take place in such a posture, there may be some difficulty in restoring the circulation; whereas, if it occur in the upright posture, the patient immediately recovers by laying him horizontal. Carditis. This important disease occupies about three-quarters of a page. There is no allusion to metastasis-to the stethoscope-to percussion-to effusion into the pericardium-nor to any of the sounds emitted during inflammation of the heart and its membranes. Neither is there mention of calomel and opium as auxiliaries to other means! The disease is to be treated as pneumonia. Epilepsy. In this opprobrium medici there is no mention of nitrate or oxide of silver. Oxyd of zinc is the favourite remedy of Hufeland. Chorea is treated in the same way, and purgatives are overlooked. We need not continue to point out farther the peculiarities of German practice. They differ from the practice and opinions of these isles, in almost every disease. The general character, however, of continental therapeutics is inefficiency, as compared with ours. We are ready to admit that, in many cases, the inertness of German therapeutics, and the medicine expectante of France, are safer measures than the heroic practice of "Young England," as regards bleeding, purging, and mercury. But, in many other cases, precious time is lost which cannot afterwards be regained. Although there is a good deal of what we might term unnecessary minuteness in Hufeland's volume, the work contains a vast deal of accurate and important observations, which even the old practitioner may peruse with advantage, and the young refer to as a hand-book or inexhaustible magazine of valuable materials. THERAPEUTIQUE APPLIQUÉE, OU TRAITEMENTS SPECIAUX DE LA PLUPART DES MALADIES CHRONIQUES. Par P. J. C. Debreyne. 2me. Edition, pp. 332. Baillière, 1844. THIS is really a very useful and instructive work. It contains the results of our author's experience, over a period of nearly thirty years, in a variety of those chronic diseases which are of most frequent occurrence. Dr. Debreyne is evidently a shrewd and practical observer; he has learned to think and reason for himself; and seems to have had, throughout his professional life, a marked aversion for all the nosological theories which have occupied so largely the attention of most of his countrymen during the present century. See, how he treats the chiefs of philosophical () medicine: "The Pinel-ists, the organicians, the anatomo-pathologists, the Broussais-ians, the statisticians, the numerists have, all, by the exclusiveness of their particular doctrines and views, stood in the way of, and materially retarded the advance of sound therapeutic knowledge. Now, however, that the system of universal irritation and of a materialist physiologism has fallen to pieces, a new era has happily opened up to our view, and Hippocratic vitalism has re-appeared amongst us in all its primitive splendour. The reign of anatomism, that is to say of necropsies and facts and figures, has nearly come to an end; and medical men now long for something more tangible and more applicable to the every-day duties of a professional life; in other words, they wish to have pointed out to them useful rules of treatment and rational means of cure, instead of endless catalogues of statistic tables and of post-mortem examinations." Dr. D. is professor of practical medicine to the establishment of Grande-Trappe (Orne), and seems to have reared a number of pupils, who have contributed, for some years past, not a little to disseminate his peculiar doctrines and modes of treatment in different districts of France. He is moreover, the author of several treatises-on Physiology, Hygiene, Moral Theology in its relations with Medicine, of which we gave a short notice in the last number of this Review. However much we may feel inclined to dissent from him on several points of practice, we have been decidedly pleased with the general tone of the present work, which appears to be a faithful record of discriminating observation of disease at the bed-side of his patients. There is nowhere any parade of learned phrases; no darkening of knowledge with a multitude of words; no wearisome and most profitless description of very common cases; no heaping together of other men's opinions and doings, with a hesitating announcement of his own. Instead of this, we have a plain unvarnished tale of what the author has seen and found in practice; and all this explained in as few words as possible. In fine, this book is thoroughly and essentially a practical one -a somewhat uncommon feature, by the bye, of a French medical work in the present day. Its motto is experire: our readers cannot do better than accept the challenge and judge for themselves. The diseases, which pass under review, are arranged in three divisions -Neuroses or Neuropathies; Chronic Phlegmasiæ; and Astheniæ. We begin with a short notice of Epilepsy. The remedy, which Dr. D. has found by far the most successful in the treatment of this disease when it is idiopathic, and there are no symptoms of existing cerebral