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tures a flight into the regions of theory, we have no wish to follow him, and, if we try, we are soon, like him, lost in fog. If Mr. Matthew Arnold had seen this book before he passed what we fear is a very undeserved compliment on our profession by crediting it with the possession of the quality of lucidity in a high degree, we feel sure lie would never have so committed himself.
What our author's own ideas are on the pathology of phthisis is not easy to make out. He appears to have imbibed all the theories that have been advanced without in the least digesting them. He thus reproduces them for our entertainment, side by side, in a crude, fragmentary form, without any suggestion as to which is most to be preferred, and along with them all, and quite uninfluenced by any of them, a chemico-humero-vital pathology of his own which crops up at odd times throughout the treatise. We will make a few selections.
"The blood fluid in all stages and conditions of purity, at high grade and low grade of vitality, passes into this sifting, assimilating, and eliminating organ to be prepared for the highest uses in the production of structural formation, and for supporting functional activity. That portions of debris should become immeshed in this network of cells does not seem strange."
"Our understanding of vitality itself is that it is a correlating energy—an energy all the time supplied by the transmutation of force ascending from the planes of the mineral, vegetable, and lower animal kingdom, and that all force is distributed from molecules. The action, then, of any specific virus or morbid force as well as the power of a drug whereby it impresses the organism, is properly spoken of as a mode of molecular energy. A remedy, if it does anything to aid vitality in its struggle against opposing forces, does so by imparting some of its own molecular energy, or by supporting the molecular or correlating energy or vitality; more commonly, I think, the first, foods and assimilable substances usually yielding the last. Indirectly, the drug energy may do something, yes, much, by removing impediments which so embarasses (sic) vital energy that assimi
VOL. XLI, NO. CLXIII. JANUARY, 1883. »
lation, which is a mode of correlation, is unable to go forward."
The above is a delightful piece of scientific jargon. It can hardly be called lucid. The following will match it. The italics are ours.
"Not unfrequently several of the varieties [of tubercle] are found in a single autopsy. Probably tubercular matter is essentially alike, the difference in appearance being accidental; for miliary tubercle commonly is soft and can be crushed beneath the fingers, and is of yellow colour, as is the caseous; more rarely it is found as a minute granule, and is semi-transparent or greyish, and hard to the touch. Possibly it may now have undergone the calcareous transformation, retaining its millet-seed form. The miliary tubercle, however, varies from what is called caseous exudation, by being sprinkled throughout the lung, while the caseous exudation is usually confined to the apices. And yet, many assert that miliary tubercle is very commonly associated with caseous exudation, the school of Bennett affirming, and the school of Virchow denying, as a rule. But this is agreed that the diffuse tubercle is miliary. Then again, it is affirmed that infiltrated tubercle is often but an agglomeration of miliary tubercle. Miliary and infiltrated tubercle are certainly found in all shades of consistency, from the soft and diffluent to the calcareous." The italics are intended to mark the author's modest deference to the opinions of others, and his very guarded non-committal language.
On page 148 we come across this, which contains something new to us, as it probably will to our readers:
"We must remember the skin has a wonderful eliminating power. 'The poison of a rabid dog, a snake bite, and other infectious poisons/ says an eastern physician, 'may be wholly eliminated from the system by baths at 130° to 150° Fahrenheit; and vaccine matter does not take if excessive perspiration follow soon after the inoculation.' The value of thorough breathing and exhalation from the skin cannot be over-estimated." [Italics ours.]
"I do not suppose that we are to drift tubercle from its lodgment in the lungs by baths at any temperature, but when nature declares her efforts at eliminating by the sweating process, it is well to inquire if we may not act on the hint. . . . Drainage of effete and tuberculous matter, either by an opening through the walls, or the emunctories, will tend to obviate the very general evil of auto-infection."
Of Sulphur he says (p. 225):
"Acting upon the glands and follicles as it does, it is easy to explain its great power as an absorbent, suggesting that it can be utilised in the matter of drainage of the system. The taking up of debris and adventitious products and causing their elimination out of the natural sewage, is most important to health. As an electric it is negative to all known substances and the exact opposite of oxygen, which is positive to all known substances: this may be of more significance than we think."
