sought in the condition of the mucous membrane of the stomach, and of its secretions, it could not long have eluded detection.

"That in gastrodynia the mucous secretions of the stomach are redundant and unhealthy is sufficiently demonstrable. If emetics be given, this mucus is copiously discharged, of a quality to show that it was not of recent formation. Instead of being fluid and pellucid, it is dense, membranous, and opaque, unlike in all respects to that which a healthy stomach discharges on the operation of an emetic. The difficulty, too, which the stomach experiences in detaching and expelling it is proportionally great, and the effort is oftentimes severe. The stools also are loaded with mucus, to which a corresponding state of the mucous membrane of the intestines no doubt contributes. The presence of this mucus evinces a previous excitement of the membrane secreting it, and in this ir ritation we may reasonably conceive the primary disease to exist. It is only, however, when the mucus thus formed accumulates and oppresses the stomach, that the spasmodic pain occurs; and when the foregoing facts are considered, in conjunction with the relief which suitable evacuants afford, it is difficult to resist the conclusion that the pain arises from a contractile effort of the stomach to detach and expel the offending matter. This view may be deemed conjectural, and in some respect it is so, resting for its truth rather on inference than demonstration; for as gastrodynia, at least in its earlier stages, does not destroy life, necroscopic observation, even if it could detect such morbid condition, cannot be referred to in proof of the lesions thus supposed. Yet it is a rational conjecture, and fully supported by all that we know both of the physiological nature of the parts concerned, of the phenomena of the disease, and of the effects of medical treatment. But we are not without direct evidences of the morbid condition of the mucous membrane here inferred, although they are not connected with the disease under consideration so as to make them available for directly illustrating it. All pathological anatomists who have investigated minutely the lesions of the gastro-intestinal mucous membrane, bear ample testimony both to the frequency of vascular congestion, and to the abundant mucus connected with it. In respect of the latter, Andral says, on opening dead bodies one is sometimes struck with the prodigious quantity of mucus on the internal surface of the stomach and intestines.' Again he remarks, we find vomiting produced by all possible degrees of irritation of the gastric mucous membrane, which cause the patient to throw up food and drink, or else the bile which had previously been attracted by the irritation of the stomach. In other cases the matter vomited consists of blood exuded by the irritated mucous membrane, or of mucus secreted in superabundant quantity, which last by accumulating becomes a kind of foreign body, and produces by its presence secondary irritation more considerable than that to which it owed its existence.' The vascular congestion has been distinguished as existing in the capillaries, in the larger vessels leading to them, or in both. The hyperemia of the capillaries is

regarded as arising exclusively from irritation; and as these pervade the mucous follicles, and are in fact the source from whence mucus is secreted, there seems to be little difficulty in perceiving how irritation must almost of necessity beget an increased secretion of mucus.

"If then, as appears, irritation occasions increased secretion of mucus, and if this mucus is capable of accumulating and of becoming a kind of foreign body, producing by its presence a secondary irritation more considerable than that to which it owed its existence, we have the elements of that pathology which long and patient observation of the effects of medical treatment has led us to assign to gastrodynia. What the precise affection is to which French practitioners give the name of 'embarras gastrique' we are not aware, but many circumstances in the following extract from Andral shew that it is nearly allied to that morbid condition of stomach which prevails in gastrodynia, and of which spasmodic pain is only a contingent symptom."-Pp. 328, 329.

From these facts he deduces the following pathological references and therapeutic rules.

