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North American Medical and Surgical Journal, Vol. 2, No. 3, July, 1826
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In anasarca, an error is sometimes committed, especially by young practitioners, of estimating the degree of danger, and the necessity for active treatment, by the single consideration of the extent of the oedematous swelling. This, however, should be guarded against, as the swelling may be very considerable, and the disease subsided, or of little consequence; whilst, in other instances, the reverse may be the case. In the first instance, where the disease is not seen early, the treatment must sometimes be limited to those means which promote the absorption of the water, and neither venesection nor leeches will be required. In such cases, the practitioner must be guided by the state of the pulse and urine; the presence or absence of vascular excitement; the history given of the case up to the period when visited, and particularly by the progress of the swelling.

"When the dropsy of the skin is considerable and long protracted, and symptomatic of some visceral disease, as it most commonly is in these cases, and is attended by a serous state of the urine, and a general failure of the strength, the cachetical state of the system may be considered as established, and the treatment is then beset with difficulties. For the general means, which are useful in the earlier states of the disease, and when the vital strength is entire, become injurious in this, by the tendency they have, aided by the effects of the visceral disease, to diminish farther the vigour of the system; whilst, at the same time, the treatment, which is suited to support the declining strength, can contribute nothing towards lessening the constitutional and local diseases, but will frequently increase the morbidly excited state of the circulation, which, analogous to what occurs in diabetes, will continue and increase under the most decided marks of general constitutional weakness. Pending the continuance of that inflammatory state of the system, in which the urine is charged with serum, the debility will be mainly derived from that drain of its nutrient parts, which is thus established in the body, assisted by the weakening effects of the organic disease. If blood be drawn, it will be found, in many of these cases, to exhibit the usual signs of inflammation; and the treatment of the tonic kind, when employed to support the strength, will be found to act unfavourably.

"The plan to be pursued must consist in the use of such means as shall assist the powers of digestion and assimilation; so that, by a highly nourishing but plain diet, the drain from the system may be somewhat counteracted; and, at the same time, the cause of the effusion is to be corrected by the use of local depletion and blistering, and by the temperate employment of those general means, which are useful in the less aggravated forms of the disease."

The diet of patients, in the symptomatic forms of dropsy, should be plain and unirritating; and in the idiopathic states, the antiphlogistic regimen should be rigidly enforced; particularly an abstinence from all fermented liquors, until the inflammatory period of the disease be removed. The clothing should be moderately warm, and selected of that kind, best suited to promote the insensible perspiration of the surface.

Before taking leave of Dr. AYRE, we cannot omit adverting, in a very few words, to a circumstance noticed in his preface, and which we think of some importance. He remarks, that if, in the prosecution of his task, he has had no acknowledgments to make to any individual as his guide and authority, he is nevertheless indebted for many important facts to the writings of the late Dr. WELLS, and of Drs. BLACKALL, ABERCROMBIE, and DUNCAN, jun. and particularly to the system of pathology of Dr. PARRY. He further remarks, that he entertained and taught for many years, the views advocated in this work, and that, after the manuscript had been sent to press, he had seen a copy of an abridged edition of the elaborate Dictionnaire des Sciences Medicales, in which the doctrine of dropsy, maintained in the larger work, is relinquished; whilst others are given in their place, conformable, in the main, with those which it is the object of his treatise to establish. Now it would appear, from these expressions, that Dr. AYRE wishes to inculcate the idea, that the English writers, whom he has cited, were the only ones who had published anything valuable, and conformable to his doctrine; and that prior to 1823, the year of the publication of the Dictionary above mentioned, the French entertained very different views of the pathology of the disease. We think it our duty, however, to rectify our author in this respect, and to show to our readers, that, even allowing full credit to Drs. WELLS, BLACKALL, ABERCROMBIE, &c. for their researches into the nature and treatment of dropsy, the American, French, and Italian pathologists are entitled to a much larger share than is allowed to them in the present work. A few references will be sufficient. Many years ago, our celebrated RUSH taught, that general dropsies "depend on a certain morbid excitement of the arteries;" and that hydrocephalus, "in its first stage, is the effect of causes, which produce a less degree of that morbid action in the brain which constitutes phrenitis." In 1812, Dr. BRESCHET, of Paris, published an excellent dissertation on active dropsies. In the early writings of BROUSSAIS, though more particularly in the propositions prefixed to his Examen, the opinion is maintained, that all active dropsies depend on irritability, either primary or secondary, of the serous and cellular tissues,—a theory more closely allied to Dr. A.'s, than all that is contained in the writings of Drs. WELLS, PARRY, &c. But what, perhaps, is more to our purpose, Dr. GEROMINI, of Cremona, published a work, in 1816, on the origin and cure of dropsy, in which he compares the dropsical accumulation to that of serum produced by the inflammation of a blister, or by fire; and in which he also maintains, that a slight inflammation occasions a flow of limpid serous fluid, whilst a higher degree gives rise to the formation of pus. From these circumstances, he concludes, that the hydropic fluid, which contains little albumen, is the product of a lower grade of inflammation. In the same work, he finally asserts, that in more than 200 individuals who had died of dropsy, he invariably found marks of inflammation or its effects; views which our readers will readily discover to be nearly allied to those supported by Dr. A. In making these remarks, however, we do not wish to be understood as asserting, that the theory advanced by our author did not originate also with him. We have too favourable an opinion of his honesty, to accuse him of plagiarism. Our sole intention has been to render unto each the degree of praise to which he is entitled, and, by pointing out this coincidence of opinion, to derive a further proof of the correctness of most of the pathological views, so ably defended in the present work.



ARTICLE VIII.—An Essay on Venereal Diseases, and the Uses and Abuses of Mercury in their Treatment. By RICHARD CARMICHAEL, M.R.I.A. With Practical Notes, &c. by G. EMERSON, M. D. Philadelphia, J. Harding, 1825; pp. 360.

One of the most important improvements in practice, which modern experience has established, is the reformed method of treating venereal diseases.

To the labours of several distinguished military physicians and surgeons of Great Britain, we are chiefly indebted for the facts and researches connected with this interesting subject. And although we may have much to learn in regard to the true nature of these complaints; yet the plan adopted by Mr. CARMICHAEL, of determining their distinct pathological characteristics, and applying the remedies accordingly, is the only one likely to subvert the empirical routine of prescribing mercury on all occasions, a practice which derives such strong support both from the indolence and prejudices of the profession.

In this country, many eminent practitioners have contributed to restrain the abuse of mercury; and it is believed, that Professor CHAPMAN has for many years, in his lectures, disseminated the most enlightened doctrines on this point. Dr. HARRIS and other surgeons of the navy have made a fair trial of the non-mercurial treatment, and with the most satisfactory results.

The great object, so desirable of attainment, is to form a correct discrimination between the diseases, which may be cured or benefited by the exhibition of mercury, and those which do not require this medicine, or become aggravated by its use; for it seldom fails to do injury, when its advantages are not very obvious.

Mr. CARMICHAEL has taken the most conspicuous part in this investigation for the last fifteen years, and from the extensive theatre, in which his inquiries were conducted, has had the best opportunities of arriving at the truth. He, therefore, who undertakes the management of these affections, may be justly pronounced culpable, if he neglect to make himself acquainted with the experience of this eminent surgeon.

In this enlarged and improved edition of his work, several subjects have not been treated of so copiously by the author, as was requisite to render it acceptable as a book of reference; but the judicious notes of Dr. EMERSON, whose attention has been profitably directed to the investigation of venereal diseases, have well supplied the deficiency.

A brief outline is here presented of the contents.

The author describes the various symptoms in plain and intelligible terms; rejecting such unmeaning appellations as syphiloidal, pseudo-syphilis, &c. as designating no particular phenomena, and therefore of no use in describing a disease.

He thinks there is a plurality of venereal poisons, and has divided the disease into four classes, from their different primary and secondary symptoms; making the eruptions on the skin the most certain criterion of distinguishing them from each other. These classes are:—the papular venereal disease; the pustular; The phagedenic; and the scaly venereal disease. The latter is the true syphilis.

First, the Papular. This is the most common disease, and the most easily cured. Its primary symptoms are, a simple ulcer without induration, without elevated edges, and without phagedena. Sometimes there is a patchy excoriation of the glans penis, attended with a purulent discharge. This disease and gonorrhoea are caused by the same poison. The constitutional symptoms are:—fever; pain in the head, shoulders, and larger joints, pain in the chest; dyspnoea; a papular eruption on the forehead, chest, and back, sometimes extending in a more scattered way over the extremities. It is often attended with iritis. It never gives rise to nodes. The sore throat is different from that of syphilis; the latter having deep excavated ulcers. If buboes accompany it, they are mostly of an indolent nature. The eruptions do not all appear at once; but follow each other. When on the decline, they are of a pale red or copper colour, not scaly, as in syphilis, but papular; disappearing and recurring repeatedly, and ending in desquamation.

Remedies.—Venesection; cathartics; antiphlogistic regimen; antimonials, combined with decoction of sarsaparilla. Alterative does of calomel and antimonials, when the eruption declines.

The local treatment consists in astringent washes and simple dressings.

Iritis is to be cured by venesection, cathartics, mercury, blisters, and belladonna.

This disease will yield to the powers of the constitution. Mercury is always injurious in the early stage.

Second, Pustular venereal disease.

Primary ulcer of a reddish-brown colour; borders closely on the phagedenic character. The edges raised and well defined; not excavated, but on a level with or above the surrounding skin. In the commencement, a small itchy pustula; distinguished from the ulcer attending the papular disease by its well defined and elevated edges, and by the absence of the smooth fungous surface of the former; from the phagedenic by its well defined margin and its corroded-like surface, and the absence of acute pain; and from chancre by the absence of the callous edges and base. These ulcers are of a chronic nature, showing little disposition to spread. The ulcers from buboes partake of the same character, the edges being hard and the ulcer disposed to burrow. These edges Mr. C. removes with the knife. The disease is rendered extremely obstinate, where full courses of mercury have been given. The more closely the eruption approaches the papular, the more mild and manageable will be the disease.

