effectual collyrium is formed of one drop of the sulphuric acid, and an ounce of distilled water, to which may be added a few grains of Zincum vitriolatum, and a small quantity of brandy. Nor, is a solution of the argentum nitratum, in the proportion of from half to a whole grain to one ounce of distilled water, and half, or a whole drop of the nitrous acid, a contemptible tonic collyrium in this case. Even cold spring water is a remedy, by no means destitute of efficacy in this stage of the complaint. The above eye waters, being intended to act as corroborants, should of course, be applied cold, three or four times a day. As Mr. Stevenson's treatise is more of a practical than a speculative nature, and contains some novel methods of managing a disease which seems to have been much misunderstood, we do not hesitate to recommend it to our readers. When our Analysis was going to press, we received the following Letter: GENTLEMEN, I take the liberty of requesting a place in your very respectable Journal, for the following observations upon a publication of Mr. Stevenson's, upon the disease called weak sight. My sole wish, in communicating these remarks, is to do justice to a most respectable member of the profession, whom I have long known, and also to set some other matters upon their proper footing. In attempting to effect these objects I should be sorry to shew any disrespect towards Mr. Stevenson.The first observation which I shall make upon the dissertation, is, that from the language used in page 5 of the preface, the reader might conclude that the knowledge of the proximate cause of the disease in question, as well as the plan of cure, originated with Mr. S.-"I was," says he, "repeatedly disappointed in any attempts to relieve it, before a different view of the proximate cause, and a corresponding variation in the mode of cure suggested themselves." This view of the proximate cause is described by Mr. S. in the following words: "And with regard to the proximate cause of weakness of sight, instead of local debility, I will hazard the opinion, that it consists in an exquisite irritability and sensibility of the retina, the effect of a great turgescency of the vessels, or a chronic inflammation of that membrane, or the choroid." Mr. S. however, in the next sentence, quotes this opinion from Sauvages: "Intolerantia lucis retina sensibilitatem adauctam esse probat, sive detur ejus infarctus phlogisticus, sive tensa sit nimium choroidea, ejusque expansio uvea." This quotation from Sauvages, appears to me to convey nearly the same opinion as that suggested by Mr. S. But leaving the reader to judge for himself, I shall proceed to say a few words upon the corresponding variation in the mode of treatment, which suggested itself to Mr. S. at the same time. In this point, also, or at least, in the chief part of it, Mr. S. it would appear, had been long anticipated by Mr. Ware. To make this clear I need only refer the reader to the cases quoted at length from Mr. Ware's observations. From these cases (which extend from page 51 to 58, inclusive, of Mr. S.'s work) it is evident, that evacuation by means of leeches was used by Mr. Ware, when the plan which he usually adopted, proved ineffectual.-Independent, however, of these considerations, the general plan recommended by Mr. S. 2 is by no means new. I am acquainted with many eminent practitioners in different quarters of the kingdom, who occasionally resort to leeches, but uniformly employ the other parts of the evacuant plan, such as purg. ing with calomel, biisters, setons, &c. They have also used remedies to promote a determination to and discharge of blood from the nose, of which Mr. S. makes no mention. To those surgeons, however, who were ignorant of the evacuant plan, Mr. S.'s statement of the fact will be acceptable. Valeat quantum valere potest.-Having now done jus, tice to the celebrated Sauvages and Mr. Ware, I shall next say a few words respecting the validity of the proximate cause. Mr. S. has, however. stated it in terms so different in different pages of his work, that it will be necessary to collect the whole into one point of view. After describing this cause in the words already mentioned, (page 11) Mr. S. next remarks, (page 12) "that this highly nervous and vascular tunic (the retina) is either in an actually inflamed, or, at least, in a morbidly distended, and, consequently, irritable condition." He next observes, (page 12) "that genuine weakness of sight is actually a disease in the retina arising from the great turgescency, or chronic inflammation of that membrane," &c. Next (page 33)" the exquisite sensibility of the eye might with more probability be the result of a chronic inflammation, or, at least, highly turgid condition of the blood-vessels of the retina or choroid." Next (at page 60) "The proximate cause of weakness of sight is a turgescency or more or less inflammatory affection of the posterior vascular membranes of the eye." Soon afterwards (page 62) is this expression, "Do not the history of the above case and its dissection demonstrably prove, that weakness of sight does not, always at least, proceed from a nervous affection of the retina, but that it is the actual result of a greater or less degree of inflammation of the choroid ?" Lastly, our author observes, (page 29). In these cases (of psoroph thalmy) the inflammation seems continuous, extending itself from the margin of the taisi along the PALPEBRAIC to the CORNEAL conjunctiva. Even in this instance, however, I conceive that the intolerance of light does not arise, at least only sympathetically, from an affection of the ret na, but rather from the cornea itself, which" &c. &c.