perplexed the followers of these great men, involving them in the obscure research of causes, and misleading them from the more tranquil study of effects, and from that plain method of induction which can alone be the groundwork of the medical art. The new doctrine is better calculated than the Brunonian to inspire confidence at the bed-side of sickness, because it does not reject many of the old and established modes of treatment, because it proscribes all abstract opinions, and because, having grown up more in practice than in study, it rejects many of the palpable errors which the pride of theory maintained against the commonest observation of facts." Della Nuov. Dott. p. 3.

"This new Doctrine," he says in another place, "was born in Italy; on this soil, ever fruitful in useful discoveries in every branch of science and art, it has grown up; and it looks to the united zeal of Italian physicians for its highest possible perfection." Ib. p. 43.

In Italy, the very great contrast between the new doctrines and the old,—and yet more, between the new practice and the old, naturally give to the former a great appearance of novelty; but in this country, in which the Brunonian system was never prevalent, these pretensions cannot but seem overstrained.

This will appear sufficiently obvious, from the following brief sketch of the New Doctrine, which we shall give without noticing, in general, its relation to former and existing systems.

Agents are conceived to operate on the living system in two different and opposite ways; the one set (the stimuli of Dr. Brown) exhausting the excitability, and thus producing excitement; the other (the sedatives of the Cullenian school) lessening the excitement without any previous or accompanying stimulant operation whatever, and in a manner equally direct and independent. The forme class of agents are called stimulants, the latter, contrastimulants; and the general state of the system, or diathesis, produced by their respective operation, is called stimulant and contrastimulant.

The immense Brunonian class of diseases from indirect debility is reduced, in the new system, to a very insignificant number indeed; and the great influence of this, as a general source of diseases, is declared an illusion. Thus almost all fevers, and all inflammatory affections, in every stage, are considered, by the new school, as uniformly and invariably sthenic. In the New Doctrine, the nature of general diseases is considered (in opposition to the schenie of Brown) to have no necessary dependence on the nature of the cause; and local affections no necessary similarity to the existing diathesis. Thus, a sedative power may give rise to a disease of excitement, and an accute local inflammation may arise in a most debilitated system.

The class of agents named contrastimulants are thus described by Tommasini :

"They act on the living fibre in a manner directly the reverse of stimuli, and immediately produce those effects on the excitability which Brown derives negatively from the diminution of stimulation. They remove the effects of excessive stimulation, and without any (necessary) evacuation; and, when used in excess, produce diseases which can only be removed by the use of stimuli : in their remedial effects, therefore, they operate like blood-letting and purgatives, and other evacuating measures."

The two classes of agents, stimulants and contrastimulants, reciprocally correct each other's effects. The measure of the existing diathesis is afforded by its capacity to bear agents of the opposite class; and this degree of tolerance is a much better index of the nature and degree of the diathesis than the symptoms are.

A condition of the system neither stimulant nor contrastimulant may exist, consisting rather of a disturbance of action, than of an increase or diminution of action. This state is called irritation, and the diathesis irritative. The number of diseases depending upon this state are very few; the great majority belonging to the stimulant diathesis.

Pain, and certain other nervous affections, exert a great influence in modifying diseases. In acute diseases, these sensorial affections often act as contrastimulants, forbidding, for a time, the employment of other contrastimulants, which are indicated both before their occurrence and after they have passed off.

In the new doctrine, the phenomena of inflammation hold a most conspicuous place; and as well on this account, as because the subject can never be too much impressed on the minds of practitioners, we shall notice this part of the system somewhat more at length. With this view we shall avail ourselves of the larger work on inflammation, by Tommasini; and, in glancing over it a second time, shall put down a few of the more prominent subjects discussed, in the order of their occurrence, and without much connexion.

All inflammation is the simple product of excess of stimulus; all its characters as traceable to this, from the "primissimo rubore" to the extreme of disorganization. All inflammations, therefore, are uniformly, and in all circumstances, sthenic; and as the phenomena of the greater number of fevers, and of all the phlegmasiæ, are (contrary to the dogma of Brown) considered to depend on a primary local inflammation, this doctrine must be of immense importance in the practice of medicine. Perhaps no part, once inflamed, ever returns to its original soundness, although it appears to do

so to our imperfect senses. This is proved by the proclivity to disease or rather the augmented excitability-remaining in a part that has been once inflamed; and is not the less true, although contrary to the usual laws of habit and the Brunonian doctrine of exhaustion. By this means, a new temperament or idiosyncracy, general or local, may be produced. Inflammation in its duration retains no relation to the operation of its cause, but proceeds much less influenced by the state of the general system, than the system is influenced by it. In a case of mere stimulation or excitement, (as in the condition resulting from violent exercise, ebriety, sun-stroke, &c.) the subtraction of the cause removes the effect; but when once inflammation is by any of the same causes lighted up, it will hold its course, in a certain degree at least, however the cause be withdrawn. Inflammation is, therefore, an independent process; a fact which is farther proved by its arising in the most debilitated subjects, as after hæmorrhages, and in the last stage of febrile diseases. All authors, from Galen to Darwin, with the exception of Brown, considered inflammation as always a state of increased action; the error loci, the spasm, the obstruction, &c. &c. of different systems, being merely the antecedents or causes of the inflammation, like the thorn of Van Helmont, or the stimulus of Haller. All practical writers admitted the various kinds of inflammation, as modified by the varying state of the general excitement, the character of the part, &c. but still they considered the action of the affected part as increased. Brown alone conceived the idea of asthenic inflammation. It is true that two opposite general states of the system (diathesis) cannot coexist; but the coexistence of a state of general debility with a local excess of stimulus, and vice versa, is very comprehensible. Although local inflammation is, in a certain respect, independent of the diathesis, still it is influenced by the latter, and vice versa. Thus, if the general excitement be morbidly high, this will augment the local inflammation; if the general excitement is moderate, it will be increased by the local excess of stimulus; and if the general excitement is very low, it will lessen the degree of the local stimulus. It is this last way in which general antiphlogistic treatment relieves local inflammation. In judging of the nature of a disease it is of great importance to distinguish between its primary essential characters, and its ultimate condition, or consequences. Gangrene and sphacelus are assuredly very unlike inflammation in many respects; but there was a time when these very processes were inflammatory and curable, if curable by antiphlogistics. On every account, therefore, both in a pathological and practical point Vol II. No. 8. 5 E