Constitutional symptoms.—The eruption is pustular, and often exhibits simultaneously new pustules; also scabbing ulcers, the crusts of which fall off, and leave discoloured patches of skin after healing. For these ulcers of the skin, the best remedies are, sulphur fumigations, nitro-muriatic acid baths, and ointment of tar and sulphur.

Remedies.—Rest; gentle astringents; mild ointments; antimonials and sarsaparilla:—for the constitutional symptoms; venesection; cathartics; antimonials; sarsaparilla.

Mercury is decidedly injurious, until the disease is on the wane, when alterative doses may accelerate the cure.

Third, Phagedenic venereal disease.

The primary ulcer has a corroded appearance. It exhibits neither granulations nor induration. It spreads sometimes rapidly, sometimes slowly; healing in one part, while ulcerating in another. It is mostly situated on the glans and prepuce, and often attended with hemorrhage. In this disease, buboes most frequently appear.

The sloughing ulcer occurs also in this disease. Mercury is extremely pernicious, always rendering the disease more inveterate and rapid in its progress.

Constitutional symptoms.—High fever precedes the eruption, but abates afterwards. Nocturnal headachs; tenderness of the scalp; slight dyspnoea; tenderness of the sternum on pressure; soreness of the chest; an eruption of tubercles, or pustules, or spots of a pustular tendency, which quickly degenerate into ulcers, with thick crusts, that heal from the centre, while they extend from the circumference, with phagedenic borders. The crusts are often of a conical figure. The ulceration of the throat is of the most formidable nature. It commences in the form of a small white aphthous sore; which usually attacks the velum or posterior part of the pharynx, mostly the latter. It extends rapidly, destroying the parts, and at last attacks the bones. It often attacks the larynx, after which, the patient seldom recovers. The affection of the bones of the nose is never joined with the papular eruption, nor with the scaly syphilitic lepra; but in every case with the pustular description, and when scales and ulcers were present. At the time of the eruption, pains in the knees, wrists, and ankles occur, attended with swelling and redness. He has never seen nodes in the disease, except in cases where mercury had been given. Full courses of mercury introduce the disease into the deep seated parts; for the bones are seldom or never affected in this disease, unless mercury has been given.

Remedies for the primary symptoms.—Absolute rest; venesection; nauseating doses of antimonials; warm poultices and fomentations; opium; hyosciamus and cicuta in sufficient doses to lessen pain and irritation. For the sloughing ulcer, stimulating applications are often useful; such as Venice turpentine or balsam copaibae, mixed with olive oil.

For the secondary symptoms:—Venesection; antimonials; sarsaparilla; Dover's powder. Mercury increases the ravages of the disease, except when on the wane, when it may be given in alterative doses, with safety and advantage. For the pain in the head, a blister to the nape of the neck. If the eruption appear scaly, then mercury is likely to be useful. If the throat and skin are affected, muriate of mercury in solution, and decoction of sarsaparilla. If the ulcer in the throat be small, touch it with the oxymel aeruginis, or solution of nitrate of silver, grs. v a x to an ounce of water; but if there exist extensive ulcerations, fumigations with red sulphuret of mercury ought to be employed.

Fourth, Scaly Venereal Disease, or Syphilis.—Primary ulcer of a circular form, excavated, without granulations, with matter adhering to the surface, and with a thickened edge and base. The hardening is very circumscribed, not diffusing itself gradually or imperceptibly into the surrounding parts, but terminating rather abruptly. Its progress is slow, sometimes assuming a tawny appearance.

Constitutional symptoms.—Sometimes the skin, at other times the throat, is first affected. There is headach, restlessness, and fever. The scaly eruption appears, but does not relieve the fever, as in the other diseases. This eruption commences with a small hard reddish protuberance; and as it advances, the sides are raised, and centre depressed or flat, and covered with thin white scales. It terminates in ulcerated blotches. This eruption appears on the forehead, breast, back of the neck, and groin; often in large copper coloured blotches, in parts near the hair. The ulcers of the throat mostly affect the tonsils, and come on without much previous pain or swelling; although there soon appears a considerable excavation of the tonsil, attended with evident loss of substance. The ulcer is foul, with thick white matter adherent to it, which cannot be washed away. The bones then become affected, those nearest the surface being most liable to attack; such as the tibia, sternum, clavicle, and cranium.

The remedies for syphilis are full courses of mercury, for both primary and secondary symptoms; except where a tendency to phthisis, or a delicate constitution forbids them. He thinks syphilis a rare disease now, compared with what it was formerly.



ARTICLE IX.—Remarks on some Means employed to destroy Taenia, and expel them from the Human Body.—By LOUIS FRANK. M. D. Privy Counsellor of her Majesty, Maria Louisa, Duchess of Parma. [Lond. Med. Rep. April 1825.]

The symptoms produced by the presence of tape worm in the human body, are exceedingly distressing, and the sufferings of the patient are increased, by the obstinacy, with which these animals resist the operation of the most disgusting, and even painful and dangerous remedies. Improvements in the mode of attacking and expelling them, therefore, should be gladly received, and widely made known.

The numerous reports which we have received, concerning oil of turpentine as a remedy for taenia solium, have already given to that remedy the highest character; but many cases have been only partially relieved by it. The ol. tereb. seems to be capable of causing the separation and expulsion of portions of the animal; but while the head remains unexpelled, it is supposed to be capable of reproducing the joints, to a degree not yet ascertained. If we may believe medical writers, the taenia has been observed of the enormous length of 700 feet. It is probable that the reproduction, after the loss of large numbers of joints, is often very rapidly effected; as was the case in a patient treated at the Carey Street Dispensary, mentioned in their report for Aug. 1813,[18] This person always discharged very considerable quantities of joints or fragments, after the use of oil of turpentine; after which he remained free from the complaint for a few months, until the taenia recovered a troublesome magnitude; when it was again easily reduced to less uncomfortable dimensions.

We are not able to state positively, how long the oil of turpentine has been in use as a remedy for taenia. The Carey Street Report for Feb. 1810, informs us, that a mechanic in Durham, having been very successful in the treatment of taenia by means of this article, the circumstance was communicated by Dr. SOUTHEY, of that place, to Dr. LAIRD of London; and it was accordingly prescribed in doses of [Symbol: ounce]ss. to [Symbol: ounce]ij. at several of the London charities. It had been found, says the report, that ol. tereb. might be thus given, as safely as so much gin, and frequently caused the expulsion in two hours: Dr. KNOX says it has been in use in Germany for fifty years for the expulsion of taenia.

The experience of Dr. KNOX, concerning taenia, at the Cape of Good Hope, is the most extraordinary that we are acquainted with. Dr. SPARMAN, the traveller, had observed, that worms were exceedingly common in the northern parts of the colony; but Dr. KNOX, who was there in 1819, did not notice any special prevalence of verminous disorders, "previous to Oct. 1819, when the tape worm became so general among the troops, as to resemble an epidemic."[19]

Most of these troops had been employed on a short campaign to the east of the great fish river. They had been compelled to live on very bad beef and mutton, driven and starved half to death; and Dr. KNOX thinks he has proved, that the taenia in these cases did "arise from the use of unwholesome animal food; from the flesh of animals, which had been diseased." Two out of five of the troops, who had been thus employed and fed, were affected with worms. Of a detachment of 86 vigorous, healthy young men, 36 were found, on inquiry, to have tape worm. Those who remained in the colony did not suffer so much, as those who had been out on the campaign, the ratio being as one to four; whereas of the others, it was two to five. Dr. KNOX had ample experience of the utility of turpentine during this singular prevalence of taenia. Concerning the 36 men above mentioned, he says, "the cure of all, who chose to adopt the means, was easily effected by small doses of the spts. of turpentine, after the failure of purgatives and various other remedies."

He considers ol. tereb. as the most efficacious remedy. He does not approve of large doses, because of headach, vertigo, and delirium, which have been produced by them in "many patients."

"I have generally found," says he, "that from one to two drachms of ol. tereb., given in a little water, morning and evening, for three successive days, were sufficient to destroy the taenia solium, (even in the most obstinate cases,) and cause it to leave the intestines, without the aid of any purgative medicine." He advises, however, to give a little castor oil each day about noon.

It has been a very common observation in regard to the dose of turpentine, that the patient suffers more cephalic distress when it is given in small quantity, than in a large dose. The writer of this has been obliged to desist from the exhibition of oil turpentine, in doses of [Symbol: dram]ij twice a day, in consequence of a vertigo so considerable, as to alarm and distress his patient very much. Perhaps there might have been in this case some peculiar liability to nervous excitation, which in another patient would not have been worthy of much notice. Dr. KNOX'S opinion is of great weight.

The celebrated remedy of CHABERT, Dr. KNOX thinks, owes its efficacy to the ol. terebinth. combined with it.

Dr. FRANK, whose name stands at the head of this article, was informed by the celebrated helminthologist, Dr. BREMSER, at Vienna, in 1814, that he had for ten years preferred the use of CHABERT'S remedy, and with invariable success.

CHABERT was a veterinary surgeon of Alfort, who used the animal oil of Dippel in many diseases of animals, as well as those of men. This oil he often gave for the purpose of removing taenia in his animals. He often combined it with spt. terebinth. and gave equal parts of these substances, in doses of [Symbol: dram]i.[20] The London Medical Repository states, that CHABERT'S remedy is prepared from

Ol. Corn. Cerv. Foetid. 1 part. Ol. Terebinth, 3 parts.

