to take exercise, even on horseback, after seven o'clock in the morning, during the coolest season; and, as there is hardly any twilight within the tropics, he would not be able to enjoy the coolness of the evening, in this way. If we have found cause to condemn Italy as a summer residence for consumptive patients, there seems no just reason why we should commend the West Indies, even in winter, the temperature of which is above the summer temperature of any place in the south of Europe. If to this consideration we add the numerous privations, annoyances, and discomforts which are almost inseparable from a residence in the West Indies, I think we might almost be justified in erasing these islands from the list of places suited to the phthisical invalid. Among other contingent disadvantages may be mentioned the difficulty of procuring houses in proper situations, the expences of living, the annoyance of musquitoes, sandflies, &c. &c. "If to these objections, founded on an impartial consideration of the nature of the climate and of the disease, we add those of a more conclusive nature, derived from the experience of medical men, I conceive the question of the propriety of sending patients labouring under confirmed consumption to the West Indies, will be set at rest for ever.

"In the first place, I may remark, that tubercular phthisis is by no means rare, even among the white inhabitants of the West India islands, while it is of frequent occurrence among the black; and it is not uncommon for individuals affected with this disease to migrate in search of health to a more northern cli

mate.

"These circumstances, however, although properly noticed here, are not adduced as arguments against the propriety of sending consumptive patients to the West Indies; because we find phthisis prevailing, in a greater or less degree, among the natives of every civilized country in the world. But a very different conclusion must be drawn from the fact confirmed to me by numerous medical friends, who have resided in the West Indies-that consumptive cases sent thither proceed much more rapidly to a fatal termination than in temperate climates. And, indeed, this is what we should expect, a priori, from considering the nature of the disease, and the well-known influence of the summer climate of the south of Europe on its progress. I am not, however, prepared to maintain that cases of consumption do not occasionally present themselves, in which, even in the advanced stages, a temporary residence in the West Indies might not prove useful. But I do venture to affirm, that such instances are of comparatively rare occurrence, and I would scarcely attempt to designate them. If there are any such, they will be found among the more chronic examples of the disease, which occur about the middle period of life, and which are attended with little constitutional excitement. But I advance this merely as a suggestion, founded on what I know of the disease, as occurring in certain constitutions, and the effects of climate upon these, rather than from practical experience of the effects of that of the West Indies. More extended experience, and more accurate, observation than has hitherto been applied to pulmonary invalids sent abroad, can alone enable us to speak positively on this point. In the mean time, every thing that we know regarding the nature of consumption, and the influence of a high temperature on it-supported by our practical experience of the effects of the climate now under consideration, bear us out in laying it down as a general rule-that the climate of the West Indies is an improper one for consumptive patients." 24.

In respect to those people who are only predisposed to phthisis, or what is called threatened with that disease, there is some diversity of opinion among resident practitioners in the West Indies. The subject indeed is a difficult one to investigate. Dr. Ferguson is in favour of the climate as a prophylactic; but much will depend on the nature of the individual's constitution, viz. whether it is calculated to bear the heat of a tropical latitude, or likely to sink under the irritating and exhausting effects of heat.

"When the morbid condition of the system, which gives reason to fear the approach of phthisis, depends chiefly upon hereditary predisposition, and occurs in early life, especially in feeble, irritable constitutions, the climate of the West Indies will disagree. When it occurs at a more advanced period of life, and in a constitution free from much disorder of the nervous system, and of the digestive organs, a temporary residence there may prove useful. The revolution effected in the distribution of the circulating fluids and in the secretions, may have the effect of enabling a constitution in which there exists considerable powers, to overcome the tuberculous diathesis." 26.

The inconvenience of the voyage, especially to females, and the want of accommodations and comforts in a foreign and tropical climate, are circumstances which ought also to be well weighed before undertaking such an important step. In fine, we may safely conclude that the cases of consumption in which the climate of the West Indies promises advantage are very few, and their characters scarcely ascertained-if ascertainable; while those in which it produces mischievous effects are numerous, and generally wellmarked. "Even of persons predisposed to the disease, the proportion can be but small who are likely to be benefited by the climate." Chronic diseases of the bronchial membrane are those most likely to be ameliorated by residence in the West Indies, especially if the constitution be otherwise tolerably sound. This is the opinion of Dr. M'Arthur, the talented physician of Deal, who resided several years in Antilles. He considers the climate of the West Indies, however, as unfavourable to asthma. In stomach complaints there can be no doubt that a tropical climate, east or west, is injurious. Chronic rheumatism has been supposed, more from theory than observation, to be one of those maladies for which a tropical climatemust offer advantages. The authority above-mentioned, Dr. M'Arthur, considers the climate of the West Indies as favourable to those cases where the constitution is otherwise sound; "but when the health is deteriorated (and it is seldom otherwise) the powers of the digestive organs weakened, or the disease attended with profuse perspirations, nothing but a return to a cooler climate can save the patient." Nothing, indeed, is a more common cause for invaliding.

