"There is a kind of physiognomy in the titles of books, no less than in the faces of men, by which a skilful observer will as well know what to expect from the one as the other."

Here is matter for the metaphysician and the moralist, as well as the physician. The stream of life from the cradle to the grave!

"The life of man is the incessant walk of time, wherein every moment is a step towards death. Even our growing to perfection is a progress to decay. Every thought we have is a sand running out of the glass of life. Every letter which I now write is something cut off from the measure of my existence here." Dr. Johnson divides it into ten septenniads, and treats of all its various conditions-the evolution and progress of functions-the changes peculiar to the different periods-the diseases of most common occurrence, under varieties and vicissitudes of climate and seasons-and the gradual decay of the mortal fabric. All these important matters are the subjects of Dr. J.'s philosophical observation and speculation, and the manner in which they are treated illustrates the advantages arising from a comprehensive knowledge of the whole science.

During all this time his literary labours in the Medico-Chirurgical Review have been indefatigable, though assisted by his son, and by various writers now employed in that work. For the first ten or twelve years, almost every article in that journal was written by himself, for which I have his own testimony, affording a sufficient proof of the assiduity of his studies, and the remarkable facility of his compositions. He states himself to have been almost entirely self-taught, both literary and professional; and from the expiration of his short apprenticeship, he supported himself without ever receiving a shilling from his

relations.

Through a long and chequered life, he seems to have offered an exception to the dictum of the poet :

"Haud facile emergunt, quorum virtutibus obstat
Res Angusta Domi"

for he overcame all obstacles apparently without difficulty, and rose to comparative affluence and reputation, by easy but regular exertion of his intellect. Considering the difficulty and danger of the office of reviewer, I believe that he has made exceedingly few personal enemies-and most of these few have become his friends in the sequel.

In private practice he is one of the most popular physicians of this metropolis. His manners are mild and kind to his patients, and he has the art of inspiring great confidence in those whom he attends—an art, which like that of poetry,

"Nascitur non fit."

In his domestic affairs he has been fortunate and happy. His eldest son, Mr. H. J. Johnson, is united with his father as editor of the review, and is very much liked as a teacher of anatomy in the Kinnerton-Street School, and bids fair to

arrive at lucrative and honourable distinction in his profession. His second son Mr. W. Johnson, took honours at Cambridge, obtained a fellowship, and is called to the bar. His third son is a solicitor: and his youngest son is studying under his eldest brother for the profession, at St. George's Hospital. His only daughter is married to a gentleman in the legal profession. Dr. Johnson may, therefore, now be considered as practising for the love of his profession, rather than for the support of a family, who are almost all provided for. He has always been a sedulous attendant on the various medical societies, and an active promoter of medical discussions in these institutions, where, indeed, he seems to be a general favourite. Though remarkably cheerful in society, I have reason to believe that the subject of this memoir is pensive and rather melancholic in private. This is probably the case with a majority of those whose literary productions and convivial conversations would lead us to think them the gayest of the gay. In religion, general politics, and medical politics, Dr. J. is known to be liberal, though free from scepticism, or ultra-radicalism. In the relations of private and domestic life, nothing is known but what is most honourable to his character.

DELIRIUM TREMENS.

OUR readers must all remember a very unseemly TRIAL of a septuagenarian surgeon of a public institution, for mistaking delirium tremens, or delirium traumaticum for mania. Now we would ask the hypercritics in such cases, whether mania does or does not exist in fully-formed delirium tremens? No man who ever saw the disease would attempt to deny the existence of mental derangement in the case under consideration. Why, in the United States, where the disease is ten times more prevalent than in this country, it is termed “MANIA A POTU.” But the sticklers for a definite mark of diagnosis, say, "Oh we can tell delirium tremens from common mania by its cause, not by its SYMPTOMS." Indeed! This is rather an unscientific procedure as well as a very unsafe one. We are called to a patient, and asked to examine him and give the name of his malady. But after a close investigation, we say-" Oh you must tell us the cause of his complaint, otherwise we cannot tell you its name." This is a precious piece of diagnosis! Then let us observe that, in the first place, delirium tremens does not always acknowledge intemperance for its cause-and that the ordinary cases of acknowledged mania do very frequently result from habits of intoxication. Thus a man who lives well, but not intemperately, meets with a compound fracture of the leg, and consequently is debarred from animal food and wine. He gets delirium tremens or traumaticum, and presents the same phenomena as the man who has been drunk every day. An internal inflammation, as pneumonia, will sometimes occasion all the symptoms of delirium tremens, in good constitutions, but where food and wine are withdrawn, and the lancet and purgation employed. Thus, then, in a majority of cases, the symptoms are precisely those of a sudden burst of mania-often taking on the character even of monomania -and the causes are often those of common mania, and by no means universally intemperance in spirituous or vinous potations. We have seen several instances of temporary mania assuming the character of delirium tremens so exactly, that nothing but the history of the cases undeceived us. We may mention a recent A young medical gentleman was suddenly taken with symptoms of delirium tremens, and we were sent for to visit him. He had red ferretty eyes— cold clammy skin-dry tongue-incessant jactitation-quick small pulse-no sleep for some nights-violent gesticulations-rapid talking-aberration of intellect.

case.

