BIBLIOGRAPHIC NOTICES,

1. Urinary Diseases and their Treatment. By ROBERT WILLIS, M.D., Licentiate of the Royal College of Physicians, Physician to the Royal Infirmary for Children, &c. &c. London, 1838.

2. Traite des Maladies des Reins et des Altérations de la Secretion Urinaire, étudiées en elles-mémes et dans leurs rapports avec les Maladies des Ureteres, de la Vessie, de la Prostate, de l'Urèthre, &c.; avec un Atlas in folio. Par P. RAYER, Médecin de l'Hopital de la Charité, &c. &c. Tome I. 1839.

3. On granular Degeneration of the Kidnies, and its Connexion with Dropsy, Inflammations, and other Diseases. By ROBERT CHRISTISON, M.D. F.R.S.E., President of the Royal College of Physicians of Edinburgh, Professor of Materia Medica, and one of the Professors of Clinical Medicine in the University of Edinburgh, 1839.

Ir was originally our intention to have drawn up, from the works placed at the head of this article, a digest, concise but complete, of all the multiplied and important discoveries which have enriched the pathology of the urinary apparatus, since the publication of Dr. Prout's admirable work. But when we came to arrange the notes which we had collected for this purpose, we found them to contain such a vast variety of valuable matter, that they could not, even in their most condensed form, be comprised in the space to which we are necessarily limited. To gloss over these works with a merely passing notice, would be unjust to their authors and the subject; we have chosen therefore a middle course, and selected such topics as appear to us of paramount interest, being reconciled to the neglect of others, by the conviction, that our readers will not fail instantly and diligently to peruse the original volumes.

It would be unprofitable for us to enter into an analysis of these various works, pursuing the particular arrangement of

each author; we prefer instituting a method of our own, and placing the selections which we shall display before our readers under the separate heads of Anatomy, Physiology, Pathology, and Diagnosis; by this means we flatter ourselves with the hope of being enabled to condense a greater quantity of material in a much smaller bulk.

Anatomy of the Kidnies.

Dr. Willis, p. 19, gives a concise and excellent description of the structure of these organs according to the views originally promulgated by Mueller; but, notwithstanding the care with which the structure of these organs has been investigated, many important anatomical considerations have been overlooked, or erroneously stated. Thus their normal weight, the relative proportion of their elements, their consistence, colour, &c., have not hitherto been made the subject of careful observation. To these points M. Rayer has directed his attention, and we shall here condense the results to which he has arrived. Weight. The kidneys were prepared by removing their fibrous tunic, and cutting the ureters and vessels as close as possible with scissors. It was then ascertained, first, that kidnies taken from different healthy persons of the same age vary much in weight. Second, that in infants the rapidity of growth differs so much in different individuals, that a child two days' old, sometimes, was found to have larger kidnies than one aged seventeen days. Third, that atrophy, or hypertrophy of one or both kidnies can only be determined when present in a very remarkable degree. Fourth, that these organs in women, and the aged, are usually lighter than in adult men; but in the aged they are heavier than in youths. Fifth, the left kidney is heavier than the right. Sixth, kidnies similar in size may dif fer in their density, and the weight is liable to vary in the same kidney from various causes, such as the quantity of blood, the rapidity of evaporation, &c.; and lastly, it is always to be taken. into consideration, before we pronounce any very great difference in weight between the two kidnies, to be a morbid phenomenon, whether the amount of secreting substance be more or less than equivalent to that of two organs of an ordinary weight.

Volume.-In opposition to the general opinion, M. Rayer asserts the left kidney to be larger than the right. Meckel has, indeed, stated, that there is no difference in size between them. Adults have the largest kidnies; these organs diminishing in age, as their density increases.

Colour.-In the surface of the kidney we may perceive little,

spaces, rounded, angular, or serrated into each other, about 0.4 of a line in diameter. These spaces have a blanched or greyish appearance, more uniform than the vascular ramifications which surround them. In certain cases of hyperemia, these little polygonal spaces present, in the centre of each, a red dot, (glandula of Malpighi,) perceptible by a lens, or even the naked eye; but it cannot be seen in the normal kidney. The size, and degree of projection of these little spaces are always found to vary; but in disease this variation becomes exaggerated.

When we examine a section of a kidney, we generally find, especially in phthisical subjects, the extremities and posterior part more coloured than the rest; but it is to be recollected that this is, for the most part, cadaveric. M. Rayer enters into a minute description of the different degrees of normal coloration, not only in the cortex and tubuli, but also in the apices and bases of the papillæ, and different portions of the cones in the adult and foetus. This degree of refinement may be questioned, as regards its practical utility; but it is better to be too accurate than remiss.

