respiratory organs of a child, whose body was examined by that very zealous and enterprising man.*

If these observations have any foundation in truth, what then becomes of Dr. Duncan's facility of diagnosis? By a physician, enjoying his opportunities of instruction and research, and grown gray in the contemplation of diseases, this invaluable talent may, doubtless, have been acquired; but to the coarser perceptions of ordinary men, such happy powers of delicate and correct discrimination are, we well know, almost universally denied.

Upon this subject we pause, to comment with some earnestness; convinced that mischief, rather than good, must result from such statements, implicitly received and confided in.What, we would ask, can be more likely to excite inquietude and disgust in the human mind, than a sense of inferiority to other men engaged in similar studies and pursuits? or, what calculated more effectually to awaken this painful and humiliating consciousness, than representations like that, upon which we now feel ourselves called to animadvert? Relying upon his powers of discrimination, which he has been told that it is a very easy business to acquire, the young and inexperienced physician hurries to the chamber of his patient; upon his anxious queries, a perplexing and contradictory "tale of symptoms" is unfolded: doubt and obscurity envelop the disease; the fair delusion vanishes; confusion and discouragement take possession of the inquirer's mind. From frequent repetition of his difficulties and discomfiture, he becomes timid and distrustful. First impressions are not easily obliterated: and he may lose, perhaps irrevocably, that self-possession and confidence essential to the physician's success. Nay, he may even quit in disgust, for some less sterile field of science, a path of study which his talents, properly directed on the onset, might have enabled him to explore with signal honour and reputation to himself, and benefit to his fellowcreatures. We have ever been led to consider-we have invariably found the diagnosis of diseases a branch of practical medicine more difficult, and requiring, for its successful cultiva

* See our critique on Dr. Watt's book, at page 169 of the 7th volume of this Journal.

tion, greater skill, and patience, and delicacy, than any other. In fine, the mind of man, in whatever path of science or labour it be engaged, will, we are persuaded, be only stimulated to more vigorous and steady exertion by a correct survey of the difficulties opposed to its progress; while, from an occurrence of unexpected obstacles, for which it has never been duly prepared, nothing but chagrin, indifference or disgust, can, sooner or later, be expected to accrue.

"Observations on the general plan of cure in pulmonary consumptions," form the subject of our author's seventh chapter. Occupied here with the leading indications of cure, which present themselves in the apostematous form of pulmonary phthisis, Dr. Duncan remarks:

"In this species of phthisis then it must be evident, that a first and principal object is to discharge that purulent matter which is collected in the apostema. For accomplishing this, when the cyst remains entire, the first requisite is, that it should be ruptured; and for this purpose, measures may sometimes be advantageously employed by the physician; such, for example, as concussion of the system by the action of vomiting, of coughing, or the like."

On the soundness of this doctrine, or general expedience and advantages of the practical conduct which it is calculated to suggest, our minds, however, have not come to any decisive or satisfactory conclusion. The proximate cause of hectic fever, like that of the other phenomena exhibited by the living system in health and in disease, has hitherto baffled every effort of human genius for its discovery. Yet an opinion has gone abroad, and we are far from considering it destitute of plausibility, that this fever does not invariably or indiscriminately arise from the mere absorption of purulent matter into the system, but from its introduction only, when, from the influence of exposure to atmospheric air, or other unknown and inexplicable change, certain noxious qualities have been acquired by it.

Upon this intricate question, we presume not positively to decide. But, however it be, we have certainly seen large collections of pus deposited in the vicinity of the psoas muscle, or other parts of the body; and, after remaining a considerable time, eventually removed by the process of absorption, without inducing in the system the phenomena and ravages of hectic

fever: and in a case of abscess of the lungs, however considerable, we have reason to believe, that the peculiar and distinctive features of this morbid state are rarely or never developed, until purulent expectoration has been decidedly established. Complete absorption of pus from a large pulmonary abscess, the efforts of Nature, or resources of art, are, we apprehend, seldom adequate to accomplish; yet by the bare possibility of an occurrence, thus fortunate, we are surely warranted to regard the attempt to procure it as our first indication in the treatment of such disease. Preparations of quicksilver, foxglove, counterirritation established in the vicinity of the purulent deposit, offer, perhaps, in this view, the fairest prospects of success. It should be recollected, that by the rupture of a vomica, even under circumstances the least inauspicious, a patient is unavoidably brought into a situation of pressing danger.

To the interesting subject of tuberculous phthisis, as connected with morbid enlargement of the mesenteric glands, not the slightest allusion is made by Dr. Duncan. This is surely an inexplicable omission; and may be justly pronounced to constitute another very striking defect in the outline and execution of his work.

