gentleman who has been for many years extensively engaged in both public and private practice, we cannot but consider it as entitled to our respectful atten

tion.

The diseases in which Dr. Hamilton has adopted the plan of so largely administering purgatives are principally Typhus, Scarlatina, Marasmus, Chorea, Chlorosis, and Hæmetomesis. To each of these a separate chapter is devoted, in which the particulars of the practice, and the circumstances which led to it, are briefly detailed. The author was originally induced to pursue his present method of treating typhus, by observing that the antimonials, which were formerly so largely employed in this disease, appeared to be most serviceable when they operated upon the bowels. This led him to suspect, that any purgative medicine might be substituted in their place, and that the debilitating effect of vomiting and sweating might thus be avoided. Experience has fully confirmed these conjectures, and after a trial of some years he is now 'thoroughly persuaded, that the full and regular evacuation of the bowels, relieves the oppression of the stomach, and mitigates the other symptoms of fever.' He has accordingly almost entirely given up the administration of other remedies, and trusts to the exhibition of frequent and copious purgatives. It might have been apprehended, that this plan of treatment would have aggravated the debility, which constitutes a striking symptom of typhus; but ample experience has proved this not to be the case. The purgatives which Dr. Hamilton has employed in fever are calomel, calomel and jalap, jalap and crystals of tartar, aloes, solutions of mild neutral salts, infusion of senna, and sometimes the two last medicines conjoined.

In the chapter on scarlatina the author is naturally led to discuss the much agitated question, whether the scarlatina and the cynanche maligna are different diseases, or only varieties of the same complaint. He inclines to the latter opinion, but at the same time, proposes it with that modesty, which is a distinguishing characteristic of the work before us. As it is in that form of the disease, which is called the cynanche maligna, that the use of purgatives has been regarded as the least admissible, the author enters more particularly upon the consideration of this part of the subject, minutely considers all the objections that have been urged, and endeavours to repel them.

The chapter on marasmus is perhaps the most valuable part of the volume. The disease is characterized in the following terms:

"A sluggishness, lassitude on slight exertion, depravity and loss of appetite, wasting of the muscular flesh, fulness of the features and paleness of the countenance, swelling of the abdomen, an irregular and generally a costive state of the bowels, a change in the colour and odour of the feces, fetid breath, swelling of the upper lip, and itching of the nose, mark the beginning of the disease. "When these symptoms have continued for some time, they are followed by alternate paleness and flushing of the countenance, heat and dryness of the skin, feeble and quick pulse, thirst, fretfulness, increasing debility and disturbed sleep, during which the patients grind or gnash their teeth, and are subject to involuntary starting, and twitching

of different muscles."

This disease is frequently met with among the inhabitants of close cities, in crowded manufactories, and particularly among the children of the poor, who are deprived of the benefits of fresh air, cleanliness, and nutritious diet. This combination of symptoms has been generally conceived to depend upon the presence of worms in the alimentary canal, but their existence is, by no means, decidedly proved; worms are not unfrequently present, where no previous disease of the kind here described had been observed; and in a great majority of the cases of marasmus, the presence of worms has never been ascertained. Dr. Hamilton supposes the disease to proceed from a torpid or weakened action of the alimentary canal, and on this opinion he founded his practice of administering purgatives, which, when fully and steadily adhered to, seldom fails of producing the desired effect. Marasmus itself is a disease sufficiently formidable, but it appears to have an intimate connection with two others that are still more so, hydrocephalus internus, and epilepsy. Without entering minutely into the pathology of these complaints, our author thinks that there is a close relation between their existence, and a morbid state of the bowels, and his practical experience has amply confirmed this opinion.

Dr. Hamilton has been equally successful in chorea. The practice of exhibiting frequent purgatives in this disease was employed by Sydenham, and although he did not manage it in the most advantageous manner, he was, upon the whole, successful. Since his time a totally opposite treatment has been adopted, and

certainly with little benefit. Dr. Hamilton has seen in all above twenty cases of this disease; formerly he followed the practice then in vogue, of administering tonics and stimulants, and met with the usual disappointments; he was afterwards led to adopt his present views upon the subject, and has been uniformly fortunate. He has been equally so in his application of the purgative treatment to Chlorosis and Hæmatemesis, to neither of which one would, at first view, have thought it peculiarly applicable. The author examines the different hypotheses that have been proposed to account for chlorosis, but conceiving them to be inapplicable, and the practice founded upon them inefficient, he particularly directed his attention to the state of the bowels.

