of calomel every fourth hour. In forty-eight hours the evacuations had become mercurially green. No increase of symptoms had occurred, but no abatement, and her strength had fallen much. "Having observed some periodicity in her symptoms, and some other hyste rical phenomena, and trusting that the calomel had placed her in a state of safety relatively to the congestive part of the case, I now gave her Quina. Disulphat. gr. ij. every fourth hour for five doses. On this her strength increased, and the rigours ceased; her mind also became clear. And now set in a series of hysterical symptoms."-P. 87. Here nearly two scruples of Calomel appear to have been given in the course of 48 hours; and this active mercurial course was immediately followed by liberal doses of Quinine. We strongly suspect that a much simpler plan of treatment would have been both wiser and safer. In this case, as in so many others of Hysterical suffering, the bowels were evidently much at fault; for we read that, "ever since the first head-symptoms gave way, the patient had constantly complained of much tenderness of the abdomen. This continued long, and left her gradually, assisted apparently by aperient enemas with assafoetida. Indeed, the symptom so frequent in hysteria showed itself largely, that, namely, of immense fecal evacuations coming away as the spasmodic symptoms yielded. When waywardness occasionally occurred, we repeated the cold affusion, provided there was present sufficient heat of skin. But she continued long in a very weak state." This case is related in the chapter on "Hysteria and the Hysterical Diathesis." The object of this chapter is to show that inflammatory and other morbid affections, occurring in hysterical patients, require the same mode of treatment that is called for under other circumstances. After the narrative of some cases in the way of illustration, and a criticism upon one reported by Sir B. Brodie in his work on "Various Forms of Local Hysterical Affections," our author observeş : "Much loose language respecting the proteiform nature of hysteria, and its tendency to simulate other diseases, has been led to by the confusion of this disease with diathesis, above illustrated. But I am disposed to think, admitting the objectionable nature of such terms, that more valuable practical results would be gained from an hypothesis of palsy simulating hysteria than from the (present) reverse hypothesis. Cases of both kinds may be found in the valuable posthu mous medical writings of Dr. Parry, of Bath; and Dr. Billing has recorded a case, in which globus hystericus with palpitation, ensued in a young man upon a violent strain of the spine, resulting from a fall under a heavy weight. I have known no instance in which the treating a 'local hysterical affection as humoral or inflammatory, would have been so mischievous, as the contemplating that globus hystericus, and the accompanying affection, in the light of hysteria."P. 100. But then there is infinitely less chance of the latter, than of the former, mistake. For a single case of the one, there are many hundreds, nay thousands, of the other. Again, surely few physicians will agree with Dr. Mayo, that "more valuable practical results would be gained from an hypothesis of Palsy simulating Hysteria than from the reverse hypothesis." We have said that Dr. M.'s practice appears to be often far more active 1847.] Treatment of Scarlatina Maligna. 391 than the symptoms seem to require. In the chapter on "Blood-letting in cases of Congestion," we meet with the case of an infant, in whom hepatisation of both lungs was believed to have supervened upon an attack of Measles. Now, what was the treatment pursued in this instance? Besides three leeches and a blister to the sternum, the infant appears to have taken daily from three to six grains of Calomel with several grains of Hemlock, for ten days or a fortnight before its death! Dr. Mayo, at the close of this chapter, quotes with approbation the following extract from the posthumous work of Dr. Parry; telling us, at the same time, that his own experience perfectly coincides with the doctrine taught therein, in its yet more extended application of bleeding for Cerebral Congestion. Difference of effect between small and large bleeding in Hemiplegia.-When Dr. H., who was about 70 years of age, was seized with hemiplegia, in which he totally lost the voluntary power of his arm and leg, I ordered him to be cupped. This was done only a few hours after the seizure. While the operation was performing, when only four ounces of blood had flowed, the power of voluntary motion returned to his limbs; but again vanished by the time ten ounces had been taken."* Yet in one of the cases, which he had related, just before, without any comment, the enormous (surely we may say, the excessive) quantity of between 50 and 60 ounces was drawn at one bleeding from the arm, and 20 ounces more, very soon after, from the temples by cupping. The object of Chapters XII. and XIII. is, in the first, to illustrate the rapidity with which a fatal issue takes place in some cases of Scarlatina Maligna; and, in the second, to suggest how far the common practice among English medical men, of commencing the treatment of this, and of almost all other fevers, with a purgative, does not often tend to aggravate the symptoms and accelerate the death of the patient. We think him quite right in this particular. Indiscriminate active purgation in Fevers of a bad type, and more especially in the Exanthemata, has unquestionably produced a great deal of mischief. The older physicians very generally condemned the use of purgatives at the commencement of malignant febrile diseases. As a general rule, it would be much safer and better