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much service, are said to be those occurring “ in girls of spare habit, in whom the whole muscular system is weak ; where the vertebræ are thinly covered with the muscles, the spinous process being prominent throughout the whole length of the spinal column ; the scapulæ on both sides projecting and wanting their close adaptation to the ribs, owing to the absence of sufficient power in the muscles to keep them in their natural position : where the curvature of the spine is general throughout its whole length, and can be easily altered in one direction or the other, the bones being but loosely connected owing to deficiency of strength in the liga. ments; the shoulder of one side being higher than the other, though not to any marked extent, and the ribs of the left side, though less convex than on the right, still are not compressed to an extent sufficient to cause a hollow beneath the left scapula : lastly, where the curvature has existed for a short time only, and will admit of being easily redressed by pressure made with the hands."
Now compare such cases with another set, in which the exercise of the muscles is declared by our author to do more harm than good; viz.
“ Those where the curvature, although it may be confirmed, may not yet be fixed ; by which I mean, the deformity may be very great, but yet there may be sufficient yielding in the spine to allow of it being moved or acted upon when pressure is made forcibly against it; where the ribs are more increased in convexity on the right side and more depressed on the left, with a corresponding projection and sinking of the scapulæ of the two sides, causing also the corresponding difference between the level of the two shoulders. Any increased power given to the muscles in these cases, without attempting mechanically to support the ribs and spine, and to support the left shoulder, which by its weight is tending to bear downwards and to increase the concavity, will, as before stated, only keep up the deformity, and in the majority of cases increase it. This opinion, I am aware, is at variance with that which is advocated by those who look to increased muscular development as an important point in the treatment of these cases; it is formed upon the reasons I have already given, and from my own experience I believe it to be a correct one. The grand point to attend to, is to bring the spine as nearly as possible into its normal erect line; to relieve the compressed ribs of the left side, by supporting the shoulder which is bearing upon them with its weight, at the same time that the opposite or convex side is pressed upon by a force that gradually admits of being increased.” P. 102.
It will be observed, from the passage we have had printed in Italics, that our author somewhat qualifies his opinion as to the hurtful effects of exercises even in these cases. As a matter of course, when the deformed vertebral column has become, from the long-standing of the case and the age of the patient, rigidly fixed in its altered position, no rational man can expect that any sort of muscular exercise can ever correct the evil. All that can then be done is to have recourse to a well-devised mechanical support, frequent reclination in the horizontal position, and great attention to the general health.
The exercise, we should have remarked, recommended by our author, will be best understood from the following passages :
“ The position that I believe to be the best, is one that throws the whole spine more backwards than forwards; which tends to redress the curvature, at the same time that the muscles of the spine are brought actively into play; and the following is the one I should recommend. Attach two pullies or hooks (and 1847] Searle on Cholera, Dysentery, and Fever. 515 pullies answer the purpose better) to the ceiling of the room, or to an artificial frame-work placed in some situation about two or three feet above the head. The patient is to stand in a position, that the pullies may be about a foot and a half or two feet behind her. "She is then with both hands to take hold of a stick or spindle, to which two ropes are attached, and which pass through the pullies, having weights fastened at the other ends sufficiently heavy to require some exertion to draw them up, the weights of course being increased or diminished according to the strength of the patient. I generally find six or eight pounds in each quite enough, and as much as the patient can raise without over-fatiguing herself. The ropes should be long enough to allow her to incline the body forwards on the hip-joints, without bending the spine itself, drawing the weights upwards as much as she can, keeping the arms extended above the head all the time, and bringing them as far forwards as the inclination of the body will admit of, without the necessity of moving the feet from the position in wbich they were originally placed. The body is then to be brought into the erect position again, by raising the trunk on the hip-joints, and letting the weights fall, and so to pull the arms behind and above the head. It may be as well to tie a knot in the ropes, to check the fall of the weights, to prevent the arms being strained beyond the point of extension to which they can easily be carried behind the head.” P. 108.
