blood, venæsection is asserted to be prejudicial. Dr. Wilson appears to have had some transient notion of these inconsistencies, and his own statement in consequence betrays some indecision. He observes with respect to bleeding, "in acute rheumatism it is seldom adviseable to push general evacuations till the local symptoms are relieved in this disease the danger proceeds not so much from the local as from the general symptoms." p. 289. If the danger alluded to be that of a fatal termination, we apprehend that in pure rheumatism no such danger exists. If it be the danger of a long, severe, and deplorable disease, not less painful than the original complaint, and wearing out the strength of the patient, we apprehend it will proceed from the local symptoms, which Dr. Wilson seems to be aware that bleeding has little power to relieve. Nay he observes that "profuse evacuations, besides sometimes inducing other diseases of debility, frequently change the acute into an obstinate chronic rheumatism, which may continue to torment the patient for many years." Yet he adds, "It must not however be supposed from what is here said, that these means are rarely to be employed in acute rheumatism; the general excitement for the first days of the complaint is often such as warrants even repeated blood-letting." p. 290. And again, "It is not to be overlooked that, from the presence of the local affection, a less degree of excitement warrants blood-letting than in synocha." p. 291. This again is immediately followed by an observation, that Sydenham acknowledged that his later experience taught him a more sparing use of the lancet, than he had formerly employed; and that Dr. Cullen himself confessed that this treatment is attended with many inconveniences. And after all, these remedies cannot be said to have cured the disease, since, according to Dr. Wilson, "the disease is usually protracted for a considerable length of time." "The acute rheumatism," he observes, "may be said almost always to terminate in the chronic, as the pains generally remain for a considerable time after the fever." p. 282. We know that this is true, where this Sangrado treatment has been pursued; and in that liberal and enlightened school from which Dr. Wilson, as well as ourselves, derived the elements of his knowledge, and in which this practice is still pertinaciously continued, we re

member to have seen many miserable victims, whose pains and emaciation bore sufficient testimony of the truth of this remark. Yet still the same changes are rung upon inflammation, buff, and bleeding, and the danger of opium; and patients continue to groan and linger in misery, worn down by a long-protracted disease. These circumstances are, in our opinion, sufficient to have warranted some deviation from the practice recommended by those, who consider rheuma tism as a pure phlegmasia: and the experiment has been made by many intelligent practitioners with great success. We believe too that those who have dis carded blood-letting, and those more particularly who have freely employed opium, in conjunction with diluents and gentle laxatives, will not complain, or rather will deny the assertion, that rheumatism is generally a tedious and long. protracted disease, or that it commonly terminates in the chronic form, the pains remaining long after the abatement of the fever. We are disposed to think that even neglect in the commencement of the disease is less detrimental to the patient, than considerable evacuations of blood. In these observations we speak from experience, which has been confirmed by that of other practitioners. It is not enough to say, that the excitement demands evacuation, that opium is prejudicial in phlegmasiæ, or that the evidence of Sydenham, &c. is against its use. The general excitement in rheuma. tism is never fatal; the local symptoms do not, as in phlegmasiæ, tend to produce death; and they remain indepen dent of that general excitement, which Dr. Wilson informs us we are to combat; and lastly the evidence of other practi tioners of distinguished talents is in favour of opium in this disease; it may be suffi cient to mention the name of Heberden. Dr. Wilson's observation is undoubtedly not to be overlooked, that its operation must be at the same time directed to the skin; and for this purpose copious tepid drink is sufficient. Its tendency to produce constipation should also be obviated by frequent gentle laxatives.

We have enlarged upon this topic, from a conviction, of what indeed Dr. Wilson's account, like others of the same description, bears internal evidence, not only the insufficiency, but the disadvan tages of this evacuating system in rheu matism; and because we have frequently had the satisfaction to witness the efficacy

of the treatment which we have described. This must be our apology for the freedom of our remarks.

On the subject of gout, Dr. Wilson has given us a long and very excellent dissertation. The great argument against the exhibition of opium in this disease, we believe, with the author, is "its favouring by the debility it induces in the organs of digestion, the appearance of atonic gout.' A tendency, he adds, which Dr. Cullen seems to have overlooked, when he pronounces its exhibition safest in the aged and those who have been long subject to the gout. With respect to local remedies, we shall recommend a passage to the attention of Dr. Kinglake, and the advocates for cold water. "Upon the whole, it may be observed, it will require a very long experience to establish the safety of any remedy of this kind, for even the most pernicious have been repeatedly employed before their bad effects appeared." p. 372.

