atances which contribute to the production of these exciting causes scrofula, and they are too well known to require enumeration; one fact also renders the subject rather complex, scrofula being a disease of debility, and the persons in whom it is to occur in future life, being generally very weakly in infancy, digestion in them is imperfectly performed, and acidities are produced; the scrofulous symptoms which afterwards appear, are then attributed by the author to this acidity, and weak digestion as its proximate cause; although during the existence of these scrofulous symptoms, neither weak digestion nor acidities can be discovered. How easily scrofula may be produced, and by what a variety of causes may well be imagined; and the author says, "in one of the worst cases of scrofula I have met with, and which continued even to manhood, the disease was attributed, by the mother of the patient, to his eating a large quantity of manna that was accidentally left in his way." The treatment of scrofula will of course be founded upon the opinions of the author previously delivered, and a summary of it is contained in the following quotation: Having so far ascertained that indigestion is the proximate cause of scrofula, and that the remote causes are weakness of fibre, a want of due exercise, damp cold air, and acescent diet; the indications of cure are evidently to restore the digestive organs to the due exercise of their functions by the necessary attentions to diet, air, and exercise, and by the administration of medicines capable of correcting the morbific products of indigestion, and of exciting a healthy state of the digestive secretions." The weakness of fibre which is here described as a remote cause of indigestion, has generally been considered as a predisposing cause of scrofula; whatever therefore will contribute to remove this weakness of fibre, will certainly be useful in the treatment of scrofula, and we approve of the exercise and other strengthening means recommended by the author, without assenting to the accuracy of his notion respecting indigestion being the proximate cause. The cases given in the former part of the book, exhibited the mode of treatment adopted by the author in the bowel complaints of very young children, and he has in addition given us several cases of real scrofula, treated in the same manner; and we shall now examine the result. We call it real scrofula, because in most of them the disease occurred at the usual age, viz. from five or six years to adult age, and the symptoms were such as have hitherto been denominated scrofula. "I usually commence my plan of treatment by the exhibition of a purgative, in order to meet the symptoms which denote a foul and overloaded state of the primæ viæ; for this purpose I prefer calomel, because, while it empties the bowels, it induces an increased secretion of bile, by its peculiar effects upon the hepatic system. Two grains of calomel may be stated at the medium dose for children under twelve years of age, combined with ten of rhuM 2 barb. barb. To adults I usually give three grains, and always exhibit the medicine at bed time, as it will be more likely to remain a longer interval in the bowels while the patient continues at rest, and is not exposed to any variation of temperature. Calomel given in this manner, increases the secretion of bile before we can suppose it to Lave entered the circulation, and through that channel affected the liver. "In the morning following the exhibition of the calomel, a dose of vitriolated magnesia, proportioned to the age of the patient, generally produces four or five evacuations. For the first eight or ten days, I repeat the calomel every second night, and the neutral salt the following morning, which never fails to lessen the tumid state of the belly, and the swelling and itching of the nostrils and upper lip. The patient, instead of being reduced by these evacuations, is really improved in appearance, health and spirits. "This plan does not interfere with the exhibition of the carbonates of soda and lime, which I give twice or three times daily to children under twelve years of age, the medium dose of which may be stated at half a drachm of the former to double that quantity of the latter. To those more advanced in life, I give these medicines in as large doses as the stomach can bear without inconvenience. "After the first week or ten days, I generally omit the neutral salt entirely, and exhibit but one grain of calomel every second night, with ten grains of rhubarb; but in this I am determined by the degree of tumefaction of the belly, and swelling of the lip, invariably persisting in the neutral salt as long as these symptoms continue. Bitters or tonics I seldom employ, because their exhibition with the other remedies would be apt to cloy or overload the stomach; besides, I conceive that bitters can only be of service as a substitute to the bitter resinous principle of the bile, when that secretion is vitiated or deficient. And if the mercurial stimulus is sufficient to promote a healthy secretion of bile, the use of bitters