own responsibility, double the strength of his remedial measures, and fix their own time for its administration, Dr. Henderson* need not be so very indignant at Mr. Bell likewise choosing the amount of his dose, and for himself determining when and how often to employ it.

But leaving the adherents of Hahnemann's system to reconcile these differences, we come to a point in the argument concerning both him and them, which we shall take the liberty of settling for ourselves. Hahnemann distinctly says (as we have already quoted) that the peculiar action of belladonna does not last above three days, and the repetition of the dose of the prophylactic at the end of every seventy-two hours is, therefore, strongly insisted upon, and (though he has mentioned longer intervals) appears always to have been acted upon. He never allows seventy-two hours to pass without the administration of a dose, though, if the epidemic of the disease be very violent, he counsels the safety, if children could bear it, of giving the second dose twenty-four hours after the first, the third dose thirty-six hours after the second, and the fourth forty-eight hours after the third; thereafter to let the subsequent doses be taken every seventy-two hours until the end, in order that the system may not at first be taken by surprise by the miasm. Now, if we inquire the reason of the period of interval of the doses being at all events limited to seventy-two hours-never allowed to exceed that period-we are met by the (homoeopathically speaking) very sensible answer, that "the peculiar action of this plant does not last above three days." Now, if that was Hahnemann's opinion-and these are his ipsissima verba-we should like to know what believer in the homoeopathic action of medicines has any right to dispute it? besides, Hahnemann first proposed belladonna as a prophylactic in scarlatina, and-to use the argument adopted by Professor Henderson, in addressing himself to Mr. Bell's experience therefore try his way of it, and adopt his theory regarding it, else leave it altogether alone. But we do not require to do this; all the followers of Hahnemann acknowledge that the period of the duration of the effects of the "divine" remedy never exceed seventy-two hours. "Vis per 56 horas ad minimum, per 72 horas ut plurimum durat," says the founder of the homoeopathic school; and it makes very little matter if Hahnemann's ignoble editor, Dr. Quin, daring to attempt to improve upon what he has said and done, adds, in a note, "Aliquando belladonna ad diem vigesimum primum et ultra (most convenient) vires retinet;" or that Jahr still further improves upon both by saying that the duration of the action of belladonna extends "from one day to eighteen months."§ If, then, Hahnemann's idea be correct, that the action of belladonna as a prophylactic against scarlatina is exerted only, at the farthest, for a period short of seventy-two hours, we are fairly entitled to conclude, that all these instances of preservation from the disease in which the drug was exhibited at intervals exceeding that space of time, and which have been attributed to its prophylactic action, are just as likely due to any one of the many other causes which may be presumed to have acted beneficially in contributing to the exemption, and to some of which we shall presently allude. We shall, assuredly, not insult our readers, nor these pages, by enquiring if the exhibition, according to Hahnemann's direction, of the 200th of a grain of belladonna, at intervals not exceeding seventy-two hours, can, or ever has, preserved those exposed to the contagion of scarlet fever; we can unhesitatingly answer the question we put to ourselves in the negative. And now we pass on to the second. It may, perhaps, have occurred to our readers, that if we proposed to ourselves the settlement of this question by reference to the numbers of the facts and illustrations we advanced, that we were not doing ourselves justice, but that, on the contrary, we were assigning to the believers in the prophylaxis of belladonna an easy triumph. We beg to remind our readers of our expressed determination to give our opponents fair play; and further, of our own

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* I am persuaded, says Dr. Henderson, Mr. Bell will pardon me for asking if he made himself acquainted, before he began his researches, with Hahnemann's instructions as to the proper dose, and the interval that should elapse between the successive repetitions of it? If he did not, why try the medicine at all; since there was no other discoverer of the alleged preventative power of Belladonna than that same Hahnemann, who also says, that the dose ought to be very small, and ought not to be repeated above once in two or three days? We should prefer Dr. Black's answering this question.

↑ See Dr. Dudgeon's Translation, p. 439.

Fragmenta de Viribus Medicamentorum positivis sive in sano corpore humano observatis, a Samuele Hahnemann, M.D. Edidit F. F. Quin, M.D., p. 21. Hull's Jahr, p. 161.

acknowledgment that we have been content to adduce a few of the many instances of failure of the drug in the hands of experienced and competent observers. Now, we are ready to acknowledge that, in attempting to determine for ourselves the right of the question we have proposed, we escape from none of those difficulties which all are ready to acknowledge perplex the path of him who, by a reference to the experience of several or of many, endeavours to determine a question in therapeutics. We do most entirely agree wiih Dr. Alison, who, in the course of an article in this journal,* replete with valuable information and the soundest reasoning, writes:

"We do not mean to deny that questions occur in therapeutics, likewise, as to which large numbers of cases may be compared with advantage, and the numerical method' applied, but we think it is reasonable and right for practitioners to build their opinions, as to the powers of a remedy, on observations of very different kinds, besides the mere enumeration and statement of ultimate results of cases in which it is given; or, as it is shortly and justly expressed by a practical author, that, in order to make up our minds as to any such question, it is better, in general, to watch than to count."

