verdicts enumerated in the preceding section, and such decision shall be final.

SEC. 5. When a final decision is reached, the President shall, in the presence of the tribunal making it, pronounce sentence upon the convicted as contained in the verdict.

SEC. 6. When a Guardian of Health is accused, he shall, before proceeding to trial, deliver into the hands of the President his diploma, and his refusal or neglect to do so shall be regarded as conclusive of the truth of the charges set forth in the accusation.

SEC. 7. If either of the first three verdicts, as above, be found against the accused, the President shall return to him his diploma at the time of delivering his sentence. If the fourth verdict is found, the President shall return to him his diploma when his suspension ceases. And if the fifth verdict is rendered, the President shall file the diploma among the archives of the State Association, there to remain.

CHAPTER XII.

MISCELLANEous.

SECTION 1. A proper preliminary education should embrace a good English education, a knowledge of Natural Philosophy, and the elementary Mathematical Sciences, including Geometry and Algebra, Mental and Moral Philosophy, Botany, Natural History, Inorganic Chemistry, Geology, Zoology, and an ability to read the Latin, Greek, French, and German Languages.

SEC. 2. A proper professional education should embrace a practical familiarity with the whole range of Medical Sciences, including anatomy, histology, physiology, pathology, pathological anatomy, materia medica, medical chemistry, pharmacy, therapeutics, clinical medicine, clinical surgery, clinical obstetrics, medical jurisprudence, hygiene, and medical history and bibliography.

REPORT ON THE MICROSCOPE.

BY CALVIN WEST, M. D., HAGERSTOWN, IND.

The study and investigation of disease from the earliest times has led slowly, but surely, to the knowledge of the normal structure of the part diseased; thus enabling the investigator to judge with accuracy how far the morbific cause had changed the structure in which disease was located from its normal condition. This process of investigation has been successfully prosecuted down to our time, and during the twenty-five years last past, extraordinary success has rapidly developed many new and astounding facts. At one time all diseases were thought to exist in the fluids; at another time authors thought that they existed solely in the solids; others again thought, after the nervous system came to be understood, that all diseases had their primary seat in the nervous system. In this our day, most teachers of Pathology admit that any or all of these tissues may become the location of disease.

Among the humoral pathologists no uniform method of description is found, but everything was conjectural, yet an inductive process and chemical investigations have proved the truth of many of those conjectures.

Celsus, a solidist, described disease by the terms of heat, redness, friability, and hardness, and from his writings we derive also the terms atheromatous, osseous, calcareous, steatomatous, melicerous; but these have mostly fallen out of use since the microscope has been applied to the investigation of the normal structure of the tissues composing the human body, showing the existence of an organic cell, from which proceed liquids, granules, filament, and membrane, and from these organic primary formations, by the morbific cause, abnormal or pathological forms are derived.

Microscopists teach that this instrument is most successfully applied to disease manifesting itself in the solids. Some of these manifestations are discoverable during life, and others only after death. All discharges from the body, whether from abscess or otherwise, may be readily examined.

This instrument gives no indication in regard to the cause of disease, other than in such discharges as can be made to assume the solid or crystalline form.

Some alterations are discovered only by the microscope, and a power from 150 to 500 diameters is thought to be amply sufficient for pathological research.

Of the diseases recognizable during life, we may mention Morbus Brightii, and simple irritation of the bladder. Carcinoma has, by study with this instrument, been diagnosed with more certainty than without it, and much of the mystery in which it has been shrouded dispelled, and probably the time is not far distant when its nature will be thoroughly understood. Tubercle, wherever accessible to examination, is now determined with much certainty. Discharges of blood, pus, false membrane, cancerous cells, or tuberculous cells from the alimentary canal, may be readily recognized.

Tinea toususans (Favus) is now recognized as vegetable fungus, and so of many other cutaneous diseases.

Unknown to the profession, until this instrument revealed it, was sarcina ventriculi. The circulation is most beautifully shown, and made clear to the comprehension of every reflecting mind.

The microscope, in the hands of Dr. Woodward, of Philadelphia, has contributed largely to develop the structure and define the true nature of heart clot, or polypus. These clots are "composed of tough, well defined fibrillated fibrine, entangling in their meshes a considerable number of white, and some few red blood globules."

As regards their origin being analogous to polypi and their attachment to the endocardium, the Dr. holds the following language: "By these investigations, the normal character of the epithelial and fibrous layers of the endocardium, and of the adjacent muscular tissue, were abundantly established. The idea of an endocarditis, standing in causal relation to the heart clot, is at once excluded by these anatomical relations."

