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635 REVIEW. Tlte Science of Surgery, or the Principles of Pathology made the basis of Medical and, Surgical Practice. By W. W. SLEIGH, Esq., Lecturer on Anatomy, Physiology and Surgery. 8vo. pp.310. London, 1825. Anderson. Vol I. THE author informs us, that the present work constitutes " the substance of his annualcourse of surgical lectures," and that it is published " with the desire of placing the healing art upon sound, scien- tific principles-of divesting it of empiri- cism, and of facilitating the acquirement and advancement of medical knowledge." He divides surgery into " art" and " science," the former comprehending whatever is mechanical " or actually done by the hand," and the latter, 11 a variety of7 affections which become so mingled and interwoven with medical ones,’ that it puts human ingenuity at defiance to separate them." He hopes « to enable the practitioner to act upon physiological and pathological principles ; to unshackle him from the dogmas of others ; and to teach him to build his practice upon the laws of nature alone." How far he has accomplished these desirable objects will appear as we proceed. After condemning nosological works, and those of Cullen and Thomas, the author makes a few remarks on the laws of the animal economy, and proceeds to inform us, that he has reduced " medical and surgical practice (manual operations excepted) to three principles, viz. noso- coilia,* (vo&sgr;os, morbus, et &kgr;oi&lgr;ia, venter,) debility and inflammation; by which mor- bid affections may be treated, not as a vast variety of distinct diseases, but as connected to one or other of these three heads." He says, chap. i., sec. 1.:- Sed potius Nosocœlia.—En. " Nosocoilia, debility, and inflamma- tion, are three morbid conditions of the system, which are distinct from each other in their nature, cause, and symp- toms. I say conditions of the system, although each of them may be local or general, that is, confined to a part, or affecting the whole machine. There is no disease, whether local or constitutional, unless a congenital orga- nic affection, that is, not referrible to one ,or other of these heads; so that the whole catalogue of diseases generally enumerated by medical authors, should be treated not as distinct affections, but as connected with one or the other of these. If this assertion be true, (and I doubt much, although it may be impugn- ed, that it can be overturned,) it is only necessary to be perfectly acquainted with these conditions to treat diseases upon scientific principles." . We pass over the second and third sec- tions (on the physiology of the digestive apparatus and process of digestion) which are merely compilations, and proceed to " the functions of the liver," Sec. 4, where the author promulges the following theory :- " The use attributed to this gland by physiologists in general is, simply to pre- pare the bile from the blood, which hile is to assist in the process of digestion ; but I am inclined to believe that this is not the only use of the liver—the largest gland in the body ; nay, I would venture to assert that this use is only secondary; and that the primary use is, to assist the lungs in the process of regenerating the blood, by freeing it of its carbon and hydrogen ; and thus to act the part of an auxiliary to the lungs. The process of respiration is considered by the majority of the profession, at the present day, to consist in the digestion, as it were, of the blood by the lungs ; the lungs abstracting from it carbon and hy- drogen, and supplying it from the atmo- sphere with oxygen. Some, however, deny that any oxygen is added to the blood by this process. The analogy between the process of respiration and the formation of bile is remarkabte: for the lungs and the liver have each two distinct sets- of blood ves- sels ; one set conveying blood for their nonrishment, the other set conveying it for them to act upon, and to digest. Thus the lungs have the pulmonary arteries carrying to them venous blood, in order to be converted into arterial blood, which
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REVIEW.

Tlte Science of Surgery, or the Principlesof Pathology made the basis of Medicaland, Surgical Practice. By W. W.

SLEIGH, Esq., Lecturer on Anatomy,Physiology and Surgery. 8vo. pp.310.

London, 1825. Anderson. Vol I.

THE author informs us, that the presentwork constitutes " the substance of his

annualcourse of surgical lectures," andthat it is published " with the desire ofplacing the healing art upon sound, scien-tific principles-of divesting it of empiri-cism, and of facilitating the acquirementand advancement of medical knowledge."He divides surgery into " art" and" science," the former comprehendingwhatever is mechanical " or actually doneby the hand," and the latter, 11 a varietyof7 affections which become so mingledand interwoven with medical ones,’ thatit puts human ingenuity at defiance toseparate them." He hopes « to enablethe practitioner to act upon physiologicaland pathological principles ; to unshacklehim from the dogmas of others ; and toteach him to build his practice upon thelaws of nature alone." How far he has

accomplished these desirable objects will

appear as we proceed.After condemning nosological works,

and those of Cullen and Thomas, theauthor makes a few remarks on the laws

of the animal economy, and proceeds toinform us, that he has reduced " medical

and surgical practice (manual operationsexcepted) to three principles, viz. noso-

coilia,* (vo&sgr;os, morbus, et &kgr;oi&lgr;ia, venter,)debility and inflammation; by which mor-bid affections may be treated, not as a

vast variety of distinct diseases, but asconnected to one or other of these three

heads." He says, chap. i., sec. 1.:-

Sed potius Nosocœlia.—En.

" Nosocoilia, debility, and inflamma-tion, are three morbid conditions of thesystem, which are distinct from eachother in their nature, cause, and symp-toms. I say conditions of the system,although each of them may be local orgeneral, that is, confined to a part, oraffecting the whole machine.There is no disease, whether local or

constitutional, unless a congenital orga-nic affection, that is, not referrible to one,or other of these heads; so that thewhole catalogue of diseases generallyenumerated by medical authors, shouldbe treated not as distinct affections, butas connected with one or the other ofthese. If this assertion be true, (and Idoubt much, although it may be impugn-ed, that it can be overturned,) it is onlynecessary to be perfectly acquainted withthese conditions to treat diseases uponscientific principles." .

