Book reviews

Biological Evolution.Peter W. Price. Saunders College Publishing (Harcourt Brace College Publishers), Orlando. 1996. Pp. 429. Price £19.95, hardback. ISBN 0 03 096843 7.

Twenty years and half a life are sonorous words, but, like every thing in this world, they are only comparative. The youth fresh from the shop, views the man of forty as somewhat beyond his maturity, whilst the veteran is apt to consider him still in his boj'hood, We are not now referring to Mr. Charles Bell's age, of which we know nothing ; but, recollecting him as a young writer, and not over delicate in his remarks on his seniors, we acknowledge that we do not easily surmount our first impressions. This our readers will consider as a confession, and one which we wish them to keep in mind, should we express less satisfaction with individual parts of this work than we hope to do with the whole.
The first report on Caucer contains a short account of the institution of a cancer ward by theirs/,Mr. Whitbread, which introduces the recommendation of the plan of compression by the late Mr. Whitbread. " I have only (says Mr. Bell) to observe, that the essential part of this new plan of cure is the compression of the cancerous tumour, gently at first, and with a force gradually increased, till at last it is augmented to a very great degree: and that the means are these?if the cancer be open, the various holes and cavities are filled up from the bottom with chalk, finely levigated, and all the surface is thickly covered with hair powder; over this, long plaster straps are put, so as to cover the whole surface of the tumour, over this again are placed linen compresses, bound down with the turns of a roller, firmly applied, and of six yards in length; or over the first straps are laid a second set, bracing the parts more firmly than the first, over this a plate of lead, and lastly, the long roller is carried round the chest, compressing the whole." A Report of the Medical Committee follows ; by which it appears, that eight cancers in.an ulcerated state, and eight in a scirrhous state, have been submitted to this treatment; that in some cases of open cancer considerable relief was afforded, but that the specific nature of the cancer remained the same, and, that in some instances, the fatal issue was hastened. In the scirrhous stage, the benefit was still more doubtful. We copy the following ?penultimate paragraph, as we may have hereafter occasion to refer to it again. " Your committee, however, although they cannot lay claim to the discovery of a specific, have still the consolation to believe that they have in many cases succeeded in obtaining great alleviation of suffering; such alleviation as might, perhaps, induce some speculative minds, less disciplined by experience, to conclude, that they had at length succeeded in discovering a cure for cancer." Some observations follow by the author. Here we expected a most minute description of those cases in which pressure had been useful, contrasted with those in which it had proved useless, and had even done harm. From sucli sources of experience, and such habits of observation, we expected nothing less than instructions under what circumstances we might use pressure with safety or advantage, and such in which it would aggravate a most painful disease. If in this we expected too much, we might at least have been informed, that, after the most diligent research, the committee were not enabled to offer any instructions concerning the character of any local ulcers or tumours, in which they might expect benefit or injury from pressure. Another circumstance will probably strike the reader, " that the com^ mittee do not lay claim to a discovery of a specific." However, as faras the remedy goes, they have the consolation?of what??of adopting a plan, the benefit of which, Mr. Whitbread witnessed under Mr. Young, who, though not named, we conceive is sneeringly alluded to as one of those " specuting minds, less disciplined by experience." Some remarks follow on the advantages of bandaging in sinuous ulcers, and of rest in some obstinate spreading sores. Reverting to the work recommended by Mr. Whitbread, we are told, the only successful case " is a cancerous lip;" and, in this, it is easy to prove, that they are anticipated in the method of curing what is called cancer of the lip." What induced Mr. Charles Bell to commence this remark by they, "vve know not, but, when he concludes this sentence, by assuring us that rest and pressure will " infallibly cure malignant ulcers of the lip without excision we cannot help wishing he had taught us how to distinguish such an ulcer from a cancer, for Ave believe that many of the young gentlemen to whom he addresses himself, will recollect cancerous lip, for which the operation has been imperfectly performed, and in which, after stitching, long continued pressure, and rest, the disease has returned with such increased violence as to discourage all future attempts.
These events, however, show, that pressure may be useful in some cases which are not easily distinguished from cancer. This is the consolation, and by the passage above quoted, such would appear the implied " discovery of the committee," were it not for the penultimate paragraph of the " additional observations." " And now (says Mr. Charles Bell,) it only remains for me to state, that the idea of destroying by pressure, dangerous tumours, which could not be extirpated with the knife, is familiar to me from my first entering upon the study of our profession. Mr. John Bell had an opinion, that it was possible to suffocate and subdue the action of vessels in tumours by the compress and bandage. This he *vas wont to illustrate by the effect of that bandaging of the limbs, by 480 Critical Analysis. by which mendicants reduce the substance of their limbs to a third part of their natural bulk; by the example of the feet of the women of China, and other ingenious analogies. Me argued, that, if the natural structure of the body could be moulded by pressure, why should not these formidable tumours 1" In these remarks and extracts we have omitted to notice some theories which Ave hope will be hereafter explained.
According to the author's observation, pressure " does not subdue specific action. Nor is it desireable; that absorption of the matter of cancer should take place. In true cancer, there is a peculiar matter unlike the original structure, produced by the specific action, and deposited in the texture of the tumour. Now were it possible, that the compress and bandages did actually excite the lymphatics to absorb the cancerous disposition,"?we stop here, as we are afterwards told, " this a mere matter of opinion and speculation." Still it should be intelligible ; matter and structure are two things, and ought not to be compared together. Still more difficult is it to conceive, how the lymphatics should absorb a disposition.
The second report on diseases and wounds of the larynx, and of the operation of bronchotomy, contains many just suggestions, but nothing new to those who have perused some of our numbers of the last and preceding volume.
We wish Mr. Bell had been more explicit in the following short paragraph. " In these four examples (says he, alluding to four preparations in the Museum) of disease of the larynx, we see the nature of the membrane of croup. It is formed by inflammation of the membrane lining the larynx and trachea, by which a proportion of coagulabfe lymph [more or less, according to the violence of the inflammatory action] is added to the mucous secretion. Accordingly, it assumes, in one instance, [No. 1], the appearance of concreted mucus; in another, [No. 4], the character of coagulable lymph." Every one knows how uncertain a sense the sight is, and particularly when applied to wet preparations, seen through two or three mediums. Though, therefore, the youths (Mr. C. B.'s hearers) might seem ready at taking their master's ?word, and giving him credit for his accurate discrimination between coagulated lymph and concreted mucus, yet a teacher should always remember, that the apparent acquiescence or dutiful silence of a scholar, is no proot that he is satisfied with, or even that he fully comprehends his teacher.
The third report of diseased pharynx and oesophagus ha? some interesting and useful cases, with good practical remarks. The fourth, containing cases of fistula in perineo, is V ? full Mr. C. Bell's Surgical Observations. 475 full of histories of those complicated evils with which the Urinary, genital, and neighbouring parts are so often afflicted.' The fifth report is on fracture and dislocation of the spine, "with injury of the spinal marrow; cases of fracture of the ribs, attended with emphysena and with caries. We copy the first case as a specimen of the mode in which young gentlemen should be admonished in lecture, and afterwards print. " *1 am happy to meet you again, and especially, because there is a subject on which I wish to address you: and you must excuse me for saying, that it is a subject of which you are criminally negli-, gent. It is easy to know whether or not a student be properly educated, by observing the things to which he attends in an hospital, just as you may know a gentleman of liberal pursuits by his conversation, and the objects which interest hiin. You will presently observe the application of this remark.