—From the quotations it appears, that Mr. S.'s opinion respecting the proximate Cause is somewhat fluctuating. For my own part, I think it questionable and inconsistent with facts, but to attack it under all its protean forms would be a fruitless task, or almost impossible; for I confess myself ignorant of Mr. S.'s meaning when he talks of the distended condition of the turgescency, or of the nervous affection of the retina, or oj the posterior vascular membranes of the eye. Still less can I comprehend how "6 light really acts in expanding the vessels of the retina :” (page 16.) That blood may expand, or distend these vessels, is obvious: but we have yet to learn what expansive powers are exerted upon blood vessels by light, even from the meridian sun, which as our author informs us (page 15) destroyed the Roman general Regulus. I' shall therefore confine myself to Mr. S.'s first opinion. The first observation, which I shall make, is, that Mr. S. in defining his proximate cause, supposes that exquisite irritability and sensibility of the retina, is the enect either of chronic inflammation of the retina, or of the caroid indifferently. Why chronic inflamation of the choroid should produce produce the same symptoms, as a similar affection of the retina, since the two membranes are totally different in their structure and uses, requires elucidation. My next observation is, that the chronic inflammation of any membrane or organ, with which I am acquainted, is with difficulty and only gradually removed. This does not well accord with the astonishing and immediate efficacy of leeches and evacuations. Nor does chronic inflammation ever exist long without leaving lasting marks behind it. How few anatomists, however, have detected any obvious morbid change in the retina or choroid. In the But admitting that chronic inflammation, or a great turgescency of the vessels of the retina or choroid coat exists, it is somewhat remarkable that these affections do never spread to the iris. The blood-vessels of the iris. are most intimately connected with those of the choroid, yet the latter may labour under great turgescency, without producing any perceptible change in the former. The same observation may be made with respect to one part of the vessels of the sclerotic coat. These are derived from the same source as the vessels of the choroid coat, nay some of the vessels of the choroid itself pass directly through the sclerotic coat, and ramify upon it externally, yet, in the disease in question, no symptoms of turgescency appear in these vessels, however close their connection. For these reasons I consider Mr. S's opinion highly questionable: and if I may be allowed to advance another, I would say, that weakness of sight is, probably, produced in this manner. fist place, the exciting causes, such as excessive light, intense reading, &c. being frequently applied, the sensibility of the retina is increased, which induces some degree of increased action in its blood-vessels, and those of the choroid also, by sympathy. This state would, in most cases gradually subside, were the exciting causes withdrawn. From the repeated application, however, of these causes, a morbid action at length arises in the secretory vessels of the choroid.. This so far alters the quality or quantity of the secretion of pigmentum nigrum, as to ren der it unfit for its purpose of absorbing erratic or reflected light within eye. In short, I conceive, that the state of the eyeball in this disease, bears a striking analogy to that defective state, which obtains in albinos.- -Such a state, I apprehend, perfectly coincides with the effect of the evacuant mode of treatment, and is liable to no material objection.- -The effect of the first application of leeches is probably that of allaying the irritability of the retina: this topical evacuation, with the use of sedative applications, and the removal of all exciting causes is principally instrumental in suspending this most distressing symptom of the disease, and at the same time lays the foundation of that healthy change in the action of the secretory vessels of the choroid, which is finally completed by the use of purgatives. The morbid action in the secretory vessels of the choroid, in this instance, is, probably, not inflammatory, but rather bears an analogy to that change, which occasionally occurs in the action of the vessels of other secretory organs, producing an alteration in the nature of their secretions, without being accompanied by any symptom of turgescency or inflammatory disposition. The effects of purging and other evacuations, in re-establishing their healthy functions, is well known. This view of the proximate cause explains also, why tonics, conjoined with sedative applications, and freedom from all the exciting exciting causes, are, in particular habits, effectual in removing this disease; particularly if conjoined with alterative doses of calomel. I shall not dwell longer upon this subject, as I am, by no means, very solicitous about the adoption of this or that opinion respecting the proximate cause of weak sight. What is of much greater importance, is, that Mr. S. setting aside all selfish motives of concealment, has candidly made known to the profession at large his experience in means, which few practitioners have employed more extensively