Dr. Kinglake, probably aware that the term vital motion might not be fully comprehended by some of his readers, proceeds to explain it in the following luminous paragraph. "By vital motion is meant a repellency, subsisting between the constituent particles of all matter. This innate power or property is, by a law of nature, spontaneously evolvracter and determinal force, when issuing from the congeries, or combination of material substances, which forms specific or particular structure." ed from atomical surfaces, and assumes cha As the idea appears to us to be perfectly novel, we shall indulge the reader with the following quotation, in which the hypothesis is still farther developed. "The exertion of this universally repelfent power, in the organic fabric of the animal economy, is life, or vital motion. The action of this power denotes itself in animal feeling as heat; an undistinguishable identity, therefore, with respect to the object, subsists between what has been variously denominated repulsive motion, vital action, and heat. These several modes of the same thing arise from the different circumstances in which it is operative. Repulsive motion is the natural efficiency of matter, and universally pervades every conceivable atom; vital motion is the organic efficiency of matter, and heat is the impression only, which that power makes on animal sensation." Laying aside the author's peculiar notions respecting the nature of heat, it appears that he conceives gout to consist merely in the excessive accumulation of it in the diseased part. Dr. Kinglake congratulates himself on the happy manner in which this hypothesis, respecting the proximate cause of the disease, applies to the method of cure, which he remarks is "unique in the catalogue of diseases." In the following sentence we meet with the hypothesis of Dr. Kinglake, respecting the manner in which caloric is generated in the human body.' « As vital motion, in healthy as well as morbid states, is generated by the atomical and compound efficiency of organic matter, its excess, defect, and diseased agitation, must depend on the existing motive conditions of the animal fabric." We do not perceive that the author adduces a single argument in favour of his hypothesis, or attempts to repel any objections that might be urged against it. He is indeed so fully persuaded of its truth, that he boldly asserts, that "though excessive heat should not be thermometrically discoverable at the surface, yet it actually prevails as the necessary effect of commotion." The 4th section contains an account of the "cure of gout." The originality which our author has displayed in his ideas respecting the nature and cause of this disease, prepared us for some new opinions respecting the method of cure; and we have found his opinion no less sagacious on this point, than on the other parts of his subject. The gout consisting solely of a morbid accumulation of heat in the affected part, the only thing necessary for its cure is, he conceives. the removal of that heat by external cold. The application of cold water is the most commodious method of producing this effect, and this indeed is very nearly the whole of Dr. Kinglake's prac tice. This simple plan of treatment is unfolded in the following eloquent paragraph. "Cold water is the universal boon of nature, is the vehicle of atmospheric temperature, in which the functions of health are carried on, and to the refrigerant offices of which, intemperate heat yields its hurtful influence. The fluid then which bears this salutary temperature, is the simple and effica cious remedy here proposed, for the immediate relief and speedy cure of gouty in com mon with every description of inflammation. It should be applied topically to the affected parts, either by means of wetted cloths, by gentle showering, or actual immersion. A durable degree of cold must be supported; the refrigerant force, therefore, of its first application must be uniformly continued, by frequently renewing the cold water, which soon becomes heated by the inflammatory temperature of the affected parts. This course should be pursued until the painful sensation of burning heat shall subside, and with it the concomitant efflorescence and tumefaction." In conformity with the leading idea of the identity of all inflammatory affections of the joints, the author conceives that they must be combated by the same remedy, and to this alone he seems to trust the removal of every kind and degree of gouty affection, with scarcely any limitation or exception. As far as we are able to comprehend the author's more recondite speculations, we conceive him to be a zealous disciple 3 E 4 of the Brunonian doctrine; this idea affords us the only clue to the explana tion of the following remarks. "There are indeed two modes of reducing inflammatory neat: the one is by diffusion, or transference through substances at a lower temperature; the other is by exhausting the fuel, or the pabulum which evolves it: thus, combustive force will diminish, as the final destruction of the burning body approaches; but it must be remembered also, that it will cease altogether, when the body is wholly burnt: in like manner organic structure may be so stimulated, as at length to be nearly exhausted of vital power, and consequently