These are well mixed, and left at rest four days; they are then distilled in a sand bath, till three-fourths of the liquor has passed over. It must be kept tightly stopped, out of the light.[21]

The great objection to CHABERT'S remedy is its disgusting flavour; which is the more obnoxious, because the remedy must be continued for a length of time. Dr. FRANK cured two persons affected with taenia solium, after considerable perseverance with it: he cured two other persons with a preparation as follows:

Ol. Terebinth. [Symbol: ounce]ss Aether Sulphuric. [Symbol: dram]ij Pulv. G. Arab. [Symbol: ounce]ss Aq. Flor. Chamam. distil. [Symbol: ounce]xvj m.

Two spoonfuls morning and evening.

Four of these mixtures were sufficient to cure the patients, who remained well two years afterwards.

A fifth patient, unable to take the last named medicines, was cured by the boluses subjoined:

Sem. Santonic. pulv. [Symbol: ounce]ss Pulv. Jalap. Ferri Sulphat. aa [Symbol: dram]i Ol. Corn. Cervi, gtt. viij. Syrup. q.s. Make 20 boluses.

One to be taken morning and evening. These 20 boluses being repeated three times, the patient found himself perfectly well. In the above 5 cases, the taenia was discharged in fragments.

Dr. FRANK does not say much concerning the bark of pomegranate root, which has come into vogue lately as a remedy for taenia. He refers to the Med. Chirurg. Transact. Vol. XII. for accounts by some English physicians, and remarks, that Dr. GOMEZ, the Portuguese physician, had cured 14 cases with this bark.

Dr. POLLOCK (vide Ed. Med. and Surg. Journal, Oct. 1819) treated a child, aged 14 months, with the decoction of bark of pomegranate root, so far back as the year 1811. This infant, under the use of the medicine, discharged at several times upwards of 30 feet of taenia solium, and was cured. We learn also from the Med. Repository,[22] that MM. DESLANDES, SOURYA, and BOURGEOISE, have employed pomegranate with great success; that the decoction generally expelled the worm in two hours; that it sometimes occasioned vomiting and griping pains; and that it has been a common remedy for tape worm, in the East Indies, and among the blacks of St. Domingo.

From the same source we are informed, that the French pharmaceutists recommend, before boiling the bark, that it should be allowed to swell (macerate) in cold water. [Symbol: ounce]ij of bark should be boiled in lbij of water to [Symbol: ounce]xii. Of this decoction, [Symbol: ounce]ij may be taken every half hour. The worm is here said to be passed often in twelve hours instead of two. It may be necessary to continue this plan four or five days, taking care to suspend the medicine, in case any vertigo, or intestinal disease supervenes. A dose of castor oil is recommended after the 4th bottle; even though the worm be happily for the patient expelled.

In the Revue Medicale is a case, in which pomegranate succeeded in discharging three ells of taenia; but the patient broke off the worm in attempting to extract it with too much violence. This circumstance recalls us to the consideration of Dr. FRANK'S communication. He recommends much caution in the extraction of those portions of taenia, which have remained partly in the intestine; and says that Dr. CAGNOLA proposed touching the extruded portion with prussic acid, in hopes of killing the whole animal by means of this violent poison. Dr. GARLEKE adopted this plan on an extruded portion of four inches in length, and in one hour afterwards the whole animal came away dead. Dr. F. suggests, that the electric shock might weaken the taenia, so as to cause it to let go its hold, and thus be unresistingly extracted. BRERA recommended that the worm should be tied with a piece of silk. In this manner, it is retracted into the bowel, but begins to descend again not long afterwards. He dissuades from any attempt at forcible extraction, which excites the most distressing sensations in the bowels, and causes the risk of bringing on convulsions.

We are informed by Dr. FRANK, that a surgeon of St. Petersburg succeeded by passing the worm through a canula, and the canula through the sphincter ani muscle, so as to obviate the resistance caused by its contraction. In this manner, he easily succeeded in withdrawing the taenia whole, which is always desirable.

The writer of this article succeeded in removing many pieces of taenia from a female, by means of the tincture of black hellebore, given in doses of a teaspoonful for another object. The patient has since been affected with the same symptoms, and took to-day, Oct. 19th, in doses of [Symbol: ounce]iss, repeated every hour, sixteen ounces of a decoction of the rind of pomegranate fruit, (none of the cort. rad. being procurable); after which she took a dose of castor oil. It is said, we know not on what authority, in a French journal, that this preparation possesses the same powers as the root. It may be so; but this patient had no discharge of the tape worm, after swallowing the whole of this very astringent decoction, and following up the plan by taking [Symbol: ounce]iij of ol. ricini.

Perhaps the taenia had been effectually destroyed before. She has seen none of the joints for 18 months. The accounts, however, of the expulsion of taenia by the bark of the root, are so encouraging, that we have much pleasure in recommending it to the notice of the medical public in this country.

FOOTNOTES:

[18] Ed. Med. and Surg. Jour.

[19] Ed. Med. and Surg. Jour. July, 1821.

[20] Dict. des Sciences Medicales.

[21] There can be no particular benefit derived from the distillation. The simple mixture of the materials, above indicated, is all that is necessary. CHABERT'S remedy is therefore easily prepared.

[22] Lond. Med. Repos. April, 1825.



ARTICLE X.—Researches Physiological and Pathological, instituted principally with a View to the Improvement of Medical and Surgical Practice. By JAMES BLUNDELL, M. D., Lecturer on Physiology and Midwifery at the United Hospitals of St. Thomas and Guy. London, 1824, pp. 146, 8vo.

Dr. BLUNDELL is the author of some celebrated experiments on the physiology of generation, and the transfusion of blood. The work at present under consideration consists of physiological observations and experiments, the substance of a paper read before the Medico-Chirurgical Society of London, in the year 1823, and not heretofore published; of experiments on a few controverted points, respecting the physiology of generation; and lastly, of some remarks on the operation of transfusion.

The first part seems intended to ascertain what degree of lesion, or losses by extirpation, the body may sustain without inducing death; and thus, to open a way for improvements in surgery, by rendering the surgeon not only more bold and fearless, but more frequently successful in his attempts to preserve life, or counteract the inconvenient effects of disease and accidents. We shall make a short analysis of the first paper.

In four experiments, Dr. B. removed the left kidney of the rabbit, by incision on the outer edge. Ligatures were applied to prevent bleeding.

Two died; one in 60 hours, the other in 4-1/2 days: both of inflammation. One recovered, and lived 5 or 6 weeks, and then died. The 4th also recovered, but died in 5 or 6 weeks. On examination, a sac was found (in place of the kidney) filled with a semi-fluid substance, resembling custard, p. 4.

In seven rabbits, removed the spleen. One recovered permanently, and one lived six months. p. 5.

In five rabbits, opened the abdomen, and punctured the fundus of the bladder with a lancet. Three of them recovered entirely. p. 6.

In two rabbits, cut off one-fourth of the bladder with scissors, having applied a ligature first. One died in seven months; the other still lives in good health.

Into the peritoneum of four rabbits, threw [Symbol: ounce]i of human urine; then washed it out by injecting tepid water. One died of collapse in less than 24 hours, and two of inflammation, in 60 and 19 hours respectively. The fourth is now (12 months) in good health. p. 7.

In seven, injected [Symbol: ounce]xi decoct. quercus into the peritoneum. Only one recovered.

Dr. B.'s inferences from the foregoing experiments are:

1st. "Large apertures into the peritoneum of the rabbit, do not immediately induce a dangerous prostration, of strength." p. 9.

2ndly. "Large apertures into the peritoneal sac of the rabbit, are not necessary, nor perhaps generally, productive of fatal inflammation."

3dly. "In the rabbit, the kidney, the spleen, and a large piece of the bladder may be extirpated, without necessarily causing death; though death under the first operation is probable." p. 10.

4thly. "When the abdomen is laid open, and parts are removed from it in the rabbit, the first danger arises apparently from collapse; the second from general inflammation; and the last from chronic disease." (Vide experiments.)

5thly. "The rabbit's abdomen is very tender, probably no less so than that of man." See exper.

6thly. "Success in abdominal operations on the rabbit, furnishes a presumption in favour of success in similar operations on the human abdomen; and, therefore, from these experiments, we may infer, presumptively, that moderate openings into the human peritoneum will not necessarily, nor even generally prove fatal from inflammation or otherwise; and further, that certain viscera or parts of viscera, not essential to the welfare of our structure, may be removed from the belly, without necessarily, or even generally, producing death. The extirpation of the kidney must be highly dangerous; but there is a presumption in favour of the successful removal of the spleen, the ovaries, or even of large pieces of the bladder." p. 11, 12.

Dr. B. having stated the foregoing results and inferences, proceeds by relating instances of severe injury sustained by the human body, without being followed by death. These are confirmatory of his inferences from the experiments on rabbits. The instances given are—an os uteri torn off; extensive laceration of the uterus and rectum in labour; four uteri extirpated on account of chronic inversion, (p. 13.) One of these last under his own care. It was removed by a wire, and came off in 11 days, without one bad symptom, (p. 14.) Rupture and laceration of the abdominal coverings, four fingers' breadth, the bowels hanging out, (p. 14.) Two spleens removed; one in a soldier after the battle of Dettingen, who recovered without inconvenience afterwards; the other in a Mexican, whose case is related by Dr. O'BRIEN, in his Inaugural Essay, Edinb. 1818, (p. 15.) Three cases of rupture of the dropsical ovary. Two cases of opening into the abdomen, for the extirpation of dropsical ovaries, (p. 18.) Five cases of laceration of the uterus by natural efforts. Four of the women died, but in the fifth, Dr. BLUNDELL turned and delivered, after the child had escaped into the peritoneal sac, and the woman recovered, (p. 20.) Cesarian operation, three times by friend of Dr. HAIGHTON; once successfully, (p. 22.)

