Book reviews

THE original essay of which this is a German translation is in Danish, and was published in 1885. The author is a Professor of Pathological Anatomy in Copenhagen, and is well known both as a practical physician and as a man of science. He does not pretend to deal fully with the complicated and difficult questions connected with the expression of the emotions. He examines, however, with much care the physical accompaniments of sorrow, joy, terror, and anger; and he offers important suggestions as to the point of view from which the entire subject can be most successfully studied. That emotions are not, in any sense which can be recognized by science, the causes of the physical phenomena associated with them is a proposition on which he lays great stress; and in support of his opinion he presents a number of arguments which deserve the attention of all who are interested in psycho-physiological studies. The German translation is very clear, and will no doubt find readers in England as well as in Germany.Ueber Gemüthsbewegungen.Von Dr. G. Lange. Autorisirte Uebersetzung von Dr. H. Kurella. (Leipzig: Theodor Thomas, 1887.)

XI.?Two Cases of Inflammation and Enlargement of the Pancrcas; by the same* This is a paper of considerable value; for, although the disease of which it treats is not of frequent occurrence, yet, as Dr. Percival remarks, the difficulty of ascertaining the condition of this organ by any other symptoms than such as are secondarily manifested in the stomach or liver, must render our opinion 011 many cases uncertain, and our practice erroneous.
u When pain and tumor of the pancreas (says the author) are mistaken for inflammation of certain parts of the liver, the remedies of depletion, which are applicable to both, may resolve the disorder, before the error of diagnosis is discovered. But a more obvious and fataJ error may arise from confonnding the pain and jaundice caused by the pressure of an inflamed pancreas upon the ductus communis choledochus, with spasm or calculous obstruction of that canal; and it is chiefly with a view to obviate this mistake, and its consequences, that I offer the following cases to the notice of the Association." In one of the cases that occurred to the observation of Dr.
Percival, which terminated fatally, " On examining the abdomen, the pancreas, greatly enlarged, ?was found occupying the place of the tumor before felt in the epigastrium. The ductus communis choledochus was imperforate in the parts adjacent to the pancreas, and where its pressure had been greatest. The gall-bladder was full, and the cystic duct pervious; the substanee of the pancreas was scirrhous, and, on being cui into, was found to contain a considerable abscess* The kidneys "were sound, but the liver was much diseased. " A case of scirrhous pancreas, which illustrates some points in the foregoing histories, is related by Mr. Todd in the first volume of the Dublin Hospital Reports, &c. art. xiv. The reader is also' referred to a paper by Dr. Latham, in the llth volume of Transactions of the College of Physicians, art. v. which contains some ?cry just observations on the diagnosis of abdomical tumors/' (Transactions of the College of Physicians in Ireland. 409 We shall transcribe the account of the case which terminated favourably, as it will point out the diagnosis of this diseasej and the medicinal measures likely to be most beneficial. 66 An elderly gentleman, inclining to corpulency, was frequently seized, in the last autumn, with acute pains in the epigastrium, attended with soreness and tumor of the parts, and followed toy jaundice. His medical attendant prescribed cordial draughts and mercurial purgatives, which relieved, but did not remove, the urgent symptoms. After some weeks, the patient began to experience an obscure pain in his chest on making any bodily exertion ; but it was unattended with cough or any difficulty or disturbance of the respiration. As this pain or uneasiness appeared to be associated with the distress in the epigastrium, a blistering plaster was applied to the latter part with much benefit: neither local nor general blood-letting had been resorted to.
"On the loth of November I saw this gentleman, two days after his arrival in Bath. His complexion was dingy, and yellow about the eyes; his tongue much furred; his urine scanty and high-coloured ; his pulse, in the morning, did not exceed 78 strokes in the minute.
On viewing the epigastrium, I found it prominent, especially in the central part, between the umbilicus and scrobiculus cordis.
