earlier or later stages of the fatal disease,-whether they coexist accidentally, or have occurred as causes and effects of each other, and especially whether they have been induced in the last stage of all, or have been the effect of the state of sinking, &c. &c. The last point is of the utmost importance as well as novelty. It is noticed more than once in M. Laennec's immortal work, but altogether demands a renewed investigation. The next subject brought under our review by M. Rostan, is that of the mental qualifications necessary to the study of physic. These he enumerates thus: first, attention; in the second place, an ardent and pure love of truth; in the third place, a state of moderate scepticism, equally avoiding prejudice on the one hand, and incredulity on the other.

The attention must not only be great, but it must be kept up, and that even after we have come to our conclusions respecting the nature of the case. For who is the physician who has never had occasion, to correct and change his opinion during his continued attendance on a patient? and how shall he be apt to correct his opinions unless his attention be continually kept alive to fresh or varied appearances in the course of the disease? And then, admitting our first opinions to be just, how often does the disease itself change both its form and its seat, or become complicated by the superinduction or supervention of others; and how shall these changes be instantly detected except by a strict and sustained attention?

But if the error which results from a defective attention be serious, it is at least pardonable in comparison with that which is the effect of prejudice or of the want of a pure and simple love of truth. Here is scope for discipline of the heart as well as of the head. Our readers remember that when the celebrated Dr. Sangrado was told that all his patients died, and that he must, therefore, alter his system of bleeding and warm water, the doctor replied, "impossible, for I have written a book upon it." It is a sad snare to have written a book. It is rarely that men are, like Sydenham, above a prejudice or bias produced by their own writings. But we have already treated of this subject, and will dismiss it by referring to what we have already written.*

A doubting spirit, is also that which keeps the attention alive. He who knows little, doubts little, and remains perhaps error; whilst he who has learnt to doubt, continues to observe, and corrects or confirms his own opinions by a well

in

* The Number for April, 1825, p. 419.

sustained attention and observation; his ultimate opinions being thus formed, are well formed, and stable in proportion.

The next subject, treated of by M. Rostan, are the therapeutic indications. Of these we need not treat at large. Our author's remarks contain little or no novelty and scarcely admit of animadversion. In stating the diagnosis to be the basis of the treatment, M. Rostan concurs with the author of the only treatise on this subject in the English language, and, we believe, with every intelligent practitioner on this island. The sources of the therapeutic indications are thus enumerated.

"1. The causes of the disease.

2. The nature of the disease.

3. The course and duration of the disease.

4. The strength of the patient.

5. The age of the patient.

6. The constitution of the patient.

The sex, and

8. The habits, and idiosyncrasies."

These subjects are treated of very cursorily, and are too important to be so treated of. The same may be said of a little section on the " means we possess to fulfil these indi

cations."

We shall next, therefore, proceed to notice the second part of M. Rostan's work,-that to which the part already noticed is, indeed, merely introductory. But as the character of this second part is altogether more practical than the first, we shall reserve it for a second article in our next; especially as we wish to condense upon our pages, all the useful observations it contains. In this part of our review we have enlarged freely upon our author's observations; in the next, we purpose to adopt a different course :-viz. to compare M. Rostan's account of the symptomatology with that contained in the only work on this subject in our language ;—we mean the Essay on the Symptoms and History of Diseases, by Dr. Marshall Hall-to transfer to our pages such observations as appear to form useful additions to those contained in Dr. Hall's work, and to intersperse such remarks as may tend, we think, to the advancement of this important department of medical science.

III.

Transactions of the Medico-Chirurgical Society of Edinburgh. Vol. II. with Plates.

(Continued from No. X. p. 408.)

ART. I.

A Case of Purpura Hæmorrhagica terminating fatally, with the Appearances on Dissection. By P. FAIRBAIRN, M.D. THERE are few diseases which occasion more perplexity and doubt in the mind of the practitioner than the one in question. He sees blood oozing from the mouth and other openings, while dark or livid spots are scattered over the surface, apparently indicating a broken down state of the vital fluid. Yet he is told by great authority, that the hæmorrhagic effort is of an active kind, and requiring depletion-while others, of no mean note, view the disease as one exemplifying a high degree of asthenia, and demanding the most effective tonics. It, therefore, requires some nerve, or some insensibility of nerve, to go coolly to work in such cases. We want farther evidence indeed, and a greater number of facts, to settle the pathology and treatment of purpura hæmorrhagica.

