84 MRS. PHILLIPS.—RUCCO ON THE PULSE.

ing fixes the character and determines thefate of this school, for no student will enterto it unless he be the meanest and most spi-ritless mortal that ever disgraced the formof man. The entire class has been seized

by the throat, has been dragged, has beenshaken ; and what apology can be deemedan equivalent ? ’Ve are told that ruffians

and bullies attended from the brothels in

Kent Street, to overawe the students on this occasion. But if the ruffians can intimidate

the pupils when in the theatre, they canhave no control over them whilst out of it.

And where are to be found those young men

who, at a pecuniary sacrifice, will seek to beassaulted and despised. Assaulted the pupilshave been, and, if they tamely submit, des-pised they must be ; for they will only beknown by the designation of " Sutton Streetslaves."

DEATH OF MRS. PHILLIPS, OF FINCHLEY.

THE LANCET was the first journal that

pierced beyond any portion of the veil whichhung over this mysterious and appallingcatastrophe. At the outset, we did not hesi-

tate to declare that the matter could not ter-

minate with the inquest, and that the inter-ference of the magistrates was imperiouslycalled for. Public justice re-echoed the de- mand in a voice of thunder, but what hasbeen the response of its ministers ?-" Eti-

quette forbids !"The analysis of the mixture alleged to

have been tuken by Mrs. Phillips, exhibitedtwelve grains of soli(I opium in each dose !Twice was this medicine taken, without

producing even stupor ; but the third dose,we are told, produced the sleep of death !What think you now, ye magistrates of

Bow Street? Was the inquest a " compe- tent" tribunal ?

The conduct of Mr. Snow has been manly,discreet, and generous ; and lie has com- pleteiy succeeded in exoneratingDr.Tweedie,! iand -Alr. Ilill, the assistant, from any charge of unskilfuluess, or neglect.

Introduction to the Science of the Pulse, asapplied to the Practice of Medicine. ByJULIUS Rucco, M.D. &c. &c. London,1828. Burgess and Hill. Royal 8vo.2 vols., pp. 802.A RATIONAL, systematic work on thepulse, has long been a desideratum in

English medical literature. It is with feel-

ings of disappointment, then, that we find abook with so many pretensions as the onenow before us, should be so very far from sup.

plying the deficiency. Not only is the smallquantity of information which it contains, ob.scured by aheavy, verbose style, by bad gram-mar and worse composition in every page,but it is mixed up with gross physiologicalerrors, and with absurd and fanciful assump.tions, put forth with all the gravity of esta-blished and important facts. This is a heavycharge, but our readers will presently see

that it is but too well founded.The first volume is occupied by a long

preface, containing general observations on,and a history of, sphygmica, or the scienceof the pulse ; and by a detail of its generalprinciples.In the most ancient periods, as at present

is the case in the half.civilised empire ofChina, an undue preference was given tothe pulse above every other means ofinves’tigating the nature, and predicting the ter-

mination, of diseases ; as a more obvious andaccessible means of diagnosis, and beingless dependent on anatomical knowledge, itpresented many inducements to the con-

fidence of the physicians. But as thescience of medicine advanced, and especiallyafter the discovery of the circulation, it lostmuch of its imaginary importance ; and al-though it has never ceased to be resorted toby medical men, less reliance has, perhaps,since been placed on it than it deserves.This may be owing to the exorbitant valueat which it has been estimated, and the fan-ciful theories which have been started bymost of those who have written expressly onthe subject, from Galen downwards, to themore modern authors, Solano, Borden, Kihe)),Cirillo, and Fouquet. Yet these are the

writers whose works are extolled by Dr.Ruceo, above the rational and just observa-tions of Boerhaave, Iloffman, Senac, Van

Swietcu, and flaller, from whose Elem.

85RUCCO ON THE PULSE.

Pbvsiol. he has however quoted larger, in the most, if not the only, sensible part of his ;book.

’

The chapters on the heart and arteries,and their physico-vital powers, contain no-thing of interest, and are remarkable chieflyfor the ignorance of anatomy and physiologywhich they betray. Thus in p. 18, he says," The heart of the fostus is destitute of theabove-mentioned fleshv septum (ventriculo-rum), its place being supplied by the foramenovale, &c." In the first place, the period atwhich the septum is wanting, is a very earlyone indeed, and longbefore the foramen ovaleis formed ; and in the second, it requires but avery moderate knowledge of anatomy to beaware that the latter never can occupy thesituation of the former.