The verge of the liver was pretty clearly ascertainable, bearing free pressure, and betraying no sign of organic disease ; but detached from this organ, in the gastric region, was an unusually dense mass, tender to the touch, and yielding slowly on pressure. The gentleman complained of chilliness in an even* ing, and his flesh and strength were much wasted. Eight leeches applied to the epigastrium bled copiously, and produced some faintness. The tumor and tenderness were considerably reduced; the urine became free and of natural appearance, the pulse fuller and softer; and the patient expressed himself greatly relieved from his oppression. A vesication on the same parts, kept open for ten days, with the use of saline aperients, an occasional warm bath, and a restricted diet, so far restored the patient, that he assured me he had not, for a long time, felt himself in such good general health. Still a tumor and hardness were discernible in the epigastrium ; until a spontaneous diarrhoea occurring, it shrunk rapidly in its dimensions, and before the expiration of a fortnight (Dec. 8th) entirely disappeared. " It is deserving of remark, that, in the progress of this subsidence, the tumor assumed a more distinct form, like the smaller extremity of an egg, and preserved this shape till it could no longer be felt. 44 Some slight vestiges remained of the obscure pain or uneasi. ness in the chest on making any unusual bodily exertion, or sometimes even in walking at a gentle pace; but neither the pulse nor the respiration were, in the slightest degree, affected under these circumstances." tfo. 2&S. * 3 G 410 Critical Analysis, Dr. Crampton also adduces two cases of a similar disease; one of which terminated favourably, by the use of measures similar to those employed by Dr. Percival; the other ended fatally. The morbid appearances were analogous with those related by Dr. Percival.
In the 25th volume of our Journal, an instance is given of death ensuing from rupture of the gall-bladder, consequent on the obstruction of the ductus communis choledochus from an enlarged and indurated pancreas. This Memoir of Dr. Crampton will not, it must be evident, admit of a general abstract adapted to the limits of our Journal: to derive from it all the benefit it is calculated to effect, it must be studied in detail. We shall, therefore, only cite a few of the most striking facts; but those, we trust, will be such as are calculated to excite reflection, and furnish useful information respecting the nature of dropsical affections in general. We shall select them from such cases as terminated fatally, and of which histories of dissection after death are given ; as it is those that are best calculated to lead to correct pathological knowledge, and, when this is acquired, the appropriate medicinal measures are sufficiently obvious.
"Case J.?Mary Callaghan, xt. 22, June 27th, 1817, was admitted with symptoms of very general anasarca: the face, the trunk of the body, the thorax, especially the legs and thighs, were unusually (edematous; the abdomen much distended, and fluctuation evident; pulse small and oppressed, respiration hurried and laborious; urine of a high colour. She suffered excessive pain m the scrobiculus cordis. Dropsical symptoms were present only six weeks.
"She had been given mercurials inwardly by her husband, in Transactions of the College of Physicians-in Ireland. 411 the form of solution : this was followed by severe pains io her bowels, the catamenia became suppressed ; the swellings then appeared. She attributed her illness to the mercurial medicine. " On her admission to the hospital, venisection, to the extent of ten ounces, was twice performed at the interval of a few days : this afforded temporary relief to the pain ; the anasarcous swellings left the upper extremities, and there was a considerable diminution in the size of the abdomen. Symptoms, however, of distress iu her breathing, return of pain in the scrobiculus cordis, greenish vomiting and hiccup came on; and she died in agony on the 8th of July.. " Dissection, 9th July.?Lower extremities anasarcous; only two quarts of fluid in the abdomen ; abdominal viscera sound ; lungs quite healthy, but adhering in many points; above half a pint of serous fluid, with flakes of lymph, in the pericardium; a white spot on the right ventricle, half an inch in diameter, evu dently from a deposition of coagulable lymph." "Case 2.?Edward Anderson, set. 1.9, July 4-, 181/. Anasarca of the face, head, and arms, legs, thighs, and body, has come on in the order of the parts enumerated. Abdomen distended, and contains a fluid ; lips and cheeks appear purple and livid; cough, and pain of the left side; pulse small and indistinct, not frequent; urine scanty and red; diarrhcea. Has been dropsical for seven months: it came on immediately after a fall from a car.
