which he names as furnishing rare examples are those of butchers and policemen. As regards the former, we must say our experience does not coincide with the author's, especially if slaughterers are to be included; and policemen soon cease to be such if they indulge the habits which induce the disease. Our own impression is that occupation has no influence at all, except so far as it renders impossible or easy the taking frequent small doses of alcohol.

The theory which we have ventured to suggest, as to the symptoms of alcoholism being an attempt of the system to regain vitality, is supported by the remarkable fact of their often first occurring, still more often becoming aggravated, "after the habit of drinking to excess has been given up, and even in many instances after a complete abstinence for some time from alcoholic stimulants." Many instances of this will be found recorded in Dr. Marcet's table. He further remarks:

"I have been led to observe that the injurious effects of the long-continued abuse of alcoholic stimulants are frequently not developed to any extent until the occurrence of another circumstance which is the immediate cause of the attack. It has not been possible for me to determine satisfactorily whether an attack of chronic alcoholism may supervene long after the individual has given up drinking, and without his having at all suffered from the nervous derangement known to result from frequent excesses; but this much may be safely stated, that in the great majority, if not in every case, the patient's constitution has been so far affected that the slightest cause will be sufficient to startle or frighten him, produce giddiness, headache, and keep him from sleeping at night, yet without preventing him from attending to his occupations, or proving of any material inconvenience; and such patients are very liable to a regular attack of chronic alcoholism from some cause independent of drink."

And he might have said, "acute alcoholism also." An instance of that rare phenomenon, a fatal delirium tremens in the female, occurred in our practice to a healthy young woman who occupied the responsible post of chambermaid in a large hotel. She had indulged some time previously in secret dram-drinking, but had concealed both her habit and her leaving it off from her most intimate friends. She remained perfectly well till she was accused (we believe with injustice) of stealing, when she was instantly attacked, with the unhappy result above mentioned.

Among the "Immediate Causes of an Attack of Chronic Alcoholism," Dr. Marcet enumerates several diseases which have produced the effects in conjunction with alcohol, such as bronchitis, gout, rheumatism. As to affections of the stomach, he feels dubious whether they are cause or effect. Here, again, we would suggest whether the connexion between these ailments does not lie in the diminution of excreting power rather than in their weakening the body, to which the author attributes their common influence in chronic alcoholism. Many diseases which weaken the body more-such, for instance, as acute fever-do not act in the same way; and some really seem a direct preservative. Ague, for instance, and malarious neuralgia, certainly are followed by anæmia and debility quite as much as gout and bronchitis; yet instead of making the patient liable to chronic

alcoholism, they seem to guard him from it. Persons affected with the aguish diathesis often take habitually quantities of alcohol which in health would affect them most injuriously.

The most important point in Dr. Marcet's volume is the remedy which he proposes for chronic alcoholism. He does not recommend one remedy for a certain symptom, and another remedy for another symptom, but endeavours to show that there exists a substance possessed of powerful and definite medicinal properties, and having the remarkable property of restoring to health, or at all events of greatly relieving, the disordered nervous system of persons suffering from chronic alcoholism; the medicinal agent in question acting efficaciously in cases where the principal symptom may be either sleeplessness or hallucinations or trembling, or any other; and this substance is oXIDE OF ZINC."

The physiological action of oxide of zinc on the healthy body is not clearly known. One great difficulty in the investigation is its partial solubility, and hence the small, but variable quantities that are taken up into the system. The effects are by no means in proportion to the dose; but, whatever their nature, they are principally manifested in the nervous system. Moderate doses cause slight nausea, giddiness, black specks before the eyes, rumbling in the ears, and fainting. Oxide of zinc also, alone of all metals, is a soporific, producing considerable drowsiness even in the daytime. The absence of very marked effects from large doses, or, in other words, the small doses which are actually absorbed, have made some persons sceptical about its powers, and they have attributed to the imagination of either patient or physician the benefit which has appeared to follow its use. It is seen to do so little harm, that there is a suspicion that it does no good. Dr. Marcet upholds the power of his drug at the expense of its benignity, and shows that it can do mischief sometimes. He also cites an instance of its favourable action on a dog affected with epik psy and paralysis, where, of course, imagination had no influence. lts beneficial, though not absolutely curative administration in certain cases of chorea and epilepsy appears to be gradually receiving general assent, though, from the nature of these diseases, evidence of the action of remedies upon them must necessarily accumulate with extreme slowness. Convinced that it was a medicine of real, though obscurely manifested powers, Dr. Marcet was led to try it in chronic alcoholism, and he appears to us, from the examples he cites, to have obtained undoubted proof of its efficacy. Let it be observed that the proof is much stronger than it can ever be in the case of remedies for chorea and epilepsy; for the first of these diseases is well known often to run a definite course like an acute fever, and to get well spontaneously; and the second is so little understood, and so irregularly intermittent, that its changes have been made to justify the use of the nastiest and absurdest articles in the pharmacopoeias; while chronic alcoholism is a continuous ailment with little or no tendency to spontaneous cure, so that the action of drugs on it can be readily noted. It may be remarked, also, that the observations are made upon outpatients more or less engaged in their usual occupations, so that the