" There was an old Irishman, one of my patients in the accidentward, when I left town, in whom I took much interest, and often I drew your attention to the case, and made you feel his sides. To many of you I explained his critical situation. Shall I confess I was concerned to observe the little attention that you paid to this subject? " He was a man of sixty-five years of age. He had fallen from a ladder and struck his left side upon the corner of a chair; he re* mained at home for three days, until his master, having called on me, procured his admission here, to which you know his misfortune gave him a title without my influence. I found him sitting up in bed, suffering much from pain in his side, aggravated by a short cough. On exam|ning the side, it was not possible to feel the ribs, but you might perceive other evidence of his ribs being broken in the emphysematous tumour which covered them. He was fat, with that looseness of skin which is characteristic of his years; the skin was blown up, forming a tumour extending from the ilium to the clavicle. " There was no doubt that the rib was broken, and the lungs torn. I witnessed his situation with considerable uneasiness; but, as he could lie down, and as he repeatedly affirmed he was easy, but for the troublesome cough which he said gave him pain in his side, I Was satisfied with ordering him to be bled, and to have a litictus for his cough. I sent to inquire for him in the afternoon: 1 visited him in the evening: 1 sent again in the morning: and I saw him at twelve o'clock. The tumour spread further over the breast, and over the hips; but nothing untoward occurred. He continued better the third day; on the fourth, he was still better. On the sixth and seventh day from the accident, the emphysema began to dissipate, and, by the common attention to confine the motion of the rib, and keep the circulation low, he quite recovered. The sixth Report contains cases of Femoral Hernia. In the first of these the. author shews very satisfactorily that the incarcerated part of the gut is not filled with alimentary or stercoraceous matter from the parts above it, but by a secretion of its own. The consequent remarks are very judicious. We can only admit a short extract, which, we trust, will induce the reader to examine the whole,?and we cari assure him he-will not be disappointed. " Anus at the Groin.?In my Collection there is a preparation which illustrates this subject. A middle-aged woman had a tumour in the groin, which was soft, cedematous, and inflamed. From' the train of symptoms, it was obvious that this was a herniary tumour: but she would not permit the operation, nor even the approach of a surgeon. In a few days, the tumour burst, and discharged matter and feculence. She lived three weeks from the time we saw her.
On dissecting the body, I saw in the labium a bag of matter, and an ulcer, with sinuses in the groin. The portion of the intestine which had been held in the sac was quite sloughed away, and the sac was jio longer distinguishable. An opening, through which the little finger could be introduced, communicated with the gut, and formed an anus at the groin. On opening the abdomen, two portions of the ileon were seen tending to one point, the passage under the feinoral ligament; they were in close contact, and agglutinated as they approached the passage, and adhered to the peritoneum. In the preparation, it is still observable that these two portions of the intestine have one opening tovyards the groin, which is owing to the wasting of the intermediate septum; and here it appears, that, if the opening had been closed outwardly by granulations or adhesions, a communication might still have remained betwixt the two portions of the intestines. " When we look to the preparation, it appears an easy matter to pierce or to destroy that septum by either of the means 1 have spoken of: but let it be remembered, that, when the anus at the groin is thus established, the opening is irregular and deep. Although it may be easy to find the passage by which the fieces came out, it does not follow that the passage to the lower part of the in- 477 ? % f ? s testine shall be found with the same ease. Here is an additional reason for passing the seton ligature into the extremities of the gut; in preference to passing it through the mesentery at the time of the first operation. The ligature serves to distinguish the two extremities of the gut, and, if it do not prove effectual to the formation of a communication betwixt them, it will facilitate whatever operation may afterwards be attempted. Before this simple means be rejected, let it be remembered that there is a natural tendency of the two portions of the gut to form a communication by ulceration; Which appears to me to ensure the enlargement of the hole made by the seton, and its continuance." The subject will again occur in a future report. The remainder of the present is made up of some remarks on the prostate gland, and on amputation at the shoulder-joint* The first are best suited to the meridian of Windmill-street: the last it is unnecessary to do more than announce, as such an operation can never be undertaken but by a surgeon of courage and experience, nor without a complete acquaintance of all that has been done before.
The third number contains " Pulmonary Diseases irt connexion with Local Irritation, and consequent upon Wounds and Surgical Operations?Inflatiimation of the Lungs from Compound Fracture, and Disease of the Bladder i Inflammation of the Lungs from Compound Fracture, and Aneurism of the Aorta; Inflammation of the Lungs from Compound Fracture, and Injury of theS^ine; Disease excited in the Lungs by the irritation of old Gun-shot Fractures ; In* flammation of the Lungs succeeding to Amputation." Some observations follow " on the Ligature of Arteries, with some Examples of Wounded Arteries?Of the Cutting the internal Coat, effect of a loose Ligature, Ligature of a single Thread, manner of taking away a large Ligature, of catting the Li^ gature short; Wound of the Humeral Artery ; After-Treat*, xnent; Dissection ; Observations on the Case; Case illustrating the State of a Limb when the Main Artery is torn: by Gun-shot; Bleeding from returning Vessels,; Wound of the Inguinal Artery, the External Iliac Artery tied, fatal from Haemorrhage by returning Blood; Remarks on the Cases." On these subjects, we trust Mr. C. Bell will avail himself of the hints we ventured to offer in the Retrospect at the commencement of our present volume.
. We have next a <? Report of Cases of Wounds in which the Question of Amputation is brought forward." This is; intra*, duced by the following paragraphs : " The wards containing, at present, cases which must have ex:cited the sympathy of the pupils, and taught them to reflect, with great interest, upon the question of amputation, I think this the best The pupils have seen, with their eves, those things of which no words can convey a distinct impression, and which are, notwithstanding, necessary to the comprehension of this question, and to the formation of a right judgmeut. " This is a subject of great extent, and embraces a great variety of diseases; but I shall throw out of the discussion the cases of wounded arteries, white swellings, carious bones, tumours, &c. and confine myself to the questions of amputation in the cases of wounds and fractures. Through the whole range of these cases, the influence of the constitution on the wound is the circumstance the most to be attended to; for, without reflecting on this?without determining how much of the character of a wound is a direct consequence of the injury, and how much is to be ascribed to the reflected influence of the constitution, a very difficult question is made still more obscure. I shall, therefore, present, in the first instance, examples of slighter injuries, aggravated by the vice of constitution* and giving rise to the question of amputation. The question will then be stated in reference to the violence sustained, as by machinery ; then will follow the examples of compound fractures; and, lastly, a comparison will be instituted betwixt the compound fracture and gun-shot fracture." On all these subjects, we meet with several useful remarks; but Ave cannot help thinking that in this, as in most other disputes, the best-informed men are more nearly of the same opinion than they seem to be. The author shews several points in which the army and navy surgeons would differ much less if they adopted the same language. Another thing, we conceive, is not often enough attended to:? In injuries where the loss of blood is inconsiderable, and the subsequent operation, in that respect, equally successful, we have thought that the abstraction of blood from a vein would very much lessen the danger of that rapid inflammation, which, in young men, full of animation, and preternaturally excited, so often leads immediately to mortification. It is, however, scarcely possible that this question can remain any longer in doubt, after the carnage of the late war, and the vast number of operations by well-informed surgeons from every part of the world, conducted in every climate and in every possible state of health. The number concludes with a report of the use of the nitro-muriatic acid bath in certain obscure cases of syphilis.
