fraught with danger; and having omitted that, his doctrine must be necessarily crude and imperfect, and his contemptuous animadversions on the opposite opinions altogether unjustifiable. In this we entirely coincide with Mr. Parkinson. But when he affirms that the sudden stoppage of the diseased action in the inflamed parts by cold media, or by any other external application, is not justifiable in any case of gout or acute rheumatism, since although no mischievous effects may be immediately discovered, there is great probability that consequences of the most serious and distressing nature may occur at a distant period;" when this is affirmed, we must wave our concurrence. We have no doubt that, in many instances, the paroxysm of gout has been immediately suppressed without any obvious inconvenience; and we might appeal to Mr. Parkinson's own case for satisfactory evidence of it and as to any distant, unforeseen, and indefinite event, which may occur in a gouty constitution, we cannot but think it highly unphilosophical and absurd to attribute it to the long previous use of a then salutary remedy. In two or three attacks of gout in the author's own person, the local disease was annihilated in a few hours by immersion in cold water, and he was set at liberty to pursue his professional avocations in good health. We doubt not that Dr. Kinglake will quote his antagonist's case, as one of the best illustrations of the refrigerant practice. Mr. Parkinson relates two or three cases, not however in the most discriminating manner, in which severe affections of the head or viscera ensued upon the suppression of the local gout.

This sudden suppression of the disease, then, according to the author's own evidence, is sometimes perfectly salutary, sometimes attended with unpleasant or dangerous consequences and this we have all along considered as the truth of the matter. The question at issue is, what are the circumstances under which danger is to be apprehended from the speedy removal of the local affection, and what are those which indicate its safety? This question Dr. Kinglake was bound to resolve before he sent forth his new theory. to the world; for while we remain in uncertainty, without any criteria which may enable us to judge of the result, the practice at large is dangerous. For the sake of those instances in which it appears to be remarkably salutary, we should have been glad if Mr. Parkinson had entered more philosophically into the discussion, and endeavoured to trace the connection of the circumstances of the cases with the remedy employed, since he has witnessed both its good and its bad effects. On the whole his attempt at confutation is fecble; we seem to observe a struggle of preju dice, and a favourite hypothesis, against his personal experience; and we are left precisely in the state of uncertainty in which we commenced the perusal of his work.

What effect the alkaline medicines, pushed to a great length, might produce, we know not; but the system of temperance in diet, and regular exercise, which he recommends, whether it may chiefly counteract the formation of lithic acid or not, is undoubtedly the sole cure for the gouty constitution.

IN our last volume we noticed a pamphlet by Mr. Edlin, in which he gave an account of two cases of gout that terminated fatally, in consequence, as it appeared, of the external application of cold water: we have now to announce a reply from Dr. Kinglake, in which he attempts to repel the charges brought against his new practice. With respect to the two cases, it may be necessary to bring to our readers' recollection; that one only of them fell under Mr. Edlin's own inspection, and to this alone can any importance he attached,

as the other refers to an event which took place many years ago, and is related upon evidence by no means sufficiently direct to establish so important a conclusion. The first case, however, was under Mr. Edlin's immediate care; he had an opportunity of observing its progress from the commencement, and in the latter stages he had the co-operation of Dr. Haworth.

In the work now before us, Dr. King. lake does not attempt to bring forwards any new fact respecting the case; admitting the general statement, his aim is to

prove that a wrong inference has been drawn from it. The points which immediately suggest themselves as of the chief importance in this discussion, are, whether the disease was in reality gout, and whether the secondary symptoms which appeared to terminate in death were owing to the cause assigned. As to the first point Dr. Kinglake would cut us short at the outset, by flatly denying that such a case as repelled gout can exist, and refers us to the arguments stated in his larger treatise in proof of this position. We are, however, unfortunately not convinced by them; and are, moreover, decidedly of opinion, that repelled gout is a case of not unfre quent occurrence. But as Dr. Kinglake will not admit the complaints to have been symptoms of gout, to what cause does he ascribe them? To this obvious and important query we do not meet with any very direct or satisfactory reply. We are indeed told, that the account of the case is probably exaggerated, and that

"Palpitation of the heart and icy coldness of the stomach are not characteristic symp toms of a high degree of visceral excitement; they rather indicate a diminution of motive en rgy, and are not explicable by any rational idea of transferred irritation."

Still, however, we are not informed what was the nature of the complaint. The following remark is the only clue which can lead to the discovery of our author's opinion.

They (¿. e. Dr. Haworth and Mr. Edlin) might, in proportion to their opportunities for observation, have seen many instances of the protracted pain of gout in the joints of the extremities, having propagated by sym pathetic influence, fatal irritation to the system; but blinded by groundless prejudices, they could not perceive this scientific truth. It appears to me, through the mists of Mr. Edlin's partial statement, that the disastrous course of this case did not arise from any irremediable grievance of the heart and stomach, but that it was rather induced by the stimulant treatment to which the patient was subjected; for it was observed he was liberally dosed with æther, camphorated julep and

opiated confection, and farther overwhelmed with external heat.”

