cines form our sheet anchor. But, as our author justly observes, we should never exhibit a medicine of strong sedative power, when a milder will produce equal relief-since the disease is of long duration, and every medicine will at last fail in producing its effect. Hyoscyamus and conium may be first employed, and afterwards we must have recourse to stramonium, belladonna, and opium. In some constitutions the solid opium, in others the liquid form will agree best-some prefer liq. opii sedativus-others, the black drop -in short, he will be the best practitioner who best understands the adaptation of these means to their end, and who can smooth the passage of the afflicted patient from this to another, and, we hope, a better world!

We

We have now turned over the last page of Mr. Clarke's work, and take our leave of him, perhaps for ever. implicitly believe the concluding assertion.

"In thus concluding his work, the writer can conscientiously. assert, that he has made no statements which, in his opinion, are not founded in fact, and that he has withheld nothing which might in any way tend to the advantage of the practitioner, or to the comfort of the patient." 237.

The language is plain and perspicuous, and Mr. Clarke has the art of embodying his ideas in the most distinct and tangible shapes-an art, of all others, the most useful and. difficult. To us, who are plain practical men, the work ap-. pears highly valuable; and we leave it to our readers to form, their own conclusions from the ample specimens which we have now laid before them.

VI.

A Letter to Charles Henry Parry, M. D. F.R. S. &c. &c.' on the Influence of Artificial Eruptions, in certain Diseases incidental to the Human Body, with an Inquiry' respecting the probable Advantages to be derived from further Experiments. By EDWARD JENNER, Esq. M.D. LL.D. F.R.S. M. N.I. F. &c. &c. &c. and Physician Extraordinary to the King. Quarto, pp. 67. London, 1822. COUNTER-IRRITATION, as a remedial measure, is one of the oldest and best established principles in medicine. We every day witness it employed by Nature-we every day act upon it, either designedly or undesignedly. Thus we see sponVol. III. No. 9.

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taneous eruptions on the skin relieve internal disorders-and irritations in the bowels, inducing diarrhoea, carry off affections of parts situated at a great distance from the alimentary canal. These phenomena must have led careful observers, in the earliest ages, to imitate nature by art. Accordingly we inflame the skin by blisters or other irritants when disordered action or pain is going forward in a deep-seated part and we irritate, by emetics and purgatives, the internal surface of the body (the stomach and bowels) on the same principle, when either the skin or any other part than the alimentary tube is in a state of morbid irritability.

The ancient observation-"ubi stimulus ibi affluxus"has been amply illustrated and explained, in our own times, by Dr. Parry, under the terms natural and artificial "determinations" to particular parts of the system, as will be seen in the first article of this number. In short, the principle of "derivation," or "counter-irritation," is that which is the most widely employed by all classes of practitioners, of any principle in pathology or therapeutics.

The illustrious discoverer of vaccine security has long directed his attention to the effects of pustular eruptions, arti-, ficially excited, in many diseases incidental to the human body, and has now laid before the public an ample collection of facts and histories for the illustration of those effects. We shall present our readers with short analyses of many of these cases, as the quarto form of the publication will limit its circulation through the minuter ramifications of the profession.

Case 1. A man, 60 years of age, originally a seaman, had been occasionally affected with sick head-aches, but otherwise in good health. A disappointed scheme threw him into a state of hypochondriasis, which ended in decided insanity, in about three months from the commencement of the hypochondriacal affection. He went through the ordinary routine of treatment, of bleeding, purging, and antimonials; but the disease continued, and the bowels were so obstinate, that it was almost impossible to get any passage through them. A drachm of tartarized antimony, incorporated in an ounce of simple cerate, was now rubbed on the insides of the arms, from the elbows to the wrists, night and morning. Papulæ of some magnitude were produced, and the transition from derangement to health was inconceivably rapid. The cure was permanent. The next case related is of a similar description, and with the same result.

Case III. A youth, ætat 17, was found by our author apparently in the last stage of pulmonary consumption, the

symptoms of which are too well known. In addition to the usual phenomena, however, "there was a perceptible enlargement about the centre of the left side of the thorax." To engage his mind, and without any hopes of ultimate recovery, the antimonial ointment was rubbed on the protuberant part until pustules were produced, which was effected in a few days. In a week there was some amendment in regard to the cough and other distressing symptoms. The application was continued with the view of keeping the pustules in full activity. At the expiration of a fortnight the general bad symptoms had considerably abated, and the patient's looks were much improved. From this time the convalescence was so rapid that, in six weeks more, no vestige of disease remained, and the youth began to renew his ordinary avocation, that of a stone-cutter. Dr. Jenner very properly wishes that it may not be inferred from this case that he supposes genuine confirmed phthisis is to be cured by artificial eruptions.

The fourth case was a woman, 54 years of age, subject to spasmodic asthma. She used the ointment on the nape of the neck, after which the complaint was more slight, and the intervals longer.

Case V. A scaman, 47 years of age, was suddenly seized with inflammation of the right eye, but not so violent as to prevent him pursuing his avocations for nearly three weeks, when a chill came on daily between three and four o'clock.

