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experience, that "with proper care and treatment phthisis may be arrested in this country much more frequently than was formerly supposed, and that there is no reason to believe that such arrestment is more common in Madeira, Egypt, or Italy, than in Edinburgh or London."*
It may, perhaps, be objected that the discovery, to which we alluded above, of the deposition of tubercle in acute tuberculosis being of an infective character, and the result of retrograde metamorphosis of "cheesy" pneumonic products, seems to point to a mild climate as the most favorable, as there can be no doubt that pneumonia is often caused by cold. But, in the first place, acute tuberculosis is a totally different disease from the one under consideration; and, secondly, it results not from an attack of intercurrent pneumonia occurring in a duly nourished frame, but from the morbid degeneration of old pneumonic products in a debilitated constitution. If assimilation be only properly effected, no disease is more easily treated, or, in fact, requires less treatment, than pneumonia. In such cases the disease will run its natural course; the exudation will pass through its normal stages, and will finally become absorbed and its products be duly eliminated by the natural emunctories instead of remaining behind as "cheesy" deposits. So that the great preventive of acute tuberculosis is due attention to nutrition; when it has once fairly set in it usually runs its course in from one to four or six weeks, so as to render banishment to a remote island impossible, even supposing this were capable of producing the smallest benefit in such cases, which it confessedly is not. Where such "cheesy" deposits already exist without acute tuberculosis having as yet declared itself, let due attention be paid to bringing about a state of general eucrasia, and these untoward reliquiae will speedily become encapsuled and harmless. These general hygienic and dietetic measures are the same as those above described.
* The only statistics of any value relating to the effects of the climate of Madeira in the treatment of phthisis are those giving the results of the celebrated Brompton experiment. Twenty-seven cases were sent out a few years ago by the Brompton Hospital, with the following results:—2 returned improved, 7 slightly improved, 12 neither better nor worse, 6 were made worse, and 1 died. See Dr. Thorowgood's treatise on the Climatic Treatment of Consumption. The statistics of Dr. Lund, even if we were to suppose them accurate, give no better results than are constantly obtained in England with the improved treatment of modern times, and Dr. Schultze has committed himself to so many extravagant theories as must tend to discredit any of his conclusions. For example, he asserts Cod-liver oil to be of no value in the treatment of phthisis; maintains that this, disease will be revealed by Hutchinson's spirometer when percussion and auscultation have failed to detect it; gives the death rate of Great Britain as 1 in 60, and the deaths from phthisis in Britain as 1 in 5. See Dr. Ireland's pamphlet.
But while the climate of Madeira is, as we have seen, little likely to prove beneficial in phthisical cases, we know of none more admirably adapted for such more local respiratory affections as laryngitis and chronic bronchitis. Here its warm, moist, equable temperature is just the very thing to be desired. In all these respects it is far superior to the climate of Torquay, Queenstown, Jersey, Men tone, Hyeres, Nice, Rome, Naples, or any other invalid resort with the statistics of which we are acquainted; and although the climate of Malaga may, perhaps, vie with that of Madeira in point of equability, still, the accommodation of that town is described as being so very inferior (for here we cannot speak from personal knowledge) that the island must unquestionably, all things considered, bear off the palm. Besides, the humidity of the atmosphere in Madeira is, in such cases, a positive advantage, and furthermore renders the island likely to prove highly salutary to most asthmatic patients. Some really remarkable and wellauthenticated cures of gangrene of the lungs, as that of Dr.* Dyster, are also recorded to the credit of Madeira. Elderly persons in general are likely to enjoy this genial climate, and certainly could find no lovelier spot for their closing years; and cases of hopelessly advanced phthisis may sometimes be transported thither with some hope of euthanasia, but this is not a very certain result of the experiment.
A permanent residence in the island, in the case of those who have families, entails a necessary separation from their children, not merely on account of the climate being highly pernicious to these latter, but for the muchoveightier reasons that there are no means of education, and that the moral and social influences are deleterious in the last degree. Those among the children of British residents who are not sent home for their education grow up utterly untaught, speaking a sort of hideous mongrel patois bearing about as much resemblance to refined English as it does to Low Dutch; and their ideas, i/» Dr. Johnson was so ungallant as to say of the sentiments of a lady of Boswell's acquaintance, are "very fit for a brothel."