In a chapter on "Tubercular Transformations" we are told that " of the earthy constituents, it is proved that the salts found are composed chiefly of the insoluble phosphate and carbonate of lime, mixed with a small proportion of the soluble salts of soda;" and a few sentences lower down we have this: "It will be remembered that the phosphates and carbonates of lime and soda are remedies that have thus far gained the highest reputation in the treatment of pulmonary tuberculosis with the dominant school, and that these have been supplemented with cod-liver oil." The last sentence contains a confusion of many distinct things. In the first place it is not phosphates but phosphites that are so largely used now by the dominant school. Then again the use of these was not "supplemented" with codliver oil, but the cod-liver oil treatment of consumption was introduced into practice by the late Professor J. Hughes Bennett long before the use of the phosphites was thought of. The credit of bringing the latter into note is due to Dr. J. F. Churchill, of London and Paris, who has advocated their use for many years, and has published a book with cases setting forth his theory of their action, and how he came to use them. He lays claim to the discovery of what he calls " stcechiological medicine/' by which he means medication directed to the ultimate elements of the tissues. Knowing tuberculous matter to consist largely of phosphates, that is, salts in which the phosphorus is fully combined and neutralised, he fancied that the lung tissues required more free phosphorus for the due discharge of their functions, and for the formation of less devitalised, and consequently more easily removable substances than tubercle. His aim was to supply the phosphorus. But this substance he found too irritating to administer in the crude state, and he was thence led to try its combinations in which the phosphorus preponderated over the base. He found what he desired in phosphoric acid, and the hypophosphites of soda and lime, and it is these which our author had in his mind when he penned the sentences quoted above. Dr. Churchill's success has been very great, as we who know the virtues of phosphorus can well understand. If he had only known the Hahnemannian method of attenuating medicines, he might have saved himself much trouble, and his patients much unpleasantness, and some risk. For he found that caution was needful; as in some cases, which he could not explain, the effect of the hypophosphites was to bring on all the train of consumptive symptoms, and complete the picture of the disease where nature had left it half finished, unless the remedy was promptly stopped. How he explains this on his "Stcechiological" theory we do not know. We have another way of looking at it—in the light of the law of similars. Dr. Brigham mentions later on in his book Dr. James Henry Bennett. The case of this physician, who was himself far advanced in phthisis, will be found reported in full in Dr. Churchill's book, taken from Dr. Bennett's own writings. Dr. Bennett is the author of two books, one on the South of France, and one on the treatment of phthisis. In the former, which appeared first, he gives all the credit of his recovery to Mentone, and the sagacity of Professor J. Hughes Bennett who ordered him there. But it appears that on his way he stayed in Paris, and consulted Dr. Churchill, who advised him to take his hypophosphites, which he did with great benefit, continuing their use when he went to the south. Mentone, however, got the credit, and Mentone's fortune was made. In other writings, Dr. Bennett has given the hypophosphites their share of the praise, though not, according to Dr. Churchill, due credit to him for prescribing them.
The hypophosphites are rather unstable compounds. Those of lime and soda Dr. Churchill found most useful and gave them in the form of syrup. It is to these we suppose Dr. Brigham alludes in the sentence quoted above as having gained the highest reputation in the dominant school. What he means by including in the same category carbonate of soda, and carbonate of lime, we are at a loss to divine.
It may be that from the above quotations our readers will be able to form some definite idea of our author's views of the pathology of phthisis. For our own part we confess that we have failed, and are not without a suspicion that Dr. Brigham has no very definite ideas at all on the subject.
In the chapters on " Physical Signs," we find little that is original, and much that is sound. Not unfrequently, however, the author's fatal want of lucidity steps in, and obscures what was plain enough before. What, for instance, are we to think of the writer of this:
"Mastery of the totality of symptoms must be made if we expect any success; not the outward symptoms alone [italics the author's], or chiefly, but the dyscrasia, the
radix, and the most occult vital impediment
Certain it is, there is no excuse at this day for a man's being ignorant in our methods of physical diagnosis. If he cannot tell, as a rule, if he have tubercular dulness [italics ours], bronchophony, cegophony, or pectoriloquy, he is not to be commended for his learning, and yet there are weightier matters; yet it may be doubted if one knows nothing of physical diagnosis, if he will be a very good diagnostician on higher grounds."
It is very comforting to us to be told there are "weightier matters," even if we have to surrender our claim to being "very good diagnosticians on higher grounds," as we fear we must, since we confess that we cannot tell if