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These observations fully justify the author's claims to novelty. We know not, indeed, whether his theory, his philosophy, or his taste, is the most truly original. And as to the air of obscurity, which hangs over the above hypothesis, and which may be said to render it almost incomprehensible, it was no doubt a part of the author's design; since obscurity, according to Burke, is a characteristic of the sublime, and Tacitus considers it as a source of general admiration. The practical conclusion, however, is sufficiently obvious. Gout is a sort of combustion;-cold water is the natural antagonist 10 fire;therefore cold water must be the proper extinguisher of gout. Q. E. D.
It would be difficult to offer a serious comment upon this luminous theory. In a subsequent paragraph it becomes still more mystical; for the doctor discovers a super-abundance of heat, where it is neither to be detected by the sensations, nor by the thermometer! either a painful or heated sensation serves to mark morbid deviation from the standard temperature; and though excessive heat should not be thermometrically discoverable at the surface, it actually prevails, as the necessary effect of commotion; and its dissipation, or transference, by cooling means, will most effectually restore the motive power to the duly repulsive or healthy harmony. P. 80.
In the next section we are directed in all instances to apply cold water to gouty inflammation, regulating the degree of the application by the degree of the local inflammation and pain. We are informed of no other limitation nor direction. It should not be forgotten,' we are told in one paragraph, that the object to be effected is literally the extinction of fire.' and in the next it is said, that, as gouty excitement is kindled only by excessive heat, it is solely this exuberance that is the object of reduction.' P. 84. In addition to this, the internal use of cold water, and the careful avoidance of all stimulating food, and fermenting liquors, are prescribed. Both the local and general mode of reducing morbid heat, here recommended', must be understood to be as strictly applicable to every shifting or sympathetic attack on a fresh joint, as to the original seizure. P. 87. Yet with a gross inconsistency, we apprehend Dr. Kinglake occasionally combines with these refrigerant operations, stimulants no less powerful than opium, camphorated tincture of opium, and ammoniated tincture of guaiacum. He employs these medicines, very judiciously, in those instances of old and protracted gout, where there is considerable debility and irritability of the system; and it is probable that their stimulant effects may have counteracted the deleterious operation of his antiphlogistic plans in such constitutions. He con
cludes this long chapter with an ample store of declamation against the folly, stupidity, and irrationality of medical practitioners in persisting in their routine of stimulation, and shutting their eyes against the light of nature and of his theory.
Section 5th, though it contains no new views, comprehends a full and judicious statement of the means of prevention in the intervals of gout, such as have been recommended by the best practitioners, from Sydenham downwards.
The appendix, which occupies more than half the volume, contains a considerable number of cases, related by the author, and by other practitioners, in which the free application of cold water was attended with invariable success: no instance at least is mentioned, in which any untoward symptom occurred; and in two or three there had been repeated attacks, and the constitution was debilitated. Several cases of acute rheumatism are also related, in which the external use of cold water was equally beneficial. The number of these cases, we must do Dr. Kinglake the justice to add, is such as to lead us to doubt, whether the common fears of repulsion, &c. are not carried to too great an extent. We therefore the more ardently wish, that Dr. Kinglake and his correspondents had been more particular in their detail of symptoms, and of the circumstances of the patient's constitution in each case. The histories are sufficiently numerous to excite some scepticism as to the foundation of the current opinion, and some degree of confidence in the remedy proposed; but they are far too vague and inaccurate to lead to any just conclusion, or to afford even the groundwork of a satisfactory induction. The experiments must be repeated by more acute and philosophical enquirers than Dr. Kinglake and his correspondents, before the idea of danger can be justly confuted. We have only to add, that the declamation, sarcasm, and abuse which the author pours forth most abundantly in his notes to the appendix, serve but to weaken his credit, and to degrade both himself and his cause. But Tempus omnia revelat, as he very classically observes; and we cordially hope that future investigation will confirm the safety and utility of his practice.
ART. XI.—An Account of Trvo Cases of Gout, which terminated in Death, in Consequence of the external Use of Ice and Cold Water. By A. Edlin. 12mo. 15. 1805. ART. XII.-A Reply to Mr. Edlin's Two Cases of Gout, &c. &c. By Robert Kinglake, M. D. 8vo. 2s. 6d. Murray. 1805.
ONLY one of the cases in question occurred under Mr. Idlin's personal observation; and, like those in Dr. Kinglake's
appendix, it is related in too general terms. A medical prac titioner was attacked with an inflammation in his foot, which he believed to be gout. He applied cold water to the part freely, and was speedily relieve; but a sense of coldness at the stomach, faintness, fluttering pulse, and coldness of the extremities supervened, which were twice removed by strong stimulants, but on the third attack, proved fatal.
Dr. Kinglake replies to every paragraph contained in this pamphlet, in a very angry strain: and it is remarkable, that the very fault which is so conspicuous in his own book, and so completely fatal to his own doctrines, is one of the first which Dr. Kinglake discovers in the narration of Mr. Edlin; viz. the omission of the particular circumstances of the patient's constitution, as well as of the specific appearances in the case. It must be admitted, with Dr. Kinglake, that this omission renders any conclusion nearly nugatory; but it tends, in a vague way, to counteract the vague evidence, which he had brought forward on the opposite side of the question. Dr. Kinglake presumes to censure in strong terms the stimulant practice, which was employed on the accession of the retrocedent paroxysm; but had he been acquainted with the nature of those diseases of the stomach and system at large, which succeed to the repulsion of gout, and which he very erroneously supposes to be always inflammatory, he would have withheld that censure, which appears to be altogether unmerited.
