wise adherent to the bone contained withinit. The deceased (H. V.) was a soldier,apparently about thirty years of age, and,so far as I know, had never complained ofuneasiness in the left hypochondriac region.I kept this specimen of bone, with otherswhich I had collected, intending to sendthem to the Army Medical Museum atWashington ; but being ordered away sud-denly for a campaign in Florida and Ala-bama, I was obliged to deposit, with otherarticles, my specimens in a quartermaster'swarehouse at New Orleans. On my returnI learned that the property, belonging toseveral regiments, which had been deposit-ed in the above mentioned warehouse, hadbeen removed to other buildings, and thatmy specimens had been lost.

Bony deposit in the spleen is of rare oc-

currence, I believe, and so I have thoughtthis instance of sufficient interest to patho-lotrists to be recorded.

J. T. Payne, M.D.,Late Surgeon Volunteers.

New Orleans, La., July 18th, 1868.

UNSUCCESSFUL ATTEMPT TO CLOSE AF\l=AE\CALFISTULA

Ma. EniTou,—F. B. was stabbed in his leftside with a two-edged dirk, an inch abovethe ilium, penetrating the descending colonjust beneath the external wound. Ficcalmatter issued through the external woundever afterwards. Nine months after the acci-dent, this wound having partially closed, fuo-cal matter burrowed in the cellular tissue,and ulcerated out at two points, half way be-tween the spine and the opening made bythe dirk. Up to this time he hoped to re-cover, but now he felt that without somesurgical operation he must be worn outwith the discharge and die.

At the urgent solicitation of himself andfriends, and after some delay and muchhesitation, I consented to operate on him,and give him what slight chance there wasfor life. He was much emaciated from awhole year of confinement.

Dec. 17th, 1867, a year from the time ofthe stab, I operated on him by opening theabdomen, finding the hole in the intestine,and sewing it up. The perforation in theintestine was more than an inch in length.I took eight interrupted silk sutures, andcut the ends off close to the knots. líobore tho operation well, and was more com-fortable the forty-eight hours that he livedafterwards than he had been for a long time.He died from exhaustion.

A post-mortem examination showed notraces of inflammation, or attempt at repa-ration. N. L. Folsom, M.D.

Portsmouth, N. H., July, 1868.Portsmouth, N. H., July, 1868.

Bibliographical NoticesMicroscopic Examinations of Blood; and

Vegetationsfound in Variola, Vaccina andTyphoid Fever. By J. H. Salisbury,M.D. New York: Moorhead, Bond &Co., Printers. 1868. 8vo. Pp. 65.This is a remarkable book, as those fa-

miliar with the previous writings of the au-thor will be prepared to believe. It containsaccounts of discoveries startling alike totho pathologist, chemist, and physiologist.They are announced, too, in a manner quiteas novel as their character is surprising.It has been the custom of students of natu-ral science to substantiate each step claim-ed in advance of previous knowledge bycarefully recorded observations, and to offerin support of new theories at least somedata which can be generally accepted.This custom the author lias largely ignored,so that in reading his book one is obligedto take his statements on faith, or else re-fuse to accept views so strange until theyare corroborated by the observations ofothers. Unfortunately, Dr. Salisbury ad-vances so rapidly from one discovery to an-other that it must be a long time before weshall obtain from observers capable of ex-pressing an expert opinion confirmation oftheir claims, unless it be that some of themare so utterly at variance with firmly estab-lished doctrines that they will remain un-noticed by men of science.

It may be already forgotten to what anextent Dr. Salisbury has been a discoverer.It was only in 1862 that he announced thatcamp measles, then so prevalent in ourarmies, was caused by the presence of a

straw fungus. The fallacy of this theoryhas been repeatedly shown by army sur-geons who have had tho largest experiencewith this disease, among the latest of whomis Dr. Bartholow, in Dr. Flint's recent vol-ume on army diseases.

