No. 410.

LONDON, SATURDAY, JULY 9. [1830-31.

The Effects of the principal Arts, Trades,and Professions, and of Civic States andHabits of Living, on Health and Longe-vity; with a particular reference to theTrades and Manufactures of Leeds; withSuggestions for the Removal of many ofthe agents which produce Disease andshorten the duration of Life. By C.TURNER THACKRAH. 8vo. pp. 124.

London. Longman and Co. 1831.

WE hail the appearance of this interestinglittle volume with feelings of much satisfac-tion, as well for the intrinsic value it pos-sesses as because it seems to be the precur-sor of some public excitement on the impor-tanttopic to which it relates. The necessityof such excitement is great beyond belief. Inthis country alone, of all the nations whichclaim the epithet of civilised, is the conser-vation of the public health abandoned bythe legislature to the caprice and neglect ofthe community itself. In France, the codeof health devised by Napoleon waff found so ivaluable in its action, and to exercise socomplete a preservative influence, that hisstupid and fanatical successors, while theydefaced multitudes of the monuments of

that great man’s glory, upheld this in itsfull force, and even made additions to itsutility. In Germany, the same solicitudeprevails ; and even the savages of the

Dnieper and the Don are protected by im-perial ukases from the operation of the insi-dious causes by which national constitutions(taken in the strictly physical acceptationof the term) are liable to be undermined anddestroyed. In England alone is it that theprinciples of popular liberty are so sagelymaintained that the people are allowed to

poison themselves with adulterated food andmedicines, or to be suffocated in the asphyx-iating vapours of manufactories, without the

slightest concern being manifested by therulers of the land.From the annexed quo-tations and re-

marks, some notion may be formed of theenormous losses this nation has already sus-tained, by the reckless and insensate neglectby her constituted authorities, of the choicesttreasure a country can possess, namely, anumerous and athletic population. How

deeply, in the sequel, this neglect will de-base us in the scale of nations, how effec.tually it will incapacitate us from com-manding the respect of foreign powers, it isa matter of painful facility to perceive.

Mr. Thackrah’s volume is principallyfounded, as its title imports, on the obser-vations made by the author and his pupilson the state of health of the manufacturersin the town of Leeds and its vicinity. Thework commences by some apt remarks, io-which he points out the destructive influencewhich many trades and manufactures exerton the health of the unhappy and unprootected workmen; and by comparing the billsof mortality in the rural and manufacturmgdistricts, he establishes beyond the poesi-bility of denial, as his first general positica,that the balance of disease and death is

frightfully against the unfortunate artizan." The destruction of 450 persons year by

year in the borough of Leeds cannot be con-sidered, by any benevolent mind, as ac’

insignificant affair; still less can the im-

paired health, the lingering ailments, the-

premature decay, mental and corporeal, ofnine-tenths of the survivors, be a subject offindifference. Assuredly an examination!into the state of our manufactures has long-been demanded, alike by humanity and byscience. The object of this paper is ta ex-cite the public attention to the subject.Mvself and my pupils have personally andcarefully inspected the state of the artizansin most kinds of manufacture, examined theagencies believed to be injurious, conversedon the subject with masters, overlookers,

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and the more intelligent workmen, and ob-tained many tables illustrating the characterof the disorders prevalent in the severalkinds of employ. From these sources col-lectively I have tlrawn up statements which,though avowedly imperfect, must, I con-ceive, approach to the truth. It will beremembered that the subject is new ; thatthe West-Riding manufactures have notbefore been examined in their important re- Ilations to health and longevity, and that Iscarcely any-thing has been published evenon the employments common to England atlarge."

But we may be told that this informationis not novel ; that these facts have long sincebeen matter of notoriety/but that it is uselessto discuss the extent of an evil, the existenceof which is necessary, and its nature irreme-diable. Mr. ThackTah meets this objectionfully; he denies the alleged incurabitity ofthe case. His observations and illustrationare well worth attention." From a reference to fact and observa-

tion I reply, that in many of our occupa-tions, the injurious agents might be imme-diately removed or diminished. Evils aresuffered to exist, even where the means ofcorrection are known and easily applied;thoughtlessness or apathy is the only obsta-cle to success. But even where no adequateremedy immediately presents itself, obser-vation and discussion will rarely fail to findone. We might even say, that the humanmind cannot be fairly and perseveringly ap-plied to a subject of this kind without (le-cided tffect. When, moreover, an evil is

