206

imperfect view is not now held is very ob- fvious. He remarks :- 1

" It is long since the study and descrip-tion of those diseases which appear on the I

exterior of the- body with characteristicsymptoms, were detached from general pa-thology, and it is impossible to deny that thehistory of these diseases has been more fullyand satisfactorily given by the writers whohave made them objects of their peculiarconsideration. Nevertheless, it must be

allowed, that many serious inconvenienceswould arise from completely abstractingthis study from that of the other morbidconditions of the economy. It would,above all, be a grave error to separatecertain cutaneous eruptions from lesions ofother systems, when both derive their originfrom the same cause. To attempt to isolatethe venereal eruptions, for example, fromthe other symptoms of syphilitic infection,exostoses, periostoses, nocturnal pains in thebones and joints &c.,—would evidently bearbitrarily to disconnect the different ordersof systems of one and the same disease.These venereal eruptions have, farther, so

intimate a relationship with the primarysymptoms to which they generally succeed,that it even becomes imperative on us toinclude both under the same general headof investigation.

" Certain diseases, such as the eruptivefevers, produced by infection of the wholesystem, although they indeed exhibit them-selves on the exterior of the body at deter-minate periods in peculiar and characteristicsymptoms, are, to all intents and purposes,general diseases, the -effects of which are

occasionally felt with far greater violence byother systems than by the skin. In somecases, indeed, in variola, rubeob, scarlatina,&c., no eruption ever makes its appearance,and the skin then continues entirely a

stranger to the effects of the contagion.Who does not know, moreover, that thesediseases impress or modify the constitutionso deeply, that it generally becomes for everafter unsusceptible of being influenced bythe cause which produces them ?"-p. xxix.

The literature and history of skin diseasesare considered in detail; and if much criti-cal sagacity or novelty is not displayed, asober judgment never forsakes the writer. ’

Again. The Atlas is now rendered sovaluable and extensive, as to form the promi-nent distinction of the work. No atlas re-

presenting cutaneous diseases rivals it inmerit. And we are happy in being ableto add that the plates were executed by aBritish artist, who in Paris added to his origi-nal pursuit the study of medicine. "The diffi-culties," says M. Rayer, "inseparable fromthe accomplishment of such an enterprise

(the formation of the atlas) would certainlyhave prevented me from undertaking it

without the assistance of Mr. James Youngof Paisley, who, to perfect familiarity withthe diseases of the skin, adds the talent ofseizing, to admiration, the different appear-ances they exhibit, and of representing thesewith great fidelity."

It is only just to add, from our own

knowledge, that the engagement of Mr.

Young in this work, and the friendship ofDr. Rayer, are highly creditable to both

parties.The translation has been made into En.

glish by an accomplished scholar, and pre-sents all the ease and perspicuity of anoriginal work.

A Treatise on the Functional and StructuralChanges of the Liver, &c.; with numerousCases exhibiting the Invasion, Symptoms,Progress, and Treatment of Hepatic Dis-ease in India. By W. E. E. CONWELL,M. R. I. A., M.D., &c. London : Duncan.8vo. pp. 531. 1835.

A Treatise on the Functional and StructuralChanges of the Lit’er, 4-c. with nu2nerousCases exhibiting tlae Inval?Îon, Symptoms,Progress, and Treatment of Hepatic Dis-ease in India. By W. E. E. CoNWEi.,

, M. R. 1. A., M.D., &c. London : Duncan.Svo. pp. 531. 1835.

OuR brethren in India, separated from us byso many leagues, and exposed to a climatewhose ravages annually decimate their ranks,and which fosters the indolence natural tomen whose existence is assured, alwaysclaim our attention, and possess our heartiestsympathy, in their literary tasks. We feel,besides, a high degree of interest in the re-sult of their investigations; because, besetas they are with difficulties, it still lies intheir power to solve some of the most im-

portant problems connected with the etio-logy of disease. But we know, that to en-title our opinions to weight on the banks ofthe Ganges, they must be strictly impartial,that we must withhold eulogium from pre"tensions which are poorly supported,-frombooks which contribute nothing whateverto the advancement of medical knowledge.Under neither of these categories does the

work of Dr. Conwell precisely fall; but cer-tainly a very lax principle presided over its

composition. What induced the Doctor towrite a thick octavo on hepatic disease ?Was it the simple fact of his having residedtwenty years in India ? We hope he cananswer these questions to the satisfaction ofhis own conscience. In summing up theamount of his literary sins, the 232 abridgedcases which he has transcribed from his

rougli note-boo],-, can alone, in our opinion,

207

afford him any solace, or offer us any " cre-dits " to oppose to the "debtor" side of hisaccount.

