pen

fity of its affairs does not require. On the contrary, Mr. Eden's weight in the ftate and his abilities, command attention; and the counfel he gives will be followed. Should it, therefore, hapthat he is wrong, and that our fituation is perilous in the de gree I have represented, he has been urging us towards a precipice, and the confequences may prove fatal.-In this refpect, we are like two persons who obferve a friend heavily burdened plunging into a deep water, one of whom, believing that he is not in a condition to combat danger, calls upon him to come back: and the other, believing the contrary, advises him to go on. If he takes the former advice, he will, at worft, be only over-cautious. But if he takes the latter advice, and should find himself deceived, he will lose his life.

After all. Did I apprehend that we were in a fituation which admitted of no retreat, I fhould, however I might lament the misconduct which has brought us to it, think myself bound to be filent. But our circumstances are not, I hope, so desperate. A retreat is, probably, ftill practicable by the fame measure which would certainly have faved us not long ago-by with drawing from that country where all our troubles have originated; and yielding to the colonies that bleffing, which we are employing our armies to force from them, but which every country values above all bleffings, and the lofs of which we ourselves are now deprecating as the greatest calamity that can be the confe quence of our prefent difficulties.'

Modern Improvements in the Practice of Phyfic. By Henry Manning, M. D. 8vo. 6 s. boards. Robinfon.

Modern Improvements in the Practice of Surgery. By Henry Manning, M. D. 8vo. 6 s. boards. Robinson.

THAT both phyfic and furgery have received extraordinary improvements within the laft forty years, muft be acknowledged by all who are converfant with the progrefs of thofe arts: nor is it lefs certain that a collection of fuch improvements, which have hitherto lain scattered in a multiplicity of publications, muft alfo prove highly acceptable to the medical and chirurgical profeffions. Upon this idea, Dr. Manning has compiled the prefent work, which, should it meet with the fame approbation that was obtained by his treatise on the Diseases of Women, will remain, till time has effected farther innovations, a moft ufeful production on the subject.

The work begins with the moft approved method of cure in inflammatory fevers. These conftituting a clafs of diseases of great frequency and importance, we fhall extract, as a fpeci men of the practice recommended, what relates to this fubject.

Through

Through all the fluctuations both of theory and practice, from the earliest ages of phyfic, bleeding has been confidered as the principal remedy in the cure of inflammatory diseases. So indifpenfible is this evacuation, that the delaying it too long, or not repeating it oft enough, is an error in practice which can never be compenfated by any other means, however powerful. Twelve or fixteen ounces is the quantity moft ufually drawn from a ftrong adult in an inflammatory fever at the first or fecond bleeding, but at all the fubfequent times lefs. It is proper to obferve the colour and confiftence of the blood while it flows, as by thefe the quantity ought in a great measure to be regulated. When it is thickish, and of a dark caft (which is com monly the cafe in great inflammations) we are authorised to take it away more freely. But the ftrength and hardness of the pulfe, with the other concomitant fymptoms of infiammation, afford the most certain rules by which to proceed. When large quantities are neceffary, it is beft to bleed the patient lying, in order to prevent his fainting before enough be drawn; other, wife, in all inflammatory pains, the animi deliquium, .upon the lofs of blood, is accounted a favourable circumstance.

• After bleeding, an early fweat is of great advantage for ftopping the progrefs of the difeafe. One of the best medicines for this purpofe is a draught of vinegar-whey, with some spirits of hartfhorn. Or, instead of it, we may give two fcruples of the falt of hartfhorn, faturated with about three fpoonfuls of common vinegar, in one draught, and promote the diaphorefts with fome warm diluting liquor. It has been usual to give the theriaca for the fame intention: but Sir John Pringle justly obferves, that all fuch drugs increase the fever, if they do not procure a sweat; while, on the contrary, the faline mixture operates without heating. The theriaca, however, is rendered more fudorific by adding to half a drachm of it fome grains of the falt of hartfhorn, and by encouraging the fweat with vinegar-whey, or thin water-gruel acidulated with vinegar.

