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Art. XIII. Medical Notes and Henry m.d. &c. Reflections. Holland, f.r.s., By to the 1839. 628. Physician Extraordinary Queen.?London, 8vo, pp. This volume consists of a number of detached on various sub- essays to the and of medicine. Taken collec- jects relating philosophy practice to a class of which are because not tively, they belong numerous, writings for their a character of mind and a of ac- they require production range to be met with. an illustration from the quirement rarely Borrowing fine we them to if drawn arts, which, may compare simple designs, by an would hand, be and but under ordinary which, meager unimpressive, the hand of a are made to and vivid master, embody just conceptions, and evince not more but more than an ela- only power, learning many borate on which all the minor resources of art have been picture The absence of detail serves to show the truth and expended. very of : the inferior works owe their whole effect to the details. vigour design An of the kind alluded to results from the mature reflection of a essay mind and well liberal studies. Such naturally capacious, disciplined by in are to the literature of our own coun- works, medicine, nearly peculiar were more in the last than are in the try. They frequent age they pre- in the old and accorded well with a turn of mind sent, conspicuous Dr. Holland's Medical Notes and 483 1839.] Reflections. character whose evanescence from the drama of English physician?a real an inevitable of the more life, though perhaps consequence general diffusion of for our own shall never cease to we, knowledge, part, regret. In the which and Dr. Holland's Notes spirit them, pervades Reflections are redolent of the old have the same school; good air, they philosophic the same tincture of and the same from the vice good letters, exemption which of constitute excellencies in the of book-making, leading writings and those of more recent in but of similar character. Mead, Ferriar, date, remind in these some of the of While, however, us, they respects, pro- ductions of the to bygone time, they are, nevertheless, perfectly adapted the state of it is but to our author to science; indeed, present justice say that we have seldom with volume so a met a of of treating great variety the writer of which has shown himself so au niveau subjects, completely du sikcle in them all. But we must to the reader some idea of the contents of proceed give Dr. Holland's The or is on medical book. first rather, chapter, essay evidence." "There can be few better tests of a sound our than understanding," says author, various are the it the estimation of medical so evidence; right complexities presents, so numerous the sources of error. The of observation are those in which subjects under the and Matter and Mind are concerned?matter subtle complex concurrently whence and all its functions are in its derived; mind, organization, vitality equally to numerous relations to the thus formed?both subject agencies mysterious organs from without?both from disease within. Individualities undergoing great changes in and these the most ardu- of each have their influence creating difficulties, amongst ous which beset the of the Few cases occur even when alike, path physician. strictly same. causes of disease are often the source of disorder is the Primary manifestly those of kind. remote from each other obscured wholly by secondary Organs by Translations of morbid action take and function are disturbed. simultaneously place from one to another. Nervous affections and often assume place part sympathies While remedial are rendered uncertain in effect character of real disease. agents every the various forms of each the of the the disorder, by by idiosyncracies patient, by or transmission into the and of their securing equal system, difficulty application the of the remedies themselves." 1.) finally by unequal quality (p. Such the of the data on which rational belief in complexity being that the mass of mankind has medicine is it is not wonderful founded, to the most and a to ever been prone abject credulity, prey every species but it does somewhat unaccountable that of appear physi- imposture; of the cians in their of the merits doctrines and themselves, appreciation have shown themselves less credu- of remedial means, efficacy scarcely than the multitude. lous Else whence the so of effects and cures agents frequent description by put only and the or belief those on other once or twice who, trial; ready eager given by upon would and even on the of physiology, instantly subjects, closely-related questions of the Conclusions for their a feel the insufficient nature proof. requiring authority and freed from the chances of error or of cases, selected, many long average carefully are often and received sufficient to promulgated upon grounds barely ambiguity, them." warrant a of the trials which first suggested (p. 2.) repetition a era of medical from Our author enquiry anticipates very improved of numerical and statistical state- the introduction methods, averages, in hands of ments. are of inestimable value These, doubtless, capable but we that such and them capa- constructing using aright; apprehend 484 Dr. Holland's Medical Notes and Reflections. [Oct. imbued with the can exist in those whose minds are city only already with the of universal of and informed principles just reasoning, spirit we hail the announcement of more correct science; while, therefore, methods of we have to lament the too limited extension investigation, yet of that frame of mind which alone can render them and which available, of the medical student is to be attained the only by directing path of Aio rwv te oi the fields (txeSov tztpi tyvoEwg through general philosophy. icat tiov oi oi teXevtoxtiv ?xXemttoi, rrjv larpiov ipiKocroipairsptoc; texvt)v [ietlovteq, fiev ek ra oi de twv eiq LaTpiKi)Q apxovrai iaTpiKr}Q.* 7T?pi TTEpi <pv(teojq TTEpi Dr. Holland concludes his on medical evidence with a few chapter remarks on undue This is a real but of minor scepticism. evil, extent, as well as less than The same frequent occurrence, credulity. remedy to both of these vicious conformations of mind. Habits of applies and cautious induction exercise of the will disciplined reasoning powers teach us alike to embrace what to what is and is to true, false, reject our on what is doubtful?in which third a suspend judgment category of what we call medical science" is still large proportion unhappily included. ii. is on disease." Our author here as admits, Chapter hereditary his the basis of the law Dr. Prichard, reasoning, general developed by that all or connate tend to become heredi- original bodily peculiarities while in the structure of the from ex- ; individual, changes organic tary ternal causes end with and have no obvious influence on during life, him, his This is as a law, however, one, progeny." recognized only general in where to as those instances necessities of subject many exceptions, situation certain of the of and where alter the animals, parts organization continuance of such altered structure is needful for their preservation under new a case of which the domestication of animals circumstances; affords a familiar The to disease shows example. hereditary tendency itself either in the anormal conformation of and textures, particular organs or in of various morbid which the be presence products products may to their to the variations of or to conceived owe organic texture, origin transmissible in the blood and fluids. With to respect peculiarities of the of Dr. Holland's peculiarities texture, scope argument hereditary similar to those which is to show their on laws rise to dependence give or monstrosities. In the more marked anomalies of organization pursu- he an intimate of the doctrines of this theme knowledge ing displays transcendental This new and has extraordinary study grown anatomy. barrier even in its It has down the between gigantic, infancy. flung where and abstract science, blend, physical by indicating points they in and in to the mind without lost each other; a being presenting rational of material forms to our has in some sort senses, type subjected idea the subtleties of and revealed to us the its realized Plato, stamping influence into matter. It has extended its de- upon already every impress and it is difficult to conceive of and the partment physiology zoology; of its Few have hitherto limits attempts, however, possible application. to it to bear on there can be little been made bring although pathology, to that it in the most relations this branch doubt has, reality, important the notion of M. Serres to have entertained of such science. appears Aristot. Lib. de Sensu et i. Ed. Duval. Sensibili, cap. Dr. Holland's Medical Notes and 1839.] 485 Reflections. relation more than former but in Dr. the distinctly any writer; Holland, before has encountered the and much us, credit, paper actually subject, we is due to him think, for the bold manner in which he yet judicious has handled it. The observations on tendencies to following hereditary based on the of evince disease, much principles philosophical anatomy, of condensation thought: of the anormal conformation of transmitted "Examples particular organs, by are alike numerous and familiar. If form and fea- descent, of external peculiarities whencesoever tend so to become ture, derived, originally speedily hereditary,?? as we see on not families and intermixture affecting, every side, alone, but, descent, by whole races of can have no doubt that deviations of internal mankind,?we structure, be of or or of trans- other are (whether they deficiency excess, nature,) any similarly mitted and with them or conditions morbid action in the ; to, propensities of, parts thus and the direct is not for the two cases, organized. Though though proof equal the effects are of such different is it certain that the resulting importance, yet peculi- so carried on from one to have reference for both to one arities, generation another, common law. And it is to the same that we must look for of principle explanation the difference in the duration of life in fact well attested different average families;?a in the which the laws or social of itself, usages notwithstanding many exceptions mankind are ever it. Those deviations from the or common inducing primitive upon of the which occur in the or mus- structure, type species, chiefly bony integuments, cular varieties in the outward form and in the texture or fabric; feature, producing colour in im- of the exist to without skin, hair, &c., extent, affecting any may great the health or natural functions of the individual. On the other hand, portant way much smaller deviations from this in the internal of circulation, type, organs respira- or in the brain and nervous tion, secretion,?or digestion, absorption, system,?may of deviations morbid in and fatal in result: each class produce actions, painful progress alike transmissible to under the same law. This distinction is obvi- progeny, general of and of wide one of in the ously disease, capable very summary importance history It throws the connexion of various morbid states, application. light by giving upon the in their and this one relation to a common cause; principle physical principle is no which is associated with other of the more laws of life. There reason general to doubt that of structure are as and hereditary frequent varied, perhaps peculiarities as in the internal as