In 1866 he announced tho discovery ofthe causo of intermittent and remittent fe-vers. The enthusiasm with which this wasreceived is well remembered, as well as theclaims to priority of discovery which werestarted in various parts of the world ; of a

discovery which rested on investigationsunsatisiactory at the time, and which so far

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as we know have never since been pushedto a conclusive termination either by Dr.S. or any other observer. Without disctis-s'rig this question at length, it may be stat-ed that it has not yet been demonstratedthat the vegetable organisms to which the°rigin of the disease is attributed are notfound in localities where intermittent feverdoes not exist ; or that they ever producethe disease when transported to regionswhere this affection docs not prevail. Sucha theory in no way furnishes a satisfactoryexplanation of the long periods of incuba-tion so characteristic of intermittent; ofits return after prolonged intervals and remo-val to non-malarial districts ; and of its non-

contagiousness under all circumstances, not-Withstanding the gieat production withinand constant excretion from patients of thoVery germs which are claimed to be theorigin of tho disease. Furthermore, per-sons suffering with this affection here donot appear to excrete any such organismsas Dr. Salisbury has described. Tho wholetheory seems to rest at present upon evi-dence quite as unsatisfactory as that withregard to measles which preceded it.

In 1866 ho also published an article onthe functions of tho spleen and some re-markable peculiarities in some of the ele-ments of the blood, which will again be re-ferred to bolow.

In 1861 he published an account of threenew chemical varieties of rheumatism caus-ed by the presence in tho blood of crystalsof oxalate of litnc, cystin, and phosphates,which can be noticed only in tho briefestmanner. Oxalic acid, as is well known,stands in intimate relationship to uric acid,and it needs but a slight jostling of theequilibrium which exists between tho suc-cessive processes by which the metamorpho-sis of our tissues is effected, such as dis-turbances of respiration or digestion, toconvert effete materials into the former*n placo of the latter. So readily is thissubstitution effected, that it can scarcelybe looked upon as abnormal, at least not asa serious deviation from the law. When-ever oxalic acid is formed in our economy,there it must necessarily be converted intooxalate of lime, which in the blood is holdin solution by other salts there present.No observer has over seen it in tho bloodin its crystalline state in all the innumera-ble examinations of this fluid hitherto made. Dr. S., however, says the blood is full ofsuch crystals in one variety of rheumatism,and that its presence there is the specificcause of the disease, the incubative stage°f which, according to him, may last " from

a few months to many years." Oxalato oflime, he states, is " formed by tho diseasedparent blood gland cells, and being insolu-ble in the fluids of the body accumulates inthe blood." With this sentence is setaside tho accumulated observation of thomost renowned physiologists and chemistsof modern times in relation to the formationof this substance. When opinions clash inthis irreconcilable manner, wo must fallback upon the character and reputation ofthe observers in determining which we areto accept.

Tho same may be said with regard to hiscystinic rheumatism. Cystin, accordingto the most recent investigations of Gorup-Bc8ancz, Kühne, Robin and others, iaknown only as an extremely rare ingredi-ent of urinary calculi and sediments. Ithas also been extracted from tho kidneyand liver in one or two instances and invery small quantity. As to its physiologi-cal relations we are in almost completo ig-norance. It has never been observed inthe blood or perspiration by any reliableobserver. It has a distinct crystalline formand well-marked chemical reaction. NowDr. S. would have us believe that this veryraro substance occurs in tho blood "oftenin great abundance," where it producespuerperal mania in pregnant women, andis a frequent cause of insanity in youngladies. It produces also the enlarged jointsof chronic articular rheumatism. Theseviews seem to be based upon tho disco-very in the blood and excretions of certaingranular or semi-crystalline bodies whichhe calls cystin. Ho does not say that hohas analyzed them, but they certainly inno way resemble the crystalline forms ofcystin known to all tho rest of the medicalworld, and without tho stamp of the che-mist cannot pass as such. It is upon suchevidence that bis new varieties of rheuma-tism rest.

In January, 1868, an article from his penappeared in the American Journal of theMedical Sciences, entitled " Description oftwo new Algoid Vegetations, one of whichappears to bo the specific cause of Syphi-lis, and tho other of Gonorrhoea." One ofthese plants, called crypta syphilitica, al-though of the very lowest order of vegeta-tion, is possessed of wonderful faculties, aswill be seen, if we believe with tho authorthat while being the cause of the primarysore, as well as of tho succeeding consti-tutional symptoms, it may yet remain inthe system for years or a lifetime withoutproducing serious trouble, or may be trana-mitted by a father, once syphilitic, to aud

