prescribed by the Senatus of each University, and must report themselves to the Senatus as intending so to do; and when irregularities occur, it shall be in the power of the Medical Faculty to report the same to the Senatus, as a ground on which the latter may hold the attendance of such private Teacher or Lecturer not to be adequate.

We propose that the Winter Session shall be six months in length, and the Summer Session four months.—p. 59 and 60.

We are farther of opinion, that Degrees ought not to be granted to persons who are under the age of twenty-one years.

It may be here proper to notice, that it has appeared to us to be es sentially necessary that Degrees in Medicine should not be conferred by any of the Universities in which there is not a certain proportion of medical classes regularly taught. A Degree in Medicine cannot be considered merely in the light of an honorary distinction; and for the reasons already adverted to, it appears to us that it is most inexpedient that the Degree, which confers a right to practise, should be granted by any University in which there is not an adequate number of Medical Professors. p. 64.

In regard to the nature of the Examinations for Degrees in Medicine, which were originally conducted in Latin, the practice has recently been introduced of examining in English. We are of opinion that this change is beneficial. We have already explained the provision by which we have endeavoured to secure an adequate knowledge of Classical Literature, and that object being otherwise provided for, we apprehend that an Examination in English is better calculated for ascertaining thoroughly whether the Candidate has that knowledge of the various branches of the science of medicine which he ought to possess.

We have therefore adopted the fol

lowing Resolution :- That the Examination of Candidates for the Medical Degree should be in the English language, and that Candidates for that Degree should not be obliged to prepare or print a Thesis; but that they should have permission to do so in whatever language they may select; that the Medical Professors should be the Examiners of Candidates for that degree; that the fees paid for obtaining it should be collected into a fund, out of which a fixed salary or remuneration shall be given to the Medical Examiners under the authority of the University Court; that no Medical Degree should be granted to a person under twentyone years of age; and that no Medical Degree shall be conferred by any University where there are not Professors teaching the several classes, of one or more of the years of the Curriculum."-p. 65.

A Treatise on the Diseases of the Heart and Great Vessels, comprising a new View of the Physiology of the Heart's Action, according to which the physical signs are explained. By J. HOPE, M.D. senior physician to the St. Mary-le-bone Infirmary, formerly house physician and house surgeon to the Royal Infirmary of Edinburgh, &c. 8vo. pp. 612. London, 1832. W. Kidd.

The vast importance of this truly valuable work induces us to offer a brief notice of its merits in our first number, in order to place the name of its learned and experienced author in association with those of the highly distinguished individuals, the results of whose experience we now submit to our readers, with the intent, however, of reviewing the work fully in an early number.

The claims which this production has upon the profession are irresistible, and these are, new, instructive, and most valuable information upon the physiology, pathology, and treatment of the diseases of the heart and blood-vessels. We heartily congra

He

tulate the author on the complete success with which he has so ably executed his difficult undertaking. He has produced a work of reference and authority which must have a place in every medical library. After having fairly acknowledged the respective claims of Corvisart, Kreysig, Burns, Laennec, and Bertin, he clearly proves, that much more evidence is wanted to elucidate the nature and proper treatment of the diseases under notice. To supply a part of this evidence, he performed a series of experiments before a number of the distinguished physiologists and pathologists of this metropolis, which enabled him to explain the physical signs of diseases of the heart. disproves some of the opinions of the illustrious Laennec, to whom he justly offers the high eulogy to which that great physician is so eminently entitled. He communicates the longwished-for information, the correct diagnosis, and the effectual treatment of cardiac diseases. He affords abundant evidence of the curability of these maladies, when recognisable, as they now are, in their incipient stages. He states, on the grounds of incontestable experience, that in their early stages, they are, in a large proportion of instances, susceptible of a perfect cure; and in general may be so far counteracted as not materially, and sometimes not at all, to curtail the existence of the patient. Such are the direct practical improvements to be expected from a better knowledge of diseases of the heart. These are vast improvements indeed; but there are collateral ones of no less magnitude. These are exemplified by the frequency of apoplexy and palsy, in alliance with hypertrophy of the heart; which, if overlooked, may lead to fatal results. An inattentive or injudicious observer may suppose that in all cases an apoplectic tendency is to be removed by active exercise, which will suddenly produce the disease which it was intended to remove. Again, organic disease of the heart is

said to be caused by dyspepsia; "good air and plenty of exercise are remedies;" and apoplexy the consequence. As the incipient disease of the heart might be removed, the recovery was regarded, by those who assumed this class of diseases to be incurable, as a proof that the malady was merely dyspeptic. Hence dyspepsia was said to cause disease in the head, which was really caused by disease in the heart. The converse of this error is, in mistaking nervous or dyspeptic palpitation for disease of the heart. "The frequency of cases of this kind," says Dr. Hope, "especially amongst men of studious habits (and more particularly, I have noticed among those of my own profession), is truly surprising; and, as it has always been considered difficult, and by many impossible, to distinguish the two affections, the alarm created is sometimes distressing." The author assures us that the discrimination may be made with ease and certainty, and has given a separate article on the subject.