We pass over the second and third sec-

tions (on the physiology of the digestiveapparatus and process of digestion) whichare merely compilations, and proceed to" the functions of the liver," Sec. 4, wherethe author promulges the followingtheory :-" The use attributed to this gland by

physiologists in general is, simply to pre-pare the bile from the blood, which hileis to assist in the process of digestion ;but I am inclined to believe that this isnot the only use of the liver—the largestgland in the body ; nay, I would ventureto assert that this use is only secondary;and that the primary use is, to assist the

lungs in the process of regenerating theblood, by freeing it of its carbon and

hydrogen ; and thus to act the part of anauxiliary to the lungs.The process of respiration is considered

by the majority of the profession, at thepresent day, to consist in the digestion,as it were, of the blood by the lungs ; thelungs abstracting from it carbon and hy-drogen, and supplying it from the atmo-sphere with oxygen. Some, however, denythat any oxygen is added to the blood

by this process.The analogy between the process of

respiration and the formation of bile isremarkabte: for the lungs and the liverhave each two distinct sets- of blood ves-sels ; one set conveying blood for theirnonrishment, the other set conveying itfor them to act upon, and to digest. Thusthe lungs have the pulmonary arteries

carrying to them venous blood, in order tobe converted into arterial blood, which

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iit the proper secretion of these organs !,white the liver has the vena porta con-veying to it venous blood, which it di-

gests, and from which it forms the bile.The lungs have also the bronchial arte-ries conveying to them arterial blood fortheir support, while the liver has also thehepatic artery conveying to it arterialblood for its nourishment. These are theonly two viscera in the animal economythus similarly organised.The blood which is carried to the lungs

by the pulmonary artery is loaded withcarbon and hydrogen, principles which itacquired by its circulation through thebody. It is of a dark purple colonr,heavy, and a few degrees lower in tem-perature than the blood at the left partof the heart.The blood conveyed to the liver by the

vena porta is also peculiarly impregnatedwith carbon and hydrogen, which it ac-

quired while circulating through the tor-tuous vessels of the intestines and spleen.For the vena porta is formed by the me-senteJic and splenic veins; and appears,from its very formation, to be for the pur-pose of collecting from the system as muchcarbon and hydrogen as possible. Thevena porta thus formed, and conveyingvenous blood, enters the great transversefissure of the liver, and distributes itsbranches through the substance of thisgland ; at the extremities of which thebile is formed, a fluid which abounds withcarbon and hydrogen. In like mannerthe pulmonary arteries enter, and aredistributed to the lungs : at the extremi-ties of which the arterial blood is formed,and carbon and hydrogen given off.In further corroboration of this liypo-

thesis, I will call the attention of thereader to a few circumstances (otherwiseunaccountable) in the economy of thefoetal functions. First, the disproportion-ed and immense size of the liver in the

fcetus, although the process of digestiondoes not then take place. Now if the onlyuse of the liver be to form a fluid whichmay assist in the process of digestion,(as the profession believe,) there shouldbe no bile formed until this process re-quired it; whereas, on the contrary, wefind a considerable quantity of it formedbefore birth.*But this circumstance appears satis-

factorily explained, when we recollectthat the blood in the foetus does not cir-culate through the pulmonary tissue, andconsequently is not regenerated by theprocess of respiration, till the animal is

’ The,meconium which fills the intes-tines in the foetus, consists principally ofbrIe.

born. This change in the blood is, fill

birth, accomplished by the liver and theplacenta: by the united powers then ofthese viscera, the placenta and liver, theinactive etate of the lungs in the fcetus iscompensated for. The former organ isdivided into two distinct portions, thematernal and fmtal placenta, betweenwhich there exists no direct communica-tion, any more than there is between thebronchial and pulmonary systems in thelungs. The foetal blood is partly rege.nerated in the placenta by the maternalblood, and this process is completed bythe liver. The only difference betweenthe process in the placenta and lungs is,that in the former it takes place betweentwo fluids, the maternal and foatal blood;in the latter, between a liquid and anaeriform body, the blood and the atmo. I

sphere. After birth, this is the only diffe- ,

rence between the process in the liverand in the lungs, except it be, that in thelatter the blood receives a portion of ioxygen gas : but the possibility of the !blood being altered without the assis-tance of the atmosphere, as in the pla.centa, establishes, I conceive, the proba.bility at least of the correctness of mytheory. That the liver secretes the bilebefore birth, only to keep this organ fit foruse immediately after the child is sepa.rated from its parent, will by no meanssolve the difficulty: it is only cutting the ’

knot, not untying it; for there are many ’iorgans which are in a perfectly dormantcondition during the period that the ani.mal is in the uterus, which are forthwith !called into action the moment after birth,viz. the lungs, kidneys, salivary glands,&c.

If the liver be only to assist the pro.cess of digestion by secreting bile, whyis bile formed, in a vast quantity, formonths before the process of digestioncommenced ? Why does an additionalquantity of blood pass through the liverin the foetus, when the umbilical veinmight run directly to the vena eava,without giving a single branch to this

organ ? If thebile be merely to act onthe food, why is it formed from venousblood ? * Could not nature produce bilefrom arterial blood, as well as she doesall the other fluids of the body, whether

* The circumstance that one or twoanomalous cases have occurred, wherethe hepatic artery alone supplied the

liver, and consequently that the bile wasformed from arterial blood, is no more anargument against my theory, than thefact that many have been born with amalformation of the heart and otherorgans.

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ealine, albuminous, oily, or watery, &c. ?But it would appear that as the lungs inthe fcetus are inactive, this is compensatedfor by the peculiar activity of the liver,digesting the vast quantity of blood thatat this time circulates through it ; themoment the animal breathes, the func-tions of the liver are proportionably dimi-nished, the lungs then performing theirduty.’-pp. 48-54.