practice to substitute an emetic for the purging dose, that is now so usually prescribed under such circumstances. Dr. Mayo seems to have a decided leaning to the use of the cold affusion in the treatment of Scarlatina, but he does not adduce any evidence in its favour. He considers it not improbable that "the deep-seated tendency of the English practitioner, always to commence the treatment of fever with aperient medicines, may have rendered the experiment of cold affusion thus far unsuccessful in fever generally;" and he thinks that "the neglect, which Dr. Curry's discovery has met with, is infinitely discreditable to the medical science of England." The chapter headed "Chronic Cerebral and Spinal Cases successfully • Medical Writings of the late C. H. Parry, M.D., vol. i. p. 474. treated," is surely not worthy of a place in any collection of medical cases. Take, for example, the following report, as one of the instances of the successful treatment of a chronic, spinal, or cerebral disease! "The Rev. R. S., aged 37, of a pallid countenance, but strong, short figure, consulted me in February, 1838. He complained of inability to walk, or take any excise, from vertigo and languor; of a fixed pain, and sense of obstruction, in the occiput, and uneasiness and numbness in the loins. His utterance was slow, and very laborious; and I ascertained from his friends that complaints which he also made of growing incapacity for business, were not exaggerated, whatever the cause might be. He was a sensible man, of an even temper. I ascertained that in early youth some evil habits of an enfeebling nature had been indulged in. He was married, without children, and lived in the country. Sumat Pil. Hydrarg. Sub. C. gr. iij.; Pil. Galbani C. gr. v., o. n. B Sp. Ammonia Succinat. 3 iss. ; Aquæ 3 vj.; 4tam partem ter quotidie. B Ext Colocynth. C. Rhei. ää j.; Ext. Hyoscyam. gr. x.; in pil. x. divis. j. vel. ij. p. r. n. "This course was pursued, with slight modifications, to the beginning of May, and was attended by the greatest relief of all his symptoms. No change was made in the general habits of Mr. R. which could explain his cure, independently of the medical measures. I may add, that I have seen this gentleman since in the enjoyment of good health."-P. 126. The solitary case of " Meningitis, showing only increased vascularity," related in the next Chapter is-standing as it does by itself to say the least, very profitless. "Every day's additional experience," remarks our author, "tells us, how little we know, so far as post-mortem appearances are concerned, of the evidence of sthenic inflammation, where only increased vascularity is present, in cerebral disease; and, again, the inexpediency of a depletory system in acute mania rests on good authority.” Can we report more favourably of the contents of the next Chapter, entitled "Albuminous urine-Ascites-Paracentesis Abdominis ?" In truth, we cannot. The narrative of the first case is so slovenly and imperfect that it is impossible to make any thing out of it. The specific gravity of the urine in the first case is stated to have been 10; the author means, we suppose, 1,010. Then, from the mere circumstance that it was slightly albuminous, he takes it for granted the kidneys were affected with granular degeneration; and, finding that his patient appeared to be rather benefited than otherwise by the use of mild mercurials, he hints that these have been needlessly reprobated in Renal Diseases. "The opinions, expressed on high authority against the use of mercury under presumed granular disease, deserve to be reconsidered. The inflammatory process often attendant on that state is such as mercury influences curatively in other instances. The question, no doubt, must be settled by experience; but, as far as analogy is concerned, the burthen of proof rests rather with those who impugn the expediency of mercurials in these cases, than with those who may assert it." The case of presumed "Cæcal Abscess," opening externally upon the right nates, deserves brief notice only from the strange tone of the remarks with which its history concludes: 1847.] The Claims of Mesmerism. 393 "Besides the general interestingness of the subject, I am inclined to think that our diagnosis, both in abdominal and thoracic disease, might be helped by farther enquiry into the distinctive cerebral phenomena to which they may give occasion. "Whatever interest the above particulars may claim, not the least important fact which they convey is the completeness of the patient's recovery under the agency of the waters of Homburg and Schwalback. And I may here observe, that the patient, whose judgment and clearness of intellect might well be relied on, has affirmed to me with great distinctiveness the benefit which she received from those waters, independently of the general good obtained from air and scene, to which we are, perhaps, disposed to attribute more than the due share which they are entitled to in the recovery of chronic cases."