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since the time of that original observer, to accomplish such a consummation, the physician is every day taught to feel that it is far from complete.
Impressed with the reality of these difficulties, no doubt, Borsieri, Darwin, and Joseph Frank found it impossible to reject from a complete classification of diseases headach, whether of the temporary or the chronic description ; and we find accordingly, that these authors have adhered to the common practice of ancient and modern physicians. It is scarcely necessary, however, and, at least, we do not think it judicious, to defend this practice by the importance with which Fothergill and Warren, and some other authors, have laboured to invest the form of the complaint denominated sick-headach, which had been shown long before by the indefatigable Robert Whytt, to be a symptom and part of dyspeptic, arthritic, hypochondriac, or hysteric disorders, and which even Tissot willingly admitted to belong to this head. It is preferable, we conceive, to admit the propriety of giving a separate place to this complaint, on the sole and reasonable ground, that in practice the several varieties of headach cannot be always traced to the same pathological cause, or to any certain pathological cause at all.
The present author, admitting fully the dependence of the state of the textures of which the head consists, on the condition of other parts of the system, and especially on that of the stomach, liver, the intestinal tube, and the womb, properly contends, nevertheless, that headach, severe and enduring, may arise and continue, or after remission, recur, when the organs now mentioned are all in the most obvious healthy state, and consequently must take place in consequence of some disorder or excited state of the vessels of the sensorium itself. But independent of this peculiarity, it must be kept in mind, he further contends, that not only may a common cause affect the head and the stomach, but the long-continued, or often repeated, irritation of a disordered stomach, may to all appearance excite in certain constitutions local disorder of some of the tissues and organs composing the head.
Rejecting the ancient distinction of headach into acute or temporary, or cephalalgia, and dull, chronic, and enduring, or cephalæa, Dr Burder regards the former term as sufficiently characteristic and comprehensive for all practical purposes ; and of this he presents six species;-1. the muscular; 2. periosteal; 3. congestive; 4. organic; 5. dyspeptic, or the sick-headach of Fothergill and Warren ; and 6. the periodical. Some defects in this division, which perhaps is not quite so logical as might have been expected, it would be easy to point out; but the descriptions appear to accord reasonably well with the distinctions,
and to be readily susceptible of practical application in treatment; and we therefore refrain from minute criticism.
The two first varieties are easily understood from their specific names. The second is important, in so far as the author represents it to be occasionally induced by long-continued or oftenrepeated cerebral or cerebro-meningeal excitement from moral causes, after which the local disorder thus induced reacts on the cerebro-meningeal vessels, and thus is enabled to convert a temporary into a permanent disease. In illustration of this, the author details the following case.
“ A gentleman of a susceptible constitution, who had long been subject to occasional attacks of dyspeptic headach, and had frequently suffered from mental application during a long and laborious course of study, was thrown at once into the onerous duties of a large public institution. Much pain and excitement of head ensued. General and local bleeding, mercurial purgatives, antimony, low diet, &c. were considered necessary. The symptoms subsided considerably, but the brain and nervous system remained in a state of extreme susceptibility. On some recurrence of pain, it was judged needful to shave the head, which happened to be done under circumstances of great exhaustion on a cold wet evening. The ordinary covering of a thin night-cap was alone worn during the night. On awaking from sleep, a severe constrictive pain was felt over the whole head, attended with heat and tenderness of the scalp, throbbing of the temporal arteries, considerable cerebral ex. citement, and vomiting. In truth, an external periosteal disease was thus engrafted upon a head previously suffering from high and continued excitement. After a few days, the more superficial tenderness subsided, but the periosteal affection proved exceeding. ly intractable. In this case it seems probable that the frequent occurrence of sympathetic headach, aided by the excitement atten. dant on long-continued study, had induced an undue degree of vascularity and of nervous susceptibility in the head generally; while the remarkable prostration of vital power consequent upon the depletory measures employed, served to increase the nervous susceptibility, and thus concurred to form that twofold predisposition of which we have before spoken, and without which, we apprehend, the subsequent exposure to cold and humidity would have been insufficient to excite this peculiar periosteal cephalalgia, although it might have produced an ordinary rheumatic affection of the scalp. So exquisitely sensitive does the pericranium remain in these cases, so readily affected by every exposure to humidity or sudden reduction of temperature, and so apt to participate in every occasional excitement of the brain, that one attack of the complaint has scarcely time to subside before some fresh exposure gives rise to a decided augmentation of disease.”—P.381.
To the same head the author also refers periostitis of the cranium,-a disorder which has been generally classed under the
head of cephalæa, but which it is certainly better to refer at once to the affected tissue.
The congestive headach is chiefly that which, taking place as represented by the author, in three classes of subjects, the plethoric, the delicate and irritable, and the feeble and leucophlegmatic, is in all probability connected with an irritable and enfeebled state of the cerebro-meningeal capillaries, and consequently an irregular state of the distribution of their contents, and thereby inducing morbid accumulation.
The organic and dyspeptic forms are sufficiently explained by their denominations. The periodic is that resulting in general from the operation of malaria, and connected with the presence of an aguish disposition.
The whole article is written with ability, and with much practical knowledge of the subject.
A good article on Hæmoptysis, by Dr Robert Law of Dublin, deserves some notice.
Dr Law properly resorts to the anatomical distribution of blood-vessels in the lungs, in order to explain the mechanism of pulinonary hemorrhage, and represents every cause which deranges either the general circulation or that of the lungs as competent to induce this hemorrhage. He then proceeds to explain the influence of derangements of the general circulation, and more particularly that of disease of the left side of the heart, in inducing pulmonary apoplexy, in the following manner.