congestion, is the extract of Belladonna. He gives it in the form of pill; beginning with about one or two grains per diem at first, and gradually raising the dose to four or five grains, prɔvided no affection of the sight or any other intoxicating symptom is induced. In some cases, he conjoins with advantage the use of a decoction or infusion of Valerian. But neither this latter remedy, nor yet the oxyde of Zinc, nor the nitrate of Silver-although all of them have been found occasionally useful-can be trusted to alone. In general, the more frequent the paroxysms are, the more hopeful we may be of making an impression on the disease: it is when two or more months intervene between each attack, that this Neurosis is usually most obstinate and intractable. In such cases, the Belladonna should be administered for a week or two before the expected invasion. When this is preceded by a distinct aura Epileptica, a strong dose of Ammonia will sometimes serve to ward off the attack: the patient therefore will do well to carry a small phial of the volatile alkali in his pocket. In some cases, the paroxysms of Epilepsy may be arrested for several months by the use of the Belladonna ; but nevertheless they ultimately return almost as frequently as ever, in spite of the prolonged continuance of the remedy. It is under such circumstances as these that the decoction of Valerian root, or of Orange leaves, should be exhibited at the same time. Dr. Debreyne does not conceal the fact that several writers have recorded their opinion that his favourite remedy has utterly failed in their practice. He mentions particularly a report by M. Picard of 22 cases that were treated with it by M. Ferrus, in the Bicetre Hospital, in 1837. He attributes its failure in these cases-in part at least-to the injudicious manner in which the extract was given; the doses being far too large, and carried to such an extent as to prove rather poisonous than sanative. This is certainly not the way to give a fair trial to the remedy. Our author remarks that, if in symptomatic Epilepsy, after the removal of the exciting cause, the paroxysms continue from a sort of nervous habitude, they will be best obviated by the Belladonna; and, in the event of this failing, by the use of Quinine and Valerian.' Hysteria. The following formula is very highly lauded by Dr. D. in the treatment of this too common disorder. RP. Camphoræ P. Assafoetidæ 3ss. 3ss. Div. 9j. Mix and divide into 120 pills; commence with two at first per diem, and gradually increase the dose to six in the 24 hours; they should always be taken before food. Occasionally a wine glassful of the infusion of Valerian or Orange leaves may be given with much advantage along with each dose of the pills. Dr. D. is in the habit of administering them also for the cure of general or partial nervous Trembling, and of Chorea. Sometimes he exhibits, in the latter disease, the Belladonna by itself; and, he says, very generally with success. When it fails, he has recourse to cold bathing. No allusion is made to the use of Steel in the treatment of this complaint by our author; an omission that seems the more strange, as we shall afterwards find that he is so partial to ferruginous medicines in the treatment of many diseases of debility. According to our opinion, the remedy for Chorea is the carbonate or sesqui-oxyde of Iron, especially when administered in any bitter infusion. Neuralgia." For the last fifteen years, we have been in the habit of using with the greatest success, in all the forms of neuralgia,-Sciatica excepted-the Belladonna as an external application. Our favourite formula is this: A portion of this ointment, as big as a hazel-nut, is to be well rubbed upon the affected part two or three times a day, or whenever the paroxysms of pain are severe. The rubbing should be continued for eight or ten minutes at a time, until the ointment is quite absorbed by the skin: a little saliva may be added every now and then to promote the absorption. Let it be remembered that the use of this ointment should be at once suspended, if the sight becomes very sensibly affected, or any unpleasant cephalic symptoms supervene. In very obstinate cases, Dr. D. conjoins the internal administration of the extract of Belladonna or Opium with the use of the above pommade; but in the majority of instances, this is unnecessary, as the pain will very generally yield to the outward application. We employ it, he says, specially against facial neuralgias and other local painful affections of a nervous character, the Megrim, &c. In one very severe case of Neuralgia, which had lasted for nearly twenty years, and which had resisted our author's quasi-specific pommade, as well as a score or two of other approved remedies, the pain, which was seated in the skin, over the lower left ribs, at length yielded to the application of the Vienna Caustic paste, so as to produce a pretty large eschar upon the affected part. With respect to the treatment of Sciatica-which, as we have seen, Dr. D. separates, in a therapeutic point of