"2. Its quantity may be increased (hyperæmia or polyhæmia) or diminished (anæmia or hypæmia.) This increase or diminution may either be general, extending to the whole organism, or local, and restricted to particular parts of the body.

"3. It may be effused in consequence of laceration of the bloodvessels, into the interstices of the parenchyma of certain organs, or into some of the cavities of the body, constituting extravasation.

"4. The hæmatin may, by a process of decomposition, become dissolved, and then be imbibed by the tissues."

p. 59. The blood also becomes changed by the absorption of ferments and other extraneous matters, by which its character is at times essentially altered; and this, after all, is one of the most important considerations to be borne in mind in regard to the blood as a source of disease, and as suggesting methods of medication in various pathological states now properly esteemed of bloodorigin. The pathological relations of the blood are, however, not easy of appreciation; but, for that very reason, they should be more closely investigated.

From the chapter on Independent organisms in the human body-Parasites-we extract the following in relation to Epiphytes or parasites derived from the vegetable kingdom.

"All the parasitic plants which, up to the present time, have been observed in the human organism, belong to the lowest forms of vegetation-the algae and the fungi. They are all very minute, so that, to the unaided eye, the greater number are totally invisible, and others are only perceptible when accumulated in large masses. In order to recognize their peculiar structure, and thus to arrive at a more accurate diagnosis, the microscope is invariably necessary, and very high powers are often required. They are found either upon exposed surfaces, namely, upon the skin and mucous membranes, or floating in the fluids of the body. I am acquainted with no authentic case in which they have been observed during life in the parenchyma of human organs. Respecting the origin of vegetable parasites, there are the same two different views which have been noticed in relation to the origin of parasites generally. Whilst, for instance, attention to the lower

Kützing, who has devoted much of his algæ, maintains, that their origin by repeated spontaneous generation is possible, others limit their origin to the mode by

Phycologia generalis, Leipz. 1843, p. 129, &c.; or his remarks in Erdmann's Journal f. prakt. Chemie, 1837, vol. xii. p. 391.

propagation. Although a positive decision of this disputed question may at present be impossible, it nevertheless appears to me that there are overwhelming reasons in support of the view that they invariably owe their origin to propagation alone. These reasons are chiefly founded upon the researches of Schwann on fermentation, upon similar investigations of Holmholtz,* and upon others which Dr. Merklein has abundantly instituted upon this subject, all which show, that under conditions which otherwise prove favourable to the formation of fungi and algæ, these do not present themselves, when the possibility of the transference of uninjured germs is precluded. Moreover, all the parasites hitherto observed increase in enormous ratios by means of germules or spores: the latter are so infinitely numerous, so minute, and maintain their germinating power so tenaciously against the most common external agents, that by means of water and currents of air they certainly become universally dif fused, and can, therefore, develop themselves wherever they meet with favourable conditions. That we have hitherto, in most instances, failed to demonstrate the origin of fungi by transference of germs, can be no argument against this mode of propagation; for, even in the most careful examination, certain fungus-spores, whose diameters are sometimes less than the 1000th of a line, may, and indeed always will escape the notice even of the most practised observer. In some cases the transference of parasitic fungi, or of their spores, from one subject to another, becomes facilitated by distinct relations, as immediate contact, &c., as may occur in porrigo, in some forms of impetigo, mentagra, &c. These are the cases which are especially regarded as contagious. In general, however, peculiar conditions appear requisite for the development and increase of the transferred germs-conditions which are in general only realized by pathological relations. It appears, for instance, that the surface upon which they are to develop themselves must in general, if not always, be in a certain state of chemical decomposition (putrefaction or fermentation;) as, indeed, we find that externally to the human and animal organisms, most fungi are developed only on putrefying substances. Experience shows us, that parasitic fungi are especially liable to occur on foul ulcers, and probably only exist on the skin or mucous membrane in the cases where these are furnished with a layer of decomposing exudation. Parasitic plants have so far a diagnostic value, that they indicate that a process of decomposition is going on, however locally circumscribed it may be Hence it follows that they do not become developed at all spots on which the germs are deposited: their growth indicates a certain morbid disposition. This view

'Müller's Archiv. 1843, p. 453, &c.

is opposed by the results of experiments made with the view of showing that parasitic plants can be transferred by inoculation to apparently healthy organisms, and then give rise to morbid phenomena: thus, for instance, Hassal' was able to transfer, by inoculation, parasitic fungi from diseased to healthy lettuces, in which they produced the same disease, (softening of the stem.) These cases, however, prove but little: they merely show, that in some instances the disposition to fungoid development need not be great; and they are, moreover, open to the objection that the plants which were inoculated having, perhaps, the same habitat, and living under similar relations, already bore within them the morbid disposition." p. 428.

