Vesical Calculi. The largest vesical calculi are only very large gravel stones; they have commenced by small calculi, which, from some mechanical impediment, have been detained in the bladder, and have increased by the addition of successive layers; even when these are removed by lithotomy or lithotrity, the immediate cause of pain is got rid of, but the disease is not cured, nor even attempted to be cured; consequently, calculi very frequently form again, and require another painful operation. Surgeons have not sufficiently attended to this point; as soon as the stone is extracted it should be submitted to a careful analysis, and a treatment adopted according to the nature of the gravel which formed its nucleus. Prout has proved, that two-thirds of the total number of calculi are formed of uric acid, or have a uric acid nucleus; therefore, in the majority of cases, the treatment for red gravel is to be recommended: if the calculus is found to consist of any of the other principles, the patient will require the same remedies which were recommended for similar sorts of gravel.

M. Majendie devotes a short chapter to the "empirical treatment of gravel;" he confesses that, as no theory will comprehend the explanation of all the causes of calculus, or the mode of action of all the curative remedies, the most experienced physician must have recourse to means of cure, whose efficacy has been proved by experience, although it cannot be accounted for by reasoning. Thus, he says, these patients are benefited by remedies which are useful in relieving the dyspepsia which often accompanies their disease, such as small doses of rhubarb and magnesia, quinine, repeated purgatives, &c. Other causes, such as change of air and occupation, relief from mental anxiety, &c. act beneficially, but no plausible explanation can be given of their mode of acting.

We have now fulfilled our promise, and have given the whole of the practical information contained in M. Majendie's work. It is valuable, from its accounting, on physiological principles, for the action of animal food in the production of uric acid, and it contains many judicious hints, which may be made available in practice, but M. Majendie simplifies too much, he endeavours to trace the origin of every species of gravel to the same cause, and to enforce a similar treatment; his mechanical notions of imbibition have influenced him too strongly, and he looks on the human frame rather as a piece of human mechanism, than as a body endowed with life. He founds his practical observations on comparative physiology, but even here there are startling exceptions, the urine of the lion and tiger, although they are carnivorous animals, contains no uric acid, whilst that of the boa constrictor is almost wholly composed of it. Foucroy and subsequent chemists have also found uric acid in the urine of domestic fowls. There are similar exceptions in practice; although the bon vivant may be benefited by complete abstinence from animal food, yet the debilitated sufferer from depositions of the phosphates, according to Dr. Prout, a high practical authority on this point, is relieved by a moderate animal diet more than by an acescent vegetable one. The same obscurity hangs over the action of some medicines; Dr. Prout forbids the use of saline purgatives, containing a vegetable acid, in the phosphatic diathesis, as he has observed that they render the urine alkaline. Surely such instances prove that the vital action of the digestive or urinary organs of different animals, in a physiological state, and of different individuals in a pathological condition, produce some change in the ingesta more important than the mere mechanical separation of their elements, which M. Majendie alone recognizes? Besides, there are other sources by which nitrogen is conveyed into the circulating fluid, and which M. Majendie has not mentioned-respiration and absorption. The experiments of Dr. Edwards on this subject, proving that the absorption and exhalation of this gas by the lungs varies in different temperatures, ages, seasons, of the year, &e. may perhaps cast some light on these diseases, and explain more satisfactorily some of their causes. Although M. Majendie allows that there are many remedies which have a beneficial effect on gravel, whose action he cannot

explain, yet he does not appear to have tried them in his own practice, and is contented with the mere enumeration of them. We suspect that the practical opportunities which he has had of testing the truth of his physiological speculations have been confined to one class of individuals, those who are addicted to the pleasures of the table, otherwise he would hardly have asserted that a restricted diet was a certain cure. Notwithstanding this Sangrado simplicity of treatment, so exclusively recommended in all cases, and which forms a strong contrast to the manner in which Dr. Prout discusses the same subject, there are many obscure causes of gravel mentioned by him, for which M. Majendie satisfactorily accounts, such as the deposition of a red sediment after hard exercise, an unusually large meal, &c. which all who have a susceptibility to these depositions must have constantly observed; the greater frequency of gravel in old people, &c. So little is at present accurately known of the manner in which medicines or food act on the various organs of the body, that any successful explanation of their modus operandi must be hailed with pleasure; this is one of the great practical benefits to be expected from the study of physiology, and we are happy to recommend to our readers a useful and instructive work, in which this application has been made by one of the most celebrated experimental physiologists of France.

IV.

A TREATISE ON THE EPIDEMIC CHOLERA, AS IT HAS PREVAILED IN INDIA, FOR THE PURPOSE OF ASCERTAINING A SUCCESSFUL MODE OF TREATMENT; WITH A CRITICAL EXAMINATION OF ALL THE WORKS WHICH HAVE HItherto appeareD ON THE SUBJECT. By F. Corbyn, Esq. Bengal Establishment. Calcutta, 1832.

