right capsule of the length of nine centimetres. This resulted from the prolongation of its anterior lip, which reached to the level of the hilus of the kidney, and really covered that viscus on its anterior surface in the greater part of its extent at least. The lip, thus lengthened, was constituted entirely of the fibrinous envelope of the capsule, except at its edge, where there was a fringe of its proper parenchyma. From its change of form, the convex margin of the capsule had become parallel to the convexity of the kidney. Such intimate adhesions had occurred between the fibrinous membranes of these two organs that neither could be separated from the other. In the same subject, the left capsule adhered with equal force to the kidney, and where the adhesion occurred, in a certain space, only presented the fibrous envelope, the laminæ of which were glued together. "In four instances, I found engorgement of the supra-renal capsules-viz., in a fœtus of nine months; in an infant six days after birth; in the body of a man dead with choleraic symptoms; in that of one with symptoms of asphyxia. "In a subject of phlogosis of the enveloping membranes of the capsules, which occurred in my experience, these membranes presented a lively and uniform redness; moreover, in some parts were perceivable spots of more intense redness. The whole fibrous envelope was covered by a false membrane, rather thick and resistant, and so adherent in some points to the proper envelope that it was impossible to separate them. The parenchyma of the organ was healthy." Of these morbid complications apoplexy is that which stands in strongest relief in the pages of our author. Addison, we believe, quotes but a single case of apoplexy of the supra-renal capsules; it was' a case in which mechanical pressure by a tubercle on the large capsular vein occasioned extravasation.* Other systematic writers have not appreciated the disease. Only Rayert puts it prominently forward in a memoir written by him on diseases of the supra-renal capsules. He mentions six cases of apoplexy with one or more large clots or centres of extravasation; and moreover, he affirms that he has found in newly-born infants blood infiltrated in the form of ecchymosis in the interior of these small organs. The observations of Siguor Mattei and of Professor Giorgio Pellizzari do not accord with those of Rayer as regards the considerable frequency of interstitial apoplexy in the capsules of the newly-born. It would seem to occur in them with more facility than in adults, however subject these organs may be throughout life to engorgement, as appears to be much the case, especially when there is some mechanical impediment, or an alteration in the crases of the blood. Half the number of cases known to our author occurred in newly-born, and were due apparently to pressure, there being no other assignable cause. This observation is very worthy of the attention of accoucheurs. * In vol. xiv. of the Trans. of the Path. Soc. of London, two cases of extravasation of blood into the supra-renal capsules are related: one by Dr. Dickinson, at page 256, and another by Mr. Canton at page 257; one also by Dr. John Ogle, is related at page 280 of the 11th volume. Recherches Anatomico-Pathologiques sur les Capsules Surrénales. (L'Expérience, 1817.) Loc. cit. The following is a case of interstitial apoplexy in an infant, quoted by our author: The "In the month of May, 1862, the body of a female infant, born at full term, was brought into the dead-house of the hospital at Siena; it was said to have died during birth from compression of the umbilical cord. This child was well-formed and well-developed, of normal appearance and colour. meninges and encephalon were healthy. The thoracic organs were sound, but the lungs undilated. The liver was large, and somewhat gorged with blood. Nothing was observable in the abdominal organs excepting in the supra-renal capsules, which were infiltrated with blood, as Rayer has described." In this case the symptoms of compression of the umbilical vein, sufficient to produce death, were wholly wanting. No one would, we think, attribute death to engorgement of the liver. Signor Mattei refers it to capsular apoplexy. Such is the disease as described by him. Our author has not omitted to place before us the obscure symptoms attributed to supra-renal apoplexy in the adult : "Domenico Ronciani di Terranuova, aged sixty years, was received into the hospital of Santa Maria Nuova, in Florence, for sore legs, under the care of Dr. Bosi. On the 11th of November, 1858, he was seized with strong pains in the lower belly, which ceased only with extinction of life. This fatal result occurred at six in the morning of the following day, after six hours of great agony. On dissection, on the 13th, nothing was found but apoplectic clots in the two supra-renal capsules; all the other organs were sound. To what shall we attribute the abdominal pain, and the death of the patient? I do not hesitate to refer both to the apoplexy of the capsules, for the following reasons: 1. Because this was the only visible alteration. 