be reduced to languid motion; but here too, its total exhaustion is hazarded, which would be tantamount to death itself." We shall pass over the pages in which the author feelingly laments over the prejudice which still prevails in favour of encreased temperature in these complaints. We do not perceive that any additional arguments are brought forwards in support of his opinion, or that his remarks contain any thing new, except the language in which they are conveyed. The section concludes with some general observations upon the method of removing the stomach affections, which, though not any essential part of the disease, sometimes accidentally_accompany the gouty inflammation. He seems indeed, as might be expected, to attach but little importance to their opera tion. The subject of the 5th section, the "prevention of gout," is obviously of peculiar importance. For though, according to the statement of the author, this disease may be so easily cured, still it is more adviseable altogether to prevent its attacks. Food being one of the principal stimuli which produce the ex citement of the system, and predispose to this disease, a proper attention to the quantity and quality of the diet, or to use the more elegant expression of Dr. Kinglake," dietetic regulation," must afford an important means of preserving the state of the health. We are accordingly informed, that "the errors of both excess and defect are correspondently manifested in vital action, which will be shaped and characterized by temperamental susceptibility for morbid impres sion." It is stated that when the system is weakened by "dietetic excess," we learn from experience that the ligamentliable to become the seat of inflammaous and tendinous structure is peculiarly tory action. Restriction in diet becomes therefore the necessary method of preventing gout, a conclusion to which we most fully assent, but which we do not find receives any additional confirmation from the speculations of D. Kinglake. As co-operating with the effects of abstemiousness, exercise, moderate temperature, the prevention of indigestion, and washing the hands and feet in cold water, are recommended. But we have dwelt so long upon the former part of the work, that we feel it incumbent upon us to hasten to the conclusion of this article. The 6th section, entitled "recapitu lation," consists of the matter of the forseries of propositions. The 5th, 6th, mer sections, drawn up in the form of a of the leading doctrines respecting the and 7th propositions contain a summary nature of gout. “5. The nature of gout is purely inflam inatory, and possesses no peculiar or specific properties to distinguish it from coininga inflammation, but what are referable to the structure or organization of the affected parts. "6. The seat of the gout is exclusively in the ligamentous and tendinous fabric; the texture of which, when inflamed, affords all that is peculiar or characteristic of gout, This fabric therefore is necessary to the constitution of what is called gouty inflammation, which evinces that it cannot occur on any of the visceral or vital organs, as these possess nothing of the ligamentous or tendi ness of the disease, which, consisting in an inflammatory irritation of the ligamentous and tendinous structure, will exclusively remain such, however variously and capriciously denominated." In the 8th it is expressly stated, that the origin of gout is always local, as it can only arise in the ligaments and tendons; and in the 9th it is maintained, that it must necessarily remain confined to this particular structure, and there fore cannot pass into the brain, stomach, or bowels. To the body of the work is subjoined an appendix of nearly 200 pages, containing the detached papers, originally published in the Medical and Physical Journal, by Dr. Kinglake and his correspondents. A number of original cases are added, many of them from very respectable practitioners. The body ART. IX. An Account of two Cases of Gout, which terminated in Death, in consequence of the external Use of Ice and Cold Water. By A. EDLIN. pp. 24. "THE little experience" which the author has had in the application of cold to gouty inflammation, a practice which has almost petrified him with horror," he is anxious to relate, in order to guard the unwary against the delusion of Dr. Kinglake's "plausible theory." It consists in fact but of one case; for the second is related merely from the recollection of two old ladies, one of whom attended the patient's funeral, upwards of 30 years ago. The case, which the author saw, is that of a respectable sur geon at Uxbridge, who, by means of sponging with cold water, and afterwards by the application of cloths dipped in iced water, immediately relieved, and in less than three hours removed the pain from his inflamed foot, which he considered as affected with the gout. In the course of a few hours he was seized with palpitation, vomiting, and a sensation of great coldness in the stomach, intermitting pulse, and cold extremities. These symptoms were removed by strong antispasmodics internally, and by the external application of bladders of hot water. Three days afterwards the same alarming symptoms returned, and were by the same means alleviated. But after another interval of four days, they recurred a