in the external of the body. Analogy extensive, organs, parts would as it is confirmed in measure this and observation; suggest great by probable, On the same more as the examination is rendered more minute. grounds extensively it be that there is a ratio between the resemblance of external may presumed general child most like its in features and that of internal of structure. The parent parts in traits of countenance and has closest kindred with him other and figure probably here is that of more minute of conformation. The evidence chiefly similarity points and of morbid affections in such cases?a fact almost which, ascertained, indisputably if the in this be affords the best we can reason- views contained correct, proof chapter the children most seek for. In the instauce of it has been that observed, ably gout have to the disorder. This can be the resembling greatest liability only gouty parent in those of internal structure a likeness explained by supposing corresponding parts be which are concerned as causes or seats of the disease. It must admitted, chiefly in of its on first that this is still and, view, indeed, many enquiry incomplete parts; extensive than those of it that such internal deviations were much less might appear outward we can name of which conformation. But scarcely any organ importance from structure and transmissible does not afford evidence of diseased derived actions, the descent. And to the textures more diffused through body,? by widely looking to have reason as the different vascular the nerves, &c.,?we every suppose, systems, variations of struc- the be less that are to hereditary though proof direct, they subject those not of each but minute in detached ture, system, throughout merely parts functions of the both branches and terminations where the most body, important of this how- animal and be to take On a nature, vital, may presumed place. subject it is to division of external and internal not sufficient to refer the ever, vague merely VOL. VIII. no. xvu Holland's Medical Notes and 486 Dr. [Oct. Reflections. The distinction between the animal and vital is at the foundation of organs parts. into connexion with such and each must be brought every enquiry, particular question The fact be considered as that the vital are to it. ascertained, organs subject may of animal more and extensive deviations from the natural than those frequent type of it be in the the latter, life; (essential may deemed) principle symmetry perhaps be limited for the of the that all such deviations should functions, requiring, integrity It is a remarkable attestation of this that where anormal varieties of in extent. fact, the muscles occur much rarer event than in the vascular there seems a (a system), in to for the two sides. A these varieties become pre- strong tendency symmetrical hence that the to transmission descent would might sumption arise, tendency by and the to life offer more cases follow the same law, belonging organic frequent parts of malconformation than the animal I know not that this of hereditary organs. question of relative has ever been answered. There is, however, enough frequency explicitly to make it that no exists of the kind and just indicated; proof probable disproportion that anormal structure in the of animal life is as liable to be transmitted parts quite as in the the obvious these more nu- organic. Taking instances, indeed, may appear merous but as the of observation is much in the latter it is ; case, difficulty greater to in the fact that both life liable to this rest the divisions of are enough great general and not in different law, probably any degree." 16-19.) (pp. which The author adds some curious of defect, examples hereditary have within his own and the of a fallen observation, suggests probability similar of some endemic as and the diseases, goitre plica polonica, origin of in certain has received no ex- which, regions, satisfactory prevalence He is to from local circumstances or modes of life. inclined planation in in certain to refer the of stone the bladder, districts, great frequency a like the of this view as increased and considers cause, by probability the well-known connexion of the calculous with the diathesis. gouty The is a curious made Dr. with following observation, Holland, by to trismus nascentium. respect some facts as to When in in I had the of Iceland, 1810, opportunity collecting the of this disease in the Vestmann on the southern coast of singular frequency Isles, this island. On these desolate the of which does not exceed 160 rocks, population I in infants of this found a of 25 186 souls, that, disorder, period years, perished under the of 21 of which 161 died between the fourth and tenth after age days; days of life of these is 75 on the the condition birlh; Though people eighth day. poor fish and the of sea-fowl their sole is it not aliment, singularly destitute, eggs being yet so different from that of the Icelanders of the mainland as to the frequency explain of this fatal disorder and it would seem as if some constitutional and among them; causes were concerned." hereditary (p. 22.) In this instance we think that some local on the ner- cause, operating vous functions of the is to be much more influential individual, likely than vice of as such causes conformation, hereditary especially may to abound in islands In be conceived of volcanic origin. general, readily the with which we set out?that all con- however, admitting premises of structure tend to become and that genital peculiarities hereditary, morbid are connected with of intimate many dispositions peculiarities must have structure?it becomes evident that hereditary predisposition influence in the of endemic since the ex- diseases, great perpetuation trinsic causes which first a of structure must impress peculiarity operate on each successive with the increased force derived from generation transmitted susceptibility. As of Dr. Holland considers it established facts, general expression of that or texture of the is from the chance no organ body exempt * Dr. Holland's Medical Notes and 1839.] Reflections. the of in other is disease,?or, words, being subject hereditary every part of deviations the or from normal natural structure, susceptible type capa- ble of to and of morbid actions, being conveyed offspring, producing which are under the name of successive thus, disease, through propagated generations." (pp. 22-3.) A of this law is that which has been called atavism; singular variety where an or in a is lost in one disease, anomaly existing family, genera- and in the Dr. Holland remarks that in tion, reappears following. this, some on of and cites an instance known cases, sex, may depend change to himself of in three out of four successive hydrocele occurring genera- tions in one the omission in the of a in female, family, being person whose son the disease He well observes that there (p. 20.) reappeared, be in which the structure affected cases, may analogous by hereditary disease is such as to be or other casualties in disguised superseded by the conformation of the individual. There are numerous instances, bodily where sex and all other obvious circumstances the however, being same, the disease is in one of or or more individuals a anomaly missing family series and recurs in their children. It is with external as the lineaments with the of internal and we often find some peculiarities structure, feature of face or form lost in one individual of a strongly-marked family and restored in his is at fault in the solu- offspring. Physiology entirely tion of such Dr. all concur to but, Holland, says they phenomena; establish an of and a relation which unity plan general among them, makes the resemblance of an external feature the of simple exponent other in which the most severe diseases are from cases, conveyed parent to offspring." (p. 23.) in the transmission of Another circumstance disease is inexplicable that where several children of a are affected in common with some family of which no indication has in either of the malady appeared parents. An our has occurred to roe in one of three author," example," says lately family, sons and a one of whom underwent an attack of before daughter, every hemiplegia, the of neither father nor mother had been affected. I age forty-five, though similarly find another in where three brothers suffered instance my notes, severally hemiplegia, and about the same of without record of the like event in the life, period any family. I have seen a fatal case of cerebral with in a disease, fits, recently epileptic young with of two sisters of whom had died about the same similar age, lady twenty-four, neither had been to such disorder. I am symptoms, though parent subject acquainted affections of with a in which four children have died from the family during infancy without like instances in the on either side. In another brain, any family family, without similar disease in the or four had three children fits. any parents, epileptic I have notes of several similar instances: as I but not think, chiefly, exclusively, disorders of the and nervous I have known three cases of diabetes brain system. in of them fatal in mellitus under ten of in the same one brothers, years age, family; result. In another four cases of ascertained disease of the all fatal instance, heart, about in the and sisters of one the same of occurred to notice brothers life, period my without as for as I could of the been the learn, having family, any suspicion, parents of this disease. a another instance is known to me, subjects By singular coincidence, and other dis- where four brothers between and of ossification died, sixty sixty-five, ease of the heart: but here there to have been cases of the same kind in appear prior the In the the instance of the deaf and referred to, family. dumb, already examples are out of a and curious of several children thus affected (five family frequent being of four from a of without similar defect in the eight, family seven), existing parents. At there were the school for the deaf and in in dumb, Manchester, 1837, forty-eight 488 Dr. Holland's Medical Notes and Reflections. [Oct. in children taken from seventeen the total number of children these families families, and an of three such cases in therefore, each being 106; giving, average nearly family. Out of these instances there but one in which the defect was known to exist appears and we consider this as one of most in either the may rightly, therefore, parent; of the fact under consideration." striking examples (pp. 24-5.) The remainder of this is with of essay occupied great interest, points but difficult solution. Such is the into those diseases which enquiry very to on the formation of morbid and the appear depend mainly products, which involves the of how far the to the pathology question tendency of such resides in a formation of the solid products peculiar organization and how far in a taint of the blood. In reference to this parts, question allusion is made to the of is more commented subject gout?which largely on in a of scrofula the of ; ; subsequent essay?that pellagra Lombardy and other affections. the disorders of the brain and Among hereditary holds the most author nervous Our system, insanity conspicuous place. not dilate on the but in note we trans- does a which subject, suggests, a notion of attention. cribe, highly worthy Here as so often we are called to note the close relation of again, before, upon morbid to more in the to