Again. " Almost aU the arterial vessels

discharge themselves into the venous rami-fications, which commence at the point where the arterial ones terminate, and those Ivessels which do not find venous ramificationsfree to receive them, unite themselves logo-ther by anastomosis." p. 42. Which is asmuch as to deny the existence of any exha-lant or secretory arteries, for these do notterminate by either of the modes which are (mentioned. Again, " Aneurisms only occurin this cel1ular tunic-and this is the reasonwhy true aneurisms never occur in surgery,"However this statement may be supportedby the authority of Scarpa, it is certainlycontrary to experience ; and ther", is scarce. IIva museum of any extent in London inwhich the author might not have been con-vinced of his error.

"On the left ventricle the aorta divides,itself into two principal branches, of which,the firat, because it takes an upward direc- tion, for the purpose of rt aching the neckthe head, and the upper extremities, takesthe name of the ascending aorta, the other branch is called descending, as it, &c." p. 51. To judge from this sentence, one mighty i

suppose that Dr. R. had never dissected ahuman subject, the distribution here de-scribed being found in 1Uminating animals,but certainly not in man.

:

" Like the heart, the arteries have thepower of contracting and dilating themselvesalternately in the presence of the stimulus of,tht-r.d blood. That the red blood, by its.particular character, contributes to the beat- ing ca tim arte:ies. is proved by Bichat’sex re- imeiit for making the red blood eircu-

late in the veins. For this purpose he ap-plied to the carotid artery and the jugularvein of a living animal two curved tubes,and thus made the red blood pass from oneto the other. Scarcely did the red bloodcommence its passage into the jugular vein,when be observed that the latter gave sigusof a species of isochronic oscillation at the

beating of the heart, similar to a murmur,noise, or obscure pulsation, which could onlybe derived from the specific action of thered blood, which, on account of its not find.ing the same organic dispositions of the ar-teries in the veins, produces in the latter aspecies of obscure pulsation, and a decisiveand more sensible beat in the former." p. 59.We do not remember this experiment of

Bichat, nor what was the conclusion he drewfrom it ; it is, however, very evident, that

the obscure pulsation observed in the veindid not depend on the chemical or vital properties of the blood, but on the impulsecommunicated to it by the heart, and would,

doubtless, have been equally manifested inany flexible, inanimate tube, of the same dia-meter.

At p. 63 it is stated, that it is ’ the toni-city of the arterial tunics," and this alone,which keeps an artery closed after the liga-

ture has been removed. Now every tyroknows that this effect is produced by theeflusion of lymph and the adhesion of thearterial coats, though it may be true that theartery is subsequently closed by °’ tonicity, "for a certain distance above the spot wherethe ligature was applied.I Of the various opinions relative to the

pulse, which are quoted in the chapters on

"the Mechanism and Causes of the Pulse,"Dumas believed, that the arteries were notdistended by the influx of blood, but spon-taneously dilated in order to receive it. p.78.Soemmering, that the arteries were dilatedby the blood, and contracted 11 vi vitali " to

expel it, and that the pulse depended,both on this dilatation and contraction, andon the locomotion of the arteries, especi-ally where they are loosely attached, p. 87.

Richerand maintained, that the dilatation

was entirely owing to the action of the heart,and the resistance offered bv the bloodalready contained in the arterie3, and thatthe pulse was owing chiefly to this dilata-

tion, but partly to the displacement of thevessel. p. 89. From Dr. Parry’s experi-ments, it should seem that the displacementof locomotion of arteries does not altogether

86 RUCCO ON THE PULSE.

depend on the action of the heart, as heobserved it only in a few instances, wherethe artery had been laid bare, and then cor-

responding with the hurried inspirations,and not with the pulsations which mightstill be felt with the fingers separately. p. 98.The author, in direct opposition to his

own statement, at p. 59, attributes the

pulse entirely to the effort made to remove

the pressure of the finger or other superin-cumbent body, and says that "the arteriesare always full of blood, and consequentlyalways dilated," and that, therefore, " noreason can be given why they should be-come dilated during the beating of thepulse." p. 101. Conclusions so absurd donot to require refutation. ’iNow it is every where admitted, that the I

alteries always contract when the quantityof blood in them is diminished, so as to adaptthemselves to it, however small it may be ; it cannot be denied also, that, during thediastole of the ventricles, they will containless blood than during the systole, since it does not proceed in a continued stream ; Itheir diameter must therefore be smaller Irduring the diastole than during the systole,and it is a matter of no moment, whetherwe call the former or the latter condition

their natural one, whether we say, that

they are dilated by the impetus of the blood,and returu to their natural calibre immedi-

ately on the cessation of that impetus, orthat they contract, from the diminution ofthe quantity of blood contained in them,and are restored to their natural size by afresh influx of it.

