struction. These cases demonstrated not merely the existence of this class of diseases, but proved with what violence of symptoms a simple affection, not possessing any diathesis, can assume the appearance of a severe malady. The great infrequency of similar affections, however, ought to convince us, that, in most cases, the irritative agency of the first cause, however slight or transient, is soon followed by processes that constitute an affection of diathesis, independent of its cause, and no longer curable by its removal. All the intermittents were cured, although in many of these, a chronic inflammation of the liver or spleen, required the long-continued use of antiphlogistic measures. We were equally successful in the catarrhal and synochal affections, although many of these exhibited symptoms which would have rendered the application of depressing measures much less steady in the hands of any practitioner who was not convinced (as I have long been) that all these affections, viz. synocha, synochus, and typhus, are mere varieties and degrees of the same disease; and that it is by the employment of an opposite plan of treatment that the simplest synocha is often converted into the severest typhus." Prospetto, pp. 21, 22, 23.

In illustration of this last statement, he adds, in another place

"It is a fact that, during the period when exciting remedies were so much used in febrile affections, nervous and typhus fevers were not only more frequent, but the mortality from them much greater, being never less than 18 or 20 per cent. The diminution of mortality during the latter years, throughout Italy, since the establishment of the antiphlogistic treatment, has been wonderfully great; and we see in the results of the table, given above, that the mortality in nervous fever, in our clinical wards, has been less than eight per cent." P. 25.

1

He says that acute inflammatory diseases are those most prevalent in Bologna, particularly during the winter. Those admitted into the clinical hospital consisted of a few cases of exanthemata, (which Tommasini considers in all their forms simply as inflammatory affections of the skin and vascular system,) rheumatism, gout, &c. the remaining being affections of the internal viscera. Of these latter, the diseases of the chest were most numerous. Of 115 pneumonic subjects, 14 died; and of the whole 209 cases of acute inflammation, the mortality was 10 per cent. On the subject of blood-letting in these cases the author makes the following remarks:

"In some cases of uncommon obstinacy, or of relapse, occurring in strong constitutions, the repetition of venesection must keep pace with the pertinacity of the disease. But, in general, I am unwilling to have recourse to an extraordinary number of bleedings, because I am of opinion that there is a term beyond which the continued

application of contrastimulants may be necessary, and yet bloodletting not be so; and because I have found so potent a succedaneum in the use of kermes mineral, nitre, squills, acetate of potass, and laurel water." P. 27.

In most cases, he says, even the most severe, he rather trusted to the use of remedies positively sedative, than to profuse abstraction of blood. He briefly refers to the particulars of many of these cases, wherein blood-letting and other antiphlogistics were freely used, even in the last stages, and with decided benefit, even in the most unpromising cases. In one instance of a peripneumony arising during the progress of a most severe nervous fever, he mentions the success obtained from "the continued use of the antiphlogistic regimen, even to the last, and in defiance of the mortal symptoms of physiological debility." In a case of what he calls "acute pneumo-trachitis," he says, that "neither the long-continuance of the disease, nor the prostration of strength and emaciation, prevented the continued application of depressing measures, stibiated tartar and kermes in large doses, antiphlogistic beverages, and bleedings patiently repeated ;" all of which cured the disease, and prevented the accession of a tracheal phthisis that appeared inevitable. He mentions a third attack of peripneumony in a woman who had been bled seventeen times in the former attacks, but who was eventually cured by the perseverance in the depressing plan, including even venesection." P. 33. In another case he mentions having bled a man eighteen times, and with final success. In a case of most severe synochus, he bled fourteen times, besides using, at the same time, "various remedies all unequivocally of the class of depressing or contrastimulant." P. 34. We shall conclude with the following case detailed somewhat more at length.

66

"A woman came into the hospital on the 11th day of a peripneumony, which had been entirely neglected hitherto, and was consequently now very violent. The patient was old, the respiration sonorous, the quantity of expectoration surprisingly great, the pulse small, and the physiological prostration of strength great. In these circumstances, nevertheless--confident in the maxim, (confirmed to me by a thousand cases, and a thousand dissections,) that inflammation is always one and the same, and, where curable, curable only by antiphlogistic means-so far from attempting to excite the depressed powers by stimulants, I employed bleedings proportioned to the patient's condition; and, encouraged by the resulting amendment, repeated them to the fourteenth time, and with complete success."

It may be here necessary to observe, that the bleedings mentioned in the above cases were probably what we should call

very small, although the author nowhere mentions the quantity of blood taken. Dr. Clark, in his excellent and amusing work on the climate of France and Italy, in speaking of the practice of this very place (Bologna) remarks as follows:

"Their treatment of pneumonia differs chiefly from ours in taking away smaller quantities of blood at a time, which necessarily requires the evacuation to be more frequently repeated. This does not appear to arise from a fear of taking away too much blood, for they seem liberal enough in the use of the lancet. This practice is not peculiar to Bologna. In going round one of the hospitals of Rome, with the physician, we came to a young plethoric man labouring under inflammation of the lungs. He had been in the hospital twenty-four hours, and had been bled three times,twice to seven, and once to six ounces, and had had four blisters applied, one to each arm and one to each thigh. On inquiring what he expected from the numerous blisters, he said they were contrastimulants."-Medical Notes, p. 201.

