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phthisis, under the tonic treatment of Dr Stewart, were cases only of consumptive symptoms, that is, of weakness, emaciation, cough, and occasional sweatings, but without the true characters indicating the presence of tubercles. Most of them occurred in ladies, were instances either of dyspeptic complaints, combined with irregularity in the uterine function, or of dyspeptic phthisis, or, in other words, of chronic catarrh in relaxed habits, with irregular local determination. That cases of this kind recovered under tepid ablution of the chest, and other means calculated to restore the function of the cutaneous circulation, and the state of the digestive organs, is by no means wonderful; and many more extraordinary cures are daily performed. Where the cases were purely chronic bronchial disease, it is no more an object of astonishment that they recovered ; and we refer to a small work published in 1801 by Mr Charles Pears of Kensington, for an account of forty-nine cases, which that gentle. man, in the most amiable simplicity, calls pulmonary consumption, and in which twenty-one recovered, but which, most assuredly, from the symptoms, were merely bronchial inflammation. • In the second place, we can state positively that we have seen several, and known many, cases of genuine tubercular consumption, in which the individuals were, after obtaining the advice of Dr Stewart, put on the method of treatment recommended by that gentleman; and all these cases terminated as all other cases of consumption terminate. It is not to be denied that there is always some room for explanation. The case had been treated too long according to the debilitating plan; the patient had applied too late ; or, in plain terms, for that is the true signification of such explanations, tubercles were in the lung, and had gone on to softening. We are really astonished to hear any professional person, who understands what tubercles are, talk in this manner.
In the third place, we have often repeated, that it is not a single tubercle or single excavation that the physician has to contend with in attempting or expecting the cure of phthisis ; but in general a series of them in both lungs, so numerous and aggregated, that while one tubercular mass in the upper lobe is breaking down and undergoing elimination, others in the lower part of the upper lobe, and the upper part of the middle lobe, are proceeding to softening; and, all thickly distributed through the middle and lower part of the lungs, are keeping up the inflammatory and congestive irritation, and in some instances giving rise to bronchitis, in others to a constant peripneumony. We beg to ask, can any one who has inspected half a score of phthisical lungs talk of the tonic treatment under such circumstances, or expect that recovery of any kind, or under any treatment, is to take place? It is only in cases in which a single excavation, or two perhaps, exist, and in which either the extent of the lung is comparatively unaffected, or one lung at least sound, that we can expect, and that under very peculiar circumstances only, any thing like recovery. Whether tonic treatment, so called, will then do good, must depend on other circumstances altogether, which our limits will not allow us to spe
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But we further have to object to the introduction of the au. thority of Dr Stewart on the influence of the tonic treatment in phthisis on other grounds still more forcible. Every physician knows that, though the disease named consumption depends on the softening and elimination of tubercles, and the consequent bronchial and pneumonic inflammation, yet no two cases are similar to each other; and even in the course of the disease in the same patient, it assumes different characters and different symptoms. Supposing, therefore, a tonic method useful in one case, or at one stage of a case, it could not be expected to be beneficial in all cases, or at every period of the same case. In defiance, however, of this most certain conclusion, the treatment of Dr Stewart was one invariable and identical method for all, and must therefore have been injurious in nine cases in ten at the very lowest computation. We say this not only from our personal knowledge, but upon the combined testimony of several professional friends, all of whom have seen the treatment fairly tried in many different individuals. We care not what is the opinion of one set of fashionable but ignorant supporters of the merits of this method, or what is the opinion of another. We always regarded the confidence reposed in his method as a most perfect delusion on the part of the unhappy patients and their friends, and in all respects the object of pity rather than either of indignation or refutation. The confidence with which the alleged recoveries, on the other hand, were announced, was calculated only to be matter of ridicule, and not deserving seri. ous attention. But when we see a rational physician in a scientific work, seriously commending a method which originated in ignorance, was propagated by delusion, and owed its temporary and apparent success to the mistake of confounding one disease for another, and which, as a system of the most indiscrimiDate and irrational empiricism ever practised, is now fallen into deserved contempt,—we confess it does make us consider whether it is always possible to ally science and medical practice. In a second edition we trust this pernicious advice, which is highly discreditable to the work, will be expunged.
On Hemorrhage in general, its theory, causes, and treatment, a very excellent article is given by Dr Thomas Watson.
Dr Kerr has communicated in an article on Hydatids, a sketch of their natural history, pathological relations, and effects on the bodies of men and animals, which was much wanted in the profession, and the perusal of which will be of great use in communicating correct views of the nature of these parasitical animals, and the causes of their production in the human body,
The article on Hydrocephalus by Dr Joy, and those on Hydro-pericardium and Hydrothorax by Dr Darwall, would both require long notices, for which our limits allow us no space. Both are very excellent and instructive essays on the subject.
The article on Hydrophobia by Dr James Bardsley, is decidedly the best essay on that subject extant. With perfect knowledge of the literary history of this immedicable disorder, Dr Bardsley has succeeded completely in giving a view of its history, of its symptoms, of the circumstances in which its transmission and its developement depends, and of the various methods which have been employed to combat its effects, not only useful and instructive to the physician, but interesting to the scholar and philosopher.
