cases, as it still adds to the good effects of the alteratives, provided there is an evident tightness of the pulse, even when the skin is below the healthy standard. In such cases it is best combined with some warm medicine, as tinct. orange peel, or comp. tinct. cardamoms.

Generally, in those cases where the surface is inclined to be cold, depression of strength and spirits Occurs. Here warm medicines are strongly indicated, and the use of ammonia in considerable doses is very beneficial, and interferes but little with the alterative effect of the nitrate. If the nitrate, as it does occasionally, produces a chilling effect, and this cannot be counteracted by any suitable stimulant, its use must be abandoned. In some cases, from idiosyncrasy, even very small doses of this remedy cannot be borne; this is the case sometimes with all salts, into which potash enters as an ingredient. Five or six grains is a small dose; it should, however, never be given in such doses as to increase the sense of depression. The good effects of this medicine are increased by adding a small quantity of mucilage of gum arabic, and a slight anodyne. From 6 to 12 minims of tr. hyoscyamus, or a combination of two or three drops of laudanum, with four or five of vin. ipecac. Dr. P. has found the best. Indigestion lays the foundation of most of the diseases of infancy; the duration of the first stage is very various; the symptoms of the second stage showing themselves at various periods in different cases. In children, they supervene very early, and the disease in them often appears to commence in the liver rather than

"It

the stomach, the latter suffering secondarily, which is the reverse of what occurs in the adult. is the early supervention of the second stage which renders saline medicines so essential in their diseases," and if the disease has progressed considerably in them, no course of mercurials will succeed without the aid of this description of remedies. Dr. P. has found the nit. pot. invaluable in most of their diseases. Their nerves and vessels are more irritable than those of the adult. On this account, in them the advanced stages of indigestion more readily supervene, and are attended with more fever. Continued irritation of the digestive organs, which produces tightness of the pulse in the adult, often with a tendency to increased heat, produces in children actual fever.

Of this nature is the, so called, remitting fever of children, which is prone to end in effusion on the brain, "the part most liable to suffer from general irritation, kept up by a deranged state of the digestive organs. For once that hydrocephalus of children arises from other causes, it arises twenty times from affections of these organs."

Of Tartarized Antimony.--It is proper in many of those cases in which nit. pot. is so beneficial, but it is possessed of different properties. From some experiments of Dr. P., published in the last volume of College Transactions, it appears that of all the means employed, tartarized antimony was most efficient in suddenly exciting the action of the skin. It has little effect in exciting sensible perspiration. But these experiments tend to show, that "it is not by sensible per

spiration, but by a free state of the insensible action of the skin, that its vigor is indicated."

From the foregoing observations respecting the state of the skin in indigestion, we are prepared to appreciate the good effects of this medicine in protracted cases. Many of Dr. P.'s patients have told him they could always secure a good day, by exciting sensible perspiration in the morning.

This, however, should not be our aim, though it is more favorable than the arid state of the dyspeptic's skin. When the surface is dry, and the feverish tendency considerable, and we have reason to infer that the disease is supported by the state of the secreting surfaces, the tartarized antimony is often of great value; and Dr. P. observes, "I was agreeably disappointed to find that doses so minute as neither to excite nausea, nor any increased sense of debility, are often sufficient to produce a sensible improvement." Nausea, if slight, is of little importance, and seldom impairs the appetite. If this remedy appears to increase the sense of sinking, it should be laid aside. The dose employed is from the tenth to the eighth of a grain, three or four times a day.

Dr. P. has never seen any bad effects from such doses, even when used for months, and the patient has frequently requested to resume it, missing its good effects. It is serviceable to combine it with nit. potassæ, when the febrile tendency is great. In those cases where there is a determination of blood to the head, owing to the dry skin and debilitated state of the excretories, it has been found to be productive

of the greatest benefit. Even in the early periods of the disease, much advantage is frequently derived from combining small doses of tart. ant. with cathartics; it renders their action more free. It may sometimes very advantageously be substituted for mercury, and often be combined with it, to render less of the latter necessary.