Case. On the 18th November, 1823, Dr. Fairbairn was called to a man, aged 24, of regular habits and robust constitution, but subject to vicissitudes of temperature, in his trade of book-binding. He complained of deep-seated pain in the left breast, aggravated by deep inspiration or coughing-breathing laborious, with sense of suffocation on attempt to standcountenance flushed and anxious-copious discharge of dark venous blood from the mouth, apparently oozing from its mucous membrane, and partly expectorated from the lungsnumerous petechiae and vibices on the arms, neck, and trunk, varying in magnitude from a mere point to the size of a sixpence. There were none on the hands or face. On the chest and leg, of one side, there were two large livid blotches resembling ecchymosis. These petechial spots were of various colours-bright red-purple-yellow, but not elevated. In the mouth, similar spots occupied the gums, cheeks, tongue, and fauces. The tongue was covered with a dark fur-urine of a grumous appearance-pulse 110, firm and sharp-some

heat of surface-bowels loose. Reports that he experienced depression of spirits, lassitude in the limbs, pains in the head and chest, tickling cough, chilliness and flushes for several weeks previously. On the 16th November, the petechiae made their appearance-on the 18th, he was seized with difficulty of breathing and fixed pain in the side. Dr. F. bled him to 26 ounces, which produced a disposition to syncope, and was followed by considerable relief. Blood not buffy-coagulum soft and tremulous. Fifteen drops of diluted sulphuric acid to be taken frequently in cold water. He had a restless night, from turbulent dreams; but the pectoral symptoms were relieved next day. Blood still continued to ooze from the mouthand febrile symptoms were present. Eighteen ounces of blood from the same arm, and exhibited the same appearances. A dose of salts, which produced a fetid, loose stool. The next day he was again bled to 20 ounces, having shewn symptoms of determination of blood to the head. Syncope took place, and he expired on the morning of the 21st, the sixth day after the appearance of the petechia.

Dissection. The petechiæ appeared nearly the same as before death. The cellular and muscular textures on the neck and chest were injected with blood, and emphysematous. The thorax contained a pound of fluid resembling blood, of a dark colour and viscid consistence. The lungs contained a bloody serous fluid, and were less crepitous than natural. The bronchial tubes and trachea were filled with a similar fluid, and, beneath the internal coat of the latter, there was a slight effusion of dark venous blood. Dark blood was also effused into the anterior mediastinum, and between the layers of the peri→ cardium. The heart was pale and flaccid; and, under its internal membrane, there was a similar effusion as in the trachea, giving a deep livid colour to the surface of the heart. The inside of the aorta presented an increased tint of redness, without evident thickening or change of texture. The floating viscera of the abdomen were of a dark leaden colour-there were a few petechiae on the intestines-and the pyloric orifice of the stomach was studded with them. The liver was paler than natural, and somewhat softened-the spleen, when torn, effused a quantity of dark-coloured matter of a semi-fluid consistence. There were two large ecchymoses under the scalp -the brain and its membranes being healthy.

. Remarks. This case is remarkable, as occurring in a stout muscular young man, and also on this account, that the shooting pains in different parts of the body, the general vascular

excitement, the congestion and extravasation of blood into the mediastinum and other parts, afford strong grounds, in Dr. F.'s opinion, for considering the foregoing case of purpura as bearing a striking resemblance to active hæmorrhage, warranting the depletive measures recommended by the late Dr. Parry. It is questionable, as our author candidly observes, whether the depleting system was not carried too far, in this instance. But it is difficult to decide this point in the present state of our knowledge.

ART. II.

Observations on the Physiological Principle of Sympathy, chiefly in reference to the peculiar Doctrines of Mr. Charles Bell. By W. P. ALISON, M.D. F.R.S. E. Secretary to the Society and Joint-Professor of the Theory of Medicine in the University of Edinburgh.-(Transactions of the MedicoChirurgical Society of Edinburgh, Vol. II.)

THE question of the sympathy of the nerves has been so involved in obscurity from the want of data for discussion, that it has been almost abandoned by modern physiologists. Indeed it is obvious that, until we have attained a knowledge of the functions of the nerves, on which sympathy depends, little progress can be made in the investigation. During the times of Whytt, Haller, and Munro, this subject engaged the attention of a numerous class of writers, and was the source of many an ingenious and many an incomprehensible theory. In reviewing these theories, we observe that, although there was much abstruse and subtle reasoning employed in their support, yet the anatomy of the nervous system, as it was then taught, could never be brought to lend them much assistance. By some, the theories were retained, although the facts of anatomy were altogether neglected; and if there were others who sought to strengthen their views by reference to anatomy, they were accused of perverting it to suit their purposes. "Solent qui ita sentiunt, varias nervorum connexiones, maximè tum paris vagi, tum intercostalis nervi, quod latissimè pateant, studiose inquirere et ambitiose exaggerare, ut tum multis et tam variis sympathiis explicandis possint accommodari: sed operam manifeste ludunt et suo abutuntur otio."-Astruc.

When we mention the names of Dr. Whytt, Dr. Munro, and Haller, as having been engaged on this subject, it is sufficient to show that the "Principle of Sympathy" was not neglected. Yet these celebrated men have left it exceedingly vague and