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We should not have thought the country of Dar-Fur, worthy of a separate section; for though we are more particularly acquainted with this kingdom, through the researches of Mr. Browne, it does not appear to be a state either of much extent, or of considerable importance, being on the contrary inferior to many other in the interior of Africa, but which are less known to Europeans.
In vol. II. p. 221, False-bay, near the Cape of Good Hope, is erroneously called Simon's-bay, which is the name of only a roadstead, in False-bay. The colony of Sierra Leone is also said to be abandoned, which is not the case; the author we suppose alluded to the settlement attempted in 1793 on a similar plan, at Bulama, at the mouth of Rio Grande, which did not succeed.
Amongst the African islands, those of St. Thomas, Fernando Po, and Annobon, possessed by the Portuguese, in the gulph of Guinea, have not been noticed; and of the West India islands, those of Barbuda, Tobago, St. Lucia, St. Martin's, have also escaped attention.
Dr. Aikin's punctuation is, in many places, defective; in the extract we have given, more than one paragraph will be found curtailed of its due proportion of commas. We recommend him likewise to revise the passage, page 17 in vol. I, where it is said, the species of rat, called the leming issues in innumerable armies, devouring every thing before them, till their course is stopped by the sea,' which is involved, if not ungrammatical. In page 336 of the same volume, the term, " one of these ports," applied to Trebisond, seems to refer to the immediate antecedent, the Russian ports,' while it is meant to relate to the general expression in the same paragraph, the ports on the Black sea;' for Trebisond is not a Russian port. Page 40 of vol. II. requires also emendation in the following passage; vast bodies of cavalry, which are brought into the field by the native armies,' instead of by the native powers.
We have been more particular in our attention to these minutiæ, as the geographical delineations are likely to be found in most schools, parlour windows, and juvenile libraries.
Art. VIII. Surgical Observations, Part the Second: containing an Account of the Disorders of the Health in General, and of the Digestive Organs in Particular, which accompany local Diseases, and obstruct their Cure: Observations on Diseases of the Urethra, particularly of that Part which is surrounded by the Prostrate Gland: and, Observations relative to the Treatment of One Species of the Navi Matèrni. By John Abernethy, F. R. S. &c. &c. 8vo. pp. 250. Price 6s. Longman and Co. 1806.
HE division of labour in any department of science, appears to bear a constant relation to the state of our acquaintance
with it. In nearly all cases, it is the most important means, as well as the invariable consequence, of improvement. With respect to the healing art, the most important division separates diseases into two classes: under that of Medicine are comprized such disorders, as depend on the general state of the system or on the deranged functions of some internal part, and as yield only to the operations of medicine; those, on the contrary, which are local, and generally removable by external means, are included under the head of Surgery. These two, which of course exclude Pharmacy, are often practically subdivided by the peculiar taste or talent of respective practitioners. It would indeed be amusing to examine, into how many different hands the various employments are now assigned, which the celebrated Parish Clerk,' as Pope assures us, discharged without any coadjutor.
By such divisions, however, the judgement and skill of individuals are most usefully increased; and medical science in general, derives large additions of information, from the results which their attention, thus concentrated, enables them severally to communicate. Yet it would be absurd to suppose, that a practitioner, who devoted himself to one branch of the profession, could never devise an improvement, or develope a fact, in another; and still more absurd to deny him the right of imparting to the world, discoveries which his peculiar talents or circumstances had placed exclusively within his own observation. Some original and important information, however, we naturally expect, when a man of Mr. Abernethy's celebrity, in the surgical department, presents the public with his remarks, on subjects which are usually referred to the medical; and we state, with pleasure, that his work fully answers the expectation it excited.
Mr. Abernethy justly observes, that the attention of the physician and surgeon has been too exclusively directed to those diseases, which custom has allotted to their care. So much so has this been the case, that except in Mr. John Hunter's celebrated work on the blood, inflammation, &c., no satisfactory observations have been published, either on the general affections of the system dependent on local disease, or on the changes which local diseases undergo from the reciprocal operation of disorders of the general system.
Considerable injury of particular parts is frequently succeeded by a correspondent derangement of the whole constitution; and this has been considered by Mr. Hunter as the result of universal sympathy. This consent of the whole constitution, with the injured parts, is manifested by the disturbance of the function of different organs in different cases; the difference appearing to depen deither on predisposition, or on some unknown state of the nervous systein. Hence fever, if the sanguiferous system is disturbed; vigilance or delirium, if the nervous system is chiefly
affected; and convulsions and tetanus, if the disorder more particularly affects the muscular system. When the affections just enumerated arise in consequence of injuries of the limbs, they are produced, Mr. Abernethy thinks, by irritation imparted to the brain, which, by a kind of reflected operation, occasions a greater disorder of some organs than of others, and thus gives a character and denomination to the disease.
It has been long known, that from various local injuries, the consequences of disease, accidents, or surgical operations, the stomach has appeared to be the part principally affected. But the subject, in Mr. Abernethy's opinion, has never been extensively surveyed, nor viewed with that accuracy of observation which it requires. He has therefore selected two cases, to shew how the digestive organs may be affected from local disorder.
