Зображення сторінки

chery; and he looks upon it as the nidus or matrix of the subsequent disease of the lungs.*

It is as a powerful adjuvant of the medical means best calculated to remove this disorder—for, unlike its progeny, it is often curable—that removal to a mild climate is strongly recommended. The same measure is likewise advised, though with much less confidence, when there are strong reasons for believing that tubercles are actually formed in the lungs. But it is denounced, as we have already stated, in the strongest terms, not only as useless but cruel in the extreme, except in a few particular cases, when the disease is confirmed. We will here allow Sir James Clark to speak for himself; only observing that we entirely accord with every sentiment expressed by him in the following extract:

• Unfortunately it too often happens, that the period of constitutional disorder, which we have just been considering, is pernitted to pass ; and it is not until symptoms of irritation or impeded function in the lungs, such as cough, difficult breathing, or spitting of blood, appear, that the patient or relations are alarn.ed, and that fears are expressed that the chest is “threatened." Such symptoms are but too sure judi. cations that tuberculous disease has already commenced in the lungs. It may, indeed, be difficult, in some cases, to ascertain the positive existence of this, although, by a careful examination of the chest, and an attentive consideration of all the circumstances of the case, we shall seldom err in our diagnosis; and it need not, at any rate, affect our practice, as a strong suspicion of the presence of tubercles should lead us to adopt the same precautions as the certainty of their existence.

When tuberculous matier is deposited in the lungs, the circumstances of the patient are materially changed. We have the same functional disorders which existed in the furiner state : and we have also pulmonary disease, predisposing to a new series of morbid actions to bronchial affections, hæmoptysis, inflammation of the pleura and lungs, &c.—which calls for important modifications in the plan of treatinent. Removal to a mild climate, especially if effected by means of a sea voyage, under favourable circumstances, may still be useful as in the former case-namely, as a means of improving the general health, of preventing inflammatory action of the lungs, and even, perhaps, arresting the progress of the disease.

When consumption is fully established—that is, when there is ex. tensive tuberculous disease in the lungs, little benefit is to be expected from change of climate ; and a long journey will almost certainly increase the sufferings of the patient, and hurry on the fatal termination. Under such circumstances, therefore, the patient will act more judiciously by contenting himself with the most favourable residence which

• See also his treatise on Consumption and Scrofulous Diseases. London : 1835.

his own country affords ; or even by remaining amid the comforts of home, and the watchful care of friends. And this will be the more advisable when a disposition to sympathetic fever, to inflammation of the lungs, or to hæmoptysis, has been sti ongly manifested.

• It is natural for relations to cling to that which seems to afford even

ray of hope ; but did they know the discomforts, the fatigue, the exposure, and irritation, necessarily attendant on a long journey in the advanced period of consumption, they would shrink from such a measure. The medical adviser, also, when he reflects upon the accidents to which such a patient is liable, should surely hesitate ere he condemns him to the additional evil of expatriation; and bis motives for hesitation will be increased when be considers how often the unfortunate patient sinks under the disease before the place of destination is reached, or, at best, arrives there in a worse condition than when he left his own country, and doomed shortly to add another name to the long and melancholy list of his countrymen who have sought, with pain and buffering, a distant country, only to find in it a grave. When the patient is a female, the objections to a journey apply with increased force.

It is not, therefore, in the hope of his patients finding something specific-some mysterious and occult virtue—in the air of a milder climate, capable of curing consumption, that our author sends them to Italy or Madeira; but it is because the climate of these countries permits the application of the means best calculated for preventing or removing those morbid actions which too often terminate in consumption. The fatal error of this country is – to wait until the lungs are obviously affected, and then to hurry the unfortunate patient at once to a mild climate; without considering, in the first place, whether the case is of such a nature as really to afford any reasonable hope of benefit from any climate ; and, secondly, if a prospect of benefit really exists, which of the milder climates is best suited to the particular case. The plan recommended by the author is to watch the development of that train of symptoms, which, if left unchecked, too generally terminates in consumption; to institute then a comprehensive and combined system of treatment calculated to restore the disordered functions; and, as enabling some parts of this system to be carried much more effectually into operation, then to remove the invalid to the mild climate which is best suited to the peculiarities of the case. Such a climate, among other advantages, tends to produce a greater equality in the circulation, by determining the fluids to the surface and extremities; removes considerably the risk of catarrhal affections, which, in predisposed sulijects, often aet as exciting causes of tubercles; and—the greatest advantage of all-enables the invalid to be much more in the open air, and, consequently, to take much more exereise than he could possibly do in England, during the winter. With such advantages as these, the plan of treatment calculated to restore the general health, and thereby to avert the threatened disease of the lungs, has obviously a much fairer chance of success in such a climate as Madeira, where there may be said to be a pei petual summer, than in so cold, moist, and variable a climate as that of England. We

say the plan of treatment has a fairer chance of success in such a climate-not that the climate is to be considered as the sole or even principal agent in averting the impending malady ; much less in curing it when it has already made good its footing. The fact is, that although a change to a mild climate may be sufficient, in some cases, to enable the natural powers of the system to restore the disordered functions without the aid of art, these powers will fail in a great majority of cases; and yet, not so much, perhaps, from their deficiency, as because they are impeded and thwarted by an injurious system of regimen or medical treatment. In the severer or more strongly marked cases, (even before the development of tubercles,) it will be of little avail that the invalid changes our cold and gloomy atmosphere for the soft breezes and brilliant skies of the south; unless he changes, at the same time, the habits which have induced, or aggravated, or accelerated his present disorder; and unless he, moreover, adopts measures calculated to aid the sanative powers of nature. Nay, we will assert, however great may be the advantages of a mild climate in such cases, (and we consider them as very great,) it will be much better for an invalid to remain in England under good management, than to go abroad to the best climate, under no management at all, or under bad management. Cæteris paribus, a mild climate is, in this case, greatly preferable to a cold one; but a good system of discipline is indispensable in both.

