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DIALOGUE BETWEEN A PHYSICIAN AND A PHYSIOLOGIST; OR
MECHANISM versus VITALISM.
Physician. Is it true, my dear Magendie, as reported in your lectures, that you can produce inflammation in the dead body?
Magendie. I can.
Physician.-The cardinal points or phenomena of inflammation, as laid down. by all writers, from Celsus to the present time, are rubor, tumor, calor, dolor. Magendie.-Very well.
Physician.-Can you produce rubor in the dead tissues, and if so, by what
Magendie.-Nothing more easy. I dip the parts in red ink, or inject the vessels, with red wax.
Magendie.-By injecting the cellular membrane with warm fluids of any
Magendie.-I immerse the parts in hot water, or hang them before the fire. Physician.-Humph! These are very mechanical processes for producing the first three phenomena of inflammation!
Magendie.-Doubtless. But all Nature's processes, in health or disease, are mechanical, quite as much so as those by which I imitate her operations. Physician.—There is one phenomenon more, however, which I think will pose you. How do you produce the dolor?
Magendie." There you are in the clouds and fogs of vitalism-clouds and fogs by which you strive to conceal your ignorance. Sir, I admit the existence of no phenomenon or process in the living or in the dead body, but what can be made cognizable to the senses. We have no other inlets of knowledge than through the five senses. Now Sir, I ask you, can you see pain? No. Can you touch pain? No. Can you hear pain? No. Can you smell pain? No. Can you taste pain? No. Then, Sir, what monstrous absurdity is it to talk of a phenomenon presenting itself, you say, in a patient before you, and of which you cannot learn the most minute iota by the evidence of your own senses! Sir, I repudiate, scorn-nay, detest, all those phenomena and explanations which are founded on vitalism,-and thus I throw them to the winds." While pronouncing these last words, with great violence of gesture, and action of his arm, which he waved over his head, he struck his right hand with such force against a lamp which hung in the laboratory, that he roared with agony, and thrust his knuckles into his mouth to mitigate the pain!
Physician.-Ah! Friend Magendie! What say you to the evidence of the senses now? Here M. Magendie flounced out of the laboratory, and slammed the door in the physician's face, who was following him in a convulsion of laughter.
DR. GRANVILLE AND DR. ROE.
In our notice of Dr. Roe's work on Hooping-cough, in our last number, we made a mistake of twenty instead of ten years as the period of Dr. R's. experience of prussic acid, thus leaving Dr. Granville ten years of priority in the use of the remedy.
DR. SCHOLEFIELD AND DR. HOOPER.
IN our Journal for October 1837, we took a short, but favourable notice of a little work on the Climate and Diseases of Jersey, by Dr. Hooper. It appears that Dr.
Scholefield furnished the Medical Chapter of Mr. Inglis's Work on the ChannelIslands, published in 1834, and he now comes forward to accuse Dr. Hooper of plagiarism, and of culling materials from his Chapter above-mentioned, without acknowledgment for his recent pamphlet. In the JERSEY TIMES, of the 23rd of November last, Dr. Scholefield has collated, in juxta-position, the original passages and those which he deems to be pirated by Dr. Hooper. We have not space for this controversy about priority; but, on glancing over this collation (not a cold one certainly) we apprehend that Dr. Scholefield has some reason to complain on this occasion-not of us—for our commendation of the pirate (if a pirate) was surely a compliment paid to the original writer.
SCOTT ON COVE.
To the Editors of the Medico- Chirurgical Review. GENTLEMEN.-May I beg to call your attention to one or two errors which crept into the notice of my paper upon the Medical Topography of Cove, and which you did me the favor to call the attention of the profession to in the Number just published of your valuable Journal. Your reviewer writes thus-" this is Spike Island at the entrance of Cove Harbour, &c." Now the sentence should be, this is Cove in the County of Cork. Spike Island is barely incidentally mentioned in my paper, and how the accident of substituting it for Cove could have occurred I do not know. Again, the Reviewer says at line 40, "the island and its village are sheltered from the winds, &c." This should be the town is sheltered from the winds, &c.; for it is the town of Cove that enjoys protection from the colder winds, and not the island. It is beside a large town, and it will give an idea of its size when I name its population at near 9000 souls. These errors I need only point your attention to, I am certain, to have corrected; as to your readers they would convey indeed a very erroneous idea of, without any partiality, one of the most beautifully and favorably situated towns that can be seen. Your most obedient and obliged servant, D. W. SCOTT.
Cove, July. 28th, 1838.
FURTHER TESTIMONY OF THE REMEDIAL VALUE OF THE CARBONATE OF SODA.
