A Treatife on Blood-letting; with an Introduction recommending a Review of the Materia Medica. Part I. By Thomas Dickfon, M. D. Phyfician to the London Hofpital. 4to. Is. 6d. D. Wilfon.

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O afcertain the powers of the various articles in the Materia Medica, to adopt the efficacious and useful, and to reject thofe of a contrary character, is a work of the utmoft confequence to the practical phyfician. Notwithstanding the great pains taken by many able men, our Author thinks that little has yet been done towards an accurate and faithful hiftory of the powers of medicines; that the Materia Medica ftill remains in most parts a mere wilderness; and that its defects are in a good measure concealed by the improvements in botany and natural hiftory: which he fays are more amufing and ornamental than neceffary, and of much lefs confequence to phyfic than they are generally fuppofed to be.-This unlimited cenfure muft not pafs unnoticed. The business of botany and natural history, is fo to clafs the great variety of fubjects which make up the fofile, vegetable, and animal kingdoms, that each may at once be diftinguifhed and known: it is poffible indeed, that a perfon may be a good botanist or naturalift, and yet have little knowlege of the powers and effects of medicines; the former, however, naturally and almoft neceffarily leads to the latter; and the ftudent who is ready at diftinguishing the various claffes and fubjects, will enter with more eafe and fatisfaction on the medicinal hiftory of bodies. The fault more frequently lies in the other extreme; our students too much neglect this part of the medical education.

Our ignorance of the genuine powers of medicines, Dr. Dickfon attributes to feveral other causes: these we have collected together. The monstrous cuftom of crouding a multitude of things into one prefeription;-the afcribing folely to the medicines which have been used, the fub equent change of fymptoms, when this has been nothing more than the natural progrefs of the difeafe ;-the power of prejudice in favour of particular remedies; and the too great deference to authorities.—To thefe our Author might have added ;-the mifapplication of mathematics in drawing out laborious and ufelefs explanations of the mechanical operation of remedies; ill-founded theories ;the varieties which occur in the fame remedy, whether from climate or culture ;-thofe idiofyncrafiæ, or peculiarities of conftitution which fometimes difappoint and puzzle the practitioner; -the inaccuracy of authors in relating their obfervations; their carelefinefs in afcertaining the effects of remedies; and the indifcriminate

criminate officioufnels of compilers in tranfcribing and perpetuating virtues which never existed.

Dr. Dickson, who it feems thinks it neceffary that we should return to our A B C, proposes to begin with fuch parts of the Materia Medica as are in molt frequent ufe, and are endowed with the most active powers. To thefe a fair trial fhould be given, by adminiftering them by themselves, and perfevering in their ufe for a proper time; and, as occafion may require, gradually to increase the dofe. The phyfician ought to be well acquainted with the natural progrefs of the fymptoms in the difcafe before him; and for this purpose the hiftories of Hippocrates are judiciously recommended: thefe are hiftories drawn from nature, very little interrupted by the adminiftration of medicines. Sydenham too, when a new epidemic arose, did little more than attend moft diligently to the appearances of the difeafe; and candidly owns, that in this way he lost some patients, before he could form a right judgment of the genius of the dif temper. Thefe obfervations lead Dr. Dickfon to conclude his introduction with a fort of decent hint to the apothecaries."Difeafes, fays he, are feldom feen with their natural faces by a phyfician; for, before he is called, the patient has been either blooded or bliftered, purged or vomited, and perhaps many other things done which give them often a very artificial complexion."

Our Author looks upon the Materia Medica as being in fo des plorable a ftate, fuch, a mere wilderness, that we might suppose the whole art of healing was to be at a stand, till fuch time as he had gracioufly cleared the way. Many excellent workmen, however, have gone before Dr. Dickson ; men who have even borne the heat of the day.-Not to mention a confiderable number whose labours have their merit; we fhall juft refer to Dr. Lewis, who has very ufefully employed much time in his experimental hiftory of the Materia Medica; and has often specified what ingredients might ftill be judiciously retrenched from many officinal compofitions. To name but one more, Dr. Tiffot, in his late Medical Advice to the People, has ftrongly reprefented the abfurdity of leffening the dofe of any certain remedy, fuch as the Bark, by the fuper- addition of any lefs fignificant and efficacious medicine. The Difpenfatory alfo of our college, is defervedly esteemed, and has for fome time taken the lead in Europe: though yet deficient, it has its degree of fimplicity and propriety; and for this we are much indebted to the unwearied labours of an excellent chemyft, Dr. Pemberton. Our phyficians likewise are become more chafte and referved in their prefcriptions it must be acknowledged indeed that we have ftill among us fome moft enormous practitioners; men who throw REV. June, 1765.

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in fuch a weight of compounds, in bolus, mixture, draught and apozem, as they themselves would think it hard, very hard to be loaded with, were they in the place of the poor patient. These are they, who bind on burdens they will not touch with the finger; who take their fees, and prefcribe bountifully for the benefit of the apothecary.-This obfervation can give no offence to the many, who, by their judgment, affiduity and humanity, do honour to the profeffion.

The importance of the fubject has induced us to say so much on the Author's introduction of fcarce eight pages: we shall only add, that fimplicity in every art or fcience is the fureft mark of perfection; and the practitioner who removes diseases with the feweft remedies, will be juftly eftcemed the most able and judicious physician.

As to our Author's Treatife on Blood-letting; we shall give an account of his extenfive defign in his own words. In the introduction (fays he) I have endeavoured to fhew the neceffity of determining with more precifion the effects of medicines; but this in many cafes cannot be done, while the effects of bloodletting remain obfcure, as it is fo frequently used along with them. And on this account likewife I am induced to make an inquiry de novo.