view, from the other forms of Neuralgia -his usual plan is first of all to order the application of several volant blisters along the course of the affected nerve; and, if these do not quickly succeed in relieving the pain, to have recourse to his terebinthinate mixture, which is only a modification of that recommended first by Professor Recamier, and subsequently by Dr. Martinet. The formula is this: B. Aquæ lactucæ Olei volat. terebinth. The dose, a large table-spoonful, in a glassful of rice-water, three times a day, upon an empty stomach. Dr. Debreyne recommends at the same time the external application of an embrocation-composed of Spirits of Turpentine, Ammonia, Camphorated Spirits of Wine, and melted lard,with which the affected parts are to be vigorously rubbed night and morning. In still more intractable cases, he has recourse to the use of moxas, applied over the seat of the chief pain; the best point generally for their application is immediately behind the great trochanter. In conclusion, he frankly admits that the use of his favourite Belladonna ointment is seldom efficacious for the relief of Sciatica. Paraplegia and Local Palsy.-" Before we were acquainted," says Dr. Debreyne," with the special action of Nux Vomica on the spinal-marrow, we were in the habit of trusting almost entirely to the use of moxas, applied over the lumbar or sacral vertebræ, for the cure of Paraplegia. But, for the last twenty years, we have invariably commenced our treatment of this disease with the alcoholic extract of the Nux Vomica, exhibited in the form of pills, each containing one grain of the extract." He begins with one, and gradually increases the dose until six-two at three different times-be taken in the course of the twenty-four hours. Whenever the patient experiences cramps and spasmodic twitches or tetaniform rigidity. in the limbs, the action of the medicine must be narrowly watched; and it will be prudent either to diminish the dose, or even to suspend its use altogether, if these symptoms become excessive. The object should be to keep up the nervous excitement in a moderate and safe degree for a con siderable space of time. If after a month or two's use of the Vomica, no decided benefit is obtained, Dr. D. advises the application of one or more moxas over the lumbar region. He very properly cautions his readers not to expect the same benefit from the use of the Nux Vomica in the Hemiplegic, as in the Paraplegic, forms of Palsy. It may, indeed, prove serviceable in some cases of the latter, where there is every reason to suppose that the sanguineous coagulum within the cerebral substance has been nearly or altogether absorbed; but in no case of this description should we be sanguine of doing much good. For the cure of Amaurosis, our author relies chiefly on the repeated application of small blisters in the neighbourhood of the affected eye, first on the temple and then over the eyebrow. In obstinate cases, the blistered surface should be sprinkled with a powder composed of starch and strychnine-about a fifth of a grain may be used at first, to be gradually increased. When this treatment fails, a seton should be tried. Dr. D. has used with very decided success a collyrium, containing some extract of Belladonna, in a good many cases of day blindness or Nyctalopia. He also mentions a simple remedy for nervous Deafness, which may deserve notice. Let the patient fill his mouth with the smoke of Tobacco, or of any other dry aromatic plant-Sage, for example—and then make a forced expiration, while the mouth and nostrils are closed: this should be done several times in the course of the day. The smoke enters the Eustachian tube, and thus produces a slight stimulant effect upon the internal ear. The remedy can do no harm; and this is saying a good deal in its favour, considering the nature of many of the means of acoustic medication. It is best suited to those cases where the deafness has supervened on some catarrhal complaint, and whenever we have reason to believe that the pharyngeal end of the Eustachian tube has become thickened or obstructed. Asthma." For the last twenty-five years we have seldom prescribed any other formula but the following: --- To be divided into 90 powders, of which one is to be taken three times a day." Our author assures us that he has witnessed excellent effects from this remedy, not only in asthma, but also in a variety of chronic pectoral affections, when they are unaccompanied with fever or inflammatory irritation; as, for example, in what has been called Catarrhal Phthisis, and so forth. To allay the cough in such complaints, he combines the use of the Iceland moss jelly with the anti-asthmatic powders. When these fail— which, according to his report, is not often the case-he advises a trial of the Stramonium inhalation, and also of a strong infusion of the Camphrée of Montpelier (Camphorasma Monspeliaca)-with the medicinal virtues of which our author was first made acquainted by a writer in the Revue Medicale for March 1821. During the paroxysms of asthmatic dyspnea, |