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those who have laboured to reform the organization of the medical profession in Great Britain; and we hope with him that if, at this late period, some slight differences may appear to linger between the various corporations whose interests are more immediately involved,
“The Government will exercise that most legitimate influence, by which the differences incident to every large body, made up of sections heretofore acting under separate banners, may be induced to yield to the general good.”
ART. VI.—New Remedies, with Formula for their Preparation and
Administration. By ROBERT DUNGLISON, M.D., Professor of the Institutes of Medicine, &c., in the Jefferson Medical College of Philadelphia Seventh Edition, with numerous Additions.
Philadelphia, 1856. pp. 769. As a work of reference upon all new remedies, this is one of the most complete with which we are acquainted. The quotations of authorities are extensive, minute, and carefully given; and we are satisfied that no medical man would regret following our advice to acquire it, as daily opportunities will occur in which he may both test its value, and increase his own knowledge, in searching for the practical information it affords.
ART. VII.—The Hygienic Treatment of Pulmonary Consumption.
By BENJAMIN W. RICHARDSON, M.D., Licentiate of the Royal College of Physicians, Physician to the Royal Infirmary for Diseases of the Chest and to the Margaret-street Dispensary for Con. sumption, Lecturer on Pathology at the Grosvenor-street School of Medicine, and Corresponding Fellow of the Pathological Society
of Montreal.—London, 1857. pp. 115. We hold the opinion that, whether tubercle consists in a fatty degeneration of epithelium, in the exudation of an unorganisable fibrin, or of an excessive production of epithelial débris, the efficient cause of the disease is to be found in the prolonged inhalation of a vitiated atmosphere. Other influences may be at work to impair the tone of the muscle and the plasticity of the blood, but none of them are able to produce tubercle, unless the food that is offered to the lungs is deprived of its due amount of oxygen, or adulterated by the addition of carbonic acid, sulphuretted hydrogen, ammonia, or similar noxious gases. If this principle be conceded, it follows, as a matter of course, that whether we have regard to the prevention or the cure of the tuberculous diathesis, the first element for the physician to attend to is the provision of a pure atmosphere. The patient must be constantly surrounded by air, which enables all the vital processes to be carried out vigorously. Without pure air, the depuration of the blood must be defective; and if the surface of the pulmonary mucous membrane, the extent of the human ventilator, has once been diminished by the deposit of any material that interferes with the function of respiration, the influence of atmospheric impurity will gain in noxious power in the ratio of a geometrical progression. Let all medical men ponder well upon the importance of pure air; let them unite to enforce the purification of the atmosphere outside our dwellings, and its free and unintermittent introduction into our rooms, and the misery and mortality resulting from tubercular diseases will be reduced in a manner which only those can estimate, even approximately, who are able fully to appreciate the physiological bearings of the process of respiration. But it will not suffice to wait till the oxygen is brought to us. We must go in search of it. We must encourage the inetamorphosis of our tissues and the eliminatiou of the waste products by exercise, while we supply healthy nutriment to the stomach, and provide against excessive waste and exhaustion, by proper clothing and due nightly rest. Dr. Richardson discusses all these elements in the physiological treatment of consumption in a healthful spirit; they are views which are, we believe, shared by many medical men, though they have not been, perhaps, so specifically brought to hear upon the treatment of pulmonary consumption as in the present instance. We shall gladly see the volume obtain a wide circulation in and out of the profession, because it is impossible to preach too widely and too frequently the superlative influence of pure air in the treatment and the prevention of disease generally, and of tubercular disease in particular.
The author divides his work into seven chapters. The first introduces the subject of the hygienic treatment of consumption; the second is devoted to the consideration of the supply of pure air as the first indication in its treatment, and the necessity of active exercise. Climate, dress, rest, form the subjects of the third chapter. In the fourth, the occupations and amusements of the consumptive patient are considered; while the importance of cleanliness, of abstinence from all kinds of sensual extravagances, 'the dangers of marriage on the part of consumptive females, are enforced in the fifth chapter, which concludes with remarks on diet, and the use of tobacco by phthisical patients. A few brief remarks on the medicinal treatment of the disease, in which Dr. Richardson well exposes the folly of seeking for a specific in the phthisis, occupy the sixth chapter. The seventh and concluding chapter is devoted entirely to a comparative examination of the various modes of artificial ventilation proposed, from the time of Dr. Hales downwards.
