extensive influence on the profession, es. pecially on the junior orders, cannot be questioned; and if the matter of the lectures presents legitimate subjects of discussion, or even criticism, we think that no publication can better deserve an examination than that which is most universally read and most generally influential. We shall, therefore, take up the various diseases treated of in these lectures, promising that our comments shall be guided by no other feeling than a desire to establish truth.

PHYSIC AND SURGERY-FEVER.

Mr. A. upholds the "unity and indivisibility" of physic and surgery-and then goes on to maintain, that the symptomat ic fevers arising from local injuries are "exactly like those which Cullen has described under the heads of synocha, synochus, and typhus-and no physician can distinguish them from those which occur without any external injury." Again, he says "I will venture to assert, that the fevers produced by local disease, are the very identical fevers which physicians meet with where there is no external injury." This doctrine we hold to be equally erroneous and dangerous. It presumes that the CAUSES of fever make no difference in the character of the disease. This is a great error. Look at two men, one of whom receives a bayonet-wound in the chest-the other a malaria in Walcheren -or the contagion of typhus in the purlieus of Saffron Hill. Will the period of incubation, the invasion, the nervous and vascular phenomena, the duration, or the termination of the two fevers be identical? No! Is the fever resulting from the contagion of typhus, or the miasm of the fen, as much within the control of art, as the symptomatic fever arising from the wound in the lungs? Can we "put out" the typhus fever in two, three, or four days, by venesection, not measured by ounces, but by wash-hand-basins full ? No, verily. If, then, the character, the course, and the treatment of the idiopathic and the traumatic fevers, are different, as we maintain them to be, how is Mr. Abernethy justified in the sweeping assertion, that they are identical? It is very true that, towards the fatal close of all fevers, whether symptomatic or idiopathic, the features approximate, and the

character of the morbid phenomena becomes nearly, if not wholly, identical. But this is no fair reason for confounding them all together. The very description which Mr. A. gives, at page 7 of his first lecture, negatives its application to the great class of malarious and contagious fevers. There is no similitude between the symptoms of these last, and those resulting from a compound fracture, as delineated by our author.

Mr. Abernethy next proceeds to what is called the "ratio symptomatum" of sympathetic fever, which is summarily despatched in the following manner. "Hang it, I need not trouble you with this; the symptoms explain themselves; they are the natural consequences of the excitement of the heart and arteries, and the disturbed state of the digestive organs." This is certainly a very easy way of cutting the Gordian knot! The whole ratio symptomatum in fever is explained by excitement of the heart and arteries-and disturbance of the digestive organs. Whether this disturbance is the cause, or an effect, of the local and constitutional affection, we leave our readers to judge. It would not be worth our while to enter into an examination of this point, in the present instance. The treatment is still more easily managed.

"Treatment! there is no treatment. The disease is the necessary and natural consequence of the injury it must inevitably take place:-You may mitigate, but you cannot cure it." What! there is no treatment-yet "you may mitigate"

the disease! Is this not the treatment in the great majority of diseases? Can we in any case, take the ratio medendi out of the hands of Nature, and cure the disease by the main force of art? The lecturer goes on to say, that we must bleed in symptomatic fever; but really his ob servations are calculated to destroy the manufacture of lancets, to starve the increasing population of cuppers, and to revive the trade of leech-catching!

"Do not take away his blood, which is his life, for you may find after a certain time, that he will stand in need of every degree of vital energy to recover from the injury. I have seen a patient bled, and bled, and two or three days after, the medical man has been glad to throw in the bark, and try every means, when it is too

late, to give strength and vigour to the constitution of the patient."

Again, Mr. Abernethy says:

"As the fever subsides spontaneously on the third or fourth day, when suppuration takes place, avoid bleeding the patient if possible. Give him diluent drinks and acids, such as lemonade, &c. for which he has a desire."

Cleansing the bowels is properly insisted on, as a necessary measure. But, as the lecturer grounds his observations on a case of compound fracture, and that in a London subject, where he does not think a healthy subject is to be found, it is manifest that the didactic precepts, as far as regards fever, are extremely imperfect-not to say erroneous. London is not spread over the whole surface of the earth--and injuries

*Is it not astonishing that a man, professing to be an accurate observer of nature, and a critic on the opinions of the most eminent physicians of the world, should maintain that a fever "which subsides spontaneously on the third or fourth day" is identical with that which physi cians meet every day where there is no external injury-in other words, that this fever from a wound is the same as that from contagion or malaria !! Is this

a doctrine to guide the rising generation of pupils, when they go into the country to practise their profession?