This exercise should often be taken with the left arm only. He adds :
“ The grand principle I wish to lay down, is, to exercise the muscles with the arms placed above and behind the head, while the body is kept in the erect, and not in the horizontal position. If this principle be well carried out, and a strong and efficient spinal support be employed at the same time, I believe that all slight cases of lateral curvature may be cured without the necessity of employing couches at all.” P. 112.
In taking our leave of Mr. Lonsdale's work, we cannot but express our opinion that he seems disposed to attach a somewhat exaggerated importance to the use of mechanical means, and to undervalue the benefits to be derived from the judicious employment of muscular exercises, in the treatment of lateral deformities of the spine. With this qualification, we think that many of his suggestions are sound, and well deserving of the attention of the profession.
CHOLERA, DYSENTERY, AND FEVER, PATHOLOGICALLY AND PRACTICALLY
CONSIDERED ; OR THE NATURE, CAUSES, CONNEXION, AND TREATMENT OF THESE DISEASES IN ALL THEIR FORMS, By Charles Searle, M.D., late of the E. I. Company Madras Establishment, &c. &c. Pp. 120. London : Churchill, 1847.
DR. SEARLE is surely a very fortunate man above his fellows; for his work has gained for itself a very wide circulation, and the prestige of a favourable reception, ere it yet appeared before the public, or passed through the ordeal of the press. “ The Court of Directors of the East India Company, with their usually enlightened concern for the millions under their paternal dominion, and regard for the welfare of the many in their employ, have enabled me-with a liberality demanding this public acknowledgment—to present to each of you (the medical officers of their service-Rev.] a copy of this publication, which has for its chief object, the dissemination of IMPROVED PRINCIPLES of treating that scourge of India, and it has been said.—'opprobrium medicorum'--the Cholera.”
Emboldened by so flattering a compliment, the author "calls upon the press generally to aid him in its circulation, at the same time that he calls upon the profession and all mankind either to confute him in argument, or to exhibit by facts, why the practice enjoined and the treatment recommended should not be accepted as deserving universal adoption." Now, without regularly entering into the lists with so proud and confident an opponent,--the limits of our space would not allow us to do justice either to ourselves or to him--we shall do little more at present than select a few passages from his message, adding but a word or two of our own in the way of remark.
Nature of Malaria.--"Sulphuretted hydrogen, one of the offensive gases issuing from sewers, and a product of the decomposition of animal and vegetable substances, is so truly poisonous to the animal system, that a bird, or other small animal, exposed to an atmosphere containing but one fifteen-hundredth part of this gas, dies almost immediately from its effects; and a horse has been killed by exposing it to breathe an atmosphere containing but one-250th part. That malaria, which is a compound of this and some other gases equally noxious, developed by the decomposition of aniinal and vegetable substances, wherever they exist, may be truly affirmed to be a poison; and which, under certain conditions of the atmosphere and states of the system, will produce cholera ; and under other circumstances of exposure to its influence will occasion typhus fever, dysentery, scarlet fever, erysipelas, rheumatic fever, influenza, or other modification of fever of a remitting type with local affection-either of the brain, lungs, or abdominal organs.'
P. 28. In a previous page, 484, we have questioned the propriety of regarding sulphuretted hydrogen or any chemical gas whatsoever as a necessary ingredient in the malaria or miasm that produces fever, whether of a periodic or of a continued type. We know of no experiments or observations that at all warrant the idea, more especially in reference to Intermittent or Remittent fevers, and still less as respects Scarlet fever or Rheumatism. Dr. Searle does not seem to be quite satisfied himself as to the origin and morbific effects of malaria, if we may judge from the following remarks :
** We must not,” says he, "confine our ideas to the immediate or direct decomposition of such (animal or vegetable) substances, issuing from sewers, drains, and other foul sources. We must not, however, confine our ideas to the immediate or direct decomposition of such substances, or to the sources that I have mentioned exclusively; the exhalations from marshes, or the paddy grounds of India, from jungle or forest, as well as from the uncleanly persons of both men and animals, or the deteriorations of the air by respiration in crowded apartments, and imperfectly ventilated or confined situations, are quite equal, in cer. tain conditions of the system, to produce the same effects, viz., cholera, or, as I have before said, under other circumstances, typhus, or remittent fever, these diseases, under ordinary circumstances, having the same common origin, and being intimately associated in character; and hence, the latter in India, and the former in Europe, frequently becomes the sequel of the former affection." P. 35.
