an observation of the effect of remedies, it has often produced an injurious reaction on the subsequent treatment, as may be observed even in the case of Sydenham himself. It is fortunate that the great body of practitioners has seldom allowed itself to be influenced by hypotheses in its treatment of disease, such influence having been usually confined to their speculative originators and a few zealous followers. Not only do hypotheses exert an ill effect upon the practice of medicine, but they impede its scientific advance, precisely as did the false philosophy impede the march of physical science. Nevertheless the use of theory or hypotheses need not be utterly exploded, provided it be received as mere conjecture and not as an element of science. "One of the finest modern instances that I have met with, of the legitimate and admissible use of hypothesis and of the exact appreciation and estimate of its true function and position, is to be found in Dr. Holland's remarks' On the hypothesis of insect life, as a cause of disease.'”

The various "medical doctrines" as Methodism, Cullenism, Brownism, Broussaism, are briefly adverted to and condemned: but the coup de grace is inflicted upon hypothesis in an examination of Homœopathy, the claims, of which to the rank of a system, Dr. Bartlett maintains, are equal to any of these, as far as legitimate foundation is concerned, although they have been more mixed up with charlatanism. The author's compatriots are treated with no gentler hand than the European speculators, for we have a chapter devoted to the exposure of the errors of Rush-ism, Cooke-ism, Gallup-ism, and Thomson-ism.

We must extract his remarks upon Broussais. After observing, that pre-occupation by hypothesis disqualifies the mind for accurate observation, he goes on to say :

"I have just mentioned Broussais; and I may add, that nowhere can a more striking exemplification of the influence of which I am speaking, be found, than in the history of his mind. His two great works are the History of Chronic Inflammations, and the Examination of Medical Doctrines. The former is almost entirely a work of pure observation. The clear-headed, sagacious observer, shines out in every one of its pages: they are all luminous with practical wisdom. I am sure that no man at all capable of appreciating it, can read this book, especially the first parts of it, treating of diseases of the lung and pleura, without feeling, that it proceeded from a mind of extraordinary capacity and strength; and without entire reliance on the accuracy and good faith of the author, as an observer. What precision and positiveness in his diagnosis! What enlarged, but cautious comprehensiveness in his general conclusions! What honesty and frankness in his admission of the frequent impotency of medical art! What admirable tact and discrimination in his selection and use of remedial measures! How clear and sound the philosophy which illumines and binds all this together! How true his appreciation of the emptiness and worthlessness of theoretical speculations; equal almost to that of Newton and Davy!

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* But in his Examination of Medical Doctrines, all this is far otherwise. Broussais had now become an à priori medical philosopher: he had framed a creed of rationalism: he had established a new doctrine of his own he was the acknowledged chief of a new party: a single dominant idea had taken possession of his mind. In this work, as in the other, the traces of his great genius are still evident. His greatness he could not put off, if he would but the scientific rectitude of his mind is no longer present the clearness. of his vision has become obscured: the acute and circumspect observer of dis

eases, and their relationships, indifferent as to the result of his investigations, provided only, that this result was the expression of the actual truth, is now the interested seeker for certain particular phenomena, which he wishes to find; the upright and impartial judge has become the ex parte advocate and witness. And, as generally happens in similar circumstances, not only is his mind perverted by the influences of a false philosophy, but his passions are excited by the controversies which grow out of it. His arrogance and dogmatism are as offensive as his criticisms of those who refuse to follow him are injurious and unjust. The exigencies of his own creed led him into inconsistencies, and his contradictions of himself are as direct and flagrant, as they are humiliating. He has himself become an illustration of the reasonableness and propriety of one of his own sayings:- I hold it as a principle always to suspect the experience of a man whose mind is pre-occupied.' He remarks of Lord Bacon, that he often sacrificed at the altar of one of the idols which he had overthrown. And he too, it may be more truly said, redoubtable iconoclast as he is, has set up as false an idol as any which he has broken: and declared a vindictive and uncompromising warfare against all who refuse to fall down before it. And such are the natural, and almost inevitable results of a belief in any of those à priori systems." 210.

