required in the abstraction of blood, lest the necessary strength be impaired. Convalescence requires watching; and on the recurrence of pain, or disturbance of the digestive organs, mild antiphlogistics must be resorted to. M. Haspel believes that emeti:s exert a beneficial effect in aiding the disgorgements of the liver; but in enfeebled subjects they must be used with caution. They do not operate so easily or so effectually on the engorgement in the spring, as in the autumn, when the bilious condition prevails. Of all the purgatives the author gives preference to calomel, of which he entertains a high opinion, giving it in 15 or 30-grain doses, and preceding its use by a mild laxative, in order to prevent salivation, which he regards as injurious. He prefers friction with mercurial ointment, also, to that with iodine, from which he has derived no benefit. When the antiphlogistics are of litle avail, large blisters are often of great service, and this even in cases which seemed evidently doomed to go on to suppuration. Tumefactions of the liver, also, occurring in subjects apparently in good health, are sometimes dispersed by their means. Change of climate is sometimes a very efficacious

measure.

When the threatened abscess may be supposed to be of small size, and the subject is robust, its extension may be circumscribed by the cautious use of antiphlogistics; but in weakly subjects, some form of issue should be substituted. When, however, hectic becomes established, active revulsion of any kind only adds to the danger of purulent resorption; and every means of supporting the patient's strength must be resorted to. M. Haspel strongly insists upon the necessity of opening those abscesses which are accessible to the surgeon; and of the various means that have been recommended for accomplishing this, he prefers the use of the caustic potass as favouring the production of adhesions preventive of effusion into the cavity of the abdomen. The chief objection to this procedure is its slowness; and when, from the urgency of the case, a more rapid one is necessary, the plan of M. Begin, of carefully cutting down to the cyst of the abscess, and opening this at the expiration of three days, when adhesions with the external wound have had time to form, should be substituted. However well the operation may be executed, it does not always save the patient's life, for the collection may prove larger than was anticipated, or the complications of the disease. may be of a fatal character. M. Haspel considers that the operation should be resorted to as soon as the presence of pus is ascertained; and that cases have been lost in waiting for too evident fluctuation, and from the timidity of the surgeon. Even where the abscess is large and the powers exhausted, the operation should be performed, as giving the patient his only chance, especially since some cases have recovered under apparently hopeless circumstances. The author does not approve of injecting the cavity of the abscess with tepid water, or any other fluid-at least prior to its becoming encysted.

3. Atrophy of the Liver.-M. Haspel wishes to draw attention to a form of atrophy of the liver met with in Algeria, arising from the circulation in the organ becoming impeded by the retraction of its component parts. As a consequence of its repeated congestion in dysentery, and especially in obstinate intermittents, the parenchyma of the liver, and sometimes that of the spleen, may acquire the consistency and hardness of cartilage, undergoing very great diminution in size, and giving rise to symptoms of hepatic derangement. The disease is of frequent occurrence in Africa, and M. Haspel relates the particulars of three of the cases.

It usually commences obscurely, and has already made considerable progress before it has excited attention. A disturbed state of the digestive organs, and a feeling of debility, which is explained by no obvious cause, are the earliest symptoms. After one or more months, ascites appears, and this usually prior to cedema of the extremities. Ascites is indeed often the only symptom that excites attention; and when this appears without obvious cause or distinctive symptoms, this disease is always to be suspected. Attacked at an early period, the disease may, by preventing congestion, be arrested; but it is seldom recognised before all means of treatment are unavailing.

4. Ramollissement of the Liver.-Although authors have admitted an inflammatory and non-inflammatory ramollissement of the liver, they have not offered any distinctive

description; and it is M. Haspel's desire in some measure to supply the deficiency. All forms of it are dependent originally upon partial or total congestion of the organ; and of these forms M. Haspel describes three-ramollissement, with infiltration of red blood, which is not always a product of inflammation; ramollissement, with infiltration of pus; and ramollissement with serous infiltration. There is also another remarkable form of diminished cohesion of the texture of the organ, termed by Ferrus and Bérard dry, and described by Louis, in his work on typhoid fever, as friable.

The first-named group (of which several cases are given) of infiltration of blood into the liver, or red ramollissement, may be produced by various causes, such as hepatitis, a traumatic rupture of the capillaries, or a general hæmorrhagic disposition due to a change in the fluids, as in the scorbutic state. In the second form where pus is infiltrated, the yellowish granular appearance observed in some cases is due to the abnormal development of the fibro-cellular tissue, which constitutes the areolæ. It almost always precedes the formation of abscess, and may be usually observed around these after their formation. It is in this cellular tissue, surrounding the elementary tissue of the organ, that the most important pathological changes take place. The most frequent one is a reddish or brownish infiltration, as in commencing phlegmasia, when the limits of the cells and the cellular tissue can be no longer distinguished, and the parenchyma of the organ presents a uniform appearance. If in place of blood being depos ited in the areola of the cellular tissue, these contain a yellowish consistent matter, resulting from an abnormal secretion of the tissue, an appearance of either hard or soft granulations is produced; and the liver presents a yellow, anæmic, granular aspect.

