them through the windpipe and its branches, but from the continual inhalation of the glanderous effluvia arising from the diseased surfaces in the nostrils and sinuses. The lungs, however, do not prove diseased in all cases of glanders." (p. 283.) The larynx is not infrequently the seat of glanders, but the author is of opinion that there is not the same susceptibility in the "membrane lining the windpipe as in other parts of it, or even in those divisions of it constituting or lining the pulmonary aircells."

Mr. Percival enters, con amore, into the views of the pathology of glanders propounded by M. Leblanc, of Alfort, in an admirable monograph published by him in 1839. The author tells us that he is indebted to accident, a few months before writing his present article on glanders, "for small work wherein, to his great satisfaction, he found notions entertained such as for many a year had been floating about in his own mind." It appears somewhat singular that M. Leblanc's important memoir should have escaped the notice of a writer of a text book on veterinary medicine for nearly five years, and then that he should be indebted to accident for its discovery. However, when he did find it out, he makes up for former negligence by adopting wholesale the doctrines of that excellent veterinarian. The principal novelty in M. Leblanc's views is that glanders, like farcy, is a disease of the lymphatic system; that the pimples or tubercles observable in the incipient stages of glanders are nothing more than so many farcy-buds, which in time became pustules, burst, and end in turning to so many open, foul, and spreading ulcers,— in short, that the little eminences which Dupuy called "tubercles" are nothing more than so many farcy-buds, and that these consist of albuminous matter. M. Leblanc considers the pulmonary glanderous tubercle to be precisely the same morbid product as a farcy-bud, and not, as Dupuy supposed, identical with the tubercle of phthisis in man. Mr. Percival, with whom we perfectly agree, does not believe there is any analogy between the elementary lesion of glanders in the horse and that of phthisis in the human subject.

M. Leblanc thus explains the alteration which takes place in the lymphatic fluid during the progress of the disease. It first turns yellow and becomes coagulated within the canals of the lymphatics and the cavities of their glands, the tunics of the vessels thickening and turning opaque, exhibit red points upon their inner surface, and adhering in places to the coagula within, and in other places growing more or less softened, without, as yet, showing ulceration. In time all the thickened parts of the vessel partake of this softening, spreading from a single point upon its circumference, the coagulum within softening likewise, and the cellular tissue corresponding to the point of ulceration becoming tumefied, then hardening, and lastly softening. And now a little tumour exists, having its seat in part in the lymphatic vessel, in part in the cellular tissue, close upon the situation of the lymphatic valves, which accounts for the elevations, the lymphatic fluid in its incrassated or coagulated condition not being able to pass the valves. This explains the knotted aspect of the corded swellings in farcy. M. Leblanc explains his views of the nature of what has been called the "glanderous tubercle" in the following terms, with which Mr. Percival coincides:

"Examination of the mucous membrane of the nose of a glandered horse will show, in a certain stage, that it becomes thickened. And that this thickening, which is owing to an accumulation of fluids of a white or whitish-yellow colour, precedes the appearance of the tubercles, the same as tumefaction of the cellular membrane precedes the formation of farcy-buds. In this (thickened) condition the membrane assumes a shiny and more humid aspect than it has in health. Then, upon divers points of its surface, and notably upon the middle part of the nasal septum and within the doubling of the nostril, make their appearance little white or yellowish-white pimples (élécures), rather prominent at their centres, with borders insensibly declining to a level with the surrounding membrane. These pimples or tubercles correspond to the course of the bundles of lymphatics, and very probably have their seat in those vessels. 'At least,' continues Leblanc, 'I have been able to prove that little shreds (masses élongées), in composition absolutely like what is found within the lymphatics of a farcied limb, were inclosed within their canals, from which it was easy, with the points of the forceps (d'un instrument) to extract them: they proving adherent only in certain places, marked by some increase of redness. I have found the greatest analogy between these alterations and those which the lymphatic fluid commonly undergoes in farcy."" (p. 288.)

We perfectly agree with Mr. Percival in his views of the specific nature of the virus of glanders, in fact, that no other animal poison will produce that disease but its own; but we differ from him when he says that the lymphatic system is not liable to derangement or inflammation from other causes. Septic matter, as Rayer observes (Cyclopædia of Surgery, art. Farcy), different from that either of farcy or glanders, may give rise in the quadrumana to inflammation of the lymphatic vessels and ganglions, accompanied by general phenomena of infection, and often terminating fatally; but nevertheless it is not glanders. We agree with the author in looking upon glanders as a constitutional and not a local disease. The constitutional disturbance, the eruption of the disease in other parts of the body in the form of farcy, the contaminated state of the blood, as shown by transfusion into another animal, and the inefficacy of topical remedies, are surely sufficient to prove that the disease is not local.

FARCY. As the history of this disease is for the most part involved in that of glanders, we shall be brief in our remarks upon this part of Mr. Percival's work.