2. Because the hæmorrhage was recent, as proved by the physical characters of the blood, and its behaviour when exposed to the air. 3. Because the abdominal pain was sudden, and it was the most prominent and earliest symptom. 4. Because the cause of it must have been in the abdomen; and finally, there was no other source to which we could attribute it." Signor Mattei takes much account of the pressure of the enlarged capsules on the semilunar ganglia and their appendages, especially on the right side, where the liver increases the weight of pressure. Resistance is afforded by the spine and pillars of the diaphragm during inspiration. In one of the cases of apoplexy the semilunar ganglion was found imbedded or indented in the capsule. It will be remembered that Dr. Brown-Séquard has shown that mechanical injury of either semilunar ganglion, especially of the right side, will arrest, or at least diminish, the movements of the heart. Blows over the stomachnot to invoke more refined observations-serve to prove the strong influence of these organs over vitality. It seems not unlikely that violent impressions on the very numerous filaments of the supra-renal nerves might both cause harm and afford ready evidence of it. In connexion with this subject, Signor Mattei adduces the following experiment: "In a rabbit, I somewhat violently compressed both supra-renal capsules, at the same moment, using the forceps pretty roughly as I did so. The animal, at the moment of compression, gave a sharp cry, and fell instantly into a sudden and marked prostration. The respiration which, from the section of the abdominal wall, had increased in frequency and in noise, became all at once small, frequent, and silent; the state of general and violent contraction of the muscles ceased, and the animal, when loosened, scarcely stirred. In a few minutes it was dead." It thus seems that innervation and enfeeblement of the heart's action follow injury of those parts. The cause of apoplexy in the supra-renal capsules has been referred by Rayer to want of firmness in their so-called medullary structure, and in the fragility of the veins which it contains. Moreover, the large size of the chief vein of the capsule, according to Mattei, exposes it to pressure, which the numerous small arteries escape, so that any afflux of blood while pressure exists on the veins may tend to accumulation and rupture. In four out of six of Rayer's cases, we may add, the extravasation was on the right side. On this side the capsule is generally larger and thinner, in accommodation to the liver, whose proximity appears to modify its shape. It will be seen on reading the work of Mattei that he has not related a single case of bronze-skin in connexion with the morbid anatomy of these organs. Yet he quotes with high respect the statistics of Dr. Chavanne, who found that in 44 cases of bronze-skin 34 were cases of diseased capsules. So high a proportion deserves weight, from the comparison that in establishing the connexion of fatty liver with phthisis the proportion of its occurrence, according to Louis, is only 1 in 3 cases. Signor Mattei seeks conscientiously for a solution of the difficulty. When we reflect that the bronze-skin is found far more constant in its alliance with diseased capsules, while these, on the other hand, seem evidently more independent of the complication called bronzeskin, a just and natural reasoning would rather and more naturally attribute to the skin that originating element which should include the other in its consequences; but as we are not likely to rest satisfied with an argument based on such feeble calculations of frequency, it will no doubt be necessary to search in the field of physiology for some common cause which may yet not offend by leaving any of the pathological phenomena unaccounted for. Considering that the lesion of the functions should determine the seat of the malady, our author believes it would be difficult to assign any common cause so proximate as a morbid condition of that ganglionic system which presides over and connects itself with the multiform operations of organic life. The lumbar pain, gastralgia, frequent nausea, and occasional vomiting which occur in so-called Addison's disease, are thus accounted for; so, also, the feebleness of the heart's action, the anæmia, the mental and bodily prostration, with subsequent muscular wasting and more rare symptoms, epileptic and other forms of convulsion. It is, then, as a neurosis of the ganglionic system that our author has brought himself to consider this disease; and he seems to arrive at the conclusion by a process of