Considering the reception accorded to Dr. Ireland's temperate and unanswerable pamphlet by those whose pecuniary or professional interests were involved in the reputation of Madeira, we have little doubt that if our article shall fall under the notice of such persons it will be the signal for a burst of insular indignation, expressed in terms which are likely to be a good deal more forcible than elegant. Few, indeed, in the island took the trouble of reading so calumnious a production as Dr. Ireland's publication, and, even if they had done so, still fewer were capable of understanding it. But all felt themselves fully qualified to join in a universal bray of terrified cupidity and injured self-esteem. A physician practising in the island hit upon the truly ingenious and economical device of writing a letter to the Guardian, assuring the editor and readers of that periodical that all English visitors to Madeira might rest satisfied that their spiritual wants would be attended to in the most efficient manner, and in every variety of style, by the British chaplains of different denominations resident in the island. We can from* our own personal knowledge affirm that this assurance is strictly true, a3 the gentlemen who now officiate in that capacity would adorn any sacred office to which they might be appointed. But as the typical valetudinarian is, unhappily, a very selfish and not over spiritually-minded specimen of humanity, we fear the medical gentleman's interesting piece of religious statistics was contributed mainly with the view of acting as the vehicle of the gratuitous advertisement of the island itself, and of one at least of the distinguished sons of iEsculapius, who favour that fortunate locality with the benefit of their learned services. If our article shall call forth a second advertisement of similar character we shall wish the latter all success for the sake of those interested, but as we have been rigidly careful to make no statement in the course of our remarks which will not bear the strictest investigation, we stand in no fear of criticism, and however many exploded vagaries may be trumped up in maintenance of theories long since discarded, we, at least, shall assuredly not cry peccavi. And as we do not understand that the echoes of the Madeiranese outcry were so distinctly audible in this country as to disturb Dr. Ireland's well-earned nocturnal repose with their thunder, or to distract the attention of the editor of the Edinburgh Medico-Chirurgical Journal from his important labours, we take our leave of the subject of Madeira, satisfied with having spoken the truth, and with the consolatory assurance that as any counter-statements must be destitute of foundation in fact, so remote provincial vituperation is impotent of harm.
ON THE TREATMENT OP SOME SKIN DISEASES.
By Dr. Clotar Muller.*
The Leipzic Homoeopathic Dispensary, with which I have been connected as ordinary medical officer for a long series of years, has brought under my observation a rich array of exanthematic diseases. In some kinds of these diseases I believe I have observed in my frequent treatment of them a certain steadfastness in the occurrence of certain results. I therefore do not hesitate to give a resume of my observations and deductions respecting them with all caution. These will doubtless be comparatively few in number if I confine myself to what seems to me the necessary limits. Not that the number of cures effected was so very small, although these must be regarded as not very numerous compared with the number of cases treated, owing to the difficulty of exercising any control over the patients frequenting a dispensary. But in conformity with the special object of this communication I must pass over all those curative results even of a striking and decisive character which only occurred in single cases and were not confirmed on the occurrence of analogous circumstances. In like manner no notice can be taken here of all those cures where the curative medicine was chosen not exclusively or chiefly with reference to the exanthematous symptoms, but with reference to the general morbid phenomena, whether these were the consequence or the cause of the skin affection. For in the great multiplicity of these morbid symptoms, which may be present in the most various forms of exanthemata, the skin symptoms themselves have little or no influence on our selection of the drug, and it would be incorrect to infer that the same remedy would again be useful in the same form of skin disease if the general morbid symptoms that determined the selection were not likewise present. In the present short communication, I repeat, I shall confine myself to the few constant curative results obtained in certain forms of exanthemata, in which that which determined the selection was found in the skin symptoms themselves, and, consequently, I was able to repeat the curative experiment with the medicine in the same cases of skin diseases, and others may now test the matter for themselves.
*Internationale Hom. Presse, iv, 1. VOL. XXXII, NO. CXXVIII. APRIL, 1874. P
Limiting myself thus, I shall not enter into the question of the constitutional or local nature of skin diseases, nor as to whether Hahnemann's psora theory should be accepted fully or with limitations, or entirely rejected. But I may be allowed to make a few general observations on this latter point suggested by a postscript by Dr. SiissHahnemann to Dr. E. Blake's paper translated in the first volume of the Internationale Horn. Presse.
Whether Hahnemann, if he had become aware of the existence of the Acarus scabiei, would have treated the itch with