phenomena presented to the observation of Dr. Antonini, who was then in charge of the Military Hospital. When he was first received, the skin was of a yellowish tint-eyes sunk-head inclining forward-some infiltration in the abdomen and lower extremities- sense of oppression in the chest, with difficulty of breathing—dull sound over a considerable extent of this quarter-pulse rather quicker than natural, but hard, full, and strong-inability to lie in any other posture than on the backsleep very disturbed. This still continued, with some trifling variations, till the last; but never prevented the patient from getting up in the day time-even on the day of his decease. The treatment was chiefly directed towards the affection of the chest, which was considered as the principal seat of disease. With this view, general bleeding was several times practised, as well as leechings and blisterings. These produced some relief for a time only. Debility gradually increased-but the state of the pulse above-mentioned never altered, which led to the prognosis that there was inflammation of the sanguiferous vessels, and that the patient would be lost.

Dissection. The chest sounded dull in almost all parts of its circumference. The dura mater was slightly injected, and a considerable portion of the arachnoid was opake. No other alteration in any part of the brain. The coverings of the spinal marrow presented unequivocal marks of intense inflammation. Some portions of the medulla spinalis were softened, and there was considerable serous effusion between it and the membranes. The cellular tissue enveloping the large nervous trunks, as they issued from the spine, was inflamed, but the neurilema itself, and the medullary structure were apparently sound. In the chest there were about two pints (French) of serous effusion-lungs studded with tubercles (some of which were suppurated) and gorged with blood -larynx, trachea, and bronchia inflamed. There was considerable effusion in the pericardium-cavities of the heart filled with black blood -lining membrane of the chambers of an intensely red colour, which extended into the great vessels. The aorta and its branches, as far even as the popliteal artery, were inflamed. The carotids presented the same appearance, and the arteries of the upper extremities, near to the wrist, shewed similar phenomena. The corresponding veins were equally red and inflamed. The vessels of the short circulation presented the same appearances as those of the general circulation. Our author did not conclude that the red colour was proof of phlogosis till after numerous fruitless attempts had been made to obliterate it by washing.* In the mucous membrane of the stomach and bowels were many traces of chronic and acute inflammation. Large ulcerations and erosions were found in the neighbourhood of the ileo-cæcal valve. The liver was enlarged, and greatly degenerated in structure. The various other traces of disease we shall pass over, as of inferior importance.

Remarks. The first thing in this case which our author notices is the fact

Our readers will see in this number some important observations on the fallacy of post-mortem appearances in the vascular system especially.

of the pulse never having been reduced by the numerous bleedings which were practised. This symptom, he thinks, will one day be acknowledged, in conjunction at least with others, as characteristic of inflammation of the blood-vessels. But as in this disease there are generally a great many other lesions going forward, the diagnosis will be always difficult. The softening of the spinal marrow in this case was a very unexpected occurrence, as the patient walked about the ward, even on the very day of his death! There was no paralysis-and the debility of muscle was not greater than might have been expected in a chronic disease of the same standing. This is one of the mysteries of the nervous system, which it would be difficult to unveil.

20, ON PURGATION, AS A REMEDY IN DISEASES.*

The intercourse between nations, like that between individuals, tends to the mutual advantage of both parties, by rubbing off the rust from either. Men are much more keen in detecting the errors of others than of themselves—and seldom very backward in portraying them to the world. In this way the Continental and British practitioners have been, for many years past, keeping up a kind of critical warfare respecting purgation, as a remedial agent, in many diseases, and especially in febrile affections. In England, since the first appearance of Dr. Hamilton's book, the sale of purgative medicines has been quadrupled, and hypercatharsis has long been the order of the day. In France, and in many other parts of the continent, the doctrines of Broussais have produced a kind of cathairo-phobia, or universal dread of purgation, in consequence of the real or supposed inflammation of the mucous membrane in many diseases, and the morbid appearances which that tissue so often presents after death. Every unprejudiced and attentive observer must see that the two extremes into which men have run, in this respect, on the north and south sides of the English channel, were attended with positive mischief in practice. The free intercourse between the two countries is now beginning to correct the errors of both. The increased and increasing attention to the pathology of the mucous membranes, in the British Isles, is checking considerably the mania for unbounded purgation here; and the good effects which the English have so long attributed to this measure, are opening the eyes of the French to the utility and administration of purgative medicines." A late edition of Dr. Hamilton's work has just been translated into French, by M. Lafisse, and has given rise to many a hearty laugh at John Bull's cathairo-mania, in the French Journals and medical coteries. In a very sensible and favourable review of this translation, [Revue Medicale for December] the reviewer observes:-" The work of Dr. Hamilton has run through seven editions in the course of a few years, in England. Is the translation of the work likely to meet with similar