or successfully, than himself; and that he has, moreover, announced some important improvements in the treatment of Blear-eye, which, after repeated trials, he at length discovered (See note, page 28). That the public may lose no part of the advantage to result from this discovery, I dare say, that the Editors of the Medical and Physical Journal will be happy to place it without loss of time amongst their excellent pages. I am confident that Mr. S. will parc ardon any liberty I may have taken, in making these remarks upon his publication. To do justice to all parties has been my sole aim, and 1 know that no member of the profession would with more pleasure "reuder unto Cæsar the things which are Cæsar's." Shrewsbury, I remain, Gentlemen, A Treatise on the Venereal Disease. By JOHN Hunter. With an Introduction and Commentary; by JOSEPH ADAMS, M. D. Author of Observations on Morbid Poisons, &c. 8vo. London, 1810. pp. xvi.-600. six plates. WE should not have thought it necessary to notice a third edition of this valuable work, had it not been for the illustrations of one who has so long been considered the interpreter of his favourite master. To pursue the plan we have hitherto adopted, we shall content ourselves with offering a few extracts as a specimen of the work, instead of the often unthankful task of minutely criticising individual passages. The following is Dr. Adams's commentary on that part of Mr. Hunter's introduction which relates to hectic fever. "The hectic fever, till Mr. Hunter's time, was usually considered as the effect of matter absorbed. Phthisis pulmonalis and psoas abscess seemed to furnish proofs of such a cause. The late Dr. Heberden has, however, a very ingenious paper on hectic fever, making the first article of the second volume of Medical Transactions. This accurate writer seems rather to consider the disease as the effect of repeated formations of matter, than of its absorption. He calls it the symptomatic, the irregular intermittent, and the fever of suppurations. The disease itself is most admirably described by him, but some parts of the paper are confused, from the difficulty the author found in tracing the cause constantly to suppuration. Hence he describes the various symptomatic fevers as making different forms of the hectic. Thus the shivering from the first formation of matter, and the high feverish irritation sometimes consequent on a wounded tendon, are all inncluded in the hectic, which would be reasonable enough, if the symptomatic fever always became hectic, which we shall presently see is not the case. Mr. Hunter, though he considers both as the effect of sympathy, yet distinguishes them as arising from different causes, and exhibiting different phenomena. The symtomatic fever is usually acute, and arises from, or is only a symptom of some acute local injury, which, throughout all its stages, whether in its commencement or its progress to suppuration, is attended with shivering and cocsequent fever. Sydenham has well marked these stages in small-pox. They occur in every common abscess, if the progress is rapid. Hectic, or (if we translate the word) habitual* fever, is less acute than the symptomatic, but more permanent in its returns. As it almost always attends phthisis pulmonalis, and large incurable abscesses, it was supposed to arise from the absorption of matter. But this error might easily have been removed by reflecting, that in large abscesses matter is sometimes absorbed without injury to the constitution. Suppuration is one of the curative processes of nature, in parts which cannot return to their original actions, and like other new actions is usually ushered in by shivering, and consequent fever. But where suppuration is unattended with inflammation, the constitution is little affected, so that no shivering or consequent fever arises. Thus in the psoas abscess, whilst it is continually enlarging by an increase of matter, or by fresh suppurations, the constitution is very little affected, and in the lungs large tu bercles are formed, which suppurate, and whilst the matter remains in the capsules, the constitution only suffers from the loss of so much lung. But as soon as the abscess is opened by nature or art, or the matter of tubercles finds its way to the bronchia, inflammation takes place over the whole surfaces, as the first means by which the part is to be restored; and this inflammation is attended with shivering and heat, constituting a paroxysm of fever. If this attempt made by nature to restore the part is ineffectual, she renews it; but this and every future attempt are often insufficient to relieve so much mischief as the parts have sustained. Still, however, the attempt continues as long as the constitution retains power to excite inflammation, and each attempt is attended with a similar paroxysm. Hence the fever becomes habitual or hectic, not from. the absorption of matter, but from the repeated attempts at restoring parts which cannot be restored. This will be further illustrated when we arrive at Mr Hunter's doctrines concerning lues venerea. Thus the symptomatic and hectic fever are both of them similar, in * The Greek word ExTixos can scarcely be translated by any other word than habitual. In both languages it is derived from the same root, from exw haben, habitus, and Exrixos habitu positus, or as we say in English, habitual. Habitual, though there is no such classical word as habitualis, must be derived from the Latin habitus, from which we vernacularize habit. |