MILAN.

This city, which is called the Paris of Italy, contains about 130,000 inhabitants. Intermittent fevers prevail here, together with pulmonic inflammations, and phthisis. Scrofula and the pellagra are common at Milan and in the plains of Lombardy. The method of Grannini, which consists in the affusion of cold water on the body, after the hot stage has become developed, is going out of use. We wonder how it ever could have come into practice. The physicians of Milan are divided into three sects-the eclectics, the contro-stimulists, and the followers of Broussais. In the first class are the medical officers of hospitals-in the second, the pupils and the partisans of Rassori. This last professor had been a most zealous Brunonian, and had translated Brown's Elements into Italian with notes; but shocked and grieved by the havoc which this doctrine had caused in the epidemic fever of Genoa, he abandoned Brunonianism, and erected on its ruins the celebrated controstimulism of the present day. Rassori now gives large doses of sulphate of quinine, generous wines, and opium in feversand swears they are excellent contro-stimulants!

He believes in the existence of idiopathic fevers-and considers the local inflammations which we find, after death, as the effects rather than the causes of the fever. He bleeds where much excitement appears in the beginning. In pulmonic and other visceral inflammations he depends chiefly on large doses of emetic tartar, with drastic purgatives. The general opinion in Italy is, that the doctrine of Rassori will shortly undergo the fate of Brunonianism. The followers of Broussais, composing the third class, are not numerous, but they are very zealous. They have a medical journal in their service.

Dr. Valentin gives some account of that curious cutaneous disease, the PELLAGRA, endemic in Lombardy, The backs of the hands and of the feet are the principal seats of the disease. The skin becomes red, wrinkled, and at last furfuraceous, but without heat or pain. The patients are emaciated, melancholy, and hypochondriacal, in a high degree. They suffer much along the spinal column, and are extremely weak, The disease becomes complicated with insanity, maniacal delirium, or pneumonia, tabes, dysentery, edema, &c. but without any diminution of the pellagra itself. Many instances of suicide are the result of this strange malady.

This disease appears in the spring, increases in summer, and declines in the autumn. The causes are unknown, and the cure is chiefly effected by repose, milk, good diet, wine, and

warm baths. Emigration to another part of the country cures it, if early put in practice.

Dr. Strambio has minutely examined 38 bodies dead of this disease, and found organic lesions in the head, the vertebral canal, the chest-but especially in the abdomen. "He was the first to demonstrate that the cutaneous affection was merely symptomatic, and that the stomach, liver, and intestines, were the primary seats of the disease." M. Brera avers that he has found the ganglionic nerves in a morbid state in this disease, which is not improbable. We wish he had given the details of his dissections.

We must now hasten to a close: under the head of Parma, where our author gives, as usual, a description of the hospitals and all other public places, we find the following case of rupture of the uterus and gastrotomy.

Case. Angiola Grossi, aged 44 years, had borne five children, and was pregnant of the sixth. Labour came on at the proper time. She suddenly turned sick, and fainted. When she recovered, she felt extreme pain in the abdomen, with dreadful sense of distention. The abdomen swelled-the vomitings increased-the difficulty of breathing became alarming, and Professor Jos. Rossi was summoned, who soon recognized rupture of the uterus, and the escape of the fœtus into the cavity of the abdomen. Several medical men were now summoned, and Professor Cecconi undertook the operation. This was performed two hours after the rupture of the uterus. The incision was made in the left side-the fœtus seized by the feet, and extracted, together with the placenta. The wound was sewed up, and in 40 days afterwards, Grossi was able to walk about quite well. P. 331.

Three years afterwards this woman again became pregnant, and was delivered without accident.

At length Dr. Valentin turns his face homewards, and makes various excursions among the Alps. He visited Chamouni, the Montanvert, Mere de Glace, &c. His health was now greatly improved, and he had lost many troublesome symptoms, especially palpitations of the heart, and vertigo. "Ma santé s'est trouvé meilleure ; des palpitations et des vertiges, qui compliquaient mes anciennes infirmités, ont desparu.' Dr. V. cannot be very young, since he informs us that 36 years ago a medal was given him by the Royal Academy of Surgery, for an Essay on Goitre and Cretinism. He means to publish again on the same subjects.

* See Dr. Johnson's remarks on the effects of travelling among the Alps on the functions of the heart and of various organs, at pages 121-7 of his Essay on MORBID SENSIBILITY of the Stomach and Bowels,

We cannot help reiterating our opinion that, on such a journey as this, Dr. V. might have made a much greater number of original observations than he has done. The work may be useful, as a “compagnion de voyage," for the medical traveller; but is worth little to those who must travel by the fireside through the medium of others. We have given the whole of the purely medical information in a single sheet of our Journal.

V.

An Inquiry concerning that Disturbed State of the Vital Functions usually denominated Constitutional Irritation. BY BENJAMIN TRAVERS, F.R.S. &c. 8vo. 1826. (3d and last article.)

