of illustration, or farther multiplicity of words, which I could em-. ploy: Pater ipse colendi (medcædi), Haud facilem esse viam voluit, primusque per artem, A Treatise on the Nature and Treatment of Scrophula; describing its Connection with Diseases of the Spine, Joints, Eyes, Glands, &c.. &c. &c. Founded on an Essay to which the Jacksonian Prize, for the Year 1818, was adjudged by the Royal College of Surgeons.. To which is added, a brief Account of the Ophthalmia so long prevalent in Christ's Hospital. By EUSEBIUS ARTHUR LLOYD, Member of the Royal College of Surgeons in London Senior SurgeonTM to the General Dispensary, Aldersgate-street; and late HouseSurgeon to St. Bartholomew's Hospital. Svo. pp. 330. London: J. Anderson. 1821. THE bibliology of scrofulous diseases is now nearly as extensive as that of consumption and stomach complaints; and, although the author before us asserts that "the disease [scrofula] has never yet been subjected to any particular and scientific investigation," he must mean within the circle of his own knowledge; for there is scarcely another complaint of the chronic kind that has had more monographers than the one he has undertaken to write upon. Without mentioning HAMILTON'S Observations on Sirofulous Affections; NISBET's Inquiry into the History, &c. of Scrofula; BEDDOES' Essay on Scrofula, in his Hygeia; CARMICHAEL'S Essay on the Nature and Cure of Scrofula, RUSSELL'S Treatise on Scrofula; GOODLAD's Essay on the Absorbent System, and many more, one or two of which are named and quoted by Mr. Lloyd himself; we would wish to remind him of the numerous publications on the same subject which have appeared in other parts of Europe, particularly of those of Weber, Hufeland, Ritter, Pujol, Capelle, Hebreard, Baumes; all of which writers have treated the subject of scrofula in "a particular and scientific" manner within the last twenty years. We are not, however, sorry to see another labourer in this vast field of inquiry; and, when the ample opportunities which Mr. Lloyd has enjoyed of conducting a fresh investigation into the nature and causes of scrofula are taken into consideration, few there will be who will not be disposed to welcome a professed work on that subject from his pen. "I have had frequent opportunities of examining by dissection the morbid parts, when they have been separated from the body by ope ration, as well as the bodies of those who have fallen a victim to the * Introduction, pp. 1–2. disease. I have also had, for many years, under my inspection patients labouring under this disease in all its various forms, and in many cases have been so fortunate as to be able to trace them from their commencement to their termination." The public must not, however, be hurried away, in their judgment on the merits of the present performance, by the mere consideration of those favourable circumstances in which the author was placed, and which he has detailed in the above extract; nor by the more honourable fact, that Mr. Lloyd obtained the Jacksonian prize from the Royal College of Surgeons for the substance of this very essay. It is the mode in which an individual has availed himself of any advantageous opportunities he may have had for the promotion of science, and not the opportunities themselves, by which we should decide of his claims to public approbation; and, as to the reward he has already received at the hands of a most respectable body of medical men, we cannot forget that a similar one was awarded to another essay (Mr. Good lad's,) some years before, in which the subject of scrofula had been treated on different principles; nor can we attach much importance to these sort of academical distinctions, when we reflect that another body corporate, of as great respectability as the College of Surgeons, once proposed the following question on the subject under consideration: "An strumæ vel scrofulæ hoc etiam seculo, curari possint solo attactu regum Gallie et Anglia ?" We shall now proceed to give as clear an account of Mr. Lloyd's performance as we can, offering from time to time such critical remarks as the subject-matter may suggest, in the same spirit in which the author himself has declared that he has spoken of the opinions of others,-" without any intention to give offence; and trusting, therefore, that none will be taken at the free expression of our opinion."* The work is inscribed to Mr. Abernethy, whose great and constant kindness to the author, while a pupil in St. Bartholomew's Hospital, naturally called forth this token of gratitude. There were, moreover, two other motives which in this case influenced the author in selecting the object of his dedication:"a wish to conciliate the public by an apparent union between himself and Mr. Abernethy;" and, lastly, a desire to maintain by facts and arguments (verbis et armis,) the truth of those principles which have been established by the same distinguished individual, concerning the dependence of local diseases on a general disorder of the system, and particularly on disorder of the digestive organs. We may then, even in limine, assume the following as a Sce Preface, p. xii. proposition of the author,-that scrofula is a disease dependent on disorder of the digestive organs; a point which Dr. R. CARMICHAEL, of Dublin, endeavoured successfully to establish long before Mr. Lloyd, in his "Essay on the Nature and Cure of Scrofula, and a Demonstration of its Origin from Disorders of the Digestive Organs." In the Preface, we are informed that one of the objects of Mr. Lloyd's was to make the principles of Mr. Abernethy, on which the treatment for scrofula is founded, better understood by those out of the profession; and that the great aim of the work is" to show that scrofulous diseases are, in general, to be removed by attention to the general health of the patient; and that the disease itself is to be considered the secondary, not the primary, object of attention." Mr. Lloyd's book is divided into two parts. The first, extending to forty-eight pages, contains the author's general views on scrofula; its character and symptoms; its causes and treatment. The second part takes a wider range, and embraces considerations, practical as well as doctrinal, on local affections, the effect of scrofula. I. Characters and Symptoms of Scrofula.