He averred that the devil and a coati mondi were under the bed, and that

conspiracies were formed against his life. There was tremor of the hands and agitation of the limbs. In short, a more complete picture of delirium tremens we had never seen-and this we mentioned to one of his friends, while we inquired whether or not he had been lately indulging in drink. We were informed that he was a “ Tea-totaller”—a young man of the most temperate habits—but that some moral causes, of a very exciting nature, had lately been in active operation, the precise nature of which we do not deem it necessary to mention. This information modified our treatment, or rather our prognosis. We did not exhibit opium or stimulants, but prescribed soothing and sedative remedies-few of which, however, were taken. In ten or fourteen days he was well. A remarkable occurrence took place during our attendance on this gentleman. A female acquaintance much interested in his fate, visited him and remained several hours at his bed-side. The state of her friend's case made such an impression on her nervous system, that, soon after her return home, she presented a train of symptoms resembling those already described-merely from sympathy. We did not ourselves see the lady after she left our patient's bed-side; but were credibly assured of the above occurrence. Here then we see the effects of purely moral causes-namely, the symptoms of delirium tremens.

The advocates of a definite line between delirium tremens and a sudden outburst of mania have still a strong-hold to retreat to, if beaten from the outworks. The treatment, they say, is different in the one case from that which is proper in the other. On this point we have no fear of joining issue with them. In the first place, what line of distinction can be drawn in the treatment where, as is often the case, the mental derangement, acknowledged as such, results from habits of intemperance? None.-But whatever be the cause of the mental aberration, the essential moral treatment is in all cases the same. The patient must be kept under surveillance-or even under restraint if necessary. In delirium a potu, the tendency to self-destruction is often as strong as in mania from any other cause. The utility and necessity, therefore, of personal restraint is as necessary in the one case as in the other, whenever the aberration is considerable, and violence is manifested.

Thus, then, we find an identity of symptoms-often an identity of cause-and frequently a similarity of treatment in mania "a potu," and mania from any other cause. It is hardly necessary to observe that the adjunct " tremens" is obviously improper, since it is by no means a necessary accompaniment of mania "a potu." It is often present in other complaints, or even where no complaint is made by the patient, but where habits of intemperance are established.

If the above observations are correct, or founded on observation, (and we believe they are)—if mania a potu cannot always be distinguished by its symptoms or its causes from any other case of mania—and if the moral treatment, as far as restraint is concerned, be the same in both-then we say that Sir Anthony Carlisle has been hardly treated for mistaking a case of delirium tremens or traumaticum for one of mental derangement. The great ground of complaint against Sir A. has been the order to remove the patient from the ward of an hospital to an asylum. Now we confess that we do not see clearly the justice of this complaint. We conceive that, during the existence of the delirium or mental aberration, no place can be worse, either for the patient himself, or the other inmates of the institution, than the ward of an hospital. The room, or even the dark cell of an asylum is infinitely preferable during the temporary insanity. We allude only to the diagnosis of delirium tremens and temporary mental derangement, in this case. If the medical officer was guilty of negligence in his duty, the charge should have been placed on its proper basis, and no side wind ought to have been taken advantage of, to bring forward an accusation of ignorance.

SOME CASES BY DR. BEemner.

