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governor's order; and some other offenders, in the very commission of their crimes, had boasted of the impunity which they could obtain through the influence of Betsey Goodwin. A report had circulated, at least a fortnight before Denny's condemnation, of his having received assurances from her, that, let the event of his trial be what it might, she would protect him.” P. 639.
The sketch of the constitution of Barbadoes convinces us how difficult it is to imitate that of England, and how easily some of its most valuable privileges may be perverted or misapplied. As the latter part of this volume treats of times just passed, it is of course less interesting; for absolute impartiality, which is the soul of history, is not to be expected in a writer who is a member of so small a community, and perhaps personally known to nearly all the white people of the island. About four hundred and fifty subscribers, however, patronise his labours, which will perhaps be better received, both in his own and this country, than he seems to expect.
Clutterbuck's Inquiry into the Seat and Nature of Fever.
[Continued from p.55 of this Volume.] IN the fifth and last chapter, Dr. Clutterbuck treats of the cure of fever generally, in relation to his doctrine; or chiefly, as theoretically deducible from the pathology which he has laid down; namely, “topical inflammation of the brain, or its membranes.” Accordingly, the common treatment of inflammation is recommended; “evacuations of various kinds, as blood-letting, purging, sweating, &c.; the application of cold, and irritation of neighbouring and distant parts, as by blisters, sinapisms, &c.”
Our author, however, does not contend that this mode of treatment is universally applicable in inflammation. “There are many inflammations," says he, “that are best treated by means the reverse of this----by remedies that give vigour to the system, and increase its activity.”. In this opinion we cordially agree, and think we could show that the antiphlogistic method of cure, as it has been termed, is much less applicable in the treatment of in Aanimation than has been hitherto imagined. We confine our observations, however, to the subject of fever. Is fever, then, an inflammatory affection?--and if so,
is blood-letting a proper remedy in this disease?
s If, under the title of inflammation of the brain, we are to consider only the most violent and acute form of the disease
that to which authors have especially given the denomination of phrenitispindoubtedly it differs in many points, both in its symptoms and mode of cure, from ordinary fever. No one doubts of the propriety and necessity of having recourse in this case to profuse evacuations of every kind, and especially blood-letting; to the most rigid abstinence; and to all the other means calculated to subdue active inflammation. But it by no means follows; that, because this practice is not generally applicable in the treatment of fever, the disease must be of a different kind, and the doctrine that ' fever is inflammation consequently ill founded. If it be admitted that the brain, like other organs, is susceptible of different degrees of inflammation -- that the inflammation may be more or less diffused or circumscribed; in other words, that it may partake of the nature of erysipelas or of phlegmon -- that it may be with or without general affection of the vascular system -- that it may take place in different habits of body, and in combination with other affections; circumstances, all of which are found to modify greatly the treatment of inflammation wherever seated --surely it ought not to be expected that blood-letting should be universally admissible in the cure of inflammation in the brain: nor does its frequent inutility in fevers constitute an objectiou of any weight to the doctrine here endeavoured to be maintained.""' p. 233.
By this sort of probation we may prove any thing, or nothing, in medicine ; for example:
" This, I know, is in opposition to received opinions, and will be supposed to involve an inconsistency; namely, the recommend ing at once blood-letting, and the use of tonic and stimulant remedies. The inconsistency, however, in this case, is more apparent than real. If disease do not consist essentially in weakness simplyas has, I think, been clearly shown -- but in some unknowo deviation from the natural and healthy mode of acting; then it is clear that it may be obviated, and health restored, by remedies of either the stimulating or debilitating classes, which have no right therefore to be set in opposition to one another on this occasion. ' In fact, Whatever is capable of producing any considerable impression on the system, or of changing its mode of acting, may become a remedy for its disorders; and hence means apparently the most opposite are often found to remove one and the same disease. Diseases accompanied with great debility have often been cured by loss of blood, and other evacuations, while those of an opposite character have, in many instances, yielded 10 the most active stimulants. A slight acquaintance with the history of physic will serve to convince us of this. The practice of Sydenham was in many respects in direct opposition to that of Morton: the one employed bleeding, where the other gave the most active stimulants; yet there can be no doubt that they both frequently succeeded in curing their patients.” P. 237.
Aud in killing them, too, we should suppose ! --- Accor
ding to this 'mode of reasoning, medicine is a perfect chaos. In what does disease consist? “In some unknown deviation from the natural and healthy mode of acting."- How is this “ unknown deviation” to be removed ? By remedies of either the stimulating or debilitating classes.” In short, we know nothing about the matter; and therefore one remedy may be just as good as another.
« The advantages to the medical practitioner,” however, “of a just theory of diseases, will scarcely be denied. Experience, undoubtedly, is a sure and safe guide, as far as it goes; but it is too often lame and defective. It is impossible to foresee and provide adequately for the infinite diversity of changes that take place in living bodies, without the aid of analogy and induction : the practice of physic without these must ever be incompetent to meet the continually-varying circumstances of disease." P. ix.
Impressed with these principles, we shall endeavour to apply them in what we have further to offer on this subject.