kept before the public attention, other in-vestigations, or the advance of science inother departments, often provide a remedy.Thousands of lives have been lost by ex-plosions in coal-mines, and thousands morewould have perished if the properties ot thegases had not been examined. Yet theminer, no doubt, has often said, before theinvention of the safety-lamp, " These rx-plosions are certainly very shocking occur-rences, but we cannot prevent them. Theyare inseparable from the nature of the em-ploy." Such, indeed, will ever be the sen- Itiments or the language of those who areeither too distrustiul of the resources ofscience, or too intent on the pecuniary cha.racter of their undertakings, to investigatethe causes of a great and concomitant evil.’ IThe author then proceeds to divide the Iinhabitants of Leeds into four great classes,viz., operatives, dealers, master-manufac- Ifturers (including merchants), and profes-sional men. As it is impossible for us tofollow him through his entire details, we I

shall select from the description of the firstclass, one of the examples which prove, moststrongly, the necessity which exists for le.gislative enactments in the regulation ofthe injurious oecupations.

STATE OF HEALTH OF THE LEEDS

FLAX-WORKERS.

" Workers in flax, from their number andthe effect of their employ, deserve particu-lar attention. In the flax-mills, all the de.partments, with the exception of the spin-ning-and reeling, produce dust; the roving-rooms have a little, and the dry-house hasa varying quantity ; the carding-rooms arealso dusty ; but the worst department is

certainly the heckling; this, in some mills,is carried on by hand, and in such the roomsare greatly clouded; in other mills, wherethe process is effected by machinery, the

quantity of dust is considerably less. Still,however, it is such that a visitor cannotremain many minutes without being sensibleof its effects on respiration. Children, anda few overlookers, are here the operatives;but in the old mode, I believe, men only areemployed. Though attention is generallypaid to ventilation, and the rooms for theseveral departments are spacious, they arenot sufficiently lofty ; a suffocating sensationis also often produced by the tubes which’convey steam for heating the rooms. Per.sons in the dusty departments are generallyunhealthy ; they are subject to indigestion,morning vomiting, chronic inflammation ofthe bronchial membrane, inflammation of thelungs, and pulmonary consumption. The

dust, largely inhaled in respiration, irritatesthe air-tube, produces at length organic dis-ease of its membrane, or of the lungs them.selves, and often excites the developmentof tubercles in constitutions predjspased toconsumption. There is little doubt that sconsiderable quantity is also swallowed withthe saliva, and deranges, in a greater or lessdegree, the functions of the stomach. Asthe stethoscope could not be satisfactorilyused in the place, and I wished to examinethe health of such as have worked in the

dusty departments for an unusually longperiod, and still continue the employ, I re-quested a few such individuals to be sent tomy house for inspection. Six came; andin each I found the lungs, or air-tube, con-siderably diseased. The process of heck.ling flax is generally the most injurious tohealth. A large proportion of men in thisdepartment die yo very few can bearit for thirty years, and not one instancecould we find of any individual who hadbeen forty years either in this or any of thedusty rooms. We find, indeed, cumparj-tively few old persons in an.7J of the depart.ments of the flax-mills. On inquiry, atoneof the largest establishments ia this naigh.

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bomhood, we found that of 1079 per-sons employed, there are only nine whohave attained the age of 50; and besidesthese, only 22 who have reached even 40.Formerly heckling was effected by hand;now it is performed chiefly by machinery ;and fewer men and more children are em-

ployed. The substitution of children for

adults produces less apparent and immediateevil. Young persons are observed to bearthe occupation much better than those offull age; they do not manifest serious dis-ease in the lungs ; they are, indeed, verysickly in appearance, and their digestiveorgans become impaired ; but they make nourgent complaint, and are able to pursuetheir labour with little interruption. Atthirteen or fourteen years of age they aredismissed from the mill, or transferred to

another department ; and thus they avoidthe effects of bronchial irritation, which, ata later period, might have led to consump.tion, a disease known to be most fatal be-tween the ages of eighteen and thirty. I Iam by no means convinced, however, that Iyoung persons escape without ultimate in-jury to the lungs. The powers of life, whichin a natural state would carry the body tothe age of seventy or eighty, are prema-turely exhausted ; and human beings, likeour horses, when worked at too early anage, may be said to decay before they ar-rive at the term of maturity. The employ-ment of young children in any labour is

wrong; the term of physical growth oughtnot to be a term of physical exertion; lightand varied motions should be the only effort- motions excited by the will, not by thetask master-the run and the leap of a