laws; and, case, particular phenomena general present laws which determine the varieties of character in and of those nations communities men. deviations in such as come under the character of excess, Hereditary insanity, or limited the of common are corrected Those variations from the by usages society. we this term to mind as well as which are not so controlled, (if may apply body), type of in the and in combination with other causes, may, infancy any community, become the basis of those more traits which we as the character permanent designate of a Such diversities as and in cases people. existing, they actually do, being many within human must from this source. be derived in some record, perpetuated part Or if we could it otherwise as to it must at least be admitted that this suppose origin, in cause is concerned their races of men." among perpetuation (p. 32.) Dr. Holland concludes to what extent the of by enquiring changes or other material causes of disease continue organization, hereditary may their successive and what are the limita- progress through generations, tions to such In of the solution these he changes? attempting questions avails himself of the afforded again happily analogies by philosophical and as most that the varieties anatomy; admitting, probable, throughout of and anomalies there are fixed which the laws, organization by per- of each is manence so in the less obvious secured, likewise, species changes structure or condition on which of the tendencies to disease hereditary there is a certain to which the of the modi- point, depend, up repetition circumstances tends to and confirm the but variation; augment fying which are restrained the more laws of beyond they by general organiza- and the of the which define their extent tion, original type species, in different of the but still with an structure, differently, perhaps, parts eventual and certain limit to all." We have dwelt at considerable on this on account both length essay, of the and of the and the able manner importance novelty subject, very its outline has been in which traced Dr. who that Holland, by remarks, it in its whole extent is a a work desideratum. Such a embracing yet work would a rich and field of but he who open very research; profitable would it must be a man of no for he must endowments; explore ordinary a of be at once the first and an ob- physiologist magnitude, experienced, and learned serving, physician. Notes Dr. Holland's Medical and 489 1839.] Reflections. iii. is on in Affections of the Brain." It to Bleeding appears Chap. of us that a error has obtained in the general reasoning pathologists very of the brain. like other with to the of disease This, respect symptoms has its own individual of texture and modes of nutri- organs, properties which are liable to various unlike other tion, perversions but, any organ of the its influence is so diffused over the frame, except heart, every part to universal function. the error that it be said exercise an Now, may we refer that the effects of function of the to is of confounding deranged brain on the entire with the of some lesion organism, particular symptoms of cerebral of the brain in such itself; whereas, reality, derangement with the all its extensive function, may consequences throughout system, from the most conditions of the arise, brain,?condi- opposite pathological tions which in in the functions of the agree nothing except disturbing effects on centre of animal but hence life, great producing analogous functions. For we find a various remote and dependent example, insensible and of with dilated patient voluntary motion, pupils, deprived the stertorous and and we these are convulsions; breathing, say symp- are not in- toms of of the brain. But so; merely compression they they dicate the lesion or of certain functions of the which brain, suspension and the arise from various of which is one causes, compression may of these circumstance that the most is, compression perhaps, frequent no connect the alluded to in a more does means causes, by symptoms of relation to this than to of the other causes any capable pro- necessary the similar of the cerebral functions. Viewing ducing derangement much if it would be to state the matter in this we doubt light, possible characteristic of one condition of the brain, symptoms any pathological of other acute in as in inflammation which, except inflammation, organs, is the febrile excitement of the nature of the morbid action indicated by the and its seat the local system, by pain. reason that If the remarks be it is not without foregoing just, a still too Dr. Holland is not asks, depletion by bleeding practice and indiscriminate in affections of the and in brain, especially general instances which the different forms of He adduces various paralysis?" and that show that this must be answered in the affirmative, question various states of diminished cerebral which symptoms power produce the delirium lead to the destructive use of the lancet. Such are might the and of the acute and of fever; head, general typhoid throbbing pain excitement of the on the ver- hemorrhage system, consequent profuse of delirium and delirium from starvation?the tigo arising phenomena infantile in which of cerebral the cases of disease tremens; symptoms of A. excitement follow excessive and the Sir ;* experiments depletion vertebral in which it was found that the of the two Cooper, tying of as well as arteries on various spasmodic brought species paralytic affection. than The of the brain in children seems more obscure and intricate pathology yet simulate those of in the for not do the of cerebral exhaustion adult; only symptoms in children is but the state of real and active inflammation excitement, very young often to our own dilated masked. observation, coma, strangely According profound of the and sometimes from the commencement attack, convulsions, coexist, pupils, on the with febrile excitement of the and this in cases where, dissection, high ; system of acute inflammation alone are without cause of appearances visible, any compres- sion.?Rev. 490 Dr. Holland's Medical Notes and Reflections. [Oct. Some remarks follow on several of the common to judicious symptoms different and states of the brain as ; coma, opposite vertigo, lightheaded- the of of the and ness, the headach, degree contractility pupil, suscepti- of the retina. bility The observations on the treatment of are with following replete palsy and the cautions as the author practical wisdom; they suggest, though, familiar to are in in view. admits, not, many, general, sufficiently kept Even were the to seizures as lessened tendency paralytic generally by bleeding as common could it does not thence follow that abstraction of blood practice imply, from the brain should be needful in or desirable immediate to such attack. sequel In cases it is otherwise. The when on many undoubtedly paralysis, depending with extravasation of blood or or on other cause of continued apoplexy, serum, come on and admit of relief in its may pressure, by degrees, progress by emptying the of vessels the head. But often it occurs as an instant shock to a of the portion brain or without of or extravasation obvious cause of spinal marrow, any proof shock itself of it leaves pressure;?the being momentary duration, though lasting effects on of the nervous In thereon these and parts cases, system depending. they are the causes of the are little known to us. There are frequent, physical change reasons for that the nervous substance itself is often affected. supposing primarily We have no sufficient of mere from of vessels fulness certainly pressure being proof to warrant after the stroke of has concerned, large bleeding, especially palsy actually occurred. The of coma and these seizures is not alone degree attending following sufficient cause for the and will subside without where the practice; usually it, attack is not such as to life. original endanger indeed to the of the event common reason would Looking magnitude between, doubt whether the same treatment can be desirable suggest immediately before, and after a stroke of I do not mean to this the of an palsy. give weight argument. From the nature of the it is difficult to circumstances, extremely bring unequivocal on the but there is to believe that the of much cause subject; bleeding proof practice in the latter case is often The I will be risk, believe, injuriously pursued. generally less from a certain observe the effect of what has occurred waiting time,?to upon the the and the from circulation, breathing, sensibility,?than hastily taking away at the moment of a shock to the and before we can blood, brain, great rightly appre- ciate its This effect the functions of life us in fact consequences. upon greater gives the best information we can have in of further But this we forfeit guidance practice. in the makes in and disturbance the great part, by any large depletion system, parti- in the which these functions The cularly organs upon depend. practical importance of this consideration be understood. may readily Even where evidence is obtained of the fitness of soon after one bleeding para- for as the of the still remains to the manner lytic attack, another, prevention question of at or smaller this,?whether by copious depletion once, by bleedings, repeated as observation And this the while for may suggest. question practitioner, prepared boldness in all fit and bound before is to him; urgent cases, always keep seeing that excess in the on the mischief it is especially any great remedy may hurry very to I believe that in method is to be most cases the latter sought prevent. preferred. It accords better with the state of our of these involves no disorders; knowledge irretrievable and in most to its affords the information decide step; requisite progress how far it should be carried into effect. cases there are of Paralytic presumably such that a few of at intervals will ward off ounces blood taken nature, regular away recurrence of the which and sudden would attack, any large depletion probably on. I The here can seldom be but the is one hurry proof explicit; presumption have often been led to entertain." 