LITTLE did Mr. Corbyn dream, when he finished his volume, that at least 500 authors, to him unknown, had written on cholera about the time that volume was closed! Mr. Corbyn has given a digest, not quite so full as we have done in this Journal, of the reports made to the three Presidencies, together with analyses of several detached works, which had appeared previously to the appearance of the epidemic in Russia, or in the Western parts of Europe. The information, therefore, to be derived from this volume by the European practitioner now is very small-if we except the criticisms of Mr. Corbyn himself. These are, occasionally, tart enough, and the author has expended an unusual share of his critical acumen on the Editor of this Journal, though certainly in a gentlemanly manner, and without any tincture of illiberality. It is chiefly at Dr. Johnson's theoretical speculations that Mr. Corbyn has levelled his censures; and Dr. J. no doubt, was unaware of the weight of his sins; for, by Mr. Corbyn's account, he has led almost the whole of our Indian brethren astray in matters of theory.

The prevalence of the Cholera in an Epidemic form has given rise to a number of treatises, in which attempts are made to explain its proximate cause, from which the mode of treament is necessarily deduced. Before I proceed to a consideration of the principles which the authors of these works have endeavoured to establish, I must take notice of those which form the basis of Dr. James Johnson's practice, as that gentleman considers

the disease as an Endemic, to which the inhabitants of tropical climates are at all times liable. The distinguished author of the Influence of Tropical Climates on European Constitutions, and of the Influence of the Atmosphere on Health, was among the first to attract the public attention to the disease; and, accordingly it is to be supposed, that his views have had considerable influence in forming the opinions, and directing the practice of the medical officers of the three Presidencies." 215.

Again, at page 253, Mr. C. observes :

"I proceed to examine the Reports furnished by the medical officers at the three Presidencies, commencing with those of Bengal, in which the same train of reasoning with that of Dr. Johnson, has been followed with very little variation."

Once more, he says, at p. 273:

"Mr. Scot, the Secretary of the Medical Board of the Madras Establishment, on whom has devolved the task of digesting various reports from the Medical Department on that Establishment, unequivocally follows Dr. Johnson's train of reasoning on the proximate cause, and deduces from it the same course of treatment."

If Dr. Johnson has erred in theory or practice, it is evident that he has done so in good company; for he is not vain enough to suppose that the short notice which he took of cholera, from observing a few cases of the disease in a sporadic form, was capable of leading astray such men as Jameson and Scot. Of Mr. Corbyn's own doctrines we cannot form a very clear idea. He seems, like many critics, to be more successful in demolishing the theories of others, than the establishment of his own. If we understand him rightly, he looks upon cholera as a purely inflammatory disease, and therefore to be combated by depletion and sedatives. The following extract will convey some notion of Mr. Corbyn's therapeutics, and perhaps of his pathology also.

"The indications of cure are, first, to allay the irritability and spasm, and prevent inflammation. Second, to excite biliary effusion into the bowels, and alvine dejections of a healthy consistence. Third, to determine blood to the surface. Fourth, to restore the system to its former tone and healthy action. The first indication is accomplished by bleeding, sedatives, and anti-acids. The second, by calomel and drastic purgatives. The third, by counter-irritants. And the fourth, by corroborants.

First, bleeding. This may be effected by the lancet, by leeches, or by cupping. The most successful is by the lancet; but we find that it is not always practicable; either syncope comes on, or otherwise congestion has taken place, which prevents the flow of blood from the arm or jugular vein; in either case, we should have recourse without delay to leeches, which ought to be applied over the epigastrium. They are not, however, at all times and in all places to be procured, to the number required. When this is the case, cupping supplies the desideratum.

The extraction of blood from a large vessel, at a distance from the inflamed part, will be more beneficial than tropical bleeding. Clinical practice shews, that the patient's safety absolutely depends upon an immediate stop being put to the first approach of inflammation and congestion; and that tropical bleeding only proves powerfully efficacious when general plethora or congestion has been previously removed. We shall find, therefore, according to the urgency and importance of the case, that venesection, or arteriotomy

will not only be once, but repeatedly necessary, in conjunction with leeches and cupping. The quantity of blood to be taken away must depend, in like manner, upon the severity and urgency of the symptoms, the strength, and age of the patient. We must ever consider, however, that in the majority of cases, especially among Europeans, cure depends upon the boldest use of the lancet. In the records to be found in the second part of this work, instances are stated in which life seems to have been saved by the sacrifice of some hundred ounces of blood in a few days; and that 60 ounces were drawn at a time, with unequivocal success, in which the small extractions would have failed to render the least relief.

Our object, in this disease, is obviously to evacuate a considerable quantity of blood; hence we must operate in such a manner as not to induce fainting. Now we know from experience, that during the operation of evacuating blood, the patient is liable to fall into a state of syncope; a horizontal position, therefore, is to be preferred to any other; for fainting is not so liable to occur in a horizontal as in an erect posture. But admitting that in any position fainting occurs, we should not on that account suppose the blood will not again flow, we must wait patiently, at the same time moving the arm in all the variety of positions that can probably assist in bringing the openings of the skin and other integuments to correspond with that of the vein, until the blood begins to flow. Throwing the muscles of the part into constant action, or giving the patient a cane or other firm substance to turn frequently around in the hand, will often produce a flow of blood which would not otherwise ensue. The experienced practitioner knows these circumstances to be true; but as the tyro, ignorant of such facts, might not adopt these alternatives, I have thought it proper to be thus particular.

