DISEASES OF WOMEN.*
fins late Dr. Goocn was born at Great Yarmouth, in 1784 ; and at fifteen he became apprentice to an apothecary of that town. He studied for his degree,' which he obtained in 1807, at Edin- burgh College. He came, shortly after this, to London, and was for several years the principal contributor to the London Medical Review. In 1812, he was elected physician of tlieWeetminster. Lying-in Hospital; the line of accoucheur being that which, from * An Account of some of the most important Diseases peculiar to Women. Ry Robert Gooch, M.D. Laudon, Mo. inclination and the advice of his friends, he had selected on enter- ing upon his professional career. His first professional place of abode was Alderma,nbury ; but in 1816 he removed to Bemers Street, where his practice very soon became extensive and lucra- tive. In 1826, GOOCH was, by the friendship of Sir WILLIAM KNIGHTON, appointed librarian to the King ; an honour which he did not long enjoy. The diseases of women and children had formed the objects of his practice for twenty years, and he had for some time contemplated a work on the symptoms and treat- ment of the more formidable. The last sheets of it were corrected by him while residing at Brighton in 1829, vainly seeking to reno- vate a constitution which was irremediably broken down. He died in February last ; not, however, until he had the satisfaction of finding that the volume on which so much pains had been be- stowed had been most favourably received by the profession at large. We do not prirpose to enter upon a critical examination of Dr. Goocifs work ; but, at the suggestion of a medical friend, we give a short account of the more important of the essays that it contains.
• Under the head of Peritoneal Fever, we have a specimen of Goocn's powers of weighing evidence ; few equal to which will be found in the writings of medical practitioners. He first gives a clear and concise description of the disorder. " It consists essen tinily in fever, with an inflamed state of the peritoneum ; but fever may vary, not only in degree, but in kind, as it is commorify called, in type ; and itiflamMation may vary, not only in degree, but also in kind or type." The next step is the investigation of a most important question, "Whether this disease differs so much in kind or type that the mode of treatment which is necessary in some cases is destructive in others ? " And here the information (riven by all the best authors, as well as the writer's own expe- rience, is adduced, to prove "that puerperal fever, accompanied by an affection of the peritoneum, and often epidemic, does assume different types in different seasons, being sometimes acutely-in- flammatory and bearing and requiring early and active depletion-; at others characterized by debility, or which has been called action without power, in which depletion, however early and actively em- ployed, is useless and pernicious. Dr. Goocii calls on the practi- tioner, with SYDENHAM, to attend to the "Constitution of the year" in the treatment of this formidable disease,—" that is, in plain language, the prevailing state of the human body, indicated by its prevailing diseases," and by the modes of treatment which these diseases bear and require ; by the character of the pulse during the early hour of the disease, and by the effect of deple- tion; "and not to think that these epidemics depend on one and the same state—acute inflammation of the peritoneum—demand- ing one and the same treatment." It is to be regretted that very little is said about the contagious nature of the disease. As from his treatment of the plague ques- tion, this point would probably have been settled, had the author thought it necessary to discuss it.
The substance of the observations of the disorders of the mind in lying-in women, was presented to the College of Physicians in 1819; and published by them. Since that period, we find it stated that the opinions of the author had been confirmed by much experi- ence. The principal object of the essay is to connect this form of mental derangement with the physical state of the patient more plainly than had been done before ; and to deduce from it a ra- tional mode of treatment. Agreeing with BURKE that to begin by investigation is better than to define at the outset, Dr. Gooca wisely leads us from truths to the stock on which they grew. He offers us specimens of mania and melancholice, in preference to a general description ; observing, "that such descriptions are com- monly formed of a bewildering multiplicity of circumstances, which never occurred together in one and the same instance ; so that they are pictures which resemble nothing in nature; like the ab- stract ideas of the old metaphysicians." These specimens are well selected, and the remarks accompanying them exhibit great discrimination ; they cannot be too frequently perused ; and the style in which the cases are drawn up cannot fail to arrest atten- tion and interest the most careless.