buoyant and unshackled spirit. How difer-ent the scene in a manufacturing district!No man of humanity can reflect, withoutdistress, on the state of’ thousands of chil.dren, many from six to seven years of age,roused from their b{>ds at an early hourhurned to the mills, and kept there, withthe interval of only forty minutes, till a latehour at night; kept, moreover, in an atmo-sphere impure, not only as the air of a town,not only as defective in ventilation, but asloaded also with noxious dust. Heaith !cleanliness! mental improvement! Howare they regarded? 1 Recreation is out ofthe question: there is scarcely time for

meals ; the very period of sleep, so neces-sary for the young, is too often abridged ;Bay, children are sometimes worked even inthe night. The time of labour in the flax.mh is excessive. The people are now I(Xof. 1830) working from half-past six intb morning till eiaht at night, and are

a’!oH’<’d only an interval of forty minutes 11)

all that time. Thus human bemgs are keptin an atmosphere of flax dust nearly thirteenhours in the day, and this not one, but six

days in the week. The wages for thislabour are by no means great; hecklers,indeed, earn from 15s. to 20s. a week; butwomen cannot earn more than 8s., and oftenindeed not more than 6s. per week. Theduration of labour is the opprobrium ratherof our manufacturing system than of indi-viduals. The masters with whom I haveconversed are men of humanity, and willing,I believe, to adopt any practicable proposalto amend the health and improve the stateof their work-people ; but they are scarcelyconscious of the extent of mischief. Weunderrate evils to which we are accustomed.The diminution of the intervais of work hasbeen a gradual encroachment. Formerly anhour was allowed for dinner, but one greatmanufacturer, pressed by his engagements,wished his work-people to return five mi-

I Inutes this abridgment was promptlyadopted at other mills ; five minutes led toten. It was found also that breakfast and"

drinking" (afternoon meal) might betaken while the people were at work. Time

: was thus saved, more work was done, andthe manufactured article consequently couldbe offered at a less price. If one houseoffered it at a lower rate, all other houses,to compete in the market, were obliged touse similar means; thus what was at first

partial and temporary has become generaland permanent, and the unfortunate aitizans,working before in excess, have now to carrylabour to a still greater and more destruc-tive extent; the sound of the steam-engine

i anticipates the cock-crowing of the morn-ing&mdash;nay, often it is heard throughout thenight. This, ,however, is not peculiar to

flax-mills; it is indeed less frequent in themthan in other manufactories : in cloth-millsit is by no means uncommon. So establishedare the hours of work, that no individualmaster can, without loss, liberate his peo-ple at an earlier period. A legislative enact-ment is the only remedy for this, as well asthe other great opprobrium of our manu-factures. Were a bill drawn up to limit theduration of labour, and prevent the improperemployment of children, I feel assured ttiatit would be weil supported by petitions,not only from the public, but from the rnas-ters themselves." May I suggest a plan for carrying off

the dust? Let channels, about a foot in

breadth, be made in the floors, each withone end opening into the room, and theother outside of the budding. Over theformer let a light broad wheel, attached tothe machinery, be made to revolve rapidly.A current of air wiil thus be produced, andthis entering the channel will draw downthe greater part of the dust, and carry it outof the building. If the plan succeed in theflax-mills, it would avail also for removingthe dust of corn and malt-mills, indeed of

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all the manufactures which affect the lungsby mechanical irritation. A subject of suchgreat importance to health and longevitywill receive, I trust, the attention of thosewho are not only much more conversantthan I with contrivances and inventions,but more directly obligated by social prin-ciple, to improve the state of the operatives,by whose labours they are enriched."The great extent of this quotation pre-

venta us from making it the subject of anylengthened remarks. We would simply en-treat of those in power to ponder well onthe awful fact that the preceding statementsdescribe but an atom of the vast mass ofdisease and misery thus engendered in GreatBritain. We would also refer them to awork the title of which may be seen below,*where they will find a distinguished Frenchwriter coolly arguing on the diseased con-dition of the artizans in the potteries of

Staffordshire, as a proof that this countrywill soon be powerless in foreign wars, andincapable of resisting external aggression.Even at this time it is notorious that our

agricultural population does not bear theproportion to the arable surface of the

country, which will permit of abstraction fromit for military purposes. We are told, itis true, that in Ireland we shall always haveat hand a sufficient stock of bone, and mus-cle, and combativeness, to replenish ourarmies in time of need; but as the discussionis rather foreign to our pages, we shall onlysay that such an argument is utterly falla-

cious, and direct such as wish for proof,and for further and curious information onthe subject, to the able and extraordinarywork to which we have already referred.Of the mechanical plan recommended byMr. Thackrah for the removal of the per-nicious dust, we cannot speak in terms ofapproval ; not that it is absolutely bad, butthat we can recommend a better one, namely,a modification of that lately devised byM. Parent du Chatelet for the ventilationof anatomical theatres, and described by himin the Annales de Hygeiene Publique forApril of the present year. The principle ofthis invention is, by the rarilieation of air ina tube, or chimney, above the level of theapartment, to cause a current of cooler airto enter an opening in the floor. The an-

Commentaries on the Biography of TheobaldWolfe Tone, by M. Colonel Philippe Rocbe Fer-moy. Paris. Bailliere. 1829.

nexed diagram sufficiently illustrates the

design of the apparatus.

