from the surface, as in affections of the spinal marrow and hip. To perfect this eschar, the moxa must remain until its combustion is complete, and then the part will be black, and the surrounding skin slightly red, and wrinkled. Here it will sometimes be useful to increase the intensity of the heat by the blow-pipe, and, previously, the moxa ought to be surrounded by a cylinder of card-paper. Moreover, the spot should be marked with a little circle of ink in which the moxa is placed; and in using the blow-pipe, the adjacent parts must be protected by a dry piece of paper, antecedently wet in a saturated solution of the sulphate of alum, or muriate of soda, having a hole in its centre for the moxa. These solutions diminish the combustibility of the paper, and render a spark from the blow-pipe powerless. In paralysis, some obstinate forms of sciatica, and analogous cases, the frequent repetition of the moxa will be demanded. When eschars are thrown off, ulcers are formed; and, when numerous, considerable irritation is excited, and a weak habit may be injured by their discharge. In these instances of deep-seated disease, the moxa, in conjunction with the needle, which is the fifth mode of application, has an excellent effect.

"When the moxa and acupuncture needle are used together, I perforate a moxa of a proper size, by a needle of such a length as will be sufficient to reach the seat of disease, and at the same time extend so far beyond the surface of the skin, as to keep the moxa about one inch from it, or so far as to secure the texture of the skin from injury. The needle is then introduced, as far as the seat of disease, by the assistance of the port-aiguille; and as soon as it has been introduced, the port-aiguille is removed, the needle being left in the part. The moxa, which had been previously perforated, should be now placed in a state of combustion on that end of the needle which projects beyond the surface of the skin, and allowed to burn round the needle by which it is thus transfixed. The heat disengaged from the moxa is communicated to the needle, and thence conveyed to the seat of disease. When the needle has cooled it is removed, and the wound or eschar produced by it is scarcely observable." 71.

Immediately after the application of the moxa, Baron Larrey advises us to wet the skin with the water of ammonia for the express object of preventing inflammation:-the very effect which those, that are ignorant of the true principle of the action of this agent, strive to accomplish. The aqua-ammoniæ succeeds in its purpose, and so do alcohol, æther, turpentine, ammonia, or even bruised garlic. In the first and last modes of employing the moxa no after treatment is needed. When eschars exist, they should be covered with adhesive plaster until they separate, which may be expected in eight, ten, and, occasionally, twenty days. The moxa acts more favourably when the eschar is thrown off very slowly. Superficial ulcers and excoriations may be washed once or twice daily with a solution of the nitrate of silver, or sulphate of copper, and covered by adhesive plaster.

Our analysis now brings us to the adjuvants of the moxa, since, like every other therapeutic agent, it is not above collateral aid. As those diseases, which are suited to the action of this remedy, consist in an atony, and often in an overloaded state of the absorbents and capillaries, the means, as adjuvants, may be placed under two divisions: 1st, Those that act by directly increasing the tone of the vessels, and consequently the rapidity of absorption and of capillary circulation: and,

2dly, Those whose beneficial influence depend on their emptying the overloaded or distended capillaries. The former are denominated tonics; the latter evacuants. In general, the mineral are preferable to vegetable tonics, especially mercury, iron, arsenic, silver, and copper. The only useful vegetable ones are cinchona, guaiacum, and turpentine. The precise doses of tonic medicines deserve consideration, and in numerous instances they may be greatly increased, and the medicines themselves occasionally changed and alternated. Local, like general tonics, are, essentially, stimulants, and produce their influence on the functions of capillary circulation and absorption, by exciting a degree of increased action, which is favourable to the acquisition of power. Those that can co-operate with the moxa, act either directly on the immediate seat of disease, or influence it by their action on the skin over the affected part. To the first class belong acupuncture, and probably galvanism; and to the second, the alternate aspersion of hot and cold water, trebinthinate and ammoniacal liniments, with other cutaneous stimulants. The acupuncture certainly acts as a stimulant, but whether by its mechanical power, or the disengagement of a minute portion of galvanic fluid, is doubtful. The operation of the moxa and acupuncture has already been explained, and the latter may also be used in conjunction with galvanism. To excite the capillary vessels to increased contraction, no remedies are more effectual than turpentine, ammonia, ice, or hot and cold water. Among those means that act on the general surface of the skin, hot baths, fumigations, &c. should be mentioned, and both may be either simple or medicated. Of those which act on a limited portion of the skin, the vapour douche, dry cupping, the long continued application of irritating embrocations, liniments, &c. must not be forgotten; nor blisters, scarifications, leeches, and those remedies that produce artificial eruptions, although all the latter act both as evacuants and counter-irritants.

