Obrazy na stronie

fephus, Tertullian, Sulpicius Severus, Clemens, Irenæus, Cyprian, Origen, Ignatius, Eufebius, Juftin Martyr, Optatus, Lactantius, Epictetus, Marcus Antoninus, Pliny, Orofius, Gregory of Tours, Le Clerc, F. Paolo, Bayle, Fabricius, Grotius, Mofheim, Boffuet, Dupin, Tillemont, Pagi, Lyttelton, and the authors of the Universal History; and produces many paffages, in which he has been guilty of plagiarism from Middleton, Barbeyrac, Daillé, Beaufobre, Dodwell, Lardner, Abauzit, and Tillemont.

In these inftances the reader will obferve, that there are various degrees of mifreprefentation and plagiarifm; and that fome of them may be excufable in an extenfive work, through which it is hardly poffible to preferve an unremitted attention.

It will likewise be urged, in favour of Mr. Gibbon, that the examiner alleges a fimilarity of thought, as a proof of plagiarism. To this objection he replies:

If we confider that Mr. Gibbon's talents fhine most confpicuously in the elegance of language, we muft naturally imagine, that he would not conftantly adopt the very words of the author, as he could fo eafily fet off the fentiments in new and more graceful expreffions, which would, at the fame time, ferve to disguise the plagiarifm. Befides, it being my intent to prove to the Chriftian world, that our author has, in fact, produced no new objections against our religion, and that his boasted attack is made with arguments and reflexions long ago exploded; to convict him of a fimilarity of fentiment fully anfwers this purpose.'

This writer however does not reft in a mere exhibition of fimilar paffages. He produces inconteftible evidence; and particularly fhews, that Mr. Gibbon's plan of accounting for the progress of Chriftianity from fecond caufes is a ftale infidel topic, urged and confuted long fince,' as the reader will find in bishop Atterbury's Sermons, vol. i. ferm. 3. On this occafion Mr. Davis fubjoins the fentiments of the learned and judicious Mr. Mofheim.

When we confider the rapid progrefs of Chriftianity among the Gentile nations, and the poor feeble inftruments by which this great and amazing event was immediately effected, we must naturally bave recourse to an omnipotent and invifible hand, as its true and proper caufe," &c.

"Such then were the true caufes of that amazing rapidity with which the Chriftian religion fpread itself upon the earth; and those who pretend to affign other reafons of this furprifing event, indulge themselves in idle fictions, which muft difguft every attentive obferver of men and things." Sect. 8. 10.

This is a warm and fpirited attack on the literary character of Mr. Gibbon, and supported with indefatigable industry, accurate investigation, and extenfive reading.

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Medical Cafes, felected from the Records of the Public Difpenfary at Edinburgh; with Remarks and Obfervations. By Andrew Duncan, M. D. 8vo. 55. boards. Murray.


HE ufefulness of medical cafes, when thofe are faithfully related, and judiciously treated, is too obvious either to admit of doubt, or require commendation. It is by accurate registers of this kind that the practice of phyfic has been fo much improved within the prefent century; and every benevolent mind muft feel pleasure at the growth of fuch inftitutions, as are calculated not only to relieve the immediate diftreffes of the fick, but to extend the bounds of fcience, by pathological obfervations. It appears that a difpenfary has lately been opened at Edinburgh, under the direction of Dr, Duncan, the author of the treatife before us; and the cafes which he now prefents to the public, are thofe of fome patients who had been committed to his care, in this department. The history of the patients and their diseases, however, though indifpenfibly fubfervient towards elucidating the method of cure, form the leaft confiderable part of this voJume, which confifts chiefly of the obfervations delivered by the author in his clinical lectures, to the ftudents who at tended him.

As no general account of the work can convey fo clear an idea of its nature as a fpecimen, we shall lay before our readers one entire lecture, curtailing only the introductory narra tive, which the length of the quotation will not allow us to prefix. But to fupply the deficiency in fome measure, it may be neceffary to obferve that the difeafe which is the fubjec of this lecture, was an enlargement of the abdomen, and that the principal remedies prefcribed by Dr. Duncan were small dofes of cream of tartar, frequently repeated, and squill pills. Here follows a copy of the lecture.