In taking leave of Dr. Richardson, we would thank him for the able addition which, in the book before us, he has made to the great edifice of sanitary science. It is here that our real strength lies. While we accept gratefully the beneficent agency of the contents of the Pharmacopæia, which Dr. Richardson, in our opinion, estimates at their true value, we know that the most powerful weapons that can be wielded against the inroads of disease and the devastations of premature death, are those which the patient too generally thinks least of, because they are at hand, and may be had without the intervention of a soothsayer or a prophet.
ART. VIII.—The Structure, Functions, and Diseases of the Lungs.
By THOMAS WILLIAMS, M.D., F.L.S., Physician to the Swansea
Animals, and Aquatic Respiration.)-London, 1877. pp. 201. The original of the present work, in the year 1842–3, procured for its author the high distinction of the triennial prize of the Royal College of Surgeons. That fact alone would make it imperative upon us to examine it with care, and place before our readers the results of the laborious researches of Dr. Thomas Williams. A cursory inspection shows the work to be one of no ordinary merit. For the present we must, however, content ourselves with announcing its appearance; we shall wait for the appearance of the second part, which will bring the physiological inquiries of the author, on the subject of the respiratory apparatus throughout the animal creation, to a close, and then seek to present to our readers the views and observations of Dr. Williams in a condensed form.
ART. IX.-A Report upon some of the more Important Points connected
with the Treatment of Syphilis. By HOLMES COOTE, F.R.C.S., Assistant-Surgeon to St. Bartholomew's Hospital. —London, 1857
Svo, pp. 141. The author enters upon an independent investigation of some of the phenomena of syphilis. We rejoice to see this fertile subject occupying the attention of hospital surgeons, and we trust that Mr. Coote will continue to pursue the inquiry he has commenced in that large field which is open to his labours.
In the introduction, Mr. Coote states that his experience does not confirm the doctrine, that a primary sore giving rise to suppurating bubo, is not usually followed by secondary symptoms. In illustration of this he instances the cases of eleven male patients in the venereal wards of Bartholomew's suffering with secondary syphilis ; in two there had been suppurating bubo. There were also nine females, of whom four had had suppurating bubo.
We are compelled to observe, that these statements prove nothing with regard to the real point at issue. Were the suppurating buboes specific, or were they ordinary inflammations of the lymphatic glands, such as we know are constantly recurring from slight local injuries of any kind, especially in weak constitutions ? Nothing but the test of inoculation could have proved that. If the secretion from the inguinal swelling were inoculable, the affection was specific, and the probability is that the constitution would not subsequently suffer, the virus being (such is one theory) eliminated by the lymphatic system. If it were not inoculable, the affection was probably a simple inflammation, between which and the chancre there is no ground for believing any specific relation to have existed. That the latter was the true pathology of these cases, appears to us to be indicated by the author (although unintentionally) in the following remark:
“It must be remembered that women living on the streets are unable to rest at the commenceinent of their attacks of disease; and hence suppuration of the inguinal glands is by no means uncommon.” (p. 11.)
The cause suggested explains the suppuration—a simple, not a specific one. Inability to rest would, in the same way, determine the existence of a suppurating gland after a scratch on the leg, or a sore corn. Without inoculation, the specific character of the inguinal swelling cannot be affirmed ; and, wanting a knowledge of this important datum, no inference can be drawn respecting the nature of the process which has been set up there, whether it has been virulent or otherwise. Granting that these buboes were simply the results of local irritation, not of the specific poison (and this is certainly a probable view of the case), these cases entirely cease to controvert the doctrine which Mr. Coote disbelieves. A somewhat similar, but not identical doctrine, has been for some years past taught in Paris, and has in part been brought prominently forward in this country by Mr. Henry Lee, and as much of it as relates to this question—discussed as it is by Mr. Coote without reference to an observation of the primary sore-may be thus formuled
A primary syphilitic sore, followed by three or four small indurated glands, without tendency to suppurate, is almost certainly followed by secondary symptoms.
