two concluding chapters treat very briefly of "Sprain, and Rupture of Muscle and Tendon; and of Bruise."

We trust that the epitome we have thus given of Mr. Miller's production will justify our commencing observation, that a reference to its pages entirely removed any feeling of its unnecessariness, induced by its title. We have much pleasure in recommending the work to all members of our profession, whether they be yet students of our art, or actively engaged in administering the inestimable benefits of medicine; whether devoted to an exclusive branch, or to general practice, much instruction and assistance will be gained from its perusal, and frequent reference to its pages. The manner is unfortunately not always an exception from that which generally stains medical writings; a looseness and indistinctness of language often prevails, with occasionally a spirit of dictation which, however it may be excused in the lecture-room, is better avoided in a publication.

I. RECHERCHES ET OBSERVATIONS SUR LES CAUSES DES MALADIES SCROFULEUSES. Par J. G. A. Lugol, Medecin de l'Hôpital St. Louis, &c. &c. Octavo, pp. 372. Paris, 1844. Fortin et Masson.

II. RESEARCHES AND OBSERVATIONS ON THE CAUSES OF SCROFULOUS DISEASES. By J. G. Lugol. Translated from the French, with an Introduction, and an Essay on the Treatment of the principal Varieties of Scrofula, by W. Harcourt Ranking, M. D., Physician to the Suffolk General Hospital. Octavo, pp. 306. London, 1844. Churchill.

III. SCROFULA; ITS NATURE, CAUSES, AND TREATMENT, AND ON THE PREVENTION AND ERADICATION OF THE STRUMOUS DIATHESIS. By W. Tyler Smith, M.B. Octavo, pp. 172. London, 1844. Churchill.

THE grand aim and leading object of this new work of M. Lugol are to prove that Scrofula is a disease essentially hereditary in its origin; and that, unless there be a congenital tendency to it in the system, external causes will very rarely, if ever, induce its development in an individual; although they may not unfrequently do so in his offspring. The motto affixed to the title page-la santé des enfans tire son origine de la santé des parents-may be considered as the text on which the author discourses with great volubility and earnestness through upwards of 300 pages. Like all very ardent inquirers, he may be inclined to push particular views a little too far; but, in the main, he is unquestionably right; and his elaborate and extensive researches are calculated, we think, to elucidate a very important point of pathological research.

Scrofulous disease manifests its baneful effects from the very earliest months of intra-uterine life. A vast number of cases of Abortion are attributable to its influence on the system, either of the mother or of her

offspring. After birth, it arrests the moral, as well as the physical development of the child, inipressing its stamp upon every disease to which it is subject, and vitiating more or less profoundly all the successive evolutions of infancy and youth. At a more advanced period of life, it reveals its existence by a great multitude of morbid conditions and phenomena the common origin of which has been too generally overlooked by medical men, and which, accordingly, some of our most esteemed authors have very erroneously described as particular and individual maladies.

No part of the body is exempt from the invasion of scrofulous disease; although certain parts or tissues usually suffer much more than others. In not a few cases, the mucous membranes are chiefly affected: hence the Ophthalmias, Coryzas, Leucorrhoeas, mucous Fevers, intestinal Worms, &c., that are so frequently met with in practice. If the skin be the principal seat of the disease, we find that there is an unusual liability to Chilblains, various sorts of Eczematous and Impetiginous eruptions, and obstinate ulcerations; also to pedicular maladies, "which," says M. Lugol-" like the verminous affections of the bowels, continue to be re-produced until the constitution of the patient be regenerated."

When the cellular tissue is most affected, then we have the formation of abscesses in various parts; when the bones are so, Caries, Necrosis, and Rachitis are most frequently the consequences.

Now, however much these various maladies may differ from each other in their outward appearances, we should bear in mind that they are all the offspring of one common morbid state,-the difference being only in their seat, or, in other words, in the tissue affected. Hence it is that we often see more than one form of the disease developed simultaneously in the same individual; while, in other patients, there is a renewed succession of different forms, following, and perhaps alternating with each other.

