Imatges de pàgina
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ness. The sensitive plant, the lily, the passion-flower, and the rose of human gentleness and excellence, are almost exclusively the objects of her rapacity. Upon the cheek, tinted with the warmest hues of youth, of beauty and intelligence; upon the eye, illumined by the fire of genius and sensibility; upon the heart, throbbing with benevolence, and animated by all the gentlest and most noble affections that can adorn or dignify the human character, this fiend of desolation delights to prey. Her very name conveys to the generous mind a sensation of chilliness and dread. Whenever that hopeless sound strikes upon our ear, scenes of woe and wretchedness, to which we have in past years been witness, flit across the darkened mirror of recollection;-the venerable form of age, bent in silent anguish over the faded, sinking wreck of all its earthly hopes and happiness; ardent and impassioned manhood straining, with convulsive agony, to its widowed heart, the cold but yet lovely and interesting relics of plighted tenderness and truth;-unconscious infancy gazing with artless merriment upon the hectic cheek of its faint and gasping mother, or perhaps, drawing the seeds of future suffering and death from her shrunk and almost exhausted bosom. These are scenes which we can never turn to contemplate without emotion. Against the depressing influence of such recollections, long familiarity with spectacles of human misery, and the stern habits of retirement and criticism, have not yet sufficiently fortified our nature. A more than common gloom, inspired by such meditations, and by the acknowledged inefficacy of every attempt yet made by human science and industry, to oppose this desolating malady, hung over us, as we sat down to the perusal of the present work. Not even the reverend name of Duncan possessed a charm, sufficiently potent to dispel it.

To investigate with patience, and discriminate with accuracy, the various species and modifications of any given disease, are assuredly objects, than which, none more important can occupy the attention of medical observers. And where the modifications of such disease are found, as in pulmonary phthisis, to possess strongly-marked features of distinction, upon a a correct appreciation of which the knowledge of their origin and probable termination, and the decision of an appropriate plan of medical treatment, must be founded; this truth, in all

cases, most evidently applies with peculiar force. Thus viewed, the labours of Dr. Duncan come with no feeble claim to our respect and consideration. Striking differences of character, among those pulmonary diseases, classed, from the similarity of termination, under one common title, must, particularly in the incipient and more early stages, have obtruded themselves on the notice of every man, gifted with a common portion of discernment and penetration. Not a day, it is to be feared, passes, but many cases of phthisis, capable of great and even permanent relief by the well-directed resource of science, are abandoned as hopeless: some of which, terminating successfully from the unassisted energies of nature, serve only to deck, with unmerited honour, the nostrum of some vile empiric, and to degrade the regular physician in the eyes of the public.*

In corroboration of this remark, and as a specimen of the style and design of our author's publication, we transcribe a passage at length from his introduction; to some parts of

* We adduce, in support of this bold assertion, the following case; for the truth and accuracy of which, we pledge ourselves. A young woman, after suffering two months from pulmonary disease, was seized with purulent expectoration, and all the other symptoms of confirmed phthisis. Her case was considered hopeless by her medical attendants; and she was abandoned to the care of a very young and inexperienced man, with strict injunctions that nothing but occasional doses of opium should be administered. He found her, upon his first visit, lying upon her back in bed; her countenance pale and deathly; her eyes closed; her respiration short, and excessively laborious; her power of utterance gone. The body was covered with a clammy moisture; the pulse could no longer be felt. The inferior extremities were greatly distended by serous effusion. The poor girl was supposed to be dying. A jug, containing about one pint of nearly unmixed purulent matter, stood upon a table by the bedside. This attracted the attention of our young inquirer. He was told that the whole had been coughed, or rather vomited up, within two hours. He investigated minutely the history of the case. The girl had evidently been affected with chronic pneumonia. The inference was obvious. Such expectoration could only arise from extensive vomica, not from tubercles. A large vesicatory was applied to the sternum; heat to the extremities. A light cordial evidently recruited the nearly exhausted system. Opium and digitalis were administered, at regulated intervals; mild nutritious aliment directed to be frequently given, in small quantities. Under this plan, the state of the patient was hourly ameliorated. In three days, she sat up; in a week, quitted her chamber. Steel, alkalis, and bitters, completed her restoration. This happened several years since. We believe her to be still living in health.

which, sensible and judicious as we, upon the whole, consider it, strong and obvious objections, hereafter to be noticed, present themselves.

"The following remarks on that interesting subject, (phthisis) are the result of observations made with fidelity and attention for more than half a century. And if they shall enable future writers to improve the means of distinguishing the different modifications of pulmonary consumption from each other, they may be productive of some benefit to mankind: For by proper treatment, adapted to each particular modification from an early period of the disease, there can be no doubt that many valuable lives may be saved.