A primary sore, followed by one acutely inflamed gland, which suppurates and is inoculable, is, on the contrary, rarely followed by infection of the system.
But then it is unphilosophical to regard this question of bubo separately from the character of the sore which gave rise to it. The firstnamed sore is the indurated chancre; the second is the non-indurated, non-infecting, but most common variety. Each has its own specific action upon the lymphatic glands, as described above : the first alone extends to the system also, and gives rise to secondary symptoms; the virulence of the second does not go beyond the suppurating gland. Either may give rise (from irritation, as of walking, or without it in certain constitutions) to a simple gland enlargement and abscess, but without specific virus in the pus. Hence a non-indurated chancre, followed by acute gland suppuration, the pus of which will produce a similar chancre, is never followed by secondary symptoms. Such is the doctrine referred to-a doctrine demonstrated and emphatically taught by Ricord, and which our own experience corroborates the truth of; but it is widely different from that which has been enunciated in its place by Mr. Coote, for purpose of disproof; viz., that,
"In those instances in which the irritation of the lymphatic glands is the greatest, and where, consequently, we have the best evidence that the morbid matter has entered them, there is very seldom any secondary syphilitic affection.” (p. 10.)
But the author does, in the case of the men only, refer to the cha
racter of the sore, stating that “not one had the true indurated chancre. The primary sores were superficial ulcerations of the glans and prepuce, leaving cicatrices, and one case of primary phagedana.”
The italics are our own. The fact of the non-induration is affirmed, not on observation of the sore, but of its cicatrix. Nothing can be more doubtful than the inference.“ But," the author proceeds, in most cases the patients stated that the glands in the groin swelled up for a week or more, and then subsided.” This is the very form of gland-enlargement, pointed out in the formula above, as characteristic of the indurated chancre, and is strong evidence, in absence of an actual observation of the primary sore, that such was its nature in the “most cases" adduced.
Passing to another topic, we learn that Mr. Coote adheres to the belief that gonorrhoea is the result of a specific poison. He quotes the following case as proving that “its existence retards, as it were, the action of the syphilitic virus.” (p. 31.) A patient was admitted to the City Bridewell with gonorrhoea of fourteen days' standing. After three weeks' residence it left him, and very soon “a superficial nonindurated venereal sore” appeared on the skin of the under part of the penis. There could have been no fresh infection from the other sex. The source of this sore is then discussed by the author, who doubts that in this case intra-urethral chancre complicated the gonorrhea, but that the sore on the penis was due to syphilitic virus, the incubation of which had been delayed by the first-named complaint, because
“There were no symptoms whatever of ulceration of the urethra; there was not excoriation at the orifice, nor induration along the canal, nor pain upon pressure, nor any sign by which such an occurrence could be suspected."
Surely we cannot forget that many infecting sores seen on the exposed part of the penis possess no characters by which it would be possible to determine their existence by any physical examination, supposing them to be seated within the urethra, and beyond the reach of vision. We cannot doubt that this was a case by no means rare, of gonorrhæa co-existing with intra-urethral chancre, of the ordinary nonindurated form, by which the skin of the penis was subsequently inoculated. That the two things do co-exist has been proved a hundred times by Ricord-a fact familiar to those who know his practice.*
In asserting the existence of but one syphilitic virus; that the character of the sore is determined greatly by the natural structure of the part in which it is situated ; that the occurrence of phagedana depends much on the constitution of the individual ; and that the course of secondary symptoms is not to be predicated, Mr. Coote opens up topics, to enter upon the consideration of which would require very extended limits. Some of these positions are regarded by very high authorities as requiring modification, under the light which has, during the last few years, been thrown upon the subject of syphilis.
Nothing new transpires respecting treatment. The plan commonly followed by the author consists in that invaluable resource, early cau• See also his Lettres sur la Syphilis. Paris, 1851. The fourth to the eighth, inclusive.