After stating briefly several other cases, no less strikingly illustrative of the new doctrines than the above, he comes to speak of dropsy; and it is truly gratifying to find the pathology and practice in this disease, lately so much the subject of investigation in Englaud, so well understood in Italy.

"Neither is the dropsy curable by any other means, when it is the result of the chronic inflammation of the viscera or glands, or of the superficial phlogosis of the internal secreting surfaces, as is the case in the greater number of instances." P. 43.

"But were there no examples of asthenic diseases, namely, diseases produced and maintained by defect of stimulus, or by the diathesis of contrastimulus? Such diseases assuredly were very few, as may be seen from the table. This is no fault of ours; but the fault of an erroneous theory that formerly led men t see things otherwise than they were in nature. To prove the rarity of such diseases, it is enough to mention the single fact, that of a hundred dead bodies, of all diseases, 95 will exhibit either actual inflammation, or its traces, or its relics." P. 44.

But we must here conclude this already too extended article-congratulating the medical profession on the progress of a sounder philosophy and practice throughout the world, -congratulating Italy, more especially, on the superiority of her therapeutics over those of many of her continental neighbours and expressing an earnest hope, that the present fervour of her sons in the cause of contrastimulants and antiphlogistics, may not lead them beyond the bounds of prudence to be again the victims of their misguided zeal, and to afford once more, amid the ruin wrought by their errors, the occasion for yet another new doctrine, to flourish and to fall, like those that have preceded it.

ས.

Observations on those Diseases of Females which are attended by Discharges. Illustrated by Copper-plates of the Diseases. By CHARLES MANSFIELD CLARKE, Member of the Royal College of Surgeons, London. Part II. Octavo, pp. 243. Four Plates. Lougman, London, 1821.

"Helleborum frustra, cum jam Cutis Egra tumebat,

"Poscentes videas ;-venienti occurrite morbo."-Pers. Sat. 3.

THIS work was long promised by the author, and anxiously expected by the profession. The majority of medical works, nowadays, are written to procure, not to record, practice, like a surgeon, some 20 years ago, who advertised a book in the press, on a particular operation, in order thereby, to get some cases to compose the work, not really commenced in manuscript! When, therefore, a practitioner, of Mr. Clarke's standing and experience, condescends to lay open the results of his observations to the public at large, we naturally attach a comparatively high degree of importance to the publication, as one that will not be likely to lead us astray, though it may fall short of the expectation which we too sanguinely indulge, respecting the productions of men standing high in professional rank and reputation. The name of Clarke, too, has long been associated with obstetric studies and pursuits, the gifted brother of the present author having left an indelible impression on the minds of all his numerous pupils. Alas poor Yorick! He, whose wit so often set the class-room in a roar, is now, in his turn, chap-fallen and silent! A few years more, and those who still cherish his memory, will also sink in the tide of time, never to rise again! But it is useless to repine. The whole frame of Nature and all its minutest parts are undergoing the same revolutionary process, and eternally changing forms, by an irresistible action and reaction of their own constituent elements. The sea sends forth its rains, that soften, and wash, and wear down the hardest rocks, and highest mountains while these debris in time accumulate, and encroach on the dominions of the ocean. Changes and contentions of this kind, are going on in every thing, from the continents and seas of the earth, to the solids and fluids of an animalcula. Man, with all his towering intellect and proud prerogatives, falls into the mysterious circle of transmutation, and nothing is permanent in this world, but the laws which govern its instability!

The first volume of Mr. Clarke's work has now been long before the public, and its contents well known. In the present volume, our author has entered into the consideration of many diseases which, he thinks, have hitherto been but imperfectly discriminated from one another, and treated with little regard to any principles. Mr. Clarke justly observes that, although many of these diseases are invariably fatal, yet the acceleration or retardation of their progress depends upon the knowledge of the practitioner. Many of them, too, are accompanied with great pain-and, whether that pain is to be aggravated or subdued-whether the patient is to be allowed to expire in torture, or slide into eternity with mitigated suffering, will be determined by the information of the medical attendant, and his acquaintance with the means of diminishing those physical ills to which humanity is subject, These are cogent reasons why the medical practitioner should allow no opportunity of augmenting his knowledge to pass unimproved. Neither should he proudly and obstinately rely on his own observations alone, but listen meekly to the suggestions and remarks of others also; for it has been wisely said, that as "the greatest friend of TRUTH is Time, so her greatest enemy is Prejudice, and her constant companion, Humility."

Mr. Clarke has comprehended all the discharges from the vagina under the following five heads, viz, Transparent Mucous Discharge-White Mucous Discharge-Watery Discharge-Purulent Discharge-and Sanguineous Discharge.* The first, or Transparent Mucous Discharge, has been treated of in the preceding volume, and to that we must refer. Our next subject, therefore, is the

1. White Mucous Discharge. Our author has defined this to be opaque, and perfectly white in colour, resembling a mixture of starch and water, or thin cream, easily washed from the finger, and capable of diffusion in water, rendering the latter turbid.-This discharge appertains to but one morbid state of the uterus, but characterizes that state very constantly. It probably results from a morbid state of the glands of the cervix uteri, for when pressure is made upon that part, the woman complains of considerable pain. The examination of this discharge should be made when the patient has been some time quiet, for the transparent mucus, if

*Mr. Clarke very properly excludes from his classification, gonorrhoea, for what could be more absurd, than to term that a "disease of females.” which is equally common to both sexes?