with this part of his work; and he has displayed an unusual share of learning and acuteness in tracing its progress, as it, from time to time, became known under a variety of ap pellations, in all the different parts of Europe, during the last three centuries. We have some reason for supposing that it was observed by Aretæus, Acetius, and Aricenna: but the first unequivocal account is by Ingrassin, a Neapolitan, who wrote in the beginning of the 16th century. It appears that the term rubeola was originally applied to scarlatina, and that morbilli was the name given to the measles. During the 16th and 17th centuries, it occurred in almost every part of Europe, frequently committing the most dreadful ravages. It was called by a variety of names; and very different opinions were entertained respecting its nature, and its relation to other diseases. Morton was the first English writer who distinctly described it, but he imagined it to be only a variety of the measles. The term scarlatina seems to have been first applied to it by Sibbald. Even until the middle of the 18th century. it still continued to be very imperfectly understood; and while by some writers it was regarded as only a variety of the measles, others supposed that the different varieties were each distinct diseases. This opinion was adopted by Dr. Fothergill; whose treatise, published about the middle of the last century, contributed very largely to diffuse a more general knowlege of the complaint. As far as we are able to ascertain, Dr. Clark of Newcastle was the first writer who distinctly described the three varieties, and yet considered them as only species of the same disease; an opinion which was afterward decidedly embraced by Dr.Withering, and, in consequence of the authority of his name, has been since very generally admitted.

After the history of this disease, we proceed to the method of treating it.The scarlatina simplex requires little medical aid. The scarlatina anginosa was formerly treated on the antiphlogistic plan, but this is now very generally given up by the English practitioners. Emetics, which were first brought into notice by Dr. Withering, form a principal part of the remedies; to which Dr. Willan, from his own experience, and that of Dr. Stanger, adds the oxymuriatic acid. Blisters are generally allowed to be inapplicable. We regret to learn that the affusion of cold water is only beginning to be employed in London. From the account given of its effects in the "Medical Reports," we should conceive it to be a more important remedy in scarlatina than in typhus itself. In the scarlatina maligna, bleeding, blisters, and purging, are highly injurious; and on the continent, where they are still employed, they are productive of the worst effects. Dr. Fothergill first pointed

out

out their fatal tendency, and recommended a totally opposite method of cure. It does not appear, however, that bark has been able to maintain its reputation in other hands; so that we may question whether the benefit supposed to be derived from it, when introduced by Dr. Fothergill, ought not to be referred to the omission of the former treatment. Dr. Withering thought that this medicine was improper, and Dr. Currie coincided with him.

Dr. Willan concludes with some remarks on the method of avoiding the contagion of this disease, and preventing its diffusion through a family in which it has commenced its influence. This caution is the more necessary, since it has been ascertained by experience that the mildest case of scarlatina simplex may propagate the disease in its most malignant form.

ART. VI. A Treatise on the Process employed by Nature in suppressing the Hemorrhage from divided and punctured Arteries; and on the Use of the Ligature; concluding with Observations on secondary Hemorr hage: the whole deduced from an extensive Series of Experiments, and illustrated by 15 Fiates. By J. F.D. Jones, M.D. &c. Svo. pp. 250. 1cs. 6d. Boards. R. Phillips, &c.

A

METHOD of stopping the flow of blood, which issues from divided or punctured arteries, must necessarily have been one of the earliest objects to which the attention of surgeons would be directed. When wounds were inflicted in battle, this circumstance claimed the immediate notice of the practitioner; and when it was accomplished, he considered himself as having executed all that his art required of him. In the operations that were performed by the antients, the difficulty of stopping the hemorrhage was the point which gave them the most serious alarm; and which, in consequence of their imperfect knowlege on the subject, actually proved fatal to a large number of their patients. We find indeed that, in all periods down to the present time, the different means which have been proposed for arresting the flow of blood have always been received with a degree of eagerness, which proves that they were regarded as the most valuable acquisitions to the art of surgery. The practice of the present day is, no doubt, much superior to that of former times: but it must be confessed that we are yet far from having arrived at absolute certainty, or at that point of perfection which renders all farther inquiry un-. necessary. The most eminent surgeons still differ both in the directions which they prescribe on this subject, and in the immediate object which they expect to accomplish; and we have still to lament that the success of some of our most scientific

operations is too frequently counteracted by the bursting out of vessels, the slipping of ligatures, or some other occurrence of a similar nature. The experiments related in the treatise before us are, we think, calculated to remove a great part of this uncertainty; because they clearly point out the means which are employed by nature in restraining hemorrhage, and consequently shew us the best method of directing the efforts of art.

