magnify them to be. Flattery injures the giver, without benefiting the receiver. Certain of our physicians are qualified as excellent writers, while it is plain from their works that they are ignorant of the elementary rules of the art of writing. .....Chénier has exactly defined the qualities that a good critic ough to possess. The ignorant person, he says, does not see what is beautiful; the detractor will not see it; the critic sees it, and puts it in evidence. He speaks of great authors that have passed away with respect, but not with idolatry. He is just to the dead, just and benevolent to the living. He does not limit himself to the admiration of grand works, but pays a tribute of esteem to useful labours. Criticism is the science of taste illuminated by justice...........The end of criticism is to instruct. To fulfil it a journalist should possess profound and varied knowledge, in order to judge soundly of the relations to the medical sciences. A vast erudition must be accompanied by the art of writing, and especially by good taste; without which his criticism would disgust his readers. And in giving an account of a new book, he should avoid every kind of digression, follow the path of the author, and bring forward his principal ideas, either to approve them, or compare them with others analogous, put forth by contemporaries or by the older writers-endeavouring always to vary his style according to the theme, in order to sustain the attention. The nature of the materials submitted to his criticism does not prevent him from writing with the necessary elegance." (pp. 48-53.)

We pass without further comment to a chapter on the "age of the physician." It is written to show that talent and not years is the true test of the practitioner; that knowledge makes a young man old, ignorance an old man a tyro.

In a following chapter on "literary habits in medical men," it is justly argued that he who devotes his whole time to the study of medicine does well, but that he who studies with equal ardour, and yet employs some time in general literature, does much better. The belles lettres have the same effect upon the intellect that an excellent diet has upon the body. Haller and others are quoted as proofs that physicians may be good poets; but the author strongly dissuades them from publishing the verses they compose as a pastime. He thinks the ridicule attached to an indifferent poet compromises the dignity not only of the professor but of his art. The study of moral philosophy is recommended from its numerous relations with medicine. We thus trace the formation of ideas, the rules that ought to direct life, the paths to happiness, the influence that different climates exercise over the physical powers of man and on social institutions, the power of regimen upon the passions and intellectual faculties, and that of disease upon the operations of the intellect. We advance even to the operations that constitute the function of intelligence and determine the will, and learn to decipher the various characters of the passions. Nothing can ever separate the study of the physical man from the study of the moral man.

After a long chapter successfully combating the charge of atheism and irreligion brought against medical men in general, the author treats on the relations of physicians with each other. We are sorry to see it stated that "in general true friends are rarely found among individuals of the same profession; envy and interest are in opposition." (p. 98.) It says little for our Italian friends. The medical philosopher should be superior to the petty calculations of sordid interest; it is only base minds that envy affects. This the author fully allows, and urges the most scrupulous

delicacy in all our dealings with each other. One of his hints will not be understood in Italy only.

"Nothing can be more shameful than the transactions which take place between some physicians and unscrupulous druggists. Every physician who feels the dignity of his profession will reject these illicit gains and vile associations." (p. 139.)

It is not every day that we can look over a series of portraits of the professional men of any nation, drawn by one of themselves; but here, in a chapter "on some defects which should be avoided in practice," there is quite a little picture gallery. We shall follow the guidance of Dr. Sava, and act as interpreter to our readers.

"1. On routine, or mechanical practice. The routine physician practises an art, the philosophical principles of which are unknown to him. Without good founda tions, without medical genius, he reasons solely upon the perceptions of the senses. Aged in his ideas, indifferent to the progress of science, he obstinately confines himself within the limited circle of certain actions; and all his knowledge, all his ability, consist in seizing the first appearances of things, and in prescribing certain formulæ. He resembles the pilot in a tempestuous sea covered with rocks, who is ignorant of the existence of the compass as a guide in navigation. Very ignorant, therefore stubborn and obstinate, he is incapable of supporting the arduous labour and profound meditation that the difficult art of recognizing and curing diseases require from the practitioner. Like a machine, the wheels of which always determine the same effects, the routine physician always repeats the same acts. His indolent, dull, obtuse intellect is never applied to reflection, and abhors everything that has an appearance of labour: observation to him is dumb, and its brilliant light cannot clear away the dense cloud which closely covers his eyes. "Many varieties of routine physicians may be distinguished-some, servile imitators of the ancients, are far from supposing that twenty centuries of experience have wrought any progress in medicine. Hippocrates was a great physician, yet he was not acquainted with tartar emetic and quinine-therefore in their opinion quinine and tartar emetic are useless remedies. Such physicians declaim against vaccination, and in general against all the discoveries of genius. Others unite to the most profound ignorance-to the absolute incapacity of appreciating the merit of the ancients, a stupid pride which will not allow them to recognize anything valuable in their contemporaries. No principle guides them, and they might paint themselves approaching blindfold the bedside of a patient, close to which death stands watchful and prompt, raising an axe impelled by chance. . . "It is difficult to visit a great number of patients and defend one'sself from the tendency to blind medication induced in man by the natural slothfulness of his intellect, and on this account routine physicians especially abound in hospitals. "These persons recognize a disease at a single glance-that which presents the most difficult diagnosis is characterized most easily by them-nothing embarrasses them. After a few questions made for form's sake to the patient, they mechanically prescribe a formula, which the student, after having heard the indicating word, writes at full length in the visiting-book. This is all their art—this is their conduct, always the same. But these practitioners, the number of whom is fortunately inconsiderable, scarcely know the faces of their patients.