Without doubt the liver is destined to

secrete bile for the purpose of animalizingthe fluids and fitting them for joining the

general mass of the circulation. If, asthe author asserts, its use be " to assist

the lungs in the process of regeneratingthe blood, by freeing it of carbon and

hydrogen," why is the bile so animalizedor loaded with nitrogen ? And surelythe lungs themselves expend carbon

enough without calling in the assistance

of the liver, for, as an accurate author

has informed us, respiration alone requiresthe carbon contained in at least eight orten pounds of food in the day, which is

much more than is usually taken. Besides,there is no proof that the process carriedon in the lungs, has any other object thanthe preservation of temperature, or that

any hydrogen is separated by it; and un-til we know more of the changes whichthe blood of the foetus undergoes in the

placenta, no feasible argument can be

grounded on the fact, that bile is secretedbefore digestion is required. The hypo-thesis seems to have originated in the

observation of some one, that those ani-

mals which have small lungs, have liversparticularly developed.

Nosocoilia, the symptoms, causes, treat-ment, and effects of which are detailed inthe next chapter, is, in truth, the 11 dis-

ordered digestion" of Mr. Abernethy andother writers, and need not be dwelt

upon. The following, however, is a spe-cimen of the author’s theory :-

" When an individual is exposed to

contagion, or meets with an accident, na-ture immediately summons to her assist-auce those organs she is wont to use, to

expel from the system morbific matter ;bnt having lost her control over them ina nosocoiliatic habit, summons them invain.The method she adopts for this pur-

pose, is to direct towards various glandsa plentiful supply of blood; but theseglands having been previously burdenedwith half regenerated blood, in conse-quence of nosocoilia, are incapable of dis-charging their duties, and thus give riseto the morbid symptoms of fever. In ahealthy and natural condition of the ani-mal body, fevers are frequently pre-vented by the noxious particles of conta-gion being carried out of the system bysome extraordinary discharge, as by anexcessive perspiration, a diarrhoea, &c.*As old age, syphilis, scurvy, and cancer,are said to predispose the osseous systemto fractures, by rendering it preternatn-rally brittle, so nosocoilia may be said topredispose the whole system to disease,by rendering it susceptible to the powersof, or unable to expel, morbific parti-cles."—pp. 91, 92.

Debility.-The terms weakness and de-bility are, the author thinks, too frequent-ly used by the profession without any de-finite meaning, wherefore, to obviate all

ambiguity, he has two species, viz. debi-litas genuina, and debilitas ficta, the

former indicating 11 a real loss of tone,"and the latter that state of the systemin which there are " the external ap-

pearances of debility, but in reality noloss of tone or stamina in the body, the

symptoms proceeding from increased

action."" Debilitas genuina.-By this term’ I

mean that condition of the system wherethere is a deficiency in the vital powers ;a loss of strength, or tone, in the solids ;and an alteration in the quality, andsometimes in the quantity, of the fluids.

’ The causes of this species of debilitymay be considered under two heads, viz.the natural or organic, and the accidental.Among the natural causes we may reckon,

* The lachrymal apparatus affords a

striking example of the exertions of na-ture. No sooner does a foreign body getinto the orbit, than this gland becomes acentre of fluxion, and the offending par-ticle is washed away by a flood of tears :though she sometimes fails even in thisfunction.

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1st, age—very young and ’very old per-sons being proportionably weak or fee,ble ;-.-2d, scrofula, which consists of tpeculiar debility of the lymphatic system- and, Sdly, organic congenital affec.tions, such as a mal-formation of theheart, longs, &c. The second class maybe considered as composed of accidentalcauses, the number of which is infinite;and each sufficiently obvious to accountfor the symptoms of genuine debility.These are to be divided into—1st, Awant of a due supply of nutriment; 2dly,Nosocoilia ; Sdly, Some or all of the func-tions of the system having been exces-sively exercised, as after inflammation orfever; 4thly, Artificial or unnatural

drains, such as suppuration, diarrhoea,active or passive haemorrhages, &c. ;5thly, Violent emotions of the mind;6thly, and lastly, Although not less pow-erfully, cold. I have thus been particti-lar in enumerating many of the most di-rect causes of debilitas genuina, in order.to oontrast them hereafter with those ofdebilitas ficta; and it should be recollect-ed that, while these circumstances pro-duce debility in all classes of persons.the young, the adult, the old, male andfemale, the quantity of the exciting cause,necessary to produce real debility, willdepend much upon the age, sex, and

constitution, of the individual; e. g. astrong adult man will bear with compa-rative impunity a loss of blood, or a vio-lent diarrhoea, which would diminish con-siderabty the strength, if not totally ex-tinguish, the vital spark in another.The symptoms of debilitas genuina

come on most generally in a gradual man-ner, augmenting in number and in degree,gradatim. The symptoms are, a sensa-tion of weakness-inability to performthe usual duties of life-great fatiguesucceeding the least exertion-suscepti-bility considerable-a full soft pulse,sometimes slow, but more frequentlyquick, at all events increased by the mosttrifling stimuli—a general relaxation ofall the secretions, producing excessiveperspiration, a moist tongue and mouth,pale copious urine, diarrhœa, loss of ap-petite ;-and lastly, great weakness, anda general emaciation and wasting of thebody. These all are proportioned to theduration of the affection, and to the vio-lence of the exciting cause.-pp. 103-106.

0 The above catalogue contains the

symptoms, modified according to the na-ture of the cause of all the diseases ofdebility, as hectic fever, phthisis,-&c. &c.