fallacies arc excluded which arise from the improved hygienic conditions of a hospital ward.

The effects of oxide of zinc in simple cases of chronic alcoholism are improvement in sleeping, diminution of hallucinations; black specks and crawling creatures no longer flit before the eyes, and extraordinary noises are no longer heard; the trembling hands become steadier, and gradually muscular power returns; the appetite gets better, and the mental depression disappears. When organic diseases, especially of the lungs, exist, the power of the drug is interfered with ; but even in them, Dr. Marcet says he has found advantage in beginning with the oxide of zinc, in order to alleviate as much as possible the functional derangement of the nervous system, and afterwards to adopt such a course of treatment as may be considered the most suitable to the occasion. The dose in which Dr. Marcet seems generally to have used the drug is that of two grains, gradually increased to ten, twice a-day.

It might have been anticipated à pricri, that the diminished vitality which accompanies the use of alcohol should lead to a diathesis of general degeneration. No part of the body seems exempt, but it is of course most notably manifested in those organs which are of the first necessity, such as the liver and the kidneys. We cannot agree with M. Lallemand in explaining this by irritation occasioned by the passage of alcohol through those organs especially; otherwise, how should the lungs escape, through which alcohol in the first instance escapes? Neither does our experience induce us to agree with him in attributing renal degeneration to alcohol as the most usual cause; it is a joint cause doubtless, and an important one, as diminishing general vitality; but, like M. Rayer in France, we have found in London, cold, want, and exposure by far the most potent originators of Bright's disease. It is much more common among those who have been subjected to these influences without being intemperate, than among intemperate persons who have been defended from them.

Earliest probably of all parts of the body this degeneration commences in the blood. Some years ago, Dr. Boecker noticed the alterations undergone by the blood of habitual alcohol drinkers as yet in good health-namely, a partial loss of power to become red by exposure to the air, in consequence of the loss of vitality in a portion of the blood-discs. This loss of vitality manifests itself by the formation of black specks (oil) in the discs, and then by their conversion into the round pale globules which, in all cases of disease (i.e., of diminished vitality), are found in excess in the blood.* To this he attributes the darkening of the blood by alcohol mixed with it, either in or out of the body, which was noticed by MM. Bouchardat and Sandras,† as the immediate result of the reagent, and thinks that it takes place more or less in proportion to the dose whenever alcohol is ingested. If the dose is moderate, reaction quickly occurs and restores the blood by

*Boecker's Beiträge zur Heilkunde, Band i. p. 277 et seq. This is not the place to go into the argument which induces the author to agree with Schultz (Die Verjüngung, pp. 48-806) in viewing the colourless globules as a stage in the destruction of the red discs.

Annales de Chimie, Oct. 1841.

increased excretion to its normal state; but if it is continuously repeated, the state of diminished vitality is kept up and becomes capable of detection by examination of the fluid. This devitalized condition of the nutritive fluid is probably the first step to the devitalization of the tissues which it feeds. In the liver, instead of glandular substance, the vital energy produces the less complex, less high development of connective tissue, sometimes in large quantities, forming an enlarged liver, sometimes in smaller quantities forming a scarred, contracted, granular liver. And mixed with this hard tissue, it exhibits the still lower development of vitality in the shape of fat.

But this morbid degeneration into fat is a very different thing from "stoutness" and "obesity." Where these are developed in drunkards, they must, if the result of drink at all, be due to the starchy and saccharine substances imbibed, or to the lazy habits of the imbibers.