Explanation&mdash;a a a a a,* a tube with bell-shaped mouth, running from about a footabove the floor, beneath its centre, opening

into the fire-place b, and terminating beyondA&mdash;c, a ventilator-d, register of the grate.

When the fire is kindled in b, and the

register d is closed, it is evident that air must, be supplied through the tube a, and thatcurrents will be established in the directionof the arrows. All dust and floating parti-cles are thus wafted through the bell-shaped

orifice, and consumed in the grate, while the

superfluous air, and the vapour of the con-sumed coal, dust, &c., is removed throughthe continuation of the pipe a, into the com.mon flue of the building.

In conclusion, we confidently recommendMr. Thackrah’s work to the attention of the

profession, among which we trust he willfind some successful followers in the bene-volent course he thus invites others to pur-

sue.

An Essay on the Influence of Tempera-ment in modifying Dyspepsia or Indi-

gestion. By THOMAS MAYO, M.D. Oxon.Physician in Ordinary to the Duke of

Sussex, Fellow of the College of Physi-cians, &c. London. B. Fellowes. 1831.

8vo. pp. 144.I DR. MAYO was not altogether wrong whenhe suspected that the title which he hadchosen for his volume was improperly limit-ed to a single disorder. 11 It may possiblybe urged," he observes in his last page,

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" that many of my remarks would apply,or actually are applied, to other diseases,just as well as to that which I have chosenfor my subject." In presenting our readers,indeed, with some account of his volume,it is in this more extensive view of its pur-

pose that we ought to regard it. It wouldbe wrong for the medical man to approachthe couch of any patient without bearingprominently in mind the considerations towhich Dr. Mayo has plincipally devotedhis volume. -

I

We should premise, perhaps, that theseconsiderations are none of them new. Theyare not now enforced for the first time.The varieties of temperament (a most un-philosophic term,- and one of those whichmedicine as a science will not long tolerate)which distinguish different constitutions es-cape the notice of no man. But Dr. Mayo, Iby the publication of his essay, shows thathe does not think sufficient attention is paidto the subject, because, probably, the clas-sification or division of temperaments hasnot been well laid down by writers.

Especially directing his mind, then, tothe subject of dyspepsia, and regarding,we imagine, almost all patients as pri-marily or sympathetically the subjects of

indigestion, he explains his own views on

this disorder, makes it his object " carefullyto point out the relation in which they standto the stores of knowledge collected byothers," defines the different temperamentswhich the human frame presents, and showshow far their various qualities should mo-dify the treatment to be pursued to obtaina cure.

Of the definition and symptoms of indi-gestion, as contained in Chapters I and III,we shall say nothing. The information con-tained in them does not demand a particularnotice, or affect the real, the practical pur-pose of the essay. Neither does Dr. Mayolay down a new division of temperaments,nor make any addition to the old one.

"The temperaments, or natural aptitudesof mankind in regard to health and disease,were considered, by the earliest writers,in relation to four supposed humours, andreceived a corresponding division. Thesehumours were, bile, black bile, mucus or

phlegm, and blood. From the time of Hippo-crates to our own, this kind of division maybe traced in the opinions and writings ofmedical men, and even in ordinary Ian-

guage. The phlegmatic, the melancholic-

the bilious, and the xanguine, are alludedto in conversation and in books, as possess-ing each a combination of physical andmoral qualities correspondent to their names,even by those who attach no medical mean-ing to these words. On these grounds Iprefer making use of the above division,illustrated as it is, and sanctioned by longusage, to advancing one altogether new."’ His purpose is rather to illustrate accord-

ing to his own views and experience, andthis he does under the improved headings ofthe Bilious, the Nervous, the Sanguine,and the Phlegmatic or serous, temperament.The bilious temperament implies a tend-

ency to either of many disorders of theliver-an obstructed, a vitiated, a copious,or an excessive secretion of bile :