I have long prescribed it,-frequently in large doses; and without enumerating its beneficial action in typhus fever, in dyspepsia, certain states of anemia, &c., I will content myself with pointing out its great value in the treatment of phthisis. Some of the numerous cases in which I have prescribed it are on record in my recently published work on consumption and scrofula; and, so far from its having caused liquefaction of the blood, infiltration of the lungs, or pneumonia, I think I have great reason to laud its tonic effects in removing crude tubercles, as well as in obviating that state of superabundant carbon in the blood, and that sluggish condition of it, which I believe to obtain in phthisis, in some of its stages, and the existence of which I have, in that work, endeavoured to show. It has been especially useful in threatened cases of tubercular infiltration. It has not even appeared to increase the frequency of that intercurrent pneumonia which is so often observed to occur in phthisis still less to give rise to it; indeed, my experience would incline me to support the very reverse propositions.
The direct injection of the carbonate of soda into the blood is one thing; but the introducing it into the stomach is another; and whether or not it there meets with free hydrochloric acid, or is otherwise changed, the ultimate effect, as regards the blood, must be very different from that of direct injection; at all events, similarity or identity of effect must not be hastily assumed.
Hertford, Nov. 18, 1838.
J. J. FURNIVALL, M.D.
AN ACCOUNT OF AN EPIDEMIC Cholera, whiCH PREVAILED IN THE DISTRICT of Berehaven, IN IRELAND, IN THE AUTUMN OF 1837. By Edmund Sharkey, M.B. T.C.D.
DURING the months of September and October, 1837, an epidemic diarrhoea prevailed here to a very great extent, in very many cases combined with vomiting, and amounting to a bilious cholera; but never presenting any approach to the malignant type. It affected adults exclusively, and yielded almost universally to laudanum, given in doses of 30-40-50 drops in a little peppermint water. Very rarely it lapsed into dysentery, and required the employment of calomel, opium, and hippo, followed by astringents. About the end of October, it had nearly subsided, but at the beginning of November the malignant form of the disease appeared at Castletown; no case existing of it at the time in any part of the surrounding country. The prominent symptoms of the disease being the same as elsewhere observed, are already sufficiently known. There was one, however, which presented itself very frequently, viz. a sense of "blowing in the ears, which I had not previously noticed. A remarkable circumstance was, the almost constant uniformity of the hour at which the disease made its attack: this was, in nine cases out of ten, a little before day-break. Whether this was merely a coincidence, or whether it depended on any particular stage of the digestive process, I will not pretend to decide; we know that the attacks of several diseases are periodical.
With regard to its mode of propagation, that is a point on which I will not now touch; I will confine myself at present to practical considerations.
The number of cases which occurred in this district, comprising the Barony of Bere, and containing a population of 15,000, was 360, out of which there were 162 deaths. The duty was divided between my friend Dr. Philip, A. Armstrong, and myself; and I believe I may safely assert that never did duty more laborious fall to the lot of medical men. Ah! little do city practitioners, who have only to go round their hospitals and issue their orders, know the difficulties, obstacles, and discouragements, which the provincial physician has to encounter in such a country as this. Judge what sort of co-operation we could expect in the treatment of such a disease as cholera, in cabins wholly destitute of all the appendages of comfort, nay even of the most indispensable household utensils, and where the sole assistant (as was the case at the commencement) was some devoted person, generally an old stupid creature, whose life was not considered by the runaways as worth preserving.
Often in one of these wretched hovels, where I could scarcely stand upright, have I been obliged to go my rounds to the straw beds of four or five individuals stretched in all the horrors of cholera on a damp floor, to give them both medicine and nourishment, and frequently delayed a long time for the mere want of a spoon in which to give them. Obliged, then, to go through the several operations of killing, skinning, and committing to the saucepan, a chicken to supply them with broth, which I have been obliged, for want of a messenger, to carry from house to house. I could easily enlarge upon these various vexations, but will only add that, when it is further considered that the practitioner has to go through such a routine as this several times in the day, at places remote from his residence, and from each other, and in so doing to travel over roads scarcely deserving the name, perhaps, in bad weather, it will not, I think, be denied that No. LIX. U
it requires no small stock of perseverance to struggle against such a tide of opposing circumstances.
Of the cases, 154 were males, 206 females; of the deaths, 71 males, 91 females. Of the cases which fell to my lot, I was unable to take notes of more than 103; many died before I could reach them, and to others I could not go at all.
These cases were as follow :—
Hence it will appear, that, in forming a prognosis, the age of the patient is an important element of the calculation; and is also one on which, in fatal cases, will greatly depend the period of the disease at which death ensues.
Thus, we see that above the age of 40, there was no case of recovery from collapse in the second degree, or extreme collapse; while, as we descend, we find that, within certain limits, the powers of resistance or re-action increase. Thus of 13 recoveries between the ages of 30 and 40, four had been cases of extreme collapse: from which we may conclude that the age at which there is, cæteris paribus, the best chance of recovery is that between 10 and 40; those above the one and below the other, being seldom able to withstand the consecutive fever ensuing on the state of extreme collapse. For the convenience of detailing the treatment, I will divide the disease into three stages; viz. the 1st, or premonitory; the 2nd, or that of collapse, in the first degree; and the 3rd, or collapse in the second degree.