After a short account of the structure of arteries, Dr. Jones undertakes to examine the experiments and hypotheses of those who have preceded him in his inquiry. It was not until nearly the middle of the last century that this subject became a question of scientific investigation, when M. Petit directed his attention to it; and, from some observations which he made, he concluded that the hemorrhage was stopped by the formation of a coagulum of blood, at the mouth of the divided artery. This opinion, which is to a certain extent well founded, met with a number of opponents, each of whom proposed his rival hypothesis. M. Morand thought that the blood was repressed by the contraction of the artery; M. Pouteau, by the swelling of the cellular substance around the vessel; the English surgeons seem in general to have acquiesced in the opinion of M. Morand; while, in Scotland, Mr. John Bell, as far as we are able to develop his meaning, appears to coincide with that of M Pouteau. To the whole, or the greatest part of these hypotheses, Dr. Jones allows a certain degree of merit; they seem in general to have been deduced from actual observation, but they are all defective in being too limited: they exclusively direct the attention to one of the changes which take place, while in reality the effect is produced by the co-operation of several. Another defect in them was that, although the framers of them professed to ascertain the operations of nature, they made their observations on cases in which art had interfered; and instead of. watching the process in its earliest stages, they did not make their examination until after a considerable length of time, when the parts had undergone a complete change of structure and appearance. These objections are altogether avoided in the experiments performed by Dr. Jones, which indeed seem to have been conducted in the most unexceptionable manner.

The first series here related are intended to illustrate the process which nature employs when the vessel is completely divided. Dr. Jones's operations were performed on horses and dogs; the parts were left in the natural state, and were examined at different periods after the flow of blood had ceased. Nineteen experiments were made, and their results appear to be faithfully related and exhibited in a series of well executed

and

and expressive plates. The inference, fairly deducible from the experiments, is that different circumstances co-operate to produce the effect, and that these may be divided into temporary and permanent; the temporary, consisting of the retraction and contraction of the artery, and the formation of a coagulum at its mouth; the permanent, of the inflammation and consolidation of its extremity, by an effusion of coagulable lymph within its canal, between its tunics, and in the cellular substance surrounding it. After some time the coagula, and the other newly formed substances, having fulfilled their necessary office, are absorbed; and the vessel being no longer pervious to the blood, its cavity becomes obliterated, and its condensed tunics assume a ligamentous appearance.-Having in this manner endeavoured to establish his own idea of the process by which hemorrhage is repressed, the author proceeds to examine, with some minuteness, the facts that have been stated by physiologists who have supported different hytheses; and he fairly shews that, when duly estimated, they are decidedly in his favor, although they were brought forwards with a different object.

Dr. Jones next enters on the 2d branch of his subject; viz. respecting the natural means by which hemorrhage is suppressed from arteries that are punctured, or only partially divided. The first remarkable circumstance which engages our attention is the difficulty with which aneurism seems to be produced in horses and dogs, which were again the poor animals destined for experiment. Instead of this occurrence, the author found that, when the puncture was of small dimensions, it completely healed, and the artery continued pervious; and when of more considerable size, either the vessel became obstructed, or it was intirely divided by the ulcerative process. We are therefore obliged to suppose that there is something different in the structure of the arteries of these animals and those of the human subject; or that the state of rest, in which they were kept, prevented the dilatation of the vessel. In operations on the human subject, it will be more prudent not to expect so favourable a termination; after having tied the artery above and below the wounded part, it is proper to cut it entirely across.

The process which takes place when the artery is punctured seems to be, first, the formation of a coagulum of blood between the artery and its sheath, which serves as a temporary restraint; afterward, a portion of lymph is poured from the part surrounding the lips of the wound, which unites to the coagulum, secures the part from the access of the air, and after some time completely consolidates it.

A third object which the author proposed for inquiry, and hot the least interesting or important, is the effect produced by the application of the ligature. Dr. Jones found by experiment that, if a ligature be affixed round an artery, and then removed, although the circulation is immediately restored through the vessel, so that it appears to have undergone no change, yet, after a certain space of time, the vessel becomes completely impervious. This effect, as it appears, is produced in consequence of the ligature dividing the internal and middle coats of the artery, and thus inducing the inflammatory action in them, attended with the exudation of a quantity of coagulable lymph; an effect which was pointed out to Dr. Jones by Mr. Thomson of Edinburgh. We must, however, remark that we do not perceive, in the work before us, any absolute proof of the fact; and the subsequent inflammation of the coats might certainly have been caused by their having been merely bruized or wounded. It is said that this effect of the ligature was originally noticed by M. Dessault; and we regret that Dr.Jones has not given any reference to that author's works. On the subject of the ligature we have a number of experiments related, which display the same accuracy and discrimi nation that we have before so highly commended; and from which the writer conceives himself warranted in drawing these conclusions:

The effects of tying an artery properly appear then to be the following:

1°. To cut through the internal and middle coats of the artery; and to bring the wounded surfaces into perfect apposition.

2o. To occasion a determination of blood on the collateral branches.

3°. To allow of the formation of a coagulum of blood just within the artery, provided a collateral branch is not very near the ligature.

4. To excite inflammation on the internal and middle coats of the artery by having cut them through, and consequently, to give rise to an effusion of lymph, by which the wounded surfaces are united, and the canal is rendered impervious: to produce a simultaneous inflammation on the corresponding external surface of the artery, by which it becomes very much thickened with effused lymph; and at the same time from the exposure and inevitable wounding of the surrounding parts, to occasion inflammation in them, and an effusion of lymph, which covers the artery, and forms the surface of the wound.

5°. To produce ulceration in the part of the artery around which the ligature is immediately applied, viz. its external coat.

6. To produce indirectly a complete obliteration, not only of the canal of the artery, but even of the artery itself to the collateral branches on both sides of the part which has been-tied.

REV. APRIL, 1807.