third time, and proved fatal. We agree with the author, that this was probably a case of what has been called repelled gout. But the nosological term is not associated so strongly in our minds with a certain invariable treatment, as to preclude us from viewing calmly any judicious deviation that may be proposed. And before we conclude that particular treatment is detrimental, we must be satisfied that it was judiciously employed. The author, however, has omitted to state the particular circumstances of the patient, which might determine our conclusions. He has not told us the age, the temperament, the state of constitution of the patient, nor the previous number of attacks, all which, as well as the mere existence of the local inflammation, should be considered in determining the danger of a metastasis to the stomach, in consequence of a removal of the local disease. The authority of Dr. Kinglake is not sufficient, we apprehend, to counterbalance the evidence of the most judicious physicians, by whom an affection of the stomach, or other vital organs, consequent to a suppression of the local inflammation, has been frequently described, and is still frequently observed. But, on the other hand, the deleterious effects of the practice which he recommends, cannot be asserted from a single case, nor from a number of instances, unless it were judiciously employed, with every attention to collateral circumstances. 鹦 ART. X. A Treatise on Febrile Diseases, including intermitting, remitting, and continued Fevers; eruptive Fevers; Inflammations; Hamorrhagies; and the Profiuvia; in which an Attempt is made to present, at one View, whatever, in the present State of Medicine, it is requisite for the Physician to know respecting the Symptoms, Causes, and Gure of those Diseases; with Experimental Essays, on certain Febrile Symptoms, on the Nature of Inflammation, and on the Manner in which Opium and Tobacco act on the lving Animal Body. By A. PHILIPS WILSON, M. D. F. R. S. Ed. Fellow of the Royal College of Physicians, Edinburgh, &c. Vol. 4. 8vo. pp. 740. THE three preceding volumes of this work were published previous to the commencement of our Review. They have obtained a considerable and wellmerited share of approbation from the public, and afford a judicious and comprehensive view of some of the more important genera of the Pyrexia of Dr. Cullen, arranged according to his system. The remaining diseases of that class, with the exception of catarrh, which the author deemed it unnecessary to treat of, are comprised in the volume before us; viz. Cynanche trachealis, the inflammations of the thoracic and abdominal viscera, rheumatism, gout, the hæmorrhagies, phthisis pulmonalis, and dysentery. Dr. Wilson is entitled to considerable credit, for the assiduity and judgment with which he has compiled the most valuable observations of the older writers, and discarded their absurdities; but he has perhaps too seldom ventured to interpose the result of his own experience, where they have left the matter in much doubt, or even as serted contradictions. His information is extensive, and his opinions, if not bearing the stamp of originality, are the result of good sense; and, on the whole, this volume appears to us to contain the best systematic treatise on the diseases, which it includes, that is extant. We shall state a few of the observations which occurred to us in perusing it. In the first chapter, the author has made a division of croup into two va rieties; that which we sometimes meet with in adults, and that which attacks children from the time they are weaned till about twelve years of age; yet he acknowledges that the symptoms, and the remedies required, are the same in both. Were we thus to multiply diseases, we must run into endless confusion; and lose sight of the only advantages which attend a nosological division, the precision with which the nature of the disease may be ascertained, and consequently the peculiar treatment which it requires. It cannot be doubted that the diseases are the same. In one case which fell under our notice of a gentleman, aged 45, who died on the second day from the attack, with the symptoms of croup, the peculiar symptom, or, as it has been supposed, the proximate cause of the disease, consisting of an exudation of evagulable lymph into the trachea, was ascertained by dissection. It is not easy to collect from the author's observations, whether he considers the acute asthma and croup as different diseases, with Michaelis and Dr. Millar, or whether, with Dr. Rush, he would call the one cynanche trachealis spasmodica, the other cyn. trach. humida. We are rather disposed to think with Dr. Cullen, that they are one and the same disease; in some instances combined more or less with pneumonic symptoms, more or less remittent, &c. In the very ample detail of remedies, he has said little of mercury. He merely remarks that Dr. Rush has recommended it as possessed of some virtue, independently of its purgative quality; and adds, "It is probable that it may be of service in the croup, though not in the degree in which Dr. Rush alledges." p. 40 We notice this on account of the strong testimony, which has been added by Mr. Rumsey to that of Dr. Rush, in favour of the powerful effects of this remedy in the cure of croup. (See