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charges of mucus, pus, and serum from inflamed parts, as the bronchia, liver, &c. it is considered by our author, as the topical effect of that increased momentum, forming a part of local inflamination. The same effect may happen from general plethora, as is shown by the bloody urine following scarlatina, and sometimes measles ; forming, in scarlatina, one link of a series of effects, of which articular inflammation and dropsy often constitute other links. Here anasarca or ascites being vicarious with hæmorrhage, affords new evidence of the nature of dropsy, as discussed on a foriner occasion. Our author has more than once seen obstinate and extensive anasarca cured by spontaneous hæmorrhage. Active hæmorrhage is always accompanied with phlogistic diathesis, and when the blood is discharged from the nose or viscera, it appears to be arterial, either from ruptured arteries or open mouthed capillaries.

Dr. Parry here mentions" a modification of purpura, exhibiting those appearances under the skin, which from their size and shape have been generally called petechiæ, maculæ, or vibices. They are usually flat, but sometimes considerably relieved above the rest of the skin. They are of different tints and shades of colour, from a pale red to a logwood purple, or even nearly the hue of a black currant. They do not become in any degree fainter from pressure, and are evidently ecchymoses or spots of extravasated blood. Their chief, but not only seat, is the upper or lower extremities. In most cases they have followed or accompanied pretty severe pain in the limbs, which has sometimes had the form of articular inflammation.” P. 156.

Dr. Parry bas published two cases in the 5th vol. of the Edinburgh Journal, and we ourselves have witnessed with in these few weeks a similar disease, which embarrassed us much at the beginning.

A young gentleman, after a hearty supper of oysters, was seized next day with bilious vomitings, head-ache, and considerable pyrexia. The fever continued for several days, with great determination to the head, notwithstanding strong cathartics were daily administered. About the sixth or seventh day, he was seized with violent pain in the small of the back, and in the region of the kidnies ; soon after which, an eruption, similar to that above described, came out on the lower extremities, accompanied with excruciating pain in the limbs, and great tenderness and irritability on the surface; fever and restlessness still continued; and the intestinal discharges were invariably dark coloured and offensive. For three days, he took a grain of calomel and two of antimonial powder every three or four hours, which kept up a constant catharsis,

and finally carried off the complaint. The appearance of these petechiæ would, we presume, a few years back, or even among our Brunonian brethren of the present day, have given origin to a very copious exhibition of bark and wine, to correct the putrescency of the humours and the debility of the solids.

Hænatemesis and hemiplegia are brought forward by our author ; the latter he has seen rapidly follow a violent pal. pitation of the lieart, and was occasioned by a large extra: vasation of blood into the medullary substance of the brain, under which the patient lingered several weeks. In these cases of hemiplegia, and in many other hæmorrhages, the patient is, to all appearance, in such a state of previous good health, that one can hardly suspect phlogistic diathesis, or attribute the accidents to any other cause “ than simple excessive momentum, acting perhaps, on vessels previously disposed to be so affected.” Hæmorrhages may arise from general excessive momentum alone, as an exciting cause. Thus globules of blood are sometimes seen mixed with the perspired fluid in the axillæ of young persons after violent exertions; strong exercise, late hours, close rooms, or exposure to the intense heat of fires or sun will produce nasal hæmorrhage, and the same is produced by hard drinking in

older persons.

“ Sanguinis a naso Auxum, fere lethalem, Juveni a coitu prima nuptiarum nocte sæpius repetito accidisse novi.”

In respect to passive hæmorrhages, Dr. Parry seems a little puzzled, as there is seldom any indication of increased momentum.

“ But if,” says he, “ a great degree of momentum be required to produce hæmorrhage in vessels little disposed, a slight degree will be sufficient in vessels which are strongly disposed. These, therefore, are the two states which constitute active and passive hæmorrhage.” 162.

Dr. Parry regrets, that he has not seen a sufficient number of cases of sea scurvy, to enable him to decide whether, at a certain period of that disease, there be not excessive momentum that may ultimately produce those extravasations and passive bæmorrbages so characteristic of the disease. We have had extensive opportunities of seeing scurvy, and Dr. Parry's reflections on the subject have recalled to our minds many circumstances favourable to his ideas. We always observed, that the first symptoms of sea scurvy broke out among those who were addicted to drunkenness, laziness, and gluttony, all which undoubtedly tend to produce general or local plethora, with consequent hæmorrhagic discharges. We observed, on the other hand, that after great exertions of body and anxiety of mind, any sudden disappointment, as the escape of a prize, the discomfiture of an attack, or the like, gave origin to a formidable list of scorbutics, which extended even to those of active, sober, and cleanly habits. This we conceive, was owing to the sudden atony of the extreme vessels invariably following the application of the depressing passions to minds and bodies bor. dering on exhaustion from previous fatigue, and very fairly accounting for the hæmorrhages and extravasation in question.

The petechial spots in typhus itself are usually the result of undue action of the heart upon skins suffering an accumulation of heat from various causes, as alcohol and other stimulating ingesta, and seldom appear where the treatment goes to regulate the balance of the circulation,

The varicose state of the saphena, giving origin to hæmorrhage, is often certainly the consequence of mechanical obstruction to the return of the blood ; but in many other cases, a diseased state of the coats of the vein is more probably the cause of the morbid dilatation, and of the hæmorrhage.