"About half an hour after each attack, a pain seized the right side of the head, principally about the orbit of the eye, extending in the course of the temporal muscle. It continued to return every afternoon at a certain hour, and at length became so violent as to deprive him of sight and intellect. In one of the paroxysms he grew enraged with his wife, because he supposed that she had not lit him a candle, although one was burning before him. These periodical attacks became marked in the end with raving madness. In a paroxysm, with extreme severity of pain, he was at the point of destroying one of his children. He was bled from the arm, leeched, and took purgatives up to drastics, but they took no effect upon the malady. Seeing the impression which tartar emetic had made on affections connected with a disordered state of the brain and nerves, I did not hesitate to direct the application of the ointment, and it was applied to the left arm. Pimples followed in twenty-four hours, and as soon as they became acuminated, and contained a little limpid fluid, the patient found ease; the pain continued to abate, and at the end of three days it was quite gone. He continues well. This man, like many others who ply as mariners on our river, (the Severn,) was a hard drinker." P. 9.

Case VI. The sixth case was a boy, 12 years of age, who had been ill six months, with what is called chronic hepatitis. His liver felt hard, enlarged, and very sensible to the touch. The cachectic appearance and general emaciation were such as indicated the probability of a fatal termination. At this period the ointment was applied, with the usual cutaneous effect," after which he recovered with astonishing rapidity, and no vestige of the induration or enlargement within the abdomen remains." Mild aperients were used during his indisposition.

Cases VII. VIII. IX. The seventh and eighth cases are equivocal, or unsatisfactory. The ninth case was that of a young woman with mania, the patient of Mr. Fewster of Thornbury. Her ravings were violent. Leeches were applied about the head, and the ointment upon the lecch-bites. "As soon as vesicles appeared, she was well." Having neglected to continue the ointment, she experienced a relapse, and became decidedly maniacal. The ointment was reapplied, and she soon recovered.

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Case X. (A patient of Mr. Fry of Dursley,) Mrs. B. ætat 23, was seized with puerperal mania the second day after parturition, and became totally unmanageable, refusing food and medicines. The antimonial ointment was rubbed along the inner surface of the forearm, from the joint to the wrist; but a fortnight elapsed before a vesiculated eruption was brought out. As soon as the eruptions appeared, amelioration of her symptoms was evident." She was kept under the influence of the medicine nearly three weeks, during which time she progressively improved. During the external applications she took occasional purgatives, and a solution of tartarized antimony internally in nauseating doses. Considering that this was puerperal mania, and that the other means were pretty efficient, we can hardly agree with our worthy author, that her restoration may be chiefly imputed to the ointment."

Case XI. The eleventh case was insanity unconnected with pregnancy. The disease was removed by the ointment; but the patient relapsed, and when the work went to press, her friends were endeavouring to get her into Saint Luke's.

Case XVI. We shall pass on to the 16th case, the intervening ones not being particularly interesting.

Mr. F. S. ætat. 37, a hard drinker, caught cold in an open carriage, which was succeeded by hæmoptoe. His respira

ration, at the time of report, was very quick and difficult, with cough, and expectoration of viscid phlegm. Has been bled repeatedly during his illness, now of thirteen weeks du ration, and with some relief. Last of all he, used the ointment, which excited a very irritative crop of pustules on the chest. When they were fully formed, and had discharged, the patient found great relief of respiration, but not so decidedly of the cough. In another month the patient was farther improved, but the account breaks off, when he was very far from well.

Case XVII. This was a man, 40 years of age, apparently phthisical for 25 years past, and subject to attacks of hæmoptoe.

"After being severely indisposed with affections of the chest, viz. cough, and impeded respiration; he was seized, last summer, with a dangerous recurrence of the haemorrhage. It was concluded that he had pulmonary consumption in the last stage, and the case afforded every indication of terminating fatally, but the hæmoptoe, which became more and more violent, was at last arrested by superacetate of lead, and the tart. emet. ointment was applied to the chest. As soon as the eruptions vesiculated, he got better; when they died away, he began again to feel uncomfortable about the chest, complaining that he felt "plugged up in breathing." He finds immediate ease by a renewal of the eruptions, and has, in consequence, continued under their influence for nearly twelve months past. His skin is so irritable, that pimples almost immediately follow the application, though in some individuals three days will elapse before they will be excited. The ointment gives him most relief when applied to the opposite side of the chest to that most affected." 23.

Case XVIII. We marvel much that our able and intelligent author did not place the following cure to its real cause the removal of obstruction from the hepatic duct, rather than the application of antimonial ointment. We shall give the case entire, that our readers may judge for themselves.

"John Gay, 39 years of age,-Was taken ill about four months ago, with feelings of languor and nervous debility, accompanied with dyspepsia, bilious and acid eructations: he had also pain in the right hypochondrium, dry sore throat, and general feverishness. With these symptoms he had pyrosis. His complaint continued to grow worse, especially a dull pain which had been going forwards in the region of the liver, till he was seized with symptoms of complete obstruction of the common duct of the gall-bladder. His skin became tinted with a deep blackish yellow colour. The food and medicines which he took, for some time after the symptoms of of obstruction, regurgitated in an unaltered state, from the stomach.