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"Ore trahit quodcunque potest, atque addit acervo."
Notices of some New Works.
ON THE SUCCESSFUL TREATMENT OF CONSUMPTIVE DISORDERS, AND FEMALE COMPLAINTS CONNECTED THEREWITH; ON SCROFULOUS DISEASES, &c. &c. By J. J. FURNIVAL, M.D. Octavo. London, Nov. 1838.
We confess that the first two words in the title-page of this little volume excited some suspicions that another diappointment was about to be added to the many that we have experienced in a long career of practice, both at the bed-side of sickness and in the dissecting-room of the library. It was not unreasonable that some of the charlatanneries, couched under the seductive titles of "Consumption Curable," &c. should rise on our mental horizons, and make us sigh for the respectability of physic! From the mummeries of mesmerism, which, for six or eight months past, have excited the risibility and ridicule of every person capable of knowing his right hand from his left, but which are now laid in the Tomb of the Capulets, we must fall back upon the dull and disgusting scenes of stale, money-making, pickpocketing, homicidal QUACKERY, unredeemed by a single touch of that sublime absurdity which rendered the animal magnetists the laughing-stocks of the profession, and the merry-Andrews of mankind! Such were the transitory reflections that passed through the mind, while cutting open the first few leaves of the little volume before us. But we very soon perceived that the very suspicion of quackery excited by the title-page, was baseless, and that the author was of a stamp that secured him effectually against enrolment in that degraded list. Dr. Furnival is evidently a man of experience, observation, learning, and general science. Indeed, if we were inclined to "hint dislike, or hesitate a fault," it would be on the score of shewing off too much erudition and knowledge in a popular work like the present, and on a subject where classical lore and general science can avail us but little, and where close clinical observation and judicious experiment are the chief, if not the only means by which we can hope to benefit the community.
Our author has evidently read a great deal on consumptive diseases, and is in possession of all that ancient observation and modern dissection could do in illuminating their pathology, etiology, and treatment. The first seven chapters embrace pathogeny, and the non-naturals, as diet, exercise, secretions, sleep, study, &c. in which the author is rather discursive-perhaps a little theoretical, or even fanciful—but that is very pardonable. The selections which the author has drawn from various sources are generally the best that could be collected, and his own observations, forming the connecting link, are judicious. There can be no doubt that, if proper hygienic precepts were carefully acted on, the ravages of consumptive diseases would be greatly curtailed.
"If due attention have been paid to the foregoing hygienic precepts-if a wholesome climate, with its purer air, have been secured-it the secretions and excretions have been attended to-if the mind have been preserved in the happy
medium between inactivity and over exertion-if daily muscular exercise have not been neglected-and if, above all, the skin have been maintained in a healthy state by proper clothing, by frictions, by cleanliness, and bathings or spongings with cold water or with iodine solution-we may venture to assert that in persons so treated, the tendency towards deposition of tubercles will be counteracted, or if already deposited, there is much probability that they will be prevented from assuming an active condition; or still further, that they may be even absorbed. By these means the delicate constitution may be strengthened throughout the very important periods of childhood, adolescence, and puberty; and disease, if it do occur, may be so successfully resisted as to prevent a fatal issue."
Unfortunately the medical practitioner is rarely consulted till the phthisical disposition is formed, or even considerably advanced. And if he is resorted to for advice at an early period, that advice is not followed. Youth will not be held in trammels-fashion must have its victims-delicate young ladies must go to balls and routs half naked-to theatres when the thermometer is below 32°— and the portions of their bodies that are deemed worthy of vesture, are girded into the narrowest span that whalebone and cordage can effect.
The eighth chapter treats of the symptomatology of phthisis, and is well written, evincing accurate observation. It will be very useful to parents whose progeny are disposed to tubercular affections. The medical reader is but too well acquainted with the phenomena of consumption. The ninth is a short, but well-executed chapter on diagnosis, from which we are tempted to make an extract, as a specimen of Dr. F.'s style and manner.
"In the early periods we must first ascertain that the dyspnoea, livid face, dry cough, or else the frothy sputum streaked or dotted with blood, do not depend upon cardiac disease solely; and then we must take care not to mistake for this disease that affection of the bronchial mucous membrane called dry catarrh. In both diseases there are wasting of body, a dry cough, dysprœa, and oppression; and these two last symptoms are exacerbated on exertion, such as running, ascending any elevation, and sometimes after meals. In both, too, these signs may remain in a latent or unchanging state for a long time, even for several years.
The oppression about the sternum and præcordia in these cases of catarrh, is also an unfailing attendant in consumption; and I doubt not but that it is connected with, if not caused by, the too carbonaceous state of the blood in this disorder.
