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taken up with a review of the writings of Bichat, Pinel, Broussais, and one or two other writers; and then there is such an unmerciful repetition, on many occasions, upon the same subject, that the reader often feels indignant at his patience being so unnecessarily taxed.

Another prominent feature of this Nosography is the ever-renewed and almost ceaseless attempt to reduce all diseases to a very few simple types; whose existence, it is alleged, may very generally be discovered by the physician versed in all the exact knowledge of modern times, and the discovery of which is supposed to lead with an almost inevitable precision to a course of successful treatment. The author's grand aim and object are, as he often tells us, to establish unity and a sort of mathematical precision and exactitude in medical practice. Diseases are, in his view, so many entities, that have very generally certain steady characters, and that may be made subject to certain curative and therapeutic rules, which it is the object of the philosophic physician to discover. We shall find, as we proceed, that he talks of an almost unerring certainty in the cure of some maladies, by following a particular line of treatment. He goes further than Bichat, who anticipated that the time might come when the diagnosis of diseases would be so rigorously accurate as to entitle medicine, in one respect at least, to take its place among the exact sciences. M. Bouillaud would extend this remark to the department of therapeutics. He seems, indeed, to regard the human body as an engineer regards any piece of finely-adjusted machinery, which is every now and then subject to casualties and injuries; but these may generally be rectified by the skill of the wise and cunning workman. No allowance is ever made for the influence of the mind and feelings on the corporeal tenement, or of those subtle and mysterious agencies, atmospheric and terrestrial, of which we know so little except from their morbific effects. He is essentially a Materialist in all that pertains to pathology. Hence his inordinate confidence in what he considers the proper line of treatment, and his contemptuous disparagement of all who trust much to the vix medicatrix naturæ. The reader might often believe, from the unwavering nature of his author's assertions, that medicine was almost a perfect science; and yet, a few pages further on, he discovers a lamentation over the utter uncertainty that still prevails on the nature of some of the most wide-spread maladies. At one time, the fancy strikes him that, if there could only be a M. Bouillaud in every region of the world, the whole troop of acute diseases might be chassé from the surface of the earth, or at least brought under the dominion of science, and the clear light of unerring truth would be spread over every spot in the wide domain of medical inquiry. At another, he finds himself with his author plunged in the most perplexing darkness and confusion.

But it is time to proceed to an examination of the specific contents of the work before us; and we shall begin with the beginning. The first volume opens in these words :

"Medicine is unquestionably in the first order of those sciences which, in modern times, have undergone that fundamental transformation invoked by the illustrious Chancellor Lord Bacon. It is indeed a magnificent spectacle for the philosophic observer to contemplate how, under the supreme empire of the law of progression, the sciences in general, and medicine in particular, accomplish,

in spite of obstacles that are constantly springing up, the great work of their evolution. It would be too long to review all the successive stages through which the science of diseases has passed before arriving at the new era, that is to say, at the era of precision and exactitude. We must content ourselves with some rapid observations upon this very important subject.

"It is proper to render justice to the labours and discoveries of medical antiquity, and we should, without doubt, ever respect the almost divine name of Hippocrates, and bow before the lofty and vast genius of Galen. But our respect and admiration for the ancients must not, in any way, approach to idolatry, and hinder us from rendering justice to the moderns. Thus, then, without forgetting to honour past ages, let us also dare to praise the grand epoch in which we live, the true golden age of medicine and of the other natural sciences. To propose for our imitation, in the present day, the Hippocratic school of medicine, is about as reasonable as if we proposed for our model in physics and chemistry, the physics and the chemistry of Epicurus, Aristotle, or of Thales. The human mind does not thus move backwards, and our modern Hippocratists are at least twenty centuries behind their age! Who does not see, at the first glance, that Medicine as long as she was deprived of the light supplied by post-mortem examinations, and unacquainted with the exact methods of investigation derived from the study of physics and chemistry-could be little else, if I may use the expression, than a scientific abortion bereft of every sense? Now this was very nearly the sad condition of ancient medicine!"

