assuredly be felt, and the forceps or vectis would be applied by every practitioner. If, on the contrary, it had not, version would be resorted to, and with far less chance of injury to the mother, a far more speedy termination of her sufferings, and less risk to the life of the child, than could be expected from the use of the long forceps, employed by the most expert operators, who are not always to be obtained in these emergencies. Certainly for ordinary practitioners to resort to this instrument under such circumstances would be highly improper, to use the mildest terms, and is even deprecated by both author and translator of this work a few pages on: so that the true drift of his recommendations is somewhat difficult to arrive at. Dr. Chailly says" when the head is half engaged in the superior strait, the rules for the application of the forceps are precisely the same as when it has descended into the cavity. The operation, however, is more difficult and dangerous for both mother and child. It should, therefore, never be had recourse to, except where version is impracticable in consequence of the excessive ascent of the uterus, and (is it possible he can recommend its employment in place of the perforator in this case?) when the pelvis is malformed or the size of the head very large. The regular application of the branches at the superior strait is exceedingly difficult: indeed it may be said to be impossible in most cases." Let the reader bear in mind these are the words of one of the most expert of French accoucheurs, kept in constant practice by the resources of a large hospital; and then ask himself whether, in general practice, the risking the safety of the mother for the very remote chance, under these circumstances, of preserving the life of the child, is a justifiable procedure. "Too much attention," says the translator, "cannot be given to the opinion of M. Chailly in reference to the difficulty and danger of applying the forceps where the head is at the superior strait a rule which I hold to be almost universally proper: to turn rather than attempt delivery by the forceps when the head is still at the superior strait."

"

* * * * *

We quite agree however with this gentleman in deprecating the practice of MM. Dubois and Chailly of employing the forceps in a furtive manner. Keep the patient in ignorance," they say, of what you are about to do, assure her that the hand alone will suffice, conceal the instrument from her sight, and be careful not to make any noise in locking the branches. With this view the forceps should be enveloped in a cloth, and placed on the floor at the foot of the bed." We can, indeed, conceive the case of some of these young French accoucheurs, to whom this advice is addressed, being hereafter not only very desirous of concealing that they were about to employ this instrument, but also of preventing its being known that they had done so. In England, we believe, that no lecturer would recommend, or any practitioner attempt, to employ this, or any other surgical instrument, independently of the patient's entire knowledge of the object in view, and free consent to the endeavour at its accomplishment.

In another point also we cordially agree with Dr. Bedford, namely, his recommendation of the more frequent employment of the manakin. The majority of lecturers and great body of pupils neglect this far too much; for, although the most valuable lesson that can be taught the pupil is a full reliance upon the great powers of Nature, and the impropriety of hastily interfering with her proceedings, yet the acquisition of sufficient

dexterity for the employment of interference when it is necessary is of scarcely less importance. Nay its possession is available in even the common routine of midwifery operations; and many imaginary difficulties in the extraction of the placenta (some of which are recorded as rare cases) have arisen from the untaught clumsiness of the operator.

"I cannot too strongly impress upon the pupil the value of this machine. To become a dexterous and safe obstetric operator, two things are necessary, and they are so essentially material that, if they be neglected, failure must often be the result. In the first place, the accoucheur should have a clear perception of the principles on which rests the mechanism of natural labour. And, secondly, he should reduce those principles to practice on the manakin. The manakin is as important to the obstetrician as the cadaver to the surgical operative surgeon: and if practitioners could be made to appreciate the benefits to be derived from practising on it, much good would necessarily result to those, who in their hour of peril, need not only the sympathy, but the consummate skill of their medical attendant." 320.

The author makes no allusion whatever to the lever or tractor.

I. TRAITÉ COMPLET DE L'HYPOCHONDRIE. Par J. L. Brachet. (Ouvrage Couronné par l'Academie Royale de Medecine. Octavo, pp. 736. Paris and Lyon, 1844. Baillière.

II. TRAITÉ PHILOSOPHIQUE DE MEDECINE PRATIQUE. Par A. N. Gendrin, D.M. Tome III. Octavo, pp. 675. Paris, 1843. Baillière.

