ordinarily witnessed from certain medicines depend on their diffusion through the system, or on sympathetic connexion, remains open for investigation; but many new researches are requisite to furnish the means for satisfactory conclusions. We now commence with the discourse on the classification of the materia medica; but a desire to pass on to that part of the work devoted to practical illustrations, will render our remarks on this subject but very concise: we shall confine them to a few general reflections, chiefly relating to the classification adopted by the author.

Dr. Chapman very properly separates the consideration of articles of diet from that of medicines; not that the qualities of the former are unworthy the attention of the physician, but because they should form a distinct subject for investigation.

After some remarks on the difficulties attendant on a classification of the materia medica, from the same article being expressly emetic, cathartic, diaphoretic, &c. under different circumstances, he notices the errors of that of Cullen; which is, indeed, quite inconsistent with his own doctrine of solidism.

Dr. Chapman then exposes that which he has himself adopted, which, as he acknowledged in his Preface, is not free from important errors, and is by no means the best that could be formed in the present state of medical knowledge. He, in the first instance, states that every medical substance is more or less stimulant to the animal economy. This proposition must be admitted, generally considered; but it is not a good foundation for the classification of them which Dr. Chapman has adopted, that is, into general and diffusible stimulants. A few observations will render this evident. Wine applied to the stomach under certain states of disease, and even of relative health, will lower the temperature of the skin and render it pallid: here, then, it acts locally as a stimulant, but remotely as a sedative; a phenomenon arising from sympathetic connexion and concentration of the vital powers. On the other hand, cold air applied to the skin will, on some occasions, increase the powers and actions of the stomach, while it renders the skin pallid, from the causes already mentioned. A blister, too, is frequently the most powerful sedative that can be employed, from its withdrawing the vital actions from a remote part by the local irritation it produces. And, finally, certain substances applied to the stomach will increase the actions of remote parts in one state of the body, and depress them in another; phenomena depending chiefly on the greater or less plethoric state of the system, and the different degrees of vitality with which it is, under various circumstances, endowed.

There is another objection to this method, that has not escaped the penetration of Dr. Chapman ; which is, that even the local agency of certain medicinal substances that is stimulant in the state of health, will be, apparently, relatively sedative in certain states of disease. He observes, as whatever produces any positive impression on the living system, must do it by an irritant power, there can be no doubt that, in a very strict sense, every medicinal substance is a stimulant. But the effect thus created may be inferior to the natural degree of excitement, and much less than that of disease. When this happens, as les

sening action, the article may with propriety be denominated, and in a practical view considered, sedative, in contradistinction to our more energetic remedies."

Their mode of agency may be thus regarded: the substances in question, by producing the actions dependant on their own specific influence, supersede the morbid actions, or the actions to which every part is excited by the influence of the rest of the economy.

This principle is practically applied to a great extent by many of the most eminent Italian physicians of the present day; and they administer tartar emetic, several other of the metallic salts, opium, &c. to parts suffering morbid action, even of an inflammatory kind, from the views thence derived.

Reasoning on it is not very satisfactory, but actual observation seems to show its truth. The eye, under certain forms of inflammation, will furnish a ready means for the illustration of this subject. This doctrine of counter-stimulation was first advanced by RASORI, on renouncing Brownism. Considering inflammation as the sign of increased action, and yet being obliged to acknowledge that topical stimulants sometimes remove it, it became necessary to resort to the reasoning we have above alluded to.

According to the present state of our knowledge, the most correct and useful classification of the materia medica must be that proposed by BICHAT; which Dr. Chapman acknowledges by saying, "I am now persuaded that a much more natural, as well as useful, arrangement of medicines might be made, on the principle of their affinities to the several systems of the body; and, should an opportunity be ever afforded me, it is the one which I shall attempt to establish."

M. ALIBERT, whose fame is secured by the records of so many branches of medical science, has done much for the development of those views; but it will require the labours of successive generations to render them complete.

Dr. Chapman has in some degree modified his plan on those principles; for, though he divides medicinal substances into the two classes of local and diffusible stimulants, he treats of those coming under the former according to their influence on particular functions, as emetics, cathartics, diuretics, lithontriptics, diaphoretics, expectorants, emenagogues, anthelminthics, and epispastics. In a perfect system of this kind, it would be necessary to comprise the particular influence of medicines on the elementary textures of the body; for it seems evident that certain ones affect particularly the serous, others the mucous membranes, &c. The second class of Dr. Chapman includes tonics and astringents. We shall first enter into the consideration of the former.

