monary emphysema as a partial destruction of the organ of respiration, a destruction which renders the lung completely useless for the functions of hæmatosis. Pulmonary emphysema, far from being an hypertrophy, is then a real atrophy, and this opinion is so well founded on facts, that in an emphysematous lung, we find, beside the tumefied lobules, the vestiges of other lobules, which have completely disappeared from atrophy of the tissues. Such is the opinion which our author has arrived at by direct observation of emphysematous lungs: he next endeavours to trace the relations which connect pulmonary emphysema with the symptoms observed in persons whose lungs have undergone this dogeneration.

The symptoms of emphysema may be divided into two classes: the first class comprising those which are the immediate consequence of the prolonged sojourn of air in the lung; the others, though connected probably with this circumstance, are not the direct result of insufficiency of respiration.

With the first class are connected sonorousness of the chest, the absence of the respiratory murmur, the abnormal development of the thoracic parietes, and debility of the muscles of inspiration noticed by Dr. Stokes as the consequence of the forced extension in which they are kept by the morbid development of the lungs.

In the second class may be reckoned dyspnoea, frequency of pulmonary catarrhs and cough, which is the consequence of the latter, palpitations, bypertrophy of the heart, and oedema of the lower extremities.

On comparing these two classes of symptoms with the anatomical state of the lung as already described in this article, it will be found how easy it is to account for the production of the different symptoms now enumerated. It has been shown that emphysematous lungs are transformed into irregular cavities circumscribed by a thin, membranous tissue, which has lost the elasticity necessary to drive out the air conveyed to them by inspiration; besides, this air being heated by its sojourn in a body whose temperature is very high, acquires a much greater size. From these two physical facts result all the symptoms of the first class the sonorousness of the chest, a considerable quantity of air remaining confined in the lung; the abnormal development of the chest, it being a matter of constant observation that the parictes of the cavities are moulded on their contents, and that if the lung keeps itself permanently in a state of forced distention, the corresponding portion of the chest must become developed in the same proportion. The absence of the respiratory murmur is the natural consequence of the fulness of the lung, which being already distended beyond measure by the atmospheric air, can no longer receive any at each inspiration. The weakness of the inspiratory murmur appears also to be connected with debility of the inspiratory muscles. There is not then any one of the symptoms of the first class which is not satisfactorily explained by the morbid state of the emphysematous lung. Those of the second class are also an evident consequence of it, though less directly than the preceding; for they result, some from the obstruction occasioned to the circulation by the obliteration of the greater part of the capillaries of the lung, and by the forced distention of the lung; this will account for the palpitations, hypertrophy of the heart, and the anasarca which is the consequence of it; the others arise from the obstacle caused to the respiration by the state of permanent development

in which the lung is kept in emphysema; in this way our author accounts for the dyspnoea, cough, and pulmonary catarrhs so frequent in emphysematous patients; the latter symptoms may also, he conceives, be the result of the increased activity of the bealthy parts of the lung in persons in whom an entire lobe, and oftentimes an entire lung, has become completely useless for the function of bæmatosis.

IV. PRACTICAL CONSEQUENCES RESPECTING THE TREATMENT OF
PULMONARY EMPHYSEMA.

Our author now applies the preceding remarks to the treatment of pulmonary emphysema. Those who consider this disease hypertrophy by passive dilatation of the vesicles, endeavour to restore tone to the bronchial muscles and for this purpose they recommend strychnine; this medicine however can evidently be of no use to re-establish the septa of the vesicles which have disappeared; probably however it might be employed to restore a little tone to the thoracic muscles from its marked and striking influence on the spinal cord, and consequently on the nerves which it sends to the respiratory muscles. The author never tried this mode of treating the disease. Louis employs opium, which possesses decidedly beneficial properties with respect to diminishing the difficulty of breathing in emphysematous patients. Dr. Lombard supposes that it may produce this effect by diminishing the physical want of respiration, and consequently by putting a stop to that state of spasm in which the anxiety of the patient keeps all the respiratory muscles. Laennec used to recommend polygala, oxymel of squill, &c. in order to diminish the dyspnoea in emphysematous subjects: the only effects however such medicines could have is to diminish the viscidity of the sputa; it is obvious that none of these means could exercise any influence on the lesion which constitutes pulmonary emphysema.