"The slightest attention to the general history of the disease evinces, that costiveness precedes, and accompanies the other symptoms. Costiveness induces the feculent odour of the breath, disordered stomach, depraved appetite, and impaired digestion. These preclude a sufficient supply of nourishment, at a period of growth, when it is most want ed: hence paleness, laxity, flaccidity, the nervous symptoms, wasting of the muscular flesh, fanguor, debility, the retention of the menses, and suspension of other excretions, strous effusions, dropsy, and death."

He also objects to the common opinion respecting hæmatemesis in females, that it is occasioned by a retension of the menses, and that it is vicarious of this discharge; his objection indeed seems very decisive, viz. that the disease exists in its most perfect form, while the menses continue regular. At all events, whatever be its cause, purgatives given in sufficient quantity, appear certainly to remove it, aid produce their effect without any unpleasant action upon the system at large.

About one-half of the volume is occupied by a collection of cases, illustrative

of the doctrines maintained in the preced. ing part, principally extracted from the records of the Edinburgh infirmary, in which are given, at full length, and much in detail, both the symptoms as they appeared from day to day, and the remedies that were prescribed. The large quantity of purgatives given to young subjects, and those labouring under what have been usually considered as diseases of debility, will excite a good deal of surprize, and must materially affect our future reasonings on such subjects. Much as we feel impressed with the value of this treatise, we shall point out two circumstances which, in our estimation, must tend somewhat to diminish their practical impor tance. From perusing the cases of typhus, particularly the more violent of them, we are decidedly of opinion, that the disease might have been more quickly subdued by the use of the cold affusion. In the first case, for example, of a patient with the skin very hot,' on the third day of typhus, we should have had no hesitation in deter. mining how to proceed. Our second observation is, that it would appear to us almost impossible, in private practice, to prevail upon our patients to take the imHamilton's method seems to require, nor mense quantities of medicines which Dr. do we conceive that it would be easy to persuade the friends or attendants to administer them. These considerations, however, do not make us withhold our warm approbation from the contents of the volume. They undoubtedly throw a new light upon an important function of the animal economy, and must afford many useful suggestions, even to those who do not directly imitate the practice. The candid spirit which pervades the work cannot be too highly commended, a spirit which, in medical writing, is unfortu nately as rare, as it is desirable.

A very essential difference between the medical writings of the older physicians, and those of the present day, consists in this circumstance; that formerly almost every one thought it necessary to compose a regular treatise upon each subject, whereas now we frequently confine ourselves to the relation of individual cases. This change has taken place, not only from a gradual improvement in our ideas

respecting medicine, but from the different method which we employ for acquir ing knowledge of all kinds. We have at length learned to estimate the value of experience, and though it may be impos sible entirely to check the propensity to theorize which the human mind has always exhibited, yet there never was a period when theory had less influence over the judgment, and when facts were

more assiduously investigated. The work now before us is altogether of the modern species; it is the result of a considerable quantity of practice, condensed into a small compass, and arranged in a tabular form. For an undertaking of this kind Dr. Haygarth is, particularly well fitted, not merely from his extensive knowledge and his acuteness of observation, but more especially from a habit which he has followed for many years of noting down, during the time of his visit, every circumstance of importance in the state of the patient's symptoms, the remedies applied, and their apparent effects. The present volume contains the result of his experience in two diseases, the acute rheumatism, and the nodosity of the joints.

During a period of thirty-eight years our author has taken notes of the cases of 10,549 patients of these 470 were rheumatism; but of this number only 170, or about one-third, had any fever: these last therefore form the subject of the present essay. Dr. Haygarth gives us a summary view of all the observations that he has recorded; he points out the causes of acute rheumatism, the period at which it appears after the application of the cause, the diseases with which it is connected, the state of the secretions and excretions, of the pulse, and of the blood; and finally,

we have an account of the remedies employed. On each of these topics the author furnishes us with the direct results of his practice, as taken from his journals, thus affording us a more extensive range of observations than had ever been before collected. We shall briefly mention the different conclusions which are deduced from this valuable body of experience. . A greater proportion of males than females are attacked with acute rheumatism, a circumstance which probably ought to be iscribed to the former being more exposed to the exciting cause of the disease, cold. Although the disease affects all ages, yet he period from fifteen to twenty is the nost subject to its attacks. The time which intervenes between the application of the cause, and the production of the liscase, what the author calls the latent eriod, seldom exceeded forty-eight hours, nd, in some instances, the interval was carcely perceptible. In a great majority of cases the joints were the parts princially affected; sometimes both the joints nd the muscles, and in some few instances he muscles only. The average of the ulse was about 100; the blood, when Fawn, had almost always the inflamma

tory crust. One case only is stated, in which the rheumatism was transferred to the stomach. But the most interesting information is the account which is given of the beneficial effects of bark in the acute rheumatism; indeed, the recom mendation of this remedy may be consi dered as the main object of the work.