In the two preceding articles on Mr. Travers's work, there has been little else attempted than an exhibition of practical illustrations, or examples of local and constitutional irritation, without entering into the theory or nature of the subject. This was the course pursued by our author, and we were obliged to follow him in his arrangement, which is the reverse of that usually adopted by writers, who generally state their theories first, and their illustrations afterwards. We do not say that the arrangement of Mr. Travers is inferior to the other-on the contrary, the presentation of those facts, on which a theory is based, prepares the mind for the theory itself, and probably predisposes to an assent which might be withheld if the doctrine were abruptly revealed, without the precession of facts and examples.

In the fifth chapter, then, of the work, Mr. Travers commences his investigation of the theory. of irritation, by some observations on the "reciprocal relation of the vital functions." Our author, while he exhibits a decent respect for the experimental investigations of modern physiologists, appears to place little confidence in the conclusions to which they have led. Thus he observes that, although the experiments of Dr. Philip go far towards the presumption of identity between the neryous and electric fluids, yet, "the knowledge of an instrument which serves as a conductor of nervous power, makes feeble approximation to a solution of the problem of life and living actions." And, again—although it appears that some nerves

are destined to be conductors of sensation, and others for motion, yet, "to what a monstrous solecism in pathology, says he, "would the doctrine lead, that the heart is independent of the brain, because its action continues for a period after the brain and spine are removed-or that the muscular action is a distinct and inherent property of that texture, independent of the nervous, which is only one of its stimuli!" Taking the word independence in its common acceptation, as applied to two nations or two individuals, it is perfectly ridiculous, when pressed into the service of physiology, and was a very unhappy expression to select. The heart is no more independent of the brain, than the brain is of the heart. The function of one cannot exist without the other. All the vital viscera, in short, mutually assist and derive support from each other, and the destruction of one must inevitably prove the destruction of the others. But, notwithstanding this mutual dependence on one another, there is still a kind of independence attached to each. The heart has its function to perform, and has its peculiar nerves -so has the stomach, and so on. In perfect health and tranquillity, therefore, these organs appear to carry on their duty with little interference from others. But let the function of one be disturbed, and almost instantly the functions of all the others are influenced in one way or other. Let the heart cease, as in syncope, and see what will become of the sensorial functions let the cerebral functions cease, and see how long respiration, digestion, and circulation will go on. While we agree with Mr. Travers that "facts of every day's occurrence speak a language far more explicit than that which is extorted by artificial and unavoidably imperfect contrivances;" and that "no result has yet appeared to invalidate the fundamental truth that the brain in totality holds in dependence, immediate or intermediate, all the phenomena of life," we are still of opinion that the ganglionic system of nerves holds as absolute dominion over the viscera to which they go, as the brain does over the voluntary muscles. There is, it is true, an intimate connexion established between the two systems, by means of the great sympathetic, the par vagum, the phrenic, &c. so that the one system has the constant means of powerfully influencing the other, without, however, destroying that comparative or qualified-independence of which we have spoken. It seems, indeed, a wise provision of Nature that the vital viscera and their functions should have a degree of independence of the brain, and vice versa. When morbific agents, however, are applied to either system-sensorial or ganglionic-we find this degree of independence not a whit too great. In short, we would not,

perhaps, be far wrong, if we were to assert that one half of the morbid phenomena, presented by the sensorial system, results from the influence of the ganglionic viscera-and that one half of the disorders of these last organs is produced by mental, or in other words, sensorial agency. While physiologists, therefore, go on disputing about the independence of these or those organs and functions, the physician can see nothing of such independence; but, on the contrary, the perpetual sympathetic operation of one organ and function on another, throughout the whole chain. This, indeed, is the conclusion to which Mr. Travers, and every practical man comes at last.

“There has been much fallacy, as it appears to me, in Bichat's and other estimates of the comparative influences of the vital functions upon each other; but admitting their general accuracy, to what inference do they lead? Not to that of the independence of either, but the contrary, viz. the inseparable connexion and dependence of each upon the other. In fine, the alliance between the nervous and vascular systems is such as renders it impossible for either to be affected in any serious degree, exclusively." 429.

If the nervous energy be essential to the muscular action of the heart, so is the perpetual current of blood to the functions of the brain. It is, therefore, idle to argue about primordial priority in these two functions. "It may be that one is specifically constituted to receive and transmit impressions, both from within and from without, thus establishing the relation of all parts of the system with each other, and of the whole with the material world; and this being unequivocally the case with the nervous system, it must be regarded as that which presides over the vital functions, and through the medium of which they are prompted, regulated, and harmonized." The following appears to be a kind of definition of irritability and irritation, to which we see no objection.

"The irritability of a part conveys to my mind the idea of a sensitive impression and a consequent action. Such impression and action may be strictly local, i. e. not reported to the common sensorium, and under ordinary circumstances, this is the case as regards the involuntary muscular system. The exaltation of this impression under extraor dinary circumstances, and its propagation to the brain constituting a sensation, occasions an interference, greater or less, with the habitual actions of parts not subject to the will. Thus extraordinary sensations disturb the habitual action of the heart, liver, bowels, and other viscera. I can see no inconsistency in this explanation of the habitual excitement of the involuntary actions by local and unconscious impressions, with the theory of the universal instrumentality of the nervous system, and it accords with the separableness, to a certain extent and no more,