The disease called farcy consists of small tumours along the course of the lymphatic vessels, in the form of a knotted cord, which in time ripen into pustules, and terminate in ulceration. The disease most frequently attacks one or both of the hind legs. On viewing the limb from behind a fulness on the inside of the thigh may be seen, along the course of the femoral vein. Tracing the cord upwards from its place of origin, which is usually above the hock, the hand is carried into the groin, and there discovers a lobulated tumour, a swelling of the inguinal glands, which is called a bubo. The disease is sometimes developed in the course of a night, whilst on other occasions it appears in a more insidious manner. It may assume an acute, subacute, or chronic character. The solid buds gradually grow soft, from centre to circumference, and at length become pustules or little abscesses, which burst as soon as they are ripe. Instead of breaking, however, the farcy-bud sometimes hardens and becomes indolent, and remains so for a considerable time, but ultimately gives way, and, like the former, terminates in ulceration of a chancrous

5. A medical journal is wanted which should communicate only cases that have ended unfavorably. It would be of more service than a number of others. 6. In all medical narratives the subjectivity of the observer plays its part, and injures the objectivity.

7. Medicine, in order to its advancement, should assume its old Hippocratic state-i. e. one should learn to observe without writing a recipe.

8. It would be well worth while to collect together all that is positive in medicine, and of which not a jot is transitory. It would make but a small book. 9. Rationalism, with Hippocrates in the mouth, and the quill for writing recipes behind the ear: such is the true picture of many practitioners.

10. One hears often of favorite medicines; but can disease have to-day a partiality for one medicine, to-morrow for another? Partiality is a weakness in men. Partiality in science arises from defective knowledge and one sided views. 11. "La méthode c'est la médecine," says Barthez truly. Those physicians should learn this who, year after year, wander from one medicine to another, but overlook the application of method to their multifarious pharmacopœia. 12. Thick darkness besets the subject of etiology. Not unfrequently causes are found for diseases which, after a time, are found to be completely false. How often are colds and wettings cited as causes of disease! In the course of the musical festival which took place in the Palatinate, under the direction of Hofzollmeister Frank Lachna, a party of at least 20,000 was assembled near the ruins of Magdeburgh castle. The whole of them, with scarce an exception, were wet through without any disease ensuing, as many feared there would. 13. Dr. C. Walther praises roses in a particular treatise, published at Stutgard in 1837, entitled the Healing Virtue of Roses in Persons threatened with Atrophy and Consumption.' The sick are daily to inhale air impregnated with the fragrance of roses, to drink rose tea, rose water, and rose wine; to eat preserved roses, honey of roses, and rose cakes; to rub in rose salve and rose oil: and all this will not save them from the churchyard roses-the so-much dreaded roses without thorns.

14. In stomatitis, peppermint drops allowed to melt in the mouth produce a feeling of coolness, and are a good palliative.

15. Cold foot-baths at bedtime are a valuable remedy in that sleeplessness caused by loss of blood.

16. In ganglions, acupuncture is an easily managed, little painful, and generally successful mode of treatment, and, according to Barthélemy, (Gaz. Médicale, 1839,) to be preferred to the subcutaneous incision.

17. Ergot has such a specific action on the uterus that it should be more variously employed. In painful menstruation, accompanied by spasms, it acts like a charm, as also in the eclampsia of childbed.

18. Specific medicines are generally too little employed. Thus tincture of cantharides, judiciously employed in retention of urine from cold, and where no organic diseases exist, will often obviate the necessity of catheterism.

19. Brandy-drinkers can generally bear very hot baths; the peripheral nervous system being dulled in them.

20. I have twice seen those horn-like prolongations of the toe nails which sometimes occur in old women, accompanied with misshapen toes; that is to say, there was an exostosis surrounding the nails like a wall.

21. Persons, especially men, who eat and drink freely, are threatened with apoplexy when, though their general embonpoint remains, their arms and legs begin to waste.

22. The therapeutic skill of many physicians consists in prescribing oleum jecoris aselli. Would it not be well henceforward to name it oleum jecoris

asini?

23. I would lay down the following as an axiom which may be easily proved: "In every local inflammation, unaccompanied with fever, general bleeding, if

not absolutely hurtful, will be at least useless. Half the cases of ophthalmia are examples of this.

24. Not unfrequently medical men repent of their choice of a profession; this arises from their being unable to find a compensation in the science for the daily toil in the practice of their art. A physician, to be happy, must love science with the admiration of a lover. She must fill his whole soul; she must be incorporated with his whole being; and then she will daily appear to him new and interesting. Medicine is exciting, precisely because no man can ever arrive at a complete knowledge of her; and in this she differs from sciences which are complete in themselves. Whilst in them at best one yawns over quiet undisturbed possession, in medicine there is daily new life, new excitement. 1 shudder when I fancy myself a jurist or a theologian. Heinrich Heine says somewhere, the Frenchman loves liberty as his bride, the Englishman as his wife, and the German as his grandmother. I say that jurists, mathematicians, theologians, &c., can at most love their science as a wife; to the physician alone is it granted to love his as a bride with all the ardour of first love.