44-6.) (pp. Sudorific There is reason to believe iv. is on Medicines." Chapter that what called involves two distinct oae is perspiration processes, in exhalation from the and therefore surface, purely consisting simple Dr. Holland's Medical Notes and 491 1839.] Reflections. which is in its the other in a vital of secretion, nature, physical process therefore states of the circulation and nervous influenced the various by functions. The latter is the of view in which it can be only point The with reference to the of medicines. regarded operation general the relief which of our author's observations is to show that tendency natural in diseases is not necessarily accompanies diaphoresis many on such and that the sweat with as much dependent evacuation, may, of be as the of an altered state the probability, regarded merely sign the on which the He instances system improvement depends. supposed critical in adverts to the familiar which occur and fever, perspirations that remission or intermission takes with accom- fact, place, frequently or no actual alterations of the state of the but with little skin, panying Even in the of the hot simple perspiration succeeding stage. paroxysm which seems to the instance most favorable to the idea of afford ague, a critical the is sometimes absent, diaphoresis, sweating stage entirely and it. We are convinced from the febrile off without paroxysm goes our own in which has not been that there this small, disease, experience is no relation of cause and effect between the three stages necessary We have which constitute the of ordinary paroxysm ague. occasionally seen the and have much more the cold without the hot or sweating, stage observed the subsidence of the hot without gradual stage any frequently entertained marked We are that the notion perspiration. persuaded by the different of and of a fixed relation between Cullen, others, stages is erroneous and we how is it ; indeed, ague ask, possible entirely may, that such relation should unless the cutaneous circulation bore, any exist, in the other functions ? Of two the same relation to individual, every men in one will run a mile without while another health, sweating, perfect of that will be drenched with before he has run a third perspiration part the movements of the circulation affect the distance. natural If, then, can it functions of the skin so in different be individuals, differently more uniform ? that the effects of its morbid excitement will be expected occurrence of Our author alludes also to the spontaneous frequent of without and sometimes with relief, aggravation perspiration any disorder: in continued Proofs of this be drawn from common fevers, may experience acute and various other diseases attended with where fever, pneumonia, rheumatism, doubtful benefit or even or often with occurs, profuse long-continued sweating manifest to the The in hectic fever, though disadvantage patient. perspirations several of the distress of the the marking remission, augment patient, periods yet the more and increase his weakness. In the fever the influenzas, attending epidemic state of the skin is that of a not general clammy manifestly producing perspiration, in where it remission of the Even the exanthematous fevers, might any symptoms. more be inferred from the that would be eruptive symptoms diaphoresis uniformly of where natural and a cases beneficial, treatment, constantly happen legitimate object to force it out is attended with no obvious and where the sweating good; attempt medicines or other means is to the by distinctly injurious patient. in illustration of the same other instances will more or less occur, Many directly in those termed and where there is bilious, accumulation, point, complaints usually or disordered in break out of the change secretion, digestive organs, perspirations in various often and without relief to the The same happens copiously, any system. between disorders of the an effect of the intimate this alimentary canal; sympathy A to is internal membrane and the surface of the tendency perspiration great body. all causes even the of in as indeed of which, consequence purging any excess; 492 Dr. Holland's Medical Notes and Reflections. [Oct. without tend to debilitate the These less determinate fever, instances, body. though than those of and determinate illustrate the same view. If fever, general simple yet be as an index of the of rather than as the perspiration regarded change symptoms, cause of such it be to occur in where it does not cases, change, may expected many favorable and where in fact none takes indicate such any alteration, place." 54-5.) (pp. that there must and Dr. Holland remarks be at least two, possibly under which takes the one con- more : conditions, perspiration place in relaxation of the cutaneous the other in vessels, sisting simple of the same the fluid is vessels, augmented activity whereby forcibly thrown out.* The the reverse of that which obtains former, being during of indicates an entire remission febrile the hot of the fever, state, stage while the latter is attended with little diminution of it. He that consideration is due both to the and admits, also, quantity of the as the blood of or matter, quality perspired ridding superfluous which derives noxious a view increased from. ingredients, importance those show that a function to researches which analogous respiration is carried on the and that the of carbon eliminated skin, by quantity from the blood be increased this channel. considerably through may The influence of in animal presumed perspiration reducing temperature must also be taken into as our author the account; but, observes, heat continuance of morbid excessive frequent during perspiration proves that there is relation between the two which can be of no symptoms any value in On the Dr. Holland the use of great whole, regards practice. as less determined method or reasonable than diaphoretics by experience down that of other evacuant and the as remedies, lays following positions established sufficient evidence by as well as beneficial in that it is more to have First, reasonable, regard practice, to the in the circulation than to the action of changes producing diaphoresis sweating amount of is a itself. that the measure of And, secondly, perspiration rarely just the obtained and that to make this a is to a good ; primary object likely give wrong and bias to the treatment of disease.'' 62.) injurious (p. v. is on the Effects of Mental Attention on Bodily Organs." Chapter This is an on a curious Dr. Holland ingenious essay very subject. while the will on the commences that influence of the by observing, and of the of the mind on other of the muscles, voluntary passions parts have been little notice has been taken of the studied, economy, long effects of consciousness directed a effort to by voluntary particular parts the of the This concentration of attention on one body. any part may, of he be exercised as a mental act, without the says, suggestion previous sensation. it be termed a function will directed towards the it of the Though may body, indeed no effect on the muscular structure as such. Where the attention produces external it is but another name for sensation is excited itself; by impressions, perhaps but we need a different term for that act which the consciousness re- by voluntary it a local retained for a time in this state. as and is effort ceives, were, direction, by that the of medicines act the Presuming greater part diaphoretic by relaxing we have a instance of the distinct nature of the two modes of cutaneous vessels, good the horse. In this animal is excited in exercise; perspiration perspiration easily by will a that the force of the but no medicine is, circulation, produce by increasing who effect. We have met with human subjects perspired very diaphoretic frequently little effect.?Rev. exercise or but on whom sudorific medicines had heat, readily by Dr. Holland's Medical Notes and 493 1839.] Reflections. It is this I which do not find to have been the made; enquiry explicitly though of the and of the to well as the effects, familiarity language them,?as applied specu- lations vital a common to of be regarding principle, physiologists every age,?may said to have in all the in implied reality points question." (p. 64.) The has been but the not, indeed, subject sufficiently investigated, truth was mind of John to the who general Hunter, distinctly present made also an of it to animal similar to that which magnetism application we shall find noticed Dr. Holland. presently by In Mr. Parkinson's Hunterian find the Reminiscences we following words of this who had to himself consented great physiologist, subject to animal : magnetism I feared lest for the event should on and that my anxiety bring my spasm, should be to animal but that if was magnetism; considering any person imputed affected it must be the worked attention to the by it, by imagination being up by be and I could I went: to counteract affected, thinking this, and, part expected when I arrived at the I was the that convinced, accordingly, place, by apparatus, was calculated to affect the When the everything imagination. magnetiser began his and informed me that I should feel it first at the roots of the nails of operations that hand nearest the I fixed attention on where I was toe, apparatus, my my great to have a fit of the and am confident that I can attention to my wishing gout; fix until T a sensation in that Whenever I found any part, feel part. myself attending to his I fell to work with it which means tricks, toe, working about, &c., my great by I its effect on me." prevented having any (Hunter.) on such are the materials for observation Although points very inasmuch as man carries about a store of them in his abundant, every own there are two causes which render it difficult to person, extremely to the is arrive at certain conclusions with them : one the any respect of on definite nomenclature of the sensations; impossibility fixing any other is the different relations which subsist in different individuals and the functions of between the nervous at system large particular we believe that the which Dr. Holland seeks to Still organs. principle establish has a firm foundation in truth that continued atten- namely, of conscious- or in more the continued direction tion, precise language, has a not of their to ness, altering sensations, particular parts, power only but of their functions in a or less He adduces affecting greater degree. actions be excited a of in which sensations or by variety examples may of attention to the Thus the direction organs. cough- simple yawning, and are excited in this manner. The ing, sneezing, occasionally organs are to the same influence : of articulation and deglutition variously subject who stammers will stammer more than usual if he wishes par- person to and the act of is rendered ticularly speak plain, swallowing always on it. A similar direction of conscious- difficult the attention by fixing the of the stomach causes a of ness to feeling weight, oppression, region seems to or other when the stomach is uneasiness; and, full, greatly The action of the lower bowels is often excited interfere with digestion. is attention to and a desire to the bladder them, empty readily by manner. The last-mentioned is occasioned in the same phenomenon of in nervous if see the common persons, who, they prospect very highly an of confined for some of time without being length opportunity will be seized all of a sudden with a inclination to strong empty retiring, the often and we as a curious that the bladder; fact, notice, kidneys may 494 Dr. Holland's Medical Notes and Reflections. [Oct. of the thus with the bladder induced, sympathize irritability artificially and of urine in a short secrete a time. large quantity very The stimulated attention to of the has in which this particular body power parts not the sensations derived from but also more or less their them, altering, only in other functional be instanced The for state, many ways. glands, may salivary are thus altered in their be secretions; example, manifestly organs,it may remarked, affected all In of mental emotions. the being instantly by singularly susceptible the sensation created attention to them arise almost into gums, by given may pain. in The in the like are and well marked. Or feelings produced tongue way peculiar a or even of a be taken for and a limb, single limb, portion may experiment; sense of and even to be weight restlessness, peculiar approaching cramp, produced the attention it. Here the muscular texture be by urging upon may expressly to be and with much akin to those affected; presumed chiefly feelings generally from or causes. Sensations of other heat or arising fatigue, stagnant circulation, or other more on the surface