" When a poor creature is reduced to great weakness, despairing from long suffering and disappointment, covered with scabs and ulcers, and loathsome, and. rejected of his friends;?When such an object, half poisoned with mercury, and still suffering from syphilis, or its sequelae, presents himself, what a relief is it to be able to take a jwdfUp course; to possess a remedy which, wjthfiut further . ' weakening Mr. C. Bell's Surgical Observations. 479 Weakening the powers of life, can clear the skin, and dry up-the ulcers, give animation and colour to his countenance, and thus enable us to return him to society. What, although witnessing such effects of a remedy, we were to be left disputing about the action of the medicine, or the nature of the disease?of how little real consequence is this difference of opinion T " It is not my purpose to enter upon the investigation of the fictitious diseases, as they have been called, nor to object to the names which have been given them, nor to deny the existence of new diseases; but I must express my belief, that the subject of pseudosyphilis has acquired an importance, from the multitude of cases of syphilis improperly treated, which offer themselves in public institutions. We find practitioners screening themselves under the authority of great names, and believing themselves to be blameless, because dealing with some new form of disease, when, in fact, they have mismanaged a common case of syphilis. Whatever advantage hereafter may accrue from the new opinions, they have, in the meantime, encouraged great negligence and irregularity in the treatment.
" On slight suspicion of infection, small doses of mercury are given, which control and change the signs of the disease without curing it, and hold its virulence suspended, or weaken the attack. The improper treatment of the primary sore is another source of error.
They attempt to destroy it with caustic, or they apply escharotic and stimulating dressings, while they load the system with mercury. By local applications, the hardness of the ulcer is kept up, and the mercurial course is pushed with the design to destroy the hardness;?then comes mercurial sore-throat, and they have entered the labyrinth! Instead of waiting to observe the character of a sore, and avoiding every thing which can change its aspect, they engage in a mercurial course before they have ascertained the disease.
It may happen that mercury aggravates the disease, and they attribute to the progress of syphilitic poison that which is the consequence of the remedy. Another source of error is from pushing the mercurial course, when either the disease is not in a condition to be cured, or the health is so reduced as not to be able to withstand the remedy in that degree necessary to overcome the disease. The opinion that mercury will certainly overcome the true syphilitic disease, if given in sufficient quantity, leads, in the first place, to very severe trials of the remedy, and to the conclusion, that it cannot be the disease which remains or returns, after an interval of health, in a new form. The symptoms are, therefore, trifled with, and treated with small doses of mercury, which tend to suspend, and not to eradicate, the disease. Scrofulous complaints will sometimes be excited, which give rise to mistakes. Often a scrofulous ?swelling of the glands of the groin will be excited by venereal virus, which mercury is unable to subdue. Scrofulous ulcers of the amygdalaj occur during a course of mercury, being excited by the remedy; and these also lead the surgeon into the most serious mistakes," A few 480 Critical Jnalj/sis.
A few remarks follow on the use of mercury in the trua syphilis, after which Mr. B. continues, "These are some of the causes why syphilis shews itself weakened, almost worn out, but not extinguished, liable to break out in circumstances favourable to its development, but still in a state to be subdued by the lesser remedies; and, in the meantime, the patient drags a wretched existence. These, too, are some of the causes why so many patients are seen, whose constitutions have been destroyed by repeated long courses of mercury, which still seem to have been given ineffectually, since the patients are covered with sores and cutaneous eruptions." Though we have endeavoured, as much as possible, to shorten the above extract, yet we expect the reader to accuse us of its length; and it must be admitted that too much is said unless the question were regularly argued. Pseudosyphilis and scrofula are words which mean every thing and nothing. Eradication of a disease is a dangerous figure, and the return of the symptoms in a new form is not a return of the symptoms, but of new symptoms, not only in form but in place also. We admit all this would require an essay of itself, and that Mr. C. B. professes only to tell us the effect of a new remedy in certain obscure cases. To this we answer, that the title of the paper should have been On the effects of these baths in certain obstinate ulcers and ill-ascertained cutaneous diseases; and the paper itself should have been confined to informing us that we have a safe empirical remedy for some local disease which we are often at a loss how to treat. Let not the reader be offended at the term empirical. We mean it only in its proper sense, a remedy which we are justifiable in trying, without exactly ascertaining our disease or the modus operandi in cure. Had such been the language, as it is the true meaning, of the author, we should most unreservedly have applauded the manner in which he accuses " practitioners of screening themselves under great names," when, in fact, neither they nor their teachers have any rational, or, if they please, any object truly physical in view; that is, any inquiry into the laws of a disease, or the operation of the remedy. A paper is added, by Dr. Scott, the author of this remedy, in which it is shewn that these baths have been useful in many hepatic diseases. We cannot question the credit of such authors, and are ready to offer our acknowledgment for the discovery of a new remedy, and its practical application. But why this unnecessary guess,?that" not a particle of the acid enters the system, and that the whole effects arise from chlorine ?" Surely such a suggestion is premature. Is there any reason why these substances should not be "absorbed when Mr. C. Bell's Surgical Observations. -431 when the skin is broken ? or what do we know of the medical effects of chlorine, the existence of which has only lately been ascertained ? If the acids are not absorbed, may we not suspect that the whole benefit is derived from the fumes entering by the lungs. Let us recollect, too, what the celebrated Abbe Elesee performed with Bareges water, and afterwards with his artificial Bareges water, which was brought in " common wine bottles from the apothecaries and chemists." Here the acid used was the sulphureous. But it is time to dismiss the subject, which, however, we cannot do without wishing the gentlemen to consider the question as hitherto empirical, and to direct their experiments in such a manner as to reduce the result to certain laws, after which the practice may be dignified with the title of physical. The fourth part commences with a most interesting inquiry?the fungus hscmatodes of that meritorious writer Mr. Hey. We might express our astonishment that so dreadful a form of cancer should so long have remained undescribed or undistinguished, Avere it not that only a fewyears before, angina pectoris was confounded with the more common forms of asthma; and that Mr. Hunter first suggested certain characters by which syphilis may always be distinguished, and certain laws by which the disease and its remedy are governed.
The cases related by Mr. C. B. are only interesting as all other tragical histories prove. They are also well told, and convey a sufficiently accurate idea of the phenomena and progress of the disease. But we cannot pass over certain objections which struck us most forcibly in the introductory remarks. After informing us, we doubt not with great justice, that the disease was well known, but inaccurately described, as well as ascribed to an inefficient cause, before' Mr. Hey wrote, Mr. C. Bell cannot refrain from amending, if not the description, at least the language, " of one, than whom," he remarks at the same time, " no one can boast a more useful life." " The term spongoid inflammation has no other recommendation than the merit of him who used it; and the name of'fungus hccmatodes neither accurately corresponds with the character of the disease, nor serves to convey an idea of it sufficiently alarming. The bleeding from these tumours is in a great measure an accidental circumstance; and it is not the growth of a fungous tumour which is alarming, but the propagation of a disorder fatal to life. " In all these cases which I have published, the patients were of an age and of a constitution which would have inclined me to say they were scrofulous; and this is at the same time saying that they tvere not of the age or constitution which we find subject to cancer. 'Indeed, Some other cases follow, in which the author, having seen his patient earlier, was successful in his operation. This is an important chapter, nor do we recollect to have seen the disease so well described in print. Mr. Hunter, we believe, in his lectures, mentioned it under the name of the " fungating sore," and advised the actual cautery to be applied on the bone after the tumour is as much removed as the scalpel and scraper can effect.