Here seem to be the rudiments of a new speculation; though gout cannot exist in the system, yet gout in the extremities may produce an irritation in the system of a fatal tendency. The following paragraph will farther illustrate the hypothesis.

"The complaints usually arising in the system during protracted gout, are indeed chiefly of the spasmodic kind. They proceed from the debilitating influence of long-continued pain. They are of the tribe of the locked jaw, which is often induced by the exquisite torture occasioned by either sprained or wounded ligaments and tendons. An unre duced dislocation has frequently produced this afflicting disease. In this case the iLflammatory affection is on the ligaments and tendons, and (as affirmed in my Dissertation on Gout) is strictly identical with that disease."

It appears, then, that our author's sentiments concerning the case in question are as follow: the first set of symptoms were produced by irritation arising from the previous pain that the patient had suffered, and his death was occasioned by the medicines given to remove this irritation. Both these positions we cannot but consider as highly improbable. It does not in fact appear that this irritation is produced by gout, when existing in its most painful form; while, on the other hand, we find it to occur, as in this case, after the pain has ceased, and when it had not previously been peculiarly violent. farther, supposing the symptoms to be of that irritative kind which the author conjectures, we are of opinion that the remedies prescribed in this case were the most likely to remove it. We cannot take our leave of this performance without strongly reprobating the supercilious and disrespectful terms in which Dr. Kinglake speaks, not only of his opponent, but of every one whose opinions differ from his own.

THIS title is a misnomer. We have been able to discover nothing in the shape of "cautions" in this pamphlet, unless general and unqualified condemnation, abuse, and ridicule, of Dr. Kinglake and his practice, be econsidered as such by implication. It seenis-somewhat extraordi

nary that the contemplation of a series of pathological experiments should drive a man into spleen and anger; and not less so, that he should imagine he can refute the results of such experiments by ridicule and declamation. The author has not a single fact to oppose to the number detail

ed by Dr. Kinglake; but is compelled to repeat to us the old story of Mr. Edlin's friend at Uxbridge: and he promises that, if this cargo of declamation does not completely overwhelm the new doctrine, he will freight another pamphlet with a load of quotations from authors, which will infallibly crush it. We do not mean to defend Dr. Kinglake's hypothesis, or to assert that his facts are related in a clear and unexceptionable manner; but we enter our protest against all such attempts to smother a philosophical question by declamatory rhapsodies, when facts, or legitimate deductions from facts, can alone ultimately decide it.

The author assumes an air of great wisdom, and lays down his medical axioms with no small degree of dogmatism; but he unfortunately betrays gross ignorance of the pathology of the human body, and of modern medicine. He asserts, for instance, that inflammatory rheumatism, Jike all other diseases that are productive of sizy blood, is to be cured by bleeding and purging, to the liberal use of which I

know no bounds short of the destruction of the disease." p. 15. Did he never hear that the blood is sizy in all stages of pulmonary consumption? Yet we presume the destruction of his patient would be the first consequence of the "liberal" use of these remedies in that disease. “Did he never discover that these liberal evacuations in acute rheumatism were con demned by Dr. Fothergill, by Dr. Heberden, and Dr. Haygarth; and that the best physicians in the metropolis are of a simi lar opinion? He farther asserts that gout in the stomach, as it is called, is an inflammation; and condemns Dr. Kinglake's prescription of camphorated tincture of opium, &c. as highly prejudicial. But in nine cases out of ten the disease produced by metastasis is spasmodic, and requires the most powerful stimuli for its cure.

We shall stop here. We wished merely to shew to the careless reader, that the author is not a magnus Apollo, and that he may yet suspend his judgment. Adhuc sub judice lis est.

THIS very distressing disease of the eye has been described nearly in the same terms by physicians and surgeons, from the time of Hippocrates to the present day; and the operation which was recommended and described by the father of physic, with a view to its cure, is nearly the same which is now performed and advised by the eminent surgeons of this metropolis. After considerable experience, and much observation of this disease, the author was led to form a different notion of the nature of the affection, and consequently to have recourse to a different operation in order to relieve it; and his attempt has been followed by success. The ancients admitted two distinct cases of entropeon, arising from different causes. In the one, the growth of a supernume rary row of hairs on the internal margin of the eye-lids, was considered as the source of all the symptoms of the disease, which they termed distichiasis. In the other, which was termed ptosis or phalangosis, the margin of the eye-lid, armed with its hairs, fell upon the eye, in consequence, they supposed, of the relaxation of the skin of the eye-lid. These opinions have been adopted without alteration by almost all writers on the subject, and the various operations recommended for the cure of both varieties are recounted by

Dr. Crampton. In order, however, to shew the grounds upon which he maintains that the proximate cause has been misunderstood, and consequently the operations erroneous, he gives a very accurate description of the eye-lids and their appendages; whence he is led to infer, "that a contraction of the internal membrane of the eye-lid, and not an elongation of the external integument, is the immediate cause of the entropeon." p. 35.