" He was partially relieved by a single venisection, the cough and pain of his side having been removed ; in other respects the treatment was ineffectual. He died on the 18th# 44 Dissection, \tyth July.? Body anasarcous; not much fluid iri the cavity of the abdomen ; liver enlarged, presenting a peculiar marbled appearance ; some effusion of lymph about the spleen. The other abdominal viscera healthy ; lungs souud, slightly adhe-r rent; the heart adhered to the pericardium in many points,?thp bands of adhesion appeared not to have been of recent formation." <4 Case 9.?Laurence Mulhall, aet. 45, Oct. 10, 1817. Ab, domen very large, tense, and containing a fluid ; legs cedematous above ten months; cough and pain of sternum, with frequent pulse; urine red and scanty. Was injured in his chest by falling, and being bruised in a mill: to this accident, in which he was much exposed to wet and cold, he, attributed his illness. " He was directed venisection to ten ounces on his admission ; and a repetition of the same measures on the I3lh, as he still complained of the severity of the pain in his chest, 44 The brachial artery was punctured in the operation of bleeding, and an aneurism became formed. On the 24th, the whole arm was enormously swelled and blackish; his dropsical symptoms had nearly disappeared. 44 He was removed to a surgical ward, where he died on the 20th of November.
Abdomen contained about four quarts of fluid, of a palp straw co*? 3 g2 412 Critical Analysis, lour, mixed with flakes of lymph ; the liver, spleen, and kidneys, were healthy; but the stomach was one schirrous mass, except a small portion of the cardiac orifice. Omentum could not be dis? covered, except a small portion which partook of the disease of the stomach. 44 The small intestines were much thicker in their coats than natural, and covered externally with small white elevated spots. 44 The puncture in the artery was closed up, and the aneuri9mal pulsation had ceased five days before his death." 44' Case 10.?William Tuite, aet. 24, a newsman, November 10, 1817. A relapse of general dropsy, both anasarca and ascites, to a considerable extent; breathing much distressed, pulse hurried, urine scanty and red; no cough or local pain. He was cured of dropsy in September, but, returning to his intemperate habits, and being constantly exposed to cold and wef, the disease recurred. 44 He died on the lj)th of December, having suffered severe pain in the umbilical region, and excessive distention, for some days antecedent to his death. He would not submit to the operation of the paracentesis. 44 jDissection, 20th December.?Abdomen was enormously distended with fluid.
On opening it, a portion of the omentum was found adhering, by recent exudations, to the umbilicus. Liver diminished in size, but tuberculated throughout: the peritoneal membranes of it were coated with lymph, as well as those of the parietes of the abdomen. Stomach healthy, intestines distended with air; coats of the small intestines were thicker than natural, with effusion between their laminae. Spleen somewhat enlarged; kidneys healthy. Thoracic viscera in a sound state." 'f Case 14.?John Shawe, ast. 6*0, November 14th, 1817. A very intemperate man, who procured bodies for dissection, had Tepeated returns of ascites within the last two years: they were generally removed by purgatives, by jalap in prticular, according to his account. 44 His first dropsical attack came on with cough and hoarseness. His last illness was present six months: it was preceded by a paralytic attack, during which he lost his speech ; from this state he was restored by arteriotomy. ; His abdomen is now very large, and general anasarca prevails; breathing oppressed ; pulse moderate ; bowels costive, urine red. A syphilitic eruption is likewise observable all over his body. 44 A single venisection was practised with a view to relieve his breathing; purgatives and mercurials were directed. He died, bowever, on the 21st November, in an attack of apoplexy. " Dissection, lUnd November.?Abdomen contained a considerable quantity of fluid; liver hard, tuberculated, but very much shrunk in dimensions. Peritoneal covering of the liver coated ?with lymph. Vessels on the arachnoid and pia mater were turgid and a slight effusion of serous fluid had taken place in the ventri* cles of the brain. f* The thojacic visccra were healthy.V.
Transactions of the College of Physicians in Ireland. 413 Case 15.?John Murtagb, set. 29> a butcher, April 3, 181 S. Sallow and emaciated ; much addicted to drinking ardent spirits ; enormous cedematous swellings of the lower extremities for twelve months; ascites had supervened within the last three weeks; cough and soreness, with flying pains in his chest and abdomen; pulse frequent, small and hard ; urine scanty and high-coloured: attributed his illness to cold. " Venisection was directed: it was not practised, as a profuse nasal haemorrhage came on after the visit. He was slightly relieved by the paracentesis, which was performed on the ?Jth ; but he died on the 16 th of April.
*' Dissection, 17th April.?Abdomen was full of a yellowish serous fluid. Liver tuberculated throughout; some of the mesenteric glands were enlarged and indurated. Peritoneum liuing the parieties of the abdomen thickened and very vascular, about the iliac region especially ; reflections of that membrane over the stomach and intestines much thickened, as well as their muscular coats, seemingty by the intermediate deposition of Jymph, as well as a serous fluid." Histories of thirty-five cases which terminated favourably then ensuej which lead to the following reflections :?