Are we to understand from this that exhalations " from the uncleanly persons of both men and animals, or the deteriorations of the air by respiration in crowded apartments," ever produce a case of genuine Remittent' fever? If this be the meaning of our author, we must entirely dispute the assertion, and call upon him for his proofs.
Among the causes of Epidemic Cholera is enumerated a thunder-storm, and its modus operandi is thus attempted to be explained analogically:
“ A thunder-storm may also be considered such a cause, as evinced by its capability of addling or destroying the vital qualification of eggs; or arresting the process of fermentation, and souring beer, exposed in a bad cellar to its influence; or, as it is said sometimes to do, to kill the fish in a pond-effects which are known to succeed to a thunder-storm of even half-an-hour's duration. Now, 1847) Searle on Cholera, Dysentery, and Fever. 517 as the vitality of fish is dependent upon certain chemical changes which are going on in the body of the amimal, which are common to the rest of the animal creation, and the incubation of the egg is dependent upon changes of a like character, and the fermentation of beer also dependent upon the same, and which, in either case, are effected by the agency of the oxygen of the air, in its combination with the carbon of the blood of the animal, or that of the white of the egg, or of the carbon of the sugar of the beer-we are naturally led to infer, seeing the same chemical process is going on in man's system, and upon which his life is dependent, that this process may be arrested or impaired by the same cause, or some analagously suddenly altered electrical condition of the atmosphere--and the disease, as a consequence, be induced, in persons predisposed by previous derangements of health, or subjected to a greater amount of exposure to the influencing cause, or possessing a greater susceptibility of system to be affected by it." P. 107.
In the Treatment of Cholera, Dr. Searle seems to regard calomel as an all but specific remedy, not only from its potent action on the hepatic functions, but also as a direct antidote to the morbific cause. His own words are
“ With respect to the first mentioned indication (restoring the liver's function) universal experience testifies, that calomel has a direct and immediate exciting effect on the liver, increasing its secretion and the flow of bile into the bowels; and further, universal assent will be given by the profession to the fact, that it not only excites secretion of the bile, but all the secretions; and if it excite all the secretive organs, it must necessarily act generally upon the system, and excite all the functions, including those of the heart and brain. That it does so, thirty years' experience justifies me in confidently asserting, the pulse manifesting its exciting operation. And further, as it can only thus operate in admixture with the blood, into which it must be admitted by absorption from the stomach, it must of necessity operate, as it is a stimulant, as an antagonist agent also, in supercession of the depressing influence of the poisonous cause of the disease; and if this be the case, it is a remedy to which we might, under ordinary circumstances, apply the term specific in the cure of this disease ; and, as the fruit of all my experience, I fearlessly aver, that it is as much so as it is possible any single remedy can be." P. 49.
So bent is he upon affecting the system with Mercury, that, when calomel appears to have little effect, he recommends a solution of corrosive sublimate to be given both by the mouth and in the way of injection--an eighth part of a grain every half-hour, or so, until the pulse improves and excitement becomes developed. He suggests also the trial of mercurial inhalation. “As the simplest mode of practising it, a tile, or brick, being made red hot, and put upon some sand in a dish, may be placed beneath the bed-clothes, and the patient, enclosing his head, may be allowed to breathe the vapour developed by throwing half a drachm of calomel, or red sulphate of mercury, on the heated object; or it may be inhaled from the tube of a funnel inverted over the dish. This might be repeated every hour or two, till amendment takes place."
