21 JANUARY 1843, Page 17


STRICTLY speaking, the title of this volume does not accurately indicate its character ; the work being rather a description of dis- ease than a method of curing it. The main object of Dr. M.CoastAc would appear to have been to describe the treatment of disease ; but his book is brief and general on the art of healing—full and elaborate on the nature, origin, and characteristics of disorders. In this sense, the Methodus Medendi may be considered as a useful addition to the library ; for it presents a condensed view of the opinions of the most eminent modern writers, British and Continental, especially as regards the pathology and diagnosis of disease, tested, modified, and it may be corrected, by the experience of Dr. 1%1‘Coastac. A similar plan is followed by the author with respect to remedies— as to whether such a course of treatment or such a medicine ought or ought not to be adopted ; the leading authorities pro and con being given, with the opinion of the author himself. '1 he statement that the description predominates over the prescription must not therefore be carried beyond its terms. The account of a disorder is followed by the " methodus rnedendi "; but the directions are general, chalking out the plan, but leaving its execution to the p, r- neular practitioner in the particular case. To illustrate the author's method in this branch of his subject, can scarcely be done in a mis- cellaneous journal, because of the technical shape which the direc- tions assume ; but we will approach as closely as we can, by quoting some passages from the chapter on Consumption. It will be seen that Dr. M'Coamec differs from certain modern writers, who hold that true consumption is curable—by themselves at least.


The remote or predisposing causes of phthisis are numerous; but doubtless, IS the great majority of instances, a cachexy or morbid tendency, hereditary or superinduced, subsists prior to the local change. • * • There can be no doubt, that occupation often exercises great influence ; yet the rich, who are addicted to none, are carried off in great numbers. Among accidental sources, fever, and the febrile exanthemata, display considerable influence in the predisposed. 1 am now attending a gentleman in whom fever was the ap- parent exciting cause. Mineral dusts are excessively destructive, giving rise to local irritation and taberculization in those who inhale them ; just as particles of quicksilver are said to do when this mineral is passed down the trachea of rabbits. Thus, the gt‘pe.masons of Edinburgh, the needle pointers of Worcester, the dry- grinders of Sheffield, and the flint-cleavers at Berri in France, as welt as else- where, unless they leave off in time, are destroyed at an early period. Some occupations are preservative: butchers, who live in the open air, take abun- dant though not excessive exercise, and consume rich, nutritious food, are almost all exempt from tubercles. I recollect no phthisical or even scrofulous butchers, except in the case of those who had not been brought up to or long engaged in the trade. In fact, a highly azetized food, together with the life that butches lead, almost constantly in the open air, is opposed to phthisis. Gouty people, it is well observed by Roche, do not become consumptive. Car- nivorous animals, every thing else alike, are less liable than herbivorous : the cows in Paris and other large towns, unduly confined to close stalls, are uni- versally tuberculous; just as rabbits, as Baron has shown, become so when treated in a similar manner. Whereas horses, however artificial their food, do not contract tubercle in nearly the same proportion, in consequence of their free and frequent access to the open air. The practice of keeping sitting- rooms darkened, to save furniture, is decidedly injurious. We are insuffi- ciently clothed, especially in winter ; and in place of living in the free, open air, grovel in the narrow and often sordid precincts of rooms and houses. The consequence of all this, more especially in large cities, is evident in the young. Depressing passions are destructive ; not so much, perhaps, by their direct influence, as by withdrawing attention from acts necessary to the healthy maintenance of animal life. Laennec speaks of a nunnery in Paris, the in- mates of which, with few exceptions—such was the austerity of the rule, were swept off by phthisis twice or thrice within ten years. Despondency, weariness of mind, and uncorrected sedentary pursuits, are alike injurious. The ill effects of sexual excess, of intemperance, of disease, and of the abuse of medicine, are well known. There can be no doubt, with Fotherg:11, that over-feeding, out of proportion to the expenditure or powers of digestion, is injurious ; but for once that the predisposition is created by excessive nutriment, the converse is the case in hundreds and thousands. • • • People in the South of Europe will hardly admit consumptive patients into the house : Morgagni was averse, en the score of infection, to examine their remains; but the notion is too im- probable to require serious refutation. 1 have again and again witnessed the closest contact night and day without any such result; but am free to confess, that I have more than once known the disease follow the grief, the loss of appetite, of exercise, and of rest, consequent on the unintermitting care of a beloved object. In every such case, believer, there was evident predisposition.


Neither prussic acid, nor conium, nor digitalis, nor mercury, nor tartar emetic, nor asses' milk, nor vegetables, nor beet-steaks and porter, whether ex- hibited empirically or with scientific precision, will cure consumption. But where these fail nature sometimes succeeds ; though, unfortunately, we can- not imitate the process. The only cases of recovery which Roche witnessed, were two in which cavernization, perhaps the only certain pathognomonic sign, subsisted. Yet, when recovery ensues, how can we be certain, considering what Andral justly terms the immense difficulties of the diagnosis, whether the disease was phthisis or not ? How numerous the instances which we are unable to distinguish from intercurrent pneumonia, pleuritis, or bronchitis, and in which we are only aware of the fact from the issue; while at other times, in the lungs, as elsewhere, tubercles may pursue their course of silent devastation without a sign. Boyle was of opinion that recovery on any terms was impos- sible. I witnessed three instances, in which purulent sputa, night-sweats, hectic and emaciation, were most decided. Laennec, Andral, Fournet, Hirtz, and Rogde, what from occasional cicatrization of cavities, what from cretaceous transformations of tubercles—which, as the last has shown, is more frequent than what is commonly supposed—have argued for the occasional curability of phthisis. To these rare occurrences, however, Louis attaches comparatively little importance.