Dr. B. says, "From these (facts) few as they are, I feel conscious that no certain inference can yet be drawn; though presumptive inferences certainly may, and they seem to me to be the following:

"1st. Small wounds, as tapping, hernia, &c. do not induce fatal peritonitis; and therefore the vulgar opinion that inflammation in a spot of the peritoneum will almost invariably diffuse itself over the greater part of it, is probably unfounded.

"2nd. Extensive divisions of the peritoneum are not necessarily fatal by inflammation or otherwise, and probably not generally so.

"3d. That the womb, spleen, and ovaries, may be removed in the mode mentioned, without necessarily, and, presumptively, without generally destroying life.

"4th. That the gravid uterus may be torn open; the child may escape into the peritoneal sac; the os uteri may be torn off: not indeed, so far as these cases may be relied on, without great danger, but twice, in seven instances, without death. p. 28.

"5th. The peritoneum and abdominal viscera will bear more injury than the British surgeons seem disposed to admit.

"6th. That the above observations on the human abdomen, are in unison with those drawn from observations on the rabbit; and that observations made on the brute have more correspondence with those on the human being, than is generally believed."

Dr. BLUNDELL next remarks, that the facts related create a suspicion that a bolder abdominal surgery would not be unattended with success, and recommends the following operations to "consideration merely, and not to practice, except in otherwise desperate cases."

1st. "When the Cesarian section is performed, divide or remove a small piece of Fallopian tube, so as to prevent the danger of reimpregnation, without destroying the sexual propensity. The need for a second operation might thus be certainly prevented, without scarcely increasing the danger."

2ndly. "Extirpation of healthy ovaries."

3dly. "The extirpation of the ovarian cyst in scirrhus, combined with dropsy, or in simple dropsy." He remarks, "This operation will, I am persuaded, ultimately come into general use; and if the British surgeons will not patronize and perform it, the French and American surgeons will." p. 26.

4thly. "The removal of a large circular piece of the cyst in ovarian dropsy, when the sac itself cannot be extirpated."

5thly. "The removal of the cancerous womb, when the ulceration first makes its appearance. Might not the womb be taken out above the symphysis pubis, or through the outlet of the pelvis?" &c. 27.

6thly. "Extirpation of the puerperal uterus." He suggests the removal of the whole womb after the Cesarian section, in order that the smaller might take place of the larger and more formidable wound through the uterus—but says expressly, "No operation perhaps can be more unpromising, shall I say more unjustifiable, in the present state of our knowledge; but I thought it proper to mention it." &c. p. 28.

7thly. "Should the bladder give way into the peritoneum," he asks, "Why should we not lay open the abdomen, tie up the bladder, discharge the urine, and wash out the peritoneum thoroughly, by the injection of warm water?" p. 28.

8thly. - - - - -

9thly. Injection of astringents into the ovarian cyst or peritoneal sac, unjustifiable.

10thly. "In cases of strongly characterized introsusception," why not make an opening into the peritoneum; and "pass the small intestines, fold by fold, through the fingers." Dr. B. has repeatedly done this in the dog and rabbit, without producing death, or extensive and dangerous inflammation.

11thly. In the rabbit, he has tied an abdominal artery, and carried the end of the ligature with a broad needle out through the back, opposite to the place of the vessel. This ligature can come away, and is a better mode than to leave it hanging out at the abdomen, or entirely among the bowels, where it forms a sac of puriform matter, and to appearance lays the foundation of chronic disease. p. 30.

Dr. BLUNDELL closes this paper by saying, that since the substance of it was read before the Medico-Chirurgical Society in 1823, Dr. RITZIUS, a Swedish physician, had informed him in London, "that the complete removal of the cancerous womb had been, to his personal knowledge, performed on the Continent five times. All the patients recovered from the operation," &c. "The womb was removed through the outlet of the pelvis." p. 36.

Since we read Dr. BLUNDELL'S recommendations to the new operations, we have been astonished to notice in the Ed. Med. and Surg. Journal, July, 1825, that a German surgeon had actually treated a case of ileus in the manner recommended by Dr. B. It is from Hufeland's Journal of Feb. 1825. After it was ascertained that an immoveable introsusception existed—

"The patient was placed on a convenient table. We examined accurately the situation of the hardening, (which marked the diseased part), and determined on opening the abdomen at the outer edge of the right rectus muscle, about two inches above the navel. After dividing the integuments with a common scalpel, and making a small opening in the peritoneum, I introduced my finger, and with a blunt pointed scalpel divided the peritoneum, so as to make it correspond with the external opening, which was between two and three inches. I then besmeared my hand with oil, and carried it into the abdomen, in order to feel for the indurated part. Scarcely had I introduced my hand, than an attack of the pain came on, and a portion of the intestines was protruded through the wound, which was immediately replaced by my assistant. On continuing the examination, I discovered in a transverse portion of the ileum, a foreign substance, just where the hardened intestine was to be felt. I drew the intestine out, in order to examine it more minutely. The intestine was neither inflamed nor expanded, but it contained in its cavity a soft coherent and compact mass, which at its upper part was somewhat compressed, and thus felt harder than the rest. So far as I could follow this part of the intestine, this contained matter was to be felt: I also here immediately detected an intus-susception, but in spite of all my efforts I could not reach the commencement of it, so as to bring it out. Two modes of proceeding were open to me, in order to remove the intus-susception; either to make a transverse incision in the integuments, from the right to the left side, or to open the intestine itself. The last mode seemed to me the most adviseable, both because the patient was already very much exhausted, and because the operation would be sooner completed. The intestine was opened at the end of the discovered intus-susceptio, and immediately a part of the strictured intestine came into view. I introduced my finger into the opening in the intestine, which was made about two inches in length, and gradually pushed the intus-suscepted part back from the right to the left side, whilst I gently drew that part of the intestine which contained the intus-susceptio towards me. By this means I fortunately succeeded in unfolding the tangled intestine, which amounted to two feet in length. There was not the slightest trace of inflammation, nor any thing unnatural to be discovered in the part; there was merely a round worm, which was situated in the upper part of the intus-susceptio. The intestine was brought together by means of six spiral stitches, after the manner of the glover's suture, and the end of the silk was allowed to hang out of the external wound in the abdomen."

The sutures were removed on the 8th day. On the 14th day, the man was cured, and continues well up to the date of the account.



ARTICLE XI.—An Inquiry into the Nature and Treatment of Diabetes, Calculus, and other Affections of the Urinary Organs. By WILLIAM PROUT, M. D., F. R. S. From the second London Edition, published in 1825; with Notes and Additions, by S. COLHOUN, M.D. Philadelphia, Towar & Hogan, 1826; pp. 308.

A very acceptable service has been done to the medical profession in this country, by the present republication of Dr. PROUT'S work on affections of the urinary organs. The American physician will now have it in his power, at a reasonable cost, to possess one of the best treatises on this interesting subject. From the known accuracy of Dr. PROUT as a chemist, and his reputation as an accurate observer of nature, much new light was naturally expected as the result of his observations. Nor indeed have these high expectations been disappointed. After a careful perusal of his work, we have formed the highest opinion of his powers, both as an original thinker, and experimental inquirer.

Dr. PROUT begins his treatise with some introductory remarks on the composition of the urine, and on urinary derangements generally. After giving a comparative tabular view of the composition of the blood, and healthy and diseased urine, he proceeds to notice in succession, their principal constituents. As albuminous urine is of frequent occurrence in dropsical complaints, and its presence regulates in some degree the practice proper to be pursued, the following characters, given to it by Dr. PROUT, should be well understood.

"Albuminous urine, on being exposed to a temperature of about 150 deg. becomes opaque, and deposites this principle in a coagulated state. The precipitate varies considerably in its appearance in different instances. Sometimes it is of a firmer character, and similar to that formed by the serum of the blood, from which, in this case, it may be supposed to be derived; at other times it is very delicate and fragile in its texture, and somewhat resembles curd, when it may be supposed to be of chylous origin. In some instances, the effects of heat upon albuminous urine are increased by the addition of nitric acid. But the most delicate test of albuminous matter in general is dilute acetic acid, and the prussiate of potash." p. 6.

Dr. PROUT combats very successfully the opinion, generally entertained by chemists, that the power of healthy urine to redden litmus depends on the presence of free lithic acid.[23] That this power cannot depend upon lithic acid uncombined, is made evident to Dr. P. by its sparing solubility; it requiring, according to our author, 10,000 times its weight of water to dissolve it, or six times as much as is stated by Dr. HENRY. The reddening power of the urine is attributed by Dr. PROUT to the presence of lithate of ammonia, and superphosphate of ammonia: the former of which, contrary to what might be expected, is found capable of reddening litmus, and of remaining in solution with the latter, without decomposition.

The following interesting remarks are made by Dr. PROUT on the effects of muriatic acid, in precipitating lithic acid gravel:

"The muriatic acid, in combination with soda and potash, occurs both in the blood and in the urine; thus appearing to pass through the kidneys unchanged. This acid and its compounds formerly appeared to be of less importance in a pathological point of view than any other similar principles existing in the urine: but since the unexpected fact has been ascertained, that muriatic acid in a free state exists abundantly in the stomachs of animals during the process of digestion, I have attended a little more closely to the appearance of this principle in the urine, and am disposed to believe, in consequence, that it is the cause of the precipitation of lithic acid gravel from the urine more frequently than any other acid. I do not mean to say, that it is the immediate cause of the precipitation of this acid; for in most instances, it acts like all powerful acids do under similar circumstances, namely, by liberating the weaker acids, which are thus enabled to act in their turn, and separate those having still weaker affinities than themselves. Thus, in the present instance, the muriatic acid may be supposed to separate the lactic, while the latter precipitates the lithic, &c. If this opinion be well founded, as I believe is the case, the muriatic acid may be considered of very great importance, not only in a pathological, but a physiological point of view; for if the muriatic acid, found in the urine in such instances, be supposed to have its origin in the digestive organs, we see at once the reason why the deposition of gravel is so liable to be influenced by the derangements in general, and more especially by the acidity, of the stomach."