“ We are now prepared to understand a circumstance to which we shall have occasion to advert when we come to speak more particularly on the subject of pulmonary apoplexy. Although this affection generally consists in the extravasation of blood into the parenchyma of the organ, and of hemoptysis inore or less extensive at the same time; still this latter phenomenon may be altogether absent, and the hemorrhagic engorgement (which is really the essence of the disease) alone be present. In fact, we regard the ad. dition of the hemoptysis as a mere accident, though a measure of the intensity of the cause which has given rise to the hemorrhagic engorgement; and we readily account for its frequency by the fa. cility with which an injection is found to pass from the pulmonary into the bronchial artery. The communication which we observed to exist between the pulmonary vein and pulmonary and bronchial arteries, furnishes us with the rationale of hemoptysis dependent upon particular lesions affecting the left side of the heart. Thus, from a narrowing of the communication between the left auricle and ventricle, the pulmonary vein is prevented emptying its blood into the auricle; and as it is the channel into which the pulmonary and bronchial arteries empty their contents, the effects of its con. gestion are necessarily felt in these arteries. Besides, the remora of the blood in the lungs opposes a resistance to the efforts of the
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right ventricle to drive its blood through the pulmonary artery and lungs, and, demanding increased efforts of this ventricle, occasions its contents to be thrown with unusual force into the minuter vessels of the pulmonary artery, and the communicating minute branches of the bronchial artery: it is in this way that we explain the frequent hemoptysis in this particular lesion of the heart. From the foregoing observations it is obvious that the blood-vessels of the lungs form a circle ; and that hemoptysis may result from derangement of the circulation affecting any part of it.”—P. 401.
Dr Law afterwards proceeds to consider the connection between hemoptysis and actual lesion of the tissue of the lungs, as induration, tubercular deposition, &c.; and after, perhaps, more discussion than the subject demanded, comes to the conclusion which has been so generally maintained, that hemoptysis is very often a consequence of the previous formation and existence of tubercles in the pulmonic tissue.
He then considers the sources from which the blood may proceed in these cases, and represents them to be either the bronchial membrane, a tubercular excavation, or the pulmonic tissue or parenchyma.
This mode of examining his subject leads him to consider, in speaking of the treatment, the best mode of treating phthisis, especially when connected with, or giving rise to hemoptysis. And here he takes occasion to condemn, as all good physicians do, the unlimited and indiscriminate use of the depletory sys. tem, and to recommend a more tonic and stimulating mode of management. In doing so, however, we regret to observe, that he adduces an authority which must be regarded as inadequate, and the example of which would certainly be unsafe. The following observations show the author's mode of thinking on this subject.
“ We would here express our decided conviction that phthisis, of which hemoptysis is so frequent a symptom, would be treated with much more success if physicians were not continually haunted with the apprehension of exciting or keeping up inflammation; a feeling which, within due limits, should ever be present, but still when pushed too far, and acted upon too rigorously, it deprives the system of its remaining stamina, and unfits it for bearing the exhausting effects of a wasting disease. A gentleman in Scotland (Dr Stewart), who has now ceased to be a member of the medical profession, long since ventured to deviate from the routine of practice in this disease, and pursued a mode of treatment which has had most encouraging success: the principle of this treatment was to strengthen the constitution. He argued, that when the tubercles softened and the expectoration became purulent, the treatment should be the same as that required by the formation of matter in other parts of the body, when we have no other view than that of supporting the system. To fulfil this intention he treated the disease with tonic medicines cautiously exhibited, but placed his chief reliance upon cold bathing, exercise, and nourishing diet. His plan with respect to cold bathing consisted in making the patient sponge the entire body in the morning, and the neck, chest, and shoulders at night, with tepid vinegar and water, whose tempera. ture was reduced each day till it was quite cold: this sponging was followed by rubbing for half an hour with flannels, and then with a flesh-brush. By degrees, as the feverishness subsided, the vinegar was laid aside. This was a preparation for cold bathing, and afterwards for sea-bathing. We do not mean to affirm that tubercles do not often form in an inflammatory habit, and that bleeding is not often required in such a habit; we only question its propriety as a preventive measure.”—P. 408.
Now we should like that the tonic method of treating consumption had been recommended on grounds much less liable to question than those now given. It is so very pleasant to be allowed to eat beef-steak, broiled fowl, chickens, veal, and all sorts of palatable food, and wash the whole down with four glasses of Port or Madeira, or six of claret, in measured allowance daily, instead of being compelled to starve on boiled bread and milk, rice, arrow-root, sago, or millet seed, qualified only with whey, lemonade, and such weak watery liquors,—that we do not wonder that the tonic system has numerous advocates.
Then it seems so pathological, so rational, and so plausible, to talk of supporting the system under the suppuration of the tubercles, or consequent upon them, to wait until the disease comes to a crisis, as we have heard some of those sage observers speak, and so absurd, unnatural, and chimerical a thing to expect, that starvation and medicine, bleedings every fortnight or month, blistering every week, and tartar emetic ointment successively, till the poor patient is in such a state that St Bartholomew was a fool to him,-are ever to give flesh and strength, that we do not wonder that the one has many supporters and the other few friends.
The whole doctrine, however, agreeable as it seems, rests on a delusion which ought to be dispelled without delay. It is doubtful whether a single case of genuine tubercular consumption ever recovered under the tonic method, even as practised by Dr Stewart. It is quite certain that many have died under it,
-certainly without their symptoms being alleviated, or the course of the disease being retarded by the treatment. And, lastly, cases of genuine tubercular disorganization which have recovered have proceeded to that result independent of the tonic method, and often of any method whatever. These assertions require some explanation.
In the first place, all the cases of alleged recovery from