CASE OF INTROSUSCEPTIO CURED BY FORCING AIR INTO THE INTESTINES. JAMES THOMPSON, æt. 44, of a rather spare habit of body, but in the general enjoyment of good health, was suddenly taken ill with pain in his bowels, about ten o'clock in the evening of the 25th Nov. last. He took some spirits, warm drinks, bathed his feet in warm water, and applied warm fomentations to the belly, thinking the pain would wear off. It continued to increase however, and I saw him on the morning of the 26th. I found him labouring under the following symptoms. Pulse full and not particularly hurried-tongue clean-face anxious-belly not distended, and partially relieved by severe but equitable pressure. No alvine discharge since 4 P. M. the preceding day—pain about the umbilicus most excruciating-not steady, but at intervals of from three to four minutes, accompanied by severe vomiting and great thirst. I immediately ordered a purgative glyster, which came off almost immediately, bringing with it the contents of the rectum without abating the pain. I ordered its repetition-part returned the same as thrown up, and part remained; but the violent pain still continued. I then applied a blister over the whole surface of the abdomen, and gave him a powerful opiate; after an hour this settled the vomiting, and in some degree dulled the pain. I then gave him s. m. hyd. gr. xii. and left him. Twelve hours after the pain and vomiting had returned as violently as ever-still no pain on pressure. I then endeavoured to open the bowels by throwing up as much warm water by the domestic machine as I possibly could; he complained of straitness, and part of the water returned without any effect-I then repeated the calomel and left him. On the morning of the 27th, the calomel had proved useless, and the vomiting and pain were as violent as ever; thirst severe, and perspiration profuse. On pressing the belly pain was now felt in the region of the caput cæcum. It now was evident that unless he was speedily relieved death must ensue. I again attempted to overcome the obstruction by throwing up about a gallon of warm water until it was forced back and a considerable part discharged without the least relief. Having some little time ago seen the injection of air suggested in cases similar (I think in a recent Number of the MedicoChirurgical Review, although I cannot lay my hand on it just now), I determined to try it. Having nothing at hand but a common bellows, I inserted the tube into the rectum, and commenced gradually to force up the cold air. As soon as it found its way into the intestines, the patient said he felt somewhat easier, and I persevered until I could force no more. In a second or two the rarified air was forced back with great violence bringing with it the remaining portion of the water I injected, but nothing more. He said he felt rather easier and urged its repetition. This I did for other two different times with no appearance of relief. On the fourth trial, however, the room was filled with a most fetid smell and a very free discharge of fæculent matter-he felt relieved, the vomiting ceased, and he complained only of general soreness. I now gave him 8 grs. of cal. with one grain p. opii, and left him. That evening he had an alvine discharge, and on the following morning he got ol. ricini, 3j. which operated freely in the course of the day, and the cure was complete.

Whether the foregoing case was real introsusceptio or not I am not prepared to say, but I am sure of this, that, had I not succeeded by the forcing up of air into the intestines, there were no other means that I am aware of whereby I had the least chance to save the poor fellow. I have given the case at this length, as I conceive the plan pursued worthy the attention of the profession in similar cases. It would be absurd to draw a conclusion from a single case, but from what occurred to me in this instance, the practice appears to be perfectly harmless, since the moment the air became rarified it came off with great force, and left no disagreeable consequence behind.

POST MORTEM EXAMINATION OF A CASE OF DROPSY.

Mrs. Rac, æt. 68, applied to me about the end of Nov. last; she complained of difficulty of breathing. I found her emaciated-pale-pulse weak-tongue dry and morbidly red-urine scanty-belly swelled and tense-fluctuation distinctly felt. She had been married, had several abortions, but never bore a child at the full period. As the swelling of the abdomen was not sufficient to account for the great difficulty of breathing, on examination I had every reason to think there was water in the chest; from this and her general broken down state of health, I did not consider myself justifiable in drawing off the water, but ordered a few of the pil hyd. with a mixture of squills and digit. and made her drink freely of the sup. tart. pot. in gruel without any beneficial effects-she expired on the 2d Dec.. On laying open the chest the right lung appeared healthy, with scarcely any water in that pleural cavity. The left lung was greatly diminished in volume, the cavity being completely filled with urine. The heart and aorta were healthy, with scarcely any water in the pericardium. The abdominal cavity was completely filled with serum, but not particularly distended. The abdominal viscera generally presented nothing peculiar from ordinary cases of dropsy, but those on the pelvis were one mass of disease. The bladder was much enlarged, and adhered in the greater part of its posterior surface to the left ovary, which was distended much in the form of a pear, the upper portion pointing towards the umbilicus, its diameter at the middle was nearly four inches, and its long diameter about six and a half. To its posterior surface in its whole extent the rectum firmly adhered, and was with difficulty dissected off. On laying the tumor open, it proved to be a complete cyst filled with serum, and the bottom of this cyst was a congeries of smaller ones, varying from the size of a pin's head to that of a pea, presenting the appearance of a half-expanded cauliflower. The uterus was so contracted and embedded in the mass that it was with difficulty distinguished. The right ovary was about the size of a walnut, much of the same shape and filled with a soft substance exactly resembling brown paint. The bladder contained a good many loose particles of sand, some of considerable size, and more than two-thirds of its whole extent were covered with a calcareous deposit, not in lines or in one particular place, but in patches, varying in size from an eighth to two inches in diameter. When these patches were taken out, the scalpel would not pass through them, and they broke over like a piece of mica; when touched on a yielding surface by a metallic body they gave a sensation like that the sound does in striking a stone. The woman to my knowledge never had a symptom of calculus, or complained of any disease of the urinary organs.

In this case, there were many loose particles of sand, and those of sufficient size, had they passed into the urethra in an awkward manner, to have called attention to the bladder, and had the sound been used a stone would have been indicated. Had an operation been undertaken, no knife would have passed through the neck of the bladder had it been considered necessary to cut that part, as it was completely surrounded by calcareous deposit. But independent of this it is possible that, in similar states of the bladder, an operation might be undertaken, and still no stone there. The only thing valuable in this case is the extent of the deposit and its disposition, which may direct the attention of others to diseases of a similar nature.

Huntly, N. B. Dec. 5, 1838.

JAMES BEEMNER, M.D.