"The muriatic acid may be shown to exist in the urine by the white curdy precipitate insoluble in nitric acid, which is formed, when the nitrate of silver is added to it, after the sulphuric and phosphoric acids have been removed by the nitrate of barytes or lead." pp. 20 and 21.

After finishing these introductory subjects, Dr. PROUT proceeds to the consideration of the diseases of the urinary organs themselves; which he divides into functional, mechanical, and organic. Under functional diseases, we have first, those, in which principles soluble in the urine are morbidly deranged in quantity or quality, embracing three chapters; and secondly, those affections, in which principles insoluble in the urine are morbidly deranged in quantity or quality, comprising six additional chapters. Under the first subdivision, the first chapter is on the affections, characterized by albuminous urine; the second, on diseases, in which an excess of urea is the characteristic symptom; and the third, on diabetes.

The diseased derangement, consisting in an excess of urea in the urine, has not been particularly noticed by any writer before Dr. PROUT, who believes that it has probably been confounded with that form of diabetes, called diabetes insipidus. The state of the urine and symptoms in this species of urinary derangement are thus described by our author:

"The average specific gravity of the urine seems to be a little above 1.020, and occasionally to vary from 1.015 to 1.030. Most generally it is pale, but occasionally it is high coloured, and exhibits somewhat the appearance of porter, more or less diluted with water; and this variety in appearance not unfrequently takes place in the urine of the same person. When first voided, it reddens litmus paper. For the most part, it is entirely free from sediment, except the mucous cloud of healthy urine; and the only remarkable property which it appears to possess, is that of containing abundance of urea; so that on the addition of nitric acid, crystallization speedily takes place. From the quantity of urea present, it is very prone to decomposition, and soon becomes alkaline, especially in warm weather.

"There is almost constantly in these diseases, a frequent and urgent desire of passing water both by night and day. This desire is for the most part evidently excited by actual diuresis, or the increased quantity of urine; but frequently it cannot be ascribed to this cause, as the quantity voided at one time is often by no means considerable; though in almost every instance that has fallen under my observation, the total quantity voided during any given time has appeared to be greater than natural. The quantity appears also to be particularly liable to be increased by cold weather, and by all causes producing mental agitation. There is sometimes a sense of weight or dull pain in the back, but this is by no means a constant symptom. There is also occasional irritation about the neck of the bladder, which sometimes extends along the urethra. The functions of the skin appear to be natural; at least in every case which has come under my own observation, perspiration has been rather easily induced. The pulse is not affected. There is no remarkable thirst, nor craving for food, except in extreme cases; nor are the functions of the stomach and bowels much deranged. Hence for the most part the tongue is clean, and the dejections regular and apparently natural.

"In most of the cases of this disease, which have hitherto fallen under my own immediate observation, the subjects have been middle-aged men, of thin and spare habit, with a sort of hollow-eyed anxiety of expression in their countenance, free from gout and constitutional disease in general, and, as far as could be ascertained, from any organic defect in the urinary organs. In every instance they had been induced to apply for medical advice, not so much from the pain, as from the inconvenience of the disease, and the dread of its ending in something worse; and, what may be worth remarking, in several instances confessed, that they had been addicted to masturbation from very early youth," p. 41, et seq.

The remedy for this morbid derangement in the urinary secretion, most successful in the hands of Dr. PROUT, was opium, either administered alone, or in conjunction with alkaline medicines. It is rather a rare affection. When not arrested, it is liable, according to Dr. PROUT, to pass into diabetes.

In his chapter on diabetes, our author makes many interesting remarks; but the space we are enabled to devote to this analysis, will permit us only to make an extract, which seems to prove a close connexion between the disease characterized by an excess of urea, and diabetes.

"It has been mentioned in the preceding pages, that an excess of urea frequently precedes the appearance of saccharine matter in the urine. Now it is a remarkable fact, that in diabetes, in proportion as the saccharine matter diminishes, that of urea generally increases; and in such instances, the presence of the former principle can not only be no longer distinguished by the sensible properties of the urine, but scarcely be demonstrated by the utmost skill of the most experienced chemist, though the specific gravity of the urine may at the same time be nearly 1.040. I have recently been favoured by Dr. ELLIOTSON with the most complete and remarkable change of this description that has yet occurred to me. The patient, besides being diabetic, was in the last stage of phthisis, of which he died shortly afterwards. The quantity of urine passed daily, when I first examined it, was six or eight pints; its specific gravity was 1.038, and it contained a large proportion of very white sugar and very little urea. Dr. ELLIOTSON under these circumstances gave opium, beginning with gr. i, and increasing the dose to gr. iii, thrice a day. The opium produced stupor, and was obliged to be discontinued; but the effects produced upon the urine by its means were most remarkable. In about 60 hours, the quantity of urine diminished to two pints, its specific gravity was reduced to 1.0174, the saccharine matter had apparently disappeared, and was superseded by urea, the quantity of which had become excessive. This alternation of a principle containing nearly half its weight of azote, with another containing no azote at all, is perhaps, one of the most singular facts occurring in physiology." p. 74.

The second subdivision of functional urinary diseases comprises six chapters: first, on urinary gravel and calculi; second, on the data, showing the comparative prevalency of different forms of urinary deposite, and the order of their succession; third, on the lithic acid diathesis in general; fourth, on the mulberry or oxalate of lime diathesis; fifth, on the cystic oxide diathesis, and sixth, on the phosphatic, or earthy diathesis.

Under the first chapter, we have an account of I. Pulverulent or amorphous sediments; II. Crystallized sediments, or gravel; and III. Solid concretions, or urinary calculi. Of the latter, our author enumerates thirteen species.

1. The lithic acid calculus.

2. The lithate of ammonia calculus.

3. The oxalate of lime, or mulberry calculus.

4. The cystic oxide calculus.

5. The bone earth, or phosphate of lime calculus.

6. The triple phosphate of magnesia-and-ammonia calculus.

7. The calculus, composed of a mixture of the phosphate of lime, and triple phosphate of magnesia-and-ammonia, or fusible calculus.

8. The alternating calculus.

9. The mixed calculus.

10. The carbonate of lime calculus.

11. The xanthic oxide calculus.

12. The fibrinous calculus.

13. The prostate calculus.

Of these, the 2nd, 4th, 5th, 9th, 10th, 11th, 12th, and 13th species are more or less rare, and consequently of less interest. The remaining 5 are of much more frequent occurrence, and are thus described by our author:

"The lithic acid calculus is generally of a brownish-red, or fawn colour; but occasionally of a colour approaching to that of mahogany. Its surface is commonly smooth, but sometimes finely tuberculated; and upon being cu t through, it is usually found to consist of concentric laminae. Its fracture generally exhibits an imperfectly crystallized texture, sometimes an amorphous or earthy one, in which case, it usually contains a mixture of other substances. This is one of the most common species of calculi.—Chemical characters. Before the blow-pipe, this calculus blackens, emits a smoke having a peculiar odour, and is gradually consumed, leaving a minute quantity of white ash, which is generally alkaline. It is completely soluble in caustic potash, and precipitable again by any acid in the form of a white granular powder. Lastly, if to a small particle, a drop of nitric acid be added, and heat applied, the lithic acid is dissolved; and if the solution be evaporated to dryness, the residue assumes a beautiful pink or carmine colour."

"The oxalate of lime, or mulberry calculus, is generally of a very dark brown colour, approaching to black. Its surface is very rough and tuberculated (hence the epithet of mulberry.) It is usually hard, and when cut through exhibits an imperfectly laminated texture. This species of calculus seldom surpasses the medium size, and is rather common. There is a variety of it remarkably smooth, and pale coloured. These are always of small size; and from their colour and general appearance, have been termed the hempseed calculus.—Chemical characters. Before the blow-pipe, this species of calculus expands into a kind of white efflorescence, which, when moistened and brought into contact with turmeric paper, stains it red. This white alkaline substance is the caustic lime deprived of its oxalic acid."

"The triple phosphate of magnesia-and-ammonia calculus is always nearly white; its surface is commonly uneven, and covered with minute shining crystals. Its texture is not laminated, and it is easily broken and reduced to powder. In some rare instances, however, it is hard and compact, and when broken exhibits a crystallized texture, and is more or less transparent. Calculi composed entirely of the triple phosphate of magnesia-and-ammonia are rare; but specimens, in which this salt constitutes the predominant ingredient, are by no means uncommon.—Chemical characters. Before the heat of the blow-pipe, this calculus gives off the odour of ammonia, and at length melts with difficulty. It also gives off ammonia, when treated with caustic potash. It is much more soluble than the preceding species in dilute acids, from which it is again readily precipitated by ammonia in its original crystallized form.

"The calculus composed of a mixture of the phosphate of lime and triple phosphate of magnesia-and-ammonia, or the fusible calculus, is commonly whiter and more friable than any other species, resembling sometimes a mass of chalk, and leaving a white dust on the fingers. This species is generally not laminated. Occasionally, however, it separates readily into laminae, the interstices of which are often studded with sparkling crystals of the triple phosphate. The variety of this species which is not laminated often acquires a very large size, and assumes the form of a spongy friable whitish mass, evidently moulded to the contracted cavity of the bladder in which it has been formed. This species of calculus occurs very frequently.—Chemical characters. It may be readily distinguished by the ease with which it melts before the blow-pipe. It also dissolves readily in acids, and particularly in dilute muriatic acid; and if to the solution, oxalate of ammonia be added, the lime is precipitated alone, and the magnesium may be afterwards separated by the addition of pure ammonia.