of the be cold, vague feelings, body, may readily in similar In that state of of which created skin, however general way. produced, is the the attention directed will itching symptom, upon any particular part, very often this sensation to it. Such cases as where it is difficult these, bring immediately to more than a or increase of sensation from the under this in- change parts prove in But that some real alteration is made in fluence, may appear ambiguous proof. or from as either their nervous or is them, state, circulation, both, respects probable the more distinct evidence of this in other from the same cause of excite- instances, ment." (pp. 67-8.) "All of this are and notice in their parts subject curious, deserving especial relation to the of disease. The case of the I have symptoms dyspeptic already mentioned. akin to this is the disorder of some of the the Closely hypochondriac; most of which admit of the same Here the singular perversions explanation. patient, in his with morbid intentness creates not consciousness on certain fixing organs, disordered but often also disordered actions in them. There sensations, merely may and be of the hurried or choked flatulence other heart, palpitation respiration, distress of irritation of the all from this morbid direction stomach, bladder; arising of attention to the in It is certain that of the secretions are organs question. many affected emotions of and the case to be the same immediately by mind; appears from anxious and sustained attention to the concerned in these functions. parts In and nervous actions other diseases where disordered chorea, occur, hysteria, the same is more or less but without distinct inter- concerned; principle equally of as in cited. Yet vention consciousness and the most of the instauces will, already in the instances are of attacks on the mere hysteria, frequent brought by expectation of or or even a sort morbid solicitation them; imitation; by occasionally by of of the to these actions. Of the latter fact medical furnishes organs experience singular In diseases of this such results are connected with class, extraordinary examples. those sensorium the more as disorder of the recognized upon commonly produced by animal and vital organs." (pp. 69-70.) The does some of the results of animal author not hesitate to ascribe to the effects in different concentration of magnetism induced, parts, by the attention and he that when the head or them; remarks, upon in are the so praecordia parts influenced, especially hysterical subjects, result. The and may very singular, apparently mysterious phenomena fact the words we have in italics in the fore- which expressed by placed is Dr. Holland as an going extract, regarded affording explanation by state. To of some of the more incidents of the singular alleged magnetic of the cases we have this we assent. In a entirely large proportion were in the however, witnessed, others, patients manifestly impostors; the to be those of real determined as to phenomena appeared hysteria, their character and an and locality by eager expectation particular Dr. Holland's Medical Notes and 495 1839.] Reflections. desire of their occurrence. It be added when have may that, they once taken habit must exert a influence in their place, powerful reproduction. How it comes to that the direction of consciousness to a can pass part thus create sensations and is one of the most modify organic functions, difficult in As Dr. Holland there are observes, problems physiology. several reasons which render it certain that some nervous function nearly is concerned in the of these results. This production being conceded, the what class of nerves are such actions carried arises, question through on? Those of motion our can be voluntary (says author,) scarcely because motion is no of the and the influence admitted, part effect, extends to over which we have little or no on parts voluntary power: the other if we resort to the nerves of we must hand, sensation, recog- nize two modes of action in directions the course of the opposite along same but of this we have no nerve, proof. We with our that we no means of the author, agree possess solving if we venture an we on should ; but, difficulty might hypothesis, suggest as that a sensation of the kind alluded referred to a to, possible though does not in that but in an particular part, originate part, is, reality, in a internal sensation the sensorium from arising exclusively repetition of that former sensations external action causes whereby produced by have been Of the of such a case we have perceived. reality ample proof in the sensations which are referred to the of a limb months extremity after has been and with the most minute it amputated, frequently reference to certain of as a or a toe. With to the it, finger respect parts under we should be on this consideration, inclined, changes of function them to the of the nerves influenced to refer hypothesis, agency organic the continuance of the cerebral actions above nor mentioned; by long do we see in this because there is little anything unlikely supposition, its functions be doubt that the distinct and though ganglionic system, is much under the influence of the brain. We have peculiar, very noticed this at considerable because the of it has chapter length, subject in the of nervous relation to obscure diseases^ many points pathology and a direct some remarkable has moreover bearing upon phenomena which have attracted much and rise to no small attention, lately given These now exhibition of and folly credulity. phenomena, heterogeneously under the name of animal will in associated magnetism, probably lead, of a new and the hands of sober to the enquirers, discovery important have no truth in tract of Pseudo-sciences, though physiology. they have some truth under them. them, generally where a Patient for himself.'' vi. is on Points may judge Chapter sound as to the licence to be conceded to It contains some precepts with to their own choice of diet, temperature, posture, patients respect or the fitness of and confinement to bed otherwise, particular remedies, of medicines. of or the use and the discontinuing propriety protracting the often On all these Dr. Holland believes that may points practitioner the of the natural and derive from patient's feelings knowledge expression is as needful to and concludes that a discreet forbearance instincts, and the best rule is not to be the as firmness, implicitly physician of to a maxim essential in all cases to the subservient rule, right practice which are ever in the arising medicine, seeing many contingencies 496 Dri Holland's Medical Notes and Rpflections. [Oct. contradiction to its soundest methods aud We precepts." strongly recommend this to the attention of routine practitioners, chapter affords convinced as we are that the of the advice it would adoption that the what in prevent very frequently happens, namely, patient, addition to of the runs some risk of the bored to disease, being perils death the doctor. by In viii. on the Abuse of will be found Medicines," chapter Purgative on some animadversions the too of constant just prevalent practice giving and on without reference to the evacuations, purgatives, insisting daily natural constitution of the individual. The author remarks that a certain of distension of the intestine is essential to its degree large and that the continual use of state, cathartics, healthy by preventing and a and distension this, air, substituting partial unequal by produces and the natural actions. irritation, impedes peristaltic He the habitual of this class of reprobates particularly employment medicines in cases of of the bowels from arising torpor debility. "The cannot or its the colon, contents, perchance, readily quickly though propel of earlier are well and To this it is digestion easily defect, stages performed. remedy the constant use of which fret the stomach and goaded by cathartics, injuriously long tract of bowels which have to before this The through they pass reaching part. habitual irritation of the membrane its mucous alters and secretions depraves the whole course of the a further canal, throughout alimentary becoming thereby source of mischief and to the These disordered secretions are too suffering patient. often in of the need of further error sometimes urged proof evacuation, (an arising from sometimes from a and thus the inexperience, graver source;) practice proceeds, in a vicious circle of from which the is extricated without more habit, patient rarely or less of to his future health." injury (pp. 99-100.) Dr. Holland if we seek in such cases that to obviate the evil observes, means which act we shall increase it: irritation, the through only by is to combine tonics with laxatives. There are he cases, proper plan if in there be no irritation of the mucous which, says, (inflammation?) bark will is often actas a laxative. The observation membrane, perfectly correct. The author has several remarks on the use as well as abuse good of Where this class of remedies is he advocates purgatives. indicated, the exhibition of full with intervals in doses, proper between, preference to the more of smaller those cases frequent repetition doses, excepting where the vital is too feeble to encounter sudden power any change without risk. We believe the to be The precept practically good. observation on the treatment of obstruction of the bowels is following most and well of attention: just worthy I do not mean that should not be in cases of obstructed purgatives given bowels; I wish to the 1 but as the too uniform direction convey caution, think, required, by of in these viz. that if there be distinct local instances; practice pain, threatening in of inflammation the or much active with nausea and canal, irritation, any part and if the first cathartic fail of vomiting, medicines, freely given, success,?it well to behoves the consider whether he shall this treatment further. physician urge There are doubtless cases where it is to do but others where the expedient so; many irritation of drastic hurries on the to or fatal and result; purgatives patient danger not where abstinence from and this is food unfrequently, quiet; equally medicine; leeches and fomentations over tender of the or still in some abdomen; better, parts leeches to the hemorrhoidal would and have removed cases, vessels, obstructions, relieved the complaint." (pp. 104-5.) Du. Holland's Medical Notes and 497 1839.] Reflections. We are convinced that cases of fatal enteritis quite many originate in a to that here recommended. entirely practice opposite Dr. Holland with that the abstraction of blood from the observes, truth, hemorrhoidal veins is too much in this It neglected, especially country. in the form of in which a sufficient is, fact, only general bloodletting reason can be for blood from one vessel rather than given drawing inasmuch insulated as the is in some from another, portal degree system the and in the is more concerned func- circulation, general immediately tions of the viscera. The immense relief which chylopoietic every prac- titioner must have witnessed from a free hemorrhoidal in discharge various diseases of the indicates one of those abdomen, instances, clearly too in which intention be few, unhappily therapeutical may directly founded on a natural remedial We that the think, however, process. of natural as it be is not called, study therapeutics, may sufficiently and that careful observation and cultivated, experiment might multiply such instances to a extent than is believed. greater generally ix. is on Methods of It contains some Chapter Prescription." judi- cious remarks of a nature: we and these, however, over, general pass to notice the of Gout and the use of proceed important subjects with which x. is Colchicum," chapter occupied. The author in the as either assumes, limine, following postulates or to be ascertained : strongly presumed to 1. That there is some of because it is organization gout, part bodily disposing an disorder. 