from some analogous affection of the parts immediately adjoining. Nevertheless, as these neuroses often depend also on perceptible alterations of the "nervous centres," they are usually regarded as general affections of the nervous system; for which reason, says the author, we shall dispense with speaking of them in this dissertation. Dr. D. next proceeds to give what he calls a very curious case of alteration in the third pair (trijeaumeau) of nerves, from the practice of M. Serres, and then concludes his volume with some "observations" of local palsy. The first of these, and that communicated by M. Serres, are valuable pathological documents, and may be consulted with advantage in the original.

We regard this dissertation of Dr. Descot's as a commendable essay towards the advancement of pathological history, and, consequently, as being in some degree adapted to facilitate the study of this branch of medical science; for this reason, we have thought it right to exhibit a comprehensive view of his doctrines, leaving our readers to examine, generally, the facts which the author has selected for their foundation. In all that concerns the treatment of the local affections of nerves, the book is useless; but the Doctor has not undertaken to discuss this difficult question, and assuredly he had a right to choose his own subject. We close his book, in fine, with sentiments of gratitude and respect; and our desire is, that he may be inspired with a large portion of his patron's spirit.

IX.

A Physiological Enquiry respecting the Action of Moxa, and its Utility in inveterate Cases of Sciatica, Lumbago, Paraplegia, Epilepsy, and some other painful, paralytic, and spasmodic Diseases of the Nerves and Muscles. By WILLIAM WALLACE, M.R.I.A. &c. Surgeon to the Charitable Infirmary of Dublin; and to the Infirmary for the Treatment of Rheumatism and Cutaneous Diseases, in that City, Lecturer on Semeiology and Clinical Surgery. One vol. 8vo. pp. 148. Dublin, Hodges and M'Arthur, and W. Curry and Co.; London, Longman and Co.; and M'Lachlan and Stewart, Edinburgh. 1827.

THE author is anxious to overcome the prejudices which exist in these kingdoms against the use of moxa, and desirous to exalt a remedy so valuable in public estimation. He is certain that the employment of it is impeded by its mode of action having been compared and confounded with that of other agents; and he strives to demonstrate, in limine, that the prevailing opinions respecting this subject, are altogether erroneous; and to prove that the moxa affords a remedy which cannot be equalled. His views are illustrated by select cases of an unequivocal nature, because other measures had been tried in vain, and the cures were principally accomplished by this agent; and his opportunities have been greater than those of hospital surgeons in general, from a connexion of above eight years with the Dublin Infirmary for Diseases of the Skin.

The moxa may be defined to be any substance whose gradual combustion on the skin is requisite for the relief or cure of disease. The

remedy is, in truth, a very ancient one, but its present celebrity on the Continent arises from the writings and exertions of Larrey, Percy, Dupuytren, Pelletan, Richerand, and Roux. The effects of it have been

erroneously compared with those of a blister or issue, whereas, when properly applied, and in appropriate cases, the moxa produces neither inflammation nor discharge, except in rare instances, and even then they are contingent, and not salutary occurrences. The moxa has been condemned as a most painful application; yet those that have undergone it have acknowledged that the pain is not equal to that of a blister, or caustic issue. Sir William Temple, a naine dear to every Englishman as the patron of Swift, applied the moxa to his own person, and thus describes its consequences. "For the pain of the burning itself, the first time it is sharp, so that a man may be allowed to complain: I resolved I would not, but that I would count to a certain number, as the best measure how long it lasted: I told six score and four as fast as I could, and when the fire of the moxa was out, all pain of burning was The second time was not near so sharp as the first, and the third a great deal less than the second. The wound was not raw, as I expected, but looked only scorched and black."* Kempfert observes, "The pain is not very considerable, and falls far short of that which is occasioned by other caustics or actual cauteries. I have seen many times the very boys suffer themselves to be burnt in several parts of their body, without shewing the least sense of pain."

over.

The author, after stating certain experiments and observations, concludes that the application of a precise degree of caloric to the body is followed by a contraction of the capillaries, and an increase in the rapidity of their circulation; and that this contraction does not proceed from a mere physical action, but is the result of the influence of heat on the vital properties of the vessels. Yet it is important to decide, whether this influence of caloric in exciting the actions of the frame continues beyond the period of its application. Experiments and observations would seem to prove that it does ;-but another question springs from this, namely, are the effects of caloric limited to the point to which it is directly applied, or do they extend more or less beyond that point? There is sufficient proof that caloric can excite an action in living structures to a considerable extent; for it acts on the capillaries as a local tonic, or stimulating astringent, and the power which this class of remedies possesses, of extending their influence by sympathy along continuous surfaces, or similar textures, is well known. The direct effects of the moxa are seldom, if ever, confined to the skin. If an eschar be formed, that eschar extends to the superficial fascia, or subcutaneous cellular tissue; and if the moxa be applied, through the medium of a needle, the caloric may be made to propagate its influence to any depth. Caloric, then, applied under certain circumstances, and with appropriate restrictions, stimulates, in a powerful manner, the capillary vessels, causing them to act with more force, to contract their diameters, and to circulate their blood with greater velocity; and, either by this action on the capillaries, or by a direct one on the lymphatics of the part, it has also the power of exciting the function of the absorbents in a remark

