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

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

In Corol. 3, our Author endeavours to ascertain the seat of the suffocatio fridula : 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 profefs we cannot see with what propriety this disease can be said to be seated in the cavity of the trachea independant of its coats. It is true, indeed, the membrane which is found on dissection, 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 preternatural, diseased state : and Dr. Home so far forgets himself as soon after to observe, that this distemper 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 sure a very uncommon place for the seat of a disease; but our Author's sprightly imagination may possibly have catched the thought from a circumstance not unfrequent in bis 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 such a building, but none in the foundation :- now property fo situated may be justly termed a tenement in the air : and why may not Dr. Home be indulged in fixing the seat of the croup in a manner alike fanciful and aerial !

The obfervations and conclufions concerning the cause 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 þe, 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 distemper. But from the inspection of the morbid body, that true source of knowledge, we learn, that the cause of this disease is a preternatural, white, tough, thick, membraneous crust, covering, often for many inches, the inside of the trachea,'- -This wonderful membrane seems to be our Author's hobby horse ; mounted on which, he with the greatest ease bounds over every difficulty relative to the nature, feat, and cause of the croup.—But the observation 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 ftomach and

inteftines; 5

intestines; in flight inflammations of the glans penis, we have observed a similar, thin, membranous coat, formed between the prepuce and the glans ; practical writers mention a number of cafes, in which it has been coughed up in greater or lesser portions from the afpera arteria and bronchiæ. The epidermis or interior membrane of the trachea is destroyed and renewed, fays 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 folids or Auids of the system, as to interrupt the natural and regular motions of fuch fyftem : hence a variety of unusual fenfations and appearances; these constitute the symptoms; and a particular enumeration of fuch 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 fubfequent corollaries, divides the suffocatio Aridula into two stages, the infiammatory and the purulent. In the latter he says the membrane is compleatly formed; he fufpects it is not fo during the inflammatory state; nay, in another paffage, he even questions whether the membrane is not a sequel to the purulent state. Dr. Home supposes, that mucus, by heat and flagnation, 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 afpera arteria ;-confequently a fow of mucus upon thefe parts. This mucus is changed into pus; and this pus is converted into that membrane, which is the true cause of the croup:-or, in plain English, after the disease has run through its fuft stage, and is come to the close of the laft, there is then formed the true and genuine cause of fuch antecedent disease. Good logic ! found philosophy! and the most penetrating acuteness in physiological difquifitions !

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 little outré. Pus is not formed, he fays, as is generally supposed, by the veliels of the ulcer; it exists in the blood, and is probably the

• Vid. Hailer Elem. Phyfiol. lib. 8. p. 148. 150.

true, their 6

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 ferum, by an evaporation of the warry parts and the fubfiding 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 homogeneous mass of matter.

Corol. 5. contains our Author's account of the different stages of this disease.-Cor. 6. his ratio fumptomatum. -Cor. 7. his prognostics.-Cor. 8. some general rules with regard to practice. Dr. Home in his conclufion is a little upon the PARADE: We have now, fays he, brought our inquiry to a conclufion. The facts, we hope, will appear curicus, exact, and fufficiently numerous for eur purpose; the method such as is used in mathematics and natural philosophy, for discovering unknown truths; and the conclufions new, furprising, 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 wished, we have the fatisfac. tion, at least, to think, that, fo far as we go, our discoveries are certain, as they are built on the foundation of nature.

Shunning, with all imaginable care, fruitless and deceitful speculations, however entertaining, we have conftantly 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 extraordisary as the last. The science of medicine has been, gradually, advancing for these two thousand years by paft; and is now brought to a degree of improvement; perhaps to‘as great a de. gree, every circumstance confidered, as the difficulty of the art, the limitation of the human faculties, and the continual attempts to further refinement, too o ten conducted merely by fancy, will admit of.' We hope and truft, 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 disa eases, 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 SEER, as the metropolis in which he resides, contains one of the beft colleges of medicine in Europe:- 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 improvements may reasonably be expected.