Without even so much as alluding to the writings of any medical men between the age of the Greeks and Romans and the commencement of last century, M. Bouillaud then with rapid wing comes down to the period when Morgagni "erected the first great monument to the new science of medicine," by the publication of his admirable work De Sedibus, &c. But it is to his own immortal country that belongs, we are told, the glory of having established the new school; and it is, our author thinks, a circumstance worthy of notice that this medical regeneration was effected "at nearly the same period at which, working for the benefit of the whole world, she (France) gave birth to a political revolution, which all future ages will remember with gratitude, and without which every sort of scientific progress must have been deprived of the liberty necessary for its fulfilment." Forthwith, we are favoured with a long analytic review of the labours of Pinel, and more particularly of those of Bichat-" he who with an eagle's flight traversed, in the course of a few years, the entire field of medical research, and, like an Alexander of a new stamp, achieved the conquest of the whole scientific world,"—and are then brought down to the time of Broussais, of whom our author has ever been a most ardent disciple. The subsequent career of medical science is thus portrayed :

"From the time when the doctrines of Broussais were predominant, medicine has steadily continued the course of its discoveries, and has been acquiring a continually increasing character of precision and exactitude. Favoured by happy circumstances, this science, thanks to the labours of men whose names will be cited in the course of this Nosography, has, during the last twenty years, made more real progress than she had ever accomplished in the same space of time, and the conquests, with which she has enriched herself, have been achieved in all the divisions which compose her vast empire. Medical philosophy has been systematized (formulée.) The old methods of observation and research have been perfected, at the same time that new ones have been invented. By the united help of all these means, and above all, by the clear light of the (properly called) accurate methods, physical and chemical, Medicine in our days has suc

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ceeded in discovering a good many diseases, hitherto overlooked, and it has, at the same time, more accurately determined the nature and true character of the greater part of those which were already known."

M. Bouillaud proceeds to detail some decisive conquests which he has achieved himself, within the last fifteen years, by following in the steps of his great teacher; he alludes more particularly to the discovery of the frequent existence of Endocarditis in Rheumatism; of the blowing and other peculiar sounds in the arteries when the blood is poor and watery, as in Anæmia, Chlorosis, &c.; and of the new formula for extinguishing inflammation by bleeding coup-sur-coup, &c. His grand object, he goes on to inform us, is to establish unity in medical doctrines, as it exists in those physical sciences which have attained the highest degree of exactitude. "This great work once accomplished, there will henceforth be no more merely routine medicine, and our science shall then have its code, like that of jurisprudence." He seems full of ardent hope upon this subject, being strongly impressed with the idea that the department of the diag nosis of diseases has already been brought to a truly marvellous degree of exactness, and that, when we have once discovered their natural seat, we can scarcely have any difficulty in employing the appropriate means for their cure. Something has gone wrong with the machine. Find out the seat of the mischief at once; be prompt and vigorous in applying the proper remedy; and, in the course of a day or two, all will be right as before. He over and over again appeals to the astonishing success which has attended his practice for the last twelve or fifteen years; and, upon this ground alone, he utterly rejects the idea adopted by some recent writers (Louis among the number) that the duration and mortality of diseases are often but little affected by the line of treatment that is pursued. Need we say that he is any thing but favourable to the expectant mode of treatment under almost any circumstances? If an enemy be in the camp, why not expel him at once, if you have the means? all delay but serves to make his expulsion the more difficult.

In the treatment of Inflammatory Diseases, he does not hesitate to affirm that his favourite plan of bleeding coup-sur-coup is omnipotent (toutepuissante) for their cure, reducing their mortality almost to zero! He illustrates his peculiar doctrines by the following comparison, that is, it must be confessed, more lively than convincing :—

"Therapeutics is, at the bottom, an art which approaches to that of war; it is a sort of warfare against diseases. Now, just as is the case with the art of war, so that, which consists in combating diseases, ought surely to be subject to precise and accurate rules; and therefore the tactics of therapeutics, if I may venture to use the expression, must be reduced to certain exact formulas, in the same manner as military tactics are. Moreover the general principles of therapeutical tactics must be made to accommodate themselves, and bend to the different circumstances, from the operation of which various maladies are developed. In acute, violent diseases, which compromise in a greater or less degree the life of the patient, it should be the first principle to act with the greatest possible promptitude, and to oppose to the disease, that is to say, to the enemy, means which surpass it in strength and rapidity. The means generally used until of late years were much less active than the intensity and rapid progress of the disease required. These means also failed in a great number of cases. It is to avoid similar checks and defeats that, in our practice, we have acted with

more force and rapidity than our predecessors have usually done; and, thanks to heaven, success has crowned our efforts beyond all our hopes."