“ Inflammation occurs as readily, generally speaking, in weak as in strong habits: there appears even reason to believe that the former are in some respects more disposed to it than the robust and vigorous. It seems to be a general law of the animal economy, that, in proportion as the powers of the body are diminished, the excitability with regard to impressions, and consequently the disposition to be thrown into irregular action, are increased. Hence weakness, though never of itself a disease, may predispose to it. But the diseases which arise under such circumstances are characterised by less activity, and go on more slowly to disorganisation; and they commonly also require a less active mode of cure.
“ When inflammation arises in debilitated habits, it is often not. only not curable by general blood-letting and other evacuations, if employed to any considerable extent, but may be even rendered thereby more difficult of removal; and that, probably, for the reason above stated; namely, that weakening the system increases the disposition to irregular action, or predisposes to disease. The rule, however, is by no means constant, that blood-letting is improper as a remedy for inflammation in debilitated habits. On many of these occasions, it is found to be scarcely less effectual than in a state of vigour. To determine in different cases when it may be proper, of otherwise, is a very difficult task, and requires much judgment and, experience on the part of the practitioner. From my own observa. tion, I am inclined to believe, that, when properly adjusted to the actual strength of the system point of the first magnitude, but which has been too much overlooked there are few cases of inte flammation that are not capable of being relieved by it, and that it may
r-form a valuable auxiliary to other means, even to those of a tonic and stimulant nature.' P. 235.
66 This,” Dr. Clutterhuck is aware, “is in opposition to received opinions, and will be supposed to involve an incon
sistency”-an inconsistency, in our opinion, not to be easily obviated, unless indeed it could be shown that bloodletting is adapted to remove that "unknown deviation from the natural and healthy mode of acting" of which our author speaks. He is inclined to believe" it, however, from his own observation;" and on the same ground to believe that “there are few cases of inflammation not capable of being relieved by” blood-letting- i.e. “when properly adjusted to the actual strength of the system.” But we are aware of the value of medical facts and observations --- we also know something of the nature of medical evidence and our author knows that “experience is too often lame and defective."
Dr. Clutterbuck's reasoning, however, chiefly hinges on theory, and here we shall follow him.
From the passage which we have just adverted to, we learn that the benefits of blood-letting are only to be expected when it is properly adjusted to the actual strength of the system.” The question of blood-letting then does not involve the topical inflammation of the brain or its membranes,” abstractedly considered; nor the “unknown deviation from the natural and healthy mode of acting, which Dr. Clutterbuck considers as the true morbid state. It only regards the actual strength or weakness of the system, which, according to our author, is “never of itself a disease," but only predisposes to it.
Now, “ inflammation occurs as readily, generally speaking, in weak as in strong habits; there appears even reason to believe that the former are in some respects more disposed to it than the robust and vigorous.” Nay, “it seems to be a general law of the animal economy, that, in proportion as the powers of the body are diminished, the excitability with regard to impressions, and consequently the disposition to be thrown into irregular action, are increased.” Bleed your patient, then, under the state of predisposition, and increase his susceptibility to be thrown into irregular action”
the true morbid state. But you are not to bleed him under the “weakness" of predisposition, but after he is “thrown into irregular acţion," ---into the real state of disease.” When infiammation arises in debilitated habits," however, “it is often not only not curable by generai blood-letting and other evacuations, if employed to an
considerable extent, but may be even rendered therebore difficult of removal, and that probably for the reason above stated; namely, that
weakening the system increases the disposition to irregular action, or predisposes to disease.” Again, “ I believe that blood is often drawn in too large quantity from the sick, without - sufficient attention being paid to their state of weakness at the time. I have observed a manifest reduction of the strength, and a feeling of weakness continuing for several days, induced by the loss of not more than from two to three ounces.” Now the question is—if weakness disposes to “irregular action,” or the actual state of disease, will weakening the system still further enable it to throw off these “irregular actions ?” This we cannot believe.
Dr. Clutterbuck indeed speaks of blood-letting “in debilitated habits," under fever, with caution; and even adinits, that in such habits "it may be rendered thereby more difficult of removal.” But what is the difference between the strong and the weak man in fever? If the strongest man be under fever, he is no longer strong.
He has suffered the action of certain debilitating powers, and he has all the symptoms of debility. His body is deranged or debilitated, and displays “irregular action," or some unknown deviation from the natural and healthy mode of acting.". But we call it derangement, or debility, because we understand as much by these terms, as by "irregular action," or "some unknown deviation,” &c.
Reasoning in this manner, we think of the cure, or of promoting a favourable termination of the disease. We avoid all irritating, deranging, or debilitating powers, because they might operate in a somewhat sinular manner to those which caused the disease, and we employ those of seemingly opposite tendencies. We excite the system to throw off its “irregular” or inorbid action, and we avail ourselves of any thing like true experience. In all our measures we proceed with caution and circumspection ; because we know that, on many occasions, the system has a power of repairing its injuries -“that fever has a strong disposition to terminate spontaneously” --and that "it is a disease the essence of which is not understood.”
This is our theory with regard to fever; and the general practice wė deduce from it.
From experience we have little assistance.
Every age, and almost every practitioner indeed, possessed of sufficient courage to think and act for himself, has had his favourite remedies, which have been relied upon as if they were exclusively adapted to the purpose.” P. ix.