ftate of irritability, but which for the most part would be referred to the diabetic affection. The quantity of urine made, however, was not above fix or eight pints; the thirt was moderate, the fkin not completely deprived of its natural moisture, and the prefence of faccharine matter in the urine was not fo manifeft as is ufual in diabetes; though it was found upon evaporation. In this cafe the fame plan of depletion was refolutely purfued, under a variety of circumftances; and the quantity of 154 ounces of blood was taken, in the courfe of the cure-but fome very important facts, not previously observed, were afcertained in the progress of it. The cafe from the first had been attended with a variety of fymptoms, indicative of much bodily and mental irritability; fo much fo, as to occafion fome doubt, whether it could properly be confidered a cafe of diabetes. Among other fymptoms, there was a variety of fpafmodic affections, inflamed eyes, contraction of the prepuce, and in particular, a highly irritable ftate of the bladder: and upon this account it was, during the first fortnight, treated folely with the view of relieving thefe fymptoms: lenitives, antifpafmodics, and powders of uva urfi were tried, without proving of service; and it was then determined, notwithstanding "circumftances were moft inaufpicious," to make ufe of extenfive blood-letting; and in the enfuing eleven days, 102 ounces of blood were taken in fix different bleedings. The immediate effects obferved, and the changes that took place in the appearance of the blood, were fimilar to what had been noticed in the former cafe, but thefe favourable fymptoms did not long remain; the cafe fhortly became "very perplexing," for though many of the fymptoms were removed, and others alleviated, yet the bleedings did not appear capable of accomplishing a cure. The animal diet was moft rigidly purfued, but without fervice, and the patient was found to get daily worfe and worse.

"At length," fays Mr. Watt, I fufpect I perceive our error; but the difcovery is perhaps too late. While, on the one hand, we have been endeavouring to reffore the balance by venefection; on the other, it has been as effectually deftroyed, by the conftant and too great fupply of new chyle. Abftinence is probably as neceffary a part of the treatment as venesection.

If the morbid fecretion of urine were corrected, it is probable, the bladder would relax to its former dimenfions, and take on its natural action, in the fame manner as phy mofis goes off, without any local application, when the original difeafe is cured.

"According to my prefent view of the fubject, the treat. ment ought to be venefection, low diet, and blistering: We

have been led into our prefent error, by adopting half meafares, by a fear of abandoning, altogether, the animal diet." P. 96.

Dr. Cleghorn was confulted, and the "fuggeftion was readily agreed to," with the addition of an anodyne as occafion might require. Venesection was again had recourse to; 52 ounces were taken during the next fortnight, in four different bleedings, and their effect affifted by repeated blifters over the region of the kidneys, gentle opiates, and the most abftemious regimen. The refult now was, in every respect, the most happy; the patient fpeedily recovered his health, his ftrength, his weight, his fpirits, and his mental energy. The irritability of the bladder gradually fubfided, the quantity of urine made, became natural; his appetite and digestive powers returned, and in fix weeks he was able to resume his ftudies at the University.

This cafe, upon the whole, is more fatisfactory than the former, for it embraces the fubject in a much clofer compafs; and the operation of the practice employed cannot be mistaken. In the courfe of the obfervations which Mr. Watt himself makes upon it, our attention is called, in a forcible manner, to the effects of diabetes upon the state of the mind, a fubject which, moft certainly, does not always meet with fufficient attention from medical authors, in the hiftory of difeafe in general.

The remaining cafes undoubtedly tend to confirm the practice adopted, in those of which we have given an abftract; and though from their fmall number, they are very infufficient to incline us implicitly to adopt the practice, and more especially the opinions of Mr. Watt, yet they most furely do, collectively, contain a mafs of interefting evidence, which all practitioners in medicine will do well to confider, not only with admiration and refpe&t, but with an intention of cautiously treading the new ground, upon which this author has certainly the credit of having thrown the first glimmer of light. Perhaps it is hardly fair to exprefs fome difappointment, at finding the advice contained in the admirable letter of Dr. Cleghorn not completely followed; but certainly it would have added greatly to the value of the book could a criterion have been fixed, " by the help of which an attentive practitioner might be able to ascertain, 1ft. When it was neceffary to take away blood, in fpite of apparent debility; and 2dly, how far the evacuation might be carried in fuch a cafe; or, what is the evidence of its having been carried far enough." P. 141.

K

BRIT. CRIT. VOL. XXXV. FEB. 1810.

We

We have before hinted that the first part of the work, was that which we conceived moft worthy of attention; we fhail however proceed, if able, to give an abftract view of the hypothefis which this author has adopted, and which appears to us, to have more immediately led to the excellent practical obfervations juft noticed. This hypothefis is more completely developed in the latter fections of the work entitled, Phyfiology, Pathology, and Practice, throughout which alfo the author fill continues to command our attention, by the continual occurrence of thofe uleful practical defcriptions for which he appears to poffefs a peculiar talent.

"Two things," fays Mr. Watt, "appear to be effentially neceffary to the exiftence of every animal, a fupply of food, and a fupply of air. All are provided with a fet of lacteals, calculated to abforb and digeft their aliment; and fomething which performs the office of lungs." P. 198.

"The lungs finifh what the digeftive organs have begun,' p. 200, and by their joint operation perfect blood is formed. From this, by means of "a variety of organs," the fecretions are fupplied, the folids increased and repaired, while "another fet of veffels takes up whatever has become ufeless in the fyftem, and carries it back to be renovated by the lungs, or difcharged by fome of the outlets." P. 202.