_

The Doctor says that he has " commencedwith a minute examination of the structureof the liver." This turns out to be fifty-sixpages of anatomy, forty of which are occu-pied with the distribution of the various

twigs of nerves which ramify through theentire body. If the M.D. and M.R.I.A. will

give his solemn assurance that an old edi-tion of the "Dublin Dissector" did not liebefore him, while every line of his " exami-nation" was written, we will willingly ab-solve him from any charge of premeditatedguilt in this intemperate transcription. The

impulse of charity-in excusing the con-coction of this elementary catalogue, done,as it is, in the style of the common horn-book" Companions to the Hall,"-suggest at firstthat the treatise was intended for transla-tion into Hindostanee, for the instruction ofParias, or perchance for Moosulmen; but itwas not printed at the-Baptist press in Cal-cutta, and the preface states that it reallywas intended for the practitioner on his ar-rival in the East.

Dr. Conwell knew nothing of Kiernan’sresearches; but he has constructed a theo-retical liver which would have saved Mr.Kiernan a great deal of trouble (p. 53),and which accounts admirably for all the

hepatic affections of India. To his other

proclivities he adds that of inveterate andperpetual theorizing-never stating a phy-siological or a therapeutic fact without ac-counting for it on the simplest principlesimaginable. Indeed, so great a dread hashe of pure observation of plain facts, ar-

ranged according to their analogies, andsubjected to the process of logical induction,that we might suspect him to have beenbitten by a certain professor of materia me-dica, and caught his disease. Again, in dis-cussing the causes of hepatic affections, the z’Doctor places first " external injuries or

violence, falls, and accidents." 11 Ex-

perience," he says, " has demonstrated thegreat extent to which the circulation of theliver becomes deranged by falls or acci-dents." He alludes to the abscesses fre-

quently found in the liver after death fromfracture, and accidents followed by suppu-ration : but by this time he ought to knowthat the hypothesis which explained the ex-istence of abscess Hi the liver, by concussion

or laceration, is given up by modern pa- ,

thologists. These abscesses, surrounded byno signs of inflammation in the liver, aredepositions of pus, such as those found roundthe sheaths of tendons, in the lungs, in mus-cles, and in the brain. They are discoveredafter operations where there has been noconcussion; and the veins leading from thesuppurating parts are generally filled withpus. Are some of the purulent collectionsfound in the diseases of India, similar de-posits from the blood ?The following observations are interest-

ing ; they relate to the causes of tropicaldisease:-

"Experience shows the changes ordi-narily produced on European constitutionsby a long residence in India. The Euro-pean, after several years’ residence, exchanges his clear complexion for a 1>arch:ment, yellow, a leaden, or a dark-pale-yel-lowish colour. His vascular and musculartissues become flaccid and relaxed, and hisanimal and mental energies more or lessdiminished. His general health is im-’

paired, and he continues, particularly as

his residence becomes protracted, in a stateof valetudinarianism. Medicine is at last

constantly necessary to stimulate the func-tions of the liver, and of the gastro-intesti-nal tube. This is a very summary, but anexact sketch of those changes which the

greatest number suffer from an intertro-pical residence. Some men retain healthunder singular disadvantages in India, as inall other parts ; but they are here, as else-where, comparatively very few. Those leastexposed to the inconveniences and evils ofthe climate, as might be expected, suffer theleast from a residence in it.

" It would seem in part, from the historyof medicine, that increased temperaturealone does not constantly produce hepaticdiseases, because they were formerly saidto be little known in the West Indies, onthe coast of Guinea, &c. On the otherhand, late writers afhrrn that hepatic dis-ease is not an extraordinary occurrence atthose places. On the Coromandel Coast,and on the island of Penang, hepatitis, dy-sentery, and remittent fever, are the reign-ing important maladies, in various forna ;amongst the European troops, hepatic dis-ease is very frequently an exciting cause ofdysentery, of fever, of pains, &c., or it simu-lates rheumatism. But what are the diseasesof the aboriginal Indians ? They are quitedifferent. The natives occasionally havefevers, depending on derangement of thegastro-intestinal tube, or originating fromindiscreet exposure. In their own opi-nions their disorders proceed from bad

water, or insalubrious air. Now whence

originates this striking difference in the

208

diseases of the European and the native?The European soldier’s daily food consistsof three plentiful meals, embracing animalfood, curries, &c., and six ounces of arrack(an ardent spirit), three in the forenoon andthree in the afternoon. The natives, on theother hand, adopt the following diet :-

" Gentoos.-,8reakfast. Boiled rice andcold water, with cr without spice and

pickles.-Dinner. Mutton or fish, curry andboiled rice, with vegetables.&mdash;<S’Mpe’. Thesame as for dinner.

