milk alone as to other circumstances co-operating with it, Dr. Routh next proceeds to consider the advantages which evidently attend the use of this natural food over all other kinds of diet. If from some inevitable and urgent reason a mother cannot suckle her own child, a properly selected wet-nurse will be the best succedaneum. In selecting one, however, we are surrounded by some great difficulties. It is well known to be a very common practice to make choice amongst "fallen women." This practice the author strenuously opposes as one fraught with danger to the infant, the household, and to general society. We do not propose here to consider the pros and cons of the subject; we will here only observe that the reasons adduced for this objection by our author are many and forcible, and will well repay the consideration of the medical adviser. The wetnurse ought to be, it is affirmed, a married woman, and "should be chosen amongst mothers of many children" (p. 87), as if not so chosen, her experience in the management of infants will not be greater than that of a woman after her "first fall"—a person who constitutes the beau ideal of a wet-nurse in the opinion of many. So great are the difficulties, indeed, attending this method, that Dr. Routh talks of "leaving the employment of a wet-nurse as a pis aller.” If the

mother

"be not able to wet-nurse the child at all, certain principles ought to be observed in feeding it, whether the artificial food given be animal milks or something more distinctly artificial.. no treatment can be safely recommended in these cases which can bear any comparison with that which experience has proved to be most successful in other countries: I allude to the direct suckling of the child from the breast of some other animal, as, for instance, of the goat, to which I have already referred (pp. 141 and 156). Besides, it is the most natural. This itself is no small advantage. But it also does away with the necessity of an experienced nurse to prepare the child's food secundum artem, so that it shall not disagree. Lastly, no improper practices of the animal are likely to endanger the safety of the child, which, after suckling a short time, it will come to love and protect as its own offspring." (p. 307.)

But it is evident that such a plan can be only of limited adoption; what, then, is the next better and more successful method of artificial feeding? In early months the food should be exclusively animal, and milk obtained from a cow at grass will be more likely to be wholesome. This should be given in a diluted state, of the proportion of one or two pints of water to one of milk, according to the age of the child, the amount of water being diminished as the child becomes older. To this diluted milk sugar should be added in the proportion of one or two drachms to every pint. All admixtures of vegetable matters in early periods as contrary to nature, except in disease, should be avoided or given only as correctives of bad milk. When the child gets some teeth, it is an indication that those physiological changes which are essential to the digestion of vegetable material have taken place; then vegetable aliment may be usefully combined with the food which is given to the child:

"Of these, several preparations have been from time to time recommended and used with advantage. Thus we hear of Hard's farinaceous food,' of

baked flour, tops and bottoms, biscuit powder, and a variety of other aliments of that kind. In my own practice, without necessarily denying that with some children these substances will prove occasionally very useful, I have generally limited myself to the employment of three substances: Mrs. Well's vegeto-animal food,' 'Robb's biscuits,' and 'lentil powder.'” (p. 344.)

In feeding or bringing up a child by hand, circumstances will frequently arise which will necessitate a change being made in the food usually employed, or the adoption of some additional article like wine, raw meat, whey, &c.; upon the use of such agents much interesting and valuable information may be found in Dr. Routh's little treatise. He has subjoined, we may add, in conclusion, an appendix to it, in which he discusses the question as to the possibility of mental influences being transmitted through the milk of a wet nurse. He deems that the whole analogy of nature proves that it is possible to put that into the infant which shall contaminate the life of the man-taint his whole constitution and influence his psychical power.

The public have much reason to thank Dr. Routh for the painstaking inquiries he has made respecting the bringing up of young children; the more so, as it must have been quite apparent to him that -as the reviewer of Wertheimber,* in a recent number of the 'Journal für Kinderkrankheiten,' observed-such a study promised but little reward, honour, or profit, whereas, could he discover a new cystic entozoon, or a queerly-tailed cell, renown would freely be accorded to him by "Young Medicine."

REVIEW IV.

Principes de la Doctrine et de la Méthode en Médecine. Introduction à Etude de la Pathologie et de la Thérapeutique. Par J. DELIOUX DE SAVIGNAC, Professeur de Clinique Médicale à l'Ecole de Medicine Navale de Toulon, &c. &c.-Paris, 1861. 8vo, pp. 834. Principles of Doctrine and Method in Medicine. An Introduction to the Study of Pathology and Therapeutics. By J. DELIOUX DE SAVIGNAC, Professor of Clinical Medicine in the Naval School of Toulon, &c. &c.

