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or only under the form of slight pains confined to the heart, are those formerly mentioned in the case of neuralgia of the lungs, and especially the magnet. This I use in the following manner: I apply two strongly magnetized steel plates, of a line in thickness, of an oval shape, and bent so as to fit the part,—one to the left precordial region and the other exactly opposite on the back, in such a manner that the magnetic current shall traverse the affected part. This method is not infallible, any more than others employed in nervous cases; but I must say that it has succeeded better in my hands in the case of angina than any other, as well in relieving the paroxysm, as in keeping it off. Magnetism was, perhaps, too much cried up by some medical men in the last century; but I am of opinion that it is too much neglected at present. That it acts on the animal system, is sufficiently proved by the fact of its giving rise not only to very obvious general effects, but even to local ones. In the case in question, after a certain time it most commonly produces an eruption of small pimples, which are sometimes so painful as to oblige us to interrupt the process for some days. This effect cannot be attributed to the action of the oxidized plates on the skin, as the eruption almost always takes place under the anterior one: and I have observed similar results from plates applied over the abdomen and loins. By means of these plates (applied to the epigastrium and spine) I stopped, at once, a hiccup which had lasted three years. At the end of six months, the patient having one morning neglected to put on the plates, the hiccup returned; but was removed upon their being replaced. In another case in a patient affected with imperfect paraplegia, without any sign of structural lesion of the spine, and for which moxa had been used without success, I inserted, to the depth of half an inch, a needle near the vertebral column and another into the thigh near the external popliteal nerve, and connected these by means of magnetised rods; and at the very instant of contact there occurred an involuntary dejection, which had never previously happened to the patient. In the angina when the magnet gives but little relief simply, this is sometimes found to be increased on applying a small blister under the anterior plate. During the paroxysm, if the oppression is considerable, we must bleed the patient, if he is at all plethoric. Leeches applied to the epigastrium or cardiac region sometimes give more relief than venesection; but sometimes their application is impracticable from the extreme agitation of the patient. Derivatives are also beneficial, particularly sinapisms to the lower extremities and blisters to the fore part of the chest; as are also antispasmodic medicines, with the infusion of cherry laurel or digitalis, and also the fetid gums. A mild regimen, with the use of the tepid or cold bath, according to the season, are among the best means for preventing a return of the paroxysm."

As to the magnetic treatment, we cannot say any thing from personal observation. The management of the paroxysm must be very different from the treatment during the intervals. Those who have witnessed a severe attack of this terrible disease, can never forget it. The sufferings of the patient must be dreadful. The respiration is sometimes threatened, and the rattling in the throat induces us to draw blood in order to prevent immediate suffocation. In other instances, the breathing appears but little affected, and a cessation of the circulation seems impending, and we are forced to administer cordials. In almost all cases, anodynes and ether, with camphor, are necessary. In the intervals, quietude and temperance, with tranquillity of mind, would be the surest prophylactics-where, alas! are these to be found in this world? Those who have not real woes are tormented with imaginary ones-or, at least, woes of their own creating. Within these very few weeks we witnessed a most distressing case of this disease, which has made a strong impression on our minds, and harrowed up the recollection of several other instances of this deadly malady.

The patient (General B- -) was on the borders of 80 years; but remarkably healthy, hale, and vigorous for that advanced age. He was of a very florid complexion, and plethoric constitution-had resided long in a tropical climate-and was addicted to the pleasures of the table, not amount