First, or Premonitory Stage.-This, in a majority of cases, consists in what would, in ordinary times, be called simple diarrhoea, with the addition, sometimes, of an occasional cramp, and an absence or diminution of bilious colour in the discharges, sometimes there are merely borborygmi. If there be no diminution of bile in the fæces a commanding dose of tinct. opii, e. g. gtt. Ix. (to an adult), will frequently arrest the disease; but if the secretion of bile be also diminished, we should premise cal. gr. iii., op. gr. ii., and in the course of an hour or two (if necessary) give the laudanum. If nausea be also present, the addition of a few drops of ol. menthæ pip. will be advisable. This form of premonitory stage, exists sometimes for several days without advancing further, being occasionally so slight as to attract little or no attention; and such cases have been by some authors set down as the most dangerous; but I have found it otherwise, and, indeed, would à priori expect to find it so; for the symptoms becoming, as it were, stationary on the threshold, imply a power of resistance to the inroads of the distemper. In some cases there is at first no affection of the bowels, but merely a general feeling of malaise, conveyed by the people here in the vague expressions of a" great weight about the heart," with an unaccountable degree of languor, depression, and weak pulse. This, in my experience, has been the most rapid and uncontrollable form of the disease, and generally
occurs in persons worn down by previous apprehension about it; as by unrelieved attendance on the sick. Vomiting, purging, and cramps come on almost simultaneously, and carry off the patient in three or four hours. In this case, I have found the following formulæ very useful-R. Camphoræ 3i., tinct. opii 3ss., ol. menthæ pip. gtt. xvi., tinct. cardam. comp. iss. solve. A drachm of this tincture may be given in any agreeable vehicle, and has, I think, rescued many from impending cholera. More rarely the first symptom is vomiting, in which case, it being probable that there are some offending matters in the stomach, an emetic is the most advisable remedy. Most rarely of all does it happen that the disease begins with cramps; and here the combination of camphor, opium, and capsicum, sometimes acts like a charm.
Case. A man, aged 60, at the burial of his wife, who had died of the disease, drank two glasses of raw whiskey on an empty stomach. Shortly afterwards, he was attacked with most violent cramps of arms, legs, and thighs, hurried breathing, jactitation and nausea, but no vomiting nor purging. He had also the decided cholera expression of eye. I gave him 4 grains of opium, 10 grains of camphor, 3 grains of capsicum, and 4 drops of oil of peppermint, followed by a cordial draught, and ordered heat to be applied to the extremities and spine. In the course of a few hours copious perspiration, followed by sleep, came on; and he was well. In all cases it is most important that the patient should be at once placed in bed, as nothing is more injurious in every stage of the disease than the exertion of gaining or keeping the erect posture, and it has happened that they have died in the effort. The usual means for preserving or restoring a proper temperature, should at the same time be resorted to. If the treatment above recommended should not arrest the disease, and diarrhoea continues or supervenes, or where there is, in addition, an irritability of stomach, forbidding the use of remedies by the mouth, an enema, containing plumbi acetat. ii., tinct. opii 3i., ought to be immediately administered; and this invaluable remedy is the sheet-anchor also in treating the more advanced stages.
Second Stage, or Collapse in the first degree.-By this I would be understood to mean that state in which there are vomiting and purging; the heat, though diminished, not being wholly extinct, and the skin dry, or at least not covered by a cold perspiration: there is also the sunken eye and hollow voice, the cold tongue and breath, and absence of pulse, with or without intense thirst and cramps. The latter, though generally attendant, is not always. In some old debilitated subjects the vis vitæ seems so completely extinguished as to be incapable of the abnormal nervous action. Neither is the danger always in proportion to their severity when they do occur.
As to the prognosis in this case, we may state generally, that if matters remain stationary for six or eight hours, this will be favorable. Within that time, in such cases, warm perspiration commonly sets in, purging wholly in great measure ceases, water is passed and vomiting is superseded by nausea and eructations, in short, a mere irritable stomach amenable to ordinary remedies. And with respect to vomiting in general in this disease, I have long learned to look upon it as by no means the formidable symptom. On the contrary, I consider it as an indication of a certain vital energy remaining, and have seen cases terminate most favourably where it has continued incessant all through. I accordingly never think of endeavouring to check it directly; nay, where it has ceased before reaction has begun to set in, and where, the thirst continuing, a quantity of fluid is accumulated in the stomach and oppresses the respiration and the general system, I am sure it is advisable to re-establish it. The following is a case in point.
Daniel Hanly, æt. 60, an asthmatic of long standing, 13 hours ill. Symp