Page images
PDF
EPUB

than in proportion to the quantity drawn : but, at the same time, it supports the author in his opposition to Mr. Hunter's practice, of applying leeches to inflammation produced by external injuries. The practice is, however, fashionable, and will continue, for a time, to be so, though the charmer charm never so wisely

In the eighth section Mr. Hunt returns to historic Surgery, in “The historical Evidence of the Effects of the Bark in Cases of Mortification.' -Our author examines the original writers in this part of the work; and we find that, in this discase, it was used earlier than the practice of the elder Monro. We believe, however, as we have already said, that he first gave it in the worst cases of small-pox. In this inquiry Mr. Hunt examines particularly all the early cases, and endeavours to show that the bark was useless, and that the salutary terminations were owing to the cordials, or the spontaneous efforts of nature. We are surprised that a man of Mr. Hunt's acuteness should have overlooked a circumstance in the case recorded by Mr. Douglass. In this, the worst symptoms occurred on the 30th of April: on the 3d of May, two abscesses were already formed, ready for opening. The fever was evidently the last effort of nature to produce these abscesses, and the relief sprung from their formation *.

• Section IX. The chirurgical Treatment of those Diseases which are the immediate Consequence of external Injury.'-We cannot follow our author minutely on this subject, and can only notice the more prominent and important positions. In general, Mr. Hunt prefers warm applications for external injuries, and even when mortification impends. When moisture may be injurious, or its application attended with inconvenience, dry heat may, he thinks, be advantageously employed, with the stimulus of volatile alkali on the neighbouring parts. Compound fractures, if no mortification menace, or loose bones require removal, should not be very frequently opened; and, in general, the less the irritation, the more safe and rapid will be the cure. Fractures, he thinks, should be reduced early, even though tumefaction appear. The swelling is in this way sooner lessened, but a kind of emphysematous intumescence is sometimes produced, which even a slight pressure will remove.

. Section X. The medicinal Treatment of those Diseases

• It is singular that accident often interposes to assist the credit of new remedies ; and it is curious to remark that first trials often dazzle by an appearance of astonishing success, which future experience does not always confirm. The person on whom Mrs. Stevens's medicine was tried by authority of parliament (a convict), was reported cured ; and, indeed, the stone could not be felt hy the sound. It appeared, on dissection, ebas it had formed a sac, by pressing through the coats of the bladder Our author adds another instance of early success, not supported by sabsequent experience in his use of the digitalis. Rev.

which are the immediate Consequence of external Injury, illustrated by the Phänomena of analogous Disease.'--Bleeding our author had before spoken of; but, as external injuries are not usually attended with phlogistic diathesis, bleeding he thinks not particularly requisite. This remedy he asserts to be incom• patible with opium; but he does not appear to recollect that the opium, in the works quoted, is mixed with an antimonial. This union he afterwards seems to approve; and, as purging in fractures is inadmissible, the antimonial with nitre is the chief reinedy for reducing the fever. '. After the 'fever is lessened, bark may be employed; but, as Mr. Hunt is an enemy to its general and indiseriminate use, we shall select his own words.

. I do not pretend to determine at what distance of time from the period when the accident first took place, the bark may be given in cases of external injury of the extremities; it is the state of the disease, aná not the time of its duration, that is to determine the point in question. If the free use of the lancet, which some have recommended, can ever be thought necessary for the purpose of correcting the increased action of the system, hark in this state of the disease must certainly be improper. But at that very instant when the increased action begins to diminish and the fever to subside, at that critical period not a moment should be lost, and bark then becomes a most important remedy.

At the same time that it will be necessary to watch the progress of the disease with the most cautious attention, as the fever may

subside in some instances sooner than in others, and as in some cases it may be difficult to ascertain the time when this critical period does take place, it is certainly an object worthy of our consideration to determine whether the bark may be given with safety before the crisis of the fever dois take place, as it certainly would be right to meet that hazard which is attended with the least danger on this occasion.

I do not mean to compromise the matter with those who advise the use of the bark at the commencensent, or in an early period of the disease, for the purpose of preventing mortification; I only wish to recommend a cautious line of conduct, and to guard against a practical error of an opposite nature that might prove equally prejudicial. I do not think this is a question that almits of compromise in principle ; but as it is impossible to regulate our practice with scientific certainty, I only wish to introduce this observation for the purpose of guarding as much as possible against an imperfection that is, in some degree, unavoidable.

' I do not suppose that any one will contend that the fever immediately changes from the highest degree of morbid action to the lowest degree of putrid debility. But I think it is evident that the declension is by degrees, and that there is a regular decrease of action from the

to the commencement of putrid diathesis. But whatever may be the rapidity of the declension, no truth can be more evident than that the change must take place before it can become perceptible. Now as it is, in my opinion, an object of great importance that the

acme

[ocr errors]

energy of the constitution should be supported at this critical pericd, and as in practice it will be impossible exactly to mark the change; I should by the bed-side advise that the bark should rather be given a' few hours too soon than one too late.' P. 251.

Bark our author prefers to every cordial; and thinks, if the bark should prove useless, all others would be of little avail.