"Some physicians become machines as they grow old; age does not allow them to follow the progress of science, or subject themselves to new studies: obstinately attached to their old doctrines, they will vary nothing; everything new they treat with disgust and disdain, and thus they never read. After fifty years of medical practice it is impossible for them to adopt other principles, different from those they have acquired, and been accustomed so long to follow.

"2. On presumption. Do not ask this doctor what he knows, but rather what he is ignorant of. He has read everything, has seen everything; the most delicate surgical operations to him are mere pastime; nothing confounds him his genius foresees everything, undertakes everything. He speaks in magnificent periods, and considers it dishonorable to appear ignorant of anything. What diseases has he not cured? Confirmed cancer and hydrophobia in his hands have ceased to be incurable; without vanity he believes himself to possess all the knowledge that he can have, or can even acquire: the first aphorism of Hippocrates has no signification for him: in him he believes that the power and genius of Esculapius self are infused.

In

"3. On timidity. This physician has great talents, profound and vast knowledge, yet he does not succeed, and will never occupy a part in the hierarchy of his profession; and with the most extensive acquirements, he has the appearance of ignorance. Question him-his replies are most confused and inexact. The most simple cases alarm him—he detests acting, and always does it with fear. vain nature announces a favorable result―still trembling he dares not second her. He has never felt those sudden unlooked-for inspirations which reveal to the man of genius the character of a disease complicated in its progress and diagnosis, and make him discover in untrodden paths the means of overcoming its violence and obstinate resistance. Thus he loses in deliberation the favorable opportunity and the moment of risking with advantage. Such a physician does not kill his patients, but he lets them die.

"4. On false judgment. Some physicians puff themselves up with pride, boasting scepticism in their science. Free from every prejudice, they regard the precepts of the oracle of Cos as idle nonsense. Immoveable in their opinions, they Jook upon the most authentic facts as fables, and the art of knowing and treating disease is, in their eyes, quackery founded upon the ignorance and credulity of the vulgar. But how are we not imposed upon by persons initiated into all the secrets of medicine? How suspect them of unfairness, when in truth they make the sacrifice of so many years of study of such painful toil? In this manner many ignorant persons argue. Still the impartial man soon discovers in these pyrrhonians, these empirics, that, disgusted by an unfortunate practice, they impudently accuse medicine of the errors exclusively imputable to their own ignorance. Without learning or talent, ignorant of the elementary principles of science, with judgment essentially false, in order to appear freethinkers in the profession, they slander that of which they are ignorant, condemn everything they are incapable of comprehending, and become a mark of the public contempt for daring to exercise a calling they themselves condemn as useless to society.

Other physicians perceive nothing obscure in the science of humanity. Nature has no secret they cannot discover-no veil hides from their penetrating regard the mysteries of our organization. There are no diseases they cannot perfectly explain and cure. They regulate themselves blindly by all the observations contained in books, and all the axioms of Hippocrates appear to them immutable truths. Experience would accuse their doctrine in vain-the teacher has said it,they reply in his defence that he is never deceived. Thus for them all new discoveries in science are valueless, indeed they will not suppose them true, All the phenomena, all the changes that a disease presents during its course, depend in their eyes, not upon the efforts of nature, but upon the drugs they have administered, however inactive and useless these may have been, and with their lofty idea of the powers of medicine. They imagine that none of the evils which

⚫ We once heard an old and experienced physician of this stamp declare, that though he had practised medicine fifty years, he had scarcely ever left a patient's house without feeling a desire to go back and alter his prescription! And yet our friend was a man of great intellectual power and much learning. He was only singularly deficient in force of character, or, as the phrenologists would say, in combativeness.-ED.

afflict the human species can resist them; and indiscriminate dispensers of tonics, bloodletting, emetics, and the more active remedies, they still think that they must act, and act with all energy.

