Page images
PDF
EPUB

termination of blood, especially to the head and alimentary canal, parts that almost invariably suffer previously to, or during the intervals of gouty paroxysms. This is evinced on one hand by flatulency, predominant acidity, heart-burn, irregularity of appetite and bowels, and different degrees of sickness : on the other, by listdessness, incapacity of attention, depression of spirits, dreaming sleep, weight or pain in the head, vertigo, &c. Now during this excessive determination of blood to these important organs of the animal frarne, there is, often, an unusual degrec of coldness in the lower extremities, naturally proceeding from the defective balance of circulation. “Such is the state of circulation in the extremities, which usually precedles, and probably causes, the reaction of the constitution," which reaction, in an early period of life, is sometimes a mere aching and preternatural heat of the extremities, and perhaps, occasional cramps; " bnt at more advanced periods, especially in persons who have been subject to excessive determinations of blood to the head and alimentary canal, producing the symptoms above described, the reaction goes on to the extent of cansing gout, erysipelas, anasarca, or other inflammatory affections of the lower extremities." 424. In these paroxysms, the aid of the heart is usually, but not always contributed towards the restoration of the long defective determination ; and by this process, as by that of age, the constitution is, for a greater or less length of time, relieved from those disorders, or from that tendency to disorder, under which it had before suffered.

In the first beginning of gout, a very short period seems sufficient to restore the balance of the circulation, and th. patient is absolved by one fit of inflammation of thirty-six or forty-eight hours duration in a single joint, which is fullowed by celematous swellings, and the speedy recovery of health. But at a more advanced period of life, each attack of gout consists of several distinct inflammations of different parts, occurring in succession, with short intervals, during which, not only those parts of the extremities, which have not been affected, still remain preternaturally cold; but even the toes shall be cold, while the instep of the foot suffers burning heat. 427. Thus the disorder proceeds till, if the progress be favourable, a complete restoration of warmth in the extremities ensues. Thus while one final end of gout may be, the evacuation of the habit, and the consequent reduction of a plethora which is relatively excessive, another end is the restoration of the due balance of circulation previously determined in excess towards other and more vital parts. Such are the pathological views of our author on the important subject of gout; and as they are the deductions of experience in a mind of no ordinary power of discrimination, they are of more value than all the chaotic speculations on that disease with which the public have been nauseated, from the water-works at Taunton to the quackeries of Montpellier; all of which have the same Lethean tendency, in the opinion of more than ourselves.

“ If the representation, which has thus been given be just, we can well understand why many local diseases cannot be removed, or even in a certain degree checked, by local remedies, without the hazard of converting a topical into a more general malady, or of causing a constitutional eflort on some other part; which part may be more essential to life, than that which the attempt was made to relieve. The same evils may attend the administration of certain internal remedies, the tendency of which is not to cure the constitution, and so remove the necessity of the local disease, but merely to check the present salutary action of the system, and thus to cause only a temporary and delusive supension of present suffering. Sucli, in the far greater namber of instances, is precisely the action of the Eau Medicinale of Husson; the injurious, and even fatal effects of which, local circumstances give me peculiar opportunities of witnessing.'

We have now closed the longest analysis that perliaps las cver been given of a Medical Work in any Review. The ideas and the facts of our author were in such a state of concentration, that it required unusual exertions on our part, to exhibit the prominent features of this excellent work in any reasonable compass. We sincerely trust-nay, we confidently hope, that our labours in this article will contribute towards the accomplishment of two objects—the diffusion of the volume already published through the profession at large, and the completion of the work by the author's son-a task which seems to have been prophetically announced by Dr. Parry himself, in the preface to the work before us. If we be successful in these attempts, we shall not have lived in vain-if unsuccessful, we bave at least the consolation of having done our duty.

P.S. We have just learnt that Dr. Parry has paid the debt of Nature. His works are the best monument of his fame-and the foregoing analysis is the best eulogy which we could pronounce.

II. Miscellaneous Works of the late Robert Willan, M. D.

F.R.S. F.A.S. comprising un Inquiry into the Antiquity of the Small Pox, Measles, and Scarlet Fever, now first published : Reports on the Diseases in London, a new edition: and detached Papers on Medical Subjects, collected from various Periodical Publications. Edited by Ashby Smith, M.D. Licentiate of the Royal College of Physicians in London ; Member of the Medical and Chirurgical Society of London, and of the Royal Medical Society of Edinburgh. One vol. 8vo, pp. 488. London,

1821. Dr. Willan was a learned, able, and indefatigable physician, who reflected honour on his profession, and did service to his country. Dr. Ashby Smith, his "relative and friend," a young physician of promise, bas piously gathered together the disjecta membra of Dr. Willan's productions, and added to them a hitherto unpublished memoir on the antiquity of small pox, measles, and scarlet fever, enriched with some notes and references by himself. It is highly proper that the scattered writings of eminent men should be collected by themselves or others, and left as imperishable memorials of talent well applied, for the encouragement as well as the improvement of the rising generation. Of the unpublished memoir, Dr. Smith has drawn up, in the preface to the volume, a very excellent analytical view, of which we shall take the liberty to avail ourselves in the article which we hiere dedicate to the work before us.

