22 DECEMBER 1838, Page 18

MEDICAL PEIILICATIONS.

THE gradual inpourings of the medical publishing season have brought so many books before us, that it will be convenient in noticing them to divide them into two classes,—one consisting of works that take a general view of disease. or popularly handle the disorder they treat of; the other embracing publications of a pro- fessional nature. We will this week t, ke the more 1. Practical Observations on the (muss.,. and Treatment if the CUP.

notitri s tge the Spine. By SA u I i.UIE, Surgeon. 2. A Treatise. on Neuralgia. By PocHARD ItowL.Ixo, a. Obsercatiems on the Oriental Plague,. By JOHN Bownixu. 4. On tie Surcestful Treatnwnt of Conveaptice Dis, th,..... By J. J. FrIINI VALI., 1. 3Ir. Mites Obserrutiells nn Ceercatnrcs of the Spine. The

spine or back-bone, as it is the most important, so is it the most euriuusly and carefully constructed bone in the body. Designed to sustain the head and shoulders in their upright position, and to

give to man his distinguishing characteristic the al sublime, it possesses considerable strength. Containing in itself the spinal

marrow, the slightest injury to which, as the puncture by a bodkin, will produce instant death, the bones are very thick, and besides being imbedded in muscles and cartilage, have at their back very strong pea jecting processes, which have the effect almost of a double bone. But had mere strength only been considered, man's body would have been "as stiff as a poker :" to obviate this, the spine is really formed of twenty-four bones, each articulated into the other so as to give requisite flexibility to the body—but so finely united by their fitting and the cartilaginous substance which connects thetn, that they appear (and are popularly considered) but as one bone

—and so sirmetly. that dislocation is impossible unless by fracture. In the generality of cases, these precautions fulfil their purpose to the utmost ; and disease of the spinal bone is rare, if not unknown, amongst savages, the poor, and the male sex. The corrupting influ- ences of civilization, wealth, and fashion, are, however, too much for nature ; and spinal weakness, or distortion of some kind, extensively prevails amongst females of the :middle and higher classes—Mr. HARE goes so far as to assert " that few in the middle and higher ranks of society arc entirely exempt front it." The remote cause of this extensive affliction, is the sedentary and effeminate habits of modern life, which weakening the general health, pre- dispose persons to attacks of disease : but the proximate cause of spinal distortion, is the habit of tight-lacing,—a practice as foolish as injurious, for the effort and artifice are immediately detected; and it' it were concealed, the stiffness and tenuity of the waist would be unpleasing to the true judge of beauty. Besides the injury the internal organs receive by the interference with their action, which compression produces, tight lacing directly operates to cause deformity in this way. " A very little reflection will show the reader the mode in which lateral curva- ture of the spine is generally produced. The upper parts of the stays are brought close under the arms, and being tightly girt behind, they cause excessive pressure on the scapulr or shoulder-blades; these, in their turn, press upon the ribs and spinal colunm, and by this pressure the free use of the arms is ob- structed. The various avocations of life unavoidably tend to a much greater use of the right hand and arm titan of the left ; by which means, the former are enabled to emancipate themselves, in some measure, from the unnatural and disgreeable restraint in which they are held, whilst the latter continue, compa- ratively, motionless : this is the immediate and constant cause of that elevation. of the right, and consequent depression of the kit shoulder, so common amongst females in the middle and higher classes of society. The disproportion in the size of the shoulders, which is so evident. is not occasioned by any material en- urnmeut of the right shoulder, in which little or no difference takes place ; the disparity arises from the diminution in size of the left, occasioned by the inju- rious pressure and confinement to which it has been subject. This more fre- quent use of the right hand and arm, which custom has rendered almost uni- versal, combined with the injurious effects of pressure by stays, the consequence of tight-lacing, is productive of the general prevalence of lateral deformity in young females, espcially when of delicate constitutions. By the general use if one mirth and side, as already stated; and the feeble resistance offered by the other to the confinement and pressure of stays, the left scapula is forced against the ribs, and these, in turn, against the spinal column, which is thus pushed towards the right side; and, in severe and long-continued cases, some of the vertebra, generally a part of the dorsal, are so tar displaced as to he driven under the heads of the ribs on the right side, which being bent at an acute angle, form a ridge that upon a superficial examination may easily be mistaken fur the prominence of the true spine, inure or less curved, the convex side being towards the right shoulder."

The distortion * thus produced by weak health and compression goes On increasing ; the deformity aggravating the previous ill health, and the increased ill health reacting upon the distortion, till the figure is sometimes permanently deformed, the health entirely gone, and life shortened, though its bitterness is such as to make the shortest seem too long.

