gance; and we cannot but be of opinion that the improvement of medicine will, during the next century, proceed much in that direction. More accurate investigation of the fluids in a state of health will lead to a fuller acquaintance with the changes effected in them by disease, and it is not forbidden to us to hope that more direct means may eventually be discovered of checking several diseases than we have yet ventured to suppose the existence of. This probability, however, has been recently disputed; the chemists, on the one hand, being accused of expecting too much from their science, and the physiologists, on the other, reproached with a neglect of chemistry. Dr. Thomas Thomson of Glasgow, a chemist of the first reputation, and a man of great knowledge and great wisdom, expressed himself on this subject in the following terms, in a work published a few years ago : "I need not observe to those gentlemen who have paid attention to the subject, that by far the most likely means of improving physiology is a cautious application of chemistry to the investigation of the different constituents of the human body. An accurate knowledge of the chemical composition of every organ, and of the alterations produced on that organ by disease, would probably throw new and unexpected light upon the nature and treatment of many diseases. Physiology hitherto has been handled almost exclusively by the anatomists. These gentlemen have acted with a zeal and industry that cannot be too much admired.***** A new and more subtile species of anatomy remains still to be applied. Where the labours of the anatomist terminate, those of the chemist should begin. This chemical investigation of the animal body may be just said to be commencing at present; for it was not till the atonic theory was brought to considerable simplicity and perfection, that such an investigation was possible. It is easy to see that it must contribute prodigiously to the advancement of physiological knowledge."* tice of medicine will ever rest on chemical principles alone. [Of late, increased attention has been paid to chemistry, owing to the researches in organic chemistry of Liebig, Boussingault and Dumas, and others; but they do not modify the inferences expressed above.] There is much reason to believe that the advantage derived from medicines in some states of disease arises from the changes they effect in the intimate elaborations carried on within the blood-vessels, and of which the products are the various healthy and morbid secretions. Such would seem to be particularly the case in the instance of specific inflammations; and the same is very probably true as respects several or all of the morbid formations. The disposition of a scrofulous constitution to wards the formation of tubercles is probably connected with as definite a change in the character of the blood as that which more palpably, and by gene ral acknowledgment, exists in chlorosis and in scorbutus, in some fevers, and in the Asiatic cholera. In many of these cases, as well as in colica picto num, and in the tremours produced by exposure to mercurial fumes, it cannot at present be decided how far the supposed sanguineous detriment exists, or if existing, to what extent it is combined with, or even dependent on, injury of the nervous system. In several disorders which the pathologist unhesitatingly admits to be nervous in their character—in tic douloureux for example-the cure by specific modes of treatment seems to depend on some change wrought in the condition of the nerves or nervous system itself different from mere sanguineous excitement or congestion, and differ ent from deficient supply of blood. The whole subject of nervous pathology is in great obscurity. It is possible that the minute ramifications of the several nerves may possess various properties as distinct from and to as great a degree independent of those of the larger nervous masses as are some of the functions of the capillaries from those of the heart; and a knowledge of such properties, if existent, must be preliminary to any near approach to correct principles of treatment in nervous disorders. More recently, Dr. Prout has expressed him self in terms more sanguine: and to the controversy which ensued between this distinguished pathologist and Dr. Wilson Philip, a physician A few medical applications require to be sepawho stands peculiarly characterized by the philo-rately alluded to, as being employed on mere mesophical spirit with which he has cultivated physi- chanical principles;-demulcents in irritations of ology, pathology, and the practice of medicine, the mucous passages; some of the anthelmintics, as reader might with less hesitation be referred, if the the filings of tin; and various emplastra, when discussion had not provoked more discourtesy than the intention is to give support to subjacent or should ever be shown by great improvers of neighbouring parts. None of these require furscience, to whom truth alone should be of any ther observation. real consequence. All parties and all authorities will, we believe, at least concede that chemistry may and will prove a valuable auxiliary to physiology and to pathology; and that its subsequent application to the treatment of diseases may not unreasonably be expected. No one will be found, we imagine, to contend that chemistry will ever explain every thing in physiology, or that the prac * An