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THE

CRITICAL REVIEW.

SEPTEMBER, 1803.

ART. I. ---Historical Surgery, or the Progress of the Science

of Medicine: on Inflammation, Mortification, and GunShot Wounds. By John Hunt. 4to. 11. 1s. Boards. Rivingtons.

MR. Hunt appears to be an attentive judicious practitioner: he probes, however, to the quick; and his applications are in some degree corrosive, when, perhaps, emollients might have been applied with more advantage. To drop the metaphor, his criticisms, though accurate, are severe; and, were a reviewer, in his warfare, to be as extreme, to mark what is done amiss, he must expect more clamorous complaints, than are generally met with, large as is his constant portion. In the introduction, he speaks of the advantages of experimental philosophy to a surgeon; but its importance is somewhat exaggerated. So far as it facilitates contrivances of convenience, and stores the mind with ready resources, it may be highly useful; but its actual employment scarcely extends beyond the first principles of mechanics. When we advance to the sublimer regions of philosophy, and endeavour to apply its truths to the animal machine, the greatest ertors have been the consequence. Our author quotes, as an instance of this nature,: 3r. Mend's, tract. De. Imperio Solis et Lunæ in Corpore humano,' founded on the Newtonian theory of the tides. The sun and inocr.cannot, he shows, have any influence on the human body: but inis objection he carries too far. The Mediterranean has no tides, because its extent is not sufficient for the heavenly bodies to produce the necessary expansion; and De la Place has demonstrated, that, unless we admit the depth of the ocean to be much greater than philosophers have supposed, tides cannot be produced, even in the Atlantic, by the attraction of the sun and moon. This gives additional force to the objection of our author: but he does not advert to a more remote influence. Aërial tides are certainly produced; and, from the variation of the air's pressure, the human body is affected. The mercury in the Torricellian vacuum, from the same change, feels the influence of these bodies, as minuter observers of the variation of the height of the quicksilver have shown. Epilepsy we have certainly seen affected by the growing moon; and we must admit, with practitioners of credit, in warmer climates, Crit. Rev. Vol. 39. September, 1803.

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that the periods of fevers are also influenced by the changes of that luminary. These observations, however, do not acquit Dr. Mead cf the charges adduced by our authors and his fate affords a melancholy picture of the little durability of professional fame. Dr. Mead, not long since at the head of the medical profession, is now in the lowest rank. His works are seldom quoted, but to be confuted; and, when examined, they will be found not to add a grain to the stock of medical science. He was a man of learning, not of judgement: he could probably remember what his predecessors had observed; but he could not combine it with his own acquisitions: he could not, by reflexion, by comparison, or abstraction, elicit new truths, in addition to the dogmas of his masters. The could not?'—the expression may be too strong: he certainly did not.

The first section of this work is on 'The Imperfections of the Treatment of Mortification, exemplified by the indiscriminate Use of the Bark at improper Periods of the Disease.'-- In his historical view of the subject, Mr. Hunt begins with Mr. Bromfield, and marks, with disapprobation, his vague, indiscriminate, and contradictory language on the subject. We have not a word to say in his favour: but think Mr. Hunt somewhat unfair, in not taking up the inquiry ab ovo, and giving the state of our knowledge of the subject at the time of Mr. Bromfield's publication. One of the earliest, if not the earliest, authors who recommended bark i mortifications, was, we believe, the first Dr. Monro, who also first applied it in the worst stages of the small-pox.

The second section comprises The Division of Mortification into two Species, illustrative of the Effects of Bark and Opium.'-This part.pdates to lirPott's observations on the mortification of the çöes and sett; flour qu'hor is peculiarly severe on the confusion of Mr. Pott's language, and the irrelevance of some of his retrarles Hunt pretty plainly intimates, that the opjuin was used by accident; and, when the surgeon was successful; he was nos are to what he owed his

A want of canttuur, inniot mentioning his predecessor Mr. Sharp's remarks, is also, in our author's opinion, reprehensible; and where opium has appeared to succeed, much may be probably attributed to the eforts of the constitution in the conquest of the disease.

Ill. Amputation considered as a Remedy in Cases of Mortification; and the Ambiguity of the pulic Opinion on this Subject.'— In this section, also, our author supports the opinion of Mr. Sharp, that no amputation should take place, till not only a separation appears, but the constitution has regained some sha

of firmness; and is severe on Mr. Bell, not only for seeming to lean to the side of those who would perform the opetation before any separation was obvious, but for more point

success.

ediy recommending the operation very soon afterwards. The opinion of Mr. Sharp should, however, be taken with some limitations; and, when the strength is much lessened, the operation will be more early admissible. The hæmorrhage must, in this case, be guarded against with peculiar caution, and the most active cordials and tonics employed to support the strength. We would put also another question. As it is easier to prevent than to cure, may there not be a case of such peculiar rapidity, that death must be the consequence of delay ?-If then we operate on a sound part, is it not probable that the impending gangrene on the stump may be prevented by remedies, which would not operate on the existing disease in the extremity?