Having spoken of warm applications, our author digresses a little in examining their effects, and the means by which they succeed; and, in this inquiry, he rests on the experiments of Dr. Parr (published, we believe, in a thesis), analysed in the Medical Commentaries. He next proceeds to visceral inflammations, in which he commends the warm bath, with bleeding, and expresses the strongest disapprobation of the use of opiates. Our experience and we can in some measure boast of our success—does not, however, agree with that of Mr. Hunt; and we greatly regret it, as he seems a very attentive and judicious practitioner. We will, nevertheless, remark, that his good opinion of bleeding, and dislike of opium, appear to us as the effects of a little prejudice, unless the peculiarity of his situation in the country may be allowed to explain it. We have always given opium early, and in quantities to relieve pain, and diminish the too great irritability of the stomach: after that effect has been produced, we order laxatives. This plan has very generally succeeded. Unfortunately for the warm bath, those who have been immersed in it, and we believe those only, have fallen. Tartar emetic, in a desperate case, we once found successful. An eighth of a grain was given every five minutes, then a sixth, then a quarter; each dose in a small tea-spoonful of water only. Mr. Hunt pursues the subject; but his apparent antipathy to opiates remains unsubdued. The cases of internal suppuration, appearing at first as inflammation of the bowels, are, we suspect, owing to inflammation, and consequent suppuration of the peritonæum. We some time since saw several instances of this kind, in several of which suppuration was prevented: in others it proceeded: but one of these only survived, with symptoms not unlike those of the successful case recorded by our author. In these instances, as well as in dropsy, Mr. Hunt seems to approve of the fox-glove, and thinks that it acts by lessening the secretions, as it lessens the action of the whole sanguiferous system. Various observations on this medicine in phthisis, with digressions on collateral subjects, fill the remainder of this section, which are too miscellaneous to be minutely pursued, and perhaps too slightly connected with the principal subject, to have occupied so many pages.

The last section is entitled, “The operative Part of Surgery, considered as a Remedy for Disease.'-This needs not detain us long, as a great part is employed in remarks on the modern me

thods, and projected or pretended improvements of later surgeons, in performing amputation. Mr. Hunt, with great propriety, recommends early operation in cases of external injury. *The extraction of balls, and other extraneous matter, from gunshot wounds, should also, in his opinion, be attempted early; and he adds some remarks on the opposite advice of Mr. Hunter. The directions for the management of the tourniquet are judicious; and it is properly observed, that it should not be twisted tighter than is suflicient to check the circulation of the blood in the artery.-The remarks on the operation of trepanning, and that for the reduction of the bubonocele, are not of particular importance.

After the long account which we have given of the present work, we need not add any general character. Mr. Hunt appears to be a judicious practitioner, and an able operator; yet we have perceived and marked some opinions which bear the stamp of prejudice, and prove that he has practised in a part of the country where diseases are more acutely inflammatory, and evacuations of blood are borne more easily. To surgeons this work will be of importance; and the younger surgeon may study it with peculiar advantage,

Art. II.-Chalmers's Edition of the British Essayists. (Con

tinued from our last volume, p. 301.) THE Spectator has been so often the theme of panegyric, that eulogy can scarcely invent new terms to convey its merits; and perhaps the excellence of these volumes will in no instance be more strongly felt, than when, after years of other pursuits and different inquiries, we return to their perusal. We may sometimes, indeed, be shocked by an inaccuracy of language in these boasted models of perfection: we may feel, with some force, the exhibition of manners less correct than our own, of foibles apparently more glaring, because less common; for follies have their æra, and change without any real melioration of morals. But, on the other hand, the generally elegant simplicity of the diction, the curious felicity of the expressions, will still delight the cultivated mind: the critical remarks, equally distinguished for their refined delicacy and sound judgement, will polish the taste, and add to our knowledge : the defences of the moral duties, and the great truths of our religion, will awfully impress us with the indispensable importance of each. It is a subject of regret that so few of its authors are now known. It was the bow with which, when striplings, they first attempted to contend with Ulysses ; and by the use of which they arrived at greater strength, and more matured powers.

The Tatler, it is observed, closed unexpectedly, for reasons

not very satisfactory or conclusive. The appearance of he Spectator, however, should have at once solved the ænigna. Addison's latest contribution to the Tatler was on the 23d of December; and the last paper of the work itself was published the 2d of January following. The first paper of "The Specta. tor' is dated March 1, of the same year. In this short period, a plan of vast extent, comprising a great variety of objects, matured in its different parts, and finished with peculiar care, was completed, if we allow not an earlier communication between Steele and Addison. Whether the Tatler were, or were not, a trial of skill, as has been pretended, it was evidently encumbered with some extraneous and unsuitable additions, which broke the uniformity of the whole, and narrowed the limits of more important discussion. It was probably resolved that it should drop; and Steele may have done abruptly, without Addison's particular concurrence, what was not designed to last much longer. The Spectator, as we have said, succeeded after a very short interval; and was supported with a steadiness, spirit, and ability, which have rendered it the admiration of succeeding years—we had almost said ages: but we have ourselves seen some of the heroes of that field, and conversed with them on the events of the warfare. The secrets, however, which they chose to conceal, it becomes not us to enlarge on.

Addison brought to this attempt the hoarded treasures of a youth spent in study-the result of much reflexion, and varied as well as extensive inquiries. It is thus that men are often supposed to write with little labour, because the toil is not perceived at the moment. The well-regulated mind has its stores in complete order; and, when the subject is once given, has only to draw on the bank of his former inquiries. Such a man writes, indeed, with facility and fluency: but the labour is that of years long since elapsed ; and a few lines may contain the result of much reflexion and intense study. To Addison, at that time, little remained but to write what he had before considered; and he had sufficient time to polish his language, which he did with a scrupulous, a punctilious nicety. Steele, as in the Tatler, returned the ball with less anxious accuracy, but with a spirit which sometimes prevents us from determining whence it came. We cannot find a stronger instance of this kind, than in the character of sir Roger de Coverley, as stated by Mr. Chalmers, which, after all that has been said of Addison's exquisite humour in the delineation, was really first described by Steele. After copying Dr. Beattie's masterly observations on the remarks of Johnson relative to this subject, Mr. Chalmers proceeds:

· No addition is necessary to this vindication of the character of sir Roger de Coverley in the general; but it has not been attended to by either of these critics, that sir Roger was not the creature of Addison's,

« PreviousContinue »