M. DE SAVIGNAC is of opinion that the treatises we possess on general pathology, and still more those on general therapeutics, are insufficient for their end, because none of them embrace a philosophical exposition of the general truths of medical science. However this may be, we

think that there was abundant room for a new work on the more scholastic and theoretical departments of medicine, and that M. de Savignac has produced one which will be found in some respects of great utility to the medical student. It appears to us, however, that he would have done better if he had confined himself to a review of the labours of preceding writers, with such modifications and additions as might have been needful to bring the subject up to the present state of knowledge. This object he has indeed accomplished in a manner which shows extensive and accurate information, and, in some instances, considerable soundness of judgment; but in going further

• Diätetik der Neugeborenen und Säuglinge. München. 1860.

than this, and attempting a new classification of diseases and of therapeutical agents, he has, we think, been eminently unsuccessful.

He divides his work into two books. The first contains a review of medical doctrines, and their influence on practice from the earliest times to our own. We consider this as by far the most valuable portion of the work. The author has succeeded very happily in catching the leading ideas and characteristic peculiarities of each successive sect and system, and especially in enucleating those views by the persistence in, or the subsequent recurrence to which, the science of medicine as it now exists has been gradually built up. And this is no small praise; for though we have several so-called histories of medicine, and some of them replete with learning, they can scarcely be regarded as histories in the truest sense of the term, the most important object of all history being to illustrate the present by the past. We regret that our limits will not allow us to present our readers with any specimens of this portion of M. de Savignac's work.

The second book is on pathology and therapeutics, and contains much instructive disquisition on the general bearings of these subjects, which we are obliged to pass by, because our limits would not allow us to do it any sort of justice. M. de Savignac is very full upon the subject of nosology, and is greatly in favour of a natural method, which, according to him, is one presenting "a systematization of all the morbid facts, logically grouped into classes, orders, genera, and species, according to their natural relations." (p. 500.) We may suggest, in passing, that a writer who, like M. de Savignac, makes no inconsiderable display of logic, should be careful not to use such absurdly inaccurate expressions as "morbid facts." If facts be subject to disease, we should decidedly be for rejecting all but the healthy ones. We entirely differ from our author as to the superior advantages of what is called a natural system of nosology. The natural relations of diseases necessarily involve the intimate nature and the causes of the morbid actions; but concerning these there has been, and is, an endless diversity of opinion; and it appears to us that the attempt to found the definition and classification of diseases on such uncertain and fluctuating data has contributed, more than anything else, to give rise to the serious question whether nosology has promoted or retarded the progress of medicine. This question, however, in as far, at least, as relates to the definition of diseases, appears to admit but of one rational answer-namely, that medicine, like all other arts and sciences, must have some language of its own, in which, as far as possible, the same things shall be designated by the same terms. In this view, the most useful, or rather the only useful method, would seem to be an artificial one, founded merely on symptoms and external appearances, to which may be added what are called "physical signs," where these exist and are sufficiently certain and uniform. It is true that no just parallel holds between the definition of an ordinary object of natural history, as a plant or a mineral, founded on its external characters, and the definition of a disease founded on its symptoms. In the one case we have to deal with a tangible object marked by characters in a great measure con

stant; in the other we have to deal with an abstraction, derived from an assemblage of phenomena subject to great variation in different cases and at different times. Nevertheless, if we cannot attain to precise definitions of diseases, we must take up with such as may yet serve the main purpose of coupling intelligible general notions with given modes of expression. Thus, although we cannot give such a definition of hysteria as shall embrace even the leading phenomena of every case, we may easily give such a definition as that no one shall suppose us to mean thereby smallpox or the gout, and such as shall in general apply with reasonable accuracy to the disease intended to be designated. If symptoms, signs, and external appearances can afford us this amount of accuracy, they will do for us, we conceive, all that is to be expected in the definition of disease, and more than can be obtained from the application of any so-called natural method.