In the prophylaxis we are to aim at improving the general health, and ward- ing off occasional or predisposing causes. It cannot be that Nature intends the destruction of so many in their early prime. The very mortality is presump- tive of some infraction, which being obviated, things would go on otherwise. I am myself firmly persuaded, that proper air, food, and exercise, would go fur to diminish the evil immediately, and eventually to render it comparatively in- frequent. A judicious alternation of vegetables, fruit, eggs, milk, and bread, would, I doubt not, suffice to maintain human stamina in the fullest vigour. At any rate, we find that those well supplied with animal food, and who take plenty of exercise in the open air, are exempt, or nearly so, from scrofula and phthisis. It is notorious that butchers and fishermen, their wives and children, are strong and vigorous, and that consumption is not among the diseases which shorten their career. Now, the important inference is not assuredly to make people follow these occupations, but to supply every one, from youth upwards, with abundance of nutritive food, warm clothing, and copious exercise in the open air. Butchers and fishermen, the latter particularly, often intermarry; they inhabit inferior dwellings, they are exposed to evils, griefs, and cares, in- habit a cold wet climate, and yet are exempt from consumption. A great deal has been said, and well said, on the manner of rearing children, and avoiding scrofulous nurses ; yet butchers, fishermen, and even savages, for whom able physicians draw up no hygienic rules, have offspring free from all phthisical taint. Every one of formed constitution, and children in proportion, should live at least four hours daily in the pure sweet air. Short of this, the blood is not oxygenized, nor does it undergo those other depuratory changes so opposed to the tubercular cachexy. The body should be further well covered, so that at all seasons, with moderate steady exet eise, animal warmth might be efficis ently maintained ; the surface, in a word, should be kept warm, and the circu- lation active. Exercise in-doors, though excellent in its way, is no substitute for that in the open air, where the currents play free and the sun's light flows unrestrained. Cold or tepid sponging, or immersion, is good for both adults and children, and so inures the frame to climatic influences as to neutralize their occasionally baneful effects. Houses and rooms ought to be adequately heated and ventilated; sleeping-apartments should not be unduly crowded with drawers, tables, and other lumber. Ox-beef, wether-mutton, good fowl, and fish are consumed by the rich; yet of these, with good bread, fruit, and vege- tables, there should be an abundant provision for all. Deficiency in the pabu- lum of life only increases fever, consumption, and other destructive complaints. The absurd and brutal practice of taxing the necessaries of hfe has tended, in every country, to promote disease. The octroi at the gates of Paris on wine and eatables, as Duchatelet and Dezeimeris have shown, leads to the adultera- tion of the one and the substitution of an inferior article for the other. Dis- eased cows, inferior sausages, rabbits, and even horse-flesh, are largely consumed in that great city, to the proportionate augmentation of consumption and scro- fula. The excessive duties on foreign wines, malt, tea, coffee, and sugar, lead to the substitution of ardent spirits, falsification, and intemperance without end. A sanatory police might interdict industrial occupations destructive of life. Dry grinding by band should be prohibited by law : moist, though not conferring so high a polish, answers every purpose. Stones might be cut by machinery, or otherwise kept wet. Intermarriages, though they unquestion- ably enhance the tendency, have been exaggerated as causes of consumption. The Pitcairn islanders, like every isolated community, intermarried again and again ; yet their offspring, it is said, display admirable health and vigour. Jews, so far as I know, are not peculiarly prone to phthisis. Change of climate may not cure, but will often avert consumption. Forbes does not speak fa- vourably of Penzance; indeed, there is not much use in dabbling about home, or even going to the South of France or Italy, where the disease, in fact, abounds : I would recommend North or South Africa, or New South Wales. Madeira is a delightful place; 1 have spent some weeks in it; but, as Renton and Gourley show, it is not free from the complaint. Laing, though not a medical authority, mentions that phthisis is' are in Australia. Clbt makes the

same remark with regard to Egypt. I would advise those who are anxious about their children, and who have the means, to remove at once to the Southern hemisphere. Such expedients, however, will not lessen the average mortality of pbthisis, and are quite beyond the reach of the great majority ; to whom, now and always, the best and surest safeguard will be attention to the laws of our physical nature in relation to outward influences.

The arrangement of the work is into eight classes; each class embracing some distinctive character of disease—as fevers, or complaints attacking some particular function or organ—as diseases connected with respiration or circulation. As the seventy or eighty diseases which Dr. M'CORMAC discusses are all separately presented, mere classification is a very subordinate matter, even if the place of the mass of these were not undisputable, and of some few not readily fixed.

The execution of the work may be called professionally popular. The style is clear, close, and sometimes animated ; the matter condensed ; and the manner original, with a touch of character ; whilst the necessary dryness attached to the details of morbid anatomy, and so forth, is frequently varied by striking sketches from the author's experience of the characters of climates and particular cases of disease. The too great condensation, however, occasion- ally imparts a heavy and literal air to certain passages, with a sort of curt abruptness ; and the profuse use of learned terms wears an appearance of pedantry.