the nature of each case, and the manner of "examining it in every possible way, as in Italy," pointed out-the diagnosis and prognosis exposed, the general principles of the cure developed, and the adaptation of these to particular cases determined; in short, you would have heard a full detail of every circumstance which, in the opinion of the professor, could tend to the improvement of the pupil, including (in the fatal cases) a most careful inspection of the body after death." 9.

Dr. C. proceeds to consider the question of the relative merit of clinical lectures delivered apart from, or in presence of, the patients, (the former practice being that of Edinburgh, and the latter that generally adopted in the Italian schools,) and decides, as we think most justly, in favour of the first method. In defending his alma mater from the charge of leading her sons into habits of a servile and perilous imitation of the practice of their teachers, our author strongly retorts the accusation on the very school of Tommasini himself, telling him, with an insinuation sufficiently obvious, that"in Edinburgh no medical professor can enjoy the exclusive opportunity of inculcating a favourite theory or unique practice on the minds of the hearers." "There (he continues) the professor of the practice of medicine is not venerated as the infallible oracle of the healing art, and his peculiar doctrines received as the sole rule of practice; since pupils are obliged to attend the instructions of the other professors also, to accompany them to the hospital, to observe their practice, and to compare it with that of the former.".

We now proceed to Dr. C's account of the Edinburgh Clinical School; and, as it is at once extremely concise and correct, we shall translate it for the information of such of our readers (especially the juniors) as have not visited that admirable field for the acquisition of practical knowledge. And we may be allowed here to express our surprise that no clinical wards, on the Edinburgh plan, have hitherto been established in our London hospitals. The want of these is certainly a defect in our metropolitan school, which (very superior as it is to Edinburgh in many other respects) none of its other advantages can compensate. We trust, however, that this defect is not only not irremediable, but that we shall yet see it remedied; and we are well convinced that the individual who shall have the spirit to put such a scheme in effect, will have ample reasons, both public and private, for congratulating himself on its adoption.

"The annual course of clinical instruction at Edinburgh occupies nine months, three professors of the university officiating successively, each three months. Each professor, on his accession to office, selects two of the pupils most advanced in their studies as assistants, (called clerks,) one for the men's ward, the other for the

women's. These gentlemen write down the history of each case, on the entry of the patient into the ward, in a very full and distinct manner. At the professor's first visit thereafter, this history is read aloud to him at the patient's bed side, and in the presence of the pupils, when he makes any ulterior examination of the case that may seem to him necessary-calling the attention of the students to any circumstances of the case that may deserve partieular attention, but reserving for the lecture the complete exposition of the nature of the At certain times in the day the journals of the physician's assistants are exhibited in public rooms in the hospital, in order that the students may have an opportunity of transcribing the preliminary histories of the cases into their private journals, to which they afterwards add the daily reports from the vivâ voce dictation of the professor, at the bed-side of the patients.

"Beside the clinical lectures already mentioned for the consideration of the cases individually, each professor, at the termination of his course, gives a general review of the diseases treated by him during the preceding three months-explaining their general character, the effects of the various plans of treatment, and the general results obtained;-instructing, in a word, his pupils to generalize the knowledge obtained from the inspection of the individual cases, and habituating them to the conception and details of practical medicine: the whole forming a course of medical instruction so practically useful and so complete, as can hardly be met with any where else." P. 13.

Among the innumerable blessings of peace, the advancement of the arts and sciences resulting from the free and unrestrained intercourse of nations holds a conspicuous place. This is strikingly illustrated, at this moment, in the case of our own art, by the singular dispersion of our countrymen over the continent of Europe. In France and Italy more especially, there is hardly a great city that does not reckon a resident English physician among its inmates. The practice of these gentlemen, it is true, is in a great measure confined to the colonies of their countrymen, expatriated by fashion, established there; still the influence of their opinions and practice must necessarily extend beyond the immediate sphere of their personal exertions, and thereby affect, more or less, the indigenous science and practice of the respective countries. This will more particularly happen where the interloping practitioners are, like Dr. Clark, of a character and talent that would secure to themselves distinction even at home; and when they do not merely trust to the silent operation of their practice and opinions, displayed in their own small sphere, but, entering the field of foreign literature, boldly challenge the attention of the whole profession to the superior claims of their native country.

X.

A Treatise on the Nature and Treatment of Scrophula; -describing its Connexion with Diseases of the Spine, Joints, Eyes, Glands, &c. founded on an Essay to which the Jacksonian Prize for the Year 1818, was adjudged by the Royal College of Surgeons; to which is added, a brief Account of the Ophthalmia, so long prevalent in Christ's Hospital. By EUSEBIUS ARTHUR LLOYD, Member of the Royal College of Surgeons in London; Senior Surgeon to the General Dispensary, Aldersgate Street; and late House Surgeon to St. Bartholomew's. Hospital. Octavo, pp. 342. London, 1821.

