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20, 30, 10, or 5 parts of lard), night and morning, as one of the best, when used in combination with baths, the patient always sleeping in the same shirt and bed-clothes. The ointment has to be employed for several weeks, and if it is to prove efficacious, a white line will be seen after a while to form around the circumference of the spots, produced by the decoloration of this. In the varieties of psoriasis termed guttata, gyrata, orbicularis, &c., it is from the centre to the circumference that the whiteness and the cure proceed. Alkaline ointments are best formed of carb. soda (from 2 to 8 parts previously dissolved in water to 30 of lard), and will sometimes cure a psoriasis which has resisted tar. Indeed lard will occasionally do this, and should be generally employed for children either alone or feebly medicated. White precipitate (2 to 6 parts to 30 lard), is not unfrequently successful, but it may, if the surface is an extensive one, produce salivation, a result less likely to follow the use of calomel ointment mixed up with a few grains of camphor. Vapour or alkaline baths should be conjointly employed with the above means, the latter being formed with carbonate of soda, to which salt is added, if a tonic, or gelatine if an emollient effect be desired.

In choosing among the various modes detailed several circumstances have to be considered. 1. If the disease is hereditary, whatever treatment we adopt we shall rarely produce a complete result. 2. If the patient possesses a strong constitution, we must not fear employing perturbatory medicines, which would be improper for weakly habits. 3. We must learn the duration of the disease, and whether it is a relapse. If it has never yet been treated, we must use every endeavour to procure a radical cure; but if it has been already treated we must fear its re-appearance, and, for its temporary dissipation in this case the external treatment is especially indicated. 4. Whenever the lepra or psoriasis is of recent origin, especially if occurring in a robust patient, from the internal treatment (arsenical or antimonial) we may expect a radical cure, providing always that the patient afterwards takes as much care as possible of the skin. If the patient is weakly, sickly, or of a bad constitution, we must be content with the external treatment.

In young, delicate, and feeble subjects, the hydrotherapæic method has a corroborant effect. By its aid I have cured cases of very long standing. The patients in general, too, bear it well, and under its use, in spite of the sweating induced, they gain flesh, probably in consequence of the more vigorous appetite that is produced. In most of the cases I have so treated, however, relapses have occurred in the course of a few months; so that it seems to possess no more power of radically curing the disease than the other external measures.-Gazette des Hôpitaux, 1847, Nos. 1, 13, and 22.

OBSERVATIONS UPON ITCH. By M. DEVERGie.

M. Devergie believes that some of the generally-received opinions concerning this disease possess a very insufficient foundation, and, after long and attentive observation in the wide field at his disposal, he has arrived at the following conclusions.

"1. There is a very general opinion prevailing in the world, that the itch is the cause of the skin diseases which may subsequently occur. Without attaching too much importance to this, does it not rest on more or less probable foundations? 2. Although itch is said to be essentially contagious, it may yet frequently arise spontaneously in individuals placed in similar conditions under which it was primarily developed. 3. There is no proof that it has been transmitted from animals to man. 4. When medicines cure the itch, it does not follow that this is by destroying the acarus. The cure of the pustules may be rather said to lead to its death. 5. This insect may just as well be considered

