ART. IX. A Treatise on Nervous Diseases. By John Cooke, M.D. F.A.S. late Physician to the London Hospital, &c. &c. In 2 Vols. Vol. I. on Apoplexy, including Apoplexia Hydro-, cephalica, or Water in the Head; with an Introductory Account of the Opinions of ancient and modern Physiologists respecting the Nature and Uses of the Nervous System, read at the College of Physicians as the Croonian Lectures of the Year 1819. Svo. pp. 469. 12s. Boards. Longman and Co. ART. X. History and Method of Cure of the various Species of Palsy being the First Part of the Second Volume of a Treatise on Nervous Diseases. By John Cooke, M. D., &c. 8vo. pp. 215. Longman and Co.

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UR medical knowlege is at present in a state of such very. great accumulation, that few persons have leisure or opportunities sufficient to enable them to trace the history and treatment of diseases, from the early periods in which we find them first noticed in the records of medicine, down to the present day; yet all will admit that to do this would be highly important to individual improvement, and to the general interests of medical science. The writings of physicians have usually been composed with the professed object of communicating some new view of the history, the nature, or the treatment of disease; and rarely with the modest intention of exhibiting, in a faithful digest, the results of preceding labors in the same field of inquiry. It is therefore with much pleasure that we now welcome the appearance of a work of this latter description, by a physician of talents, and of such experience as will enable him to speak with confidence of the value of those statements which he has collected from the writings of others.

In some preliminary remarks, Dr. Cooke has explained his views on this subject with much modesty and good sense.

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If the example which I have presumed to set should be fol lowed if persons, better qualified for the task than myself, would investigate other important diseases on a similar plan, a system of medicine would be formed which might prove eminently useful, both by lessening the labours of the student, and affording practical facilities to persons actually engaged in the duties of the profession.

After an experience in medicine of many years, I have ventured occasionally to introduce into this compilation my own opinions and practice, as well as to comment upon those of others but I trust that in this I have betrayed no signs of dogmatism, or self-confidence.'

In the introductory essay on the Nature and Uses of the Nervous System, which occupies considerably more than à fourth part of the first volume, we have an extended and

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amusing (though not very profound) view of the various opinions held on this subject, so inexhaustibly prolific in speculation. These are traced from Hippocrates, Plato, and Aristotle, through the writings of the disciples of the Alexandrian school, of the Arabian physicians, and their successors, down to M. Le Gallois, Dr. Wilson Philip, and Doctors Gall and Spurzheim. The ideal theory, so suc*cessfully combated by Dr. Reid, is also brought under review; . and the doctrines of the materialists are considered at some length. The author is inclined to believe that the ideal theory is not inconsistent with a belief in the existence of an external material world. The theory of perception,' he observes, by images or pictures necessarily implies the existence of something external, of which they are pictures or images.' (P. 151.) This is one of the very few instances, throughout the whole of this introductory paper, in which Dr. C. ventures to throw the weight of his opinion into the scale of any of the speculators. Indeed, so great are his impartiality, and his anxiety not to misrepresent the writers whose opinions *he reports, that he has sometimes been betrayed by these feelings into prolixity, and at others has testified a degree of deference for doctrines the absurdity of which we think The must have felt. The dissatisfaction, with which he rises from this unprofitable discussion respecting the nervous system, may be seen from the following passage:

Physiologists have often erred by paying more attention to the investigation of the nature of the subjects of their enquiries, than to that of the laws by which they are governed. Of the ~ultimate nature or essence, either of mind or matter, or of that compound which we call the Nervous System, we know nothing; but of the laws by which it is governed, or rather the circumstances by which it is influenced, we know enough to enable us, in some degree at least, to understand the nature and causes, and to explain the phenomena of many of its morbid affections. Instead, therefore, of perplexing ourselves in vain efforts to comprehend "what the great Author of nature has placed beyond our reach, and indulging in speculations which, however interesting, can "lead to no satisfactory conclusion, let us turn our attention to a subject better suited to our powers, namely, the investigation of the diseases of the nervous system."

The portion of the work which is dedicated to the subject of Apoplexy is arranged with methodical clearness, under the several heads of Definition and History, Dissections, Causes of Apoplexy, Distinctions into different Species, Diagnosis, Prognosis, and Treatment; and in each of these divisions, Dr. C. has presented us with a very complete and satisfactory view of every thing important that is known respecting this disease. Not much, however, is added from his own

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stores; nor are his critical remarks often of such a nature as to attract our notice. He states it as his belief that recovery sometimes takes place from the strong apoplexy; and he adds,

I am informed by Dr. Baillie, Mr. Astley Cooper, Mr. Wilson, and other professional friends, that in many cases where persons had recovered from apoplexy, evident marks of effusion of blood have a long time afterwards been found in the brain. Mr. Cooper has favoured me with a communication on this subject, in which he says, "The dissections which I have made of cases of apoplexy, and extravasations of blood upon the brain from accident, bave led me to the belief that the effused blood never becomes absorbed, but that the brain gradually acquires the power of bearing its pressure, and that thus the symptoms which are produced at the first moments of general extravasation gradually diminish."'