Debilitas ficta.—The appearance)! of ‘,debility may arise either from a deficien-cy of the vis vitæ, or from an over or un.natural action of those vessels which con.vey those substances of those liquids orfluids over the body, upon which all partsdepend for support. The whole body de-pending directly for life andstrengthuponthe blood, is affected by this fluid, eitherwhen there is a denciency or an over

quantity of it: the latter is actually as in.jurious to the body, or to any part of it,as the former. Each organ or viscus re.quires a certain portion of it, which he-ing either increased or diminished inquantity, more or less deranges the func-tions of that part; producing in the formercase a morbid activity-inflammation;and in the latter, a want of energy orpower-debilitas genuina.

If the cause producing the morbid ac.tivity be considerable ; if the system hasbeen labouring under the effects of noso-coilia ; or if the organs affected be sup-plied with nerves from the great sympa.thetic ; the symptoms which usually cha.racterize inflammation do not appear,but symptoms very much resemblingthose of debilitas genuina supervene-these appearances deceive not merely thefriends of the individual, but too fre-

quently the medical attendants. This iswhat 1 term debilitasficta.How an increased quantity of the blood,

which conveys to all parts nutrimentitiousprinciples, and upon which the whole ani.mal machine directly depends for powerand for the vis vitae, can possibly pro-duce the appearances of weakness is, Iacknowledge, with some difficulty com-prehended. But were I even unable

satisfactorily to elucidate the way inwhich this spurious debility is produced,or the modus operandi of nature in thosecases, the innumerable facts which I couldadduce from my own experience and thatof others, would be sufficient to substan-tiate the truth of my theory.The three circumstances which I have

just mentioned as predisposing the sys-tem to debilitasficta, act pretty much inthe same way: whether it be the degreeof the exciting cause-the nosocoiliaticstate of the system, or the parts being in-timately connected with the brain by thegreat sympathetic nerve, the powers ofnature appear to be unable to producethat re-action which causes the symptomsof inflammation, but now those of debi-litas ficta. These symptoms being moreor less suppressed in this case, life be.comes extinguished by a latent action,resembling an internal combustion, which

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sometimes proceeds with the most effec-’ Itive energy, even to the utter consump-tion of the body in which it exists.

The plain and obvious reason why, inall cases where there is increased action,the common symptoms of inflammation dopot appear is, that nature, either fromthe quality of the cause, or of the partaffected, is actually unable to excite thosepowers which, under ordinary circum-stances, she readily does. The patholo-gical condition then of the system, whenlabouring under debilitas ficta, is an over-burdened state of the vessels, smotheringas it were the symptoms of inflammation,and exhibiting the external appearancesof debility.That this state of the system is not

merely imaginary, can be proved by manycircumstances ; but none is more con-

vincing than the fact, that blood drawnin these cases always relieves the indi-vidual, removes the symptoms of weak-ness, and brings on the real characteris-tics of inflammation. To produce theseeffects from blood-letting would be ut-terly impossible, were there an actual lossof tone in the system, or was not the pa-thological state of the body such as hasbeen described in the preceding para-graph. Let not the reader, however,suppose that debilitas ficta is of rare oc.currence, far from it : there are manydiseases described and treated as cases of

genuine debility, that are really examplesof this species."-pp. z121.

The exciting causes of debilitas fictaare all those which excite fevers, such

as damp air, the poison of contagion,suppressed perspiration, &c. Debi-

litasfieta, in fact, is only atiotlier namefor the first stage of fever or inflamma"tion.

11 The fact is," says the author, " thatthe only way in which the symptomsof debilitas fieta differ from those ofactive inflammation is in the sensa-

tion of weakness, and the smallness andfeebleness of the pulse ; in every otherrespect they are the same. In shortywhat is this debilitas ficta but a violentand dangerous degree of inflammation,so affecting the vital powers as to sup-press the exertions of nature ; and beingthus likely to deceive, to demand parti-cular attention.

It was stated before that the symptomsof debilitas genuina come on gradually,while those of debilitas ficta come on forthe most part suddenly, and unprecededby any circumstances sufficient to accountfor the degree of weakness that is felt.I shall now enumerate and contrast the

symptoms or appearances of both spe-cies :-

In Debilitas Genuina. In Debilitas Ficta .

1. The symptoms Gradually and Slowly.* Suddenly.come on fAre never such as are cal-

2. Causes Always manifest. culated to produce real debi-lity. j3. Sensation Of weakness. Of weakness.

4. The parts af- Muscular, Glandular, andfectedwitlide- Absorbent systems, prima- pnly the voluntary muscles.rily; and all parts seconda- } Only the voluntary muslces.bility

5. The pulse Soft and full, easily excited. Small and contracted.

6 The bowels Relaxed. Constipated.7. Secretions Relaxed. Suppressed or Diminshed.8. Syncope Very common. Never occurs.

Sometimes a considerable Always comparatively short,9. Duration length of time ; except when sometimes not more than 72

produced by some manifest hours when life becomes extin-cause. by some ) guished. when life becomes extin- )

except when produced by haemorrhage, or any violent accident, in which case.the causes being sufficiently apparent, there is no danger of being deceived.

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A little attention to these symptomswill enable any person to distinguish be-tween the two species of debility-thesymptoms of debilitas genuina coming ongradually, preceded by some circum.stance sufficient to account for the weak-ness, and the general relaxation of thesecretions, should at once point out thenature of the case : whereas the symp-toms of debilitas ficta coming on suddenly,unpreceded by any debilitating cause, andthe suppression of the secretions are, onewould suppose, sufficient diagnostics.The bare sensation of weakness shouldnever influence our judgments, withoutother concurring circumstances ; and weshould be the more cautious in preventingourselves from being swayed by that natu-ral prejudice respecting debility, which isso general, as the two species require thevery opposite modes of treatment-thatwhich is suitable in one, being downright’fatal in the other."-pp. 123-126.

