The fracture of the apophyses of the scapula, the rupture of muscles, and of tendons, form, it is true, exceptions to this rule. The capsular ligament is, in every case of luxations effected by external force, ruptured according to the experiments and observations of our author.

After the head of the humerus has been forced in the way pointed out, from the glenoid cavity and capsule, and the dislocation effected, it may take three different positions, according to the quantity and direction of the force applied; downwards and forwards in the axilla; upwards and forwards under the clavicle; and in some rare cases, downwards and backwards between the scapula, and ribs.

In reducing the dislocation of the humerus, he recommends the extension to be made upwards, and a little forwards, in the direction of a line passing between the tendons of the subscapularis and teres, minor. The arm, therefore, must be elevated and sustained by the surgeon, who pulls upwards, while an assistant supports the inferior angle of the scapula with one hand, and with the other depresses the acromion. The surgeon also having made the necessary extension, may assist the reduction, by pressing the fingers of the other hand on the humerus in the armpit, while he suddenly depresses the arm. Where a greater force is necessary, the rope and pully may be used, after the manner of Mr White.

III.

Observations on the Preparation, Utility, and Administration, of the Digitalis Purpurea, or Foxglove, in Dropsy of the Chest, Consumption, Hemorrhage, Scarlet-Fever, Measles, c.; including a Sketch of the Medical History of this Plant, and an Account of the Opinions of those Authors who have written upon it, during the last thirty years. By WILLIAM HAMILTON, M. D. Physician, Bury, St Edmunds, Suffolk. Illustrated by Cases. London,

1807. 8vo. pages 214.

DIGI

IGITALIS is a medicine now in very general use. There still, however, exists some difference of opinion amongst medical practitioners, not only with respect to the general action of this drug on the system, but with regard also to its administration in

particular

particular diseases. Much information has certainly been accumlated, since the publications of Dr Withering and of Dr Ferriar, the only monographers on the virtues of the digitalis. A variety of cursory observations, now scattered in the writings of physicians, and in the medical journals, deserved to be brought together. The task has been undertaken by Dr Hamilton. He has himself had considerable experience of this remedy; and, without indulging in fanciful speculations, he has brought tother, in a plain and instructive form, all that can be collected from published documents relative to the effects of digitalis, and its administration in diseases. His object has been, "to collect under one distinct view, and attempt to reconcile the contrariety of opinion that at present prevails, respecting the use of this medicine; to ascertain, as far as experience will permit, the diseases in which it may really be expected to produce beneficial effects; and to give such an account of its preparation, and mode of exhibition, as may render it as invariably to be depended upon as the nature of the disease to which it is adapted, and the ever-varying state of the human body will admit."

In the first place we are, with great propriety, presented with a sketch of the medical history of digitalis, in which the observations and opinions of Dr Withering, Dr Darwin, Dr Ferriar, Dr Currie, Dr Beddoes, Dr Drake, Dr Fowler, Dr M'Lean, Dr Mossman, Dr Kinglake, Dr Reid, and others, are successively brought under review. In distinct sections, our author then proceeds to the consideration" of the cultivation and preparation of digitalis ;-of the exhibition of digitalis, with practical observations and precautions ;-of the utility of digitalis in hydrothorax, and other effusions of water within the cavities of the chest-of the utility of digitalis in phthisis pulmonalis ;—in hemorrhage ;-in scarlatina;-and in measles. An appendix exhibits the histories of several cases of hydrothorax from his own practice, and from that of his friend Dr M'Lean of Sudbury.

The choice and preparation of this plant are circumstances of great importance, and there is reason to believe, too much overlooked, from which arises some share of the uncertainty complained of in its operation. The largest and deepest coloured leaves should be selected and gathered when the flower-stems have shot up. They should be carefully dried, reduced to powder, and kept in coloured bottles, unexposed to the light. The powder ought to be of a fine green colour," and a fragrant smell, not unlike that of new made hay, but stronger." Our author does not think the cultivated plant inferior to the wild, but it is proper to reject the white flowered variety, the leaves of which are of a paler green.

The

The forms in which the digitalis is employed are those of infusion, tincture, and powder. The infusion seems the best when the full diuretic powers of the plant are required. But in most other cases, where the chief object is to reduce the velocity of the pulse, the saturated tincture is preferred, the dose of which can be proportioned, and gradually and accurately increased. The powder has rarely been used by Dr Hamilton; although a form which we have often found the best and most convenient; a form in which it can be so easily combined into pills with calomel, or mixed with the supertartrite of potash, adjuvants which eminently conspire with it as diuretics in dropsical cases. Indeed, these combinations we have frequently known to succeed where the ingredients, given separately, have, in succession, failed. It is allowed, indeed, by our author, that much advantage may be occasionally derived from the powder. "In chronic coughs, dyspnoea, &c. &c. accompanied by considerable expectoration of mucus, and a tendency to effusion into the cells of the lungs, pills formed with the powder will be taken, when the patients cannot be prevailed upon to confine themselves; and notwithstanding that, under such circumstances, a full dose of the medicine must not be risked, it may, nevertheless, in this form, and especially in combination with other means of relief, be productive of considerable benefit."

