Imatges de pàgina
PDF
EPUB

(p. 130,) "I have met with, the urine was never deranged in quantity or character, either during or between the paroxysms." He adds, however, that in these cases, the hepatic, or some other functions, were usually disordered.

The usual deposits in an attack of gout are, in the acute stage, lithic acid and lithates of ammonia and soda. Phosphatic deposits may occur after some time, more especially if the patient's constitution be shattered. These consist chiefly of the phosphate of lime and of magnesia.

In regard to therapeutical indications afforded by the states of the urine, the author makes an observation (p. 133) in keeping with the one we have just quoted above, and the accuracy of which we can confirm, and which we cite as calculated to check the disposition prevalent with the class we may call urinary pathologists, too much to found treatment on a single branch of symptomatology, and not, as true physicians ought to do, on a comprehensive survey of the aggregate of morbid phenomena. "As to the treatment of gout," says Dr. Robertson, "it will be found that the condition of the urine, judged of per se, has little to do in regulating or modifying it, however valuable it may sometimes be, when looked upon as subsidiary to other treatment."

We cannot accompany the author through his long and (if condensed and better methodized) really valuable history of gout. The fault we have to find with this portion of the work is this, that the author, by noticing in connexion with gout, almost every symptom of derangement incident to the human body, and the occasional association of which with arthritic disease may be termed casual, destroys, as it were, the individuality of the malady of which his work specially treats, and converts his book into a sort of confused jumble of universal pathology.

The treatment recommended by the author, is, on the whole, judicious, and is, in short, that which is usually pursued. Leeching, he observes, as well as the lancet, or cupping, are seldom of the slightest use in simple gout they may do harm, but do no good. Purgatives and diaphoretics, he states, to be the evacuants chiefly to be depended on; and he might have added diuretics, a free action of the kidney being nearly as indispensable as a free action of the bowels. The hostility of Sydenham to purgatives, both during the gouty paroxysm and the interval, is well known. The author does not entirely adopt on this subject the opinion of the great authority just named; neither do we. In a multitude of cases of gout, both during the paroxysms and at intervening periods, judicious regulations of the bowels, we do not say violent purging, is of evident use, as far as our observation extends. The purgatives must not, indeed, be cold and drastic, but warm, cordial, and what is called stomachic. The author justly discountenances the addition of narcotics to purgative medicines : the union is at once irrational, useless, and pernicious. Colchicum, so far as it is a narcotic, is to be excepted from this remark. We have not yet brought ourselves to regard it as a narcotic at all, but attribute the abatement of pain, which it often affords, both in gout and rheumatism, to its setting suspended secretions free, as for example, the biliary and the urinary. Its lowering of the heart's action we refer to the same cause.

We shall not follow the author through the remaining part of his volume, in which, had brevity and the omission of speculative discussion but been

more attended to, the useful practical matter, now made to appear only longis intervallis, would have presented itself to much more advantage, and would have been more conveniently and readily got at by the reader. He finishes his volume by two chapters, the one of which is devoted to the consideration of the treatment and management of the gouty habit; and the other to the prevention of gout. Both of these contain no small amount of extremely useful and intelligent hints, directions, and suggestions, and are less chargeable with unnecessary prolixity than the earlier portions of the work.

Our opinion of Dr. Robertson's treatise may be gathered from our preceding remarks. It is this; that within the 372 pages constituting his volume, there is matter which, if properly condensed and arranged, would form a very useful practical volume of 120 pages, that is, one third the size of the book actually before us. In other words, we think two thirds of the volume might with advantage be spared to us. At the same time we cannot conclude without expressing our opinion that the author is a man of very considerable intelligence; and many even of the "faults" of his volume "lean" to "the side of ability.

ART. XX.

The Nature and Treatment of Cancer. By W. H. WALSHE, M.D., Professor of Pathological Anatomy in University College, Physician to University College Hospital, and to the Hospital for Consumption and Diseases of the Chest.-London, 1845. Svo, pp. 590.

THIS work has reached us at so late a period of the quarter, as puts it out of our power to lay before our readers any such account of it as its importance demands. We have, however, seen enough in the imperfect examination we have been able to make, to convince us, that the volume before us constitutes one of the completest and most valuable monographs of an individual disease that exists in medical literature. In our next Number we hope to prove the correctness of this judgment by an ample analysis of its contents. We are induced to notice the volume on the present occasion, chiefly that we may make our readers acquainted with the improved method of treating cancer, introduced into practice a few years since by Dr. Arnott, and which is here fully set forth by Dr. Walshe for the first time. We have been constantly expecting that this great invention for it is really such-would have been given to the world, formally and in detail, by its author; but Dr. Arnott would seem to be as careless of ordinary fame, as he manifestly is of what is as generally prized in these later days-money. He has successively given to the world truly given, given unconditionally and without any hope or possibility of pecuniary return-invention after invention, all designed for, and ministering, in the most striking manner to, the improvement of human health and comfort, and the relief of human suffering; which, if he had been so minded, might have become to him the certain means of almost boundless wealth. First, the hydrostatic or water-bed, and strap-hammock