Bloodletting and the antiphlogistic regi-men must be employed.

The author has frequently been calledto attend patients labouring under debi-litas fieta, and has always had to encoun-ter the greatest prejudice." I recollect," says he, " attending a

lady in the winter of 1823, in this city ;she was about fifty years of age, themother of a large family, and the wife ofan opulent merchant. Upon first seeingher, I at once conceived she was labour-ing under debilitas ficta, she having manyof the symptoms described under thathead. She was rather of a delicate ap-pearance, and complained of a sensationof great weight at her chest ; her coun-tenance was sallow, her tongue white,her mouth parched, accompanied withgreat weakness, a total loss of appetite,&c. Considering it to be produced bynosocoilia, I ordered cathartics and blood-letting. The latter proposal was at firstrejected with great confidence; some ofthe friends observing, that if it werepossible to put blood into her, it wouldbe more proper than to take it from her.’To which observation I replied, that Iwas willing to meet any medical gentle-man on the subject ; if they differed withme, I would of course yield; but if bloodwere not taken, and the tonic plan adopt-ed, the lady’s recovery I verily believedto be impossible; and if she did recoverunder their mode ot’ treatment, I shouldgive up my profession, acknowledgingthat I knew nothing about it, and there-fore could not conscientiously practise it.’

The confident manner in which I spoke ofmy proposal made them consent ; and Iforthwith detracted sixteen ounces ofblood. During this operation, the pulse,which before was small and contracted,became fuller and freer, and the weightwhich she complained of at her chest was

: diminished. Next day she felt, on thewhole, somewhat better ; the blood exhi-

bited a considerable huffy coat, and wasi very much cupped. I considered it judi.; cious to repeat the bloodletting that andthe following days, which was attendedI with the same beneficial effects. Having: then, as I conceived, sufficiently unbur.dened the vessels, I directed my whole; attention to the chylopoietic viscera, andin the course of a few weeks removed

i the affection, for which I was sent for. Ihave detailed this one case out of many,: in order to give the inexperienced prae-titioner some idea of the dimcuities hewill have to encounter in treating debili-tas ficta."pp. 129-131.We are next presented with the case

of the late Lord Byron, which the authorhas transcribed from the account givenby Count Petro Gambia.

11 April 9th, Lord Byron had sufferedvisibly in his health during the last day ortwo : the events just mentioned, and the

weather, had made him more than usually; nervous and irritable ; but he this morn.ing received letters from Zante and fromEngland, which raised his spirits exceed-ingly. He had not been on horsebackfor three or four days ; and though the

weather was threatening, he resolved toride. Three miles from the town we were. overtaken by a heavy rain, and we re-

turned to the town-walls wet through,and in a violent perspiration. Two I,oursafter kis return home, he was seized withI a shuddering : he complained of fever, and rheumatic pains. At eight in the

evening I entered his room; he was Iy.ing on a sofa, restless and melancholy.He said to me, I suffer a great deal ofpain ; I do not care for death; hot theseagonies I cannot bear. The medical men

I proposed bleeding, but he refused, ob-serving, ’ Have you no other remedythan bleeding ?-There are many moredie of the lancet than the lance.’ Someof the physicians answered, that it wasnot absotutety necessary to bleed as yet,and I fear were too much inclined toflatter his prejudice against that operation.But there was not then the slightest siis-picion of any danger, nor was there auyat that moment.

10th. The next day he felt himself per.pctually shuddering; but he got np at

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his usual hoar, and transacted business ;but he did not go from home.l2th: The next day he kept his bedwith an attack of rheumatic fever.

13th. He rose from his bed the next

day, but did not go out of the house.The fever appeared to be dimini,lted ; butthe pains in his bones and head still con-tinned : he was melancholy and veryirritable. He had not been able to sleepsince his attack, and he could take noother nourishment than a little broth, andaspoonful or two of arrow-root.

14th. The following day he got out ofbed at twelve : he w as calmer ; the feverwas less, apparently, but he was veryweak, and suffered from the pains in hishead. He wished, however, notwith-stamling the weather was threatening, togo out on horseback, or at least in a

boat; but his physicians dissuaded him.It was now thought that his malady wasgot under, and that in a few days hewould be quite recovered. There was nosuspicion of danger.

15th. The fever was still upon him ;but the pains in his head and bones weregone. He was easier : he even wished toride out; but the weather would not

permit. Both on this day and the daybefore, he had entertained some suspi-cions thathis complaint was of no ordinarynature, and that his physicians did notunderstand it ; but he had not the leastapprehension of danger.

16th. He was better; his complaintwas following the usual course, and therewas no fear.

17th. The next day I contrived to getto his room. His countenance at onceawakened the most dreadful suspicions :he was very calm ; he talked to me in thekindest manner. This was the first daythat the medical men seemed to entertainsedons apprehensions of the event : hewas bled twice ; first in the morning, andat two in the afternoon, and lost about twopounds of blood. He did not faint, andhis eyes were lively, but he had no sleep ;he perspired on the head and neck : andthe disease seemed attacking the head.He was dreadfully distressed by want ofsleep; and he now said to Dr. Millingen,’ I know that without sleep, a man mustdie or go mad: I would sooner die athousand times.’ He repeated this to hisvalet Mr. Fletcher.

18th. During the night of the 17th, hehad some attacks of delirium, in whichhe talked of fighting; but neither thatnight nor the next morning was he awareof his .peril. This morning his physicianswere alarmed by appearances of inflam-mation of the brain, and proposed anotherbleeding, to which Lord Byron consented, I

but roon ordered the vein to be closed.Dr. Bruno entreated him, with tears inhis eyes, to be again bled. No, he said :it’ my hour is come, I shall die whether Ilose my blood or keep it.