M. Bouillaud is naturally very much annoyed that scarcely any of his compatriotes, who have written on the subject of fevers and inflammation since the first announcement of the nouvelle formule, have even so much as taken notice of it. M. Martin Solon, in the Dictionary of Practical Medicine and Surgery, does nothing more than dire le plus petit mot upon the subject. M. Magendie is still more discourteous; for he does not hesitate to affirm that experience has condemned the practice of our author, and he goes so far as to insinuate that M. Bouillaud is often incorrect in his diagnosis: il est fort douteux que ce soit toujours la maladie qu'on jugule the last word alludes to the strangling or extinguishing effects of bleeding coup-sur-coup. M. Andral has expressly said in the second edition of his Clinique Medicale, that there are very few cases indeed in which an inflammatory disease can be suddenly removed by blood-letting, however copious and frequently repeated. The same sentiment is expressed in his edition of Laennec; and in his late work on Hematology, he does not even deign to make any allusion to a practice which, we are over and over again assured, has already saved the lives of thousands. According to M. Andral," it seems that, whenever the blood has begun to be charged with the excess of fibrine, it requires a certain time, whatever is done in the way of treatment, before this disposition can be removed." No one, replies our author, will deny the truth of this assertion, that "a certain time" is required to effect a cure; but this is not the point at issue. M. Andral cannot be ignorant that the new formula has not only diminished the amount of mortality from inflammatory diseases, but has also very materially abridged the duration of each case. Lastly, M. Louis has been equally unjust and illiberal; for, without giving the results of M. Bouillaud's practice, he does not hesitate to condemn the treatment employed by him: "we cannot strangle (juguler) inflammations, as some persons are too often pleased to say. Blood-lettings are not to be multiplied in the vain hope of obtaining this imaginary result." All this must be very mortifying to our author's vanity and pride: it is only to be regretted that he should so pertinaciously adhere to dogmas in practice, the fallacy of which it would not be difficult to prove from the pages of his present work. To us it is satisfactory to find that the opinions which we have uniformly held respecting M. Bouillaud, and which, during the last ten or twelve years, we have so often expressed without reserve in the pages of this Review, are fully confirmed in every particular by the express declarations of some of his most distinguished confrères in the existing school of French medicine.

There are many other subjects introduced and discussed in the Prolegomena; but our limits utterly preclude our noticing them now; and this is the less to be regretted, as they are all subsequently brought, at greater length, under the consideration of the reader in the special divisions of the work. We shall therefore now, without any further delay, proceed to a rapid analytic review of its chief contents; and, first of all, the subject of the nosological arrangement, or Classification of Diseases, adopted by our author, deserves a brief notice. He makes scarcely any reference to the labours of those who have preceded him, in this department. Pinel is the

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only one whose system is mentioned; and his "nosological pentateuch," as our author calls it,-1, essential or primitive fevers; 2, phlegmasiæ; 3, hæmorrhages; 4, neuroses; and 5, organic lesions,-is thus summarily disposed of:

"Content with having criticised the doctrines of his predecessors, and substituted his famous code for more ancient systems, he troubled himself very little with formularising (formuler) any new doctrines on the nature or mechanism of diseases. Proceeding after the manner of naturalists, as he often complacently remarked himself, it was enough for him to describe what he called the external characters of diseases; and, conformably to this method, he described his essential fevers without formally attaching them to any special organs, in other words, without localizing them; and thus he incurred the reproach of being an ontologist, and too often shewed himself unfaithful, even in principle, to the fundamental doctrines of the medical school, whose founder was Morgagni." So much for the system of the celebrated author of the Nosographie Philosophique. Let us now see what is proposed in its stead, in the pentateuchal or five-volumed Nosographie Medicale of M. Bouillaud.

He starts with the assumption that "a truly philosophical and rational classification of diseases must rest upon the nature of these diseases; every nosological edifice, founded on any other basis, is necessarily unstable and fragile." He admits that a good deal remains to be done, before it can be said that we really know or understand the real nature of many maladies; still he thinks that our knowledge of medical etiology is sufficiently accurate to warrant the classification of all diseases under the following three heads or families:

"The first family is composed of organico-vital or chemico-vital diseases, which essentially affect the chemical constitution or (as it is called) the internal structure of parts. The second comprehends such diseases as are purely dynamic, the Neuroses or lesions of the vital or nervous powers. To the third belong all the changes which occur in the purely physical, anatomical and static conditions, or, in other words, in the external structure of parts." But we must enter a little more minately into particulars; because the nosological classification of our author, professing to be built upon the physiological nature of diseases, forms a key, as it were, to the discovery of his therapeutic principles. His primary three-fold arrangement is divided into, and made to comprehend, 12 classes; of which the first five belong to the first and second great families, and the seven last belong to the third family. Here is the Synoptical Table of these twelve classes, which, be it remembered, embrace surgical as well as strictly medical diseases.

I. Fevers and Inflammations (Pyrexiæ.) IV. Miasmatic and Virulent Diseases.