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be formed in the blood of tho wife and chil-dren many years afterwards without pro-ducing upon them any visible impression.It seems to us that this subject scarcelydeserves tho serious attention of the readeror reviewer as thus presented to them, fornot a shadow of evidence is offered that theforms seen and figured by Dr. S. have any-thing to do with the cause of syphilis or

gonorrhoea.In the next number of the same Journalthere is another article on the parasiticgrowths connected with tho urine, in whicha dozen or more of new cryptogamic plantsare described, all of which are supposed tobe more or less productive of disorders ofthe urinary and genital organs. Dr. Salis-bury is certainly fortunate as a discoverer.An extensive acquaintance with the micro-scopic appearances of urine in health anddisease will satisfy any observer of the fre-quent occurrence of fungoid growths in itin warm weather, and of their multiform ap-pearance, but we doubt if one conversantwith the latest phases of cryptogamic bota-ny would think of dividing them up intoindividual species as Dr. S. has done, or

consider it necessary to look elsewhere fortheir origin than to the spores with whichterrestrial space is crowded.

With this passing glance at the announce-ments of our author during the last twoyears, which is offered in no way as.a tho-rough criticismof their character, weshall beprepared the bettor perhaps to understandthe nature of the volume before us.

The first chapter treats of the microsco-pic examination of the blood, and has al-ready appeared in the New York Journal ofMedicine of the present year. Tho authorbegins by stating that he has already madeover thirty-five thousand individual exami-nations, that an hour may frequently bespent with profit in exploring a single dropof blood, and that not one microscope infifty of those in present use is suited forthis kind of study. He then gives a list of" some of the conditions, states, and pa-thological products to be sought for inblood," which amount to sixty-seven innumber, without counting in "many otherthings to be sought for in pathologicalblood." To attempt to criticize the detailsof this list would be to review the wholefield of modern physiological and patho-logical chemistry, so that only the fewpoints which arc enlarged upon in subse-quent pages can be noticed hero.

First, some remarks upon the fibrin in theblood of health and disease claim our atten-tion. They are introduced with the strange

announcement that " thero is no possibledoubt that the fibrin filaments exist readyformed in tho blood stream, and that thesefilaments are developed from fibrin cells,tho nucleus or yolk of tho fibrin cell form-ing the blood disc, while tho portion of thecell outside of the nucleus is spun intoa fine fibrin thread." Now physiologicalchemistry teaches us that the substance woare familiar with in blood outside the bodyas fibrin may be made to assume a filament-ous or gelatinous structure while coagu-lating as we please to change its externalsurroundings ; that we may prevent itsformation altogether if we choose ; and far-ther, that in all probability there does notreally exist ready formed in tho blood anysuch substance as fibrin, but two albuminoidbodies, called by the latest German observ-ers Paraglobulin and Fibrinogen, by theFrench collectively Plasmine, which afterescape from tho vessels by chemical actionunite to form for the first time the Fibrin,and which aro prevented from such union,or in other words coagulation, within theeconomy by the vital influence of the wallsof the bloodvessels. This is to a certainextent a new doctrine, but one accepted bysuch men as Virchow, Schmidt, Kühne,Brücke, and by Robin in his recent " Logonssur Les Humeurs." Do wc want any higherauthority of the present to confirm theopinion always and universally held thatblood does not coagulate until it has lefttho body ?

But what aro the grounds on which Dr.Salisbury's statements arc based ? He says" by a little practice, the eye can begin toexplore a drop of blood under the micro-scope, in one second after leaving the blood-vessels. * * * * In a few moments will bonoticed faintly delineated filaments, crossingand recrossing each other, forming a mesh-work. * * * * This net-work of organizedfibrin gradually loses tho almost perfecttransparency it has in the blood stream,and becomes little by little more and moreopaque and visible in outline, till in thecourse of five or ten minutes after it isdrawn, the net-work of threads reaches itsmaximum opacity, the filaments being tothe educated eye well defined." Is anycomment necessary ? Can any one but Dr.S. beliove that those filaments existed priorto "the few moments" which elapsed bo-fore he saw them '! Is not something morothan this required to convince us that ourphysiology is in error on this point ? Suchbeing the foundation of his premises, itwould be useless to more than mention thepathological deductions ho has drawn from

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them. Upon the size of the meshes formedby tho interlacing of these filaments in thevessels and the consequent free or obstruct-ed passage through them of the morpholo-gical elements of the blood, depend in groatmeasure, according to him, such morbid con-ditions as rheumatism, phthisis, thrombi andemboli, «fee.