There are still in the present volume various other important articles which are entitled to particular mention ; such, for instance, as that on Identity by Dr Montgomery, those on Hypochondriasis and Insanity by Dr Pritchard, that on Hysteria by Dr Conolly, and that on Indigestion by Dr Tweedy J. Todd.
These articles are so comprehensive and elaborate, that they would require to be reviewed separately, and not as parts of the present notice. If, therefore, we feel this requisite, we may at some future season take a survey of them in this manner. But at present we feel that we have, in our desire to do justice to each subject, far exceeded the usual limits assigned to such an article as that for the volume before us ought to be. The articles on Insanity and Indigestion are particularly excellent; and while the former shows well the long experience and study which the author has had in the observation and treatment of the forms of mental derangement, the latter exhibits a most complete view of the causes of the various forms of disordered digestion.
Upon the whole, we conceive that the second volume of this work most amply sustains the character which we have already expressed of the first. The majority of the articles are written in a masterly style, with perfect knowledge of the subject, and on a scale so comprehensive as either to give the reader a full view of all the most authentic and important information on each subject, or at least to put him in the way of supplying any defects which are inevitable in the best treatises. • Of the occasional inequality of the Essays, viewed as a whole, we have formerly spoken. We almost begin to think that this is produced by the great merit of those which are most elaborate and complete. The contrast which thence results is quite sufficient, without charging the others with inferiority, to give rise to a considerable degree of necessary and inevitable inequality.
The other inconvenience, of repetition and interference, we think ought to be avoided as much as possible; for though the reader thus enjoys the advantage of the views of two or more different authors, the practice, if often repeated, will swell each volume, and therefore the whole work to a much greater size, and with less reason and advantage, than if the rule were rigidly observed, to the exclusion of more useful matter.
ART. II.-A Treatise on the Venereal Disease and its Va
rieties. By WILLIAM WALLACE, M. R. I. A. &c. &c. &c. Surgeon to the Jervis Street Infirmary, Dublin, and to the Infirmary established in that City for the treatment of Cutaneous Diseases, including Venereal Diseases. London, 1833. Pp. 382.
UBING the last twenty-five years the treatment of syphilis has been much improved, in consequence of the symptoms having been more accurately noted, and the effects of various medicinal agents on the disease more carefully investigated. Much, however, remains to be done to reconcile and explain the discordant facts and opinions brought forward on the subject; and there is yet wanting a series of cautiously conducted and accu. rately related experiments on the nature and cure of the disease.
Mr Wallace evidently has it in his power to contribute largely to this; and were he to append to the forthcoming part of the work before us a tabular view of his cases and experiments, he would greatly enhance the merit of his treatise, and enable us to judge more accurately of the value of his conclusions. In the meantime, it may not be amiss to lay before the reader a short abstract of some of the author's doctrines and modes of treatment, referring to the book itself for the proofs on which they rest.
His general doctrines are, “ that there exists among all the venereal affections the closest analogy ; that, though greatly diversified in appearance, they are referable to one regular form of the disease, and to a limited number of varieties, as fixed in their characters and relations as the varieties of any other disease;" (Preface, p. vi.)—" that there exists nothing in its appearance or progress which is not in accordance with the general laws of pathology ;” (Ibid.)—and that all the diseases resulting from impure coition are produced by one specific cause or morbid poison.
These doctrines are pervaded with several gratuitous and even erroneous assumptions; and we confess we cannot understand why Mr Wallace has, without assigning reasons which may be deemed by competent judges adequate, here promulgated a set of opinions and inferences which are at variance with the united experience of most rational practical observers.
He examines the opinions of most writers since the time of Hunter, who seem to have understood true chancre always to possess a certain definite form and appearance, whereas Mr Hunter himself has alluded to its mutable character by such expressions as “ venereal ulcers have commonly one character,"
-“ a chancre has commonly a thickened base,” &c. so that what is called the Hunterian chancre, is an ideal disease, ever confusing or misleading those who believe in the existence of the phantom.
The author has failed in his attempt to prove that gonorrhea and syphilis are effects of the same poison. All the cases hitherto reported of different individuals being affected some with gonorrhæa, others with syphilis, in consequence of connection with the same woman within a very limited period, are liable to one of these objections; either that there is no proof that the same female may not have had both diseases, or that the men may have had communication with other women shortly before or after. The well-known case of the students, mentioned by Bell, is a strong proof of the incorrectness of the author's doctrine. Of this, however, he takes no notice, and, instead of giving us a few well-marked and well-authenticated cases, or direct experiments, he supports his opinion by a most extaordinary and somewhat unintelligible hypothesis, which our limits will not permit us to notice.
He classes all the primary diseases arising from impure coition under two heads.
1st, Primary syphilis.
The degenerations of primary syphilis comprehend two divisions; the one characterized principally by irregularity in the processes of ulceration or destruction, the other by irregularity in the processes of reparation. The former comprehends three