"From the foregoing discussion it will, we think, be admitted that the researches of pathological anatomy are at least not opposed to that pathology of gastrodynia which assigns the spasmodic pain to the presence of offending mucus, and the efforts of the stomach to get rid of it. Irritation is no doubt the primary affection that leads to increased secretion of mucus, but it is to the secondary irritation caused by this mucus when redundant and accumulated, and to the efforts which the stomach thus exerted makes to throw off into its cavity what offends it, that the peculiar pain of gastrodynia must be referred. The spasmodic nature of these efforts accounts for the alleviation of pain produced by opium and stimulants, and the cause not being thus removed, we at once understand why such relief is but transient and ineffectual. The perfect relief desirable from suitable evacuants, without any aid whatever being required from narcotics, proves unequivocally how much more concerned the offending matter is in causing the pain, than is the muscular coat of the stomach which this matter so grievously disturbs, and which needs only to be freed from the disturbance to return at once to healthful quiescence, and, if the primary irritation have ceased to operate, to that ordinary exercise of functions which in health is so tranquil as not to be a subject even of consciousness.

"On these principles, then, the cure of gastrodynia requires that the mucous membrane be freed from the redundant secretion with which it is loaded and oppressed, and that a healthful state of the secreting membrane be established so as to guard against renewed accumulation. And here it may be remarked that accomplishing the former purpose ministers to the latter; for when the accumulated mucus is dislodged by suitable evacuants, not only is a direct source of irritation removed, but the secreting organs are restored to a more effective exercise of their functions, by which

the primary irritation, and the congestion consequent to it, are best and most effectually relieved. The effect of irritation is congestion of blood-vessels with hyperæmia of the capillaries, and these beget increased secretion from the mucous follicles by which the overcharged vessels are unloaded, and the natural cure of the disease effected. When these conditions and natural changes are clearly understood, the treatment of the disease becomes simple in the extreme; and if the success of others in treating the malady on the principles here inculcated but equal what the writer of this essay almost daily witnesses, he will have little apprehension either of the pathology here advanced being rejected, or of the practice enjoined being condemned."-P. 329.

The subject of Gout is treated by the same gentleman in the most able and intelligent manner; and the author has by an extended view of the different circumstances of the organic system which concur to the production of this painful and unmanageable disease, exhibited one of the best accounts of its pathology

and treatment extant.

It cannot fail to be known to the readers of this Journal, that Dr Barlow has already directed the attention of the profession to the previous states of the human frame, manifested by the fulness, overloaded, and oppressed state of the vascular system; and that he has also laboured to show, that unless these states be removed, and their recurrence counteracted, it is in vain to think of attempting to cure gout on rational principles. These views, which were very minutely developed in the author's treatise on the Medicinal Efficacy of the Bath waters,* Dr Barlow reproduces in part in the introductory observations of the present article. The different kinds of plethora maintained by Dr Barlow, in imitation of the pathologists of the Stahlian school, but more accurately defined than by these theorists, and which correspond to various degrees of the state denominated determination by Dr C. Parry, or at least give rise to that state, are doubtless perfectly real; and though perhaps it may be doubted whether they in truth imply an absolute increase in quantity of the contents of the vascular system, or merely a relative change in distribution, or at least in the equality of distribution,-it is still certain that some state of the vascular system exists in those persons liable to gout, previous to the actual attack of the disease, and in consequence of which an acute attack is, on the application of a cause otherwise slight, immediately induced. These views will be more completely understood in the following passages.

"When the latter, viz. the increased action, consequent on the overloaded and oppressed state of the circulation, attains its fult

Edin. Med. and Surg. Journal, Vol. xix. p. 305.

activity, it constitutes what we call fever or inflammation, and any accident may determine the part which is to suffer most, and the function which is to be most depraved. When this plethoric and inflammatory state arises in a gouty habit, the result is an accession of the disease.