Properly speaking, says our author, there is no Scrofula of any single tissue or organ. In all cases, it is the same disease, which in one patient indeed may affect the skin or mucous membranes, and in another the bones, &c. but without ever fixing itself upon any of them in an isolated manner. The invasion of any one organ is sufficient in itself to make us dread the development of the evil in some other part of the body. In the same manner, as we shall afterwards find, whenever the disease manifests itself in one member of a family, there is, in that circumstance alone, a strong presumption that it will appear in some, if not in all, of the other children. If it be asked, What is Scrofula, and wherein does it consist?-we must frankly acknowledge that we cannot answer the question when so put. All that we are prepared to affirm is, that this vice, or morbid state, is congenital, and is always manifested by the development of tubercles. This production or deposit is in truth the disease itself, its anatomical and pathognomonic sign, that which characterizes it, and which gives value to all the other symptoms. In other words, whenever a patient is affected with tubercles-no matter where they are situated-he is, in our opinion, scrofulous. Whether he is affected with an ophthalmia, a cold abscess, a caries of the bones, a white-swelling, &c., the nature of these diseases cannot, and ought not to, be questioned: they are all scrofulous, if there have been tubercles, or if there is a coincidence of these morbid productions, either in the patient himself, or in some member of his family.

A Tubercle may be regarded, says M. Lugol, as having the same origin and mode of formation as any of the ordinary organs of an animal body. It is itself a sort of organ, possessed of its peculiar life or mode of existence, just as the Liver or Spleen have theirs; like them, it undergoes a spontaneous evolution. It is a morbid production that sensibly modifies all the organic elements, and deeply affects their functions; and which stamps every person, in whom it exists, with a peculiar complexion, and physiognomy-characteristic of the tuberculous disposition. It is with this peculiar complexion or constitution that the immense number of diseases, improperly termed scrofulous, is associated.

The particular nature and seat of scrofulous affections vary a good deal, according to the age of the individual: the same person is differently affected at different periods of life. In infancy and childhood, the most common forms are chilblains, intestinal worms, the production of lice, ophthalmia, and bronchitis. At, and about, the period of puberty, the signs of tuberculous disease of the lungs-with or without the preceding maladies-usually make their appearance; and at a more advanced age, the formation of cold abscesses, white-swellings, &c., are the usual manifestations of the existing Cachexy. In short, the medical history of a single scrofulous patient will often suffice to exhibit a complete nosological tableau of the disease.

As to the primary causes of Scrofula, it would seem that whatever has the effect of enfeebling the energy of the solids, and depraving the quality of the fluids, is liable to induce its development-if not immediately, at least in the next generation. Scrofulous maladies are essentially the diseases of civilization, or, more properly speaking, of the artificial mode of life that usually accompanies it.

"They are extremely rare (we quote from Dr. Smith) "among savage races, except when these are brought into contact with the vices of civilized life, or transplanted into an ungenial climate. With all civilized nations, on the contrary, they are well known to prevail to an immense extent, and in none perhaps more than our own. Tuberculous disorders affect too, all the domestic animals which man has reclaimed from the savage state, and they are common among the species brought from tropical climates to our own country. Climate appears, in the first instance, to have given rise to the peculiarity of constitution most favourable to scrofula; and the wants and vices incident to civilized life, seem to be the agents which have produced the disease in the soil already fitted for its reception." 3.

In a subsequent part of his work, the same writer very justly remarks:

"The lower order of townsfolk, and indeed the upper also, though from other causes, are continually falling into a state of disorder, termed by Dr. James Johnson the wear and tear malady, out of which scrofula is prone to take its rise in predisposed constitutions. Large numbers live in the great towns, in cellars and underground. They present a blanched and etiolated appearance. As a class, such people are very poor, and live badly; so that here we have large masses subjected to precisely the same physical conditions,-living on scanty and unwholesome food, and deprived of light,-as those by which pathologists have been able to produce tubercular disease at will, and to any extent, in the lower animals." 37.

In a vast number of cases, we cannot trace the development of scrofu

lous disease to any distinct cause, save and except that of hereditary trans. mission. Whatever, indeed, as we have already said, enfeebles the powers of the system, seems to promote and accelerate its formation; but it is very doubtful whether any external cause is sufficient in itself to induce its occurrence, if there be no family predisposition to the diathesis in some one form or another. Hitherto, medical men have not examined with due attention the laws of hereditary transmission in reference to this too frequent disease; they have generally confined themselves merely to the ascertaining of the bare fact, whether one of the parents of any patient may have exhibited decided marks of the Scrofulous cachexy, or not. The question we shall find, as we proceed, to be one of much more extensive application, and one which requires a much greater extent of research than has usually been given to it.

