a fair and regular distribution, which must be enforced, in one way or other, by legal enactment. It being understood that there are no laws on the subject to repeal, save that one, or part of one, which directs murderers to be hanged until dead, and their bodies to be given over for dissection,' and for the reception of which bodies the College of Surgeons is bound by their charter, to find a proper place, which is at present in the vicinity of Newgate.

“Laws proposed to be enacted.—1. Punishing all persons actually engaged in exhumating or stealing a dead body, or of selling it without authority, and who can be proved to have been so engaged after this Session of Parliament. For the first offence, six months to hard labour, and to find two securities, in fifty pounds each, for future good behaviour; to be kept to hard labour until procured. For the second offence, double the punishment. Medical or other persons knowingly receiving such dead bodies, three months to the treadmill, and a fine of one hundred pounds; to be kept to hard labour until paid.

"2. Rendering the practice of dissection, and the possessing of dead bodies, legal; and protecting the persons so employed, and their property, by the same laws as protect persons and property generally.

"3. Directing the five sources of supply of dead bodies, as at pages 30 and 31.

"4. Declaring it to be illegal to require or to take during life, in any hospital, workhouse, or other place for the reception of sick, or poor people, securities in money or otherwise for the burial of such persons. Penalty, twenty pounds.

"5. Declaring it legal, and directing all treasurers, governors, trustees, or others in authority, in hospitals or other places; and all vestries, church-wardens, overseers of the poor, and others in authority in the parishes, to give over for dissection to the College of Surgeons, or persons appointed by them, the bodies of all persons who have died, under their care or charge, without the means of burying them, and who have no relatives or persons previously known to have been friends, who are willing to do it; and all other bodies in their charge which come within the meaning of classes four and five, of the means of supply indicated, pages 30 and 31.

"6. Appointing the Royal College of Surgeons of London, by their secretary, or other person nominated by them, the proper authority or authorities, to whose order the bodies are to be delivered.

"7. The Royal College of Surgeons to report quarterly to the Secretary of State for the Home Department, on every point connected with this subject.

"8. The funeral service to be read over all bodies, (unless forbidden by law,) before delivery for dissection.

"9. Legalizing the sale of a dead body by the friends of the deceased, after it has been viewed in the usual manner by the parish or other authorities.

10. The Council of the Royal College of Surgeons, in making regulations for the proper distribution of the bodies placed at their disposal, to find a proper cemetery in various parish church-yards for the interment of remains after dissection; and the Council of the College to be authorised to make such charge for each body as may be considered proper ; subject to the approval of the Secretary of State for the Home Department.

11. All minor regulations of arrangement and detail made by the Council of the Royal College of Surgeons, and approved by the Secretary of State for the Home Department, to be binding on the different persons concerned. Penalty, twenty pounds.

"12. Every dispute which may occur, and every offence to which a penalty is attached, to be settled by information laid in the usual manner, before any three police magistrates of the division in which the offence has been committed; and whose decision shall be final. "In order to enable all parties to act with precision, and a due regard to decorum, the following minor arrangements are proposed, under the authority of the Secretary of State, to be varied from time to time, by his sanction.

"The Council of the Royal College of Surgeons, having the collection and distribution of all dead bodies intended for dissection, directs,

"1. An establishment of men, four or eight in number, to be ready for service every evening in the winter season from six to ten o'clock, and to proceed as directed with a shell (in a manner similar to that at present adopted by undertakers,) to the spot where the body is to be found.

"2. An establishment of one or two plain hearses, with two horses, a driver, and an attendant, in black, (like an undertaker's party,) to be ready to go to greater distances.

"3. The secretary, or proper officer, appointed by the college, gives an order for the delivery of the body, which will be the receipt to the person who delivers it.

"4. The servant of the college who receives the body, delivers it again, according to an order received to that effect from the secretary; and the anatomist or gentleman who receives the body from him, gives an acknowledgment, signed by himself or his assist

ent." 35.

V.

AN ESSAY ON REMITTENT AND INTERMITTENT DISEASES, INCLUDING MARSH-FEVER, NEURALGIA, &c. &c. By John Macculloch, M.D.