We have dwelt so long on tins performance, that Ave can only announce the remaining papers, reserving a few remarks for the conclusion. to which they are exposed, and proving Design in what has been attributed to Accident." We would wish to ask who ever attributed " this formation to accident?" It is very much the custom of another class of writers to suspect what, by the help of a pun, they call the religio medici. But Mr.
C. Bell should know better. As far at least as our knowledge extends, who have lived longer than Mr. C. B., no physiologist of this country has ever questioned design in the formation of the skull, or of any other part of the human or animal frame in general. They have not, it is true, always had the courage to ascertain what the design might be^ but, where so many evident marks occurred, they have been ready to admit the prevalence of the same in all others, Hitherto we are ignorant of the uses of the red particles in the blood; but we never heard a suggestion that they were not of use. If any thing can lessen our admiration of a First Cause, it must be the obstinacy with which some deny im, perfection in a fabric, the consequence of whose imperfections we are every moment cailed upon to remedy. There is, indeed, another mode of undervaluing the inimitable provisions of nature, which the zealots, from the best intentions, are too apt to fall into. Thus, one writer tells us of the structure of a watch, as a proof that there must have been an Artificer for the living productions of nature; and Mr.
Critical Analysis. C. Bell talks to us of carpentry, groinings, abutments, and arches; tenons, mortises, and other terms, taken from the mechanical powers and their application to operations. In all this he appears to us to lessen the dignity of the object he means to exalt. Where are the arches, where the centre-pieces or key-stone, where the abutments, where the piers, of the skull ? In other words, are not all these effects brought about by means which show a power infinitely beyond the application of the laws of mechanics, though those powers, in a few instances of the laws by which common matter is governed, are made to co-operate in the general design. When we hear of watch-makers, carpenters, and masons,?of their labours brought as an illustration of what they never can imitate, we are always fearful lest the allusion should be still more familiar, and the tendons of the fingers should be illustrated by the machinery in vogue with the four-in-hand gentlemen. In this last instance, the allusion is much closer; nor can we be surprised if, in their structure, a disposition of bones and tendons something like the laws of common mechanism should occur. But is this to be brought as a proof of design, when they evince only what, to a certain degree, can be imitated by man, who can only avail himself of materials unconnected with life?
It is not our intention, by this, to doubt for a moment the goodness of Mr. C. Bell's meaning ; but to remind him and others of the uselessness, not to say impropriety, of using such means to prove what no man can doubt whose opinion is worth any regard.
Such are the general outlines of these Observations. That the compilation is useful, cannot be questioned ; and it is with pleasure we find the author intends to continue it. We are not less pleased at his not wishing to " promise the same regularity or frequency of publication in future." We shall be ready to wait with patience, trusting that the delay will be " counterbalanced by the Reports being richer in cases and pathological inquiries, and more carefully composed." We recommend a revision, also, of some of the papers; and, above all, a more accommodating style. There is no reason or propriety in continually courting novelty of expression, or seizing opportunities of inducing the reader to believe that all knowledge is confined to one particular source.
IVlr. C. Bell has merit enough, without assuming more than lie possesses, or without undervaluing the acquirements of others. By J. B. Sheppard, Member of the Royal College of Surgeons in London, and Surgeon in the Royal Navy. This paper contains a very ingenious elucidation of Dr. R. Jackson's remarks, published twenty years ago,t concerning the fevers of St. Domingo, namely, that the supposed benefit of mercury was altogether fallacious. That the common remark concerning the certainty of the remedy when the mouth, could be made sore, amounted to no more than to shew that in some subjects the disease was so mild as to leave the constitution still susceptible to the impression excited by mercurj', but that in the worst cases there was a total insensibility to the stimulus it usually produces. Thus, as the sagacious Sydenham remarked of the small-pox, in the severe form it is often beyond the reach of the physician ; and in the mild form it is not always in the power of the nurse to kill the patient. Perhaps, in the present instance, we might say, of the doctor; for we have no doubt manysubjects have been destroyed by the time lost in the use of mercury instead of the lancet, and that many, under slighter cases, have been unnecessarily tormented with a mercurial ptyalism. As a preventive, we believe some practitioners are not so much of opinion that " whatever cures necessarily prevents," but have thought that a previous salivation might lessen that high health which renders the access of yellow fever particularly formidable to new comers.
Notwithstanding the few remarks we have made, we con* sid?r this paper ingenious, well written, and replete with, useful and well-digested matter.
Art. IV.?Observations on Inflammation and Brain Fever 1 By James Wood, M.D. Newcastle.
In this paper, cold affusions and bleeding are strongly recommended in brain-fever, and in the disease lately called delirium tremens. We have every reason to confirm the author's sentiments, and again to remind our readers of the practical remarks of our valued correspondents. costiveness arise from stricture of or near the rectum, and, by the inattention of the practitioner, who is satisfied with the temporary relief by a cathartic as long as it be procured, such cases prove fatal, without a knowledge of the cause tili all remedies are useless. Nothing can excuse such inattention. After every examination and inquiry, our art is sometimes imperfect, a consideration which should induce us to redouble our diligence, and to demand examination as often as we conceive any doubts may be removed by it. and, if we can induce the people of the United Kingdom to depend more 011 temperance than on drugs, for the recovery or preservation of their health, we shall wish his work every possible success/ Such is the superficial flimsy jargon of a conceited reviewer, ou which it is hardly worth while to waste any remarks. It is manufactured in the usual style of the minor critiques in the common run of inferior miscellanies, which, by a sweeping assertion, or flippant paragraph, appear to do great things, and perhaps leave 011 the idle portion of tlitir readers a strong impression of profound erudition and oracular dignity. The ' slashing Bentfey' of the review above mentioned also says, ' On the decline of states, we usually find their philosophy and literature minced down into dictionaries and Bibliot/iecas.' Now, this last sentence is mere nonsense. In a note, in Mr. Royston's hand-writing, on the margin of this review, now before me, is this remark : ' As states rise into a high degree of civilization, their literature and science increase and accumulate.; and, in consequcnce, Bibliothecas become useful and necessary.' This critic, whoever 406 k Critical Analysis. whoever lie is, does not know that the character of a Bibliotheca comes nearer to that of a Review tiian to a Dictionary. In fact, it should be a good review, on a great scale, extending, in a certain department of science, back to a period of publication long prior to the institution of critical journals. v " No one can doubt, however, notwithstanding the palpable examples exhibited in many reviews of inadequacy to their task, or of characteristics worse than this, of their general utility. Numbers of them certainly exhibit the most glaring instances of the abuse of a. thing in its principle good. Medical critics should, most especially, keep clear of such blemishes. When, indeed, vast quantities of medical books issue from the press, neither containing any thing new, nor exhibiting any thing old in a new light; adding to the heavy expence of study, ostensibly original works, but covertly only ponderous and circuitous advertisements; preceding, not consequent on practice;?the intended cause, not the valuable result of professional experience;*?it is then that the medical censor should speak out, forcibly and firmly. To stop, or, if he cannot stop, to divert the wordy torrent, to point out only what is excellent to the student, to whom money often may be, and to whom time always ought to be, most valuable; he must mark, with decided disapprobation, literary quackery and pseudo-philosophic imposition, whether of native or of foreign growth; and discriminate between productions likely to facilitate the anxious progress of the student, and crude compilations fitted for the mere ' helluo librorum/ lie should separate w hat are. real improvements in science from scholastic hypothetical dicta, too often palmed on the world under the semblance of system. To do this is to do right; but the task is not easy, nor the gratitude of the public very abundant for the performance of it.
