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a soft mucous substance, which sometimes becomes very thick, peels off, and leaves the skin red, smooth, and tender; the substance of the tongue is often swollen, oedematous, and impressed by the contiguous teeth; the red papillæ are often seen rising above the mucous load; there are indentations, often formed into creases or folds, with deep and numerous furrows; sometimes it is less loaded and indented, and its edges are red and even. In chronic dyspepsia, the tongue is more usually furred than loaded, the fur being like coarse velvet, and dry; in some cases, the papillæ enlarge, in others the tongue is lobed, and in others smooth and glazed. In chlorosis, at the commencement, the tongue is pallid and tumid, with enlarged papillæ, loaded, indentatious, and sulci; it afterwards becomes cleaner, smoother, more pale, of a lilac hue, and semitransparent; the papillæ disappear, and a morbid smoothness succeeds.

The loaded and swollen tongue is usually ASSOCIATED with an oily and swarthy state of the surface and complexion; the pale, tumid, and clean tongue, as in chlorosis, is accompanied by a tendency to tumidity of the integuments and edema of the ankles; the clean, papulated, lobulated, fissured, or morbidly smooth tongue, is united with a nearly natural state of the general surface. The morbid secretions of the tongue seem, from these facts, to be connected with a morbid secretion of the skin,-a connection which merits farther research. The appearances of the tongue also often mark the duration of a complaint, the mere load being recent while the swollen tongue indicates a longer disease. A practitioner who attends to these can often surprise his patients by his accurate knowledge of their case.

In common acute fever, the GENERAL SURFACE of the body is characterized by a tumid, smooth, soft, and dry state of the surface, with a sense of glowing heat, and a florid colour; sometimes there is perspiration. In acute hectic, the surface is nearly natural; but in chronic hectic there is a chilliness, with lividity, and profuse morning sweats; while in common slow fever the skin is dry, rough, harsh, and shrinking, with acrid heat, and sometimes the cuticle rises into miliary vesicles on the neck and breast, or it exfoliates. In typhus fever, the surface is various, and not very characteristic; the heat is nearly natural, or a little more, with dry parched skin, or clammy perspiration, and miliary or petechial eruptions. In the cold stage of intermittents, the skin shrinks, becomes pale, cold, rough, and anserine,-the temperature as low often as 74°; in the hot stage, the skin is hot and dry, the integuments tumid and injected, and the temperature sometimes 105°; in the last stage, these appearances cease, and give place to a general perspiration. In scarlatina, the inte

guments are very tumid and injected, temperature as high as from 105° to 1120, the rash continuous, giving a deep red hue to the skin, which is hot, smooth, soft, and dry,-terminating at the decline in roughness and exfoliation. In scarlatina maligna, all these appearances are reversed, and there is even sometimes a shrinking, cold moisture, and a pale or livid rash. It is of the utmost importance to observe this, as the cold affusion, where the skin is not dry and hotter than natural, may prove instantly fatal. (CURRIE'S Med. Rep. ii. 76.) In rubeola, the heat of the skin is from 99° to 102°, with little tumidity and injection, except of the face and eyelids. In dyspepsia, there is a tendency to diminished temperature, with great sensibility to cold, and perspiration excited by the slightest hurry or fatigue. In strumous disease of the mesentery, this sensibility to external cold is very great, the least draught of cold air driving the patient to hang over the fire, till the hands and legs assume a brown colour. la organic diseases of the glands of supply, such as the liver, the pancreas, the spleen, the mesenteric glands, the stomach, and the small intestines, there is considerable emaciation, and the gradual return of flesh, under a curative process, is often striking; on the contrary, in organic diseases of the glands of waste, such as the breasts, the kidneys, and the large intestines, the emaciation is less and less rapid-(See PEMBERTON on the Abdo minal Viscera, ch. vi.)*

In symptomatic fever the HANDS and FEET have little of the tremor observed in idiopathic fever. In acute fever there is tremor and burning heat. In typhus the tremor is often so great as to amount to subsultus tendinum: when it occurs in a violent degree, it usually foreruns delirium, as in delirium tremens. In acute dyspepsia tremor is observable on extending the arm and hand;-the palm becomes cold and clammy, the nails become lilac, and their tips white and opaque. The feet and nose are also liable to become cold. In ehlorosis, the hands, fingers, and nails become very pale and bloodless,-and in protracted cases the nails sink in irregularly in the middle,

* It is a great loss to the profession, that Dr. Pemberton should have been sa long and so hopelessly afflicted with Tic douloureux, which is so severe as to have made him relinquish a very lucrative and increasing practice. It is publicly, and, we believe, creditably reported, to the honour of Sir A. Cooper, that he lately sent Dr. Pemberton, in a present, a check for a thousand pounds; and it is added, that Dr. P. immediately remitted Sir Astley a bond for the amount, which bond Sir Astley most generously destroyed. Such actions are worthy of the leading men of the profession.

and break off in pieces from brittleness, so that the patient cannot take a pin out of her dress. In organic disease of the heart, the hands become cold and livid, and the finger ends expanded. (See Farre, Malform. of the Heart.)

The more sudden effects of INTESTINAL LOAD and IRRITATION, SO frequently mistaken for inflammation, are either or all of the following:-acute pain of the head, of the side, of the loins, of the iliac region, or of some other part of the abdomen; attacks of vertigo, of dyspnoea, of palpitation, of vomiting, of hiccup, anxiety, and distress, clammy perspiration, or, on the contrary, febrile heat. In such cases, enemata and purgatives are to be tried; but bleeding will be most injurious. These effects usually occur after great exertion, agitation, pain, fatigue, hæmorrhage, undue blood-letting, or purging,-and in the course of diseases.