The disease of this patient, in my opinion, is not altogether without ambiguity, There are, indeed, many lymp toms here, which are confidered as the characterizing marks of a dropfical affection, And, from the fwelling of the abdomen, the difficulty of breathing, the thirst, and scarcity of urine, we might conclude, that she is fubjected to afcites. I am inclined. to think, that this is really the cafe. But here a very essential circumftance is wanting, With this fwelling of the belly, there is no evident fluctuation, a circumftance which is almost conftantly observed where an enlargement of the abdomen depends upon water; or even where any other liquid, fuch, for example, as blood, pus, or the like, is depofited in the cavity of the abdomen. The want of fluctuation, then, would naturally


lead us to inquire, how far there is reafon to faspect, that the fwelling here depends on any other caufe And there is the rather room for fuch an inquiry, as there is no appearance of effused water in any other part of the fyitem. Pure afcites, indeed, may, and frequently does exift; yet, for the most part, it is conjoined with other dropfical affections.

There are two other fuppofitions refpecting the cause of this fwelling, which here naturally present themselves. It fometimes happens, that fwellings, in appearance, fimilar to the prefent, depend upon a folid matter. But, to this fuppofition, there are here two unfurmountable objections. The firft may be drawn from the progress of the disease. Where the enlarge ment of the abdomen depends upon a folid matter, it very generally begins at a particular spot, and from thence it is gra dually extended to other parts of the abdomen. But, in the prefent cafe, although the increase has been gradual, yet, it has been uniformly extended over the whole, and no particular local hardness has ever been discovered. Befides this, fwellings depending on a folid matter, are not liable to fudden changes. With our patient, however, fuch changes manifeftly occur. Hence, for the fuppofition of the fwelling depending on folid, there is little foundation.

Another fuppofition is, that the fwelling here occurring may depend upon air; that is, that our patient may be subjected to tympanites. But, of this affection alfo, fome of the chief fymptoms are wanting. No found is obferved to be emitted on per cuffion of the abdomen, nor is any relief afforded on the dif charge of wind. Upon the whole, then, I reckon it at least the most probable fuppofition, that it does depend on water. The want of fluctuation may arife from different circumstances. It may depend upon the state of the integuments; it may arife from the condition of the vifcera; or it may proceed from the water being contained in hydatides. And, I confider the thirst and carcity of ur ne, as giving strong prefumption of a dropical affection; yet I fhall not be furprised to find, that it turns out of a complicated nature, neither entirely depending on water nor air, but partly on both.

With this uncertainty, I am not here difpofed to give a very favourable prognoftic. The youth of this patient is indeed fomewhat in her favour; and, it is ftill more fo, that the has received, at least, temporary relief. from the quantity of her urine being increased. But, these circumftances excepted, most others are again our patient. While we have much uncertainty refpecting the nature of the difeafe, we have at least fome reason to dread a local affection; and, from the pain of the belly of which the complains, we can prognofticate nothing favourable. From the continuance of her difeafe, alfo, we may conclude it to be of a ftubborn nature. For, although the be but eight years old, her affection has been obferved for no less than five of thefe. And there are even fome indications of its

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being of a much earlier date. For we may confider, as a fymptom of it, the thirst with which he has been affected from the time that he was on the breaft. To all thefe circumftances, it is farther to be added, that her complaints have already refifted the power of feveral medicines. If, therefore, it admits of a speedy and fortunate termination, it is, I own, much more than I expect.

