posed to enter into metaphysical, or rather physical investigations, we think we could elucidate the etiology of this contrariety in human nature, by somewhat more satisfactory reasons than the Roman satirist has adduced; but into these domains we dare not venture in this place.

all

We do not think it worth while to search the records of antiquity-or even Dr. Good's "Study of Medicine," to ascertain whether a Chaldaic, Arabic, Greek, or Roman name, has been given to a class of diseases which have more precise and determinate causes than any in the whole range of nosology. Neither is the disease rare or uncommon. It has prevailed in ages of the world, and among all classes of society. What was the long INDISPOSITION Of ACHILLES, at the seige of Troy? A huge fit of MALINGERING! But Achilles was a great man, and his malingering nearly ruined the Greek cause-therefore he has been rewarded with immortality in the deathless verse of Homer! Malingering indeed is not confined to the RANKS in the army-nor is it only to be found BEFORE THE MAST in our fleets. When an officer finds a ship or a regiment uncomfortable, he is seized with a fit of malingering—and is removed to another. When the statesman finds the helm of politics unmanageable, he is attacked with the malingering malady-or his wife is attacked with it, which is the same thing, and he quits his post. Nay, there is scarcely a private family in which the medical practitioner will not occasionally meet with a sulky Achilles or a foreboding Cassandra, malingering for some secret purpose. In these last cases, however, there is little mischief done. If the doctor is deceived, and prescribes strong medicines, the patient takes good care to throw them into the fire-if he detects the imposture, he prescribes some very pleasant julep, pockets his fee, and the malingering fit is allowed to take its course. But it is very different in the public service. The naval or military surgeon must decide between real and assumed diseases-between those produced by inevitable causes, and those induced by art, for the purpose of deception. And truly this is no easy task. It is difficult to discriminate between an ulcer kept up by irritating substances clandestinely applied, and one that is maintained by a peculiar habit of body. The moral evidence of malingering is not to be got. There is a free-masonry among soldiers and sailors that completely seals their mouths against any thing like blabbing the secrets of their messmates. Indeed there is great reason to believe that, in some regiments, the methods of malingering have been regularly systematized, and handed down as heir-looms for the benefit of those who may be inclined to make trial of them.

The following picture will shock the eyes of our innocent civilians, who look up to the heroic soldier as the BEAU IDEAL of human valour and simplicity of heart.

"As allusion has been made to ophthalmia, I may take the present opportunity of observing, that I never saw a more humiliating picture of depravity, or perversion of reason, call it what we may, than I have witnessed in a ward filled with soldiers labouring under that disease; most of the cases, as I learnt from the surgeon in attendance, being factitious. The methods, by which inflammation of the eye is produced and maintained, have not all been brought to light, but quick lime, infusion of tobacco, the gonorrheal discharge, cantharides ointment, nitrate of silver, blue stone, and other metallic salts, are probably among the most common irritants employed. Inflammation thus caused is most painful, and is kept up under every privation which can make life miserable locked up in a dark ward, and permitted to have intercourse only with the officers of the hospital, nurses and orderlies, confined to diet which, from the absence of every stimulating material, is most disrelishing, suffering under painful external applications, and nauseating internal medicines, phlebotomized and leeched till their complexions are bloodless, their pulse hæmorrhagic, and the frightful train of nervous

symptoms, which excessive bloodletting produces, is established in the system.-All these evils, in many cases, have no effect but to confirm the soldier in his determination to destroy one or both of his eyes, that he may be dismissed from the service with the chance of a small pension.

"Wonderful indeed is the obstinacy which some malingerers evince. Night and day they will remain with the endurance of a fakir, in a position the most irksome. For weeks or months many men have, with surprising resolution, sat and walked with their body bent double. Some have continued to irritate sores in the leg until the case became so bad as to require amputation of the limb, and many instances have occurred, in Military and Naval hospitals, of factitious complaints ending fatally."

The medical officer is placed in an awkward predicament in many cases. Men have been suspected of malingering, when concealed disease was going on internally, and punishment has been inflicted where the unfortunate sufferer has been labouring under natural afflictions. Thus a soldier of the 9th regiment of foot, who complained of great uneasiness in the loins, was treated as a malingerer, " and was sent to punishment drill, at which he was kept till a tumour appeared in his back, symptomatic of a lumbar abcess, of which the poor fellow died." Humanity shudders at such a history! But we must now proceed to notice some specimens of malingering, which will not be devoid of physiological interest.

1. Paralysis. This is often feigned by the soldier. Dr. Cheyne augurs that it is so, when it comes (or is said to come) on suddenly in one member, the rest of the body being free--the health good-and the sensorial functions in a state of integrity. These reasons are not proof positive, in our minds, though they may fairly lead to suspicion in military life. Smart shocks of electricity generally cure these malingerers. Some, however, have had stoicism enough to resist all electric batteries. A trooper of the 12th pretended he had lost the use of his right arm, and, after numerous attempts to detect or cure him, he was discharged. When fairly seated on the top of the coach, he waved the paralytic arm in triumph, and cheered at the success of his plan.