Attempt to establish the First Principles of Chemistry by Experiment. By Thomas Thomson, M. D. Regius Professor of Chemistry in the University of Glasgow, &c. &c. Lond. 1825. Introduction. † See the Report of Dr. Prout's Gulstonian lectures, and the whole controversy, in the Medical Gazette for 1831; also a paper in the same volume by Dr. Stevens, on the Treatment of Malignant Diseases. The principle of treatment sometimes recommended in chronic and obstinate diseases, and spoken of in the article disease, that, namely, of producing some strong impression or commotion of the system, in the hope that the system may, in such an artificial and general disturbance, rectify or right itself, might, in different cases, produce its advantages by acting on the nervous or on the vascular system, or on both. As views of treatment become more and more understood, such treatment, however, will be less and less resorted to; and if sudden and violent measures should be thought desirable in lingering states of disorder, the principles of their application and use will be better comprehended. It may be observed that much of the success of irregular practitioners | these indications are very various; and if the seems no less to depend upon this principle than that part of the benefit often ascribed to the use of various mineral waters arises from the general change of diet, regimen, and habits of life, with which a temporary residence at watering places is almost in all cases accompanied. The principle by which these circumstances effect favourable changes in the health seems especially deserving of consideration, both in such cases of chronic disorder as are connected with morbid conditions of the nervous system, including those which especially and in various degrees affect the mind; and in all diseases which depend upon, or which have induced, an altered condition of the blood. Careful consideration will generally show, even in chronic, and obstinate, and anomalous maladies, some clear indications to be followed for the relief of the patient; and in the cases in which any expectation of a perfect cure is to be indulged, the means of effecting it can hardly ever be wanting to those who can reasonably entertain the expectation. The very principle on which relief seems sometimes to be obtained by changing the habits of the patient in many particulars, may perhaps be found, if inquired into, to be resolvable into that of removing some unexpected cause of irritation, which removed, digestion and assimilation, and the proper distribution of venous and sanguineous energy are restored, and the balance of health is regained. The means of relief will still be found to have been something which has imparted power or stimulus to overcome the morbid obstacle, or something which has directly allayed some morbid irritation; or, lastly, something which has produced a delayed or much required evacuation of some morbid material, or something which has improved the state of the blood. The principle of relieving long-continued ailments by attention to the digestive organs is spoken of by Dr. Heberden in his Commentaries.* It has of late years gained much attention in this country, and still more on the continent, insomuch that practitioners have not been wanting who have ascribed every possible disorder to primary digestive derangement. A direct improvement of the blood is a very probable consequence of such a plan, and various ameliorations of nervous and vascular actions may follow, or may only accompany this change. The first principles of practical medicine, then, are few and simple. In a work every article of which is an illustration of those principles, we need not dwell longer on the principles themselves. It may almost be said, employing the words of Hoffmann, that there is no other method of cure, and that there should be no other intention in the physician, than to reduce to order the actions and excretions when not in a natural state; and that all kinds of medicines do but this, to allay actions which are excessive, and excite or promote and equalize those which are depressed and obstructed.f But the means of fulfilling * De Ratione Medendi. See also Baglivi. In chronicis pauca remedia requiruntur semper tamen in monorum diuturnitate consulendum est digestioni bus. Animadv. Pract. Nov. † Neque aliam dari medendi viam, vel etiam medentum debere esse intentionem, arbitramur, quam ut mo tus et excretiones, a naturali statu desciscentes, in ordinem reducant. Omnia enim remediorum genera id tan▼ judgment of the practitioner is exercised in their application, so their increase and diversified combination afford equal scope for his ingenuity and invention. Departing from all rational principles, physiological or pathological, the physicians of the middle ages vainly sought some universal medicine which should accomplish every varied indication at once. Such dreams have long ceased to be indulged in, although some base pretenders yet insult the public sense by professing them; and the only hope of attaining to principles of universal application depends on the gradual improvement of our knowledge of all the actions of the body in health and disease. The principles of medicine, not dependent solely on a doctrine of solidism or of the humours, lead, therefore, to no extreme and exclusive practice; and the influence of the moving powers is admitted without excluding