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turned pale at the sight of armed bigotry, darkness was indeed spread over the earth ; and so on. For the rest turn to the work itself, or, as we should more conscientiously recommend, wait till the rhyming translation makes its appearance.
Art. VI. 1. Observations on Pulmonary Consumption. By Henry Her
bert Southey, M.D. 8vo. pp. 174. price 79. Longman and Co: 1814. 2. Letters Addressed to his Royal Highness the Duke of Kent, on
Consumption : containing Remarks on the Efficacy of Équable and Artificial Temperature in the Treatment of that Disease. By Thomas Sutton, M.D. &c. &c. 8vo. pp. 59, price 2s. 6d Under
wood, 1814. MEDICINE, it will be allowed by most persons, is already
divided into a sufficient number of departments. The three separate heads of physic, surgery, and pharmacy, seem to preclude the necessity of any subordinate divisions, or more minute ramifications of the healing art. It, nevertheless, now and then happens, either from early bias, accidental impression, or some other causes, that a particular branch of one of these departments is selected by the medical artist, not for exclusive, but for prominent regard. Thus, for example, during the preparatory course of studies for the formation of a surgeon, the exquisite structure and interesting physiology of the eye shall attract, in a more than ordinary degree, the attention of the student; his reading, his researches, his dissections, and his experiments, will, in consequence, tend to a more minute and close investigation of that favourite subject; and he will come out from his studies a well instructed surgeon in general, but an oculist in respect to the feeling of particular preference. So will it sometimes happen in the pursuit and practice of medicine. The diseases of one part of the frame shall appear to deserves, in some instances, especial observation, and more than ordinary research; and when we recollect that consumptlon of the lungs is the giant malady of this country, that it stands first and foremost in the long list of formidable British diseases, it is not to be wondered at, that British physicians should often come out with dissertations on this most melancholy of subjects.
Within the last ten years, indeed, we have had nearly as many treatises on pulmonary consumption, all of them written by regular and respectable practitioners. To persons who are at all familiar with modern writings on medicine, the names of Beddoes, Bourne, Reid, Saunders, Buxton, Woolcombe, Duncan, will immediately occur; and to these we have now to add that which stands at the head of this article,-a name whicb, if it be right to make any comparison, we may be
permitted to say, deserves to rank by no means last on the list of comparative merit. In our critical analysis of Dr. Southey's work, however, we shall have fault to find as well as praise to bestow; and we hope to do both with the same feelings of candid impartiality.
In the remarks, connected with this and other works on the subject of consumption, which we are about to present to the reader, it is our intention to steer as clear as possible of technical phraseology: not that we profess ourselves by any means unqualified advocates for the principle of popular and unprofessional medicine, (for we are, indeed, of opinion, that, with some good, much mischief may spring from this source,) but from a feeling that the more than common importance of this subject, may induce anxious inquiry beyond the pale of the profession
Without presuming far on the influence of our journal, it may very fairly be supposed, that the present article will find some readers, who are looking out, in every quarter, for information relative to a subject upon which seem to hang almost all their earthly hopes and fears; and such persons will not be prevailed upon to shut their eyes against the mysteries of medicine. Information, either good or bad, they will certainly get at; and it is in the power of all so to do, while the vernacular language is used as the vehicle of professional instruction.
The question then is, not whether it is expedient totally to prevent profane research, but which is the best mode to turn the tendency of inquisitive minds to a good account, and secure inquiring individuals against the tricks and snares of quackery. Here we may be allowed to avail ourselves of authoritative opinions from another quarter; authoritative, inasmuch as they are the sentiments of one of the most amiable and most able of medical professors. It were better, perhaps, (says the late Dr. 'Currie,) that medicine, like other branches of natural knowledge, were brought from its hiding place, and exhibited in the 'simplicity of science and nakedness of truth.'
Dr. Southey divides his work into four sections. First, He treats of the symptoms.' Secondly, He speaks of the appearances on dissection.' Thirdly, Of the predisposing and exciting causes.' And, lastly, He considers the treatment of the complaint.' We shall first accom. pany the Author through these several topics; and then conclude the article by offering a few reflections of our own, principally in reference to the production and prevention of pulmonary disorders.
Systematical writers (says Dr. S.) have enumerated several species of pulmonary consumption, and undoubtedly there exist many varieties; perhaps no two cases will be found precisely similar; but
for practical purposes it appears sufficient to distinguish carefully between the consumption of the lungs, which occurs in persons of the strumous temperament, and that which, from accidental causes, or as a consequence of other diseases, may attack constitutions of a very different description. Strumous phthisis, as the most common and most destructive in this island, demands the first and greatest share of attention. The individuals most likely to be attacked by this form of the disease are distinguished by a combination of many of the following marks, sometimes by all of them : fair, thin, smooth skin, through which the blood vessels may be seen, blooming cheeks, light soft hair, light eyes, with dilated pupils, thick nose and upper lip, white teeth, head rather large, narrow chest, flaccid muscles, and long weak fingers, of which the last joint is large. To these external appearances in children precocity of intellect is often joined Dark hair, dark eyes, and dark skin, are sometimes combined with the other signs of scrophula ; but the skin is always thin and transparent, the pupils large, and the muscular fibre lax.'