"The operation of colchicum is in many respects analogous to that of antimony." Dr. P. has often used it in the advanced stages of indigestion, for the purpose of relaxing the skin, and softening the pulse, in very minute doses.

It often has a peculiar effect in relieving the local inflammatory affections, which are apt to supervene in protracted cases, "particularly those of the head and chest, and rheumatic pains of the muscles." We shall, however, be disappointed in this effect before evacuations, though it acts like a charm after them. Dr. P. uses it in very small doses to relax the pulse and excretories; in rather larger ones to re-lieve cough and pain, always lessening the dose if it resulted in more than a gentle action of the bowels, or decided softness of the skin.

In the second stage of indigestion, much depends on gentle treatment. "All powerful means, which are necessarily transitory, because they would soon destroy the patient if they were continued, fail to cure, and very often aggravate it. From a comparison of the effects of colchicum and antimony, keeping in view the foregoing observation, it appears that the former is on the whole less suited to the second stage than the antimony. Tartarized

antimony has a remarkable effect in severe nervous agitation, and Dr. P. has found larger doses than the above stated, combined with moderate doses of hyoscyamus by far the most efficient means of allaying the more severe forms of nervous irritation, which occasionally appear in protracted cases of indigestion.

Of Ammonia. The effects of this remedy in certain states of indigestion are of great value, and cannot be produced by any other means. In some cases with the contracted pulse attending the second stage, the vital fluids seem to leave the surface, which is obstinately cold. The pulse is always very feeble, and the patient complains of great depression, hangs over the fire, and exercise fails to warm him. "The temperature measured by the thermometer is actually, and some times considerably below that of health." Here the ammonia is of striking advantage, as it is "less apt than any other stimulus of the same power with respect to the nerves, to excite the heart and bloodvessels."

The carb. ammonia may be taken in from five to ten grain doses several times a day, with safety, and seldom fails in proper doses, in connection with exercise, to diffuse warmth throughout the frame. This remedy is also of value in most of the nervous affections which accompany indigestion, if the patient is not particularly chilly, "provided the nerves are so far languid in the function of preserving temperature as to allow of its being taken in considerable quantity, without heating too much, an inconvenience which attends the free use of it in most cases of the second

stage of the disease." The liquor ammoniæ acetatis is eminently serviceable in this stage, when the ammonia itself could not be borne, owing to its heating too much. Our author, in some just observations enforcing the adaptation of our treatment to the peculiarities of the case, without placing implicit reliance on general rules, states that there are cases of the second stage, "in which an abstinence from animal food is proper;" these are, however, rare. "But when the pulse is obstinately tight, abstaining from it two days in the week, I have sometimes found to produce an effect which it is impossible to procure by any other means." The patient feels himself almost immediately more at ease, bowels less irritable, more obedient to medicine, skin softer, countenance improved, and ammonia, and other stimulants, better borne.

Some brief but interesting observations respecting the influence of habitual indigestion on other diseases, close the book, which we are under the necessity of passing by without further comment, as this review has already exceeded the limits originally contemplated.

From the N. A. Med. and Surg. Journal.

ELEMENTARY SYSTEM OF PHY

SIOLOGY.

An Elementary System of Physiology. By JOHN BOSTOCK, M.D. London, 1826, pp. 643, 8vo. Vol. 2d.

DR. BOSTOCK has been long so advantageously known by his various contributions to physiological science, that we have no occasion to conciliate the good will of our readers to this great achievement in this valuable department of knowledge. To read

is to admire the skill, candor, and industry, which have been combined to produce a body of physiology, suited to the present enlightened period of the world; and containing, as well, a succinct and lucid detail of the physiological histories, and theories, of times long gone by, as a fair exposition of the opposite sentiments which are still held by different parties, and the stubborn facts which all parties equally concur in admitting to be demonstrated.

We have taken up the 2d volume in this article, not only because we could not possibly comprise, in a short space, any useful view of the immense variety of details, scattered through more than 1000 pages, full of knowledge and wisdom; but also, because the first has been before our brethren since 1824, and has even been republished in Boston, so that it could be obtained by those who desired to have it.