It is true that Mr. A. apparently recollecting himself, says "if a man be shot through the body--if an internal and vital organ is injured and inflammation come on that organ," you must bleed repeatedly and decisively. "We do not, however, bleed here for fever, but for inflammation." Now by this passage, Mr. A. virtually gives up the identity of idiopathic and symptomatic fevers. According to this doctrine, we have no warranty for venesection, however high the symptoms of fever may run, unless we have evidence of inflammation of a vital organ! We are not to bleed for fever--but for inflammation. Mr A. ought to know that most violent fevers commence without inflammation--and if we did not bleed, in such cases, inflammation would assuredly supervene in some organ or structure. The doctrine is decidedly bad.

are not confined to compound fractures of the legs of drunken draymen in the vicinity of Bartholomew's Hospital. What would have become of our soldiers and seamen in the late war, if the fever induced by the wounds of bayonets, bullets, and splinters, had been treated according to the economical principles inculcated in these lectures? If our medical officers had acted on these narrow principles of economy, in respect to bloodletting, we can only say that they would have verified the old adage-" pennywise and pound foolish." The lecturer remarks that purgation, by promoting the secretions, lessens the plenitude of the blood-vessels. "This is a fact which those who have not studied anatomy and physiology cannot be so thoroughly ac quainted with as those who have." The ancients were well acquainted with this fact, although very imperfectly versed in anatomy and physiology. But leaving this on one side, who are those against whom the above sarcasm is levelled? Against PHYSICIANS, of course! They can be supposed to know nothing of into the medical societies of this or any anatomy and physiology. Yet if we go sicians are not behind the level of their other metropolis, we shall find that physurgical brethren, in anatomy, physiology, or pathology. No class of the profession should be singled out for animadversion. He who cultivates his art should be reve

renced, be his designation what it may-

he who does not keep himself on a level with the progress of science should be stigmatized, even if he were a teacher of the art. Medical knowledge is not res tricted to names, grades, or ranks. It is a REPUBLIC in which TITLE will not always screen ignorance, nor HUMILITY always prevent the rise of merit.

9. INFLUENCE OF THE STOMACH ON THE BRAIN.

In a former paper we gave some account of a dissertation by M. Bayle, on the influence of chronic inflammation of the stomach and bowels in the production of mental alienation. In a second memoir, he adduces further examples of this influence, and winds up with certain conclusions or reflections, which we shall briefly notice.

1mo. In a few cases, chronic phlegmasia of the mucous membrane of the stomach and bowels, is capable of inducing mental alienation-and, in many cases, it is capable of keeping up the mental malady, and modifying its char

acter.

2ndo. Most of those who become deranged at the close of chronic gastroenteritis, have inherited a constitutional predisposition to the disease from their parents. Their mental faculties are generally weak-the brain irritable. The dyspeptic and nervous sufferings of people Jabouring under gastric and intestinal irritation, tend very much to mental hallucination.

3tio. The anatomical characters of the gastro-enteritis which accompanies or causes mental alienation, does not differ from that which is unaccompanied by any mental aberration.

4to. The manner in which the gastroenteric affection acts on the head is twofold. When the pain of the abdominal malady is great, it is sympathetically propagated to the brain, and there disturbs its functions, in the same way as it is propagated to the heart, and produces the phenomena of fever. Hence the symptoms of mania. But when the gastro-enteritis is chronic, and less intense, or the cerebral system of the patient less disposed to irritation, then the dyspeptic sufferings of the individual gradually dispose to hypochondriacism and hence arise various kinds of monomania-and especially the dread of being poisoned, with obstinate refusal of food, &c. These two forms differ only in degree, and they often pass from one into the other.

5to. This dread of poison aud obstinate refusal of food are regarded by M. Bayle as the most constant and essential symptoms of mental alienation accompanied by chronic inflammation of the mucous membrane of the digestive tube. The two symptoms above mentioned are "the expressions of gastric and intestinal sufferings in mental alienation." They may exist, he observes, without this condition of the stomach or bowels, but he has never seen a case where they were present, and where the symptoms of chronic gastro enteritis did not show themselves during life, or the traces of it were found af ter death.