With respect to classification, again, any attempt at a comprehensive arrangement of diseases according to their natural or true relations and dependencies must necessarily fail, as requiring an amount of knowledge which we neither possess, nor seem likely soon to attain ; and the best recommendation of any nosological arrangement would perhaps be the negative one of doing the least possible violence to what we know of the natural affinities of disease. On the other hand, if a natural classification fail us, we are left without an alternative, as any artificial principle would here evidently be altogether inapplicable; so that, on the whole, the attempt to frame nosological classifications would appear, in the existing state of knowledge, little better than labour thrown away. True, we have long possessed a few extensive groups, formed by a sort of instinctive recognition of the natural affinities of disease. Thus we speak of febrile diseases, inflammatory diseases, pestilential diseases, spasmodic diseases, &c.; and, in as far as individual maladies can be fairly brought under such general heads, they may have a place assigned them, but where they cannot, they had better, we think, be left to shift for themselves. According to our view of the matter, then, nosology is of indispensable use in reference to the definition of diseases, but at present, of very little in reference to their classification.

M. de Savignac takes a widely different view of the subject, and has been at the trouble of framing a new nosological arrangement founded on the "elements" of disease. The doctrine of morbid elements is one to which he attaches the highest importance. He speaks of it as "that great doctrine of elements which is coeval with medicine, the cultivation of which is perpetuated in the school of Montpellier, which justly boasts of it. A doctrine elsewhere ignored or forgotten; submerged by the wave of systems which the last half-century has raised, in spite of the precepts and protestations of those who remain faithful to it. The greater part of modern treatises on pathology do not even deign to make mention of it. To become acquainted with it, one must read Barthez and Dumas, who, taking up and restoring all the details of a plan on which the school of Montpellier has worked since the nosology of Sauvages, formed definitively, out of this doctrine, the code of diagnosis as applied to treatment. If any one shrink from the laborious reading of these old masters, he may at least derive an idea of this important subject from the remarkable article Eléments,' in the 'Dictionnaire

des Sciences Médicales,' which bears the signature of an illustrious disciple of the school of Montpellier, Frederick Bérard." (p. 542.)

It would not be difficult to show that the modern doctrine of elements in relation to disease differs very widely from the ancient, and that even the term "element" is used in a totally different acceptation. But this would be unprofitable. The subject of morbid elements belongs properly to scholastic medicine, and not to that inductive science which we now cultivate by observation and experiment; it is, therefore, worthy of attention only as a part of the history of medicine.

But let us see how M. de Savignac applies his favourite doctrine to the definition and classification of diseases. Take, for example, the "rheumatic element." This, it appears, is at the bottom of a class of diseases which he names "Rheumatalgia" (rheumatalgies), and which includes three genera-namely, rheumatism, gout, and neuralgiæ. The Rheumatalgia are thus defined:

"Diseases essentially painful, of a congestive rather than an inflammatory nature, affecting particularly membranous and fibrinous organs, localizing themselves especially in the articulations and the course of the nervous cords, changeable and erratic in their course, accompanied in some cases with various degrees of alteration of the organic fluids (superabundant fibrine, excess of uric acid, alkaline urates), and occasioning anomalous secretions (sweats, catarrhal flux, herpetic eruptions, articular concretions.)" (p. 605.)

Now, admitting that this definition applies with tolerable accuracy to gout and rheumatism, and to neuralgia, as dependent on the gouty or rheumatic diathesis, it is applicable to neuralgia arising from any other cause in no particulars except those of pain, and location in the nervous fibre. Nor is the relation of neuralgia to rheumatism rendered at all more intelligible by what M. de Savignac calls a "complementary species of neuralgia, which he characterizes as "the most complex of all," belonging as much to rheumatism as to neuralgia, or rather best showing the resemblance of these two states-namely, "general neuropathy, in which the hyperæsthesia and pain radiate through all parts of the nervous system." (p. 606.)

But, setting all this aside, what useful purpose is here answered by the introduction of the "rheumatic element?" We can see nothing in this so-called element but a vague general expression for the phenomena of diseases supposed to be akin to rheumatism, or a still more vague expression for some unknown cause of such phenomena. A system thus based upon "elements"-in other words, upon abstract notions hatched in the brain of the nosologist-would appear to lead to nothing but an endless controversy as to what the elements might be; one disputant contending for an inflammatory, another for a congestive, another for a neurotic, another for an asthenic, another for a caco-chemical element, and so on ad infinitum, according to the particular theoretical views of each. But the worst of all is, that M. de Savignac does not stick to his own text. For example, on his fourth class, or "Pyrexia," he makes the following remark:

"I consider this class as altogether temporary, and destined to disappear from nosology before the progress of pathology. Maladies cannot be diffe