The value of the present volume is, in respect to the execution, at least equal to the former, and so far as it depends on the numerous references, and notes, superior; for these are more full, and more numerous. With regard to the topics, we do not conceive that they can be so engaging as those of the former volume, in which the sentiments of the most distinguished medical philosophers, on contractility, sensibility, and the circulation of the blood, are portrayed with masterly skill, and ability; these being, perhaps, the great foundations on which all physiological superstructure must necessarily be raised.

The present volume commences with chapter VII, on Respiration, and proceeds to treat in chapter VIII, of Animal Tem

perature; IX, of Secretion; X, of Digestion; and XI, of Absorption; which closes the volume; soon, we are promised, to be succeeded by a third.

The author commences with an account of the mechanism of respiration, and gives a description of the trachea, with its ramifications; the pulmonary system of bloodvessels and the diaphragm. The mechanical act of respiration consists essentially in flattening the arch of the diaphragm ; for, the slight increase of capacity which the thorax could acquire by raising up the ribs, can be of very little importance in the act. He supposes, therefore, that the function of the intercostal muscles, which has been so much discussed, consists in fixing the ribs firmly, so that they may not be drawn downwards by the action of the diaphragm. We would beg leave to object to this explanation of Dr. Bostock, that the diaphragm, being inserted into the lower rim of the bony thorax, could have no tendency to draw the ribs downwards. Suppose the axis of the chest to pass through the centre of the diaphragm, it is evident that the direction of the contractile efforts is upwards, and would strike the axis, where it perforates the muscles, at various angles of from 25 to 40 degrees. We see not then how it could draw the ribs downwards, unless the concavity were reversed, or made to look upwards.

The lungs are every where in contact with the cavity containing them; whence it follows, that when the capacity of the thorax is increased by flattening the diaphragm, the air in the lungs must become rarified, and a portion of

The author examines very fully the question, what is the bulk of air taken in by an ordinary respiration, and furnishes us with the statements and reasonings of Borelli, Jurin, Goodwyn, and Menzies, and fixes the average quantity, after Goodwyn, at about 40 cubic inches, though he notices the discrepant results obtained by Davy, 13 cubic inches, and Messrs. Allen and Pepys, who found that 16 were commonly taken in by the persons they employed in their experiments. But though 40 cubic inches be the measure of an ordinary inspiration, it is by no means the measure of -the quantity of air contained in the thorax. Dr. Bostock found from experiments performed on himself and others, that 160, or 170 cubic inches of air can be expelled, after an ordinary expiration has already taken place; so that 200, or 210 cubic inches, may be considered as the difference between the states of ordinary inspiration, and of forced, or extraordinary expiration. No act of expiration, however powerful, can completely empty the lungs, and the probability is, that at least 120 cubic inches remain, after the most complete act of

expiration, even the last, or that which takes place at death.

He sums up the whole of this subject, at p. 34, as follows. Assuming 170 cubic inches as the quantity which may be forcibly expelled, and that 120 will still be left, we have 290 as the measure of the quiescent lungs. Add to this 40, the amount of a natural inspiration, and we have 330 cubic inches of air, as the capacity of the lungs in their distended state. Oneeighth may be changed by each respiratory act, or 4000 times their bulk may be expelled in 24 hours. The whole quantity of air respired in 24 hours, is about 666 cubic inches, equal to 1,152,000 cubic inches.

The next subject is a curious. one, which was proposed by Wm. Harvey for the consideration of his contemporaries. What is the cause of the first inspiration? A child born at the seventh month of uterogestation will breathe as soon as it is born, but cannot live an hour afterwards without breathing. Why is it under the necessity of breathing always, after having once respired; since it might have continued to live and grow, for two months, if the first act of respiration had not been performed? Notice is taken of the answers of Whytt, Haller, and Darwin; yet Dr. Bostock thinks it may be doubted, whether we are in possession of any data, which will enable us to explain the difficulty. He suggests, however, the state of compression exercised in the uterus on the surface of the child's body, and its position which prevents the descent of the diaphragm and the rise of the ribs; but when these circumstances are changed after birth, air rushes down the tra