potash, which is strongly recommended, but we know not upon what authority. Opium, Dover's powders, and the nitrous spirit of ether, are indiscriminately prescribed at bed-time, as if they possessed similar virtues, and were equally applicable in all cases and if subsultus tendinum supervene, ether, camphor, ammonia, castor, and musk, are recommended en masse, while opium, which is probably equal to all the rest taken together, is neglected. Finally, we are told that "sedative and antispasmodic remedies may also be employed externally by means of friction;" here, as in the former instances, we should have been glad to have seen some authorities quoted. After this comes a pretty copious detail of the employment of the cold affusion, professedly taken from the medical reports; it is fairly stated, though certainly out of place; the cold affusion is the most applicable, indeed almost exclusively so, in the early stages of the disease. Of typhus gravior the author attempts a new definition. "Morbus contagiosus; calor intensus et mordax; pulsus durus, parvus, debilis, plerumque frequens et abnormis; nausea; vomitus bilis subviridis vel nigri coloris; vultus rubore suffusus; lingua plerumque arida et nigra; urina parum mutata; vires maxime imminutæ plerumque cum petechiis; sitis inSedabilis." We must beg leave to criticise some parts of this definition. Though the pulse may be occasionally hard, this state is by no means characteristic of the complaint, or very generally present in it; the vomiting of bile is quite an accidental circumstance; and the redness of countenance is so far from being a constant symptom, which should enter into a definition, that we believe the contrary state of pallidness is a more frequent occurrence. The directions given for the treatment of typhus gravior, considering that they only occupy three pages, are upon the whole not injudicious, though we observe a little of that trifling which we noticed in the former chapter. Clysters of carbonic acid gas are recommended; the sulphuric and muriatic acids are advised to be mixed with the patient's common drink; swelling of the parotid glands is spoken of as an usual occurrence, and we are told that "it will be most advisable to make an incision into the tumour, without waiting for a fluctuation, or even a softness of it." The cold affusion is recommended here, as in the former case, towards the conclusion, not brought forwards in the commencement to strike at the roots of the disease. Upon these we make no comment. We shall give our readers one more example, in Dr. Clarke's account of the treatment of the cynanche maligna. We must begin by remarking, that this disease and the scarlatina are placed in different parts of the work, according to the nosology of Dr. Cullen; and the author gives no intimation of the opinion entertained by a great number, if not the majority, of the most respectable practitioners, that they are only modifications of the same disease. Our author has stated, at full length, the diagnosis which was laid down by Dr. Withering, though, in a subsequent edi tion of his treatise, this judicious physician recanted his former opinion, and considered them as originating from the same contagion. In the commencement emetics are recommended; then he directs the mildest laxatives, but particularly specifies, in the same sentence, mercurial cathartics. We are afterwards advised to apply "small repeated blisters" to the external fauces, although Dr. Withering, and after him Dr. Currie, conceive them to be of no use. Gargles of different compositions are then directed, and afterwards we are told that "wine, opium, the cinchona, acidum muriaticum vel sul. phuricum, and the other remedies recommended in the treatment of the typhus gravior must be employed with assiduity." Such general and vague directions can be of little use in guiding the practitioner in doubtful cases, or in informing him at what period these powerful remedies are to be begun, to what extent administered, and when discontinued. We have next some observations which are not injudicious, upon the method to be pursued, if diarrhoea, vomiting, or suppression of urine supervene, and, as usual, we find at the end of the chapter some suggestions modestly stated in the form of queries. Might not small electric shocks, passed frequently through the tonsils, be of service; or might not the other sulphuricus be applied to the external fauces with advantage?" The reader will notice that not a word is said about the cold affusionin the treatment of this disease. These examples will be sufficient to give a fair idea of the merits and defects of Dr. Clarke's performance. The articles which we have selected for animadversion are important in themselves, and at least as well digested as the other parts of the work. It will be admitted that it is a very