For promoting perfpiration, Sir John Pringle acquaints us, that he once followed the common method of joining the tefta cea to nitre, without paying any particular attention at first to the effects of the former; but having fince difcovered a septic quality in thofe fubftances by experiments out of the body, he thinks it probable that they exert a like power when taken by way of medicine, which perhaps would be more frequently obferved, were it not for the quantity of acids ufually given in acute diseases; whence not only the feptic nature of the reftacea is destroyed, but fome of the acid neutralized, and thereby rendered more diaphoretic. The putrifying quality of thofe powders was alfo corrected by the contrayerva root, and by. the camphor, which was added to them. The common dofe was a fcruple of the pulvis coutrayerve compofitus, with ten grains of nitre, and three grains of camphor, given four times a-day, in a little barley-water.

• These

These powders were given partly to promote a diaphorefig when nature seemed to point that way, and partly to abate fpafms, as the head was fo apt to be affected; but being a me. dicine which had little fenfible effect, the judicious phyfician above-mentioned placed the lefs dependence upon it.

Sir John Pringle's first practice in every inflammatory fever was to blifter, especially in the advanced state, when he believed that the patient could not bear any farther lofs of blood. But afterwards finding that the folution of the fever was not to be procured by that means, he confined the ufe of blifters to those states of the disease in which he could be more affured of their efficacy; fuch as that of a head-ach, when not removed by the firft bleeding, or by opening the body. In this cafe a blifter between the fhoulders feldom failed of giving ease.

• When the patient had a cough, or any other fign of inflammation in the lungs, a blifter was also applied between the fhoulders, though not with equal certainty of relief; but if there was a ftitch in the fide, the plafter was laid on the part affected.

If the body was bound, it was opened (after the first bleeding) by fome gentle laxative; but throughout the course of the fever coftiveness was fufficiently prevented by almoft daily clif ters, if the patient had not otherwife regular ftools. If the fever in the beginning was attended with gripes and a loosenefs, after bleeding, fome rhubarb was given, and if the purging ftill continued, four fpoonfuls of the chalk-julep were ordered after every Loofe ftool.

Towards the crifis, or in the decline of the fever, a little wine was added to the panada, or given in fome other shape, as the best cordial; but in great finkings, fome drops of spirit of hartfhorn, in a tea-cup full of white wine whey, were preferred to every other medicine.

After recovery, fome mild purge was often requifite, to prevent the too hafty repletion of the convalefcents upon indulging their appetite; cathartics at that time feeming otherwife unneceffary.

With refpect to opiates, which a young practitioner might think expedient amidit fo many complaints of pain, looseness, and want of reft, Sir John Pringle obferves, that these remedies were to be given only in the advanced state of the disease, when the inflammatory fymptoms were much abated, when the head was not affected, and when the patient, after long watching, believed he should be well enough if he could but fleep. At fuch times, especially about the crifis, he ufually ordered two fcruples of the confectio Damocratis at bed-time, with good effect. If the paregoric was continued, coftiveness was prevented by clyfters, or some laxative.

In thefe, as in other fevers, the thirft was moderated by barley-water acidulated with vinegar, or by balm-tea with lemon-juice. As to diet, the patient was always kept upon the

lowest,

loweft, fuch as panada, water-gruel, and the like, without allowing any broth till after a breaking and a fediment in the urine. When this happened, a decoction of the bark, or the elixir of vitriol, completed the cure.

• Dr. Grant obferves, that the practice of giving heating medicines in inflammatory disorders is now almoft generally exploded; and people are not so much afraid of free air, and the erect pofture, as formerly: but there is yet an error of a different kind which remains to be corrected; viz. the giving of antifeptic medicines inftead of antiphlogistic. Thus the rough acids of unripe fruits, or of the mineral kingdom, which are found to moderate the heat and anxiety of the putrid fevers, are frequently employed in thofe of the inflammatory kind.

The fame author obferves, that the bark given as foon as there are figns of coction, is frequently pernicious, and in no fever more than the fimple inflammation, especially when it is likely to go off by the natural emunctories.'