just views of their solid and fluid results. The mutual dependences of the nervous and vascular energies, and the properties of and changes effected in the blood, being all taken into consideration, we admit nothing but what is known, and wait for further explanations from the constant progress of all the sciences connected with medicine. From early infancy even to extreme old age, the few principles now enumerated seem at present to be the constant guide of our art in its attempts to rouse, to regulate, or to appease, actions insufficient, or too disorderly, or too energetic, to be consistent with comfort, with freedom from uneasiness and pain, or with the maintenance of health and strength of body or of mind. In all the varieties of their application, the object is to restore healthy actions as soon, and with as little waste of strength, and with as little suffering as possible: or, as a fashionable physician of ancient Rome was in the habit of professing to do, cito, tuto, et jucunde: and where a cure is out of the power of our art, the same principles lead to means of relief by which life is made comfortable for a long period, during which the patient if left to nature would be consigned to misery. The time may come, when, guided by yet undiscovered knowledge, and new and more direct principles, the tendency to tubercular and other morbid formations may be surely checked; chronic inflammations readily cured; and fever suspended in its first movements. But the day of these triumphs is yet distant. Hoffmann mentions it as the first criterion of a man skilled in the medical art, to know “cur et quare hoc vel illiud alimentum ad valetudinem conservandam morbosque sanandos salutare vel minus tale sit dicendum ;" and he quotes with deserved praise the eulogium of Thuanus on Hollerius, a famous physician of Paris, who by constant meditation had so improved his judgment, that he often cured those ill of such deplorable maladies as the other physicians of the time, "riding rapidly through the streets," (per vicos vaga cursitatione mulos fatigantibus,) knew little or nothing about. We may confidently recommend to the student the diligent perusal of the works of the admirable tum præstant, ut vel nimis auctos motus sedent ac moderentur, vel depressos et impeditos excitent, promoveant et rursus æquéles reddant. Opera omnia, Præfat. of another generation. A long existing defect in this respect has doubtless obscured the principles of practice, and in many instances quite shut them out of the practitioner's view during his whole life.* physician whom we have here and already more | of this admirable method will be the inheritance than once quoted in this article. His learning and admirable good sense, the liberal spirit in which he viewed all parts of medicine, his discrimination as regards the innumerable controversies existing in his time, his wise direction of the medical practitioner's mind to things concerning which the senses could give information, things useful and about which men could speak reasonably," quæ in sensus incurrunt, quæ usum habent, et de quibus evidens ratio constat et dare potest,"-rather than to subtile disquisitions relating to things more obscure ;-these and many other merits have not only endeared his name to learned physicians, but to liberal scholars, from the time when his writings appeared to the present day. Notwithstanding the subsequent undoubted advancement of medicine, there are few pages of his voluminous works to which the practical physician may not yet refer with advantage. The number of writers in whose publications any specific notice of the abstract principles of medicine is to be found, is not very great. We do not mention writers professedly on the practice of medicine, whose works are like the separate articles of this work, illustrations of principles. Many valuable observations occur in Baglivi, (Opera Omnia, Lugd. 1733), and many ingenious ones in Cabanis, (Du Degré de Certitude de la Médicine); the works of M. Broussais, amidst much false and much doubtful theory, contain views and principles both original and important. In Dr. Heberden's Commentaries will be found a sensible chapter, De Ratione Medendi, and another in Dr. Gregory's Conspectus Medicinæ Theoreticæ, with the same title. Dr. Burne made it the subject of an excellent oration delivered to the Medical Society of London a few years ago, and since published. And we may mention, that in the Outlines of Pathology, just published by Dr. Alison, the English reader is for the first time presented with so clear, condensed, and comprehensive a view of the whole subject of disease, as can hardly fail to lead those who read it with care and reflection to a knowledge of the principles by which their practice should be regulated in all diseases. At the same time, no reading nor reflection can make a good practitioner. Like an able orator, he must add to all the rules of his art daily habit and practice. His mind must be continually presented even with numerous examples and illustrations to guide and assist his judgment, and to correct the errors of reasoning on a practical subject. The symptoms of disease may be well understood and remembered, and the general principles of practice; but the treatment of diseases comprehends a multiplicity of details, essential or indispensable to the cure, and yet which easily, or almost inevitably, escape the