inadequate guide for practice, at the same time that it is no way calculated for popular perusal. Dr. Clarke has indeed taken care to remove his work from vulgar use, by introducing technical terms on every possible occasion. In speaking of the external applications for phlegmon, he recommends the murias ammoniæ, half an ounce dissolved in a pint of the acetum," in plain English, sal ammoniac dissolved in vinegar; then we have a composition which contains "a tea spoonful of murias sodæ”, id est, common salt. But this is not all; the author, though writing and publishing in London, has chosen to dignify his performance with the splendid nomenclature of the new Edinburgh pharmacopeia. In one place we have the decoctum anthemidis nobilis recommended, which, after some reflection, we discover to be our old friend chamomile tea. Many of the chapters are concluded by queries, some of which we think very fanciful and trifling, while others manifest an extraordinary deficiency of information. In speaking of the cure of agues, he asks whether the atfusion of cold water, or brine, might not be employed with every prospect of success, immediately after the hot fit is completely formed." This, every one knows, is the identical practice which is most accurately laid down by Dr. Currie; and still more unaccountably overlooking the discoveries of this celebrated and much-lamented physician, Dr. Clarke concludes his account of scarlet fever by asking, "might not the affusion of cold water, employed with the precautions mentioned when treating of typhus, extinguish incipient scarlatina?" Art. IV.—The Philosophy of Physic; or the natural History of Diseases and their Cure: being an Attempt to deliver the Art of Healing from the Darkness of Barbarism and Superstition, and from the Jargon and Pedantry of the Schools: showing a mor, eusy and certain Way of preserving and recovering Health than any hitherto known. By the liet. WILLIAM WILSON. 8vo. pp. 329. THIS is one of the most impudent attempts to impose on the credulity of the ignorant that we have ever had occasion to peruse. Its title, we apprehend, was invented upon the old drinciple of lucus a non lucendo; for it is the very antipode of philosophy, the bathos of physic. The purport of this tissue of ignorance and imposition, is nothing less than to recommend to the public a certain powder, which, not from its appropriate virtues, but that it may have a well-sounding name, to distinguish it from the nostrums of Brodum and Solomon, is denominated the Antiarthritic Powder. To this all-potent drug, the nature of which this conscientious divine means to keep a profound secret for the good of mankind, all diseases yield at once. Every disorder, acute or chronic, bilious, nervous, inflammatory, spasmodic, visceral, or cutaneous; scrofula, cancer, consumption, siphylis, &c. &c. all disappear before the virtues of this magic powder. 66 And moreover the reverend quack (if, indeed, he really belongs to the sacred order) has the assurance to stigmatise the whole race of physicians, from Podalirius and Machaon downwards (he read of them, we presume, in Pope's Homer), and to brand that science with the charge of barbarism, the very language of which he does not understand. Thus, he says, in derision, "we read of pyrexia, of dispnæa, dispepsia, hemoragia, menoragia, hemeptoe, &c." p. xi.: from which we may judge of his complete ignorance not only of medical terms, but of that elegant and polished language of antiquity, with which it is somewhat disgraceful for one, who calls himself a divine, to be unacquainted. ART. V.-Observations on the Nature and Cure of Gout; on Nodes of the Joints: and on the Influence of certain Articles of Diet, in Gout, Rheumatism, and Gravel. By JAMES PARKINSON, Hoxton. 8vo. pp. 174. ALTHOUGH the author was incited to the publication of these observations by the appearance of Dr. Kinglake's work, and by a consideration of the danger which would ensue to the public from the general adoption of the practice which Dr. Kinglake recommends, yet it would scarcely appear that he had it in view to refute or to answer the propositions, which this gentleman has endeavoured to esta blish. His object appears to be rather to recommend a practice, which he considers as more safe and more effectual than that of Dr. Kinglake, and thus to supersede. the necessity of recurring to the latter. It seems to us, indeed, that the points to which the respective methods of Mr. Parkinson and Dr. Kinglake are more particularly directed, are totally distinct; and that, provided the latter be as void of danger as Dr. Kinglake affirms that it is, the two methods of treatment, so far from being in opposition or even incompatible with each other, might be employed in mutual aid, to effect the completion of the same desirable end, the removal of gout from the