DR. HOLLAND'S MEDICAL NOTES AND REFLECTIONS.
THIS volume is the result of the observations and reflections of twenty years, drawn up from notes made day by day upon suggestive facts in Dr. HoLeami's practice. The subjects discussed are chiefly of a general or popular nature, which the non-professional reader can always understand, while in some of them he will find hints from which he may profit. Of this description are the chapters " on )Diet and Disorders of Digestion," and " on the Exercise of Respi- ration," in which Dr. HOLLAND suggests a simple mode of strength- ening the lungs by exercise. "'1 he Abuse of Purgative Medi- chic, ' and " on Points where a Patient may Judge for Himself," are amongst those subjects which, though primarily depending upon the medical man, admit of his views being forwarded, modi- fied, or altogether thwarted, by the patient or his friends. Such papers as those on Dreaming, Insanity, Intoxication, the Epidemic Influcnzas of late years, and the Hypothesis of Insect Life as a Cause of Disease, involve matters of medical or metaphysical speculation. The direct use of the very able chapter on Methods of Prescription is limited to the profession ; and " Some Points in the Pathology of the Colon," and the papers on certain medi- cines, are still more technical.
In putting forward his work, Dr. Meta /in makes no claim to. any striking novelties. Indeed, the modern English practitioner, occupied half his life in pushing his way in the world, and, when he has attained eminence, daily exhausted in a ceaseless round of hasty visits, has fair less opportunity for making discoveries than the foreigner, whom the customs of his country enable to disregard the amassing of wealth, and rather to confine himself to a hospital, in which every patient is treated to the very letter of his directions, where he can watch any critical case himself, and subject every flied result to a past newton examination, it slobbered over in haste, but minutely analytical.* Medical Notes-and Rellections professes to be what it really is—the result of long observation in an extensive practice on a variety of points ; some of which may seem trivial or minute to ignorance or inexperienced rashness, but not to those who have learned that NAPOLEON'S exclamation, " Sir ! nothing is a trifle in aver," may be applied to physic. The defect of Dr. HOLLAND, ill a critical sense, is a want of com- prehensive grasp, or at least the power of so condensing his views as to give them the external form of comprehension. His great merit is common sense ; the well-tempered and cautious sagacity which nothing but time and practice can impart ; and a thorough knowledge that the art of physic consists in assisting Nature, who is often assisted by the simplest means.
As a: specimen of the book,- we quote a passage that may be of general use in the sick room, from the chapter on
POINTS WHERE A PATIENT MAY JUDGE roe 'mow,.
st—The patient may almost always safely choose a temperature for him- self; and inconvenience in most cases, positive harm in many, will be the effect of opposing that which he desires. His feeling here is rarely, if ever, that of theory T though too often contradsetal by what is merely such. It "^""e.e”,- ..4", *definite state of .• Its pemture desired is that best adapted for relief; and the test of its fitness usually found in the advantage resulting from the change. This rule may be taken as applicable to all fevers, even to those of the exanthematous kind; where, with an eruption on the skin, the balance between the outer and inner surfaces of the body, and the risk of repression, might seem, and actually are, of greatest importance. In whatever stage the eruption be, if the patient expressly seeks for a cooler atmosphere or cooling applications, they may be fully conceded to him, without fimr of ill result ; and under the guidance dried.), of his feelings as to the time during which their use may be continued. Except in some cases of vitiated sensation from nervous disease, I have scarcely ever known the judgment of a patient practically wrong on these points ; and in this case of exception the error itself is of very little consequence. Secondly—In the majority of instances of actual illness, provided the real feelings of the patient clothe ascertained, his desires as to food and drink may safely be complied with. 'Whatever be the physical causes of the relation (and they are yet beyond our research), the stomach itself is the best expounder of the general and more urgent wants of the system in this particular. But un- doubtedly much care is needful that we be not deceived as to the state of the appetites, by what is merely habit or wrong impression on the part of the patient, or the effect of the solicitation of others. This class of sensations is much more nurtured out of the course of nature than are those which relate to the temperature of the body. The mind too becomes much more deeply en- gaged with them; and though in acute illness they are generallysubmitted again to the natural law, there are many lesser cases where enough remains of the leaven of built to render every precaution needful. With such precautions, however, which every physician who can take schooling from experience will employ, the stomach of the patient becomes a valuable guide—whether it dic- tate abstinence from or recurrence to food—whether much or little in quan- tity—whether what is solid or liquid—whether much drink or little—whether things warm or cold—whether sweet, acid, or saline—whether bland or stimu- lating to the taste. As respects limitation of food, indeed, the "tempestiva abstinentia" is often with the patient himself an urgent suggestion of nature, especially in cases where fever is present. It is a part of the provisim: for care which we hold in our hands ; and if not sufficiently regarded, all other remedies lose greatly of their value. Here, then, we are called upon to maintain the cause of the patient, for such it truly is, against the mistaken importunities which surround him, and which it sometimes requires much firmness to put aside.