Now, the great objection we have to the evidence which has all along been adduced in favour of the employment of belladonna in scarlatina is precisely, that "counting" has taken the place of "watching." Numerous circumstances in the particular epidemics, have either been altogether passed over, or, at least, have not been exposed to the infection of scarlatina (the degree of exposure is seldom noticed, or, at all events, is very inadequately described), and belladonna has been administered; and of 100, if either all or a very large proportion have remained free from the disease, the post hoc ergo propter hoc has heen, in every instance, adopted; and, apparently, as if there could be no objection offered to its adoption; because belladonna was taken and the 100 children preserved-therefore the belladonna preserved them. Again, and irrespective of the necessity of attention being paid, in such investigations, to the minutest particu lars, to which we shall presently refer, let it be held in remembrance, that the great majority of facts which have been advanced in favour of belladonna are entirely of a negative character, while those we have brought forward in opposition to it are positive. "I conceive," writes the lamented Dr. Pereira on this point, "twenty cases of failure are more conclusive against the opinion than one thousand of non-occurrence are in favour of it. The cases which I am acquainted with are decidedly against the efficacy of the

remedy."†

Let us very shortly glance at some of the foreign cases, and then more particularly consider what Dr. Henderson calls the "Edinburgh experiments." Now as regards the former, there is not one favourable to the belladonna theory which in the least degree approaches to the "experimentum crucis," and not one of any weight at all; if, perhaps, we except the experiment of Dr. Dusterberg at Warbourg, the principal features of which have been already detailed. The choice of an individual in each family to whom the drug was not administered, and the subsequent infection of the whole so excepted, is, we acknowledge, a startling circumstance. Still we are not satisfied, even supposing the statements of Dr. Dusterberg to be perfectly accurate, that the mode of experiment was a good one. The exemption from the belladonna treatment of one half of each family would have been much fairer; the exemption of only one in each family would undoubt edly serve as predisposing the ones so exempted to contagion in another and very marked manner, which is not even alluded to by the experimenter; the mental influence exerted over the exempted child of each family, we hesitate not to say, would be very decided, and all in favour of his or her contracting the disease. But apart from this consideration, there are points in the narrative of Dr. Dusterberg which make us very sceptical as to the reality of his experiments. Unlike most authors, he speaks of a "contact intime" between those who had taken the belladonna and those who were affected by the disease. And further, he asserts, that in most instances of those subjected to the belladonna treatment, at the end of some days there appeared "a general eruption resembling that of measles," and that all who presented this appearance remained free

from the disease. We take leave to doubt the reality of the above altogether; indeed, as we have previously stated, it is exceedingly doubtful if any eruption over the skin of any kind whatever follows the internal employment of belladonna. Some of the other experiments, whose results appear in favour of the prophylactic action of belladonna, seem, as far as numbers are concerned, to tell well. Of 195, 14 attacked, 181 preserved (Berndt's experience). Of 525, 522 preserved, only 3 attacked (Schenck's experience). Out of 20 families, 2 attacked (Gumpert's experience). But apart altogether from any favourable circumstances, which, it is not unreasonable to suppose, may have existed in these cases, and of which the exemption of so large a number as 181 out of 195, and of 522 out of 525, renders all the more likely, are not facts of this kind allowed every day to pass under our eyes, and to attract our attention, while they only, and very properly too, elicit the remark, that these are unusual, or, at the most, remarkable coincidences? The truth is, in regard to scarlet fever, as well as many other infectious diseases, that an amount of capriciousness so evidently attends their progress, indeed, if we might so speak, regulates their progress, as to make it a very difficult matter to decide if, at any time, or in any degree, their occurrence is at all affected or moderated by external circumstances; and if this be true, as undoubtedly it is, how far more difficult must it be to decide if the exhibition of any prophylactic means does good?

Vaccination in its effects made itself at once recognised, and the contrast between the ravages of small-pox at the commencement of this century, and the almost entire immunity from that disease in an epidemic form, which now prevails, are facts so plainly recognisable, and so appreciable, as in the instance of that disease entirely to remove the difficulty referred to. It is altogether otherwise with scarlatina: notwithstanding the introduction of belladonna, and its extensive employment, both in this country and abroad, as a prophylactic against scarlet fever, we are not aware that the mortality in either has been reduced; a circumstance which in itself militates very strongly both against the prophylactic and the remedial efficacy of belladonna. But let facts like the following be, moreover, taken into consideration.