The position—that a particular physical state is the cause of these disorders--he discusses at some length. After observing that "the sexual system in women is a set of organs which are in action only during half the natural life of the individual, and even during this half they are in action only at intervals ;" and that "during these intervals of action they diffuse an unusual ex- citement throughout the nervous system. He goes on to reply to the old objection—"that the bodily disease which accompanies mental derangement is too slight to occasion it, and never was it met by so direct and so felicitous a refutation. The anti-mate- rialist or theorist argues, that in insanity no morbid appearances met with after death are sufficient to account for the disorder; and thence he concludes, that it does not depend on the state of the or- gans. On this assumption, which might be directly denied, the philosopherobseives—you admit "that puerperal insanity depends on a peculiar state of the bodily constitution, although this state,. so far from being obvious, is often known to exist by a disordered condition of the mind, and you deny that other kinds of insanity depend on the state. of the body. That is to declare that some- times the mind is independent of the body and sometimes not--a manifest absurdity." The author comjeats also the too gene:rally received notion that cerebral excitement depends invariably Oirin- flammation or congestion, and conjures the practitioner to take into consideration every part or the whole of the individefil, and to
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founding treatment upon reason and experience—not on theories. Be deprecates our present mode of incarcerating lunatics • and urges the necessity of trying what can be effected by moral im- pressions as a cure. " I shall be told," he says, " that, when pa- tients are mending or have recovered, the most common cause of relapse is too early an introduction to friends, and too early a re- turn home. When the patient is recovering, or has recovered, I do not recommend these measures. It is when the patient has not recovered, and is not recovering, that I advise them to be tried ; when month after month passes without any amendment, and her delusions assume a shape accessible to moral impressions, then it is that I would advise an interview with a fiiend." A most interesting case is then given in support of this doctrine (page 169 ;) and indeed the whole that relates to insanity is original and valuable, and deserves the careful attention of the public as well as of medical men.
On the mode of distinguishing pregnancy from the diseases which resemble it, there is the same clearness which pervades the rest of the book. The cases under this head are of the greatest value, and form an excellent series for accoucheurs to refer to.
In treating of certain symptoms in children, erroneously attri- buted to conjestion of the brain, the principal object is show that drowsiness, great languor, and headach, depend always on too great tendency of blood to the head. The statement in support of this fact is brief, and the lane-Inge is forcible, The tact, as he cor- rectly states, is one "of great practical importance ; for if we take delicate feeble children, and by bleeding and purging- for an imagi- nary congestion of the brain, reduce their circulation to a very low ebb, and keep it so, we run the risk of producing t hat very effusion of serum into the brain which we are endeavouring by our reme- dies to prevent. It is surely impossible," he continues, " for the reader to mistake me so far as to suppose that I am denying the important practical truths that heaviness of head and drowsiness in children commonly depend on congestion, and are to be relieved by depletion ; and that acute hydrocephalus is a serous effusion, the result of inflammation, and capable of being cured in the inflam- matory stage only by bleeding and purging. These vital truths I would state as strongly as any man ; but there are opposite truths." The paper on the question " Is the plague a contagious disease ? " was published in the Quarterly Review in I S25, when it was
honoured by an acknowledgment from Ministers that it had satis- fied them that the qutu'antine laws were necessary. The evidence is strong, and seems to prove almost demonstratively that the
plague may be carried from place to place. Still, Dr. Goom is not content with this ; he endeavours to win the sceptical by an appeal to logic as well as fact. "There are occasions," says he,
" when it is necessary to act upon the supposition that a disease
is contagious, though the evidence for this opinion is far short of proof. The question is sometimes so difficult—life and health are so precious—and the precautions necessary to prevent the com- munication of the disease, if it should be contagious, compara- tively such trifling; evils—that a prudent physician will take care to be on the safe side, and act as if he was certain it was conta- gious, although to an indifferent person, weighing the evidence in the scales of mere speculation, it would appear only a bare possi- bility. And here is the difference between a science the subjects of which are inanimate things, like alkalies and acids, and a science the subjects of which are flesh and blood and limn h and life,— that whereas in the former, the onus probandi lies on him who affirms the proposition, because the disbelief of it leads to no in- jurious consequence, in the latter the onus probandi lies on him who denies it, because the disbelief would occasion the neglect of measures, which are harmless even if they be unnecessary, but the neglect of which may be fatal if they be essential." The writer then proceeds to establish, "1st, that the plague is most liable to affect those persons who approach patients affected with it, and that in proportion to the nearness of the approach ; 2dly, that those who avoid all intercourse with persons affected with the plague, generally escape the disease, and that in proportion to the Care with which they avoid it." These positions are made out by an elaborate survey of the history of this frightful disease, which the author traces from Marseilles in 1720, to Moscow in 1771, and
Malta in 1813 ; carefully recapitulating all the circumstances of each visitation, and weighing them with admirable perspicuity. He strengthens his proofs by the testimony of a number of com- petent and unbiassed judges ; and finally he proceeds to point out the weakness of the objections which have been made to his conclusions. " When we consider," he concludes, " the immense
mass of evidence for the foregoing propositions, the clearness and distinctness with which they are made out, the small number of dissentient voices, and the tremendous importance of the stake at issue, one would suppose it impossible that there should be men not merely incredulous enough to dissent from this opinion, but mad enough to wish to act on their dissent. Yet such is the fact."
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