In describing the fingers, or the explo-ratory organs of the pulse, as he calls them,he says, The nervous papillae with whichthe cutis of the fingers is furnished, are foundthere in greater numbers, a kind of mucoushumour which proceeds from the epidermismoistening the said nervous papillae, &c."

p. 110. This can hardly be a typographicalerror, but yet if it were not for the numerousother blunders, we should scarcely be in-

clined to suppose the author so ignorant as to attribute a secreting power to the epidermis.Under the head of "rules for the correctobservation of the pulse," we have among others the following directions, which arejudicious enough, though perhaps super-fluous. The observer’s arm should be stea-

died and supported, so that it may be main-

tained in the requisite posture as long as

may be necessary, without fatigue or exer-tion ; all the four fingers should be appliedto the artery, the index being just above thestyloid process of the radius ; the patientshould always be in an easy position, and hisarm free from all pressure and confinement.

p. 130. In simple inflammatorv fevers theobject in feeling the pulse being chiefly to

determine its force and frequency, the ex-amination need not be continued so long asin chronic and organic diseases, where manynicer points are to be observed ; in the for.

mer case, however, the fingers should not beapplied for less than a minute.

., That man’s natural pulse varies in pro-portion to the changes which take place in hisorganisation is an indubitable truth, the evi,dence of which is supported by the testimonyof nature herself, when we observe that thepulse of man, without losing an atom of itsnatural character, can indicate the state ofhealth in three different ages, though it maybe quick and small in children, elevated,full, and strong in adults, and slow, rare, andhard in old persons." p. 151. "In com-

paring, however, the morbid pulse with thenatural one, in any individual, we shouldattend, rather to the degree of general de-velopment, than to the numerical age."p.159." The pulse of women is in general small,

quick, yielding, and energetic, whilst that ofmen is strong, full, and developed." p. 170.In short persons the pulse is strong, full,quick, and energetic ; in tall ones, slow,less full, and weaker ; and this is owing in agreat measure to the heart being proportion.ally larger in the former than in the latter."p. 17 2. "The pulse of large animals is ge-nerally rarer than that of small ; thus, in theelephant it is only 20 in a minute ; in thehorse, 32 ; in the ox, 36 ; in the sheep, 65;in the dog, 78." p. 175.

After observing that the temperamentshave a direct influence upon the variationof the pulse, he takes some pains to provethe incorrectness of the old division into san.

guineous, phlegmatic, choleric, and melan-cholic, which, upon the authority of a

modern writer,* he supposes, most erro-

neously, to be still generally received inthis country. p. 179. Yet after all this, andafter protesting against the " arbitrary re-duction of so many temperaments to four on.ly, as if nature had not formed so many indi-viduals, and not so many classes of indin.duals," with extreme inconsistency, he pro-

Hooper, Medical Dictionary.

87RUCCO ON THE PULSE.

poses to divide aU temperaments into fourclasses, characterised by the " degree of ir-ritability and sensibility," viz. "fat persons ;thin, lean, and emaciated ; robust, strong,and lusty ; and slender, delicate, and weak ;"and two secondary classes, comprising thosewho come between the first and second, andthe third and fourth. p.189. An arrange-ment, which is even more vague, and liableto more objections, than the one which he iscombating.We have looked in vain for any original

or interesting observations, in the chapterwhich treats of the influence of the passionson the pulse, and have found nothing butthe common-place, and unsatisfactory ex-planations, to be found in almost every sys-tem of physiology.

After mentioning that the circulation ismore energetic, and the pulse quicker, in

high than in l0w situations, he blames thepractice of sending consumptive patients tothe former, because the air, being more oxy-genated, " will increase still more the fe-

brile celerity of the pulse, and inflame,alter, and destroy the tissue of the lungs,which is consumed like any other combusti-ble body, when subjected to the process ofa rapid combustion, to which respirationbears no slight resemblance."-p. 236.There are three gross errors comprised

within these few words; first, the relativequantity of oxygen in the air is the same onthe top of the highest mountain as in thelowest valley ; secondly, the process of re-spiration, at least as far as the substance ofthe lungs is concerned, cannot be cODsider-ed as at all analogous to combustion; onthe contrary, in almost all diseases of the

lungs, especially those of an acute nature,their bulk and weight are increased; thirdly,it has never, as far as we know, been the

" practice of medical men," to send theirphthisical patients to elevated situations ; onthe contrary, the sea-coast, and low-shelter-ed valleys, are generally recommended.