Dr. Haygarth was first induced to employ it from the recommendation of Dr. Fothergill, who was in the habit of annually visiting the county of Chester, and was consulted in a case of acute rheumatism that was under Dr. Haygarth's care. Dr. Fothergill proposed that bark should be prescribed; and in answer to the objections raised by our author, against the use of bark in an inflammatory disease, he replied that

"When I was a young physician, being twice called out of my bed to visit patients in a frosty night, I caught a very severe rheu matic fever. By the advice of my medical brethren I had been blooded repeatedly and remained unsubdued, and my blood still exlargely, even to 70 ounces. My disease yet hibited an inflammatory crust. Hence I was convinced that the method of curing this fever by such copious evacuations was erroneous. Soon after my recovery, I was desired to visit a patient ill of an acute rheumatismi. At my request, sir Edward Hulse, at that time the most eminent physician in London, was consulted. le proposed that we should order the Peruvian bark. I gladly agreed to the proposal, as I thought there were several analogies between an ague and a rheumatic fever. In both diseases, the urine lets fall a similar lateritious sediment. In intermittent, as well as rheumatic fevers, the blood when let is covered with an inflammatory crust. The pain and fever of rheumatism have certain periodical, though not quite regular paroxy sins and intermissions.

"In this consultation with sir Edward Huls, the bark was given with such manifest advantage, that I have ever since adopted the practice in this disease, and recommend it to you in spite of all medical authorities to the contrary.'

It appears that the use of bark in acute diseases originated with Morton, who, in his treatise on this complaint, mentions his having prescribed it in conjunction with Hulse.

Since the consultation with Dr. Fothergill, which took place thirtyfive years ago, Dr. Haygarth has been in the constant habit of prescribing it, and he has been continually acquiring additional confidence in its virtues. In order to furnish every information on the sub ject, our author states, at some length, the history of all the cases in which it appeared to afford no benefit: these scein

to have been but four out of one hundred and twenty-one, a proportion altogether inconsiderable. Dr. Haygarth sums up his experience on the subject in the following words.

"After the stomach and bowels have been sufficiently cleansed by antimony, I have, for many years, begun to order the powder of the Peruvian bark in doses of gr. v. x. or xv. every two, three, or four hours; and if this quantity has a salutary effect, it was gradually increased to gr. xx. xxx. or xl. with scdulous attention never to add more than what perfectly agrees. It has generally been taken in milk, mint-water, or the decoction of bark. "With the exception of the few cases above noticed, the bark has uniformly produced the most salutary effects. The pains, swellings, sweats, and other symptoms of inflammatory fever, manifestly and speedily abate, and gradually cease, till health is perfectly restored.

"Dr. James Currie, in his Medical Re

ports, p. 421, observes that the inflammatory rheumatism is one of the most tedious and intractable of diseases.' This remark of a physician of such extensive experience, and medical knowledge, deserves particular attention. It proves the value of an inquiry which attempts to discover a safe and certain remedy for such a malady.

"Another circumstance merits great attention. When the rheumatic fever has been treated by bleeding, leeches, sudorifics, &c. it is well known that pains of the diseased joints and muscles often afflict the patient for many months or even years. In my clinical reports I find no instance of this kind, and have reason to think that the bark entirely prevents this cause of the chronic rheumatism as a consequence of the inflammatory fever.

"Except mercury in the siphylis, there are few or perhaps no examples where a remedy can produce such speedy relief and perfect recovery in so formidable a disease. For many years I have been thoroughly convinced that the Peruvian bark has a much more powerful effect in the rheumatic than any other fever: and that it does not even cure an ague so certainly and so quickly.”

To the essay is subjoined what are called "proofs and illustrations;" among other information, we have a full account of all the cases of acute rheumatism which terminated fatally; they amount to twehe out of one hundred and seventy. It 2ppears that there was, in all these instances, a translation of the disease to some vital part, or a combination with some other complaint. Next follow the tables; they consist of twenty-nine columns, in which are arranged every circumstance of importance respecting either the symptons or method of cure.

The second part of the work gives an account of the nodosity of the joints, a disease which has generally been classed with gout or rheumatism, but which Dr. Haygarth conceives is sufficiently disin guishable from either of these complaints to form the subject of a separate inquiry. It has occurred to him in thirty-four cases out of 10,549: it is almost peculiar to women, and generally begins about the period when the menses cease. The ti gers are the parts usually affected.