THE name of Brachet deservedly stands very high in the present medical literature of France. It is now upwards of twenty years since he published an Essay on Hydrocephalitis; and, since that time, he has produced several esteemed works on various professional subjects-Memoirs on the Use of Opium in certain Inflammatory Diseases, and on Asthenia; Statistical Researches on the relative Numbers of Marriages and Deaths; an Elaborate Enquiry into the Functions of the Ganglionic System (1837); and a Practical Treatise on the Convulsions of Infancy. We are not therefore surprized that he has been the successful competitor for the prize offered by the Royal Academy of Medicine of France for the best memoir on the subject of Hypochondriasis. It is indeed a most elaborate and able work, and cannot fail to be recognised as a standard Treatise on the disease which it undertakes to describe. Dr. Brachet is a man of a calm reflecting mind, free from prejudices, and not under the dominion of any favourite doctrine. He does not profess to suggest any original views, or to propound any new theory, on a question that has vexed the ingenuity of medical speculators in every age; but he has applied himself to a much more useful subject, that of discussing the theories of others, collating and comparing them, one with another, and separating the results of actual observation from the delusive dreams of the imagination. His remarks throughout bear the impress of one who has seen much and read not a

little; who has studied Nature for himself, but who has not neglected to make himself acquainted at the same time with the opinions of others, and more especially of the leading physicians of former times. Independently therefore of its own intrinsic merits, this work of our author deserves particular notice on another account;-inasmuch as it (and, we may add, that of M. Gendrin also) emphatically indicates a change in the spirit of medical literature that has sprung up of recent years, not only in France but also in our own country. Every one must have observed that there is a gradually increasing attention paid to the consultation and study of the writings of the old physicians, and that medical men, now-a-days, are not exclusively and altogether occupied with the plausible, but often most erroneous, explanations which have been given of the origin and treatment of maladies, since the beginning of the present century.

Something more, it is now generally acknowledged, is required, for the skilful management of disease, than a mere notation of the symptoms during life, and a knowledge of the appearances discoverable on dissection. The practitioner must learn to take a broad and comprehensive view of the various agents and influences which may have led to the development of existing diseases, and seek to appreciate the multitudinous, and often secret, circumstances that very materially modify their type as well as their duration and event. Now, there is not a member of the whole nosological catalogue, to which this remark is more truly applicable than that of Hypochondriasis; and it has been from the neglect of the precept here suggested that so many and so conflicting opinions have been held at different times as to its nature and mode of treatment. Our predecessors acted more wisely in this respect than we of late years have done. How frequent are the allusions in their writings to the modifying and often perverting influences of climate, season, locality and so forth, on epidemic and other diseases! The whole book of Hippocrates de aere, aquis et locis is full of them; and we find Celsus expressly saying, aliud opus esse Romæ, aliud in Egypto, aliud in Gallid. Baglivi knew well the truth and importance of this, when he penned the simple but emphatic words: Scribo in aere Romano.

It is far from being an unprofitable labour, to study the literary history of a disease, and to collate and compare the writings of various authors in different ages and climates upon it. For, however fanciful and erroneous their theories respecting its origin and essence may be, there is always some good to be obtained from knowing the sentiments of observing and experienced men on such professional topics as are of a practical nature. It is for this reason that we propose, in the present article, to confine ourselves chiefly to that section of M. Brachet's work which gives an historical sketch of Hypochondriasis, derived from the writings of the most celebrated physicians from the earliest times down to the present age. As a matter of course we begin with the Father of Medicine himself.

In his second book De Morbis, Hippocrates obviously describes, in the following terms, the most prominent symptoms of Hypochondriasis, under the names of morbus dessicatorius, and morbus ructuosus.

Neque sine cibo esse, neque cibum acceptum tolerare potest. Verum ubi quidem sine cibo manet, viscera sugunt, os ventriculi dolet, et aliàs alia vomit, et bilem, et salivam et acria; et postquam vomuit aliquantisper,

melius habere se videtur. At, ubi cibum accepit, ructus adsunt, et cum rubore exardescit, et semper multum se cacaturum esse putat. Ubi vero ea gratia desederit, flatus prodit et dolor caput habet, totum corpus velut aciculis pungi videtur, alias alia parte, et crura gravia sunt ac debilia, et consumitur ac debilis fit. Huic medicamentum bibendum dato, primum deorsum purgans, posteà superne, et caput purgato, et a cibis abstineat dulcibus ac oleosis et pinguibus, et ab ebrietatibus. Vomat autem a succis et a cibis, et pro anni tempore lac aut serum assininum bibendum præbens; pharmacum insuper bibendum dato; utro tandem magis opus esse tibi visum fuerit. Estate et vere frigida lavet. Autumno autem et hyeme unguento utatur, et deambulet, et modice se exerceat. Si vero debilior sit quam ut exerceri possit, iter faciat. Et cibis frigidis ac alvum solventibus utatur. Et, si si venter non egerat, molle infusum per clysterem injiceto. Morbus hic diuturnus est; et consenescentes, si ita futurum est, relinquit. Siu minus, commoritur. In a subsequent passage in the same book, we find an emphatic allusion to the despondency and mental disquietude which so generally attend gastric and intestinal derangements : Anxietudo ipsum invadit, lucem et homines refugit, tenebras amat, metus corripit, septum transversum exteriore parte intumescit, ad contactum dolet, expavescit, terriculamenta et formidanda cernit. From these extracts it is abundantly obvious how well acquainted the old Coan was with the disease itself, if not with the name which was afterwards (from a mistaken theory) bestowed upon it. It has been generally alleged that Hippocrates attributed the symptoms of Hypochondriasis to the presence of atrabilis in the system. This, however, seems to be a mistake; for there is not even a hint as to the cause of the malady in the passages from which we have quoted; and it is only in a subsequent part of his writings that he treats of Hepatitis and other diseases of the liver, that we find an allusion to this suppositious humor.

