share of favour and of blame. The followers of Sylvius, the Iatrochemists, as well as the Iatrophysicists, were more given to theoretical fabrications based on the weakest foundation of facts, than to observation or experiment. Even the restoration of the practical, truthful, Hippocratic simplicity of clinical experience by Sydenham, failed to advance the pathology of the liver. The age acquiesced in the theory of Franz de la Boë Sylvius, who maintained that the fermentation of the juices formed by the spleen, pancreas, and liver, was of great importance to chylification and the proper mixture of the blood. But practical medicine paid no attention to affections of the liver. Meanwhile morbid anatomy had begun in silence to store up materials, from which the pathology of the future might draw supplies for its construction. Benivieni, Vesalius, and Fallopia were the first to give accurate descriptions of biliary calculi, and of the consequences of their presence in the gall-bladder. Vesalius reported a case of bursting of the portal vein in consequence of cirrhosis of the liver; he observed the deleterious influence of spirituous liquors upon the liver, the connexion of intumescence of the spleen with liver diseases, and many similar points which are now well established by accumulated observations.

Glisson's anatomy of the liver contains some valuable observations on tumours of this organ in rhachitis. Abscesses and concretions in it were described in Bartholin's history of anatomy. Baillou, a very practical physician, gave an account of malignant icterus. The comprehensive work of Th. Bonnet (1679) contains a series of post-mortem examinations of persons dead of jaundice, and observations of cases of inflammation, tumour, scirrhus, obstruction, cysts, calculi, &c. This author's discussion of many of his observations is very defective, but some subjects are remarkably well treated. The description of cirrhosis, for example, might have been written in our days.

Bianchi endeavoured to collect the scattered materials of the history of diseases of the liver and bile into a monograph, which, although it contains much crude and ill-digested matter, and was therefore justly subjected to severe criticisms by Morgagni and Haller, nevertheless went through three editions. Its influence upon hepatic pathology, never very great, was soon eclipsed by the clinical works of Boerhaave and Stahl, and by the morbid anatomy of Morgagni.

Boerhaave extended the technical system of observation, which Sydenham had revived, to the disorders of the liver, in which he saw the local origin of the majority of chronic diseases affecting the whole system. The primary cause of those morbid processes he correctly observed to be an aberration of the digestive function, producing a diminution of the quantity of bile secreted. In accordance with this latter supposition he endeavoured to explain dropsy, cachexia, leucophlegmasia, &c., as consequences of a faulty chylification. His pathogenesis had a further resource in his ingenious error as to the portal circulation. The motion of the blood in the portal vessels was to him independent of the propulsion of the heart. By endowing Glisson's capsule with contractile powers, he created a separate heart for the liver-" cum sinus portarum pariter sit cor hepatis, uti cor dictum

universo corpori." Notwithstanding the assistance which he believed must be afforded to this propelling apparatus by the pressure of the abdominal muscles, this machinery was particularly liable to impediments and arrosts. Here was the nidus of the humor atrabiliarius→→ here the doorway by which a host of diseases effected their entrance— "vena porta porta malorum." One perceives, with astonishment, that a sensible physiology of the liver failed to produce the slightest effect upon pathology, which adopting the worst relies of ancient doctrine, superadded the creations of fancy, and thus became enveloped in a tangle, from which the science of our days has not yet been able to extricate it.

When G. E. Stahl maintained "that no less a share of chyle was conducted to the blood by the mesenteric veins and through the liver, than entered by the lacteal vessels," he opened a new road to pathology. The diseases of the portal vein, to which he referred the disorders of all the abdominal organs standing in communication with that vessel, were classified accordingly. His theory was, however, more the result of a process of thought upon the basis of anatomy, than a deduction worked out by physiological experiment. Less fortunate than the great chemical theory of the illustrious philosopher, this hepatic pathology found few professional followers, but the doctrine of abdominal plethora and congestion became deeply rooted in the minds of the laity. It offered an easy and fanciful explanation of all abdominal ailments, and thereby naturally retarded the progress of their true diagnosis.

There can be no doubt that during the entire century commencing with Stahl, medical practice did everything to neutralize the efforts of medical science. The haughty ignorance of routine found favour and culminated in Kaempf's abdominal infarctus and clysmata.

