produced by rheumatism, or by accident, or unusual exertion of the right arm, are likewise liable in India to be considered hepatic. In these and similar cases, or when the soldier feigns a pain in the region of the liver, the real nature of the complaint is most likely to be detected by a full consideration of the history and attendant symptoms, and by the effects of remedies."

In the treatment of hepatic inflammation the objects sought to be attained were—1st, to lessen the force of the circulation generally and locally; 2d, to excite another action more or less extensive; 3d, to remove peculiar symptoms; 4th, to restore the patient's strength after the disease had been subdued.

To fulfil the first indication venesection was employed, according to the urgency of the general disorder and the strength of the patient, followed by leeching, purgatives, and antimonial diaphoretics, and occasionally by poultices and fomentations to the part affected. For the second indication-the excitement of another action in the system generally-calomel, usually in combination with antimony or opium, was given as early as possible.

"It was believed, and this was confirmed by experience, that the specific action of mercury being excited in the constitution, the disease would give way to it, and the patient be left without any complaint but that produced by the effects of the medicine. In short, that simple inflammation and the action produced by mercury were incompatible in the same system; and hence that the sooner the latter took place, the more speedily the recovery of the patient would, in like manner, ensue." (p. 404.)

With the view of exciting a local action near the inflamed part, blisters were applied, and were found very useful in hastening the cure, and in saving depletion and consequent debility. The occasional symptoms demanding treatment were dysenterie or diarrhoeal affection of the bowels, constipation, vomiting, and cough. With regard to these, the only peculiarity to be remarked was that the dysenteric affection occasionally produced by the use of calomel was almost invariably removed by a dose of castor oil, followed by an opiate. To accomplish the fourth object of treatment, the restoration of the patient's strength,-nitrous acid, tonics, and, in protracted convalescence, wine, were given. When quinine was employed, its effects were closely watched, as it was supposed, where a tendency to inflammatory action remained, it might be renewed by a premature use of this remedy.

Such was the general line of treatment in the cases of inflammation, modified, of course, by the severity of the attack and the attendant complications, general bloodletting being less frequently necessary, and purgatives more trusted to, in proportion to the mildness of the disease. In cases of probable abscess, a local action was excited by means of blisters, which were kept open for some time, and counter-irritation by other means was also employed. Quinine was likewise given to check the disposition to fever, which, by producing debility, tended to diminish the powers of recovery. When suppuration was believed to have taken place, calomel was exhibited in smaller quantities than when the object was to remove inflammatory action. Our author believes the benefit in such cases to arise from the action of the mercury in exciting the absorbents to the

removal of the purulent matter, and has found more benefit from it where only slight soreness of the mouth was produced than where this became severely affected.

Throughout the course of the disease, it is hardly necessary to observe, great attention must be paid to the diet of the patient. In the early stages this must be as low as possible, and afterwards the transition to his usual mode of living must be very gradual. Our author notices the advantage, in chronic cases, to be derived from a sea voyage, or even from change of residence.

"Many officers of the Indian army are annually sent on ship-board, suffering under symptoms of this disease; and of these a large proportion, by a voyage to Europe, or by proceeding to the Cape of Good Hope, New South Wales, or elsewhere, and a sojourn in those climates for certain periods, are eventually enabled to return to their duties free from complaint. A land journey, performed by regular marches, has occasionally been attended with the same effects." (p. 415.)

The next subject discussed includes a series of cases classed under the head of

ABDOMINAL INFLAMMATION, comprehending "all the instances of simple inflammation of any of the contents of the abdomen, with the exception of those of the liver," and the majority of which consisted of cases of splenitis. There does not appear to be anything connected with them which demands particular notice. Only one fatal case is included in this section, arising from peritonitis produced by rupture of the stomach, and escape of its contents into the abdominal cavity. The man, having been previously in good health, was suddenly seized with pain of abdomen, attended with vomiting, thirst, restlessness, and general soreness. The pulse became frequent, small, and contracted, the face collapsed, the cheeks sunk, cold sweats supervened, and he died in seventeen hours from the commencement of the attack.

"On dissection, a greenish, muddy, watery liquid was found in the cavity of the abdomen, with a few particles of some oil that had been given him three hours previously, floating in it. The whole of the intestines were glued to the omentum by coagulable lymph, and all these parts showed much vascularity. The external surface of the stomach also presented the same appearances; and it was found, on separating it from the body, that a small hole, round, and with even edges, penetrated its substance near the pylorus, and thence the liquid had escaped into the abdomen. This opening had scarcely an ulcerated appearance; and the inner surface of the stomach, as well as the intestines, was otherwise in a healthy state. The man had been nearly six years in India, had not been in hospital during the previous six months, and in none of his former illnesses had exhibited any symptoms which could be connected with the cause of his death." (p. 435.)