The general mode of treating these distressing complaints, has been by counter-pressure, which has often increased the disorder it was designed to cure. Referring, the reader, who is interested in the subject, to 3l•. Ilaaufs popularly-written work, we may state the principles of his practice: which, though exhibiting some sur- prising cures, has nothing in it but what is perfectly intelligible and sound. R,,st seems one of the principal curative means. By rest the ti.actured limb or the wounded flesh is healed ; when the eye is inflamed. we instinctively shade it ; when the ankle is sprained, we rest it ; is the digestion impaired, we ought to give the stomach less to do ; and diseased lungs are not allowed to be used more than is needful. And rest, combined with constitutional treatment to tone the sy..tem and restore the general health as much as pos- sible, is Mr. IlisE's principle. The patient reclines upon a board of simple construction, weights imperceptibly drawing the dis- torted parts towards their natural position ; the medicines of course varying with the condition oldie patient. Taking the cases as they stand before us. they offer instances of surprising cures. But the wonder is lessened when all the circumstances are considered. The detbrmity dues not seem to have been time result ofpurely natural pre- disposition; the surgeon had the patients under his own eye— a mostly in his establishment, or in lodgings in his neighbourhood; and the treatment was ■-egidarly persisted in till the cure was effected, though it extended over many months. The sant:- system attempted on a home patient at a distance, we conceive likely to fail in many cases, because neither the constitutional treatment nor the rest would be so steadily persisted in. There., is an additional chapter on the subject of Consumption ; the most important point in which is. that Mr. llint; does nut con- ceive it SO hereditary as i. q ncrally supposed, but that it mostly originates in rimier diseases, from which the patient has not tho- roughly recer. en.:(1. The originality disorders are the inflamma- tions of infancy and ;&c. in riper years. Mr. HARE also taunts the efficacy of his IT Llining-bnard : but upon what principle it can be efficacious in consumption, we do nut perceive.

2. Dr. Ricuano RovvrAND's Treatise au Neuralgia. " Neuralgia " is a compound word, signifying nerve-ache : its most common term is the toothache—its most terrible. in popular apprehension, the tie dobireetx ; but it attacks many other parts besides the thee, and in- deed might seem to exist wherever there are sentient nerves, though happily, excepting the toothache, it is rather a rare disorder. The causes of it are seldom discoverable : for even when death has ensued, morbid symptoms frequently cannot be found in any struc- ture ; but when any cause can be traced, it is mostly of a seemingly insignificant kind. The exposure of the merest fraction of a nerve in the tooth is timmiliar to us all; a small tumour or pimple, seated on a nerve, will produce it ; and many diseases, such as disordered indigestion, it is held will cause it. The probability is, that when the nerves, or any particular nerve, is the " weak point," as Dr. DICKSON has it, trifling circumstances excite neuralgia, which would have no effect in a person differently constituted.

In cases of confirmed neuralgia, the agony is excessive, and the patient submits to, if he does not propose, any operation which will give him a chance of relief. Their termination is seldom im- mediately fatal, the frame taking years to vicar out under simple pain; but the disorder is rarely curable, ranking amongst the many opprobria medieime. Various remedies and various specifics have been cried up, and supported by cases : but, not to speak of the wonder-working powers of imagination and of nature in all nervous disorders, as well as of the temporary relief so often affimrded by new remedies, we may say of " cases " as the sceptic said of the votive names in the temple of Neptune—" Here are those who are saved, but where are those who have been drowned''"

Dr. ROWLAND'S treatise on this dreadful class of disorders, is a studied and well-arranged compilation. He gives the different opinions of the most eminent authorities upon the subject ; states

* The present slatternly mode of dressing with the shoulders bare, is pro- ducing, according to Mr. HARI:, another disfigurement- " A further deformity is taking place among the young females of the pre- sent duty, who, hi addition to their having lateral curvature, are generally be- coming round-shouldered, owing to their dress not resting, as it ought to do, upon those parts, but pressing against their 111.1111i, a little below the aeromion ; the obvious tendency of which is to bring the scapuhe forwards, to obstruct time free use of the arms, and cause an unsightly protuberance of the shoulders and upper part of the back."

the various medicines that have been prescribed with success;" treats of the different shapes in which the disorder usually appears ; throws out some suggestions as to the mode of examination, and the points to be attended to, illustrating the whole with cases of his own and other practitioners. But the book seems rather made from books than produced from observation ; and, though pains- taking and soundly orthodox, is deficient in the breadth and cer- tainty which result from original thought.

