23 JANUARY 1841, Page 17


distinction between essential and secondary properties is Often used as a puzzle to the vulgar,—for example, the merit of the organ bellows-blower in producing music ; and though the ontologist may readily enough point out the differences and their causes, in many practical matters an error in the subordinate will be almost as fatal as an error in the principal. The necessity of exactness in all particulars is more especially the case in disease; where causes are frequently unknown, where the treatment is often conjectural, the modus operandi of the curative agents mysterious, and the common elements of life—air, heat, nutriment, &c.— may in that balanced, or rather unbalanced state of the vital powers, effect more for good or evil than all the prescriptions of physicians. Dr. ANTHONY Toon THOMSON has therefore rendered a service to humanity (for all of us must sometimes be sick) in pointing out, upon philosophical principles, the Domestic Management of the Sick-Room; though his work is of necessity more desultory, and to appearance less scientific or profound, than many books of less observation.

The object of Dr. THOMSON, it should be distinctly understood, is not to teach people how to prescribe for themselves, but how to give the best effect to the prescriptions of the physician, by atten- tion to regimen, air, exercise, and all those things which fall under the head of self-management ; or in acute disorders, when the pa- tient is Confined to his bed and often insensible, to enable his family or attendant to take this management upon themselves. The chief exceptions to this principle, if exceptions they can be called, are twofold-1. The general observations which commence the work, upon health and disease, and the influence of what are strangely called the non-naturals—that is, air, meat and drink, sleep and watching, motion and rest, retention and excretion, and the passions of the mind : 2. The directions for the physical and mental training of children from birth till puberty, in order to strengthen the constitution, especially if any scrofulous or other hereditary taint in the blood be suspected. The rest of the work purely concerns the sick and convalescent, or those who have to attend upon' them. In The Domestic Management of the Sick- Room will be found catalogues for furnishing it, directions for its cleanliness, temperature, °light, and darkness; hints as to the qualifications and choice of nurses, and the behaviour of friends ; the way to give physic and to make it palatable ; how to apply leeches, blisters, lotions, and poultices; some good directions for ready and simple baths—warm, douche, and vapour ; together with a variety of particular directions in specific disorders, or general in- formation for the management of the patient till he reaches a state of convalescence. Then commences another course of instruction for diet, and of receipts for convalescent cookery—or tit-bits to tempt appetite without overloading the stomach or exciting the system. Some useful forms of domestic medicines, a few general remarks on mental influence upon the body, together with religious consolation in disease, and the necessity of caution in administer- ing it, complete the work.

The specific directions of Dr. Tnomson are not, of course, adapted for quotation ; but we will take a few extracts from general matters, as specimens of his style and method, pleasantly relieving subjects which appear at first sight minute or old womanish.


Peculiar effects of medicines sometimes depend on the imagination of the in- valid, sometimes on preconceived prejudices respecting the action of the medi- cines. Many instances of these influences might be mentioned; but three will suffice to demonstrate their power. The late Dr. James Gregory had ordered an opiate to a young man, to relieve sleepless nights under which he had suf- fered in convalescence from fever. He informed the patient that he had pre- scribed an anodyne, to be taken at bed-time ; but the invalid, being somewhat deaf, understood him to say an aperient. Next morning, on the doctor inquir- ing whether he had slept after the anodyne, he replied, " Anodyne ! I thought it was an aperient; and it has, indeed, operated briskly." A female lunatic was admitted into the County Asylum at Hanwell, under Sir William Ellis : she imagined that she was labouring under a complaint which required the use of mercury; but Sir William, finding that the idea of the existence of that dis- ease was an insane delusion, yet considering that flattering the opinion of the lunatic to a certain degree would be favourable to the recovery of her reason, ordered bread pills for her, and called them mercurial pills : after a few days, she was salivated, and the pills were discontinued ; on again ordering them after the salivation had subsided, she was a second time affected in the same manner ; and this again happened on the recurrence to the use of the pills a third time. A lady, who was under the author's care, assured him that opium in any form always caused headache, and restlessness, and vomiting on the following morning: and on prescribing laudanum for her under its usual name " tinctura opii," he found that her account of its effects was correct; but on prescribing it under the term " tinctura thebaica," which she did not under- stand, (she read every prescription,) it produced its usual salutary effect ; and was continued for some time without inducing the smallest inordinate action. The author has also met with instances where similar prejudices respecting particular medicines were as readily overcome. Nostrums owe the beneficial powers which they occasionally display to this influence of the imagination.