In fubfequent chapters, the author treats in the fame practical manner of the other kinds of fevers: among which he has given a copious and useful account of the fmall-pox, including the whole method of inoculation, and a variety of remarks on that subject.

In treating of local diseases, Dr. Manning begins with those of the head, and thence proceeds downwards to the disorders of the thorax and abdomen. He afterwards gives fuch as are not fixed to any particular part, nor of a febrile nature; concluding with a full account of the means of recovering perfons drowned, and apparently dead.

To the improvements in the practice of phyfic is fubjoined an appendix, containing a fhort account of the principal remedies which have been introduced, or their ufe extended of late years. *Thofe are, fixed air, antimonials, arnica, Peruvian bark, blifters, cicuta, &c.

The volume containing the Improvements in Surgery, commences with an account of inflammation, which, during the prevalence of the Boerhaavian theory, was fuppofed to proceed ab errore loci, but is now generally thought to confist in an ircreased action of the veffels of any part, accompanied with a fpafm of the arterial fyftem. The proper treatment of inflammations in general, Dr. Manning exemplifies by that of the phlegmon; treating afterwards of abfceffes, gangrene, and ulcers, the latter of which he confiders at large under their feveral different kinds.

In the account of the particular difeafes that require the aid of furgery, the author begins, as in the former volume, with thofe of the head, and continues his obfervations, in regular order, to the lower extremities; on the palfy of which we are

pre

prefented with many valuable remarks from Mr. Pott. This difeafe confifts in a partial or total abolition of the power of ufing, and fometimes of even moving the lower limbs, in confequence, as is generally imagined, of a curvature of fome part of the fpine. From various circumstances, Mr. Pott has been induced to fufpect, that when we attribute all the symptoms attending this disease to the accidental curvature of the fpine, in confequence of violence, we mistake an effect for a caufe; and that previous both to the paralytic ftate of the legs, and to the alteration of the figure of the back-bone, there is a predifpofing cause of both, confifting in a diftempered state of the ligaments and bones, where the curve foon afterwards makes its appearance.

Mr. Pott informs us, fays Dr. Manning, that the remedy for this dreadful difeafe confifts entirely in procuring a plentiful difcharge of matter, by fuppuration, from underneath the membrana adiposa on each fide of the curvature, and in maintaining fuch difcharge, until the patient fhall have perfectly recovered the ufe of his legs. To accomplifh this purpofe, Mr. Pott has made ufe of various means, fuch as fetons, iffues made by incifion, and iffues made by cauftic; between which though there be no very material dif ference, he prefers the latter. He obferves that a feton is a painful and nafty thing; befides which it frequently wears through the fkin, before the defign of it has been answered; and that illues made by incifion, if they be large enough for the intended purpose, are apt to become inflamed, and to be very troublefome before they come to fuppuration: but openings made by cauftic are in general not liable to any of those inconveniencies, at leaft, not fo frequently, nor in the fame degree. Neither are they fo troublesome to make or to maintain. Mr. Pott makes the efchars of an oval fhape, near an inch and half in length, on each fide of the curve, taking care to leave a fufficient portion of skin between them. In a few days, when the efchar begins to loofen and feparate, he cuts out all the middle, and puts into each a large kidney-bean. When the bottoms of the fores are become clean by fuppuration, he fprinkles on them, every third or fourth day, a fmall quantity of finely powdered catharides, by which the fores are prevented from contracting, the difcharge is increased, and poffibly other benefit obtained, He keeps the iffues open till the cure is completed, that is, until the patient perfectly recovers the ufe of his legs, or even for fome time longer. He likewife thinks it more prudent to heal only one of the fores at first, keeping the other open, until the patient can walk firmly, and without the affiftance of a ftick; until he can ftand quite upright, and has recovered all the height, which the habit, or rather the neceffity of flooping occafioned by the distemper, had made him lofe.

But though Mr. Pott is of opinion, that the discharge by means of the iffue is fufficient to effect a cure, he thinks there is

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