pp. 1-5. We fully agree with the Author on the great importance of ascertaining, by external signs, the strumous, or, as it will be more generally understood, scrophulous tendency in the habit, in reference to the diseases in question ; and we have seldom seen exhibited, at once to our view, so concentrated and faithful a delineation of these signs. We consider, however, that part of the statement erroneous, and calculated to mislead, which makes thinness and transparency of the skin an absolutely necessary mark of the scrophulous constitution. Much internal scrophula, at least, if we may be allowed the expression, we think we have seen fully marked in individuals of a swarthy complexion, and where the skin is any thing but transparent. Were we inclined to dispute on words, we might, indeed, object altogether to the term dark skin ; but we wish to confine ourselves entirely to facts generally understood. Now it shall sometimes be found in the child of parents who are differently constituted both as to complexion and habit, that such child shall be a mixture of the two. It shall have the internal peculiarities of the one parent, with the external marks of the other, although that external appearance shall in general stand as an index of a very different inward state of things from what it does in the present instance. It would seem proper, therefore, to point out fineness of skin, as a very usual accompaniment of a scrophulous constitution; but very improper to insist, as our Author has done, on the absolute indispensableness of its presence.
There is one mark of a scrophulous taint, which we do not perceive that the Author has noticed, though it is almost always found either in a greater or less degree. We mean a very peculiar pearly appearance in the white of the eye, not very easy, indeed, to describe ; but which, at the same time, is very evident to those who are much accustomed to these observations; and
which, together with the largeness of the pupil, always gives a very marked character to the eye of an individual, in which scrophula, if we may so say, abounds.
A strumous disposition is very generally’indicated, though not invariably, by a redness and constant tendency to inflammation in the eye-lids; and we are disposed also to lay much stress on the inclination, during infancy, to glandular swellings of the neck, to hardness and a knotty feel in the abdomen, and a tendency to the generation of worms.
The make of the body, also, is of much consequence in assisting our decisions on consumptive tendency. Narrowness in the chest is very properly noticed, by Dr. Southey, as one of the marks of scrophula; but in a person disposed to consumption there is something very singular in this narrowness. Besides a want of full sweep in the form of the ribs, there is a remarkable shortness as well as an upward direction in the collar-bones, which occasions the shoulders to stand prominent and high, and gives to the shoulder blades the appearance, as Dr. Beddoes aptly describes it, of wings just raised from the body, and about to expand for flight.
Mere narrowness of the chest, however, sometimes exists in a high degree without affording any real ground for apprehension, as it is not seldom indicative of a feebleness of frame, which is not of a scrophulous kind; and here, it may not be unseasonable to observe, that we think the author just mentioned has not made out his case, in attempting to generalize scrophula into a state of mere debility. Weakness it certainly is ; but it is weakness of a peculiar kind, and affects principally one system of organs. Dr. Cullen has, perhaps, best characterized it by calling it' a ' peculiar state of the lymphatic system, and had we space to pursue the investigation, it might easily be shewn in what manner every mark of the state in question, might be satisfactorily accounted for, upon the principle of peculiarity in lymphatic action.
Dr. Southey, in the twelfth page of his work, well observes, that. There is a form of pulmonary consumption, in which the mucous membrane, lining the air cells of the lungs, seems affected in the same manner as the similar membrane, lining . the urethra, is, in Gonorrhæa Virulenta.' Surprise is sometimes expressed, by professional men, at recoveries from consumption after true pus had been expectorated for some time; but we believe these would be found to be cases in which the diseased action had been confined to the mucous membrane in question, and had not extended itself to the cellular portion of the lungs, the residence of those bodies which are termed tubercles, of which it is now in place to say a few words respecting their structure and origin.
It is in the second division of his treatise, that Dr. Southey engages in the consideration of tubercles in connexion with consumption; but we do not find any thing in this part of the work, at least so far as the question of tubercle is concerned, that prefers much claim to notice.
There is, confessedly, a great obscurity in the theory of tubercular production. We believe that these bodies are very seldom found to exist except where scrophula is present; and from this circumstance, as well as from their similarity in appearance to hard and tumified lymphatic glands, it was a sufficiently natural supposition, in the first instance, that they were diseased glands. This, however, has been demonstrated to be an erroneous notion. 'Tubercles,' says Dr. Baillie, 'consist of rounded, firm, white bodies, interspersed through the sub< stance of the lungs. They are, I believe, formed in the cellu< lar structure which connects the air-cells of the lungs toge'ther, and are not a morbid affection of glands as has frequently
been imagined. There is no glandular structure in the cellu'lar connecting membrane of the lungs, and on the inside of the 'branches of the trachea, where there are follicles, tubercles have ' never been seen.'
The presence of these bodies, we have just stated, is almost peculiar to scrophulous habits; but the precise manner in which they are formed and deposited in the lungs, to which we think Dr. Southey, in a treatise on consumption, ought to have given a little more attention, seems to require some further investigation. It would appear, that any irritation, of whatever kind, which may take place in the pulmonary organs of a scrophulous subject, has more or less power in creating these mischievous productions; they are scrophulous deposits from inflammatory action.
Dr. Haighton and others have, however, ascertained, by experiment, that a foreign matter, artificially introduced into the blood-vessels, may be made productive of precisely the same effect. Dr. H. injected running quicksilver into the crural vein ' of a dog. The fluid metal being circulated along with the 'blood found its way to every part of the body. The animal 'did not seem to be disagreeably affected during the first day. 'It then became feverish, and afterwards laboured under difficulty of breathing. A cough succeeded. These complaints 'went on increasing till the death of the dog. In the lungs
were found tubercles, of which many contained matter.. That 'these tubercles had been produced by the injected mercury ' was demonstrated by cutting into their substance, from which 'it appeared that each contained a particle of metal.'
We do not profess ourselves friendly to those views of pathology, which look, for the explication of diseases, into the mass