Classification of Diseases.-The author thus states his proposition upon this subject. "Diseases, like all other objects of natural history, are susceptible of classification and arrangement, which will be natural and perfect, just in proportion to the number, the importance, and the degree of the similarities and the dissimilarities between the diseases themselves." The funda mental error which vitiates all existing classifications is, that they are founded upon the examination and comparison of only certain particular and limited portions of the phenomena and relationships. Generally certain striking symptoms of the disease are selected, omitting others often equally essential, and leaving unnoticed the morbid processes and alterations, which constitute the very diseases themselves. Additional impediments have arisen from the belief that the arrangement of diseases is capable of being as fixed and absolute as that of objects of physical science, thus producing a completely artificial system; and from the imperfect knowledge of the nature of many of them which prevailed at the period when these nosologies were constructed. The author proposes a more natural system, in which large classes of diseases may arrange themselves, according to their affinities, more or less nearly around certain centres, occupied by "typespecies.'

"One of the best and purest examples, one of the most perfect models, of such a family, is to be found in the exanthematous fevers. They constitute what may be called the type family, amongst these groups. Occupying the central region of this group, we find small-por, cow-pox, chicken-por, measles, and scarlet fever, bound closely together, by numerous and very intimate affinities. They are all marked by the presence of that general morbid condition, designated by the term fever; they are characterized, each of them, by the presence of a peculiar cutaneous eruption; they are all self-limited, in duration; they pass through a regular series of processes, or changes, constituting so many distinct periods or stages; each of these diseases is capable of propagating itself, by means of a specific poison, or contagious principle; and finally, they rarely affect the system more than once. At distances, farther and farther removed from this central position, we shall find the disease called roseola, nettle-rash, erysipelas, plague, malignant pustule, and perhaps some others. These latter possess several of the characters, which belong to the former, but not all of

them; and, as the affinities between them and the type species become fewer and feebler, they gradually recede from the central region which these occupy." 230.

Illustrations of similar arrangements into families are brought forward in fevers, inflammations, neuroses, &c.: the object of the author not being to frame a nosology, but to suggest the principles upon which it should be constructed. Of Definitions he says :

"Although an adequate definition of a group, or family may be given in a few words, this is not often the case with a species, or a single member of one of these families. Such a definition must include all the important and more constant phenomena and relationships of the disease. It must be a clear and comprehensive enumeration of its elements. The omission of any one of these elements renders the definition, so far, inadequate, and defective."

It

After devoting a chapter to the consideration of the relations of the chemical and vital forces, in which he endeavours to place some curb upon the hastier generalizations of Liebig, the author terminates his work with a review of the future prospects of medical science. He considers that the direction the medical mind has taken during the last quarter of a century, holds out cheering prospects of future progress in the right direction. is true that improvements in the treatment of disease have not, during the above-mentioned period, proceeded pari passu with our improved knowledge of the nature of disease; for the study of therapeutical relations is far more difficult and complex than that of the pathology and diagnosis of disease, and is perfected later than these, which are thus necessary preliminaries. Yet even the treatment of disease has made great advances, and will make yet greater, by reason of the great perfection of accurate diagnosis that has been arrived at. It is a matter of congratulation, too, that the employ. ment of heroic remedies has become so moderated, and that a proper trust in the restorative powers of Nature is beginning to be felt. The axiom of Chomel that to do good is only the second law of therapeutics, the first being not to do harm, is fast making its way among us.

In estimating to whom will be due the future advancement of practical medicine, the author takes a brief review of the present position of medical science in France, Britain, and the United States. France he considers as justly entitled to the honor of having established the modern school of medical observation, with its minute analysis of morbid phenomena, and rejection of à priori reasonings. The works of Prost, Broussais, Corvisart, Laennec, Serres, Rostan, Lallemand, Rayer, Martinet, Chomel, Andral, Louis, and a host of other celebrated names, present a galaxy, of which that country may well be proud.

"Since the time of Hippocrates, there has not appeared in any age, or country, a series of cotemporaneous publications, upon similar subjects. at all equal to these in extent, variety, and positive value. There is hardly an important point in pathology upon which they have not shed new light-there is hardly a disease, the diagnosis of which they have not rendered easier and more certain, than it formerly was, while in many cases we are wholly indebted to them for our means of diagnosis: and they have added not a little to the exactitude of our knowledge in regard to some therapeutical processes."

The British school of observation commenced with Sydenham, and has undergone little change, having but slighly participated in the great continental movement of our times.

"This school has been marked by some of the strongest and best qualities of the British character-sagacity, shrewdness, and sound common sense. It has been regularly progressive since the time of Sydenham, and has accumulated a vast amount of most excellent practical knowledge. Its therapeutical resources have been more various and extensive, than those of its continental rival; and, if it has done less for the advancement of medicine as a science, it can hardly be doubted, I think, that it has accomplished more, as a useful and beneficent art. The principal defects of the British School are its want of comprehensiveness, of rigorous and positive conclusions, and the habit of mixing up, with its observations, reasonings and interpretations altogether hypothetical in their character; and then of regarding these reasonings as more important, more valuable, more essential, to the constitution of science, than the observations upon which they are founded."

