"To avoid the farther detail of particular cases, it may be sufficient to state, that in all the subjects I have examined, who have died of the fever at present under consideration, there have been evidences of the maturation of the disease, modified, of course, by the nature of the parts upon which its influence was directed, and by the accidental state of the individual's constitution. Thus it was sometimes thrown on the vascular system, as in the first case, and by injuring the texture of the vessels, disposed them to rupture, or gave origin to hemorrhage from the nose and rectum. When the result of the disease has fallen on the substance of the brain, this organ after death exhibited a most remarkable state of congestion. On cutting the medullary mass, a quantity of thin blood, apparently in a dissolved state, was poured from innumerable points. These cases were by far the most rapidly mortal; some have occurred to my observation when this state of the brain was about to commence, and before many minutes elapsed, the progressive changes towards death took place while I was standing by the patient. In all the cases of this kind which I have examined, there were observed patches of several inches in extent of a dark colour upon the ileum. Upon opening this intestine these patches were found to be occasioned by a state of vascular congestion on the mucous surface, sometimes even apparently abrasions were observed; indeed, in one case there were several perforations, so that the contents of the intestine escaped into the cavity of the peritoneum. In these cases the fatal train of symptoms generally commenced with abdominal pain, but the state of the brain soon rendered the patient insensible to the progress of disease in the abdomen, although he may be still capable of giving a rational reply to the questions of his medical attendant.

"When the patients have survived a day or two after the result of the disease had been deposited on some internal part, bands of adhesions were observed; but in the rapidly fatal cases, the coagulable lymph and curd-like substance could be wiped off the organ, and then the surface would appear quite sound." 11.

From these and other circumstances, our author is induced to think that there is some peculiarity in this fever which disposes to the formation of a morbid matter that acts like a poison, and quickly destroys the powers of life. In this view, he is supported by Dr. Marsh, whose paper will be found reviewed in the present number of our Journal. In former epidemics, our author had observed many symptoms which seemed to indicate a tendency to generate a morbid poison; but he did not meet with the regular train of symptoms in any individual case, such as occurred in the present epidemic.

"The generation of this morbid poison appears to take place at some uncertain period of the disease, and seems as if thrown on particular organs or parts exclusively, leaving all other parts of the body apparently in health. Probably the peculiar state of the VOL. VIII. No. 15.

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patient's constitution at the time, may determine the situation where the morbid change may be developed." 16.

Impressed with the idea of such a tendency in the prevailing fever, our author sought to counteract it, and, for this purpose, tried the hydro-chloruret of lime-first with patients who had no prospect of surviving their disease under the ordinary mode of treatment. The following is an instance.

Case 5. John Coyne was admitted into the hospital in the last stage of dysentery, which came on after a tedious fever. The discharges consisted of a bloody sanies, intermixed with a dark-coloured matter highly offensive. The stools were passed involuntarily, and the patient was reduced to an idiotic state. Dr. R. considered that erosion of the intestines had taken place, and that death was inevitable. He directed ten grains of the hydro-chloruret of lime to be added to the common enema of the Pharmacopoeia, and to be thrown up, night and morning. The stench was corrected, the evacuations became more natural, and pure blood was sometimes discharged. His tongue became clean and moist-but exhaustion increased, yet he lived a fortnight after this. No dissection was made, and we believe that Dr. R. was right in supposing that the intestines were ulcerated, and that death was inevitable.

6. Encouraged by the effects of the hydro-chloruret in correcting the fetid discharges in the above patient, our author next directed its administration to a female lying ill with dysentery after fever, and whose evacuations were so intolerable, that the other patients declared they could not stay in the ward. The first day after the injections, the patient experienced considerable relief of all the symptoms. In a few more days, the fetor was corrected. The progress of the cure was gradual and steady, and she entirely recovered.

Case 7. In this case the medicine was exhibited by the mouth. The patient was a very old man, of broken constitution, who was admitted for dysentery succeeding fever. He had frequent bloody evacuations, attended with great pain in the abdomen-tongue loaded-thirst urgent-great debilitysome appetite. Dr. R. directed a mixture composed of ten grains of hydro-chloruret of lime, two drachms of tincture of colombo, and four ounces of water, to be taken in half-ounce doses every hour. Next day the tongue became moist, though still loaded. The medicine to be continued. On the third day the evacuations were changing to a more natural appear

ance, and he had longer intervals from purging and pain. The medicine was continued for a few days longer, when he got quite well.

The patient had

Case 8. This was a very formidable one. been in Sir Patrick Dunn's Hospital for dropsy, where he was tapped. A week after leaving the hospital, he was seized with dysentery, in which state he had been three weeks before he came into the Fever Hospital. He complained of severe pain in his bowels-had incessant alvine evacuations of thin fetid matter intermixed with bloody sanies. The abdomen was swelled, and his legs were cedematous. Two days were spent in the administration of some medicine, and then the hydrochloruret was given, nearly in the manner above related. He soon began to mend, and, in a fortnight, the dysentery had greatly abated, and he was able to sit up and put on his clothes.

