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A detailed account is given of sixteen cases of the disease which fell under the author's care, and from which we obtain a very accurate idea of the symptoms of the complaint and the method of cure. If left to follow its own course, the malady would terminate fatally, or produce a permanent injury in the mental faculties: but it is fortunately under the influence of medicine, and may be relieved with considerable certainty by a simple and easy mode of treatment. The great specific is opium: which, if administered in proper doses, seems always to produce beneficial effects. The author's confidence in the salutary operation of this drug was not gained without his having made a previous trial of other methods of treatment; and indeed it was from the decided difference which he observed in the effects of remedies in this complaint, and in phrenitis, that he was first led to notice them as being two distinct diseases. Bleeding and blistering are quite unnecessary, and even injurious; purgatives are proper, so far as to remove costiveness, but beyond this they do not seem to be of any advantage.

In the second part of the work, Dr. S. treats on Peritonitis, and some other internal inflammatory Affections.' It is remarked that inflammation of the peritoneum is an obscure disease, dangerous, and often difficult to remove; and which, when not fatal, is apt to lay the foundation for other complaints. Its attacks are so gradual and insidious, that it is frequently not recognized until it has made considerable progress, and perhaps produced irreparable mischief among the abdominal viscera. It is not uncommonly mistaken for hypochondriasis, or indigestion, and the patient's sufferings have been classed under the general denomination of nervous feelings. Dr. S. observes that the symptoms of this disease, and those arising from an inflammatory state, have not unfrequently been conceived to be of a directly opposite nature, and consequently the most inappropriate treatment has been em ployed. He also thinks that practitioners are not generally aware of the tendency of the disease to relapse; and, in order to impress both these circumstances on the reader's attention, he relates a number of cases, to the amount of eighteen. The account of them is perhaps unnecessarily minute, but the experience derived from them is valuable, and generally tends to the same conclusions; that the free and early use of bloodletting is always advantageous; that great attention should be. paid to avoiding all external causes of irritation; that the strictest regimen should be observed in diet; and that the bowels should be kept open. The only new practice recommended is the topical application of cold to the abdomen,

in the form of lotion. We shall give the author's ideas on this subject in his own words:

The result of the above cases and observations proves that much advantage may be derived from a cold application, under circumstances in which such a remedy has not been hitherto thought of, or, if so, only transiently noticed. Hitherto the powers of cold, through the medium of a fluid, permanently applied, have been generally employed for the cure of external diseases, with the exceptions of affections of the head, of hernia, and of internal hæmorrhage; and its employment in these instances has more resulted from the opinion that the disorders were actually local, and independent of any general affection of the system. In diseases attended with fever, the powers of cold have been employed in a very transient manner; and have, in this way, been advantageous in many such disorders; but the permanent use of cold and moisture, and this assisting in producing cold to a certain extent by evaporation, has never been ranked among the number of remedies for the cure of internal diseases accompanied by fever, and has least of all been thought of as a remedy for affections of the chest. There have been discouragements arising from theory, against the use of such a remedy, added to the apparent certainty that such an application would bring on all those diseases which are supposed to be derived from cold applied in the ordinary intercourse and transactions of life. The remedy, however, when applied, has in no instance been noticed to produce inconveniences of this sort.'

Some remarks occur at the end of this section, respecting the application of cold to the chest in inflammation of the lungs; a practice which we cannot but regard as hazardous, and the facts that are adduced are not very decisive.

The last part of the volume treats on gout. Dr. S. begins by remarking that a great revolution of opinion has taken place on this subject during the last few years; and he fully enters into the views of those practitioners who conceive that gout is a disease which may and ought to be cured. He professes to have adopted his present ideas from the suggestions thrown out by Drs. Kinglake, Heberden, and Hamilton of Lynn, matured by his own experience and reflections; and he was induced to pay more minute attention to the subject in consequence of being himself a sufferer from the disease. During his first attacks, he submitted to the usual treatment: but, being led to change his views, he afterward proceeded on a more vigorous and determined plan. This plan consists essentially in the regulation of the alimentary canal, and depends on a proper system of regimen, combined with purgatives to remove obstructions in the bowels, and opium to relieve irritation. He conceives that the famous Eau medicinale acts on this principle of combining the effects of a purgative with an opiate; and he proposes, as a substitute for it,elaterium, in doses of one or

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two grains, with 40 or 60 drops of tincture of opium.' The remarks on gout deserve attention, but the suggestions of the author are not established by very extensive experience.

On the whole, we recommend this volume as the production of a writer who seems to possess good sense, together with a talent for observation. In general, all that he proposes is supported by facts; and, when he dissents from popular opinion, he does this apparently on good grounds, not from an idle desire of distinction.

ART. XIII. Treatise on the History, Nature, and Treatment of Chincough including a Variety of Cases and Dissections. To which is subjoined, an Inquiry into the Relative Mortality of the principal Diseases of Children, and the Numbers who have died under ten Years of age, in Glasgow, during the last thirty Years. By Robert Watt, M. D., Member of the Faculty of Physicians and Surgeons of Glasgow, &c. &c. 8vo. pp. 392. 10s. 6d. Boards. Longman and Co. 1813.

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N consequence of an unfortunate occurrence which took place in the family of the author of this volume, we learn that he was led to turn his attention very particularly to the subject of chincough, and the result of his investigation is now before the public. The work professes to afford a complete account of the history, nature, and treatment of the disease; both to give an abstract of what has been done by others on the subject, and to present us with original views respecting its pathology. We do not hesitate to say that on each of these points the author shews considerable ability. In the first part, he conveys much interesting information; and in the others he enables us to form a clear conception of points which were before very imperfectly understood.

