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erefla cum molimine; of which, our Author's leading symptoms, the farp, fhrill, ftridulous voice; and the quick, difficult, high breathing, would not be a bad translation.

In Corol. 2, Dr. Home observes, that as the suffocatio Bridula is peculiar to a certain age, as it is local with refpect to its situation, so it is likewise particularly connected with the cold i and moist weather of winter.

In Corol. 3, our Author endeavours to ascertain the seat of the (uffocatio ftridula : it is not placed in the muscles of the glottis; - nor in the lungs ;--nor in the coats of the trachea ;but in the cavity of the trachea.-We profess we cannot fee with what propriety this disease can be faid to be seated in the cavity of the trachea independant of its coats. It is true, indeed, the membrane which is found on diffection, and which is described

by our Author, is feated in the cavity of the trachea ; but then }} this membrane is only to be considered as a symptom or effect;

and is produced by an encreased secretion from the mucous membrane, or the glands of this organ, which are in a preter. natural, diseased state : and Dr. Home so far forgets himself as soon after to observe, that this aistemper ought to be considered as originally feated in the mucous glands which are in great abundance in the coats of the trachea. The airy cavity of the windpipe is to be fure a very uncommon place for the seat of a disease; but our Author's sprightly imagination may possibly have catched the thought from a circumftance not unfrequent in his part of the world, the houses there consist of a great number of

stories ; and a person may have property in the upper parts of fuch a building, but none in the foundation :-now property so fatuated may be justly termed a tenement in the air : and why may not Dr. Home de indulged in fixing the seat of the croup in a manner alike fanciful and aerial !

The observations and conclusions concerning the canfe of the croup, in Corol. 4, are equally wild and unphilosophical, and quite unbecoming that gravity, soundness, and reserve, which are generally associated with the word COROLLARY.Various, says he, have been the theoretical opinions of people, who never had the opportunity, or gave themselves the trouble, to search into the real cause of this diftemper. But from the inspection of the morbid body, that true fource of knowledge, we learn, that the cause of this disease is a preternatural, white, tough, thick, membraneous cruft, covering, often for many inches, the inside of the trachea,'This wonderful membrane seems to be our Author's hobby horfe ; mounted on which, he with the greatest eale bounds over every difficulty relative to the nature, scat, and cause of the croup.-Bur the obfervation of this membrane is not so very nouvelle as Dr. Home may imagine: it has been seen lining the back-parts of the fauces, the stomach and


intestines; in flight inflammations of the glaris penis, we have observed a similar, thin, membranous coat, formed between the prepuce and the glans; practical writers mention a number of cases, in which it has been coughed up in greater or lesser portions from the aspera arteria and bronchia. The epidermis or interior membrane of the trachea is destroyed and renewed, says Haller, and is sometimes coughed up in the form of a thick, white membrane; the mucus of these parts is in like manner thrown up in fome diseases, and retains the form of the cavity from which it was rejected *. This membrane, however, has but a slender claim to be considered as the cause of the 'croup.

The proximate cause of every disease we apprehend to be such an alteration in the solids or Auids of the system, as to interfupt the natural and regular motions of such fyftem: hence a variety of unusual sensations and appearances; these constitute the symptoms; and a particular enumeration of such fymptoms forms the history of the disease. From the histories related by our Author, the membrane seems to be rather an effect, than the cause of the disease ; this too is confirmed by Dr. Home, who, in one of the subsequent corollaries, divides the fuffocatie Stridula into two stages, the inflammatory and the purulent. In the latter he says the membrane is compleatly formed; he fufpects it is not so during the inflammatory state; nay, in another passage, he even questions whether the membrane is not a fequa! to the purulent state. Dr. Home supposes, that mucus, by heat and stagnation, may be converted into pus; and perhaps, says he, this change from mucus to pus happens before the membrane is formed, as pus shows such a tendency to assume a folid form.'-The natural progress of things, therefore, according to Dr. Home, is as follows: there is a fever ; a quick, difficult respiration; a degree of inflammation affecting the glands and coats of the aspera arteria ;-consequently a flow of mucus upon

This mucus is changed into pus; and this pus is converted into that membrane, which is the true cąuse of the croup:-or, in plain English, after the disease has run through its first stage, and is come to the close of the last, there is then formed the true and genuine cause of such antecedent disease.-Good logic ! sound philosophy and the moft penetrating acuteness in physiological disquisitions !

But our Author proceeds to inquire, whence there is pus, or true matter, without ulceration? _That pus is formed without ulceration we know and believe from experience; but Dr. Home's thoughts on this subject are certainly a litde outré. Pus is not formed, he says, as is generally supposed, by the vedels of the ulcer; it exists in the blood, and is probably the

these parts.

• Yid. Haller Elem. Phyfiol. lib. 8. p. 148. 150.

true, true, nutritious, coagulable part of our fluids. In one place we are told that pus is formed from the lymphatic part of the blood; in another, from the secreted mucus ; and in a third, from the serum, by an evaporation of the watry parts and the subsiding and inspissation of what remains :-in short, pus is this or that, any thing or nothing, as best suits our Author's ready knack at drawing a conclufion. We should be glad to know from what pus is formed, when in a large abscess the whole folids and Auids of the part are diffolved down into one homogencous mass of matter.