ART. V.

1. An Essay on the Use of Narcotics and other remedial agents, calculated to produce Sleep in the Treatment of Insanity. By JOSEPH WILLIAMS, M.D.-London, 1845. 8vo, pp. 120.

2. Practical Notes on Insanity. London, 1845. 8vo, pp. 120.

By JOHN BURDETT STEWARD, M.D.—

I. To the essay of Dr. Williams was awarded a premium placed at the disposal of the King and Queen's College of Physicians, by the Lord Chancellor of Ireland, for an essay on some subjects connected with the treatment of Insanity.

The author commences his essay by alluding to the very varied causes producing the insomnolence which so frequently precedes an attack of insanity, and forms, in general, so important a feature of the disease throughout its progress; and the consequent necessity, in a work treating on the means of procuring sleep in insanity, of discussing remedies which cannot be regarded as narcotics. Accordingly, we have in his essay articles on bleeding, general and local, purgatives and emetics, narcotics, stimulants and tonics, warm baths, exercise, &c.

After a brief allusion to the several forms of the disease and its varieties, as adopted by systematic writers, together with an outline of the causes most frequently conducing to its development, he refers to the importance, at the commencement of an attack of insanity, of accurately discriminating its cause, and the state of system under which it appears, as upon the treatment pursued at this period most frequently depends the result of the case, and whether it shall rapidly subside or terminate in a chronic form of the disease.

"There is always extreme irritability in incipient insanity. Generally the brain suffers first, then some other organ. The great object, however, is always in the first to allay irritation, and to endeavour to ascertain whether the brain was primarily affected, or whether insanity followed some visceral affection. It is of the greatest importance to determine whether insanity is symptomatic or idiopathic; whether the result of mere error of perception, [?] or whether the medium through

which we reason is at fault. Mind is independent of matter [!] and it may by some sudden shock become incapable of perceiving, discriminating, or judging correctly; and it is in such cases when tranquillity has been restored by narcotics, that the metaphysical treatment has been successful. If the excitement consequent on reaction in these cases be not speedily lulled, the brain itself often becomes congested or inflamed; and this continuing, symptoms increase, and those alterations in the brain and membranes so frequently observed more or less speedily occur." (p. 28.)

Bleeding. Dr. Williams agrees with most writers on this subject, in recommending caution in the use of general bleeding, which he regards as applicable only to the cases of the disease appearing in strong, robust persons, living in country situations, and in whom the attack has followed the suppression of accustomed evacuations, as epistaxis in men, or the suppression or cessation of the catamenia in females. In these cases, also, it is rarely, if ever, applicable, except in the early stage of the disease, and must be employed sparingly. In ordinary cases he prefers local to general depletion; the abstraction of blood by the cupping-glass, or by leeches, being less likely to produce undue depression afterwards, or to be followed by reaction. He alludes to what we have frequently observed, the soothing effect produced on maniacal patients by the gradual abstraction of blood by leeches, and regards this mode of treatment as not having received sufficient attention. In all cases when antiphlogistic measures are about to be had recourse to, it becomes of the greatest importance to discriminate between the symptoms resulting from active inflammatory action and those originating in irritation; and in many cases where general or local depletion is required, it will be necessary carefully to support the strength of the patient, or even to exhibit stimulants at the same time.

Many cases of insanity arise from extreme irritability dependent on prostrated powers; and to support the person by good nutritious food, and sometimes even with brandy and wine, at the same time soothing the system by procuring refreshing sleep at night by morphia, will speedily evidence the advantages of such treatment. The great error originally was allowing the powers to sink; it is of the greatest importance that those powers should be supported; the nervous excitation must be calmed. In these cases mistakes are but too frequently made; irritation is confounded with inflammation. The maxims so ably taught by Mr. Travers are forgotten; the object being to calm the action, not to diminish from the power-this nervous power being much more easily depressed than raised. Should this advice be neglected, and bleeding be ordered, stupor, or coma, or confirmed mania may be the consequence. In many cases, when there is the most ferocious delirium with great muscular power, yet the pulse is very quick, weak, and fluttering, and even the slightest depletion at once knocks down the powers; but even if the patient should again rally, there is great danger of his becoming idiotic." (p. 32.)

Purgatives, antimonials, and emetics are applicable in conjunction with the general antiphlogistic treatment, but more especially may be employed in those cases of inflammatory excitement when depletion has already been carried as far as may be regarded as safe, or when the more active antiphlogistic measures are inadmissible.

"Many cases of vigilantia, dependent on monomania, or even furious mania, will yield to ant. potass. tart., and often, on the vomiting ceasing, refreshing sleep will follow. It has been remarked by Dr. Cox that one third the usual dose of tartar emetic will prove efficient if a narcotic has been given the night before; generally,