A rational treatment, according to our author, of this disease, should, in the first place, modify the pulmonary circulation so as to prevent the obliteration of the capillary blood-vessels, and, in the next place, render the expiration more complete. Of these two indications the first is much the most difficult to be fulfilled, inasmuch as it is evident that the phenomenon it would combat is enveloped in the utmost obscurity; however, observes our author, going on the fact that obliteration of the capillaries is the natural consequence of their diminished activity, it is readily understood that if it was possible to foresee the formation of pulmonary emphysema, it would be necessary to combat this disposition of the blood-vessels to become obliterated by all those means which should increase the movement of the blood through the lung; a sharp and bracing air should be recommended to the patient; exercise continued for a long time, and so conducted as to render the respiration more complete; in a word, the tonic and strengthening treatment would be the best adapted for the first period of emphysema, and might be successfully employed in young persons whom either an hereditary predisposition or attacks of dyspnoea seemed to threaten with this disease.

The second indication, that which consists in driving out the air confined in the lung, might be fulfilled by all those means capable of rendering the respiration more complete, and above all the expiration more easy. Such

are gymnastic exercises, riding on horseback, and all those exercises which tend to strengthen the muscles of the trunk. Strengthening douches on the thoracic parietes, sea bathing and stimulating frictions on the chest, might be employed in the same cases. Probably also the strychnine recommended by others for a very different reason, however, might fulfil the indication now in question by rendering the contractions of the diaphragm and of the intercostal muscles more complete and more energetic. Pulmonary catarrh and hypertrophy of the heart, when consequences of emphysema, are to be treated in precisely the same way as in one who is not emphysematous.

In conclusion, the author acknowledges that, with respect to the tonic treatment here recommended and to which he was led by the theoretical views which he has given of this affection, it has not yet received the sanction of experience, without which no method of treatment can be recommended with anything like confidence, practical medicine being one of those objects in the circle of the sciences to which unfortunately à priori reasoning is but little applicable.

AN EXPOSITION OF QUACKERY AND IMPOSTURE IN MEDICINE, &c. By Dr. Ticknor, with notes by W. Wright, SurgeonAurist. S. Hodson, Fleet-street.

QUACKERY and imposture" will continue in medicine, so long as there are people to be gulled, and lucre obtained by gulling. This "we calculate" will be for ever. Is quackery or imposture confined to physic? No verily. It has existed in every profession and trade from the very origin of arts, and is only now more extensive than hitherto, because Arts are more numerous and general. Was smuggling ever put down by penal enactments? Never. It can only be annihilated by randering the trade unprofitable-by taking off the duties. Can quackery and imposture ever be rendered unprofitable in physic, or in any profession? We think not. It exists and has always existed even in religion. The priests were quacks and impostors from the earliest ages, when they pretended to have influence on the skies, and to even hold the keys of Heaven. Have we not plenty of quacks and impostors in religion at this very day! How often is the mask of sanctity worn by the hypocrite for the purpose of obtaining his own selfish ends? Do not the lawyers impose on their credulous clients and urge them to suits where the lawyer only is the winner. Is there a single lawsuit in which one party is not deceived by the opinions of their legal advisers? But there is not a single art, profession, or science into which "quackery and imposture" do not force their way-and medicine cannot expect to escape. This science, if indeed it be one, is more open to quackery and imposture than any other. One half of our practice is guess-work, and in matters of such uncertainty the ignorant will have his guess, and assert that he knows more than his neighbours. But then there are unqualified men who practise physic without a diploma-and consequently are quacks. This is a very small portion of the evils of quackery and imposture in medicine! The mass of trickery and

humbug in medicine-and legalized too-is to unlicensed practice as the Atlantic ocean to the lake of Keswick. What is the unbounded practice of detraction but quackery and imposture! A medical man is shewn the prescription of another medical man, and, as a matter of course, pronounces it to be totally inappropriate to the case, significantly hinting his astonishment that the patient is alive to tell his tale! Is this practice frequent? More frequent, we believe, than unlicensed practice-and it is more disgraceful— more unchristian-and more detrimental (si sua bona norint) in the end to the medical profession. Many, we have no doubt, commence this mala praxis from necessity, and continue it from habit, without sinister intentions -as liars at last believe their own falsehoods, so often repeated.

The object of the work before us is to "overthrow quackery in medicine, by exposing its errors, &c." Good intentions, no doubt, but quite impracticable. Dr. Ticknor tells us that

"It is neither the ignorant nor the superstitious alone who are gulled by the designing; for in this country such individuals are rarely to be found and yet there are plenty of subjects upon whom these harpies prey." 6.

