count of the constant agitation of the tendons. The skin is warm, and he does not appear to have any sensation of chilliness. The upper part of the body is in a state of profuse perspiration, and smokes. He complains of vertigo and head-ache, "I ordered him to be bled, and a large orifice was made in the arm, from whence the blood flowed in a full stream. Thirty-eight ounces, avoirdupoise, had flowed, before syncope came on. When about half the quantity had flowed, the tremor became more general, and the convulsive jerking motion now occupied the glutei, which threw him up from his seat, with the action of a man sitting on a trotting horse. As soon as he became sick and fainting, the arm was tied up, and he was laid upon a bed: the tremor immediately ceased, except some slight and partial quivering. "He was ordered Pulv. Cath. 3ss. statim. Mist. Cath. 4. qq. h. Pil. Cath. omni nocte. 5. 11 A. M. Return of the tremor. Cold affusion. The cold water was thrown over him, and produced an immediate cessation of the tremor. He became afterwards hot. "11. Tremor came on about six A. M. but continued only twenty minutes. "He got rid of the tremors after this time, but fell into a state of debility. 66 April 11. Appetite fails. May 12. disorder in the Mist. Aper. o. m. Coughs and spits much. Acido Sulph. ter indies. Recovered from his complaint. Has, however, a arm, the effect of inflammation in a vein, which came on after bleeding. On account of this he is now in the surgery ward." 396. The treatment of this disorder will be conducted on the same principles which guide us in epileptic and convulsive diseases in general. In most instances, Dr. Prichard thinks, it will be found symptomatic of uterine irregularity, or disorder of the digestive organs, and, of course, will be best managed in the manner recommended for those varieties. Our readers will have remarked that we have obtruded very few of our own observations in the course of this analysis-a plan, we believe, too much neglected in general, but which should be very strictly pursued in analytical reviews -otherwise they cease to be such, and become mere vehicles for anonymous criticism or pedantry. We may be permitted, however, to make a few, and they will be very few, commentaries on the work before us, or rather on that portion of it which we have selected for this article. In the first place we may observe that there is little that is new, either in the arrangement, pathology, or treatment of the disease. Almost all authors who have written on the disease have described the sympathetic species, though Dr. Prichard perhaps considers this division as being much more extensive than it is represented by others. We have shewn that, the pathology of the disease adopted by Dr. Prichard, is that of Dr. Parry, who published several years ago. The systematic treatment flows from the pathology, as a matter of course, and mainly consists in reducing and preventing cerebral plethora, as Dr. Parry and the best modern practitioners have inculcated. We have been a little surprized to observe that, while Dr. Prichard traces a great deal of epilepsy, in females, to the uterine system, he should entirely overlook the influence of the genital organs, in producing the disease in the other sex. We are not solitary in believing, that irritation and torpor, (for extremes meet,) in this class of organs, determine the epileptic state very frequently; and, that medicines, which act with something like specific effect on these organs, are very useful items in the methodus medendi. Les organes de la reproduction," says Jourdan, "sont aussi le siége sur lequel s'exerce la cause epileptique, et d'ou, comme par irradiation partent les premiers phenomènes de l'accès. Cette espece, qu'on peut appeler genitale, est plus frequente chez les femmes. L'onanisme a frequemment predisposé à cette terrible maladie, &c." Our author, however, may plead that he has rather stated what he has seen, than combined the experience of others, in the work under review. But in a treatise, it is incumbent on an author to avail himself of the observations of others, else it becomes an essay and not a treatise. While we perfectly agree with our author in the systematic and rational treatment of epilepsy, we are disposed to think, that we are not so far advanced in the pathology of the discase, as to renounce the aid of certain remedies to which the term empirical may probably apply. The nitrate of silver, and the misletoe of the oak have unquestionably been productive of service in epilepsy-and we are not authorized to object to their use, because we cannot explain their operation. We have, within these few years, given the nitrate of silver in five cases with considerable benefit-in two, with complete success. In these two cases, the medicine was continued for three months, and taken, ultimately, in doses of eight grains a day in one, and six grains a day in the other. In some other cases, the medicine produced little or no benefit. The tinctura lyttæ, carried to the effect of producing strangury, was beneficial in several cases under our observation, and we have lately exhibited it in conjunction with the argenti nitras. We may here observe, that we have seen or heard of no case with one exception, where the argenti nitras produced discoloration of the skin under five or six months, and the usual precaution given by the best practitioners, now is, not to per severe longer than three months in the use of the remedy. We have recently heard that a gentleman became blue in somewhat less than three months. This must render us still more cautious than heretofore. We part from our author, for the present, with feelings of great respect for the talent, observation, and sound judgment, every where displayed in the work-which is unquestionably the best in the English language, on the subject of epileptic disorders. In our next number, we shall finish our review of the volume by taking up the important subject of maniacal affections. IX. Lettera di Giacomo Clark, M. D. della Universita' de Edimburgo al ch. Sig. Professore Tommasini, &c. intorno alle sue Osservazioni sulla Scuola Medico-Clinica di Edimburgo, &c. Pp. 16. Roma, 1822. WHEN a friend from Italy put into our hands the little pamphlet whose title we have just transcribed, we did not at once recognize our old acquaintance, the author of the "Medical Notes," under the metamorphosis of his Italian name. Many of our readers are aware that, Dr. Clark has resided, for some years past, at Rome, where, we believe, he