On the whole, we can neither coincide with Mr. Edlin, in invariably proscribing any particular treatment, in forms of disease nominally the same; nor with doctor Kinglake in his invariable use of any one remedy under these circumstances. We have no doubt, that there are cases of gout, in which the refrigerant practice may be eminently useful, and others, in which it will be extremely deleterious. It remains for future observers to point out the appearances, which may direct. our steps. In the mean time the advocates of Dr. Kinglake's practice will do well to attend to the discriminative observations of Celsus, who recommended the use of cold water, with these judicious limitations; Ubi dolor vehemens urget, interest, sive tumor is sit, an tumor cum calore, an tumor jam - etiam obcaluerit.' Lib. iv. c. 24. In the first case, he advises the use of warm fomentations; in the second, that in aqua quam frigidissima articuli contineantur;' and in the last, cool applications only. In addition to this, we apprehend, they will consider the strength or debility of the constitution, the previous number of attacks, and the tendency to affections of particular viscera. To adopt any remedy in any disease without considerations of this kind, is arrant blundering empiricism. And Mr. Edlin's case, uncircumstantial as it may be,
and more especially the fatal case lately published by Mr. O'Neil in the Medical Journal, afford but too obvious proofs, that those rational cautions are in this instance indispensable.
ART. XIII.—Letters written during a Tour through South Wales, in the Year 1803, and at other Times; containing Views of the History, Antiquities, and Customs of that Part of the Principality, &c. By the Rev. J. Evans. 8vo. 8s. Baldwin. 1804.
MODERN tourists have of late years so successfully copied the bombast and fustian of modern novelists, that the reviewer almost dreads the hour when he is compelled to reading, which rarely excites any emotions but those of disgust. He who passes a leisure week in a state of restless migration through a small portion of a county, must now give his travels to the world; must tell them of all that the eye could rest on in a walking tour of an hundred miles: how the morning sun shed its first beams upon his knapsack: that the countrymen he met could neither read nor spell: that on the margin of the sea he heard a scream, which he afterwards discovered proceeded from a gull: that the weather was warm, they sky serene, the scenery grand, the churches pretty, and the walk fatiguing. Loose traditions are detailed for history: country prejudices for philosophy: the observations are alternately minute and superficial: anecdotes are told with an affected oddity to secure that interest, which of themselves they are not calculated to excite: grammatical inaccuracy is combined with pedantry and affectation; and the memoranda of the pocket-book embellished, not with references to works of solid learning and intelligence, but with phraseology and consequential trifling, borrowed from the trash of a circulating library.
When we meet with a work that is an exception from this general character, like the traveller who finds an unexpected fountain in the desert,
We bless our stars, and think it luxury.'
Such, indeed, is the case with the work before us. nifests a degree of knowledge and talent that we do not often meet with in a Tour; and though in many parts there appears a hurry of composition, and a negligence of language, it has been evidently much indebted to the researches and reflections of the closet. It abounds not only in correct and curious description, but in lively and judicious remarks upon ancient history and manners; and will repay both the casual and scientific reader for perusal. The pleasure which
the author received from the romantic scenery of North Wales, excited a strong desire of visiting the southern parts of the principality; the more varied history of which, its mixed population, and extent of maritime boundary, seemed likely to afford materials of at least equal interest with its grand and romantic neighbour.
To accompany Mr. Evans through his tour would be impossible. We shall therefore select a few specimens of his work, and consign it to the candour of the public. One we have chosen as the description of a ruin, known no doubt to many of our readers, Caerdiff Castle.
The entrance into the castle is by a bold Gothic gateway, furnished with two portcullises and massy gates. The ruins of the castle have been repaired and modernized under the present proprietor lord Mountstewart, baron Caerdiff. The keep, which stands in the centre of the inclosed area, is a handsome octangular tower; and a high terrace is carried round the inside of the whole extent of the embattled walls that surround it: but the modernization of the present mansion, and the close mown grass and gravel walks of the area, but ill accord with the stately architecture and ivied walls of this proud pile, which has withstood the storms of seven centuries. The internal part of the present house remains in an unfinished state. In the dining-room and saloon are several good paintings of the Windsor family, ancestors of the marchioness of Bute, done by Kneller, Dahl, and Vandyke; with a curious family piece of seven figures, in the best style of Hans Holbein.
A melancholy circumstance attaches to the history of this castle, which casts a gloom over the recollection. The unjust imprisonment and barbarous treatment of Robert Curtoise, duke of Normandy, by his cruel and unnatural brother Henry I. The prince had displayed eminent courage and abilities in heading the crusade to the Holy Land; and, in consequence, was fixed upon by the confederate leaders to be the king of Jerusalem. Whether he had an eye to the crown of England, then vacant by the death of his brother Rufus, or foresaw the difficulties attendant on a crown in a distant country, not yet established by right or conquest, or what motive was the cause of his refusal, is not apparent. The religieux of the time did not fail to consider his want of zeal as the cause, and, arrogating the privilege of heaven, to assert, "that as he refused to join the cross to the crown, the cross was given him without it that he never atter was successful in any thing he undertook; and that the frowns of heaven were distinctly visible through the future period of his life." But this is taking an undue liberty with the providential government of the world. Respecting individual judgments, it behoves us to be sceptical; and, on this occasion, rather to shed a tear over the hard fate of so brave a man, and indulge a just indignation at the cruelty that could ap point it. That he experienced a miserable reverse of fortune, was