Previously to his observations on the use of emetics, the author ad. duces some remarks on the act of vomiting, and on the way in which this is excited by certain substances. Physiologists now seem to agree in the opinion, that, concurrent actions of the stomach itself, the dia phragm, and some of the abdominal muscles, ordinarily take place in this act. Perhaps the difficulties the author notices in accounting for

the agency of emetics, may be obviated by referring this to that law of the animal economy, by which every organ enters into a sort of action calculated to remove what is injurious to it; and, by motions tending towards the surfaces of the body, rather than such as may transmit them further into the system, when the matter is of a noxious quality. Thus, we find that substances irritating to the stomach, and not fit for the exercise of its digestive functions, are ejected from it by vomiting, if deleterious to the general economy, and transmitted to the bowels, if not so; whilst alimentary matter is pertinaciously retained until it is properly elaborated. These seem to be general laws, although they are often apparently diverged from; probably, in consequence of the common outrages committed against nature by civilized man in respect to his food.*

Emetics, Dr. Chapman observes, influence the system in various ways besides that depending on the mere removal of the contents of the stomach. They incite the liver and gallbladder, secretion and evacuation of bile, and probably the pancreas, in a similar manner. From the sympathy of the stomach with the rest of the system, various morbid actions are averted by the powerful action and subsequent repose of this organ. The skin is peculiarly affected on this occasion, and is generally incited to increased secretion of a salutary tendency. The pulmonary organs are also called into action in a similar manner. The powerful effects of emetics in promoting absorption have been long observed, although not satisfactorily explained. The rational doubts that have lately been advanced respecting the influence of the lymphatic vessels on these occasions, especially as relates to the removing of collections of purulent matter, &c. must turn our attention to what seems to be the true means, but of which we have not yet sufficient knowledge to enable us to form any conclusions.

"In fever," Dr. Chapman says, "when the attack is exceedingly vehement, whatever may be the type, we should never fail to resort to an emetic, and even to repeat it, if a very successful impression be not made on the case by the first exhibition. This precept, however," he adds, "is more applicable to the bilious fevers of our own climate, and especially as they occur in the southern States, where they prove exceedingly intractable under any other mode of treatment." This observation is particularly interesting, as coming from a physician who considers that fever, "whatever may be the cause, is always a disease of sympathy, having the primary link of its ultimately length. ened and complex chain in the stomach. It is upon this organ that contagion, marsh effluvia, and other noxious matters, act; and hence, precisely as in the cases of poison, a local irritation at first occurs, which, if not at once arrested, spreads itself by multiplying the trains of morbid association, till the disease becomes general, involving more or less every part of the animal economy." Those who have adopted the doctrine of the gastric origin of several species of fever, have in

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* See the fortieth volume of this Journal, pages 581, 534, 535, 536, for some interesting illustrations of this subject.

general been much afraid of the use of emetics, considering that they are hazardous remedies at any stage of the disease of the species alluded to; and Dr. Chapman, indeed, very strongly urges the im portance of restricting the administration of them in what are called malignant fevers, to "the forming state:" it is in this way only, he says, that they are admissible."Exhibited in the more advanced stage of the case, or after the disease is absolutely confirmed and pervades the system, they not only prove wholly incompetent to its re. moval, but generally heighten the worst symptoms, and augment the difficulty of cure. This effect was most remarkably exemplified in the treatment of our yellow-fever, and has been remarked in some other epidemics, as the plague, &c." Whilst we state our dissent from the author's universal* application of a correct and important view of the origin of fever, as regards the seat of the "primary link of the mor bid chain," we must express our conviction of the truth and value of his remarks respecting the use of the remedy under consideration. We believe it is solely from its having been employed after real inflammation of the gastric passage has come on, that it has fallen into its present disrepute. Reasoning, as well as experience, leads us to conclude, that an emetic will very frequently subvert the morbid action before it has acquired this degree of intensity; but, after this is established, emetics are commonly injurious: this distinction should have been more clearly made.