Before the days when the light of the stethoscope was thrown upon our paths of practice, there is little doubt that these catarrhs were mistaken for tubercular consumption; but now, we can discover that percussion of the chest returns a healthy sound; and that although the respiratory murmur is, in severe cases, nearly inaudible at certain points for a time, yet it is still in most cases quite distinct; and that a slight clicking may occasionally be detected upon coughing or upon a deep inspiration. After a time the cough increases; but with judicious treatment the disease is gradually resolved, or it would have been followed by emphysema of the lungs. The various coughs, called nervous coughs (arising from hysteria, disease of the brain, &c.), stomach or liver coughs—those caused by elongated uvula, pharyngeal, laryngeal, or tracheal irritation-will, for the most part, readily be diagnosticated, by the general signs as well as by the negative results, in respect of the lungs, afforded by the stethoscope.
Chronic or senile bronchitis may be mistaken for phthisis in its latter stages, when vomica have formed; the opake, yellowish or dirty green, pelletty sputa of bronchitis being not altogether unlike the tuberculous matter; but in complicated bronchitis, the history of the disease will inform us that the lower lobes were first or simultaneously affected; and also, that there has been a mucous wheeze, together with considerable distinctness of the respiratory murmur from the beginning."
The tenth and last chapter is on the treatment of phthisical diseases, accompanied by a few select cases. The principles of treatment-at least of preventive treatment-may be easily gathered from the following few lines.
"From the preceding observations, it may be collected, what means must be adopted with a view to strengthen the constitution of a person who is in delicate health; and that those means are directed towards inducing a healthy state of every organ, by promoting the due performance of every function in the human body. The prominent tendencies in the weak or invalid constitution, seem to consist in, or to produce, an imperfect action or debility of the capillary system -a torpor of the cutaneous functions-internal congestions (venous)—and an arterial blood not sufficiently decarbonized. These states or conditions of the human animal economy, if suffered to remain unchecked would soon lead on to disease, most serious as to character, most threatening to life, and very intractable as to treatment."
This principle of prophylaxis applies to almost every disease in the nosology. It applies to the cure, too, as well as the prevention. If we can bring every organ and function into a healthy state, we shall have no disease to debar or cure. The worst of it is that such a state is never seen-even in the most apparent health-and can never be induced in such a class of diseases as that of consumptive-or indeed of any class. In the scrofulous and phthisical constitution we can seldom keep even the majority of functions in a state of health. All we can do, then, and all that we can expect, is to lessen as much as possible the derangements of function in the several organs, since we well know how little power we have over organic changes. This minute attention to all the functions, and exact regulation of all the non-naturals, is the "successful" method of treating consumptive diseases announced by our author—and doubtless it is the most rational and the most effective plan of treatment. Dr. F. proclaims no specific-no inspired nostrums-no lung-stretchers-no infallible liniments or other quackeries. The following passage may be easily applied where the shoe pinches.
"One cannot but be aware of the danger which now exists, of overrating the influence of remedies in phthisis. Since the time when Laennec discovered the cicatrization, or fibro-cartilaginous lining of cavities left by vomica: and when he, in prophetic, as well as strictly philosophical spirit, boldly announced the future curability of consumption, many persons (some, perchance, with motives not altogether above suspicion) have raised a cuckoo-note, and proclaimed themselves consumption-curers, even in advanced stages of the disease;-with stethoscope in hand, they profess that they can watch, and accurately tell, to what extent each cavity fills up, from day to day. With such persons, the faithful inquirer cannot coincide. For although we may effect a great deal of good in the early stages; and although we occasionally meet with extraordinary instances of suspension of morbid action in the more advanced periods; yet in these latter, when disorganization has ensued to a considerable extent, the medical practitioner can do little or nothing as to cure, though he can help much as to palliation."
The abominable length to which the Charlatanneric abovementioned is now carried by certain unprincipled practitioners, is truly disgusting. These vampires have no hesitation in assuring their patients and the relations of their patients, even a day or two before death, that the excavations are filling up rapidly, and that recovery is certain! What care they about the disappointments-bitter ones-which the friends are doomed to experience. They know that the mouths of their patients will be sealed by the hand of death, and that the friends will be ashamed to proclaim the quackeries of the doctor, as reflecting, in some degree, on those who employed and believed him.
We must close our notice of this respectable little volume with one more
"Fortunately for those whose purses will not allow of travelling and sojourn ing in foreign lands, but very few if any cases will now imperatively require to be sent abroad; for lately a most ingeniously constructed and practically useful apparatus has been offered to the public, the objects of which are to enable the pulmonary or consumptive invalid to take exercise, without risk, in the open air as frequently as may be necessary, and to prevent the bad effects arising in the respiratory passages from sudden changes in the temperature. I allude to the Oral Respirator.
One of the great benefits afforded by a warm climate consisted in this, that it allowed the invalid to take exercise and walk about in the open air, at less risk and with less coughing than was possible in a colder or more variable climate; but from a residence of some years in a warm climate, whither invalids were wont to flock, I am convinced this advantage was not always obtained, and that many a piercing change of weather, incidental to such climates, was unnoticed or disregarded by writers, who recommended these migrations.
However this may be, this benefit is now offered to the Englishman in the Respirator; and he may enjoy every possible home comfort, at the same time, that by doing so he does not throw away any of his chances of recovery. Such is my high opinion of this instrument, after having worn it, and after having seen how it has acted with several of my patients, that I would now with great confidence of success, enter on the treatment of many a case of pulmonary consumption, and of irritable air-passages, which hitherto I should have deemed it my duty to send to Madeira or elsewhere."