During the prevalence of scarlatina in Edinburgh and its vicinity, the writer of this article was requested to visit a young gentleman of twelve years of age, a boarder in an educational establishment at a little distance to the west of the city.† He was found to be labouring under well-marked scarlet fever, the characteristic eruption of which had made its appearance the day previously. In the room in which this boy lay there were other eight boys, only two of whom had suffered from the disease; and of sixty-five boys who lived under the same roof, there were thirty-eight who were in similar circumstances. The sick boy was immediately removed to the hospital at a little distance, the room he had occupied was well aired, and the bed-clothes removed from his bed; but, with these exceptions, no other means were adopted; the eight boys continued to tenant the same room, and no other case of the disease occurred.

A few months before this occurrence, the writer visited a young lady, one of a family of eight, whose ages were from six to twenty-four, occupying a comfortable, but neither very large nor very well-ventilated house, in the new town of Edinburgh. She passed through a severe attack of scarlet fever, having in particular very severe cynanche, and afterwards very profuse desquamation. None of her sisters or brothers, nor her mother, who nursed her, nor any of the domestics, contracted the disease. In the same streetnot a very large one-there were, at the same time, at least two other houses in which the disease existed. These are not singular instances, nor are they recorded here in that belief; on the contrary, we know that the experience of every practitioner could amplify such a catalogue. But from such cases we do learn not a little; and this in particular, that the disease we have to deal with is a very fickle one, and that at times, in circum

The total number of deaths in England and Wales from scarlatina alone, during 1847, was 19,816 and in London, during 1848, out of a total mortality from all causes of 57,628, there died 4756 of this disease. It may be said that belladonna was only very limited in its employment; but so far as we have been able to learn, there are very few medical men who have not, at one time or other, employed it in their practice; it follows, that they have abandoned it on account of its inutility, or, as is the case with several, on account of its injurious consequences,

At the same time, cases of scarlet fever had been known to have occurred in one of the houses nearest the place of this boy's residence; and but a few days before the attack we are presently to notice, the writer had been consulted in regard to the adoption of any measures which it might be expedient to put in force, seeing the disease, for which all directors or governors of such institutions stand in great awe, was then visibly within a few hundred yards.

stances in which we should feel disposed to look with certainty to its diffusion and spreading, it will, why or wherefore we cannot tell, .pleasingly disappoint us. Had belladonna been employed in either of these two instances, or in any of the numerous similar ones which have occurred, we do not doubt the exemption of the thirty-eight boys in the former, and of the eight individuals (exclusive of domestics, who were comparatively little exposed) in the latter example, would have been attributed to its prophylactic action.

As regards the "Edinburgh experiments," we attend to them here for this reason particularly, in order to notice a remark of Dr. J. D. Gillespie, who observed and described an epidemic of scarlatina which prevailed in Donaldson's Hospital.* Dr. Gillespie did not employ belladonna, because "had belladonna been administered, the experiment would not have been decisive without allowing the healthy children to mingle freely with the infected." This Dr. Gillespie did not deem warrantable, as very great facilities were afforded for keeping the children separated. Fifty-two children of a hundred who had not previously had the disease, took scarlet fever. Isolation of the sound from the sick, and removal of the sick from the part of the hospital occupied by the sound children, was, under Dr. Gillespie's judicious management, effective, to the extent of preserving 48 of the 100 children.

In criticising the accounts of the Edinburgh experiments, and contrasting, in particular, the experience of Dr. Gillespie in Donaldson's Hospital, with that of Mr. Bell in George Watson's, Dr. Henderson, while assuming that some of the boys in the latter. institution were protected by the belladonna, speciously endeavours to account for (what appears to us) the entire failure of the drug in Mr. Bell's hands, by urging the greater liability of the boys to contract the disease on account of the amount of belladonna taken. This argument, though ingenious, is most fallacious. We shall not go back to the Hahnemannic view of the action of belladonna in scarlatina, further than to point out this fact, and it is a very striking one, that though Mr. Bell's care and attention, and evident determination to let the experiments in his hands have fair play, led him, "in a few days," owing to the dilatation of the pupil and impaired vision, to lessen the amount of belladonna the boys took; yet he never in any instance for months noticed either the sore throat, or the rash over the skin of the body, which Hahnemann described, and which he asserts led him to recognise in belladonna at once the prophylactic against, and the remedy in, scarlatina. Will it be contended that the small dose produces these symptoms, and the larger those which Mr. Bell has so faithfully described? If so, we can only add, that after repeated attempts we have failed to produce any rash by the employment of very small doses of belladonna.

