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commends the practice of repeatedly exhibiting Dovar's Powder, or a fudorific opiate, in concuffrons of the brain; inftead of following the common method of ufing evacuations by bleeding and purgatives, and making openings through the skull by means of the trephine.

Though we defigned only to give a bare tranfcript of the titles of the Author's chapters, yet the importance of the prefent fubject obliges us fo far to depart from this plan, as to ani madvert particularly on a propofal to difcontinue the prefent. rational practice, of emptying the fyftem in general by bleeding and other evacuations, and of perforating the cranium, when there are fufficient grounds to believe that the brain, or its membranes, are affected by the preffure or acrimony of a fluid extravafated there while we are advised to substitute, in the place of thefe means of relief, the exhibition of opiates, on fuch fender, or, at leaft, dubious grounds as the following:

We are told, in the first place, that the common practice will not always fucceed ;-that a certain Empiric, as our Author has been informed, had often given relief in injuries of this kind, by means of opium;-that the practice of evacuating, &c. in, the prefent cafe is founded' (as our Author erroneously infinuates) on our fixed idea of inflammation, which is fuppofed. to be owing to obftruction, and to be kept up by a plethora; but that inflammations are frequently caufed by fpafms, and opium is the most likely remedy to take off fpafin;-and finally. that the Author had ufed this remedy to many without înjury; and that of four cafes in particular, here related, in which it was exhibited, three terminated happily.

It may however be objected that toward the latter part of the preceding fummary, we have not done juftice to the Author's propofal;, or given, in its full ftrength, the fubftance of the following paragraph; which we fhall therefore tranfcribe.

I cannot fay, fays Mr. B. that I ever knew any one the worfe for taking this anodyne fudorific, though I have given it to hundreds; but, on the contrary, patients, labouring under the fymptoms of concuffion, were by this method recovered, and, two in particular with fractures of the fkull, without the opera tion of the trephine being performed.'

Here the Reader is first told that the medicine has been given, with fafety, to bundreds.' It may firft be afked, to how many hundreds, and fill more properly, what were their ailments? Were they flight colds, with running at the nofe--or fractures of the skull, attended with concuffion?-Not the latter certainly; for in the next member of the fentence, where the Author particularly names fymptoms of concuffion,' the indefinite term, patients,' only is employed, without the moft diftant hint of number; though it is now palpably on the decline. And,

laftly,

laftly, when the Author mentions cafes attended with fractures of the skull, he abruptly and rapidly finks from his hundreds, down to number two.

What a loose, indifcriminate, and poffibly fallacious manner is this of enabling a Reader to form a juft estimate of the utility and fafety of a new and, feemingly at leaft, hazardous practice-in a cafe where the furgeon probably, to use the words of Pliny, quoted by us on a former occafion, is Vitæ necifque noftra imperator!-The Reader is likewise to obferve that when the three fuccefsful cafes are related, they are not mentioned as extracted from hundreds, or any smaller number, of a fimilar kind: nor indeed are the cafes themfelves, or the treatment of them, fuch as, by any means, juftify the Author's random declaration at the end of the recital; that he firmly believes that the greater part of these patients would have died, had they been treated in the ufual manner, the trephine applied, &c.

But granting, for argument's fake, that opiates might be. fafely, and even with advantage, administered to a patient already perhaps comatofe, and deprived of fenfe and motion, in confequence of a violent concuffion of the brain, a rupture of its veffels, and the confequent preffure, or acrimony, of their extravafated contents; furely this new practice ought only to have been propofed as an auxiliary occafionally to be employed in conjunction with those already univerfally adopted. Whatever realons, theoretical or practical, may have induced the Author to entertain a favourable opinion of the practice here propofed by him, they certainly cannot juftify him in recommending it in fo unguarded a manner as he has here done; apparently to the total exclufion of the most obvious and palpable means of relief. And yet the Author does not appear inclinable that these last should even co-operate with the noftrum, or have any fhare in the cure to be effected by it; though he brings no objections to their ufe, except that they are not always fuccefsful..