EXHAUSTION, from great evacuations, fatigue, or fasting, or from digitalis, produces severe rigour, long continued, succeeded by great heat, frequent pulse, and the head or the abdomen seriously affected. In slower attacks, less rigour, heat sometimes absent, throbbing pain in the head, vertigo in the erect posture, palpitation, hurried breathing, sighing, and irritability of the stomach and bowels, or constipation, and sense or fear of impending death. This, with the exception of the affections of the head, is very much like the Erethismus Mercurialis, so well described by Mr. Pearson, (Lues Venerea, ch. 12.) and so painfully experienced and amply detailed by the late Dr. Bateman, (Med. Chir. Trans. ix. 220, and M. HALL on a serious Morb. Affect.)

The state of SINKING is very different. It is attendant on gangrene and on death, giving the fallacious appearance of a cessation of disease. (ABERCROMBIE, Edin. Journ. xvi. 22.) Sometimes it is accompanied with jactitation, hiccup, and catching respiration; or with gasping, throwing off the bedclothes, sighing, feeling of the approach of death. Mr. Johu Hunter describes it well under the term dissolution, (On Inflamm. ii. 9. 3.) and Sir H. Halford has applied it to prognosis. (Trans. Coll. Phys. vi. 15.) These subjects our author justly thinks, are of "stupendous importance."

The morbid states of the functions of the BRAIN are necessary to be strictly attended to, such as the state of its energies in general, the sleep, the mental faculties and temper, the senses and sensations, and the motions,-voluntary, functional, and of the sphincter muscles. It is very singular that the energies of the brain should become very similarly affected, varied only in form and degree, in the two opposite states of fulness and depletion;

and the remark applies equally to the function of respiration, as affected by these opposite states of the brain, for example, in exhaustion and in plethoric apoplexy.

In the affections of RESPIRATION we must attend to the kinds of dispnoea, of cough, of expectoration, of the effects of a full inspiration and expiration, and of the affections of the voice and articulation. By attending to these alone, for instance, to the difference of sound and continuance in cough, we may often determine the character of a disease. Dr. Hall very justly depends more upon the effects of a strong expiration than of a full inspiration in detecting inflammation of the bronchia or of the lungs, or in asthma. Why is this so much neglected by practitioners ?

It is not unusual to observe, that, in various diseases, the frequency of the PULSE remains, when the morbid actions have apparently subsided. In such case, it is necessary to continue our attention, and watch and wait for the diminution of the frequency of the pulse; and if this event do not take place in a moderate space of time, to ascertain whether the disease be in fact subdued, or only mitigated, and pursuing its course in an insidious form. This vigilance is particularly necessary in cases of pleuritis and peritonitis.-Connected with this subject, Dr. Hall promises us, at an early period, an essay on the effects of the loss of blood, and on the use of the lancet. The subject is important, and the annals of the profession abound with valu able materials.

Under the head of the HISTORY of DISEASES we have a few rules for dispensary practice, which are satisfactory as far as they go, but by no means likely to supply the place of a system of clinical instructions,-a desideratum in English medicine.

We have said enough, and abstracted enough, to shew our estimation of the tenor of the work. It does not want its faults. A main one is the absence of reference to the labours of others. The style is, perhaps, too aphoristic, and though it is in general correct and classical, we observe, more than once, the vulgarism of named for mentioned,-"I have named the tendency,' (p. 246.) But we are at all times more willing to praise the good than to bring forward the inferior parts of the subjects submitted to our decision; and we cannot too highly praise Dr. Hall.

MR. BARLOW ON MIDWIFERY.*

WHEN such a man as Mr. Barlow vouchsafes, after a long life of experience, to present his opinions to the public, we are bound to receive them with respect and gratitude. After we had seen this work announced, we were impatient until we obtained a perusal of it, and from that perusal we are happy to find it will by no means diminish the justly acquired reputation of its author. We wish it to be understood that we are speaking of it in a professional point of view only as a literary production, it is very faulty, abounding with grammatical errors, and marks of carelessness, at which we are surprised-such as "pelvises" for “pelvis," "column" for "collum," "spasm continue," and the like.

The surgical essays are placed first in the volume; they relate principally to the diseases of the urinary organs, and the operation of lithotomy. As it is our professed object merely to furnish our readers with a condensed view of what we consider most useful in the works which we analyse, we shall make no remarks on this first portion, as we meet with little to demand our notice, after our ample details of these subjects (Quart. Journ. iii. 38, 284, 292,) but shall at once proceed to the examination of those essays in which the author offers the results of his experience in the pratice of midwifery.

In the first essay, after combating Dr. Osborne's ideas on the subject of laborious parturition, Mr. Barlow goes on to speak of the preternatural retention of the placenta, and the difficulties connected with it, under the following heads :

ATONY of the UTERUS, attended with FLOC DING, may be excited by many causes, amongst which are, improper dilatation of the os uteri and vagina-artificial rupture of the membranes a close warm room during labour-imprudent attempts at extracting the head of the child-or rash efforts to drag the body into the world in the absence of uterine action. All these are to be cautiously avoided. With regard to the time when it is desirable that the placenta should be expelled, Mr. Barlow thinks it should follow the delivery of the child either from one to two hours, according to the circumstances of the case. This practice he prefers to leaving it altogether to the efforts of Nature, on the one hand, or to its immediate extraction

→ Essays on Surgery and Midwifery; with practical Observations, and sclect Cases. By James Barlow, Surgeon. With Plates. pp 417. 8vo. London, 1822.