He next observes, that an immense number of asthmas and of universal dropsies result from disease of the heart. "If the cause be overlooked, the asthmatic is harrassed with a farrago of inappropriate and unavailing, not to say pernicious remedies; and the hydropic is treated with dangerous activity for imaginary affections of the liver, the lungs, or the kidneys." On the other hand, if the cause be detected in the incipient stage by precautionary measures, both the one effect and the other may in general be prevented. The judicious and talented author next adverts to carditis and peri-carditis, induced by metastasis of rheumatism; and informs us also, that disease of the heart, accompanied with obstruction of the circulation for any considerable period, produces enlarged liver, and its ordinary consequence, abdominal dropsy. Yet the treatment is solely directed to the liver, and not to the heart. Persons affected with cardiac disease, are extremely liable to rapid and destructive

inflammation of the lungs. If copious and repeated venesection is employed the patient sinks suddenly. The characters of the pulse may be deceptive, and fevers or inflammation from diseases of the heart, and bloodletting may be carried too far, or not far enough. In fine, there is scarcely an affection with which diseases of the heart may not be interwoven. Such then are the vacuities left by preceding writers; and such the advantages to be anticipated from their being supplied. The author describes the arrangement which he adopts, which is extremely correct and accurate. He selected his cases from the Hospitals; and he invariably re

body in the state of collapse in cholera, typhus, scarlatina, and numerous other diseases in which the vital We powers are greatly depressed. have examined Mr. Le Beaume's apparatus, which is applicable to the whole or any part of the body. In cases of rheumatism or paralysis of particular parts, it can be applied with facility. We strongly recommend this cheap and really useful production to our readers.

ON THE INFLUENCE OF THE NERVES OVER MUSCULAR CONTRACTILITY.

The

before the death of the patients, which were astonishingly correct. These are attested in some cases by the signatures of the medical officers of various Hospitals in London, Edinburgh, Paris, and Rome. accuracy of Dr. Hope's opinions on the nature of the most opposite diseases of the heart were invariably attested by dissection. He is uncommonly well versed in the diagnoses and treatment of diseases of this organ; and will be consulted in such cases with the greatest advantage, both by the profession and the public.

On the Portable Sudutory or Hot Air Bath, with Cases illustrative of its Medical Powers in various Diseases, and its utility in Cholera; with Directions for its administration; together with Remarks on the applicability of Galvanism in the first stage of that Malady.-By M. LE BEAUME, Medical Galvanist and Electrician in Ordinary to the King. 12mo. 84. London, 1832.pp. Highley.

THIS is an exceedingly instructive essay, containing the most satisfactory and conclusive evidence of the efficacy of hot air to the surface of the

Surgical Journal.

GENTLEMEN,

I shall feel much obliged by the insertion in your valuable Journal of the following observations, if you should consider them worthy :

Physiologists, I believe, consider the contractility possessed by muscular fibre to be an inherent property; they suppose likewise this property to be under the regulation of the nerves, and that their influence disposes to contraction. Dr. Mason Good says, the nervous influence is continually being communicated in jets. There are several objections which may be urged against this view of the influence of the nerves.

If nervous influence is continually being sent into a muscle, it must either give rise to constant contraction, or it

must accumulate there.

It seems strange, that an additional quantity of the self-same influence that predisposes to contraction should be required in order to produce actual contraction. The theory, in fact, supposes an inherent disposition to contract in the muscular fibre itself, a continual exciting cause in the efflux of nervous influence; and still contraction does not take place, unless further excitement is furnished by a sudden additional charge of nervous

power.-What an accumulation of causes is here!

How can we, according to this theory, reconcile the anomaly of spasmodic action taking place, when we have evidence of nervous debility co-existing?

It is a fact, that our best antispasmodics are direct or indirect stimulants to the nervous system ;-e. g. æther. If muscular contraction depend on sudden increased nervous influence, then stimulants would increase the disorder they are intended to re

move.

How can an animal relax those muscles which are without antagonists, if every property of the muscle itself, and every influence added to it, be for the purpose of favouring contraction?

In considering these objections, I have been led to imagine that the influence of the nerves over muscular fibre may be of a nature totally different to what is generally supposed. The opinion I have formed on the subject I now beg leave to offer to your consideration.

I will take advantage of the acknowledgment that muscular contractility is an inherent function-that it is the very nature of muscular fibre to shorten itself by contraction. I admit too, that this contractility is regulated by the nerves, and through their medium subjected to the influence of the will, or, as in the instance of involuntary muscles, of their proper stimuli.