Although Mr. Bromfield acknowledges that he at first purfued a trimming fyftem; mifled by his attachment to long-eftablifhed practice, and intimidated probably by the formidable or fufpicious aspect of the new medicine: yet he advises others to bave no fuch qualms; and incites them, both by precept and example, boldly to persevere in it, without halting between the two opinions, as he did; when not finding the patient greatly relieved by the firft dofe, he fled to evacuations, fufpecting a fecond might do mischief.'-On the contray, Aut non tentes,' fays he, vel perfice.'-That is, in plain English, truft to the powder, and let the patient take his chance. Though the most

* M. Review, vol. xl. March 1769, p. 210.

decifive

decifive figns fhould appear that the dura mater is detached from the cranium, and the brain opprefied with extravafated blood, lymph, or matter, do not let it out; the powder provides for every contingency; it will make the abforbents do their office and fuck it up again; and a copious fweat will fend it out of the fyftem. The patient lies ftupid and fenfelefs through fpafm; and opium is a fovereign remedy against fpafm.-Such, at least, is the general refult of the Author's reafonings and precepts; or the impreffions they are naturally fitted to produce on the minds of his Readers.

We have not been induced to dwell thus long on the prefent fubject from bigotry to ancient practices, or through a spirit of cavilling; but on account of its great importance, and through an apprehenfion that this new method of treating concuffions of the brain may be improperly pursued, while other means are neglected, by a rafh prefcriber, or a timid operator; naturally influenced in favour of it, by the weighty recommendation of a gentleman who has, we doubt not, defervedly acquired a confiderable degree of eminence in his profeffion. The matter is certainly of the laft importance; it is not corio, but cranio humano ludere: and how much foever we may deplore the want of fuccefs, that often attends the ufual attempts to relieve an oppreffed brain; yet certainly the furgeon who lofes his patient, after having followed the prefent practice, founded apparently on the most rational indications, will have a confolation which can scarce be the lot of another, who has loft his, after having folely trufted to the ill-afcertained virtues of an antifpafmodic or fudorific powder.

In the remaining part of this chapter, the Author relates the happy effects produced by iffues made in the interval between two ribs, in complaints of the cheft, and particularly in cafes which threaten to terminate in a confumption. He afterward fhews that great advantages may be derived, and have been experienced by him, from incifions properly made on the whole length of the additamentum of the temporal future. They are faid to have been found ferviceable in removing fymptoms that have remained after violent concuffions of the brain; and not to have been lefs beneficial in the gutta ferena, coníequent to an extravafated fluid preffing on the optic nerves, as well as in epileptic fits. We have already given the titles of the fucceeding four chapters, which are followed by the fixth, in which the Author treats of the Reduction of the Os Brachii when diflocated.' An Appendix terminates this volume, containing, principally, obfervations relating to the ftopping of hæmorrhages.

In the fecond volume the Author treats in chap 1, Of the Difcafes of the Bones; in chap. 2, Of the Rickets; 3. On the Contufion of the Synovial Glands; 4. On Fractures; 5, On

the

the fractured Patella; 6, On fractured Ribs with Emphysema; 7, On Compound Fractures; and chap. 8, 9, and 10, with the last of which the work is terminated, contain fome obfervations On the Stone, on the Operation of the Lithotomy, and on the Diseases of the Urethra.'

Though many really useful remarks are to be met with under fome of thefe heads, their utility is confiderably leffened, and their merit obfcured, partly by the manner in which they are prefented, and partly by the intermixture of materials of a very inferior quality. Among thefe we may reckon those parts of the work where the Author undertakes to theorize, or to enter into phyfiological difcuffions. One specimen will be fufficient to justify this laft remark.