The author has added little on the subject of hæmorrhagies to what is to be found in Cullen. His section relative to phthisis pulmonalis merits the general commendation which is justly due to the greater part of this volume. We were, however, rather surprised to find Dr. Wilson, in the present state of our know. ledge, adducing arguments to prove that hectic fever is never distinctly form ed without the presence of pus in some part of the body. We greatly approve of his cautions against the indiscrimi nate use of blood-letting in this disease. "It has been the practice of many to let blood in this complaint on very slight occasions. Some have not scrupled to recommend it two, or three, or more times in a week, and to persevere in its use while there are any remains of the buffy coat in the blood; another instance in which an attention to this appearance,

without considering the other circumstances of the case, has led to erroneous practice. The danger of recommending the most debilitating of all remedies, where debilityis the most urgent symptom, is too apparent to require any comment." p. 529. We have too much reason indeed to fear, that many cases of remediable pulmonic complaints have been converted into phthisis, by the practice just alluded to.

The appendix contains an account of some experiments made with a view to determine the manner in which opium and tobacco act on the living body, and some observations on the doctrine of the sympathy of the nerves. The former are conducted with considerable cruelty. and afford us little knowledge. In reasoning on the latter subject, the author concludes, "that the immediate cause of sensations exists in the sensorium commune; and that they are referred to the parts, on which the impressions causing them are made, by experience alone." He consequently infers, that the phenomena which are attributed to a sympathy of the nerves, proceed from certain changes in the sensorium commune, and the sensations are thence referred each to its corresponding part of the body. If there be any difference between this notion, and the opinion commonly adopted by physiologists, we apprehend it is chiefly verbal. These essays, we are informed, were published several years ago.

We have seldom had occasion to peruse a volume so replete with typogra phical errors; many of them betraying not only great carelessness, but great ignorance on the part of the person employed to superintend, we cannot say to correct, the press. The author's long list of errata might be easily quadru pled.

DR. Pearson recommends, in the first place, that the performance of quarantine be strictly enforced; and if we were assured that the regulations in this respect would in no instance be infringed, they would afford, he believes, a sufficient security. But as this is hardly

be expected, he farther recommends

that committees of health be established in all the principal sea-ports of the kingdom, which, by their vigilance, might be able to extinguish the first spark of contagion, ere it burst forth into a destructive flame. He proposes also that there should be a central committee, or general board of health, in t

polis, maintaining a constant commu. nication with the provincial committees. These committees should hire receiving houses for the sick and suspected, in which the same measures of ventilation, fumigation, &c. should be adopted, as in the fever-wards at Manchester, &c. "With regard to the arrangements here proposed, it is readily acknowledged, (the author observes) that in principle they have been long known and approved; and that if there be any thing novel in them, it is only in their application and extent." p. 10. Government, we believe, has been for some time past concerting measures for the establishment of committees of health on a plan similar to the one here recommended.

It may be remarked, that perhaps an unnecessary stress is laid upon the degree of separation requisite for the receiving houses, which might prevent the adop tion of this plan where an insulated building could not conveniently be procured. From the experiment of fever wards, we have learnt that contagion is not communicated through the air, beyond the distance of a few feet from the body of the sick; and that it has not only never spread to adjoining houses in the same street, as at Manchester, and in Gray's Inn Lane, London, but has been easily confined to individual wards in the same hospital, and to individual rooms in the same house, as in several schools and workhouses.

HOWEVER we may deprecate the principles which induced the French to undertake their expedition against Egypt, we must do justice to the ability which has been displayed by them in investigating the nature of the formidable diseases which infest that country. M. Assalini has been one of the foremost in this arduous career, and we have in the present publication the result of the observations which he made during his residence in Egypt and Syria.

The work commences with some remarks upon the disease which has received the denomination of plague, "the chief symptoms of which are fever, buboes, partial gangrenes, or carbuncles, prostration of strength, head-ach and delirium, and which generally carries off the patient on the 3d or 5th day." This disease appears every year, about the month of September, along the coast of the Mediterranean and Archipelago, from Alexandria to Constantinople; it rages with more or less violence during the winter and spring months, and uniformly ceases in June. Both by the natives and the different Europeans, whose commercial concerns have induced them to settle in that country, it has always been considered as highly contagious, and almost the only methods employed to counteract its progress, are such as depend upon

avoiding all intercourse with the infect ed, and in using the most assiduous precautions against touching those substan ces which can be suspected of harbouring the seeds of the contagion. This circumstance, which has hitherto been considered as one of the most distinguishing characteristics of the disease, has been called in question by the French physicians, for reasons, which if not convincing, are at least plausible. M. Assalini discusses this point at some length in the commencement of his work.