The distinction between the inflammatory ramollissement and the third form, or the serous non-inflammatory ramollissement, is not always easy. In a paper formerly published, M. Haspel declared his conviction that ramollissement never resulted, except from phlegmasia or from the rupture of capillary vessels and consequent effusion of blood; but additional experience has modified his views, and he now presents examples of the cases which induced the change. They are chiefly found in instances of pernicious intermittent, in which watery exhalations in the form of diarrhoea, cerebral effusion, and copious sweats are common-and constitute examples of the dropsy of the hepatic parenchyma of Glisson. In all the examples of pernicious fever in which this affection of the liver has been observed, there has been found great poverty of blood, with ramollissement of, or serous effusions into, other viscera. In both the first and the third forms of ramollissement, an afflux of blood had preceded; but in the one case an abundant, rich, plastic, highly-coloured blood was poured into the areolæ, while in the other it was only a pale, serous, watery blood. Thus we may have the same origin (local sanguineous congestion), the same danger, the same symptoms and general phenomenon (febrile paroxysm)-the anatomical characters alone establishing a difference, and these due to the remarkable change which the blood itself has undergone. This form of ramollissement is, in fact, only met with in pernicious or typhoid fever, and in scorbutus-all diseases in which evident alteration in the blood has taken place.

"According to the cases we have related, this ramollissement may occur in two modes: 1st. It may sudenly acquire its highest degree of intensity, and give rise to a train of symptoms that may rapidly lead to death; 2nd. In other cases it only reaches a certain amount of intensity, and that gradually. The loss of consistence is sometimes only manifested by a pasty softness of the tissue; and at others, as Andral observes, the perenchyma becomes truly liquefied, presenting the appearance of having been long submitted to maceration; or, again, the softened part takes on a greyish or dead-leaf colour, the gall-bladder containing only a viscous serosity. In all cases it is a general, diffused infiltration-the organ often presenting the appearance of a homogeneous detritus." (p. 388.)

The notice we have bestowed on M. Haspel's work shows the estimate we have formed of its contents; and in our next number we shall give an analysis of his second volume, which has just made its appearance.

ART. IX.

Hydropathy as Applied to Acute Diseases. Illustrated by Cases. By T. B. ARMITAGE, M.B. Lond., M.R.C.S.-London, 1852. 8vo, pp. 178.

DR. ARMITAGE has chosen a dangerous title for his maiden publication, unless he desire to appear in the character of a candidate for the management of a water-cure boarding-house. It seems to indicate that he is a follower of Priessnitz, and a postulant for fellowship with the motley crew who practise the healing art under the banners of that successful charlatan. Professedly, however, the object of the publication is far different, inasmuch as it is declared to be the resuscitation of Currie's method of treating fevers by cold affusion. Dr. Armitage observes, that

"Dr. Currie, by the publication of his numerous cases fifty years ago, placed the general advantages of the hydropathic treatment in fever beyond a doubt. No one can read his Medical Reports' without being satisfied that he had more success in fever by cold water affusion than is obtainable in the present day by all the aids which medical science, confessedly so greatly advanced since his time, can supply. My chief desire has been to remedy, however inadequately, a want which I felt in reading those otherwise valuable reports; and if I have pursued a closer investigation of the immediate effects of water treatment, and have given more definite indications for its use, the object I had in view will have been attained.” (p. 23.)

Dr. Armitage ought to be aware that in applying the term "hydropathic" to Currie's treatment, he is wronging the memory of that honourable physician. It is a term which savours too strongly of quackery to be pleasant to the ears of the upright practitioner. It is a term strictly and exclusively belonging to the quacks' vocabulary. If it were not the unmeaning and absurd word it is, and truly expressed the therapeutic use of water, still it does not follow that it should be adopted; on the contrary, the fact that that theraputic use, so long known and so long esteemed by the profession, has been so designated by a band of empirics, is a sufficient reason for its rejection. Dr. Armitage has, we think, committed another indiscretion in publishing the subjoined.

"I mean no disparagement to the great practical skill which Priessnitz undoubtedly possessed in the treatment of disease, by calling attention to the fact that his want of any scientific knowledge rendered him utterly incapable of forming a correct diagnosis." (p. 16.)

