the whole frame, in those who suffer from obstruction in the windpipe, or die from hemorrhage. The sensation seems to have its origin in the heart and lungs: being conveyed to the sensorium, it produces those phenomena through the medium of the respiratory nerves. Through this sensibility, the heart and lungs are so combined, that, in all the variations to which they are liable, they are still found to correspond; the accelerated action of the one being directly followed by the excitement of the other. If there be an increased activity in the heart, it is necessary, for the circulation of the blood, that the apparatus moving the lungs should be accelerated in a corresponding degree: and, as the lungs themselves are passive, the influence must be sought for in those muscles which move the chest, the throat, and the nostrils. "It is this painful sensation that introduces us to this breathing world,' which guards the vital functions through life as it draws us into existence. Pain is the agent which most effectually rouses the dormant faculties of both mind and body. While the child slumbers in the womb, it does not live by breathing, it possesses an organ which performs the office of the lungs. In the birth there is a short interval, betwixt the loss of the one organ and the substitution of the other: nor would the breath ever be drawn, or the lungs perform their function but for this painful and irresistible viscus which calls the whole corresponding muscles into action. Spasms and contractions are seen to extend over the infant's chest: the features are working and the muscles of the face agitated, probably for the first time: at last air is admitted into the lungs, a feeble cry is heard: the air in successive inspirations fully dilates the chest, and the child cries lustily: Now the regular inspiration is established, and the animal machinery subsides into repose." "We came crying hither; "Thou know'st the first time that we smell the air In various powerful affections of the mind, there is a sensation referred to the breast, the existence of which is manifested by external signs. Emotions have been classed by writers on metaphysicks separately from the intellectual states of the mind, on account of the peculiar "vividness of feeling" which belong to the former. It would appear that simple consciousness is too dull a medium for these affections of the mind to be impressed through it alone; and there is added an excitement * Essays on the Anatomy of Expression by Mr. C. Bell. Second edition. of the frame, which gives intensity to the feeling. There is a certain turbulence produced in the action of the heart and the dilatation of the chest, and in the contractions of the throat and face, whenever the mind is intensely affected with emotion: thus, for example, in terror, the heart beats with force against the ribs; "there is a spasm on his breast; he cannot breathe freely; the chest is elevated; the muscles of the neck and shoulders are in action; his breathing is short and rapid; there is a gasping and convulsive motion of his lips, a tremor on his hollow cheek, a gulping and catching of his throat." The explanation of these phenomena seems to be this:-The nerves of respiration have been influenced by the condition of the mind to produce these actions; this disturbed state of the heart and respiratory organs is quickly referred to the mind, through that sensibility which we formerly said watches over them and thus a sensation is produced, very nearly resembling that which accompanies threatened suffocation.* This view of the matter illustrates how corporeal sensations are reflected to the mind, to render us more vividly alive to its emotions; and it also shows that the mind may rouse certain parts of the body into activity, independently of a preceding sensation. In these instances, sensation is not the cause, but the consequence, of the particular actions already produced in the body. According to Dr. Alison, in adopting Mr. Bell's views, “We should be obliged to suppose that there are bound up, in what is commonly called the olfactory nerve, one nerve destined for the perception of nauseous smells, and connected with the nerves of the abdominal muscles and diaphragm,"-(and the stomach, &c. if he supposes the act of vomiting ;)" one for the smells that cause faintness, connected with the nerves of the heart; and one for savoury smells, connected with those of the salivary glands. And in the fifth pair of nerves we must suppose that there are bound up, one nerve for the perception of cold applied to the face, and connected with the phrenic and intercostal nerves, by which the act of inspiration is performed, and also with the cutaneous nerves of the whole surface, by which a general constriction of the capillaries is produced; one for the perception of irritations of the nostrils, connected with the phrenic and lower intercostals and lumbar nerves, by which the act of sneezing is performed; and one for the perception of pain in the eyeball, cheeks, or teeth, possessing little or no connexion with the respiratory nerves; and so in other instances." If, indeed, we expected to see all obscure phenomena ex For further illustrations of this subject, the reader is referred to the second edition of Mr. Bell's Essays on the Anatomy of Expression. plained, the effects, for example, of odours giving pleasure or pain, or exciting disgust and nausea: if all those singular nervous affections, which are variously exhibited in different individuals, had been attempted to be accounted for, by this new system of the nerves, we should have thought of Mr. Bell's observations as Dr. Alison does. But we have remarked that he most resolutely avoids entering on subjects of this kind, which promise no successful results. He has limited us to the observation of certain facts: he has taught which nerves convey sensation from the part to the sensoriúm: he has shown by what nerves the impression proceeds from the sensorium to the muscles, combining them into simultaneous operation. But he has not attempted to explain anatomically what connexions are formed betwixt the roots of the sensitive nerves and the muscular nerves, in what is called the sensorium. We have heard Mr. Bell propose it as a question in his Lectures, how far the motions of parts, excited by titillation or irritation, depend upon the connexions of the nerves in the body, and how far on the connexions of the nerves in the brain. For example, when a creature continues to breathe without its head, or when an acephalous