In hot climates the pulse is frequent (100to 120), and more or less irregular ; in coldcU-uates, it is full, strong, steady, and slow.tt’heu the inhabitant of a cold country goesinto a hot one, his pulse loses in strengthand gains in frequency; when the inhabit-ant of a hot climate goes into a cold one, thereverse occurs.--p. 248 et eeq.

Cinchona and analogous medicines, whengiven during health, or when duly indicated,produce a quicker and fuller, but soft pulse.Camphor, in small doses, and given underthe same restrictions, makes the pulse fullerquicker, and harder; but if it be alreadytoo quick from debility, it reduces its fre-

quency. Nearly the same may be said of

opium, and both medicines, when given inlarge doses, retard the circulation, and pro-duce a slow, labouring pulse,266, et seq.

The continued use of mercujy quickensthe pulse, and renders it rather hard and

strong, but where salivation is induced, itbecomes " agitated, irritated, and small."270, et seq.

I Purgatives elevate and accelerate the

pulse, when they relieve the overloaded orobstructed bowels ; but render it small,weak, and slow, when carried so far as toproduce frequent watery stools, &c.-p. 272.

Diaphoretic, diuretic, and expectorantmedicines, by relieving the circulation, pro-duce a full, soft, strong, rather quick pulse.—p. 294. If used, however, injudiciously,they will ’ depress the whole system, andrender the pulse slow, weak, and small:’-p. 275. " Tartarised antimony and digi-talis render the pulse weaker and slower,"both of them, according to Dr. R., indirectlyby exciting nausea and vomiting. Laennee,however, states, that tartar-emetic, in largedoses, was equally efficacious in diminishinginflammation, when it did not excite nausea,as when it did ; and every tyro is aware,that digitalis seldom causes nausea, thoughit hardly ever fails to affect the pulse.The pulse is sometimes intermittent in a

state of health, and regular in febrile andother diseases, so that, contrary to what isusually the case, its intermittence is a fa-vourable sign. Instances of this are men-

tioned by Corvisart, Frank, and several otherwriters.-p. 290.

After repeating what we have alreadyquoted, relative to the difference of the pulsein different ages and climates, he says,-

" In short, all the difficulty of verifyingthe presence of morbose pulses, consists inascertaining, at the moment of examiningthe artery, whether the beating of the pulseis such as it should be during the state ofhealth of this or that individual, which iseasily ascertained by comparing iu the mind,the beating of the pulse which is underobservation with its physiological (natural)

88 RUCCO ON THE PULSE.

sta’e; fur the analogy, or the difference,will show, either that it is in its natural

state, or has suffered some alteration fromit."-p. 297.

Why truly so, indeed; for, with the know-ledge of the pulse of a given individual dur-ing health, any one may easily determinewhether it varies or not in disease, and with-out such a knowledge, the author, with allhis " sphygmical" science, does not fur-nish us with the means of doing so.When speaking of the changes which the

blood undergoes in the lungs, he says,-" The blood which passes from the las

ramifications of the aorta to those of thevenae cavae, after it has completed its coursethrough the differeut ])arts of the body, isblack, thick, and altogether vitiated, so to

speak, by the excess of carbon and hydrogen,as well as frequently by the presence of

many other foreign elements which are

there introduced through the thoracic duct,which pours them, with the chyle, into theleft subelavian vein. Thus heterogeneous,the blood cannot obey the pressing demandsof life, a flame which would certainly beextinguished at the first gush of wind, wereit not promptly succoured by the oxygenand caloric, and other nutritive fluids withwhich the blood loads itself iu passingthrough the lungs."- p. 302.Now, foreign elements have never been

detected in the chyle, at least in a state ofhealth, though it has been supposed, thatcertain substances are transmitted by it,from their being found in the urine ; theblood does not absorb oxygen when passingthrough the lungs, nor any thing else, ex-cept caloric, which cannot be called a nutri-tive fluid. His physiology is, however, aswe have already observed, of a very strangekind ; he believes, for instance, that the

brain cannot affect the heart immediately,but only through the lungs; and not satis-fied with making these organs the mediumof communication between the heart and the

brain, he even supposes that the size of thelatter depends on their greater or less deve-lopment, and says,-

.. It is not, therefore, without reason,that those animals whose respiratory appa-ratus is more complicated and perfect, havethe brain proportionably more voluminous,and vice versa."-p. 314.

