the merit and chief utility of the author's considerations on, them consist in the appropriate application of common measures to the various states of disease, not in novel remedies; and they cannot be shown without entering into extensive details. We may, however, just remark, that the author is inclined to resort to the use of leeches, and let the patient bear, for some time, the depression resulting from the deprivation of stimulants to which he had been accustomed, than to attempt to remove the inflammation suddenly, by copious and frequently-repeated blood-letting. In the less inflammatory cases, blisters sometimes relieve the symptoms without the aid of leeches; but this relief is, in general, not permanent, unless the more stimulant part of the treatment is abandoned. He has not found it necessary to have the patient abstain wholly from wine, though the quantity of it should be lessened; and it may be drank diluted, except in a few cases attended with a considerable degree of hardness of the pulse, when a diet wholly vegetable, besides, has been very advantageous. Mercury is here, in general, beneficial. The author's mode of administering it is peculiar to himself: he says,

"I have generally given a grain of the blue-pill, sometimes only half a grain, twice or three times in twenty-four hours, till the secretion of the bile appeared to be healthy, repeating these doses when it was again disordered; and by such doses, which may appear to many little better than trifling, I have seen the bile gradually restored to a healthy state, when larger doses had been employed in vain. They not only often succeed where larger doses fail; but the change, in propor tion as it takes place more slowly, seems generally to be more perma❤

nent.

"The correction of the state of the bile, however, is but one of the effects of such a plan. Along with its improvement, the skin generally becomes relaxed, and of a proper temperature; the pulse more dilated; the colour and expression of the countenance better; and, in particular, that expression of languor so peculiar to the advanced stages of the disease, abates. As all these changes depend on a common cause, and consequently take place together, the state of the bile, which should from time to time be ascertained, is a good indication of the general effects of the medicine."

He has always discontinued the use of mercury when the slightest affection of the mouth appeared, and any degree of salivation has generally seemed to him " to do more harm than good." When the blue-pill, in the form above prescribed, disorders the bowels, it should be combined with the extract of poppies, hemlock, or hyosciamus, especially the latter, in doses of not exceeding a grain of the extract, two or three times aday. When the mercury cannot be borne in any way, the mineral acids are to be substituted for it; and the author thinks

that the external use of them, as recommended by Dr. Scott, is much more powerful and efficacious than the administration of them internally.

After discussing particularly these and various other remedial measures, amongst which, the nitrate of potass, taken in a considerable quantity of water, with a proportion of mucilage, is spoken of with much approbation, the author notices the curious circumstance of the stomach becoming relieved, and performing its functions with tolerable energy, when the sympathetic affections have attained a certain degree of severity, and now engage all the attention of the patient, as well as require the especial consideration of the medical practitioner. Sometimes, on the development of this change, but little is complained of besides great general debility; and it is not uncommon for patients to express their surprise that they should be so weak when the stomach performs its office so much better than when they felt very little of this general debility; and the author adds, what is very remarkable, that he has found the debility most obstinate when least complicated with determination to particular parts, provided change of structure has not taken place in the latter case. The effects of the disease have here very frequently been augmented by the means of cure, when mercury has been employed to any considerable extent; and yet, from mercury, under these conditions, temporarily affording relief, by restoring the suspended secretions or correcting such as are morbid, its aid is still very commonly resorted to. It is more frequent, however, for the disease to manifest itself particularly in one organ than to produce merely this state of general debility. The treatment should, of course, vary essentially according to the presence or absence of chronic inflammatory disease in the parts secondarily affected. there is no local inflammation, blood-letting is out of the question. The pulse is generally hard; "and this hardness," the author says, "is relieved with difficulty; because, not depending on the affection of any one part, local evacuations influence it but little, nor are they at all the appropriate remedy; and the general state of debility admits of but a very cautious use of those which produce their effect on the whole system."-"The pulse," he adds, "must be softened by a mild diet and medicines which excite the secreting surfaces." Mercury is objectionable, for the reasons already mentioned. "The moderate use of saline medicines is among the best means in such cases. It would surprise any one, whose attention had not been particularly directed to them, to observe the effects which a diet composed wholly of vegetable substances and milk, if the stomach can bear it, often produces in those labouring under this form of the disease, who have been vainly endeavouring to

When

support their strength by a large proportion of animal food. It has long been admitted, indeed, that such a diet is sometimes useful in cases of debility."

The medicine from which the author has seen the most beneficial effects arise, in the generality of cases, is sarsaparilla; "which often seems," he says, "by its continued use, to give a general tendency to greater freedom in the secreting surfaces. I have frequently seen it, by its mild stimulant and tonic powers, succeed where every thing else had failed."

A favourable climate, that is, one where the air is dry, fresh, (but not very sharp,) and clear, is particularly beneficial: the author speaks of Malvern, as a place of residence, with particular approbation. A mere change of air is often very advantageous.

We shall not attempt to follow the author through his particular discussions on the treatment of the secondary affections: his precepts are conformable with general principles of pathology and therapeutics, and more or less similar to those commonly prevalent. We turn over, therefore, forty or fifty pages," to the chapter on the "third stage of indigestion," (that is, the state where "change of structure" has taken place,) which commences with the following general remarks:-"The stomach is less liable to change of structure than most other organs. This change, therefore, although sometimes taking place in it, is much more frequent in the parts with which it sympathizes.'