The utility of pressure in disease needs no illustration. Since the days of Hippocrates and Celsus, friction has been a practice, more or less generally adopted, to relieve parts, in a state of debility, by mechanically assisting the too languid circulation of the fluids. Mr. Grosvenor, of Oxford, extended this practice considerably, but claims to originality he has none, as the reference to Celsus,* the mere echo of the words of Hippocrates, will decisively establish.

"Nor is this one art easily acquired by nurses of ordinary intelligence. If at any time I have occasion to increase the number of those rubbers, whom I keep in constant employment, I find that, with all the attention I can give to directions, my wishes are never carried into execution with accuracy. In fact, although it is a very mechanical process, it requires months of prac tice to render a person perfect in the art of employing it. I am convinced that the principal cause of the neglect of friction among the moderns, arises from the difficulty of obtaining persons properly experienced in the art. The imperfect manner in which the operation is commonly performed struck me forcibly some years ago, when, on a visit at Oxford, during the life of Mr. Grosvenor, I had an opportunity of observing the adroitness with which his rubbers used friction, and the steadiness with which they continued it for hours without any interruption. It was this visit which induced me to edu

* De Medicina, Lib. II. sect. xiv. p. 76.

cate some poor persons in the art, and to keep them in my constant employ. ment as rubbers." 93.

The bare hand, or the hand covered with a woollen glove, is the best instrument for friction. A small quantity of hair powder, or fine flour, should be interposed between the skin and hand to prevent any chafing. Great advantage will be derived by causing a gentle stream of vapour to play upon the part while friction is applied.

The various mechanical operations which have been denominated massing, shampooing, thumbing, kneading, &c. &c. may be included under the term percussion, since each and all of them essentially consist in the application of a circumscribed, momentary, or transient pressure, frequently repeated; and produce their beneficial effects by compressing the vessels to such a degree, as to increase the rapidity of their circulation. They may, perhaps, also act by a stimulating agency. These practices, although little used here, are much in vogue elsewhere, and especially in Finland, Russia, Turkey, Egypt, India, China, and the South Sea Islands, where they are universal, although the manner differs in different places. The hand is the best and most commonly employed mean for performing these various processes. It may be used in different ways-as by gently pressing or kneading with the thumbs; or with the ends of the fingers; or with the closed hand; or by causing the hand, or points of the fingers, to be propelled with an impulse upon the part; or, lastly, by grasping alternately, with either hand, the limb affected, one hand being placed at either side, in such a way that each may meet and surround the limb. But in every mode, and in every instance, the operation should be conjoined, whenever practicable, with the exposure of the patient, during the process, to the influence of heated air or vapour.

"If practice be necessary to enable an attendant to perform friction with art, it is still more necessary in shampooing. But the nurse-tender, who has been instructed and who has acquired a knowledge of friction, soon becomes an expert shampooer. Indeed, shampooing and friction may, and should, almost always be combined. The following is the manner in which these processes are performed at the Skin Institution. The patient, previously undressed, enters the shampooing apartment, already heated to the tempe rature of about 110° Fahr.* He then reposes on a cane sofa, and a small quantity of aqueous vapour, impregnated by passing through some aromatic or odoriferous herbs, is allowed to enter the apartment. This vapour gradually diffuses itself, and distributes a delightful fragrance. The patient re mains in this situation until the surface of the body becomes gently moist. The shampooer now enters, and first submits the entire body of the patient to that degree of friction which may be necessary to disengage all branny or furfuraceous deposit from the surface of the skin. The process of shampooing is then commenced; and the shampooer, by gently grasping, pressing, and kneading with the fingers, thumb, or entire hand, variously modified and employed, from the extreme parts to the trunk, in the line of direction of absorption and venous circulation, continues the process for a longer or shorter time, according to the nature of the disease, and the feelings of the patient, the percussion being occasionally interrupted for the purpose of extending, in a gentle manner, such parts as are in a state of rigidity.

* "For a description of the shampooing apartments at the Dublin Skin Infirmary, see my account of the apparatus, &c. &c. illustrated by many plates. In 4to.

