REVIEW

453

motion of the intestines, which is neces-sary to a perfect performance of theirfunction. Bnt it admits of no relief fromart. For the treatment of preternaturalaccumulation of fluid in this cavity,(ascites,) I must refer you to the generaldoctrine of dropsy, already given. I shallonlyobservehere, that when attended withmarks of inflammation, which is no iiii.common occurence, an antiphlogistic p; anof treatment is required, or which blood-lettitig may often usefully make a part.Indeed, I liave seen it alone cure manyof these crlses; but only when the diseasewas recent.I cannot qnit this part of our subject,

Gentlemen, without adverting to thenndneimportance attached, by certain modernpathologists of high reputation, to the Idigestive organs, or as it is the fashion toterm them, the chylopoictic viscera, (in-elnding of course the liver,) as the sup-posed somce of a great numher of dis-eases, and those of the most oppositenatnres, but t,,,I)(-cially affections of thebrain or nervous system. Indeed, nothingappears to be necessary to establish sucha snpposed connexion and dependence,but the slightest degree of imperfection ondisorder in the secretion of bile, or in theperformance of the digestive function inany of its parts. Another unfoundednotion attached to this, is a sort of spe-t’ific power supposed to be possessed bymercury, in affections of the liver, and inrestoring healthy secretions, as the ex-

pression is.With respect to the pathology above

alluded to, the effect appears to me to betaken for the cause; in consequence of

which, the former is alone attended to inpractice, while the latter is overlooked orneglected, or not treated with adequateattention. As to any specific power pos-Msscd by mercury, either in the slape ofcalomel or the blue-pill, the opinion maybe very safely rejected, because it rests

npon nothing like satisfactory evidence.The notion of a poison (such as mer-

cury is, and often proves itself to be,)restoring healthy action, aud regulatingthe secretions, at leat in a direct way,is too absurd to be dwelt upon. Likeother powerful agents, it may occasiouallyinterrupt the course of various diseasedactions, and no doubt those of the liveras well as others; but it is far too indis-criminately nsed, both for this and otherpurposes. It is very necessary you shouldbe sceptical with regard to the reportsmade on such subjects.

REVIEW.

An Inquiry into the Seat and Nature ofFever, as deducible from the Phenomena,Causes, and Consequences of the Disease,tlae effects of Rernedies, and the Appear-ances on Dissection.—By HENRY CLUT-TERBUCK, M.D., Member of the RoyalCollege of Physicians, Senior Physi-cian to the General Dispensary, &c.

8vo. pp. 494. Second Edition. Lon-

don, 1826, Anderson.

THE former edition of this Work ap-

peared nearly twenty years ago, and

althongh the antiphlogistic or coolingplan of treatment had at that periodmore or less obtained, and the anthor’s

doctrines in their full extent have been

but feebly supported ; it is easy to ob-

serve that they have considerably influ-enced the practice of physicians, con-

tributed much to discourage the iudiscri-minate use of cordial and tonic medi.

t’ines, and to establish a rational iiiettiod

of treatment in febrile diseases. Althoughfew will go the length with our author toassert, that in every case of idiopathicfever the brain is inflamed, it cannot bedenied that delirium, or some degree ofmental alienation, indicating, at least,some functional derangement, or erethism,as it has been called, of that organ is

usnally present. How far does this state

differ from inflammation, which is o;ten

transitory, evanescent, and, to the dismayof the morbid anatomist, leaves not 4 a

trace behind! Bichat is a strong autho-

ritory upon this point ; he says (Anat-Gen. Vol. 1. 570,) " A serous membranemay have been considerably inflamed

during life, and yet present nearly a naturat appearance after death; and it is

just the same in erysipelas. I should fre-

quently," he adds, " on dissection have

454

been induced to pronounce the non-exist-ence of an affection which had actuallytaken place. The same remark is appli-cable to the cellular tissue and mucous

surfaces, affected with inflammation."

Wanting this knowledge, as he remarks,he was often led into error respecting the

intensity and even the existence of acuteinflammation. The fact is well established’

and therefore the objection that the brainoften appears healthy after death from

fever, which has been urged against ourauthor’s theory, cannot be maintained ;and if morbid appearances do presentthemselves to the anatomist, it must not

be inferred that they caused the symp-toms which were observed dnring life,but are to be received as evidence onlythat disease has existed in the part, or, inother words, of an effect." This," as the author jnstly observes,

" is clear, when we refer to cases of epi-lepsy, mania, or other periodical affec-tions of the brain ; where alterations ofcerebral structure are frequently found,which, having once taken place, must ofnecessity be permanent, although the

symptoms are of occasional occurrenceonly. And the same conclusion may bedrawn from the great similarity observedin the morbid appearances, after differentdiseases of the brain ; so that in fact itwould puzzle, I believe, the best anato-mist to indicate, from post mortena ap-pearances merely, the disease underwhich the patient had laboured ; or, onthe other hand, to predict, with any to-lerable certainly and precision, what theappearances would be after death, fromany given set of symptoms manifestedduring life. The essence of disease, inshort, consists in something far moresubtle and fleeting than the gross changesthat are to he detected by the knife of theanatomibt."

Pathological researches, observes Dr. ( Goode, rarely give the student " any in-

formation concerning the elementary orchemical changes that have taken placein the animal fluids ; and may lead him,in a thousand instances, to mistake effectsfor causes, the results of symptoms oraccidents for that of idiopathy, even in

morbid changes of structure," implying,that as we know nothing of the first linkin the chain of diseased action, that is,the state bordering on, and interchangingwith health, so we cannot, in any rationalmanner, rnn through the series of changesnp to dissolution, ar draw any practicalinference from what may be found af.

terwards.

It is true that the study of pathologicalanatomy has sometimes led to the neglectof symptomatology, and to the introduc-tion of bolder plans of treatment thancircumstances should appear to warrant,but upon the whole, it is the proudestdistinction that modern medicine can

boast of, and, more than any tbingelse, acause of the present advanced state of

surgery. Generally it will neither sup.

port nor discountenance the author’s hy-pothesis, nor indeed does he seem to relymuch upon it, for he says (Pref. p. 23.)" I do not know how to explain the sa.

lutary effects of bloodletting in the cure offever, now so generally admitted,withoutreferring to the supposed inflammatorynature of the disease."

We have reason to know that blood.

letting as here recommended, has been

sufficiently successful in the practice ofDr. Clutterbuck, and that with some

practitioners it has been improperly em-ployed, and carried to a dangerous ex.cess. While therefore we recommend

the work to the notice of the profession,we intreat our junior friends to study it

attentively, ere they employ that generalplan of treatment which, primafacie,it it

might appear to inculcate, Dr. Clutter-

buck’s ideas of fever have been exten-

sively circulated through the medium ofthis journal, which is our excuse for

the hasty view we have taken of the pre.sent erudite and clever performance.