"These are fanatics in medicine: such are the enthusiastic partisans of any doctrine. Let every one beware of censuring their venerated idol; if he should have such temerity, the abuse vomited from their mouth would equal in quantity the words that Homer makes the aged Nestor deliver in public discourse, comparing them to sheets of snow impetuously falling. They are filled by exclusive admiration, and despise even what is judicious in other schools." (pp. 140-7.)

We have given this chapter at length as a good specimen of the author's style-perhaps the portrait painting is not altogether free from caricature, but if it be true that men are more readily laughed out of their errors than preached out of them, it may not be without its good effect. The succeeding chapters "on the mode of questioning patients," "on the patience, prudence, charity, discretion, chastity, philanthropy, and magnanimity of the physician," "on the peculiar qualities of the surgeon," "on the duties of physicians to the dying," "on mental medicine," and "on fees," are sound and sensible, but rather too commonplace to be adapted to our pages. That on mental medicine is perhaps the worst in the book, being merely a superficial glance at a most important and interesting subject. We felt almost tempted to preach a sermon on the author's text, but our space is already exceeded, and we must close with thanks to Dr. Sava for a well-written and interesting book, full of sound, sensible, and acute observation. The only fault we find with it, is that self-love and self-interest are too much worked upon as main-springs of conduct, to the neglect of those high feelings of honour which should guide every one in his course through life.

On looking over some of our remarks on the manners of the physician, it seems to us possible that some of our readers may be led to believe that we attach undue importance to superficial accomplishments. We wish, therefore, to observe here, that, while we consider a deep and thorough knowledge of his profession to be the real claim of every medical man to distinction and reward, we are desirous that these claims should not be obscured by inattention to minor matters. The grand difference between the well-bred and ill-bred man, lies in the degree of attention paid to the feelings of others. A man of common sense, with a moderate supply of good nature, just sufficient to make himself cheerfully undergo a little self-denial for the sake of others, cannot be guilty of any real offence to good breeding. It requires a certain amount of observation and knowledge of the world to acquire unembarrassed, easy, and graceful manners; but the more the power of such manners is insisted upon in covering the want of merit, the more clearly do we see their influence in adorning it.

ART. XI.

Scrofula; its Nature, its Causes, its Prevalence, and the Principles of Treatment. By BENJAMIN PHILLIPS, F.R.S., Assistant Surgeon to the Westminster Hospital.-London, 1846. 8vo, pp. 379.

THIS is one of the few books which may be said to be after the critic's own heart. It is a book that was wanted; the object of it is excellent; it has been carefully planned; the investigations required by the plan have been conducted with the utmost energy, industry, and carefulness, in a sufficiently extensive field, and over a sufficiently long period of time; the immense mass of materials thus obtained has been examined and weighed with the greatest attention and impartiality; the inferences and results have been honestly and cautiously deduced and elaborated, and condensed into the smallest possible space consistent with perspicuity; while the whole style and manner of the composition is such as ought to characterize the production of a well-educated, a learned, and an experienced surgeon. In saying thus much, we are far from implying that the work is a perfect one; and we suspect that the author is himself the last person who would claim such a character for it. It is, however, but doing simple justice to Mr. Phillips to state, that we believe the work to be as complete as it could well be made under all the circumstances of the case. Though generally agreeing with the author in his views and conclusions, we occasionally differ with him in both; and in presenting to our readers as fair and complete an analysis of his book, as we can, we shall not hesitate to display what we may regard as its errors with the same freedom as we hold up its manifold excellences to the admiration and imitation of his brethren. It would be paying the author of such a book a compliment most unworthy his acceptance, to hesitate to express our honest and candid opinion on any of the questions discussed in it, whether that opinion was in unison with his own or in opposition to it. His object, like ours, is to reach the truth; and he will not, we are sure, quarrel with us or any one else who can aid him, even in the least degree, in attaining it.

We cannot do better than introduce our review of this work in the words of its author.

"In the course of my professional practice, and especially in the discharge of the duties entrusted to me as surgeon to a large metropolitan infirmary, the treatment of scrofulous affections formed a subject of frequent and anxious consideration. I often felt desirous to relieve myself of anxiety, by consulting the experience of others, as recorded in their published works, but I found that something was wanting in all those to which I referred-too much was assumed, too little carefully examined; and although many of the works on scrofula which we possess have deservedly acquired a high reputation, at an early stage of my investigations I was led to the conclusion, that much was yet wanting to complete our knowledge of the disease . . . Fully satisfied that a more extended collection of facts, and a more accurate classification of phenomena than had yet been attempted, were necessary and practicable, I entered upon the task which has now been brought to a close, and men who have been engaged in such extensive and minute inquiries can alone appreciate the patient labour which has been devoted to the work.

"The materials which I have obtained and used, are probably the most ample