Again: the state of the pulse in inflam-mation of the stomach, kidneys, or otherviscera, he attributes entirely to the stimu-lus communicated to the heart, by the mi-

nute arteries of the part affected, without

allowing the nervous system the least in.

fluence.-p. 334. In opposition to whichwe will only observe, that the capillaries ofan inflamed joint, or of a limb affected byerysipelas, must be as much ’ stimulated"as those of an inflamed stomach or kidney,and yet the effect of the pulse, and the

system in general, will most commonly bemuch slighter in the former case than in

the latter. But we have quoted errors andabsurdities enough, and will now pass onto the practical part of the work, in the se-cond volume, where we may find somethinga little more satisfactory.The author divides pulses into three or-

ders, diagnostic, organic, and critical; the

first of which, comprehending all those

pulses which do not indicate the disease ofany one organ in particular, nor the approachof a critical discharge, lie Subdivides into

great and small, hard and soft, strong andweak, quick and slow, frequent and rare,equal and unequal pulses.-p. 4.

" The great morbose pulse is full,strong,and not easily compressible ; it depends’ on the increase in the size of the artery,

on the degree of force with which the leftventricle contracts, and the quantity of bloodwhich it receives."-p. 8. It is observed

chiefly in inflammatory fevers, inflamma-

tions, acute haemorrhage, &c., and is, of

course, much more intense in young and

robust, than in old and debilitated subjects.Occasionally, however, especially in warmclimates, the pulse in real inflammatory dis-orders and in robust subjects, " from the toogreat repletion of the arteries, is deep andobscure instead of great," but becomes soafter a moderate bleeding ; in such cases,

however, the other symptoms are generallysuch as to leave but little doubt or ob.

scurity.The small pulse is when 11 the efforts

made by the artery to free itself from the

pressure, diminish almost to nothing, or arescarcely perceptible.’’—p. 9.

This is the whole of the author’s defi-

nition, and it evideutly rather applies to thesoft, than what is usually called the smallpulse, to which, however, the subsequentobservations certainly refer. It depends onthe depression of the vital powers of the

heart, and the consequent imperfect con-

89RUCCO ON THE PULSE.

traction of the ventricles, and is almost al-ways a bad symptom, but more especially soin small-pox and the exanthemata, when theeruption is suppressed, or has receded.-

p. 27.r-- - -

The character of the hard pulse " arisesfrom the sharp, resisting, and hard sensa-tion, which the artery causes to the finger ;"it depends either on rigidity of the arterialtunics, as is often the case in old persons, oron density of the blood, and vehement con-traction of the heart. In the latter case, and

when it is also great, it is almost always asymptom of some phlegmasia, as pneumonia,hepatitis, &c.-p. 30. The hard and small

pulse, on the contrary, is observed in " in-ternal gout, in nervous chronic rheumatism, iiin the advanced stage of phthisis, in hyste-rical and hypochondriacal affections, and

many other hyposthenic complaints."-p. 32; and lie should have added, in someof the phlegmasia attended with great pro-stration of strength ; the hard and wiry pulseof enteritis, for instance, must be familiar tomost of our readers.The soft pulse, which scarcely requires a

definition, depends " on the weakness of thecontractions of the ventricle, and the some-what full state of the arteries."—p. 37;(probably also on the atony of their coats;)when the soft pulse is, at the same time,moderately full and regular, it is almost al-ways a favourable symptom, especially if it

had been previously hard; if, on the con-trary, it be small and irregular, it is as gene-rally unfavourable.-p. 41. et seq.

’i he strong pulse is compounded of thegreat and the hard pulse, and is observed

in " inflammatory, ardent, gastric, and bi-lious fevers, in the more intense phlegmasia,in sanguineous apoplexy," &c.--p. 46.

As the strong pulse is compounded of thehard and the great, so is the weak pulse ofthe soft and the small, differing from thelatter in being dependent more on the weakness of the action of the heart, than onthe condition of the artery.-p. 54. It oc-curs in " malignant, nervous, liectic, and

lymphatic fevers, in passive haemorrhages,in epidemic dysenteries, and in many otherdisorders which derive their existence fromthe lowering of the vital powers,"-" and isthen a much more important and unfavour-able sign than in chronic disorders, whichare the effect of distress of mind, want of

food or sleep, excessive evacuations, fatigue,&c"-pp. 58-61.

The quick pulse differs from the frequent,with which it is often confounded, in con-

sisting, not in the shortness of the intervalbetween the separate beats, but in the

rapidity with which the artery dilates, andthe consequently short space of time duringwhich it is felt by the finger.-p. 64. It is,therefore, opposed to the slow or labouring,as the frequent is to the rare pulse, and maybe combined with either of the two last.