F. R. S. &c. Two Volumes, Octavo, 1827-8.

[Art. IV. (and last) TREATMENT of NeuralgIA.]

We are now enabled to complete our analytical review of Dr. Macculloch's interesting and valuable volumes-and we do not regret or apologize for the great space which we have occupied in this analysis. We are convinced that we have, through this medium, disseminated more original and important matter, and that to a greater extent, than has ever before been done through the vehicle of a review. We are confirmed in this opinion by the numerous applications which we have, from time to time, received, soliciting a further prosecution of the analytical delineation of our author's volWe now hasten to put the finishing hand to our task.

umes.

CHAP. X.-RHEUMATISM OF THE EYE-OR, NEURALGIA OPHTHALMICA.

Dr. M. assures us that the doctrine of the malarious nature of neuralgic ophthalmia was entertained by him a great number of years ago—and has since been annually confirmed by extensive personal observation. Dr. M. remarks that, whenever medical practitioners shall pay minute attention to the distinction between this disease and common ophthalmia, they will find plenty of examples. The loss of sight is not an uncommon consequence of want of discrimination in such cases.

"In some places, this ophthalmia is arranged by Sauvages with his Migraine or Hemicrania, under the term 'migraine des yeux,' and in others under other titles: proving his want of correct notions respecting it: while Cullen does not take the slightest notice of it in his very meagre and superficial description of the general disorder. The former remarks that it produces inflammation in the globe of the eye, terminating in a confusion of the humerus and in suppuration; unaware apparently of the milder cases, yet, in another place, noticing its tendency to return in the second eye after destroying the first. In St. Yves and Maître Jean, some cases of it are described by the term amaurosis; that expression apparently meaning the destruction of the humours: while it is remarked that it endures for months or years, that it is attended by fever, hemicrania or clavus, want of sleep, and giddiness, and that it attacks one eye after the other: while the former oculist, adopting the usual resource which ignorance has resorted to in so many more of these disorders, proposes to prevent this second attack by extirpating the first eye. I did not say too much when I said that had the surgical sect believed the sciatica to be Neuralgia, and dared to extirpate the sciatic nerve, they would equally have had recourse to their panacea, the knife.

Among many casual notices of this peculiar ophthalmia, and unsatisfactory as casual, I must however distinguish the essay of Wardrop; the first, I believe, through which the attention of physicians was fairly called to it. To praise that essay for the accuracy of its description of a much neglected disease, is but to agree with all who have read it: yet I should be negligent of my duty did I not remark, that however perfectly my able friend VOL. X. No. 20.

48

has seen and discriminated this variety, his account is limited to the severer cases, and that he has not appeared to be aware, in his essay, whatever may be the case otherwise, either of the slighter or less marked, or even of the chronic, varieties, or of the extreme prevalence of this peculiar species; and that, in consequence, there is almost as much error prevailing, in practice, respecting it, even under the name which he has adopted, by those who have had the advantage of his experience, as there was before. Thus also I perceive no notice of its properly intermittent and alternate characters; while with respect to other portions of the description, such as the general fever, the bilious symptoms, the decided neuralgic and periodical pain, to which I may also add the utility of bark, I should desire no other evidence to prove that it demands the term which I desire to apply to it, and that it is in reality a mode of Neuralgia. I shall however be able to produce much further evidence of its connexion both with that disease and with intermittent: and if I were inclined to express any surprise that so acute and experienced an observer had not formed the conclusion to the very verge of which he has approached, I should suppress that by recollecting, that in this as in every other disease which I have here described under this leading character, the foundation and cause of all the error must be sought in the want of a correct and broad view of the fundamental disease itself: Neuralgia." 252.

Dr. M. acknowledges that, on farther research, he has found notices of the connexion between ophthalmia and intermittent, in the writings of Morton, Strack, and Monfalcon--the latter remarking that this kind of inflammation is very common in the malarious districts of France, and is very apt to terminate in opacities. Like all the neuralgic diseases, this one sometimes occurs under a periodical character-at others, it is irregular. But the same may be said of rheumatism of the face, of which it is a near relative,

"It is observed, and perhaps very commonly with truth, that this ophthalmia is produced by exposure to cold winds, very often by partial cold, and very particularly, as it is thought, by a sudden impulse of the east wind on the eye, or face. The popular term in this case is, a 'blight; while as it is not unusual for the east wind to be especially attended by dust, this is often esteemed the exciting cause, and is as often vainly sought after; the patient being misled by the well-known sensation which follows the enlargement of the small vessels.