memory of him who, although thoroughly grounded in the principles of medicine, is not continually exercised in prescribing for the sick. The great utility of teaching by examples, selected at the bed-side, or by what is called clinical teaching, so long neglected in this country, and for the introduction of which we owe so large a debt of gratitude to Rutherford and Cullen, begins to be universally acknowledged. The full benefit But, if so engaged and so prepared,-by the principles already mentioned, and by others hereafter to be discovered, or by additional means of fulfilling the indications of medicine, the practitioner of the medical art has the privilege of feeling assured that he is useful; and the art itself, thus guided, and in every stage of its imperfection even to its final advancement, will continue to be of most singular service to mankind; relieving the sick, to use the expressions of Hippocrates, from the greatest of evils, from diseases, from pains, from sadness of mind, and from death. By no one circumstance, we would add, will the practitioner find himself more assisted in his practical efforts, more enriched in practical resources, and better able to command them in all emergencies, than by the cultivation of a sincere and anxious desire to relieve his patients from whatever physical evils oppress them :-in all the varieties of his practice, no other feeling will so surely and so happily stimulate his mind. J. CONOLLY. MELENA. - This name (μέλαινα νοῦσος, the black disease,) was adopted by Sauvages from the writings ascribed to Hippocrates, to designate a genus of disease which he defines, “Alvifluxus materiæ nigricantis, atro-rubræ, dejectione aut vomitione frequenti notatus ;" and this is the sense in which it is generally employed by modern nosologists and practical writers. We mean, therefore, by melana, the occurrence, as a symp tom in any disease, of very dark-coloured, grumous, pitchy, often highly-fetid evacuations by stool, commonly joined with sanguineous vomiting; or we use the word as the name of a disease in which such evacuations, with or without vomiting of blood, constitute the characteristic symptom. In these two senses authors speak of symptomatic and idiopathic melana; but even where the latter phrase is with most propriety employed, the hemorrhage may generally be traced to some constitutional disorder or local organic disease as its primary cause. It has been mentioned in the article HEMATEMESIS, that there is so close an affinity between that disease and melana, that often they are not easily to be discriminated. Hæmatemesis is properly an hemorrhage from the mucous membrane of the stomach, and is chiefly characterized by vomiting of blood: melæna properly consists in hemorrhage from the mucous membrane of the small membrane, and is chiefly characterized by the dark evacuations by stool which have just been described. But as Edinburgh, the reader is referred to Dr. John Thomson's *For an account of Dr. Cullen's clinical teaching in recently published life of Cullen. Every pupil of the great school of Edinburgh must rejoice to see the reputation of one of its greatest founders, and one to whom practical medicine is so immensely indebted, placed in its true light by a man of learning and science, and rescued from the superficial criticism in which it has of late years been too much the habit of a certain class of wri ters and lecturers to indulge when mentioning Dr. Cullen's practical works. these two symptoms very frequently concur in the same case-as blood poured out by the stomach is often carried downward into the intestines, and blood effused in the duodenum may pass upwards through the pylorus into the stomach; and as, moreover, these two hemorrhages are so much akin to each other in their seats, their causes, pathology, and treatment, a distinction between them is not always easy, and is seldom practically important. There exists, how sufficient distinctions between them in all these respects to make it proper to treat of them separately in a system or a dictionary of medicine. Synonymes. Médaiva vodoos?(Hippoc. de Morbis, lib. ii.) Morbus niger; Fluxus spleneticus; Melæna splenetica (Sauvages); Secessus niger (Hoffmann). ever, The description of the paiva voucos by the author of the treatise "On Diseases" ascribed to Hippocrates, is rather a matter of literary curiosity than of any practical importance. It is in the following words, translated as literally as the English idiom will permit: "The patient vomits black bile (péλaivav), resembling lees of wine; at other times a matter resembling blood. Sometimes the matter vomited resembles the second wine, (oivov ròv dɛúrepov, that obtained by putting the grapes into the winepress :) sometimes it is like the ink of the cuttlefish; sometimes it is acid, like vinegar; sometimes it consists of saliva and thin phlegm; sometimes of greenish bile. When the black blood-like matter is vomited, it smells like putrid or sanious blood (dokei olov póvov ošetr). The fauces and mouth are scalded by the acrimony of the vomit; it sets the teeth on edge, and effervesces with the earth on which it falls; (this is probably the meaning of tǹv yňv aïpɛɩ.) When the vomiting is over, temporary relief ensues; but the patient cannot bear either emptiness or fulness of the stomach, the first causing flatulence and acid eructations, the latter a sense of weight at