of view, it is of the utmost necessity to watch the beginning of diseases.

"E duopo abituarci a prevenire con attività i passi ulteriori ; ad agir con prontezza, trattandosi di violenti malattie, in que' primi momenti, i soli pur troppo che prestino un filo alla diagnosi, i soli a mio avviso che debbano considerarsi preziosi per l'arte, e per l'umanità." Dell' Infiammazione, p. 111.

Of the application of these new doctrines to practice, in the Italian school, we are furnished with an interesting exemplification in the third work of Tommasini, named at the head of this article. This, as will be seen by its title, is a brief report of the practice in the clinical wards of the university of Bologna, for the three years ending in 1820, delivered by the author in the form of a lecture to the students. With a transcription of the Professor's list of diseases, and some of his remarks, we shall conclude this article without any further comment of our own. It must appear to all that the new practice is very superior to the old; but many will be disposed to fear, with ourselves, lest it be carried too far, if it has not been so already, The Italians ought to recolJect that their country was once before inflamed from a neglect of the maxim-in medio tutissimus ibis-and pronounced too by the very god of physic.*

*The doses in which medicines are exhibited by the Italian Physicians, are so enormously large, as almost to exceed credibility. As a specimen we insert the following list, which, we are assured, was furnished by Dr. Carlo Bellati himself, one of the most distinguished of the physicians of the hospital at Pavia :

Tartar emetic, from half a drachm to three drachms daily.

Extr. of aconite, from two grains to three ounces (he must mean drachms) daily.

Digitalis from two to six grains daily.

Gamboge, from six grains to thirty every three hours.

Cream of tartar, three ounces a day for a month.

Muriate of lime, from a drachm to half an ounce daily.

Extr. of henbane, from two grains to twenty-four every two hours.

Carbonate of soda, a drachm to an ounce daily.

Carbonate of ammonia, half an ounce daily.

Powder of nux vomica, from a grain to one drachm daily.

The same of the extract.

"I can hardly believe," says Rasori, "that the toleration of such large doses of emetic tartar will be attributed to any want of strength in the medicine. The physicians of Genoa know that the tartar emetic of their apothecaries, prepared from the glass of antimony, produces vomiting in doses of two or three grains."

In the management of sthenic or inflammatory dropsies, whether anasarca, ascites, or hydrothorax, Rasori gave large doses of the tartrite of antimony, with nitre and diluents, which, joined to abstinence, were productive of the

LIST OF DISEASES.

Acute Inflammations, including 15 cases of rheuma-
tism and eight of exanthemata

Chronic inflammations, including 13 cases of dropsy 38
Synochal and catarrhal fevers -

Synochus, nervous, or typhus fevers

Severe acute diseases from defect of stimulus

Simple intermittents, or combined with physconia

209

21

5

35

57

4

45

"Of the above diseases," the author remarks, "the least severe were the 35 cases of synochal and catarrhal fevers, the 45 intermittents, and the 11 painful, convulsive, or febricular affections, manifestly merely irritative in their nature. These last were all cured by the removal of the exciting cause, either by its expulsion or de

best effects. Some of the patients took daily seven or eight grains of emetic tartar, with an ounce and a half or two ounces of cream of tartar in divided doses. In other cases, thirty grains of jalap with cream of tartar were given in the same way.

Tommasini, however, acknowledges that diseases decidedly sthenic, and requiring the depletive plan, fall sometimes, in the course of the phlogistic process, into a state of temporary but evident "counter-stimulus," in which they will not bear that depletion before tolerated, and subsequently again required. This state, he thinks, is often produced by pain, and by some other secret pathological condition, not yet detected. See Bell, in Dr. Chapman's Journal, No. 5, for November, 1821.

Surgical? We believe visi strumentali, which the reviewer has queried, does not mean surgical, but organic diseases. In a work of Professor Barzellotti, published last year, he has arranged diseases into two classes-those of increased, and those of diminished action. The latter are subdivided into six orders, the fifth of which contains those vizi strumentali, the literal translation of which would be" organic derangements," but which he has thus defined: "Derangements of the functions of the most important organs, (namely, of the brain, heart, lungs, and chylopoietic viscera) which have not been produced primarily by any disease in the organs themselves, and which are not symptomatic of any of the other diseases before arranged." He then gives a list of the diseases comprehended in the above term, among which we observe asthma, angina, pectoris, pertussis, &c. &c. &c. Ed.