The history of chincough commences with some remarks on the name and antiquity of the disease, its contagious nature, the predisposition to it, and the influence of climate and season: the last two heads containing tables of the cases in Glasgow, arranged so as to exhibit the ages and months in which the disease is most prevalent. Next we have an account of the early symptoms, a description of the paroxysm, and some remarks on the recurrence of the paroxysms, on the state of the appetite, on the febrile symptoms, on the state of the respiration of the head, of the stomach and bowels, and of the other excretions. Lastly, we arrive at the termination of the disease, its diagnostic symptoms, and particularly the connection between chincough and Bronchitis as described in the publication of Dr. Badham.From this recapitulation of the topics, our readers will perceive

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how wide a range of subjects is embraced by Dr. Watt. In this part of his work, however, we do not meet with much that is new: its merit consists principally in giving a clear and connected view of facts and opinions that lie scattered in a va riety of quarters: but the idea which is suggested of the resem blance or relation between chincough and bronchitis is in some measure peculiar to this author, and it is developed more at length in the subsequent portion of the volume.

We now arrive at the second division, that which treats on the nature of chincough. We have first a rapid sketch of the opinions of the early writers, beginning with Willis, who first distinctly described it; and afterward of the late writers, particularly Cullen and Darwin. The ideas respecting the nature and seat of the disease are extremely various. By some, it is assigned to the air-vessels of the lungs; by others, to the alimentary canal. Some place it in the superior parts of the airvessels; others in their more minute ramifications: some in the pharynx, others in the stomach, and others in the intestines. The nature of the affection is not less a subject of dispute; one set making it to consist in spasms, another in laxity, and a third in inflammation. Some assert that the fluids, others that the solids, alone are affected; and some that the disease equally affects both. In stating his own opinions, the author begins by attempting to shew that the cough has nothing dif ferent from the effect which would be produced by any violent irritation applied to the parts implicated; and he adduces cases in proof of this assertion, in which children have had the wind-pipe mechanically obstructed by saw-dust or other hard bodies, producing a state of the respiration and a cough similar to those of chincough. This position is still more enforced by appearances found on dissection, of which Dr. Watt gives a minute account; and it may be remarked as a singular circumstance, that these are almost the only dissections which have been made in this disease. The result of the examination was that the cells were found to be filled with a whitish purulent looking mucus, with only a small admixture of air.' The inside of the trachea was lined with red vessels appearing to be the seat of recent inflammation. The same general train of phænomena was observable in every case of chincough which was examined; in all of them, some part of the pulmonary system bore marks of considerable inflammation; and the passages were lined or plugged up with purulent matter or mucus. The morbid change was, however, produced in different parts in the different cases: in some, the upper parts of the trachea seem to have been the immediate seat of the disease: in others, the ramifications of the bronchial tubes; and from this circumstance the author endea

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vours to explain the variations which occur in the state of the cough and the respiration:

With regard to the breathing in this disease, and also in croup, I have noticed two very distinct states. In one set of patients, the dif ficulty seems to be at the top of the wind-pipe, hence the stridulous sound in the one case, and the hoop in the other; but in these cases the diaphragm, and the muscles of the abdomen and thorax, are not in any very violent action. In the other set of patients, the diaphragm and the muscles concerned in the process of respiration act most convulsively, but the patient has not the sense or the appearance of constriction about the throat. In the one case, the cells of the lungs seem to be incapable of taking in a sufficient quantity of air, or the air when it is taken in does not seem to serve the purposes of respiration in the other, the capacity of the lungs is entire, a vacuum can be speedily produced, but, from some constriction or difficulty in the passage, the air enters slowly, and with a wheezing, crowing, or stridulous noise. In the first case, it may be said, that the patient is threatened with symptoms of suffocation; in the last, with symptoms of strangulation.

Of these two opposite, or at least very different conditions of breathing, the two cases just given are very good examples. In the first, the action of the diaphragm was excessive; in the last, the difficulty seemed to be chiefly in the wind-pipe. In the former, I suspect that the inflammation began in the air cells, and extended upwards, affecting the trachea last; in the latter, it probably began at the same time in both, or perhaps began first in the upper parts, and extended downwards.'

This explanation accords sufficiently well with the symptoms, and is probably founded on a correct pathology.

The result of dissection seems to concur with every other circumstance in proving that chincough is an inflammatory disease: but, although this point be admitted, still a question arises whether the inflammation be of a peculiar kind. The following remarks of Dr. Watt probably contain all that can at present be said on the subject:

I am rather disposed to think, from a variety of circumstances, and particularly from its occurring only once to the same individual, that it is peculiar. But the peculiarity is perhaps entirely with regard to the cause, and not the inflammation itself. Thus the erythematic affection which surrounds the vaccine pustule is not different in its nature from erythema in general, though the cause is certainly very different. As a proof that it is the same, it can be moderated and even removed, as far as the stage of the pustule will permit, by the ordinary remedies which moderate and remove other cases of erythema

Is it not possible then, that there may be some eruptive disease of this membrane of the air-cells and bronchiæ, so minute indeed as to escape ordinary observation, but so considerable as to excite that inflammation which is apparently the principal part of the disease?'

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