Dr. Hamilton's Observations on Purgative Medicines in several Diseases. Eighth Edition, Ed. 1826.

success in France? assuredly not. Will this want of success prove that the work is worth nothing? No, doubtless. It will only prove that the theories of the English and French schools are very different. How, in fact, can a work which recommends the employment, nay the abuse of purgatives, in cases where the majority of French physicians hold these medicines to be most destructive, hope for a patient perusal; at a time too, when the aversion to purgatives is often carried to the most ridiculous extremes?"

In the course of the critique, the French reviewer, (M. Tavernier) makes many judicious reflections on Dr. Hamilton's work; and he fairly admits that the translation of it into the French language, will have the good effect of awakening the attention of continental physicians to the utility of moderate purgation in many diseases, from the treatment of which, this measure is now banished by a blind and unreasonable prejudice. We cannot help quoting the concluding passage of the review, it may afford some entertainment to our readers.

as

"Ah! if French physicians should adopt the practice of Dr. Hamilton, what a number of people will consider it as the regeneration of medicine in this country! With what exultation will the whole class of pharmacopolists view the termination of a calamitous revolution, by which their shops have been left deserted, and their drugs allowed to rot ! If purgation should come into vogue, what will become of the poor leeches?"

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We must now dedicate a few pages to this last edition of Dr. Hamilton's work, in which the author has introduced a new chapter cold-bathing, considered in its purgative effect, in fever, dyspepsia, cholera, tetanus, and in the treatment of infants."

Our author sets out with questioning the truth of the general opinion, "that the efficacy of cold-bathing proceeds exclusively from its tonic or bracing powers." "Till cases," says he, "of direct debility are ascertained to exist, and to which this tonic power is applicable, and while other circumstances readily explain the influence of the coldbath in the cure and prevention of some diseases, it will not be unreasonable to suspend our assent to a supposition which, in its narrow and limited view, sanctions the indiscriminate view of cold-bathing."

"An occasional interchange of their functions is a consequence of the connexion which subsists among the excretory organs of the body," page 11. To this interchange it is owing that different applications to the surface move the belly. Among these, that of cold water is conspicuous, whether it be made by sponging, affusion, or by resort to the cold-bath.

"Pathological facts, and the experience of those who, enjoying good health, bathe for amusement, prove the alvine evacuation to be promoted by the aspersion of, or by immersion into cold water. This effect, how greatly soever it merits attention, and however much it ought to regulate the practice of cold-bathing, both in health and in disease, has been, in a great measure, if not altogether, overlooked by late writers on the VOL. VI. No. 12.

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popular and interesting subject of the application of cold water to the surface of the body." 160.

To this obvious effect on the alimentary canal, the benefit derived in fever (Dr. H. thinks) from sponging with, or from the affusion of cold water, may, in part at least, be attributed. The influence of a favourite theory over the best regulated mind, will be easily seen from the following passage, in which there is a mixture of fact and hypothesis. The laller we cannot help considering as greatly overstrained.

"An agreeable sensation of coolness, a lowering of the pulse, a disposition to sleep, and to perspire, are the immediate consequences. Abatement of sickness, of anxiety, and thirst, and cleaning of the loaded tongue, are the subsequent effects of the impression made on the surface. By this the peristaltic movement of the intestines, retarded or suspended during the febrile state is excited, and accumulated, and noxious fæces are propelled and evacuated. The repetition of the sponging or affusion, as is generally practised, promotes the further expulsion of fæces; at any rate it will co-operate with mild purgatives, and secure daily a moderate alvine evacuation, so necessary at all times to the well conducting the cure of fever." 160.