The second chapter is entitled " the blooddisc, a vehicle for transmitting nerve food,"and its object appears to be to show thatthe blood discs carry cholesterin, or nervefat as he calls it, to the nerve tissue, andthat the excess or diminution of this sub-stance in the blood, as shown by micro.-scopic examination, gives rise to some veryill defined symptoms, which he calls cho-lestcraemia. Cholesterin, so far as we knowit, is not really a fat, but plays no doubt an

important role in the economy, as it is foundin so large proportion in the nerve tissue,and possibly does not exist in the blood atall, although its elements do. Our knowl-edge of its physiological or pathologicalrelations, very small before, is not enlargedby what is here written.

The remainder of the volume is devotedto the description of cryptogamic vegeta-tions found in both healthy and diseasedblood. Two species are represented as

always occurring in blood both healthy anddiseased, though one of them is stated asdifiicult of demonstration until the bloodhas been allowed to stand from one to threedays at a temperature of 60° to 70° F. in a

bottle, conditions which certainly would notremove the scepticism of one predisposedto deny the existence of such organisms inthat fluid. If we accept the statement as a

fact, which is in no way improbable, it doesshow that the blood may contain cryptoga-mic growths without in any way affectingthe health ; an important point to be re-membered in our study of this subject.

An algoid vegetable, Crypta carbunculata(Salisbury), is then described and figuredas the cause of carbuncle. The authorstates that whenever he has found this plantin the blood, the patients have been moreor less affected with carbuncles, and thecarbunoular sloughs have also containedthe same kind of filaments.

Wo now come to the two most importantchapters of the book, that is if the opinionstherein stated are correct. The first con-tains the " description of a new vegetationhaving fungoid and algoid phases of growthfound in the blood and eruptions of variolaand vaccina, and which appears to be thespecific causo of these diseases." Thisplant Dr. S. describes under the name of

los variolosa vacciola, and is representedas possessing two phases of growth, a fun-goid, which he calls I. variolosa, and an

algoid, called I. vacciola. Both forms aremet with in the eruption and blood ofsmallpox according to his statement, andif the vegetations of a smallpox pustule beinoculated into a person who has never hadvariola, the same contagious disease, in a

modified form, and the same vegetation isproduced. If, however, the samo be inocu-lated into a cow, a pustular disease is pro-duced, but the eruption is found to containonly tho algoid stage of growth, the losvacciola. The fungoid phase is not pro-duced in the cow. If now this matter fromthe pustule of cow-pox is inoculated intothe human subject, a pustule like vaccinaand variola is produced, but it containsonly the algoid stage like the cow-pox sore.The vegetation of the vaccine pustule likethat of cow-pox is supposed to have no

power of penetrating the epithelial envelopeof the body, and is therefore only trans-mitted by inoculation. The other form,that of smallpox, is supposed to be an activecontagion, the spores of which " falling uponepithelial surfaces that have not had theimpress of immunity stamped upon themby a previous invasion, penetrate to thedeeper tissues, aud pervade tho entireorganism."

This is the theory of Dr. S., stated nearlyin his own language, and in his opinion itthrows " a flood of light upon some singu-lar features of the disease." Not a singleexperiment is referred to, nothing is statedas to the number of cases of the disease hehas examined, of the number of persons orcows inoculated by him with smallpox, orof the number of cows affected by cow-poxobserved to test the truth of his theory, orof tho method of conducting his investiga-tions. Wo are expected to believe withoutthe exercise of our judgment. But if weaccept every statement as well establishedby faultless and repeated experimentation,and admit that one and tho same plant isalways found in smallpox and its alliedaffections and under no other circumstances,would this satisfactorily explain all that woknow of their manifestations ? How, forinstance, does it account for that "modifiedform " which Dr. S. says is produced byinoculating the vegetation of a smallpoxpustule into a person who has never hadvariola, when the same vegetation accordingto him is produced as when the disease istaken by contagion ? How can vaccinationprotect against variola, or in other words,how can the growth in the blood of one

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plant at a previous period prevent thegrowth of the same or of another plant at a

remote period in this ever-changing fluid ?These are but a few of many questions towhich Dr. S. makes no allusion in his book.