The above cases were selected from a great number of the same kind. Dr. R. thinks they were cases that would, most probably, have terminated fatally under other treatment. Several cases are next detailed, in which the medicine was administered in certain stages of fever, and apparently with considerable advantage. These we need not state. The foregoing observations will probably lead many of our readers, in this and in other countries, to try the means recommended by Dr. Reid. We shall conclude this paper with the following extract, which also concludes the pamphlet.

It may be necessary to state that the substance known in the shops under the name of hydro-chloruret of lime, is extremely variable as to the quantity of the soluble salt it contains. When first I employed this substance as a medicine, I prescribed the supposed necessary quantity of the dry substance. I soon observed, however, that the operation of the medicine appeared extremely irregular ; I was, therefore, induced to examine the substance by some test which would give an indication of the quantity which was capable of being dissolved in water. As it was known that this substance has the property of discharging the colour of indigo when dissolved in sulphuric acid, I directed three grains of indigo to be dissolved in three drachms of sulphuric acid, to which were added three ounces of water. This I reserved as a standard of comparison. Three ounces of dry chloruret of lime having been put into a pint of water, the mixture was occasionally stirred for twenty-four hours, and then filtered through paper. The strength of this liquid was ascertained by the number of drops required to discharge the colour of twentyfive drops of the indigo solution. I observed that the strength of the liquid varied from nine to twelve. It was, therefore, directed

that each quantity of the solution, on being filtered, should be marked so as to indicate the strength, or the number of drops capable of discharging the colour from twenty-five of the indigo solution.

"I have selected the foregoing cases from a great number, as being those in which the evidences of the efficacy of the hydro-chloruret of lime were most unequivocal. From attentive observation relative to the mode of action of this remedy, I am induced to consider it astringent in its primary local action, without apparently exciting inflammation. In certain stages of dysentery, therefore, it will be found of the highest importance. The cases of Rose Macnamara and Heron evince its powerful efficacy in that stage of the disease which has been heretofore so tedious and intractable. As to its secondary influence, it seems to produce very general effects upon the functions of the ganglionic system, principally evident in correcting the formation of morbid matter. In some cases it appears to act as a diuretic. The urine, however, when increased in quantity under its influence, appears to be of that kind which was formerly supposed to indicate a termination of disease, thus agreeing in its effect with the observation of Hippocrates, cocta non cruda sunt evacuanda.' More frequently perspiration seems to be its most evident effect. In such case also the same observation is fully applicable, as the perspiration is seldom profuse, but always of that healthy feel, which has been usually considered by the physician as the most satisfactory solution of a severe disease.

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From the observations I have made of the efficacy of this medicine, in cases which exhibited all the symptoms of that severe disease which medical writers have denominated yellow fever, I can with some confidence recommend it as a valuable remedy. Indeed, the cases to which I at present allude, having had all the symptoms of that formidable disease, which the difference of climate in these countries could admit, I am induced to expect, that when properly employed, the hydro-chloruret of lime will be found as valuable a remedy in the treatment of yellow fever, as mercury has proved in syphilitic disorders.

"When a remedy has been found very efficacious in some states of disease, the practitioner, by not carefully observing its operation in the animal economy, is induced to appropriate the medicine rather to the name of the disease as known to nosologists, than to the morbid actions which the remedy is peculiarly adapted to correct.

"The practitioner, therefore, should be careful not to expect too much from any single remedy, for the records of medicine show how many substances have been at times lost to the physician, and at other periods proving of the highest value in the science of medicine." 35.

IV.

Traité sur les Gastralgies et les Enteralgies, ou Maladies Nerveuses de l'Estomac et des Intestins. Par J. P. T. BARRAS, M. D. Medecin des Prisons et du Bureau de Charité, &c. Octavo, pp. 330. Paris, 1827. Balliere, Bedford Street, London.

In the 10th Number (fifth volume) of this Series, p. 489-500, we gave a very extended analysis of a paper on the above subject from the same author; in which was detailed Dr. Barras' own case, forming, indeed, the basis of the Memoir. It will be found, that some of the best monographs we possess arose in this way from the personal sufferings of the writers. No verbal description is equal to individual feeling in symptomatology, and, therefore, it often happens that the pain inflicted on a single person forms a kind of expiation for the multitude. This is particularly the case in respect to stomach affections, to which medical men are very liable, and, from which, the author of the work under Review has experienced no small portion of misery. Since the original Memoir was published, he has collected fresh materials, and added them to a more systematic Treatise on this important malady than the Memoir could be said to embrace. We shall endeavour to avoid, or touch very lightly on, the materials contained in the original Memoir, and select, from the present volume, as much of the new matter as possible.

I. Our author takes the definition of Pinel for the class of neuroses, or nervous diseases-"lesion of sense and motion, without inflammation or lesion of structure." This is, perhaps, as good as any other definition. The new, or physiological doctrine is acknowledged to have done great good to medical science, though not unaccompanied by evil in the shape of error. One of these errors is strongly protested against by M. Barras-namely, the doctrine which amalgamates the neuroses with_the_phlogoses-a doctrine powerfully supported by the late Dr. Parry in this country, but still, a doctrine untenable in theory, and dangerous in practice.

Before the days of Broussais, those nervous affections of the stomach known under the terms gastralgia, gastrodynia, cardialgia, dyspepsia, &c. were treated with bitters, tonics, anodynes, and mineral waters, together with country air and exBut the New School could see nothing in this class of