would be superfluous; and I have had suffieient experience to satisfy me, that the remedies I have recommended are in general sufficient to answer every necessary purpose." This mode was followed by the most beneficial consequences; in three or four months, the symptoms receded, and except in a few obstinate cases, the patients are reported cured. It must be observed, however, that this plan of treatment was begun in all of these cases, in June 1809. Well knowing that the symptoms of scrofula, spontaneously recede at the latter end of summer, to return again the following spring, we require a longer time than has yet elapsed to convince us these patients have been cured. Indeed, in one of them (Ward), the ulcer of the leg had broken out in the January following; this is the case which was produced by eating manna. Several of the cases here described, occurred in the girls at a parochial school, and the author attributes the disease in them to their being deprived of their accustomed exercise. a short time from the commencement of this sedentary life, scrofu 6 In la la began to make its appearance, and afterwards affected near a' third of their number." It certainly is against the generally re-, ceived opinion that scrofula can be produced in so short a time, by such a cause, in habits where there does not exist hereditary predisposition; and this appears more unlikely still, if we admit indigestion and acidities in the primæ viæ to be the proximate cause, for then we should suppose causes applied immediately to the organs of digestion would be more speedily followed by their proper ef fects; yet in the boy who ate a great quantity of manna, thereby. instantly disturbing the digestive organs, scrofula did not appear, the author informs us, till the following year. Ever since the author has been satisfied that scrofula depcnds. upon the deranged action of the chylopoietic viscera, he has not failed, in the cases that came under his care, to make inquiries concerning the state of these organs. As a proof that his opinions are not to be overturned by trifling circumstances, we give the following quotation. "To my inquiry concerning the state of her bowels, I was informed that she was regular, but this I am inclined to doubt; for, from the view we have taken of the effects of exercise and pure air, in promoting the action of digestive organs, I cannot think it probable that digestion could have been performed with the same regu-, larity in a young person, who was deprived of the exercise and purity of air, to which she had been accustomed from her infancy.". The impression that remains on our mind in closing the volume is, that the plan of treatment recommended by the author in infantile diseases, is proper and judicious, little differing from that generally adopted by medical practitioners; that its utility in the advanc ed stages of scrofula is at least ambiguous, further time being required to make a fair estimate of it; and that the hypothesis of scrofula depending solely upon the deranged functions of the chylopoietic viscera as its proximate cause, to the exclusion of hereditary predisposition, is not only unsupported by, but is directly. contrary to the actual and acknowledged facts in the course of that disease. THE EDINBURGH JOURNAL, No. 23. ART. 1. Medical Report for Nottingham. By JAMES CLARKE, M. D. Physician to the General Hospital, and to the Vaccine Institution. Dr. Clarke has here presented us with another Medical Report, which, like the former ones, is a proof both of his indefatigable industry and attentive observation. After some remarks upon the revolution which medical opinions occasionally experience, and the desiderata to be had in view by writers of future accounts of the Walcheren Fever, he has given us a case of Diabetes, which, notwithstanding a great variety of treatment was adopted, at length proved fatal. The dissection showed, what might have been' expected from the course of symptoms, organic disease of the M 3 bladder, bladder, schirrus of its neck, and a cartilaginous structure of the urethra. Bleeding appeared to afford at least considerable relief to this patient, and Dr. Clarke seems to regard this remedy with a favorable impression. But what we are particularly inclined to attend to in this article, is the new theory of the disease suggested by Dr. Clarke, which we shall give to our Readers in his own words. "It has been already observed, that in most of the cases of this disease, the individuals have been previously subject to profuse sweating, which was suddenly checked by external cold, by drinking cold liquids, or by eating acid fruits, and speedily afterwards the diabetic affection appeared. Reflecting on this circumstance, it appears very rational to conclude, that the kidney became the receptacle of this suppressed fluid, and that the sweating, not simply the perspiration, was kept up from the kidney. This revulsion, as the ancients would call it, is admitted to occur from the kidney to other organs, and the converse must be equally correct. 