It is become, however,an indispensable duty, and if, in the discharge of it, the critic acts from pure motives, positive utility to science may be the result of his efforts, and he will have for consolation, at the least, the ' mens sibi conscia recti.' " But whilst, on the one hand, medicine has to lament the quackery of book-making, she is, on the other, often compelled to regret the loss of much excellent practical observation. Many practitioners of celebrity, who have obtained the ' otium cum dignitate,' consequent on long success in life, ought to be less reluctant in giving the world condensed views, at least, of their extensive experience. Few such works as those of Hamilton and Hebeeden appear in an age ; and yet many eminent physicians, of practice equally extensive, too churlishly withhold from their brethren the results of their truly useful labours. Satisfied with having basked in the very sunshine of practice, it is to be regretted, that they who have, as it were, for a series of years, been absorbing so much of the light of " * See also excellent observations on medical book-making, by Mr. Royston, Med. and Phys. Journal, vol. xxiv. p. 2." experience, Dr. Mill's 072 the Morbid Anatomy of the Brain in Typhus. 4g| experience, should hot reflect some of its rays upon the less en? lightened of their contemporaries. " I now conclude this paper. It may be said by many, that iii (some places I have used too much the language of panegyric. It may be so, perhaps it is so. For the general strictures included in these observations I offer jjo apology;?' Licet  " While an epidemic typhus, fatal, especially among the higher orders, spreads general alarm in several parts of this country^ whatever throws light on the nature of that disorder cannot fail to interest the public mind. , " In a work, written expressly on the subject of Fever, I proposed venesection and evacuants as the best remedies in typhus, and gave numerous cases, from my private as well as public practice, in which these remedies were used with advantage. " This mode of treatment has since received the sanction of practitioners of eminence; while others, without adopting it themselves, liave been disposed to allow, that it is not attended with any injurious consequences; ' J " But, besides my own experience and that of others, I think it proper to appeal to a test,' no less decisive, as to the merits of any practice?the morbid changes which appear in the bodies of the dead. An examination of these changes, as Dr. Baillie, in his Morbid Anatomy, observes, is calculated to correct theories too Jiastily taken up about diseases. " I recommended venesection on the ground that the disease, though attended with extreme debility, proceeded froin inflammatory actions in the brain. If this be a theory taken up hastily, or from erroneous views of the subject, dissection will detect its errors; but, will, on the other hand, give it additional strength, if it be founded on just observation and in truth.
"The following sheets present twelve cases of dissection, shewing $he mprbid appearances of the brain in typhus, or brain-fever." ? We transcribe only ope of ;the cases, as, with a few exceptions, chiefly in degree, they are all similar. "Mrs. , aged 32,?Townshend-street,?of a melancholic temperament, and subject to a lowness of spirits. Nine days ill of fever, caused by suppression of the menses and exposure to cold and Jio. 226; ' ' " Critical Analysis.' wet Shivering, pain and fulness of the head, languor, loss of appetite, and a soreness of the flesh and bones, ushered in the attack.
The pulse was frequent, irregular,-and variable in strength; the skin was hot; there was delirium, throbbing of the temples, coma* deafness, and hurried respiration; there were involuntary dejections: the body was covered with petechite, and there was a loss of speech and the power of deglutition. " The patient died on the 15th day of the fever. <.
*l On dissection, several distinct osseous tubercles were found along the line of the longitudinal sinus; the dura mater was highly vascular, and adhered closely to the cranium; the veins of the pia mater were turgid, and there was a considerable degree of arterial vascularity throughout this membrane, particularly at the posterior part; the arachnoid membrane was raised from the pia mater by a serous effusion, principally at the anterior portion of the brain.
Br. Mill's on the Morbid Anatomy of the Brain in Typhus. 493 ances, taken down on the spot from their report, were confirmed by my own immediate examination.: " These appearances were almost uniformly the same;?vessels; gorged with blood, extending themselves through the substance of the brain, overspreading its lining membranes, the dura and pia mater, and the arachnoid coat; and effusions between these mem-, branes and into the cavities Of the brain. These are analogous to the changes observed in phrenitis, in hydrocephalus, in apoplexy, and similar to those which are found in the cavities of the chest or abdomen, after a fatal pleurisy Or peritonitis. " While we pronounce, without hesitation, that, in these cases, the changes are indicative of increased and inflammatory actions in the organs in which they are discovered, can we suppose in typhus fever, where analogous changes take place in the brain, that the same disordered actions do not go forward ]?especially, since the appearances on dissection, by shewing the relation between the symptoms and the organic changes produced by disease, are explanatory of the phenomena. " It is true, great debility occurs; but, when the brain is oppressed and deranged by excess of action, that consequence is to be expected, since the oppression is exerted on an organ which is the very source of muscular energy: and hence, in the apoplectic, where the oppression arrives at its height, the powers of the voluntary muscles cease altogether. " The effects of stimulating medicines in such a state of the brain must be to urge the blood with still greater violence on vessels already overgorged, and to increase action in the exhalents which are disposed to inundate the cavities with their exuding fluids.
" On the contrary, whatever lessens the strength of the circulation, the very same remedies which are administered in phrenitis, seem to be called for here?sedatives, purgatives, and venisection, employed and repeated according to the state of the symptoms. " Such is the conclusion which, I think, the unprejudiced would draw, and it is supported by my experience and by that of practitioners who have adopted the practice in the present prevailing epidemic. " Among other communications, I have been favoured by Mr; Henry, surgeon, who has the care of the Dispensary at Castlepollard, with an account of the epidemic fever, as it appeared in that town and its neighbourhood. " ' The symptoms,' he says, ' were chilliness, pain in the head and back, low and quick pulse, weakness, petechias, delirium, stupor or heaviness in the head, foul tongue, thirst,-and restlessness. Reco* veries generally took place from the 9th to the 13th day. " * Contagion appeared to be the cause, as it attacked successively several in a family. My apprentice and I blooded nine on the same day, in one family of the name of Walsh, two miles from Castlcpollard, on the estate of Thomas Webb, esq. " * From the dispensary books it will appear that there were about 3Q0 ill of the fever, all of whom were blooded, and not one 3 S 2 died. 494 ' --CriticalAnalysiil > died. Some were blooded three times: one of these was my apprentice. The quantity of blood taken at each time was from si* to eight ounces from adults?less from children.
" ' I had several patients not on the dispensary books, and I treated them in the same manner, and with the same success: I also employed purgatives and sudorifics.
? " 4 The head was invariably relieved by each bleeding. I found that small and repeated bleedings were more effectual than large ones. i ... i " ' The blood was seldom buffed, but generally dense. The fever terminated sometimes by perspiration, but often without any sensible evacuation, with a return of sleep and appetite.'" Such are the important facts contained in this valuable compilation, on which we cannot help making a few remarks.