bed, for invalids; then the self-regulating air and water stoves known by his name; then the air-pump, the self-poised chimney-valve, and fish-gill air-warmer, for heating and ventilating ships, public buildings, and rooms; and, lastly, this philosophical apparatus for supplying pressure in morbid growths: a series of effective appliances for the promotion of human weal which, we venture to say, will not merely transmit Dr. Arnott's name to future times as one of the most inventive geniuses and enlightened philanthropists, but will even form no mean element in constituting the present time an epoch in the glorious history of human amelioration. Had NEIL ARNOTT lived in the later days of classical antiquity, he would have had statues raised to him in his lifetime in the public places of his country; had he flourished in a yet earlier age, he would have come down to posterity among those benefactors of their race, whom the simple and beautiful faith of Humanity's childhood has gratefully enrolled among superior beings.

Dr. Walshe's volume is divided into two parts : "The first is devoted to the subject of Cancer in general; the second to the description of the disease as it occurs in all those tissues and organs of the body in which experience has established the fact of its existence." In both of these departments, we believe the reader will not be disappointed if he expects to find everything that was already known on the subject of cancer placed in the clearest possible light, and not a little also that is novel both in fact and doctrine.

We must here also refer, in passing, to another thing that has particularly struck us in going over Dr. Walshe's book-its strikingly practical character, and the author's enlarged general views of the nature and proper treatment of cancer. In the pages of Dr. Walshe, the disease is no longer the local, external, or surgical malady which it has been too much the fashion to consider it; but a true constitutional, general, medical disease, of which the local manifestation, particularly on the surface, is a comparatively small and unimportant feature. A very large part of the treatise is devoted to the disease as it affects internal organs, the diagnosis of which is here put in a much clearer light than heretofore. The strongest proof we can adduce of the constitutional nature of cancer is the fact, incontrovertibly made out by Dr. Walshe, that extirpation or ablation of the local affection by the knife, should only be had recourse to in an infinitely small proportion of cases.

Before introducing to the reader the subject of compression, which is the more immediate object of this notice, we cannot resist the pleasure of quoting two other short passages, which will give a little insight into some of the original and ingenious views of the author.

Dr. Walshe's views of the Nature and Progress of Cancer.

"I had scarcely commenced the study of adventitious products, before I became convinced that much of the obscurity pervading the subject arose less from its nature, than from the erroneous manner in which its investigation had been conducted. I found observers had overlooked the fact, that the higher orders of these products were real existences developed within existences, and possessed of two distinct modes of life: a life, subject to its variations of health and disease, irre

spective of the organism in which they had taken birth; and a life influenced by the conditions of the various structures and functions of that organism. I saw that phenomena, accessory and contingent, were confounded with others necessary and essential; and that, as a natural consequence, misapprehension of many pathological relations had followed. Desirous of removing this source of unsound doctrine, as it affects the most important of adventitious growths, Cancer, I have separately considered (on the plan habitually employed in my Lectures) the healthy and diseased conditions of vitality of that product." (Preface, p. i.)

"The following is the view which, I conceive, may be taken of the nature and sequence of the phenomena of the disease. A certain constitutional state exists, and may continue to exist for a variable period without giving functional evidence of its presence, although the blood and solids of the body are specially modified. In consequence of local injury, or otherwise, exudation takes place; upon that exuadation the constitutional state has impressed special attributes and tendencies, (p. 50;) among these attributes ranks an intrinsic power of vegetation. This vegetating faculty of the exudation reacts on the system by constantly draining it of a portion of its nutrient materials,-the progeny feeds upon the parent organism, and the first phasis of evolution is accomplished. But the natural tissues have been so modified in properties by the constitutional state, that they are incapable of resisting the encroachments of the vegetating exudation, and hence become the seat of atrophous, ulcerative, and other modes of destruction. Discharges of various kinds now still further drain the system of its fluids, and impair its vital energies; and the second phasis is established. Meanwhile secondary alteration of the blood is effected; this fluid becomes the vehicle for the circulation through the system of elements possessed of a germinating force,these stagnate, are deposited, and new local vegetations spring into life and activity. The same series of phenomena is again and again gone through; until the system, drained of its reparative fluids in feeding exudations and supplying discharges, exhausted of almost every drop of pure blood through the influence of secondary cancerous impregnation, paralysed in its nervous energies by physical anguish and deficiency of pabulum, sinks in the struggle against the superior powers of the new existences it has created,-and in death is closed the third phasis of the disease." (pp. 189-90.)

