discharge, sometimes streaked with blood. The heat painfully increases, but there is no lancinating pain; there is soreness, but scarcely any pain from pressure with the finger. Violent hæmorrhages sometimes ensue. The complaint always terminates fatally. In TREATING the disease, it is right to mention, that if the inflammation indicated by the sense of heat be timely subdued by repeated cupping or leeches, the ulceration may, perhaps, be prevented ab initio. The hip-bath of 94° is also recommended, or sponges dipped in warm water, or warm water injected,—the horizontal position being strictly enjoined. Neutral salts with any aromatic water, and conium, with tinct. opii, or hyoscyamus, subdue inflammation and tranquillize the system; but sarsaparilla in large doses, often deranges the stomach. The diet should be abstemious. In the latter stage, mild astringent injections will be proper. He distinguishes CARCINOMATOUS ULCERATION from the preceding, by the presence of a hardened or thickened structure, and its earlier occurrence, which is between the ages of thirty and forty.. At first, there is usually a puffy state of the external parts, with erisypelas and distressing itching, and desquamation of the cuticle and irritating furfuraceous scales, extending sometimes to the groins. The discharge, which at first is ichorous, and afterwards purulent, is not copious. It is fœtid, and sometimes streaked with blood, or mixed with small coagula. Hæmorrhage may also take place, so great as to cause syncope, and giving temporary relief. At this stage, the disease very often extends to the rectum, the bladder, and the urinary passage; the parts are corroded, and the faces, the urine, and the discharge, now become intolerably foetid, pass from the vagina, irritate the soft parts, and cause inflammation and sloughing. The general system, of course, becomes affected by hurried circulation, great emaciation, hardness in the coats, and diminished calibre of the arteries and veins. The stomach refuses, or rejects all food, bile is vomited, sores arise on the angles of the mouth, and the tongue becomes dry, glossy, and either pale or dark red, and the mouth and anus aphthous. There is burning heat of the stomach, with greedy and insatiable thirst. The patient is tortured by violent, acute, and darting pain through the pelvis, depriving her of all repose day and night. The discase terminates, though the period is uncertain, by the exhaustion of strength, caused by this accumulation of misery. The disease is TREATED according as the patient is plethoric or otherwise, general blood-letting, repeated according to the symptoms, being employed in the first case, and local blood letting in the second, by cupping, above the fissure of the nates, to the extent of from six to twelve ounces, or by leeches, scattered about the pubis from groin to groin, or even introduced within the vestibulum. This treatment must also be pursued, but with greatcaution, to prevent the deposition of new matter froin thickening the parts, when ulceration is beginning or begun, the indications of which, are accelerated pulse, increase of heat in the skin, and of the lancinating pain, flabbiness of the integuments, and softness, and shrinking of the muscles, with the discharge more puriform. Blood in small quantities may be abstracted with advantage in the very last stages. The spreading of the ulcer may be retarded by promoting cleanliness, and the absorption of the ichor, for which the hip-bath of from 86° to 94°, and syringing the vagina while in the bath, are recommended. He also recommends injections of strong decoction of carrots, or three or four drachms to the pint of water of extr. conii vel hyoscyami, or two drachms of opium, or half an ounce of extr. papav. to the pint of water. Instead of water-starch, or quince-seed-mucilage, may be made the vehicle of the sedatives, as this will make them adhere to the surface of the ulcer. If opium be used in enemata, the practitioner' should carefully watch its effects, as it has when thrown into the rectum, produced vomiting, syncope, and cold extremities. Plasters, liniments, and lotions, with large proportions of opium, are of some advantage. Injections of acetic, or nitric acid, in very small proportions, are useful. In profuse and debilitating discharge, strong astringent injections are indispensable, such as alum, kino, decoct. cort. granati.; sulphate of zinc, and even nitrate of silver. All these remedies must be used, or not used, according to the necessity of the case, and he will be the best practitioner who best adapts the means to the end; but it ought to be a standing rule, never to give a sedative of great power, when a milder will procure relief: and to vary not only the medicine, but the form of it, as it is found to agree best. When opium fails, extr. stramonii may be tried. The author is apprehensive of belladonna, from having seen a patient nearly killed by two sinall doses. When the RECTUM becomes carcinomatous, from its neighbourhood to the diseased uterus, tenesmus comes on, great distress on going to stool, and exquisite tenderness of the gut on touching it. When the disease attacks the BLADDER, there is shivering, heat, great pain fixed and constant, and stranguary ;and if it proceed to the abdomen, there will be symptoms of peritoneal inflammation. In all these cases, local bleeding must, cæteris paribus, be employed. It is quite possible, from the near neighbourhood of the one to the other, to mistake CARCINOMA OF THE RECTUM, for carcinoma of the uterus. The uterus is, however, the most frequently attacked; and examination will usually decide the point. When the finger is stopped in the rectum, by a thickened constriction, exquisitely painful, we need not attempt to ascertain the extent of the disease, for that will do no good, as we cannot operate here, and the most trifling carcinoma of the fourth of an inch, requires as much care, and will equally prove fatal with an extensive affection, from the effects on the functions. A large tubercle of the liver, for example, may long exist, without giving much trouble, while a small one, or the thickened heads of the tumours, compressing the gall ducts, will soon cut off the patient by jaundice, dyspepsia, or dropsy. The mesenteric glands. may enlarge greatly, without producing more evil than debility; but if they enlarge, so as to press on the great blood-vessel of the abdomen, convulsions and death will ensue. Of such a case, Mr. Clark has a preparation. In the same way, a fourth of an inch of the rectum, constricted by carcinoma, will stop the fæces and cause death, as certainly as six inches soconstricted. The TREATMENT of this is precisely similar to that just detailed, as applicable to uterine carcinoma. After so ample an analysis, we require not to say a single word in praise of this highly useful production, of which, every accoucheur should possess a copy. PRICHARD ON THE DISEASES OF THE NERVOUS SYSTEM.