From the result of the cases recited, it appears that a greater number of dropsies connected with disease of the thoracic viscera were relieved by medicines, and admitted of cure, than those combined with disorders in the viscera of the abdomen. This may,, perhaps, appear strange when the vital importance of the viscera of the thorax is considered, and when the opinions of others on this subject are consulted. Ten of the fifteen patients examined after death had either the liver, stomach, or spleen, tuberculated: if any reliance is, therefore, to be placed in a conclusion drawn from so limited a number, ascites, with scirrhous liver, should be considered a more incurable or fatal form of disease even than hydrothorax combined with some organic disorder in the cavity of the chest, provided the organic derangement, is at all compatible with the functions of circulation and respiration. " Of the patients cured, a considerably greater portion were affected with disease in the thoracic viscera; some of them had evidently organic affections of the heart, and yet they appeared to be acted upon by remedies with infinitely more ease than those where disease had established itself in the cavity of the abdomen. " VVe should, therefore, not be too confident in our expectations of recovery in ascites, even though the strength be unimpaired, the respiration and the pulse good ; nor, on the other hand, should we despair, where the pulse is feeble and intermitting in hydrothorax and the breathing difficult and laborious.
" The diagnosis to ascertain the organ which has been first affected, and which is chiefly oppressed, is extremely desirable, with a view to the mode of treatment and the remedies to selected.

414
Critical Analysis, tc In either general or partial dropsy, the preceding cases war* rant us in stating that, whenever the organs of respiration appear to labour, if the strength is not much impaired, and if the disease is recent, it will be safe to practise general bleeding : still more so, if, in addition, there are symptoms which denote inflammation of any texture in the cavity of the thorax. In some of the cases, a single venisection appeared to arrest the progress of a recent dropsical disease ; in others, a repetition of that practice seemed necessary to ensure success. In such a complication, other rerne dies appeared to be thrown away; diuretics would not act, and purgatives did not afford any relief, until after venisection had been practised.
" After the removal of congestion or of inflammation, should either be present, it is less difficult to regulate the secretions ; and, perhaps, there is less nicety in the selection of remedies than is commonly imagined. Blisters, after one or two bleedings, afford yelief, on the same principle and in the same manner they do in the other pneumonic disorders not complicated with dropsy.
i( If a chronic or a sub.aeute inflammatory condition of the ?iscera in the thorax should maintain a dropsical disease, masked by debility, and not developing itself by its legitimate symptoms, a single bleeding will often tell the true state of the patient, by showing the quality of the blood. In incipient dropsy it is generally buffed, but not always so: at all events, a small venisection, cautiously practised, can do no harm. The strength of the patient, the state of the pulse and respiration, with the presence or absence of local distress, appear to be better foundations to determine whether venisection should be practised, than the characters of the urine." After some observations tending to appreciate the value of the different medicines usually employed in dropsy, Dr. Crampton concludes with remarking that, 4f# " * Critical Analysis.
XV.?// Case of Inflammation of the Ear, attended wit ft.
Symptoms of Compression of the Brain; by Richare* Grattan, M.D. Fellow and Censor of the King's and Queen's College of Physicians, &c. This was a case somewhat analogous with the preceding: it occurred in a lady who had been " at all times extremely subject to inflammations of the face and throat, from any incautious exposure to cold/" On one occasion of this kind she became affected with acute pain of the ear, which continued to increase for several days, until it was accompanied, with symptoms of severe inflammation within the cranium.
We cannot enter into a particular history of the symptoms which appeared, and the remedial measures that were had recourse to, but must observe, in a general way, that, under the use of blood-letting, purgatives, saline diaphoretics, calomel, and digitalis, this case terminated in a favourable manner.
Dr. Grattan takes this occasion to adduce some reflections on the nature of inflammation, and on the effects of digitalis and mercury as auxiliaries to blood-Jetting in the treatment of inflammatory diseases.
