tend about an inch and a half in depth. The steruum being cut from the ribs, and laid back, a considerable quantity of air escaped with violence from the right cavity of the thorax. The right lung was compressed to the size of a person's hand, and, upon examining its external surface, an ulcerated hole, about the size of a shilling, was discovered, near to its centre, through which the air had escaped into the cavity of the thorax, and compressed the lung. The internal substance of the lung, when cut into, presented a tuberculated appearance throughout its whole substance. The left lung was also found to be much compressed, and smaller than natural; and its internal structure presented the same tuberculated appearance, although in a much slighter degree.

"The pericardium, containing the heart, was found forced entirely into the left cavity of the thorax, and was pressing upon the left lung, so as to impede, in a considerable degree, its free action. Upon laying open its cavity, there flowed from it about 3vi. of a transparent yellowish-coloured fluid. The heart was larger than natural, much loaded with fat, and its coronary vessels were distended with blood. The right auricle was turgid with blood, partly coagulated, and partly fluid; the foramen ovale was found completely closed; both ventricles were also filled with blood; every other part of the heart, valves, &c. were found to be sound and healthy. The contents of the thorax being removed, its internal cavity appeared to be large and roomy.

"From want of time previous to the funeral, the cavities of the cranium and abdomen were not opened.

“Sectio tumoris.-Upon dissecting back the surrounding inte guments from the tumour, the belly of the sterno-mastoid muscle appeared greatly diminished in bulk, and the muscular fibres immediately over the tumour were almost absorbed. The sterno◄ hyoideus muscle was found to be in a similar condition. The su perficial veins in the neighbourhood were considerably enlarged, and distended with blood. The sterno-mastoid muscle being separated from its attachment with the sternum and clavicle, and reflected upwards, the tumour appeared to consist of three masses, distinct from each other, excepting at one side, where they were slightly connected. Underneath, and stretching into the axilla, a number of enlarged glands, of different sizes, could be detected by the fingers. After injecting the left common carotid artery, at its origin from the aorta, with vermilion injection, its diameter was found to be considerably enlarged, but its trunk was entirely unconnected with the tumour, excepting by means of these branches which supplied it with blood, and which were considerably enlarged, cellular substance every where intervening betwixt it and the tumour.

"Upon dividing the largest tumour into two equal halves with a clean scalpel, it was found to possess all the characters of the medullary sarcoma of Mr. Abernethy.

ઉં Upon inquiring into the previous history of the above-mentioned patient, we learned that she bad led a very laborions and active life, from her earliest years, as a farm-servant in the country, NO. 222.

and

and that she had enjoyed perfectly good health, until within these last two years, when the above-mentioned symptoms commenced, and gradually continued to get worse. The tumour in her neck commenced six years ago, and, when first observed, was about the size of a horse-bean, and, since that period, it has gradually continued to enlarge, but particularly within these last two years.

"The cause of the livid colour of the integuments in this patient (or morbus cæruleus) appears to me to have been owing to the very imperfect circulation of blood through the lungs, and, consequently, to its having been very imperfectly supplied with oxygene from the external air during respiration. The right lung, as appeared upon dissection, was compressed to the size of a person's hand, by the quantity of air which had escaped from the ulcerated hole in its surface, and must, consequently, have been rendered almost incapable of performing its natural functions. The pressure of the air from the right cavity of the thorax upon the mediastinum, during the action of the right lung, had also forced the pericardium and heart totally into the left cavity of the thorax, and, of course, greatly diminished the functions and size of the left lung. The diseased tuberculated state of the substance of both lungs themselves must also have contributed greatly to produce the disease. The action of the heart itself and arteries, upon examination before death, appeared to be irregular, stronger, and fuller at one time than at another, which might arise from the pressure retarding their free action. The pressure of the tumour upon the trunk of the left internal jugular vein, particularly when the patient was lying upon her right side in bed, might have produced the great turgescence of blood in the face, and head-ach.