the præcordia, and a feeling as if the breast and back were pricked with sharp instruments. There are aching pains of the sides; a slight fever; the sight grows dim; and the patient is unable to stand. His complexion turns dark-coloured, and he becomes emaciated." Such is the description of the disease: the treatment it is unnecessary to give at length, even were it possible to render it faithfully. As far as we can understand it, it consisted in purgatives given frequently, (pápμakov MiniσKELV Oapà,) emetics, (papuakonorías ràs avw,) and afterwards venesection, if not forbidden by debility; a diet of whey, milk in the proper season, and whatever is cooling and laxative, excluding sweet, oily, and rancid articles; emollient clysters, if required on account of costiveness; a great quietude,' and regularity of regimen. If these things be done," adds our author, " the disease, as age advances, is removed, even if it remains in the habit till old age. But if the skin assumes a dark hue, it (quere, the colour or the disease?) will continue till death." It is remarkable that the above description contains not a word respecting the black discharges by stool, which, with Sauvages and the moderns, characterize melæna, though this sympton (boχωρήματα μέλανα, ὁκοῖον αἷμα) is often mentioned in other parts of the Hippocratic writings. Hoffmann treats at considerable length of hæmatemesis and melana, the latter of which (vomitus cruentus cum secessu nigro) he considers by far the more dangerous form of the disease, and identical with the morbus niger of Hippocrates. (Opera Omnia, tom. ii. p. 214.) Sauvages introduced the name of melæna to denote this particular disease. He makes it a distinct genus, and assigns to it several species, some of which appear to be founded on observation, if not on correct pathology; others are hypothetical and fanciful. Although Cullen has omitted melæna in his catalogue of diseases, he gives some account of it in his "First Lines," principally with reference to its pathology. Morgagni, Haller, Lieutaud, Tissot, (Epist. ad Zimmermann. Epistolæ Medico-Practice, 12mo. Lausannæ, 1782,) but especially Portal, (Mémoires sur plusieurs Maladies, tom. ii. pp. 129, seq.) have, among continental writers, mainly contributed to advance our knowledge of the history, pathology, and treatment of this disease. The series of cases and dissections recorded by Portal are particularly worthy of diligent perusal. In the publications of our own country, Dr. Francis Home, (Clinical Exper. and Hist. p. 127,) Dr. Marcard, (Edin. Med. Commentaries, vol. iv. p. 203,) and more recently Dr. Brooke (Irish College Transactions, vol. i. p. 124,) and Dr. Cheyne (Dublin Hosp. Reports, vol. i. p. 259,) of Dublin, Dr. Ayre, (On Marasmus, pp. 113, 117, first edit. 1818,) and Dr. Belcombe, (Med. Gazette, vol. iv. p. 109,) have recorded instructive cases and dissections of this disease. But there are few subjects in pathology which stand more in need of fuller and more careful investigation. General history and symptoms.-Melæna, as well as hematemesis, so generally occurs as a symptomatic affection, that a description can hardly be framed which shall embrace all the va rious symptoms by which it is accompanied, according to the various causes which produce it. A much better notion of these will be gathered from a perusal of the cases above referred to, especially those so admirably detailed by Portal, than from any general description. The following may, however, be taken as a comprehensive view of the usual course of what has been termed idiopathic melæna. The patient has for a considerable time shown symptoms of progressive constitutional disorder; the functions of the stomach have become debilitated; those of the liver and the bowels are imperfectly and sluggishly performed. The countenance has assumed a sallow, dusky, or "leaden" hue; the adnate of the eyes have become dull or gible, but seems to indicate that the disease in question is one of a very chronic nature and slow of removal; ταῦτα ποιεῖν· καὶ ἅμα τῇ ἡλικίη ἀποφεύγεται καὶ ἡ νοῦσος, El kai karayýpaokei oùv tỹ owμari îv de pedavoy, ovvaTo@vhaKEL. The two other diseases, called åλλŋ μédaira νούσος, and σφακελώδης (νοῦσος) have nothing to do with our present subject. and spleen has been found in cases where the symptoms had led to suspect them to exist during life. It is highly desirable that in future investigations not only the state of these viscera he most carefully examined, but also the condition of the circulating system, and especially of the heart and great vessels, morbid alterations in which have only of late begun to attract a proper degree of attention, as causes of venous congestion and of passive hemorrhage. greenish; the tongue is furred and clammy, or the bowels. Morgagni records a case where the more or less dry; the breath often tainted. The whole tract of the intestines was found" horribly pulse is habitually frequent, or is periodically ac- inflamed." But much more frequently no trace celerated towards evening; in other cases it is of disease is discovered in the stomach and intesintermitting and irregular; and there are palpita- tines; these organs have on the contrary been tions of the heart, or a pulsation at the epigas- found remarkably pale and exanguious, (Mortrium. The symptoms altogether are those of gagni) while marks of congestion appeared in the aggravated