6to. It follows from these premises, if they are correct, that the treatment of insanity, where these phenomena obtain, must be specially directed to the gastrointestinal affection--and does not differ from that which is necessary or proper where no cerebral disturbance is complicated with the original malady. This treatment hinges almost entirely on repeated leechings of the epigastrium-mucilaginous drinks-extremely abstemious regimen--exercise in the open aircounter-irritation.-REVUE MEDICALE.

Fanciful as the above doctrine may appear to those who look no farther than the organ apparently most affected, for the source of a disease, we believe there is some foundation for it in fact. The mental miseries resulting from gastrointestinal irritation are but very imperfectly known even to the most experienced physicians. Nothing, in short, but actual personal sufferings can teach the terrible but instructive lesson!

10. IRRITABILITY OF THE AIR-CELLS ASTHMA.

A perusal of Mr. Abernethy's lectures, as now published through more than one channel, is calculated to excite various emotions. There is a mixture of accurate observation, eccentric, not to say erroneous deduction, shrewd remarks, and humorous naiveté, which is altogether unparallelled in didactic instruction,and medical literature. It is our intention to give a running commentary on these lectures, which we hope to render somewhat interesting. The present subject is irritability of the mucous membrane of the air-cells, as one of the principal causes of that mysterious disease asthma.

Of the irritability of this membrane Mr. A. entertains no more doubt than of the irritability of the urethra-of which there can be no doubt.

"Ordinarily, respiration may be said to be a mechanical process; we enlarge the capacity of the chest by the intercostal muscles, and the air is forced into the lungs we diminish the chest, and the air is forced out of the lungs, just as if you were using a pair of bellows. Ordinarily, respiration is carried on merely as a mechanical process; but,

extraordinarity, do we not find manifes tations that air cannot get into the lungs, though we do endeavour to enlarge the chest? You know you never could lift up the board of the bellows, if you were to stop up the holes that admit the air, and why? On account of the immense weight of the atmosphere. Just so, if you were to put a rope round a man's neck, and stop the air from entering into the trachea; it is not the strongest man that ever lived that could afterwards enlarge that man's chest; to do that, would be to lift up an immense load of air. A man having irritable lungs, may be sitting comfortably enough at the fire-side, but a little smoke comes into the room, and he can breathe no more: he gasps for breath, he cannot enlarge the chest, and he finds the utmost difficulty in respiring; but where is the difficulty? Where is the sensation of pain and contraction? Why, in the lungs themselves; the hindrance is there; I believe it is all irritability.'

Passing over the error that respiration is carried on by the intercostal muscles alone, we cannot but see the want of analogy between the bellows and the lungs in this case. If, indeed, Mr. A. had said that irritation of the mucous membrane of the glottis, might throw the surrounding muscles into a state of spasm or contraction, and thus prevent the ingress of air into the lungs, we could readily understand him; because it is in this way that irritation of the urethra causes temporary or spasmodic stricture of that canal. But, when he says that irritation of the mucous membrane lining the air-cells causes contraction of the said cells, and shuts out the air, we are at a loss for the quo modo-unless he can demonstrate muscular fibres in the parieties of these cells. We are inclined to to think that the true explanation will be found in irritation of the membrane lining the passages leading to the lungs (and which, as we said, are surrounded by muscles) rather than in the air-cells themselves. Be this as it may, it is very difficult to account for the phenomena presented by what are termed asthmatic people. Pure air generally relieves the dyspnoea, where there is no organic dis

* Lectures, page 375.

ease-but not always. Asthmatic people of London go about the streets "with their shoulders hitched up to their ears, and using every auxiliary to enlarge their chests." Mr. A. instances the case of a neighbour whom it was painful to see walk about, while breathing an impure air, as he appeared to be in imminent danger of suffocation. Such was his state in Bedford-row, but by the time he had got to the top of Gray's Inn-lane, in his way to his country-house, for a mouthful of fresh air," he breathed perfectly well." But there are many others who breathe better in an impure than in a pure air. Mr. A. knew a man, "whose lungs were so asthmatical that he could never lay down in his bed at night," and he was advised to go to the South of France. He consulted Mr. A. "I told him what I tell every body else, that the best thing he could do was to take care of the state of his stomach. In about three weeks he called again on Mr. Abernethy, and reported that he had done according to his directions, and that he had breathed the air of London for the above-mentioned period of time, without the least difficulty of breathing. He went back to his native air, which was on the top of a high hill -and he was nearly suffocated the very first night he slept there. Another man lived in a room which was filled with sulphuric acid gas, and found that "it relieved his difficulty of breathing in an amazing degree."