"The alternating calculus, as the name imports, may consist of different layers of any of the preceding species. Hence its general appearance, texture, &c. will depend entirely on the composition, and may be very varied. Most commonly it is composed of a lithic acid or mulberry nucleus, and an external crust of the fusible calculus. In some rare instances, it is composed of laminae of all three of these substances, and sometimes of even more—the mixed phosphates still continuing to constitute the external crust. This species of calculus often acquires a very large size and is very common.—Chemical characters. The chemical characters must of course vary with the composition; and as the different substances of which it is composed must almost certainly be some of the preceding, the nature of the different laminae can be readily ascertained by what has been already stated," p. 79, et seq.

In the chapter on the comparative prevalency of different forms of urinary deposite; and the order of their succession, we have a number of important facts and observations. Dr. PROUT calculates, from the data collected by him, that about one-third of the urinary calculi which occur, are of the lithic acid species, and that another third are formed on a nucleus of this acid. Hence, "we may assert," says he, "that at least two-thirds of the whole number of calculi originate from lithic acid; that is to say, if a lithic acid nucleus had not been formed and detained in the bladder, two persons at least out of three, who suffer from calculus, would have never been troubled with that affection. This is a most important fact, and deserves to be constantly borne in mind."

The relative prevalency of the oxalate of lime calculus is very various. The average proportion, as determined by Dr. PROUT is about one in seven. Of the calculi, examined by Mr. BRANDE, 1 in 25 was of the mulberry species; while in the Norwich and Guy's Hospital collections, the proportion is about 1 in 4. In the Bristol collection, one-sixth of the whole, was composed of oxalate of lime, nearly pure; while, including all the concretions containing more or less of the oxalate, the proportion was nearly one-half! This great disparity in the proportional frequency of this calculus in different districts of England, clearly shows the great influence of local causes, in determining the character of urinary concretions.

From a careful observation of the order of deposition of different species of calculous matter, Dr. PROUT has been enabled to deduce the following general law; "that, in urinary calculi, a decided deposition of the mixed phosphates is not followed by other depositions." So that it would appear, that a redundancy in the earthy phosphates is the last link in the chain of diseased alterations, to which the urinary secretion is liable.

In the third chapter, under the second subdivision of functional urinary diseases, Dr. PROUT describes the lithic acid diathesis, and communicates several important original observations. After remarking that the dyspeptic are particularly predisposed to lithic acid deposites, he enumerates, as exciting causes of this species of gravel, 1st. Errors in diet; 2nd. Unusual or unnatural exercise of the body or mind, particularly after eating, and the want of proper exercise at all other times; and 3d. Debilitating causes. Under errors of diet, an unusually heavy meal, especially of animal food, and the use of heavy, unfermented bread, or compact, hard-boiled, fat dumplings or puddings, salted and dried meats, acescent fruits, malt liquors, and acescent wines, are enumerated as particularly hurtful in the lithic acid diathesis.

The above remarks refer to the amorphous lithic deposites, consisting of lithate of ammonia. In regard to crystallized sediments, or, more properly speaking, gravel, our author makes the following remarks:

"Crystallized sediments, or red gravel, consist of lithic acid, nearly pure. Lithic acid, as has been before stated, exists in a state of combination in healthy urine; and in such a proportion, as to be held in a state of solution at all ordinary temperatures. Sometimes, however, a free acid is generated by the kidneys, which precipitates the lithic acid in the pure crystallized state we see it—a phenomenon easily imitated artificially, as is well known, by the addition of a few drops of any acid to healthy urine. The precipitation of crystallized lithic acid does not, therefore, necessarily indicate an excess of lithic acid in the urine, but the presence only of some free acid in that fluid; though such an excess does, for the most part, exist in this form of disease, as will be shown hereafter. With respect to the nature of the precipitating acid, it is probably not always the same. Most generally it appears to be the muriatic, sometimes the phosphoric or sulphuric, and occasionally other acids. In general, however, it is to be understood, as noticed elsewhere, that when the mineral acids are present in excess, these are the immediate cause of the preternatural acidity in the urine, and consequently of the precipitation of the lithic acid. The stronger acids act by decomposing saline compounds, into which destructible acids, such as the lactic acid, &c. enter, and setting them free. Hence the immediate cause of the deposition of lithic acid gravel is generally a destructible acid of very weak powers: even, perhaps, in some instances, the carbonic acid. When the urine contains a free acid, it is commonly more transparent than usual, and of a bright copper colour." p. 112.

The treatment recommended by Dr. PROUT in this species of gravel is as follows: First, a strict attention to diet, avoiding the hurtful articles already enumerated. Secondly, the use of alkaline remedies; but those must not be depended upon, without the aid of other means, more especially of alteratives and purgatives. Accordingly we are informed that

"The pil. submur. hydrarg. comp., or a pill composed of the pil. hydrarg. and pulv. antimonialis, may be taken twice or thrice a week at bed time, and followed up the next morning by an active dose of the sub-sulphate of magnesia, or a mixture of Rochelle salts and magnesia, or carbonate of soda. A little of either of these compounds may be also taken twice or thrice in the day, so as to keep the urine constantly neutral or alkaline, and the bowels freely open; or gr. x to xx of magnesia may be taken for the same purpose in a glass of soda water, as often as it may be found necessary."

In the chapter on the mulberry, or oxalate of lime diathesis, Dr. PROUT gives a number of cases, from which he draws the following conclusions:

"1st. That this form of disease occurs in both sexes; that it may exist before puberty, and at all ages between that and 40 or 50, at which time it seems to occur most frequently; but that no case occurs beyond the age of sixty. Hence that it is probably not a disease of old age.

"2nd. That it is not incompatible with gout, but seems occasionally to be associated with it. I have also seen it connected, as lithic acid frequently is, with a tendency to cutaneous disease.

"3d. That this variety of calculous affection occurs in individuals of sound constitutions, and who ordinarily enjoy good health; and that it rarely occurs a second time, except at long intervals, during which the intermediate health is good; which latter facts, it may be proper to observe, are confirmed by other observers, and particularly by Mr. BRANDE and Dr. MARCET.

"4th. That the urine is acid, and apparently but slightly deranged in this form of calculus, and remarkably free from all sorts of sediment and gravel.

"5th. That as renal calculi of the oxalate of lime often subsequently acquire considerable magnitude in the bladder, it may be inferred, that the formation of this compound is connected with a distinct diathesis, excluding the existence of other diatheses, and that is not an accidental occurrence, happening in common with many others to the urine.

"6th. That from the dissection of calculi, formerly mentioned, it appears that the oxalate of lime diathesis is preceded and followed by the lithic acid diathesis; a circumstance which seems to be peculiar to these two forms of deposite, and which, when taken in conjunction with the other circumstances, already related, appears to show, that they are of the same general nature; or in other words, that the oxalic acid merely takes place as it were of the lithic acid, and by combining with the lime naturally existing in the urine, forms the concretion in question.

"7th. That the diathesis being of a similar nature, the principles of treatment adapted for counteracting the original tendency to it must be also similar, that is to say, of an antiphlogistic character; great attention being at the same time paid to the digestive and assimilative functions." p. 137, et seq.

The diagnostic signs of the oxalate of lime diathesis are very obscure, as will appear from the following extract:

"With respect to the means of determining when this diathesis is going on in the system, I am sorry that I can give but little positive information. The absence of urinary sediment, &c. are of a negative character, and lead to no inference, where other circumstances are wanting, as is most generally the case. But if there be pain in the region of the kidney, and other symptoms of gravel, without any appearance of sediment; and if the urine be acid, and of the yellow tint above alluded to, the stomach deranged, and an inflammatory diathesis, either general or local (i.e. about the urinary organs), be present; and if all these are associated with suppressed gout, or tendency to cutaneous disease,—the existence of this form of the disease may be suspected, and means immediately taken to counteract it." p. 138.

We omit any analysis of the next chapter on the cystic oxide diathesis, on account of the rare occurrence of this state of the system.

The next chapter of our author is on the phosphatic, or earthy diathesis.

The phosphatic deposites are of two kinds; the crystallized, consisting almost invariably of the triple phosphate of magnesia-and-ammonia, and exhibiting the appearance of white, shining crystals; and the amorphous, consisting always of a mixture of the phosphate of lime, and the triple phosphate of magnesia-and-ammonia.

The causes apt to produce a deposition of the triple phosphate of magnesia-and-ammonia, are thus enumerated by Dr. PROUT:

"Any thing acting generally, and producing a nervous state of the system, such as the distressing passions, and particularly mental anxiety or fear, will frequently produce in many people an excess of this salt in the urine. The same is also true of many articles of food or medicine that produce a hurried secretion of the urine, and act as diuretics; as the neutral salts in some cases, and particularly the Rochelle salts and other saline compounds, in which the acid is of vegetable origin. So also, a long continued use of alkaline remedies, or of mercury, in irritable habits more especially, will likewise produce a tendency to an excess of this salt, as well as of the phosphates in general, and even lead to an actual deposition of them from the urine. The same sediment also frequently abounds, or is easily induced, in the urine of those who have long been in bad health, and in whom the constitution may be considered as giving way, or, to use a common expression, breaking up. In general, it is to be understood, that the slighter causes affect only the predisposed, and those in particular who are subject to other diseases of the urinary organs or urine. It may be also remarked, that children are more subject to this form of deposition than adults; a circumstance, perhaps, to be referred to the irritability of the system at this age, and the great derangement of the digestive organs, to which they are subject." p. 151.