* BEFORE we proceed to Dr. Prichard's good things, we shall, as we are very friendly to him, exercise the highest privilege of friendship,-to tell him some of his faults. We object then, at the outset, to the greater part of his theoretical discussions; • A Treatise on Diseases of the Nervous System, Part I.; comprising, Convulsive and Maniacal Affections. By J. C. Prichard, M. D., &c. London, 1822. pp. 425. not only as of little utility to the practitioner, and of less to support his own judicious practice; but as often unsound, and far from being intelligible, when considered merely in the light of philosophical disquisitions. Such may do very well to amuse his leisure hours of speculation on the Physical History of Man ;* or when he is tired of Jablonski and Bryant and the hieroglyphics, may afford an agreeable variety to his Egyptian researches†; but in a practical work on diseases, such exercises of a philosophical fancy are sadly out of place, and the purchaser looks upon them, as nothing but useless lumber, among which he has to search and dig, for the only thing which he cares for -PRACTICAL FACTS. It indeed appears to us, that as far as his theories are just, he has illustrated them only by known common places; and when he attempts to step out of the common road, he very often goes astray. Pathemata, indeed, is a very fine word, but its only use, we conceive, is to skreen ignorance, and make us fancy that we know what we do not know. We should, therefore, advise Dr. Prichard, as the greatest improvement he could make, to leave out the whole of his theory in his forthcoming new edition; and supply the chasm out of the ample store of interesting cases, which we infer, from the specimens here given, he must still possess. Another of Dr. Prichard's prominent faults, is the indistinct and involved arrangement which he has adopted. It is probable, his theory led him into the labyrinth; but be this as it may, we are certain, he would require the aid of his Egyptian friend, Hermes Trismegistus, and even of Isis and Osiris to unravel it. In our analysis, we shall follow a more obvious and simple outline; and we shall also avoid, as much as we can, the professional slang, in which Dr Prichard occasionally revels, though we marvel how a man of taste like him, who quotes Shakespeare, and Greek epigrams, should mar the clearness of his statements by borrowing such terms as Leipothymia, Juvantia, Laedentia, &c., even from Sauvages, or Dr. Gregory. But we must go on to what is practical in the book, and of this we think very favourably. His cases are particularly instructive and valuable, and full of acute observation, and accurate detail, while his practice is for the most part sound, and unexceptionable. We are, indeed, sorry that we can afford so * Researches into the Physical History of Man. By J. C. Prichard, M. D. &c. Evo. 1813. See the Author's Work on Egyptian Mythology. little space to this article, otherwise, we readers with a more ample selection cases; but we shall give the principles the more minute details, we must refer to EPILEPSY. hould have treated our om these interesting his practice, and for the work itself. attended by sudden isness, and a conthe whole frame. which is less freconvulsion, but muscles, which form, which is laxed, and the. he pulse as in pothymia. THE more common form of epilepsy, is fits, total or partial loss of sense, or conse vulsive agitation of the voluntary muscles In the form of disease, resembling tetanus quent, there are sudden fits of coma, witho with what may be called a tonic spasm of t become rigid and inflexible. There is a thi akin to apoplexy; in which the muscles are patient lies in a state resembling sleep, with syncope. This Dr. Prichard is disposed to call. There is sometimes, a remarkable approach to tressing sense of inflation in the præcordia, for cult respiration, palpitation, borborigmus, the fe rising from the stomach to the throat occasioning a striction, accompanied with frequent micturition all of which symptoms of hysteria, occur in case epilepsy. steria-a dis ́ample, diffing of a ball nse of conpale urine; of genuine Those symptoms, reckoned the most uniform, ar sometimes wanting, such as the convulsions, and the subse nt stupor. Even the insensibility during the fit, is occasionally sent, and this is regarded by Sauvages and Dr. Ferriar, as a racteristic of uterine epilepsy, but Dr. Prichard's experience is t variance with this. There seems to be a peculiarity in the ite of the brain during sleep, which favours epilepsy. One patient of Dr. Prichard's, was almost sure to be seized a few m utes after falling asleep. He was a young labourer, rather the apoplectic make, and had enjoyed good health till two y rs before, when he was suddenly awaked in the night by a pasmodic action of the muscles of the left shoulder, violently extending the arm, and drawing the head down to the shoulder: the whole muscular system was next affected. He attribute plaint to his falling from a waggon, on his shoul dozed but a few minutes during the day, a fit woul The treatment which was recommended, only serve his strength. We know a gentleman of nervous temperament regularly after he has slept for five or ten minute starting, often slight, but sometimes violent,-ray mare. This brief fit passes off, and he sleeps his com If he eize him. to reduce who almost wakes with like nightundly for the |