I " The bodily conformation of the biliousis usually represented as rigid and spare,rather than fuller largely developed. Theeffect of the bilious temperament upon complexion is certainly to render it less clear,less brilliant, more sallow, than the samecomplexion is, whether dark or fair, underthe sanguine temperament. In this sensealone we are authorized to describe it as in-

fluencing colour. The texture of the skinseems, on the other hand, very materiallyinfluenced by temperament. In the bilious,compared with the sanguine, it is harsla,and often arid. The sanguine tempera.ment, as will be observed, gives a remark-ahle smoothness and elasticity, as well asbrilliancy, to the skin." Among its most admitted traits, I

should enumerate a gloomy but active

imagination, a jealous, distrustful, and unAsatisfied disposition, and an anxiously re-flective cast of thought."The principal characters of the nervous

temperament are thus stated :-"First, that it is highly susceptible of

impressions ; secondly, that impressionsonce made are easily re-excited ; tlirdly,that when it is in the state of morbid actionproper to it, the solids of the body exhibitearlier and more marked phenomena thanthe fluids. In the well-developed nervoustemperament the susceptibility is so much

heightened, that affections of that systemare capable of being propagated as if by in-fection from one person to another. Thus

hysterical spasms are often communicated,and it must be by this kind of sympathythat the remarkable influences of animalmagnetism are produced."Nervous susceptibility may, according to

the author, be viewed in relation to thenervous temperament under three heads.

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"A person of a vigorous intellect, and ofa firm and intrepid spirit, may be so or-ganised, that the loss of a trifling quantityof blood by the lancet shall produce syn-cope, even when he is in a high and com-plete state of health. Of this I know aninstance in a very Z5 gallant officer, who haslost blood copiously from wounds, withoutany such result ; but whom, on the aboveaccount, it is extremely difficult to bleed." Totally distinct from this, is the suscep-

tibility of nervous affection from moral im-pressions ; a species of nervousness whichI shall call moral. It is remarkably shownin the bodily symptoms occasioned bytimidity. But in each individual it must- wary in form, according to the class of emo-tions to which he is most predisposed.

" There are persons in whom some ope-rations of the intellect instantly produce adisturbance in the nervous system, whichgreatly interferes with the success of theseoperations. I have heard the sufferer de-scribe this state of his nerves, as occasion-ing a cloud or mist suddenly to diffuse it-self through his mind. In this wav, again,nervous defects in articulation may be ex-plained."

The sanguine temperament seems, in itsordinary form, says the author, more alliedto healthy than to morbid actions.

" It implies a free and energetic circula-tion, a well-developed but firm muscularsystem, and a powerful conformation of thewhole person. The complexion is usuallyfloiid ; but the principal characteristic ofthe temperament in this point is ’ brilliancy.’This term best expresses, in English, whatwould, I believe, in Latin be ’nitor.’ Themoral and intellectual properties of the san-guine are assumed to be such as correspondto a vigorous structure. These are vivacity,energy, and conndence. It is, I believe,not an ungrounded remark, that the buoy-ancy, the brilliancy, the joyousness of thesanguine temperament, somewhat indisposethe mind for persevering exertions of

thought. Hence the advantage possessed,in comparison with it, by the bilious tem-perament."The main characteristic of the phlegmatic

temperament is described to be a deficiencyof energy, and to admit of a division intotwo heads ;One embracing those cases in which

the want of energy appears connected witha want of excitabi:ity; the other compris-ing those in which it is connected with av-’aut of power. The first of these divisionsis well described by the popular term re-

laxed; the other is the basis of the asthenicor feeble cocstitution, and as such, is pro.

ductive of the long and melancholy class ofscrofulous affections. In both of these formsof the serous temperament the natural com.plexion is most frequentlv pallid. In boththere is a remarkable absence of buoyancyand resiliency of habit. But the skin of therelaxed person, though pallid and bloodless,differs greatly from the unwholesome dtli-

cacy of the asthenic, and his muscular sys.tem is often even largely developed ; while,on the other hand, in the asthenic form, itusually happens, that the bodily structure,if not actually small, is rather fat than mus-cular. Persons of the relaxed habit are

colourless; while the complexion of theasthenic is often of a delicate redness. Thepulses of both, except where fever occursin the asthenic, are languid : but the lan-guor of the relaxed seems connected withsluggishness, that of the asthenic withfeebleness. In the relaxed person theremay indeed be power ; but it is difficult tocommunicate an impulse which may bringthat power into action. In the asthenic,the impulse communicated is felt indeed,but it elicits no reaction, it merely ex-

hausts."It is with a watchful and scrutinising eye

to the detection of one or other -of these

temperaments in his patient, that Dr. Mayowould have the practitioner always enter