On the subject of hæmorrhoidal discharges, Dr. P. declines speaking, but refers to the illustrations of Mr. Aber. nethy. P. 166. Final Causes of Inflammation, Dropsy, and Hæmorrhage.

In the preceding pages, an attempt has been made to shew a coincidence of action or affection between imflammation, dropsy, and hæmorrhage, inasmuch as each of them is the consequence of excessive momentum of blood, whether relative or absolute."

These actions or affections of the part often remove the local malady, which in its turn frequently bas a tendency to relieve the general momentum. Blood being the great stimulus to the heart's action, a certain fulness of the vessels, proportioned to the varying state of the system, is necessary for a due action of that organ. Thus excessive quantum increases, defective diminishes the action of the heart, as is evinced by the pulse in arterial and venous plethora following full living, " and the immediate change of that state by blood-letting. 169,

“ These circumstances,” says Dr. P. “ render it probable, that one of the ends to be answered, in such cases, by the supervention of local inflammation, is, in various ways, to evacuate and soothe the constitution, which was before unduly stimulated by excessive vascular fulness." Ib.

In this way we partly conceive the salutary influence of gout in constitutions subject to excessive sanguineous mo. mentum, and how other local affections supply the place of gout, as erysipelas, and various cutaneous affections. So also, hæmorrhages and bæmorrhoidal discharges prove vicarious of the same disease; thus our author has seen a patient accustomed to vernal gout, and missing the annual fit, have erysipelas ; the next spring, hæmorrhoids ; the following spring, a fever, cured by blood-letting ; each with equal relief to the constitutional symptoms. The same effect precisely (in his experience) has been produced by anasarcous swellings of the lower extremities occurring at the gouty seasons. These circumstances then, shew, that constitutional errors of circulation are alleviated by local inflammation, hæmorrhage, and dropsy.. So also, increased action of the heart is relieved by dropsical effusions. Our author has seen a hectic pulse of 130 reduced in a few hours to 60, by the supervention of violent anasarca in the lower extremities.

“ I have, indeed, so often known constitutional maladies suspended, and life evidently lengthened and rendered more comfortable, by the coming on of various dropsical effusions; and, on the contrary, so many persons suffer aggravations of disease, or even death, very shortly after the spontaneous disappearance of dropsy, that I cannot avoid considering that effusion as a salutary process, rather than as an actual disease.” 171.

These pothological points are certainly of the utmost importance, both in a speculative and practical view, inasmuch as they direct or sanction modes of treatment so active as to be either essentially beneficial on the one hand, or highly injurious on the other.

T'he coincidence of hæmorrhage with dropsy is not frequent; but Dr. P. has seen a long-continued and large bæ. morrhage from the lungs, accompanied with hydrothorax, anasarca, and ascites, with a pulse at 136, all relieved together, and the patient restored to health as soon as, by digitalis, the pulse was reduced to 40 in the minute. Alihough dropsy often appears a consequence of hæmorrhage, Dr. P. thinks that it is rather from the cessation of hæmorrhage. Where the latter is accidental, but in some degree habitual, the dropsy arises either from a similar cessation, or from too sudden nutrition, both of which produce excessive plethora, often resulting from the means employed to arrest the disease and restore the strength! Vol. III. No. 9,



Simple Excessive Determination, or Tulness of Blood.

This is a very long and a very important section in our excellent author's work, and must receive proportionate attention.

Every accurate practitioner must bave observed, that long after the subsidence of actual inflammation, gout, &c. in parts, an increased momentum of blood, accompanied by pain, swelling, or serous cffusions, remained. Pains of various other parts appear to originate in this increased momentum, producing excessive impulse on them when in a state of susceptibility; and lience idiopathic pain in the animal frame can only be accounted for in this way (independent of " inexplicatle nervous sympathy") "since pressure, bruising, tearing, cutting, stretching, suction, and probably oll chemical operations, are mere modifications of that power.' 178. One principal, and almost only objection to the doctrines of Dr. Parry, is a total neglect of the nervous system.

“ He utterly, and for ever, disclaims all reliance on the neurological systems of pathology hitherto extant. He considers them as founded on principles which are either visionary or inapplicable, and which lead to practices tending equally to debase the moral character of mankind, to produce or perpetuate disease, and to discredit the medical profession.” Preface, v.

This is too severe, and perhaps unjust. The nervous system must not be overlooked in pathology ; for we are quite convinced, from attentive observation and reflection, that whether primarily or secondarily affected in discase, it plays as important a part as the vascular system ; in short, that the two systems are so mutually dependent on, and connected with each other, that our views must be constantly directed to both, if we wish to practise with discrimination and suc

But to return to our author. “ Pain itself has a tendency to diminish the action of the heart, and therefore that increased momentum or fulness of blood which produced it." 178.

Does not this very sentence of Dr. Parry's admit the mutual connexion we have been insisting on? Dr. Parry justly remarks, that we often see swelling, increased heat or redness, and occasionally all tliree, without actual inflammation, though these are the common characteristics laid down by Nosologists. Since, however, the two states vibrate backwards and forwards into each other, so that what is one day a determination to a part, will the next be inflammation, there is evidence of one common condition in the two cases.


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