RHEUMATISM. During the five years 215 per 1000 of the strength were admitted annually into hospital affected with this disease. The seasons do not seem to exert any marked influence on it.

"Generally, it is to be remarked that neither the occurrence of heat, rain, or cold appears to have any reference to the prevalence of this disease. The following is the order in which each month ranges in respect to this circumstance: viz. July, December, April, October, May, June, August, September, February, March, November, and January; presenting in the first six months, or those in which it was most prevalent, the same number [of months] belonging to each season as in the healthy half year." (p. 443.)

During the period our author was in charge of the regiment 457 cases were admitted, the details of 312 of which, occurring in 160 individuals, were recorded by him, and form the subject of his remarks. Our space will not permit us to do more than advert to one or two of the more striking points. With regard to the seat of the disease

“On a general review of the whole, 47 individuals are discovered to have been subject, either in their primary or relapsed attacks, to rheumatism both in the muscles and ligaments; 43 had those structures affected along with that of the periosteum; 28 and 23 had respectively disorders of the ligaments, or of the muscles only; in five individuals the disease was confined to the periosteum; in eight this structure was attacked with that of the joints, and in three with that of the muscles only. In the remaining three, the disease was chiefly of a neuralgic character, attended in two with rheumatism of the ligaments and muscles." (p. 444.)

The different parts of the body were affected in the following order of frequency: "the shoulders, particularly where both are seized, the knees in like manner, the loins and back, the thighs, one elbow, one shin, the hips, both or singly, the arms, ankles, back of the neck, and one heel, or both heels."

Dr. Geddes goes into minute details relative to the presence of fever in these cases, and its character, the number of relapses, the duration of the cases, and the period between each attack, with the apparent influence of native country and previous occupation on their prevalence. Into these particulars we do not intend to enter, but shall proceed to the consideration of the predisposing causes. In 52 individuals, or nearly one third of the whole, furnishing 117 cases, the disease was believed to have a syphilitic origin.

"In 13 of these persons the venereal affection had been confined to ulcers on the penis; in a like number there had been both ulcers and bubo, but the latter had not advanced to suppuration; in 7 the bubo had proceeded to this termination. In 19 cases the disease had been confined to one or more buboes, without any ulcer having been observed or recorded during the patient's stay in hospital; and in 10 of such cases the glandular affection had gone on to suppuration. In 19 of these 52 patients no mercury had been exhibited during the existence of the venereal disorder; in 4 this medicine had been given, but there was no affection of the mouth; in 9 it had produced a slight soreness of the gums; in 8, a greater degree of this; and in 12 cases the salivation was considerable. It is scarcely to be observed that the total absence of mercury, or its various degrees of exhibition or impression upon the system, had any effect in bringing on the rheumatic pains at an early period, nor does the nature of the venereal symptoms seem to exercise any influence in producing such result.” (p. 450.)

Although in these cases syphilis appeared to be the predisposing cause, our author does not consider rheumatism to be a very general consequence of the disease.

"Of 180 individuals who came under treatment for venereal, 109 suffering under the different varieties of the complaint above mentioned, and apparently presenting no decided peculiarity, either in symptoms or treatment, different from those having rheumatism afterwards, were quite free from any attack of this disease..... ...The general results would appear to be that, from constitutional peculiarities, the syphilitic virus gives a tendency to the occurrence of rheumatic inflammation; and it is probable that this disposition is increased by the exhibition of mercury, when the effects of this medicine are not so severe as to induce the patient to avoid exposure during the period of its being given to him.......

The only peculiarity in these cases was a greater tendency to affections of the small ligaments, as those of the hands and feet, or of the os sacrum; and to disorder of single joints, as of one elbow or one knee, than in other cases; while rheumatism of muscular parts, or of the same joints in both sides of the body at one time, are less frequent." (p. 451.)

The other classes into which our author divides the cases of rheumatism are, first, those in which the rheumatic diathesis appears to have become excited by a previous state of indisposition-as fever, dysentery, hepatitis, and, in a less degree, diarrhoea, cholera, and scrofulous tumours-aided by the exhibition of mercury. This comprises 31 cases, occurring among 18 persons. 2d. Those referrible to previous disease, like the preceding, but in which no mercury had been exhibited; and in this class are included 20 admissions among 11 persons. In the other cases of this disease no predisposing cause could be traced.