But Dr. Salisbury is not the only personwho claims to have discovered the cause ofsmallpox in the presence of vegetable or-

ganisms in tho system. Prof. Ilallier, ofJena, has been working in the same field,and has just published the results of hisinvestigations in a volume of 80 pages, en-titled Parasitologische Untersuchungen be-züglich auf die pflanzlichen Organismenbei Masern, Hungertyphus, Darmtyphus,Blattern, Kuhpocken, Schafpocken, Chole-ra, &c. Prof. Ilallier seems to possess, inthe first place, the requisite intimate know-ledge of cryptogamic botany to be able todistinguish tho old from the new in theselow forms of plant-life, and the plan he haspursued in his studies is in theory the cor-rect one so far as it goes, though in prac-tice open to grave errors. He finds in thefluids and excretions of thoso diseases cer-tain forms which he considers as belongingto vegetable life, but in so low a stage ofdevelopment that the microscope cannotdistinguish one from the other in all cases,or of what mature plant or individual spe-cies or genus they are the representatives.These forms he calls inicrococcus, and theymay be so small as to be scarcely recogni-zable when magnified 1000 diameters. Inorder to determine, therefore, their indivi-duality, he cultivates them in apparatus iso-lated, as ho thinks, from all connection withtho air, and upon other substances as milk,fruit, cork, starch, eggs, &c, and then exa-mines the forms developed as he assumesfrom such primitive germs. These matureforms he regards as the plants which causetho diseases in which tho inicrococcus isfound. The error of this process lies inthe impossibility, one may almost say, what-ever be the precautions taken, of destroy-ing similar germs which preexist in thesubstances used in such experiments, asthe history of the modern controversy con-

cerning spontaneous generation has shown.The experiments of Prof. II. are impor-

tant and highly interesting, but it will beimpossible to give an account of them hero.What is of immediate interest to us in thisconnection is to mark how two observers,workingindependently ofeach other andbothclaiming to have discovered the cause ofsmallpox, arrive at the same end, as of coursethey must, if they have discovered its cause.Wo have seen that Dr. S. describes thiscryptogam as a now plaut and calls it los

variolosa vacciola, but Prof. n. tells usthat the micrococcus of vaccine lymph dc-volopes into Torula rufescens, a commonmould, while the corresponding form fromvariola lymph exhibits, when mature, a

modified growth of the same fungus, nei-ther of which, however, are identical withor in any way resemble that figured anddescribed by Dr. S. Here, then, two ob-servers discover two distinct causes ofsmallpox. They cannot certainly both beright in their inferences ; but one of themhas given us proper scientific data by whichwo may judge of tho merits of his investi-gations, tho other leaves us wholly in thedark. It is to bo feared that we must yetwait for the discovery of the cause ofsmallpox.

The concluding chapter of Dr. Salisbury'sbook is on the " Vegetation in TyphoidFever which appears to bo the specificcause of the disease." This, he states, isa peculiar minute algoid plant, which de-velopes upon all the epidermic and mucoussurfaces and penetrates to all tho tissues ofthe body, flourishing with special luxuri-ance in the glands of Poyer, and increasing" until the organism finally becomes so poi-soned and vitiated, that it seems to be no

longer able to propagate tho vegetationthat has been the specific cause of all thotrouble." This plant ho calls Biolysis ty-phoides. If we turn again to Prof. Ilal-lier's pages, we find that he has also beeninvestigating the cryptogamic nature ofthis affection, and has concluded, from thecultivation of tho spores or rnicrococcus hofinds in the blood and intestinal evacua-tions, that it is caused by two fungi, Rhizo-pus nigrioaiis and Pénicillium crustaceiim,lioth well-known moulds. These plantsalso resemble in no way that described asthe specific cause of typhoid by Dr.Salisbury.