Since tlteir last consultation, the majo-rity of the medical men had thought thatthe crisis of the disorder was now come,and that the principal danger now wasthe extreme weakness of the patient; andthat restoratives should be administered.Dr. Bruno thought otherwise ; but it wasresolved to give a draught of claret andbark and opium, and to apply mustardblisters to the soles of the feet. Byrontook the draught readily, but refused theblisters : accordingly I was sent for to

persuade him, and I returned in all hastewith Mr. Parry.

It was about six o’clock in the eveningwhen he said-I want to go to sleep now ;and immediately turning round, he fellinto that slumber, from which, alas! henever awoke!On my arrival, they informed me that

he was asleep, and that he had sufferedthe blisters to be applied, not to his feetbut elsewhere. The physicians auguredwell of this sleep-perhaps it was but theeffect of the medicine, and only hastenedhis death. °

Dr. Bruno’s report of the appearances onDissection.

1. On opening the body of Lord Byron,the bones of the head were found ex-tremely hard, exhibiting no appearanceof suture, like the cranium of an octo-genarian, so that the skull had the ap-pearance of one uniform bone: thereseemed to be no diploe, and the sinusfrontalis was wanting.

2. The dura mater was so firmly at-tached to the internal parietes of thecranium, that the reiterated attempts oftwo strong men were insufficient to de-tach it; and the vessels of that membranewere completely injected with blood : itwas united from point to point, by mem-braneous bridles, to the pia mater.

3. Between the pia mater and the con-volutions of the brain were found manyglobules of air, with exudations of lymphand numerous adhesions.

4. The great falx ot the dura mater wasfirmly attached to both hemispheres bymembranous bridles, and its vessels weretinged with blood.

5. On dividing the medullary sub-stance of the brain, the exudation ofblood from the minute vessels producedspecks of a bright red colour. An ex-travasation of about two ounces of bloodyserum was found beneath the pons va-

rolii, at the base of the hemispheres, and

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642in the two superior or lateral ventricles asimilar extravasation was observed atthe base of the cerebellum, and the usualeffects of inflammation were discoverablethroughout the cerebrum.

6. The medullary substance was inmore than ordinary proportion to the

corticle, and of the usual consistency.The cerebrum and the cerebellum, with-out the membranes, weighed six pounds,(’ mediche.’)

7. The channels, or sulci of the blood-vessels on the internal surface of the cra-nium, were more numerous than usual,but small.

8. The lungs were perfectly healthy,and of much more than ordinary volume,(’ gigantiselle.’)

9. Between the pericardium and theheart, there was about an ounce of lymph; ;and the heart itself was of greater sizethan usual, but its muscular substancewas extremely flaccid.

10. The liver was much smaller thanusual, as was also the gall-bladder, whichcontained air instead of bile. The intes-tines were of a deep bilious hue, and dis-tended with air.’

11. The kidneys were very large, buthealthy, and the vesica relatively small."pip. 131-138.

That this noble author was improperlytreated, partly from his own obstinacy,and partly by the physicians who ad-

ministered the bark and wine, is obvious

enough. Mr. S. next speaks of the caseof Lord Londonderry, which he says :-

" - - - affords another instance of theevil of medical men not distinguishing be-tween debilitas ficta and genuina. Hadthat nobleman (the loss of whose serviceshas been so deeply felt by his country).upon complaining of general uneasiness,weakness, and slight pains in his head,been treated as the nature of his disease(which I maintain to have been debilitasficta,) required ; and instead of the ap-plication of cupping-glasses, had bloodbeen detracted from him copiously, hisvaluable life would no doubt have beenpreserved. In corroboration of this as-sertion, I appeal to the fact of his imme-diate restoration to his senses upon theloss of blood produced by his fatal act;and this is very evident from the earnest-n ss of appeal to his physician.’-pp. 139,40.

A correct account of this lamented

statesman’s case has not been pub-lished, and consequently we are unable

to judge of the propriety of the plans oftreatment which were adopted. The

last sentence of the author savonrs of

ingenuity, and what else we know not.

The fourth section, which embraces the

subject of inflammation, its treatment,terminations, &c., is for the most partcompiled from the works of Hunter,Thomson and other eminent writers.-

After a description of the various speciesof mortification, and their proximatecauses, we have the following observa.tions on that which is produced by in.flammation:—" Many who have written on this ex-

tensive subject, (a mere outline only ofwhich I have given,) and many who treatit at the present day, appear to forget,-1st, That a mortified part is actuallydead; and 2dly, That there are more

spesies than one. There appears greatambiguity in the treatment of mortifica.tion, which I conceive may, in a greatmeasure, be obviated by simply attend-ing to the cause which produced it. Whena part is mortified nothing can restore it,therefore our whole attention mnst bedirected to the condition of the livingparts in its neighbourhood. In treatingany of the species of this affection, it willbe of the first importance to considerwhat is the pathological condition of themortified part, and of the parts in its

vicinity ; the former is dead, without

vitality-an inorganic mass-the state ofthe latter depends entirely upon the ex-citing cause.The first kind of mortification is that

produced by inflammation, by increasedaction of the vessels of the part; the ves.sets, before this occurs, are in an activecondition, similar to that before suppu-ration takes place, only in a muchgreaterdegree. Nature, in mortification, is re-lieved by the part becoming dead, and insuppuration, by the vessels becoming un.burdened ; so that "the spreading ofmortification," as it is commonly termed,is owing entirely to the state of the ad.joining parts. The object then to be ac.complished in the treatment of niortifica-tion is to prevent the affection fromspreading : this can be done only by re-moving the proximate cause, which Ibefore stated to be, in this species, thehighest degree of action of the vessels.Whatever therefore was, previous to themortification, calculated to prevent itsoccurrence, must of necessity possess