Letter of Sir W. Temple, Bart. &c. Swift's Ed. p. 135, vol. I. London, 1720. History of Japan, vol. II. sect. iv. page 39.

able manner. Again, the beneficial influence of moxa, in relieving or curing disease, apparently depends on its tonic action over absorption and capillary circulation. Hence, it should be employed in those caseg only, in which there exists a state of debility of the capillaries, a consequent retardation of their circulation, and a diminution of absorption; and invariably avoided whenever there is increased action, or active inflammation.

"I have heard of, I shall not say irretrievable mischief, from the employment of moxa in the state of increased action and acute inflammation; but I shall say, I have often heard of much unnecessary pain having been produced, and considerable aggravation of those symptoms which it was meant to relieve. I will candidly admit, that misapplication of a similar kind occurred in my own practice, before I had formed a correct opinion respecting the mode of action of this powerful remedy. Having been taught to suppose that its therapeutic influence is analogous to that of a blister, I formerly employed it indiscriminately in those cases in which blisters are commonly applied; and it is not necessary to observe, after what has been said, that it must have often failed to produce the relief I intended." "Although the effects of moxa are so universally compared to those of a blister, it can never be used upon such a principle. Certainly heat may be so applied as to excite, like blisters, vesication and discharge, and cutaneous inflammation; but, while it produces these effects on the skin, it will act on the deep-seated parts as a powerful stimulant, and thereby often cause, in cases to which blisters are peculiarly suited, more injury than it can do good." "Let it, therefore, be laid down as a principle not to be deviated from, that this remedy shall never be employed in cases of increased action, or of active inflammation, or even in cases of subacute inflammation, that is, when the acute inflammation is lapsing into the state of chronic action; and this principle should be implicitly adhered to, whether the active inflammation has attacked parts previously in a state of health, or has supervened on the state of passive inflammation." 49, 50.

If a part be not fit for the application of the moxa, it must be made so by appropriate means. One of the most useful external remedies for the reduction of increased action is the warm bath; yet caution is demanded relative to its temperature. If applied as an antiphlogistic, it should not be used higher than 97 Fahr. nor lower than 80°. The patient should also remain in it, provided no inconvenience be experienced, forty minutes; and, in general, a much longer period. Evaporating lotions are of considerable utility, and, for their perfect and constant application, the author has invented a very convenient instrument; and of which a plate is given. It is now employed in the Charitable Infirmary of Dublin with great advantage; not only because it affords the means of treating certain cases with accuracy and care, but also from its causing a saving of expenditure in bed-linen. Such an instrument, in our opinion, deserves the attention of every surgeon; and is well worthy of immediate trial; and consequent adoption, if it realize expectation. We would observe, that what Mr. Wallace writes on this, and similar subjects, is highly deserving of consideration, inasmuch as he has long been intimately connected with large public establishments, in Dublin, where the moxa, evaporating lotions, cupping, friction, and shampooing, are necessarily used on a most extensive scale, and under the most auspicious circumstances. For these reasons, we shall transcribe his interesting observations on a new mode of cupping; and, ul

timately, advert to his remarks on friction, and introduce his account of the practice of shampooing.

"I prefer the following mode of performing the operation of cupping; and, since I have adopted it, I have never failed to obtain any quantity of blood required; nor have I ever seen it fail in the hands of those pupils who have adopted it by my directions. In the first instance, let me observe, that for the purpose of exhausting the cupping-glasses, the combustion of a few drops of any spirituous liquid on a little tow or lint, is the mode which I much prefer; not only because it is more convenient, by enabling us to dispense with a number of instruments, but also because the degree of heat produced renders the circulation in the cutaneous capillaries more rapid; and, consequently, facilitates the discharge of blood when these vessels have been divided. A cupping-glass having been thus exhausted and applied for some minutes to the part, as well for the purpose of determining to the skin, as to mark the extent of surface which should be scarified, with the assistance of a lancet-scarificator or gum lancet, as it has been called, drawn lightly over the skin and with great rapidity, I traverse the surface, as far as the mark formed by the edge of the glass, with superficial incisions about the fourth of an inch distant from one another. These incisions should be so slight as to be scarcely visible. The operator need not fear that they will not bleed, for the moment the cupping-glass shall be applied, the blood will be found to stream from them with a rapidity which quite surprises those, who, for the first time, have seen the operation thus performed. The reader may suppose that it is more tedious, and, therefore, more painful; but, I assure him, he would be surprised at the rapidity with which the lancet-scarificator may be made to traverse the surface; and that this operation is not so painful as that in common use, I have had innumerable opportunities of ascertaining. The structure of the integument explains the superiority of this mode of operating, and affords proper rules for its performance. The vascularity of the skin is so very different on the external and on the internal surface, that the former may be considered as one of the most vascular textures of the body, while the latter is one of the least vascular."

