The physiology of Dr. Trotter, we have already ventured to criticise; it appears to us to be in general founded upon loose analogy, rather than accurate deduction from fact. It is somewhat singular, that while modern chemistry, in point of precision, yields only to the mathematical

sciences, those physiologists and patho logists who have applied chemical reasoning to the phenomena of the living body, have been, almost without exception, notoriously vague and hypothetical.

THESE two small works are upon the same subject, althogh the title-pages are different. There seems to have been some crossing and jostling in the course of publication; but no notice at all is taken of such a circumstance. We judge from internal evidence. The publication of Mr. Alley's Essay has been delayed nearly four months, by the difficulty of procuring good engravings; at last it is published without any. In the mean time Dr. Moriarty appears to have stepped forward to tell the world all that he has seen, heard, and could collect on this subject at Dublin and Edinburgh. Mr. Alley's Essay is entitled to precedence on many accounts, though there is not much to claim such decided preference in either of these two treatises.

This discase, we are informed, first became known to the surgeons of the Lock Hospital, in Dublin, in 1789. They considered it as arising from the use of mercury, and adopted a successful mode of treating it in consequence of such an opinion. Mr. Alley, in describing the symptoms and general appearances of the disease, divides it into two species, the mild and the malignant, each character ised by different degrees of febrile derangement of the whole system. The patient is seized with the usual symptoms of pyrexia, accompanied with prickly heat and itching of the skin, which pre cede the eruption. This begins about the scrotum and the inside of the thighs, and soon spreads over the whole body. It is said to be similar to that of measles, excepting that it is different by the spots being larger, and of a less florid colour. The plates referred to are unfortunately not given to assist the description; they were so incorrectly finished that the author thought it best to omit them altogether. In the mild cases the eruption begins to desquamate on the fourth day. This desquamation is frequently attend.

ed with profuse serous discharge, which stains the linen, and is peculiarly fetid. The cuticle peels off in large flakes, but the febrile symptoms do not subside. In some cases the symptoms are not so regular; the desquamation does not begin so soon in the more unfavourable instances. The fever terminates in general on or before the eleventh day: sometimes this fever is of the low typhoid kind, and proves fatal. Mr. Alley next proceeds to point out the distinguishing characters of this mercurial disease, as he calls it, from all the exanthemata, and from one species of venereal cruption.

The method of treatment now successfully adopted, is, first to desist entirely from the exhibition of mercury, to remove the patient from the mercurial atmosphere, to change the cloaths, and to cleanse the skin by the tepid bath. Antimonial medicines, and acids, are given with advantage. At the commencement of the disease, bark and wine aggravate the symptoms; but when the febrile state is diminished, the free exhibition of these remedies is of great importance. Pow. ders, and frequent washing, should be applied to the excoriated parts.

Several cases are detailed: some of them with a tedious degree of minuteness; the languid and prolix copies of some common prescriptions is quite ridiculous. It is curious to remark that the venereal complaints in all the patients disappeared during the continuance of the fever, while the use of mercury was suspended; and the patients were dismissed without having recourse to the exhibition of mercury again. This ap pears to render the histories somewhat equivocal, at least it suggests some sus picion of the diseases not being in the first instance venereal.

This eruption which attacks some persons on taking mercury, has hitherto been neglected. It well deserves at

tention, inasmuch as the febrile state sometimes proves fatal. Both these pamphlets, after being condensed into one, are insufficient to convey a complete view of the subject. They are both su perficial; both imperfect productions.

Perhaps it was wrong to expect more than we find, since one of these young authors seems to have copied from the other, and both to have borrowed their ideas from the observations of others.

A NEW edition of Dr. Currie's Medical Reports having been for some time called for by the public, the author has embraced this opportunity of making some alteration in the arrangement of the former part, and adding a very large quantity of new matter. The merits of the original work are sufficiently well known; the practice which it recommends has stood the test of ample experience, and it may now be justly ranked among the decided improvements in medicine, established beyond the reach of our commendation or censure. Our attention at present will be chiefly confined to the new matter which is contained in this edition.

The principal alteration which has taken place in the arrangement of the former materials is, that the articles which were before thrown into an appendix, are now introduced into the body of the work. An account of two cases of tetanus, which were successfully treated by the author, since the publication of the second edition, are inserted in the first volume. The first case was produced by a wound in the leg. About 15 days after the accident a stiffness of the jaw first appeared, and continued to increase for six days, notwithstanding the plentiful use of opium and wine. At this time the affusion of water of 75° was em'ployed, and produced an evident alleviation of the symptoms. The patient

"Found considerable and immediate relief from the affusion, which, at his own request, was constantly repeated whenever the symptoms were the most severe, and always with sensible and instant benefit. From this time the symptoms became stationary: in a few days there was an abatement of their violence, and under a continuation of this treatment, he finally recovered. The case was, however, a considerable time doubtful; it was not till after the expiration of twenty days that we could consider the recovery as certain. He took during this time, on a medium, twelve grains of opium, and nearly

three pints of wine in the twenty-four hours, and had the cold affusions between three and four times daily."