2. That there is a materies whatever its morbi, nature, hereditary capable of within the of of accumulation in the removal change body,?and system,?of place from it. 3. That be not hitherto there is a re- though identity proved, presumable and the matter of lation between the lithic or its and a acid, gout; compounds, connexion this with other forms of the calculous diathesis. 4. That the accu- through to be in the and its mulation of this matter of the disease be may presumed blood; retrocession or of when to be effected the same change place, occurring, through 5. That an of so consists or tends to the medium. attack gout, called, in, produce, removal of this matter from the either in the affected circulation; by deposits parts ; or in other less obvious the train of actions the excretions some ; way, through by is the of the disorder. 6. That there intimate relation between forming paroxysm the condition of and the functions of the and both in liver, gouty habit, kidneys or which in health and disease. 7. And that the same state of habit, predisposition, some the outward attack of does in and others, persons produces gout, particularly internal and of the in itself disorders of females, testify solely parts, especially by digestive organs." (pp. 116-7.) of The second of these a material cause principles, regarding gout in the and eliminated from it the fit or in circulating system, by gouty other has been as it is authorities; but, disputed by high acquiesced ways, the facts and furnished in is all analogies by many, supported by by and affords a readier solution of the difficulties of the recent enquiry, makes than other that has been Dr. Holland it any proposed, subject his the basis of reasoning. to the Under this less is attached than view, formerly importance as one of actual of since it comes to be paroxysm gout, regarded only of within the the a series ; though, perhaps, changes taking place system of the most characteristic and in its obvious effect relieving interesting causes of the constitution for the time from the malady." Admitting arises a morbific matter as the efficient cause of the gout, question Holland's Notes and 498 Dr. Medical Reflections. [Oct. whether the to this disease consist in a tendency disposition hereditary to form or accumulate such matter secretion or retention within the by in of texture in the solid or some system, peculiarity parts, rendering of a and the them liable to inflammation kind, occasioning specific of the matter when in the from abounding system deposition peculiar other causes ? The former of these is Dr. Holland, opinions espoused by as more who affirms that we have no reason to regard hereditary gout a to a certain morbid matter within the than disposition generate in effect of certain circumstances of structure either its favouring body, formation or that excretion of it from the which is preventing system essential to a in other as an state; words, healthy or, gout hereditary either in the disease some transmitted may depend upon peculiarities of or in which certain are those assimilation, organs by parts separated from the mass of the blood." We cannot that we are inclined to so humoral a pa- say exclusively of as our as we do the author, because, thology gout admitting fully the relations between this of a morbific matter in the blood, presence with the materials of life are so fluid and the textures which it supplies that we cannot conceive a morbid of the blood to be intimate, peculiarity from to without as a neces- transmitted generation generation, inducing, of minute in all the textures. consequence, organization sary peculiarities that circum- on the other it is conceivable other Yet, hand, perfectly the of the solids as to render them stances so influence may organization less of influence from the morbific cause resident in more or susceptible the blood. We that a combination of the think, therefore, suppositions of stated Dr. Holland affords a better solution of the phenomena gout by than either of them taken and of those to separately, especially relating in families. the of certain individuals exemption gouty the constitute the Dr. Holland believes that which peculiarities gouty diathesis in the individual of be independently any may generated taint. We would extend this admission to all diseases hereditary communicable from one individual to whether another, by consanguinity, who this seem to or other means. Those forget contagion, any deny that have in the of some one or disease must every originated person or it could not now and if we must either admit that exist; so, other, the disease have a new in other individual cir- origin any similarly may in circum- cumstanced with the or that the first was first, placed physical be a stances in which no human could ever again, being placed highly not absurd With to the actual to respect improbable, say supposition. nature of the morbid matter of Dr. Holland thinks gout, It is that the if will show it to a matter alien be,?not probable discovery, made, either from to the and morbid in rather the kind,?but excess, super- system, wholly formation or undue in the of some a certain abundant retention blood, material, the health of the amount of which is or even with, to, incompatible necessary body. view be modified in in the Or this that, though generated may part, by supposing hurtful in it is as an excretion needful to be and its retention so, removed, body, only I to what at is the most or accumulation there. have alluded present already to our future on the Without antedate venturing plausible conjecture subject. the of to be either lithic or matter acid, urea, defining gout knowledge, by expressly or one of the lithic or or other azotised it is purpuric salts, any highly principle, in the blood some animal not to that there is principle impossible suppose produced and morbid either in kind or matter close kindred with excess;?a having these, by Dr. Holland's Medical Notes and 1839.] 499 Reflections. in the of which the are and the retention of concerned, separation kidneys largely which in the is the cause of various to the system disorders, according sex, age, or other of the affected." temperament, peculiarities 128-9.) persons (pp. He is of that researches in this direction are to opinion pursued likely lead to a more intimate of the disease in its active and knowledge form, also of its connexion with other local or constitutional disorders. Modern observation has led us to some of these relations under the recognize of names and bronchitis. own gouty headach, gouty ophthalmia, gouty My expe- rience would lead me to add certain forms asthma of to the number. But many more remain to be and not the least those undoubtedly determined; yet important, which subsist between and the of the brain and nerves. Reference has gout system been made to and it is that other disorders already hypochondriasis; highly probable of the same still less viewed this under will hereafter be class, connexion, generally submitted to it. The relation of to the functions and disorders of the is another gout liver, point in of much interest attested both in the active of the pathology,?clearly symptoms and those which are common under other forms of the disease, by gouty tempera- Its with ment. connexion cutaneous diseases is an additional almost topic, yet I cannot from own of unexamined; doubt, that certain these though my observation, disorders as effects of in occur the habit I have so often seen questiou. psoriasis, for in acute families,?sometimes with attacks example, prevailing gouty alternating of the sometimes sometimes to them disease, suspended them, by seeming prevent in individuals thus it is difficult not to the morbid same cause disposed,?that assign to these however its mode of action under such different forms. results, unintelligible But the as are the of the stated, kidneys, already evidently organs body, upon the disordered or deficient of action which those in the depend changes circulating which have closest relation to all the of These it fluids, phenomena gout. functions, is to at variation successive of important observe, undergo life, periods independently of actual disease. such variation serve in to the destined of By they part changes the at these this influence attested an altered state body respective being periods; by in of the secreted both the nature and of several of its fluid, proportion ingredients. That which the decline from manhood is marked period begins perfect generally if it an be so of the lithic which continues more or less excess, termed, acid, by may after itself with the and often through life;?testifying greatest safety, remedially, by habitual of this substance from the a source of large discharges kidneys; becoming and various disease where this is insufficient or inter- grave separation suddenly Much certain for the as future even the causes rupted. discovery (perhaps respects and of be affirmed to lie in this of phenomena fever) may particular path physiology. And much more of caution even from be our know- practical might drawn, present with as to interference these whether in health or in the ledge, functions, important treatment of disease." (pp. 129-130.) Some other of considerable interest are adverted to Dr. points by which lack of our He to Holland, space prevents noticing. subjoins some remarks on this the use of colchicum. And first he essay enquires, does its consist in the matter of some operation destroying gout by or in it from the affected into the specific change, withdrawing part or in it from the some of circulation, general removing system through the ? he seem to include all the modes excretory organs These, observes, in which it can be to the one of its act, supposed except improbable exclusive influence on the nervous affords system. Experience ample of the of colchicum in modification of the in disease, proof efficacy every whatsoever texture it and hence led be we are situated; may naturally to infer its action on the morbific matter diffused the throughout system: but this inference no means chemical or other by implies any change effected on the matter it is more that the itself; probable immediately 500 Dr. Medical Notes and Holland's Reflections. [Oct. medicine exerts its on some the function of which organ specific power is connected with the morbid conditions of He thinks expressly gout. that colchicum acts on than on the more other kidneys decidedly any and this of the of disease or part, independently presence any gouty On the nature of the induced it in the changes by disposition. urinary secretion he has not been able to he is convinced himself, satisfy though that its is not confined to a mere increase of but operation quantity, in the nature or of the animal involves a change proportion compounds excreted. This idea accords well with the views pathological already with the nature of the morbific and with the stated, presumed matter, of the and calculous