foetus breathes without cerebrum or cerebellum, is there not a connexion between the heart and lungs and the muscles of respiration, without the intervention of the brain? He illustrated this question by mentioning, on the other hand, the muscles of the eye acting under the irritation of the eye, as a proof that the brain forms a part of this circle of relations; but the excitement of the heart and the intestines, contracting upon being distended, as other instances of the connexion being formed without the intervention of the brain. Dr. Alison is not aware of the care with which Mr. Bell has impressed in his Lectures, that there is a whole system of nerves, of which the powers are not yet ascertained,— those called the sympathetic, which may at some future time be made to resolve these difficulties. It is only by observing the actions of certain parts of the body, and then by referring to the ascertained functions of the nerves which supply these parts, that we can distinguish which nerves were influenced directly by the sensorium in producing these actions: it therefore appears that so long as our acquaintance with the functions of the nerves is imperfect, we shall experience difficulties in accounting for sympathetic actions. Thus, recurring to the instance of irritation of the eye, it was noticed that, besides the spasmodic closing of the eye-lids, there was an increased secretion from the lachrymal gland, and a blush of inflammation on the conjunctiva. It was not attempted to explain by which nerves the two latter circumstances were effected; because physiologists have not yet ascertained which nerves proceeding from the brain possess an influence over the secreting and the circulating organs. At present it is only stated by Mr. Bell as a conjecture that the sympathetic nerve controls these functions. But, in explanation of the winking of the eye, we were enabled to say, that the portio dura caused this, because we know it is the function of that nerve to command the muscles of the face. We, who are pleased with the simplicity and the interest which these views give to the nervous system, may be allowed to express a regret that an ingenious physiologist, conversant with many of those authors who have written on the theories of the nerves, should present us their anatomy in the same intricacy with which it has been hitherto enveloped. Let us mark the advantages which the physiology of the nerves has derived from the strict attention which Mr. Bell has paid to the facts of anatomy in his late investigatious. First, he has shown the composition of the spinal nerves; that the whole range, arising from the spinal cord, having ganglions upon their roots, are sensible nerves; and that the anterior roots are muscular nerves: Secondly, that the fifth pair in the head is of the same composition with the nerves of the spine: Thirdly, that, as this nerve corresponds in structure with the spinal nerves, so it corresponds in function: Fourthly, he has distinguished the nerves of the face into two classes, and shown that they possess distinct endowments: Fifthly, he has proved that there is a set of nerves exclusively distributed upon the muscles of respiration: Sixthly, he has shown, by comparative anatomy, that these nerves do not exist, except when the act of respiration is to be performed:-These form altogether a most brilliant proof of the importance of anatomical investigation. We have heard some gentlemen say that these new views are very ingenious and very curious; but they have asked, of what use are they in the practice of medicine and surgery? We may reply, that it is impossible, in the early stage of any discovery, to foresee how far its influence may extend.. But is it nothing to have proved that palsies, which were supposed to depend on the condition of the brain, may arise from local causes, quite independent of that organ, and comparatively of little danger?-To have pointed out to the surgeon the difference between a motor nerve and one of sensation, and the consequent impropriety of cutting them indiscriminately in cases of tic douloureux, as formerly? Will any surgeon, who is acquainted with these new views, in operating on the face, divide the portio dura, in the expectation that its functions would be performed by branches of the fifth pair? Or would he hazard the destruction of the eye, when operating on tumors of the face, by unnecessarily dividing those branches of the portio dura which pass to the eyelids? In conclusion, we would say that it is to be regretted, with regard to papers such as we have been endeavouring to criticise, that the general reader, who may not, perhaps, be very intimately acquainted with the subject, is more apt to rely on the character of the writer, than to weigh critically the value of his arguments. ART. III. A Case of Empyema, successfully treated by Paracentesis Thoracis. By JAMES PITCAIRN, M.D. Fellow of the Royal College of Surgeons. Case. Susan Smith, aged 114 years, had been a healthy child, but had received a fall on her left side, a week before the date of report, by which some of her ribs were supposed to be hurt. On the 19th, (month not stated) there came on acute pain in the side, with fever, cough, and quick breathing. On the 20th, Dr. P. saw her, and found the difficulty of breathing amounting almost to orthopnoea-great pain in the side, tickling cough, hard, full pulse, flushed face. She was bled to 14 ounces, by which she was much relieved. Purgatives and antimonials. The relief was but temporary-the bad symptoms returned-she was again bled to syncope, with immediate benefit. But the inflammatory symptoms often returned, and in spite of antiphlogistic measures, a deep-seated pain remained in the thorax, with cough and short breathing, aggravated by exposure to cold air. The pulse kept uniformly above 110, ranging to 130. In the course of six weeks she was much emaciated-had constant cough, with copious expectorationfrequent diarrhoea-and hectic paroxysms. She was sent into the country, but soon returned unbenefited. Six months after this Dr. P. was sent for, on account of the extreme urgency of the cough, profuse expectoration-difficulty of breathinglivor of countenance. On examination, the left side of the chest was found to be very much enlarged and prominent in all directions. "The base of the heart was found pulsating under the right nipple, and its apex about 24 inches more to the right." The action of the organ was regular, but very rapid, 145 in the minute-respiration short, rapid, and difficult. |