The other case was much more violent. It originated from a splinter running under the finger nail. In about a fortnight the disease had assumed the most formidable aspect. Large quan tities of opium in the liquid form, the cold affusion, and the free use of wine were had recourse to, and in spite of the most violent symptoms, were finally successful in combating the disease.

"Being in the vigour of life, and of great bodily strength and resolution, the exertions he made were very uncommon. He could swallow at intervals only, and for several days never, but when turned on his face; and his upper jaw was rigidly shut; yet as it lapped over the under one, he drew duced, and a much larger quantity of wine up the medicine through the orifice thus proand nutriment than was expected. An accurate journal was kept by his attendants, from the 13th of April to the 11th of May, of every circumstance respecting his case, which extends to forty-two pages 4to.; and from this it appears, that in the interval of time just mentioned, he drank, mixed with nourishment, and by itself, the extraordinary quantity of a hundred and forty bottles of wine, being five bottles of Madeira a day, besides some ale, and several gallons of brandy. From the 13th of April to the end of that month, he took, one day with another, a hundred and fifty-five drops of laudanum daily, being in all five ounces and six drachms; and used during the same time, twenty-seven ounces in embrocation, with twice the quantity of æther. He also used three drachms of powder of opium in ointment."

"In the use of the cold bath Mr. P. was in like measure left a good deal to his own discretion. From the 13th of April to the 8th of May, when he left it off entirely, it ap pears that he bathed sixty-five times, twice using the tepid, and sixty-three times the cold affusion. As he sweated profusely, we directed the water to be made milk warm; bus finding no relief from it in this way, he himself desired to return to the cold affusion."

"The efforts required to move him out of bed were most painful and difficult. Happily the unscles of his arms and shoulders were less affected than those of the rest of his body, and he was able to make some exertions with them. But it was often fifteen or twenty minutes before he could turn his legs over the side of the bed, into the tub in which he stood while the water was poured over him; and the process of his rising was always in terrupted by one or more convulsions. In one of these he seized hold of the post of the bed with his hands, and stood upright, so rigidly constricted, that he could not change his position for two hours, the sweat all the time pouring in torrents over him."

It is remarked by the author that

Notwithstanding the violence of the disease, and the vast quantity of wine and opium which he swallowed, Mr. P.'s heat was never greater than the natural standard. The superfluous heat which these medicines ought to have produced, was no doubt carried off by the profuse and constant perspiration. Neither did I observe his heat, except in a few instances, below the standard of health; and there seems little doubt that the wine and opium enabled him to sustain the cold affusion under the profuse perspirations which they excited.”

From these, and other similar cases, which have been published during the last few years, we think the method of treating tetanus may be considered as sufficiently established, and where no untoward circumstances take place, the cure of the disease may be looked forward to as a probable event. Perhaps,

henceforth the instances of failure may be more instructive than those of suc

cess.

The "additional reports" principally consist of the author's experience of the effects of the cold affusion, subsequent to the publication of the former edition, and of the communications of other medical men on the same subject. The author has of late extended the practice to some of those cases where its use was before left undecided; he has employed it with great advantage, even in the last stage of typhus, where the temperature of the body did not immediately forbid its use. He appears to have carried to a greater extent than in the earlier part of his practice, the exposure of the body to cold air. To a free exposure to the air he attributes the benefit which Dr. Jackson supposes is derived, in cases of fever, from travelling; an opinion in which we entirely coincide with him. To the same cause is ascribed the singular instance

of recovery mentioned by Desgenettes, of persons who escaped from the Egyp tian hospitals, in the delirium attendant upon the worst kind of plague; and in this state, either plunged into the Nile, or wandered for many days through the deserts, and were finally restored to health. Of an analogous nature we conceive the circumstance to be which is related by Assalini, that he always found his patients to be relieved by the removal to a new situation.

On the subject of the Egyptian epidemic, we meet with the following just and elegant observation.

How fruitless and how perverted are the efforts by which learning and science have in general attempted to combat this fatal disease! The medical departments of both armies seem to have been arranged with the greatest care; but the best remedies for the plague were probably missed by the physicians both of France and England. They were not to be traced in the prevailing systems of medicine, or in the pharmacy of our shops; but it is probable they might have been found in the refreshment of the breeze, in the dews of night, and in the waters of the Nile.”