It is obvious, indeed, he observes, from a mere inspection of the eye-lid, that au elongation of its external skin would never preduce the disease. The numerous folds which we perceive in the eyelids of old and relaxed persons, demonstrate that the external integument gives no support to the tarsus; consequently the inversion of the one can never be produced by the relaxation of the other. Upon this notion, however, the cure has hitherto been attempted, by removing a part of the external integument, in the time of Hippocrates by means of a ligature, at present by the knife. The author maintains that the relief afforded by the operation is seldom permanent. He thus briefly states his opinion of the origin of the disease.

"When the eye is voluntarily opened, the upper eyelid is not drawn vertically upwards,

but backwards, describing a line paralle! to the anterior and superior surface of the eye over which it moves. When the eye is completely open, the eyelid is lodged in the space cont uned between the roof of the orbit, and the superior surface of the eye. But should this space be filled up by the thickened or contracted conjunctiva, the levator palpebræ cannot execute its functions. Every accession of inflammation contracts the conjunctiva. The conjunctiva terminates upon the margin of the eyelids; which deriving no support from without, and being constantly acted upon from within, readily yield and become permanently inverted." p. 51.

"A thickened and contracted state of the conjunctiva being admitted as the cause of the entropeon, the remedy becomes obvious, It consists in removing the stricture, and restoring the parts to their natural dimensions and position. The mere division of the conjunctiva, from one angle of the eye to the other, is not sufficient to fulfil the first of these intentions, as its thickest and strongest fold is a little within the external canthus. In fact, it there forms the internal connecting ligament

of the tarsi.

"The first great object of the operation is the division of this ligament. This should be done so as completely to liberate the extremities of the tarsi towards the outer canthus. But as the extremities of the tarsi towards the inner canthus are confined, as well by the action of some of the fibres of the orbicularis, as by the contracted state of the conjunctiva, they must be freed from their connection with bota." p. 40.

The tarsus is then left comparatively loose, and in the worst cases can with ease be reverted. The next, and scarcely less important, object, is, "to retain the parts in their natural position, till, by recovering their original healthy state, they are enabled to perform their functions." The particular mode of executing both these parts of the method of cure, is clearly detailed in the history of the cases which are subjoined, and in which permanent success is said to have been attained.

With respect to that modification of the complaint which has been denominated distichiasis, and which, if it arose merely

from a supernumerary growth of cilia, could not with propriety be considered as a species of entropeon, the author affirms, that it is also occasioned by a contracted state of the conjunctiva; and that the under row of hairs is neither supernumerary nor displaced with regard to the tarsus, though their curvature is altered by lying upon the convexity of the cornca. He adds,

an

"In such cases of the disease as I have had

opportunity of observing, the cartilage as evidently inverted, and if any hairs were sa pernumerary, they were those which gen the natural direction of the cilia; bu rather inclined to think that in such corre inversion of the cartilage is not complete. " inner range of hairs alone touch the c and are retained there by the inclinatio the tarsus, and by the humidity of ture e the upper ranges of the ciliæ, "stiil retai,” their disposition to point upwards, presise an horizontal direction.

"Thus we are led to measure the ma ti

of the tarsus by the upper range of the cla, and to suppose that the inner row, which lies upon the cornea, is inordinate or supernume rary." p. 36.

Professor Scarpa does not admit that there is ever a supernumerary row of hairs. The contracted or thickened state of the conjunctiva, which is productive of the mischief, is the consequence of inflammation, especially of neglected or repeated inflammation, of the eye; and it is, en this account, chiefly prevalent among the lower classes of the people.

Dr. Crampton appears to have made his observations on this disease with considerable acuteness; and is apparently indebted to experimental enquiry alone, and not to hypothetical invention, for the doctrine and the practice which he recom mends: and he speaks with candour and liberality of those who entertain different opinions.

Two plates are annexed to the pamphlet illustrative of the structure of the eyelid and its appendages; and of the instrement used to support the eye-lid in its natural position, after the operation has been performed.

ON opening this work, which professes to take a view of the varieties of a disease that had not been distinctly pointed out by practical writers, we were naturally led to expect that the author had returned, with

his stores of personal experience, from the seat of hostile operations in Egypt or the Indies, and that the errors or inadvertencies of preceding observers had been corrected by the toil of actual investigation.