The use of the respirator is becoming daily more extended and appreciated. It will enable thousands to pursue their avocations in the open air, who were formerly confined to their houses during a considerable portion of the year, and hundreds to remain in England, who would otherwise emigrate to Italy and Madeira. We take leave of Dr. Furnivall with sentiments of respect, and wish him success and health in his rural life, as contrasted with his metropolitan avocations.
ON THE IMPROVEMENT OF MEDICINE. BY THEOPHILUS THOMPSON, M.D.
This little brochure formed the oration at the London Medical Society in March last, and was well received by the members. The author sets out with the increase of longevity, proved by the bills of mortality, as owing, at least in part, to improvements in medical science and practice-and this boon may be fairly granted. But he comes to closer quarters, and examines the comparative mortality of particular disease, now and heretofore. At one of the puerperal hospitals in London, half a century ago, the average of deaths in parturient females was more than one in sixty-it is now little more than one in three hundred. A similar diminution is recorded in the mortality among children. Since vaccination, the mortality from small-pox in the metropolis is reduced from five thousand to three hundred per anaum. Sea-scurvy has now nearly ceased to exist in our navies-but this is more owing to good diet, comfort, and discipline, than to lemon-juice.
Our author adduces the treatment of insanity as a proof of advancing medical science. The disease is now very generally considered as the consequence of some corporeal disorder, and, of course, the treatment is more successful than formerly. The use of the stethoscope-the diminution in number of surgical operations-the improvements in the physical education (?) of children-the attention to diet-all these, he thinks, offer indubitable proofs of the march of medical intellect.
From the future he anticipates much, and thinks that the labours of Bell, Breschet, Hall, and many others, will remove much of the veil which hangs
over the mysteries of the nervous system. He particularly alludes to the investigations of Dr. Todd of Brighton, respecting an "artificial digestive fluid," by means of which he has succeeded in resolving the tubercles of phthisis into their constituent globules, thus dissipating the theories of Gendrin, Baron, Carmichael, and others. The agency of mineral waters on the minute extremities of the human tubes is expected to do great things in therapeutics. The numerical or statistical method is now being cultivated with considerable ardour and expectation.
"No one can too much admire the noble, self-denying contempt of labour, or the comprehensive talent of Louis, the founder of the numerical school, leaving the lucrative engagement of an established practice, and devoting himself, in the hospitals of Paris, to a rigid investigation of medical doctrines; but what are the practical results of his exertions? To mention one of the most prominent illustrations: he has detailed a number of cases of inflammation of the lungs, giving the numbers treated by various methods and the proportions recovering, under each plan, with a view to determine the comparative efficacy of different modes of practice, especially bleeding, and the conclusion is, that in pulmonary inflammation the power of bleeding is very limited; in short, that it is almost indifferent whether we bleed or not. You will at once perceive, Sir, the fallacy of the conclusion. We know, from our own experience, that in pneumonia, a free use of the lancet (with the aid of antimony) is generally followed by a cure; and some of us, who have had occasion, on the Continent, to witness the practice of those who disapprove of bleeding, have too often seen the disease, under such circumstances, proceed to a fatal issue. No numerical rules can be expected to determine the treatment of diseases, which must be modified by age, sex, temperament, period, state of atmosphere, habits of life, and other circumstances, which is not in the power of figures to express. The vital principle is not amenable to numerical laws."
Yes. Those are some of the blessed effects of continental doctrines and practice. In the mode of bleeding in France, there is much less advantage gained than in that which is adopted here, and hence another reason for its deprecation amongst our neighbours there.
A great many useful hints are thrown out by Dr. Thompson respecting medical education, as tending to the improvement of medical science. He censures severely the new poor laws, as respects the medical contract system; but he has not alluded to the greatest grievance of all, and that which retards the cure of disease (which after all must be the grand object of our art) more a great deal than the new poor laws-the mode of remuneration for medical services in private life. This is the plague-spot, which medical reform writers seem afraid to contemplate or even mention! The mode of remunerating medical men for the drugs delivered rather than swallowed, is injurious to the patient and degrading to the practitioner. If all the medicines are taken the stomach is overloaded and sickened-if they are thrown aside-half or more of them-then the practitioner is deceived, disappointment results in that way! It is true that a few general practitioners, long established, and enjoying the full confidence of their patients, are able to charge for their visits, even under existing laws;-but the great mass of junior medici dare not risk such a step, and the evil continues. Nor will that body which regulates the education, and superintends the affairs of the general practitioners, ever try to remedy the evil in question. It is their interest to perpetuate, not to eradicate it. The more drugs that are swallowedthe more must be bought and sold—and the more grist must come to the medicine-mill in Bridge Street. Our sentiments on this point have long been known -but we confesss our astonishment at the manner in which medical reformers slur over this paramount evil, while others of very minor consequence are daily and weekly dwelt upon with all the fire of angry denunciation.
The oration is very creditable to Dr. Thompson.