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cident, and in which the patient is either carried off by hectic, or, if he survive, is left with his limb shortened, and almost useless. The paper tends strongly to corroborate the idea that has been long entertained respecting the good effects of the Bath waters in this complaint; which are the more useful the earlier they are employed, and, after the suppurative stage has commenced, are no longer admissible. Leeches and blisters are sometimes found necessary to be employed together with the water; and occasionally opium and Dover's powders are beneficial adjuncts.-Dr. Falconer gives, in the form of a table, the result of all the cases which have been treated in the Bath Infirmary during a space of 16 years. The whole number,. deducting those that were not deemed fair subjects for atrial, is 415 103 of these were entirely cured, 168 received considerable benefit, 111 were materially relieved, and 33 only were dismissed without gaining any advantage.-For this paper, Dr. Falconer received a silver medal from the Society.

Dr.Smith, of New Hampshire, has contributed some remarks on the Position of Patients during Lithotomy. He objects to the present plan of binding down the hands to the ancles; by which posture the abdomen must be compressed, and the intestines forced towards the bladder, and thus rendered more liable to be injured. In the 20th memoir, Dr. Broadbelt of Jamaica relates a case of great Enlargement of the Scrotum, which took place in a negroe, apparently in consequence of a stricture of the urethra. On the next paper, by Dr. Bostock, of Liverpool, the Society bestowed their honorary medal. It contains an account of two cases of Diabetes. After an accurate enumeration of the symptoms, the author relates the result of a number of experiments which he performed on the diabetic extract, which he appears to have examined with much care: but he does not enter into any detail of the remedies employed.

Nearly all the remainder of the volume, consisting of more than 300 pages, is occupied with remarks on the Influenza which was so prevalent in the spring of 1803. The Society issued to their correspondents a set of queries, to which they received answers from 58 medical gentlemen in different parts of Great Britain and Ireland; and these communications are all published, without alteration: forming a valuable but confused mass of information, which we regret that the Society did not take the trouble of analyzing and arranging. One of the most characteristic symptoms of the disease was debility, which eame on from the commencement of the attack, and was frequently the first circumstance that arrested the attention of the patient. It has been a subject of discussion how far the disease was con tagious; for the most part, the correspondents of the Society

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seem to consider it as not of this nature, but some very respectable practitioners adopt the contrary opinion, and support it by plausible arguments.

ART VI. A Clinical History of Diseases, Part First, being, 1. A Clinical History of the Acute Rheumatism. 2. A Clinical History of the Nodosity of the Joints. By John Haygarth, M.D. F.R.S. &c. 8vo. pp. 168. 5s. Boards. Cadell and Davies.

T is generally admitted that in no science is it more difficult to convey information by means of books, than in practical medicine. In some degree, this difficulty depends on the nature of the science, but a part of it must certainly be attributed to the mode which has been usually pursued by those who have attempted to instruct mankind on this subject. Most of the older authors, and many of the moderns, whose works are in the highest estimation, have been writers of systems; they have undertaken to treat of the whole circle of diseases on a regular plan; and this plan has always involved an hypothesis, which has perverted their description of the phænomena of disease, and influenced their method of cure. Another mode has, of late years, been more in fashion; viz. that of publishing single cases. At first view, this might be considered as much less exceptionable; it professes to be the simple relation of facts, and, as such, must necessarily have its due weight in the formation of opinion and the advancement of knowlege but, unfortunately, the publication of cases has not been productive of all the advantage that might be expected from it. This failure is owing to several circumstances; perhaps the most important of which, and the only one that we shall now specify, is the fondness which every one naturally possesses for presenting something extraordinary to the world. In consequence of such a feeling, practitioners are induced not to give an account of their experience in diseases that are of frequent occurrence, or of great fatality, but of such as are uncommon; and to the same cause we may attribute an irresistible propensity, even among men of veracity, of magnifying the importance of these rare occurrences, and of placing every thing in that point of view which may excite surprise rather than impart information. The work now before us is executed on a plan in which the advantages of both the former modes are in a considerable degree combined, while their disadvantages are equally avoided. We have in it the benefit which is to be derived from generalization, united to the minuteness which is found in the relation of single cases.

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Dr. Haygarth informs us in his preface, that since the year 1767, he has constantly recorded, in the patient's chamber, a full and accurate account of every important symptom, the remedies which were employed, and, when an opportunity offered, the effects which they produced.' After an extensive range of practice, for nearly 40 years, he has resolved to lay the result of his observations before the public; and the method which he has adopted is to analyze all his records concerning each particular disease, and to deduce from them a series of facts respecting it. Perhaps no medical writer ever proceeded on a basis of observation at once so accurate and so extensive. The present volume contains the account of two diseases, acute rheumatism, and the nodosity of the joints; and we shall briefly notice some of the positions which Dr. H. has established on these subjects.