: First, We have still to learn what constitutes typhus. Is it contagion? The author seems rather to insist on debility and the other symptoms. Now, all these symptoms may occur in scarlatina, measles, or ^mall-pox; or in continued fever from any cause. That the brain was oppressed in these, and is in most or all o^her, fevers, cannot be questioned. But, when we are told that, the appearances are similar to those observed after phrenitis, hydrocephalus, apoplexy,?and that such changes are similar to those found in the cavities of the chest and abdomen after fatal pleurisy and peritonitis, we must pause before we admit that effects from such causes are similar. In phrenitis, we have often preternatural strength during life. In violent inflammation of the brain, we have epileptic symptoms, attended also with preternatural muscular strength for a time. In apoplexy, we have entire or partial loss of sense and motion. In the first, we find, after death, strong adhesions of the membranes,' with effusions of coagulated lymph. In the second, a peculiar firmness of the brain, probably the effect of effused coagulum. In the third we have extravasation of blood in the ventricles betweein the convolutions, or, more commonly, under the dura mater. In phrenitis, the blood drawn is usually buffy and cupped. We take no notice of the turgid appearance of the vessels of the brain, as nothing can be more uncertain. Now, it is to be remarked, that, where the blood wai drawn in this fever, the appearance, so far from denoting inflammation, was directly the reverse: " dense," which, we conceive, can only mean of a creamy consistence, the constant mark of blood which coagulates imperfectly, as if from the same diminished power which it partakes with the solids. At the same time, it cannot be questioned that there was effusion on the brain. This, we conceive, takes place in all fevers, and to be the cause of that dulness of c" ' the Mr. Pring's View of the Relations of the Nervous System. 49^? the senses which the best writers have considered as favourable in a certain degree. Deafness is the sense generally marked, because it is in an organ which is principally wanted during disease.
But, if it is the property of every fever to induce this effusion on the brain, there cannot be a doubt that such a process should be closely watched. When it extends no further than to produce a general dulness of the senses, such an effect may be desirable ; but, wherever a new action is set up, it may be carried further than is consistent with health.
Hence, this effusion may extend to extravasation, in whicfi case we have apoplexy,, by no means uncommon in the very commencement of some of the worst kind of camp-fevers.
It may induce inflammation, in which case we have delirium ferox; or, without either, it may be so considerable as to produce a greater interruption to the necessary functions of the brain than is consistent with the maintaining of those actions by which life is supported. Under any of these circumstances, the indication is to determine less blood to the head, which must be accomplished either by lessening the action of the vessels about the brain, by taking away blood from the common mass, by other evacuations, or by exciting higher action in other organs. The first is accomplished by cold applications to the surface of the head, the second by venzesection or cupping, the last two by purgatives; and, if the symptoms are threatening, all three may be necessary. But, neither the symptoms in their ordinary form, nor the advantage derived from these remedies, convince us that inflammation of the brain attends every fever; or that a limpid effusion to such a degree as merely to obscure the senses is not salutary in fevers. At the same time, we perfectly agree in the practice; and are convinced that the omission of early evacuations, and, still more, the use of stimulating remedies have produced all the mischief of which they are accused, and of which the most zealous Cullenians ar& gradually convinced.

Callow.
Irksome as disquisitions on the brain and nerves usually are, we could not withhold our attention from a paper which received the prize from such an ordeal, and had been revised for 49f> v Critical Analysis. ; * 'T for four years after b)? the author. We acknowledge that we found our task often irksome, which may in part be imputed to the great pains taken by the writer to compress what was familiar to himself, though new to some ot us. Whilst, therefore, we endeavour to give the spirit of the work, our readers must be aware how difficult it is to compress what is intended only as a selection.
After a short chapter on the structure of nerves, another succeeds on their power of contraction when divided. This the author proves, by a very satisfactory experiment, is not the effect of mere elasticity^ but of the vital power. He observed also, by similar experiments, that the same power exists in the spinal marrow* The next series of experiments satisfactorily proves, that a punctured or divided nerve may be restored to all its functions, and probably to its original texture. Whether this is by an approximation of the divided parts, or by an union of them from a newly-formed part, does not seem ascertained. The latter, however, seems the most probable result of the author's observations; and we think, we somewhere recollect, that, when Mr. Hunter not only divided, but dissected out, part of a nerve, he afterwards found the lost substance restored, first by the union with coagulated lvmph, which was gradually converted into the same sub-, stance of the nerve.
Mr. Pring next considers the Relation of Nerves with their.
Centres. By this term he designates the structure which forms a medium for the union of nerves of different distributions. Some have a relation to each other by the medium of the brain; others of the spinal marrow. Hence the sympathies of various parts which are destroyed, if their centres, or the nerves by : which each part is connected with those centres, are destroyed. Thus an injury to the leg induces an action in the arm, and vice versa; but, if the sciatic nerve, the spinal marrow above the lumbar vertebra;, or the axillary , plexus, be divided, that reciprocal influence which naturally exists between the muscles of the leg and of the arms would be destroyed. This leads the author into some inquiries concerning the seat of sensation from the wound of a part, whether in the brain or in the part itself, and also into the doctrine of vibrations. The first, we conceive, never can be accurately ascertained, or else that it is a mere dispute about words. The doctrine of vibrations is refuted by the result of every experiment of the author's, which proves that there is no.motion in the nerves, not even elasticity, Without life. The doctrine, indeed, has gradually fallen into oblivion, since Haller and Miv Hunter have taught usto' u> ^consider life and its actions as the only nieans of accounting for whatever we see in the physiology of animals.
A chapter on the Relation between Nerves shows, that where the nerves are double in the same organ, the division of one set induces a greater power in the corresponding set, provided the divided nerves are prevented from uniting.
The experiments in proof are judiciously selected, well conducted, and the inference fair. w I exposed (says Mr. Pring) the lower portion'of a sciatic nerve (five days after it had been divided, and some recovery of its powers was indicated) for the extent of an inch: it was cut, pinched, and lacerated with the forceps: the animal did not evince the slightest sensation, but he started if the superior portion was in the least degree irritated.
1 . " June 5. I applied two ligatures on the sciatic nerve of a rabbit, and divided it between, them. I: preferred the ligature to a simple division, in order to provide against a speedy re-union, which Would have frustrated the design of the experiment. " August 5. A considerable improvement of the voluntary powers of the limb had taken place; so great indeed, that I was fearful my care to prevent a premature re-union had been without success; but, in this suspicion, I was mistaken. I exposed the parts of the same nerve, and continued the dissection near two inches bev low the place of its division. I then applied a ligature to the most inferior point of the lower portion, but the animal did not evince the slightest evidence of sensation: the nerve was divided by the scissars with the same result. If the superior portion was pinched,' or irritated, a lively sensation was manifested.