Before proceeding with our selection of extracts, it is right to mention that M. Brachet groups and classifies the various authors, whom he quotes, under four heads, according as they have placed the seat of Hypochondriasis in 1, the Humours of the Body; 2, the Abdominal Viscera; 3. the Organic Nervous System; or 4, the Brain and its attributes. Although objections may be very reasonably taken to this quarternary division,— inasmuch as many of the authors quoted have not held the single and exclusive doctrine imputed to them—we shall adhere, for convenience sake, to it, with one or two exceptions.

Galen-who is generally regarded as the founder of Humorism, in consequence of the great extension which he gave to its principles-did not fail to apply this doctrine to the explanation of the phenomena of Hypochondriasis. He attributed the disease to the blood becoming thick and viscid, and to the existence of atrabilis in the system. At the same time, he seems to have placed the actual seat of the malady-at least, at its commencement-in and around the stomach:-cum igitur, says he, circa ventriculum inceperint accidentia, hypochondriacum flatuosumque morbum nominabimus. The description, which he gives of it, is both longer and more lucid than had been given before his time. The Galenic view of the disease continued, with occasional modifications, to be the predominant one in the schools of medicine up to the epoch of the revival of letters. During this long period, the greater number of medical writers regarded the Liver

and Spleen as the foci, whence arose those pernicious vapours which were considered as the proximate cause of all the hypochondriac's troubles. Etius pushed the humoral doctrine of the disease as far as possible; nevertheless he did not fail to observe that the earliest symptoms of the morbid process had their origin in the Brain. He supposed that the entire mass of the blood remained in a healthy condition, save and except that portion which is present in the brain: Alio tempore, sanguine in toto homine illæso permanente, is, qui juxta solum cerebrum est, alteratus; and that a humoral vapour arose from the stomach to the head, the communication between the two being maintained by means of the pneumogastric nerves.

According to Avicenna also, the morbific matter which produces the disease, proceeds from the stomach and liver; the deranged state of which organs was regarded by him to be the primary and essential cause of all its phenomena.

Sennertus held a somewhat similar opinion; but he carried his views farther; for he maintained that the blood became corrupted by the unwholesome chyle that was generated in the digestive viscera, in consequence of the disorder of their functions. His definition of the disease is as follows: Colluvies vitiosorum humorum, imprimis melancholicorum, sæpe etiam pituitorum et biliosorum in venæ portæ et arteriæ cœliacæ ac mesenterica ramis, in hypochondriis, præcipuè sinistro, inter ventriculum et lienem, maxime iis locis ubi plures majoresque venæ portæ et arteriæ huic conjunctæ sunt. The humorism of Sennertus is altogether more physiologically reasoned and argued than that of his predecessors.

The opinion of Vieussens coincided very nearly with that of Sennertus. Sometimes he made the disease depend upon an impure state of the blood at other times upon obstructions of the bowels by vitiated chyle. But it was always some disordered state of the chylopoietic viscera that was viewed by him as the primary cause, and that which induced the unhealthy and corrupted state of the humours of the body.

In 1670, a sharp discussion took place between Willis-who, we shall afterwards find, was a zealous advocate of the nervous theory of Hypochondriasis—and Highmore, who followed in the wake of those authors we have been mentioning. In the reply of the latter to the former, we read, among the causes of Hypochondriasis, of the fibres of the stomach being feeble and relaxed; the digestion difficult and imperfect; and the chyle being badly elaborated, and mixing too soon with the blood, which becomes in consequence acrid and hot. The residue of the digestion, he says, remains too long in the stomach, and there it degenerates into a viscid phlegm, which subsequently ferments. The blood, also, being too fluid and flatulent, has a tendency to accumulate in the lungs and heart, and in these organs experiences a sort of effervescence which impedes the free play of their functions, and the easy descent of the diaphragm.

Lange supposed that the materies of the disease was a ferment generated in the spleen, and giving out a melancholic vapour, which was conveyed by the nerves to the stomach and other viscera. Stahl, in spite of his vitalism, attached so important an office to the vena portæ and its contained blood, that he may be classed at present among the humorists, more especially among those who had themselves dwelt much in their ætiological reasonings on the portal circulation, and who had designated No. LXXXII.

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