It may feem ftrange, that hitherto I have taken no notice of a circumftance particularly mentioned in this cafe, that is, the worms which she has, at different times, been obferved to dif charge by ftool, There are fome practitioners, who, with fuch circumstances as occur here, would look upon worms in the inteffinal canal to be the caufe of the greatest part, if not of all the symptoms. I muft, however, own, that I do not fuspect them to have any connection with the prefent complaint. Worms, indeed, in the inteftines, are by no means a rare occurrence: yet, as far as my inquiries go, I think I may venture to affert, that, in this country, they are lefs frequent than in fome others; and that now, they are lefs frequent here than they were formerly, which I am inclined to afcribe to changes which have taken place with respect to diet. Cafes are often to be met with, in which they are unquestionably productive of the moft threatning and moft anomalous fymptoms; yet there can be no doubt, that they are frequently prefent in the alimentary canal when they are productive of no inconvenience. This fufficiently appears from their being obferved to be discharged where there has been no preceeding uneafinefs.

In the cafe before us they appeared chiefly during the course of a fever. It is to be obferved, that, during febrile affections, worms frequently appear and, when this is the cafe, there are many who are difpofed to confider them as the cause of the fever. This conclufion, however, is, I imagine, often drawn without good reafon and I cannot help thinking, that they are frequently difcharged merely in confequence of the fever. It would feem, that, from the morbid affection which exifls, probably from the increased heat of the body, their fituation becomes difagreeable to them. And I reckon it probable, that this may have been the cafe in the inftance before us. Our patient has, even of late, indeed, difcharged one, which gives a prefumption that there may be still others prefent. And the action of thefe on the alimentary canal, may either be the caufe of fome fymptoms, or may aggravate them; yet, admitting that, I muft own, I do not confider them as forming any dangerous part of the affection; and I do not think that our attempts to cure are to be directed with a view to these.


Refpecting the general plan of cure, from what has been faid, it may be concluded, that I am much at a loss. I have, however, begun the treatment of this cafe, on what I reckon the most probable fuppofition; that is, the idea of its being a


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dropfical affection. Suppofing that there is a collection of water in the cavity of the abdomen, it is my intention to attempt to discharge it by natural outlets. Of these, the chief are evacuation by ftool and urine. From the first of these, we can obtain the moft immediate and moft fudden discharge; from the laft, the evacuation which takes place has the leaft influence, as debilitating the patient; and, on this account, diuretics can be used with more regularity, and for a greater length of time, than purgatives. To thefe, therefore, I am chiefly difpofed to truft in the prefent cafe; yet I with, in fome degree, to conjoin the advantages both from diuretics and purgatives. It is from thefe confiderations that I have put this patient on the use of two different remedies, cream of tartar and fquills. While the first operates, moft immediately, as a purgative, it is, at the fame time, powerfully diuretic. The laft is intended folely with the view of increafing the quantity of urine. If, from these medicines, we can obtain a copious difcharge of urine, with a diminution of the fwellings, and, at the fame time, without debility, it may go far towards the recovery of the patient. At the fame time, in dropfical affections, I confider the evacuation of the water as the leaft important part of the cure. And, in almost every case, it is a more difficult matter to prevent the return of effufion, than to produce evacuation. It may, therefore, be neceffary, in order to fecure the good effects which may be derived from these evacuants, to have recourfe to Peruvian bark, and other tonics. At the fame time, I would by no means be understood to promise that we shall ever come this length in the cure; and, we may even be foon fatisfied, that the prefent plan is not to be perfifted in. The evacuation may be greater than our patient is able to bear, or it may take place without a diminution of the fwellings. In either cafe, it would be prejudicial. Suppofing this to happen, I muft own, that I cannot, at prefent, even conjecture what meafures I may then be difpofed to adopt. I fhall probably, however, try fome of thofe medicines which more immediately tend to increase the tone of the alimentary canal; particularly those which pafs under the general titles of ftomachic and carminative medicines. It is, in fome measure, with an intention of this kind, that I mean to conjoin, with the present course, friction of the abdomen. And, merely as an inducement to its being continued for a fufficient length of time, I fhall order it to be performed, either with oil, or with fome foft powder, but without expecting from thefe any other effect than as leading to the continuance of the friction.


Sequel ] Soon after the 7th of December, befides the continuance of the cream of tartar and fquills, directions were given, that this patient fhould have her belly carefully rubbed every evening for the fpace of half an hour. And, as the repeated evacuations by ftool feemed to induce debility, the purgatives were ordered to be intermitted. But, not long after



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