The appearance of adhesions is due to an interlacing of the fibrine with the tendimous and muscular columns of the cardiac parietes. He states that clots, large, free from color, thoroughly ramified, and composed of fibrine, quite well coagulated, though not common, are far from being rare, and may be met with in the most diverse, morbid conditions. Heart clots may exist in connection with endo-carditis, and endocarditis may exist without the clot. Of several specimens in the writer's museum, one shows the inflamatory action to have been set up.

Rockitansky, Virchow, and Woodward, each and severally deny the

possibility that this or any other similar clot can be formed completely, or in part by a Diphtheritic or other lymph deposit or product, occurring as an exudation from an inflammation of the endocardium into the cardiac cavities.

They readily admit that the similarity of the lining membrane of the heart and blood-vessels, with other epithelial surfaces, and especially with the serous membranes, is quite considerable; and as these latter readily produce upon their surface, during inflammation, lymph masses of all characters, or even pus, the same has too readily been presumed to result from inflammation of the lining membrane of the heart and blood-vessels.

After reviewing all recent investigations, and his own works on this subject, Virchow deliberately asserts, that no investigator, who carefully discriminates the coagula of the blood itself, from the supposed exudation, has ever seen a single case of exudation poured out into the caliber of the blood-vessels or the cavity of the heart; the supposed lymph products of vascular lining membranes, or even purulent exudations in cases of phlebitis, being now known to be degenerated blood-coagula.

Rokitansky thinks that the lymph products of vascular membranes are to be found, not on the free surface, but primarily in the substance of the membrane involved, which, in consequence becomes thickened and loses its translucency, and may even ulcerate and then determine, by the action of the roughened surface upon the blood-stream, a coagulation to a more or less extent of the blood or its fibrine only, as happens especially where the process affects the cardiac valves.

Dr. Lopez, of Alabama, on the subject of milky urine (chylous and albuminous urine), by means of the microscope, assisted by chemical manipulations, shows that such urine contains milk globules, casein, phosphate of magnesia and ammonia, mucus, lithate of ammonia and urea.

Drs. Keller and Packard have, by this instrument, shown that the brain, by the softening process, is attended in a marked degree by pouching of the tubuli of adjacent portions of brain. Such brain also contains numerous oil-drops and a large number of dark conglomerate looking corpuscles. In a given specimen the basilar artery was atheromatous and blocked up; the heart was fatty as well as the liver, and atheromatous patches were found throughout all the branches of arteries immediately leaving the

aorta.

Dr. W. Atlee, in fluids obtained from abdominal tumors, asserts, that when the microscope reveals cell-forms, rich in oil, combined with bloodglobules, epthelial scales, pus and pyoid forms, we may regard such characteristics, as pathognomonic of ovarian disease and in a large majority of instances will be perfectly reliable. The peculiar cell is of a fine granular appearance.

The continued investigations of Dr. Woodward have not changed his convictions "that cancer consists of mal-formed and abortive new-formations of connective tissue."

In regard to the structure or mode of development of this tissue, nothing new has come to the knowledge of your reporter.

Dr. J. F. Brown, of the S. E. Branch of the British Medical Association, after rehearsing the views of Drs. Andrew Clarke and Shroeder-Vander Kolk, and "their simultaneous and independent" discoveries of the pulmonary trabeculæ in the sputa of phthisis, proceeds to give the results of his observations under nineteen heads, among which he makes the following statements, to-wit: "The air-vesicles are the seat of tubercle in the lung. When the tubercular matter accumulates to such an extent as to compress the walls of the air-vesicles, the entire structure of the walls

disintegrates, except the elastic trabecula which are alone characteristic of the air-vesicles."

The elastic trabeculæ are seen in the sputa, lying in disorder among the disintegrated elements of the tissue, and are readily detected by the aid of the microscope. The elastic trabeculæ are present in the sputa during the eliminative process of the tuberculous matter, and constitutes the diagnostic marks of this stage.

If elimination takes place with only minute deposite in the lung, this instrument will reveal the disease sooner than the pleximeter and stethoscope; but when there is a considerable mass of tubercle in the lung, without elimination of any portion, percussion and auscultation, taken in connection with general symptoms, will detect the disease, whilst the microscope gives negative results.

Again, minute deposite will be overlooked, in a quiescent state, although both the ear and the eye be employed for its detection.

When the trabeculæ are found in the sputa, the physician may confidently assert that Phthisis is present.

Phthisis commences with the deposit of tubercle, and tends to one of two issues:

1st. To recovery by absorption, by calcification, or by induration and pigmentary transformations;

2d. Or, to suppuration and the establishment of hectic fever. It is yet uncertain whether recovery or progressive disease be more frequent.

