Action of Tobacco.-It was soon found to be, in the main, a sedative. Lord Bacon considered the powerful consequences to depend upon a condensation of the spirits, without however alluding to any previous abnormal expansion. But perhaps we ought mostly to admire Willis's notion of the spirits being driven back by tobacco from the centre to the cortex of the brain, like a defeated army in consternation, whereby the soul being more contracted, retiring into itself lies down in rest, just almost in the same manner as throwing water upon a fire that breaks vehemently out immediately beats down the aspiring flame.

Be this as it may, the following are the effects of tobacco. On the reception of a moderate dose, the secretions are for the most part increased, especially the mucous surfaces of the intestinal and urinary organs, and even the skin is to a small extent interested. These phenomena are gradually increased in intensity on a larger quantity of the medicine being administered, until diarrhoea and vomiting, accompanied with nausea, relaxation of the muscular fibre, tottering of the limbs, and very great depression of strength supervene. The pulse during this stage is very small, weak, and even intermitting; the face is blanched and contracted, frequently bathed in cold perspiration, while at the same time, the mind is in a very depressed condition, and frequently complete syncope winds up the train of symptoms. In the third stage of symptoms caused by tobacco, viz. that of poisoning, the breathing becomes very difficult, the limbs are alternately convulsed and paralysed, the muscles of the neck frequently affected with tetanic spasm; the pulse becomes weak, slow, and fluttering; the pupil is contracted and insensible; a universal rigour prevails in every part; and the patient is in general cut off during the existence of a paroxysm.

Short, however, of this, ill-natured persons say that tobacco spoils digestion. Every body knows that a quid is a cheap meal, and some who smoke are not much the hungrier for it. Old smokers, we have observed, are no great eaters, labour under dyspepsia, and are apt to have scaly eruptions on the skin. The effect on the appetite has long been known, and even embodied in verse :

"All dainty meats I do defy,

Which feed men fat as swine,
He is a frugal man indeed,
That on a leaf can dine.

He needs no napkin for his hand,
His finger ends to wipe,
That keeps his kitchen in a box,

And roast meat in a pipe."

"the

Sanatory Effects of Tobacco.-Our forefathers set a great value on them, and with reason. For, "in the first place," says Chrysostom Magnenus, manner in which the flowers adhere to the head of the plant indicates the Infundibulum Cerebri and Pituitary Gland. In the next place, the three membranes of which its leaves are composed announce their value to the stomach, which has three membranes."

Dr. Cleland observes that as the maladies for the alleviation of which it has been recommended and administered embrace those contained in almost every genus, order, and class of Cullen, we cannot do better than subjoin the nosology. After this it would be superfluous to go on. From toothache to tetanus,

and from Chrysostom Magnenus to Dr. O'Beirne is a jump wide enough in all conscience, at all events enough for us. And so we conclude, wishing all good to the "weed," plenty of it to our readers, Havannahs of the finest quality to Dr. Cleland, and Theses as entertaining and as instructive withal from every candidate for the Doctor's degree in the University of Glasgow.

MEDICAL RELIEF OF THE SICK POOR IN ROME AND

PRUSSIA.

I. REMINISCENCES OF ROME: or, a Religious, Moral, and Literary View of the Eternal City, in a Series of Letters addressed to a Friend in England, by a Member of the Arcadian Academy. London, 1838, pp. 298.

II. REGLEMENT FUR DIE STADT-ARMEN KRANKENPFLEGE DER HIESIGEN COMMUN, &c. Berlin, 1823.

Rules for taking care of the Town's Sick-poor, &c.

III. SUMMERISCHE UEBERICHT DER IM JAHRE 1838, IM KÖNIGLICHEN. CHARITE-KRANKENHAUSE VERPFLegten Kranken, NEBST EIVEM UEBERBLICK DER BERANDERUNGEN DIESER AUSTALT IN Dem letzten DECEMNIUM. Berlin, 1839.

A Summary Account of the Patients who were treated in the Charity Infirmary during the Year 1838; and a Statement of the Alterations which have taken place in that Establishment in the course of the last ten years.

In the present article it will be our endeavour to present a complete view of the provisions for the relief of the sick-poor, in the principal capital of Christian Europe," where every stone is a book-every inscription a lesson -and every ante-chamber an academy;" and in the chief kingdom of Protestant Germany, the paternal character of whose king, and the mild despotism of whose government, appear to have been mainly exercised in improving the social condition of the people at large.

Travellers and tourists even of the medical profession, when they visit Rome, visit her as "the ancient emporium of art and science," and view her only under the appearance of " a time-worn and decrepit matron sitting disconsolate amid the tombs of her departed heroes-her sages-and her saints." And when they visit Germany, it would seem as though they did so merely to reverberate the echoes of other men's admiration and wonder, who had gone before, and already surveyed the grandeur of her hills, and the magnificence of her rivers.

