change to another, a tertian become a quotidian, and the reverse; but there is reason to believe, that, when an intermittent becomes remittent, it is to be attributed to some alteration in the condition of some of the viscera. This opinion is confirmed by the effect of remedies given for the cure of it. I have seen cases of tic douloureux, originally intermittent, which had become remittent, and again assumed the former type; in some, after an emetic and brisk purging; in others, after a free use of calomel, sufficient to affect the system." 155.

If, when the disease has become remittent, the medicines which had proved useful in its intermittent state be persisted in, especially bark and quinine, harm will result. Deobstruents and evacuants must be employed until the visceral engorgement be subdued, after which the anti-periodic may be usefully resumed, occasionally interposing a purgative.

Sedatives.-Employed usually on their introduction into practice as the principal means of cure, these are now looked upon only as valuable auxiliaries, not to be needlessly engaged, and to be dismissed on the earliest safe opportunity. Dr. Hunt states the extract of belladonna to be one of the most valuable, a full dose being a grain, which he has never repeated oftener than for three-hourly doses, two of these ordinarily giving relief. It is well known that, in these cases of excessive pain, full doses alone are of use, so that almost incipient poisonous effects have to be produced before relief is obtained.

"That large doses are necessary to produce these effects, and do not cause any of the dangerous symptoms sometimes to be anticipated from them, may be thus explained. The state of the system on which the pain depends, has either the power of resisting the action of these medicines, or a certain amount of their power is expended in bringing the nervous system to its normal state, and until that is effected, the usual symptoms of their action will not be developed; that, however, being effected, a small additional quantity will produce the symptoms above alluded to; which will clearly indicate that the required quantity has been administered, and that relief will soon be afforded, or must not be expected from them." 161.

The author prefers giving a full ordinary dose, very frequently, to administering a very large one at once, or gradually increasing a small one. Thus the sedative may be given every two, or even every one, hours, with far more safety than in one of the other modes, and with more certainty than in the other. When relief has been effectually obtained, the medicine should be suspended, and a smaller dose will in future suffice to keep the pain in check. A third or half a grain of belladonna may be continued two or three times a day, with a larger one at night, in proportion to the degree of pain and irritability which may remain. As the case improves, the medicine must be still further diminished, and the patient instructed so to take it as to anticipate the paroxysm, when possible.

Sedatives are most useful in the cases of genuine neuralgic habit, where irritability and debility predominate; and in such they must be continued, in small doses, even after the pain has been subdued, gradually diminishing these, and replacing them by invigorating measures, as the improved condition of the symptoms permit. They are very useful, given just before the menstrual periods, in neuralgia, arising from menorrhagia and other uterine disorders. When there is morbid sensibility of the intestinal mucous membrane, although sometimes useful, in small doses

combined with ipecacuanha, or hydr. cum creta, yet, in most cases, they are hurtful. When the urine is pale, copious, and of low specific gravity, they may usually be given with advantage. In a congested condition of the abdominal viscera they do much harm, until, at least, these have been unloaded by purgation, &c.

Sesqui-oxyde of Iron.-This is a valuable medicine in the anæmic condition, and occasionally in other cases dependent upon no obvious cause. It would seem to cure by giving tone to the system, thus economising the predisposition arising from debility; and is, therefore, sometimes advisable, in cases where the pain has already been relieved by arsenic, sedatives, &c. in order to aid in rendering the cure more permanent.

The immensely large doses in which it has been given, are useless or prejudicial, and it usually requires to be continued for several weeks before benefit is derived from its employment.

Arsenic. Dr. Hunt places great confidence in the beneficial effects of this medicine in properly selected cases, when it is judiciously administered.

"Arsenic operates most favourably on persons who are of lax fibre, accompanied by a languid state of the circulation, and whose secretions are rather profuse than otherwise; the urine pale and plentiful, and more especially on those whose skin is cold and moist. In persons of this description, whilst arsenic, to an extent far beyond other medicine, relieves the neuralgic pain, it improves the general health, and gives firmness and vigour to the constitution.

"I do not mean to assert, that arsenic invariably disagrees with persons of an opposite condition of the system; but when the urine is of a deep colour, and scantily secreted, or when it deposits the lithate of ammonia; the tongue loaded, especially if the tip or edges of it are red; arsenic almost invariably disagrees, and aggravates the pain. But as this morbid state of the system frequently depends on, or is complicated with, disorder of some important viscus, arsenic will often agree, and relieve the neuralgic pain, after the visceral disorder has been removed by appropriate remedies.