"I have seen a great number of persons (says our author) who have been attacked by the epidemic, after having had communication with others, who were already sick; and I it was to the contagion they ought to attri would have adopted the conclusion, that bute their disease, if I had not also seen a much greater number who continued to enjoy good health, in spite of the most decided communication. I have even seen several individuals contract the disease, and die, although they had been living shut up, according to the manner of the Franks. I should have thought it right to conclude, that the disease of which we are now speaking was contagious, had I seen the Egyp well as our soldiers, with whom they had con tians and Syrians fall under its influence as stant intercourse. As soon as any one of our men was attacked, two Turks led or carried

him to the hospital. There is no doubt that

several of them shared the cloaths of infected persons, without contracting the disease. If it had been contagious, as is pretended, it would not have been possible to have arrested its progress in Lower Egypt, nor to have hindered its spreading to Cairo."

With respect to the question of the contagious nature of the plague, a question in every respect of the highest importance, we may remark, that the facts and arguments brought forward by Assalini, however curious and interest

"After the death of several medical officers at Jaffa, General Grézieu, commanding this province, recommended to the commissary of war, a native, who had the reputation of being an excellent physician for the plague: it was agreed that he should prescribe under the inspection of a French surgeon. This man opened the buboes indiscriminately, his knowledge in medicine not being exten sive. For several years he had attended such inhabitants of Jaffa as were attacked by the plague, and he used no precaution whatever to preserve himself from this complaint, nor to avoid contact. I have seen him get up with his bare feet on the bed of General Grézieu, covered with sweat, and take him

by the arms to change his posture, although he was then attacked with a carbuncle, of which he died an hour afterwards. When he had opened the buboes with his bistoury, he took a bit of lint, or a little charpee, to wipe it, after which he placed it between his forehead and his turban: he went in this way from one patient to another, not only in the hospital, but even throughout the city, and did not put it back into his case, until his visits were over."

The courage, or temerity, of Desgenettes, who inoculated himself with matter taken from a pestilential buboe, without producing any injurious effect, has already been made known through the medium of his own interesting pub. lication. The author, however, makes a concession which may be thought almost inconsistent with his former opinion, when he admits that

"One may contract, in my opinion, this disease, when the causes which produce it shall by degrees have impaired the health, and predisposed the body to take on diseased action: I will then admit, that if a person be exposed to breathe the infected air in the chamber of a patient, or should he stay too long in the same atmosphere, he will run a great risk of contracting the prevailing malady. I have been careful never to stay longer by the sick than the time requisite to perform the necessary operations; after which I always went out to respire a better air. In this way I have been preserved from a disease which, in forty days, carried off one third of the garrison of Jaffa, including the commandant of the province, the governor of the place, and nine medical officers."

They indeed prove that an individual, apparently liable to receive the disease, is not always infected, even when placed in circumstances seemingly the most favorable for its reception, while, on the other hand, persons are frequently seized with the complaint in its most fatal form, where no obvious source of contagion could be discovered. This general statement of the case is, we apprehend, not materially different from the acknowledged fact respecting the common typhus of this country, of the contagious nature of which, no doubt has been entertained. The controversy will therefore be resolved into a question of fact, which can only be decided by a sufficient number of observations, made under the most favorable circumstances. The belief of the contagious nature of the pla gue is built upon the concurrent testimony of all mankind, and we ought at least to hesitate, before we permit our judgment, on a point of great practical importance, to be influenced by the report of individuals, however able and candid.

But if we admit, as Assalini himself appears to do, that the breath of a person infected is capable of communicating the disease, we are conceding a very important point in favor of its contagious nature. It is by the ef fluvium from a diseased body, communicating to the air the power of produc ing a similar disease, when received into the lungs, that contagious febrile diseases are, in most cases, supposed to be propagated. The grand difference between the two opinions will be, that in one case it is imagined that the infectious effluvium, emitted from the body of the sick, can attach itself to various substances, which will themselves have the power of infecting other living bodies; whereas M. Assalini conceives that the disease can only be communicated immediately, from one human being to another. The opinion of Assalini also differs very materially from that generally adopted, with respect to the origin of the disease; it is commonly supposed to be produced only from previous contagion, either existing in a living body