as a morbid product as a cause. 6. The experiments undertaken to show that the contagion is operated by means of the insect, offer insufficient proof of this being the sole means of infection. 7. In the hypothesis of contagion being due solely to the acarus, as the contact of individuals with each other does not always take place in the same manner, we must suppose that the acarus for a certain period crawls over a large portion of the surface of the body to the place of election (the hands and feet), to the neglect of many other portions, which a few days after will be covered with itch-pimples. This regular and simultaneous development is much more likely to be dependent upon a general cause acting upon the entire economy, than upon a local one, arising from an insect transplanted from one individual to another. 8. If the acarus is the cause of the itch-pimple, it seems difficult to understand how it escapes from the central point of the pustule while digging a deeper gallery beyond it, scarcely ever having any communication with another pustule. This fact, which may be daily observed by the naked eye, is much more in harmony with the hypothesis of a morbid generation. 10. There is nothing fixed in the incubation of itch, which is much more in accordance with what takes place in other cutaneous diseases than with the idea of infection by means of an insect. 11. It is in the severest form of itch, the pustular, that we find the fewest acari. This form is cured most easily, and seems the least contagious. 12. It is singular to find the same insect producing three different forms of eruption; and not only are these forms different, but so are their contagious properties and the number of insects found in them. 13. Statistics show us that itch is the most common antecedent of impetigo, lichen, and eczema. 14. The itch may disappear for a greater or shorter period under the influence of a general affection of the economy, and, like the other cutaneous diseases, remain latent, and then re-appear with renewed energy after five or six weeks, without any new infection having taken place." From these corollaries M. Devergie draws the following conclusions:"1. If the acarus is one of the phenomena of itch, its existence as a morbid product is as admissible as an agent of transmission. The known facts agree much better with the former hypothesis than with that which considers the insect as the exclusive agent of transmission and only cause of contagion. If even the acarus, by being transported to another individual, may communicate the disease, the products of secretion, the itchy atmosphere, and the clothes impregnated with this, may also produce it. 2. The principal therapeutical consequence deducible is, that we must treat the itch, and not the acarus, contrary to what is generally the practice. We should treat the disease like other cutaneous affections upon general principles, and not by mere local applications. Indeed, is it not reasonable to take into consideration the two well-marked symptoms, whose sudden suppression is so mischievous in other cutaneous diseases, viz. the itching, become habitual in proportion to the duration of the disease, and the secretion in the pustular form. In the place of searching for means to cure the itch in the shortest possible time, should we not endeavour to do so gradually in proportion to its duration? Should we not, after its cure too, prescribe in some subjects the prolonged use of simple baths, to reduce the morbid sensibility of the skin and re-establish its functions, or even vapour-baths to produce a sedative effect on the nervous system, as well as a depurative cutaneous secre tion, if I may be allowed such an expression? So, in regard to pustular itch, should we not act revulsively upon the intestinal canal by means of purgatives, to compensate for the suppression of secretion over so multiple a surface? This is my practice, and I do not feel disposed to abandon it, because it seems a rational means for the prevention of the ulterior development of other cutaneous diseases, of which I believe itch to be one of the predisposing causes."-Gazette des Hôpitaux, No. 32.

[M. Devergie seems to us, in the above observations, to have raised a very

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important point for consideration. That the doctrine of the exclusive propagation of the itch by the acarus is baseless, we have long been convinced; but we must confess that we have not hitherto viewed the rapid suppression of the disease in any other light than a very desirable circumstance, seeing the great amount of bodily and mental irritation its persistence keeps up. The employment of baths and purgatives, however, after the cure, as recommended by M. Devergie, is a most rational procedure, and one far too much neglected.-Rev.]

A SKETCH OF THE LIFE AND WORKS OF JAMES TOMMASINI, READ BEFORE THE ROYAL INSTITUTE OF VENICE. By Professor GIACOMINI. It is very remarkable, I may say almost marvellous, that among so many justly celebrated men in Italy, so many savants desirous of renown; amidst such a diversity of principles as prevails in our peninsula, it is agreed on all sides, without even excepting his adversaries, that Tommasini may be considered as the foremost, the most experienced, and the most profound clinical observer of our epoch in Italy. The true reason of this general fact is found in the immense services which this great man has been rendering for more than half a century to his art and to society, whether as a professor, a writer, or a practitioner. To him in fact we owe the happy direction which medicine has received throughout Italy from the commencement of this century, the greater part of our best clinical observers having been formed in his school. Elected at an early age to the professorship of physiology and pathology in the University of Parma, he exhibited great intellectual power and practical tact in the first work he published (Critical Lectures in Physiology and Pathology, 1802). Even now we admire in this work deep sagacity, healthy criticism, practical deductions of great importance, and an erudition alike rich and in good taste.