"A militia soldier, who pretended that he had lost the use of his inferior extremities, was reported unfit for service, by the late Dr. Harvey, and discharged. When he had obtained possession of his discharge, he caused himself on a field day, to be taken in a cart to the Phoenix Park, and in front of the regiment, which was drawn up in line, he had the cart driven under a tree, upon which he hung up his crutches, leaped out of the cart, sprung three times from the ground, turned his back to the regiment, and having slapt his breech, he scampered off at full speed."

Surely there must be a defect in the laws to allow such scandalous proclamation of persevering falsehood and deception.

2. Deaf and Dumb Malingerers. As those who are born deaf never acquire speech, however perfect may be the organs of the latter faculty, so the soldier, thinking that these two defects must be necessarily connected, pretends to lose the two faculties at the same time. This, in itself, Dr. Cheyne thinks a sufficient proof of imposture; as it is improbable, in the highest degree, that paralysis of the two sets of organs should occur at the same instant, the health and mental faculties being otherwise good.

3. Eneuresis, or incontinence of urine, is a common case of malingering. It is detected by giving a large dose of opium in disguise, when the malingerer will fall asleep, and pass the whole night without wetting his bed.

4. Epilepsy. This disease is often simulated, and is sometimes extremely difficult of detection. The author relates a case, where a soldier feigning a paroxysm, was unmasked by an assistant putting some spirituous tincture into the man's eyes. He could not bear the pain of this-suddenly left off his contortions, and jumped up, to the no small amusement of the by-standers.

5. Insanity is a species of malingering which is equally difficult to feign and detect. Dr. Cheyne gives a long list of distinctions between real and counterfeited insanity, some of which are curious, if not whimsical. Thus, he says, there is often in the nature of this paroxysm, something which is inimitable--as, for example, "an astonishing power of stringing rhymes together." This probably explains the near alliance of poetry to madness. 6. Haemoploe is rather a favourite disease with soldiers who wish to obtain their discharge. It is detected by careful examination of the chest, and of the attendant symptoms. The complaint is feigned by bringing blood, by means of small punctures, from some part of the mouth or nose, as from the gums, fauces, Schneiderian membrane, &c.

7. Phthisis. Who would expect that this disease should be selected for imitation! Yet the malingerer "will often undertake a perfect portrait of that disease, and this he will sometimes execute with great cleverness.” These people show themselves more attentive students of symptomatology than some of their medical attendants.

8. Palpitation of the Heart. This is produced by taking white hellebore, as proved by Mr. Copland Hutchison.

We shall conclude this article with the following extract, which may be useful to the routine practitioner, who pins his faith on the doctrines and practice of Abernethy, to the ruination of hundreds of stomachs annually.

"Perhaps I may be permitted to remark that the present treatment adopted by many civil as well as military practitioners of medicine, for the cure of supposed liver complaints, or even of actual liver complaints of a slight kind, is sometimes productive of very sad consequences. Many a course of mercury is undergone, to the indescribable discomfort of the patient, for pains seated in the intestines, in the duodenum or colon, perhaps in the biliary ducts, or even in the liver itself, which would have yielded to cupping, blistering, common purgatives, and a change of regimen. Thus, for example, there is a pain in the right hypochondrium which belongs to hysteria, which will yield to aloetic purgatives, the belladonna plaster, to infusion of valerian and snake root with ammonia, change of residence, exercise in an open carriage or on horseback, and light animal food without wine, which has entailed on many a sufferer, not one, but repeated courses of mercury, each in succession tending more and more to confirm the pain, till at last, by these means, the comforts and prospects of the patient have been utterly destroyed. Moreover, a great proportion of the cases of dyspepsia, which are generally treated on what is called Mr. Abernethy's plan, may be removed, with equal certainty, without giving a grain of mercury, by means of a pill every second evening, containing aloes, if it agrees, if not, a pill which will act slowly and moderately, a draught before meals containing some bitter infusion with an alkali, or some nervous medicine, carminative, or chalybeate, according to the case, appropriate diet and regimen, and change of residence. My opportunity of observing most of the varieties of disordered digestion, and my experience in treating them without mercury, leads me to protest against the present routine of practice in these cases."

It would be a merciful dispensation of Providence, if every young practitioner were to have one year's misery. of dyspepsia--say the first year, when he would have plenty of time to attend to himself! It would save some thousands of his future dyspeptic patients from the murderous practice of blue pill at night, and black broth in the morning-a practice which we verily believe inflicts a greater annual amount of moral and physical sufferings on humanity, than all the other" errors of medicine" put together! We seriously advise the rising generation of the profession to look to this in time. The non-professional public is every day acquiring experience on this point; and we have the means of knowing, that an important revolution is on the eve of bursting forth, in respect to the propriety of deluging the dyspeptic stomach with drastic medicines.

