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THE

BRITISH AND FOREIGN

MEDICO-CHIRUEGICAL REVIEW.

JULY, 1857.

PART FIRST.
Analytical nnfcr (Critical 3£ctu'etos.

Review I.

Of Nature and Art in the Cure of Disease. By Sir John Forbes, M.D., D.C.L. Oxon., F.R.S., Fellow of the Royal College of Physicians, Physician to the Queen's Household, &c, &c. — London, 1857. pp. 264.

The inquiry which Sir John Forbes suggests, as to the relative powers of Nature or Art to cure Disease, is one that involves a variety of questions affecting the science, the practice, the polity, and the ethics of medicine. The regiminal treatment of disease is by no means an invention of modern date, but its merits, as opposed to a more decidedly medicinal treatment, divided the ancients, as it has formed a subject of discussion in more recent times. The public have also ever been alive to the question, in evidence of which we would only quote one lay-author, who, in the 'History of a Foundling,' observes:

*' If the number of those who recover by physic could be opposed to that of the martyrs to it, the former would rather exceed the latter. Nay, some are so cautious on this head, that, to avoid the possibility of killing the patient, they abstain from all methods of curing, and prescribe nothing but what can neither do good nor harm."

Fielding evidently thought Nature was not to be trusted, for he continues:

"I have heard some of these with great gravity deliver it as a maxim, that Nature should be left to do her own work, while the physician stands by, as it were, to clap her on the hack, and encourage her when sne doth well."

The subject is one that every tyro in the profession occasionally reflects upon; but it is essentially one upon which the opinion of men who rank highest in the profession, by the length of their experience, or the labours by which they have achieved distinction, deserves to be listened to with the most respectful attention. The 39-xx. 1

book before us is the production of one who, after having been engaged in the practice of medicine for fifty years, feels, to employ his own words, that bis profession has claims on him for much more than he has hitherto been able to give it, but that he is called upon now to communicate any information he may possess, if he is to communicate it at all.

"In doing so," he continues, "I cannot helpteing'impressed with the feeling of solemnity which naturally accompanies any act that is to be the last of its kind. And in this mood I would fain regard the present work in the light of A Legacy to my younger brethren, which, slight as it is, may not he found altogether unworthy of their acceptanee. I would indeed bequeath it in full confidenee of its value, if I might reckon on its being received in the same way as the Legacy of the Pot of Gold in the fable was received by the rustic testator's sons. If my book—though, like the old man's vineyard, really containing in itself no gold—should only lead to the zealous cultivation of the subject of which it treats, the result could not fail to be of inestimable value to the cultivators. l?or, on the profoundcr, more critical, and purer study of Nature as manifested in diseases, rest, in my judgment, the best hopes of improvement in the medical art; and to this study the spirit of my book may, at least, lead the way and give the initiative, if its actual contents are found of lesser importance."

The error which the author regards as the great taint of medical science, and which he combats throughout this book, is a want of trust in the powers of Nature to arrest the processes of disease, and a consequent overweening faith in remedial agents as the sole means of cure. His main object is to endeavour to expose these misconceptions, so as to impress the minds of the younger and less prejudiced members of the profession with the truth and importance of the principles advocated, and also to prepare a work which might convey to educated members of the general public a juster knowledge of the real nature of disease, and the true characters and powers of the medical art. Dealing professedly in deductions of which the premises are supposed to be known to the reader, we fear that, however intelligible the author may render his views to professional readers, the unprofessional reader will fail to appreciate them, because the first elements —the actual observation of disease—will be wanting to enable him to judge of the justness of Sir John Forbes's remarks. The current theories of the day generally ooze out sufficiently to infect the lay public; a true theory of disease, one, to use Mr. Spencer's words, of which the negation wo\ild be both false and inconceivable, once established among our Asklepiadai, and the public would not fail speedily to be imbued with so much knowledge as would be good for them. Until our own banquet is secured, we do better not to invite strangers to the feast; but we may prepare them against the happy consummation, by placing before them such sound and wholesome fare as they can safely digest. Let the public, high and low, be instructed in the plain, well-proved facts of anatomy and physiology; let them learn the wonders of our healthy fabric, and the greater marvels of the functions that minister to life; and thus prepared, we will induct tbem into the inner shrine, when we ourselves have raised the veil. Our duties to ourselves and to our high calling demand an humble, earnest, and assiduous devotion to the study of Nature in health and disease; we may thus ultimately succeed in understanding, to the full of man's capacity, workings that arc yet mysterious; we may thus obtain, at last, what is the very starting-point of Sir John Forbes's Theory "of Therapeutics—a Natttral History of Disease.

But, though we may be a long way from the goal, we must not ignore the fact that the whole tendency of the present age is to arrive at an interpretation of disease, such as the author shadows forth; Physiological Pathology, which forms the title of more than one work of distinction of recent date, has for its object the search into the relation of the morbid processes of disease, to the analogous processes of health; or into the mode in which the normal changes of the body are perverted, in the disturbances constituting a deviation from health. What is the meaning of the term metamorphosis of tissues, now so often employed 1 Is it not applied equally in physiological and iu pathological conditions, and do we not know that that metamorphosis passes through an endless variety of phases, both in health and disease; but that the transition is often imperceptible, showing the non-essentiality of disease as a separate entity, and proving that, in many cases at least, the same elements go to make up the sum of disease that previously, in a somewhat different order, constituted the normal state of health I

Let us suppose, for instance, that one of the essential features of pneumonia consists in the arrest of the chlorides of the blood in the lungs; physiology instructs us that a certain average of chlorides passes off by the urine in the four-and-twenty hours, and pathology informs us that in an individual labouring under certain symptoms, termed inflammation of the lung tissue, the renal secretion yields a much smaller quantity of this constituent; we conclude that by restoring the secretion of chlorides by the kidneys, we shall relieve the organs of respiration, and promote the restoration of the various disturbed functions to their healthy condition. The practical question, then, comes to be, whether we may or may not rely exclusively upon the natural powers to re-establish the proper balance; whether we are to employ artificial means to aid in its re-establishment, or whether we may trust Nature herself to effect it.

Again, let us take the case of a person wasting under a tubercular disease, in which hectic and colliquative sweats and diarrhoea are sapping the vital powers; we know that the metamorphosis of the tissaes is going on so rapidly that, if left to herself, Nature will speedily wear out that thinning frame,—may we still place our faith iu the tendency of disease to overcome its own evil, or in the unaided physiological powers to cast out the demon 1 or may we come to her aid with such helps as the study of Nature has proved to be conducive to an arrest of that excessive metamorphosis, and thus, if not save life, yet prolong its span 1 Or, to select a still more striking example, as capable of more positive synthetic and analytical proof:—in metallic poisoning, where all the tissues of the body are impregnated with the metal, and where disease is produced by the presence of the foreign substance in the muscles, the brain, the bones, what results

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