A short time after a wider field of observation presented itself to the investigating spirit of Tommasini. We allude to his clinical labours. This epoch was full of events of the highest import to Italy. Natural philosophy, restored by the labours of Bacon and Galileo, had produced so much embarrassment among the prevailing medical doctrines, that physicians gifted with more than ordinary intelligence, acquired a melancholy scepticism respecting practice. And thus no sooner had Brown's seductive doctrine appeared above the horizon than it was welcomed with avidity, and in a short time medicine in every country was found to be modelled on the views of the Scotch philosopher. Rasori was the first who made known the principles of the new school in Italy, by translating Brown's "Compendium" and he it was who first, towards the end of last century, clinically demonstrated its errors. The Scotch physician had laid it down as a principle that all agents applied to the living tissues exerted upon them a stimulant effect, and that diseases emanated from defective vitality, as was made apparent from the loss of strength which was observed in all diseases. Rasori exposed the errors of this doctrine by proving, as Hippocrates had already established, that the greater number of diseases which lead to death induce in the organism a condition of excess of the vital powers; and demonstrated by "solemn" experiments at Genoa and Milan the law of morbid capacity and the existence of medicinal substances which act positively and directly by depressing the organic forces, and modifying the organism in a manner directly opposed to that of the action of stimuli, and which for this reason he has termed contrastimulants. From these very simple principles, based upon experience, the medical

* Tommasini was born in Parma in 1765, and died there in 1846.

reform operated by the powerful genius of Rasori in Italy, took its origin. This great observer, however, carried away, after the discovery of these fundamental facts, by the whirlwind of political events, was compelled, for a long time, to leave his official post at the hospitals, and live in a kind of obscurity, after having gone through the severest trials during the course of those revolutionary times: so that the primary basis of the medical reform might have remained unimproved, and without a worthy interpreter, if Tommasini, who was the fellow-citizen and fellow-student and rival of Rasori, had not taken possession of them, to develop and confirm them by new experiments, and place them in the full light of day, with all the importance they deserved. Tommasini was in fact the first who exhibited in relief the immense practical consequences which flowed from the new facts discovered by Rasori, and he occupied himself by means of numerous observations upon a great number of medicinal substances and diseases, in proving their reality. He has in this way really enriched Italian medicine with a great number of novel facts, which have thrown the greatest light upon its practice, and led our physicians upon a way of investigation entirely different to that which they had hitherto followed; and this assemblage of facts has constituted so compact and immoveable a phalanx, that he has been able, since its accumu lation, to defy his adversaries with impunity, and to resist, with a brilliant success, all the attacks which the advocates of retrograde opinions have incessantly directed against him.

Consequently it is to Tommasini, beyond all others, that we owe the new reform in Italian medicine-a reform which has continued progressive from its commencement, and which is incessantly extending itself in the medicine of all countries in which practitioners take for their guide true experience and the precepts of natural philosophy. The entire proof of the truth of what I advance is to be found in the numerous works themselves of our illustrious countryman. It will suffice if I refer to those most directly bearing upon my subject; and it will be easy for me to prove, that the new facts with which he has enriched science, have influenced the practice of our art among all civilized nations, not excluding even that of his own adversaries, who have adopted them, masked under a different phraseology. We may first refer to his experiments and observations upon various remedies, especially digitalis, commenced in 1804. Any one reading these, and the long and varied discussions they gave rise to on the part of his celebrated adversaries, will find wherewith to become edified upon the subject of experimenting and the true logical method of drawing deductions from experiment. He will see that the experience which every one invokes with a sort of ostentation, I may say to a tiresome extent, in support of his own opinions, is itself, in the absence of philosophy and criticism, the first source of error. At the present day, when time has pronounced its verdict upon the famous question which cost Tommasini and his adversaries so much pains and labour, viz., whether digitalis exerts upon the economy a stimulant or sedative effect, we feel astonished that so evident a fact as the contra-stimulant of power this drug should have had so much difficulty in making its way. And yet the fact in relation to the action of digitalis, which is now generally recognized, is no less evident in respect to a crowd of other contra-stimulant remedies, concerning which observations, just as numerous and conclusive exist―observations which the obstinacy of some adversaries persists in neglecting, substituting with a desperate constancy preconceived opinions to the material facts which alone should be invoked in questions of this nature.