How an incorrect diagnosis and such correct treatment as is characterized by the phrase "great practical skill" can co-exist, is beyond our apprehension. It may be readily granted that the man knew pretty well the cases which might be benefited by regimen and the internal and external use of water; but as to those in which his method was useless, we suspect he was quite at sea, and his "great practical skill" was only shown in avoiding gross blunders in their management. Dr. Armitage appears to have a predilection for the system, as he informs us, that "at the present moment I am subjecting myself to active hydropathic treatment, for the alleviation of a complaint that I have but little hope of removing either by medicine or regimen." Now to this no objection can be fairly urged; but we doubt very much the propriety of the following:-"To many invalids, also, I would recommend a residence at some well-regulated hydropathic establishment, in preference to any other mode of cure." We are very decidedly of opinion that the practitioner should prefer any other possible mode of carrying out a hydriatic system of treatment, and never sanction the establishments referred to. Dr. Armitage will probably think we are very hypercritical; but if he will pay a visit to the Ben Rhydding Hotel and Boarding-house, he will find a text-book for the inmates which contains statements sufficiently decided to warrant us in looking upon books like his with suspicion. Dr. Macleod, the hydropathic superintendent, has undergone the profitable infliction of martyrdom for his adherence to homeopathy. As a fellow of the Royal College of Physicians of Edinburgh, Dr. Macleod has committed breaches of professional etiquette of a character sufficiently serious to render certain resolutions of the college applicable to himself. Having identified himself with the aqueous and globulistic quacks, the fellows of the college pressingly invite him not to

identify himself any longer with them. This calls forth a letter from Dr. Macleod, addressed to Dr. J. Y. Simpson, the president of the College, but evidently intended for the perusal of the customers of the Ben Rhydding Board and Lodging house. If we were to accept the writer's account of himself as a true statement, he is a paragon of virtue rarely to be met with; so sound in judgment, so diligent in study, so zealous and courageous in the pursuit of truth, so totus teres atque rotundus. He began his medical career (he tells his readers) as "an ardent student," adding "and during nine months each year, and for years together, I was an occupant of the dissecting room, on an average, six hours a day. I laboured with zeal in the pathological department of the Royal Infirmary for upwards of three years. I performed nearly all the weights and measurements made there during that period. I devoted much of my time to microscopic studies. I went round the wards of the hospital when the physicians were not there, regularly for several years, watching and examining for myself every case of interest and practical importance: so that I might be able to comprehend, with as much completeness as was possible, the progress of diseases, their varied phases and tendencies," &c. There never was such a practical, such an unwearied, such a painstaking student-if we may believe Dr. Macleod's account of his own conduct. And what was the conclusion this Sydenham secundus çame to? That the practice pursued was 66 DANGEROUS, FREQUENTLY UNDERMINING THE CONSTITUTION FOR LIFE, AND SOMETIMES HASTENING DEATH." Dr. Macleod "being," as he says of himself, "a searcher after truth, and never caring much from whom it came, provided I could discern and appropriate it," proceeded to Vienna to study and be convinced of the "truth" of homoeopathy and hydropathy. Returning home re infecta, he, quite characteristically, "longed for the appointment of Physician to the Royal Infirmary," but quickly discovered that Edinburgh was no place for him. At this "critical juncture" the situation at Ben Bhydding became vacant, and our adventurer, when he "dwelt on the rare opportunities it might afford for the development and promulgation of Truth," was moved to offer for the situation, "with little regard to pecuniary remuneration," and so got the "inestimable boon." There is a good deal of truth, probably, in one or two of the latter statements; for when stripped of the absurd sentimentality in which they are wrapped, they indicate a sharp eye for "the main chance." But as to the rigmarole description of his virtuous truthfulness, we take leave to express our doubts of its correctness, for the simple reason, that in the same pages he has slandered his brethren, and wilfully misstated ourselves. We subjoin the following note, having reference to an article in vol. vii. of this journal, which we find at the foot of page 12 of Dr. Macleod's "Letter":

"I point, for the assurance of our timid hydropaths, to an article in the last number of the 'British and Foreign Medico-Chirurgical Review,' on the use of baths-an article slight in itself, but sufficient to mark the direction of the wind. It is mainly an analysis of a volume by an excellent and instructed American physician and hydropath-Dr. John Bell, of Philadelphia -bearing the prudent title of‘A Treatise on Baths.' Taking his cue from the title, the reviewer ventures to allege that the doctrines in question had long influenced medical practice-a delusion readily forgiven him, since he would help the said doctrines to be recognised as a part of authorized practice now. He assents, in the course of his remarks, to almost every important advantage claimed by hydropathic practitioners for the use of water--among others, to its efficacy in scarlatina, typhus, &c. He assigns the credit, not, of course, to unlucky hydropaths, but to certain spongers; forgetting, however, to ask, or at least to answer, two questions-1st, whether the said spongers would not have sponged more largely," &c. &c.