The profession is not likely to have much confidence in the judgment of a writer who suggests such extravagances as these, nor in the sober sense or honest word of any one who pretends that the early and steady application of any means whatsoever will in general, far less invariably, prove successful, as Dr. Searle does not hesitate to assert, in the cure of so lethiferous a disease as Pestilential Cholera.
As to our author's views respecting Fever, that “will-o-the-wisp," as he calls it, and whose proteiform disguise has, in his opinion, so baffled the efforts of all writers to reveal its true nature until he took the subject in hand himself, it is far from being easy to make them out with any degree of precision. We must therefore beg our readers to consult his work for themselves, if they wish to know more about them,
REMARKS ON VIVISECTION, AND CERTAIN ALLEGATIONS AS TO ITS
UTILITY AND NECESSITY IN THE STUDY AND APPLICATION OF PhySIOLOGY. By George Macilwain, F.R.C.S., &c. &c. 8vo. pp. 27. London, 1847.
This is an excellent pamphlet, well argued and very gracefully written. It contains much that deserves the serious attention of the truly philosophic, as well as of the purely benevolent, physician. The author, not satisfied with protesting against the cruelty, exposes the worthlessness in a mere scientific point of view, of many (we do not say all) of the experiments on living animals, which have at different times been adduced in favour of the practice he condemns. He comments more particularly on certain experiments of Hunter, Orfila, Sir A. Cooper, and Sir C. Bell.
It has been often alleged that the great improvement, which Hunter introduced into the treatment of aneurism by operation, was the result of this mode of investigation. That such was not the case, but that the happy thought of tying the artery at some distance from the seat of disease sprung solely and entirely from the observation of pathological phenomena-we allude more particularly to his knowledge of the fact that “the sac often by it increase presses on the sound part of the artery and becomes the cause of its obliteration," whereas the diseased portion of the vessel, when encircled with a ligature, will seldom uniteand from the simple deductions of legitimate reasoning thereon, is clearly made out by referring to the history of the very case which led Hunter to its adoption. It is given at page 10 of the •Remarks."
Mr. Macilwain's observations on Orfila's experiments, which have certainly been among the most barbarous of the present age, are so good that we could wish to have been able to give them entire. We shall select the most striking portions.
“The nature of the experiments, and M. Orfila's narrative, alike demonstrate the tortures by which they were accompanied. He tells us of animals dying after hours of pain, in the midst of the most horrible sufferings, 'au milieu des souffrances les plus horribles, douleurs les plus atroces,' ' poussant des cris les plus plaintives'in most dreadful pain,' uttering the most plaintive cries,' and similar unequivocal expressions of sustained agony. It would be some little satisfaction could we assert that these expefiments had contributed to the advance of science, but, as will be immediately shewn, this is far from having been the case.
“ The experiments varied; those chiefly referred to, consisted in exposing an animal's csophagus (or gullet), by dissection, making an opening into it, and injecting thereby poison into the stomach; the gullet was then tied! and the animal left to itself. In some cases the ligature was removed and more poison, or its supposed antidote, injected; other experiments consisted in making a wound, and sewing up some poison in it, to see what effect would be produced. Although the influence on science exerted by these experiments is the point with which we have to deal, we may venture to remark that there were philosophical objections to them, on the very threshold-insuperable, because loaded with so many elements of fallacy. I shall very briefly advert to them : Ist. To ascertain the effect of a poison introduced coincidently with the infliction of a severe operation, it is obviously necessary that we should be able distinctly to separate the disturbance occasioned by the operation, from that resulting from the poison; but this cannot be done, because the same amount of local injury even in animals, by no means always produces the same consequences.
“ 2ndly, Every one knows that many substances in nature excite very different effects in dogs, horses, hares, goats, &c., from those which they produce in man.