Dr. Henderson makes no objection to the experience of Dr. Newbigging, in John Watson's Hospital, yet his boys received larger doses than Mr. Bell's, for he gave the extract in the proportion of one-sixth to one-fourth of a grain twice a-day, and never diminished it, continuing its use for five weeks. Mr. Bell began with a fifth, and finding, in a few days, that dose to be too large, he diminished it. Seeing that the injurious effects which led to the diminution of the dose by Mr. Bell were discernible in a few days, and that Dr. Newbigging continued the employment of the belladonna in some cases, in even larger doses than Mr. Bell had ever administered, we do think that a fairer statement of the case may be put than the one by Dr. Henderson. If large doses of the belladonna are to be regarded at once as exposing to the contagion of scarlatina, and as freeing from that contagion, there must be an end to all argument, for such a proposition tends in no small degree to the reductio ad absurdum.

Now, we do not mean to say, that Dr. Henderson wishes this to be believed as his opinion, yet his words undoubtedly admit of this interpretation: for when he consigns Mr. Bell's cases to the ready action of the scarlatina poison, owing to the largeness of the doses of belladonna which they have consumed, and attributes the freedom from infection which Dr. Newbigging's enjoyed to their having had the belladonna administered-he in reality says nothing less-for during five weeks Dr. Newbigging continued to dose the children at John Watson's Hospital with a fourth, a fifth, and a

*Monthly Journal, 1853.

sixth part of a grain, while the second of these was found by Mr. Bell, in the course of a few days, to be too large. It will not do to say that the continuance of the drug in Dr. Newbigging's experience for a few more weeks might have caused the children to take the disease; for, most assuredly, if such effects as Mr. Bell has described were produced with smaller doses than Dr. Newbigging for the most part employed, in the course of a few days, it is only reasonable to conclude that their continuance for a period far short of five weeks, would have produced all those effects upon the boys which Dr. Henderson imagines caused Mr. Bell's boys to fall an easy prey to the contagion. Dr. Henderson, determined to leave no stone unturned, having already, in regard to other experiments, suggested that some other drug than belladonna was used, conjectures that the extract of belladonna used by Dr. Newbigging was not so strong as that used by Mr. Bell. We venture, however, to remark that just on account of the variation in the strength of the extracts of belladonna, both gentlemen would satisfy themselves of the potency of the specimens they obtained.

The very accuracy which attended Mr. Bell's experiments, the evident care and attention he paid to all the particulars in connexion with them, makes his experience one of peculiar value: and we have little hesitation in saying that his "excellent" paper will continue to be regarded alike an authority condemnatory of the so-called prophylactic action of belladonna, and on the general treatment of the disease. It is our opinion that experience has altogether failed to recommend the employment of belladonna, and that now we should be prepared to abandon the practice, as not only insufficient but absurd.

We sum up our disbelief in the prophylactic action of belladonna on account of the following reasons:

1. Numerous facts attest its want of success.

2. All those facts which apparently testify in its favour admit of other and ready explanations.

3. These explanations are, in themselves, perfectly satisfactory and philosophical. In conclusion: We have thus seen that it is impossible to accept the facts which have been advanced (with as strict a regard to impartiality as possible) as establishing the prophylactic action of belladonna; for though, at first sight, not a few of them seem to give countenance to that view, these do not so in reality, and very many directly oppose it. It may be that a prophylactic against scarlatina exists, but, assuredly, it yet remains to be discovered; meantime, our knowledge of what affords the best protection against that disease cannot be said to have advanced far beyond what was known to Frank, in whose words, equally truthful now as when written, we shall not inappropriately close: "Salus igitur in sola fuga contagii quæri debet, cui scopo regulæ adversus febres contagiosas jam traditæ, præcipue vero cura severa scholarum et ambulacrorum publicorum infantilium inserviunt."

J. Warburton Begbie.

REVIEW VIII.

1. Lehrbuch der Physiologischen Chemie. Von Professor Dr. C. G. LEHMANN. Dritter Band, 1852.

A Compendium of Physiological Chemistry. By Professor LEHMANN. The Chapter on Digestion.

2. Handbuch der Physiologischen Chemie. Von Professor Dr. C. G. LEHMANN.Leipzig, 1854. 8vo, pp. 334.

A Manual of Physiological Chemistry. By Professor LEHMANN.

3. The Bakerian Lecture, on Osmotic Force: delivered at the Royal Society. By Professor GRAHAM, F. R. S., Corresponding Member of the Institute of France. ('Medical Times and Gazette.')

In the number of this Journal for July, 1853, we gave a succinct account, drawn from the most recent sources, of the digestive fluids in their physiologico-chemical relations; and more lately (p. 144) we have brought before our readers all that is contained, on