But rescue was now near at hand, for a hero had gathered his followers and irresistible they were. By dissections and clinical labours Morgagni for the first time investigated, in a clear and comprehensive manner, the seats and proximate causes of diseases, and drew the precise outlines of what we now consider to constitute the morbid anatomy of the liver. The changes in the structure of that organ, and their genesis and consequences, so far as they could be investigated with the naked eye, were for the most part clearly established. To these, sixty years later, were added the results of microscopical study. The store of facts recorded in the works of Lieutaud, A. Portal, Matthew Baillie, Carswell, Andral, Cruveilhier, Rokitansky, is the nucleus round which the modern pathology of the liver has consolidated itself.

The minute structure of the liver, as first recognised by Henle and Kiernan, has in some minor details been further analysed by assiduous labourers. But physiological anatomy brings home the conviction with irresistible force, that structure alone cannot teach function-that form is only one of the elements by which we ascertain the properties of matter that quality, behaviour under metamorphosing influences, and relative quantity-that is, quantity as it exists during a limited and given time--must be equally ascertained before we can ascribe to any substance, or peculiarly-shaped chemical compound, such as a gland, or

an organism, its place in the household of nature. The result of this conviction is, that the physiology of the liver has in our days been immensely extended by chemical investigation. Plattner's discovery of crystallized bile, Strecker's lucid researches on the composition of that secretion, Bernard's discovery of sugar and of the dextrine-like material from which it is formed, the discovery by various observers of a series of products of the retrograde metamorphosis, such as uric acid, xanthic oxide, sarkine, creatine, of the changes which fibrine and blood corpuscles undergo during their passage through the capillaries of the liver, and of the changes which take place in fats within the liver-cells, are recent additions to our already rich store of hepatic chemistry.

The pathology of the author of the work placed at the head of this article, purports to start from this physiological basis, and to try it by researches at the bed-side and on the dissecting table. This task is very difficult, not only from the want of unity in the basis itself, but also for various other reasons, such as the inaccessible situation of the liver, the fact that its secretion, being discharged into the upper part of the intestinal canal, cannot be procured unmixed from the living body-its relations to intermediate metamorphoses the products of which do not directly appear in the excreta. Experience in showing us that affections of the liver are often associated with diseases of the digestive canal, of the spleen, and general disorders influencing sanguification and metamorphosis, exhibits us a long series of complications, which warn us to use the greatest caution in the construction of pathological theories.

The work before us offers many questions without attempting to solve them, and others to which the reply is only fragmentary; but many and important points in the clinical history of the liver are treated of in a complete and satisfactory manner. The author not only investigated the anatomical lesions, but also their physiological influences upon the metamorphoses of matters carried on in the gland. He has combined with morbid anatomy the chemical method of investigation, and has, on a limited field, reaped a harvest which augurs well for the cultivation of the large area that offers itself to the zeal and industry of the rising generation of physicians.

The size and weight of the liver in its diseased and healthy state, with the natural modifications due to age and sex, the influence of food upon the quantity of blood contained in it, form the subject of a chapter, which is full of original observations. It is followed by a clinical chapter, which minutely details the manner in which the anomalies of form, and size, and position of the liver may be discovered during life. This chapter is illustrated by numerous diagrammatic

woodcuts.

The fourth chapter is devoted to icterus. As the author does not share the opinion of Budd and Bamberger concerning the existence of a form of jaundice from insufficient or deficient secretory activity of the liver, two modes only remain by which, according to him, an accumulation of bile in the blood can take place, namely, an increased absorption of bile from the liver into the blood, and a diminished disin

tegration of biliary matters taken into the blood. Thus an excessive production of bile, polycholia, may lead to some forms of jaundice. The whole doctrine is well supported by arguments, observations on man, and experiments on animals; the changes which the tissues of the kidneys undergo under the continued influence of icteric blood and urine are well described and illustrated by some excellent engravings in Plate I. of the atlas. The chapter occupies more than a hundred pages. It is succeeded by a review of bilious fevers and epidemic forms of jaundice; this latter symptom our author, conformably to Annesley and Griesinger, derives from polycholia. An appendix on icterus neonatorum leads us on to acute or yellow atrophy of the liver, otherwise termed malignant icterus. We will give an extract of one of the author's cases, No. 15, p. 212, which is highly interesting as illustrative of his method of investigation and treatment.