Of Compression in the Treatment of Cancer, more especially by means of Dr. Arnott's Apparatus.

"In the year 1809 Mr. Samuel Young conceived and acted upon the idea that the continued nutrition of scirrhous tumours might be completely prevented, and the absorption of existing substance insured, by submitting them to methodic compression. The results of the practice, as made public by himself, have been condensed as follows by Dr. A. L. J. Bayle. The number of cases given is nineteen; of these, seventeen relate to cancer of the breast, two to ulcers of the cheek and upper lip. Twelve cases terminated by cure; five were considerably benefited; the two cutaneous ulcers improved somewhat. The majority of the tumours were hard, irregular, tuberculated, and the seat of lancinating pain; six of them were ulcerated, and discharged ichorous pus. Even in the worst cases the tumour diminished in size, but the patients fell victims to the diathesis.

"In consequence of Mr. Young's announcements, the plan was tried at the Middlesex Hospital, and a committee appointed to report upon the results. The conclusion of the report, drawn up by Sir Charles Bell, was, that compression could not be regarded as a 'specific' cure, and bad no claims to notice except for its power of alleviating pain. But, as was justly rejoined by Mr. Young, much of the want of success described may have arisen from defective management of

the plan; no details of the cases are given. The spirit in which Sir Charles Bell judged, may be inferred from the allusion to the mode of treatment as a specific; a character with which Mr. Young never sought in the remotest degree to invest it; it would in truth be just as wise, observes the latter, to speak of the pad of a hernial truss as a specific against strangulation, as to assign the character to compression in cancer.

"The testimony of Mr. Travers (loc. cit. p. 306) is favorable to the practice. He has known tumours, such as those already described (p. 206), ' gradually reduced, and at length absorbed by equal and persevering compression, as by strips of soap and adhesive plaster, or, what is better, by an elastic roller passed many times round the chest, with layers of the Amadou smoothly interposed between the turns of the roller.' M. Recamier has employed compression upon a very large scale, and the more important part of his results is as follows: 'Of one hundred cancerous patients, sixteen appeared to be incurable, and underwent only a palliative treatment; thirty were completely cured by compression alone, and twenty-one derived considerable benefit from it; fifteen were radically cured by extirpation alone, or chiefly by extirpation and pressure combined, and six by compression and cauterization; in the twelve remaining cases the disease resisted all the means employed' MM. Blizard and Masson have published three cases, and M. Carron du Villards three others,-in all of which irregular nodular scirrhi, the seats of lancinating pain, &c., were removed by compression. Dr. A. L. J. Bayle (loc. cit.) gives, as the general results in 127 recorded cases, 71 cures, 26 instances of improvement, 30 of total failure. These results, the most favorable on the whole that can be adduced in favour of any mode of treatment, bear scrutiny of the severest kind. It is no doubt true, that, in some of the cases alleged to be cancerous, neither of the anatomical species of that affection existed; but it is on the other hand perfectly unquestionable that many of the absorbed growths were not only actually scirrhous, but had already become the seat of ulceration, when submitted to compression.

"Difference of opinion has existed as to the best mode of applying compression. M. Recamier employs perfectly smooth disks of agaric, laid over each other, and retained in situ by a roller, as the compressing materials. M. Bégin sometimes substitutes a laminated plate of lead, modelled to the tumour, and surmounted with a pyramid of graduated compresses. This application (which is far from a novel one) frequently becomes painful, and cannot be endured. M. R. recommends a renewal of the apparatus every day, or every second day: M. Bégin thinks it better to change only when the bandages grow loose; and prefers, in consequence of this view, an elastic corset, capable of accommodating itself to the decreasing size of the part, as the compressing agent, wherever circumstances admit of its use. But all contrivances of these kinds are ineffectual, for various reasons: in the first place, they exercise unequal and irregular pressure on the tumour; in the second, they confine the movements of the chest to a degree varying with the amount of constriction; in the third, the force employed is not directed against the diseased mass alone, but wasted in great measure upon the healthy parts; and, in the fourth, while the difficulty of applying the apparatus effectually is extreme, it invariably loosens and becomes more or less disarranged within a short period after its application. Besides all this, the least unevenness in the material lying next the diseased structures renders the compression unbearable, from the pain it produces. These are the chief reasons, doubtless, which have hitherto prevented compression from taking its ground as a general system of treatment of various external cancers.

Dr. Arnott's Plan.

"The fertile ingenuity of Dr. Neil Arnott (already so successfully and so variously employed in devising mechanical means of relieving human suffering) has triumphed over these difficulties. Dr. Arnott has invented a method of applying

« AnteriorContinua »