We gave a detail of the hypothesis of inflammation adopted by Dr. Grattan* in our last " Historical Sketch.of the Progress of Medical Science," not, as we should then have remarked, on account of its novelty, but from its being a clear and lucid display of one that has had several ingenious physiologists for its supporters. This hypothesis wasadvanced, with nearly all the arguments in favour of it that have since been proposed, by Sig. Vacca, as early as 1765 ;* and some persons may, indeed, be disposed to consider it merely as a revival of that of Erasistratus.
The hypothesis adopted by Dr. Wilson Philip, and which he has endeavoured to substantiate by experiments, rs somewhat analogous with this, he says?" Inflammation seems to consist in the debility of the capillaries, followed by an increased action of the larger arteries j and is terminated by resolution, when the capillaries are so far excited, and the larger arteries so far weakened, by the preternatural ;tction, that the power of the capillaries is again in due proportion with the vis a tergo"f ? .
The limits of a review will not permit us to enter into a indeed, we consider that the questions which Dr. Philip has himself advanced, as difficulties in the way of it, forcibly show its want of conformity with the general known laws of the animal economy, and thus constitute in themselves the most powerful of theoretical objections.
Why does a failure of power," says Dr. Philip, " of small extent in the capillaries of a vital part strongly excite not only the larger arteries of the part affected, but those of the whole system; while a more extensive debility of the capillaries of an external part excites less increased action in the larger arteries of that part, and often none at all in those of the system in general & Why does inflammation often move suddenly from one part to another, when we see no cause either increasing the action of the capillaries of the inflamed part, or weakening those of the part now affected ? Why does inflammation often arise in parts only sympathetically affected, and consequently far removed from the offending cause ? Why is inflammation often as apt to spread to neighbouring parts, between which and the part first affected there is no direct communication of vessels, as to parts in continuation with that part ?"* The experiments-}-of Dr. Philip may be rationally considered as but a weak foundation for such an hypothesis, particularly when we reflect on the circumstances under which they were executed, and the state of the system under which inflammation is most readily excited ; its apparent remote causes, and arguments from analogy with what appears to be best substantiated respecting the laws of the functions of the animal economy, all militate against this hypothesis. Several of the above objections will also apply to the hypothesis adopted by Dr. Grattan and, although this may seem more rational, it is controverted by observation and experiments, not made under such objectionable circumstances as those of Dr. Philip; and it rests on a basis that is merely imaginary, and not supported by any analogous facts. The inflamed sclerotic membrane of the eye is a fair and evident subject for observation, and for thence deducing conclusions respecting the nature of inflammation. The microscope does not here show any inct eased action of the arteries running to and through the inflamed part.
Increased action of the arteries going to an inflamed part seems to be a mere casual, a mere accidental, concomitant. The ex- perimentsof Mr. BRODiEand some other eminent physiologists appear, as far as experiments can prove any thing respecting the more minute actions of the organs of an animal body, to have satisfactorily controverted the notion of increased action of the arteries being an essential circumstance in inflammation. The same observations and experiments also appear to disprove the existence of obstruction to the course of the blood through the capillaries; an opinion which has been successively adopted by Asclepiades, Boerhaave, and Cullen, but which is not supported by any wellascertained facts.
But how satisfactorily are the queries of Dr. Philip replied to, and how well are the principal phenomena of inflammation explained, by the hypothesis, we would almost say theory, of Bordeu.
<e Perhaps what has been termed a congestion of blood," says Bordeu, " and which has been regarded as the cause of inflammation, is only an effect of a particular predisposition that has taken place in the part, the nerves of which have acquired a certain and somewhat violent degree of action, and which is, properly speaking, the cause of inflammation. " If each trunk of the blood-vessels be surrounded with nerves, as we have supposed, and these nerves become irritated, they will propel the blood in greater quantity, and with much more force than ordinary, towards the ramifications of those vessels, as takes place in glands to which the fluids are carried in greater quantity, and with more force, during the action of secretion. " If we acknowledge that every part has vessels which do not, in the ordinary state, receive all the fluid they are able to contain,?that is to say, that these vessels, more or less dilated, will receive different parts of the blood,?we might suppose that inflammation has its seat in these vessels, which are so contracted in the ordinary state that they receive only lymph, although they have sufficient capacity to become blood-vessels (admitting the expression) on certain occasions ; for example, in the state of inflammation. " These vessels, then, have the property to be both bloodvessels and lympathics; ordinarily they contain only lymph, because they are contracted so as only to admit that fluid.
