Les trésors spirituels couleronts par torrens, Et notre Dieu se montre à l'homme tel qu'il est ! ! ! ' Here M. VILLEMER gets above the stars: but, when he is in the midst of them, he does not shine; and the astronomical science which he displays receives no attractive lustre from his verse. ART. IX ie. Description des Maladies de la Peau, &c.; i. e. A Description of Diseases of the Skin, observed at the Hospital of St. Louis and a Detail of the best Methods that have been adopted in the Treatment of them. By J. L. ALIBERT, Physician to that Hospital and to the Napoleon Lyceum, Member of several Aca demies, &c. &c. No. 1. Imperial Folio. Paris. Imported by De Boffe, London. Price 31. 13s. 6d. R EPORT has for some time apprized us of the appearance of this splendid work; and indeed the first number has been suffered to lie a few months on our table, in the hope that we might receive some additional parts of it. Despairing, however, of obtaining them at present, we shall now communicate to our readers the result of an examination of its commencement. With regard to its magnificence, fame does not appear to have exaggerated; since it is one of the most superb medical publications that ever issued from the press: the paper and type being admirable, and the engravings beautifully executed. Having paid this tribute to its external form, we must now look into its professional and scientific merits. The first circumstances which arrested our attention, and on which we stumbled at the very threshold, are the exces sive egotism of the writer, and the pompous vanity which pervades his style. We shall quote the introductory sentence in his own words, since it were almost hopeless to endeavour to transfuse their full import into our language :—' j'entre dans une carriere presque deserte, où peu d'hommes ont pénétrés avant moi, où aucun travail anterieur ne m' a servi de guide, où tour est nouveau pour l'observation, où tout est probléme pour la pensée. J'ai frayé moimême la route que je parcours. Qu'on juge des nombreux obstacles dont il m' a fallu triompher! This exordium is indeed truly Gallican, and worthy of the great nation; whose aspiring genius will not permit them to profit by the labours of their contemporaries, and who systematically undervalue every thing that is produced on this side of the English English Channel. We feel at a loss to determine whether this declaration of the present author be really the result of his ignorance; whether a person entering on the publication. of a medical work unequalled in expence, and intended to supersede every thing that had been previously written on the same subject, could possibly be so totally unacquainted with the labours of his predecessors as he is here represented; and whether an eminent practitioner in Paris, professing to write a complete treatise on the diseases of the skin, and to illustrate his descriptions by engravings, could be uninformed that exactly the same path had been trodden in this country by Dr. Willan. Whatever be the real state of the case, the fact is that M. ALIBERT refers only once to our countryman, and that in the most general way; while no other writer, antient or modern, who has attempted to arrange cutaneous diseases, is even once mentioned. We have, in course, no synonymes, no comparison of the author's descriptions with those of others, no criticisms on former nomenclatures; every thing rests on his sole authority; and the whole medical world is expected to yield an implicit obedience to this selfcreated dictator in medical science. It is not, however, solely of the arrogance and presumption displayed by M. ALIBERT that we must complain. Even admitting that his knowlege is so decidedly superior, and his means of observation so much more extensive than those of every other person, as to warrant him in his neglect of them, and to give him that marked pre-eminence which would justify his attempt to erect a new and independent system, still his work lies open to severe animadversion. Had he but condescended to have followed the example of Dr. Willan, he would have begun by tracing out the general plan of the classification which he proposed to adopt, have given accurate definitions of the terms which he meant to employ, and have minutely described the primary affections which contribute by their modifications to form the diseases that fall under the inspection of the practitioner. An example of all this he would have found in Dr. Willan: but it did not assort with M. ALIBERT's plan to bring into view any rival publication, and he adopts every means of preventing his readers from forming comparisons. Instead of the kind of introduction to which we have referred, he has given a long preliminary discourse filled with rhodomontade and egotism, containing much uninteresting matter, and very little that is to the pur pose. We find remarks on the influence of different external circumstances on the diseases of the skin, such as the effect of temperament, season, diet, sex, &c. purporting to be the result result of the author's observations deduced from his hospitalpractice but they are stated in too vague and cursory a manner to enable us to derive any advantage from them. The present Number is entirely occupied with a description of the different kinds of Tinea. We do not, however, meet with any generic definition of tinea; nor do we, after having perused these pages, precisely comprehend what the author includes in his idea of this disease. It is divided into five species, the characters of which we shall quote from his pen, in order that our readers may obtain some judgment of his nosological abilities: 1st. Tinea favosa ;-Tinea in which the crusts form tubercles of a yellow colour, some of them single and circular, others joined together, and constituting large plates on the hairy scalp; the centre of them is depressed in the shape of a cup, and the edges are prominent and raised, so as to give them some resemblance to the cells of a bee hive. - 2d. Tinea granulata ;-Tinea the crusts of which form tubercles of a colour sometimes yellow, sometimes brownish, of a very irregular and very unequal figure. These tubercles have neither excavations nor hollows on their summits, a circumstance which obviously distinguishes them from the preceding species.-3d. Tinea furfuracea;-Tinea not forming crusts but branny scales, white, more or less thick, sometimes moist, and adhering to the hair by means of a viscid and fœtid exudation; detaching themselves very readily from the head.-4th. Tinea asbestina ;-Tinea never presenting crusts, but shining silvery scales, which by their concretion mat together the hair into bundles, whose silky and glistering appearance strongly resembles amianthos.