In this passage Dr. H. evidently underrates the influence of cold on the surface, as affecting the nervous system generally, and lowering the excitement of the heart and blood-vessels. Our own observations would lead us to attribute extremely little influence to the sponging as a purgative in fever. Indeed we have rarely witnessed any decided effect of this kind on the intestinal canal, although we are ready to grant the intimate sympathy which exists between the mucous membranes and the skin.

In respect to dyspepsia, our author differs (and with good reason) from Dr. Cullen, who looked upon the disease as depending onimbecility, loss of tone, and weakness of the muscular fibres of the stomach." These three states of the muscular fibres are, in fact, all the same for what is imbecility but weakness-what is weakness but loss of tone? And yet we do contend that this is not at all the prox imate cause of dyspepsia, as Dr. Cullen would have discovered, had he ever laboured under the disease. It is far too mechanical a proximate cause. The nervous power, and the state of the gastric juice, (so much dependent on the nerves) must be taken into account. The muscular fibres of the stomach can only be instrumental in moving forward the layers or strata of digested matters towards the pylorus, and finally discharging the chyme through that portal. They can have no influence on the digestion itself. We agree, however, with Dr. Hamilton, that this doctrine of muscular debility in the stomach has had a pernicious influence on medical practice, as leading to the routine of "tonic medicines, bitters, astringents, and chalybeates," as well as antispasmodics and opiates. We agree with him also, in the opinion that these medicines, so indiscriminately employed, " often disappoint expectation, and by protracted use aggravate the supposed loss of tone, in place of

remedying it." Dr. Hamilton, of course, in consonance with his favourite theory, attributes the good effects of the cold-bath in dyspepsia, to its power of opening the bowels.

"Among other tonics, operating, as it is supposed, upon the general system, and through it upon the weakened muscular fibres of the stomach, the cold-bath is mentioned. Much dependence is placed upon it, and justly so; but not, in my opinion, on account of its more than doubtful tonic powers, but on account of the impression made on the surface being communicated to the bowels, by which their languid action is excited, with a propensity to evacuate their retained contents.” 163.

Whatever may be the modus operandi of the cold-bath, and more especially the shower-bath, the fact of its utility in dyspepsia is unquestionable; but we would beg leave to observe that there are stages and states of dyspepsia, in which the shock of the cold bath would be dangerous, and where the tepid bath is of far greater utility. The improvement of function in the stomach and bowels, through sympathy with the skin, admits of explanation without recourse to the purgative effects of cold applied to the surface.

Without admitting fully Dr. Hamilton's theory, we agree with him practically, respecting the advantages derived from sponging regularly with cold water in tropical and other hot climates. This practice tends to counteract the deleterious effects of a high temperature on the human frame. But Dr. Hamilton is quite mistaken when he supposes that the bowels become constipated in proportion as the perspiratory process is increased when we first enter a tropical climate. The case is just the

reverse. So much for the speculations of the closet.

Dr. Hamilton enters his caveat against the practice of plunging infants into cold water with the view of rendering them hardy. He observes that it requires only moderately warm cloathing, a sufficient supply of light nourishing food, and free access at all times to pure air, that the child may continue in health and grow in strength. If by bathing, the important process of ablution only be kept in view, "it will be accomplished more effectually and safely by employing warm water, in which the child delights, and in which he loves to linger." In this sentence we are not inclined to agree with our author. We would prefer the mode, which we have often adopted and seen adopted, of first sponging or immersing with warm water, and then with cold. The prior application of the warm water brings the blood to the superficial capillaries, and enables the individual to resist the shock of the cold application infinitely better than if no previous heat be employed. One of the most important objects of cold-bathing or sponging, is the insusceptibility to atmospheric impressions which results from the practice. The insusceptibility is more certainly secured, and to a still greater amount, if the application of heat be previously made. The value of such a state of constitution in this climate will be readily appreciated. We know many people who preserve themselves from colds