By "change of structure" and " organic disease," the author means such change of structure as is apparent after death. The comparative freedom of the stomach from this may, perhaps, be in a considerable degree attributable to the circumstance that the sympathetic affections so frequently suspend or remove the irritation of this organ.

The diseases arising from neglected indigestion are so various, the author observes, that to give any thing like a satisfactory account of them would require a treatise of greater extent than the whole of that now before us; and, he adds, "a superficial account would be worse than none:" he therefore considers only those cases, to which, from their great frequency in this country, his attention has been particularly directed, that is to say, "the pulmonary affections produced by a disordered state of the digestive organs." His dissertation on these subjects is but an amplification of those he had already produced in: a Paper, published in the seventh volume of the Transactions of the Medico Chirurgical Society, on Dyspeptic Phthisis; and in one read to the Royal Society in 1816; and some observations in his "Experimental Inquiry," on the efficacy of

galvanism for some species of asthma. We need not, therefore, occupy ourselves now with what has been for so long a time before the public, considering that the present additions are principally details intended to illustrate the author's former observations.

Observations on some of the General Principles, and on the particular Nature and Treatment, of the different Species of Inflammation; being, with Additions, the Substance of an Essay to which the Jacksonian Prize, for the Year 1818, was adjudged by the Royal College of Surgeons. By J. H. JAMES, Surgeon to the Devon and Exeter Hospital, and Consulting Surgeon to the Exeter Dispensary. 8vo. pp. 328. T. and G. Underwood, London. 1821.

THIS work is concise in its details, and exhibits an extended view of the phenomena, causes, and connexions, of the subjects which it embraces. The therapeutical precepts are briefly, but very correctly, laid down, and unencumbered by superfluous matter. The mode in which the subject is arranged is novel; and, although we shall feel ourselves bound, in the spirit of independent criticism, to dissent from the principle on which it is founded, yet we consider it, upon the whole, managed with considerable ingenuity. We can, therefore, and chiefly on account of the condensed view which it exhibits, recommend it as a useful manual of the class of disorders which it comprehends. But, at the same time, we can confidently say, that the arrangement here proposed will never obtain any thing like general adoption.

The basis of the classification chosen by the author, and which we believe to be his own, is a characteristic of inflammations much insisted upon by the justly celebrated JOHN HUNTER, Whose peculiarities of reasoning he has in a considerable degree imbibed; and, instead of attempting at least the explanation of phenomena, he in many instances has been contented with the use of terms that mean no more than the expression of their existence in the disease which he describes. Upon these grounds, therefore, we consider his pathology to want depth.

It was, perhaps, the greatest fault of the master of British pathology just alluded to, that he substituted expressions which implied a specific and an appropriate intelligence to the parts concerned in the phenomena which he described, and which, by easily solving the difficulties that could not elude his penetration, and from coinciding in some degree with his doctrines respecting the seat of vitality, become eagerly embraced by all the followers of his school; and the more so, because it carried them at once and without difficulty to the ne plus ultra of causation. Although no one can be more impres

sed than we are, (and we speak it with the warmest feelings of admiration,) with the wisdom of the intelligence that regulates the animal system, yet we cannot conceive any thing more absurd than the supposition of a peculiar part of that intelligence to be allotted to the various organs of the body. The Supreme Intelligence operates by more simple and more sublime causes; and what we, in the limited state of our faculties, view as a law of nature, may, nevertheless, be itself the result of a still more remote, and surely not less beautiful, principle giving rise to and regulating that and many other phenomena both in the material and animal creation. To assign to a particular law of nature all the sensible phenomena which our confined views of her operations can but imperfectly explain, would be to multiply those laws to a degree incompatible with the simplicity which, in the spirit of true philosophy, we ought to consider one of the chief characteristics of her beautiful agencies. But we must proceed with the work under consideration.

The author divides his work into two parts. The first contains observations on the general principles of inflammation: namely, the state of inflamed parts-on the accordance of the general and local symptoms of inflammation;-on the causes which, affecting the system generally, influence its progress;on the purposes and uses of the different modes of inflammation; --and on mortification.

The second part is occupied by the different species of inflammatory action; considered in detail, according to the classification which he has been led to adopt.

We shall follow the author through the successive chapters of his work, and endeavour to present our readers with a critical analysis of the matter which they contain.

The first part is introduced by a view of the principles on which a classification of inflammations may be founded. The necessity of a just arrangement is discussed along with the difficulty of forming one against which formidable objections may not be urged. The author remarks. "There can be no question that in the study of every science, a just arrangement will greatly facilitate the acquisition of knowledge, as well as enable us to recollect what has been learnt, or refer to what we wish, with greater readiness, and will probably lead to more correct and enlarged views respecting its various branches. It is one of the principal objects of this essay to attempt such an arrange ment in that extensive and important department of medical science, which comprehends the various kinds of inflammation."

He pleads as an excuse for the imperfection of the classification which he has adopted, "the want of permanence in the characters of diseases; from their liability to be affected by a variety of circumstances, from which the subjects of natural