And here, before we conclude, and lest we should be thought desirous of having it supposed that we ourselves, or the author of this work, possess some new and potent system of medieation - calculated to avert the poisoned arrows of the pest,' or to stay its giant strides-we deem it necessary to state, in a very few words, the general complexion of the plan of treatment which he recommends, and in which alone we have any faith, in the case under consideration. In the first place, we utterly disclaim the possession or prescription of any specific remedy in such cases; and, in the second place, we profess to be most sparing in the use of medicines of any kind. Indeed, we are of opinion that medical science has now arrived at that stage when, in practice, it may frequently content itself by looking rather to the pathological condition of the subject, than to the efficacy of any remedial measures. At all events, we think it will generally be found, that the most scientific and skilful physicians are the most sparing in the use of drugs. The plan we advocate in the present case, consists essentially in taking a close and comprehensive view of the whole disorder under which the system labours ; and in adapting our remedies (often extremely simple) to every part that is affected. What we consider as most faulty in the prevailing systems of medicine in this conntry is, the too great simplicity of the views of disease taken by practitioners, and the consequent too partial and exclusive system of therapeutics founded on them. We wish practitioners, in their study of chronic diseases, to endeavour, like the author of the work before us, to combine the Hippocratic system of close and comprebensive observation with the more rational views of disease brought to light by modern Pathology; and in their practice to endeavour to restore, at the same time, all the parts that are disordered ; and to restore them by such mild and simple means as are calculated rather to solicit than to force their natural actions. In the case now more immediately under consideration-the morbid state entitled by Sir James Clark Tubercular Caeherywe find almost every part of the system disordered, although some are much more so than others. There is an irregular distribution of the circulating fluids, of the nervous power, and of the animal temperature; the circulating fluids are ibemselves in an unhealthy state, and most of the secretions are depraved; the organs of digestion are particularly disordered; the skin and all the mucous surfaces are affected; and there exist local congestions, or irritations, or inflammations of the mucous surfaces, viscera, and internal blood vessels. Now, is it to be supposed for a moment, that medicines, or any system of treatment that regards only one or two links of the chain, can stand any chance of removing a disorder at once so general and so deeply rooted ? The experience of all the best physicians of the present day, and the results of our author's observations, recorded in the present work, and in his Treatise on Consumption, strengthen and confirm our own convictions, founded on long attention to the subject, in replying in the negative.

ART. VI.-Lives of Eminent Foreign Statesmen. By G. P. R.

James, Esq. (Forming part of the Cabinet Cyclopædia.) 5 vols. 12mo. London: 1838-40.


R James, one of the most voluminous and rapid inventors of

fictitious narratives, and tales of fancy, that any country or age has produced, is also known to the world, and not without some credit, as a devious labourer in the sober paths of historical enquiry-in which he has ranged over periods and reigns so widely separated, and so diverse, as those of Charlemayne and our William the Third—has, in the above work, produced a biographical collection in the loftiest walk of that department, and of such extent that years of laborious research and patient reflection might have been well employed in its composition. Yet, though neither possessing any new information, nor expressing any original or striking views regarding any of the illustrious names which it embraces, it may still be allowed to form a not unacceptable manual of the political biography of the Continent, for those who are satisfied with a tolerably agreeable and instructive account of personages frequently named, but whose lives and characters are but little known, except by the learned.

To go over so multifarious a collection, with any particularity of remark, would be altogether incompatible with our limits. Among the best of its sketches are those devoted to Barneveldt and De Witt; two statesmen who greatly adorn the annals of a country not over rich in such characters, and not so generally known as they deserve. We shall, therefore, content ourselves with a few notices and reflections regarding them-taking the latter first, as giving more effect to the observations we mean to introduce.

John De Witt, Grand Pensionary of Holland, is one of the very few unsuccessful statesmen— for such, on the whole, he must be considered-to whom merit of the highest order has been adjudged. But the wisdom of his views was so evident, and they were so ably elucidated and defended by himself, that posterity has done justice both to his abilities and his virtues, though the singular difficulties of his life prevented him from accomplishing the more important of his ends. His great anxiety was to preserve a peace which should enable Holland to rise to prosperity through the uninterrupted pursuit of commerce. Yet the whole of his official career was spent either in actual warfare, or in preparation for it. He laboured with zealous perseverance to secure the republican institutions of his country, by abolishing the anomalous office of Stadtholder; and by educating the young Prince

« НазадПродовжити »