348 Tour, &c.....Dr. Parry on Mr. Bell's Anatomy. this building, which a few hundred pounds would finish, and make an ornament to the city of Dublin, has food for near twenty years in a three-quartererected state, as if fhivered to pieces, and rent afunder by a thunder storm. SIR, repeating thefe experiments." Coffeeus, and Valverdi, and Hoffmann, are quoted as mentioning certain facts relative to a fhe-goat, a young man at Pifa, and certain Affyrians; and Valfalva (whom, I obferve, Mr. BELL always calls Vasalva), Van Swieten, Pechlin, Lower, Drelincurtius (whofe name is printed Drelincartius), and even Morgagni himself, are all alike cenfured for propagating, or deigning to inquire into thefe idle tales. Having given this advantageous fpecimen of his modefty, his literature, and his logic, Mr. BELL next does me the honour to advert to me. I beg leave, in order to avoid mifreprefentation, to quote his remarks at full length: "There is nothing new under the fun. We are continually tantalised with old tales in new forms. Who would expect to find at this very day, a practical application of the fhe-goat and the Affyrian young men? one author has published to the world, that young lady, of a nervous and delicate conwonderful variety of forms, but more especiftitution, fubject to nervous diftreffes in a ally in the head, fometimes afflicted with head-achs, fometimes with convulfions, was relieved by compreffing the carotid arteries. Often by compreffing the carotid arteries, this gentleman prevented the delirium; for all thefe complaints proceeded from a violent palpitation of the heart, with the ftream of blood rushing violently towards the head. He has feen this compreffion bring on a ftupor; he has feen it bring on a profound fleep. Is it the hiftory of this bufinefs, and joined to not a pity that he had not attended more to thefe facts, the ftory of the fhe-goat and the young men of Affyria? IT T was not till yesterday, that I happened to see a work intituled, "The Anatomy of the Human Body," by Mr. JOHN BELL, furgeon, of Edinburgh. This work contains excellent engravings, and much useful anatomical information; but is debased by a ftile of the most dogmatical affertion, by a puerile affectation of pleafantry, by frequent mifconception and mifreprefentation of the opinions of others, and by the moft fcurrilous abufe of all living authors. I have had the misfortune to be plentifully splashed by this writer, in his headlong plunge into the foul fink of obloquy. He attacks, with much acrimony, certain opinions contained in a paper on the medical effects of arterial compreffion, which I fent, nearly ten years ago, to the Medical Society of London, and which is inferted in the third volume of their Memoirs. This attack I might, perhaps, have wholly difregarded, or at least, might have omitted to repel it, till I could have done fo at greater length, in a larger work, which I am preparing on the fame fubject. But as the period of my intended publication muft depend on my health, my leifure from profeffional avocations, and many other circumftances, connected with the times, and totally uncontroulable by me, and as, in the mean while, Mr. BELL'S work will probably have a wide range, and occafion a mifchievous prepoffeffion nofe, wounds about the jaw, cutting the paagainst the purport of my paper, I feel rotid gland, or operations about the tonfils, or myfelf called upon for a defence, which tongue! But there is a dangerous mistake here; for there is, as I know by much exI cannot offer to the public through a perience, a wide difference betwixt preventbetter channel, than that of your imparing the pulfe of an artery, and fuppreffing tial Magazine. Mr. BELL begins with telling us, that the antients called certain arteries carotids, or foporiferæ, believing that, if they were tied, the perfon would fall afleep; and then proceeds to deny that tying them would produce fleep, because he cannot comprehend how this fhould happen. As, therefore, that gentleman cannot himself comprehend how this fhould happen, it follows of courfe, that many of the best anatomists, in the best age of anatomy, have abused their time 66 "If what Dr. PARRY fays, be true, that in lean people, in women at leaft, we can, by reclining the head backwards, comprefs the carotids entirely against the forepart of the neck with the finger and thumb; why, then, we need have no fear of hemorrhages of the the flow of blood through it. In the cafe of the Dr. Parry on Mr. Bell's Anatomy. the pulfe of the femoral artery with my forefinger, I could not command its blood with the whole strength of my body, but have feen it, with horror, rush as freely as if my hand had not been there." Vol. 2. P. 