With respect to arteriotomy, we are aware that its most strenuous friends have shrunk. from any attempt of this kind on the larger arteries. Perhaps in no affection is arteriotomy in the smaller branches more desirable than in Epidemic Cholera, in which we require immediate and large evacuations of blood. But let us now suppose that we fail to obtain blood by venesection, arteriotomy, and cupping; we must then have recourse to such measures as will draw the blood to the surface, such as friction and the hot bath. It often. happens, that we can draw blood while the patient is in the hot bath, which would fail to flow in any other situation. The bath must therefore be at hand.

Sedatives are laudanum, calomel, magnesia, and hot bath.

Landanum. This medicine may be given in doses of sixty to eighty and one hundred and fifty drops with great safety, and the effect is favourable in producing sound sleep, assuaging pain, removing spasm and irritability. But laudanum in less doses operates in a different way; fifteen and twenty to thirty and forty drops produce a high degree of excitement, sometimes apparent inebriety and delirium, and if the patient should doze,, frightful dreams awake him in convulsive startings.

Calomel, în doses of from fifteen to twenty grains, is a sedative, and has the singular good qualities of immediately stopping violent vomiting and purging, removing spasmodic irritability, producing tranquillity of mind, exciting the secretion of the liver, and preventing the progress of inflammation. I have known a patient labouring under frequent dysenteric evacuations, with tenesmus, to be under the common course of small doses of calomel and opium for a fortnight without effect, and strange to say, one dose of twenty grains of calomel, at once stopped the purging, removed the tenesmus, aud soon restored the bowels to their former tone. Calomel, in doses of from one to five and ten grains, acts as a stimulant, produces vomiting, and violent purging, lassitude, restlessness, and almost insupportable griping pains of the abdomen. Although such are the effects of calomel om the constitution, it is equally important to mention the form in which calomel ought to be given in acute diseases." 197..

From the above extract it will be seen that Mr. Corbyn does not differ, in any essential manner, from the practice which Dr. Johnson suggested long before the disease broke out in its virulent and epidemic form in the East. Dr. Johnson would say, that Mr. Corbyn has misunderstood, rather than unfairly criticised his theoretical speculations, and freely absolves him from any intention to misrepresent him. It is now too late in the day to quarrel about hypotheses, since a wide field, unfortunately, for observation in our own country, has tended to cool the most ardent of our theorists, and compelled them to acknowledge their ignorance.

We shall advert to a circumstance or two before we close our notice of this volume. The following passage at page 45, will set at rest the assertion that the epidemic is a new disease of 1817. Mr. Corbyn, who has been in India since 1814, and constantly among cholera patients, must surely be allowed to be a competent judge on the present occasion.

"In 1814, I was myself eye-witness to the destructive operation of this disease on board the ship Mangles, on which I embarked for India. We had been at sea about two months, when it burst forth with awful violence. During the short period of six weeks, sixty-four bodies were thrown overboard, and four men died one after another just as we had cast anchor in Table Bay." 45.

Thus then a ship from England, three years before the outbreak in Jessore, presented a frightful visitation of cholera, two months after she left an English port, and buried 68 men between England and the Cape!

Mr. Corbyn comes to the conclusion, from all that he has seen of Cholera, that it is not contagious.

"From personal experience, I feel satisfied that the notion of the Cholera being contagious is quite unfounded. I breathed the atmosphere of my hospital in the centre division of the grand army, where were the most distressed and poorest classes of people, morning, noon, and night; yet neither myself, nor any of the attendants were affected. During this time I have also visited officers on the staff whose tents were adjacent, but I never communicated the disease to any.

Those, however, who have written on contagion, advance, that some constitutions are not susceptible of contagion in any way, yet they may become the medium of communicating it to others. We ought to be cautious in maintaining opinions which suppose contagion in so remote and equivocal a manner as this, knowing the alarming consequences of such a belief. Through fear of contagion the sick may be forsaken and die for want of proper care; hospitals may become crowded, and cleanliness neglected for want of attendants, and thus a diseased atmosphere induced." 97.

We shall make only one more observation on the treatment which Mr. Corbyn has laid down in the extract already quoted. He makes no allusion whatever to the premonitory diarrhoea-makes no provision for its cure-a convincing proof, we imagine, that the said premonitory diarrhoea made no conspicuous figure in the character of the disease in India, else it would not thus be overlooked. This is the grand distinction between the disease as it appeared in the Eastern and in the Western hemisphere. Here it forms a most important beacon or warning, by attention to which nine-tenths of the cases of fatal cholera would be prevented.

Mr. Corbyn's object was to present the young Indian practitioner with a digest of what had been written on cholera, up to the year 1831 or 1832,