system. Dr. Kinglake's refrigerating plan applies exclusively to the acute paroxysm of gout; whereas Mr. Parkinson's method of cure, as we shall see, is directed to the prevention of the paroxysms, or to the correction of the gouty diathesis. Mr. Parkinson possessed an hereditary disposition to gout, and was attacked by it no less than fifteen years ago. Since that time he has made trial of a variety of remedies on himself, of which the application of cold water during the paroxysm was one; and it appears to have been attended with all the success which Dr. Kinglake ascribes to it. But "the suspicion that the immersion in cold water had been productive of injurious effects, led to the employment of other means. The most important among these was the fixed alkali, the beneficial effects of which appeared to be satisfactorily evident." Pref. A few years back the composition of those concretions, which form on the joints of gouty persons, was ascertained by Dr. Wollaston. They consist of the lithic acid and soda, constituting a neutral salt, a lithate of soda. The existence of this acid was also demonstrated by Dr. Pearson and M. Fourcroy in the calculi of the urinary passages. Independantly, therefore, of the previous experience of the preventive powers of the alkalis in regard to gout, which Dr. Cullen long ago noticed, it was an easy and natural step to suppose that the acid of these concretions might be arrested or neutralized in its incipient formation, and easily removed from the system. Dr. Wollaston himself offered the suggestion. The purport of Mr. Parkinson's "Observations" is, to prove the existence of the lithic acid in the humours of the gouty, and hence to recommend the use of alkaline remedies for the removal of the disease. Mr. Parkinson has shewn considerable ingenuity in the evidence which he has collected in support of this doctrine. We are indeed somewhat inclined to the opinion that, in the gradual progress of medical theories, from Stahl and Hoffmann up to their acme in the schools of Brown and Darwin, we have conceded too much to the sensorial powers of the animal body, and have unjustly excluded all consideration of the humoral changes. But mere hypotheses of the one class or the other excite little of our interest. If the prac tical deduction be clearly made out, we care little for the fate of the hypothesis connected with it. Had Mr. Parkinson presented us with a series of circumstantial and unequivocal experiments or facts, tending to demonstrate the powers of alkaline medicines in eradicating the disposition to gout, he would have claimed our unqualified praise; and he might have indulged himself, without animadversion, in the amusing fields of hypothesis. But the general impression left by the latter on the mind is feeble and transient, because the practical inference is supported rather by collateral facts, than by direct experiment. The peculiar acrimony" of which the author speaks, is something altogether indefinite; and whether it exists at all in the blood, or in what state or combination, he is altogether unable to shew. "No evidence, indeed, is likely to be adduced, to shew in what state, or in what stage of combination, the principles of this peculiar acid exist in the blood. To have the least of experiments would be required on the chance of success in such an enquiry, a series blood of the healthy, as well as on that of the gouty" (why were not some experiments attempted, before this crude hypothesis was brought forward?); " and were these experiments even to be performed, with all due ac curacy, yet positive information would hardly be obtained. "It is most probable that the uric acid would not be found to exist, formally, in the blood. A superabundance of the acid principle only might be detected in the blood of the arthritic and nephritic. That combination, from which the uric acid results, must be the work of some part of the animal system, since it is not known to exist in any of the substances which are employed as food: but in what part of the system this operation is performed, it is, perhaps, impossible at present to determine. It appears to be most probable that a superabundance of its principles are introduced into the stomach, and thence passes into the blood, forming there a saline acrimony of a peculiar kind. But that peculiar arrangement and modification of its principles, from which its existence in the actual form of uric acid proceeds, is most probably the result of the action of those vessels, by which it is also separated, an! deposited in different parts, as the kidneys, ligaments, tendons,' &c. p. 10. This is very vague; and, after all, the peculiar vascular action, as in all other secretions, is resorted to as the principal agent in these humoral changes. The author goes on to shew, that a considerable part of the aliment used