Abbildungen der Seite
PDF
EPUB

and useful thought-contained in his pamphlets, all we shall say is, that the extracts we have given are amongst the most favorable specimens of his various polemical sheets, and fragments of sheets, which have been inflicted upon us. Of the gross illiberality that pervades the “ Discourse,” almost every page furnishes one or more examples, and where the object is to vent illiberal feeling, the language certainly savours, at times, too strongly of hyperbole. Thus, in speaking of the school, once highest in his favour—the one at Lexington—the south-western neophyte of one year's standing remarks:

“ Lexington, which does not contain over eight thousand inhabitants, had for many the second, and for some years the third medical institution in the United States, although, at present, from causes to which it is now useless to advert, it has sunk so low as to be, we believe, the tenth or twelfth of the Union.

Where is the authority for this? We know of none.

It will be observed, that we have entered into no vindication of the north-eastern schools against the attacks made upon them by the editor of the South-western Medical Advocate. It would be idle to answer that which requires no answer, and the object of which must be apparent to the most careless reader. We have been desirous only of shewing up the Journal and the Editor by his own shewing; to announce, in sporting language, “the name of the horse and the colour of the rider;" and the result must have been a desire on the part of every friend of the whole profession, and especially of south-western medicine, that this South-western medical Detractor, rather than South-western medical Advocate, should quit the course-that it should cease where it has begun, and that the prolific author should follow the example set him by Cid Hamet Benengeli, in the last chapter of Don Quixotte, and promise repose to his pen. Especially would we advise him-although we are satisfied that the office of advi. ser is, at best, but a thankless one, and that the advice will be wholly thrown away-to be a shining speciinen, not of the Acarus Crossii, which has so much puzzled the naturalist, and whose precise position it has been so difficult to define, but of the south-western genus of physicians, as he describes them, “ who observe and reflect more, but write less than the phy

а

[ocr errors]

sicians of the large cities of this Union, because what they write is for the instruction of the profession.” Let him but succeed in

" this, and we shall be the first to herald and applaud the happy change.

A Treatise on the Practice of Medicine. By GEORGE B.

Wood, M. D., Professor of Materia Medica and Pharmacy in the University of Pennsylvania; one of the Physicians to the Pennsylvania Hospital; one of the Authors of the Dispensatory of the United States of America, etc., etc. 2 vols. 8vo. Grigg, Elliott & Co. Philadelphia, 1847.

Formerly, the appearance of a general Treatise on the Practice of Medicine was the event of an age; of late years, it is scarcely less than an annual occurrence. So numerous are they on our shelves, and some of them so complete, that one is at a loss to conceive of the occasion for a new one. Until lapse of time and the advancement of our science have added new facts, or shed more light upon what is already known, it would seem difficult for a writer to find materials out of which to construct such a work, without injustice to his readers, and to those from whom he derives whatever is valuable in his production.

Dr. Wood experienced the truth of these observations, and accordingly, in his preface we find the following apology.

“In adding another to the many valuable Treatises on the Practice of Medicine, the author may be reasonably expected to show, upon what grounds he has ventured to advance a new claim to the public attention, already so fully occupied. He has no other excuse to offer than this; that he has written in obedience to impulses which he could not well resist. Having been engaged, for nearly thirty years, in public and private practice, and, during that time, devoted an almost exclusive attention to the study of diseases and their remedies, he has accumulated facts, and formed opinions, which have been long soliciting expression, with an urgency to which he has at length yielded, though unfeignedly distrustful of their sufficient value.”

What are the facts which have been accumulated, and whether derived from authors who have preceded him, or exclusively of his own discovering, and in relation to what subjects, is not stated in the preface, and consequently it is only after tracing them out by searching through the work, that we are enabled to ap

[ocr errors]

preciate them. From the connection in which the subject is presented, we infer that the facts alluded to are original with the author, although not so clearly stated, and if so, it is to be regretted, considering how sew are the discoveries of this kind which it is the fortune of a single observer to bring to light, that time and further investigations confirm,—it is to be regretted, we say, that these, which ought to be the gems of the work, were not more specifically pointed out: it would at least have saved the reader the task of wading through two ponderous volumes to find them. The “Opinions" which the author, in the course of nearly thirty years, in public and private practice," has formed, are neither so sparse nor so difficult to discover, and, after all, constitute the most interesting as well as original part of the work. Without dogmatism of expression, they are yet put forth on most occasions in a way that leaves little room to suppose that any doubts are felt of their correctness. When reference is niade to the opinions of others, it is in a courteous spirit, and rarely for the purpose of criticism. On other occasions, dissent and commendation are equally withheld.

Dr. Wood has divided his treatise into two Parts, each divided again into sections, sub-sections, and articles.