diatheses. acknowledged affinity gouty if Such a affords some view, admitted, important practical suggestions as to the administration and as to its use as ofcolchicum, especially pre- ventive. Dr. Holland has no belief in the that this medicine ren- opinion ders the recurrence of the more This he frequent. paroxysm opinion believes to have arisen from the effects of the disease for those of mistaking of the and from the or insufficient the and latter; remedy, faulty application he such to exclusive attention attributes the too to misapplication given the external of the disease. The medicine has been used development to remove the local and discontinued when inflammation, empirically this was whereas it admits of continued use on the definite effected; of the morbific matter from the to attain principle eliminating system: to which end it should be with means sustain all the conjoined adapted in a this the best that excretions sufficient the degree; being guarantee matter is carried out of the circulation. fairly We that we cannot follow out our author's observations on this regret but we have stated above the which them: subject; principle pervades in and made an we think that it well deserves to be view, kept object animal chemist and of both the the enquiry by physician. xi. is on some Diseases of the Some good Chap. supposed Spine." remarks will here be found on a class of cases in which disordered function of the nerves is liable to be mistaken for disease spinal organic and of the These cases are most in females, spine. frequent especially those of an habit. There is no doubt that hysterical misunderstanding of their true nature and does still lead to much led, formerly frequently in the of confinement to the recumbent practice posture, injurious way local and severe all of which in the tend, depletion, counter-irritation, does not most direct to the disorder. The author manner, aggravate lay to in his view of the and we shall not enter claim any originality subject, into it further than to our satisfaction at one of the curative express measures lie exercise of the limbs enjoins, namely," sedulously persevered of that in and extended." We believe that a effect indo- frequent bodily and which obtains lence which is one of the evils of civilization, greatest in the is to exalt the functions of the female sex, sensatory particularly at the of the motor tracts of the the functions nerves cord, expense spinal of the latter enfeebled not called into action. being by being sufficiently manifold to the At all events we can from speak experience practical muscular exercise is the most truth that powerful properly regulated in cases of irritation. some remedy spinal There are several in this volume which treat of chapters respectively the Brain as a Double on Intoxication," Organ," Dreaming, Insanity, Notes and Dr. Holland's Medical 501 1839.] Reflections. on "Time as an Element in Mental on "Phre- on Functions," "Sleep," the and on the Present State of into Nervous Enquiry System." nology," that it would be These are so connected in their difficult to subjects essays them for examination. We omit all insulate one or more of particular detailed of them at because the notice first, purely physiological present: with of them will come under review on an occasion the part early along works because of the of some other authors; secondly, many topics they involve much to as to and the as medicine; practical belong psychology character of this Journal us to exclude such on obliges subjects, except occasions. We would for a moment be however, particular not, thought to a for the on abstract science as the depreciate study physician: contrary, we number of medical writers evince so that the sincerely regret greater little with and there is which we admire in more, it, nothing familiarity the of an these of Dr. than evidences afford Holland's, they essays assiduous addiction to mental philosophy. xiii. some Points in the of the Colon." is on Pathology Chap. Our author here offers the that the First, following suggestions: large than of its intestine is more an of secretion and that organ absorption, subservient to in the matter secretions are not changes merely passing but useful or in other excrementitious through it, necessary removing some as matters from the whence considerations important system: to forms of such as whether the treatment of certain diarrhoea, the diarrhoea be checked or allowed to and whether should proceed, alteration of or should be directed to the the secretions practice gradual matters. that the immediate removal of noxious morbid Secondly, many states of canal which are referred to the stomach or liver the alimentary little noticed in have their real seat in the colon?a fact but of books, endowed with which we conceive no observation can any practitioner have to the attachments of this the smallest doubt. that, owing Thirdly, of intestine and its immediate to several portion proximity important and of its distension rise changes organs, unequal frequent position give to various the nature of which is mis- affections, frequently sympathetic remarks are those understood. The most on the morbid important This has been secretions of the intestine. too however, large subject, little afford data for critical examination of Dr. to any investigated in a Holland's are advanced which, indeed, views, only very general we this as well of manner. On the whole, worthy attention, regard chapter is of and several on which there need indicative of enquiry. points of certain vii.and xiv. treat on the Connexion and Diseases," Chapters of late We notice these on the Influenzas "Epidemic years." chapters because have a common tendency. together they him to trace a Dr. Holland's observation has led concurrence singular and infantile remittent in of measles, scarlatina, fever, hooping-cough, of and he districts about the same has noted time; also, period particular of these disorders is often as a variation of this that one fact, exceedingly in certain while another is so at the same time localities, equally prevalent the familiar fact that scarlatina and in He alludes to contiguous places. have an which sometimes renders them difficult of dis- measles affinity these diseases have been and further remarks that crimination, very at which times a class of cases the course of influenzas, frequent during of a and character themselves, singular ambiguous present having many "13 VOL, VIII. NO. XVI. 502 Da. Holland's Medical Notes and Reflections. [Oct. each to of the exanthematous disorders above appearances analogous but as he to He notices the scarlatina. ten- mentioned, thinks, chiefly, and fever to assume an form in of puerperal dency erysipelas epidemic the same and the increased of both these disorders seasons, frequency the of influenza. He observes that during prevalence hooping-cough fever "are both and infantile remittent coincident with remarkably that as an without a influenza; rarely hooping-cough prevails epidemic simultaneous of those bowel affections attended with fever, prevalence in their more distinct forms obtain the name of infantile which, fever; of the and that ulcerations or and mouth, fauces, nose, eruptions lips, are at children those when face, very frequent, especially among periods disorders of the whatever be their are bowels, cause, particularly and severe. The of he has various adults, continues, prevalent dysentery relations to infantile fever in the course of the in the textures symptoms, and and in the lesions there affected, it; consequent upon perhaps may be no what are differences between the diseases with beyond compatible a common cause under different conditions. He extends this acting remark to the that the disorders of childhood men- suggestion already tioned have a virtual with certain fevers or other diseases of may identity adult the of the causes under altered circumstances. age, operation varying Is this view in an in unison with xxiv. quite opinion expressed chapter on but once in Life?" It is there "Diseases commonly occurring maintained as that the series of actions or probable changes constituting such diseases have their seat in the and are carried on blood, throughout the and that the future arises from a circulation, by insusceptibility the essence of in the state of the blood. The first change position?that these in on the blood?can be diseases consists a virus acting hardly called in but if the diseases with a new face in the reappear question; it follows that the blood in some retain its sort, adult, must, susceptibility rather led to ascribe the of the action of the and we should be virus; constitution of the solids. It is difference of its effects to an altered to on what is thrown out in the form fair, however, scarcely argue only of or insist on too exact a between ideas to which, suggestion, congruity in the state of our can at best be but defined. present knowledge, dimly are Dr. Holland observes that dysenteric symptoms generally prevalent alluded to. He has also found with the diseases of childhood along just that other bowel affections become much more on and frequent dysentery the decline of catarrhal It is doubtful whether this should epidemies. be as a translation of morbid action from the same regarded original to which the becomes or as an incidental effect cause, merely system liable from disorder: Dr. Holland inclines to the former the previous He comments on the which influenza bears supposition. finally analogy The to the milder forms of and to intermittent fever. intermittent typhus is insisted and is character of the catarrhal fever on, epidemic strongly who describes the same the of Sir Baker, supported by testimony George of fever the influenza of 1762. It will be easily type accompanying how- that Dr. Holland's aim is to establish some real relation, perceived and to them ever a number of different diseases, indefinite, among bring in the of from the con- all into with influenza, deriving apposition hope some of of the last-mentioned principles general templation epidemy and apphcation utility. Dr. Holland's Medical Notes and 1839.] Reflections. "In thus to these which have so fre- referring frequently epidemic influenzas, and of late I that no class of diseases add, quently widely prevailed years, may lays to us a field of as relates not to their own larger practical enquiry, open only nature, but also to the connexion of other with which are diseases, associated. they closely The simultaneous or successive influence a common of morbid cause over rapidly communities and countries discloses relations which in no other are large way equally accessible to research. In the a various forms which disease is showing single capable of it illustrates the nature and action of the circumstances which thus assuming, and the effect of in textures the of the modify it, especially altering particular aspect We have not drawn from this source of It is symptoms. sufficiently knowledge. that we hereafter learn from it the virtual of probable may diseases; identity many hitherto asunder distinctions which have foundation in subordinate placed by only from us what is both in most and symptoms, thereby disguising important pathology if no such be we find less Or, practice. identity proved, may evidence, scarcely state of of an endemic constitution it called or other curious, (be adynamic, by any with the same causes that the of in- which, name,) originating produce symptoms for a renders the more than