reasoning which, if from its nature * Gazette Hebdomadaire, 1860, tom. vii, p. 99. not wholly satisfactory, has the merit of being logical, consonant with modern physiology, and, we will add, in accordance with the earliest and most recently advanced views of pathology on the subject. It receives some degree of corroboration from those experiments of Brown-Séquard,* who in various animals has noticed the formation of pigment, and even of pigment-cells, after removal of the suprarenal capsules. As regards convulsions,† the same physiologist observed convulsive phenomena in animals to follow on lesion of the capsular nerves; and, finally, the question may be put thus-In what other direction than in the ganglionic nerves are we to look for an explanation of the whole of the symptoms of Addison's disease? As regards analogy, the phenomena of chorea, hypochondriasis, and hysteria are invoked by our author as examples to demonstrate how the first of these neuroses, in the existence of worms or other irritation, the other two, in irritation of special organs, serve to explain the part performed by the supra-renal capsules in co-operating with the nerves so as to develop the complementary phenomena which constitute the entire disease. The peculiar dead and earthy hue observed in the skin of starved and underfed races of mankind, as well as its well-known rosy or transparent tint in the florid and well-nurtured, still further, according to us, favour Dr. Mattei's opinion of the modified dependence of this organ, for its integrity and normal beauty, on the nerves of organic life. We may also notice the occurrence of ulcers of the skin from an endemic cause, or bad diet, as in ships, barracks, and jails, and we may be allowed to advert to the observations of Dr. M Cormac on a character of skin occurring in the milder cases of epidemic fever in Ireland, 1843, which might be termed bronze for want of a better term, and to the observations of others regarding the deposit of colouring matter in the skin in the course of various morbid conditions. We must state, however, that Signor Mattei does not subscribe to the opinion that the so-termed Addison's disease, in its greater or less development, results from a general diathesis or dyscrasia, or that the supra-renal organs are often the subject of tuberculosis. In fact, according to his observations, disease of the supra-renal capsules seldom accompanies extensively developed cancer or tuberculosis in other viscera and organs. Most commonly they escape disease. When affected, the cause seems, according to him, rather referrible to obstruction from mechanical impediment or peculiar blood crasis. Except in the cases of apoplexy, the disease in the capsules never constituted the sole morbid alteration. We feel we have been unable to do full justice to Signor Mattei in that part of his work which sets forth, at greater length than we can afford to follow him, the ground and substance of his opinions. The extensive extract which, as of the highest importance to place on record, we have taken the liberty to place before our readers, will fully display his merit as a laborious investigator; and those who will make his pamphlet the subject of careful study, will, we are persuaded, entertain like ourselves a high opinion of the author's merit. REVIEW VIII. 1. Gazeta Medica de Lisboa. Redactor Principal Dr. PEDRO FRANCISCO DA COSTA ALVARENGO. Publica se nos dias 13 e 28 de cada mez. Imprensa Nacional.-Lisboa, 1862-3. Medical Gazette of Lisbon. Principal Editor Dr. PETER FRANCIS DA COSTA ALVARENGO. Published the 13th and 28th of every Month. Printed at the National Press.-Lisbon, 1862-3. 2. Jornal de Pharmacia e Sciencias Accessorias.—Lisboa. Journal of Pharmacy and the Accessory Sciences.-Lisbon. 3. O Escholiaste Medico.-Lisboa. The Medical Scholiast.-Lisbon. 4. Compendio de Materia Medica e de Therapeutica. Por CAETANO MARIA DA SILVA BEIRÃO, Lente de Materia Medica e de Therapeutica na escóla Medico-Cirurgica de Lisboa, &c. Tomo 1moLisboa, 1862. Compendium of Materia Medica and Therapeutics. By C. M. DA SILVA BEIRÃO, Professor of Materia Medica and Therapeutics in the Medico-Chirurgical School of Lisbon, &c. Vol. I.-Lisbon, 1862. 5. Estudos sobre a Hemeralopia a Proposito dos Casos observados no Quarnicão de Lisboa, offerecidos á Academia Real das Sciencias de Lisboa. Por JOÃO CLEMENTE MENDES, Cirurgão de Brigada, &c. -Lisboa, 1862. 8vo, paginas 80. Studies on Hemeralopia in reference to Cases observed in the Garrison 6. Anatomia Pathologica e Symptomatologia da Febre Amarella em 7. Estudos sobre o Garrotilho ou Crup. Memoria apresentada á Academia Real das Sciencias de Lisboa. Por ANTONIO MARIA BARBOSA, Socio Effectivo do mesma Academia, Cirurgião Honorario da Camara de suá Magestade Fidelissima, Lente da Escóla MedicoCirurgica de Lisboa, &c.-Lisboa, 1861. 4to, paginas 189. |