"Between these extreme states of the system, there are many shades of difference, which require modifications both in the general treatment, and in the use of arsenic: which it would be needless, were it possible, to describe." 174.

Arsenic is peculiarly indicated in neuralgia from malaria, the neuralgic habit, and in that form which arises from morbid sensibility of the stomach or uterus. It is usually hurtful when the cause of the pain arises from spinal diseases, anæmia, local disease, or injury of the nerves and an engorged condition of the abdominal viscera.

When the bowels have been thoroughly cleared out it may be given in doses of four minims of the liquor three times a day, and in some cases only in two minim doses. A minim to be added daily, until the peculiar effects of the medicine begin to shew themselves, when the dose should not be further augmented, and the medicine employed for a few days longer, and then suspended, to be again resumed, in the small doses, if the pain recurs. The disagreeable effects it produces on the skin, stomach, &c. must not be excited to a great extent, and the medicine can seldom be used for a long period without occasional suspension. Where

the liquor has failed, the arsenic in substance, rubbed down with a little black pepper, and carefully divided, has, in doses of or often succeeded in relieving the disease.

of a grain,

Dr. Hunt considers that the danger arising from an accumulation of arsenic in the system has been exaggerated. The condition of the urine often alone indicates the propriety of suspending it.

"I have often observed, that one of the earliest indications of its operation is the change in the state of the urine. The urine is less plentifully secreted, becomes more acid, and of a deeper colour; and precipitates, if the medicine be continued for any length of time, the lithate of ammonia. Should no other indication be manifested after arsenic has been given for some time, and in pretty large doses, the use of it should always be suspended, when this alteration of the urine is perceived.”

Local Remedies.-Upon these the author places little reliance, although employing them occasionally as means of relieving the pain. Their operation is uncertain, arising, in some measure, as he observes, from the different condition of the nerve, at the seat of pain, where they are applied, as regards tenderness, heat, &c. The aconitine, one grain to the ounce, produces a temporary palsy of the nerve, but the pain returns when this effect has subsided. Belladonna, either alone, or combined with ung. picis and creosote, or a poultice of linseed meal and bruised stramonium seeds, have been found also temporarily useful. Veratria the author has never found so, even when employed in the proportion of ten grains to the ounce.

In conclusion, Dr. Hunt, remarks, that he is well aware there are other causes of these neuralgic affections besides those he has alluded to, but which from their obscure nature too often defy successful investigation. In the mean time, we can only correct every apparent disorder of the system; and by diligently observing the various phenomena endeavour to obtain a clue to their origin and successful treatment. Our object should be not only to examine into the various exciting causes of the disease, which have been now alluded to, but to endeavour to discover the nature of the constitutional peculiarity upon which their influence depends; from among the vast number of persons who are subjected to them, only a small proportion, owing to the operation of such peculiarity, become afflicted with neuralgia. So, in treating the case, the ostensible relief of the affection is not sufficient; and we must, by amended habits of life, judicious diet, and persevering attention to a variety of apparently minute circumstances, strive to eradicate the delicacy of frame or other peculiarity in which the disease seems primarily to originate; and, in proportion as we succeed in our efforts, will the security against relapse be obtained.

The work, as we have already observed, is valuable, as containing a correct estimate of the amount of our present knowledge concerning this painful and interesting class of diseases, and indicating the mode by which this can be most effectually augmented. Each division of the subject is illustrated by some very interesting cases. We cordially recommend the

book to our readers.

THE EPIDEMICS OF THE MIDDLE AGES. From the German of J. F. C. Hecker, M.D. Translated by B. G. Babington, M.D. F.R.S., &c. Octavo, pp. 418. London, 1844.

I. THE BLACK DEATH.

THE volume before us is the first publication of the Sydenham Society, and contains three translations from the celebrated Hecker, viz. the "BLACK DEATH"-the "DANCING MANIA"-and the "SWEATING SICKNESS," of the Middle Ages. Those dreadful scourges that have, at longer or shorter intervals, desolated the earth and thinned the ranks of mankind, must always prove highly interesting to the physician and the philosopher; but we are far less sanguine than either Hecker or his Translator, that the most accurate and authentic history of these terrific visitations will ever throw light on their nature and cause-perhaps not even on their treatment. Thus, what do we know of the origin, cause, or nature of cholera, which we have all witnessed a few years ago, more than we knew before the advent of the pestilence? Has the dire experience of that epidemic led us to any successful mode of treatment? It would not be easy to answer these questions in the affirmative. The absurd notions that have prevailed in all countries and in all visitations of this kind, that the wells were poisoned, sprung up, even in this enlightened age, when cholera raged throughout the land! True, there were not so many barbarous sacrifices of human life, at the altars of ignorance and prejudice, as in the days of Thucydides, or in the times of the Black Death;" but still the ridiculous suspicion was harboured by thousands in this country and on the Continent, little more than ten years ago! The talented translator himself seems aware of the mysterious nature of these fearful scourges, and the difficulty of accounting for them on any theory hitherto broached.