Med. and Chi rurg. Trans. vol. 2.) If its valuable qualities, experienced by Mr. Rumsey in the treatment of this disease, be cor roborated by general experience, none of the other remedies proposed can be put in competition with it. The section on pneumonia is valua ble: but the author perhaps leans with too much confidence on the authority of some names which, in our ignorance, we had never heard before, and others to which we did not attach any great respect. Quasin, Wendt, Schroeder, &c. are quoted again and again, for facs of rare occurrence and opinions of doubre ful validity. Dr. Wilson has demon strated the error and absurdity of divid ing pneumonia into the two species, pleurisy and peripneumony, which Dr. Cullen was induced to adopt, rather in compliance with general prejudice, than as the result of his own conviction. Upon comparing the different accounts given by the writers who assume this division, Dr. Wilson affirms, that the only points in which they all agree are, that an obtuse and pretty general pain, or the total want of pain with a great degree of dyspnea, is the chief characteristic of peripneumony; and an acute pain, of pleurisy. Yet even this limited distinction is invalidated by dissection. The parenchyma has been found inflamed, where the symptoms had been those of pleurisy, and vice versa. The author also maintains, what we believe is equally indubitable, that the inflammations of the diaphragm, mediastinum, pericardium, and of the heart itself, are not to be distinguished from inflammations of the lungs or pleura. Dissections, related upon the authority of Morgagni, Cullen, Cleghorn, &c. prove that the symptoms attributed to an inflamed state of these organs respectively, have been present where the organs were found free from disease; and on the contrary, that these organs have been found greatly inflamed on dissection, when the peculiar symptom supposed to indicate inflammation in them had not previously appeared. The symptoms of pneumonia belong equally to them all; and the same remedies are required. The author has added an ample detail of the varieties of pneumonia, including not only the pneumonia typhodes, peripneumonia notha, bastard pleurisy or rheumatism of the muscles of respiration, but those varieties also which arise from irritations in the abdominal viscera. With respect to some of the latter we must confess ourselves somewhat sceptical. The pressure of a schirrous liver, or an indurated spleen upon the diaphragm, may possibly in some instances excite inflammation in the lungs ; but we doubt much whether a distant irritation in the intestines, independent of mechanical pressure, and through the medium of a supposed nervous sympathy, can be said to have produced a pulmonary inflammation; nor do we conceive that the discovery of a superabundance of bile, or of a lumbricus, in the elementary canal of a person destroyed by pneu monia, is a sufficient evidence that the fatal disease originated from the irritation which they had occasioned. The frequent existence of these irritating matters, however, suggest the propriety, as the author has remarked, of clearing the primæ viæ in all cases of pneumonia, whether symptomatic or not. In that unmanageable part of the disease, called pneumonia typhodes, where much must depend upon the judgment of the prac titioner, the author has particularised the remedies with becoming caution. Bleeding, he observes, has been found in general to accelerate the fatal termination; and, upon the whole, the treatment which he recommends, is dictated with a view to the typhoid, rather than to the inflammatory symptoms. The safest and most useful remedy in putrid pneumonia, is wine. The bark, in the author's opinion, is more exceptiona ble. The chronic hepatitis is introduced among the phlegmasia, perhaps with little propriety. The symptoms which are said to characterise this obscure disease, have nothing in common with those of acute inflammations; and, on the other hand, they occur in many or in all those chronic derangements of the structure of the liver, which we are seldom able to discriminate during the life of the patients. We conceive, therefore, that this class of symptoms should have been excluded; or, if the author was unable to point out the diagnostic marks, by which simple chronic inflammation might be distinguished from the various schirrous and tubercular diseases, which are discovered by dissection, he should have included the consideration of these modifications of hepatic disease; which, however, he has omitted to mention. On the subject of acute rheumatism, we are accustomed to see a good deal of inconsistency in the observations of writ ers, and no very satisfactory account of the efficacy of remedies. In both respects Dr. Wilson has exposed himself, though in a less degree, to the same censure. We are often told that rheumatism is a pure phlegmasia, yet that it neither tends to suppuration nor to gangrene. The fever, it is said, is a simple synocha, yet it does not like synocha terminate frequently in typhus. The blood, we are informed, exhibits a buffy coat equally strong as in the most violent inflammatory fevers, therefore profuse venæsection is to be prescribed; yet in the gout, where according to Sydenham there is the same appearance of the |