"Now, so far from this view of the cause being averse to the opinion of its belonging to the class of intermittent and neuralgic disorders, cold so applied is precisely one of the causes which produces these also, just as it excites the rheumatism of the face; adding a proof, such as it may be thought, respecting the true nature of that disease as well as of the ophthalmia in question. An average of cases will show that the rheumatic ophthalmia is much more common in spring and during east winds than at any other time, and the very vulgar themselves are indeed convinced of this as to ophthalmia generally: while it will I believe be found, that nine cases of ten, or indeed far more, if not even all of the ophthalmias thus occurring, are this very disease. And I formerly showed, while I have attempted to explain the cause, that such east winds, at that season of the year, do produce intermittents as well as Neuralgia; so that as far as cause is concerned, the whole of these disorders unite under one general head, instead of being separated by differences of cause: while it is still easy to see how the local action of cold on the eye or face, might determine the local disease especially; the wind thus acting by a double pow

er." 256.

The above reasoning is equally ingenious and just-and it will be found, on accurate observation, that this disease abounds most in those seasons or years in which marsh-fever rages most. It is completely proved by the geographical bearings of this ophthalmia, that malaria is at least its principal cause. It is endemic on all the coasts of the Mediterranean where fevers

prevail, occurring very remarkably, at the same season, or in the pestilential months of Summer and Autumn. It prevails along the marshy coasts of Barbary, during four months of the year—while at Tripoli few escape it. It is common at Rome, Naples, and other parts of Italy, where malaria is acknowledged to be predominant. In Spain, this ophthalmia is extremely prevalent on the maritime coasts that are subject to fever--especially at Valencia, Albatera, and Clivillente. The following is the graphic description of the disease itself, as drawn up by our very intelligent author.

"There is a peculiarity in the aspect of the inflammation itself, far easier to recognise than to describe, and by which alone it is generally distinguishable, even at a distance, and on a mere glance, to those who have acquired that experience which in other cases is called the tactus eruditus I have sought in vain for expressions to say fully what this is; but I believe it to be as useless as difficult, since, however accurate they might appear to those who already know this inflammation by sight, they would not teach others to know it, inasmuch as no visible object can be justly described to the previously ignorant; while such a description would be useless to those who are already experienced in this ophthalmia. The more obvious character, however, is a dull, rather than a lively red colour, not unfrequently attended by a tinge of yellow; the cause of which is especially visible in the sound eye when but one is inflamed, and the source of which must now also be obvious, particularly in autumnal cases. This inflammation occupies the whole conjunctiva, even to the verge of the cornea ; and while the redness is rather produced by the minutest branches of the arteries than the larger ones, the general aspect is almost that of an additional coat of red cloth in the severer cases, sometimes attaining a higher level than that of the cornea.

"In severity, however, it differs exceedingly, from a mere general, and somewhat pale, redness of the conjunctiva, to that violent inflammation just noticed. Here, it is apt to resemble the celebrated contagious and purulent ophthalmia; but it can nevertheless be distinguished by attending to its progress and to the collateral symptoms, while it never, as far as I know it, suppurates on the surface, like that disease. This is a part of its history however on which I must yet speak with some hesitation; as, after many years of observation, whence I concluded that it never did suppurate, my opinions have been recently shaken by one or two cases, though I had not the opportunity that was necessary for satis fying myself as to the real nature of the disease in these. Whenever it shall, as a separate disease, have received from physicians the further attention which it requires, this, and some other circumstances which I cannot now well elucidate, will be better understood; while I shall gladly avail myself of such information; though it will be necessary that this disorder shall be truly discriminated for this purpose, lest we return into worse confusion than that which I am attempting to rectify." 261.