In the first of these, which is that of a gentleman who underwent an operation for the return of an adherent omental hernia, the bowels were supposed to have been emptied by two evacuations from manna and salts, taken on the morning of the operation; his diet on the preceding day having been scanty, and entirely composed of fluid substances. After the operation, in which a portion of the omentum was cut off, general disorder of the constitution took place, and the stomach became particularly affected, being distended, uneasy on compression, and rejecting every thing that was swallowed. The sickness abated the next day; but the stomach recoiled at every thing that was offered it. An ounce of salts having been taken and retained, but without effect, and no sleep being obtained on the second night, the salts were repeated with senna. This also proving ineffectual, a grain of calomel was given that night, and repeated the following morning, the loathing of food still continuing. The third night being passed as ill as the former ones, aperitive pills were administered on the following day, but without any evident beneficial effect, and the patient again passed a distressful night. On the following morning, however, he felt his bowels apparently filling, and a profuse discharge took place by many copious, fetid, and black evacuations; the appetite returned, the tongue became clean, and sound sleep was restored. This case, and many others which might be adduced, demonstrate, in Mr. A.'s opinion, that local irritation may produce a great disorder of the digestive organs, by a reflected operation through the medium of the nervous system.
A less degree of irritation is supposed, by our author, to produce slighter effects of the same nature. Such he considers the disorder of the abdominal viscera, and that difficulty of breathing which has been so generally remarked in the last stages of A similar state of the chylopoietic organs is observed in the advanced state of lumbar abscess, compound fractures, and even
in a disease of so little seeming importance as a small ulcer in a fretful state but the circumstance of this kind, of most common occurrence, appears to be the effect on the health of children, so frequently observed during the progress of dentition.
After some useful illustrative remarks in the symptoms which denote disorder of the digestive organs, Mr. A. introduces some appropriate observations on the several changes which the aliment undergoes during its passage through the stomach and bowels, and endeavours to shew their dependence in this supposed disorder.
It is a circumstance however highly worthy of remark, that in many fatal cases of cancer, lumbar abscess, and other great local diseases, in which the digestive organs had been affected in the precise manner described by our author, no alteration could be discovered on dissection, in the structure of the chylopoietic viscera, which could be decidedly pronounced the effect of the disease.
The following inferences Mr. A. thinks may be fairly drawn from the facts already stated.
1. Sudden and violent local irritation will produce an equally sudden and vehement affection of the digestive organs. 2. A slighter degree of continued local irritation will produce a less violent affection; the ordinary symptoms of which are recited in p. 18. 3. This affection is a disorder in the actions, and not a disease in the structure of the affected organs; although it may, when long continued, induce evident diseased appearances, both which circumstances are proved by dissections. 4. A similar disorder of the digestive organs occurs without local irritation, and exists as an idiopathic disease; in which case, it is characterized by the same symptoms. 5. There are some varieties in the symptoms of this disorder, both when it is sympathetic and idiopathic. These are enumerated in p. 46. 6. The disorder probably consists in an affection of all the digestive organs in general, though in particular cases. it may be more manifest in some of those organs, than in others. 7. That disorder of the digestive organs frequently affects the nervous system; producing irritability and various consequent affections. This is proved by the effects of blows on the belly, in persons previously healthy and the same consequences are often observed from whatever cause the disorder originates. At the same time weakness must be produced from imperfect digestion; and from the combination of these causes, viz. weakness and irritation, I deduce the origin of many local diseases, and the aggravation of all, as will be seen in the relation of the cases.' pp. 49-51.
The application of these principles to those cases in which the derangement of the digestive organs appears to be idiopathic, is ingenious and useful as this derangement may frequently be traced to causes which primarily affect the nervous system: such as anxiety, too great exertion of the body or mind, &c. The following observations are truly important: they receive
confirmation from the cases which occur to every one whose practice is extensive, and must therefore be of the highest value to the less experienced practitioner.
'It is generally admitted, that disorders of the chylopoietic viscera will affect the source of sensation, and consequently the whole body; but the variety of diseases which may result from this cause, has not been duly weighed and reflected on.
It may produce in the nervous system an abolition of the functions of the brain; or a state of excitation, causing delirium, partial nervous inactivity and insensibility, or the opposite state of irritation and pain. It may produce in the muscular system, weakness, tremors, and palsy; or the contrary affections of spasm and convulsions. It may excite fever by disturbing the actions of the sanguiferous system, and cause various local diseases by the nervous irritation, which it produces; and by the weakness, which is consequent on nervous disorder or imperfect chylification. Or if local diseases occur in a constitution deranged in the manner which I have described, they will become peculiar in their nature and progress, and difficult of cure. Affections of all those parts which have a continuity of surface with the stomach; as the throat, mouth, lips, skin, eyes, nose, and ears, may be originally caused or aggravated by this complaint.' pp. 59, 60.
The method of treatment recommended by Mr. Abernethy is simple, and apparently well founded.
Believing the disordered parts to be in a state of weakness and of irritability, my object has been, to diminish the former and allay the latter. Believing also that the secretions into the stomach and bowels, upon the healthy state of which, the due performance of their functions depends, were, in consequence of such disorder, either deficient in quantity or depraved in quality; I have endeavoured to excite, by means of medicine, a more copious and healthy secretion.' p. 61.
In support of the opinions which are here delivered, several interesting cases are adduced, which tend to evince the extensive influence of disorder in the digestive organs. From these it appears, that weakness and paralytic affections of the lower limbs, much resembling those morbid affections resulting from diseased vertebræ ; imbecility and wasting of the muscles in one of the lower extremities, similar to the effects of disease of the hip joint; wastings of one of the upper extremities, in children; and distortions of the limb, from a predominance of the action of some muscles over others, frequently depend on a general disorder of the health, in which the digestive organs are usually much affected, and are consequently removed by due attention to these particular circumstances. To the same cause Mr. Abernethy refers cases which he has seen resembling tic doloureux; and even in cases of tetanus, he supposes that the local injury may, in this manner, lead to the production of tetanus, at a time when the wound is no longer irritable.