"A remarkable peculiarity of gouty accession is, that the supervention of the local inflammation gives relief to the constitutional disturbance, and that, having effected this, it quickly and spontaneously subsides, at least in the earlier attacks, leaving the part so lately the seat of formidable derangement, somewhat weakened indeed, but otherwise in perfect health. The dyspeptic derangements connected with gout are no doubt traceable in a great degree to the luxurious living and consequent irritation of stomach habitual with those who chiefly suffer from this disease. But this is not their sole cause, for independently of the various excitements to which the stomach is subjected, the direct effect of plethora is to induce a congestive state of the capillaries of the mucous membrane of both stomach and intestines, and an increase of its appropriate secretions,-a condition which is the fruitful parent of gastric and intestinal maladies of various kinds. In the absolute plethora of robust habits, especially when the gastro-intestinal membrane is excited by full living and stimulants, this increased secretion of mucus in the stomach and intestines is considerable, and its production is readily accounted for. The efficient cause seems to be excitement of the secretory vessels by determination of blood to the capillaries, and by the blood possessing, from the redundancy of nutritive matter, more stimulant properties; the end,-increased appropriation of the nutritive matter of the blood, and consequent relief to the overloaded circulation from that redundancy which oppresses and disturbs it.

"In the less vigorous and more temperate a correspondent state arises, when from diminished appropriation of blood, through sedentary life, inactive habits, or any other cause, the relative quantity of nutritive matter becomes greater than can be healthfully disposed of. And this serves to explain how a state of plethora and of febrile tendency so often occurs even in habits naturally spare, and where no obvious intemperance has been practised. Yet even in these the evidences of a plethoric state are readily discernible, and at an early period, if the phenomena which indicate it are rightly understood; and the effects, as displayed in the gastric and intestinal secretions, are in them even more signal than those which positive plethora usually displays, the morbid condition of the mucous membrane being generally of longer continuance and more confirmed ere attention is directed to it. These effects, though modified, are essentially the same in both, and require a similar treatment; this differing in degree only according to the different powers of the constitution so affected, and being modified only by the state of the mucous membrane, and the greater or less time during which the congestion has been suffered to endure."-Pp. 359, 360.

The pathological principles thus established are made to form the basis of a judicious system of treatment, in which Dr Barlow proposes first to subdue the inflammatory symptoms actually existing, then to remove the state of plethora, absolute or relative, and to prevent its recurrence, and lastly, to regulate the ingesta and egesta by means of diet, temperance, exercise, and other means, so as to prevent excrementitial plethora, and the tendency to the recurrence of paroxysms.

We pass next to an intelligent article on Headach, (Cephalalgia) by Dr Burder.

This term, it is well known, has been employed by Aretaeus the Cappadocian, Cælius Aurelianus, Alexander of Tralles, Paul of Egina, and others of different sects of antiquity, to designate symptomatically the presence of pain, more or less intense, of various regions of the head, enduring for some hours or a day or two, but rarely longer; while, if it endured longer than this, and was more violent and tensive, or was constant, it was denominated Cephalaa by the same authors. It is not unimportant to remark, that Alexander of Tralles, one of the most acute and rational of the methodic sect, ascribes Cephalaa in general to inflammation of the pericranium, or of the cerebral membranes, or at least congestion (emphraxis) of the latter. (Lib. I. xl.)

Both terms were afterwards adopted by Sennert, Nicolaus Piso, Baillou, Sauvages, Lieutaud and Tissot, with the same restrictions in signification; that of Cephalalgia was retained as a disease by Willis and many others; and they have been very generally adopted by physicians after the examples of the authorities now mentioned. It is quite undeniable that the circumstance of pain of the head,-a phenomenon which takes place in many different diseases and states of the system, cannot be regarded by any one who is accustomed to reflect on the pathological cause of disorders, in any other light than as a mere symptom; and on this ground, doubtless, Cullen, under the influence of the severe but salutary system of philosophical distinction which he established, thought it right to exclude both Cephalalgia and Cephalea from the list of primary diseases.

There is, however, only one way in which practical experience can bend to theoretical and scholastic distinctions; and that is by rendering the knowledge of individual cases so complete and so accurate, that it becomes easy in any given case to discard symptoms entirely in nomenclature, or to associate them so exactly with their essential causes, as to designate each disease from its pathological or organic cause alone. This degree of perfection, however, pathology had not attained in the time of Cullen; and though very considerable efforts have been made