usual to certain other dis- fluenza, body period prone the material causes of which are ever more or less Each mode of orders, present. is correct the in and are viewing subject probably part, they perfectly compatible with one another." (pp. 92-3.) The idea is and far be it from us to the ardour of good, damp enquiry; but the of the on influenza is sufficient to show that the chapter perusal benefits to from the of this disease special pathology study widely-spread for author's remarks as to are in our its and nature reversion; yet origin consist in a statement of with a difficulties, however, chiefly conjoined, of the course of most to lead to their judicious exposition enquiry likely the treatment solution. His as to we in are, think, precepts general sanctioned the of the best One of practitioners. them, by experience to the use of the of is founded on the relating sulphate quina, prevalence in this disease which have of an intermittent to type appears presented itself to Dr. Holland than to other and more observers, distinctly many more we than to ourselves. so, confess, in inference that be as to its from the the drawn, use, Any might tendency these intermittent is the actual effects. It disorder to actions, fully justified by as relieves when almost as and the attacks them, established, fully speedily certainly and this whatever the of the so affected. This re- of a common ague; part body over one of the conditions of the disease so far a markable gives power specific to the that it be in of a state character remedy, may rightly adopted prevention of It is not to define an exact time at which its use which it is curing. easy capable in be This must in different and different should degrees begun. vary temperaments, But it is an inference from the reasons that of the disorders. already stated, quinine in is still be and cases where there hard cough, may given safely beneficially many and confirms this conclusion. with restlessness;?and experience pain, oppression, often with these and furnish A soft feeble and moist concur skin, symptoms, pulse, for the If the as additional itself, authority practice. cough frequently happens, the of the becomes and tends to intermittent character, security remedy greater, effects more its 211.) speedy." (p. contains some brief but comments on the Method xviii. just Chapter for a full of of as to The author refers, Contagion." exposition Enquiry to a the late Dr. in the Fourth the laws of Henry contagion, paper by be found in the of the British Association. A review of it will Report Second Number of this Journal. The xix. is on the Medical Treatment of Old Age." subject Chapter in is introduced with some remarks, which, appropriate physiological 504 Dr. Holland's Medical Notes and [Oct. Reflections. the do towards the author leans more than we are to however, disposed belief that the arcana of life. laws enter into merely physical largely We think the of old afford the case in favour phenomena age strongest of an As advances laws assert a opposite opinion. age gradually physical vital in the Because the energy increasing power organism: why? which are controlled is more feeble. by they becoming progressively Death all to the domain of resigns physics. reference Some of the best observations in this have practical chapter to which our those increased common in old excretions, habitually age, author and hence as rather than morbid regards depurating processes; inculcates caution in with them. He instances interfering particularly the of mucus in the bronchial affections of old augmented discharge age, and the increased excretion of lithic acid with the urine. He notices, as in of less but still to be mind, also, occurrence, frequent worthy kept under the same of incidental to old the view, point passive hemorrhages from &c. the uterus, age: epistaxis, hematuria, bowels, hemorrhages The consideration of these carries us back into the Greek subjects era of much which we are convinced is destined to diffuse medicine, over the future annals of the science. light There is a we notice because the remark the which concerning pulse, fact to which it is too often overlooked in refers, though obvious, very or- We allude to the stroke of the caused practice. by jarring pulse which is liable affections of the so common in old and ganic heart, age, to be mistaken for an indication of This strength. applies particularly to the advanced and one treatment of disorder of life, apoplexy?a which is indeed associated with disease of the heart. It very frequently has occurred to us more than once to see a practitioner fully prepared to take but or ounces of in a case of blood, away thirty forty apoplexy, astonished ounces had been to find the sink to a thread before ten pulse withdrawn. Holland his in a that there is no Dr. belief, note, expresses structural disease of the heart which is not in important represented some manner the as felt in a vessel of the size of the radial pulse, by and doctrines an corroborated the views artery opinion strikingly by Whatever doubts of Dr. as detailed in a article. may Hope, preceding be entertained the of minute the of such discrimination, ge- possibility neral that the should be considered in two points principle, pulse always of of view?as an index to the state of the heart as well as that namely, the we of conceive, system?is, great practical importance. for the This contains both chapter good general precepts, hygeienic of old which materials and treatment suggest therapeutical age, might for a treatise on a too little attended to. complete subject classes There are several on the of of chapters application particular antimonial medicines?as and medicines. emetics, opiates, digitalis, a of author's manner of We have our treating already given specimen in our notice of the on and such diaphoretics purga- subjects chapters Those above enumerated we are to but there is tives. obliged pass by; which we must for one on the Uses of on Diluents," chapter pause yet attention to a class of remedies as a if it were to solicit moment, only British as are rendered much practitioners they unduly neglected by their our continental brethren. Dr. Holland views by opera- prominent tion under three conditions : as First, diluting principal mechanically Dr. Holland's Medical Notes and 505 1839.] Reflections. and excrementitious or noxious matters from the alimen- washing away as certain morbid conditions of the tary canal; secondly, modifying blood ; as various functions of secretion and and, thirdly, affecting those of the and skin. We recommend excretion, especially kidneys his remarks on all these heads to the of the and attention practitioner, one included under the not referrible to first, especially though strictly the of it, internal use of cold water as a local means namely, refrigera- tion. He of heat from an that the abstraction very observes, truly inflamed or irritable internal membrane is often as as the salutary quite direct use of cold to a hot and the former application skin, although dry of the remedial limited. He for obvious more is, reasons, adds, agent have seen the from cold in the of benefit enough given liquids freely acute of and with febrile, stage gastric disorders, inflammatory express reference to this of of to the recommendation point temperature, justify more to are to find so recourse it in We frequent practice." happy in of a commou and sense, good authority suggested by support practice of the us. of which our own has convinced utility experience amply xxii. is kind." on Morbid Actions of intermittent Chap. As an article in our last Number was with the consideration occupied of detail on intermittent we be excused from into fevers, may entering the this the author also are of The observations of subject chapter. directed to the theoretical of from the absence of which, it, chiefly part sufficient is of too a character to demand our atten- data, vague special tion. The extend of Dr. Holland's remarks?which general tendency to the intermittent disorders of and as well sensation motion, voluntary as to to febrile affections of the same to and refer connect, type?is some common law and morbid actions of the various periodicity, healthy of the which have a recur at intervals. to system disposition regular This is the track of but it is the most evidently right perhaps enquiry; obscure in the Not a of whole of medical science. light range ray crosses and the to its is it; exploration only encouragement attempt the that a of the on one of the en- probability glimpse truth, any part soon enable us to unveil the whole quiry, might mystery. is the term of existence so for all Why living beings, rigidly prescribed and so for different ? are yet variously species Why infancy, youth, mature and ? is the so definite in their age, senilitude, Why periods term of uterine fixed for of animal ? do gestation every Why species the catamenia does an occur in the human female? monthly Why or a return at When we can answer certain intervals? ague megrim one of these we shall most have a any questions likely unequivocally, clue to them all. It is matter of to us we are unable to afford even the most that regret Influ- consideration to a and excellent on the cursory long very chapter ence of Weather in directs his atten- Relation to Disease." The author tion to the of weather as determined the subject simply, by temperature, and electrical conditions of the hygrometric state, atmosphere, weight, of chemical in the air or the admixture of exclusively itself, change other Holland here or of animal or miasmata. Dr. gases, vegetable evinces much and but the acute observation; physical knowledge is to and treated in so that vast, subject outline, any attempt only condense this would be chapter unprofitable. 506 Dr. Carpenter on the Physiology [Oct. " " Four other on the Exercise of on Diet and chapters Respiration/' Disorders of the on the Questions Digestive Organs," present regarding Balance and and on Disturbed of Circulation Metastasis Vaccination," of we must also refrain from on. There is another Disease," commenting on the of Insect Life as a cause of which chapter Hypothesis Disease," we must content ourselves with to those of our readers recommending can said Dr. who wish to know all that be the Holland upon subject. states the in favour of the insect and of argument origin propagation and as as could be wished cholera, diseases, pestilential especially lucidly the advocate of that to our strongest hypothesis, which, however, by author no means himself convert. We must by professes acknowledge that we consider this of consideration. scarcely hypothesis worthy grave If or similar be extended the of insect cholera, migration epidemies, by these insects must be of life and in all swarms, susceptible activity and Now this would be an localities, seasons, climates, temperatures. so and so to hitherto known anomaly extraordinary, opposite everything of the conditions animal adduce such a external of that to life, suppo- sition for the solution of the as to the of question spread epidemies to us to be to solve what is difficult what appears simply attempting by is impossible. But we must now take leave of our which we do with author, many of the and instruction we have derived from acknowledgments pleasure and as his work. It is with information with and, pregnant thought; we recommend it to our readers. such, heartily
Journal
The British and Foreign Medical Review – Pubmed Central
Published: Oct 1, 1839