A married woman, twenty-four years of age, was received in the clinical ward of the hospital Allerheiligen, on January 21st, 1858. She was well formed, in excellent condition, and in the seventh month of pregnancy. She had for some days been suffering from loss of appetite, constipation, headache, and low spirits. On the day on which she entered the hospital a slight icteric coloration of the face supervened. During the night after her reception she repeatedly vomited a dirty greyish fluid, and then became suddenly delirious. The pulse was 80 per minute, respirations 20. The temperature of the skin was not raised. The pupils of the eyes were not enlarged, reacting slowly upon exposure to light. The conjunctiva had a slight yellow tinge, as also the skin of the face and neck, while the abdomen and lower extremities exhibited no sign of discoloration. The abdomen was soft, and contained only a moderate amount of gas; the epigastric and both hypochondriac regions were tender on pressure. On percussion hardly any dulness was discovered in the hepatic region, except at the axillary line, where it was found for about an inch and a half; at the other places the intestinal sound passed directly into the pulmonary. The patient took muriatic acid. In the night between the 21st and 22nd the distress of the patient increased; she screamed and threw herself about; the pulse rose to 112, and the breathing became stertorous. On the morning of the 22nd she was delivered of a dead fœtus of seven months, which had no signs of jaundice on it. There was profuse uterine hæmorrhage. After the abortion the excitement of the patient became less, and she was quiet for short periods, but in an unconscious state. The pulse and respiration, and the irritability of the pupil, remained unchanged; but the jaundice became more intense. The hepatic dulness disappeared everywhere. The bowels had been confined for the last three days. The urine, which had been drawn by the catheter, was acid, of a reddish-yellow colour, clear, free from albumen, of specific gravity 1018-5. On the addition of nitric acid the discolorations, characteristic of bile pigment, could not be perceived. On standing, the urine threw down a slight deposit, composed of numerous needles, single and in groups, mixed with yellow epithelial cells from the tubules and the bladder. The patient took some tincture of colocynth, and afterwards jalap. During the night between the 22nd and 23rd she lay in a comatose state;

some of the muscles of the neck and upper extremities exhibited tremulous contractions. The uterine hæmorrhage continued.

On the 23rd the jaundice had become more intense. Pulse, 108; respiration, 24, stertorous; temperature not raised, skin dry.

From time to time there was vomiting of grey mucus, mixed with blackish-brown flakes. Notwithstanding the purgatives, the bowels remained costive. The urine became darker, continued acid, and exhibited distinctly the reaction indicating bile pigment, but did not contain any biliary acids; its specific gravity had risen to 1024. On standing in the cold it deposited greenish-yellow light flakes, consisting exclusively of globular masses of needles of tyrosine. A drop of urine on evaporation upon an object-glass left a residue, which, when seen under the microscope, consisted almost exclusively of crystals of leucine and tyrosine of a very striking form, tinged with biliary matter. Fig. 4, Table III., represents a view of this residue. A sample of urine just drawn by the catheter was freed of colouring and extractive matter by basic acetate of lead; the excess of lead being removed, the residue was concentrated and left to crystallise. After twenty-four hours the tyrosine had crystallised in brownish and greenishyellow spherical groups of needles (Fig. 3, Table III.), which after re-crystallisation (Fig. 5, Table III.) were found sufficiently large in quantity to serve for several elementary analyses. These were performed by Städeler, and the results, together with the tests for and the behaviour of the substance, left no doubt of its being tyrosine. The liquid from which the tyrosine had crystallised consisted of leucine and a glue-like substance. Urea was searched for in vain. Ammonia was present, but in such small quantity as was altogether insufficient to account for the absence of urea by decomposition. The urine when first passed (by the catheter) was acid, contained traces of uric acid, left 4.98 of dry residue and 0-148 of ashes, exhibiting no trace of phosphoric acid and of lime.

The patient died on the third day after her reception into the hospital. The post-mortem examination showed, as the principal lesion, extreme atrophy of the liver, with destruction of its tissue and disintegration of the cells. The weight of the liver to that of the body stood in the proportion as 1 to 68, while in healthy females the proportion is 1:28. From the history of the case and its anatomical features it was concluded that the liver must within six days have lost more than two pounds in weight.

The recital of this and other cases is succeeded by a full discussion of the symptoms, anatomy, and nature of the disease. The therapeutical chapter offers but little matter for congratulation. If, however, anything is calculated to inspire confidence that the efforts of medicine may at a future time be crowned with success, it is the mode of analysing disease carried out by the author.

Chapter VI. treats of chronic atrophy of the liver, and contains a variety of interesting cases. Chapter VII. gives an account of fatty liver, as found in post-mortem examinations; for our author, like Louis, candidly avows his inability to diagnose this condition during life. This chapter, although containing many original researches, is