has obtainedamong our rich and distinguished countrymen, that annually crowd to the "lone mother of dead empires," the unbounded confidence to which his professional skill and knowledge give him so good a claim. Amid the bustle of practice, and the manifold allurements of so attractive a scene, we are glad to perceive that, the institutions and science of his native country still retain that superior hold on his regard, which their vigorous and philosophical character ought to give them. In the present little work, he stands forward in the face of the whole Italian medical world, and in their own language, as the defender of the English school of medicine, unjustly attacked by one of the most distinguished medical philosophers of the present day in Italy. Whether Dr. Giacomo Clark writes in "choice Italian" or not, we fear we are not enough versed in the niceties of that beautiful language to pronounce; but we are sure, that his foreign garb and idiom bave detracted nothing from the wonted zeal, simplicity, and good sense, conspicuous in his vernacular productions. It appears, that Professor Tommasini of Bologna, of whose name we made honourable mention in our last number, visited this country two years since, and on his return, published a report of the state of medicine, and medical education, as observed by him during his residence in Great Britain. Among other things, he gives an account of the Clinical School of Edinburgh; and it is to the exposition and correction of his mis-statements regarding this, that Dr. Clark's letter (addressed to Tommasini himself) is especially devoted. As we are disposed to believe that, the Clinical Institution of Edinburgh is but imperfectly known even in this country, and as we look upon it as the characteristic excellence of that celebrated school, we shall, for the information of our readers, translate Dr. Clark's concise account of it. We shall, however, in the first place, make one or two other extracts from his letter, as affording, at once, a specimen of the degree of knowledge of our medical literature possessed by foreigners, and of the error into which one is likely to fall, in attempting to delineate the full features of a strange land from a short and hasty inspection. "I cannot help expressing my extreme surprize," says Dr. Clark, "on reading your discourse, to find that you are unacquainted with so many of our most estimable modern authors, a knowledge of whose writings would have enabled you to form a more correct judgment respecting the actual condition of our medical literature and practice. Such are the works of Parr, Saunders, Beddoes, Willan, Currie, Parry, Armstrong (John), Clutterbuck, Johnson, Bateman, Jackson, Cheyne, Marcet, Thomson, Duncan, Philip (Wilson) Abernethy, &c. which, (not to mention others) assuredly you could have never read at the time, when you asserted, (p. 19,) that the greater number of English authors present little more to us than individual cases and particular histories of disease, deducing therefrom no general doctrine or principles which can serve as a guide, &c.' Had you been acquainted with our best writers, you would have found that English physicians, although deriving their practical knowledge from the observation of individual cases, (the only legitimate source of practical knowledge,) are sufficiently disposed to generalize their ideas respecting the nature of diseases, and the principles that regulate their treatment. It is indeed true, that they frequently have recourse to individual examples in illustrating 1 and confirming their positions, a practice, not merely advantageous, but rendered often absolutely necessary, by the very imperfection of our art, and, moreover, sanctioned by the authority of the best writers in every country. Our medical literature, it is true, was never exclusively devoted to any one theory of disease, but it has certainly been far from being restricted in the manner you mention. On a fuller acquaintance, you would have found that, English medicine could not only boast of being founded on the sure basis of inductive science, but that its philosophic principles afford a faithful guide in practice: most assuredly, you would not have found those vacillations of opinion and errors of practice which disfigure the medical history of some other nations, and which we have seen checking the progress of the art in Italy, to this very day" 6. Dr. C. then adduces the history and fortunes of the Brunonian system in the different European countries, as placing in a clear point of view, the superior discernment of our countrymen. The following extract from Tommasini's Discourse, seems to contain the main part of his attack on the Edinburgh School. "Clinical instruction in Edinburgh, is limited to the mere exhibition of what the professor sees in, and prescribes for, a disease,-to the bare history of symptoms and the dictation of remedies; a mode of proceeding, which affords no greater treasure to the student than a collection of cases, and must too frequently lead, in practice, to a servile and perilous imitation. The pupil is neither guided in his studies, nor taught to recognize or define the disease, nor permitted to try his own powers in its treatment under the eye of his teacher and his fellow students. In a word, he neither sees investigated, nor is taught himself to investigate, a disease, in every possible way, as with us in Italy. No explanation is given of the precise circumstances on which the diagnosis, prognosis, and plan of treatment are founded. Nothing is said of the doubts and difficulties which so often leave us uncertain of the truth of our diagnosis, and thereby render our practice inert; nor are the pupils guarded from the risks of a superficial imitation, by having pointed out to them how frequently diseases apparently similar are, in truth, very different, and vice versa. In short, in England no analysis is made of diseases at the bed-side of the patients, and in the presence of the pupils, &c." The following extracts are from Dr. Clark's reply to those charges of imperfection and inferiority to the Italian schools: "A completer examination of the Edinburgh school would have shown you how very different in reality the clinical institutions are from what you state them to be. If you had been present at the Clinical Lectures dellvered there, (of the existence of which I can hardly believe you to be ignorant, although no mention of them is made in your discourse,) you would have then heard explained Vol. III. No. 9. X |