Are the nerves which accompany them irritated in a certain manner ? these vessels dilate themselves and alter their position : they, from being tortuous, become more or Jess straight, eriguntur ; and this sort of erection, or of active dilatation, occasions the blood to enter them in greater quantity j besides which, it is also driven into them by the Transactions of the College of Physicians in Ireland. 419 influence of the nerves on the trunk of the principal vessel of the part. " This is very different from what has been commonlyadvanced on this point: the tumor has been regarded as the effect of the rush of blood; and, perhaps, indeed, the tumor or congestion (disposition bouffie) of the part may occasion the blood to flow to it in greater quantity, and with greater force." After some observations tending to show the probability of what he has here advanced, Bordeu thus continues:?ii Can we understand the nature of this phenomenon without considering that that which occasions the tumefaction is principally the erethism or the particular tension of the nerves and vessels of the part ? <c This is not the place to extend this theory :* it is sufficient to remark that an inflamed part is, in a manner, a distinct body (corps a part) ; at least, it is so for a certain time. It has a sort of action superadded to that which constitutes life; it makes a distinct circle ; and what passes in this part resembles what takes place in glands and other organs to which the blood is directed, and where there are species of torrents that practitioners have called raptus. 420 Critical Analysis.
Analogous phenomena are also apparent in the ducts of the secretory glands: as the sudden flow of milk from a woman's breast at the sight of her infant, from which she has been absent a little time ; the common act of milking a cow or other animal; (we may here observe, that the explanation given of the mode in which an infant sucks,?that is, by forming a vacuum round the nipple,is obviously insufficient;) and it may be demonstrated by an easy experimentstand before a mirror after having fasted a little while ; raise the tongue, and think on some favourite species of food ; a jet of saliva will instantly spring from the orifices of the glands on each side of the frsenum of the tongue. We should, however, turn to Bordeu for the most striking and beautiful illustrations of this phenomenon ; but, then, to do it effectually, would require us to transcribe the greater part of his Recherches sur les Glandes.
Mr. John Hunter, it should be remarked, supposed that a sort of active dilatation of the capillaries took place in inflammation ; but, without being suspected of want of due respect for the opinions of our great physiologist, we may say that his reasoning on this subject is extremely vague*, and, as the name of Bordeu is hardly known in this country, we should observe that he flourished a short time previously to Hunter : the opinions we have here adduced were published in the year 1752.
We must now, though reluctantly, quit Bordeu ; but we intreat the younger part of our readers to study his works; this, however, they cannot fail being induced to do ere long, for his glory is now just breaking through the clouds that have long obscured it, and the truth of several of his original and beautiful doctrines is daily illustrated by the observations and reflections of the most eminent physiologists. Bordeu was one of the few cultivators of medical science, who, like a Galileo, a Roger Bacon, and an Epicurus, in physics, sprung so far before their contemporaries that they have been lost until men of subsequent generations have arrived to where they terminated their career; and then, and then only, has their merit appeared.
We are disposed, however, before we resign.this subject, to adduce a short extract from Bichat, which expresses, in another way (which may, perhaps, be more distinctly intelligible to some persons), what has just been advanced re^ specting inflammation.
Is a part irritated in any way, its sensibility immediately alters?it increases. The capillary system, hitherto a strange? to blood, assumes a relation to it; it calls the blood, in ^ manner; the blood flows to it, and remains accumulated in.
Transactions of the College of Physicians in Ireland. 421 the part until its organic sensibility returns to the ordinarystate. " The penetration of the capillary system by the blood is, then, a secondary effect in inflammation. The principal phenomenon, that which causes all the rest, is the local irritation, which has changed the organic sensibility of the part."* The arguments of Dr. Grattan in favour of the use of digitalis and mercury in inflammation, are deduced from the ideas and opinions he has formed respecting the nature of that affection ; they are now to become the subject of our remarks: we must, however, previously observe, that the use of those remedies for the same purpose is not novel in itself; although really original with respect to Dr. Grattan, since he was led to it by his own particular theoretical views.
Dr. Mossman was, we believe, the first who argued for the utility of digitalis in inflammatory affections, frOm its influence on the minute arteries : his reflections on this subject were published in the fourth volume of our Journal.