"With regard to the treatment of the tumour, in a surgical point of view, there must have been much hesitation and doubt, from the uncertainty with regard to its nature, as by some people it was supposed to be an aneurism, and its connexion with the surrounding parts, which were of such importance to the animal economy. From its immense size,-from the important situation which it occupied, imbedded among the large blood-vessels, nerves, glands, supplying the head and neck,-from the uncertainty whether or not the common carotid artery might be immersed in its substance,from its depth, the serious nature of the operation, and the debilitated state of the patient's constitution,-its extirpation was delayed, and she was recommended to the physicians, under whose care she eventually died. By the dissection, all these circumstances were explained; and it became evident, that the tumour might have been removed without risk, excepting from the extent of the wound, and the debilitated state of the patient's constitution, arising principally from the internal disease under which she at the same time laboured."

In this instance there was much pulmonary disease, besides the distress arising from the tumour; but it not easy to say how much of the whole distress arose from the tumour. We perfectly agree with the author in the danger of cutting out such a substance; but we can see no objection to making an

opening

opening through the integuments into the substance of such tumour. The contents, as far as is necessary for the immediate relief of the patient, would be pressed out by the act of respiration, and though the part might not heal for many months, yet the patient would have a better chance of recovery.

In our next, we shall notice the other original articles, which are more than usually numerous in the number before us. Though somewhat out of place, we think it right to acknowledge, that, from our eagerness in attending to the important facts in Mr. Birnie's paper, connected with prophylactics, we omitted his method of cure. It is "contained in very few words;" and consists, chiefly, in very free venæsections. His opinion of calomel and bathing, particularly the former, is similar to Dr. R. Jackson's.

[As the Editors of the New-England Journal have done us the honour to adopt our review of the Medico-Chirurgical Transac tions, we make no apology for availing ourselves of their labours on a work which we have not yet been able to procure, especially as it affords us an opportunity of offering the opinions of others on nosology and contagion.] First Lines of the Practice of Physic. By WILLIAM CULLEN, M.D. late Professor of the Practice of Physic, in the University of Edinburgh, &c. &c. With Notes and Observations, practical and explanatory; and a preliminary Discourse in Defence of Classical Medicine, by CHARLES CALDWELL, M.D. 2 vols. 8vo. Philadelphia: Edward and Richard Parker, 1816.

It is somewhat singular that while Dr. Cullen contributed, perhaps more than any other person, to diffuse among medical men those principles of physiology and of pathology which now prevail, yet his own peculiar theories scarcely find a single defender among the physicians of our day. His works, and that before us more particularly, are highly valued and are diligently read, but not for the sake of the peculiar theories they present to us. The excellence of Dr. Cullen is, that he gives his descriptions and his theories distinctly; and that he is peculiarly clear and just in his delineations of disease. As a systematic writer, he is, perhaps, unrivalled in this respect. In regard to individual diseases, there are, no doubt, many who have given descriptions as faithful, and, of course, more full and minute, than those of Cullen.

But the merits of this distinguished teacher are universally known, and we have not taken up the work before us with an intention to review his writings. Our business is with this edition of the "First Lines, &c." in which is found much matter peculiar to itself. This matter consists of a

x 2

preface

preface and a preliminary discourse, and of numerous notes or commentaries. In these notes, the intention of the editor is, not to explain the doctrines of the original work, but to furnish corrections in respect to theory, and to supply deficiencies in respect to practice. As the editor is a gentleman who ranks very high among the physicians of Philadelphia for his literary and scientific attainments, the additions which he makes to this valuable work must be regarded with interest. But this interest is much increased by what appears in the prolegomena, viz. that this work comes out under the sanction of the present Professor of the Theory and Practice of Physic in the University of Pennsylvania; and that he adopts it as his text-book. Even more, we are informed that, the editor has had access to some of Dr. Chapman's manuscript lectures, from which he has enriched his work, and from which, in two or three instances, he has given us extracts. The opportunity of learning the doctrines and precepts inculcated in the first medical school in our country, and, if the number of its pupils be a criterion, one of the first in the world, cannot be regarded with indifference.