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ing perhaps to what might be called intemperance. Up to within a very few weeks of his death (February, 1828) he took active and passive exercise in the open air, and could walk from his residence in Portland-place to the Royal Exchange, as quickly as most men of 50 years of age, though now 80. He had undergone the operation of lithotomy some 20 years ago, under Sir Astley Cooper, and had no return of stone. He never made any complaint of heart affection, and had a strong, equal, and excellent pulse. His only complaint was a sense of occasional fulness about the head, for which he often resorted to cupping. He had also some slight dyspeptic symptoms, in the shape of acidity-depression of spirits-irritability of temper. A very few weeks before his death he complained of shortness of breath, and pain darting from the region of the heart down along the left arm, when ascending the stairs of his own house-and, latterly, when walking in the street, especially if he went against a current of wind. The writer of this article was consulted, and on strict examination, could detect no change of structure or irregularity of action in the heart. He readily recognized, however, that the patient had symptoms of angina pectoris, and stated this to his friends. He advised quietude, temperance, and abstinence from all active exercise. But neither the General nor his friends would be quiet-and therefore they summoned a celebrated surgeon, whose knowledge of anatomy must, of course, enable him to detect the most obscure diseases of internal parts. He came-saw disorder of the digestive organs"-and prescribed blue pill at night, and black draught in the morning. Six days after this treatment had been put in force, the writer was summoned, in the middle of the night, to the patient, who was said to be dying. When he arrived, the General was labouring under one of the most terrific paroxysms of angina pectoris which he ever witnessed. The face was pale, the lips blue, the countenance indicative of unutterable anguish, the pulse scarcely perceptible, the breathing laborious, with what has been not inaptly termed, the "dead rattles" in the throat. The unfortunate sufferer was propped up in bed--tossing from side to side-praying for relief from the horrible pain in the region of the heart and left arm. It was evident that the lungs were gorged with blood, and a lancet was immediately pushed into a vein in the arm. At first a little black blood trickled out-then it came more freely-and, at last, in a stream. When twelve or fifteen ounces of blood were abstracted, the "dead rattles" ceased--the pulse rose-and relief was considerable, though by no means complete. Thirty drops of Battley's liquor opii sedativus, which happened to be in the house, were given—and, in an hour, the patient fell asleep. Next morning, all urgent symptoms were gone. He was ordered to keep his bed for two or three days and then only sit up in his bed-room. No symptom of angina pectoris returned--and on the sixth or seventh day, the General would no longer submit to restraint. He came down stairs-dined in the parlour on fish --took his first glass of wine in good spirits--and while drinking the second glass, he died as instantaneously, as if a cannon ball had passed through his chest!

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God forbid that we should attribute any part of this tragic finale to the treatment on which the patient was placed for disorder of the " DIGESTIVE ORGANS;" but we can only say that, if General B. died of this said disorder, we are totally ignorant of the nature of the complaint.

We shall take up the subject of other nervous affections of the heart in our next Number.

Periscope;

OR,

CIRCUMSPECTIVE REVIEW.

JANUARY 12, 1828.

UNDER this division, we shall endeavour to collect from the periodical press those scattered fragments of practical or scientific knowledge, which it would be as difficult to set forth in separate articles of our Review, as it would be disadvantageous to overlook. But how are we to classify or arrange these multitudinous contributions to our stock of information? The more we reflect on this subject, the more the difficulties accumulate and become insurmountable. Hic labor, hoc opus. If ever there was a cycle or circle in any science, it is in medical science. From whatever point, in that circle, we start, in practice, to that point must we daily and hourly return

Whatever link we strike, Tenth, or ten thousandth, breaks the chain alike.

How it is possible to separate even the

STUDY of morbid anatomy from that of simple anatomy? Can we tell diseased structure without comparing it with healthy structure? Can we separate the treatment of a disease from an investigation into its history, its etiology, its symptomatology? Or can we study any of these advantageously, except in connexion with its pathology? Certainly not. In the common routine of practice, the whole circle of medical science comes into play at every step we take-at almost every bed-side to which we are called! What physician is deserving of that name, who is not intimately acquainted with the effects of external agents on the human frame, whether they be in the shape of moral impressions, atmospheric influences, accidental violences, or surgical operations-a mental misery, a malaria, a blow on the head, a shattered limb, or an amputation? What surgeon is deserving of the appellation, who is not as well acquainted with the symptoms, causes, stages, diagnosis, treatment and morbid anatomy of peripneumony as of erysipelas? The FORMER supervenes almost as fre

VOL. VIII. No. 16.

quently on the flourishes of the catlin and saw, as does the LATTER. As for the GENERAL PRACTITIONER, if he had the hands of Briareus, the eyes of Argus, and the ear of Dionysius, he would daily have occasion for them all, in each and every branch of medical science and practice.