256, 257. There is nothing new under the fun. Of the truth of this general principle, our author affords an excellent illuftration. It is not new for a man to treat with ridicule what he has not the opportunity, the capacity, or the inclination to underftand. If Mr. BELL had read the paper which he criticifes, he would have feen, and then poffibly might have believed, on my affertion, that my idea of compreffing the carotid arteries was fuggefted by the actual phenomena of the difeafe before me, and not by the tales which he reprobates; whether those tales were well or ill-grounded. But the knowledge of this fact would not have fuited his purpofe. It would have taken away an opportunity for much declamatory invective. It would have been fomething new to Mr. BELL under the fun. In reality, at the time of my writing the paper alluded to, I had never read thefe hiftories and remarks in Galen, Rufus Ephefius, Morgagni, or any other author; and if I had, I should not have formed from them the conclufions which I have related. Phyficians, in all fucceeding ages, have read them without any fuch application; nay, Mr. BELL himfelf, who cannot, furely, be fufpected of giving another more credit for fagacity than he does himself, has ftudied them with great attention; and yet, at this moment, he is fo far from having deduced from them any valuable conclufons, that he derides the important theory to which he ignorantly afferts that they have given birth. It is true, that I have mentioned ftupor and fleep, as produced by compreffion of the carotids. I have mentioned them, because I saw them; and could I have anticipated the critique of Mr. BELL, I fhould not have omitted to mention them, out of compliment to the fcepticism of himself, or any other human being. Now, however, that he cannot controvert the fact, he may congratulate himself on having found fomething new under the fun. So much for the origin of this difcovery. Next as to its effects; as Mr. BELL has, in the first paragraph which I have quoted, accufed me of drawing from a fource which I had never vifited, fo in the fecond he afcribes to me words which I have never employed, and deductions 349 which I have never forined. He makes me fay that I can entirely compreis the carotids with iny finger and thumb. This is a total mifreprefentation of my words, which muft greatly mislead all those who are inclined to repeat the experiment. In reality, after having remarked the difficulty of compreffing one carotid in men; and the till greater difficulty of compreffing both, especially in a state of convulfious, I add, "In women, however, who have generally longer and flenderer necks than men, one can often, without difficulty, produce a complete compreffion of the artery against the vertebræ of the neck," &c. "Medical Memoirs,” vol. 3, p. 100. Instead of the carotids, I fpeak of one carotid only; and instead of ufing my finger, or my finger and thumb, for the purpofe of preffure, I have never been able effectually to fucceed in any other way than by ufing the thumb only, while the neck is at the fame time kept firmly in its place by preffure on its back with the unemployed fingers of the fame hand. With me, who have probably made the experiment a hundred times as often as any other per fon, all attempts to make a competent preffure on an artery with my finger, have uniformly failed: Neither, it feems, have the effects of Mr. BELL in this way been more fuccesful. When he makes the experiment in a proper manner, the event may poffibly be different. ap But we will for the prefent fuppofe him to deny the poffibility, on any occafion, of completely compreffing with the thumb one carotid artery. The evidence on which I founded my affertion was, that in the inftances to which I alluded, all pulfation in the temporal artery was deftroyed by the compreffion of the correfponding carotid. But Mr. BELL informs us, that though he could fupprefs the pulfe of the femoral artery with his fore finger, he could not command its blood with the whole ftrength of his body (I fhould be curious to know how he plied the whole ftrength of his body by means of his fore finger), but faw it with horror ruth as freely as if his hand was not there. Does he in the first part of this fentence mean, that he fuppreffed the pulfe with the compreffing finger, fo as no longer to feel it with that finger, in the point where the compreffion was made? He certainly cannot have this meaning. The conclufion would be too frivolous. He muft with us to understand, that when he had compreffed the artery above, fo as to obliterate the pulfe below, the blood ftill continued to rush from below as 350 Dr. Parry on Mr. Bell's Anatomy. as ftrong as if there