The autumn of 1800, which in most parts of the island was attended with an unusual quantity of disease, appears in Liverpool to have been peculiarly fatal. Typhous fever, dysentery, and scariatina, were all prevalent at the same time, and were no less violent than frequent. On the treatment of dysentery we meet with the following remarks.

“ On the whole, where the patient was in the first stages, and his strength not much reduced, nor his stomach unsettled, it was a successful practice to clear the first passages. and open the pores of the skin, by ipecacuanha, or James's powder, afterwards keeping the bowels regular by small doses of calvinel, and allaying the irritation by opium. In other cases saline purgatives, followed by anddyne clysters, proved successful. Castor oil could seldom be retained on the stomach. Calomel was more generally useful, and in some instances it was combined with chrystals of tartar, with great apparent advantage. In other cases calcined magnesia, in small doses (sometimes combined with opium and ipecacuanha, or with opium alone), and followed by successive draughts of lemonade, answered every purpose. In a few cases I made a trial sea-salt, dissolved in vinegar or in lemonof the remedy of my friend, Dr. Wrightjuice. Used in the early stages of the disease, this remedy seemed to answer the character he has given of it; but in the latter stages it failed, as, indeed, the communication I had

that the scarlatina is a disease which only occurs once to the same individual. The contrary doctrine was formerly prevalent, and is still adhered to by some respectable individuals: the following statement is, however, a powerful argument in favour of the author's opinion.

"That the experience on which I give these opinions may be justly estimated, I may mention, that for the last twenty years the scarlatina has never been a whole year together absent from Liverpool, and that besides

the single cases which are often occurring, there is scarcely a year that passes in some part of which it is not more or less epidemic. The following observations, as well as those preceding, must, therefore, be considered as the result of personal observation."

The author notices a variety of scarlatina, which we believe has not been hitherto described; at least not in so accurate a manner.

The form in which the disease usually appears is described with his accustomed elegance and propriety.

"After some previous lassitude or weariness, of uncertain duration, the scarlatina anginosa comes on with the usual symptoms of pyrexia, shivering, pain in the back and head, nausea, and frequently vomiting; in proportion to the violence of these symptoms, and to the rapidity of their progress, is the dan ger of the disease; in an hour or two the heat begins to return, and speedily mounts up far beyond the temperature of health, this return of heat being generally attended by a great sensibility and bright-red flushing over the whole surface of the body, with some stiffness of the neck, hoarseness of the voice,

and rawness of the throat."

The temperature in this disease is more increased beyond the standard of health than even in typhus: in the more violent cases the thermometer rises to 108, 109°, and 110°, and it has been seen by Dr. Currie as high as 112°, the greatest heat which he ever observed in the hu man body. During this stage the cold affusion may be applied in its utmost extent, and with the most decided advan tage. The efflorescence on the skin, and the ulceration in the throat are speedily removed, and the secondary syniptoms, which are so peculiarly distressing, are entire prevented. To the benefit which has been supposed to arise from the employment of bark in this disease, the author evidently attaches but little credit, and he agrees with Dr. Withering in reprolating the application of blisters to the fauces. He also coincides with this

excellent physician in recommending the early use of emetics. The author details at length an account of his practice in some particular cases of this disease, which, together with the former observations of Dr. Gerard, place the importance of the cold affusion in scarlatina beyond the possibility of doubt, and in our opinion render all farther evidence upon the subject superflucus. Viewing the matter in this light, we are inclined from Dr. Gregory of Edinburgh, might to think that two long, gossiping letters have been omitted without any deuriment to the work. We do not perceive that they contain a single piece of information in any way interesting to the public, and we cannot but suspect that the learned professor must regret to see them in print.

At first view it might seem that the practice of the cold affusion would require no farther testimony in its favour than what may be deduced from the experience of Dr. Currie himself. It must, however, be acknowledged, that not a few cases have occurred in the history of medical science, where persons of learning and respectability have proposed the adoption of new remedies, and cited what have appeared the most unequivo cal facts in their favour; yet, in "other hands, the desired effects have not been produced. We think, therefore, that Dr. Currie has acted with great propriety in presenting the world with an abstract of the experience of others in the use of the cold affusion, who from their situatica cannot be suspected of any undue prejudice in its favour.

He first gives us an account of the communications which he has received "respecting the use of the cold and tepid affusion in different parts of Great Britain." The author makes a remark, to the truth of which we are sorry to be obliged to subscribe, that the practice has been more coldly received in London than in most other places. It has, however, at length excited some attention among the metropolitans, and we have a very complete testimony in its favour from Dr. Dimsdale, late physician to the London house of recovery. The value of this communication, however, depends more upon its exactly coinciding with the experience of Dr. Currie, than from azy new light which it throws upon the application of the remedy. The practice appears also to have been followed to a considerable extent, and with equal suc