The whole process is then terminated by gently cleansing and drying the entire surface with a soft towel. The patient then withdraws into an adjoining apartment, the temperature of which is not inferior, when he enters it, to that of the shampooing room; but after he has reclined for some time on a bed or sofa, or after he has got himself dressed, the heat of this second room is gradually lowered to that of the external atmosphere, by a particular contrivance, but in so slow a manner, that no vicissitude whatever is experienced by the feelings of the patient. The beneficial consequences which always result from the process of shampooing, when properly employed, and in appropriate cases, are most striking. I have often known patients sink into a slumber, and enjoy several hours of delightful tranquillity after the operation, who had scarcely slept for weeks before; and I have known patients, who were scarcely able to move a limb on entering the apartment, and who were consequently carried into it, able to walk out erect, and with steadiness. Again, on the other hand, I have found a single operation produce feverish symptoms, and a restless night, when employed contrary to my wishes. The principles which have been laid down fully explain these opposite results. In fact, if those remedies, which are calculated to excite tone, be employed in the state of increased action, they will uniformly increase the disease, and aggravate every symptom, while the same cases will be benefited by opposite measures." 96.

It may be farther observed, that if remedies, which are adequate to diminish action, be persisted in beyond a proper time, they will render the disease more malignant in its nature, and more difficult of cure. "That disease," remarks, Mr. John Bell," which, with but a little indulgence, a very little encouragement of fomentations, poultices, bleeding, and low diet, would end in white swelling of the knee, may be stopped even by so simple a matter as a well-rolled bandage."

The work concludes with an account of thirty cases, which occurred in the private and hospital practice of Mr. Wallace, and were cured by different applications of the moxa. These cases may be briefly enumerated:-Nine of sciatica, and painful affections of the nerves; seven of lumbago, and other painful disorders of the muscles; eleven of paraplegia, and other paralytic affections; and three of epileptic, or spasmodic. Presuming, as we do most sincerely, on the accuracy and veracity of the reporter, and taking into consideration, as we ought to do, the unbiassed testimonies of other surgeons, we cannot help thinking that the efficacy of the moxa, as a therapeutic agent, in certain forms of disease, is incontestably established. A plate is annexed, which repre sents the porte-aiguille, the instrument for the application of evaporating lotions; the moxa forceps, with a moxa, surrounded by a bit of flat silver wire; a scarificator, of the form used by Baron Larrey; a blow-pipe, and a glass tube.

We recommend this work to every practitioner who is, and surely all are, anxious to alleviate human suffering, and desirous to understand the various modes of applying the moxa, and the true principles on which it is supposed to act. The author is an active and ingenious surgeon; he has had opportunities, and he has not neglected them: like every man that reasons, he is sometimes right and sometimes wrong; yet his facts are valuable. He is already favourably known to the professien; and if our approbation can impart pleasure, it is bestowed willingly, because deservedly.

* Principles of Surgery, vol i. p. 127.

Quarterly Periscope

OF

PRACTICAL MEDICINE;

BEING

The Spirit of the Medical Journals,

Foreign and Domestic;

WITH COMMENTARIES.

PART I.

"Ore trahit quodcunque potest, atque addit acervo."

1. ON INTERMITTENT IRRITATIONS. BY M. DUFAU.•

THE disciples of Broussais have very ingeniously availed themselves of the phenomena of irritation, to shew that inflammation itself may be of an intermittent character, and thus to support the doctrine of ague being, like all other fevers, dependent on local inflammation, the latter of a periodical type. Without being entire converts to the doctrine of either Broussais or Clutterbuck respecting fever, we may allow, what, indeed, common observation shews, that irritation, with or without the phenomena of phlogosis, very often assumes a periodical character; and on this account we shall dedicate a few pages to the paper of M. Dufau, which contains many interesting cases.

He first (and very properly) tells us what he means by the term irritation. Our organs answer to the impressions made on them by external agents, in virtue of a property which we term excitability. When this excitability is in a due and healthy degree of exercise, we call it excitation; but when raised beyond that point by a too powerful stimulation, it constitutes irritation. This we consider to be a simple and correct definition of irritation.

This state presents different phenomena, according to the organic element in which it predominates. Confined to the nervous structure, it causes pain, more or less acute, and then receives the name of neurosis, or, more properly, neuralgia. When the irritation extends to the sanguiferous capillaries, and is accompanied by the phenomena of heat, redness, and swelling, we call it inflammation. It takes the denomination of hæmorrhagic irritation, if the sanguiferous capillaries give way, and pour out their contents. Finally, it is termed lymphatic irritation, or sub-inflammation, when it predominates in the lymphatic series of