Medico-Chirurgical Review,

No. XVI.

[FASCICULUS II]

JANUARY 26, 1828.

ART. III.

Cases illustrative of some of the Appearances observable after Death, when DROPSICAL EFFUSION has been connected with disease of the Liver. By RICHARD BRIght, M.D.

[Reports, &c. from Guy's Hospital.]

"Quum vero a splene aut HEPATE in hydropem transitus fit, effugiunt non valde.”—HIPPOCRATES, de Affectionibus, lib. xiv. cap. xxiii.

"Neque ignoro, Erasistrato displicuisse hanc curandi viam morbum enim hunc jocinoris putavit: ita illum esse sanandum."-CELSUS, lib. iii. 21.

"Corrupti jecoris vitio vel splenis acerbus crescit hydrops."--SERENUS SAMONICUS.

THE three quotations which we have introduced from three of the most

ancient works on medicine, will show at what an early period dropsy was traced to disease of the liver. Erasistratus, like some hobby-horse riders of modern times, wrote a book to prove that dropsy was always dependent on hepatic disease; but the remark of Celsus on this doctrine is equally terse and true. "Sed primum, non hujus visceris unius hoc vitium (hydrops) est: nam et liene affecto, et in totius corporis malo habitu fit." Loco citato. We shall not, however, wade through the innumerable speculations which have been entertained as to the nature, causes, or treatment of the dif. ferent species of dropsy. We shall only remark one or two curious facts; first, that the father of physic recognized cases of anasarca which occurred suddenly in robust constitutions, and required blood-letting.-De Victu Acutorum, Ixii. How far Hippocrates anticipated modern pathologists on this point, it is not necessary to inquire. The second remark is, that Areteus appears first to have noticed hydatid--or rather ovarian dropsy, in which paracentesis was not effectual. This sagacious disciple of Esculapius made a confession, which, though unpalatable to the " march of intellect" in the present day, contains, nevertheless, some truth. He tells us that few have been cured of dropsy-and that those who have been so fortunate as to escape, may thank the Gods, rather than the doctors, for their recovery! But we must come at once to the work before us. In our last numVOL. VIII. No. 16. 41

ber, we gave an analysis of Dr. Bright's first division, in which an attempt was made to prove that many cases of dropsy depended on certain organic changes in the kidneys themselves. The next division relates to the etiology of dropsy, as connected with hepatic disease. Dr. B. sets out by expressing a conviction, that many cases of this effusion are owing to renal, which are set down to the account of hepatic affection-but, at the same time, he entertains no doubt that, "in many other cases, the liver is the real cause of the dropsical effusion, frequently showing most extensive disease, when the kidneys are quite healthy." In fact it did not escape, Dr. Bright's notice-and it cannot escape the notice of his readers, that, in almost every case which he has detailed of renal disease in connexion with dropsy, there was also more or less of disease in the liver. The dissections of Morgagni, Bonetus, and Lieutaud, corroborate the facts disclosed by Dr. Bright, and all these circumstances, taken in connexion, tend to throw a considerable shade of doubt on Dr. Bright's doctrine of the renal origin of dropsy. The same doubt, however, does not apply to the present section of the work under review.

In the preceding section, Dr. B. had often expressed himself thus:"The liver showed a tendency to granulation"-thus intimating a doubt as to the existence of actual change of structure. Dr. B. explains himself in the following terms.

"The fact is, that the liver in these cases has usually preserved its natural figure; the acute margin has been perfect, and the general size has not been augmented; the peritoneum has been quite transparent, and attached only in the ordinary degree to the viscus; the texture of the liver has neither been unnaturally firm nor morbidly flaccid; but, on examining the surface, it has been evident that the colour was less uniform than in perfect health: the whole was marbled, consisting of very small light spots in a darker ground; but on making a section perpendicular to the surface, though the same general variety of colour has been observed, yet in some parts of the section it has been doubtful whether the darker or the lighter part should be considered as the ground-work : in general however, by attentive observation, it will be found that, in the centre of the lighter spots, small depressions or openings are visible, and that the darker parts appear to be the connecting medium of the lighter parts, which seem to be the acini of the glandular structure. Although in most cases these appearances scarcely attract attention, yet in other cases they become more obvious, either the white portions becoming larger in proportion, or the whole viscus appearing to have lost a little of its natural pliability, to have become hard, and to break down with a slighly granulated fracture."

In all these cases, Dr. B. observes, "the secretion of the bile is tolerably natural, the gall-bladder being well supplied with bile, of a sufficiently dark yellow colour." We have reason to believe, that much error has arisen respecting the healthy secretion of the liver, because the colour of the bile has appeared natural in the gall-bladder and in the secretions. It should be recollected that it is in the gall-bladder the bile assumes that colour which tinges the faces--and that only a certain portion of the bile that passes into the intestines has ever been in the gall-bladder. Now the biliary secretion may be much changed, and yet that portion of it which regurgitates into the above-mentioned reservoir may there assume the usual colour,