Dr. Vogel then describes the different fungi found in animal fluids—the yeast plant, and sarcina ventriculi; and next the parasitic fungi found on the integument, and its appendages, of man-those of porrigo, mentagra, plica polonica, and of the mucous membranes; after which he treats of the different parasitic animals; terminating with a learned view of malformations, in which he includes the different forms of monstrosity.

The plates, ten in number, are well executed, and the whole work is exceedingly instructive. It indicates on every page that the author is a well read, painstaking, and accurate observer; fully aware of what has been done in other countries as well as his own; and always anxious to do justice to his brethren who have been engaged in the same labours. We shall look with anxiety for the promised volume on special pathological anatomy, which we doubt not will be worthy to take its place alongside the one before us.

Dr. Day-the translator-appears to have executed the dutyif not elegantly—faithfully. He modestly states in the preface, that the additions he has made are trivial and unimportant, with the exception of the plates and their explanations. "These," he remarks, "are almost entirely selected from the author's 'Icones Histologiæ Pathologicæ,' and will, I trust, be found valuable aids to the clear understanding of the subjects they are intended to illustrate." p. xx. We wish he had added "Tabula xii" of the "Icones"-"Epizoa atque Entozoa Hominis," in which the different parasites are delineated. The other plates, *Froriep's N. Notizen. Oct. 1843, p. 54, &c. 3

VOL. X.

referring--as they do-to lesions of special organs, will doubtless appear in the next volume.

We are glad to find, that this valuable treatise is about to be reprinted in this country by the enterprising house of Lea & Blanchard of this city.

Medical Instruction in the United States: an Address delivered to the students of the Philadelphia Associa'ion for Medical Instruction, at the close of the Session of 1846. By ALFRED STILLÉ, M. D., Lecturer on Pathology, and the Practice of Medicine.

In this address, Dr Stillé controverts the assertion of Professor Paine "that American physicians greatly surpass all other nations, not only in the decision, but in the success of their practice," and argues that in attainments, so far from being equal to those of the different nations of Europe, they are greatly behind, and therefore cannot possibly surpass them in decision or success in the treatment of disease.

After contrasting the qualifications for entering upon the study of medicine, demanded in various sections of Europe, with the looseness which prevails in the United States, the lecturer makes the following statement:

"After all the preparatory study we have described, what term of attendance on medical lectures is required of European students? In Austria and France fifty months; in Prussia and the secondary states of Germany forty months; in Great Britain and Ireland twenty-four months; while in the United States, we undertake to produce a competent physician in eight months, or one-third of the time deemed necessary by the lowest of the European schools."

In this statement the system of medical education pursued in the United States, it strikes us, is not quite fairly compared with what obtains in Europe. With us, three years study we believe is demanded by all the colleges, including attendance on lectures. The student in his attendance on lectures, instead of being confined to two or three subjects in different years, thus extending the term to four or five years, is occupied with all the branches at once, so that in two courses of four months each he may hear as many lectures on certain subjects as would consume double

the period of time when but half the number are given. Whether the number of subjects taught simultaneously is more than the mind of an industrious student can master is another question. Every one, who attends but two lectures a day, will not learn more of these particular subjects than others who are engaged with six; and therefore, according to our republican notions of justice, the industrious man, who can acquire a competent knowledge of his profession to commence the practice of it in three years, should not be subjected to the expense of a protracted pupilage, because the drone and the dolt may require five or seven. With us, it must be recollected, no part of a medical student's expenses are borne by government, as in continental Europe, and in the yet infant state of our country the means of parents generally are not adequate to great expense in the edu cation of their sons; nor does government, in most of the states, afford to the regular physician any protection against competition from the uneducated.

There is a wide difference in these respects, between our situation and that of the old institutions and despotic governments, to which Dr. Stillé refers as patterns for our imitation.

Under the circumstances in which we are placed, it would be both unjust and impolitic to prescribe a longer time or greater outlay than experience may show to be indispensably necessary for the accomplishment of the desired object. What may be the shortest time necessary is a question about which men of equal experience will differ; but as the object of all hese requirements is to insure a competent amount of knowledge for the safe and judicious exercise of the office of a physician, and as this can be arrived at by a proper examination, and in no other way, there ought to be no difference of opinion on this point. If every aspirant for admission into the ranks of the profession were subjected to this test, there would be little occasion for any other. There need be no inquiry where he got his knowledge, nor how long he was about it. But here lies the difficulty. The completeness of the examination must depend upon the character of those who are to conduct it. Who shall these be? In order to arrive at a correct appreciation of this matter, we must first look to the form and operation of our government, for no voluntary or self-constituted board, whether examiners or