In the middle of the polemics which overturned Brownism in Italy, Tommasini published his monumental work, Pathological Researches on the Fever of Livorno, the Yellow Fever, and other analogous Diseases, 1805. In this were discussed and resolved the most important questions in relation to fever, and the true pathology of gastric and bilious fevers, and the doctrine of the diffusion of local inflammations established. He therein, too, signalized the true material condition of

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continuous fever, and liberated for the first time the numerous family of fevers from the empire of the abstraction and the essential nature. He demonstrated that the phlogistic process was always the same in its forms and consequences, in its acute as in its chronic progress, and he laid down general precepts, which have become inviolable practical laws in Italy, for the exact appreciation of diseases in clinical practice-precepts which recal to mind those contained in the works of Hippocrates, of which Boerhaave said Quo plus evolvo eo ditior in "prari fio !

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The various works published subsequently by Tommasini are but amplifications, based upon a much more extensive practical experience, of the principles expounded in his "Researches"; so that we must refer to the epoch of that work, and of that published upon the Genoa epidemic in 1799 by Rasori, the commencement of the great reform in Italian medicine-a reform really based upon Hippocratic principles, or in conformity with these principles and with those of experimental philosophy which the doctrines of Brown had caused to be completely forgotten in Europe. This work of Tommasini's went through a great number of editions in a short time, and was translated into several languages; and I must here advert to a fact of importance as regards the history of the medicine of our times. While this work was in the hands of all our practitioners and justly appreciated by them, the celebrated Broussais was then with the French armies in Italy, and sojourned for a long period with us. turning to France, this illustrious physician published, in 1808, his first work on the History of the Chronic Phlegmasia. This work is but the echo and copy of the doctrines of Tommasini concerning chronic inflammations and the nature of gastric fever and of fever in general; with this sole difference, that while the great Italian physician placed the seat of fever, according to the symptoms, in a phlogosis of this or that viscus, and frequently even in a diffuse inflammation of the entire sanguineous system, the celebrated Frenchman located it exclusively in the gastro-intestinal canal. Broussais could not be ignorant of the opinions of Tommasini upon this subject, nor have omitted the careful study of his works; and the just reclamations which were raised in Italy upon the appearance of his work, obliged him to offer an explanation in his Annales de Medicine Physiologique." "He acknowledged his acquaintance with the works of Tommasini while in Italy, and admitted that he had been preceded by him both in his researches and his conclusions. In the mean time French pathology (not so therapeutics, for unfortunately Broussais had not availed himself of the studies of the Italian school upon medicinal substances, but retained all the old aberrations of Brown respecting these) received from the labours of Broussais a vigorous impulse. This physician created for himself an European reputation, and his sarcastic language in the end obliged his very adversaries to change their principles. And strange to say, Broussais, who had only borrowed his pathological principles from Tommasini, acquired partisans in Italy among the very persons who had rejected the conclusions of Tommasini!

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In all the various works of Tommasini, whose titles even I cannot enumerate, there will be found pervading each page a judicious and practical spirit, founded upon the works of Hippocrates, full of sagacity and wisdom, enlightened by a prodigious erudition, and enlightened by that probity and love of truth so delightful to find in men of science. We can, therefore, in no-wise feel astonished that, as a practitioner, a writer, or a savant, he has always been considered, both in Italy and elsewhere, as the true patriarch of Italian medicine, just as he was really its regenerator. In his clinical histories published in so many of the Italian journals, he was most especially careful in the relation of unfortunate cases, accompanying them with considerations and warnings of great practical interest, and concluding with valuable remarks upon the causes which had led him or might lead into either error or doubt as to accurate diagnosis or treatment. It was in these cases that his enlightened circumspection and great prac

NEW SERIES, NO. XI.—VI.

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