Corol. 5. contains our Author's account of the different stages of this disease.-Cor. 6. his ratio fymptomatam.-Cor. 7. his prognostics.-Cor. 8. fome general rules with regard to practice, -Dr. Home in his conclusion is a little upon the PARADE: “We have now, says he, brought our inquiry to a conclusion. The facts, we hope, will appear curious, exact, and sufficiently numerous for our purpose; the method such as is used in mathematics and na-, tural philosophy, for discovering unknown truths; and the conclusions new, surprising, and naturally arising from the facts. If we have not brought this inquiry to that degree of perfection, in every point, that we could have withed, we have the satisfaço tion, at least, to think, that, so far as we go, our discoveries are certain, as they are built on the foundation of nature. Shun.. ning, with all imaginable care, fruitless and deceitful speculations, however entertaining, we have constantly kept our facts and experiments in view, as the only road to the improvement of medicine, and the good of mankind.'

The first paragraph of this little piece is almost as extraordie nary as the last. The science of medicine has been, gradually, advancing for these two thousand years by past; and is now brought to a degree of improvement; perhaps to as great a de, gree, every circumstance considered, as the difficulty of the art, the limitation of the human faculties, and the continual attempts to further refinement, too often conducted merely by fancy, will admit of.'—We hope and trust, however, that Dr. Home will prove a false prophet; that from a judicious attention to fact and experiment, many discoveries will yet be made in the physiology ; that from a more accurate history of diseases, their characters will be more strongly marked; and that medicines may be prescribed with a greater degree of certainty, from their virtues being more exactly ascertained. We are the more surprised at this piece of foreknowlege in our NORTHERN SÉER, as the metropolis in which he resides, contains one of the beft colleges of medicine in Europe :--a college, in which this mixed science is cultivated with the greatest success; in which a nunerous set of pupils have the best opportunities for prosecuting their studies ;--and from which, still many i reasonably be expected.


Remarks on the Disease commonly called a Fistula

cival Pott, F.R.S. and Senior Principa Bartholomew's Hospital, London. 8vo. Hawes and Co.

HERE was a time, when our good neig

in the art of surgery. Whatever might be age, it is evident, on comparing the present with that of London, that we are now infinit point of fimplicity of operation, and conseq surgery. To this truth, the treatife now bi cial testimony:

Mr. Pott's first intention is to inform thofe that a real fiftula in ano is a much more uncon is generally supposed; and that what is freque such, is a mere abscess, or collection of matt or callosity. He proceeds, in his second sectio disease under its various appearances with rega tion, and symptoms : but as these are generall pass on to Sect. 3d, in which our Author deliv treating the patient before the maturation of t we find him, in two instances, advising, from thod of proceeding very different from the ufua lar occasions. Speaking of that fpecies of tur skin wears the yellowish tint of the erysipelas inflammation, says the Author, generally mak nausea, vomiting, slight rigor, heat, thirst, and quickness of pulse, and heat of skin are indica gree of evacuation, and indeed sometimes re but it is a very prevailing opinion with many there evacuations should be freely made, and fre in short, that the cure of this kind of inflammai effected by them; which is so far from being to tice has proved fatal to many. This obferva tleman of Mr. Pote's experience, deferves par especially as it applies equally to erysipelatous every other part of the body.

The other instance in which, in the first ft the Author, most judiciously, steps out of the pears in his method of relieving the patient in

of urine ; a symptom frequently attendant on the formation of an abscess near the re&tum and bladder. "They who have not often seen this case, generally have immediate recourse to the catheter; and for this they plead the authority of precept: but the practice is so effentially wrong, and I have seen such terrible consequences from it, that I cannot help entering my protest against it: the neck of the bladder, from its vicinity to the parts where the inflammation is seated, and from its being involved in the fame common membrane, does certainly participate, in fome degree, of the said inflammation. This will in some measure account for the complaint; but whoever considers the extreme irritable state of the parts composing that part of the urethra, (if I may be allowed to to call it) and will at the same time reflect on the amazing and well-known effects of irritation, will be convinced that the principal part of this complaint arises from that cause; and that the disease is, strictly speaking, spasmodici?

The true, safe, and rational method of relieving this complaint, is, by evacuation and anodine relaxation : viz. venefection, gentle cathartics, femicupium, bladders of hot water applied to the pubes and perineum, glysters composed of warm water, oil and opium. There may have been cases, subjoins our Author, which have sefisted and baffled this method of treatment, but I have never met with them.'

Suppose the matter already formed fo as to require being let out, he advises the use of the knife or lancet in preference to the caustic, the latter being necessarily attended with loss of subkance; and, instead of cramming the wound with a large quantity of escharotic dreings, to introduce such only, as, by their Imall quantity and emollient quality, will permit and encourage a gradual suppuration. If, upon opening the abscess, it should appear, either from the rectum being perforated or denuded, that there is a necessity of laying the two cavities into one, he advises the operation to be immediately performed in the following manner:

• The curved probe-pointed knife with a narrow blade (of which there is a plate given) I have always found to be the most useful and handy inftrument of any : this introduced into the finus, while the turgeon's fore-finger is in the inteftine, will enable him to divide all that can ever require division; and that with less pain to the patient, with more facility to the operator, as well as with more certainty and expedition than any other inftrument whatever. If there be no opening in the intestine, the smallest degree of force will thrust the point of the knife through, and thereby make one ; if there be one already, the same point will find and pass through it: in either case, it will be received by the finger in ano, will thereby be prevented from deviating, and being brought out by the faid finger, must neeellarily divide Ray, Dec. 1765 FE


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