It is obvious, from even a mere glance at the article referred to, that this letter, addressed to the president of the College of Physicians of Edinburgh, was not really intended for his instruction, but for the perusal of the non-professional people who board at Ben Rhydding. How otherwise could Dr. Macleod have ventured to pen the passage quoted-so utterly at variance as it is with truth? The "credit" was "assigned" to Floyer, Baynard, Cheyne, Wright, Jackson, Currie, Gerard, Kinglake, Good, Forbes-men who would have felt degraded by the designation "hydropath," and who advocated cold bathing before that class of aqueous charlatans existed. The word "sponger," or "sponging," is never applied by us, directly or indirectly, to their

methods of using water to the surface, and only occurs once, and that exceptionably, in the whole article of twenty-six pages. That once is when we refer to our personal experience;" whenever we feel an aversion (which may be termed instinctive) for the bath, we are content with cold-sponging"--are the words used. Dr. Macleod must excuse us expressing a confident conviction that his self-laudations are as utterly unfounded as his assertions about the "spongers." If he can venture on statements so outrageously at variance with the truth, on occasions when he can be confronted, what will he not say when he cannot be confronted? Undoubtedly he is safe from detection by those amongst whom his "letter" is intended to circulate, and his profession of love for truth may win their confidence in his bold assertions; but still it is equally certain that his sin will find him out, and public opinion adjudge his case rightly.

This conduct of Dr. Macleod's is very instructive to the profession, as to the best method of warring with quackery. It is only through their pecuniary interests that any impression can be made on charlatans, or on those practitioners who desert the ranks of the legitimate body. Abuse they welcome, but any measure which will effectually weaken their craft meets their instinctive opposition. In penning the mendacious note we have quoted, Dr. Macleod knew well that the general adoption, by the profession, of the principles laid down in that article, would eventually extirpate the special establishments, like Ben Rhydding; because water as a therapeutic agent would then be placed within the reach of all classes. It would be equally applicable by the ordinary practitioner at Brighton as at Cheltenham, at Harrogate as at Scarborough, in the city or village as at Ben Rhydding. Nothing is more certain, we think, than that all special methods of treating disease are essentially charlatanic, and inevitably infect the profession of quackery. Hence we would have the profession generally and well informed as to all the methods of using water, which have been found the most beneficial and the most convenient, and as to the diseases which may be so treated with the most probable success. Dr. Macleod instinctively perceived, on reading our article, the dangerous results to the hydropathic craft which would follow from our views; and hence that eminent "Searcher after Truth" (as he chracterizes himself), unguardedly manifested his feelings in a feeble explosion of calumnious misrepresentation.-Holding these opinions, we welcome all additions to our knowledge of the therapeutic uses of water, and gladly present to our readers a short analysis of Dr. Armitage's book.

The writer travelled on the Continent, towards the close of the year 1849, for the purpose of visiting all the great hospitals, and arrived in Berlin in January, 1850. Having attached himself to the Charité Hospital there, he obtained the opportunity he had much desired of testing Currie's method of treating typhus fever, Schönlein having given permission to his assistant, Dr. Traube, to carry on experiments with this view during the vacation. Previously to commencing these, Dr. Armitage paid a short visit to Gräfenberg, to be initiated into the mechanical processes used there. Currie's method had already been successfully practised at the hospital by Horn, when, in 1813, the retreating French, on their road from Russia, left typhus everywhere in their track. Dr Armitage adds

"Something of this method of treatment has been, ever since Horn's time, continued at the Charité, but the administration of the baths was left too much to the discretion of the bath servants and nurses, so that at the time when I arrived at Berlin, the method had so degenerated that it could scarcely be recognized. A very powerful douche had been substituted for the much more troublesome practice of cold affusion. I have frequently seen this allowed to fall for several minutes together on the head of the unfortunate patient. It is no wonder, then, if such a method should frequently be unsuccessful, and that the whole method should fall into disrepute. I have been told by the bath-master, that he has seen several cases of death while the patient was actually under the douche." (p. 7.)

Not only fever, but Asiatic cholera, and cases of delirium tremens and thoracic and abdominal inflammation, were treated by baths and affusions, or the wet-sheet. The whole number of cases of typhus treated, while Dr. Armitage was at the Charité, was sixteen. Six of these were treated on Schönlein's plan of heroic doses of calomel, of