"I say that is whimsical; but all this leads to convince me, that there is a state of irritability in the lungs, and which proceeds from the state of the stomach too."

It is almost needless to say, that this physiology and pathology of the mucous membrane of the bronchia and air-cells, is extremely imperfect, and far from what we would expect from such a man as Abernethy. When we find a paroxysm lasting for one, two, or three days, and of spasmodic asthma, as it is called ending in a copious expectoration, we cannot but conclude that a turgescent condition-a congestion, if you will-of the vessels distributed over this extensive membrane, had previously existed-and that Nature had relieved the dyspnea, by the discharge of a copious effusion or exudation from the said membrane, in the shape of a muco-purulent expec

toration. The doctrine of mere irritation then, is, like many other doctrines, too confined and exclusive. It is not founded on an extensive and liberal view of the phenomena presented by disease.

11. DIAGNOSIS OF HERNIA.

A very animated discussion on this point took place at the Westminster Medical Society, on the evening of the 15th, and really some observations fell from one or two gentlemen on the occasion, which, as the Americans have it, would be exceedingly important, if true.

The subject was very ably introduced by Mr. Cæsar Hawkins, who considered, seriatim, the symptoms diagnostic of hernia-the tumours which may be mistaken for it, or combined with it-the contents of the sac, where a hernia has been proved to exist-and, lastly, these having been ascertained, their pathological condition. From this it is evident, that the field was a very extensive one, and we are sorry that our limits will not permit us to do justice to Mr. Hawkins' observations. With regard to the symptoms of strangulation, Mr. H. thought that it was exceedingly difficult to distinguish between them and inflammation of the intestines, or ileus, in acute cases; but, in the chronic forms, the diagnosis is by no means so difficult. Varicocele, or varix of the veins of the round ligament, a very rare disease, of which we detailed a case in our last fasciculus, is not unfrequently mistaken for omental hernia; but, by placing the patient in the erect position, and making pressure at the ring, the descent of a hernia is prevented, whilst the varices, if they exist, become turgid. Enlargement of the femoral vein, too, beneath the crural arch may counterfeit a femoral hernia. The diagnosis, however, is similar to that in the former instance, viz. pressure on the groin, which causes the vein to swell, but prevents the descent of a herniary tumour. Hydrocele, encysted hydrocele of the cord, especially the latter, and an enlarged absorbent gland, which is situated just within the external ring, may be severally mistaken for inguinal hernia, whilst it is well known that surgeons, even of eminence, have cut down upon a bubo, imagining it to

be a femoral hernia. After noticing various other sources of error to which the practitioner is exposed, Mr. Hawkins proceeded to point out the distinctions between intestinal and omental hernia, which he thought of importance, especially in the more chronic cases. In the former, when the intestine is closely girt, purges may be useless, or worse; whereas, in epiplocele, they may prove of service, and, at any rate, we have more time afforded us, before having recourse to an operation. In the acute cases of intestinal hernia, Mr. Hawkins was of opinion that bleeding and the warm bath should precede the application of the taxis, as they tend to diminish the inflammatory engorgement of the tumour.

Dr. Somerville remarked that he had frequently seen patients die after the operation for hernia, performed apparently under favourable circumstances, when no organic lesion of any consequence could be detected after death. In such cases, the nervous system appeared to have received a shock, and the patients to have sunk under that state which has been designated by the name of "constitutional irritation." This was a most unfortunate phrase, for no sooner was it uttered than Mr. Lambert started on his legs, and expended we know not how much valuable argumentation, to prove that this "constitutional irritation" was a mere non-entity-an ignis fatuus in the Doctor's brain. Mr. Bennet observed that there is most certainly "a something," call it what you will, which supervenes even on trifling accidents or operations, and carries off the patient quite independent of any inflammatory process. Thus, in opening the abdomen of dogs, Mr. B. had seen them die in so short a period, that it was impossible for inflammation to have developed itself.

Dr. Duffin having related a case in which he had nearly mistaken an enlarged and suppurating gland, under very obscure circumstances, for an inguinal hernia, was attacked, unguibus et rostro, by Mr. Lambert, who declared, that the symptoms of strangulated hernia, were so decided, that no surgeon who knew any thing of his profession, ought to mistake them! Mr. L. was then asked by Mr. North to detail those symptoms of strangulation, seeing that they were