In puerperal fever, Dr. Chapman has prescribed emetics with advantage, "not so much to meet the general indications of the disease, as to relieve one most distressing symptom. The stomach is here not unfrequently loaded with a dark offensive matter, resembling the black vomit of our pestilential fevers, which occasions great distress and sickness, and, if allowed to remain, uniformly keeps up fever, and depresses the system into a typhoid state. To evacuate this noxious matter, an emetic is indispensable; and its operation, in some instances, will be followed by effects the most prompt and satisfactory." His opinion respecting the nature of this disease, is, that it has its origin in a primary irritation of the uterus; and that the peritoneum, in the more violent cases, takes on inflammation from sympathy.

The difference between the state of the uterus resulting from the nervous irritation causing this malady and real inflammation, is well pointed out by the judicious and experienced GIANNINI; and his views of this subject have led him to adopt a mode of practice that appears to have been extraordinarily successful. The remedy on which he has placed most reliance, is the cold, or the semi-tepid, bath, according to the state of the patient, the season of the year, and the stage of the disease. His expression relative to its utility is very strong: he says, "when the disease is treated by cold immersion, all other remedies may be dispensed with as useless, in the greater number

From other parts of this work, we are led to suppose this to be an inadvertent expression; and that the author means only to apply it to what are called malignant fevers, with the consideration of which the paragraph in which this expression occurs commences. Dr. Chapman's remarks on the nature of Puerperal Fever seem to prove this,

of cases." The auxiliaries he resorted to were slight tonics, laxatives, and opium.*

Emetics have not preserved the repute they once acquired in the cure of hæmorrhage from the lungs; and Dr. Chapman joins in the opinion that their use on those occasions is hazardous: though, he says, the worst case of this kind he ever witnessed was completely sus pended by a dose of digitalis that produced violent vomiting. In the more slight and chronic forms of this affection, they may be exhibited with safety, and are often very beneficial.

Dr. Chapman makes a distinction between menorrhagia and menstruation, however profuse in the former, he considers the discharge to be really blood; whilst that occurring in the latter, is the result of a secretory action of the uterus. He has never employed emetics in uterine hæmorrhages, but very frequently nauseating doses of the medicine, and with a complete confirmation, in his mind, of what had been previously said respecting the efficacy of this measure. Dr. Chapman refers particularly to the statement of BERGIUS, and ALTHOF of Upsal; and states that he has witnessed several cases, where, "the moment the nausea was induced, the flooding ceased." He prefers ipe. cacuanha for this purpose, and frequently combined it with opium, in the quantity of two grains of the former with half a grain of the latter, giving this dose every two or three hours. The same medicine was employed in dysentery with equal benefit, confirming the statements of Cullen, Sir George Baker, Mr. Playfair, Mr. English, Mr. Hamilton of Ipswich, and Mr. Joseph Arnold.

In croup, the author thinks very highly of their use, more so than we believe is generally done. There is often great difficulty in exciting vomiting in severe and sudden attacks, especially when it is of a spasmodic, rather than an inflammatory nature. On this occasion, Dr. Chapman says, "My experience teaches me that nothing is so effectual as the warm bath; and, where it fails, venæsection, in extreme cases, even ad deliquium animi. Never have I witnessed one solitary instance in which these means combined did not succeed in awakening the susceptibility of the stomach to the action of the emetic, and effect. ing all which can be expected from the most free and copious vomit. ing."

In the malignant sore-throat, and in complaints of the chest in general, the author concurs in the common opinion in favour of their considerable utility.

In rheumatism, he has not had much experience of their use, ex. cepting in that species "originating in districts exposed to marsh exhalation, and where the attack, as sometimes happens, is blended with intermittent or remittent fever. They here prove serviceable, on a principle perfectly intelligible." In dyspepsia, his "first step is generally to resort to this remedy." We have ourselves seen much

* See Della Natura delle Febbri, e del Miglior Metodo di Curarle, &c. Del Dottore GUISEPPE GIANNINI, Medico nello Spedal Maggiore di Milano; tom. ii. p. 117. We shall take another opportunity of noticing this physician's observations and opinions on this and several other febrile diseases, in a more particular

manner.