Yet, after having made this distinction, theauthor immediately afterwards falls into thecommon error, and speaks several times ofthe " quick pulse," the " quickness of thepulse," when alluding solely to the increasein the number of the beats.-p. 66. et seq.The slow pulse is natural in old persons,

and in the inhabitants ofvery cold climates;it is alone of not much value as a diagnosticsign, but when it occurs in acute diseases,and is, at the same time, weak, small, orirregular, it is a very unfavourable symptom,especially when the change from quick toslow takes place suddenly.-p. 72, et seq.The frequent pulse is the most common,

and the most relative of all the morbid

pulses ; for the frequency which would beperfectly natural in an infant, is decidedlymorbid in an adult, &c. (In general thepulse of the latter is called frequent, whenit ariounts to 85 or more in a minute.) Itoccurs in an febrile diseases, in the exanthe-mata, synochus, &c.; it is, at the same time,quick, and often strong, in nervous, putrid,and malignant fevers; and in many otherasthenic diseases it is quick and weak, andits frequency is generaily in a direct ratio

With its weakness, the heart being, both inhealth and disease, most irritable when

weakest, as in very young infants, for in-stance, in whom the pulse is very feeble andrapid.-p. 76, et seq. the frequent, or thefrequent and quick pulse, may, therefore,be produced by two very different conditionsof the heart, great vigour and energy, andgreat weakness ; in the former case, how-eVtr, it will be much less easily excited thanin the latter.-pp. 80-25.The rare pulse, as has been already

stated, depends on the length 0f the inter-val between the beats. The pulse of an

adult is usual!y termed rare, when it is be-low 60 in a minute : it depends on a generalwaitt of tone of the whole system, and more

90 RUCCO ON THE PULSE.

especially of the heart and arteries, and is, therefore, natural in old persons, and in cold--blooded animals ; in large animals, also, thepulse is much rarer than in small ones,which possess much more vigour and

strength, in proportion to their size.--pp. 86- 88." But the rarity which is natural to the

beatings of the pulse of the inhabitants ofcold countries, is evidently different, andarises from the vigorous strength with whichthe ventricles of the heart send forth and

dispatch, in every systole, so much blood tothe different parts of the body, that they donot feel the least necessity for repeatingtheir contractions with frequency.-p. 90."

It would have been more correct to haveattributed it to the lower degree of irrita-

bility which such persons possess ; for if theheart be stimulated, it will continue to sendforth its blood at a rapid rate, whether therebe any « necessity " for it or not.The rare pulse occurs in most diseases of

debility not accompanied by irritation, butis not alone a symptom of much diagnosticvalue ; a good deal must depend upon itsbeing also quick or slow, strong or weak,&c.-p. 93.

Under the head of the unequal pulse, theauthor treats very briefly of the intermit-tent pulse, and of those which are irregular,either as to force or frequency, which wemight certainly have expected to find sepa-iately described in a systematic work likethis, and where pulses which never were,and probably never will be distinguishablein practice, are minutely described, and se-parately denominated.-p. 96.

It depends on 11 some disturbance of the

organic functions, either from mental emo-

tions, or from disease of the heart, arterial

trunks, lungs, &c.-p. 93.

The regularly unequal pulse, or that inwhich the unequal stroke or interval recurs,always after the same number of beats, is

most frequently observed in chronic,-theirregularly unequal in acute diseases.-p. 99.

In treating of each of the pulses whichwe have just noticed, the author lays greatsttcss upon the necessity of taking into con-sideration, in every individual case, the condition of the pulse in the state of health, bwhich the degree of its morbid deviationmust always be measured, a point whichseems so plain and obvious, that we have

not thought it necessary to touch upon it moreparticularly, any more than the equally evi.dent one, that the pulse, when morbid, is

rarely changed in one respect only, and sel.dom becomes more frequent, quick, or

strong, for instance, without being also

harder, softer, or weaker, &c. than natural.We have been thus particular in going

through the first hundred pages of the secondvolume, because we consider, that except-ing the aphorisms (at p. 105 et seq.) andsome scattered observations under the headof " critical pulses," it is the only part of itfrom which any useful information may beobtained ; we do not say original, for thereis nothing which was not known long ago ;indeed, whenever the author quits the ob.servations and conclusions of others for hisown theories and reasoning, he runs into somuch error and absurdity, that we scarcelyknow whether he is deceived himself, or isattempting to deceive his readers. We haveseen some instances of this in the first vo.

lume, and we shall find many more in goingthrough the section " on organic pulses;"" The origin and foundation of these, andthe justness of the principles on which thedoctrine of them is firmly established bynature," the author deduces ‘° from the reo

searches made in the first part of the work,"which is what, we believe, none of his read.ers will be able to do. It will not be worthwhile to notice the arguments which are ad-duced in addition to " the researches," to

prove the existence of a separate and dis.tinct pulse for the disorder of each organand each secretion, since besides being veryimperfect and confused, they can only serveto prove, that the pulse is affected by the

diseases of the different organs, a fact whichno one will be inclined to dispute.