Dr. Farre also, some years since, indicated the mode in which mercury relieves inflammation, on principles similar to those advanced by Dr. Grattan. Mercury had been previously employed in various inflammatory affections by numerous practitioners; but this appears to have been done from observation of the results from its use, rather than from theoretical principles. Even Dr. Rush, who employed mercury in the early stages of phthisis with remarkable success, seems to have considered that its beneficial effects in that disease arose solely from the counterirritation it produced in the salivary glandsj since his constant object was the excitement of salivation.t We consider that Dr. Grattan has not formed a strictly correct opinion respecting the mode in which digitalis acts on the animal economy : he states that it immediately lowers the action of the heart, and diminishes the frequency of the pulse. This is contrary to the observations of Dr. Saunders and every other physician of eminence who has carefully watched its effects; alt of whom concur in asserting, that, when the action of the heart and the frequency of the pulse are below a certain point, (about 130 or 140 in a minute,) it universally increases their force and frequency before it diminishes them. When the pulsations of the arteries are above 150 or 160 in a minute, digitalis has been frequently * Anatomie generate, Sy si ernes Capilluires, ? vi. t See London Medical and Physical Journal,vol. xix. p. 47,passim. 422 Critical Analysis. found to lessen them immediately; and so would wine or alcohol under the same circumstances; but it would not thence be proper to call them sedatives even on these occasions.
The state of health is that in which the influence of medicinal substances on tlie animal economy can be most accurately determined ; and, from having this view of the subject, the writer of this critique instituted a series of experiments on himself, with several of what are commonly termed the vegetable poisons. Those with digitalis were repeated several times, under various circumstances, with different objects: this substance constantly increased thfe force and frequency of the action of the heart and arteries before it diminished them; the lessened degree of action appeared to ensue in consequence of the nervous sensibility becoming depressed from its previous excitement; and, by repeating the dose of the vegetable at short intervals, and constantly and progressively increasing it, preternatural force and frequency of the action of the heart and arteries were maintained during eighteen days, when the experiment was terminated, in consequence of the serious derangement of the bodily and intellectual faculties that was produced. In another experiment, in which the quantity of the vegetable taken was less, and the intervals between the doses longer, the action of the heart and arteries, after having been increased in force and frequency during two days, fell below the natural standard ; but even then it was again excited for a short time after each dose, although it did not rise to the ordinary degree on these occasions.
Dr, Grattan also considers that digitalis, whilst it lessens the action of the arteries, increases that of the absorbent vessels ; and this appears to be a common opinion : but we iave been led to conclude that it has but little influence on the absorbentSj~that is, but very little when compared with what it has on the minute ramifications of the arteries.
2t appears that it is from the continued use of digitalis lessening in a considerable degree the action of the latter, whilst it has but little effect on the former, thus destroying the ordinary balance between exhalation and absorption, that the opinion above stated has arisen. Dr. Grattan, however, proposes as a question? " May riot digitalis, at the Same time that it increases the ac.
In inflammation of the mucous membrane of the lungs in weak and debilitated constitutions, accompanied with quick laborious breathing, orthopnoea, tumid countenance, and dark colour of the cheeks and lips, the use of digitalis and mercury, with auxiliary remedies,?" such as blisters, expectorants, &c. and sometimes stimulants, when the general debility and absence of acute inflammation appeared to indicate them,"?has been found so beneficial by Dr. Grattan, that " he never lost a patient under those circumstances, when the system was once fairly under the influence of mercury and these remarks, he states, apply to inflammation of every other organ as well as the lungs. The metastatic action may be determined to various parts of the bodily system ; these may be classed under two heads: "1. The metastatic action may actuate the muscular system. " 2. The metastatic action may produce increased actions of the arterial system.
In entering upon the consideration of metastatic action determined to muscular parts distinct from the uterine system, the author proceeds to enquire more precisely into the nature of that action of the uterus commonly denominated " labour pain." In this investigation, he satisfactorily exposes the inaccurate and contradictory notions of former writers on this subject, and deduces from the facts as they have appeared to himself,? " 1. That the uterine action is not necessarily accompanied by a spasmodic state of the uterine muscles, and consequent pain. 44 2. That the most distressing pains of parturition may be totally unconnected with the action of the uterus. 44 3. That such pains are inefficacious and unprofitable." The pains of parturition depend upon two different principles. 425 " 1. The sensations excited in the uterine system itself by the direct action of the parturient energy.