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643

equal power in checking its progress, notby acting on the dead but on the livingparts. Further, whatever was calculatedto increase the inflammation in the first

instance, will of course tend to augmentit in the latter, and oC necessity to pro-duce more mortification, or, as it is im-

properly expressed, to cause it " to

spread." What then is to be thought ofthose gentlemen who advise, indiscrimi-nately, hot spirituous applications to a

mortified part? In the first place, theyappear to know very little about the con-dition or nature of pai ts under such eir-cnmstances; or if they know much, theirpractice is not influenced by their know-ledge. Secondly, the fatal terminationof many cases of mortification, which theyscientifically say " cannot be checked,"may justly be attributed to the mode oftreatment; for I assert, without fear ofcontradiction, that nothing can possiblybe more calculated in this species of mor-tification (which occurs ninety-nine timesotit of a hundred) to increase the destruc-tion of the parts, than the before-men-tioned application. Let any one proveto me, that the theory I advanced re-specting the proximate cause of mortifi-cation is incorrect, and then I will ac-’knowledge the above assertion to bewrong; but while I know that increasedaction of the vessels of a part is the prox-imate cause, I can never view the aboveremedies but with abhorrence. I requestthe reader to recollect, that I do not say.hot spirituous applications are improper inevery kind of mortification, I only alludeto the species of the affection now underconsideration.After what I have just said, but little

remains for me to add on this part of oursubject. As the sphacelated or mortifiedpart therefore is dead, cold or hot, sooth-ing or stimulating, applications to it areall the same,’ nothing can produce analteration or an amendment in a deadpart. Whatever, therefore, we order,must be with a view of acting upon theliving parts, so that in the present in-stance, while they are labouring underthe highest degree of arterial action,morbid sensibility, &c., in fact high acuteinflammation, our duty will be to treat itupon the common principles. In propor-tion as we subdue this increased action,do we put a check to the further progressof the mortification.This plan is to be persevered in till the

adjoining inflammation terminates by sup-puration. Should there afterwardsbe muchgeneral debility, the method of treat-ment does not differ from that of debilitasgennina. Notwithstanding all that hasbeen from time to time written on the

subject of mortitification, implying that itstreatment is very diffienit, I trust thereader will no longer conceive that thereis attached to it any such ambiguity. Thefirst stage of this species comes underthe head of inflammation, and is to betreated according to the antiphlogisticregimen ; while the second stage belongsto debility, and is to be treated withtouics : where then is the difficulty, theambiguity, and the uncertainty in thetreatment of this affection so generallybelieved PBefore concluding this part of the sub.

ject, I must notice a direction fonnd inmost of the best surgical books, but ofwhich I beg leave to remark, that it itunscientific, erroneous, and injurious.-The direction I allude to is the following,viz., "that when there is necessity toremove a mortified limb, we should alwayswait for a line of separation between theliving and the dead parts." Now thisdirection is only applicable to one spe-cies of mortification, viz., that arisingfrom an internal cause; and the reasonwhy it is even in this case applicable, isbecause we know not the powers of na-ture till this line be formed; and there-fore there would be no use in operatingon an unfortunate person whose strengthwould not be sufficient to heal the wound.I do not by these remarks pretend toassert, that we should, forthwith upottmortification occurring, remove a limb:who would dare, at the present day, tooperate on inflamed parts ? but as soonas the inflammation in the neighbouringparts has subsided, then, if it be judi-cious to remove the limb at all, the ope-ration should be performed."pp. 182-187.

The author next proceeds to make a

few observations on the nature and treat-

ment of fever, or debilitasfieta, more fullydeveloped. Commencing with Cullen’s

class, pyrexia, which contains forty af-fections, he observes, that " instead oftheir being distinct diseases produced byvarious proximate causes, and requiring a

variety of methods for their treatment,they are, with a few exceptions, only mo-difications of the same state of the sys-

tem," and that " their treatment, whichis included in the antiphlogistic, tonic,and antinosocoiliatic regimens is the

same, differing only in degree, not in na-ture." In this, indeed, there is little of

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644

novelty, for who doubts thatphrenitis and,pneumonia are equally inflammations, re-quiring generally the same plans of treat-ment ; or that an ague, whether under ,,

the quotidian or tertian type, indicates asimilar state of the system ? Accordingto Cullen, where synochus ends, there

typhus begins, from which it clearly ap-pears that he, like our author, viewed.the change as only " a modification of

’the same state of the system." Synochaprobably seldom occurs without local in--flammation, and therefore properly be-

longs to the phlegmasiae ; but the aboveremark is equally applicable to epistaxisand haemoptysis, under the class of hae-

morrhagies, and to several others. Mr.

Sleigh further asserts, that fever is an in-flammation of the whole body, that it onlydiffers from a local inflammation in beinguniversal. A doctrine unhappily muchbroached of late, which has led to the em.ployment of general bloodletting in feversof the worst description. Sydenham, it is

true, whose worst points have been mostcopied, recommends bleeding in the early’stage of every fever ; but as a generalprinciple the practice is highly to be

-condemned, and should never be employed,especially in London, unless some topicalinflammation, or other urgent circum-

stance, indicates it. In rheumatism, it

notoriously protracts the cure, and favoursa metastasis to the vital organs ; and in

the fever called typhus deprives the pa-tient of that support which no stimulants

can restore. Where, a fever is ferm-ing in young and healthy persons, the

practice may be admissible, not as a

matter of course, but with due caution

and deliberation. Where, however, avital organ is implicated, bloodlettingmust be promptly and vigorously pursued.With the following s&ntiments of oar au-

thor we entirely concur

. "Were I asked," says he, "would I

:bleed in fevers, or would I order tonics,

I would not give a decisive answer: myreply would be, it must entirely dependupon circumstances; in many cases Ishould detract blood, and that most co.piously ; while in others I would givepowerful tonics : the symptoms would bemy only guide, and the only regulators ofmy practice."p. 249.