" This experiment appears to be as conclusive as any which will readily suggest itself, on a very important point of the pathology of the nerves: without such a decision, every thing which we can de-> vise for the improvement of the practice which has been instituted for the cure of some diseases of the nerves, must he futile and nugar tory; for if it should be proyed, that the sensibility of a nerve is acquired below the place at which it is intercepted, by communication >vith sound nerves, we have but little to hope from the success of a project, which is calculated to prevent permanently the transmission of ceutral influence. But if the improvement of the faculties of the nerves had taken place by derivation of nervous power from sound nerves (in some measure analogous to the effects of the anastamoses of the arteries), the sensibility would surely have been excited by the application of a ligature, wjiich never fails to produce exquisite pain in a nerve which is not deprived of its sensibility. "We must conclude, therefore, (if the sufficiency of these data be admitted) that the improvement of the nervous function of a limb, previous to the reunion of one of its divided nerves, results from the assumption of an increased power or energy, or an increase of the properties, belonging to the sound nerves. It is sufficient for the general purposes of this branch of surgical pathology, that we can ...... . positively i!9& Critical Analysis! ^ positively deduce this inference in regard to the sensibility possessed by the nerves: it is probable that the same conclusion may be ex* tended to all the other faculties belonging to these organs, which are derived from their respective centres." Some remarks follow on the relation of nerves with muscles. These, in our present improved physiology, need only be mentioned. In England we grow tired of inquiring into the nature of muscular motion, and are satisfied with tracing the facts in order by them to learn the laws without attempting to dive into the causes; and the inquiry would, probably cease, were it not for the, institution of certain prizes from endowments made in. less enlightened days,, The continentalists are slowly learning to do the same; but they cannot divest themselves of some mysticism ip language. Highly as we esteem Bichat, we .never read hi.m without feeling a wish that he had.never imbibed themechanical reasoning of his countrymen or that he had checked the sallies of his imagination by the physiological simplicity of Mr. Hunter, " According to Bich&t, (says Mr. Pring) a voluntary muscle disi plays four kinds of contractility: animal contractility, as when it acts at the instigation of the will; sensible, organic contractility, as "by the action of a chemical, or other extraneous stimulus; insensible, organic contractility, as by the impulse of its fluids, constituting tone; contractility of tissue, as by a transverse section of its fibres, arising, as it is said, from failure of extension." If this be put into common language, it can mean no more than that a muscle contracts by the will, which is voluntary inotion; by its living powers, and without the concurrence of .the will from local stimuli, as when a part is pricked or Otherwise stimulated. The two other kinds of contraction are not so readily comprehended, and, perhaps, on that;account may be more agreeable to a certain class of readers. The first, however, means no more than that plumpness, as it is usually called, which distinguishes youth and health, and is more particularly attended to in the cheeks of both sexes, and in the scrotum of male infants* the last scarcely deserves notice. Indeed, the whole paragraph is given by the author and transcribed by us with a view of showing the ^tate of science on this particular subject. Mr, Pring next offers a very few remarks on the relation of nerves with the lungs. These go only to show, that aU voluntary action of the muscles, by which the lungs are inflated and emptied, pease as soon as their communication with the brain is cut off. The subject of artificial breathing, and the generation of heat will be considered hereafter.
The relation of nerves with the heart contains many excellent observations. After a fair analysis of all that has beeri s*i4 Mr. Priug's Fiexv of the Relations of the Nervous System. 499 said of the dependance of the action of the heart on the nerves, and of its continuing to beat after decapitation, the author with much prudence concludes? " As every physiological inquiry has for its most important end the development of the relations which obtain in the economy of the human subject, so it is necessary, in prosecuting the investigation, to confine the researches to animals which bear with the human subject a perfect analogy in the circumstances which form the topics of the inquiry. We cartnot extend the observations made upon coldblooded animals to the phenomena of the mammalia, because the diversity of the laws to which they are obedient, is the proof of the absence of that analogy upon which alone the argument can be founded. Shall we conclude that the nervous system is not necessary to sensation, or the muscular structure essential to motion, because the zoophytes, according to Cuvicr, display the faculties both of sense and motion, although they possess neither fibres nor nerves?* " We perceive by this analysis, that much has been attempted for the understanding of the mode of the action of the heart; that some of the particulars which have been investigated, are still undetermined; and that many more remain, which have not yet been submitted to the test of experimental inquiry." The truth is, all we can infer from the experiments of Bichat *nd others is, that after decapitation it is some time before the parts die, though the actions by which life is supported are so prevented as never to be restored. As long, however, as the divided parts retain a living principle, so long will they obey their accustomed stimuli. The stimulus from the will is superseded for ever; but the action of the lungs is the Stimulus to the action of the heart. As long, therefore, as the lungs are made to act, or are alternately tilled and emptied, so long will the heart continue its action, provided its life continue. But, after the body has suffered such violence, life must be gradually extinguished. Hence, we lind the secretions cease, and the generation of heat with it, and, by degrees, life ceases, sooner or later, accordingto a variety of circumstances attending the animal, and the injury he has received. After this, no stimuli can excite any action. It is the want of attention to these circumstances, principally the mode of dying, that bewildered so many experimenter.?. This doctrine is still better illustrated in the succeeding chapter on the " Relation of Nerves with Arteries." By jsome well-constructed experiments, the author shows satisfactorily the futility of many others, from which hasty conclusions are drawn ; andconvinces us, that, by habit and long ? 11 i... .,

,
--1 j. reasoning on the subject, and every necessary improvement in conducting his experiments, he has acquired a superiority in his inductions over many who fancy they have devoted their lives to physiological discoveries.
" That the action of the arteries of a limb (savs he) is not dependent upon the medulla spinalis, is proved by the fact, that the pulsation of the arteries in the fore-leg of an animal will continue after a division of the axillary plexus. " It is also demonstrated, that the secretions, and the processes of regeneration, will likewise proceed below the place where the communication of nerves with their centre is intercepted. A testicle has been known to suppurate after the division of the spermatic nerves. But, as I was desirous of acquiring a more precise information on this point, than I had been able to possess by report, I divided, with as little injury as possible to the surrounding substances, the nerves of the axillary plexus of a rabbit, at a distance of about threefourths of an inch from the ribs: I was particularly careful to divide every filament of nerve; and, as the operation was familiar to me, I believe that I succeeded. The limb lost its sensibility, and was rendered incapable of motion; the circulation was, however, maintained in it.
