Page images
PDF
EPUB

that the disease itself generates a disposition to indulge in hurlful things. Our author bas known the disease called forth by vivid moral impressions. He states the case of a female who, by the death of her husband, fell from affluence to indigence. A severe attack of bæmoptysis was the first consequence of the mental affliction, and this terminated favourably by suitable treatment in six weeks. Her convalescence was slow, and interrupted by pains in her limbs, and excessive perspirations. The menses now became suppressed, and immediately prurigo formicans was developed on the trunk of the body, and the nape of the neck. The itching was dreadful; but the disease was at length removed by emollient baths.

Treatment. The remedial indications in this disease are founded on very uncertain bases. Art is yet in its infancy as far as regards the cure of prurigo formicans. The disease is but too often confounded with psora, and the means had recourse to are generally prejudicial. When prurigo is purely accidental --when it attacks vigorous subjects-and can be traced to evident external causes, it may be cured by emollient baths and a cooling regimen. But when it attacks old people, we are foiled. It is scarcely less obstinate when it occurs soon after birth.

Our author has known many children in whom the disease persisted till the age of puberty. When prurigo is caused by the suppression of some accustomed discharge, it is much more easily cured than when owing to a more profound and inveterate origin-provided too active repellents are not employed, by which we risk the transferrence of the irritation from the perephery to the brain. Mental alienation is a common consequence of this metastasis. A young female was affected with prurigo from her infancy, which obstinately persisted, in spite of every means that could be devised. At length she was persuaded to apply the anti-psoric liquor of a celebrated medicaster of Paris. The eruption was suppressed very promptly indeed; but since that period Mademoiselle has not enjoyed one moment's repose. She is tormented with a feeling of extreme formication all over the cutaneous surface, but without any perceptible eruption. M. Alibert, at the time he wrote, was prescribing the warm sulphureous baths, with the view of restoring the papular eruption too suddenly suppressed.

M. Alibert offers a few laconic rules for the treatment of this troublesome complaint. When a patient first applies, he recommends that the primæ viæ should be well cleared for which purpose an emetic is often a proper remedy. After purging, the patient is to be put on a course of diluent and apericnt drink, as whey, barley water, &c. The regimen should be particularly attended to. Nothing but the simplest food should be allowed. All salads and spices must be interdicted. The juice of bitter and diuretic herbs is useful. The patient should go daily into an emollient bath, after the example of the ancient Romans, who used oleaginous baths. He has known children cured by daily baths of warm milk. Excepting some mild ointments, containing the precipitates of mercury, M. Alibert seems averse to all external applications.

We shall only add a few observations from Willan's costly work, which is not likely to be in the hands of the majority of our readers. From alkaline medicines he has seen some relief obtained; but he has generally prescribed sulphur internally, every morning and evening for a fortnight, in doses varying from ten grains to a drachm. In some cases the sulphuric acid may be taken with advantage, after the sulphur is left off. Dr. Willan has often prescribed the sulphur combined with the fossil alkali, (natron preparatum,) at the same time directing an infusion of sassafras, or the tops of juniper, to be drunk freely. Under this course, the symptoms are, in many cases, gradually alleviated, and the complaint disappears in a month or six weeks. Dr. Willan seems to have little faith in any

other external application than the warm bath, or the same impregnated with alkalized sulphur. Sea bathing has also, in some cases, entirely removed the complaint, as was long ago observed by the medical poet, Q. Serenus Samonicus.

“ Pruritus autem salsos levat humor aceti;
“ Sive maris rabidi sudor, cochleæque minutæ,
“ Quarum contactu perimetur acerba libido."

Precepta, cap. 7.

VIII. Nlustrations of the Enquiry respecting Tuberculous Dis

eases. By John BARON, M.D. Physician to the General Infirmary at Gloucester. Octavo, pp. 236. five plates,

coloured. London, Dec. 1822. THROUGHOUT the preface to this volume we think we can perceive a tone of querulous animadversion on modern medi. cal investigations--on the modes in which researches are carried on-on the validity of medical testimony and medical records on the claims to improvement which the moderns have set up over their forefathers and on the want of logical precision in our language and reasonings. That there is room for complaint, and still more for regret, on all these points, we are ready to acknowledge; but as the cause of these evils lies more in the difficulty of the subject than in the negligence or incapacity of the investigators, we cannot join in this declamation against the latter. We are really tired of the exhortations to medical logic and mathematical precision, when the things themselves are but imperfectly known, (many of them totally unknown,) and where language and terms must alter with every advance or discovery, whether of error or truth. Let these complainers look at the science of chemistry, which may be termed an exact science. How often bave the theories, the terms, and the language altered and vacillated, even in the short space of twenty or thirty years! The science of medicine is a thousand times more difficult than that of chemistry, because we have not only the laws of physics but the laws of life to study-most of the latter entirely beyond our ken, and few of them as yet understood. Again, as it is only from those who are engaged in the busy scenes of actual practice that we can hope for improvements in medical science, bow are we to expect all that rigid mathematical exactness and logical precision wbich are the products of intellectual labour in the cabinet, rather than the offspring of observation at the bed side. We consider it indeed as yet the age for accumulating facts rather than for arranging deductions; and therefore we firmly believe that hypercriticism on the modes of recording those facts and observations which serve as the basis of our science, are more calculated to retard than to accelerate its progress. We confidently appeal to all those who know the difficulties of medical investigations—the drudgery of practice the shortness of time--the anxieties and distractions of life-and the thousand obstacles to abstract reasoning, whether one in a thousand can either prosecute or profit by studies attended with such exquisite refinement, mathematical correctness, sceptical scruples, and laws of logic, as a few modern reformers are labonring to introduce upon all occasions, wbether of theory or practice.* This much we know, that it is labour