HIPPOCRATES, and the primeval physicians of Greece, Italy, and Arabia, invariably recognized in scrophula the distinctive characters of a local disease. Without alteration, this view of its nature continued to glide along the current of medical philosophy, till the close of the sixteenth century, when certain eminent pathologists in England, France, and Germany, began to promulgate doctrines assumptive of its origination from a constitutional source. These doctrines suggested perhaps by a change in the scrophulous phenomena themselves, or by the speculative efforts of genins disentangling itself from the trammels of authority and empiricism, have never ceased to be admitted or modified by those spirits which guided the march of science, from the period intermediate to its revival and that of its ascendancy in our own times.

Prefixed to Mr. Lloyd's work, is a dedication to Mr. Abernethy, in which he declares

"That one of the principal objects of his book is to establish in a single but important instance, the truth of those principles which Mr. A. has so long maintained concerning the dependence of local diseases on general disorder of the system, and particularly on disorders of the digestive organs, and which have now forced their way through all the opposition of prejudice and old opinion, in a manner which marks at once their inherent excellence and truth."

Mr. Lloyd divides his treatise into two parts. In the first he treats of scrophula in general, under three sectional heads;-of its characteristic signs-of its origin or causesand of the curative means best adapted to remove that peculiar state of constitution on which it depends. He describes in the second, the topical effects produced by this state of .constitution-the particular changes determined by it in different structures-and the local treatment of these structural

changes, under the various modifications they are known to

assume.

PART. I. Pathology. Mr. Lloyd is not unsuccessful in his attempts to establish, by characteristic indications, a distinction between the scrophulous state itself, and the morbid disposition from which originates this disposition, which really exists in nature, and is at all times accessible to observation. It has also been perspicuously drawn in Dr. Thomson's Lectures, the superlative merits of which will never cease to secure to them a prominent situation in every medical library.

"The term scrophula," says the professor, "is used by medical writers in two senses, first to express the existence of a disease, which seems to possess certain distinctive characters in whatever part of the body it may appear; and, secondly, to indicate a disposition, diathesis, or state which predisposes some part or other of the body to become affected with scrophulous diseases."'

This malady, whatever be the form it assumes, is as insidious in its approach as it is gradual in its developement. Various constitutions and very dissimilar textures are susceptible of the morbid actions on which it depends; and these constitutional as well as textural circumstances, in a particular manner, determine its characteristic manifestations. Children and the young suffer oftener from this disease than those of riper years. From its influence, however, no period of life or condition of sex is altogether exempted, Age, indeed, alters the predisposition to it, in different structures. In childhood and adolescence, the upper lip, the eyes, and the glandular system, are prone to become the site of scrophulous lesions: the lungs, the visceral tissues, and spongy part of bones, acquire an increased degree of liability to sustain their ravages in after-life.

Symptomatology. Systematic writers, in general, regard the scrophulous habit as being characterised by a great assemblage of distinctive symptoms. Mr. Lloyd's symptomatography of it is less comprehensive. Persons in whom it obtains, according to his observations, are distinguished by a particular delicacy and languor of countenance; their cheeks are soft, smooth, and flaccid; the lips retain a mellow redness, while the parts around the mouth are of a dull pallid hue; there is an indescribable appearance about the

Lectures on Inflammation, p 132.

eyes; the pupil is considerably dilated; from its vessels being impermeable by the red globules of blood, the conjunctival membrane exhibits a pearly whiteness; and the superior eyelid is unusually depressed..

Mr. Lloyd believes, and universal experience confirms the remark, that there are no legitimate grounds for regarding the white and rosy check, the flaxen hair, and azure eye, as symptoms indicative of a predisposition to this disease. He is fully convinced, from very extensive investigation of the subject, that persous having every variety of complexion, from the fairest European tints to the darkest Ethiopian,, are alike exposed to it: and that it is only necessary to, place them in circumstances favourable to its development, to have it fully established.

Etiology. Mr. Lloyd considers the origination of a scrophulous state as being, in some degree, determined by the simple or combined operation of such causes as the following:-cold and variable temperature; excessive humidity and impureness of the atmosphere; mental disquietude; inactive, luxurious, intemperate life; indigestible, defective, or insalubrious nourishment; precarious health induced by inflammatory, febrile, and nervous diseases; debility resulting from the action of mercury; contagions of various kinds; hereditary or congenital peculiarity of organization; and, in a chief degree, all those agents whose influences derange the vital, particularly the digestive functions; and, by altering the natural actions of a part, give rise to that change of structure which is termed a scrophulous disease.

According to Dr. Thomson of Edinburgh, scrophula "has been observed to occur in children who, instead of being suckled at the breast of the mother, are fed with the spoon; in others, who, though suckled at the breast, have had only a scanty allowance of old and vitiated milk; and also very. frequently in those who, while young, could obtain only a watery vegetable aliment."

Among its exciting causes he likewise enumerates the impure air of erowded schools, hospitals, and manufactories; too warm clothing in bed, and two little when exposed to the air; and every thing which can tend, either more directly or more remotely to weaken the general system, or to induce debility.

Illustrative of the suddenness and certainty wherewith derangement of the alimentary functions produces local mischief, Mr. L. adduces five pathographical histories; and by their inductive testimony, regards the doctrine as being satisfactorily confirmed. We transcribe the first.