"The ends of the bones, the periostem, capsules or ligaments, which form the joir, gradually increase. These nodes are not se parate tumours, but feel as if they were 22 enlargement of the bones themselves.”

It is a disease slow in its progress: bet it advances without remission; and wha is fully formed, it almost entirely d stroys the use of the joints.

it

The remedies which Dr. Haygarth found the most efficacious for this distressing malady were "the warm bath, with t repeated application of leeches on L diseased joint." Upon the whole, he ap pears to place the most dependance on the leeches; but he candidly admits that out knowledge on the subject is still very La perfect.

8vo. pp. 450.

the present, when the votaries of scient are so numerous and of such various o scriptions, well-digested compendia, git ing a concise but correct view of the pr gression of knowledge, are eminently us ful. Such productions, though less bri liant than works of original genius, perhaps inferior to none in the effect which they produce, by affording an en access to scientific information, and t very considerably promoting its gett

diffusion. They may either profess to exhibit a complete and elaborate view of the subject, or they may aim only at giving a popular and superficial sketch, and they may still be each of them highly valuable. Their objects are indeed different, and their style and method should be so too. The one is necessarily much extended, goes into minute details, is couched in strictly scientific language, and is addressed to those already masters of the subject. The other is more brief, seizes only the striking features, is conveyed in a clear and familiar style, and is intended for the instruction of those who are only at the threshold of knowledge. Examples of these two species of productions must be familiar to every one, in the various departments of philosophy and literature; when they are ably conducted we feel grateful to the author, whichever method he may choose to adopt.

On some occasions, however, we meet with anomalous performances, which are not easily referable to either class; like those amphibious animals, who are capable of moving in different elements, and are equally awkward in both, so these works partake of the disadvantages of each, without fully answering the intention of either. They are too concise for the inquisitive student, and too technical for the general reader. This we apprehend to be the case with Dr. Clarke's work; but lest we should be accused of condemning it with out showing cause for our judgment, we shall proceed to give our readers some account of its scope and execution.

In a moderate-sized octavo volume the author professes to give a complete account of" the modern practice of physic." The diseases are classed according to the nosology of Dr. Cullen, and a short chapter or section is allotted to each, in which are stated in succession, the definition, syınptoms, causes, diagnosis, prognosis, and treatment. They are not stated in a popular manner, or in a style adapted for the perusal of the unprofessional; but they are brought forward in such a manner as evi, dently designed for the use of those engaged in practice. The size of the volume can only admit of the exhibition of a few leading facts and principles, and whatever merit we may suppose the author to possess in selection and compression, he has undertaken what is not to be accomplished, or at least not to be accomplished in such a way as to be either interesting or valuable.

We shall proceed to illustrate our re

marks by some examples. Typhus is divided into the two forms of mitior and gravior, each of which is treated of in a separate chapter. We are not informed whether Dr. Clarke considers these as two distinct diseases, depending upon different external causes, and different actions of the system; or whether he only considers them as exhibiting a greater or less degree of the same morbid state. We are, however, led to conceive, from the manner in which the subject is stated, that the former is the case. Dr. Cullen's definition of typhus is adopted by our author for his typhus mitior; an account of the symptoms, causes, diagnosis, and prognosis, are given with tolerable accuracy, and moderately detailed, and we then proceed to the treatment. Upon this part of the work, as one in which the author is more than usually copious, and which we select on this account, we shall offer a few remarks. Passing over the commencement, where the Darwinian hypothesis of morbid catenation is adopted without ceremony, he directs, "that after the operation of an emetic, a purgative of calomel be given." This advice is given unconditionally, without noticing the numerous cases, familiar to every practitioner, where such a medicine would be absolutely improper, and without informing us in what dose it is to be administered. The author then proceeds to state that wine and opium should be given in small quantities; and, from the context, it is to be supposed that he recommends their use from the very commencement of the disease. We are next told,

that the administration of oxygen gas will also prove an useful auxiliary;" but the reader is not informed in what way it is to be given, or what evidence we have of its utility. Any one who has actually practised in typhus, knows that it is too serious a complaint to be trifling with the pneumatic medicines, or harassing the patients by attempting to make them suck in the gases.

We are then ordered to use different methods for relaxing the skin and diminishing the heat in order that bark may be given, as if bark had any specific power over typhus, as sulphur has over the itch. It would have been more prudent to have advised the early use of the cold affusion, in order that the disease might be destroyed at its commencement, and the bark rendered unnecessary. Instead of this powerful remedy, we are detained with the spuma cerevisiæ, as the author chooses to call it, and the oxygenated muriate of