That a morbid condition of the mesentery and the tubercu lar modification of pulmonary consumption are frequently complicated in the same individual; that the phenomena, peculiar to these forms of thoracic and abdominal disease, do clearly and conspicuously alternate with each other; are facts as firmly established on the basis of correct observation, as any with which the science of medicine is enriched. We need only watch with sedulous eye the varying features of tubercular consumption, to be convinced of the one; or examine the lungs and mesentery of a few deceased pulmonics, to obtain satisfactory demonstration of the other. Now, by some physicians of great experience, and high practical authority, it is contended, that the tubercular disease of the pulmonary organs is ever and invariably complicated with, and in fact, should be regarded as a consequence of, the mesenteric affection. These doctrines involve many and most important questions; we shall, therefore, pause for a while, to examine the validity of the ground on which they rest. In the first place we may remark, that disease of the mesenteric glands has frequently existed

long in its most dire and destructive form, where no disorder of the pulmonary organs was observed during life, nor the slightest deviation from their natural structure detected after death. Secondly, In the abdomen of subjects, who have perished from tubercular phthisis, alike severe and protracted, vestiges of morbid alteration have frequently been sought for in vain. For the accuracy of these assertions, we might appeal to many a long and lonely dissection, which the hand, now inditing them, has performed. How far they serve to invalidate the the correctness of the proposition by which they have been porvoked, it is needless to expose.

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Again, in the phenomena of diseased action, as in all the operations displayed upon the great theatre of the universe, the link which connects the successive changes is generally so delicate, so difficult of detection by our coarse and imperfect organs, that we have no means of estimating with precision their mutual relations, or the influence which one must essentially exercise on the production of another. Nor, even where one change or one set of phenomena invariably succeeds another, is it necessary to infer that the last in order is dependent solely for its existence on that which precedes it; or, in other words, that they should be beheld in the absolute relation of cause and consequence. But we have shown, that disease of the mesentery, however long established, is not always followed by a tuberculated state of the lungs: and, on the other hand, that the pulmonary affection may assume its most aggravated and fatal aspect, without having been, in the slightest degree, preceded by the abdominal malady. The application of this reasoning to our argument is at once striking and correct; its hostility to the opinions we are assailing, equally obvious and decided.

Moreover, were tubercular phthisis, in all cases, dependent on a pre-existing state of mesenteric disease, the pulmonary affection should surely yield, if not wholly, at least in some degree, to the remedies which are employed with success to palliate or remove its cause. This, according to our experience, is not the case. A patient presents himself to us, in whom these forms of thoracic and abdominal disease are obviously complicated. We succeed, by the employment of the appropriate remedies, in relieving the pain, and tension, and irritation

characteristic of the latter; but the peculiar and more formidable features of the pulmonary affection are commonly, in a proportionate degree, aggravated. Palliate the latter, and the mesenteric symptoms will soon resume their original preponderance and intensity. How little does the remarkable propensity of these diseases to alternation bespeak the influence of those laws which are generally observed to regulate the operations of cause upon effect, and decide the obedience of the latter to the impulses of the former.

Lastly, it is certain, we repeat, that in many cases of tubercular consumption, mesenteric disease does exist, or has previously existed. But, perhaps, in all such cases, it will be most consonant to sound observation and correct reasoning, most useful in the views and decisions of practice, to behold them, not in the relation of cause and effect, but as the co-existing consequences of one common and yet unknown morbific agent. We cannot refrain from an expression of surprise, that to a man, possessing Dr. Duncan's field of inquiry and talent for discrimination, the experience of "more that half a century" should not have suggested some views, however faint or limited, of this striking and momentous connection between pulmonary and mesenteric diseases.

The eighth and concluding chapter presents our author's "Observations on particular practices employed in Phthisis Pulmonalis." These are extended to very considerable length; and our strictures have already so far transgressed the limits of ordinary criticism, that we must not allow ourselves to enter into any particular comments upon them. Among the more important remedies in this disease, he considers venesection; blisters and issues; emetics; refrigerants, as the vegetable acids and nitrate of potass; digitalis; milk diet; sea voyages; the bark of cinchona; vegetable balsams; myrrh; mercury; sarsaparilla; mezereon; tussilago farfara; lichen islandicus; conium; mineral water; and pneumatic medicines. Of all these he treats in succession: and the relative merits of each, and their correct applicability to peculiar circumstances of the disease, appear to us to have been appreciated and pointed out, by Dr. Duncan, with no common share of acuteness, accuracy, and candour.He thinks favorably of the effect of inhaling the vapour of sulphuric ether, in which the dried leaves of conium maculatum VOL. VI. 2 F

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