Out of 10,549 cases, in the higher and middle ranks of society, of which Dr. Haygarth has kept records, 470 are rheumatism, and of these 170 were attended with fever, exhibiting that form of the disease which is called acute. The common cause of the complaint appears to be cold, particularly when conjoined with moisture; more males are attacked than females, probably because they are more exposed to the exciting cause; and for the same reason, it is more frequent in winter and spring, than in summer and autumn. All ages, from 5 to above 60, are subject to it: but it occurs more generally between 15 and 20. The latent period, i. e. the period between the application of the cause and the appearance of the symptoms, is shorter than is commonly imagined, and sometimes there was no perceptible interval. Dr. Haygarth has not been able to perceive that any other disease precedes the acute rheumatism, or is united with it, so constantly as to imply any connection between them. The pulse is commonly above 100, and the blood when drawn exhibits a strong inflammatory

crust.

With respect to the method of cure, the strict antiphlogistic plan is the one which is commonly adopted: but, as the author observes, although the disease is seldom or never fatal, it is under this treatment exceedingly protracted, and sometimes. scarcely ever entirely removed. In an early period of Dr. Haygarth's professional life, he received from the late Dr. Fothergill the idea of employing bark as a remedy in acute rheumatism; and on trial he found it so beneficial that he has ever since employed it, with the greatest success. The manner in which he administers the bark we shall state in his own words:

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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 2, 3, or 4 hours; and if this quantity has a salutary effect, it was gradually increased to gr. xx, xxx. or xl. with sedulous attention never to add more than what perfectly agrees. It has generally been taken in milk, mint water, or the decoction of Bark.'

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He concludes by remarking;

Except Mercury in the Syphilis, 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 Rheumatick than any other Fever: and that it does not even cure an ague so certainly and so quickly.'

Twelve of the cases which are classed under the head of rheumatism having proved fatal, the particulars of them are related at full length; partly for the purpose of shewing that the bark was not in any way accessory to the event, and likewise that death was to be attributed to some other disease,

superadded to the rheumatic affection. We have next a set of tables, in which all the phænomena of the 170 cases are accurately classed in parallel columns; so that we are able immediately to trace the history of each case by carrying the eye in one direction, or to compare the different cases with each other by moving down any one column. We highly approve this arrangement; and we cannot but regret that the author intends to discontinue it in his subsequent publications.

The nodosity of the joints, the account of which is included in the remainder of the volume, has generally been confounded with rheumatism, though, as it appears, it is clearly distinguishable from it. Thirty-four cases of it have fallen under Dr. Haygarth's observation; they were almost all fem les; the affection supervened about the middle period of life; and the fingers were the parts commonly affected. The seat of the disease is in the ends of the bones, and the periosteum, capsules, or ligaments of the joints; these parts gradually increase, so that the joints become distorted and useless; and sometimes they even appear to be dislocated. This complaint differs from gout, in the circumstances that the latter disease is attended with inflammation and redness of the skin and of the soft parts, and comes on in paroxysms; and it differs from rheumatism in the nature of the swellings, which are harder, more durable, and less painful. The best remedies for the nodosities of the joints appear to be the warm bath, a stream of warm water, and leeches applied to the affected part. We doubt not that these remarks of Dr. Haygarth will excite the attention of prac

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titioners

titioners to this distressing and hitherto neglected complaint; which, we apprehend, will be found a more frequent occur rence than it is generally supposed.

ART. VII. The Stranger in Ireland; or a Tour in the Southern and Western Parts of that Country in the Year 1805. By John Carr, Esq., Author of a Northern Summer, or Travels round the Baltic, the Stranger in France +, &c. 4to. PP. 530. and 17 Plates. 21. 53. Boards. R. Phillips.

CERT

ERTAIN tourists may be considered as literary haberdashers, or dealers in small wares; and in serving their customers, they have often the pert flippancy of haberdashers' shopmen or apprentices. They collect shreds and remnants of knowlege, which they puff off with a smirk or a smile of the most perfect complacency; and if they obtain encouragement, they will try to sport a commodity which they mistake for wit. What could have tempted Sir John Carrt to enlist into this class of book. making ramblers? Did he conceive that any tissue would serve for a tour in Ireland, and that from him any thing would be acceptable? Sterne was vain enough to suppose that his readers would tolerate whatever flowed from his pen; and perhaps Sir John was of opinion that, if he tried sometimes to be pompous and at other times to be facetious, he should ingratiate himself with the multitude and even impose on the critic. He has artfully managed to flatter the Irish, by taking every opportunity of detecting bulls which are not Irish for the sake of shewing that the manufactory of them does not belong exlusively to the sons of Hibernia; and he marks also the striking phraseology of the low Irish, which indeed is not exceeding the province of a Stranger in Ireland: but we cannot tolerate his stale Joes, and his incessant à propos de botte. He contrives, when anecdotes fail him, to advert to some trivial circumstance which happily reminds him of something that was said or done in another place, and that was worth relating; and, as a good thing cannot be told too often, he obligingly communicates it to his reader. To expand his narrative, also, he collects hear-say tales, right hand and left, without perplexing himself with the consideration of their probability or improbability.

See M. Rev. Vol. xlviii. N. S. p. 133.

+ ibid. Vol. xli. p. 393.

The contents of this volume seem to have been so gratifying to the Irish nation, and to the Vice-Roy, that the latter has been induced to bestow the honour of knighthood on its author.

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