In treating of the theory of inflammation (vol. i. p. 65, 66.) the Author fpeaking of the globules' of the blood which drop, during phlebotomy, on the furface of the mafs coagulating in the porringer, obferves that from the appearance of the blood running on the furface of the coagulum, we might conclude it to confit of globular particles; but experience fhews, these globules contain particles that are angular and aculeated; for, when their cyfts are broken by beating them well with a stick in a bafon, their contents fubfide, and the cyfts adhere to each other, and form what is called the fibrous part of the blood, which being taken away, the remainder will never after separate into traffamentum and ferum, but continues a feemingly homogeneous fluid, denominated, perhaps too hastily, a broken ftate of the blood. This easy experiment fhews, that thefe red particles, and the falts of the blood, are not globular, as the fpicula of thefe falts, acting on the coats of the arteries, occafion a brifker circulation, which, being continued, produces a fever.''

At the beginning of this ftrange paragraph the Author evidently appears to confound the red globules, which can only be discovered in the blood by means of a microfcope, with the large drops of blood that proceed from the arm, in venesection, and which fometimes preferve, during a short space, their fpherical figuré unaltered, on coming into contact with the blood contained in the porringer. The coagulable lymph which phyfiologifts have difcovered to be a component part of the blood, is here defcribed in fuch a manner as fcarce to be known again. It is represented as conftituting certain cyfts or tunics, invefting the aforefaid large drops, burft by the ftrokes of the ftick, and difcharging, on their rupture, certain angular and aculeated particles, which are here faid to be fhewn by experience.' This prolific but eafy experiment' likewife brings to our view the falts of the blood,' the spicule of which, we are told, produce fevers; nay, it further fhews that neither thefe Spicula or the red particles are globular.-What a train of errors,

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or misconceptions, and what a ring of erroneous deductions from them, are comprized in this fhort paragraph!

In the foregoing obfervations we have principally, indeed almoft folely, dwelt on fome of the more obvious imperfections of this work; which we could not, with any regard to our own credit, pafs over in filence, or without particular animadverfion. Notwithstanding thefe and other blemishes, we fhall repeat, that many pertinent hints, and useful obfervations and improvements, particularly relative to the operative part of furgery, are to be found, scattered in different parts of this performance, which merit the attention of practitioners. Had not the work poffeffed fome fhare of merit, we should not have bestowed so much attention upon it.

B-y.

MONTHLY CATALOGUE,
For MAY,

MEDICA `L.

1774.

Art. 16. Experiments upon the Human Bile; and Reflections on the
Biliary Secretion. By James Maclurg, M. D. 8vo.
Boards. Cadell. 1772.

WE

3 s. 6d. VE find ourselves fo largely in arrear, with refpect to medical articles in particular, that we are under a neceflity of giving only a fummary and fuperficial account of fome of these productions, that might be thought deferving of a more particular notice. With regard to the prefent work, however, we should obferve that it has been rather accidentally overlooked by us than neglected. It contains an account of several experiments made by the Author on the human cystic bile, with a view to throw fome light on the nature of this fluid; principally by mixing it with the different mineral and vegetable acids, and marking the phenomena refulting from their action upon it. Thefe experiments lead the Author to refults very different from thofe of preceding enquirers, who have attempted the analysis of this fluid. They are followed by reflections on the nature of the biliary fecretion, and on thofe parts of the animal economy that are connected with it, particularly on the influence of the bile on digestion, and on temperament; as well as on the difeafes produced by a redundancy of that fluid. The work is terminated by. fome obfervations on the nature and formation of biliary concretions, which, the Author fuppofes, may poffibly be produced by a coagulation of the bile by means of an acid generated in the ftomach or duodenum.

We must not pass over, without fome notice, the Author's ingenious and well-written introduction, in which he endeavours to evince the utility of theorising in phyfic, and to fhew that the progrefs of fcience is quickened by the contentions of rival theorifts. The practical errors, however, into which we may be led by an erroneous theory, he acknowledges fhould induce us not to be wedded to a fyftem, but only to treat it as a mistress.-But a miftrefs will often make Rev. May 1774.

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