The above mentioned causes are stated to be equally productive of amorphous phosphatic sediments.

Our author next enumerates the very distressing symptoms, by which the deposition of the earthy phosphates is attended. They consist in great irritability; derangement of the chylopoietic viscera, evinced by flatulency, nausea, obstinate costiveness, or peculiarly debilitating diarrhoea; extremely unnatural stools, nearly black, or clay-coloured, and sometimes resembling yest; pain, uneasiness, or weakness in the back or loins; sallow, haggard expression of countenance; and finally, if the disease be not arrested, great languor and depression of spirits, coldness of the legs, and complete anaphrodisia, as occur in diabetes.

A curious and important fact has been stated in regard to the remote causes, producing the phosphatic state of the urine. It has been observed by Dr. PROUT, that a large proportion of cases of this complaint may be traced to some injury of the back from mechanical violence, such as a fall from a horse, &c.

The remedies for this diseased state of the urine, found most successful by Dr. PROUT, are,—opium, in from one to five grain doses, repeated two or three times a day, until the unnatural irritability of the system is relieved,—the same remedy in more moderate doses, in conjunction with the mineral acids, cinchona, uva ursi, and the different preparations of iron,—a large pitch, soap, or galbanum plaster to the loins,—and setons or issues in the back, when the disease manifestly arises from local injury. With respect to the bowels, Dr. PROUT remarks, that they are very difficult to regulate. He has occasionally seen serious consequences to arise from the exhibition of a small dose of calomel, such as diarrhoea and debility, much aggravating the disease, and endangering the life of the patient. For the regulation of the bowels, small doses of castor oil, and laxative injections are most to be relied on; while saline purgatives, more especially Rochelle salt and Seidlitz powders, as containing vegetable and therefore destructible acid, must be avoided.[24] Mercury, in all its forms, is also inadmissible.

"Alkaline remedies of every description, must be most carefully avoided, their use in every point of view being most mischievous when the phosphates are concerned. Indeed all remedies that act as diuretics should, in general, be shunned, and the patient should be prohibited from drinking too much. With respect to drinks, in general, they should be of a soothing, demulcent character, and prepared with distilled or the softest water that can be procured; as hard waters are literally poison in this form of disease."

The second division of the work under review treats of the mechanical and organic diseases of the urinary organs. This portion of the subject is handled with the same ability as the first. We regret, however, that our space will not permit a further development of the author's views. We trust, nevertheless, that we have imparted to our readers adequate notions of the scope of the work, to render them sensible of its value as a manual of urinary diseases. It is illustrated by a good coloured plate, representing the principal varieties of urinary calculi.

The additions of Dr. COLHOUN consist of foot notes, and paragraphs inserted in the text of the original work. We would not, however, wish to be considered as approving of the course, for the most part pursued by Dr. C., of inserting his amplifications in the text of the author, merely distinguished by brackets. Besides the absence of sufficient distinction between the matter of the author and commentator, the text of the former is thus injuriously disjointed, and dependent sentences sometimes widely separated.

In regard to the execution of the present edition, we regret to say that it is wanting in typographical accuracy.

FOOTNOTES:

[23] The reader will bear in mind, that this acid is the same as the uric, the name by which it is generally known.

[24] The reason of this exclusion of salts, containing a vegetable acid is, that they become real alkalies in the course of assimilation by the destruction of their acid, and therefore add alkaline properties to the urine, already too alkaline.



MEDICAL LITERATURE.



ARTICLE XII.—RETROSPECTIVE REVIEW.—Tractatus de Ventriculo et Intestinis, cui proemittitur alius, de Partibus continentibus in Genere, et in Specie de iis Abdominis. Authore FRANCISCO GLISSONIO, &c. &c. Lond. 1677, 4to.

As it is not our intention to confine our remarks to the work above mentioned, we shall deem no apology necessary for the somewhat excursive nature of this article, which would not answer our present purpose, if we were obliged to follow the costive details of the venerable FRANCIS GLISSON, whose villanous bad style, and execrable latin, are only to be excused or overlooked in consideration of the great importance of the topics which he handles, and the profound reflections which he makes on them. GLISSON is recognised as author of the physiological term Irritability, and as the assertor of the inherent activity of matter. HALLER says of him in his XIth book. "FRANCISCUS GLISSON, qui universis elementis corporum, vim motricem tribuit, etiam nostram vim, Irritabilitatem vocavit," &c.

He was a native of Dorsetshire, and was appointed professor of physic at Oxford in 1627. This post he occupied during forty years, and is much distinguished by his treatise de vita naturae, and by the work which forms our caption. As he is the first who used the physiological term irritability, we have thought that some researches on this subject in general, and more particularly on his peculiar sentiments, might profitably occupy our retrospective department; for it is very evident that this subject is in general but vaguely discussed, both in medical writings and conversation.

The ancient philosophers did not agree among themselves as to the nature and origin of matter; some of them considering it as eternal in its essence, and others as mutable and changeable in form. The theory of atoms, published by DEMOCRITUS, and subsequently carried out so elaborately by EPICURUS and his disciples, seems to have reached even to our own times, with an increasing reputation and acceptance. According to this theory, the kinds of matter, or elements, must he regarded as infinitely various. HERACLITUS, who taught philosophy about 550 years before Christ, considered all things as derived from an elemental heat or fire;[25] a philosophy which seems to us to have formed the basis of the Hippocratic doctrines of life. Like HERACLITUS, HIPPOCRATES tells us, that the calidum was the first principle of things, and that by an expansion or extension of itself, it constitutes all the objects of the material world. He expresses himself in the following manner. That which we call warmth, or heat, seems to me to be something immortal; something which comprehends all things, which sees and knows all things, as well present as future. Thus assuming as a basis, that the calidum is an almighty, all-wise being, or in other words, a God, all in all, the cosmogony was developed as follows: Chaos he regarded as that condition of the calidum, which preceded any exertion of the Almighty faculties. In emerging from the chaotic state, the greatest part of the heat having assumed the uppermost place, formed the aether; another part having gained the lowermost place, constituted earth; a third portion, midway between earth and aether, became air; and a fourth part, establishing itself between the two latter, became water. So that by means of the extension of this all-wise, elemental calidum, we have the four elements, earth, air, fire, and water, out of which are ultimately composed all the aggregates of the material world.[26] Now, to apply this general principle to the formation of the living being man, who seems to be a sort of microcosm in himself, we are told, that that portion of heat which remained with earth, being expanded and spread abroad in divers places, in some more, in others less, the earth became dry, and something like membrane or pellicle was formed; the matters contained in which, being heated as by a sort of putrefaction, some parts became bone, some nerve, some veins and their contents, and some formed the cavities and their contents, as the urinary bladder, for example.[27]

The full exposition of the opinions of HIPPOCRATES was left for GALEN, and we prefer to make reference to him on this theory, which by his genius and talent was so much embellished, that it became the glory of science, exercising an almost undisputed authority during a long lapse of ages. Indeed the gigantic intellect of this great man, still continues to shed its vast illumination over the world of science, particularly that of medicine; which, if it owes its birth to the divine old man of Cos, is not less indebted for its nurture and growth to the celebrated native of Pergamus. GALEN is the facile princeps of physicians. His astonishing industry, perseverance, and acquirements, his ingenious arguments, and persuasive eloquence, give him an unquestionable claim to the title of princeps, so long accorded to him; and those who even in the present enlightened period, will study his works, shall find themselves almost irresistibly led away by the charm of his suasion.

GALIEN est le seul des anciens qui ait donne un corps complet de medecine: Quoique forme des debris de toutes les doctrines precedentes, son systeme offre cependant, malgre les contradictions ou il tombe assez souvent, une unite remarquable dans toutes ses parties; un ensemble seduisant, qu'un genie de l'ordre le plus eleve pouvoit seul imprimer a un pareil edifice. Ramenant tout a un petit nombre de principes generaux, qui s'ils ne peuvent satisfaire la raison, fournissent du moins une reponse facile a tout, ce systeme dut etre adopte avec empressement, et sa fortune ne peut etonner.—Biographie Medicale, Tom. IV.

GALEN may perhaps be justly regarded as an eclectic; but it is manifest, that he mainly walked after the steps of his great predecessor, and recognised model. The following passage seems to contain ideas not much differing from those of HIPPOCRATES which we have presented above: "Who is there, says he, that judging from the origin and constitution of animated beings, doth not immediately infer the existence of a mind, possessed of wonderful energies, extending to, and pervading every portion of the universe! We every where perceive animals procreated, which are possessed of the most admirable structure, and yet what portion of the universe can be more ignoble than this earth of ours? Yet a grand intelligence is seen to have reached even it from the celestial bodies, which for their beauty are so astonishing, and which, as they are for purity far more excellent than our earth, so they are the seats of intelligences, far more pure and perfect than those which inhabit these lower regions." He proceeds to remark, that animals, worthy of the greatest admiration, are produced out of the slime and mud of ponds and ditches, and even in putrefying vegetables, which, as they indicate the miraculous properties of their author, also show us in what estimation we should hold the higher orders of being. "We may even perceive a rational nature in men, if we refer to such examples as PLATO, ARISTOTLE, HIPPARCHUS, ARCHIMEDES, and many others. If, therefore, in such a colluvies as the human body, (for by what better name can we characterize a mixture of blood, bile, and phlegm,) a mind is formed of such great and excellent faculties, what must we think of the excellence of that which exists in the superior bodies?"