by man is of the acescent kind, and that impaired digestion is a most prolific source of acidity in the human system, in consequence of a sort of fermentation, considerably different, however, from the acetous fermentation, with which it has been confounded. This "gastric acid" is the source of much mischief at all ages. In infancy it is productive of vomitings, severe gripings, and sour green stools, and probably also of rickets, by neutralising the earthy matter destined for the formation of the bones. As life advances, the morbid effects of this acid become more evident; indigestion, heartburn, pain of the stomach, acid eructations, are some of the distressing consequences which result from it. He acknowledges that he can not trace it regularly from the stomach, through its various modifications and combinations, to the actual formation of gouty or urinary concretions; but he thinks that he discovers a salutary discharge of some intermediate form of it in the lateritious sediment of fevers and of gout; and in the perspiration, especially during the critical periods of some diseases, and of gout itself. These are the two natural emunctories of the superabundant acid. "Eut in those cases where the excessive indulgence in such articles of food, as yield much of the acetic and carbonic acid, has generated a larger quantity of this acid than can be removed by the joint operation of the kidneys and skin, disease most probably will succeed. "It appears, by Dr. Wollaston's experi ments, that the uric acid, as well as that com pound of it with soda, which forms the gouty concretions, requires a very large quantity of fluid to hold it in solution. Whenever, there fore, it exists in a morbid proportion in the human system, a strong predisposition to its crystallization must prevail; and its separa tion in a solid form is reasonably to be expected. The part where this separation will take place, will necessarily depend on certain particularities in the general diathesis not perhaps to be explained. In some habits the ANN, REV, VOL. IV. kidneys will prove to be the organs destined to effect this morbid separation; in which cases, the saline concretion will be found either in the urine, bearing the appearance, or forming one species of urinary calculus. In other habits, the ligaments and tendons will be the parts on which the morbid excess of this acid will be deposited. In this case gouty inflammation will be induced, and after every attack a thickening, with a considerable degree motion, will be occasioned in consequence of of stiffness of the ligaments, and hindrance of the deposition of the gouty matter. At the commencement of this disease, when the paroxysms are slight and seldom, a sufficient opportunity is yielded, between the fits, for the absorption of the deposited matter, which is in general soon removed, and the motion of the joint in a little time quite restored. But when the paroxysms are of long duration, the intervals from disease are not suffi→ cient to allow of the removal of the deposited matter, before a fresh separation and deposition takes (take) place; hence accumulation proceeds, until considerable collections are formed in different joints." p. 23. We apprehend that the notion of the deposition of urate of soda, in the first paroxysms of gout, is altogether gratuitous; and we do not perceive clearly in what manner the sudden cessation of the inflammation of the extremities, and the consequent spasmodic attack of the stomach, in retrocedent gout, is to be explained on the supposition of such a deposition of matter. The author proceeds to enforce his doctrine, in the next chapter, by a view of the remote causes, which he divides into two classes; "such as promote the ge neration of morbid matter, and such as prevent its expulsion from the system." Among the former, indigestion, produced either by the quantity or quality of the aliments, intemperance in the use of spirits," but more especially "of wine, or of other fermented liquors," are principally insisted on. The greater acescency of wine is, in the author's opinion, one great reason why the intemperance of the wealthy is productive of gout, while that of the poor rarely excites it; and he quotes Dr. Huxham to prove the connection between the use of cyder, and arthritic and rheumatic complaints." The ceasing of usual labour, cold applied to the lower ex tremities, and night-watchings," which are enumerated by Dr. Cullen among the occasional causes of gout, come under the second class of causes. In his fifth chapter Mr. Parkinson treats of nodes of the joints, a subject on which he has been in some degree anticipated by 3 F acid most probably derives its consti. tuent principles, may not be produced. The use of wine is to be discontinued: "in proportion to the strictness of the abstinence from the use of wine will, in