Thus then amongst the learned and intelligent, in the United States, as indeed in this country, the quack finds his ready customer! And what is the remedy proposed by our author? A general study of medicine by the community. The thing is impossible-and if it could be put into execution, the mischief would be incalculable. The smattering of medical science which could possibly be attained by the masses, would only render one half of them hypochondriacs-and consequently the prey of charlatans. Even medical men themselves are far more frightened by their own ailments than are the most ignorant of their patients. But how would it be possible for one in one thousand of the community, to acquire even a smattering of anatomy, chemistry, practice of medicine, &c. The thing is as Utopian as any scheme ever propounded to the world.

The greater portion of the work consists of a slight popular delineation of health, disease, and remedies-interlarded, however, with a great many anecdotes of quackery and its victims. These are, of course, the only portions of the book that can claim any notice from the medical reader-and, to say the truth, they are the portions of the work which will do most good to the community-by drawing their attention to the iniquities of empiricism -and the gullibility of its customers. We shall cull a few samples from these anecdotes.

"An empiric of the first water, not many years ago, had made himself famous for the cure of all human maladies, by the administration of peculiarly large pills of his own invention. What contributed not a little to the increase and spread of his reputation was the fact, that he used frequently to tell his patients, that from their symptoms he was confident some particular substances were lodged in a portion of the alimentary canal. At one time he would tell a patient that he had apple seeds retained in his bowels; and again he would tell another, that he had kernels of different fruits, and grains, in his stomach, and if by questioning gentlemen he could ascertain that they were fond of shooting, it was not seldom that he attributed their complaints to having accidentally swallowed a few shot. As nothing could so conclusively prove his prognostics correct, as the simple fact of finding the articles named, so the old gentleman's character for wisdom and skill became more and more firmly established; for the identical causes of

mischief were invariably discovered after taking a dose of the 'big pills.' At length, a lady of the first respectability, having suffered a long time from deranged digestion, applied to the celebrated doctor for assistance. After a few questions, he told her very promptly that he understood her complaint, that he knew what ailed her, and more than all, that her doctor was a fool, and assured her that his big pills would effect a cure. Neither of these assertions she exactly credited, but nevertheless, concluded, to try his remedy if he would make known to her the complaint. Why,' says he, 'you have got lemon seeds in you—you must take some of my big pills and get rid of them, and you'll be perfectly well again.' Why, Doctor,' said the lady in amazement, I bave not eaten a lemon for six years; and what you say is altogether impossible.'

'No matter, madam, if you have not eaten a lemon for twenty years, the fact is just as I tell you, and if you will take the pills you can be satisfied of it.'

The pills were taken, and to the utter astonishment of the patient, the lemon seeds were found; a second dose was taken and still more seeds made their appearance. A thought now flashed upon the lady's mind. One pill was yet left which she examined, and behold! a lemon seed in its centre-the secret, truly, of the Doctor's astonishing wisdom, and successful practice." 49.

This was no bad trick of the transatlantic charlatan, and we should not be at all surprized to find the hint taken by some cisatlantic worthies of the same class.

2. It appears that the lobelia inflata is working its mischiefs on both sides of the Western Ocean. We observe, almost every day, in this Metropolis, the injuries occasioned by the administration of the tincture, in what are called asthmas, but which are, in reality, neither more nor less than bronchial inflammations. In such cases, as might be expected, the irritating tincture of lobelia inflata does much harm.

"A melancholy instance of death occasioned by the use of this plant in the hands of a quack, is detailed in the sixth volume of the Massachusetts Reports, in the trial of Samuel Thompson, an empiric, practising in Beverly, for the murder of Ezra Lovett. In this trial, it appeared that the patient, being confined by a cold, sent for the pretended physician, who gave him three powders of lobelia in the course of half an hour, each of which vomited him violently, and left him in a great perspiration during the night. The next day two more powders were administered, each of which operated by vomiting, and occasioned great distress. In like manner two other powders were given the subsequent day, leaving the patient in a state of great prostration. Several days after this the physician (?) came again, and finding his patient still worse, administered several more powders, which occasioned great distress, and at length ceased to operate. Finding that the stomach was not sensible to the emetic effect of the lobelia, the physician (?) repeated the dose, and when the patient complained of great distress at the breast, and said he was dying, the doctor (?) assured him the medicine would soon get down, or operate as a cathartic. However, on the same evening, the patient lost his reason, and became convulsed, so that two men were required to hold him. To relieve which, the doctor forced down two more of his powders, and the patient, as was expected, grew worse, and continued so until he expired.

The doctor, who had thus terminated the disease and the patient at once, was arrested and put upon trial for murder. But the homicide proving a legitimate one, from the want of a sufficient evidence of malice prepense, he was acquitted and set at liberty.'" 56.