'When the urine is not excreted, on account of some defect of the kidnies, ureters, or bladder, it has been exhaled into the skin, ventricles of the brain, or into the whole cellular fabric. The perspirable matter of Sanctorius, though so fluid, is sent off by the urinary passages, and by fear, or by medicines, through the excretory villi of the intestines.' (Haller's Physiology, 8th edit. p. 100.) The kidney will then have to throw off this sweating fluid in combination with the urine, which, from the stimulus given by this unnatural irritation, would be secreted in greater quantity; and to this stimulus the urinary organs cannot become habi, tuated, as it is to be supposed it will be subject to the same variation as the cuticular discharge, sometimes being mild, at other times irritating; and on this principle, the constant irritation of the urinary passages, and the phymosis, may be explained. In consequence of this increased action, the circulation in the kidney will be quickened; a greater supply of blood will be required. Hence the stomach is called into inordinate action, and the demand for food proportionably increased; the appetite becomes craving; it is no sooner gratified than digestion hastily commences; chyme is formed, from which the chyle is quickly separated; but from the urgent demand of the kidney, it cannot be completely formed into blood, and in consequence, passes into the kidney with the blood, and there mixing with the urine, gives to it the saccharine quality; thus we may explain the bulimia, dyspepsia, and sweetness of urine. Hence the increased celerity of the blocd so easily forces the red globules through these tubes, (uriniferous tubes) and, by morbid relaxation, they transmit the true fat and the chyle, and the salts of the meat and drink.' (Haller, p. 385.) Whilst this increased action is kept up in the kidney, every successive increase of debility in any other organ, will throw the more on the kidney. The stomach suffers first, being kept in constant action, and irritated by the gastric juice, which the con stant stant sense of hunger calls into this cavity; and the more action required from this organ, the quicker must be the circulation thro it; and if the supply of blood be not adequate, and the balance preponderate in favour of the kidney, the stomach must suffer doubly by the irritation of the gastric juice, and the want of support, which at last render it unable to digest its contents, and the patient dies from inanition." It frequently happens, that the most obvious and insurmountable objections to an hypothesis escape the notice of its framer; and we are apt to think this has been the case with Dr. Clarke: we trust, therefore, he will excuse our pointing out a circumstance or two which make against his opinions, and of which we must see an explanation before we can become converts to this new theory; for however ingeniously it is supported by its author, it yet appears liable to some difficulties and doubts, which we should thank Dr. Clarke to answer. If the increased flow of urine, in the first instance, is merely a vicarious discharge; if nothing but the " sweating fluid" is sent to the kidneys, to be thrown off by them in com bination with the urine, we see no possible source of mischief, nor can we allow that any unnatural irritation is thereby produced, the two fluids being so exactly similar, we may almost say identically the same; if also we suppose urine to be secreted in greater quantity, we should not expect the constant irritation of the urinary passages and phymosis to be referable to this circumstance, since we should apprehend these symptoms would rather take place from a greater concentration of that fluid than from its increased quantity and greater dilution. Admitting the increased action of the kidnies to take place, we do not see why a greater supply of blood will be required for the system, so that the stomach must be called into inordinate action, and the desire for food proportionably increased, without time being allowed for its complete formation into blood. Were this true, the same effect must follow from any excessive discharge or waste of blood from the system; in weakness produced from hæmorrha ges, for instance, a greater supply of blood will be required; and if the demand for it is too urgent to allow sufficient time for the complete conversion of the chyle into blood, the chyle must be hurried through the circulation into the kidnies, for by that source most fluid matters not converted into blood are discharged, and diabetes would be produced. In extensive local inflammations, of whatever description, there is increased action, and the circulation in the part is quickened, a greater supply of blood to the part is therefore required; yet we do not find the stomach called into inordinate action, nor the demand for food increased. The stomach being irritated by the gastric juice, which the constant sense of hunger calls into the stomach, is certainly a novel idea, but perhaps not a very just one. Wherein resides this sense of hunger? and how it is produced? The converse of the proposition may be M 4 true, |