the room of the dyspeptic, and indeed thesick of all classes, lest the remedy for oneman prove the poison for another, and whileadvocating the propriety of paying a strictattention to the leading principles whichshould always direct his practice, Dr. Mayobeseeches the physician st&ugrave;l to bear iumind how many causes may disturb the

analogy from which his theories derive theirpractical utility.On the varieties, and shades of varieties,

of these temperaments, and the modificationsof treatment which they require, the fourprincipal chapters of the work next treat; forthese we refer our readers to the workitself. They contain the precepts of a

judicious physician, unmarked by any doc-trines decidedly novel, and such as do notadmit of a condensation which would be

practically useful, though a few of theauthor’s remarks will bear selection fromthe mass. We have marked the followingpassage for extraction. The reasoning onthe use of aperients deserves more atten-

tion than it often obtains. Food is, andought always to be attempted to be made,the true aperient of the bowels, and in mostcases requires only a previous proportionate

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fast to make it so. On the strict observanceof the fast, however, does its virtue in this

respect depend.,,But of all the measures by which the

bilious dyspeptic may obtain both imme-diate relief and protection against theseverer symptoms of his disorder, the fre-

quent use of mild aperients is the most

important. A very ill-founded prejudice isentertained against the continuous use of,aperients. It is assumed that this practice Iimplies an unnatural and artificial procedure, (,calculated as such to end in mischief. Thosewho hold this doctrine forget what are theprinciples on which the action of the bowelsis maintained, where no medicine is used.In such cases, it is the dai!y food whichexcites the peristaltic movements, and elicitsthe secretions of the intestines, and thusoccasions their requisite action. Nowape-rients do precisely the same thing; and itwill be difficult, by any reasoning, to make Igood the supposition that small portions ofaloes, of rhubarb, of ipecacuanha, or of com- Ipound extract of colocynth have generallya more unwholesome purgative effect thancabbages, potatoes, and turnips. Of thispoint I feel certain, that the state of theintestinal canal in many nervous persons.who are so far from requiring aperients, thata tendency to irritation is constantly be.setting them, possesses a more morbid cha-racter than the opposed condition of thebilous temperament. In the latter case,digestion may be very well performed, pro.vided the aperients are well selected. Inthe former, or nervous case, it must fre.quently be hurried." ’

Dr. Mayo awards their full merits to iexercise and temperance.As an instance of dyspepsia remarkably

illustrating the effect of the nervous tem-

perament in occasioning the ordinary func-tions of digestion to become, even in theirmoderate performance, a source of mischiefthrough exhaustion, he gives the following

CASE.

"A gentleman of a highly nervous tem-perament, placed in a situation of continuedmental exertion, and much responsibility,in a West India island, was subjected, forsome bilious symptoms, which were viewedwitbout any reference to the predominantcharacter of his constitution, to a severemercurial treatment. He, at the same time,suffered from hemorrhoids, occasioning pro-fuse discharges. His strength broken; his Jcirculation so disturbed that apoplexy atone moment, heart affection at another,seemed closely to impend ; his skin con-.stantly arid and giving no relief by perspi-

a ration to these last symptoms, he returnedto this country. It is not my present pur-

pose to detail the subsequent treatment ofthis case ; I wish to call my reader’s atten-tion to the fact that it was found necessary- in the course of his treatment, to allow a farlonger supension of the action of the bowelsthan accorded with the general principles of

t practice, or than was comfortable to his ownfeelings, rather than expose him to the in-tense nervous excitement and exhaustion,

which were occasioned by the process offaecal evacuation, even when conducted inthe mildest way. The relief, indeed, from

feelings of obstruction, which purgativeswere calculated to give him, his bowels

being always in a confined state, was com-pletely overborne by the attendant aggrava-tion of all his other symptoms, such as flatu-ience, violent palpitation at the heart, withsense of approaching syncope, and vertigin-ous feelings in the head. All these sensa-tions ensued upon the action of aperients so