The instances adduced in continuation by Sir Astley Cooper certainly prove that, in those cases at least, the extravasated blood had not been absorbed: but they were cases of only a few months' duration, and do not by any means shew that such absorption never takes place. Indeed, it seems difficult to account for the appearances exhibited by apoplectic cysts, which were so well described by Dr. John Hunter in the Gulstonian Lectures, (1796,) and afterward by Dr. Baillie, without admitting the reality of such absorption of blood extravasated into the substance of the brain. On inspecting the body of a person who had suffered a paralytic attack 21 months before, we found, in the posterior part of the left hemisphere of the cerebrum, an irregular elongated cavity, containing about one ounce of turbid serous fluid, and communicating with the lateral ventricle of the same side. was lined with a distinct membrane, which in some places lay in folds, and exhibited several tortuous capillary vessels filled with red blood. This cavity seemed as if formed at some remote period by the rupture of the posterior wall of the inferior cornu of the left lateral ventricle, for the appearance of the natural structure of that part was completely destroyed. In this instance, it was very improbable that the texture of the brain could have suffered so great an injury without extravasation of blood; yet here only serous fluid was discovered.

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In the treatment of apoplexy, Dr. Cooke advocates the propriety of blood-letting, with much clearness and strength of argument; and he exhibits, in his account of the opposite doctrine, an amusing illustration of those discrepancies of opinion among medical practitioners, which have so often brought scandal on the profession. When apoplexy is REV. OCT. 1823. ascribed

ascribed to the suppression of accustomed discharges, or to metastasis of disease, Dr. C. attaches much weight to the restoration of these antecedent maladies: but the great object, in all such cases, is to relieve the apoplectic state by every powerful remedy within our reach, and at our leisure to attend to those diseases which are thus supposed to have migrated from their accustomed seats. Any other practical doctrine will endanger the safety of our patients, by leading us to neglect the adoption of those vigorous measures which a little delay will certainly render ineffectual.

After the consideration of apoplexy, Dr. Cooke proceeds to make a few remarks on other soporose diseases: lethargy, coma, carus, cataphora, catalepsy, extasy: which are briefly discussed by him without adducing any thing particularly worthy of remark, excepting a curious case of a young lady, who was subject to frequent fits of profound and long-continued sleep, which were at last followed by an attack of mental derangement.

The author next takes up the subject of Hydrocephalus internus, to which he was in all probability led by the arrangement of Cullen, who has referred it to the genus apoplexy. The true hydrocephalus, both acute and chronic, certainly wants that rapidity of progress which is distinctive of apoplexy: but there is one form of disease, which Gölis has named Hydrocephalus hyperacutus, and water-stroke, which without doubt belongs to the genus apoplexy, and may be considered as a sub-species of Apoplexia serosa. In this part of Dr. C's 'treatise, he has furnished us with a very complete view of the labors of our best writers, down to Coindet, on the subject of acute hydrocephalus: but perhaps too much deference is shewn by him to the opinions of Dr. C. Smyth, who, with many pretensions, had obviously a very imperfect knowlege of the disease in question. The subject of chronic hydrocephalus, either as a sequel of the acute or as a congenital disease, has not been once introduced by Dr, Cooke; an omission which we cannot help regretting. When he compiled this part of his volume, he was unacquainted with the work of Gölis; otherwise, we have no doubt, he would have gladly availed himself of the rich materials which it contains. Having so lately introduced to our readers Dr. Gooch's translation of that valuable treatise, we shall not at present enter farther on the subject of hydrocephalus: but we cannot refrain from pointing out an error into which Dr. Cooke has fallen. He appears to regard Dr. Vose's case

(Medico-Chirurgical Transactions, vol. ix. part ii.) as one of external hydrocephalus; in which, we are convinced by an examination of the paper, he is mistaken.

In the first part of Dr. Cooke's second volume, the subject of apoplexy is very properly followed by the consideration of Palsy, which is so frequently the effect of the former disease; and we have great pleasure in saying that, in our judgment, the author has executed this division of his task with still greater ability than he has shewn in the first volume. The matter is better condensed, the facts are more briefly expressed, the arrangement is more luminous, and the text is less loaded with quotations. The disease called Palsy is defined, a general history of it is given, and hemiplegia, paraplegia, and partial palsy, are successively described. The causes of paralytic affections are next considered; then follow the appearances on dissection, the diagnosis, and prognosis; and the discussion is closed by an account of the most approved modes of treatment.

On the subject of the causes of palsy, Dr. C. has entered at some length into a consideration of the opinions of M. Serres; and he has succeeded in shewing, very clearly, the fallacy of that gentleman's reasoning.

M. Serres states, that he has in many instances thrown blood upon and into the meninges, the cavities, and the substance of the brain, without producing apoplexy or even somnolency; that upon the examination of a very great number of persons after death from apoplexy, he has found the meninges bearing evident marks of irritation (inflammation), accompanied with effusions of various kinds, and in various situations within the cranium; that sometimes he has observed the brain itself to have been injured in its substance, but without effusion; that in the former cases he has ascertained the preceding apoplexy to have been simple, and in the latter, combined with palsy; and that he has known many cases of apoplexy without effusion, and of effusion without apoplexy and hence he concludes that he has overturned the doctrine of apoplexy and palsy from pressure, and has established better system respecting the distinctions and nature of the diseases, than any hitherto presented to the world: but the accuracy of one of these conclusions at least, may, I think, be reasonably doubted.'

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He has shown that blood has been effused in various situations within the cranium, without apoplexy; but he c cannot hence fairly conclude that effusion never produces the disease, Since he admits that there is effusion in the ineningeal apoplexy, how can he prove, even allowing it to be the consequence of what he calls irritation of the meninges, that the irritation, and not the effusion, is the immediate exciting cause of the disease. If compression by fluids were the cause of apoplexy, M. Serres says

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