" Moosulmen. - Breakfast. Ten a.m.

Wheaten cakes made up with ghee (butter,boiled or fried) ; or meal prepared from akind of pea boiled with rice.-Dinner. Foura.m. Palow (or rice, with a little meltedbutter thrown over it), with mutton curryand pickles.

" Parias -BrEakfast. Boiled rice and coldwater, with pickles, and, if procurable, pan-cakes, bread, &c.-Dinner. Mutton or fish,curry and boiled rice, with vegetables, &c.-Supper. Pepper, water, and boifed rice,or the same as for dinner.

" Water is the only drink of the nativesof India, hut some, from European inter-course, have fallen into the habit of drink-ing spirituous liquors. Curries are preparedeither with animal food, minced, or withfish, or with vegetables, by stewing the ma-terial with a little butter, and, towards theend of the process, adding the curry powder,of which the composition is now generallyknown in Europe. The curry serves thenatives as a sufficient condiment, with theaddition of a little salt; and the cravingappetite for brandy, gin, and wine-and-wa-ter, or for beer, is happily unknown to them;so, likewise, are the numerous diseases towhich those who use those liquors to excessare liable." A subject so important as this is, may

seem to be treated with too much brevity ;but this notice will suffice to strike the a.-tention of observant individuals who reasonon facts. Judging from the dissections Ihave made, I am of opinion that hepaticcomplaints are rare amongst the natives ofgood habits, and my experience in the treat-ment of their diseases further confirms thatfact. The natives employed as servants inEuropean barracks, and some domestics whoacquire European vices, are equally, or

more, subject to hepatitis, and less able tosustain the depletion requisite for its cure."-pp. 71, 74.

The addition of the dissections enhancesthe value of the cases; we give a specimen: &mdash;

" Case.-Patient admitted with dysentery.Pulse 120, small and hard; skin cold andmoist; passed blood and mucus. Calomel

j; Opii gr. ij, hor&agrave; somni: OZ. Ricirti 3jmane.-May 17. No change. Con.-18.Slight improvement. Pil, Hydrarg. gr. v ;

Ipecacuan. gr. iij ; Opii gr. j. M. bis die.Ol. Ricini gvj pro re nata.. Infusion of co-lumbae, and red wine, were used in addition,and the opiate was occasionally increased,but with some slight variations. Exhaus-tion, sinking, and coma, progressively ad.vanced until the 16th of June, when he diedat eight a.m.

"Dissection made by Dr. Conwell.&mdash;Thebody is six feet long ; greatly emaciated;numerous osseous concretions are observedin the cellular tissue. Cerebral surfaces pale;much fluid within the arachnoid; no cerebralcongestion. The spinal cord is swollen inthe cervix ; its pia mater is of a dark slatecolour, as in cholera. The equinal nervesare blanched ; there is slight congestion ofthe capillaries on the surface of the cord in-feriorly and posteriorly, resembling ecchy-mosis.&mdash;Thorax. The lungs contain spumousfluid ; the heart is wasted and pale; points ofossification in the lining of the aorta; thecoronary arteries partially ossified.-Abdo-men. The liver contains four extensive ab.scesses ; a large branch of the hepatic veintraversed the largest superiorly, and parts ofits coats were removed by ulceration ; pusand mucus occupied the caliber of thispart, and a coagulum of blood filled the

cavity of the tube, on the other side, nearestto the biliary acini. The contents of theabscesses are dark-coloured, and some bilemingles with each; sundry corrugations,covered with thick layers or false membrane,indicate the probable site of previous he-patic abscesses. The spleen is puce-co-loured ; the pancreas is dark; the kidneysare small and pale; the tongue is marked by

longitudinal and transverse sulci ; the mu-cous membrane of the stomach is pale, andpartially corrugated and flaccid ; the mucousmembranes of the duodenum and jejunum

are pale ; capillary congestion commences in; the ilium; the mucous membrane is ex-

tremely thin, and engorged in parts ; chroniculcers, with irregular margins, are observedin the csecum. The mucous membrane ofthe ascending colon, and thence to the rec-f tum, remains only in shreds and patches,- the greater part having been removed byt ulceration.