3. Dr. Bowario's Observations on Plague and Quarantines were addressed to the Medical Section at the last meeting of the Bri- tish Association ; and their object is to get a Commission appointed to investigate the character of plague, as well as the uses and re- gulations of quarantines in different countries. Cautiously pre- mising that he makes no pretensions " to any medical acquire- ments," 1)r. BOW R ING proceeds to denounce the inconveniences and loss attendant upon quarantine,—the latter estimated (but upon no data) " at millions of pounds sterling ;" and to assert that the plague is not contagious ; thence deducing the inutility of sanatory regulations at all. The pamphlet is written fluently ; and to per- sons knowing nothing of the subject and taking every thing upon trust, is probably convincing. To us. the Doctor seems one-sided and zealous, and not always sound or distinct in his arguments or views. If he does not confound together, he does not mark the difference palpably between, sanatory regulations, operating cruelly, and perhaps uselessly, to sunder natural tics in an infected city, where the air, the habits, and the constitutions of the inhabitants rAider all men more or less obnoxious to the disease—and quaran- tine regulations designed to prevent the importation of the pestilence from plague-breeding countries, into places (assumed) rarely or never to be afflicted with it unless imported. A similar remark may be extended to his views on contagion. No contagionist of autho- rity supposes plague to be Notelll propagated by contact, independent of all external causes,—as the state of the atmosphere and the country, with the mode of life of the people, and the habit of body of the individual exposed to °infection. Neither does any, that we remember, maintain that the disease will in all cases follow contact. What the contagionists contend for is, that it may be communicated to persons who but tar their contact with the infec- tious principle would have escaped. Timis hypothesis, it will be re- marked, is not opposed to the opinion that the plague may be epi- demic. or even endemic ; that atmospheric causes may render it, as it is well known to be, more virulent at certain seasons ; or that some local influences may confine its ravages within certain dis- tricts. But, whether well founded or not, there is nothing in Dr. llow K I N :'S pages that materially shakes the theory of contagionists. Ile picks up the exaggerated notions of the ignorant Levantines, and thinks that in exposing their tiellacy he is overturning the opi- nion which some of the- first medical authorities have held. lie tells us, that the inhabitants of countries where plague rages, do not act as if it were contagious; and almost immediately after, we learn that in the plague of 1s:;4-5, two hundred thousand of these non-contagionists perished in Egypt : whilst it is well known that those who are the most careful in avoiding contact, generally escape,—though this may also be owing to their greater prudence in other respects, as well as the advantagcs of better living, air, and advice.

As regards the Commissitah which the pamphlet and the British Association recommend, although it would no doubt be of use to a certain extent, we do not see that it is more called for than commissions tam many other subjects, where information and im- provement are inure easily wished than gotten. It is a sad truth, but it is a truth nevertheless, that no English practitioner of experienced ability, (much less of genius, should such a one exist.) would give up his practice and go plague-investigating in Egypt and Turkey, for a Commissioner's salary. And what could a parcel of raw, in- experienced, Whig M.D. s tell us about plague, more than is known already front the labours of time classics of the medical art ? That some foreign lazarettos are pretty well managed, and others very badly, we know from the reports of a variety of travellers; who all loudly complain of the tedium of their detention. But would time Commission be able to remedy this? If Russia or Austria, as there seems small doubt, make their quarantine subserve poli- tical purposes, would they give it up on the recommendation of a batch of English itinerants, whose views were opposed to their own medical authorities ? And, however humane it aright be to im- prove the hospitals of Turkey and Egypt, our interference upon such a subject would be somewhat irregular, even if these insti- tutions did not in a great degree take their colour from the public mind. Whatever is defective in our own lazarettos, it is the duty of Government to remedy ; and if they choose, upon inquiry, (which will, however, only illustrate the adage that " doctors differ,") to risk the relaxation of quarantine, let them do it. But to expect that a few Commissioners, whose authority would be slight or

nothing in the scientific world, could settle the vexed question of contagion, seems to us Quixotic.

4. Dr. FURNIVALL'S book on Consumptive Disorders is the result of a considerable, and he says, of a successful, practice in the country. In his general views, that to effect a permanent cure a constitutional mode of treatment must be adopted, we see nothing new ; and not much in his modes of practice. His opinion, that the predisposing "ill health" arises from an unusual quantity of carbonic acid in the blood front the inefficient action of' the lungs,

• In intermittent or remittent cases of neuralgia., the "intermittent fever" of Dr. Die liSON, quinine, the grand remedy for ague, has been used with re- markable efficacy.

may have some novelty. The general hygyenic directions are judi- cious, but common ; and derive no aid from the languid std le and discursive method of the Doctor.