D.

Remarks on the Disease commonly called a Fistula in Ano. By Per

cival Pott, F. R. S. and Senior Principal Surgeon to St. Bartholomew's Hospital, London. 8vo. 25. 6d. sewed. Hawes and Co.

TH

HERE was a time, when our good neighbours the French

were generally believed greatly to excel all other nations in the art of surgery. Whatever might be the case in the last age, it is evident, on comparing the present practice in Paris with that of London, that we are now infinitely before them in point of fimplicity of operation, and consequently in rational surgery. To this truth, the treatise now before us bears special testimony

Mr. Pott's first intention is to inform those of less experience, that a real fistula in ano is a much more uncommon disease than is generally supposed; and that what is frequently mistaken for such, is a mere abscess, or collection of matter, without fiftula or callosity. He proceeds, in his second section, to consider the disease under its various appearances with regard to aspect, situation, and symptoms : but as these are generally known, we shall pass on to Sect. 3d, in which our Author delivers his method of treating the patient before the maturation of the tumour. Here we find him, in two instances, advising, from experience, a method of proceeding very different from the usual practice on fimilar occasions. Speaking of that species of tumour in which the skin wears the yellowish tint of the erysipelas, “ This kind of inflammation, says the Author, generally makes its attack with nausea, vomiting, flight rigor, heat, thirst, and restlessness. The quickness of pulse, and heat of skin are indications for some degree of evacuation, and indeed sometimes render it requisite; but it is a very prevailing opinion with many practitioners, that these evacuations should be freely made, and frequently repeated : in short, that the cure of this kind of inflammation is safely to be effected by them; which is so far from being true, that the practice has proved fatal to many.' This observation, from a gentleman of Mr. Pott's experience, deserves particular attention; especially as it applies equally to erysipelatous inflammations in every other part of the body.

The other instance in which, in the first stage of the disease; the Author, most judiciously, steps out of the beaten path, appears in his method of relieving the patient in a total suppression

of

1

of urine ; a symptom frequently attendant on the formation of
an abscess near the rectum and bladder. “They who have not
often seen this case, generally have immediate recourse to the
catbeter ; and for this they plead the authority of precept: ut
the practice is so effentially wrong, and I have seen such
rible consequences from it, that I cannot help entering my p.
test against it: the neck of the bladder, from its vicinity to the
parts where the inflammation is feated, and from its being involved
in the same common membrane, does certainly participate, in
some degree, of the said inflammation. This will in some mea-
fure account for the complaint; but whoever confiders the ex-
treme irritable state of the parts composing that part of the ure-
thra, (if I may be allowed fo 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, spasmodic.'
~ The true, safe, and rational method of relieving this com-
plaint, is, by evacuation and anodine relaxation : viz. venelec-
tion, gentle cathartics, femicupium, bladders of hot water ap-
plied to the pubes and perineum, glysters composed of warın wa-
ter, oil and opium.' • There may have been cases, fubjoins our
Author, which have resisted and baffled this method of treat-
ment, but I have never met with them.'

Suppose the matter already formed so as to require being let out, be advises the use of the knife or lancet in preference to the eaustic, the latter being necessarily attended with loss of subItance; and, instead of cramming the wound with a large quantity of escharotic dressings, to introduce such only, as, by their. small quantity and emollient quality, will permit and encourage a gradual fuppuration. 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 instrument of any : this introduced into the finus, while the surgeon's fore-finger is in the intestine, 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 intrument whatever. If there be no opening in the intestine, the {mallest degree of force will thrust the point of the knife througļi, and thereby make one; if there be one already, the same point will find and pais through it: in either cafe, it will be received hy the finger in ano, will thereby be prevented from deviating, and being brought out by the faid finger, muft necessasily divide REV. Dec. 1765. Ff

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