was no preffure. Credat Judeus Apella! Till I have myself seen a firm compreffion on the femoral artery with the finger, or any other fixed power, obliterate the pulfation of the popliteal artery, and yet the blood rufh through that artery when divided, as freely as when the preffure fhall have been removed, I fhall beg leave to doubt. I will not affront your readers by demonftrating, that fuch an affertion cannot be true. Mr. BELL must have been deceived. If the fame quantity of blood paffed through the artery in a given time as before, he could not have diminished its area by compreffion. That the femoral artery, deeply feated as it is in its leaft covered part, and imbedded in yielding, mufcular, and cellular fubftance, fhould be much, affected by the compreffion of the finger, is what indeed I should not à priori have expected; though Mr. BELL himself, after having, as from his own experience, denied the poffibility, in the words which I have quoted, acknowledges,on a fubfequent occafion, page 456, that though it is not an eafy thing, it is, perhaps, not impoffible." To obliterate the pulfe below from compreffion above, is, on many occafions, fufficiently eafy. Leaning the arm over the back of a chair will ftop the pulfe in the radial artery; and the fame thing has often been done by perfons, for fraudulent purpofes; merely by preffing the inward part of the humerus ftrongly against the fide. The effect of a tourniquet in this view, even on the largest arteries to which we have accefs, is tolerably well known to MF. BELL; and I, who do not profefs furgery, am acquainted with no criterion by which we are to judge that the purpose of that inftrument has been anfwered, but the failure of the pulfe in fome part, or branch of the artery more diftant from the heart. It is poffible that the flow of blood through the compreffed artery, is, in neither of these cafes, entirely impeded; and whether the area of the carotid artery can be fo diminished by the preffure of the thumb, as to anfwer the purposes of a furgical operation, I will not pretend to decide; and I prefume no one, except in a cafe of fudden neceffity, will be hardy enough to try. It is, however, true, that I have often moft evidently moderated bleeding at the nofe by imperfect preffure for a few feconds on one carotid; which is as much as can reasonably be expected by thofe, who confider that fome of the arterial branches distributed within the nofe are derived from the internal carotids, which anastomose with each other, and within the vertebral arteries with the cranium. Mr. BELL quotes Acrel, who fays, that he stopped a hæmorrhage of the femoral artery, after every other meafure had failed, by ftrongly refting with his thumbs against the external iliac in the groin. Page 456. The compreffion of the carotid is at least as practicable as that of the external iliac artery, not only on account of the interpofition of very little foft fubftance, but because the vertebræ of the neck form an extensive, hard, and immoveable pillar, against which the preffure may be made. That fome circulation continues in certain cafes of Syncope, whether from furgical operations, or other caufes, there is little doubt. I will not however admit that what Mr. BELL calls "a hysterical faint," is a cafe of Syncope; the face in that ftate, is all the while more or lefs ruddy and warm, the refpiration free, the pulfe good, and the circulation in other refpects perfect; it is an example of ftupor, of the fame nature as that which follows the Epilepfy. I beg leave to point out to Mr. BELL, that this diftinction between these two cafes, founded on the actual phenomena, is a third instance of fomething new to him under the fun. When I fpoke of compreffing the carotid arteries, it was with a view to fhew that manydifeafes arife from too great a momentum of the blood, through thofe veffels into the head; and I pointed out the effects which I had obferved from preffure on the carotids, and certain beneficial conclufions in practice, which had refulted from those obfervations. Whether I could entirely intercept the blood that paffed through the carotids to the head, or not, was to me of no importance. For my purpose it was fufficient, that I could intercept a confiderable part. All this Mr. BELL does not appear to have understood; but, begging the question that the whole was a filly old tale, tantalizing by an affectation of novelty, proceeds to examine the merits of the operation, as it might be applied to Surgery, of which, at the time, I never thought. This irrefiftible direction of all the ideas to one point, is often a very ferious malady. But when the object is innocent, the patient is fuffered to walk abroad