Organic pulses he divides into superiorand inferior, the former including the pulsesof all those organs which are situate abovethe diaphragm; the latter the pulses of thosewhich lie below it. The superior pulses,which are, " in general, vibrating, quick,and vehement," are the capital, nasal, gul-tural, and pectoral; the inferior, which

are " small, deep, and often slow and rare,"are the stomachic, hepatic, splenic, intes.tinal, uterine, haemorrhoida), urinary, andcutaneous ; the former, therefore, dependon regions, the latter on organs-a very un-

equal distribution.

91RUCCO ON THE PULSE.

The character of the uterine pulse is," that the digital part of the pulsatile arteryis close and concentrated, and that in thispart is felt the impression of so many smallround bodies, which appear to succeed eachother with a certain degree of velocity: ’-p. 233. Like the other organic pulses, itwill be most marked in the right or leftwrist, according as the right or left side ofthe organ ia most affected ; and as the authorbelieves in the long exploded opinion, thatthe uterus consists of two halves, and thata male foetus always lies in the right, and afemale in the left, he maintains the possi-bility of predicting by the pulse the sex ofthe fcetus in utero, and gives three instanceswhere his prognosis (or, as we would say,guess) was correct. He does not, however,mention those in which he was mistaken,which are, doubtless, by far the most nu-merous.

The chief absurdity in his theory, or doc- itrine of organic pulses, is, the supposing thata certain phenomenon can take place in oneparticular artery alone, and in one part onlyof that artery, from causes which could not Ipossibly affect it, except through the general circulation. All those pulses, or variations ’ of the pulse, which have been hitherto ad- mitted by enlightened physiologists and

practitioners, may be felt alike in everyartery of the body, allowing only fur the dif-ference in the thickness of the integuments,and the relative situation of bones or otherhard parts, whilst these" organic pulses "are to be felt at the wrist alone, and there Ionly in a limited space. But let us examineinto the particular characters of some of!them, and we shall see to how many other! objections they are liable. The capital pulse is " sometimes only an elevation, ex- tending throughout the whole arterial canal;" in plain English, therefore, it is nothing Imore than a somewhat full, hard, and jerk- ing pulse, such as is observed in the affect-tions of many different parts, and whichcannot possibly serve to distinguish those ofthe head.The pectoral pulse, as we have seen Iaerves to indicate the presence of affections

of the thoracic viscera; it is true the authordoes not pretend that the pulse will be the ’

same in every respect in the various dis- ’

eases of the lungs, heart, and large arteries . but he maintains, that, in all of them, whe-

ther it be hard or soft, quick or slow, it will

preserve its peculiar organic character,which is not at all consistent with the greatdifference in the symptoms of these diseases,nor, indeed, with his own arrangement,since he makes a different pulse for the sto.mach and intestines, the diseases of whichare much more analogous in their generaleffects on the system, than those of theheart and lungs.The character of the organic pulse of the

spleen, is so utterly absurd, that the authormust have a very large stock of imaginationhimself or suppose a large fund of credu-lity in his readers, to have committed itto paper. It is going quite far enough tosuppose the possibility of even the most

practised finger, feeling a minute pyramidaleminence upon a beating artery through theinteguments; but when we hear this pyra-I mid described as vertically cut, and havinga small lrenciz on the one side, while it is

regular on the other, we can hardly bringourselves to believe, that the writer is notspeaking of some crystal, or other solid

body visible to the eye, rather than of thesoft flexible coats of an artery, perceptible; only to the touch, and that for less than a

second of time. We shall not, however,fatigue our readers by unnecessarily multi-plying objections against the doctrine in

question, but pass on to the concluding sec-tion of the work, which treats of critical

pulses.These are divided nearly in the same man-ner as the organic pulses,-into nasal, gut-

tural, and pectoral, intestinal, urinary, cuta-neous, stomachic, hepatic, hasmorrhoidal, and