"By phthisis pulmonalis, or pulmonary consumption, is to be understood, that affection in which a general wasting or consumption of the body arises from a disease of the lungs. Among eminent writers, it has been a subject of dispute, whether phthisis pulmonalis can ever be considered as a proper idiopathic disease. By many, it has been regarded merely as symptomatic of other affections, particularly of hæmoptysis, catarrh, scrofula, pneumonia, and several other genera. But there can be no doubt, that it may justly be considered as an important genus by itself; and that it very frequently makes its approaches in such a gradual and imperceptible manner, as to be beyond the power of art, before it be certainly discovered to exist.

"In every instance of this affection, that modification of fever, which has been termed hectic fever, is very generally observed some time before a fatal conclusion takes place. And this fever principally, perhaps even solely, arises from the absorption of purulent matter, or rather from the absorption of a sanious or vitiated purulent matter, which produces in the human system effects much more deleterious than the absorption of mild pus, void of any peculiar fœtor or other strong sensible qualities. Such a sanious matter, however, when generated in the lungs, may be afforded from different causes. Hence, among those writers who have considered phthisis pulmonalis as a genus of disease, that genus has been divided into many different species. In the system of Sauvages, twenty species are enumerated under this genus. But from such minute divisions, no benefit, and much inconvenience arises.

Hectic fever, indeed, produced by purulent matter absorbed from the lungs, may arise from many different accidents, and many different diseases: And thus, it cannot be denied, that there is a foundation for many different species of phthisis. But after, in these cases, phthisis is induced, such species can neither be distinguished from each other by the symptoms, nor do they require a different mode of cure. A more simple view, therefore, of the divisions of this genus may be taken with advantage.

"In the division of any genus of disease into species, two great objects are to be had in view. The first and principal object is to point out such species as require a different mode of practice from each other. And the second object is to point out those species which can be distinguished from each other by obvious symptoms during the life of the patient. The distinction of species, which can be discovered only by dissection after death, serves merely to perplex and puzzle, without being of any material benefit. On this general ground, and with these objects in view, in phthisis pulmonalis, three different species may be pointed out, which may not only be distinguished by obvious symptoms during the life of the patient, but which also require some difference in that mode of treatment best fitted for the removal of each.

"These species may be distinguished by the titles of the catarrhal, the apostematous, and the tuberculous phthisis. The principal circumstance between these, requiring variety in the mode of treatment, is the difference in the source from whence the purulent matter is derived. In the first modification, it is merely separated from an inflamed surface, in a manner similar to the separation of pus from a blister-issue. In the second modification, it is furnished from an abscess of a considerable size, which may be formed in the cellular substance of the lungs, as well as of any other part of the human body. In the third, it is furnished from a tubercle, or from the parts surrounding a tubercle, terminating in suppuration; and commonly yielding, not proper purulent matter, but rather an ichorous sanies, somewhat resembling that which is often yielded by lymphatic glands, in cases of scrofula, when they terminate in suppuration. But the distinction of each of these modifications, during the life of the patient, can only be drawn VOL. VI. No. 22.

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from an accurate account of the symptoms with which they are attended. And with that intention, a short history of each is subjoined.

"In every modification of phthisis, the symptoms may be referred to three heads: the pneumonic or pulmonary symptoms; the symptoms of hectic fever; and the supervening affections, or what may be termed the consequent symptoms. The morbid affections, however, referrible to the last two heads, are very much the same in all the species mentioned above; and it is always principally, often entirely, on the pulmonary symptoms, that the three species obviously differ from each other. In describing these affections, then, with a view to the diagnosis, it will be sufficient to give a separate account of the pneumonic symptoms occurring in each different modification of pulmonary consumption."

After the introductory Remarks upon Pulmonary Phthisis, Dr. Duncan proceeds to delineate the "pneumonic symptoms" occurring in each of the three species of this disease, to the consideration of which his work is exclusively devoted.

His first chapter is occupied by a description of the morbid phenomena exhibited in the incipient stage of "catarrhal phthisis." This is sufficiently minute and correct; but presents nothing peculiarly claiming attention or comment. At the close of this chapter, the ingenious experiments of the much-lamented Charles Darwin, to determine the chemical properties which distinguish pus and mucus, are noticed; and a summary of the conclusions to be drawn from them, accompanied by some comments of the doctor, is delivered. These we shall transcribe. They involve questions of high practical importance; and are not, perhaps, generally or accurately understood by the many, whose attention, absorbed in the ceaseless cares and labours of practice, is diverted from cultivating, or improving, an acquaintance with the arcana of experimental chemistry.

"1. Pus and mucus are both soluble in sulphuric acid, altho' in very different proportions, pus being by far least soluble.

"2. The addition of water to either of these solutions decomposes it. The mucus, thus separated, either swims on the top of the mixture or forms large flocculi suspended in it; whereas, the pus falls to the bottom, and forms, on agitation, an uniform turbid mixture.

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