unattended. Every one has heard of Jedediah Buxton; who, though unable either to read or write, multiplied nine and thirty figures into each other by memory only. In London, they took him to Drury Lane, and to St. Andrews Dr. Parry, of Bath, on Mr. Bell's Anatomy. Church in Holborn. It might be expect ed that he was aftonished at the fublime combinations of mufical chords in the blind Stanley, and melted by the unaffected pathos of Garrick. Nothing lefs. He made himself mafter of the exact number of words, fyllables, and letters pronounced by Garrick; but the rapid execution of Stanley defied his powers of reckoning, and he returned home abashed, as under irretrievable difgrace. Jedidiah Buxton was an Arithmetician. Mr. BELL is an Anatomist. Although that Gentleman could not advert to the confequences which I drew from the compreffion of the carotids, I must beg leave to repeat them for his benefit. I learnt from it, that all nervous difeafes depend upon irritation of the brain, either from nechanical ftimuli, or the fulness of its veffels; and that in every constitution, without exception, they are to be cured, if at all, by thofe means which diminish the flow of blood to the head. I learnt from it, that all tonic medicines, as they are called, full diet, wine and all other cordials and general ftimulants, are injurious; and that the only efficacious remedies, are as low a diet as the digestion will allow, uniform and gentle exercife, and perfeverance in evacuants, fedatives, and thofe remedies which are called febrifuge or refrigerant. I inferred that, among the evacuants, the chief confidence was to be placed in bloodletting, not with a view of preparing for tonics, as recommended by Sydenham, nor in order to counteract accidental plethora, or to relieve a particular fpecies of a genus, as by my late revered mafter, Dr. Cullen; but frequently, and in fmall quantities, as a radical, and generally indifpenfable remedy. And during eleven fucceeding years, I have had the fatisfaction (one of the greatest which the human mind can feel) of finding that my theoretical expectations have been infinitely more than anfwered by practical fuccefs. Thus a clafs of difeafes, which were before confidered as incurable, are now as abfolutely within our power as the most obvious inflammations. Mr. BELL, if he would, or if he could, might have profited from the principles which I have laid down; and then he would have had no reafon to complain of my having inflicted on him the torments of Tantalus. Is it my fault, if his mind is its own tormentor? At prefent it seems that this practical fyftem of nervous diseases is a thing new to Mr. BELL under the fun. Permit me, fir, to add with confidence, that when Ar published, it was equally new to MONTHLY MAG. No. XXXI. 351 others; for I will venture to affert, that "Medical Memoirs:" my fuc Excufe my thus dwelling on myself. I am compelled to do so, left hereafter, when my method of cure in fuch difeafes comes into general use, as it certainly will, fome future Mr. BELL, envious of a difcovery which chance allotted to another, may rake out from amidst the dust and mould of a College library, fome dark paffage, in which he may develope my whole fyftem; and then, like his worthy predeceffor of the prefent day, exclaim, THERE IS NOTHING NEW UNDER THE SUN. With this gentleman, fo far as refpects, myfelf in particular, I have now done. But I beg leave to add a few words on behalf of fcience in general. It is usual with authors to difcufs grave fubjects in a grave manner; and one would have thought, that the importance of pathological inquiries would have fecured them from all admixture of levity. But Mr. BELL's conftitution is fuch as to defy all common rules of conduct. Almost in the fame page he dictates, and pouts, and fcolds, and laughs, and cries; and each. fo immoderately, or in fo wrong a place, that one cannot avoid picturing to one's felf a fine lady in a fit of hysterics. It may. reasonably be hoped that age, and a little whole fome mortification,will diminish this irritability of Mr. BELL's nerves; and then, probably, medical fcience will owe much future obligation to the acuteness of his genius. I am, fir, &c. &c. Bath, April 22, 1798. C. H. PARRY. For the Monthly Magazine. A DIALOGUE IN EMPYREUM. L. R OYAL martyr, brother of my fate, take me to thy embrace. With thee at least I am fecure of fympathy, the only alleviation my hard lot admits. C. Hail, brother! L. It comforts me that I have burst, although by death, my bonds, that I breathe not in the fullied prefence of those wretches whom I remember the dependants of my nod, the creeping flatterers of my power, who won my confidence, like Dalila, to fhear