The most that can bo claimed for theseso-called discoveries is the presence in theblood and tissues of persons affected bycertain diseases, of forms of cryptogamicvegetation. Even should it bo subsequent-ly demonstrated that their presence undersuch circumstances is constant, and thatthey never occur at other times, it wouldnot follow necessarily that such plants arethe causes of those diseases ; for accordingto tho observation of Dr. S., there aro twosuch plants always existing in the bloodwithout affecting its condition. Why maynot the new forms bo due simply to a che-mical change in the nature of this fluid dur-ing disease, for instance, for we know how"materially the growth of such plants is in*

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fluenced by variety of soil or food ? Thowhole subject is one of great importance,and will very likely some day be found tocomprehend the laws which govern themaintenance of some of our most fatal dis-eases; but it is still almost an unknown re-

gion, the secrets of which are to be reach-ed not by hasty generalizations, but bypatient observation and self-sustaining ex-

périment. J. C. W.

Twenty-first Annual Report of the Officers ofthe New Jersey State Lunatic Asylum atTrenton, Dec. 1, 1867.During the past year extensive additions

to the buildings of this Asylum have beenmade, making it now one of tho most com-

plete in its arrangements, as well as one ofthe largest institutions in tho country.Five hundred patients can bo comfortablyaccommodated ; and this is as large a num-ber as it is deemed expedient to collect un-der the care of one institution, in view ofthe practical details necessary in the over-

sight, proper classification, medical treat-ment, employment and amusement of thatnumber of insane persons. As a largonumber still remain unprovided for in NewJersey, a new hospital is to be built and lo-cated in the eastern part of the State.

The number of patients in the asylum,Nov, 30,1866, was 409 : 205 males and 204females. During the year, 212 were admit-ted, 85 males and 127 females; 171 were

discharged—72 as recovered, 54 improved,8 unimproved, and 37 died; leaving in theasylum, at the close of tho year, 450—200males and 250 females.

From the report of the Superintendent,Dr. II. A. Buttolph, we learn that sincetho opening of the asylum, May 15, 1848,2986 patients have been admitted. Ofthese1173 have been discharged recovered, 818improved, 96 unimproved, 9 eloped, 4 notinsano, and 436 died.

As the Legislature of the State had notdecided to build another hospital when thisreport was written, the Doctor argues thenecessity for additional accommodation,and in doing so quotes his remarks madeat the previous meeting of the Associationof Medical Superintendents of AmericanInstitutions for tho Insane, while the subjectof making provision for tho chronic insanewas under consideration. Among the mostimportant of these remarks, are the follow-ing :—" I believe it to bo tho duty of tho Na-tional and State governments, assisted bysuch voluntary contributions as wealthyand benevolent individuals may oiler, to

provide hospital and asylum accommoda-tion for all insane persons who need anddesire them." "The advantages of thedistrict system of providing for all classesof insane are, first, the least possiblo ex-

posure, fatigue, and expense in removingpatients to and from tho institution ;secondly, the greater readiness with whichprivate individuals and public authoritiesliving near them avail themselves of theirbenefits ; and last, though not least, thogreater case with which tho friends of in-sane patients can visit them when it isdeemed suitable for them to do so."

The general operations of the asylum, itis stated, have been conducted with aver-

ago success and satisfaction ; while nearlyone hundred more persons have receivedits benefits than in any other year.

C. K. B.

Medical andSurgicalJournal.Boston: Thursday, October 1, 1868

THE DISEASES OF CHILDRENPkw physicians have forgotten what

doubt and perplexity in their student daysand in their earlier years of practice, ob-scured their diagnosis of children's sick-nesses. To most of us, for aught wc were

taught, or for aught wo could gather fromthe bewildering compilation called our text-book of such maladies, the illness of littlechildren remained a mystery, a sealed book,to be opened with difficulty, and to bo readonly by the confused light of our own smallexperience. To many of us, still, this classof affections remains tho most difficult tomaster ; and it has been well said that thephysician must have children of his own, inorder to comprehend tho multiform phasesand changes of mind and body among thochildren of his patients.

Any new work, then, that can throw ad-ditional light on such a subject must bedoubly welcome ; and we have seen nonesince tho treatise of West, which pleasedus moro than the volume before us.* TheFrench schools have produced the best cli-nical teachers on this subject, owing to tho

* Piscases of Children. A Clinical Treatise based ouLoctiircs delivered at the Hospital for Sick Children,London. By Thomas Hilller, M.D. Load, l'liiladel-dclpUiu: Lindsay & Blukistou. 1868. 8vo. Pp. 102.

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