’ uterine. The first, however, and the fourlast, the author considers rather as symp-tomatic than as really critical, a true crisis

being never effected by a discharge of blood

from the nose, rectum, or uterus, of aliment-ary or other subst.rnces from the stomach,or of bile from the liver; except that theyare fuller and stronger, they are all distin-

guished by the same characters as the or-

ganic pulses, and therefore liable to the sameobjections. It cannot, however, be denied,that there are some conditions of the pulse,by which certain discharges, whether criticalor not, may be predicted, though they are notdistinguished by such particular and minutecharacters as those which are he’e laid

down. Such are the pulses which precededischarges of blood, profuse and critical

92

sweats, and critical urinary and intestinalevacuations. The first of these has been

long known under the name of the doublecr dicrotous pulse, and consists of two beatsoccurring almost at the same moment, thelast being the strongest. The second, which

corresponds almost exactly with the author’soutaneous critical pulse, has been denomi-nated inciduous or wavy, and is characterised

by the pulsations gradually increasing in

strength and fulness to the fifth or sixth,when suddenly diminishing, and againgradually increasing, &c. The third, whichis much more doubtful and obscure, is theconverse of this, the pulsations graduallydiminishing, instead of increasing, in forcea:id fulness ; and the fourth is distinguishedonly by its smallness, hardness, and inter-

mittency, and by the accompanying symptoms, as coldness and constriction of tilt

skin, &c. These are, we believe, all the

critical pulses which have been observedfiy enlightened and unbiassed practitioners,and the author would have been much better

employed in explaining and illustratingthem, than in making new and subtle dis-tinctions, which have no foundation in na-ture, and can only serve to deceive andmislead his readers.When speaking of the pectoral critical

pulse, he laments "the prejudice which for-bids to profit by the light which the scienceof the pulse diffuses over practical medicine,"and gives, as a fatal instance of the neglectof this light, a case taken from Fouquet, ofa young man

" attacked with putrid fever,who died from his physician not knowingprecisely the character of the critical pectoralpulse."-p. 346. The patient in question,who was in the ptime of life, towards theend of the fever, after a very restless nightwith some dyspnoea, felt beter in the morn-ing, and began to cough and expectorate.Notwithstanding this amelioration, becausethe pulse was rather fuller and quicker, thephysician ordered venesection and a purga-tire, which cliecked the critical expectora-tion, and threw back the patient into a

worse condition than befure ; his good con-stitution, however, overcame this injudicioustreatment, and after three days th3 samesymptoms returned, and we:e again re-

pressed by the same bad treatment. This

took place four times, and the patient, a;.might have been expected, died at last,

quite exhausted. Now. without any assist.1 ance from the 11 critical pulse," there weresymptoms enough to have shown the impro.priety of the first, and much more the second. bleeding, and no one who reads the case

will, we think, be inclined to conclude withDr. Rucco, that the patient was lost fromwant of a precise knowledge of the criticalpulse.

In the absence of a better work on the

subject, this work will probably find somereaders, but it will be of very little use to

the student, or to any one who is not wellable to separate the metal from the over.

whelming dross ; and we would recommendto the author (though we fear there is little

chance of his attending to our recommend.ation), if the work should ever reach a se-cond edition, to reject the greater part of thephysiological observations, to extend the

section on diagnostic, and curtail that on

organic pulses, and to have the languageand style of the whole corrected by someEnglishman, which would certainly renderit less disagreeable and more instructive.

lt may, perhaps, be as well to mention inconclusion, that the author was professor ofmedicine, and afterwards of anatomy, at

Naples, between the years 1804 and 1815 ;that in the latter year he went to the United

States, as he tells us, solely from a laudablewish to benefit science ; practised in NewYork and Philadelphia until 1820 ; has sincethen been practising in London ; and that

during the greater part of this time, his at-tention has been especially directed to thescience of the pulse. The imperfections ofthe work cannot, therefore, have been causedby want of time or experience.

GUY’S HOSPITAL.

AN extraordinary scene occurred here on

Tuesday evening’ last. The introductorylecture of Mr. Key was to have been givenou the Friday previous, but in consequenceof the burial of Mr. Hunt (the strange gen-tieman, who has lately left a great sum ofmoney to this institution) in the vaultof the Hospital, the evil day, to the greatjoy of the lecturer, was postponed until

Tuesday the 6th. It appears, that the pupilsattending his class, have charged Mr. Keywith a violation of a promise, distinctly andunelluivocaHy given iu the early part of thelast 6essiori, that he would award a surgical