me of my strength, and who have fince announced their influence over my people by a climax of Z z horrors 352 A Dialogue in Empyreum, between Louis XVI. and Charles I. horrors, by plunder, by affaffination, by regicide. C. If fympathy be thy only wish, feek it rather among the kings who have feared than among those who have undergone thy fate. A hundred and fifty years refidence in Empyreum is a marvellous corrector of impaffioned judgments and fierce refentment, when we have much converfed with men of other times. L. Was ever prince mifufed like me? Always diftinguished for love toward my fubjects; did I not employ Turgot to please them the Americans to pleafe them-call the States-General to please them-accept the conftitution to please them; and for all this, their ingratitude annihilates my income, traduces my character, and as my fources of influence abate, they drag me from the throne to a dungeon, and thence to a fcaffold. C. Let us analyze the benefits you enumerated. About the year 1774, the philofophic fect of Phyfiocrates was already organized into a political body, which had friends in moft of the great incorporations of France, in the chambers of commerce, the magiftracies, the parliaments. Some powerful families among the nobility, who pleased not at your court, fupported this faction. L. Only the Rochefoucaulds-thofe hereditary heretics. C. A fedition broke out in the metropolis. You was alarmed, and accepted at their hands Turgot for minifter, under conditions which you fubfcribed, like a conquered enemy. Security was foon restored, and reformation began. But Turgot having the weakness to believe, that the opinions of the wife will never be thofe of the people, continued the retrictions of the preis. He formed, therefore, no barrier of public opinion against court-mutability; and, as foon as the Parifians had forgotten politics, to enter into Rouffeau's quarrel about their mufic, Turgot found his fupporters purchafed, undermined, deterred, diftanced, diffipated-and had to refign. L. It was not I who difappointed this minifter of influence, but the management of the queen's advifers. C. France is not the only country which a double cabinet has condemned to fluctuating counfels. Your next minifter was NECKER, a man whom Turgot had oppreffed for writing in favour of limitations upon the corn trade-a moderate man in temper, in abilities, and in opinions. You chofe him because the Paris bankers would lend to no one elfe. His talents, as a financier, the enemy of your enemies applauded in the English parlia ment, whilft he was borrowing capital to pay the intereft of the French debt, and thus, by the accelerated operation of compound intereft, was fecuring that financial catastrophe. L. Which the church-lands and a tax upon noble eftates might easily have averted. C. Not expecting, however, the fabmiffion of thefe powerful orders to your authority, like vulgar bankrupts, you fummoned a meeting of your more notable creditors, relations, and friends, who advised the convention of the state; after which, even CALONNE dared not help you through without convoking them. L. Ah! C. Of all your boafted conceffions thus far, which of them could you have avoided? Which of then was even made with a grace? Which of them was not the obvious preference between two evils? L. The the declaring for the Americans. C. And you will be rewarded for it by the generous pity of American and Englith republicans. Yet, even in this cafe, was you not a little eager to busy fome stirring fpirits among the more gallant, of your nobility? To avoid a civil, wage a foreign war, is an old adage of profigate ftate-craft. fo. L. Some people about me might reafon C. The ftates met. Is there a fingle boon they owe to your generofity? Your people pulled down the Baftille, or you would have iffued lettres de cachet against their members. Your foldiers refufed their bayonets, or you would have overawed their deliberations, and have L. Not I, not I, others might withC. In a word, you found that public opinion, and confequently public force, was at the command of thefe national affemblies. They raifed NECKER to the clouds when you wanted to difmifs him, in order to fhew him independent of you. Reftored at their bidding, they fuffered him to refume his pompous importance. L. A curious proof of the caprice of popular affemblies. C. The conftituting a popular affembly! Yet De Retz faid to me, after the 4th Auguft, you fee all great bodies are populace; when they are not puppets." L. Puppets!-are fenates ever To? I feel that kings may C. And fometimes, as in your cafe, fhould. Your vetes, when exerted at the requeft of a party, always drew attention, even after your captivation. |