2. The sensations excited in parts distinct from the uterine system, by the metastasis of the parturient energy from that system to different parts.'* The painful sensations from uterine action are either from spasmodic action of the muscular structure of the uterus, or from pressure produced by the contractions of the womb upon the os uteri, vagina, and other parts connected with the passage for the child. -The pains arising from metastasis of the parturient energy to other muscular parts are, in general, of a very distressing nature, and are usually described as " cramping, cutting, grinding, rending." When the rectum or bladder become the seat of metastatic action, a sensation of the expulsive actions of those organs is experienced, and a sense of bearing down, which is often confounded with the regular propellent action of the uterus on its contents. Other peculiarities of these pains are observable, and their independence of true contractile effort of the uterus is demonstrable by the flaccid feel of this organ to the hand imposed upon the abdomen during the paroxysm. With these views of the author, we feel disposed very fully to coincide; and we think it would be difficult to withhold conviction from his very luminous exposition of them.
On the metastatic excitement of the arterial system, according to Mr. Power's opinions, depend several adventitious phenomena of parturition, which we are inclined to consider as not having before been placed in so intelligible a scheme of relationship. The excitement may be more or less general, or restricted to an individual part of the system, presenting appearances modified by the peculiarities of its several seats of action. The author is of opinion that, amongst other effects, the metastatic action may excite determination to the brain, occasioning " a. A state of convulsion known as puerperal convulsion. " J. A state of syncope or hysteria. " c. It may give rise to febrile state." These are subjects of the highest interest, and will command attention to any plausible hypothesis which promises to throw light on their hitherto obscure nature.
For the suspension of the parturient energy, Mr. Power assigns the following causes :? " 1. The nervous power may be insufficiently produced. " 2. The nervous power may have been exhausted. " 3. The irritations of the uterine orifice, which should deter* no. 243. 3 I 4&C Critical Analysis* mine the nervous power tb actuate the uterine muscles, tnirf Be insufficient to excite such effect.** These causes are all separately considered, and made to appear adequate to the production of the effect assigned to them.
On the deviations from mechanical obstruction to the expulsion of the uterine contents, the author touches very slightly, giving merely the outlines of a very perspicuous arrangement of them. The consideration of these several circumstances evinces the same deafness of conception, accuracy of judgment, and habitual attention to order, which mark every page of this masterly production. We should exceed our limits were we to indulge our inclination to follow the author minutely through every section.
In the fourth chapter Mr. Power presents us with a synoptical arrangetnerit of the varieties of the parturient state, founded on the principles "which he has in the former chapters 'so luminously developed. His distribution is lucid, natural, and complete.
With this synopsis the author closes the first part of his book.
The second part of Mr. Power's work comprises practical observations relative to parturition ; and, relying on the correctness of the principles which he has endeavoured to establish, he infers, and justly we think, that their influence in practice must be considerably important. His work is professedly but a partial treatise on Midwifery, either as a science or as an art; and he, therefore, in his practical considerations, limits himself to those points which seem to be immediately dependant on his own peculiar principles.
The progress of a perfectly natural labour calls for little pr no interference from art; and, consequently, the indications are rather to guard against aberrations, than to offer active assistance. The general view which the author here takes of this class of parturition is clear and correct, and his practical inferences highly judicious.
In the obstetric department of the profession, as well as in the other branches, the attention of the practitioner is mainly directed to deviations from a state of natural aqd healthy 4 Mr. Power's Treatise on Midwifery. f27 action. The class dystocia, therefore, is that which becomes chiefly interesting in the view of the practical reader; and of this class the second part of the work under notice treats principally of the first order, under Mr. Power's arrangement, or " Unnatural Parturition, arising from derangement of the parturient energy." The most commonly occurring genus of this order is that of " labour with painful uterine action." If simply confined to this character, it rarely calls for interference ; and the author refers the accustomed treatment to the respective cases, rather to show the inutility than to enforce its adoption. At the same time, circumstances are pointed out which indicate the advantageous interference of art.
" Labour with partial uterine action" is not of frequent occurrence, and is so nearly connected with the subsequent genus in its causes, effects, and treatment, as scarcely to demand a separate notice.
In Mr. Power's view, the most frequent cases of protracted parturition, unconnected with mechanical impediment, will be found to belong to the genus.