"The fame order exifts in the vegetable kingdom. The roots abforb and digeft the aliment; the leaves convert it into the peculiar juice of the plant." P. 199.

1

Our author continues-" If the roots digeft, and the leaves affimilate the food of plants, the one must always bear an exact proportion to the other. When a plant is transferred from a rich to a barren foil, its leaves are neither fo large, nor fo numerous as before if through the fummer, a part of its nourishment be taken away, a fimilar proportion of the leaves decay and fall off. On the other hand, if transplanted from a barren to a fertile foil, the leaves are proportionally augmented, both in number and in fize; or if additional nourishment be fupplied after the leaves are formed, the equilibrium between the two fyftems is preferved by an eruption of new leaves. It is not fo with animals, though the quantity of nourishment be encreafed, no augmenta. tion in the extent of the lungs can follow. This apparent defect, however, is made up by various outlets. The veffels which open into the lower part of the intestines, the kidneys, and the cutaneous exhalents are the principal means employed, for preserving a due balance between the two fyftems; in other words, for preferving the health of animals. It must be remarked too, that though no augmentation in the extent of the lungs can take place, their action is often quickened, so as to do more work in a given time." P. 202.

"The

*The lofs of balance between the digeftive and affimilative tgans may be produced two ways. The lungs may be impaired in their action, while the lacteals go on in their former courfe; or the action of the lacteals may be encreased, by a morbid irritability in themfelves, or by fome preternatural ftimulus in the matter they convey; in either cafe the equilibrium between the two systems is destroyed, and disease produced." P. 204.

This is exemplified by the effect produced upon a plant, when a confiderable part of its foliage is deftroyed, and by a circumstance found to occur in the animal economy, which has often been noticed with wonder, namely, that "We fee every day perfons taking great quantities of food, and yet their bodies are rapidly wafting away," (p. 205), in which cafe more chyle is formed than "the lungs can affimilate; it only remains an incumbrance on the system, or is difcharged by one or other of the excretories."

From this fhort abftract it will appear evident that the author refers disease to a discontinuance of the due balance between the actions of the parts effential to the perfect formation of the blood,-now that this lofs of balance muft occafion disease, and even death, if the defect be not speedily rectified, we moft readily admit.

But, upon the whole, we cannot confider ourselves as having made any very great progrefs in our attempts to afcertain disease, were we to be fatisfied with the discovery of the neceffity for restoring the loft balance, between the chyliferous and refpirative organs. If the proprietor of a watermill find his mill endangered by a flood, he will certainly open. an additional fluice till the flood be fubfided; but if the accumulation of water be the confequence of fome irregu larity in the machinery of his mill, he may deem it prudent to open a temporary fluice, but will not conceive the evil remedied till he has rectified the part of the machine which was out of order; though the balance between the entrance, and exit of the water fhould be perfectly restored; for he would not confider the flood as the caufe, but the effect of the diforder which he had obferved. In difeafes of the human frame, therefore, while we admit that the balance between the chyliferous and refpirative organs is generally deftroyed, and allow that the temporary reitoration of this balance by mechanical means, is frequently a wife and falutary measure of precaution, yet fomething more, varying according to the nature of the difeafe, will ever be neceffary, before the return to health can be perfectly accomplished. This fomething more, Mr. Watt entirely overlooks in his hypothefis, though in his practice he fufficiently evinces his con

K 2

viction

viction of the neceffity for attending to it with the utmost

caution.

We have endeavoured to give a concife view both of the practice, and of the opinions brought forward by this author; from which we think it will appear, that in the former much judgment, and determined perfeverance is difplayed, while the latter are marked with confiderable thought and ingenuity. That his ideas, however, are not altogether new, will appear from the following extract from a very celebrated author; no lefs a perfonage than Hufen Slawkenbergius, who, in his learned work, de Nafis, thus difputes the poffibility of a nose ever growing to the fize of its poffeffor.

"This event could never happen fo long as a man had but one tomach, and one pair of lungs: for the ftomach being the only organ destined for the reception of food, and turning it into chyle, and the lungs the only engine of fanguification, it could poffibly work off no more than what the appetite brought it: or admitting the poffibility of a man's overloading his ftomach, nature had fet bounds, however, to his lungs the engine was of a determined fize, and ftrength, and could elaborate, but a certain quantity in a given time; that is, it could produce juft as much blood as was fufficient for one fingle man, and no more; fo that, if there was as much nofe as man, they (the disputants) proved a mortification must neceffarily enfue; and forafmuch as there could not be a fupport for both, that the nose must either fall off from the man, or the man inevitably fall off from his

nose.

"Nature accommodates herself to thefe emergencies, cried the opponents, elfe what do you fay to the cafe of a whole ftomacha whole pair of lungs, and but half a man, when both his legs have been unfortunately shot off?

"He dies of a plethora, faid they, or muft fpit blood, and in a fortnight or threee weeks go off in a confumption."

It happens otherwife, replied the opponents." "It ought not, faid they,

&c.

Vide Triftram Shandy, Vol. ii. p. 27.

Seriously, we cannot fubfcribe to Mr. Watt's hypothefis as a whole; and must even with caution admit many of those acute phyfiological and pathological obfervations, upon which he has conftructed it. We much doubt, indeed, whether Mr. Watt himself, (however determined he may appear to purfue his investigations with the most anxious watchfulness), is not unconfciously led, by the warmth of his fpeculative genius, to recommend a practice before he has been furnished with the means of contemplating a fufficient number of facts to demonftrate its propriety. In particular we doubt whether it will be found upon further experience, th

te