Dr. Bartlett admits, however, that these blemishes are not universal, and are in course of disappearing, and states that, although our modern medical observers have been too slow in adopting the rigorous numerical method of Louis (to whom he dedicates his work with a just eulogium,) several of an older date pursued inquiry by means no less exact, as Percival, William Brown, of Edinburgh, Woolcombe, John Cheyne, &c.

The medical mind in the United States seems to partake of the characters of that of both Britain and France. Prior to the publication of Bichat's General Anatomy, medical opinions were almost exclusively derived from Britain, and nearly every English work of importance has been re-published and extensively read.

"The last 15 years, however, have witnessed a great change in this respect. While our medical relations with Britain are still, as they will always continue to be, numerous and intimate, they are altogether less exclusive than formerly; and they are now probably inferior, in interest, influence, and importance, to those which exist between us and France. Our young men have almost ceased to visit the British capitals, in order to complete their education; and the number of those who have repaired to Paris, for this purpose, for many years past, has been very much greater than has ever been the case with Edinburgh and London. The leading works of Louis were earlier and more widely circulated in this country than in Britain; and the principles of his school and method have taken deeper root here, than there." 306.

We believe the author has somewhat exaggerated both the amount of evil which the indulgence in hypothesis has exerted upon the progress of medical science, and the actual extent of its present influence in practice, especially the latter. So too, as before mentioned, he appears to us to misapprehend or confuse the ordinary acceptation of the process of reasoning by induction; and hence to seem in hostility with a mode of procedure he is really not only not adverse to, but an eloquent and able advocate in favour of. However this may be, we cordially recommend his work to the notice of our readers, as one of the highest utility in its general tendencies.

AN APOLOGY FOR THE NERVES, OR, THEIR INFLUENCE AND IMPORTANCE IN HEALTH AND DISEASE. By Sir George Lefevre, M.D., late Physician of the British Embassy at the Court of St. Petersburgh, &c., &c., &c. 8vo. pp. 363. London, Longman and Co. 1844.

THE Travelling Physician," now that he is established amongst us, seems resolved to write himself into public notice; and, were he to take a little more trouble in the arrangement and connection of his works, he would bid fair, we think, to attain considerable success in this way. He evidently possesses a good many of the qualities that are necessary for a popular medical writer. He has a lively and quick perception, a considerable fund of agreeable information, and an alert and active mind, that is ever on the search for whatever bears on his subject. With light and nimble wing, he skims the surface of a variety of topics; never rudely brushing his feathers against any impediment in his way, nor encountering, save in the most peaceful collision, another brother of the quill.

The great defect of the present work is the utter want of unity or me. thod in its execution. The imp of confusion seems to have been perched on the pen of the author, whenever he took it into his hand; and we might even fancy that it had more than once maliciously displaced the pages of the manuscript, when the knight had left his sanctum to repose. At the end of a chapter, the reader will not unfrequently find himself in uncertainty whether he understands the drift or meaning of his author's reflections; nay, the thought may arise in his mind, has the author himself quite formed his opinion on the subject which he has undertaken to discuss?

There is moreover so much irrelevant matter introduced, and the various topics, that are brought under consideration, are held together by so flimsy a thread of connection, that we have often exclaimed in silence to ourselves, what has all this to do with an Apology for the Nerves?" But, when we call to mind the motto of the work, Without a nervous system there is no animal, there can be none; without a circulating one there are myriads-a dogma, by the bye, the truth of which is merely asserted, and by no means proved-we perceived the train of our author's reasoning that whatever appertains, whether in health or in disease, to a living animal body, must have some relation or another with the nerves. Sir George shews his good judgment in never introducing the appellation of his work into the discussion of any of the topics which it treats of. The reader thus forgets the professed object of the volume; and, as he passes over its pages, may naturally suppose that he has got hold of some "Leaves out of a Physician's Scrap-book," or "Random Sketches in Medicine," dashed off with a free and easy pen to amuse a passing hour. That Sir George is capable of something of a higher cast than he has yet essayed, we have no doubt. He has been an observant man of the world; and there is no want of tact or cleverness about him in distinguishing truth from error, and in applying his knowledge to practice. He is ever the courteous