dyspepsia, to which are often super-turgescence of the mesenteric and gastric veins, added those of visceral congestion. On examina- loaded with dark-coloured blood. (Portal.) Chrotion of the abdomen there is to be felt a circum-nic enlargement or structural disease of the liver scribed enlargement of general tension and fulness in one or more of the abdominal regions; sometimes also tenderness to the touch. Upon the occurrence of any exciting cause of hemorrhage, an attack of melana is induced, which is most commonly, but not always, accompanied by hematemesis, and at any rate with the same or very analogous symptoms. After complaining of much præcordial oppression and anxiety, tensive pain of the hypochondria, or dull pain at the scrobiculus cordis, with nausea, general uneasiness of the abdomen, and more or less tormina,-together with the common hemorrhagic symptoms of giddiness, coldness of the extremities, a tendency to faint, &c.—the patient is suddenly seized with vomiting of dark-coloured blood, together with a discharge, by stool, of blood of the same appearance, or more frequently of a very dark and often extremely fetid semi-fluid mass, of the consistence and colour of tar. Sometimes this discharge by stool occurs without any vomiting: it is invariably accompanied by great faintness and exhaustion. Occasionally the black matter discharged by stool is mixed with blood of more unequivocal appearance, or with dark-coloured bile, which may be distinguished from the former by dilution with water; which brings out a yel-casion hemorrhage in general, as intemperance or lowish or greenish tinge. In some comparatively rare cases, the matter discharged by stool and vomiting is of a sooty blackness, (olov nódunov Ooddy, Hippoc.) has no smell, and assumes neither a bilious nor sanguineous tinge on dilution with water: this appears to be the true melanosis of the ancients. For some time after the cessation of the hemorrhage the patient remains in a very weak and precarious state, extremely liable to its recurrence, and requires to be carefully watched. Even after the attack appears to be entirely over, a predisposition to its return remains, and unless this be overcome by medical treatment, or by the resources of the constitution, it will in most cases ultimately prove fatal. Appearances on Dissection. — Although a considerable number of dissections of patients who have died of this disease have been recorded, the subject is one which stands in need of much further investigation with a view to a satisfactory pathology of the several varieties of melæna and hematemesis. It is sufficiently established, by the researches of Portal, Andral, and other morbid anatomists, that no lesion of the mucous membrane of the stomach and intestines, except in some very rare cases, is to be met with in cases of gastric and intestin 1 hemorrhage. (See HEMATEMESIS.) Causes. The predisposing and exciting causes of gastro-intestinal hemorrhage have been pretty fully considered in the article HEMATEMESIS, and therefore it is not necessary to prolong the present article, by recurring at any length to this part of the subject. Organic disease, a cachectic or greatly debilitated state of the constitution, sedentary employment, intense anxiety and close application to business, and a full and stimulating diet, with neglect of air and exercise, are the most usual predisposing causes, to which must be added fretfulness and irascibility of temper. These causes are most apt to induce a predisposition to melæna in males about the age of forty-five or fifty, in females about the time of the cessation of the menstrual periods. The exciting causes are those which oc any kind of excess, but especially any violent mental emotion or struggle, and none so frequently as a burst of passion. This has often induced not. only a first attack of melæna or hematemesis, but the same cause has given rise to its recurrence at several times, when the patient seemed to be going on favourably, and to the final catastrophe, by bringing on a last and fatal attack. This is well illustrated in Portal's first case, (that of the botanist Aublet,) and furnishes a most important caution as to the moral management of patients who are predisposed to, and especially who have already suffered from this disease. Irritating and dras-tic purgatives are well known to occasion bloody stools, when injudiciously employed, and sometimes when given with every proper precaution: but they can hardly be supposed to induce a true attack of melana, unless where a great predis-position exists. Varieties of Melana.—It is important in melana, as in hematemesis, to distinguish with as much accuracy as possible the varieties which exist in the disease, or the species into which it may be distinguished, according to the nature of its causes, the kind of constitution in which it occurs, and the series of symptoms which precede or accompany it. It is evident that on such discrimination alone, a rational pathology or judicious theIn a few cases partial reddening, softening, and rapeutical system can be founded. The fullest oozing of dark-coloured fluid (similar to that dis- and most accurate enumeration of these varieties charged during the disease) is stated by Portal to which has yet been made, is that of Portal. (Op. have been observed in the villous membrane ofcitat. p. 211.) His species are the following:- VOL. III.-36 |