Few medicines are agreeable to the taste; but one of the objects of the art of prescribing is to modify their nauseous properties as much as possible. In the domestic administration of medicines this should not be overlooked ; in- deed, it is more essential than in medical prescriptions, as the medicines are most frequently given in their simple form. Nauseous medicines have little taste when mixed with some substances, and when they are taken the moment they are mixed. Thus the taste of Peruvian bark and that of rhubarb, when either is mixed in milk, is completely covered if the mixture be taken directly. The nauseous taste of castor-oil is covered by warm milk, or by coffee; and it is also much diminished when the oil is floated upon some cold water, and a teaspoonful of brandy floated upon the oil. The disagreeable taste of scone is considerably less when the infusion is made with cold water, although it does not lessen the activity of the drug. The taste of the ordinary senna-tea is covered by the addition of a few grains of cream of tartar, or by the admixture of common Bohm tea. Aloes are rendered more palatable by a little of the extract of liquorice added to their solution.


treat it will not be thought out of place here to mention some of the ge- neral morbid effects of fasting; more especially as the zeal of one set of well- intentioned religious enthusiasts is labouring to restore the fastino"s of the pri- mitive church as an essential duty. It must be remarked that these effects ne- cessarily vary in different individuals, and different conditions of the digestive organs; but the following may be regarded as those which result from long fasting. The first are feelings of general debility, which are followed by "fever, delirium, violent passion, alternating with the deepest despondency "; the tem- perature of the body is lowered; "the respiration becomes fcetid ; the secretion of the kidney is acrid and burning "; the emaciation of the body. is extreme ; and, when the fasting has been so protracted as to terminate In death, the stomach has been found contracted. Fasting, it is true, has been often borne for along time with impunity in disease, especially in insanity • but in health it cannot be supported many days without imminent risk to life. The strict observance of the Catholic fasts has often been productive of dyspepsia; and other enthusiasts, who have regarded abstinence a virtue—for instance, accord- ing to Pinel, the Brahmins, the Fakirs, and the Anchorites of the Thebaid- equally suffered from this cause.


When all the arrangements are completed in the sick-room, little benefit can be anticipated if a proper nurse be not obtained to render them available to the invalid. Before describing the qualifications requisite to constitute an efficient nurse, I cannot avoid embracing this opportunity of mentioning the great difficulty of procuring properly. instructed nurses in this country. It is, indeed, to be greatly lamented, that amidst the numerous improvements which cha- racterize the present wra, the females who assume to themselves the character of sick-nurses, and are employed as such, are still left to acquire information respecting the important duties which their office demands, from imperfect ex- perience or from accident. We expect that the skill of our medical attendants shall be certified by diplomas and licences before they are permitted to practice ; but we leave their orders to be executed by the ignorant and the prejudiced, who not only too often fail in performing what they are ordered, but who, with the usual temerity of ignorance, presume to oppose their own opinions to those of the physician. Every female who wishes to act as a sick-nurse, should be obliged to serve a certain time as an assistant nurse in one of the public hospitals, and to receive a certificate of her efficiency before she leaves the establishment. The advantages which the public would derive from a body of nurses educated in this manner, must be obvious to every one who has had opportunities of observing the miserable working of the present system. We should no longer have to lament the neglect of cleanliness, inattention to ventilation and temperature, an obstinate and presumptuous opposition to the orders of the medical practitioner in reference to diet : we should no longer hear of doses of medicines being given hazardous to life, or of patients poisoned by topical applications administered as internal medicines, and of numerous other evils which are now, unhappily, of daily occurrence.