Heroes, and sages, and saints, even in this the 19th century, when intellect is said to be "on the march," are still exceptions to the average stature of mankind considered in relation to the prowess, the wisdom, and the goodness of the mass of working, walking, and talking human beings. Of Howards and Frys we are only permitted to see one in an age. And to this cause it is perhaps owing that we may search through more than a hundred volumes of tours on the Continent, and travels in Italy and Germany, without being able to glean any satisfactory particulars respecting the poor of those countries, and especially the sick-poor.

From a Roman Catholic priest in our neighbourhood we have received, in the volume which stands at the head of this article, a pleasing exception to the general rule, as respects the "Eternal City;" while a Protestant gentleman of the legal profession has transmitted us the regulations for taking care of the town's sick-poor, and the excellent report by Rust of the Royal Infirmary of the Charité at Berlin. And by means of these we proceed to make our readers acquainted with a feature in the civil aspect of two very differently constituted States, with which travellers and tourists in general have failed to render either the public or themselves familiar. And, we choose the present time for doing so, on account of the pending discussion in Parliament of the great question of Medical Relief to the Sick Poor-a question which will only then be settled when the basis of any provision for rendering that relief satisfactory to the medical profession and to the poor, shall be one of justice to the former-and mercy to the latter. I. We begin with ROME. One of the officers of the Papal household is called "l'Avvocato de Poveri." The almoner, generally an archbishop (in partibus) is another officer at the Pontifical Court. The chief business of the former is to watch over the interests of the imprisoned-of the latter, to provide for the necessities of the indigent poor.

Medical assistance and medicaments are gratuitously provided out of the Papal Almonry, "for bashful paupers, who are ashamed to apply to the public hospitals for relief. The almoner, who keeps a list of this class of persons, appoints deputies to see them properly attended at their own homes." And, or the better distribution of the relief thus provided, eleven clergymen, eleven physicians, eleven surgeons, eleven chemists, and two druggists are selected, and employed in the different wards of the city.

It is calculated that, in almonry, the Pope bestows annually not less than 50,000 crowns; which sum, though considerable, does not amount to the half of what his almoner had to dispose of prior to the French Revolution. "The other public institutions of charity in Rome, have also revenues to the amount of 764,000 crowns a year!"—Reminiscences of Rome, p. 179.

The public hospitals, considering the comparatively small population of the city, estimated at about 160,000 inhabitants, are indeed magnificent, but their magnificence, like the dome of St. Peter contrasted with the surrounding buildings, is utterly disproportionate to the extent of the city, or its populousness. For example, the Hospital of San Spirito, for males alone, is capable of containing 3,000 beds; and its annual average of inmates is about 12,000. The hospital for females, again, Archiospedale del Santissimo Salvatore, contains 600 beds, and admits annually about 3000 patients. The surgical hospital, for the reception exclusively of accidents, receives 900 patients annually. The hospital of incurables contains 350 beds; and the annual average of patients is not less than 2000. The number of convalescents annually received into the hospital of the Holy Trinity, from other institutions, for the furtherance of their recovery, amounts to 15,000. The hospital for cutaneous diseases contains 200 beds, and receives upon an average 400 patients in the year. The fever hospital has 80 beds, the number of its annual inmates is not stated, although, from so fruitful a source as the Pontine Marshes, we may be sure it is constantly filled; and from the limited duration of most cases of fever, we may be also certain that its tenants in the course of the year will be altogether out of

The

proportion to the size of its dormitories, or the number of its beds. lying-in hospital, during ten years, has received nearly 2000 pregnant women. And, in the Roman lunatic asylum, there are accommodations for 400 patients, and the number of admissions annually amounts to 100.

Taking the sum of the foregoing particulars, it will be seen that, in Rome, with a population of 160,000, and without enumerating 18 minor hospitals for poor sick foreigners, there is hospital accommodation for the sick, the hurt, and the scabbed, the convalescent, the incurable, the lyingin, and the lunatic, to the amount of not less than 5000 beds; and, there are actually accommodated upwards of 34,000 patients. This exhibits certainly a frightful extent of bodily suffering in so small a community, but displays also, in favourable contrast, an immense expenditure of human beneficence to alleviate that suffering.

The proportionate mortality in the various institutions differs very greatly; Morichini (degl'Instituti di Carità) calculated the number of inmates in the Hospital of St. Spirito at 12,000, and the mortality at from seven to twenty per cent. During the year 1832, according to the official register, of 15,524 patients admitted, only 1246 died in the hospital!"-Reminiscences of Rome, p. 183.