"In all classes the frequent recurrence of the disease, or its lengthened duration upon any one occasion, renders the patient pale, emaciated, and cripple; and other disorders, in some individuals, become generated, which eventually eclipse the original disease. The most common and formidable of these are ulcers on the skin, and certain symptoms referred to hepatic disease. By either, or as is usual, by both of these combined, or succeeding each other, rheumatism has occasionally proved fatal." (p. 472.)

Dr. Geddes gives an abstract of seven cases which terminated thus, and in six others it became necessary to discharge the men as unfit for service. In no class of diseases are the benefits of change of climate more strongly remarked than in this, the health being greatly improved, and often entirely restored, by a short residence in England.

We must now bring to a conclusion our account of the volume before us, which, as already observed, is most creditable to the author. We have endeavoured to lay before our readers a general idea of the contents of the work, but have been obliged to pass over many interesting points discussed in it, because, from the adoption of numerical statements, Dr. Geddes has given his observations in a form that scarcely admits of condensation, and which want of space prevents our giving at length. To the medical officers in India, and especially to those about to proceed thither, this will be found a valuable book of reference, and well merits to be included in the list of works with which officers are required to provide themselves on joining the service.

The author states in his preface that, should his health permit, and the present volume be favorably received, it is his wish and intention to extend his researches over the remaining diseases of which he has records in his possession, comprising, among other subjects, the very important class of diseases of the bowels. We sincerely trust he may be enabled to fulfil his intentions, and to complete a work which cannot fail to be productive of benefit to those in whose welfare, from his long association with them, he must feel a warm interest; and which will supply "to the experienced practitioner the means of knowing the success of certain methods of treating the diseases of India, and to the student of medicine a full and minute description of those diseases which he is most likely to meet with in the exercise of his professional duties in the East."

ART. VII.

1. Der Speichel in physiologischer, diagnostischer und therapeutischer Beziehung. Eine mit Anmerkungen vermehrte Bearbeitung, nach S. WRIGHT, M.D., &c.-Wien, 1844. 8vo, pp. 213.

2. Het Speeksel uit een, physiologisch, diagnostisch, en therapeutisch oogpunt beschouwd, door S. WRIGHT, M.D. Naar de Hoogduitsche bearbeiding van Dr. S. ECKSTEIN, vertaald en met aanteekeningen voorzien door F. RIENDERHOFF.-Amersfoort, 1846. 8vo, pp. 220.

THE fact of a work being translated into two different languages, shortly after the publication of the original, suffices to show, at least, the interest attaching to the subject, and may be regarded as a fair indication of its importance, as well as of the satisfactory way in which the subject has been handled by the author. Admitting this, it may seem strange that such a work, coming out in our own country and in our own tongue, should have remained unnoticed by us until we received it in the shape into which it has been put by our German and Dutch brethren. The truth is, that Dr. Wright's treatise has never been published in this country in the form of a substantive book at all. It appeared originally in the Lancet' journal, as a series of papers; and it is from these that the translations now before us have been made.

As we doubt not that we shall have another opportunity of considering Dr. Wright's labours in a yet more perfect form, we shall, on the present occasion, confine ourselves to giving a mere analytical outline of the work, without any comments, critical or otherwise. And, in doing so, we shall— as well for our own case as for the sake of perfect accuracy-make use of the author's original diction, as given in the 'Lancet,' instead of retranslating the passages from the volumes on our table.

Dr. Wright commences by tracing the derivation of the term SALIVA. After quoting a variety of opinions upon it he concludes that, "the word is probably derived both from the Greek and Latin languages-the one being expressive of the manner in which the fluid is secreted and discharged; the other bearing an allusion to its saline constituents. Hence the Irish term silim, which signifies to drop or to distil; and the Welsh haliw, from hál, salt." The author then passes on to consider the chemical history, properties, and composition of the saliva in its healthy state. Having quoted the authorities preceding him, he details his own process for the analysis of saliva. To obtain this fluid unmixed with buccal mucus is a matter of the greatest consequence, and not always easy of accomplish

ment.

"By moving the lower jaw and the tongue, as in the ordinary way of procuring saliva, this fluid necessarily becomes united with some mucus from the lining membrane of the mouth. For accurate investigation, it is necessary to obviate this intermixture, and it is best effected, according to my own observation, in the following way. The mouth should first be washed with cold water, and then, having depressed and fixed the lower jaw, the fauces are to be tickled with a feather, sufficiently to excite nausea, without the risk of vomiting. The saliva will sometimes run from the mouth in a stream, and generally it may be obtained in sufficient quantity for examination, and free from extraneous matter. A little

XLV.-XXIII.

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