In scrofula affecting the external parts of the body, the West India climate has been considered as favourable, especially by Dr. Ferguson.

Of all the West India islands, Barbadoes is probably the best for an invalid, being cultivated throughout, free from marshes, level for exercise, and furnished with many accommodations. The capital, however, (Bridgetown) is not very salutary—the most salubrious part of the island is a place called Scotland, 800 feet above the level of the sea, and for ever fanned by the trade winds. It is remarkable that change of air, even from one healthy island to another, has always been observed to be highly beneficial-and this is one cause of the salutary effects of travelling. Kingston, the capital of St. Vincent, has the singular advantage of being built in a salubrious situation on the shores of a fine bay. It is therefore a healthy residence. A cooler station may be found by ascending the mountains; but no accommodations are there to be expected.

The reader will perceive, from this short article, that considerable and valuable additions have been made to this new edition of a work which will become a classical standard of reference on the subject, for the profession. in this country.

XI.

RETROSPECTIVE REVIEW.

HAVING cleared our score with the current publications of the day, we shall now try back on our retrospective plan, and present our readers with the analyses of some important works which are unknown to the juniors of the profession and forgotten by too many of the seniors. It is surprising, indeed, how soon even the best productions are buried or swallowed up in the vast torrent of works which issue from the press-so that it is only by recalls like these, that they are preserved from annihilation or oblivion! We are convinced, therefore, that an occasional reminiscence of this kind will be a useful labour-more useful perhaps than a search after what is called novelty.

ESSAYS ON HYPOCHONDRIACAL AND OTHER NERVOUS AFFECTIONS. By John Reid, M.D. Member of the Royal College of Physicians, London; and late Physician to the Finsbury Dispensary. 8vo. pp. 272.

So close is the connexion of the mind and the body, and such is their mutual influence in action or suffering, that in no possible case of human life, can the one be affected without producing some impression on the feelings of the other. Yet this truth, which has never been denied even by the sternest stoic, or the most subtle metaphysician, has attained universal assent, rather as an article of sensation than of science; as being the compulsion of experience more than the result of enquiry. Some men may call in question the liberty of the human will; and others may weave a fine spun chain of arguments against the existence of matter and the reality of an external world: but after all, whether our thoughts are strung together by necessity, and our movements are impelled by causes over which we have no control; whether the forms that occasion pleasure or pain are substantial or ideal, still the conclusion is the same, as it relates to the sympathy by which the mental and corporeal faculties mutually operate to the ease or disquiet of the entire system. It is, therefore, mortifying to the pride of man's wisdom, that in an age which, above all others, has pushed with the greatest effect the energy of philosophical investigation into the hidden mysteries of Nature, which has traced the minutest essences through a variety of modifications to their elemental principles, with an assiduity that claims applause, and a success that commands admiration; still, after all, and to abate the swell of vanity arising from this consciousness of intellectual superiority, man is made to confess that he knows more of the world around him, than of that which he carries within his own compact form. They who, more than others, are obliged to study the constitution of the human frame, and to extend their inquiries into a vast variety of scientific objects, that they may be qualified to render that study complete and beneficial, even the professors of the noblest art that can engage the time and the talents of man, are in like manner compelled to acknowledge their total inefficiency to account for the aberrations that so frequently disturb the machine with which they are most acquainted. This crux medicorum is the more distressing, because while it urges application, it confounds the judgment; and at the same time that it calls for the discovery of a remedy, it baffles hope, in being under the necessity of leaving that to chance which can never be de

termined by any certain principle of operation, or be regulated by any rule of practice. Without presuming to advance that the awful malady of Insanity, in all its shades of gradation, can never become so precisely defined as to admit of medical management with a probability of success; we must at least be allowed to say, that hitherto our acquaintance with mental diseases has gone little further than to an observation of general causes and effects, over which professional skill may exert its best efforts in vain. With this impression on our minds, we took up the present volume, in the expectation of seeing much ingenuity wasted in an attempt to remove that opprobrium of medical science, which the subject of insanity has so long proved. We were prepared, indeed, from what we had with pleasure read in the periodical reports of the author, to meet with some acute and lively remarks on extraordinary cases, as also with sagacious counsel in regard to the means employed for the relief of persons affected by nervous disorders. But we had no thought that in a book bearing an unassuming title, and upon an unpromising topic, would be found so many new lights, in the simple form of hints, on the various excitements to mental disease, and upon the injudicious manner in which they are too commonly treated. That the author has been prevented from fulfilling his original intention of publishing a systematical treatise on the subject, is rather a matter of congratulation than otherwise; as, by throwing out his observations in the form of Essays, he has rendered his work more likely to become popular and beneficial, by bringing it immediately to the view of those who would be alarmed at the thoughts of perusing any thing like a theoretical or argumentative performance.