The air-vesicles may remain filed with tubercle in a state of complete quiescence, without softening or eliminating for years. This state the microscope will not determine. It must be worked out by the study of symptoms and auscultatory signs. The elastic trabeculae of the air-vesicles cannot be confounded with any other yellow elastic tissue, likely to be found in the sputa, because of their character and arrangement.

To distinguish tubercle of the tonsils from that of the lungs, it is only necessary to notice that the bands seen in sections of the tonsils are in separate pieces, whereas the pulmonary trabeculæ are continuous, and wavy. Chemical tests will soon allay all doubts in this particular, if the microscope fail to clear them up, to-wit: yellow elastic tissue resists the action both of acetic acid and liquor potassæ, whereas the elongated tonsil cells resist acetic acid only, but yield to liquor potassæ, being rendered invisible by it.

The microscopic examination of the sputa enables us to detect softening tubercle in progress of elimination, which could not otherwise be detected; it confirms or corrects the diagnosis of phthisis, dilated bronchi, chronic bronchitis, and determines the actual progress of the lesion of the lungs.

Thus it is seen that the microscope confirms the opinion of the vulgar as to "spitting up their lights," an actual fact.

The developments made, and doubts removed, and assumptions confirmed, bearing upon this disease, may be counted one of the greatest improvements of the age, and through knowledge derived from it, untold thousands may be saved from a premature grave, and their bodies escape the terrible ordeal of becoming the receptacle of numberless, nameless, abominable compounds.

The importance of being aware of the true state of affairs in any given case, cannot be overrated, and when once we can pronounce a man under phthisis (in an anatomical sense), we are likely to use therapeutic measures with greater prospect of success than if we consider the case one of catarrh, simple dyspepsia, or that Monstrum Horrendum, debility.

William Adams, surgeon to the Royal Orthopaedic Hospital, London,

reports microscopic investigations upon sections of tendons in orthopaedic operations, extending from four days to a year and a half after the operation. He says, "Upon section, this new connective tissue presents a somewhat gelatinous appearance. Under the microscope, it was seen to consist of nucleated blastematous material, in which numerous small, oval, and rounded nuclei were apparent. No linear arrangement of nuclei could be traced, no fibrillation, but after being teased out' with needles, or compressed with glass, it still retained a torn, membranous character. At sixteen days after section, the new material appeared chiefly made up of granular nebulous matter. There was a slight attempt at dove-tailing between the new and old tendon.

"At six weeks after section, dove-tailing strongly marked, and under the microscope, a delicate fibrillated appearance was exhibited, but splitting into fibres only where portions of the old tendons were included. The abundant nuclei displayed by acetic acid, partook of a parallel, linear arrangement, so that a perfecting of the new connecting tissue, towards the characters of well formed tendon, was clearly traced."

At three months, careful observation was necessary to distinguish old from new tendon.

At a year and a half after division, with exception of particular adhesions to its sheath, the tendo achilles presented its natural appearance.

Mr. Adams arrives at the conclusion, “that inflammatory exudation is equally a cause of complication and delay, and that the true source of reproduction lies in the sheath. This becomes first vascular and swollen, and exudation of blastematous material is infiltrated through its meshes. This blastema, under the microscope, exhibits the development of innumerable small, oval nuclei, which appear to become gradually elongated, and upon addition of acetic acid, to assume, in cases advancing towards recovery, a parallel linear arrangement.

Our author still doubts whether fibres are formed in this way; but after examining numerous specimens of rabbits, as well as of the human species, he is inclined to believe in the development of fibres by this process. He believes the new tendon remains during life a permanent tissue.

Dr. Dacosta has recently published his discovery of tuberculous matter in the walls of the heart, in the shape of "granules, oil-drops, non-nucleated cells," which seems to be the confirmation of previous discovery.

Mr. Simpson, on Hæmatoma of the pelvis, relates a case where a definitive diagnosis, without microscopic aid, would have been impossible, and by which the minute particles of the tumor, withdrawn by the exploring needle, it was shown to consist of "blood-disks in various stages of disintegration, and some hyaline or pyoid bodies, but no pus-globules." Thus the diagnosis being accomplished, the duties of the physician were plain, and his treatment rational.

Julius Kolb demonstrates the existence of miliary tubercle in the substance of the heart imbeded between the muscular fibres; they were found to follow the course of the fine capillaries. In the voluntary muscles, Virchow records a case of miliary tubercle in a patient in whom there was no other appearance of tubercular lesion.

Recklinghausen describes a case of miliary tubercle of the muscular structure of the heart, of a patient in whose lungs, pleura, liver, spleen, kidneys, thyroid glands, and prostate, they were also found.

M. Nivet, by this instrument, has demonstrated that the blood in the umbilical vein of the fœtus, is in every respect similar to the blood of an adult.