power to ward off a hectic, notwithstanding that opinion has had its advocates. Did not indeed the existence of a chronic intermittent, at the time the pneumonitis set in, facilitate the development of hectic-a paroxysmal fever with an evening chill, naturally, recurring at the same hour, which in him was the hour of recurrence of the mismatic chill? Did not the two modes of constitutional mordid action, notwithstanding the difference in their origin, so much resemble each other, as to coalesce? When, in singing, we open the mouth in the manner it is opened in yawning, that function is apt to be performed, although the condition which naturally prompts it is not present. But we shall not speculate further on this connexion, but request such of our readers as live in regions where ague is endemic, to keep on the look out for facts having a bearing on its relations with hectic fever.

What is the morbid anatomy of the lungs of this patient? The left is sound and sustains the onus of respiration. The right would appear to be impervious throughout, at least in its vesicular structure. The larger bronchial ramifications, only, admit air. How long it has been thus hepatized cannot be ascertained. From the general state of feeling of that side, and the condition of his pulse, it would appear that the inflammation had nearly ceased. Has the secretion into the parenchyma, been so great as to obliterate the capillary system to such an extent, that the inflammation ceased? May not a lung continue a long time in that condition, as it often does in a state of induration, from the compression of coagulable lymph, contracting around it? We have certainly met with cases of hepatized lung, connected with mild occasional hectic fever, which have continued for several years; and we may suppose that some very chronic cases which were regarded as tubercular have been of this kind.

The laryngeal affection in this case is distinctly marked. The relaxation of all the ligaments and muscles is indicated by the looseness of structure of that organ, and the play of the os hyoides upon it; not less than by the feebleness and flatness of the voice and cough. It is not impossible that the mucous membrane of the right side is in a state of surperficial ulceration. The tinge of blood which he lately threw Whatever may be the perhaps, sympathetic of

up perhaps came from such a spot. exact pathology of this organ, it is, the disease in the right lung.

Let us turn our attention to the abdominal viscera. It is worthy of note, that notwithstanding the repetition of ague for many successive years, the spleen is not enlarged; and we may here say, what should have been said before-there is no anasarcous infiltration into the extremities.

The liver is undoubtedly in a state of chronic inflammation. The tenderness under pressure, the occasional saffron color of the urine, the turbid and sallow hue of the skin, the early tendency to diarrhoea, the tenderness in epigastrio, and the cough with regurgitation, after a full meal, may be received as evidence of disorder of the liver, The preference for lying on the right side is ambiguous, inasmuch, as the great amount of respiratory duty, thrown upon the left lung, requires that the weight of the body should not rest on that side. But what shall be said of the bulging out of the false ribs over the liver? Was there a swelling, inflammation and abcess of that organ, some time ago, which pressed out and changed the convexity of those ribs? Is the liver at this time enlarged upward and outward? Is there a collection of pus in the sac of the pleura, resting upon the diaphragm? If so, there must be adhesion of the membrane above, for the protuberance is as great in a recumbent, as upright posture.

At this time, and indeed, for many months the more energetic morbid actions in this case, seem to be in the mucous membrane, more especially, perhaps, that of the great intestines. We did not see the discharge which the patient described as purulent, but presume they may be of that character. Are they from the liver, or from the intestinal membrane? The latter is most probable; and taken in connexion with the general abdominal tenderness, and the tenesmus, can leave little doubt of ulceration-probably in various places. Has this condition of the membrane arisen directly from the ague and fever; or is it a sympathetic effect of the liver disease; or has it come on in the way it arises in the progress of hectic fever from tubercle?

We shall conclude these off-hand pathological speculations with a few clinical remarks and suggestions.

It appears to us, that the right lung had passed through a transformation, and that although it will doubtless, at no distant time, be the seat of a revived and suppurative inflammation of a fatal kind, there was not any existing morbid action upon which remedies need to be directed, or, indeed, could be, if morbid action did exist. Our thoughts turned to the state of the liver, and especially the intestinal membrane, both of which, at the present moment, seem to be the seats of sub-acute inflammatory action. Although, however, we have called the action inflammatory we cannot regard it of such a grade, as to call for depletion. Moreover, there seem to be several objections to a depleting plan. Ist. The pulse is not hard nor frequent. 2d. An organic lesion, so extensive as that in the lungs, renders debilitating measures, to any degree, injurious. 3d. Ulceration of the bowels may be prevented by depletion, but it by no means follows that it can be cured by the same mode. Ulcers of the skin, of the va

gina and uretha, of the meatus externus, of the conjunctiva, of the mouth and throat, especially when chronic, are not in general successfully treated with emollients and refrigerants, but with stimulants, astringents and escharotics, and often heal more kindly, if tonics be administered internally at the same time; wherefore should chronic ulcers of the colon and rectum be made an exception to these, and the patient subjected to a debilitating treatment? 4th. This patient for several weeks past, has been using a bitter tincture, made with whiskey, during which time there has been no aggravation of any of his symptoms, but an increase of flesh and strength.

Under these views we made the following prescription :1. A liquid, demulcent and gelatinous diet-in moderation. 2. The nitro-muriatic bath, to the region of the liver, epigastrium and umbilicus, every night.

3. A draught, three times a day, of 3ij. of decoction of cinchona, and 3ij. of lime water, mixed.

4. A pill every night, composed of two grains blue-mass, two of ipecac. and one of opium.

Are we asked, do you expect the final recovery of the patient under this or any other treatment? We answer no.

To such of our readers as may think their time lost by the perusal of this article, we beg leave to say, that the afternoon (July 29) is oppressively hot; and that, if we were writing in as pleasant weather as they will read, we should no doubt forestall them in that criticism.

REVIEWS.

ART. V.—1. A Memoir of the Life and Character of Philip Syng Physick, M. D. By J. RANDLOPH, M. D., Lecturer on Surgery, Member of the American Philosophical Society, etc., etc. Philadelphia: T. K. & P. G. Collins. 1839. 8vo. pp. 114.

2. Necrological Notice of Dr. Philip Syng Physick; delivered before the American Philosophical Society, May 4th, 1838. By W. E. HORNER, M. D., Professor of Anatomy in the University of Pennsylvania, etc., etc. Philadelphia: Haswell, Barrington & Haswell. 1838. 8vo. pp. 32.

THE biography of Dr. Physick possesses no uncommon interest, if we estimate it by the incidents which it affords. Yet it is a biography which, on account of the celebrity of the individual, will be extensively read, and which is calculated to exercise a most excellent influence upon the young men of the profession of which he was for many years the acknowledged head and centre in America. Dr. Physick was reputed, and we believe justly, a great man-as a Surgeon pre-eminently great; but his greatness was of a kind which does not oppress or alarm the beholder, but rather inspires him with a hope that he may attain to something like it, because it was the result of industry long directed to a single great object. It was a greatness, too, which we may admire without any painful abatement on the score of mingling