62. There are various modes of applying the moxa. Different substances have been used in different countries to produce moxabustion. The Nomades employed wool, and certain spongy matters growing upon oaks, and springing from the hazel-the Indian, the pith of the reed, and flax, or hemp, impregnated with some combustible material-the Armenian, the agaric of the oak-the Chinese and Japanese, the down of the artemisia-the Thessalian, dried moss-the Egyptian, Arracanese, and several oriental nations, cotton-the Ostiaks and Laplanders, the agaric of the birch-and the Aborigines of North America, cotton and dried wood. Baron Percy prefers the medulla of the helianthus annuus, or sun flower, and when this cannot be obtained, cotton impregnated with a saturated solution of the nitrate of potash; while Larrey employs a cylinder of carded cotton, unimpregnated, but surrounded by a capsule of linen. Caloric, however, is the only therapeutic agent evolved during the combustion of these various substances, and consequently that should be selected whose combustion is slow and steady. The author forms his moxa, by immersing either surgeon's lint, or fine linen, in a filtered solution of chlorate of potash, in the proportion of one drachm to four ounces of distilled water. This burns slowly, but steadily; even the blow-pipe produces no sparks; and there is neither trouble to the operator, nor alarm to the patient, from the combustion being scarcely observable. Fine linen will answer best for moxas of a

small size. The substance used must be perfectly dry when folded, should possess a proper degree of firmness, and after it has been rolled up, and fastened with two or three stitches of a needle, the end ought to be cut to make it level for application. The length of the moxa should be about three-fourths of an inch, and the diameter may vary from one quarter to a whole inch.

:

"The instruments which I use in applying the moxa are of the most simple kind a porte-aiguille, which I have invented (see plate), or a pair of dressing or artery forceps, furnished with a screw at about three-fourths of an inch distant from their point, which screw serves to press the blades of the forceps very tightly together; a bit of small, flat, silver wire, about three inches in length; a bit of card paper; a blow-pipe; a set of needles; and a small glass tube, are all that are required. With the silver wire a small hoop is formed to grasp the moxa, the size of the hoop being made to vary according to the size of the moxa; and the ends of the hoop are grasped in the forceps, which are made tight on it by the screw with which they are furnished. The hoop should be applied about a line distant from that end of the moxa which is to be placed on the skin." 68.

The moxa should be applied, in painful affections, to the point where the greatest distress exists; and, in paralytic diseases, over the origin of the nerves which lead to the morbid parts, and afterwards along the same nerves in different positions of their course. There is scarcely a part in the body to which it may not be applied in one form or other; even to the eye, in the form of the objective moxa, as has been often done by our author, with great advantage, in obstinate chronic ophthalmia. But we must specially attend to the size of the moxa on every occasion, the manner as well as the length of its application, and these must be regulated by the depth of the disease, and the nature of the textures. It may be used so as not to cause any injury; in a greater degree, so as to produce vesication; and, in a still greater degree, an eschar, and the eschar may be either deep or superficial; or, finally, it may be employed with the acupuncture needle. These modes may be denominated the first, second, third, fourth, and fifth forms of application of the moxa. The first will answer when the disease is very su'perficial; it is the objective cautery of the French authors, and is deemed a powerful remedy for the cure of ulcers. It may be serviceable in neuralgia, when the nerve is superficially situated; or in affections of the joints, where the synovial membrane is, as in the knee and wrist, immediately under the integuments. The moxa should be repeated at least once a day, and applied by holding it, within the forceps, as close to the part as is endurable. The second is seldom used by Mr. Wallace, because less effectual than the third, and more troublesome eventually. It may, however, be beneficially employed in tic douloureux, and in parts on which a cicatrix would be objectionable. The moxa should be holden steadily, and as close as possible to the skin without touching, and until that skin becomes white from the detachment of the cuticle, and the formation of a blister. In a large proportion of cases, the superficial eschar, or third form, will be the best. To produce this eschar, the moxa must be placed on the skin, and kept there until that skin appears brown under it, and which will, in general, occur when the combustion has extended to the distance of a line from the spot. The fourth, or deep eschar, will be required when the disease is far