Section IV. The Physiology of the Circulation of the Blood considered as the Basis of the Pathology of Inflammation, and its Consequences.'- In this section, our author notices Mr. Hunter's opinions respecting the circulation, from his work on gun-shot wounds, and points out many inconsistencies and errors. Mr. Hunter is of opinion, that the circulation is carried on by the powers of the heart alone.

- Section V. The modern Treatment of Mortification, in Cases of Gun-Shot Wounds,'—- Mr. Hunt's object is to show that the modern practice on this subject is neither rational nor discriminated. The limits within which bark, bleeding, and opium are necessary, practitioners have not yet ascertained. This is particularly shown by observations on Mr. Hunter's work, in which that author's vague and inconsistent directions are shrewdly pointed out, and somewhat severely criticised. Mr.Hunter's want of education is, indeed, conspicuous in every one of his volumes and papers. We are dazzled with new views, and tantalised with the prospects of new discoveries; but, when examined, the light is an ignis fatuus, and the discoveries are loose and uncertain hints.

< Section VI. The Distinction between local Inflammation and phlogistic Diathesis, with an Explanation of the Effects of Bleeding in inflammatory Diseases.'-- In this section, our author treats of bleeding very satisfactorily. He limits its particularly salutary effects to the inflammatory state of the system, distinguished by sizy blood; and remarks, that, in wounds of the extremities, though, in the full and plethoric, bleeding may be useful, yet it is not an absolutely essential remedy.

• In many instances of fever, where the pulse is hard and full, a single bleeding may be made use of with advantage, merely to correct the plethoric state of the system, but can seldom te repeated with safety. It is in true inflammatory diseases that bleeding is so particularly efficacious; in simple fever and in many other cases, where it is indiscrimirately made use of, it can only be looked upon as a doubtful auxiliary ; but in true inflammation it is a specific antidote. It is only in those dis

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eases that produce a sizy state of the blood that bleeding is so particularly salutary; an inflammatory disease may exist without a sizy state of the blood, but a sizy state of the blood cannot exist independent of an inflammatory disease ; this state of the blood is the consequence and not the cause of the disease.

*I have carefully attended to the progress of the inflammatory symptoms in cases of active hæmorrhage, and, being apprehensive of the approaching paroxysm, have taken away a large bason of blood, which has not shown the least appearance of size; and I have frequently met with instances of this disease, where the hæmorrhage has taken place in less than an hour after I had bled the patient. I have under these circumstances immediately repeated the bleeding, and found the blood taken by this second operation strongly marked with size; in many instances I have found the returning hæmorrhage, and the sizy state of the blood, so regularly accompany each other, as if the sizy state of the blood was the immediate consequence of the discharge.' P. 122.

Erysipelas is included among the infiammatory diseases; by which it appears probable, as well as from some of the other remarks on bleeding, that the author has practised in the country. In crowded cities, these directions must be followed with some limitations. The buffy coat seems to influence Mr. Hunt more than it does other practitioners, though he chiefly rests on the symptoms of the complaint, as well as on its seat. Since inflammation of the viscera is generally attended with inflamma. tory diathesis, in every, at least almost every, instance of this kind our author seems to think bleeding useful; nor does he consider those internal inflammations, from what is called mis. placed gout, to be an exception. He seems inclined, in the latter instance, to believe the gout suspended, rather than that its seat is changed; and adds some arguments in opposition to Mr. Hunter's opinion, that two diseases cannot exist, at the same tiine, in the same system. So far as the opinion is true, it is, that one disease may suspend for a time the action of the other; and, in this view, the doctrine is as old as Hippocrates.

Section VII. The Influence of topical Bleeding demonstrated, and the Inefficacy explained.'-General bleeding, Mr. Hunt thinks to be chiefly effectual, by the sudden depletion of the system, in which topical bleeding must fail. Even opening the temporal artery is, in his opinion, ụseless, in comparison. with the evacuation from the arm; and leeches, or cuppingglasses, still less powerful. The arguments by which he endeae vours lo disprove the utility of topical bleeding, we cannot answer; but we think its efficacy supported by experience. One circumstance, respecting the operation of leeches, has not been sufficiently attended to, though we have often mentioned it; vit, that the leech draws its blood by previous suction, and the first effect is filling the vessels around with blood. In this view, the effect, in relieving over-distended vessels, is somewhat greater

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