The general effects of digitalis upon the system, in so far as we are yet acquainted with them, are referable to its extraordinary power of affecting the vascular and absorbent systems, in seemingly very different manners; of reducing the action of the heart and arteries, and of increasing the activity of the absorbents; and in the different diseases in which it is administered, one or both of these are the indications kept in view by the practitioner. Our author very properly avoids the foolish and interminable question, whether the digitalis acts as a stimulant or sedative? He contents himself with the practical fact, that, in certain states of the system, it seems to depress and restrain the action of one set of vessels, while it increases the exertions of another.

It is, however, a circumstance of curious and interesting moment, not, perhaps, very generally known, that a relaxed, weakened, and depressed state of the system, is the most favourable for displaying the full effects of digitalis. Dr Withering had early pointed out the fact, that in persons of tense fibre, and of great natural strength, labouring under ascites or anasarca, the digitalis seldom succeeded; and that, on the contrary, where the pulse was found feeble or intermitting, the anasarcous limbs, and body soft and yielding, the countenance pale, and the skin cold, the diuretic powers of the plant were conspicuous. The obser

vation,

vation, in so far as it regards ascites and anasarca, is confirmed by our author, as we believe it is by general experience. In hydrothorax, however, he asserts that the digitalis succeeded in the opposite state of the system. "Of my patients, several were men of very rigid fibre, and great natural bodily strength; yet the foxglove produced effects upon these equal to what could be expected from it in more enervated habits."

He founds an explanation of this unvaried success in hydrothorax, on the difficult transmission of blood through the lungs, and its partial exposure to the influence of the air in that disease, whence, he supposes, may arise a relaxation favourable to the diuretic operation of the digitalis. This, however, is a sort of circular reasoning: If the system is relaxed and reduced in every case of hydrothorax, the observation of Withering is confirmed and generalized. It signifies nothing how the relaxation is brought about. And we believe, generally, that whatever the natural bodily strength may have been, that most individuals labouring under hydrothrax, are reduced low enough: We say generally, because, great as our faith is in digitalis, and wonderful as the cures are which we have witnessed, we cannot assert with our author, that "we have never seen one case, however advanced or desperate, that was not speedily relieved by it." And the few cases of hydrothorax in which we have unsuccessfully employed the foxglove, have been precisely such as quadrate with the observation, that a state of the system bordering on. what has been called phlogistic diathesis, is unfavourable to the operation of this medicine. They have been recent cases, in persons not much advanced in life, in whom the complaint had come on precipitately. In the three cases to which we allude, the limbs were also anasarcous, but hard and resisting, in one case even painful.

The observation respecting the difficulty of affecting dropsical patients of considerable irritability and tenseness of fibre by the digitalis, we believe to be applicable to every other case in which it is administered, and therefore, to the other general indication for which we employ it, the reduction of the velocity of the circulation.

A certain degree of relaxation and weakness is most favourable for the accomplishment of this indication by the digitalis. “Our attentive consideration," says Dr H. " of the causes which seemed to prevent the operation of foxglove, by which I have so often been foiled, has convinced me that they are to be found in the presence of inflammation, or of a tendency to inflammatory action of the vascular system." Hence it is that in pneumonia, the action of digitalis cannot be depended on till the tone of the

system

system has been much reduced by previous blood-letting; and the same difficulty obtains in phthisis in proportion to the inflammatory disposition of the vessels. "When the pulse is hard and bounding, the countenance flushed, the heat and thirst considerable, and the difficulty of breathing, accompanied with pain of the chest, urgent, little advantage will be derived from the use of this remedy, until these symptoms shall have been removed; nor indeed can the pulse be readily or at all reduced in frequency when they are present, unless the digitalis be given in such ample doses as to produce unpleasant effects," In such circumstances, it is necessary, by an antiphlogistic regimen, first to reduce the tone of the system; and when the propensity to inflammation shall have been suspended, the use of the foxglove may be commenced,

IV.

Observations on the Application of Lunar Caustic to Strictures in the Urethra and Esophagus. By R. W. ANDREWS, M. D. Member of the Royal College of Surgeons, London; late Army Surgeon, and now Physician at Madeira. London, 1807. Svo. Pp. 173.

THIS HIS is a book of cases rather than one of observations, and after what has been already delivered to the public by Mr Home, must be regarded unnecessary, as it is uninteresting and uninstructive. We learn from it indeed, that Dr Andrews has destroyed a great many strictures with the lunar caustic; that he is bold and free in the application of this potential remedy, and that he has a very high opinion of its efficacy. What more can be collected from a constant repetition in the same unvaried style,-that a gentleman applied to him-that five applications of the lunar caustic removed a stricture at four inches-eight or ten, another stricture at five inches-and sixteen or eighteen applications a third at seven inches, after which the catheter passed on to the bladder?

We have already delivered our opinion of this practice in reviewing the books of Mr Home and of Mr Whatley; we deem it therefore unnecessary to enter deeply into the contest with Dr Andrews. We have admitted the advantages of the caustic bou