It is not wholly paradoxical to say that we arc authorized to giro greatest heed to the stomach, when it suggests some seeming extravagance of diet. It may he that this is a mere depravation of the sense of taste ; but frequently it expresses an actual need of the stomach, either in aid of its own functions, or indirectly, under the mysterious law just referred to, for the effecting of changes in the whole mass of blood. It is a good practical rule in such cases
to withhold assent, till we find, after a certain lapse of time, that the same desire continues or strongly recurs; in which case it may generally be
taken as an index of the fitness of the thing desired for the actual state
of the organs. In the curly stage of recovery from long gastric fevers, I recollect many curious instances of such contrariety to all rule being aceai- * Of course an English practitioner might so devote himself, if he chose ; but he would chase away his patients, live an poverty, be looked down upon by the heads of the profession, and considered a fool for his pains.
owed in, with manifest good to the patient. Dietetics must become a much more exact branch of knowledge, before we can be justified in opposing its maxims to the natural and repeated suggestions of the stomach, in a state either of health or disease. * * * * * *
Thirdly—As regards exertion of body, posture, continuance in bed or other- wise, the sick may generally be allowed their own judgment, provided it is seen to be one dependent on bodily feelings alone. And so equally with re- spect to fresh air, methods of exercise, and times of repose. In these things, as on points of diet, suggestions, founded on careful notice of the feelings of the patient, and watchfulness as to the effect of the first trials, are all that is required from the physician; and more than this often does mischief. I have often witnessed the ill effects of minute interference in such matters ; whether arising from excess of caution, or from the mischievous spirit of governing every thing by medical rule and authority ; without appeal to the feelings of the patient, even where these may securely be taken in evidence.
The most important exception to this rule is in certain nervous and dyspeptic disorders of chronic kind, where it is needful to urge bodily exertion upon the patient, in contradiction to his own sensations, and sometimes even where the first trials are seemingly unsuccessful. With moderate care in observation, the tests of fitness here are so simple that there can be little chance of any error leading to injurious consequences.
As respects mental exertion during illness or convalescence, much more caution is needful. Here the patient is usually less able to estimate his own power, and is more entirely at the discretion of those around him. The pre- sent condition of life among the higher classes produces as much of evil from excesses of moral and intellectual excitement, as from those of the stomach ; and it is equally difficult to place watch and reasonable restraint upon them. In these instances, and they are of constant occurrence, the judgment of the physician, as well as firmness in his manner of interference, arc urgently re- quired. But in ordinary cases, and under more tranquil methods of lite, he may leave much to the discretion and feeling of power in the patient himself; with the simple injunction that this feeling should be duly consulted before
any change is made.
In our remarks upon the sensible character of Dr. Hor.r.Axn's views, it will not be understood that we implicitly adopt every opi- nion he puts forth. For instance, agreeing with him in the main, in his judgment of the abuse of purgative medicines, we think the relief they afford to the dyspeptic patient is not altogether de- pendent on fancy, or habit: many purgatives, at least many com- pound medicines, act more or less upon the secretions : the nature of the diet of many such patients must also be borne in mind. If' they would rigidly observe a diet adapted to their case, (the grand problem,) and their hopes could be excited, they might throw phy- sic to the dogs.
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