The method which I propofe to make ufe of is, in the first place, to examine the foundation on which the ancients, and all those who preceded the difcovery of the circulation of the blood, built the choice of the veins from which blood was taken away, that we may fee how far it arofe from theory or from obfervation. In the next place, I fhall continue my inquiry in the fame way from that æra to the prefent times, and confider, in the concifeft manner poffible, the different theories. Thirdly, I fhall endeavour, from the writings of authors, experiments and obfervations, to ascertain the effects of blood-letting; and laftly, to fhew in what cafes it is beneficial or hurtful.'

There is little in the prefent publication but references and quotations, to prove that Hippocrates and the fucceeding authors, down to the time of Harvey, are most infufficient authorities on which to establish a choice of veins in blood-letting; that their directions are founded on falfe theories and crude notions of the animal oeconomy.-Poffibly Dr. Dickfon may have confidered his fubject in this limited point of view, and has confined his references to the ancients, to fuch paffages only, as respect the choice of veins, to try how cavalierly he could trample on antiquity. As he is difpofed to be merry, even at the expence of the grave and venerable Hippocrates, we fhall give our Readers a fpecimen of his archnefs. Hippocrates in defluxions on the

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hip, advises to open the veins behind the ears. interefting obfervation that informs us in another paffage, of the confequence of opening the veins behind the ears? nothing lefs than impotence! What a dead fecret this must have been among his male-patients, that were to be cured of their hip-complaints at fuch an expence !'-That fo glaring a contradiction fhould be attributed to a perfon of only common fenfe! That so many things fhould be quoted from Hippocrates which never belonged to him!-'Tis true, indeed, he laboured under many difficulties:-the philofophy of the times was very trifling and defective-the circulation was unknown: He had but a flight acquaintance with anatomy, and little affiftance from the then inadequate knowlege of the animal oeconomy in its found and natural ftate. Let us not therefore be wanton with his necessary imperfections! Let us rather with gratitude admire his many, his great excellencies !-Hippocrates had a genius the most happily turned for obfervation ;-the greatest affiduity; the most commendable integrity; and an amazing degree of judgment and penetration. Had he given the fame finishing hand to all his works, which he certainly did to fomte ;-had not the loofe materials from which he formed the most perfect of his remains, been too religiously preferved; and many spurious writings incorporated with thofe which were genuine; there would have been much less room to charge him with inconfiftencies, forced analogies, or extravagant theories.

On a farther examination of Hippocrates and fome others of the old authors, Dr. Dickfon may poffibly find that their directions, folely as to the choice of veins, were not so very abfurdly founded on crude theories and false notions of the animal oeconomy. By carefully and judiciously attending to diseases, they obferved that nature relieved very painful complaints by hæmorrhages from, or near, the part affected. Of this kind are the critical hemorrhages from the nose, lungs, and hemorrhoidal veffels; which give much greater relief than the fame quantity of blood from any other part of the body. The direction therefore, in painful topical ailments, to take away blood from the part affected, or as near as poffible, is a judicious imitation of nature; a practice confirmed by experience and found reafoning. If our Author will carefully read over that chapter of Celfus, de fanguinis detractione per venas, which he has partially quoted, he will find many excellent obfervations and directions concerning blood-letting.

But to speak more explicitely our ferious opinion of this performance, after no fuperficial confideration of it, thofe cenfures of Hippocrates, Celfus, Mead, and other juftly celebrated medical writers, with which it abounds, manifeftly affume or im

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ply the extraordinary penetration of the phyfician, who has accufed or convicted thefe great men of fo many errors: they must have been intended as pregnant teftimonies of the fuperior experience and abilities of this hofpital phyfician. In vain have we been admonifhed by an excellent Critic, that fuch characters fhould be mentioned with great modefty and circumSpection. Our Author probably intended to defend himfelf from an imputation to the contrary, by profeffing (in a fhort parenthefis) that he is an admirer of Hippocrates; tho', to the beft of our recollection, he never cites him more than once, except to reprehend him. So that what he fays of Celius, carping at Hippocrates, p. 25, feems as ftrictly applicable to himself. Befides, we cannot difcern any neceffity for expofing the errors of Hip. pocrates with regard to Bleeding, fince we may fuppofe his authority, on that point, has very little influence on the practice of those gentlemen, who are best qualified to read and to underftand him and Harvey too. The ignorance of this truly great Father of Phyfic was the ignorance of his time, of that juniority of mankind and medicine, which it may juttly be termed. Our prefent great Author is one of the many heirs, as it were, of the circulation, and of many other anatomical and phyfiological difcoveries. But to draw the jufteft parallel between the abilities of DICKSON and HIPPOCRATES, let us fuppofe them to have been cotemporaries; and perhaps it will not be very difficult to determine, whether the knowlege of their having been fuch would ever have reached our day; or if it had, the latter might probably have been credited with equal genius and eloquence at least, and with a little more candour and modefty, as we can fearcely difcern the leaft trait of either in the prefent lucubration.

We readily admit at the fame time, that in cafes which may affect health, and even life, no authority fhould be too implicitly fubmitted to; but there have been too many instances of perfons rejecting fuch as was very good, with a nullius in verba, who really needed the affiftance of better judgments than their own. One example of this was a noted practitioner and author, who affumed this very motto; and who, in his treatment of a gonorrhæa, directed fuch violent irritating purges, as must have increafed the inflammation, and entailed an obftinate gleet even on many robuft fubjects; while he incurred a great rifque of finking hypochondriacal, hysterical and very delicate perfons into a more incurable ftate, than what he found them in.

Modeftè et circumfpecto judicio de tantis viris pronunciandum eft --ac fi neceffe eft in alteram errare partem, omnia eorum legentibus placere, quàm pauca difplicere maluerim. QUINTIL.