14 ported by any juft evidence, and leading to no useful conclufion. Mr. Mill agrees much more with the author in his attach ment to the fyftem of perfectibility, which one of our countrymen carried to fuch extravagance. We do not, however, fee any great objection to what is faid in its praife, either by M. V. or his learned tranflator. From their remarks we collect, that they are no further advocates for it, than to regard it as a truth, that the human race in general is always advancing to a higher ftate of perfection, but subject to hindrances and interruptions, which may, for a while, make its movements appear retrograde. Now it is furely not to fuch a fyftem of perfectibility that fuch horrible confequences have been afcribed, as Mr. Mill infinuates. The great objections to the fyftem, are the evils to be apprehended from conceiving the perfectibility of man to be fo invariably and conftantly progreffive, as that ancient eftablishments, and tried opinions, and fixed ftandards of religion and morality, are all to be facrificed to the luft of novelty, prefuming upon improvement, when change only is made, and are all to be condemned in a mafs, merely on account of their antiquity. Many certainly rendered diftracted by the fafcinating promifes of this fyftem of perfectibility, confidered the eventful period of the French revolution as a moment of universal reformation, in which old things were, merely as fuch, to be done away, and every thing indifcriminately made new: but M. Villers allows, that the fyftem is often interrupted in its progrefs by cafual convulfions," and "violent fituations of affairs." We fhould hope, therefore, that though he might have good reafon to affert, from the afpect of fome things in the French metropolis in the year 180, fuch as the numerous and magnificent inftitutions for the advancement of general knowledge, the great encouragement given to the tudy and improvement both of the ufeful and fine arts, and other objects of this nature, that our age is far before that of the Goths and Vandals, he could not be unmindful (though he was wife to suppress it) that he was writing amidst the fpoils and the plunder of Rome, and Florence, and all Italy; in a place where the Chriftian fabbath had been abolifhed; the temples of God, beyond every thing that was before heard of, polluted and abused; atheifm publickly avowed, and publickly approved and applauded; juftice vio lated and trampled on; the moft amiable feelings of our nature treated with derifion; virtue, honour, and common honesty discountenanced and degraded; and under a chief who who could, with equal eafe, be a Muffulman in Egypt, and a faithful fon of the Pope at Paris! Such interruptions in the fyftem of perfectibility deserve confideration. That Chriftianity itself is a fyftem tending always towards perfection, we moft firmly believe; "That in God's heaviest worldly judgments, there may lie hidden. mercy," as the excellent Hooker fays, we nothing doubt; and that in his own good time he will bring great good out of all the evil that happens through the folly and perverfenefs of man; but that there is nothing fixed; nothing yet known or difcovered, but what is capable of improvement, we do not believe. New fyftems of religion and morality we require none. Here the fyftem of perfectibility, in our efti mation, can have nothing to do, but with the practical effects of the duties and obligations of which the world has long been in poffeffion. We want no modern refinements to instruct us how to worship God more devoutly, or love our neighbour more fincerely, than our Proteftant ancestors; we want no modern refinements to difcover for us a higher principle of obligation to enforce thefe duties, than the known tendency of the Chriftian precepts to promote the good of mankind, and the affurance that they have been enjoined us by the everlafting SON of GOD, Incarnate! ART. VIII. A Clinical Hiftory of Difeafes, Part First, being ft. A Clinical Hiftory of Acute Rheumatisms. 2d. A Clinical Hiftory of Nodofity of the Joints. By John Haygarth, M. D. F. R.S. c. 8vo. p. 168. 5s. Cadell and Davies. 1806.. THE HE author has been accuftomed, he fays, to take minutes of the cafcs he attended, in the chambers of the fick, nearly for forty years, and to mark the effects of the medicines that were given, in a manner fimilar to that used by the late Dr. Heberden. In thofe minutes, "The feasons and the fexes are always," he fays "mentioned, a full account of the remedies, is commonly given. The antecedent duration of the disease, is, generally, the age of the patient, the effect of the remedies, and the termination of the disease, are frequently noted." From this register, he has extracted for the prefent publication, fuch obfervations as he finds recorded on acute rheumatifins, and on nodofity of the joints. Of Of 470 rheumatic patients, 170, or about a third of them, were afflicted with acute rheumatifm. Of these 97 were mates, and 73 females; the proportion nearly as four to three; this he fuppofes to be occafioned by inen being more exposed to cold and damp, the most frequent caufes of the complaint, than women. No age is exempt from the difeafe, but the greatest number of the patients were between the ages of fifteen and twenty years. It also makes its attack at all feafons of the year, but fomewhat more frequently, as might be expected, in the winter, than in the fummer months. Ordinarily, acute rheumatifm makes its attack almoft immediately after the occurrence of the circumitance giving rife to it. Perfons, therefore, who attribute their complaint to a cold. taken a month or fix weeks before the fymptoms of rheumatifm manifefted themfelves are, the author thinks, miftaken in that point. In a great majority of cafes, the disease affects the joints only, in fome the joints and mufcles, and in a fmall number, the mufcles only. In most of the cafes, the colour of the skin was little, if at all altered; in a few, the fkin appeared to be inflamed. The urine in rheumatic fever is high coloured, when voided; on ftanding, it depofits a copious, brownish red fediment, like brick duft, very fimilar to the urine voided by patients in agues or intermittent fevers. The pulfe beat generally from 84 to 107 in a minute. In fome