I cannot allow that the influence which is present when the muscle is relaxed, is of the same nature as that which by a sudden influx causes contraction; I suppose that the nervous influence which is present in relaxed muscular fibre, is the only influence which the nerves of volition possess over that tissue, that its office there is, to restrain or controul the tendency to contract which is inherent in the muscle, and that contraction can only take place when by an act of the will this iufluence is suspended, the muscle being then left to

act according to its own innate properties. Is it not more reasonable to suppose that the nerves occasionally suspend, than that they only occasionally exert their full influence? And when we are told that muscles are ever ready to contract by virtue of a principle peculiarly their own, are we not to suppose that any influence imparted to them, is for the purpose of reining in this disposition to act, rather than that any additional power is necessary for the performance of an act, which experiments prove can go on without such additional power?

The nervous influence, then, is imparted to muscular fibre, for the purpose of restraining its contraction; and the action of the will, and of all other disposers to contraction, is simply to withdraw for awhile this influence, so as to allow the peculiar property of muscular fibre to shew itself. Sir Charles Bell has said, that when a muscle loses all governance of the nerves, the vis insita falls into partial and general convulsions. Surely then the nature of the governance here alluded to, must be to restrain contraction.

This restraining influence is not derived from the brain; it exists in the extremities of the nerves, even after they are detached from the brain; their connection with this organ is, to admit of the transmission of volition along the media of connection, the nervous trunks. Thus, a muscle detached from the body will contract, but only when particular applications suspend the restraining nervous influence which exists for some time after death. In proof of this, I may observe, that though certain sedatives applied to a portion of a nerve, prevent the extremities of that nerve being acted on by a power applied above the seat of the injury, yet they are readily acted on by a power applied below it; so that division of a nerve produces paralysis by interrupting the communication of volition, not by having its influence on the muscular fibre positively destroyed.

According to the theory here attempted to be explained, we have a beautiful provision for contraction, in the innate and independent property of the muscle itself, and another, equally beautiful, to enforce relaxation, in the nervous influence which is superadded to it: thus we are enabled to account for the active dilatation of the auricles of the heart; the blood in the heart causes the nerves to suspend their influence, the muscular parietes of the heart contract, and expel the blood; the nerves are now at liberty to resume their functions, the muscle relaxes from its contraction, and is compelled to an active state of diastole, and the blood again rushes in to supply the vacuum which would other: wise be produced.

Perhaps the phenomena of secretion may be accounted for in the following manner:-It has been asserted, that the capillary arteries are furnished along their sides with innumerable foramina, each foramen being provided with a sphincter muscle. Is it not probable that these sphincters are furnished with motory nerves, which are incapable of being acted on except by peculiar substances? When, there

fore, the matter of the various secretions which is combined with the circulating fluid, comes in contact with the nerves of these little sphincters, they are thereby stimulated to exert their power in producing relaxation, so as to admit that which it is their function to separate from the blood.* Any substance in the blood, which is not of the exact nature of the required secretion, exerts an opposite action on these nerves, causing them to suspend

It may be objected, that unless their sphincters possessed the power of chemically decomposing the blood, they could not separate fluids which are combined with it ;-but it must be evident, that even mechanical division of a compound substance cannot proceed beyond a certain extent, without eventually separating its component parts by dividing it into its ultimate simple atoms.

their functions, so as to permit contraction of the sphincters, for the exclusion of foreign substances. The action of the lacteals in separating chyle from the contents of the intestines, of the pyloric orifice of the stomach, and of the epiglottis, may be accounted for in the same manner.

I may add another reason which has induced me to adopt this theory, and that is, what is called the tonic contraction of a muscle, as instanced in the stiffened corpse; this I suppose to be nothing more than an uniform exertion of the power of muscular contractility, which takes place over the whole body, when the nervous influence is totally lost, and lasts until the property of contractility is destroyed in the muscles themselves: for the muscles retain their functions longer than the nerves. We find this stiffness comes on gradually, and that is because the nerves lose their power of restraining contraction by degrees.

The nervous system, in well regulated constitutions, is kept in full possession of its properties by the ordinary nutriment of the body; but there are substances which peculiarly excite and increase the power of the nerves, such as spirituous liquors of all kinds, and which, after being persevered in for some time, become absolutely necessary to keep the nerves in full tone; these substances may then be called the food of the nerves. After a short abstinence from this food of the nerves, the habitual drunkard is unable to regulate the action of his muscles until his nerves are supplied with the peculiar stimulus for which he has caused them to acquire a morbid appetite, and a morbid necessity. The convulsive twitchings of the muscles in delirium tremens, are evidences of an imperfect supply of the nervous restraining influence, and the cause of this is abstinence from their accustomed, and, consequently, necessary food. The most obvious way to relieve this condition, is to break this fast of the nerves, that those properties may be