The sixth chapter, which treats of

certain morbid affections of the viscera,is a sort of appendix to that on nosoeoitia,and is illustrated by the following, and afew other cases. .

" I was consulted in the month ot

August, 1823, by a gentleman of aboutthirty years of age, for a violent pain inhis chest, with a difficulty of breathing.He said these symptoms came on sud-denly about three or four days past, butwere now very much augmented in vio-lence. He also stated, that better than ayear before he was attacked in a similarway, and was attended by two or threemedical men ; that he had been then bledrepeatedly, and had been confined to hisbed for nearly three months, and now,’he added, ’ I fear I shall be laid np forsome time ; but do you take enongh ofblood from me at once, if possible, tocheck it in the beginning.’

I made several inquiries, from his an-swers to which I concluded his symptomsarose from an affection of the digestiveorgans, and consequently that I had noauthority to bleed him. I came to theseconclusions upon the following grounds:first, he had not been exposed to theex-citing causes of inflammation ; secondly,he had been exposed to the excitingcauses of nosocoilia; thirdly, the diffi-culty of breathing, and the pain in hischest came on suddenly after eating ahearty supper ; fourthly, the othei, symp-toms of inflammation would, at this stageof the disease, have been very evident,had it been an inflammatory attack,whereas there was a total absence ofthem; fifthly, the general symptoms ofnosocoilia were present; sixthly, andlastly, he had been a little relieved by adose of salts he took the day before heconsulted me. ’

Upon my communicating to him my be-lief of the nature of his present affection,and that I would not bleed him, he wasmuch surprised, and having read somemedical works, he observed, " are not

pains in the chest, and a difficulty ofbreathing, the true symptoms of ptexrisy;and is not (deeding the sure method ofcoring me ? for I am convinced I wouldhave been in my grave only for the loss

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645

of so much blood when I’was attackedbefore with exactly the same affection."However that may be, I said, I am con-vinced that you do not at present requirebleeding; and letting blood would be

highly injurious to you. I further endea-voured to explain to him, as well as Icould to a person unacquainted with theanimal functions, the grounds of my opi-nion, and that if I did not considerablyrelieve his safferings in forty-eight hours,I would then bleed him. ’ Well,’ saidhe, I I will try you for this day ; and if Ido not, at all events, feel a little relievedon to-morrow, I then must be bled."

I then ordered him an emetic of ipeca-cuanha, and in the evening a strong ca-tiiartic, composed of six grains of calomel,and ten of jalap. Next day he felt muchrelieved, and by repeating the catharticmedicines for two or three days, his-pul-monary affections were totally removed ;and he said he was now convinced by ex-perience of the utility of my plan, andattributed his former tedious recovery tothe methods that had been adopted by hismedical attendants:’-pp. 266-268.

In the concluding section the causes ofphthisis pulmonalis are discussed, but thegist of the argument is to prove thattubercles in the lungs are frequentlyproduced by disorders of the digestiveorgans, (nosocoilia,) and all that is ad-

vanced to support the assertion will occurto the reader who has reflected on theauthor’s theory of the functions of theliver. The liver, which according to that

hypothesis, is auxiliary to the lungs, is

rendered incapable of separating from theblood that quantity of carbon and hydro-gen which the well-being of the systemrequires; the other organs sympathize ;the skin becomes hot and dry ; the urinescanty, and the bowels constipated ; thewhole burthen falls upon the lungs, whichbecome so oppressed that difficulty of

breathing and pain are produced ; andthose fluids which should have been car-ried off by the liver and other auxiliaries,are partly taken up by the lymphatic ves-sels, and produce in the glands of the

lungs that altered condition which con-stitutes tubercles. Such is the author’s

theory; the treatment is of course di-

rected to the artifex sceleristhe diges.-tive apparatus. Four cardinal rules for

the regulation of medical and surgicalpractice conclude the volume. In con-

clusion we must observe, that the expec-tations which a perusal of the intro-

ductory paragraphs excited in our mindshave not altogether been realized. In-

deed it is very doubtful whether the,

author has established any thing that wasnot previously known, or whether his

work possesses any determinate advan-

tage over those elementary treatises

which have preceded it. He has cer-

tainly hatched a new theory or two, andnewly fangled some of the doctrines ofhis predecessors, but we are not certainthat he has been happy in either. What

is his nosoeoilia, but the chylopoieticderangement of Abernethy ? Or the

debilitas ficta more than the first stage of

fever, the prœgressis languore, &c. of

Cullen? His views of inflammation and

fever are not novel, and what he has ad-,vanced on the causes of phthisis is des-

titute of proof. Bating theory and con-troversy, what remains of the work will,be useful to the student.

WESTMINSTER MEDICAL

SOCIETY.

Discussion on Hydrophobia.-January 21.

A Mr. Hunt, on taking the chair, said.that he had been requested to do so in con-sequence of the non-arrival of the presi-dent, and as there was no paper imme-,diately before the Society, he should feelobliged by any member or visitor intro--ducing a subject for discussion. A longsilence followed, but at length Dr. So-merville rose for the purpose of relatinga case of hydrophobia, which fel I undet,.his notice some time since. The patientwas in St. George’s Hospital, and had tlte,usual symptoms of this dreadful malady,which came on three weeks- after a bite,from a rabid dog; the case terminatedunsuccessfully the treatment empjoycd,


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