As the interest we feel in tracing the origin and progress of diseases corresponds, in some degree, to the extensive range of their visitations, and the devastations which have marked their course, it is not to be wondered at that the class of contagious eruptive fevers should have received a large portion of attention. More than a thousand writers may be cited on small-pos alone! The origin of this dire affliction is involved in obscurity, and, on that account, has been productive of great controversy. We need only allude to the discussions between De Hahn and Werlhoff in the early part of the last century, and the more recent investigations of Woodville, Moore, Monro, &c. &c.

By one class of writers it is maintained that the smallpox and measles (which were long considered to be varieties of the same disease) were known to the practitioners of Grecce and Rome-by another class it is contended that their origin cannot be traced farther back than the comVol. III. No. 9.

G

mencement of the Mahometan æra, when the Saracens had the honour of first describing them. The former class assert that the descriptions extant in ancient writings resemble those of small-pox and measles as ncarly as might be expected, when we take into consideration the influence of climate, customs, and habits of life-not to mention the changes which time may bave produced in the character of these as of many other diseases. Another argument used on this side of the question is, that the earlier oriental writers who describe these diseases unequivocally, make no pretence to discoveries, nor to the recent introduction of such maladies“ whereas, had such been the case, it is not to be believed that they would have failed to record with their ravages, the age and birth-place of pestilences so destructive to the human race."

“ The more general opinion, that the contagious eruptive fevers did not prevail among the antients, is founded almost solely upon the want of direct and precise evidence of that nature in their works ; it being considered incredible that such formidable maladies, if they had indeed existed, could have escaped the attention and accurate delineation of observers, the fidelity of whose descriptions in reserence to affections of far less moment, is easily recognized at the present day.Pref.ix.

To this it has been replied, that the paucity of information and direct testimony may be accounted for by the practice usual among the ancient physicians of referring to the same pestilential constitution, different malignant fevers—the eruptions being regarded as crises varying less in their nature than in the accidental combinations of the peccant humours. To this may be added, the dread of contagious and fatal disorders, and the general conviction that they were dispensations of divine vengeance on guilty nations, and consequently beyond the reach of medicine or human aid. Dr. Willan's arguments are in support of the affirmative of this question-namely, that the diseases alluded to were known to the ancients. One of his main objects therefore is to shew that these diseases were in existence when the authors in question flourished; but that looking on these complaints as merely species of the common pestilence, they treated of them conjointly with it, considering it unnecessary to assign to them particular denominations, or to leave precise and accurate descriptions of them as discriminated from the generic distem per on record.

Rbazes, the first writer who mentions small-pox under a specific name, supposed it to have existed as early as the second century, and that it was well known to Galen. The Greek translator of Rbazes's Treatise adverts to Galen's ac

quaintance with the disease as an undoubted fact. The title of this translation (Tepe doumns) and its preface* proves that the small-pox had been known to the ancient Greeks, under the name of Loimiké, (the loimic or pestilential disease,) and even divided into two species-the Loimiké and Eulogia, the latter term signifying the more troublesome species of the two. Haly F. Abbas observes that “the Al-gidri (variola) are numerous small ulcerations affecting the whole or greater part of the surface of the body, which the anlients called Anthrakes; but which the (Syrian) Greeks and Arabians called daughters of fire.” Constantinus Africanus says

-“ Antiqui vocant has (variolas) ignis carbones :" and the modern Greeks yet apply the terms Loimé and Loimic discase to the small-pox and measles.

The identity, or near resemblance at least, of these several denominations to those employed by the same people to describe the plague itself, and its characteristic eruptive symptoms (Loimos and Anthrakcs) implies such an imagined close affinity between the things denoted by them, as proves the confusion of all these diseases, and goes far (Dr. Willan thinks) towards explaining why the descriptions of, or allusions to, the variolous eruptions, actually transmitted down to us in their writings, should have been overlooked by the moderns. Pursuing this idea, Dr. Willan institutes a strict analysis of the leading published statements on pestilence, and the results, he thinks, clearly evince that certain parts of them must, in almost every instance, refer to the small.pox--and to the small-pox only. For example, an cxamination of the epidemic which broke out at Alexandria, A. D. 252, and which spread with great fury for twelve or fisteen years, proves that pestilence was not one uniform disorder, but comprised several different kinds under it, distinguished by the narrators from the common Loimos.

• The histories of the next considerable plague in point of time (that which prevailed in Syria in the reign of Dioclesian) lead to the following deductions vitally material to the question at issue. 1. The mortality was not occasioned by one form of disease, but, independently of the common Loimos, there was, according to Euse bius, another disorder termed, from its fiery nature, Anthrax. 9. This Anthrax spread over the whole bodies of the sufferers. 3. The eyes were very frequently affected, producing blindness in thousands

• Written in the 10th or beginning of the 11th century. The translator says" it seems strange that he who first organized the medical art, (Galen,) and defined what had been left indeterminate, should have but slightly noticed a disease (small-pox) to which every man is born liable."

« PreviousContinue »