" Observa-,Iio2ts. - The hepatic abscesseswere chronic, as their contents indicate, andwere formed long before the patient was re-ceived for treatment. The pulse indicatedbleeding, however, at reception; the opiummight have been spared ; it is rarely usefulin cases of hepatic inflammation, congestion,or obstruction, or in abdominal plethora."

’

- pp. 508, 9, 10.

If Dr. Conwell will study, for instance,Carswell’s Illustrations of PathologicalAnatomy, read Louis’s Works, imitate thesevere spirit of observation and reasoningof those authors, and collect such returns

209

as have been published by Dr. Burke, oreven tread in the footsteps of Dr. Twining,he may yet redeem himself from the awk-ward position into which he has been be-trayed by the publication of this- work.

Gregory’s Conspectus. A Literal InterlinearTranslation of the First Ten Chapters,with an Ordo Verborum, and Rules ofGrammar, with Examples. By ROBERTVENABLES, M.B., Oxon. London : Sher-wood. 1836. pp. 122.

Gregory’s Conspectus. A Literal ZiaterlarneauTranslation of the First Ten Chapters,with an Ordo Verborum, and Rules ofGrammar, with Examptes. By ROBERTVENABLES, M.B., Oxon. London : Sher-wood. 1836. pp. 122.

DR. VENABLES has the credit of being agood Latin scholar, and on the faith of thatcharacter we should be disposed to considerthe present translation a correct one. It

certainly exhibits proofs of great industry.However, we can never take up any of theinnumerable editions of the two best-

thumbed Latin medical authors, without

experiencing feelings of disgust, and has-tening to return it to the shelf. The

existing system of Latin examinations,and the test to which a pupil is put to provehis knowledge of the language in whichCelsus and Gregory penned their medicallore, present to us the greatest absurdities,to which gross ignorance alone can havegiven birth. What should we think of theman who might exhibit in France an En-glish edition of Shakspeare, prefaced by aGallo-Anglic grammar of sixteen pages, toteach the reader the language in whichthe plays were written ? Not that the

editor himself would deserve either laugh-ter or censure for his production ; for hemight thus defend himself: -" In Paris" we require men of letters, when they gra-"duate, to understand the English tongue," and the authorities have decided that the" candidate for honours who can in any

" way make out the text of Shakspeare," shall pass for a scholar in that language." We therefore circulate copies of the drama-" tist, with an interlinear translation, to" render students iiuent in his terms, and" we prefix a skeleton grammar, to facilitate"the task; and we find that between the" two every thing is effected that the exa-*’ miners require." The scene transferred toanother shore, the folly or the roguery of theauthorities becomes abundantly apparent,and to avoid the resulting laughter or con-tempt would be altogether impossible.

THE LANCET.

London, Saturday, November 7, 1835.

VENABLES’ GREGORY.&mdash;EXCLUSIONS FROM THE COUNCIL.

THE first great reform meeting of themembers of the London College of Surgeons,held in the spring of 1826, was at-tended byseveral of the hospital surgeons, when a fewof the expectants of seats in the Council

condescended to treat the company with

brief plausible orations on the subject ofmedical reform. The PURES, on that inte-

resting occasion, were all, without a singleexception, for presenting a " remonstrance"to the Council, and WILLIAM LAWRENCEconcun;ed with them in thinking&mdash;no, notin thinking, but in expressing an opinion, thata spirited address to the Council would

have the effect of removing the evils-thenumerous grievances-of the existence of

which the members so loudly and generallycomplained. An immense majority of that

meeting, which consisted of nearly twothousand gentlemen, dissented from the

views of the disinterested PURES, and re-

solved that a petition should be presented tothe House of Commons, praying for an or-ganic change in the constitution of the

College. At the second meeting, which washeld in about a month after the first, Mr.LAWRENCE had changed his opinions.Only a brief period had elapsed, but that

mattered not. The change had been ef.fected, and he considered that the memberswould never obtain a redress of their griev-ances, unless the charter were abrogated,and the general proceedings of the Collegewere founded on a new construction of the

governing body.Mr. WILLIAM KINGDON, who now com.

plains of his exclusion from the Council, ad-hered, we believe, to the proposition whichwas first propounded. This gentlemanthought, and continued to think, possibly,until the lash of persecution was applied tohis own feelings, that a " remonstrance, afirm but perfectly respectful remonstrance,"