general, be found the degree of benefit experienced:" malt liquors should be sparingly drunk, and in a mild state; pastry and confectionary articles avoided; and soda taken regularly. Occasional bitters and tonics may be used to strengthen the digestive powers. Mr. Parkinson, we may remark, gives the most satisfactory expla nation of the fatal effects of the Portland powder that we have seen. He says, Dr. Haygarth. These diseases have been little noticed by medical authors, and have been generally classed among the consequences of chronic rheumatism; from which, however, as well as from gout, Dr. Haygarth has pointed out a decided distinction. Mr. Parkinson differs in some respects from Dr. Haygarth in his account of these nodes, and considers them as dependant upon the same condition of the fluids which gives rise to gout. He asserts, contrary to Dr. Haygarth's observation, that they most frequently affect "the labouring poor," and that they often occur to men. Among upwards of seven thousand poor patients whom we have seen, we recollect but a small number of cases of When, from the powerful stomachic efnodosity, and those almost exclusively in fects of the bitters, not only a greater portion of food is taken into the stomach, but a greater women. In stating the result of his method of treatment, the author omits to in- quantity of chyle, and consequently of blood, form us of the number of his patients, and is produced, a plethoric state may be induced; the quantity of blood may exceed the powers of the comparative success and failure of of the already weakened vessels in which it his remedies. In the "few instances" in is contained, whence may proceed those con which they have been employed they have gestions on which the production of asthma, been "generally successful." The indi- apoplexy, dropsy, &c. may depend. A cir cations upon which he has proceeded, cumstance of pretty general occurrence will strongly tend to produce this effect. The arthritic, suffering under considerable debility, to which diminished appetite and impaired digestion has much contributed, delighted with the restored powers of gratification, and eager to obtain a rapid renovation of his health, dulges his appetite without restraint, and thus totally destroys his health, which he was confidently hoping to establish." p. 98. are, "1st, To diminish the increased action of the vessels, in the part by which the secretion of the morbid matter is performed: 2dly, To promote a free perspiration of the part affected: and, 3dly, To correct the prevailing disposition to acidity in the primæ vix, and in the system in general. The two first purposes were fulfilled by applying leeches, and a plaister of diachylon and soap to the nodes; and the third by avoiding acids and acescents in diet, and taking soda in the quantity of from five to fifteen grains a day. "From the combined influence of these measures, the utmost success that hope could look for has been obtained. The gradual diminution, and, finally, the complete removal of such tumours as have existed for several months, have been thus procured; whilst those which have existed for some years have been so much reduced, as to allow of considerable motion in joints which had become nearly immoveable." p. 81. The author recurs, in chapter 6, to the subject of gout, and proposes his indications of cure, and indications during the fit, by which it is obvious he means the indications of prevention and cure of gout. With a view to the first, the objects of the physician are said to be, ", to prevent the formation of the morbid acrimony, to remove and correct that which already exists, and to repair the diminished strength of the system." Attention to diet is therefore of the utmost importance, that the gastric acid, from which the uric or lithic If the dietetic plan, and the course of antacid medicine, have been steadily pursued during the interval, the treatment, when the paroxysm occurs, will require little deviation from the method recom mended by Sydenham. The author still advises, however, the use of the alkalis, fixed or volatile, the choice of which may be directed by the state of the skin and bowels. As for the treatment of the local affection, the indication is simply "So to manage the inflammation, that, although the extreme violence of the pain he moderated, the parts shall not be interrupted in the functions they are now called upon to perform; and, at the same time, the escape of any injurious matter from the pores of the part affected shall be promoted as much as possible." The author's last chapter is dedicated to the confutation of Dr. Kinglake's practice. He justly remarks, that Dr. Kinglake has omitted to examine those circumstances, under which, according to the common opinion and the highest authority in medicine, the sudden suppression of gout was |