The Essays are twenty-seven in number; and although they have not the formality of a connected arrangement, yet, as if the maxim of Horace had been under contemplation, the reader will find in his progress, that the order could not have been better disposed, even to constitute a train of leading principles.

The first Essay is "On the Influence of the Mind on the Body," in which consciousness, as the peculiar faculty of man, is set forth in strong and elegant language. The following remark, at the close, strikes us as equally new and important.

"The class of persons whose lives are devoted to mere manual labour, especially the more indigent part of them, are, to a certain extent, distinguished by the character of their diseases, as well as that of their other evils. They differ from the higher orders, less perhaps in the actual quantity, than in the glaring and obtrusive colour of their calamities.

"There is no person, perhaps, who is apt to form so low an estimate of the value of human existence, as a medical man practising amongst the poor, especially amongst the poor of a great city. But it is not impossible that he may exaggerate the excess of their sufferings, by combining, as it is natural for him to do, their external state with those feelings which he has acquired from very different circumstances and education. As the horrors of the grave affect only the living, so the miseries of poverty exist principally, perhaps, in the imagination of the affluent. The labour of the poor man relieves him at least from the burden of fashionable ennui, and the constant pressure of physical inconveniences, from the more elegant, but surely not less intolerable distresses of a refined and romantic sensibility. Even those superior intellectual advantages of edu cation, to which the more opulent are almost exclusively admitted, may, in some cases, open only new avenues to sorrow. The mind in proportion as it is expanded, exposes a larger surface to impression."

Essay II. On "The Power of Volition," exhibits some curious cases, wherein several persons have been known to "possess power not only over

the feelings and faculties of the mind, but likewise over what are called the involuntary muscles, and even the blood-vessels of the body." But, amusing as this part of the Essay is, what the author has observed on the inhumanity of treating hypochondriacs with ridicule, is better adapted to improve the feelings and to regulate the practice of men.

"No one was ever laughed or scolded out of hypochondriasis. It is scarcely likely that we should elevate a person's spirits by insulting his understanding. The malady of the nerves is in general of too obstinate a nature to yield to a sarcasm or a sneer. It would scarcely be more preposterous to think of dissipating a dropsy of the chest, than a distemper of the mind by the force of ridicule or rebuke. The hypochondriac may feel indeed the edge of satire as keenly as he would that of a sword; but although its point should penetrate his bosom, it would not be likely to let out from it, any portion of that noxious matter by which it is so painfully oppressed. The external expression of his disorder may be checked by the coercive influence of shame or fear; but in doing this, a similar kind of risque is incurred as arises from the repelling of a cutaneous eruption, which, although it conceal the outward appearance, seldom fails still more firmly to establish the internal strength, to increase the danger, and to protract the continuance of the disease. By indirect and imperceptible means the attention may, in many instances, be gently and insensibly enticed, but seldom can we with safety attempt to force it from any habitual topic of painful contemplation. In endeavouring to tear the mind from a subject to which it has long and closely attached itself, we are almost sure to occasion an irreparable laceration of its structure."

In the third Essay, "On the Fear of Death," the reader will meet with much excellent reasoning, to dispel apprehensions which are, in themselves, more tormenting than the object of dread. The author deprecates all tendency to encourage despondency; and among the rest, he shows the fatal effects of predictions of death.

"In dangerous maladies, the person in whom there is the least fear of dying, has, other circumstances being the same, the fairest chance to survive. Men, in critical situations, are apt to be overwhelmed by their terrors; they are drowned by their too eager struggles to emerge; they would keep afloat, if they remained quiescent."

The effects of PRIDE on the mind in producing mental derangement, constitute the subject of the fourth Essay; in which we were much pleased with this judicious discrimination in the mode of treating different persons. "The humbly nervous ought to be treated with the most encouraging respect, and with the most courtier-like attention. We should endeavour, by expressions of an extraordinary regard for them, to supply the want of satisfaction which they are apt to feel with themselves. On the other hand, a haughty imbecility ought to be met by a management that is calculated to depress the patient in his own eyes, and to sober a spirit that may have been intoxicated by draughts of a servile or treacherous adulation."

The next Essay is on "Remorse," which, beyond doubt, is one of the most dreadful of all diseases when it has become fixed in the mind, and the most difficult to cure. But it should be considered, and the author has prudently laid great stress upon the fact, that remorse is not always occasioned by actual misconduct. It is in truth, perhaps, no less frequently the suffering of a tender and upright mind, than of a guilty conscience. Of this we have in addition to some well known cases, the following; which came under the observation of the author himself.

"It is not very long since I had a professional opportunity of knowing something of the morbid history of a man, who had succeeded to a peerage, and an