advantageous to the student to contemplate them by the lights of this system, but we cannot admit that it is without difficulties. Thus it rarely, if ever, happens, that one of the great functions can be disordered, and the others remain unaffected; and in the majority of cases the lesion of structure is manifestly the result of irregularity in more than one of the functions. To select a simple case, the hypertrophy of an organ, although, immediately, the effect of an excessive energy of the nutritive function, is generally attended equally with an excess in its circulation. But to choose a stronger and more complicated example-in induration what do we observe? A chronic inflammation, (lesion of the circulation,) sustained no doubt by a lesion of the innervation, a lesion of the blood, indicated by its siziness, and a lesion of secretion, if not indeed of nutrition. To refer an indurated tissue to any one of these heads is then, evidently, an arbitrary decision.

Perceiving this difficulty, professor Carswell of London, one of the ablest pathological anatomists of the age, in his splendid and expensive "Illustrations of the Elementary Forms of Disease," (he should have said, of deranged structure,) determined to class the morbid appearances according to their affinities. Thus, to cite a single example, he brings together all the cases of softening, however diverse the lesions of function generating them; and then proceeds to enumerate those lesions. This is the plan adopted by professor Gross, and we think it decidedly preferable to that of Andral.

Nevertheless, whatever method of classification the pathological anatomist may adopt, he must always commence with inflammation; for it is undeniable, that of all the modes of morbid action, this one is most prolific in those results, which are the immediate objects of his study.

To this great truth our author is quite alive. Indeed, he

seems to favor the opinion, that all derangements of structure depend directly or indirectly on this kind of morbid actionmore or less intense, and modified in its phenomena and effects, by the tissues in which it occurs, the nature of the remote cause, and the temperament of the patient. Thus he assigns the same proximate cause-inflammation, for the false membranes of the pleura, the tubercles of the lungs, the serum in hydropericardium, and scirrhous tumours-it being understood, however, that some of these inflammations are of a common kind-others specific. At the same time, he is a decided advocate for the doctrine, which teaches the local origin of all diseases, and the sympathetic origin of all constitutional affections. In this generalization, which reduces every morbid state to inflammation and constitutional disturbance, as its effect, there is certainly an attractive simplicity; but we are not yet fully prepared for its adoption. Used in this comprehensive sense, the word inflammation becomes nearly synonymous with the morbid action of our celebrated countryman Dr. Rush; which, in turn, is but an equivalent for disease and these different forms of speech might indeed be indiscriminately employed.

A mode of morbid action is characterized, first, by the phenomena which it displays during its existence, second, by its effects. When both have been adequately observed, and are found to be constant, we admit, that occurrence of this mode in any particular case, may be established, either by the symptoms, or the morbid appearances, found after they have passed away. Whenever the well known phenomena of inflammation are present-or the appearances on examining a morbid structure are such as are known, at all times, to have been preceded by those phenomena, we must grant of course that the disease is inflammation. But we are not bound to grant,

when neither the symptoms nor the morbid products known to result from inflammation show themselves, that the disease was inflammatory. Thus, if we observe swelling, redness, pain and heat, or a majority of these conditions, in a part, we say that it is inflamed; and if we find deposits of pus, or of coagulable lymph, in the form of false membranes, in tissues which have ceased to be the seats of morbid action, we admit their inflammatory origin, because observation has taught us, that inflammation and it only produces them. When, however, we find serum, scirrhus or tubercle, in parts which have not emitted the symptoms of inflammation, and unassociated with false membranes or purulent secretion, it is gratuitous to affirm, that they are the offspring of inflammation. The existence of any one of them in any particular case, cannot, therefore, be cited as evidence of previous inflammation, until it is shown by testimony, that inflammation has in other cases produced it.

We grant that these, and other morbid products of a like kind, may be the offspring of inflammation, and it is due to the class of pathologists of which our author is one of the ablest, to admit, that they are not without facts of a weighty character to sustain their conclusion.

First.-The vast number of cases in which inflammation is the undoubted cause of morbid structure, would seem on the principles of analogy, to warrant the conclusion, that all morbid structures are its consequence. This however is but presumptive evidence.

Second. Many inflammations it must be confessed, from the nature of the tissues in which they are seated, and from their mildness, give little pain and awaken but few constitutional sympathies; they may, therefore, exist to the extent of producing deranged structure, without manifesting them

selves by the usual signs; and it cannot be said, that certain serous effusions and non-analogous deposits, are not of this kind. Thus tubercle may be secreted under such an inflammatory action. But here again is nothing more than probability.

Third. It is affirmed, that many inflammatory congestions disappear, when the patient is in articulo mortis, or immediately after death. When we recollect, however, that the difficulty of washing or expressing the blood, from an inflamed tissue, is given as an evidence of the existence of previous inflammation, we cannot grant, that the number of cases of resolution at the close of life is as great as some pathologists believe. We conjecture, moreover, that it is in cases of short duration rather than chronic, that the inflamed capillaries thus unburthen themselves.

Fourth.-Almost all deranged structures, manifestly depend on deposits from the blood. Now inflammation, in all its stages, is known to favor effusion, and it may, therefore, be presumed to occasion all that we find. It is, however, an unquestionable fact, that we may have copious and altered secretion without inflammation. Blood is extravasated into the cutaneous or subcutaneous parts in scorbutus-the kidneys, and intestinal mucous membrane, secrete copiously an altered fluid under certain mental emotions, and the skin pours out freely in the very hour of death. There is no inflammation in any of these cases.

Fifth. It may be, that certain heterologous matters, such as tubercle, melanosis and scirrhus, take the place of the ordinary lymphatic deposits afforded by common inflammation, which latter do not therefore appear. This must be granted; but the possibility of such an operation cannot be admitted as evidence of its actual occurrence.

Sixth.-An argument on which our author lays great stress is, that the deposit of lymph is one of the most characteristic effects of inflammation, and that a part at least of the heterologous structures, when analysed, are found to be nearly of the same composition. Some of them, however, are highly albuminous. Moreover, all deposits must be from the blood, and all which solidify must be composed in a great degree of the coagulating or, at least, the coagulable parts of that fluid. The source and material, then, of the analogous and the nonanalogous deposits, must be the same; but it by no means follows, that the mode of action which produced the extravasation is the same, and to it our attention is now directed.

Seventh. The heterologous deposits possess in themselves the power of generating blood and vessels to circulate it, which inosculate with those of the tissue into which the deposit has been made; a phenomenon identical with what we see in false membranes. This fact is entitled to grave consideration; but we cannot admit its conclusiveness; for, in the first place, it has not yet been established, that all of these productions possess this self-organizing power; and secondly, if they do, it would not prove that the action which extravasated the altered lymph that generally enters into their composition, was inflammatory. We do not know, but that other modes of morbid action may throw out lymph capable of generating blood and vessels. When this is shown to be impracticable the controversy will be at an end.

Lastly. All the non-analogous structures, are sooner or later associated with inflammation in the surrounding tissues, and most of them present it in their own substance. But this association, established long after they were deposited, can throw no light on the mode of morbid action which occasioned their deposit.