-P. 152. The case of "Double Consciousness, &c.," occurring in an hysterical girl, related in Chapter XVIII., leads Dr. Mayo into the dubious paths of metaphysical speculation. He shows a kindly feeling to the Mesmerists, and considers that they have been unfairly dealt with by the medical profession. "We allow our nurses," says he, "to rock our infants to sleep. Are we to be told that it is absurd and unjustifiable to produce a form of sleep, during which pain is unfelt, and irritation allayed, by movements of the hands?" He evidently believes in the reality of the mesmeric rapport, and its accompanying marvels: "Whatever the beneficial effects of mesmerism may turn out to be, it comes before us fraught with liabilities to abuse and mischief in its application to chronic disease, which is likely to be its especial subject, of no common kind. The possession which it gives to the manipulator of the person's mind who is subjected to his agency, is of a nature to justify these fears, and there is reason to suppose that it has been sometimes turned to the worst account by unprincipled persons."P. 157. There is no evil that we ever heard of as likely to result from mesmeric manipulations save that a great and most mischievous one, it must be admitted of their being made the occasion of acting upon the sexual feelings of young females. This, in short, is the secret of almost all the cases of successful mesmeric practice having occurred in unmarried women. Hence, too, its deserved reprobation by the great mass of the medical profession, as well as by the public generally, as a means of therapeutic relief. The guarded and hesitating manner, in which our author handles the subject, betrays a sad want of confidence in his own judgment; for, if we mistake not, Dr. Mayo has been making enquiries into Mesmerism for some years past. With a decided leaning to its claims-for in one passage he does not hesitate to recognise the truthfulness of the assertion, that Mesmerism is a law of nature which is as much a part of the human constitution as the processes of thought and digestion"!-he will not, however, commit himself either one way or the other, but suggests that the Royal Society, or some such public body, should appoint a commission to examine into its merits. "One would have thought, that the extremely interesting nature of the mental phenomena disclosed by mesmerism, supposing it to be truthful, or to contain truth, would have so strongly disposed philosophical men to the enquiry which I am suggesting, as that no arguments such as I am adducing should be needed. It is to be regretted that there is no royal society for psychological as well as for material phenomena. "A candid enquiry into what may be termed the more substantial forms of empiricism is expected generally from us by the public; for the most important physical truths must have had an empirical period in their promulgation. At the same time, considerable difficulties are thrown in our way by that same public, in the execution of this duty. The public is, indeed, a severe task-master. It is at once inquisitive and sensitive in regard to so-called quackery; prompt in imputing that contumelious term to regular practitioners, if they afford attention to the class of subjects, and equally prompt in imputing to them an uncandid spirit if they decline to do so. "Our efforts in this direction will, in truth, be most effective, and at the same time least detrimental to ourselves, if directed from without; the governments of other countries have empowered commissions of enquiry into such matters. There never has been an epoch in the history of medicine at which such a commission has been more expressly indicated than at the present moment." P. 159. What good, may we ask, has the double French Commission done? Next to nothing; both parties, mesmerists and their opponents, have appealed to its reports in justification of their opinions. The transition from one description of empiricism to another is just what might be expected. We were therefore not surprised to find, after Dr. Mayo's bland demeanour towards Mesmerism, that he was nearly equally courteous to the sister science (!) of Homœopathy. He alludes, at first, with expressions of admiration, to the "philosophical investigation" of its claims, which one of our contemporary Journalists has recently instituted, and the result of which has been to convince him (not Dr. M.) that the homoeopathists have the merit of curing nearly as many patients as the regular practitioners! Our author has not a single word to say in the way of contradiction or of protest against this specimen of ignorant credulity. But when he is coolly told by one of this gentleman's correspondentswhose communication is declared to be "of high stamp and admirable tendency," that, "in all cases and on all occasions, Nature is truly the agent in the cure of the disease; and that, as she acts in accordance with fixed and invariable laws, (what, pray, is the meaning of this in reference to diseases?) the aim of the physician ought always to be to facilitate her efforts, by acting in harmony with, and not in opposition to, these laws," he at once detects the fallacy of the assertion, and exposes its absurdity with considerable spirit in the following passage: "That diseases follow laws and a course imposed by nature is most true; this I presume to be the meaning of Dr. Combe; it is moreover equally true, that in many cases this law, or course, though it is quite compatible with the completion of the disease, is incompatible with the life of the patient. Thus, when pneumonis proceeds from its congestive to its inflammatory stage, then onward into hepatization and purulent infiltration, can any thing be more natural or more fatal than its progression? As a disease in which the so-called natural treatment is applicable, that is, in which most of those resources must be excluded which thought has elicited from the stores of nature, Dr. Combe has most unhappily selected pleurisy; and here, supposing the exciting cause not to have been violent or longcontinued, he recommends the absence of medicinal agents. He even argues in favour of effusion being allowed to take place. The possible slowness of its unassisted absorption, its injurious influence upon the investing membrane of the thoracic cavity, the gradual substitution of a purulent for a serous effusion, where blood-letting and the use of mercury might have forbidden that event, is left un |