"The contagionist and the anti-contagionist may each find ample support for his belief in particular cases; but in the construction of a theory sufficiently comprehensive to explain throughout, the origin and dissemination of universal disease, we shall not only perceive the insufficiency of either doctrine, taken singly, but after admitting the combined influence of both, shall even then find our views too narrow, and be compelled, in our endeavours to explain the facts, to acknowledge the existence of unknown powers, wholly unconnected either with communication by contact or atmospheric contamination."-Preface, xxiv.

We were somewhat amused with our Translator's apology for delaying the publication "till a moment when it is presumed that men's thoughts will be especially directed to the approaching hour of public thanksgiving." Alas! good, pious, and most religious Doctor, if you allude to Christmas or Easter, you are most egregiously mistaken! The elders of your readers will be far more occupied with the thoughts of roast beef, plum-pudding, and "red Port," than with the Black Death" of the Middle Ages:while the younger ones will think a great deal more of balls, concerts, quadrilles, and waltzes, than of the "Dancing Mania" of the Fourteenth

"

Century! If it be EASTER that is alluded to, the steamings to and from Greenwich will leave little time for reflection on the "Sweating Sickness" of our forefathers. But the Translator is too modest. His work will survive many a Christmas and Easter, and be read long after the present generation are in their graves.

THE DISEASE.

The BLACK DEATH appears to have been a real Oriental plague, presenting many of the essential characters exhibited by that malady down to the present day. It desolated Asia, Africa, and Europe in the Fourteenth Century, and swept away a fourth of the population of the Old World in four years, while in England the rate of mortality was double that! The disease was characterised by inflammatory boils and tumors of the glands— black spots on the skin-affections of the head-black tongue and faucesburning thirst, &c. These were the ordinary symptoms, though not always present in the same case. But there were others of a graver dye. The organs of respiration were seized with a putrid inflammation, with violent pain in the chest, while blood of a pestiferous odour was expectorated from the lungs. In the West of Europe the predominating phenomena were, ardent fever, with evacuation of blood, often proving fatal in three days. Carbuncular affections of the lungs frequently destroyed life before buboes had time to come out. It was believed that the effluvia of the breath spread the disease far and near. At Florence it commenced with bleeding at the nose-a most dangerous symptom-then followed buboes and tumors indiscriminately all over the body, with black or blue splotches on the arms, thighs, &c. No medicine appeared to be of any use, and death was generally within three days.

"In England the malady appeared, as at Avignon, with spitting of blood, and with the same fatality, so that the sick who were afflicted either with this symptom or with vomiting of blood, died in some cases immediately, in others within twelve hours, or at the latest, in two days. The inflammatory boils and buboes in the groins and axilla were recognised at once as prognosticating a fatal issue, and those were past all hope of recovery in whom they arose in numbers all over the body. It was not till towards the close of the plague that they ventured to open, by incision, these hard and dry boils, when matter flowed from them in small quantity, and thus, by compelling nature to a critical suppuration, many patients were saved. Every spot which the sick had touched, their breath, their clothes, spread the contagion; and, as in all other places, the attendants and friends who were either blind to their danger or heroically despised it, fell a sacrifice to their sympathy. Even the eyes of the patient were considered as sources of contagion, which had the power of acting at a distance, whether on account of their unwonted lustre or the distortion which they always suffer in plague, or whether in conformity with an ancient notion, according to which the sight was considered as the bearer of a demoniacal enchantment." 7.

Doubtless the Mesmerists will press the "clair-voyance" of the plague patients into their service. The Chronicles report that only one-tenth of the inhabitants of England remained alive!!

The various histories of the various parts of Europe and Asia where the "BLACK DEATH" appeared, leave no doubt that the malady exhibited all the characteristic features of the modern plague. It is hardly necessary to say that the contagious nature of the disease was firmly believed