But it must be known, that the doctrines referred to are not those which we have hitherto received from the Philadelphia school. Those were the doctrines of Rush; and, whether correct or not, we deem it certain, that his persuasite eloquence, and the force of his genius, caused them to be received with very little opposition during his life, by those who resorted to his lecture-room. Now that the voice of their author has ceased to resound on the ears of his pupils, these doctrines must rest on their own merits alone; and it remains to be seen which of them are placed on stable foundation, and which upon the personal influence of the celebrated Professor. Already it seems, that, under the sanction of the successor of Dr. Rush, there is a formal attempt to overthrow his most favourite principles, and almost to expose his system to derision.*

* We cannot believe that Dr. Rush would wantonly submit any thing from Dr. Cullen to derision; still less that Dr. Rush's successor would be guilty of such indecency to the illustrious dead. We are perfectly of opinion that nosology is liable, like all artificial arrangements of nature, and probably more than any other, to appear in a very disadvantageous attitude. Of the unity of diseases we shall say nothing till Dr. Rush's words and arguments are stated. We have already announced a very learned work on Nosology, which, if leisure permits, will appear in our next, and to which we promise the same candour as it is always our wish to show. Our opinion on that subject is very well known, but we trust it will not influence us. If it should, our readers will not question our good intentions, however they may doubt our impartiality. London Editor. σε Το

"To those, who, for the last fourteen years, have been conversant with the history of medicine in the United States, it is perfectly known, that a bold and persevering attempt was made, by the late Dr. Rush, to overthrow entirely Methodical Nosology, and erect, on its ruins, his favourite hypothesis of the Unity of Disease. Nor was he altogether unsuccessful in the pursuit of his enterprise. By a combination of popular and imposing qualities, superadded to an ascendancy derived from his station as a public teacher, he implanted in the minds of no inconsiderable portion of the physicians of America, a disbelief in the truth and value of classical medicine.

"To endeavour to counteract this evil, which, from the simplicity it appeared to have introduced into medical science, had become exceedingly seductive of indolent minds; to recall the prevalence of correct principles, touching the subdivisions and classification of disease; and, to restore to our profession the advantages of system, constitute the object of our Preliminary Discourse."-Preface to American edit, p. ix.

Accordingly, in the preliminary discourse, Dr. Caldwell points out the true basis of system and classification in science, viz. "affinity in some points, and dissimilarity in others;" and he shows the object and tendency of this clas sification. He illustrates its importance, and the benefits to be derived from it, by a reference to the various branches of natural history, and particularly to zoology. The only question is, whether diseases are susceptible of a similar arrangement. Dr. Rush thought that they were not, but Dr. Caldwell says that they are, since they have affinity in some points and dissimilarity in others; and subsequently he shows, that Rush himself had in effect a system of nosology. In his endeavours to establish the differences among diseases, Dr. Caldwell is led to consider the doctrine of unity of disease promulgated by Dr. Rush. On this doctrine were grounded the principal objections of this learned Professor to systematic nosology, and, if that can be proved to be untenable, the superstructure raised upon it must be deserted. The editor of this work contends, that the doctrine of the unity of disease implies the unity of excitability and the unity of stimuli. The editor himself seems to us not to distinguish sufficiently between sensibility and irritability, properties essentially different and perfectly distinct; but which, by Brown and his followers, are not distinguished at all. Without, however, availing himself of this distinction, the two properties being comprehended under the term excitability, Dr. Caldwell satisfactorily disproves the doctrines in question. In truth, we doubt exceedingly whether any physician ever lived, who, after one year's practice, verily believed that all stimuli produce the same effects, and that all parts of the body are affected in the same mode by the same stimuli.

In