It may be said that GALEN expresses, in these passages, the Platonic dogma of an anima mundi. But they certainly agree with the sentiments of HIPPOCRATES; and whether he derived them from the former or the latter, matters not, as both of them have invested matter with certain qualities, which render it active, whether it be so essentially or by the act of the Creator. GALEN may be also regarded as partially an Epicurean; for he insists that there are several sorts of matter, or as we should say, several elements; but he differs from that sect again in affirming for it a passible quality. To show that there must be more than one element, or kind of matter, he says, that if there was only one element, or a unit, it would be impassible; it could undergo no change whatever. For there would be nothing by which it could be made to suffer any alteration, or into which it could be altered. Whatever is changed, is changed into something else, and whatever suffers, suffers from something extrinsic: therefore he affirms, that of necessity there must be several sorts of matter, or elements. He says, "there are only two theories on this subject deserving our attention; one of which affirms that sentient bodies are composed of elements possessing the faculty, (cum patiendi tum sentiendi,) both of suffering and perceiving an alteration;" while the other affirms that such bodies are formed (ex patibilibus, sed sensu expertibus) out of passible, but not sentient elements. Neither of these doctrines does he consider tenable, so long as only one element is affirmed, as earth, air, or fire alone, which could never become capable of that great variety of actions we witness in living bodies: but, admit several elements, and we suppose that the mutual interchange of powers would yield a compound body, capable of all the vital phenomena. Such, therefore, says he, as consider the human body to be composed of fire, air, earth, and water, mutually transmuted, alternated, and reduced to a given temperament, and thereby vested with a sentient faculty, speak reasonably; and it is evident that there must be more than one element, and that these elements are passible bodies.

PLATO had taught, that, though all bodies are formed of matter, yet matter itself is not a body; and the same idea is conveyed by ARISTOTLE, in the Lib. de partibus animal. & earum causis, II c.i. "Prima statui potest ea quae ex primordiis conficitur, iis quae nonnulli elementa appellant terram dico, aquam aerem & ignem: sed melius fortasse dici potest ex virtutibus confici elementorum, iisque non omnibus sed ut ante expositum est humiditus enim, & siccitas, & caliditas, and frigiditas, materia sunt corporum compositorum."

GALEN also states, that in fire there exists a perfect heat and dryness, in earth a perfect coldness and dryness, and so on of the rest of the elements. For you cannot expect to find in nature a perfectly simple and isolated element; because they are always mixed two or more together. Hence the real terram, aquam, aerem, and ignem, become rather a metaphysical abstraction, than a real entity. That is to say, matter has no real existence, but is mere quality; for earth is not the mere representation of dry or siccum; it is the representative of siccitas, or dryness: fire is not the eidolon of calidum, but of caliditas; water of humiditas, and air of frigiditas. Yet all these elements are in nature possessed of more than one property. Fire is hot and dry, earth is dry and cold, water is cold and moist, &c. If we refer, however, to his account of the soul, we perceive at once, that these inseparable qualities of the elements are the real active agents of life. He plainly declares, that the soul is the mere result of organization, and perishes with the structure in which it dwells. He thinks, "corporis temperiem censendum est." As to the active powers of the four primary qualities, he says, "At mihi quidem tam venae, quam reliquarum particularum singulae, ob certam quandam temperiem quam ex quatuor sunt qualitatibus nactae, hoc vel illo modo videntur agere."—De nat. fac. I.

It is plain he thinks, that the elements consist of a materia and qualitas; but they are elemental by the qualitas and not by the materia.

After establishing that there are four elements, which are the common and simple bases of all things, he goes on to show, that the proper proportion and admixture of these, constitute the healthy state of living bodies. If the calidum, for example, be unduly increased, the body is destroyed; if it be improperly diminished by excess of the frigidum, it will also perish. The business of the physician is to keep the proportions just and harmonious; but, as no pure element exists alone, the physician must employ the qualitas in conjunction with the materia. These (to make a phrase) substantive qualities, are found in medicines or food, which, like all objects of sense, are either cold, hot, dry, or moist, and available of course in the management of a cold, hot, dry, or moist derangement of the living body.

The elements of the human body exist in the four humours, blood, bile, atrabilis and pituita; and these four humours correspond in quality with the elements. Blood, which is the reservoir or continent of them all, is a temperate humour. Bile, being the representative of calidum, is hot and dry. Melancholy represents, in our microcosm, the element earth or siccum, and is dry and cold. But pituita, which is moist and cold, corresponds with the humidum element. Air exists in animals nearly pure, as we learn from the phenomena of the pulse and of respiration. It answers to frigidum.

He shows us in his lib. de naturalib. facultat. that, out of the humours, all the parts are formed, and these parts are either similar or dissimilar; i. e. simple or compound. Bone is a similar part, that is, it is a simple part; so is an artery, or vein, or ligament. Each of these is so constituted, as that it has a predominance of one element in its nature; and it is therefore dry, or cold, or moist, &c. But if an adust element be, by accident or disease, accumulated in a part naturally cold, the function of such part is morbidly affected. The natural tendency, however, of similar humours to unite, causes each part to receive its regular supply; a principle which BICHAT has since characterized as, contractilite organique insensible.

To show the wonderful simplicity of the Galenical system, which for plainness and easy attainment may be compared with the improved nomenclature of chemistry, we will cite a passage from ARGENTERIUS, who, perhaps, was as learned in this kind of lore as any man of his time. In his Tractatio de calidi significationibus, he says; "If any body would undertake to give a general enumeration of those circumstances, in which this term calidum and the others (frigidum, humidum, &c.) are applicable to the explanation of this warmth, he shall find truly, that they are the elements, the humours, the parts, the whole body, medicines, food, air, climate, the weather, the season of the year, and even ages; for these all are either temperate, or hot, or cold, or humid, or dry."

The animal body is moved and governed by two principles; one of them corresponds to the vie animale of BICHAT, and the other to the vie organique. Since the power of sensation and of voluntary or elective motion, says he, is a property of animals, and since that of growth and nutrition is common both to animals and plants; the former may be called attributes of the soul, and the latter attributes of nature. Whence we say, that animals are governed by the soul and by nature, while plants are governed by nature alone.

The powers of the body are faculties; and these are either natural, vital, or animal: but they are so subdivided, that we have as many faculties as there are sorts of action. Under the class of natural faculties, we find three principal sorts; to wit, a facultas generatrix, an auctrix, and a nutrix. But if you ask, says GALEN, how many faculties there be, which result from the action of these on each other, you will find them as numerous and diverse as there are numbers and diversities of the animal parts. For example, we have an attractrix faculty, a retentrix, alteratrix, expultrix, &c. &c., all of which are variously modified, according to the nature of the similar or dissimilar parts they are exercised in, or, in other words, according to the nature of the tissues or organs, in which they reside.

Need we go further to show, that GALEN, believing all matter essentially conjoined with the hypothetical caliditas, frigiditas, &c. &c., taught that it was gifted with such a degree of inherent activity, as to render it capable under certain states of combination, of exhibiting all the phenomena of organic and animal life? It is certain that he regarded these active qualities, as the causes of all the phenomena, whether of living or dead matter.—GLISSON ought not certainly then to be regarded as the author of this dogma in medical philosophy. PLATO certainly taught it. VAN HELMONT could not get along without investing matter with what he called a "seminal likeness, which is the more inward spiritual kernel of the seed," &c. But we will let him speak for himself. "Whatsoever," says V. H., "cometh into the world, must needs have the beginning of its motions, the stirrer up and inward director of generation. Therefore all things, however hard and thick they are, yet before that their soundness, they inclose in themselves an air, which representeth the inward future generation to the seed in this respect fruitful, and accompanies the thing generated, even to the end of the stage: which air, although it be in some things more plentiful, yet, in vegetables it is pressed together in the show of a juice, as also in metals it is thickened with a most thick homogeniety or sameliness of kind. Notwithstanding this gift hath happened to all things, which is called archeus, or chief workman, containing the fruitfulness of generations or seeds, as it were the internal efficient cause; I say that workman hath the likeness of the thing generated, unto the beginning whereof, he composeth the appointments of things to be done. But the chief workman consists of the conjoining of the vital air, as of the matter, with the seminal likeness, which is the more outward spiritual kernel, containing the fruitfulness of the seed; but the visible seed is only the husk of this. This image of the master workman, issuing out of the first shape or idea of its predecessor, or snatching the same to itself out of the cup or bosom of outward things, is not a certain dead image, but made famous by a full knowledge, and adorned with necessary powers of things to be done in its appointment; and so it is the first or chief instrument of life and feeling. But since every corporeal act is limited into a body, hence it comes to pass, that the archeus, the workman and governor of generations, doth clothe himself presently with a bodily clothing. For in things soulified, he walketh thorow all the dens and retiring places of his seed, and begins to transform the matter according to the perfect act of his own image; for here he placeth the heart, but there appointeth the brain, and he every where limiteth an unmoveable chief dweller, out of his whole monarchy, according to the bounds of requirance of the parts and appointments. At length that president remaineth the overseer and inward ruler of the bounds, even until death; but the other, floating about and being assigned to no member, keeps the oversight over the particular pilots of the members, being clear and never at rest or keeping holiday."

Notwithstanding the affected and euphuistic jargon of the above passages, it is evident that VAN HELMONT'S idea is very similar to that of GALEN. By seminal likeness, we are to understand an aptitude in matter to take on certain determinate forms, and this may be supposed to differ not very essentially from those laws, which govern matter in crystallization. But even this seminal likeness, as we perceive, is a sort of abstraction, very analogous to the Galenical caliditas; for it is the more inward spiritual kernel of the seed, whereby the matter is enabled to enjoy a certain degree of activity, the degree of which is much increased by the union of the air, or archeus, with it. So the caliditas of GALEN, which, after all, is matter, gives to its subject the powers which it enjoys. GLISSON, speaking of the natura seminalis, says that it is a certain or specific essence, superadded to mere elementary principles, by means of which mixt bodies adopt certain determinate forms, and acquire the faculty of performing essential operations, more noble than those which belong to naked elements.

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