-Authors in general, Mr. Lloyd thinks, have fallen into the error of describing the state of a patient labouring under scrofula, after the disease had given local evidence of its existence; for they enumerate among the symptoms of a scrofulous diathesis, or which only denote a tendency to scrofula," a thickened, chapped upper lip; tu mescence and redness of the tarsi, with weakness of the eyes in general; tumid belly; and enlargement of the lymphatic glands, particularly those of the neck." They ought, on the contrary, says Mr. Lloyd, to have informed us of the temperament or habit of body of the patient antecedent to the existence of any decisive evidence of the disease. We had therefore expected, in the book before us, a different description from that of any other author,such a description as would enable us to become acquainted with the nature of the disease in its first and earliest stage; to anticipate its march; and to prevent it, by every possible means, from obtaining a local habitation' in the body of any individual." In this expectation we were, however, dis. appointed; for, when we came to read that part of Mr. Lloyd's book which he considers as giving an account of the symptoms "indicative only of a disposition," we found it to embrace, more or less, the same symptoms mentioned by the authors he condemns; symptoms which do not describe a forth-coming disease, but a disease already settled and developed, as our readers will see from a perusal of the following extract: "Scrofula oftener affects children than persons of any other age, though no age is altogether exempt from it. It appears, however, that NO. 272. 3 F the susceptibility which different parts have to it, is altered by age: thus, in children, the upper lip, eyes, glands of the neck, and those of the mesentery, are generally the parts first affected; the lungs, bones, and other parts, being subsequently attacked. It happens sometimes, too, in children, that small lumps form under the skin in various parts of the body, which suppurate, ulcerate, and pursue the same course with scrofulous abscesses in general. These we consider as scrofulous, from the nature of the matter they contain, and from their co-existing with other affections evidently of this description, and from other circumstances which will be mentioned in their proper place." If we comprehend rightly Mr. Lloyd's meaning, it comes to this-that, if a child or an adult, enjoying an apparently perfect health, having neither "small lumps" under the skin, nor "a species of warts" about the face and neck, nor thick lips, nor a thick nose, nor an enlargement of the lymphatic glands, nor a tumescence and redness of the tarsi, nor a tumid belly, be presented to him, he (Mr. Lloyd) will be able to tell whether such a child or adult is likely to be affected by scrofula: "and will anticipate its march, and prevent it from obtaining a local habitation." That the author himself may be able to effect this, we are by no means disposed to doubt; but, that he has imparted to us the same faculty by his description, is what we are not prepared to admit. Let the reader judge. "The appearance of the countenance is really that of delicacy and langour; though, to the common observer, from the fulness, the peculiar smoothness, and the beautiful colour of the cheeks, it is often that of the highest and most complete health. If, however, it be attentively observed, it will be found that the checks, though full and tumid, are softer and more flaccid than is natural to health; and that, instead of being fixed and firm, they hang as it were loose on the face. There are, nevertheless, persons who have the greatest tendency to scrofula, in whom none of these apparent signs of health exist," [and he should say, where these apparent signs exist, who never afterwards exhibit symptoms of scrofula,]"but whose complexions are peculiarly dull and pallid; in these, the appearance of delicacy and langour is even greater than in the former. In the former state, the lips gene. rally partake of the fulness of the face, and are of a beautiful red; while in the latter they are pale. It often happens, too, that the parts about the mouth are of a peculiar dull pallid huc. There is also a remarkable appearance about the eyes, which cannot be accurately described; but the conjunctiva is particularly free from blood-vessels, the pupil is generally much dilated, and the upper eye-lid drops more than natural; to which, perhaps, as well as to the delicate state of habit, the dilatation of the pupil may be in some measure owing." With regard to the distinction commonly made between children of fair complexion and light hair and eyes, as more liable to scrofula, and those of quite a different external charac ter, our author contends that it is not founded on legitimate grounds. The extensive investigation he has given to this subject, and his opportunities of examining numerous children in some of the largest charity-schools in London, authorize Mr. Lloyd to entertain a very different opinion, and incline him to say that "three-fourths of the children in this country have not what any impartial person would call fair complexions and light hair and eyes." If this be correct, then what remains for us to judge by as to the probable coming-on of scrofula in an healthy individual? II. Causes of Scrofula.-Every day's experience convinces Mr. Lloyd that the local diseases called scrofulous arise from something wrong in the general health, sometimes co-existent with birth, and at other times entirely produced by improper attention to diet, to the alimentary viscera, and other occasional or accidental causes. This is intelligible as far as cause and effect; not so with regard to the modus operandi of the cause producing the effect. We confess we cannot look upon the explanation offered by the author as at all convincing, namely, "that certain derangement of the vital functions, capable of being produced by a variety of causes, may effect such an alteration in the natural actions of a part, as to impair its functions, and give rise to that change of structure which we term a scrofulous disease." Were it so, how comes it that every deranged stomach does not give rise to scrofula? Mr. Lloyd may argue, that the deranged stomach must "affect an alteration in the natural actions of a part, so as to impair its functions, ere it can give rise to a scrofulous disease;" but, in that case, it will be incumbent upon him to demonstrate how such an alteration in the natural actions of a part as he alludes to, is brought about; and what sort of deterioration of its functions must that be which will give rise to scrofula rather than to any other disease. Until he have done this, the doctrine of scrofulous diseases is just where it was, before either Mr. Lloyd or Dr. Carmichael applied Mr. Abernethy's principles as a formula for solving this complicated equation. We know that the majority of our readers will side with us when we advance, that, in merely stating that A (the stomach,) produces an alteration in the natural actions, and impairs the functions, of B (another part of the body,) and gives rise to a subsequent effect (scrofula,) Mr. Lloyd has not thrown a clearer light on the etiology of that disease, than the humorists have done, with their virus,-the chemio-physicians, with their degenerated fluids, their alkaline and their acid principles,-or the vitalists, with their vascular debility. Mr. Lloyd, in illustration of his position, that disorder of the digestive organs is capable of deranging the whole system, |