Relative Development of the Cortical and Tubular Substances. In the foetus the cortex is less developed than in the infant, and in the latter less than in the adult. The increased development takes place principally between the cones, thus removing the lobulated appearance which this organ presents during the intra-uterine life. The papillæ of newly-born infants project more into the calyces than is observed in adults; but in the latter they are sometimes depressed in an exaggerated degree by the presence of accumulations in the calyces. The uriniferous conduits are never apparent, even with a lens, in health; but in disease they may become enlarged, sometimes obliterated; occasionally they become swollen into vesicles. In examining the cortex of a healthy and full-grown kidney, we find it to present partly a striated, and partly a granular appearance; the latter is chiefly observed between the cones, while the striated portion is more superficial, more vascular, and more subject to lesion. The real thickness of the cortex is constantly liable to be disguised by the presence of sanguineous, serous, or urinous congestions. The medullary portion is rarely the seat of primitive lesion; but, on the other hand, cartilaginous bodies are most frequently found in the tubuli.

Consistence.-The assertion made by Meckel, that the kidnies are firmer than other glands, must be taken with some modifications. The cortex is less consistent than the medullary portion, and not more so than the liver. Bichat's aphorism, that the kidnies of the aged are less consistent than those of the adult, is incorrect. M. Rayer finds that the cortex in

variably tears in the direction of the striæ, but could never get it to rupture from the bases of the cones, in the manner described by Bertin.

With respect to the accessory organs, we find little that is new or important. M. Rayer, in opposition to Bichat, believes in the existence of a proper cellular membrane he asserts that the renal veins are more subject to disease than the arteries. We may also notice his confirmation of M. Comhaire's experiments, who found that dogs exhibited but little sensibility when the kidnies were pinched and torn.

Much, if not, all of the foregoing particulars are probably already familiar to the excellent anatomists of this country; but M. Rayer deserves great credit for the extent and accuracy of his researches; and the brief sketch of his results which we have here given will enable us with greater facility to describe the pathological appearances which are represented in the various works before us.

Physiology of the Kidnies.

One of the most remarkable differences between animals and vegetables, consists in this: that in the latter, molecules, once deposited in the solid tissues, are for the most part liable to no further change; while in the former, to borrow an expression from Cuvier, there seems to be a continual vortex of renewal and decay, in which particles are being alternately attracted from, and thrown back into, the nourishing fluid. This law it is, which absolutely limits the maximum size of every species of animal; while the plant must continue to enlarge, until accident or some necessary condition of its organization deprives it of life. It is for this reason, likewise, that we find so marked a discrepancy between animal and vegetable respiration; in the one case, carbon is eliminated, in the other it is absorbed; a beautiful contrivance, by which, not only at this time, both hemispheres of the living world compensate for each other's influence on the composition of the air; but by the instrumentality of which, it is reasonable to believe, the præadamite atmosphere was originally fitted for animal existence, in the very process of storing up those enormous heaps of bitumen, that now enable this generation to work its marvels with gas and steam. We allude to those acknowledged truths, on account of some obscurity which appears in the introduction to Dr. Willis's work, wherein it would seem to be advanced, that animals and vegetables are subject to the same laws of growth and respiration.

The following extract is taken from Dr. Willis's work, page 17.

"Among animals, carbon and nitrogen, if not universally and alike elements of nutrition, still are they both universally elements of composition and accordingly, we observe not only an apparatus for purging off the carbon, as among plants; but one in addition for abstracting the nitrogen. A lung, or something analogous to it, is the apparatus in reference to the carbon; a kidney, that in reference to the nitrogen. The lung and the kidney, consequently, taken together, constitute the apparatus of rejection among animals."

May not the liver and skin be considered organs of elimination? We suspect that Dr. Willis has been led to confine this function to the lungs and kidnies, from M. Chossat's experiments, of which more anon. But we may here ask, why two of these glands, the liver and lungs, secrete from venous blood; while the others secrete from arterial blood? Jacobson announced in 1813, that in birds, reptiles, and fishes, the kidnies are supplied with venous blood, but this has not since been confirmed.

"Recent researches have also shown that we descend very low in the scale of creation, before we lose traces of a kidney, or apparatus for freeing the system of nitrogen. The long, and from their magnitude alone, evidently important Malpighian canals in insects, have been found to secrete, and even to contain, calculi of uric acid. The same substance has also been discovered in the matter elaborated by the saccus calcareus, the organe de la viscosite of Cuvier, of mollusca; and as in the case of the lung, when we have lost traces of a concentrated and special organ, that might be called a kidney, we find evidences of a means diffused through the system for accomplishing the important end of azotic purgation."

Dr. Willis might have added, in proof of the necessity of this function, that death, with cerebral symptoms, supervened a few days after excision, or mortification of the kidnies. And again, as the third kind of evidence which is required to establish the relative importance of organs, he might have shown the constant co-existence of kidnies or analogous organs, with a vascular circulation, with the dorsal vessel of insects; in the chick on the sixth day, or in the form of "corpora Wolffiana," according to Mueller, even on the third day of incubation.

Both M. Rayer and Dr. Willis quote M. Chossat's experiments, which lead to the belief that the food may be regarded as finally decomposed by the action of the animal organism into carbonic acid and urea. Knowing the difficulties by which any investigation of the kind must necessarily be surrounded, we have the less hesitation in instituting the inquiry -If this be so, from whence comes the bile?

M. Rayer has collected, from different sources, instances