasible, and we do not see any material objection that can be urged against it, in its application to practice, which is a consideration of great consequence. + We much wonder that such an observer as M. Broussais should have passed over marsh exhalations, which are unquestionably the most powerful and frequent of all causes of intermittent fevers. These invisible agents we suppose he includes in the latter part of the proposition. or migratory through the way of sympathy, and terminate by crises; or by fixing themselves on some particular part, in an acute or chronic form, in the same way as visceral phlegmasiæ do, when left to themselves. 231. Gout does not differ from common inflammation of articular structures, except in the circumstances attendant on the age, manner of living, and idiosyncrasy of the individual. 232. Unimportant. 233. That form of articular inflammation called GOUT, is often, but not always, complicated with a degree of chronic gastro-enteritis, which modifies its progress, and invites irritation towards the viscera. 234. The liver is only affected consecutively in gout, in consequence of the gastro-enteritis which accompanies it. 235. The irritation of gastro-enteritis is communicated to the articulations through the channel of sympathy, in the form of arthritis or gout; but this is only when the articulations have been predisposed to inflammation by atmospherical vicissitudes or other causes. 236. The irritation of the articular phlegmasiæ is propagated to the stomach sympathetically, and may there become the predominant affection occasionally. 237. The multiplied infirmities by which the aged subjects of gout are tormented, can only be attributed to the sympathies between the head, stomach, and other organs, which, in time, establish sub-inflammations, neuroses, or even phlegmasiæ of various organs and parts. 238. In chronic phlegmasia of the articulations, the irritation always tends to proceed from the circumference to the centre. This indeed is the case with all other inflammations of the periphery. 239. The transformation of gout into another malady is nothing more than a change of seat in the principal point of irritation-the phenomena being modified by the functions and structure of the part to which the irritation moves. 240. It is absurd to give the appellation of gout to an affection which has not been preceded by articular inflammation: for to say that gout is transferred to the brain, when mania supervenes on articular phlogosis, is as much as to affirm that mania is transported to the great toe, when an attack of gout supersedes an attack of mania. 241. In retrocessions of gout, it is of no other use to inquire what was the part inflamed previous to the metastasis, than to be able to determine the best part to which it may be recalled, by way of revulsion. 242. Revulsion is difficult, if not impossible, in cases of what is called "MISPLACED GOUT," except where the organ attacked is free from structural disease. 243. The narcotic vegetables, and alcoholic substances, in large doses, excite gastro-enteritis, (at first without ulceration) and engorge with blood the encephalic vessels, producing, in bad cases, convulsions. They also engorge the lungs. 244 to 253 relate to the action of various acrid and powerful substances on the stomach and bowels. They need not be detailed here. 254. Putrid animal substances which the stomach is unable to digest, produce gastro-enteritis, with irritation and engorgement of the brain, giving rise to the symptoms of typhus by the intensity of nervous phenomena. But ulceration of the mucous membrane does not take place, except consecutively, and after a certain duration of the inflammation. 255. Putrid fish and poisonous champignons produce the same effects. 256. All the irritating and escharotic vegetables, animals, and minerals, when applied to the skin in sufficient quantity, develop in the mucous membrane of the stomach and bowels, in the brain, and sometimes in the lungs, an inflammation analogous to that which is produced on the surface of the body, through the means of irritation transmitted from the periphery to the centre. 257. Poisons of every kind, if injected into the veins, occasion gastro-enteritis, if they are not sufficiently powerful to occasion death before the inflammation has time to form. 258. The same may be said of putrid animal substances or sanies inserted into the living flesh, or injected into the vessels. They produce the same effects as if taken into the stomach. 259. The bites or stings of venomous animals, where poison is left in the wound, determine a local phlegmasia, passing quickly into gangrene, according to the intensity of the irritation. The more virulent of these prove fatal by their deleterious influence on the nervous system. But if life continues long enough, the inflammation is repeated in the principal viscera, especially in the line of the primæ viæ, with a strong tendency to gangrene. The weaker poisons of this kind are restricted in their operation to the production of local inflammation. 260. The bites of mad animals determine also inflammation of the mucous surfaces, which is often repeated in the pharynx, brain, and even in the lungs. The delirium and convulsions appear to be consequences of these irritations and inflam mations, varying according to the degree of susceptibility in the individual. 261. Worms in the bowels seem often to result from derangement of the intestinal secretions, and the increase of temperature attending inflammation of the mucous membrane, more or less acute. END OF THE PATHOLOGICAL DIVISION. We have now brought to a close the two sections on PHYSIOLOGY and PATHOLOGY, and hope we have done a service to the English profession, by presenting them with a more complete view of the doctrine of Broussais, or, as it is called, the NEW PHYSIOLOGICAL DOCTRINE, now so extensively prevailing on the continent. In our next Number we shall complete the subject, with the section on THERAPEUTICS, which is very extensive, and embraces a variety of the most important topics of discussion. II. MEDICO-CHIRURGICAL TRANSACTIONS. [Vol. XIII. Concluded.] ART. I. Hydrometra and Dry Gangrene. Dr. THOMSON. BEFORE We make any remarks on Dr. Thomson's case, we shall lay the particulars of it before our readers. Mary Rae, aged 65, was admitted a patient in the Infirmary of the Chelsea Work-house, April 1, 1823, having previously enjoyed good health, and reported herself of temperate habits till very lately, when grief for the loss of a husband induced her to take to the use of spirituous liquors. She had borne two children. On admission, she laboured under acute rheumatism, for which she was bled, purged, and took colchicum and oil of turpentine. In two months she was discharged convalescent; but, in five months afterwards she returned, being emaciated, and complaining of pain connected with a tumour in the abdomen, which she had perceived six weeks previously. This tumour was situated in the lower part of the abdominal cavity, rising as it were out of the pelvis, and occupying the iliac, |