’1 mild and so carefully chosen, as to imitate

strictly the operations of nature, and yet tounload the bowels completely. Time, a pa-

tient endurance on 7tM part of symptoms of

which it was hazardous to attempt the com-plete relief, and a persevering abstinenceon tlte part of his pltysician from such mea-sures as might relieve present symptoms,and yet increase exhaustion ; and, finally,a very cautious use of bark, ultimately re-stored him to health. The decisive andcomplete evidence of his recovery was,according to his own remark, the power ofperspiring freely."The ensuing reflections on the public

examination of students, which occur at theclose of chapter V. require remark:-" With regard to nervousness, as shownin the operations of the intellect, its effects

through this medium upon health are per-haps no-where more observable than in tlie

preparation of young men for public exami-nation. The prospect of a severe oral ex-

amination mischievouslv excites the irrita-

bility of an intellect thus constituted. Ihave seen all the early symptoms of indiges-tion result from this state, and the intellectitself eventually enfeebled by their reaction.I do not, however, mean to draw any infe-rence from this remark against public oralexaminations. They are of incalculableservice in promoting promtitude and vigourof thought, and inducing a state of the in-tellectual powers, in which alt their re-

sources may be instantly made available,even at a disadvantage, towards a givenpoint. But, making this admission, I maystill urge, that the severity of the disciplineshould have relation to the capacity of thepupil for attaining this gift. Iiiascr-,rtainin(rthis point, in giving him as much of this

456

kind of hardening as the metal will bear,

Iand in placing before him such other trials,with their appropriate honours, as maybetter suit him, the tutors and guardians of ihis college should become in some sort hismedical advisers. Much of the future hap-piness of his life may depend upon the cor-rectnessof their judgment."We are glad to find Dr. Mayo an advocate I,

for the only proper test of qualifications ,,

for medical diplomas, but in reasoning atall on the subject we regret he did not seeor say, first, that the real value of publicoral examinations is to be found, not in thecasual and very doubtful effect which one ortwo such trials can have upon the intellec-tual powers of the student, but in the assur-ance which they afford the public that nonebut competent men are admitted to practice.It is the public who are the more interestedparties in these examinations ; and it isalone by bearing that consideration in mind,that effectual tests will ever be ensured.

Secondly, we would have had the doctor re-commend that ‘&deg; the discipline " should bejust the same in all cases, hut that the modeof its administration should be softened andmoulded to the courage of the candidate, bybenevolent, kind, and courteous examiners.The pupil who knows the answer to a ques-tion can always give it, and the desirable

object is, that the guardians of the publichealth should join to the learning of a Hun-ter or a Duncan, the " gentle manners, andmild affections" of a Gay. Success in one’ trial " ought never to be a proof of thecandidate’s qualification for another.The last chapter of the work is devoted to

a brief consideration of some of those cases,- apparently," says Dr. Mayo, Ic cases

of atrophy,"-which, as Mr. Abernethysaid of them before he hit on the blue-pillsystem, "would puzzle the d&mdash;I himself totreat." While society continues to exist inthe cramped and artificial state to whichthe civilization of the human species seemsto be constantly driving it, cases of thiskind will always abound, and we believe itmust be confessed that after they have

reached a certain stage, there is no com-

plete remedy for them but that which was,in the following case, accidentally placedwithin the power of the lady referred to.

CASE.

’ The following case of atrophy cannot

be explained by the application of anytheory of temperament with which I am ac.quainted, neither was there in this case anyinfluence from accidental disease to accountfor its commencement or development. Thepatient was a married lady, aged thirty-two; Ther constitution might be termed sanguine ;she was strongly made, of a full, well-formed’figure, and of a system remarkably free fromany kind of nervousness. Her habits werethose of active exercise in a very bracingair; she was happy in her married state,and had two healthy children ; finally, shewas in affluent circumstances, and of a verywell-regulated mind. She complained to

me, when first I saw her, of a confined stateof bowels, of deficient catamenia, and ofgeneral oppression ; she described her headas feeling very full. The carotids were

beating very strongly, and disproportion.ately to the pulse at the wrist. It mighteasily have been supposed that this ladywas a full liver, and neglectful of the regu.lation of her bowels. The fact, however,was, that she had been very moderate inher diet. alwavs. indeed. a person of smallappetite, and very attentive to the state ofthe alvine evacuations; but that latterly herappetite and almost her power of takingfood had left her, and that extreme consti.pation had taken place. I also learnt, onauthority on which I could depend, thatsome years before her marriage an attack,beginning with similar feelings of oppres.sion and apparent fulness, had placed her inthe most extreme danger from a long con-tinued inability to take, or, if taken, to

digest, nourishment. I was further in-formed of the complete inefficacy of everydepletory measure then applied, which hadonly tended to reduce her strength. I con-cluded that the singular disorder with whichI had to contend, was a loss of power in thedigestive organs, and that venesection, whichhad been tried unsuccessful though fullyon the former occasion, was not more ap.propriate on the present. From this time,having once directed bloodletting at the veryoutset of my attendance with little effect, Isteadily abstained from such depletion ;but, for several weeks, I persevered in a

course of calomel, with a view to establisli-ing an improved secretion of bile. The

prominent features of this case, during thistime and afterwards, were the most com-plete inappetency, nausea or sickness soonafter eating, urine bigh-coloured and scantc,the whole abdomen very tense and hard, butnot painful, fasces consisting either of un.digested food or of a dark slime. Yet forsome time she preserved her freshness of

appearacce and fulness of person. Such

were the resources and vigour of her con.stitution ! She rode, indeed, and walked,long after her powers of obtaining support