the relation of a source with a channel of distribution, we have no absolute proofs; our testimonies amount only to this evidence, that these are the effects (viz. those which have been noted from a sensible demonstration) of a division of nerves. Such appears to be the condition of the evidence which relates to the connexion between remote organic life and the central termination of nerves.* Though we find a great many good things in this chapter,, yet we cannot help thinking the author has unnecessarily involved himself in mechanical and chemical causes, especially when he ascribes inflammation to any other cause than the actions of life. Perhaps Are shall be told, that all the " chemico-hydraulic agencies" of which he speaks, are " directed by the principle of life, to which a preternatural condition is superadded." This means, if we understand him, that they arise from the actions of life changed according to the nature and properties of certain stimuli; and that all fcuch changes, or such preternatural conditions, being different from the original or healthy actions, constitute disease. All this is extremely intelligible, and we heartily Avish he had stopped here, by which he might readily have explained some difficulties, which, as they are insulated in notes, we shall transcribe. The first is as follows;? " I am inclined to think, that there is a property of preserving, for a certain time the fluidity of the blood, belonging to the vascular system, independent of motion; and that this property is one dependent upon the nerves. The first part of the position is, in a great, measure, confirmed by the formation of a clot in thesheath of a divided artery, which would no more take place in the sheath than in the vessel itself, if the fluidity of the hlood were wholly dependent upon its motion; for this motion continues while the coagulation is taking place. The coagulation of the blood is, in this instance, accounted for, by supposing that it becomes entangled, &c.; which is a very entangled sort of a supposition, because it flows in a space, and through this same space it may continue to flow, if its fluidity were maintained by its motion. This proof is not perfect, because the fact is not unquestionable; at least, the assigned order of its occurrence is not unquestionable. With regard to the second part of the position, the reasons which affect it are meutioned elsewhere." " * This expression, ' the central termination of nerves,' is frequently employed; and I adopt it, after Ileil, because the denomination appears to me good for the purposes of distinction." "I have remarked it only in two cases of inflammation; one of them has been already mentioned, the other was as follows: A woman, when rubbing a jleal table, fofced a splinter of wood half an inch in length under the nail of the second finger ; it produced intolerable pain and rapid swelling: about three-quarters of an hour after the accident, I extracted the splinter, and, upon examination, found the arteries which supplied this finger beating 104 strokes in a minute, while the radial artery was beating only 92." The third. " It is not the mere cessation of life which produces a slough. I believe that under some circumstances of the identity of this influence which is exerted by the nerves, a kind of inverse operation takes place upon the subjects of its former alliance, and that the slough so produced is essentially different from that putrefaction which succeeds to ordinary death; that it is, in short, a state of the sensible textures, which no other agent in the universe could produce, save that principle of life, and which the principle itself can produce only under one condition of it. After ordinary death, the integrity of the textures may be a long time preserved; a slough may be formed in a few hours after the influence of a cause whose relation is with the principle of life." What connexion have these properties with hydraulics or chemistry ? They are all of them the properties of life, which cannot be imitated by the application of any other laws. This is well enough illustrated in a passage in the text, which we shall transcribe, in order to relieve, as far as vie can, this intelligent author from a difficulty we did not expect would be started in such a quarter. " The same principle (says he) not only regulates the calibre, but the cohesion also, of vessels: in acute inflammation, that property of the principle which prevents rupture of the arteries is generally increased, as the vessels in this state bear a great degree of distention: we have, however, an analogy for this in the arteries of the penis; we may therefore presume that the natural strength of the property is not diminished in inflammation. In the local determination of blood to which apoplexy succeeds, the force of this property must be diminished; because I have seen a man, who had two attacks of apoplexy, sustain phrenitis without such effect. This distinction, which lias been deduced from my own experience, is very similar to one of Mr. Hunter, who supposed that in phlegmonous inflammation there is an increase both of the action and of the power of the vessels; while in inflammation which terminates in mortification there is an increase of action, but not a correspondingincrease of power :* by this word ' power' (than which no expres-upon his knee. The thumb was bent in towards the palm of the hand: a spasm came upon the muscles of the arm, making them bend the elbow, and immediately he became insensible: in a quarter of an hour he perfectly recovered himself. Some hours after, upon bending his thumb, to shew what had happened to him in the carriage, there was a return of the same attack, which also rendered him insensible for a few minutes." No ill symptoms returned till more than two months after, when, eagerly waving his hand, a contraction seized the patient, and he suddenly fell to the ground in a state of in, sensibility. From this time, these events occurred frequently, without any apparently exciting cause: the spasms were, however, in a certain degree, arrested by a tight ligature ; and, as they were generally preceded by universal uneasiness, a tourniquet was always ready to be tightened on the first alarm. Electricity was found useless.
From the effect of pressure, and its interruption of the continuity of action, it was presumed that a division of the nerve might produce a more powerful effect. This was accomplished where the fibre passes under the annular ligament of the wrist to the thumb. The retraction of the cut-ends of the nerve was much greater than expected, as the nerve had been previously detached from all its surrounding connexions. A temporary universal spasm succeeded thin division ; but, for eight hours afterwards, no spasm occurred, In fifteen hours the spasm was general, excepting that the brain wras not affected. The wound not healing by the first intent, the callosity of the cicatrix became a source of uneasiness, and the spasms continued with little alteration.
They were somewhat abated, as that hardness was absorbed; but returned in such a manner as to prove the inefficacy of the operation, which Sir Evcrard imputes to the wound not healing by the first intention. " From this time (continues Sir Everard) the patient was not under my direction; but I understood that he tried the effect of large doses of opium, which did not afford relief. H,e was then induced to employ electricity, which was also unsuccessful; and he died in a fit, which at the time was believed to be apoplexy, about five months after the operation had been performed; but, as the body was not examined, the nature of the fit could not be ascertained. " In this case, some of the branches of the median nerve had .acquired from disease an unnatural power of contraction, which was made evident by the operation; and there is every reason 1 q believe that the spasmodic attacks which took place were in reality convulsive motions in the nerves themselves, which excited corresponding contractions in tliese muscles which were under theijf iafl peace." Mr, Mr. Pritjg, with much prudence, prefers resting his references on cases related by others who were unacquainted tvrith his opinions. To this impression we are to impute the relation of the above cases, which, with all his abbreviations, occupy more room than appears to us necessary, as the result only shews what is pretty well known, our incapacity to ascertain any limited laws to the phenomena attendant on diseased nerves.- " We coine now (says Mr. Pring) to speak of tetanus, the nature of which will be best described by a few examples. The following is a case of trismus, which occurred without being preceded by a wound. " A woman, who had been standing in the street about an hour in an intensely cold day (in the winter of 1813-14), was seized on a sudden with a torpor and incapacity of (he whole body: she was perfectly sensible, but she was unable either to move or to speak. She was taken into a house,and made warm by a fire; and in about an hour the motions of the limbs were restored. "At this time I saw her, and found the jaw so closely locked that it appeared impossible to introduce a sixpence between her teeth. I directed the face and neck to be rubbed with a stimulating embrocation, and tjiat an injection should be administered. The pulse was quite natural.* " Two hours afterwards I saw her again; and, by using some force, was enabled to iutroduce the liandle of a spoon between her teeth, and in this way, by a little mechanical violence, succeeded in opening her mouth so as to give her six grains of calomel and a cathartic draught. As soon as the spoon was withdrawn, the jaw became again immoveably fixed. I left her for the night, merely ordering the injections to be repeated every three or four hours. " My reason for directing the treatment so specifically to the bowels was, that, as far as I could understand from those who lived with her, she had had no alvine evacuation for five or six days. In this supposed connexion between the state of the bowels (establishing perhaps the predisposition) and the symptoms I was not deceived. " On the following morning, my patient was in the same state as on the preceding night. I was able, though not without much difficulty, to open her mouth by the same means, and to give her more cathartic medicine. This operated in about two hours afterwards, and produced very copious discharges from the bowels. In less than an hour after the first effect of the cathartics, she was able to open her mouth, and to talk intelligibly; though, before this effect, " * Dr. Parry makes the following important remark on the pulse in tetanus: * If, in an adult, the pulse, by the fourth or fifth day, does not reach 100, or perhaps 110, beats in a minute, I believe the "patient almost always recovers. If, on the other hand, the pulse qn the first day is 120 or more in a minute, few instances will, I ap-prehend, be found in which he will not die.' Cases of Tetanus and. Kabies Contagiosa, p. 18," pot Mr. Pring's View of the Relations of the Nervous System. 507 Hot the slightest abatement of the spasm had taken place. A little stiffness remained about the neck, which gradually left her.