M. Lugol, on more than one occasion, alludes to the not unfrequent seeming exemption of one or two members of a scrofulous family from the hereditary taint, and shows how very generally, even in them, the inborn evil makes its appearance at some time of life or another. The family resemblance, which may hitherto have never been perceptible, at lengthperhaps upon some accidental occurrence-becomes too obvious not to be at once recognised. Our author quotes the following case in illustration. A lady, having all the appearance of sound and healthy constitution, was the mother of several children who were decidedly scrofulous. She was much surprised at this, although one of her own sisters was in the very same condition, and another had been affected with rickets. No person could have perceived any resemblance between her and her two sisters, until they had reached l'age de retour. "The first time that I remarked it," says our author, "was on seeing them all in tears upon the death of one of the children. They wept in the same manner; they had exactly the same tone of voice, the same accentuation of their words; there was in all of them the same peculiar movement of the commissures of the lips, arising in part from the loss of the very same teeth; their features also were drawn down in the same manner; and altogether the external signs of relationship were most apparent."

We cannot wonder at this; all the children of a family must necessarily partake of essentially the same sort of constitution, however much the outward features of this may vary, in consequence of a variety of modifying circumstances on the part, alike of the parents and of their offspring. M. Lugol strenuously insists upon the truth of this position, and adduces a vast number of observations in support of it. It is the pervading principle of his whole work.

Whenever, says he, one member of a family is affected with distinct scrofulous disease, we may be sure that traces of the same malady, or at least of the diathesis which has given rise to it, will be found in the other members. There is a something in the complexion of them all that indicates a similarity of constitution. How often do we see, in the case of scrofulous children, that the skin is soft, flabby, and white; that the head is disproportionately large; that its openings are unusually wide; that the trunk and the extremities are unequally developed-the former being large and tumid, and the latter being comparatively small, the joints only excepted! In not a few instances, we observe that the median line is not

in the middle of the trunk. The result of this deformity is, there seems as if there had been a faulty junction of the two lateral halves of the body; one being placed somewhat higher and more anterior than the other. This formation of the frame, arising from an inequality of evolution, M. Lugol regards as a sufficient ground for an unfavourable prognosis in disease in general. Besides the corporeal defect now mentioned, we may state that most cases of congenital malformations-such as hare-lip, pigeon-chest, fissure of the linea alba, non-descent of the testicle, &c.-occur in scrofu. lous children.

Scrofulous persons are generally of small stature; occasionally, however, they are of unusual and even inordinate size. Both extremes may be attributed to the circumstance, that the vital powers have been deficient in that degree of energy that is required to regulate the development of the organs hence it is that either a partial arrest, or a hypertrophic enlargement, of the body, is apt to follow.

According to M. Lugol's observation, the majority of scrofulous patients (in France) have dark or even black hair: the proportion of those with light hair is but small. A similar remark applies to the colour of the eyes and the hue of the skin: the latter is much more frequently darkish than fair. He acknowledges that his observations on these particulars are at variance with the statements of many writers; but he appeals to the wards of St. Louis hospital in confirmation of them. The evolution of the teeth, especially those of the second dentition, is almost always tardy in such habits; and the teeth themselves are weak, friable, and apt to be discoloured. The spongy ends of the bones are large, compared with their shafts or compact centres, and also with the adjacent soft tissues,

The evolution of the generative organs is usually more tardy in scrofu. lous than in other children. In scrofulous youths of 16 or 17 years of age, it is not at all uncommon to find that one of the testicles has not descended into the scrotum. In girls, the catamenial function is often very irregular in its establishment; the secretion being generally either scanty or excessive, and usually accompanied with much suffering and general disturbance. The regular development of the Mammæ and Ovaria is apt to be tardy in such cases. Considering these things, we must at once perceive the importance of scrofulous youths of both sexes avoiding the premature or inordinate indulgence in sexual pleasures. One of the most certain means of fortifying their health consists in keeping all venereal passions in check, until the body has acquired its full and mature develop

ment.

The functions of the digestive organs, too, are very generally irregular and deranged in some way or another. Very often there is a deficient appetite, owing doubtless to an atony or inertia of the stomach-which, our author considers to be dependent upon "un etat catarrhal de meme nature que l'ophthalmie, le coryza, l'otite, les bronchites, les leucorrhées, &c." Occasionally, however, the appetite is voracious; but, even then, the food does not afford the nourishment to the system that might be expected. The alvine evacuations are seldom quite healthy. In many cases there seems to be a sort of intestinal leucorrhea, giving rise to an obstinately relaxed state of the bowels: portions of the food are then very usually voided, unchanged, along with the fæces.