Such is the general and obvious character; but there are one or two remarkable circumstances that yet deserve remark. It is often unattended by any pain in the eye itself-especially where it is of long standing and not very severe. There are cases, however, where the pain and irritation are as great as in purulent ophthalmia. This is a peculiarly obstinate and untractable disease-lasting, for months, as a mere deformity, and with little suffering, resisting every means of relief-and being generally aggravated by depletive measures.

Mr. Wardrop has remarked a peculiar sense of dryness in the eye at the commencement-followed ultimately by a copious lachrymation. The latter symptom Dr. M. can confirm by ample observation. He cannot so speak of the first.

"When there is no pain in the ball of the eye, it would seem that the conjunctiva alone is affected; while, when irritability to light attends, we must suppose that the neighbouring vessels, and nerves, within the eye, are in that state, be it from sympathy or exten

but

sion, which so often occurs in the rheumatism of the face, and in common Neuralgia, where, added to the decided inflammation and pain, there is an excitement, a tenderness, or an irritability in the adjoining parts. It is not necessary that the eyelids should be affected, or that the inflammation of the conjunctiva of the eye should extend over that of the eyelid ; though this happens in the severer cases, and, as it would seem, rather in the acute than the chronic ones It is a fortunate circumstance, that this inflammation is so much and so often resisted by the transparent cornea, as is the fact also in some other ophthalmias; abundant instances of this do nevertheless occur. Rigidly speaking, and in the severer cases, the cornea becomes dull; and if this opacity proceeds, it at length forms a cloud or a spot which diffuses itself over the whole eye, while it is more condensed in the centre. Fortunately, even when very considerable, this commonly disappears under proper treatment of the general disease, and even within a day or two; while I have seen it return many times, under different relapses and in successive seasons, without any more permanent effects. In such cases also, it will sometimes be found, by means of a lens, that there is an ulterior disorder of the cornea, resembling very superficial ulceration; equally disappearing, and without bad consequences, with the general inflammation. Far more rarely does it affect the iris: but cases even happen, as I shall soon show, where that membrane alone is the seat of the disease; the neuralgic affection producing here a rheumatism of the iris; to adopt the common phraseology." 264.

Some

The neuralgic opthalmia sometimes attacks suddenly, and arrives at its full degree of intensity in a few hours;--but it is often preceded by an intermittent or remittent febrile state, which, however, is too generally overlooked. Some symptoms of this kind will almost always be detected during the attack, a fact which we can substantiate by personal observation. times this ophthalmia is the sequela of a neuralgic pain in the face, as in the eye-brow, temple, or lower jaw-or even in remote parts of the body. All these circumstances mark indistinctly its connexion with intermittent and neuralgic affections generally. Great modifications will be produced in the characters of this complaint, according as it is in an acute or a chronic form. The following circumstances will, however, be detected by all careful ob

servers.

"A watchful physician will rarely fail to perceive that physiognomical mark of a cold. stage at some period of the day, which I have so often pointed out; as the fever of this disorder is generally, but not invariably, a quotidian; while in many cases, that stage, and even a hot fit also, are distinctly marked. This is true even of the slightest varieties and of the most chronic or most habitual and repeated ones: while in the severer, acute disease, the fever is strongly marked as a remitting, or even as a continuous one; as continuous at least as in simple remittent; though, under types more distant than quotidian, I have met few of a severe character; those of a tertian form which have occurred to me having been most commonly mild, or else chronic cases.

"Such a febrile state is often, as usual, paroxysmal while the inflammation is permanent; but this is no cause for surprise, as the same happens in the rheumatism of the face, in that of the intercostal muscles, and in other analogous affections, and also not unfrequent in the purer Neuralgia, as in sciatica. Supposing this febrile state to be present or not, or to be more or less distinct, there is frequently a separate neuralgic pain accompanying the inflammation, throughout the disease, or, occasionally, for some days only; being the hemicrania, or the pain in the temple, or in the eyebrow, which I formerly noticed as sometimes preceding the attack; and being sometimes an extremely severe Neuralgia. This is the symptom which forms that criterion for the disease which ought never to be mistaken, though in reality rarely attended to; and it is so marked and so discriminating, that to pass it without notice, or, when present, to treat the disease as common ophthalmia, is unpardonable in even the most mechanical practitioner." 269.