To recapitulate-we think that the evidence, as far as it has yet gone, shows the action of alcohol upon life to be consistent and uniform in all its phases, and to be always exhibited as an arrest of vitality. In a condition of health it acts in some measure immediately on the extremities of the nervous system by direct contact, and is also carried through the universal thoroughfare of the circulation to the brain. To nerve-tissue chiefly it adheres, and testifies its presence by arresting the functions of that tissue for good or for evil. In a condition of health this temporary arrest is rectified by reaction, and the body regains its normal amount of life. But if the reaction be impeded by fresh doses of alcohol, the temporary arrest becomes permanent, and disease is the consequence. The most special exhibition of disease is in the special function of the nervous system, the life of relation, to perform the duties of which the devitalized nerve becomes inadequate. Then the vegetable life suffers; the forms of tissue become of a lower class, of a class which demands less vitality for growth and nourishment -connective fibre takes the place of gland, and oil of connective fibre. The circulation retains indeed its industrious activity, but receives and transmits a less valuable, less living freight, and thus becomes the cause as well as the effect of diminished vitality.

We

Thus deadly when abused, this powerful agent may be made an instrument of life and happiness when used in accordance with reason, as we have already noticed. In addition to its hygienic employment, a deep interest attaches to the aid it affords to the physician in his treatment of disease; so deep, indeed, as to preclude the discussion of the subject at the end of an article containing other matter. will merely remark that hitherto the arguments rested upon seem to have been purely empiric and statistical, and that the rational and experimental part of the inquiry has been much overlooked. Moreover, two modes of treatment, assumed without proof to be opposite, are illogically compared with one another; it is taken for granted that patients must be either bled or brandied; whereas no comparison is made with those who are submitted to neither treatment, or to both together. So imperfect is the statistical reasoning, that, with all its shortcomings, we confess we prefer the rational.

REVIEW VII.

On Myalgia: its Nature, Causes, and Treatment. A Treatise on Painful and other Affections of the Muscular System which have been frequently mistaken for various Diseases. By THOMAS INMAN, M.D. Lond., Physician to the Liverpool Infirmary, &c.-London, 1860. pp. 307.

THE profession, one and all, should not be slow to thank the man among them who forbids their neglect of the muscle, and compels them to think upon pain. The muscle, by which all is done within and without us that man is permitted to do: pain, its great antagonist, than which nothing more interferes with the muscle at its work. Such are the terms of Dr. Inman's Myalgia; and of the volume to which it is prefixed, this compound neo-classical title is not the least important part. It is forthwith expanded, under the author's definition, into certain muscular disorders which are wanting in the element of pain, and by a further exegesis of mistake, negation, and denial, is made to introduce many local organic diseases that have nothing to do with the muscle. In it the more exact and less pretending titles of two former works (doing duty in the preface as so many previous editions of the present treatise) have been made to merge. Myalgia is at once the key-note and thenie of the composition in both its parts. Here, there, everywhere, chapter, introduction, and index, myalgia. It is more than the title of the work; it is the title of a work which is the work of a title. In his dedication the author paraphrases his treatise as an essay. It is a bundle of essays-or rather two bundles of essays-of which myalgia is the binding knot. Moreover, it is a picture-book, with illustrations, highly varied and of a somewhat eccentric character. Opening the volume a few pages on from the title page, we find ourselves engaged with the anatomist in his dissecting-room. The well-developed muscles of a healthy male subject are laid bare for demonstration. By the frontispiece we are introduced to the sculptor's studio, in presence of a female model the paragon of living grace and unadorned beauty. Advancing in the bookseller's window towards the public gaze, she will assuredly be identified by the street flaneurs as the Myalgia of the title-page which she fronts. In such case, her equally fascinating sister of Plate VI., retiring as if by order from the student's notice, cannot escape the more familiar appellation of Neuralgia. In the passionate indulgence of his pathological fancies, has our author become enamoured of his own abstraction and graduated as a nympholept? Pulvermacher's nude electric damsels are scientifically hung in chains. It is as well that Mr. Bagg's myalgic lady-models are anatomically tattooed. There are sundry little anomalies in the arrangement and making up of this volume which we note more to satisfy the enthusiastic author that we have read him through, than from any belief in their importance. In the preface, which is pleasant, and pleasantly short, we were somewhat bewildered among the dates and aliases of former editions, first,