Seeing, then, that these branches or parts, to which we have given such learned Greek titles, are locked and intersected at every movement in our daily rounds, how can we usefully classify them in this our little microcosm? On what plans did Morgagni, Bonetus, Baillie, proceed in their arrangements and classifications of the "seats and causes,' " "the hidden causes," (abditæ causæ, Bonet.) the "morbid anatomy," of diseases? On the plan of the unlettered butcher in the shambles ! The butcher first kills his patient, viz. the sheep, and then strips off the skin.* He next decapitates, and offers the head separately to the public, then the neck, the upper extremities, the contents of the thorax and abdomen, the pelvis, (saddle of mutton,) and lower extremities. So did Morgagni, Bonetus, and Baillie. They could invent no other arrangement or classification than that of quartering and eviscerating the human machine, presenting us with diseases of the head, of the neck, of the thorax, the abdomen, the pelvis, &c. as if all these parts were independent and insulated organs, whose derangements of function and alterations of structure could be as distinctly marked on the pathological chart, as the 32 counties of England on pasteboard! What tyro does not know the absurdity-the impossibility of these unnatural insulations in actual practice! What man ever saw the brain diseased, without various other parts

* By this we do not mean to infer that the doctor fleeces his patient before he kills him.

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We maintain then in the first place, that the PRACTICE of MEDICINE necessarily includes a knowledge of surgery-secondly, that the PRACTICE of SURGERY necessarily includes the practice as well as the knowledge of medicine-and thirdly, that the PRACTICE of these two great artificial divisions, necessarily includes a knowledge of all the other divisions, however designated as subordinate, auxiliary, or collateral. Midwifery, pharmacy, chemistry, medical botany, ophthalmic, acoustic, and dental surgery, &c. are all as arbitrary dislocations as those of the unlettered butcher, the erudite Bonetus, or the experienced Baillie. To these separate branches let men attach themselves, (after being grounded by education in all the others,) as interest, inclination, or individual genius may prompt. But, for our parts, we shall make no distinctions between the different members of the same family -nor shall we impose on ourselves any other rule than that of selecting the grain from the chaff-and thus separating useful facts from idle or erroneous opinions.

Floriferis ut apes in saltibus omnia libantOmnia nos, itidem, depascimur aurea dicta.

PRACTICE OF MEDICINE AND SURGERY.

IN looking round the circle of the periodical press, we are nearly as much embarrassed in the selection of a STARTING POINT, as we were in respect to our nosological arrangement. Shall we begin at home or abroad? Shall we give the post of honour to age, to size, to slow or to rapid phases, to talent-to aristocracy, or to democracy? Objections might be urged against each of these modes of setting out. In beginning at home, where charity is said always to begin, we should fail in politeness to our worthy CON

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FRERES on both sides of the Atlantic-and in giving a foreigner precedence, we should offer a terrible violence to the prejudices of JOHN BULL. In respect to AGE, it is not every man-or woman either, who likes to be put into the front rank on THAT score. The SIZE of a book is an awkward claim to precedency. Independent of the vulgar adage about the calf and the veal, and the more classical adage, a great book is a great evil," there are several other considerations that might well deter us from placing the Goliahs of periodical literature at the head of our Periscope. In literary warfare, weight of metal is of less importance than swiftness of sailing:-and water, as the source of steam and vapour, is often more potent than alcohol. As for TALENT, it is like Hamlet's Ghost-" hic et ubique." We live in the very age of talent-" the march of intellect." On every point of the medical horizon, TALENT rises on our view. We have journals of great talent-journals of little talent-journals of "all the talent"-and(as a necessary consequence) journals of no talent at all. Talent, therefore, is such a drug, that it will never do as a qualification for precedency. It only remains, then, to balance between ARISTOCRACY and DEMOCRACY. The FOR

MER is too much encumbered with ancient armour to lead the van-too much inflated with ancestral pride to bring up the

rear.