457

from external sources had almost ceased;and it was long before her person displayedalarming symptoms of emaciation. Mean-while I husbanded her strength, and appliedevery strengthening measute that I couldobtain from mv own resources, or the expe-rience of Dr. Farre, whom I met in consul-tation. I gave up the use of calomel aftera fair trial; it had only nauseated her. Idid not try sea-bathing or sea air, havingfound that in her former illness the latterhad not profited her, and that every kind ofbathing had aggravated her symptoms ofcongestion. As her strength diminished,the catamenia became more scanty, thehead more uneasy. This local fulness Icould only venture to relieve by cold vine-gar and water, small blisters, and a strawpillow. After many months, and when shewas in the most deplorable state of exhaus-tion, her tongue and mouth being coveredwith aphth&aelig;, an opportunity presented it-self to her family of realizing an anxiouswish, which I had long expressed, that sheshould find a drier and more buoyant airthan that of England. She set sail forCanada at my strong suggestion. Fromthe very commencement of her voyage to itsconclusion, the above symptoms all beganand continued to disappear, and after herarrival in Canada her recovery continued toits completion. During her convalescencemuch anasarca took place, which had alsoterminated her former illness. This was I,successfully treated with calomel and diu-retics, which, in this country, in the earlierstage, had been absolutely valueless. !The influence of sailing in equalizing the

circulation never was more fully shown thanin this instance. The passage was a roughone, and the rougher it was the more freeand relieved were the feelings of the pa-tient, particularly in the head. Duringthe voyage the catamenia and the action ofthe bowels, the kidneys, and the skin, wereall restored in a considerable degree."We should hardly know how better to

describe the process of cure than by sayingthat the whole body being thoroughlysliaken, the seeds of disorder found their

way to the surface, and were there blown offby the winds. This is figurative, and yet al-most literally true.As we have already intimated, the essay

is the work of a judicious, acutely-discrimi.liatinm, and experienced physician,&mdash;perhapsnot highiy philosophic in tone, but cau-

tiously written, and forming an agreeablepresent from a practical man toprofes-sional theorists.

LITHOTRITY;ITS APPLICABILITY AS AN OPERATION FOR

THE CURE OF STONE IN THE BLADDER.

ILLUSTRATED BY CASES.

By W. B. COSTELLO, Esq., late Assistantto the Inventor, Dr. Civiale.

(Lately read before the Royal Society.)

Continued from p. 366.OUR task would be pleasant indeed, if

lithotrity were always so simple and so easyof application, as in the cases narrated in.

our preceding article ;* but, unfortunately,it is not so. Cases occur in which its appli-cation requires the greatest care and cau-tion, and in which, nevertheless, its result isdoubtful. We shall now proceed to consi-der cases presenting various degrees of com-plication.

1 feel a considerable degree of pride inassociating the name of the most distin-

guished ornament of his profession, Sir Ast-ley Cooper, with the introduction of litho-trity into England. This eminent surgeonhad declared himself the patron of this me-thod, as he is of every-thing that conducesto the advancement of science, from themoment he had witnessed an application ofit, at the time of his late visit to Paris. Atthat period Sir Astley encouraged me inthe kindest manner to’ return to England.On my arrival in London, he, with the libe-rality and zeal for science which characterisehim, hastened to confide to my care, thefirst calculous patient that presented himself in his private practice. The state ofthis patient’s health having rendered it ne-

cessary to temporise, a second patient soonoffered, whom Sir Astley confided to mycare also.

CASE 5.&mdash;Several Calculi in tlae Blad-der-this organ columnated&mdash;H&oelig;mor-rhoids&mdash;the application of Lithotrityhaving been preceded by an attempt atextraction by Fooceps.Mr. George Stone, a magistrate of the

town of Folkestone, Kent, aged 52, of goodconstitution,hadlaboured under symptoms ofstone in the bladder for the last three years.His sufferings during this period were some-times so severe, as to confine him to his bedfor several days together, and sometimesthey only amounted to a sense of weight inthe perineum, with difficulty of voiding theurine. During the last year, his crises ofpain were frequent and violent. He wasanxious himself to go to Paris to place him-self under the care of M. Civiale, but liav.

* See LANCET, No. 407.