"

In the hospital del Santissimo Salvatore, 12 per cent. is the average ratio of mortality. In the surgical hospital, the member of the Arcadian Academy tells us that "not more than five per cent." of the patients annually admitted, "succumb under treatment"-which expression, we presume, implies, that this is the proportion of cases which prove fatal.

In the Hospital of St. Giacomo, for incurable invalids, about 200, or 10 per cent., die annually.

In the Hospital of St. Gallicano, for diseases of the skin, 30 deaths out of 400 patients is the calculation.

We have no data before us from which to fix the ratio of mortality in the hospital cases of fever.

Of 2000 lying-in women, delivered in the St. Rocco Hospital, not more than 12 died in childbed, although, according to Morichini's calculations, instrumental assistance was employed in the ratio of five per cent. of the whole number of deliveries.

A third part of the insane are reported to recover-the number that die are not stated.

To

The medical administration of the hospitals above enumerated may be understood from an attentive consideration of the following particulars :— The Hospital of San Spirito has twelve physicians, six of whom are assistants or "sostituti" only, and four surgeons, with 100 resident servants. the hospital" del Santissimo Salvatore," four physicians and three surgeons, with assistants, are attached—" the ordinary operations of surgery, such as bleeding, &c. are performed by the resident nuns themselves."

190.

To the surgical hospital there are four surgeons and two physicians. To the hospital for cutaneous diseases, three physicians and three surgeons, with about 40 other attendants. The hospital for incurable invalids has four physicians and four surgeons. With the exception of one extra physician, the entire service of the hospital for fever patients is performed by the confraternity or religious order, known as the Fate Ben Fratelli, or Do-good Brethren, "who attend the sick confided to their care night and

day, ministering to their spiritual and temporal wants with the utmost solicitude and attention." 197.

The revenues and œconomic management of the foregoing institutions are confided for the most part to the clergy, and are generally ample. The revenues of St. Spirito considerably exceed 100,000 crowns per annum―it was given in charge by Pope Innocent III. to a religious order of Hospitallers, founded in France, by Guy de Montpellier, as the order of the Holy Ghost. The revenues of the Hospital del Santissimo Salvatore amount to 32,000 crowns a year, and are administered by a lay and ecclesiastical committee, with one of the cardinals for president. Those of S. Maria della Consolazione, (for accidents,) and amounting to 12,000 crowns, are managed by a special committee, appointed by the Papal Government. A committee, composed of two ecclesiastical dignitaries and a lay gentleman appointed by the Pope, act as trustees for the administration of the revenues (of the Hospital of St. Giacomo) amounting to about 30,000 crowns per annum. The Trinity, or Convalescent and Pilgrim Hospital, is endowed with property to the value of 18,000 crowns a yearand the Government contributes to the hospital for the maintenance of each invalid soldier, fourteen bajocchi, or halfpence, per diem. The funds are managed by trustees, appointed by the arch-confraternity, "Della S. S. Trinità de Pellegrini, e Convalescenti." The lying-in hospital was endowed by Cardinal Salviati, with a revenue of 2,500 crowns per annum. The lunatic asylum has an annual revenue of 12,000 crowns, two-thirds of which are furnished by the State. The Pope's exchequer also defrays the expences, 12,000 crowns per annum, of the institution for patients with cutaneous disorders. His chancellor appoints the committee of management in this instance. The lunatic asylum is superintended by a lay and ecclesiastical committee, under the presidentship of the Commendatore di S. Spirito-a prelate of the first rank in the Roman Court. The gross revenue of the whole, not including that of the fever hospital, amounts to 228,500 crowns per annum.

It is no part of our business as medical reviewers to meddle with the religious opinions of men, or to discuss different modes of faith-but we may observe here, that, to the predominance of religious habits and feelings in the Roman community may be traced one of the most pleasing, if not the most pleasing feature of their system of administering medical relief to the sick poor, we mean the substitution of voluntary for hired nurses, and the very ample, and, to our Protestant eyes, excessive provision for their spiritual wants.

In the large hospital for females, and in the female department of that for incurables, a community of female hospitallers, introduced from Genoa in imitation of the French Sisters of Charity, attend to the sick as nurses, and themselves bleed and perform all the minor operations of surgery. In that for incurables, St. Camillus, in 1584, founded his order, the members of which have the spiritual direction of it still. This order, distinguished from the other clergy by a red cross worn on the upper part of their black mantles, and known as the " Chierici, Regolari Ministri degli' Infermi," "are obliged by vow to attend upon the sick at their own homes, when sent for, even during plague, or any other contagious disease."

The reflections of the author of Reminiscences of Rome upon this part of