-5th. Tinea mucifera ;-Tinea presenting yellow crusts, which are easily detached from the hairy scalp, or furnish a mucous matter which encrusts the hair in masses and layers. This tinea is not confined to the hairy scalp, but sometimes spreads over the forehead, face, temples, and ears.' After these definitions, the question that obviously occurs is, do they correspond to the appearances which we have usually observed, and are we able to recognize the different varieties which M. ALIBERT has described ? We must answer in the negative; since, as far as we can understand the meaning which he attaches to the term tinea, we do not think that either his plates or his descriptions convey the precise idea of the disease which generally falls under our notice; we have never observed those differences in the forms of it which could enable us to divide it into the distinct species here detailed by the author; and we are also of opinion that his account of its effects is much exaggerated. We are aware that something may be owing to a difference of climate and modes of life, and many striking instances of this kind are known to exist: but, making a fair allowance for the probable probable variation of London and Paris, we are still under the necessity of observing that the author's distinctions are more fanciful than real; and that his plates must, to a certain extent, be considered rather as tallying with his accounts than as correctly copying nature. Having given a description of each species of tinea, M. ALIBERT makes remarks on its history, pathology, and treatment, and relates a number of cases. Some of his statements are curious, and deserving of attention: but we are throughout irresistibly impressed with the idea that they are much overcharged. To illustrate this conviction, we shall quote one passage among many others that might be selected. Speaking of the local effects of the disease, he says; The hairs are soon inundated with this impure matter, which, being coagulated by the action of heat and air, causes them to be glued together. The waves of this viscid humour, which flows from an abundant source, and which sometimes resembles melted resin, follow and propel each other reciprocally, if we may use the expression. Thence proceeds a multitude of crustaceous or scaly layers, which form by their union a horrible and hideous covering to the head. But under this covering resides a putrid sanies, which attacks the skin, corrodes the hairs even to their bulbs, consumes the neighbouring mucous tissue, and threatens even the bony substance of the cranium. Some patients become a prey to nocturnal and severe pains. Some fall into a dreadful emaciation, which ar progress of their growth.' rests the Respecting the nature of the disease, the writer's opinions are very strongly tinged with the doctrines of the humoral pathology. Although he disdainfully rejects the notions of the antients, who ascribed cutaneous diseases to a degenerated bile, to acid, alkaline, or acrid humours, to the vitiated or corrupted blood of parents or nurses, and applies to them the degrading title of scholastic verbiage',-yet we do not observe that his own hypothesis, attributing these affections to the existence of a morbid humour pervading the body, which by escaping from the surface prevents other more formidable complaints, has either a better foundation in fact or is possess. ed of more antecedent probability. This hypothesis, however, lies at the foundation of all his pathology, and materially influences his method of treating the disease. The ensuing paragraph contains the principal proofs which he adduces in its favour: It appears that we must compare the crustaceous or scaly matters of which the hairy scalp of children purges itself, to the different gums or juices of which trees rid themselves by the bark, when they are elaborated by a too great organic activity; and these eruptions eruptions are almost always the result of the exuberance' of the vital principal, for which nature provides a discharge. The vulgar even are convinced of this truth; and thus we often see mothers in the lower classes regret that their infants are without these eruptive complaints, and attempt to produce them. Persons of the greatest experience in the profession have the same wish. This remark particularly applies to the superficial ulcerations that constitute the mucous tinea, which we every day endeavour to bring out by topical stimulant applications. It is impossible to controvert the happy effects that are derived from them.' With regard to the superstition and folly of the vulgar, we cannot wonder at any extent to which they may be carried: but we are rather surprized to find that the practitioners of Paris consider these loathsome diseases as salutary or desirable. It is really shocking to observe that they have the temerity to push their hypotheses to such an extent, as even to inoculate children with the matter of tinea, with the express intention of producing the disease on them. This is the more remarkable because, at the very time that we are amused with stories of the beneficial effects of these scabs and ulcers, and are told that they are nothing but the exuberance of the vital principle, we learn that they are the product of famine, misery, and wretchedness; that their effects are most distressing both on the mind and the body of the sufferers; that they are extremely difficult to cure; and that they have a tendency to become hereditary. On the cure of the disease, the author's remarks are meagre and unsatisfactory. His mind, indeed, appears to have been in a continual struggle between hypothesis and experience; so as to render it doubtful whether he would cure tinea if he could, or whether he could if he would. He seems to be strongly impressed with an idea that a speedy cure is dangerous, and dissuades from the attempt; yet we find that he has tried the most powerful applications, and after all has not gained his point. An adhesive plaister is minutely described, which is used in the same manner with the pitch plaister in this country, and by which the hairs and scabs are all to be torn off together. This cruel operation, however, is not represented to have been generally successful; nor were the results more favourable when metallic ointments or washes, cicuta, tobacco, or nitric acid, were employed; and sulphur alone seems to have been useful. The treatment recommended principally consists in an attention to cleanliness, and to those circumstances which tend to improve the general health. Our readers will probably anticipate us in the remark that the perusal of this number has caused considerable disappointment; 8 |