As for the LATTER, decency forbids that the SANS CULOTTES should be exposed to the gaze of the world at the head of our columns. In this dilemma about precedency, we shall adopt the plan of reverting to first principles-that of A, B, C. In marshalling our cONSCRIPTS On the field, we shall summon them up in strict ALPHABETICAL order, at a first introduction, after which, we shall stand on no ceremonies, in calling on them for their respective contributions. The following journals are regularly received in exchange, or purchased for the use of our Periscope.

Annales de Med. Physiol. (Broussais.)
Archives Générales.
Bibliotheque Nouvelle.

Bulletin des Sciences Medicales.
Gazette (London Medical.)
Journal Complementaire.
Journal de Médécine.

Journal de Physiologie. (Magendie.)
Journal de Progrès.

Journal, (the Edinburgh Medical, &c.)

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Besides the above, we receive, though not very regularly, two or three German, and one or two Italian Journals. Let any one glance his eye over this list, and say whether or not a PERISCOPE is necessary, for the purpose of culling the more important information from these journals, for English readers, not one in a thousand of whom can get at the originals.

We have now only to remark, in conclusion, that it is our intention to review the English periodicals within the phases of their publication, commencing with the present year. A greater latitude must be allowed for the foreign journals, though we shall endeavour to bring up our information to the latest moment. In this review of Journals, however, we shall touch upon no matters but what are useful, or injurious by being erroneous. The FORMER we shall condense, and transfer, as far as is practicable, to our pages: -The LATTER we shall censure or disarm, in as few words as possible. The great mass of inert harmless, or ponderous materials, with which our periodicals are ballasted, rather than freighted, we shall permit to float quietly down the stream of time, to take their proper places, according to their specific gravities, in the ocean of oblivion.

The moral and physical shock of an operation predisposes a person peculiarly to those accidents which naturally arise from the wound, and the judgment of the practitioner, on these occasions, is often of more importance to the patient than his manual dexterity while the knife was in his hand. There are still some disciples of Frêre Jacques in the surgical world. "I have cut you for the stone-may GoD cure you." If trifling injuries and operations are sometimes followed by the most serious constitutional disturbance, how careful should we be, after great operations, to guard the patient against every source of supervening disease! Sometimes we see deep-seated inflammation arise in an organ or part to which the knife has been applied-and the sympathetic fever kindled up destroys the patient, when success seemed certain. other times, a rigor announces the formation of matter in some vital organ, when the preceding fever was so masked, or so trifling as to throw the surgeon off his guard. In other patients, the nervous system becomes highly irritable after an operation, and spasms or tetanus itself ensue. In some a species of delirium succeeds the operation, which is of singular frequency and by no means devoid of danger. Obscure in its causes, variable in its march, but alarming in its symptoms, traumatic delirium is rarely fatal, if treated judiciously and energetically. following cases are selected from a great number of others, that occurred in the wards of M. Dupuytren. The reflections that are appended belong also to the same illustrious surgeon.

At

The

Case 1. A young man from the country was operated on by M. Dupuytren, in the month of June, for sarcocele, of large size. He was much afraid of hæmorrhage, and kept himself in a fidgetty state all the day after the operation. On the third day he was still more anxious, and he was irritated by every motion, gesture, or word of the neighbouring patients. Soon afterwards he complained of pain in his limbs and in his chest. [M. Dupuytren and M. Helis, Hôtel Dieu.] His eyes became animated-his breathing

1. ON A PECULIAR SPECIES OF TRAUMATIC DELIRIUM.

The author justly observes, that it is not merely sufficient to prepare a patient for a surgical operation, and to perform that operation adroitly;-the more difficult part remains the subsequent treatment.

hurried-he demanded food-and insisted on getting out of bed. In short, he was evidently delirious. His cries, the sparkling of his eyes, the immobility of the pupils, the perspiration on his face, the calm and regular pulse in the midst of this commotion, convinced M. Dupuytren

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