it beat 120, and, in a fmall number, 130 ftrokes in a minute. Blood drawn from rheumatic patients. was generally covered with a dense fizy cruft. The remedies the author generally found to have been ufed before he faw the patients, and which he employed in the early part of his practice, were bleeding from the arm, or with leaches, preparations of antimony, the compound powder of ipecacuanha, and the cicuta, and thefe medicines were generally continued until the complaint was fubdued. After a few years, bleeding, and other evacuants, as emetics and eccoprotics, were only adminiftered by the author preparatory to the exhibition of the bark, to which the cure was principally trufted. This mode of practice the author learned, he fays, of Dr. Fothergill. To Dr. Fothergill it had been fuggefted by Sir Edward Hulfe, who, in his turn, received the first intimation of it from Dr. Morton. We will give the author's manner of exhibiting the remedy, and the refult, in his own words. "For feveral years," he fays, p. 66, 66 my ufual method of treating the acute rheumatifm has been to give either the antimonial powder or tartarifed antimony, generally the former, till the the ftomach and bowels are fufficiently cleanfed. Without waiting for any other evacuation or abatement either of the inflammation or the fever, I order the bark; at first in small doses, and if they fucceed, gradually in larger. But if the bark in any ref pect difagree, or even if it do not produce manifeft relief of the fymptoms, the bark is always fufpended, and the antimony again repeated, till it fhall have produced fufficient evacuations. After the ftomach and boweis have been well cleanfed a fecond time, the bark is adminiftered again in like manner, at firft fparingly, and then more freely. But it is never continued longer, nor in a larger quantity, than what perfectly agrees with the ftomach, the fever, and the rheumatic inflammation. If doubts occur on any of thefe points, recourfe has been had to bleeding by the lancet, or leaches, or both, and to more evacuations with antimony. In fuch cafes the bark is not again employed till the inflammatory fymptoms are abated.” Thefe cautions are very prudently recommended, as the ufe of the bark in thefe cafes, notwithstanding the high authority by which it is fupported, is by no means general. It appears that the author has given the bark, in this manner, to 86 patients, afflicted with acute rheumatifm, and with the exception of four only, with whom it did not appear to agree. "It uniformly," he fays, p. 89, "produced the moft falutary effects. The pains, fwellings, fweats, and other symptoms of inflammatory fever manifeftly and speedily abate, and gradually ceafe, till health is perfectly reftored." The time in which this was ufually effected, was about four weeks. Among the proofs and illuftrations, where the author gives a detail of fome cafes attended with peculiar circumLances, he recommends wort, in a state of fermentation, in fcurvy, and in putrid fever, in which he has given it, he says, with fingular advantage. The next differtation treats of nodofity of the joints. The author had feen 34 perfons affected with this complaint. It is nearly peculiar to women, one of the patients only being a man; and it came on, in the cafes that fell under our author's care, foon after the women had ceafed to menftruate. The nodes may affect any of the joints, but they appear to attack those of the hands and fingers oftener than any others. They feem to confift in a thickening and enlargement of the ends of the bones of the periosteum and ligaments, and being once formed, they go on enlarging, until they, in a great measure, take away the power of moving in the joint. They They are attended with conftant pain, but not acute, and with tenderness of the fkin lying over them. The nodes appear to be propagated from one joint to another, but without procuring eafe to the joint firft affected. The author knew one patient, he fays, whofe fingers, wrifts, knees, ancles, fhoulders, and lips, were all affected with the complaint at the fame time. The difeafe has been confidered as gout or rheumatism, but it differs materially from either of them; and ought, the author thinks, to be efleemed a diftin&t complaint. No remedy has been found adequate to the removal of the complaint; but relief has been given by the repeated application of leaches to the parts, and by the effufion of warm water upon them. The late Dr. Heberden appears to have defcribed the difeafe in the 28th chapter of his commentaries, De nodis digitorum, but not with fo many circumstances as are here noticed. He does not intimate that they are incident folely to females, and fays exprefsly, they are free from pain, "vacant omni dolore," but admits, that they remain through life, and at length occafion fome impediment to the motion of the joint. He propofes no remedy for them, probably as they only occur at that time of life, when the fymmetry, or beauty of the limbs, which they principally affect, ceafes to be an ob ject of much folicitude. "Proinde," he fays, "deformitas major eft quam incom. modum; quanquam motus digitorum aliquantulum impeditur.” We have been ample in our account of this little volume, induced to it by the refpectability of the writer, as well as the importance of the fubject: for though the bark fhould not prove, on further experience, to be equally efficacious and certain, in curing acute rheumatifm, as in curing ague, which the author intimates, (p. 91), we at the left learn that it is a fafe and powerful auxiliary in combating that painful, troublefome, and extremely obftinate disease, in the cure of which, few practitioners have hitherto ventured to prescribe it. We cannot quit the fubject without expreffing our hope, that the author's leifure may permit him to favour us with fome further extracts from his regifter, and without the tables, which, though highly useful to him in forming his collection, embrace fo many objects, and are confequently branched out into fo many columns, that few readers will take the trouble of picking out the facts from them. They are befides unneceffary, the known good faith and diligence of the author being a fufficient guarantee for the correctness of the deductions, ART. |