* Even the “great Haller,” whom our author has eulogized, (and we wish not to detract from his merits,) was evidently convinced that very few indeed could proceed on these nice steps so warmly recommended by himself and our present author. We give the quotation which Dr. Baron himself has brought forward.

« Est in his omnibus ars quædam inveniendi, quæ breviter dici non potest, ct quam paucis mortalibus

in vain. They are incapable of effecting the refinements they propose; and if they were, they would have few disciples among the great mass of the profession. We confess it, (perhaps it onght to be with shame) that we are among those who are not “ too fond of the right to pursue the expedient ;" for we have rarely seen any practical good result from attempts to carry this “beau ideal" into execution. It must be by patient industry, close observation, and plain pbilosophizing, that medicine can be rescued from empiricism or conjecture.

“ How different," says our author, “ were the feelings and principles which actuated the minds of some of the distinguished men who have, in times past, successfully cultivated either physiological or pathological science, from those which are most generally adopted at the present day.” P. xxi.

We much doubt whether our forefathers had a bit more zeal, or better means, or honester intentions than ourselves. True it is there were fewer writers among them, from their being compelled, in general, to write in a learned language; consequently, there was then a great deal less of the trash which now daily issues from the toiling press. But, on the other hand, there was far less attention paid throughout the great mass of medical society, in those times, to pathology which, as connected with close observation of symptoms at the bed-side, must form the firm basis of all our useful knowledge.

We shall now quit this subject, and endeavour to convey to our readers as clear an analysis of the work before us as we are able—and that without prejudice or partiality. : This illustration is divided into six chapters, three of which, viz. the first, second, and sixth, will principally occupy our attention the other three being chiefly a series of criticisms on modern and ancient writers. The first chapter is “on the Progress of Pulmonary Tubercle ;” and, as our author thinks that it will facilitate the understanding of what he has here to advance, if he briefly recapitulates some of the propositions set forth in his printed “Enquiry,” we shall give the recapitulation in his own words.

First, then, I affirm, “That tubercles exist in almost every

natura concessit. Oportet absque prejudicio ad opus venire, non eo animo ut videas, quae classicus auctor descripsit ; sed ea cum voluntate, ut ea videas quæ natura fecit.” Now we firmly believe that the modern physician comes to the interrogation of Nature with fewer prejudices than did the ancient; besides the advantages of an accumulated stock of knowledge transmitted by record.

texture of the body, and that their origin and essential character will probably be found to be the same, wherever they are discovered.'*

“ II. That tubercles in their commencement, are small vesicular bodies, (i.e. hydatids) with fluid contents.

III. That these bodies subsequently undergo transformations, on the nature of which their tuberculous character depends ; that these transformations are progressive, but not uniform, and that it is only in the larger bodies of this kind that they can be accurately traced. That they commence with an opake spot, which advances with different degrees of rapidity, and ultimately converts both the contained and containing parts into substances very different from what they were at first. I

“ IV. That on the size and relative position and structure of the tubercles, which are thus formed, depend the characters of many of the most formidable disorganizations, to which the human body is exposed.

* V. That considering the transmutations, which these bodies undergo, the condition in which they may be found will be modified by the time at which they may happen to be examined.]

“ VI. That it is rarely that we can have an opportunity of seta ing the first steps of these morbid phenomena in the human subject, because the tubercles are generally formed, and the elementary character of course lost, before death permits us to make enquiries respecting altered or morbid structure. I

“ VII. That some tumours are formed by the aggregation of tubercles, and that the characters of such bodies are materially influenced by the relative position and contents of the elementary parts, of which they may happen to have been composed, or in other words, that varieties in the arrangement of the elementary parts of morbid growths, will of course cause corresponding varieties in their appearance.'

“ VIII. That, therefore, diversity of appearance in tubercles or tumours does not imply diversity of origin, for it has been demonstrated that substances and textures of very different properties may be found even within the same cyst, thereby merely denoting dif

, ferent gradations in the changes, to which these bodies are liable.b

IX. That the disorganizations above referred to are not the product of any species of inflammation, and that though inflammation may attend their growth, and modify the symptoms, which they occasion, yet that it is very different both in its origin and consequences from that species which attacks a part unaltered by previous disease; that in the first instance it is to be considered as the consequence, and in the latter as the cause of altered texture."

It is necessary to bear in mind that the morbid appear

• Vide Enquiry, p. 75.

§ Id. p. 215. • Id. p. 218. et cet. loc.

+ Id. p. 214. | Id. p. 93. et cet. loc.

Id. p. 217. | Id. p. 241. b Id. pp. 221, and 231.

c Id.

p. 120.

« PreviousContinue »