Part I. is devoted to General Pathology and Therapeutics, and consists of four chapters; which treat respectively of the “constituent forms of disease, as disease of the fluids and disease of the solids; causes of disease, or .etiology; symptomatology, or semeiology; course, duration, and termination of disease ; diag. nosis; prognosis; general therapeutics, embracing general indications and general therapeutic processes.

Part II. treats of special pathology and therapeutics, and is divided into three classes, under which are arranged general diseases, constitutional diseases and local diseases. Under the head of general diseases we have fevers—including plague, variola, vaccina, varicella, rubeola, scarlatina, and erysipelas; the class of constitutional diseases includes only rheumatism and gout ; whilst that of local diseases, amongst a vast catalogue, embraces insanity and delirium tremens-epilepsy and chorea, hydrophobia, hysteria, etc.

In the yet unsettled state of pathology, all classification of diseases must be imperfect, and consequently arbitrary, but it

[ocr errors]

seems to us that this one does not represent the present state of our knowledge. Take, for example, the iwo last nained diseases, and apply the author's own definition of the terms, and see how far they answer to the character of local diseases. “ Hydrophobia is a peculiar disease, resulting from the entrance into the system of the poison of a rabid animal.” It is not alledged that the local phenomena that are described, “such as aching, ting. ling, burning, coldness, numbness, or stiffness in the cicatrix” constitute the disease, any more than the pustule which follows the insertion of the virus of small pox or vaccine into the arm. In the former as in the latter instances, the disease is referred to the entrance into the system of the poison,and why in the one case it should be regarded as a local and in the other as a constitutional disease, it is difficult to conceive. Again: “Hysteria is a disease consisting in a morbid excitability of the general nervous system, [the italics are our own,] showing itself in occasional convulsive paroxysms, and diversified functional disorder,” As already remarked, all classifications of diseases are necessarily to some extent arbitrary; an author may therefore devise or adopt that which may best accord with his own views, but it is not to be expected that he shall contradict himself—that the phenomena which constitute the disease, according to his own description, shall be general, whilst it is included in the catalogue of such as are regarded as local. It is not our purpose, however, to enter upon an extended criticisin of the work, but, having mentioned its general contents, make such occasional comments as the nature of the subjects may suggest, and our restricted limits permit. In our "devious course" we shall doubtless find much to commend, and, perchance, something from which to dissent.

In his observations on general pathology, under the head of Depression, we find the following remarks, which are a fair specimen of the author's style and mode of reasoning:

“ There are three conditions in which the system is below the ordinary standard of health, and which, though if slight and of brief duration, they would scarcely be accounted morbid, are decidedly so when considerable or protracted. These three conditions are often confounded under the name of debility, or asthenia, but are essentially distinct, and sometimes require different if not opposite modes of treatment. It is, therefore, important to have

. clear conceptions of their nature, and to be able practically to distinguish them. The conditions alluded to are depression, debility, and diminished excitability. It must be borne in mind that action, the power to act, and the susceptibility to the infuence of excitant agents, which is here denominated excitability, are different conditions or qualities of the system, and may each be reduced without a necessary reduction of the others. A morbid diminution of action is depression, a similar diminution of power is debility, and the term diminished excitability explains itself.”

“ These conditions,” the author remarks, “may and often do co-exist;” but he thinks they are essentially distinct, and may exist separately. This position he explains as follows:

That power may be diminished, without a diminution of excitability or of action, is no less true. It is notorious, that a debilitated system is often thrown into tumultuous disorder by causes which would produce no such effect in health. Thus, in an individual much reduced by an impoverished diet, or by de. pletion, how often do we observe a panting respiration, and an almost convulsive action of the heart, under a degree of bodily exertion which would have scarcely discomposed these functions, in the ordinary state of the system! How often, under similar circumstances, do the slightest causes produce great nervous disturbance, amounting in the female to violent hysteria! These results can be accounted for only by admitting an increased excitability, which enables the same amount of excitant influence to produce a greater amount of effect.

Dr. Wood may be regarded as a strenuous advocate of the modern doctrine of humoral pathology. He considers it “certain that, in some diseases, as in malignant fevers, for example, the blood does undergo great deterioration, either from the direct action of the poison introduced, or from derangement of the organs, and thus becomes wholly unfit to support the healthy actions, which are consequently greatly depressed.”

We are glad to find the following sound views expressed on a subject too much misunderstood by many physicians, who seem to think that excitement is always to be overcome by means that reduce the strength of the system, and especially by blood-letting.

“ But it must be borne in mind, that a mere loss of blood, or a mere diminution of its stimulant properties, without any positive noxious deteioration, though it may cause debility, does not necessarily diminish excitability. On the contrary, the organs feel more acutely the impression of other excitants, and are stimulated

« ZurückWeiter »